Health Group Discussion Notes

Develop list of items to work on (Categorizer)

Family planning

1. The most effective method for reducing carbon dioxide emmisions is family planning.
2. Very important to environmental and human health.
3. Fighting cultural barriers, survival odds
4. Mechai: Mr. Condom, Thailand. Highly effective. Cabbages and Condoms.
5. What FP opinion in Islam? Koran says only if the mother's life is at stake. Nurse/MW/Doc How many now?, how educate? How feed?, Pill available for 30 years. Herb-based abortion. If unmarried, both can be killed. Malcom Potts of UC-B PH is in Afghanistan now.
6. Rape needs to be escalated as a major cultural crime. Not a cause for blame or ostracism.
7. Contraception to those who really need it.
8. Children are energy. Use those terms. Energy in the broad sense. Fuel.

Cultural Infrastructure

1. Network of relationships.
2. Cultural: real issue is to find the infrastructure in a community and use that instead of bringing in an infrastructure. Identifying the cultural infrastructure.
3. Question: How to work with cultural practices that may be internal to the culture but we find detrimental in many other senses, i.e. communication, implementation of systems. Some people within that culture may agree with certain practices, others don't -- is it our place to tell them what's right and wrong. If we don't get rid of specifically destructive practices then how do we really bring in healthful practices?
4. There are mechanisms for training locals within the camps to fold into working in the clinics. Take advantage of what's in the camps.
5. Is it valuable to have the people who have been part of the culture to be the ones to pass along the message to new refugees.
6. How do we encourage the network of relationships? Within the subunit of the camp provide something, i.e., a central tent, that is a center of the community.
7. Re-establish place, create ownership.
8. Another health issue: how people establish identity of place and how that affects mental health.
9. A well-planned (culturally appropriate) Village is more often a safe community.
10. Tension between decentralized and heirarchical systems, insiders and outsiders.
11. Developing symbols and myths to facilitate positive change.
12. Humility and adaptation should be our watchwords.
13. Community-organization skills
14. Sister communities with expats for support and direction.
15. Look at example communities and borrow what seems right: Curitiba, Campenas, Gaviotas, others

Female Education

1. Identity
2. Empowerment, particularly that she is protected by the rule of international law. Not Sharia, but the Declaration of Human Rights
3. There's a distinct relationship between literacy and birth rate.
4. Self-Defense training
5. Conflict-resolution skills

Camp Health Care Delivery

1. Sanitation
2. Mycelia
3. Monitoring, surveilliance
4. Mental health + disabilities.
5. Eyeglasses, dentures, nutritional input.
6. Immunizations
7. Oral Rehydration Solution
8. Acute Respiratory Infection
9. Micronutrients
10. TB
11. Malaria
12. STDs, including HIV
13. Clean water
14. Fun is a critical component of any re-development, and is DRAMATICALLY missing in any camp we've ever heard of.
15. Mushrooms 7Basic study in Asia, supplement in food boxwith spirulina and 7Basic or immunomodulation.

Repatriation Health Care Delivery

1. Look at systems of healing that already exist in nature.
2. Making of the place an Eden
3. Bioneers: "Solutions from the Heart of Nature"
4. Precautionary Principle: First do no harm
5. Medicine: IndoEuropean root: to take appropriate measures
6. Highest number of land mine injuries are in Afghanistan-need to look at issue of handicapped people and how to care for them.
7. A million and a half handicapped children.
8. Paul Stamets has more hard science on the nutritional value and yield of mushrooms than anyone.
9. There is a difference between concentration of a substance and mass loading. Remember that sometimes a concentration of substance can over time have a mass loading that can have a dramatic effect.
10. If we're going to build sustainable systems, make sure we keep track of the whole picture; e.g. PVC pipe toxicants can lead to long term detriment
11. Need to remember the health of the workers at the camps -- it has to be an entirely different level of care. Ratio of workers to number of refugees is maybe 10 workers for 10,000 refugees.
12. How to create support for the workers in a situation like this. Use all available resources (not just medical), triage and community (drop 50% in alcohol and depression).
13. Care for disabilities. Quite a bit of that exists in camps. These people become pariahs, rejects of the community.
14. Look at possibility, from a health standpoint, look at "tweaking" more of the health issues with disabilities and restoring dignity to individuals and promoting that within the community.
15. Goal of "health" is resilient and dynamic homeostasis
16. Bioremediation from a health perspective
17. Medicinal plant farms as a part of the village
18. Effective non-medicinal therapy is available.

