Today we came together on this first day of the IPHU from all over our small planet:  Ghana, Guinea, Haiti, Kenya, Lebanon, Puerto Rico, Russia, Rwanda, Thailand and the United States.  The day begins with introductions that are more than asking this group of inspiring and eloquent agitators the bland recitation of names, organizations and what are you interested in; we are asked to speak of ourselves through our personal and social mandates, or, what is the change you wish to see in the world and how do you see it?  As  brothers and sisters, we respond with a passion born of being fed up with a global system that perpetuates inequality and injustice at the cost of the health of our communities, and speak of our hopes and common threads of the need for advocacy, speaking truth to power, and alternative models and ways of thinking about health and health care that is people centered, not profit focused:  “Health for all Now,” “Love Solidarity,” “Access,” “Health Activism,” “Meaningful Participation,” “Progressive Work,” “Mental Health,” “Englightening,” “Bright Future,” “Visual Healing,” “Cultivate Love,” “Health Education,” “Awakening,” “Education Action.”

Next, David Legge gives a comprehensive overview and history of the People’s Health Movement, International People’s Health University (IPHU) and the People’s Health Charter (PHC).  We go over this radical document, a unifying, organizing vision that views health as a right for ALL.  This profoundly simple understanding is so fundamental, that some of us in our small group discussions ask, “Why Not?” Not “Why Not” as this is a good idea, but “Why Not” as in why is this socially, economically and just idea not implemented and what do we as advocates and activists need to do to push this forward, use this in our work, and what do we need to include (LGBT rights, more emphasis on gender inequality, and a suggestion to create a handbook on how to use the PHC)?

Laura Turiano follows with a presentation on using a Human Rights based approach to advocate Health for All Now.    Next follows participants’ big task:  group work on our projects that advance the idea of Health for All in our communities.  Our task at hand:  present our projects with our compadres in small groups where, over the course of the week, we will support each other to: analyze, re-think, re-fine, conceptualize, strategize, and put into action our vision of the world and communities in which we wish to live.

The “formal day’s agenda” concludes with a brief introduction of the Theatre of the Oppressed by John Sullivan.   Free form movement and human sculptures is what we are and mold ourselves into as we attempt to convey the fundamental values and concepts of the days proceedings:  Hope, Inspiration, Thinking, Motivated…all conveyed through our bodies, expressions, and movements.  The consensus over dinner discussions and late night debates, rabble rousing, getting to know you sessions, is:  this is going to be a great, learning filled, intense, memorable week.

We’re writing to remind you that applications are due in just over two weeks (July 30, 2010) for this exciting social medicine and global health course held in Northern Uganda. Please see the course invitation below and feel free to let us know if you have any questions:

Course Invitation 2011
We invite you to apply for the second annual Beyond the Biological Basis of Disease: The Social and Economic Causation of Illness, an on-site immersion course in social medicine offered at Lacor Hospital in Gulu, Uganda from January 10, 2011 through February 4, 2011. This intensive course designed for 15 international medical students (clinical years) and 15 Ugandan medical students (3rd-5th year) from Gulu University intersects the study of clinical medicine in a resource-poor setting with social medicine topics such as globalization, war, human rights, and narrative medicine, among others. This highly-interactive course is taught through a combination of lectures, small and large group discussions, films, community field visits, ward rounds, and clinical case discussions. Credit for away-rotations can also be arranged. It is estimated that total student costs for the course will be $2650. This total includes roundtrip travel to Uganda from the US ($1700), full room and board in the hospital guesthouse ($500), and a course fee ($450).

For more information, we invite you to read the attached prospectus and view the short video about this year’s course, available at:

If you have any questions or are interested in applying, please email us at social.medicine@yahoo.com. Applications are due July 30, 2010.

Sincerely,

Julian Jane Atim, MD, MPH
Amy Finnegan, MALD, MA
Michael Westerhaus, MD, MA
Brigham and Women’s Hospital
Division of Global Health Equity
Boston, MA 02115

Discussion in 2010 Course

The opening speaker will be Dr. Joia Mukerjee of Partners in Health who will discuss “Social  Forces in Medicine.”  This event will take place at 5:30 PM at the Riklis Auditorium and will be followed by a reception. Subsequent sessions will take place each Wednesday (with one exception) at the 5th floor Forchheimer Auditorium at 5;30PM. Dinner is provided.  All events in this series will be listed at the top of our blog roll.

