Helping the underserved

[flaahless]

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Rhetorical question: When you think of helping the underserved, what comes to mind?

Last night my roommates and I went out to this restaurant with these girls. We were there drinking Heff, talking and whatnot, and then I noticed some people run into the restaurant and the all the waiters crouch down. I'm thinking it's maybe a surprise party or something, but I still duck under the table as a precaution. One of my roommates grabs the girl he is talking to and jumps behind a wall and screams... "they shooting!"

So now, everyone panicks and tries to run out the front door. As soon as we get there, there is a guy laid out in the parking lot, shot in the head, bleeding five feet in front of us. He was in his 20s, and could have easily been me or one of my roommates. Early talks was that it was gang related but no one knows. This story comes in lieu of Eve Carson, but unfortunately, this story is quite common.

Now back to the rhetorical question.
When I was in HS, I used to think that helping the underserved meant working in underserved areas and practicing in county hospitals. But as I get older I realize there is so much more to be done. It's not enough to just patch up the gunshot victims, but we nned to prevent the victims.

So my question is, what other ways outside of direct healthcare, can we use our influence/skills/status etc. as physicians to improve the quality of life for those who are less fortunate?
Is it Education? Mentoring? Fiscal support? Combination of all three? Any ideas?

Here is the article if you want to read it: http://www.presstelegram.com/ci_8624567?source=rss_viewed

 

[Lawliet2008]

Rhetorical question: When you think of helping the underserved, what comes to mind?

Last night my roommates and I went out to this restaurant with these girls. We were there drinking Heff, talking and whatnot, and then I noticed some people run into the restaurant and the all the waiters crouch down. I'm thinking it's maybe a surprise party or something, but I still duck under the table as a precaution. One of my roommates grabs the girl he is talking to and jumps behind a wall and screams... "they shooting!"

So now, everyone panicks and tries to run out the front door. As soon as we get there, there is a guy laid out in the parking lot, shot in the head, bleeding five feet in front of us. He was in his 20s, and could have easily been me or one of my roommates. Early talks was that it was gang related but no one knows. This story comes in lieu of Eve Carson, but unfortunately, this story is quite common.

Now back to the rhetorical question.
When I was in HS, I used to think that helping the underserved meant working in underserved areas and practicing in county hospitals. But as I get older I realize there is so much more to be done. It's not enough to just patch up the gunshot victims, but we nned to prevent the victims.

So my question is, what other ways outside of direct healthcare, can we use our influence/skills/status etc. as physicians to improve the quality of life for those who are less fortunate?
Is it Education? Mentoring? Fiscal support? Combination of all three? Any ideas?

Here is the article if you want to read it: http://www.presstelegram.com/ci_8624567?source=rss_viewed

First of all, I'm glad that you or your friends were not hurt and it's terrible that that poor kid was shot. A good friend of mine lost a cousin who happened to be hanging out with his friends when some random guy comes and shoots all six. My friend's cousin was shot in the head and died on Friday night.

Secondly, I think that in underserved areas, education is always the answer. The statistics about young African-American men is astonishing. If these kids have schools that provide programs and incentives that will teach them to be as competitive as the rest of the kids in the States, this will probably be a huge step in the right direction.

What's probably happening is that kids don't know how valuable education is until it is too late. If this is taught to them at an earlier age (i.e. prizes, money, etc.) then they will be motivated to live up to their full potential and succeed.

 

[flaahless]

First of all, I'm glad that you or your friends were not hurt and it's terrible that that poor kid was shot. A good friend of mine lost a cousin who happened to be hanging out with his friends when some random guy comes and shoots all six. My friend's cousin was shot in the head and died on Friday night.

Secondly, I think that in underserved areas, education is always the answer. The statistics about young African-American men is astonishing. If these kids have schools that provide programs and incentives that will teach them to be as competitive as the rest of the kids in the States, this will probably be a huge step in the right direction.

What's probably happening is that kids don't know how valuable education is until it is too late. If this is taught to them at an earlier age (i.e. prizes, money, etc.) then they will be motivated to live up to their full potential and succeed.

Yeah I feel you. It reminds of enzyme kinetics. Like, although education is a process that is abundantly rewarding, I feel that the "activation energy" so to speak is too daunting for a lot of young kids.

But as future physicians, how can we help educate urban youth? Can we have any impact on primary and secondary education, or should that issue be left up entirely to the board of education?

Growing up as a kid I always wanted to be a dolphin trainer. But a lot of my cousins and friends wanted to be whatever the guy was with the biggest rims and hottest car. Being a doctor just wasn't cool. How can we glamorize the profession and make it more appealing to young folk? I think we need to redefine what cool is. Make scrubs be the new UGs. I dunno, I'm still a little in shock so I'm probably just rambling. Sorry.

