Western Health Research Articles

Breaking the general practice-hospital divide: Engaging primary care practitioners in multidisciplinary cancer care.

To integrate primary care into multidisciplinary cancer meetings and improve communication between hospital- and community-based care providers. A 12-week pilot study was conducted at Western Health, implementing a model of care, where two general practitioners (GPs) were recruited from the local community to attend weekly breast and lung multidisciplinary meetings in a liaison role as a primary care representative (PCR). Community GPs and hospital specialists were surveyed at the end of the study to assess the impact of this model of care. All stakeholders agreed that two-way communication between hospital- and community-based care was improved. The role of the PCR enabled better engagement of GPs in cancer care, allowing them to manage their patients with more confidence. Patient information contributed by GPs provided a wider context for hospital specialist treatment planning and decision making. This project has demonstrated an effective model to integrate primary care practitioners in multidisciplinary cancer care, as it enables timely and relevant two-way communication between the community and hospital care.

Cardiac Arrest in the Cardiac Catheterization Laboratory: Initial Experience With the Role of Simulation Setup and Training.

With rising complexity of percutaneous coronary interventions being performed, the incidence of cardiac arrest in the cardiac catheterization laboratory (CCL) is likely to increase. The authors undertook a series of multidisciplinary simulation sessions to identify practice deficiencies and propose solutions to improve patient care. Five simulation sessions were held at Western Health CCL to simulate different cardiac arrest scenarios. Participants included cardiologists, intensivists, anesthetists, nurses, and technicians. Post-simulation feedback was analyzed qualitatively. Challenges encountered were grouped into 4 areas: (1) communication and teamwork, (2) equipment, (3) vascular access and drugs, and (4) physical environment and radiation exposure. Proposed solutions included regular simulation training; increasing familiarity with the physical environment, utilization of specialized equipment; and formation of 2 team leaders to improve efficiency. Cardiac arrest in the CCL is a unique clinical event that necessitates specific training to improve technical and nontechnical skills with potential to improve clinical outcomes.

Factors related to the adoption of the Brazilian National Immunization Program Information System

BackgroundOne way to optimize the adoption and use of technological innovations is to understand how those involved perceive, assess and decide to use them. This study aims to analyze the attributes that influence the adoption and use of the Brazilian National Immunization Program Information System (NIPIS) from the perspective of vaccination room workers.MethodsThis is a mixed method research, and a quantitative cross-sectional analytical study, with concomitant triangulation of data, carried out in a region of Brazil by using the Diffusion of Innovation Theory. We used a questionnaire with 183 nursing professionals who work at vaccination rooms in 12 municipalities. To test the research model, partial least squares structural equation modeling (PLS-SEM) and SmartPLS 2.3.0 have been applied to estimate the model. The qualitative research had a descriptive-exploratory character, using interviews (n = 18) analyzed through thematic analysis.ResultsThe model proposed showed a mean correlation between the perceived attributes in the adoption and use of NIPIS. The results of the multiple regression indicated that the attributes “relative advantage” and “image” have a significant effect at 5% level (T > 1.97), positively influence the adoption and use of NIPIS; the attribute “voluntary use” negatively influences the adoption and use of the system; the attributes “experimentation”, “compatibility”, “profitability”, and “ease of use” did not influence the adoption and use of NIPIS. Emphasis has been placed on aspects that weaken the adoption and use of NIPIS such as lack of good quality internet and resistance to use the technology by some professionals. Workers perceive the importance of NIPIS for the municipality and point out that technological innovation provides data at an individual level, inserted in real time, which makes it possible to assess vaccination coverage. Lack of an unstable internet compromises data release due to system slowness.ConclusionsThe mixed method allowed an in-depth analysis of the adoption and use of NIPIS in the Western Health Macroregion of Minas Gerais State, and similarities were observed in the results. The attribute “relative advantage” is the one that most influences the adoption and use of NIPIS, which is the strongest predictor of innovation adoption rate.

