By Jenny Eaton Dyer, PhD

Having just concluded teaching my annual course at Vanderbilt, Global Health Policy and Politics, I am inspired to write a blog series based on a session I teach regarding the “psychology of global health.” In that session, I have students read a chapter from Peter Singer’s The Life You Can Save. In this chapter, he outlines six reasons  for “Why We Don’t Give More” in terms of philanthropy.

In this blog series, I will write on both why you may OR may not care about global health, along these lines of Singer’s arguments, and I will offer reasons for both. I think this helps explicate our thinking and behavior when it comes to helping people in our global village. It may explain why you are drawn to a specific nonprofit to donate or why you could care less about advocacy, for example.

The first reason it is difficult for us, as humans, to care about global health issues is that it is overwhelming! We are MUCH more apt to give or participate if we focus on ONE single person. Studies show that if we can focus on ONE name, ONE face, and ONE story – we will donate or act far more than if we had the opportunity do the same amount of good for 1000 people. Or even just two. This is called focusing on the “identifiable victim.” We have the capacity to hone in on the one, but not the many. Not even more than one. 

Because a group of people can easily succumb to anonymity in our minds, we lose the emotional stamina and persistence it takes to altruistically donate or take action to save lives. “The many” overwhelms our emotional response system.

We need an image of just ONE person to sustain our interest long enough to feel a human connection, perhaps a transference, with their personal story. This is why child sponsorships are so successful, for instance.

Perhaps put more clearly, we have two systems of thinking. Our first system is emotional, intuitive, and reactive. This system allows us to give generously during an earthquake as we mourn the victims or come to aid quickly during a flood. This system responds immediately with an outpouring of altruism.

Our second system is analytical, logical, and deliberative. As we consider more deeply our actions, we tend to act less quickly and allow for strategy and pragmatism to prevail. 

Most non-profit organizations will attempt to elicit your emotional—system one--response  to a crisis. They want you to move quickly without much analysis.

When it comes to advocating for maternal and child health and the healthy timing and spacing of pregnancies, we instead are asking you to deliberate. To think along the lines of action at a global scale. We would like to ask you to engage system two for a thoughtful, long term stragey of prevention.

220 million women around the world don’t have access to family planning but want to avoid pregnancy, and 287,000 women lost their lives in childbirth last year. Moreover, 6.9 million children will die from preventable, treatable disease this year.

We challenge you to think strategically about these problems for a moment and to partner with us as we draw on years of research, on-the-ground experience, and cultural expertise.

Over the next several weeks we’ll discuss why you may or may not care about global health. We will review Singer’s work highlighting how futility, parochialism, the diffusion of responsibility, fairness, and money affect the good we could do for global health.

We will look at the flip side of that as well. We will discuss why global health is of utmost importance in terms of national security, foreign policy, economics/investments, public health, and humanitarian reasons.

In this age of increasing globalization—we are the generation that can feasibly achieve global health goals for millions. Far beyond our expectations.

We hope you will join us.

 

My name is Courtney Stanley and I am a senior at East Tennessee State University College of Public Health. I am currently earning my B.S. degree in Public Health with a concentration in Community and Behavioral Health. I was fortunate to have the opportunity to travel to Munsieville, South Africa, and complete my internship with The Thoughtful Path, along with my colleague and fellow student Sarakay Johnson.     

The first week of my internship with The Thoughtful Path has been tremendous, to say in the least. I have been able to experience and accomplish more in my first week here than I ever expected. The plane landed Thursday, September 6th at 3:00 pm, and by Friday morning Sarakay Johnson and I were walking through the informal settlements in Munsieville along with Betty Nkoana, the on-site director, and Abi Brooks. The informal settlements, or townships, are where the lower income families and the individuals who have not received any government housing live. The individuals residing in these settlements are at a great mental, physical and social risk. To be able to visit and actually go into these houses and talk to the families living there was amazing. It was overwhelming at first to experience such extreme poverty firsthand. Despite all the education and training I have received as a future public health professional, there was a moment of questioning what I would ever be able to do. Soon after this, however, the ideas started to flow. 

