Rwanda and the importance of preventative care

We here at GlobeMed adore Paul Farmer and his work as a medical anthropologist and a physician.  When Dr. Farmer talks, we listen.  And recently, as GlobeMed alum Neal Emery writes, he’s been pushing Rwanda’s dramatic healthcare overhaul as one of the brightest global health stories to come out of Sub-Saharan Africa in recent years.  This is an article we shared with you on Wednesday in celebration of World Day of Social Justice, but I just wanted to highlight two things I took away from reading it.


I love the fact that Emery highlights the importance of primary care and preventative procedures.  Emery writes, “All the while, Rwanda increased from 870 people on HIV treatment in 2002 to more than 100,000 in 2012 while retaining 92 percent of patients in care – compared to 50 percent in the United States – not in spite of but because of the investments in primary care.”


Many experts now say one of the biggest problems with the US healthcare system is the lack of focus on preventative medicine and primary care.  The lack of interaction with doctors on a regular basis makes it hard to establish a relationship with physicians, makes catching deadly diseases such as cancer, diabetes, and hypertension less likely, and increases the cost of having to treat a patient with such illnesses down the road.  The US seems to have good (or at least well-funded) “sick care”, but not anything near proper “health care”, especially considering how much money is spent annually.  Rwanda, however, spends next to nothing on its healthcare system compared to the US, and has had incredible success, all things considered.


Finally, I wanted to point out a fantastic quote that Emery includes about the interdisciplinary nature of global health.  HIV/AIDS is still a major problem in Rwanda, but the attitude of the government on the best way to treat and prevent the disease gives me great optimism that if they keep this up, the disease will be eliminated or made insignificant in the near future.  The Minister of Health, Dr. Agnes Bingawaho, said, “HIV does not exist in a vacuum — if an HIV program does not address the associated problems such as tuberculosis and malnutrition, it will fail.”


Global health issues don’t exist in a vacuum, and yet too often we see well-meaning but misguided groups of Americans and Europeans coming to third world countries and handing out medicines and vaccines, and returning home after only a week and thinking they did a great thing.  While these trips can prove to be incredibly powerful experiences for the people that go on them, they really do not address or help the situation of the people they were trying to serve.  They fundamentally miss the point when it comes to such service trips: global health is complex and involves many different facets; if only one facet is addressed, the problem will not be solved.


Feel free to comment and add your own opinions on what this article means to you and what you take away from it.


Also, check out our photos from World Day of Social Justice on our Smug Mug!


And as always, please consider donating on our Global Giving website and our Web Thrift Store.

World Day of Social Justice!!

World Day of SocialAll people deserve happiness! Justice is here!  Take a look at what GlobeMed chapters from across the country are doing to celebrate and raise awareness about social justice issues around the globe.  Take a look at our Facebook page for photos of students saying what they believe all people deserve, and finally, a challenging but inspiring article from former GlobeMed National Office staff member Neal Emery on the incredible health care system in Rwanda.  Take some time today to think about the social justice issues that plague our world, how you can learn more about them, anrachel spannd what you can do to help create positive change.  Together, through strong partnership, hard work, and the passion and enthusiasm of people like us, we can make a change, we can inspire hope, we can bring about a more just, more peaceful, more amazing world for the future!


As always, please consider donating to support GlobeMed at Northwestern, either through our Global Giving website or through our Web Thrift Store.

World Day of Social Justice Ponderings


“Injustice anywhere is a threat to injustice everywhere”

-Martin Luther King, Jr.


World Day of Social Justice is tomorrow, the perfect time to reflect on the blessings we all have and the opportunities available for us to continue to positively impact the world around us.  Remember, the question GlobeMed is asking everyone to ponder is, “What do all people deserve?”


As you reflect on that prompt, I invite you to read this brutally honest critique of the American Dream by Joseph Stiglitz, a Columbia University professor and recipient of the Nobel Prize in Economics.  He denounces the idea that the United States is the Land of Equal Opportunity as a complete myth in our modern era.  Despite the advancements we’ve made in racial and gender equality, there are still noticeable differences in socio-economic status between white and non-whites, especially blacks and Latinos, and between men and women.  And perhaps even more egregious, there is as little social mobility as there’s ever been in the history of this country, and is lower than in most of the other developed nations around the world.  While racial and gender inequality decreased from the 1980s onward, economic inequalities increased.


