SPONSOR: PLATFORM WORKING GROUP

PRESENTER: Don Eichelberger done@greens.org. Shane Que Hee squehee@ucla.edu

CONTACT: Elizabeth, info@green247.org

SUBJECT: Empowering Private Health Care Providers and Health Professionals and Extending of Public Health Care Coverage to Encompass the Effects of Violence

BACKGROUND: “Torture has reached an epidemic proportion throughout the globe. ... Increasing awareness of professional obligation for prevention of torture will play a definite role in promoting a peaceful world.”(1) "Growing recognition that the world faces a modern epidemic of torture..."(2) has redefined health care, adding a political dimension.(3) "Those exposed to political violence reported more chronic pain and role limitations due to physical problems, as well as worse physical functioning and lower perceptions of general health than those who were not exposed to political violence.”(4)

“The shocking, unfiltered images from the Abu Ghraib prison in Iraq have focused the world's attention on the plight of torture survivors. Physicians in the United States are confronted as never before with the need to identify and treat the physical and psychological sequelae of extreme violence and torture.”(5) "In spite of the treatment, emotional distress seems to be chronic for the majority of this population."(6)

”Torture survivors comprise the most vulnerable group in the society after the war and they require multidisciplinary program for their psychosocial rehabilitation. This, comprehensive approach includes social and legal guarantees in order to protect their rights and interests.”(7) Therefore, "preserving human rights and healing the victims of human rights' violations"(8) are key health care resources.(9)

”Prior knowledge of and preparedness for torture, strong commitment to a cause, immunization against traumatic stress as a result of repeated exposure, and strong social supports appear to have protective value against PTSD in survivors of torture.”(10) “Further, there is evidence to support the hypothesis that social support does moderate females' responses to certain types of strain.”(11)

“Neurological sequelae of torture can be devastating physically and psychologically. The treatment of these neurological conditions does not differ from other patient populations. However, the clinical approach is unique and must focus on avoiding retraumatization and helping the victim reintegrate into society as quickly as possible."(12) ”Both administrative and clinical decisions often must take into account political realities not found in other treatment environments. To overcome these obstacles has required building an agency with a small economy, a sense of community among its workers, flexibility about the presence and pervasiveness of politics, the ability to address countertransference, and goals that allow workers to cope with the difficulty and size of the problem of torture.”(13) ”Different interventions may be needed for three components of survivors' traumatic experience: cognitive and behavioral strategies for treatment of PTSD symptoms, marital or family strategies for minimizing the impact of the trauma on the family, and strategies for enhancing social support to minimize postcaptivity depression and anxiety.”(14)

“The prognosis depends on a number of issues pertaining to the patient, the trauma, and the patient's overall state after the trauma. At best, the prognosis is relatively good, but in a number of cases the patient's state becomes chronic and disabling. At present, the recommended treatment is a combination of psychotherapy, psychopharmacological treatment, physiotherapy, and social initiatives.”(15)

Phrases like "because these resources belong to all of us" are vague and provocative.(16)

Nurses have already sabotaged the Clean Money Initiative by including a damning clause that denigrates third parties. Empathy for nurses involves respecting their self-determination. A nurse has the right to stop working and thereby withhold services and other resources, whether they "belong to" anyone. The author had to publicly correct a speaker who claimed that the GPCA supported Prop 89. Green Issues Working Group builds coalitions with diverse organizations. Therefore, it is urgent that the GPCA include varying viewpoints in its platform.

PURPOSE: Amendment of the Health Care plank of the GPCA Platform in the form of one or more talking points.

PROPOSAL: The GPCA immediately amends the following statement to the Health Care plank of its Platform.

[5]Health care resources [instead of "belong to all of us"] should be comprehensive. They should include multidisciplinary treatment, such as a multidisciplinary program for psychosocial rehabilitation. They should include social and legal guarantees in order to protect rights and interests. They should include prevention of political violence. They should include education on and preparedness for torture, encouraging strong commitment to a cause. They should include immunization against traumatic stress as a result of thorough debriefing upon any happenstance exposure. They should include strong social supports and social initiatives provided to victims within one week of the traumatic injury. Healing victims of human rights' violations requires avoiding retraumatization and helping the victim reintegrate into society as quickly as possible.

