Who should be responsible for prisoners with HIV and/or TB, or with drug use problems, after their release from prison? That question has resulted in some heated discussions among my colleagues. One makes the reasonable point that released prisoners are no longer the concern of the corrections service. After release, they are the same as any other members of the community, and should therefore be served by community health centres, hospitals, social welfare services and support groups in the same way as anyone else,
But released prisoners surely do have some special needs. One of my colleagues who spent two drug-use terms in the Kerobokan prison ten years or so back recounts his experience. Before release, he knew exactly what he would do after he got out. But once he actually stood outside the prison gate, his mind became blank. Absent any real alternative, he wandered back to his old haunts, and immediately picked up where he left off - except that he had now lost his tolerance for heroin, and was lucky not to overdose. It wasn't long before he was back in his cell.
There have been a number of studies worldwide showing that adherence to antiretroviral therapy (ART) falls drastically among prisoners after release - if indeed they don't drop out. The same is true for those still taking anti-TB therapy. This is not surprising. Therapy in prison is often effectively directly observed, and adherence is better than that among almost any other group of people taking medications. Enforced discipline is developed. But once outside, they lose this support; the discipline is lost. They have to find a referral clinic, visit it regularly and develop their own ways to ensure that they take their medications on time. Most don't.
Those with a drug problem face even greater challenges. If they've been on methadone in prison, they must find the nearest clinic - surely much more difficult to access than the service in the prison. Chances are that without support they won't bother; just like my colleague, they'll return to their old friends, and the sugesti (craving) will immediately take over. And what about the increasing number addicted to meth?
The parole service in the prison does have the task of attempting to identify such needs before release, and referring the prisoner to appropriate services after they get out. Everybody seems to agree that responsibility after release passes to the Social Welfare Service and/or to NGOs. But the former seems to have very limited if any resources for this, while there are few NGOs working in this field, and fewer still are funded for the work. And it is rare for either to actually work with prisoners before release to ensure continuity.
I'm told that recidivism is low in Indonesia, although probably higher among drug offenders. So this may (or may not) counter the argument that more should be done to reduce re-offense. But surely there is a human rights imperative to help ex-prisoners reintegrate into the community, including ensuring their continued access to appropriate health care. Whose job is it?
Babé
Showing posts with label Human rights. Show all posts
Showing posts with label Human rights. Show all posts
Wednesday, 3 August 2011
Sunday, 7 June 2009
Pedestaled in triumph
Some of you may have followed the story of the young (nursing) mother who was remanded in prison on the charge of defaming a private hospital in the Jakarta area. A test at the hospital lab had indicated she had very low platelets, and as a result she was diagnosed with dengue and was admitted and infused. But the next day, it appeared that her platelets were in fact normal, and the diagnosis was incorrect.
She moved to another hospital and was correctly diagnosed and treated. Following this, she apparently tried to view her medical record at the original hospital, but this was allegedly refused. She then sent a private E-mail to a friend, indicating that she felt that she had been treated badly. This E-mail was then forwarded to a mail list, resulting in wide distribution. As a result, the hospital took legal action, and she was arrested by the police and locked up.
A number of things about this case have upset many in Indonesia. First, how could the doctors in the hospital concerned allow such a thing to happen? Should they not have put pressure on the hospital management to be more compassionate - do we not expect all our doctors to show that quality? Second, the Minister of Health washed her hands of the problem, saying she has no control over private hospitals.
Although the law on Doctors' Practice (no. 29/2004) very clearly states that patients own the contents of their medical records, and that they are entitled to a second opinion, requests for both in Indonesia are routinely effectively denied.
As the BMJ pointed out several years back, Doctors will get off their pedestals when patients get off their knees. One of our efforts is indeed aimed at trying to get HIV-infected people to get up off their knees and become empowered patients. But actions like this will set back the whole process.
Babé
She moved to another hospital and was correctly diagnosed and treated. Following this, she apparently tried to view her medical record at the original hospital, but this was allegedly refused. She then sent a private E-mail to a friend, indicating that she felt that she had been treated badly. This E-mail was then forwarded to a mail list, resulting in wide distribution. As a result, the hospital took legal action, and she was arrested by the police and locked up.
A number of things about this case have upset many in Indonesia. First, how could the doctors in the hospital concerned allow such a thing to happen? Should they not have put pressure on the hospital management to be more compassionate - do we not expect all our doctors to show that quality? Second, the Minister of Health washed her hands of the problem, saying she has no control over private hospitals.
