Upstream - Palestine Pt. 3: Settler-Colonialism and Medical Apartheid with Rupa Marya & Jess Ghannam

Episode Date: December 5, 2023

As the ongoing ethnic cleansing campaign against Palestinians continues, it’s important that we also continue to raise a magnifying glass to its perpetrators, not just looking at the state of Israel as a whole or the IDF—as blood-soaked as their hands are—but also looking at the some of the perhaps less publicly scrutinized institutions complicit in this genocide.  In this episode in our ongoing series on Palestine, we’re going to focus on healthcare institutions and their complicity in the devastation and destruction taking place in Palestine. What are the underlying power structures that support and uplift settler colonialism, white supremacy, and health apartheid? Why is it that so few health institutions in the west have spoken out against Israel’s genocide of the Palestinian people? What does that tell us about the failures of our healthcare systems and much of the medical community?  To discuss these questions and more we’ve brought on two guests today. Dr. Jess Ghannam is a Palestinian professor in psychiatry at UCSF in San Francisco working in Gaza. Dr. Rupa Marya is a professor of medicine at UCSF in San Francisco and co-author, along with Raj Patel, of Inflamed: Deep Medicine and the Anatomy of Injustice.  Thank you to Carolyn Raider for this episode’s cover art and to Sabreen Group & Majazz Project / Palestinian Sound Archive for the intermission music. Upstream theme music was composed by Robert Raymond/Lanterns. Further Resources Upstream: Decolonizing Medicine with Rupa Marya and Raj Patel Rupa Marya on Instagram Inflamed Deep Medicine and the Anatomy of Injustice There’s No Justification for Destroying Gaza’s Health Infrastructure, Yes Magazine Health Professionals and War in the Middle East, JAMA Upstream: Health Communism with Beatrice Adler-Bolton Upstream: Palestine Pt. 1: A Socialist Introduction with Sumaya Awad Upstream: Palestine Pt. 2: Justice for Some with Noura Erakat This episode of Upstream was made possible with support from listeners like you. Upstream is a labor of love — we couldn't keep this project going without the generosity of our listeners and fans. Please consider chipping in a one-time or recurring donation at www.upstreampodcast.org/support If your organization wants to sponsor one of our upcoming documentaries, we have a number of sponsorship packages available. Find out more at upstreampodcast.org/sponsorship For more from Upstream, visit www.upstreampodcast.org and follow us on Twitter, Instagram, Facebook, and Bluesky. You can also subscribe to us on Apple Podcasts, Spotify, or wherever you listen to your favorite podcasts.

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has tried to create this narrative of justifying genocide and healthcare genocide, which is just bizarre and morally bankrupt, but then the more insidious way is to shut us down, to not speak about it. You're listening to upstream. Upstream. Up upstream. Upstream. Upstream. Upstream. A podcast of documentaries and conversations that invites you to unlearn everything you thought you knew about economics.

I'm Robert Randon. And I'm Deli Duncan. As the ongoing ethnic cleansing campaign against Palestinians continues, it's important that we also continue to raise a magnifying glass to its perpetrators. Not just looking at the state of Israel as a whole or the IDF, as blood soaked as their hands are, but also looking at some of the perhaps less publicly scrutinized institutions complicit in this genocide. In this episode in our ongoing series on Palestine, we're going to focus on health care institutions and their complicity and the devastation and destruction taking place in Palestine.

What are the underlying power structures that support and uplift settler colonialism, white supremacy, and health inequity? Why is it that so few health institutions in the West have spoken out against Israel's genocide of Palestinian people? What does it tell us about the failures of our healthcare systems and much of the medical community? To discuss these questions and more, we brought on two guests today. Dr. Jess Gannam is a Palestinian professor in psychiatry at UCSF in San Francisco, working in Gaza.

Dr. Rupa Marien is a professor of medicine at UCSF in San Francisco and co-author along with Raj Patel of Inflaint, Deep Medicine and the Anatomy of Injustice. We're really excited to share this conversation with you, but before we do, really quickly, upstream is a labor of love. If you haven't already, if you can, you're in a place where you can afford to do so and it's important to you to help us keep upstream sustainable. Please consider going to upstreampodcast.org forward slash support to make a recurring monthly or one-time donation. Also, if you can, please go to Apple Podcasts and Rate, Subscribe, and leave us a review there. You can also go to Spotify to leave us a rating and review there too. It really helps us get in front of more eyes and into more peers.

We don't have a marketing budget or anything like that for upstream, so we really do rely on listeners like you to help grow our audience and spread the word. Thank you, and now here's Della in conversation with Dr. Jess Gannum and Dr. Rupa Maria. Dr. Jess, Dr. Rupa, thank you so much for joining us on Upstream. We always start with introductions. I'm wondering if let's start with you, Dr. Jess, if you might introduce yourself and also share maybe your hope or intention for this conversation today. Yeah, thanks for the invitation today, Della.

This is Dr. Jess Gannum. I'm a professor in psychiatry at UCSF in San Francisco, but I would say probably more importantly, I'm Palestinian, and I've been working in Gaza for over 25 years now, doing my field work and relationship building around global mental health. And I think part of my hope and intention today is to give voice to something that hasn't been given voice to historically. I mean Palestinian voices typically are silenced or minimized anyways.

But in terms of our discussion today in the health care sector with with, you know, hospitals being bomb physicians being killed, kidnapped, targeted. I think there's a special feeling on my part and intentionality on my part to make sure those voices are heard and that narrative is articulated very clearly given how dire the situation is in Gaza right now. Yeah, thank you for setting that intention and your introduction. And Dr. Rupa, what about you?

