[Ann Miriam]

Lack of personal commitment
Lack of personal interest as well as heavy work load
Lack of resources

I am able to give only one minute preceptorship and not more than that. The reasons are single consultants managing large volumes (650 deliveries per month, 250 major surgeries per month) plus outpatient work make it difficult to have regular classes. The best training that can be given in this situation is an apprenticeship model with one to two minute classes when something needs to be demonstrated.

[Ann Miriam]

Question 1:

1. The universal health coverage policy should be realistic – fitting into the government’s budget yet ensuring that available resources provide the best possible range of services that provide the maximum decrease in morbidity and mortality.
2. Social and economic issues of the people that affect healthcare outcomes must be integrated into the policy.
3. Adequate resources should be allocated for the policy to work and there should be political will to ensure equitable distribution of services to all segments of the population.
4. Expensive treatment options for rare diseases should be prioritized to those who will have the best outcomes so that the bulk of the available resources go to the greatest number of beneficiaries.
5. Health policies should also be integrated with other programs that increase its effectiveness such as education, security and development.

Question 2:

1. Tea garden employees are amongst the most impoverished people in northeast India. Their healthcare is provided by their employers under the Plantation Act. The quality of healthcare services is poor leading to deaths due to nutritional disease, infections, maternal disease etc. This is further complicated by alcoholism and poor health seeking behavior. Tea estate owners provide rations (food, clothing, housing etc.) along with a very low wage.
2. CHWs should empathize with the target population, understand their motivations and unique set of constraints and help them to make the best use of available resources for food and modify behavior by avoiding habits like alcoholism.
3. They should liase with government and not-for-profit health service providers to ensure that diseases are diagnosed at early stages and quickly treated before avoidable morbidity and mortality results.
4. They should ensure complete participation in free government programs such as the Extended Program for Immunization, Tuberculosis/Malaria/Leprosy control programs, maternal/child health programs etc.
5. They should liase with tea-plantation owners and trade unions to ensure that the best services are provided to the workers.

[Ann Miriam]

question 1
National government and international entities interested in prevention and management of complex humanitarian emergencies should develop robust monitoring mechanisms to predict the occurrence of an emergency and identify at an early stage to decrease losses. In the absence of adequate local resources to manage these situations external support should be arranged for and be available at short notice so that lag period is reduced as much.
Local populations should be made aware of possible emergencies and should be trained to manage it with available resources.Some preventable interventions are vaccination , safe water , shelter , food security , hygiene and psychological support to the victims.
Question 2
When disasters occur / awareness of the need and support is rapidly mobilised by mass media and pressure is exerted on governments and aid agencies to mount a rapid response. Donors contribute large amounts of funds and materials and manpower. Prior to a disaster preparedness
is usually the responsibility of the local, regional and national government.
External institutions are not involved. Local governments would rather invest scarce resources on what they think or other priorities. Disaster preparedness therefore attracts less attention compared to disaster response.

[Ann Miriam]

Question 1
Language and cultural differences can cause misunderstandings between doctors and patients.
Use simple and plain language .
Hire bilingual staff to get reliable source of information from patients.
Use universal healthcare symbols – visual method of communication.
Orientation of the health care givers to language and cultural differences enable them to engage with patients effectively and gain acceptance. This helps in shared decision making.
Use repetition till they understand.
Be respectful – know their beliefs, attitudes and behaviours – talk slowly, don’t force your views on them.
To overcome difficulties in culturally dissimilar interactions and remove cross-cultural barriers to health care, a culturally sensitive physician considers his or her own identity, values, and beliefs, recognises the similarities and differences among cultures understands what those mean, and is able to bridge the differences to accomplish effective communication.

Question 2
Volunteers should be sure of their aims and objectives before leaving for a short term trip.
Establish common sense of purpose between the institution and volunteers.
Have good relationship and collaborate well with the community and its health needs.
Good team work .
Reciprocal learning, empowerment and capacity building to be pursued.
Evaluation of the outcomes to be done to know if the goals are met.

[Ann Miriam]

Question 1
Eradicate hunger – should lead to nourishing growth and productivity for individuals and nations .
Malnutrition is still an underlying cause of death and disease for nearly half of all children who die before the age of 5. Healthy food does more than just fill their stomachs- it nourishes growth by helping women and children break the life of poor health, poverty in We need to change the way food is produced, processed, consumed, transported and sold to the customers. We need to make it available through out the year whether from their own fields or a local market.
their communities. Healthier food, healthier lives, healthier world.
Current food system falls short of achieving our vision of no hunger, nutrition for all.
Encourage small farm holders, as well as at home to produce nutritious food for consumption . Encourage markets to work better for the needy by providing food at a that is safe from contamination, nutritious and affordable.
Increase consumer knowledge on safety and health benefits of the food they eat and bad effects of taking too much of processed food. Empower women.
Involve policy makers, donors, civil society, research in agriculture and businesses towards strengthening of commitment to nutrition.
Keep in mind the changes due to climate change – encouraging smallholder agriculture, organic farming is also important in poverty reduction and food security.
When people have access to healthy food , we are closer to attaining our SDG 2.

