Sympathy on the Death of Dr. Moti Lall

Hits: 3221 | Published Date: 14 Jun, 2012

| Speech delivered at: 22nd Sitting- Tenth Parliament

| Speech Delivered by : Dr. Leslie S. Ramsammy, MP

Minister of Agriculture [Dr. Ramsammy]: On January 10, 2012, I received the shocking news of the passing of a colleague and friend, Dr. Moti Lall. I knew that Dr. Moti Lall had a medical problem which he managed for years, but I also knew he managed his medical condition well and took great care of himself. I had spoken to him only a few days before and he was his usual self, regaling me with suggestions about the tuberculosis programme. There was no inkling that he was unwell and so, when I heard the news, I was therefore very shocked. On that day I lost a friend and I lost a comrade, as did many of us.
We always, no matter what, started our conversation by finding out about each other’s health. We shared the same medical condition, but he somehow treated me as if I have a worst problem than he did. He was always calling me to make sure I was taking good care of myself. But we bonded not because of that, we bonded because both of us had a passion for public health. Our last conversation indeed was about his passion to control and the elimination of tuberculosis as a public health problem in Guyana and around the world. I kept reminding him that I was not the Minister of Health anymore, and that I was the Minister of Agriculture, but he kept reminding me of the work we did together here and around the world to bring better management and better understanding of tuberculosis.
As I join you, my colleagues and my comrades, to pay tribute to Dr Moti Lall, we must not think that we are merely paying tribute to a former Member of Parliament. Indeed, he was a Member of Parliament from 1992 to 2001, but he made contributions that were not ordinary, and in some respects were extraordinary. We, therefore, today must understand that we pay tribute to a Guyanese brother, a Guyanese comrade, who, through his work and contributions, made our country better. At least, as I stand to make my contribution to this motion, paying tribute to a fallen comrade, I do so with the conviction that I pay tribute to a friend whose death truly made us realise that it is possible to make a difference in the lives of our families, in the lives of our communities and our country. We pay tribute today to such a gentleman who lived among us.
He served the health sector as a doctor, a public health professional and as an administrator. Indeed, today, two of the Caribbean’s leading professionals on tuberculosis control are the Chief Medical Officer of Guyana and the present Director of the tuberculosis programme in Guyana; they both benefited from the support and the teaching of Dr. Moti Lall. Dr. Moti Lall was, as you have heard, first registered by the Medical Board of Medical Practitioners in the early 1970s, after he returned home from studying in the German Democratic Republic. He graduated from the University of Rostock as a medical doctor in 1968 and he continued with postgraduate studies for a diploma in Pulmonary Medicine and tuberculosis control. On his return to Guyana he was immediately placed at the tuberculosis clinic. That was the assignment to the West Demerara Regional Hospital, that the Prime Minister mentioned, but it was then not the West Demerara Regional Hospital. It was actually the Best Sanatorium. He was appointed as the Principal Tuberculosis Officer in 1982. He held that position until 1997 when he retired.
Those were difficult days. There was virtually no project for tuberculosis control in Guyana in the 1980s. Guyana, as every other country in the region, had thought that tuberculosis was something of the past. While Guyana kept the tuberculosis clinic running, we virtually closed the tuberculosis programme. Other countries did the same. It was under those circumstances that a frustrated Dr. Moti Lall was trying to pursue his passion - control and elimination of tuberculosis. His frustration was not only that there was no resource for the fight against tuberculosis then, there was also the prevailing view that the tuberculosis problem no longer existed. Things improved somewhat in the 1990s as Guyana began to recognise the tuberculosis was a serious public health problem and that Human Immunodeficiency Virus (HIV) was a serious scourge that threatened our very existence, but the allocation of funds for the fight against tuberculosis remained woefully inadequate.
He later confided in me that he did not know at that time in the early 1970s, whilst he was in Germany, about Acquired Immune Deficiency Syndrome (AIDS). No one did. But once AIDS hit the world in the early 1980s many physicians and many public health officials began to realise that the signs of this new public health scourge were already visible in the early 1970s. They simply did not know then that the things they were dealing with in the 1970s came out of AIDS. He confided in me that as a young doctor, studying for his diploma in Germany, in the Pulmonary and Tuberculosis Department, they saw the re-emergence of tuberculosis, in Germany. They read about the re-emergence in other developed and developing countries, but the tuberculosis was coming with other illnesses, with other viral attacks, and they could not understand why the tuberculosis patients were having so many problems. No one was aware then that those cases in the 1970s were the first wave, the first manifestation, of a new syndrome that we would later call AIDS.
When he began his practice, therefore, in Guyana, it was a time that Guyana and the Caribbean took a stance that tuberculosis was licked and that it was no longer a public health problem - no longer a public health concern. Guyana was not unique in virtually closing down the tuberculosis programme or in starving the programme of financial support. Other Caribbean countries did this, other countries in the world. It was a global norm. If anyone has read Laurie Garrett’s The Coming Plague: Newly Emerging Diseases in a World Out of Balance, one would have seen that throughout Canada and the United States of America that they were closing down the tuberculosis clinics. Guyana was not unique. Guyana was simply doing what other countries did. It was in those circumstances that a young doctor, who thought that his country and the world was going down the wrong path, had to develop his own career.
