Question

Families whether in Cambodia, India, Angola, Haiti, Peru, or Fiji are faced with different health care challenges unique to their communities’ conditions and resources. Approximately, thirty percent of the children in the global community don’t have access to adequate nutrition and hence experience stunting, while forty percent of women have anemia.   Nutrient deficiencies of iron, vitamin A and iodine affects close to two billion people, majority of whom live in the lesser-developed countries of Africa, eastern Mediterranean, south and Southeast Asia, and western Pacific. Food insecurity, defined as inaccessibility to sufficient and safe food for nutrient needs continues to be a major challenge for families. In times of natural disaster and economic downturn families with limited resources are most affected by food insecurity and pursuing health care conditions.

Although, the challenges of today’s global health care may seem insurmountable, a positive outlook is necessary. Current technology is supporting the search for new therapies based on human genomes, while children and adults are living longer. For instance, in 2000, the average life expectancy at birth in the US, an economically developed country, was 79.5 years for women and 74.1 years for men (Arias, 2002). Meanwhile, as we work to support the overall goal of health, which is the state of wellbeing, we need to reflect on the current challenges that require consideration from the individuals, families, communities and nations. Today, as societies develop economically they seem to experience higher rates of chronic diseases, while others who struggle with poverty continue to experience devastation from infectious diseases. The rise in violence and infectious disease along with the cost of chronic diseases, which is far beyond the resources of many countries and families, poses the need for a more global solution. For instance, obesity increases the risk of mortality for many causes of death. It is a risk factor for coronary artery disease, type 2 diabetes, cancer and some musculoskeletal disorders. Most of the increased risk is related to cardiovascular causes (National Institute of Health, 1998). In addition, obesity exacerbates many other health conditions. The financial burden of obesity in the US is $99.2 billion annually (Wolf & Colditz, 1998) comparable to the 1999 Gross National Income for Israel (World Development Indicators, 2001). The direct cost is estimated at $51.6 billion or 5.7% of the US health expenditure and the indirect cost is $47.6 billion. Today, there are no countries even the more economically developed ones with resources that can adequately treat chronic diseases. While, the current political and economic policies are not addressing the global burden of disease, families and individuals are less inclined to have the solutions, rather they just develop strategies to cope with the burden of the problem.

In addition to the burden of health care cost, families in many parts of the world are experiencing social stigma associated with certain diseases. For instance, with regards to HIV/AIDS individuals may not want to be tested because they don’t want to know that they have been infected with the virus. Once they know they have the disease, they would then have to hide it from their families, because it would bring shame to the family.   Such families are judged by the community because they are seen as having a family member who is either sexually promiscuous or drug user. In many parts of the world HIV/AIDS is associated with promiscuity or drug use. Also, since families don’t understand the disease, they may ostracize their members and even isolate them. They may have misconceptions; such as breathing the same air might result in getting HIV/AIDS. In regards to HIV/AIDS, the cost of the drugs may make it inaccessible to the families. In some countries due to the cost of the management of the disease, parents are not treated resulting in their death and orphaned children who become a burden to the extended family. Another stigmatized health care disease is tuberculosis (TB). Issues associated with TB for families are similar, in that TB is feared and dreaded disease. Historically, although severe chronic coughing indicated TB, it was known as “consumption”, because over time it gradually sapped all of the body’s energy, causing weight loss, consuming the victim, and resulting in death. In the old days if someone had TB they would be put in an asylum or shipped to an island. That was the only way a community could contain the disease. In many countries today, the older generation has memories of this experience. A number of these individuals today may be affected, but may not want to let their family know, so their family does not get ostracized resulting in them being removed from society or dying because of all the treatment.   People with active TB usually feel sick and are away from work for periods of time, affecting economic productivity. The challenge facing TB eradication is not the cost of therapy, because the drugs are inexpensive and readily available, but rather the method in which the drugs are prescribed and given to patients. If several drugs are administered in combination for 6-9 months then the cure rate is extremely high. If not, relapses occur and the TB becomes resistant. Resistant TB, especially in AIDS patients is very difficult to treat. The most successful treatment programs are to give the medicine in clinics or by trained health personnel and to actually observe and record that the patients are taking their medicines. These programs are called “Directly Observed Therapy” (DOT) programs. Today, lesser-developed countries have access to the medicines, but may not have the political will to effectively establish DOT programs. Also, practitioners who don’t understand TB are providing partial therapy and inaccurate diagnosis making the problem worst for the governments who seem to have great difficulty in controlling the private practitioner. In general, TB has to be controlled and monitored by a health authority. When diagnosed, managed, treated inappropriately, and not reported to authorities, a country cannot control it. When field workers are themselves affected, they also don’t want to report their TB. Non- reporting and mismanagement of cases are the major challenges of TB control today. Tuberculosis is the leading cause of death of any infectious disease in the world. Thirty-percent of the world’s population is affected by TB. HIV/AIDS is a growing concern with 40 million infected cases as compared to TB with 2 billion affected. Although, the relative number of HIV/AIDS cases is smaller than the number of TB or malaria cases, HIV/AIDS is devastating because it kills people in the prime of life, a time when they are most productive to society and are often caring for children. Malaria, like other chronic infectious diseases such as HIV and TB, also impacts productivity. Recurrent fever, body aches, anemia, and fatigue associated with malaria often lead to loss of work. Children and pregnant women are particularly at high risk for severe disease. For children, recurrent fevers, anemia and anorexia lead to malnutrition and stunted growth. This in turn makes them more susceptible to other diseases. Today, the combination of malnutrition, malaria and diarrhea is a major cause of mortality in children.

