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Question Answered step-by-step Review the Unnatural Causes video transcript  Episode 6 - "Collateral Damage  1. Identify the Social Determinants of Health that were illustrated in this video transcript.   (Transcript)Yeah in the middle of the Pacific Ocean there's a small country made up of a chain of islands with white sand beaches and an aqua green lagoon The marshals people have made their home here for many centuries. But in the last 60 years something has gone terribly wrong in the Marshall Islands. Today the tuberculosis rate here is 23 times that of the United States. Other infectious diseases also gone rampant. There are many reasons why the health of the Marshall these people is compromised their long relationship with the United States maybe 11 of the islands e by a mile long and an eighth of a mile wide. But it's home to about 10 thousand people making it more densely populated than Manhattan This crowded environment is ideal for the spread of infectious diseases like tuberculosis. You cannot build anything anymore and you buy this crowded. So if somebody in their family as TV of course eventually is going to spread to everybody in the house in a short period of time. If somebody diagnosed with TV I said will go out to their neighbors and even to the same household and start giving them medication right away. From this side all the way to the other side this is where TV never goes away. What is the reason I guess is because the houses Are very close together. And so many people in one house and be like 20 or more than 20 individuals each ours. Like everywhere else in the world the frontline soldiers in the fight against TB are public health outreach workers like Wiener James and Molly may. Every day they drive the streets a B by tracking their patients to make sure they're taking their TB medications they don't have money to come to the hospitals that we have to make sure they drink the medicine. So that's why we have we go to those who cannot come The marshals are hardly alone in suffering high rates of TB. It's a disease that shows up wherever people are poor. Public health experts estimate that 1 third of the Earth's population about 2 billion people carry the bacterium that causes TB. But most of those people will never become sick. Their immune systems will keep the disease in check. However about 9 million people each year do become sick with this potentially deadly lung ailments. Often because they live in conditions of poverty that compromise their immune systems and undermine their body's ability to fight it off. And because it's airborne TB can spread rapidly among people who live in crowded urban environments. What tuberculosis needs to flourish in a person's body is a broken down immune system suggests the stress itself of poverty can contribute to the likelihood of developing active tuberculosis. And malnutrition we know that people living in poverty a malnourished. And there's nothing like malnourishment to decrease the immune response enough to let tuberculosis flourish. One facing here And the door opens to the outer door and we just treated the other one on this side. And then now we're coming to the site. She was starting to lose weight and chest pain and SLP shortness of breath. And she doesn't feel well shapefiles we call the time. So she was actually admitted into hospital and they refer to To us to successfully cure tuberculosis requires completing a full course of treatment on schedule up to four different drugs a day every day for six months. If patients fail to complete their drug regimen the disease can come back in a drug resistant form far more dangerous. My she's she said she's doing. She that some TV Once swelling stomach. For the marshal these were once known as the master navigators of the Pacific. They created stick charts their own unique navigational aids to plot their way through almost a million square miles of ocean. For centuries the marshals lived like other Indigenous peoples in the Pacific. The traditional diet as bread fruit was terrible not out naturally grown crops. It was a lot of Fisher was bananas in fruit cup and just were loaded with natural vitamins and minerals that over thousands of years. That's what these people subsisted on Today much of that cultural legacy is lost to centuries of colonization by other countries. But when the United States took the Marshall Islands from the Japanese in 1944. It triggered changes. No one could have foreseen. The islands remained under US control until the late 19 seventies. When the Republic of the Marshall Islands became an independent nation. But the US military has never left one island quadRule and home of the Ronald Reagan ballistic missile base. A facility the US considers vital to its national security. This is where the controversial Star Wars anti-missile program carries out its testing about 1700 mostly American defense contractors and their families live on potentially in a suburban environment. With a golf course a country club a small department store and access to state-of-the-art healthcare. More than 1100 marshals people work on quadrant. The Army Base is one of the few large employers in the nation. But only a few Marshall these contractors are allowed to live on quadRule and each day the marshals employees take a ferry home to the neighboring island of E by a divide that takes only 30 minutes to cross. But one that separates two worlds of wealth and health. Julie Crocker is an American anthropologist who lived in the Marshall Islands for three years. On that ferry going felt quadrupling the base to e by Island I just can't believe it. Sometimes. This relationship is so powerfully unequal. Though E by is just three miles from the US military base on quadrupling. The contrast between the two islands is an everyday reminder of how inequities in wealth affect people's health. The health of Americans living on quadrant is similar to what you'd expect for a middle-class American neighborhood. While on the other Marshall Islands the indicators are very different. On average Americans live to 77.5 years