Showing posts with label Public Health. Show all posts
Showing posts with label Public Health. Show all posts

Saturday, April 12, 2014

What Can We Do About Child Marriage?

Lauren Farmer’s article “Child Marriage: When does a cultural practice become a global health issue?” appearing in Berkeley’s Public Health Advocate magazine issue of fall 2013, encourages readers to rethink how passively we approach the issue of child marriage in developing countries, as it is protected by the limitations on our cultural prowess due to ideals of reverence and appreciation of societies different from our own that have emerged since the fall of Western imperialism. We understandably fear overstepping our boundaries as it could provoke subdued emotions regarding the era of colonialism in the countries that we—the West—had once oppressed, resulting in numerous political problems that I, as a science major, can only guess at. The only problem here is, what if our regard for another’s culture enables the suffering of millions of young girls around the world every year to take place?
As an individual pursuing the medical and public health track, I don’t look at the photograph in the article of teenage fiancés who are meeting for the first time on their wedding day being wed as an expression of a culture and tradition that are hundreds of years old—I see only the injustice being carried out that results in the numerous medical problems detailed in the article, and this doesn’t even begin to explain the human rights and mental health issues at stake. Chief among these problems are early and frequent childbirths that has been causally linked to seizures, hemorrhaging during labor, chronic incontinence, infections, and even death of the child and the mother.
              The problem tree continues to grow: when a girl is married young and is made to start a family young, she is generally sexually assaulted by her husband—especially as she cannot really consent—she drops out of school, she loses the opportunity for a job, and she ends up minimally contributing to society, the economy, and her country (unless, of course, she produces a number of male offspring).
              When all of these undesirable consequences are occurring with child marriage at the root of the problem, can we really coax ourselves into thinking we have no say in that cultural realm? And if not, how can we reconcile cultural differences into a feasible solution while inviting minimal amount of hostility from those whose culture we are criticizing? I am not naïve and recognize that a glorious solution with which all parties involved will be happy is not going to occur, but the faction of impoverished female children with opportunities being snatched from them before they are even old enough to know what those might have been, has been given the short end of the stick for far too long.

              We need policy change, we need action. We need to make a better world for the children who are being veiled not only in a wedding outfit but by the notion of cultural boundaries and the inability of those with power to take a risk to reach out behind the veil and help them.

Sunday, March 9, 2014

The Sanitary Pad Takes on New Meaning

http://www.bbc.com/news/magazine-26260978

It is absolutely amazing to me that this man, Arunachalam Muruganantham, conquered all the odds--financial, cultural, familial, educational--and revolutionized how women feel about and experience their menstrual cycles.
A man playing such a critical role in all of this. Unheard of in a country whose culture thrives on maintaining a profound separation between all things female and all things male; where women cannot possibly hope to openly discuss their periods or feel comfortable confronting issues of reproductive health.
As the article describes, while on their periods women are essentially treated as "Untouchables"--the lowest status a person can achieve in India's outlawed but historically rooted hierarchical caste system. Being banned from the kitchen, being unable to practice their religion (particularly in Hindu households), and even having to sleep separately from their husbands in another room to maintain the purity of their marital beds.
Why is such disgrace and impurity associated with a perfectly natural bodily process, which is the very reason women are capable of producing children and is in fact celebrated in western cultures as it marks a woman's coming of age? For a country that rejoices in the birth of children so much so that its population growth rates are skyrocketing, this is highly hypocritical.
From a clinical standpoint, poor quality sanitation pads--essentially dirty rags that the protagonist of this amazing real life story states he "wouldn't even use to clean his scooter"--have resulted in numerous reproductive diseases that many poor and/or rural women cannot afford to treat, and many of which aren't even curable. All of these issues have such an easy solution: use disposable sanitary napkins that are actually sanitary.
But there are several more problems with this: pads are difficult to access in rural areas, they are sold by male vendors which is quite the deterrent for women to purchase them, and they are expensive.
So what did
Muruganantham do that was so revolutionary? He dedicated years to research and understand how pads are made and work, and came up with the idea of inventing machines that uneducated women could easily use to create their own sanitation pads. In traveling to the poorest and most illiterate reaches of India, Muruganantham not only employed around a million women, but he used the already available market of women needing cheap but quality pads that are sold by other women in nearby locations to his advantage. And he made every woman's life better not only through employment and better reproductive health and comfort, but also by providing hope. Muruganantham faced the hardships of family abandonment, societal gossip, and accusations of pervertedness--all to improve the lives of reproductive age women across the entire developing world.
Thank you, from women everywhere, for being human enough to understand how difficult it is to be a woman, and caring enough to do something about it.

