Tag Archives: Reviews

The Promises and Pitfalls of Global Health Volunteering

Hoping to Help: The Promises and Pitfalls of Global Health Volunteering, written by Judith N. Lasker, shines light on healthcare-based volunteering in developing contexts. While it does not explicitly focus on aging, this book poses a bold and poignant question: Does international medical volunteering really help patients?

Developing countries struggle with both acute diseases such as malaria that are less prevalent in developed countries, as well as many of the same chronic diseases, such as diabetes, that routinely affect people in nations like the United States. According to the World Health Organization, chronic diseases, which often impact older adults, are the leading cause of death or disability in the world. Many medical professionals who volunteer abroad often end up treating patients with such chronic diseases.

For example, International Volunteer HQ – a large volunteer-host connection service – offers North American medical tourists the opportunity to work with older adults in Argentina, Colombia, Guatemala, Sri Lanka and Zambia. Another NGO, UBELONG, offers short term volunteer trips to Ecuador, Costa Rica, and Peru. Other programs, such as the volunteer surgeons who perform cataract operations, also target diseases that primarily impact older adults.

In Hoping to Help, Lasker investigates the impact of global medical volunteerism on patient health. She finds little evidence that global medical volunteer trips are actually helpful to the patients:

  • Lasker points out that most trips have no follow-up. Thus it is impossible to determine whether the patient benefited from medical care.
  • Most trips do not provide long-term solutions to chronic diseases; many individuals were prescribed medication –for example, blood pressure – without having access to a sustainable supply of the medicine. Once the volunteer leaves, the patient may become worse. Even a seemingly innocuous treatment, such as medication to reduce hypertension, can lead to a rebound hypertensive effect.
  • Finally, volunteer medical students or nurses will often conduct procedures or give treatment that is outside their scope of practice in their home countries.

The positive or negative effect on the health of patients treated by these practitioners are not well known, but it is safe to say that the impacts of global health volunteering are not all positive. There are many debates about the possible good or harm international medical volunteers can do to host communities – while some have compared the practice to colonialism, others have defended the noble intentions of these programs. What this debate leaves out, however, is the patient’s version of the story.

For individuals who wish to volunteer and contribute to aging in developing nations, Lasker’s book serves as a useful guide. She clearly delineates the positives and negatives of the programs. Volunteering is one way to help aging individuals in developing countries, but an investment in infrastructure development in the health sector will have a more meaningful, long-term, and sustainable impact.

Grace Mandel is a project manager for the Baltimore Fall Reduction Initiative Engaging Neighborhoods and Data (B’FRIEND) at the Baltimore City Department of Health.

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Open Your Eyes: A Journey from Darkness to Sight

Open Your Eyes is a recently produced documentary on the impact of cataract surgery in Nepal. The film shows the transformation of health-related quality of life for older adults with access to medical care. In the film, Manisara and Durga make the long journey to get cataract surgery. Both husband and wife are blind and depend on family members for their most basic needs. Despite being blind, Manisara and Durga help care for their grandchildren and have an important place in the family. Their journey to the city is filled with nervous trepidation, but after the surgery, both are able to see their grandchildren and contribute to valuable work that benefits the entire family and community.

Open Your Eyes highlights the successful use of foreign funds to combat treatable diseases. The funding helps develop sustainable infrastructure and pays for many public health interventions such as cataract surgeries. In a previous article titled Hoping to Health, Global Health Aging reviewed the impact of NGO’s working on health including the effect of global health volunteering. Such efforts look very different in the Lions Club of Nepal – a club established by the service membership organization Lions Clubs International – where medical volunteers are Nepali citizens.

Overall, some questions were not addressed in the documentary. It was unclear if there was adequate follow-up care to prevent infection. And while Manisari and Duraga had no complications, both would have been virtually unreachable if they needed medical attention after they returned home. Cataract surgeries have a positive health impact due to their low complication rate and high degree of efficacy. It is not clear, however, that this model would translate for more risky procedures. In the end, Open Your Eyes does not discuss the challenges of bringing medical care to rural areas. Instead, it makes a compelling case for older adults as valued members of society who deserve quality care. Check out the trailer!

 

Grace Mandel is a project manager for the Baltimore Fall Reduction Initiative Engaging Neighborhoods and Data (B’FRIEND) at the Baltimore City Department of Health.

Alone Together: Why We Expect More from Technology and Less From Each Other

Sherry Turkle is a professor at MIT who views artificial intelligence and technology through a sociological and psychological lens. In the first half of her most recent book, Alone Together: Why We Expect More From Technology and Less from Each Other,  Turkle addresses the impact of technology on older adults. Technology advances such as robotics and assistive technology are making headway in society, especially in elder care. These new technologies can provide some comfort or care for older adults with chronic diseases. Turkle’s focus, however, is on the substitution of robots for human interaction and the emotional aspect of care performed by another human being.

