The Occasional Perspective - 7/20/23

Opinions and Reflections 

Opening Our Eyes: Seeing The World – First, please note that “The Occasional Perspective” became a bit longer than I originally anticipated primarily because of the importance of the issue. As a result, there are fewer of the Consulo Indicium (i.e. shorter) blog items. They were displaced by this longer missive. Also, as you read this section of The Fickenscher Files, I’ve taken the thoughts of Bethany Bruzzi, DO (SEE above quote) to heart. In fact, a “global thought process is ingrained when you work in primary care.” And, it is in that vein that I offer up the following perspective on a very important issue facing societies around the world.

I just returned from our annual trip to Greece for a visit with our adopted Greek family. It was – as usual – an incredibly relaxing visit that met all of my culinary dreams as well as the frequent “discussions” on a wide range of issues facing the world, random observations about people, places, and things; and, the solutions to global problems 😊. On the side of the observation, I noted the much more relaxed, “open collar” wear of passengers traveling to and from Greece who were there from throughout the world. There was also less of a business-like atmosphere at the airports by both visitors and attendants in their interactions with one another. It was a notable change in atmosphere. At the same time, the usual friendliness of the entire Greek community was evident throughout our entire visit.

While I was ruminating on the discussions, debates, and dialogues that were ongoing all around me, I received a download from The New Yorker on “The Case Against Travel” that reviewed both the upside and downsides of travel. At first, I was taken aback by the notion of the article seemingly chastising travelers for “experiencing” interactions outside the norm of their personal boundaries. As I continued the article; however, it became clear that a deeper understanding of what we “see” when we travel is often missed by the traveler. Over the years, I’ve always tried to step back from my usual customs, norms, and bias to observe. It has helped me to gain a better perspective on the cultures and peoples of the places I’ve visited. Although I’m clearly not an expert in that regard, the article encouraged me to continue my efforts toward gaining a better appreciation of all those people and places outside the bounds of the United States. It’s a work in progress…

So, as I engaged in the conversation side of the travel equation suggested in the article, I was struck by the Greek reaction to the many global issues which are coming to dominate the experience of the human species. For example, climate change is not only a central focus of discussions in the USA but also a dominant topic in Greece and throughout the entire world. These factors are at the forefront of discussions throughout all of Europe, the Middle East, Africa, Asia, or the entire world for that matter. The discussions are somewhat different in all of these nations depending on how climate change is directly impacting a particular society. However, regardless of the specifics, it is very clear that global warming is directly impacting the economics, culture, politics, and social capacity of all nations – including the Greeks and others in the Mediterranean basin. Furthermore, the impact is accelerating.

And, the questions that come to the forefront when one travels overseas are:

• Are we listening to one another?
• Are we seeking solutions that solve problems?
• Or, are we putting bandages on open, compound wounds?

One of the issues that came to the forefront for me during my visit to Greece this year is the increasing migration of people all over the world from areas of climate devastation to places where people are only now beginning to experience the direct impact of climate change. In particular, I was struck by the similarity of discussions that emanate not only from my friends in Greece but also from friends in Texas, Florida, California, and other “entry” points of immigrants to nations from around the world. For example, Greece has served as the entry point to the European Union for the Pakistani diaspora of about 200,000 immigrants to date. The other European members “cherry-pick” the Pakistani diaspora for workers at a level that meets their particular national needs. However, cherry picks only represent a relatively small percentage of the overall immigrant population. As a result, Greece is left with the responsibility for managing, integrating, and resourcing the new members into their society which is creating increasing anxiety, conflict, and militancy on the issue at the local, community, and national levels across the country.

The politics in Greece – like the USA – is becoming increasingly divisive! Greece for all intents and purposes serves as the “primary entry point” for the immigrant populace from Africa into Europe, much like Texas, Florida or California do in the United States for Latin America. As a result, in both the United States and Europe there is a diversity of opinion on how best to manage the immigrant issue depending on where you live. For example, I suspect – although I have not checked the accuracy of this statement – that the immigrant issue is not as dominant in my original home state of North Dakota as it would be in the three states I just mentioned. I leave it to you to determine why?

At the same time, in much of Europe and the United States, there is a shortage of entry-level workers. In Maine – my adopted home state – we are woefully short of workers for the hospitality, restaurant, and other service industries as well. Much like my family in the 1890s who were immigrants from Germany, the immigrants of our era desire work and are very willing to work (Remember: all of us emanated from immigrant families – except our native colleagues). And, not to be forgotten, the new immigrants are willing to work at jobs that many existing folks in both Europe and the USA would turn down.