Tuesday, March 4, 2014

Changing Maternal Mortality in Peru

https://www.youtube.com/watch?v=a4GWl7pQIic

      This above link discusses the issues and realities of many pregnant women from rural and indigenous communities. This video not only discusses the complications that may arise for women in these communities, but also talks about a newer program in Peru which not only helps to address these problems, but also sets a model for other Latin American countries to follow.

     Throughout history, indigenous women in the Andean mountains have given birth in the comfort of their own homes with family and maybe a midwife. Many women however, develop complications at the end of their pregnancy and are days away by foot and hours by car. By then, it is too late for many. Often minimal emergency care is required to prevent these unnecessary deaths. Out of the various health outcomes that the UN has pledged to improve, reducing maternal death in child birth has been the least successful. It is important to note the key identifying factors to those who are at risk for higher rates of maternal mortality. Most of these deaths happen in remote areas and the video also mentions that 90% are in developing countries. It is clear there are a lot of health disparities and inequality among low-income populations, but even more so in low-income women populations. In relation to my practice experience, which will be me doing basic medical work (shadowing, assisting, and the like) in Peru, it would be really interesting and important to understand the root causes and history as to why high maternal mortality rates among indigenous women is the reality.  

    In response to the seemingly exponential increase of maternal mortality rates, Peru has enacted a national program to change this. Dr. Oscar Ugarte Ubillis, Minister of Health in Peru, says " the critical problems is the amount of time and distance it takes to get attention when complications arise in child birth, so we've created 450 waiting homes through the country." This video specifically talks about a pregnancy home built in small town in the mountains called Vicashuaman, for women late in pregnancy to live. This pregnancy home is a space where pregnant women can not only feel at home, as they bring their children and cook their own meal, but also allows women to have the necessary medical support to safely deliver their babies. The home tracks pregnancies in the region with a basic map and places each woman's home a long with the amount of time it takes to reach them on it. The home has radios to connect with the nearest hospital four hours away in Ayachuco when serious complications occur.

    When this program first began, it was difficult to convince indigenous women to go because they have many traditions and rituals around pregnancy and child birth. However, these programs allow women to maintain their traditions like skirts they wear for modesty while in labor, herbs and tea used to strength in delivery, and birthing in sitting position, which the obstetricians are trained to know how to do. The work in the pregnancy homes of Vicashuaman and Ayachuco, has significantly dropped mortality rate 50% from 1999 to 2005. While these programs are great, I still find myself asking questions. Although these homes give access to women in rural regions, is there enough space and resources for all the pregnant women? Do they have to apply or pay to live in these homes, or is it something the government is paying for? I also wonder how the staff stay in these regions and are incentivized enough to stay. Regardless I think this is an amazing program which many other countries could use as a model to address maternal mortality. It is clearly effective and is also an intervention from Peruvians for Peruvians, people who understand the context and culture of the situation.

Saturday, March 1, 2014

The Emergency Room as a Place of Change



"If airports can become shopping malls and McDonalds can become a local playground, surely we can reinvent the clinic waiting room."


Above is a Ted Talk by Rebecca Onie, founder of Health Leads. The goal of Health Leads is to connect low-income hospital patients to basic needs and resources such as food, housing and health insurance. The idea behind Health Leeds is to put "health" back into the healthcare system by viewing it in a holistic. In her Ted Talk, Rebecca Onie discusses using a hospital waiting room as place of social change and cites a man named Dr. Jack Gieger as her primary influence. In 1965, Dr. Gieger founded one of the first two community health centers in the United States, located in some of the poorest areas of the country and he noticed that although many of his patients came in with a variety of symptoms and ailments, most were suffering from malnutrition. He began to notice that the root causes of most of their illnesses went back to being starving; he began prescribing food as a result. The patients would then take these prescriptions to the grocery store and the pharmacy budget would be charged to cover the cost. After his funders got upset and told him he was supposed to use the budget for medical purposes only, Gieger responded "Last time I checked my medical textbooks, I read that the cure for malnutrition was food." Dr. Gieger's powerful words laid the foundation for Health Leads: that good health health starts at basic needs and hospital visits should be about more than making basic clinical diagnoses.


