C.L. Katz

K. Fujitani

R. Yanagisawa

Annals of Global Health

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ROLE OF GLOBAL HEALTH IN LOCAL HEALTHIf global health is local health, then where is the south in“global health”?M. Damaj1, E. Dumit1, A.L. Dengo2, R. Afifi1, J. Dejong3, B.K. Singh2;1American University of Beirut, Faculty of Health Sciences, HealthPromtion and Community Health Department, Beirut/LB, 2EARTHUniversity, San Jose/CR, 3American University of Beirut, Faculty ofHealth Sciences, Epidemiology & Population Health Department, Beirut/LBBackground: “Global health” is an emerging concept that continuesto be redefined, but much of that process is not adequately includingvoices from the south. This has repercussions on programs andglobal policies, creating a pattern of northern hegemony in researchand practice.Structure/Method/Design: The data presented is a result of aliterature review of peer-reviewed journals and studies on “globalhealth” in the last decade, as well as outcomes of the Global Collo-quium of University Presidents 2013.Results (Scientific Abstract)/Collaborative Partners (Program-matic Abstract): Three main themes emerge from the global healthliterature. First, the “health” being addressed in global health pro-grams remains disease-focused, primarily defined within the frame-work of the MDGs, with insufficient attention to social and politicaldeterminants of health. This contributes to a lack of contextual un-derstanding of social inequities and population needs, and conse-quently to poor health outcomes. Second, slow economic growth isportrayed as the cause of and solution for global health issues. In-equalities due to globalization have been seen to cause declines inhealth and the stagnation of growth, and yet the focus of global ini-tiatives has focused on economic growth as the central goal todevelopment, with the health of populations as an incidental benefit.Additionally, insufficient attention is being paid to the income-in-equalities within countries and how these affect population health.Third, the global perspective is generally missing from “globalhealth.” A clear northesouth distinction persists in programs stilloperating with an “international health” approach, and in percep-tions of global health as staving off the spread of diseases indigenousto the south. Global health is currently being defined from a pre-dominantly northern perspective, research is being funded by thenorth—90% of papers are authored by academics in North Americaninstitutions—with the risk that the field will be actively developedthrough the lens of the north for the benefit of the south, withoutachieving southern ownership. This is promulgated by superior,funded research programs in the north, while institutions in thesouth are burdened by challenged research infrastructures and un-equal partnerships with northern institutions.Summary/Conclusion: These factors have created unequal part-nerships that continue to obscure the voices of the global south in theglobal discourse on health.Exploring the utility of Psidium guajava leaf extract as anadequate treatment for Giardia lambliaF. de Souza1, T. Parker2, A. Ali2; 1Yale University School of Medicine,New Haven, CT/US, 2Natural Doctors International, San Diego, CA/USBackground: Giardia lamblia is one of the most common intestinalparasites with as many as 1 billion cases diagnosed at any one timeworldwide. Symptoms may range from the asymptomatic shedding ofcysts to failure to thrive. Psidium guajava (guava) leaf and bark extractsare common folk remedies used to treat Giardia.This prospective cohort study assessed the clinical utility of astandardized guava extract compared with standard treatment, tini-dazole, and no treatment given at a natural medicine clinic inOmetepe, Nicaragua.Structure/Method/Design: Eligible participants were children andadults in two rural communities positive for Giardia by ova andparasite testing. Patients receiving standard doses of tinidazole andpatients not receiving treatment were also followed for 2 weeks.The utility of the guava treatment was assessed by stool micro-scopial examination 3, 5, 7, and 10 days following treatmentcompletion. The primary outcome measure was change in Giardiacysts or trophozoites seen on at least three consecutive stool tests.Subjects were also queried about their knowledge and use of anti-parasitic medication and guava remedies.Results (Scientific Abstract)/Collaborative Partners (Program-matic Abstract): 664 individuals submitted stool for examination;87 of these individuals tested positive for Giardia and 79 enrolled inthe study. Of those enrolled in the study, 39 individuals were pre-scribed the guava extract and returned for re-examination. Of these 39assessed, 11 tested negative for Giardia cysts and trophozoites on allstool tests, 16 persons tested positive for Giardia cysts and