In-Class Participation Assignments

Ghanaian Case study

In Ghana, West Africa in a rural community 50 miles from Accra, the capital city, a family from the Akan tribe lives with their 5 children in a home with no electricity and water from a nearby well. The youngest child who is two-years old is on his third bout of malaria and his belly is swollen because his liver and spleen are enlarged. He has not been eating well and has had recurrent fever. His last visit to the medical center indicated severe weight loss, which caused real concern for the mother whose one-year old niece had recently died. The mother worries about her son not eating well. With the rainy season he has had a bad case of bloody diarrhea and feeling very lethargic. The health center is 50 miles away and with 4 other children at home, she can’t take him back again to treat his bloody diarrhea. The danger of the disease is unknown to this family, especially since malaria can kill within 24 hours if it is not treated. Although health care officials in Ghana realize that malaria is more deadly than HIV/AIDS, because it can kill people faster, families tend to downplay it because they have lived with it for many years. The Ghanaian health authorities report on average more than 40% of all outpatient visits in Ghana are from malaria, with about 10% being hospitalized. In addition, 22% of all mortalities in children less than five years of age and 13% of all mortality cases are due to malaria with impact on families (http://www.africaonline.com/site/Articles/1,3,50591.jsp). According to Dr. Carol Baume of Academy of Educational Development (AED) "More than one million people die each year from malaria, most of them children in Africa. Controlled field trials show use of treated nets can reduce childhood mortality by 25 percent." These nets, which are treated with insecticide, have a high cost to the public sector in Africa (estimated at $450-$600 million/year) and so far it has prevented its accessibility to the families such as the family in Ghana (http://www.aed.org/news/news_release_NetMarkMalariaStudies.html).

Indian Case Study

Bandhura, meaning pretty, is the name of the oldest daughter of the Dalai family in a small village in the state of Orissa in Central India. Bandhura lives with her four sisters in a poor family who has always subsisted on agriculture. Despite the poverty, Bandhura’s father has the responsibility to obtain dowry for each of his daughters to facilitate their marriage. Historically, dowries were practiced in the Brahmanical Hindu society, however, today even though her family is from the shudra (lower caste), her father is required to obtain dowry to marry his daughters. One day during the dry season, when the rain was scarce and the crop production was low, Prakash arrives in the village to employ girls to work in a craft business in the nearby town. The villagers take Prakash to Bandhura’s father thinking that he might need to send his daughter to raise money for her dowry. Prakash promises Bandhura’s father that his daughter will engage in local craftwork and will surely learn a skill that can support her after she returns home. Bandhura is taken away in the back of a mini truck along with couple of other girls who were in similar situation to the nearby town and prostituted. In this and other similar towns truck drivers stop at the prostitution houses to relieve the stress of their travel by engaging in unprotected sex and transmitting HIV/AIDS at a rapid rate along their journey to young girls. In a short time, Bandhura gets HIV and decides to return to her village. She feels ashamed and does not want to tell her father the reason for her HIV. She along with a number of other women have been trapped in these prostitution rings without control over their destiny. Today, Bandhura is one of 4 million adults in India who are infected by HIV/AIDS.

Case Study Discussion Questions

1.     What are the options for both the West African and Indian family in regards to their health care challenge?

2.        For each case study describe how cultural beliefs and attitudes might influence the family’s response to the health care issue.

3.      Please describe which of these theories (human ecology, family systems, and social construction) might be used to frame the experience of each of these families?

Answer 1

1 . Children nearly about 30 percent , do not have adequate food and hence suffers from stunting . Around 40 percent of women suffers from anemia.

Nutrient deficiencies are also noticed specially that of iron , vitamin A and iodine .

Not securing proper food , thus leading to unsafe foods. Hence , leading to food insecurity .

People in West Africa suffers from having no electricity and water .

In Indian Family ,

Poverty and bad condition of agriculture led them to suffer in a poor way . Father of Bandhura wanted his daughter to get married . But in order to do so , he needed dowry to get Bandhura married . They were financially weak . A person named Prakash assured her father that Bandhura will get to learn crafts work , and by doing so she can raise some moeny . Hence , Prakash took him . But , working as a prostitute was something she never knew. Unknowingly , she got infected with HIV/AIDS.

2. A case study on West Africa , is that of Akan tribes . They are deprived of proper food, electricity and water. Most of the people die of malaria , in Ghana . A net is being used , in order to avoid malaria . But they are very costly and hence cannot be bought by them . Hence , majority of them die because of malaria .

Another case study is based on Indian Family . It speaks a lot about their cultural beliefs . In Brahmanical Hindu Society , dowries are still practiced . Bandhura's family was poor. In order to give financial support to the families , she was unlnowingly sent to a brothel . Bandhura's family had been given hopes of learning crafts work from where she could earn money . Working in brothel , was something not desirable. She thereafter developed HIV/AIDS.

3. According to me , it would be Human ecology theory . It focusses both on the physical state as well as the social interaction of human beings . It is an interdisciplinary subject, speaking about the relationship of humans in terms of natural and social enviromnment .