Turkle conducts experiments where she brings different types of robotic technology such as AIBO, My Real Baby, and Paro the Seal into nursing homes. These robotics provide companionship and not practical assistance. For instance, many older adults began speaking to their robots, going over important life events and reminiscing about old times. They found that spending time with the robot reduces anxiety and isolation. The impact of My Real Baby, an “interactive learning doll”, was particularly significant in experiments because it gave older adults a sense of purpose. The My Real Baby doll needed comfort, changing, and other activities that made older adults feel needed (105). This promotes higher quality of life for older people.

Turkle also conducts research involving children, where children discuss the role of robotic technology in their lives. The children profiled in the book worry about technology replacing real human interaction. One child says, “that grandparents might love the robot more than you… They would be around the robot so much more.” (75). Another child worries “that if a robot came in that could help her [grandmother] with falls, then she might really want it… she might like it more than me.” (75). In her discussion of experiments conducted in nursing homes with the doll, My Real Baby, Turkle finds that older adults do not want to give the doll back at the end of the experiment (111). One grandmother even ignores her grandchild who is visiting to take care of the hungry doll (118).

What Turkle does best in this book sharply contrasts the ideal situation of having loving children or family who can visit and provide social interaction to the reality of isolation in many older adults. While Turkle acknowledges the barriers to artificial intelligence and technology as companionship for older adults, they surpass the alternative of no social interaction at all. She notes, “If the elderly are tended by underpaid workers who seem to do their jobs by rote, it is not difficult to warm to the idea of a robot orderly”. (p. 107).  She then points out that when given the choice between interacting with robots and interacting with a member of the research team, almost all of the older adults chose a member of the research team (p. 105). At the end of the day, these robots are not capable of producing the same amount of interaction and support as a human being. Turkle muses, “An older person seems content; a child feels less guilty. But in the long term, do we want to make it easier for children to leave their parents? Does the ‘feel-good moment’ provided by the robot deceive people into feeling less need to visit?” (p. 125). Robots providing clinical care may be an ideal solution to the shortage of workers caring for an aging population, but are no replacement for social interaction.

Grace Mandel is the project manager for the Baltimore Fall Reduction Initiative Engaging Neighborhoods and Data (BFRIEND) at the Baltimore City Department of Health.

One Child: The Story of China’s Most Radical Experiment

One Child: The Story of China’s Most Radical Experiment by Mei Fong presents a compelling analysis of the impact of China’s “One-Child Policy” on older adults. The one-child policy, a compelling story of population control for economic growth, has long term implications that are only now apparent. Fong describes the challenges of a rapidly aging population as she focuses on families who are struggling to care for older adults, and those who have no children to care for them in old age.

Published November 2015

One of the book’s most gripping stories is of parents during the 2008 Sichun earthquake. According to official reports, “eight thousand families lost their only children in the disaster.” (p.3) These parents, and other parents who have lost their only children, face barriers in accessing nursing homes, health care, and burial plots. Fong notes, “they are also more financially vulnerable than ordinary retirees, and more prone to depression, studies show.” (p. 41) While these challenges are tangible, the emotional challenges of losing support systems in old age is also a prominent problem. Fong addresses the growth of China’s hospice industry, stating that many older adults without family feel unable to contribute to society. (p.151)

The book also digs into the cultural complexities in aging and filial obligation. In one notable story, that received national acclaim in china, Liu Ting brought his mother with him to college, when she was too ill to care for herself. His mother suffered from kidney disease and uremia. Although Ting received fame and attention, his job opportunities after college were limited at the expense and time required to properly care for his mother. (p. 92)

While Fong discusses other implications of China’s one-child policy such as rise in adoptions, increase in bride prices to compensate for the greater number of men than women, and the further consequences of sex-selective abortions, the primary implications of the policy relate to the care and treatment of older adults. With only one child per two aging parents, the traditional way of caring for Chinese parents will cause economic slow down, and place burdens on the younger generation.

Fong is at the forefront of a wave of journalism that will detail the challenges of aging in China. She acknowledged that it could be difficult to find many children who were burdened by caring for aging parents, as more parents of children from this time period are in their 50’s and 60’s (p. 86) However, her book is at the forefront of a problem that will only become more prominent in the coming decades.

Grace Mandel is pursuing a Master of Public Health in Health Systems and Policy at the Johns Hopkins University Bloomberg School of Public Health.