Peace-through-health and Health Sciences Education

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Peace-through-health and Health Sciences Education: Teaching Students New Skills. McMaster-Lancet Peace Through Health Challenge Conference. October ...
Peace-through-health and Health Sciences Education: Teaching Students New Skills McMaster-Lancet Peace Through Health Challenge Conference October 2001

Jennifer Hughes, April Kam, Raj Grewal, Fahreen Dossa, Tobey Audcent, Meaghan McLaren, Ekta Khemani, Jeremy Penner Introduction In a discussion over lunch with several medical students about the recent suicide hijackings in New York and Washington, a colleague rationalized that the only method of resolution was to raze all of Afghanistan to the ground in the hopes that those people specifically responsible would be killed. This student is not alone in thought; the Globe and Mail published the following quote on September 12, 2001: “I know nothing’s been proven, but I feel like bombing every Muslim country on the face of the earth. Maybe it’s wrong, but that’s how I feel.” How is it that in an ostensibly peaceful culture, values of revenge and war are cultivated? How is it that a future physician who has so much potential to promote peace and mitigate conflict could instead endorse violent retaliation that would inevitably result in the loss of innocent lives? A strong sentiment of anger and of a need for swift and brutal retaliation seems to be sweeping North America. While it is impossible to fully appreciate the trauma and grief experienced by the thousands of people affected, the emerging desire to blame someone has dangerous ramifications for everyone. The disbelief that anything so heinous could happen in the mighty United States brings home the message that even in an allegedly peaceful nation, ideas of retribution and intolerance exist. It is also confirmation of the need for peace-building at home, for destructive conflict does not just exist in the developing world or in nations at war. The opinions voiced by some of our colleagues poignantly substantiate our belief that the concept of peace-through-health should be included in health sciences education. Health care workers need to be exposed early in their education to the role they can play in promoting peace both globally and locally. Introducing health science students to the tools and strategies they can use to successfully meld health initiatives with peace initiatives will not only enrich the education of these students and influence their potential career choices; it will also benefit the communities with whom they work. As the world is trying to understand the recent violent events in the United States, it becomes clear that the role of health professional as peace-builder is too important to ignore.

Peace-through-health: the connection Peace has long been known to be an important determinant of health on many levels, both physical and psychological. Physical trauma and increased mortality of young healthy populations are only some of the most immediate health effects of violent

conflict. Factors such as the disruption of food supply, dislocation of populations and emotional stress have long-term implications for individuals and communities. Health care professionals who concern themselves with the health of these populations must also concern themselves with the physical and psychological threats to health that exist in a community engaged in destructive conflict. In this way, the health care worker finds her- or himself responsible for promoting peace in order to protect and promote health. Health professionals can be involved in peace-building through several identified strategies, including: conflict management; solidarity with people and groups working to build peace; strengthening the social fabric of diverse populations in conflict through health care delivery; active dissent with violence-oriented policies; and mitigating the destructiveness of war by working to have military or other policies modified by international law (MacQueen and Santa-Barbara 2000). Several key case studies of peace-through-health mechanisms illustrate various ways health professionals can be involved, although they are by no means exhaustive and do not include initiatives in North America. For example, the Butterfly Garden in Sri Lanka was developed to allow children from both sides of the ethnic conflict to come together in a safe environment. Health professionals were involved in working with children to address their traumatic experiences and allow them to begin healing emotionally. Another example is the Mass Immunization Campaign (MIC) in Afghanistan, which orchestrated a humanitarian ceasefire in 1991 in order to vaccinate the country’s children. Similar immunization ceasefires have been implemented in other nations (eg. El Salvador and the Philippines), with the ultimate goal of using the common value of children’s health to initiate conflict mediation (Peters 2000).

