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Andrija ©tampar in COVID’S Aftermath of Time A global voice of yesteryear for tomorrow

Publication date: 07.04.2020
Author: Jeffrey Levett

Jeffrey Levett is a regular contributor to Wall Street International Magazine. Read his articles here.

Homer gave us the first ever description of an epidemic that swept through the Greek ranks outside of the Walls of Troy thought to be malarial fever and told us of the Trojan horse. Troy was destroyed towards the end of the Bronze Age and Great civilizations of the Aegean and Near East, unraveled and cataclysmically collapsed. Athens survived but in poverty. The Greek Dark Ages whose cause is still obscure, were underway. In the 6th century, Justinian ran into the Plague; one third of the inhabitants of Constantinople and one quarter of the total population within the Empire perished while half the population of Europe was affected. Outbreaks continued for more than 200 years. Europe’s population was significantly reduced as the Black Death killed 25 to 30 million people. it resulted in peasant uprisings brought Feudalism to an end and was a boon to the Ottomans’ encroachment on a weakened Europe. To protect the city from the Bubonic plague, Dubrovnik introduced Quarantine. In modern times the Spanish flue covered the globe killing 50million people. Its cause was also considered to be the work of German agents and the wide spread use of aspirin. Today, the COVID-19 pandemic is upending the world having registered more than 1m cases, killing 55 thousand people, exhausting and the surge capacity of what were efficient and effective health services and systems and putting the planet on lockdown. At that moment, we entered another life removed from time.

In antiquity, the Plague of Athens in its devastation precipitated the end of the Golden Age. It entered the city in wartime through the city's supply port, Piraeus, killing perhaps 100,000 people and giving rise to rejection of authority and the rule of law. In the aftermath, laws became stricter; non-citizens who claimed to be Athenian were severely punished. Athens was hard pressed on every side, crushed but not destroyed and despair was everywhere. Despair’s cause was war, never better expressed than by Aeschylus: pain so intense, not forgotten, even in sleep, falling from the heart, drop-by drop, until in our despair, against our will, Wisdom comes, through the terrible grace of God; The wisdom in Aeschylus is philosophy, which together with the golden mean provides a road to peace.

It was Martin Luther King who said injustice in health is the most shocking and the most inhumane form of inequality. Over his grave, after assassination, Robert Kennedy recited the words of Aeschylus. It was the eccentric Lord Byron who said never under the most despotic of infidel governments had he seen such squalid wretchedness and in the very heart of a Christian country as in the downtrodden of society in the working class parts of Nottingham, meagre with famine, sullen with despair. He defended English textile workers who destroyed machinery believing that their jobs were threatened (1811–16) while the British government quashed the uprisings by making machine-breaking punishable by death. It was just another case of pray and endure or rise up and rebel. Several decades later, Edwin Chadwick, noted for his leadership, reformed the Poor Laws in England and instituted major reforms in urban sanitation and public health. He understood the need of replacing earth closets and cesspools with water-closets, with adequate water drainage and sewers. Without such basic technology, sanitary conditions were much worse. It took another 100 years, the Boer wars in which the youth cannon fodder proved unhealthy precipitating the stumbling beginnings of the Welfare State and two World Wars before the National Health Service came about. Now we have World Toilet Day (29 November) and Global Handwashing Day (15 October) dedicated to raising awareness of hand-washing with soap in disease prevention and which checksrespiratory and intestinal diseases all of  vital importance to help break the spread of COVID-19. Obama gave America Obamacare and supported quarantine at the time of Ebola.   Vociferous always, Stampar fought quackery, condemned governments for being in the hands of gangsters and kidnappers and likened Balkan banditry to disease. He saw that endemic malaria killed one tenth of the population annually and transformed fertile land into cemeteries.

