PHR Student Program Midwest Regional Hub

Boston Area Readers: PHR Invites You to a Public Forum:

WHEN THE STATE MAKES DEMANDS:

MEDICAL PROFESSIONALISM, DUAL LOYALTY, AND HUMAN RIGHTS

THURSDAY, MAY 12, 7 P.M.

Carl W. Walter Amphitheater
260 Longwood Avenue
Tosteson Medical Education Center
Harvard Medical School

This program is presented by Harvard Medical School, Physicians for Human Rights, and the United States Holocaust Memorial Museum.

Featured Speakers:

• Holly G. Atkinson, MD, Past President, Physicians for Human Rights
• Robert Jay Lifton, MD, Lecturer in Psychiatry, Harvard Medical School, and Distinguished Professor Emeritus of Psychiatry and Psychology, The City University of New York
• Jonathan H. Marks, BCL, Professor of Bioethics, Humanities, and Law and Affiliate Law Faculty, Pennsylvania State University Dickenson School of Law, and Edmond J. Safra Research Fellow, Edmond J. Safra Center for Ethics, Harvard University
• Robert N. Proctor, PhD, Professor of History of Science, Stanford University

The history of the Holocaust teaches us that in Nazi Germany, the state relied on the support of medical professionals to implement its eugenics program and ultimately enable genocide. The history also reminds us of the pressures that health care workers can face and the need for vigilance to protect health and human dignity as well as the needs of society.

Join the Holocaust Museum as experts in medical ethics, psychology, and the history of medicine delve into the history and lessons of the Holocaust for physicians and explore the difficult ethical questions that medical practitioners face in today’s society.

Panel Moderator

• Mildred Solomon, EdD, Associate Clinical Professor of Medical Ethics, Department of Global Health and Social Medicine, Harvard Medical School; Associate Clinical Professor of Anesthesia, Children’s Hospital Boston; and Director of the Fellowship in Medical Ethics, Harvard Medical School

The program is free and open to the public. Reservations are requested; register online or contact the Museum’s New England Regional Office at 202.488.6585 or newengland@ushmm.org.

Parking information and directions.

Following PHR’s calls for the release of detained doctors and medical staff in Bahrain, nine doctors were reportedly freed. According to PHR’s sources in the field, eight female doctors and one male doctor were released late yesterday evening.

Doctors in Bahrain have been disappearing as part of a systematic attack on medical staff, as detailed in PHR’s recent report, “Do No Harm: A Call for Bahrain to End Systematic Attacks on Doctors and Patients.” Many of the medical professionals are being held incommunicado in unknown locations and on Tuesday the government of Bahrain charged 47 medical staff with trying to overthrow the regime.

Last month, PHR launched the campaign, Bahrain Free the Docs. The campaign has called for the release of detained medical staff and for the government of Bahrain to end violations of medical neutrality, a principle enshrined in international law and international humanitarian law which dictates noninterference with medical professionals in times of civil unrest and conflict. In the weeks following, PHR released a report, PHR members wrote letters to the Crown Prince of Bahrain calling for the release of the doctors and PHR joined with prominent medical associations to call for the Crown Prince of Bahrain to cease the attacks on medical staff. The campaign resulted in widespread media coverage including pieces on CNN and in The New York Times as well as the US State Department expressing concern about the violations of medical neutrality in Bahrain.

While PHR celebrates with the families of those released yesterday, we continue to call on the government of Bahrain to free the remaining physicians and stop their attacks on health professionals.

Physicians for Human Rights (PHR) today released an emergency report which documents and decries systematic human rights abuses in Bahrain. For the first time, the report, “Do No Harm: A Call for Bahrain to End Systematic Attacks on Doctors and Patients,” provides forensic evidence of attacks on physicians, medical staff, patients and unarmed civilians with the use of bird shot, physical beatings, rubber bullets, tear gas and unidentified chemical agents. The report was featured on several major news outlets including the Associated Press, AFP, BBC, CNN, the Independent, New York Times, and Washington Post.

The report details systematic and coordinated attacks against medical personnel, as a result of their efforts to provide unbiased care for wounded protestors. These attacks violate the principle of “medical neutrality” and are grave breaches of international law which dictates noninterference with medical services in times of civil unrest. Included in the violations were targeted kidnappings, beatings, and threats of rape and killing by security officials. These attacks extended to the patients of medical personnel created an atmosphere of fear which dissuaded patients from seeking care.

The report concludes with policy recommendations for Bahrain, the Unites States and the international community. Among other calls for action, PHR demands for Bahrain to immediately cease and desist all attacks on medical personnel and facilities. PHR also calls on the Obama Administration to lead an international effort to appoint a Special Rapporteur on Violations of Medical Neutrality through the United Nations Human Rights Council.

