Author: internationalhealthstudents

I have been a registered nurse with over 15 years of experience in healthcare. I returned to school and was awarded a graduate degree in public health from Kent State University in 2013 with the desire to serve vulnerable populations. For reasons I am unable to explain I had the desire to travel to Africa. I served as a volunteer in 2013 and 2014 with two local Kenyan community groups, Project Mabawa and Victoria Sports Association. As a result of working with and learning from richly spirited, yet economically deprived at-risk youth in Kenya, I was inspired to develop GSYE (Global Society for Youth Empowerment), a charitable foundation earlier this year to offer increased support. We have on a small scale provided funding for education, financial resources, hygienic and self-care supplies, as well as guidance in helping young women and girls develop self-esteem. One of my immediate goals is to decrease the high rate of early marriages and pregnancies for young women. In the spring of 2015, I will be traveling to Zambia to continue working to empower young women and girls. Currently, I serve as adjunct faculty at Cuyahoga County College’s School of Nursing and volunteers with LEAF, a program providing support to families of prisoners, and the YMCA Youth Achievers Program, guiding at risk youth. My areas of interest are:  Environmental Impact on Health (utilizing mapping to explore and determine use of limited resources)  Global Health/Women’s Health/Empowerment of Women and Children  Social Networks and Health Behavior

Urban Jungle by M. L. Tatum

by internationalhealthstudents, posted in APHA IH Section

I returned to Northeast Ohio for a brief visit and was feeling a bit nostalgic; however, I did not stroll through my childhood neighborhood with the same ease of once upon a time ago. I felt a bit apprehensive. With an expressionless face, I kept my head up, looking straight ahead, and making no eye contact, this just did not feel right; it felt so wrong being on guard. What happened?  I am missing the past when neighbors use to watch out for each other. It was okay for strangers to wave and even engage in verbal interactions. What has happened to this once—thriving, working class community? It’s difficult to imagine the beauty of manicured lawns, various flower shrubs, and fruit trees, or the streets filled with vibrant life, as children played ball or hide and seek.

The term “urban jungle” adequately describes the unaesthetic appearance of dilapidated homes, storefronts, and gas stations in need of repair. Not to mention, the abandoned buildings with exposed frames (I assume this is from random people ripping off the siding for quick cash), missing window frames and doors, allowing access to anyone wishing to enter, the yards with overgrown grass and shrubs. It’s a bright beautiful day, but these streets appear dim with an overcast of gloominess.

Urban decay is a public health nightmare. Moreover, the number of related health issues that need to be addressed are overwhelming, including, but not limited to: teen pregnancy, substance abuse, inadequate nutrition, food deserts, gun violence, obesity, lead poison, HIV cases, high school drop- out, unemployment, single parent homes, crime, and the list goes on. In this particular urban community, the land area is 3.09 square miles with 5,782 persons per square mile, in contrast to 282 persons per square mile in the state of Ohio (U.S. Census Bureau, 2015).  According to the most recent US Census Bureau report, the median household income in 2009-2013 for this community was $20,577. Forty two percent of the population lived below the poverty level during this time, with only 33% of the residents owning their home.

Sadly, this is one of many “urban jungles” within the United States that is in need not of destruction, but support. Those who empathize and have the skills should offer assistance to community leaders who are struggling to make a difference.

Potential can, and does, exist anywhere and everywhere. Even in this urban blight, I can see a few community gardens trying to produce edible foods in between abandoned buildings, an adolescent engaging with an elderly man, and a woman picking up trash along the street. These are the stakeholders who would benefit the most from support in such communities.  As humanitarians, it would behoove us to engage, inspire, and assist those who desire positive change, for these communities to thrive once again.  It would not only benefit the immediate community, but us as a nation, overall.urban blight

Modern Day Slavery: A Public Health Concern?

