Land evictions in Cambodia
Kelly Schunk
Published on December 7, 2007 in International Herald Tribune
November marks another month of forced land evictions in Cambodia. On Nov. 2, an entire village of 130 families was demolished near Phnom Penh, and on Nov. 15, another 300 families were evicted in Northern Cambodia.
I recently spent several months in Cambodia working for a nongovernmental organization in a community development project, where I saw first-hand evidence of the problem. I will never forget the Cambodian woman who stood before me, clutching her baby and holding on to another child. Tears poured down her face as she described her eviction by the police and relocation some 20 kilometers outside Phnom Penh. Her new "home," is an unsettled site that offers nothing more than a makeshift shelter, lacks running water, latrines, electricity and access to a clinic or school. For entire article, go to: http://www.iht.com/articles/2007/12/07/opinion/edlet.php?WT.mc_id=rssopinion
Justice for Genocidaires
Claire Tebbets
Published on Nov 19, 2007 in The Austin Statesman
Thirteen years ago, violence erupted in Rwanda. Over the course of 100 days, 800,000 Tutsis were slaughtered as extremist Hutus engaged in what has aptly been called genocidal mania by one human rights group. By the time the killings abated in July of 1994, the population of the country had been literally decimated.
Despite the heinous nature of the acts committed during the Rwandan genocide, more than a decade later many of the perpetrators of these acts have not been brought to justice. Estimates of participants in the genocide vary wildly, from tens of thousands to several million. Regardless of the true number, what is clear is that the overwhelming majority of these so-called genocidaires have escaped punishment. This is unacceptable. Both the United States (US) and the larger international community must act now to prosecute these crimes of genocide. For entire article, go to: http://www.statesman.com/opinion/content/editorial/stories/11/18/1119tebbets_edit.html
Thirsty Georgia, Thirsty World
Faith McCollister
Published on December 5, 2007 in The Rockmart Journal (Georgia)
The state is going thirsty. With Georgia’s drought rating exceptionally high and water levels in Lakes Lanier and Allatoona lower than ever before, Georgians have had to get used to a formerly unthinkable threat: not enough water. We are collecting rainwater, letting our lawns go dry, and thinking about the terms “climate change” and “water rights” in a new light. While we may feel that this is a crisis without precedent, our state is actually just joining the ranks of many countries that have been dealing with this pressure for a long time.
Despite Governor Perdue’s recent prayer service, there is still not enough water falling from the sky. There are multiple claims on the dwindling water that Georgia collects in lakes and reservoirs but our neighbors rely on as well. The frustration that many in the Southeast are feeling over government wrangling about water use mirrors the frustration that people in the developing world have felt for years over the increasingly pinched global water supply.
Fights over rights to a region’s water are not unique to the southern United States. Internationally, governments are fighting challenges from other nations and even private companies for rights to local water. For example, in 2005, a town in southern India sued to block the Coca-Cola Company from using vast amounts of local groundwater to bottle beverages at the expense of farmers’ crops and local drinking water.
Desertification is a process that has been occurring in the Sahel, a region in western Africa, for decades and is threatening many people’s livelihoods. Careless cutting of trees and vegetation and poor farming methods have combined with a long-term drought to turn much of the area’s fertile soil to infertile desert. In addition to the obvious problem of a lack of food, the growing water crisis has caused disputes between local groups of farmers and herders.
The problem is growing: about 40 countries in Africa and the Middle East may experience severe shortages of water by 2025. Food supplies will be affected, and disputes between upstream and downstream communities will increase. As we have seen in the South, booming cities will compete for increasingly limited rural water supplies.
The United Nations Economic and Social Council stated in 2002 that access to water is a “human right” and that governments “have to adopt effective measures to realize, without discrimination, the right to water.” According to the World Health Organization, over a billion people in the world do not have access to safe drinking water. A rapidly increasing global population is forcing many to consider whether water is a right, something all humans need and should have access to, or a commodity to be sold to the highest bidder, with the disadvantaged losing out.
As we take shorter showers and re-think plans for landscaping projects, we as Georgians must keep in mind that we are not alone in our fears about the water shortage. This water crisis, while hopefully temporary, can serve to make us more aware of our global neighbors’ struggles with a dwindling water supply.
