Nov 1, 202312 min read

November Newsletter

2023 Edition

"There is a stubbornness about me that can never bear to be frightened at the will of others. My courage always rises at every attempt to intimidate me."

Jane Austen

The Editor's Take: November Newsletter

Welcome back, AMWA, to the November Newsletter! In this edition, your writers have written on Telemedicine, Unsafe Ratios in Hospital Staffing, Community Health Workers, and the importance of Preventative Healthcare. We also have two paired articles - Spotlight on Dr. Linath Lim and Hot Button: Dangers of Anti-Vaccination Movements. As always, check out our Spotify Playlist!

If you have topics or your own writing that you would like to see featured, email me at Tanya.Baiju@utdallas.edu.

- Tanya

Spotlight: In Memory of Dr. Linath Lim

By: Alyssa Chiev and Sahaana Anand

Dr. Linath Lim is a survivor of the Khmer Rouge regime that took place in Cambodia from 1975-1979, wiping off nearly a quarter (about 3,000,000) of the Khmer population. Her early childhood was shaped by starvation. Four of her siblings were sent to work in labor camps, and her father passed from hunger. She eventually fled the country and came to America at the age of twenty. The difficulties of her childhood drove her passion to serve people as a physician.

Within two years, Dr. Linath Lim earned her GED and graduated from Taft Community College. She then attended Fresno State and then—Drexel University College of Medicine. While attending college and medical school, she was trying to scrape by. She was sleeping on friends' and family members' couches and borrowing money. When she graduated, she returned to California to pursue her medical career there, serving underserved communities, particularly Cambodian refugees. Lim joined the Cambodian Health Professionals Association of America on trips to Cambodia, where she treated impoverished communities.

"She was a kindhearted, very gentle person. She went beyond the call of duty to do special things for patients," recalled Tan, a survivor of the Khmer Rouge.

Dr. Lim's passions were clear, and they got her out of the dire situations of her upbringing, mostly unimaginable for us all. By becoming a physician who could give back to the exact group of people that she grew up with, she fulfilled her life's role and led with courage. Besides her professional career, she was family-orientated in her own way. She viewed her fellow workers and the people she took care of as her own and would consistently cook for them. As someone who has suffered a great deal of tragedy and difficulties, she made it out to be a strong, humble, and highly empathetic woman.

Her story, however, took a turn for the worse in light of the COVID-19 pandemic. Once the virus hit California, she selflessly worked extra shifts to provide for all the admitted patients in the emergency room. Even with all the risks it posed, she was known to love her job. After countless nights and long hours, Dr. Lim eventually got sick and told friends over the phone that she only felt "exhausted, achy and having trouble breathing" but felt the need to isolate and rest at most (Bazar). Given her underlying medical conditions of diabetes and not being vaccinated against the coronavirus, the virus got the best of her. Her brother stopped by her house to check on her after a few days of not answering calls or texts to find out that she had died.

To think that someone who survived what killed her immediate family, what starved everyone for years, what stripped apart her chance at a "normal" life, what shredded up people's survival in front of her own eyes, could not survive the COVID-19 pandemic is simply unexplainably unbelievable.

Frontline healthcare workers who were as fearless as Dr. Lim have put their lives on the line during the 2020 pandemic, but their legacy deserves to live on. Through the awareness of these words, the heroes on the frontline live on, and the impact they have had on every single patient or person lives even longer!

Telemedicine

By: Riya Ramani

Telemedicine encompasses the use of technology to deliver medical services remotely. This includes various services, including virtual consultations, remote monitoring, and digital platforms to facilitate healthcare communication.

One of the most significant advantages of telehealth is the unparalleled accessibility it provides to healthcare services. Patients no longer need to travel to a medical institution; instead, they can communicate with healthcare providers from the comfort of their own homes. This is especially beneficial for people who live in rural or underserved areas, where access to healthcare may be limited. The removal of geographical constraints expands the reach of medical care and promotes inclusivity.

