Is Life Worth It?

I want to share a quick story about how I experience the effects of rising health care costs in my line of work.

I work as an EMT (emergency medical technician) responding to emergencies, stabilizing patients, and transporting them to emergency rooms. Getting people to definitive care at a hospital for trauma accidents, cardiac conditions, strokes, seizures, etc. is imperative to their survival and long term-health, however, it is often very costly. As we know, not everyone has insurance but emergency responders will never turn a patient away. Those same people are generally impoverished, and ultimately more vulnerable to disease compared to wealthy individuals who can afford preventive care and quality insurance.

That being said, I remember a specific patient experiencing an ischemic stroke (block of blood vessel in brain) and needed to be taken to the closest stroke center. My partner and I stabilized the patient as much as we could and transported the patient immediately. The patient was an elderly, lower-class Hispanic male without insurance. My partner drove while I monitored the patient in the back while questioning the wife who rode in the back with me. She mourned. She was afraid. I assured her that we were doing our best and that her husband was in good hands. After a while, she explained that it was his third stroke and that they weren't even done paying for the first treatment. She was afraid for her husbands health, but at the same time, she was afraid to think about how they would pay off the hospital bills for a third round. I don't know if he passed away after dropping him off in the ER, but I know that his wife would be left the pay for the bill either way.

With the cost of health services and the current health care system, people can't even concentrate on wishing their loved ones to get better soon. People resort to questioning if being saved is even worth it. Some people disproportionately more than others. How can we let this happen, even in a "developed" society?

Mountains Beyond Mountains: A Book Review

http://www.tracykidder.com/books/mountains/

I recently read a very inspirational book that I would strongly recommend to everybody for some motivation to continue working in the field of global poverty. The book is centered around Paul Farmer, a well-regarded doctor who many know from his publications on Haiti, including The Pathologies of Power. Mountains Beyond Mountains, written by Tracy Kidder, is sort of a biography about Farmer’s work in Haiti, Peru, and many other countries. I wanted to share some thoughts and questions that the book brought up for me, and relate it to my own experiences abroad.

One of the most inspiring aspects to the book was the morality of Paul Farmer, especially his rationale that those who have less money, especially in the developing world, should not have to suffer from worse medical treatment. Many policies and programs come to the conclusion that treatments  make more sense when they reach the greatest number of people, often meaning those who are chronically ill or require a more expensive treatment are left out. Farmer instead works by the logic that every patient should receive the best quality care that he can provide, and on a couple occasions he even flies his patients to Boston to receive treatment. Another reason this book was so inspirational to me was seeing Farmer’s extreme dedication to the people of Haiti, as well as the respect he received from those that he treated. He appears to genuinely care for every individual he encounters, and works as hard as possible to treat them. Many people seem to spend a couple years working in a developing country, or dedicate their lives to a certain organization but spend most of their time at an office in the US. Farmer, on the other hand, constantly flies around the world to do the most he possibly can, rarely taking a break or settling down. Overall, this book kept me motivated and has given me a lot of respect for Paul Farmer and his work.

While Farmer truly inspired me, I also finished the book a bit depressed about what I have accomplished so far and what I will every really be able to do. I am not planning to ever become a doctor, which is a resource that can literally save lives in a very direct and tangible way. What will my academic studies really allow me to do, and how much do I really know about the world as a whole? Additionally, I began to question the sustainability of Farmer’s work. Despite his consistent effort, what is his work doing on a larger scale for the people of Haiti? While a clinic is certainly necessary, and treating all patients not by the money in their pockets but by their value as an individual is clearly a necessity, is this really the way to end global poverty? Even my work with Fundacion Cantaro Azul is touching very few lives in the greater context of Mexico or even Chiapas. Rather, is targeting the political economy or powerful institutions a more sustainable and meaningful angle? Of course, I suppose nobody knows all of the answers, and this is why we are all in college minoring in Global Poverty. Either way, I really recommend the book—it is a fun, easy read that will be sure to leave you with many questions and reflections.

The Mango Doctor

I don't tell people this story. It's too close to my heart to tell in person. But it is part of what drives me and provokes me to question myself: What am I willing to do?

My father was a passionate man and an intuitive physician. When me (age 9), my brother, and he lived in the Philippines, he had given up a career as a doctor in California to raise mangoes in his home town -- a small, rural town predominated by agriculture and fishing. Yes, I said mangoes. He had denied himself and us the luxurious lifestyle that he had built in order to pursue what he really cared for. With constant typhoons destroying the crops and without a stable source of income, we quickly fell to a less than modest lifestyle. Despite all the conditions we faced, my father still managed to practice medicine in the town.

There was no clinic with health care services in the town; the closest place to receive any form of decent treatment was an hour drive away into the city. When the townspeople became sick, they could not afford to travel the distance or the care they required for even the simplest things. Family, friends of family, friends of friends of friends of family came to rely on my father for his medical consultation. I would follow my father around as he made house visits to anyone who requested his help. He performed whatever diagnostics and procedures that he could, such as circumcisions, wound cleanings, acute and chronic illness diagnoses, etc. He even spent what little money he had to buy medications or supplies for those who could not afford them. Not once did I ever see him accept or ask for payment. This was his community and he served it better than the state did. People came to know him as "the mango doctor."

With our financial and home conditions depreciating even more, he became sick. But that didn't stop him from continuing to provide whatever primary care services he could offer to whoever needed his help. It wasn't until he passed away that I realized just how much of an impact he made on that town; one man who embodied the true essence of medicine. Medicine and health care beyond clinical walls.

I want to be like him. I want to practice medicine as he did. I want to serve as he did. But I've tasted what a better life for me is like. So everyday, I ask myself: what am I willing to do?


What are you willing to do?

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.

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.