Miscellanea

Some perspective, via Penelopeinparis on Twitter.

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Last week, the blogosphere and Twitterverse couldn’t stop debating the new MSF UK ad titled ‘The Boy.’ While exploring the ads of MSF UK through the years on YouTube, I stumbled across more ads by British humanitarian and human rights NGOs. It didn’t take me long to realize how much more provocative –and creative–  these were than ads produced by similar or even sister organizations in the United States. Take the following Amnesty UK ads, neither of which I can imagine ever running on television in the United States, as but two examples.

Amnesty UK anti-torture ad.

Amnesty UK anti-extremism, pro-human rights ad.

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I have recently been thinking of the 2006 Economist editorial in which the publication took a shockingly bold stance against torture, and with a twist. Instead of arguing against torture based on torture’s ineffectiveness  as an intelligence-gathering tool –the line of argument adopted by many torture opponents in the American media– the Economist assumed torture to be very effective, and argued against it anyway. Maintaining a society in which people are free from state repression comes at a price, it stated, and in our era that price may well be thousands of innocent lives lost to terrorism.

When liberals put the case for civil liberties, they sometimes claim that obnoxious measures do not help the fight against terrorism anyway. The Economist is liberal but disagrees. We accept that letting secret policemen spy on citizens, detain them without trial and use torture to extract information makes it easier to foil terrorist plots.

[...]

To eschew such tools is to fight terrorism with one hand tied behind your back. But that –- with one hand tied behind their back –- is precisely how democracies ought to fight terrorism.

[...]

Human rights are part of what it means to be civilized. Locking up suspected terrorists –- and why not potential murderers, rapists and paedophiles, too? –- before they commit crimes would probably make society safer. Dozens of plots may have been foiled and thousands of lives saved as a result of some of the unsavoury practices now being employed in the name of fighting terrorism. Dropping such practices in order to preserve freedom may cost many lives. So be it.

This is the liberal meaning of “freedom isn’t free.”

So be it.

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The Refugee Recertification Network is up and running on Ning.

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Safrang on the Afghanistan mission at a critical juncture.

The debate and the buzz is likely to continue and to build to a feverish pitch as the US administration considers its options in Afghanistan. With Iraq largely off many radars, the loud noise, mud-slinging, and endless debate that we saw occupy TV screens, opinion pages and most political conversations between 2003 and 2008 is now focused on Afghanistan. The real side of all of this debate, however, plays out in Afghanistan and not in the American op-ed wars of the left, the right and the middle. Any policy preferences bear life and death consequences for the people of Afghanistan.

A question about doctors in Afghanistan

There are 2 doctors per 100,000 people in Afghanistan, and some provinces have almost no medical professionals. Two days ago, I watched this news video about Afghan medical school graduates being unable to find work in their profession because the cities are too competitive and there’s no money in being a rural doctor.

My question is twofold: is there any large-scale program, governmental or NGO-run, to pay new doctors and midwives well enough to set up and run rural clinics? If there isn’t, why not?

This would seem a very easy way to improve access to basic medical care for some of the most deprived people on the planet. Maybe I am missing a huge, obvious piece of the picture. Please, educate me.

(Hamesha and Harry, I’m looking at you guys.)

New York State bans shackling prisoners during childbirth

Earlier this summer, Human Rights Watch (one of many organizations that campaigned to end the policy of shackling pregnant inmates) wrote to the New York State Assembly:

Shackling of women in these circumstances represents a grave health risk and an unacceptable and unnecessary affront to women’s dignity. By passing NYS 1290, the New York state legislature would join a growing community of medical authorities, international bodies, and penal systems that have come out against this dangerous practice and in favor of ensuring the human rights and constitutional rights of women in state custody. We urge you to vote in favor of this important legislation.

Women who are shackled are at risk for injury during transportation to medical appointments, can suffer added pain during delivery, and may be deprived of appropriate care during examinations and delivery.[ii] Officials from the American College of Obstetricians and Gynecologists have stated that “physical restraints have interfered with the ability of physicians to safely practice medicine by reducing their ability to assess and evaluate the physical condition of the mother and the fetus … thus, overall putting the lives of women and unborn children at risk.”[iii] This risk is heightened by the fact that the pregnancies of women in custody are usually already high-risk.[iv] In addition, the humiliation brought on by the shackling is inflicted on a population with a high incidence of past sexual or physical abuse.[v] Finally, it is inflicted without a persuasive security justification: The large majority of women in prison are there on account of convictions for non-violent offenses,[vi] and those jurisdictions that have restricted the use of shackles have not reported security problems.[vii]

The Assembly, to its credit, passed legislation that bans shackling unless the woman in question is a threat to hospital staff or guards. New York Governor David Paterson signed the legislation into law this week. This change in policy is, as Michael Mechanic put it in Mother Jones, “a small, humane step for a very, very troubled American institution.”

