[Austin Scott]

You are so right. Dependence is the biggest barrier. There just seems to be this fear to equip the locals with the skills they need and then let them get after it. We want to be in control and that is simply not Christ’s way.

[Austin Scott]

Q1. The current model of international missions creates dependence, as western organizations are more inclined to “give people fish” instead of teaching them “how to fish”. All over the world (and I mean everywhere), Christian organizations from the west, operate to promote their institutional and denominational distinctives rather than nurturing indigenous Christian movements. In other words, instead of fostering the independence of the nationals they come to “serve”, western Christian organizations absorb them into their institutions, thus “expanding the brand” in their country. This practice is nothing more than “white father” colonialism under a “Christian” guise as it perpetuates dependence and underdevelopment. With this practice being the modus operandi of most missionary agencies, it is no surprise that the nationals feel no sense of urgency to take the initiative to help themselves. What is so insidious about the process, is that organizations create the dependence, and then complain about the people being dependent. However, the root of this approach to missions is always money. Organizations make their money through big splashy, short-term projects that make donors feel good about giving. Hosting a medical outreach where 15,000 locals get treatment is much sexier than building a training hospital that will produce enough local doctors and nurses to put the western mission organization out of business. In nearly every instance, the planning and execution of services are conducted without indigenous input as to cultural appropriateness, impact on the local economy, sustainability, or effectiveness. I was on a plane last year, on my way to the Global Health Missions Conference, and I met a woman who was head over an organization that operated in Honduras. When I asked her if the Honduran government sanctioned her activities, she said, “No. Why would I ask the government for permission when they are just going to tell me, ‘No'”. This type of arrogance is typical among western Christian mission organizations and it has caused many barriers for other groups to operate in hard-to-reach countries. In light of all this, the problem Dr. Burdick describes in the article is nothing more than a symptom of the greater problem of the western approach to missions.

Q2. While resource-poor, one thing I have encountered in nearly every developing country I visited is that the people are humble, thirsty for knowledge, and eager to help themselves, especially in critical areas like healthcare. One of the most exemplary clinical teaching organizations that meet this need is I-TEC. They host TRAININGS for indigenous tribal groups that are so effective that those with no background in healthcare can perform the basic functions of a doctor or dentist. What I appreciate most about I-TEC is that they leave the area completely once the training is over and the locals feel confident in their skills. At that point, they make themselves available only as consultants.

[Austin Scott]

Thank you for your post. You said, ” A doctor in one place might only see 6 patients a day because in that culture you see them as a patient, but then you have dinner with their family because that is what is expected.” This behavior is a matter of culture and that is my argument. There must be a culture of care for the patients in order for Universal Healthcare to work.

[Austin Scott]

Q1. The author cited that in certain countries such as Bangladesh and Uganda, even with the proper equipment and infrastructure, they still struggle with doctor absenteeism which is between 40% and 60%. What we ascertain from this statistic is that Universal Healthcare, which means accessibility of equipment, infrastructure, and personnel is not enough to ensure the delivery of quality care. Rather, what is needed is a culture of care, where human life is prized, such as the operations of the clinic Evangelica Monrova. In their case, even without the most modern equipment and limited personnel, the quality of care they provided the Maskito people left a permanent impression on Nicaragua.
Q2. The issue with the development and utilization of community health workers has nothing to do with their availability in impoverished communities, their willingness to work, or access to proper equipment. CHW’s are more than willing to work and equipment can be purchased. The problem is, as the author noted, “… many countries remain reluctant to allocate health sector resources to the community level…” So long as governments refuse to empower their local communities with training, infrastructure, and equipment, the people in these areas will continue to languish until the regional or federal governments intervene or NGO’s provide assistance. Governments in these developing countries are also reticent to provide clean water and basic sanitation in these same communities.

[Austin Scott]

Thank you for your post. I find incentivizing physicians to educate themselves on their patient population to be a unique idea. I believe you are right that we should not have to do this, but in some instances it may be necessary. What kind of incentives would you give?

[Austin Scott]

I agree with you. The medical establishment is not interested in curing anything. They are only interested in “treating” the illness because it makes them billions of dollars annually. Holistic approaches to medicine are marginalized by the medical industrial complex.

[Austin Scott]

Question 1: Education as to what constitutes “food” and access to nutritious foods are essential to improving global nutrition. The authors expressed concerns that global food production trends are following the western diet with its highly processed and energy dense foods. However, just because something is edible, does not make it food. Real food provides your body with the minerals and nutrients that sustain long-term health. Processed foods do not accomplish this need. Therefore, corporations must stop disincentivizing organically grown foods by making them more expensive than processed foods. I cannot comprehend how a food grown without chemicals and heavy processing, can cost more than a food that is heavily dependent upon chemicals and is made with heavy processing. Therefore, to improve global nutrition we must look at the supply chains of our food sources and ensure that they are organic, fairly produced, and affordable to all.
Question 2: The author mentions “environmental hygiene” as a significant obstruction to global health. It appears to me that global health begins with the basics such as sanitation, clean water, and education. Providing toilets for every home, bio-sand filtration systems for every facility, and educating the populous on personal hygiene, are simple and cost-effective actions that governments can take to ease the disease burden in their countries. However, as someone who has worked in the non-profit world, the easy, simple, and practical do not make the headlines, and thus do not attract investment. Notwithstanding, these basic steps of providing toilets, filtered water sources, and personal hygiene training can revolutionize a country, enabling more able-bodied men to enter the workforce instead of the hospital.

[Austin Scott]

I think approaching the question without objectivity is one of the biggest problems.