Earlier In 1828, four years after Byron’s death from malaria the wretched conditions of infectious disease during the War of Independence Count John Capodistria first attempted to organize public health after an epidemic of cholera. A century later and in a little different Greece, the Hellenic School of Public Health was founded, 1929. Its logo was the daughter of Asclepios, goddess of health. Its inscription on the original parchment read In the absence of health, life suffers. The School  kicked off a short-lived and politically driven public health revolution within what was dubbed, the four golden years permitting the health status of the Greek population to slowly climb; domestic life improved and by 1970 life expectancy gained 20 years and infant mortality dropped dramatically. The historical School inaugurated by Eleftherios Venizelos and rejuvenated by Constantine Karamanlis was  a landmark and should be remembered as a historical and social dividing line between a pitiful state of public health at a time when refugees overwhelmed Greece and dengue fever closed its borders and another modern Greece admitted to the league of advanced nations as a result of its health gains.  In 1974, Constantine Karamanlis having gained insights into public health while exiled in France made the revitalization of the Athens School a priority. He effectively raised the School from the ashes of the dictatorship. Today it does not bode well for the future that many countries today are not treating their Schools of Public Health with due respect but with lip service, that the European parliament…….

In the midst of world misery and as Italian health professionals desperately deal with an overload of coronavirus patients within a crumbling health system and its related deaths, most of them elderly with serious medical histories, Pope Francis delivered an inspiring extraordinary blessing, a dramatic solitary prayer urging the world to see the coronavirus pandemic as a test of solidarity, a reminder of our basic values and to realize that we are all in the same boat called upon to row together and to comfort each other. While his voice is a tremendous comfort and his urging that we must all pull together is necessary, unfortunately, the voice of the Pontiff is not sufficient to slow down the spread of the pandemic or add to the surge capacity of national health systems, exhausted in Italy and Spain, compromised in France, Germany, Greece and the UK. What course the Pope’s boat will take is yet unknown since the world has lost its compass, what weather it will weather is also unknown except that storms will be more frequent and worsen. Surely, it will run into icebergs, be swept over by tsunamis and battered by hurricanes. As the outbreak took off in Italy, the Greek authorities acted proactively but neither is the health sector or the country out of the woods. After the ongoing pandemic we have to ask what next for Europe and the world and where will the embattled international community be a year from now? Will public health preparedness prevail? Will the children’s crusade survive? Will our humanism be preserved?  COVID, SARS, MERS, Ebola are great teachers telling us, yelling at us that we need interdisciplinary public health, its competences and its ethical framework. the choice will be either more authoritarian, violent states or radical reconstruction of society with more humane conditions

Andrija Štampar, whose name was given to Zagreb SPH would in his uncertain English but universally convincing tone, say let’s have one seaworthy boat for public health and for the people. Ban Ki’ moon Secretary-General of the United Nations  who has reminded the world of many things relating to public health, human rights, philosophy and peace reminded us about Andrija Stamapar on a visit to the Andrija Stampar School of Public Health, Zagreb, 2012. He reminded us that development depends on public health, which starts with basic sanitation and hygiene practices. It was Stampar who introduced the Kentucky closet to Yugoslavia. The said toilet was used in the fight of endemic hookworm in the American South, which today infiltrates the feet of children. 

Some European Schools of Public Health were developed to support colonialism and became focal points for change in sanitation, their opposition to slavery and support for human rights. Their prestige abroad in hot colonial climates exceeded their cooler acceptance on the home soil.

From the past, prestigious voices rise from men and women of incredible significance, who never lost sight of the true life ahead, Florence nightingale. Florence Nightingale in the Crimea: “get the horses out of the drinking water,” she told the British brass.  Virchow, Chadwick and Andrija Štampar’s saying that we are not all in the same boat; there were three, that set out from Spain to discover a new world taking infection, two boats today one leaky from inequality, the other luxurious for the few and the one boat of yesterday named the Titanic that would never sink while on board the social gradient prevailed.

Andrija Štampar’s humanism and philosophy of life are found in the “the Magna Carta of Health” a preamble to the constitution of the WHO; his politics were the needs of people. His life’s mission was to improve the health and wellbeing of peasants and workers. He was of a rare breed, known for unimpeachable honesty and entrusted by international institutions with large sums of money for investment in public health. An expert on infection disease, one of his early initiatives was to stop the authorities from transferring army recruits from infected areas to healthy ones. Later he would see the World Health Organization (WHO) as “an instrument making it possible for people to solve truly global problems in a spirit of true international cooperation to make the world better place to live in and in every respect healthier.  Perhaps the greatest payable tribute is that he fulfilled the tasks set down for him by Batut  on his way into exile in China and remained ever faithful to his early values expressed in a youthful publication. As clouds gathered over Europe and the League of Nations was heading for disaster Andrija Štampar headed for China. It was after his politically motivated dismissal carried by the weight of a royal decree on a cause of incompetence, and protested by the Director of the Rockefeller Foundation. He had run afoul of the corrupted elite in Belgrade.

