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???

Week 7 - The Environment and Promoting Sustainability

Last Thursday we talked about many aspects of environments great and small and how circumstances affect people's health. The case study regarding the inequities caused by access to enclosed bathroom facilities was extremely eye-opening and a simple luxury we definitely take for granted. In addition, the video illustrating what is happening to communities where there is no sanitation was horrific and it is an atrocity that situations like this still exist in today's world. I was very impressed that our discussion regarding proposed solutions kept leading back to renewable technologies and sustainability. My thoughts crept back to some issues of Dwell magazine (my favorite!) and examples of sustainable practices, mainly architectural, at work all over the world. By the way, I whole-heartedly recommend this publication. There is something about sustainability in every issue and it's printed on recycled paper. There have been some amazing articles about sustainable green houses built in various cities, architectural firms designing and building sustainable green modular homes, even some that can be retrofitted to protect against earthquakes, and sustainable green products like toilets and energy efficient appliances. What is great about many of these inventions is that they are extremely affordable and cut costs on bills in the long run as well. Unfortunately, technologies like these are moving slowly to catch on, but at least it shows that good things are coming out of private enterprise. So it made me think that it might be possible to get some of these "good" companies to impart their wisdom in order to work on solutions to the basic environmental problems and needs, which would only benefit their cause. This could help build economies and communities with better, sustainable futures as well as stimulate this kind of change and growth in developed nations by creating a new market. It seems like a great place to start considering these sustainable technologies have been proven to be cost-effective short and long-term which would inspire more research and bring more funding. Eventually, we could maybe even go beyond sustainability....

"Sustainability is just a minimum. If I asked you, 'How's your relationship with your wife?', and you said, 'Sustainable', I'd say, 'Oh, I'm so sorry for you!'" - Michael Braungart published in Dwell, Sept. 2006 issue, pg. 19

Week 6 - The Power of Mental Health

The quote Dr. Shahi used in the beginning of his lecture on this day really struck home for me. "All that we are is the result of what we have thought. The secret of health for both mind and body is not to mourn for the past, worry about the future, or anticipate troubles, but to live in the present moment wisely and earnestly." The Buddha (Hindu Prince Gautama Siddaharta, the founder of Buddhism, 563-483 B.C.) Much like the simple phrase coined by Descartes: "I think therefore I am". Our world is created by thought that leads to action. Everything begins and ends in the mind. We are constantly absorbing and producing new experiences, reliving the past and contemplating the future both consciously and subconsciously. I have found it necessary to detach myself from situations in order to see them more clearly. In fact, yoga has really been my saving grace, an amazing practice which allows me to cultivate the art of living in the moment and releasing myself from my actions and reactions. At the end of each class on Wednesday nights, the whole class says a silent prayer lead by the instructor dedicating the practice to those people who need the strength and clarity and who don't have the luxury of doing yoga in a safe and amazing environment. This little reality check is always a welcome reminder of just how lucky we are to be empowered that way. If everyone had the chance to take a little respite from the ever spinning wheel of life, I think the world would be a much better place. However, so many people, as we have been discussing, don't even have the basic necessities such as clean water, sufficient food supply, or safe living situations that allow for time to reflect on philosophical notions. It is clear that these problems must be addressed so that good mental health can have a fighting chance. This is clearly laid out in Maslow's Hierarchy of Needs which Dr. Shahi presented in his slides, and more than just needs, I believe they should be rights of every human being. The right to have the opportunity to have all of those things: Physiological well-being, Safety, Love/Belonging, Esteem, Self-Actualization. And so when we examine these problems every week in class and whether they can be solved, I guess the answer is best described as the following:

"Whether you think that you can, or that you can't, you are usually right."

- Henry Ford (1863-1947)

"I have come to believe that the whole world is an enigma, a harmless enigma that is made terrible by our own mad attempt to interpret it as though it had an underlying truth."

- Umberto Eco

"The significant problems we face cannot be solved at the same level of thinking we were at when we created them."