Telehealth also helps to improve healthcare delivery efficiency. Virtual consultations shorten appointment wait times, allowing patients to obtain immediate medical attention. This is especially important when dealing with acute health issues and guaranteeing quick intervention. Furthermore, the ease of use of telehealth reduces the need for travel, saving both time and money. Individuals with mobility issues, chronic illnesses, or those seeking routine check-ups will appreciate this.

However, telehealth has its challenges. One significant problem is the digital gap, which means that those who do not have access to technology or stable internet connections may be excluded from the benefits of telehealth. This potential inequality highlights the need to fix infrastructural gaps and provide fair access to technology for all parts of society.

Another disadvantage is the restriction on physical examinations. While telehealth allows consumers and healthcare providers to communicate more effectively, specific medical assessments require in-person examinations. This is especially true for treatments involving hands-on examinations, diagnostic tests, and situations requiring a tactile understanding of the patient's condition.

In conclusion, telehealth represents a transformative force in healthcare, offering unprecedented accessibility and efficiency. Its benefits in terms of inclusivity and convenience are immense, but tackling issues such as the digital gap and physical examination constraints is critical to reaching its full potential and providing equitable healthcare for all.

Unsafe Ratio in Hospital Staffing

By: Alyssa Chiev

Our healthcare system faces many challenges. These challenges include but are not limited to cost cutting, long hours, the rural population, diversity disparities, and staff shortages. Staff shortages are a significant challenge for all healthcare workers, especially nurses.

Another term for staff shortages among nurses is “Unsafe Ratios.” As the name suggests, “unsafe ratios” are ratios that have statistically proven to be unsafe for patients. According to the Journal of the American Medical Association, hospitals that staff 1:8 nurse-to-patient ratios experience five additional deaths per 1,000 patients. The recommended nurse-to-patient ratio is 1:4. The odds of patient death increase by 7% every time a nurse takes on a new patient. If hospitals were to abide by these ratios, patients would have shorter hospital stays and a longer life expectancy. A study by Dr. Linda H Aiken, Ph.D., RN, FAAN, FRCN, has shown that there would be 4,370 fewer hospital deaths among medicare patients within two years in a New York State hospital if the hospital had implemented safe ratios. Why is it specifically the 1:4 ratio that is proven to be safe? The 1:4 ratio reduces nurse burnout. Maintaining the 1:4 ratio reduces the workload on nurses, allowing them to respond to patients faster when an emergency has occurred, increase the overall quality of care, improve patient outcomes, and improve compliance with regulations.

Overall, keeping the ratios between nurses to patients 1:4 has shown to be effective and increases overall patient care. However, there are some concerns about whether keeping these ratios at the minimum would close hospitals and be a good use of funds. The New York State Nurses Association reported that a hospital in California increased its income from 12.5 billion to 20.6 billion after implementing these regulations. Safe nurse staffing reduces turnover in hospitals. When ratios are overwhelming, this leads to unsafe practices and patient dissatisfaction, increasing the cost of care. Turnover rates are expensive, costing about $80,000-$82,000. Keeping these ratios at the minimum would not close hospitals and waste funds; it does the opposite and has proven to be more effective systematically.

Unsafe ratios in hospital staffing are an issue that health professionals have to deal with daily, especially with nurses. Keeping these ratios within 1:4 nurse to patient has been proven to be cost-effective and good for patient care and recovery. When these ratios are not maintained, chaos can ensue and affect the entire hospital system.

Hot Button: Dangers of Anti-Vaccination Movements

By: Zoe Du and Riya Ramani

A sniffle here, a cough there; it’s that time of year again. October might be spooky season, but it also marks the start of flu season. One of the best preventative measures, besides practicing good hand hygiene, is to receive an influenza vaccine every fall. However, the start of vaccination campaigns is frequently accompanied by the rise of anti-vaccine sentiment, which gives rise to dangerous public health threats.