Stiglitz’s op-ed calls for a dramatic overhaul of our education system, especially with regards to how much funding public institutions receive.  Take a look at this quote:


“Unless current trends in education are reversed, the situation is likely to get even worse. In some cases it seems as if policy has actually been designed to reduce opportunity: government support for many state schools has been steadily gutted over the last few decades — and especially in the last few years. … Young people from families of modest means face a Catch-22: without a college education, they are condemned to a life of poor prospects; with a college education, they may be condemned to a lifetime of living at the brink. And increasingly even a college degree isn’t enough; one needs either a graduate degree or a series of (often unpaid) internships. Those at the top have the connections and social capital to get those opportunities. Those in the middle and bottom don’t. The point is that no one makes it on his or her own.”


As Stiglitz says, the point really is, “No one makes it on his or her own.”


America is a country founded by people with individualistic tendencies, traits that allowed people to excel at entrepreneurial enterprises and boldly go forth seeking their own prosperity and happiness.  The history of the United States is filled with fantastic tales of people coming to this country building up their own business, working hard to support their family and themselves, and becoming successful.  These are inspiring stories that touch upon some of the best qualities of Americans throughout history: hard-working and dedicated, innovative and creative, bold and resilient.


But we live in a changing environment, where it simply is not possible to do what the pioneers did decades ago when they boldly set forth towards the West in search of land and freedom.  The world is more interconnected and intertwined than ever before, and as a result people are more connected and engaged in something beyond themselves than ever before.   This is not to say that entrepreneurial opportunities are not available anymore; on the contrary in fact.  But it simply isn’t possible to do it purely by yourself anymore (it can be argued that it never really was possible, but that is more true today than ever before).  American individualism made our country prosperous, but it is threatening to divide our country into those who have the freedom of opportunity, and those that simply do not.


So if we are really to address this issue of social and economic inequality that continues to plague this country, if we are to really change the way things are and give people more opportunities, if we are really to work towards upholding the creed that America is the Land of Equal Opportunity, we need to have an honest and open discussion about this issue of American individualism, why it exists, what allows it to continue, and what sort of things we can do to try and tone it down.


I recently finished reading a particularly engaging book entitled Outliers by journalist Malcolm Gladwell, who argues simply that in evaluating human potential we typically spend too much time focused on the individual in question, when we really should be looking at the forces surrounding the individual, such as where and when they grew up, what sort of household environment they were raised in, and the culture they were exposed to from an early age on.  Gladwell draws attention once again to the simple fact that, “no one makes it on his or her own.”  While Gladwell focuses on why certain people have become successful in our modern era, why not flip the equation upside down and look at how we can broaden the number of opportunities for people to become successful.  Use what Gladwell’s research tells us, that cultural forces play a much bigger role than normally assumed in helping to determine who succeeds and who falls short, to devise a strategy to level the playing field, to allow more people to have the opportunity to be successful and move up the economic ladder into prosperity.  Devise a strategy to create more outliers, rather than continue to stifle the few chances that limit most Americans already.


So while tomorrow we’ll reflect on social justice issues around the world, today why not stop and think about the social justice issues facing our country today, and what we can do about it.



For another great op-ed article about inequality in America, check out NY Times columnist Paul Krugman’s latest on minimum wage


And as always, please support GlobeMed at Northwestern by donating to our Global Giving site, or checking out some of the awesome things for sale at our Web Thrift Store!

World Day of Social Justice is next week!

February 20, exactly a week from today, is World Day of Social Justice.  We encourage you to check this link out to learn more, and follow us on Facebook and Twitter for the latest updates.


The question we are encouraging you to think about is, “What do all people deserve?”  To get you thinking, consider the Hierarchy of Needs as created by psychologist Abraham Maslow, and reflect on what sort of items you personally value versus the things you could live without.


