Hesperian Weblog

Health advocates condemn Binayak Sen’s unjust conviction

On December 24th Dr. Binayak Sen, a vibrant voice for bringing health as a human right to the poor in India, was sentenced to life imprisonment for sedition. Hesperian has been campaigning against Dr. Sen’s unjust imprisonment and conviction, and stands with health advocates around the world in condemning his sentence. More than two dozen Nobel Prize winners have signed statements demanding his release and demonstrations have been held in many countries around the world against his trumped up conviction.

Read statements from our partners in Jan Swasthya Abhiyan (the Peoples’ Health Movement – India) and The Lancet below, and a statement from Dr. Sen here. You can also read mainstream media coverage of the initial protests against his sentence here, listen to radio coverage here, and find more information on the Free Binayak Sen campaign website. The campaign will be organizing a Global Day of Protest around January 30th, including a protest outside of the Indian Consulate in San Francisco on January 28th at 10am.

PHM India (JSA) statement on Binayak Sen's conviction
Date: 27 Dec 2010

We, the Jan Swasthya Abhiyan, a coalition of national networks and organizations actively working for health rights in the country, express our outrage at the verdict of the Raipur district and sessions court, on 24th December 2010, declaring Dr Binayak Sen, General Secretary of the Chhattisgarh People's Union for Civil Liberties and Vice-President of the National PUCL, guilty of sedition and treason, and sentencing him to life imprisonment.

Dr Sen has an illustrious record of over 25 years of selfless public service in areas of health and human rights. He has been an active member and former convenor of the Medico Friend Circle, a national organization of health professionals working towards an alternative health system responsive to the needs of the poor. He has been closely associated with the Jan Swasthya Abhiyan, the Indian chapter of the People’s Health Movement. In recognition of his work, the Christian Medical College, Vellore conferred on him the Paul Harrison Award in 2004, which is the highest award given to an alumnus for distinguished service in rural areas. He continues to be an inspiration to successive generations of students and faculty. Many of his articles based on his work have been internationally appreciated.

His indictment under the draconian and undemocratic Chhattisgarh Special Public Security Act, 2006, and the Unlawful Activities (Prevention) Act, 1967 is utterly condemnable. Not only has the farcical nature of the trial been reported in the media, the charges against Dr Sen, of engaging in anti-national activities, have been widely held as baseless. This judgment is an unacceptable attempt to intimidate and vilify those who advocate for the rights of the poor and the marginalized, and reveals the indiscriminate use of state machinery to stifle democratic dissent.

JSA believes that a great injustice has been done, not only to Dr Sen but also to the democratic fabric of this country. JSA salutes Dr Sen’s work, and demands that justice be delivered in his case.

Binayak Sen’s conviction: a mockery of justice
The Lancet
January 8, 2011

On Jan 4, the day this issue of The Lancet went to press, Binayak Sen should have been celebrating his 61st birthday. Instead, found guilty of treason and sedition by a court in the central Indian state of Chhattisgarh, Sen is facing the bleak prospect of a life behind bars. It is an inhumane sentence for a committed humanitarian, whose life before his imprisonment was devoted to improving the health and welfare of some of the most marginalised and poverty-stricken people in India—the Adivasi. This work led to Sen becoming the first Indian recipient of the Jonathan Mann award for Global Health and Human Rights in 2008.

From the outset the charges against Sen reeked of political motivation—a reaction to Sen’s tireless documentation of human rights abuse at the hands of the state. He was accused, on the flimsiest of evidence, of acting as a courier for the imprisoned Maoist leader Narayan Sanyal. The subsequent trial, spanning more than 3 years, was Kafkaesque. Its conclusion is a travesty.

Reaction to the ruling was swift, with the Indian press unanimous in their criticism of the court’s decision. Amnesty International described Sen as a prisoner of conscience, while a statement signed by over 80 prominent academics worldwide decried the sentence as savagery. The Lancet adds its voice to this chorus of condemnation.

In April, 2009, we called for the Indian Government to intervene in the case, and ensure that justice be done. An injustice can still be overturned by India’s supreme court. If it is not, the already profound damage done to India’s credentials as an upholder of human rights will be damaged for years to come. Where the state failed to provide for its poorest citizens, Sen stepped in to give them health care and to champion their rights. His reward: to be convicted under a section of the penal code first introduced by the British to quell political dissent, and later used to convict Mahatma Ghandi. On his conviction, Ghandi argued that the administration of the law had been “prostituted consciously or unconsciously for the benefit of the exploiter”. The conviction of Binayak Sen shows that, in parts of modern India, precious little has changed.

Photo courtesy of AFP/Getty Images via The Lancet. 

US affirms Human Right to Health with signing of Declaration of the Rights of Indigenous Peoples

On December 16, 2010, President Obama announced that the United States will sign the UN Declaration on the Rights of Indigenous Peoples. Among many other rights, the Declaration affirms that indigenous people are entitled to the human right to health:

Article 24, Section 2: Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively the full realization of this right.