How might you introduce yourself today and also share what your intention is for this conversation? Hi, it's good to be back. Thank you so much for all your work. And my name is Rupa Maria. I'm a professor of medicine at the University of California in San Francisco as well, a colleague of Jess's. So excited to learn about his incredible work and also surprised not to have known about it as we both are scholars in decolonization and understanding the health impacts of

colonialism at large. I'm a scholar and activist and artist, a mother turned farmer, activist and artist, a mother, turn farmer, and they work at the intersections of structures and health. And so my hope is that we can precipitate a avalanche of solidarity, as Dr. Matt Gilbert said, you know, that's what's needed right now in the avalanche in the face of this avalanche of human suffering, an avalanche of solidarity from the medical community to understand how what is happening right now this genocide in Gaza is connected to all the kinds of issues we experience in Western medicine, not being able to get the support and the health disparities to close. The reasons why are being

explicitly laid out for us right now, both in terms of genocide, the targeting of hospitals, and the response, the complicit silence from Western medical institutions. Yeah, so let's let's un-pick that a little bit and you know, the show is called upstream and it actually comes from public health or at least that's where we learned it. This metaphor of going upstream from the challenges of our time to the root causes. And so, Rupa, Dr. Rupa, I'd love to ask you, you know, what is it that's breaking your heart, particularly right now, around what's happening in Gaza, and what do you see when you go upstream? What are the root causes that you're experiencing, noticing, and discovering?

Gosh, what's breaking my heart is just witnessing this utter devastating violence. That's being enacted upon the people of Gaza, the children, watching my colleagues across the way murdered in the act in our sacred act of healing, watching patients murdered in the places of our sacred profession, watching I mean, so many aspects of this, the US medical institution silence, people who are speaking out against this violence, and what that means for, you know, learning about and seeing the 75 years of oppression of Palestinian people, learning about how Nelson Mandela understood that this was how racial, you know, the apartheid state of Israel is synonymous with what they had in South Africa, and that these structures of power are recreated throughout the world.

And right now we're witnessing, you know, the latest example of European conquest continue to happen in a 600-year, you know, the latest example of European conquest continue to happen in a 600 year, you know, project. And then the tar, I guess specifically the targeting of healthcare has been truly devastating, but also truly illuminating to me. And it's critical that we learn and witness and speak up in this moment. So, yeah, these are patterns of violence that have been in motion for 600 years and they're all interconnected. So we can't hope to protect our own area of health equity

as scholars to look at black maternal health and not see how those disparities here in the United States are connected exactly to what's happening in Gaza. And as we start to make these connections, it's utterly critical that we, as people in medicine, stand up and speak out and get involved in stopping this genocide in any possible way that we need to. Thank you.

And Dr. Rupas, you're speaking and saying around the interconnectedness, I'm seeing that amazing diagram that you've released and then is shared so prolifically this diagram that connects things like trauma and capitalism and colonization. And if folks haven't seen it, we'll link to it in the show notes and also I know it's pinned to your Instagram. But maybe can you just say a little bit more about what is interconnected so that we have that, maybe that visual in our mind

as we continue forth. Yes, this mentality of colonial capitalism has been exported around the world since the 1400s, since the papal decree in 1455 that was called the doctrine of discovery. That said that European Christians can go around and conquer specifically Muslims and Brown and Black people, commit them to enslavement, steal their lands for the purpose of their profit. And that people decree is what led to the you know sea to shining sea here on Turtle Island. It led to the colonial policies in my home lands where over a hundred million people and that's a conservative estimate died because of British colonial policies in between 1880 and 1920.

So these kinds of like mass loss of life of brown and black people around the world has been written into the imaginations and to the cosmological understandings of Europeans and people who have taken up their charge such as Modi and Indian, other now societies that have fashioned themselves after this European invention. And to understand that it requires systems of supremacy, it requires different ways of structuring societies along hierarchies, caste systems, to function. And when we understand that, and not just in terms of identity, but also class, we can start to dismantle and build systems of solidarity to counter it and get rid of it.

Yes, beautiful. So, Dr. Jess, what about you? When you feel into what's happening right now in Gaza, what is it that's breaking your heart? What is it that's really holding your attention or your care, your concern? And when you go upstream from that heartbreak, what are you seeing as the root causes? My heartbreak is pretty immediate and pretty intense. Only because over 25 years, I've built really deep significant relationships with Palestinian colleagues in Gaza.

I've seen them get married, I've seen them have children, I've seen them build their lives under a systemic system of oppression and occupation and apartheid. And now the pain that I feel devastating grief and pain that I feel every day because five of my colleagues have been killed along with their families, you know, totaling 43 people whose lives have been lost now to this brutal depraved aggression that the apartheid state of visual is engaging right now. And so when I see the images of children, you know, being pulled from the rubble, I see my own children, I see my own boys. And the pain and the grief and the loss that's attached with that every single day is breathtaking for me. I mean, I've been doing this work a long

time. I've been working in Palestine a long time. And this level of destruction is just beyond the pale. And you know, for Palestinians living in Gaza right now, this is the sixth major war that has happened since 2005, since the blockade in Siege of Gaza occurred. So, you know, if you're a child, if you're 16 years old now in Gaza, you've lived through six major cataclysmic devastating wars. So, dovetailing with Dr. Arupa, looking at the impact of these traumatic systemic forms of control and oppression, deeply have affected people in Gaza and in Palestine. And now, it's just more extreme. So when I swim upstream and it's going to dovetail a lot with Dr. Rupus as when I swim upstream

from this and kind of look at the root causes, even though part of the dominant narrative is, oh, it's so complicated, we can't talk about it. I mean, you know, that's kind of the pushback from power, right? We can't talk about this because it's so complicated, but the reality is this is not that complicated. And in terms of root causes, we look back 600 years to look at basically the settler colonial project that started, you know, 600 years ago from the people decree that has worked its way into power throughout those centuries and landed in Palestine. And so when people say, oh my God, what happened on October 7th, it's kind of a mythology and kind of a gaslighting

that power uses to say, well, this just started on October 7th. When the reality is that it started 75 years ago with the Israeli settler colonial project that has been winding its way in Palestine for that many years, for over 75 years. And when I go back to 1947 and 1948 and 1949, for example, 800,000 Palestinians were ethnically cleansed from their homes in historic Palestine from 1947 to 1949. This is even before Israel was a state. 500 villages were depopulated, and that project has been winding and winding and growing and kind of working its way where we are today.

