Zika in Puerto Rico

As we all know, Zika is a very prominent global health crisis right now. Due to this, coupled with my interest in sexual health, I will be discussing a current approach that Puerto Rico is using to try to combat this Zika problem.

So far, they have had more than 8,700 confirmed Zika cases and by the end of the year, the CDC is predicting that 20-25% of the total population will have been infected (Beaubien, 2016). The scary thing is, 900 of the 8,700 confirmed cases are women who are currently pregnant and there is nothing they can do to prevent the possible associated birth defects.

What they can do is try to prevent this from happening to even more pregnant women. To do this, obstetricians and gynecologists are offering free contraception to anyone that wants it. In the past, Puerto Rico has had barriers to accessing contraception, so this is a radical initiative for them. The OB/GYN that is heading up this initiative, Dr. Bracero, says that “condoms and birth control pills are low-efficiency, low-compliant methods” so they are offering more modern, long-lasting and expensive options such as implants and IUD’s as well as condoms and pills (Beaubien, 2016).

Although they are offering these options, Dr. Bracero mentions that the use of birth control in Puerto Rico is still low, but does not mention why. I am assuming that due to the fact that Catholicism is the dominant religion in the territory, women are worried that taking advantage of this preventative measure will go against their religion. But how far will people go to prevent the devastating potential side effects of this virus? Hopefully this initiative will keep the number of pregnant women infected with Zika to a minimum.

Beaubien, J. (2016, August 6). Puerto Rican OB-GYN's offer free birth control to fight zika. Retrieved August 31, 2016, from http://www.npr.org/sections/health-shots/2016/08/06/488992750/puerto-rican-ob-gyns-offer-free-birth-control-to-fight-zika

Brain Drain

The U.S. congress has set aside 50,000 special immigration visas for nurses willing to work in U.S. hospitals and all caps on the immigration of nurses were removed, while American nursing schools reject more than 150,000 applicants per year due to poor qualification (“The Challenge of Global Health,” 2009).  This creates a brain drain in developing counties that are desperate to build infrastructure that support a healthy population. The developed world then launches a campaign where for-profit, not-for-profit and NGO etc begin to collect and donate money to the developing countries from people who are giving out of a sense of moral obligation, emotional response or because they are aware that microbes have not borders, yet virtually no provisions exist to allow the world’s poor to decide which project serve their needs or adopt local innovations (“The Challenge of Global Health,” 2009). The influence of intergovernmental agencies is being crowded out by donor-driven funding patterns that may not be fully responding to country needs (The Lancet, 2009).

Let’s first address the fact that instead of fixing the unfunded and desperate education system in the US we are willing to forgo investment in our nation education for the resources that other countries possess. When we take the best and the brightest from other countries we are not only bankrupting these countries economically but also in health care systems and infrastructure.  This begins a vicious cycle where we then throw money at the problems that arise due to the lack of that same infrastructure which we destroyed. We don't really address the problem and we need to address it. I am not saying that giving money for these cause is wrong, what I am saying is that let’s tackle the problems from both sides.  The US is in need of well-trained doctors and nurses, and other countries have them, but those counties are in need of infrastructure, and instead of one country benefiting and the other not, there should be some type of reciprocation.  Like the US send doctors and nurses (who may be from developing countries themselves) to train people in developing counties it seems that the best of the developing countries should train people in the US on how to be better educators for their population. This could start a global collaboration effort, where developing counties are seen as equal and due the same respect as the US and other developed countries. This would also ensure that developing countries get a say in what their needs are and what issues they would like to tackle first because quite frankly you can’t treat TB without addressing Malaria and you definitely can’t treat HIV/AIDS without addressing the systems that drive it such as access to birth control, or adequate health care.  What should global health include then, Szlezak et.al, says that: “Global health needs to include disease prevention, quality care, equitable access and the provision of health security for all people.  The global health system is the constellation  of actors (individuals and/or organizations) whose primary purpose is to promote, restore or maintain health and the persistent and connected sets of rules (formal or informal) that prescribe behavioral roles, constrain activity, and shape expectation among them. Such actors may operate at the community, national or global levels and may include governmental, intergovernmental, private for-profit and/or not-for-profit entities.” I think this takes into account all the actors that play a role in global health and creates a collaboration rather than a savior relationship.

Tuberculosis in the U.S.

