A Personal Reflection On The Concept Of Liberation Medicine

 

By Jennifer Kasper, MD, MPH

Pediatrician at Boston University Medical Center and South Jamaica Plain Health Center

 

I was asked to offer some of my thoughts on the concept of Liberation Medicine, so I first turned to one of my favorite books: the dictionary. Liberation means freedom, emancipation; to liberate is to release, to unfetter, to set loose. So I guess we must first ask ourselves if this is the current state of the world's people, i.e. is everyone truly free? The majority of the earth's people make less than $1 a day; 800 million are malnourished; millions in Africa are dying of AIDS (and the $400 billion pharmaceutical industry cannot seem to find a way to get appropriate treatment to them); millions of indigenous peoples in India are literally watching the ground beneath their feet wash away thanks to World Bank-funded dam projects in the Narmada Valley; it distresses me to know I could use the rest of my allotted time to simply quote statistics and I would not finish. So then, what tools are necessary so that people can become advocates for their own emancipation? I struggle with my role in this world, how I might be a facilitator in the emancipation of people, the poorest individuals of the world, the ones who consume the least in terms of material goods and get consumed the most by preventable diseases, political struggles, and the powerful wealthy.

 

For me, liberation medicine requires a melding of health in the broadest, most holistic sense, and human rights. The World Health Organization defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease. This very statement makes it evident that we must address environmental issues, economic disparities, educational needs if we are truly to help someone be of optimal health. Couple this with article 25 of the Universal Declaration of Human Rights, which states clearly and concisely that all have a right to food, clothing, shelter, health, and education, and the intricate, intertwining nature of these two spheres is evident. Health and human rights are not mutually exclusive. Good health implies that a person has access to safe water, adequate food, a means of economic security. Would we not want the same for ourselves?

 

Having had the honor of working alongside campesinos, community health promoters, kindergarten teachers and midwives in rural El Salvador for nearly two years, as well as a couple of brief stints in among the poor of Honduras, I have learned that true development requires meeting people's basic human needs and education. I recall my struggles with foundations who wanted to give our organization money to build things-buildings, roads, bridges- but who did not, could not see the merit in providing a livable wage to the health promoters so that they could receive an education and thus provide important health services to their communities. I would rather have hollow buildings than hollow minds. I wanted donors who were interested in building the infrastructure of a person's mind and heart.

 

I believe the fishing analogy is appropriate: give a person a fish and (s)he eats for a day, teach him/her how to fish and (s)he can eat forever. A partnership, a mutual participation, acompanimiento between those of us who have so much and those who do not is necessary. If our goal as a human species is to create a world in which all can reach their human potential, then conscientization is critical. Paolo Freiere defines it as learning to perceive social, political and economic contradictions and to take action against the oppressive elements of reality. This applies to all of us who live in powerful countries like the United States, who need to be aware of how our country interacts with other countries and understand the hidden agendas. And it applies to the ones who are oppressed, so that they realize that their way of life (i.e. survival) is not as it should be.

 

It's funny, because as a pediatrician I am constantly asking the parents of the children I help care for how their children are doing developmentally, e.g. are they sitting without support, have they said their first word, have they starting walking yet. Would that we pay such meticulous attention to the birth, growth and development of a multitude of communities worldwide. Has the community learned how to organize itself and use the talents of all its members so that the community can learn to "sit without support"? Has the community spoken its first word of what it wants for its people? Is it walking on its own yet? Paso a paso. Just as we marvel at the transformation of an infant to a toddler to a child and adolescent, we can marvel at the transformation of a community. And just has human development takes time, so does the development of a community.

 

The world is an incredibly fragile place. And its most precious commodity, human beings, are entitled by the mere fact of their humanness to have their hopes, dreams and desires realized.

 

Thus the approach towards liberation must be integrated, the linkages between health and human rights must be demonstrated, solidified, concretized. Examining a problem in isolation may result in an expedient answer, but it will be superficial and will not address root causes. A more thoughtful, time-consuming approach is a long-term investment worth making.