Taiwan tops the expat health care charts

Nearly seven in 10 expats in Taiwan say they spend less on health care than they used to before moving – compared with a global average of just three in 10.

The FCO [Foreign and Commonwealth Office] states in its guide to the country: “As is to be expected of a nation as developed as Taiwan, health care facilities and medical equipment are of outstanding quality. Since 1995, Taiwan has had a socialised health care plan, the National Health Insurance (NHI) which covers nearly all citizens.”

- The Telegraph

My thoughts: Of course the survey is biased, in particular a lot of selection bias. Its respondents are not randomized, so you don't get a good representation. Also, the more important question is do you get quality health care for your dollars spent, however much less you do have to spend? That was a major debate in the comments section... I wish I had more time to look into this more, but some anecdotal "evidence," I've heard from friends who've spent time in Taiwan that you do get decent healthcare in Taiwan. I don't think anyone can beat the technology and innovation of the U.S., but we already know that U.S. health care system is far from being a model one.

Also, this is another piece of real life evidence that a country can be non-socialist and still have a socialist health care finance structure and not combust into a complete socialist government. So surprising! (Not.)

Lessons Learned Circumnavigating the Globe

"This was the first time that I realized that my own country, where we lament bad health care and florid corruption, could be seen as privileged. No child here has to die from hydrocephalus. That day I realized that the people for whom I advocate are more than the people of South Africa, more even than the people of Africa. As I walked out of the orphanage, all I could think of was how to fix this – this country I had never before seen nor felt particularly drawn towards. In the global village, the disenfranchised of Vietnam – and of any other country – are our compatriots, too."

--Lessons Learned Circumnavigating the Globe

The most powerful thing you can do is to simply write about what you know.

Lessons in Global Health: What Every Student Should Know

• One of the first and most important lessons I learned was that earlier in your career, you will receive far more than you will be able to give.
• Nonetheless, they were still important because they taught me the complexity of navigating research design and protocol in other  countries, the uncertainty involved with international endeavors, and the persistence that differentiates those who remain in global health and those who come to visit for a short time.
• They [the patients] sacrificed, not necessarily because they believed it would make a difference in their lives, but rather because in poorer regions of the world, relationships and hospitality are valued sincerely.
• Another important insight I gained only by taking chances was that you are your only limitation.
• One last lesson I learned was that as a student in global health, your biggest contribution will be determined by the greatest need.

AMSRJ Spring 2014 Vol. 1, No. 1

On applying to elective opportunities like global health

I really found this inspiring. I love that she found motivation from her grandma. Go grandmas!

I’ll be honest- I didn’t think I had a smidgen of a chance of becoming a Global Health Corps fellow. I had two reactions upon reading the position descriptions and mission statement of GHC. 1) Unprecedented excitement. I knew this was the opportunity I had been looking for, the next step in my career and the chance to actually apply my college education and internship experience into the real world of public health – basically my dream. The combination of fieldwork and professional development, but with an emphasis on fostering a community of leaders dedicated to achieving global health equity, seemed almost too good to be true. This led to thought number 2) Self-doubt. Although on paper I felt qualified for the position I was interested in, and I definitely had the passion and commitment GHC was looking for, I lacked confidence in my ability to persuade the GHC and mothers2mothers teams that I could be the one. Intimidated is an understatement for how I felt while perusing the GHC website. I didn’t have a Masters degree, wasn’t a doctor treating thousands of people on my own, and hadn’t established an NGO at the age of 18. Was I good enough to be one of those smiling faces? Nah, definitely not. Yet, I couldn’t get GHC off my mind. I had to at least make an attempt.