I especially began referring to concepts learned in the ESSENTIAL’S class I took over the summer. There are so many basic improvements that can be made that would have an immense effect. First off, is the issue of cooking with a paraffin stove. The possibility exists of creating a brick oven to be used for cooking, or using the bricks to create a stable surface for the paraffin stoves to be placed. There is a brick making site that has finished being constructed, so there is potential create a coalition between the individuals making the bricks and those that are working on home safety. Another issue that I feel needs to be addressed is access to a proper hand washing station. There are only a few pumps between the two different formal settlements that provide access to clean water. I believe the tippy-taps I learned how to make in the ESSENTIAL’S class would serve very well as an affordable and achievable solution.  

After we finished with the walkthrough, Sarakay, Betty and I had a meeting to discuss the projects that we would be working on over the course of our internship. They range from projects such as training adolescents and younger adults on how to educate young children in basic healthcare practices, to creating health education material to be available to everyone in Munsieville, and to creating home based, cost-efficient, nutritional gardens that we can train children to manage. There are several others that I will go into detail at a later time.

This first week Sarakay and I have also been assisting Yi He, a doctorial candidate also from ETSU, with the data capturing project started during his time here.  There was a slight confusion with how the surveys were being recorded. After working with Yi and the surveying team however, we were able to get everything corrected. 

Another rather large and slightly unexpected project that I have worked on this week was a health fair conducted in Mshenguville. Mshenguville is one of the more disadvantaged informal settlements in Munsieville. So, The Thoughtful Path decided to go to Mshenguville and conduct a health fair for the population residing there. Betty requested that Sarakay and I create suitable health information and conduct a health class at the fair.  After meeting with the Health Promotion Unit, we decided to focus on hand washing and oral hygiene for younger children. We created interesting and informational posters that would attract the children’s’ attention. To make it fun and interactive we purchased the supplies for hand washing and had the children create their handprint a piece of paper, then showed them how to properly wash their hands afterwards. We also held small tooth brushing classes intermittently throughout the day. After the children completed the class we awarded them with a gold star. That way when the other children saw the stars they would also want to participate in the class. Another volunteer translated a rhyme while Sarakay and I demonstrated the proper technique, then we had the children repeat it with us. After the children completed the class we awarded them with a gold star. That way when the other children saw the stars they would also want to participate in the class.

The rest of the time, we have been assisting in preparing for the visiting board members of Project Hope UK, Project Hope U.S., and other various partners of The Thoughtful Path.  This was an absolutely amazing experience. We had the opportunity to meet with many influential people within these organizations. I was able to have a discussion concerning the concentration paper and various projects I will be completing with Bradley Wilson, the chairman of Project Hope UK.  It was wonderful to be able to hear the opinion of someone who has so much experience with Project Hope. Also, I attended a leadership lecture conducted by Dame Amelia Fawcett, a board member of Project Hope UK. 

Needless to say, my first week of my internship with The Thoughtful Path has been teeming in extraordinary experiences.  I know that this trend will only continue for the next ten weeks and I cannot wait to continue to develop and demonstrate my public health knowledge with such a wonderful organization.      

Sometimes the most difficult parts of a job produce the situations you learn the most from. Often doctors will remember their most challenging patients for the rest of their lives and rarely forget what they’ve learned through those interactions. Working at Georgetown public hospital has afforded me a wealth of opportunities such as these in my short time here. 

