Author Archives: laurahahn4

Dr. Paul Farmer’s Reflection on Haiti

Dr. Paul Farmer, in my opinion, is one of the most extraordinary persons I have ever heard of, and I have learned more from his story and biography of what it means to give your heart to the poor and vulnerable than any other person I have come across in my readings.  His dedication to serving the poor is infectious and he shares with us important insight into what is most effective and just when it comes to improving the quality of life for people of poor economical, social, and political environments–such as those victims of the Haiti earthquake.

What strikes me most about Dr. Paul Farmer, is his ability to see into the hearts and souls of his patients.  When he treats patients, his priority is not to diagnose and administer some “magic bullet” cure that will clear up an infection or illness.  Rather his primary focus is on the underlying structures and institutions that have led to such a devastating presence of disease and malnutrition in an entire country.  The deeper and broader social issues at play are what Farmer emphasizes are indispensable to any form of public health or social just work.  His organization Partners in Health are orientated towards thinking this way when they treat patients in Haiti, and often Farmer admits that many of his patients come to him not for medical treatment, but for non-medical requests, such as whether he can help secure an education for their children, or whether they could help them find a job?  Farmer notes that in an absence of addressing this broader social concerns, public health works will have little long-term successful consequences.

So what are the five immediate public health actions that should be implemented in the securing and rebuilding of Haiti in the next few years?  In Farmer’s opinion, it is that foreign aid needs to consist of less monetary “charity” donations in exchange for a greater number of people actually engaging with patients and citizens on a regular basis.  Taking the time to listen to patient’s medical and non-medical needs can help alleviate both the immediate and long-term effects of a devastating natural disaster and a fringed economy.  In particular, Farmer addressed the five things we have learned as it pertains to foreign aid from the Haitian Disaster:

1.  Jobs are everything:  without jobs, Haitians can’t meet basics needs of food and water.

2. Don’t starve the Haitian government: international community doesn’t know what’s best for Haitians, they do.

3. Give Haitians something to go home to and fight for: give the people the power to own their own homes

4. Waste not, want not: reconstruct how aid gets distributed to countries in need

5. Relief is the easy part; reconstruction of a strong economy and spirit people is the hard part: bringing relief is only 5% of fixing the problem.  The other 95% lies in efforts to rebuild a strong economical and social country.

Ultimately, Paul Farmer’s reflection on what we have learned from the Haitian disaster serves as a platform on how our attitude should be directed towards helping the poor and vulnerable.  Much of what we have learned from Haiti falls within the realms of Liberation Theology, which very much emphasizes the a personal relationship with the poor as well as empowers the most devastated to share their insight into how to strengthen and rebuild their community.

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With This Surgery, I Thee Wed

We all want to grow up and marry (for those who wish to be married), the love of our dreams…and of course live happily and healthy ever after…

Come ‘on…who are we kidding….we want to marry for the insurance and health care security right???  It seems ridiculous, but many couples admit that their marriage was in part not an expression of pure and never-ending love for each other, but rather a means of securing insurance for both themselves and their domestic partner.  But you may be asking yourself, does this really happen?  Do people really get married just to get insurance coverage…and why can’t they get affordable insurance on their own?  We’ll the answer lies in the some 1,000 legislative laws that are extended to married couples or even same-sex domestic partners but nor to heterosexual domestic partners.  I believe that this sort of marriage has become so popular in recent years that even the media is drawing more attention to its rising popularity.

In the ever-dramatic episodes of Grey’s Anatomy, there was an incident in which this idea of “with surgery I thee wed” comes into play within the hospital of Seattle Grace Mercy West.  In episode 10, Dr.  Teddy Altman, cardiothoracic surgeon,  meets Henry Burton, a patient with the rare genetic condition Von Hippel-Lindau disease and who can no longer afford to pay for his medical care.  Out of concern for his well-being and lack of family for support, Teddy marries him  in order to ensure that he has insurance to undergo a life-saving surgery.  Right before surgery, Dr. Altman signs a simple signature to ensure that Henry will be insured in the procedure later that evening. 

