Healthcare in underdeveloped nations

In certain impoverished nations, unless you pay at the reception, you cannot see a medical professional–even if you are bleeding, there is nothing they can do other than give you a cloth to wrap and stop the bleeding and that’s if someone is kind enough. This means that you must pay out of pocket for healthcare services each time you see the doctor. In these countries, unemployment is very high, sanitation is very poor, and people are highly susceptible to illness not once or twice, but constantly, with no access to healthcare.  As a result of having to pay for these services out of their own pockets, the lack of financial security increases families’ financial strain.

“Without health care, how can children reach their full potential? And without a healthy, productive population, how can societies realize their aspirations?” said UNICEF Executive Director Anthony Lake. “Universal health coverage can help level the playing field for children today, in turn helping them break intergenerational cycles of poverty and poor health tomorrow.”

The most primary and infectious causes of death in developing nations are malaria, AIDS, and tuberculosis. In fact, these diseases can be prevented in the same manner as in industrialized nations. Tuberculosis? implying that both adults and children lack access to immunization. Immunization, seriously? Everyone should be vaccinated against these deadly diseases, which have claimed countless lives before our great-grandparents were born. In the 1700s, tuberculosis was not only referred to as the white plague due to the sufferers’ pallor, but also as the “Captain of all these men of death.” Now that it is possible to contain the disease, why not do so in every region of the world and not only in wealthy nations? 

If an outbreak occurs, it can affect people in both underdeveloped and developed countries. For example, Ebola emerged in 1976 in the DRC and South Sudan. After a period of few to no occurrences, an outbreak resurfaced between March 2014 and June 2016. This was the largest Ebola outbreak ever reported, with over 28,000 cases. This occurred not just in West Africa, but also in East Africa, Italy, Spain, the United Kingdom, and the United States. If these regions of Africa had proper healthcare, the disease may have been efficiently contained. National and international authorities collaborated to help terminate this outbreak by building prevention programs and messages, as well as implementing policies with care. Personnel from the CDC were dispatched to West Africa to aid in response activities, including surveillance, contact tracing, data management, laboratory testing, and health education. In addition, the CDC team assisted with logistics, staffing, communication, analytics, and management.

During the height of the response, the CDC trained 24,655 West African healthcare professionals in infection prevention and control methods. In addition, by the end of 2015, 24 laboratories in Guinea, Liberia, and Sierra Leone were equipped to do Ebola virus testing. If all these strategies were done not only during pandemics, we would be able to avert a great number of outbreaks. These nations and others would be able to contain an outbreak before it spreads internationally. However, we wait until a pandemic threatens our minds before implementing laboratories and educating more healthcare staff in developing nations. Why not do this in the absence of a potentially deadly disease? Why not be prepared for anything that could affect us in both developed and poor countries?

We’re not ready for the next epidemic, Bill Gates remarked during the ebola outbreak. Obviously, Covid happened, and what appeared to be a simple sentence made so much sense. He went on to explain that we require a response system with the capacity to mobilize tens of thousands of healthcare staff. During his TED talk, he mentioned that in order to combat an epidemic, we need robust health systems in developing nations– where mothers can safely give birth there, and children can receive all of their vaccinations there. However, this is also where the outbreak will appear first.

“Past experiences taught us that designing a robust health financing mechanism that protects each individual vulnerable person from financial hardship, as well as developing health care facilities and a workforce including doctors to provide necessary health services wherever people live, are critically important in achieving ‘health for all,’” said Mr. Katsunobu Kato, Minister of Health, Labour and Welfare, Japan. 

What are we waiting for to improve healthcare in developing nations? In other words, what affects individuals in developing nations is likely to impact developed nations. Why not collaborate to create not only a better national healthcare system but also a universal healthcare system? Universal health means that everyone has access to and is covered by a well-organized and well-funded health system that provides quality and comprehensive health care and protects individuals from financial ruin if they utilize these services.

