Caring for marginalised people : Appropriate external intervention is needed

British Medical Journal. 2000 April 22; 320(7242): 1144.

Editor—Medicine usually fails marginalised people, as Smith observed.1 But it is not just medicine that fails them. Every technology invented so far has failed them and will continue to do so. Information and communication technologies have exacerbated the divide between rich and poor nations and have also further marginalised those who are already marginalised within nations.2 Reverend Jesse Jackson has drawn attention to how these technologies have led to a deepening of the racial divide in the United States.3
In analysing papers published by medical researchers in India I found that much of the research carried out there has not been done in the areas in which it is most needed, such as respiratory diseases, diarrhoeal diseases, and ophthalmological disorders. A comparatively large amount of research is being carried out in the areas of cancer and cardiovascular diseases, although these are not significant causes of morbidity and mortality in India.4
The idea of paying special attention to “the poor and mean and lowly” has been emphasised throughout human history by noble souls like Jesus Christ and in recent times by Mahatma Gandhi and Mother Teresa. Yet it is something that is consistently forgotten by most of the rest of us.
Both human nature and technology need appropriate external intervention if they are to work in a manner that is beneficial to the mass of humanity. For Smith, the appropriate external intervention that can drive medicine in the right direction is found in “professional and political leadership, unceasing commitment from the top, a clear vision of what is needed, resources, and a strategic approach”; and the intervention that can correct human nature is for doctors to rediscover the religious underpinning of medicine “while operating in an increasingly secular world.” I could not agree with Smith more.
In support of his case, Smith quotes from Corinthians. Gandhi said: “Recall the face of the poorest and the weakest man whom you have seen and ask yourself if the steps you contemplate are going to be of any use to him. Will he gain anything by it? Will it restore to him control over his own life and destiny?”
1.Smith R. Medicine and the marginalised. BMJ. 1999;319:1589–1590. . (18-25 December.). [PubMed]
2.Arunachalam S. Information and knowledge in the age of electronic communication: a developing country perspective. J Information Sci. 1999;25:465–476.
3.Ladd D. Digital divide: high tech as the new civil rights battleground. Village Voice 1999 July 21-27. (Available at:
4.Arunachalam S. How relevant is medical research done in India? Curr Sci. 1997;72:912–922.

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