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In response to Question #2
Activating the learner can be translatable to education in LMIC locations. I say this because the learner’s motivation plays a significant role in accepting education and health promotion initiatives. In my stove project where we introduced safe wood burning stoves with a closed firebox in a community, we needed to make sure each family was engaged. Initially we surveyed them regarding signs and symptoms of the harmful effects of open fire cooking in the home. Recognizing that their resp illnesses may be a consequence of the open fire cooking was motivational for them to partake in the project and take ownership in accepting a stove from the initial steps of helping to move the materials to the final steps of removing the open fire area from the home and using the new stove. In this example, the learners are the villagers in each community. the other learner in this situation was the community health promoter, who while he did not have a medical degree, came to understand the harmful effects of open fire cooking and the benefits of using a closed fire box safer stove.In response to Question 1: this article points to a lot of barriers/ challenges. I think any type of education/ health promotion initiative/ leadership building must involve the community being focused on. strategies for education must consider the local needs and the available resources. Barriers to development of programs likely involved poor buy in from the local community because of lack of involvement at the table with those trying to develop the programs. I think education and health promotion would be more successful if we were better at involving the local communities rather than deciding for ourselves what WE think is best for THEM. Another challenge may be lack of trust of the community of outside influence. Another challenge is differing cultures and how education must take into account culture to be appreciated and accepted.
in response to Judith’s answer to question #1: I completely agree that faculty are not incentivized to teach and develop curriculum and this is a huge challenge. this is also seen even in developed countries in organizations that do not stress the importance of scholarly activity.
In Response to Matthew: I agree completely that community health workers can educate their community. And you make a very important point… that community health workers can empower patients and this can lead to a healthcare system in their own community that is accountable for the care they provide. Community health workers will likely be more dedicated to serve their community than outside providers or physicians that work for profit. The community health workers would be knowledgeable about community beliefs like the example you give of insulin being thought to be dangerous as a foreign substance. Their knowledge will certainly prove to be helpful in educating their own community.
1. What additional elements would be necessary for universal health coverage to be effective?
From this article, there is a lack of quality in the medical care that is available in developing countries. Work ethic among medical providers seems to be lacking. Some health care providers are seeing very few patients per day and only spending a few minutes with each of those patients. There is also a statement that doctors provide more effort and deliver higher quality of care in private vs public clinics. These medical professionals are poorly trained, undermotivated, and do not have peers/ mentors on site to supervise them according to this article. With insufficient volume of patients, they cannot hone their skills. Without dedication and improved work ethic, it will be difficult to lead to effective universal health coverage. I think training more community health workers who are committed to their communities would be helpful. this training needs to be offered world-wide to reach the poorest communities.2. Guatemala/ Central America is my community of interest. Community health workers have proved to be very helpful in carrying out community surveys that lead us to determine needs in a community. In addition to determining what their community needs to improve their health status, community health workers can help with education of the community. When a need is identified, and a health promotion initiative planned, community health workers will be the best at educating the community on this health promotion initiative. Often health promotion initiatives do not last and communities return to prior practices that may not be as safe or healthy for them. Community health workers will have a role in ensuring that the health promotion initiatives or the changes made in the community continue to be carried out.
Question 1: What prevention interventions could best help reduce consequences of complex humanitarian emergencies?
Infectious disease outbreaks are a large concern when it comes to complex emergencies or natural disasters when people groups are displaced to locations with poor healthcare infrastructure, poor sanitation, lack of clean water. Vaccine preventable diseases can be targeted as a prevention intervention. Many of the types of outbreaks in this study were vaccine preventable diseases. Increasing vaccine coverage in developing countries would serve to reduce the morbidity and mortality of complex emergencies according to this study. Vaccines campaigns would help prevent the loss of herd immunity which affects the local and global region.Question 2: Why, in your opinion, is disaster prevention minimized in comparison with disaster response? This is difficult to answer but I think it may be due to the unpredictability of disasters. Some disasters while they may be predictable, it may be difficult to prepare against them. Both war conflicts or natural disasters may be foreseen but may not be preventable. I think for this reason there is a focus on how to prepare/ respond to the disaster.
