Why your doctor should care about social justice | Mary Bassett

Prevodilac: Ivana Krivokuća Lektor: Tijana Mihajlović

When I moved to Harare in 1985,

Kada sam se 1985. godine preselila u Harare,

social justice was at the core of Zimbabwe's national health policy.

društvena pravda bila je u jezgru nacionalne zdravstvene politike Zimbabvea.

The new government emerged from a long war of independence

Nova vlada je proizašla iz dugog rata za nezavisnost

and immediately proclaimed a socialist agenda:

i odmah proglasila socijalistički program;

health care services, primary education

zdravstvena zaštita i osnovno obrazovanje

became essentially free.

postali su u suštini besplatni.

A massive expansion of rural health centers

Ogromna ekspanzija seoskih zdravstvenih centara

placed roughly 80 percent of the population

smestila je oko 80 odsto stanovništva

less than a two-hour walk from these facilities,

na manje od dva sata hoda od ovih ustanova;

a truly remarkable accomplishment.

zaista izvanredan uspeh.

In 1980, the year of independence,

Godine 1980, godine nezavisnosti,

25 percent of Zimbabwean children were fully immunized.

25 procenata dece Zimbabvea u potpunosti je vakcinisano.

By 1990, a mere decade later,

Do 1990. godine, samo deceniju kasnije,

this proportion stood at 80 percent.

taj procenat iznosio je 80 odsto.

I felt tremendously privileged to be part of this transformation,

Osećala sam se izuzetno privilegovano jer sam deo ove transformacije,

a revolution.

revolucije.

The excitement, the camaraderie, was palpable.

Uzbuđenje, drugarstvo, bili su opipljivi.

Radeći rame uz rame sa briljantnim građanima Zimbabvea -

Working side by side with brilliant Zimbabweans --

scientists, doctors, activists --

naučnicima, lekarima, aktivistima -

I felt connected not only to an African independence movement,

osećala sam se ne samo povezano sa afričkim pokretom za nezavisnost,

but to a global progressive public health movement.

već i sa globalnim progresivnim pokretom javnog zdravlja.

But there were daunting challenges.

Međutim, bilo je obeshrabrujućih izazova.

Zimbabwe reported its first AIDS case in 1985, the year I arrived.

Zimbabve je izvestio o svom prvom slučaju side 1985. godine, godine mog dolaska.

I had taken care of a few patients with AIDS in the early 1980s,

Brinula sam se za nekoliko pacijenata sa sidom ranih 1980-ih godina,

when I did my medical training at Harlem Hospital, but --

kada sam išla na medicinsku obuku u harlemskoj bolnici,

we had no idea what lay in store for Africa.

ali nismo imali pojma šta se dešava u Africi.

Infection rate stood at about two percent in my early days there.

Stopa infekcije iznosila je oko dva odsto mojih prvih dana tamo.

These would soar

To će skočiti

to one out of every four adults

na jednu od svake četiri odrasle osobe

by the time I left Harare 17 years later.

u vreme kada sam otišla iz Hararea 17 godina kasnije.

By the mid-1990s,

Do sredine 1990-ih,

I'd told hundreds of people in the prime of life

rekla sam stotinama ljudi u najboljim godinama

that they were HIV-positive.

da su HIV pozitivni.

I saw colleagues and friends die,

Gledala sam kako moje kolege i prijatelji umiru,

my students, hospital patients, die.

kako moji studenti i bolnički pacijenti umiru.

In response, my colleagues and I set up a clinic.

Kao odgovor na to, moje kolege i ja smo osnovali kliniku.

We did condom demonstrations.

Demonstrirali smo upotrebu kondoma.

We launched school education and workplace interventions.

Pokrenuli smo edukacije u školama i intervencije na radnim mestima.

We did research. We counseled the partners of infected men

Sproveli smo istraživanja.

Savetovali smo partnere zaraženih muškaraca kako da se zaštite.

about how to protect themselves.

We worked hard, and at the time, I believed that I was doing my best.

