2012 cambridge health and illness


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Slides for Isaac Holeman's presentation in the health and illness module in the master of philosophy of sociology at Cambridge University. The broader theme is public health and welfare states, focusing on the sub-theme of failures of clinical biomedicine.

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  • These stories are related to my experience cofounding Medic Mobile, we’ve undertaken 35 mobile health projects in 20 countries. \n
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  • St Gabriel’s Hospital in Namitete, Malawi\n
  • A woman carries a child on her back in the traditional manner. \n
  • A typical home in Malawi. About 80% of Malawi’s population lives in rural areas. \n
  • This is a photo of the road to a clinic in rural Liberia, where Medic Mobile supports local partner Tiyatien Health. \n\n
  • Transportation is a health issue. \n
  • Is the health worker crisis a sign that we haven’t invested enough in clinical biomedicine? Or is at a failure inherent in the system?\n\nInternational notions of biomedical ‘best practices’ structure investment in the individual--a fungible asset that can be appropriated by wealthy countries.\nIn the 1990s there were more Malawian physicians working in Manchester than in Malawi.\n\n\n
  • Failure to seek medical care and engage in healthy practices is regarded as a major explanation of the failure of clinical biomedicine to improve health outcomes in some countries. This explanation emphasises the shortcomings of patients rather than emphasising the shortcomings of clinical care. \nDecisions to seek medical care are influenced by sense of medical efficacy, perceived and actual self efficacy. \n
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  • How do health workers in Malawi diagnose Malaria?\nMalaria is a mosquito-borne infectious disease of humans and other animals caused by protists (a type of microorganism) of the genus Plasmodium. \n\nThis is a photo of a Plasmodium in the form that enters humans and other vertebrates from the saliva of female mosquitoes (a sporozoite) traverses the cytoplasm of a mosquito midgut epithelial cell.\nhttp://en.wikipedia.org/wiki/File:Malaria.jpg\n\n\n
  • Is this technology trustworthy?\n
  • At what point would you chose to reject biomedicine?\nAlternatives to western medicine--herbal remedies at Lighthouse.\nIs this example a rejection of biomedicine?\n\n
  • www.africanews.com/site/Malawi_HIV_drugs_used_to_ferment_local_gin/list_messages/27954\n
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  • This is Deus, a community health worker in Malawi. \nIn the 1940s Chairman Mao began to critique structures in the biomedical profession that fostered an urban elitism and left the rural poor behind. China sparked the CHW movement with their Barefoot Doctor program, training over 1.7 million farmers by the mid ‘70s.\nIn 2011 the WHO estimated that there were 1.3 million CHWs worldwide, but this is a gross under-estimate. “Task shifting” from physicians to less-trained professionals is widely regarded as a major strategy for improving outcomes in poor areas.\n\n
  • Many CHW programs emphasize “social” motivation rather than financial compensation. Regardless, managers of CHW programs concern themselves with appropriate training, monitoring, supervision and support.\n
  • Increasingly mobile phones are being used to coordinate health service delivery. \n
  • Who is a health worker? “Anyone in a group of people working together to solve a problem.” - Dr. Gwenigale, Minister of Health in Liberia\n
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  • Bangladesh. \n\nSome appendix slides in case people feel like discussing technology and CHW programs.\n
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  • Nepal MCH study.\n
  • Working with disease surveillance officers, CDC, and WHO, we are building a platform for community-level disease surveillance focused on polio, measles, and pneumonia. The technology also has implications for cholera and tuberculosis tracking.\n
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  • 2012 cambridge health and illness

    1. 1. Clinical Failureisaac@medicmobile.org Health & Illness, Nov 2012
    2. 2. Access
    3. 3. http://www.guardian.co.uk/global-health-workers/interactive/infographic-mortatlity-rates-health-workers-uk-us-worlld
    4. 4. Seeking Medicine
    5. 5. “We don’t know who needs emergency care.”
    6. 6. “We don’t monitor danger signs during pregnancy.”
    7. 7. “We don’t know who has tuberculosis.”
    8. 8. (mis)managing health information
    9. 9. Protists of the genus Plasmodium cause malaria
    10. 10. Oxygen mask use has varied across time and space
    11. 11. A waiting area becomes a one-stop-shop
    12. 12. Who Cares?
    13. 13. Discuss.isaac@medicmobile.org Health & Illness, Nov 2012
    14. 14. Further Reading.Introduction to the social scientific view of global health:Pathologies of Power by Paul FarmerCommunity Health Workers:Rosenthal MM, Greiner JR. The Barefoot Doctors of China: from political creation to professionalization.Hum Organ. Winter 1982;41(4):330-341 McPake B, Mensah K. Task shifting in health care in resource-poor countries. Lancet. Sep 132008;372(9642):870-871.Singh, P. (2012). One Million Community Health Workers (p. 104).
    15. 15. Phones all over the place
    16. 16. 2x TB patients 150 emergencies 1000s of hours saved
    17. 17. Supervision & drug resupply 4x cheaper, 134x faster
    18. 18. Increased immunisation coverage from 60% to 99%
    19. 19. ANC, PNC, and danger sign monitoring
    20. 20. toolkit for vaccination programs
    21. 21. SIM apps on any phone