Andrija Štampar might easily have faded from the health scene but for his experience in China. Ludwik Rajchman (1881 – 1965) arranged his first mission to China, through the League of Nations and the Rockefeller Foundation remembering his own exile from Poland, (1906) a result of socialist activities. As a public health and medical adviser to Chiang Kai-shek, Stampar developed Rural Health and Rehabilitation Programs. He spent most of his time in predominantly agricultural areas of China, and noted that the gentry had a dual role of money lender and landlord. If a farmer defaulted on a loan he lost farm and freedom and became a tenant. It contributed to social unrest; uprisings, smuggling of narcotics and a lucrative field service for farmers to ensure their heroin injections, especially at harvest time. While he was chastised by the Chinese authorities as a meddling foreign devil he was praised and respected for his services in public health. The Chinese authorities turned a deaf ear when he told them that social problems cannot be solved by cannons and guns. With Rajchman he witnessed the health consequences of disastrous flooding, disease, poverty and horrendous inequality in China. Work there was interrupted as a result of Japanese protests over the League’s assistance to China.

He presided over the first World Health Assembly (1948) while during the 8th in Mexico (1955) he received the prestigious Bernard Leon Prize. In his closing remarks he said: “the few years of active life that I have left will be dedicated, as those of the past, to our common aim: to world health”. Mexico’s agenda was malaria eradication and the peaceful use of nuclear physics in medicine, is still extremely current.

Stamper was deeply troubled as to whether the work of public health  would ever pay off abroad in China or at home in Yugoslavia since it seemed unnecessary to decision makers fearful of having to give up some crumbs from their opulent table. He fully grasped the role of science as a social instrument to satisfy the needs of people and which would fail because of the shortcoming in social-economic systems and was deeply conscious that the bright vista surrounding the drafting of the WHO constitution, and the mood of optimistic confidence, was not without its coming darker shadows.

If after the overwhelming despair from this novel coronavirus the world decides to take the Aeschylian road to peace it means a global embrace of interdisciplinary public health, much better support for the world’s Schools of Public Health, and irrevocable recognition of science, for the World Health Organization and the international community. In other words preparation for what we know is coming but in the modified words on the readiness for death and endings of Hamlet if it be not now, tis yet to come; if tis yet to come, it be not now, yet it will come.

Let me end with an excerpt from the book of a friend when it  asked will the world ever be worthy of its children anddescribes the emotional appeal from the heart of two unnamed children from war torn Barundi and Sierra Leone to stop all wars this relating to the report A world fit for children which emphasizes the need for new models of education with information technology but culturally specific linked to peace and appropriate development. The very next moment a rogue plane hit the twin towers.

The ongoing global health crisis as tragic and despairing as it is will come and go. The growing existential threats facing humanity, nuclear mishap or war, global warming and surveillance artificial intelligence will be left in place. Without political support of public health, all can be lost! Then the impoverished and disenfranchised will never inherit even a small part of the earth. The well to do, affluent and super rich can all go down too!


References

MD Grmek. Serving the Cause of Public Heath. Selected works of Andrija Štampar, Zagreb, 1966 and published as the time of ASPHER’s birth in Zagreb.

Jeffrey Levett. Severe Acute Respiratory Syndrome (SARS): Loud Clang of the Leper’s Bell, 2003.

Jeffrey Levett. Disastrous Events and Political Failures. Prehosp Disaster Med. 2015;30(3):1 2.

Boudewijn Mohr. A destiny in the making: From Wall Street to UNICEF in Africa.

Jeffrey Levett. Hidden Devils, Lepers and Warning Bells, We have to put our faith in science, 16 February 2020

ASPHER,s response to Ebola

Athens ASPHER Accord

https://www.aspher.org/articles,4,67.html Ted Tulchinsky’s interaction with ASPHER’s position paper on COVID-19 

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