Category Archives: International
Robert Wood Johnson Foundation Executive Nurse Fellows program alumna Debra Toney, PhD, MS, BSN, FAAN, was one of 22 people selected by the Coca-Cola Company to carry the Olympic torch in Kirtlington, England, in a relay across the country leading up to the opening ceremonies for the 2012 Olympics. Here, Toney, director of nursing for Nevada Health Centers and immediate past president of the National Black Nurses Association, writes about the experience.
Have you ever done something that changes your life? Have you met people who inspire you to do more? These are just a few of the many feelings I have experienced after participating as an Olympic Torchbearer! They are certainly great feelings to have and I have been on cloud nine since returning home.
The opportunity to participate in this international event which celebrated the accomplishments of some very amazing people was a proud and humbling moment. Humbling because I never expected something this significant would happen to me. However, it is an experience that could happen to anyone.
While flying home I had plenty of time to pinch myself to wake up, but I was awake. Did this really just happen to me? The opportunity to spend time with people from different parts of the country and hear their stories of giving has given me the drive to do more. We came from different cultures, spoke different languages and enjoyed different food, yet we had a lot in common. We want to make the world a better place to live.
The Flame was finally delivered to London, after being transferred from one Torchbearer to another, spreading the message of peace, unity and friendship. It ended its journey as the last Torchbearer lit the cauldron at the opening of the Olympic Games. I experienced a feeling of honor and joy as I watched in awe the opening on television, knowing I played a role in this great history making event.
This post is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Julia Lynch, PhD, is an associate professor at the University of Pennsylvania. Lynch is a recipient of a 2006 RWJF Investigator Award in Health Policy Research at the University of Pennsylvania and an alumna of the RWJF Scholars in Health Policy Research program (2003-2005).
The first emergency room is one you know: the ED in your nearest inner-city or rural hospital. There you’ll find trauma cases, heart failures, emergency appendectomies, heroic rescues by doctors and nurses working through the night, just like on TV. But also, waiting in chairs (lots of chairs), the frequent fliers, the preventable complications of asthma and diabetes, the people awaiting primary care in the worst possible medical environment for it. These are America’s emergency rooms.
And then there are Italian emergency rooms. As an expat living in Italy, I’ve navigated hundreds of miles of red tape to get a car registered, a telephone line installed, a tax ID number. I’ve paid notaries hundred upon hundreds of Euro for the stamps and forms needed to make the transactions of daily life (renting an apartment, selling a car) legal. Just imagine the emergency room. Better yet, don’t. I’ll tell you about it.
Some years ago, just after my husband and I had moved to Italy for my research, he cut his finger while preparing dinner. It looked bad, but it was Saturday night, and the one doctor we knew of who accepted our weird Belgian insurance policy for expats wasn’t in his office. So when the cut failed to stop bleeding overnight, we reluctantly made our way to the city hospital, asked for directions to the pronto soccorso (literally “immediate aid”), and prepared ourselves for a very long wait.
In the area to which the hospital greeter had directed us, we found a closed door, and three empty chairs in the hallway. After some confused wandering around, we knocked on the door, and once again asked for directions to the elusive ER waiting room. A doctor poked his head out, pointed to the three chairs, and said he’d be with us as soon as he finished patching up a motorcycle accident.
How long would that take, we wondered? And how many heart attacks, asthma attacks, and gunshot wounds would come in while we were waiting?
But the remaining chair in the hallway remained empty; and within ten minutes, the very same doctor who had answered our knock glued my husband’s finger back together and sent us on our way. Minimal wait, one doctor, no paperwork, and no charge—despite the fact that neither of us had an Italian National Health Service (NHS) card. Our Belgian insurance policy would not be billed. The doctor explained proudly that Italy’s NHS looked after everyone, even visitors.
And that’s not all: we didn’t know at the time that there is a designated doctor for every quartiere (neighborhood) in Italy, called the guardia medica, on call for minor nighttime emergencies. The doctors of the guardia medica, which I’ve also since had the occasion to call, are paid by the Italian state. They make house calls, with a little black bag and everything. The doctor for our quartiere could have glued my husband up on a Saturday night, in the comfort of our own home, again at no charge.
I know you must be thinking “But all this must be terribly expensive!” It’s true. Since our visit to the Italian ER, many patients of the NHS have been subjected to new out-of-pocket charges for medicines and specialist visits, and lines have grown longer in emergency departments as regional health budgets have come under pressure. But primary and emergency care is still free at the point of service. And Italy still spends considerably less than its neighbors do on health care: $2,870 per capita in 2008, compared to $3,129 in the UK, $3,696 in France, $4,063 in the Netherlands—and $7,538 in the U.S. Even so, income disparities in both access to care and health outcomes remain small in Italy, and most readers of this blog will know that Italy outperforms the U.S. on virtually every indicator of health and well-being.
Where does this tale of two emergency rooms leave us? The Affordable Care Act (ACA) brings us nowhere near a National Health Service on the Italian or British model. And not even the most ardent advocates of cost-effective medicine can imagine a way, under the ACA, to reduce our health care budget by 60 percent to bring us in line with what Italy spends on a per capita basis.
What the ACA does do is bring us one step closer to being able to say -- as that Italian ER doctor could -- that our health care system “looks after everyone.” It may even bring us nearer to the day when the waiting rooms of our emergency departments aren’t packed with patients seeking primary care, and care for complications resulting from a lack of primary care. Perhaps even a day when our emergency departments look a little more like three empty chairs in a hallway.
