MedicGuild Guest Post: Dr. Li Wenliang & the Consequences of Speaking Out
Published on May 3, 2020. Updated on Oct 27, 2020.
As the COVID-19 crisis intensifies, the threat to the community as well as healthcare workers on the frontline grows. But doctors are finding they are not always free to voice their concerns for their safety and the safety of their patients. Doctors and nurses in the UK say they have been gagged from speaking out about the lack of personal protective equipment (PPE). The New York Times recently published that doctors in the U.S. have also experienced disciplinary action for when their judgment for wearing PPE conflicted with hospital administration. Going forward, Dr. Li Wenliang’s example of doctors speaking out in favour of public health remains strikingly pertinent.
When Dr. Li Wenliang, an ophthalmologist from Wuhan, China, raised concern among colleagues in December 2019, that patients in his hospital were presenting with a strange virus resembling Severe Acute Respiratory Syndrome known as SARS — an earlier coronavirus that led to a global epidemic in 2003 — instead of initiating a public health investigation, the Chinese government reprimanded him for “spreading false rumours” and "disturbing the social order." He was one of eight doctors who were punished by authorities for raising the alarm.
The police then forced him to sign a document to stay silent, stating that if he “stayed stubborn and failed to repent and continue illegal activities, (he) will be disciplined by the law”. After the cases of what is now known as COVID-19, began to rise, and public awareness grew, the government reversed its position and the state's chief epidemiologist subsequently declared the eight worthy of "utmost respect."
Dr. Wenliang was not known as a political agitator, but when it came to a public health crisis he was not willing to stay silent, in spite of China’s strict censorship. When he contracted the disease after treating a patient for glaucoma who was infected with COVID-19, he vowed to do what he could to address the crisis as soon as he became well. “After I recover, I still want to return to the frontline,” he told the Chinese newspaper, The Southern Metropolis Daily. “The epidemic is still spreading, and I don’t want to be a deserter.”
Public health experts criticized the Chinese government’s attempts to stifle communication and not move quickly enough to contain the disease, saying that they lost their chance to prevent an epidemic.
“This was an issue of inaction,” Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations who studies China told The New York Times. “There was no action in Wuhan from the local health department to alert people to the threat.”
Transparency was also an issue in Dr. Wenliang’s hour of death when there were conflicting reports about what time he died. Initially, it was said to be 21:30 local time but then journalists and doctors at the scene, who did not want to be named, told the BBC that authorities intervened, giving him ECMO life support treatment. He was officially declared dead at 2:58 AM on February 7.
Public outpourings of grief and anger on China's social media platform Weibo were also censored in the wake of his passing. According to The Guardian, #WeWantFreedomOfSpeech had nearly 2 million views on Weibo by 5 AM local time, but was later deleted. The phrase “Wuhan government owes Dr Li Wenliang an apology” also attracted tens of thousands of views before it too vanished. Others used the quote from Dr. Wenliang to Caixin Media, “A healthy society should not only have one voice.” There were also public displays of commemoration with people shining torches and blowing whistles outside his hospital in Wuhan.
Dr. Wenliang left behind his son, his pregnant wife, and his mother, who claimed she didn’t even get to say goodbye.
But this censorship around health crises in China is not new. Similarly, in 2003, the Chinese government was found to have covered up the extent of the SARS crisis before the then 72-year-old military surgeon, Jiang Yanyong, spoke out to expose the growing epidemic. Although he subsequently became a national hero, he, too, was not immune to China’s strict censorship. Now at 88-years-old, according to The Guardian, he has been under house arrest since last April, after asking the government for a reassessment of the 1989 Tiananmen Square pro-democracy movement.
Dr. Yanyong sees his role as a doctor as inextricably linked to a commitment to the truth. In light of the COVID-19 outbreak, The Guardian recently published this quote from a 2013 interview with Southern People Weekly, when Dr. Yanyong said, “As a doctor, protecting patients’ health and lives is first and foremost …the most basic requirement for a doctor is to speak the truth. I have experienced numerous political movements for 50 years, I feel deeply that it is easy to lie, so I insist on never telling lies.”
Australian doctors speaking out
While the Chinese government's level of censorship is extremely high, with China ranking almost last in the 2019 World Press Freedom index, doctors in Australia and around the world are still placed in a difficult position when what they believe is best for their patients conflicts with official government policy. For example, when it was suggested that the Australian COVID-19 evacuees from Wuhan, China, be sent to the immigration detention center on Christmas island, AMA president Dr. Tony Bartone, wrote, “We feel that the repatriation to Christmas Island, to a place which has been previously the focus of populations under enormous mental and physical trauma and anguish, is not a really appropriate solution. We’ll be calling on the PM and the relevant ministers to find a much more humane solution to dealing with a group of very vulnerable and concerned Australians.”