But, have we created an environment that allows the new immigrants to work and build a sustainable future? I don’t think so. Rather, we divert attention by sending busloads of people to distant cities or pushing them to cross borders into other countries as the “solution” to the problem. However – rather than solving the problem – we are exacerbating the problem. Furthermore, problems are not resolved through polemics and public diatribes. Rather, we accomplish solutions when a diversity of opinions and perspectives sit down and work together to come up with long-term solutions. They evolve from dialogue, debate, and decisions emanating from leaders who recognize their role in resolving the issues of the day! Has this been the focus in Europe and the USA? I don’t believe so…

People do not naturally pull up roots and head off to some strange land arbitrarily, especially when life and limb are at risk. Immigrants most often decide to move from their home country for reasons of life, liberty, and the pursuit of happiness (we’ve heard that before, I believe) or family. In my case, the Fickenscher clan moved from Germany to the USA to avoid inscription in Chancellor Bismarck’s wars. According to family lore, they left Bavaria with steady jobs as weavers to become homesteading farmers on the prairies of Nebraska. They were part of that great wave of immigrants from across Europe that moved to the USA throughout the latter part of the 1800s.

So, why do we see immigrants now? There seem to be two prevalent reasons: 1) as I mentioned, the evolving environmental devastation occurring as a result of climate change is a major factor; 2) the growth of illegitimate and corrupt autocracies across the globe; and, 3) the economic disruption to people’s lives due to the secondary effects of events like the war in Ukraine. If I were being subjected to the same experiences that face the multitudes of immigrants from Central and South America as they head north or the vast corruption and famine in Africa – I too would be an immigrant not just for me but for my family as well. So, it seems to me that we are only at the formative stages of the “immigrant problem” that will be facing the more developed and privileged nations of the world over the coming decade.

In 2022, the World Bank issued its ongoing Groundswell Report noting that more than 200 million people across six world regions will be on the move by 2040. This includes 86 million Sub-Saharan Africans, 49 million East Asians and Pacific Islanders, 40 million South Asians, 19 million North Africans, 17 million Latin Americans; and, 5 million Central Asians. Those are whopping numbers!!

OK, Kevin. What’s this got to do with health care? In a new report from the United Nations Office of the High Commissioner (UNOHC), the impact of climate change highlights several other issues that are adversely impacting the immigrant populace. The report – released on July 12, 2023 – notes that nearly one-half of all humanity, or, about 3.3 billion people – are living in nations that expend more money paying the interest on their national debt than they spend on health care or education. As noted by UN Secretary -General Antonio Guterres: “Half our world is sinking into a development disaster, fueled by a crushing debt crisis.”  The global public debt problem has now reached a record $92 trillion (with the USA representing 1/3 of that number) and now includes nearly 59 nations compared to a decade ago when the number was 22 nations with “debt beyond their limits to pay”. Furthermore, developing countries carry a disproportionate amount of the overall world debt. Is this not going to make a bad problem even worse? I think so. When families cannot obtain access to basic health care services, when food cannot be put on the table, when basic community capacities like clean water are no longer available, and, where education is thrown aside to pay for debt – primarily to the “have” nations – we have a staggering problem on the horizon. It’s not about people crossing borders. It’s about WHY are they crossing borders? If we think the immigrant problem is going to resolve itself without a consensus approach to the real problems rather than polemic and rhetorical stunts – we are sadly mistaken.

Frankly, I am increasingly worried about the USA debt level and the potential impact it will have on our social programs of Social Security (21% - $1.2 Trillion); and, the national health programs of Medicare / Medicaid / Childrens Health Insurance Program / Affordable Care Act (25% - $1.4 Trillion). These two social commitments now consume[1] roughly one-half of the entire federal budget. So, we are facing a compounded problem (= financing our social programs) on top of a set of exploding problems (= massive debt by developing nations and climate change impact). There once was a Roman Emperor who fiddled away while his capital burned! Are we engaging in the same behavior? I think so. And, we are hearing proposed solutions that will never work: border walls that are clearly porous, deportation policies that force immigrants to attempt other entry points, busing people to cities for political stunts, and the like… This is not a Texas, Florida or California problem. This is a United States problem! The health of the people demands it.

As healthcare professionals, we need to step forward and actively participate in developing and offering solutions. The health of the people demands it. As I noted earlier, I’ve just returned from a two-week hiatus in Greece, the home of Hippocrates – the Father of Western Medicine. He was born around 460 BCE on the Island of Kos with his paternal heritage extending back to Asclepius and, his maternal heritage to Hercules. For the very first time in my life, I read Aphorisms – the writings of Hippocrates. His very first missive in the collection which covers the waterfront of serving as a physician back in his day (PS – we’ve come a long way 😊) was as follows:

“Life is short, the Art long, opportunity fleeting, experiment treacherous, judgment difficult. The physician must be ready, not only to do his duty himself, but also to secure the co-operation of the patient, of the attendants, and of externals [emphasis added].

Wise words from across the millennia. Your thoughts – as always – are appreciated! 

[1] https://www.cbpp.org/research/federal-budget/where-do-our-federal-tax-dollars-go