Health Leads as it exists today trains doctors and other healthcare professionals to recognize the social determinants of health and incorporate them into traditional models of care. When physicians treat someone that has health needs that go beyond the parameters of biomedicine, they refer them to the Help Desk that situated in the hospital waiting room. This way the patients can work with a volunteer advocate at the Help Desk to get other aspects of their health situated while they’re waiting for their "traditional" prescriptions to be filled. The volunteers, typically undergraduates interested in a career in health care, connect the patients out to the existing landscape of community resources. For example, doctors might treat asthma by prescribing a medication for it but people at the Help Desk would try to instead identify a cause; perhaps the patient has mold in the walls of their apartment, so in response we would try to find them better housing and get them a lawyer to advocate for their tenant rights. These sorts of Help Desks exist as a two-fold: to make a positive impact on people's lives in the waiting room, and also to train the next generation of healthcare professionals to recognize health needs beyond a basic clinical diagnosis. Help Desks aim to treat the cause, not the illness. Health Leads is currently working on providing a business case as to why the healthcare system as at large should pay for this type of care in addition to what they already provide in addition to policy work.


Help Desks like Health Leads are gaining ground across the country and more and more every year are being incorporated into traditional models of care. My PE at Highland Hospital is modeled after Health Leads except it is run on a purely volunteer basis, whereas Health Leads has paid employees as overseers. Berkeley students reached out to Health Leads in 2012 to start help desks in the Bay Area, but at that time Health Leads was not ready to expand so the Berkeley students did it themselves through Big Ideas at Berkeley [http://bigideas.berkeley.edu/winners/highland-health-advocates/]  Highland Health Advocates is just a part of the Bay Area Regional Health Consortium, which is a team of doctors, lawyers nad undergrads devoted to helping those in poverty acheive good health. According to their Big Ideas at Berkeley page,"The goal of this interdisciplinary approach is to improve the health of low-income patients, enhance the patient experience, reduce emergency room utilization by high frequency patients and ultimately lower healthcare costs in outpatient clinics and the emergency department." The pilot Help Desk through the Consortium was founded at Highland Hospital in Fall 2012 with 8 undergraduate volunteers and has since grown to over 60 undergraduate volunteers in Highland Hospital, Oakland Children’s Hospital, and San Francisco General Hospital.

If anyone is interested in volunteering with us, let me know! We require a minimum of one semester. We’re also looking for summer research interns.


Friday, February 28, 2014

Michael B. Katz in relation to LIFEhabits


Yesterday in class we discussed the six problems of poverty that Michael B. Katz addressed in his essay “What kind of Problem is Poverty? The six different problems are: persons, places, resources, political economy, power, and markets. After a short discussion of how each different problem is important in its own way, the professor had us get into our groups to discuss how our group projects related to one or many of the six problems of poverty. My group’s project: Learning Important Fun Eating habits (LIFEhabits), will be focusing on looking at obesity rates in a school district and more specifically focusing on 8th grade middle school students. Our goal is to educate students about the importance of eating healthy.

As we were discussing where our project’s goals would fit under, we came to a consensus that our project problem solution fell under resources. In Katz essay, his explanation of poverty based on resources focus a lot on money, and how poverty is the absence of money. In our case, our group felt that resources for us meant something more than money; it meant having the knowledge to understand what is happening, or why things are happening. The levels of obesity in middle schools might be the result of lack of education on nutrition. There is no real solution to this problem is all we do is give people money to try and change things without really analyzing the problem, and why it keeps happening. Like one of my classmates mentioned in class. It’s like giving homeless people money to go to the doctor, you re giving them the resource (money) but they will not go because they will either spend the money elsewhere or not be informed on where to go. The solution would be to taking them ourselves. Same thing will happen with middle school children and their schools. We can give them the money they need to change the lunch menu, but unless the students are aware of why it is best to eat healthy foods instead of Burgers and pizza every day, they will not eat during lunch, instead they will continue their eating habits outside school. Is all about knowledge. At least that is what many of us though as we started thinking about our projects.  But is it really? Professor Talwalker left us thinking about a question she wrote “is knowledge most likely conceived as a resource, or not?” on the board.

