Tagged: maternal child health

Five Radically Different Approaches to Women’s Health

PSFK-Boring-James-Ward

So often, public health interventions are boring — recommend more education, evaluate an existing program, come up with a list of resources….yawn.

But although they don’t always make headlines, there are lots of fantastically innovative people working to improve women’s health. I’m always excited to see these types of projects which have the potential to do so much good.

Here are five truly different approaches to improving women’s health:

  1. Naturopathic Oncology. Seems like a contradiction, right? Wrong. I’ve been intrigued by efforts to initiate more natural approaches to cancer treatment ever since I researched breast cancer activism in graduate school and met the woman who started this  great project. But apparently, naturopathic oncology has started to take hold in the more mainstream medical field, and the Seattle Cancer Treatment and Wellness Center actually has naturopaths on staff.
  2. Cultivating and caring for “mad gifts”. The Icarus Project has a completely unique approach to mental health. Rather than calling it “mental illness” they “envision a new culture and language that resonates with our actual experiences of ‘mental illness’ rather than trying to fit our lives into a conventional framework.” So important, and so rare.
  3. Midwifery and fertility services for the rest of us. Not surprisingly, most prenatal care is very straight-oriented. But Maia Midwifery takes a different approach, prioritizing the needs of queer families. I love that the approach is so radically different from some of the overly granola earth-mama stuff that is part and parcel of most midwifery practices. Also in California is ReCLAIM Midwifery, which focuses on transgender health. This is true innovation, but it will probably be a very long time before this approach is incorporated into mainstream prenatal services.
  4. Real sex education. Rather than the lip service paid to sex education that happens in schools, Scarleteen is a resource for teenagers that provides a wide range of resources. Created in response to 1998 abstinence only policies, the site uses message boards, tweets, Tumblr feed, SMS (and Facebook and even Pinterest)  to connect with its audience, and has zillions of real life questions and answers. I hope it’s still around when my four year old is a teenager.
  5. Telling and talking. Speaking of four year-olds, after a completely useless preschool lesson on Martin Luther King Jr. (my son learned that King “changed our world” but had absolutely no idea why or how) he told the teacher that  he would like to learn about where babies come from. Awkward. We took a trip to the library afterwards, and I satisfied his curiosity with a picture book called It’s so  Amazing. But this isn’t the end of these types of questions, so  I’m excited about  this series of books developed specifically for families with children conceived with donor assistance.

What about you? Have you heard of exciting, cutting edge programs or innovations in women’s health?

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Giving up butter is just the tip of the iceburg

Hmm...maybe I could just sculpt with it?

Hmm…maybe I could just sculpt with it?

So, I went to this yoga class a couple months ago at my local YMCA. The quality of the classes there is not consistent, but this particular one was pretty great.  The teacher gave a very insightful talk about self-care. Why, she asked, don’t we take better care of ourselves? Even when we have the tools?

It’s a good question. A new study about baby boomers and their health reveals that even though folks in their sixties have a lot of the tools they need to stay healthy, they’re taking scads of medications. Only 13 percent say they are in excellent health, a sharp decline from just a generation ago.

Why is this? One explanation might be that they have high expectations of health, and this shapes their perceptions.

How we define health is so crucial. Is it the lack of pain? The lack of illness? Is it the seemingly unattainable way the World Health Organization defines it?  If you feel healthy, are you healthy?

I’m not feeling that healthy.

I have no chronic health problems, I’m not on any medication, and I know how to cook healthy food.  I don’t have health insurance. If I had health insurance, would I feel healthier? Maybe.

But really, my main health problem is that I’m almost 40 years old and I still don’t know how to take care of myself. I mean, sure, I know how keep myself alive, but making my health a priority is a major struggle.

When I was experiencing post-partum depression, I had to  practically be dragged to the doctor’s office. Doing yoga is perpetually on my to-do list, but I only actually practice once or twice a month. I know meditation and breathing exercises are important, but I don’t make the time.

And my eating habits are terrible.

I am a lapsed vegetarian who used to be very health conscious about food. But over the past couple of years, I’ve  hit new lows. Greedily wolfing down the occasional cheeseburger. Settling for turkey hotdogs and mac and cheese for lunch. Pepperoni pizza at a friend’s house, because hey, it’s a birthday party! I’ve even flirted with a Diet Coke addiction. And yes, I’ve indulged in way too much cake.

