The WHO explains that “a shortage of qualified health workers in remote and rural areas impedes access to health-care services for a significant percentage of the population, slows progress towards attaining the Millennium Development Goals and challenges the aspirations of achieving health for all.” The WHO’s recommendations come at the request of global leaders, civil society groups, and Member States. WHO recommendations fall into four categories, with greater detail and context available within the body of the Report:

1. EDUCATION RECOMMENDATIONS
   Recommendations include targeted admission policies to enroll students with a rural background (who are statistically more likely to then practice in rural areas), exposing students to greater rural field work, and locating schools and residency programs outside of major cities.
2. REGULATORY RECOMMENDATIONS
   Recommendations include the creation of compulsory service requirements in rural and remote areas, educational subsidies offered with enforceable agreements of return service work in rural areas, and a focus on increasing the scope of medical practice in remote regions to increase job satisfaction.
3. FINANCIAL INCENTIVES RECOMMENDATIONS
   The WHO suggests “a combination of fiscally sustainable financial incentives, such as hardship allowances, grants for housing, free transportation, paid vacations, etc., sufficient enough to outweigh the opportunity costs associated with working in rural areas, as perceived by health workers, to improve rural retention.”
4. PERSONAL AND PROFESSIONAL SUPPORT RECOMMENDATIONS
   Recommendations include improved living conditions for health workers and their families in remote locales, career development programs to help rural workers progress in their careers, and the creation and promotion of senior posts in rural areas so that advancing workers are not forced to leave their communities.

The WHO suggests policies should be implemented in conjunction with the country’s national health plan and should be guided by the concept of health equity. The Report states that some countries, the Lao People’s Democratic Republic and Mali among them, are already considering using WHO recommendations to inform their retention policy.

As WHO guidelines have been disseminated, an August 14 article in The Lancet registered a first critique, underlining the roles of NGOs and INGOs in the internal brain drain within struggling countries. As an addendum to the WHO report, the article offers further policy recommendations, to be implemented in conjunction with WHO strategies.

Health and human rights education (HHRE) is my number one priority for the Physicians for Human Rights National Student Program.  I firmly believe that HHRE is essential to a quality medical school education and for the continued development of our health care system – both nationally and internationally.  Without a clear understanding of human rights and how human rights violations impact individual and group health, the failures in the health care systems around the world will persist.

At the national level, we will provide as much support as possible for local chapters that are working to implement HHRE.  This includes increased communication between interested chapter leaders, the development of resources, model curricula, and Toolkits online.  A group of students, who have already implemented some form of HHRE at their schools are available to you as HHRE Mentors who can offer information and ideas.  If you are interested in any of these, please don’t hesitate to contact Hope O’Brien with the National Student Program and she can put you in touch with the correct people.

At the University of Kansas Medical Center where I attend, the student chapter is working to gather the information and allies we need to attempt to introduce HHRE as a formal part of the curriculum.  We operate under a modular, systems-based curriculum and our chapter hopes to integrate at least one lecture on a human rights issue into each module.  Ideally, these lectures will be related to the module being discussed. For example, the curriculum of a sexuality and reproduction module would benefit from a lecture discussing the historic and continued oppression of women and the lasting health impacts that this has had.  Most of our modules (GI/Nutrition, Infectious Disease, Foundations of Medicine, etc.) offer fantastic opportunities to discuss human rights issues.

We are currently struggling with content for the lectures as well as a cohesive vision for the larger goals of the curricular change.  To address this, we have opened our discussion up to other students and physicians across the US to find out what are the most important parts of an HHR curriculum and what is the best framework to present it in.  I am happy to say that a number of colleagues, in and out of PHR, are assisting us with this.  We have also identified a number of faculty allies, but feel like we have not found a champion to take the mantle when we head into curricular discussions.  I am confident that we will be able to get investment from a physician by the time we have a more cohesive, complete vision.

I know that this will be a long process, both here in Kansas and nationally, but I think it is a battle worth fighting.  It always excites me when I hear about what other schools are doing and have done.  I would love to hear from some of you about what you are doing, planning, or dreaming of.

