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<p class="MsoNormal" style="text-align:center;margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif" align="center"><b>David Sanders,
pioneer of Health for All – as remembered by David Werner<span></span></b></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">When David Sanders died suddenly of a heart attack on August
30, 2019, it was a great loss. But his many friends and colleagues around the
world can take heart that his passing did not leave a vacuum. To the contrary,
David left a legion of fellow travelers around the world who, thanks to him,
are today more strongly committed, better prepared, and have a greater sense of
solidarity to continue the uphill struggle for health. After his passing, the
huge outpouring of appreciation for his exemplary contribution worldwide makes
it clear that his contagious spirit, boundless energy, and unflinching honesty
in the face of power lives on in the vast spectrum of people – from community
health workers to international movement organizers – who had the good fortune
to know him. <span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">Indeed, so many fine tributes have already been circulated
in praise of David Sanders that it seems there is little more to add. Therefore
I will focus on my own personal interaction with him,<span> </span>which began over 40 years ago.<span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">I first met David in the late 1970s in London, where he was
working for Oxfam. At that time David was in exile from his homeland in
Rhodesia, where he’d been a strong proponent for that country’s independence
from Great Britain’s colonial rule. As a pediatrician in that land, David had
an early exposure to the devastating impact that entrenched inequalities of
power had on the wellness of the subservient population. Thus, in the pursuit
of health and social justice, he’d become an avid activist in the grassroots
movement for Rhodesia’s independence. Faced with threats to his life, he went
into exile to the UK, where he continued his advocacy for Rhodesia’s
independence.<span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">On one of my trips to London during that time, to present a
paper on “Health Care and Human Dignity”, David Sanders invited me to his
circle at Oxfam. He’d used my books <i>Where There Is No Doctor </i>and <i>Helping
Heath Workers Learn</i><i><span style="font-size:10pt"> </span></i>in his community heath promotion in Rhodesia, and in our
Hesperian newsletters he’d read about Project Piaxtla, the villager-run health
program in western Mexico I’d helped start. He told me of his goal, once
Rhodesia was liberated, of helping the newly independent country set up a
national health program based on Comprehensive Primary Health Care, in which
local community health workers – chosen for their commitment to the common good
– would be agents of change in the promotion of a more equitable, just, and
thereby healthier society. <span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">No sooner did Rhodesia – now Zimbabwe – in May 1990, win its
independence from the UK, than David Sanders at once returned to his homeland,
where he was recruited to play a key role in forming the new Ministry of
Health. <span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">In that early realm of independence, David Sanders invited
me to visit Zimbabwe, both to witness the new, people-centered mobilization
that was underway, and to share some of my experiences of community-based
health promotion in Mexico and elsewhere.<span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">Part of David’s motive in bringing me to Zimbabwe was for me
to give presentations and exchange observations with key honchos in the new
health ministry, some of whom were still wedded to the conventional model of
Western (i.e., colonial) medicine, with its hierarchical pecking order and its
focus on sickness rather than health. <span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">For a while David and his cohorts made a good progress with
the new, more holistic, community-centered initiative, along the lines heralded
in Alma Ata as “Primary Health Care”. The nation’s top decision makers – still
imbued with the revolutionary spirit of newly won independence, made space for
this more democratic, people-empowering approach to health care. But sadly, as
so often seems to happen in human history, those who had been heroes in the
fight for liberation, once they rose to power, gradually became oppressors
themselves. As wealth again began to concentrate at the top and the state became
more authoritarian, priorities shifted. The egalitarian, more empowering
community-based approach to health promotion advanced by Sanders and his
colleagues fell out of favor with the controlling class – especially with the
conventional medical establishment. His detractors began to hit below the belt,
lambasting David as a “white colonial” who was trying to impose second-class
services on what he viewed deep-down as second-class people. <span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">This was painful for David, who was deeply committed to
health and fair treatment for all. In time the barriers to advancing universal
primary health care in Zimbabwe became so great that David decided to move to
South Africa. At that time South Africa was still under apartheid rule, with a
huge gap in wealth and health between the white elite and the black majority.
