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Austing, I like and agree with your discussion on the first question, although I want to point out your comment regarding the lady you met working in Honduras and not working with the government. Perhaps it is not arrogance for I think sometimes there is wisdom in not working with the government most especially in these developing countries when there is so much pocketing and laundering of resources and abuse from the govt. Perhaps this lady has seen it and learned not to trust the government. I just talked to a lady who started a very successful and flourishing sustainable health community in Nepal. She learned to work independently from the govt. Granted you cannot entirely ignore working with them, but to plan on more autonomy from them may prove more beneficial.
Question #1: Dr. Burdick describes qualities of effective programming and global collaboration. What barriers exist to expansion of faculty development programming in LMIC (low and middle income) settings?
Dr Burdick identified 3 barriers in the faculty development programming: alignment with local needs, persistent dependency, and development of trust. I agree with him. Definitely making sure that the local needs not just aligned but I believe that it should be the central point of the education efforts. Persistent Dependency can be a barrier most especially considering the low resources from these communities and the response from the international community to just hand out money and send the foreign “experts” to save the day. These are well and good but become a barrier when the locals are conditioned to just receive and think that they must not be good enough to be able to do it for themselves. And of course, developing trust the trust from the locals would be hard as we know the adage “don’t talk to strangers” ha ha. What may make it worse for international health partnerships could be seen from the history of most of these developing countries coming out from centuries of colonialism, they are more cautious and fearful of trusting strangers again. And when trust is violated it is harder to gain back and develop. I would add language barrier and governmental red tapes that most often exist when working with developing countries.Gregor, good point on focusing as well on the teamwork of everyone involved in providing the healthcare services, perhaps in communicating priorities as well, as they organize the problems as you mentioned based on whose available to help at that time.
Question 2: How could low-resource communities better make use of community health workers?
Low-resource communities can start by recognizing the important role of CHW in the health of their community. They need to empower them by allocating funds to give them fair wages for their work, providing training to armed them with knowledge and skills on how to deliver preventive and curative services, giving them plenty of opportunities to be able to apply these knowledge and gain ample experiences to be effective, and ensuring that they have computers, data systems, equipments, medical supplies, as much as possible, to be successful in their work. I agree with the author that low-resource communities need to institutionalized CHWs within the community health systems not as an afterthought or luxury but as a priority!Question # 1 : Universal Health coverage focus has been in providing health care services to all regardless of one’s ability to pay. The problem is that the quality of healthcare services suffer. It is like focusing on the forest but forgetting about the trees. Healthcare services may have been made available to all but: Are the services being offered effective in providing for the care the patients really need? Are the services safe? Are they really looking out for the welfare of the patient? These are the three necessary elements to be added to ensure the effectiveness of the universal health program. The quality of the health services greatly hinges on the medical providers hired. The article pointed out the need to bridge the gap between the knowledge of the providers and their actual practice. There also has to be a need to ensure that medical mistakes are avoided for the safety of the patients. I am not surprised with the statistics that medical errors account as the number 3 leading deaths in the country (although it has been widely refuted in terms of the data used). My husband had a supposedly simple procedure, ERCP, at KU but his bile duct was accidentally poked. I spent a lot of time in hospital waiting rooms and talked to several patients/families whose current problems were due to misdiagnosis or medical errors by the providers. Very sad situation! And the last element is to focus more on the patient by spending longer time with them and giving a thorough analysis of their needs. Not prescribing antibiotics and other drugs or procedures just to get more $ but to see if it is really beneficial to the patient. Treating them as not just another number in the waiting room to check off but a person whose life is being entrusted into their hands.
Abanda, I love how you always qualify terminologies before you answer. That is really great! And I like your last comment for question 2 “An effort to progress in the sustainable development agenda of communities as well as prevent conflicts and maintain peace is key”. I agree!
Question 2: What prevention interventions could best help reduce consequences of complex humanitarian emergencies?
