Digging deeper with Dr. Mukherjee
by Victor Roy on December 16, 2008
Imagine an orphaned 9 year old girl caring for her 3 siblings in a village in Rwanda. What are the girl's risk factors for getting HIV/AIDS?
On Tuesday, December 9th, the GlobeMed Network had the great opportunity to engage in such questions with Dr. Joia Mukherjee, the Medical Director from Partners in Health, on a webinar devoted to November and December's globalhealthU theme - Health and Structural Violence. Students from across the country participated, as Dr. Mukherjee used photographs and conversation to reveal the root causes of suffering and disease.
When Dr. Mukherjee asked the question I started this post with, we listed off factors like unsafe sex, promiscuity, and other standard factors. If these are the real factors, then "how come Keith Richards doesn't have AIDS?", Mukherjee asked. Main point: underlying racism triggers a set of "normal" responses, even from socially aware students, that harm our ability to identify the root factors of disease - poverty, inequality, among others. Instead, such assumptions lead to the creation of public health strategies that do little to bring relief and hope to those most vulnerable.
If we're to become effective advocates, then we'll have to understand that health is shaped by deeply embedded social, political, and economic structures which often exclude people from vital resources required for a healthy life. War, poverty, gender inequality, along with racism, are examples of structural violence that Dr. Mukherjee highlighted. Dr. Mukherjee did a great job of asking questions and conversing with students about many examples of structural violence she's seen from her work and experiences in global health.
Two ways, among many others, jumped out to me during the webinar as ways of addressing structural violence.
The first method is a pragmatic global health strategy advocated by many and highlighted by Dr. Mukherjee on Tuesday - employ and train community health workers. CHWs provide dignity and hope, both attacking a community's health problems while also providing a vital source of employment for tens of members in a community. Often, CHWs are healed patients themselves, who then gain a source of income through the job, sustain themselves and their families, and break the cycle of poverty in the process. CHWs are literally foot soldiers fighting structural violence. They're worth atleast several more blog posts (and a ton more funding!).
The second method can be used by all of us all the time, and was at the basis of Mukherjee's presentation: we should question our (often clouded) assumptions about the roots of disease and suffering and ask hard questions about how to act effectively in support of the poorest and most vulnerable. We must recognize how our own contexts and livelihoods (often amidst relative wealth and abundance) might shape initial assumptions that are mistaken and how our efforts can better reflect a clear understanding of structural violence.
Thank you, Dr. Mukherjee, for helping us to dig deeper.
Also, check out Jon Shaffer's (Northwestern chapter) thoughts on the webinar!
Ankur says on January 07, 2009 at 8:49am:
Digging a bit deeper into the idea of CHWs, you might notice that the link about 'dignity and hope' is talking about volunteer CHWs (that is some of the poorest, most marginalized women in India who are not actually receiving payment for their work). Now, I'm not sure of the particulars of the program showcased in your link, but more generally, the "debate" over whether CHWs should be paid -- even though few NGO directors would hesitate to receive payment for their work in a developing community -- is just another example of deep-seated assumptions and ideas.