Health and Human Rights:

Tuberculosis and Human Rights

The case of a Burmese student with TB

It was one late afternoon in January 1989 when I received a phone call from the NLD office that one of the tricolor students, who is also one of the body guards of Ma Ma Suu, was ill. He was having bouts of hemoptysis (coughing out blood). I asked them to bring the student to Rangoon General Hospital and I had his Chest X Ray taken at the emergency department. As expected he had tuberculosis (TB of the lungs). I got him admitted to my medical ward 19&20 and appropriate treatment was given. Ma Ma Suu phoned me to enquire about his condition. She was worried and really concerned for the student whom she regarded as just like her own son. I told her not to worry as TB is a treatable and curable disease — just take the treatment for one year (or at most maybe one and a half years) and then he will be fine. BUT I WAS WRONG. The student was taken to the prison before he could complete his anti-TB treatment.

It has been 12 years and he is still in Myingyan prison, still suffering from bouts of hemoptysis (from uncured tuberculosis), weakness, and edema (swelling of the limbs). He is not getting any treatment for the illness he is suffering from.

International standards for the treatment of prisoners

The rules governing the treatment of prisoners are codified in a number of instruments:

• United Nations Standard Minimum Rules for the Treatment of Prisoners
• United Nations Body of Principles for Protection of All Persons under Any Form of Detention or Imprisonment
• Council of Europe Recommendation Concerning the Ethical and Organizational Aspects of Health Care in Prison.

The Third Report of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment reads in part:

• Article 71: The health-care staff in any prison is a staff at risk. Their duty is to care for their patients (sick prisoners).
• Article 72: The available resources (for medical services) should be managed by a (qualified medical authority), not by bodies responsible for security or administration.

Prisons and Human Rights

Here I would like to raise the issue of prisons, tuberculosis and human rights, and their inter-relation.

Human rights derive from the dignity of the individual and are universal. Tuberculosis is easily diagnosed, treatable and curable, but may lead to death if neglected. Not getting appropriate treatment in the prisons is considered as a violation of human rights.

Because proper diagnosis and treatment of tuberculosis are life-saving, treatment and control of tuberculosis and any other diseases is the component of a prisoner's minimum rights. Prisoners have the right to health care at a level that meets community standards.

No incarcerated individual should bring tuberculosis into the prison; no prisoner should be exposed to tuberculosis while in prison; and no released prisoner should take tuberculosis from the prison environment back to the community.

Prisoner's rights must be respected while taking public health considerations into account. The conditions of prisons in Burma are cruel, inhuman and degrading. They are torturous. Prisoners are denied treatment.

In places where basic human rights are well respected, tuberculosis is a tradeable commodity. Prisoners may even try to get on tuberculosis programs because of the benefits of getting special diet, heated bed and etc.

The role of health care workers

Health workers employed by the custodial authorities are at risk of developing divided loyalties (or fear of losing job, fear of persecution), between the service that employs them and the patients (prisoners) entrusted to their care. If medical staff are not independent, ill prisoners may be exposed to a variety of abuses.

Health workers must have the ability to report to and appeal to a superior medical authority or to the Minister of Health in the event of conflicts between professional ethics and requirements imposed by the custodial authority.

We have studied medicine in order to care for the people, not to kill them. It is time for the health professionals to stand up for what is right!!

Dr. Khin Saw Win (Alice)

This commentary is based on a posting Dr. Khin Saw Win made in the soc.culture.burma newsgroup and the FreeBurma Yahoo! Group on 2000-11-10. The posting has been edited for inclusion on the Burma Watch International Web site.