 

[Lawliet2008]

Yeah I feel you. It reminds of enzyme kinetics. Like, although education is a process that is abundantly rewarding, I feel that the "activation energy" so to speak is too daunting for a lot of young kids.

But as future physicians, how can we help educate urban youth? Can we have any impact on primary and secondary education, or should that issue be left up entirely to the board of education?

Growing up as a kid I always wanted to be a dolphin trainer. But a lot of my cousins and friends wanted to be whatever the guy was with the biggest rims and hottest car. Being a doctor just wasn't cool. How can we glamorize the profession and make it more appealing to young folk? I think we need to redefine what cool is. Make scrubs be the new UGs. I dunno, I'm still a little in shock so I'm probably just rambling. Sorry.

I can't even imagine how terrifying that was. I know that if that were me, I would need some kind of counseling or I would have to talk with someone.

Also, I don't think the answer is in glamorizing the professions, I think the answer is in glamorizing education itself. If you think back to grade school, I know that I would study for two reasons:
1. my mom would kick my butt if I didn't
2. I really liked studying because I thought I was good at it.

People don't really play instruments, or do sports, or even spin plates on sticks because of the glamour associated with these activities, they do it because they're good at it. I think a lot of the children have lost confidence in themselves, and I think that step number one must be to restore this confidence in terms of education.

There's this program associated with Habitat for Humanity that, if a child brings home a certain grade, they will get a month's rent paid off of their new home.

As doctors, or even just as a citizen, the key is in organizing programs in which:

1. children are rewarded substantially (i.e. ipods, not stickers) for receiving certain grades and then publicizing their achievements to boost their confidence.

2. parents get involved.

 

[Jolie South]

I can't even imagine how terrifying that was. I know that if that were me, I would need some kind of counseling or I would have to talk with someone.

Also, I don't think the answer is in glamorizing the professions, I think the answer is in glamorizing education itself. If you think back to grade school, I know that I would study for two reasons:
1. my mom would kick my butt if I didn't
2. I really liked studying because I thought I was good at it.

People don't really play instruments, or do sports, or even spin plates on sticks because of the glamour associated with these activities, they do it because they're good at it. I think a lot of the children have lost confidence in themselves, and I think that step number one must be to restore this confidence in terms of education.

There's this program associated with Habitat for Humanity that, if a child brings home a certain grade, they will get a month's rent paid off of their new home.

As doctors, or even just as a citizen, the key is in organizing programs in which:

1. children are rewarded substantially (i.e. ipods, not stickers) for receiving certain grades and then publicizing their achievements to boost their confidence.

2. parents get involved.

I agree with this. I haven't really worked in the inner city/underserved areas in America, but I think a lot of the same rules apply for what i saw in Peace Corps.

If parents aren't excited and involved in their kids progress, the kids don't care about school. the school can be full of great programs and teachers but if kids aren't getting that kind of support at home, forget about it. so many times, i would see parents that didn't value education because it's not something that they knew or really saw the value in. these parents would force the kids to work around the house or in their family farms to make a few bucks immediately, not seeing that the way for the family to leave poverty was through the future of those kids and their education.

it really is a community effort. everyone has to think that education is cool before kids will be interested in it and parents will support it.

however, for one of us to make a difference later, i think we need to start small and gain trust and respect in the community. "converting" people one by one until it becomes a massive movement. this is the only way i ever saw change as a peace corps volunteer. the more people saw me as an outsider and different the less i could accomplish. everyone can do their part where they live. so to answer the big question, that's how all of us can help the underserved.

i know i'm going to get flamed here for "vomiting a bunch of liberal sunshine," but i really do think this works.

 

[flaahless]

I agree with this. I haven't really worked in the inner city/underserved areas in America, but I think a lot of the same rules apply for what i saw in Peace Corps.

If parents aren't excited and involved in their kids progress, the kids don't care about school. the school can be full of great programs and teachers but if kids aren't getting that kind of support at home, forget about it. so many times, i would see parents that didn't value education because it's not something that they knew or really saw the value in. these parents would force the kids to work around the house or in their family farms to make a few bucks immediately, not seeing that the way for the family to leave poverty was through the future of those kids and their education.

it really is a community effort. everyone has to think that education is cool before kids will be interested in it and parents will support it.

however, for one of us to make a difference later, i think we need to start small and gain trust and respect in the community. "converting" people one by one until it becomes a massive movement. this is the only way i ever saw change as a peace corps volunteer. the more people saw me as an outsider and different the less i could accomplish. everyone can do their part in where they live. to answer the big question, that's how all of us can help the underserved.

^^^ That's real.

