Health

Discussion Stream Notes

The most important factors that influence health in a refugee camp (as in society at large) are factors outside the usual jurisdiction of doctors. Typically, by the time a doctor gets involved with refugees, the state of their health has already been determined by the sanitation, nutrition, security, economic stability, and mental health support network in the camp. Doctors need to be involved in the larger issues of refugee health, including monitoring community systems and community health (regularly checking the water purity, and monitoring child malnutrition, etc.) to catch causes of health problems before they result in epidemics. Public policy is critical, as is evident by the numerous examples of public programs that have resulted in disastrous effects on health (such as public housing projects and Native American Indian reservations), as well as examples of public programs that have improved health (as in Curitiba, Brazil). The three individual projects established included:

1. Family Planning

Family planning is critical to both human and environmental health. It is such a culturally sensitive issue, however, that it is absolutely essential that natives of the culture provide the service, and provide it in a culturally appropriate way. What might work very well in some cultures (e.g., cartoon characters that promote contraception in the Far East) won't work in other cultural settings (e.g., Afghanistan). Aid agencies should work with the local community and religious leaders to assist them in providing this service. Women's education is likely the most important aspect of family planning. There is a direct correlation between female literacy and reduction in child mortality. Literacy enhances a woman's sense of identity and empowerment (particularly the knowledge that she is protected by the rule of international law, the Declaration of Human Rights); this in turn enhances her ability to make decisions that will promote her own health and the health of her family. Educating women will not only reduce child mortality rates but will increase family health at low cost. (A study on longevity found that the five countries that most successfully achieved longevity at low cost had all of the following: political commitment, female literacy, nutrition, and equity healthcare.)

2. Mental Health Treatment

The main mental health problems that arise in refugee camp situations include post-traumatic stress, depression, apathy and boredom. Mental health disorders are as debilitating as tuberculosis. Good mental health is arguably the largest asset of the camp; restoring it improves the capacity of the community. The group recommended that mental health care for post-traumatic shock syndrome (PTSS) should be provided by community health leaders who would be trained in the "Sambhavna" program (the disaster-relief program enacted in Bhopal after the Union Carbide tragedy). Building a community facility to provide a meeting space for peer support would be a tremendous benefit for people with PTSS.

3. Improve Inhabitants Immune Systems

Since the most effective way of promoting health is preventing disease in the first place, the group recommended providing key nutritional supplements to boost the immune systems of refugee camp inhabitants. Like the Food & Nutrition Group, the Health Group turned to mushrooms to most effectively and inexpensively serve this purpose. There are seven basic medicinal mushroom varieties that could be incorporated into the "Seed Box" that was suggested by the Food & Nutrition Group. Mushroom growing would be incorporated into culturally appropriate farming techniques. In many cultures mushrooms are already an element of the culinary tradition, in other cases they might have to be introduced as a new element or incorporated "invisibly" into other foods. To get the mushrooms started, either spores or freeze-dried mycelium (spores are hardier) could be delivered to the camp. Once the mushrooms have been cultivated, they can be preserved for later use. This and other information about mushroom cultivation and use would be incorporated on the boxes.