Why Not? By Lanny Smith |
As you have probably heard many times (since even within the last four years we have given more than 100 workshops and presentations on the subject), Liberation Medicine is "The conscious, conscientious use of health to promote human dignity and social justice."
Know anything about global ecology and the concept of mutualism? Mutualism is defined as the "Interactions between individuals of different species that benefit both partners." There are optional and obligatory forms of mutualism, and they create the ecological integrity of the world around us.
| “That is the way our world is made. No individual or nation can stand out boasting of being independent. We are interdependent.” |
I myself am very ignorant about global ecology, but I have been trying to find new ways to illustrate that interdependence that Dr. Martin Luther King, Jr. and others teach is crucial to our survival: "As long as there is poverty in the world I can never be rich, even if I have a billion dollars. As long as diseases are rampant and millions of people in the world cannot expect to live more than twenty-eight or thirty years, I can never be totally healthy even if I just got a good check-up at Mayo Clinic. I can never be what I ought to be until you are what you ought to be. That is the way our world is made. No individual or nation can stand out boasting of being independent. We are interdependent." (The Words of Martin Luther King, Jr., p. 22.)
We are six billion humans and more, around the world. How many of us have the opportunity to be what we ought to be? What binds us together? The air, for one thing. Tropical rain forests seem so far away from Fernbank Forest, home of the last remaining virgin deciduous biosphere in the state of Georgia (where DGH is incorporated). Many of us have worked in El Salvador, which is the second most deforested country in the Americas. Between 1990 and 2000, El Salvador lost 4.6% of its remaining stock of forest. Haiti, already the most deforested, lost 5.7%.
At the same time, the average temperature of the earth's surface has risen by 0.6 degrees Celsius since the late 1800s and is expected to increase by another 1.4 to 5.8 degrees by the year 2100. Even if the minimum predicted increase takes place, it will be larger than any century-long trend in the last 10,000 years.
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| Lanny Smith (far left) at a DGH-sponsored Liberation Medicine workshop at the American Public Health Association Annual Conference in Chicago. |
Actually, let's explore the leadership potential of the US. Have we signed the Convention on the Rights of the Child, adopted by the United Nations General Assembly on November 20, 1989? Only the US and Somalia have not signed it. What about the UN Convention on the Rights of Women (CEDAW)? No. How about the treaty banning land mines? No. What about the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment? That one we signed, years ago, with many "reservations," such as "(b) That the United States understands that the definition of torture in article 1 is intended to apply only to acts directed against persons in the offender's custody or physical control."
Forty years ago Dr. King said: "The greatest irony and tragedy of all is that our nation, which initiated so much of the revolutionary spirit of the modern world, is now cast in the mold of being an arch antirevolutionary. We are engaged in a war that seeks to turn the clock of history back and perpetuate white colonialism." (The Words of Martin Luther King, Jr., p. 87.)
Echoes haunt us: the poetry of napalm and depleted uranium; the logic of Agent Orange in Vietnam repeated now with Plan Colombia, as vast tracts of rain forest are cleared of people to make way for Monsanto monoculture (only their genetically modified seeds withstand their manufactured defoliant) and petroleum exploitation.
Remember that at the School of the Americas (since renamed so as not to transliterate so easily with "School of Assassins"), manuals on the use of torture were used for training Latin American officers. I remember in 1996 when a US General stated publicly that the use of these manuals was "unfortunate" and that such practices would never be done by the US Armed Forces again. No wonder the US is currently dead set against an international court, as we explore the precedents for Abu Ghraib. Actually, now that I am onto a bit of history, I would like to lead us in an exercise in humility. (I do not mean this to in any way suggest that I do not love the people of the US as much as I love any people in this world.)
Where did the first airplane bombardment of a civilian population take place? Ocotal, in northern Nicaragua, ten years prior to the Franco-invited Nazi bombing of Guernica. The reason? A Nicaraguan guerilla leader, Agusto Cesar Sandino, was winning against the US Marines. Sandino wanted autonomy for his people and said "free country or death" (was that not what our very own Patrick Henry called for?).
He was considered such a problem that the US sent Henry L. Stimson, then US appointed Governor of the Philippines and thus well-practiced in the art of repression, to use the marines to keep a puppet Nicaraguan government in power. Stimson later wrote, in a book entitled Nicaragua, that Spain had made an error in not killing all the native peoples of Nicaragua because they were "barbarians." (This last from the book Mas Alla del Homo Sapiens, or Beyond the Homo Sapiens, by Mariú Suarez, which I highly recommend as an extraordinary and unique history encompassing the human struggle for liberation and the human creation of art.)
There was also General Leonard Wood, who had extraordinary influence on both Cuba and Philippines in the name of the US. Wood was a Harvard Medical School graduate, who interned (as I did) at Boston City Hospital in 1884. Personal physician to Presidents Cleveland and McKinley, he was a Rough Rider with Roosevelt and stayed in Cuba as Military Governor from 1899 to 1902. He then went to the Philippines, where he "was in charge of several bloody campaigns against Filipino troops, which was to be the beginning of his unpopularity there. He was noted for his harsh, unpopular policies." (Wikipedia, Columbia Encyclopedia Online.) He was later appointed Army Chief of Staff by President Taft and after retiring from the army in 1921 served as Governor General of the Philippines from 1921-1927. Which makes me also humbly recall that William Walker was also a physician. From Tennessee, Walker managed to gain control of Nicaragua in 1888 with Vanderbilt money and immediately declared the reinstitution of slavery. His short-lived government was nevertheless recognized as legitimate by the US government.
Now I do not want you to think that the US people are universally seen as malicious and self-serving around the world. You must know that in Nicaragua, as in El Salvador, and in fact in most other places I have had the chance to ask, the people have a keen appreciation that the government acts differently than most of its people would wish.
