Weekly Post

Last weeks discussion was quite interesting though I felt that there were certain aspects of discussion that I did not quite understand. There is a lot about the politics of health care that I will admit I do not know much about. And as the floor was opened up for a larger dicussion, it seemed as if the policts of health care was the main issue at hand. So that was a little bit disengaging for me. What did strike interest in me was our discussion of health care and insurance. We are fully aware of the issues of the health care system in the U.S., and it was intersting to hear about some of the facts, specifically about colon cancer. What was surprising to hear is that, I may be wrong in how I've interepreted this, but what I think the speaker was talking about in this regard was individuals diagnosed with colon caner with insurance who are able to pay for the additional testing do more harm in increasing the risk for futher complication than patients without this insurance. I'm not sure if this was the exact point that was made, but I do our speaker mentioning something about how unnecessary the additional treatment was for colon cancer, and how it possible has more adverse outcomes. Regardless, this was a pretty interesting talk and I'm glad we had the opportunity to attend.

March 3

Bottom line: I really learned quite a few interesting things from Dr. Otis Crawley's presentation. Granted, it was a little fatalistic in that his presentation focused a lot on the pitfalls of the system; but I think that this is an important way to start an informed debate on the issue. It was incredible to hear the different debates surrounding equitable provision of health care. Dr. Crawley made an interesting statement: that we need to consider "rational health care, not rationing health care". This concept was reinforced by a different point which he brought up: there is a difference between access to health care and quality of health care. What kind of information do underserved communities have access to and how does this affect the quality of the health care they receive? Additionally, the concept of "rationality" in distribution of access to health care was reinforced by a graph which Dr. Crawley presented. This graph was incredibly compelling because it essentially showed that a person with colon cancer (in the span of five years) is likely to live longer with stage two of the disease with insurance than a person with stage one of the disease without insurance. This is not only a presents a huge ethical problem, but also highlights the importance of rationality in the healthcare.

Another super interesting debate that we sort of continued amongst ourselves after the event includes the question of race and physiological distinctions/susceptibilities to certain disease. Many of people agreed that race in itself is a social construct which cannot be used to accurately characterize suceptibilities to disease. In terms of gathering demographic information about correlation with certain racial/ethnic groups and diseases, I can understand using racial categorizations (for statistical purposes). However, it seems slightly shady to me to claim that there is a causal pathway between race and disease.

Yeah.

Similar to other people's reflections on Dr. Brawley's talk, I was just surprised at how kitchen-level the discussion was. Thank goodness for the Stanford surgeon to our right that started what I thought of as the real-issues investigation. I'm sure Dr. Brawley is more than qualified and has addressed very difficult issues, but when he stated that reform will come, either now or when the system implodes on us, I was personally frustrated. The entire country knows the system is due to crash, this isn't news, so why reiterate the scare tactics to a well-educated Stanford audience. Shouldn't talks like these at Stanford be where solutions are investigated, scrutinized, and proposed? In addition, it was just plain annoying when he refused to answer a question just because the answer might be too politically charged. That's what people in Washington do, but politics should never restrain doctors from speaking the blatant truth, nor should it ever intimidate them. I must say that we are just students and perhaps naive regarding such things, but ideals must be preserved despite the political climate. I think it would be more beneficial both academically and socially if such talks were in the future specifically directed at providing solutions.

I was also a little under-whelmed with Dr. Brawley's talk. For one thing, I felt like a lot of it was in doctor-speak and therefore slightly difficult for me to follow. For another, I don't think he talked enough about how cultural differences and culturally-motivated actions associated with race are linked to certain health outcomes. Perhaps I misunderstood, but he seemed to argue that if all under-insured people acquired adequate insurance, they would have similar health outcomes. This is simply not the case, as Dr. Barr pointed out from the audience. In response, Dr. Brawley did bring up a few points - like how higher-carb diets among lower SES and certain racial populations lead to actual physiological differences in those populations - but I felt that the points he made were a little too 'surface.' I agree with Dan that Dr. Brawley introduced a lot of stats that most people interested in the state of American healthcare are already aware of. Given how decorated he is, I hoped that he would offer more unique and interesting insights than he did.

While I enjoyed Dr. Brawley's lecture, I don't think he really offered much more than a lots of good data. Instead of supplying possible fixes for our nation's dismal healthcare system, he analyzed data that many people already know (people of lower socioeconomic class get worse healthcare) and expressed it slightly differently to make his points. For example, his data that show that people with stage 2 cancer and insurance are more likely to survive than uninsured people with stage 1 cancer simply underscores his point that poorer sick people die more frequently, as if saving lives is as easy as insuring more people. In effect, it probably is, but he failed to point to any means of fixing our system. Additionally, I felt that much of what he covered was motivated by race, as I note in his example that blacks and hispanics are sicker, less insured, and die more frequently as a result of diseases like cancer more than whites do, while he validates this point by identifying race as a social concept rather than a physical one. Ultimately, while he is certainly very knowledgeable and a good speaker, much of his lecture was an elementary data analysis from the point of view of a doctor, which failed to come to any helpful conclusions.

Week 8 Response-Elena

I thought that the speaker was interesting and very relevant, but I was somewhat disappointed by the lack of realistic solutions presented. Like Sharada, I completely agree with the speaker's statement about our overflow of money into our health care systems. There is no doubt that the U.S. spends too much money on care and sees very few positive health outcomes (We're ranked way too low for supposedly being a "world power", and one of the most developed countries). As Sharada also pointed out, the influence of consumerism in medicine is huge, and the idea of faith-based medicine is pretty ridiculous--why should people feel like a treatment or method is more effective and better just because it is more expensive, or has been pioneered by someone famous??? These problems, though I've heard them being discussed countless times, never cease to shock me. The problem I had with the talk was that Otis Brawley didn't bring up any possible solutions! Aside from saying that we need a major paradigm shift (duh), his message was more pessimistic, and it seemed to me as if he was saying that Americans are so stupid we're probably going to continue along on this path until the entire health care system implodes and we are forced to rebuild it. He said that health care reform was coming, but mainly implied that it was the wrong kind of reform (more money, whereas we need a shift in emphasis to education and prevention). I wish there was more hope for change.