Question 2
What are today’s greatest obstacles to global health?
Climate Change a threat to health
Delivering health in conflict and crisis zones
Making health care affordable to all- decreasing the gaps between the haves and have nots
Stopping infectious diseases spread
Preparing for pandemics
Protecting people from dangerous products- drug abuse, alcohol, harmful fats, sugary drinks
Investing in healthcare workers and research
Keeping children and adolescents safe – from RTA, suicide, domestic violence – preventable cause of deaths
Earning the trust of people

[Ann Miriam]

Question 2

1. Gains due to good nutrition are lost by poor sanitation, hygiene and clean /safe water. Programs should therefore implement both approaches simultaneously.
2. Gaps in nutrition and WASH should be separately evaluated and closed.(It is possible that the gaps may be more in one than the other- good nutrition practices with poor WASH practices)
3. If the entire target community has a uniform gap in nutrition:WASH, the common strategy should be evolved taking into consideration social, cultural, economic issues.
4. Outcomes must be measured (improvement in percentiles in road to health chart etc.) till targets have been achieved.

[Ann Miriam]

Question 1:

1. Study and enumerate availability of reliable resources including man power, infrastructure, training (skill and knowledge acquisition) and equipment.
2. Map out pockets with the worst healthcare indices(such as NMR,IMR) – these are the areas with the highest potential for improvement with the least investment.
3. Match available resources to areas of greatest need and estimate costs involved. If adequate funds are not available prioritise resources to areas with greatest need.
4. Identify bottle-necks – poor road connectivity, poor execution by adequately trained staff (motivation and commitment issues), health worker fatigue etc.- and address each issue with assets at disposal.
5. Identify gaps – people excluded because they are not registered etc – find ways to close the gaps.
6. Ensure accurate documentation and best possible quality control.
7. Evaluate and fine-tune till best possible outcomes have been achieved (with available resources and inspite of local constraints).

[Ann Miriam]

Question 1
Approximately 1.5 billion people are currently living in countries affected by conflict , fragility or large scale violence. Women and children account for roughly 70% of the displaced people and 20% of the displaced are women of reproductive age.

Direct effects are due to injuries and deaths sustained by mothers who are non-combatants.
sexual violence may also be used as a weapon of war to terrorize communities and make them abandon their homes and lands.
war like situations can also lead to restricted access to healthcare and cause preventable maternal and child morbidity and mortality.
It can increase the direct, travel and oppurtunity costs of health services, which in turn reduce mothers from attending health facilities.
Medical personal and supplies are also disrupted. destructuon of health posts , intimidation of health workers and frequent disruption of transportation services.

question 2
Areas of the world with the worst health care indices especially those that affect women are also the ones where low amounts of investment in funds ,infrastructure and man power will produce the greatest transformation. Each country should evaluate its options and choose the best strategies. Often national health care facilities are affected by internal politics that do not reach the most needy. Similarly, corporate health care facilities are not interested from those whom profits cannot be made. In such situations emergency and short term health care may be provided by organisations like Red Cross and MSF. Long term health care support to needy communities could be provided by supporting not for profit organisations like mission hospitals wha are present in those areas. In addition long health programs like empowerment of women, cancer screening, non- communicable diseases, community health and development, education and awareness creation programs should run simultaneously. Advocacy should be done in religious and local community leaders so that social practices which have an adverse effect on women”s health are slowly reversed.

[Ann Miriam]

!. The barriers of Control of HIV can be overcome by monitoring and prevention of transmission in high risk groups like FSWs and Male homosexual,
IV drug abuse. Elimination of HIV infection needs a lot of advancement in behavioural practices , biomedical HIV prevention .
SOCIAL STIGMA has to be addressed . This is one of the most important reasons of delay in early detection and treatment.
2.As usual all over the world women and children are treated as second class citizens.Their voice is unheard and very few are standing up for them.

[Ann Miriam]

People in poverty live and work in poor ventilated and overcrowded conditions which provide ideal condition for bacteria to spread.
Poor are the ones who are malnourished having weak immune systems and also are associated with drugs, alcohol, and HIV. They are also the migrants in cities.
Compliance is the key to prevent development of MDR and XDR TB and elimination of disease in communities.
Keeping in mind the social, economic back ground and the constraints of the health care system the most efficient and effective means of identifying TB patients and ensuring compliance must be developed.
question no 2
Raising awareness about NTDs among the affected and also among the privileged is important.
Sharing the concerns of the neglected people and the neglected diseases with the policy makers and politicians and requesting them to look into it.
Motivating new comers to reach out to the needs of the unreached.

[Ann Miriam]

i agree to what is said by Dr.Chering

[Ann Miriam]

FOOD SECURITY
1] Transfer of most appropriate agricultural ,fishery, and animal husbandry best practices are areas of great need.
2] Best remuneration and insurance to subsistence farmers
3}Storage including cold storage and value addition (conversion into non perishable forms) of food to avoid wastage
4)understanding social and cultural factors within communities and families and training them in the best use of available resources including finance
5)Culture appropriate awareness of the best use of locally available food

MEASLES ELIMINATION
1) Pressure on national governance to prioritise elimination of vaccine preventable diseases in the national plan and allocate adequate resources
2) Understand social and cultural factors that are important barriers to adoption of vaccination and design / evaluate appropriate strategies to overcome them
3)Ensure excellent supply chain for adequate high quality availability of vaccine at the grass root level
4)Provide incentives to healthcare workers and communities and governments foe achievements of realistic immunisation targets
5)Address underlying factors such as nutrition , housing , etc to reduce mortality and morbidity in patients with measles

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