Although the law on Doctors' Practice (no. 29/2004) very clearly states that patients own the contents of their medical records, and that they are entitled to a second opinion, requests for both in Indonesia are routinely effectively denied.
As the BMJ pointed out several years back, Doctors will get off their pedestals when patients get off their knees. One of our efforts is indeed aimed at trying to get HIV-infected people to get up off their knees and become empowered patients. But actions like this will set back the whole process.
Babé
Sunday, 8 March 2009
Law embodies the story of a nation's development
My brain (that box that sits beside my keyboard) reminds me that I planned to write more about laws addressing HIV in Indonesia. As I mentioned, there is no national law on HIV, and this in theory presents a challenge for provincial legislators. This is because a local by-law must refer to a higher level law (those paragraphs starting 'Mindful of' and 'Paying attention to'). Without that higher authority (so I'm informed) they are not fully valid.
It's not only by-laws on HIV that are of questionable validity. But since the central government seems to have no wish to take on the local administrations. and perhaps because many of the national laws appear to be just as unconstituional, nothing is done. Of course, few laws are actually implemented - or even have the required implementing regulations, so everyone is 'fat, dumb and happy,' as one of my mid-West colleagues used to say.
Back to the topic. Another of my more recent colleagues, Bang Syaiful, has carried out a review of 21 of the 22 provincial by-laws on HIV that have so far been enacted. He reports that without exception they place their main emphasis on morals. In doing so, as he says, they encourage stigma and discrimination.
For example, he notes, several prioritise the role of 'faith and piety' in HIV prevention. This despite the mountains of evidence that it is no more effective now than it was almost 25 years ago, when in 1985 the then Minister of Health replied to a journalist's question that "with faith in God, we don't need to worry about contracting AIDS." So much for pious hopes!
The by-laws also refer to 'healthy living' (the NGO I first worked for here in support of people living with the virus had the slogan "healthy living prevents AIDS"; I had quite a job explaining that to my 'clients', for whom this suggested that they had been living unhealthily. But then, who can claim to live a healthy life now?).
The other favourite cliche in the by-laws is 'family solidarity'. As Bang Syaiful notes, they are effectively saying that HIV-infected people are not pious, have no faith (in God), live unhealthy lives and come from broken families. Good excuses?
And as a result, Bang Syaiful notes, a member of the staff of the provincial AIDS Commission in Aceh told him and other journalists firmly and repeatedly that AIDS control in Aceh would in no way include reference to condoms. As he says, surely use of a condom is part of healthy living?
Babé
It's not only by-laws on HIV that are of questionable validity. But since the central government seems to have no wish to take on the local administrations. and perhaps because many of the national laws appear to be just as unconstituional, nothing is done. Of course, few laws are actually implemented - or even have the required implementing regulations, so everyone is 'fat, dumb and happy,' as one of my mid-West colleagues used to say.
Back to the topic. Another of my more recent colleagues, Bang Syaiful, has carried out a review of 21 of the 22 provincial by-laws on HIV that have so far been enacted. He reports that without exception they place their main emphasis on morals. In doing so, as he says, they encourage stigma and discrimination.
For example, he notes, several prioritise the role of 'faith and piety' in HIV prevention. This despite the mountains of evidence that it is no more effective now than it was almost 25 years ago, when in 1985 the then Minister of Health replied to a journalist's question that "with faith in God, we don't need to worry about contracting AIDS." So much for pious hopes!
The by-laws also refer to 'healthy living' (the NGO I first worked for here in support of people living with the virus had the slogan "healthy living prevents AIDS"; I had quite a job explaining that to my 'clients', for whom this suggested that they had been living unhealthily. But then, who can claim to live a healthy life now?).
The other favourite cliche in the by-laws is 'family solidarity'. As Bang Syaiful notes, they are effectively saying that HIV-infected people are not pious, have no faith (in God), live unhealthy lives and come from broken families. Good excuses?
And as a result, Bang Syaiful notes, a member of the staff of the provincial AIDS Commission in Aceh told him and other journalists firmly and repeatedly that AIDS control in Aceh would in no way include reference to condoms. As he says, surely use of a condom is part of healthy living?
