When a giant falls, dwarfs have no shadow

Abstract

It is said that in times of war old people bury young men. As we live in times of peace, and we are old, youngsters will need to bury us.

It is said that we become good people after we die. But some of us were good before dying. They were good, generous and honored, wise and tender, effectively human.

Some who passed away used to give us a cozy and protective shadow, and their absence leaves us unsheltered, alone with danger.

A long time ago, one of our children asked to us: “When an old wise man dies, where does his knowledge and experience go to?”. We were not quite sure about the answer.

“When this person has family and friends, they all learn from him. Thus, there will be a lot in their hearts and minds, and his/her kindness, culture, wisdom and accomplishments will be a part of memory, which will pass from generation to generation; it has been this way since the beginning of humanity. If this person diffused activities and work, whether written or illustrated, these will be his/her own words, and this person may be seen and revisited from time to time. Sometimes, words remain and we do not even know to whom they belong to, like Gilgamesh and his poem. Other times, authorship is neglected, even if we know who the author is, like Aristotle. And, other times, memory is alive and recent, like the work of Albert Einstein”.

At that time, we did not think about it – but we do now – when a giant dies, we are left without a shadow.

Barbara Starfield passed away, a giant in Primary Health Care (PHC), and her protective shadow abandoned us. She was a wise elderly woman, even though she looked young and looked like a student. Barbara Starfield had friends and family members who are capable of passing on her legacy of knowledge, kindness, culture, and wisdom, including many of her deeds and anecdotes.

Barbara Starfield also leaves multiple registers, articles, books and presentations, which will serve as a path for others to go further. She was good, even before her death. Now, it is time for tributes, compliments and epitaphs, praised obituaries, and the public memory, which mixes the fear of death that writes its own show, and the desire to forget the mistakes of those who are highly appraised. Now it is time for tributes to death and for the dead.

There was time for love, will, friendship, sharing, friendly respect; but many times, there was no time, and it is too late to go back and repair damages and mistakes.

“To infinity and beyond”, say the grandchildren to their grandparents, asking them to push the swings harder. Others will come, and within the years, decades, centuries and millenniums, time will fade the memories of a giant, whose shadow no longer protects the dwarves (and this is how we are).

Now we are aware of how small we were, exposed to the devastating environment of an arrogant Medicine, which despises everything it ignores, and it ignores almost everything.

Now, we are aware of the damage we caused, and that getting a visa was a constant inconvenient for Barbara Starfield in her trips to Brazil. It would have been more worthy, and easier, to name her a Brazilian honorary citizen!

We are aware of the damage we caused, and not little damage, when she was turned down at a doctoral examination board in Zaragoza (Spain) for not having a doctorate in medicine. It would have been more worthy, and easier, to name her doctor honoris causa!

Now we are aware of her little impact on public health policy in USA, her home. Neither there is a “prophet” in his own land, nor a giant that shadows his close neighbors. It would have been much easier to take her recommendation and establish a strong PHC in her country’s health system, the less developed among the developed ones.

Barbara Starfield was a leftist, always sensitive to the suffering of others and an activist against injustices. She met her future husband, who was also a medical student, in an act in favor of the Lincoln Brigade veterans, one of the international brigades that supported the Spanish Republic against the Nazi barbarism.

She graduated as a pediatrician, and was a real cosmopolitan. She started her research on the organization of health services with KL White, master and friend, the one from the “medical care ecology” or “it is better to be approximately right than precisely wrong”. This giant accompanied her to the USA, just as other unique giants accompanied her to the United Kingdom, such as John Fry and Julian Tudor Hart.

She had a positive critical attitude, pointed out the errors of a sanitary care based on experts, and showed its dangers (especially on her text about the medical practice as a preventable cause of death); with time, she developed an impressive theoretical foundation at the defense of PHC as the best response to excesses in Medicine and prevention. She knew how to analyze the excesses of a weak use of statistics, which was summarized in her article: “Internal elegance, external irrelevance”. She also knew how to compare countries, open paths, and respond to social and technological changes. She never forgot the impact of inequity on health.

Many say her name in vain. Many justify barbarian actions on behalf of Barbara Starfield. There are many who confuse PHC with a solution that is exclusive to the poor, low-quality, and based on vertical programs. It is terrifying to think of the manipulation of her ideas by the ones who need them.

It is no longer worth it to write things together to mark new paths, to claim for her work and her journey. Now, we have memories, the consolation of prayer in some synagogue, and the goal to follow the path that has been opened “to infinity and beyond”.