Archive for October, 2008

Thing with No Name: HIV/AIDS in South Africa

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Sarah Friedland, a filmmaker and friend who has collaborated with us in producing documentaries about health activists, is currently on tour with Thing with no Name, a film she directed about HIV in South Africa. Its next showing will be at the Starz Denver Film Festival from November 13 to 19,2008.

The film, shot in the summer of 2006, traces two Zulu women with AIDS as they begin treatment with anti-retroviral medications.  The following You Tube clip gives a sense of the issues raised by the movie as well as its visual beauty and quiet flow.

Here is their description of the film:

Thing With No Name, a feature-length documentary, is an intimate portrait that follows two women with full-blown AIDS in rural South Africa as they try to access treatment through the public sector. The film takes the viewer to Okhahlamba, a traditional Zulu area nestled in the shadow of the Drakensburg Mountains, a stunning UNESCO World Heritage Site. Filmmakers Sarah Friedland and Esy Casey were introduced to this community by one of its members, their friend and Ground Producer Phumzile Ndlovu.

Through this connection, the filmmakers were able to integrate into the families with ease, participating in the daily activities of people living with the illness, and sharing in their moments of pain, joy, and humor.

This film is a portrait of two families, and more specifically, two individuals: Danisile Mvula and Ntombeleni Mlangeni. The film opens with both women describing their history and understanding of HIV/AIDS. From there, it takes the viewer through both womens’ experiences as they initiate treatment. Danisile responds well to the medications that she is now committed to for the rest of her life; she creates nicknames to help her remember the different pills, and goes over the protocol with her family and her homebased caregiver, a volunteer nurse. Ntombeleni does not respond as positively, losing all strength. Unable to walk, she is carried home from the hospital on her sister-in-law’s back. She becomes delirious, refusing to take the medicine, but gradually adjusts to it, and there is a brief moment of calm as both women begin their new reality. At this stage, other aspects of Ntombeleni and Danisile’s lives are explored: Danisile’s strained relationship with her teenage daughter, and the traditional Zulu ceremonies that Ntombeleni’s family
holds to combat her illness in their own way.

The filmmakers have also produced a production blog recounting the story of the movie’s creation and current distribution.  For an interview with Sarah Friedland, see Indiewire.

posted by Matt Anderson, MD

Snapshots of Health Care Activism, October 2008

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There has been a flurry of activity around the country recently in support of health justice.  It is almost as if the silence on the part of the official US media and the official US political parties has caused an outpouring of grass roots voices.  Here is some of what is going on:

The Women’s Economic Agenda Project has been holding truth commissions to discuss the impact of poverty on Americans.  They are designed “to expose the truth when powerful forces would rather keep it hidden.” “WEAP uses this format with its international origins in order to show how poverty violates internationally sanctioned human rights standards.  When used in this way, truth commissions demonstrate the growing gap between wealth and poverty in America and the urgent necessity to take action now to address this injustice.” Following this strategy WEAP has advocated for health as a human right and the denial of health care as a human rights violation.  You can see testimony from a WEAP truth commission on health at this You-Tube link.  Their site also contains a useful toolkit for developing the concept of health as a human right.

The California Nurse’s Association has established a fiesty website under the banner: “We don’t need insurance. We need guaranteed healthcare.” On the site they document cases of people – with health insurance – who are denied care.  On their blog, these stories are mixed with accounts of RN activism in support of a single payer system for the United States.

On a somewhat tamer note, October 23 & 24th saw a National Summit of Clinicians for Healthcare Justice in Washington, DC.  This was a one time meeting of all the healthcare safety net programs, including; community healthcare centers, migrant health, and healthcare for the homeless programs.   The conference heard from several Surgeon Generals, engaged in lobbying and held a vigil on Capitol Hill.