by internationalhealthstudents, posted in APHA IH Section

Guest Blogger: Carli Richie-Zavaleta

Social Justice in Public Health

Dan Beauchamp’s professional and academic works have established a legacy of connecting public health with social justice. It was during my first year of a graduate program at Drexel University School of Public Health when I was introduced to the framework of Social Justice in Public Health. Through Beauchamp’s social justice framework, we—public health students, practitioners, and researchers—are challenged to rethink our approaches to public health practice. He challenges us to dismantle the social structures of society and examine health disparities. His framework is to analyze health disparities as consequences of a lack of an ethical approach to the protection of the health of those who have limited or no social, political and economic power in society. Recognizing these social structures that benefit those in power and create disproportionate health disparities among vulnerable subgroups of the population is the first step. Secondly, it is not enough for Beauchamp to merely illuminate the health disparities in society. For him, being a public health doer is a collective movement that struggles politically to restructure fundamental systems of justice.

As I have experienced graduate school here in Philadelphia, Pennsylvania, Beauchamp’s framework has resonated with me more and more. It has pushed me to rethink my public health doing in terms of finding approaches that continue to create collective definitions of public health that prevent health disparities. More importantly, it has challenged me to begin seeking a greater understanding of policy creation—one that would be effective at protecting those who are vulnerable due to health disparities.

Modern Day Slavery and Public Health – The Connection

It was twelve years ago when I first learned about Modern Day Slavery (MDS). It was through reading “Disposable People New Slavery in the Global Economy” by Kevin Bales (1998). MDS, commonly known as Human Trafficking or Trafficking in Persons, is a global issue that is found in most corners of the world—most likely in your own locality. Research of MDS victims’ vulnerabilities (qualities that put victims at higher risk prior to their experiences), speaks loudly of the inequalities and health disparities these people are burdened with, prior to their victimization (See Supplementary Reference List[i]). Here lies the call for concern for public health doers: to create a collective concern for MDS in our field, as a preventable social peril, especially for those who are most vulnerable. In addition, in our attempts to narrow the gap of health disparities, it raises the need to prioritize the creation of policies and accountability of said policies to protect the lives of those who are disenfranchised in our communities, including the United States of America.

No easy solutions exist to address social perils; yet, the history of mankind demonstrates that when collective forces unite their voices, talents, and resources, change happens. Examples of achieved social change in the context of the US are the African American man’s right to vote, a woman’s rights to vote, and more recently, the unconstitutionality of DOMA (Defense of Marriage Act). In the international context, the creation of the Universal Declaration of Human Rights, the Millennium Development Goals, and now the working of the Sustainable Development Goals are also great examples of collective movements that have forged new paths of justice and protection of human rights.

When I first learned about the social peril of MDS, I was hopeless and overwhelmed to say the least, but I have come to develop new perspective. I have seen through my professional and academic background that beginning with our locality, we can move forward to create change. California was the first state in the US to define MDS at a state level. This was a collective effort of local committed citizens, MDS survivors, non-for-profit organizations, and governmental agencies that came together to create a state-level definition of Human Trafficking. The goals were to be able to prosecute the Human Traffickers, but also to increase the protection of victims, to provide more financial resources to victims, and to create programs that focus on assisting and providing victims autonomy once more. The latter resulted in the creation and the passing of CASE (Californians Against Sexual Exploitation) with over 10 million votes! As I witnessed and participated in the process as part of this movement in my locality at the time, San Diego, California, I developed an approach to engage in social change:

CRZ graphic

The above model is not a simple one. It requires at the very least a commitment to the cause, time, and resources; nonetheless, that is what we are being challenged to do when we want to be doers of Public Health.

My hope is that you join me in the collective construction of MDS as a concern in the Public Health field in our localities. As we join together, we can propagate a culture of social justice that translates into the narrowing of human right violations and health disparities. As a MDS survivor put it, “…in the fight to abolish [MDS] we all stand in Unity! There is no big I’s and little U’s”.[1]

