Forum

Often times when we think of South Africa our minds wander to Nelson Mandela or even Desmond Tutu, well known leaders who paved the way for human rights during the apartheid, a word that is enriched with history as it reminds us of the suffering that many endured for 50 years. The Apartheid, which is translated in Afrikaans meaning “apartness”, was a system in South Africa, which was created by the National Party government in order to advance the minority white population. Though the apartheid is no longer a running system it’s damages still live on as it has affected the way of life for many South Africans, specifically black South Africans. As destruction permeated it’s way through the lives of many people it was able to have extreme effects on one’s health. HIV, which was known as a taboo disease throughout the years began to make its way through South Africa becoming AIDS which took the lives of millions. South Africa soon began to be the “poster country” for HIV infections. Statistics show that there are approximately 7.1 million people living with HIV in South Africa being one of the largest in the world. I am interested in understanding how policies and socioeconomic status can contribute to one’s health. As I examine these factors, I would like to analyze how destruction generated by the apartheid has played a role in the widespread of HIV as well as how we can relate this back to a broader scale of global health and development. Policies can be used for good intent for a greater good or can deliberately used to achieve an unreasonable outcome. When the apartheid started slowing making it’s appearance in South Africa, government officials had put policies in place which inhibit black people from living in areas where their white counterparts were located. This caused many to live areas known as Bantustans, which were territories set aside for black people. Within these Bantustans, healthcare was primarily governed by each individual Bantustans. The South African government did not govern the quality of health services in these areas. Overtime these places became known for maltreatment and malpractice because of the limited resources they have. Soon after the end of the apartheid, the government promised to promote primary health care services and prevention through the National AIDS Plan which would strengthen the Bantustans health systems. This plan, though cause many problems because it didn’t face the problems that had already existed from past policies and existing organizations. As we see that policies implemented had a negative impact on the widespread HIV, we can also see how the socioeconomic landscape of South Africa post-apartheid played a crucial role in the HIV epidemic. Policies links to socioeconomic status, which then links to our health. Many people don’t realize that HIV often times can be a connecting factor to poverty or vice versa. According to STATS SA, three million South Africans were pushed below the poverty line. Black South Africans were the most negatively group impacted by poverty. Since limited resources and economic opportunities weren’t readily available many chose to engage in other avenues that may benefit them and/or family. For example, adolescent girls who come from lower income families may engage in transactional sex which is exchanging sex for material benefit. This action puts adolescent girls at a greater risk for HIV. Many of these girls are living in Bantustans which are already facing neglect by the health system. As we look at how policies and socioeconomic status has been a contributing factor to HIV in South Africa, we can take a look and see how we can relate this back to global health and development work. Using South Africa as a model, we can see that different establishments can clearly target our health. It’s important to note that in order to provide proper access to health care as well initiate different services we must understand the history of the community we are serving. Institutions and systems have negatively impacted the way many communities take care of their health. Hopefully for those of us who are working in this field we can understand that in order to dismantle inequalities in health we must aim at the root cause.

