Healthcare financing and global health

Money makes the world go round, it has been said... Global health holds no exception. The amount of money circulating around the world is not endless and has to be maximized to yield the best results. It's been suggested many times that simply giving all the poor people of the world money will not solve the problem of poverty. In the same way, just by having a lot of money in a system doesn't mean that the citizen's will have the most optimal health. It's all about management. The U.S. has proved over the years this theory as it spends the most on healthcare, but does not have the healthiest people. Japan which has been ranked really high up (I think #1, but hmmm) does not invest as much money into their system but produces much more results. In her attempt to reform, the U.S. must figure out the distribution of money in the health care system to allow for everyone to have equal access to health care. The use of private v. public funds allows for a good collaboration, as the private industry is primarily for profit and the public is supposed to hold the interest of the citizens. Money does make the world go round, but until it is evenly distributed, the world will not look the same for everybody.

Triage, response systems and global health

Disaster have been made more noticable in the world, with the improved use of media. Natural and man-made disasters are all covered more frequently; people are interested in knowing what's going on. This can be attributed to technological advances that have made the transmission of news so easy and effective as well as globilization: many more people know someone that is in another part of the world. Human activity have also caused an increase in both natural and man-made disasters. Global warming can certainly be attributed the change in weather patterns. Man-made disasters can be attributed to greater tension between regions. Sometimes, man-made disasters like war, which can result in the wiping of agriculture, can aid in the occurrence of a natural disaster, like a drought. In all cases, it is imperative to save as many lives as possible. It is also important to rehabilitate after the disaster. In saving lives, the triage seems to hold such an important place. It allows for the most humanly possible way to play God; some can say that if a person is destined to die, nothing can save them. In the same way, if a person has been marked as deceased in a triage, but it's not their time to go, nothing will allow them to die. In any case, this system certainly has flaws, but is the best thus far that can be done.

These last few weeks have been so interesting to me because I have learned a lot more that I had no clue about; whereas the first few weeks provided me with more information. It's been really nice marinating all this information as I've read and heard. Hopefully the next time I hear some of this information, I would have enough knowledge about them to engage in intelligent discourse.

Technology innovation and global health

Discussion this week was another mind-blowing experience for me. I guess I am still stuck in the rural areas of the world where there is no electricity to support many of the technological advances discussed. I'm struggling with the idea of investing in expensive equipment, when we as a world cannot take care of the basic necessities of the world.

Cell phones have a great role even in modern societies. However, those that invest in cell phone towers generally do not think about rigging them up in rural areas. I have a cousin who's training as a nurse and after their school training, they have to spend a few years on site. Most people get posted to rural areas; and she was no exception. It's no use trying to get in touch with her on either of her cell phones, but neither one works in that area. Which means that in order to use that technology to help people, the infrastructure must be developed. But how many governments will be willing to expend that kind of funds; and if they could do that, why wouldn't they have provided better facilities and basic necessities for their citizens.

Telemedicine will at some point become a highly useful technology. I can only imagine it being a luxury, however, even in a country like the United States. It involves some kind of coverage from insurance, or people with money. I can definitely not see it working in the world without the right resources. Telemedicine has a place in our world, but when it can in incorporated is a different story.

I am one of those people that believes in paying off all debt before investing in anything beyond my bare necessities. This of course is very protective here where credit is important, but in order to appreciate technology innovation and global health, i have to step outside that thinking. The world must develop regardless of those lagging.

Ghana is 50 years old!

http://news.yahoo.com/s/csm/20070306/ts_csm/ofifty;_ylt=ArfpuRSL7s4ub_0LDnmpa2m96Q8F

http://www.news10now.com/content/top_stories/default.asp?ArID=97431

http://www.msnbc.msn.com/id/17467403/

http://www.cnn.com/2007/WORLD/africa/03/06/ghana.independence.reut/index.html

http://news.bbc.co.uk/2/hi/in_pictures/6422989.stm

http://news.bbc.co.uk/2/hi/africa/6421819.stm

Technology

In discussing technology and its role in global health, I'm torn between feeling the need to solve the problems in the most simple and tradiational way or introducing innovations that can potentially solve problems better and faster. In the 21st century as we know it, technology has become an everyday part of our lives. Children know how to work computers better than their parents (at least my brother does). Introducing or encouraging technology to meet the needs of those that need it the most. I'm still skeptical about it, but I guess I should think about it a bit further.

