Archive for the ‘Uncategorized’ Category

Pipestone

March 26, 2017

https://reddaysblog.wordpress.com/2017/03/13/pipestone/.

 

Today, perhaps more than ever, we see an incredible proliferation of non-Western healing methodologies in the collective American socio-economic context. Many, including myself, might reference many of these attempts to prescribe healing pathways that are foreign to the “American body politic” as appropriation. Though, beyond this, and even more perplexing, if not ironic, is the fact that health systems are based on evidence-based practices – and it is not until a practice is appropriated into our positivist Western culture, that it is widely accepted, typically by way of publication in peer-reviewed journals. What we don’t know, however, will not kill us, it may make us stronger as a collective. Certainly, in my mind, this is the case of culture and healing for co-occurring disorders among American Indian and Alaska Native youth.

Despite not engaging in clinical trials, practice-based evidence and culturally appropriate services are oft cited as the critical healing mechanism and metric to which these debilitating co-occurring presentations require for any relief. In this case, traditional practices, cultural and tribal customs are understood to be the arbiter of health and healing in AI/AN communities. Unfortunately, however, the main actors (i.e., Indian Health Service) and federal regulations, as well as the movement of Evidence-based practice serves to only stifle the efforts of tribal and Indigenous communities to serve their communities, according to tradition and origin of their original teachings.

Right now, AI/AN communities are in the midst of a mental health crisis. Not only are AI/AN among the poorest, least educated and youngest of other U.S. races, they also suffer from disproportionate rates of substance misuse/abuse, suicide, depression, unintentional injury, domestic/interpersonal violence, etc.

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Such circumstances within AI/AN communities are the result of generations of oppression steeped in a history of discrimination and genocide. The fate of young AI/AN people are in the hands of culture and tradition that breathe in embers, once a spirited fire that warmed each of the 567+ “Federally Recognized” nations. Many understand the co-occurring illnesses to be symptoms of colonization. Without acknowledging the sovereignty of our First Americans to practice their beliefs and own their healing, at any cost to American Society, the children may continue to be lost.

For this reason, it is important to allow space and rights for Indigenous people to practice customs, according to their traditional teachings in federal spaces, especially those spaces that are dedicated, by treaty and law, to the healing and wellness of AIAN people.

Stop Fracking: Education and Advocacy

March 12, 2017

A fight is raging in the middle of Pennsylvania over a process called hydraulic fracturing, commonly known as “fracking.” Shale gas will comprise 45% of all natural “dry” gas used in the United States by 2035 (shown in Figure 1).[1] This estimates to trillions of dollars for gas companies.  But not only the gas companies benefit. These profits extend to private-owners. Business Insider has suggested that in 2010, $21 billion has been paid to landowners across the country. Specifically, a pay-out of $1.2 billion has been given to Pennsylvania land-owners in 2012.[2]

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However, environmental scientists have shown that one of the largest problems is the leakage of fracking products that contaminate watersheds and aquifers that people use for potable water.[3] [4] [5] Drinking contaminated drinking water with the inputs and outputs of fracking will cause significant health effects.

A large reason for aquifer contamination is that cement is the only barrier that prevents byproducts from reaching ground-soil. Similarly, storage of fracking wastewater isnot well-disposed or handled after fracking [6]. After years of weathering and neglect, these concrete structures can fall away and allow for free-water flow into the ground.

 

There are many organizations that have stake in proposing regulation and policy-briefs about fracking, including Green-Peace and Earth-Justice.[7] Earth-justice, among others have issued initiatives to prevent fracking in public and private lands.[8] We need to support these advocacy groups AND educate people in Pennsylvania about the deleterious effects of fracking. Similarly, Advocacy journalism and advocacy social media play significant roles in reaching out to policy-makers and gas-companies. These actions, will promote public outcry.

Enough public outcry can promote a systemic change in how fracking is managed and regulated. We must educate people, promote initiatives, and demonstrate why companies need to responsible for both cleaning up their waste-water and maintaining the integrity of abandoned fracking wells.

Adoption of New TB Drugs

March 12, 2017

TB is an airborne infection that, if untreated, causes coughing blood, wasting away, and an inevitable slow death. In 2012, an estimated 8.6 million people developed TB, and 1.3 million people died from it. TB continues to cause a huge amount of sickness and death since it evolves into drug-resistant TB (DR-TB) resulting in a lower probability of cure.

  • According to WHO estimates, in 2012, there were 450,000 new cases of MDR-TB among detected TB cases and nearly half as many remained undetected
  • Pakistan has the fifth highest number of MDR-TB cases in the world
  • MDR-TB is 3.5% among new TB cases and 32% among previously treated cases

Some challenges for treatment of DR-TB are:

  • Low cure rates due to poor activity of second line drugs to treat MDR-TB
  • Treatment requires 4 to 5 “effective” second line drugs and most of these drugs were invented decades ago. These drugs fell out of use due to weak sterilising activity or severe side effects 

    After 50 years, there’s a ray of hope, as two new drugs (i.e. bedaquiline & delaminid) have been developed and approved by the Food & Drug Administration and the European Medicines Agency. Due to lack of sufficient data and evidence on safety and efficacy, the governments are reluctant to adopt these drugs in their national TB programmes.

