training health workers in skills related to the topics above and in the ethics of collaborating with regimes using torture.[12]
Technologies used for torture are mostly familiar: batons for beatings; electricity for shock; cigarettes to cause burns. Occasionally there is some innovation in torture, such as beatings on the soles of feet (falanga) in order to inflict pain without leaving physical traces. In such cases there is a place for research to develop new means of detecting torture. Turkish physician Veli Lök helped develop a method of detecting falanga using bone scintigraphy. Courts have used medical reports based on this method as proof of torture.[13]
As well as exposing abuses by repression regimes, another and bigger task for health workers is to promote a healthy society. A society in which people are healthy and self-reliant in health care is undoubtedly better prepared to resist aggression and repression. Maintaining health in the face of attack is a tall order. Aggressors might
assault nonviolent protesters or bystanders;
engage in forced labour and torture;
impose a blockade that cuts off food and medical supplies;
destroy power supplies or sanitation facilities, increasing the risks of disease;
lay landmines;
spread diseases, inadvertently or purposefully;
launch military attack, including bombing.
When a population uses only nonviolent methods of resistance, full-scale military attack is less likely than when there is violent resistance. Nevertheless, it is important to be prepared for serious health consequences of aggression. In such a situation, it is unlikely that the conventional medical system could cope. A large influx of casualties would overwhelm hospitals. Emergency procedures, familiar to doctors working in theatres of war, are appropriate.[14] Disaster planning — usually the province of civil defence managers — is needed for the health sector as well as others.
More generally, many members of the community need to develop skills in diagnosis and treatment. Simple first-aid measures are often sufficient, even for some serious injuries. A society prepared for the adverse health consequences of aggression might:
make first-aid training a regular part of nearly everyone’s continuing education;
run medical disaster simulations, analogous to fire drills;
provide subsidised packages of basic medical materials to every household and building;
make widely available handbooks describing basic medical procedures;
set up decentralised production facilities for basic medical items such as anaesthetics and antibiotics;
promote a simple, nutritious, locally obtainable diet;
support use of effective alternatives to conventional medicine[15];
engage in ongoing discussion and debate about self-help and low cost methods of promoting health.
These sorts of initiatives towards self-reliance in health care often conflict with the priorities of industrialised medicine, with its reliance on expert professionals, expensive technology and drugs provided by transnational corporations. Industrialised medicine is vulnerable in the face of attack, whereas self-reliant health care is resilient.
Miriam Solomon, a researcher into health and democacy, has thought about these issues. She draws attention to the rhetoric of the World Health Organisation (WHO) “on primary health care and health promotion, as embodied, for example, in the Ottawa Charter. That document urges a range of strategies, including political ones, for developing personal skills, strengthening communities, improving the social and physical environments, reorienting health services (away from the medical model), and incorporating health sensitive public policies in all sectors.” She notes that the same principles that apply to food, energy and so forth also apply to health.
The decentralisation of service provision, the shift away from high technology, specialised, institutionalised curative oriented care, towards community and individual control over social, political and physical environments, as well as being consistent with health promotion and primary health care strategies, would probably also be the best preparation for social defence. Thus the uncorrupted interpretation of the New Public Health and the WHO interpretation of Health Promotion are what is needed for preparing for social defence. They are about giving people control of their own lives, empowering individuals and communities, learning skills for becoming politically and socially aware, and building community cohesion and political constituencies, with adequate sensitivity to the needs of other environments and communities.[16]
Appropriate technology (AT)