Ed Mills: A champion of health and human rights
Following his involvement in The Lancet’s current series, Nadine Cozens and Rachel Brown quiz Dr Ed Mills on the vital role of medical students in Health and Human rights. An ideal candidate for bringing this subject to light, Dr Mills’ work is focussed on the application of evidence-based decision-making to international health interventions and human rights, specifically concentrating on HIV/AIDS in developing countries. Dr Mills is based at the British Columbia Centre for Excellence in HIV/AIDS and Simon Fraser University in Vancouver, Canada.
At the beginning of our interview with Dr Mills, we realised that our knowledge of global health related human rights issues was little beyond what would be considered normal common sense. The right to health isn’t exactly a topic particularly focused on in UK medical schools, or, if it is, it is skated over in other disciplines such as ethics and medical sociology, or just assumed. So, we asked, why should medical students be interested in human rights?
Dr Mills’ answer was frank, “because of the failure of previous generations to deal with the problems that we are facing”. Dr Mills said that there was little that these previous generations could now do and that it required “radical thinking” to come up with new solutions. Such thinking, he said, could only come from young people.
Dr Mills also stressed the specific importance of healthcare specialists in delivering health rights. “Only healthcare understands healthcare,” he said. That is, only those people trained in healthcare work, whether medicine, nursing, physiotherapy or other health disciplines, can recognise the limitations and demand for healthcare in different regions and are in a position to advise policy makers. While he recognises that it is not always doctors who are directly implementing patient care, he said that they still have an integral role and must “collaborate with nurses and other healthcare workers to ensure the fulfilment of patient rights”.
We asked about the main issues for today’s medical students to be aware of. Dr Mills highlighted health worker shortages as his most important issue. “Such shortages prevent drug distribution even where they are available”, he said. This problem is being faced throughout Africa, including Malawi, Zambia and parts of Uganda.
Facility shortages are also a problem, especially space issues. Dr Mills said that bed shortages, not just in Africa but also in parts of Asia, are furthering the spread of TB. “Patients without TB are entering clinics or a hospital, ending up sharing beds with patients who have TB and then contracting the disease themselves” he explained. “We need specialist care centres specifically for TB patients in these countries.”
Another key issue Dr Mills thinks students should be aware of is healthcare borders, which arise following conflict and internal displacement of people, neglect (eg, in Darfur) and differences in values (certain aid agencies provide healthcare only in regions which accept certain teaching practices). It is for this reason that he praises organisations such as Médecins Sans Frontières (MSF). “These organisations break down borders and send medics and other professionals to countries regardless of the politics which prevent other organisations from doing so” he said.
We asked Dr Mills if he thought medical students should be campaigning to see the introduction of specific teaching on health and human rights into the curriculum. “It’s already coming in”, he said. “Already, particularly in certain American medical schools, teaching about the right to healthcare is being given more focus and while this is still largely elective, it is filtering in more and more”. In the meantime, he suggested inviting speakers, such as medical students who have worked in the field, or more importantly, patients who have experienced healthcare injustice, to talk in medical schools. Dr Mills said that first hand experience was crucial and the only way of dispelling the “complacent attitude” established by reading about conflicts and statistics in the mass media.
We asked how students can get involved in human rights issues. Many students take a serious interest however few will find the opportunity in the already jam-packed curriculum to actually get involved, and the majority will put these thoughts on a back-burner until the final year elective is being planned. Dr. Mills emphasized that that students, in addition to being a key target group for future action, “really can help”, and in ways that can be incorporated into university life. For instance, by joining advocacy campaigns, amnesty groups, fundraising activities, or even doing what students do best, putting pen to paper and writing to their MPs. Whichever way, Dr Mills said that “any effort will support the growing need for awareness of global health rights”.
When it comes to electives, many students choose to visit parts of the developing world, but are often not fully prepared for or feel ill-equipped to face health right issues. Dr. Mills’ main advice was to understand the importance of “changing mindsets” before embarking. “Only by absorbing all the information possible about the area being visited and the chief problems there, can students begin to appreciate what is to be encountered, which may be a world apart from what students have grown accustomed to whilst at medical school”.
He acknowledged that health and human rights issues were also important in the UK. “You don’t need to go to Africa to find examples of health right breaches” he said. Groups neglected in the UK include the elderly, individuals with mental health problems, and individuals coping with drug addiction. Therefore awareness of global human rights issues can be applied to UK-based medicine.
We asked Dr Mills if he had any additional messages for students. “It’s important to understand that health and human rights is still in its infancy with few right answers but many wrong ones”, he explained. He said that it needed “bright young minds” to decide “whether to concentrate on finding out what is wrong with existing policies or just start completely anew.”
”Today’s medical students will be crucial in the future promotion of evidence-based humanitarian aid and in the introduction of more accurate ways of surveying morbidity and mortality and interpreting the evidence to teach policy makers.” “Currently,” he said, “policy makers do not understand the evidence that is collected for them”.
Finally, he reiterates what he said to us at the beginning of the interview, that medical students can do massive amounts for health and human rights. “Neglected populations know they are being neglected” he said. “If a western person can go and stand in solidarity with neglected populations, whether in the UK or abroad, then this can be a big step”. “Just holding somebody’s hand will make a difference, but imagine doing more?”
Nadine Cozens
Fifth year medical student
Kings’ College London,
University of London, WC2R 2LS
nadine.cozens@kcl.ac.uk
Rachel Brown
Third year medical student
Somerville College
University of Oxford,
Woodstock Road,
Oxford, OX2 6HD
r.l.brown@some.oxon.org
August 15th, 2007 at 3:14 pm
I enjoyed your article Nazdine and Rachael. As health is so interlinked with politics and society, teaching about the right to health seems essential to any curriculum that aims to train “health” professionals. It’s interesting that Dr Mills notes in particular that teaching about the right to health is coming in in American medical schools, given the health system there! It’s great news if this results in doctors taking up this issue and improved access.
Perhaps the right to health becomes an even broader and more important topic where medical schools begin to address global health as well as national health.