Empowering the Very Poor for Better Health Outcomes

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Empowering the Very Poor for Better Health
Outcomes

• Shelanne Lighthouse, RN, BSN
• Washington State University

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• Introduction
• Goals and Objectives
• Learning Activities
• Basic Needs Essential Services
• Principles of Effective Practices
• Examples of Effective Practice

• Ineffective Practices and Examples
• Detrimental Practices and Giving
• Personal Experience and a Story
• Final Thoughts
• Evaluation
• References

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Introduction

• Travel to developing countries is becoming more
  frequent
• Concept of combining adventure with service is
  becoming popular
• Individuals have good intentions, but lack
  adequate knowledge and preparation
• Interventions are often ineffective and
  occasionally detrimental

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Intended Audience

• Any professional considering working or
  volunteering (short or long term) in developing
  countries for humanitarian or international aid
  purposes
• This presentation is specifically designed for
  health care workers, but much information applies
  to other disciplines

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Overall Goals and Purpose

• Provide both scholarly and experiential resources
  that encourage development of
• Sensitivity to local customs, networks, and
  available resources
• Awareness of local perception and long term
  impact of outside assistance
• Help prepare individuals for meaningful and
  effective service in underserved areas

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Specific Objectives

• Understand the most basic needs of the poor and
  essential resources for proper health.
• Differentiate between effective, ineffective, and
  detrimental health practices.
• Identify five (5) principles of effective
  interventions with the destitute poor.
• Demonstrate an understanding of why some common
  practices of individuals on short term
  international aid trips can be detrimental.
• Develop a broader understanding of global health
  issues and challenges.

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Learning Activities

• Read the required articles
• View the PowerPoint and peruse the websites for
  which links are provided
• Search the internet for other resources
• Read the case study and determine your actions
  based on what you have learned
• Participate in the discussion board and share
  your findings

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Readings ResourcesRequired

• Fauchald, S. K. (2004). Using
  academic-community partnerships to improve health
  care services for underserved population.
  Journal of Multicultural Nursing and Health,
  10(1), 51-56.
• Ghosh, A., Bharat, R. (2000). Domestic burns
  prevention and first aid awareness in and around
  Jamshedpur, India Stategies and impact. Burns,
  26, 605-608.
• Grennan, T. (2003). A wolf in sheeps clothing?
  A closer look at medical tourism. Medical
  Ethics, 1(1), 50-54.
• Please see notes for discussion of these
  resources!

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More Required Readings

• Bishop, R. A., Litch, J. A. (2000). Medical
  tourism can do harm. BMJ, 320, 1017. Retrieved
  April 12, 2006 from http//bmj.bmjjournals.com/cgi
  /content/full/320/7240/1017
• Pruitt, S. D., Epping-Jordan, J. E. Preparing
  the 21st century global healthcare workforce.
  BMJ, 330, 637-639. Retrieved April 12, 2006 from
  http//bmj.com/cgi/content/full/330/7492/637
• International Council of Nurses (n.d.). ICN on
  poverty and health Breaking the link.
  Retrieved April 12, 2006 from http//www.icn.ch/ma
  tters_poverty.htm

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Readings ResourcesRecommended

• Wilson, A. T. (2005). The effectiveness of
  international development assistance from
  American organizations to deaf communities in
  Jamaica. American Annals of the Deaf, 150(3),
  292-304.
• Perin, I., Attaran, A. (2003). Trading
  ideology for dialogue An opportunity to fix
  international aid for health? Electronic
  version. The Lancet, 361, 1216-1219.
• Unger, J. P., De Paepe, P., Green, A. (2003).
  A code of best practice for disease control
  programmes to avoid damaging health care services
  in developing countries Electronic version.
  International Journal of Health Planning and
  Management, 18, S27-S39.
• Farmer, P., Campos, N. G. (2004). Rethinking
  medical ethics A view from below. Developing
  World Bioethics, 4(1), 17-41.
• All these articles may be obtained through
  CINAHL

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Websites

• International Council of Nurses Site ICN
  Partnership Database
• Health Inc. - Health, Environment and Literacy in
  the Himalayas in Cooperation with Local
  Communities Cynthia Hunts work in Tibet
• HealthWrights Dr. David Werner Where There is
  No Doctor

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Human Basic Needs

• Safe environment
• Balanced and adequate nutrition
• Adequate shelter (clean, not crowded)
• Proper sanitation
• Clean, safe water
• Opportunities for sustenance
• Access to health and medical care
• Education

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Western Needs/Desirables

• Nice clothes (multiple)
• Objects of entertainment
• Variety of foods and edible treats
• Convenient transportation
• Materialistic possessions
• Opportunities for advancement and power
• Hi-tech health care and interventions

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Principles of Effective Practice

• Understand the culture preferably the language
  also
• Think ahead and long term - What will be the
  impact 5 or 10 years from now?
• Develop lasting partnerships with
• Patients or clients
• Local organizations
• Local willing and trainable individuals

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Principles continued

• Encourage and enable the development of
  information systems and communication
  technologies including networks
• Teach and encourage quality improvement
• Maintain a population and public health
  perspective Work in/with communities
• Focus on proactive, planned, preventive care
• Create training opportunities for locals

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Pruitt and Epping-Jordan, 2005
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More Principles

• Communicate, communicate... Dialogue with locals
  to understand their needs
• Work from a grassroots or bottom-up
  perspective not top-down
• Try to be aware of local sentiment and perception
  of interventions
• Educate Effective education provides resources
  for lasting change

