California Enacts Interpreter Law for Patients

On January 1st, California became the first U.S. state to enact legislation requiring that all nonpublic managed care health plans cover costs for providing interpreter services to state residents with limited English proficiency (LEP), the Sacramento Bee reports. The law requires health, dental and specialty insurers to provide translators for all languages, either by phone or in person, for subscribers when visiting a physician, pharmacist, ophthalmologist or dentist. Written translation also will be required for select languages.

The article notes that insurers expect to spend a collective $25 million to comply with the new law. However, patients' rights advocates praised the law, saying it will help reduce care quality disparities stemming from miscommunication. California plans to launch a publicity drive in the coming weeks to raise awareness of the new law. Meanwhile, noting that the new law stipulates only that interpreters demonstrate proficiency in interpretation, the California Healthcare Interpreting Association is recommending a certification program to ensure that the interpreters used by health plans are familiar with medical language and how to accurately translate medical terms.

Increasing Organ Donations from the South Asian Community

A Sikh health expert has been awarded £130,000 for a two-year research project which could prove vital in efforts to increase the number of UK organ donations from south Asian and black ethnic groups. NHS Blood and Transport has awarded the funding to Professor Gurch Randhawa, Director of the Institute for Health Research at the University of Bedfordshire. It is hoped his findings will inform strategies for future organ donation appeals. Changing perceptions about organ donation among south Asian and black groups is already part of a campaign to increase donations by 50 per cent in the next five years.

Dr. Randhawa states that the need for organ donors was three or four times higher among black and Asian people than among the general population, but donation rates were relatively low among those groups and this impacts directly upon those communities. His project has the backing of a Sikh family in Luton, close to the Bedfordshire university. In January 2001, Mandip Mudhar, a 20-year-old student, died in London’s Royal Free Hospital six days after suffering severe head injuries in a road accident. Told that he would not recover consciousness, his parents decided to donate Mandip’s heart and two kidneys. The Mandip Mudhar Memorial Foundation was started by Mandip’s family.

Among potential donors the refusal rate for non-white groups is 69 per cent, according to Professor Randhawa, compared with 35 per cent for potential white donors. “Community leaders and religious groups need to engage with their local community to encourage organ donation and we need to identify what would make the gifting of organs relevant to a multi-ethnic and multi-faith society,” said the professor.

The Sikh perspective on organ translation is addressed on a leaflet available at the UK Transplant website. It reads: “Sikh philosophy and teachings place great emphasis on the importance of giving and putting others before oneself” It also stresses “the importance of performing noble deeds and there are many examples of selfless giving and sacrifice in Sikh teachings by the ten Gurus and other Sikhs. Sikhs believe life after death is a continuous cycle of rebirth but the physical body is not needed in this cycle – a person’s soul is their real essence.” (The dead sustain their bond with the living through virtuous deed.” Guru Nanak, Guru Granth Sahib, p 143) Dr Indarjit Singh, Director of the Network of Sikh Organisations UK has stated that: “The Sikh religion teaches that life after death continues after death in the soul, and not the physical body. The last act of giving and helping others through organ donation is both consistent with, and in the spirit, of Sikh teachings.” [link]

Hospital Sorry for Shaving Sikh's Beard

I was about to blog on news regarding a hospital who recently shaved off a Sikh patient's beard, without his consent - however, a blogger (also friend) did an excellent job covering this issue and I will link to his cover of it. Here is his post, you can view it directly here.

A tragic story came from BC this week about a elderly Sikh patient's beard being shaven off during his stay at the Royal Columbian Hospital in New Westminister.

B.C.'s Fraser Health Authority has apologized for shaving a 70-year-old man's beard -- something forbidden by his Sikh religion. It happened during an overnight shift at Royal Columbian Hospital in New Westminster. The Health Authority says the nurse, who recently came from out of province, feels terrible about the incident. "We are very sorry on behalf of Royal Columbian Hospital that this happened," says spokesperson Mariam Stewart. "There have been numerous memos going out to other intensive care units and hospitals in Fraser Health of the fact that, with the beard, the beard is very, very important." (Link)

The worst part is that the Sikh was in hospital after being shot during an earlier robbery at at a Surrey gas station. The victim's son in law says the senior has been victimized twice by what the hospital has done.

