Blog Post #7: Buenos Aires, Argentina 4/3/18

What I learned from this week’s readings actually came from our time at the Immigration Museum. At the museum it seemed that in the late 1800’s to the late 1900’s immigration was actually encouraged as a way to fill positions and build the economy in Argentina. After the reading on immigrant’s rights it seems that a restriction was put into place in 1981 to limit the masses entering the country, so the once simple process of coming to Argentina and finding a job which would allow them to stay in the country has become much more difficult. I find this interesting because after our guest lecture we learned that today Argentina’s health care access laws are almost too lenient since citizens of neighboring Bolivia come to the country to utilize services then leave without intending to stay in Argentina. It seems that Argentina needs to find a good middle ground between the restriction act of 1981 and increased access policies of the early 2000’s. A good policy would allow immigration for those that want to enter the country and fair access to resources, but would also keeping policies strict enough not to corrupt health care and education systems. 

                  After reading the NY Times article on deportation of immigrants, I am sad to see that other countries have similar policy ideas to what our president in the US is trying to put into place in terms of immigration restriction. For a country that is historically made up of immigrants, I have noticed that many mention the earlier European influence and often ignore the newer neighboring country immigration. I have come to understand that like the US, Argentina is proud of its European heritage, but considers immigration after that wave as generally unsafe and unwanted. The views of American citizens’ superiority in the US and Argentinian citizens’ superiority in Argentina currently dominating in their governments can cause uncomfortable and unfriendly relationships with other countries. The Trump Administration has put a lot of focus on keeping those in Mexico and Latin America in general out of the country, so I have never thought that those countries may have similar feelings about keeping their own country “protected”. Since many view American as one of the most unwelcoming countries due to its immigration policies, I never realized that other countries may share common ideas. It is unfair for both the US and Argentina to be blaming migrants for issues within the country such as unemployment in the former case and crime in the latter. 

                  The third article for this week touched on the improvements in health that Argentina has seen recently. Most countries we have been to this far on the trip have a strong focus on non-communicable diseases, but it seems that Argentina has only recently dealt with a few communicable diseases such as dengue, rubella, measles, and TB. Also, like in China, smoking seems to be a top priority due to its prevalence. This article reports a significant decrease in cigarette use between 2006 and 2012, but just walking the streets I have already seen a much higher number of smokers than I experiences in Australia. Altogether, though there seem to be many recent improvements in Argentine health, there is always a push for even better health for a country’s citizens.

Blog Post #6: Sydney, Australis/ Buenos Aires, Argentina 3/22/19

The first obvious difference between Argentinian and Australian health care is that of their immigrant health policies. In Australia, with a large focus on asylum seekers, it was clear that they have little to no access to health care until they are declared as refugees, and even then it could be difficult to find affordable and culturally appropriate care. Small grass-roots organizations that we learned about and visited in Sydney have started to recognize this lack of health care for immigrants and have focused their attention towards helping people obtain the care they need. However, this is much different from Argentina in which health care is provided to any person who enters a public health care facility, regardless of whether or not they have documentation of their immigration status. The issue with this is that it is causing a large influx of Bolivians and other peoples from surrounding countries to enter the country for health care and leave immediately after their needs are met. Australia’s policy was put into place to decrease the number of immigrants and Argentina’s policy was created to make health care more accessible, but the former just created health care disparities between immigrants and non-immigrants and the latter just increased non-permanent immigration. Both systems have seen negative consequences that are currently an issue for both countries. 

            In comparison to China, I wonder what the conditions of rural health care are in Argentina. In China there is a resting disparity between the care received in urban areas as compared to rural areas, so much so that it pushes those to major cities to receive the care they need. Being situated in another major city, Buenos Aires is not representative of the majority of Argentina, so I am curious as to what coverage and access is present in these areas. In China we learned about the Barefoot Doctors popularly used in the 1960s and I wonder if there was ever anything similar in regions that many gauchos and farmers lived. Even seeing the hospitals in the greater Buenos Aires area, outside of the city, on our way to the estancia, it was clear that they were less modern and well kept then those I have seen while in the city. 