I will admit that I am the Queen of procrastination. I couldn’t bring myself to actually sit down and complete the application. I had the essay topics written on napkins that I tacked over my bed, hoping that I’d get some inspiration in the middle of the night and magically produce acceptance worthy essays. Obviously that did not happen. A week before the application was due, I hadn’t written one word. At this point in time, I had just graduated from George Washington University with an undergraduate degree and was working and traveling around Indonesia. I had a scheduled Skype date with my parents, and as a special surprise, my 92 year-old Grandma joined as well. I excitedly told my family about the GHC application, but as quickly as I lit up about the job posting at mothers2mothers, I followed with a negative remark along the lines of  “I’ll never get it-there’s no point blah blah blah woe is me.” My Grandma abruptly shut me up, told me if I didn’t apply she’d disown me, and proceeded to detail all of the reasons why I would be an exceptional candidate. She wouldn’t sign off of Skype until I virtually pinky promised her that I’d apply no matter what. There was something compelling about my Grandma screaming into the computer because she thought being halfway across the world implied that I wouldn’t be able to hear her. Her point came across loud and clear. I signed off after taking an award winning screenshot (see below), went for a surf, and mulled over my options. I could a) not apply, lie to my Grandma, and feel guilty for the rest of my life (this is dramatic but entirely true), b) apply, not become a fellow, but know that I at least gave it a shot, or, c) apply, BECOME A FELLOW, and be one step closer towards pursuing my dreams.  A few interviews and one acceptance email later, I became one of the 90 chosen as part of the 2012-2013 GHC fellow class.

The world is copying me

Just kidding.

But still, I thought I was unique...

• Secretary Clinton's Remarks on Global Health Initiative: "The United States is investing $63 billion - first, to sustain and strengthen our existing health programs, and second, to build upon those programs and take their work to the next level by collaborating with governments, organizations, civil society groups, and individuals to help broaden the improvements in public health that we can expect. We're shifting our focus from solving problems, one at a time, to serving people, by considering more fully the circumstances of their lives and ensuring they can get the care they need most over the course of their lifetimes. ..." (Btw, this speech was actually at the Johns Hopkins SAIS in DC. Crazy. Hopkins represent!)
  
• And this dude...who started a public health education and training program for rural Haitian youth: "I'm striving to be more than just a physician. I want to be an advocate for human rights, a voice for those whose voice goes unheard and a face for the poorest of the poor. I don't imagine myself in a hospital or in a lab. I'm interested in political medicine, changing policy, the way medicine is practiced, the way it is distributed, and how it is defined."
  
• And this other Dr. Francis Collin dude too: "The aim of the [NIH/PEPFAR $130 million global health initiative], Collins told Nature in an interview in July, is 'to build research capacity in African institutions to enable them to begin to play a larger role in studying their own health needs, in providing solutions, because I think the era of the developed world swooping in, doing the research, saying 'here's what you should do' and leaving is not the era we want anymore.'"
• And this dude Nicholas D. Kristof, this chick Maggie Doyne, this dude Professor Peter Singer: "Many people want to connect to a cause larger than themselves, but they are busy and juggling priorities, have limited time and don't know quite what to do. There's a market failure there; so many people who would like to help, and so many people who would benefit from that help, but there's a shortage of channels to connect them...The challenge is to cultivate an ideology of altruism, to spread a culture of engagement - and then figure out what people can do at a practical level."

23-year old Maggie Doyne with her kids at the Kopila Valley Primary School, which she is the founder and principal of.

• And this mere commentator dude on Kristof's article: "I am sad to say that I am afraid you are correct, and Americans will turn back inwards. After 911, it was fear that motivated many, I believe. I think the only way to hope for us to really get it would be for us to learn the real links between our own prosperity and the poverty of so many worldwide..."
  

Poo. :(

Oh well, on the bright side, and the only side that matters, other people are already acting on good ideas and doing good. How awesome is that?

Grateful + frustration

Recently, reading about
        -- the health disparities around the world

Waiting room at a clinic. Cholera epidemic in Haiti because of a lack of clean water system.

        -- the harsh reality of this:

Living as a girl in Kibera, the largest slum in Nairobi, Kenya.

This makes me so grateful for the upbringing I had. And then I think about America's long standing problem with

Obesity.

If I end up being involved with global health as I plan to, I'm wary of the frustration that I might feel with patients who can't keep their weight down. I know it's a complicated issue. Obesity is a result of genetics, the environment, our culture, exercise, etc. etc. I know that every patient has suffered and deserves at the very least a doctor's respect, but on the inside, I fear I will be looking down on them. I will think, there are people fighting for their lives, living in disgrace, and here, you can't find the willpower to keep your weight down.

Every person is a human being.
Yet, I'm a little torn.

Does this make me a terrible person?
How do I deal with this?


Photo credits: Haiti & cholera, Michael Appleton for The New York Times; Shining Hope for Communities