Author Archives: ealbrit1

Female Genital Cutting: How Should Public Health Respond?

Last semester for my Honors Introduction to Global Health project, I put together a presentation on the very serious issue of Female Gentital Cutting (FGC), also known as female circumcision or female genital mutilation (FGM). FGC involves a number of procedures, all of which involve the removal or refiguring of outer female genitalia. All of the associated procedures also lead to a number of very serious health conditions for girls and women, including excessive bleeding, any number of infections, and often fatal complications during childbirth. Many of the reasons for the perpetuation of this practice involve the very rigid gender expectations surrounding cleanliness, beauty, and sex.

FGC is still practiced in dozens of countries, including some in Asia, the Middle East, and Africa. Despite its global prevalence and the over one hundred millions girls currently living with the effects of this practice, many people in Western nations know little about the practice, including health care professionals. This is beginning to change, however, as this article in the New York Times notes. Increased immigration to the United States as also increased the number of girls and women living in the U.S. who have undergone this practice. Many young girls are even sent to their nation of origin to have the procedure done, often without their prior knowledge or consent.

This is certainly an issue that public health must be aware of and active in addressing. Addressing gender inequities is certainly one approach to eliminating this practice. However, addressing this practice in a culturally competent way is a major challenge. For instance, what are the implications of using the word “cutting” as opposed to “mutilation?” As the article notes, many girls and women avoid seeing health care professionals or talking to their physicians about undergoing this procedure because U.S. health professionals have little to no experience with this issue. Further, these women feel that they will be judged as “backward” or “uncivilized” if others find out about having the procedure done.

This practice is illegal in the United States, and there is a push to also make sending girls abroad to have it done also a crime. However, there is concern that this will only drive the practice underground, which will only magnify the negative health effects as women will either choose or not be allowed to seek medical attention in order to protect family members. Others are arguing for a harm reduction approach that medicalizes the procedure, especially in areas where the practice is common place. Currently, the practice is not usually done by someone with any medical training, in very unsanitary conditions, with a very unclean instrument. The argument is that by medicalizing it, and allowing it to be done under the care of a health care professional, the health effects can be minimized, saving a lot of pain and many lives. But would this legitimize the practice? Or would it be another step along the way to eliminating the practice? There are no easy answers to these questions, but they are questions that need to be explored both globally and in the United States.

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Whats Up Magazine

If you frequently cross Grand at the main crossing between the BSC and DuBourg Hall, chances are you have seen and heard the man that is often there asking for people to donate to the homeless. When I have walked pass this person, I often hear other SLU students making comments about him that are quite derogatory. I have heard others comment on his race and general appearance, while many others have speculated that if they were to donate anythign to this individual he would use to buy drugs or alcohol. Rarely have I seen people stop and realize that this man is actually selling What’s Up Magazine. This magazine aims to raise awareness about social issues, particulary homelessness and other urban issues. The magazine is distributed by vendors who are experiencing homelessness, who purchase the magazien for $0.25, and then they sell the magazine for $1.00 to generate some income. People experiencing homelessness and poverty also figure prominently in the design and publication of the magazine.

One article in the current issue focuses on Homeboy Industries, a program established by Fr. Greg Boyle, SJ in East Los Angeles. Homeboy Industries is a program that provides services like a 12-step program, case management, job training, legal assistance, employment opportunities, and even tattoo removal for gang members who are seeking a new life. In this story, Fr. Boyle brings up many of the issues that we have discussed in class. One of these is constraint on choice that many who end up joining gangs experience–they are often born into a environment of gangs and see few other viable options than joining a gang for protection, brotherhood, and status. Fr. Boyle also challenges us to consider those on the margins of our society, particularly gang members and the homeless that those of with privilege tend to be so uncomforable around, as members of our community. Fr. Boyle says that he wants “to erase the notion that we are disconnected to the people with whom we share our cities and neighborhoods.” Homeboy Industries is also an example of realizing the “privileged knowledge” that the “the poor” possess, as the oranization structures its programs around what the individuals they are trying to help sayt they need, and these former gang members fill many positions within the organization.

You can access this article here, but I also encourage everyone to keep an eye out for a Whats Up Magazine vendor and buy an actual copy of the whole magazine as well. Two other articles in this issue, one on homelessness and another on the harm reduction approach to addiction also raise issues related to much of what we have talked about in class.

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What does it mean to “suffer with?”

