East Of 82nd: Raising Children In A 'Food Desert'

Oregon Public Broadcasting has begun a series entitled "East of 82nd." This series, through a collection of stories told on NPR, and through this Tumblr page will explore some of the unique characteristics and disparities that this rapid growing East Portland area faces. The first story East of 82nd: Raising Children in a "Food Desert" can be found here.

Cross-Cultural Comparisons of Alzheimer’s disease - Further Information

Introduction to Blog and Cross-cultural component 

Renee Henriques

Scientists have yet to discover the cause of Alzheimer’s disease, but it is suspected that an individual’s risk of developing the disease is determined by multiple factors, including genetic and personal components. The current belief is that there is not one single cause of AD, but that an individual’s risk is determined by the influences of multiple factors, including demographic, socio-economic, and cultural, and personal factors. Age is the most important known risk factor with the risk of developing Alzheimer’s disease doubling every 5 years after the age of 65 (http://www.alz.org/research/science/alzheimers_disease_causes.asp#age)

Research is currently underway to study the influence of family history, gender, education-level, and diet/nutrition for their influence on the development of AD http://www.cdc.gov/aging/aginginfo/alzheimers.htm. Although progress is being made in the identification of risk factors, there remain many important questions to be answered in order to understand the underlying causes of AD, and to develop effective treatments. There is currently no cure for Alzheimer’s disease, but there are some treatments that have yielded positive results for individuals diagnosed with AD, including medications as well as non-drug therapy.  Common medications to treat the psychiatric and behavioral symptoms include antidepressants, anxiolytics, and anti- psychotics. For a complete list of these medications, visit: http://www.alz.org/alzheimers_disease_standard_prescriptions.asp
The FDA has approved the use of five drugs to specifically treat symptoms of AD. Four of these medications are cholinesterase inhibitors – which treat cognitive symptom such as memory, language, judgment, and other cognitive processes. http://www.alz.org/national/documents/topicsheet_treatments.pdf
Global rises in morbidity and mortality due to this disease have led to increases in research that examine the presentation and progression of AD from an etiologic perspective. There are differences across ethnic groups, cultures, and geographic regions in the recognition, diagnosis, progression and treatment of AD (Gibbons et al., 2002; Hu et al., 2012)Age and family history are known risks, but cross-cultural studies have demonstrated significant differences in the recognition and treatment of AD (Karim et al., 2011; Chandra., 1996; Mangone., Shaji et al., 1996; Hendrie, 1999; Guo et al,. 2000)  A study in the International Journal of Geriatric Psychiatry found significant differences in affective symptoms, personality changes, and the ability to perform every day activities between Pakistani and Caucasian patients diagnosed with AD (Karim et al., 2011). The findings from these studies can provide important insights into the underlying causes of this complex, and lethal disease. 
Cross-cultural comparisons of Alzheimer’s disease can be challenging for several reasons. Although several studies suggest differences between different cohorts, there are doubts regarding the reliability of techniques used to conduct this research across cultures. One of the challenges inherent in cross-cultural research arises due to a lack of culturally-sensitive instruments, which can threaten a study’s reliability and validity. A primary concern of researches conducting cross-cultural studies is to minimize the effects of translation on test items. Some tests have been found to be fairly reliable across different cohorts, such as the Mini Mental State Examination (MMSE) http://www.utmb.edu/psychology/Folstein%20Mini.pdf  (Folstein et al., 1975), and the Montreal Cognitive Assessment MoCA-C http://www.mocatest.org/ (Nastreddine et al., 2005).

Works Cited

1)      Karim, S. et al (2011). The Symptomology of Alzheimer’s disease: a cross-cultural study. International Journal of Geriatric Psychiatry, 2011; 26: 415-422

2)      Gibbons, L. et al (2002). Cross-cultural comparison of the mini-mental state examination in United Kingdom and United States participants with Alzheimer’s disease. International Journal of Geriatric Psychiatry,2002; 17: 723-728

3)      Hu, J.B et al, 2012. Cross-cultural difference and validation of the Chinese version of Montreal Cognitive Assessment in older adults residing in Eastern China: preliminary findings. Archives of Gerontology and Geriatrics, 2013; 56: 38-43

4)      Chandra, V. (1996). Cross-cultural perspectives India: behavioral and psychological sign and symptoms of dementia: implications for research and treatment. International Psychogeriatrics 

Infanticide

The term infanticide refers to the killing of a newborn baby. Infanticide is a practice that has deep roots within human civilization. In ancient times, infanticide was committed as a sacrifice to appease the gods, this particular practice was common to the Native populations in the Americas.