[1] Supplementary Reference List

  1. Bean, L. J. (2013, June 26). LGBTQ Youth at High Risk of Becoming Human Trafficking Victims. Retrieved June 14, 2014, from Administration for Children & Families: http://www.acf.hhs.gov/blog/2013/06/lgbtq-youth-at-high-risk-of-becoming-human-trafficking-victims
  2. Greenbaum, V. J., and Crawford-Jakubiak, J. E. (2015, March). Child Sex Trafficking and Commercial Sexual Exploitation: Health Care Needs of Victims. Pediatrics , 566-574.
  3. Greenbaum, V. J. (2014). Commercial sexual exploitation and sex trafficking of children in the United States. Current problems in pediatric and adolescent health care , 44 (9), 245-269.
  4. Hodge, D. (2008). Sexual trafficking in the United States: a domestic problem with transnational dimensions. Social Work , 53 (2), 143-52.
  5. Oram S, S. ̈. (2012). Prevalence and Risk of Violence and the Physical, Mental, and Sexual Health Problems Associated with Human Trafficking: Systematic Review. PLoS Med , 9 (5), online.
  6. Polaris Project. (2014). Human Trafficking The Victims. Retrieved May 10, 2014, from Polaris Project: http://www.polarisproject.org/human-trafficking/overview/the-victims
  7. U.S. Department of Health & Human Services. (2013, June 26). LGBTQ Youth at High Risk of Becoming Human Trafficking Victims. Retrieved June 14, 2014, from Administration for Children and Families: http://www.acf.hhs.gov/blog/2013/06/lgbtq-youth-at-high-risk-of-becoming-human-trafficking-victims
  8. Walk Free Foundation. (2015, April 17). Findings. Retrieved May 20, 2015, from Global Slavery Index: http://www.globalslaveryindex.org/findings/

[2] Miller, D. (2013). I have a dream. In A. C. Richie-Zavaleta (Ed.), Unheard Voices of Redemption Transforming Oppression to Hope (p 125). San Diego: Justice Press. (Original work published 2013). http://justicepress.net/home.html

carli pic

 Arduizur Carli Richie-Zavaleta, MASP, MAIPS, DrPH(c)

Carli grew up in Mexico City and immigrated to the US at age sixteen. She has worked as a professor of Sociology, medical interpreter, program director, field researcher, and mediator with diverse populations in the United States and abroad—from children to adults with a range of socioeconomic, cultural, and racially diverse backgrounds. Since 2010, Carli has focused her energy on conducting social research on human trafficking in San Diego, California, as well as volunteering for non-for-profit organizations that reach out to victims trapped in sexual exploitation. Her research and advocacy work in San Diego, California culminated in the publication Unheard Voices of Redemption Transforming Oppression to Hope (2013)—an anthology of creative writing and essays from victims and those who advocate in ending Modern Day Slavery (MDS). Carli is currently a doctoral candidate in the School of Public Health at Drexel University under the department of Community Health and Prevention. Her doctoral dissertation focuses on understanding the experiences of MDS survivors in the health care settings with the aim to create feasible and viable intervention programs to identify and assist potential victims.

Water is Life by Mary Louise Tatum

by internationalhealthstudents, posted in APHA IH Section

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Water is the essence of life. Your body is mostly composed of water, approximately 60% (water.usgs.gov/edu/propertyyou.html).  As a result, without water you would cease to exist. Yet, 1.1 billion people lack access to safe drinking water (World Health Organization). The World Health Organization (WHO) and United Nation’s Children Fund (UNICEF) Joint Monitoring Programme (JMP) for water and sanitation defines drinking water as: water with microbial, chemical, and physical characteristics that meet WHO guidelines and are used for drinking, cooking, and personal hygiene. The collaboration further defines access to safe drinking water as a source that is less than 1 kilometer away from place of use and reliably supplies 20 liters per household member daily (http://www.who.int/water_sanitation_health/mdg1/en/).

One of the natural wonders of the world, Victoria Falls, located in Zambia, has approximately 625 million liters of water flowing over its edge per minute (www.victoriafalls-guide.net/facts-on-victoria-falls.html). During the peak flood season, the Falls create a thunderous roar and drench all that is near. Nevertheless, UNICEF reports 4.8 million—approximately one third of the population— Zambians are without access to clean water. Moreover, insufficient drinking water and poor sanitation in the country have contributed to over 800,000 deaths related to diarrhea alone (not including other illnesses related to water issues) (World Health Organization).

