Hoe kies mens as jy geen keuse het nie?

Ons word daagliks hier in die industriele lande gebombardeer met die regte keuses en aksies wat ons moet neem vir die omgewing. Tog, as mens net bietjie onder die oppervlakte gaan krap is min van daardie keuses regtig beskikbaar. Meer nog, in derde wereld lande bestaan die infrastruktuur daarvoor nog nie.

Laas naweek het ons beplan om die ferry te vat Engeland toe om vir John se broer te gaan kuier. Ons sou lekker baie koolstof emmisies kon spaar deur nie te vlieg nie, en dan skuldloos lekker vakansie hou. Maar nee, die ferry is 4x duurder as die vlug! Selfs al is dit 4x so lank ook. Dan is daar nie n gereelde trein van Holyhead waar die ferry aankom inland nie, so ons sal die kar moet oorvat. En dan n halwe dag lank ry tot in Oxford. Om vir n naweek Engeland toe te gaan met die ferry van Dublin af, het ons na n paar uur agterkom, is heeltemal onprakties en onbekostigbaar. So moet ek nou my kop in skaamte laat sak en se ons het gevlieg.

Maar dit was dieselfde penarie met ons trippie Dingle toe. Mens kan die 200km of afle deur 4 ure met die kar te ry, oordat die paaie so om en dom en vol is, of ses ure met die trein ry en dan in elk geval daar n kar moet huur en nog meer as n uur tot by Dingle. Publieke vervoer bestaan net nie daar nie! So, dan klim jy maar in jou eie kar, want n naweek is net so lank.

Totdat die regering dit nie in hulle eie hande neem om publieke vervoer bruikbaar en bekostigbaar te maak nie, kan hulle nie van die bevolking verwag om die regte keuses oor leefstyl te maak nie. Maar nie net vervoer nie, elektrisiteit, behuising, dis als die regering se verantwoordelikheid om seker te maak ons het keuses om uit te voer. Die regering besluit waar om geld in te stoot, en keer op keer stel hulle ons terleur terwyl advertensies steeds voorhou dat ons kan en moet kies hoe ons wil leef.

Hier is slegs een elektrisiteit verskaffer. Geboue word met so min as moontlik nuwe tegnologie toegerus en ontwikkeling geld word slegs in paaie ingestoot. Toe ek die engelse treinstasies en treine sien het ek besef, hulle is ligjare vooruit en selfs daar bou hulle kool kragstasies, brei vir heathrow uit, stroop die green belt. Seid euch verruckt? Is ons mal?

In Suid Afrika is dit dieslfde storie. Eskom sukkel tans geweldig met krag omset. Nou offload hulle deur die gebied sonder krag elke paar ure te roteer, sodat almal in die pyn deel. Dis als goed en demokraties. Wat nie goed is nie is dat hulle die mense se krag verbruik beskuldig as die oorsaak vir die tekorte. Maar mense het geen ander keuse. Eskom is die enigste elektrisiteit verskaffer. Meer nog, daar is geen sonpanele of windkragopwekkers beskikbaar nie. In n land van sonskyn en wind, is dit skandalig. Eerder as om hierdie hulpbronne beskikbaar te maak draai die regering 'n blinde oog en se mense moet onthou om hulle ligte af te skakel. Mens bekragtig 'n bevolking deur hulle keuses te gee. Mens maak hulle mismoedig en desperaat deur hulle hande af te kap. Dit was aaklig om te hoor dat my skoonouers voel hulle enigste uitweg is om n diesel kragopwekker te koop. En ek wil nie eens aan die sekuriteitsrisikos dink wat gepaard gaan met beplande krag onderbrekings nie.

Dis die jaar 2007 en ons maak nogsteeds keuses uit die 1980's. Regerings laat nogsteeds grootskaalse uitbranding van woude, vissery, aviation, en uitbreiding van motorwee toe. Watter hoop is daar dan dat ons betyds n oplossing vir klimaatverandering gaan vind? Watter hoop is daar dat die verandering wat ek in my daaglikste bestaan probeer maak (en meestal vaal) 'n impak gaan he? Watter hoop is daar dat ons n werkbare oplossing voor 2015 gaan implementeer? Kanse lyk al skraler. En die volgende geslag gaan ons met ongeloof aankyk as hulle besef ons het teruggesit en op beter dae gewag. As daar ooit 'n tyd was om los te moet breek van regerings se leuens, valse voornemens en lee beloftes, dan is dit nou.

Regerings is deesdae te gemaklik, te goed gebuffer teen die bevolkings wie hulle skroef, en te ryk om aan enigiets anders as die bevordering van hulle eie rykdom te dink. Ons is weer in n posisie waar Marie Antionette ons uitlag en koek aanbied. Ons revolusie moet begin. Ek wil my kinders eendag in die oe kan kyk, en met trots kan se ek het hierteen baklei. De le Rey, De le Rey, daar's baie meer as boere trots wat tans in die weegskaal le, dis die mensdom se oorlewing waarvoor ons moet baklei.

Dis tyd om ons kwasi-demokratiese regerings reg oor die wereld te herinner dat die mensdom nog n stem het, en dat ons nie dankbaar is vir die grootskaalse verwoesting van ons wereld en onderontwikkeling van alternatiewe nie. Gee nie om wat die GDP is nie. Regerings het ons lank genoeg omgekoop met geld en goed. Dis tyd om te fokus en te begin DEMAND.

laat jou stem gehoor word!

15 Oktober is blok aksie dag! Hierdie jaar skreeu ons hard saam oor omgewing kwessies:

The starfish dilemma

www.who.int

The age old story contained in every "Chickensoup of the soul": a man walking along the beach comes across another guy, throwing starfish back into the ocean one by one. Asked why he even bothers since there are about a million washed up on the shore that will not be saved, and with millions more in the ocean he isn't really making a statistical difference; the wise, patient man replies "it made a difference for that one".

