Cell 2 Soul: The Humane Health Care Blog

Alberto Cairo: There Are No Scraps of Men

Alberto Cairo's clinics in Afghanistan provide prosthetics and much more. They used to close down during active fighting. Now, they stay open. At TEDxRC2 (the RC stands for Red Cross/Red Crescent), Cairo tells the powerful story of why -- and how he found humanity and dignity in the midst of war. This is 19 minutes long and worth visiting.  See: Cairo/TED.

Mama Hawa, Courageous Somali Doctor

"On May 5, just after sunup, 750 militants surrounded Dr. Hawa Abdi’s hospital. Mama Hawa, as she is known, heard gunshots, looked out the window and saw she was vastly outnumbered.

“Why are you running this hospital?” the gunmen demanded. “You are old. And you are a woman!”

They did not seem to care that Mama Hawa, 63, was one of the only trained doctors for miles around, and that the clinic, school and feeding program she built on her land supported nearly 100,000 people, most of them desperate refugees from the fighting and poverty that has afflicted this nation.

The Saturday NY Times Profile (Jan. 6, 2011) "Under Siege in War-Torn Somalia, a Doctor Holds Her Ground."  Read article.  

Cholera and the Epidemic Blame Game

No good deed goes unpunished.  Thus, Haitians are pointing the finger at the United Nations peacekeepers from Nepal for bringing cholera to Haiti, it’s important to remember that the blame game for pandemics eventually involves everyone.

Donald McNeil, Jr. has an excellent article in the Sunday, November 21, NY Times called "Cholera's Second Fever" which is well worth reading.

Health Care Quality in the U.S.

June 24, 2010

According to new annual report from the Commonwealth Fund, a private foundation that focuses on health care, the U.S. health system presents a rather dismal picture in terms of overall quality of health care.

The analysis comparing the nations spending and health outcomes with seven other industrialized nations, found that despite outspending the other competitors, the Americans are getting less for their money and are languishing behind in common health issues.

The Commonwealth Fund's president, Karen Davis, stated, "On many measures of health system performance, the U.S. has a long way to go to perform as well as other countries that spend far less than we do on healthcare, yet cover everyone.

"It is disappointing, but not surprising, that despite our significant investment in health care, the U.S. continues to lag behind other countries.”

America scored poorly in most of the five key areas of health service in comparison to the other six competitors despite the country’s healthcare system being the most expensive in the world.

The rankings of the 7 countries
The Commonwealth Fund report was based on a survey of both patients and primary care doctors for the years 2007, 2008 and 2009 in Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom.

The focus of the report was five essential measures of health care- access to care, equity, quality, efficiency and the ability to live long, healthy, productive lives.

The overall winner was Netherlands scoring the highest in the list. The country topped in access and in equity, and ranked second in quality of care.
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The Dutch were closely followed by UK and Australia while Canada ranked sixth and America fared the worst in the list.
                                                                                                                                                                                                                                                             
US healthcare system the most expensive in the world
The United States scored poorly in most of the five key areas of health service despite the country’s healthcare system being the most expensive in the world.

The other six countries spend approximately half that of the United States yet are able to provide better universal care to its citizens.

In 2007, the nation spent $7290 per person which was more than double that of Canada, three times more than New Zealand and also much higher compared to the $3800 per person, spent in the Netherlands.

Some specific findings In areas of providing safe care, the United States ranks last and second last on coordinated care.

Patients with a chronic condition in the nation are most likely to be given the wrong medication and the wrong dose and delays in being informed about abnormal test results.

Another major problem is efficiency. The nation also ranks last on spending on administrative costs, use of information technology, duplicate medical testing and re-hospitalization.

In addition, the nation fared the worst in infant mortality and healthy life expectancy among older adults.

A large number of Americans go without care because of the cost. The report pointed out that the United States was the only country on the list that does not give all citizens healthcare coverage.

The authors of the report stated, "For all countries, responses indicate room for improvement. Yet, the other six countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States.

“These findings indicate that, from the perspectives of both physicians and patients, the US health care system could do much better in achieving value for the nation's substantial investment in health."

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Notes on "Social Pharmacy" from Penang

We would like to welcome a new author, Shazia Jamshed, to Cell 2 Soul.   She is fortunate to be researching and studying Social Pharmacy on the magical island of Penang, Malaysia.  "Simply put, social pharmacy relates medication use to individuals and to society at large by using the methodology of the social sciences. In this field, pharmacy is coupled with psychology, economics and sociology. It is truly a blend of science and art.  Social pharmacists advocate for radical change in the recognition of pharmacists' status.  They initiate policies to change the system and attempt to become an integral part in developing and implementing such policies." 

