Cause of death: poverty

In practice, it turns out that our services are none too different from the ones we tend to scoff at in other countries

A seven-year-old Nigerian girl was found dead at the Dominican Sisters home in Zabbar
A seven-year-old Nigerian girl was found dead at the Dominican Sisters home in Zabbar

So there I was, thinking that nothing could really shock me anymore... only to read in the papers that a seven-year-old girl died in this country as a direct consequence of poverty and neglect.

Well, that’s how it was initially reported in the papers, anyway. And much as I hate to say this about the profession I form part of myself... (note: you can take this as a ‘mea culpa’ for all the things I’ve also got wrong in my career)... you do have to be a little careful about what your ‘read in the papers’ these days.

In fact, the Maltese press would be wise not to adopt too critical an approach to the many ‘systemic failures’ involved in this case. There are ‘systemic failures’ within the media, too. One of them concerns a truly worrying tendency to simply pole-vault to all the wrong conclusions, without a shred of evidence to back up the story.

We were initially told, for instance, that the girl in question ‘died of starvation’ at the Zabbar residence where she lived... when in reality she died at Mater Dei Hospital, of a rare condition known as ‘aplastic anaemia’ (though naturally, malnutrition couldn’t have helped much either). Seriously, though: would it have been too much trouble to wait for a solid lead on the cause of death, before running such an inaccurate story? And if the Maltese press can’t get even such a simple fact right – the result of an autopsy, for crying out loud, or where that poor girl actually died – why should anyone believe a word we print about any other issue or occurrence, of any kind?

Perhaps, we should stop boasting about our economic success... and start asking ourselves why so little of this newfound wealth is being spent where it should be spent

All the same, however, I will not retract my earlier claim that the cause of death was ‘a direct consequence of poverty and neglect’. Some of the details now emerging are almost more shocking than the fatality itself.

Consider this testimony of a family friend: “Late last year, the children were referred to hospital for a medical examination but, for some reason, they were instead seen by a psychologist. Following the examination, the parents received three bills – one for each child – and this put them off ever seeking medical help again for fear of accruing debt they knew they could not settle.”

It is not clear whether the children were ‘referred to hospital’ by Appogg social workers... who were aware of this case since 2016... but it is fairly evident that something must have gone horribly wrong with the referral process itself. I was under this vague impression that our national healthcare system – so much in the news these days – offered its services for free to all residents and EU citizens. That includes persons enjoying refugee status, too – the category we are talking about here. So why was that family billed for what should have been a free service? And how did a ‘referral to hospital for a medical examination’ – which might have picked up the eventual cause of death in time to avoid it – get so hopelessly lost in translation, that the children ended up being seen by private psychologists instead of NHS doctors?

Even without these details, however, I feel this case should really force us to confront certain realities we have been avoiding for too long. One of these concerns a general misconception about the quality of our social welfare system as a whole. We tend to think of ourselves as extremely generous and civic-minded (compared to other countries) when it comes to financing social services through public money.  But ask anyone actually involved in social welfare, and the picture you will find yourself looking at will be very different.

Very different, that is, from the way the Maltese welfare state is portrayed. In practice, it turns out that our services are none too different from the ones we tend to scoff at in other countries. I don’t want to be too dismissive here – this is not meant as criticism of the people who work in social welfare. And besides: if even much richer countries are plagued by similar systemic failures... wouldn’t it be patently unrealistic to expect anything better here?

Erm... no, actually, it wouldn’t. There are a number of good, solid reasons why Malta should indeed have a far superior social welfare safety net than other countries: i.e., a social welfare system of the kind we like to think we have, as opposed to the one we have in reality.

For one thing, the size and scope of the society those services cater for is infinitely more manageable here than it would be in much larger countries: where not only is the number of social cases (and, by extension, the expenses involved) much greater, but so is the disparity of wealth. Poverty on the level we are now talking about may not be entirely ‘alien’ to this country – it probably never was – and there is evidence that it is on the increase. But it remains nowhere near the scale of poverty you will find in, for instance, the United States, or the depressed suburbs of several European capitals. And apart from the, logistical implications... there is a cultural dimension to this scenario. Unlike so many other countries, our philosophy concerning social welfare is underpinned by two massively perennial cultural traits: Socialism, and Christianity.