 

[LadyDoc2]

I think education is empowerment, and the impetus for real change. as physicians we will be in a great position to do good, but that does not mean it will be easy. I also think that legislation is a key factor. Not only do community members need to be educated, but also our representatives, so that they can support policy that will do some real good.

 

[SweetButterfly]

I remember a similar situation. It was Dec 15th and my 2 sisters (1 older 1 younger) and I went to my older sisters friends house to take her to the airport. We went in said hi and left my little sis inside. My older sis and I then went out to the car to clean iit out. While doing so, we heard people arguing at the barbershop beside the house. My sister looked up and kept cleaning out the backseat while I observed what was going on. I had stopped cleaning out the front passenger side. The group of people arguing started splitting up and one guy suddenly ducked to the side of the building. One of the other guys had his hand to the side of his body (while being "held back") and i realized something was wrong. I told my sis "i think they have a gun". The crowd started quickly dispersing and the guy who had his hand in his pocket had one friend went to their car. They started driving away and right as they were about to pull out of the parking lot, the car stopped, the doors flew open, and the driver (who had his hand in his pocket earlier), got out (movie style...and started shooting at the barbershop) IT was crazy. I ducked down to the side scared as hell. all doors to the car were open. The only road the shooters could leave by had a clear view of the car and holy cow that scared me. All that could go through my mind at the moment was that we were witnesses to whatever just went down. Couple of seconds later another car flies to the back of the building. The car was being shot at and the trunk was shot open. I somehow called 911 and managed to spit out the story as calmly as possible.


Anyhow. It was a crazy experience One that i hope never happens again.
I volunteer with kids in the inner city. I find that yes, parent support is very important. Once the parents step in and support and encourage the kids, we notice a difference. In the case that parents arent there we try to have positive role models that support and encourage. I think its key.

 

[Drogba]

Rhetorical question: When you think of helping the underserved, what comes to mind?

Last night my roommates and I went out to this restaurant with these girls. We were there drinking Heff, talking and whatnot, and then I noticed some people run into the restaurant and the all the waiters crouch down. I'm thinking it's maybe a surprise party or something, but I still duck under the table as a precaution. One of my roommates grabs the girl he is talking to and jumps behind a wall and screams... "they shooting!"

So now, everyone panicks and tries to run out the front door. As soon as we get there, there is a guy laid out in the parking lot, shot in the head, bleeding five feet in front of us. He was in his 20s, and could have easily been me or one of my roommates. Early talks was that it was gang related but no one knows. This story comes in lieu of Eve Carson, but unfortunately, this story is quite common.

Now back to the rhetorical question.
When I was in HS, I used to think that helping the underserved meant working in underserved areas and practicing in county hospitals. But as I get older I realize there is so much more to be done. It's not enough to just patch up the gunshot victims, but we nned to prevent the victims.

So my question is, what other ways outside of direct healthcare, can we use our influence/skills/status etc. as physicians to improve the quality of life for those who are less fortunate?
Is it Education? Mentoring? Fiscal support? Combination of all three? Any ideas?

Here is the article if you want to read it: http://www.presstelegram.com/ci_8624567?source=rss_viewed

Man that is intense. I've never seen anyone shot in front of me like that but one of the most affecting experiences I've had is seeing an 18 year get his chest opened up in the ED for an emergency thoracotomy after beeing shot through the heart. He died on the table, or rather, he stayed dead, despite the thoracotomy. I remember thinking "f*** man, this kid is 2 years younger than me." This is unfortunately not a very rare occurence in my city where we average >1 murder per day. Many of the victims are <18 yo.

Per the bolded part, this is something I've struggled with for a long time and I continue to struggle with it. It is obvious that the "underserved" are betrayed by much more than the health system. There are resource access issues (labor market, education etc) as well as more sociological issues such as family and peer group dynamics. These constrain the choices individuals make or at least increase the likelihood of making unhealthy decisions. They also increase the repercussions of making poor decisions. Even in the purely medical sphere it is amply obvious that a lack of medical technology is not the salient issue facing underserved communities.

Realizing this has caused me to strongly consider pursuing a medical anthropology PhD as well as an MD. The main research tool of the branch of anthro I'm interested in is ethnography. This approach helps build a perspective that is more nuanced than nearly any other social science methodology. Some times you can directly inform clinical practice with what you learn from this type of research. You can also direct future research and develop hypotheses that are testable by more quantitative methods. ideally, elucidating social mechanisms (the effect interpersonal relationships, interactions with important institution and personal characteristics etc) can inform policy and clinical/public health practice. In the very least it can help focus our attention where it needs to be. Also, on a more abstract, but nonethless important (in my opinion), level writing ethnographies is also a way to lend a "voice" to populations who are systematically silenced or whose mainstream representation is often full of stereotypes and unfounded misperceptions.

