When Culture Meets Medicine: Reflections on a Medical Mission to Cameroon

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The West-African nation of Cameroon is one with limited access to health care, with a ratio of only 1.9 physicians per 10,000 people. Such statistics demonstrate the health care needs of this country; however, personal experience provides a much more striking perspective of such health care disparities. Because of a five-week medical missions trip to Cameroon, I have come to better appreciate the need for health care providers around the globe. During my visit, our team of health care providers, in collaboration with the Cameroonian organization ASCOVIME (Association des Compétences pour une vie meilleure), was able to provide free medical care to over 1,500 Cameroonians from the rural villages of Minkang II, Lomie, Doukoula, and Nditam. These villages warmly welcomed our team, enabling us to provide care through general consultations, ophthalmology screenings, and surgical interventions while being immersed into Cameroonian culture.

Delivering Healthcare in Somaliland, NW Somalia

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Abstract Limited provision of quality healthcare in Somalia has contributed to infant (109/1000), child (180/1000) and maternal (1,400/100,0000) mortality rates that border the world’s highest (WHO). The self-declared Republic of Somaliland (NW Somalia), with 3.85 million people, is recovering from ruins of conflict. The health sector was hardest hit with distinct challenges in urban and […]

Understanding Rural-to-Urban Migration in Ethiopia: Driving Factors, Analytical Frameworks, and Recommendations

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Climate variations are occurring. Global temperatures are increasing, erratic precipitation patterns are becoming the norm, and extreme climatic events are becoming more severe and frequent. These environmental changes are having deleterious effects on the lives and livelihoods of poor rural farmers globally who depend on rain-fed agriculture for their income, for their health and nutritional status, and for their subsistence. In the country of Ethiopia, adaptation strategies such as small-scale irrigation, farm mechanization, and the use of more water-efficient crops have been implemented at the household level. Nationally however, there are large gaps in infrastructure development, risk reduction and coping strategies, and political will. Given these constraints, migration, specifically rural-to-urban migration is increasingly used as a last-resort coping strategy for the poorest of these subsistence-farming families. Literature review provides evidence that short-term population migration is a common adaptation or coping strategy to environmental stressors. Most population migration is short-term and used to diversify household livelihoods and income, especially when affected by environmental extremes. Eighty-five percent of Ethiopia’s population participates in rain-fed agriculture on plots of land ranging from 0.25 hectare to 2.0 hectare on average. Environmental extremes such as drought are decreasing the land’s productive capacity leading to a decrease in subsistence agriculture, income, assets, and a rapid decline in the health and nutritional status of the rural population. Ethiopia’s largest city – the capitol city – Addis Ababa, is growing rapidly, in part due to rural-to-urban migration. Urban sprawl is facilitating the deterioration of an already weak infrastructure, promoting health and sanitation problems. However, migrants still come to the cities with the belief they will earn a labor wage, one they can remit back to the families and social supports they left behind. Understanding the interactions among “push” and “pull” factors that drive the decision to stay or to migrate in the context of changing environmental conditions is increasingly important as the global population grows. Examples of previously developed frameworks are presented and reviewed in the Ethiopian context. One framework that is reviewed is adapted to the Ethiopian-context to demonstrate how specific drivers within Ethiopia are influencing the decision to migrate. Moreover, this adapted framework is examined as a way to provide practical policy recommendations that may delay or better, prevent the onset of migration, by providing social and economic protections to rural households that protect rural livelihoods, and promote health, and nutritional status.

Health Care Issues Facing the Maya People of the Guatemalan Highlands: The Current State of Care and Recommendations for Improvement

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The indigenous population in rural Guatemala has access to a variety of treatments from both the traditional and biomedical realms. A review of the current literature was performed to determine the major factors influencing the decision to seek care and choose a provider. Despite a high prevalence of non-biomedical beliefs among the native population, folk healers are rarely used. Local unlicensed pharmacies are frequently used to obtain advice and medications. Utilization rates of the public health care system in the region are relatively low. Perceived lack of severity of illness, cost, mistrust of the provider, and quality of services as determined by the patient are the major deterrents to seeking medical care in the public health care system. Cost is particularly important as non-traditional medicines are often expensive and biomedical health care providers prescribe medications that patients cannot afford. In addition, government health posts often lack culturally sensitive care creating a significant barrier for indigenous populations. Access to a government health post does not appear to be a major factor in determining health care-seeking behavior. A system that minimizes cost barriers, while providing culturally sensitive care may lead to greater access and use of the public health care system among the Maya in Guatemala.