But it was not without hope for change. There was a strong and growing
resistance led by the African National Congress (ANC) and others. Even the
medical establishment itself was divided. After the mainstream Medical
Association of South African (MASA) defended a doctor who had overseen the
torture of Steve Biku, an outspoken leader of the Black Consciousness Movement,
a portion of MASA’s members split off in protest. They then formed NAMDA
(National Medical and Dental Association), which took a united stand for racial
equality. NAMDA also introduced a network of community-based health care in
shantytowns, providing training and backup for local, relatively unschooled,
but socially committed health promoters. <span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">As part of the coordinated effort to promote international
awareness and solidarity in support the South African struggle against
apartheid, David Sanders and his colleague reached out to the global health
community. Among other actions, David arranged for NAMDA to invite me to visit
the mushrooming shantytowns outside Johannesburg and to engage in an
educational exchange with its field organizers. While there, we shared
experiences and methods for implementing CBHC (community-based health care) in
marginalized communities, and encouraging people to analyze the social and
physical determinants of health and to work together to improve their
situation.<span> </span><span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">This exchange – instigated in large part by David Sanders –
took place (I believe) in 1992. The growing anti-apartheid tide was then being
countered by a ruthless escalation of repression, curfews, and arrests of
activists. Many in the struggle grew discouraged. But David Sanders and other
leaders of NAMDA were confident that the racist regime was planting seeds of
its own demise. Its draconian clampdown on protest only triggered greater
resistance. … And sure enough, in an attempt by the ruling class to quell the
rising storm, Prime Minister F.W. de Klerk agreed to hold South Africa’s first
all-race, democratic election. In May 1994, Nelson Mandela – who had been freed
after 27 years in prison – became South Africa’s first president of the
nation’s post-apartheid era. <span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">Much of the more recent history of David Sanders’s
indefatigable role in promoting health-for-all and social justice – in South
Africa and worldwide –<span> </span>is well known to
his contemporary friends and colleagues. Many have given tribute to his
on-the-ground research and service-oriented training of students, which he
spearheaded for decades at the University of the Western Cape. I will therefore
focus here only a few more of my own undertakings with David, with which some
of his younger colleagues and admirers may be less than familiar.<span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">Everyone is aware of the seminal role that David Sanders has
played in the formation and ongoing pursuits of the People’s Health Movement
(PHM). But fewer may be familiar with his previous key role in the
International People’s Health Council (IPHC), which in many ways was the
precursor of the PHM.<span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">The International People’s Health Council was launched in<span> </span>Managua, Nicaragua, in December 1991, at the
closure of a small international symposium on <a name="__DdeLink__27655_123575017">“Health Care in Societies in Transition”</a>.
The symposium and the IPHC that grew out of it were conceived and organized by
several of the same pioneers in Primary Health Care who, nine years later, in
2000, would be instrumental in midwifing the first global People’s Health
Assembly (PHA) and the People’s Health Movement that grew out of it. These key
players in launching both the IPHC and the PHM included Zafrullah Chowdhury
(Bangladesh), Mira Shiva (India), David Sanders (South Africa), Maria Zuniga
(Nicaragua), and myself. The idea for the symposium had initially been
conceived several years before, during the Sandinistas’ heyday in Nicaragua,
when revolutionaries, backed by a diverse workforce of <i>brigadistas de salud </i>(community
health brigadiers), had overthrown the tyrannical Somoza government and set up
a people’s republic. In a few short years, the fledgling government – backed by
strong community involvement – had achieved spectacular improvements in health.