We also said that our project fell under people. The only solution will not only be informing students about the benefits of healthy eating habits, but also outreaching to them and trying to change their way of thinking. Many students do not like fruits and vegetables, and that is understandable because most of us went through that phase. But the only way to have these children change their way of thinking when it comes to choosing between healthy foods and junk food, is by motivating them and once again informing them about nutrition. At the end of the day this could be our biggest problem, having children understand.

Finally the third category in which our project falls under is places. For this category we are still debating whether it actually does fall under places or not. In class our group we had agreed that it did because where someone lives also affects their way of thinking, but after discussing as a class, our group said that maybe it did not because we were not focusing on a certain race, we wanted to apply our project to multiple school districts, wealthy or not, and finally we were not going to solve this problem by moving everyone out of their neighborhood. But when we presented our project to the class, a classmate and professor Talkwaker both mentioned that place might actually be a problem. Yet we are debating whether place is a solution to our problem.

Overall Katz essay was in my opinion a well-written essay that helped us start thinking about specific problems and solutions for our group projects that we are going to encounter along the way.

Thursday, February 27, 2014

Obamacare vs. Affordable Care Act - Jimmy Kimmel Live

Being a fan of the Jimmy Kimmel Live show, I saw this clip last year, where they sent out a camera crew to Hollywood Boulevard to conduct an experiment on the community's opinion on Obamacare and the Affordable Care Act. As Jimmy mentioned in the clip, Obamacare and the Affordable Care Act are the exact same thing. The purpose of the experiment was to determine how informed the public is on the subject of the Affordable Care Act. This video was my inspiration for the idea of our group project.

http://www.youtube.com/watch?v=sx2scvIFGjE

The video is very funny and entertaining. It also indicates that the general public is not very informed about the Affordable Care Act at all, despite their strong opinions. We can see in the video that a large majority of the people stated that they agree more with the Affordable Care Act and that it is the "better" option. One man even said that it is "more American."

It is very interesting to see what their responses are when asked about why they disagree with Obamacare.

-"there's a lot of holes in it"
-"to force people to pay something and doctors to make something, limiting their ability to do their job, that's kind of anti-American"
-"I just don't agree with the whole Obamacare policy thing that's going on"
-"I don't like anything that has to be forced for everybody to buy"
-One womyn was asked if she thinks Obamacare will lead to gun prohibition, she responded, "yes."

I think that when the general public is not informed about certain topics, they lean towards a certain side based on the names of the topics; whichever name that sounds "more" right and interesting. Even though this can possibly be an issue of naming of the health care program, it does not hide the fact that the general public does not know that they are the same. How can a program that is developed to serve Americans be "anti-American?" Or, is the name "Obamacare" what actually sounds "anti-American" to him? I actually found it quite funny that the womyn responded "yes" to the question about Obamacare leading to gun prohibition. What could be a potential relationship that she saw between the two? I cannot see the relationship yet and actually think that it was just a random question to test her. Another thing that stood out to me was the fact that this video was taken at the Hollywood Boulevard in Los Angeles. Generally speaking, I would assume that these members of the public are from a pretty well off background, since Hollywood Boulevard is an affluent part of LA. It is also a tourist attraction; in order to be a tourist and travel, one must also have the financial capabilities to do so. This brings up the question that, if the middle and upper middle income class do not know about the Affordable Care Act, how much does the lower middle class knows? Have they heard of the Affordable Care Act? Do they know what it offers and what their options are?