Let’s just say I’m not experiencing quantum wellness.

Last month I did my own version of an elimination diet to establish  why the skin on my hands was acting crazy. Actually, I already knew why. It’s because I love butter.  I have a love/hate relationship with butter, ice cream and cheese. I love it, my skin hates it.

But on the off-chance that it was gluten or sugar or eggs or turkey hotdogs, I cut out all animal products, gluten and sugar  for an entire week. What happened next was not pretty. As much as I wanted to be peaceful and calm while I sipped my vegan smoothie and did breathing exercises, the perceived deprivation drove me batty.  I paced the kitchen like a caged animal most afternoons, stuffing my face with almonds and dates even though I wasn’t at all hungry.

At the end of the week I realized two things:

  1. I am totally addicted to sugar. I should probably quit eating it–I could even buy a new cookbook (I love cookbooks)– but I’m afraid I wouldn’t want to live if I couldn’t eat sugar.
  2.  I am definitely allergic to dairy products. After one week, the eczema on my hands went away. I started eating bread, eggs and meat and my hands were just fine. So I had some butter, and just an hour later, the eczema was back.

So, having figured this out, you’d think I’d just cut out dairy. And I did, for about one more day. But then I fell off the wagon. I  realized that I have no commitment to the dairy-free goal. Yesterday I ate cookies made with butter, cream cheese on crackers, and even pancakes made with whole milk. And now my skin is suffering again.

Yes, butter is good, but it’s not that damn good.

The whole experience catapulted me into the painful admission that I’m bad at taking care of my own health. It’s a complicated thing, with psychological as well as physical elements. I can find a million ways to justify abdicating responsibility for my health: Self-care is just a first-world indulgence. Becoming vegan is just way too bougie. I don’t have time. It’s no big deal. I have other priorities. I like to have the freedom to cook whatever I want. My family doesn’t want to give up dairy.

But in the end, all this rationalizing is really about avoiding  self-care. I’m cringing as I type. I hate self-care. It seems so corny. But hey:

Self-care is not self-pampering .

Self-care is not self-indulgence.

Self-care means choosing behaviors that balance the effects of emotional and physical stressors: exercising, eating healthy foods, getting enough sleep, practicing yoga or meditation or relaxation techniques, abstaining from substance abuse, pursuing creative outlets, engaging in psychotherapy.

Um, yeah. Choosing healthy behaviors is not exactly my strong point. Put like this, it makes me wonder, why am I so resistant to choosing healthy behaviors?

Apparently I think I need butter (and sugar)  to survive. I  really am afraid to give it up, because what the hell will that mean?  That I’m a person who practices self-care? Will I even recognize myself in the morning?

I’m not ready to define health as a complete state of social, mental and physical well being, since I doubt I (or anyone else, for that matter) will ever achieve that goal. But maybe it means choosing behaviors that are good for you more often than choosing behaviors that are bad for you. I’m starting to realize that actually, it’s impossible to be healthy without some good old self-care.

What do you think? How do you define health? Are you good at taking care of yourself?

Insourced

 

It’s been a rough year for workers in the US, with about 10 percent of the population unable to find a job, and many more not able to find enough consistent work. One sector that is consistently adding jobs is the healthcare industry. Since about 90 percent of healthcare support workers are women, and over half of new medical students are female, this should be great news for women, right?

Well…maybe. But maybe not.

In reality, the healthcare field is a complex and varied industry that often perpetuates inequality on a global scale. In her new book  — Insourced: How Importing Jobs Impacts the Healthcare Crisis Here and Abroad — Kate Tulenko exposes how global inequalities are reproduced by US immigration policy and lack of strong healthcare worker recruitment policy.

For example, almost 6,000 regions in the US don’t have enough healthcare workers, but recruitment of potential healthcare workers from these communities is rare. At the same time, a study in Malawi showed that there are more Malawian physicians in Manchester, England than in Malawi. Ironically, poor countries such as India and Malawi, invest a significant part of the income into training physicians and nurses who often go abroad because the pay and working conditions are better, meaning that the countries don’t even get a return on their investment.

 

The US facilitates this process by providing special healthcare worker visas to those seeking to immigrate.

Tulenko, the senior director of health system innovation at IntraHealth International, has worked both domestically and abroad and experienced many of these inequalities firsthand. She points out that when the US facilitates immigration of healthcare workers from these countries, it negatively affect health indices.

