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.