On the Map

I try my best not to watch too much television, but it happens and despite having 200+ channels of cable I often find myself just hanging around the networks.  Since the new year, I have begun watching a new series on ABC – Off the Map. While the lack of creativity when it comes to plot themes is getting a little tiresome, I keep coming back week-after-week for its “professional” relevance (and I went to school with one of the stars!) Off the Map follows the trials and tribulations of a collection of doctors (mainly American) in the jungle “somewhere in South America” (a.k.a. Hawaii).  Characters’ personal drama and a relatively swanky built environment aside, each episode so far has touched on themes found throughout medical anthropology.

From the start of the show, the docs that have been “roughing it” for years already herald the “greatest medical resource on Earth” in which they find themselves.  And while not explicitly stated, there is a vague sense of cultural competency.  The newbies are chastised for not having learned Spanish before they arrived and for assuming everyone will want their help.  Example – the young plastic surgeon not grasping the nuances of treating TB in rural settings.

Following episodes have touched on medical pluralism (western medicine and ethnomedicine happily co-existing); shamans and local healers (and their significance in local health and acceptance of biomedicine); and medicinal botany’s legitimacy.  Without going into the complexities and significance of these concepts, the show has at least put them on the map and woven them into the sexiness of today’s global health – freak zip-wire accidents and anaconda attacks not included.

Image:  ABC’s Off the Map.

Being Part of the Change

This past week, ABC News launched its Be the Change: Save a Life initiative – “stories and solutions for a global health initiative”. The idea, the way I understand it, is to highlight and share real world solutions to the array of global health challenges. One of the components I find fascinating is how these solutions are coming from every sector, not just medicine and public health. There are portable and re-heatable (without electricity) baby incubators from a group of Stanford students; pumps to clean water from a former nightclub owner; and local solutions too, like horses to get HIV tests to labs in time in Lesotho.

Being local, which won’t be a surprise to my regular readers, is key. Nifty tech devises and creative fund-raising are important, we need both for innovative and sustainable solutions. However, to make innovations work a) the local needs, environment, and lives must not just be acknowledged, but understood and b) solutions need to be fostered from within communities and not just presented to them.

This year-long initiative will undoubtedly share with all of us some truly remarkable solutions…for determinants and disease. And hopefully, as with the piece on child nutrition in Guatemala (I know someone involved with this initiative!), medical anthropologists and other community thinkers will be engaged and highlighted. For when all of us are part of the change, practical, simple and human solutions become a reality and lives are saved.

Mechanics of Determining Access

There is a lot of talk about access in health – in the U.S. in regards to our insurance driven culture and in developed countries in regards to basic medical services – as the golden ticket, one of the elements once available to all will solve the world’s health disparities. I completely agree that “little a” access is important to lessening disparities and providing more people with the quality services they need and deserve. Often times, however, discussions of access trump discussions of root causes and determinants – fixing the problems we have now rather than figuring out how to keep them from repeating and spreading. Earlier this week I came across (what I believe) is a new blog series on the NYTimes called Fixes. The tag line reads “Fixes explores solutions to major social problems…” and in its first installment tells the tale of a very simple solution to a very common problem – access.

The problem as they state it is that many in the World continue to be afflicted by diseases which “we” have treatment for, simply because they do not have access to them. True. The solution they highlight (not suggest, but already happening!) is to give CHWs and other community medical personnel a means for getting to the people in their communities besides their feet. In this instance, give them motorcycles.  Tsepo Kotelo, a CHW in rural Lesotho was provided with a motorcycle which has allowed him to go from reaching only 3 villages a week to reaching 20 – and accessing some of the hardest hit areas by HIV/AIDS and TB in the world!

Kotelo riding his motorcycle (NYTimes)

Straight forward solution, yes, but here’s the kicker – not only did the Elton John AIDS Foundation provide him with a motorcycle, they have also linked Kotelo with a mechanic for monthly maintenance checks through Riders for Health. Providing him access to a needed service, that is not health care, but is having a determining impact on the health of many others.

Fixes mentions the other possible topics which the world needs solving…education, energy, clean water, jobs, etc. Listing them just as I have, as individual entities. Yet, as the post so clearly frames, a solution to one problem can be a solution to many. Furthermore, these solutions – when appropriately introduced within a given structure and cultural setting – can effectively address determinants of health. For example, the motorcycle and maintenance of it: Provide training and jobs, giving Kotelo and others with the needed access to the people they help, but also providing stable incomes to everyone involved; Greater economic stability, which in many cases allows for better access to foods; And long-term, these increases in nutrients (hopefully!) can have a positive affect on family and community health.

Education, energy, clean water and jobs all need global solutions and they all have strong determining influences on communities’ health. Access to these solutions as they come along will be important – harnessing them to address determinants, in particular social ones, and disparities can make them health in all* important!

*Health in All Policies — One of my current areas of research/work. Expect more!

Image: Photograph from first Fixes post in the NYTimes — October 18, 2010.

Bring on the May Flowers

I will be taking a short hiatus from posting the first couple weeks of May – mainly due to starting a new job in public health policy development in Washington, DC. While I’m away, if you are looking for interesting things to read, please look back at the post’s related to some of my most common topics: AIDS, obesity, TB, health equity, global health, and well-being. Also, take a look at media outlets such as NYTimes Health, Times Health, and NPR Health. And please, please make some visits to my fellow bloggers listed on the blog roll. I look forward to getting back at it later in the month…and hopefully they’ll be a number guest posts once summer is in full swing!

Be well!

P.S. Don’t forget Mother’s Day!

Image is author’s own: Gardens of Magdalen College, University of Oxford.

Eat Your Chocolate!

What was that you read last week about exercise not having any impact on weight loss? Or the headline a couple month’s back about H1N1 prevention tactics being over-rated? Ok, so I made both of those up, but we are all bombarded with “health” headlines on a nearly daily basis. More often than not they seem to contradict a claim made only a few weeks or months earlier – it really is dizzying! A few weeks ago, a study published in the European Heart Journal claimed small amounts of dark chocolate lower CVD and stroke risks. The media had a field day… Chocolate Can Save Your Life! (For the record, I love chocolate. It’s an interest on Facebook. The darker the better, please!) Whatever the headline may be, even for those of us who read health and medical publications on a regular basis, it can be difficult to navigate what is purely sensationalized and what might actually help our or someone else’s health.

In March, I mentioned the book Bad Science which takes on a lot of these sensationalized headlines – examining the differences between fact, fiction, perspective, perception, and down-right lies. A recent article in The Times points out how convenient the release of the said chocolate study was to Easter (and how insignificant the results actually are). This is an issue that everyone, not just public health and policy professionals, can be more vigilant with. Using a little common sense when ingesting health news can weed out radical and sensationalized claims from the practical, groundbreaking, and effective innovations in health. Working to more appropriately translate academic studies to real world results is something those of us involved with various aspects of health and well-being can strive to do on a daily basis – whether it’s the impact of recess on childhood obesity or the DOTS program on global TB rates. And remember, eat your fruits and vegetables, cover your mouth when you cough, and don’t forget your celebrity sleep secrets!

*Image is author’s own.