Global Health Issues and Personal Experiences

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Global Health Issues and Personal Experiences

• Reflections on Social Justice
• James Beebe, Professor, Doctoral Program in
  Leadership Studies

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Health Care as a Global Issue

• 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
• 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
  such as nurses of primary health care.
• Assumption that the traditional approach of
  anthropologists, including long field work, is
  the only approach.

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• PEACE CORPS VOLUNTEER

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Peace Corps, Public SchoolCastillejos, Zambales,
Philippines
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Peace CorpsIn-service training for teachers
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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 CORPS Impact

• The importance of culture
• The joy of working cross culturally and
  internationally
• Immersion into a culture based on relationship
  and marriage into that culture.

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Peace CorpsExperiences with health issues

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

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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.

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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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• My 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 a 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 almost 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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RAPID ASSESSMENT PROCESSAn Introduction (2001)

• http//www.rapidassessment.net

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RAPID ASSESSMENT PROCESS

• Paul Farmer identified the central thesis of
  Pathologies of Power as that human rights abuses
  are best understood, that is, most accurately and
  comprehensively grasped, from the point of view
  of the poor.
• Rapid Assessment provides a tool for
  understanding issues from the point of view of
  the poor.  

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WORKING COLLABORATIVELYUse of Rapid Assessment
HIV/AIDS

• A Tshwane (Pretoria) municipal government
  official requested training.

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WORKING COLLABORATIVELYUse of Rapid Assessment
HIV/AIDS

• Training program based on doing a RAP with grant
  funding from USAID
• Team involving the Municipal Department of
  Health, the Centre for the Study of AIDS at the
  University of Pretoria, and the School of Nursing
  at the University of Botswana.

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WORKING COLLABORATIVELYUse of Rapid Assessment
HIV/AIDS-Orientation Session
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WORKING COLLABORATIVELYUse of Rapid
AssessmentHIV/AIDS Primary Health Care Clinic
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WORKING COLLABORATIVELYUse of Rapid Assessment,
Southern Africa, HIV/AIDS, RAP-First group
interview
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WORKING COLLABORATIVELYUse of Rapid Assessment
HIV/AIDS RAP-Session between interviews
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WORKING COLLABORATIVELYUse of Rapid Assessment,
HIV/AIDSRAP-Second of four interviews
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WORKING COLLABORATIVELYUse of Rapid Assessment,
HIV/AIDSRAP-Team members work on report
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WORKING COLLABORATIVELYUse of Rapid
AssessmentNursing faculty, University of Botswana
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WORKING COLLABORATIVELYNursing faculty,
University of Botswana

• Group interview training led by Botswana faculty
  member who participated in Tshwane RAP

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Experiences with health issues

• Stupid Deaths and Angels
• Cholera Vaccinations and Tradeoffs
• Rabies and Rural Reality
• Infections and the Environment
• ORT a small but significant innovation
• TB and the ability to sustain treatment
• Pneumonia and access to medical care
• Malaria and the limits of prevention
• Ebola Fever and almost accidental exposure
• Schistosomiasis and culture
• Hepatitis and the difficulty of diagnosis

59
Health Care as a Global Issue

• 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
• Relevance of Rapid Assessment