This is an emerging field that holds great promise for us as patients and caregivers.  To read Dr. Jamshed's brief discussion of Social Pharmacy see.  Download Social Pharmacy--edited    

Marginal Notes: Aftershocks

I listened to the initial reports of the devastation caused by the earthquake in Haiti while driving home from work Tuesday evening. Later, I tried to read the lead articles at the New York Times website. I had a great deal of trouble making it through the first several paragraphs. Even at the outset the carnage was too much to comprehend—50,000 to 70,000 feared dead in the worst earthquake to hit the country in 200 years.

 

Today I scanned photographs of bulldozers dropping dead bodies into dump trucks; piles of corpses lying in the streets; faces holding empty buckets up to be filled with fresh water; a bag of IV fluid hung from the branches of a tree infusing into the arm of a woman reclining on a mattress on the grass; faces of pain, faces of grief.  >>more

 

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life." 

Cuban Healthcare Invasion

On August 4, 2009 an interesting article appeared in the NY Times: "Doctors in Cubs Start over ihe U.S."   It  addresses the fact that while Cuban doctors have been fleeing to South Florida since Fidel Castro seized power in 1959 the pace intensified after 2006, when the Department of Homeland Security  began a program that allowed Cuban medical personnel “who study or work in a third country under the direction of the Cuban government” to travel to the United States legally. The program has effectively turned a crowning achievement of Cuba’s foreign policy on its head.

The bottom line is that Cuba may have more physicians than it needs, so it has to farm some of them out to countries in South and Central America, Africa and S.E. Asia.  ThisTimes article is well-worth reading.One of the protagonists is a physician (pictured here) who works as a nurse administrator in a hospice in Florida.  His salary is > $100,000 per year.  In Cuba it would have been ~ $300 per year.  The article raises many questions.

A Silent Epidemic

"Pregnancy and childbirth kill more than 536,000 women a year, more than half of them in Africa, according to the World Health Organization.

Most of the deaths are preventable, with basic obstetrical care. Tanzania, with roughly 13,000 deaths annually, has neither the best nor the worst record in Africa. Although it is politically stable, it is also one of the world’s poorest countries, suffering from almost every problem that contributes to high maternal death rates — shortages of doctors, nurses, drugs, equipment, roads and transportation."

This is an important article in the Sunday, May 24, 2009 NY Times.

It is a topic which Kim Gutschow covered in her course "Williams Reproduces" Spring 2009.  We will ask Kim and some of her students to comment. 

See post on obstetrical fistulae and also the fine documentary "A Walk to Beautiful." 

Photo from Radio Free Europe web site.

The Medical Duppy

Larry Zaroff relates the strange story of a Jamaican health clinic, the duppy that haunted it and some Western medical workers from the good ship, Hope..  To many in the Caribbean, duppies, jumbies and other creatures of the night are real.  Dan Tormey, a chaplain on the hospital ship, Hope, told this strange tale to Larry. 

The Medical Duppy: Download MEDICAL DUPPY

*Larry Zaroff, a frequent contributor to Cell 2 Soul, currently teaches medical humanities to premedical and medical students at Stanford. He has received awards as the outstanding faculty advisor for the Human Biology program and in 2006 was honored as Stanford's Teacher of the Year.  You may email him at: larryz.zaroff@gmail.com 

Photo Credit: johnstilgoe.co.uk . 

Himalayan Cataract Project

Drs. Sanduk Ruit and Geoff Tabin at a rural eye camp.

Jose Ruiz, Williams '10, has arranged an important presentation for Friday evening, April 10.

Lecture:  Light of the Himalaya

8:00 p.m., Weston 10 (if you need directions, please contact DJE)

Dr. Geoff Tabin is a Professor of Surgery and Ophthalmology at the University of Utah School of Medicine and Co-Director of the Himalayan Cataract Project. He was the fourth person to climb the "7 Summits," the highest point of all seven continents; and has pioneered difficult technical rock, ice, and mountaineering routes on all seven continents including the East Face of Mt. Everest. He is the author of "Blind Corners - Adventures on Everest and the World's Tallest Peaks." In 1994 he co-founded the Himalayan Cataract Project which strives to eradicate preventable and curable blindness in the Himalaya through high quality ophthalmic care, education, and establishment of a world-class eye-care infrastructure.

If you possibly can, try to attend this session.