Tweaking Bedside Manner
Moneeza Walji
Published in The Mississauga News (Canada)
Female Genital Cutting or Female Genital Mutilation (FGM) as it is more widely known is practiced on over 3 million girls a year. It is estimated over
130 million girls have been affected by the practice. Many of whom are
from countries such as Somalia, Eritrea, Mali and Nigeria.
FGM involves a range of practices that remove or alter a part of the
external female genitalia, usually of young girls (anywhere between 3 days
to 15 years old). The practice is often a deeply entrenched social norm,
through which families gain social status. Despite what many who
propagate the practice say, it is not mandated by either Christianity or
Islam, but is an age-old tradition which has become a right of passage in
many African and Middle Eastern countries.
In the past the Canadian medical community had no need to be prepared
to deal with the practice, as women from these regions were
underrepresented. Much has changed. Ontario is now the home to the
largest population of Somalis outside of Somalia (upwards of 150,000). It is
estimated FGM is practiced on 98% of Somali girls. With simple math it is
obvious: the numbers are no longer insignificant.
FGM is merely one example. The marking of World AIDS day on Saturday,
highlights another. Currently there is limited discussion around FGM in
medical schools, despite the fact that it often results in serious medical
complications during childbirth. It is time the Canadian medical curriculum
be updated to deal with this and the breadth of other issues which arise as
a result of a changing Canadian population.
We need to ensure that those who enter Canada as refugees or
immigrants be met with a health care system which addresses their
needs. Despite the Trillium Health Centre’s recent success as the hospital
with the lowest death rates, I wonder how many physicians would be able
to explain what FGM was, let alone not panic when presented with a case
during a regular physical examination. Perhaps it is time we take our
multicultural principles to our bedside manner.
Brain Drain: The Quiet Killer
Lucy Anderson
Published on December 4, 2007 in The Berkeley Daily Planet (California)
It is devastatingly ironic that the world’s poorest countries are, to some degree, subsidizing the healthcare of the wealthiest nations. For years, rich nations encouraged African countries to invest in infrastructure (education, hospitals, medicine); much aid was given to strengthen these very systems. Although it was unintentional, the donations proved to be quite self-serving. As wealthy countries give aid to struggling nations to improve healthcare outcomes with one hand, they siphon off graduates of medical schools with the other. The developed world benefits from the skills and knowledge of newly arrived doctors and nurses while the countries that produced these professionals suffer from staffing shortages.
The reasons behind the migration of health care workers are fairly obvious. Most hospitals in Sub-Saharan Africa are dismal places: over-crowded, grossly understaffed and under-equipped. Medical personnel are often frustrated. Salaries are very low and rarely enough to entice doctors, nurses, and clinical officers to stay in rural areas or even capitol cities. Trained in the treatment of patients, they are unable provide these services due to a lack of essential equipment and supplies. It may be difficult to imagine a hospital wanting in stethoscopes, hospital beds, gloves, and syringes yet these are the issues countless providers face every day.
Of course the West did not intend to decimate Africa’s medical force but this is what is happening. Countries like the United States, England, and Australia have nursing shortages they are unable to meet. The United States alone needs 129,000 additional nurses to meet today’s health requirements. There are not enough American nurses to fill the demand and the US and other developed countries in similar positions eagerly hire doctors and nurses trained in other parts of the world. This is especially true for former commonwealth nations as English-speaking staff from poor countries are quickly absorbed by hospitals in London and New York. The United States employs half the world’s English speaking physicians. Developed countries need staff to maintain high medical standards and to care for aging populations. Cataclysmically, underdeveloped countries face a double burden of disease; chronic non-communicable diseases as well as HIV/AIDS and many diseases that no longer affect rich countries.
Market forces and a bleak future at home have led many health workers to emigrate. The more that leave, the worse the situation becomes and the more difficult it is to keep floundering health systems afloat. As poor governments struggle to run schools of medicine, pharmacology, nursing, dentistry, etc students graduate and leave to look after patients in richer parts of the world. Poor countries cannot compete with the salaries offered in industrialized nations. International aid organizations who hire national staff exacerbate the problem as well. By paying medical personnel up to ten times their public sector jobs they draw them away from district and rural facilities and provide no one to fill the gap.
