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The Case for Strengthening Laboratory Medicine in Africa
Infectious disease is the most common cause of illness and death in Africa, yet health practitioners routinely fail to identify causative microorganisms in most patients. As a result, patients often do not receive the right medicine in time to cure them promptly even when such medicine is available, outbreaks are larger and more devastating than they should be, and the impact of control interventions is difficult to measure. Wrong prescriptions and prolonged infections amount to needless costs for patients and for health systems. In Divining without Seeds, Iruka N. Okeke forcefully argues that laboratory diagnostics are essential to the effective practice of medicine in Africa.
The diversity of endemic life-threatening infections and limited public health resources in tropical Africa make the need for basic laboratory diagnostic support even more acute than in other parts of the world. This book gathers compelling case studies of inadequate diagnoses of diseases ranging from fevers-including malaria-to respiratory infections and sexually transmitted diseases. The inherited and widely prevalent health clinic model, which excludes or diminishes the hospital laboratory, is flawed, to often devastating effect. Fortunately, there are new technologies that make it possible to inexpensively implement testing at the primary care level. Divining without Seeds makes clear that routine use of appropriate diagnostic support should be part of every drug delivery plan in Africa and that diagnostic development should be given high priority.
Restoring Humanism to Medicine through Student Community Service
Today's physicians are medical scientists, drilled in the basics of physiology, anatomy, genetics, and chemistry. They learn how to crunch data, interpret scans, and see the human form as a set of separate organs and systems in some stage of disease. Missing from their training is a holistic portrait of the patient as a person and as a member of a community. Yet a humanistic passion and desire to help people often are the attributes that compel a student toward a career in medicine. So what happens along the way to tarnish that idealism? Can a new approach to medical education make a difference? Doctors Serving People is just such a prescriptive. While a professor at Rush Medical College in Chicago, Edward J. Eckenfels helped initiate and direct a student-driven program in which student doctors worked in the poor, urban communities during medical school, voluntarily and without academic credit. In addition to their core curriculum and clinical rotations, students served the social and health needs of diverse and disadvantaged populations. Now more than ten years old, the program serves as an example for other medical schools throughout the country. Its story provides a working model of how to reform medical education in America.
Humanitarian Quests, Impossible Dreams
Médecins Sans Frontières / Doctors Without Borders (MSF) is a private international medical humanitarian organization that was created by a small group of French doctors and journalists in 1971. In 1988, MSF was awarded the Nobel Prize for Peace in recognition of the worldwide assistance it provides for people in distress who are victims of manmade and natural disasters and armed conflict. Committed to the principles of neutrality, impartiality, and independence, the men and women of MSF bear witness by speaking out about conditions of extreme need and suffering, acts of violence against individuals or groups, and threats or hindrances to medical care that they observe in the course of carrying out their work. Renée C. Fox is a sociologist known particularly for her pioneering work in medical sociology and for her ethnographic research and writing. Doctors Without Borders is based on the first-hand research she conducted about and within MSF since 1993. Its vivid, “thickly descriptive” data are derived from her participant observation, in-depth interviewing, and collection of primary and secondary documents in numerous MSF contexts. The book begins on the ground with the blogs of women and men of MSF in the field, recounting their experiences in moving detail. From there it chronicles MSF’s early history and development, paying special attention to its inner struggles, during the first decades of its existence, to clarify and implement its principles and to more fully realize its “without borders” transnational vision. Detailed case studies form the core of the book, describing MSF in postapartheid South Africa, dealing with that nation’s rampant epidemic of HIV/AIDS, and MSF in postsocialist Russia, responding to the thousands of homeless persons on the streets of Moscow and to the massive epidemic of tuberculosis in the penal colonies of Siberia. The book ends with an account of the fortieth anniversary meeting of MSF in Paris and with the author’s exit from the field. Doctor Without Borders tells a narrative enriched by photographs of MSF missions and by ironic, self-critical cartoons drawn by a member of the Communications Department of MSF France.
Memoirs of a Nurse Practitioner
The Tobacco Syndemic in Oceania
Tobacco kills five million people every year and that number is expected to double by the year 2020. Despite its enormous toll on human health, tobacco has been largely neglected by anthropologists. Drinking Smoke combines an exhaustive search of historical materials on the introduction and spread of tobacco in the Pacific with extensive anthropological accounts of the ways Islanders have incorporated this substance into their lives. The author uses a relatively new concept called a syndemic—the synergistic interaction of two or more afflictions contributing to a greater burden of disease in a population—to focus at once on the health of a community, political and economic structures, and the wider physical and social environment and ultimately provide an in-depth analysis of smoking’s negative health impact in Oceania.