Near the end of a shift one day I saw a patient with chest pain—a thin, uncomfortable-appearing woman in her 50s. When asked where her pain was she did the classic motion of waving her hand over her entire chest and abdomen, attempting to help me pinpoint where she was hurting. I started with x rays, an ecg, and blood tests but unfortunately these would take quite a long time during this busy day. Hoping for faster results, I looked for the ultrasound machine to assist in my work up. After a long search and a battle to keep the battery on, we had it at the bedside. Looking at her heart, lungs, kidneys, liver, and great vessels with the ultrasound machine gave me a wealth of information. I could see she had fluid around her heart and one of her lungs. That provided me a clear start that ended up guiding much of my treatment for her. Although getting the ultrasound, using the machine, interpreting the US (no Radiology to help interpret the scans) were all much more difficult than doing the same would have been in the United States, I can honestly say I learned even more from the process than I would have in my home institution. The difficulty in getting the machine caused me to use it as a precious resource, getting every possible use out of it that I could for that patient. Not having Radiology back up or easily obtainable diagnostic tests caused me to fully scrutinize every image, think outside the box, focus on physical exam clues, and test my confidence in my own ability to obtain and interpret ultrasound findings. On top of all that, I got to teach a group of residents and nurses aspects and uses of ultrasound that they had never seen before. The experience highlighted learning opportunities I take for granted working in the United States and helped me develop my own diagnostic abilities.     

Apr 09 2014

Technology and Poverty

Contraception in Ethopia

Today, I am speaking at the Information and Communications Technology for Development and Faith (ICT4DF) Network Conference preceding the Infopoverty World Conference hosted at the United Nations this week. This conference focuses on the interface of technology and the alleviation of poverty in the developing world. In particular, my session hosts a number global health experts speaking to this issue from a faith-based perspective. Questions include: (1) How do ICT4DF tools maximize results in empowering global missions outreach and sustainable development; and (2) how can we transform traditional organizational paradigms from charity-based missions to maximum impact for developing communities. 

I speak at the Church Center for the United Nations on the new technologies of family planning or Health Spacing and Timing of Pregnancies (HTSP). I will discuss the issues and facts around maternal, newborn, and child health as well as HTSP.  In doing so, I will highlight Ethiopia as a strong example of increased contraception prevalence. Moreover, I will share the newer implant, Jadelle, as a contraceptive option available for Ethiopian women who wish to avoid pregnancies for up to five years. These kinds of technological advances in reversible contraception will save lives, keep girls in school, and increase economic stability—for families and for the nation.

Roman Tesfaye quote

 

We are taught during medical training to be very cautious and to only proceed with decisions and procedures when we are well prepared. Putting in a breathing tube, for example, when a patient is having difficulty breathing or has lost consciousness, is a procedure that can be done with just a few simple pieces of equipment. But in an attempt to ensure success, we bring in advanced tools for back up, cameras to get a better look down the throat, smaller tubes in case the size we have chosen doesn’t fit. Once we are prepared for anything, we are ready. But in many places around the world, including Georgetown Public Hospital in Guyana, those backups are simply not available.

In so many ways the Guyanese healthcare providers have used their limited resources not as an excuse to give up but as an education in how to efficiently and effectively work with what you have. Although the Accident and Emergency Department has less than 20 beds and staffs only a handful of nurses and doctors, they are able to see over 70,000 patients a year, what would be a sizable number for any large tertiary care hospital in the United States. Hallways are lined with chairs for patients who are healthy enough to sit up and often patients walk themselves to the lab to have blood work done or X-ray for their imaging. While working in the A&E one day I saw a 21-day-old baby with a large infected abscess on his arm. The mother brought the child to my chair where I was doing initial evaluations, after seeing the infection we set the baby on a nearby stretcher, cleaned the area and sprayed it with an anesthetic, used a scalpel blade to drain the infection and wrapped the arm back up. We gave the infant some antibiotics and had them go back out into the waiting room until there was a bed available in the Nursery. Neither the staff working with me nor the mother was bothered by our inability to get blood cultures, the lack of a crib or incision and drainage kit, or the fact that they had to wait outside the A&E for a bed. Everyone was just glad this was a child we could clearly help, as opposed to the unfortunately numerous cases where the patients are too sick to turn around.