Understanding Women’s Intergenerational Knowledge Transfer in Rural Mali: Lessons from the African Sky Mothers and Daughters Summit

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In January 2011, the nonprofit African Sky facilitated an educational conference in Markala, Mali for pre-existing associations to come together and share knowledge and skills for mutual benefit. The participating groups (N = 6) held expertise in areas of: organizational management, income generation, and family health and sanitation, and were grouped as “established” peri-urban (N=2) and “emerging” rural (N=4) associations. Proficiency was measured on a four-point scale (1 = below basic, 2 = basic comprehension, 3 = proficient, 4 = advanced proficiency) for 14 items. Six months following the Summit, the two established women’s associations achieved 100% proficiency in organizational management, family health and sanitation, and income generation. After six months, the remaining emerging association decreased in knowledge to 50% proficiency in income generation, and only 10% proficiency in both organizational management and well as family health and sanitation. The authors hypothesize that the gains were maintained in the established organizations as these associations had the monetary means to implement the business plans they developed at the conference. Organizational support for immediate application of newly acquired skills may increase retention of skills and knowledge.

The Cultural and Psychological Context of Development and Healthcare in the Tribal Region of Sargur, India

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Located 55km northeast from Mysuru, the isolated region of Sargur, India is a highly forested and remote area. The population of this region is considered a minority and vulnerable due to lack of access to care, low life expectancy, and high levels of poverty. This tribal group has a unique culture, language, and way of life that is novel to outside medical professionals or development leaders that attempt to work in the region. To better serve the community and improve access to care, the Swami Vivekananda Youth Movement (SVYM) created an integrated development model which customizes the current standard development models to accommodate the tribal value system and attitudes regarding education, health, and socioeconomic empowerment. This report summarizes how the revolutionized education and healthcare system addresses the challenges of catering to a population prone to migration through understanding the definition of health according to the local attitudes and interpreting the impact of way of life in the development models appropriate for this population. This report reinforces the integral role of cultural competence when attempting to work with marginalized populations. The local approach varied from the traditional development models and was based off of direct experience with the population and cultural competence. This account analyzes the cultural norms of the tribal individuals, evaluates the appropriate technology and interventions used within the region, and assesses the barriers to healthcare and sustainable development.

When Culture Meets Medicine: Reflections on a Medical Mission to Cameroon

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The West-African nation of Cameroon is one with limited access to health care, with a ratio of only 1.9 physicians per 10,000 people. Such statistics demonstrate the health care needs of this country; however, personal experience provides a much more striking perspective of such health care disparities. Because of a five-week medical mission trip to Cameroon, I have come to better appreciate the need for health care providers around the globe. During my visit, our team of health care providers, in collaboration with the Cameroonian organization ASCOVIME (Association des Compétences pour une vie meilleure), was able to provide free medical care to over 1,500 Cameroonians from the rural villages of Minkang II, Lomie, Doukoula, and Nditam. These villages warmly welcomed our team, enabling us to provide care through general consultations, ophthalmology screenings, and surgical interventions while being immersed into Cameroonian culture.

A Student’s Observations on the State of Maternal Care in India

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As the second most populous country in the world, India struggles to provide universal healthcare with an infrastructure that has not kept pace with its economic growth and expanding population. With limited resources, physicians are spread thin and standards of health are low. As a result, the wealthy opt for private healthcare and receive world-class medical attention while the majority subsists on the most minimal treatments. These limitations, in combination with a traditional male-dominated culture, leave women with little freedom of choice when it comes to treatment of their bodies. This gender inequality in healthcare is amplified by a lack of education of family planning strategies. After spending a month shadowing physicians in both private and public hospitals in India, I saw first hand the shortcomings of the Indian health system, particularly in relation to women’s health. Despite the obvious need to repair public healthcare, overpopulation and government corruption prevent improvements in the healthcare infrastructure.

