In the midst of the enveloping skepticism, the National Assembly members opted for N110 billion palliatives to themselves composed of the allocation of N70 billion for disbursement to 306 newly elected colleagues, in addition to N40 billion set aside for the purchase of Sports Utility Vehicles (SUVs) and bulletproof cars for principal officials and members
REMI MEDUPIN
Point of Takeoff: Clarification on a Connection and Distinction
A widely shared understanding is that philanthropy means generosity in all its forms and is often defined as giving gifts of time, talent and treasure to help make life better for other people. You can practice philanthropy by making a monetary gift, such as a donation to a cause you believe in. Broadly, therefore, it represents altruistic concern for human welfare and advancement, usually manifested by donations of money, property, or work to needy persons, by endowment of institutions of learning and hospitals, and by generosity to other socially useful purposes. People have wondered what connection exists between philanthropy and charity.
As an analyst explains it, philanthropy is more long-term and strategic and often involves making multiple gifts to help people over a number of years, it is focused on helping people and solving their problems over the long-term. Charity, on the other hand, is focused on providing immediate relief to people and is often driven by emotions.
As to responsibility, this refers to having a duty to deal with something or of having control over someone. In general management parlance, "a true leader takes responsibility for their team and helps them achieve goals". A responsibility is something you are expected to do; being responsible: doing the things you are supposed to do and accepting responsibility, that is, taking the praise or the blame for something you have done. From all these, one can see that there are a few different ways we can talk about responsibility, such as: being responsible, taking responsibility, acting responsibly, and having responsibilities. In simple words, responsibility is about doing the things we are supposed to do, and accepting the positive or negative outcomes of our actions. In the illustration of Cambridge University Dictionary, having responsibility is to be in a position of authority over someone and to have a duty to make certain that particular things are done. A responsibility might be a way you are expected to act; thus, responsibility means being dependable, making good choices, and taking accountability for your actions.
From the private to the public domain
Most definitions and illustrations of responsibility are at the individual, that is, personal or at best corporate, that is organizational levels, rarely making reference to government, which constitutes our focus here. So I think the appropriate primary point of reference should be a country’s constitution. For example, the Nigerian 1999 Constitution (as amended) specifically Chapter II headed as Fundamental Objectives and Directive Principles of State Policy has the following provisions of relevance to our theme: Section 16 (1) stipulates that: The State shall, within the context of the ideals and objectives for which provisions are made in this Constitution, do the following: (a) harness the resources of the nation and promote national prosperity and an efficient, a dynamic and self-reliant economy; and (b) control the national economy in such manner as to secure the maximum welfare, freedom and happiness of every citizen on the basis of social justice and equality of status and opportunity. Furthermore, it is stipulated in Section 16 (2)that: The State shall direct its policy towards ensuring: (a) the promotion of a planned and balanced economic development; (b) the material resources of the nation are harnessed and distributed as best as possible to serve the common good; (c) the economic system is not operated in such a manner as to permit the concentration of wealth or the means of production and exchange in the hands of few individuals or of a group; and (d) suitable and adequate shelter, suitable and adequate food, reasonable national minimum living wage, old age care and pensions, and unemployment, sick benefits and welfare of the disabled are provided for all citizens. Finally, for our purpose here, 17 (1) declares that the State social order is founded on ideals of Freedom, Equality and Justice and in (2) that in furtherance of the social order-(c) governmental actions shall be humane; and in (3) provides that the State shall direct its policy towards ensuring in (g) that provision is made for public assistance in deserving cases or other conditions of need.
We can therefore see how the organic law of Nigeria has saddled the government with defined responsibilities to the citizenry which in our circumstance covers the issue of palliatives. Not surprising, both in policy declaration and in practice, dispensation of palliatives is undertaken in various economies although the contents differ. Without losing focus, it’s not out of place to peep into how the notion of palliatives is interpreted and applied in a few selected climes, opening with the origins and essence of the palliative concept.
