Humanizing Medicine: Making Health Tangible: Memoirs of Engagement with a Global Development Network by Azim H, Jiwani (FriesenPress, 2021).
Review by Theo Richardson-Gool, CEO of Public Health Pathways. He also works in impact for the University of Bristol’s Medical Research Council Integrative Epidemiology Unit and with Caafi Health at a grassroots level in Bristol.
A timely critique of global health. Jiwani’s memoir presents opportunities for a holistic and compassionate approach to patient care.
Our health is complex, nurturing population health is an ongoing process. Following the COVID-19 pandemic, we have learned of our shared vulnerability. But we still need to share resources. For those working in the health sector, health leaders, aspiring public and global health professionals who want to expand themselves to develop a systems understanding of the sector, I recommend Jiwani’s memoir.
The author writes that medicine as a profession presents ‘almost limitless frontiers’ which afford an ‘unparalleled panorama of human condition – its riches, frailties, hubris, and potential.’
Azim Jiwani’s memoir focuses on building a sustainable culture for healthcare systems in Pakistan and Kenya, linking primary and community care alongside preventative health. What is evident from his memories is the indefatigable work ethic of those in healthcare. Jiwani, who joined the first Aga Khan University (AKU) in Pakistan in 1980, argues for grounding professional education in the humanities and anthropology for more balanced curative and preventative medicine. He spearheaded the integration of training that emphasises critical reflective skills, problem-solving, leadership qualities, inclusivity, and a humanistic outlook to advance the education of doctors and health workers in “developing” countries. Jiwani became a professor at the University of British Columbia – yet his journey started in Makerere University in Uganda. He then travelled to Norway and parts of Europe and Canada where he obtained further education at institutions such as the Karolinska Institutet in Sweden, and then Toronto General Hospital.
The book offers three paths to humanizing medicine and making health tangible
First, placing global health at the intersection of geopolitical discourse. The legacy of colonialism, poor governance, stark inequities, and shifting focus on our planetary health still need to be addressed. Second, learning from the Aga Khan Development Network (AKDN) which focuses on sustainability, pluralist values, and ethics. Third, greater emphasis on training doctors and health workers through a holistic pedagogy that encompasses ethics and scientifically sound care – underpinned by compassion.
“Jiwani’s search presents the pathways for all those who see medicine as a service to humanity. Compassion, though inherent, does not come automatically. We have to practice compassionate medicine and instil this value into all our trainees.”
Amina Jindani. Professor of Tuberculosis Therapeutics at St George’s, University of London. Founder of World Without TB.
Jiwani questions the disparity between the “developed” North and the “developing” South – which remains “unanswered”. In 2021, 65% of the population in Africa live below the poverty line, and 30% are considered malnourished.
Leveraging expertise from “developed” countries to establish stronger health systems in “developing” countries would address the legacy of colonialism and exploitation of people and resources. Yet the converse occurred. During the COVID-19 pandemic; wealthy countries imported medical professionals from “developing” countries to provide health care for “developed” countries.
Correspondingly the late, Paul Farmer, founder of Partners In Health (PIH), considered the approach of “with the limited resources we have, what is the most good we can do?” as soft bigotry. He believed the question should be: “what are the resources needed to make it happen?” (Jha, 2022).
Like, Farmer and PIH, through the AKDN, Jiwani found a way to go beyond delivering world-class health services in the “developed” world. He worked closely with hospitals, healthcare workers, and universities in the “developing” world to build capacity and train the next generation of health professionals.
The university and the hospital in Pakistan Jiwani helped develop – links a major medical hub with healthcare centres across the counry, thus serving rural populations. This hospital and medical school later morphed into the international AKU, which now has faculties in Asia, Africa, and the United Kingdom.
The AKU is part of AKDN, founded by Aga Khan IV in 1981, and is part of the network of private, non-denominational development agencies that work primarily in the poorest parts of Asia and Africa – now has programmes in 30 countries.
What is distinctive about the professional training of medical students at the AKU in Kenya, Tanzania, Uganda, and Pakistan, is that ethics and the humanities are embedded into the training. Part of the wider AKDN ethos includes cultural restoration and intellectual pursuits to search for new and valuable knowledge to enhance quality of life, promote ethical and affordable solutions, and develop local leadership.
The AKDN model ensures higher educational standards exist in “developing” countries. It works closely with the United Nations Agencies, National Governments, and Non-Governmental Organisations.
Augmenting a humanitarian emergency response from “developed” countries stabilising volatile circumstances and tackling economic growth is an ongoing challenge. Indeed, a reason for the emergence of decolonising global health is that western governance bodies have too often sought to impose their logic, methods, systems and beliefs without acknowledging the needs of specific cultural, social and economic contexts.
The book illustrates how the AKU builds resilient health care systems through training students in local knowledge systems and invests in coordinating all health system levels in “developing” countries. Three examples are pertinent. In Pakistan, young practitioners learn how urban, rural, and remote communities such as “katchi abadis” [informal settlements] fit within the ecosystem. And in Kenya, experts stress the need for ‘streamlined and harmonised patient care processes’. Thirdly, Jiwani advised the Tanzanian government on a new curriculum for generalist physicians covering epidemiology, and preventative and curative health care.
In global health, we must consider the value of non-conventional alternatives that may open paths to a more holistic and compassionate approach to patient care. Critics of non-conventional medicine argue its interventions are inconsistent with well-established evidence and theories. Conversely, defenders of alternative medicine say that the focus in “Western medicine” that targets disease symptoms is excessively reductionist. Defenders argue that a more holistic approach to disease allows us to consider the patient’s whole life to uncover the deep causes of disease. Perhaps we should consider using the French for alternative medicine, “médecine douce”, translated as “gentle medicine” (Stegenga, 2018, p. 169). Jiwani invites us to consider alternative paths that complement an evidence-based scientific approach. Indeed, since his memoir, in 2022, the World Health Organization set up The Global Centre for Traditional Medicine in India. This Centre will perhaps unlock a holistic path to humanize medicine and healthcare, respect ancient wisdom, and bring a pluralistic approach.