Six states now prohibit shackling inmates during childbirth under either all of most circumstances. Forty-four more to go.

Ken Bacon on healthcare

Refugees International President Ken Bacon, who died today from melanoma, will be remembered for his tireless advocacy on behalf of refugees and internally displaced people.

In light of the increasingly irrational and unhelpful tone of the healthcare debate, it is important to keep in mind the essence of the issue: that the healthcare system we have now is ineffective and cruel, and we owe it to ourselves to find a better way. Bacon knew this all too well. In the last months of his life, he wrote:

My oncologist has spent hours filling out forms and arguing with the insurance company to arrange coverage for my chemotherapy. Now my wife and I are waging our own fight with the provider to arrange payment for my daily brain radiation, which has been rejected as ‘not medically necessary’ even though the cancer in my brain is growing rapidly.

[...]

For me and other Americans suffering from advanced cancer,the health-care debate this summer is no abstraction. It is a matter of life or death.

Bacon was luckier than the vast majority of Americans, something he readily admitted. With his excellent employer-provided health insurance, he could afford at least most of the treatments he needed, and his doctors were among the best in the world. Access to healthcare prolonged Bacon’s life and his advocacy, which was instrumental in changing how the US Government responds to the Iraqi displacement crisis.

If Congress continues to drag its feet and cave to the demands of private insurers, the right to healthcare will continue to be deprived to tens of millions of Americans. That is an ethically unacceptable outcome anywhere, but especially so in a society as wealthy as ours.

Scattered thoughts

Tomorrow the Refugee Health Mediation Project proposal goes to the foundation. The field office director is still  trying to get some audit stuff that needs to be attached, and our DC people  seem to be in no hurry to provide it. We’ll see what they produce in the next few hours. It’s maddening to spend months working on something and have it held up for no good reason. DC had ample, ample time to prepare what we asked for.

Grrr…  inefficiency.

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Last night, for work, I went to a dinner for visiting members of the Malawian Parliament. The conversation at my table  revolved more around the Afghanistan project than the Malawi one, though, because a table-mate just recently got back from Kabul and had stories to share. Oh, how all that Afghanistan talk tormented me!

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One of the things I asked my recently returned colleague was how the international-national staff dynamic was playing out. His gritted teeth and guarded answer instantly made me think of this from Hamesha:

right now i am here sitting in a cafe a safe distance away from a vociferous expat who is grumbling and ranting loudly about lack of this and lack of that, from lack of capacity to lack of electricity and lack of security and lack of good food and lack of internet and lack of talent and lack of hygiene and lack of deodorants and lack of good weather and lack of good colleagues and lack of traffic rules and lack of obedience to traffic rules and lack of obedience to rules writ large and lack of knowledge of the english language and lack of appreciation for shakespeare and lack of…

how about lack of right attitude? for working in a an admittedly difficult postwar environment? and what the hell were you thinking when you landed that lucrative contract? how about lack of cultural sensitivity? and lack of humility? and how about an overabundance of presumption and self-righteousness and arrogance? and how about getting the hell out of here if it is all so difficult and unpleasant and insufferable?

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I have been applying to every job I have a 1% or better chance of getting. Also, I despise Openhire.

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It’s bitterly cold here, with a sharp wind that slices into any exposed flesh. I waited for a half hour at the bus stop this morning (because upstate NY somehow cannot provide public transport at the quality level of even, say, Pristina) and I was physically in pain and slurring my speech by the time the bus arrived.

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I just found out that the refugee resettlement office was robbed. Two computers were stolen, including a laptop I donated when I left.  Fuck.  It was hard enough before.  Anyone have computers to donate?

Refugee resettlement and health mediation: part II

As I mentioned in my last post on this subject, I drafted a proposal for a health mediation program before I left the resettlement field office.  The proposal will be considered next week, and I have a meeting with the field office director at the coffee shop down the street in about an hour. We’re going to make some final edits and then have it approved by the HQ folks.

