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6.2MedicalHumanitarianism.pptx6.2: Medical Humanitarianism and the “Four Cultures” of Global Health
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Exam study topics
Describe the 4 “cultural roots” of the current global health system, including the main health and economic orientations of each root.
Given a case study about a global health issue, identify the particular culture/s at play in the situation
Understand the origins and differences between the ICRC and MSF
Describe the moral and ethical dilemmas involved in the medical humanitarian response to the Rwandan refugee crisis
What is “temoignage” (bearing witness) and why is it an important element of MSF’s mandate?
List the kinds of things that go into a humanitarian kit for a refugee camp
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19th-century roots: “The four cultures” of global health
Adapted from Brown, P. J. (2019), in Foundations of Global Health, eds. Brown and Closser.
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International Health Regulation
Disaster and War Victim Relief
Military Medical Research & Hygiene
Medical Missionaries
Recap of Lecture 5.3: Eras of International Health Activity
“Bureaucratization and Professionalization,” 1946–1970
Permanent health organizations founded
Large scale training of personnel
Global disease campaigns in the context of the Cold War
“Contested Success,” 1970–1985
Vertical campaigns (e.g., smallpox) versus horizontal health and social infrastructure efforts (e.g., primary health care)
“Evidence and Evaluation,” 1985–present
Demand for measurable successes and “evidence-based” interventions
Reinforcement of technical and cost-effective global health initiatives
Renewal of countering paradigm stressing social justice, infrastructure, human rights
Birn, et al2017, p. 52
Here’s what we looked at in lecture 5.3 at the end. The main message was that there are multiple approaches and ideologies influencing global health right now. Sometimes these priorities are compatible but others times, they are not… [go back to previous slide]
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Adapted from Brown, P. J. (2019), in Foundations of Global Health, eds. Brown and Closser.
“Miasmists” vs. germ theorists origins of modern biomedicine
Collection of vital statistics revolutionary
Cholera interrupting trade and commerce
International Sanitary Conferences (11 held between 1851-1903)
Origins of the WHO
1. Regulation: goes back to the debate between “miasmists” and “germ theoriests” – the latter is the foundation of modern biomedicine. Based on microbiological discoveries and hospital-based experiments, and the new practice of collecting vital statistics. Remember John Snow? He was the vanguard of the germ theorists. Cholera was a scourge at the time, especially because it was interrupting international trade. Ships often had to sit in bays of foreign ports undergoing lengthy and costly quarantine. Many foreign ports has strict laws on quarantine. Germ theorists thought those laws were too onerous.
There were annual international “Sanitary Conferences” held to deal with these things, to generate international cooperation and to maintain epidemiological boundaries (quarantine, vaccination, and inspection of foreign travelers and immigrants). These international conferences were the basis for the founding of the WHO in 1948!
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International Health Regulation
Adapted from Brown, P. J. (2019), in Foundations of Global Health, eds. Brown and Closser.
Humanitarian aid began in the mid-19th c. in response to war, famine
New weapons technology changed warfare (swords machine guns)
Red Cross/Red Crescent societies and Geneva conventions established
Professionalization of nursing, based on biomedicine and duty to alleviate suffering
Often work in tandem with military establishment
Key to humanitarian aid: principle of neutrality
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Disaster and War Victim Relief
Adapted from Brown, P. J. (2019), in Foundations of Global Health, eds. Brown and Closser.
New killing technologies better treatments for wounded soldiers
Colonial armies in tropical areas had high morbidity and mortality rates
Advances in the smallpox vaccine technology allow it to be used in tropical areas
In the colonial home front: cost-effectiveness was the rationale for sanitary laws
CDC originated from the “Malaria Control in War Areas” agency
Chloroquine and DDT developed during WWII by military medical-scientific research program
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Military Medical Research & Hygiene
Adapted from Brown, P. J. (2019), in Foundations of Global Health, eds. Brown and Closser.
Heyday of Protestant missionaries in South Asia and sub-Saharan Africa: 19th and 20th c.
Long-term view, permanent outposts to “serve the natives” mind, body and soul
Demonstration of Christian kindness and mercy and…
…the superiority of Western Christian society, culture and science
~60% of health services in Kenya today through Faith-Based Organizations
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Medical missionaries
Health Orientations
Public health
Research
Prevention
Disease Specific
Clinical care
Action
Cure
Comprehensive Health
Adapted from Brown, P. J. (2019), in Foundations of Global Health, eds. Brown and Closser.
