22 Dec, 08 | by BMJ Group
Last week I was in Uganda, speaking at a conference on monitoring the right to health. During the conference I met a fourth year medical student from Zimbabwe, Norman Matara. Norman is a tall, slim, gentle, slightly stooped young man. He does not talk much, but when he does he is thoughtful and softly spoken. He will say a few words, then lapse back into introspective silence. Although he is young, when he is not smiling his forehead creases easily with anxiety. Norman wants to be a paediatrician.
When he talks about medicine he is animated and hopeful, with a tall man’s habit of looking over your head and into the distance. But Norman and his fellow Zimbabwean medical students have a problem: all the universities have been closed and nobody has any idea when they will reopen. Instead of drifting into the black economy, or taking up subsistence farming in order to feed himself, he has opted to do what work he can in human rights.
He is taking a risk. By their nature, human rights call governments to account. They remind them of a certain minimum set of obligations they owe to their citizens – everyday things such as a right to life, a right to a fair trial, a right to be free from torture. They also remind governments of their obligation to strive to provide the basic conditions for life: food, clean water, a functioning health system.
The government of Zimbabwe, like every tyranny, does not like to be reminded of these obligations. It rules not by consensus but by fear. It does not promote the interests of its citizens; it brutally subdues them to the interests of the political elite. Human rights activists have been beaten, abducted and killed. Civil society has been all but silenced. Into this toxic zone, force of circumstance has pushed this young, gentle and unassuming medical student.
When you’re working in human rights there are inevitably times when a sense of unreality creeps over you. It certainly felt a little strange to be talking about the role of health professionals in monitoring the right to health in East Africa, while in Zimbabwe the last hospitals had closed and cholera was stalking the land. I could not help the feeling that Rome was burning and I was busy with a fiddle.
In Uganda I went on a visit to Butabika psychiatric hospital outside Kampala. It was an immaculate complex, perched on a quiet hill overlooking Lake Victoria, cooled by the lacustrine breezes. But in the acute male ward there was one nurse looking after a 115 patients. On admission they were given high doses of chlorpromazine, which was subsequently titrated down. The more heavily sedated patients moved like automata, staggering and drooling. Although the health professionals were little short of heroic, given the chronic shortage of staff, and the tiny drug budget, it was not easy to distinguish between therapy and control.
One of the criticisms that is sometimes levelled at human rights is that they are a western invention. In exporting them across the world the west is engaged in a species of moral imperialism, that having sacked the world of its riches we are now trying to tell the world how to be good. I admit to being no fan of cultural relativism. As Samuel Johnson said of nationalism, it is too often the last refuge of a scoundrel. Taken to its extremes it would mean that cultures are incapable of criticising, and therefore learning from, each other. While there are problems with human rights – as there are with all moral theories, if moral theory it is – it is clear that, for many developing countries, it is the language of choice for those pushing for political change. For all their rhetorical excess, and their uncertain metaphysical base, human rights have replaced socialism as the language of political aspiration in some of the nastiest administrations in the world.
On the last day of the conference I was asked by another of the medical students what I did when I ran out of hope. The world being what it is, where did I turn when things seemed irredeemable? I have to admit that for a moment or two I felt awkward. It is a terribly difficult question, and the answer usually a very personal one. But I thought for a minute, and then it was obvious. There is your answer, I said, pointing to Norman. Hard to imagine a more potent image of hope in desperate circumstances than this quiet and courageous young medical student. I take my hat off to him.
Julian Sheather is a senior ethics advisor, British Medical Association.