Tuesday, December 9, 2008

Webinar with Dr. Joia Mukherjee

Sorry for the recent lack of student-global-health-blogging-goodness. Now that exams are largely done for the quarter, I should be able to jump back into it full force.

A good start:

I just got off of a very interesting webinar with Dr. Joia Mukherjee who is the medical director of Partners in Health. It was put together by GlobeMed as a part of its globalhealthU, health and structural violence theme.

The discussion touched on some extremely important themes that are too often not addressed by those who make policy decisions regarding global health. The fact is that health is structured by social forces. Decisions that affect an individuals health - whether or not to engage in transactual sex, to go see a doctor for an infection, to wash hands - are shaped by social conditions. Wealth, race, gender, all play a part in determining an individuals agency in decision making.

One of the most poignant examples of structural violence came from a simple slide with two photos: one of Keith Richards and the other of fouryoung Rwandan children. The children were orphans, and the oldest, age 9, was the head of their household. She posed the question: what are the risk factors for becoming infected with HIV? We rattled off the standard list of promiscuous and unprotected sex, injection drug use, and other "risky" behaviors.

Why then, she asked, is Kieth Richards not the poster child for HIV? The reality was that these four children had a far greater risk than Kieth Richards (who has participated in every risky behavior in the book) of becoming infected with the virus. Their risk factors for acquiring HIV were not "risky sexual choices" but instead were simply trying to survive and exist in a situation that was deeply unjust. The children's risk of becoming infected with HIV was structured by the same violent forces that allowed a 9 year old girl to be the sole provider of a family of four.

This raises another question: How is it possible that a 9 year old child is allowed to be solely responsible for 3 small children?

It's basically unfathomable for a little 9 year old girl in Evanston, Illinois to raise her siblings by herself. Goverment or nonprofit agencies would step in and provide much (although not perfect) assistance. Yet, for some reason we aren't easily rattled by the same exact circumstance occuring to these African children. Its not easy to dismiss the fact that we almost expect these circumstances for African children. By expecting it, we learn to accept it. And, by accepting it we expose the fact that we too are immersed in and contribute to structural violence.

More that anything, I hope that GlobeMed can contribute to developing a culture of self criticism and the awareness of structural violence amongst students devoted to improving global health. Webinar events such as this will continue to go a long way to expose students to these powerful and important ideas.


Christine Gorman said...

"Structural violence," like "capacity building" is an important concept burdened by opaque jargon.

A truly fantastic contribution to global health would be to come up with more evocative phrases for these bloodless terms.

jshaffer said...

Hi Christine,

I agree that terms such as those are mired in jargon. However, like most things in global health, structural violence is such a big, broad, complex issue that it is really hard to boil it down into a few words. I'm sure hundreds of books have been written about the sociological term, "structure." I'm sure the same is true of "violence."

The thing that has always amazed me about Farmer, Mukherjee, and the whole PIH crew is that they are so good at communicating these massive ideas through poignant anecdotes. Concepts that may seem sterile and academic become gut-wrenchingly real when they are presented as the story of an actual patient whose life has been harmed by forces outside of their control.

Ashley said...

Great post, Jon. I have a few 'unsettling' feelings of my own after reading your paragraph about how we "expect" a 9 year old in Africa to care for 3 children. I hardly think that anyone could feel content after Joia explains that this small girl acts as a mother to 3 others.

It isn't lack of empathy for such situations that increases our contribution to structural violence, but rather lack of awareness. We don't often enough ask ourselves and our peers the tough questions that Joia posed in her webinar. Through education, peer discussions, and a little critical thinking we can begin to better understand how things like structural violence contribute to the twin epidemics of disease and poverty.

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