Maybe one of the reasons that there are still infectious diseases and people living without water, electricity, proper and adequate sanitation is because it is a heavy burden and very difficult for the world to take care of. By simplifying the way to reach out, maybe more people can be helped. So that if the people of Angola were provided with food that contains necessary vitamins, like Vitamin C, then less people have the chance of suffering from scurvy and therefore resources can be allocated to other needs. But since poverty has not been eradicated, then how would innovation and technology enhance distribution of resources. I guess distribution methods can be made simpler by technology. Hmm, I guess I have a lot more to learn about this.

Environment and Global Health

We live in a world of finite resources. I'm not sure at what time we started feeling that we can spend it all anyhow, and that it'll keep coming. The U.S. as a nation is wasteful as they come. The wastefulness is included in the culture; the children of the U.S. do not learn how to conserve resources. Most people do not think about where their next meal, or electricity or clean water would come from; and as long as they have money and can afford amenity, it means it has to be used.

But the truth is that our resources will not last forever. There needs to be a drive for conservation. Those that have, must leave some for their children. At the same time, there is a need to extend the resources to those that do not have it. The sad part is that there is a nice chunk of people around the world do not have the necessary resources for survival. For them, electricity has come very few times if at all, water does not come through a faucet, but rather from a river.

It is sometimes very difficult for those of us on the outside to really comprehend how bad the problem is. When I was growing up, I was mostly in the city, where we received most of our water from natural water bodies; the water was of course purified before it made it to our homes. Electricity came from the dam on a lake and therefore, if we had seasons of drought, the electricity coorporation rationed the electricity, sometimes by street or by towns (e.g. street A would have electricity Monday, Wednesday, Friday and Sunday, and street B would have electricity Tuesday, Thursday, Saturday and Sunday). Water sort of worked the same way.

Now those in the rural areas had a different scene all together. In my 6th grade, I was in a cadet corp and we got to plant 1000 trees in a rural area outside the city. We camped in one of the schools (because mosquitoes and small rodents do not really allow for tents and proper camping). We brought a huge tank to provide us with water; and we had to get the water from a spring in the neighborhood. There was no electricity in the area, so we used flashlights and created a huge bonfire. The bathroom at the school was actually a latrine and none of us could stomach the smell or the sights enough to use it, which meant that nature became our natural bathroom. Our shower, well, we had to get water from a river and we took our 'shower' in a huge pineapple plantation that was sort of blocked off. It made quite an impression on us, the suburb children.

Now up the street from our campsite, was a huge mansion that belonged to a foreigner (we'll call her the white lady). She had water that came to her faucet and she also had a fully functioning toilet. We stored our seedlings in her huge compound before planting them.

I had this image in mind during our last class, because I have experienced the water and sanitation problem. It is imperative that when we get into the field, we examine all facets of the problem with the society with which we're working. For example, the little town where we camped could get access to clean water and even electricity as was demonstrated by one mansion having such access. But it takes initiative and the locals believing that they also deserve such amenities. We have a huge battle up ahead and it is important to be armed with all the right information.

A global look at mental health

(The picture is of a coffin; for those that couldn't afford the real thing in their lifetime; this is a very interesting practice in many countries including Ghana, but not necessarily the most popular choice of a coffin).

I initially started writing up an entry about mental health as discussed in class, but changed my mind when I received news about the death of someone very close to me. All of a sudden he became one of the statistics that we've discussed in class: global road traffic injury mortality. I started thinking about mental health as concerns death and the way it can affect the people of a community. When a person dies of chronic disease or some kind of preventable disease, we tend to blame the person; afterall it was preventable. When a child dies because of mother-child transmission of HIV, we experience different emotions; what did the child do to deserve such a death.

Global health has to include the examination of mental health in such a way that public health workers are empathetic to a wider variety of emotions. Why are the peole of South Africa depressed? How does one expect an intervention to work when the people mourn new deaths daily? How do we incorporate these distresses into our work as public health professionals. Can we overlook the fact that the parent resorted to excessive eating as a way to deal with the untimely death of a child? At the same time, we have to examine the resources available. How many of the countries stricken with the high death rates have the proper professionals that can help the people deal with the problems and emotions associated with the loss of a loved one.

