January 2010

Meet Our Featured Guest Columnist: Laura Janneck

served as the American Medical Student Association’s Global Health Education Coordinator in 2008. She was inspired to attend medical school after seeing the slums of Brazil and recognizing the links between poverty and disease.

Q: What does "health and human rights" mean to you?

A: More and more, people are coming to understand health as a human right, as something that all people are entitled to, no matter where or under what circumstances we are born. Just as civil rights have gained widespread recognition in the past 50 years, social and economic rights such as health care are taking hold in our collective consciousness as fundamental to the human condition. This recognition holds us responsible for ensuring that these rights are upheld. We cannot stand idly by as human rights such as the right to the highest attainable standard of health are violated. Each of us is responsible to challenge the structural violence and systems of inequity that violate the right to health, and to create a world that upholds this right for everyone.

Q: How/why did you get involved in global health issues?

A: After my first year of college, I went to Brazil with a friend for the summer. I recall the first time I set my eyes on the favelas--the slums--of São Paulo and the visceral sensation of my heart squeezing at the sight of such enormous poverty: the wall of tin shacks that seemed to reach to the sky, the children begging at stop lights, and the glistening skyscrapers and walled-off condominiums of the wealthy in the background.

I spent most of that summer in a rural village north of São Paulo where I had the pleasure of befriending several local people my age, many of them servants to the wealthy landowners. Seeing their struggles - teenagers working full-time to support their families, fathers suffering from undiagnosed major depression, kids traveling hours to attend a dirt-floored public school that at least had regular lessons - I decided to use my privilege to somehow change these unfair and unjust circumstances. Upon returning to college, I directed my academic pursuits toward international development. A particular class on the burden of disease in developing countries and the professor, who remains a mentor of mine, showed me that global health is not only morally compelling but intellectually fascinating. With a penchant for science and working directly with people, I decided to enter medical school to start a career tackling the inextricable link between disease and poverty.

Q: Describe some of the successes you have seen in your work.

A: During a stay in Johannesburg, South Africa, I shadowed a doctor at the AIDS clinic in a downtown neighborhood. The clinic is actually a Catholic convent that includes an orphanage, old age home, hospice, and AIDS clinic. I asked the doctor where they got their funding from, expecting mention of the Church, private donors, or the South African government, but I was a bit surprised by the answer I got: PEPFAR. PEPFAR is the President's Emergency Plan for AIDS Relief, a foreign assistance program that provides funding for AIDS prevention and treatment programs in developing countries. I smiled a bit to see that the AIDS advocacy movement I had been a part of in years past had tangible results. A growing movement of dedicated activists in the United States and other countries has been instrumental in getting the AIDS epidemic on the global political agenda. This movement has achieved many incremental successes, the passage and reauthorization of PEPFAR among them. Writing letters and calling congressmen can feel a bit distant at times, but standing there in the chilly clinic, I met in-the-flesh people taking the life-saving medicines we had in mind when we made those calls, a testament to the changes we can make together when we speak with one voice for the rights of the sick to treatment.
Another story that stands out in my memory is that of a young father in Guatemala. When Hurricane Stan tore through Guatemala in 2005, everyone in this man's village fled to higher grounds as the ensuing landslides destroyed their homes. Almost a year later, they were still living in USAID tents in the foggy highlands, unable to return to where their village had once stood because of the instability of the land. I followed a Cuban-trained doctor who took his free weekends to provide what medical care he could to the displaced villagers. One of our patients was this young man who was bedridden with a severe cough. Squinting in the darkness of the tent in which he lay, we took his history, heard the crackles in his lungs, and diagnosed pneumonia. He had been taking penicillin donated by a foreign hospital, but the drug was not working. His only hope was to go to the hospital two hours away for intravenous antibiotics. He resisted, afraid to leave his family and despairing that he could not afford it, but finally conceded when, with the help of the doctor's professional connections, we arranged for it to be free. Two weeks later, he was back home and in excellent health.

These stories illustrate to me the incredible power and potential of modern medicine. The reason why global health is so compelling is that the medical treatments and cures we develop in one corner of the world work for people in other corners of the globe. When the barriers to the delivery of health care are overcome, we can expect AIDS to not be a death sentence for South Africans, and pneumonia to be curable for indigenous Guatemalans.

Q: What are some of the challenges that remain?

A: The individual successes mentioned above demonstrate that achieving quality health care for the poor is not just a nice idea, but an achievable goal. Yet these cases also demonstrate the complexity of the challenges to that goal and the enormity of the task at hand. In order for AIDS drugs to reach every patient that needs them, international trade laws and national laws must be made equitable and enforced; armies of health care workers must be trained to distribute, monitor, and modify the treatment regimens; production of effective drugs must be scaled up and their prices dropped; investments must be made in new pharmaceuticals and technologies designed for resource-poor settings; the sick must be located and partner with the health delivery system; and so on; and all of this must be maintained in perpetuity. Even this chain of steps is a health-centric list. In order to really get at the root of disease and poor health, we must go after food insecurity, unemployment, poor housing, gender inequity, racism, war, and every aspect of violence toward people that emanates not only from other individuals, but from the historical structures of our society which constrain the underprivileged. Along every step, particular attention must be paid to the most vulnerable among us, and we all must challenge the paradigms in our world that perpetuate any sense of the normality of inequity.

Q: How can young people make a difference?

A: I see great potential in my generation. We have the fortuitous position of being able to stand on the shoulders of giants, the pioneers that have brought global health issues to the forefront of the world agenda, and truly transform the growing awareness of our globalizing world into a movement of social change.

There are countless ways for young people to be involved and make a difference in global health. They can become active in advocacy organizations such as the American Medical Student Association, Physicians for Human Rights, the Health Global Access Project, etc., that work for policy changes to enable equitable access to health care. They can educate themselves and their peers about the complexity of the issues, so that they can come up with creative ideas for change. They can build community with those who are oppressed and underprivileged, in their hometowns and distant lands, and be a part of a global community that can provide locally appropriate solutions. By building equal relationships with the poor and underserved, those who are fortunate enough to be in positions of privilege--as American citizens, as native English-speakers, as well-educated, as wealthy--can use their advantage to strengthen the voices of those with less power. Young people are already making a difference doing all of these things. They need not wait to lead political movements and campaigns, teach and inspire each other, and continually work for social justice.