Hesperian joins the People’s Health Movement and tribal leaders across the United States in applauding this move, especially in President Obama’s choice to specifically recognize the health disparities that exist in Native American communities. During a speech at a White House Tribal Nations Conference, President Obama said, “We know that Native Americans die of illnesses like diabetes, pneumonia, flu – even tuberculosis – at far higher rates than the rest of the population. Make no mistake: These disparities represent an ongoing tragedy. They’re cutting lives short, causing untold pain and hardship for Native American families. And closing these gaps is not just a question of policy, it’s a question of our values – it’s a test of who we are as a nation.” Hesperian and the People’s Health Movement have long believed that to achieve good health, communities (and governments) must address the underlying causes of poor health, including poverty, discrimination, and economic disparity.

A detailed, 15-page statement from the U.S. government on their support of the declaration can be found on the United States Mission to the United Nations website.

Graphic courtesy of UN Permanent Forum on Indigenous Issues

Hesperian friend Amy Hagopian under attack by Bill O’Reilly

Should We End Military Recruiting in High Schools as a Matter of Child Protection and Public Health?  

Amy Hagopian is an Assistant Professor at the University of Washington, and a long time friend of Hesperian who is now under attack by Bill O'Reilly of Fox News. Hesperian’s Director, Sarah Shannon, has worked with Amy on the Governing Council of the American Public Health Association, and in various activities within the International Health Section of the APHA and the People's Health Movement.

O'Reilly is attacking Amy’s well-researched and thought-provoking study, “Should We End Military Recruiting in High Schools as a Matter of Child Protection and Public Health?” published in the American Journal of Public Health. The study, co-authored with Kathy Barker, makes the case that military recruiters in high schools are a violation of the UN Convention on the Rights of the Child and a threat to the public health of adolescents. We're sharing a link to Amy's excellent paper, and an article from the Huffington Post denouncing O'Reilly’s attacks on her.

Read Amy’s paper here. 

An Indecent Man: Bill O'Reilly's Shameful Campaign Against Amy Hagopian
Dave Zirin, Sports correspondent for the Nation Magazine

In my mind, when the Fox News star Bill O'Reilly decides to make you a target, it's a badge of honor. This is a man who politically is a proud Islamaphobe, declaring, "We have a Muslim problem, not a Muslim extremist problem." And personally? Anyone who likes to tell people how his "happy ending" masseuse thinks he's well endowed clearly has trouble distinguishing fantasy from reality.

That's why his latest attacks on University of Washington Assistant Professor Amy Hagopian tells far more about the twisted mind of O'Reilly than the serious study the professor authored. Hagopian wrote an academic paper for the American Journal of Public Health making the case that military recruiters in high schools were in violation of the UN Convention on the Rights of the Child, a threat to the public health of adolescents, and even suggesting military recruiting behaviors were akin to -- as she put it -- "predatory grooming." It's a serious, data-packed analysis of the way recruiters have manipulated information and targeted the most economically disadvantaged students to fill the ranks of those fighting and dying in Afghanistan and Iraq.

The overarching thesis of the study is hardly shocking or groundbreaking. After all, we know that in 2005, the Army ordered its recruiters to "stand down" for a day of retraining because of habitual mendacity. We know the intense pressures on military recruiters to meet quotas has led to a series of high profile ethical violations. I know from my work at DC area high schools that the recruitment booths aren't set up at elite institutions like St. Alban's or Georgetown Prep. They're at public high schools like Ballou and Bell. In other words, recruiters fish in places where young people have fewer options. Hagopian's academic study simply backed up what has been over the last five years, a very public scandal. This is what I thought when I read her paper.

When O'Reilly read her paper.... all right let's stop there. I will contend there is no way Bill O'Reilly actually read her piece. None. He doesn't reckon with any of Hagopian's sobering data. He doesn't reckon with the suicide rates among troops, the effects of exposure to depleted uranium, or any of the ways that the realities of war are fudged over by recruiters to fill their quotas. There is just O'Reilly doing his neo-McCarthyite best to chill free speech. All O'Reilly needed was Hagopian's use of the word "predatory" when describing recruiters. Next thing you know, he was hitting the airwaves attacking Hagopian for calling recruiters "child molesters."

This is sick. Why this is where O'Reilly and his producers' minds go is honestly between them and their internet browsers. But tragically, when he sends his shock troops into battle, they can damage a person's life. Now, Amy Hagopian, for the unholy crime of conducting academic inquiry into a public scandal, has been harassed by O'Reilly's loyal listeners. They have sent threatening letters and emails to the school offices. They have made a series of profane phone calls to her colleagues. They have contacted her university and demanded that she should be fired for writing what is a peer-reviewed publication in the primary journal of public health in America. Please take a moment and imagine if that was you. Imagine if you created a contribution to public discourse to provoke discussion and debate. Imagine if you were ready to defend your findings against others who would surely disagree. And then imagine if instead you found yourself a personal target for a reactionary media giant using his outsized pulpit to make your life a living hell. That's not journalism and it's not punditry. It's the actions of an obscene, indecent bully. If there is one object lesson I've learned about O'Reilly's character from these attacks, it's that he clearly despises women who tell sobering truths. I suppose he just wants them to administer happy endings.