I read sometime last year that in Ghana, there were less than 10 psychiatrists in the entire country. Most of the country's disturbed can be found in markets, dirty and mostly naked wandering around talking to themselves and sometimes wielding cutlasses. I had the opportunity to visit one of the places where mentally disturbed were kept. The majority were men and several proposed marriage to me. The place looked worse than a prison and it was heavily understaffed. The person we were visiting was sent to the place (called Asylum Down) because he burnt a Bible in front of someone's hair salon and he swore that he could hear God telling him to do it. When the police could not figure out what to do with him, they banished him to Asylum Down.

Mental health is unique because it cannot always been seen and it can't always be explained. However, it forms a basis on which other health stand. A person that is mentally unstable or disturbed has a better chance of being inflicted with other diseases, simply because their immune system is more compromised. That same person has a better chance of accidents, etc, simply because the person might be more distracted and less aware of their surroundings. It is imperative for us to appreciate a person's mental state in order to provide the best help to them.

Slavery in Ghana

I found a video that shows some information about slavery in Ghana. I plan on commenting extensively about the report on Oprah about the child slavery in Ghana. In the meantime, check out this interesting video. It's quite an eye-opener and contained very new information to me.
http://www.ghanaweb.com/GhanaHomePage/diaspora/view.video.php?ID=3

Ghana on Oprah

Check out the full show:
http://www.oprah.com/tows/slide/200702/20070209/slide_20070209_284_101.jhtml

Ghanaians the world over are devasted, why? Because the woman they've always wanted to visit their country, did have a special on the country....but it was about child slavery. Now this is one of many many white elephants that exist in the land of Ghana and Ghanaians are upset that of all the things in the country to focus on, Ms Oprah chose to talk about the long hours these babies (ok kids) spend on boats (mind you, most of them can't swim) doing various jobs including scooping out water from the boats to prevent capsizing and sinking. According to the report, most of these children were "given" to the fishermen by their parents, because of various reasons. A lot of these parents have no idea under what kind of conditions their children live, but they understand that their children might have more than they can themselves provide.

Child slavery takes many forms. Before the days of colonization, child slavery was practiced when parents gave up their children to debtors. The white men from the ships were at first rather disgusted by the practice by these black people. But somehow they realized that the disgusting part was the children, but trading the black people was quite alright. Then started the Trans-Atlantic slave trade. Since the abolishing of the "official" slave trade, child slavery has continued to thrive. Folks realized that children make great sex slaves; they don't talk much (well not to authorities) and they do pretty much anything with the right pressure and fear. So that battle continues; some children are sold to be sex slaves, others are sold to work in boats or to sell pure water in the early mornings (of course they're not allowed to have any water themselves).

So what amends can be made about the situation. It's important to understand that a lot of poor families see children as assets. The children can work for them and at least bring some money home. In order to mend the situation, the families have to be provided with alternatives and educated about the importance of education for their chidren. Now, Oprah's crew worked with an organization in Ghana and helped take some of the child slaves back to their parents along with money and a chance for education.

Public health workers will be confronted by such situations. I can't provide a suggestion about how we deal with this. I simply understand that when I go home, I won't be one of those educated women that bring girls from the village to be their housemaid, with barely any pay and certainly no freedom.

Nutrition and health

Poverty in the 21st century is an indication that while there have been developments around the world, there still exists a very vulnerable population that do not have something as basic as food and water. There are many ways to solve the problem of poverty, but the truth is that those who have that ability do not necessarily trust the integrity and the world of the poor. With a critical look it is obvious that the poor exist everywhere in the world. I have heard many stories of people living check to check with the fear that without the next check, they can be on the streets. Barbara Ehrenreich's Nickel and Dimed shows how this struggle plays out in America.

Liyan's presentation of RUTF showcased an important innovation that can help in the struggle against poverty. Of course, a "treatment" like RUTF comes with many challenges, the first being its acceptance as a way to treat children. another is the possibility of abuse, though I don't exactly see how much of a problem that would pose to society. If the millions of children that are malnourished around the world right now, had access to treatments like RUTF, that would be a start. Of course the only problem would be the need to sustain them on regular food and good nutrition, which is the problem in the first place. I guess treatments like RUTF will only be beneficial when governments and societies have worked out a way to provide proper nutrition and food to the starving and poor.

It is unclear whose responsibility it is to keep the poor alive and nourished. It is however clear that the world cannot celebrate her achievements if she does not take care of her most vulnerable.