Understanding Women’s Intergenerational Knowledge Transfer in Rural Mali: Lessons from the African Sky Mothers and Daughters Summit

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In January 2011, the nonprofit African Sky facilitated an educational conference in Markala, Mali at the request of women’s associations in rural partner villages. The Mothers and Daughters Summit was a venue for pre-existing associations to come together and share knowledge and skills for mutual benefit. The participating groups (N = 6) held expertise in areas of: 1) organizational management, 2) income generation, and 3) family health and sanitation. Proficiency was measured on a four-point scale (1 = below basic, 2 = basic comprehension, 3 = proficient, 4 = advanced proficiency) for 14 items across the three areas of expertise. Evaluations were conducted pre- and post-intervention. The participating associations can be grouped as “established” peri-urban (N=2) and “emerging” rural (N=4) associations. The evaluation of the summit showed proficiency levels of 87% on measures of organizational management and family health and sanitation, and 50% on measures of knowledge of income generation. Six months following the summit, the two established women’s associations achieved 100% proficiency in organizational management, family health and sanitation, and income generation. The emerging women’s associations reported less promising results after six months. Three emerging associations were lost to follow up, and the one that remained showed a decrease to 50% proficiency in income generation, and only 10% proficiency in both organizational management and well as family health and sanitation. Organizational management and family health and sanitation showed larger gains than income generation. The authors predict this is because these topics are better understood, whereas formalized income generation is a newer topic being introduced to the groups. It is likely that being from larger towns, the participants from the established organizations had more experience with formal education. The emerging organizations did not have an opportunity to practice their new skills because they did not have the minimal startup funds necessary. The authors hypothesize that the gains were maintained in the established organizations as these associations had the monetary means to implement the business plans they developed at the conference. Using peer-to-peer mentoring as a model for teaching skills proved effective for skill-sharing in this sample of rural women’s associations in West Africa. Organizational support for immediate application of newly acquired skills may increase retention of skills and knowledge.

“Cruzada de la Esperanza” (Crusade of Hope): Promotion, Prevention and Diagnosis for Breast, Cervix and Uterus Cancers, Sexually Transmitted Diseases and HIV-AIDS in Honduras Rural Areas 2008-2009

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A pilot public health project in Honduras aimed at providing services for promotion, prevention and diagnosis of breast, cervix and uterus cancers, sexually transmitted diseases and HIV-AIDS was implemented. “Cruzada de la Esperanza” targeted 789,415 women of fertile age older than 18 years in impoverished and hard to reach rural areas. The project was funded by The China-Taiwan Republic and The Honduras Health Ministry. “COCSIDA” Centro de Orientación y Capacitación en SIDA (Center for Counseling and Training on HIV–AIDS) was the institution administrating and implementing the project in 108 municipalities and 576 villages. The health threats in this population are due to the close relationship between women’s reproductive health issues and components of human sexuality; influenced by socio-cultural factors expressed through male “machismo”; female subordination and lack of empowerment and education. The project’s demographic coverage was every person who directly or indirectly benefited from the services. The criteria for intervention were those for the targeted health threats and pregnant women. The Crusade’s main goal was to decrease late detection for the stated cancers and other health problems. Another goal was the increase of access and services utilization including mammography, vaginal cytology, rapid HIV testing and counseling, diagnosis of sexually transmitted diseases and positive case referral to a higher quality health care center. By achieving the above goals the Honduras female population was educated to adopt better and safer health care practices and access to those services will increase. The main strategy of implementation was the use of 3 mobile mammograms, radiological and laboratory diagnostic equipped vehicles available in a community health fair atmosphere. The plan was to provide 10,800 mammograms, 25,920 ultrasounds, 25,920 vaginal cytologies, 12,920 HIV tests and 20,000 sexually transmitted disease attentions. The crusade began in May 2008 but ended in March 2009. A total of 102 municipalities in 13 departments and 263,242 people were serviced. A total of 330,154 attentions out of 312,736 planned (105.6%) was accomplished. Of these, 15,390 were mammograms, 9,187 were ultrasounds, 27,271 were cytologies, 13,681 were HIV tests and 8,808 were STD attentions. 305 vaginal cytologies and 70 mammograms were suggestive of malignancy. 21 cases were HIV positive. 100% of the suggestive malignancy and HIV cases were referred and inserted in a specialized institution for medical care. Due to the successful results, the funding donor entities granted one more year of activities, sadly canceled due to the Honduras political crisis.

