Rights as Relationships: Collaborating with Faith Healers in Community Mental Health in Ghana.

This paper explores the ways in which mental health workers think through the ethics of working with traditional and faith healers in Ghana. Despite reforms along the lines advocated by global mental health, including rights-based legislation and the expansion of community-based mental health care, such healers remain popular resources for treatment and mechanical restraint and other forms of coercion commonplace. As recommended in global mental health policy, mental health workers are urged to form collaborations with healers to prevent human rights abuses and promote psychiatric alternatives for treatment. However, precisely how such collaborations might be established is seldom described. This paper draws on ethnographic research to investigate how mental health workers approach working with healers and the moral imagination which informs their relationship. Through an analysis of trainee mental health workers' encounters with a Prophet and his patients, the paper reveals how mental health workers attempt to negotiate the tensions between their professional duty of care, their Christian faith, and the authority of healers. I argue that, rather than enforcing legal prohibitions, mental health workers seek to avoid confrontation and manouver within existing hierarchies, thereby preserving sentiments of obligation and reciprocity within a shared moral landscape and established forms of sociality.

The Harms of a Penal Colony.

More than just a jail, Rikers has become a site of shifting discourse on punishment and justice in the United States. In the book Life and Death in Rikers Island, Homer Venters argues that the systematic failures of jails to provide appropriate safety and care constitute human rights violations and public health risks. The former chief medical officer and commissioner of correctional health services for the NYC Health and Hospitals system, Venters offers critical insight on the Rikers jail system. "Because jails are chaotic and concealed from outside view," he asserts, "we only become aware of them when very bad outcomes occur, such as deaths." Life and Death's success lies in how it blends Venters's experiences on the ground as a health care professional with the empirical data he's been able to collect and analyze over the tenure of his career. According to Venters, all suicides, homicides, and accidental deaths in jail are jail attributable, as they reflect system-wide failures in safety.

Should clinicians boycott Australian immigration detention?

Australian immigration detention has been called state sanctioned abuse, cruel and degrading and likened to torture. Clinicians have long worked both within the system providing healthcare and outside of it advocating for broader social and political change. It has now been over 25 years and little, if anything, has changed. The government has continued to consolidate power to enforce these policies and has continued to attempt to silence dissent. It was in this context that a boycott was raised as a possible course of action. Despite discussions among the healthcare community about the merits of such action, a number of questions have been overlooked. In this article, I will examine whether a boycott is both ethical and feasible. Taking into account the costs and benefits of current engagement and the potential impact of a boycott, more specifically the potential it has to further harm those detained, I conclude that under current circumstance a boycott cannot be justified. This however does not mean that a boycott should be dismissed completely or that the status quo should be accepted. I discuss potential ways forward for those seeking change.

Conflict, Complicity, and Challenges: Reflections on the South African Truth and Reconciliation Commission Health Sector Hearing.

PURPOSE: This article describes the work of the South African Truth and Reconciliation Commission (TRC) in examining the role of the health sector in human rights violations in the protracted conflicts during apartheid. ORGANIZING CONSTRUCT: The enabling legislation contained in the Promotion of National Healing and Reconciliation Act of 1995 allowed for in-depth examination of violations and complicity in human rights abuses. We provide an overview of the process of the public hearings, soliciting submissions, examining evidence of abuse, personal testimony of conflict in situations of dual accountability, and ultimately the recommendations made by the TRC. The article also outlines the responses of various health professional training institutions to the TRC's recommendations, the implementation of university health and human rights courses, and some current challenges post-TRC. CONCLUSIONS: The health sector hearings of the TRC provided a window into the structural unequal access, racial discrimination, prejudice, and abuse in the health services under the apartheid regime. Examination of past violations perpetrated by an abusive regime and by those such as health workers operating in such a system is imperative to ensure that these abuses are not repeated in the future. CLINICAL RELEVANCE: In delivering comprehensive, compassionate, and ethical care, healthcare professionals have accountability to respect and promote the human rights of their patients. Training in human rights and its relationship to health should be incorporated into all health professional programs.

The "hot potato" topic: challenges and facilitators to promoting respectful maternal care within a broader health intervention in Tanzania.

