[Nelson Morris]

Hi Judy,

I will miss reading your amazing stories. I am sure you would make a great instructor. Thank you for sharing your thoughts and experiences with us.

Best,
Nelson M.

[Nelson Morris]

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?

In my opinion resources is a major barrier to expansion in LMIC. One resource in particular is local leadership. If there is not a strong presence of local leaders to support the expansion then this will create “persistent dependence” as one of the many challenges the author mentioned.

Question #2: Which habit of exemplary clinical teaching is translatable to education in LMIC (low and middle income) settings? Can you provide an example of effective implementation from your own experience?

The method of activating the learner is translatable to education in LMIC. I personally do not benefit from passive learning – it allows me to distance myself from what is being taught without realizing it. During active learning my attention is entirely invested in what is being taught. I think this can be done even with little resources, since it depends on the instructors approach to teaching. During my preceptorship over the summer I was actively involved in history taking and became more confident over the course of two weeks.

[Nelson Morris]

Hi Judi,

Thank you for sharing your comments. I hope someday to work with an organization like the Medical Corps. Also, that is amazing that Cuba has a vaccine for lung cancer. I hope that makes it to the states ASAP.

Thank you for sharing,
Nelson

[Nelson Morris]

Question 1: What additional elements would be necessary for universal health coverage to be effective?

The article highlighted the need for more competent and caring physicians. Access to healthcare does not do any good if the care is poor quality (if anything that is two steps backwards). So I think that a quality control measure is necessary for universal health coverage. Another problem is the gap between knowledge and practice. The amount of effort varies greatly and the poor countries tend to produce less motivated physicians, regardless of competence. It will be a challenge to encourage unmotivated physicians (in general) to work hard without resorting to higher pay. But the element of effort in patient care is necessary for an effective universal health coverage to be effective and promote health.

Question 2: How could low-resource communities better make use of community health workers?

Low resource communities can improve the use of community health care workers in three ways: by providing them with better resources and training; they can invest more funding into their services by increasing compensation that will generate a return of 10:1; and they could improve policy making to make sure that society can shape healthcare decisions to make a career as a community health worker noble and worthwhile.

[Nelson Morris]

Hey Jacob,

I agree that vaccine distribution can help to reduce the damage done by CEs especially because we have the resources available (vaccines) and are already familiar with how to distribute them to developing countries. Thank you for posting.

[Nelson Morris]

Question 1: What actions can healthcare providers take to decrease cross-cultural barriers?

Health care providers can decrease cross-cultural barriers by eliminating language barriers, make mental health issues part of the differential when indicated, be aware of stereotypes that can make the patient uncomfortable. To eliminate language barriers health care providers need to identify patients who lack proficient English and then provide them with a trained translator. The bilingual efforts the institution makes should reflect the patient demographic (if the clinic/hospital is on a Native American Reservation then the health care information should include their native language). Hurricane Katrina is an example of how mental health can slip through the cracks of a health care system and have lasting effects on patients. A decade after the disaster people are still suffering from “mental health difficulties brought on by the disaster” in large part because mental health issues were not identified earlier. Patients do not want to confirm negative stereotypes so they become anxious if they feel like they will in the health care setting. Therefore providers should encourage open dialog about their anxiety or encourage them to bring a friend to the appointment to help them feel more comfortable.

Question 2: What prevention interventions could best help reduce consequences of complex humanitarian emergencies?

One of the consequences of complex humanitarian emergencies is infectious disease outbreaks. A study done by the WHO found that “increased vaccine coverage in developing countries prone to emergencies could reduce morbidity and mortality associated with CEs” which makes vaccination efforts an important prevention measure to reduce the consequence of CE. I think increasing vaccine coverage is a feasible effort that will make a difference in the mortality of a complex humanitarian emergency.

[Nelson Morris]

Jake,

I agree that war is the biggest obstacle to global health. War and conflict has never coexisted with health and prosperity.