Guaranteeing the right to health means eliminating all kinds of barriers to accessing services…

Dr. Carrissa F. Etienne– Director of the Pan American Health Organization

Some Key actions for Universal Health are:

  1. Expanding equitable access,- Initiating and gradually extending primary care models and comprehensive service delivery that are centered on people’s needs. Assuring the prudent utilization of medications and health technology.
  2. Increasing stewardship and governance by teaching and empowering people and communities about their health-related rights and duties and encouraging them to participate in the development of health-related policies.
  3. Increasing and enhancing finance through eliminating payments at the point of service entry, identifying sustainable means of increasing health financing, and financially protecting individuals. These are only a few examples; the list is far longer.

The enhancement of health care in developing nations will have a substantial effect on the mental health of an infinite number of individuals. Healthcare is a human right!

References

World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses. (n.d.). World Bank; http://www.worldbank.org. Retrieved June 7, 2022, from https://www.worldbank.org/en/news/press-release/2017/12/13/world-bank-who-half-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses

CDC. (2022, January 14). World TB Day History. Centers for Disease Control and Prevention; http://www.cdc.gov. https://www.cdc.gov/tb/worldtbday/history.htm

Fact sheet about malaria. (2022, April 6). Malaria; http://www.who.int. https://www.who.int/news-room/fact-sheets/detail/malaria

2014-2016 Ebola Outbreak in West Africa | History | Ebola (Ebola Virus Disease) | CDC. (2019, March 8). 2014-2016 Ebola Outbreak in West Africa | History | Ebola (Ebola Virus Disease) | CDC; http://www.cdc.gov. https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html#:~:text=The%20patient%20recovered.,hospitals%20in%20the%20United%20States.

Universal health coverage (UHC). (2021, April 1). Universal Health Coverage (UHC); http://www.who.int. https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)

Gates, B. (n.d.). Bill Gates: The next outbreak? We’re not ready | TED Talk. Bill Gates: The next Outbreak? We’re Not Ready | TED Talk; http://www.ted.com. Retrieved June 7, 2022, from https://www.ted.com/talks/bill_gates_the_next_outbreak_we_re_not_ready

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Quote of the day

Many cultures, particularly in developing countries, continue to believe brain disorders in the context of metaphysical affiliations, exorcisms, taboos, bad luck to the family, et cetera… To this day so many people suffering from mental illness are homeless and left on the streets, where they are mocked, beaten, harassed or jailed.

DMK

Quote of the day

You fall into one of two categories: normal or abnormal. Because MENTAL HEALTH is non-existent in developing countries, there is no in-between of rather mental disorders. That is, if there is nothing physically wrong with you, you must be fine; otherwise, you are insane, or perhaps your behavior is insane. 

DMK

Linkpost — Mental health in developing countries

Linkpost— Misconceptions and stigma of mental illness

Quote of the day

When you want to be understood but your brain is unable to decode the message of the spoken language, you experience a wave of frustration. 

–DMK

Linkpost— Language barrier and mental health awareness

Quote of the day

What happened is that in underdeveloped nations, there is such little/no knowledge of mental health disorders that by the time persons with these conditions are transported to the hospital, there is no longer room for survival.

–DMK

Linkpost— Mental health in developing countries

Quote of the day

People in developing countries are left with wandering minds, more akin to a state of limbo when you know there’s something seriously wrong with you because you can feel it in every inch of your body, and it’s screaming at you excruciatingly—becoming louder and louder with time. 

–DMK

Linkpost— Mental Health in developing countries

Quote of the day

The term “SAD” is simple; everyone experiences sadness; therefore, it was never taken seriously that being sad for a longer period has its own term: depression. Yes, depression is unheard of in most developing countries; you had to be a robot and resilient — you had to be strong or drink your misery.

–DMK

Linkpost— Mental Health in developing countries

History of mental health

Even in developed countries, mental health has not always been seen as such. It does have a journey, a transformation, and advocacy for its current state. Mental illnesses have a long nasty past and continue so today through stigmatization and prejudices.

Since the ancient period, there have been three main notions on the causes of mental illness: supernatural, somatic, and psychogenic. For the supernatural,  It was claimed that demonic or bad spirits are to blame for mental conditions, as well as gods’ displeasure and the gravitational pull of the Earth. An example of a supernatural explanation for mental illness is the trephination procedure.  Prehistoric people drilled holes in the skulls of people suffering from mental disorders to heal head injuries and epilepsy, as well as to let evil spirits trapped in the head be expelled from the skull. [1] As early as 2700 B.C.E., the Chinese idea of “yin and yang,” or the balance of opposing positive and negative physiological forces, was used to explain mental (and physical) sickness. Somatogenic theories classify physical dysfunctions as a result of sickness, hereditary inheritance, or brain injury or imbalance. Traumatic or stressful experiences, maladaptive learned associations, and cognitions, or distorted perceptions are the focus of psychogenic theories of mental illness.

