The medical profession, often seen as a bastion of healing, is itself wounded by sexual harassment and abuse. This chapter delves into the experiences of doctors who have suffered sexual trauma, highlighting the silent struggles and complex barriers that prevent them from seeking help.

Survivors often grapple with feelings of shame, fear of retaliation, and a lack of understanding of their own experiences as trauma. The chapter emphasizes the importance of breaking the silence surrounding sexual harassment and abuse in medicine. Survivors can regain agency by understanding and incorporating their trauma into their own personal and professional narrative, as long as they are supported with wise therapists who are able to help them do so. Healing not only benefits individual doctors but also improves the overall culture within the medical profession.

Advocacy is a broad term, arising from the Latin word ‘advocare’ meaning ‘coming to the aid of someone’. Implied in this definition is the concept of lending one’s own power to the cause of another. The power to direct the goals of any advocacy effort should remain with the individual or group that will benefit from the advocacy campaign. Advocacy can be misdirected if the voices of the individuals for whom advocacy is sought do not speak, or are not sufficiently heard.

Many of the authors in this book have shared their experiences advocating for change. In this chapter, we will explore how advocacy can occur by examining where within the system advocacy efforts can be directed, the process of planning, implementing and evaluating advocacy, and how an individual can determine where to focus their efforts. We will also draw on examples from various authors, illustrating how and why they undertake their work, and the lessons they have learned through their advocacy journeys.

This chapter offers insight into some of the kinds of positions people can take in their emotional and personal journeys as advocates within medical training. It includes people in different positions in their advocacy journeys, offering their visions for the kinds of changes that need to happen to make a difference to sexual harassment in medicine. May Erlinger writes from her perspective as a medical student, describing the personal and emotional journey of becoming mobilised around sexual harassment in Australia. Becky Cox and Chelcie Jewitt are the co-founders of ‘Surviving in Scrubs’, an online campaign to tackle the problem of sexism, sexual harassment, and sexual assault in the healthcare workforce. They launched Surviving in Scrubs as doctors in training in the UK, giving a voice to women and non-binary survivors in healthcare to raise awareness of the problem, and to demonstrate the diversity of lived experience that needs to be addressed. Louise Stone and Fiona Moir are senior medical educators, who have had senior roles in medical student and GP training in Australia and New Zealand. They discuss the range of roles and challenges they have addressed in managing professionalism, wellbeing and professional identity formation in policy, teaching and leadership.

Introduction

There is a slow, albeit steady, evolution towards the significance and development of economic, social, and cultural rights (ESCRs), moving from international to regional and national systems. Constitutionally elevating ESCRs to fundamental human rights places substantive meaning on the notion of indivisibility and justiciability of all human rights. Climate change poses a threat to this elevated set of human rights, disproportionately impacting the historically marginalized and underserved communities on a global scale. Moreso, progress towards sustainable development for the Global South has been negatively impacted by climate change disasters – severe weather conditions such as droughts and floods have become more frequent and destructive. Consequently, the financing gap and general capacity of the Global North and Global South countries to progressively realize ESCRs is ever widening. It is a major concern that the climate emergency the world is confronted with is a problem to which the Global South has played a minimal role contributing. Rapid industrialization, wealth creation, and improved living standards in the Global North have been spurred by a tainted history of unsustainable natural resource extraction and unsustainable industrial practices much to the detriment of the Global South, which has given rise to the notion of climate justice.

Climate justice is not an exclusively environmental concern but also has implications for the implementation and protection of fundamental civil and political rights, as well as ESCRs. On 28 July 2022, the United Nations General Assembly (UNGA) through resolution A/RES/76/300 confirmed the United Nations Human Rights Council (UNHRC) resolution recognizing for the first time that access to a clean, healthy, and sustainable environment is a human right.

This chapter discusses an integrated and holistic approach to preventing, responding to and managing sexual abuse of doctors, at organisational as well as individual level. Organisational factors which can predispose to abuse are discussed, alongside opportunities to engage in work to prevent abuse. A case study illustrates themes and impacts in cases of abuse, and the holistic lens through which support can be offered. The authors are experienced across the medical career spectrum including the support and case management of a number of doctors in training affected by sexual abuse. This includes organisational level interface with employers, regulatory bodies, health and legal services in relation to matters resulting from sexual abuse of doctors.

This chapter discusses relative clauses in some theoretical detail. It begins by establishing a working definition of relative clauses appropriate for the purposes of the book, providing an overview of the different semantic and syntactic types. It then moves on to the way in which these clauses are analysed within Minimalist linguistic theory, weighing up the Head-External, Head-Raising and Matching analyses; this is followed by a more detailed look at the left periphery as a vital part of this structure. The chapter concludes with a discussion of the ways in which these formal approaches have been applied to ancient Indo-European languages, isolating the points of identity and divergence between them. These establish the relevant points of comparison, which inform the reconstructive program pursued in subsequent chapters.

Introducing our interlocutors and our research

Our methodological approach was based on semi-structured interviews conducted between October 2022 and February 2023. These interviews involved indigenous, Afro-descendant, and Campesinx leaders from academia, labour unions, and social movements. We conducted the interviews in person through video calls, email, and phone. Due to the diversity of the participants, the interviews were performed in Spanish, Portuguese, and English. We had the support of native and bilingual speakers to review the translations1 and shared the final version of the document with the interviewees.