Thanks for your post.
Nelson

[Nelson Morris]

Question 1: What actions are most important to improve global nutrition?

From reading the article, two important actions to improve global nutrition could be to ensure both macro and mico nutrients requirements are being met. The macronutrient consumption is easier to estimate by looking at how much food is on the plate. Just as important but perhaps more difficult to asses is the micronutrient consumption of the child which “could be a common cause for stunting in both undernourished and obese children” and therefore makes for an effective target to improve global nutrition. If having to choose one, I would start with micro nutrient because it would benefit both the developing and developed countries to prevent growth stunting.

Question 2: In your opinion, what are today’s greatest obstacles to progress in global health?

In my opinion, the greatest obstacle to progress is war. It is absolutely true that education will take people to greater health. However, there is not an opportunity for quality education in the setting of war and conflict. I used to think that a country was becomes prosperous due to the individuals that lived there. More and more I realize that a country becomes prosperous from the opportunity it offers to the people. In a country where war (internal conflict) is present there is a lack of opportunity, regardless of the potential of the people. When there is no war, there will be opportunity. When there is opportunity, there will be education. When there is education, there will be new ideas and better judgment. And when there is better judgment there will be better health.

[Nelson Morris]

Hello Judith,

Thank you for your comment. I would also support the establishment of “Women’s only” units because I think it would provide a much more accurate sense of value in women, that they are infinitely greater than a pregnancy or child. Their healthcare and social would be met at all stages of life in a place that specializes in women health to ensure they are healthy and happy. I think women only units would be a great solution to accomplish that.

Thank you,
Nelson

[Nelson Morris]

Question 1: What is the mechanism, in your opinion, through which WASH and promotion of nutrition complement one another?

I think the mechanism through which WASH and nutrition complement one another is they both promote an optimal environment for growth and development. As we learned in previous modules, a child who is malnourished will not physically or mentally reach their full potential, regardless of a lack of illness (infection). The child lacks the nutrients to build protein and fat stores. One could say this “environment” is not equipped to support growth. On the other hand, a child who lives in an environment where there is poor water sanitation and poor hand washing is at risk of contracting communicable diseases that will compromise their bodies potential for growth, even if there is access to nutrients. I think both nutrients and lack of infection are required to promote the ideal environment for growth in a child.

Question 2: In your opinion, how should maternal healthcare be best expanded to protect women throughout their lives?

The article states that the current focus on maternal healthcare is “a narrow period of women’s lives—pregnancy, childbirth, and 6 weeks’ post partum” which is underwhelming, representing only a brief moment in the women’s life. The study mentioned that a majority of women today are dying from NCDs but that is not being addressed on the large scale of maternal healthcare. I think there should be health milestones set in place that should be tracked throughout a women’s life and doctors should see that everything is being done to reach those milestone such as: a healthy birth, reaching the age of 12 in good health, completing an education, starting a family in adulthood (when ready), and maintaining good health in late adult hood. To distill the life of a women down to pregnancy and childbirth is wrong because “it is unacceptable and unethical to prevent a woman from dying in childbirth, yet to allow her to die of a preventable or treatable condition such as cervical cancer or diabetes.” Since the future generation depends on the health and wellbeing of women today “the maternal health agenda must encompass a life course, women-centred approach, including those who have children and those who do not”. That way society is supported by a foundation of healthy and happy women and I think that can only be a good thing.

[Nelson Morris]

Hey Gannen,

Thank you for your post. I agree when you say, “Even when diagnosed early on in the disease process, there are some that may not seek care due to social factors, ie. fear of the stigma that surrounds HIV in their society.” There is a lot of social work still to be done so that everyone feels comfortable to seek healthcare, especially those high risk populations. I think that if there was less stigma surrounding HIV there would be more people seeking screening tests and treatment.

Thank you,
Nelson

[Nelson Morris]

Question #1: From your perspective, what are the largest remaining barriers against worldwide HIV control?

