I have long been a fan of the
work of the philosopher Ivan Illich. Many people don’t like his writing, which
has often been described as polemic, challenging and rhetorically
intoxicating. Part of his appeal for me
is not just in the subjects that he chose to write about, but also in his use
of words. Like my artist friend Urpu Sellar, Illich liked to use words outside
of their normal context and generally accepted meanings. Whereas Urpu uses words to produce tongue in
cheek ceramic sculptures, Illich produced trenchant accounts of his analysis of
many of societies social institutions (education, medicine, the law and so on).
In his book the Limits to
Medicine he argued that the medicalisation of so many of life’s vicissitudes
(birth and death for example) often caused more harm than good, and introduced
the wider public to the concept of iatrogenesis. He described the concept in
both its strict sense of the word – harm that comes from direct medical
intervention and also in its wider sense, a cultural use where as a society we
become, over time less reliant on ourselves to look after ourselves and others,
and more reliant on the state (in this case medicine) to look after us.
I was prompted to recall his work
by a couple of things last week. One was being asked to choose which
antimalarial medication I wanted prescribing for a trip next weekend to Uganda.
Anyone traveling to Uganda is advised to take precautions against malaria
including taking antimalarial medication. It makes sense, as there are
approximately 750,000 deaths a year from malaria, most of which occur in
sub-Saharan Africa. Some 3.2 billion people worldwide are at risk of malaria.
Despite the news last week that the pharmaceutical company Glaxo Smith Kline,
after nearly 30 years work, had developed a malaria vaccine, preventative and
control measures are still required to reduce the number of deaths.
Antimalarial medication is part
of these preventative measures. However, the side effects of the medication can
be pretty awful, ranging from a sore mouth, headaches, diarrhoea through to unusual
bleeding, and mental health problems – however unpleasant, all of which are
obviously better than death. I am going
to Uganda as part of a team from the NHS Health Education England Global Health
Exchange. I will write more about this trip and what the initiative involves in
future posts, but is both important for the School, communities across Uganda
and the wider NHS.
The second Illich memory prompt
came from reading the publication ‘the art of the possible – what role for
community health services', published by the NHS Confederation. I found this a rather
archaic paper. Aimed at meeting the needs of people with long term health
problems, it appeared to state the obvious. For example, that practical support
from community health services those with chronic conditions would enable
primary care to work faster and at a larger scale.
To be frank, I was more inspired
by my Friday morning meeting with Jim Taylor and Charlotte Ramsden. Jim is the City Director, Salford City Council,
and Charlotte is responsible for children and adult services in Salford. They were both a breath
of fresh air. Totally switched on when it came to integrated care, new future
for social work and how we might look for the added value in initiatives such a
‘devo manc’. I was really pleased at the
range of opportunities we discussed for working more closely together, particularly
so as last week I was sent a ‘storify link’ which showed the contributions our social
work colleagues made at the recent Joint Social Work Education and Research Conference
(JSWEC). The range of papers on their research, new approaches to teaching and service development they presented was fantastic. See for yourself here.
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