May 19-23 found me busy in Geneva, Switzerland, as a member of the World Organization of Family Doctors (WONCA) delegation attending the World Health Assembly (WHA72). The Palais of the United Nations, was busy with people from over the world speaking the language of health and health care. NCDs and communicable diseases, infant, maternal and child health, mental health, access to vaccines, emergency preparedness, patient safety, palliative care, were once again being discussed in its many rooms, and resolutions voted on by the member states of the World Health Organization (WHO). Yet this year finds leaders of the world following the outcomes of the Declaration of Astana with a true awareness that what the world needs to improve health outcomes is for the majority of care to be delivered by primary health care (PHC), through the work of interdisciplinary teams, and that these teams need to be well trained, well organized, well supported and well-funded to succeed.
The mind-body connection is well established. We all know “real life” problems of our patients make them vulnerable to chronic disease and stress. As licensed clinicians, social workers are authorized to diagnose pathology per DSM-5 guidelines. The reality is that family medicine social workers live in the V codes of DSM-5 and Z codes of ICD-10: “Person in Situation.” These codes represent social determinants of care that have wide ranging psychological impact: from trauma to everyday challenges, such as food insecurity and caregiver burden.
The growing number of children in foster homes is a national, state-wide and local problem. At nearly 11,000 kids, the foster care population in North Carolina alone is greater than the total number of residents in Camden, Jones, Graham, Hyde, or Tyrrell counties. This is just a fraction of the 442,000 children and young adults in the foster care system nationwide.
Locally, there are about 300 children in foster care in Durham but only about 100 licensed foster homes in the entire county. Often overlooked, children in foster care sit in classrooms alongside our own children while simultaneously sitting in the uncertainty of not having a permanent home. While there are always serious circumstances that precede a child being placed into foster care, don’t assume you know their stories.
“Good night, sleep tight. Don’t let the bed bugs bite.” Literally. For many community members this is all too real a hope as they close their eyes. A simple phrase of seemingly well-intentioned nighttime wishes takes on a whole new meaning when you have been a victim of a bed bug infestation. Bed bugs do not know the difference between a poor man and a rich one. They know no barriers.
Over the last decade or so, bed bugs have seen resurgence. It is all too often that our patients have to battle these little pests. Though they are not known to carry disease, the CDC and the EPA have referred to bed bugs as a “public health pest. “ Interestingly, no literature exists on the untold costs associated with bed bug infestations — inability to receive care due to inability to get transportation, declines in health status due to inability to get needed services in the home to retard deterioration of a patient’s condition, emotional turmoil, and social isolation associated with bed bugs — to name a few items. And as this continues to be an issue across the United States and in our local community, being aware of the risk and especially to the risk of vulnerable populations is a must. Instead of cringing and just adding “bed bug infestation” to the problem list, we (as medical teams) must ask ourselves how we can help without creating health care disparities.
http://www.euro.who.int/__data/assets/pdf_file/0009/113877/E93944.pdfWhile living in Argentina, back in 1978, I was 14 years old when my father, a vascular surgeon, showed me a newspaper article that highlighted the Declaration of Alma Ata. “This,” my father said, citing the call to action to develop primary health care with an emphasis on health equity and health for all, “will make a difference in the health and lives of people of the world.” I read it with attention, and told my dad I wanted “a career that would involve primary care, taking care of babies, children and adults together with teaching and policy making at the world stage.” “What specialty should I go into?” I asked. “That specialty has not been created,” my dad said. “You will find your own path.”
Forty years later, I find myself at the Global Conference on Primary Health Care hosted by the WHO, UNICEF and the Ministry of health of Kazakhstan, an Argentina and U.S.-trained family physician, a clinician and educator representing the World Organization of Family Doctors together with the WONCA Leadership team. Having spent the last year involved in inputs to the Declaration of Astana and collating the collective responses of family doctors from around the world, I have a sense of responsibility to represent, to engage, to collaborate, to listen and to advocate for health for all. In this role, I am making the case for health systems and governments investing in the training of family doctor leaders and members of teams to meet the health care needs of communities worldwide.