old. In the Marshall Islands longevity is 62. Infant mortality in the US is seven deaths per 1000. In the Marshall Islands it's 52 deaths per thousand. In the US 7% of the population has diabetes. In the Marshall Islands it's about 30%. And the rate of tuberculosis in the Marshall Islands is 23 times that of the US. They have probably the worst of both worlds. They have Lot of developing country illnesses all the infectious diseases you'd find in Africa and places in Asia in India. Dr. Neil Fox is a family practitioner who researchers health issues that affect the islanders. Then they have the illnesses that interface with westernizing countries heart disease for instance is the number one cause of death. A lot of high blood pressure strokes and then in-between to have malnutrition to they have a spectrum of illness which represents both. While this makes it a very difficult situation. For most of E buys 10 thousand residents The chores of daily life or made difficult by a neglected infrastructure that can't handle the overcrowding. E bys plagued by power outages and water shortages. May delegate power it delegates. Problem we get another luck. Attic jello jello me on. My you know made for we divvy out a mid-year. And while we know a melee does a languorous has lived on E by four over 30 years. The water shortages mean DSA and other residents often can't do their laundry on eBay. Instead they take a water taxi or ferry to the American base quadrupling where they can do laundry as long as they have a special permit and can pay the price. You wait effect in quite a bit of magnesium provided me the violin. One email. Carry three bet. Cheeto banner lambda-d. Following a lab three wanting to. Wow. You know we get Mt For the people of the Marshall Islands like DZ there's another fact of life besides poverty that has profoundly affected their health. Between 1946195867 nuclear devices were detonated on and around the northern most Marshall Islands. Measured in tons of TNT. It was the most extensive nuclear weapons testing ever carried out by the United States. The yield of those tests has been estimated at 1.7 Hiroshima shots. Every day every day for 12 years. The largest explosion took place March first 1954 codenamed Bravo. It was a 50 megaton hydrogen bomb equivalent to one hundred ten hundred Hiroshima is. A miscalculation caused the radioactive fallout to drift onto two inhabited at hose. More than 200 men women and children were on those tones Among them was D's a languorous a four-year-old growing up on MongoLab. Way. We're now though validating mean pick an allele can young people at the time were saying middle or they thought the powder that was falling from heaven not to rolling out already. We have in mind when he then within me and they rub their faces hands and legs with the touring me. And that's how they got skin burns from the farmer. Getting at any vowel the limp book with that do what God and they were treated and then tracked to study the effects of nuclear fallout on human beings. Among them was these A's father. Father. These are photos of her father. Dsa has never seen before. Like you've been treated for burns around is here. To make way for the testing US military authorities moved hundreds of Marshall's people off their home islands and resettled them on different islands. These dislocations triggered a chain of events that tore apart Marshall's culture. And that continues to undermine their health. When you move people off their islands where they lived to the testing. You break down your entire community structure Impact on health distress issues. You contaminate their lands they can grow things that you see to get more diabetic because they're eating Western diet. They weren't urbanized but when you urbanize infectious diseases tend to take on because tuberculous transmitted person to person very close very crowded. The changes on E By began in 1951. When US military authorities resettled about 600 people from quadRule into e by Make way for the military base in the decades since thousands more marshals have settled here. Hoping to get a job at the military installation. Now almost 1 fifth of the nation's population lives on eBay. And the small island can't absorb them. In one part of E by residents don't even have indoor toilets. Only Lian advocate engine Madison grew up on ebay before it became so crowded Guinea and she's now a senator in the Marshall Islands parliament Right here is the public toilets and these individual units are assigned to individual families. Top of the toilets there they're open. So even at nighttime they have to use a toilet that they used in the dark. There's no sink to wash their hands so everybody is responsible to leave their toilet and their houses to wash their hands There are many reasons for the slums on E by most agree that a leading factor is the law of jobs at the US base on quadrupling. The health problems that one would witness on an E by coagulant are a result of the military base being there. And a political decision to accommodate the military base being there. Because military bases attract people who seek jobs. And as long as the people who are attracted to the military base cannot be accommodated A better situation you guys will have the social problems of E by providing more doctors or nurses or revise diagnosable problem there has to be a political decision weight. There's always been questions of corruption at this level that level misspent monies. And certainly there's even been talk about the US government and the auditor general's report that the US government didn't do its homework and monitoring monies Poverty creates a dynamic in individuals where they feel they don't control their lives or any things that occur in their lives. You don't feel that you have the ability to move or you have to move. If you feel that the environment controls you as opposed to you being able to control your destiny. And I think that's what's happened a lot in Dubai in other places in the Pacific where there has been this level of poverty that's been introduced because of dynamics that have occurred So in a