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1. There are many barriers to expansion of faculty development programs in LMIC. One is the “what’s in it for me” question for the local leaders. Will this result in improved performance, better patient care, increased revenue, decreased mistakes, higher prestige, ect? One must develop an effective argument to address the WIIFM question. Lack of establishment of community among the leaders, educators, and students can doom the program. Translation barriers, as Rubel suggested, certainly have an impact. Lack of communication of successes can harm the program. Selecting projects that are irrelevant to the community can also adversely affect a program. I am a nursing instructor in Nursing International. We are a non-profit that has developed a tech savvy open access nursing program that is free to anyone, targeted for low income settings. It is used throughout the world. Check out our website at https:nursinginternational.org. Our vision is “Improving the health of the world, one person, one nurse, one community at a time.” Our motive: Love God. Love people. Our motto: Listen. Learn. Serve. Share. Our biggest challenge is securing funding as I think it would be for most organizations.
2. I liked this article. In June of this year, I resigned as a nursing professor. On my last rotation, most of the clinical experiences for the previous year had been in the simulation lab. When we went back to the hospital, I noticed the students didn’t know how to chat and touch a patient in a caring way. I typically performed “think out loud” as I demonstrated a physical exam. When I had down time, I was in with patients, sharing a story or a laugh, or meeting with family members. They started doing the same. I watched a group of shy individuals turn into a group of joyful contributors by the end of the term. I was shocked that I was nominated twice for the prestigious Daisy Award for excellence in teaching. I also employed “activate the learner”. We came across several diagnoses that I had little knowledge. I would assign the student to do a quick PPT and they would be rewarded not only with more knowledge, but also a lottery ticket!! Finally, I would add “carry a life preserver”. I was teaching leadership in their last semester. They were so tired and worn out. One day, I exchanged their extensive written assignment for a paragraph response to a speaker for the day. I brought in an ICU nurse who was a former Green Beret and medic. He was a scruffy guy with tattoos. He even decompressed his own pneumothorax after being shot in the back in Afghanistan. He motivated us all to stay the course.Hey Nelson,
I am sure they would help with paying off loans!! Great folks and they would be lucky to have you.
Toodles,
JudyHello everyone!
Q1: Very interesting article. It validated many of my observations and outlined some thoughts that may be hard to accept. Because many went into medicine/nursing with the wrong motivation, I think the way to obtain effective universal coverage is through the development of a Medical Corps. We have one in the US and I worked along side of them on three Indian Reservations. I was impressed by their knowledge, passion and willingness to work hard. By increasing the size of the corps, clients would be drawn to participating and leave the private physicians as “concierge positions.” Pay to enter the corps should be attractive and entrance will be dependent on potential contributions, not ability to pay tuition. Data regarding outcomes can be tracked nationally. I am studying Cuban HealthCare. I think many of their ideas could be replicated. I love the concept of a doctor/nurse team responsible for the health status of 600-900 patients. They visit their patients in their home together. Cuba developed their own COVID vaccine and are administering it. Many do not realize Cuba has a vaccination for lung cancer.
Q2:
Elevate the position in respect, as reflected by appropriate remuneration. Have the CHWs participate in the development and promotion of the program. The CHW is the closest to the community and can identify needs promptly. Assure communication that is regular and frequent.Krishma, I appreciate your suggestion to leverage the capabilities of social workers. They are great communicators and we often forget the how important it is to deal with the coordinating and housing issues, along with their ability to provide counselling. At the refugee camp, we asked every adult if they would like to see a counselor and then referred them to MSF (Doctors without Borders) who had a counselor. I was surprised that over 50% requested such assistance. I think it would be helpful to have “Counselor/Social Worker” shirts so that people could approach them. We were unable to do that at the camp I was at because the medical workers were being targeted by the cartels.
Q1:Assessing the characteristics of the population served would be the first step in addressing cross cultural barriers. Neighborhoods change over time. Making real attempts at hiring staff that reflect the demographics of the served population is a positive step. The annual required competencies should include cultural sensitivity issues. The physical environment should reflect the cultural served. Both Pine Ridge and the Colorado River Indian Reservations incorporated Indian artwork. At the refugee centers, we attempt to find physicians who are refugees, to work with us on the team. This allows us to learn from them what would be appropriate interventions for the populations served. At a couple of places I have worked we had “chicks on a stick” which was a translation service with the person on an ipad hooking to a moveable platform that we literally moved around with us. It worked very well but I understand the service was spendy. Finally, at a rural hospital I worked, we allowed the community to eat lunch with the staff. I REALLY got to know the farmers.
Q2: I was surprised to find out that outbreak occurrences are higher in a CE as compared to an ND, especially vaccine-preventable outbreaks. I have not really considered vaccine teams as a big part of disaster care, but I do now. Perhaps developing some pre-emptive strike teams to treat prior to the specific events. Global Response was on the ground at the Philadelphia airport as the initial Afghanistan refugees were welcomed. I don’t think they administered immunizations, but I am going to check with them. Our national intelligence can predict instability. Do we need to intervene prior to breakdown? Having duplicate communication networks established prior to events can also be a goal.
