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Winning the War Against Illicit Health Practitioners

Thoughts From Afar
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Many seem to confuse healthcare cost with the amount of money they need to pay out when they have an episode of ill-health and fail to have an idea of what the true cost of ill health is.
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“In order to get a holistic explanation, anthropology often has to upend common sense and question what gets taken for granted. Anthropology prompts us to reconsider not only what we think we know – what it means to be affluent, why blood matters, what constitutes reason – but also the terms by which we know it.” -Matthew Engelke

I have always battled with why we have failed thus far to eliminate the menace of drug peddling and quack doctors in our society. To start with, all those in authority, including politicians cloaked with the responsibility of fighting them, know the dangers they bring. Unfortunately, this knowledge has done little to ensure that we have the financial capability, human resource or political will to make these practices part of our history. Whilst I have found this realisation hard to swallow, I have begun to think that the answers to ridding ourselves of this problem may lie in understanding why these illegal practitioners engage in their illicit activity and why citizens patronise their services. A read around their practices and conversations I have had point to the fact that the main factors that keep them in business are a perception of low financial cost, convenience and empathy. In this piece, I will try and look at these factors and suggest how they could be turned around to fight these menaces.

Many seem to confuse healthcare cost with the amount of money they need to pay out when they have an episode of ill-health and fail to have an idea of what the true cost of ill health is. They fail to quantify the incurred loss in earnings if self-employed, or the inconvenience their employer is put at if they are employed as part of the total cost. They also do not realise that treatment failure prolongs ill-health and increases cost. Thus, they see nothing wrong with taking a chance when feeling unwell with unscrupulous operators. How and why we have failed to leverage this as part of the conversation to encourage enrolment in the National Health Insurance Scheme may be one of the biggest failures of this country’s public health education.

A look at our history indicates that many especially in the rural areas had large families mainly because of high infant mortality and also as a means of using them as farm hands. Based on this simple observation, and with infant mortality on the decline, was it beyond us to have researched into the average number of farming days lost due to ill-health? Could this be used as a means of convincing the rural folk on the net benefit of having an insurance safety net in this age where the extended family safety net has all but collapsed? Is it also not true that with such information and the observation that even if they wanted to, many cannot currently have large families because they lack the ability to feed them? Could we have made a solid case for an enrolment uplift for the National Health Insurance Scheme?  Is such a scenario not a win-win for all leading to a drop in the patronage of illicit health practitioners?

When it comes to convenience, I feel even more let down. We seem all fixated with the idea that convenience can only be achieved if health facilities are built in close proximity to the population and hope that ideally these facilities will be endowed with health human resources as well as equipment and medical supplies. The reality, however, is that as a country we lack the financial clout to achieve this utopia. Sadly, we forget that without these, drug peddlers and quack doctors have even in areas where roads are unpassable found a way to still reach citizens. We also forget that during political campaign periods various novel ways are found to reach these people. Is it too difficult for us to find a similar way of getting health to these people without the utopian luxuries we crave for? Take our bus terminals for example, can we not station community nurses and other paramedics at these to routinely check the blood pressure, pulse rates and body temperature of passengers and provide them with relevant advice based the outcome of these preliminary tests before the drug peddlers get on the buses to sell them one drug or the other as a solution to all their health problems?

Is it not feasible to have health posts at these areas of mass congregating that will provide better services than what the quacks do? Is this not the medium recognized groups exploit for their health outreach programs?

Let no one tell me passengers are always in a hurry. A simple visit to any bus terminal will dispel this notion. Is it not the case that many have to sit in vehicles for close to an hour till they have full capacity? Does this time window not allow for such preliminary screening to be done? I have often heard health regulators arguing that it is the responsibility of Traffic Road Transport Unions to ensure that their terminals and vehicles are not havens for the activities of illicit health practitioners. Whilst agreeing with them, I have also wondered whether they are aware of the saying by Aristotle that “Nature Abhors a Vacuum?” If they have, then it is strange that they have failed to realise that riding these premises and vehicles of such practitioners without filling the void was an exercise in futility. As people who have become so accustomed to the activities of these practitioners, we need to evolve strategies that will exploit this perceived convenience positively by mimicking their behaviours whilst pushing them out of business. Is our failure to do this not indicative of a crisis of thinking?

When it comes to empathy, the least said the better. How we have come to accept that those selling more or less death potions are empathetic; and have failed to fashion arguments to dispel this just beats me. It does because, in a country where political propaganda can be conjured out of thin air, I struggle to believe that we cannot think our way to destroy this narrative. In my mind, it sounds more like we have resigned those who have to rely on these illicit operators to their own devices and do not want to expend intellectual energy on solving their problems. In doing so we have failed to ask the relevant question that will help us unravel the mystery surrounding these practices. We have ignored the need to study our environment as a means of solving our problems and have preferred to give excuses that prevent us from acting.

I believe it is not too late to start taking this fight seriously. I believe the solutions are hidden in plain sight and can be found. I am convinced that by studying our society and taking a historical look at our health anthropology, we can map out the behaviour of these illicit actors as well as their patrons and work out a simple way of ridding our society of their activities. All it will take is an intellectual commitment to undertake this exercise and a willingness to stay the course.

Edited by Winifred Awa.

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