Caitlin Cohen

Recent Activity

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  Caitlin commented on the article | almost 2 years ago

  For Better or Worse: Exporting U.S. Ideas of Insanity

  I think there is a tendency to privilege mental illness as somehow less "real" or "physical" than somatic or bodily illness because someone's social experience contributes to mental health. But your physical health also says worlds about your social experience and your environment: diabetes describes changing nutritional status, tuberculosis describes community crowding, lung cancer describes exposure to cigarettes.  In a similar vein, your experience and psychosocial changes cause brain changes: some of these are good (eg learning) some of these are bad (eg PTSD).  Hundreds of studies have borne out changes in functional MRIs and various neurotransmitters in patients with various mental illnesses. These diseases are real, and they are physical. Our limited understanding of the brain makes it hard to label and treat them as we would kidney disease. But ignoring them, and stigmatizing them, is inhumane.

  
  

  I think there is an important distinction to be made here between what are called "Axis 1" disorders, and personality disorders.  Axis 1 disorders are considered to be disorders of brain chemistry.  Personality disorders are considered a maladaptive series of personality traits.  The former are fairly common across all cultures, and the later are culture-specific (and are not usually treated with medications). 

  
  

  I have worked with women in Rwanda who have PTSD and HIV as a result of rape during the genocide. I have seen these women's lives transformed by medications. We may not know exactly how these medications work, or the exact pathophysiology of the disease. To deny them this medication because their disease is a poorly understood "western construct" is like denying a patient in the 1800s supportive treatment for "consumption" (TB) just because we didn't yet fully understand it.  We often treat patients before knowing the exact mechanism of their disease. I agree that psychological medications are overprescribed in the developed world, but this is hardly the case anywhere in the developing world. In 50 years we may no longer use the term "depression" or "PTSD" just as we no longer use the word "consumption", but these diseases will still exist and still deserve as much respect and consideration as any other ailment. 

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  Caitlin commented on the article | about 2 years ago

  Fast Food: An All-American Epidemic? Not Anymore

  Hello Bryan and Some Dood,

  
  

  Firstly, there are billions of dollars invested by both private companies and the government in researching how to change metabolism. The market for weight loss is stunningly large, so there are new drugs being tested all the time in the hopes of developing a holy grail. The problem is that they don't work, or they cause side effects that are even less healthy than obesity.  Some of the research that has been done involves things like the altering the ventromedial hypothalamus in the brain, changing chemicals called ghrelin and leptin, and thryoid function hormones like TSH. 

  
  

  Secondly, I think you misconstrued my recommendations: I am not saying that we need solely more education, I am saying we need food security initiatives.  If you have a boom/bust agricultural or financial cycle where you get too much food some of the time and are starving the rest of the time, this promotes obesity. "Food security interventions" are things like crop insurance, foodbanking, risk grouping, drought and famine prevention, mandating that supermarkets in poor areas carry nutritious foods, and emergency food distrubtion in the case that the other interventions do not work.

  
  

  Modern agriculture practices and quality of food are different issues.  I think we could be absolutely using our modern agricultural practices to promote the creation of and distribution of more nutritious food, even by doing things that are simple like switching from palm oils to vegetable oils and switching from corn syrup to sugar or other sweetners.

  
  

  Obesity is not a strictly MEDICAL problem, a strictly SOCIAL problem, or a strictly BEHAVIORAL problem.  A true solution will address all three of these causes.  And if we twiddle our thumbs until we've found that holy grail pill that resets our metabolism to the enviromental conditions of our modern age, we will have lost the battle.

  
  

  Caitlin

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  Caitlin commented on the article | over 2 years ago

  What Could the iPad do for Global Health?

  There are much better PC repair mechanisms in place in the developing countries that I have been to.  That said, desktops can be expensive to ship/transport, so I am a proponent of portable computers. The current internet speeds tend to be infernally slow (as in mid-90s speeds... 52k is good) and are frequently down in Mali so web-based apps tend not to be good. The freeware can be, though...

  
  

  We tried (unsuccessfully) running ubuntu on some old laptops that were donated from a former US clinics old EMR... the failure of this experiment really boiled down to a lack of user-friendliness.

  
  

  I highly recommend contacting the friendly folks at Frontline SMS, as they have tons of experience with the practicalites of implementing an EMR in the developing world. My organization, MHOP (www.malihealth.org) is working with them to do a trial in Mali.  Alex Harsha is really the one who could give you much better insight into the realities of implementing this kind of system. 

  
  

  http://frontlinesms.ning.com/profile/AlexHarsha

  
  

  alex@medic.frontlinesms.com

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  Caitlin commented on the article | over 2 years ago

  What Could the iPad do for Global Health?

  Hello Jared, I agree that the CURRENT (well, soon-to-be) iPad is not going to be deployed in healthcare. But regarding a couple of points on your blog, I am referring to developing-world healthcare systems: most of them lack EMRs, so there isn't a software compatibility issue, plus opensourced apps for apple products make it fairly flexible for the small and rural clinic.  I don't think it will have much of a use in a large facility or a facility with pre-existing EMRs. Many of the tiny rural clinics have physicians who have never used the internet. Apple's user-friendliness for complete tech novices, the surprisingly low price, the web readiness and size all make it seem like the iPad is better than prior tablets for this specific use.

  
  

  That said, if these are going to become useful tools for developing world healthcare, they would need to a) be reduced in price and b) have good repair services... my mac once broke in Mali and they asked me if I was anywhere near Johannesburg (my response was something along the lines of "i am a (bleep) ton closer to (bleeping) Boston!").

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  Caitlin commented on the article | over 2 years ago

  Post-Traumatic Stress Disorder May Be Haiti's Next Disaster

  Hi Alanna!

  
  

  Thanks for these very intelligent comments.  The same article you cite actually shows that the rates of moderate to severe mental health problems was 30-50%... PTSD is only a fraction of these. "A misconception is that PTSD is the main or most important mental disorder resulting from disaster. PTSD is only one of a range of (frequently co-morbid) common mental disorders (mood and anxiety disorders), which tend to make up the mild and moderate mental disorders, and which become more prevalent after disaster."  Personally, I do believe that the impact that mental health plays in the global burden of disease, including the impact on economic development, is usually understated and frequently ignored altogether.  One reason is its fairly simple to rebuild a building, but its incredibly challening to rebuild a psyche.

  
  

  I also wanted to mention to readers that mental health is a very challenging thing to measure internationally, because the criteria for mental health diagnoses are based on tools (DSM IV) that have only been validated in certain populations (mostly US and European).  What constitutes a "disorder" is specific to individual societies, and therefore these measures may be quite off-base.

  
  

  Take care, and thanks again for sharing this article.