Q1: Hello everyone! I have had a lot of “schooling” in my years, but infrequent education. I say this because true education involves integration and often they don’t do that in schools. The most helpful class of all was “Empathy Training” at the Denver Seminary. I wasn’t a good seminarian because I like to drink and dance so I dropped out. Along with the education that Jacob and Rubel so nicely describe, we need to develop empathy to those who have less than us. That will lead to will, and then to a way. I love the idea of a simple standard nutritional model. I also think the WHO has done that and promoted it. Our country needs to provide meaningful support to WHO.
Q2: War, poverty and greed are the biggest barriers to global health. I experienced an example this week. We were not allowed to give the refugees food at the base camp because the cartels had food to sell and they didn’t want us to compete. Food was provided at our secondary site, Senda de Vida, however, it wasn’t the highest quality. Our Sidewalk School staff denied to pay extortion and the cartel wrecked the school. Think of the money spent on the military. I would like us to shift to sponsoring a new “Homesteaders Act”” where refugees are assisted in setting up communities. They want to work! There is plenty of land and wealth in the US. GRM has empowered the Reynosa Camp sanitation team by providing facilities and money to bring in clean water. They also opened a free store stocked with toilet paper, soap and sanitary pads. Finally, we need to get out of our silos. I’m not Catholic, but I loved chatting with the American priests who were giving used clothing and soap. We coordinated with MSF (Doctors without Borders) to alternate days on staffing. We were able to get 60 pillows for the Angry Tias. I am connecting GRM with the Green Valley Samaritans. We need to think globally and act locally. Finally, let’s learn more about what caused this violence by studying history.
1. What is the mechanism through which WASH and promotion of nutrition complement one another?
I think Lauren addressed this question appropriately, addressing the major issues. I will add a different perspective because of my current situation. I am at a refugee camp and have met 2 WASH engineers. They have done amazing work. They have been successful by building social capital through local resources and collaborating with other groups, I am with Global Response. Doctors without Borders (Medecins San Frontiers, MSF) is also very active. The two engineers have just started their NGO, Solidarity Engineering. They have identified and empowered 60 refugees to be the Sanitation Crew. They stand outside of the bank of porta-potties and hand out a single sheet of toilet paper for each visitor. They build a hand washing station. They opened a free store where anyone can get soap, condoms and menstruation pads at any time. The WASH group implemented a life straw program to provide potable water. Although, I see patient after patient all day with urgent issues, generally I see less diarrheal concerns than I would expect due to their effort. We do generously hand out children, adult and pre-natal vitamins, along with folic acid to support the nutritional issues. Due to security issues, we are unable to provide nutrition because of the Cartels. By empowering the refugees, they have helped develop the refugees sense of power and worth. This week, the WASH group is placing a library for the refugees (albeit very limited) to learn. As Lauren stated, by learning they can improve their nutritional status. Finally, all encounters with our group and the WASH group are done with an attitude of caring and concern. It is amazing what a gentle touch and a lollipop, along with seeing their provider dance, can do! I forwarded this article to our WASH engineer.
2. How should maternal healthcare be expanded to protect women throughout their lives?
Again, I think Lauren well articulated interventions and outcomes that could be achieved through education and empowerment. I remember going to my OB-GYN several years ago and finding out I was being fired from the service because they wanted to focus only on OB. I found that very odd. As the article mentioned, there are plenty of women who are not mothers who need care. I would encourage the establishment of “Women’s only” units for several reasons. It would demonstrate value regarding females, no matter what their maternal status. It could become a safe haven for those experiencing domestic violence. Attention could be given to development of rape protocols. We could easily address hypertension, heart failure and diabetes to a certain extent. Cancer treatment may be more challenging. When I was on a mission in the jungle of Belize we discovered extensive cancer upon doing a lap chole on a 24 year old. Cancer treatment was not an option at that time, but her family could be prepared. Finally, we must empower women to feel a sense of worth by allowing them to provide whatever they can to support others. Finally, through technology, let’s train local health care workers to assume much of this activity, with consultation.Hello all,
Enjoyed everyone’s response and think we are in agreement about the importance of education and the marginal status children are placed just because they are children. I would like to toss out one more idea. We also mentioned access to resources, education ect. I think part of that is due to what I call “medical exclusivity” where we multi-degreed folks think we are the only ones that can take care of business. During this course I have valued the role of the Health Care Workers and the significant contribution they can provide. Part of my doctorate was on developing a program to train nursing assistants to be diabetes educators. They did great!! Let’s all remain humble as we share our learnings with those who may be better positioned, have greater influence and desire than we do. Just my 2 cents. JudyQuestion 1
