1. Challenges in Medical Peace Education PtH-Challenge Conference May 8, 2005, 09:00-09:30 McMaster University klaus.melf@sih.uit.no

2. Challenges overview 1.Definitions and concepts 2.Teaching frameworks 3.Conflict fields / issues 4.Objectives 5.Methodology 6.Implementation strategies 7.Access and networking

3. 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?

4. 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

5. 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

6. 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

7. 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.

8. 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

9. 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)

10. 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 violence Structural violence Cultural violence Micro level Macro level

11. Scope of different frameworks Peace through Health Health as a Bridge to Peace Ecosystem Health Violence Prevention Global health Medicine and Human Rights Health and Human Rights Medical ethics

12. 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?

13. ETH DOU WOR DISC BUL SUI DOM YOU CUL REF HR = 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 GLO PRI ECO POV DIST WAR REL WEA SMA DIL MYT = 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

14. 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?

15. COM LIS DIA ANA HAN CRE KNO TEA 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 PUB NET GRO TEAM PRO RES 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

16. ETH CON PSY RIS ROO DYN STR = 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 GLO INT IMP 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

17. RES PEA TRU MOD PAT COM COMP NEU = responsibility for others’ health and life = peace, non-violence = truth, honesty = modesty = patience = commitment, involvement = compassion, humanitarian attitude = neutrality, impartiality SOL RESP INQ EQU TOL CON OPT = solidarity = respect for others’ culture and knowledge traditions = being inquisitive = equity, partnership = tolerance, respect for diversity = confidence in local capacities = optimism, belief in improvement

18. 5. Teaching methodology Lesions 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

19. 6. Implementation strategies Lesions 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)

20. 7. Access and networking What 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)

21. Challenges overview 1.Definitions and concepts 2.Teaching frameworks 3.Conflict fields / issues 4.Objectives 5.Methodology 6.Implementation strategies 7.Access and networking

22. I would like to thank Joanna Santa Barbara, Rob Stevens and other conference organizers