Among all the remaining barriers against worldwide HIV control, the high risk populations are still difficult to reach because of the stigma of the disease and the demographic of high risk populations. For example, sex workers are at high risk of HIV and should be tested and monitored closely for their wellbeing and for others. However, they are less likely to seek help because of stigma. Another example is IV drug users for the same reason. People who live in poverty are at a greater risk for HIV because they have less access to health resources which would lower the risk of living with HIV and the chance of passing it on to other people.

Question #2: Why, in your judgment, is pediatric HIV control lagging behind that of adults and what should be undertaken to reverse this status?

The efforts that have been take identify the children born with HIV are noble. I think that perhaps the lag behind HIV control in adults is in part due to the lack of continued screening and testing after the child is no longer a neonate. The article mentions how not every child with HIV will be identified at the time of birth and those are children who are missed “by insufficient HIV testing in malnutrition wards, tuberculosis clinics, and general inpatient services”. I think providers and institutions should have the resources to test a child who warrants clinical suspicion of HIV infection in any healthcare setting to “optimise the use of human and financial resources and have the greatest effect” so children with HIV can be identified and treated as soon as possible.

[Nelson Morris]

Hi Julie,

I appreciate how you related TB to COVID in that MDR TB is a relevant issue to the United States because disease travels across borders. That should motivate developed nations (drug companies) to help treat developing countries so the diseases there do not eventually end up in their country. The COVID pandemic is a reference from which we can learn in how to handle infectious diseases in the context of world health. Thank you for your comment.

[Nelson Morris]

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?

As a medical student I learned that TB is a disease that greatly affects the immunocompromised. A lot of people are infected with TB but their immune system sequesters the bacteria so they never suffer the symptoms (instead disease becomes latent). My assumption is that those who live in poverty have a greater chance of having a poor immune system. This might be due to malnutrition, unmanaged HIV infection, undiagnosed/untreated diabetes, etc., factors that are not suffered from in developed countries. Therefore, the control of TB could be managed by improving the overall health of those in poverty. If those in poverty had healthy immune systems then the chance of an active TB infection could be reduced.

Question #2: What, in your opinion, are two interventions that would be most effective against neglected tropical diseases?

Intervention 1: Leprosy education

I worked in a leprosy colony in Southern India over the summer when I was 17 and the lesson I learned was Leprosy elimination is attainable. Leprosy colonies exist in India because those who contract the disease do not seek medical assistance. Instead, there is a social stigma that drives them to live out the disease. We know that the progression of leprosy is slow, so there is time for treatment. While I was there I lived in an orphanage called Rising Star Outreach. One of the children presented with a well demarcated, hypopigmented spot on his knee. We drove hime to a clinic where he was diagnosed with leprosy. They gave us the course of antibiotic treatment for him and he was taken back to the orphanage where he would be looked after. That child will not live in the colony. He was protected from the stigma. If the people can break the tradition of believing it is a curse and seek treatment when the first signs present, then I think leprosy can be eliminated and the colonies will become extinct.

Intervention 2. Blue marble health

I was shocked to read that there are “millions of Americans living in the United States with an NTD” because until now I thought NTD’s were diseases of poverty. Certainly the United States has the infrastructure to greatly reduce the amount of NTD cases but “it’s not been possible to get this concept on the agendas” for undisclosed reasons. My opinion on this matter is that if we cannot fix the NTD burden in the United States then how can we expect to developing countries solve their NTD burden? This is a great “chance [for the United States] to simultaneously eliminate disease and improve their own economies” and in-so-doing, learn how to help the developing countries tackle NTDs.

[Nelson Morris]

Hi Julie,

I like your comment, “we must concurrently address the risk factors that drive the mortality like nutrition and refugee care” because it addresses health at the fundamental level. A healthy body has a better chance of overcoming an illness than a body that lacks in health. I jumped on the need to vaccinate but your comment sheds light on the bigger picture that we need to make people healthier in general. Thank you for your insight.

[Author]

Posts