Global Health Exam 2

Bernadette (originally)

in boston,84 lbs, STD (syphilis) and depression co-morbidities, very high viral load

NGO code of conduct

in order to operate effectively, NGOs should avoid creating parallel systems and advocate for structural changes

crossing the cost barriers

intellectual property rights to protect research and development and TRIPS make pharmaceuticals so expensive,

3 cycles of yellow fever

jungle, urban, savannah

Child protection services and Lia Lee

take lia for medical test and find that she is not receiving the full dose of treatments, put her in foster care,

quang dab peg

the spirit catches you and you fall down, epilepsy, considered an illness of distinction, not a medical prob but a blessing

Joesph Amon

"Right to Know" or "Know your rights", strategy of protecting uninfected, disclosing private info and discriminating against the infected

Amy Moran Thomas

"a salvage ethnography of guinea worm", about witchcraft, studied in Ghana and lived there during the wake of the disease, guniea worm was and international problem, but not for the locals

Emmanuel Levinas

"useless suffering", no way to give meaning to suffering, holocaust survivor, would say that lending meaning to suffering is violent

When did HIV medications come out?

1994

Clinical Study in Haiti

2 sectors--both offered same clinical services but only one was offered DOTS+

Traditional and Alternative healing (HIV/AIDS)

70% of HIV pos men access to CAM, some see it as disease other address with traditional methods, healers play important integrated role in ph programs by providing education and referrals

DALYS

=Years of life lost (YLL) + years lived with disability (YLD)

Bernadette (After DOTS+)

>90% adherence, 140 lbs, undetectable viral loads, new capacity to treat STD co-infection and mental health health care workers deliver meds but also she confides in the about domestic abuse and living situation (Alma-Alta)

The spirit catches you and our all down

Anne radioman, laos, cold war politics in south east asia, hmong people displaced from laos taken to California

Adapting to local context

Assess differences and distributions of disease across religion and locales, understand local politics and tensions, work with public sector to structure access to water, food and other resources, ethnography of illness meaning and stigma

invisible people

Behrman, catastrophic in sub-Saharan Africa didn't have to happen, shameful lack of involvement from US,

Great Leap Forward

China, 33 mil died, communists top-down political project was to industrialized china over night, led to wide spread famine and many other unintended consequences

Tuberculosis

DALYS model led a focus on TB, DOTS model was used, primary healthcare focus

Characteristics of Structural Violence

Different than direct violence, often invisible and difficult to pin down, normalized, routinized, taken for granted, polices and structure cause bio-inequalities, not random, not fully biological,

The struggle of the public sector

James Pfeiffer, study of mozambique (poorest), Study of PEPFAR, possibilities for health alliance international, PEPFAR is a vertical approach can't change the infrastructure, funding goes to NGO's instead

Global Health Delivery (GHD) Project

Jim Kim, scale up projects and how you should go about them, a dominant framework in global health, -adapting to local context -constructing a care delivery call chain -leveraging shared delivery -improving both health delivery and economic development

Case Study: Brac

Kim's example for leveraging shared delivery infrastructure, Bangladesh Rural Advancement Committee for economic advancement after independence, training email health workers, focus on TB screening and treatment, but provision of a wider range of services and assistance

Leishmaniasis

Protozoa disease caused by insect bite, skin deformities and stigma, vector control and treatment to prevent, risk factors of poverty, malnutrition, deforestation, urbanization

Sleeping sickness

Protozoa disease caused by insect bites, sub-saharan africa, reemergence in 2000s, vector control and treatment,causes inability to sleep leading to dementia, psychosis and possible death

structural violence and biosocial perspective

SES (socio-economic status)--flexible wage labor, poverty and precocity, Gender--dependence on partner income, subject to abuse Biology--STI acquisition more likely for women

Life of Job

Satan tests Job's faith through trials and tribulation, world makes no moral sense even though job is perfect and upright,

Rachel Carson

Silent Spring, stop spraying DDT because its causing more problems, example of robert merlons unintended consequences

Leslie Butt

Suffering stranger, is it ethical to study suffering, sympathy from afar--anthropology,

Why have the government involved in health care

accountable to citizens, only states can guarantee rights, public sector services tend to persist, public-sector systems have the broadest reach, economies of scale harnessed tough shared delivery infrastructure, national outlook

political violence, ethnic conflict, and contemporary wars

all have broad implications for health and social well-being, all lead to major health issues

societal-level suffering

as a result of major historical processes and events,

Hmong people in the spirit catches you and you fall down

attachment to place and landscape, powerful sense of cultural identity, egalitarian farming society, lack of assimilation in china, suffering is part of their society,

