What an amazing and privileged experience to be part of the One Just World forum Tuesday night at Federation Square.
Sir Gus (aka Sir Gustav Nossal, AC CBE FAA FRS) opened with a quote from Irish poet and Nobel laureate Seamus Heaney: ‘Even if the hopes you started out with are dashed, hope has to be maintained.’ He went on to outline what he saw as the ‘new and legitimate hopes’ that promise real progress in the coming decade.
He set the scene for why action is needed in global health, by outlining the best and worst statistics on life expectancy and under five mortality:
- Life expectancy best in Japan: males = 81; females = 86
- Life expectancy worst in Sierra Leone: males = 39; females = 43
- Under five mortality best in Sweden: 3 deaths per 1,000
- Under five mortality worst in Sierra Leone: 262 deaths per 1,000.
‘I don’t think I want to live in a world where there’s nearly a one hundred-fold difference in under five mortality between best and worst,’ Sir Gus said.
He argued that the Global Financial Crisis showed just what was possible in terms of funding when there is political will: the US Wall Street bail-out of $700 billion, for example; the stimulus packages from the G-20 globally worth $2 trillion. He said $120 billion per year would make the Millennium Development Goals more achievable.
Sir Gus outlined progress made in recent years due to major investments (through the GFATM and PEPFAR), including a significant reduction in global under five mortality rates, improvements in immunisation, and better malaria prevention and treatment.
While conceding that progress is not easy, Sir Gus ended with a quote from Nelson Mandela: ‘The greatest glory in living lies not in never falling, but in rising every time we fall.’
Dame Carol Kidu, CBE MP, Minister for Community Development and Women, PNG, spoke next, focusing on the issue of maternal mortality. She described the wake-up call in Papua New Guinea when the results of a demographic health survey showed in the period from 1996-2006, the maternal mortality rate in PNG had almost doubled. She said:
- 60% of women give birth without the presence of a skilled attendant
- only 35% of women use contraception
- 55% at most have 4 or more antenatal visits
Dame Carol outlined a range of responses happening from government to community level to strengthen systems, from re-opening clinics, to improving roads and reconnecting communities with services. She spoke of establishing an alliance for safe motherhood in PNG, and encouraged those present to talk about this issue that she described as an emergency.
Dame Carol said the key message needed to counter fatalistic acceptance of the status quo is that ‘every mother matters.’
The next speaker was Dr Sakena Yacoobi, founder of the Afghan Institute of Learning, which she established in 1995 in order to increase literacy rates and improve education in her home country, especially for women. She continued this work during the reign of the Talliban and even today, working as a teacher remains almost as risky in Afghanistan as going into the military.
Dr Sakena’s institute has provided education to seven million women and children, prioritising universal education, gender equity child and maternal health in their work in a country where illiteracy rates are 80-90%, health services are almost non-existent and potable water is scarce outside Kabul. Even where health services exist, human resources — trained medical personnel — are lacking and Afghanistan has the second-highest maternal mortality rate in the world. One of the programs run by Dr Sakena’s institute is midwife training.
She described the impact of war and unemployment on men and women, arguing that men needed to learn to manage their frustrations whilst respecting the rights of women. In defiance of stereotypes, she noted later in the discussion that it was her father who had encouraged and supported her to get an education. She described being traumatised as a child by witnessing her mother go through 15 pregnancies — Sakena is one of only five surviving children — and the drive this had given her to improve Afghan women’s lives.
Meeting Dr Sakena made me realise how lightly words like ‘courage’ and ‘determination’ get used: she personified these qualities.
After such presentations, I figured the only course for me as the writer on the panel was to add a more personal note. I spoke about how my experiences working in HIV and sexual health in SE Asia had informed my writing, and how I aspired to write the sort of novels that encouraged readers to think about issues to do with international health and development, while being entertained by a good story. I read an excerpt from my first novel Behind the Night Bazaar (pp.232-4) to illustrate how I raised ideas in my writing, a scene in which the main character questions how to act on an issue like child prostitution in the face of the magnitude and complexity of the problem.
The discussion that followed was far-ranging and fascinating as you would expect of such an esteemed panel. Both Dr Sakena and Dame Carol emphasised the importance of education for girls and Sir Gus noted, ‘You won’t get this passionate an advocate for health to ever say a word against education.’ One memorable moment for me when he suggested his colleagues were skirting around the ‘central problem’, namely that ‘male dominated societies are not as passionately committed to the education of women and girls as everyone in this room is.’ Dame Carol pointed out that in terms of decision-making power, she represents the 0.9% of the PNG parliament that is female.
There was time allowed towards the end for questions from the audience. When we spoke before the panel, our excellent moderator Tracee Hutchison had actually flagged what turned out to be the first question from the floor: asking the panel to comment on the notion that improved health care in developing countries would augment a population explosion and threaten environmental sustainability.
I find it extraordinary that anyone would ask such a question, given the underlying assumption that it is not ‘us’ in the (over)developed world but ‘them’ in developing countries who are responsible for environmental degradation when the opposite is the case; and on a more sinister level, the implication that people should be allowed to die in some places to protect the lifestyle of those in other parts of the world (not that I think this was the inquirer’s intent).
Fortunately Sir Gus was on hand to explain that ‘The way to control population is not through increased death rates…[but] through decreased birth rates… As you lower infant death rates, communities — who are not stupid — voluntarily lower the number of children they have.’
I would add that one of the strongest relationships in demography is that the more that women and girls are educated, the smaller the average family size. As my mother later pointed out — having watched the forum via Live Stream on the web (thank you Melbourne University) — it only took one generation for this to play out in her family.
Sheepishly I admit that the final word went to me: a quote from Gandhi to ‘Be the change you want to see’ and an exhortation to ‘do something’ — specifically in response to the disaster in Pakistan, but equally in response to the state of the world. And in this spirit:
Donate to Dr Sakena’s Afghan Institute for Learning here. USD$25 will pay for 15 women to learn to read; USD$50 will enable 36 women to receive health services.
Join the Alliance for Safe Motherhood here – joining is free.
Donate to UNICEF’s Pakistan appeal here.
You can watch the whole forum online here.