I agree with Mathew, Bradley and Judith that vaccines are an intervention that can prove to be helpful in reducing mortality/ morbidity in times of emergencies/ disasters. And I agree with Bradley with regards to the importance of a clean water supply within a country. Clean water is not readily available for many groups that are displaced due to conflict/ disaster. The lack of clean water and poor sanitation should certainly be a focus of prevention strategies prior to the occurrence of a disaster. The local communities/ country/ government would need to prioritize this for their community and their people.
In Response to Matthew with regards to the answer to question#2: I very much agree with your statement that short term trips need to be culturally competent and not try to push ideas of Western Medicine on the country one is servicing. Certainly long-term partnerships will create better relationships and be more effective. However, short-term trips if done in an ethically sound manner meeting criteria set to maintain no harm to the village may still serve to be beneficial. this is especially true if there is education/ preventive medicine taught to the community and the community leaders.
Response to Question #1 To decrease cross-cultural barriers, there are many steps that should be taken.
-Commit to training all staff. Train on implicit bias. Be mindful of stereotypes.
-Identify patients with limited English proficiency. Use formal interpreters. And use models/ drawings, and devices to demonstrate points.
-Health information should reflect the community you serve. Offer information in other languages that are predominate in the community, not just English and Spanish.
-Consider the culture of the patient when addressing mental health as this can be very sensitive for some cultures.Response to Question #2 There are many processes that should be considered to make short-term healthcare trips more effective. Many of these should be addressed prior to departure.
-Establish a common sense of purpose with a focus on contributing to greater global health equity. Before the trip: Develop objectives that all team member can review before the trip.
-Train in language and cultural normal prior to going on the trip. Pre-departure training.
-Discuss re-entry shock prior to departing.
-Identify a local liason or community health promoter to coordinate the health service, cultural, and social aspects of the experience.
-Confirm a mutual respect with local community.
-Ensure the trip will not be burdensome to the current health care infrastructure. Facilitate integration with the local health care. Ensure your services will not have a negative impact on the community/ local providers/ local businesses. Ensure dependency does not occur where the local government doesn’t respond to these short-term service trips by decreasing health spending.
-Ensure adequate supervision if you have students/ residents. Only provide services you are properly trained for.
-Ensure continuity for the patients.
-Be ready to address any ethical concerns. Trips should be ethical and sustainable. And they should empower the local community.
-Attain feedback from the community as a self-evaluation of the trip
-debrief with the team upon return, have team members journal reflections during the trip and after their return.1. I think several actions must occur to improve the malnutrition problem globally:
a. Moving food production to nutritious foods and less processed foods is key. In addition moving food production to a local level within communities.. will help self-sustainability for that community.
b. Addressing the neglected tropical diseases (poverty-related diseases) that cause malnutrition is important including annual prophylaxis in these communities.
c. simple hygiene/ clean water/ sanitary conditions are measures that need to be addressed to alleviate the risks from contamination from microorganisms and toxins.2. In my opinion, conflict is today’s greatest obstacle to progress in global health. there are so many areas in this world that have had ongoing conflict. Areas of conflict lead to the movement of peoples to typically areas with even poorer resources. They may be settled in camps with poor sanitation and lack clean water and food. This will lead to malnutrition and poor maternal and child health and poor health outcomes in general. Interpersonal violence/ disease outbreaks/ natural disasters also lead to poor health outcomes and prevent the progress of global health.
In response to Matthew’s answer to Question #1: I agree we need to move from the Western diet to a more sustainable diet in these regions while continuing to work on decreasing infectious disease transmission.
In response to Bradley’s answer to Question #2: You made a very good point that I hadn’t thought of but that’s very very important… different areas have varying potentials for farming, food sources, and protein sources. So while we can make some generalizations like moving away from processed foods, we won’t be able to generalize specific food/ protein sources for all the areas.Question 1: From this article, having a skilled birth attendant with newborn resuscitation training are evidence-based interventions. I think training a number of community health promoters in newborn resuscitation would prove very helpful. The health promoters could provide care even in areas where hospitals/ clinics do not exist. In addition, there would need to be repeat training to help them retain their new skills in newborn resuscitation. Hands-on programs would be the most beneficial. if hands on training is not feasible due to lack of mannequins, then pictures/ diagrams that are culturally sensitive may prove to be helpful.
