March 2015

Contents Related Letters

Re: “Brave New Cures,” by Esther M. Verheyen

Dr. Ivar Mendez is a neurosurgeon in Saskatoon who uses remote presence technology, what he calls a doctor-in-a-box, to see patients at a distance. It consists of a screen and attachments for clinical exams such as a stethoscope or a special camera for examining skin lesions. Using a cellphone connection, this tool allows him to effectively assess and diagnose patients from anywhere that has access to one of these devices. Such technology could easily allow a physician to set up a boutique practice, offering wealthy patients from any country in the world special access to his services from the comfort of their homes. Instead, he uses the doctor-in-the-box and a type of robot with similar capabilities to see patients in remote areas such as Labrador, Northern Saskatchewan and the Bolivian Andes.

Our health system is not generally designed upon equitable lines; more and better health services tend to be located in areas of greater wealth. Less access to health services combines with differences in income, education, employment, housing and food security, among other upstream determinants of health, to create deep inequities in health outcomes. New technologies in health can, and often do, exacerbate these health inequities, with facilities in more affluent communities often first in line to benefit from innovations. This doesn’t have to be the case, as evidenced by the work of Mendez and others who use technology to offer enhanced services where they are most needed. On a larger scale, this requires intentionality on the part of governments. How can regulations around the implementation of new technologies be designed to ensure universal access, or even preferred access for those with greater risks of illness such as people living with lower incomes, so that health inequities are decreased rather than deepened?

Ryan Meili, M.D.
Saskatoon, Saskatchewan

Re: “Of People, Pride and Potatoes,” by Arno Kopecky

I was pleased to discover Kopecky’s endorsement of the key messages in my book – Trojan Horse Aid. His identification of its oversights is also fair and to be expected. However, I cannot resist pointing to a few of Mr. Kopecky’s own errors.

First, his critique of my opting not to reside full-time in either of the villages misses my purposeful research design. The book was never intended as an ethnography of the Jalq’a, research that would have required Quechua fluency. Its ethnographic sketch serves as background for my ‘development anthropology’ of the relationship between indigenous farmers and the institutions they encountered. As a side note, I do question outsiders’ right to satisfy their research interests through full-time immersion.

Second, while I set out to write a more accessible account by including journal storytelling, it was never my intent to write a popular account of Jalq’a life and times, where academese like “juxtaposition” and “disjunction” would indeed be misplaced. Development colleagues who made it through the academese found important insights on the theory behind the incredible knowledge systems I discovered.

Finally, I had far more to say about Morales’ Bolivia than Kopecky suggests, as this excerpt reveals:

“…a nation “must be symbolized before it can be loved, imagined before it can be conceived”. Years of oppression breed self-doubt, a reluctance even to consider new possibility… However difficult the craft and art of governing will prove for the leaders within Bolivia’s Indigenous majority, they have created an ideal – a plurinational country and constitution – that offers long overdue possibility of a more inclusive and just future.”

Susan Walsh
Ottawa, Ontario

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