And really what's happening in Gaza and the West Bank and Jerusalem right now is an extension of what we as Palestinians called the Necba or the catastrophe where that ethnic cleansing was so profound in 1948. We're seeing Necba or catastrophe 2.0, 3.0 right now because I think people have to realize that the ultimate goal of the Israeli apartheid project is to ethnically cleanse Palestinians, indigenous Palestinians from our connection to our homes, our land, and our history. Fast forwarding and kind of dovetailing with Dr. Rupa is, you know, in terms of medical professionals and healthcare workers, if you look at Israel as an apartheid state and its health care system inextricably connected and interwoven within that apartheid structure, then you have medical apartheid in Palestine.

And that medical apartheid in Palestine leads to these grotesque health inequities for Palestinians and g goss in the West Bank and even Palestinian citizens who have Israeli citizenship the health inequities are very dramatic We can get into some of the details, you know a little bit later But that's kind of the the short version of my heartbreak and Kind of looking at the root causes. This did not start on October 7th This is part of a systemic unfolding of settler colonial project and apartheid. And, you know, unfortunately, the medical community continues to either be ghastlet. They're being ghastlet by the narratives and kind of participating in the silence. Or we're seeing how power in medicine, power, is trying to take over and really manipulate what's happening

right now so as to maintain the power. And you know, I'm sure we'll get into that, but that's kind of what breaks my heart and when I think about the root causes. Dr. Jess, thank you for that. And I just want to add like that in response to what I hear in responses, some of what doctor just described was, oh, but what about the indigenous claims of Jewish people to that homeland as well? And I have to say that, you know, that we have to look at who these people are and where

they're coming from. And also look at the history of the ways in which different waves of people have pushed people out of different homelands. And that claims of indigeneity do not give any group the right to ethnically cleanse the other, any group. And so that is something that needs to be, that's a fallacy that just needs to be debunked. That yes, you know, people of Jewish faith have homeland claims to that same area that does not give them the right to burn farmlands of Palestinian people to destroy these historic important ancestral olive groves to throw people out of their homes and to actually enact genocide. What we're seeing right now is AI generated genocide blocked by block and Gaza.

Typically murdering civilians for the purpose of inducing shock, and we are shocked. And our shock is the complicity of all these institutes of power in the West. We shouldn't be shocked because this is what the West does, it's what it has always done. And so I just say that to say, this is where we look at places like India and Kashmir. Another in a sand that was drawn by the West, where there's now these claims of indigenayity and the language of decolonization used

by the fascist Indian, you know, Maudi's government, to enact the same violence on Kashmiri people. These struggles are interconnected and we have to understand how power weaponizes the language of liberation, weaponizes the concepts and ideas of people who have been struggling against this power for centuries to justify and continue to enact this kind of violence. So settler colonialism does not, and we're talking about it as a structure of power, is not talking about someone's ethnic claims, it's not talking about someone's genetic claims,

it's talking about a structure of power that is being imposed upon people who have rights to their land, to their homeland, to their olive groves, to their physical homes, and to their health. And we're seeing all of those things thrown out in the pursuit of this racial capitalist project called Israel. Yeah, and I think that's really well, well said. And I just, just a dovetail on that a little bit for people who may not have the kind of historical perspective on Palestine.

Prior to 1948, Israel did not even exist. And that's hard for a lot of people to wrap their minds around because they like to articulate this kind of notion that it's been around forever. It actually hasn't. I mean, as a nation-state, Israel isn't even around in 1948. And the interesting thing about Palestine prior to 1948, it was one of the most interesting, if not incredible, multi-ethnic, multi-religious, diverse

communities anywhere in the world, because you had a community of Muslims, Christians, and Jews who were living together at a time when they spoke primarily one language, Arabic, and as my grandfather used to tell me, I mean, in the neighborhoods where they grew up, you couldn't tell who was Jewish, Muslim, or Christian by looking at them. I mean, this was a faith that was practiced privately, if not openly, but it was done in this kind of spirit of multi-ethnic, multi-religious,

multiculturalism that thrived for a very, very long time. And it's only after waves of settler colonial communities from Europe, essentially, that brought the white supremacy settler colonial mentality and power structures that uprooted a specific element of that community Palestinian Muslims and Palestinian Christians and that process is kind of where we are today. But I think many people have this misguided notion of Palestine historically and because Dr. Rupus is absolutely right. I mean Palestinians, like my family who've been there for hundreds and hundreds and hundreds of years, I mean our family tree on paper goes back 500 years in Palestine.

There's always been a welcoming of diverse communities, diverse religions, diverse perspectives that was always part of the history of Palestine prior to its colonial exploitation. So I think that's an important narrative because Dr. Rupus, right, you're going to hear all these kind of crazy narratives from power about, oh, what's happening and, oh, what about this claim and that claim? I think it's important to be clear about the history. Yeah, and thank you for bringing that word narrative in and for debunking or speaking to some of the things that you're all hearing and really going back to the history.