International Health Regulation
Disaster and War Victim Relief
Military Medical Research & Hygiene
Medical Missionaries
Economic Orientations
Public funding
Economic rationality
Measurement/statistics
Research grant funding
Private funding
Human rights over cost/benefit
“Not everything that counts can be counted, not everything that can be counted counts”
Charity fundraising
Adapted from Brown, P. J. (2019), in Foundations of Global Health, eds. Brown and Closser.
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International Health Regulation
Disaster and War Victim Relief
Military Medical Research & Hygiene
Medical Missionaries
Founded 1849, in response to Crimean War and Battle of Solferino (Italy)
Founder (Henry Dunant) received the first Nobel Peace Prize, 1901
Dunant heavily influenced by witnessing events during WWI
Crimea, Solferino battles – horrible wounds to soldiers
ICRC became institutionalized as the civilian auxiliary to national armies
Strict doctrine of neutrality and discretion
Necessary to operate on the battlefield
Problematic during Holocaust – moral authority of ICRC challenged
Not much to say about colonialism or conflict outside Europe at founding
Medical Humanitarianism:
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Founded 1971 in response to Biafran crisis (Nigeria) and flood/independence struggle in Bangladesh
Heavily influenced by the age of genocide and decolonization/independence movements of the 1960s and 70s
Combined a “realist rejection of utopian politics and a romantic rejection of authority"
Today: an international movement of 19 loosely inter-connected groups
A “more engaged and daring version of the Red Cross”
Nobel Peace Prize, 1999
Balance operational neutrality with a willingness to speak out
Medical Humanitarianism:
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What do they have in common?
Both emerged in response to conditions created by conflict
Both later expanded their scope of work to address the “expanding horizon of disaster”
How do we define a “disaster”?
What is the difference between development and humanitarianism?
Both respond to suffering through the health framework (rather than poverty or hunger)
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Moral and ethical questions of medical humanitarian aid to Rwandan refugees
Is it acceptable for MSF to assist people who had committed genocide?
Should MSF accept that its aid is instrumentalised by leaders who use violence against the refugees and proclaim their intention to continue the war in order to complete the genocide they had started?
For all that, could MSF renounce assisting a population in distress and on what basis should its arguments be founded?
From: Binet, Laurence. 2013. “Rwandan Refugee Camps in Zaire and Tanzania, 1995-1995.” Médecins Sans Frontière.
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MSF and témoignage (bearing witness)
Témoignage = Not just to witness, but also to speak out
“MSF never asks the permission of a given population to speak out on its behalf.”
Best understood as a secondary effect of medical humanitarian action – but one that is essential and unavoidable
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“Temoignage Toolbox”
quiet diplomacy
transfer of information
denunciation
accusation
withdrawal of a mission
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Transformation of MSF, 1970-2001
In 1970, an original “community of friends” offered “love to Third World populations” along with residual Maoist principles and hallucinogenic substances. By 1980, “mercenaries” of a private organization offered food aid to “Ethiopians, Afghans, and other victims of the Moscow Olympics boycott.” In 1990, a “profitable multinational company quoted on the unlisted securities market” offered assistance to populations victimized by disasters and was so overwhelmed as to “no longer know where help is needed most.” By 2000, the e-charter of MSF.com championed both the 35-hour work week and the right to “full and free on-line access for anti-retroviral drugs.”
- From Redfield (2005: 332), “Doctors, Borders and Life in Crisis”
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In the news:
March 2017 – WHO delivers cholera kits to Yemen
July 2020 – Oxfam delivers cholera kits to Yemen
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The “humanitarian kit”
Basic building block: 1 unit = 625 treatments; Weighs 6,000 kg
Drugs: 6,500 oral rehydration salt packets, 10,000 tablets of a broad-spectrum antibiotic
Materials to take patient samples (dissecting forceps, permanent black markers)
Materials for performing basic medical procedures (surgical gloves, tunics, trousers, boots of several sizes, ten 500g rolls of cotton wool, 25 arm splints, catheters and bandages)
100 buckets, 100 disposable razors, notebooks, pens, wire ties, 2 staplers
Land Cruisers (cold or warm-weather) + stickers & flags
Guidelines and “how-to” information booklets, in several languages:
Set up a simple water sanitation system
Conduct minor surgery in a war zone
Build a pit latrine
Blood transfusion in a nutshell
Look after a refrigerator
“Human rights in a nutshell”
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