Disability- Adjusted life years (DALYS)

attempt to capture years of life lot to disability and mortality in a comparative perspective used to set health and research priorities, attend to disadvantaged groups and focus on cost-effectiveness

Bed nets

became a symbol of global health intervention as it relates to malaria today

Access to Highly Active Antiretroviral Therapy (HAART)

became common in many parts of the world, extends quality and length of life

Asra

believe about malaria in southern Ghana, what we call malaria, based by excessive exposure to the su and imbalance of bodily energy, treatment by home remedies

Lia's parents

believe she's needs spiritual treatment, meds diminish the effects of spiritualism, hmong have monosyllabic yes to indicate listening but not comprehension (docs talk but they don't understand), believe they are the ones that have power of Lia, blessing not a disease

Social Advantages of Having AIDS in Brazil

benefits of government-sponsored programs for families and children with HIV, street children are not afforded access until they contract HIV, anger among mothers when their children test neg for HIV because they can't/won't get health care

Complex spread (70s and 80s)

blood industry, sex work/ sex tourism, international travel

Arthur Kleinman: Problem of cultural competency

can construe culture differences as series of traits that doctors must comply, can lead to stereotyping, instead of cultural competency should just have man competency

La Pieta Michelangelo

captures this idea of interpersonal suffering hold jesus after crucifixion, women shares his suffering

Hutu and Tutsi

categories reified after German and Belgian colonization including the use of racial science and ethnic ID cards, claimed hutus were superior, 1 mil tutsis killed in 100 days

DOTS+, community health and structural barriers

community health care workers provide advice, social work, and counseling in native languages and in view of cultural sensitivity, transportation costs, nutritional supplements, contrasts with vertical delivery of drugs, addressing cultural and structural barriers

medical schismogenics

competing claims about responsibility and irresponsibility among patients and clinicians patients think doctors are irresponsible and vice versa

Biopower

controlling of life

hurricane katrina

created a rupture for people who experienced it, becomes an episode that snap suffering, populations cut, was a societal experience, health and psychological problems

Accompanier

delvers medicine to patients

Global Malaria Action Plan (GMAP)

developed in 2008 by Roll Back Malaria partnership, target to reduce malaria by 75% by 2015, emphasis on: education and info, vector control, medical care, gradual eradication objective

Co-morbidites with HIV

diarrheal disease, pneumonia, herpes, tb, malaria

Beatrice from Uganda

didn't use condom in marriage, led to stigmatization and property loss, evidence of the unintended consequence of a focus on abstinence and the family

Farmer on social suffering

different kinds and causes, all suffering is embodied in indivudal but can be used by social mechanisms, studies the most marginalized,

DOTS

directly observed therapy short course--watching them take their meds

Jimmy Carter's eradication plan

distributed drinking straws containers which are less effective, took 20 years to eradicate

Why did the prevalence of HIV decrease between 2001 and 2012?

education regarding condom use, treatment as prevention

Cultural Barriers to condom use

importance of fathering children as part of male identity, sexual prowess and power, men often make decisions about condom use in sex work exchanges, loss of sensation, dangerous to women

Act Up Movement

in Los Angeles, demanded more awareness of HIV/AIDS movement called for lack of stigmatism, widespread awareness and treatment (demanding new rights, sympathy, medicalizing the disease and condom use)

one world one hope conference

emphasizes the universal idea to HIV prevention happen globally, in vancouver in 1996 to treat HIV

Lia Lee

epilepsy, live in California (merced), culture and language barriers in healthcare

victor turner

ethnographer in tanzania, "Lunda Medicine and the treatment of disease"

Case Study: AMPATH in Kenya

example of constructing a care delivery value chain, academic model for prevention and treatment of HIV?AIDS, integrated testing, counseling, therapies, and treatments of OIs general health services including repo health, oncology, food and social support

Guniea-worm

example of cultural competency, Jimmy carter's eradication had problems with implementing the magic bullet approach

Case Study: A to Z textile mill in Tanzania

example of improving health delivery and economic development Tanzanian company contracted to produce insecticide-treated bed nets for prevention of malaria, local company employing local people

Partners in Health

farmers group, a lot of funding comes from things like the clinton foundation, face of contemporary global health, elite white doctors working high up in struggling countries

Factors of virus transmission

features that facilitate mutation, elevated replication rate, high error rates, genetic recombination, results in significant advantages that facilitate the creation of epidemics

"know your right movement"

focuses on a right to health as human right, a broader concept of human rights and civil rights, thus proposes changes in health policies and sociocultural structure lack of funding and supports