A letter to the Editor on immigration, by PHR’s Asylum Program Director, Christy Fujio, appeared on April 1 in the New York Times.

To the Editor:
Re “Southern Lawmakers Focus on Illegal Immigrants” (news article, March 26):

The overreaching attempts of lawmakers in several states to “fix” perceived immigration problems are shortsighted and dangerous. Many proposals, including those that would bar undocumented people from attending college or marrying United States citizens, are alarmingly reminiscent of the segregation laws that plagued our country and set an embarrassingly recent precedent for institutionalized discrimination.

South Carolina’s proposed bill, which would make it illegal to transport immigrants anywhere, including to a hospital, is particularly egregious because it could effectively deny critically needed medical care to thousands of people. This not only threatens the health of individuals, but also the public health of the entire state.

Additionally, it would place emergency medical technicians in the untenable position of having to act as immigration enforcement officers rather than healers. Health professionals’ first duty is to provide their patients with the best care possible; they cannot do that if the state forces them into an enforcement role.

CHRISTY FUJIO
Asylum Program Director
Physicians for Human Rights
Cambridge, Mass., March 26, 2011

Today marks the 100th anniversary of International Women’s Day, a day set aside to celebrate the political, economic, and social achievements of women around the world. To recognize this historic day, PHR is highlighting the enormous challenges we face in addressing mass rape in armed conflicts.

Marking the 100th International Women's Day

This blog post is the first of a series of 10 posts that will chronicle PHR Deputy Director Susannah Sirkin’s recent 13-day trip to Kenya and the Democratic Republic of the Congo (DRC) accompanied by PHR Asylum Network member Dr. Coleen Kivlahan. This diary of their assessment trip seeks to highlight the small — but seminal — achievements of grassroots organizations, women’s rights groups, health professionals, and legal advocates working to serve women and girl survivors of sexual assault in Eastern and Central Africa. The blog series will also underscore the challenges and hurdles that remain.

Kenya Journal

Nairobi, Kenya: How to combat widespread impunity for rape in Central and East Africa, starting here in Kenya? As PHR and other experts have documented for more than a decade, tens of thousands of women and girls have been — and continue to be — sexually assaulted by government soldiers, rebel forces, and civilians, both during and following armed conflict.

A critical problem in addressing this crisis has been the difficulty of prosecuting crimes of sexual violence, to enable survivors to seek justice and to help deter future crimes.

Groups who seek to support survivors’ needs face daunting obstacles: shame, stigma, rejection, lack of political will and poor resources. Perpetrators act with impunity and medical and legal capacity and forensic training required to support prosecutions against these perpetrators are lacking.

We’re here to learn more about this crisis and challenge in Nairobi, and then we’re heading West in a few days to eastern Congo. Dr. Coleen Kivlahan, a veteran PHR doctor, has joined me. She’s a pioneer in setting up SAFE (Sexual Assault Forensic Evaluation) programs in the US, one of our expert asylum evaluators in the DC area, and what’s more, a marathon runner, experienced trainer, and intrepid traveler. I’d go anywhere with her.

Day 1: All over town we see the bold black words on posters, key chains, flyers, wall paintings: Sita Kimya (“I will not keep quiet” in Kiswahili): Say No to Rape — a new awareness or “sensitization” campaign funded by USAID, the US Agency for International Development.

Sita Kimya means 'I Will Not be Quiet!', a rape
awareness campaign funded by USAID

Our aim is to check out the gaps in forensic evaluation — the best practices for health professionals who respond to victims in gathering physical and psychological evidence that can be used in prosecution — and documentation needed to hold perpetrators accountable for this crime. As we know, this all-too-silent crime is suffered by countless women in war as well as in the fragile peace that follows mass violence or armed conflicts. We’re meeting with doctors, lawyers, nurses, police, program administrators, government officials in health and justice, women’s rights activists, and aid workers.

These are travel impressions. The full assessment will come as we pack in our days and peel the onion, since every time we think we understand something, a new layer of complexity reveals itself. Each interview on this trip unravels another set of challenges: policies that seem great versus practices that don’t resemble them at all:

• Standards for treatment of victims and documentation of injuries that exist on paper but are not widely known or understood.
• Confusion about police and/or medical forms required for criminal investigation or evidence.
• Incomplete or inadequate formats for forms.
• Who does what in the investigation and justice systems to prosecute sexual violence?
• What capacities do professionals gathering evidence have and need? Do they have basic equipment?
• Extraordinary people here are making change and pioneering new approaches. Is there the necessary political will to end impunity for rape and serve justice to survivors?

PHR members are invited to attend the Boston Initiative to Advance Human Rights’ sex trafficking film forum event at the Brattle Theater in Cambridge, MA, from December 2 through December 5. The festival, which is the first of its kind, will screen 12 films, which will be followed by panel discussions with filmmakers, academics, and activists.