History of Vaccines

Variolation, the intentional exposure of healthy individuals to smallpox to prevent illness, has been practiced since the 1400s, and similar practices have potentially been practiced as early as 200 BCE. The first successful vaccine was created in 1796 by Edward Jenner, who discovered that people infected with cowpox developed immunity to smallpox.

The technology has advanced significantly since, and vaccines have been developed against over 20 life-threatening diseases, including influenza, measles, and COVID-19. Smallpox has been entirely eradicated. Vaccines have saved more lives than any other medical invention in history, with estimates of 3.5-5 million deaths prevented each year.

Anti-vaccine movement

Anti-vaccine sentiment has existed as long as vaccines have. Much of the current vaccine aversion can be traced back to two things: a 1998 study by Andrew Wakefield and colleagues that claimed the MMR vaccine was correlated with the development of autism and the intense politicization of COVID-19.

The 1998 study was later deemed fraudulent and retracted. The principal author, Andrew Wakefield, has also lost his license to practice medicine. The supposed link between vaccines and autism is likely due to the coincidence that children receive many vaccines around the same time that autism is detected in children. Several studies have since shown that there is no apparent causal relationship between vaccines and autism, but misinformation and fear-mongering spread and fueled an anti-vaccine movement. Beyond the implication that a child with autism would somehow be inferior to a child without autism, the fear of vaccines causing autism is simply based on bad science.

More recently, the COVID-19 vaccine has sparked yet another wave of strong anti-vaccine sentiment. From the start, COVID-19 has erroneously been politicized in the United States, inhibiting our ability to stave off the pandemic. The COVID-19 vaccine has been no exception, with vocal backlash against vaccine mandates.

Herd Immunity and the Dangers of Anti-vaccine

Vaccination can be highly effective, but some individuals, such as those who are immunocompromised, cannot be vaccinated. To protect these vulnerable populations, we need herd immunity. For measles, a disease declared eliminated in the US in 2000, 95% of the population needs to be immunized to reach herd immunity. With growing anti-vaccine sentiment, our ability to achieve herd immunity is compromised, which has real consequences. In just the past couple of weeks, a measles case has been confirmed in Milwaukee, the county’s first case since 2011, and another in Illinois, the state’s first case since 2019.

So, as the autumn leaves fall and flu season emerges, the importance of vaccination becomes increasingly evident. The history of vaccines is a testament to their life-saving impact, eradicating diseases and preventing millions of deaths. However, the persistent specter of anti-vaccine sentiment poses a grave threat to public health. From debunked claims linking vaccines to autism to the politicization of the COVID-19 vaccine, misinformation has fueled a dangerous movement that jeopardizes the progress made by vaccines. It is imperative that we confront and dispel vaccine myths, ensuring that sound science prevails over fear and that the benefits of vaccination continue to safeguard our communities against preventable diseases.

Community Health Workers

By: Zoe Du

When I was younger, my dad began working as a nurse. Most of the time, my dad would be in the hospital providing bedside care, but a couple days a week, he would make home visits to patients. During these home visits, he would do checkups to monitor their health condition, ensure they were taking medications, and so on. I was too little at the time to fully understand the implications of this work, but I remember being struck by two things. First, my dad was able to get a look into the home life of patients and their living conditions, something that would typically be missed in a hospital visit. Second, my dad had a unique opportunity to build long-term relationships with patients that enhanced his ability to render medical care (he was even once asked if my family would like to adopt a kitten). I distinctly remember that several patients had limited fluency in English, and my dad, an immigrant himself, could converse with them comfortably in Mandarin.

In hindsight, I can now recognize that in this role, my dad functioned as a community health worker (CHW), defined by the American Public Health Association as “a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served.” While most of us probably think of hospitals and clinics when we think about the US healthcare system, CHWs occupy a unique space that deserves a spotlight, so here are seven ways CHWs enhance healthcare delivery.

Accompany patients to hospitals and clinics

Especially for rural and remote communities, it can be difficult to access health centers. CHWs can help patients make the trip and navigate the healthcare system.

