November 17, 2008
Global health goes local
I've been thinking for a while about how to get this blog going. I've had it set up since May but haven't known quite where to start. However, some recent experiences at the Olneyville Health Center, where I work every Thursday, have given me a good topic for discussion.
The cases I see in Olneyville are pretty typical of any internal medicine practice: bronchitis, diabetes, hypertension, asthma and depression. What I find most impressive about our office, however, is the extent to which globalization is reflected in the stories of the people I meet there. I see patients in conjunction with my mentor, a physician who got his medical degree in Colombia and did his residency at the University of Massachusetts. All the other doctors at the center are also foreign-born and we work with a multi-national, multi-lingual nursing staff. Our patients are, by my rough estimate, 95% Spanish-speaking, hailing mostly from the Dominican Republic, Guatemala and Mexico.
This is global health gone local. It is impossible at the Olneyville Health Center to ignore the impact of fluid borders and large-scale migration: we see patients who suffer with the isolation of being poor and unable to communicate with many of their neighbors; patients who do not have legal residency in the United States and who therefore can't get access to essential social services; patients who are far from home and have trouble managing chronic disease without the support systems a family provides. Of course, not all the stories are tragic: there are parents who work tirelessly to send their children to school and children who come to each appointment with their aging parents, asking questions and writing notes on every medicine, treatment and test we order. I even met a man who became a U.S. citizen on October 31st and voted for Barack Obama on November 4th.
These cases may seem like caricatures of the immigrant experience, but the challenges they highlight are very real factors in the day-to-day business of providing care for the patients I see. Language and cultural barriers, legal troubles, being far from home. All these take a toll on people's health, and they are part and parcel of migration and globalization.
In his book, When Bodies Remember, Didier Fassin posits that we literally embody our history, that we are physically shaped by our experiences. I see this process taking place in the lives of my patients, and I believe that those of us in the medical field must help to expand global health's scope of inquiry to include such local repercussions of transnational forces. We cannot relegate this discipline to the campo of Nicaragua or the favela of Rio de Janeiro. Rather, we must use our understanding of international relations and global migration to inform the study of medicine and public health in the United States as well as abroad.
So this is my pet project. I'm going to try to update this blog regularly with news about my exploration of global health issues in and around Providence. I hope this becomes a worthwhile project, and I welcome your feedback.
Posted by Ben Brown at 01:27 PM | Comments (0) | TrackBack
