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World Day of Social Justice

“Social justice is an underlying principle for peaceful and prosperous coexistence within and among nations. We uphold the principles of social justice when we promote gender equality or the rights of indigenous peoples and migrants. We advance social justice when we remove barriers that people face because of gender, age, race, ethnicity, religion, culture or disability.” -United Nations, WDSJ webpage (1)

In 2007, the United Nations General Assembly declared that February 20th be celebrated annually as World Day of Social Justice. A product of rising globalization, World Day of Social Justice encourages nations to devote the day towards the eradication of poverty, inequity, exclusion, and unemployment. While we know these goals cannot be achieved in a day, World Day of Social Justice provides us with a chance to look around our community, locally and globally, with extra purpose and passion. GlobeMed at Tufts and PHASE Nepal share a drive to collaborate and eliminate global health inequity, and we find inspiration in the action taken by the international community in support of global health equity. February 20th has become a day to rally, to dream, to energize, to learn, to grow, and to come together. Especially in the current national climate, it is increasingly important every single day to take action and to create hope.

This February 23rd, GlobeMed at Tufts will be hosting a film screening of Vessel, an award-winning documentary following the work of Rebecca Gomperts, founder of Women on Waves. Dr. Gomperts, a Dutch physician, activist, and artist, made it her life’s work to end the health risks associated with illegal abortions. Dr. Gomperts and her organization work on a ship-turned-clinic that sails to areas where women cannot access legal and safe abortion. Once in international waters, Dr. Gomperts and her crew are trained and authorized to administer abortions and provide contraceptives. They also train local women to administer safe abortions using non-surgical WHO-researched protocols. Through a network of empowerment, Women on Waves has given countless women access to safe abortions, birth control, and invaluable knowledge.

We find this documentary especially relevant after the reenactment of the U.S. Mexico City Policy, also known as the Global Gag. First enacted by President Reagan and most recently reenacted by President Trump, this policy blocks federal funding to NGOs that provide abortion services or counseling as well as those that advocate for the decriminalization or expansion of abortion services.

GlobeMed at Tufts is devoted to social justice, nationally and abroad, and aims to emphasize the importance of self-education and community discussion. Please join us on February 23rd at 6 PM in Tisch 304 for a free screening of Vessel with snacks, discussion, and good company! We hope to foster an open dialogue about the film and World Day of Social Justice, so all thoughts, feelings, and opinions are welcome.

Vessel trailer: https://vimeo.com/106489346

Women on Waves website: http://www.womenonwaves.org/


(1) http://www.un.org/en/events/socialjusticeday/

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Framing the Health Disparities Problem

This past week, I had the opportunity to attend the National Institute on Minority Health and Health Disparities Grantees Conference. Over 1,000 people attended, all representing different parts of academia and the non-profit world, all coming together to collaborate and present research regarding health disparities. The National Institute on Minority Health and Health Disparities is a branch of the National Institutes of Health. It’s mission is “to lead scientific research to improve minority health and eliminate health disparities.”

What are health disparities, exactly? The Healthy People 2020 initiative defines it in the following terms: “If a health outcome is seen in a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health.” Health disparities can be seen, for example if we look at something like infant mortality.

Infant mortality rates in the US by race

Infant mortality rates in the US by race

Since 1980, the US infant mortality rate has dropped from 12.6 deaths/1,000 live births to 6.17. This is okay (though it should be noted that we rank as having the 55th lowest rate for the wealthiest country on the planet). This rate takes on a new life when we break it down by race. For Non-Hispanic Whites, the infant mortality rate is 5.5 deaths/1,000 live births. For Non-Hispanic Blacks, the rate is 12.8 deaths/1,000 live births. We can see disparities again when we look at childhood obesity rates. At the conference I learned that for the first time, the national child obesity rate seems to be plateauing; yet for white, upper class children, this rate is actually declining, and for Hispanic and Black children, this rate continues to climb rapidly.

It is probably not surprising that health disparities are closely linked to what is termed, “the social determinants of health,” which can include everything from one’s education level to how close one lives to a landfill. It is important to remember that long histories of power inequality have led to many of these social determinants, and therefore, the increased health status of some groups over others.