Conception and Stories of Palliatives
In the chapter contribution to a presumably larger and joint work, Nnadi Daniel Chukwunyere has “Palliative Care: The Nigerian Perspective”, where the author went on memory lane, recalling how the word “palliative” in Latin means “caring”, which refers to the total care of patients whose conditions do not respond to curative treatment. In essence, therefore, a palliative is designed to relieve suffering and improve the quality of life for both patients and families throughout an illness experience, not just at the end of life. He highlighted the fact that sometimes, palliative care and hospice care are confused, due to the fact that they have similar goals. However, hospice care is specifically for terminally ill patients while palliative care is more general and offered to patients whose conditions are not necessarily terminal. In effect, palliative care begins when illness is diagnosed and continues regardless of whether the patient receives treatment directed at the disease.
In May 2016, the Australian government published a document, “Australian Government Response to the Senate Community Affairs References Committee Report: Palliative Care in Australia”, the second paragraph of its introduction reads: “The Australian Government recognises the importance of helping people who are terminally ill access the best care and support available to maintain their dignity and quality of life” and it makes reference to the existence of a National Palliative Care Project as well as a Palliative Approach Toolkit (PA Toolkit). In reaction to a committee’s recommendation, the document states that: The Australian Government notes that state and territory governments operate palliative care services, a form of sub-acute care, as part of their health and community service provision responsibilities (emphasis added by me).
The Government of Canada has an official document, Framework on Palliative Care which, among other clarification and specifications shows that: The term "palliative care" emerged in Canada in the mid-1970s, initially as a medical specialty serving primarily cancer patients in hospitals. However, since then, the scope of palliative care has expanded to include all people living with life-limiting illness. With an aging population, demand for palliative care, delivered by a range of providers, has grown. Palliative care is an approach that aims to reduce suffering and improve the quality of life for people who are living with life-limiting illness through the provision of: a) pain and symptom management; b) psychological, social, emotional, spiritual, and practical support; and c) support for caregivers during the illness and after the death of the person they are caring for. The national framework gave birth to Ontario Provincial Framework for Palliative Care from where we learn that, “with the passage of the Compassionate Care Act, 2020, the Ontario government is continuing to improve access to high-quality palliative care for individuals and families across the province”. Instructively, the guiding document contains the following entry:
In many ways, palliative care (which includes end-of-life care) exemplifies care that is centred on people. It focuses on improving the quality of each individual’s life, provides integrated and holistic care for individuals, their families and caregivers and ensures that they have access to the supports they need when facing illness, death, grief, and bereavement. It also helps to highlight how death, dying, grief, and bereavement are all part of life and how everyone can benefit from advance conversations about planning and goals of care.
On November 21, 2017, Anooja Chacko, Asst. Professor, Department of Economics, Zamorin’s Guruvayurappan College, Calicut-14 published a document, titled: “Palliative Care Movement in Kerala: A Historic Overview”, with focus on the southern state of India, a country that boasts of 922 palliative centres. As an explanatory note, the publication points to the fact that similar to the country’s literacy programme in education sector, health sector also affords another vibrant programme termed ‘palliative care movement’. It also recalls how, in the advanced countries, palliative care system is an integral component of the total health care, aiding a patient’s right to live with dignity and die in peace.
According to an anonymous correspondent on the topic, “Current awareness of palliative care in China”, shared on the platform of www.thelancet.com/lancetgh Vol 8 dated March 2020, palliative care was introduced in China with the establishment of a hospice care research centre in Tianjin municipality in 1988. Since then, palliative care has developed slowly in the country, with the Economist Intelligence Unit ranking it 71 of 80 countries on palliative care in 2015. With a population of approximately 1·4 billion, China had more than 150 million people aged 65 years or older in 2018, accounting for 10·9% of the total population who fall squarely within the bracket of potential of palliative beneficiaries.
In the UK, based on a 2015 study commissioned by Marie Curie to explore the evidence on equity in palliative care and to consider the economic implications of extending palliative care to those currently under-served, carried out by a team from the Personal Social Services Research Unit (PSSRU) at the London School of Economics and Political Science (LSE), a report was published, entitled: “Equity in the Provision of Palliative Care in the UK: Review of Evidence”. The report recalled that “palliative care aims to ensure the best possible quality of life for people in advanced illness and at end of life, and for their families, by actively managing pain and other symptoms and providing psychological, social and spiritual support”, noting with regret that despite steps to extend specialist palliative care, inequities in provision have persisted in the country. In specific terms, the study brought out the statistics of “an estimated 92,000 people a year in England, 6100 people a year in Wales, 3000 people a year in Northern Ireland and 10,600 people a year in Scotland who would benefit from palliative care but are not currently receiving it”.