From where do u hail

Hello everyone,

It's obvious we all associate with different parts of the world, so I wanted to know exactly which country or countries everyone relates to, either because you're from that country or your family's from there. Let me know...

First bird flu death in Nigeria

From http://news.bbc.co.uk/2/hi/africa/6317477.stm

And in 2005, this article was published on bbc: http://news.bbc.co.uk/2/hi/africa/4697522.stm
These are links to two articles about the bird flu on the continent, specifically in Nigeria. Very interesting articles that detail some of the major barriers that will be faced by the people.

Non-Communicable Diseases

This semester has been particularly eye-opening for me, in terms of the shift from infectious diseases to chronic diseases. I have had to think a whole lot about why such a shift will occur and at the end of the day I can safely conclude that worldwide, people have been failed; they have not been well educated about their own bodies and the consequences of doing too much. I think it can be said that we all understand what happens when we don't eat enough, or drink enough liquids or even take the appropriate medications. But somehow we have failed to understand that the opposite, which is overeating has equally devasting consequences. {While thinking of that, I just realized that diabetes is not always caused by overeating, but rather overeating particular foods that contribute to the disease.} Here's a link to a map showing diabetes prevalence in the world. http://www.who.int/diabetes/actionnow/en/mapdiabprev.pdf (I'm trying to find a good map showing poverty levels, but I can't quite find one). In any case, diabetes is highly associated with obesity which generally suggests excess of fats and possibly excessive food in general. I've been told that the difference between hungry children around the world is that some are malnourished (they have food, but not a good balance of essential nutrients) while others are simply starved (as in they don't even get anything to eat in the first place).

Diabetes in particular hits close to home, because my mother is diabetic and has been for a few years. She doesn't take any medications as her diet is quite sufficient in controlling her diabetes and she also supplements her diet with roots and herbs whenever she feels that her blood sugar is getting too high. She told me of her fear of diabetes because her grandfather's foot was amputed because of diabetes when she was growing up. My maternal grandmother is a bit on the overweight side and I'm not sure if she's been diagnosed with diabetes, but that will not surprise me at all. My paternal grandmother is also diabetic which means that all those sweets I grew up eating were probably not a good idea. You see, in my society, children are supposed to eat as many sweets as possible. (When I was growing up, my mother tried to keep me on a restricted sugar diet, but my grandmother said no grandbaby of hers will not have all the candy she wants and thus triggered this sweet tooth that now has required an extraction and root canal with possibilities of more root canals and extractions in the future). It is a common thought that women fall for men with pot-bellies in Ghana because it means that they can take care of the women. The bigger you are, the more status u can potentially have because it is assumed that you can afford to feed yourself and a few others as well. At the same time, we have many opportunites for physical activities and those children that were overweight were terribly teased and called "gbontos". From my understanding children at home are still feasting on the sweets but the physical activities are not as rigorous as they used to be.

I guess this entry is a bit on the ramble side, but at the end of the day, I am highly concerned about the pandemic of diabetes in the world. While some of us are pre-disposed to such a disease, we all have to think about what goes into our mouths. As professionals we will be faced with opportunities to grab some junk food on our way to a meeting; but at the same time, we have to remember that statistics do not create themselves and we have to do all we can in our personal lives to ensure that we are not included in the numbers in the pandemic.

A leader comes home

After ten years of hard work and a lot of aspirin and peptobismol (speculation, but you've got to imagine that stress level!) Kofi Annan has completed both terms in office as Secretary-General and has now returned home to Ghana. He was the second African serve this position. (Boutros Boutrous-Ghali from Egypt served 1 term before his second term was vetoed by the U.S.[Important to note that Annan was the first Black African to serve as Secretary-General, a "victory" for Sub-Saharan Africa]). Of course, as a Ghanaian, I beam with pride when people acknowledge the great things that this man worked so hard to achieve during his term. At the same time, I have read lots of comments in which he is refered to as an "Uncle Tom". As a Secretary-General, he was under scrutiny because he was supposed to lead the world towards betterment. As an African he was closely watched because the world had to make sure that the Dark continent could produce leaders, afterall. Initially, he was seen in a very favorable light, winning the Nobel Peace Prize in 2001, but after the U.S. declared war in Iraq, and things got heated in Darfur, Sudan, many critics say that Annan did not do enough as a Secretary-General. The "Food-For-Oil" scandal involving his son, definitely did not help his image. It was interesting to hear during his last speech as Secretary-General, his open criticism of the Bush administration's use or rather misuse of democracy in Iraq. But in all, I believe that the soft-spoken gentleman from Ghana is highly respected; his position as a leader has affirmed that the Black Man does have a place in world affairs and cannot be reduced to a disease statistic.