    Up till October 2016, only 5,700 patients had received bedaquiline globally, and only 405 had access to delaminid. World Health Organization (WHO) estimates that 580,000 people were eligible for MDR-TB treatment in 2015.

    International stakeholders such as the WHO Task Force for New Drug Policy Development and Stop TB Partnership are for the adoption of these two drugs in Pakistan. Moreover, the Infectious Diseases Committee in Pakistan also realises the benefits and is for the use of these drugs. However, the National TB Control Program, Pakistan is still not committed since it is assessing the costs incurred, logistics of procuring and disbursing these drugs and the risks of administering these drugs.

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Firearms and Public Health: Misguided Mental Health Crisis

March 12, 2017

The Mental Health and Safe Communities Act (S.2002) was introduced in 2015 in response to multiple high-profile gun violence incidents. The bill sought to increase awareness and treatment of mentally ill offenders by law enforcement officers.  However, the bill also liberalized gun ownership by removing the permanent prohibition of gun purchase or ownership by any person who has been involuntarily committed for psychiatric treatment or adjudicated to be mentally ill and restores their gun rights immediately after their involuntary commitment order expires.

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Furthermore, it also justifies gun possession by emergency care providers, such as paramedics, Emergency Room clinicians, and crisis intervention specialists as a protection during their work hours thus leading to criminalization and labeling of the mentally ill as a population that we need armed protection against.

President Trump also signed an executive order on February 28, 2017 overriding the Obama administration rule requiring the Social Security Administration to input records of mentally disabled people into the FBI database (National Instant Criminal Background Check System) which is used to determine whether someone can purchase a firearm. This order further erodes our ability to identify individuals that should not have access to firearms on the basis of mental illness.

We strongly oppose the justification of gun use to protect the public, the labeling of the mentally ill as a dangerous population that we need to arm ourselves against and the easier access to firearms that the bill affords.

guns-health-care-82880109353Increased availability and access to guns in our community will not improve our safety. In order to prevent mentally ill members from committing criminal acts, we have to improve awareness of mental illness among law enforcement officers, adequate training in lieu of armed forces, and better access to mental health care.

 

 

Written by Tomoyo Kasuya and Shakirat Oyetunji

National Health Reform in Mexico

March 12, 2017
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Photo credit: The Yucatan Times via google

 

In 2003, Mexico legalized a health reform policy that endorsed the introduction a health insurance mechanism called Seguro Popular de Salud (SPS).   SPS was designed to secure universal health coverage (UHC) for all citizens.

Dr. Julio Frenk, who was then the secretary of the health, led the team of reformers who drew upon years of accrued evidence to build support at the federal level through successful lobbying efforts and by sidelining opponents in the executive and legislature.  Their efforts proved successful at ensuring the program’s adoption into policy.

However, one issue of fragmentation in health services provision was not adequately addressed. Prior to the policy’s adoption, formal workers received services through either the Social Security Institute (IMSS) or the Institute for Social Security and Services for Civil Servants (ISSSTE).  Informal workers received health services under public assistance or from the private sector, with no financial protections. 

Frenk and his team pushed for a nationally integrated insurance scheme through the  Family Health Insurance Scheme (FHI) run by the IMSS that would be independent from a competitive market for services provision.  Threatened by Frenk’s competitive model , the IMSS and Ministry of Health providers resisted. So, rather than becoming a national insurance scheme, SPS was left to function as a subsidy service for the poor.

SPS has recorded notable successes in increasing coverage for mostly informal workers and for the poor. However, the program can ensure greater coverage and financial protection through risk sharing across the entire Mexican population. Additionally, the introduction of consumer choice through competition will ensure greater efficiency in service provision. To achieve these, the federal government must secure buy-in from the IMSS and MOH unions  to pass a nationally integrated insurance scheme that ensures a maximal pool and adequate competition among providers.

 

Sugar Tax in South Africa

March 11, 2017

A new sugar tax will be levied on the soft drinks industry in South Africa as of 1 April 2017 in an effort by the South African National Treasury to curb the country’s growing obesity epidemic.  The proposed tax rate is 2.29 cents per gram of added sugar which equates to approximately R2.29 per litre of sugar sweetened beverages.  This translates to approximately a 20% tax increase for Coca Cola, the country’s most popular soft drink.  While South Africa follows the footsteps of many other countries who have implemented similar taxation, it is not the first time this has been done in the country.  Similar effort targeting the soft drinks industry were instituted as early as 1993/94 but eventually abolished in 2002 following lobbying effort from the industry.  At the time of abolishment, the state estimated a tax revenue amounting to R135 million.