Basically, I feel compelled to understand the problems of "underserved" communities in a systematic way that can lead to well directed structural and personal interventions.

 

[Miss Alyssa]

From my experience, parents are really hard to reach. I go straight to the children. If I see a group of young kids hanging out on a corner or in the community when I'm on the way to Science Club, I invite them in. Yes, a lot pretend they're too cool to come, but normally there is at least one that is interested (but tries to pretend not to be, lol). Then I keep them hooked with how much fun science really is.

To reach disadvantaged populations, I bring science. I volunteer with a community organization aimed at increasing the number of African-Canadians in science and technology. We run free hands on science activities and experiments as Saturday morning programs or after school programs. Children really love it. Also, last summer I worked for Science Outreach which basically did the same thing, but went around to non-science camps (like an art camp) and gave them an afternoon of science programming. I relate it to their life. I'll talk about the kinetics and mechanics of how to improve their basketball shot. Then I'll start talking about careers in sports medicine or kinesiology. I have some grade 8s dreaming of going to university and studying aerospace engineering because they like the space workshop so much.

I'll continue to volunteer my time in these types of organizations.

 

[umz]

I have some friends who are teachers at a school on the Texas border. They are people who grew up going to the same schools they are teaching at. However, they absolutely hate their jobs, and even though they can relate and are a part of the community (and have been their entire lives), they feel completely unable to inspire education in any of the students.

They get called names, the kids are completely out of control, and one elementary student (already noted as mentally unstable) the other day pulled out a knife and said he wanted to kill certain other students and that if a teacher tries to mess with him, he'd kill them too. The punishment: suspended for a day. A DAY. And then the mother comes and says that she hates the school district and she's sending her boy somewhere else! When the friend told me this story I said, "😱, if that kid comes back and something actually happens, the school is going to be in so much trouble for not doing anything after the first incident." Her response was, "No. Probably not. Who cares about [the school]?"

My friends that are teaching at the middle school can not control their classes, but there seems to be nothing they can do about it. Students complain, saying "well, i'm just going to drop out like my brother, so this is a waste of my time."

Talking to them about this made me feel terrible, as I really felt their helplessness as educators.

I think that one answer might be athletics. If you can get a really strict athletic director to come and whip the program into shape, it will catch some of the students attention, building good character, a drive to do well, and discipline and they can pass it on to friends not in athletics. When I mentioned this to my friends they said that people would just quit playing sports when faced with actual discipline (one of the friends was a coach). I definitely think there would be some people that would say f' you to the coach, but I don't think they all would. But what do I know.

Sorry if I rambled too much or got off topic a bit.

 

[flaahless]

Man that is intense. I've never seen anyone shot in front of me like that but one of the most affecting experiences I've had is seeing an 18 year get his chest opened up in the ED for an emergency thoracotomy after beeing shot through the heart. He died on the table, or rather, he stayed dead, despite the thoracotomy. I remember thinking "f*** man, this kid is 2 years younger than me." This is unfortunately not a very rare occurence in my city where we average >1 murder per day. Many of the victims are <18 yo.

Per the bolded part, this is something I've struggled with for a long time and I continue to struggle with it. It is obvious that the "underserved" are betrayed by much more than the health system. There are resource access issues (labor market, education etc) as well as more sociological issues such as family and peer group dynamics. These constrain the choices individuals make or at least increase the likelihood of making unhealthy decisions. They also increase the repercussions of making poor decisions. Even in the purely medical sphere it is amply obvious that a lack of medical technology is not the salient issue facing underserved communities.

Realizing this has caused me to strongly consider pursuing a medical anthropology PhD as well as an MD. The main research tool of the branch of anthro I'm interested in is ethnography. This approach helps build a perspective that is more nuanced than nearly any other social science methodology. Some times you can directly inform clinical practice with what you learn from this type of research. You can also direct future research and develop hypotheses that are testable by more quantitative methods. ideally, elucidating social mechanisms (the effect interpersonal relationships, interactions with important institution and personal characteristics etc) can inform policy and clinical/public health practice. In the very least it can help focus our attention where it needs to be. Also, on a more abstract, but nonethless important (in my opinion), level writing ethnographies is also a way to lend a "voice" to populations who are systematically silenced or whose mainstream representation is often full of stereotypes and unfounded misperceptions.

Basically, I feel compelled to understand the problems of "underserved" communities in a systematic way that can lead to well directed structural and personal interventions.

That's wussup.

 

[Lawliet2008]

When I think about my above post, 1. and 2. are really doing the same thing. The reason why parental support is so important is because it is another mechanism that would increase the self-confidence a child has with respect to their academic ability. Therefore, if we can boost the confidence of a child, then it will be more likely they will continue with education.

