Challenges in Medical Peace Education

PtH-Challenge ConferenceMay 8, 2005, 09:00-09:30

McMaster University

klaus.melf@sih.uit.no

Challenges overview

1. Definitions and concepts

2. Teaching frameworks

3. Conflict fields / issues

4. Objectives

5. Methodology

6. Implementation strategies

7. Access and networking

1. Definition and concepts• What is Medical Peace Education?

– Teaching of peace-relevant skills, knowledge, values/attitudes to health professionals

• as part of the basic education (compulsory curriculum)

• as elective/specialization for students or professionals

• as part of continuous medical education

– Teaching of medical peace work

• What is Medical Peace Work?• What is Peace Work?• What is Peace?

What is Peace?

• Absence of war• What about other forms of “war”/absence of

peace?– Cold War: Mutual Assured Destruction– sanctions: 500.000 children <5 years died in Iraq– occupations– “war against women”: unorganised violence on a large

scale level

• health ↔ disease = peace ↔ violence

Violence = “unnessessary violation of basic needs” (J. Galtung)

(survival, well-being, identity and freedom) direct (physical, verbal, psychological, threat) structural (socio-economic, political) cultural (in religion, ideology, language, art, science, cosmology)

Health– not merely the absence of disease or infirmity

– state of complete physical, mental and social well-being

– “capacity of the spirit, the mind, the body and the society to handle pathogens of any kind with insight, creativity, and by healthy means”

Peace– not merely the absence of violence

– state of mutual beneficial relationships, fair structures, a culture of peace

– capacity to handle conflicts with empathy, creativity and by non-violent

means

Conflict• (lat.) “clash“ • incompatible goals in a goal-seeking system• challenges the status quo• possibility for improvement• neutral• everywhere and every time• from intern (dilemma) to global

When the “immune system” fails => conflict can led to:

– frustration (goal not reached)– aggressivity (attitude)– aggression (behavior)

‡ violence (incapacity of constructive conflict handling) ‡ war (extreme violent form of conflict handling)

content

attitude behavior

What is Peace Work?• All kind of non-violent activities which

– reduce or abolish direct, structural or cultural violence– promote mutual beneficial relationships, fair structures,

and a culture of peace– strengthen the peace capacity of individuals and society

What is Medical Peace Work?• Using medical peace-qualities, -tools and –

opportunities intentionally for improving health through violence prevention and peace promotion.

2. Teaching frameworks• IPPNW: “Medicine and Nuclear War” (1988)

– Survey in 1985: 54% of 140 responding medical schools included nuclear weapons

• UN-IPPNW-PSR: “Medicine and Peace” (1993) – Modules adjustable to local context– Incl. other types of weapons, war prevention and the

physicians’ role

• WHO: “Health as a Bridge to Peace” (1999)– Training of health personnel in ethics, human rights,

Geneva Conventions, conflict handling

2. Teaching frameworks

• MedAct: “Global Health Studies” (2002)– Includes poverty, development need, environmental

degradation, and “The Health Implications of Conflict”

• McMaster University: “Peace through Health”– World’s first undergraduate course (2004)

• University of Tromsø: “Peace, Health and Medical Work”– World’s first graduate course (2005)

Different types and levels of violence

• Direct, structural and cultural violence• Collective, inter-personal and self-induced violence

(WHO)• Mega / macro / meso / micro level

The scope of Peace Medicine:Direct

violenceStructural violence

Culturalviolence

Micro levelMacro level

Scope of different frameworks

Peace through Health

Health as a Bridge to Peace

Ecosystem Health

Violence Prevention

Global health

Medicine andHuman Rights

Health and Human Rights Medical ethics

3. Conflict fields / issues• Which issues should be prioritized?

– according to mortality and morbidity:• IPPNW: nuclear weapons, WMD, small arms, land mines

• World Report on Violence and Health: suicide

• WHO: Poverty and social inequality

– everyday experiences:• medical ethics, interpersonal communication

• stress and conflict handling

• inner peace work

– ask medical peace practitioners in Norway?