Naporno smo radili i u to vreme sam smatrala da dajem sve od sebe.

I was providing excellent treatment,

Pružala sam odlično lečenje,

such as it was.

takvo kakvo je bilo.

But I was not talking about structural change.

Međutim, nisam govorila o strukturalnim promenama.

Former UN Secretary Kofi Annan has spoken candidly

Bivši sekretar UN-a Kofi Anan je otvoreno govorio

about his personal failure

o svom ličnom neuspehu

leading to the Rwandan genocide.

koji je doveo do genocida u Ruandi.

In 1994, he was head of the UN peacekeeping department.

Godine 1994, on je bio predvodnik odeljenja za mirovne operacije UN-a.

At a 10-year memorial for the genocide,

Na spomenu održanom povodom 10 godina od genocida,

he reflected, "I believed at the time I was doing my best,

izneo je: „Smatrao sam u to vreme da dajem sve od sebe,

but I realized after the genocide

ali sam nakon genocida shvatio

that there was more I could and should have done

da sam mogao i da je trebalo da uradim više

to sound the alarm and rally support."

da pokrenem uzbunu i prikupim podršku.“

The AIDS epidemic caught the health community unprepared,

Epidemija side je zatekla zdravstvenu zajednicu nepripremljenu,

and today, when the World Health Organization estimates

a danas, kada je procena Svetske zdravstvene organizacije

that 39 million people have lost their lives to this disease,

da je 39 miliona ljudi izgubilo život zbog ove bolesti,

I'm not alone in feeling remorse and regret

nisam jedina koja oseća kajanje i žaljenje

at not having done more earlier.

što nisam ranije učinila više.

But while living in Zimbabwe,

Međutim, dok sam živela u Zimbabveu,

I didn't see my role as an advocacy or a political one.

nisam videla da je moja uloga javno zastupanje ili političke prirode.

I was there for my technical skills,

Bila sam tamo zbog svojih tehničkih veština,

both my clinical and my research epidemiology skills.

kliničkih i istraživačkih veština u oblasti epidemiologije.

And in my mind, my job was to take care of patients

U mojoj glavi, moj posao se sastojao od toga da se brinem o pacijentima

and to do research to better understand the population patterns of transmission,

i da vršim istraživanja

radi boljeg razumevanja obrazaca prenošenja u populaciji,

and I hoped that we'd slow the spread of the virus.

a nadala sam se da ćemo usporiti širenje virusa.

I was aware that socially marginalized populations were at disproportionate risk

Bila sam svesna

da društveno marginalizovane populacije imaju nesrazmerno veći rizik

of getting and dying of AIDS.

od dobijanja side i umiranja od nje.

And on the sugar plantations,

Na šećernim plantažama,

which really more closely resembled feudal fiefdoms

koje zaista više podsećaju na feudalne posede

than any modern enterprise,

nego na neko savremeno preduzeće,

60 percent of pregnant women

kod 60 procenata trudnica

tested HIV-positive.

je testom ustanovljeno da su HIV pozitivne.

I worked to show how getting infected was not a moral failure

Radila sam na tome da pokažem da zaraženost nije moralni nedostatak,

but instead related to a culture of male superiority,

već da je umesto toga u vezi sa kulturom muške superiornosti,

to forced migrant labor and to colonialism.

sa prinudnim radom migranata i kolonijalizmom.

Whites were largely unscathed.

Belci uglavnom nisu bili pogođeni.

As health professionals,

Kao zdravstvenim radnicima,

our tools were pitifully weak:

naša sredstva bila su žalosno slaba -

imploring people to change their individual behaviors,

preklinjanje ljudi da svako zasebno promeni svoje ponašanje,

da koriste kondome, smanje broj partnera.

use condoms, reduce number of partners.

Infection rates climbed,

Stopa infekcije se povećala,

and when treatment became available in the West,

a kada je lečenje postalo dostupno na Zapadu,

treatment that remains our most potent weapon

lečenje koje je i dalje naše najmoćnije oružje protiv ovog virusa,

against this virus,

it was unaffordable to the public sector across Africa.

javni sektor širom Afrike ga nije mogao priuštiti.