Kia whakatōmuri te haere whakamua: engaging Māori rural communities in health and social service care

Research on collaboration between health and social service organisations and professions often views collaboration from the narrow perspective of being between practitioners from different professions at a set point in time. This is often also focused on issues of efficacy and does not address the role of identity, values, and practices, or “culture” within collaboration, an important aspect when engaging with indigenous populations. This study presents a Kaupapa Māori qualitative case study in a small rural community, which highlights how western culture has permeated within and across a health care system. Recommendations are made to guide Crown and other western health and social service organisations and practitioners in first understanding the ongoing history of people and place, and its impact on health and social practice, and how to engage with Māori in a way that affirms, enables, and where requested supports a for Māori by Māori approach to wellbeing.

Secular trends in disease modifying treatment and expenditure in multiple sclerosis: A longitudinal population study in the north of Ireland

BackgroundThe epidemiology of multiple sclerosis (MS) is important for planning disease modifying therapy (DMT). Secular changes in the use of DMT in MS can guide future service development. MethodsA population study of the prevalence of multiple sclerosis was completed in the west of Northern Ireland – a defined geographic area making up the Western Health and Social Care Trust (WHSCT). The use, category and cost of DMT for the MS population in the WHSCT were measured over 11 years. ResultsThe WHSCT had a recorded prevalence of MS of 238.4/100,000 (95%CI 221.5–256.5) in 2018. DMT use increased over threefold in 11 years. Four hundred and nine (57%) of 720 MS patients were taking a DMT by 2018. The annual expenditure of DMT drugs had increased sixfold over ten years to £5,301,198 in 2018 (using 2018 prices), reflecting both an increase in DMT use and a switch to more intensive DMTs. Younger MS patients were more likely to be taking a DMT (P<0.001). ConclusionDMT use and cost have been increasing among the MS population in the Northern Ireland. There has been a temporal switch to more efficacious DMTs. Future research should monitor the cost-effectiveness and equity of treatment of MS patients.

Principlism in paramedicine: an examination of applied healthcare ethics

Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. This article examines the theory and practice of principlism, and shows how it is used in daily paramedic practice and decision-making. Practical guidance on applying ethics in paramedicine, illustrated with scenarios, is also provided. This is the first in a series of three articles on paramedic ethics. This series complements the Journal of Paramedic Practice's concurrent CPD˚series on paramedic law in the UK. Later articles in this series will examine the complex ethical issues that can accompany end-of-life care, and ethical considerations relating to treatment of vulnerable persons including children.

The Program for Enhanced Training in Cancer: An Initial Experience of Supporting Capacity Building for Oncology Training in Sub-Saharan Africa

PURPOSE Sub-Saharan Africa is simultaneously facing a rising incidence of cancer and a dearth of medical professionals as a result of insufficient training numbers and emigration, creating a growing shortage of cancer care. To combat this, Massachusetts General Hospital and Beth Israel Deaconess Medical Center partnered with institutions in South Africa, Tanzania, and Rwanda to develop a fellowship exchange program to supplement the training of African oncologists practicing in their home countries. METHODS In its initial 2 years (2018 and 2019), the Program for Enhanced Training in Cancer (POETIC) hosted a pilot cohort of 14 fellows for 3-week observerships in their areas of interest. Researchers distributed questionnaires for program evaluation to participants before arrival and upon departure, and 8 participated in semistructured interviews. RESULTS Five themes emerged from the qualitative data: expectations of POETIC, differences in oncology between the United States and sub-Saharan Africa, positive elements of the program, areas for improvement, and potential impact. Fellows identified several elements of Western health care that will inform their practice: patient-centered care, research development, and collaboration among medical, radiation, and surgical oncologists. The time in Boston modeled a research infrastructure that participants expressed interest in emulating at their home hospitals. In addition, the fellowship inspired some participants to address prevention and survivorship efforts in their home countries. From the quantitative data, feedback was primarily around logistical areas for improvement. CONCLUSION POETIC was found to be feasible and valuable. The results from the first years justify the program’s continuation in hopes of strengthening global health partnerships to support oncology training in Africa. One weakness is the small number of fellows, which will limit the impact of the study and the relevance of its conclusions. Future work will involve long-term follow up with participants and the development of an alumni network.