Photo by K. Barker, from the AJPH paper: Students at Garfield High School in Seattle, WA, drop to the floor for pushups under the command of a military recruiter at the school in 2009

New Contraceptives Are Not Enough

Late last month, Nicholas Kristof wrote a column for the New York Times on contraception, “Birth Control Over Baldness” as well as a blog post called “An Aside on Contraception.” 

In these two pieces, Kristof bemoans the lack of funding for new contraceptive technology, saying, “Yet after three millennia, although we can now intercept a missile in outer space, we’re often still outwitted by wandering sperm. Largely, that’s because research on contraception is pitifully underfunded; if only family planning were treated as seriously as baldness! Contraception research just hasn’t received the resources it deserves, so we have state-of-the-art digital cameras and decades-old family planning methods.” He argues that cheap contraceptives could make a huge difference in the developing world.

We agree! Helping families plan and space their children is an essential part of empowering women, especially in developing countries – and investing in new technologies that make contraception more accessible, easier to use, or with less side effects, is to be championed. However, the problem of promoting contraception use in developing countries (and here in the U.S.) is not as easy as just creating new methods.

Hesperian friend and partner Melissa Smith, medical editor of Where Women Have No Doctor, summarized these challenges in her response to Kristof, published in the comments section of the NY Times blog:

While researching low-cost effective contraceptives is critical to improving global health, let us not forget to support grassroots action to deal with barriers to family planning.

As a physician in poor Guatemalan communities, I witnessed high maternal and infant mortality rates. Data show that simply spacing pregnancies by two years can dramatically reduce these deaths.

Contraceptives, however, often sit unused on clinic shelves. Family planning myths, religious barriers, and resistance from male partners mean many women cannot access contraceptives.

Effective strategies to address these barriers do exist, though they are not widely known. Grass-roots activists are working throughout the world to change this by publicizing ways communities can overcome these challenges.

If we focus on research but neglect grassroots strategies, we run the risk that these new methods will gather dust on clinic shelves along with existing contraceptives – affordable or not.

Melissa Smith, M.D

For more information about grass-roots efforts see: Community Action for Women’s Health and Empowerment, a work in progress at the Hesperian Foundation.

Thanks, Melissa, for bringing to light many of the complexities and nuances of this issue!

The Human Right to Water and Sanitation

Hesperian has long recognized safe water and sanitation as cornerstones to health and human dignity. Today we join the global water justice movement in celebrating a major victory: the United Nations General Assembly vote to recognize the human right to water and sanitation. 124 countries voted in favor of the resolution, while 41 voiced their opposition by abstaining, including the US, UK and Canada.

As a result of this historic resolution, the human right to "safe, clean, drinking water and sanitation" is now formally recognized in international law, and is no longer omitted from the Universal Declaration of Human Rights.

Hesperian has written about how people have struggled corporate interests and even their own governments to ensure safe and sufficient water as a fundamental right here, here, and here.

In addition, Hesperian’s groundbreaking A Community Guide to Environmental Health, published in 2008, is a practical and empowering resource that clearly makes the connections between our health and the health of our environment, with water and sanitation identified as core issues (the book is available for free download here).

Today we celebrate, but we also know that this is just the first step in making sure that safe water and sanitation reach the billions that live without it.

The urgency of realizing that goal is no where better expressed than in the moving speech given by Pablo Solón Romero, Ambassador of Bolivia to the United Nations, in his effort to convince the governments represented in the United Nations to vote in favor of this historic resolution.

“The Human Right to Water and Sanitation”

New York, July 28, 2010

Mr. President,

Allow me to begin the presentation of this Resolution by recalling that human beings are essentially water. Around two thirds of our organism is comprised of water. Some 75 percent of our brain is made up of water, and water is the principal vehicle for the electrochemical transmissions of our body.

Our blood flows like a network of rivers in our body. Blood helps transport nutrients and energy to our organism. Water also carries from our cells waste products for excretion. Water helps to regulate the temperature of our body.

The loss of 20% of body water can cause death. It is possible to survive for various weeks without food, but it is not possible to survive more than a few days without water. Water is life.



That is why, today, we present this historic resolution for the consideration of the plenary of the General Assembly on behalf of the co-sponsoring countries of: Angola, Antigua and Barbuda, Azerbaijan, Bahrain, Bangladesh, Benin, The Plurinational State of Bolivia, Burundi, Central African Republic, Congo, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Eritrea, Fiji, Georgia, Guinea, Haiti, Madagascar, Maldives, Mauritius, Nicaragua, Nigeria, Paraguay, Saint Lucia, Saint Vincent and the Grenadines, Samoa, Saudi Arabia, Serbia, Seychelles, The Solomon Islands, Sri Lanka, Tuvalu, Uruguay, Vanuatu, The Bolivarian Republic of Venezuela, and Yemen.

The right to health was originally recognized in 1946 by the World Health Organization. In 1948, the Universal Declaration of Human Rights declared, among others, “the right to life,” “the right to education,” and “the right to work.” In 1966 these were furthered in the International Covenant on Economic, Social and Cultural rights with the recognition of “the right to social security,” and “the right to an adequate standard of living,” including adequate food, clothing and adequate shelter.

