Homer Venters: Q&A With a Physician for Human Rights

Homer Venters, MD, MS, recently joined PHR as director of programs. A physician and epidemiologist, he is an internationally recognized leader in health and human rights. Prior to joining PHR, Dr. Venters led health services in the New York City jail system as assistant commissioner and chief medical officer, and worked internationally to train physicians on the intersection of human rights and public health.

What do you, as a doctor, bring to the fight for human rights?

Doctors have a unique role to play, in part because of the credibility that we bring to almost any discussion. We have consistently been one of the most respected professions, and our ability to leverage insights around human rights and promote more humane policies is critical. Another important role is in understanding evidence, and in promoting the use of evidence-based practices – things we know work – in the areas we work on. The third critical role is the training and commitment that physicians have in ethics – there is a set of ethical norms that must guide every patient-doctor interaction, and promoting human rights is consistent with that.

How have you used your expertise around evidence since joining PHR?

The recent chemical weapons attacks in Syria are a good example. Physicians are very accustomed to working with other specialists who have different skill sets to quickly diagnose and treat problems in individual patients. So when we started receiving evidence of a possible chemical weapons attack in Khan Sheikhoun, it was then a natural pathway for me and my medical colleagues at PHR to review the information and together develop an assessment. I had seen and cared for immigrant farm workers exposed to poisoning by organophosphates, which are present in fertilizers and also in nerve agents, so I was able to contribute that knowledge to our analysis.

An important issue we encounter at PHR is dual loyalty – the potential conflict between doctors’ duties to their patients and to their employers, particularly governments. We’ve seen it with U.S. Navy nurses being asked to force-feed detainees at Guantánamo, or Afghan government doctors being required to perform so-called “virginity testing” on women suspected of adultery. How did you tackle the problem of dual loyalty in the New York prison system?

The second you pick up a stethoscope in a jail setting, you feel the pressure of dual loyalty. It can be the most minor decision, such as whether to prescribe someone an albuterol inhaler, which requires a detainee to be front-cuffed, so he can access the device in his pocket. But security forces may tell doctors that a detainee is dangerous and that he doesn’t need an inhaler, because they don’t want him to be front-cuffed. As a doctor, you have to take care of the patient based on their medical needs, as you would any other.

In the jail system where I worked, 23 percent of health care staff reported that their ethics were routinely challenged – and we created the country’s first and only dual loyalty training program to address that. We know this is happening everywhere, including to the health professionals who work at Guantánamo.
The dual loyalty issue is prevalent all over the world, and it has a negative impact on health outcomes. We need to acknowledge its pervasiveness and reduce the harm it does.

How do you hope your expertise and training will strengthen PHR’s work?

I have a strong belief in using the tools of epidemiology and public health to promote a human rights agenda, and I want to build our capacity at PHR to use these approaches. PHR did this in the 1990s in Cambodia, where we analyzed thousands of cases of landmine injuries and were able to show that one in 256 people had been maimed by those weapons – a horrifying statistic that was key to passing the international Mine Ban Treaty. In the prison system, I used this approach to advocate against solitary confinement; by analyzing 250,000 jail admissions, we showed that people who had been in solitary confinement had an eight times greater risk of self-harm than other prisoners. Right now, PHR is working in northern Iraq to increase capacity to document torture and other war crimes. My hope is that we can strengthen the case of the brave people who have come forward to report sexual violence by training local partners to assess the incidence and prevalence of this horrific violation, as well as many other human rights abuses. Similarly, our Syria team is working every day to provide data to the entire world about the rate and location of attacks against health care facilities. In conjunction with the personal stories that we hear every day, these are very powerful tools for advancing human rights.

I also want to introduce dual loyalty trainings through health care professional organizations; I’m doing one for the American Psychological Association in November with the goal of reaching up to 5,000 American psychologists. And we could scale up this type of engagement through the hundreds of doctors in our Asylum Network who have a special insight into health issues in immigrant and other detention facilities – an area that promises to present significant human rights challenges going forward.

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