Invest locally

  • 2011-02-16

Dear TBT,

This is a reaction to your recent article “Private clinics experience slight increase in patient numbers,” (TBT 738) which describes a contrast between medical services for foreign tourists and for the local population. I would like to evoke some potential political problems arising from this situation.

I visited Latvia in 2010, coming from France, where I live and work, in order to get dental services in a Riga clinic. I must say that I was impressed by the level of dental services. It seems that in Latvia the technical improvements worldwide are immediately studied and imported, which guarantees to visitors like me the best state-of-the-art treatment at any given time. In France the typical dentist is top-notch when fresh from the university, but after that it is up to him/her to upgrade regularly or… spend more time on windsurfing, golf or other leisure activities that higher income professions can afford.

I was also impressed by the clinic as a form of organization, compared to the typical French unit, which is an individual practice. Thanks to the clinic, I was immediately directed to the relevant and available specialists, and in one afternoon only I had all my amalgams renewed. In France it is debatable whether doctors are available for the patients, or the patients are available to maintain the standards of that very protected profession. The same work would have taken months, [with] my dentist arranging visits week after week, one tooth at a time, in order to accumulate income, and not work too much.

Last, I was impressed by the professional ethics. In Riga the chief dentist, after examining me, refused to place implants immediately, because he thought it was better to do some orthodontic correction of the existing teeth first. He could have made quick money by placing whatever implants and then send the French guy away. Well, he didn’t. Given the financial difficulties of Latvia, I found that admirable. Providing cheap services is good, but so many countries can do that. Establishing a climate of confidence is better, and it is something that Latvians can do.

Although I had come for serious medical services and not for tourism, I was also amazed by the quality of Riga as a tourist destination. The place is safe, the architectural heritage is equivalent to an Italian city center, the seaside resort nearby is as attractive as my Atlantic weekend resorts, the hotels are clean, the food in average restaurants is French level, and certainly cheaper. The few would-be yuppie-fashionable restaurants are sometimes pathetic though, but that is the case everywhere in the world, isn’t it?    

Best practices, cheap prices, great stay, all this makes Riga a premium medical destination. However, from the broader political point of view some problems remain, which shouldn’t be avoided.
First of all, I think that providing medical services that the locals cannot afford is not sustainable in the long term. It might look economically sound now, but sooner or later it will lead to political trouble. Europe was not meant for that.

The generations presently in power have a mentality shaped by Soviet occupation, and then independence, combined with economic ideas from the nineties stating that anything neo-liberal is good. However, generations pass. As the twentieth century fades away, the newer generations will not share a precise knowledge of the past; they will consider independence as a natural fact that needs no particular assertion, and at the same time they will not be shy in admitting that joining Europe did not bring them to the living standards of Western Europeans. If this discrepancy continues, sooner or later the people are going to reject Europe.

Also, the budget cuts imposed by international institutions are not always very rational, even in market-oriented terms. Who could deny that a population in better health is more employable by investors, more available to learn new skills?
By actively supporting the medical sector, a country like Latvia would not only improve the labor market, but also would help accumulate equipment and staff that could be shared by local and foreign patients, thereby benefiting each other.

The international dogma approves of some spending though, when it is called “research.” But what is meant by “research” here is in reality some specific industrial sectors, mainly information technologies, perhaps in the future, nano-technologies. It has to be something labeled new and “high-tech,” not something that looks like a classic twentieth-century industrial sector. But this is not very rational either. Nowadays everything benefits from research, everything is high-tech: agriculture is high-tech, textile is high-tech, transport is high-tech... and a medical sector with a strong connection to research, a staff with permanent seminars in the university and the latest equipment will definitely bring some serious money.

In fact, it seems that the international dogma does not care much about real money for real people. The real criteria are that investments should be directed towards export, not towards the local populations.
However, Latvia, and the Riga area especially, have an obvious vocation for tourism and well-being services. And in that case public investment certainly does not jeopardize private enterprise. Offering the guarantee of drinkable public water everywhere, for instance, would be good for all restaurants and hotels. There are also many potential Western customers who are not proficient in English, and they would feel more confident if complete packages were offered, including transport, medical and residence. But it takes a nation to maintain that sort of permanent reputation. It is just too sad to see private clinics with excellent staff remain virtually unknown in neighboring countries, with their small Web site that is difficult to find on the Internet. The truth is that it is not only each enterprise which must care for advertisements, it is Latvia as a whole which must become a trademark for tourism and medical excellence.

Global institutions care for global economics. The past thirty years have shown us that the IMF will not hesitate to sacrifice local economies in order to foster the global market. However, we also see that the countries that strive in the global economy are the countries that keep a sense of their own identities, and their own interests. Notably, such countries will do the necessary public investments that they need to keep competitive in the global market, in terms of equipment, education, and even social care.

At the rate budget cuts are going in Latvia, when I come back next time I almost expect to find the door of my clinic closed with a big sign: “Sorry we had to close, electricity no longer works in Riga.” Or maybe the doctors will have left the country, because they could no longer afford medical services for themselves.
And I believe Europe was not meant for that.

Arnaud Herve
Brest, France

 

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