Khloe Frank Autumn Quarter 2011 Global Health 401 Final Examination 1.

The required book, The Spirit Catches You and You Fall Down, exposed me to many new

ideas and perspectives concerning medicine and global health. I found the story of Lia Lee and her family very enlightening, as their interaction with doctors, social workers, and their local community revealed the many challenges and tragic misunderstandings that often occur when Western health professionals work with immigrant and international populations. For me, the narrative and commentary in this book highlight three key characteristics and competencies necessary for health professionals to work effectively with immigrant and international populations. Firstly, a sense of responsibility to understand the beliefs and unique situation of each patient and their family is crucial to success. It is important for health professionals to realize that understanding a patients social and cultural background is necessary in order to determine the best treatment to improve the patients health within the boundaries of the familys capabilities, means, and wishes. In the case of the Lees, Hmong immigrants who came to the United States as war refugees searching for a place to live with the freedom to maintain their own cultural and religious practices, the doctors treating their daughter Lia did not take the initiative to understand the beliefs and situation of the family. Lia had epilepsy, which the Hmong believe to be caused by a bad spirit catching the afflicted person and causing their soul to become lost from the body. In Hmong culture, those with epilepsy have the potential to become shamans, so the condition is considered a gift despite the suffering it causes. The Lees wanted a treatment regimen that was part medical (Western drugs and procedures) and part spiritual (traditional Hmong practices), and they did not want the medical portion to be too invasive or require long-term dependence. Neither of Lia Leess parents could read, write, or speak English; thus they lacked the ability to

Khloe Frank Autumn Quarter 2011 follow complex treatment instructions. Since the doctors were unaware of many of these beliefs and circumstances, they could not take them into consideration when trying to determine the best treatment for Lia Lee. A responsibility to understanding the beliefs and circumstances of a patient and their family is important in the health professions. This can be achieved by being patient and open minded while taking the time to learn a patients background. It is important that health professionals do not make prejudgments or generalizations based on stereotypes, and that they try to understand where the patient and family are coming from, what they think is going on, what they are able to do to facilitate treatment, and what they hope to achieve with Western medical practices. Secondly, a willingness to compromise in order to maximize the health benefit to the patient without violating the patients wishes is necessary for health professionals to work effectively with immigrant and international populations. A good approach would be to identify both the critical medical priorities and goals of the patient and family i.e. what they hope to achieve from Western health services. In Lias case, the Lees wanted short-term, relatively noninvasive treatment to relieve Lias suffering until her soul returned and to complement their traditional remedies and ceremonial animal sacrifices; the priority medical need was a drug treatment to prevent Lia from having more seizures. If Lias doctors had been willing to compromise by prescribing her one drug (so her parents would only have to learn one specific administration process and schedule) that had minimal side effects, perhaps the Lees would have been willing to keep Lia on a longterm drug treatment and take her in for regular check-ups.

Khloe Frank Autumn Quarter 2011 Willingness to compromise is a necessary characteristic for health professionals who work with immigrant and international populations. A good approach for this would be to take patient and family beliefs and traditional practices into account and minimize patient distress by working to develop a conjoint treatment in which the medicine prescribed enhances the traditional remedies and does not violate important cultural standards. To help coordinate a compromise, it would also be helpful to find a mediator within the patients ethnic/cultural community who both speaks the patients language and is on good terms with the family. Finally, the maintenance of a respectful attitude and approach is vital to success in working with people from different backgrounds. Health professionals who have a respectful disposition will maintain mutual respect in their relationship with patients, which is the best way to receive cooperation and achieve a solution that works for everyone. The characteristic of respect should always be exemplified while health professionals are working to fulfill the first two competencies listed; it is necessary to achieve success in each of these other competencies. To summarize, three key characteristics and competencies necessary for health professionals to work effectively with immigrant and international populations are responsibility for understanding patient/family beliefs and background, willingness to compromise in order to achieve medical goals while complying with patient wishes, and the maintenance of respect. 2. One important global health issue that the world is confronting today is global infection

as it is related trade and travel. Often, global health discussion and initiatives focus on specific diseases and/or specific countries; the threats of pandemics and other globalization-related health problems that could affect all countries are overlooked. Infections caused by international food and produce trade (e.g. Bovine Spongiform Encephalopathy), human to human transmission during international travel (e.g. influenza), and global warming disasters (e.g. Leptospirosis

