What are we so proud of?

Dear Editor,

But for a few more days and it will be fifty years since Guyana became an independent country. Fifty years away from colonialism, but are we better off in terms of freedom, security and prosperity? Are we a more prosperous country and have the rising economic ripples – not tide as I demonstrated in a previous letter – lifted all boats in a relatively fair and just manner? Do we live longer or has longevity increased while healthy life-years have stagnated or even declined? Did independence merely enable the capture of the surplus by home-bred colonialists instead of foreign ones?  Exactly what are we so proud of – or are we proud at all?

In terms of basic freedoms, we are certainly better off now than during colonialism, which was the mother of both slavery and indenture. We have our own constitution – never mind it is rigged and no political party seems genuinely interested in changing it – and there is greater freedom of movement, assembly and expression. Within limits, we can protest and question our government and its governance of the country; witness, for example, the discussion in both SN and KN about corruption. Press freedom has increased considerably and the three leading newspapers have a letter column that allows people to express their views.

Security has fared considerably less well.  Guyana has a high murder rate and serious crimes, including bandit-style robbery with guns, terrorize citizens. Rarely a week passes without one or more grave crimes that include murder and the criminal transfer of wealth. In an editorial, KN (May 15) captures the issue well: “… gunplay has petrified society and the citizens, including the elderly who are glued to their homes at night, terror-stricken. Although the police are inclined to have the people believe that crime has declined, the population is in panic mode. There is no end in sight to this scourge.” One wonders if the police force of today is more racially balanced and effective in protecting citizens than during colonial days.   So while we enjoy greater freedom, we still live in fear; fear of being shot, robbed and brutalized, sexually assaulted, discriminated against and marginalized, live lonely lives and die without dignity as the social fabric frays.  The poor treatment and gross eye-pass of females continue unabated from colonialism to now.

Education is free from primary to secondary level, and we have our own university, teachers’ training college and technical schools. Private schools are thriving and some offer a better quality of education (SVN, for example). Sadly, the best facilities – from education to health – are confined to Georgetown; inequality across regions is glaring, indefensible and immoral. The quality of education is poor. Guyana’s educational system delivers a competence set that markets do not need; the mismatch between what the market demands and what schools deliver is wide and growing. The absence of skills needed to develop the country is further aggravated by the brain-drain. Public health has improved vastly and health facilities exist across all regions – glaringly uneven, of course. The quality of public sector health services is low, especially in rural and interior areas. While there are occasional shortages of drugs at public facilities, it is perhaps fair to say that this is not a very serious issue.  The quality of drugs is, however, a serious issue.

Guyanese live longer today: life-expectancy at birth rose from 61.3 years at Independence to 66.4 years in 2014. Put more graphically, life expectancy lengthened by about 0.11 years or 41 days annually.  A child born today can expect to live 5.1 years longer than one born when Guyana became independent.  What a miserable performance in five decades!  Life expectancy at birth in our three neighbours in 2014 was 71.2 in Suriname, 74.2 in Venezuela, and 74.4 in Brazil. In Jamaica, it was 75.7; in Trinidad, 70.4 years; and 62.8 in Haiti. Between 1966 and 2014, longevity expanded by 9.3 years in Suriname; 11.7 years in Venezuela; 17.1 years in Brazil; 8.6 years in Jamaica; 5.8 years in Trinidad; and 17.3 years in Haiti. The increase ranged from 44 days annually in Trinidad to 131 days in Haiti.

Rising life expectancy roughly correlates with falling mortality by infectious diseases, especially for those under 5 years of age. Because children account for the largest portion of deaths in most developing countries, decreasing under-5 mortality is a most effective way to increasing life expectancy at birth. Factors contributing to this trend include rising per capita income, a decline in fertility, improved nutrition, better hygienic living conditions, investment in public health, including immunization and sanitation, but this is a worldwide phenomenon. Today Guyana is like a developed country: chronic non-communicable diseases (NCDs) are now the major causes of death.  NCDs accounted for 72 per cent of mortality in 2009.  The five top causes of death in that year (cerebrovascular diseases, ischemic heart diseases, neoplasms and diabetes) were all NCDs.  We have become fatter and unhealthier before becoming rich.  Because NCDs are more expensive to treat, they will exert an upward pressure on the health budget.

At Independence, 57.3 infants of every 1,000 live births died before reaching age 1; this figure dropped to 32 in 2015 or a contraction of 44 per cent. Guyana’s infant mortality rate (IMR) is higher than those of Trinidad, Suriname, Venezuela, Jamaica, and Brazil.   The IMR in Venezuela is the lowest of these countries (12.9); 2.5 times as many infants per 1,000 live births died in Guyana than in Venezuela.  Maternal mortality (MMR), having declined, it seems to be marching upward again. Stark contrast: IMR declining, MMR rising; so, too, is inequality across people and space.

Then there are neuropsychiatric disorders, more commonly known as mental illness or mental disorders. Guyana has the highest rate of suicide – an NCD ‒ in the world: a staggering 44.2 suicides per 100,000 people; the global average is 16 per 100,000. Most victims of suicide are young Indians. With fewer than 5 full-time psychiatrists, a shortage of social workers or psychologists and until recently, no operating crisis hotline, there are limited options for those seeking help.  Suicide accounted for about 27 per cent of all mortality by external causes from 2006 to 2008. It was the leading cause of death for people between 15-24 years, and the third leading cause of death among persons in the age-group 25-44 years. In his address to a 2009 conference, the then Minister of Health, Dr Leslie Ramsammy, said that mental health was “sidelined in the health sector here and regionally for years because of minimal investment and general neglect …” Madness as a health problem confronts political madness as neglect, ignorance and perhaps discrimination.

The prevalence of neuropsychiatric disorders in Latin American countries is 10-15 per cent of the population, with 3-5 per cent having severe chronic mental disorder.  Applying this estimate to Guyana (because data on mental disorders are unavailable), predicts that 75,000-112,500 Guyanese suffer this variety of illness.  Of these, about 22,500-37,500 would be expected to suffer from severe mental illness. “These projections,” say the WHO and MoH, “do not include the number of patients with epilepsy and mental retardation, which are not surveyed in typical psychiatric epidemiologic studies, but are included in the population serviced by mental health care services in Guyana.” It is the magnitude of the problem that prompted PAHO to write in its country cooperation strategy for Guyana, 2012-2015: “there is a national consensus that this [mental illness] represents a significant public health challenge …” Do conditions in Guyana – crime, violence, alcoholism, racism, glaring rural-urban inequalities, and discrimination – have a bearing on mental health?

Yours faithfully,

Ramesh Gampat

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