I felt that the talk about Medicine and Cancer was very disturbing. The data definitely says a lot about how we have neglected certain populations within America. I come from Georgia and understand about that disparity between African Americans and other minority groups. However, I cannot clearly pinpoint the reasoning behind these data disparities. I liked how the Stanford surgeon rose questions about the validity of certain survey methods and demographic data. At the same time, I wonder how do we address this issue. Are there cultural factors, social obstacles to access for medical care, or inherent genetic diseases? I also feel that I agree with the speaker's statement about our overflow of money into our health care systems. I feel that our country often spends too much money on care that is not preventative. Also, the influence of consumerism in medicine is very interesting in how much we feel safe in pouring money. We associate money with security rather than efficiency, which often implies socialism.

Like Sharada, I enjoyed Rob Reich's presentation because I constantly question my own motivations for involving myself in public service. Each time I sign up for a new service-related activity, I challenge myself to come up with a solid reason for signing up. Am I genuinely passionate about and/or moved by the activity's purpose? Am I simply intrigued? Or are my intentions narcissistic -- am I motivated to partake in the activity because it would look great on my resume? Have I convinced myself on false pretenses that the activity would be a 'good thing for me to do?' I find myself in semi-agreement with Sharada's (broadly-held) statement that we cannot neglect the great impact that short-term investments in public service have allowed for. Perhaps Reich's talk has caused me to be unreasonably cynical, but I cannot help but question whether the statement stems from a volunteer's vain discomfort with the idea that his/her temporary investment in service wasn't worthwhile. Afterall, it is incredibly disheartening to consider that hundred of thousands of well-meaning volunteers have spent time doing totally non-impactful service.

Week 7 Response

I think this week what has been constantly on my mind is the various levels that the issues of migrant farm worker health can be addressed. The first and largest scale view is that of the government. Obviously there is a significant role for government and policy. The laws of the land dictate what can and can't happen and have a huge impact on worker health. However, change at this level takes time. This opens up the possibility for change at a more personal level, the kind of stuff NGOs and our group will be engaging in. At this level individuals can be addressed and the impact can be much more personal. But with this comes additional responsibility. In some respects, its the job of NGOs to take a leadership role in addressing the current needs of the group. They can more readily and effectively target the group and provide immediate relief. Ultimately though, to create lasting change requires partnership between the two.

Week 7

Rob Reich's presentation was an interesting perspective on public service. Ideally, public service programs would create these large scale changes in as short a period of time and as smoothly as possible. To me, it seemed as if Reich was basing his opinion on public service on this ideal. In reality, though, this rarely, if ever, happens. Creating any measurable amount of change in society has always been seen to take years to occur to overcome the many obstacles that stand in the way. I feel that what should be appreciated about public services programs is there success in attempting to bring about change through peaceful and respectable means. If I were to run a public service program, I would feel success if I knew that I was able to feed even one person, or tutor just one student, because I would know that I am one step closer to reaching my goal. I also feel that creating such change, though, is a two step process that needs to occur simultaneously. For example, with the farm workers, I feel that change has to occur with both the governmental and international level as well as with the individual level. There needs to be aid provided to the current undocumented workers in providing them with necessities of water and shelter while at the same time governmental changes are being made, and I feel this is what makes it so challenging.

Week 7

I enjoyed Rob Reich's lecture because I constantly try to question why I am involved with public service. However, I am not exactly sure of Professor Reich's personal opinion. He did raise a lot of uncomfortable points and questions that we as students involved in service tend to overlook. For example, I have always been an ardent supporter of Teach for America. However, at the same time, we must constantly critically examine these public service organizations in order to improve them. At the same time, we cannot simply overlook the great impacts that these organizations have done simply because they have some flaws. If all organizations were perfect and making great changes, then we would not have these problems in the first place. So, I feel that while we are making criticisms of public service we must also appreciate how far we've come. Secondly, I enjoyed the discussion about migrant health and farm workers. There were extremely important questions raised about our role in aiding undocumented and documented immigrants. This debate can last for years, but I feel that I have come to a conclusion. In America, we live a double standard--one where we rely on immigrants for cheap labor and one where we want to maintain jobs and government services for our "own" people. This inconsistency in values cannot exist for effective immigration reform. We cannot welcome cheap labor while slapping away benefits for unauthorized immigrants.

Week 7 Response- Elena

First I wanted to start by reacting to Rob Reich's lecture/discussion on Ethics in Public Service. Overall I thought it was an interesting perspective to hear, but I had a lot of problems with some of his main ideas about public service. I really didn't like that he said public service was virtually useless if the time period was under a year, or maybe even two years. I understand that it's difficult to really connect with a new community enough to effect significant change in a small period of time, but I believe that public service is a lot more than the tangible advances that can be put on paper. It's possible to have an impact on a community in an intangible way, perhaps just by planting ideas into their minds. Also, I really disliked the fact that Rob Reich ignored any good that public service does for the person who is performing the service when he analyzed whether a public service trip or effort was "worthwhile". Johnny Dorsey's remark about how public service (no matter how short a trip or experience may be) can positively impact a person who is doing the service, whether through personal growth or through a grander growth in the direction of a career in public service. Even though I disagreed with many of his ideas, I still thought it was good to hear somebody speak coming from this very different perspective. I really enjoyed this last class and the opportunity to bond some more as a group. It got me really excited about the trip to look at the itinerary and discuss the health education projects. Several years ago I went on a trip to Peru with my church and actually had the opportunity to put on several skits, and all of them in spanish, so I have experience writing and performing skits in spanish! I have a couple ideas as far as skits to promote hygiene and sanitation that will really engage the kids (and adults too, probably!) and I'm excited to talk about them more with my group!

