Here I am in Guatemala

I am in Guatemala!! The flight was actually about 5 hours, and complete chaos with Guatemalans running around all over the place and ignoring all of the flight attendants' commands to sit down, even during taxi on the runway! When we finally started to decend from the clouds, we saw gigantic volcanos popping their green heads up to say good morning, some even had smoke coming out of them! We got near the runway and then suddenly did a loop de loop g-force turn that left my stomach in my eye sockets, and then suddenly started to climb. The Guatemalans put their hands up like a roller coaster and screamed, but we were looking at each other pretty certain that this wasn't normal. A few minutes later the pilot came on to tell us that he had to pull evasive maneuvers to avoid a flock of birds going through the engines. Great! Our second attempt at landing was much more successful, and we were finally on the ground. We scrambled through the airport (there were 8 of us from our group on the flight), got through customs without so much as a blink, got our luggage, and then waded through the receving line at the exit where we found our professor's niece and nephew with the hotel shuttle. Ten minutes later found us at the hotel and we finally met up with our professor and got our room assignments. The rooms are actually pretty nice, though the bathroom has sort of a florescent flickering disco light, we do have VH1 sort of in english on the tv. We had a traditional Guatemalan breakfast that consisted of eggs, meat (mine turned out to be brightly red colored ham that I didn't eat) and really yummy beans. Finally, we all retired to our beds and here I am now. We are getting ready to go out and go grocery shopping since we have kitchenettes in our suites, get some quetzales (local currency), and maybe take a drive around the city.

Week 13 - Ethics

It was surprising to me when I looked at the curriculum for our MPH program and there wasn't a course dedicated solely to ethics. Even more surprising was learning how little time professionals in the world of health are required to spend considering ethical questions and that there is no continued compulsory education in ethics. I strongly support the adherence to the ethical contract we reviewed in class which Dr. Shahi helped to formulate, and I believe that training in ethics should be obligatory in the undergraduate years as it once was, as well as every subsequent level of higher education. Not only would this make for a contemporary, educated workforce, but also boost the professional image and credibility of those in health.
One thing I really enjoy about public health is that it is inherent in our work that we dare to address so many issues that ethically all people should recognize, but would often rather ignore. It is important to review the overall effect of interventions and aid in the name of public health however, because as we discussed in class, just going in and helping for a little while then pulling out does not make for a sustainable change.
I loved the fact that Christina acknowledged the subject of torture as a public health as well as ethical issue, and something that has drawn so much hypocrisy. We in the US can not call ourselves peace keepers when we commit the same acts, if not worse, as those we so strongly oppose.
The bottom line is that there needs to be more accountability and better education. People are not making good choices, especially those in power. In addition, something that Dr. Shahi's ethical contract addressed is the need for an enhanced system of trust among professionals. We discussed the need for extreme surveillance systems in top secret jobs, which can be somewhat helpful, but I have always found that environments of distrust tend to breed negative and suspicious behavior. People need to have a certain amount of responsibility and ownership, and know that others rely on them to be trust worthy. Again, there is a balance to be met here. I know this seems rather vague, but hopefully it makes a little sense!

Week 12 - Learning from Private Enterprise

If there is one thing that has really opened my eyes in this class, it's the role that the private sector can play in facilitating change and all that we in public health can learn from companies/organizations. It makes sense, if you want something to happen you had better work with the people who have the money and the various interests. Private Enterprise has been a major motivating force throughout history, right along side religion and government. This group deserves just as much attention. In public health we often tend to think of the business/for-profit sector as the enemy, but in fact if treated right "they" could prove to be quite power allies. Granted, they most often only see the bottom-line, but that's how they subsist. In order to attain assistance and interest from the private sector we must examine in each instance what their raison d'etre is and then provide a motivation for them to join our cause. My favorite investment is people. I think almost anyone can be an asset one way or another, it's just a matter of seeing how everyone fits. I really enjoyed the role playing game we played (well done Mana and Andrea!), and in my role as Chevron in Nigeria, I suggested that my only interests in the situation would be land and a stronger workforce that can withstand the environment better than foreigners. Our group found that this was a good way to look at the situation. If Chevron could have exclusive rights to drill in the land in exchange for better health care, monitoring swamps for mosquito over-growth, and better education for local workers, then it would be a win-win situation. The fact that we are getting the chance to analyze these situations and see the whole picture and who fits in has been extremely valuable to me, and I look forward to putting this knowledge to good use!

Week 11 - Financing Our Health

Our discussion regarding capitalist society and promoting change illuminated some interesting perspectives. It seems that in order for change to happen in a strictly capitalist environment such as the U.S., drastic and even tragic event must occur for people to pay attention and do something. People like their power and are unwilling to give up what they think are personal rights and freedoms. At the same time, many other countries are functioning quite well in comparison with several different types of government acting side by side. Most of the European market is based on capitalism, yet most countries there have socialist education and health systems. They have higher literacy rates, life expectancies, and higher scores on the Happiness Index. People are stubborn, but by revamping and regulating the system a little better, we will actually have more freedom. How long do we have to wait to show that our school and health care systems as they are now are actually doing a disservice to the community? We have the data, if cost-benefit analyses could be conducted on a state by state basis according to improvements to be made by socializing these two systems, I don't think change is too out of the question. Do we want to keep up with the rest of the world or become obsolete like so many other great nations of the past? We have enough money, now we need to invest in our people and in order to do that a major shift will needs to happen on a systemic level.

