Campus & Community

Kouchner calls for global health care:

6 min read

Espouses care for ‘patients without borders’

After his talk, Bernard Kouchner (right), founder of Doctors Without Borders, confers with Paul Farmer, Maude and Lillian Presley Professor of Social Medicine at the Medical School. (Staff photo by Jon Chase)

Doctors Without Borders founder Bernard Kouchner issued a call for a new force in global health care last Thursday (March 6) in the form of global health insurance that would ensure access to basic health-care services for the world’s poor.

In a speech laced with vignettes of starving children and memories of tortured colleagues, Kouchner cited global health ills including AIDS, tuberculosis, malaria, hunger, and polluted water as he built his case for a new intervention by the world’s wealthiest nations. We already know how to treat AIDS, he said, we know how to cure tuberculosis, we know how to provide sanitation and clean water – all that is lacking is the will to do so.

Doctors Without Borders founder Bernard Kouchner will discuss ‘Iraq: The International Dilemma,’ on March 14 at 12:30 p.m. in the Snyder Auditorium, School of Public Health.

Access to Essential Medicines Expo – an exhibit that tells the story of the millions of poor suffering from treatable infectious diseases such as malaria, tuberculosis, and AIDS – will be held at Harvard’s Longwood Campus (between 200 and 260 Longwood Ave.) April 2-4 from 9:30 a.m. to 6 p.m.

And on April 2, Doctors Without Borders will screen the film ‘Your Money or Your Life’ at 7 p.m. in Emerson Hall, Room 105.

“In our day, no one deserves to die of a curable disease because he is poor,” Kouchner said. “We know almost everything except how to convince people in the wealthiest countries to give all the inhabitants on Earth an equal chance.”

Inaugural Mann lecture

Kouchner issued the call during the first Jonathan Mann Lecture on Health and Human Rights at the School of Public Health’s Snyder Auditorium. The lecture was established in memory of the late Jonathan Mann, the School of Public Health (SPH) professor who died in the 1998 crash of Swissair Flight 111. Mann, who insisted that human rights are an essential part of the fight for global health, was a founder and first director of the School’s Francois-Xavier Bagnoud (FXB) Center for Health and Human Rights.

Swissair Flight 111 crashed Sept. 2, 1998, en route from New York to Geneva while trying to make an emergency landing in Halifax, Nova Scotia. Mann, who was traveling to a World Health Organization meeting on AIDS in Geneva, and his wife, Mary Lou Clements-Mann, were among 229 who died in the crash.

The lecture is sponsored by the FXB Center and by Harvard Medical School’s Department of Social Medicine.

School of Public Health Dean Barry Bloom said he couldn’t think of anyone who exemplifies Mann’s spirit better than Kouchner. Kouchner and a group of physicians founded Doctors Without Borders in the early 1970s after becoming frustrated by the neutrality they had pledged in order to gain access to patients in developing world conflicts and disasters.

The doctors’ new organization discarded neutrality and claimed the right to intervene on behalf of victims, to provide medical aid, and to act as witnesses to human rights violations. Doctors Without Borders won the Nobel Peace Prize in 1999.

Kouchner has also served as France’s minister of health and as special representative of the United Nations secretary-general in Kosovo. He is a visiting professor at the SPH through March and a fellow at the FXB Center.

FXB Center director Stephen Marks, the Francois-Xavier Bagnoud Professor of Health and Human Rights, introduced Kouchner. He said Kouchner and Mann blazed similar trails that linked health care and human rights, and shared the courage to question authority.

Roots in Biafra

In his speech, Kouchner described Doctors Without Borders’ inception during the Nigerian civil war over secessionist Biafra in which more than a million are thought to have died, many from starvation. He spoke of treating bloated, malnourished children who came back to life “like dry plants finally watered.” He would send them home only to see them return again and again because of the Nigerian army’s food blockade until “they would all perish, so light, so frail, in our hands.”

“To give medical care and keep quiet, to give medical care and let children die, for me it was clearly complicity. Neutrality led to complicity,” Kouchner said. “The duty to interfere was born.”

Kouchner’s speech was sprinkled with such vignettes, backing up his arguments for improved global health and world health insurance with firsthand accounts. He spoke of fellow doctors tortured and killed by Saddam Hussein’s army in Iraq, of Somali children dying of hunger, of Vietnamese boat people being raped by pirates and drowned, of a Salvadoran boy among rebel forces, coughing up blood from tuberculosis as he prepared to fight the Salvadoran army, whose ranks included his brother.

Paul Farmer, Maude and Lillian Presley Professor of Social Medicine at the Medical School, responded to Kouchner’s speech, affirming the need for a new vision and a new movement in order to aid “patients without numbers, patients without limits.”

“The borders are always tricks to ensnare us,” Farmer said. “They’re not respected by bacteria or viruses. They’re not respected by bombs or bombardiers. There’s no reason why they should be respected by the forces of good.”

Patients Without Borders

The fight for world health insurance, which Kouchner dubbed “Patients Without Borders,” will be difficult, he acknowledged. Already, people have argued that the task is impossible, that it is too expensive, and that the needy don’t have roads, hospitals, or the infrastructure to take advantage of insurance even if they had it.

“Some said ‘How can we treat all of them? It’s too costly,’” Kouchner said. “The long history of medicine shows us we must start one by one, then thousands by thousands.”

Kouchner said he has been working on problems surrounding the idea during his stay at the School of Public Health and will continue work in coming talks with the World Bank and into the future. Though it may take 15 years, he said, the problems are known, the health-care solutions are known; it just remains to do it.

“Now it is time to act, and not just to denounce [poor health conditions],” Kouchner said. “Disease no longer knows any frontiers, any borders. In protecting the poor, we protect the rich. This is selfish, but effective reasoning.”

Kouchner sketched out the beginnings of a plan of action, including defining a package of basic and preventive care. He said the program would work mainly through women in local communities and will probably start in two African countries.

“[Patients Without Borders] is not a slogan, but a necessity, leading us to a reality: hope without borders,” Kouchner said.