Week 5 Response

Within the past two weeks we have been exposed to some pretty harsh realities of the migrant communities in the Central Valley area and also service efforts in general. In the movie we watched two weeks ago, Harvest of Shame, we were shown the reality of the many inequalities that migrant workers face, and some of the tragic circumstances that are a part of these inequalities. For me, this was pretty hard to see. I feel that we have benefited in one way or another from the work of these migrant workers, but up until now, I have never stopped to think about the disparities that these workers face and what can be done to alleviate them. Well what can be done? For the first part, I think that is not okay for there to be not strict regulation of farm owners. Mandates for farm workers to have adequate shade and water have been made, but if there is no strict regulation of farm owners, tragedies like Marie's will continue to happen. Also, I dont think this is a crazy idea, but farm workers need to have basic benefits as well like health and dental care. I know many may not be legal U.S. citizen, but if they are doing the work that U.S. aren't doing, I believe that's enough qualification for basic health benefits. There are many other changes that can be made, I'm sure. But I agree very strongly with Rachel, in that the very first change that needs to be made is a change of our own mindsets. We need less of a focus on ourselve so that we can see the needs of those around us.

After watching part of 'Harvest of Shame' last week, I found myself emotionally torn. One part of me felt incredibly depressed after hearing an account of Maria's tragic story and seeing the list of all the workers who have died of heat exposure in the Central Valley in the last few years. Yet another part of me felt suddenly more impassioned to work toward improving conditions for migrant workers. Like Elena, I think that class last week forced me to look inside myself and consider both my own cultural mindset regarding agricultural workers and how comfortable I am standing by as workers grapple with incredible injustice and adversity on a daily basis. Like Sharada, I think that California legislation to improve migrant workers' situation is moving in the right direction, but I don't know that the issue is the speed at which legislation is being drafted. In the article handed out last class about Maria's death, it discusses how difficult it is to enforce the measures already in place which require farmers to provide workers with shade, water, and other basic provisions. One of the reasons it is so difficult to enforce these measures is that even when violations do occur, it is basically impossible for workers to unionize and make complaints. Since Schwartzenegger has taken office, he has vetoed a bill three times that would have made it easier for workers to unionize. I think that all of this reflects on the need to alter the attitude of the general population toward migrant workers. I'm not sure how this can be done....

Week 5 Response- Elena

This week's reading was really hard for me because it forced me to take a deeper look into myself. Like Abraham, I am also from the Central Valley, so I can relate first hand to the awful heat conditions there. While reading it really hit home that everything that was being described, all the disparity, suffering, and inequality, takes place right where I grew up! And then I began to ask myself how many times I had driven by a farm, seen the migrant workers laboring under terrible conditions, and turned my head the other way without thinking twice about it. I didn't give any thought to who exactly were these migrant workers. I didn't think about whether or not they earned a fair wage and were given medical benefits. I just accepted that it was a reality that farms needed workers, and that there were certain people who were needy enough to take those jobs. I'm ashamed of myself for having this attitude, but I think it's an attitude that many Americans have today. I'm reminded about what Rachel said in class last week, that what we really need is a cultural shift in mindset--not new laws, not more money into healthcare, but rather a new outlook that isn't so self-centered. If we all cared about our fellow human beings and wanted what was in everybody's best interest (I know this is terribly idealistic of me), if we weren't so concerned with time and convenience, I think a lot of problems would solve themselves. I don't know how to do this. I think one method is to increase awareness about what's going on, much like this article did for me. Because I think most people are compassionate enough to care when they read some of the harsh realities like those presented in the article.

Week 5 Response

At the end of this weeks reading, one thing really stood out to me above all else: the absence of migrant farm workers input in the healthcare of migrant farm workers. The system as it stands now fails to include them in the process of designing the system or in the delivery of their care. As the article puts it, little data exists "on the health services that farmworkers want, or on their assessments of the health services they do receive." Its no surprise then that the current system is failing this population; we don't even know the basics of what they need. I can't help but wonder why this is the case.

I can think of several reasons why this might be the case. I must preface by noting that I am not an expert and that these statements are not based on research, just my gut instinct. I think one of the underlying reasons for this lack of inclusion is the confidence of the medical world. All doctors spend years educating themselves and spend years memorizing how to treat thousands of conditions. I feel like this is the same approach doctors take to fixing every problem. They feel like they know the answer, or at least they can figure it out, because thats exactly what medical school is like. They are responsible for finding a cure and fixing the problem. In the case, of migrant farmworkers, this approach clearly isn't working. In addition, I think the additional work required to include farmworker opinion in the healthcare approach is a deterrent. The work already has very little incentive for doctors; putting in a tremendous amount of additional work to include farmworkers in the process simply won't happen. Its obvious that this needs to be changed; the voice of the workers needs to be heard. Maybe this is a role for undergrads like ourselves to fill...

Week 5 Reflection

After reading the report on migrants, I wonder how we can address the problem of health among migrant workers. The problem seems to stem deeper than just access to health. It stems from the ability to communicate health concerns and beneficial practices. Programs that promote literacy must be implemented in addition to access to medical care. Also, many of these migrants face fear over unauthorized status due to authorities and deportation. This means that outreach efforts can only go so far because of legal issues. Also, we cannot fully know the full extent of medical problems within migrant communities due to lack of information on undocumented patients. The video about Maria was very disturbing. I grew up in a farming community. However, we never really learn about the working conditions of these workers such as whether they receive enough food and water. Also, the fact that they work in farms makes it harder for shade but that makes such a difference in hot and humid conditions. I feel that California is making the right steps to protecting labor laws but it should be done at a faster pace. I wonder if they have similar laws in southern agricultural states. **Comment for Abraham (For some reason I cannot comment on the blog): I definitely agree with you Abraham. Laws mean nothing without accountability. It will take a lot more than just passing legislation about shade. We need more union workers and supervisors that make regular trips to these farms. Also, I feel that these farmers themselves need special training to run farms. They clearly need to learn more about safer labor laws. I wonder if agricultural schools cover these topics?