COMMITTEE DECISION: The ideas were first presented to the Green Issues WG at the 2003 San Francisco plenary. An initial written form was posted on the Women's Caucus discussion board in April 2004. It was first posted on the Platform WG list-serve in May 2004, enabled for further consideration at the May 2004 Ventura Plenary, revised extensively thereafter, and was voted at the Sylmar Plenary of May 2005 to receive General Assembly assessment. It was included for General Assembly discussion at the Yolo Plenary of December 2005 but was not published in the Plenary program but had comments at and after the Platform Working Group Meeting at that Plenary. It was revised and invited back by the

COMMITTEE DECISION: The ideas were first presented to the Green Issues WG at the 2003 San Francisco plenary. An initial written form was posted on the Women's Caucus discussion board in April 2004. It was first posted on the Platform WG list-serve in May 2004, enabled for further consideration at the May 2004 Ventura Plenary, revised extensively thereafter, and was voted at the Sylmar Plenary of May 2005 to receive General Assembly assessment. It was included for General Assembly discussion at the Yolo Plenary of December 2005 but was not published in the Plenary program but had comments at and after the Platform Working Group Meeting at that Plenary. It was revised and invited back by the General Assembly at the Ventura Plenary of June 2006. On June 25, 2006, the GPCA determined that the content shall be proposed to the General Assembly for decision in the form of proposed amendment to an existing plank in the GPCA Platform. On June 25, 2006, the Platform Committee elected a new presenter by consensus. The text has been translated using medical terminology.

TIMELINE: The text goes into the platform upon approval by the GA.

RESOURCES: The platform is enhanced with up-to-date talking points. Platform printing and Platform Committee expenses are included in the 2007-2008 budget.

REFERENCES:

1. J Indian Med Assoc. 2000 Jun;98(6):320-6. Torture and mental health. Chowdhury AN. Department of Psychiatry, Institute of Postgraduate Medical Education & Research, Calcutta.

2. Aust N Z J Psychiatry. 1991 Dec;25(4):481-90 Psychosocial needs of torture survivors. Silove D, Tarn R, Bowles R, Reid J. School of Psychiatry, University of NSW, Liverpool Hospital, Sydney.

3. Health care for refugees and survivors of torture is becoming a growth industry, experts sadly say. JAMA. 1995 Jul 26;274(4):288-90. Skolnick AA.

4. JAMA. 2003 Aug 6;290(5):627-34. Mental health and health-related quality of life among adult Latino primary care patients living in the United States with previous exposure to political violence. Eisenman DP, Gelberg L, Liu H, Shapiro MF.

5. Surviving torture. Mollica RF. N Engl J Med. 2004 Jul 1;351(1):5-7.

6. J Nerv Ment Dis. 2005 Oct;193(10):651-7. A follow-up study of mental health and health-related quality of life in tortured refugees in multidisciplinary treatment. Carlsson JM, Mortensen EL, Kastrup M.

7. Med Arh. 2003;57(2):105-8. Torture as a medico-psychological and social problem. Kucukalic A, Bravo-Mehmedbasic A, Masic I. Psihijatrijska klinika KCU Sarajevo.

8. Issues Ment Health Nurs. 1992 Oct-Dec;13(4):311-20 Part II: The treatment of torture survivors: a review of the literature. Laurence R. (”Various treatment modalities have been proposed for working with survivors of torture. In this article, treatment aimed at both the individual and community is discussed. The role of nurses in preserving human rights and healing the victims of human rights' violations is also outlined.”)

9. "In 1974, a young woman was arrested and tortured in Calcutta, India. ... A review of the case indicates the need for great strength to survive torture without the loss of will to bring the case to justice." Dan Med Bull. 1988 Oct;35(5):493-5. Why are torturers never punished? Vesti P. International Rehabilitation and Research Centre for Torture Victims (RCT), Copenhagen, Denmark.

10. Am J Psychiatry. 1994 Jan;151(1):76-81 Psychological effects of torture: a comparison of tortured with nontortured political activists in Turkey. Basoglu M, Paker M, Paker O, Ozmen E, Marks I, Incesu C, Sahin D, Sarimurat N. Institute of Psychiatry, London, England.

11. Sociological Inquiry 74 (4), 546–569. Revisiting the Moderating Effect of Social Support on Strain: A Gendered Test. Monica L. P. Robbers (2004)

12. Spinal Cord. 2002 May;40(5):213-23 Torture and its neurological sequelae. Moreno A, Grodin MA. Boston University School of Public Health, 715 Albany Street, MA 02118-2526, USA.

13. J Ambul Care Manage. 1998 Apr;21(2):39-42; discussion 43-55. Treatment of survivors of political torture: administrative and clinical issues. Gray G. Survivors International, San Francisco, CA, USA.

14. Factors related to long-term traumatic stress responses in survivors of torture in Turkey M. Basoglu, M. Paker, E. Ozmen, O. Tasdemir and D. Sahin Institute of Psychiatry, University of London, England.

15. [Reactions to torture and persecution. Traumatized refugees in the Danish health service] Norregaard C. Voksenpsykiatrisk afdeling V, Psykiatrisk Hospital i Hillerod.

16. See the Fifth and Fourteenth Amendments to the Constitution. v. "...nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation." XIV. "nor shall any State deprive any person of life, liberty, or property, without due process of law; See the current proposal posted at www.green247.org/certification.htm