And I think, yeah, this time, really narratives and framings are so important and so alive. And one thing that breaks my heart is the way that social media can kind of like polarize people even further and kind of put people in these algorithms. And so the stories, the beliefs they have are so divided. And I know that we're receiving so many, whether this morning got a email from someone who says

they're an Israeli listener, and they're so disappointed with the framing in the conversations that we've been having. And so, you know, what maybe Dr. Just, what is the, you know, wise response or the ways that you're working with folks who are voicing these narratives and frames, which as you said, come from power and may definitely feel crazy, and yet for them holding them, it's true for them. And so they're very struggling with it and it's creating so much division and even animosity. How are you holding, speaking these narratives to folks and maybe what narratives are particularly

troubling for you and which ones are you trying to shift? Well, that's probably a 20-hour discussion. It's a really good question. And the kind of shock that Jewish Israelis feel right now is not that different from slave masters in the United States when African slaves started to uprise and claim their dignity, claim their self-determination. It's not that different.

It's the nature of power that when powers confronted, they will say things like, oh my God, what is happening? We don't understand. And like, power will do whatever it takes to maintain its power. It creates false narratives. And again, looking at what happened with the slave uprisings in this country and in the Caribbean and over the centuries that was going on, I mean slave owners did some really crazy things. They killed the slaves. They instituted even more control. They started to develop laws to control them. They took away

rights legally and physically. So that structure of power is a way to clearly and unequivocally understand what's happening in Palestine right now. And specifically going at the medical power structures in the United States and globally. It's a very similar thing. You have Israeli physicians, a hundred of them, over a hundred who basically said openly and proudly that the terror that was being reigned on Palestinian children, women and civilians, was brought upon themselves because they're all terrorists

and that it was okay to bomb hospitals. It was okay to kill civilians. It was okay to kill civilians. It was okay to target physicians and healthcare workers and that kind of depraved construction of a narrative that power has to justify colonial expansion to justify genocide is really what we're trying to push up against and confront in a very strong way. And we're finding, and Dr. Rupa is just heroic in her speaking truth to power because every time she does, she gets kind of attacked. And anybody who is, I mean, we'll get into this, but Dr. Rupa, I and a colleague of ours,

Dr. Lee Kimber, we wrote something into this, but Dr. Rupa I and a colleague of ours, Dr. Lee Kimberg, we wrote something to the American Medical Association challenging something they put in JAMA, the Journal of the Medical Association. Again, basically justifying the targeting of healthcare facilities. And we said, no way. There's no way you can justify ethically, morally, or under international law that you can justify the targeting of healthcare institutions and patients, and they refuse to publish it. This shows you how deep power is, how it's part of the fabric of not just political or economic power, but within the medical establishment, how deep and woven it is into everyday aspects of medicine and healthcare

delivery and public health. And so this was, it's kind of a wake up call for all of us as healthcare professionals, as physicians, as nurses, as public health professionals. We have a moral, ethical obligation to confront this kind of depraved Amorality and justification of attacking health care. There's nothing in the historical Record in the modern era where physicians and health care professionals and public health professionals Have said yeah, it's okay to kill patients. It's okay to kidnap doctors. It's okay to bomb hospitals That is so beyond the pale that it should shake our moral being to its core. And for Dr. Rupin, myself and my colleagues who are confronting this, we feel that

what we're shocked about is how power has tried to create this narrative of justifying genocide and healthcare genocide, which is just bizarre and morally bankrupt, but then the more insidious way is to shut us down, to not speak about it. You can't speak, I mean, part of the narrative that's happening now in medicine is, well, we can't talk about it. And this is shocking to us because we would say, in what world do healthcare professionals live where we don't talk about difficult things? Right?

I mean, we talk about difficult things. That's what we do. That's part of the sacredness of the practice of medicine that we all engage in. And so we're confronting that head on. We're being attacked for it. Anybody who tries to speak about it is being attacked for it and this is the major test of Medicine in the 21st century now. Are we gonna face and confront this abuse of power this corruption In medicine or we're just gonna let it go. This is the major battle right now in medicine in the 21st century and my mind

This is where we see the sharpening of a distinction in medicine between those who are committed to power and align themselves with power their silent which includes every leader of every health equity project that's in an institution of medicine in the United States. Not one of them has come forward as in their professional roles to say we absolutely have to stop the bombing of hospitals that take care of predominantly brown people. This is a racialized conflict where the power in Israel is largely held, the political and economic power by people of Ashkenazi, Jewish lineage.

These are people who are coming from Europe. And acting as violence upon people who are brown. And so when you see this lack of speaking up from all of these people in positions of power in medicine, in health equity, it makes you wonder why. Why is it that not one institution in medicine? Of course, the American Public Health Association made a call for ceasefire, but in clinical medicine, with 20 years of investment in health equity initiatives, health equity centers, diversity equity and inclusion, not one of those

groups has said stop this violence, stop this genocide, stop attacking health care workers, stop the genocide in Gaza, not one. So what does that tell us? This is the direction we have to point ourselves in and crack open what is not being seen to understand. Why is it that we have 20 years of investment in health equity and no change in health disparity outcomes in the United States? It is precisely because health equity projects are aligned to keep the power structures in

place without challenging them. And the challenge of those power structures is how we get the health disparities to close. So right now we're seeing a sharpening of our vision of who is speaking to the people and not the power. And I have been deeply, deeply disappointed in so many of my colleagues. And I also have compassion for them because I understand that they are so afraid