            An additional question that I have regarding Argentinian health care is that of its European influence. Having learned that Argentina is a country built on Italian, Spanish, French, and other European cultures and populations, I can see that these are still present today. In terms of health care, I have seen multiple hospitals for specific European ethnic groups including the German and French hospitals. I wonder if these hospitals attract people with those backgrounds, especially older patients that may easier communicate with the staff if they know the language correlating with the hospital’s focus. This in ways could segregate ethnic groups among Argentina, but may also make certain patient feel more comfortable in a health care setting catered towards their ethnicity. 

Blog Post #5: Sydney, Australia 3/9/18

This is showing an image of the panel event we attended on Aboriginal nursing and midwifery. What I wanted to highlight most in this photo it the logo depicting a Rosie the Riveter-like image of Sister Alison Bush. Sister Bush was an aboriginal midwife and the first to take a role in a major hospital. She protected female aboriginals in her hospital by teaching others to be culturally aware as well as teaching maternal health. She paved the way for further nursing and midwifery by Aboriginal people. In the “Beating the Odds” article, the story of nursing student Banok Rind supports that services similar to those that Bush worked to provide are still not up to par and women are severely maltreated in health settings even when they work there. Many are following in Bush’ footsteps regardless, so it is hoped that together, Aboriginal health professionals will help make a huge impact on health and racism within Aboriginal societies. 

This image is that of a suicide hotline in Watson’s Bay. Although this is not 100% correlated to Aboriginal people, I thought it was significant in that different languages were offered for this service, making it possible for non-English speakers to use it. Also, in the report on indigenous women’s health, it was said that “mental health problems [have] been recognized as ‘a major health difficulty for most [indigenous] communities’” and indigenous people tend to report that more stressors are occurring in their lives. Also, the rates of death by self harm or due to mental health disorders is significantly higher in indigenous populations, especially in young females. This makes it important that programs exist to help indigenous people with mental health implications. 

This wall art in Bondi Beach had a bit of graffiti depicting the globe saying “one world one people”. I think this is translating that we all share a commonality of one planet, so we are similar as we are all people and we should work together as equals. This seems to me what the overarching goal of the “Closing the Gap” plan is. As mentioned in the “Beating the Odds Article” the goal of closing the gap between indigenous and non-indigenous has become a major focus, but the gap has been widening. At least in terms of the health disparity, indigenous midwives and nurses are contributing a lot as they have valuable input that can be utilized to improve the health of Aboriginal communities and are better received by Aboriginal patients. 

Blog Post #4: Sydney, Australia 2/20/18

This poster depicts a logo that I have seen all over Sydney in our first week here. I have seen this spray painted on the sidewalk as well as on t-shirts and billboards, and this program also had a stand at the Fair Day festival to celebrate gay and lesbian Mardi Gras. The ultimate goal of this program is to virtually end HIV transmission by 2020 by, reducing transmissions in NSW by 80%. The program condones using means of safe sex to prevent the spread of HIV including condoms, PrEP, and UVL. It more specifically reaches out to gay men living in New South Wales. In the WHO Global AIDS update, the world had agreed to ending the AIDS epidemic by 2030, so as can be seen by this program, Sydney is taking steps to do so even sooner. As part of the fast-track approach to this goal which many countries are a part of (including Australia), the website listed on this poster leads you to ways to get the “HIV prevention packs”. These packs are listed in this WHO document as a great way to reach all impacted populations. 

Another stand that I saw at Fair Day reads “Bobby Goldsmith Foundation: Care and support for people living with HIV since 1984”. This organization is Australia’s longest run HIV charity and helps those with HIV deal with emotional and financial obstacles. With a focus on those that are already sick with HIV, this relates to the WHO document’s mention of the zero discrimination of those infected. For example, the program helps those with the issues that arise from not only the physical implications of the disease, but also the stigma-related impacts that people experience after their diagnosis such as how they are treated and what they have access to in terms of treatment.   

