International Health Issues and Personal Experiences

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International Health Issues and Personal
Experiences

• Reflections on Social Justice, Working
  Collaboratively, and Teaching by James Beebe

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Interest in international health

• Issues illustrated by the work of Paul Farmer
• Origins in Peace Corps Experience
• Related to
• Commitment to social justice
• Passion for working collaboratively across
  national and cultural boundaries
• Love for teaching
• Relevance of Rapid Assessment

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• PAUL FARMER

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PAUL FARMERPathologies of Power
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PAUL FARMERPathologies of Power

• This is an angry and a hopeful book. It has
  both passion and authority.
• He combines an unflinching moral stance--that
  the poor deserve health care just as much as the
  rich do--with scientific expertise and boundless
  dedication.
• illuminates the pathologies of a world economy
  that has lost its soul

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PAUL FARMER

• superb physician, a penetrating anthropologist,
  and a prophet of social justice

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PAUL FARMERMulti-drug resistant tuberculosis,
AIDS , and human rights violations
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PAUL FARMER

• Reporter With so much suffering, is it sometimes
  hard to maintain a positive outlook?
• Paul Farmer Very difficult. Its important to
  see the little victories, which are not so little
  to those who are served by these projects.

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PAUL FARMER Two issues with Paul Farmer

• Assumption that medical care is provided by MDs
  and no discussion of the role of others providers
  of primary health care.
• Assumption that the traditional approach of
  anthropologists, including long field work, is
  the only approach, with apologies for using more
  rapid approaches.

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• PEACE CORPS VOLUNTEER

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Peace Corps, Public SchoolCastillejos, Zambales,
Philippines
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Peace CorpsTeaching, Bontoc Community College
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Peace CorpsPlanting rice, harvesting the 2nd try
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Peace CorpsDeveloping curriculum materials
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Peace Corps

• Even though only a Peace Corps Volunteer for
  four and a half years, the experience has had a
  significant impact on who I am and who I am in
  the process of becoming.

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Peace CorpsExperiences with on health issues

• Stupid Deaths and Angels
• Cholera Vaccinations and Tradeoffs
• Rabies and Rural Reality
• Infections and the Environment

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International HealthInterest based on three
factors

• Commitment to social justice
• Passion for working collaboratively across
  national and cultural boundaries
• Love for teaching

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• COMMITMENT TO SOCIAL JUSTICE

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COMMITMENT TO SOCIAL JUSTICEMy belief Justice
not Compassion

• Motivation for action should not be based on
  compassion
• Compassion implies action is optional
• Those who believe that charity is the answer
  often regard those needing charity as
  intrinsically inferior

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COMMITMENT TO SOCIAL JUSTICE According to Paul
Farmer

• There is an enormous difference between seeing
  people as the victims of innate shortcomings and
  seeing them as the victims of structural
  violence.

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COMMITMENT TO SOCIAL JUSTICEHealth as a
fundamental human right

• I agree with Paul Farmer that health is a
  fundamental human right.
• Farmer contrasts this with a perspective that
  health is a desirable outcome to be attained
  through the purchase of the right goods and
  services.
• The commodification of medicine invariably
  punishes the vulnerable.

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COMMITMENT TO SOCIAL JUSTICEI join Paul Farmer
in concluding

• Social justice requires a preferential option for
  the poor.
• Conditions of the poor are not only unacceptable
  but are the result of structural violence that is
  human-made.
• Working for social justice requires working with
  the poor as they struggle to change their
  situation.

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• PASSION FOR WORKING COLLABORATIVELY ACROSS
  NATIONAL AND CULTURAL BOUNDARIES

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WORKING COLLABORATIVELY,Dissertation research on
farmersBarrio Gugo, Calumpit, Bulacan,
Philippines
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WORKING COLLABORATIVELY, GugoDissertation
research on farmers
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WORKING COLLABORATIVELY, GugoDissertation
research on farmers
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WORKING COLLABORATIVELY, GugoDissertation
research on farmers
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WORKING COLLABORATIVELY, GugoDissertation
research on farmers
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WORKING COLLABORATIVELY, GugoDissertation
research on farmers
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WORKING COLLABORATIVELY, GugoDissertation
research on farmers
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WORKING COLLABORATIVELY, GUGOExperiences with
health issues

• ORT and small but significant innovation
• TB and the ability to sustain treatment
• Pneumonia and access to medical care

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WORKING COLLABORATIVELY Umm Hijliij Breimya, El
Obeid, Northern Kordofan, Sudan
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WORKING COLLABORATIVELY, UMM HIJLIIJRapid
Assessment
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WORKING COLLABORATIVELY, UMM HIJLIIJRapid
Assessment
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WORKING COLLABORATIVELY, UMM HIJLIIJRapid
Assessment
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WORKING COLLABORATIVELY, UMM HIJLIIJRapid
Assessment
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WORKING COLLABORATIVELY, UMM HIJLIIJRapid
Assessment
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WORKING COLLABORATIVELY, UMM HIJLIIJRapid
Assessment
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WORKING COLLABORATIVELY, SUDAN Experiences with
health issues

• Malaria and the limits of prevention
• Ebola Fever and accidental exposure
• Schistosomiasis and culture
• Hepatitis and the difficulty of diagnosis

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Rapid Assessment Process RAP

• James Beebe
• Gonzaga University
• 2005

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RAP

• RAP is intensive, team-based ethnographic
  inquiry using triangulation and iterative data
  analysis and additional data collection to
  quickly develop a preliminary understanding of a
  situation from the insiders perspective.

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Results can be produced in

• as few as four day,
• but usually requires several weeks.

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The RAP team should seek out

• the poorer,
• less articulate,
• more upset, and
• those least like the members of the RAP team.

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Stories NOT Answers

• The goal is to get the insiders to tell their
  stories and NOT answer the questions of the
  outsiders.

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Successful RAP

• Members of the RAP team need to recognize
• They dont know enough to ask questions,
• They dont know enough to provide the answers,
  but
• They do know enough to want to empower others to
  solve their own problems.

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Iterative Analysis and Additional Data Collection

• Time is divided between
• blocks used for collecting information and
• blocks when the team does data analysis and
  considers changes in the next round of data
  collection.

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RAPID ASSESSMENT PROCESSAn Introduction (2001)

• http//www.rapidassessment.net