The Summit’s platform was based on several principles, several of which are “radical” in the US political context:

  • Everyone must have ready access to health care, regardless of any individual’s ability to pay for services.
  • Health care services must be of equal quality for everyone, regardless of anyone’s economic circumstances.
  • The burden of paying for health care should be borne by society broadly.
  • Market forces and private interests cannot be allowed to restrict service access to disenfranchised and marginalized groups.
  • Individuals must be able to choose their health care providers.
  • The primary health care work force must be dramatically expanded to provide care for everyone.
  • Health care providers and consumers must be accountable for efficient operation of health care systems and effective utilization of health care resources.

posted by Matt Anderson

Global Health Watch 2: Forging a Progressive Global Health Agenda

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Last week saw the release of the second Global Health Watch report, created as an alternative to the WHO’s World Health Report. It is an initiative coordinated by the People’s Health Movement, the Global Equity Gauge Alliance and Medact with input from 80 organisations and more than 130 individuals. It presents a progressive agenda for global health. A sixteen page overview of the report can be downloaded here.

The Global Health Watch is important for several reasons.  First, it provides a radical critique of the existing model of “global health” which is dominated by neoliberalism and a subservience to corporate interests.  Secondly, it is a truly international critique which draws on the resources and experiences of academics, activists, and social movements throughout the world. This is a report born with a democratic spirit.  Finally, in this international call to realize the vision of Alma Ata, we are reminded that another world is possible.  Indeed, the very creation of the report shows us that there is a broad movement to create that other world.  This is good news.

From the Press Release:

Alternative world health report calls for radical change

Civil society organizations and scientists from around the world are calling for ‘a new development paradigm’ to address the toxic combination of climate change, growing poverty and inequality and poor health.

The new report, Global Health Watch 2, says that unfair social and economic policies combined with bad politics are to blame for the poor state of the health of millions of people in the world.  The report makes stinging criticisms of key global actors, including the World Health Organization, the World Bank and the Gates Foundation. The report calls on governments to stop the Bank from meddling in health politics.

Global Health Watch 2 provides examples of civil society mobilization across the world for more equitable health care and more health promotion, although more is needed to bring about significant improvements in health.

The report reveals widespread unease about the immense but unaccountable power and influence of the Gates Foundation.  It says that although the Gates Foundation has injected vast sums of money into global health, it operates in an undemocratic way and reinforces a medical-technical approach.

Among other issues it highlights is the pressure exerted on the World Health Organization by powerful and vested interests that would prefer WHO’s activities and programme to have a more biomedical and less political focus.

The first edition of Global Health Watch, published in 2005, was hailed for its ground-breaking analysis and mobilising call to action.

Marion Birch, director of the London-based charity, Medact:

“Priorities set by the rich world damage the health of people thousands of miles away.  Funding for water and sanitation is falling while slum-dwellers in Lagos pay up to 40 times as much for water as residents in downtown New York. Oil extraction in the Niger Delta generates billions of dollars of revenue but local communities lack basic health care.”

Amit Sengupta of the People’s Health Movement in India:

“The World Bank’s job is to help transfer resources from richer to poor countries and it should act accordingly. Its impact on the health systems of poor countries has been largely negative.  Internationally, it has also contributed to the uncoordinated circus of health sector policy-making that makes it difficult for Ministries of Health to function”.

Martin Drewry, director of the charity Health Unlimited:

“The majority world does not want charity – it wants a fairer political and economic system. It needs fewer billionaires; not more. While it is great that Bill Gates is willing to donate his money towards improving health in Africa, he would do far better campaigning for more effective tax systems both nationally and internationally”.

Posted by Matt Anderson

Junot Diaz Benefit for Columbia Medical Student Free Clinc: Nov 7, 2008

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As a follow up to our October 8, 2008 posting on free and low-cost health care in New York City, our friends at Columbia Medical School sent us an announcement about Columbia Student Medical Outreach (CoSMO), a free clinic in operation since 2004.  Their website is http://www.cosmoprimarycare.org.

The clinic operates on Saturday mornings in the UrgiCare Center, located on the corner of 166th Street and Audubon Ave in the northern tip of Manhattan.  Patients who are interested in more information can obtain details on their website.

Junot Diaz, the Pulitzer Prize-winning author of The Brief Wondrous Life of Oscar Wao, will be joining CoSMO for a book reading and conversation on Friday, November 7th at 7:30pm.  All proceeds from the reading will go toward prescription medications for CoSMO’s uninsured patients.

