What the prince does not know

2020-04-28 14531

(Dr Santhushya Fernando)

"To understand the nature of the people one must be a prince, and to understand the nature of the prince, one must be of the people” - Niccolo Machiavelli-

The indignity of poverty is universal. Contrary to the popular belief, particularly in Sri Lanka, poverty is not a character flaw. Poverty is in essence a crime inflicted on humans with the consent of society, because society and politics both have the agency to fight it. And they both, often chose not to do enough about it. And Covid 19 is actually a disease of the poor.

Sri Lanka prides itself on one of the exemplary systems of health care. This low-cost model of health care is focused on perfecting the universal health coverage. It is the grand health agenda of Sri Lanka, whilst other countries in the region are lagging behind in many curative and preventive health indicators. We pride ourselves that we are a morally superior nation in health care where the prince and the people are both entitled to free health care. Little does the ordinary starry-eyed Sri Lankan know that the reality of the ordinary citizen and the actual king are so different. Without being the other, one never really knows.

So many people strive to envision the Covid 19 virus as a great social equalizer. It gives a lot of people a smug satisfaction to believe that the Covid 19 virus can kill the rich and the poor, the powerful and the powerless alike. That it has diminished the importance of money, wealth, privilege and enhanced the social validity of the sanitary worker, military personnel, vegetable sellers, truck drivers and the health care workers. There is a social media wave jocularly stating that “we are fine with the 225 rogues in lockdown”. There is also the dangerous build up towards slogans denouncing the democratic processes of governance in the name of “supporting government efforts”.

We have never been more grandly deluded about the “equal ground’ that Covid 19 created. The ground has never been more uneven than today.

According to the World Bank estimates, Covid 19 is likely to cause the first increase in global poverty since 1998, when the Asian Financial Crisis hit. With the new forecasts, global poverty characterized by the share of the world’s population living on less than $1.90 per day is projected to increase from 8.2% in 2019 to 8.6% in 2020. This means the number of the poor in the world will increase from 632 million people to 665 million people. Forty-nine million people will be pushed in to extreme poverty in this year.
World over, a disproportionate amount poor, disadvantaged and minority ethnic populations are dying of Covid 19. In the USA of African Americans and Hispanics top the deaths.

The majority of the Covid 19 deaths in Sri Lanka occurred in elderly persons who had other non-communicable disease (NCD) risk factors. World over, NCD risk factors and actual affliction from NCDs such as diabetes, heart disease, chronic kidney disease, addiction, obesity are all several folds more prevalent amongst the poor. Therefore, poverty is a correlate of infection with Covid 19. As the epidemic is changing its trajectory in Sri Lanka the majority of the people who are infected with Covid 19, especially in clusters, appear to be vendors, daily wagers, those in underserved settlements and those with high risk behaviors such as addiction. Those at risk for dying anyway from other conditions, remain at higher risk of dying during the Covid epidemic as well.

From the beginning of the Covid 19 epidemic in Sri Lanka, the reactionary nature of the response to the poor has been inadequate at best. With the Islamophobic twist that is seen during this epidemic, we may have rusty memory about the initial days.

At the beginning most social resistance was aimed at the returnees from Italy and South Korea. They were viewed and stigmatized as “selfish returnees” who came as “biological hazards” to Sri Lanka. So much of cyber hatred was seen, referring to them has "Ithalikarayo- Koriyankarayo." Consider what makes them take a flight or a Boat of Death to these countries from our "paradise island" in the first place. They leave because the life of the people is not the life of the prince. They may have left because a life that is taken for granted by many here maybe their dream life they can never aspire to achieve here. Others may have fled to save their lives in an environment of violence or political siege.

If our world were more equitable or just, people won't take the Boat of Death to Italy. If the world were just, they would not flee Italy back to Sri Lanka, looking to save their lives. Poverty, inequality and the feeling of being the “other” doesn't stop following you just because you migrate to a rich country. Probably most of these immigrants are once again, “poor” people in their new country. If you have power, money and privilege it’s so easy to make any country your own. Belonging, after all, is a complex anthropological phenomenon.

Poverty, absolute or relative, makes it so hard for people to belong. Because poverty denies people the skills that are needed to effortlessly blend in to a more lavish and affluent foreign country. It may not even economic hardship or the lack of access or quality of healthcare in the host countries that make them flee back to Sri Lanka- their home. The question is still, belonging. We may not fans of their inelegant behavior, their cantankerous drama at the airport. But if we were born at that side of the fence, we might behave that way too.

Some of the individual patients and clusters of patients of Covid 19 found in Sri Lanka dwell in underserved areas under deplorable conditions. The numbers quarantined following the identification of patients in some of these tiny locations begs the question” who sanctioned such thickly populated human settlements?”. The groups of alleged drug addicts who were rounded up and the personnel who probably paid the price of infection by Covid 19 through that exercise both originate from similar socio-economic hardship. Ironically, the chaser and the chased may have much in common.

The poor who crowd around the pawn shops every time the curfew is lifted, around the alcohol outlets, the cart pushers sharing face masks, the janitors, cleaners, the soldiers are all products of social classes that embody inequity and injustice. It is apparent that some of these groups of people have little understanding about the enormous potential of Covid 19 virus to infect and kill humans. Mathematical modelling shows that if left unattended Covid 19 will infect half of the world population in 12 months and kill over 13 million humans. The sad part is that even if they did know about this gravity of this virus, there is very little poverty allows them to alter in their lifestyle, methods of earning, crowding and unsanitary conditions.

More than ever before, Sri Lanka should think of snapping out of this dream that our health system is as utopically just and equitable. It is time to incorporate city planning, poverty alleviation, economic interventions and introducing ethics guidelines regarding stigmatization of disempowered persons. Whilst the media in Sri Lanka has no problem exposing the faces of the curfew and health guideline violators on TV screens, they are extremely conservative on the powerful politicians who do the same. It’s time for us to use our moral prerogative to press for change. To address the mental health issues; incorporate health in all policies.
Professor Sir Michael Marmot, global protagonist of Social Determinants of Health famously stated that” every minister is a health minister”. It is no longer about a good health policy. It is about health in all policy. No. Covid 19 is not a great equalizer. Covid 19 is the great health divider.

If the "Covid gap" of health is not addressed right here right now, the "Sri Lankan spring" arising from the socio-economic and psycho-social backlash of the epidemic will hit hard even before the economic plummeting. Let’s not forget, the heart can snap before numbers do.

Retrospect will show us that Covid 19 was largely a disease of the poor like Cholera or Whooping Cough. In a pandemic that is still shape shifting it’s not yet a truism. So, let’s repeat to remember: poverty is not a character flaw. Poverty is a crime propagated with social consent. Covid 19 is showing the uncomfortable underbelly of our health systems and the moral make up of media and society at large. The prince may not learn it, ever...But the people are certainly learning it.