While walking the Rose Bay to Watson’s Bay walk I came across an area called The Gap on a cliff top. This area is known as being a common spot where many come to end their lives. What surprised me in this spot was all of the precautionary measures set up and means of support available such as security camera monitoring, counseling phone booths, and informational posters filled with supportive information. This seemed relevant as in the WHO-Australian Health System in Transition article it lists mental health one of the “six national health priority areas for special attention”. Additionally, with HIV many of those who receive the diagnosis or have family members struggling with the disease often have mental health impacts, so it is important to see that Sydney is making this issues known and offering help for those that need it. In the US, mental health still does not seem to be mentioned as much especially not those ideas involving suicide. 

Blog Post #3: Sydney, Australia 2/15/2018

Something that specifically stuck out to me during this week’s readings was that “there is a dramatic gap in the health indicators for the indigenous population compared to non-indigenous Australians” as said in the Commonwealth Fund article. This seemed significant because the indigenous population has been so relevant to our trip already. Specifically, I have noticed that many speakers acknowledge the aboriginal origins of the land of Australia and our aboriginal workshop proved that the indigenous are still very relevant today. The health indicators that the article listed include mental illness, obesity, and chronic disease prevalence. The WHO supports this with “indigenous people experience much poorer health… than the rest of the population” likely due to their difficult history of being displaced and treated unjustly. However, after our workshop the other day I am wondering if their more traditional use of plants and other natural products for ailments rather than modern medicine influences health outcomes positively. It would be very interesting to compare the health care practices of indigenous and non-indigenous Australians. 

Also interesting was the statement on the age distribution of the population of Australia. The WHO document says “Australia is still a young country in population terms with fewer elderly people than many other developed countries”. However, it is expected for the population growth of those aged 65 and over to double by 2025 (to about 24%). This reminded me of what we learned in China who has a population in which 25% of the citizens are already over age 65. China provides a good example of what Australia could one day be facing. With high numbers of elderly people, there are less people able to contribute to the workforce and more people that will require medical attention. This can cause social, economic, and emotional issues for many people and society as a whole as families will need to look out for and support their elderly family members and society will need people to fill jobs that the elderly are unable to do. 

Some contributors to this currently “young” Australian society is in part migration as well as improvements in health status and treatments. There have been improvements in life expectancy recently and as a result older people are expected to live longer due to better treatment of non-communicable diseases such as cardiovascular disease. Migration can also be a contributor because migration to Australia continues today, but often consists of younger people and their families, including their children. This means that policies and plans involving health care will have to be changed and catered to the aging population. Since the population is now young, the health problems that they face will change as time progresses and the health system cannot afford to stay stagnant. As seen in China, the aging population that now makes up 25% of their people is where many initiatives are focused because there is such a high number of people that need care for issues that are common in old age such as Alzheimer’s and cardiovascular issues. Altogether, Australia faces different health problems now than they will in the future as this large young population ages. 

Blog Post 2: Shanghai, China 2/7/18

From the lectures on healthy policy China by local professors to walking down booming streets in the city, I have come to gain an understanding of the health care system in China from what I have seen and heard. While in class and discussing the issue of doctors being known as “white snakes” who receive the backlash of angry patients, I have come to realize that even today the system has major flaws. Not only does this indicate flaws in health policy but also public policy in general because physical and verbal violence results from the Chinese citizens’ lack of a right to protest. This was also the most shocking thing I learned about health in China because in the United States doctors are often respected, but in China they are abused and scolded for things that they don’t have control of, such as drug and treatment price and health insurance coverage. Even further, these certain “white snake” doctors are experiencing such bad incrimination that they tell their children not to become doctors and they often absolutely hate their jobs. In the United States, those with the desire to become doctors are looked up to and generally supported. I think that this could potentially cause a lot of issues in the future because China has a massive population, and I’m afraid the number of doctors will begin decreasing and be unable to fill the demand of everyone seeking medical attention. 