In another part of the world, in the mega-city of São Paulo, Brazil, residents go days at a time without water. How did this happen to a country with access to the Amazon River, industry, a bustling tourist industry and sandy beaches? The Amazon River, the world’s largest river by volume, supplies  Brazil its fresh water, yet due to urban growth, poor city planning, leaking water reservoirs, destruction of forest and wetlands, and pollution, there is a lack of safe water for drinking, cooking, and personal hygiene (Nations, 2015) . As a result, water is now being rationed and some residents may be allowed access to water only biweekly.

Unfortunately, the extent of water issues is not limited to merely a few, but is increasingly becoming a global issue impacting many—including the developed nations. Case in point, the western region of the United States of America, specifically California, has been experiencing increasing drought issues for years. In fact, it has gotten to the point that policy and regulations are being considered and implemented to limit use of water with fines for noncompliance.  It will be interesting to observe how the United States, who manages numerous water programs in developing nations, resolve this issue.  This is a nation of people who, for the most part, are used to having free access to water for not only basic needs, but also luxuries. And now many Americans may have to face not only regulations restricting their use of water for swimming pools, lush green lawns, washing cars, skiing, and other recreational activities, but they may also have to deal with the more serious issue of having affordable foods as the water shortage impacts the agriculture sector. It has already been estimated that California will lose $2.7 billion this year due to the current drought issues (U.C. Davis Research Project). In addition, they may have to deal with the possible increase of disease, such as West Nile Virus, and the difficulty of dealing with wildfires due to water shortages.

Of course there is much discourse regarding who or what is to blame for the impending water shortage in the US.  Is it the pollution distributed into the air from numerous factories, vehicles, and farms or is it just a natural occurrence which would occur regardless of human action? Is it archaic water regulations that have not kept up with the diminishing supply of water, or is it our disregard and misuse of what we think is a never-ending supply? Regardless, we are no longer hypothesizing about the lack of water. At least 40 million Americans are actually experiencing the reduced availability of water.

Now that the problem is no longer afar, but at our front door, what do we do?  This issue is not just an issue out west in the US. It is a global issue that will continue to worsen as the population of the earth increases. So now is the time for everyone, whether directly affected or not, to wake up and to encourage not just policy makers, but each of us to make behavioral changes and be more conscientious on our use and waste of this precious resource.

Cultural Challenge of Female Genital Circumcision by M.L. Tatum

by internationalhealthstudents, posted in APHA IH Section

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A very basic definition of culture is the cumulative deposit of knowledge, experience, beliefs, values, attitudes, meanings, hierarchies, religion, notions of time, roles, spatial relations, concepts of the universe, and material objects and possessions acquired by a group of people in the course of generations through individual and group striving (Hofstede, 1997).

Undoubtedly, most humanitarians, community workers, and public health specialists would be able to supply a sufficient definition for culture. The words may vary somewhat, but the basic concept would be the same. However, how many of them truly grasp the vitality of this definition? Moreover, truly value why various practices or beliefs came to be and have continued for generations even in today’s fast-paced and shrinking world with advances in technology, increased availability of education, increases in family income, et cetera.

One cultural practice common in parts Africa and a part of the Middle East is the practice of female genital circumcision (FGC). FGC is believed to have been initiated in the fifth century B.C and continues today, affecting an estimated 2 million girls annually (Shah, Luay, & Furcroy, 2009).

FGC is a coming-of-age tradition for females which takes a variety of forms. It includes the partial or total removal of the external female genital, near complete sewing-up the vagina with only a small opening for urination and menstruation, introduction of corrosive substances into the vagina, and other injury for non-therapeutic reasons (WHO, 1997). Some of the biomedical consequences include infection or hemorrhaging which can lead to loss of life, bowel and bladder incontinence, painful intercourse, and complications with childbirth.

Many persons would consider this to be an atrocity and defilement of girls; as a result, there has been a great deal of global support to implement programs and various interventions to support the cessation of this act. However, termination of FGC continues to be an uphill battle.