However, the human right to water has continued to fail be fully recognized, despite clear references in various international legal instruments such as: the Convention on the Elimination of All forms of Racial Discrimination, the Convention on the Elimination of All Forms of Discrimination Against Women, the Convention on the Rights of the Child, and the Convention on the Rights of Persons with Disabilities.

This is why we, the co-sponsors, present this resolution in order that we now recognize the human right to water and sanitation, at a time when illness caused by lack of drinking water and sanitation causes more deaths than does war.

Every year, 3 and a half million people die of waterborne illness.

Diarrhea is the second largest cause of death among children under five. The lack of access to potable water kills more children than AIDS, malaria and smallpox combined.

Worldwide, approximately one in eight people lack potable water.

In just one day, more than 200 million hours of women’s time is consumed by collecting and transporting water for domestic use.

The situation of lack of sanitation is far worse, for it affects 2.6 billion people, or 40% of the global population.

According to the report on sanitation by the Independent expert, “Sanitation, more than many other human rights issue, evokes the concept of human dignity; consider the vulnerability and shame that so many people experience every day when, again, they are forced to defecate in the open, in a bucket or a plastic bag. It is the indignity of this situation that causes the embarrassment.”

The vast majority of illnesses around the world are caused by fecal matter. It is estimated that sanitation could reduce child death due to diarrhea by more than one third.

On any given day, half of the hospital beds are occupied by patients suffering from illnesses associated with lack of access to safe water and lack of sanitation.

Mr. President,

Human rights were not born as fully developed concepts, but are built on reality and experience. For example, the human rights to education and work included in the Universal Declaration on Human Rights were constructed and specified over time, with the International Covenant on Economic, Social and Cultural Rights and other international legal instruments such as the Declaration on the Rights of Indigenous Peoples. The same will occur with the human right to water and sanitation.

That is why we emphasize and encourage in the third operative paragraph of this resolution that the independent expert continue working on all aspects of her mandate and present to the General Assembly “the principal challenges related to the realization of the human right to safe and clean drinking water and sanitation and their impact on the achievement of Millennium Development Goals.”

The Summit on the Millennium Development Goals is approaching, and it is necessary to give a clear signal to the world that drinking-water and sanitation are a human right, and that we will do everything possible to reach this goal, which we have only 5 more years to achieve.

That is why we are convinced of the importance of the second operative paragraph of this resolution, which “Calls upon States and international organizations to provide financial resources, capacity-building and technology transfer, through international assistance and cooperation, in particular to developing countries, in order to scale up efforts to provide safe, clean, accessible and affordable drinking water and sanitation for all.

All resolutions contain a passage that we can point to as the heart of the matter, and the heart of this resolution is in its first operative paragraph. Throughout many informal consultations, we have striven to accommodate the different concerns of the Member States, leaving aside issues that do not pertain to this resolution and always seeking balance, but without loosing the essence of the resolution.

The right to drinking water and sanitation is a human right that is essential for the full enjoyment of life.

Drinking water and sanitation are not only elements or principal components of other rights such as “the right to an adequate standard of living.” The right to drinking water and sanitation are independent rights that should be recognized as such. It is not sufficient to urge States to comply with their human rights obligations relative to access to drinking water and sanitation. Instead, it is necessary to call on states to promote and protect the human right to drinking water and sanitation.

Mr. President,

In our effort to seek transparency and understanding without losing perspective on the essence of this resolution, in the name of the cosponsors we would like to propose an oral amendment to the first operative paragraph of the resolution that would replace the word “declares” with the word “recognizes.”

Mr. President,

Before moving to the consideration of this resolution, I would like to ask all delegations to bear in mind the fact that, according to the 2009 report of the World Health Organization and UNICEF entitled “Diarrhoea: Why children are still dying and what can be done,” 24,000 children die in developing countries every day from preventable causes like diarrhea contracted from unclean water. That is one child death every three and a half seconds.

One, two, three…

As my people say, “Now is the time.”

Thank you very much.

Environmental Justice in Detroit and Beyond – Fighting the World’s Largest Trash Incinerator

The next time some perky, well-meaning health professional cheers you on to take charge of your health, remember to ask her how to do it without breathing. That’s what it would take for Detroit residents who live in the shadow of the world’s largest incinerator, owned by Covanta.

A coalition, including local environmental justice groups, the Teamsters, and neighborhood residents, is calling for the plant to be closed. Hesperian staff and several hundred others attending the US Social Forum, joined them by participating in a march on June 26. The coalition says, “Detroit’s children suffer asthma rates three times the national average. The municipal incinerator is a major contributor to these devastating health impacts. Meanwhile, the recycling rate in the city is less than a third the national average.” They are advocating for resources to be put into recycling instead of incineration, which provides good jobs and is better for people and the planet.

As we walked through the urban neighborhood near the incinerator, marchers covered their faces, choking on the thick, foul air. We walked by a park, a school, a church, and down residential streets, where people daily breathe in the incinerator fumes. We were appalled to see houses literally right next to the incinerator.

The march made it painfully clear to us that whether we are able to live healthy lives has only partially to do with the individual decisions we make or our genetic makeup. More critically, our health is a product of our environment, of our social, political, and economic realities.