In recent years, mistreatment during childbirth has captured the public health and maternal health consciousness as not only an affront to women's rights but also a formidable deterrent to the uptake of facility-based childbirth - and thus to reductions in maternal mortality. The challenge ahead is to determine what can be done to address this public health problem. A modest but growing body of research has demonstrated that interventions to foster Respectful Maternity Care (RMC) can enact change, albeit in the relatively controlled context of a trial or study. Herein we describe our experiences in weaving elements of RMC across tiers of an existing maternal and newborn health program. As a commentary, this document does not outline program results, but instead highlights challenges and facilitators to promoting RMC within a large-scale, multi-district health platform. We conclude with lessons learned during the process and urge that others share their program learning experiences in an effort to strengthen the knowledge base on what works and what does not work in terms of addressing this complex, context-sensitive issue.

Expanding the agenda for addressing mistreatment in maternity care: a mapping review and gender analysis.

BACKGROUND: This paper responds to the global call to action for respectful maternity care (RMC) by examining whether and how gender inequalities and unequal power dynamics in the health system undermine quality of care or obstruct women's capacities to exercise their rights as both users and providers of maternity care. METHODS: We conducted a mapping review of peer-reviewed and gray literature to examine whether gender inequality is a determinant of mistreatment during childbirth. A search for peer-reviewed articles published between January 1995 and September 2017 in PubMed, Embase, SCOPUS, and Web of Science databases, supplemented by an appeal to experts in the field, yielded 127 unique articles. We reviewed these articles using a gender analysis framework that categorizes gender inequalities into four key domains: access to assets, beliefs and perceptions, practices and participation, and institutions, laws, and policies. A total of 37 articles referred to gender inequalities in the four domains and were included in the analysis. RESULTS: The mapping indicates that there have been important advances in documenting mistreatment at the health facility, but less attention has been paid to addressing the associated structural gender inequalities. The limited evidence available shows that pregnant and laboring women lack information and financial assets, voice, and agency to exercise their rights to RMC. Women who defy traditional feminine stereotypes of chastity and serenity often experience mistreatment by providers as a result. At the same time, mistreatment of women inside and outside of the health facility is normalized and accepted, including by women themselves. As for health care providers, gender discrimination is manifested through degrading working conditions, lack of respect for their abilities, violence and harassment,, lack of mobility in the community, lack of voice within their work setting, and limited training opportunities and professionalization. All of these inequalities erode their ability to deliver high quality care. CONCLUSION: While the evidence base is limited, the literature clearly shows that gender inequality-for both clients and providers-contributes to mistreatment and abuse in maternity care. Researchers, advocates, and practitioners need to further investigate and build upon lessons from the broader gender equality, violence prevention, and rights-based health movements to expand the agenda on mistreatment in childbirth and develop effective interventions.

Too afraid to go: fears of dignity violations as reasons for non-use of maternal health services in South Sudan.

BACKGROUND: South Sudan has one of the worst health and maternal health situations in the world. Across South Sudan, while maternal health services at the primary care level are not well developed, even where they exist, many women do not use them. Developing location specific understanding of what hinders women from using services is key to developing and implementing locally appropriate public health interventions. METHODS: A qualitative study was conducted to gain insight into what hinders women from using maternal health services. Focus group discussions (5) and interviews (44) were conducted with purposefully selected community members and health personnel. A thematic analysis was done to identify key themes. RESULTS: While accessibility, affordability, and perceptions (need and quality of care) related barriers to the use of maternal health services exist and are important, women's decisions to use services are also shaped by a variety of social fears. Societal interactions entailed in the process of going to a health facility, interactions with other people, particularly other women on the facility premises, and the care encounters with health workers, are moments where women are afraid of experiencing dignity violations. Women's decisions to step out of their homes to seek maternal health care are the results of a complex trade-off they make or are willing to make between potential threats to their dignity in the various social spaces they need to traverse in the process of seeking care, their views on ownership of and responsibility for the unborn, and the benefits they ascribe to the care available to them. CONCLUSIONS: Geographical accessibility, affordability, and perceptions related barriers to the use of maternal health services in South Sudan remain; they need to be addressed. Explicit attention also needs to be paid to address social accessibility related barriers; among others, to identify, address and allay the various social fears and fears of dignity violations that may hold women back from using services. Health services should work towards transforming health facilities into social spaces where all women's and citizen's dignity is protected and upheld.

Slavery in New Zealand: What is the role of the health sector?

