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Learning to Cure Society's Darker Ills

Learning to Cure Society's Darker Ills

You are a doctor at a provincial hospital. A pregnant woman comes in who has been

badly beaten by her husband. How do you treat this woman? What questions do you ask

her? Have her human rights been abused?

In a novel program started just two months ago, Cambodian doctors, nurses, and other

health care workers are being trained as front-line promoters and defenders of human

rights. Developed and implemented by the American Refugee Committee for the United

Nations, the training program uses a Khmer-language curriculum designed by a group

of health professionals with a human rights background.

"We aim to help health workers in this country better understand their professional

responsibilities," said Allen Keller, an American doctor and one of the two

project coordinators. "Namely, to provide health care to all, and to understand

that all people have a right to health care, regardless of their background, religion,

or circumstances."

Consisting of a series of ten two-hour lecture-discussions, the course seeks to increase

health professionals' knowledge and awareness of human rights and emphasize the role

physicians and health workers can play in protecting them. Keller emphasized that

the program seeks to be practical rather than academic in nature, relying on case

examples familiar to Cambodian health workers as teaching tools and the basis for

discussion.

A mother brings her six-month old child to the hospital with a very high fever. The

child is unconscious and just had a seizure. The mother tells you she has no money.

A few minutes later, a man known to be very wealthy comes to the hospital complaining

of a headache. He demands to be seen immediately.

What do you do? Which patient do you see first?

The syllabus leads the discussion about treating the child first, basing the decision

for treatment and priorities on medical considerations and needs, not money, class

or other reasons. The training also includes discussion about the particular rights

of children to receive health care, not least according to the Universal Declaration

of Human Rights and the Convention on the Rights of the Child.

Funded by a grant from the Human Rights Trust Fund that was established by UNTAC

late last year, ARC developed the innovative program through extensive discussions

with its three ex-patriot and eight Khmer staff with backgrounds in health professions

and human rights. Together they developed the curriculum in Khmer, which uses common

case examples that many Cambodian health workers face as the basis for discussions

during the course.

As a practical matter, doctors need to be trained to take accurate medical histories,

and learn to ask sensitive questions that might normally be avoided. In the case

of the pregnant woman beaten by her husband, Keller said the doctors first wanted

to know what she had "done" to get beaten. But when they were asked what

anyone might do to "deserve" such a beating, let alone a pregnant women,

they acknowledged that no one deserved to be beaten, that her human rights had been

violated.

The next step would be to interview her to determine if this had happened before.

Many doctors might initially be adverse to asking about a woman's personal relationship

with her husband, considering it a private matter. But this training program emphasizes

that asking sensitive questions are a proper part of health workers' professional

responsibilities.

Some other cases that involve human rights considerations include treating prisoners,

and victims of torture, rape, and landmines. Keller pointed out that in some countries

doctors participate in torture, for example by examining someone in order to pronounce

them "fit enough" to be tortured, or else giving them enough treatment

after being tortured so that the victim can be tortured again. The training emphasizes

the role that doctors can play in stopping torture, namely by refusing to participate

in it, and reporting its occurrence to human rights organizations.

In designing the curriculum, the staff agreed that incorporating teachings of Buddhism,

particularly its emphasis on compassion, was integral to teaching about human rights.

When discussing human rights in this context, Cambodians readily understand the meaning,

because this is not a new Western idea but an old one from Buddhism.

The program has just completed its first training series for 200 fifth and sixth-year

doctors at the Faculty of Medicine in Phnom Penh, and 200 nurses and 75 midwives

at the School of Nursing. The next phase of the program will expand training to the

four nursing schools in the provinces. ARC also aims to institutionalize human rights

training as part of health workers' training, by making it part of the regular curriculum

at the Faculty of Medicine, and identifying and training faculty in provincial hospitals.

In the future ARC hopes to give Cambodian human rights groups training in medical

documentation of human rights abuses, as a way of expanding and connecting the network

of human rights activists. Another goal is to work with the Ministry of Health and

the World Health Organization to create functioning health societies in Cambodia,

as examples from other countries, notably Chile, have shown that such societies have

been active campaigners for human rights. Keller said the training made clear that

Cambodia is not the only country with a problem of human rights abuses.

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