viernes, agosto 03, 2007

The fight for physician freedom.

July 10, 2007 Carol Hilton
In some countries, health-care workers are persecuted for helping others, especially in fights for human rights. Doctor members of Amnesty International are there to help
Almost every issue of the Medical Post includes an inspiring story of doctors using their skills and compassion to help fellow human beings in need. Our contributors have traveled to remote areas of China to offer life-altering surgeries to repair cleft palates, launched a school breakfast program for children in rural Bolivia, and served as an HIV educator in Ivory Coast with Médecines Sans Frontières, to name just a few.
Toronto psychiatrist Dr. Don Payne serves as the national volunteer co-coordinator for Amnesty International Canada's Medical Network.
These efforts are celebrated, as they should be. But, on the flipside, can you imagine being persecuted for treating victims of torture? Or having your own government harass you for daring to suggest improvements to a hospital clinic? Or losing your job and having your family threatened for being a peaceful advocate for freedom of speech?
These are realities faced by physicians around the world, as they are not only morally obliged to provide care but are also among the most educated members of society and natural leaders. That has led physicians and other health-care providers here to take advantage of their freedom to support colleagues and protest these actions through Amnesty International Canada’s Medical Network.
“The mandate is to work within Amnesty International and its concerns, but we have a special interest in issues related to health care and health-care workers,” explains Dr. Don Payne, a Toronto psychiatrist who serves as the network’s national volunteer co-coordinator. “We deal with health-care workers who are detained or harassed because of the work they do, especially work on human rights. We’re also involved with health conditions in prisons, issues such as torture and opposition to the death penalty, and certain other issues that come up, such as punitive amputations.”
Dr. Payne was one of the first members to join AI’s Canadian Medical Network in the late 1970s, when Drs. Philip Berger and Federico Allodi sent out an announcement seeking interested parties. Today there are 120 members across Canada, made up mostly of physicians (60%) but also including nurses (20%) and other health-care workers (20%).
An interest in world events, different cultures and human rights made volunteering for this group a good fit for Dr. Payne, he says. One of the first cases the group worked on had particular significance for him since it involved a physician in his field.
“I think the people you admire are those who stand up for their principles no matter what,” he says. Back in the early days of the medical network, Dr. Anatoly Koryagin from the then U.S.S.R. was one of the first cases upon which the group acted.
“During a time with a great abuse of psychiatry in the U.S.S.R., dissidents were often put in hospitals and given large doses of medication to keep them quiet. Dr. Koryagin was one of the people who stood up very strongly against that, and in 1981 he was detained and sentenced to 12 years’ imprisonment. He was finally released after a lot of political pressure in 1987.”
Another case that struck a chord with Dr. Payne was that of Dr. Fanny Pollarolo in Chile. Like several other psychiatrists, Dr. Pollarolo was banished to a remote village without a trial for having treated victims of torture under the military dictatorship of Augusto Pinochet during the mid-1980s. But she was not defeated; she set up a new psychiatric treatment program in the village.
Cases of physicians and other health-care workers who are threatened or abused continue to emerge every year, and are varied and numerous. Dr. Payne notes that for Amnesty to get involved in a campaign, the organization must be able to get reliable information from the country. He says very little information trickles out of countries such as North Korea, and even when doctors were arrested after a protest in Syria in 1990, Amnesty could not obtain details on those who were detained, making it impossible to take action.
On the other hand, the group has acted on several cases in Turkey, where people working in torture treatment centers have been harassed, and doctors have been pressured to sign false death certificates after prisoners in detention died because of the torture they experienced. Another situation involved members of the executive medical association being charged for actively opposing the use of the death penalty in Turkey, with the government stating that is not within the doctors’ mandate and they should just do their work and not interfere with the politics of the country, Dr. Payne says.
“But just because there are more actions on Turkey compared with other countries doesn’t mean Turkey’s worse than other countries,” Dr. Payne continues. “There may be more actions in countries where there is more information available, or more reliable information, so there’s more for AI to act on, and Turkey is one of those countries.”
A Cuban physician living in exile in the United States says individuals can make a big difference just by showing their support to colleagues suffering discrimination and abuses elsewhere under oppressive regimes. Dr. Eloy A. Gonzalez fled his home in 1999 with his family as a political refugee, after his work as an oncologist was halted and his family harassed due to his involvement with peaceful protests and the Independent Medical School of Cuba, an organization founded in the early 1990s that promotes the development of medical work in the country without interferences of a political nature. (Dr. Gonzalez was not the subject of an Amnesty campaign.)
In an e-mail interview translated from Spanish from his new home in Fort Worth, Texas, Dr. Gonzalez explains that the Cuban government does not permit freedom of association and targets the members of this medical group. He says Castro’s communist regime holds up health care as a jewel in its crown, so any criticism of the system is not tolerated.
The Cuban Revolution took control of the prestige of the Cuban medical class . . . since from Cuba’s foundation as a nation it has been associated with two personages who reflect power: the generals and the doctors. . . . In spite of diminishing the image of the doctor and to reduce it to a health supplier, in spite of time passed, the doctor continues to be a profession admired and wanted by the rest of the population. The regime does not want to see them in opposition.”
Dr. Gonzalez now runs a blog, Medicina Cubana ( where he reports on human rights abuses perpetrated on members of the medical profession in Cuba. In one entry on his blog, he describes the case of Dr. Marcelo Cano Rodriguez, who was prosecuted in part for maintaining ties to humanitarian groups such as Médecins Sans Frontières. The police declared Dr. Rodriguez was seeking support in the form of medicine, clothing and books with the intention “to destabilize the Ministry of Public Health and to undermine the existing social system in Cuba,” Dr. Gonzalez explains.
My medical colleagues in Canada and other places of the world, I would ask them to show a noble action of solidarity and honour these Cuban doctors who today serve prolonged and unjust sentences (perpetrated by) an incorrigible dictatorship. . . . I want to express my gratefulness to the Medical Post for the opportunity to present the reality faced by Cuban doctors today.”
Dr. Payne says it’s easy in Canada to do human rights work and respond to abuses documented in other areas of the world. “It’s hard to appreciate the freedom we have in Canada when that’s not present in many other countries where you don’t dare to say anything against the government publicly.”
Looking back, Dr. Payne recalls one highlight where he was able to meet an individual who was the subject of an Amnesty appeal. The Medical Network had appealed on the behalf of four doctors imprisoned in northern Somalia in 1985 and 1986, who were arrested for belonging to an organization called Ragga U Dhashay Magaaladda, a group that did volunteer community projects, including one to improve conditions at an eye clinic (reported in the Medical Post, Feb. 11, 1986). The government claimed it was an illegal, subversive political group involved in spreading anti-state propaganda, and the doctors were sentenced to 20 years in jail for their involvement. “It was a special occasion for me to meet one of the doctors at a workshop organized in Washington in June 1991 by the National Academy of Sciences to mark their release, and to show him a copy of the Medical Post article.”
Physicians interested in getting involved with Amnesty International Canada’s Medical Network can do so with a minimal commitment. The group tackles specific issues and asks members to write letters, which Dr. Payne says can be done in just a half-hour per month. He adds that while many of the group’s members are in Toronto, there are also a number of members in small communities across Canada, as it are work that can be done anywhere.
“Physicians are usually busy, so they don’t like going to a lot of meetings,” Dr. Payne says. “They prefer specific work: ‘Tell me what to do, where I can be helpful, and let me go ahead and be helpful.’ Our network is geared to that.”