I believe us, as professionals, sometimes, do not grasp how deeply ingrained FGC is believed to be necessary in the preparation of a young girl for womanhood. The roots of this practice are so deeply psychologically and emotionally based that families have risked breaking judicial law to continue preparing their child for womanhood. For example, Kenya’s Children’s Act of 2001 made it illegal to subject girls to any form of FGC; consequently, it is believed that practicing tribes are now performing the act secretly, to decrease the risk of being imprisoned. This theory has been supported by people being caught in the act or dealing with girls who are infected or bleeding after going through the procedure (Library of Congress, 2011). What’s more, families who have migrated to Europe and the United States bring their daughters back to their country of origin when they come of age to have this procedure performed.

The complexity of cultural beliefs and their unseen components are sometimes difficult to conceptualize, thus, making it challenging to influence health behavior change. FGC is not just a physical alteration to the body; it is a celebration among friends, mothers, grandmothers, aunts, cousins, and neighbors. It means the individual has now graduated to the next level. She is now of age and ready to progress to the next stage in life. Yes, female genital mutilation is a procedure with unfortunate consequences and it should be addressed by community workers, public health professionals, and humanitarians. Nevertheless, we have to proceed respectfully and view cultural practice in a holistic manner to be effective in implementing sustainable behavioral changes.

The Severity of Racial Health Inequities

by internationalhealthstudents, posted in Guest Blog

Guest Blogger: Tiffany Gilliam

African American women are more likely to succumb to negative health outcomes than any other race or ethnicity. Health inequities are classified as the differences in health status between one disadvantaged population and a group of advantaged. Numerous social determinants of health are related to health inequities, such as:

  • Socioeconomic status
  • Education
  • Age
  • Sex
  • Race and ethnicity
  • Lack of access to quality healthcare

These factors also increase the risk of cardiovascular disease, high blood pressure, diabetes, strokes and healthcare inequity. Nearly 50,000 African American women die each year from cardiovascular diseases. There is a significant gap in life expectancy for African American women compared to white women.

Research has shown that larger populations, like those found in metropolises, correlate to wider gaps in life expectancy. The county of Philadelphia is one of the most racially diverse counties in the United States. That same county contains one of the most racially segregated cities in terms of access to quality healthcare and positive health outcomes. The Philadelphia population is estimated at 1,560,006 residents: 44.2 per cent of which are African American. A recent study conducted by the University of Pennsylvania examined the patient ratio to primary care physician (PCP) in low socioeconomic neighborhoods. The study revealed a PCP ratio of 3,000:1  in underserved areas of Philadelphia. Given this PCP a question is raised regarding the level of care provided to patients. The patient to primary care physician ratio is high due to several reasons such as shortage of primary care physicians, increased amount of Affordable Care Act-covered patients, and the high density of elderly and chronically ill in underserved areas.

In a recent conversation with Sheila, my esthetician, she stated a previous diagnosis of ovarian cancer. The physician immediately advised a treatment of chemotherapy, without any willingness to answer questions or provide additional information.

Before that treatment occurred, however, Sheila received a second opinion from another physician, which revealed that she suffered from endometriosis, not ovarian cancer. After this conversation, numerous questions were raised.  How many other African American women were misdiagnosed and treated for illnesses they did not have? Why was it so difficult for the doctor to make an accurate diagnosis? How often are doctors encouraging participatory medicine when interacting with patients?

How can public health clinicians improve negative health outcomes amongst underserved African American women populations? It is crucial that health polices are created to enforce the overall well-being of African American women of disadvantaged populations. Health policies that promote affordable education, employment opportunities, and adequate accessible health promotion programs are needed in order to improve fair and equal treatment, along with disease prevention and detection.

 Tiffany Gilliam is a first year masters student in Public Health at La Salle University, with a focus in Maternal and Child Health, Social and Behavior Sciences and Health Equity. Her academic interest includes Global Health, Reproductive and Sexual Health and Public Health Policy. For the past three years, Tiffany has worked as a Behavioral Health Worker at Northeast Treatment Center, providing coping strategies, social skills, methods to reduce impulsive behavior at school to children with Attention Hyperactivity Deficit Disorder (ADHD), Oppositional Defiant Disorder (ODD)/Conduct Disorder and Mood Disorder.