Babé
Tuesday, 13 January 2009
Faith and knowledge ... in the practice of medicine
One of the sentences in Michael's report that the editors highlighted was:
There is no doubt that this is a problem. But a recent report, The Neurontin Legacy — Marketing through Misinformation and Manipulation, in the New England Journal of Medicine (free to those accessing it from Indonesia) shows that, once again this is not a field in which Indonesia leads.
The report makes use of thousands of documents covering a case of illegal marketing in the US by a subsidiary of that giant of Big Pharma, Pfizer. The drug concerned doesn't matter much; the fact is that the company was peddling it for conditions for which it had not been approved, and persuading doctors to up the doses well above the approved level if the treatment appeared to be less than successful. Doctors were recruited, trained and paid to serve as speakers. The company sought "strong Neurontin advocates and users" to promote the drug. They made "unrestricted educational grants" to support Continuing Medical Education. They highjacked research to ensure that reports which did not support their interests were not publicized. And so on.
All very concerning. But worse is that these marketing methods are not illegal; what was illegal was just promoting the drug off-label (to treat conditions for which it was not approved). Apparently there is no law in the US (much less here) which forbids these marketing strategies as long as you are promoting the approved use of a drug.
There have been many reports from around the world of patient groups being highjacked to promote certain drugs. Is that happening with HIV? We'd be stupid if we assumed not. That is one reason why we in Spiritia (and most developing country peer support organizations) refuse to accept money from pharmaceutical companies. On the other hand, many groups in the west rely almost totally on such funding, maintaining that they are 'mature' enough to ensure no conflict of interest. Oh ya?
Back to the doctors here. With such an example from their colleagues in the West, and clearly in much greater need to 'support', who can blame them for jumping on the bandwagon?
Babé
Over-prescribing expensive medicines to uninformed patients is nothing new to observers of Indonesia’s graft-ridden health system
There is no doubt that this is a problem. But a recent report, The Neurontin Legacy — Marketing through Misinformation and Manipulation, in the New England Journal of Medicine (free to those accessing it from Indonesia) shows that, once again this is not a field in which Indonesia leads.
The report makes use of thousands of documents covering a case of illegal marketing in the US by a subsidiary of that giant of Big Pharma, Pfizer. The drug concerned doesn't matter much; the fact is that the company was peddling it for conditions for which it had not been approved, and persuading doctors to up the doses well above the approved level if the treatment appeared to be less than successful. Doctors were recruited, trained and paid to serve as speakers. The company sought "strong Neurontin advocates and users" to promote the drug. They made "unrestricted educational grants" to support Continuing Medical Education. They highjacked research to ensure that reports which did not support their interests were not publicized. And so on.
All very concerning. But worse is that these marketing methods are not illegal; what was illegal was just promoting the drug off-label (to treat conditions for which it was not approved). Apparently there is no law in the US (much less here) which forbids these marketing strategies as long as you are promoting the approved use of a drug.
There have been many reports from around the world of patient groups being highjacked to promote certain drugs. Is that happening with HIV? We'd be stupid if we assumed not. That is one reason why we in Spiritia (and most developing country peer support organizations) refuse to accept money from pharmaceutical companies. On the other hand, many groups in the west rely almost totally on such funding, maintaining that they are 'mature' enough to ensure no conflict of interest. Oh ya?
Back to the doctors here. With such an example from their colleagues in the West, and clearly in much greater need to 'support', who can blame them for jumping on the bandwagon?
Babé
Monday, 12 January 2009
Come, let's away to prison
There IS some positive news, even if you have to dig a little for it. I've written before l about the way prisons in Indonesia are responding to HIV. Far from perfect, but at least quite enlightened. This was brought home to me by a report on Voice of America at the end of last year, headed Prisoners With HIV, AIDS in Thailand Now Receive Vital Treatment.
Seeing that headline, I assumed that as usual, Thailand was ahead of us, and that antiretroviral therapy (ART) had become universally accessible in Thai prisons. But it soon became clear that this was far from the truth. In fact, it appears that it applies only to three prisons in the Bangkok area, a result that represents work by MSF since 2003.
Efforts to provide appropriate health services for prisoners with HIV started in Indonesia around the same time. I've seen no reports about progress since then, but from my own experience, prisons from Jayapura in the east to Medan in the west are offering ART to inmates. In several of them, they are in some ways better off than those outside, and I'd personally prefer to be treated in the prison clinic in Bandung's Banceuy prison than in the main (referral) hospital. And besides ART, this prison also provides methadone substitution therapy for those addicts unable to break their habit.
