#1 In chapter 11, Cecil Helman talks about stress and the culture differences stress can have on people. Hans Selye (1936) was the first person to discuss stress. Selye (1936) tells us that “stress is the generalized response of an organism to environmental change.”(p288) Selye used the word stressor to describe that environmental change. Selye then came up with the GAS model, General Adaptation Syndrome, to lay out the basics of his understanding of stress. First our bodies are alarmed, then our bodies attempt to adapt, and finally our bodies hit exhaustion. While most psychologists’ agreed with Selye, they all also agreed there was more to stress. They expanded on what exactly a stressor could be saying that it is not only an environmental change that can cause stress but things like illnesses, trauma, disasters, divorce, employment status, war, and financial issues. Psychologist Parkes mentions that not only can stressors be from negative things but they can also come from positive things like promotions, marriages, births, and winning the lottery. WHO, describes this as “stress is representation of an unsuccessful attempt on the part of the body to deal with adverse factors in the environment”. (p290)             Cultural factors that can affect stress on a patient include characteristics, physical environment, social support, economic status, and cultural backgrounds. Individual characteristics are referring to the age, weight, race, sex, and health of a patient. Stress affects everyone differently and if a patient is in good health the stress could have not as major of an effect on their body. Larson, Ahrndt, and Jansen talk about a very common effect stress can have on our bodies. Stress has the potential to cause us to have ulcers. Weinman also tells us that a patients childhood experiences can also affect the way stress appears. Stress can also be caused but the environment that a person lives in. An example of environment stress can be that if someone lives in an area where they have a lot of natural disasters then the patient might always be stressed by the damage that is done by these natural disasters. Brown and Harris talks about how social support can affect stress. One study they preformed showed someone who had social support was less likely to be affected by depression later in life. Economic status is a stress that most patients seem to be affected by. Parkes told us earlier that the initial thought it that if a patient has low income then they are stressed, but we also forget that someone with a good bit of money still has some stress. The culture we live in affects our stress levels as well. If a patient comes from a culture that is laid back and just goes with the flow stress can have a lesser affect on them than a patient that comes from a very controlling culture. Helman, C. (2007). Culture, Health and Illness. Diet and Nutrition. Fifth Edition. p. 288-293. Larson, A., Ahrndt, S., & Jansen, T. (2016). Stress Ulcer Pr ...

1. #1 In chapter 11, Cecil Helman talks about stress and the
culture differences stress can have on people. Hans Selye
(1936) was the first person to discuss stress. Selye (1936) tells
us that “stress is the generalized response of an organism to
environmental change.”(p288) Selye used the word stressor to
describe that environmental change. Selye then came up with
the GAS model, General Adaptation Syndrome, to lay out the
basics of his understanding of stress. First our bodies are
alarmed, then our bodies attempt to adapt, and finally our
bodies hit exhaustion. While most psychologists’ agreed with
Selye, they all also agreed there was more to stress. They
expanded on what exactly a stressor could be saying that it is
not only an environmental change that can cause stress but
things like illnesses, trauma, disasters, divorce, employment
status, war, and financial issues. Psychologist Parkes mentions
that not only can stressors be from negative things but they can
also come from positive things like promotions, marriages,
births, and winning the lottery. WHO, describes this as “stress
is representation of an unsuccessful attempt on the part of the
body to deal with adverse factors in the environment”. (p290)
Cultural factors that can affect stress on a patient
include characteristics, physical environment, social support,
economic status, and cultural backgrounds. Individual
characteristics are referring to the age, weight, race, sex, and
health of a patient. Stress affects everyone differently and if a
patient is in good health the stress could have not as major of an
effect on their body. Larson, Ahrndt, and Jansen talk about a
very common effect stress can have on our bodies. Stress has
the potential to cause us to have ulcers. Weinman also tells us
that a patients childhood experiences can also affect the way
stress appears. Stress can also be caused but the environment
that a person lives in. An example of environment stress can be
that if someone lives in an area where they have a lot of natural
disasters then the patient might always be stressed by the
damage that is done by these natural disasters. Brown and