Complex Humanitarian Emergencies emanating from wars and other conflicts should be easier to predict than Natural Disasters. For this reason, it would make sense that prevention interventions should be easier to plan and implement to reduce devastating consequences of CHE. Prevention interventions should start with the global involvement of all authorities when any crisis starts to surface all over the world, especially in under-resourced countries. Once identified, start to anticipate possible consequences and plan accordingly. Start planning what resources are needed from the medical aspects of trained healthcare workers who can speak the language and understands the culture (and can handle high mental health issues) and medical supplies including vaccinations anticipating diseases that will emerge from lack of proper sanitation, water, etc. In addition to this, consider the infrastructures in the area, the level of government authorities who will be left working in the aftermath, the food and water supply, and plan ahead where and how to send out help when the CE happens. Communication with a reasonable level of transparency (considering some information is confidential) is vital among different levels of authorities in all sectors of the community to rally everyone to work towards the common goal of setting up a prevention intervention plan that will reduce casualties and devastations as a consequence of CHEs. Most people will cooperate and help when it is for the common good of all.
Question 1: What actions can healthcare providers take to decrease cross-cultural barriers?
This issue should start in the healthcare institutions. More cross-cultural classes should be offered to prepare future HCP most especially at this time when the world is more globally integrated. These classes should be a requirement . These should also include foreign languages with requirements for at least two years. I believe this is a requirement in some universities now.
Regarding the healthcare providers themselves, they should be proactive in educating themselves in the community they serve. What is the percentage of the different ethnicities represented, languages, cultures, etc. I used to live in Southern California, and I can tell mostly the ethnic background of most people living in the city. I know where most of the Filipinos, Chinese, Vietnamese, Armenians, etc live. Even if it is not as obvious, like where I live now in Kansas City area, you can drive around the area, checkout the restaurants, the groceries, etc. These will give you an idea of the community. Also asking questions from the staff, looking at the records, etc. There are several ways to get to know the community you are serving and how to communicate with them to provide the best healthcare possible. If not sure, always ask for help. HCPs should take out any biases or stereotypes. Their patients should be treated as an individual above all. Always be respectful and treat each with dignity regardless of the person’s cultural background.I agree with you Austin on this. “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.”
Great discussion everyone! Sorry this is late! Ill post my answers earlier next time!Question 1: What actions are most important to improve global nutrition?
I believe the most important action to improve global nutrition is to have all nations working together as a global community address all aspects of global nutrition from food production, food consumption, health and nutrition to social and governmental responsibility. The latter as it relates to the global rise in diseases associated with the current nutritional habits which the Western influence cannot be overlooked. There are also several threats to global food security that need to be discussed which should be a priority most especially after the lessons learned from the recent global Covid pandemic.
We can start with the education on what good nutrition constitutes . Silence the loud voice of greedy multinational companies with their highly-processed zero-nutrient food, and let them take the social responsibility for the increase in deaths from NCDs due to the high blood pressure, hyperglycemia, and high cholesterol. Let the sugar battle against these companies be the next tobacco battle and start adding labels that “added sugar” or several manufactured sugar consumption is harmful to your health. Let them also take responsibility for GMOs that now pervades the food industry motivated by once again greed, and global health suffers. The results of most studies with GM foods indicate that they may cause some common toxic effects such as hepatic, pancreatic, renal, or reproductive effects and may alter the hematological, biochemical, and immunologic parameters. Educating the public with this knowledge and going back to the basic, organic, ideally home-grown food would be great.Question 2: In your opinion, what are today’s greatest obstacles to progress in global health?
The rise in DALYs from wars and interpersonal violence shows that this is still the greatest obstacle to progress in global health. It is indeed tragic as the article pointed out to see the increase in life expectancy from science and socioeconomic development only to be undermined by these conflicts. The other great obstacle I believe is the bad nutritional habits as shown in the increase in deaths from NDC. The high risk factors from high-salt diets, drug use, alcohol, tobacco & now the rise in usage of vaping in the younger population which will definitely show an increase in DALYs in future studies.Click this text link to post your response: International Public Health Week 1 Discussion Forum
Austin, I really like your answer on the problem of the statistical studies on your profession. I like the study you cited Very well discussed!
