Politics and advocacy
Paul Drain
11-16-02
Rich Kovar:
Politics is related to refugee health. Graduated from med school in 1980, did residency in family medicine. Has spent time since then doing medical work at native American reservations. Looked at going into Indian health services. 1984, experience on Thai-Cambodian border. Refugees were fleeing across the borders while military was attacking. This led him to 20-year passion of caring for refugee populations. Then went to Ethiopian border and worked with IRC. Then worked in northern Thailand with Laotian population. His experiences have build upon themselves. Now works with health centers in Seattle. Then they hired another person so they could all spend 3 months of the year abroad. He did this for 8 years. He spent time in Iraq in 1991. Also had experience in Romania, Ecuador, and Peru. Encourages people to have international experiences, especially before taking on domestic responsibilities. Currently involved with three issues. Economic problems in citywide health centers. Last year the city has proposed to eliminate most of their services. They are treating 50% of their people who don’t have health insurance, which normally don’t have a large voice. He started a grassroot campaign to try to conduct advocacy work to restore their funding. They are serving vulnerable group and fighting for their access to care. He has maintained that energy because of his experiences. Also looks at torture victims. Many people claim asylum, because they will be deported to their homeland where they could be tortured or killed. He is part of the Physician for Human Rights Assylm network. Has found it very rewarding, but challenging. He is familiar with the types of state sponsored torture. Many countries that people fear returning. Third focus is landmine work. In 1984, he took care of many civilians who had stepped on landmines. He has seen many problems associated with people hitting landmines. Currently about 80,000 landmines around the world. There is a lot of advocacy in this arena already. Landmine production has decreased due to political advocacy. Trafficking of landmines has been completely eliminated. Many countries have no signed the landmine ban treaty, but not the US. The challenges of advocacy are to get these countries to support the treaties. Last December, they had a large number of Congress people sign a letter indicating that landmines should be banned. Most of the work is being conducted at a real grassroots level. Other advocacy groups are working on victim assistance. These problems are very real and become very personal. You should all find some issues that mean something to you where you do some work and provide some effort. Should try to carry on the political work here while working as physicians.
Donna Deno:
Worked in a rural district hospital in Ghana. Did residency in peds. Joined faculty of med school in Ghana. Wanted to make a bigger contribution while working with faculty in Ghana. In 1990, tensions between Iraq and Kuwait. She is an Iraqi-American and still has family in Iraq. She is familiar with Iraq before war and during sanctions. She has also talked to people who have done diplomacy. History of Iraq according to her timeline handout. Iraq has the second largest oil reserves in the world. Much of the attention on Iraq has focused on the oil reserves. Iraq was a well-established country before the 1990 war and sanctions. During Iran-Iraq war, they were improving social and health statistics. Their gains were significant during the 1980s. There was also a significant middle class during this time. They had the best medical and education system in the Middle East. War was targeting the infrastructure of the country. The sanctions have been incredibly crippling. Because of the sanctions they have had little opportunity to rebuild their infrastructure. Many civilians have lost their lives during the war, but more have died due to sanctions. Madeline Albright said, “the price is worth it”, related to Iraqi sanctions. Iraq has moved from a developed country to a very poor nation. She has been involved with medical training of students and residents, but has a difficult time with the political issues related to health. When you run into issues that are important to you, you should get involved. Congressman McDermott has actively lobbied for the people of Iraq. He voted against the admin. Proposal to preemptively attack Iraq. Her group has done much to advocate with local politicians. Also seeing some progress with newspapers, such as the Seattle PI and their supplement on the effect of sanctions on Iraq. Although some stories don’t reflect the entire picture, there are making progress. She included a handout on how to become involved in the issues. Encourages everyone to become involved in the issues. Should take a look at national policies and our political history.
Stephen Gloyd:
Political activism usually comes from a passion and a sense of outrage. We are in a sense of outrage with many global issues. Certainly many issues that we should be outraged about and there are many things that we can do. First, one should know the issues, important to know the historical, technical, and policy issues. Second, should make friends and work with institutions. We should all be a cog in the wheel of institutions that are working in the right direction. Third, we should be persistent. In many parts of Africa, syphilis is very high and the newborns become infected. Most governments have screening programs, but it wasn’t being done. This was a great opportunity to promote their policies and show that it works. The ministry said they would do the screening and then nothing happened. They then talked to the provincial directors and worked with them individually. Started doing syphilis testing in many provinces and hit many obstacles. Then used non-reusable syringes, but had logistical difficulties in transporting supplies. This project took a lot of persistence. We also have to keep focused and he found an ally in the UNFPA. Sometimes need to map the environment to see whom you can work with and who holds the power. Also did WTO protest march in Nov. 1999. There were 50,000 marchers around the issue of global health and the whole debate around the issues of globalization has changed the actions. Sometimes we have to move in positions of taking risks. Recently 20,000 people marching in Central Park and no mention in the New York Times. Current passion is providing HIV treatment in Africa. One out of a thousand people are being treated. The public health community is perpetuating this situation. Often times, we go along with the arguments against treatment. Started two things in Seattle, formed a coalition group. Talked with McDermott for two hours. He and Nancy Pilose were head of international task force on AIDS. He said he was not taking a leadership. They were persistent. We have seen movement in the past two years. Now more willing to engage in discussion on HIV/AIDS. Last year, prime minister of Mozambique was against the use of HIV treatment in country. He would have to double health care budget to treat AIDS. The health minister was in favor of treatment. Health minister knew there were some people active around HIV/AIDS. Set up an appointment with the prime minister, they told him a friend of his just died of HIV and how they are doing treatment in other developing countries. Two weeks later he switched his posture and became in favor of doing treatment in Mozambique. Then he gave a speech at Barcelona conference on HIV treatment. The country is now looking at doubling the health ministries fund to provide treatment for HIV/AIDS. This largely the result of advocacy works by several organization. Sense is that advocacy works, but with much persistence. At some levels, advocacy may be more important than technical work.
Questions:
One voice: We need to confront elected officials to our voices. Also newspapers want to see that they are addressing the views of their readers. Also can work as a team with other people who have already established advocacy work. Also could work to save one person at a time. Often the gains are small and you have to take pleasure in the small steps. Can now go to many websites to contact people. Also can understand the issues rather easily with information provided online. Easy to find ways to get involved and there are many organizations that are always looking for help.
Orphan program: Abandoned children are very disenfranchised children. Conditions are very difficult for them to grow up. His involvement is with an international adoption agency, World Assoc. of Children and Parents. Many children being adopted around the world. Can become involved with volunteer programs to provide supplies or teach basic nursing skills. Also many other ways to become involved. Certainly can become involved with many family planning programs.
Native American: Don’t need to go further than this area to see the suffering of people. He took some class in public health and became focused on public health issues. These classes are available at any level of training. Encourages everyone to take some classes related to health of underserved populations. AMA can match up providers with opportunities in Indian health. Also could look at Indian Health Services.
Funding: Funding is certainly key. After working for a while overseas, start to learn what the issues are. Not always an issue of money. Sometimes passion is more important than money.
Change of gov’t people: Need to use experience and wisdom. Need to be informed about the message and try to appeal to all people. Have to appeal to all types of arguments. Need to become politically sophisticated. Politicians need to become re-elected and so they need to work with people and coalitions. Need to reach across political spectrums to attract allies.
Grey areas: Should know your limits and engage where you feel necessary. In addition, you shouldn’t compromise your beliefs due to your funding sources.
What should we do: First, become knowledgeable. Find groups that you can belong to and try to do work together. Talk with other progressive people and organize resources and efforts.