Intensive care services are the most expensive medical service, the costs of which services are covered by the state insurance system if the patient cannot afford their treatment. Previously, there were a multitude of reports on how private hospitals were abusing the system by unnecessarily and extensively putting the patients in ICUs and charging the public for that. But what could be seen as an investment strategy feeding corruption ironically helped Turkey in delivering effective care to COVID-19 patients.
One should also look at city-level inequalities in the healthcare system. The national figures may be misleading since the pandemic does not affect the country evenly and metropolitan cities are its epicenters. In the case of Turkey, both the health services and health expenditures are concentrated in Istanbul. This is a feature of the Turkish healthcare system that was sharply criticized for being a symbol of unequal access to health care. This fact, and again unintentionally, became one of the strengths of Turkey’s response to the pandemic. Just like NYC, Istanbul has a disproportionate share of the infections since it is Turkey’s most important international hub. Indeed, as compared to other Western countries, Turkey has fewer globally connected cities.
Finally, physicians who were used to routinely working under stress for long hours, did not seem to have been overwhelmed by the new wave of patients sent their way by the epidemic. There were many who were infected and a number of well-respected doctors lost their lives. Yet a good, devoted and highly educated medical workforce, slowly increasing in numbers, worked in favor of Turkey and positively affected fatality rates. Finally, as a member of Turkey’s Scientific Council, Dr. Alpay Azad recently said in an interview that medical practitioners in Turkey started using aggressive treatments and medication much earlier than their Western counterparts, suggesting the flexibility of treatment protocols in Turkey as compared to the Western countries. This also raised criticism towards the government for suppressing certain side effects of specific medicines.
Multiple Factors, Multiple Paths
The immediate questions about the pandemic in Turkey were well taken: how could a country that was identified as an example of declining state capacity, deinstitutionalization, and low levels of trust, have lower fatality rates than the "exemplary" countries? How could a country in which the central government keeps fighting with the local municipalities in order to hamper their capacity to deliver services to their vulnerable populations (so as not to let them get political credit) be successful in limiting the number of fatalities?
The figures are indeed counterintuitive. Yet the criticisms over Turkey’s fatality rates reflected an implicit bias. The immediate answer was found in the lack of transparency and analysts rushed to argue that the figures could not be true because they were counterintuitive. The numbers were accused of being incorrectly reported. As such, these figures have become a new battle ground. Under these circumstances, reporters and analysts failed to look into the factors that may have explained the discrepancies in numbers. This could have allowed them to give a different perspective on the comparative results between Turkey and Western European countries.
We argued that what was seen as a simple problem of transparency, may hide a more complex explanation. The crisis management system of Turkey benefited a lot from many of the negative externalities that would be seen as a disadvantage in normal circumstances. The Turkish case shows us that success in each separate case is related to multiple factors that interact with the unique social features of a given country. Demographics interacted with politics. Social structures affected the outcome in uncertain ways. Timing, population density all mattered tremendously.
The most important lesson we should draw from this crisis, however, is that in such emergencies, we need governments and elites that we should be able to trust. We need inclusive and broad health care not just to deal with this crisis but under normal circumstances as well. We need to take care of our vulnerable populations better so that they will be better equipped to survive in times of crisis. We need dense global cooperation to prevent the rapid spread of diseases. We need early detection and monitoring systems. Physicians should report new types of viruses not to their governments, but to the international bodies without fear of prosecution.
We cannot know how and which groups the next pandemic will hit. We cannot predict what the next crisis will be. A crisis should not be our guide to the future. Improving the inclusiveness of our societies in normal times should.
Copyright : Yasin AKGUL / AFP