In Moldova, in the year 2020, the parliament recognized palliative care as an essential health service to be included in its universal health care programme, when members of parliament unanimously passed amendments to its health care law. Now, there is the inclusion of the provision of palliative care as an element of the country’s overall public health strategy. Over the years, training and education programmes for doctors and nurses through basic and continuous education have become mandatory; the number of palliative care providers has grown; and essential medicines that assist with pain management have become available for both adults and children.
What comes across fairly clearly from all the above is variation in the contexts of palliative dispensation among countries even as there are unifying goals anchored to the essential principle of care. Maddison Gregor, writing on “Learn about palliative care worldwide” shared on Monday, December 3, 2018 through Palliative Care Australia website, palliative care is a discipline that is understood and performed in a number of different ways across the world. Each country utilises their own knowledge, resources and skills to provide quality palliative care for people with a life-limiting illness.
Palliative Contexts
In the publication on palliatives in the Kerala province of India referenced earlier, we are reminded how the World Health Organization in 2002 defined palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”. In other words, palliative care is aimed at improving quality of life, by employing what is called “active total care”, treating pain and other symptoms, at the same time offering social, emotional and spiritual support. In summary, the basic aims of the palliative care system are the following; (i) offering relief from pain through constant care and support (ii) enhancing the quality of life by making them as lively as possible and extend emotional as well as psychological support; (iii) relieving the patients from the fear of death and enable them to admit dying as a normal phenomenon; and (iii) extending support to the family to cope with the situation. In the contributory chapter cited earlier on palliative care in Nigeria, the author made a point which deserves to be noted especially for policy purposes and it is that “there is a gradual erosion of the hitherto extended family support and patients get isolated both at home and in the hospitals”-which underscores the increasing atomization of society in which the operating motto reads: everybody to him/herself.
It is clear from the foregoing that the context of the popularity of the palliative concept and application in Nigeria was not unique until recently; after all, what gave prominence to palliatives in the country was of course the pandemic of COVID-19. But now, however, there is the expanded notion of palliative well beyond care for the sick and the aged to embrace the general socio-economic life of the people, which carries a profound message in need of interrogation. The implied message is that the vast majority of Nigerians are literally on the sick bed, brought down by a failing if not totally failed system that bears numerous war heads in form of high youth unemployment, below-living wage rates, collapsing physical and social infrastructures and generalized insecurity. This helps to explain the topicality of the palliative paradigm. Incidentally, the COVID-19-induced palliative was inhumanly abused in diverse ways, including the hoarding of the allocated relief items later looted, as detailed in “Looting of Covid-19 Palliatives in Government's Warehouses in Nigeria: The Viewpoints of Christianity and Pragmatism”, being a January 2023 ResearchGate article by Oluwasegun Peter Aluko, Oyebanjo Adelaja Ajayi and Abimbola C. Ayegboyin respectively of Obafemi Awolowo University, Ajayi Crowther University and Bowen University. Of course, the COVID-19 palliatives were not limited to the direct distribution of food and cash, as other measures were rolled out for some targeted groups-such as: three months interest holidays for those holding Tradermoni, Marketmoni, and Farmermoni loans issued by the Bank of Industry, Bank of Agriculture, and the Nigeria Export and Import Bank. More conventional, and preceding the pandemic rush, there is the Center for Palliative Care Nigeria ((CPCN), located at the University College Hospital (UCH), Ibadan, which provides day care and outreach services for home-based care.