The night will also include free appetizers provided by Mamajuana restaurant, old school hip-hop sounds by DJ Strike (former tour DJ of De La Soul), and visual arts by the Sound of Art collective.

The fine print:

Junot Diaz: A Reading, A Conversation
Friday, November 7th at 7:30pm
Alumni Auditorium
William Black Research Building
650 W. 168th Street
New York, NY 10032
Tickets sold online: https://www.ovationtix.com/trs/pe/769922
$15 general, $10 with student ID

Some of The Brief Wondrous Life of Oscar Wao was originally published as a short story in the New Yorker Magazine.  You can also hear Junot Diaz read excerpts from the book online.

Posted by Matt Anderson

Justice is Healing: Community Health Organizing in the Southeast Asian Community in the Bronx

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Event Organizers: Chhaya Chhoum , Joyce Wong, and Ousara Phok

On Friday, September 19, 2008 we had the opportunity to attend a community health forum organized by the Southeast Asian community of the North West Bronx. The forum, entitled “Justice is Healing,” was the work of a local community group, the Youth Leadership Project (YLP).

The setting for the forum was the beautiful new Bronx Library Center off of Fordham Road. In a large meeting space below the entrance, mothers tended to noisy toddlers and infants in strollers. Hot Cambodian and Vietnamese food was served on long tables alongside literature about various immigration related campaigns. Inside the Library’s auditorium some 200 participants listened to a full evening’s worth of speakers. Most were southeast Asian immigrants from community. However, it was heartening to see faces of all complexions amongst the public. The presentations were translated into three languages: Khmer, Vietnamese, and English. Despite this often laborious process interest remained high throughout the 3 hour program and people left energized.

YLP, established in 1996 by the CAAAV: Organizing Asian Communities (aka the Committee Against Anti-Asian Violence), has been working for several years to address the needs of several thousand primarily Vietnamese and Cambodian refugees. (See our posting on Agent Orange.) These refugees were settled in our part of the Bronx is the early 1980’s. Many had suffered tremendous losses in their home countries. In some cases, their entire family had been killed. They had spent years living in refugee camps. Now they found themselves in some of the most troubled areas of the Bronx, not speaking English (or Spanish!) and with limited social services. Many suffered from post-traumatic stress disorder, a problem aggravated by neighborhood violence. In one, very public case, a young Cambodian, Kim Hong Tim, was murdered as he drove his taxi in the spring of 2000.

Local organizations reached out to help. The Montefiore Family Health Center – a federally funded Community Health Center – established an Indochinese Mental Health Program in collaboration with the Montefiore Department of Psychiatry. This Program became a lifeline for many patients. Providing much more than simply mental health, workers in the program coordinated care with the clinic’s physicians and hooked people into community resources. CAAV organized the YLP to address the damage caused by “welfare reform” in the mid-90’s. As part of this effort, YLP produced a film – Eating Welfare – which chronicles the situation in the community at the time.

Over the past two years, YLP has partnered with the NYU Center for the Study of Asian American Health to examine the health problems of local South East Asians. In 2007 YLP interviewed and surveyed 150 residents, asking them about their major health problems and their concerns regarding health care. The results of this survey can be found at the following sites:

Cambodian Community: http://www.med.nyu.edu/csaah/research/ethnic.html#cambodian_chnra
Vietnamese Community: http://www.med.nyu.edu/csaah/research/ethnic.html#vietnamese_chnra

As a result of this survey YLP made five key recommendations:

1. Improved language access and translation services.

2. Availability of complementary and alternative treatments.

3. Outreach and education programs linking trauma and diabetes.

4. Workforce development (i.e. hiring and training of southeast Asian community members).

5. Integration of health and social services

Many community members spoke at the event, detailing their experiences with healthcare in the Bronx. A common theme was difficulties with translation. In some cases children were used as translators. This is highly problematic because children should not be involved in certain health care discussions. Children may not know their parent’s language sufficiently well to function as medical translators. Using phone translators is also problematic because they are often not skilled in specific medical terms nor do they know the context of a conversation.