I know this probably seemed obvious to most people, but I just had a major Breakthrough.

 

[flaahless]

I have some friends who are teachers at a school on the Texas border. They are people who grew up going to the same schools they are teaching at. However, they absolutely hate their jobs, and even though they can relate and are a part of the community (and have been their entire lives), they feel completely unable to inspire education in any of the students.

They get called names, the kids are completely out of control, and one elementary student (already noted as mentally unstable) the other day pulled out a knife and said he wanted to kill certain other students and that if a teacher tries to mess with him, he'd kill them too. The punishment: suspended for a day. A DAY. And then the mother comes and says that she hates the school district and she's sending her boy somewhere else! When the friend told me this story I said, "😱, if that kid comes back and something actually happens, the school is going to be in so much trouble for not doing anything after the first incident." Her response was, "No. Probably not. Who cares about [the school]?"

My friends that are teaching at the middle school can not control their classes, but there seems to be nothing they can do about it. Students complain, saying "well, i'm just going to drop out like my brother, so this is a waste of my time."

Talking to them about this made me feel terrible, as I really felt their helplessness as educators.

I think that one answer might be athletics. If you can get a really strict athletic director to come and whip the program into shape, it will catch some of the students attention, building good character, a drive to do well, and discipline and they can pass it on to friends not in athletics. When I mentioned this to my friends they said that people would just quit playing sports when faced with actual discipline (one of the friends was a coach). I definitely think there would be some people that would say f' you to the coach, but I don't think they all would. But what do I know.

Sorry if I rambled too much or got off topic a bit.

Yeah I feel you man. My best friend teaches at a high school in Lynwood, a city that borders Long Beach and Compton. It's a pretty rough high school, and all he talks about is the lack of motivation that students have, their apathy, and their distrust in the educational system. He tells me stories of students rolling blunts in the classroom, drinking in the halls, not going to class etc. And I think what troubles him the most is that the students don't seem to care about their futures. And nothing he tries to do seems to motivate them.

Although I don't think athletics is the end all answer, it definitely offers opportunities for students to stay out of trouble and learn important values like discipline, hardwork and respect.

Anyways, I really like what Jolie was talking about. That change requires the collective effort of the community, it reminds me of a quote I read somewhear that... "It takes a community to raise a child."

And I know there is no easy answer to this question but, how can we use medicine to inspire a community to change?

 

[Lawliet2008]

Anybody read A Hope in the Unseen by Ron Suskind? Really good book.

 

[Drogba]

Yeah I feel you man. My best friend teaches at a high school in Lynwood, a city that borders Long Beach and Compton. It's a pretty rough high school, and all he talks about is the lack of motivation that students have, their apathy, and their distrust in the educational system. He tells me stories of students rolling blunts in the classroom, drinking in the halls, not going to class etc. And I think what troubles him the most is that the students don't seem to care about their futures. And nothing he tries to do seems to motivate them.

Although I don't think athletics is the end all answer, it definitely offers opportunities for students to stay out of trouble and learn important values like discipline, hardwork and respect.

Anyways, I really like what Jolie was talking about. That change requires the collective effort of the community, it reminds me of a quote I read somewhear that... "It takes a community to raise a child."

And I know there is no easy answer to this question but, how can we use medicine to inspire a community to change?

Re: Medicine as avenue for social change

http://www.amazon.com/Awakening-Hip...bs_sr_1?ie=UTF8&s=books&qid=1205977308&sr=8-1

It has a distinctely international focus, which might be less interesting to you. This is not to say it is irrelevant to any domestic effort.

 

[bozz]

Parents

Parents really really really have to give that initial push. Most people aren't born with any direction. In my culture, if you don't study, you amount to nothing. Noone respects you.... that alone is enough to push people... whether they like it or not. Who "likes" studying? I don't.. I hate it. I like the eventual goal of being a doctor. But as a kid with no direction, I'd rather be stealing from Walmart.. getting stuff for free sounds REALLY appealing.. even now. I never did it as a child because my whole community would find out and nobody would talk to me. Now, I don't even question it... not b/c it's "wrong" but b/c I was simply taught not to do it. Knowing why is important.... but that comes later on.

You simply cannot explain to a 5 year old why education is important. It's just not possible. You just force them to study ... if not, no Playstation, no TV.

I feel some amount of fear is necessary. I know people who get beaten with a belt if they don't bring home all As. I'm not advocating this at all. Too extreme for me... but it works. Once they leave for college (leave family behind), they've got a great work ethic, do well in college and in life. Consequences should be apparent. Force your 5 year old to do addition and subtraction next to you while you read your newspaper in the mornings.