place like E by where poverty is so deeply entrenched. How do you eradicate tuberculosis one thing is certain. It will take more than drugs. It will take an improvement in living conditions alleviating crowding. So one infected person doesn't infect others improving nutrition. So people's immune systems have the strength to fight off the disease. We know this by looking at the history of tuberculosis in the United States in the early 19 hundreds tuberculosis was a leading killer in America is crowded urban slums. There was no drug treatment available and there wouldn't be for many decades to come. Tb victims often suffered a painful death removed from their families to avoid spreading the disease. But then something unexpected happened. Tb death rates in American cities began to decline. Between 191940 the TB death rate dropped 76%. Even though drugs to treat the disease had not yet been invented. What made the difference aggressive public health policies made sure infected people were removed and isolated. So they couldn't spread the disease. Equally important social reforms brought better housing better nutrition. The abolition of child labor and a general improvement in the quality of living with the advent of antibiotics in 1944 the death rate declined even further. Both of those things are important for tuberculosis improve the overall living conditions and nutritional status And as soon as someone gets sick with tuberculosis treat them in a way. It's like a theory shameful thing. Once you get TB they they don't want people to know they don't want to come to the hospital. It's gradually going down but I think it's it's not going to go away like all of a sudden switching to the social and political reforms have been slow to come to the Marshall Islands. All command. For many Marshall's there's another option. Spring Dale Arkansas near the Oklahoma border An estimated 10 thousand Marshall Islanders have migrated here. Ever since one marshal these men arrived in the 19 eighties and got a job at Tyson's Foods. The marshals can live and work in the US freely without a visa under the terms of our special treated. Jobs are plentiful in the food processing plants. And the cost of living in spring Dale is relatively low. Life in Arkansas is much easier how fear or my kids can get a better looking forward. Good Life in the futures. But even though the marshals here can the impoverished conditions of their homeland behind and they can't leave behind the effects of having lived in poverty. Not surprisingly the rates of TB and other infectious diseases among the Marshall 0s in the US are far above the national average. So in Spring Dale As an E by public health workers drive the streets to make sure their patients maintain with a rigorous medication schedule Required to cure TB papers public health nurse Sandy Heyne line believes the high disease rate results from the pressures of making a new life in an unfamiliar place. I think this is where Kevin worked and it's stressful moving here they're coming from and a nice tropical climate they get here and they have to deal with work schedules with traffic. The cold is a serious issue for them. They just are not used to dealing with cold weather at all. And most of them work in the poultry plants where it's wet and cold at all times. And after about two years of being constantly stressed they break down into Tuberculosis or other diseases. For 60 years the Marshall he's had been living with the effects of massive dislocation and cultural disruption. Largely a result of helping us maintain a strategic military presence in the Pacific. The marshals people have paid a high price for that relationship in their economic well-being and their legacy of illness. Now there's a growing awareness that just as the marshals people didn't create these problems they won't be able to solve them without help I often tell my students that 50 years from now we will be judged on the basis of what we do for the poorest and most marginalized people on the planet. Today. We have more than enough resources to provide treatment prevention and to transform the economic and social conditions that give rise to the diseases of poverty like tuberculosis that are so prevalent today No no major funding for unnatural causes. It has been made possible by the Ford Foundation. The John D And Catherine T Macarthur Foundation. The California Endowment WK Kellogg Foundation. The Nathan Cummings Foundation Joint Center for political and economic studies. And Kaiser Permanente Additional funding provided by these funders. This program was also made possible by the Corporation for Public Broadcasting     Health Science Science Nursing NURS 474 Share QuestionEmailCopy link Comments (0)
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Question Include a brief snapshot of the patient history / case study. Do Not copy information directlyfrom the article. Highlight a few important facts that you noted in the case study.PlanCauses of Stress (Module 1)Determine the most likely causes of stress for this patient, and explain what symptoms lead youto believe she is experiencing stress.Short-term Alternative Therapies (Module 2)What relaxation and alternative therapies may be useful to promote stress reduction?Consider the patient's age, career, and mental status.Questions to Ask (Module 3)List question you would ask this patient to assess her current situation in a non-judgmental andtherapeutic way.Are there any safety issues, irrational thought processes, or personality traits evident from thecase study that you would be concerned about?Long Term Plan (Module 4)What long-term coping interventions would you suggest for this patient based on the assessmentyou made in the previous sections of this paper?Support Networks (Module 5)What support networks do you think would be best to suggest to this patient and why?ConclusionProvide a brief summary of how you would follow up on this patient to determine if theinterventions were successful. What would you expect to find in a reduction of stress? Health Science Science Nursing NURSING NSG294 Share QuestionEmailCopy link Comments (0)