“The structures that now obstruct human well-being must be changed into modes of social organization and interaction that will promote and support it. The disciplines of public health and human rights offer ways of thinking, of working, and of organizing that can ultimately give expression and concrete direction to that endeavor.”
-Lynn P. Freedman
I’ve been in Uganda for just over a week now and have already amassed stories of the desperate situation of physicians and patients struggling against a lack of resources and poor governance. I probably won’t be telling most of you anything new about the plight of health care workers in impoverished regions, but I hope this blog will at least demonstrate some of the questions that these Ugandan professionals and human rights advocates must consider in attempting to find solutions to seemingly hopeless situations. Though this may seem like a very intense and serious subject, which it is, my time in Uganda is not completely devoid of humor and fun. With this in mind, I’ll try to balance my blog with these experiences as well.
In case some of you are wondering what I’m doing back in Uganda, I came here for a second consecutive summer to respond to an inadvertent challenge posed to me last summer by a Ugandan friend. At the time I was working in a rural community on the eastern border of the country on another human rights fellowship. My friend, despite being very well versed in human rights law, advised me to leave discussions of rights between “us” and to keep any of my education programs in the rural community focused on hygiene and basic preventative health measures. In saying this, he seemed to believe that the least that I could do for Ugandans who lack health care was not waste any of my limited time there with informing them about their “rights” and how their government signed a bunch of treaties. His advice was a bit jarring; especially since I was about to begin a three-month fellowship abroad in the name of something he was insinuating I leave at home. I admit, however, that I didn’t listen to my friend much. I still tried to incorporate some basic introduction to ideas of rights in a number of my health education group meetings. I even spent a lot of time that summer traveling (in tiny minivans packed with 20 other people) around the country looking for human rights groups to collaborate on establishing a health rights project for the community.
Despite ignoring his advice at that time, the underlying questions from it have still stuck with me. In Uganda, are human rights significant for only legal academics and foreigners? Do they have any meaningful role in securing health care for the country’s vulnerable populations? Are reformists ignoring more affective modes of change for the sake of upholding impossible ideals? Spurred by these debates remnant of last summer, I’ve returned to the country to find out how similarly human rights advocates and health care professionals agree on the role of a rights-based approach in transforming the nation’s health care standards.
In the quote beginning this posting, Lynn Freedman (who I just found out is Deborah’s mom) writes that we need new “modes of social organization and interaction” to achieve the individual well-being imagined for an equitable world, and that human rights, partnered with public health, offers tools radical enough to achieve this. She defends this view of human rights, despite their “notoriously weak enforcement mechanisms,” because they still “affirm the fundamental value of human agency: the nature of human beings as effective social actors… the notion that human beings, constituted through relations with others, can still make choices about their lives, can still have something to say about how to structure and maintain relations with others, be they family, community or state.” Freedman is right that human rights are a radical worldview especially at a time overrun with violent identity politics. But regardless of how wonderful they re-imagine the world, of how they demonstrate our enhanced fate through collective agency, we have yet to see them develop effective tools to turn complaints into reformation. In fact, the UN Human Rights Council has only this past month adopted an Optional Protocol to the International Covenant on Economic, Social and Cultural Rights, which means before now there wasn’t even a acceptable proposed mechanism for complaints of right to health violations. In my interviews so far, it has also been pointed out to me that the rights road to change demands a tremendous amount of faith as recently demonstrated by Zimbabwe and Sudan’s blatant disregard for them with no serious repercussions, as well as by the United States falsely championing their cause through an unjust war. Last week while attending a workshop on the UHRC’s new Right to Health Unit, I asked an Ugandan human rights lawyer if he thought the unit would make a difference for the country’s healthcare. He responded, “When you’re drowning, you will even grab onto a floating blade of grass in hope that it will keep you from sinking.”
With this mixture of hope and suspicion surrounding the effectiveness of a rights-based approach to protecting healthcare, I have begun digging for answers about why we should believe in it and what will it need to work.
A few weeks ago, I returned along with my friends Ben and Sarika to the rural community and clinic where I worked last summer. I'm proud to say that a year later the men's group that I helped initiate is still running strong. They have gone from just attending regular health education meetings and writing a constitution to a full fledged community health operation with an office and ongoing projects. Using a point-system provided by the Foundation for International Medical Relief of Children (FIMRC), the group has recently assessed the varying levels of sanitary conditions of most the homes in the five villages that make up Bumwalukani parish. The group is also working with another FIMRC intern this summer to design a renewable fund to help alleviate the problems it's documenting in the community. Ben also brought a computer for the group, which they've already begun lessons for how to use. I should also mention briefly that the start up money for this men's health group was half provided by the members themselves and half by the University of Minnesota FIMRC chapter. (In the picture above: the Arlington FIMRC Men's Health Group [I lobbied for a shorter name] President Robert and me outside the office)
(In this Picture: Milly [the clinic's cleaning lady amongst many other roles], me, Edwin [nursing assistant], and Ben standing at the entrance to FIMRC's clinic)