I first visited Banceuy in about 2005. At that time, they were mulling over offering HIV testing to prisoners, but (as had occurred earlier in Bali), they were worried that it might lead to unrest. And they were also concerned over the cost of looking after people they assumed would be sick and need expensive treatment - at that time the health care budget per prisoner per year was Rp 700, maybe enough to buy a couple of aspirins. (I was told in Makassar last year that it had been increased to Rp 5 per inmate per day - sounded a whole load better until I worked it out!) But, we told them, if you can identify people with HIV early, before they fall sick, and put them onto ART that is available free-of-charge, you'll save all those costs, as well as the problems of escorting them to hospital and guarding them there. Don't know how much this influenced their decisions, but as I say, now they offer a model clinic.
Although there is clearly room for improvement, it is clear that in some ways Indonesia is leading the region in its response to HIV in the prisons - and hopefully that is also improving health care more generally for those incarcerated. In some ways it is sad that the country gets so little credit for this - the headlines always seem to go to Thailand, Malaysia or Vietnam. There's not much positive news coming from Indonesia; it's a pity we can't publicise the little there is!
Babé
Seeing that headline, I assumed that as usual, Thailand was ahead of us, and that antiretroviral therapy (ART) had become universally accessible in Thai prisons. But it soon became clear that this was far from the truth. In fact, it appears that it applies only to three prisons in the Bangkok area, a result that represents work by MSF since 2003.
Efforts to provide appropriate health services for prisoners with HIV started in Indonesia around the same time. I've seen no reports about progress since then, but from my own experience, prisons from Jayapura in the east to Medan in the west are offering ART to inmates. In several of them, they are in some ways better off than those outside, and I'd personally prefer to be treated in the prison clinic in Bandung's Banceuy prison than in the main (referral) hospital. And besides ART, this prison also provides methadone substitution therapy for those addicts unable to break their habit.
I first visited Banceuy in about 2005. At that time, they were mulling over offering HIV testing to prisoners, but (as had occurred earlier in Bali), they were worried that it might lead to unrest. And they were also concerned over the cost of looking after people they assumed would be sick and need expensive treatment - at that time the health care budget per prisoner per year was Rp 700, maybe enough to buy a couple of aspirins. (I was told in Makassar last year that it had been increased to Rp 5 per inmate per day - sounded a whole load better until I worked it out!) But, we told them, if you can identify people with HIV early, before they fall sick, and put them onto ART that is available free-of-charge, you'll save all those costs, as well as the problems of escorting them to hospital and guarding them there. Don't know how much this influenced their decisions, but as I say, now they offer a model clinic.
Although there is clearly room for improvement, it is clear that in some ways Indonesia is leading the region in its response to HIV in the prisons - and hopefully that is also improving health care more generally for those incarcerated. In some ways it is sad that the country gets so little credit for this - the headlines always seem to go to Thailand, Malaysia or Vietnam. There's not much positive news coming from Indonesia; it's a pity we can't publicise the little there is!
Babé
Tuesday, 6 January 2009
...crowds me till I die
"Prisons face ongoing over capacity problems in Indonesia" - so states a recent headline in the Jakarta Post. What an understatement! The article quotes Untung Sugiyono, Director General of Penitentiaries at the Justice and Human Rights Ministry as saying that Indonesia has around 400 penitentiaries with a total capacity of nearly 90,000, but currently they are required to hold more than 130,000 detainees and convicts.
That average is pretty bad, but it masks some really horrendous overcrowding in individual prisons. For example, I visited one prison in West Java in late 2007, where they told me the capacity was 400 inmates. At that time they had more than 1,100! Even worse was one just outside Jakarta with more than 1,700 inmates against a capacity of 350. One can imagine the conditions! I was told that the prisoners did not actually have to sleep standing up, but they did have to sleep right in front of the bathroom door.
According to Pak Untung, the overcrowding has caused "a spike in disease among detainees." Again, an understatement. We often refer to the spread of TB in 'congregate settings.' These must be classical examples of this, especially since overcrowding is worse in the 'narcotics prisons', the prisons set up to house the exploding number of drug offenders, many of whom have HIV.
Apparently 750 inmates died during their prison terms in 2008, most of them from HIV infections and tuberculosis contracted before they entered the facility, according to Pak Untung. He admitted that they generally got worse following incarceration: "I guess most of them were depressed because of the change of environment," the Post reports him saying. Another understatement!