Activists from Detroit and around the country described those diverse but connected realities and their common struggles for health and environmental justice—fighting coal mining in West Virginia, trash incineration in New Jersey, and the Chevron oil refinery right here in Richmond, CA. Their stories echoed others we had heard earlier that week, of people fighting for their right to health in communities across the country and around the world, often in the face of incredible odds.

Detroit’s weekly, The Metro Times, described the march in their summary of the USSF:

On Saturday, when an estimated 1,000 people marched from the city's main public library on Woodward Avenue to the incinerator located near the intersection of Interstates 94 and 75, residents of the 48217 ZIP were shoulder to shoulder with environmental activists, out-of-town forum attendees, people living around the incinerator and a dozen men wearing shirts that identified them as "Teamsters for Clean Air, Good Jobs & Justice."

Asked why Teamsters would be supporting an action like this, one of them replied, "We breathe the air too." And, moreover, said organizer Alex Young, recycling operations in places like Oakland, Calif., are providing union members good-paying, green jobs.

Among those joining the march on what has been described as the world's largest incinerator was Cynthia Mellon of Newark, N.J., home to what she said is the world's second-largest incinerator.

"We didn't know you existed before," she told the Detroiters. "Now we are all part of a big cause."

Rhonda Anderson, who does environmental justice work for the Sierra Club's Detroit office, has been one of those working for more than two years to get the incinerator shut down. One of several speakers to address the crowd, Anderson choked back emotion as she declared: "You have lifted our spirits. You have raised our expectations. You have served as a model for our children."

San Francisco author and historian Chris Carlsson described the action to close the incinerator on his blog:

“Demonstrations took place around Detroit to address local issues, from a small-ish demo outside DTE Energy, the local utility, to a larger march on Saturday against a massive trash incinerator. …. Incineration of trash instead of a curbside recycling program is a self-defeating industrial process. The utility claims that burning trash to make electricity in a state-of-the-art facility reduces carbon emissions over putting it all in landfill, which is questionable at best. But if you take into account the “externalities” of local health problems, air pollution, etc., not to mention that it takes rather fewer people to collect the garbage and dump it into an incinerator than it does to run a robust recycling program that makes use locally of the materials it recycles, and you are compounding a whole series of social problems… I learned later that the fight against the incinerator has been going on for over 20 years!”

Hesperian has long recognized the connection between health and the environment. Our newest book, A Community Guide to Environmental Health focuses on giving people the tools to address environmental problems in their communities. It includes an entire chapter of alternatives to incineration to deal with solid wastes, as well as detailed plans for health clinics to safely handle health wastes without burning.

Photo by Amanda Starbuck

Health and Human Rights at the US Social Forum

 At the end of June, two staff members from Hesperian traveled to Detroit, Michigan for the United States Social Forum, where we joined 15,000 other community organizers and social justice activists from around the US to network, share, and learn. We’ll be blogging about the Social Forum over the next couple of weeks, and wanted to begin by sharing some of the inspiring stories we heard from people across the country who are organizing around the human right to health. 

At a popular education workshop put on by the Highlander Center and Colectivo Flatlander, we came away with the clear message that, to quote the facilitator Pancho Argüelles, “people won’t fight for shit they don’t think belongs to them.” In other words, understanding that human rights – including the right to the highest possible level of health and well being – belong to all of us without exception can give us the strength to fight to make sure that those rights are realized.

In this spirit, several groups, including Hesperian and the People’s Health Movement, organized a People’s Movement Assembly (PMA) on the right to health and health care, titled “What the health happened and how do we get the health care we need?” The goal of the PMA was to develop a joint resolution outlining shared values and ways to move forward together. The full text of that resolution, along with the other resolutions created at the USSF, is online here.

Over 100 people participated in the PMA, and many shared stories of both hard times and successes – when they were denied health and dignity, and when they fought back. Often, these stories highlighted some of the opportunities (and challenges) for using a human rights framework to organize in the US.

For example, Vermont is the site of a major state-level victory in the struggle for the right to health. The legislature recently passed a bill requiring that the state hire an independent consultant to develop three plans for a universal health care system, including one single payer model.

A speaker from the Vermont Workers Center explained the human rights approach that led to this remarkable success: “human rights… really means engaging folks first. It is about finding out from people where the system has failed them.” The VWC spent the first year of their campaign holding community meetings across the state, declining to include legislators. Focusing on people’s stories and experiences meant that the campaign was centered on those most affected. Only after they had developed a broad base of support did they approach the legislature.

In the end, although legislators balked at using the term “human rights” in the bill, they enshrined fundamental human rights principles by requiring that all 3 plans “ensure universal access and coverage, be comprehensive and affordable, be transparent in design and… ensure public participation in the design, implementation, evaluation, and accountability.” Plenty of work is still needed to make sure this bill is effectively implemented, and the Vermonters called on all of us to stand with them as they continue this fight.

On the other side of the country, in South Los Angeles, shared values of health and human rights have allowed organizers, service providers, and community residents to build bridges and mobilize around the many causes of poor health in their community. Last summer, 700 people, including Hesperian staff, came together for a historic conference in South L.A. Individuals and groups working on diverse issues including homelessness, violence, transportation, food, and health care, collectively developed a framework and goals: the South Los Angles Declaration of Health and Human Rights.