However, there are many different reasons why this practice occurred. It could have been an effort of basic survival if the family felt they could not adequately provide for the child.

It could also be tradition, as in the specific practice of killing twins as they were thought to be a bad omen in certain African countries. Read this piece on an inspiring Kenyan woman intent on challenging this norm.

While shocking, throughout history, infanticide has been the rule and not the exception.Through a Western lens, this practice and the logic behind it seems arcane, infanticide is very much still prevalent in many parts of the world.

What is most common today is "Gender Specific Infanticide". Gender specific infanticide, traditionally favors male children over female children. Examples can be seen in rural parts of China.  Click here for a general picture of the state of affairs.China's controversial "Family planning policy" otherwise known as the "One Child Policy" has been thought to contribute to gender selected abortion and abandonment, despite the fact that these practices are now illegal. This policy was implemented after China's population sky rocketed to unmanageable figures shortly after Mao Zedong came to power.  

Initially, when Mao Zedong had risen to power and created 

The People's Republic of China, birth rates slowly fell. The government then began aggressively advocating for large families to empower and strengthen the country.

This chain of events has made overpopulation itself a significant health concern in China. However, it is unacceptable to consider gender specific infanticide as having anything at all to do with solving the former issue. Nevertheless, infanticide is a complex issue that is tangled with many others.  Great care would need to be employed to maintain objectivity and cultural relativism.

In the interest of global health, where does one draw the line in crafting a solution to this?

Though it is clear that female children are perceived to be less valuable than male, it does not seem practical to convince others simply that that is not the case. Even so, any solution to this problem would, at its roots, challenge this very paradigm of thought.

Unfortunately, a true solution can not be realized after infants in danger have already been born, it would already be too late. Rather, an effective, long-lasting, more upstream solution would take place in the way of socially marketing the value of family planning education to young women and young mothers. Please read about social marketing here: http://www.social-marketing.com/Whatis.html.

New ways of thinking must be strategized as if they were products that people did not feel the need to buy. Innovative and engaging practices must be implemented to create the type of long term and global changes that would alleviate the suffering related to infanticide. 

Obstetric Fistula

Obstetric Fistula

"One of the most serious injuries of childbearing is obstetric fistula, a hole in the vagina or rectum caused by labour that is prolonged – often for days – without treatment. Usually the baby dies. Because the fistula leaves women leaking urine or faeces, or both, it typically results in social isolation, depression and deepening poverty. Left untreated, fistula can lead to chronic medical problems."

Malaria in Uganda

Uganda is a part of sub-Saharan Africa, a region that is most at risk for malaria due global warming that favors the existence, growth and spread of the malaria vectors. This region is very poor and lacks a lot of resources needed to control the spreading of malaria. Uganda has the highest incidence rate of malaria in Africa, being that 473 cases/1,000 people per year are reported. Malaria is also the leading factor in mortality and morbidity in Uganda.

Sex Trafficking: Modern Day Slavery

Sex trafficking is a crime against humanity. An overwhelming number of girls and women worldwide are forced into exploitative sex work every day, often having to dismiss their families and communities and leaving not a single trace behind (Kumar, 2012). These women are stripped of their humanity and exploited in a way that damages not only their health and safety but also their psychological and emotional well-being,  

 The United Nations on human trafficking defines it as, “the recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labor or services, slavery or practices similar to slavery.”  (http://www.apneaap.org/)

The UNDOC estimated that this crime is approximated to generate $32 billion in revenue each year.

The vast majority of these people are women and young girls that come from the poorest and most disadvantaged communities (Kumar, 2006). In the world, India and Pakistan are the main destinations for children under the age of 16 who are trafficked in south Asia  EPCAT International, 2006.