In the United States, health disparities are certainly a reality. What struck me most at the conference, though, was a question posed at one of the panel discussions. The facilitator asked, “How can we combat health disparities, when the work requires that we give more to those at the bottom, while giving less to those at the top?” Though it caught me a bit off guard, this idea makes sense. Have-nots need more resources and support so that they can “catch up” so to speak, to the Haves. Though similar, this is not exactly Robin Hood logic. The rich wont necessarily be loosing out so that the poor can gain. The way the question was framed insinuated this, and it made me realize that this is exactly how some people think of health equity work. Potential supporters can be turned off to a cause when it seems like they will be deprived of something. We have seen this argument come up again and again with the Affordable Care Act. Saying things like “they’re going to make us ration health care if everyone is covered” or “we will have to wait longer to get appointments” fosters this exact type of thinking. The problem is that we’re framing it all wrong.

We need to highlight that it is important to give those at the bottom more support than we give those at the top, not even because they deserve it, but because they need it and the people at the top do not. A salient example is one from Chile, where everybody is covered for health insurance. Their public insurance option is tailored towards equity as opposed to equality—those who need more support get more support and those who need less support, well, they wont be missing out on any free services, because simply put, they don’t need them. New mothers in the lowest income bracket receive, among other things, free baby carriages. If the health sector were to view patients as equal, they’d give these to the wealthiest mothers, too. The majority of mothers in higher income brackets would probably not take the low-cost baby carriage, if they can and want to buy one of their choosing. Equity, on the other hand, still means that all mothers can and will have baby carriages, but that we should be intentional with how resources are delivered, targeting those most in need.

So, how can we in GlobeMed at Tufts use this idea of framing to combat health disparities with our partner organization, PHASE Nepal? Right now, we are fundraising through our individual giving campaign. So far we have raised almost $4500 for, our project right now, which is hitting an important determinant of health: that of childhood education. PHASE Nepal will take the funds we raise this year and hire a teacher trainer, who will work with currently employed teachers in elementary schools in the communities that PHASE serves. This trainer will help teachers utilize methods to foster creative thinking and problem solving among students of Nepal. He/she will also support child clubs, which operate as extracurricular forums for the children to play, learn, do local development projects such as planting gardens, and talk about child rights. Additionally, we envision the formation of a health curriculum to be taught as supplementary material in the Child Clubs, so that these children can begin to learn about the importance of having a healthy body and mind.

When we think about how to bolster our fundraising efforts, we need to be able to discuss how the situation in Nepal came to exist, and about the power structures that perpetuate such inequalities. When we talk about this stuff, we have to know how to frame it in a way that will help us build support for our chapter, PHASE, and the global health movement at large.

To learn more about PHASE’s work, please visit http://phasenepal.org/

To donate to our project, please visit https://www.globalgiving.org/projects/child-health-education-program-in-nepal/

Rachel Weinstock is a senior majoring in Anthropology and Community Health. She is a member of the policy team.

Article 25 Speakers

On Sunday, Tufts GlobeMed chapter will be travelling down to the Boston Common to be a part of the Rally For the Right To health, a very exciting event that many of our members have been tirelessly working on for the past several months! At the rally there will be several exciting and prestigious speakers including Professor Brook Baker and Don Berwick. Some highlights of their decorated careers are as follows:

Brook Baker is a professor at Northeastern University teaching courses in Global HIV/AIDS Policy seminar, and disability discrimination law. The focus of his work is on movements that advocate for universal access to treatment, prevention and care for people living with HIV and AIDS. In addition, he is a senior analyst Health GAP (Global Access Project).

Don Berwick has had an extensive and meaningful career in public health including being the Administrator of the Centers for Medicare and Medicaid, President and Chief Executive officer for Institute for Healthcare improvement and worked directly on both the Massachusetts health care reform and the Affordable Care act. He has worked tirelessly to bring equality to the American health care system and improve access to health care for all.

So on Sunday, cancel whatever you may have planned, grab a friend, and head down to the Boston Common for a day of advocacy, action and incredible speakers! (Plus, I hear the weather is supposed to be beautiful!)

Adrienne Caldwell is a sophomore majoring in Biology and Psychology.  She is a member of the Communications team.  

“You’re Putting Him on a Motorcycle?”

It was Wednesday, and I was sitting under the merciless Nepali sun, my pasty Irish complexion slowly roasting to a crisp red, chatting with the ladies of grade eight by the football field. Just as I started to contribute to the turning of the Bhalchandra School rumor mill by inquiring about a hush-hush puppy love courtship among two of the eighth graders, one of the younger players howled; I turned to see him stumble toward the edge of the field,  a limp hand dangling awkwardly from an outstretched arm. Nick, stopping the play to address the wailing, sat him down on a shady stone and asked what had happened. He continued to moan, the slack hand was becoming more apparent. The sleeve of the sweater (yes, he was wearing a sweater playing soccer as I sit on the sideline sweltering) was sheared to expose the damage: a grotesquely apparent, shouldn’t-be-there kink contorted his frail forearm.