 Here in the Bay Area, Hesperian has helped to start a health and human rights learning circle to strengthen our understanding about the framework and build community locally. We certainly have a lot to learn from the struggles in other parts of the country and the world, and will be continuing to meet monthly over the next year (contact phm@hesperian.org if you are interested in receiving information about meetings and events).

Nationally, many other groups are actively advocating for a just and inclusive health system—to learn more, visit the websites of the National Economic and Social Rights Initiative and Healthcare-NOW!.

Of course, in addition to envisioning and working towards truly universal and accountable health systems at different levels, we also have to address immediate challenges as best we can. We’ll be writing more on that and a workshop organized by the People’s Health Movement and Doctors for Global Health in the coming weeks. Also stay tuned for our reflections on the June 26th protest against a local incinerator in Detroit, a clear example of how realizing our right to health requires working for social and environmental justice.

Opening march photo by Chris Crass, photos of PMA by Leona McElevene

World Cup of Health: The Netherlands vs. Spain

At Hesperian, as with much of the world, football fever is in the air as the final of the World Cup approaches. Isolated whoops of victory and cries of defeat can be heard around the office, as staff members surreptitiously (or not-so-surreptitiously) keep an eye on their favorite teams. Comparisons and discussions are inevitable, and it didn’t take long to connect the game with the subject that is constantly on our minds here: health. What if the fates of the two competitors in Sunday’s final were to be decided through their approach to health and social justice, as opposed to a lucky kick of a ball?

Given the similar nature of the two countries, comparing their health systems would at first appear to be a yawn-inducing draw. Both the Netherlands and Spain have universal health care for their citizens; both are in Western Europe; and both are members of the European Union. Here in the US, where universal access to quality care is still a frustratingly distant goal, we wish we had anything like our finalists. But even with such enlightened rivals, quality health and especially health care equality is not assured.

The Netherlands uses a dual-insurance system of national health care, with long-term treatment and high-cost items such as wheelchairs covered by the state, and shorter-term procedures covered by mandatory private insurance, which is paid for by the individual and her or his employer. Spain, on the other hand, has a national health service that is all-inclusive and can be used by all residents. It is important to note that neither nation covers the important fields of dentistry and eye care. In both countries, citizens must buy private insurance for these.

Perhaps the biggest distinction between the health care in these two countries is how they treat undocumented immigrants. This is one of the many gaping holes in the recent US health reform, with the nation’s 7 million undocumented immigrants living in third-world conditions because of a lack of basic care. It seems that the Netherlands is not much different. Although they possess a wide social safety net, the Dutch do not extend it all the way down the social ladder. Undocumented immigrants do have opportunities to get care, but are often discouraged by doctors, the medical system, and other factors. Spain, in contrast, passed a law in 2002 extending full medical coverage to undocumented immigrants and there is little detectable difference between their access to care and that of the average Spanish citizen.

When the teams line up for the final this Sunday, there’s no telling who will come out the victor. In terms of equality in health care, however, the answer is clear: ¡VIVA ESPAÑA!

The Undermining of Haitian Health Care: Setting the Stage for Disaster

One of the barriers to health after the earthquake has been the lack of medically trained Haitians to care for the sick and wounded. The blame for this can be laid squarely on the doorstep of the US government which sponsored the 2004 coup that removed Aristide from power and shuttered the medical school he founded. This article tells the (very short) story of that medical school, but it also tells of how the students continued their education at the Latin American School of Medicine (ELAM) in Cuba, and returned to Haiti to work tirelessly after the disaster. Hesperian, MEDICC, and ELAM collaborated in the production of a 4-language medical glossary (Kreyol/ English/ Spanish/ French) in the days after the earthquake.

This article was taken from the NACLA website [www.nacla.org] on Feb. 22, 2010.

The Undermining of Haitian Health Care: Setting the Stage for Disaster

by Kevin Edmonds, NACLA

In December 2003, the dedication ceremony of Haiti’s first and only public medical school, a project jointly supported by the governments of Haiti, Cuba, and Taiwan, took place at the University of Tabarre in Port-au-Prince. At the time of the school’s opening, Haiti had one of the worst doctor-to-patient ratios in the world (one to 10,000 in urban areas and one to 20,000 in rural areas), and the school’s ability to provide free medical education was considered one of the most important achievements of former president Jean Bertrand Aristide’s administration.

In a declaration full of optimism and hope, the Dean of Health Sciences, Dr. Yves Polynice stated: “The inauguration of the Aristide Foundation University is an opportunity to renew our Hippocratic Oath where each physician pledges to care for the poor, widows, and orphans free of cost. We must be conscious that any illness affecting one citizen represents a threat to us all. Today we say ‘health care for all, without exclusion.’ ” On February 3, 2004, the hospital officially opened its doors and began treating many of Haiti’s most vulnerable. For many it was their first visit to a doctor.

