Licensed to Put Us All at-Risk?

This NY Times article about new drivers learning how to operate a vehicle caught my attention because 1) I have never really thought too much about this topic as a public health issue and 2) My 16-year-old sister recently got her driver’s license in October and I try to make sure she is well-informed and safe.  She went through the same process as I did to qualify for a license: driver’s ed (classroom and behind the wheel), hours of supervised driving, and a minimum of 6 months with a driver’s permit.  I always assumed this was standard for most states, but apparently some states allow children as young as 14 years old to begin driving with a permit, which seems awfully young.

If the rate of vehicle-related accidents is so high for the teenage age group, then it could be beneficial to pay more attention to this matter and evaluate what is the best process for learning to drive and being qualified for a license.  From my own experience, I think that the process I went through provided a decent base from which to work off of, but practice in real situations was definitely needed.  States that have passed laws making the license process more extensive have seen a 30% decrease in teenage highway fatalities.  Adding more supervised driving hours, limiting the number of passengers allowed in the car of a teenage driver, and increasing the driving age are just a few examples of these laws.  Those states have been successful thus far in their attempts to increase safety on the roads, so why not make changes nationally?

Teenage vehicle accidents are typically caused by errors like scanning mistakes and misjudging the speed of oncoming cars when turning left.   Another suggestion for increasing safe driving is “narrative driving,” which entails parents explaining to their teenage passengers exactly what they do as they drive, bringing attention to actions that are second nature to experienced drivers but unknown to newbies.  In the classroom, rules of the road can be taught memorized, but application is something that needs to be experienced.  By having parents or adult drivers explain how to drive, student drivers are exposed to more in-depth information for a variety of situations and driving skills.

Another major cause of teenage accidents is misjudging road conditions.  Taking a student driver out on the road in different weather conditions and at various points in the day allows for a more holistic training.  Parents often limit practice to the most optimal driving conditions.  By doing so, newly licensed teenagers will be more at risk for an accident if they are alone when they face harsh or difficult conditions for the first time.  Steering on icy roads and avoiding hydroplaning are two skills that require specific instruction.  Without knowledge of how to handle these situations, young drivers can place themselves and others in great danger.

In the U.S., learning to drive is a right of passage into young adulthood.  Based on statistics, it is also very risky and potentially fatal.  Passing laws to facilitate a safer learning experience and taking the time to teach student drivers in an active manner can save many lives and create a better environment on the roads.

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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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Dying from Drug Overdoses

In Portsmouth, Ohio the number of people dying from prescription drug overdoses is rising.  Many of those dying are adolescents and young adults.  This article describes the increasing problem in the town.  According to the article nearly 1 in 10 babies had tested positive for drugs last year. Seventh graders have been caught with prescription drugs and many rehab facilities are filling with young patients.  As of 2007, deaths from drug overdose were greater than deaths from car crashes.

This situation has been compared to the 1980s, when grandparents had to raise the children of drug addicts who grew up to become addicts, too.  An Ohio policeman talks of how children today are third or fourth generation addicts.  One fact that shocked me:  more people died in Ohio within two years due to overdoses than the number of people who died in 9/11.

A lot of people would consider drug overdoses to be a fairly private issue.  Families might be ashamed or embarrassed that their young relatives died because of prescription drug misuse.  However, in order for the issue to be addressed, the problem needs to be made public.  Local and national government officials have made this issue a priority within the past few years, designating funds to combat adolescent drug abuse.

In the Ohio town, the problem is so prevalent that business owners are having trouble finding job candidates who can pass a drug test.  The drugs are coming from a number of places:  doctors, parents, and neighbors with access to prescription drugs.

When I first read this article, I was shocked by many of the statistics, including the number of babies who test positive for drugs and the number of young drug users.  Then I thought, why is drug abuse so prevalent in this state and in this town?  Is there a reason that adolescents are turning to prescription drugs?  Shouldn’t there be help in place to prevent drug abuse from becoming a family trait?  The article noted that Portsmouth was once an industrial town.  In many towns such as this, industry has declined and there are not enough jobs.  Even those with jobs are not receiving wages with which they can live reasonably.  Perhaps this decline in productivity has led to a decline in social structure and support.  However, can the problem be solved/lessened by targeting social support systems?  Should rehab or prevention be a priority?