My 2016 summer internship at the Montgomery County Health Department allowed me to have various experiences with the health world.  Because of our focus on the local county’s health, we hardly discussed international health.  The only time we dealt with international health was with the tuberculosis (TB) patients.  I think of this experience as having been slightly international health related because the active cases were immigrant related.  I cannot give many details because of HIPPA regulations, but the active TB cases had people who were immigrants or had been into contact with immigrants to the U.S.  I am not suggesting that tuberculosis is only brought into the United States, but it is one of the factors of TB more often than not.  Before coming to the health department, I had no idea that tuberculosis was still an issue in the United States.  My previous knowledge was about the stories of tuberculosis patients being placed in quarantine hospitals in the early 1900s.  Thankfully, we are no longer that savage with our treatment of these ill people.  However, because tuberculosis is such a contagious disease, the patients and their social circle are handled with care.  When a patient comes in for a tuberculin skin test, they are normally injected in the forearm on the anterior side.  The test can only be read after 48 hours have passed since the injection.  If the test results with an induration (lump under the skin), it is more than likely the test is positive.  From there, the patient’s primary care provider will make the decision on treatment.

My experience with tuberculosis at the health department greatly increased my curiosity on the disease.  I started researching for articles and information on TB in the United States.  I found it interesting that I could hardly find 5 relevant articles on the topic.  I think this failure in information further reiterates what one of the TED talks we watched in lecture was saying.  The media is not reporting (correctly) on a wide range of topics.  Unfortunately in this case, the topic is negative versus the positives facts from that particular TED talk.  It is still our right know the health facts of our nation and to monitor the situation.  As for the future of tuberculosis, hopefully we will continue our progress in its prevention and treatment.

Erin Biesterveld

Second Year MPH

Perspective on Global/International Health

When I first heard the term international health, my perspective was drawn to the outcry of financially starved health services in the developing world.  However, Beaglehole et.al., discusses International health as that which focuses on the health issues, especially infectious diseases, and maternal and child health in low-income countries, while Global health is collaborative trans-national research and action for promoting health for all. Both focus on health of the population and community so why the separation or need to identify the purpose of one or the other. This separation and need to have a definition make it seems like what we are basically saying is we are are looking at it from a developed (international) versus developing (Global health) perspective.  International health seems to focus on the premise that health is not something to worry about on the same scale and that of countries like in Sub-Sahara Africa.  This to me is a fallacy, because there are some places in the United States and other developed countries that has health disparities and issues worse than that of the developing world.  The major factor in any health disparity is income inequalities, and this is a worldwide problem.

The definition by Rowson in the Bozorgmehr article which states that, Global health is a field of practice, research and education focused on health and the social, economic, political and cultural forces that shape it across the world”, is more palatable to me because it doesn’t center on developing or developed but on the need to look at all the factors that are affecting the health and basically the wealth of nations.  There are great doctors in developing and developed countries and having an international focus says I’m coming to help you and tell you how it should be done instead of partnering with and collaborating on sustainability, prevention and interventions. We can agree to start from here and decide how we are going to partner with other countries in global health.

Preparing for the Worst: Natural Disasters and Public Health

In the Ted Talk we watched in class by Hans Rosling, he gave some statistics on the decreasing rate of deaths from natural disasters.  While he concluded that the rate is down (because “most things improve”), natural disasters are still a global concern impacting population health.  Over the summer, I read a fascinating book called Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, by Sheri Fink. The well-researched account recalls the events that took place at Memorial Hospital in New Orleans in the aftermath of Hurricane Katrina.  Unable to evacuate all patients, in particular those depending on life-giving machines, hospital staff bunkered down to face the storm and continue to provide care.  After the storm passed and the floods set in, the situation deteriorated quickly. Despite warnings from health and safety officials, the hospital had failed to set up its back-up generators above the flood plane, and lost power to most areas of the building long before everyone could be rescued.  This presented doctors with very difficult decisions to be make when it was not possible to evacuate all patients, as the lights flickered and the sewage system backed up into the hallways and people began to whisper of euthanasia… (I won’t give away the rest; I would seriously recommend the book!)