Nancy shepard hughes

founding director of organ watch, argue that organ trade is a form of structural violence,

PTSD

generation that are part of these wars are traumatized, solider suicides outnumber deaths in action

Reason people in poor countries see organ donation scars as honor

give their organs for money or wealthy families, respected for this sign of sacrifice, give something of yourself to honor your family

leveraging shared delivery infrastructure

health infrastructures for dif diseases can often require overlapping procurement systems, supply chains and clinical resources, clinics are better prepared to diagnose and treat multiple diseases

Ryan White

hemophilia and contracted HIV through blood transfusion, suburban, white, cut, young, innocent and became face of the disease

4 H's

homosexuals, heroin users, hemophiliacs, haitians

theodicy

how do we explain the presence of evil in the world

Haiti case study on social suffering

hunger, infectious disease, women's and children's health problems, haitian in rural areas are more likely to experience various forms of suffering and premature death, historically deep analysis attended to axes of power and difference that may kay such an underdeveloped area,

SARS

icon of global health, people wearing breathing masks to prevent getting it, spread by international travel

Partners in Health: Case Study in Peru

late 90s with DOTS+ program, high cure rate of 83% (accompaniment), TB is treatable but it needs DOTS+ or accompaniment

Suicide in China

leading cause of death among young adults, especially women, 90% in rural

Decline in infectious diseases

leads to an increase in chronic diseases because people are living longer

community-level suffering

lebron james (part of a community "I can't breathe"), memorials, sentimentality,

treatment action campaign in South Africa

linked to social justice agenda and a focus on getting people treatment, critical for GH to focus on consequences of testing and the meaning and scope of rights, emphasis on abstinence, faith in relationships and condom use

Depression

major cause of global burden of disease, women twice as likely, much higher levels in the Global North

HIV in Haiti

many believed it originated here, discriminaated against, probably came from Africa to Haiti through migrant workers

madating testing

may seem like an effective public health approach, but fails to address the barriers and real risks that people face

Ian Whitmarsh

medical schismogenics: compliance and culture in Caribbean biomedicine, studied the asthma epidemic in barbados (caused by pollution

Factors involved in ID emergence

microbial adaptation and change, inter-species transmission, adoption of exotic animals, international travel, commerce, urbanization

Bernadette's Structural conditions/background

mortality rate for blacks from HIV decline less than whites, becomes more and more like the face of HIV in the US (women, heterosexual, black), most women get HIV from high risk sexual contact

yellow fever

mosquitos, affects the same places as malaria, people continuously get re-infected, diseases is capable of moving in different ecological settings, dense urban settings

Wrote tyranny of Gift

nancy shepard hughes

Farmer Aids and Accusations

need to include Haiti in the scope of medical advancements, emphasized delivering meds to haiti

Farmers opinion of invisible people

no past effort to combat disease captures the promise of medicine and global health like the worldwide response to AIDS

particular problems treating lia lee

non-compliance, drug side-effects, language barriers, mistrust of doctors, strained relationships, worsening symptoms and episodes

Farmer on social inequalities in emerging IDs

not only new, but old diseases, intersectionality of disease and social/structural ideas, re-emergence of TB alongside HIV

Non-compliance

not using the technology of the pharmaceuticals as they are instructed, way of blaming patients

Textures of Joan Didion

ordinariness, speed, quickness, a blur, confusion, lack of preparation, technical terms by professionals at scene, temporality of loss and grief, loss of familiarity, silence and space, things, texture helps us cope and understand

mental health

outcomes are worse in wealthier countries than in poorer countries

Green light committee

part of the stop TB campaign, Job is to fund NGOs to treat multi drug resistant TB ITB and MDRTB), farmer would like

DOTS-Plus

partners in health initiative, deals with problem of adherence, involve all levels of community, community health workers, refer sick to clinics, provide health education, deliver medicine/offer social support in homes

the surge

politics, violence, and children in central america and mexico come to the US from el salvador, guatemala and hounders, (very violent here)

improving both health delivery and economic development

poverty reduction is also fundamental to d=building a strong health system

Jim Kim, Dying for Growth

president of the world bank, argues that poverty is the result of economic problems

HIV-TB Nexus

prevalence of HIV dramatically worsens TB in poor countries, complex reasons for non-adherence

Prophylaxis

preventative medicine

Critiques of DALYS

problem of simplifying illness in numerical terms, standardizes strict division between mental and physical health

PEPFAR

provided treatment from >2.5 mil people in 24 nation and interventions for >500,000 pregnant women, control sexuality through abstinence training , beneficial for pharmaceuticals