It seems frustrating to me that laws have been passed allowing one set of domestic partners and not another to be covered by their partners insurance.  It also seems arguably stupid that a simply city hall preceding and signature on a piece of paper is what stands between someone receiving a life or death treatment for their illness.  There should be other, more just, ways in which people should be able to obtain insurance.   Like one 30-year domestic partner couple says, we should marry for love, not for insurance security… ’til death do us part

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Organ Donations and Organ Procurement

How much would you be willing to pay to save your life?  Anything it takes, right?  This is the ultimately question that stumps even the best public health and social justice experts when trying to establish a just system.  In the end, we are probably willing to do pretty much anything and pay almost any cost if it meant we got to keep living.  So then it comes to no surprise that people are willing to exploit this desire to live by buying and selling organs on the black market. 

The horrors of the black market have been increasingly disturbing in the past years.  The shortage of transplantation organs, and the meticulous process of acquiring and assigning needed organ based on a ranking system has led people to turn to other options.  “Black market organ donations” offer not only a relatively simpler means of acquiring organs in need for the sick, but it also stimulates impoverished people to sell their spare organs (ie. kidneys, corneas, etc.) for quick money.  The darkest side of the black market for organs is the rising increase in organ theft.  If placing a monetary value on body parts isn’t already disturbing, it is something else to acknowledge the rising number of organ thefts occurring, even to the point of committing murder for the purpose of either getting rich or not wanting to wait on the list.  In addition, much of the black market, especially when it comes to the donation and receiving of organs acts in a unidirectional manner: third-world to the frist-world market.  Obviously this is a violation of basic human rights.  The entire system in general exploits the poor and vulnerable while benefiting the rich.  Yet the reward value on both ends of the black market system perpetuates its existence and sets up a pathway for perfectly healthy individuals to become victims of the organ scavengers of the rich.

On the other hand, those lawfully awaiting an organ on the donor-list also feel that the process by which organs are extracted and allocated are not always the most just proceedings.  It is true that when dealing with organ transplantation, especially heart or lung transplantation, that there are many factors that should be considered from a biological perspective as to who should receive the organs. The fact is that organs are on short supply and it is no laughing matter that someone usually must die before another life can be saved.  Therefore, in order to make the process as fair and just as possible, the UNOS has devised a ranking system which numbers candidates by biological information, as well as clinical characteristics and time spent on the waiting list.  While this appears to be a procedural and fair way of determining where organs will be distributed from an outside perspective, it doesn’t always come across this clear-cut when you become personally involved with the situation.  Below are the five steps used to match donor organs to waiting recipients.  What makes this process difficult is that it doesn’t always take into account whether a person is “deserving” of organs over another.  It is possible that a patient who has smoked their entire life will receive a new set of lungs before a non-smoker simply because they have been on the waiting list longer and “promise not to smoke” after the surgery.  The fact is there are no guarantees and this is what makes this process so difficult in placing “worth” on human life.   

The Five Steps of the Matching Process

  1. An organ is donated. When the organ becomes available, the OPO managing the donor sends information to UNOS. The OPO procurement team reports medical and genetic information, including organ size, and condition, blood type and tissue type by entering this information into UNet.
  2. UNOS generates a list of potential recipients. The UNOS computer generates a list of potential transplant candidates who have medical and biologic profiles compatible with the donor. The computer ranks candidates by this biologic information, as well as clinical characteristics and time spent on the waiting list.
  3. The transplant center is notified of an available organ. Organ placement specialists at the OPO or the UNOS Organ Center contact the centers whose patients appear on the local list.
  4. The transplant team considers the organ for the patient. When the team is offered an organ, it bases its acceptance or refusal of the organ upon established medical criteria, organ condition, candidate condition, staff and patient availability and organ transportation. By policy, the transplant team has only one hour to make its decision.
  5. The organ is accepted or declined. If the organ is not accepted, the OPO continues to offer it for patients at other centers until it is placed.

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Falling Through the Cracks: Stories of How Health Insurance Can Fail People with Diabetes

Health insurance companies are  a hot topic in the news today!  Healthcare reform, colloquially known as “Obamacare” especially looks at what the role of the Insurance companies is now? What their role should be? and How is the systematic structure contributing (either beneficially or detrimentally) to the overall afford-ability and availability of health insurance?