The film forum will explore the power of film in bringing about a movement to combat commercial sexual exploitation and modern-day slavery. PHR recently blogged about this issue.

Additional events include an opening night live performance by Tony award-winning actress and humanitarian Sarah Jones, followed by a cocktail hour with hors d’oeuvres by legendary chef Lydia Shire of Scampo, music performance, and a silent auction. On Saturday there will be a book signing with Siddharth Kara, author of Sex Trafficking: Inside the Business of Modern Slavery.

Tickets are available for purchase now. Discounted tickets are available for students, seniors, and non-profits.

Learn more, including film titles and times, at BITAHR’s the official website, and at their Facebook page.
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Medical students during PHR's human rights training, Fall 2008.

Last year, thanks to the dedication of our wonderful PHR intern Margeaux Fischer, a donation of 441 medical textbooks was shipped to the Zimbabwe Association of Doctors for Human Rights (ZADHR), with whom we helped organize a health and human rights training for medical students in 2008.

One of the ways we were able to help satisfy the needs of the students we met was through the donation of these medical texts. Our friends at ZADHR wrote about it in their recent eNewsletter:

ZADHR in conjunction with Physicians for Human Rights (USA) has donated books worth more than US$ 50,000 to the College of Health Sciences at the University of Zimbabwe. The total number of books donated is 441 and of these books 37 have already been selected for the reserve section as they are deemed very important and needs close surveillance on their usage.
ZADHR continues working with Physicians for Human rights in trying to improve access to medical books to medical students in Zimbabwe.
ZADHR would like to continue with such a positive relationships with the College of Health Sciences and they are looking for more ways they can improve access to information and other necessary resources at the College of Health Sciences.

Senior staff from the college examine the donated books.

The ZADHR student leadership PHR trained two years ago have just conducted their own training for 37 students. Norman Matara, one of the leaders, writes:

We have just held a health and human rights where we have trained 37 students in HHR. What was really exciting was that we were the ones who made the presentations, sharing what you have taught us with our young brothers. We still fight for health rights.

Norman Matara (l) and fellow students with donated books.

PHR is proud to  support these students and others around the world. We are in discussions with other US student chapters to see if another book donation drive can be put together. Let us know if you’re interested or can help!

The World Health Organization has published new guidelines meant to address the health worker shortage that plague rural and impoverished regions. In a July 2010 policy recommendation paper, the WHO offers recommendations to aid worker retention and attract new health workers to overlooked areas. Strategies include altering the ways in which students are selected and trained, as well as improvements in working and living conditions.

The WHO explains that “a shortage of qualified health workers in remote and rural areas impedes access to health-care services for a significant percentage of the population, slows progress towards attaining the Millennium Development Goals and challenges the aspirations of achieving health for all.” The WHO’s recommendations come at the request of global leaders, civil society groups, and Member States. WHO recommendations fall into four categories, with greater detail and context available within the body of the Report:

1. EDUCATION RECOMMENDATIONS
   Recommendations include targeted admission policies to enroll students with a rural background (who are statistically more likely to then practice in rural areas), exposing students to greater rural field work, and locating schools and residency programs outside of major cities.
2. REGULATORY RECOMMENDATIONS
   Recommendations include the creation of compulsory service requirements in rural and remote areas, educational subsidies offered with enforceable agreements of return service work in rural areas, and a focus on increasing the scope of medical practice in remote regions to increase job satisfaction.
3. FINANCIAL INCENTIVES RECOMMENDATIONS
   The WHO suggests “a combination of fiscally sustainable financial incentives, such as hardship allowances, grants for housing, free transportation, paid vacations, etc., sufficient enough to outweigh the opportunity costs associated with working in rural areas, as perceived by health workers, to improve rural retention.”
4. PERSONAL AND PROFESSIONAL SUPPORT RECOMMENDATIONS
   Recommendations include improved living conditions for health workers and their families in remote locales, career development programs to help rural workers progress in their careers, and the creation and promotion of senior posts in rural areas so that advancing workers are not forced to leave their communities.

The WHO suggests policies should be implemented in conjunction with the country’s national health plan and should be guided by the concept of health equity. The Report states that some countries, the Lao People’s Democratic Republic and Mali among them, are already considering using WHO recommendations to inform their retention policy.

As WHO guidelines have been disseminated, an August 14 article in The Lancet registered a first critique, underlining the roles of NGOs and INGOs in the internal brain drain within struggling countries. As an addendum to the WHO report, the article offers further policy recommendations, to be implemented in conjunction with WHO strategies.

The World Health Organization has published new guidelines meant to address the health worker shortage that plague rural and impoverished regions. In a July 2010 policy recommendation paper, the WHO offers recommendations to aid worker retention and attract new health workers to overlooked areas. Strategies include altering the ways in which students are selected and trained, as well as improvements in working and living conditions.

