This summer, I have been volunteering in various capacities, but one in particular deserves a special mention.

Gathered at this government-subsidised housing complex are children of all ages, ranging from kindergarten to seventh grade. Most of the children are of African descent, many of whom are refugees from war zones. No, I’m not with Médecins Sans Frontières. No, I’m not in a developing country. I am somewhere in the Greater Vancouver Regional District, at an African children’s summer camp.

This camp is no CEDAR or GEERing UP. Situated within a low-income, disadvantaged area and inside the confines of a two-room apartment, which has been modified to suit the needs of the programme, up to 20 children laugh, cry, and play together with the support of two paid staff members.

A large bookshelf sits near the doorway with a wide collection of reading materials tightly placed together. Sitting at the very top of the shelf is a heavy book, one which catches my eye and brings back the nostalgia of high school. I recall using this a-thousand-some page textbook for Biology 11. Waking it from hibernation, I bring the book to two of my friends, who are beginning and nearly finishing their elementary school careers, respectively.

“Let me show you something cool. Do you want to learn about the brain?” I ask.

We flip to the chapter on the nervous system and I begin to tell them, in very simplified terms, about different parts and functions of the brain. They are intrigued by the drawings of neurons and the nervous system and would point at every single figure, followed by asking what it is. I tell them that the human brain is the most amazing, and my favourite, organ, that the back of the brain (occipital lobe) allows us to see, that the right side of the brain controls the left side of the body.

“There, now that you have learned all this knowledge, you are truly a scientist!” I tell them. Indeed, moments later, I overhear these budding scientists lecturing their friends on the brain.

According to Mark Twain, courage is “resistance to fear, mastery of fear – not absence of fear.”

According to article 21 of the World Medical Association (WMA) Declaration on Hunger Strikers:

Forcible feeding is never ethically acceptable. Even if intended to benefit, feeding accompanied by threats, coercion, force, or use of physical restraints is a form of inhuman and degrading treatment. Equally unacceptable is the forced feeding of some detainees in order to intimidate or coerce other hunger strikers to stop fasting.

I heard the bells on UBC’s clock tower singing in the distance for the first time at 4 PM yesterday, and again at 2 PM today. Twice in two days? Where have I been for the past two years? Did the bells just start ringing recently or have I been camping on other parts of campus too often? For a moment, I felt like I was in a small European town.

Speaking of Europe, which has a relatively better health care system, here’s another passage or two from Worst Case Bioethics:

As Franklin Roosevelt first noted in 1944, just before D-Day, denying healthcare denies equal opportunity and is an assault on human dignity. Concurrently, the language of social justice should be employed, especially by using stories of real Americans denied needed healthcare, to convince Americans — who probably don’t need much convincing — that it is simply unfair to deny uninsured and underinsured (and even many insured) Americans decent healthcare, as it is unfair to deny decent education to Americans who cannot afford it. Healthcare is a moral issue and denial of healthcare based on inability to pay is immoral.

Since we’re on the topic of morality, let’s talk about torture. Lawyers and physicians working for the United States government and military played essential roles in ensuring the torture of suspected insurgents. Physicians had (and still have) the “licence to torture” from the sanction of lawyers, while lawyers and law-makers made torture legal, despite the result of the Nuremberg trials and Geneva conventions, through the supposed “medical evaluations” of physicians.

Read the following statement from the former White House Counsel, Alberto Gonzales:

…the war against terrorism ushers in a new paradigm… Our Nation recognizes that this new paradigm — ushered in not by us, but by terrorists — requires new thinking in the law of war.

And compare it with Hitler’s policy:

The main theme [of Hitler's instructions] was that this was the decisive battle between two ideologies and that this fact made it impossible to use in this war methods as we soldiers knew them and which were considered to be the only correct ones under International Law. The war could not be carried on by these means. In this case completely different standards had to be applied. This was an entirely new kind of war, based on completely different arguments and principles.

At this conference the Fuhrer stated that… since the Russians were not signatories to The Hague Convention the treatment of their prisoners of war does not have to follow the Articles of the Convention.

What I am inspired by, though, is that such critical remarks and analyses can be freely discussed and even published in America and much of the Western world.

The American healthcare system is a mirror, reflecting the basic characteristics of America. To the extent this is true, it will take more than a new metaphor or a new frame to change our healthcare system. It will take a fundamental change in America itself, or at least in our perception of ourselves. George J. Annas, Worst Case Bioethics.

Some unsurprising results are published in the 2010 update of Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally: European countries lead the way with the best overall health care system performance but not with greatest amount of health expenditures per capita, while America protected the rear flank with the greatest expenditures and worst performance.

What I find surprising, however, is Canada’s performance. According to the report, Canada is second-last in overall rankings, followed closely by the United States. Furthermore, in a number of categories, such as effectiveness and timeliness of care, Canada comes in last place. On a positive note, Canada ranks second in having Long, Healthy, Productive Lives.

I was recently challenged to think about the factors that may contribute to America’s fractured health care system. My response — though brief and limited to 300 characters — is as follows (borrowed the second paragraph concept from Annas):

Among many factors that contribute to the discrepancy between America’s health expenditure per capita, quality of care, and quality of life, one which is of significance is the lack of collective will to address social inequities and guarantee health as a right.

Also, American health care is wasteful, technologically driven, individualistic, and death-denying. An better system would focus more on “upstream” factors such as the social determinants of health.

What about Canada? That’s a question worth thinking about.

Not long ago I became aware of the differences between health care reform and health system reform.

On a side note, I registered myself today as an organ donor. Can you imagine how many people die while waiting for organ transplants?

1. Love
2. Courage
3. Humility
4. Honesty
5. Generosity