When it came to mental health conditions, Greek doctors didn’t believe in supernatural explanations. Hippocrates (460–370 BC) endeavored to detach superstition and religion from medicine by establishing the concept that one of the four basic physiological fluids(humors) such as blood, black bile, yellow bile, and phlegm to be responsible for the causation of illness whether physical or mental.  He did not believe that mental illness was shameful or that people suffering from it should be penalized for their actions. Hippocrates divided mental illness into four categories: epilepsy, manic, melancholy, and brain fever.

According to Greek philosopher Plato (429-347 BCE), he believed that community and families should care for the mentally ill humanely using reasoned conversations because of the important role that early learning and social environment play a role in the development of mental problems. Also,  Galen (A.D. 129-199), a Greek physician, stated that mental diseases were caused by physical or mental factors such as fear, shock, intoxication, head traumas, puberty, and shifts in menstruation cycles.[2]

Instead of accepting Hippocrates’ theory of four humors, philosopher Cicero and physician Asclepiades (c. 124-40 BC) in Rome said that melancholy is not caused by excess black bile but rather by feelings of sadness, dread, and fury. Roman doctors used massages and warm baths to cure mental disorders.  When it comes to physical and mental health, they embraced the concept of “contrariis contrarius,” which means opposite by opposite, and used contrasting stimuli to achieve a state of equilibrium.

Economic and political turbulence endangered the Roman Catholic Church’s dominance in the late Middle Ages, which resulted in the rise of the Church and the demise of the Roman Empire. Between the 11th and 15th centuries, mental disorders were once again described as devil possession, and procedures like exorcisms, flogging, prayer, touching relics, chanting, attending religious sites, and holy water were employed to cleanse the individual of the Devil’s control. At this moment, supernatural conceptions of mental illness dominated Europe, bolstered by natural disasters such as plagues and famines. The afflicted were jailed, beaten, and even executed in extreme situations.

Women, particularly those with mental health issues, began to be viewed as witches in the 13th century. The Malleus Maleficarum (1486) was written by two Dominican monks during the peak of the witch trials during the 15th through 17th centuries when the Protestant Reformation had thrown Europe into religious conflict. However, both Reginald Scot’s and Johann Weyer’s writings were condemned by the church’s Inquisition— their writings claimed that mental sickness was not a result of demonic possession, but rather a result of a malfunctioning metabolism and disease. Only in the 1700s and 1800s did witch-hunting begin to wane, after more than one hundred thousand people were accused of being witches and burned to death. [3][4]

Protests against the living conditions of the mentally ill began in the 18th century and during the periods of 1800s and 1900s, a more humane perspective on mental disease emerged. While working at the St. Boniface Hospital in Florence, Vincenzo Chiarughi (1759–1820), an Italian physician and educator, dismantled the chains that bound people there in 1785. Patients were freed from their chains, moved to rooms that were well-ventilated and well-lit, and encouraged to engage in purposeful activity on the grounds of La Bicêtre and the Salpêtrière in 1793 and 1795, respectively, by French physician Philippe Pinel (1745–1826) and former patient Jean-Baptiste Pussin. [5]

Humanitarian changes began in England as a result of religious concerns. William Tuke (1732–1822) pushed the Yorkshire Society to build a retreat in 1796, where patients were treated as guests, not as captives. The standard of treatment was based on dignity and kindness in addition to the therapies and moral value of physical labor. [6]

While in America, Benjamin Rush (1745-1813), the pioneer of American psychiatry, pushed humane treatment for the mentally ill. His profession featured therapies like blood-letting and purgatives, the design of a “tranquilizing chair,” and a strong belief in astrology, which shows that he couldn’t escape the beliefs of his day. Dorothea Dix (1802-1887), a retired teacher worked tirelessly to change the public’s attitude toward persons with mental disorders and to establish institutions where they may get humane treatment. She was the driving force behind the mental hygiene movement, which aimed to improve patients’ physical health as well. She was a proponent of the creation of public hospitals. She aided in the establishment of around Thirty mental facilities in the United States and Canada between 1840 and 1880. [7] In Massachusetts and New York, the first asylums were erected in the 1830s. By 1860, twenty-eight of thirty-three states had established mental institutions (Braslow 1997). People with mental illnesses were able to heal from their illnesses because of moral therapy movements in both the United States and Europe.