Jake Imber
Chair, PHR Student Advisory Board

(Cross-posted from the Midwest Regional Hub.)

First, the lifting of the AIDS travel ban was a huge step forward for the US, and because of it, in 2012 we’re finally going to be able to hold the International AIDS Conference on US soil, in our nation’s capital.

But even though people with HIV can come into the US, a lot of at-risk populations still can’t. People with a history of sex work or drug use offenses are still going to run into major visa and entry issues, so we in the human rights community have our work cut out for us. We only have a scant 2 years to get the US government to lift its substance use and “moral turpitude” travel restrictions (yes, that’s the actual legal language). Having an AIDS conference in our country but not allowing the most at-risk populations to attend would be a disgrace to our country’s AIDS record, and a violation of the human rights of hundreds if not thousands of people.

Second, the first successful proof-of-concept trial for a vaginal microbicide brought us this much closer to the long-sought female-controlled AIDS prevention mechanism. This field is exploding, and holds real hope for new prevention strategies until a highly effective vaccine is available. (And, as I heard at one session, the ladies liked using the gel – they didn’t want to give it back at the end of the trial. Even better.)

So, the bottom line is, there’s reason for hope, but we’ve got serious problems to solve before then. So let’s get on it.

(Cross-posted from the Northeast Regional Hub.)

14% of Ugandan physicians emigrate abroad, largely to four English-speaking countries—the US, Canada, the UK, and Australia. This number is significantly lower than that of some other countries in peril. For example, it is frequently said that more Malawian doctors practice in Manchester, England, than in the entire country of Malawi. Although Uganda’s health workforce shortage seems less drastic than Malawi’s, the crisis is no less dire: in 2008, the study’s authors estimated that there are only 2,500 physicians for Uganda’s 31 million inhabitants. Physicians, far more so than other Ugandan health professionals, were seen by Bancroft and colleagues as dissatisfied with their work and both ready and capable of vacating their posts if the opportunity should arise. Along with nurses, physicians are the group most heavily courted by international recruiters, which means many of the physicians Bancroft spoke with may already have found an opportunity to leave Uganda.

The World Bank and International Monetary Fund have exacerbated the “brain drain” seen in Uganda and throughout Africa with “structural adjustment” policies that cap domestic health expenditures. Wealthy countries can offer doctors higher salaries, greater career advancement opportunities, and, in many cases, a more stable political environment in which to work.

The Global HEALTH Act, introduced by Rep. Barbara Lee in March 2010, would assist Uganda’s efforts and help curtail health workforce shortages in countries facing similar crises by providing $2 billion over five years to increase the number of physicians, nurses, and other health workers in developing countries—and to help retain those health workers already there. The bill not only authorizes new resources, it also calls for the creation of a US Global Health Strategy to complement the goals of countries like Uganda and ensure US aid money goes where it can make a difference. This study will help foreign aid innovations like the Global HEALTH Act to better tackle complex problems like brain drain and to work with communities to solve these challenges—something PHR is dedicated to helping support.

The PHR National Student Program is busy this summer, expanding and improving the resources available to Chapters. Among other things, we’re creating lists to help you discover new resources and opportunities. In honor of summer reading lists, I wanted to give you a glimpse of our new Recommended Reading list.

Here’s a list of some excellent books, articles, and blog posts that will appear on the Recommended Reading list. Most were suggested by PHR staff and interns. Although Laurie Garrett’s 800-page Betrayal of Trust: The Collapse of Global Public Health might not be everyone’s idea of an ideal beach read, it might be just what you’ve been looking for.

Have a favorite that you didn’t see here? Maybe something that inspired your interest in health or human rights, or offered a new perspective on a topic near and dear to your heart? Post it in the Comments section below, and we might include it in the final version of the Recommended Reading list.

Books

Health and Human Rights: A Reader, Jonathan Mann, Michael A. Grodin, Sofia Gruskin, and George J. Annas.  (1999)

Perspectives on Health and Human Rights, Sofia Gruskin, Michael A. Grodin, George J. Annas, and Stephen P. Marks.  (2005)

These texts are often used in health and human rights courses.  Both are comprehensive anthologies of foundational essays on health and human rights, and examine issues from ethnic cleansing to women’s reproductive rights.

