9.30.06   Linda Hawkin Israel: Assessment on Community Health, Altai Republic

 

My perspective is that of a Registered Nurse, midwife and strategist for rural health communication systems. The following summary represents a preliminary impression, complementary to that of Dr. Alexander Karpov who has unique telemedicine expertise and greater in-depth understanding of the sub-region.

 

Following summary includes:

 

  1. community health priorities and specific contributing factors
  2. impact of inadequate community access to medical services
  3. potential communication tracks for public health and medical services

         

1. Community Health Priorities—Contributing Factors:

 

The Ministry of Health for Altai Republic spoke with passion about the critical health needs of his people. He reported the problem of citizens not coming to health centers until they are in 4th stage of illness. He summarized most critical problems, (later confirmed and expanded by multiple stakeholders), as:

 

  1. Tuberculosis and other opportunistic diseases,

1.       inadequate education on the causes and spread of disease

2.       poor nutrition and cold that reduce immunity

3.       lack of comprehensive immunization

4.       families and communities living in close quarters

5.       inadequate government baseline knowledge of diseases and impact

6.       lack of population motivation to change health status

 

  1. Population nutritional crises
    1. anemia: reported that multiple abortions and
    2. lack of meat in diet
    3. thyroid deficiencies--lack of iodine and potentially post radiation status

 

  1. WomenÕs reproductive health
    1. Lack of education, basic health care and sense of social status
    2. Repeated pregnancies and/or abortions
    3. Difficult deliveries, possibly unattended
    4. Malnutrition
    5. Domestic violence
    6. Vulnerability to HIV/AIDS and other sexually transmitted diseases
    7. Young womenÕs economic/social risks as targets for trafficking in persons

 

  1. MenÕs health vulnerabilities
    1. Heart and blood pressure pathologies, with lack of emergency response
    2. Alcoholism
    3. Accidents and physical trauma resulting from

                                                                    a.       high risk occupations (mining, hazardous equipment)

                                                                    b.       social/criminal violence

                                                                    c.       wars (death, injury, emotional after-effects)

 

  1. ChildrenÕs health
    1. Infant mortality, due to traumatic delivery and/or lack of maternal nutrition during pregnancy
    2. Disabilities resulting from prolonged labor
    3. Anemia
    4. Lack of immunization leading to increased childhood diseases
    5. Orphan status, from poverty or other social causes, leading to vulnerability at each stage of childhood and adulthood
    6. Necessity for separation from family to receive education, leading to issues for later discussion.

 

      F.  Community vulnerability to disasters

                        1.  inadequate information systems for community planning and response

                        2.  housing and public structures present risk for collapse

                 3.  baseline economic and health status increases risk for impact

 

2. Impact of inadequate community access to medical services.

 

A.     Lack of infrastructure for medical personnel

1.       probable errors in diagnoses and patient treatment

2.       lack of ongoing education, probably reducing care quality

3.       probable inconsistencies in medical management

4.       Ōbrain drainĶ as health workers seek better environments

B.     Lack of communication and transportation of patients to health facilities

1.  patients waiting too late, before seeking medical care

2.  higher risks with lack of adequate emergency response

3.  probable maternal and child health impact

C.   Lack of basic clinic and hospital equipment, appropriate to service needs

1.  higher risk for medical errors

2.  hesitation of community members to come for treatment

 

3.  Potential communication tracks for public health and medical services

 

Communication to rural villages is uneven and telemedicine—while in planning and first stage development—requires broadband infrastructure, still not a reality, although some basic equipment is in place. Broadband and satellite communications for school-based and community education can contribute to:

  1. youth engagement, critical analysis of community health
  2. public education using existing vehicles (radio) and new media
  3. professional development and collaboration (incl. remote diagnostics)
  4. rural health services