At times I would find myself frustrated by the lack of certain simple but effective drugs, easily available CT scanners or even ventilators. But then a coworker would teach me about how they have found older, cheaper drugs that works, they use X-rays instead of CTs, and they ventilate the patients by hand. It’s not ideal, but for the most part it works. It’s refreshing to watch the innovative ways resources are used and how nothing is wasted. Even in the sometimes harsh environment of Guyana, the people have remained quickly adaptable to their changing world, generous, and extremely thankful. It is a fantastic privilege to work with them.  

While working in the Accident & Emergency Department in Georgetown, Guyana, I noticed one thing that was very different from what I’m used to back in Nashville: few to no ambulance arrivals. That is because there is essentially no EMS system in Guyana.

There are a few ambulances that are a part of the hospital system. These are used mainly for transport between outlying hospitals and GPHC, where I was working. They are also used to transport patients in our hospital to the CT scanner, located in another building, or to transport laboring mothers from the L&D ward to the main hospital, where the operating rooms are located. When used for transport from an outlying facility, they are staffed with a driver, sometimes a nurse, and an “attendant”, who might be able to assist the nurse. In addition, multiple family members will usually ride with the patient.

I happened to glance in the back of one of these ambulances to see what sort of equipment they carry. Not much, I found out. There is room for a stretcher along one wall, and along the other wall is a long bench for other passengers. There was an oxygen tank under the stretcher, although I could not tell how much, if any, oxygen was present. Having worked in EMS, I am used to seeing a bag full of airway equipment, some suction equipment, and some basic medications and IV start supplies; none of this was present on this ambulance.

While working in the A&E I received a few patients who had been transferred via this ambulance service. Occasionally, they came with a nurse who could give a patient report, as well as some papers with labwork and a history, but often we had little to no information about these patients. Notably, I never treated a patient brought in by an EMS crew from any sort of scene (i.e. an automobile accident or a medical emergency from home). Guyana does have a 911 equivalent for calling for an ambulance, but this number is not staffed at all times. Even when you can get through to someone, there is no telling how long it will be before an ambulance is available to pick you up, or what sort of personnel and equipment will come with it.  Most people who are the victims of some sort of trauma will either take a taxi or have a family member drive them to the hospital.

The problems with this are many. First, for trauma patients, there is no spinal immobilization. There are occasional attempts to stop bleeding by family members or bystanders, but often these were unsuccessful. At home, our fully trained paramedics will often pick up a patient with heart failure and severe respiratory distress and by providing treatment in the field and in the ambulance will have them almost asymptomatic by the time they arrive in the Emergency Department.

As an Emergency Physician and former EMT, I have read about the start of EMS in my country, when there was little to no actual medical care provided and was more just transportation. I was continually reminded of that while in Guyana.

The week I left, the Rotary Club had returned for the second part of a series of paramedic classes for the nurses in the hospital. While I think it is wonderful to provide this additional training, there is still much do be done in terms of infrastructure to create a functional, though needed, EMS system. More ambulances will need to be obtained, and a minimal level of equipment will need to be stocked and maintained on the ambulances. There must be a more cohesive system for dispatching the ambulances, as well as some sort of base at which the ambulance and crew is quartered. There will also need to be qualified personnel to work on the ambulances.

There is tremendous potential in creating a transport system that can respond to emergencies, provide some minimal, life saving care, transport patients to the hospital rapidly, and communicate with the receiving hospital to give basic patient information and acuity, particularly for the trauma population.

It took a while for me to realize how spoiled I am back at my home hospital, as compared to GPHC. Of course I immediately realized that that had different medications, fewer medications, and access to fewer labs and imaging tests, but I had expected and was prepared for most of that. But then one day it hit me: individually wrapped alcohol prep pads. There are at least a hundred of them in every patient room back home. In my haste to grab one, I probably drop about 3 on the floor and never pick them up.  They don’t exist at GPHC. Here, there is a large container of cotton (like a giant cotton ball), over which someone pours alcohol and then you pull off a piece of cotton.