These children are sexually exploited in brothels, massage parlors, nightclubs, and private houses known as ‘madhu charkas’ as well as on the streets. These women and children are often physically and sexually abused and forced into living conditions that are unsanitary and very unsafe. There was an estimate of 32.3% percent of trafficked girls showed major impacts to their health including debilitating diseases such as HIV/AIDS, STIs and other gynecological diseases (EPCAT International, 2006). There are a wide range of reasons for the prevalence of sex trafficking in countries including socioeconomic, political and cultural conditions and are often ignored or encouraged by governments to promote and encourage tourism.

        Human Trafficking is an illegal act that is occurring in our world that not many of us are well informed on or fully aware of. The real questions related to human trafficking though are, what is human trafficking, what/who does it consist of, and where it occurs? Human Trafficking is defined as: ‘The recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation.’ The United Nations Protocol to Prevent, Suppress, and Punish Trafficking in Persons.

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       Women are generally the ones being trafficked for sexual purposes as well as to be house servants for particular buyers. The transactions are generally done by the women being auctioned off by the person doing the trafficking or by them receiving payment from a prospective buyer. Although women are generally the ones being trafficked there is evidence that shows that children and men are also being trafficked as well. Generally the men would be trafficked for more labor extensive work as compared to the woman who are generally trafficked for sexual purposes.

             Due to it being illegal it is hard to track reliable data on the trafficking of individuals. Individuals being trafficked can be moved within their own country as well as internationally. Traffickers are rumored to receive great profits for the selling of individuals.

            Trafficking can have severe health effects on an individual. The effects do not only occur physically but it is proven that it can cause severe mental and psychological damage to the victim as well. The evidence of trafficking is fairly new and does not have a whole lot of information to go off of, but in the few cases that have been studied they have determined that human trafficking does have severe short-term and long-term health effects.

            When it comes to the fight against human trafficking, organizations that not only care for the victims, but help them move on to the next chapter in their lives are instrumental. Few organizations do a better job than the “Not for sale campaign”. This group works all around the world but just started their Thailand chapter in 2007. I found this group amazing because they not only help feed and house the victims, they also provide them with proper education and prepare them to find jobs too. What they have done in Thailand is built an organic farm, they then built homes for victims that are rescued from human trafficking and they let them live on the farm and help with duties on the farm making it self sustaining. This is no ordinary farm to live on by any means, they have basketball courts, a library, a medical center and a rec center, things that these kids would never have had otherwise, things that they deserve after having to go through the ordeal of human trafficking. As of right now, they claim to house more than 125 people (men and women), all of which are enrolled school. They add on their site that recently 3 kids that came from their rescue farm have enrolled in universities, and amazing accomplishment considering where they came from.

            The not for sale is currently in the process of establishing a jewelry design shop where they will teach the kids to be silversmiths. They plan on using the money from this side business to be able to pay the kids a small salary and reinvest the remaining funds back into sustain the farm. They identify on major problem for victims looking for jobs is that they are usually undocumented citizens, meaning they have no statehood with Thailand and therefore cannot get a job. They are setting up programs to assist in helping people obtain proper documents to become citizens so that they can get jobs once they leave the farm. Of all the organizations that are helping in the fight against human trafficking, I thought that this one really stood out, not to take away from any other organization but this one I felt covered all bases. Hopefully we will see this campaign continue to grow and spread into other areas that need them.

From the book : Sex Trafficking: Inside the Business of Modern Slavery by Siddharth Kara

The story of 15 year old Panadda
Panadda went to a government-funded school until she was 12, when her family decided that it was time for her to quit school and start supporting the family.  She was still working to pay off her debt to the brothel (that she acquired from her purchase)- yes, she owed money for her own sale! “Even though she was held against her will, she was charged monthly room and board… she had to sleep with fifty men a month to repay it. It was only after the first fifty men each month that she began to make a dent in her debt, on which she was also charged random amounts of monthly interest. Money sent to her parents was also deducted.” (p. 159)
Even though Panadda had to endure all of this, she does not harbor bad feelings towards her parents for selling her, or for sending her back to the brothel the only time she ever escaped. “It was her duty to care for them. With genuine pride, she showed me a necklace of small white beads fastened to a pendant of a lotus flower carved from a teak wood that her grandmother made for her mother. ‘One day, I will give it to my daughter.’” (p.160).