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I agree with Kimberly’s insight on WASH modeling behavior that complements the promotion of nutrition. In a world where specialization is increasing, I think it’s important not to lose sight of the big picture. Improving health, even to the end of cognitive and language development, is tied in to multiple factors such as sanitation as you pointed out. Interventions with water, sanitation and handwashing can increase access to improved nutrition and subsequently child development.
Question 2: WASH and nutrition relate in the common factor of personal accountability and health education. Promoting better sanitation, hygiene, and nutrition, enables individuals while shaping a community culture that is for improving public health. This would effectively contribute to increasing prevention, and we know that prevention is an ideal approach (and cost effective in the long run).
I think WASH and nutrition complement each other in the same way how medical conditions are rarely approached from a singular aspect. A patient with diabetes is most effectively managed not only with insulin, but with education on diet, weight loss, and its relationship with other chronic conditions if not treated. Promoting proper hand hygiene, even from simplistic view, encourages accountability and intention for positive health outcomes from both the child and parent. Improved sanitation decreases the likelihood of infectious diseases and subsequent malnutrition. I think this article showed the importance of implementation and follow up through community health workers. All of these factors are related – including behavioral such as the emotional support mentioned at the end – and I do agree that bundling targeted interventions together may prove more synergistically effective than when approached individually.
Question 1: Low resource communities will have a number of limitations, including financial constraints and health care workers. This directly impacts the availability of basic newborn resuscitation. The majority of newborns will not require advanced resuscitation, and it has been shown that range of health care workers are able to provide basic care and significantly reduce mortality. This week’s assignments have demonstrated how presence of a skilled birth attendant is extremely beneficial. Communities with high infant mortality rates should not only provide adequate training for birth attendants, but make every attempt to have enough attendants and the provision of essential equipment. When it comes to low resource communities, I think it is important to consider what small changes can allow for the greatest impact. Equipment for basic resuscitation is fairly essential, inexpensive and likely underutilized. If governments were to provide adequate funding and ensure staffing of skilled birth attendants – though I recognize this in itself could be a tall order – I believe this could make significant strides in increasing availability of basic newborn resuscitation.
I agree with Anthony’s statement on having a generalist view as well as the importance of mindset. I found that my PA training as a generalist has enabled me, even while working in a specialty, to be more inclined to provide expanded care. When I see uncontrolled hypertension or diabetes, when patients don’t have a PCP, I try to help them see the connection and implications on their cardiac health. From a maternal health aspect, in the same way I feel education and redirecting to available resources (or treating if possible at the same visit) could also be incorporated in clinic visits. I think women are more likely to seek care during or after pregnancy, so perhaps if they are being seen post partum, education on the importance of ongoing screening and prevention could be included. I’d be curious to see how that could play out, perhaps in a clinic specific for women’s health. I think also incorporating this mindset in multiple healthcare workers as you mentioned, will definitely make a difference. If this is built into the infrastructure and health care system, I believe it can bring about significant change.
Question 2: An encompassing approach in health care education and viewing women’s health as a whole should be greater emphasized. Increasing awareness of the multiple factors and inequities affecting women’s health, and defining maternal health more broadly may directly help establish systems that address more than just issues related to pregnancy, childbirth, and the postpartum period. The fact that breast cancer and cervical cancer are now leading killers, even outnumbering pregnancy associated mortality in many regions, shows that there is a greater health care disparity with women even beyond childbearing. As the article mentioned, this effect trickles down to families, society and economies. I think the interventions to change this approach of maternal healthcare are less costly and perhaps more achievable than what was discussed last week for HIV care. Education will play a huge role and implementation may come down to prevention, screening, and education.
Question 1: Conflict inevitably exacerbates the weaknesses in the current system and one aspect is maternal health care. It tends to redirect priorities, or at least the immediate ones, and women will be less likely or able to pursue antenatal care or even have ready access to healthcare. As the study mentioned, disruption in the delivery of routine health care and also the collapse of health care systems during conflict has a negatively impacts maternal morbidity and mortality. In areas where access and education were already limited, conflict can make the existing obstacles such as transportation, distance, safety and financial constraints even greater – not to mention additional factors such as greater incidences of sexual violence. Unfortunately, the increased vulnerability of women during times of conflict is shown in the excess mortality of women over men.
Hi Kun Wook Lee,
I agree with your assessment on mandatory testing. Unfortunately, the stigma and cultural norms in certain countries will limit the frequency of testing when voluntary. Thank you for pointing that out as this was not something I immediately considered. From a global health perspective, I agree that if this were implemented in medical facilities, this would lead to many earlier diagnoses and hopefully with education, counseling, psychosocial support, and other comprehensive interventions to facilitate treatment, we will see much better control of HIV in the pediatric population moving forward.