In the long term, the YLP would like to see a comprehensive war survivors clinic, a resource that would be of value to many communities in the Bronx. The demands of the YLP are very much in agreement with the vision of community health. The responsibility of health professionals extends beyond simply treating disease when it shows up in the office. The job of a community health center is to reach out to the surrounding community and particularly to the most vulnerable parts of the community. It addresses not just medical problems but also the multiple social and health issues of its community.

For additional coverage of this event, see the 10/2/2008 article in the Norwood News by Rebecca Chao. You can also listen to a radio report entitled Welcome to the Health Forum made by Radio Rootz.

Social Medicine Building Bridges @ the APHA Annual Meeting 10/27/2008

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The theme of the 2008 annual meeting of the American Public Health Association (APHA) is “Public Health without Borders.”  We are very pleased that the APHA Medical Care Section has chosen to sponsor a session examining how social medicine can help build bridges between progressive health movements in  North America and Latin America.  We reprint below the abstract from the conference program which contains links to individual presentations.  We are told this is the first time in the history of the APHA that abstracts have been printed in more than one language.

Medicina Social and Social Medicine:

A Framework for Bridging Borders

Monday, October 27, 2008: 2:30 PM

The APHA Medical Care Section founders viewed social medicine as a model for bridging the divide between clinical care and public health. This session explores how social medicine can serve as a framework for collaboration between medicine and public health and between North and South. In a 2006 article discussing the future of social medicine, historian Dorothy Porter pointed to the need to integrate “the historical wisdom acquired during the evolution of the discipline into a new framework … for understanding the complex interaction of biology with the political, economic, social, and cultural relations of the twenty-first century.” In accomplish this integration Dr. Porter proposed cooperation between the Anglo-American social medicine tradition and that of Latin American social medicine (LASM). Concomitantly, the Department of Family and Social Medicine at Montefiore Medical Center initiated a unique partnership with the Latin American Social Medicine Association (ALAMES) creating a bilingual, open-access, online journal (Social Medicine/Medicina Social) utilizing the Open Journal System (Simon Frazier University). This session will discuss key papers published in the journal and explore possibilities for collaboration between Latin American and North American healthcare workers.

Session Objectives: Recognize and discuss the unique experience of social medicine in combining personal medical care with a public health perspective. This objective will be accomplished by a consideration of “classic” papers in social medicine. Learn about Latin American approaches to issues raised in current public health debates in the United States. This objective will be accomplished by discussing Latin American analysis and approaches to health equity. Learn about and consider the application of new technologies (such as electronic publishing) to the development of cross-border collaboration and the ability of such technology to create a space for new voices in public health debates. This objective will be accomplished by the presentation of the development of a bilingual, eJournal of Social Medicine (www.socialmedicine.info) and the UNM Latin American Social Medicine database.

Organizers:

Victor W. Sidel, MD and Matthew Anderson, MD, MSc

Moderator:

Anne-Emanuelle Birn, MA, ScD

Discussant:

Nancy Sohler, PhD, MPH

2:30 PM

Social Medicine as a Builder of Bridges / La medicina social como constructora de puentes
Victor W. Sidel, MD and Peter Selwyn, MD, MPH

2:40 PM

Development of a Bilingual Online Journal of Social Medicine/Desarrollo de una revista electrónica de medicina social
Matthew Anderson, MD and Florencia Peña, PhD

2:50 PM

Latin American Social Medicine Database: A Resource for Public Health/ La Región de América Latina Base de Datos de la Medicina Social: Un Recurso para la Salud Pública
Howard Waitzkin, MD, PhD

3:00 PM

A Practice of Social Medicine / Una Práctica de Medicina Social
H. Jack Geiger, MD, MSciHyg

3:10 PM

Social Medicine in Chile / La Medicina Social en Chile
Roberto Belmar, MD

3:20 PM

Contribution of Latin American Social Medicine to U.S. Debates on Health Equity/ Contribuciones de la Medicina Social Latinoamericana al debate sobre la igualdad en salud en los Estados Unidos
Celia Iriart, MPH, PhD

3:30 PM

Discussion: Nancy Sohler to moderate

See individual abstracts for presenting author’s disclosure statement and author’s information.

