I am often asked whether I like living in Winnipeg or Toronto better. Sometimes friends assume that San Francisco or Zurich must for sure have been better places to live in than the prairies. My answer usually is that each has its pros and cons and that these are so entirely different places that one cannot fairly compare them with each other. Feeling the chill of Pacific fog sucked through the Golden Gate on a hot summer day, paying over 5 Swiss Francs for a tiny espresso in a coffee shop by the lake, stuck bumper to bumper on the 400 on a Friday evening trying to get to cottage country, or starting to talk to a foreigner on your dog walk in Assiniboine parc just to discover that you have the same friends and acquaintances, have all a totally different vibe, are unique and not comparable.
The charm of Winnipeg is it’s being a confined, “little big city” centered in a huge agricultural area. This, in my opinion, heavily influences its atmosphere and the mentality of its population: a bit heavy and down to earth, but hearty and friendly, helping each other out. Another side of this is that Winterpegers (and Manitobans) often sell themselves under their value, and tend to be self-centered in the following way: They grow up in Winnipeg, go to school in Winnipeg, study in Winnipeg, maybe spend one year (if any) outside of Winnipeg, then return, get a job in Winnipeg, raise their children in Winnipeg – and eventually are laid to rest in Winnipeg. No wonder everybody knows everybody here – and this can be a problem – which brings me to the Banana Republic.
The Banana Republic starts when the everybody-knows-everybody mentality creates perceived or actual conflicts of interest and affects decision making in matters that should be driven strictly by data and policies. Unfortunately, health care is no exception to these pitfalls. In fact, the more political the decision-making matters become, the greater is the risk that decision making is influenced by such conflicting relationships, sometimes as heavily as bordering on abuse of (private) connections. Public-private collaboration (to use government lingo) is in and serves as a scapegoat for at least borderline behavior. Too much of that and you end up with a Banana Republic. Sometimes lately I had the choking sensation that we may be, if not there yet, not far from being there.
But the Banana Republic does not start nor end with government. We all are at risk of creating a Banana Republic. We all including our highly esteemed experts, researchers and scientists are at risk of falling into the trap of not following due process, but rather using connections to jump the queue and get what we want (for whatever reason). And if only one individual (whoever it may be) is successful with this approach, it sets a precedent, and animates others to follow the slippery trail leading to Banana Republic.
Let’s be wiser than that, as tiring and frustrating as it may be. Nobody will gain on the long run in a Banana Republic. Let’s stay humble, stick to facts and data, argue persistently to the content, and follow due process, even if it is cumbersome and takes longer. Winnipeg, Toronto, San Francisco, Zurich – the location may change, but we remain who we are.