Week 10 - Surveillance

The topic of this class I found extremely interesting (not just because I gave a presentation!) for one reason that we never really discussed. We established that surveillance systems as they are now are not as effective as they ought to be, so vast improvement is needed. However, we really didn't get in to how to balance surveillance and personal privacy/individual rights. This will undoubtedly interfere with the ability to implement effective systems in the future as people will not want to give up their privacy. I think the only way to convince people that surveillance is necessary and to construct a system that works, will be to exhibit a transparency in information and procedures as well as a build a structure that is mindful of personal privacy. While steps must be taken to assure safety and prevent widespread panic, better and more in depth information must be available to establish a solid and trustworthy rapport between agencies and organizations and the public. The SARS problem in China is a perfect example. Because the government's immediate reaction was to hide what was going on, not only did the disease spread more quickly and through more people than necessary, but a feeling of mistrust was bred. We also discussed this same issue in relation to airlines and health emergencies. I see the reason for airport scanners that detect certain heat signals within the human body when illness is present, but is this a violation of personal privacy? And as a member of the public, how do I trust those machines, the people running them, and what happens to the information they collect? Already we have given up rights written up in the Bill of Rights upon which this country was founded in the name of national security, but is this right? A balance must be established between personal privacy and national security, especially when it comes to health. Health is a personal thing, but also a global thing, and as many other countries have defined it: a human right. Before we can moved forward with an effective plan for surveillance, the rights to both health and privacy should be recognized on a global level.

Week 9 - E-Health and more

This class was no less exciting than the others with innovation in case study facilitation presented in video format (great job Lawrence and Jordan!), and heated debate over the merits of remote physician-patient contact. I just have to say that I thought it was a great idea to use a different medium for facilitation since the long drawn out presentations, while informative, can be hard to follow after 3 hours of intense conversation. There are my two cents on that!
As for the idea of email, phone, and other types of remote communication between doctor and patient, I have mixed opinions. I think this could really facilitate relationships and efficiency in doctor-patient care, if done right. On the other hand it could distance people more than they already are, potentially depersonalizing communication. Ultimately, with the right balance I think this could really work. Email and sites like Myspace have actually brought people together, albeit in a way people 20 years ago probably couldn't have imagined. This would necessitate some multi-tasking on the part of certain office personnel, but it may also create new jobs and allow doctors and other medical professionals to help more people who need care. The home monitoring linked to online vitals tracking presented in the case study video seemed to be a great solution to many problems relating to seeing patients with serious conditions who can't all be seen at once. At the same time, it gives them the ability to monitor their own progress and take some responsibility in overcoming their illness. Because of this, I am in favor of these progressions in health communication.
Of course steps would have to be taken to make sure patients were still seen in person periodically and to prevent abuse of the system. But I guess this is like any other technological augmentation of a system. Check and balances are in order.

Week 8 - Innovation in Technoloy, the Road to Solutions?

After spending seven weeks discussing the major health issues of the world, it is a breath of fresh air to begin really discussing potential solutions. All of the presentations discussed technologies for improvement in biomedical sciences affecting many areas of life, and it was impressive to hear about the ideas that improved communication, access to care, and delivery of aid. Many of these inventions seem like no-brainers, but when I was listening to Farah's presentation and she mentioned one of the con's of Genetically Modified Crops it dawned on me that we really haven't touched much on the topic of ethics and whether we should be using these technologies. This has also come up in my research for my paper on the Implications of Intellectual Property Rights on Public Health. We are always asking questions to find solutions to problems: what is the problem, how can we address it, what is the best way, who is involved?? But we rarely ask: what are the implications for the future and how will this affect our environment on all levels?? These are questions no one asked during the industrial revolution and look what happened. That's not to say that what is arising from the Age of Technology isn't good, but we need more people, especially the innovators and inventors, to ask the tough, ethical questions that have to be addressed or we could end up in an even bigger mess. This is something that is not necessarily attended to in the patent/IP process and one point I will be examining in my paper, should we incorporate more of an ethics review into the patent process and even require this in the course of R&D? While there are some ethical hurdles an invention must overcome before a patent is granted, there are also many loop holes. Recently, a diagnostic test for locating a certain gene known to cause cancer in a particular group of Jewish women was granted a patent even after many appeals and controversy. Now the women who need or want to be tested have to go through this specific company or one of its designated subsidiaries and pay four times the amount of what this kind of test costs for other people, just to get a yes or no that could possibly save a life. We are also facing this problem with vaccines for flu, certain infectious diseases, and much more. So where do we draw the line???