to lose their positions, that they've worked so hard to get, that we have become atomized as individuals in a late-stage capitalist framework so that we don't understand that that actually is through our solidarity, is through building our systems of solidarity, that we can confront those systems of power. There is no other way to do it. One individual, a small team of people can't do it, a whole system of solidarity, is the only other way to do it. One individual, a small team of people can't do it. A whole system of solidarity is the only way that can do it. And so that is what this moment is really exposing for us and needs to be, you know, as we

work simultaneously to stop the genocide in Gaza and critically to support our colleagues, our healthcare colleagues there, and to answer their calls for long-term investment and long-term struggle with them to rebuild and to take care of their communities. We simultaneously have to query and not forget and go hard into an uncompromising look at why did people not speak up, why were people silenced? And what does that say about the whole project of health equity in this country? What is it serving? Has it become, is it? And I believe it is, a tool for liberal power. It is not a tool for transforming our systems to serve all. You're listening to an upstream conversation with Dr. Rupa

Maria and Dr. Jess Gannum. We'll be right back. درستیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدیدی لأشياء لأغرقي لأغرقي ما كل زر لا تغلي لتني راي مواش في الامن لأغرقي لأغرقي ل لنتفاضة السلام لا تقول لي تاني عامل مققا فيها فانا لأغني لأغني ل تسارت الحزر

لا تغري لي تاني على الوحي أصواء حما لنسى غيرا ليه لنفور حتى لسريرا ليه لصفور وليك مقوى وليك عرضه نوحي نخر الهورى ولا يكنت والأردن في نخر الهورى قلون حارن ونهون بان ومشيرا وحياة قلون حارن ونهون بان ومجرن وحياه يا صديق يا أرضنا ليست بيعاق رياس ديك يا أرضنا ليست بيعابرية صديقي مردنا ليست بيعابر

كو عروض و لها منا دواء كو عروض و لها منا دواء كو مسر دواء دو That was the track about wishes by Alpha Jair or the Dawn, composed by Sabrine Group, with lyrics by Mahmoud Darwish, and released by the Majaz Project, or Palestinian Sound Archive, an archival record label reissuing and remixing vintage Arab vinyl and cassettes. And now back to our conversation with Dr. Rupa Maria and Dr. Jess Gannon. So before the break, Dr. Rupa, you were talking about the project of health equity in the US, and you were going into the power structures and the underlying intentions.

Dr. Jess, anything you want to add to that? Yeah, I think that's really an excellent explanation, because DEI and health equity projects now have just become tools of a neoliberal system in medicine. You know, we see this all the time in medicine, right? The kind of nice, shiny images on websites of diverse communities, kind of all smiling and kind of working together and holding hands, which is really a front for underlying power to say, hey, it's that happy, shiny people narrative

that's being displayed really on websites of every major medical institution and healthcare institution in the United States, if not globally. And it's a front. And as Dr. Rupus said, it needs to be confronted because those images and that narrative are clashing widely with the reality of health inequities that we see not just in Gaza and in Palestine and in developing countries, but as Dr. Rupa said, these health inequities have not changed in the United States after 20 years. In fact, some people might argue, including myself, in some cases they've gotten worse. including myself, in some cases they've gotten worse. So you really have to look at the reality of what this 20-year investment in health equity and the social determinants of health research, what it's actually doing and what's the impact on the ground. And as Dr. Rupa said, what's

happening in Palestine right now, what's happening in Gaza right now really is sharpening the focus what's happening in Gaza right now really is sharpening the focus because clearly silence right now is putting people in power not just on the wrong side of history but putting them on the wrong side of medical ethics and medical morality. You know, we'll look back at all the people who are silent right now and see that they have that that kind of moral stain in their souls because you know they said nothing in the face of this genocide that's going on in Gaza right now. So Dr. Jess maybe can you go into the health equity a little bit more because you mentioned this earlier and then here you know what what are you seeing what are you noticing over time what is concerning you just so that we can bring those details out of it.

Well, let's just look at the reality right now, maternal and child health for African-American women and children. What has happened in 20 years since the birth of these DEI and health equity projects? Is it better? It's not. And in some communities in the United States,

it's actually worse right now. And then if you abstract that to what's happening in Palestine, you know, the child mortality rate in Palestine is 23%. And what is it? What is it for Israelis who are a kilometer away? It's three or four percent. And that's before October 7th, right? We're talking about this deep, deep health inequity that was happening before October 7th. And so the health inequities around child and maternal health, which are just staggering when you look at it in Palestine, but it's staggering for women of color here in the United States and disadvantaged and dispossessed communities here in the United States. As Dr. Rupa said, after 20 years and millions of dollars

in investment and so-called lip service to closing the gaps in that, it's not happening. It's actually getting worse in many ways. So the reality of what's happening on the ground compared to the statements is really what Dr. Rupa and I are trying to articulate in terms of this kind of fronting or false narrative that's being declared. Look at what a great job we're doing in terms of health equity. The reality in the ground, it's not happening.

That's just full stop. I mean, we don't have time today to talk about all the other health inequities going on in Palestine right now, but just an obvious one having to do with the pandemic, the number of Israelis who got two doses of the COVID-19 pandemic is like 85 to 90%. It's really, really high. And for Palestinians, less than 20%. Again, one kilometer away, and yet access less than a kilometer,

I mean, communities that are intermixed and you see the grotesque health inequities at every single level of society. But that's what apartheid is about. That's what the settler colonial project is about. And we make the direct link with what's happening to our communities, our dispossessed communities here in the United States. Narrative is so much a part of this because going back to that JAMA article that was published and I want to just stay there for a second because the editor in chief of JAMA is a black woman who was the former vice chair of health equity at UCSF.