I consider it appropriate to enter a word or two as footnote to the looting of COVID-19 palliatives hinted at above as it touches on the moral tone of the society, an issue brought up by Onah Ozoemena Oliver of the University of Nigeria in the article, “A Critical Reflection On Covid-19 Palliative Saga in Nigeria: Implications of Human Greed”, published in September 2021 in which the author averred that:
The problem of greed among Nigerians, which is most manifest among the ruling class, has actually dealt ruthless blows to Nigeria again and again. It is the greed of the ruling class that has crippled Nigeria beyond salvation, as it were. This greed explains why a particular individual would embezzle money meant for projects that would benefit a whole mass of people; money which not even his fifth generation could finish. This manifestation of greed among the political elite seems to act as a trigger for the populace to grab whatever they could from wherever they could. This is how the innate greed in human beings has caused corruption to trickle down from the high and mighty to the masses. Each one seeks the opportunity to have a bite of the national cake by every means, fair or foul.
The scenario painted here concerning the bankruptcy of leadership spilling over to followership through the morally ruptured culture of shortsighted self-centredness has given birth to justified monstrous skepticism, the most critical and recent being the widely circulated argument of Professor Jibrin Ibrahim of the Campaign for Democracy and Development, on Arise TV early July 2023 to the effect that “subsidy palliative could end up as greatest robbery in Nigeria’s history (as) the palliative can easily become another fuel subsidy” Is the reader thinking through this incisive and provocative comment? In the midst of the enveloping skepticism, the National Assembly members opted for N110 billion palliatives to themselves composed of the allocation of N70 billion for disbursement to 306 newly elected colleagues, in addition to N40 billion set aside for the purchase of Sports Utility Vehicles (SUVs) and bulletproof cars for principal officials and members, a move roundly and promptly condemned by the human rights activist, Femi Falana (SAN).on the grounds of “callousness and insensitivity”, which are apart from the decisions being “a blatant contravention of Section 70 of the Constitution of the Federal Republic of Nigeria, 1999, which outlines the appropriate remuneration and allowances for members of the National Assembly”.
As the reader must have appreciated , by their very essence, palliates are designed to lessen pain, not to remove the cause of pain; it is to make the status quo tolerable and endurable without attention to preventing a reoccurrence given that the main roots of the tree producing the infectious fruit remain untouched. So, especially in the Nigerian situation, whoever desires a lasting, sustainable solution must look beyond palliatives targeted at symptoms, to the causes of the malaise for which palliative is being administered. On this logic, somebody once quipped elsewhere that, it’s the system, stupid. My point is that a government committed to impacting positively on the lives of the citizenry has to chart a path that leads into the heart of the system which reproduces results that routinely call for our kind of palliatives. As already demonstrated with Nigeria’s constitutional provisions, this alternative path is the responsibility of those at the helm of affairs to discharge. In effect, this entails a fundamental shift in paradigm, the creation of a new world.
Another World is Possible
If we recall, according to Collins Dictionary, “a palliative is a drug or medical treatment that relieves suffering without treating the cause of the suffering”. So, even within its originally intended application, the whole idea of government palliative is conceptually of limited value as it does not go to the root of the cause of the observed suffering or discomfort. This is precisely why the role of the government must be factored into this discussion. The message that the reader should reflect over here is the abiding fact that ultimately, in a class society-constituted by a few rich, connected minority and the many poor, but marginalized majority, the state or what we loosely call government is the instrument for the ruling class to oppress and hold down the masses, guaranteeing the status quo and the sanctity of private property. Although the modern state performs many other functions-such as the minor one of administering palliatives- these are secondary to the real basis for its existence and function: the protection of a set of property relations.
Nothing in all the foregoing should lead to the conclusion of an opposition to government palliatives-far from it, just that two points should be borne in mind: one is that it is the responsibility of government-going for example by the constitution of Nigeria as cited earlier, to facilitate the welfare of citizens; and two, it is the citizens of a national space who directly or indirectly constitute the ownership of any palliatives; so, government palliatives do not qualify as philanthropy. More important is the question: who needs palliatives? This is where the priority given by government to public welfare registers its relevance and as basis for assessing the orientation of any government in power. This reminds me of the famous statement made by the late radical Burkinabe leader, Thomas Sankara, who, pointing to a model of how a better world can be created declared unambiguously, that: “We must choose either champagne for a few or safe drinking water for all”. Long live the legendary, fiery Pan-Africanist. I come in peace, please.
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