Contemporary forms of slavery and associated adverse health effects are a serious, complex and often neglected issue within the New Zealand health sector. Slavery in New Zealand has most recently been associated with the fishing and horticulture industries. However, victims may be found in a number of other industry sectors, including the health and aged-care sectors, or outside of the labour market such as in forced, early (underage) and servile forms of marriage. Victims of slavery are at increased risk of acute and chronic health problems, injuries from dangerous working and living conditions, and physical and sexual abuse. These issues are compounded by restricted access to high-quality healthcare. Slavery is a violation of many human rights, including the right to health. New Zealand has obligations under international law to ensure that all victims of slavery have access to adequate physical and psychological care. The health sector has opportunities to identify, intervene and protect victims. This requires doctors and other health practitioners to demonstrate their leadership, knowledge and commitment towards addressing slavery and its health consequences in ways that are effective and do not cause further harm. Key recommendations for a safe approach towards identifying and managing people in situations of slavery include building rapport, and culturally competent practice with an empathetic non-judgmental approach. We also recommend that health organisations and regulatory and professional bodies develop culturally competent guidelines to respond safely to those identified in situations of slavery. These responses should be based on the respect, promotion and protection of human rights, and occur within a robust person-centric coordinated government response to addressing slavery in New Zealand.

Sowing the seeds of transformative practice to actualize women's rights to respectful maternity care: reflections from Kenya using the consolidated framework for implementation research.

BACKGROUND: Despite years of growing concern about poor provider attitudes and women experiencing mistreatment during facility based childbirth, there are limited interventions that specifically focus on addressing these issues. The Heshima project is an evidence-based participatory implementation research study conducted in 13 facilities in Kenya. It engaged a range of community, facility, and policy stakeholders to address the causes of mistreatment during childbirth and promote respectful maternity care. METHODS: We used the consolidated framework for implementation research (CFIR) as an analytical lens to describe a complex, multifaceted set of interventions through a reflexive and iterative process for triangulating qualitative data. Data from a broad range of project documents, reports, and interviews were collected at different time points during the implementation of Heshima. Assessment of in-depth interview data used NVivo (Version 10) and Atlas.ti software to inductively derive codes for themes at baseline, supplemental, and endline. Our purpose was to generate categories of themes for analysis found across the intervention design and implementation stages. RESULTS: The implementation process, intervention characteristics, individual champions, and inner and outer settings influenced both Heshima's successes and challenges at policy, facility, and community levels. Implementation success stemmed from readiness for change at multiple levels, constant communication between stakeholders, and perceived importance to communities. The relative advantage and adequacy of implementation of the Respectful Maternity Care (RMC) resource package was meaningful within Kenyan politics and health policy, given the timing and national promise to improve the quality of maternity care. CONCLUSION: We found the CFIR lens a promising and flexible one for understanding the complex interventions. Despite the relatively nascent stage of RMC implementation research, we feel this study is an important start to understanding a range of interventions that can begin to address issues of mistreatment in maternity care; replication of these activities is needed globally to better understand if the Heshima implementation process can be successful in different countries and regions.

[Preventive human rights monitoring in child and adolescent psychiatry and welfare institutions]. / Menschenrechtsmonitoring im Kinder- und Jugendbereich.

Since 1 July 2012 the Austrian Ombudsman Board (AOB) together with its six regional expert commissions form the so called "National Prevention Mechanism" implementing the UN Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT). The commissions are mandated to conduct regular, unrestricted and unannounced visits to all types of places in which there is or can be a deprivation or restriction of personal liberty, such as prisons, police stations, but also psychiatric hospitals or residential homes/groups for children and juveniles supervised by youth welfare services. 20 monitoring visits have been held in departments for Child- and Adolescent Psychiatry between 2012 and 2016. In the field of residential groups for young people 40 visiting protocols (out of a total of 176 between 2015 and 2016) have been chosen for this analysis. The following article overviews the legal sources and key issues of the monitoring process in this field as well as the commissions' findings and recommendations.

[Commercial sexual exploitation of children: Meanings and practices of people who work and reside in downtown Medellin (Colombia), 2015]. / Explotación sexual comercial de niños, niñas y adolescentes: significados y prácticas de trabajadores/as y residentes del centro de Medellín (Colombia), 2015.

The commercial sexual exploitation of children is a public health problem and a serious violation of the rights of children and adolescents. The response to this problem has been affected by the meanings and practices of the actors involved. In order to contribute to a better understanding of the problem, a qualitative social study using a grounded theory approach was carried out between 2014 and 2015. The aim was to understand the meanings and practices regarding this issue of people who spend time in an area of the city center with a high presence of commercial sexual exploitation of children and adolescents. The techniques used were participant observation and semi-structured interviews. We found that the predominate conceptions lead to practices that aggravate and perpetuate rights violations. Although practices of protection towards victims were identified, these were limited to critical aspects of the context. Actions to eradicate commercial sexual exploitation should work with the community and the meanings within the community regarding sexual exploitation so as to potentiate the victim protection practices carried out and reduce barriers to such practices.