The news is not all bad: antiretroviral therapy is increasingly available in the prisons here. I'll talk about this in more detail later.
Babé
That average is pretty bad, but it masks some really horrendous overcrowding in individual prisons. For example, I visited one prison in West Java in late 2007, where they told me the capacity was 400 inmates. At that time they had more than 1,100! Even worse was one just outside Jakarta with more than 1,700 inmates against a capacity of 350. One can imagine the conditions! I was told that the prisoners did not actually have to sleep standing up, but they did have to sleep right in front of the bathroom door.
According to Pak Untung, the overcrowding has caused "a spike in disease among detainees." Again, an understatement. We often refer to the spread of TB in 'congregate settings.' These must be classical examples of this, especially since overcrowding is worse in the 'narcotics prisons', the prisons set up to house the exploding number of drug offenders, many of whom have HIV.
Apparently 750 inmates died during their prison terms in 2008, most of them from HIV infections and tuberculosis contracted before they entered the facility, according to Pak Untung. He admitted that they generally got worse following incarceration: "I guess most of them were depressed because of the change of environment," the Post reports him saying. Another understatement!
The news is not all bad: antiretroviral therapy is increasingly available in the prisons here. I'll talk about this in more detail later.
Babé
Saturday, 3 January 2009
Gone to her death!
The Indonesian AIDS mail list is frequently more like gossip over the fence, with anybody who can write (even though often with difficulty) pitching in his or her two (or 0.2) cents-worth. But sometimes a topic comes up which makes us think. This was the case with a recent one from Robert in Jayapura.
He was asking from guidance: If a transgender person dies, how should he/she be buried? In this case, Robert was referring to a male with female gender identity. If her wishes had not been stated prior to death, how can we make a decision?
Replies came among others from Dr. Nadiar of the National AIDS Commission and from the waria group in Malang. Several raised the problem that, at least for Muslims, there is a different set of prayers at the interment of a male and a female. There's also the problem of washing the body. On the other hand, the Muslim burial shroud is apparently unisex. while in Christian religions, the body might need to be dressed appropriately. But the consensus was that if the diseased had left a will designating a wish to be buried as a women, this wish should be honoured. If no will, then the wishes of the family should be considered, although as one respondent noted, most waria have limited contact with their biological families. In the absence of direction, most felt the burial should be in accordance with physical sex, not sexual identity. But what about someone who had had a sex change operation?
To me, of greater concern is how they are treated in life. The waria group in Jakarta planned to open a nursing home for aging waria, because if they go to a state-run 'panti' (welfare home), they will be accommodated in accordance with their biological sex. We can perhaps imagine what it would be like for someone who had spent her life as a women then has to spend her twilight years as a man.
A number of similar problems arise. A couple of years back we heard that the hospital in Jogja was allowing waria to be admitted to a female ward - although having seen Lenny (a well-known head-scarved waria from Jakarta) in hospital with three-days growth of beard, I'm not sure how well that would go down with other patients in the ward.
One respondent also asked about prisons. Eli has discussed public conveniences. Where would it end?
Interestingly the correspondence did not consider transgenders in the other direction. Perhaps that's because we rarely if ever hear of female transgenders here - do they exist?
On a similar note, it was of interest that the scholarship application for the 8th ICAAP in Sri Lanka provided four options for sex. Still trying to work out what 'other' might include...
As perhaps you may have noted, I try to find an appropriate quote for my subject lines. For those of you you (like me) would have to look it up, here's two stanzas from Thomas Hood's The Bridge of Sighs, from which I took today's title:
He was asking from guidance: If a transgender person dies, how should he/she be buried? In this case, Robert was referring to a male with female gender identity. If her wishes had not been stated prior to death, how can we make a decision?
Replies came among others from Dr. Nadiar of the National AIDS Commission and from the waria group in Malang. Several raised the problem that, at least for Muslims, there is a different set of prayers at the interment of a male and a female. There's also the problem of washing the body. On the other hand, the Muslim burial shroud is apparently unisex. while in Christian religions, the body might need to be dressed appropriately. But the consensus was that if the diseased had left a will designating a wish to be buried as a women, this wish should be honoured. If no will, then the wishes of the family should be considered, although as one respondent noted, most waria have limited contact with their biological families. In the absence of direction, most felt the burial should be in accordance with physical sex, not sexual identity. But what about someone who had had a sex change operation?