Check out this sites talking about his return home. Different interests and motivations for the authors are readily displayed in these articles:

From CNN:

http://www.cnn.com/2007/WORLD/africa/01/25/kofi.ghana.ap/index.html

From ghanaweb:

http://www.ghanaweb.com/GhanaHomePage/NewsArchive/artikel.php?ID=117948

Changing Trends in Communicable Diseases

Dr. Shahi mentioned ORS in class today and it brought a whole bunch of memories to me. While I do not reach for my salt and sugar when trying to find a remedy for diarrhoea, I remember that we all had to learn about ORS especially during outbreaks of cholera. This solution has saved many many lives and proven to be simple enough for almost everyone to be able to make. A country like Ghana, where cholera is still a major risk for members of her population has included simple remedies like ORS into their primary school curricula.

From the video for class today, we learned that every 14s, a child is orphaned as a result of AIDS. This is a very devastating statistic and the truth is that most of us cannot grasp exactly what that means. I know I certainly can't really comprehend the problem. I mean, in the time it's taking me to complete this entry, the number of people that would have died from AIDS is alarming. To top it off, the percentage of those who would be leaving children behind creates major distress in my mind.

As a part of rebuilding, Africa will, at some point, have to figure out what do with all these children that have no parents. The wars and other major problems have already caused enough trauma to a lot of children. AIDS has only exacerbated the situation. It would be very pertinent for nations to set aside funds and resources for her future. It would be interesting to see how Africa shapes up in terms of her youth, because they are so many distractions (child soldiers, child trafficking etc) that can cause so much more turmoil on the continent.

Globilization, Development & Health

Globilization has become a topic for all avid debaters, politicians, students and healthcare workers. On one hand, it is seen as a one size fits all solution for the world's problems. On the other hand, it is the perfect solution to robbing hardworkers of their jobs, simply because companies refuse to pay them what they're due. In the Johan Norbeg video the commentator mentioned the idea of "Americanization", which he said critcs say is what's happening instead of globilization. He doesn't outright deny it, because the truth is that globilization has indeed taken a form of americanization. This has manifested not only in businesses, but in culture. Many protective features of our cultures such as a healthy eating has been replaced with the need for status by devouring american type foods. I remember talking to my cousin and they were sitting down to dinner. When I asked her what they were eating, she said potatoes (as in french fries). Mind you, Ghana does not grow "Irish potatoes" because our climate does not support its growth, so only those with extra money and special reasons eat potatoes. Of course they weren't eating potatoes, but she felt the need to tell me this, so that her status seems better. Western foods are favored over local healthy foods because they are seen as better and they show that the person is well off. It is because of such perceptions that in the quest for globilisation, a lot of communities can potentially lose a lot of their cultures and the very protective factors that are natually in place.

The Big Picture

The world as we know it today has generated some of the greated technologies known to man. These days we can travel just about anywhere in the the universe to discover what's going on there. Many are known to spend their weeks traveling around the world on "business". Others have access to traveling to new and exciting places in the name of "pleasure" or vacation. But as the world finds more ways to connect itself, we discover that the world is not exactly a beauty for everyone. Only a certain population of the world can afford to make a trip to the airport, let alone get on a plane. In some parts of the world, wars have caused good health to be on the bottom of the priority list, as basic survival supersedes anything else. In looking at the big picture of the world, I understand that while a small population has access to the biggest chunk of resources, most of that small population does not exist anywhere near Africa. In all statistics and charts and diagrams, it is obvious that the sub-saharan Africa as it's called is quite synonymous to words like death sentence, hell, 'get out if you can'. etc. Now, since it's home to me, I have to take a step back and check my emotions. The video with Hans Roslin clearly showed how most of the world has developed forward, but somehow the dark continent remains stunted in growth with the highest number of anything bad. The portrayal of the dark continent has some accuracies which should be corrected through interventions and aid, but with such change should come a revolution of the perception of what Sub-Sahara Africa is. I hope to use this forum to enlighten my colleagues, not only about my thoughts about the subject discussed in class, but also to bring about my home.