Health and Human Rights:

Liberation Medicine and Oppression Medicine

"Health is a fundamental human right indispensable for the exercise of other human rights. Every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life in dignity." [From General Comment 14: The right to the highest attainable standard of health (article 12) of the UN Committee on Economic, Social and Cultural Rights (CESCR)]

Those concerned for human rights and health share the common goals of alleviating suffering and promoting well-being of all people. Conceptually one can point to the rising incidence of HIV/AIDS, to women's health issues, including gang rapes and the sex trade in Burma, and to the blatant violations of human rights in Burma's prisons as having brought attention to the intrinsic connections that exist between health and human rights. Medicine is the conscious, conscientious use of health to promote social justice and human dignity.

In their book The Virtues in Medical Practice, Edmund Pellegrino, MD, and David Tomasma, PhD, present the concept of medicine as a moral community: "These three things - the nature of illness, the non proprietary character of medical knowledge, and the oath of fidelity to the patient's interests - generate a strong moral bond and a collective responsibility... Medicine cannot, and should not, undertake all of this alone. It can join with other health professionals, concerned people and legislators."

Liberation Medicine

Liberation Medicine implies caring, compassion and humility — three qualities too seldom seen in clinical medicine or in the training of health professionals. The patient wants to know how much you care before they care how much you know. The caring relationship requires nurturing the patient and caring about what happens to them. Compassion means "suffering with." The best doctors feel as their own the suffering of their patients and the patients' loved ones. Compassion means empathy and kindness, which patients need much more than they need another test. Doctors usually have strong egos, strong self-confidence. But to truly understand a person requires a feeling of equality.

Oppression Medicine

There are still physicians in some parts of the world who continue to comply with governments in supporting the use of torture or other inhumane punishment as a means of exercising state control, repression or terror. During apartheid, 73,000 people were incarcerated for indefinite periods without being charged with any crime. Many were tortured. African surgeons who were responsible for providing medical care to detainees were pressured not to examine detainees who had been assaulted or tortured and not to report any injuries they did find. Health professionals have a strong positive influence on the promotion and protection of human rights within the populations they serve. Yet violations of human rights perpetrated by health professionals regularly occur. Often they occur because the health professionals fear the consequences of refusal especially if they hold a high position in the medical field or are employees in the military. This is oppression medicine.

How can we promote liberation medicine?

If we look at the South African experience, there still were a lot of South African physicians who stood up to fight against apartheid because they believed it was their moral and professional obligation to do so. The anti-apartheid National Medical and Dental Association had more than 1000 members by 1989. These physicians saw the suffering and injustice of apartheid in its many manifestations. Many took significant personal risks and suffered damage to their careers. However, it is from their values that an ethic of health and human rights may emerge.

Liberation medicine is to forge a path for hope. Like the hope found in Paulo Freire's Pedagogy of the Oppressed, "The dehumanization resulting from an unjust order is not a cause for despair but for hope, leading to the incessant pursuit of the humanity denied by injustice. Hope, however, does not consist in crossing ones arms and waiting."

Our leader Aung San Suu Kyi has stated in the Voice of Hope ....."Yes, I do hope because I'm working. I'm doing my bit of try and make the world a better place, so I naturally have hope for it. But obviously, those who are doing nothing to improve the world have no hope for it. Why should they? They are not doing anything to improve it any way. But I think that there are many people who are working really hard to improve the situation. I don't mean by this politicians or leaders of social or religious movements. I mean ordinary people. And those who are working to bring about positive changes are always more powerful, than those who are sitting and letting things take their course."

This means we must strive to work for liberation, make every effort to overcome obstacles and honor the Hippocratic oath. Individuals, groups and countries who do not believe that Health is a fundamental Human Right will not of themselves give up the position in which they negatively affect lives. The only way for them to do so is to receive pressure to do so, pressure from within their own base of support (which, of course, is also affected due to the inter-relatedness of the world — as Martin Luther King said, "you are not free until I am free").

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 2001-04-23. The posting has been edited for inclusion on the Burma Watch International Web site.