If you feel like it, a little reading...

Husserl and Merleau-Ponty gave primacy to the experience of the researcher – to his perception and his story. The knowledge of this experience allows, they said, to enter the subjective world of the person who describes, in his phenomenal field and thus to discover the reasons, the strengths and the weaknesses of the study. So let's go.

I studied medicine at the Free University of Brussels; public health at Harvard University School of Public Health, Boston; tropical medicine at the Institute of Tropical Medicine in Antwerp; epidemiology and statistics at the Université Libre de Bruxelles. In 1991, I obtained a PhD at the same university on the theme of the development of local health systems in Africa. I alternated between practice and study. For 40 years I have been trying to conceptualize my practical experience to improve access to health care, the quality of care, to develop health services for public purposes and above all, to promote medical professionalism.

At the end of my studies, I wanted to know how to manage public health services and for public purposes and I had the best school one could imagine, the Kasongo project of the Belgian cooperation in Zaire, today the Congo, led by Professors Pierre Mercenier and Harry Van Baelen, from the Institute of Tropical Medicine in Antwerp. They had managed to ensure access to medical care, preventive medicine and community health, on a territory as large as half of Belgium - with a budget of less than one dollar (then) per year and per inhabitant.

It is a defect and a quality, I am a man of action. Professional practice was my religion, and my practice was community medicine and the organization of health services. And that is why my research was inductive. I was a professor at the Institute of Tropical Medicine, but I wanted my research to go from practice to theory – to be inductive. Or again: that theory be a moment of practice. So I did general clinical medicine, then community medicine, to study the organization of health services; management of health services to study health systems and evaluate health policies; and national health policy advice to study international policies.

Action research was my preferred methodology. Necessarily. The researcher is expected to have scientific excellence. But I thought it would be good if we were expected to show professional excellence too – at least in everything related to health and education. Excellence is not about being excellent, but about not being able to sleep because you are not.

I have practiced as a public health physician in Latin America, Africa, Asia, the Middle East and Europe, focusing on different aspects of the practice of medicine and other health professions. In Asia, it was the control and regulation of care. In Latin America, the development of family medicine in public services and their co-management with communities. In Europe and Latin America, I conducted action research to defragment and de-segment the health services of the public system, and above all, to introduce reflexivity into the practice of medical and paramedical teams. And in Africa, I focused on the relationship between culture and health, strategies for the development of local health systems, the relationship between public health programs and clinical medicine; the practical organization of psychosocial assistance in medical and paramedical consultation; the professional identity and living conditions of public service paramedics; and the clinical and epidemiological control of gender-based violence.

The practice of community medicine and public health meant above all, for the researcher that I was, improving quality of and access to health care. Here are 4 examples.

• In Senegal, between 1985 and 1988, we tried to improve access to medicines with co-managed community pharmacies, integrated into health centres. They only worked if we managed to rationalize the prescription of paramedics.
• In Burkina Faso, at the beginning of the 1990s, with a World Bank project (!), we extended surgical coverage (emergency surgical interventions) to the entire national territory and created a purchasing centre for essential and generic drugs from public services.
• In Ecuador, we have promoted therapeutic communication in public services by introducing psychosocial assistance to patients during medical consultations.
• In Belgium, we have instigated a self-managed network of 'ghost health districts', without any institutional existence. It brought together generalists and hospital specialists who identified together their errors in the management of patients that they shared. And two handymen who were trying to improve the local health system were named for the occasion – according to the conclusions of the aforementioned clinical audits.

As a researcher, I made a point of publishing my analysis and action criteria in scientific journals – and not just the protocols and results of my research.

Today, I am also interested in the control of gender-based violence in sub-Saharan Africa. I studied it as a model of care and practice intended to introduce psychosocial assistance into medical and paramedical consultations in health centres and hospitals.

In 2011, our book 'International Health and Aid Policies: the Need for Alternatives', published by Cambridge University Press, denounced the dehumanization of public services in Africa, Asia and Latin America - instigated by international development cooperation, with a policy that allocated clinical medicine to the private sector and public health to public services. The book denounced the epidemiological and demographic consequences of this disastrous division of functions -– the immensity of the avoidable suffering it had caused - and which is explained by the fact that 80% of the African population did not have, and do not still has no other choice, for medical care, than public and publicly oriented health services. To show the possibility of an alternative, part of the book studied the options of health policies, management, model of care, pedagogy and organization of the health system.

For what was to raise the alarm, it was a complete flop. International cooperation has generally continued to exploit the public services of developing countries, especially their front line, for the benefit of a few economic actors, and to destroy medicine there as a professional practice. Of course, this trend only makes the exceptions to the rule more extraordinary.

What are my philosophical biases? It is in my professional principles that they are expressed:

• An ideal of solidarity and social justice.
• A mystique of action.
• A concern for culture, identities, belonging and transmission, in everything related to health and education. Acculturation and anomie, the suffering of acculturation, are social determinants of health, forgotten perhaps, but essential.
• My view of social and psychosocial suffering, and the approach to my profession, are above all political and philosophical. For example, I have a philosophical and political bias for the co-management of health services with caregivers and user representatives.
• A concern for the validation of theories and strategies;
• An ideal of professional fraternity and legality, a balance between benevolence and the need for a law.