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Toward a Globalized Humanitarian Medicine

Interview With Dr. Michele Masellis

ROME, FEB. 20, 2006 ( In 1999 a group of specialists established the International Association for Humanitarian Medicine in Palermo, Sicily, to promote and support the right to health and medical care for all.

Its director, surgeon Michele Masellis, explained to ZENIT the meaning and feasibility of this initiative.

Q: What is the International Association for Humanitarian Medicine? How was it born and what are its objectives?

Masellis: IAHM is an association made up primarily of health workers, the basis of whose activity is the defense of the right to health — understood no longer as a simple act of human mercy, but as a “duty to give to one who has the right to request.”

The idea was conceived in 1999 by a group of doctors who, aware of the spread of human suffering due to the multiplication of conflicts, natural disasters and the degradation of conditions of life in developing countries, wished to study the reasons why at present the “right to health,” acclaimed, recognized and required everywhere, does not get all the attention it deserves and is even precarious in terms of promotion, dissemination and protection.

IAHM considers fundamental for all activity in developing countries the protection of the right to health, understood as a guarantee of care, protection of human dignity, shield against speculation on others’ suffering.

Q: How can health care be guaranteed, especially where structures and medical personnel are lacking?

Masellis: By identifying new criteria of direct cooperation with the established authorities of the countries in question, with recognized NGOs [non-governmental organizations] and with international bodies and organizations specialized in the area of humanitarian action, in respect of independence and impartiality.

This enables every health intervention by volunteer organizations to be preceded by specific requests of cooperation in order that their support guarantee in the territory more effective medical actions, post-operative care and more rigorous controls, seriousness in the formation of the health personnel and adaptation to existing health structures.

In case of grave emergencies, what must be avoided is that aid be a mere episode of help, a moment of political prestige of donor countries, and not an essential point of departure for long-term development in receiver countries.

Donor and receiver countries must analyze and surmount the norms that prevent free access to patients in structures of high specialization and the free transit of health aid.

The evolution of the principle of globalization has allowed a continuous cultural growth in emerging countries with the formation of a more specialized medical class and increased respect of the person.

Intergovernmental and non-governmental humanitarian organizations that work in these countries must act in responsible and close collaboration with local health structures and medical teams.

They must receive from the latter adequate information about the existence of forms of abnormal and rare pathology, indications and opinions on what type of intervention it is possible to practice “in loco” and act as go-betweens with the voluntary health teams or with advanced hospital structures of the more industrialized countries where patients can be transferred.

In this way is guaranteed an adequate and controlled selection of patients, commitment in the training of local care personnel and a more profitable exchange of technical-scientific knowledge which will ensure post-operative treatments to patients treated “in loco” and to those who return to their homeland after care in specialized centers.

The figure of the foreign doctor, often regarded as dominating and colonizing, must be replaced by that of someone who collaborates, helps, advises and participates in the same work conditions.

Thus, conflicts with local doctors, caused by jealousies and violation of interests, will be attenuated and, finally — and it is no less an important problem — suspicions will be reduced about speculation in the management of patients by illegal local organizations, which do not disdain “selling” patients’ treatments, acting outside the control of the established authorities.

Q: You are a Christian doctor and surgeon. What do you think of pain? What are doctors’ tasks in the struggle against illnesses and sufferings?

Masellis: Pain, in general, is understood as expression of a physical indisposition that in a more or less intense way afflicts man.

He who suffers physically also suffers psychically and shows it with prostration, mistrust, discouragement and fear of dying; it is human to be afraid. Jesus, man on the cross, asked the Father for help on feeling alone while gripped by terrible physical sufferings.

The doctor observes the pain either as a symptom that expresses the evolution of a pathology or as a manifestation of devastation of the function of an organ or apparatus.

The treatment of pain is an obligation of the doctor that cannot be abolished, which in the carrying out of a therapy must be respected in its double meaning of symptom and harm, especially in so-called terminal pathologies.

As doctors, we cannot but keep present the canons transmitted by the Hippocratic oath that, for decades, were an ample testimony of medical action in the humanitarian sense, which, fixing the duties of those who exercise the medical art, establish: “I will regulate the regime of the sick to their benefit, according to my capacities and judgment and I will abstain from all evil action and injustice …,” and they underline the fundamental principles of solidarity and of dedication to the suffering.

Also present-day deontology, which has been progressively enriched in contents and imperatives, inherent to the growing ethical-social dimension of medicine, envisages in the act of loyalty to the profession: “I swear that I will take care of all my patients with the same scruples and commitment, regardless of the sentiments they might arouse in me and disregarding any differences of race, religion, nationality, social condition and political ideology.…”

The doctor’s oath, therefore, reflects the principles of a medical ethics always affirmed in human solidarity, as the basis of the commitment of care.

Q: And what to say of the psychological pain, which often is not expressed outwardly and which has its origin in gravely traumatizing episodes, such as the death of a parent, of a child, of a spouse or the mutilation of one’s body?

Masellis: Psychological pain, characterized by anguish and despair, cannot find a solution in medical therapy alone.

It requires initially a notable strength of spirit, necessary to overcome the acute phase, until that great gift of resignation begins to take effect. In such cases, faith can be an effective therapy. Fortunate is he who has and knows how to use this medicine!

Q: Present-day medical knowledge, still relative, is the greatest attained in the history of humanity; yet, important sectors of the medical and legislative world seem more concerned about regulating abortion and euthanasia than supporting life. What is your opinion in this respect?

Masellis: For a person who has chosen to dedicate a good part of his life to the care of others and to the protection of the right to health of those who are afflicted by suffering and privations, because they live in underdeveloped countries, and who upholds the principle of the right to health as “right to request, duty to give,” life is a supreme, untouchable and inviolable good.

Q: Will it be possible to extend worldwide the action that IAHM proposes?

Masellis: With its own activity, the IAHM wishes to disseminate a new way of helping peoples who suffer following the principles mentioned in the definition of humanitarian medicine it has formulated: “Although every medical intervention to relieve a person’s sickness and suffering is essentially humanitarian, Humanitarian Medicine goes beyond the usual therapeutic act and promotes, provides and teaches, supports and ensures peoples’ health as a human right in conformity with the ethics of the Hippocratic teaching, the principles of the World Health Organization, the United Nations Charter, the Universal Declaration of Human Rights, the Red Cross Conventions and other agreements and practices that ensure the most humanitarian and best possible care, without discrimination or consideration of material gain.”

This allows for that form of “protection” of the right to health, which consists of the guarantee of care, protection of human dignity, a shield against speculation on others’ suffering.

The instruments to develop the activity must be identified in a series of operative steps that include contacts with the authorities and professional organizations of the industrialized countries, so that in the major hospitals specialized sections are created dedicated to the recovery and free medical, surgical and rehabilitating treatment of patients from developing countries ….

The IAHM wishes to be the guarantor of a clear and transparent management of care to the weakest cooperating with juridically recognized national and international humanitarian organizations, involving the established authorities of countries that request aid and the public authorities, economic forces, and medical class of advanced countries, as essential primary forces to concretize the universal principle of the right to health for all.

The final ambitious objective of its action is to hear — in a not too distant day — one who has received aid say: “Thank you for what you did. We no longer need you!”

There is also a fundamental medicine to carry out a program as that of IAHM in favor of the most underprivileged sick of the world: profound faith in what one believes.

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