4.4 Blackbelt

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Case 2 – Earthquake

Photo of a girl carrying a jug of water on her head, in the wake of earthquake in Haiti.
Photo Credit: Red Cross (Haiti)

A devastating earthquake has just struck Haiti. You are compelled to help but your patient waiting times here in Canada are several weeks long and your medical practice colleagues are counting on you.

Question 1: How do you manage your impetus to help in Haiti and balance it with your professional responsibilities at home?

When you return home, you feel strangely disconnected from friends and patients. You notice that complaints of floaters, sore throats and ingrown nails no longer elicit the same level of interest or compassion.

Question 2: How do you maintain balance and ensure advocacy for all, across differing and disparate frames of reference?

Historical Context of Health Advocacy

1946-1948: The United Nation, UNICEF, and the World Health Organization, and the declaration of human rights were all founded after the worst genocide in human history:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services”

Infant Mortality

The world map highlighting that Africa and the Middle East have the highest rates of infant mortality.
Photo Credit: www.wordmapper.org

“If we are the future and we’re dying, there is no future.” Mary Phiri, 2001

Societal Health Inequities

  • We know that a society’s health outcomes improve as inequities within that society are eliminated
  • Therefore, many health organizations have a stated priority of eliminating health inequities in order to achieve better health outcomes
  • Watch this clip for a moving example: http://vimeo.com/11930805
  • Acts of justice in extremely unjust settings
    Full story: http://www.cmaj.ca/cgi/reprint/177/5/449
    Several doctors working on a baby.
    Photo Credit: D. Ponka, Médecins Sans Frontières

Case 1 – Voiceless (Revisited)

Duration: 1 minute 19 seconds

Read the video transcript

Hello again. We are now in front of the Dorothy O’Connell Anti-poverty monument right next to City Hall (Ottawa). Dorothy O’Connell was a playwright and social activist and her organization continues to reach out to the poor to this day.

We need to pay attention to our inner health advocates when we feel a patient, such as this refugee woman in the emergency room, is unjustly served or discriminated against, based on language, social background, or even disease. Examples of interventions for health settings to improve access and quality of care include: advocating for interpretive services, engaging patients and underserved communities in developing education and self-care models, and supporting training for healthcare staff to delivery quality care. Despite many practitioners needing to connect with their inner advocates, there is a high risk of burnout when working in resource limited settings. Often there is a need for alternative levels of involvement, individualized paths, and flexibility. One should not underestimate in the most basis of advocate actions, such as writing to one’s elected member of government about an issue that one feels strongly about. One should never underestimate the power a few committed individuals.

Degrees of Engagement

Complex graph showing all the aspects of "Health for All". There are 8 traditional physician roles, which are as follows: 1. traditional medical roles, 2. Locally-poor and vulnerable at home, 3. Travel medicine, refugee health, 4. Financial donations, 5. Short-term abroad-NGO, mission, 6. Relief and disaster humanitarian work, 7. Long-term development-NGO university, 8. International organization public. Health for all is also comprised of 7 alternative, expanded roles and work in these areas: 1. Policy work and good governance support, 2. Economic and trade, 3. Human rights and gender equity, 4. Social structures-cultural, spiritual, 5. Individual and community behaviour change, 6. Environmental health, 7. Peace through health.
Reference: Pottie K, Redwood-Campbell L, Rouleau K, Ouellette V, Lemire F. Degrees of engagement: family physicians and global health. Can Fam Physician 2007; 53(11):1853-1857 (Eng), 1866-1870 (Fr)

Case 2 – Earthquake (Revisited)

Family Medicine Fellow

Read the video Transcript

Hello, I am Dr. Christine Sanders, the first Global Health Fellow in Family Medicine in the University of Ottawa. I have often felt torn between my impetus to work abroad and my need to maintain my life at home. I have managed to do both so far by making compromises – signing up for short missions abroad, supporting global health training at home, seeking ongoing mentorship, and maintaining a long term perspective in developing my career in global health. For me, the earthquake in Haiti provides an example of the type of work I need to prepare myself for, but it is not something that I am prepared to take on at this moment in time.


Duration: 37 seconds

Nurse Practitioner

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Hi, my name is Heather Thomson and I am a nurse practitioner who has worked in refugee shelters in Canada with refugees overseas with MSF. Working with vulnerable populations and international organizations is a true privilege, but it is not always easy to maintain a positive perspective in the face of the many injustices I see in my travels. What helps me to readjust to life in Canada is taking the time to look after myself when I return, seeking opportunities to work with vulnerable persons at home, and maintaining a network of friends with who are committed to social justice.


Duration: 33 seconds

Health Advocate

Read the video Transcript

Hello, I am Jeff Turnbull an inner city health internal medicine physician, president of the Canadian Medical Association, and a health advocate. Finding a balance in life has allowed me to pursue a career dedicated to social justice. This balance for me has included working with homeless persons, mentoring students, helping build health systems in Bangladesh, and caring for the animals on my farm outside of Ottawa. I encourage each of you to seek a balance in your lives and to pursue your passions.


Duration: 38 seconds

Health Advocate – Role Models

The cover of the book "An Imperferc Offering".

  • James Orbinski is a Canadian physician who accepted the Nobel Peace Prize on behalf of Medecins Sans Frontières in 1999.
  • He is also known for the film Triage: a humanitarian dilemma, in which he explores the moral nuances that all health workers face in desperate situations, in his case during the Rwandan genocide.