It is irrational and immoral to recruit health workers from countries where one in five children die before their fifth birthday when we could be recruiting and training workers domestically. Doing so would help our economy, global public health and the 314 million Americans who rely on our medical system to provide high-quality, affordable care.

This immorality crosses over into domestic policies as well, since many African American and Lation communities are served by transient physicians and nurses, who come to these communities to gan experience but rarely stay on longterm. Tulenko argues that recruiting healthcare workers (of all levels) from the communities that need them most could better serve disenfranchised neighborhoods in the US.

She  writes:

There are other casualties, closer to home. Every study that has examined how to incentivize health workers to move to underserved areas has shown that training people from these communities is the most cost-effective approach. But because we’ve essentially given up on recruiting from underserved places in the United States, we’ve made their chronic lack of health workers much worse. Some 54 million people live in the 5,700 parts of the country defined as “health professional shortage areas,” the communities with the worst health statistics and the worst unemployment.

Even with the high unemployment rate, there is often a healthcare worker shortage in this country. This shortage is attributable to a variety of factors: medical school (and post-secondary education in general) has become extremely expensive.

It’s similar to the so-called “skills gap” in manufacturing, described in this article. When manufacturing workers are paid only $10 an hour to do a complex job that requires they pay for training at a community college, they often find that financially they would be better off working at McDonalds.

At the same time that there is a growing demand for healthcare workers, the educational requirements have increased.  According to a report from Georgetown University:

The demand for postsecondary education and training in healthcare, already high, will continue to edge upward. In 2010, it was 81%; by 2020, it will rise slightly to 82%. For professional and technical occupations, however, that number rises to 94%. A bachelor’s degree will be required for 24% of all healthcare jobs, up from 21%  in 2010. This high demand for postsecondary talent in healthcare is second only to STEM and education occupations

Almost 90 percent of health support workers are women.

While nurses and other healthcare professionals are paid well, according to the report, 70 % of healthcare support workers earn less than $30 000. Soon, most of these jobs will require at least some post-secondary education, but there’s no guarantee that wages will go up.

Healthcare systems – like the economic system – are intertwined, we don’t live in a vacuum. This is an interesting example of the ways that the broken US healthcare system has spread its tentacles all over the world.

Friday News Roundup

Yep, it’s inevitable. Another week has come to an end. In health news this week:

  • Saturday is World Prematurity Day, which is very close to my heart since my son was born 12 weeks too soon. The US isn’t doing a great job in preventing prematurity, we’re currently 113th in the world in numbers of preterm births (?!). According to the World Health Organization, 15 million babies are born too soon every year. That’s more than one in 10 births — and more than one million of these babies die shortly after they are born. The WHO and the March of Dimes estimate that three-quarters of preterm babies who die could survive without expensive care if a few proven and inexpensive treatments and preventions were available worldwide.
  • Turns out that doctors with less than ten years experience spent an average of 13% more than more experienced physicians.  I like this study because it looks at how physicians — instead of patients — are responsible for escalating healthcare costs. This isn’t something that you hear very often.  =
  • Drug makers called “compounders” are to blame for the recent meningitis outbreak caused by fungal contamination in a steroid prescribed to people with back pain. These companies (like Ameridose, the company responsible for the tainted steroid in question) are essentially unregulated by the FDA. They have been supported by many in congress because their products are often an affordable alternative to huge drug manufacturers. One argument about regulation was that states should be left to do it themselves. This confirms my theory that whenever a government official makes a states’ rights argument, it is cause for concern.
  • A study of pregnant Medicaid recipients in 14 southern states found that African-American women were more likely than to have longer hospital stays and pregnancy complications. The study estimated that eliminating disparities in adverse pregnancy events could save between $114 and $214 million annually in Medicaid costs in the 14 states studied.
  • Access to contraception is a human right. Even the United Nations says so.

Have a great weekend! Meet you back here next week, when I’ll be posting about healthcare in-sourcing, premature birth, and sharing an interview with a wonderful doula and author!

 

 

 

Keeping it consistent when it comes to abortion

 

Have you heard about this case in Ireland where a woman  was denied an abortion and died as a result?

Savita Halappanavar, a 31 year old dentist, was 17 weeks pregnant with her first child. She began having severe back pain and was told that she was miscarrying. She then requested that her doctors medically terminate the pregnancy, but was denied because abortion is against the law in Ireland. She died of blood poisoning a couple of days later.

