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