- Albert Einstein (1879-1955)

Week 5 - Hunger, Obesity, Paradoxes and Vicious Cycles

One of our best class discussions yet came out of this week's case study analysis. While we ended up somewhat up in arms regarding the feasibility of certain strategies to eliminate hunger, I think one thing we might all finally agree on is that it is possible to accomplish this, no matter how big the hurdles. In addition, I feel like we clearly established why it is so important to do this. Hunger, poverty, and health status go hand in hand in hand. All of them have to be improved, and for any one to be ameliorated and sustained all of them have to move in that direction. So it is in fact quite a hurdle. However, we have seen and discussed that it is possible to stimulate local economies, perhaps even through local food production, and that educating the women in local communities can improve poverty levels, health status, and therefore reducing the number of hungry people. We have also talked a lot about the roles of private and public domains and how they fit and will fit in to solving the biggest problems. I am of the mind that when presented with an opportunity to improve life that is also beneficial in other ways, I and most people would not hesitate to take part. However, there are people who will most likely never make the right decision, and who don't really care to improve life, so how does one skirt that issue? This came up when we were talking about war and violence in developing countries that has created major road blocks to establishing stability and positive, progressive change. I am not sure there is an answer, and maybe there will never be complete peace, but I do think there is a balance (yes, that word again) that can be struck so that the majority of lives can exist in positive environments. So what does all this have to do with hunger? Well, I truly believe the saying, we are what we eat. If people are suffering from malnutrition and lack proper nutrients in their diet, or if they are obese because they are eating happy meals and can't control their urges, then of course they are going to be unhappy and that will translate to the world around them. This is happening on all ends of the spectrum, both in poor and rich, and a major cause of distress, disparities, and perhaps even eventually violent conflicts. What if we could commence the road to solving some of our major problems just by growing and eating better food? Maybe this is a key catalyst we have been looking for to balance out the yin and the yang....

Week 4 - Non-communicable Diseases and more

Last week we had some pretty memorable moments in class and the reading was epic, though interesting. One thing that I really enjoyed (I know, not another video commentary!) was the video on reversing diabetes naturally. Yet one more affirmation that solutions can be simple and rather inexpensive in the grand scheme of things. To watch those people change physically, mentally, and emotionally as a result of a complete diet overhaul was pretty amazing, and something I have been researching this week for my presentation this Thursday. Don't want to spoil too much! But perhaps solutions to our biggest problems can be really simple. It's changing the way we look at our challenges and obstacles that is the most immense hurdle.
We talked about strategies of focus to eliminate infectious diseases versus non-communicable diseases and what is most important, and I believe the answer is that is it all equally important because it is all part of a precarious balance we have to achieve. That is what nature does, when one thing gets out of control another comes to balance it out, moving in a continuous cycle. Our checks and balances system has been thrown way off. In any case, in response to Payam's comments about letting the private sector take care of the things we can easily change by shifting lifestyle patterns, I agree however the public sector has to be involved in steering the ideas and the monetary resources in the right direction. We need to create interest for investment, people need to have a personal connection with a given situation in order to want to be involved. During class I kept thinking about Google and how they have little perks at work to make being there less stressful and more enjoyable. They get a better product from their employees and they are extremely successful. So why can't other systems large and small do that as well? They can, they just need to know the why and how. When we can finally shift away from the non-communicable disease trend into healthier ways of living, people will be happier, more productive, and able to contribute something instead of sucking the system dry. There are other assets we have lost as a result of this trend aside from money.

Week 3 - Reflections

On Wednesday evening in a class of 65, my yoga teacher said: "Isn't it hilarious to think about the fact that most of the time we are all walking around with this protective armour on and so concerned about keeping it together, that we don't realize that we are all doing that same thing. What would happen if we tried the opposite, and cracked that shell open, realized that we all are coming from different experiences and often the same feelings. What would happen if we were all open to one another?" She made a wise observation, and I think this is something we would need to work towards in order to accomplish some of the goals we have discussed in class such as those laid out on the MDG video, as well as something as simple as working together more cohesively. Last night Dr. Shahi spoke of the corporate committee mind at work within large public health organizations and those people believing that their meetings were their work. All too often this happens in large governing bodies of all domains and that lack of productivity eventually leads to failure of the system. So how do we become effective in an environment racked with frenetic cycles of latent energy? Some corporations have fired the top heavy management, cleaned house of the nonproductive teams, and outsourced work to those who were capable of completing it quickly, cheaply, and with quality. This way the people who want the work get the work, and the company gets to make decisions without so many politics getting in the way. While this causes immediate problems in having to lay off a stagnant workforce and leaving people unemployed, it allows for the small independent groups to get a chance at making a name in the market place. And so continues a cycle of growth and innovation. Can we then somehow take this approach to improve organizational functions in public health? Since we often face bureaucratic roadblocks and dissension between fields, is there a way to form a smaller governing unit, that we can trust to make good decisions, that will work with the satellite unit within each country to address appropriate needs? I know there are networks out there like this already, but they all seem like they get too big and become burdened with bureaucracy. We were discussing this in class, but I was wondering if anyone might like to expand on it? The last frame of the video on AIDS orphans says it all: "You have one life, Do something." I feel like that is why we are in this class, and writing these blogs, and getting a masters in public health, because we want to do something.