The mood of optimism and hope expressed by Dr. Polynice on that December day didn’t last long. Just two weeks later, on the evening of February 28, 2004, Aristide was overthrown and forcibly removed to the Central African Republic in an internationally organized coup d’état. Less than one month after its opening, the hospital and the university complex it was part of were closed down at gunpoint and occupied by U.S. Marines and the United Nations Stabilization Mission in Haiti (MINUSTAH). The 247 new medical students watched as their classrooms were turned into barracks, their instructors forced to flee from political persecution (due to threats on his life, Dr. Polynice fled to Europe), and much of their material and equipment pillaged to service the capital's private medical clinics. The school was finally abandoned by MINUSTAH and reopened to students in the summer of 2009, but with widespread budget cuts and curriculum changes that downplayed its original community service mission.

Despite the United Nations’ efforts to “stabilize” Haiti after the 2004 coup, politically motivated violence, and widespread, systematic persecution of Aristide supporters sharply escalated. In this politically charged atmosphere, the 247 medical students were never able to return to Tabarre to complete their medical education. Since the new medical facility was a collaborative project of the Haitian, Cuban, and Taiwanese governments, the Cubans extended a helping hand to the Haitian doctors and staff and allowed them to continue their medical training free of cost at the Latin American Medical School (ELAM) in Cuba.

The students from Tabarre were not the first Haitian students to study in Cuba. Since the devastation of Hurricane George in 1998, Cuba has promoted a humanitarian exchange with Haiti which provides medical professionals to the country’s remote regions and trains Haitian medical students. When the January 12 earthquake struck, there were an estimated 400 Cuban doctors working in Haiti, along with 573 Haitian doctors who were trained in Cuba, and now they are covering the entire nation.

Tabarre was not the only medical school in the country, but it was the only one that provided free education to its students. The school recruited prospective doctors from poor families from all of Haiti's nine departments. It also offered free room and board to students if they entered an agreement to serve for several years in remote regions of Haiti. These were significant agreements because some 90% percent of the nation’s doctors work in the capital, Port-au-Prince, while two-thirds of all Haitians live in rural areas. This concentration of doctors in the capital has created a situation in which the majority of Haitians—those who live in rural areas—are left without the most basic elements of health care.

At the time of the school's opening there were fewer than 2,000 Haitian doctors in the entire country. In a nation with so few doctors, this school was an ambitious, essential project. Before its closure, it was estimated that the school would train 600 new doctors during its first 12 years of operation. It was hailed as a step forward in the epic effort to provide the citizens of Haiti with a basic health care infrastructure, in spite of the ongoing aid embargo to Aristide’s administration.

After this year’s devastating earthquake, many of the medical students who had left in February 2004 returned to the site of the university and reunited with teams of Cuban doctors to provide emergency care and treatment for the disaster’s victims. Surprisingly, the medical school survived the quake intact, and by January 15 became a site of refuge for more than 10,000 victims of the earthquake. That same day Aristide Foundation spokesperson Toussaint Hilaire reported that there were many doctors on site, but critically lacking medical supplies. He emphasized that the road to the medical school was unobstructed and that supplies could be directed there. Several hundred yards away, at the newly occupied Toussaint L’Overture airport, U.S. forces were busy diverting planes bringing lifesaving medical equipment into the country in order to allow additional troops onto the island to maintain control of the on-the-ground situation.

The Aristide administration’s creation of this free medical school was a herculean achievement, contradicting the media’s claim that Aristide had abandoned his populist roots. The closure of the school has not only severely crippled Haiti’s ability to effectively deal with the barrage of hurricanes, floods, and landslides it has faced in recent years, but has also served the political purpose of erasing the legacy of Aristide and his political movement, Lavalas.

On February 10, filmmaker and activist Kevin Pina reported to the Canada Haiti Action Network that the medical school at the University of Tabarre had been once again occupied — this time by troops of the U.S. Southern Command. That a public medical school could have become a reality in Haiti despite the aid embargoes, massive debt payments, widespread destabilization, and privatization of nearly everything speaks to the iron will of the Haitian people to better themselves. Sadly, the closure and occupation of Tabarre once again reflects the equally hardened determination of others to prevent them from doing so. “While extreme earthquakes are acts of nature,” wrote Tracy Kidder in a recent New York Times op-ed piece, “extreme vulnerability to earthquakes is manmade.”

Putting the 'Humanitarian' Back in “Humanitarian Aid”

We were relieved to hear that Roseanne Auguste and our friends at the Haitian women’s organization APROSIFA survived the earthquake and are taking part in the relief efforts to rebuild a stronger Haiti. We worked closely with APROSIFA as they translated and produced Kote Fanm Pa Jwenn Dokte (Where Women Have No Doctor) in Haitian Kreyòl. The following report by Beverly Bell highlights the efforts of these incredible women to build community and help one another rather than remaining passive recipients of less than adequate aid. This article was originally posted on the Other Worlds website at: http://www.otherworldsarepossible.org/just-alternative-haiti/putting-humanitarian-back-humanitarian-aid

Putting the 'Humanitarian' Back in "Humanitarian Aid"
by Other Worlds Coordinator Bev Bell

One of the first things that Haitians now living in the streets want to talk about is their disgust over the international food aid program. In such places as the camps in the downtown parks on Boulevard Champs de Mars, residents report, food is given sporadically – last week not for four or five days. Moreover, it is uncooked rice, and many of those living in the crowded shelters have no way to cook it. Some have been able to sell the rice and, with the funds, buy food that they can eat.

