The Inca Trail, the Incas Tale and possible lessons for the NHS

One of the things I love to do is people watch. Find a pavement cafe, sit down with a glass of wine and watch the folk walking past. As I do so I try and imagine what is going on in their lives.  Of course while you can see happy smiling faces, or sad or angry  faces, from the vantage of my table, I will never know what is going on in their lives. It takes a rather more serious form of study to do that. And observation is key to study of this kind. It’s part of something known as ethnography, the long established scientific study and description of people and cultures. It’s an approach used by many who study cultural anthropology. It was an approach I used when undertaking my PhD. Indeed I pinched my thesis title from the famous Max Gluckman’s Customs and Conflict in Africa, to Customs and Contracts in the GP Fundholding Family. My thesis explored how different members of the primary health care family used a range of relationships to achieve their objectives in an highly prescribed and regulated health care market. All of which is by way of an introduction to sharing my experiences of last week. 

I’m excited to say that this week’s blog comes from Peru. J and I have celebrated our birthdays, walked the Inca Trail, explored Machu Picchu, the Sacred Valley and sat on the magnificent shores of the Pacific Ocean in Lima. It has been a wonderful trip, particularly as we have enjoyed some great guides keen to share the history of Peru - and goodness, it has been a checkered one too. At its height, the Inca Empire was the largest in the world. There were estimated to be some 20 million Incas. We have seen, and walked on some of the most amazing structures I have ever seen. When you think the Incas were around from 1438 and didn’t know what a wheel was, some of these structures are immense and wonderful pieces of engineering. The Inca stone work is civil engineering precision taken to a new level of achievement. 

We did also hear some weird and wonderful stories of their ingenuity too. They discovered how to freeze dry potatoes and seeds. These potatoes have all the moisture taken out of them and could then be stored for at least 10 years of more. Likewise, there were some other peculiarities that just felt alien to us. For example, guinea pigs are a great delicacy here in Peru, as are Alpaca Sunday roasts. The Incas had a wonderful system of taxation, paid partly in money and partly in labour. Everyone was compelled to participate. It has been said that even the beggars on the streets had their lice taken in lieu of their taxes. They were able to build such a large empire not through force, although there were countless battles, but through collaboration and persuasion. To be honest, at the time, it was better to be part of the Inca empire than be outside it. 

But this wonderful balanced way of life started to unravel with the arrival of the Spanish Conquistadors. They came at first to see what Peru and the Inca empire had to offer (what they could take for themselves, and then returned 7 years later intent on colonising the empire and taking its wealth. They were able to do so as the Inca people had never seen horses, let along armoured horses, which they thought literally ate metal, nor had they seen guns. Francisco Pizarro who led this colonisation was, himself a fearsome man. His statue in one of the parks in Lima show just what a fearsome sight he must have been. So with a relatively small force they were able to overpower the Incas. By 1572, the Inca empire was no more. 

Now you might be asking what has any of the above to do with our UK health service - a good question. Well the Peruvian health care system has considerably improved over the past 20 years As we have toured around we cam across many primary care centres and mini hospitals (akin to our walk-in, urgent care centres). Even in the deepest parts of the countryside they were to be found. However, and a bit of throwback to my PhD thesis, in a lot of the mountain villages you can still find Shamens dispensing health care. Peru spends less per head of population than all the other Latin American countries, but equally, and unusually, spends much less on defence. Of course I don’t know how effective the health care provided might be, but the infrastructure looked pretty good. 

However it was the fact that they were able to provide and nurture such a large population, and to do so well, mainly through collaboration and working for the common good that really struck home. In the UK we now have Intergrated Care Systems (ICS), that bring different health and care organisations together in working more collaboratively with each other. Not to just provide for better health and social care but to prevent many more people from needing the services in the first place. I think in many parts of England, the jury is out on whether we can define and promote what the great good might look like. I think we have a short window in time to really come together in making a difference. If we don’t I think the ICS might well will go the way of the Inca empire.