Week 5 thoughts

Seeing that video really shocked me. Throughout the course, we have spent time hearing and reading about the difficult lives of migrant farmers but that clip helped me visualize what a farmer in the central valley goes through. I live in Tracy, which is about 30 minutes away from where that video was created, and often times the weather can easily reach temperatures of 100 degrees during the summer and barely reach temperatures of 70 degrees at night. What shocked me the most was the nonchalant attitude the farmers carried with them. Even though they were working strenuously for hours, suffering injuries and even deaths, and with little food and water, work was just another day for most of them, including the teenage girls.They have been involved in such work for years to the point where they have no other choice but to accept their lifestyle. Even though there are programs who attempt to help these people receive the attention they deserve, it saddens me to see that ranchers or contractors don't even provide the simplest of aid. Even though there was a law requiring shade, there were still locations that did not have such shelter. I mean, how difficult is it to simply buy or build a simple structure to provide shade that could greatly help the farmers and could have even saved some lives? How effective can the law be if it is in no way being enforced? I do agree with what we briefly discussed in class about still having hope when hearing what people like Dr. Grover are doing. I simply wish that the simple acts of providing shade and water were not being overlooked, which could even slightly improve their healths.

Harvest of Shame

I actually watched this video a couple weeks back, and it has been on my mind since. I was afraid of how I would react - either seal myself in a wall of cynicism and rationalization or fall into bitterness and confusion -- to meeting so many people who, from my perspective are oppressed and suffering human rights abuses under my own government, in my immediate economic community. A couple of conversations have brought me back to my beliefs that everyone has diginity and we must learn to live with our inability to completely know other people's concepts of reality. We walk around with mental maps of good or bad, high status or low status, lots of choices or no choices, and we naturally put everyone we meet on that map. But everyone's map is different, most people put themselves in the middle of that map in any case. The only way we can learn how someone else sees their own situation is to listen. There will not be a lot we can do about enforcement or deep solutions in our short trip. But the hugeness of the problem does not make our attempt to learn about it and the people involved futile. On the contrary, it is our only option. Opening ourselves up to learning what don't like to imagine is the only possible first step towards changing it.

Week 5 thought

It is nice to see so many statistics regarding farm workers in this week's readings... but it is also quite easy to be carried away/mislead by some statistics (just a side note). Anyway, I was not surprised to read that in 1995 of all farm workers, 90% are Latinos. Naturally, this statistic has probably changed since then, but I think it's safe to assume that the general trend remains the same. Given the fact that we will be studying an area with a high Hmong population, I was wondering to what extent statistics regarding health vary by cultural group. For example, the reading mentioned that in California 81% of male and 76% of female farm workers were obese. How does this proportion change across cultures/genetics? Is obesity a big problem in the Hmong community where diet may be a bit different from, say, the Latino community?

Once again, we see how big of a concern it is for some migrants to stay in the shadows due to their citizenship status. This prevents them from seeking health education and healthcare (unless in a dire emergency). You all may find this article by Joseph Carens interesting: http://bostonreview.net/BR34.3/carens.php

I found his central argument to be extremely compelling... I highly recommend you all read it if you can!

Week 5 Blog

Reading the NY Times article on Hmong Shamans being available in Merced Hopsital is encouraging because it shows how far have come in terms of being more culturally competent. It's even more significant in respect to Lia's case from The Spirit Catches You and You Fall Down. Though, it is great to see this, I wonder how we can make hospital effective in catering to the need of all of their patients. We can not ignore the fact the patients who enter a hospital come from many various backgrounds and cultures. Other than language competency (through interpreters, etc) are there other ways that hospitals can provide for the needs of all other patients. My question is to what extent are hospitals required to do this. For example, I am Ugandan born, but have grown up in the U.S. If a relative from home, were to fall sick on a visit here, it would be great if there was a physician who could treat them and also speak the language (or at least Ugandan culture.) However, can a hospital ever reach that level of competency. This seems a bit cinical, but I think this reveals (at least to myself) that effective cultural competency may be simply do all one can to relate to and understand patients of different cultures, and most importantly respecting their needs and beliefs. This is difficult becasue at times these difference may prevent what may be the most effective treatment. But its important to remeber that as future physican or health care people, we are always treating a person first, not simply an illness. Therefore respecting the person, may sometimes be the best treatment we can give.

In this chapter, Barr provides interesting data that might be otherwise overlooked regarding the relationship between health and social status. I find it downright upsetting that a country that spends so much on healthcare has such poor health compared to that of other highly developed countries. This article supports the idea that healthcare will not completely solve our problems. We cannot simply put more money into the program and expect everybody to live healthier and longer. People of lower socioeconomic status are educated about personal health in a manner different from that in which we are educated. They are more likely to eat low cost food, which translates into low quality and unhealthy food. Thus, what they need beyond healthcare is education. We should not rely on the government to make us healthier by spending more of our money on health insurance. If we go into the world with the attitude that we can eat whatever disgusting foods we like, drink profusely, and smoke like chimneys, simply because the government will pay for our gastric bypasses, liver transplants, and chemotherapies, we will not become any healthier. We will only waste money - our own money - that could be better spent on other things. In order to shrink the disparity in health across socioeconomic classes, we must ensure that people in all classes receive the education needed to take care of themselves.

Week 4 Response

This article was really interesting, though I can not say that I was surprised by the information it detailed. In the U.S. there are huge disparities not just between people of different socioeconomic groups, but also amongst people of different ethnic and cultural backgrounds. As a result of this, we also see huge disparities amongst these groups in the issues of health care and access to it. Not only is there limited acess of health care to people of low socioeconmoic status there is also discrimination towards these groups as a result of this and other factors such as race. It was interesting to see that of all the OECD countries that the United States had the highest infant mortality rates. This then brings to my mind, questions what can be done to improve our methods of health care for people of all backgrounds. I often look at the health care system of the U.K. as a possible model of health care that the U.S. could adopt. However, after a recent discussion with a Stanford Professor, I have learned that you can't just adopt the health care system of another country without taking into account the cultural and political systems of the specific country. Therefore, in order for the U.S. to improve our approach to health care for all people, we must address our cultural needs. We need to focus on ways in which we can close the gap between the socioeconomic groups. Not just in terms of health care alone, but in all others areas i.e, the workplace and in our education systems. Once we close this gap, then can we move on towards creating a more appropriate and much needed health care system.