An Analysis of Ethiopian Rural-to-Urban Migration Patterns from Primary Interviews

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Urbanization is a growing phenomenon around the world. In Ethiopia, urbanization is often initiated by extreme climatic events such as drought where rural-to-urban migration is a last-resort effort to maintain a family’s farming livelihood. To better understand the influence that climate has on macro-level drivers of migration, namely political, demographic, economic, social, and environmental factors, primary interviews were conducted with rural-to-urban migrants in the capitol city of Ethiopia, Addis Ababa. For this study, two sources of data are used. The first is primary interviews with 59 adult migrants from rural villages in the Debub, Amhara, and Oromia regions, who were recruited and interviewed across 18 sub-districts of Addis Ababa. Beggars, house workers, shoe shiners, labor workers, and other workers, were interviewed with the help of an Amharic/English speaking translator. The second source of data is rainfall and climate data from the Ethiopian Central Statistics Agency. The most common reason for migrating cited by 73% of the sample is being unable to grow enough food or other products as a result of not enough land, high fertilizer prices, high cost of farm inputs, or poor harvest. The majority of migrant families (73%) held less than 1 hectare of land, 22% held between 1 and 2 hectare, and only 6% held more than 2 hectare. The second most common reason for migrating cited by 64% of the sample is the need for more money or job opportunity due to not earning enough from the harvest or labor work in their village. Cross-referencing migration year with available rainfall data indicates that where data is available, 71% of individuals migrated in years where rainfall was less than average. Length of time residing in Addis ranged from less than 1 year to more than 3 years, and nearly everyone in the sample reports they would not have migrated if they had enough in their villages or had received enough government support. Political, social, economic, demographic, and environmental drivers of migration are represented in the responses of Ethiopian rural-to-urban migrants. Inadequate land, a political and social phenomenon, affects demographic and economic factors. Lack of land itself is a proxy for household wealth. These factors are influenced by environmental extremes, and without adequate economic buffers, including animals or labor, lead to migration. A number of policy recommendations that target each of the driving factors are provided in addition to areas of interest for future research.

Understanding Rural-to-Urban Migration in Ethiopia: Driving Factors, Analytical Frameworks, and Recommendations

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Climate variations are occurring. Global temperatures are increasing. Erratic precipitation patterns are becoming the norm, and extreme climatic events are becoming more severe and frequent. These environmental changes are having deleterious effects on the lives and livelihoods of poor rural farmers globally who depend on rain-fed agriculture for their income, for their health and nutritional status, and for their subsistence. In the country of Ethiopia, adaptation strategies such as small-scale irrigation, farm mechanization, and the use of more water-efficient crops have been implemented at the household level. Nationally however, there are large gaps in infrastructure development, risk reduction and coping strategies, and political will. Given these constraints, migration, specifically rural-to-urban migration, is increasingly used as a last-resort coping strategy for the poorest of these subsistence farming families. Literature review provides evidence that short-term population migration is a common adaptation or coping strategy to environmental stressors. Most population migration is short-term and used to diversify household livelihoods and income. Eighty-five percent of Ethiopia’s population participates in rain-fed agriculture on plots of land ranging from 0.25 hectare to 2.0 hectare on average. Environmental extremes such as drought are decreasing the land’s productive capacity leading to a rapid decline in the health and nutritional status of the rural population. Ethiopia’s largest city–the capitol city–Addis Ababa, is growing rapidly, in part due to rural-to-urban migration. Urban sprawl is facilitating the deterioration of an already weak infrastructure, promoting health and sanitation problems. However, migrants still come to the cities with the belief they will earn a labor wage, one they can remit back to the families and social supports they left behind. Understanding the interactions among “push” and “pull” factors that drive the decision to stay or to migrate in the context of changing environmental conditions is becoming increasingly important as the global population grows. Examples of previously developed frameworks are presented and reviewed in the Ethiopian context. One framework has been adapted to demonstrate how Ethiopian-context specific drivers influence the decision to migrate. Moreover, this adapted framework is examined as a way to provide practical policy recommendations that may delay or prevent the onset of migration, by providing social and economic protections to rural households that ultimately protect rural livelihoods, health, and nutritional status.

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