            Additionally, I would like to highlight a more positive part of health in China and that is the initiative towards healthier lifestyles that I actually saw when walking the streets of Shanghai. Although I’m sure there is still a long way to go and the initiative will take a while to reach less developed areas, there is promise in what is happening. I saw multiple areas within walking distance of the ECNU campus with outdoor, free to use exercise equipment and parks with running paths made of track material to make exercise more accessible and easy for Shanghai residents. What also came as a surprise was the number of people that I saw using these facilities. In the United States I’m used to running on trails alone and seeing playground/ exercise areas empty, but here there were many families and even elderly partaking. I think this is a good reflection of the reactive governmental response to health care issues that there is in China. For many problems in health care and environmental health, China is quick to acknowledge the problem and attempt to deal with it. For example, in response to global warming and noting the pollution problems caused by massive industrialization, China has made bike transportation more common and seeks different ways of production to limit their emissions of fossil fuels. Conversely, in the United States people still question whether global warming is real and who is the cause, rather than coming up with solutions to the problem. 

            As for my general experience in Shanghai, it was more amazing than I even could have imagined. I came into this program with China as my most looked-forward to location because of how different I new it would be from the American lifestyle I was used to. Something I found most surprising during this stay was the development of Shanghai. Many parts of this city reminded me of the United States and the American influence was apparent in things such as food, clothing, architecture, and even lifestyle. It actually made me a little sad to see Americanization in things where traditional Chinese culture probably once stood. I think this became even more clear after our trip to Beijing, which was my favorite few days of the month-long stay. To me, Beijing seemed more traditional, had more history, smaller streets, and a tighter-knit community in general. In contrast to Shanghai, the area of Beijing that we were in had so much more Chinese culture present that made it feel a lot different from the US. 

            Another important aspect of my stay was the language barrier. I new coming in that I would be the minority, unable to communicate in the language of the country of which I was visiting (which made me a little nervous), but I was still shocked at the relatively high number of people I ran into who could not speak English. It seemed that especially the older population had little English knowledge, and younger people had at least some skills with the language. Despite this, I was often able to communicate through pointing and nodding, which felt so strange at first, but eventually became natural. It was actually really exciting when you would make eye contact with a person that you have no means of communicating with verbally, but knowing that what you wanted to say is understood simply by your body language and pointing. I think that I expected more people to speak our language because of what I have experienced in other places abroad that I have visited and how strong of an influence English seems to have around the world. This made me come to terms with the fact that I owe it to others to learn a new language. Even other visitors to Shanghai seemed to quickly switch between their native language and English, and I see how abnormal America must look for not pushing second-language learning. I hope that eventually I have the ability to show a foreign country that I am visiting the respect of being able to cater to their culture and speak their language as a stranger visiting from another place. 

            In totality, I have only explored a tiny speck of what China really is, and I hope that I will be able to one day to return to Shanghai as well as visit other areas in the country to get an even larger understanding of the country’s functioning as a whole. What I have learned so far has made me think differently already, so I can only imagine what the rest of the trip has to offer. 

Blog Post #1: Shanghai, China 1/16/18

As listed on the WHO fact sheet, sanitation facilities are increasing in number in China. However, as this photo shows, not all areas of China have seen this increase, even those that are within its booming megacities. Being in Shanghai, it seems to be an exceptionally clean metropolis. However, going into this lower-income, condensed living area I was shocked to see litter, as I had quickly become accustomed to the spotless metro and popular streets.

At the marriage market a certain umbrella caught my eye with a healthcare logo “Oppo: support your healthy lifestyle”. I did some research and found that this is an Orthopedic company that was established in Seattle and has products in over 60 countries & 5 continents. I thought this related to our readings in the influence of Western countries and the distribution of its health care products to others. The United States seems to have found its way into China’s health care system though we are so used to products moving in the other direction as imports of the US. Additionally, the slogan is characteristic of global health plans and what is currently needed to avoids NCDs. 

Looking at the 10 facts on the state of global health, it has been found that Diabetes is among the top 10 causes of death worldwide. In this photo not only is this highlighted as there is a Pizza Hut right next to a KFC, but it is also a bit ironic that both are directly next to a pharmacy. Diabetes in China is becoming an increasingly widespread and worrisome problem, so this is interesting to see and proof of what may be contributing to the issue. Additionally, this goes to show that the United States has a negative influence on the health of other countries. These brands originating in the US are becoming universal unhealthy eating choices which are now more and more available to individuals.