She ascended to that position after a white man was thrown out for saying that racism doesn't exist. And so the fact that that article was published, that tried to create moral ambiguity around bombing hospitals. And everyone should go and read this article, I think it's called healthcare in the Middle East, like how healthcare professionals should be acting about the situation in the Middle East. And the fact that this article was published that tried to create this moral ambiguity around something that has no moral ambiguity. Hospitals should never be bombed. There's no situation where a hospital where there are sick and injured patients and healthcare

providers shouldn't care of them should be bombed in any reality that should never happen. That's why we have international laws That's why we have the Geneva conventions because Mussolini was attacking hospitals and Ethiopia and saying that these field hospitals were harboring these militants and so we have historical precedent like why we don't bomb hospitals So why is it that the Journal of the American Medical Association is publishing an article just a few short days after this Israeli letter is circulating of 100 doctors calling for the annihilation of all hospitals in Gaza? What does that say? Why has that happened and why has that article not been retracted, especially now that we see that there is no Hamas Command

Center under the hospitals, but we see thousands of dead people. We see children who are dying in their corpses are in these beds of the ICU. We're seeing doctors held at gunpoint. We're seeing 30 healthcare professionals kidnapped. Why is that article not retracted? Why does this editor-in-chief still have her job? And this is how liberal identity politics, so if you take some, you put them in a position and you give them a reason to

be agents to power, they will sell out the people who they are supposed to be serving. And that is the reason, I believe, when we talk about, like, left-right dynamics, we are seeing this rise, this uncountered rise of right-wing ideology and power around the world. Because on the left, we don't even understand how to have these discussions around power and end up having this infighting about identity at every level. And so I am, it's critical that we kind of rapidly evolve these conversations because we need everybody. We need as many people as possible to stand in solidarity with the people of Palestine to demand an end of the occupation,

the end of apartheid, to demand an end to this genocide, and to, in a full-throated way, unequivocally denounce the bombing, targeting of health care facilities, anywhere in the world, no matter what religion, what race, whatever, these places are sacred, and it's critical that they remain sacred. Della, shouldn't your viewers and listeners see how crazy it is that we, as a healthcare community, are being silenced and attacked for saying don't bomb hospitals? Now let's just take a step. Isn't that just unbelievably crazy in some way that when we, when Dr.

Rupa or I or our colleagues who are standing in solidarity with our colleagues in Palestine and Gaza say, stop bombing hospitals, we are not just silenced, but then we get accused of anti-Semitism. So the kind of way in which power is attacking this is really extraordinary, that you are labeled as a health care worker as a professional, as being anti-semitic. If you say don't bomb hospitals, don't kill doctors, don't kill patients, don't let NICU babies die. That tells you how intense and how powerful this moment is for all of us, because if it becomes difficult to condemn genocide, if it becomes difficult to condemn attacks on physicians, nurses, healthcare workers, and hospitals, then it's not that we've lost our moral compass. We've

lost all morality. And that tells you something very powerful about this historical moment. And why we're fighting so much for now, because the stakes are so high right now. The stakes are so high. It's only controversial because of the dynamics of power. Yes. So if these were white Europeans, for example, in Ukraine, and their hospitals were being bombed, there was a swift announcement from the American Medical Association. Swift? Yeah, why the silence now?

And so this tells us everything about how controversial it is to talk about the slaughter of Brown and Black people. When you talk about racist police violence in the United States, that's very controversial to talk about. Why? Because that's power showing itself. It's controversial to say, stop killing Black people.

And that's, we take that on. Because we will never achieve health equity. We will never have health for all until those statements stop killing anybody. That's not controversial. And this is very much tied to Della, all the other struggles of climate and the need to protect the places on earth and the people who are taking care of those places who don't abide by these structures and systems of domination and power. This is a critical moment for us to build our networks of solidarity and stand together. Absolutely. Yeah, I really appreciate how you're connecting the different supremacies, human supremacy

over nature, white supremacy, capitalist supremacy, global nor supremacy over global south, right? And I'm also really hearing when you're speaking around what I understand as the stages of genocide, and one of them is the dehumanization, right? And that's what you're saying about this justification that is just so wild, and yet it is part of a project of moving towards genocide, is to dehumanize, to make less than human the beings. And of course, you know towards genocide is to dehumanize, to make less than human the

beings. And of course, you know, what is white supremacy or racism, if not dehumanization. So I really appreciate how you both are saying Gaza is a symptom or a part of such a larger project and and so connected with systems around the world. And Dr. Rupa, you said, you know, we need to transform our systems to work for all. And I know that it's hard to maybe feel how do we do this holistically and collectively. And so maybe if we were to zoom in on decolonizing medicine. And even that, of course, is such a huge task

and yet so necessary. So I'm wondering, Dr. Rupa, you know, what is the vision of a decolonized medicine? What would that look and feel like? And then maybe how do we get there and how can Gaza be a part of that critical movement? When I am so grateful to my colleague Jess, I'm so grateful to you Jess and our friends who are teaching us about Palestine. It's not just connected. This is the heart. This is the heart of the issue.

When we talk about decolonizing medicine, I hear people talk about decolonizing your diet, decolonize your mind. As if this is something you could do on your own As if this was some sort of therapy that you do Decolonization is taking on the structures of power. That is what it is So it specifically has to do with land It specifically has to do with the return of land to the people from whom it was stolen it specifically has to do with the

Inquiry into power and taking those systems and rearranging them so that they serve all. So what this looks like right now, as a step one, shine a light into why we are being silenced for saying, stop bombing hospitals. why we are being silenced for saying stop bombing hospitals. Just that. First step, we'll tell us everything we need to know about the architecture of power in Western medicine and how it must be changed. So that is step one. Let's shine a bright light into why we are being silenced, for saying don't

kill patients, don't kill doctors, don't bomb hospitals, don't unplug the power from the NICU, don't let those ventilators stop running. Don't do that. Don't stop the medicines from flowing it. How is it that Israel is controlling the flow of humanitarian aid into another sovereign space? When does that happen? What is that?