To me, of greater concern is how they are treated in life. The waria group in Jakarta planned to open a nursing home for aging waria, because if they go to a state-run 'panti' (welfare home), they will be accommodated in accordance with their biological sex. We can perhaps imagine what it would be like for someone who had spent her life as a women then has to spend her twilight years as a man.
A number of similar problems arise. A couple of years back we heard that the hospital in Jogja was allowing waria to be admitted to a female ward - although having seen Lenny (a well-known head-scarved waria from Jakarta) in hospital with three-days growth of beard, I'm not sure how well that would go down with other patients in the ward.
One respondent also asked about prisons. Eli has discussed public conveniences. Where would it end?
Interestingly the correspondence did not consider transgenders in the other direction. Perhaps that's because we rarely if ever hear of female transgenders here - do they exist?
On a similar note, it was of interest that the scholarship application for the 8th ICAAP in Sri Lanka provided four options for sex. Still trying to work out what 'other' might include...
As perhaps you may have noted, I try to find an appropriate quote for my subject lines. For those of you you (like me) would have to look it up, here's two stanzas from Thomas Hood's The Bridge of Sighs, from which I took today's title:
One more unfortunate,Babé
Weary of breath,
Rashly importunate,
Gone to her death!
Take her up tenderly,
Lift her with care,
Fashioned so slenderly,
Young, and so fair!
Wednesday, 24 September 2008
...em-body the law
AIDS cyberspace in Indonesia is hot about the draft law on pornography, currently being debated by parliament, and promised as a Lebaran present to the Muslim community. Although (probably) few have actually studied the draft, there is much fear that it will impact on the diversity of Indonesia. For example, will it be against the law to photograph a Papuan wearing only a koteka (a penis sheath)? Will women (again) become the main victims of the bill?
At least the draft seems to have dropped its related focus on 'pornoaksi', a very Indonesian concept of actions that are pornographic. These include the 'drilling' dancing developed by one dancer, but it was also touted as forbidding a goodbye kiss between two men at the airport.
Several AIDS activists are concerned that producing and distributing pictures of human genitals will become a criminal act. Will this apply to pictures used in activities around 'reproductive health' (the usual euphemism for 'sexual health')? What about the Spiritia Q&A forum? Although I rarely now answer them, I still often get questions using language that could be considered porno - although I'm often amused that the questioners write 'maaf (excuse me)' before such naughty words as 'penis' (or even 'constipation'!). If I reply referring for example to 'vaginal sex'. will I be locked up?
Several commentators (including Kartono Mohamad, former chair of the Indonesian Medical Association, and brother of Gunawan) have noted the several items of 'ethnic' food in Indonesia also use 'naughty' words. Kartono's example is 'kontol kambing (sheep penis)' - a cake from Malang in East Java. 'Kontol' is a very crude word, and I'm always scared to use the Indonesian word for 'control' (work it out), in case I leave out the 'r' by mistake. Will peddlers of such food also end up in gaol?
Dr. Nadiar from the National AIDS Commission (NAC) has made the reasonable point that we shouldn't criticise the draft if we haven't read it. But in many of these (unfortunately poorly-drafted) bills, interpretation is everything. And the police are not known for liberal interpretation. I'd prefer it if Dr. Nadiar promised that the NAC would defend us in cases of unreasonable arrest.
Babé
At least the draft seems to have dropped its related focus on 'pornoaksi', a very Indonesian concept of actions that are pornographic. These include the 'drilling' dancing developed by one dancer, but it was also touted as forbidding a goodbye kiss between two men at the airport.
Several AIDS activists are concerned that producing and distributing pictures of human genitals will become a criminal act. Will this apply to pictures used in activities around 'reproductive health' (the usual euphemism for 'sexual health')? What about the Spiritia Q&A forum? Although I rarely now answer them, I still often get questions using language that could be considered porno - although I'm often amused that the questioners write 'maaf (excuse me)' before such naughty words as 'penis' (or even 'constipation'!). If I reply referring for example to 'vaginal sex'. will I be locked up?