At last year’s course several local readers of the Social Medicine Portal dropped by.  Please feel free to come, but write to Ms. Karp (see below) so that we can inform security.

The list of speakers and topics is as follows:
Jan 13 ∙ History of Social Medicine ∙ Matt Anderson, MD, MS.
Jan 20 ∙ LGBT Health and Community Organizing ∙ John-Paul Sanchez, MD, MPH
Jan 27 ∙ Race and Health in the Bronx ∙ Robert Fullilove, EdD
Feb 3 ∙ Harm Reduction in the Bronx: Dealing with the Hepatitis Epidemic among IV Drug Users ∙ Donald Davis
Feb 10 ∙ Motivational Interviewing and Nutrition in the Bronx ∙Yasmin Mossavar-Rahmani, PhD, RD, CDN
Feb 17 ∙ The Impact of Hep B on Pregnancy in the Asian American Community∙Tomoaki Kato, MD; Maya Gambarin-Gelwin, MD
Feb 24 ∙ Abortion Care in NYC∙Marji Gold, MD
Mar 3 ∙ Native American Health ∙ Donna Perry, MD *Price Center Auditorium
Mar 10 ∙ Separate and Unequal: Medical Apartheid ∙ Neil Calman, MD and Nisha Agarwal, JD
Mar 16* ∙ Liberation Medicine ∙Lanny Smith, MD, MPH, DTM&H  *Tuesday at 7:15pm*
Mar 17 ∙ Reentry: Old Fears, New Hopes ∙Meekaelle Joseph
Mar 24 ∙ Street Medicine ∙ Jim Withers, MD
Apr 7 ∙ The History and Practice of Community Psychiatry ∙Thomas Betzler, MD
Apr 14 ∙ Nyaya Health: A Case Study in Developing a Healthcare NGO∙ Ryan Schwarz and Bijay Acharya, MD
Apr 21 ∙ Refugee and Asylee care: Human Rights for Torture Survivors ∙ Nicole Sirotin, MD
Apr 28 ∙ Ayurvedic Medicine ∙Bhaswati Bhattacharya, MD, PhD
May 5 ∙ The War on Women: Criminalization of Reproduction in the United States ∙Robert Roose, MD

For any questions or kosher meal requests, please contact Jessica Karp at jkarp@einstein.yu.edu.

Posted by Matt Anderson, MD

In October 2009, we will offer a one month elective for 4th year medical students interested in research based health activism. The course, now in its 8th year, combines both didactic and project based approaches, culminating with a research proposal that students can complete at their home institutions.

The didactic lectures will introduce three major topic areas: research methods, health policy, and advocacy skills. Individual and small group mentorship will be provided to help students utilize these skills by developing their own independent research proposal. Other sessions will include physician-activist guest lecturers and visits to state or private health organizations that both create and influence health policy.

Finally, students will develop a research proposal for a project reflecting their interests and an advocacy plan to gain the maximum health policy impact with the results. This proposal will be presented on the final day of the course at a luncheon including all students, the course directors, returning session leaders, and Peter Lurie, MD, MPH, from the Public Citizen’s Health Research Group.

FACULTY AND RESIDENTS:
*Aaron Fox, MD, Clinical Instructor of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Course Director, Research-Based Health Activism Course;
*Viraj Patel, MD, Primary Care Resident, Montefiore Medical Center

FOR MORE INFORMATION: Please contact Aaron Fox, MD at this link: Aaron Fox

Past Programming Tracks:

Health Policy and Activism—The history and the present: Bertrand Bell, MD: Making Real World Change As A Physician—Jo Ivey Boufford, MD: Public Policy—Joseph Ross, MD: Health Care Organization—Ernest Drucker, PhD: A Plague of Prisons: The Epidemiology of Mass Incarceration—Oliver Fein, MD: National Health Insurance for the US: Has Its Time Come?—Paul Lipson, Chief of Staff and Siddharta Sanchez, Community Liaison for Immigration & Environmental Affairs for Bronx Congressman José Serrano: Health Topics as they relate to the policies in the Bronx, NY—Ruth Macklin, PhD: Research Ethics: Protecting Human Subjects of International Research—Eva Metalios, MD: Human Rights Clinic—Barbara Seaman: Women’s Health Activism—Peter Selwyn, MD, MPH: Research and Advocacy at the Dawn of AIDS—Peter Sherman, MD: The Affects of Domestic Violence on Children—Victor Sidel, MD: Social Injustice and Public Health, and War, Terrorism, and Public Health—Hal Strelnick, MD: Health Policy at Local, State, and National Levels—Bruce Vladeck, PhD: Medicare and the Role of Physicians in the Future—Sidney Wolfe, MD: Research Topics/Questions

Research Methods—how to produce activist research:

Matthew Anderson, MD, MSc: Planning the write-up process of your project—Chinazo Cunningham, MD: Grant Writing—Robin Flam, MD, DrPH: Uses of Epidemiology—Aaron Fox, MD: Social Epidemiology—Nerina Garcia, PhD and Lucia Ferra: Qualitative data use and analysis—Alison Karasz, PhD and Galit Sacajiu, MD, MPH: The Underline Construct—Paul Meissner, MSPH: Using Secondary Demographic and Clinical Databases—Robert Roose, MD: Quantitative data use and analysis—Galit Sacajiu, MD, MPH: Research Questions—Nancy Sohler, PhD, MPH and Galit Sacajiu, MD, MPH: Study Designs

Advocacy—how to create change:

David Appel, MD: Lobbying—Ramin Asgary, MD, MPH, MSc:Humanitarian Assistance: The Principles—Oni Blackstock, MD: HIV/AIDS in Ghana: Adherence and Stigma—Bob Goodman, MD—Pharmaceutical Industry and Physicians—Kirsten Goodwin of GMHC: Coalition Building—Hillary Kunins, MD, MPH, MS and Carolyn Chu, MD: Case Workshop: Advocating for Choice—Janice Lieberman, NBC Studio: Media Relations in Health Research and Advocacy—David Matthews: Harm Reduction and HIV: a grass root organization—Steve Max of Midwest Academy: Intro to Organizing and Strategy Building—Mini Murthy, MD, MPH, MS: Women’s Health and Human Rights—Zena Nelson: The South Bronx Food Cooperative—Adam Richards, MD, MPH: Public Health and Human Rights Praxis in Burma—Minesh Shah, MD: Public Speaking—Lanny Smith, MD, MPH, DTM&H: Liberation Medicine, Health and Human Rights—Leonora Tiefer, PhD: FSD-A Case of Disease Mongering and Activist Resistance

Click on the links below for:

Course Brochure 2009
An application for the course:  2009 application
Articles about the course from the journal of general internal medicine, Academic Physician and Scientist and the New York Times

Aaron Fox, MD

We recently received the following letter from Joanna Mae Souers, one of the US students studying medicine at the Latin American Medical School (ELAM) in Havana:

It is my pleasure to introduce to you a project we have been working on since December.

Inspired by the MEDICC Conference, we put our minds together to manifest the ¡Salud! Southwest Tour:

July 28th, 2009, 12 American students from the Escuela Latinoamericana de Medicina (ELAM – Latin American School of Medicine) in Havana, Cuba will board a Recreational Vehicle (RV) for two weeks to travel across the Southwest region of the United States visiting a number of tribal settlements of American Indian Nations, community colleges and universities.

While at the various sites the students will share their personal experiences of what it’s like to study at ELAM while promoting the availability of full scholarships for students, volunteer their services while learning about some of the more significant health concerns affecting American Indian populations and to build personal and professional relationships with health care practitioners and members of Native American communities.

These 12 students are among the 104 Americans on full scholarships currently studying medicine in Cuba alongside their peers from 27 different countries across the world. They represent not only some of the brightest and most courageous medical school students this country has to offer, but also originate from some of the toughest and poorest communities in the U.S. The settlements they plan to visit represent one example of the type of historically underserved communities where all the U.S. ELAM students have pledged to work upon graduation.