Which will Trump: human rights and professional ethics, or torture redux?

Recent political developments in the United States raise concerns about the potential return of aggressive interrogation strategies, particularly in the event of another large-scale terror attack on the U.S. mainland. This essay reviews various legal, ethical and policy responses to revelations of torture during the Bush administration. It asks whether they improve the prospect that, in future, human rights will trump torture, not vice versa. The essay argues that physicians could help prevent further abuses - especially given their access, social status and expertise - but that insufficient steps have been taken to empower them to do so.

Explotación sexual comercial de niños, niñas y adolescentes: significados y prácticas de trabajadores/as y residentes del centro de Medellín (Colombia), 2015 / Commercial sexual exploitation of children: Meanings and practices of people who work and reside in downtown Medellin (Colombia), 2015

RESUMEN La explotación sexual comercial es un problema de salud pública y una vulneración de los derechos de niños, niñas y adolescentes. La respuesta a este problema se ha visto afectada por los significados y las prácticas de los actores implicados. Como aporte a una mejor comprensión del problema, entre 2014 y 2015 se realizó una investigación social cualitativa, con el enfoque de la teoría fundamentada, cuyo objetivo fue comprender los significados y las prácticas sobre esta problemática de las personas que permanecen en un sector del centro de la ciudad con alta presencia de explotación sexual comercial de niños, niñas y adolescentes. Las técnicas usadas fueron observación participante y entrevista semiestructurada. Encontramos que predominan concepciones que conducen a prácticas que agravan y perpetúan la vulneración de derechos. Aunque también se identificaron prácticas de protección a las víctimas, estas son limitadas por asuntos críticos del contexto. Las acciones para erradicar la explotación sexual deben trabajar con la comunidad sus significados para potenciar las prácticas protectoras que realizan y reducir las barreras.

ABSTRACT The commercial sexual exploitation of children is a public health problem and a serious violation of the rights of children and adolescents. The response to this problem has been affected by the meanings and practices of the actors involved. In order to contribute to a better understanding of the problem, a qualitative social study using a grounded theory approach was carried out between 2014 and 2015. The aim was to understand the meanings and practices regarding this issue of people who spend time in an area of the city center with a high presence of commercial sexual exploitation of children and adolescents. The techniques used were participant observation and semi-structured interviews. We found that the predominate conceptions lead to practices that aggravate and perpetuate rights violations. Although practices of protection towards victims were identified, these were limited to critical aspects of the context. Actions to eradicate commercial sexual exploitation should work with the community and the meanings within the community regarding sexual exploitation so as to potentiate the victim protection practices carried out and reduce barriers to such practices.

Desnutrición en niños y niñas de la etnia Wayuu: entre lo ético, lo propio y pertinente / Malnutrition in children of the Wayuu ethnicity: among the ethical, the unique and the relevant

La desnutrición ha cobrado la vida de un importante número de niños y niñas de la etnia wayuu que habitan en el departamento de La Guajira en Colombia. Esa situación existe y persiste sin que los decisores o la sociedad civil tomen acciones que reviertan el problema, mostrando total indiferencia y falta de solidaridad. En el país en general y en La Guajira en particular, es evidente la vulneración de los derechos de los niños y las niñas, como sujetos que se construyen en el presente y cuyo futuro no puede ser preparado sin su participación, el apoyo de sus familias, sus comunidades y las organizaciones civiles e instituciones del Estado. Es importante la solidaridad de la sociedad, puesto que los indígenas requieren respuestas, teniendo en cuenta las consideraciones éticas para su atención. Quienes solicitan se hagan efectivos los derechos que tanto se proclaman por distintos medios y que se han convertido sólo en sueños, puesto que la realidad es otra (AU).

Malnutrition has claimed the lives of a great quantity of children of the Wayuu ethnicity, who live in La Guajira department, in Colombia. This situation has existed for a long time without the action of the decision makers or the social society to solve the problem, showing total indifference and lack of solidarity. In the country in general and particularly in La Guajira, it is evident the violation of the rights of the children as subjects that are in the formation process at that moment of their lives, and whose future could not be granted without their participation and the support of their families, their communities, the civilian organizations and the State institutions. It is important the society's solidarity, because native people require answers and attention, taking into account ethical consideration. There are many people asking for making effective the rights that are so widely proclaimed by different means and have become just dreams, because they are another thing in real life (AU).