Now this is what all young doctors and hopefully people in most professions aspire to. Making a difference in that one person's life, saving a life, influencing it for the better or giving someone a second chance is so inspiring! But in modern society, we are forgetting the true meaning of the starfish story. In pursuing healthcare the way we are today, we are not only making a difference for that one, but also neglecting the others left over because of the way in which we are helping the lucky one.

An example: South Africa's exemplary health minister recently underwent a liver transplant. Now while the reasons behind her transplant are covered up and top secret, many aren't. For an alcoholic with liver failure to be allowed on to a transplant program that person needs to prove being alcohol free for a year. That's not too difficult and depending how much money or political power the person has, the timeframe is adjusted. A liver transplant costs $350,000. Now I am not joking. Please see the website for other complicated healthcare procedures. www.crossgrove.com/ces/cihospitalcosts.pdf

Now when a government allows procedures like these to slip into the healthcare budget of a developing country, eyebrows should start raising. How, it should be asked, can it be allowed to push that much money towards one person, a person who caused his own condition knowingly, to the detriment of basic care for so many others. The fact that it makes a difference for that one, at this point, is inexcusable.

Chris Hani Baragwanath Hospital currently spends only R7m on new equipment purchase out of a budget of R1.1bn. Some newborn babies are put into cardboard boxes because there are no incubators for them. It is being argued that too much money is being spent on admin but in the same way it can be argued that health care is not being prioritised correctly.

In healthcare there is an important and oft forgotten saying "prevention is better than cure". How did we eradicate smallpox? By vaccinating everyone. How much did it cost? Less than a dollar per person. And how many lives did it save? More than two million. Prevention is cheaper, less invasive and more far-reaching than curative medicine.

Now it's not only childhood illnesses that can be prevented, saving governments thousands of dollars to use towards other, more pressing causes. The most interesting thing about prevention is its knock-on effect.

Here's an example: Get out of your car and switch off your telly = walk around for an hour every day --> prevent pollution and obesity --> prevent global warming(with all its disastrous health effects including heatstroke, malnutrition and migration for people you don't even know) and also heart attack, stroke, diabetes, colon cancer, hip fractures and all their side-effects for yourself.

Contrary to popular belief, this is well documented with studies done to prove it. See The Lancet for more info.

Another example closer to home: Stop alcoholism --> prevent alcohol induced injuries such as car accidents, fights and falls and sexual assault --> prevent the need for urgent CTscans, brain and orthopaedic operations. Also prevent unwanted pregnancy due to irrational behaviour, alcohol dependance, depression and suicide.

The elderly are a difficult example to explain without sounding ruthless. It's much easier to think of yourself in ten, twenty or fifty years' time. And then it's also very thought-provoking to hear how doctors feel when posed with the scenario for themselves: If you are 80 years old, had a stroke, are unable, to walk, talk or even write, would you want to be kept alive at all costs? My answer is no. Standing at your elderly relative's bedside, making a decision for her is much more difficult. But my decision would still be no. Modern healthcare innovations cause many such patients to survive up to five years with a feeding tube and catheter, a myriad of medications and confined to bed. They are also exposed to numeruos hospital admissions. The costs are great, but the human suffering brought on by the condition is not allayed through the costs. This is a pit no-one should drag an elderly relaive into.

Last example. Mandatory testing for HIV --> prevent undue spread of the disease and improve cmpliance with treatment --> prevent mother to child transmission, skin cancer, malnutrition, TB, meningitis, pneumonia and gastro-enteritis: the diseases that are currently laying SA's healthcare to waste. --> prevent the death of countless teachers, police, nurses, doctors, politicians, businesspeople and labourers that have skills to enrich the country.

There are a couple of reasons why societies are not willing to take a few simple steps to markedly improve the health of their people.

Politics. It's hardly ever about money, as it is simple to see that the savings involved in implementing simple preventative healthcare measures are vast. It's more about the money in the politician's pocket. If the alcohol company is allowed to advertise and sell freely, he will ensure the politician's campaign is well funded, same with the motor industry and a good few other industries!

Human nature. We are such trusting beings. So, if my president doesn't censure my alcohol use, why shouldd I? If it was bad for me, government would have regulated it, wouldn't they? If my president doesn't beileve the virus exists, what is the testing for, then?

Family bonds, or the lack thereof. It is only when there are relationship issues between family members that you would feel guilty about stopping treatment to allow them to go in peace. How many times have you spoken to your family about what you would want when you are not able to talk for yourself? Will they feel empowered to make the right decision for you? I can promise you this, no doctor I have spoken to wants a feeding tube. They all say the same thing. "I will go in peace."

Cowboys. The first heart transplant surgeon is about as useful to the average person as the first astronaut who landed on the moon. He is a celebrity. It was a major breakthrough. But was it neccessary? And to what cost? Everyone needs the best chance in life. But if I'm saving your life to prove how amazing I am, and to the detriment of a thousand others that could have been saved for a 1000th of the price, what are my primary pursuits?

In 1970 the WHO set up the Health for All in 2000 goals. These millennium goals are still not achieved even though the world has more than enough resources, money and capacity to do so. The correct channels are the only missing ingredient to vastly improving world health.

So, to conclude, instead of blindly throwing healthcare at the sickest person, it should be worked from the bottom up, to ensure that less and less people end up needing less and less healthcare. Maybe a starfish that has been washed up on the beach is already too weak to save. Maybe it's more important to ensure the others stay in the ocean where they belong. I have decided to start focusing away from the current dilemma that the current starfish is finding itself in, and maybe rather start curing the system that got it there.

over and out.