We are seeking funding support and medical donations that will provide the substance with which lifelong alliances will be built between future American physicians dedicated to underserved communities and our national predecessors.

For those interested in making a donation please visit the MEDICC Website (http://www.medicc.org/ns/index.php?s=30&p=4), or under ¨programs¨you´ll find ¨ELAM Students Southwest Tour¨ or email our communications director, Tasha Rassuli, at saludswtour@gmail.com or directly at tjrassuli@gmail.com

posted by: Matt Anderson, MD

Catlin Polley in Estancia

January 14: Integrating Prenatal Care with the Diagnosis and Clinical Management of HIV and Syphilis: A Latin American and Caribbean Initiative, Dr. Arachu Castro, PhD, MPH.  (Presented as part of the student-organized “Sex Week”)

Arachu Castro, PhD, MPH is a medical anthropologist trained in public health, working primarily in Latin America and the Caribbean on infectious disease (HIV/AIDS, TB, dengue) and sexual and reproductive health. She is Assistant Professor in the Dept. of Global Health & Social Medicine at Harvard Medical School, Project Manager for Mexico and Guatemala at the well-renowned NGO, Partners In Health, and Medical Anthropologist at the Division of Social Medicine and Health Inequalities at Brigham and Women’s Hospital in Boston, MA.

Her talk will present an update on the Latin America and Caribbean Prenatal Testing Initiative for HIV and Syphilis, which she directs in collaboration with UNICEF, UNAIDS, the Pan American Health Organization (PAHO) ? an Initiative currently including Brazil, Colombia, Cuba, Dominican Republic, Nicaragua, Paraguay, Peru, and Uruguay, to identify barriers to testing for HIV and syphilis and scale up screening of HIV, syphilis, and other STDs during pregnancy in Latin America and the Caribbean.

January 21: Liberation Medicine, Lanny Smith, MPH, DTM&H, FACP (will start at 7PM) This talk has been rescheduled to May 12.

January 28: Social Medicine 101, Matt Anderson, MD, MSc

Dr. Anderson is a family physician working in the Department of Family & Social Medicine at Montefiore Hospital/AECOM.  He runs the Social Medicine Portal (www.socialmedicine.org) and co-edits an bilingual, online academic journal Social Medicine (www.socialmedicine.info).  In this talk he will discuss the core concepts of social medicine and how they have been developed and put into practice over the past 300 years.

February 4: Health Literacy, Jennifer Adams, MD & Fatima Ashraf, Mayor’s Office

February 11. Harm Reduction in the Bronx: Hepatitis & IV Drug Users, Donald Davis, VHIP

VHIP is the Viral Hepatitis Intervention Program, a government-funded harm reduction program geared towards education and prevention of viral hepatitis in the Bronx community. It is primarily run by NYHRE (New York Harm Reduction and Education) and AECOM faculty (Dr. Alain Littwin and Dr. Melissa Stein of the Department of Medicine.) Students are closely supervised by AECOM faculty, Irene Soloway and NYHRE supervisor Donald Davis, as they assist in giving vaccinations and phlebotomy, as well as providing health education and counseling to program clients. http://www.aecommunity.com/vhip/Welcome.html

Donald Davis is the VHIP Coordinator at New York Harm Reduction Educators. He has been in the field of HIV and Harm Reduction for over ten years, having presented at numerous Hepatitis C conferences at the local, state and national level. He works with Irene Soloway, a Physician Assistant at Albert Einstein College of Medicine’s Division of Substance Abuse, in overseeing and supervising students in provide testing, vaccination and referral services to active drug users and supervise AECOM medical students at one of the NYRE syringe exchange outreach sites in Hunts Point.