WHO 3 x 5 Program

provides antiretroviral treatment to 3 mil people in low and middle income countries by 2005, shift in accountability standards to focus on number of being treated rather than account of money being donated/spent

neoliberalism

puts responsibility on individual (ex: condom use education, obesity)

2006 change to RW program

reauthorization expanded the program to cover people living with HIV, before only focused on those with late stage AIDS in general, expensive way for caring for people

cultural competency

recommended by holmes as a means of creating a new improved forms of healthcare delivery, but must include an evaluation of the culture of biomedicine and health professionals--doctors and migrant workers have cultures

kay

refugee settlement in rural haiti

Marcos Cueto

return to the magic bullet?, significant improvement in addressing malaria, esp in Africa through roll back campaign, disease-specific interventions rather than infrastructure buying and general social programs (over-emphasis on bed nets)

Case Study: kerala, India

robust public-sector, public programs coordinate the state's health system and account for the majority of health care provision and training, priority on prevention, immunizations and infant/maternal care, large investments in public education

AIDS in Kay, Haiti

rural city, city disease associated with se, labor and travel sent sickness associated with sorcery natural sickness preventable via condom (bad blood)

Ryan White HIV/AIDS Program

ryan white care act (1990), largest HIV/AIDS program in US< provides services and treatments for people living with AIDS in low-income and marginal populations,

Apartheid in South Africa

segregation by race led to very clear health disparities, segregation was formal policy,

The organ market

selling kidney and the problem of informed consent (same as desperation?), prisoners, cadaver violation, and theft of organs, transplant tourism (cheaper in poorer countries)

doctors don't know anything

seth Holmes, common notion among migrant fruit kickers from Mexico, migrant farmworkers miss appointments, no medical records, poor communication skills, misses the picture of their working life and circumstances

interpersonal context of suffering

share in each others suffering, powerful form to feel another humans pain

haiti and rwanda

similarities--both former colonies built on exports both have endured long dictatorships, both have deep poverty

Organ donation and structural violence

social construction of the organ asa gift or sacrifice masks dangers, gender bias (vulnerable in harms way), scars symbolize masculinity and honor in the Philippines, children give organs to grandparents

WWI

social soffering, solider forced out of trenched into no mans land to get hit, nothing happened in response

Accompaniment

solidarity in action, focusing on the women, don't give medicine to poor people because they con't tell time, delivering medicine to the patient, community health worker, not a physician, community health workers accompany people on their path of treatment and suffering

Problems with Merced Healthcare Systems

stereotyping of the Hmong, counseling and social work confuse parents, disagree with medicine, labeled as non-compliant, when she leaves the hospital she recovered

Cartesian Dualism

strict division between mental and physical health seen as separate, mental health is subordinated global health

2nd order suffering

suffering we can give it meaning

1st order suffering

suffering we cannot give it meaning

structural violence

the way that policies are designed that befall certain people

abandonment and endurance

though he slay me, yet will i trust in him

Ebola outbreaks

transmission between humans and animals funerary rites, mining agricultural development

Malaria

transmitted by mosquito bites, parasites travel thru bloodstream to the liver, where they mature and release more parasites that infest blood cells, symptoms 1 month after infection, often over diagnosed

Farmer on HIV

treating people with HIV medication prevents the escalation of disease and can also reduce transmission

big three

tuberculosis, malaria, and HIV

Merton's unintended consequences

unintentionally created more TB when trying to treat it, led to crisis of multi drug resistance of TB led to worse and more difficult to treat

Case Study: Polio in Uttar Pradesh

vaccine coverage still less than 50%, predominantly Muslim population outside intervention in negative terms

Constructing a care delivery value chain

value for patients, emphasizes integration of normally separate interventions (i.e. treatment and prevention), CDVC model emphasizes care as a system and not a set of discrete interventions (integrate different systems together)

diagonal approach

vertical (disease-specific) programs often work, and they can be expanded or integrated to work horizontally (kim)

Magic Johnson

was HIV pos, playing in HBA, not overrode as homosexual, was married and had kids, not stereotypical patients like Ryan white

Klienman says this

we are storied folk, remake medical approach to incorporate a consideration of stories and subjectivities

Webers technical rationality

went in with a very technical solution, but did not consider the other facts like transportation led to non-adherence

commodifications of kidneys

where do they come from, people in poverty sell their kidneys for money, commodity is something that is not seen as having a source

Joan Didion

wrote after life, death of husband objective and subjective (natural or grieving), we are entangled in relationships that we are going to lose

Veena Das

wrote technologies of self, study of health and poverty in Delhi, conception of subjectivity forged in the workshop of everyday life, medical pluralism, wants a more mobile form of subjectivity