The WHO explains that “a shortage of qualified health workers in remote and rural areas impedes access to health-care services for a significant percentage of the population, slows progress towards attaining the Millennium Development Goals and challenges the aspirations of achieving health for all.” The WHO’s recommendations come at the request of global leaders, civil society groups, and Member States. WHO recommendations fall into four categories, with greater detail and context available within the body of the Report:

1. EDUCATION RECOMMENDATIONS
   Recommendations include targeted admission policies to enroll students with a rural background (who are statistically more likely to then practice in rural areas), exposing students to greater rural field work, and locating schools and residency programs outside of major cities.
2. REGULATORY RECOMMENDATIONS
   Recommendations include the creation of compulsory service requirements in rural and remote areas, educational subsidies offered with enforceable agreements of return service work in rural areas, and a focus on increasing the scope of medical practice in remote regions to increase job satisfaction.
3. FINANCIAL INCENTIVES RECOMMENDATIONS
   The WHO suggests “a combination of fiscally sustainable financial incentives, such as hardship allowances, grants for housing, free transportation, paid vacations, etc., sufficient enough to outweigh the opportunity costs associated with working in rural areas, as perceived by health workers, to improve rural retention.”
4. PERSONAL AND PROFESSIONAL SUPPORT RECOMMENDATIONS
   Recommendations include improved living conditions for health workers and their families in remote locales, career development programs to help rural workers progress in their careers, and the creation and promotion of senior posts in rural areas so that advancing workers are not forced to leave their communities.

The WHO suggests policies should be implemented in conjunction with the country’s national health plan and should be guided by the concept of health equity. The Report states that some countries, the Lao People’s Democratic Republic and Mali among them, are already considering using WHO recommendations to inform their retention policy.

As WHO guidelines have been disseminated, an August 14 article in The Lancet registered a first critique, underlining the roles of NGOs and INGOs in the internal brain drain within struggling countries. As an addendum to the WHO report, the article offers further policy recommendations, to be implemented in conjunction with WHO strategies.

Only 37% of Ugandan physicians are satisfied with their jobs and nearly half are at risk of either exiting the health sector or leaving Uganda entirely, according to a study published this year by the International Journal of Health Planning and Management. The study, “Satisfaction, Motivation, and Intent to Stay Among Ugandan Physicians,” is co-authored by Emily Bancroft, a former Leland Fellow with PHR in the US and AGHA in Uganda. Dovetailing with PHR’s previous works on health worker shortages in Africa, the study’s results come from a sample group of physicians working in 18 public and private health facilities in Uganda representing approximately 3% of Ugandan physicians. This study came about at the behest of Uganda’s Ministry of Health, which hopes to analyze how to implement effective policy reforms to strengthen and expand their health workforce. Bancroft’s team, headed by long time PHR advisor Professor Amy Hagopian of the University of Washington, urges Ugandan policy-makers to intervene to stem the “brain drain” that is heightened by factors such as low wages, poor infrastructure and materials, few opportunities to progress within the medical field, and regional isolation for doctors outside large cities.

14% of Ugandan physicians emigrate abroad, largely to four English-speaking countries—the US, Canada, the UK, and Australia. This number is significantly lower than that of some other countries in peril. For example, it is frequently said that more Malawian doctors practice in Manchester, England, than in the entire country of Malawi. Although Uganda’s health workforce shortage seems less drastic than Malawi’s, the crisis is no less dire: in 2008, the study’s authors estimated that there are only 2,500 physicians for Uganda’s 31 million inhabitants. Physicians, far more so than other Ugandan health professionals, were seen by Bancroft and colleagues as dissatisfied with their work and both ready and capable of vacating their posts if the opportunity should arise. Along with nurses, physicians are the group most heavily courted by international recruiters, which means many of the physicians Bancroft spoke with may already have found an opportunity to leave Uganda.

The World Bank and International Monetary Fund have exacerbated the “brain drain” seen in Uganda and throughout Africa with “structural adjustment” policies that cap domestic health expenditures. Wealthy countries can offer doctors higher salaries, greater career advancement opportunities, and, in many cases, a more stable political environment in which to work.

The Global HEALTH Act, introduced by Rep. Barbara Lee in March 2010, would assist Uganda’s efforts and help curtail health workforce shortages in countries facing similar crises by providing $2 billion over five years to increase the number of physicians, nurses, and other health workers in developing countries—and to help retain those health workers already there. The bill not only authorizes new resources, it also calls for the creation of a US Global Health Strategy to complement the goals of countries like Uganda and ensure US aid money goes where it can make a difference. This study will help foreign aid innovations like the Global HEALTH Act to better tackle complex problems like brain drain and to work with communities to solve these challenges—something PHR is dedicated to helping support.