As physicians, I'm not really sure how to go about doing this. We can affect our own families.. but I'm not sure how we can affect families who do not have this mindset at all in the first place. But IMO #1 group we should be targeting is the parents.

 

[MaryLennox]

i agree that parents caring is one of the most important things to ensuring a kid's success in school. and this is where physicians can help- family planning.

the kids i tutor are on spring break but i came in anyway just to hang out (its a community center type place) and i ended up getting into a conversation with a woman from the neighborhood and we were talking about all these things. and she said, wow, its so great you wanna be a doctor, you're so lucky that you havent gotten pregnant! and i told her, well, ummmm, that's not luck, i paid to ensure that i haven't and wont anytime soon. so then she tells me about her friend who got pregnant while on the pill which led to a discussion about how easy it is to mess up while taking it.

i have met a lot of the mothers of the kids i tutor and although i hate to generalize, i think it's safe to say a vast majority of this kids were unplanned and born to parents who are still kids themselves. and especially if their parents never got to see the value of an education pay off themselves, how will they instill it in their kids? all they have, and subsequently pass on, are survival skills. they feel school didn't help them, so screw their kids. (again, this isnt everyone, i've met some phenomenal kids and parents in this poor neighborhood.) but it seems to be the trend. and this is where volunteers step in, but . . . the parents are the MOST IMPORTANT.

how to make parents better parents? make sure thats what they want to be. better sex ed, access to birth control, and education to make sure women are picking the best one for them and knowing how to use it correctly. (it terrifies me to hear so many people talking about their pill-taking habits . . . oh my god. "i skipped a few days so i just took a whole bunch at once and then had a crazy weekend . . ." hello oops babies.

 

[Jolie South]

Yeah I feel you man. My best friend teaches at a high school in Lynwood, a city that borders Long Beach and Compton. It's a pretty rough high school, and all he talks about is the lack of motivation that students have, their apathy, and their distrust in the educational system. He tells me stories of students rolling blunts in the classroom, drinking in the halls, not going to class etc. And I think what troubles him the most is that the students don't seem to care about their futures. And nothing he tries to do seems to motivate them.

Although I don't think athletics is the end all answer, it definitely offers opportunities for students to stay out of trouble and learn important values like discipline, hardwork and respect.

Anyways, I really like what Jolie was talking about. That change requires the collective effort of the community, it reminds me of a quote I read somewhear that... "It takes a community to raise a child."

And I know there is no easy answer to this question but, how can we use medicine to inspire a community to change?

i don't want people to think that what i was talking about is easy. it was far harder than anything i've ever done or will do. it was frustrating at times and there were definitely moments when i wanted to give up. however, for a lot of communities that the "powers" in charge forget, an individual trying to make a change is all there is. in my case, i felt like the catalyst but knew that nothing would happen without the entire community working together.

i'll explain a little of what i did. when i moved to my site, i was completely demotivated. the job that i was given didn't exist. i randomly happened upon a group of women that were trying to get something going at a women's center. i was like "well, crap, i don't know anything about sewing or cooking or whatever else you're interested in." so, i offered to give talks about various health topics, but the more i became entrenched in the group and got to know the women, the more i started thinking that i should do what i could even though i didn't feel like i had much to give. it was a bunch of illiterate women and me. i somehow convinced myself and them that we could do something and ultimately we did. we built latrines, kitchens, and a well and organized sewing classes that were open to the public. sewing classes sound dumb, but for women without a source of income outside of their husbands it was a big deal. at first, no one came, but over time the center was so packed that we didn't even have space for everyone. when i left to start on another project, the women actually continued on and were trying to organize other stuff in the center. i still hear news about it to this day.

another interesting aspect is that none of the men in the village thought that we were capable. yet, at the end of the day, their attitudes had changed and they were even willing to help us financially.

it can be done. it takes a LOT of time and a strong character.

 

[bozz]

Also to add,

I was in New Orleans this break... some kids were placed in public schools that had "private-school" facilities. They had some of the most amazing technology.. I hadn't even seen on college campuses. It was mostly filled with kids who had been displaced due to Katrina. The teachers were extremely caring and patient... yet half of these kids.. when I asked them if they would like to go to college. They replied, "No way... my 18 year old cousin works as a mechanic, my 20 year old uncle paints houses and makes a lot of money." These were 6th graders by the way. They had high quality education being thrown at them... yet they didn't realize it. I don't blame them at all. So I don't really know how much "changing the educational system" will do.

It really has to come from the parents. But s MaryLennox said above, many parents don't understand the value of education themselves =(

 

[Drogba]

Parents

As physicians, I'm not really sure how to go about doing this. We can affect our own families.. but I'm not sure how we can affect families who do not have this mindset at all in the first place.