I want to give one positive example of a US-born person in the Philippines–William Henry Scott. Dr. Scott was an anthropologist and teacher who lived in Sagada, Bontoc Province, Cordillera Region, from 1954 to his death in 1993, and who was very active in the struggle against the dictator Marcos. Marcos "detained" him for deportation in 1971, but was forced by a ground-swell of public protest to set him free. After his release he wrote 15 more books on Philippine history and ethnography. As one Filipino historian wrote of Scott: "Despite his nationality, William Henry Scott belongs more to the Filipino than to the foreign group. He had been assiduous in unraveling many strands of our past. Moreover, he has done so not from the vantage point of Spanish colonialism or American imperialism but from that of the Filipino's struggle for emancipation." (Scotty, Dee and Emmett: Their Fight Against Marcos Repression, by Frank Cimatu, Baguio City.)
Now, it was not so long ago–1964 in fact–that Che Guevara could write this about the US: "We express our solidarity with the people of Puerto Rico... Puerto Rican soldiers have been used as cannon fodder in imperialist wars." (Che Guevara Reader, p. 285.)
"Those who kill their own children and discriminate daily against them because of the color of their skin; those who let the murderers of Blacks remain free, protecting them, and furthermore punishing the Black population because they demand their legitimate rights as free men–how can those who do this consider themselves guardians of freedom?" ("At the United Nations, December 11th, 1994," Che Guevara Reader, p. 297-8.)
But, that has all changed 40 years later, correct? Except, of course, for the racial difference in lifespan, in medical coverage, in AIDS infections and–especially–in incarceration of Black men. And, of course, that bit about the cannon fodder is not fair. Why, look at the No Child Left Behind Act, pushed through in 2002. Actually, if you look deeply into that act, you could call it the "no child left unrecruited" act. Section 9528, buried deep within the law's 670 pages, grants the Pentagon access to directories of students' names, addresses and telephone numbers so that they may be recruited for military service. I was informed of this by my patients in the South Bronx, for whom this little known clause is a constant source of anxiety and anger. The only way to prevent the school from giving your adolescent's personal information to the military for recruitment purposes (even for children under 18) is for the parents to write a personal letter to the administration of the school.
This seems an appropriate moment for a reminder that it is women in so many places around the world who must gather water and firewood, part of their "double-oppression" of poverty and unequal decision-making status, as noted by Jenny Hammond in a short essay on "Women in Ethiopia: The Struggle for Liberation and Development."
And yet, what happens when the whole population is displaced, as in forcible movement from the site of a dam? Arundhati Roy writes about the fate of a displaced community in an essay called "The Greater Common Good," within the book The Cost of Living: "Instead of a forest from which they gathered everything they needed–food, fuel, fodder, rope, gum, tobacco, tooth powder, medicinal herbs, housing materials–they earn between ten and twenty rupees a day with which to feed and keep their families...In their old villages, they had no money, but they were insured. They had the forests to turn to. The river to fish in. Their livestock was their fixed deposit. Without all this, they're a heartbeat away from destitution." She writes of a man in a resettlement site: "He was making a list of the fruit he used to pick in the forest. He counted forty-eight kinds. He told me that he didn't think that he or his children would ever be able to afford to eat any fruit again. Not unless he stole it."
Let me point out that the World Bank (WB) and International Monetary Fund (IMF), apparently working in coordination with a California-based private group and the government of El Salvador, have threatened to build a dam that would inundate the communities DGH has been accompanying for nearly a decade–the people of Estancia, Morazán.
Among the places where Paul Farmer works is a community in Haiti whose inhabitants found their misery when displaced by a dam. In Pathologies of Power, Farmer ponders: "These are indeed dangerous times. In the name of 'cost-effectiveness,' we cut back health benefits to the poor, who are more likely to be sick than the non-poor. We miss our chance to heal... Is this the best we can do? Attempting to provide a 'basic minimum package' for the poor is something that should be done apologetically, not proudly... The 'other criteria' in question are equity criteria, but the language of social justice is increasingly absent from public health parlance... If we lived in a utopia, simply practicing medicine would be enough. But, we live in a dystopia.
Increasingly, in this "new environment," inequalities of access and outcome characterize medicine. These inequalities could be the focus of our collective action as morally engaged members of the healing professions, broadly conceived. Throughout human history, the sick have relied on healers of one stripe or another. Throughout human history, there have been talented healers and there have been charlatans. But never before has medicine tapped the full promise of science and technology. These were twentieth-century developments, and we are now faced with a twenty-first-century decision: where will the healers stand in the struggle for health care as a human right?"
To that question, Dr. King had a corollary: "Freedom is never voluntarily given by the oppressor; it must be demanded by the oppressed." (The Words of Martin Luther King, Jr., p. 51.)
Here is a closing thought from "The People's Remedy: Health Care in El Salvador's War of Liberation," by Francisco Metzi, published in the Monthly Review: "Once in El Salvador, reality dealt me a startling blow. Bringing about revolutionary change was more difficult and so much slower than I had imagined... I had to learn that a revolution in the making consists of small and very relative successes, of errors and partial failures as well. Nothing was gained effortlessly and there were no magic problem-solving formulas. Instead, the principal tools were constant, painful arduous work, together with a discipline through which individuals exert themselves for the collective good. I came to understand that the revolution, the real revolution, is made up of lots of little revolutions."
As I finish here I want to point out that all of the above is Liberation Medicine Wood– the fuel and the foundation for making a difference in the health of people. I have given examples and warnings, but mostly it has all been a preparation for the imperative question: Why not? A question we in DGH can answer with hope because we have a group in which we can share our talents and abilities, where every person has a voice, and where we can exercise our passion for mutualism.
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