He once took me to the West Demerara Regional Hospital - I did not understand why he was taking me at the back of the hospital - and he showed me something that I did not know. I did not know that there were graves at the back of the hospital. Those were graves of our sisters and brothers, our grandparents, or our parents in some cases. There were graves of people who were sent in the 1950s and 1960s to the Best Sanatorium. People who had tuberculosis were sent without any family member because everyone understood that that was the death sentence. You went and you never came back. In those early days there were no medications. It was to simply send people there to die. This was a crucible in which Dr. Moti Lall had to begin his career. I relate this story because by the 1970s, in fact, medicines became available – that was when he was starting his career - and made tuberculosis a treatable disease and that people could be cured, but it was also a time when the tuberculosis programme was closing down. He begged for the authorities in Guyana and the Caribbean to recognise that the apparent elimination of tuberculosis in our countries was merely a quiet period and that he saw evidence in Europe during his training of the re-emergence of tuberculosis in a manner that could decimate our population. But no one listened in the 1970s.
There was another case of uncaring bosses and authorities. The professionals, as Dr. Moti Lall, knew something was happening and that tuberculosis was on the rise. What they did not know was that AIDS had emerged and was driving the tuberculosis re-emergence. It was that period when, as a professional, you knew something was wrong but you could not explain. When he became the Principal Tuberculosis Officer in Guyana, in 1982, he thought he had a chance to change Guyana’s approach, at least, to tuberculosis. He told me that he could not even get that chance to discuss his views about tuberculosis with his bosses then. They snickered and said he was like, in his words a “Don Quixote, swatting at imaginary enemies”. Indeed, the authorities were so convinced that tuberculosis was a public health problem from a previous era that they ended the life of the Best Sanatorium which was converted to the West Demerara Regional Hospital in 1986.
Dr. Moti Lall commended the move to establish the West Demerara Regional Hospital, as he firmly believed that the hospital would improve the equity of access to health care. He was strong in his support for the move to establish the West Demerara Regional Hospital, but, as the Principal Tuberculosis Officer, he rejected the idea of closing the Best Sanatorium. He often expressed to me the biggest mistake we make in public health. He thought that it was a mistake then and he thought it was a mistake we are making today, whether in Guyana or anywhere else, that because tuberculosis had become treatable – because we have the medicine to treat tuberculosis that is curable - it was still a mistake to discard the sanatorium concept. Later on the global front, I fought almost as a single voice for assistance for developing countries, as ours, to be supported in our efforts to maintain small size sanatorium.
This motion was consistently and continuously rejected by the major health organisations and public health professionals throughout the 1990s and up until 2006. But it was Dr. Moti Lall who had persuaded me and who was my strength in including the strategic imperative throughout those years. He would have always reminded me that it was a strategic imperative we must fight for.
The truth is that we have the tools today to control tuberculosis, but, even as we do, we see the emergence of Multidrug-Resistance Tuberculosis (MDRTB) and Extensively Drug-Resistance Tuberculosis (XDRTB). People with these conditions will have to be subjected to restrictions in the movements and a quarantine option must be available to public health. In those days, when Dr. Moti Lall made those arguments, he was treated as an anachronism by many international experts. People said to me that I was allowing myself to be clouded by my friendship with Dr. Moti Lall, as I took this message on our mission to have better control programmes for tuberculosis. He lived, indeed, to see that the international organisations and the public health experts realised that if we are to succeed we will need better diagnostic programmes, better medicines and we will continue to need facilities to restrict people’s movement and to quarantine in some cases. This was highlighted early in 2011 when an American took a flight and exposed thousands to the deadly XDR strain of tuberculosis.
By the late 1980s everyone knew of AIDS and everyone knew tuberculosis had returned with a vengeance through the vehicle of AIDS. One of the early practitioners of AIDS management in Guyana was Dr. Moti Lall. When he retired, he said to me, as we sat quietly in the chest clinic, that he came back to Guyana and joined the programme, the tuberculosis programme, when there was no medicine to treat patients with tuberculosis. Then in 1997, when he was retiring as a public health professional, he was retiring as part of fighting a disease for which we in Guyana still had little access to medicine. That was his regret in 1997. As he prepared to retire, he pulled me aside, in fact, and smiled and said to me - now that we have money in help, now that we have the international community mobilised - that he wished he was young again.
But he continued after his retirement to serve. I do need to mention one thing, which was briefly mentioned, that he was the President of the Guyana Chest Society. This society was established in 1903 and formerly registered as a friendly society in 1919. It became dormant for a period several persons, Dr. Moti Lall and Dr. Johnson, got together and resuscitated it. It took on a role as the leaded advocate for tuberculosis control in Guyana and it became the leaded advocate for the control of tobacco used in our country. It stands today as a leading Non-Governmental Organization (NGO) in promoting public health programmes to fight lung diseases. Tuberculosis remains as one of its primary interest, but it has also become the leading NGO in the Caribbean, fighting against tobacco.
As a Guyanese citizen, Mr. Speaker and colleagues, Dr. Moti Lall played many roles in his country. They were properly articulated by my colleagues before me, and I am sure after. Clearly, his death grieved many of us and, indeed, we have a right to feel diminished. But when we look at the tuberculosis programme in Guyana, when we look at the HIV programme in Guyana, when we look at the housing programme in Guyana, when we look at our Parliament, he answered the call and his death finds us not diminished as we carry on from strength to strength. Clearly, he had given us much to celebrate and he stood tall as a boy from an ordinary family, from an ordinary community, who rose to make his mark in Guyana and around the world. I join in saluting Dr. Moti Lall, my friend and my comrade.
Thank you. [Applause]