Implementation Challenges in Public Policies Towards Indigenous Peoples: The Impact of Health Policies in Urban Contexts

ABSTRACT How are indigenous public health policies implemented in contexts of diversity? The rural-urban migration processes that indigenous people have experienced since the mid-1990s in Latin American countries have affected the implementation of public policies, especially in the field of health. These processes have put pressure on ancestral practices of territorial representation, challenging traditional mechanisms that have supported western health policies. Based on a case study in urban Chile, this article examines the implementation processes of indigenous public policies in field of intercultural health. The analysis is informed by data collected from in-depth interviews with 35 key actors (Indigenous health practitioners, managers, health professionals, users, indigenous leaders), who have played a role in different stages in the implementation process of ‘Indigenous Peoples Special Health Program (PESPI)’. The data points to some challenges that persist with the implementation and adaption to this policy into a Western Health Model, where indigenous practices do not always find space to develop. The data collected reveals the efforts that indigenous people make in order to maintain their traditions and practices in different territorial contexts. The findings have the potential to enrich discussion and decision-making on intercultural and or indigenous health policies in other countries experiencing similar issues.

Person and Family Centeredness in Ethiopian Cancer Care: Proposal for a Project for Improving Communication, Ethics, Decision Making, and Health.

BackgroundCancer is a major burden in Ethiopia. The Oncology Department of Tikur Anbessa (Black Lion) Specialized Hospital in Addis Ababa is the sole specialist unit for cancer care in the country. With only a handful of oncologists, a lack of resources, and a huge patient load, the work is challenging, especially in terms of achieving effective and ethical patient consultations. Patients, usually accompanied by family members, often wait for a long time to receive medical attention and frequently depart without treatment. Handling consultations effectively is essential to help patients as much as possible within such limitations.ObjectiveThe project has the following three main aims: (1) to enhance and expand the understanding of communicative and associated ethical challenges in Ethiopian cancer care; (2) to enhance and expand the understanding of the implications and use of person- and family-centered solutions to address such communicative challenges in practice; and (3) to plan and evaluate interventions in this area.MethodsThis project develops and consolidates a research collaboration to better understand and mitigate the communicative challenges in Ethiopian cancer care, with a focus on the handling and sharing of decision making and ethical tension among patients, staff, and family. Using theoretical models from linguistics, health communication, and health care ethics, multiple sources of data will be analyzed. Data sources currently include semistructured interviews with Ethiopian staff (n= 16), patients (n= 54), and family caregivers (n= 22); survey data on cancer awareness (n=150) and attitudes toward breaking bad news (n=450); and video recordings of medical consultations (n=45). In addition, we will develop clinical and methodological solutions to formulate educational interventions.ResultsThe project was awarded funding by the Swedish Research Council in December 2017 for the period 2018 to 2021. The research ethics boards in Sweden and Ethiopia approved the project in May 2018. The results of the studies will be published in 2020 and 2021.ConclusionsThe project is the first step toward providing unique and seminal knowledge for the specific context of Ethiopia in the areas of physician-patient communication research and ethics. It contributes to the understanding of the complexity of the role of family and ethical challenges in relation to patient involvement and decision making in Ethiopia. Improved knowledge in this area can provide a fundamental model for ways to improve cancer care in many other low-resource settings in Africa and the Middle East, which share central cultural prerequisites, such as a strong patriarchal family structure, along with strong and devout religiosity. The project will also serve to develop greater understanding about the current challenges in Western health systems associated with greater family and patient participation in decision making. In addition, the project will contribute to improving the education of Ethiopian health professionals working in cancer care by developing a training program to help them better understand and respond to identified challenges associated with communication.International Registered Report Identifier (IRRID)DERR1-10.2196/16493