The importance of peace-through-health in health sciences education Health workers drawn to the front lines of violent conflicts often find themselves embroiled in a complex social and political web of issues. As such, they have often become involved as negotiators and mediators, in the recognition that in order to address the health concerns of a community they need to aim their efforts towards the source of the problem. Providing health care without addressing conflict is analogous to treating pain with a sedative rather than dealing with the underlying disorder. This applies not only to large-scale international conflicts, but to domestic issues as well, where alcoholism and addiction, violence, depression and stress-related illnesses point to a need for practitioners to address more than just clinical pathology. Health workers are clearly in need of conflict resolution skills as an integral part of their training. The question remains how to effectively engage health workers in the peace-building process. What are the special skills that health practitioners can bring to the table? This is where health promotion reveals itself as a powerful tool to be used in peace-building. Health issues provide a common ground across communities, and health initiatives can serve as an effective means of deliberately bringing conflicting groups together, and empowering them to work towards a common goal. As they emerge from their training, health care workers are often overwhelmed by the complexity and magnitude of social and political influences on their work. Conflict resolution skills, and more specifically, strategies for using health expertise as a peacebuilding tool need to form a fundamental part of health sciences education. In recent

years, there has been a paradigm shift towards a holistic approach to health care and this in turn has been reflected in health sciences training. There has been a recognition that health practitioners need to help their clients consider the environmental and situational factors affecting them as opposed to focusing solely on the clinical aspects of their disease process. While preventative medicine and holistic care have emerged as the new models in health sciences education, the skills to implement these models in situations of conflict remain to be provided as part of training.

How can peace education and health sciences education be linked? A group of students from several different faculties at McMaster University including medicine, science and the arts gathered together in the fall of 2000 to explore their interest in peace-through-health. Over the past year, we have contacted numerous people across the world who are involved in peace-through-health, peace education or health sciences education to solicit their opinions and ideas about incorporating conflict resolution skills and peace-through-health concepts into health sciences curricula. The challenges and barriers to the introduction of this concept are discussed in a following section. Overall, most health sciences educators felt that peace education could be an interesting (if not essential) addition to their respective curricula. Some felt that student interest would play a determining role in introducing peace education, while others felt that it should be offered as an optional experience guided by student initiative. Several modalities for introducing peace education into health sciences curricula were proposed, including: • • •

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Introducing a full lecture-based course on peace education with defined objectives and evaluation. Incorporating the peace-through-health concept into a broader course on the social determinants of health. Assembling an interactive, problem-based, case-based set of tutorial sessions to explore global peace and health initiatives (including an overview of the key examples of peace-building through health work in various countries around the world). Offering optional discussion seminars in which students would explore the dynamic relationship between peace building and health care work ideally with the help of a facilitator working in the field. Establishing a clinical overseas placement that would allow health sciences students to experience firsthand the promotion of peace by employing health initiatives. This ideally would involve international and interdisciplinary collaboration. Establishing an elective/exchange that would give students the opportunity to explore health initiatives and conflict resolution in various parts of Canada. Creating a local outreach program (community or school-based) with faculty support in which interested students could collaborate to set objectives and identify avenues for learning about peace and health while addressing community needs.



Holding a seminar day in which peace-through-health could be explored via panel discussions, poster sessions, and seminars.

Student survey In a qualitative survey of students enrolled in the undergraduate medical program at McMaster University, the overwhelming conclusion was that there is little awareness of the concept of peace-through-health, and at most, students have heard of the organization Doctors Without Borders. Most people were interested in learning more on the subject. However, students expressed concern about their busy schedules and the limited time they currently have for learning “the fundamentals of medicine”. The poor response rate of the survey potentially reflects the level of apathy in the student body on issues that do not immediately relate to their personal goals and interests. However, several students placed importance in getting a “well-rounded medical education”, which to them included learning more about peace-through-health issues. Students noted the key role physicians played in preventative medicine and recognized how “doctors are in a good position for leadership in areas beyond those specifically medical”. Student-generated ideas of integrating peace-through-health into medical education included: hearing directly from health workers involved in peace-building in the form of interactive lectures; and integrating peace-through-health learning objectives into the introductory units of McMaster’s medical curriculum. Many students felt that the peace-through-health concept should be introduced early in the program, when students have more time to explore and examine new ideas. Others suggested that interest in peace-through-health could be met independently through self-directed electives supervised by an experienced preceptor, and subsequent sharing of knowledge with the rest of the class. A final idea was to involve the entire class through an awareness or fundraising project related to an actual peace-through-health initiative. Students seemed generally aware of the realistic constraints that any health sciences curriculum faces, and consequently the ideas suggested were almost exclusively student-driven and self-directed. In light of the variable level of awareness and interest among students, it seems important for sufficient promotion to students before peace-through-health can be implemented in a health science program.

