-
(单词翻译:双击或拖选)
Rebuilding Liberia Health Care 重建利比里亚卫生保健系统
As Liberia rebuilds a healthcare system severely1 damaged by the Ebola outbreak, researchers said the nation must provide better medical services in remote rural areas. A report examining barriers to health care has been published in the online Journal of Global Health.
Liberia was declared Ebola-free on May 9th. But several new cases of late show just how tenuous2 that label can be. The first new case since May 9th was a 17-year-old boy, who died the last weekend in June.
John Kraemer has studied how Liberia dealt with the epidemic3. He said that while health officials are acting4 quickly, the fact that new infections were found is heartbreaking.
“The last time I was in Liberia was in February. The cases were essentially5 gone. And there was this sort of palpable optimism everyplace. And so it's really disheartening to see these cases back. It does appear that the ministry6 and their partners are on top of things, which is at least optimistic. Certainly, the system is fragile. What these cases indicate is hard to know, but it’s concerning that the young man who died doesn’t appear to have been on anybody’s list of contacts.”
The Liberian teenager reportedly had been identified as having malaria7, not Ebola.
Kraemer is an associate professor of health systems administration at Georgetown University. He’s also a technical consultant8 to the organization Last Mile Health, which focuses on rural healthcare.
“Before Ebola, Liberia was coming out of the war, which ended in 2003, and health indicators9 were really turning around. And so the progress that you saw in things like under-five mortality or maternal10 health indicators was really impressive, given how little money there is in the system; given how few physicians of other health care providers were in the country. Ebola, to some extent, just decimated that system,” he said.
He said it’s too soon to tell what the long-term impact of the Ebola epidemic will be on Liberia’s healthcare system. But he said with the loss of many health workers to Ebola also came a loss of trust in the system.
Medical care is more available in urban areas than rural. So Kraemer and Last Mile Health looked at how the rural population copes.
“This is a population that’s as disadvantaged as any place on the planet. And so we really wanted to understand what particular barriers this population faces in order to be able to deliver services as well as possible,” he said.
Kraemer said the main finding of the research is not surprising.
“Of course, as you get farther away from health facilities, access to care declines. And it declines fairly drastically. So, for example, one that measure we use is what we call the full maternal health cascade11, which is at least four antenatal care visits, facility-based delivery and postnatal care for the mother and child. And when we look at this measure among people who live in the most distant parts, the most remote parts of this rural population, only about seven percent or so receive that full cascade.”
That’s 75 percent less for those remote rural populations compared to rural populations closer to urban areas. The distance between those two rural groups may be just 11 to 40 kilometers.
He said, “The same thing is true for childhood illnesses. If you looked at fever treatment, we saw about nine percent of kids in the most distant group getting care for fever, potential malaria, compared to 43 percent in the nearest, but still rural, group.”
But Kraemer said no matter what the distance, parents want their children to receive care for illnesses.
“If you sort of step back a level and you ask parents: when your child had fever – when your child had acute respiratory illness, potential pneumonia12 – did they receive care from anybody? Distance didn’t matter in the answer to that question. And that’s also, of course, not surprising, right? So parents want their kids to be treated and parents would seek care from somebody no matter where they were. But parents who lived in the most rural parts of this rural area would be much more likely to get their kids treated by a traditional provider, by these providers called black baggers, which are sort of roving medical dispensaries,” he said.
He said the quality of care could be much lower in such cases.
“You don’t know what the drugs are. You don’t know if the drugs are expired or ever had active ingredients. You don’t really have diagnostic capabilities13. And so the optimistic part of that, I think, is that it suggests that there is real demand for healthcare services that can be met if you can get services out to where people actually live.”
He said with today’s technology groups like Last Mile Health can provide diagnostic and treatment for malaria, acute respiratory infections and severe diarrhea and help with family planning, among other things.
The thing that’s really complicated, but is really, really important, is referral networks. A woman goes into labor14. She needs to figure out a way how to get transported to a facility to be able to deliver in that facility. In the U.S. that would be done by an ambulance or a friend would drive the person. Here, you have to become a lot more creative. So it’s thinking about engaging people who already drive from community to community because they’re delivering things. It’s amazing to me that this happens, but finding people who are motor biking small-level supplies, who can literally15 put a woman in delivery on the back of the motor bike. I’ve never been in labor, but I can’t imagine that’s much fun,” he said.
To improve medical care in remote rural areas of Liberia, Kraemer and his colleagues recommend” community health worker-based service delivery; partnership16 with traditional care providers; mobile clinics; providing transportation costs and reimbursing17 families for seeking health care.
Kraemer is also a Scholar with the O’Neill Institute for National and Global Health Law at Georgetown University. He says that “international human rights law and ethical18 norms oblige health ministries19 and their development partners to promote equal access to essential health services.”
收听单词发音 |
1
severely
|
|
| adv.严格地；严厉地；非常恶劣地 | |
参考例句： |
|
|
|
|
2
tenuous
|
|
| adj.细薄的，稀薄的，空洞的 | |
参考例句： |
|
|
|
|
3
epidemic
|
|
| n.流行病；盛行；adj.流行性的，流传极广的 | |
参考例句： |
|
|
|
|
4
acting
|
|
| n.演戏，行为，假装；adj.代理的，临时的，演出用的 | |
参考例句： |
|
|
|
|
5
essentially
|
|
| adv.本质上，实质上，基本上 | |
参考例句： |
|
|
|
|
6
ministry
|
|
| n.(政府的)部；牧师 | |
参考例句： |
|
|
|
|
7
malaria
|
|
| n.疟疾 | |
参考例句： |
|
|
|
|
8
consultant
|
|
| n.顾问；会诊医师，专科医生 | |
参考例句： |
|
|
|
|
9
indicators
|
|
| （仪器上显示温度、压力、耗油量等的）指针( indicator的名词复数 )； 指示物； （车辆上的）转弯指示灯； 指示信号 | |
参考例句： |
|
|
|
|
10
maternal
|
|
| adj.母亲的，母亲般的，母系的，母方的 | |
参考例句： |
|
|
|
|
11
cascade
|
|
| n.小瀑布，喷流；层叠；vi.成瀑布落下 | |
参考例句： |
|
|
|
|
12
pneumonia
|
|
| n.肺炎 | |
参考例句： |
|
|
|
|
13
capabilities
|
|
| n.能力( capability的名词复数 )；可能；容量；[复数]潜在能力 | |
参考例句： |
|
|
|
|
14
labor
|
|
| n.劳动，努力，工作，劳工；分娩；vi.劳动，努力，苦干；vt.详细分析；麻烦 | |
参考例句： |
|
|
|
|
15
literally
|
|
| adv.照字面意义，逐字地；确实 | |
参考例句： |
|
|
|
|
16
partnership
|
|
| n.合作关系，伙伴关系 | |
参考例句： |
|
|
|
|
17
reimbursing
|
|
| v.偿还，付还( reimburse的现在分词 ) | |
参考例句： |
|
|
|
|
18
ethical
|
|
| adj.伦理的，道德的，合乎道德的 | |
参考例句： |
|
|
|
|
19
ministries
|
|
| （政府的）部( ministry的名词复数 )； 神职； 牧师职位； 神职任期 | |
参考例句： |
|
|
|
购买
在百度中搜索