The Oath: A Surgeon Under Fire, Khassan Baiev and Ruth Daniloff. Dr. Baiev was caught in the the struggle between Chechnya and Russia. Regardless of their nationality or whether civilian or military, he treated everybody under extraordinarily difficult circumstances.  Considered a traitor to both sides, he was called a “bandit-doctor” (for treating Chechens) and a “pig-doctor” (for treating Russians). For years, PHR has worked to protect Colleagues at Risk – clinicians who are targeted for adhering to their Hippocratic Oath, despite the political situation.

The Spirit Catches You and You Fall Down, Anne Fadiman. Described by various PHR staff as “fantastic,” “riveting,” and “devastating and totally addictive,” this describes the clash of two cultures over a child’s health. Anne Fadiman writes with the insight of an anthropologist and the compassion of a friend. I worked with refugees for years, and I also saw heartbreaking conflict between people who each had a patient’s best interests at heart, but had very different beliefs about illness and health.

Betrayal of Trust: The Collapse of Global Public Health, Laurie Garrett.  As in another of Garrett’s massive tomes, The Coming Plague, Garrett uses investigative reporting to analyze public health preparedness.

The Bone Woman: A Forensic Anthropologist’s Search for Truth in the Mass Graves of Rwanda, Bosnia, Croatia, and Kosovo, Clea Koff. Koff takes the reader inside her life as a forensic anthropologist to see what it’s like to excavate mass graves and build evidence of human rights violations. PHR’s International Forensic Program relies on these skills in Afghanistan, Central America, and elsewhere.

The Dark Side: The Inside Story of How The War on Terror Turned into a War on American Ideals, Jane Mayer. This dramatic narrative reveals the decisions behind the controversial excesses of the war on terror and considers the impact of these choices. For more background and an update, visit PHR’s reports on torture of US detainees.

PHR Reports

From Persecution to Prison: The Health Consequences of Detention for Asylum Seekers. Asylum seekers who come to the U.S. to escape torture, persecution, violence or abuse are often locked up in inhuman conditions. PHR conducted the first systematic and comprehensive study about the impact of detention on asylum seekers’ mental health.

Achieving the MDGs by Investing in Human Resources for Health and The Right to Health and Health Workforce Planning. Access to healthcare depends in large part on the ability and distribution of a country’s health workforce. Investments that sidestep the training, payment and supervision of healthcare workers do not build the overall health system.

Stateless and Starving: Persecuted Rohingya Flee Burma and Starve in Bangladesh. In recent months Bangladeshi authorities have waged an unprecedented campaign of arbitrary arrest, illegal expulsion and forced internment against Burmese refugees. In this emergency report, PHR presents new data and documents dire conditions for these persecuted Rohingya refugees in Bangladesh. PHR’s medical investigators warn that critical levels of acute malnutrition and a surging camp population without access to food aid will cause more deaths from starvation and disease if the humanitarian crisis is not addressed.

Articles

Health and Human Rights is published by the FXB Center for Health and Human Rights at Harvard University. The original editor-in-chief was Jonathan Mann, succeed by Sofia Gruskin and then Paul Farmer, all pioneers in the field. By posing the question, “What is a rights-based approach to health and why should we care?” this issue began a series that dealt with fundamental concepts regarding health as a human right.  Subsequent issues tackle accountability (10:2), participation (11:1), and non-discrimination and equality (11:2). The series concludes with the most recent issue on international assistance and cooperation, edited by Jennifer Leaning, the new FXB director and a former PHR Board member. All material is freely available online.

Health and Human Rights Education in U.S. Schools of Medicine and Public Health: Current Status and Future Challenges, L. Emily Cotter et al.  PHR’s Senior Medical Advisor Vince Iacopino and the other authors evaluated obstacles to health and human rights education at schools of medicine and public health across the country.