In Malawi, which has one of the lowest physician/patient ratios, there are about 250 doctors for a country of 13 million. With one physician per 52,000 people, and serious problem with HIV and AIDS, the situation is grim. The irony is that the areas with the highest disease burdens have the lowest numbers of professionals to provide essential care. Medical staff are not immune to the diseases that affect their patients; particularly in Sub-Saharan Africa, systems are wracked by loss of staff to AIDS.
What is to be done about this brain drain on the developing world? The reality is that more medical staff, particularly nurses, are needed worldwide. Developed countries should commit to training enough medical personnel to meet their own health needs. Expanded and new nursing schools are crucial to producing the necessary cadre of providers. Professors of nursing need to be adequately compensated and retained to teach future generations of nurses. Exchange programs between facilities in rich and resource-poor settings would allow for a wider clinical experiences and collaboration between colleagues. Wealthy nations could encourage their nurses to gain work experience in less developed settings. The Peace Corps, or a similar agency, could place American nurses in under-developed settings for a couple years in exchange for some student loan forgiveness. The situation requires new and innovative solutions. At the end of the day, it is vitally essential that developing countries are able to retain the staff in whose training they invest. Literally, the health of millions depends upon it.
Physical Therapy and Disaster Relief
Sandy Do, PT DPT
Published in Autumn 2007 issue of Dispatches, newsletter for the International Health Division of the Canadian Physiotherapy Association
Shahnaz is a 17 year old earthquake survivor I met in Pakistan 3 months after she had bone-setting surgery for her leg. She developed a preventable knee deformity in which her knee became frozen into a 60 degree flexed position. Her latest X-ray showed good bone healing and no bony structures that would inhibit normal use of her leg, yet she is unable to walk without assistance. This physical disability will potentially leave her socially isolated, unmarried, and unable to meet the physical demands of her conservative farming community. A simple and timely physical therapy intervention would have prevented this physical disability.
650 million people suffer from physical disabilities worldwide. Of these, 520 million people lack access to essential physical rehabilitation services that place them at higher risk for poverty, isolation, and socioeconomic dependence, as well as diminished quality of life. Physical rehabilitation is a basic human right for persons with physical disability.
Currently the largest humanitarian relief organizations do not recruit physical therapists (PT) in the acute disaster/emergency scenarios. This is largely because physical therapists have historically been considered tertiary healthcare providers, awareness of the profession is inconsistent, the role of physical therapy has been poorly defined, and populations most affected by lack of physical therapy services remain silent. This piece seeks to outline the potential role of PTs in the acute earthquake relief scenario, while advocating for humanitarian relief organizations to recruit physical therapists.
In many industrialized countries, physical therapists participate in the acute, sub-acute, and chronic portions of healthcare delivery. In the U.S. it is common practice to have a PT see a patient post-operatively day 1, 2, and 3 to educate the patient on movement restrictions and allowances, basic exercises, wound healing/management, pressure sore prevention, and to assist in regaining functional mobility (for example, sitting, standing, walking). Although very basic, these early interventions prevent disability, empower victims to overcome their physical injuries, and assist physicians who often have little time with each patient due to large case loads.
Especially in the initial days of a disaster, the PT can: triage severity of orthopedic injuries, decrease length of stay in field hospitals, seek the needs of the vulnerable population of persons that are physically disabled, treat physical injuries, prevent disability, and educate patients and family members on physical rehabilitation.
In the 2006 Military Medicine journal, Major Susan Davis discusses the role of PTs working side by side with orthopedic surgeons in Operation Iraqi Freedom, in which the majority of injuries were orthopedic and musculoskeletal. To manage the large influx of patients, the PT treated the majority of non-surgical orthopedic patients, thus allowing the surgeon to focus his/her time on surgical interventions. This role was essential because critically injured patients were abundant and physicians were in short supply.
The same model could be used in earthquake relief efforts, where it is well documented that injuries are numerous and severe. After the Pakistan earthquake of 2005, the predominant injuries were spinal cord injuries (741), amputations (713), bone fractures, and nerve injuries, yet no physical therapists were recruited from the Italian Red Cross until 1-2 months after the earthquake. Earthquake victims received expensive orthopedic surgeries, but were subsequently provided no meaningful physical rehabilitation services acutely. This left persons physically immobile for months as opposed to weeks causing their disability to become permanent, while congesting hospital occupancy and severely limiting the number of patients medically treated. Many patients lacked early physical therapy interventions to minimize and prevent physical disability.
