15 December 2005

A tale of two parallel worlds

In a small Latin American country, in 1947, a major decision had to be made by the unstable local Government. The country had just gained its independence, thus they had to organize a new National Guard. Typhus, diphtheria and malnutrition were wiping out whole local communities. The National Guard, as a specialized army needed healthy men and women, well trained, but most of all capable of physically dealing with the challenges of the jungle and the rainforests, the guerilla attacks and sabotages, the unfairly superior war machine of the foreign powers. However, there were only 760 local medical doctors and 4,500 nurses to serve a population of about 14 million people.
International pharmaceutical companies spotted the urgent need for vaccination, as the rest of health improvement parameters relating to nutrition and hygiene were of secondary priority at that point. It is great to serve the common good but even greater if you have a massive market as well. Four pharmaceutical companies came to a historical agreement with the local government that would provide long term solutions to the problem. More specifically:
1) It was particularly difficult to educate all the people about the need for vaccination. However, people would respond easier if they had an incentive. Being struck by poverty, everybody wanted a safe position in the National Guard and subsequently the whole State mechanism. A beneficial solution for everybody would be for the Government to establish a certificate of vaccination as a pre-requisite for every applicant, but also for every new student in every school.
2) As the Government’s medical resources could not support the existing demand, the consortium of the four companies offered to train responsible individuals in:
a. Basic principals of hygiene
b. How to give injections and control side effects
c. How to basically select and train new individuals, before they approached the consortium for the final course and certification
d. How to report to the consortium and the local Government medical authorities

These individuals would take a certificate from the consortium, recognized by the Government, which would allow them to open their own small “vaccination” clinics. These clinics could only provide the above two services, i.e. vaccination and basic hygiene consultancy.

The consortium would make money from sales of vaccination jabs. However, the need for a good job, as the State had a limited number of applicants it could hire every year, grew and this led thousands of potential clinic owners to apply for training and certification. Within the next few years the consortium saw that they could decide on a nominal fee to apply for every course and certificate granted.

The truth is that the system worked. In less than 7 years typhus and diphtheria disappeared from this country, which by the way has been disease-free since then. On top of that, the knowledge gathered over the years by the clinic owners improved the quality of services offered, many of these individuals attended extra courses, some of them even officially studied medicine and turned their clinics into proper general health care units. However, as an established para-medical field, it flourished to include 60,000 clinics in a country that, due to demographic changes, now has a population of about 12 million people. The State has not changed the out-dated law in the past 55 years, so officially these medical units are “vaccination clinics” and recognized as such. Viability stress has obliged the owners and their successors to focus on what they know best; vaccinations and basic hygiene consultancy. The worst thing is that the rest of the population, still functioning within an out-dated legal system still ask for their vaccination certificates in order to get a good position in the State mechanism, or open their own clinic. Since the people are asking for that, this is what clinics offer and a vicious circle has been created, maybe with no way to break it.

International observers in 2004 reported that this small country has been impressively disease free and products contributing to everyday hygiene sell like nowhere else. However, this country has the highest rates of child obesity, heart diseases, strokes and female cancer in Latin America.

The unions of the clinics throughout the country are aware of the overall health problem, as many of their local community members happened to apply for a job in the U.S. Their application was turned down due to their medical history. However, they all have a vaccination certificate.

The consortium of the four companies still exists, contributing to health improvement in other poor countries and just receiving nominal fees for the thousands of jabs sold in that little country every year. On top of that other, technologically more improved jabs have arrived in the market, along with other companies producing and distributing hygiene products, antiseptics, syringes, etc.

Vaccination certificate applicants of the public have a clinic next to their place. They take the whole process for granted and the priority of health improvement, along with the vaccination itself, has been degraded from number one priority to a standard presupposition. They never budget even for the nominal fees and sometimes they disappear, using another clinic for their annual booster jab.

The big challenges vaccination clinic owners come across are:
1) How do they prove that their clinic is the best compared to the competition in terms of good service, complete side-effect control, pleasant environment, and compliance with hygiene standards?
2) How do they manage the public?
3) How do they educate the public, as the consortium had to do decades ago, for them to understand that good health is ensured partly through vaccination, but without proper nutrition and on-going health care, good health cannot be guaranteed?

In that world public health is depending on such a system and expecting such answers. In a parallel world, the Greek ELT, education is expecting similar answers too.