In a heavily militarized operation, U.S. Marines distribute rice from CARE and U.S. Agency for International Development. Haitians stand in lines for hours in the hot sun, sometimes receiving nothing, or scramble for food dropped from the air. “We are not dogs,” said one woman in front of a sheet which serves as the front door of her new home in a public park. “The way they do it just breeds indignity,” said another.

Lance Jean-Francois, of the community organization Solidarite Ant Jèn Veye Yo (Solidarity Among Youth / Be Vigilant), says, “A danger of aid is that it infantilizes people. We say that what will traumatize the Haitian people even more than the 35 seconds of the earthquake is finding themselves, from one day to the next, standing with bowls in their hands and waiting for someone to give them a sheet so they can sleep. This dependence is terrible for people’s identity.”

The Marine-led distribution, involving weapons on the part of the givers, frustration on the part of the receivers, and more frustration still among those who do not receive, has led to violence. There has been neither security nor equal access for women in the process, though some of the food operations are now offering women separate lines.

Tanya Felix, also of SAJ Veye Yo, says, “U.S. soldiers giving rice… our problem isn’t insecurity. This is not how we should be helped. We need people helping us who won’t humiliate us.”

Some grassroots Haitian organizations here are showing how humanitarian aid programs can do just that, provide help without humiliation. One of these is in the extremely economically depressed neighborhood of Carrefour-Feuilles. There, the Association for the Promotion of Integral Family Healthcare (APROSIFA) has contracted with twenty timachann, small food vendors with roots in the community, and will soon contract with thirty more. Each serves one meal a day to the same ten or fifteen families, usually with upwards of seven members per family. By the time the project has fully scaled up, it will formally provide food for approximately 5,400 people each day. Moreover, says Roseanne Auguste, the technical advisor of and organizer of the program, when the women finish serving those they’re responsible for, they keep serving hungry people who come until the pots are empty – for free, out of solidarity. The program is financed by grants made to APROSIFA, and will continue until the end of April.

The food served is all domestically grown. Roseanne says, “Instead of sending rice from the U.S., I would like to tell the international community that the earthquake didn’t affect production in this country. We can produce food.”

One of the timachann’s operations takes place in the lakou, communal courtyard, of three extended families. There an enormous mango tree provides shade. This afternoon, Madame Gabeau has just finished the preparation of three industrial-sized, blackened pots containing rice, bean sauce, and vegetables. As Madame Gabeau’s team – or what she calls “her family” - awaits their food, they exchange news with each other in the shady courtyard. They are neighbors, if not friends. Two elderly matriarchs in nightgowns and short gray braids, 77-year-old identical twins, come over to tease Roseanne. Little kids strike vampy poses, pushing each other out of the way to get in the center of a photographer’s camera frame. A young woman sits on a high tree root with her baby on her lap, examining her face in a hand mirror inside a plastic Elmo frame.

People calmly talk and laugh while Madame Gabeau ladles mountainous servings into the containers they hand her: lunch buckets, tin bowls, a Styrofoam to-go box. The scene is no different than many pre-earthquake Sunday afternoons in Haiti, except that all the people here are hungry and homeless due to one of the worst natural disasters in history.

Another humanitarian aid operation is underway in a damaged kindergarten building in the beaten-down neighborhood of Belaire. Each day the youth group SAJ Veye Yo feeds 400 people and shelters 200 people, from a bright-eyed baby to a very elderly man. SAJ Veye Yo’s resources are a combination of free truckloads of water from Oxfam Quebec and a local Haitian company, and funds given by the Haitian state and a German company. Three doctors, Haitian and German, fill volunteer shifts three afternoons a week.

The main room is dark, with people sitting in small groups or alone. The walls are lined with stacks of bundles tied in sheets. Above the bundles, white banners read ‘love,’ ‘solidarity’, and ‘respect.’ A boy and a girl play checkers on a piece of cardboard; the boy assures visitors that he’s the best. A two-year old dressed only in a T-shirt toddles towards a photographer’s camera, beaming and calling, “Photo. Photo.”One woman, in response to whether she wants her picture taken, replies in perfect English: “No. I don’t want my family to see me in a shelter.”

Out back a woman sits on a stool washing a big battered pot with a small bowl of water. Two women swing on children’s swings, next to a slide which is now buried under a collapsed cement-block wall. One woman cooks in a little concrete building, while another offers glasses of cold, fresh orange juice all around. In a classroom, three volunteer medical students arrange first aid supplies on shelves.

Lance Jean-Francois says, “People need to know that we can count on ourselves. We don’t lack anything, we have the capacity. That’s what behind this initiative. We accept support that comes, but in the framework of respecting people’s dignity.”

Could these community-run responses be scaled up adequately to meet the need? Probably not; the numbers of those who cannot now afford food is unknown, but vast. The capacity of Haitian non-governmental groups is limited.

But could the international organizations offer Haitians a way to stay fed while maintaining dignity and security? The grassroots models show that the answer is yes.