Question 2. It seems that although HIV testing and access to testing and treatment has expanded over the years for the adult population, testing has not been as available or at least implemented for the pediatric population. I’m personally not aware of the current guidelines (if anyone has experience with this, I’d love to hear), but I would think that if undiagnosed adults are living with HIV and asymptomatic, transmission during breastfeeding could easily be missed. Perhaps having policies in place, led by the government, in clinics and hospitals for frequent or even mandatory testing of infants and children, could help. Vast screening could tip the scales over to more early diagnoses than later ones, hopefully leading to earlier treatment and subsequently better control of HIV in children. Controlling pediatric HIV definitely will be directly correlated with sustaining therapies and access to them, but it seems that under diagnosis might be the first issue to tackle. As I reflect back on my education, I feel the emphasis was much greater on treating and diagnosing adults with HIV, and less so with children, infants, and transmission during and after pregnancy.
Question 1. Although many barriers were mentioned in the article, I feel that the frequency of a late diagnosis is a major obstacle, and the challenge remains that HIV may initially present without symptoms. Global HIV control will be difficult to achieve if people are diagnosed later, as that increases the opportunity and likelihood of transmission over the years. Early diagnosis is key and this may require more frequent screening and high-risk populations. In addition, I do still feel there is a stigma associated. HIV prevention should be further embedded in public education and particularly on a regional level, addressing transmission and lifelong consequences of infection. Seeing how increased public awareness and the steps that Uganda took is a hopeful and promising example.
Hi Elijah, I agree with your statement on long term solutions and having strong leadership involving locals who’ve had personal experience. There are so many things that play into an effective strategy which include cultural and societal norms, that may prove to be obstacles from those outside the community. Collaboration is definitely needed as assistance is provided and implemented.
I agree with Kimberly’s assessment on a dedicated workforce, backed by appropriate policy and funding will help with reducing NTD burden especially as we see frequent reemergence during conflict. We’ve seen this strategy work well with leprosy and other diseases.
Question 2. Although not direct intervention, I believe starting with global policy and public education on these neglected tropical diseases can be effective. As mentioned in the article, many NTD’s cause a significant regional burden yet less so globally. I vaguely remember learning about these diseases in PA school, but as I never saw them on rotations or in practice, what they say being “out of sight out of mind” ultimately became true for me – even more so practicing in a specialty. For many health care workers across the world, without a real awareness of the prevalence of these preventable diseases, this knowledge gap fails to serve our global health community. Incorporating this education in is what will ultimately allow change and initiate subsequent interventions.
On a more practical level, improving sanitation and hygiene can go a long way for preventing many of these diseases in the long-term. Empowering local communities to have this standard of living, as well as training health care workers, building and implementing treatment programs and also sustainable prevention measures to prevent re-infection — these are what can significantly decrease burden. Interventions that may appear effective initially, will be futile if only the short-term effectiveness is looked at (ie. supplying medications annually, funded by other countries).
One aspect that stands out to me is the correlation with household crowding and increased likelihood of transmission. Not only has this been evident with the current pandemic, but prior studies have shown signification association with housing density, income levels, and TB. Isolation and thus mitigating spread becomes much more difficult. With poverty, there is also often decreased access to both medical care and education. So not only is prevention and spread of TB difficult to manage, but even treatment may not be completed in full especially if education and follow up is limited. Latent TB infections and drug resistant TB has complicated efforts to control the disease. Unfortunately, those living in poverty are historically a marginalized group. Barriers specific to those in poverty must be considered. I think systems set up to address these (such as DOT), greater public education on TB, increased healthcare funding specific to mitigating TB spread, and effective treatment through follow up could make a significant difference. I don’t see this happening in countries with a low prevalence of TB, and often countries with a high prevalence may not be equipped with the resources to initiate these programs. A global consensus recognizing the long-term gains (even to wealthier countries, which may be less drastic in the immediate period) to assist with implementing these efforts, may be key.
Hi everyone,
Registered a bit late here but happy to be joining everyone. I’m Jennifer, a physician assistant in Philadelphia, PA. I work in cardiology and have been in electrophysiology this past year.
I’m taking this course to further my understanding of international medicine. I am planning to join a physician and medical student on a short-term medical mission and wanted to increase my knowledge and awareness of global health issues, and to be better prepared for that experience.
For the future, I am interested in exploring options for partnering with medical missionaries. I’m not yet sure what that will look like — whether practicing internationally in a medically underserved area or participating in short term trips. But I hope to be involved in some way with global health and missions.