tropho-zoites on all stool tests, and the remaining 12 tested positive forGiardia cysts and trophozoites on one or more of the stool tests.Seven persons were prescribed tinidazole and completed requi-site follow-up visits. All tested negative for Giardia cysts or tropho-zoites on all stool tests. Eight persons remained untreated throughoutthe study period; none of the patients tested negative for Giardia cystsand trophozoites on all stool tests, five patients tested positive all onstool tests and the remaining three tested positive for Giardia on oneor more of the stool tests. Patients treated with guava and those whodid not receive treatment had no adverse effects. Reported adverseeffects of the tinidazole included dizziness, and nausea.All of the patients preferred the standardized guava medicine asthey experienced no side effects, felt it to be better for their bodies,and more effective in clearing the parasite Giardia.Summary/Conclusion: Though the guava tincture was morefavorably received and had fewer side effects than tinidazole, it ap-pears ineffective in clearing Giardia cysts and trophozoites from thestool.Prevalence of burnout and psychiatric distress in localcaregivers 2 years after the great East Japan earthquakeand nuclear radiation disasterK. Fujitani, R. Yanagisawa, C.L. Katz; Icahn School of Medicine atMount Sinai, New York, NY/USBackground: Although more than two years has passed since theGreat East Japan Earthquake (Tohoku Earthquake), which struck theNortheast region of Japan in March 2011, more than 280,000 peoplestill remain displaced from their homes and community. The sub-sequent nuclear radiation disaster has worsened the crises beyond atypical earthquake tragedy and prolonged its recovery efforts. Rescuepersonnel, recovery workers, and medical and mental health pro-fessionals are suffering significant burnout due to lack of adequateresources and unremitting workload. Our purpose is to quantify theprevalence of burnout and psychiatric distress in local caregivers 2-plus years after the Tohoku Earthquake.232 Ro l e o f G l o b a l H ea l t h i n L o c a l Hea l t hStructure/Method/Design: This pilot study measured burnoutrates of 34 health care providers from four different sites in areasaffected by the Tohoku earthquake and the subsequent nucleardisaster. We interviewed caregivers about topics of concerns andasked them to self-administer two questionnaires: Maslach BurnoutInventory for Human Services (MBI-HS) and General HealthQuestionnaire (GHQ12). Previously validated cutoffs were used toidentify high levels of burnout and psychiatric distress, as well asqualitative answers from interviews.Results (Scientific Abstract)/Collaborative Partners (Program-matic Abstract): With a response rate of 94.4%, themes listed byrespondents during the interviews were concern for children (47.1%),frustration with the inability to eat and share homegrown or localvegetables (55.9%), and having sleep difficulties (44.1%). We found58.8% of respondents to have signs of emotional exhaustion, 14.7%with depersonalization, 94.11% with low or medium personalaccomplishment, and 55.9% with evidence of psychological distress.Comparing year-old GHQ12 scores done at the same sites, the scoreremained unchanged (4.63 vs. 4.24; P ¼ 0.74).Summary/Conclusion: Local caregiver mental health has notimproved even 2 years after the disaster, and many are showing signsof burning out. Over half are emotionally exhausted and in psycho-logical distress, experiencing symptoms themselves, and burdenedwith concerns, which strongly suggest that conditions are notimproving. Radiation problems have worsened the stress, anxiety,workload, and recovery process of the caregivers, provoking higherburnout rates. Long-term psychological support and improvement incaregiver work conditions are essential to maintain sustainable care inrebuilding disaster-stricken areas in Fukushima.Global mental health: The view from AlbaniaR.L. Mueller; Indiana University, Department of Applied Health Sciences,Bloomington, IN/USBackground: Albania, which endured one of the most harshlyauthoritarian regimes of any country in the socialist bloc, has been amajor destination for foreign, particularly European, aid since itsdemocratization in 1992. In this presentation, I consider the para-doxical consequences of European infuence on Albanian mentalhealth sector reforms.Structure/Method/Design: The following results are drawn from alarger qualitative study on the variety and quality of available insti-tutional and community-based mental health services in Albania. Itwas carried out in central Albania (Elbasan, Korce, Tirane) betweenJune 1 and September 1, 2013. Information was collected through 44semi-structured Albanian- and English-language interviews withmental health professionals, family caregivers, and advocates identi-fied via snowball sampling. 