Health and Human Rights, Jonathan Mann et al. A close look at the complementary ways that health and human rights define and advance human well-being:

• The Impact of Health Policies, Programs and Practices on Human Rights
• Health Impacts Resulting from Violations of Human Rights
• The Inextricable Linkage Between Health and Human Rights

The Challenge of Global Health, Laurie Garrett. Garrett’s critique of misdirected investment in global health got a strong reaction from the media and the global health establishment. Don’t miss the exchange between Paul Farmer and Laurie Garrett. Although the funding and policy environment has evolved since this was published, it’s a glimpse of a critical moment in global health.

Blog posts

The Right to Health: A Conversation with Helen Potts, PhD on the Physicians for Human Rights site. An informative and comprehensive look at the history and meaning of the right to health.

Refugees in America: Faces and Stories Behind the Refugee Protection Act. This post by Erin Hustings, PHR’s Asylum Advocacy Associate, on the PHR blog Health Rights Advocate, offers a personalized look at the refugees who are denied asylum in the United States because of unnecessary obstacles and technicalities.

On July 18, the world convenes again for the XVIII International AIDS Conference in Vienna, Austria — but will be short two shining stars. Arash and Kamiar remain in jail today. The Iranian government accused the brothers of using trips to AIDS and public health conferences around the world to “foment a velvet revolution” and sentenced them to years in prison. We say treating AIDS is not a crime.

Friends and colleagues of the Alaeis will be in Vienna spreading the word about their case and advocating for their release, and PHR will be supporting them all the way.

Will you be in Vienna at the AIDS conference? To volunteer with these efforts, email Clint Trout at clintworldwide [at] yahoo [dot] com.

Want to take action to support the Alaeis? Sign our new petition, calling on the government of Iran to free the Alaeis.

Throughout their careers, the Alaeis have promoted public health diplomacy and supported the quest for shared solutions to the world’s shared disease burden. It is an outrage to call this treason. Medical professionals should not be put in prison for doing their jobs. Take action today and stand in solidarity with the Alaeis.

See the Background page at IranFreeTheDocs.org for more information on their case.

From Dartmouth Medicine:

The Dartmouth Medical School chapter of Physicians for Human Rights received Dartmouth College’s Martin Luther King Social Justice Award for a student group. The award was accepted by the leaders of the chapter, Katherine Ratzan, a fourth-year M.D. student, and Alexandra Coria, a second-year M.D. student.

Katie Ratzan has a long history with PHR. She interned with Sarah Kalloch in 2004-2005, before entering medical school. She served on the Student Advisory Board (SAB) and has been a leader in helping other students introduce health and human rights education (HHRE) to their med school curriculum. Katie will soon begin a Pediatrics residency at the University of Michigan.

Alexandra Coria was recently chosen to join the SAB. Last year she served as a Regional Training Coordinator.

Through activities such as their recent panel on health, human rights, and the environment, Alexandra, Katie, and the other remarkable members of the Dartmouth Chapter have increased awareness and scrutiny of important human rights issues and broadened the audience for PHR’s investigations. PHR’s mission begins with the “mobilization” of health professionals, students and the community, and education like this precedes action. Student Chapters are a critical link between PHR’s work, the public’s demands for change, and policy responses that can put an end to human rights abuses.

June 12 marks the one year anniversary of Iran’s disputed election, which was followed by a government crackdown that saw an increase in arbitrary arrests, torture, and politically motivated use of the death penalty. The Global Day of Action calls attention to Prisoners of Conscience in Iran, and demands their unconditional release.

Since last year’s elections, the human rights situation in Iran has only grown worse. PHR continues to highlight the case of Drs. Kamiar and Arash Alaei, Iranian doctors who have been held by Iranian authorities since June 2008. After being imprisoned without charge for six months, the Doctors Alaei were convicted and sentenced for the charges of being in “communications with an enemy government” and “seeking to overthrow the Iranian government.” Kamiar was given a three year prison sentence, while Arash was sentenced to six years.

The Iranian government used the doctors’ travel to international AIDS conferences as a basis for the charge. Iran cannot continue to imprison medical professions for doing their job. By equating public health diplomacy with treason, the Iranian government poses a threat to all Iranians working for scientific knowledge.

Stand with PHR and the international community to tell the world that “Treating AIDS is not a crime.” Visit iranfreethedocs.org for more information on the Alaeis. And on June 12, please help us remember and defend those in Iran jailed for their humanitarian work.