In class this past week we examined quite a few new terms and situations involved in Healthcare.  Sometimes I find that information seems vague until I either see or hear stories about how the current medical system is affecting individuals.  I came across this article and found it interesting because it not only breaks down the different levels of coverage offered at the moment, but it also offers personal stories about those individuals struggling financially to secure proper and just health insurance.

In particular, this article  examines only a small proportion of the population–those with Diabetes.  While Diabetes is just one chronic illness our neighbors suffer with in this country, the inability to get proper prescriptions, insulin, or testing strips, can prove detrimental on the health and finances of a family or individual.   To make matters worse, those individuals who have been recently laid off from work or anticipate being laid off from work must begin a transitioning process to look for new healthcare.  Often they are unable to find an affordable plan due to a pre-existing health condition.  In order to supplement these people, the government offers federal aid in the form of COBRA and HIPAA, which insure a recently unemployed individual for 18 to 36 months.  Unfortunately, in the case of Sylvia, a 52 year old diabetic patient, COBRA does not cover prescriptions or patient care.  In addition, some people like Walter of Kentucky, age 45, are recommended to test their blood glucose levels 3 times a day.  However, due to the expensive nature of his test strips (90$/box of 100 strips), he is only able to test once a day, leaving room for the potential of having too high of blood sugar the rest of the day.  Thus, while even those members who are federally covered by COBRA and HIPAA do receive some temporary healthcare benefits, the reality is that these benefits are insufficient and short-lived.  They are transitional aids, but they do not change the fact that the insurance companies can continue to simply deny these individuals based on pre-existing conditions, or minimal income, and thus high premiums.  Ultimately, many people in this article admit to forgoeing even minimal coverage because they fear the burden of having to pay extremely high prices for extra prescriptions (above the 3 allowed by some insurance companies/month) or unexpected doctors visits not covered by their plan.

In addition to the physical burden placed on the unemployed or poor when it comes to finding and maintaining good health insurance, often their is an emotional side.  When job loss occurs or unexpected hospitalization is required, patients and their families are put under pressure to choose to pay medical bills over their mortgage.  Some find themselves downsizing, or taking out more loans or even selling their house and moving in with other family members, thus extending their burden onto others.  Ultimately, there is no real simple answer, but stories like these truly hit home with us about what really is just or unjust when it comes to how insurance companies operate and extend coverage to individuals with chronic illnesses like diabetes.

 

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“Canteen Culture” of Racism

After participating in the puzzle in class the other day, I, being a member of the group who lacked event the basic resources to finish the puzzle, decided to investigate into the presence of institutionalized and personal-mediated racism in our daily life.  It was then that I came across this article in the Scotsman post about the rising racist environment in the airline industry.  Today in age we recognized three levels of racism:  institutionalized, personally-mediated, and internalized racism.  Unfortunately there is strong evidence that suggests that institutionalized racism paves the path for the latter two.  A history of segregation, discrimination, and unequal opportunity has its consequences in the mindset of people today.  Being only 50 some years post-Civil Rights Movement means that those biases and superior mindsets are still present in today’s workforce, public structure etc.  Efforts to eradicate this institutionalized racism, such as affirmative action, desegregation, equal voting opportunity, and many more are just small steps to changing how society accepts minorities and ethnically diverse people.  Unfortunately, saying that things are now fair and equal to all races is the minimal requirement that this nation needs top address in order to completely eradicate racist tendencies.  it is people who shape the policy and structure of society, thus it is the mindset of those people who need to embrace a non-discriminatory approach to their work environment.  In addition, it becomes the responsibility of each individual company, school etc, to provide available and just services for those who wish to report a racist or bias incident.  The availability of these services means that employees, no matter their rank should feel comfortable to bring a claim to the company free from fear of losing their job or being considered a “jock,” as is the case in the article concerning the BA captain.  Furthermore, the “just” portion of these services must be implemented in order to ensure that a complaint does not fall on deaf or disinterested ears.  Unfortunately in the case of this article, the pilots’ complaints were left unanswered.

