THE TANDEM PROJECT
UNITED NATIONS, HUMAN RIGHTS,
FREEDOM OF RELIGION OR BELIEF
Separation of Religion or Belief
& State
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Issue: International Conflict – Human Rights & Freedom of
Religion or Belief.
For: United Nations, Governments, Religions or Beliefs,
Academia, NGOs, Media, Civil Society
Review: Article in the Sunday New York Times, Foreign Ways and
Excerpts: are presented under the Eight Articles of the 1981
U.N. Declaration on the Elimination of all Forms of Intolerance and of
Discrimination Based on Religion or Belief.
“MINNEAPOLIS-The man from
Somalia sat nervously in an examining room at Hennepin County Medical Center,
gingerly brushing his fingertips against the left side of his head. “You’re
having surgery to remove shrapnel from your skull,” Dr. Seven Hillson told him,
pausing to let a Somaili interpreter dressed in a black head scarf and a
floor-length skit translates.
In a city where Swedes
and Norwegians once had separate hospitals, Hennepin spends $3 million a year
on interpreters fluent in 50 languages to communicate effectively with its
foreign-born patients. But since the late 1970s, this once lily-white city on
the prairie, frozen solid half the year, has also been taking in waves of legal
refuges from more far-flung parts of the world: Vietnam, Cambodia, Laos,
Russia, Bosnia and Herzegovina, Liberia, Ethiopia, Somalia, Myanmar and other
countries. The influx from
If patients reach the
point of talking about what happened to them in
Dr. Pryce and Dr. Harare,
the interpreter and patient advocate, emerged from an examining room looking
tired but wryly triumphant. The had just
finished negotiating, politely but persistently, with a patient who- just as
politely but persistently- had refused to allow any blood tests because it was
the holy month of Ramadan and he feared that having blood drawn might be a sin.
Finally, they telephoned an imam who declared there was no sin. The blood was
drawn.”
1. 3 Freedom to manifest one’s
religion or belief may be subject only to such limitations as are prescribed by
law and are necessary to protect public safety, order, health, morals or the
fundamental rights and freedoms of others.
5. 5 Practices of a religion or
belief in which a child is brought up must not be injurious to his physical or
mental health or to his full development, taking into account Article 1,
paragraph 3, of the present Declaration.
By DENISE GRADY
MINNEAPOLIS
— The man from Somalia sat nervously in an examining room
at Hennepin County Medical Center, gingerly brushing his fingertips against the
left side of his head.
“You’re
having surgery to remove shrapnel from your skull,” Dr. Steven Hillson told
him, pausing to let a Somali interpreter dressed in a black head scarf and a
floor-length skirt translate.
The
patient, Abdulqadir Jiirow, 31, nodded and explained that the shrapnel had been
there since 1991, when he was 14 and civil war broke out in
Mr.
Jiirow said he worked in a small town several hours away and shared an
apartment with other Somalis, while his wife and child lived in
“It’s
still astonishing,” the doctor, shaking his head, said after Mr. Jiirow left.
“ ‘Someone sent artillery into my home.’ But it’s common.”
Hennepin
County Medical Center, a sprawling complex in downtown Minneapolis near the
Metrodome, offers an extraordinary vantage point on the ways immigrants are
testing the American medical establishment. The new arrivals — many fleeing
repression, war, genocide or grinding poverty — bring distinctive patterns of
illness and injury and cultural beliefs about life, death, sickness and health.
In a city
where Swedes and Norwegians once had separate hospitals,
Hennepin spends $3 million a year on interpreters fluent in 50 languages to
communicate effectively with its foreign-born patients.
Many
arrive with health problems seldom seen in this country — vitamin deficiencies,
intestinal parasites and infectious diseases
like tuberculosis, for instance — and unusually high levels of emotional trauma
and stress. Over
time, as they pick up Western habits, some develop Western ailments, too, like obesity, diabetes and
heart disease, and yet they often question the unfamiliar lifelong treatments
these chronic diseases need.
Some also
resist conventional medical wisdom or practices, forcing change on the
hospital. The objections of Somali women to having babies delivered by male
doctors has led Hennepin, gradually, to develop an obstetrical staff made up
almost entirely of women.
