In the early stages of his medical career, Cameron (Cam) Bowie, was involved in helping develop the use of ‘evidence-based medicine’. In an in-depth audio interview with Seth Dellow, available on our website, he described medicine before that approach as ‘pretty laissez faire’. At that time he was trying to help doctors and public health bodies base their work ‘not on prejudice or what we think works, but actually what the evidence shows’.
To most people that would seem obvious, but as has been brought home to us in the current pandemic, medicine, along with public health is an ever-evolving process. As viruses develop and mutate or mental health issues arise from new environmental changes, doctors and health professionals have had to become agile and learn at speed from the evidence around them.
Growing up with a mentally and physically disabled brother, Cam Bowie learned about disability from a young age and was naturally drawn to medicine and care. He remembers becoming quite good at wheelchair movement and not getting embarrassed when his brother made strange movements. ‘It was very formative’ he says ‘and the way that I’ve looked at life ever since is obviously realising we’re all different and some people have more difficulties than others in living.’
He studied at St Thomas’s Hospital in London and when he married his wife Claire they bought a Land Rover and traveled around the world for two years working in Nepal and traveling from Asia to Australia and back via Africa. That was where he began to ‘appreciate different cultures, different religions, different people’s attitudes to things. And we got to know how poor people can be very happy, and how consumerism is totally different and is not something to aim for really, and I’ve been studying poverty really ever since because of that.’
Initially training as a pediatrician hoping to try and ‘help families with handicapped children’ he and his wife moved to Papua New Guinea where he was the only doctor on a 60 bed children’s ward. He worked day and night but found hundreds of children were dying of whooping cough, something he knew was a preventable disease if you are immunised. However, in Papua New Guinea the immunisation program wasn’t going well, so Cam decided to take on a public health role. He knew that trying to prevent diseases rather than deal with the cases was the obvious answer. ‘I trained up some superb Papua New Guinea nurses to do what I had been doing, like lumbar punctures and putting up drips and giving antibiotics and so forth, and organise the immunisations, and that worked really well.’
His ward was also getting a small epidemic of marasmic children which he explained is ‘children who are very wasted and dying of malnutrition in the ward.’ He discovered that it was those families that could afford to feed their children with western produced powdered milk that were getting ill. It turned out that they ‘were getting diarrhea because they weren’t being properly sterilised and the children were dying of gastroenteritis as well as the wasting. And that was crazy because Papua New Guinea are superb breastfeeders. They’re absolutely brilliant!’ Enlisting the help of a local MP he helped write a draft bill to stop the use of bottles, teats, and baby powder. It was one of the first private members’ bills to go through that government. ‘We saved probably thousands of lives’ he says. ‘One of the things I learned was that for the right opportunity, public health can do fabulous things. The message I get from that is take every opportunity you can and a crisis is often a very good opportunity. And clearly what has failed in public health with our Covid experience is that we haven’t taken the opportunity of changing things using the emergency as a way of improving public health. We’ve done quite the reverse.’
Cam’s experience in Papua New Guinea prompted him to return to England and train a second specialty in Public Health describing the NHS training as ‘superb’. He stayed in Taunton for many years becoming a consultant, a specialist, and Director of Public Health where he was involved in many innovative initiatives. One of the main ones he speaks about in this interview involved approaches to mental health. He explains how people were ‘beginning to understand that large mental institutions, asylums, were not actually appropriate and people didn’t actually get better’. He believed there was a better way of de-institutionalizing that form of care. One of his jobs was to close the huge asylums. There were two; one in Wells had 1,400 beds all with mentally ill people in them. He set out to build smaller units in local areas which were much more accessible. This allowed for ‘more daycare, live at home with support or live in a sheltered accommodation.’ It was pioneering work and Cam explains how they gave all of the money saved to social services and they built up social care for that group of people. He says ‘parents were often very worried about it to start with but when they saw that it was working and how good social services were at running the services so people could stay at home, they got respite care and helping the families cope, it was fabulous. And we were one of the pioneers in the country in Somerset to do that.’
Although now retired, insights and practical knowledge such as this mean Cam’s philosophy and understanding of public health are born from valuable experience. He worries about the move towards centralisation of services. ‘There’s been a tendency over the last 30 years with all services, it’s not just health, for centralisation’ he says. ‘And the one thing I’ve learned is that—and I’ve been advising countries around the world on how to structure their health systems—is that the more decentralised, the better. Because the system we had 30/40 years ago and before that, it was all very local. I mean before the NHS it was all local and the more centralised you have it, the worst it gets and it’s not surprising. Everybody is different, every town is different. It needs to be based around being able to know all the GPs in the area and all the consultants and I used to know everyone. You get them working together and you can run a really good service. So centralisation is harmful, and that’s true in other countries as well and subsidiarity should be the name of the game.’
Not surprisingly Cam believes the current government has dealt with the pandemic very badly. ‘They got everything wrong from the start’ he says. ‘They went for a form of trying to reduce it with herd immunity which was inappropriate. They should have gone for elimination. By elimination, you don’t get rid of all cases, but you get it down to such a level that you can pick out each case and stamp on it like fire fighting, you can do that.’
Cam also talks about the future for the NHS and the opportunities that Public Health has missed. He points to the need to use the lessons from this pandemic. ‘With Cholera, we improve sanitation and sewage and water supply. With HIV, we improve sexual behavior. With TB we improve housing.’ He would like politicians to learn from the mistake of allowing inequality. ‘Politicians don’t really, I think, understand that inequality reduces the quality of everybody’s life, not just the poor and the vulnerable. There’s some superb studies from Europe about equality and how it’s not between countries, but within countries. With more equality, you get less crime, less drugs, less alcoholism, less everything.’
Seth Dellow’s full interview with Cam Bowie is available to listen to on the Marshwood Vale Magazine website.