The PAPHIO study protocol: a randomised controlled trial with a 2 x 2 crossover design of physical activity adherence, psychological health and immunological outcomes in breast cancer survivors

BackgroundThe PAPHIO study; a randomized controlled trial with 2X2 crossover design will implement a self-directed physical activity program in which participants will engage in self-monitoring and receive motivational interviewing to enhance physical activity adherence. The study aims to determine the effects of 24 weeks self-directed activity combined with motivational interviewing (MI) on (i) psychological health, (ii) quality of life (QoL) and (iii) immune function in female breast cancer survivors.MethodsThe study will recruit 64 female breast cancer survivors within 3 years of diagnosis and at least 6 months post primary treatments at Western Health Sunshine Hospital, Melbourne, Australia. They will be randomly allocated to immediate intervention (IIG group) or delayed intervention groups (DIG group) in a 1:1 ratio. All participants will be given a wearable device (Fitbit Alta HR) and undertake self-directed physical activity for 24 weeks and will receive MI for 12 weeks (IIG; during week 0 to week 12 and DIG; during week 13 to week 24). Participants’ daily step count and the changes of immune cell functionality will be assessed at the beginning (week 1: T1), week 12 (T2) and week 24 (T3) of the program. Physical activity adherence will be assessed at T2 and T3. Participants will also complete four questionnaires assessing exercise self-regulation (BREQ2), exercise barrier and task self-efficacy, mental health (DASS-21) and QoL (FACT-B) at three time points (T1 to T3). Linear-mixed models will be used to assess the relationship between physical activity volume by step counting and mental health (DASS-21), QoL (FACT-B), immune biomarkers, self-regulation (BREQ2) and self-efficacy at T1, T2 and T3;between 2 groups.DiscussionWe expect this physical activity intervention to be acceptable and beneficial to the participants in terms of psychological and immunological well-being with the potential outcomes to be implemented more widely at relatively low cost to these or other patient populations.Trial registrationAustralian New Zealand Clinical trials Registry- ACTRN12619001271190. Prospectively registered on 13 September 2019.

Family Counselling as Decolonization: Exploring an Indigenous Social-Constructivist Approach in Clinical Practice

In Canada, Indigenous peoples’ lives are shaped by relationships with their families. These relationships are defined by traditional Indigenous conceptions of connectedness with the earth, communities, and the many relations that occur within these contexts and are based on what is termed Indigenous ways of knowing. These relationships are also described through a concept of Western social constructivism. Social constructivism is an ideal mate for Indigenous ways of knowing in the practice of family counseling because it recognizes the importance of culture and context in understanding what occurs in human interactions when constructing knowledge based on this understanding. Indigenous ways of knowing have been of recent and growing interest to family mental health practitioners and policy makers who are seeking to support clients in decolonization processes. Family service providers who work in a Western social service or health care setting have an interest in exploring forms of sociocultural theory and practice, such as Indigenous ways of knowing, in order to address and further the practitioner-family interaction and to benefit both individuals and communities in a responsible and sustainable manner. Using current and historical literature, this article presents a summary of issues and guidelines for a hybrid approach that brings together Western and Indigenous approaches for family service workers (such as counselors, social workers, psychologists, and psychiatrists), and a set of guidelines for practical application. Implications of how these practices can positively impact and promote community mental health in the current climate of recovery from colonialism and cultural genocide are presented.

Egocentric social networks, lifestyle behaviors, and body size in the Asian Community Health Initiative (CHI) cohort.