However, a large number of academics strongly opposed mental health facilities. This “tale of noble intentions gone wrong” is what Shorter calls the rise of American asylums (Shorter 1997, 33). Asylums were built in the nineteenth century on the premise of “moral therapy,” a theory that maintained that meticulously structured institutions might provide a haven from the chaos of regular life. The mentally ill can gradually adjust to and eventually adopt a sense of normalcy in an orderly setting that encourages regular social interaction, work, and recreation. [8]

Due to a deterioration in morality in the late 19th-century moral treatment approaches led to two rival perspectives – biological or somatogenic and psychogenic or psychology by the 20th century. The biological approach is challenged by the psychological or psychogenic perspective, which asserts that emotional or psychological variables have a role in the development of mental diseases. Emil Kraepelin (1856-1926), a German psychiatrist, noticed that symptoms appeared in clusters, which he referred to as syndromes. These syndromes were distinct mental disorders, each with a distinct cause, course, and outcome. When he released Compendium der Psychiatrie in 1883, he laid the groundwork for the Diagnostic and Statistical Manual of Mental Disorders (DSM) currently in its 5th edition, which is based on his classification system for mental disorders (published in 2013). Clinicians and psychiatrists now use the “Diagnostic and Statistical Manual of Mental Disorders” (DSM) to diagnose psychiatric conditions.

Despite this, not all countries adhere to the latest standards. Many cultures, particularly developing countries, continue to believe brain disorders in the context of metaphysical affiliations, exorcisms, taboos, bad luck to the family, et cetera. Psychological illness is often misunderstood by the general public, which leads to stigmatization and dehumanization of those who are afflicted. To this day so many people are homeless and are left on the streets, where they are mocked, beaten, harassed, jailed, and so on. These countries have very few if any, facilities or resources for mental health care. Many people are stuck in limbo in a state of ignorance, unsure of what might be wrong. People suffering from mental illnesses are dying at an alarming rate, yet they can be saved. Developing countries have an urgent need for education and advocacy for mental health.

References

[1] Restak, R. (2000). Mysteries of the mind. Washington, DC: National Geographic Society.

[2] “1.3. The History Of Mental Illness – Essentials Of Abnormal Psychology.” 1.3. The History Of Mental Illness – Essentials Of Abnormal Psychology, Opentext.wsu.edu, 5 January. 2018, https://opentext.wsu.edu/abnormalpsychology/chapter/1-4-the-history-of-mental-illness/.

[3] Schoeneman, T. J. (1977). The role of mental illness in the European witch hunts of the sixteenth and seventeenth centuries: An assessment. Journal of the History of the Behavioral Sciences, 13(4), 337–351.

[4] Zilboorg, G., & Henry, G. W. (1941). A history of medical psychology. New York: W. W. Norton

[5] Micale, M. S. (1985). The Salpêtrière in the age of Charcot: An institutional perspective on medical history in the late nineteenth century. Journal of Contemporary History, 20, 703–731.

[6] Bell, L. V. (1980). Treating the mentally ill: From colonial times to the present. New York: Praeger.

[7] Viney, W., & Zorich, S. (1982). Contributions to the history of psychology: XXIX. Dorothea Dix and the history of psychology. Psychological Reports, 50, 211–218.

[8] Melissa Schrift, et al. “Mental Illness, Institutionalization and Oral History in Appalachia: Voices of Psychiatric Attendants.” Journal of Appalachian Studies, vol. 19, no. 1/2, Apr. 2013, pp. 82–107. 

Farreras, Ingrid G.. “History Of Mental Illness | Noba.” Noba, Nobaproject.com, https://nobaproject.com/modules/history-of-mental-illness.