I didn't speak out

Nisam progovorila

about the unequal access to these life-saving drugs

na temu nejednakog pristupa ovim lekovima koji spasavaju život

or about the underlying economic and political systems

ili ekonomskih i političkih sistema u osnovi problema

that were driving infection rates

koji su doveli do toga da stopa zaraze

in such huge swaths of the population.

odnosi toliki ogroman broj stanovništva.

I rationalized my silence

Racionalizovala sam svoje ćutanje

by reminding myself that I was a guest in the country,

podsećajući se da sam gost u zemlji,

that sounding the alarm could even get me kicked out,

da me zbog oglašavanja uzbune mogu čak i izbaciti,

keep me from doing good work,

sprečiti me da obavljam dobar posao,

taking care of my patients,

staram se o svojim pacijentima,

doing much-needed research.

sprovodim toliko potrebno istraživanje.

So I didn't speak out

Zato se nisam izjašnjavala

about the government's early stance on AIDS.

o stavu koji je vlada isprva imala prema sidi.

I didn't voice my concerns loudly enough.

Nisam dovoljno glasno izrazila svoju zabrinutost.

Many doctors, health professionals,

Mnogi lekari, zdravstveni radnici,

may think I did nothing wrong.

možda smatraju da nisam uradila ništa loše.

Our pact with our patients,

Sporazum koji imamo sa pacijentima,

the Hippocratic Oath and its variants,

Hipokratova zakletva i njene varijante,

is about the sanctity of the patient-doctor relationship.

odnose se na svetinju odnosa između pacijenta i lekara,

And I did everything I could

a ja sam uradila sve što sam mogla

for each and every patient of mine.

za svakog od mojih pacijenata.

But I knew

Ipak, znala sam

that epidemics emerge along the fissures of our society,

da epidemije nastaju duž pukotina našeg društva,

reflecting not only biology,

odražavajući ne samo biologiju,

but more importantly patterns of marginalization, exclusion,

već, još važnije, obrasce marginalizacije, isključenosti,

discrimination related to race, gender, sexuality, class and more.

diskriminacije vezane za rasu, rod, seksualnost, stalež i tako dalje.

It was true of AIDS.

Ovo je bilo istinito u slučaju side.

It was true just recently of Ebola.

Bilo je istinito i nedavno u slučaju ebole.

Medical anthropologists such as Paul Farmer,

Medicinski antropolozi kao što je Pol Farmer,

who worked on AIDS in Haiti,

koji je radio na problemu side na Haitiju,

call this structural violence:

nazivaju ovo strukturalnim nasiljem,

structural because inequities are embedded

strukturalnim jer su nejednakosti usađene

in the political and economic organization of our social world,

u političkim i ekonomskim organizacijama našeg društvenog sveta,

often in ways that are invisible to those with privilege and power;

često na načine koji su nevidljivi onima koji imaju privilegije i moć,

and violence because its impact --

a nasiljem, jer je njegov uticaj -

premature deaths, suffering, illness -- is violent.

prerane smrti, patnje, bolesti - nasilan.

We do little for our patients

Ne činimo mnogo za naše pacijente

if we fail to recognize

ako ne uspevamo da prepoznamo

these social injustices.

ove društvene nepravde.

Sounding the alarm is the first step towards doing public health right,

Oglašavanje alarma je prvi korak ka ispravnom vođenju javnog zdravlja,

and it's how we may rally support

a na taj način možemo prikupiti podršku

to break through and create real change together.

da bismo ostvarili prodor i zajednički doveli do prave promene.

So these days, I'm not staying quiet.

Stoga ovih dana više ne ćutim.

I'm speaking up about a lot of things,

Glasno govorim o mnogim stvarima,

even when it makes listeners uncomfortable,

čak i kada se zbog toga slušaoci osećaju neprijatno,

even when it makes me uncomfortable.

čak i kada se ja zbog toga osećam neprijatno.