170301132155-01-south-africa-sugar-tax-restricted-exlarge-169Obesity and related non-communicable diseases such as high blood pressure, heart disease, diabetes and increased risk of dental caries are serious but largely preventable health problems.  According to a national study published in 2014, 22.9% of children aged 2 – 14 years, 65.1% of women and 31.2% of men in South Africa are overweight or obese.  The financial burden incurred on the healthcare system from managing these prevalent but preventable conditions is substantial.  While the government has an obligation to ensure access to health services, decreasing the cost of treating preventable illnesses through taxation is a right in line with the country’s constitution.  While obesity is a crippling global issue, populations living in developing countries such as South Africa are becoming more and more disproportionately affected by the problem.

While there are multiple stakeholders in this issue, the three major stakeholders are the South African National Treasury who proposed and will be implementing the policy; the sugar and soft drinks industry that faces profit loss as a result of the implementation of this policy; and probably most importantly, the South African Department of Health that bears the burden of resulting illnesses as a result of high sugar intake.  History has shown that the sugar and soft drinks industry have the financial and lobbying capability of successfully pushing back against such a policy.  Given the industry’s strong financial interest, it is without question that they will put up a strong resistance once again.  Considering the industry’s significant economic influence, it makes them a formidable opponent to those who are proponent of the policy.  It is imperative that if this policy is to succeed this time, the Department of Health as well as National Treasury need to collaborate efforts to garner support from other stakeholders to ensure the successful and sustainable implementation of the sugar tax policy.

 

Inclusive Education in Ghana

March 10, 2017

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Globally, about 93 million children live with a moderate or severe disability. In most low- and middle-income countries, children with disabilities are more likely to be out of school than other group of children. According to Human Rights Watch, there are over 5 million PWD (people living with disabilities) in Ghana. PWDs experience various challenges such as discrimination, verbal abuse, social exclusion, lack of access to health care and education.

In 2013, the Ghana Ministry of Education in collaboration with other stakeholders announced the Inclusive Education Policy. The purpose of this policy is to create an education system that is responsive to learner diversity and ensures that all learners are able to receive the best opportunities regardless of the their disability status. Since the implementation of the policy, various international organizations like UNICEF and local organizations have supported inclusive education and are now participating in activities to support PWDs. For instance, the Special Attention Project in Ghana conducts research, advocates for educational right and provides training to support children with learning difficulties.

Although the Ghana Ministry of Health was successful in implementing the policy, it is important that they work with entities like Ghana Education Services to ensure enforcement of the policy throughout educational institutions. A common complaint from educational institutions is the lack of materials needed to support PWDs. Funds need to be allocated towards such resources to ensure that PWDs are not only able to attend school but also achieve quality education. In addition, Ghana Ministry of Education should provide resources to train professionals and educators on the necessary guidelines to practice inclusive education. A combination of adequate resources and appropriate training within the  educational institutions  will ensure that the inclusive education policy is maintained and PWDs have equal access the education across Ghana.

Regulation And Commercialization Of Recreational Marijuana Raises Concerns About Adolescent Health

March 5, 2017
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Rising number of adolescents smoking pot.  Credit: Tomas Rodriguez/Corbis

Although medical marijuana has been legalized in Maryland, a controversial bill  has recently been introduced into the Maryland State legislature to legalize, tax and regulate the possession and recreational use of marijuana for adults. Six out of ten Marylanders  now favor further legalization of the recreational use of marijuana. Although several groups oppose this measure and argue it would lead to addiction and be a gateway to other drugs, the evidence is rather weak .  The decriminalization of marijuana has overcome great harms including unfair incarcerations, especially affecting young people who were burdened with a criminal record and significant racial disparity for marijuana possession.   Benefits of further legalization and regulation will control the quality and safety of the product, eliminate criminal dealers, provide jobs, develop a profitable industry and large tax base, and focus law enforcement resources on more pressing problems. The legalization of marijuana in several states has not led to significant adverse effects.  However, we should consider that recently, the American Academy of Pediatrics (AAP) has taken a strong stance against the legalization of marijuana arguing that this will lead to a significant increase in its use by adolescents which will adversely affect adolescent neurological development.