The talk will introduce the concept of harms reduction with a focus on hepatitis C and how community-based screenings have affected the current situation. New York City has a higher prevalence of hepatitis C than the entire United States overall. Hepatitis C is also the most commonly reported type of viral hepatitis in NYC. Donald will address some of the issues that might be related to such a high prevalence, including incarceration, socioeconomic factors, HIV/AIDS, immigration and migration, drug and alcohol use, and hepatitis B. This talk will also cover how interventions, such as testing, vaccinations, referral services, and needle exchange programs have made an impact on hepatitis C rates as well as future interventions that can be implemented at the local community level.

February 18: Gun Violence, Jackie Hilly, NYAGV

What should the medical community know about gun violence prevention? This presentation will explore the legislative initiatives on gun violence, the public health approach to gun violence, and youth development models.

February 25: Physicians and the Pharmaceutical Industry, Joseph Ross, MD, MSH

Dr Ross will discuss the many ways physicians and the pharmaceutical industry interact and work together. He will describe how common these interactions are, and what their implications.

March 4: National Health Insurance for the US: Has Its Time Come? Oliver Fein, MD

This presentation includes a history of health insurance in the United States; a review of health care macroeconomics – where we spend our health care dollars and how we raise the revenue to pay for those expenses; an outline of the five fundamental problems facing the U.S. health care system; and, a description of single payer national health insurance and how it addresses those fundamental problems.

March 11: Environmental Justice and Climate Change Health Effects, Perry Sheffield, MD

March 17 (Tuesday): Women’s Health is a Family Value: A History of Reproductive Health Policies in the US, Carol Roye, EdD, RN, CPNP

Carol Roye is a Professor of Nursing at Hunter College in New York City and a practicing pediatric nurse practitioner in the Washington Heights neighborhood of New York. Dr. Roye’s research focuses on reproductive health issues pertinent to adolescents, including teen pregnancy prevention and working with mothers of pregnant and parenting teens to improve outcomes for their daughters. She is currently at work on a book which examines the genesis of current, unfavorable reproductive health policies and the adverse impact they have on child health in the U.S. and overseas.

March 18: Interactive Session: Novel Health Care & Sustainable Living, Frank and Bonnie Gifford, MD [This session has been postponed]

Bonnie and Frank Gifford run EntropyPawsed, a nature linked low energy living demonstration site located in the mountains of West Virginia. Their vision is to endeavor to develop a strong positive vision of the future and the personal qualities of strength, courage, wisdom, and perseverance necessary to make a positive vision reality. The Entropy Pawsed mission is to offer educational opportunities demonstrating simplicity in living with a deep ecology perspective so that we may leave a reasonable world for all children of future generations. An Einstein student, Michelle, who has studied with them, has organized a unique experience for students of the Social Medicine Course: and interactive distance-learning session, where we will practice the low-energy ideals and communicate “live via satellite” style and discuss how to incorporate sustainable practices into our future careers. http://entropypawsed.org/default.aspx

March 25: The Asian American Diabetes Epidemic, Perry Pong, MD

Despite having a lower body weight, Asian Americans are more likely than Caucasians to have diabetes. Diabetes is a rapidly growing health challenge among Asians and Pacific Islanders who have immigrated to the United States, affecting about 10 percent of Asian Americans; about 90 to 95 percent of Asians with diabetes have type 2 diabetes. Come learn about how this devastating disease has hit a seldom-discussed ethnic group – Asian Americans – and the active research that is underway to stop this epidemic.

April 1: Separate and Unequal:  Medical Apartheid in NYC, Neil Calman MD & Nisha Agarwal, JD

Bronx Health REACH, established in 1999, includes 40 community and faith-based organizations dedicated to eliminating racial and ethnic health disparities in health outcomes. In addition to its advocacy efforts, the group sponsors community health promotion and disease prevention programs, with support from the Centers for Disease Control and the NYS Department of Health. REACH is a project of the Institute for Family Health, a nonprofit organization that operates health centers and trains health professionals to work in urban, medically underserved communities in New York State. New York Lawyers for the Public Interest (NYLPI) is a nonprofit civil rights law firm that strives for social justice. NYLPI has worked with the Coalition on this issue for several years.