That's called genocide. That's what that is. And so, shining a light into why that's happening is step one. But the ultimate goal is that the structures of power of medicine are made to serve everybody, especially those who have been harmed most by the colonial project. And this isn't an easy task. This is why Fanon walked away from medicine altogether because he saw that the doctors are part of the structures of colonial power.

But he also understood that if doctors align themselves with the oppressed, with the people who are being subjugated even within the system of medicine, you see the same racialized hierarchies in medicine itself. When I walk through the hospital at UCSF, I see who the janitors are, I see who's in the cafeteria, I see who has no power in our system, I see who the doctors are, I see who the heads of all the department chairs.

I see who they are. And I see what they're saying right now. And when I'm walking in those hospitals, people are pulling me out of the hallway into rooms to whisper to me. Thank you so much for speaking up. Crying, crying, I've never seen janitors at UCSF cry. I've seen nurses cry during COVID because, again, the architecture of power was saying

that certain lives don't matter and certain people's work that doesn't matter. Just suck it up. You're going to get thousands of patients coming your way because we all want to go on vacation and we want to enjoy our lives. We want to have, you know, we don't want to have to adjust our lives to attend to those who are being made vulnerable by the system. So the decolonization of medicine is a project to realize Fanon's visions. That if we, as healthcare workers, can ally with the, put ourselves in solidarity with those we serve, if we can learn to walk alongside them

and learn from their guidance and follow their leads in how to struggle for liberation so that they don't get shot by police so they can have access to clean drinking water so that they can breathe healthy air so they can have enough COVID vaccinations if that's what they want. And so this is where I think we have to see that the real potential of medicine and our love, our sincere love for serving everybody in our communities is the driving force, is the driving force to actually liberate medicine from these power clutches. And when we can liberate medicine to serve all, we open up the field of possibilities for what health can be in our communities. Because you start with medicine

and then you go on to the other structures that make it impossible for people to be healthy and those people are certain kinds of people. And so I feel as Dr. Jess, even though deeply distress, I have not figured out the work genocide balance, life balance. I have not figured that out. I don't think I ever will. But I feel it simultaneously deeply distressed and also optimistic because I've never seen so many colleagues, colleagues who I would consider the most apolitical people in my work calling me to say,

how do I get involved reading this analysis what do I do and then getting on to these threads of our communication that are now swelling to hundreds and hundreds and so that is to me a very exciting opportunity to harness our deep love of humanity and that's why we, most of us, most of us came to this profession for that work. We love people, all people, and we love to see them thrive. We love to see them thrive in their pluralism and their diversity. We love to see them thrive where we grow and we stand up together for our just deep belief that we all have the right to be in relationship to the earth in a healthy way. and we all have the right to thrive.

We all love our children. And so that is what anchors me in my faith to keep this work going. Jess, what about you? This question around decolonizing medicine. What would you say is your vision and then the path there? Well, in terms of decolonizing medicine, I think Dr. Rupa's analysis is brilliant. I want to go a level above and then a level below. I think we have to decolonize power structures, period.

I mean, of course, it needs to happen in medicine because that's where Dr. Rupa and I live and where we work. And that's our local kind of commitment to decolonizing that process. So that's essential. A step up is, and this is really what's happening in Palestine. It's about not just decolonizing medicine in Palestine, but it's decolonizing power that is seeking to ethnically cleanse Palestinians. And really, and this is really so key in what Dr. Rupa said. It's really about disconnecting Palestinians from our land, our identities, and our histories.

And using that structured to understand how we decolonize power in general, I think is an excellent model because it does come down to being further disconnected from land, being further disconnected from one another, from being disconnected from our communities, and that's the way power works. It's this isolation, siloing that happens that we have to confront at all levels. I wanna make sure there's a little bit of optimism here

because even though I'm kind of devastated by grief every day looking at what's happening in Palestine. I know that Dr. Rupa and I share this kind of really amazing experience of working with young students, young residents, junior faculty, and people who are early stage in their careers in medicine and health care, who have been a true inspiration, who because of lots of things in terms of access to information and freedom to speak and not being influenced in the same way that other generations have have been really inspirational in kind of taking on this cause of confronting the genocide in the apartheid in Palestine by Israel. And part of that comes from, you know, this kind of internal decolonization that we all have to go through,

right, that's part of the process. I mean, when we build this avalanche of solidarity and avalanche of understanding of intersectionality of Palestine with all other struggles, we're going through our own kind of internal and community internally De-connizing project of kind of confronting the kind of intensity and insidiousness of power and how it kind of gets inside of us and so I have been really Inspired by seeing a lot of our students and other community members who are coming up in a different generation and kind of confronting this and an openness and willingness to kind of learn and kind of take this on has been

pretty awesome. And I know that that's what we're working on and we'll continue to work on. Thank you for that, Dr. Rupa and Dr. Jess and I I too hold that the vision that Palestine could be is becoming the fulcrum that turns the whole world towards decolonization and peace and all of that and I really want to uplift your invitations to one shine a light on the reason why people are being silenced as well as why bombings of hospitals is permissible. This invitation to move in response to an avalanche of suffering, to an avalanche of solidarity

