Local Self-Reliant Sustainability (LSRS)
A difficult but necessary lesson our project has had to learn is the core importance of LSRS — Local Self-Reliant Sustainability.
The other core lesson is that in order to accomplish LSRS, we have to ALLY WITH THE POOR and challenge the bureaucrats, the civil servants, the politicians, (both elected and unelected), the police, the Army and the legislators.
PACE face an unequal, long-drawn out contest. But in the end we can only hope to win on behalf of the poor, through LSRS.
PACE has to be uncompromisingly PRO-POOR in order to succeed through using the strategy of LSRS.
The great state of Jammu & Kashmir in India has enough local renewable resources to feed, educate and shelter every woman, child and man.
Here below are the problems. No project , including PACE operates outside of its local-global context.
J&K is located in a conflict zone, sitting within India’s border.
India, the world’s largest democracy, sits in a tough neighborhood, with China as totalitarian aggressor, Pakistan as co-aggressor plus US/CIA’s DEPENDENT-CLIENT-STATE, and Afghanistan in a state of uneasy flux with Taliban, drug overlords and US/NATO all adding to the volatile and (extremely profitable) geopolitical mix.
The US interference in the region since the early ’50 when Pakistan was (and still is) manipulated and overrun with CIA operatives during the US-invented Cold War with the Soviets which escalated under US President Ronald Reagan, is the KEY destabilizing factor in the geopolitics of the South Asia region. Got to tell it like its.
Geopolitics trumps governance. Geopolitics, coupled with internally divisive politics trumps fairness and equity in everyday civil society governance.
Add to this the problem of divisive political Islam masquerading as governance.
When ANY religion is officially adopted or informally claimed to be the state religion and pretends to have the answers to democratic governance, it’s an ongoing problem.
No civil society governnace project like PACE,that focuses on healthcare delivery to the poorest, can operate without paying attention to all of the above factors.
Yet we have to continue to create opportunities to deliver healthcare to the poorest. That is our objective, vision and mission and we are making no excuses when we state the challenges.
Now let me give ONE example of how LSRS works to deliver healthcare to the poor.
Fowzia Gazi is a young woman I met in the Bemina locality of Srinagar town in the famed valley of Kashmir in J&k. Fozia, 22 ,lives in a large closely-knit, extended family of Shi’a muslims, who are a religious-ethnic minority in the Valley area of the state (Sunni Muslims are in the majority).
At the time of my most recent volunteering visit to the Valley this past winter, Fozia had already spent two years trying to get medical care for a serious but treatable condition that required open-heart surgery to repair a defect that prevented blood flow.
After receiving her diagnosis, Fozia and her family repeatedly ran into bottlenecks at the hospital. Because she was poor, Fozia was never routed through the hospital’s healthcare delivery system and lined up to receive open heart surgery.
In a word nothing happened after the diagnosis. Fozia was left without any further attention. No doctor was held accountable for neglect. No medical professional or administrative official had any responsibility or accountability to deliver EXISTING healthcare services to Fozia to treat and cure her condition and turn her into a productive citizen and taxpayer! Callous disregard and cynical indifference to Fozia’s conditin would never be punished by the doctor or administrator being fired on the spot.
I shouldn’t really say nothing happened at the government and private hospital. Something did happen. After Fozia received her diagnosis, she received a PSYCHIATRIC diagnosis of Major Depressive Disorder (MDD), depression, accompanied by suicidal thoughts.
This represented to me, a worthless and costly intervention — an added burden to an already overburdened and inefficient healthcare delivery system that most exploited the poor. Fozia paid out of her family’s meagre cash resources, for that worthless unnecessary psychiatric diagnosis. In her position, I wouldn’t have suicidal thoughts. I would have homicidal thoughts against the hospital staff.
Fozia’s problem was a severe cardiac problem, not a psychiatric problem.
I went to the local government hospital which Fozia had visited several times in the past two years. When we entered, it was a scene of utter chaos. Poor patients were hurrying here and there accompanied by their relatives. People were treated like sheep. There was no order or flow to the seemingly unceasing human traffic of the indigent desperately seeking help.
As I stood inside the hospital, reading the numerous signs indicating wards and departments, and trying to figure out where to start, I was approached by a young man who obviously could gather from my New York City attire (I wear the same clothes everywhere that I wear in New York, when teaching my classes or around town, donated hand-me-downs or picked out of dumpsters from NYC and I think I look pretty cool), that I might need some help and maybe he could get some help from me too!
The young man, a chemist whose family ran a medical supply store right by the hospital, temporarily appointed himself as my guide. However once I was on the Department floors, I took control. No point wasting time. I took myself to the Head Of Department, Psychiatry, to bring to the attention of the boss there about Fozi’as mistaken and costly diagnosis.
He hastily re-directed me to the person I really wanted to see, the Head of Department, Cardio-Vascular and Thorasic Surgery(CVTS). As I tried to enter, scores of patients were thumping on the door leading into his office. I felt empathy with them.
Both the top professionals I met were clearly of the highest calibre. The problem was not their credentials.
The problem was the healthcare delivery system is simply not geared towards the poor. The healthcare system, especially in our Global South nation-states, is geared towards the affluent and the influential, not the poor and the needy.
The fact is there are enough, more than enough, healthcare resources to go around, but the healthcare delivery mechanisms are self-defeating, they are ANTI-POOR, they are not geared towards promoting proactive, efficient, preventive civil society healthcare governance so that everyone can get access to healthcare when and where they need it.
The DELAY in surgery + unnecessary psychiatric diagnosis in Fozia’s case, meant an added burden to the delivery delivery system and it cost more to the J&K treasury.
In a word, delay, lack of accountability, and an added mis-diagnosis actually cost more.
In a word, it is wasteful and cost-ineffective to deny healthcare to the poor.
In a word, LSRS must be the codeword to shape the haelthcare delivery system in a democratic civil society.
How did all of this turn out.?
Well, Fozia got her surgery. Even though she qualified as BPL (Below the Poverty Line) to get FREE care, she was required to pay out of pocket, which her family did by borrowing from extended family members.
This illustrates an important point as well. In our Global South nation-states, the FAMILY unit is the greatest and most dependable asset. The state cannot be counted on. No wonder, people, especially the poor invest in thermselves, by having large families.
When and if, only if and when, the state starts to do more, give more, families like Fozia’s can and will become smaller.
But not until then. So overpopulation is a direct consequence of anti-poor state policies in healthcare, food security, housing, you name it.
Fozia’s case needs a few more details. Her excellent doctor, the one I met, performed the 10-minute procedure ( about 10 minutes, he estimated,after the heart is opened) and Fozia is recovering well.
A few more necessary details:
In order to get her costs reduced, I had to personally appeal to the Minister who represents her locality. I was routed through various departments in the State secretariat. Faxes were despatched to the local authorities. Paper was shuffled through various departments. After all, bureaucrats have to justify their existence and their lifelong salary and perks.
The salariat holds sway over poor people.
I am happy i was able to volunteer on behalf of Fozia’s serious and urgent and yet straightforward healthcare needs. But is also a pity and a tragic waste that I even had to intervene.
The fact is there are enough and more, Local Resources to provide PROACTIVE HEALTHCARE PREVENTION to every woman, child and man in the state of J&k, in every state of India and indeed throughout the Global South.
We don’t lack LSRS. We lack SOCIAL JUSTICE.
Dr. Chithra Karunakaran
City University of New York [CUNY]
Ethical Democracy As Lived Practice
http://EthicalDemocracy.blogspot.com
www.disqus.com/EthicalDemocracy
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