April 22: Health Consequences of Immigration Detention, Homer Venters, MD

Over 300,000 people are detained each year in the United States by Immigration & Customs Enforcement (ICE). These detainees are held in a wide variety of public and private jails, prisons and contract facilities but face the common problem of inadequate medical care. ICE is under no legal mandate to provide an acceptable standard of medical care, or to track and report adverse medical events for detainees. In addition, the health plan that governs much of the medical care received by detainees is inadequate and unethical. Analysis of this health plan, as well as the circumstances around a number of detainee deaths, reveals a system lacking medical sufficiency

April 29: War and Public Health, Victor Sidel, MD

May 6: Integrative and Botanical Medicine, Roberta Lee, MD

TUESDAY, May 12th: “Liberation Medicine,” Lanny Smith, MD, MPH, DTM&H, FACP

Talks (unless noted otherwise above) will take place on Wednesday evenings from 5:30 to 6:30 PM in the Forchheimer 5th floor lecture room. Dinner is provided.

Commentary:

The social medicine course, now in its 11th year, is one of the highlights of the activism by the students at AECOM.  There are over a dozen student groups at Einstein involved in questions of social justice.  They work together as part of the Einstein Umbrella.  One of the members of the umbrella is the ECHO clinic, a free clinic established by AECOM students in 1999.  This model has been followed at a number of other NYC medical schools (see our posting on Free and Low Cost Health Care in NYC).

This posting will be periodically updated as we get information from the course organizers about the details of each of the talks.

For information on similar courses in US medical schools, consult Public Citizen’s listing of health activism courses.

This posting was updated on 2/5/2009 to incorporate information about the talks.

Posted by Matt Anderson, MD

Dr. Jean Silver-Isenstadt

On Tuesday, September 11, Dr. Jean-Silver Isenstadt, the founding Executive Director of the National Physicians Alliance spoke at Social Medicine Rounds about the work of the NPA since its formation in 2005.

She began her presentation with Broken Covenant, a short film which captures the issues and events surrounding the birth of the NPA; it is available on the NPA website.  The Alliance developed from a core group of AMSA (American Medical Student Association) ex-presidents who wanted to create an “AMSA beyond AMSA,” i.e. a physician’s organization that could better express the values animating AMSA.  These core values, as identified by NPA’s founders, were: service, integrity and advocacy.

Core Issues

The core issues identified by the new organization were:

Integrity & Trust in Medicine

Equitable, Affordable Health Care for All, Without Health Disparities

Prevention and Wellness

NPA Campaigns

These core issues have translated into three major NPA campaigns:

1. The Unbranded Doctor (which will be the subject of our next posting).

2. Rx: Vote, a voter registration campaign (see our posting of June 20, 2008)

3. Secure Health Care for All

The Secure Health Care for All campaign has chosen not to endorse a specific plan, but rather endorses the Institute of Medicine’s general principles for health care reform:

1.      Health care coverage should be universal.

2.      Health care coverage should be continuous.

3.      Health care coverage should be affordable to individuals and families.

4.      The health insurance strategy should be affordable and sustainable for society.

5.      Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.

This campaign has been undertaken in alliance with a number of groups including HCAN, Health Care for America Now.  HCAN calls for a plan which guarantees affordable coverage and allows people to: “keep your current private insurance plan, pick a new private insurance plan, or join a public health insurance plan.”  It appears this plan has been controversial within the NPA, some seeing it as too left, others as not left enough.  (For a recent critique of HCAN from Physicians for a Naitonal Health Plan, see the PNHP blog).  The campaign also offers NPA’s report card on the health plans of the current presidential candidates.

In addition to these three large campaigns, the NPA website has information on campaigns to address malpractice, safety, and the global health worker shortage.

The NPA lays great importance on the role of physicians as advocates.  Dr. Silver-Isenstadt stated: “Patient advocacy is a responsibility of the profession.”  And their website offers many opportunities for physicians to work as advocates.  In addition, NPA has a blog and a facebook page.