Doctors
here say that for many of these newcomers, the most common health problems, and
the hardest to treat, lie at the blurry line between body and mind, where
emotional scars from troubled pasts may surface as physical illness, pain and
depression.
“Being an
immigrant, it will be a chronic illness for the rest of your life,” said Dr.
Veronica Svetaz, a physician from
From
Far-Flung Countries
Like many
American cities,
But since
the late 1970s, this once lily-white city on the prairie, frozen solid half the
year, has also been taking in waves of legal refugees from more far-flung parts
of the world: Vietnam, Cambodia, Laos, Russia, Bosnia and Herzegovina, Liberia,
Ethiopia, Somalia, Myanmar and other countries.
So many
people came here from war zones that a nonprofit group opened the nation’s
first Center for Victims of Torture in
The
influx from
The lucky
ones, granted refugee status, started arriving in the
“Nobody
can count us,” said Dr. Osman Harare, a physician and public health official in
The
community is thriving, though it is not without troubles. The F.B.I. has been
investigating whether young Somali men in Minneapolis have been recruited to
commit acts of terrorism in Somalia, and health officials have been looking
into reports of unusually high rates of autism in the
children of Somali immigrants.
A 446-bed
public hospital, Hennepin has a tradition of turning no one away, and it has
become the first stop for many immigrants who need a doctor.
No
questions are asked about immigration status. About 20 percent of
the center’s patients were born in other countries, and they account for $100
million of its $500 million yearly expenses for patient care. Hennepin’s
interpreters are called on to help patients more than 130,000 times a year. The
greatest demand by far is for Spanish, followed by Somali.
One of
the challenges in treating immigrants is money. Hennepin has $45 million a year
in costs that are not reimbursed, and though immigrants by no means account for
all of it, they are “a major contributor,” said Mike Harristhal, the hospital’s
vice president for public policy and strategy.
Most
Somalis are in this country legally and qualify for various government health insurance
programs. For people here illegally, it is a whole other story. They used to be
eligible for Medicaid, but are not anymore, except for
emergencies or if they are pregnant or under 18. Hennepin has sliding-scale
fees for the indigent, but some cannot afford even those prices.
Minnesota
has its share of people who oppose immigration and resent footing the bills for
foreigners, and Mr. Harristhal acknowledged that the melting-pot atmosphere at
Hennepin drives some potential customers away. But the hospital is a renowned
trauma center; even those who turn up their noses at the clientele accept that
for someone in a car accident, there is no better place to be.
Complex
Needs at the Clinic
Much of
Hennepin’s work with immigrants takes place in a stretch of examining rooms and
offices on the seventh floor, which has become an international health clinic
with certain days set aside for various ethnic groups.
On a
Tuesday afternoon last fall, a 62-year-old woman from
“I love
this big government hospital, the same government that welcomed me here after
the war and the sadness of
The
patient’s broad smile showed gaps in her teeth. She wore a traditional Muslim
head scarf, a floor-length skirt in bright blue and purple, flip-flops and a
gauzy, pale aqua shawl over a sweatshirt. Her fingernails were tinted orange
with henna.
She had a
dozen bottles of pills from other clinics in the Twin Cities, and a long list
of ailments: arthritis,
digestive trouble, allergies, insomnia and,
worst of all, pain. Twice in recent months she had gone to the emergency room
for terrible aches in her legs and burning pain in her side.
Ms. Boehm
said she would order a blood test to measure vitamin D,
because deficiencies are common in Somalis and are a frequent cause of aches
and pains. (Aching all over is not uncommon among Somalis, and older people sometimes
tell doctors they feel as if camels or horses have been walking on them all
night.)
The body
uses sunlight to make vitamin D, and dark-skinned people make less than whites.
Somali women are especially prone to deficiencies because their traditional
clothing covers so much of their skin.
The
patient said she sometimes could not recall how many of her children were still
alive. The forgetfulness
had begun when she left
Ms.
Boehm, 56, with short, curly hair and glasses, looked at the patient intently
as she took notes and said, “Haa,” the Somali word for yes. “Tell me about the
problems.”