Challenges The argument that health care workers should be taught strategies and skills to manage conflict and build peace whether working overseas in areas of war or at home in conflict situations is solid. It is just as apparent that the incorporation of peace-throughhealth into health sciences education is not without challenges. Most of the key challenges discussed here were consistently identified by peace educators, health educators and students alike, indicating a high level of awareness of the fundamental difficulties health sciences education faces. Perhaps the most obvious challenge is a financial one. Competing for funding is an unfortunate reality in all university programs, especially for curriculum concepts that

do not already enjoy the exposure and support of more traditional subjects. Similarly, without enlisting faculty support (ie. “finding someone to champion the cause in the curriculum”), efforts to erect a core initiative would likely fail. Although many faculty members at Canadian universities are involved in peace education and conflict studies or international health initiatives, few are linked to peace-through-health. Creating faculty positions or cross-appointments to address this deficiency is likely far down on the wish list of university administrators. Students also identified the realistic constraints health sciences programs face and suggested several student-driven initiatives to fill the gap, as discussed above. Although student-directed enterprises may well be successful and educational, the reality remains that without consistent faculty support and involvement, peace-throughhealth initiatives will be sporadic and variable over time, depending on the student population. Furthermore, as identified by one faculty member, optional initiatives often reach students who are already interested or knowledgeable about peace-throughhealth issues and fail to reach those who have no previous exposure. Another significant challenge peace-through-health education confronts is finding room and validity as a core component in health education. All health sciences programs need to ensure adequate professional training and adding to this demanding workload can be challenging. Yet another major challenge is a potential lack of student interest. Because the peace-through-health concept is perceived to lie outside the traditional health sciences curriculum, students are potentially more likely to not consider it seriously. It may be useful for students and faculty to conduct class surveys or research projects to document interest. One suggestion was to hold a career information session early in the academic year to raise awareness among students about the diversity of career opportunities available to them including not only clinical medicine, but also community, public, and international health in both the public, private, and charity sectors.

Summary Health professions are sometimes referred to as “the helping professions”. In fact, the desire to help others is often expressed by students as a key motivating factor in choosing health sciences as a field of study, and educational programs in health sciences strive to provide students with the tools they will need to realize their goal: helping others achieve and maintain a higher level of health. What is not explicit in this goal is the realization that health is intricately interwoven with peace and conflict and that health professionals are in a unique position to address this aspect of health care by promoting peace. Since peace and conflict can have such a large impact on health status, it seems that peace-through-health strategies should be considered an essential concept in the education of health professionals. It is logical that health professionals should begin acquiring knowledge and skills in peace-through-health early in their training for use both locally and internationally. Although the incorporation of peacethrough-health into health sciences curricula is not without significant challenges, with the commitment and collaboration of health educators, peace educators and students, this goal can be achieved.

References and Reading List Health through Peace: A Training on Conflict Prevention, Human Rights and Health. International Federation of Medical Students Association and International Physicians for the Prevention of Nuclear War, The Hague, 1999. Global Health Studies: Proposals for Medical Undergraduate Teaching, Medact, London, 1998. Large, Judith. Considering Conflict, First Health as a Bridge for Peace Working Group Meeting, Les Pensieres, Annecy, 1997. MacQueen, G. and J. Santa-Barbara. Conflict and health: peace building through health initiatives, BMJ 2000; 321:293-6. MacQueen, G., R. McCutcheon, and J. Santa Barbara. The use of health initiatives as peace initiatives, Peace and change, 1997: 22(2):175-197. Medicine and Peace: A Model Curriculum for Medical Students (draft), Commission on Disarmament Education, International Physicians for the Prevention of Nuclear War and Physicians for Social Responsibility. Peters, M (ed). A Health to Peace Handbook, McMaster University War and Health Program, Hamilton, 2000. Shankar, R. A. Health as a Bridge for Peace, Dalhousie University, Department of Economics, Halifax, 1998.