Gareth Morgan: What the doctor prescribedby Listener Archive
An unsung New Zealand doctor is achieving great things in Bangladesh.
Deep in the heart of rural Bangladesh lies the Kailakuri Health Centre, the creation of Dr Edric Baker, a New Zealander who has devoted the past 33 years to his unique formula for
providing healthcare for the impoverished of this populous country. Baker is my hero. If I were religious, I would describe him as a modern-day saint. Yet New Zealanders still know so little of his work.
There is no access to free public healthcare in Bangladesh: you need money. That locks out the poor and the destitute, who comprise much of the population. No wonder their maternal mortality rate is 24 times ours, their infant mortality rate 10 times ours, and their life expectancy for those who make it to a live birth 72% of ours.
Baker’s formula is no-frills medical care that can be administered by his team of paramedics drawn from the target patient population – most of whose education levels are well below Year 11 – under supervision of a qualified doctor. For the ongoing financial viability of the project, it’s critical that his approach be maintained.
The hospital and health outreach services would soon become unsustainable if the centre followed many standard practices. For example, the centre avoids using drugs that are more expensive than necessary, something that’s common in modern healthcare systems, which must have the latest and are susceptible to marketing hype.
It also has resisted “upgrading” to methods found in modern hospitals – such as having beds and computer systems. Replacing staff with medically trained professionals on (even Bangladeshi) market salaries would also make it impossible to keep providing all the services it does, as would dropping the patient support model – a family member must accompany the inpatient to hospital to perform the requisite nursing duties.
The centre also reduces costs – and therefore treats more patients – by not providing transport services for incapacitated patients: families bring their needy in using what transport they can afford, often a local cycle rickshaw.
What Baker has achieved is truly phenomenal. The key to his “care for the poor by the poor” has been in the way he has created a service attuned to the health needs of these otherwise ignored patients, one that can be maintained and implemented in large by the target patient group itself with very little outside intervention.
Baker, who lives a simple but busy life with next to no personal possessions of his own, has a quality most of us would be in awe of. The sheer volume of annual healthcare his operation gets through each year – 33,000 outpatients, 1000 inpatients and 21,000 receiving health education – for an annual budget equivalent to the salaries of just two New Zealand city-council middle managers, is something to make New Zealanders sit up and reflect on how fat, frivolous and unproductive our own lifestyles often are.
Problems? We hardly appreciate the meaning of the word. One thing making me very happy this Christmas is that I have been negotiating with the rich folk of Dhaka to match me dollar for dollar – let’s replicate Baker’s “care for the poor by the poor” across Bangladesh with a number of facilities. I think we might just pull it off.
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