Inspired by this success story, our motley group of health activists decided to
hold the transitions seminar in Managua. We saw Nicaragua as a shining example
of a society in transition to achieving better health. Ironically, however, we
delayed too long in getting our symposium off the ground. In 1990, after years
of ceaseless attacks by the US-financed “Contras” and of infiltration by the
CIA, the weary population voted the Sandinistas out of power and voted in a
coalition government that was puppet to US imperial interests. Rapidly the
people-supportive agenda of the Sandinistas was rolled back, the gap between
the rich and poor grew wider, and the population’s health once again began to
deteriorate. Sadly, Nicaragua was not alone in this pattern. Similar reversals
in democratic process and in the health and welfare of the people were then
taking place in many countries, spurred by economic globalization with its
structural adjustment mandates and so-called “free trade” agreements. So our
transitions seminar, initially planned to learn from societies transitioning to
<i>better</i> health, ended up discussing transitions that were endangering and
worsening the health of societies. Our seminar’s challenge was to explore
possibilities for reversing this retrograde process. (All this is written about
in David Sanders and my book, <i>Questioning the Solution – </i>see below.) <span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">We felt our seminar’s analysis of the current social and
political determinants of health, and possible action for coping with them,
were important enough they should be recorded and shared. So Maria and I and
others put together a booklet of the proceedings, which we titled <i>Health
Care in Societies in Transition </i>(published by HealthWrights in English and
by CISAS in Spanish). We also thought the dialog we had begun should be
continued, with more health activists participating. Hence we launched the
IPHC, which grew in size and had subsequent international meetings. The most
notable of these events took place in Palestine and in South Africa – the
latter adroitly organized by David Sanders. <span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">After a few years the PHM – with a much larger cast of
players – took over and expanded the role of the role of the IPHC, whose
mission it continued. David Sander was a wise and dynamic spearhead of both.<span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">David Sanders wrote over 50 groundbreaking papers and
several books. His first book, <i>The Struggle for Health: Medicine and the
politics of underdevelopment, </i>published in 1985, was a bombshell. It likely
did more than any other publication to awaken the international health
community to the fact that a population’s health is determined more by the
distribution of power and resources than by health services per se.<b><span style="font-size:11pt"> </span></b><span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">Over the years David Sanders and I realized we shared
similar perspectives on health and social justice. In the mid-1990s we started
writing a book together, which we eventually titled <a name="__DdeLink__27705_123575017"><i>Questioning
the Solution</i></a><i>: The politics of
Primary Health Care and child survival. </i>I visited Cape Town and he visited
California to complete it. This book is lengthier than <i>The Struggle for
Health</i> and contains a lot of examples from Latin America (most extensively
Mexico, Nicaragua, and Cuba). As a case-study, the book explores in-depth the
worldwide promotion of ORS (oral rehydration solution) for treatment of
diarrhea. (For this reason, with tongue in cheek, David and I titled the volume
<a name="__DdeLink__27711_123575017"><i>Questioning
the Solution</i></a><i>. </i>The idea for
the title was David’s.)<i> </i>Undoubtedly,
the vast promotion of mass-produced packets of ORS has substantially lowered
child mortality from diarrhea. Yet, as <i>Questioning
the Solution</i> points out, other solutions – namely homemade cereal-based
drinks – may have saved even more children’s lives – and done so less
expensively, more quickly, and more effectively, with less dependence on a
distantly-produced commercial product that may not always be available. Yet the
economic leverage by Big Pharma on WHO and UNICEF to promote their
commercially-produced ORS packets (which rapidly became a multi-million dollar
business) stacked the deck in their favor. So it was that the less ideal but
more profit-generating option has been universally promoted, sidelining less
costly, more quickly available, and potentially more effective home solutions.
The consequences of this grand-slam marketeering may have cost millions of
children’s lives – and still does.<span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">David Sanders felt very strongly about this exploitation of
children’s health and the myriad other ways in which Big Pharma, Big Sugar, Big
Oil, Big Ag, Big Water, Big Media, and other corporate superpowers put profit
before people – and before sustainable life on the planet.<span></span></p>
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<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif">Sadly, our companion David Sanders is no longer with us in
person. But his struggle for “health for all” lives on in the minds and hands
of the countless friends and students and activists whose lives he so deeply
touched. We all owe it to David to indefatigably keep his action, his vision,
and his passion – and his wry sense of humor – alive.</p><p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:"Liberation Serif",serif"><br><span style="font-size:10pt;font-family:"Arial",sans-serif"> </span><span></span></p>
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