"My father in law -- he's been killed twice," says Surjit Singh Virk. "To me, his pride, his honour, his belief -- everything taken away from him. It's very shocking."

The family says they will file a complaint against the hospital and are asking the Health Authority to implement a policy so something like this won't happen again.

I know that the William Osler Health Centre and specifically Brampton Civic Hospital has put a lot of effort into educating their hospital staff to the diversity of their patients. I also know their new mantra isn't the Golden Rule but the Platinum Rule, do unto others as they would want done to them. Sikhs in Illinois helped the Metropolitan Chicago Healthcare Council prepare a document entitled "Guidelines For Health Care Providers Interacting With Patients Of The Sikh Religion and Their Families". This is a great document that can be used as a template for providing something for your local hospital. Sikh-Canadians have donated millions of dollars to hospital foundations across the country. With these efforts, Sikhs also need to engage their local hospitals to ensure these kind of tragedies are prevented.

Arrogant, Abusive and Disruptive — and a Doctor

Some doctors seem to get a bad rep for being intimidating and well, not very friendly. It seems that sort of behavior is not just uncouth but it's also dangerous - an article from the New York Times suggests that doctors' disruptive behavior is leading to potential medical errors and putting their patients' lives at risk.

A survey of health care workers at 102 nonprofit hospitals from 2004 to 2007 found that 67 percent of respondents said they thought there was a link between disruptive behavior and medical mistakes, and 18 percent said they knew of a mistake that occurred because of an obnoxious doctor. Another survey by the Institute for Safe Medication Practices, a nonprofit organization, found that 40 percent of hospital staff members reported having been so intimidated by a doctor that they did not share their concerns about orders for medication that appeared to be incorrect. As a result, 7 percent said they contributed to a medication error.

Seeing the potential patient safety issues in this sort of behavior, the Joint Commission is now requiring hospitals to develope a code of conduct and to enforce it.

There are signs, however, that such abusive behavior is less likely to be tolerated. Physicians and nurses say they have seen less of it in the past 5 or 10 years, though it is still a major problem, and the Joint Commission is requiring hospitals to have a written code of conduct and a process for enforcing it.Still, every nurse has a story about obnoxious doctors. A few say they have ducked scalpels thrown across the operating room by angry surgeons. More frequently, though, they are belittled, insulted or yelled at — often in front of patients and other staff members — and made to feel like the bottom of the food chain. A third of the nurses in Dr. Rosenstein’s study were aware of a nurse who had left a hospital because of a disruptive physician.

It doesn't come at much of a surprise then when we read statistics that show a lack of clear communication is responsible for over 60% of medical errors. Read more here.

Jaago on World AIDS Day

[From The Langar Hall] Today is World AIDS Day. The theme of this year’s World AIDS Day is leadership and efforts are focused on prevention. Indeed, on this 20th anniversary of World AIDS Day, President-elect Obama has stated that his administration will focus on prevention and treatment for at-risk communities in the U.S. and rest of the world. World AIDS Day, is the day when organisations from around the world come together to bring attention to the global AIDS epidemic. In 2007, there were 33 million people living with HIV/AIDS. Women account for 50% of all adults living with HIV worldwide and young people (under 25 years old) account for half of all new HIV infections worldwide. In line with the theme of leadership which is the message of this year’s anniversary, I came across AIDS Jagoo - an effort by Mira Nair and the Bill and Melinda Gates Foundation - to bring together Indian directors and actors to create four short dramatic films that aim to “dismantle myths and misconceptions of HIV/AIDS.” The four AIDS Jagoo films come from various parts of India - each its own genre and with a different point of view on the HIV/AIDS epidemic.

Migration, directed by Mira Nair, discusses HIV/AIDS from an urban/rural angle. Blood Brothers, directed by Vishal Bhardwaj, follows the journey of a young man from a positive HIV diagnosis to the eye-opening conclusion. Prarambha (The Beginning), directed by Santosh Sivan, deals with society’s prejudices against people with AIDS through the journey of a young boy’s search for his mother. Positive, directed by Farhan Akhtar, shows a family coping with AIDS and reveals the courage they bring to overcome the tragedy. Most of the films have subtitles. Hopefully you’ll be able to watch some or all of these and join the global community in remembering those impacted by HIV/AIDS.

HIV/AIDS Awareness Of Auto Rickshaw Drivers In Ludhiana

I recently came across this interesting journal article discussing what the level of HIV/AIDS knowledge is among rickshaw drivers in Ludhiana.