Several commentators (including Kartono Mohamad, former chair of the Indonesian Medical Association, and brother of Gunawan) have noted the several items of 'ethnic' food in Indonesia also use 'naughty' words. Kartono's example is 'kontol kambing (sheep penis)' - a cake from Malang in East Java. 'Kontol' is a very crude word, and I'm always scared to use the Indonesian word for 'control' (work it out), in case I leave out the 'r' by mistake. Will peddlers of such food also end up in gaol?
Dr. Nadiar from the National AIDS Commission (NAC) has made the reasonable point that we shouldn't criticise the draft if we haven't read it. But in many of these (unfortunately poorly-drafted) bills, interpretation is everything. And the police are not known for liberal interpretation. I'd prefer it if Dr. Nadiar promised that the NAC would defend us in cases of unreasonable arrest.
Babé
Thursday, 11 September 2008
Human rights and human wrongs
Sorry, it's been a while since I wrote! The Telkomsel Internet connection in Kupang was really frustrating, on-off-on again. Almost impossible to do useful work.
The training there went quite well. The general level of participants was not very high, almost at Papua level. So we had to do a lot of extra explaining, which added at least an hour to each day's schedule. So I was quite tired by the time I returned.
As usual the session on Human Rights and HIV triggered a number of stories, many of them quite awful. The pregnant young lady in Atambua who was put under pressure to have a Caesarian, though luckily another doctor supported her choice of natural birth. But then, while nursing her one-day old, the local TV station cameraman barged in and filmed her. The clip was aired on the local news, and when she was discharged with new-born, she found herself evicted from her lodgings, Not so bad as these things go, but a reminder that although in general the situation may be improving (less hospitals are burning mattresses from beds in which PLHIV die), many of our friends still face daunting situations.
Way back when (well, in 1995), a then rising lawyer, Todung Mulia Lubis, offered to take any case of discrimination against PLHIV to court, gratis. He said he wanted to generate some precedents. Although he is now well-known, I'm pretty sure the offer still stands. But in the 13 years since then, no one has taken him up on this offer. I'm sure the main reason is that they are scared taking a case to court will only make their own situation worse. But I think partly it's because there's a feeling, reasonable in my view, that many such cases can be better addressed by advocacy. Most (though by no means all) of the cases of discrimination in the health service stem from lack of knowledge or understanding, which feeds fear. We can't take people to court for not knowing (although perhaps we should be able to sue the managers and decision makers who have neglected the training and information dissemination). Advocacy and discussion, together with experience, can usually solve the problem. Often it's only the first cases in a hospital which generate problems; once treating PLHIV becomes 'normal', the problems usually disappear.
Off to Perth tonight for the ASHM Conference (well, a few days holiday in Margaret Rive first with Tim Mackay). Hope the Internet connection is better there than in Kupang!
Babé
The training there went quite well. The general level of participants was not very high, almost at Papua level. So we had to do a lot of extra explaining, which added at least an hour to each day's schedule. So I was quite tired by the time I returned.
As usual the session on Human Rights and HIV triggered a number of stories, many of them quite awful. The pregnant young lady in Atambua who was put under pressure to have a Caesarian, though luckily another doctor supported her choice of natural birth. But then, while nursing her one-day old, the local TV station cameraman barged in and filmed her. The clip was aired on the local news, and when she was discharged with new-born, she found herself evicted from her lodgings, Not so bad as these things go, but a reminder that although in general the situation may be improving (less hospitals are burning mattresses from beds in which PLHIV die), many of our friends still face daunting situations.
Way back when (well, in 1995), a then rising lawyer, Todung Mulia Lubis, offered to take any case of discrimination against PLHIV to court, gratis. He said he wanted to generate some precedents. Although he is now well-known, I'm pretty sure the offer still stands. But in the 13 years since then, no one has taken him up on this offer. I'm sure the main reason is that they are scared taking a case to court will only make their own situation worse. But I think partly it's because there's a feeling, reasonable in my view, that many such cases can be better addressed by advocacy. Most (though by no means all) of the cases of discrimination in the health service stem from lack of knowledge or understanding, which feeds fear. We can't take people to court for not knowing (although perhaps we should be able to sue the managers and decision makers who have neglected the training and information dissemination). Advocacy and discussion, together with experience, can usually solve the problem. Often it's only the first cases in a hospital which generate problems; once treating PLHIV becomes 'normal', the problems usually disappear.
Off to Perth tonight for the ASHM Conference (well, a few days holiday in Margaret Rive first with Tim Mackay). Hope the Internet connection is better there than in Kupang!
Babé
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