Prof. Dr. Rainer Sauerborn
Interview of January 8, 2008 with Dr. Birgit Teichmann
You are the Director of the Department for Tropical Hygiene and Public Health. One of your focal points is Burkina Faso. How can one imagine your work there?
Burkina Faso is a very poor country with a different cultural and historic background, but the major health and health care problem are similar to here. We are dealing with poor and not so poor people, access to health care services, good qualities from these services. One tries to understand what the health problem is, what ails the people and how health care services can deal with it. One of the things that emerged from that is that the aging process has reached this population, where we have always thought that the population is young and the aging process won’t catch up for the next 100 years. This was a wrong assumption, life expectancy rises and rises, there are more and more older people and there is a complete helplessness what can be done with these people from a health aspect and otherwise.
How do you view the life expectancy in the developing countries versus the West European countries, in which – according to James Vaupel – a girl born today has the chance to live 100 years.
Yes, this is correct, the life expectancy of the world is presently 67 years. One always thinks the world population is young, but even in the poorest countries with large health problems, life expectancy is already at 54 years. Main reason for this is of course the reduction of infant mortality. If you know how life expectancy is calculated, that means you add all death figures, so when someone dies very early, that has the effect that life expectancy suddenly drops drastically. Many people are amazed that in some countries people live to be 80 or 90 where there is a life expectancy of only 50, but the infant mortality falsifies the statistic predictions. The first step was to reduce infant mortality, this alone raised the life expectancy to 55-60 years, the rest is a general longer life span and we have reached this stage, even in Burkina. This is our challenge.
You are a member of the Network Aging Research since September 2007. How does aging proceed in developing countries?
On one hand, it is an advantage to live in developing countries, because there aging is dealt with respectfully and looked at more positive than here, where aging means deterioration and descent, and there in a way it is looked at in a way as a social rise. This view of course is a bit romantic, because there are problems as well. The traditional structures are breaking up more and more with the spread of cities and you will find old lonesome people there as well. The situation is bad for the elderly, with respect to health care. As far as the social security problems are concerned, the family is the only support in most of these countries. If this network breaks apart, which is the case in the cities, where children do not like to support the parents any longer, as it was with us 200 years ago. As far as health is concerned, they are dealt a bad deck of cards, because they are now getting many diseases like cancer, Alzheimer, mental diseases. Most of the cancer patients live in developing countries and not with us. As far as the age of the cancer patients is concerned, it is about equal all over the world and since the aging structure in the developing countries is younger, it is absolutely less per country, but if you add the population of all developing countries, it is numerically more. That means: There are more cancer patients and more people with diabetes in the developing countries. Unfortunately I have no numbers on Alzheimer patients. For these people health care is an immense challenge. Chronic diseases are difficult to treat because they depend on constant contact with the patient and laboratory tests. We can see this with AIDS. AIDS is a chronic disease, which necessitates continued medication and care. We have a EU project “health system challenges of the AIDS epidemic” where we look and see what that means for the countries when they care for a patient life long and fight the side effects. Medication is missing, there are resistances, money is missing, it is a night mare. The health care service is over extended with simple things like treatment of malaria. Treatment of malaria takes three days, one medicine which is known since 40 years and yet there are massive incorrect diagnosis and the wrong dosage. And now we have in addition cancer with much more side effects and diabetes, which needs a tight monitoring and now Alzheimer, where I don’t even want to think about it. There is a large community of aids research and aids foundations, but I have not seen a Foundation of Aging there. I don’t know of any research center “aging in developing countries”, the academic community and the political community is missing the train.
Are there any areas, where we could learn from developing countries? You have already mentioned the integration of the “old” in social life.
Yes, one is the social negation, it is always a pleasure to see how an older person is carried by a traditional system, respected and valued because he knows a lot. That is the way it is in an oral culture, what one has accumulated during his life time is a treasure. There is no internet around the corner, where the son can google and suddenly knows more than the father. Knowledge is personified and the judgement and the social ability for integration of the old is highly valued. We can learn a lot, culturally and from the appreciation. Then the kind of wisdom, not to undergo any heroic operations, to be able to die and sometimes the desire to die, this feeling I have completed my life circle. One old told me “why should I go through any heroic operation, I am happy to be 80 years old”. This absence of heroic actions to gain as many extra days as possible and the ability to accept fate calmly is something we can certainly learn from.
You work in Germany on tropical diseases and health economy in developing countries. I expect that you are often asked the question what is the benefit of your research for us. How do you answer this question?
There is a short and important answer, which is, think about it how many Germans travel there and if they are infected by malaria, then we have a problem. Then I ask my interview partner: When was the last time you were in Bali? Then they tell me a year ago and then I ask “did you visit the clinic?” The answer is “yes” and one has the basis, which is perfectly legitimate. This is service protection of an imported infectious disease. I believe we should recognize the protection as what it really is, namely that each health hazard, somewhere on this planet, has an effect on all of us. For instance, take the bird influenza. If in China the interaction between animals, open markets, where animals are sold, usage of land and wild birds doesn’t change, then this influenza will come to us. You know how AIDS came from Africa to us. There are no walls, the virus doesn’t need a passport and visa, life styles transfer from us to there and we are responsible for the destruction of many life styles there. Nutrition, Hamburgers in New Delhi, destroy the good and healthy Indian cooking. We have a common responsibility. We have exploited and flayed these countries and now it is our term to pay back. The last argument is not very popular in a public debate, but it is alright for me. Then there are the last groups of arguments, which say, the problems are global. There is the prime minister of Australia with the one from China, next to the one from Burkina and the one from the USA, the minister from Germany, Mr. Gabriel, and they all debate how to save this planet and yet consider the interest of each member. And there it is important to know which health impact this has and this is my latest hobby, to figure out the connection. The old, the children and the poor are the victims of the climate change, as far as health is concerned. Because of the evident mutual concern on this planet, I can convince others through conversation quite quickly and I hope this is the same with you. It just does not make sense to say, I do advanced medicine, ionic therapy and let the others take care of themselves.
What do you expect from the cooperation with the Network Aging Research with regard to your work?
Honestly, I have to say, I am no researcher for aging. I am a paediatrician and start at the other end of life. I have never worked on this topic, researched or published. I am, if you want, exotic in these circles, but I had a good view into the disease burden, in the epidemiological situation and I realize the infrastructure problems and the possibilities and limitations. I know from colleagues, who were in third world countries, and who research the aging process, that there are enormous possibilities and challenges and I see an excellent network of outstanding doctors, scientists and molecular biologists and public health people, who are engaged in this subject. I hope that we can connect and integrate these two things and produce an added value that we could not produce alone, namely to establish a certain global dimension in our network. The problems are the same and an Alzheimer patient looks the same in Ouagadougou as in Heidelberg. There are simple cancer treatment patterns, which also function in the third world and in order to facilitate this, a junior group, who would focus on this subject, would be extremely important. I cannot do it myself, the young researchers can do this better and for that I would like to utilize the excellent scientific environment in Heidelberg.
Rainer Sauerborn was born in 1952 in Waldniel/Niederrhein. He graduated as pediatrician from the Universities of Bonn, Heidelberg and London. Afterwards he spent time at Harvard School of Public Health in Boston. Since 1997 he is Director of the Department of Tropical Hygiene and Public Health at the University Clinic of Heidelberg. His passion for Burkina Faso developed already in 1979, when he, as a draft resister, spent three years in Nouna as the District Medical Officer. Since then, trips to Burkina Faso are like a red threat in his life, in the meantime with numerous research projects.
Rainer Sauerborn is married, has four children and lives in Heidelberg and enjoys experimenting with recipes from foreign.