The study was conducted on auto rickshaw drivers who were currently driving the vehicle. Seven main points of Ludhiana city were identified. Out of 1050 auto rickshaw drivers contacted, 600 agreed to participate. The knowledge about HIV/AIDS was assessed by using structured interview schedule. The interview schedule mainly focused on studying the awareness about modes of transmission, source of information, curability of disease and blood testing. [link]

The results suggest that although some knowledge does indeed exist, it is low and there is a need for further intervention for this risk group. As with other studies, knowledge increases with education.

Out of total 600 Auto rickshaw drivers, 384 (64.0%) had heard about HIV/AIDS. Awareness level increased with increase in educational status. Out of 384, 74.2% drivers knew that unprotected sex is the main mode of transmission. TV (63.0%) was the common media as source of information. Only 36.2% knew that the disease is not curable.

[Un]natural Mehndi Tattoos

Dermatologists are warning that the henna tattoos, sold everywhere from beachside stands to carnivals to cruise ships, may contain a harmful chemical known as para-phenylenediamine, or PPD. Used to make the temporary tattoos last longer, PPD has been associated with major skin problems including rashes, blistering and even permanent scarring.

At the American Academy of Dermatology's Summer Academy Meeting 2008 in Chicago, dermatologist Sharon E. Jacob, M.D. of the University of California at San Diego pointed out that henna used for temporary tattoos is made from the lawsonia inermis plant. Temporary coloring of the skin with natural henna is considered harmless and only lasts for a few days. To darken the tattoo (making it more visible and long-lasting) some henna tattoo artists are adding PPD, usually used for black hair dye, into the henna mix.

The FDA prohibits direct application of PPD to the skin because of its known health risks. However, since the tattoo industry is not regulated, people, including children, are still getting black henna tattoos and potentially exposing themselves to serious medical problems. Dr. Jacobs advised that if you do choose to get a henna tattoo, do so only if you can be sure that only vegetable henna is used.

Health and Human Rights: An International Journal

On September 17, 2008, Health and Human Rights: An International Journal celebrated its recent re-release as an open access publication. Health and Human Rights is published by the François-Xavier Bagnoud Center for Health and Human Rights within the Harvard School of Public Health. Funding for the Journal and the Center comes from FXB International. The François-Xavier Bagnoud (FXB) Center for Health and Human Rights was founded at Harvard University in January 1993 and was the first academic center to focus exclusively on health and human rights.

Take a look at the journal here.

Medicare Won’t Pay for Medical Errors

From the New York Times:

If an auto mechanic accidentally breaks your windshield while trying to repair the engine, he would never get away with billing you for fixing his mistake. On Wednesday, Medicare will start applying that logic to American medicine on a broad scale when it stops paying hospitals for the added cost of treating patients who are injured in their care. Medicare, which provides coverage for the elderly and disabled, has put 10 “reasonably preventable” conditions on its initial list, saying it will not pay when patients receive incompatible blood transfusions, develop infections after certain surgeries or must undergo a second operation to retrieve a sponge left behind from the first. Serious bed sores, injuries from falls and urinary tract infections caused by catheters are also on the list. Officials believe that the regulations could apply to several hundred thousand hospital stays of the 12.5 million covered annually by Medicare. The policy will also prevent hospitals from billing patients directly for costs generated by medical errors.

Postpartum Depression Among South Asian Women

Excerpt taken from The Langar Hall.

We are only beginning to hear about the prevalence of postpartum depression in the larger community, so it comes as no surprise to me that we hear about it even less within the South Asian community. Recent research suggests that Indian women, particularly new immigrants, may be at a higher risk of postpartum depression than their non-Indian counterparts. Experts suggest isolation stemming from the immigrant experience and a lack of the traditional support system often found in the home countries, as reasons for increased prevalence among Indian women.

In the United States, about one in 10 women suffers from postpartum depression (PPD). South Asian women may be at a higher risk for PPD, due to the impact of acculturation and cultural customs including factors such as arranged marriage and the gender of the child. There are many cultural factors that impact the immigrant woman’s vulnerability of being affected by postpartum depression.