Many times throughout the semester when we have been discussing how to allocate money and other resources for health services, the issue of being less willing to pay for another individual’s health care if that person’s health issues are the result of unhealthy personal behaviors. An often used example is substance abuse, which is why I thought it would be interesting to examine this article in light of some of the things our readings on liberation theology led me to consider. This article is about some of the issues facing the unborn and newborn children of women who are addicted to opiates. Many of us are aware that abusing substances can cause serious harm to an unborn child. However, as was the case with a mother who took OxyContin for the first 12 weeks of her pregnancy, quitting can also be dangerous for the unborn child, as it can cause seizures in utero and can even cause a miscarriage. As a result, doctors choose to keep these women on methadone, a drug that keeps low levels of opiates in the body in order to prevent a withdrawal reaction, which can seriously harm the baby. However, these babies are often then born addicted to the opiate and must be weaned off of  the methadone, which is also painful and dangerous.

It would  be easy for us to place full blame on the mother for her decision to abuse drugs in the first place, let alone to do so when that decision so heavily impacted another person’s life.  However, we cannot forget the social and environmental factors that may have led to initial drug use. Poverty, level of education obtained, and access to jobs are all factors, as are exposure to trauma or abuse, and other situations that have an impact on a person’s mental health and ability to cope. As one woman in the article said about taking pills, ” It was a lot easier to get through life and have energy.” Certainly personal responsibility is at play here, but we cannot solely blame these women and forget the way that certain social structures have attempted to dis-empower them and limit the agency they have over their own lives.

We can of course design and implement interventions that aim to prevent these women from ever beginning to use drugs, not only so that they are healthier, but also so their children will never have to undergo methadone treatments and also be healthier. We can work for structural changes that will leave less people vulnerable to substance abuse. But how can we move beyond technical interventions and an impersonal redistribution of resources to truly “suffering with,” to build relationships and enter into praxis with those that have been disadvantaged by our current system, to bring about a true community? Can we really say we are “suffering with” if we are still unwilling to give up fully on our privilege?

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Violence: It’s Not Just “Cultural”

By: Ellen Albritton

This week I chose to write this blog post on an issue that is very close to home. This is not only the case because it comes from our own local newspaper, but also because this is an issue the children at my service learning site, which is just minutes from SLU, must deal with on a regular basis. The article starts off being about the recent burial of a sixteen year old girl who was shot and killed as a result of gang violence, but most of the article focuses on the larger “culture of violence” that plagues St. Louis, particularly the violence perpetrated by local gang members.

The effect that this type of violence has on the well-being of individuals can be enormous, especially for children. Through the research I have been doing for my paper on this topic, many studies have shown that youth that grow up in neighborhoods with high levels of violence exhibit similar health and personal development issues of children who have grown up in war-torn countries. Sleep disturbances, trouble concentrating, and traumatic flashbacks all wear on the psyche of children and make it more difficult for them to do well in school. Living in a violent community can also lead to difficulty forming attachments, trusting adults and others in authority, and developing sense of one’s own identity. I see all of these characteristics in many of the children at my service learning site in North City. I have also seen a marked difference in these kids in the days immediately following a violent incident in their neighborhood. In fact, I am truly amazed at the resiliency of the beautiful children I have had the honor of getting to know.

While I think it is vitally important to be concerned about the effect that violence can have on a person’s well-being, I also think it is equally important for us to be concerned about how we conceptualize and what language we use to describe an issue such as this one. The writer titled the article “Girl’s Burial Spotlights a Culture of Violence.” I think we must be very wary of characterizing community violence as result of the “culture of poverty” or the “gang culture.” Instead of focusing on the deficiencies we see in the “cultures” of communities that experience high levels of violence or of gangs, I think we should examine a type of violence that is very prevalent in our entire society—structural violence. This structural violence is the result of the way our society has been constructed–the way that some are denied their basic human rights and struggle to have their basic human needs met while others reap the benefits of a long history of systemic advantage. I think that the more we try to attribute this violence to “culture,” the less likely we will be to challenge the social structures that cause it.

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The Big “Land Grab” in Ethiopia: Who Is Benefiting?

By: Ellen Albritton

When I came across this article, I thought it would serve as a nice counterpart to the Leila’s post about quinoa in Bolivia. Currently Ethiopia is one of the world’s largest recipients of global food aid. Larger portions of Ethiopia’s populations suffers from malnutrition and all of other negative health consequences that can result from not being properly nourished. Ethiopia suffered tremendously in 2008 under the world food prices spike, and it continues to suffer as prices continue to rise. In fact, when I was in Kenya last summer, I was warned repeatedly by many different people not to travel on certain roads near the Kenya-Ethiopia border because Ethiopians, desperate from starvation, were attacking and robbing anyone with food or money.