Home visits

Like my dad, CHWs can make routine home visits to remind patients to take their medications, perform screenings, and more. Home visits can also reduce transportation barriers to accessing care.

Access medications

Medications can be costly, not only in their direct monetary cost but also in the time it takes to fill prescriptions, especially for those without easy access to pharmacies. CHWs can help deliver medications and help patients take medications correctly and on time.

Access social support

As the social determinants of health gain more attention in medicine, CHWs can be part of a solution to meaningfully addressing them. CHWs can connect patients to resources like food banks, insurance/coverage, and more.

Mental and emotional support

Addressing physical health is only half the battle. Poor health, and especially chronic conditions, can be isolating, stressful, and demoralizing for patients. CHWs can provide support to patients by regularly interacting with them and providing a listening ear.

Educate patients

CHWs can go door-to-door, offer free screenings, and organize health campaigns, such as during COVID-19, to educate the public about health conditions. As members of the community, CHWs can especially reach people whom the healthcare system might otherwise miss, and they can communicate information in a culturally relevant way.

Advocate for patients

It’s no secret that the healthcare system in the United States can be incredibly convoluted and confusing. CHWs can help patients navigate the health system and insurance and advocate for the patient along the way.

There are several roles that CHWs can play, but their ability to connect patients to healthcare and to understand patients as members of the community underscore their importance. Recently, CHWs played a crucial role in the COVID-19 response: they made over 400k referrals to health care and social services, supported 4800 vaccination events, and helped reach 9.2 million Americans with education. Unfortunately, CHW funding has historically been through short-term grants, and funding during COVID-19 was no different. With the CHW workforce facing funding cliffs and uncertainty, it is important that we support them. Currently, legislation is in the works to provide stable funding for the CHW workforce and increase access to CHW access. Please reach out if you are interested in learning how you can support these efforts!

The Importance of Preventative Healthcare

By: Sahaana Anand

In a society so focused on helping others and creating the most efficient ways to combat health-related issues, it is easy to get lost in the first step towards a healthier world- preventing those issues from happening in the first place. Of course, it is easier said than done, but nothing good ever came easy. Healthcare as a whole is focused on bettering the quality of life for every patient, so why not live that way as well? If education and the socio-economic state promoted it properly, preventative healthcare could solve so many diseases, disparities, and such. By definition, Preventative healthcare is an approach to healthcare that aims to prevent illness and promote overall well-being by taking proactive measures to minimize the risk of disease and injury. The fundamental idea behind preventative healthcare is to address health concerns before they become significant problems, to reduce the burden of illness, and to improve the quality of life for individuals and populations. The two primary approaches to preventative healthcare lie in education and the economy.

First, educating the youth and general population about the importance of a healthy lifestyle, disease prevention, and all the benefits that reap is the key to developing a healthier world. Education provides individuals with the knowledge, skills, and awareness necessary to make informed decisions about their health. It empowers people to recognize the value of preventive measures. Also, it contributes to reducing the overall burden of disease on society, leading to healthier communities and more sustainable healthcare systems. In essence, education is the key to fostering a society that prioritizes prevention as an integral part of its approach to healthcare.

Though education is a stepping stone to any given goal, it is not enough to accomplish a goal. Goals as big as that of preventative healthcare also have to be feasible, which is why a society and economy that supports this idea is important. With a government that does not make fast food cheap and healthy food expensive, most people cannot fundamentally lead a healthier lifestyle. Having policy changes and initiatives, as well as a more balanced distribution of wealth, will contribute to more affordable and easily accessible choices.

All of these approaches, combined with providing people of all ages with different forms of screenings and check-ups during their annual physicals, are the best combination to make sure everyone is as healthy as possible. Health literacy contributes to disease prevention and leads to a healthier world where public health is always a concern. It fosters a trend of health consciousness and encourages people to engage in health behaviors where everyone takes the initiative to care for themselves and others!