19th February 2020
Health professionals as advocates: should we do it?
(From 'The Role of Health Professionals in Advocating for their Patients' December 2019)
“We are not sure that words can always save lives, but we know that silence can certainly kill."
Dr James Orbinski, Former MSF President
In December of 2019, Health Professionals for Global Health and LSHTM Friends of MSF held an evening of speakers exploring the role of health professionals in advocacy both locally and internationally. Our speakers brought to the audience a range of perspectives and experiences and covered a wide range of topics across the evening - However, the audience and speakers were left with more to explore. As Health Professionals in the UK we are privileged to have the resources and security to speak up but sometimes this responsibility feels overwhelming and it’s hard to know where to start.
We live in challenging and uncertain times where, arguably, global attitudes and policies are regressing. Little is fully hidden from global media which seems to result in an inability of the world to be shocked into action, or even reaction. Perhaps it is the lack of ‘clicks’ that results in shockingly low media coverage of some of the most significant issues and crimes of today. Disregard for human rights has become a norm within Europe. Attacks on healthcare workers and civilians have become normalised and carried out with impunity. What can we learn from those who translate these feelings of frustration and despair into positive action?
We heard first from human rights lawyer, Emmanouil Athanasiou, who has worked with (but was not representing) MSF. He quoted a 1971 press release from a senior MSF official “We have to be perfectly clear: Doctors don’t go to be witnesses; they don’t go to write a novel or a newspaper article.” During MSF’s evolution they fundamentally changed their perspective with a policy of ‘témoignage’ or ‘witnessing’, and speaking out, which ultimately helped them win a Nobel peace prize. Health care professionals often bear witness to what nobody else can see. As such, they have a privileged position and their responsibility must extend beyond the patient in front of them.
Emmanouil used a real-life example to further this point and put forward complexities: imagine you’re working in a conflict zone, running a sexual violence programme. During one week you see a huge surge in cases of sexual violence. Would you respond to that, or just continue to treat the patient in from of you? This was the situation in South Sudan and MSF issued a press release which seemed important to defend the victim’s rights and protect other potential victims.
Such decisions are never easy; could this put anyone at risk? Could this damage the relationship of my organisation with the government or with local groups? Could this impact our impartiality? In conflict or adverse settings, if people are not defended by humanitarian actors, by whom will they be defended?
Carolyn Tauro, a Doctor who has also worked extensively with MSF, told us her experience of advocating with the MSF Access Campaign which increases the availability of essential medicines in developing countries. We heard about the group’s determined and systematic approach to challenging the status quo: analysis of the barriers to accessing essential medications, research, policy writing and legal challenges to achieve what often seemed impossible. Read more about their work, such as their negotiations for antiretrovirals for HIV for less than $1 per day here.
Rita Issa, who has worked for MSF, the World Health Organisation and was co-founder of Doctors for Extinction Rebellion, talked to us about the responsibilities of being an advocate – we must always ask ourselves what gives us the right to speak for other people? Which powers put us in an advocating position in the first place? Advocacy is about a power differential, and in most cases, we should be facilitating the voiceless to be heard, rather than speaking on their behalf.
In order to be effective each of us should look into ourselves to decide how we can contribute; it may not be within everyone’s comfort zone to write, speak publicly or whistle-blow – but sometimes it’s what may need to be done when others have no voice at all. It’s worth asking oneself: what are my strengths? What do I care about? What action could I take to stand up for the things that I believe to be true? To quote Richard Horton, editor of The Lancet: “Small brave acts of a large number of people have made the difference.”
Moving from an advocate to an activist “The master’s tools will never take down the master’s house”
So when does advocacy move into activism? Why does the problem exist in the first place? Can we achieve real change from within the system? Is it really enough to write letters to our MP? Extinction rebellion doesn’t think so. “Sometimes you need to step outside of the system when it is not responding to you.” This may mean you’re criticised, trolled on Twitter or feel undermined. That’s a success, by the way.
Sonia Adesara spoke to us about advocating for patients within the NHS. She became a political activist after starting work as a doctor. She witnessed poor care and the scapegoating of health care professionals rather than addressing the underlying systemic failings. She was told “this is the way things are”. Like many she had planned to work abroad until she saw the scale of the need in her home city of London. Whilst working for Doctors of the World in East London she saw the direct consequences of the ‘Hostile Environment’ policies on vulnerable people: on one occasion it was felt the safest option for a homeless pregnant woman in winter was to ride around London in night buses during the night.
Unfortunately, ignorance and apathy among health care professionals are common; there’s a feeling that “This is just the way things are, there’s nothing we can do.” Our time is limited and we feel that there is little time or energy left in the day to raise our voices. We would like to challenge that sentiment: advocacy doesn’t need to take much time - and it is our duty.
To win big, you have to take big risks
Jenny Vaughan agrees that we need to be risk takers - we need to “be alongside people when they’re in dark places and believe in the possible, even when it looks impossible”. Working with Doctors Association UK she worked with colleagues in the #Learnnotblame campaign. Working on the Sellu case, then the Bawa-Garba case, she was approached by doctors across the world who were also facing medical manslaughter charges. Health care professionals cannot begin to advocate for their patients if we do not have a blame-free and open culture. A culture of learning fosters safety and progress in an organisation. There were times during this gruelling campaign to change the laws around medical manslaughter that Jenny was told to stop, that it wasn’t worth it - but she persevered. She couldn’t see how they would succeed. “Deciding to continue fighting means you’ll lose friends, money and time”.
She shared with us a video from DAUK Doctor Don Berwick, President Emeritus and Senior Fello: “An impoverished view of how to make healthcare better is that we need to try harder, that if we just point enough fingers, create enough contingencies, rewards and punishments, increase the pressure, then somehow, frankly magically, things will get better… When things go wrong, the vast majority of the time, the causes lie in the systems of work in which we’re embedded.”
“In order to win, in order to achieve anything, you need to make yourself uncomfortable, you need to go and do uncomfortable things and you need to challenge yourself… If we make ourselves uncomfortable, and do things that challenge ourselves, that really take us out there, we’re doing the right thing, probably.” - Jenny Vaughan.