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Posts Tagged ‘health care’

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Photo: John Tlumacki/Globe Staff
Cathy Corbett got her hair cut at HER on a recent Saturday. HER is a weekly event from the Boston Health Care for the Homeless Program.

When I think of all the health care I’m able to utilize (cataract surgery today, for example), my heart breaks for people who don’t have coverage. A special program in Boston aims to help homeless women get some of what they need while also lifting their spirits with fun activities.

Elise Takahama writes at the Boston Globe, “Linda Winn … sobered up six months ago, but she’s been battling homelessness for the past year. Winn, a 51-year-old Somerville native, said she’s working with a few organizations to find permanent housing, but for now, she is staying at Woods-Mullen, a South End homeless shelter.

“A few months ago, she discovered a haven of medical care — and free haircuts — just around the corner..

” ‘I started coming a few months ago. I love the staff. It’s been helping with depression, helping with any problem I might have,’ said Winn. …

“In one corner, a group of women played bingo, while others danced and sang karaoke in the middle of the room. A table near the back was filled with markers, beads, and nail polish. Movies were shown in a separate room.

“All these activities are part of HER Saturday, a program that offers a medical clinic for women who have suffered abuse, are homeless, or are in need of health care services, said Melinda Thomas, the program’s associate medical director. …

“The HER Saturday program was launched in February 2016, Thomas said. When it first started, about 30 to 50 women would wander through the doors. Now, at least 100 women — sometimes up to 200 — line up at 7 a.m. every week, she said.

“The Saturday clinic not only gives the women a chance to get manicures and watch romantic comedies but also provides preventative health care services and cancer screenings, which include mammograms and Pap smears. Homeless women have higher rates of mortality from breast and cervical cancer, Thomas said. A medical provider, a nurse, a case manager, a social worker, and a behavioral health counselor are available every week.” More at the Globe, here.

Those of us who can have a medical check-up, a haircut, or a tasty meal whenever we want really should feel gratitude every day. I also feel gratitude for the people behind programs like this, which benefit us all if only indirectly.

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Photo: Martina Bacigalupo for The New York Times
An American pediatric specialist during a radiology teaching session with pediatric residents in Kigali, Rwanda. In the past 15 years, Rwanda has worked to build a near-universal health care system.

We like to think that American medical care is top drawer, but in some developing countries, access, at least, is much better. Would you believe Rwanda, where Paul Farmer’s Partners in Health and others have offered help to local leaders?

Eduardo Porter has the story at the NY Times, “Rwanda’s economy adds up to some $700 per person, less than one-eightieth of the average economic output of an American. A little more than two decades ago it was shaken by genocidal interethnic conflict that killed hundreds of thousands. Still today, a newborn Rwandan can expect to live to 64, 15 years less than an American baby.

“But over the past 15 years or so, Rwanda has built a near-universal health care system that covers more than 90 percent of the population, financed by tax revenue, foreign aid and voluntary premiums scaled by income.

“It is not perfect. A comparative study of health reform in developing countries found that fewer than 60 percent of births there were attended by skilled health workers. Still, access to health care has improved substantially even as the financial burden it imposes on ordinary Rwandans has declined. On average, Rwandans see a doctor almost twice a year, compared with once every four years in 1999.

“Rwandan lives may be short, but they are 18 years longer than they were at the turn of the century — double the average increase of their peers in sub-Saharan Africa. …

“In some dimensions of health care, [Rwanda] gives the United States a run for its money.

“Its infant mortality rate, for one, dropped by almost three-quarters since 2000, to 31 per 1,000 births in 2015, vastly outpacing the decline in its region. In the United States, by contrast, infant mortality declined by about one-fifth over the period, to 5.6 per 1,000 births. …

“Critically, Rwanda may impress upon you an idea that has captured the imagination of policy makers in even the poorest corners of the world: Access to health care might be thought of as a human right.”

Read how poor countries, such as Ghana, Peru, Vietnam, and Thailand, are acting on that belief, here. At the rate they’re going with access, it is reasonable to suppose that more citizens will choose a medical profession and that quality improvements will follow.

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Photo: Alison Wortman
Ingrid, a Mayan community health promoter in Guatemala, is delivering direct health services to another Mayan woman in the Mayan language.

US city hospitals have known for years that it’s important to provide health care to patients in their own language. That’s why hospital interpreter is a growing career option. But you can imagine how grateful a patient might be if the providers themselves spoke her language.

In remote parts of Guatemala, a socially conscious coffee company is supporting an initiative to do that.

As Alison Wortman wrote at the Dean’s Beans blog in May, “When I looked through all the colorful photos I took while on my most recent Dean’s Beans development trip to Guatemala, this one stuck out the most. …

“What we are witnessing here is no small feat. This is a picture (above) from a home-visit in a remote mountain village to check up on a new mom and her baby (the little guy is strapped to her back). What makes the visit so extraordinary is that Ingrid, a Mayan community health promoter, is delivering direct health services to another Mayan woman in their own Mayan language.

“This direct, language inclusive health service from the Mayan Health Alliance (known as Wuqu’kawoq) is the only health organization in Guatemala providing home-based health care to indigenous populations in their own Mayan languages. This women’s health program is one of many in their comprehensive health-care programming which includes primary and women’s health services, nutrition and early child development, treatment and support for chronic disease, medical case management services and clean water education.

