Beyond the Clinic Flashcards
(37 cards)
Virchow’s findings on the typhus epidemic
“If disease is an expression of individual life under unfavorable conditions, then epidemics must be indicative of mass disturbances of mass life.”
Virchow lay blame primarily upon German landlords, German housing and labor conditions, diet restricted by poor food availability, and the Catholic church. All of these contributed to the malnourishment and lack of sanitation which predisposed the impoverished population to being typhus susceptible.
Rudolf Virchow
Father of modern pathology and of social medicine
Same Virchow of Virchow’s triangle
The beginnings of primary and specialist care
The ideas were invented in 1919 by Sir Bertrand Dawson in the British Ministry of Health, following a growing political desire for some form of “health care system” rather than simply having sick people brought to doctors.
His ideas would not be implemented for decades, but Dawson effectively invented the model of modern health care, with primary physicians visited regularly for screening, prevention, and education and specialists to which very sick patients were to be referred.
League of Nations Health Organization
Founded in the interwar years. Addressed the problem of integrated health and development for rural populations.
Advanced by two major conferences: One in Geneva, Switzerland and one in Bandoeng, Indonesia.
Father of revolutionary medicine
Che Guevara
(mantle also carried by Allende)
Social medicine only began to take hold in the US during. . .
. . . the Great Depression.
Many Farms healthcare experiment
A community health clinic established on the Navajo reservation in the 1950’s-60’s. Trained individuals in a four month curriculum of basic medical interventions and monitoring.
The project was a failure, it did not improve health outcomes, and the conclusion was that a mismatch existed between what medical care could offer and the basic health needs of the community (clean water, healthy food, sanitation, electricity).
Ultimately ended due to IHS bureaucracy: the IHS would not continue to allow the clinic to bring on local health workers after discovering that many had low educational attainment or did not have drivers liscenses or other forms of ID.
The Tufts-Delta Program
Set out to provide care to 14,000 people in rural poverty in the Mississippi River delta. The clinic provided health education, prevention, and health care, and sought to develop community partnerships to break the cycle of extreme poverty, ill-health, and unemployment
The program gave medical perscriptions for food to malnourished patients to be filled at the grocery store and billed to the clinic, which was condemned by Mississippi officials as socialism.
Peoples Free Medical Clinics
Opened by 13 chapters of the Black Panther Party in 1970’s. Each had to rely on its own expertise, with only some help from white phyiscians and nurses. Some succeeded while others suffered from inadequate resources.
1978 WHO Conference in Alma Ata
Famously articulated the progressive vision of health care for all, in hopes that all the world’s population would have access to adequate primary care. Produced the Declaration of Alma Ata:
all signed on to the idea that comprehensive primary health care (Article VII) and community participation (Article VI) would be key drivers of change for a healthier world, and that funding could come from disarmament and diverting military spending towards health care (Article X).
Program of Assertive Community Treatment programs
Initially launched in Madison, Wisconsin. Instead of relying on patients to come to the clinic, they brought health care to them. PACT programs soon opened in other cities, and many persist today.
In some versions, there is no clinical space at all, just an administrative office, and doctors, nurses, and social workers provide all of their support within the community.
“Accompaniment”
Building health systems that can achieve equity of clinical outcomes for even the lost impoverished and destitute sick:
- If a child is diagnosed with an infectious disease, making a house call and checking on the whole family
- Ensuring personally that patients have access and adhere to antibiotic regimens
____ in the US has proven a major barrier to establishing community-based health for at-risk populatons.
The fee-for-service model in the US has proven a major barrier to establishing community-based health for at-risk populatons.
Takeaways from CHW for the modern era of medicine
- Focus on supporting those who need you the most
- Distribute care across a team of providers, with a main focus on maintaining health
- Renew the promise of engaging with communities to promote health
- Add non-medical tasks to the medical armamentarium
____ is favorable for engaging in community health programs and upstream determinants of health.
The increasingly common ACO model, encouraged by the ACA, is favorable for engaging in community health programs and upstream determinants of health.
Today’s VA was etablished by. . .
. . . President Lincoln in the 1860’s.
Currently the VA program consists of. . .
. . . 172 medical care centers and 1062 outpatient sites, with over nine million enrolled veterans.
Characteristics of the VA population
Tend to be the sicker of the veterans (healthy veterans do not tend to access care). Population is younger, more likely to be non-Hispanic black, and of lower income.
51% of those enrolled in the VA program also have Medicare benefits, 28% also have private insurance, 6.6% have Medicaid, and 20% are otherwise uninsured.
To provide proper trauma-informed care to veterans, . . .
. . . you need to have some understanding of military culture and of the unique aspects of each era of service.
Treating WWII veterans
WWII veterans often have an enduring sense of pride for having served in WWII, despite gruesome exposures and injuries.
The prototypical injuries of WWII were inflicted by artillery and bombs, making head wounds and traumatic amputations common.
Treating Korean War Patients
Began in 1950 and lasted 37 months, ending in a truce. Sometimes described as the “Forgotten War.” As it took place in the shadow of WWII during the “baby boom” in the US, it was little studied. What was termed a “police action” by President Truman was not congressionally recognized as a “war” until 1998.
“There were no celebrations in Times Square–or anywhere else. The Washington Post noted, ‘Washington greeted news of the Korean truce yesterday with a matter-of-fact attitude–quietly, without evident jubilation….’ It was peace without a clear victory”
Combat was often brutal and injuries from extreme cold and radiation were common.
Much of our modern understanding of trauma and PTSD comes from. . .
. . . the Vietnam War.
Treating Vietnam War Patients
Vietnam was the first televised war, as well as the first true US guerilla war, and possibly the best documented in history.
Unlike WWII and Korea where the enemy had a defined uniform and battle lines were clear, Vietnam had unclear conflict zones and boundaries which created unprecedented challenges for soldiers. The soldiers also did not receive any sense of gratitude from the South Vietnamese they were supposed to be fighting for.
Upon return, soldiers were discouraged from sharing their horrific narratives. Additionally, medical advances meant that severely disabled soldiers survived and made it back to America with chronic disabilities.
Irrespective of conflict, ___ is a frequent comorbidity of post-traumatic stress disorder.
Irrespective of conflict, substance use disorder is a frequent comorbidity of post-traumatic stress disorder.