BackgroundSocial networks have been shown to influence lifestyle behaviors in non-Latinx white (NLW) populations. We examined their influence in Asian American, Native Hawaiian and Pacific Islander (AANHPI) women.MethodsWe included 477 AANHPI women from the Asian Community Health Initiative Study who provided egocentric (degree, density, composition) and epidemiologic (size, types of ties) social network data and data on alcohol intake, physical activity, smoking, diet, and body size. We used logistic regression to evaluate associations of social network measures and dichotomous outcomes, and linear regression for continuous outcomes.ResultsIn multivariable-adjusted analyses, higher degree and/or proportion of friends were significantly related to higher Western diet, higher odds of any alcohol consumption, and lower odds of physical inactivity and body mass index (BMI)≥23 kg/m2. Additionally, a higher proportion of NLW in women’s networks was related to lower Asian diet but also lower waist size. Community participation was related to higher Western diet and lower Asian diet. By contrast, degree and/or proportion of relatives were positively related to BMI, waist size and to a higher odds of BMI≥23 kg/m2 and of ever smoking 100 cigarettes. Being married was related to fewer alcoholic drinks per week and higher Asian diet. A higher density of relationships with frequent contact was also associated with higher Asian diet.ConclusionsAANHPI women with larger proportions of friends and NLWs in their networks had more Western health behaviors and smaller body size. Norms for health behaviors and body size may be influenced by the size, composition, and structure of social networks, relevant to chronic disease prevention.

Methodology Matters: Designing a Pilot Study Guided by Indigenous Epistemologies

Indigenous individuals and communities have experienced historic and ongoing negative interactions with Western health care and biomedical research. To rebuild trust and mitigate power structures between researchers and Indigenous peoples, researchers can adopt Indigenous epistemologies in methodologies, such as nonhierarchical approaches to relationship. This article shares models developed to bridge Indigenous epistemologies with Western qualitative and quantitative research methods and demonstrates how these epistemologies can be used to guide the authors’ development of a pilot study on traumatic spinal cord injury.

Faktor-Faktor yang Berhubungan dengan Penggunaan KB Suntik pada Ibu Usia Kurang dari 20 Tahun

According to the World Health Organization (WHO), today almost 380 million couples run family planning and 65-75 million of them, mainly in developing countries using hormonal contraceptives such as oral contraceptives, injections, and implants. The purpose of this study was to determine the factors associated with the use of injectable birth control in mothers aged less than 20 years at the Western Health Center in 2019. The research method was analytic, using the Cross-Sectional approach. The population of this study was all family planning acceptors who came to the western health center at the time the study was conducted in 2019. Sampling used the Accidental sampling method, the research instrument was a questionnaire. The results of the bivariate analysis revealed that of 25 respondents who had good knowledge there were 24 people (72.8%) using 3-month injecting KB, while of the 26 respondents who worked there were 24 people (72.8%) who used 3-month injecting KB, Of the 26 respondents who had tertiary education there were 24 people (72.8%) using 3-month injection contraception. Conclusion there is a meaningful relationship between knowledge and injecting family planning users with a value of P-value 0,000 &lt;α 0.05, there is a significant relationship between work and injecting users with a P-value value of 0,000 &lt;0.05, education with injecting family planning users with a value of 0.000 p &lt; α 0.05.

Spatial distribution of Mycobacterium Tuberculosis in metropolitan Harare, Zimbabwe.