The
woman’s face crumpled. She rocked in her seat, choked out a few words, then bit
her hand and wiped her eyes with her shawl.
The
translation, “Don’t remind me,” was unneeded.
Ms. Boehm
calmly changed the subject to matters of digestion and a local supermarket that
sold camel’s milk.
Later,
Ms. Boehm predicted that much of her new patient’s physical trouble would turn
out to have emotional roots in
Ms. Boehm
began working with Somali women at the clinic in 1997, and her job quickly
became complicated.
“I began
to hear about the pain,” Ms. Boehm said. “I couldn’t find any reason for it.
They would say it felt like fire or electricity, descriptions I wasn’t familiar
with. I did X-rays, lab tests, ordered physical therapy.
Somehow, I just couldn’t get it to go away. After 6 to 12 months I said, ‘We
have to look at the mental health
piece.’ ”
At her
urging, the clinic brought in a psychologist, and Ms. Boehm said, “I
aggressively worked on getting these women into therapy.”
Dr. Mary
Bradmiller, the psychologist, said the rates of depression and post traumatic
stress disorder were high. Most of her Somali patients are mothers with
“tremendous psychosocial stress, domestic violence, child protection issues,
war trauma, nightmares,
flashbacks and separation from their families,” Dr. Bradmiller said.
A study
of 1,134 Somali and Eritrean refugees in the
Survivors
often resist psychological help and deny their problems. Somali culture, like
many others, stigmatizes mental illness. In
She has
deliberately kept an office in the medical clinic, a familiar place to
patients, so they do not feel as if they are going to a mental hospital. The director
of care for the Somalis, Dr. Douglas Pryce, and Ms. Boehm urge certain patients
to see Dr. Bradmiller and sometimes even walk them down the hall to make sure
they go.
“They
never come for therapy unless there’s a strong recommendation from a medical
person they trust,” Dr. Bradmiller said.
Still, it
has not been easy. Early on, she noticed insulted looks on patients’ faces when
her role was being explained and found out that some interpreters were calling
her the “crazy doctor.” Other interpreters laughed at what patients said.
Indeed,
Dr. Bradmiller said, some therapists have left the clinic because of their
struggles with interpreters. Now, she introduces herself as a “talk therapist”
and chooses interpreters carefully.
“Some
patients have completely checked out,” Dr. Bradmiller said. “The older children
are bringing up the younger ones, and the mother doesn’t leave the house.”
If
patients reach the point of talking about what happened to them in
The
patients’ stories may also bring back the interpreters’ horrific memories, so
Dr. Bradmiller has tried to find the interpreters who are the least vulnerable.
“I try
not to digest what is being said so it doesn’t affect me,” said one, Abdi
Rahmansali. “I try my best, but I’m a human being. I do get affected.
Sometimes, no matter how hard you try, you feel your hair standing up.”
Dr.
Bradmiller estimated that about only 10 percent of her patients saw the
connection between their physical and emotional pain.
But for
those who do, she said, the changes can be striking.
“They go
to school, they cook, they put on makeup and colorful clothes, they start
talking to you in English,” she said. “When life becomes more interesting than
therapy, it’s time for therapy to be done.”
Home
Health in Question
On an
afternoon in late September, Dr. Pryce and Dr. Harare, the interpreter and
patient advocate, emerged from an examining room looking tired but wryly
triumphant.
They had
just finished negotiating, politely but persistently, with a patient who — just
as politely but persistently — had refused to allow any blood tests because it
was the holy month of Ramadan and he feared that having blood drawn might be a
sin.
Finally,
they telephoned an imam, who declared there was no sin. The blood was drawn.
Dr. Pryce
says one of the great joys of working in a hospital like Hennepin is finding
ways to bridge such cultural divides — and knowing that his patients are better
off because of it. But the cultural challenges can cut both ways, he said, and
lately one issue has begun to grate on him and Ms. Boehm.
Somali
patients have been asking them to fill out forms stating that they need personal-care
assistants. Some do not need the help, Dr. Pryce said, but are being egged on
by Somali-run health care agencies that want to collect insurance payments for
the services.