The largest barrier to worldwide HIV control is lack of worldwide will. Those suffering in our poorest of countries are just trying to survive. The rest of us stay focused on first world problems. The other barrier is the reliance on sustained behavioral management. We seem to be able to handle anything when focused, but our ability to create sustainable platforms is marginal. Treatment requires patient and family commitment of time and energy. Real control will need several components: a vaccine, a shortened and easy treatment protocol and universal acceptance of the value of those infected with HIV. Expanded communication networks are helping, but we need more. Finally, we continue to fight wars. Peace brings progress; not wars. I also wonder about our moral compass when two of the richest men in the world use their resources to go into space rather than direct it to helping humanity. By the way, I was reviewing the IHS fact sheet on American Indian and Native Alaskan HIV status. 34% of the positive HIV population of that group are unaware of their status. https://www.ihs.gov/newsroom/factsheets/hiv-in-indian-country/Question 2
We take the same approach with pediatric HIV control as we do when flying in an airplane: put your own mask on first and then take care of the child. So many children are lost to follow up especially in poor countries. HIV testing at birth is occurring, but it is not universal. Coverage of early infant diagnosis within the first 2 months of life remains low especially in west and central Africa. The opportunity to test in other contact situations, such as malnutrition wards, tuberculosis clinics, and inpatient clinics is low. It’s hard enough for adults with a voice; the children have none.Hello everyone,
I finally figured out how to respond to the introductory messages. Welcome to you all! I am so humbled to be with such an extraordinaire group of people. I hope we can all meet in person at the next International Medicine Conference in June. I went a number of years ago, and it was great fun. Lauren, I bet being a rural scribe really was a great experience. Cecilia, if I was a little younger, I would be pursuing global epidemiology. At my age, I have learned not to plan to far ahead! Auggie, I was born in Oshawa, Ontario. I am a dual citizen and we are looking for a home in Nova Scotia. Where are you from? Cheers, Judy.Hi Julie,
I enjoyed your reply and appreciate the issue of lack of motivation for the pharmaceutical companies. I wonder if tax incentives would change that behavior? I also agree with your response regarding that we should all be more concerned about global health, rather than what is specific to the US. I think COVID is just an awakening. Bill Gates just did an interesting discussion on mosquitos. He has designated this week as Mosquito Week. Check it out! We have had an active monsoon season in Tucson and are paying attention to these critters.
Cheers,
JudyHi Lauren.
Before working with them, I was naïve about the wonderful efforts public health services offers in IHS. At one site, we had a mobile clinic that we drove to gathering places for various opportunities. For instance, they would go to the community centers and offer diabetes testing. Other times, we treated acne and STIs in high school, while parked in their lot. Related to TB, typically a person would eventually get to one of the hospitals and then the public health team did aggressive contact tracing with 4 wheel vehicles. The rate of active TB nationally dropped significantly between 2000-2014 but has stagnated. The rate of TB in the US Indian population is twice that of the US.
Cheers,
JudyPS I worry about the drones getting shot down, too. Maybe if we decorated them as flying pigs. . .
Two Interventions that would be most effective against NTD.
I was very discouraged after reading this article. It seems what needs to be done, cannot be done, because of lack of joint will. War is a breeding ground tor NTD that prevents patients from getting the care they need. I have no idea on how to end war.
One strategy is to incentivize the pharmaceutical companies to continue research, development and manufacturing of the medications related to the disease. Perhaps by lowering their corporate taxes might help.
Another strategy is to mobilize national health care teams, coordinated through the World Health Organization. Go to the patient with mobile units, rather than waiting for them to arrive on site. Perhaps these mobile units could be restocked by drones. Consider intermingling the teams among several countries like we have with use of the space station. Learning to collaborate could yield great outcomes.
Finally, I would suggest a blitz approach to some of the hot spot areas. I was surprised to find out that the poor living in wealthy group of 20 nations account for the majority of the world’s disease burden.
That’s all I have! I am a little depressed after this week’s reading. I also find myself getting rid of lots of bugs. . . .
Cheers,
JudyHello everyone,
Unfortunately, people living in poverty are most likely to suffer from TB because they live and work in poorly ventilated and overcrowded conditions. This makes the perfect environment for TB spread. These same people are often malnourished and may suffer from co-morbidities that decrease their immune systems. Often, there is minimal access to health care for early recognition and treatment of the disorder. Finally, because it requires completion of a full course of medications, they may not be compliant due to other priorities. We, occasionally, would have TB breakouts on the Indian Reservation. I developed a high respect for the home nurses who would first find the patients. Often the tribal members did not have addresses or telephones. Some continue to burn a fire in their home for cooking. The nurses became case managers, provided education and delivered the medication. Thankfully, the Indians did not have to pay for the medication, which eliminated that barrier.
Cheers,
JudyThank you for your thought provoking responses. I agree poverty is the key issue, and associated with that is unbalanced wealth distribution. I look at myself and question, when do I have enough wealth? Greed appears to be a core issue. Is is our religious beliefs or values that will shift our giving spirit? I do believe wealthier countries have a moral obligation to share a component of their wealth to address these concerns. As I have pursued our class and information I am learning through Global Response Management, I appreciate the leadership demonstrated by the United Nations, yet, in the US we hear so little of their influence. In fact, many question their legitimacy. How do we change that influence? I am struggling this week with the US decision to begin a booster immunization. I believe it is the right thing to do, but should be first contribute to our other world citizens?