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When Political Turmoil Spills Over into Health Care

By: Anita Cheng

The recent political uprisings in the Middle East and Northern Africa have captured the attention of the global community. Speaking for myself, I have not considered how political turmoil has affected access to health care for civilians caught in the middle of often dangerous war zones. This article in the New York Times caught my attention. The Salmaniya Medical Complex, Bahrain’s largest public hospital, is now not only being guarded by government military forces but is virtually empty of health professionals and patients. This anomaly can be explained by the fact that the Sunni-majority Bahrain Government believes that this medical facility (staffed by mainly Shiite physicians) is being used as a hub for radical Shiite conspirators. Since the initiation of the conflict, medical professionals have been stopped from treating wounded individuals who have participated in opposition activities and those who allegedly disobey this command are arrested. The current health minister defends her position by stating that doctors have been purposely depriving patients of medical care or worsening patients’ wounds then subsequently asking news media to report of these cases to prove the government’s oppression of its people.

This situation in Bahrain is a social injustice on multiple levels. Because of these terrorizing incidents, local civilians are afraid to seek care at Salmaniya. In addition, since this medical facility is one of the largest in the area, this crackdown cuts off access to emergency care, blood bank, and drugs from its patients. Physicians and other medical care providers working in Salmaniya are forced to make a crucial decision in a “lose-lose” situation – Should they stop providing care to wounded demonstrators and protect themselves or should they defy the commands of its monarchy government and risk their personal security to save those who are participating in these uprisings? Whether the health minister’s claim is correct or not, one can argue that the motivation behind these physicians is to reveal atrocious human rights violation its government has committed against its people to the world. In addition, one can point out that the government’s “plan” to prevent these doctors from doing what they are allegedly doing is counterproductive because cutting off healthcare access is a human rights violation itself and is now being revealed by this article and perhaps other news outlets as well.

Describing this situation as “tricky” or “complex” is a great understatement. Since social justice is at the core of public health, what is the “just” action that should be taken to ensure that the right to healthcare and a safe work environment is reinstated for the people of Bahrain and its physicians and health care workers? Whose responsibility is it to put an end to these human rights violations? Would political and economic sanctions even work? If the allegations are indeed true that security forces have gone as far as stealing medical records to hide evidence of these violations, how can prosecutions against the Bahraini government be made without proof? If a solution to this crisis requires the resolution of the political conflicts, how long would the people of Bahrain have to wait before they can feel safe to see their doctors?

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The Washing Machine- The Equality of Technology

Perusing Ted.com, I came across a Hans Rosling video that touches on many contemporary issues in public health. In the video, Hans Rosling makes the argument that the washing machine is one of, if not the, greatest inventions during the industrial revolution. Essentially, pre-washing machine, families, usually the women in the household, were required to go to great lengths to clean clothes. Finding water, mixing with soap, and then washing hand-by-hand each piece of clothing was the common practice. Once the washing machine came around, that time was, Rosling argues, spent reading and educating the childern of the household. This ‘revolution’ leads to one of the greatest attributes to any society: a young, educated population. The washing machine also empowered women. Instead of doing the tedious task of hand washing clothes, they could dedicate that time to more progressive tasks, like learning to read or write. As we live in 2011, however, billions of our fellow world peers still do not have washing machines. This is a justice issue. How can we allocate technology so that all can reap the most basic benefits we use every day? How is such a basic invention to us still not made a reality in many societies? Are we socially responsible to change this?

In order to argue that we should care that our fellow global peers do not have basic technology, I think it is best to step away from the moral argument and point to a more pragmatic solution. Allowing basic technology in lower-income communities would create a stronger, and more educated, world. This benefits us all. Giving each household the access to a washing machine is a preventative issue. One cannot put a price tag on a mother that can read and educate her children. The empowerment and long-term effects outweigh the price of electricity and a washing machine. So why isn’t there a global push? As we are discussing in class lately, is someone benefiting from injustices? Do those in higher-income nations feel more worthy of technology?

To begin, we do not have the most basic mindset to create global change: the idea that someone benefiting halfway around the world would benefit me. For many, in our day-to-day lives, it is very difficult to imagine what a washing machine would do for those whom we will never meet. I, as with Hans Rosling, would argue that this boost in technology would help us all. It would decrease inequity and would, as I mentioned earlier, create a more efficient and educated world.

Another touching issue within this presentation is the basic idea what attractive use of statistics can do. Hans Rosling is revolutionizing how we view basic global realities with his work. His movement will be a great benefit to us all as we move forward in public health. We have many issues to tackle, but as Hans Rosling would argue, maybe one goal should be to get washing machines in each household.

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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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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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