Organized by: Medical Care
Endorsed by: Community Health Workers SPIG, International Health, Peace Caucus, Socialist Caucus

This was posted by Matt Anderson, MD

William Jordan (Family Medicine 2007): Preventive Medicine in NYC

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Dr. Bill as drawn by one of his patients


What does a Social Medicine doctor do? Here is Bill Jordan’s current answer:

I graduated from RPSM Family Medicine in 2007, and I’m currently finishing my MPH and serving as Chief Resident in Preventive Medicine at Mount Sinai School of Medicine in New York City.

While a resident at Monte, I built on community psychiatry experience from medical school, launching an HIV prevention workshop at Geel Clubhouse, a day program for people with mental illness in the South Bronx. In addition to a recent report on this work in the journal Psychiatric Services, the workshops lived on after I left Monte, led by medical students under the stewardship of Dr. Alice Fornari.

As a preventive medicine resident, I have continued my longstanding commitment to immigrant health. I volunteer with Doctors of the World, writing medical affidavits for asylum seekers, and I regularly see new refugees at my primary care clinic in Harlem, the Barbee Family Health Center. I am also spearheading the NYC DOHMH pilot program to address cervical cancer screening disparities among female immigrants.

Finally, I helped build the coalition supporting this year’s introduction of Green Carts in New York City. The new permits allow vendors to sell fresh fruits and vegetables in neighborhoods with limited economic opportunity and low availability of healthy food. I promoted adoption of the permits with a local community-based organization representing Spanish-speaking street vendors, Esperanza del Barrio, and was recently elected to the board of directors. I am currently exploring the possibility of real-time cell-phone based mapping of vendor locations as a tool for promoting microlending to vendors and healthy food consumption by local residents. After finishing residency, I hope to continue working on the intersection of economic development and nutrition as a way of addressing health disparities.

Tracking down Free and Low Cost Healthcare in New York City: Rock Dove Nov 7 2008

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[Correction: The day of action on 11/7/1008 has been canceled.  See the comment section for another upcoming Rock Dove event.]

The Rock Dove Collective, a “radical community health exchange” is organizing a day of action on 11/7/2008 to find free and low cost health clinics in New York City.  The development of a comprehensive list of such clinics – available on the web – would be a great resource.

The NYC Department of Health has free clinics available for STD screening and treatment, dental care, as well as for the treatment of tuberculosis. [In our opinion the City’s chest clinics provide the best TB care in New York.]  Unfortunately the link to the list of all DOH clinics is down.  Calling 311 might be a good place to start to see if a clinic is available for a specific problem.

There are at least three student run free clinics in the city.  The Institute for Urban Family Health runs two.  The ECHO clinic in the Bronx was the first medical student free clinic, set up by students at AECOM.  The New York City Free Clinic in Manhattan is a project of NYU medical students  In addtition, students at SUNY/Downstate have organized the Brooklyn Free Clinic.

New York City also has an extensive network of Community Health Centers which provide low cost care to people without insurance.

Free clinics are not the solution to our healthcare problems, indeed they are a symptom of the problem.  And yet they also point to what might be the ethos of a national health system devoted not to profit, but to health.  I would be happy for interested readers to post additional resources.

What follows is the Rock Dove announcement:

Rock Dove Day of Action!!
Health Clinics for Community Healing
Friday November 7th
10:30am – 4:00pm
Your friendly neighborhood Rock Dove Collective is calling our second Day of Action! On Friday, November 7th, volunteers will fan out across the city, visiting free and low cost health clinics and gathering information about their services from both the staff and the clients who are there receiving services. Our goal is to use this information to create comprehensive profiles of health clinics in NYC, as part of our ongoing effort to make free and low cost health services accessible to those in need.