And a lot of this is about racial disparities

Dosta toga je ovde vezano za rasne nejednakosti

and institutionalized racism,

i institucionalizovani rasizam,

things that we're not supposed to have in this country anymore,

što više ne bi trebalo da imamo u ovoj zemlji,

certainly not in the practice of medicine

naročito ne u medicinskoj praksi

or public health.

ili u javnom zdravlju.

But we have them,

Ipak, imamo ih

and we pay for them in lives cut short.

i za njih plaćamo skraćenim životima.

That's why sounding the alarm

Zato je oglašavanje uzbune

about the impact of racism on health in the United States,

o uticaju rasizma na zdravlje u Sjedinjenim Državama,

the ongoing institutional and interpersonal violence

neprekidno institucionalno i interpersonalno nasilje

that people of color face,

da ljudi obojenog lica,

compounded by our tragic legacy

a što je pogoršano našim tragičnim nasleđem

of 250 years of slavery,

250 godina ropstva,

90 years of Jim Crow

90 godina zakona Džima Kroua

and 60 years of imperfect equality,

i 60 godina nesavršene ravnopravnosti,

sounding the alarm about this

oglašavanje uzbune o ovome

is central to doing my job right

od suštinskog je značaja za ispravno obavljanje mog posla

as New York City's Health Commissioner.

kao komesara zdravlja grada Njujorka.

In New York City, premature mortality -- that's death before the age of 65 --

U Njujorku, prevremeni mortalitet - to je smrt pre 65. godine starosti -

is 50 percent higher for black men than white ones.

je 50 procena veći kod muškaraca crne nego bele rase.

A black woman in 2012

Žena crne rase se 2012. godine suočava

faced more than 10 times the risk of dying related to childbirth

sa više od deset puta većim rizikom od smrti povezane sa porođajem

as a white woman.

nego žena bele kože.

And though we've made enormous strides

Mada smo preduzeli ogromne korake

in reducing infant mortality rates,

radi smanjenja stope smrtnosti odojčadi,

a black baby still faces

beba crne rase se i dalje suočava

nearly three times the risk of death in its first year of life

sa približno tri puta većim rizikom smrti u svojoj prvoj godini života

as compared to a white baby.

u poređenju sa bebom bele rase.

New York City's not exceptional.

Njujork nije izuzetak.

These statistics are paralleled

Napravljena je paralela ovih statističkih podataka

by statistics found across the United States.

sa onima koji su ustanovljeni širom Sjedinjenih Država.

A recent New York Times analysis

Skorašnja analiza „Njujork tajmsa“ izveštava

reported that there are 1.5 million missing black men across the country.

da postoji 1,5 miliona crnih muškaraca koji su nestali širom zemlje.

They noted that more than one

Istakli su da je više od jednog

out of every six black men

od svakih šest muškaraca crne rase

who today should be between the ages of 25 and 54 years

koji bi danas trebalo da imaju između 25 i 54 godina

have disappeared from daily life,

nestalo iz svakodnevnog života,

lost either to prison or premature death.

da su izgubljeni bilo zbog zatvora ili preuranjene smrti.

There is great injustice

Svakodnevno postoji velika neprada

in the daily and disproportionate violence faced by young black men,

i nesrazmerno veliko nasilje sa kojim se suočavaju mladi crnci,

the focus of recent protests under the banner #BlackLivesMatter.

što je bio fokus nedavnih protesta pod nazivom #BlackLivesMatter.

But we have to remember

Moramo upamtiti

that enduring and disparate rates

to trpljenje i nejednake stope,

and the occurrence and outcome of common medical conditions --

nastanak i ishod učestalih zdravstvenih stanja -

heart disease, cancer, diabetes, HIV --

bolesti srca, rak, dijabetes, HIV -

diseases that may kill slowly and quietly

oboljenja koja mogu da ubiju polako i tiho,

and take even more black lives prematurely.

pa čak i da prerano odnesu još života crnih ljudi.