The research highlights the perspectives of several influential voices, including Ana Lucía Ixchiu Hernández, a K’iche’ indigenous social leader and renowned activist for climate and cultural rights in Guatemala; Jen Deerinwater, an award-winning journalist and community organizer from the Cherokee Nation of Oklahoma in the United States (US); Eliana Asprilla, an Afro-descendant environmental engineer specializing in urban and management planning from Colombia; Ana Lilia Felix, an academic who aligns with the Zapatista movement's ‘Sixth Declaration of the Lacandona Jungle’ in Mexico; and Maria Estélia de Araújo and Luciomar Monteiro, members of the Landless Workers’ Movement (MST) and the Catholic Church's Land Pastoral Commission (CPT) in Brazil. For the interviewees’ biographical information and guiding questions, please refer to Appendix 7A in this chapter.

In terms of our selection criteria for interviewees, we employed a non-random sampling approach, specifically purposive sampling. This selection was based on the significant roles that these activists play in the social and environmental justice arenas within both their individual countries and the broader region.

In countries like Nigeria where the preference is for the male child, female doctors face distinct challenges regarding sexual harassment. Female doctors are likely to experience career consequences if they share their experiences, yet they want to speak out to avoid others from having to experience the same types of abuse from senior colleagues.

This chapter outlines the ongoing oppression faced by female doctors in Nigeria. The case study outlines the escalating harassment and abuse of a female surgical trainee, and the insidious abuse of authority by a senior male doctor. The case demonstrates the betrayal the woman doctor experiences when others support the abusive senior male surgeon: the report of harassment is poorly managed, with the target being asked to apologise. This chapter outlines the tangible consequences of those who dare to speak out and voice concerns about their mistreatment in this context and shows the impact of poorly managed harassment, on the lives and careers of women doctors in Nigeria.

This chapter introduces the potential legal consequences of occupational sexual harm of medical practitioners by medical practitioners, and outlines some of the reasons for non-reporting in the criminal context. The challenges of reporting of sexual harm in the workplace are discussed and followed by three illustrative case studies from Australia one from a criminal court, one from a civil court and one case brought by the Medical Board to the Administrative Appeals Tribunal. The chapter concludes with the recognition that complex structural and cultural environments exist which deter some victims from pursuing legal redress and can inadvertently harm those who do pursue it. Solutions are not simple or easy and, irrespective of the prevalence of occupational sexual harm, pursuit of legal claims is likely to remain low due to the personal and professional risks a complainant endures.

Female physicians in Japan face significant career barriers due to societal expectations surrounding childcare and family responsibilities. Traditional gender roles, exacerbated by long working hours and limited childcare options, hinder their ability to challenge stereotypes. In this chapter, we initially elucidate the challenges Japan encounters, as derived from literature reviews, and subsequently delve into specific instances.

The four authors in this chapter are from different stages of their medical careers in Japan. Dr. Watari has a Masters degree in Healthcare Quality and Safety from Harvard Medical School (USA) and has worked clinically in Japan, Thailand, and the USA. He has been actively researching gender bias in Japan’s medical field, aiming to promote gender equality among physicians. Dr Kono is a senior resident in surgery at Tokai University Hospital, and has published an article on gender inequality in Japanese academic medicine. Dr Yasuhisa is a junior resident at Shonan Kamakura hospital, with a background in pharmacy and engineering. Ms Mizuno is a medical student at Shimane University, with a background in French and linguistics. The case they present is a conglomerate of several interviews they have recorded during work on sexual harassment and discrimination in Japan.

Introduction

Linkages between environmental risks and racial discrimination have long been areas of research and activism in the domestic sphere. The term ‘environmental racism’, coined by Rev. Dr Benjamin F. Chavis Jr and Robert D. Bullard in the 1980s, refers to racial discrimination embedded into the process of environmental decision-making, whether by a conscious design or institutional neglect (Bullard 1993, 17). The results are that communities of colour are disproportionately exposed to environmental issues (Bullard 1990, 1993; Schlosberg and Collins 2014). However, an unresolved theoretical issue in this conversation is applying such framework in the global order, particularly considering Global South countries1 in the realm of international negotiations on climate change. Such an application builds on scientific evidence that communities most at risk have emitted the least greenhouse gases (GHGs) and also have fewer resources to deal with climate change, and that climate change has generated and perpetuated vulnerabilities (IPCC 2022, 9–11). This is deeply intertwined with the principle of common but differentiated responsibilities and respective capabilities (CBDR&RC principle), since it acknowledges that Global North countries should bear the higher costs of mitigation and adaptation to climate change, as well as recent discussions on climate justice and human rights – particularly considering the economic, social, and cultural (ESC) rights. However, the current understanding and operationalization of the CBDR&RC principle does not enhance climate justice and human rights, because it does not address the underlying root causes of climate change (see the third section).

This chapter analyses the left periphery of PIE with specific reference to the interaction between pragmatic fronting (topicalisation and focalisation) and clitic placement (Wackernagel’s law). This constitutes a mapping out of the CP layer in PIE, which forms a crucial part of relative clause structure, and lays the groundwork for analysing the precise syntactic behaviour of the relative pronoun, *REL.

We were both part of the team that conducted the first systematic study about sexual harassment in academic medicine in Germany and this has informed our following practice and our contribution to this book. Coming from a background in clinical medicine and public health, as well as knowledge about organizations, and personal encounters with the topic, we feel that more awareness, prevention and actionable consequences are necessary to improve working conditions in academic medicine in Germany. The anonymized case study we present showcases many of the structural problems survivors encounter and, most importantly, the fact that they often shoulder the consequences of actions they have not called for and did not want. The #metoo movement supported public discussions about sexual harassment and led to some positive change, yet much still needs to be done to structurally change our workplaces and the hierarchical culture that characterizes academic medicine.