We will meet up in downtown Manhattan at 10:30am, at a location TBA. Over breakfast and icebreakers, volunteers will receive their travel plans for the day as well as a quick training on how to gather information when visiting a clinic. Volunteers will go out in pairs and hit up 1-2 clinics before we all meet up at 4pm to decompress, share information, eat, drink, and be merry!

How to Contribute:
-Volunteer! Bring your friends!  Join us as we hoof it through NYC in search of comprehensive information about free and low cost health services. If you plan on volunteering, RSVP to Freya at freyapowell@gmail.com.
-Donate! If you can’t join us the day of, please donate food and/or cash so that we can feed our volunteers breakfast and snacks, and help them

Posted by Matt Anderson

11th Latin American Congress of Social Medicine, Bogota 11/17-21/2009

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Our friends at ALAMES, the Latin American Social Medicine Association, have just announced that the 11th Latin American Congress of Social Medicine will be held in Bogota, Colombia from November 17-21, 2009. We have published part of the announcement in our journal Social Medicine.

ALAMES was formed in 1974 in Cuenca,Ecuador at the initiative of Juan Cesar García, an Argentinean physician and sociologist.  ALAME’s membership includes some of Latin America’s most prominent academics as well as numerous activists and public health workers.  In the past few years ALAMES has been involved in designing and implementing several important health programs throughout Latin America.  Interested readers should consult Social Medicine’s issue devoted to Progressive Health Reforms in Latin America.

The Conference has two broad objectives:

1. To generate a process of political, academic, and social dialogue among organizations and social movements, health care, and academic institutions. This exchange will allow health care issues to be situated within the Latin American political agenda. It will acknowledge the different perspectives and emphasis in the social determination of health care through a prospective and retrospective analysis of health care as a right and equity as a goal.

2. To prepare a balance sheet of the developments, contributions, and difficulties of Latin American social medicine during ALAME’s 25 years with the development of proposals for its future agenda and an outline of its directives in the next 25 years.

The official languages of the conference are Spanish and Portuguese, limiting access to the conference for English-only speakers. We are hoping, nonetheless, to translate much of the proceedings into English. Interested readers of the Portal should contact Matt Anderson to see if a US delegation to the conference can be organized.

More information about the Conference can be obtained by writing the Coordinator, Mauricio Torres: maot99@yahoo.es

Posted by: Matt Anderson

Volume 3, No. 3 of Social Medicine / Medicina Social published

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We have just published the 10th edition of Social Medicine/Medicina Social, our bilingual, online journal.  It is available in both English and Spanish.

Editorial

Social Medicine/Medicina Social’s 10th Issue, The Editors: Our brief reflections on the progress and problems of publishing an online journal.  With many thanks to those of have helped us.

Original Research

Maquila Workers’ Health: Basic Issues, What is Known, and a Pilot Study in Nicaragua Lylliam Perpetuo López, Luis Blanco R., Aurora Aragón B., Timo Partanen: Trying to assess the health impact of the maquila industry and how best to study it.

Themes and Debates

Health Equity: Conceptual Models, Essential Aspects and the Perspective of Collective Health Nivaldo Linares-Péreza, Oliva López-Arellano: An attempt to review the state of the literature using the critical lens of collective health.

Social Medicine in Practice

Experiences in Popular Education in Sandinista Nicaragaua, Maria Felisa Lemus: Midwives, vaccination campaigns, the contra war, and Ben Linder riding a unicycle in Sandinista Nicaragua

News & Events

International Seminar of Public Health Policy Asuncion, Paraguay International Seminar of Public Health: A Paraguayan perspective on the right to health.

A Social Medicine Perspective on Gender-based Health Inequities: Defending the right to sexual and reproductive choice in Chile, Mario Parada Lezcano, Paula Santana Nazarit: The Chilean social medicine community reacts to a recent Constitutional Court decision prohibiting the  provision of emergency contraception by public institutions.

Latin American Association of Social Medicine (ALAMES) XI Congress, November 17-21, 2009, Bogota, Colombia Mauricio Torres Tovar: This conference will mark the 25th Anniversary of ALAMES.  What role does health play in the larger social and political agenda?  How can the social medicine community join forces with others to promote the right to health?




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