Week 4 Response

Its articles like this that make me wonder why we so often focus on medicine as the means to health in the United States. We are constantly bombarded by commercials telling us to visit our doctors whenever we have a problem. We in the United States seem to have a particularly strong faith in Western medicine. However, given that it seems health outcomes are so strongly influenced by socioeconomic status (SES), it seems to me that this focus on medicine is completely off target. To really improve health our focus should be on discovering and rectifying the symptoms of low SES that lead to worse health outcomes. The causes are not always clear. Maybe those of low SES have less access to fresh fruits and vegetables. Maybe living conditions force them to live in environments of less clean air, leading to asthma and other respiratory infections. Ultimately, it seems that improvements in health can't be had through medicine. Medicine can only respond and treat illnesses already present in people. It can't improve their health by preventing them from contracting them to begin with. It seems to me that economics and politics are more important to improving health and health outcomes then medicine can ever be! After all, why focus on treating the disease when the possibility exists for a cure?

Week 4

I was really surprised to read how directly related social economic status and health were related. It seems obvious that the rich are more likely to be in better health than the poor since they would be better able to afford health care and would have better living standards, but it surprises me how there is a similar disparity even within the middle class. I am really curious to find out what other factors cause the disparities within this class. With all the money the United States spends on healthcare, it makes you wonder where exactly is it all going. The article did point out have the decrease in TB deaths were correlated with better living conditions rather than medical treatment, which makes you question just how effective the US is in developing its healthcare. This reminds me about a paper I wrote for my PWR class. In my paper, I researched pharmaceutical industries and found out that the majority of their profits is spent on advertisements rather than research and development. In our modern society, it seems as if a lot of the research that is conducted is spent mainly on treating those who can afford it, which makes it difficult for those in lower economic statuses who can't afford the proper treatments. If the major illnesses of our time are cancer and heart disease, these treatments can be very expensive making it only possible for those in higher economic status to afford it.

The current state of health in this country is truly depressing. I would say that the state of healthcare is depressing, but after doing our reading I am much more conscious of the fact that healthcare is actually not the major contributing factor to discrepancies in health status among Americans. Healthcare, it turns out, is doing okay. As a result of large-scale government investment in healthcare, advances in technology and medicines allow our doctors to keep 80-year-olds alive for longer than doctors in other developed countries. It is basic preventative healthcare, which is inextricably linked to SES, that really fails the majority of our citizens. I knew previously that SES and income were determining factors for health status, but had not grasped the staggering extent of their influence; The excerpt from Professor Barr's writing, complete with its various charts and graphs, allowed me to do so.

First a follow-up from last week's discussion: I was reminded this weekend that although every pill in a bottle we get from the pharmacy has exactly the same balance of chemicals, and drip machines let us know exactly how much morphine goes into a patient, we do NOT control how that particular chemical and amount interacts with the patient's own body. In a basic example, we metabolize codine into morphine, but due to variations in the enzyme that does that, how various people will react to the exact same does of codine depends not only on weight and age but on their genetics. With other drugs, genetic differences can mean life or death, psychosis, or addiction. I think this should be held in mind when we compare the "predictability" and "certainty" of western pharmaceuticals with herbal medicines. For this week, I find the readings ring true with what I see around me, and also with where universities like Stanford put huge amounts of resources towards research. But doctors cannot take responsibility for their patients' lifestyle. In a hospital in Turkey, where doctors are less expected to be spiritual counselors or even know their patients like we do, doctors talked about how the same patients and kinds of patients came in again and again with the same complaints from smoking, alcohol, diet, and lack of excercise. Their advice generally went unheeded and the patient would return. And this is where the doctors and patients share language, city, and deep culture. The role of public health, education, and social change gets much, much bigger. In fact this gives an opportunity for people to make a huge impact on health without chemistry smarts and ten years of school; educating children and giving them the resources (parks, fruits and veggies) requires far less expertise than an MD.

Equality in America?

When we think of a just and stable society, equality is often the most important requirement. While just civil liberties ensure equality on a moral basis, economic equality is the true indicator of fairness in society. This is why today, decades after MLK, we have the top leaders of NAACP still arguing that our society is unequal, thus leading to the exploitation and degradation of specific groups in society. One thing that many forget is that unlike civil liberties, economic inequality does not discriminate against color, religion, or creed. Instead, it only feeds on money and wealth, and this makes economic inequality so much more disguised, sinister, and pervasive.

Today, the top 1% of American society owned about 35% of all American wealth. The next 19% own 50%. This means that 85% of American society owns less than 15% of all wealth. Now this is inequality at its most basic definition, and the economic gap between the few rich and the vast lower-middle class is expanding esp. during these hard economic times. In history, such trends have lead to the dissolution of many powerful states. What is at stake is not only the prosperity and longevity of our nation, but its very health as well (as we noted from our reading this week). When such inequality is present, we will continue to see health situation worsen. With quickly increasing costs of medicare and bankrupting social security due to the baby boomer population our parents are part of, we are expecting to see costs rise beyond anything our government can pay. In addition to a two-front war and 12 trillion dollar debt, real changes will be forced upon Americans. I don't want to be all dark and gloomy, but the publicly felt healthcare crisis is only an aching symptom of a much more serious condition our nation is sick with. Our society is as intertwined and inter-related as the human body, and right now it is sick, and any disease must be diagnosed correctly and treated.

Week 4 Reflection

As Elena stated, I find it confusing that the United States spends the most on health care and yet receives the least from it. I guess it lends itself to the idea that the United States does not do enough for preventative medication. We do have higher life expectancy for age 80—if we are able to reach that age. In order to have more people to reach 80, the United States needs to pour more resources into the preventative measures. We look to solutions to the problems rather than ways to avoid the problem in the first place. I also found the article to be very interesting in stating that poverty does not mean you are unhealthy. We often draw correlations and cause a direct relationship between factors. However, as the article stated, much more must be taken into account when accessing health care among socioeconomic class. I also thought that the TB study was really interesting. It makes a lot of sense since standard of living has a direct effect on how to prevent disease. With more money, people can buy better foods and have more options to live a healthier lifestyle. Lack of money does not necessarily cause illness. There are many factors such as buying healthy food, access to exercise, and access to regular medical check ups. If a rich person did not make the best use of their money for their health, then they are just as risk as a person who is unable to afford the luxuries of a healthy lifestyle. At the same time, a lower income person can make decisions to take of their health with more initiative not necessarily more money.