Public Policy

1. Experience with domestic Public Housing and Indian Reservations.
2. Health degradation/improvement due to capital-driven enterprise -- advertising.
3. Modular housing
4. Participation by refugees in all aspects of their life
5. Policy development integrates all stakeholders.
6. All categories (food, water...) affect health more than interventions..
7. Health degradation as a result of capital driven incursions. Another bucket?
8. Emergency medical issues: at what point do you switch to the long-term health issues.
9. Use our experience with reservations and public housing in US to see how emergency care over time becomes long-term and pathological problems. Use this experience to work with refugee camps.
10. What can we think about in terms of refugee camps that won't turn them into the Public Housing and Indian Reservation pathology factories.
11. The adversity of third-party coming in "showing up putting on a band-aid and then leaving." Identify the cultural issues and design something so that it is sustained by the people themselves. Have the sustainable development be accepted and be to scale that allows for acceptance within the community itself.
12. Caring for host-nation population near the camp?
13. Curitiba, Campinas -- examples.
14. Healthy Cities model
15. Need to be regular monitoring systems in place, i.e., monitor water, etc.
16. Need signals on malnutrition, on children, etc. so doctor serves as triage point for all these other services. Health is the overarching mechanism to see that everything else is working.
17. If we use health as an idicator is that data gathered well or too late to make a difference? Also, how do we gather that data? There will be index data, but how do you do "health surveillance"?
18. Make use of a "smart" machine to do the boring part of collecting data -- accummulation, coallation, and assessment is valuable within health.
19. Enforcement and incentive to encourage co-operation

Mental Health

1. Support and assist the development of environmental aesthetics and personal identity
2. Post traumatic stress, depression,apathy and boredom.
3. In Peace Corps, meet with worker every month, make sure to send 4 or 5 people together, supervisor visited with them once a week or so to say "we're here," and that changed the drop out rate significantly.
4. Staff and Refugees need methods for optimizing ambiguity
5. Conflict-resolution skills
6. I've never seen an adult refugee in a camp laugh. May happen, but must be rare.
Projects
1. 7-Basic Mushrooms immunomodulation supplementation with the Seed Box introducing and expanding on the message after prayers. Medicinal plant farms, including FP herbs on the seed box.
2. Community X, religious leader, find religious arguments that bolster family planning and build a specific curriculum. Use tapes of well-known Mullahs and musicians and poets.
3. PTSD mental health management with local health leaders trained by Bhopal-experienced local managers.
4. Use indirect methods apealing to them to deliver messages: entertainment, audio tapes, poetry. Music is one of the major communicators in the world.
5. Rumi has a lot of mental health advice.
6. Domestic trials of all of this by biome.
7. "advertising" and marketing will be key. Use games. Develop games, the backs of playing cards and chess boards, mancala, etc. What are the cultural colors.

Project Template (Group Outliner)

1. Area 1

1.1 Purpose of project
Stress management, particularly for mental health {#88}
1.2 Description
PTSD mental health management using local Health Leaders from the community trained by Bhopal-experienced (disaster-experienced) providers in the Sambhavna program, including a meeting space for peer support. {#85}
1.3 In which of the three "stages of encampment" will this project take place: From UNHCR Manual - Emergency, Care & maintenance, Durable solution
CM and DS {#89}
1.4 How will this idea be integrated into life in the camp(s)?
Inside-up, through the Sambhavna model, incorporating a space in early site development, perhaps incorporated into prayer times {#90}
1.5 How does this idea relate to other project ideas?
Restoration of our largest asset, improving the capacity of the community. Mitigating a disease that is as debilitating as tuberculosis. {#91}
1.6 Who knows how to develop and implement this project?
Sattyu, director of the Free Clinic in Bhopal, as well as the VA-equivalents globally. {#92}
1.7 Is this project applicable to displaced populations in other climates and cultures?
Y {#93}
1.8 What organizations must be involved, in order for this project to succeed?
UNHCR, UNICEF, Afghan-specific NGOs {#94}
1.9 When can this project be ready for use?
Six months. {#95}
1.10 Rough cost in people and materials:
Inexpensive. People-driven, within the community. Methods already tested, and ready for adaptation. {#96}
1.11 Sources of support-who can provide: Advice, Technical assistance, money or in-kind contributions?
As above. {#97}
1.12 Next steps: Who will do what next, and by when.
Peter Warshall will contact Sattyu (Eric backstop) {#98}
1.13 Time required for project experiment (or first application).
1.14 How and by whom will first implementers be trained?
1.15 Method for educating teachers whom will propagate this project in other circumstances?
1.16 By what measures will we know it works and is replicable?
1.17 Barriers to implementation: financial, technical, legal, political, cultural, institutional, geographic, ethical, medical, and philosophical.
1.18 How to overcome barriers?
1.19 List activities that must take place for this project to succeed. Include who will or should do each.
1.20 Successes with similar projects.
1.21 Sources of reference material for this idea