Email President Obama today and tell him to join the Mine Ban Treaty.

PHR shared the 1997 Nobel Peace Prize for our work to ban landmines. Since then, 156 countries have signed onto the treaty, which bans the use, trade, production and stockpiling of antipersonnel mines.

However, the US has refused to join. President Obama now has the opportunity to partner with every member of NATO—and every country in the Western Hemisphere, save Cuba—in supporting this critical treaty. Tell him to take action today.

Landmines kill thousands of people a year, with millions more affected by the agricultural, economic and psychological impact of the device. While landmines are a weapon of war, most casualties are civilians: indeed, UNICEF estimates that 30-40% of landmine victims are children. And landmines don’t just kill in conflict zones: there are millions of landmines and unexploded ordinances in more than 80 countries worldwide.

These indiscriminate weapons maim and kill, and destroy families and communities. The US has not used landmines since the 1991 Gulf War; it is time for us to promise never to use them again. Tell Obama to join the Mine Ban Treaty today.

68 Senators co-signed a letter to President Obama in May, showing their support for the Mine Ban Treaty. Now Obama needs to hear from you. Email him today, and ask 6 friends to do the same. PHR members have been advocating to ban landmines for more than 15 years. This is our best chance to join the Mine Ban Treaty in years, and we need your support.

Take action today!

Want to do more? We are asking major US health professional associations to sign a letter to the Administration against the use of landmines. If you have any contacts at health professional associations who might be able to help, please email Gina at gcoplon-newfield[at]phrusa[dot]org.

Injury and Death:

• The International Campaign to Ban Landmines (ICBL) estimates that 15,000-20,000 people are maimed or killed by landmines yearly, with millions more affected by the agricultural, economic and psychological impact of the weapon.
• UNICEF estimates that 30-40% of mine victims are children under 15 years old.
• Landmines are responsible for the injury and death of thousands of US and allied troops in all US-fought conflicts since World War II, including dozens in Iraq and Afghanistan. In the 1991 Gulf War, landmines caused 34% of US casualties.
• At the beginning of the 20th century, nearly 80% of landmine victims were military personnel. Today, 90% of landmine victims are civilians.

The Economic and Social Cost:

• The ICBL estimates that there are millions of landmines and other unexploded ordnance in the ground in over 80 countries.
• Landmines cost as little as $3 to produce and up to $1,000 per mine to clear.
• Most kinds of landmines last forever. Mines laid during WWII are still killing and maiming civilians.
• It costs $100 to $3,000 to provide an artificial limb to a landmine survivor. Adults require a prosthesis replacement every two to three years and a child must have a new one every six months to a year.
• Landmines cause environmental damage in the forms of soil degradation, deforestation, and the pollution of water resources with heavy metals. Subsistence farmers are unable to work the land in mined areas.
• Landmines affect all aspects of human life, including the ability of refugees to return home. A report from the United Nations High Commissioner for Refugees (UNHCR) published in 1997 stated that 13.2 million refugees, 4.9 million internally displaced people and 3.3 million returnees were at risk from landmines.

The US and Landmines:

• The United States is one of only 39 countries that have not yet joined the Mine Ban Treaty; in the Western Hemisphere, only the U.S and Cuba are non-signatories.
• The US has the third largest mine arsenal in the world—a stockpile of 11 million Anti-Personnel Landmines (APLs)—despite not using landmines since 1991 or producing them since 1997. Enormous amounts of taxpayer money are used to maintain these weapons.
• The United States is one of only 13 countries that refuse to halt production of APLs.
• The Bush Administration’s landmine policy, announced in February 2004, represented a major rollback of US progress on the landmine issue. The policy increased funding for mines, permitted indefinite US use of self-destructing mines, and refused to phase out long-lived mines until 2010. The Obama Administration has yet to revise the Bush policy.

These indiscriminate weapons maim and kill, and destroy families and communities. President Obama is currently reviewing US landmine policy. We need your voice to tell the President to ban mines now! The US has not used landmines since the 1991 Gulf War. It is time for us to promise never to use them again.

Take action today: email Obama and tell him to join the Mine Ban Treaty!