Author: Azim Jiwani.
Publ: FriesenPress, Victoria, BC, Canada, 2021.
Dr Azim Jiwani’s book was a surprise gift from a dear friend. This unexpected gesture obligated me to read it, which I did with much gratitude, and it even inspired me to write this review. The author’s work is a ‘pandemic baby’ born during the extended lockdown. This Kenya-born Makerere University Medical School graduate acquired wide higher medical education in the UK, USA and Canada. He established a thriving private medical practice in Calgary, Canada, enjoying affiliations with local universities and hospitals.
Dr Jiwani’s keen observations, boundless curiosity and breadth of interests give his memoir a multidisciplinary flavour.
The reader savours anthropology, architecture, civilizational history, geography, natural sciences, moral philosophy and global travel. I might add that the author carries some genes of a novelist and a travel guide.
The synopsis of this book reveals the author’s most earnest and pressing concerns, which he champions even after his partial retirement: ‘Rarely in recent times has the world found itself gripped in conditions that pose a substantial existential threat to lifeforms on earth, destabilize societies, impact health, quality of life, economic and cultural survival, and engender greater inequality and division between and within countries and regions.’ Moreover, Dr Jiwani continues: ‘The recent onset of the Covid-19 global pandemic and the accelerating but belatedly acknowledged climate crisis, and its devastating effects on human health, have laid bare the historical, political and policy and institutional deficiencies in health systems worldwide.’
Dr Jiwani’s impetus and inspiration initially stemmed from his concerns about the global arms race and its health, social and economic consequences, especially in developing countries. These apprehensions serendipitously led to a life-changing meeting with Prince Sadruddin Aga Khan, a former UN High Commissioner for Refugees, at the Prince’s chateau in Geneva in 1983. This meeting galvanized the author to further Prince Sadruddin’s efforts to foster a more just, humane and equitable world. Coincidentally, and again serendipitously, in 1985, the author found an exceptional umbrella organization to join – the Aga Khan University (AKU), an apex institution of the Aga Khan Development Network (AKDN), which he describes at an enlightening length. ‘The Aga Khan University and the Aga Khan Health Services participate in the empowerment of civil society – integral to AKDN’s mission to anticipate, and respond to, foreseeable effects of unaddressed inequities, poverty, programs and leadership deficits in some of the most challenging regions of the developing world. AKDN also endeavours to enhance local institutional capacities and leadership, establish collaborative networks and promote best practices and international standards of excellence.’
The book cogently underscores human health’s numerous determinants, foundations, ideals, realities and moral and ethical imperatives. It covers a sweeping arc of history, policy, environmental and economic factors that resulted in the vast disparities between the development trajectories of the industrialized North and the low-income countries of the developing Global South – particularly in several countries of sub-Saharan Africa (notably the east Africa region) and the Indian subcontinent, where AKDN has had a long and an enduring presence, and in more recent decades in Central Asia. With the AKDN at the heart of the development process in many of these regions and its aim being to provide the much-needed human resources, particularly in health care, this book gives insight into how a commitment to the critical vectors of development is an ongoing process and not an episodic encounter. The AKDN which oversees this process, has been committed to practical action which it undertook before the political independence of the East African countries and has continued since. The local graduates and civil society leaders that the AKU produces today in the many countries where the AKU is operating will find this book of great value in understanding the ethical principles that underpin the AKDN’s global vision and which continue to be its informing ethos.
Later chapters of the book vividly relate Dr Jiwani’s multiple roles and experiences as physician, academic, administrator and AKDN representative at various conferences. Dr Jiwani was often part of, or led, AKU teams involved in negotiating and finding common ground with private and public hospitals and universities and the local and national governments in parts of Asia and Africa to implement some of AKDN’s somewhat seemingly revolutionary medical missions. These endeavours included strengthening institutional capacity to provide quality, ethical, cost-effective and contextual health care, especially for marginalized populations. Dr Jiwani strenuously promoted continuing education of physicians widely to make medical education relevant and scientific. He convinced specialists in lucrative private practices to incorporate practical primary care approaches for better patient and population outcomes. He also led the development of advanced formal training in family and community medicine regionally and fostered on behalf of the AKU comprehensive local, regional, and international partnerships in medical education.
Despite Dr Jiwani’s demanding duties and schedules, he and his wife, Nilufa, could squeeze in travels to many exotic places. For example, in Cambodia and Morocco, their tour guides requested Dr Jiwani to examine and guide on the medical problems of their very sick family members, which he readily did. They got paid in the local ‘currency’ – hospitality, home-cooked food, and prayers and blessings for the couple’s well-being!
After more than three decades of enriching global engagement with AKDN and other national and international institutions, Dr Jiwani settled in Vancouver, Canada. His reputation derived primarily from his affiliation with AKDN as a respected healthcare and medical education expert. His passion for uplifting the quality of critical primary and secondary care medicine had preceded him. Soon he was fielding requests to help manage understaffed health clinics in the Vancouver area, especially for the marginalized people facing complex medical, mental and drug addiction problems. He did this while still trying to establish his family medicine practice. Some of the most severe cases he noticed were in the First-Nations people, where his compassion, broad experience and cultural sensibilty were appreciated in an underdeveloped native health care system.
Interestingly, his past engagement with AKDN and clinical reputation brought some very lucrative offers. A former patient, a confidante of the Royal family of a fabulously wealthy oil rich principality, had identified him as the ideal candidate to head the newly-built hospital and serve as the royal family’s personal physician. Dr Jiwani and his wife were perturbed by the wealth gap which they observed between the privileged few and the neighbouring populations, which seemed plagued with poverty. They quickly left without meeting the prince. But the adventurous doctor accepted a less lucrative, occasional position as the onboard physician for a cruise line group! His longstanding interests in natural history, environment, marine medicine and diverse cultures were richly rewarded. Besides attending to all types of onboard routine and emergency cases, the couple were able to ‘sail on every river, sea, and ocean.’ And his readers can vividly and vicariously enjoy these and other adventures as they go through this highly readable and enjoyable book.
Dr Jiwani’s fascinating and instructive memoir raises critical questions about the historical, ethical and moral foundations of healthcare and development globally. He concludes with an insightful epilogue. He states that ‘while linked, the health care crisis and climate crisis are bell-weather metaphors for many other unresolved global questions impeding the quest for a just humanity and a sustainable future. These barriers to inclusive development include authoritarianism, mounting nationalism, corruption, human trafficking, forced and indentured labour, and poor human rights’. These are the daily headlines of a dystopic global order. Dr Jiwani reflects on the necessary conditions for equity, justice, access and quality and appeals for increased global cooperation in order to ensure greater equity in health in the current geopolitical divides.
The book is available in hardcover, softcover and digital formats. Notably, the author has committed all royalties to the Aga Khan Foundation to support patient care for the needy in parts of Asia and Africa. His memoir would likely appeal to healthcare and other professionals or avid general readers interested in international organizations, career advancement, or simply expanding their knowledge about the interdependent planet we inhabit.
As at March 2022 the book is on the Finalist list for the prestigious Chanticleer International Book Award (CIBA) in the investigative journalism and memoir division.