Wednesday, February 26, 2014

Greek Austerity and Health Care

Greece’s austerity measures have long since disappeared from front page news, but a lot of the consequences are only starting to be felt. I was shocked to read about the state of the healthcare sector recently, and I think it deserves more attention. Almost every Greek has been affected: health insurance is typically tied to employment (and unemployment is now nearing 27%, leaving 800,000 uninsured), pension funds and social security have been slashed, and public health spending has decreased by 25% ($12 billion). This has resulted in higher charges by the hospitals for the services offered. So people have lost their insurance and assets, the quality of care has diminished, and now rising prices are making health services even more difficult to afford. NGOs and volunteer clinics are doing what they can, but they were designed to help immigrant populations, and cannot handle the increased demand from the general public. This is clearly evident by the rising disease levels: the closing of safe needle programs has led to a 200% increase in HIV infections, and the end of mosquito spraying programs has resulted in the return of malaria, after a forty year absence. The suicide rate has also jumped – it rose 45% between 2007 and 2011, which could be tied to the 250% increase in rates of depression.
The future population is increasingly at risk: Greece had a very low fertility rate before the recession (about 1.4 children per woman), but the birth rate has decreased by 15% in the last four years, infant mortality has risen by 43%, and the rate of stillbirths has risen by 21%. So women are having fewer babies to begin with (possibly the rampant unemployment and general unrest have discouraged them), and the women who do have children are in much greater danger of losing them than they were four years ago.
Overall, the situation is quite alarming, and the government has done little to address it. International organizations could try to find more funding to expand the clinics, but it would be an unsustainable solution – funding is unpredictable and insufficient to fill the gaping hole left by the government. Plus, providing basic public health services undeniably lies in the realm of governmental obligations, as far as I’m concerned. I think the current situation poses interesting questions – is there a point of economic chaos where a developed nation’s government can justify eliminating health services? From a purely economic standpoint, maybe the answer is yes, but social justice perspectives might think otherwise. And if the government is too dysfunctional to provide healthcare, what are the obligations of the country’s doctors, international aid, and regular citizens? It seems unfair for medical NGOs, which are needed more desperately in other areas, to divert funding to a developed nation. And it’s certainly unfair to doctors to expect them to provide services for free when their own jobs and futures are at risk. I won’t pretend to have an in-depth knowledge of Greece’s situation, but from what I do know, it seems like the government made this mess, and that they are the ones who need to fix it.
I realize that money is incredibly tight right now, and that a lot of hard decisions had to be made, but the drastic cuts to health care are shortsighted and cruel. In addition to the multitude of negative consequences for the country right now, the reduction in health care quality jeopardizes the country’s ability to recover in the future. The working population is shrinking (from disease and emigration), and the rising infant mortality has made the next generation smaller than expected. There won’t be nearly enough young people to support the aging population, especially now that retirees’ assets have been severely reduced. The Greek government would do well to follow the austerity measures of some other European countries, like Iceland, which refused to cut health budgets. Instead, they are jeopardizing the health of their citizens, especially the most vulnerable and poor among them – the elderly, immigrants, infants, and the unemployed. Greece has a long road to recovery ahead, but it would be a lot more manageable if the population were healthy. Until policies are shifted and health services are regained, progress will be stunted and limited.





The Use of Art in Activism

http://gabrielmcortez.com/2014/02/08/13-short-film-perfect-soldiers/

I was sent this video by my roommate in a Facebook message urging me not to, ehrm, get too excited by the new piece done by one of my favorite Cal poets. The spoken word video by Gabriel Cortez allows for the use of art in the call to action. This could be thought of as an example of the community taking a step from within to inform of the problems affecting the poor. In this video the poet is able to take on the issue of food justice and contextualize it; providing the audience with a picture of how it is historically situated for the community it affects. Similar to the work we are doing now in GPP 105 to prepare us to go out into our practice as knowledgeable volunteers (yikes, not really sure how knowledgeable we can really be) Gabriel is not only making a statement about diabetes but is additionally making a statement about the communities it affects and the reason why those communities are affected. This art work is a reminder that things don't happen in a bubble and interconnections are key when looking at an issue when attempting to combat it.

Tuesday, October 1, 2013

The PE unicorn: now coming to you.

One hot afternoon in Wheeler auditorium, I was sitting in an introductory Public Health course, thinking that 6:00 PM could not come any faster. I was fanning myself, struggling to get my mind into gear for another 50 minutes, when Dr. Karen Sokal-Gutierrez pulled up her presentation for the lecture about tooth decay. I had the urge to double check my class syllabus, since this was Nutrition week for the course, but Berkeley time had all but waned, and honestly, I was just too lazy.

Dr. Karen launched into her personal story of working in El Salvador with the Peace Corp 20 something years ago, returning again rather recently to rotten smiles and a dominating presence of junk and processed foods. She unpacked her hypothesis, that junk food and the nutrition transition in various developing countries around the globe were all exacerbating malnutrition in children in a very digestible manner: junk food and sugary drinks lead to tooth decay, which prevents children from eating due to mouth pain and inability to chew, and also instills in children the preference towards junk foods over traditional, healthy foods.