Week 4 Reading Thoughts- Elena

No matter how many times I hear the statistic and see the graph, it never ceases to amaze me that the U.S. spends by far the most of its GDP on health care, and yet our health outcomes (measured several ways, including infant mortality and life expectancy) rank far below those of other countries who spend a much lower percentage of their GDP on health care. Where is all our money going? How can this statistic exist while the government, and the population, has not yet made some drastic changes that we need to make to our health care system? The discovery that the definition of the word "health" needed to be expanded to include occupation, socio-economic status, and other contributors to physical and mental well-being happened a while ago; so why is it taking us so long to react to reduce disparities of social class, race, ethnicity, and overall health? Well, that task is obviously easier said than done, and I think one of the greatest difficulties is to decide whose job it is. Maybe doctors, who are called "health care professionals" are supposed to oversea everything that influences a person's health. But when it comes to lifestyle factors like divorce rates, moving rates, and substance use rates, is it possible for anybody to oversee and try to change them? What I think is fascinating about the relationship between socio-economic status and health is that it is continuous. This makes it relevant for everybody! I can't say that the poorest of the poor have terrible health, the richest of the rich have amazing health, and everybody in between has decent health. Each higher level of socio-economic status correlates with a little bit better health. I hope that this correlation makes everybody realize how important it is to eliminate disparities in socio-economic status.

To be completely honest, I am not unwavering in my desire to be a doctor for the underserved. Sometimes, I am convinced that to do so is my life passion. I am fascinated by health and healthcare. I love science. I love people. Though I am well aware that this sounds somewhat narcissistic, I always feel great about myself when I participate in community service and/or when I devote my time to something outside of myself. At other times, I am viscerally opposed to the idea of holding such an occupation. As I think I mentioned during the last class, I spent past August in rural Guatemala, volunteering as a public health aide in an indigenous community. In the brief period of a month, I had frustrating experiences similar to those encountered by doctors at Merced who treat Hmong patients. In Pueblo Nuevo, where I was living/working, inhabitants who came to my volunteer group claimed to be looking for health-related advice and basic medicines, whereas they really only seemed to be looking for free pills to pop. In the former part of the month, I earnestly tried to explain the need to drink water and eat leafy green vegetables to women complaining of vague pain and weakness; their eyes glazed over and they (quite obviously) pretended to listen when I denied them antibiotics. It was exceedingly frustrating for me that such inhabitants didn't seem to actually be interested in improving their health. At the same time, I was well aware that cultural and language issues prevented me from really connecting with my 'patients.' I was not well equipped with the cultural and anthropological background necessary to contextualize whatever ailments they were dealing with. Reading about the care of Hmong immigrants in Merced gave me cause to think more about something I began thinking about last August -- about how complicated patient care really is. Serving patients as culturally different as the Hmong people truly requires integration of Western medical and 'foreign' (and non-harmful) health-related practices. As Dr. Garcia told us repeatedly last Wednesday, medical practice is only part of the equation. I am very interested in acquiring the cultural background necessary to deliver optimal care to underserved patients, but I am also honestly deterred by how daunting a task it is. Like some of the doctors described in the excerpt we read, I don't think I will ably 'love' the Hmong people. I think it will take serious work for me to get to the place where I feel comfortable treating them. That idea of investing time in such work scares me.

Week 3 Responses

I found the Hmong article and reading to be very interesting. When we think of migrants, Americans tend to have a view of a Latino worker. We never really think of the implications of migrant health in Asian communities. The articles raise key points about the use of home herbal remedies, doctor relationship to patients, and societal norms. Firstly, at what point can we tell a cultural society that their practices are wrong and that they must use medical remedies approved by America? We can have the convincing point that medical remedies are proven to be more successful, but are we in the place to shut down all cultural heritage? Also, the reading raises an important point about doctor communication. Doctors are just as responsible in clear communication just as the patient. It’s important to note that visiting a doctor can be a very difficult and nervous experience for different people due to the lack of privacy and physical examination. We put an immense amount of faith into doctors where as in other cultures, that trust takes much longer to build. Also, doctors have been known to not clearly articulate the problem to the patient but rather hastily subscribe solutions and move on. It requires patience and mutual understanding of both parties. We must work to have an agreement as seen in the NYT article. We need more cultural immersion programs integrated in medicine to make transitions and we need more cultural training for doctors.

Fadiman's writings consider a doctor-patient relationship that I had never before imagined possible. I can't fathom how frustrating it must be for a doctor to be unable to provide adequate care on the basis of cultural beliefs that he or she does not understand. Beyond frustration, the physician must feel pain for the patient in knowing that western medical practices are scientifically proven to cure or treat many of the problems for which Hmong culture has other treatments. These treatments, which I assume are backed by very little, if any, scientific knowledge or research, are focused on healing the soul and preventing its capture by evil spirits. While it seems reasonable, albeit unfair, that western doctors attribute these bizarre treatments to ignorance or lack of care for their people, doing so is certainly offensive to Hmong spiritual beliefs, and only further contributes to the idea that Fadiman cites in which the Hmong believe that physicians are trying to kill them. Ignorance can account for some of the enormous incongruity between our beliefs and theirs, specifically in their reluctance to consent to post-mortem organ donation of dying family members, since they know nothing about human anatomy because of their custom of burying bodies untouched. While it seems obvious to us that organs in humans would be similar to those in other mammals, especially large ones, we cannot presume that all cultures could deduce this. However, as a strong supporter of organ donation (given that my organs are useless to me once I'm dead), I cannot seem to let this one go. While I have heard outrageous proclamations of conspiracy in hospitals in which doctors "try less hard" to save the lives of those with extensive acute trauma who are registered as organ donors, I find this accusation sickening. I cannot believe that there is one single doctor, let alone an entire ER trauma team, that would commit such a heinous act. As a result, I can't pull myself to empathize with the Hmong who believe that organ donation is a death sentence. On the other hand, I'd hate to say that I'm not accepting of their spiritual beliefs, so it seems that this massive cultural gap is one that I cannot currently overcome.

