Health Disparities are Issues of Poverty
[Note from BRI executive director, Beth Haynes, MD: “Thanks to our generous membership who donated to support Faith’s 2016 trip to Nigeria.”]
Benjamin Rush Institute’s vision of “a world of quality healthcare accompanied by accelerating medical innovation and excellence,” resonates with me. At the 2016 BRI Leadership Conference in Washington, DC this past April, I met Aishat Olanlege, a fellow BRI chapter founder and president, from the College of Medicine at the University of Ibadan, Nigeria. Her presentation on healthcare and health management in rural Nigeria sparked in me a desire to make a difference in impoverished rural communities. Ibadan would be a great place to start.
“PovertyCure’s mission dovetails with Benjamin Rush Institute’s mission.” ~Faith Njoku, BRI-UC Irvine School of Medicine chapter founder & president
Purpose: Individual health status is related to one’s ability to access and afford quality medical care, but even more directly related to education, income and lifestyle choices. Therefore, we posit that adverse health disparities are issues of poverty. The purpose of this research trip is to create a basis of discussion for how education and the economic empowerment of individuals relate to healthcare management and how health policy can foster socio-economic solutions in rural villages in Nigeria.
BRI Chapters Involved: Faith Njoku, first year medical student and BRI chapter president at UC Irvine School of Medicine will travel to Oyo State, Nigeria for thirteen days to work with Aishat Olanlege, sixth year medical student, and BRI chapter founder and president at the University of Ibadan Medical School.
Background: PovertyCure is a six-DVD video course produced by PovertyCure.org, an international network of organizations and individuals seeking to ground a common battle against global poverty. Foundational to this battle are: 1) a proper understanding of the human person and society, 2) encouraging solutions that foster opportunity, and 3) unleashing the entrepreneurial spirit that already exists in the developing world.
The instructional video series emphasizes individuals’ dignity and creativity. People are willing to work hard towards solutions if they can see that there is the possibility of improving their lives. Michael Matheson Miller, Research Fellow at the Acton Institute, director and producer of the award-winning documentary Poverty, Inc: The Business of Doing Good, and director and host of the PovertyCure series, identifies major factors that prevent the poor from escaping a poverty cycle. These include minimal or unenforced property rights, an arbitrary or entirely absent rule of law, and the injustices that ensue from both. He also looks at globalization, examining both the dangers and opportunities it presents for the poor.
As health and health outcomes are a direct function of poverty, we believe that PovertyCure’s mission dovetails perfectly with that of Benjamin Rush Institute, namely: “Promote healthcare solutions that protect the doctor-patient relationship as the primary means of delivering quality medical care and rely on free enterprise—not bureaucratic dictates—to encourage life-saving innovation and reduce costs.”
Benjamin Rush Institute (BRI) is a 501(c)3 public charity organization that unites medical students, residents, fellows, and doctors from across the political spectrum — as well as members of the general public — who believe that the medical profession calls its practitioners to serve their patients, rather than the government. We believe that the doctor-patient relationship is a voluntary and mutually beneficial one, which both parties have a right to enter freely. The proper role of government is to protect this freedom, not to diminish it. Sadly, the days are gone when doctors could practice their profession without significant political interference. Because healthcare policy has such a direct and pervasive effect on patient care, medical students must understand healthcare policy in addition to medical sciences.
Proposal: Ms. Njoku will visit Nigeria where she will meet with other BRI leaders, members and supporters, using what she has learned from PovertyCure and elsewhere to create a platform from which to discuss how education, improvements in healthcare management, and refocused health policy can foster positive socio-economic solutions in rural Nigerian villages. By reaching medical students, local physicians, and the greater Ibadan community, Ms. Njoku and the “Project Group” will explore the local government’s role, or lack thereof, in Ibadan’s primary health sector.
Premises: There are critical issues in the primary health care services in Nigeria. Primary health care service is provided by local government authority through Primary Health Centres (PHC’s), staffed by nurses, midwives, community heath officers, heath technicians, community health extension workers and physicians. The services provided at PHC’s include: prevention and treatment of communicable diseases, immunization, maternal and child health services, family planning, public health education, environmental health and the collection of statistical data on health and heath-related events. This primary health care is supposed to be the bedrock of the country’s health care policy, yet less than 20% of potential patients who could use it do so. Many patients bypass this primary level of care because they regularly encounter limited medical supplies and resources, lack of essential drugs, and an inadequate competent staff to deliver maternal and other health services.
The PHC’s ineffectiveness is due in part to the health system’s bureaucratic structure, with the PHC level of care regulated by the local government—the government’s weakest level. Patients unable to access the tertiary hospitals end up seeking informal care from local drugstores and traditional healers. Additionally, certain PHC centers are inconveniently located and unevenly distributed throughout the local community. Primary care facilities are grossly underused and yet do not have the resources needed to be the first line of defense in their communities. The “Three A’s” — Affordability, Accessibility, and Appropriateness are all important aspects of a new healthcare delivery design.
In addition to governmental aspects of inadequate health outcomes, a patient’s own “health literacy” is vital to improving health outcomes. Local healthcare providers can improve health literacy by utilizing essential medical technology and educating patients in basic health and hygiene, and about which procedures, drugs and technologies will best serve their individual needs. First, local physicians need access to and proper education in this technology. Physicians working in rural communities should be equipped with the right education, sufficient autonomy, and access to technology that will best serve their patients. When local physicians and medical students — the ones most familiar with their community’s needs and challenges — are empowered to care for their community’s overall health, they can create a stronger platform for implementing workable solutions.
Prospective Outcomes: According to Ms. Njoku, “I will meet with local healthcare professionals, physicians, midwives and nurses concerning the state of their healthcare system and garner their ideas for ways to improve it.”
Trip Itinerary: May 27th 2016 – June 8th 2016
University of Ibadan Medical School, Ibadan, Oyo State Nigeria
University of Ibadan Community Event: June 4, 2016
Agenda: (details and times TBA)
1. Silent opening prayer
2. Speaker and guest introductions
3. Introduction to BRI: Why it is valuable to medical students
4. Film screening: Poverty, Inc.: The Business of Doing Good
5. Guest student speaker (Faith Njoku)
6. Question and answer session
7. Sign ups and feedback session
8. Announcement of next event
9. Vote of thanks and acknowledgements
10. Silent closing prayer