2. Harris talks about how social support can affect stress. One
study they preformed showed someone who had social support
was less likely to be affected by depression later in life.
Economic status is a stress that most patients seem to be
affected by. Parkes told us earlier that the initial thought it that
if a patient has low income then they are stressed, but we also
forget that someone with a good bit of money still has some
stress. The culture we live in affects our stress levels as well. If
a patient comes from a culture that is laid back and just goes
with the flow stress can have a lesser affect on them than a
patient that comes from a very controlling culture.
Helman, C. (2007). Culture, Health and Illness. Diet and
Nutrition. Fifth Edition. p. 288-293.
Larson, A., Ahrndt, S., & Jansen, T. (2016). Stress Ulcer
Prophylaxis: Who, When, and Why Stress Out About It?.
South Dakota Medicine: The Journal Of The South Dakota State
Medical Association
,
69
(4), 176-177.
http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&sid
=fd2af64f-b87e-4ed6-b6e8-
bcb537ef38d9%40sessionmgr4007&hid=4211
#2 chapter12
What does the migration of healthcare professionals have on
global healthcare?
Migration has always been a human trait, movement of people
with their resources from one place to another in a bid to
finding a better place to settle down. This has been happening
as far back as when mankind started inhabiting the earth. I
believe that proper documentation did not exist until a few
centuries ago. A number of archeologists had carried out

3. researches on this, coming up with varying claims as to how
long ago, and precisely the races involved in these migrations.
Gugliotta, G. in his article ‘the great human migration’ in the
Smithsonian magazine (July 2008), claimed this migration took
place 80,000 years ago, when humans set out from their home in
Africa to colonize the world. Looking at migration today, the
reasons for it are numerous as illustrated by Helman (2007),
chapter 12, with particular reference to healthcare professionals
(HCPs).
The migration of HCPs for better conditions of service has a
disproportionate distribution on the global healthcare system.
As Helman (p.312) elaborates, the growth of international labor
market paved the way for healthcare worker abandoning poorer
countries for the richer ones that pay better wages; resulting in
‘brain drain’ and ‘brain gain’. My country of birth, Nigeria,
suffered a huge migration of its HCPs in the 1980s when the
policies of the then military regime impacted negatively on the
health sector. It is still felt up till now. The health sector was
grossly under-funded, medical equipment could not be
purchased, infrastructures were left to rot, salaries and
allowances did not improve. This led to mass migration of
HCPs to the middle east (Saudi Arabia, UAE, Bahrain) and
Europe. This pattern is found in most countries of sub-Saharan
Africa. Most of these personnel were trained by the government
and on bonded to serve the nation for a certain number of years
after training. But such conditions could not hold them back
because the atmosphere for meaningful work was absent. Even
those in training outside the country, on learning of the harsh
working conditions at home opted chose not to return.
According to WHO (2013) in a ‘policy dialogue….’ points out
that “that many countries of the world, so long as their services
are needed and valued better in other countries of the world,
this trend of health personnel moving from England to
Australia, Canada, Copenhagen and the united states and vice
versa will continue”. Within the borders of a country, the drift
is to cities and private practice where the pay and amenities are

4. better than in the rural and government-run hospitals. As
pointed out by Helman (2007), ‘In 1994, 52% of the doctors in
Mozambique were concentrated in Maputo the capital’ (p.94).
In the long run, the HCPs, after the laborious training they go
through, want to be paid handsomely in compensation. World
health Organization (WHO), according to Helman, (p.90), ‘In
1978 issued its famous Alma-Ata declaration of Health for All
by the Year 2000’. Did it work? No. With what I have
illustrated and other setbacks caused by natural disasters, man-
made disasters and political insensitivity of governments
against their people, the declaration is doomed to fail. Nair, M.
and Webster, P., (2013) also corroborated the fact that
migration as cited by WHO has been the cause of shortage and
disparity in the distribution of HCPs among the population in
many countries, especially 57 being in sub-Saharan Africa (p.
157).
Now, that we know some causes for the imbalances created by
the migration of Healthcare professionals in the global
healthcare system; what can be suggested to correct these
imbalances?
REFERENCE
Helman, C. G., (2007), CULTURE, HEALTH AND ILLNESS,
(5
th
edition), Boca Raton, FL. Taylor and Francis Group.
Gugliotta,G., (July, 2008) SMITHSONIAN MAGAZINE; ‘THE
GREAT HUMAN MIGRATION’
www.smithsonianmag.com/history/the-great-human-migration-
13561
Nair, M. and Webster, P., (2013). HEALTH
PROFESSIONALS’ MIGRATION IN EMERGING MARKET

5. ECONOMIES: PATTERNS, CAUSES AND POSSIBLE
SOLUTIONS. PUBLIC HEALTH. Vol. 35: p.157-163.
http://www.ncbi.nlm.nih.gov/pubmed/23097260
WHO (2013). WHO POLICY DIALOGUE ON
INTERNATIONAL HEALTH WORKFORCE MOBILITY AND
RECRUITMENT CHALLENGES: TECHNICAL REPORT.
COPENHAGEN: THE WHO REGIONAL OFFICE FOR
EUROPE.
http://www.euro.who.int/__data/assets/pdf_file/0007/200698/W
HO-policy-dialogue-on-international-health-workforce-
mobility-and-recruitment-challengestechnical-
report.pdf
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