IntroductionThe contribution of high tuberculosis (TB) transmission pockets in propagating area-wide transmission has not been adequately described in Zimbabwe. This study aimed to describe the presence of hotspot transmission of TB cases in Harare city from 2011 to 2012 using geospatial techniques.MethodsAnonymised TB patient data stored in an electronic database at Harare City Health department was analysed using geospatial methods. Confirmed TB cases were mapped using geographic information system (GIS). Global Moran’s I and Anselin Local Moran’s I (LISA) were used to assess clustering and the local Getis-Ord Gi* was used to estimate hotspot phenomenon of TB cases in Harare City for the period between 2011 and 2012.ResultsA total of 12,702 TB cases were accessed and mapped on the Harare City map. In both 2011 and 2012, ninety (90%) of cases were new and had a high human immunodeficiency virus (HIV)/TB co-infection rate of 72% across all suburbs. Tuberculosis prevalence was highest in the Southern district in both 2011 and 2012. There were pockets of spatial distribution of TB prevalence across West South West, Southern, Western, South Western and Eastern health districts. TB hot spot occurrence was restricted to the West South West, parts of South Western, Western health districts. West South West district had an increased peri-urban population with inadequate social services including health facilities. These conditions were conducive for increased intensity of TB occurrence, a probable indication of high transmission especially in the presence of high HIV co-infection.Conclusions and recommendationsIncreased TB transmission was limited to a health district with high informal internal migrants with limited health services in Harare City. To minimise spread of TB into greater Harare, there is need to improve access to TB services in the peri-urban areas.

Effect of Wound Closure Technique in Proximal Femoral Fractures: A Prospective Cohort Study.

To compare the effect of different wound closure techniques on wound drainage, postoperative length of stay, and complications in patients with proximal femoral fractures, including femoral neck fractures (31A fractures) and peritrochanteric fractures (31B fractures). Prospective cohort study. Footscray Hospital, Western Health, Victoria, Australia; an acute teaching hospital. All inpatients receiving surgery for proximal femoral fractures at our facility between May 2016 and August 2017. A total of 486 consecutive patients who presented during the study period were included in the study. Three cohorts of consecutive patients were assigned to use either skin staples, monofilament absorbable subcuticular sutures (Monocryl), or, sutures with the addition of 2-octylcyanoacrylate (OCA) (Monocryl and Dermabond), respectively, for skin closure according to when the patients entered the study. The primary outcome of interest was prolonged wound drainage measured using a standardized technique after postoperative day 3. Secondary outcomes included inpatient length of stay and overall complications. We found a statistically significant increase in prolonged wound drainage in the staples cohort compared with the subcuticular sutures cohort and the sutures and OCA cohort (21.1% vs. 8.5% vs. 4.4%, P < 0.001). Inpatient length of stay was also significantly increased in the staples cohort (5.83 days vs. 4.78 days vs. 5.5 days, P = 0.005). There were no statistically significant differences between the 3 cohorts when comparing incidence of any medical complications, withholding of thromboprophylactic agents, or usage of topical negative pressure dressings. In patients with proximal femoral fractures, closure with staples has the highest rate of prolonged wound drainage and length of stay. Subcuticular sutures in combination with OCA result in the lowest incidence of prolonged wound drainage. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Social influence of adult children on parental health behavior among South Asian immigrants: findings from the MASALA (Mediators of Atherosclerosis in South Asians Living in America) study

ABSTRACT Objectives: Examine the social influence of adult children on the cardiovascular-related health behaviors of older South Asian (SA) immigrants to inform lifestyle interventions. Design: This mixed-methods study used data from an ancillary study of social networks (2014–2018) in the Mediators of Atherosclerosis in South Asians Living in America cohort. Phase 1 was a quantitative analysis of self-reported diet and physical activity among SA adults (n = 448, mean age = 58 years, SD 8.4) who named at least one adult child to their social network. The Alternative Healthy Eating Index (AHEI) was used to measure parents’ diet; higher numbers indicate a healthier diet (range 0–110). Phase 2 was a thematic content analysis of in-depth qualitative interviews from a subsample of these parents (n = 23, mean age = 55, SD 7.6). Results: Parents with an adult child in their network who consumed uncooked vegetables daily had mean parental AHEI score 1.5 points higher (adjusted p-value = 0.03) than those who had a child in the network who ate uncooked vegetables less often. When at least one adult child in their network ate fresh fruit daily compared to less frequently or when at least one child ate non-SA food daily compared to less frequently, mean parental AHEI scores were higher by 2.0 (adjusted p-value = 0.01) and 1.6 (adjusted p-value = 0.03) points respectively. Parents with an adult child in their network who exercised at least weekly were more likely to meet guideline-recommended physical activity levels than parents with children who exercised less often (76% v. 56%, adjusted p-value = 0.02). Adult children provided social support and were seen as ‘role models’ for healthy behavior, especially when adopting Western health behaviors. Conclusion: Positive role modeling and support from adult children were important facilitators of healthy behavior change in older SA immigrants and can inform health behavior interventions for SA adults.