Somalis
in Minneapolis, often entrepreneurial and business minded, have opened the
agencies to take advantage of relatively generous rules in Minnesota that were
originally meant to help keep the elderly and chronically ill out of nursing homes.
Tricia
Alvarado, director of home care for the Minnesota Visiting Nurse Agency, which
evaluates requests for home help, agreed that there had been an explosion of
Somali agencies, with 100 or so opening in just the last three years. Many are
run by people without any medical training. And Ms. Alvarado confirmed that the
agencies were putting a hard sell on potential clients.
“ ‘Diabetes?’ ”
Dr. Pryce said, relaying what he said was a typical conversation between a sick
Somali and a Somali-run agency. “ ‘You need a personal-care assistant.
Here’s a form. Give it to your doctor.’ ”
Dr. Pryce
turns down requests that he thinks are unwarranted, but patients argue and
sometimes even act sicker than they really are.
The whole
thing leaves him “hopping mad,” Dr. Pryce said. “I want to be a good steward of
our resources, the tax money we’re all paying.”
The same
thing happened with Russian immigrants in the 1990s, he said, even though state
regulations were stricter then.
The
current situation with the Somalis is part of a larger problem in
___________________________________________________________________________________________________________
Documents Attached:
Somalia to Minneapolis - Foreign Ways & War Scars Test Hospital
The U.S. Constitution and the Cross
Minneapolis-St. Paul Area Survey on Freedom of Religion or Belief.
United Nations Secretary
General Ban Ki Moon, at the Alliance of Civilizations Madrid Forum said; “never
in our lifetime has there been a more desperate need for constructive and
committed dialogue, among individuals, among communities, among cultures, among
and between nations.”
Genuine dialogue on human
rights and freedom of religion or belief calls for respectful discourse, discussion
of taboos and clarity by persons of diverse beliefs. Inclusive dialogue
includes people of theistic, non-theistic and
atheistic beliefs, as well as the right not to profess any religion or belief.
The warning signs are clear, unless there is genuine dialogue ranging from
religious fundamentalism to secular dogmatism; conflicts in the future will
probably be even more deadly.
In 1968 the UN deferred
work on an International Convention on the Elimination of all Forms of
Religious Intolerance because of its complexity and sensitivity. In forty years
violence, suffering and discrimination based on religion or belief has
dramatically increased. It is time for
a UN Working Group to draft what they deferred in 1968, a comprehensive core
international human rights treaty- a United Nations Convention on Freedom of
Religion or Belief: United
Nations History – Freedom of Religion or Belief
The challenge to
religions or beliefs at all levels is awareness, understanding
and acceptance of international human rights standards on freedom of
religion or belief. Leaders, teachers and followers of all religions or
beliefs, with governments, are keys to test the viability of inclusive and
genuine dialogue in response to the UN Secretary General’s urgent call for
constructive and committed dialogue.
The Tandem Project title,
Separation of Religion or Belief and State
(SOROBAS), reflects the far-reaching scope of UN General Comment 22
on Article 18, International Covenant on Civil and Political Rights, Human
Rights Committee (CCPR/C/21/Rev.1/Add.4). The General Comment on Article 18 is
a guide to international human rights law for peaceful cooperation, respectful
competition and resolution of conflicts:
http://www.unhchr.ch/tbs/doc.nsf/(Symbol)/9a30112c27d1167cc12563ed004d8f15?Opendocument
Surely one of the best
hopes for humankind is to embrace a culture in which religions and other
beliefs accept one another, in which wars and violence are not tolerated in the
name of an exclusive right to truth, in which children are raised to solve
conflicts with mediation, compassion and understanding.
The Tandem Project is a non-governmental organization (NGO)
founded in 1986 to build understanding, tolerance and respect for diversity,
and to prevent discrimination in matters relating to freedom of religion or
belief. The Tandem Project has sponsored multiple conferences, curricula,
reference materials and programs on Article 18 of the International Covenant on
Civil and Political Rights – Everyone shall have the right to freedom of
thought, conscience and religion - and 1981 United Nations Declaration on the
Elimination of All Forms of Intolerance and Discrimination Based on Religion or
Belief.
The Tandem Project is a UN NGO in
Special Consultative Status with the
Economic and Social Council of
the United Nations