The Ethiopian government has recently sold enormous tracts of land to many large, foreign, and very wealthy agri-businesses in Gambella region. Although this land was sold for already very low prices, these companies will also benefit from tax breaks, and roads will be built at government expense for these large farms. Despite this large investment by the Ethiopian government and the great need in Ethiopia, much of the food will be exported to wealthier, developed countries, and the profits will go to these foreign investors.

The Ethiopian government argues that this is the type of foreign investment that is needed for Ethiopia to develop economically. The hope is that this economic development will ultimately reduce Ethiopia’s dependence on global aid of all types, including food aid, and that in the end, the investment of these foreign companies will serve the greater good of all of Ethiopia. Others argue that, in addition to the destruction of local ecosystems that the massive land-clearing is causing, this “land grab” will do nothing but to make these already wealthy businesses and people even wealthier, while those living in extreme poverty will continue to suffer without adequate nutrition. Already there are claims that both foreign companies and the Ethiopian government have failed to deliver on promises they made about establishing schools, clinics, and clean water infrastructure. There is also controversy about whether or not Ethiopians are being forced off of their land in order to make more room for these huge areas of new farmland.

Is is just for us in the developed world to benefit from the food we will eat that is grown on Ethiopian land, while Ethiopians continue to starve, even if it will really help in the “long-run”?

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The Lack of Health Literacy in the U.S.

By: Ellen Albritton

This article discusses the alarmingly low rates of health literacy that affect a large number of people in the United States. The definition of health literacy given in the articles is “the ability to obtain, understand, and use health information. In fact, only 12% of the of the people in a study was deemed proficient, 50% fell at the intermediate level, and a huge 36% were classified as basic or below basic. It provides a number of examples of what can happen when a patient does not understand how to take a prescription, cannot read or comprehend a warning label, or cannot accurately follow directions given to them by their doctor. Some of the things that have resulted include developing an unnecessary infection, a perforated ear drum, and inaccurately completing medical forms.

While some of the things that patients do not understand may be the result of medical professionals using too much professional jargon that very few people would be able to understand, but there is a more basic reason for the lack of health literacy as well. In this week’s reading, Powers and Faden discussed how one social determinant can often affect more than one dimension of well-being. I see the case of health literacy as presented in this article one example of that. The social determinant of education certainly affects the reasoning dimension, as low-quality education can lead to an insufficiency in reasoning. Low quality of education can also affect the dimension of health, as low general literacy levels play a huge part in someone being health literate. Low health literacy disproportionately affects those living in poverty, as well as recent immigrants, two groups that are also disproportionately represented in under performing schools.

One final thing to think about from the article–The other day in class we talked about how people can internalize racism. Similarly, a patient educator that contributed to the article noted how many patients who lack basic health literacy will “tune out or shut down” because they know how it will make them look if they ask certain questions or say that they don’t understand.

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Mental Health in the United States

By: Ellen Albritton

Across the country, states are experiencing severe budget crises. Deciding which programs and services will get cut in order to balance the budget is often a battle dramatically played out in the media. Less common is media coverage following the cuts to social services, so we often fail to hear the stories of those individuals whose daily lives are deeply affected by the policy decisions that our lawmakers debate so heatedly. This story in the New York Times sheds light on the current experiences of people with mental illness in Texas, as well as what may happen to these vulnerable individuals if  proposed cuts to mental health are passed. These proposed cuts in Texas could lead to a 20% cut in funding to community mental health centers. However, these facilities are already falling fall short of being able to provide for everyone in the community suffering from mental illness.

For many people in the United States dealing with mental illness, their best chance at receiving medication and treatment for their illness is within the walls of a prison. As the article states, “the jail is the largest mental health institution in the state.” What does the incarceration rate of people with mental illness tell us about the way we view the mentally ill regarding community? Why do we still view mental illness with so much stigma? What is preventing us from extending our notion of community to include these vulnerable members of our society?

There is a full spectrum of crimes for which people who are mentally are incarcerated. These range from violations of minor local ordinances to very violent crimes. How much can we hold these individuals personally responsible for their actions, especially when there continue to be fewer and fewer treatment and support options available to them? What about their right to self-determination? Those suffering from severe mental disorders may pose a threat to themselves or to others. Do we have the right to disregard their self-determination and forcibly medicate or forcibly admit them to a mental health institution? Finally, does the stigma surrounding mental illness lead to more allowances for overriding self-determination than is reasonably necessary for public safety?

 

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