Ashley Brown baby

After that, I began to notice more and more how spoiled I had been. One patient had accidentally ingested a bit of formalin. What would have been a 5 minute call to the poison center became over an hour of research and calculations to figure out if she had ingested a lethal amount. A 6-year-old child with an unrepaired congenital heart lesion arrived cyanotic (blue), with dangerously low oxygen levels. Though I had just given the residents a lecture on the topic a week prior, this was the first patient I had actually seen with the condition, as most patients in the US with this lesion have had it repaired very early in life. We gave the appropriate treatment within the bounds of available medications, but what I really wanted was a conversation with a pediatric cardiologist.

I will come home appreciating all of these experiences when I had to figure it out on my own, and I think I am a better physician because of it. Now, though, I have a new appreciation for the vast resources that are just a phone call away.

Mar 28 2014 - Mar 29 2014

The Economic Benefit of Contraception

There are currently 222 million women worldwide who want access to modern contraception but don't have any way to get it. We know that the healthy timing and spacing of pregnancy can improve the health of both mother and child, but did you realize there was a significant economic benefit to making contraception accessible to women living in extreme poverty? This short video by Population Action International summarizes the economic benefits beautifully.

My first week back in Guyana began with the third annual Crash Course in Emergency Medicine. A couple of years ago, Vanderbilt began an Emergency Medicine Residency Training program at Georgetown Public Hospital Corporation (GPHC). With every new class of residents, we put on a “Crash Course,” an intensive four-day lecture series, so that all the new residents can get some intensive training on common emergencies, and all the older residents get an intensive review.

This time, we welcomed our third class of residents. First things first, though—tests for the senior residents! The very first day, we got up early to put all of our upper level residents through an entire day of in-service exams. They had a written test all morning, oral exams, and then an individual simulation case. For the simulation scenario, I was the “nurse” assisting the examinee. It’s a fun position to be in because I get to provide helpful hints if they’re going down the wrong path, or make the case more challenging for the more advanced residents who were knocking it out of the park.

FGHL Ashley Brown Chalkboard

The next day we got up bright and early to begin the crash course. For this four-day session, the new class of residents joined us as well. I participated in the crash course last year, and it was great to see how much the upper level residents had grown, both in knowledge and confidence. I got to lecture on some favorite topics of mine and listen to some great lectures by Vanderbilt faculty as well. One of the most encouraging parts of crash course was the return of faculty from the University of the West Indies in Trinidad. Dr. Joanne Paul, a Pediatric Emergency Physician, returned again to crash course to lecture, along with Dr. Georgia Baird, an Emergency Physician. They both also lectured for a CME course over the weekend that was open to the community. During their visit, they were also able to network with our residents to discuss the role of Emergency Medicine throughout the Caribbean. Our residents are in uncharted territory in Guyana; in fact, Emergency Medicine is a relatively new field throughout the Caribbean. Dr. Paul and Dr. Baird helped to give the residents some insights about how to make the field more recognized and accepted, and how they might begin and organize specialty groups.

FGHL Ashley Brown students

After four days of around 8 hours of lectures daily, we went as a group to tour a local sugar factory (although I think most of the residents were so tired at that point they probably would rather have taken a nap!). It was great to have that time to get to know the new residents I would be working with in the coming weeks, and to see them immediately welcomed as part of the group. Now that we had given them a foundation, it was time to get back to work in the A&E!

Anyone you talk to will tell you that they care about mothers and babies. But many people here in the United States don't realize that a mother dies somewhere in the world every two minutes. Every two minutes. The data is staggering.

Our hope is to make sure Christians don't let that overwhelming statistic leave them feeling overhwelmed to the point that they fail to act. Because the connection between maternal health and faith is so important.

We recently discovered this Q&A article with Courtney Fowler, a conference lay leader in the United Methodist Church, who connects the dots between maternal health, faith, and reproductive justice. It's a great resource for those who are starting to dip their toes in this issue of women's health and who passionately care about the lives of women all over the world, because you believe God cares about them too.