In several studies conducted in India and Europe, giving birth to a female infant was directly related to postpartum depression. There is great pressure on women to produce a male heir, especially for women who already have one girl child, the studies concluded… “The struggles of fitting into a new society and the isolation many women feel increases stress, which can result in mood disorders,” says Narasimhan. She has found that key factors in successful acculturation include community support, places of worship and the company of other women. Genetics can also play a role. “If your mother and grandmother suffered from postpartum depression, it’s likely you will as well,” Narasimhan says. Other physical factors for postpartum depression include hypo-thyroidism and anemia, both prevalent among South Asian women.

Read More.

Punjabi Language Domestic Violence DVDs

A new series of culture and language-specific DVDs aimed at helping new immigrant women, children and seniors understand and escape abuse in the home is set to be released across Metro Vancouver to prompt discussion on a topic many who work to prevent domestic violence feel has too long been overlooked.

"We want to trigger a conversation. It's like giving permission to the communities to talk about this," Assanand said. The DVDs will be available in three languages -- Punjabi, Mandarin and Spanish, each with English subtitles -- and will depict three culturally specific scenarios of child abuse, wife abuse and elder abuse. Punjabi speakers, for instance, will see a domestic abuse situation that features not just a husband and wife, but also an extended family, including a mother and father-in-law. "The male may do the final act of hitting, for instance, but the other members of the family can either prevent or aggravate the situation," Assanand said.

The scenarios were put together by an advisory committee, with strong input from members of each ethnic community, in order to deliver a message that really hits home, while remaining sensitive to community values. Common themes in each production include the stresses of resettlement in Canada, language barriers and culture shock. The three language groups were selected for the DVD project in order to maximize exposure to the largest number of people, and not because the groups are exposed to more abuse than others. The program was launched following a number of high-profile murders of women in B.C.'s South Asian community in recent years. [link]

Celebrity Degrees

I've always thought the Public Health field attracted the most interesting, amazing, and definitely cool people. So, it doesn't surprise me that celebrities are also being drawn to obtaining public health related degrees,

Christy Turlington is going back to college to study maternal and child health at Columbia University. "I have explored several career paths and have discovered that in addition to being a mother, a career in service is most fitting," she told us. Perhaps she can study nights with Chelsea Clinton. The former First Daughter is also starting a master's program at Columbia, majoring in public health policy, according to a source. [link]

I'm not getting excited just because they are famous ladies, I'm excited that more attention is being given to the, often neglected, public health field.

Extended Absence

Friends,

I apologize for my extended absence from the blog this summer. I spent the summer in Punjab and had an amazing experience and feel very inspired! I hope to share that inspiration with you over the following months.

SK

Punjab's Cancer Belt

In the village of Jaijjal, Kartar Kaur, 70, lies on a charpoy (string bed). When asked about the deaths of her three sons from cancer, she shakes her head, refusing to speak. [link]

The "bread basket" of India, Punjab was proud of its "Green Revolution" in the 1960s when crop production soared thanks to hybrid seeds and easy access to pesticides. But the harvest it is reaping now is one of malignant tumours. In "the cancer belt", pesticides have contaminated the underground drinking water. "All I do is attend funerals. There are villages where almost every family has someone suffering from cancer," said Manpreet Badal, a member of Punjab's legislature.

Meena Sudan, head of oncology at Amritsar's Sri Guru Ram Dass Rotary Cancer Hospital, says the number of cases has trebled in five years. "We used to get two or three new cases every day, on average. Now we see six to eight, so you're looking at 50 new cases every week. It's frightening." The associate director of the New Delhi-based Centre for Science and Environment, Chandra Bhushan, said: "In a random survey of blood samples from four Bhatinda villages, we found traces of between six to 13 pesticides. Some samples had levels of pesticide up to 600 times higher than those found in American farmers."

Indian cancer sufferer Mukthiar Singh, second to right, sits with family members on a platform in Bhatinda, waiting to board a train known as the "Cancer Express".

Read more about the impact of pesticides on Punjabi farmworkers here and here.

Diabetes Video in Punjabi

A Punjabi-language video has been released online by the Fraser Health Authority [Canada] to help South Asians learn about the dangers of diabetes. It’s the latest move by health officials to combat diabetes rates that are three to five times higher in local Asian communities. Left unchecked, the blood sugar regulation disease can lead to heart or kidney disease, blindness and amputations. The video teaches people how to watch for signs and symptoms and ways to manage the condition.