Who is the patient?

In the readings from The Spirit Catches You, the most peculiar observation I made was the interconnected and sometimes juxtaposed roles of the doctor and the patient. We all know very well the societal definitions of who is the doctor and who is the patient, but in the doctors' interactions with Hmong patients, I often felt it were the physicians who were being treated. Some of the doctors needed more severe treatment for their disease that was ignorance. The Hmong patients indirectly or sometimes directly taught the doctors how to feel for others, how to bridge cultural barriers, and thus how to most effectively provide care, and eventually bring peace and wellness into the doctor's mind and aptitude.

This inter-relationship between the doctor and the patient is one that must be embraced if we are to learn the people we are trying to help. Ignorant treatment may very well result in the opposite outcomes, and one of the tenets of the Hippocratic Oath is to know the patient.

Galym

Maybe I am just a linguistics junky, but I am intrigued by how differences in definitions create so much conflict in The Spirit Catches You. Raquel Arias felt stressed and frustrated because she felt her treatment of Hmong patients was "sub-optimal" care. Shouldn't "optimal" be defined by patient outcome? And if a patient does better with lower-tech treatment and some placebo effect, isn't that course of action "optimal" for that particular patient as opposed to an invasive procedure that is frightening and does psychological harm? Similarily, nurses who could not deal with Hmong births were imagining a completely different experience than what a Hmong woman would imagine under the concept of "birth." The definition of "well-being" already varies person-to-person, but in The Spirit Catches You, it varies so much that the meanings of "success" and "failure" in treating Lina were at times opposite in her family's perspective and her doctors' perspective.

Samri-Post 2

"Medicine was religion. Religion was society. Society was medicine" (Fadiman 60). This is perhaps the most poignant and generally relevant line in this reading. This statement is a powerful reaffirmation that the study of medicine is equally as anthropological as it is scientific (if not more so). This is especially true in immigrant communities where culture and tradition vary significantly from American (or "Western") style of treatment. This leads inevitably to the politics of cultural relativism: is American medicine more "correct" or legitimate? How does this phenomenon dictate policies/practices surrounding healthcare services? Is there a cultural superiority complex which ultimately results in adverse effects when it comes to equal, humane, and sensitive access to healthcare to under served (immigrant) communities?

Week 3 Reading Response

The readings this week from The Spirit Catches You and You Fall Down struck me in a way nothing else had before. The details of the interactions of the Hmong patients and doctors were vivid and led me to new insights on the importance of cultural beliefs to maintaining health. What was most interesting to me however, was the perspective of the doctors. The frustration of the doctors is apparent throughout. From having to deal with Hmong patients traditional healing methods (which include loud banging and chickens). For doctors, who are taught throughout medical school of the merits of Western medicine, the methods employed by the Hmong can appear not only foolish, but also needless. Doctors may even feel that the traditional Hmong practices are hurting their patients by delaying their application of Western techniques. This article sheds light on the importance of incorporating traditional cultural practices with Western medicine, somethign I hope to carry with me into future medical practice.

Week 3 Thoughts

I appreciated the article "Delivery of Health Services" because I feel that it gave a more in-depth analysis of what farmworkers experience. This article seemed to further discuss the issues of barriers and health concerns of farmworkers as we read the week before. What was different, though, was that this paper included a more detailed discussion of what current programs are doing to overcome the issues that farmworkers face. It was interesting to read about all the health services programs like Farmworker Justice Inc. that were actually taking action to help farmworkers. This article also brought up an interesting point about how there was not much data that was directly addressing the concerns of farmworkers and how there was little information about how effective these programs are. I feel, though, that as long as these programs are doing something to help is better than no help at all. I really enjoyed reading the NY Times article. The cultural barrier is a big issue keeping patients from receiving medical attention and it was very interesting to see the hospital incorporating multiple ways of healing to overcome the cultural barriers the patients faced. This shows that there are ways of helping to overcome the barriers farmworkers face and it was comforting to read about programs and hospitals who are actually doing it.

Response to Delivery of Health Services to Migrant Workers

I really enjoyed reading the article Delivery of Health Services to Migrant Workers. At the beginning of the paper they started out by listing a lot of facts that were very familiar to me. But seeing all of these statistics presented before me made me question what could be done to improve health care access by migrant workers. This is the good part, because as soon as these questions started to develop in my mind, the article began to highlight all of the initiatives that are currently being done by many organizations. It was greatly refreshing to see that so much good work is being done already to improve the health care conditions of migrant workers. One of my biggest concerns was that when migrant workers relocate, it become difficult to keep up with their health information. The article then mentioned a specific organization MCN Network that provides a database that is free for both patients and clinic, to keep track of the heath information of migrant patients. This is a great way to reduce the confusion that is often cause when migrant workers relocate and receive additional care from physicians who are not informed about their health circumstances. This is exciting to hear about because I believe that a lot of the progress that has been made to improve Migrant workers' access to health care services often goes unnoticed.

Week 3 Reading Thoughts- Elena

In chapters 6 and 18 of The Spririt Catches You and You Fall Down I was struck by how difficult of a situation there is for both parties- the Hmong patients and their doctors. On the Hmong patients' part, there are enormous difficulties as far as a lack of understanding of Western medicine, an inability to communicate their worries and desires, and the racial and class discrimination that they face in the health care arena as well as outside of it. On the part of the doctors, there is a lack of cultural sensitivity education, similar communication difficulties, and the huge conflict between doing what they have been taught is good for the patient versus satisfying patient demands that conflict with what they have been taught. After reading about these difficulties I find it no surprise that tensions run so high in hospitals where there are a large number of Hmong patients (or patients of any other different cultural background). It was shocking to read about the one doctor who spoke so distastefully about his Hmong patients- I found it hard to believe that someone so invested in the well-being of others could show such disrespect. It was definitely sad to read about the case studies in which the cultural barrier between the Hmong patients and the doctors directly prevented improved health. However, I found it uplifting to read in this book about the success stories. Along the same lines, the article "A Doctor for Disease, a Shaman for the Soul" gave me hope for the future of breaking down cultural barriers. It's great to know that there are people out there dedicated to that endeavor, and it got me excited to work with some of these people firsthand over our spring break trip!