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Altered brain function smoking marijuana.  Credit: Ashtari et al, Children’s Hospital of Philadelphia

 

We support the further legalization and regulation of sales of marijuana for recreational use in the state of Maryland for adults, but recommend that the bill provide increased funding through the Maryland Department of Health to educate the public, youth and parents about the potential harmful effects of marijuana use by adolescents. This should include large media campaigns, increased educational programs in schools and counseling by pediatricians to their adolescent patients and their parents

Supplying Hydroxyurea to treat sickle cell disease in Jamaica, WI

September 9, 2016

In Jamaica, sickle cell disease is a public health issue. Approximately, 1 in 150 births are diagnosed with sickle cell disease.  In the past, Jamaica has been the focus of studies on the disease due to its population(http://www.sciencedirect.com/science/article/pii/0268960X9390001K).  The genetics of the disease, treatment and coping skills of those affected have been published.  Jamaica is a developing country and therefore all resources for the treatment of sickle cell disease is not readily available to all patients.  Though overall Jamaican patients with sickle cell disease have an better experience with the disease, they deserve to have access to all treatments (http://onlinelibrary.wiley.com/doi/10.1002/pbc.25563/epdf).  Hydroxyurea is a drug that has been significantly beneficial for sickle disease.  The drug does not cure but lessens the symptoms of disease.  Until recently, the drug was only available to those on the island that could afford it.  Currently, there has been an investment by the government to provide Hydroxyurea to all sickle cell patients who would benefit.  I would like to see continued commitment by the country to secure funds to support the treatment of sickle cell disease with Hydroxyurea.  My fear is that in a country where the US dollar is worth approximately 115 Jamaican dollars, there will be difficulty maintaining this financial support. Also, access to the medication may also be compromised due to the countries financial standing.

Stakeholders include first, the National Health Fund (http://www.nhf.org.jm/) which in 2015, contributed funds to have patients receive medication including Hydroxyurea to treat sickle cell disease (http://www.jamaicaobserver.com/news/Persons-with-sickle-cell-disease-can-now-benefit-from-NHF-_19153890).  The fund has significant interest in providing policies to assist with the care of the sickle cell population.  Second, Ministry of Health (http://moh.gov.jm/annual-reports/) in 2015, established National health fund with sickle cell disease as a priority for the island.   Third, would pharmaceutical companies which produce Hydroxyurea  be willing to supply the medication at a lower cost to this developing country?  What are benefits and burdens to those companies.  Fourth, the University of the West Indies Hospital, which is the home hospital of the Sickle Cell Trust. This is one of the teaching hospitals in Jamaica.  Fifth,  Kingston Public Hospital (http://www.serha.gov.jm/)hydroxyurea would be made available to patients at this institution as well, however, unsure of their commitment to treating sickle cell disease.  Finally, the sickle cell support foundation of Jamaica (www.sicklecellfoundationja.org/) raises awareness about the disease. Funding for patients. Among the founders are at least one with sickle cell disease and they have a positive bias to try and assist others with the disease.

I support making Hydroxyurea available to many of the patients with sickle cell disease. It is not a cure, but is less expensive with lower morbidity and mortality than the cure, bone marrow transplant.  In the long run, Hydroxyurea will save the island money that may have been used to care for these patients in the hospital either as outpatients or inpatients.  In addition, the medication could improve the experience of those with sickle cell and eventually change the stigma that surrounds the disease in Jamaica.  I would primarily appeal to the ministry of health to continue their efforts to support the supply of hydroxyurea to those with sickle cell anemia in the country.

 

Playing By the Rules: How to Address Attacks on Healthcare in Combat

August 23, 2016

The last decade has seen a rise in attacks on healthcare workers in areas of conflict. Alongside increasing attacks on civilians, ambulance drivers, doctors, and healthcare support staff also find themselves unwilling targets of modern warfare. Such attacks are a clear violation of International Humanitarian Law as stated by the Geneva Conventions and threaten to destroy our concept of human rights and civility.

As the nature of warfare changes, strategies to enforce the protection of civilians and healthcare workers must be adjusted. Ensuring that innocents are protected and access to health is not hindered must always be a priority.

In May of this year the UN Security Council took the first necessary step in protecting the lives of healthcare workers by adopting Resolution 2286 condemning attacks on medical personnel and facilities. However, until the perpetrators of these heinous acts are held accountable for their actions these measures amount to nothing more than empty words.

The Unites States has an opportunity to set an example of how attacks like these should be addressed. On October 3, 2015 an airstrike hit the MSF-run Kunduz Hospital in Afghanistan killing 42 and injuring more than 30. It has since been discovered that the attack was conducted in error by a US Airforce gunship. While the US government has conducted investigations, acknowledged errors and punished those who were involved, they have been rightly criticized by many for the inherent bias in such investigations and the reluctance to call these attacks crimes against humanity.

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Medical staff after the attack on Kunduz Hospital – photo courtesy of MSF

If “even wars have rules,” as stated by Secretary Ban Ki-moon, then it should follow that all member states should abide by them. Until the US attack on Kunduz Hospital is treated as a crime against humanity and a transparent and independent investigation is conducted there will be no hope for rogue nations, terrorist organizations and other actors to respect these foundations of international law. The United States needs to recognize this challenge and play by the same rules it would readily enforce upon others.