These culturally sensitive pictures would depict people in the native culture in the pictures with regards to their skin color/ physical features, native clothing.
The pictures could show steps in the neonatal resuscitation.Question 2: It seems like the increased interpersonal contact between parents and children may be the mechanism through which WASH and promotion of nutrition complement one another. How this works is not clear to me. I believe the idea of the community health promoters GOING INTO the homes of people to teach about interpersonal communications between mom and child and to teach about WASH and nutrition promotion is more effective than not going into the homes and providing the education elsewhere.
Response to Mathews’ answer to question 2: I agree with your comments that high amounts of promoter contact allows for both programs to complement one another. Frequent promoter contacts with education is beneficial because the repeat education will lead to retention of that education on WASH/ nutrition or whatever is being educated on.
In Response to Matthew: I completely agree with you that “security, geographical and financial reasons, and reduced functionality of the healthcare system” are impacts of conflict on maternal health. You made a very good point that I had not thought of that when there is conflict, government finances may be going towards the actual conflict (for example in a civil war) rather than towards the indirect effects of the conflict such as rebuilding health care facilities that had been damaged or improving sanitation and providing clean water/ food in refugee camps.
2. I think maternal healthcare certainly should be expanded to protect women throughout their lives. However, in order to do this, developing countries must first recognize that women are assets to their community. Women can be productive contributors to their community. I believe once this is recognized, more work will be attempted to improve the healthcare of women throughout their lives. There is a documentary called Girl Rising that shows how young girls who receive an education can go on to essentially be productive contributors to their community and economy. Unfortunately, the education of girls is not a priority as is the education of boys in many countries. I believe educating communities and the use of community health promoters, which I am very much a proponent of, is key to expanding the healthcare offered beyond just the traditional maternal time-frame. Women and men in these communities need to stand up for the needs of women’s health care. While I am sure this is a challenge, women’s voices may be heard better when an entire community fights for this.
1. From reading this article, it seems like the most direct impacts of conflict on the health of pregnant women is displacement. This article also mentions the breakdown of social and health services, increased risk of disease due to poor shelter and sanitation, overcrowding, and loss of access to clean water and food.
I believe these are direct impacts of conflict on maternal health. The lessons speak to the conflict in Haiti and the displacement of many. The women described sexual violence towards them. This was similarly seen during the Yazidi genocide. Women in the Middle East during this time of conflict were displaced from their home. They (women and children) were taken captive by terrorist groups and they describe being sold/ traded like scarves in a warehouse. The sexual violence, poor conditions, lack of safety, and lack of health care certainly put these women, pregnant or not, at risk. What I was surprised to read in this article was that some women, despite the poverty and lack of health care, wanted large families and wanted to replaced lost loved ones. This is just something I had never heard of or read about and I found that interesting.Question 1: I think the stigma and discrimination associated with HIV are some of the largest barriers to end HIV. Because of the stigma, less individuals are going for testing, less individuals are seeking HIV treatment, and less individuals are being compliant with the full treatment course. Education in a culturally sensitive manner should be provided in these countries, especially low resource countries, to reduce the stigma and discrimination. In addition, the growing human trafficking crime is going to worsen the HIV epidemic. Women and children in many countries are forced into trafficking and may not have control over their bodies. This may lead to a rise in HIV cases and the stigma will remain if not worsen. Education can change the stigma/ discrimination barrier.
