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