[Austin Scott]

Question 1:My work is at the nexus of Christian missions, higher education, race, and culture. Often, comparative statistics between ethnic groups concerning social, academic, and economic status are riddled with bias. For example, the Journal for Blacks in Higher Education will post a statistic on its website comparing the average salary of Whites with PhDs, to Blacks with PhDs, with Whites almost always having the higher salary. However, the comparative analysis is confounded when taking into account the fields in which both Blacks and Whites obtain their PhD’s. Whites typically procure PhDs in STEM fields that are rewarded by the market with a higher salary. Whereas Blacks tend toward procuring terminal degrees in the education field which will garner a lower salary. I agree with the author that statistics training should be used in every field that relies upon statistics.
Question 2: I believe consistency is the guideline that makes the strongest case for causation. If the same risk factors at different times and different places can be associated with a particular illness, it is more plausible to be the cause than if the risk factors and illness were localized.

[Austin Scott]

Thank you for your post. I must say I was “confounded” by the article. I agree with you that health affects drinking behavior but just as equally, drinking behavior affects health. A person may drink socially, to medicate their pain, or any number of other reasons. This is a difficult subject because health explains behavior and behavior explains health. The relationship between the two is dynamic.

[Austin Scott]

Q1. Drinking behaviors affect health, and health influences drinking behaviors. Therefore, any study that measures alcohol-related disease and treatment without accounting for drinking behaviors will have a confounded study.

Q2. The test Dr. Liang proposes that confounding in an epidemiological study (particularly alcohol) can be determined by whether the risk ratio by previous exposure status among non-users at the beginning of the study does or does not equal one. The author suggests that randomization is the best method of eliminating confounding, with stratification as the preferred secondary method if randomization is not available.

[Austin Scott]

Hi Kathryn. Thank you for your post and your kind response to mine. I believe that the submission of your relative’s pacemaker data to a medical institution is completely appropriate, as their receipt of the information is a matter of life and death. However, I do not believe this scenario is what the author had in mind when referring to passive monitoring. What he is suggesting is something comparable to how the internet tracks our every move to market every conceivable good and service to us based upon our interests. His idea is to not only collect data pertaining to chronic illnesses but to have records of the full spectrum of a person’s health.

[Austin Scott]

In modern medicine, health monitoring by medical institutions occurs episodically, usually while giving acute or long-term care. The problem with this approach is that the data collected during these crises do not present an overall picture of the patient health, only the health status of the patient as affected by the illness (“sick care”). Our health care system in its present form only allows for a reactive approach to care, and this is in large part due to the inability to regularly monitor individual health. For instance, according to Schatz (Population 2), there are approximately 16 million diagnosed COPD cases in the US, but that figure only represents half of all cases. To remedy this crisis, he asserts, “Passive monitors with ordinary smartphones could automatically perform case finding for entire populations, while routing potential cases into primary care for confirmatory diagnosis and prevention” (Schatz 2). The implications of this summation lead to the answer to the second question.
2. The trouble with the mass collection, transfer, and analysis of personal health data is that it poses many legal and ethical challenges related to the issue of privacy and human rights. What Schatz suggests is not unlike the bulk data collection program established by the Central Intelligence Agency under the 2001 USA PATRIOT act. This program allowed the US government to collect phone, media, and other personal data on US citizens and foreign countries. The effort was eventually amended by the 2015 Freedom Act due to intense pressure from human rights groups and other forces within the US government. Though potentially not as extreme, Schatz’s plan requires the general populous to allow for the medical establishment to track their movements at all times, circumscribing privacy and thus restricting individual liberty. Of course, malefactors could procure this information through cyberattacks and utilize the information for illicit gain.

Reference
R. Schatz, B. (2018). Population measurement for health systems. Npj Digital Medicine, 1(1). https://doi.org/10.1038/s41746-017-0004-2

[Austin Scott]

I agree that the virus should be researched further but the process must be democratized. The general populous must have a hand in the conducting of the research in order for them to be confident that they had direct involvement in any conclusion that is reached by the medical community. In this way, the people will be confident in any vaccinations that are offered.

[Austin Scott]

Question 1: Management of epidemics can become more effective when the idea that the burden of responsibility for their eradication shifts from the government and healthcare entities to the whole of society. We do not have the technology that makes the average person “citizen-healthcare workers” like Twitter, Facebook, and Instagram have made the general populous “citizen journalists.” Another problem that hinders effective responses to epidemics is that these occurrences are viewed primarily as a healthcare issue as opposed to an economic one. One of the primary drivers of the spread of pathogens is the mass influx of people leaving the rural districts for cities in record numbers. This mass migration is not principally due to preference but necessity. People living in rural areas often experience a lack of government investment in infrastructure, education, sanitation, and telecommunications, while the infrastructure of the cities is often well subsidized and developed. For example, I live in North Carolina. In 2022, there are people living in the rural areas of Eastern and Western NC that still do not have running water and electricity. Many of these make their way to Charlotte, which is the wealthiest city in the state. In this light, it is evident that this population is relocating to the cities to secure better financial and educational opportunities. The preference of governments to invest more in the cities than the rural areas creates a kind of “double jeopardy” situation for government officials. For, while they are generating revenue from their investment in the cities more than in the countryside, they are driving the exodus from the countryside into the cities, increasing the spread of pathogens and the likelihood of a pandemic.

Question 2: Pastoral leadership, cultural anthropologists, and Christian missionaries must be systematically integrated into any epidemic response as they are responsible for knowing the granular details of the communities they serve. This is not a novel suggestion. To help eradicate the Smallpox virus in central Africa, the World Health Organization called on Christian missionaries to apprise them of any new outbreaks. It was largely due to their efforts that the WHO knew precisely where to provide vaccinations, thus eliminating the virus.

Question 2:

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