From the NPA website: “Jean Silver-Isenstadt holds a doctorate in the history and sociology of medicine from the University of Pennsylvania, a medical degree from the University of Maryland, and a master’s degree in nonfiction and science writing from the Johns Hopkins University. Her doctoral work focused on 19th-century American health reform.  She is the author of Shameless: The Visionary Life of Mary Gove Nichols (Baltimore: Johns Hopkins University Press, 2002), a biography of the infamous and influential health advocate and social reformer best known for her leadership of the water-cure movement and for her scandalous public lectures to women on anatomy and physiology.”

After her talk, Dr. Silver-Isenstadt reminded me that the Social Medicine Portal was one of the first sites to give publicity to the NPA in 2005.

Posted by Matt Anderson

“Introduction

The health of the world’s population is divided into two groups, those who have access to health care services and those who do not. The effects of this divide can be seen on the international level where life expectancy in Switzerland averages 80 years as opposed to 38 years in Zambia. Infant mortality rates are often used as a general indicator of health and socioeconomic conditions since rates are affected by factors such as access to perinatal health care. A direct relationship has been shown between higher income and education level and lower rates of infant mortality. This may explain in part an infant mortality rate of 4.5 per 1,000 live births in Connecticut in comparison with 12.2 in the Washington, DC area.

A major influence in access to services is the availability of trained health care workers. The World Health Organization estimates that the world will need at least 4,250,000 additional health workers to address these health disparities. In the face of this work force crisis we are left wondering how to fill in the gaps left by the mass exodus of health workers from developing nations to industrialized ones.

Cuba has tried to address these problems by sending thousands of healthcare professionals to work in some of the most impoverished and medically underserved regions in the world. Over the years, their attempts have evolved to include training professionals from underserved areas to provide enduring sources of health care for their populations. Perhaps the most valiant of efforts was the creation of the Latin American School of Medicine in Cuba (called ELAM, Escuela Latinoamericana de Medicina), which currently is training over 10,000 students from at least 27 countries, including the United States. Despite ELAM’s impressive numbers, its founders recognized that solutions to what has become a global health care crisis depend not only on the number of physicians produced but also on how they are trained as providers of care. To that end training is oriented toward primary care, public health and hands-on clinical experience. Perhaps no one can speak better about the training at ELAM than the actual students sitting in its classrooms. The following is a student perspective on ELAM and its educational program highlights, as viewed by two of its North American students.”

To read the rest of the article, please click here.

-posted by Matt Anderson

Earlier this year we invited Asa Cristina Laurell, a prominent Mexican public health activist to prepare a special issue on progressive health reforms in Latin America. Dr. Laurell was the head of the Mexico City Health Department from 2000-2006 and – had the Mexican elections not been stolen by the right – she would currently be Mexico’s Minister of Health. She contributed a paper describing the Health Department’s experience with providing free medicines and medical care to people who did not qualify for coverage under Mexico’s employment-based Social Security System. Other papers examine Brazil’s Unified Health System, the SUS, which is one of the world’s largest public health systems; the Venezuelan attempts to provide free health to the all citizens with assistance from the Cubans; Uruguay’s moves to a public-private system that will guarantee the right to health; and finally Bogota’s experience with providing poor communities with access to health care through the Health at Home program.

American readers may be particularly interested in the article by Razel Remen and Lillian Holloway, two US students studying medicine at the ELAM school in Havana Cuba.

We publish two articles of original research. A Hong Kong team reports on public attitudes during the SARS epidemic in 2003, while Dr. Paula Acevedo presents data on reproductive patterns among Latin American immigrants in Spain.

Sadly, we publish the last article written by Edmundo Granda, one of the founders of ALAMES, the Latin American Social Medicine Association. He passed away in April of this year. He approved the final galleys of the Spanish version of his paper via blackberry from the hospital on the week he died. His paper considers the historical trajectory of ALAMES and where Latin American Social Medicine may be heading.

Finally, Dr. Lanny Smith interviews Chilean activist Victor Toro, a political refugee from Pinochet’s Chile, who is now facing deportation from the US, his home of nearly 2 decades. Ironically, he has been a immigrant rights activist (and patient of Dr. Smith) in the Bronx, New York, for most of these years. His account of becoming ill in an ICE detention facility mirrors the concerns discussed in our July 10^th posting about Dr. Homer Venters.

Posted by Matt Anderson