“In addition to culturally inclusive services, [the] community outreach workers at Wuqu’kawoq have also become role models for the future generation of girls in a country where 70% of indigenous girls do not make it past 6th grade. …

“Dean’s Beans sent three social workers to Guatemala (Annette Cycon, Jean Marie Walker and myself) for 10 days to prep, introduce and facilitate trainings in Annette’s Group Peer Support Model (GPS). GPS is a powerful and effective group support model that focuses on social support groups to address isolation, mental health concerns, self-esteem building and women’s empowerment. …

“At the end of class the woman served lunch. They all ate half of their portions and wrapped the rest in a bowl covered in bright cloth to take home. Although at first we thought it was to share with their families, we learned later [that] it was to prove to their husbands and mother-in-laws that they had indeed gone to class. This was another example of the oppressive conditions many women face in a country where gender based violence are at epidemic levels.” More here.

That comment reminds me of certain Syrian refugee women I work with. The men are definitely controlling what they do. I think you have to be careful to teach without messing around with another woman’s culture unless you are sure that is what the woman wants. So hard to witness some things, though.

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In last week’s Boston Globe, Bella English had a sad-happy story about a nonprofit that reaches out to families impoverished by their children’s cancer, Family Reach Foundation.

English writes that Carla Tardif once promised a friend who died of cancer that she would help families who were struggling with a child’s treatment. In searching for the best way to do that, she ended up at Family Reach, which helps families get back on their feet. The stories she hears are heartbreaking.

“ ‘On top of watching your child suffer, people get threatening eviction notices, calls from collection agencies, or they can’t make a car payment so they lose the car and can’t get their child to treatment,’ says Tardif.

“Medical hardship is one of the leading causes of personal bankruptcy in the nation,” writes the Globe‘s English. “According to a Harvard University study, more than 62 percent of bankruptcies are caused by overwhelming medical expenses — and cancer is the most costly. ‘It’s because a parent needs to stop working to take care of the child,’ says Tardif. ‘The average cancer treatment without complications is two years.’ …

“ ‘What I’ve learned is that it’s about so much more than money,’ Tardif says [of her work]. ‘That someone cares and gets it, has a really profound effect on families.’

“Just ask Raquel Rohlfing, who at fund-raisers tells her story. Homeless, with a son [Mikalo] who had undergone a bone marrow transplant, she got a call from Tardif, who arranged payment for a year’s rent on a Winchester apartment, not far from her own house.”

In Rohlfing’s case, Tardif really went the extra mile.

English writes, “Tardif’s husband, a builder, put in a new kitchen and floors, and fixed the bathroom in the apartment. But Tardif wasn’t finished. She is also executive director of Music Drives Us, the nonprofit founded by car magnate Ernie Boch Jr. Rohlfing needed a job, and Tardif needed help, so she hired her at Boch’s foundation.”

Read more.

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As long as health insurance is out of reach for so many, creative approaches to coverage are likely to keep sprouting up.

I knew a doctor 30 years ago who took care of elderly single people for life — and inherited their houses. He ended up with a lot of houses.

More recently, CBSNewYork/AP reported that “a new program lets uninsured New York City artists exchange their art for medical services.

“Tony-Award winning actor Lin-Manuel Miranda and rapper and radio personality Roxanne Shante helped launch the ‘Lincoln Art Exchange’ at Lincoln Hospital in the Bronx” early this year.

“Under the program, artists will earn ‘health credits’ for every creative service they perform. In exchange they’ll be able to obtain doctor’s visits, laboratory tests, hospitalization, emergency care, dental care and prescriptions at Lincoln.” Read more at CBS Local.

I would be interested in other unusual examples of how people are accessing care today.

Photograph: nyc.gov

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Dr. Paul Farmer, the subject of a great Tracy Kidder book called Mountains Beyond Mountains, has spent many years delivering medical care — and working to alleviate poverty — in remote areas of Haiti. His nonprofit organization, Partners in Health, takes the word “partners” seriously. The teams do not tell the locals what is good for them but makes a point of learning from them and helping them get what they need.

In recent years, Farmer has been in demand in other countries, too. One focus area has been Rwanda. I liked a recent Boston Globe article on the approach to building a Partners in Health hospital there.

“The designers quickly realized that the challenge was not simply to draw up plans, as they had first thought, but rather to understand the spread of airborne disease and design a building that would combat — and in some cases sidestep — the unhealthy conditions common to so many hospitals.

“Learning from health care workers that hospital hallways were known sites of contagion, poorly ventilated, and clogged with patients and visitors, MASS Design decided that the best solution would be to get rid of the hallways. Taking advantage of Rwanda’s temperate climate, they placed the circulation outdoors, designing open verandas running the lengths of the buildings. …

“When it came to building, MASS Design looked at the Partners in Health model of involving local poor communities in health care, and realized that they could apply the same ideas to the construction process. The hospital was built entirely using local labor, providing food and health care for the workers. Unskilled workers received training that would help them get more work; and skilled laborers, notably the Rwandan masons who built the hospital’s exterior from carefully fitted together local volcanic stone, refined their craft and found themselves in demand all over the country. The construction process also beefed up local infrastructure — new roads and a hydroelectric dam — creating more jobs and literally paving the way for future projects.”

To paraphrase what Farmer often says, the biggest challenge to health is poverty. Read more.

Update on the designers from the June 19, 2012, Boston Globe.

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