2. Area 2

7-Basic Mushrooms immunomodulation supplementation with the Seed Box introducing and expanding on the message after prayers. Medicinal plant farms, including FP herbs on the seed box.
Purpose is to improve immune system {#73}
2.1 Purpose of project
Immunomodulation through nutritional supplements {#86}
2.2 Description
7-Basic Mushrooms immunomodulation supplementation with the Seed Box introducing and expanding on the message after prayers. Medicinal plant farms, including FP herbs on the seed box. {#72}
The mushroom spores can be delivered or freeze dried mycelium
(Spores are hardier)
At the camp the refugees can air dry the mushrooms--this just preserves it
Cells need to be tenderized by heat, acid or enzymes (the quickest way is to make into soup our tea). {#82}
2.3 In which of the three "stages of encampment" will this project take place: From UNHCR Manual - Emergency, Care & maintenance, Durable solution
Care & maintenance and durable solution {#71}
2.4 How will this idea be integrated into life in the camp(s)?
Integrate into culturally appropriate farming techniques and food products--it may be appropriate to take a pill, or putting the nutrients into some other food may be better {#70}
2.5 How does this idea relate to other project ideas?
Incorporated into Seed Box {#102}
2.6 Who knows how to develop and implement this project?
Information from Paul Stamets
Money from James Dow, who has $1 billion to fund preventative medicine {#74}
2.7 Is this project applicable to displaced populations in other climates and cultures?
Absolutely {#75}
2.8 What organizations must be involved, in order for this project to succeed?
World Food Program Implementing Partner;
Indigenous Afghan NGOs, or whichever NGOs are appropriate for the specific culture {#76}
2.9 When can this project be ready for use?
According to Paul, the technology for mushroom encapsulation is ready so it is a matter of getting the policy into place and the development of the Seed Box and the cultural intel for effective delivery and acceptance. {#77}
2.10 Rough cost in people and materials:
Paul claims it is relatively inexpensive. It will be even cheaper when the population is growing the mushrooms themselves {#78}
2.11 Sources of support-who can provide: Advice, Technical assistance, money or in-kind contributions?
Paul--technical
James Dow--money
Local NGOs--support and cultural information on how best to introduce
UNICEF, UNDP
International NGOs
Corporate support? {#79}
2.12 Next steps: Who will do what next, and by when.
The company that is going to create the Box that has the seeds & map will also add the 7-mushroom "starter"
Involve universities--get them to do hands on real life projects (like Engineers without borders & Docs w/out Borders) {#80}
2.13 Time required for project experiment (or first application).
2.14 How and by whom will first implementers be trained?
2.15 Method for educating teachers whom will propagate this project in other circumstances?
2.16 By what measures will we know it works and is replicable?
2.17 Barriers to implementation: financial, technical, legal, political, cultural, institutional, geographic, ethical, medical, and philosophical.
People are afraid of mushrooms--you may find prejudices (what are we doing in the "psychadelic business.") You'll need education to address this. {#81}
2.18 How to overcome barriers?
2.19 List activities that must take place for this project to succeed. Include who will or should do each.
2.20 Successes with similar projects.
2.21 Sources of reference material for this idea
www.fungi.com {#83}

3. Area 3

3.1 Purpose of project
Family Planning {#87}
3.2 Description
Community X, religious leader, find religious arguments that bolster family planning and build a specific curriculum. Use tapes of well-known Mullahs and musicians and poets. {#84}
Female literacy is #1 reason for dropping birth rates
It will also be major factor in environmental sustainability
Educating women will improve family health, reduce child mortality rates
Increase family health at low cost (In the 5 countries that achieved longevity at low cost, they
had political commitment, female literacy, nutrition & equity health care) {#101}
3.3 In which of the three "stages of encampment" will this project take place: From UNHCR Manual - Emergency, Care & maintenance, Durable solution
CM&DS {#100}
3.4 How will this idea be integrated into life in the camp(s)?
Build on "Save the Children" Foundation efforts up to a Policy level. Coordinate with local cultural intelligence to avoid fatal mistakes. {#103}
3.5 How does this idea relate to other project ideas?
Probably the single best intervention for both the population and the environment. {#104}
3.6 Who knows how to develop and implement this project?
UNFPA, Save the Children, UNDP, OCHA, UNHCR, the Afghan Mullahs, Karzai, the King, {#105}
3.7 Is this project applicable to displaced populations in other climates and cultures?
Y {#106}
3.8 What organizations must be involved, in order for this project to succeed?
See above. {#107}
3.9 When can this project be ready for use?
Six months. {#108}
3.10 Rough cost in people and materials:
Moderate technical cost, moderate replenishment cost, significant political cost. {#109}
3.11 Sources of support-who can provide: Advice, Technical assistance, money or in-kind contributions?
3.12 Next steps: Who will do what next, and by when.
3.13 Time required for project experiment (or first application).
3.14 How and by whom will first implementers be trained?
3.15 Method for educating teachers whom will propagate this project in other circumstances?
3.16 By what measures will we know it works and is replicable?
3.17 Barriers to implementation: financial, technical, legal, political, cultural, institutional, geographic, ethical, medical, and philosophical.
Huge impediments. US policy impedes directly. Muslim culture, poverty and wealth indicators. {#110}
3.18 How to overcome barriers?
3.19 List activities that must take place for this project to succeed. Include who will or should do each.
3.20 Successes with similar projects.
3.21 Sources of reference material for this idea