The U.S. government reports that a 16-year-old Guatemalan died on Monday at a Border Patrol station in South Texas, the fifth death of a migrant child since December.The teenager was apprehended in South Texas’ Rio Grande Valley on May 13th and was found unresponsive Monday morning, May 20th during a welfare check at the agency’s Weslaco, Texas, station. The cause of death is unknown. The agency did not say why the teenager had been detained for a week, but said he was “due for placement” in a facility for youth operated by the U.S. Department of Health and Human Services. After the deaths of two children ages 7 and 8 in December, the Department of Homeland Security ordered medical checks of all children in its custody and expanded medical screenings. This phenomenon is not unique to the southern border of the United States but can also be seen worldwide. Immigrants often leave their countries in search for a better life . Furthermore, attempts to adjusting to a new culture and lifestyle spans beyond the pursuit of citizenship. Pertaining to this current crisis at immigration detention centers in Texas, I would propose the inclusion of healthcare workers and volunteers to screen each individual upon arrival to the U.S, especially children, in order to not only preserve their health status but also protect the public health of citizens by reducing the risk of introducing endemic diseases into the population. This will also prevent the spread of disease in the centers among the detainees and allow people who have come from different backgrounds with different exposures to receive prompt medical care after their long journey to seek refuge in another country. In the case concerning this teenager in Texas, it cannot be confirmed if he was truly medically screened and assessed in a timely or thorough manner. This can also be translated when concerning the vaccination of travelers into African countries. Immunizations and health records of foreigners must be assessed in order to avoid the introduction of new diseases into our region. Health policy in this regard is not strictly enforced and often medication can only be accessed by people that can afford it which comes as an expense to the people of our communities when resources are allocated to foreigners. Immigration is not merely a change in citizenship or search for a better life. Its concerns does not only impact job availability, overpopulation or crime rates. Immigration also affects healthcare and health policy and it is imperative to consider how public health affects global health beyond the boundaries of the hospital setting.

As I was preparing to travel to Ghana for a medical mission trip affiliated with CFHI, I was prompted by the health agency I will be working with that I will be required to get a yellow fever vaccination to enter the country. This is when I was made aware of the international shortage of the vaccine since the only company that manufactured it (Sanofi Pasteur) had suspended production of the vaccine temporarily at one of their mass production locations. Yellow Fever is an acute viral disease caused by infection with the yellow fever virus and transmitted to humans through the bite of an infected mosquito. Symptoms of infection include fever, chills, flu like symptoms, nausea and vomiting progressing into worse symptoms such as heart, liver or kidney conditions without prompt medical attention. I attempted to contact numerous travel clinics and was told that they were either out of the vaccine or I would have to wait for up to 2 months till the next available appointment or shipment of the vaccine from France due to pending FDA approval of the drug Stamaril which is a derivative of the vaccine produced in France. Stamaril (Produced by Sanofi Pasteur in France) I was finally able to obtain the vaccine 10 days prior to my departure for a cost of $210 and began to research on the efficacy of the vaccine and why it was required to gain entry into the country. In Ghana, the Ministry of Health reported outbreaks of yellow fever in three different districts; two deaths and one new case involving a 12-year-old boy from the Kassena-Nankana-West district who died within one week of displaying symptoms (reported in 2012). Travelers arriving to Ghana from the United States are required to be vaccinated at least 10 days prior to arrival in the country. From an epidemiology standpoint, this will decreases the risk of introducing this viral infection in other countries or acquiring it within the affected country. In recent years, there has been a mandate by the CDC and WHO that requires this vaccination in order to gain entry into Ghana and some other nations with high prevalence of yellow fever cases. However the reinforcement of this public health concern is questionable. Multiple people have reported entry into Ghana without being vaccinated or are vaccinated upon entry to the country along with a fee paid at the airport (which renders a risk since the full effect of the vaccination is not activated till about 1.5 weeks post inoculation). I am also appalled by the fact that the citizens of Ghana know little about this viral illness hence vaccination rates within the country itself are low. Due to the worldwide shortage, affected African nations that actually need the vaccinations to prevent the spread of this incurable illness have little to no access to the vaccination. In a world where technology, industry and medicine are inseparable, I am concerned about what that means for poor African nations with low health education and resource access. Many diseases that have been eradicated in first world nations still remain a threat to the people of the African continent due to lack of educational resources and health innovations. I am well aware that the continent is more prone to mosquito-borne illnesses as a result of the climate and environmental conditions that allow such species to thrive, which is even more reason for an interest in health care discoveries by the people who live in that region instead of being dependent on international healthcare agencies that seek to protect their own interests and national health. I hope that we would one day become a people group that protects the health of our own by investing in healthcare and technological innovations that may do much more than merely cure us temporarily from diseases but instead completely eliminate endemic diseases that plague our beautiful continent due to the lack of the pursuit and dedication to healthcare research and technological innovation.