The all-Punjabi video can be viewed on the web here.

Obesity, diet and a sedentary lifestyle are factors contributing to higher diabetes rates among the entire population. But the higher rate among South Asians –  it is their number one killer –  is attributed partly to over-consumption of rich, traditional Indian foods after coming to Canada. [Link]

The Unbearable Muffin Top

Within our community we're acutely aware of Punjabis being prone to weight gain. Now scientists have pinpointed a gene sequence linked to an expanding waist line, weight gain and type 2 diabetes. While the gene sequence is carried by 50% of the population, it is a third more common within the Indian community.

The finding might provide a possible genetic explanation for the particularly high levels of obesity in Indian Asians, who make up 25% of the world's population, but who are expected to account for 40% of global cardiovascular disease by 2020. The gene sequence sits close to - and possibly influences - a gene called MC4R, which regulates energy levels in the body by influencing how much we eat and how much energy we expend or conserve, and which has been directly implicated in rare forms of extreme childhood obesity.The researchers discovered that the sequence is associated with a 2cm expansion in waist circumference, a 2kg gain in weight, and a tendency to become resistant to insulin, which can lead to type 2 diabetes. [Link]

Quote

When health is absent
Wisdom cannot reveal itself,
Art cannot become manifest,
Strength cannot be executed,
Wealth is useless, and
Reason is powerless.

Herophilies - 300 B.C

Unnatural Causes: Racism and Immigration

The PBS documentary, Unnatural Causes (previously discussed on here) started airing a couple of weeks ago. One issue that is particularly interesting is how racism adversely impacts an individual’s and ultimately an entire community’s health. Researchers are circling in on a way to explain the presence of worse health outcomes among minorities and suggest that the chronic stress of racism can be embedded in the body, taking a heavy toll on people of color. The researchers suggest that when you have a reaction to a situation in your life that makes you anxious or gets you stressed out, you not only have a psychological or emotional reaction but you also have a biological reaction. If that stress is chronic, over time it creates wear and tear on your body’s organs and systems and thus, causing illness. Another issue of interest is the fact that immigrants, who are often poorer, tend to be healthier than the average American. However, the longer they live here, the worse their relative health becomes, even as their economic status improves. Children of immigrants are particularly at risk for obesity, heart disease, and mental illness. The documentary explores what it is about new immigrant communities that shield people from poor health and how this protective shield erodes over time.

Both these issues are relevant to the Punjabi Sikh community. It’s important to look at the social conditions as mentioned in this documentary to help us understand the high rates of heart disease, obesity, diabetes, and mental illness that are impacting our community.

Confronting the Public Health Workforce Crisis

The U.S. faces a future public health workforce crisis. The current public health workforce is inadequate to meet the health needs of the U.S. and global population.

KEY FACTS:

ASPH estimates that 250,000 more public health workers will be needed by 2020.

The public health workforce is diminishing over time (there were 50,000 fewer public health workers in 2000 than in 1980), forcing public health workers to do more for more people with fewer resources.

This challenge is compounded by the fact that 23% of the current workforce – almost 110,000 workers – are eligible to retire by 2012.

There are documented and forecasted shortages of public health physicians, public health nurses, epidemiologists, health care educators, and administrators. Without enough public health workers protecting us where we live, work and play, we all are vulnerable to serious health risks.

To replenish the workforce and avert the crisis, schools of public health will have to train three times the current number of graduates over the next 12 years.

Learn more...

Looking After Our Elders

[Crossposting with TLH]
A recent documentary on BBC Asian Network discusses the growing population of South Asians entering old age and the impact that is being felt on the middle generations who look after them. The documentary discusses the responsibilities second-generation Asians have to look after their elderly family members while balancing a career at the same time. The documentary illustrates the difficulties and sacrifices people make when looking after their parents/grandparents and the subsequent loss of dignity the elderly experience when suffering with illnesses and a loss of independence. I’m glad the documentary brought attention to an important issue that we have not readily addressed in our community.

Having had recent personal experience with this issue, it is something I have thought about extensively. In our community, it is natural for children and grandchildren to take care of their parents or grandparents. It is an integral part of our culture and in fact, I think it creates a special bond between generations who are often pulled apart by language and culture. The documentary talks about the duty to look after our elders and the guilt individuals feel when they are faced with the decision to put their parents/grandparents in a nursing home. Read more...