The “Harvest of Shame” helped me see how far I have to go . . . somehow it is different than learning about similarly bad living conditions and entrenched injustice in our economy when it geographically located farther away, under governments I don’t call my own.

To pick one thing that stuck out the most, it is the lack of choice. I was reminded of briefly working with a woman who had less than five years of school, began farmwork and mothering at 15, and plans to continue for the rest of her life. The difference was that she lived in what she felt was “home,” with extended family around, ate some of her own produce and made decisions about her farmwork, and felt some measure of choice and autonomy in her decisions even if her material options were extremely limited. The young women we are learning about in Central Valley lack that autonomy of making practical choices, and support of home and family. The rancher whose wife started as a farmworker and now has a degree intrigued me: why was he using this story to justify himself? To convince himself his workers (will) have choices/freedom?

In “The Spirit Catches You,” Americans wanted to convince the Merced Hmong community that institutionalized American treatment is more effective than traditional medicine. The description of the healthcare path for a farmworker in California (Bade) made me realize that since communities with severely limited access to healthcare see only the part that deals with symptoms (emergency care), in their reality, American health care always fails members of those communities, pushing them away from utilizing it.

Sharada's post

After my ASB last year to Arizona, I became interested in immigrant rights. However, I was a bit shocked by some of the stories and stats. I grew up in a farming community in South Georgia. However, I never really took the chance to understand some of the working conditions of some migrant workers.

Did anyone find it shocking that 11% of physicians work in rural areas? Is that not surprising since 17% of the population lives in rural areas?

I also found it to be ironic that migrant works have to eat crappy junk food due to low wages that are funded by picking fresh veggies and fruits. Also, I couldn’t imagine how the live on these salaries and work in harsh conditions. There labor day job starts early in the morning and they don’t even make but cents per bucket! I think our current poverty rate is ridiculous and cannot accurately measure poverty in America. But the fact that some migrant families live off half the poverty rate (with $11,000) is ridiculous!! It makes the stories more believable.

post by Sharada

What I appreciated most about the readings this week was that it provided me with an understanding of what really goes on in the life of the underserved and the difficulties many farmworkers go through. When I initially thought about the term 'underserved', I thought about people who simply did not have proper insurance to receive medical attention. The readings, though, made me realize that there is much more to it. What surprised me the most was how there were many other barriers that hindered people from receiving simple medical attention like location and language. Even though there are over 45 million uninsured people in America, people who do have insurance still are underserved because of a lack of physicians in the area or an inability to simply communicate the health concern. This bothered me the most because many farmworkers are placed under harsh conditions for hours and many of them get sick and injured without being able to receive proper treatment. Even though the second reading was lengthy, I was really surprised to read about the detailed lifestyles of farmworkers. I was always under the impression that farmworking was a difficult task, but this reading really clarified just how difficult it was. These people literally spend all day working for pennies and then to back to a home full of people, if they even have a home to go back to. Worst of all, these people have been enduring such harsh conditions with no major support for the last 20 years! Even though there seems to be some programs that attempt to remedy the situation, there are still millions of farmworkers who are in desperate need of attention. It was just extremely surprising to me that so many people are forced to endure such painful tasks because it is their only chance of survival for them and their families.

It was hard to stomach the article "Underlying Conditions Affecting Farmworkers' Access to Health Care". I don't understand how there can be articles like this, and other information that clearly shows the disadvantages and disparities faced by agricultural workers in California, and yet their situations haven't improved in decades! It's a really disheartening reality, and it made me realize how emotionally taxing it's going to be to witness this reality and interact with these poor families firsthand over spring break. While reading "Who are the Underserved" I felt like I had heard most of the statistics before about the number of uninsured, and other issues of social class, race, ethnicity and health through the Human Biology core. What I didn't know about was the existence of the "safety net". Reading about this system gave me hope in what seems to be a sea of impossible problems. I also really enjoyed reading the section on The Art and Science of Community-Based Medicine because it highlighted how health care is so much more than just medicine. I admire the physicians and other health care professionals who work in the community clinics on a day to day basis, performing their job but also giving so much of themselves personally as well.

Week 1 Reading Response

Reading this week, I was appalled to discover how little i really knew about the situation of California's agricultural workers. The readings were very revealing about the nature of the lives and struggles that, currently, these workers have no choice but to endure. Bade's report on the underlying conditions affecting access to health care left me stunned. I had no idea the extent to which the situation of the farm worker was ingrained in the social structure. The contractors who hire the workers not only turn a blind eye to the immigration status of their workers (or at least pretend to) but even find ways to provide their workers with permits and social security numbers. This results in workers paying taxes into the system but, as undocumented immigrants, they are unable to benefit from any of the governmental programs they help pay for. Beyond that, they force their workers to buy the tools necessary for the crop and pay for transportation, expenses that greatly take away from their already meager pay.

While the previous article focused on the plight of one undeserved group, the other article took a broader view of undeserved groups. Some of the statistics in that work shocked me. From the number of uninsured (45 million) to the lack of access to care in rural areas. However, though these statistics are rather grave, I think it is important that medical practitioners needs not be overlooked in the attempt to resolve this disparities. For example, lack of medical practitioners in rural areas can be attributed to the increased difficulty in profiting in these areas and possibly lack of a desire to live in these areas. I feel the best solutions to such issues will incorporate incentives for doctors to enter these areas. In this way, both doctor and patient stand to benefit.

Hey ASBers!

This is going to be the main way we share the bulk of our thoughts, questions, and challenges to the weekly readings. These readings are an awesome way for us to begin to understand some of the issues facing the farmworking population of the Central Valley.

Here is a link to an interesting and somewhat shocking video about the situation of farmworkers in our backyard:

http://vimeo.com/1551798