In Drinking Smoke the idea of a syndemic is applied to the current health crisis in the Pacific, where the number of deaths from coronary heart disease, cancer, diabetes, and chronic obstructive pulmonary disease continues to rise, and the case is made that smoking tobacco in the form of industrially manufactured cigarettes is the keystone of the contemporary syndemic in Oceania. The author shows how tobacco consumption (particularly cigarette smoking after World War II) has become the central interstitial element of a syndemic that produces most of the morbidity and mortality Pacific Islanders suffer. This syndemic is made up of a bundle of diseases and conditions, a set of historical circumstances and events, and social and health inequities most easily summed up as “poverty.” He calls this the tobacco syndemic and argues that smoking is the crucial behavior—the “glue”—holding all of these diseases and conditions together.
Drinking Smoke is the first book-length examination of the damaging tobacco syndemic in a specific world region. It is a must-read for scholars and students of anthropology, Pacific studies, history, and economic globalization, as well as for public health practitioners and those working in allied health fields. More broadly the book will appeal to anyone concerned with disease interaction, the social context of disease production, and the full health consequences of the global promotional efforts of Big Tobacco.
Mac Marshall is emeritus professor of anthropology and community and behavioral health at the University of Iowa.
Des experts analysent les divers aspects de la santé dans l'espace public et privé en s'appuyant sur une approche multidisciplinaire qui laisse une grande place aux aspects psychologiques et sociaux de la santé dans différentes populations. Ils y discutent également de la représentation des médicaments, de leurs usages et de leurs répercussions sur la santé.
Disasters, both natural and manufactured, provide ample opportunities for official coercion. Authorities may enact quarantines, force evacuations, and commandeer people and supplies—all in the name of the public’s health. When might such extreme actions be justified, and how does a democratic society ensure that public officials exercise care and forethought to avoid running roughshod over human rights? In The Ethics of Coercion in Mass Casualty Medicine, Griffin Trotter explores these fundamental questions with skepticism, debunking myths in pursuit of an elusive ethical balance between individual liberties and public security. Through real-life and hypothetical case studies, Trotter discusses when forced compliance is justified and when it is not, how legitimate force should be exercised and implemented, and what societies can do to protect themselves against excessive coercion. The guidelines that emerge are both practical and practicable. Drawing on core concepts from bioethics, political philosophy, public health, sociology, and medicine, this timely book lays the groundwork for a new vision of official disaster response based on preventing and minimizing the need for coercive action.
Au primaire, au secondaire, au collégial et à l’université, des gens engagés dans l’éducation à la santé ont développé des outils, imaginé des méthodes et exploré des pistes pour contribuer, selon leurs moyens, à l’éducation à la santé en milieu scolaire. Cet ouvrage collectif, qui présente leurs projets, leurs recherches et leurs réflexions, démontre l’importance de faire participer parents, élèves, personnel enseignant et non enseignant, et autres acteurs des milieux communautaire et de la santé publique. Les intervenants des milieux scolaires de tous les ordres d’enseignement y trouveront des ressources et des références pour alimenter leurs réflexions et, surtout, pour soutenir leurs actions.
Collected Works of Florence Nightingale, Volume 6
This sixth volume in the Collected Works of Florence Nightingale reports Nightingale’s considerable accomplishments in the development of a public health care system based on health promotion and disease prevention. It follows directly from her understanding of social science and broader social reform activities, which were related in Society and Politics (Volume 5). Public Health Care includes a critical edition of Notes on Nursing for the Labouring Classes, papers on mortality in aboriginal schools and hospitals, and on rural health. It reports much unknown material on Nightingale’s signal contribution of bringing professional nursing into the dreaded workhouse infirmaries. This collection presents letters and notes on a wide range of issues from specific diseases to germ theory, and relates some of her own extensive work as a nurse practitioner, which included organizing referrals to doctors and providing related care.
Currently, Volumes 1 to 11 are available in e-book version by subscription or from university and college libraries through the following vendors: Canadian Electronic Library, Ebrary, MyiLibrary, and Netlibrary.
Local Responses to Health Care Needs
In community after community, pro bono and student-run health clinics have sprung up over the past 30 years, providing critically needed care to medically underserved populations. Free Clinics is a mosaic formed by accounts of such clinics around the United States. These wide-ranging narratives—from urban to rural, from primary care to behavioral health care—provide examples that will assist other communities seeking to find the model that best fits their needs. The Patient Protection and Affordable Care Act has improved access to health care for many Americans, but millions remain and will remain uninsured or underinsured. Free clinics provide non-emergency care to those in need. Nationwide, professionals can be found offering volunteer services at these clinics. Contributors to this volume—typically people with personal familiarity (as clinicians or area residents) with the clinics they write about—cover a variety of topics, including a review of the literature, data-driven accounts of clinic usage, and ethical guidelines for student-run clinics. They describe the motivations of clinic staff, the day-to-day work of a family nurse practitioner working in clinics and teaching at a university, the challenges and rewards of providing health care for homeless people, and more. Student-run clinics are the topic of the second section: in addition to providing care to a small subset of those in need, student-run clinics are an important venue for training future clinicians and helping the seeds of altruism with which many enter their professions to germinate. Free Clinics will be useful to policymakers, students and faculty in public health and health policy programs, and clinicians and students who are embarking on launching new clinics.