Since I started working in the travel clinic office, my interest for global health was growing steadily. Like many doctors I have thought about joining MSF or similar organizations before. But I was not sure, if my expertise was useful and heard varying opinions from others. I did not want to end up as a voluntourist, which is a dilemma in my opinion and we have to ask ourselves before, if we are really doing good and being altruistic.
We had a lecture about the Ebola crisis once. Last year it was big on media. A scenery like an apocalypse movie with white monkeys in space suits. This fits television perfectly. But what happened and what went really wrong?
First of all, there have always been sporadic Ebola outbreaks in the area. Unlike it seems in many media reports, it is nothing new. Usually those outbreaks were confined to small villages. The people in those villages tended to run away for a while into the immediate surrounding and came back once every sick person had died. Thus it was self-limiting.
In recent years quiet some changes have taken place in those communities. Roads have been built, infrastructure became better, mobility is on the rise. People from remote villages actually were enabled to move to the cities. One can argue if this is a good or a bad thing in general. But what happened in the Ebola case? Sick and contagious people started travelling along this road and so did the virus.
Second interesting point was the response of helping organizations. What would you think if a bunch of people in alienating suits, not even speaking your language came with trucks to put your deceased relatives in plastic bags, spray them with a strange smelling substance and take them away? Anyway more people get sick and disease spreads further after they came. Right. They are evil. Grip on the situation could be rapidly established after local people were educated and were leading the action.
It happens more locally too. Returning health care providers were regularly put in quarantine before being allowed back into society again, even if they did not show any symptoms. Even the possible chance for infection is a stigma. Look at how HIV patients are treated by the community and that does not even come close to Ebola. It goes beyond any rationale.
The role of culture, traditions and specific behaviour in the prevalence and development of disease but also the amount of suffering due to certain conditions is fascinating. The importance of understanding the people to establish a working treatment paradigm is what intrigues me. And we need an interdisciplinary approach for this.
I wanted to learn more about the field and came across a network of several European Universities working on these issues: The NOHA network.
The Network On Humanitarian Action is an international association of 12 European and 5 international universities which aims to deliver an interdisciplinary academic approach to humanitarian help. It was founded in 1993. They offer a Master programme as well as several short term courses. So last week I went to Budapest for spring school.
The program was intense. One week, 5 days, stuffed with 8 hours of lectures each. Every topic was addressed, even if shortly. Information thus stays mostly superficial to fit the various backgrounds of each attendee and give a short and narrow overview. It is very interesting to meet all those different people and we had good discussions in between and after lectures.
The program started with a general introduction and history of humanitarian aid. The 4 humanitarian principles (humanity, impartiality, neutrality and independence), the challenges of those in recent situations and the disappearance of a clearly defined humanitarian space.
It then went on to international humanitarian law and human rights. When is which law applicable? Basically international humanitarian law is applicable only in a war situation, which can be international or on a national level with different armed parties. Human rights act as a gap filler for situations that are not clearly defined as war. In the end there is only an agreement on and no organ for persecution to ensure these rights.
One day was devoted to the current humanitarian problem inside the refugee crisis. The number of displaced people is shocking. 60.000.000 people worldwide are currently expelled from their homes. That is 1 in 120. Almost 1%. UNHCR delegate Mr Hoisaeter talked about refugee rights and the UNHCRs role in advising governments. Unfortunately because of the shooting incident close to the hungarian border he did not have much time for discussion, what would have been very interesting.
One big issue that is being addressed by humanitarian organizations is protection of civilians. As a risk can be defined as threat + vulnerability x time, it is important to act on the vulnerability of a population and ensure more resilience, as it is not always possible to remove the threat. But also take into account that in order to be able to access an area in need, it might often be necessary to negotiate with rebel groups for example to ensure protection of civilians and care providers.
All in all it was a very interesting program with lots of information to think about. There was little time for exploring the beautiful city of Budapest, but we did have some beers together in the evenings.
I want to promote one project of my fellow attendees here. If you have some time and want to engage in something useful while having a meditative task, you can help with mapping. One problem for humanitarian aid is access to remote areas where help is needed. Many times useful maps in these areas are missing. This is where the community of open street maps comes into action. In collaboration with MSF and the red cross there are several defined tasks to map these areas. Everyone can join forces. Map buildings in defined areas and locals will add current information to them. Find the tasks and instructions here.
I added a list of useful background information in the links section.
DocSpiration 