We hear it every day.  Racist jokes passed between friends about other minority groups.  But this so-called harmless “name calling” is more than just fun-and-games.  While students may find it entertaining to poke fun at other racial groups (even if there are members of that racial group participating), the reality is that these people are participating in a form of personally-mediated racism which can ultimately establish a routine of racist remarks in a more professional and censored environment in their future careers.  It happens in the airline industry everyday. Imagine flying for hours in cockpit with just a few other crew members who have  a level of time and freedom to speak candidly about other crew members or there passengers’ ethnicity that they have flown with in the past.  As senior pilot of British Airways attests, there is a canteen culture of racist remarks that are thrown around in the cockpit on daily basis.  Despite being briefed with classes such as “diversity in the cockpit,  pilots tend to feel that their uncensored comments are acceptable, and the small cockpit environment makes it intimidating for any crew member to immediately chastise a particular comment.

In addition to the racist comments witnessed by Mr. Maughan of British Airways, the airline industry, specifically the Air Force Academy frequently report that despite the military’s exemplary record of opening doors to minorities, only about 300 of nearly 15,000 pilots in the Air Force are African-American.  Obviously there is some inherent factor that is causing African-Americans to either not consider the Air Force as a career or causing them to drop the program at  higher rate than any other minority.  Ultimately, Captain Maughan’s complaints of racial and derogatory remarks in the airline industry went unheard by authorities.  His concern is if someone of his seniority cannot invoke a response by authorities in his company, then how is anyone else lower in the totem pole supposed to be heard?  This culture of racism is a problem that extends the globe and all ethnic groups today.  Individuals should be mindful of how there remarks affect those in their surrounding and companies should spend more time ensuring that their employees are respectful off their other crew members and passengers.  As we can see from this article, it takes both personal and collective commitment to change these forms of racism in our companies today.

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Longevity: A Concern for Future Public Health

Longevity: The Next Public Health

Often we get wrapped up in the problems of today, especially when it comes to health and situations of justice. However, in more recent news, there has been more attention turned towards the public health and social justice concerned with the growing longevity of the population. According the a recent article in the New York Times, “since 1900, the life expectancy for the average American has increased by three decades, creating a host of medical, financial, and public policy challenges.” An increase in longevity of the average American is a public health problem that we must begin tackling immediately so as to ensure that our future elderly (who will most likely be living longer than the current elderly) are protected and insured. In addition recent survey suggests that American citizens are lagging behind twelve other countries who report having an increase in longevity. Initial efforts to uncover this disparity ruled out “obesity, smoking, traffic accidents and homicides” as sources of blame for the disparity. Instead, the researchers concluded that “costly specialized and fragmented care.” Today, nursing home or dependent living facilities are expensive and far too sparse. Only the rich are able to afford the high cost of putting their loved one in an assisted living home. Those who are unable to provide these living facilities for their elderly are often left to take on an additional financial and personal burden of ensuring their safety within their own homes. In a poor income house, the consequences could mean that individuals of the family are left at home to care for their elderly instead of working to bring in income or go to school.

Ultimately, the particular situation for the elderly person and their family has consequences for everyone. If an elderly is in constant state of embarrassment for not being able to provide for themselves, then they cannot according to Dr. Robert Butler, “have the freedom to live with change, to invent and reinvent themselves” no matter what their age. A shortage in accessible geriatric living and medical facilities will have consequences on the elderly, their families, and the society as a whole. It is estimated that in twenty years 1/3rd of the population will be over the age of sixty and in need of end of life insurance and care. With the increase in technology, these individuals will be living for a greater amount of time and will require assisted living and Medicare benefits for a longer sustained period. More funding will be needed for providing at minimal the basic needs of shelter, food, medical access, and the freedom to explore and flourish as an individual. Thus it comes to no surprise that there is a great emphasis on longevity in emerging Public Health professionals.  Perhaps it is our American mentality that sets us apart from other nations, but there seems to be lacking that sens of duty to take care of our parents within our home.  Instead, when we can afford it, we place them in nursing or assited living housing.  However, many of these living facilities are not weel funded or well staffed and often there are reports of negelect and abuse.  In addition, many of these facilities are not equipped with the needed machinery and services to provide their seniors with the required “on-site” medical, psychological, or social stimulation.  For example, many patients on dialysis need to be transported via ambulance or other medical vehicle to a separate facility for treatment.  This arguous and sometims embarassing process has detrimental affects on the individual’s sense of security and well-being.    