As the #BlackLivesMatter movement unfolded,

Dok se pokret #BlackLivesMatter odvijao,

I felt frustrated and angry

osećala sam se frustrirano i ljuto

that the medical community

zato što je medicinska zajednica

has been reluctant to even use the word "racism"

oklevala čak i da upotrebi reč „rasizam“

in our research and our work.

u našem istraživanju i radu.

You've probably felt something every time I've said it.

Verovatno ste nešto osetili svaki put kada sam je izgovorila.

Our medical students held die-ins in their white coats,

Naši studenti medicine su održali simulacije smrti u svojim belim mantilima,

but the medical community has largely stood by passively

ali medicinska zajednica u velikoj meri ostaje pasivna

as ongoing discrimination continues to affect

dok diskriminacija neprekidno utiče

the disease profile and mortality.

na profil bolesti i mortalitet.

And I worry

Brinem se da trend

that the trend towards personalized and precision medicine,

ka personalizovanoj i preciznoj medicini,

looking for biological or genetic targets to better tailor treatment,

traganju za biološkim ili genetskim metama kako bi se bolje prilagodio tretman,

may inadvertently cause us to lose sight of the big picture,

može nenamerno dovesti do toga da izgubimo iz vida širu sliku,

that it is the daily context,

odnosno svakodnevni kontekst,

where a person lives, grows,

gde osoba živi, razvija se,

works, loves,

radi, voli,

that most importantly determines population health,

što u najznačajnijoj meri određuje zdravlje u populaciji,

and for too many of us, poor health.

a za previše nas, loše zdravlje.

As health professionals in our daily work,

Kao zdravstveni radnici u našem svakodnevnom radu,

whether in the clinic or doing research,

u klinici, kao i obavljajući istraživanja,

we are witness to great injustice:

svedoci smo velike nepravde -

the homeless person who is unable to follow medical advice

beskućnik koji ne može da sledi savet lekara

because he has more pressing priorities;

jer ima više gorućih prioriteta,

the transgender youth who is contemplating suicide

transrodni mladić koji razmišlja o samoubistvu

because our society is just so harsh;

jer je naše društvo tako surovo,

the single mother who has been made to feel that she is responsible

samohrana majka koju su ubedili da se oseća odgovorno

for the poor health of her child.

za loše zdravlje svog deteta.

Our role as health professionals

Uloga nas, kao zdravstvenih radnika,

is not just to treat our patients

nije samo da lečimo pacijente

već i da oglasimo uzbunu

but to sound the alarm

and advocate for change.

i zalažemo se za promene.

Rightfully or not,

Opravdano ili ne,

our societal position gives our voices great credibility,

društveni položaj koji imamo daje našem glasu veliki kredibilitet

and we shouldn't waste that.

i to ne treba protraćiti.

I regret not speaking up in Zimbabwe,

Žalim što se nisam oglasila u Zimbabveu

and I've promised myself

i obećala sam sebi

that as New York City's Health Commissioner,

da ću kao njujorški komesar za zdravlje

I will use every opportunity I have

iskoristiti svaku priliku koju imam

to sound the alarm

da oglasim uzbunu i prikupim podršku za pravičnost u zdravstvenim pitanjima.

and rally support for health equity.

I will speak out against racism,

Govoriću protiv rasizma

i nadam se da ćete mi se pridružiti,

and I hope you will join me,

and I will join you when you speak out against sexism

a ja ću se pridružiti vama kada budete govorili protiv seksizma

or any other form of inequality.

ili bilo kojeg drugog oblika nejednakosti.

It's time for us to rise up

Vreme je da ustanemo

and collectively speak up

i kolektivno glasno progovorimo

about structural inequality.

na temu strukturalnih nejednakosti.

We don't have to have all the answers

Ne moramo da imamo sve odgovore

to call for change.

da bismo uputili poziv na promene.

We just need courage.

Potrebna nam je samo hrabrost.

The health of our patients,

Zdravlje naših pacijenata,

the health of us all, depends on it.

zdravlje svih nas, zavisi od toga.

(Applause)

(Aplauz)