Well, as a social scientist you can explore why certain communities might have an oppositional orientation towards mainstream institutions whether they be the school system or something else. Your post touches on a very deep and central issue, that of value construction. What qualities makes a personal valuable and accomplished varies greatly from community to community. This salient value construction is usually highly dependent on the social context of the individual you are looking at eg peer group influence vs influence of other role models, family dynamics, material circumstances, institutional interactions etc.

As a pure clinician you probably cannot address any of this directly. At best you can work to increase the access of medical services to neglected communities and try and play an active role in your community to serve as one possible role model. One of the reasons I'm interested in academics is to gain some level of freedom from the restrictions of todays health service bureacracy which makes it difficult to spend more than 10 minutes with your patients let alone use medicine as a tool for social change.

 

[Lawliet2008]

Guys, ask yourselves, why did you take school seriously? Why do you (or did you) like to study? Is it not the high we get from knowing we are good at something?

Could you imagine how your life would have turned out if nobody told you that you did good for getting an A as a child? What would you have done instead?

When I think about this, I thank God for my parents and all of the wonderful teachers I had. Without them...who knows?

Again, as physicians, or not, the most important programs that we can support or start are those that teach children that education in and of itself (i.e. don't worry about the goals it can help you accomplish. I don't think many elementary kids are studying for tests that they can get into med school) is possible to be good at. I'm a tutor, kids of all ages give up and act up when they don't understand something. But the moment you make them believe that they can understand it (i.e. give them easier problems, lots of praise), their whole face lights up and they try again.

 

[Drogba]

i don't want people to think that what i was talking about is easy. it was far harder than anything i've ever done or will do. it was frustrating at times and there were definitely moments when i wanted to give up. however, for a lot of communities that the "powers" in charge forget, an individual trying to make a change is all there is. in my case, i felt like the catalyst but knew that nothing would happen without the entire community working together.

i'll explain a little of what i did. when i moved to my site, i was completely demotivated. the job that i was given didn't exist. i randomly happened upon a group of women that were trying to get something going at a women's center. i was like "well, crap, i don't know anything about sewing or cooking or whatever else you're interested in." so, i offered to give talks about various health topics, but the more i became entrenched in the group and got to know the women, the more i started thinking that i should do what i could even though i didn't feel like i had much to give. it was a bunch of illiterate women and me. i somehow convinced myself and them that we could do something and ultimately we did. we built latrines, kitchens, and a well and organized sewing classes that were open to the public. sewing classes sound dumb, but for women without a source of income outside of their husbands it was a big deal. at first, no one came, but over time the center was so packed that we didn't even have space for everyone. when i left to start on another project, the women actually continued on and were trying to organize other stuff in the center. i still hear news about it to this day.

another interesting aspect is that none of the men in the village thought that we were capable. yet, at the end of the day, their attitudes had changed and they were even willing to help us financially.

it can be done. it takes a LOT of time and a strong character.

Have you read Death Without Weeping by any chance? It was written Nancy Scheper-Hughes who served in "O Nordeste" of Brazil as a peace corp member in the 1960s. She went on to become one of the most prominent medical anthropology and currently teaches at Berkely.

DWOW explores the themes of child death in environments of extreme deprivation and the indifference mothers seem to have towards infant mortality. It is really interesting though quite disturbing in many parts. It's a seminal piece of medical anthropology scholarship. I just thought it might be interesting to you since she got her start as a PC volunteer.

 

[Jolie South]

Have you read Death Without Weeping by any chance? It was written Nancy Scheper-Hughes who served in "O Nordeste" of Brazil as a peace corp member in the 1960s. She went on to become one of the most prominent medical anthropology and currently teaches at Berkely.

DWOW explores the themes of child death in environments of extreme deprivation and the indifference mothers seem to have towards infant mortality. It is really interesting though quite disturbing in many parts. It's a seminal piece of medical anthropology scholarship. I just thought it might be interesting to you since she got her start as a PC volunteer.

no, i haven't. i'll have to check that out.

i can sort of see how mothers would be indifferent in those types of environments without most medical care that we have here. the philosophy is to have lots of children so that some of them survive. well, that's what it was though i can see it changing. vaccines, mosquito nets, etc are penetrating areas that never received them in the past.

 

[Drogba]

While I agree with the general sentiment here about the importance of having parents who value education I'd like to point out that that this is only a piece of the puzzle. The influence of parents on the lives of their kids can be relatively limited especially as kids get older and face some serious challenges to parental authority from friends and older role models who have high social status (the local drug dealer for example). I know most people are not intending this but everyone seems to be placing the blame entirely at the feet of parents when in fact many parents are well intentioned and DO try to encourage responsible behavior. This is not to say that many kids in impovershed communities do not have dysfunctional families.