International support to protect the rights of persons with physical disabilities is growing and can no longer be ignored. The Convention on the Rights of Persons with Disabilities was adopted by the UN in 2006, the World Confederation of Physical Therapy issued a position statement supporting physical therapy interventions in disaster relief in June of 2007, and the WHO Disability and Rehabilitation group is gaining recognition. The protection of the rights of persons with physical disabilities, are in accordance with other vulnerable populations that are well recognized, namely women, children, the elderly, and people living with HIV/AIDS. Now is the time for MSF, Oxfam, and the Red Cross to address the needs of this vulnerable population by recruiting physical therapists during acute disasters.
Por qué el sensacionalismo sobre la violencia sexual en El Congo
Norma Constanza Tobasía
Al regresar a Colombia, después de servir como médica con víctimas de violencia sexual en el Este de La República Democrática del Congo (DRC), quedé impresionada por la gran cantidad de artículos y otras publicaciones relacionadas con el tema de mi trabajo. Desde la frívola revista Glamour hasta el prestigioso New York Times, los diferentes medios parecen haberse puesto de acuerdo en presentar la misma patética, pero bastante ingenua y poco analítica versión de lo que ocurre con las desvalidas mujeres congolesas, sus odiados victimarios los “Interhamwe”, y las sacrosantas ONGs que trabajan con “altruismo” por el bien de las víctimas.
Mi mente es bombardeada por una recurrente yuxtaposición de imágenes. Por un lado, el rostro ensombrecido por la desolación y la tristeza de Zawadi, una de mis pacientes más queridas, y por el otro, la sonrisilla macabra de satisfacción de otros como el Presidente Ruandés Paul Kagame y algunos directores de las ONGs que funcionan en la región. Las interpretaciones sensacionalistas del atroz fenómeno de violación de mujeres en el Este del Congo son alimentadas tanto por ONGs ávidas de donaciones y medios de comunicación hambrientos de publicidad, como por intereses políticos de quienes buscan vías para satanizar a sus oponentes y legitimar incursiones militares y saqueo de recursos naturales en el territorio Congolés. Esta amañada versión de los hechos no solo ha fallado en el intento de transformar la mediocre asistencia ofrecida a las víctimas, sino que también ha servido para socavar las acciones políticas necesarias para el alcance de una verdadera solución al conflicto regional, el cual viene dejando desde hace más de 10 años, miles de mujeres y comunidades sumidas en la pobreza, la humillación y las injusticia.
La primera vez que la vi, Zawadi se encontraba al igual que otras más de doscientas víctimas, en un mismo servicio hospitalario esperando ser sometida a una cirugía para la corrección de la fístula vaginal, de la que sufría como consecuencia de la barbarie con que fue violada múltiples veces. Zawadi enfrentaba cada día, sentada en el piso de tierra del patio trasero del hospital, la miseria de las condiciones en las que transcurrían sus ya casi 12 meses de espera. No disponía de más servicios sanitarios que una letrina nauseabunda y carente de agua, jabón y otros utensilios de aseo personal. Sus alimentos eran preparados en el piso de una maltrecha cocina construida con plásticos y latas. En medio de tales condiciones, se exponía diariamente a la “mala suerte” de contraer tuberculosis o malaria, dos de las enfermedades más frecuentes propias del hacinamiento en la zona. La atención médica se reducía a cuatro entrevistas durante ese año, mientras el llamado soporte psicosocial era prácticamente inexistente no extendiéndose más allá de una entrevista inicial con la psicóloga del programa y diez minutos de cantos y oraciones diarias. Las alabanzas solían repetirse cada vez que algún político, periodista o donante visitaba el programa para conmoverse con las víctimas y felicitar a las directivas por el “gran éxito” alcanzado.
Mientras el director del programa gastaba un tercio del año haciendo campañas turísticas de “sensibilización” en Europa o apareciendo en shows de televisión, yo me preguntaba por qué Zawadi no había sido aún operada. Muy pronto descubrí que su historia clínica se había perdido, como otras, entre montañas de archivos desordenados. Cuando indagué a algunos de los coordinadores del programa, quienes coincidencialmente resultaron ser familiares del director, la respuesta fue que Zawadi tendría que esperar un poco más o tenía la libertad de regresar a su comunidad, donde seguiría siendo segregada y estaría bajo riesgo de caer de nuevo en manos de sus victimarios.