There has been worldwide media attention on the case, since it’s a situation where an abortion actually would have saved the life of the mother.

Ireland’s constitution officially bans abortion, but in 1992, the Supreme Court ruled  that it should be legal when a woman’s life is at risk.The government never passed a law to this effect, which means that Irish physicians are very reluctant to perform abortions, regardless of the circumstances.

In 2010, three women sued the Irish government in the European Court of Human Rights for denying them access abortions. The women each had extenuating circumstances: an alcoholic with four children, two of which were disabled; a woman undergoing chemotherapy, and a woman who had taken emergency contraception that had failed to work. The court found they had no right to abortions under the constitution, and their complaints were dismissed. However, the court also found that Ireland’s ban on abortion even in the case of life-threatening pregnancies was in violation of European Union law.

Halappanavar’s death coincided with the release of a  long-awaited expert report that recommends  possible changes to Irish abortion law. The report was commissioned by the Irish government   after the 2010 European Court of Human Rights ruling.

Currently, about 4,200 women travel outside of Ireland every year to terminate pregnancies.

I’m as pro-choice as they come, but you’ve got to give it to the Irish. They are so adamantly against abortion that they sought a travel injunction against a 14 year old who was raped by a neighbor and whose parents were trying to get her to England to have an abortion.

They refuse abortion in all cases. No matter what. No exceptions for rape, no exceptions for life-threatening conditions, no exceptions for the threat of fetal-alcohol syndrome, or neglect, or deformity caused by chemotherapy.

It ain’t pretty, but if you are against abortion, then own it.

They acknowledge that sometime women die when they don’t have access to safe, legal abortion. They have no problem with the fact that outlawing abortion means that  women and girls are forced to carry pregnancies to term and then parent children that are the product of rape when they are denied access to safe and legal abortion.

That’s the reality, and at least the Irish government is willing to take the fall out.

What do you think?

 

Irihs Times op-ed

Call the Midwife: Season Finale

Appropriate technology?

Yesterday my post about post-partum depression was featured on the BlogHer website! Wow!

This morning on my morning drive to work,  I heard a report on the BBC about a non profit called Global Advocacy, One Laptop Per Child.

The group gave tablet computers to poor children in Ethiopia with apparently stellar results.  In this particular region of Ethiopia, the children were particularly impoverished, did not read, and were not going to school. “We went in, gave them the tablets and walked away,” said Matt Keller, the Vice President of the Global Advocacy.

These kids are learning faster than they would be learning in school. When you give a child that tablet and all the other children in the community have the tablets, the children learn form each other, they teach each other, the dynamic is so intense that I have to say yes, it’s better than a classroom.

The story jumped out at me because as a parent, I am repeatedly warned against exposing my child to too much “screen time.” I just got an email from my child’s preschool teacher that cautioned television watching before bedtime, and in my social circles, dropping off a bunch of iPads to kids and then just letting them sit there and play with them all day would be seen as tantamount to child abuse.

What happens when toddlers zone out with an iPad? asks Ben Worthen in the Wall Street Journal, and concludes that the things aren’t good for his child because he goes into a sort of trance and it becomes a daily battle to get the boy to put the  thing down and go the fuck to sleep to bed.

Apparently they can be a great tool for kids with autism, cerebral palsy and various other disabilities. But table comptuers can also make it more difficult to sleep, and there is persistent concern about their effect on children’s brain development, attention span and learning ability.

In public health, we talk about providing appropriate technologies for the situation. Is dropping off a bunch of tablet computers to poor children an appropriate technology? Does it make sense in the context that they live?

Do we have different standards for the health of our own children and the health of other people’s children, poor children? Would we want this for our own children.

Paul Farmer talks about creating a preferential option for the poor, arguing that it is the role of the non-profit and charity world to charge themselves with offering the poor people of the world the same –if not better — medical care as wealthy patients in developed countries.

Idealistic? Yes. But it’s something that I always think about when new programs are rolled out or when a researchers is talking about their groundbreaking work in a poor country.

What do you think?

Have you heard about  One Laptop per Child ?Do you worry about whether too much “screen time” affects the health of your own child(ren)? Are there other programs that you know about that employ new technologies innovative ways? Tell me, I want to know!