Lack of adequate evacuation/shelter opportunities presents a clear public health concern. We touched briefly in class on the threat of living in disaster-ridden areas and methods of inhabitants for coping with the dangerous conditions.  New Orleans is unfortunately one of these places, and one coping mechanism people had when they could not evacuate was to seek refuge in hospitals like Memorial.  In this instance, even the hospital was not able to provide a functional shelter to those who had previously depended on it.  When the place that is supposed to preserve your health cannot even keep the lights on, what does that say about emergency disaster preparedness? If these concerns aren’t being addressed in one of the most disaster-prone regions of our country, how can we hope to continue to reduce the rate of deaths from natural disasters?  What example are we setting for the rest of the world?  We can only hope that lessons were learned and such simple mistakes will never be made again.

Bringing Care to People rather Than People to Care – SEM approach

Watching the video of “the name of the disease” and mentoring the bad health conditions, through my dental experience, in the developing countries, triggered my memory back to my first patient in the pediatric dentistry clinical class when I was a fourth year dental student. I recall how shocked I was when I saw this kid whose teeth were badly mutilated although he was only 6 years old. Back then; I wondered, as a dentist, what my role is towards this kid. Should I only fill his cavities, extract his badly broken down teeth and apply the artificial appliances? I still remember my professor who told me then “A successful dentist is not only treating teeth, but rather is treating PATIENTS having teeth”. These words became the base of my professional career, since then.

Having this background makes me agree completely with Dr. Neiderman in his article Bringing care to people rather than people to care, that the role of a dentist is far beyond to drill, fill then bill. The statistics that was clarified in his article showed that the incidence and prevalence of untreated caries remained unchanged from 1990 to 2010, and this sounds the alarm that focusing on surgery is not the solution for dental caries as a major public health problem. I like how the author presented the concept of the delivery of preventive dental care via three levels; patients (through brushing and flossing), non-dentist community health workers and school systems (through provision of oral health facilities), and community wide programs and improved infrastructure capacities (through community water fluoridation). However, I believe that the role of the dentist is mandatory along with these levels not only through tertiary prevention (by providing dental care and rehabilitation) but also via oral health education, counselling and orienting patients’ minds towards adopting new healthy behaviors.  

Although adopting a new healthy behavior is a long process which is not that easy, it is not impossible. In my opinion, it can be tailored according to individual variations in age, psychological and cognitive development. However; these steps won’t be successful without making the environment more conductive to facilitate, support and maintain that behavior. Such an approach supports the concept of the complementary role of (the community, individuals, experts, public health professionals and governments) which is a classical representation of the socioecological model (SEM). I believe that all should work together towards improving health conditions among populations especially developing ones that are struggling under various extreme harsh conditions.

References:

“The name of the disease” video – (MIT Poverty Action Lab)

Niederman, R. (2015). Bringing care to people rather than people to care. American Journal of Public Health, 105(9), 1733.

TED Talk: Preparing for Alzheimer's

For this week, I would like to talk about my thoughts and feelings after watching the Ted Talk about preparing for Alzheimer’s. She mentions that Alzheimer’s and dementia are global issues and that by 2030 there will be 70 million people suffering from this disease. While watching the video, it was my immediate reaction to cry and feel sad. This woman is having to watch what Alzheimer’s is doing to her dad and constantly be reminded that there is a good chance that it could also happen to her. As stated in the synopsis under the video, most people would respond to this situation with denial or how thoughts on how to prevent it. But the reality is, if you’re going to get it, you’re going to get it. But instead, global health expert Alanna decides to prepare for the day that she too could get the diagnosis.

She decides to be proactive instead of reactive when it comes to your health. Alanna is choosing to act now, before being diagnosed with Alzheimer’s, to prepare her mind and body for the possibility. Rather than waiting for a doctor to confirm an Alzheimer’s diagnosis she chooses to get new hobbies, improve her balance and physical strength and become a better person.  She believes that these will help her if she does end up getting Alzheimer’s or dementia.

It is very important to always follow the proactive route when it comes to health. This means getting regular physicals, staying up to date on mammograms, always eating healthy, exercising for at least 30 minutes a day, wearing sunscreen and seatbelts, and avoiding tobacco and alcohol use. Whether it is preparing for Alzheimer’s, dementia, diabetes or cancer, it is important to be proactive and take responsibility for your health in order to better combat these global issues.

https://www.ted.com/talks/alanna_shaikh_how_i_m_preparing_to_get_alzheimer_s?language=en