Muchos donantes como la Unión Europea aportan “desinteresadamente” cientos de miles de dólares anuales a ONGs al servicio de las víctimas de violencia sexual en DRC y de paso se benefician políticamente de lo que significa tener sus nombres ligados a programas internacionales de ayuda humanitaria. Sin embargo, de hecho, la calidad de atención otorgada a las víctimas permanece extremadamente ineficiente, y las causas políticas de dicha barbarie continúan sin abordaje profundo ni definitivo. La situación se ve empeorada aún más por el gran número de periodistas dispuestos a publicar noticias “calientes” mientras favorecen por el camino a los que buscan fondos para dichos programas. Como resultado, las ONGs que trabajan con víctimas de violación se mantienen sin incentivo alguno para mejorar sus servicios y los actores políticos, tanto nacionales como internacionales, permanecen callados y ocultos tras la fachada del “principio humanitario”.
Más grave aún es el hecho que esas sensacionalistas y escandalosas aproximaciones, presentadas por las ONGs y los medios de comunicación, caen fácilmente en la trampa de demonizar exclusivamente a los “Interhamwe,” Ruandeses de la etnia Hutu acusados de llevar a cabo el genocidio en su país y algunos de los cuales figuran ahora como rebeldes de las llamadas Fuerzas Democráticas para la Liberación de Ruanda, FDLR. Al señalar a los FDLR como únicos autores de violaciones, se simplifica el análisis de un fenómeno tan complejo como la violencia sexual dentro de la guerra y la guerra misma en El Congo, a una reduccionista pero conveniente explicación que limita toda la responsabilidad a un solo victimario, bien definido, y con un legado suficientemente oscuro como para cometer crímenes de lessa humanidad. Esta simplificación no solo ahonda la ignorancia de la comunidad internacional, aún arrepentida y deseosa de lavar su conciencia por no haber detenido la catástrofe de 1994 en Ruanda, sino que legitima los fuertes intereses políticos del gobierno Ruandés, dominado por la minoritaria etnia Tutsi. El presidente Kagame ha aprovechado los abusos de los FDLR que operan en la frontera y que constituyen su único opositor político viable, como pretexto y justificación para invadir al Congo, específicamente para ocupar repetidas veces las provincias del Norte y Sur Kivu entre 1998 y 2002.
Si bien es cierto que los FDLR se hallan entre los más crueles victimarios, reportes consistentes de la Misión de las Naciones Unidas en El Congo confirman que el ejército congolés has sido el responsable principal de la mayoría de los casos de violación en el país. Incluso, fuerzas rebeldes aliadas a Kagame han hecho de la violación masiva una estrategia de guerra. En junio de 2004, soldados del Laurent Nkunda, con el soporte táctico del gobierno y el ejército Ruandés, ocuparon la ciudad de Bukavu, en el Sur Kivu, y durante 6 días de destrucción y saqueo, violaron a docenas de mujeres, incluyendo a una extranjera del cuerpo humanitario.
En una simbiosis sustentada por los desembolsos económicos que fluyen ciegamente en sus cuentas bancarias y por el reconocimiento y el poder que la noticia “caliente” genera en la comunidad internacional, ONGs y medios de comunicación, supuestamente llamados a actuar a favor de las víctimas, se convierten en cómplices de la perpetuación de una guerra que sigue destruyendo el cuerpo físico, psíquico y social de las mujeres congolesas que padecen la violencia sexual.
Es imperativo que los donantes internacionales demanden un mejoramiento sustantivo en la calidad de atención otorgada a las víctimas en El Congo, así como transparencia y responsabilidad como precondiciones para futuras donaciones. Igualmente, es urgente un entendimiento holístico de los múltiples responsables de la guerra y sus trasfondos. Sobre todo, se necesita una comprensión amplia de las dinámicas regionales del conflicto político, como pilar para evitar alimentar el fuego que consume a las mujeres congolesas y que amenaza con justificar nuevos intentos de invasión del Este del Congo por parte del ejercito Ruandés. Aunque hoy las versiones simplistas y sensacionalistas pueden saciar la avaricia de las ONGs y el hambre de noticia de la prensa, a futuro, inevitablemente representan un obstáculo en la puesta de punto final a este conflicto que termina utilizando el cuerpo femenino como campo de batalla preferido y escenario para la medición de fuerzas e intereses políticos.