Her project, a public health intervention, appeared successful and sustainable. Implemented in numerous countries, her project collaborated with local NGOs, which picked Community Health Workers to work on the project’s mission throughout the year. Once a year, the Berkeley team traveled to each country and implemented health camps and collected data, taught mothers and children proper tooth brushing methods and applied fluoride varnish.

She explained further that her research relied heavily on student involvement, which was open to undergraduates and before I knew it, I was working with Dr. Karen and the rest of the team and shortly after left to Mumbai and Kathmandu, Nepal. I think most Berkeley undergraduates can relate when I say that it felt like I found a unicorn. I absolutely couldn’t believe that I joined a project like this in the way I did.  What’s more is that Dr. Karen not only cares about the project, but also respects and is interested in her student volunteers and their experience with the project.  I know that everyone already has their PE chosen, but for anyone looking to become more involved in Public Health, nutrition, education or community-based interventions, this really is a great opportunity since most of the teams are in need of volunteers (especially students that speak the native language). 

As I was reading the Participatory Development article actually, I found myself nodding vigorously and making notes in the margins since I found that this Oral Health Project fit the bill almost completely for Participatory Action Research. The project works closely with not just with the NGOs and Community Health Workers under the NGOs. The beneficiary families are a crucial part of the project, since they help the Berkeley team assess the current climate surrounding oral health, oral hygiene and nutrition education in the local communities through focus groups and mother interviews. Additionally and most importantly, through these focus groups and interviews, they help the project identify the educational avenues it needs to focus on and address before returning for future health camps (i.e. create or improve educational materials, find additional teaching resources, develop specialized training for the health workers who will go and talk to mothers and children about oral hygiene and nutrition). 

The project operates in Kenya, Nepal, India (where I am focusing on for my PE), Vietnam, Ecuador and Peru.

Here are a few links for anyone to learn more about the project:
http://newscenter.berkeley.edu/2012/06/15/healthy-teeth/ (Dr. Karen’s e-mail is posted at the bottom of this article.)
Dr. Karen’s TEDxBerkeley talk last Spring: http://www.youtube.com/watch?v=YnsTvfNXPk4


As for the experience itself, I found myself overloaded with feelings, emotions and realizations that, quite frankly, came to blows with each other. On the one hand, I felt very lucky for the experience. But I was also frustrated that the conditions I saw were so many people’s reality. I was grateful for my own upbringing, but I was for some reason very guilty for it. I valued the sustainability of the India Smiles project and was pleased to see the community health workers and families excited about the health camps, but I also felt slightly hopeless amid all the colossal billboards with junk food ads and the dirty old candy wrappers crunching under my feet everywhere. And while I found myself constantly fueled by a burning ambition and newfound passion for the work I was doing, I felt dragged down when I discovered how little scholarship I possessed in regards to poverty action. So I embarked on the GPP minor in a non-traditional way, which is all the more enriching, and I’m looking forward to returning again for my official PE this winter break and to apply the new perspective I’ll gain throughout this semester. More to come on this, but for now, I wanted to extend this opportunity to you all since it has been transformative already for me. 

Thursday, September 19, 2013

Planning or Searching for your Practice Experience

Two weeks ago, for GPP 115, I read Easterly's work on Planners vs. Searchers. He described planners as out of touch academics who set unspecific goals and create plans (or programs perhaps, from todays lecture) which are not tailored to the unique context of a country.  He attributes the failures of the World Bank and other aid organizations to their reliance on planners, who develop complex conceptual plans of action or goals, and then force these plans onto problems. He contrasts planners with searchers. Searchers are those who look for demand, who find out what people need, or what they are willing to pay for, and find a way of getting them that product.
I do not completely agree with Easterly's criticism of Sachs or the Planner Searcher dichotomy, but it did make me reconsider how I have been approaching my practice experience.

Has anyone else been planning for their practice experience, rather than searching for it? I chose to do my practice experience in Spain because I was studying abroad there. I chose to work with an organization focusing on healthcare because I have interest and experience in health care. I planned when I would work around my school schedule, and where I would work based on where I'm staying. What I didn't do was search for a problem I could fix. I didn't search for an organization looking for people with my skills, or seek out a group which was in particular need. As it turns out, the Spanish Healthcare System covers almost everyone, for almost free.

I think this also speaks to the arrogance many people have about 'solving' poverty. I assumed that because I'm almost educated and have health care experience, I could make a positive impact. Has anyone been struggling to situate themselves within their organization to make the greatest difference?