there are other barriers that we cannot change. For example, the initially asymptomatic stage in some patients with HIV prevents early diagnosis. While we cannot change this, offering work-wide testing can certainly be beneficial, as has been seen in high resource countries.Question 2: There are several issues leading to pediatric HIV control lagging behind adults. Statistics quote 1 in 5 women are not tested or treated with ART during pregnancy. I think stigma associated with HIV plays a role in pediatric HIV control. Also, there is loss of follow up after delivery. There needs to be a comprehensive care plan for pregnant patients world wide that includes a focus on HIV testing/ evaluation and treatment from the initial diagnosis of pregnancy, through the course of the pregnancy and at delivery. And more importantly, I believe education to reduce the stigma would be very promising for pregnant patients and newborns with HIV. Reducing the stigma may reduce the patients lost to follow-up after delivery. While education itself would be helpful, I think this has to be approached in a culturally sensitive way in each country/ culture. This poses a challenge in that we cannot come up with one universal educational plan.
In response to Matthew: I absolutely agree. I think the lack of education and the stigma around the disease are the main barriers against world-wide HIV control. And I agree that educating the nations is very important. I think this needs to be done in a specific way in each country. In developing an education program, many things needs to be considered including: culture, poverty level, current access to resources including testing and treatment availability, and current behaviors.
In response to Judith’s post… I agree that the approach to fighting TB cannot be one dimensional. The cycle of poverty that you mention with regards to the illness diminishing one’s ability to work which leads to further illness is a huge problem. it’s a cycle that is certainly difficult to break. and as you mention, those living in poverty are more likely to have multi-generational homes secondary to culture as well as poverty. In these homes, if the adults fall ill, the children may need to drop out of school to work to support the family. The lack of education/ the inability to be in school physically… puts them at many risks including poorer health. Children, girls who are not in school are also at risk of childhood marriage, HIV contraction, kidnapping, trafficking, etc. these cycles are why fighting diseases of poverty cannot be just one dimensional.
Question #1: From your perspective, why are people living in poverty most likely to suffer from TB, and how should this fact influence efforts to control the disease? Because TB is so easily spread through resp droplets, isolation is important to reduce the spread. However, for those living in poverty, isolation may not be a reasonable option, leaving close contacts at risk of contracting TB. In addition, those who live in poverty are at high risk of malnutrition. So even in the case with TB is suppressed and becomes latent, the malnutrition can cause reactivation. Those living in poverty typically have crowded living conditions, poor nutritional status, and traditionally used drugs are less effective. In order to determine how best to control the disease, one focus could be to improve nutritional status of those living in poverty, as this would have many benefits, not just to reduce the reactivation of latent TB. There also needs to be a focus on increased testing and improved accessibility to medications that are effective. Another focus would be looking at medications that require shorter treatment courses to improve compliance.
Question #2: What, in your opinion, are two interventions that would be most effective against neglected tropical diseases?
From the lessons, it sounds like annual community prophylaxis has been a focus to treat NTDs. However, poor sanitation that comes with poverty is a barrier to reducing these NDTs. An intervention that focuses on clean water and sanitation would help reduce NDTs as well as other health problems. Education should be part of this intervention and should be done by community leaders within the community that have a rapport with the people there. I would consider community annual prophylaxis as the other intervention that would be effective. This would be no easy task as the medications would need to be physically available as well as financially accessible. The other challenge with this intervention of community prophylaxis is reaching what many refer to as “those at the end of the road”… those in remote villages on sides of mountains/ in jungles, etc… villages that are themselves not easily accessible.Hi Everyone!
My name is Nancy Nagib.
1. I’m on faculty at a family medicine residency in York, PA. I practiced inpatient and outpt family medicine for 7 years before I joined the residency as faculty. I participated in my first short term medical service trip to Guatemala as a 4th year medical student. And I have continued to take short term medical service trips since then, over the last 15 years.
2. I joined the residency as faculty almost 5 years ago and over the last 3 years, I have had the opportunity to co-direct a global health track for the residents at our hospital. I would like to improve my global health medical knowledge and understand the current global health and public health issues so that I can better educate the residents in the global health track.
3. My future plans are to complete more medical service trips to Central America and other developing countries. My family is also dedicated to serving in developing countries as we are able to. I am also interested in global health promotion initiatives and currently carrying out a research project in Guatemala to promote the use of safer stoves over cooking over an indoor open fire.