Despite a per capita increase in health care spending in the U.S., the country is falling behind other countries according to lead author, Dr. Peter Muennig, assistant professor of health policy management at the Mailman School of Public Health. Perhaps the problem is an appropriate delegation of the resources available to those who are in most need. Perhaps not enough money has been delegated to the resources needed to protect the rights and liberties of an elderly person. It seems just that elderly (or any retired person for that fact) deserves to live a life free from fear of future medical, personal, or social barricades. Ultimately, we are unprepared for the future of our elderly citizens. There is a dire need to focus on long-term health benefits for senior citizens as well as government funding available retirement homes which are available to all.

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Homelessness

In light of the recent severe cold and blizzard weather we have been experiencing here in St. Louis, I would like to take this opportunity to bring up a social justice issue that is often forgotten as we sit inside our warm houses and apartments waiting for the storm to pass…and that issue is Homelessness.

While browsing the internet, I came across an article on medscape.com titled Homelessness in the United States: History, Epidemiology, Health Issues, Women, and Public Policy.  This article offers us each an opportunity to examine the social justice and public health issues surrounding homelessness.  

Have you ever wondered how people become homeless in the first place?  Don’t they have some sort of family to turn to…or if not, doesn’t our nation have laws protecting the Universal Declaration of Human Rights of all humans which states that “Everyone has the right to … food, clothing, housing and medical care and necessary social services.”  Perhaps people really do not have anyone to turn to, or any means to get into contact with others.  The cycle of poverty is a devastating trap which often is hard to break out of even if given the opportunity to work part or full time  Why should we be the ones to judge them on their appearance or lack of motivation?  Just get a job, right, and everything will be fine!  Well unfortunately that is not the case!  Last time I checked college graduates were fighting for employment spots here in the United States. 

How do you feel when you see a homeless person on the side of the road begging for money?  Do you ever feel caught between wanting to help someone in need and worrying that others will judge you for your stereotypical act of  “encouraging their drinking or drug problem” which you assume has obviously led caused them to become poor and homeless?  Perhaps we fear that our money will go to waste on cigarettes or alcohol.  Yet even for those of us who do manage to share a few dollars here and there with the homeless, we know this is  far from a permanent solution.

Only with the correct policy and support from the entire society can homelessness become eradicated.   Attempts have been made in the past century to try to meet the housing needs of its citizens in the Housing Act of 1949 and again in the Fair Housing Act of 1968.  Regrettably, neither has proven effective in eliminating the problem of homelessness.  The result of this failure to provide adequate shelter for it citizens has resulted in a population with limited if not zero access to public health and preventative education.    As a result, homeless persons, according to the article, “tend not to get adequate preventative care and appropriate routine management of chronic illnesses as hypertension, heart disease, diabetes, and emphysema.”  In addition, the mortality rate for a homeless individual is four times that of the general population.  Unfortunately these high mortality rates and short life expectancy are a direct result of the many concurrent medical ailments that homeless people suffer from.  Medical, functional, and psychological limitations all factor into the health problems which tend to affect the homeless population at much higher frequency than the general population.  More specifically we see young women greatly affected signs of chronic diseases due to the lack of funding and time dedicated to providing preventative tests.

Homelessness is not so called “city problem.”   It is a social and humanitarian issue that cannot be ignored any longer.  What would you do if it was one of your friends or family members out there on the cold streets of Saint Louis tonight?  Would you be satisfied with just handing out a few dollars or a few items of clothing every now and then, or would you demand something more?   Well I would expect more from myself and from my community to support my friends.  We all have a story, and even a homeless person has intrinsic value and worth in this world.  Maybe it is time for our community to take a second moment to reflect on how homelessness reflects a deeper social justice matter about our own community’s selfishness and ignorance to those less fortunate than ourselves.

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