If all goes to plan and we get the requested funding:

-The resettlement office will FINALLY have a full-time refugee health coordinator on staff.

-Refugees who need it will have accompaniment to medical appointments during the first six months following resettlement.

-Newly resettled refugees will have “Health Care in the United States” orientations, and workshops on women’s health,  Medicaid, family planning, nutrition, and mental health will also be conducted.

-The health coordinator will put together a step-by-step guide to treating refugee patients for medical practitioners in the area.

-The office will finally have the time and money to conduct a survey of how local hospitals are implementing (or not implementing) the 2006 New York State law that requires them to provide non-English speaking patients with adequate interpretation.

-And so much more!

Here’s hoping.

Refugee resettlement and health mediation: part I

Before landing an international development fellowship, I spent eight months working at a regional refugee resettlement office. Initially, I was attached to the human trafficking victim services program, but I was later moved (or moved myself) to outreach and program development.  Additionally, I, like the rest of the staff, spent a great deal of time just running the office, especially after the director moved on to a better position elsewhere and left us leaderless during the high season of resettlement.

The office I worked at was typical of refugee resettlement offices in the United States: underfunded, understaffed, overworked, and underpaid. Case managers scrambled just to provide minimum services to their long lists of clients. Often, colleagues and I would work from before opening well into the night, go home, and do it all over the next day. And yet, there were still tasks that never saw completion, and programs that fell through because they were staffed entirely by people who were already splitting time between two or more full-time programs. “Cloning is our only hope,” I once joked with my supervisor. Joking aside, during my time at the resettlement office, I became aware of a serious gap in the services provided to clients (refugees). That gap was health mediation.

The largest refugee populations resettled by the field office were Burmese, Iraqis, Afghans, Congolese, and ethnic Nepalis from Bhutan, but we also resettled Somalis, Meskhetian Turks,  and Kunama, as well as asylees fom Sudan and Iran. Each population suffered prior to resettlement and had its  set of common health problems. For the Burmese, coming mostly from overcrowded camps along the Thai-Burma border, the list of ailments was almost endless: rotted teeth, skin infections, malnutrition, lead poisoning (from contaminated water in camps), post traumatic stress and depression, eye problems, amputations (often from some time ago) that had not been performed properly, respiratory disorders, complications from pregnancy, and lots more.  For the Afghans and Iraqis: lots of stress and trauma, as well as  dental problems. The other groups had combinations of all of these. The Kunama and Somali women added the issue of FGM. And several clients were torture survivors.

Just housing and feeding a rapidly swelling list of beneficiaries pushed the small staff to its limit. Unpaid interns were brought in to perform full-time work in education, ESL, and housing services –work so technical and time-consuming that it should have been done by a full-time staffers. Health fell by the wayside. It was everyone’s problem and no one’s responsibility. If a client came in and showed a prescription, obviously confused, someone would rush out of an office, give it a glance, and send the client on his or her way, usually just as confused as before. Occasionally, someone would draw the short straw and have to take time out (invariably from another task nearing deadline) to drive a client to the doctor’s office or hospital. If a client required accompaniment to the low-cost health clinic, a member of the staff or an intern would lose her or his entire day, because the clinic was  a nightmare of hurry up and wait and endless paperwork.

Most of the time, however, clients were on their own. This usually resulted in poor care and lapses in treatment for serious conditions. Medical providers, especially those that catered to the poor, had neither the time nor the know-how to properly provide medical care to refugees.  Clients who spoke no English were often treated without explanation or real consent (telling someone to sign next to the X when she or he has no idea what that will authorize is not consent.) One client, a young and frightened woman resettled just weeks before, gave birth without interpretation services because no one was there to tell her doctors that they needed to get a Karen interpreter on the language line. When it came to mental health care, well, the story was even bleaker. Depressed Afghan? Traumatised Iraqi?  Sorry, you’re SOL, I’m afraid. I could go on and on with anecdotes, each more distressing than the last, and, in fact, I spent many late nights at home doing just that over sad beers with my roommate-coworker.

Complaining can be useful –it brings problems to light and can spur others to voice  similar concerns– but it needs to be followed with action to be productive. Before I left the refugee resettlement office, I fiendishly researched health mediation programs for refugees. I found programs in the United States and elsewhere and looked into how they were funded and implemented and what the results were. Then, I drafted a proposal for a refugee health mediation program for my field office.

to be continued…