The immediate effects of the Covid-19 pandemic are severe enough, and sometimes unexpected. The higher covid-19 mortality amongst health care workers and others from black and minority ethnic backgrounds in the UK have not been observed in Africa and South Asia. This has obliged those of us who work in the National Health Service to ask ourselves difficult questions. Is the service as fair and equal to all as we like to think? [1] How much unthinking bias do we engage in? When councils in the UK delivered emergency food parcels to people who were shielding, they provided pork products to Muslim families. As well as leaving struggling families with insufficient food, this has been described as an example of structural and institutionalized racism in our society, where the views of minorities are not considered.[2] How much greater are the global implications of such thinking?
John Donne’s poem ‘No man is an island’ published in 1624, is well known.[3] The language is archaic, but the message is pertinent.
No man is an island,
Entire of itself,
Every man is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thy friend’s
Or of thine own were:
Any man’s death diminishes me,
Because I am involved in mankind,
And therefore never send to know for whom the bell tolls;
It tolls for thee
Even high-income countries are struggling to meet the medical and economic needs of their populations. Middle- and low-income countries have greater dilemmas. They have imposed lockdowns to prevent virus spread but have often had to lift them prematurely. Where people are dependent on working to earn money for food for the day the risk of infection is measured against the risk of starvation. If markets close, traders cannot earn, and local people cannot obtain food. If farmers cannot work their fields, whole communities are at risk from crop loss and hunger. There are much wider issues than caring for those who become seriously ill, something which is challenging enough in itself.
We are entering world recession. The longer-term effects are going to be massive. The most vulnerable nations and communities are at highest risk. Appealing to the world’s leading industrial nations, the G20, to increase support, Mark Lowcock has estimated that ‘due to disruptions to health systems caused by the pandemic, some 6,000 children could die each and every day from preventable causes, while annual deaths from HIV, tuberculosis and malaria, could double’. He went on to say that ‘the prospect of cascading crises more brutal and destructive than anything the virus alone can do must jolt us all out of our comfort zone.’ [4] This is not a welcome message, but we must listen to it.
Written in 1250, the words of the Persian poet Saadi Shiraz, who had travelled widely and seen war and devastation, are woven into a carpet displayed on a wall at the United Nations headquaters.[5]
Human beings are members of a whole,
In creation of one essence and soul.
If one member is afflicted with pain,
Other members uneasy will remain.
If you have no sympathy for human pain,
The name of human you cannot retain.
This message has been received and acted on in positive ways. Scientific cooperation has largely replaced competition. New information about the coronavirus has been shared rapidly. International partnerships are working to trial potential covid-19 vaccines. Health services have changed rapidly, and clinical teams have cooperated in new and unusual ways across the world. It is important not to lose this momentum, and we will need to go further.
How then should we as individuals and health professionals respond to this global crisis?
It is all too easy to become immersed in our own local and personal problems, which may at times feel overwhelming.
Certainly, we need to pay attention to our own needs, and those of our friends, colleagues, and neighbours.
We also need to pay attention to the needs of the wider world, however uncomfortable that may be.
We need to value our International links, listen to each other and pray for each other.
We need to remember the words of John the Baptist. ‘Whoever has two coats must
share with anyone who has none; and whoever has food must do likewise.’ Luke 3 v11.
The concept may seem simple, but working it out in practice requires thought, hard work and commitment. It is costly. In sharing our resources, we may find ourselves with less for ourselves than we would wish. It is a price we may need to be willing to pay.
Dr Rebecca Torry
[1] Partha Kar: Covid-19 and ethnicity – why are all our angels white? BMJ 2020; 369:m1804 [3] John Donne, British poet (1572-1631) [5] Abu-Muhammad Muslih al-Din bin Abdallah Shirazi, known as Saadi Shirazi, Persian poet (1210-1292). |
