Friday, September 6th, 2013


Elorm Avakame

(This photo is from the  Treblinka Concentration Camp.)

As I write these words, I hang suspended over the Atlantic Ocean, hurtling in excess of 500 miles per hour roughly off the coast of Norway. Soft white clouds lie between my plane and the rippling blue water, as if to form a protective cushion in case the plane’s engines should fail. I am on a return voyage from Warsaw, Poland where I spent the entire month of June participating in the Humanity in Action Fellowship (HIA).

Humanity in Action is a non-profit international educational organization. HIA educates, inspires and connects a global network of students, young professionals and established leaders committed to promoting human rights, diversity and active citizenship—in their own communities and around the world. The Humanity in Action Fellowship brings together international groups of university students to explore national histories of discrimination and resistance, as well as to consider potential solutions to some of today’s most challenging issues can be considered and discussed. The programs are also intended to instill a responsibility among Fellows to recognize and address the need to protect minorities and promote human rights—in their own communities and around the world.

The reasons for my decision to pursue the HIA Fellowship were much the same as the reasons for my decision to pursue a career in medicine. Like many aspiring health professionals, I aim to use the skills and expertise I gain over the course of my medical education to improve the quality of life of marginalized populations. However, I recognized that the traditional medical education framework does not provide as much space as I need for investigating issues of human rights, minority rights, discrimination, and systemic marginalization. This is not to say that the system is at fault. Its primary objectives are to teach the diagnosis and treatment of human disease and to teach the art of the doctor-patient relationship, and it functions remarkably on both fronts. Moreover, curriculum reform has brought discussions about class, race, sexual orientation, gender bias, and discrimination to medical schools across the country. Still, though, I pursued HIA as an opportunity to gain an intense human rights education that would supplement my medical training both now as a Summer Fellow and for the length of my career through the Senior Fellows network.

Naturally, the first questions I will be asked upon my return are: “How was it? What did you learn?” (Most likely followed by: “So what did you get me?!”) There is no short answer to those questions. I could write for hours about lessons learned during my experience in Warsaw and indeed I have for my personal blog. Here, I will briefly share the reflection that I think is most useful for future physicians.

One morning, we traveled on a site visit to a small village in northeast Poland called Treblinka. It is a serene location, littered with small cottages that stand modestly, yet proudly – just as the folks who inhabit them. Most houses are accompanied by large piles of firewood, and some display satellite dishes that connect families to the images of bustling city life. The calming sounds of the surrounding forest are only rarely interrupted by the crunching of vehicle tires along gravel roads. Today, it is a picturesque countryside that seems recreated from a postcard. In 1942, it was the location of a Nazi extermination camp where hundreds of thousands of human beings were murdered.

During World War II, Jews and other targeted populations (Roma, LGBTQ, disabled) were brought to Treblinka in shipments using the same train cars used to transport cattle. They were fooled by the Nazis into thinking that they were heading to find work. Upon arrival at the train station in Treblinka, they were asked to remove their clothes to have a shower. Given that they had just traveled for days in a dirty train, this was a welcome invitation. When they entered the showering chamber, doors locked around them. An old diesel engine came to life, pumping exhaust into the chamber. Within twenty minutes, every lung was filled with carbon monoxide and every heartbeat was silenced. The total time elapsed from arrival at Treblinka to death by carbon monoxide poisoning was as little as two hours. Victims were exterminated at a rate of up to 2,000 per day.

As a future physician, the most sobering fact that I learned that day was that the ruthlessly efficient technique of mass genocide employed at the Treblinka extermination site was designed in large part by physicians. I imagine that those physicians, like most of us, embarked on their career journeys with noble aspirations. They sought knowledge for the purpose of alleviating disease and suffering. They gained the skills and expertise necessary to manipulate the human body for better – and for worse. In a 12-month period between 1942 and 1943, the same knowledge that allowed them to save human lives was used to devise a system that robbed 900,000 innocent people of their lives.

Their story is a lesson to all of us about the power of medicine. Upon entering this profession, we will vow to do no harm — yet we will undoubtedly have opportunities to break that vow. We will become armed with incredible knowledge. Society will confer power, influence, and authority upon us. True, we may never participate in such explicitly destructive systems as the Nazi genocide system, but we may yet do harm all the same – especially when choosing otherwise comes at a cost to us. We may choose to discriminate against patients based on any number of characteristics. We may lend our support to policies that disadvantage certain populations. We may ignore opportunities to improve access and quality of health care for those that need it most. As physicians – indeed, as humans – we are equally capable of choosing to good or to do harm. May we always have the courage to make the correct choice.

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