30+ additional hours of participant-observation were completed with psycho-social staff and consumers atthe Sadik Dinci Psychiatric Hospital in Elbasan, Albania.Results (Scientific Abstract)/Collaborative Partners (Program-matic Abstract): Mental health system reform in Albania has largelyattempted to recreate European mental health infrastructure locally.Unfortunately, this system is functioning well below its intended ca-pacity in the Albanian context. The network of Community MentalHealth Centers—based on the Italian model—is a particularly starkillustration of the ways “innovative” services in Albania replicatetreatment as usual: a top-down, medical model which disempowersthe consumer. Paradoxically, it appears that Europe-driven aid andinitiatives have stunted local capacity. As European investment andthe physical presence of foreign advisors decreases, Albania’s mostfragile service sector lacks the tools and experience to sustain reformsand continue to improve upon them.Summary/Conclusion: Albania’s geographical and cultural prox-imity to Italy, a leader in community mental health services and socialinclusion initiatives, should be an overwhelming positive for thecountry. Unfortunately, the partial implementation of progressivemodels of care has led to poor consumer outcomes. Lessons forglobal mental health professionals include the need for initial needsassessments that consider whether intended reforms can be fullyimplemented and, if not, how the impact of partial implementationmight be maximized through specific initiatives.Policymaking process of a maternal near-misssurveillance model in Colombia: Local effects of globalpolicies generated by an epistemic communityM. Ronderos1, C. Quevedo1, K. Ariza2, J.M. Rodríguez2,M.A. Matallana2, J.M. Trujillo2, A. Beltran2, R.E. Peñaloza2; 1Pontif-icia Universidad Javeriana Bogotá, Departamento de Medicina Preventivay Social, Bogota D.C/CO, 2Pontificia Universidad Javeriana Bogotá,CENDEX, Bogota D.C/COBackground: In 2005, the Colombian Ministry of Health (MoH),concerned with slow progress toward the MDG target to reducematernal mortality by 2015 initiated the implementation of anExtreme Maternal Morbidity Surveillance Model (EMMSM). In2013, we undertook an evaluation of this process at the request of aninternational agency (IA) and the MoH. This paper describes thepolicymaking process and possible unintended local effects.Structure/Method/Design: Descriptive study with mixed-methodsdata analysis. Data were collected through structured questionnairesand semi-structured interviews with the main actors at the nationallevel, in 8 departments, 8 municipalities, 12 tertiary-level hospitals,and 6 health insurance organizations. Grounded in the theory ofepistemic communities, we analyzed both the documents and actorsdiscourses to reconstruct the policy process from conception toinception into the National Public Health Surveillance System(NPHSS).Results (Scientific Abstract)/Collaborative Partners (Program-matic Abstract): We identified three stages of policymaking: 1)2005-2007: Colombian gynecologists develop a model built on thematernal “near-miss” concept proposed by gynecologist in the UK in1990 and set forth by WHO in 2004 as “near-miss audits.” 2) 2007-2010: The model is piloted in 15 tertiary-level hospitals by the MoHin association with an IA. 3) 2011-2013: “Extreme MaternalMorbidity” (EMM) is made notifiable to the NPHSS by secondaryand tertiary-level hospitals. Obstetricians at pilot hospitals perceive themodel improved the quality of obstetric care in their institutions,however,they recognize that most EMM cases arrive in critical con-dition and many lack adequate antenatal care and/or care in their firstinstitution of contact was deficient. While tertiary-level hospitals haveincreased their obstetric Intensive Care Units capacity, two De-partments have closed several primary care facilities. Municipal andDepartmental maternal health programs were found to be under-staffed and poorly financed.Summary/Conclusion: The maternal “near-miss” approach initi-ated by the gynecologists’ epistemic community and fostered by in-ternational agencies for inception as national policies, whenintroduced into the Colombian context of market-driven health ser-vices and weak primary care systems, may have contributed to drivehigh technology-based obstetric care in tertiary-level hospitals. Thismay be having unintended effects on equity in access to quality

Prevalence of burnout and psychiatric distress in local caregivers 2 years after the great East Japan earthquake and nuclear radiation disaster

http://www.annalsofglobalhealth.org/articles/10.1016/j.aogh.2014.08.186/galley/2266/download/

Prevalence of burnout and psychiatric distress in local caregivers 2 years after the great East Japan earthquake and nuclear radiation disaster

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