EPI 390 Lecture 15Outline of Last Lecture I. An Introduction to Microbes and AntimicrobialsII. Resistance in MicrobesIII. A History of AntimicrobialsIV. Antimicrobial MechanismV. Mechanisms of ResistanceVI. Examples of Multidrug ResistanceVII. An Introduction to BioterrorismVIII. The History of BioterrorismIX. AnthraxX. Classification of BioweaponsOutline of Current Lecture Guest Lecturer: #4 Dr. Connie CurrierI. Explanatory Models: Culture and Global HealthII. Types of Explanatory ModelsIII. Understanding Culture in Public HealthIV. Benefits of Understanding Explanatory ModelsV. Sectors of Healthcare in GhanaVI. The Ghanaian Explanatory ModelVII. Factors that Impact Receiving HealthcareCurrent LectureI. Explanatory Models: Culture and Global Healtha. Global Health - An area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. i. Equity refers to fairness – in access, affordability, and availability of health. ii. Global health is multiple disciplinary b. Emphasis of Global Health (Koplan, et al., 2009, p. 1995).i. Global health emphasizes transnational health issues, determinants, and solutions ii. It involves many disciplines within and beyond the health sciencesiii. It promotes interdisciplinary collaboration;These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.iv. It is a synthesis of population based prevention with individual-level clinical care c. Culture - Culture is the full range of learned and shared human behavior patterns. d. Cultural beliefs and values:i. Explain what’s good, right, normal, correct, idealii. Are rules for living provided by societyiii. Serve as a model or ideal way of beingiv. Are selectively internalized into the individual personalityv. Act as individual guides to self-evaluation, motivation and behaviore. Explanatory Models - An explanatory model of health and illness – it includes what people in a given culture believe about the nature, cause, prevention, and response to a health-related event.i. Explanatory models were developed by Arthur Kleinman to improve healthcare in the context of the patient’s culture.1. The Kleinman Questions were developed to elicit a person’s explanatory model.a. What do you call the problem?b. What do you think caused your problem?c. Why do you think it started when it did?d. What does your sickness do to you? How does it work?e. How severe is it? Will it have a long or short course?f. What do you fear most about your sickness? g. What are the chief problems that your sickness has caused for you? h. What kind of treatment do you think you should receive? i. What are the most important results you hope to receive from this treatment? II. Types of Explanatory Modelsa. Focus on balance in: Energy, Social relationships, Hot/cold i. e.g. In Indian philosophy, the 7 chakras or energy centers must be balanced to be in full health. Each chakra has to be clear for the individualto be healthy. A blocked chakra causes internal problems.ii. e.g. A person from Romania may believe that bad luck, bad behavior or contamination has caused his/her illness. iii. e.g. Certain diseases and certain foods are hot or cold. To treat the illness,you would avoid the food that matches the disease. In some Asian cultures, eczema is a “hot” disease. A person with eczema would avoid "hot" foods like garlic, onions, or chocolate because they could make the "hot" disease worse.1. A cold is cold disease, so you would avoid foods like lemons.b. Focus on relationships that are spiritual between: Humans, Humans and non-humans, Humans and the supernatural. i. e.g. Between humans - In Latin American societies, “susto” or “fright” is acommon cause of illness in which a shocking emotional situation causes aperson’s soul to leave their bodyii. e.g. Between humans and non-humans - In many parts of West Africa, it is believed that witches, wizards, dwarves and other creatures who practice witchcraft are the cause of illness. iii. e.g. Between humans and the supernatural - Humans are spiritual beings. A curandera – like this one in Celaya, Mexico, performs spiritual cleansings and other rituals to heal people’s physical and spiritual illnesses. c. Focus on environmental forces: Natural elements - Exposure to air and water (airpollution, water pollution – can cause illness), Natural forces (electromagnetic waves), Germs.i. The biomedical model assumes illness is physical and that illness operatesaccording to the causal principles of the physical world. This is the model used in the US.ii. e.g. The “plumbing model” or metaphor of the body – the body is a series of cavities/chambers (chest, stomach) connected by pipes or tubes (windpipe, intestines, blood vessels). To maintain health, all pipes must beclear to allow free flow (or air, blood, food, urine, feces) between cavities or to the outsideiii. e.g. The body as a “machine” - Body is like a car with electrical wiring, fuel, partsIII. Understanding Culture in Public Healtha. Not understanding the culture you are working with creates an obstacle in establishing and improving public healthcare. It can either result in a lack of understand or an unwillingness to listen and change due to a cultural slight.i. i.e. The Zimbabwean family planning campaign, which was primarily enacted by female volunteers and was targeted toward women, even though the men were the decision-making force in the culture, and wouldnot listen to women trying to instruct them in contraceptives. b. If you understand the explanatory models used by the patient, you are better able to understand why they act certain ways and can determine the best form oftreatment as well as the best way to explain it based on the patient’s comfort level and understanding.IV. Benefits of Understanding Explanatory Modelsa. Health information is more relevant to the culture and more acceptableb. Diagnosis is more likely to be accuratec. The patient is more likely to understand and adhere to treatmentV. Sectors of Healthcare in Ghanaa. The Popular Sectori. Lay, non-professional, non-specialistii. Includes self treatment, advice from others, healing from cults, churches or self-help groups1. This treatment includes things like having chicken soup, or tea, or herbal remedies when you feel sick.b. The Folk Sectori. Individuals who