This would be my answer: All people deserve the right to pursue their dreams and better themselves and their families.  The structural issues that hold individuals and communities back from reaching their potential and contributing to the world in a positive, meaningful way is a violation of human rights and should be one of the top priorities of governments and organizations all around to the world.”


What do you think?  Care to agree or disagree with me?  Share your ideas and start a conversation, and keep checking back here for the latest on World Day of Social Justice!


We here at GlobeMed at Northwestern also believe all people deserve to have access to proper and comprehensive health care because health is a human right.  If you believe that too, please help support us in any way you can, though donations to our Global Giving website or Web Thrift Shop.

Living Longer versus Living Healthier

Global health is an inherently interdisciplinary field, and those studying trends in health around the world can only gain insight if they are looking into more than just the raw numbers, more than just the biological science of disease and illness.  It involves looking deeply at the underlying issues surrounding why people are at risk for diseases and illness, and what potential multi-faceted solutions would work within the given economic, political, geographical, and especially socio-cultural limitations of a particular region.  These philosophies are core to understanding why certain well-meaning global health groups have failed when others have succeeded, and these ideals are central to the tenants upon which GlobeMed was founded.


With that in mind, I encourage you to read this article written by former National Office staff member and Northwestern alumnus Neal Emery, entitled “How the World Gets Sick and Dies”.  A fascinating read, it references recently published studies that indicate people today are living longer than people even just twenty years ago.  While that might sound positive and encouraging, as we know, global health issues are rarely that simple and straightforward.  The truth of the matter, as these studies underscore and Emery elucidates, while people are living longer, the quality of their life is diminished by disease and illness.  People are still getting sick – they’re simply not dying as fast.


The article in many ways is the epitome of what it takes to look critically at global health.  You first begin by taking a simple statistic: the life expectancy of the world is increasing.  Then you start to look carefully at what might explain that statistic: in this case, one reason life expectancy is increasing is that more money is being spent on communicable diseases such as TB and malaria, and the results show fewer people are dying from such diseases today than in the past.  But instead of being content and continuing whatever advocacy was already present, you need to critically examine whether or not these facts really tell the whole story.  Does that one statistic really explain what’s going on around the world?  What sort of underlying issues are not illuminated by that one stat?  Does increased life expectancy simply mean people are living and leading healthier lives?


Those sort of questions lead researchers to conduct further studies, talk to more subjects, and examine more global trends in a much more thorough and interdisciplinary manner, and, not surprisingly, the reality of the situation is much more complicated than one statistic could ever show.   Without further research that explicitly tried to get at the core of the issues surrounding global health, we would never have been aware of the increase in non-communicable diseases, such as diabetes and mental health complications.  We would have never been aware that the overall burden of disease has shifted towards more disability in adults.  We would have never thought to examine the global implications of something like increased access to modern, processed, high-fructose corn syrup-filled foods in relation to diabetes and other cardiovascular diseases.


Such complex conclusions and results do not have easy conclusions, but are important for understanding the best way to tackle the underlying problems, which can guide policymakers and inspire grassroots global health movements.  It is critical to remember to not lose sight of the forest behind the big tree.



Dr. Ali Mokdad, a professor at the University of Washington and mentioned in Emery’s article, did a great interview with NPR a couple years ago about the disparity between women’s and men’s health

-A fascinating article from 2009 that we mentioned in our weekly GHU session on Wednesday about a small Wisconsin community with a seemingly random drop in infant mortality

-Potentially something we will discuss more on this blog, check out this series of articles detailing the latest in decoding your own genome and genetic engineering


Chapter updates:

We are going to be hosting an event on March 6th featuring a documentary called The Unforseen.  More details forthcoming.  Additionally, we encourage everyone to check out our new Web Thrift Store, which has a ton of great things for sale and provides a fantastic opportunity to donate anything you don’t want anymore.  All the proceeds go directly to GlobeMed at Northwestern.  If you prefer old fashioned monetary donations, please visit our Global Giving page and donate to help children in Namugoga, Uganda.