Prioritized conflict fields

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

ETHDO

UW

ORDIS

CBUL

SUI

DOM

YOUCUL

REF HRGLO PRI

ECOPOV

DIST

WAR

RELW

EASM

ADIL

MYT

ETH

DOU

WORDISCBUL SUIDOMYOUCULREFHR

= Ethical dilemmas in clinical practice and research

= Double-loyalty in public health, military-, prison

service, etc.= Workplace environment = Discrimination against women= Bullying in schools= Suicide = Domestic violence= Youth violence, gang fights = Cultural intolerance, racism= Refugee/migration problems= Human rights violation and torture

GLOPRIECOPOVDIST

WARRELWEASMADILMYT

= Globalisation= Privatisation and patent rights= Ecological degradation= Poverty and development need= Distribution of resources and North/South

research priorities= War and terror= Religious fundamentalism= Weapons of mass destruction= Small arms and landmines= Dilemma in humanitarian aid= Myths about Norwegian peace engagement

Prioritized conflict issues for Medical Peace Education

4. Objectives

• Which peace-relevant skills, knowledge, values/attitudes should be taught?

– according to peace effectiveness

– Ask what medical peace practitioners in Norway regard as the most important peace-qualities?

Most important skills for medical peace work

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

COM LIS

DIAANA

HANCRE

KNOTEA

MOB

PUBNET

GROTEAM

PRORES

BUIEVA

COMLISDIA

ANAHANCREKNOTEA

MOB

= communication and dialogue= exact listening= diagnosis and documentation of violence= conflict analysis= conflict and stress handling = creativity, improvisation= knowledge building, research= teaching of knowledge and involvement= community mobilization

PUBNETGROTEAMPRORES

BUI

EVA

= public work, use of media = broad networking= group leadership and organizing= team work= process facilitation, mediation= respectful behaviour in local culture and context= building of self-confidence, strengthening of self-healing capacity= evaluation of own involvement and its consequences

ETHCON

PSY

RIS

ROODYNSTR

= medical ethics and national guidelines= connection between physical, psychological and social health = psychology/sociology of aggression, violence and identity= risk factors and violence-preventive measures= root causes of conflicts = dynamics and complexity of conflicts= strategies for conflict resolution on macro and micro level

NEE

LOC

GLOINTIMP

QUI

HBP

= what is needed for a stable and peaceful society= the local context (culture, geography, language, etc.)= global health issues= international law and human rights = health impacts of different types of violence and weapons= quick construction of a stabilizing health service = health as bridge to peace

Most important knowledge for medical peace work

0 %

10 %

20 %

30 %

40 %

50 %

60 %

ETH CON PSY RIS ROO DYN STR NEE LOC GLO INT IMP QUI HBP

RESPEA TRUMODPATCOMCOMPNEU

= responsibility for others’ health and life= peace, non-violence = truth, honesty = modesty= patience= commitment, involvement= compassion, humanitarian attitude = neutrality, impartiality

SOLRESP

INQEQUTOLCONOPT

= solidarity= respect for others’ culture and knowledge traditions= being inquisitive = equity, partnership = tolerance, respect for diversity = confidence in local capacities= optimism, belief in improvement

Most needed attitudes and values for medical peace work

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

RESPEA

TRUM

ODPAT

COM

COMPNEU

SOL

RESPIN

QEQU

TOLCON

OPT

5. Teaching methodologyLesions to learn from “medical ethics” or “violence

prevention” education research:

– Case-oriented– Experiential learning– Multi-disciplinary faculty and curriculum– Goal-driven curricula, stage-specific,

tailored to local context, varied and innovative approaches

6. Implementation strategiesLesions to learn from “medical ethics” or “violence prevention”

education research:– Demonstration projects (pilot testing and refining, teaching

material)

– Integrated approach, horizontal and vertical

– Electives for interested students (“change agents”)

– Support from dean and influential faculty

– Support from professional and accrediting organization

– Integration into medical licensing examination

– Peer-reviewed journal

– Centres of excellence

– Teaching the teacher (critical mass, modelling)

7. Access and networkingWhat would be the best way to make medical peace education

available and to link the experiences?– Conferences– Articles– Internet – Teaching material

European “Medical Peace Work” project?• 60h - distant learning course (7 modules)• Online handbook• Teaching ressources (curricula, existing courses, presentations,

film material, reference lists, ressource people & organizations)

Challenges overview

1. Definitions and concepts

2. Teaching frameworks

3. Conflict fields / issues

4. Objectives

5. Methodology

6. Implementation strategies

7. Access and networking

I would like to thank

Joanna Santa Barbara,Rob Stevens and other conference organizers