Doctors and other health professionals have also played a critical role in speaking out against conditions in Australia’s offshore and onshore immigration detention centers, revealing systemic abuses, including rape, sexual abuse of women and children, violent assault, as well as epidemic levels of self-harm and suicide. Around 20 years ago, clinical psychologist, Prof. Zachary Steel began publishing the traumatic psychological distress asylum seekers were experiencing in Australia’s immigration detention facilities. 14 years later, Dr. Peter Young, formerly the head of mental health for immigration detention healthcare provider IHMS, blew the whistle on abusive conditions and inadequate care in offshore detention. Dr. Young told The Guardian at the time that the conditions fulfill the definition of torture with an “environment that is inherently toxic."
In 2016, doctors at Brisbane’s Lady Cilento hospital refused to discharge the asylum seeker child known by their pseudonym Baby Asha, after they were treated for burns because the Nauru detention centre was deemed as an unsafe environment. A spokesperson for the hospital told The Guardian that, “As is the case with every child who presents at the hospital, this patient will only be discharged once a suitable home environment is identified.” After this stance by medical staff and sustained protests outside the hospital calling on the government not to deport the child back to Nauru, the government changed its position to allow the child to live in community detention in Brisbane.
Later that year, the group Doctors for Refugees, continued its advocacy for asylum seekers by challenging the Australian government’s censorship laws in regards to immigration detention. When announcing the challenge, Dr. Barri Phatarfod, the founder and president of the group, told The Guardian that, “Doctors are obliged to put their patient’s interests above all other interests and to advocate for public health... No one should expect any less from their doctor, or from the medical profession as a whole.”
The government settled before the case reached the High Court, reversing its position and amending section 42—the secrecy provision—of the Border Force Act, so that healthcare workers were free to speak out publicly on behalf of the refugees and asylum seekers that they treat.
In 2018, the international medical humanitarian organization, Médecins Sans Frontières (MSF) was forced to leave Nauru within 24 hours, after working in Australian run detention facilities for around 11 months. There was speculation at the time, according to ABC reports, that the decision to terminate their provision of mental health services was in response to the, “MSF practice of giving patients access to their files, some of which have become public”. This termination came after MSF described the mental health situation of asylum seekers and refugees on Nauru to the ABC as “beyond desperate" and just days after a Nauran security guard was convicted of sexually abusing a child at one of the island's refugee settlements. When leaving the island, MSF said in a statement that, "We are extremely concerned that the health of our patients may be affected by this decision and [we] urge the authorities to grant us permission to continue our lifesaving work."
Considering these experiences, the founder and president of the group Doctors for Refugees, Dr. Barri Phatarfod, sees parallels between what happened to Dr. Wenliang and what’s happening to doctors in Australia.
“While we don’t have the same sort of sensibilities the Chinese government appears to have regarding public health, our hysteria is directed against refugees and more specifically towards boat arrivals,” Dr. Phatarfod told Medic Guild in an email.
Dr. Phatarfod says that she has experienced intimidation by the Australian government, and, as Dr. Wenliang’s case shows, when political interests are placed above the interests of patient health it can have devastating consequences for not just the doctor or their specific patients, but for public health in general.
“Many Australian doctors who have advocated for refugees have had their phones and internet communications monitored. I have been taken off a domestic flight by the Federal Police and had my phone and laptop searched by them, and they have also presented at my place of work and behaved in an intimidating manner,” Dr. Phatarfod went on to write.
“Two other doctors from our organization who spoke out publicly had similar experiences with the federal police at Australian airports. This was during the Border Force Act time  as well as the Hamid Khazaei Coronial Inquest , of which we (Doctors for Refugees) were a part. In this situation there is no one to whom we could complain except when the UN Special Rapporteur on Human Rights Defenders visited Australia a few years ago and he made a report referencing these incidents in his report to the Australian Attorney General.”
For these reasons, Dr. Phatarfod suggests that doctors remember the Australian Medical Board Code of Conduct, which drew inspiration from the World Medical Association’s (WMA) inaugural assembly in 1947, when, in the wake of gross human rights abuses perpetrated by medical professionals at the behest of the government, they vowed to prevent this from happening in the future.
“The principle was reinforced that we have a duty to patients that overrides any political hysteria of the day. It is tragic that doctors needed reminding of this.”
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