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7 Factors of Effectiveness

• Employ culturally and linguistically competent
  individuals to implement interventions
• Support and network with indigenous organizations
• Involve indigenous people in program planning,
  implementation, and evaluation
• Develop a basic knowledge base and competence of
  cultural issues and expectations
• Develop an awareness of the cultural perception
  of health and appropriate health/medical care
• Maintain accountability to supporting individuals
  or organizations ensure positive representation
• Network with others engaged in similar work

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Adapted from Wilson, 2005
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Effective Practice Examples

• Cynthia Hunts Work in Tibet Browse the site
  and be sure to click on the link to the trailer
  for The Magic Mountain
• ICN Partnership Database Click on the link to
  view the database pages and learn about projects
  that make a positive impact
• Academic-Community Partnerships Fauchald (2004)
  discusses partnerships between student nurses and
  organizations in rural, underserved areas

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Ineffective Practices

• Designing interventions without adequate or
  accurate understanding of culture
• Short term interventions without collaboration or
  long term follow-up
• Provision of acute care to individuals rather
  than education and provision of resources to
  local communities
• Reactive practices that offer an immediate quick
  fix solution
• Top-down approaches that impose Western
  standards, methodologies, and values

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More Examples Resources

• Medical Tourism Can Do Harm Read this article
  and the Rapid Response comments that others
  have posted
• Story of Rwandan Twins - Example of the
  challenges involved in making decisions that
  encourage problem-solving rather than enable
  dependence
• Can you think of other examples?

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Detrimental Practices

• Provision of acute care by individuals not in
  collaboration with local organizations
• Provision of care by individuals lacking
  international experience or training
• Offering aid in an arrogant mannerDisrupting
  and taking over local services
• Providing handouts and gifts to random people
  because they have nothing

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Is it Ever Good to Give?

• Here are some principles to use when giving
• Will it provide resources that enable an
  organization to serve people better?
• Is it in payment for some service? If so, is it
  congruent with typical local practices?
• Will the gift have any positive impact on quality
  of life 5 years from now?
• Is the gift given in conjunction with some type
  of community educational program?
• Will this gift put me in a position of power?

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Personal Experience
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A Final Story
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The Earth is a Satellite of the Moon
This poem truly humbles and disturbs me. I
wanted to share it with you!
Leonel Rugama, Sadinista 1949 1970 Poem
quoted in Pathologies of Power (Farmer, 2005,
p. 247)
NASA - Visible Earth (http//visibleearth.nasa.gov
/)
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Final Thoughts

• Policy change is the most effective way to impact
  the health care for millions
• In whatever manner possible, seek ways to
  diminish inequalities and disparities
• Advocate for more equitable distribution of the
  worlds resources
• Acknowledge and utilize the expertise and
  resources of the local people and area
• Act with sensitivity and humility
• Go out and make a positive difference

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Evaluation

• View the grading rubric here
• Read the case study and plan your interventions
  based on what youve learned from this module
• Post your case study response under the forum
  titled Case Study
• Answer the discussion questions and post under
  the forum International Aid
• Share your resources under the forum titled
  Resources

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Questions for Discussion

• Respond to at least 3 of the following questions
  on the discussion board
• What stands out most in your mind from the
  materials you viewed or read?
• How do you feel about the idea that giving gifts
  to needy populations often leads to dependence,
  unrealistic expectations, and may even perpetuate
  injustice?
• Discuss three principles for effective health
  interventions with poor populations in developing
  countries that you feel are most promising and/or
  practical.
• Have you ever done any kind of health care work
  in a developing country? If so, share your
  experience What was good? What do you think
  needed to change?
• How will this information affect your
  international travel plans in the future?

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References

• Bishop, R. A., Litch, J. A. (2000). Medical
  tourism can do harm. BMJ, 320, 1017. Retrieved
  April 12, 2006 from http//bmj.bmjjournals.com/cgi
  /content/full/320/7240/1017
• Farmer, P. (2005). Pathologies of Power
  Health, human rights, and the new war on the
  poor. Los Angeles, CA University of California
  Press.
• Farmer, P., Campos, N. G. (2004). Rethinking
  medical ethics A view from below Electronic
  version. Developing World Bioethics, 4(1),
  17-41.
• Fauchald, S. K. (2004). Using
  academic-community partnerships to improve health
  care services for underserved population
  Electronic version. Journal of Multicultural
  Nursing and Health, 10(1), 51-56.
• Ghosh, A., Bharat, R. (2000). Domestic burns
  prevention and first aid awareness in and around
  Jamshedpur, India Stategies and impact. Burns,
  26, 605-608.
• Grennan, T. (2003). A wolf in sheeps clothing?
  A closer look at medical tourism. Medical
  Ethics, 1(1), 50-54.

Menu
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References continued

• International Council of Nurses (n.d.). ICN on
  poverty and health Breaking the link.
  Retrieved April 12, 2006 from http//www.icn.ch/ma
  tters_poverty.htm
• Perin, I., Attaran, A. (2003). Trading
  ideology for dialogue An opportunity to fix
  international aid for health? Electronic
  version. The Lancet, 361, 1216-1219.
• Pruitt, S. D., Epping-Jordan, J. E. Preparing
  the 21st century global healthcare workforce.
  BMJ, 330, 637-639. Retrieved April 12, 2006 from
  http//bmj.com/cgi/content/full/330/7492/637
• Unger, J. P., De Paepe, P., Green, A. (2003).
  A code of best practice for disease control
  programmes to avoid damaging health care services
  in developing countries Electronic version.
  International Journal of Health Planning and
  Management, 18, S27-S39.
• Wilson, A. T. (2005). The effectiveness of
  international development assistance from
  American organizations to deaf communities in
  Jamaica. American Annals of the Deaf, 150(3),
  292-304.

Menu
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