By Adam Pike, BSN, a Robert Wood Johnson Foundation New Careers in Nursing (NCIN) scholar and recent graduate of the Donna and Allan Lansing School of Nursing and Health Sciences at Bellarmine University in Louisville, Kentucky. Read more about second career nurses like Pike in the latest issue of Sharing Nursing’s Knowledge.
I had blown off graduate school for a semester and moved in with a friend living in northern Honduras, ostensibly to spend time developing my Spanish language skills. We occupied a small one—room, key—lime concrete block, completely permeable for a variety of local fauna. A coconut tree was visible from our small stoop on which I sat during many afternoons while rain rattled the metal roof like a snare drum. We washed our laundry with a washboard and cistern in the company of chickens, dogs owned by no one, and playful, kind neighbors who regarded us as a kind of novelty. It was the perfect environment in which to pull back from familiar routine and plunge into academics and artistry. I carried out this mission somewhat anonymously in our austere apartment, with the exception of trips for fruit to the ancient wooden cart at the corner, or perhaps to the pharmacy to remedy the inevitable abdominal maladies that occur for foreigners.
Of the many bouts of illness we fought, only one was potent enough to warrant a hospital stay. On this occasion, as I stood in the dilapidated public ER, looking down at my sick friend in his hospital bed, I saw a young Honduran woman wheeled through the entrance of the ER and immediately placed in a vacant bed adjacent to my friend. In this open room, filled with patients suffering from dengue fever, dehydration, and physical trauma, it was immediately clear this pale, sweating woman, desperately gasping, was far more ill than the rest. As she disappeared in an impromptu room the staff conjured from panels of spare drape, I saw patches of dark bruises climbing her forearms.
As the evening passed, my friend napped, and I ventured behind the white curtains to offer anything I could—really, nothing—to the young woman breathing through a mask and her mother, her only company. For what followed, nothing could have prepared me. We conversed, traded stories, said prayers.
Cleopatra M. Abdou, PhD, is an assistant professor of gerontology at the University of Southern California, and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program. Her research utilizes experimental, survey, and qualitative methods to investigate how society, culture, stress, and positive resources interact to affect health, well-being, and aging more broadly. Special attention is given in her research to cultural and social influences on health and health-related decisions across the lifespan as well as across multiple generations.
Dr. Abdou recently launched Healthy Egypt, a blog that discusses current health-relevant issues in Egypt while making social and health science concepts accessible to diverse audiences. The topics covered in Healthy Egypt emphasize the experiences of Egyptians, but are relevant to other Arabs and all humans across the globe. The following was originally posted on Healthy Egypt.
The first time I traveled to Egypt alone, I was carrying what turned out to be this magical piece of paper. It was a note from my father, handwritten in Arabic. I walked through the airport in Cairo delirious from the long trip and mesmerized by my surroundings. I was trying to read all of the signs in Arabic while also taking in the sea of faces—more faces similar to my own than I had ever seen in one place before. I noticed the people staring at me, but it did not matter because I was finally in the land of my mother and my father. I thought of my mom, who we lost in childbirth when she was very young, walking through this same airport; and I felt a happiness I can’t describe.
Sidney Coupet, DO, MPH, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Michigan, is the founder and executive director of Doctors United for Haiti. Read more about his work on the RWJF Human Capital website.
Did you know the average Haitian physician sees about 100 patients a day? Can you imagine if your doctor had to see 100 patients a day? Trust me, remembering your name would be the least of her problems! In a country with rampant chronic and infectious diseases, the poor health state – and an ambiguous health care system – can be overwhelming for Haitian health care professionals. Many of them leave the country in hopes of a better career and life.
But simultaneously, an overwhelming number of U.S. physicians are traveling to the shores of Haiti. They’re providing humanitarian aid and lifting a burden, intervening before Haitian health care professionals decide to flee their own country.
And they’re doing it through Doctors United For Haiti, an organization I started in 2006 to help my parents’ native country.
Doctors United For Haiti (DUFH) has created an academic environment in which both American and Haitian health care professionals benefit. Our program creates an opportunity for doctors, nurses, allied health professionals, mental health professionals and health administrators to share and exchange knowledge in a non-threatening environment. This academic approach was created as an opportunity to empower, educate and support Haitian health care professionals as they deliver quality care to their own people.
Simultaneously, it provides opportunities for American health care professionals to receive global health training. While this model is obviously providing opportunities for improvement in Haiti, our doctors will return with skills that will save our own system money and make it run more efficiently.
By Susan Hassmiller, Ph.D., R.N., F.A.A.N.
Director of the Initiative on the Future of Nursing and RWJF Senior Adviser for Nursing
Last summer, I fulfilled a lifelong dream in journeying to London and Turkey to follow in Florence Nightingale’s footsteps. I wanted to learn how her groundbreaking efforts to create modern nursing and make systematic changes in sanitation laws, military hospital design, the field of statistics, and of course, nursing, impacted nursing today.
What I discovered is that Florence’s work is relevant to all of us, particularly as our generation works to remake our health care system to ensure that all Americans receive integrated, equitable and cost-effective services through the Future of Nursing: Campaign for Action. This multi-year initiative seeks to advance comprehensive change for patients and the country by fully utilizing the expertise and experience of all nurses.
Among other things, this Campaign is working to improve nursing education and training, promote nursing leadership, enable all nurses to practice to the full extent of their education and training and improve data collection – all areas that Florence impacted in her day.
As we celebrate Florence Nightingale’s birthday May 12 and National Nurses Week, let’s continue her legacy.