Traditional Chinese Medicine: A Qualitative Study for Reconsidering Nursing Care in the United States.

Purpose: Traditional Chinese medicine (TCM) proposes the world as a holistic unity of energy. With a long history of use, TCM is generally accepted in the Chinese health care system. Despite growing global interest and use, TCM has received a mixed response from Western health care systems. This study aimed to describe the underpinnings of TCM, compare TCM and Western medicine, and suggest how key modalities might be applied to strengthen holistic nursing care in the United States. Design: A qualitative, descriptive exploratory investigation employing a constructivist grounded theory. Method: Interview of TCM healers in Hong Kong (n = 5). Transcripts were reviewed to identify common themes and categories. Findings: Five themes were identified: improvement in energy flow and health, TCM as "a way of knowing," curing source versus symptoms of disease, declining TCM practice in Hong Kong, and need for interprofessional education. Conclusions: TCM is considered useful in chronic illnesses, whereas those with acute illnesses often seek Western medicine. Failing to address the holistic care needs and preferences of individuals results in less than optimal health outcomes. Nurses need explicit TCM content and would benefit from a restructuring of curricula and clinical experiences to foster integration into caring practices.

El Sistema Público Nacional de Salud desde la Perspectiva de la Interseccionalidad en la Línea de Frantz Fanón

En la investigación se utilizó el Paradigma Indígena de Investigación, el dialogo intercultural y se aplicó en el Sistema Público Nacional de Salud desde la perspectiva la Interseccionalidad en la Línea de Frantz Fanón. Conclusión: Las Instituciones de Salud occidental y la Misión Barrio Adentro manejan las mismas políticas y programas de salud. La Medicina de las instituciones de salud oficiales tiene enfoque occidental, colonial, hegemónico, curativa, biologicista, capitalista y mercantilista. La Misión Barrio Adentro, es vista por las instituciones occidentales como un subsistema paralelo. El Sistema Público Nacional de Salud esta fraccionado en subsistemas, dividido, cada institución va por su lado con sus lineamientos. La medicina tradicional se expresa con sus prácticas realizadas por los boratios, curanderos, los Homeópatas y por la medicina china. Estamos llamados a un cambio de actitud ante las posiciones de occidente, a descolonializarnos, a tener una cosmovisión de la pluriversidad y la interculturalidad en salud.

Health Theatre: Recognizing and subverting the tactical farce of the medicalization of everyday life

This article considers the implications of Western health and wellness culture’s strategic co-option by industry, embodied by the rise of wearable tech, the commodification of the self-help movement, and the datafication of the human body. Said culture has come to bear the paranoia observable in the West’s approach to national security, which is widely dubbed as “security theatre”. “Health theatre” is put forth here as an analogous phenomenon to security theatre, wherein the populous is subject to invasive scrutiny by governing structures, enacted in the name of their own wellbeing. Both phenomena are characterized by their sensationalist rhetoric and effective impotence in producing results consistent with their alleged purpose. Health theatre can best be understood as an organic symptom of the broad medicalization that has permeated Western culture over the past century. Medicalization pathologizes the scope of human experiences, while situating the problem at the level of the individual where solutions are then couched. Further, by positing health as an elusive state to be perennially pursued, the individual is left in a perpetual state of dependency. Should health theatre proliferate, the West will continue to suffer a fear-based, atomizing system of health promotion. Means of resistance to health theatre are proposed here as a return to engagement with communal forms of reproductive care that reject pathologizing diversity in psychological and somatic states.