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1. I would probably have to say that the biggest impact on women’s health as a result of armed conflict would be access to care. Without access, there is no care. Armed conflict increases anxiety about moving around. There could be violence anywhere. Everywhere, sometimes even your own home would feel unsafe. Women wouldn’t be seeking out routine care because it could seem to be a risk to their life to go out. Not to mention the care centers may not exist anymore. The doctors may have fled, the centers may have been turned into acute care facilities for the injured, the buildings could have been destroyed, etc.
2. As mentioned in the article, non-communicable diseases are a major cause of morbidity and mortality in this group. Addressing those diseases by increasing screening would be a major step towards reducing these preventable deaths. Diabetes and hypertension would be quite simple to improve screening for by providing these areas with blood pressure cuffs and handheld blood sugar and A1C test kits and educating the staff on their use. Screening for breast and cervical cancers would be more difficult, as pap-smears and mammograms require more resources. While treating them is another battle with more complexity, they won’t be treated if they are unaware of the issue. By increasing screening, we would get a better idea just how prevalent these issues are. That would help to drive policies in the region to provide more resources for the specific issues that plague their women.
Dr. Lee,
Good question. In medical school, our ethics classes taught us about the principles of ethics in medicine, and this question addresses the autonomy principle, or the ability to make decisions for yourself. In America at least, patients have the right to refuse treatment, even life-saving, if they so choose. But I suppose the testing of HIV is not treatment, so do they have the full right to refuse? They can certainly refuse to know the results of the test, but it would be beneficial in some ways for the medical care team to know whether or not they were caring for a patient with a highly infective disease. So I would not think it wrong in areas where HIV is more common for HIV testing to be relatively routine, particularly for patients undergoing surgery, etc. where physicians/nurses/etc are exposed to their bodily fluids and have increased risk for infection themselves. Do the medical team not have the right to know what risks they are taking when caring for patients as well?
Dr. Lee,
A very interesting observation about how the religiously based societal constructs pose a difficult barrier to the treatment of HIV. However, with much of the spread being outside of homosexual activity, this should not be the case. These governments need to be provided data that there are numerous routes of infection outside of these forbidden practices. Somehow there needs to be a way to provide treatment for these people, even if they are practicing homosexuals. Focused diplomatic interaction must be a priority to engage these patients in treatment and reduce the spread and improve their lives.
1. Knowledge. The knowledge of how the virus is spread and how it causes disease in the populations at risk, how to avoid spread, and possibly most importantly, knowledge of their current disease state. If you are asymptomatic, you likely don’t know you have HIV without being tested. But you are not likely to get tested unless you know you have some risk of having been infected. Increasing testing availability would be an important part of addressing this. Spreading knowledge of the disease process would likely increase people’s willingness to get tested because they would be more aware of the fact that they are at risk. Increasing people’s awareness of the prevalence of the disease and that it is medically manageable could reduce stigma, also increasing willingness to get tested. Knowing you have the virus will (hopefully) guide people in their future behaviors, as well as seeking treatment, making them less likely to spread it.
2. Reducing spread is a major goal to addressing the epidemic. The more well-known methods of spread are through sexual contact and IV drugs. Babies do not do either of these, and I would suspect that the goal of reducing transmission was more targeted at these. I will say that I was not keenly aware of the transmission to children through breastmilk before this lesson, so I would assume that would be the case for a significant number of others as well. And because breast feeding is the only reasonable option for many people, there is no feasible way to prevent the spread through this mechanism in those populations, even if they knew it was a risk.
Hi Jennifer, I appreciate that you brought up the fact that the wealthier countries that are generally minimally affected by TB compared to impoverished countries will still see benefit from assisting the impoverished countries in their efforts to control TB. As interconnected as the world is today, and as transmissible as TB can be, it is almost certain that someone will bring the disease over to the wealthier nations. Be it a tourist returning home, an international student taking a class abroad, businessmen, refugees, politicians, etc. Even though the poorer nations see a greater benefit because they carry the majority of the burden, there is still a benefit to be seen on both ends.
Dr. Lee, I strongly agree with this response. While there definitely are steps that the wealthier nations can and should take to assist those most affected by these diseases, much still lies on the nations themselves, both individually and federally. Long term solutions are needed in these cases, and those that are not directly affected will not remain involved for that long term. Therefore the leadership in obtaining the goal of eradication, or at least significant reduction, must be passed off to local officials. They have likely had personal experience with these diseases on some level, and will be more effective long term at keeping them at bay in their community.
1. People living in poverty are at increased risk for TB for a few reasons. I would posit that one of the main reasons is that they live in closer quarters. TB spreads by airborne particles, which makes it relatively easy for it to spread from person to person if people are constantly in close proximity. Homes are smaller because land and space are commodities, which cost money. Poorer families and poorer countries have smaller homes, and sometimes they are even single room homes. Many of these individuals also often work in close quarters, such as what we call “sweat shops.” These working conditions will also increase spread between homes, increasing likelihood of TB outbreaks. TB can also be latent and reactivate in some individuals, leading to consecutive outbreaks in the same areas if screening is not performed adequately. Screening is likely to be less effective in areas of poverty where they do not have the best lab or imaging technology readily available, of where people who are asymptomatic do not go in for screening because they are being relied upon to work for their family’s survival.
2. The article mentions political destabilization multiple times, and that “next to poverty, conflict may be the biggest social determinant of NTDs.” War destroys infrastructure, making it difficult for those areas to create treatments and difficult to get treatments to the areas. It also deters many people, at least in the moment, from intentionally going into those areas for fear of self-harm. Bringing peace to war-torn areas would a major first step in healing the regions of these NTD’s.
Secondly, our good old friend “education” returns as an answer. Because different regions have different NTD’s that are endemic to them, it would behoove each area to be able to set up research labs to study their particular disease, so that they do not have to rely as much on outside assistance. Educating the local population, both about the disease processes, but also so that individuals can be raised up to take over those labs and bring about better treatment opportunities for the diseases that plague their homes. People that are emotionally invested in a cure are more likely to work harder and to find one, and then implement it in a way that their culture will accept.
I am currently a 3rd year medical student in Ft. Worth. Prior to medical school I worked in the ER as a scribe and have some experience shadowing various medical specialties.
I am taking this course, in part because I find the subject interesting. I believe it is an important subject to be familiar with, even if you are not pursuing it professionally. I also believe that the knowledge gained through the course will be beneficial to myself and some of my patients in my future practice.
I will graduate May 2022 and begin residency shortly thereafter, but have not decided what field to pursue quite yet. I do plan and hope to participate in medical missions throughout my career.