Reinventing Biostatistics Education for Basic Scientists. PLOS Biology 2016
Question #1: What problems have you observed in the application of statistical information? What steps are necessary to improve use of reliable statistics in your own profession?
Definitely the main problem is the misuse of statistical methods used in the research which as the authors mentioned stems from the lack of understanding of the statistics. The author mentioned the problem of one-size-fits-all regarding the sample size, I would say the grave mistake in academia is the assumption of one-test-fits-all as evidenced by requiring only General Statistics in most graduate study programs.
In my field in Natural Medicine, the important step necessary to improve the use of reliable statistics is definitely in reporting and analyzing more the attrition and outliers in the research. The attrition bias happens when participants drop out from a study. Missing or incomplete outcome data due to attrition can definitely weaken the validity of the study most especially when most of the time you already have a small sample size in the first place. The missing or incomplete data can change the interaction of the variables you are studying. You may erroneously say there is a correlation when there is none or come out with no correlation when there could be one.Association and Causation in Epidemiology – Half a Century Since Bradford Hill’s Interpretational Guidance. Royal Society of Medicine 2015
Question #2: Which, in your opinion, of Bradford Hills ‘guidelines’ make for the strongest defense for causation? Why do you believe this? I would say ‘temporality’ (the effect follows the potential cause after an appropriate interval) since this is the only one, as even discussed in the lesson, considered to be an essential for the causal inference. It makes sense to expect that if you are looking at the causation that the effect has to occur after the cause and if there is an expected delay between the cause and the expected effect then the effect must occur after the delay.Barry, good discussion on the drinking behavior.
I do agree with everyone about the article’s confounding effect on our brain, ha ha!Question #1: In what ways can drinking behavior confound the measurement of disease status and treatment?
If you are studying the effects of smoking on heart disease, drinking behavior will confound the measurement of heart disease since alcohol consumption is also directly correlated to heart disease. Another example would be the study of high-fat diet on obesity. Drinking behavior will definitey be a confounder since alcohol consumption affects obesity.Question #2: What is the proposed simple test to identify confounded epidemiology studies?
The proposed simple test is blocking the effects of the confounders on the given study.
To investigate the effects of alcohol use at baseline on the mortality of chronic disease, the confounding effects on health at baseline by the confounders are blocked. If the effects of alcohol use at baseline by the confounders are blocked (or removed) then any alcohol use prior to the baseline will not affect the mortality of chronic disease at baseline.Question #1: What are some current problems with collecting reliable information about health status?
The problem with collecting reliable information about health status is the high accuracy needed with the high volume of information collected. There is a need to monitor all of the people all of the time most especially with chronic patients then accurately compute their status and accurately sort them into treatment cohorts. The second question offers the solution to this problem
Question #2: What, in your opinion, are some potential advantages and disadvantages of passive electronic health monitoring?
The passive electronic health monitoring offers a solution to the problem of monitoring all of the people all of the time and computing their status. This is a great advantage especially when the passive monitors just run without a lot of additional tasks from the patients. This technology tremendously helps those unable to monitor themselves. The problem posed by this solution is its accuracy. Some monitors have to be worn in the right way with the right position otherwise you get inaccurate information. Wearable fitness devices require compact form to be conveniently used. There is also the issue of limited battery life which limits sampling like measuring cardiopulmonary function.Responses to Comments: I agree with the comments regarding the major advantages of this technology most especially in monitoring hearts for the pacemakers and the blood sugar level for diabetic patients. Even for the healthy population now, with regards to tracking walking, running, and other activities have definitely saved time and even encouraged people to be more health conscious. The future preventive measures using these passive m
monitors are also very optimistic. It can help detect issues even before or even without the annual physicals, which a lot of low-income people without insurance cannot afford anyway. But as always, with these kinds of technologies, commercial profitability comes first before the patient’s privacy. In the absence of more protective laws, you just have to weigh whether the benefit outweighs the cost. We have been giving away a lot of our own privacy even in social media anyways, what more for something that can save your life!