and to decolonize, you know, all our systems and particularly a medicine to decolonize medicine. And I really hear your love of the profession and really the sacredness of the profession. It's really coming true and through. And so I wanna just ask, maybe Dr. Jess, if you have any other closing invitations for those of us listening. And particularly as something that Dr. Rupa mentioned,

that it is very hard. I mean, it's always been hard. There's always a lot of suffering happening, but particularly right now for folks to maybe stay engaged, to continue to be with the news and to show up in protests and in other ways. So any advice, maybe as a doctor or just as you are of how we can be with the pain and suffering of what's happening and not turn away from it, but also maybe be able to keep regulation in our bodies, our systems, and continue to turn towards what feels helpful

and hopeful for today. So Dr. Jess, any closing evitations and anything, we might add there. I think that's such a great question, Della, really. And to my colleagues and coworkers and peers, all of whom I have deep respect, admiration, and love for who are suffering right now, and there are many of us who are really suffering.

The challenge is to be able to sit with, hold and contain profound contradiction, right? And I'm just talking about my own experience and how I work and kind of try to support the people that I really love who I'm working with right now like Dr. Rupa. And it's being able to hold and contain contradiction on the one side that the kind of profound devastation, loss, and grief that we feel seeing communities being destroyed essentially in the name of medicine or in the name of power or in the name of peace, whatever. But at the same time, feeling hopeful and optimistic that this historical moment can lead to change that can be enduring and so communities can reclaim all of our communities can reclaim our rightful place at the table in terms of our connection to the land

dignity, self-determination and freedom. So the call that I have is to not be isolated, not to turn away, to stay engaged, but to continue to take care of yourself, and be mindful of what, you know, we talk about this frequently. To be a warrior for health justice, you have to also take care of yourself, your home, your community, your family. There's no easy solution to that, but coming together in community is a great way to do it. Okay, you can't do this by yourself. This struggle that Dr. Rupa and I and our colleagues are involved with is not an individual struggle. It's a community struggle and we all have to be unsyeloed and engaged together as a community. And the awesome thing right now is that there are so many healthcare worker communities,

physician communities, nursing communities, public health communities that are engaged around Palestine. It doesn't take much to find that online, to get plugged in and to stay engaged. And so for those of you who are listening right now or viewing and are feeling kind of pessimistic or kind of deflated by it, don't be. This is a awesome opportunity

to reconnect, to get engaged, and to basically save medicine, and to save Palestinian children and women and men who are being slaughtered right now because every day that we can get this genocide to stop where the bombing stop saves hundreds of Palestinians. So it's immediate and I would just say, you know, to listeners and viewers, join us. Hold our hands. Let's walk shoulder to shoulder as we march toward freedom, dignity, and self-determination for Palestinians. Because when Palestinians are free, then we're all going to be free. Dr. Rupa? I don't see health anymore as an attribute of individuals.

I don't say, oh, you're healthy to my patients because I understand health is a phenomenon that emerges when systems are in harmony. And systems are in deep disharmony over the last several hundred years because of our violence towards the earth, our violence towards one another, and our fracturing of our relationships that are dictated in a duty to care, a duty to care for one another, a duty to care for the earth. And so what I see here in this struggle is an absolute urgent need to understand the interconnectedness of these struggles and to care for one another as we come into our consciousness, as we find our courage, as we find and mobilize our

courage. Because it isn't simply enough to witness these things and feel away about it. You have to engage that place of moral courage to start working together. And so, in community, in conversation, in actions, in discussions, unrelenting pressure on different systems and pressure points, and finding your place in

that ecosystem and finding your place in community in that ecosystem. So I think that those kinds of, it's an exciting moment of awakening that I haven't seen in a while and it's something that should really be honest because as we struggle for Palestine, we start to see how this is connected to the struggle for Black maternal health here in the United States, for the right for people in East Oakland to breathe clean air. These are completely connected. Taking care of myself looks like spending time with my kids, spending time by the earth, and then hanging out with Jess, talking to Jess every single day and my other friends. It's understanding that the therapist I had for six years who told me that the letter

circulating to Israeli doctors saying to bomb hospitals when she told me this is Russian propaganda, understanding that it's okay to fire those people and find a therapist who will actually take care of you and understand that your emotional health in that struggle is not being around people who are gaslighting the struggle. And so I'm very grateful to the elders in my life. I'm very grateful to Walter Riley, to Ida B. Wells' grandson, Troy Duster, and I call on these elders right now to sit with me and inform me and teach me why we are here right now and how we can continue in strength and build upon this moment.

You've been listening to an upstream conversation with Dr. Jess Gannon, a Palestinian professor in psychiatry at UCSF in San Francisco working in Gaza, and Dr. Rupa Maria, professor of medicine at UCSF in San Francisco and co-author, along with Raj Patel, of Inflamed, Deep Medicine and the Anatomy of Injustice. We spoke with Dr. Rupa and Raj on their book when it was published in 2021. So if you'd like to take a deeper dive into the theme of decolonizing medicine, make sure to check out that episode. And please check out the show notes for links to any of the resources mentioned in this episode,

including ways that you can support Palestine. Thank you to Carolyn Raider for this episode's cover art, and to Sabrina Group and the Majaz project for the intermission music. Upstream theme music was composed by me, Rob. Upstream is a labor of love. We couldn't keep this project going without the generosity of our listeners and fans. Please consider chipping in a one-time or recurring donation at UpstreamPodcast.org for its last support. And because we're fiscaly sponsored by the nonprofit independent arts and media, all donations to Upstream in the US or Tax Exempt.

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rating and review. It really helps upstream get in front of more eyes and into more ears. Thank you. you