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Pre-Break: Ominous walk to the soccer field.

I turned and trotted down the main/only village road, looking into all the local tea houses hoping that I would stumble upon Kriti, the closest medical care provider. Kriti is a 21-year-old Auxiliary Nurse Midwife (ANM) in training, completing her On-the-Job training of five months under PHASE while living in the village. We had shadowed her days before at a nearby outreach clinic that she mans on a weekly basis, a sparse but clean and efficient one room medical office in which she saw patient after patient, most of them older men and women who came for follow-up visits to refill medication and track symptoms. No emergencies to be seen that day. We later learned that some of them had to walk significant distances to reach the outreach clinic, despite their age and ailments. The outpost is of great value, as the next provider, a larger medical post, is about a half hour walk up the road. Stumble upon Kriti I did, discovering her in the canopy of a tree off the side of the road about a third of a mile away from the incident. She was hacking away at the highest branches.

“KRITI, SOMEONE BROKE THEIR ARM IN HALF.” My rushed and slapdash-shouted English was hard to follow (even more so than my usual quick diction).
“Okay.”
She continued to lop off branches.
“KRITI,” more slowly this time. “SOMEONE BROKE THEIR ARM IN HALF.”
“Ooo.”

I pivoted and ran back, with Kriti (I assumed) following. It was her last day in the village, as she had just completed her training, and was set to return to Kathmandu the next morning. I arrived back at the scene to find that a crowd had gathered around the broken boy. Several of the onlookers decided to take a more hands-on role in the situation, and one woman (who we later found out to be the aunt of the boy) was massaging the break. As Nick and I tried to disperse the crowd and prevent any more fracture-kneading, I asked if anyone had called an ambulance. There were a few confused nods, confirming my suspicion that no, no one had called an ambulance. While in the states, there would be no question as to whether an ambulance would have been called, or at least a car prepared to take the boy to the hospital, it was a question without any definite answer in Rayale.

This, upon reflection, sheds light on the true meaning of the frequently discussed community health buzzword of accessibility. In places even as rural as the small village of Manadhova, which, thanks to it’s proximity to Kathmandu and the frequent buses to the nearby city of Panauti, is not considered very rural by many standards, accessibility is simply too limited to ensure quick care for real medical emergencies. We were in luck to be close to the main road and within a 5-minute walking distance of Kriti and her house full of supplies. While the boy was soon whisked away by motorcycle to a hospital about an hour away, the time elapsed between fall and arriving at the hospital was, as precisely as I can remember, a very, very long time. While there is an ambulance that services the area, it takes, at minimum, half an hour to arrive. Having traveled to some of the students’ homes higher in the hills of neighboring villages, it’s clear that a more immediate medical emergency in a harder to reach area (of which there are very many) could not be handled as straight forwardly and as quickly.

Before the boy was tossed atop the bike, Kriti soon arrived, looked at the arm with a empathetic mien of pain upon her face (precisely the same face as Nick displayed upon seeing the arm) and took a (painfully) bumpy walk with the boy to her nearby place of residence as she held a make-shift notebook-and-string splint. There, she quickly addressed the arm with a expertly-applied sturdy cardboard splint and a gauze sling.

The broken-arm incident naturally made the idea of the lack of healthcare accessibility a very clear one. While, in places like the U.S., financial barriers are often the ones preventing needed care from being received, we witnessed a situation where the geographical obstacles were the more immediate concern. Even without a single thought to the financial aspect of care, the boy probably could not have received care any more quickly. Of course, in places like this, both financial and geographical barriers are hinderances to receiving proper and needed care.

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Nick, what do you got there?

A few days later, Nick and I trudged up a steep and rocky hill not without difficulty a ways away from the football field to the home of the boy; it was certainly not an easy walk. His hand and fingers were shades darker and clearly very swollen on the broken side than on the non-broken side, and he told us he didn’t feel any better and that the pain hadn’t subsided. He would be out of school for two months due to the injury (it was his writing hand, and, moreover, the walk to school was not a short one). In the same room, his incredibly petite and very elderly grandmother lay bedridden and unexpectedly talkative, a outmoded-looking green tank providing her oxygen through a nasal cannula. As I sat on the bed by her, I wondered how they got the tank, and her, down and up the steeply rugged path to the house; yet another medical concern exacerbated by the hard journey to the closest provider.

Morgan Jordan is a junior majoring in Biology and International Relations.  She is the Director of the Finance team.