In other thoughts...
The video on BRAC makes a good point in relation to our class last week and our studies in general. As Dr. Calderon said in class this week, "you can not solve health problems in a population by public health interventions alone". Efforts must be integrated, as we saw in the BRAC example. During her presentation, Mana mentioned taking a holistic approach to solving problems which make sense, and has become an underlying theme in our discussions - especially in relation to globalization. We can not just look at the symptoms of a population suffering from poverty driven diseases, we must look at the whole picture. A population, especially if it is a state of extreme poverty, can not progress or remove itself from its circumstances if the people are not in good health, they are not going to worry first about health when they have to worry about where their food is coming from or being shot for walking down the street at the wrong time. I admire these organizations who are going out and giving support in terms of "teaching a man to fish", rather than just "feeding him for one day".
And finally....The part of the case study that really caught my attention besides the fact that signs point to a major pandemic some time in the not too distant future, is how those people outside of the medical and public health world are really not prepared for something of such a large scale disaster. From what we have seen of the response to the major environmental disasters in the last few years, some energy obviously should be focused on educating people on what to expect and how to react as well as enabling a surveillance system as discussed in the Brillant Tedtalks video from the past week. I believe there would be major problems with managing population flow, keeping people from traveling and working, how do you keep the entire planet from infecting one another? Yes, telecommuting can work, and systems have become less expensive and easier to use, but I can't get over the fact that despite these advances in technology, many people just feel like they have to make personal appearances at work or the world will stop turning. Email and video conferencing may not be enough to get them to stay at home, even in the face of a pandemic for there is always a sense of invincibility. I guess I don't have a better answer right now, except that currently businesses are required to have safety procedures in place, and they are usually quite inadequate and lack current information. I guess we would have to go back to disseminating more information.
Hopefully I haven't completely typed myself in circles on this one....

Week 2 - Globalization

I was so exhausted by the end of the class, but by the time I got home, I couldn't sleep because there was just too much to think about! The main thing that struck me after reading, watching videos and listening to everyone in class, was that as Hans Rosling said we just need to get this information out in simple, accessible ways. There are so many misconceptions and vague ideas of reality masking truth that it is nearly impossible to discern one thing from another. All I can say is that I am glad I am taking this class to get some concrete clarity that I can share and work from.
The presentation given by Andrea Rios was really great for so many reasons (love Manu Chao!!), especially since I have often questioned the numbers and accusations of undocumented immigrants using social services made in the media and the actual direct impact this has on us. I was not surprised by what the article had to show, and hope that others outside or our class will take the time to read it as well (HealthCareUseAmongUndocumentedLatinoImmigrants.pdf ). All in all, it seems that everything comes back to education, in one form or another, to bring opportunities to those who need/deserve them and to work towards more level playing fields. From the first video on globalization we can see that sweat shops are not necessarily the evil corporation way of exploiting cheap labor but rather an economy builder for those who may not have any other means. In the case of the Nike factories in Taiwan, the workers were thankful for the opportunity to learn a new trade and make money they would never have a dream of earning on a farm. If the activists were successful in closing down those factories, what would happen to those workers? Where else would they start? On the other hand we see the example of Kerala, where things were working out and then globalization introduced relatively unnecessary luxuries that threw off the equilibrium of the economy. So in the end I think we have to come back to education to help enlighten us on where to find a balance.

Week 1 - The Big Picture

Last Thursday we met for our first class in Emerging Trends in Global Health and I was amazed at the energy and enthusiasm generated in the class. My thoughts on issues raised are as follows...
This was the first time I had seen some of the charts shown on the lecture slides and they really helped put things in perspective. I knew that there were deficiencies in some countries as far as population growth, but did not realize that on the whole the world population was actually moving towards equilibrium. I knew that chronic/non-communicable diseases had over-taken infectious diseases in global mortality rates, but the fact that they afflict 60% of the world's population is still astonishing to me and I realized that not many people outside our realm of global health realize this. In fact, during a discussion over the weekend with some friends i relayed this information and they were as amazed as I was. Just getting this kind of information out to "every day people" who may not dig for information past the MSN home page would improve global consciousness immensely. I liked the video for the Millennium Development Goals established by the WHO (http://video.google.com/videoplay?docid=-8153215241403626500&q=development+and+health&hl=en) and found it to be especially effective in broadcasting its message. It is important to set high goals, and while they may seem difficult to achieve given the context of the present world (perceived apathy, confusion of information), it would seem that this gives us even more of an incentive to strive for these accomplishments. Even in attaining these goals we would never be finished, for things keep on moving and changing. I am sure as goals are approached, new ones will always appear.