 

[Drogba]

no, i haven't. i'll have to check that out.

i can sort of see how mothers would be indifferent in those types of environments without most medical care that we have here. the philosophy is to have lots of children so that some of them survive. well, that's what it was though i can see it changing. vaccines, mosquito nets, etc are penetrating areas that never received them in the past.

Yeah. Perhaps I should of been a little more explicit in my explanation though. She didn't observe indifference solely, but indifference to the point of neglect. If a child was identified as unlikely to live or without "a desire to live" they were often left to die even if they were still viable. Its an extreme form of indifference. One of the main purposes of her book is to challenge the notion of universalizing, biological, feminine "maternal extinct" and how extreme maternal deprivation as well as other social and cultural forces can cause women to deviate from something that is largely talked about as a fundamental feminine characteristic.

 

[noluckstar]

deleted

 

[rbnsafsadgf]

It's not enough to just patch up the gunshot victims, but we nned to prevent the victims.

So my question is, what other ways outside of direct healthcare, can we use our influence/skills/status etc. as physicians to improve the quality of life for those who are less fortunate?
Is it Education? Mentoring? Fiscal support? Combination of all three? Any ideas?

I think you mean supporting applied "Social Justice".

 

[Drogba]

I think you mean supporting applied "Social Justice".

Thanks for the semantic clarification... I guess.

 

[HumidBeing]

When I think of underserved populations, I think of low income rural inhabitants and migrant workers. Those are people who actually are underserved in health care, education, and public services, in general. These are the people who lack access and resources. The deaths from lack of access to appropriate health care in rural communities don't tend to make the news the way that deaths by violence do.

Our cities have accessible resources and abound with opportunities. Still, they are what comes to most people's minds when they think of underserved. Maybe a more appropriate term would be ineffectively served.

This is a good thread with some good thoughts. My thinking along these lines is more pie in the sky societal engineering. City planning that eliminates high density, low income, enclaves and intersperses small numbers of low income housing units in mixed residential areas. Free family planning. Mandatory parenting classes for teen parents with intensive follow-up home visits, and open community parenting classes. Require parents to be involved with the schools. Return vocational skills to the curriculum. Small community libraries w/large inter-library loans. Change in thought so that there is no stigma to voluntarily giving up one's children at any age if one does not wish to raise them. Elimination of tax deductions and credits for dependent children. Variety of after school programs. Good public transportation infrastructure. Minimum driving age of 18 in cities. Neighborhood policing. Just like some neighborhoods have association fees, they could have mandatory community involvement and volunteering. I think it's really all a matter of community involvement because change has to come from the people desiring a change and feeling that they have the ability to make it happen.

Our current system has been a failure for decades. I think the changes have to be large scale in order to break the cycle.

 

[Miss Alyssa]

If you're going to volunteer with children, honor your commitment and stick with it. Children do remember you, and they do notice when you leave and never come back. We had a volunteer show up in the first 2 Saturdays of the school year. The children are still askin what happened to her.

 

[SweetButterfly]

If you're going to volunteer with children, honor your commitment and stick with it. Children do remember you, and they do notice when you leave and never come back. We had a volunteer show up in the first 2 Saturdays of the school year. The children are still askin what happened to her.

I know! Im a Big Sister through my high school and in the beginning they made sure we knew how much we would mean to the kids and how we would have to be consistent because its something that alot of the kids lacked at home. Halfway through the year we had 2 kids drop out. One for medical reasons, the other just "didnt care". Their little brother and sister were devastated. They DO remember. They enjoy the company before and/or after school. We get to help them with homework and just talk about life and school and friends. Its heartbreaking alot of times about some of the injustices some of the kids have faced. Some things that even I as a senior in HS probably wouldnt be able to handle but they come to school. My little sister told me the other day that she wanted to make her parents proud even if they didnt care. She comes from an unstable home but it never fails to amaze me how she views the world/what she has gone through. She said she wanted her 2 brothers to look up to her (so she makes sure she does well in school so she can help them). I asked her what her goals in life where as of now and she said she wanted her brothers to succeed so they could be betteer than their father.

Ive met kids who like school and do well because they compete with each other. Ive also met kids who work hard in school because its their only hope and going to school is an escape from whatever else is going on in their life.

When i moved here from Kenya I made sure I performed well in school for several reasons. It was a great opportunity to go to school in the U.S and I wanted to make the best of it. I went to great schools in Kenya but this by far was a great opportunity. My motivation was simply that I had a chance to get an education that would be recognized around the world, that would make my dreams come true, no matter what they were.

 

[Drogba]

Bump. This old thread is probably relevant for some...
I'm interested to hear what the new batch of premeds has to say ;]