Khloe Frank Autumn Quarter 2011 outbreak after flooding disasters) have become possible due to the globalization of todays world. These health problems have the potential to become pandemics that would affect people worldwide; therefore surveillance and effective feedback and action systems are necessary to prepare for this possibility, so that a global disaster can be prevented or controlled early on. Another important global health issue is the role of evidence and accountability in the implementation of global health policies. Global health has become a huge field that continues to grow, but it is important to remember that global health measures are dynamic, not static; governments and organizations have a responsibility to evaluate the efficacy of implemented policies and programs and make improvements to ensure that they are fulfilling their proposed roles and achieving the desired results. 3. Three articles from this quarter had a great impact on me concerning my perceptions

about global health and my future career goals in the field. Firstly, Health Equity in the USA by lecturer Dr. Stephen Bezruchka modified my understanding of the determinants of good health. The article discusses how social and economic factors lead to health disparities in the United States, where these disparities are often ignored due to the countrys developed nation status. Research, however, reveals that the U. S. has the lowest life expectancies and worst health disparities compared to many other rich, developed nations. Although medical healthcare is an important service, studies show that it is not the major determining factor in population health. Social and economic factors are much more influential, yet many people are unaware of this fact; often, healthcare is the only focus of political measures to improve overall health in the United States. The thesis of this article can best be summarized by a quote given at the conclusion: The primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart.

Khloe Frank Autumn Quarter 2011 This article enhanced my understanding of the relationship between medicine and social and economic factors in health. Though the United States is the focus of this particular article, the conclusions drawn from the data and evidence can be applied on a global spectrum. I now understand that although healthcare and medicine are important, economic and social factors cannot be ignored when considering why health disparities are prevalent and how to address them to improve population health. In the future, I hope to become a medical doctor practicing with underserved populations in the United States and also working to improve global health. This article has reinforced my goal to take courses in both science/medicine and social studies as I continue my education, so that I will have an interdisciplinary understanding and perspective of health and can therefore work to help develop global health solutions that are more likely to make a real impact in population health around the world. Secondly, the article, 10 Best Resources on . . . Health Workers in Developing Countries that accompanied Dr. Amy Hagopians lecture also influenced my thinking about global health and my future career. The article focused on three main issues concerning health workers in global health worker to patient ratio requirements for health systems to function, behavior of health workers (and the related effects), and migration of health workers (also often referred to as the brain drain). The main point of the article is that various research studies have been done to draw conclusions about the necessary amount of health care workers for successful health systems in developing countries, the motivations and incentives of health workers, and the culture of health worker migration and its positive and negative effects. Studies vary in their methods, analysis, and conclusions, and as global health professionals become more aware of the important role of health workers in global health, hopefully more research will be

Khloe Frank Autumn Quarter 2011 done so that comprehensive solutions can be developed to address the issues related to health workers within health systems. This article improved my understanding of the issues concerning health workers within the spectrum of global health. As I plan to become a doctor in the future, Dr. Hagopians lecture and this article made me reflect more on my motivations and incentives for practicing medicine within particular communities in the United States and/or abroad. I was previously unaware of the huge percentage of doctors practicing in the United States who have immigrated from developing countries, and as I continue studying global health, I plan to keep this problem in mind when considering the relevant effects and potential policies to improve the situation so that every country can maintain the health workforce necessary to serve its population. Thirdly, the article, Strengthening the Prevention and Care of Injuries Worldwide by lecturer Dr. Charles Mock expanded my awareness of the huge role of injuries in global health, particularly in children and young adults. Previously, I had not realized that injury is one of the main causes of death and disability in the world, nor had I put much thought into how to study and address injuries in different countries. This article detailed the importance of surveillance, prevention, and treatment to reduce injuries and the associated deaths and disability adjusted life years (DALYs). It also emphasized that these measures can be accomplished with policy-based solutions such as commitment to the development of safe infrastructure and road engineering, the promotion of safe behaviors, the adoption of the most effective injury treatment methods, and the establishment of necessary trauma services with well-trained workers. This contributed to my perception that global health solutions need to be both medical and political in nature. As a future doctor, I could both treat injuries and analyze my personal experiences and observations in order to help develop policies that would prevent and treat injuries effectively on a wide scale.