Malta is an exception to the general rule elsewhere in Europe, in that there is broad political consensus here: not only to retain a fully-free social welfare model (without means testing, etc), but also to expand on it wherever possible. Consider, for instance, how the two political parties routinely accuse each other of wanting to erode social services – by privatising parts of the NHS, for instance – while simultaneously promising to protect the free-for-all model in its entirety. You won’t find that in many other countries, you know. There will always be at least one political party across the full spectrum that will argue the opposite: that their country was spending too much on social welfare, and should start scaling back its services.

It’s generally called the ‘right wing’, and it exists (everywhere else in Europe) as a purely mainstream political phenomenon. Not in Malta, though. In Malta, what passes for ‘rightwing’ is limited only to extreme examples like Norman Lowell, and to divisive issues like immigration. I have yet to hear a single mainstream political party in this country advocate a mainstream rightwing approach to social services. That is probably because Malta is very emphatically NOT rightwing in this regard. William Harcourt’s famous quote - ‘We are all socialists now’ - is applicable here with astonishing precision: everyone and his dog is a ‘Socialist’ in Malta, in that everyone believes we should all, by rights, enjoy access to the most generous welfare state possible.

Until, of course, it comes to the part about actually paying for it. This is where the Christian side of the argument comes into play. Here I shall have to bite my lip a little: part of me feels strongly compelled to point out the outrageous hypocrisy of people like Edwin Vassallo... who always kicks up such a ruckus as is always kicked about the (remote future possibility) of abortion... but then seems to have nothing to say about the death of a child who’s already been born.

But that would be to miss the point slightly. One other thing that emerges from this case – and others, too – is that Malta’s supposedly generous welfare state is actually apportioned between government agencies, paid for by the State, and Church-run institutions that are (in the main) self-financed. The Dominican Sisters, for instance, run a number of homes for vulnerable children and other social cases: not just the Zabbar one where this tragedy unfolded.

To this, of course, we have to add all sorts of other Church-run facilities: shelters for migrants, orphanages and crèches, ‘Dar Tal-Providenza’, etc. Some government subsidies will no doubt be involved here and there... the State still pays all salaries in all Church schools, for instance. But the bottom line is that most of these facilities rely exclusively on charity for survival. And all of them provide essential services that should, by rights, be provided by the State...and which, indeed, the State claims to provide, but evidently does not.

‘Generous social welfare state’, my foot. Maltese governments have been collectively shirking their responsibilities towards social welfare in this country for decades: content to simply let the voluntary sector – be it Church or lay – do the government’s job for it; only without a government’s resources, and at its own expense. Take away all those voluntary institutions, and we all know that Malta’s welfare state would instantly collapse under its own weight.

And they may well disappear in a not-so-distant future. The Church already struggles to finance its own services and facilities: Mgr Lawrence Grech regularly raises the alarm about lack of funds at Dar Tal-Providenza, for instance. Our answer is to always reach into our pockets and donate generously during mass fund-raising activities.  How is it, though, that nobody ever questions why we have to keep such an essential service alive through private donations, when we already pay taxes so that government can provide those services itself?

The question is worth asking for another reason. In the past, it was always argued that Malta couldn’t afford to maintain a comprehensive welfare system – for years, we laboured under the threat of excessive deficit procedures, etc – and perforce had to rely on voluntary organisations to supplement the public service. From the outset this was always a dubious excuse... if a country can’t afford to provide essential services for the most vulnerable, how on earth can it possibly afford to pay University stipends (to name but one luxurious extravagance that we are only too happy to finance at the expense of much more pressing necessities)?

But in contemporary Malta, the same excuse cannot possibly be expected to hold anymore. Hardly a day goes by without government boasting about its dazzling economic achievements... about budget surpluses, unprecedented economic growth, a GDP that is the envy of the Western world...

Yet a seven-year-old girl can still end up dying of poverty here... here, in what is now a prosperous country that prides itself so much on the quality (and generosity) of its social welfare state?

Perhaps, we should stop boasting about our economic success... and start asking ourselves why so little of this newfound wealth is being spent where it should be spent. Perhaps we should finally put all this newfound money where our mouth is, and start actually living up to the ‘generous social welfare’ myth we have created about ourselves. After all, for arguably the first time in our history, we can afford to...

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