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PubMedDate not supplied

[The prepayment scheme in Rwanda (II): membership and use of services by beneficiaries].

In Rwanda, the Ministry of Health is rebuilding the health sector destroyed during the genocide while trying to guarantee the financial accessibility of the population to the services through the setting up of a prepayment scheme. Membership remains low in the three pilot districts where the prepayment scheme was introduced four years before (15,6%). In two of these districts, the curative consultation and maternity utilisation has increased appreciably. The members of the prepayment scheme make greater use of the services than the rest of the population. There is a significantly higher prepayment scheme membership among households with a relatively high income and those with a large family (more than 5 family members). Overall, non-members of the prepayment scheme spend more on health services than members do. There are indications that developing the prepayment scheme would be very useful for the people in Rwanda if specific strategies geared to the poor were set up.

Eligibility Determination↗
PubMed2005

Restoring diabetes care in Rwanda: the need for effective partnerships.

In 1994, more than one million people died in Rwanda in one of the worst genocides in modern times. Rwandan society, at all levels including healthcare, continues to count the human and financial costs of the tragedy--a burden which is compounded by the debilitating scarcity of resources in the nation as a whole. Most of Rwanda's 8,200,000 inhabitants are united by poverty: according to figures published by the World Bank, the yearly per capita income in Rwanda is US dollar 220. The author reports on the status of diabetes care and makes a call for cost effective collaborative solutions to the dire problems faced by people with diabetes in Rwanda.

Cooperative Behavior↗
PubMedDate not supplied

Embracing global solidarity.

For more than 60 years, Catholic Relief Services (CRS) has provided emergency relief overseas. But the guiding principles underlying the organization's work have evolved over time-particularly over the last decade-as staff members have adopted a new view of their role in supporting people in need worldwide. In CRS' early years, its focus was on corporal works of mercy: providing food, drink, clothing, and other material goods. Although the organization's breadth of services and geographic presence expanded throughout the latter part of the 20th century, it wasn't until the mid-1990s that the agency questioned its foundational principles and made an organization-wide move toward change. The impetus for change was the 1994 Rwandan genocide crisis. CRS staff members were deeply affected: not only were their aid programs destroyed; they also lost friends, colleagues, and family members. CRS staff realized that unless they addressed the justice issues underlying their beneficiaries' concerns, their aid would have minimal impact. Changing the way the organization approaches relief has been an extensive process. Staff members developed a strategic plan, held retreats and workshops to define the concept of justice, educated colleagues worldwide on the new approach, facilitated "Justice Reflections" to explore the basics of Catholic social teaching, and developed guiding principles and a vision. Despite challenges, CRS is successfully transforming itself into an agency that not only provides physical relief but also strives to help build a culture of justice, peace, and reconciliation.

Catholicism↗
PubMed2006

Relationship of African Americans' sociodemographic characteristics to belief in conspiracies about HIV/AIDS and birth control.

Although prior research shows that substantial proportions of African Americans hold conspiracy beliefs, little is known about the subgroups of African Americans most likely to endorse such beliefs. We examined the relationship of African Americans' sociodemographic characteristics to their conspiracy beliefs about HIV/AIDS and birth control. Anonymous telephone surveys were conducted with a targeted random-digit-dial sample of 500 African Americans (15-44 years) in the contiguous United States. Respondents reported agreement with statements capturing beliefs in HIV/AIDS conspiracies (one scale) and birth control conspiracies (two scales). Sociodemographic variables included gender, age, education, employment, income, number of people income supports, number of living children, marital/cohabitation status, religiosity and black identity. Multivariate analyses indicated that stronger HIV/AIDS conspiracy beliefs were significantly associated with male gender, black identity and lower income. Male gender and lower education were significantly related to black genocide conspiracy beliefs, and male gender and high religiosity were significantly related to contraceptive safety conspiracy beliefs. The set of sociodemographic characteristics explained a moderately small amount of the variance in conspiracy beliefs regarding HIV/AIDS (R2 range=0.07-0.12) and birth control (R2 range=0.05-0.09). Findings suggest that conspiracy beliefs are not isolated to specific segments of the African-American population.

Adolescent↗
PubMed1991

[Continuity--adjustment--autonomy--physician--patient--an overview of medical cultural philosophy in former East Germany].

The author probes into the "culture" of medical thinking in the former GDR in respect of the interlinking of socialisation of the doctor, within the framework of socialism, with the fate of the patient; the fundamentals of the development of science and of the pattern of cultural life; and the development of moral consciousness and health policy under the influence of Marxist-Leninist teachings. (One should not neglect the difference made by the author between "official Marxism-Leninism as decreed by the state" and "Marxist theory" as well as "public level of consciousness".) Errors of judgment, illusions, so-called "noble" ideals of the medical profession such as ambitiousness, engagedness, and readiness to shoulder responsibilities, were interwoven with the trend to functionalism, to keep the party bureaucracy of the SED in power. One of the thematic points of emphasis was the "changing of paradigms in medicine", such as the hostility to psychology as a feature of GDR socialism, or the sociopolitically dictated condemnation of non-institutional or "alternative" medicine. The author sees a basic trend to technocracy in GDR medicine. He shows up trends to "moral remote control" of the doctor, to a deliberately practised illusionment, a systematically engineered demounting of decisions based on moral constraints--such demounting being promoted both in the doctor's mind and in actual practice--and to eliminating emotional obstacles officially construed as "interfering" with a strictly objectified doctor-patient relationship. Nothing in this context can be soft-pedalled and excused. The author points specifically to the officially promoted vision of a "successful repair and construction of a New Man". Within the context of socialist ideal views and actual socialisation of the doctor there are similarities between the balance-sheets of 1945 and 1989 in Germany without attempting to suggest that this amounts to a comparison on the same level with the genocide and war guilt of the National Socialist era. Guilt is a burden on the mind, but non-assessed guilt and lack of a possibility of redemption destroys humans. The article is a plea against an increasing tendency to criminalize the former GDR citizen and the doctors. "It will be necessary to honestly review the past history embodying my own errors, mistaken concepts and illusions." All this is only a first approximation to an important and complex subject. It is the author's aim to promote a better understanding between the former GDR citizens and those of West Germany.

Continuity of Patient Care↗
PubMed1978

[The problem of information of the patient about medical malpractice (author's transl)].

The treatment contract of the physician does not include the duty of legal counselling of the patient. The physician should avoid amateur attempts at legal advice. The civil contract between physician and patient includes the duty to inform the patient of blatant negligence by others or himself in the observation of the generally recognized rules of medical science. An unsubstantiated suspicion of malpractice without obvious adverse effects should not be revealed to the patient. Critique of the treatment by a colleague is not unprofessional when a higher legal obligation than the professional obligation to a peer is at steak. The physician is not obliged to inform the police of malpractice by a colleague. Only imminent crimes such as manslaughter, murder or genocide must be reported.

Germany, West↗
PubMed1995

Misleading the deaf community about cochlear implantation in children.

Activists are misleading the deaf community in an effort to generate opposition to cochlear implants in children. Their methods include both misinformation and the use of inflammatory, illogical rhetoric. To date they have been successful in causing anger, frustration, and overt violence among the culturally deaf with the use of such terms as "genocide" and "child abuse." Because the average reading level of a deaf residential high school graduate is at the third or fourth grade level, a small elite is able to control the interpretation and flow of complex information to many deaf people. It is a challenge to make accurate information, both positive and negative, accessible directly to deaf society. Just as the deaf have abandoned opposition to cochlear implants in adults, the same might be expected to occur in children when they and their parents become aware of the results of implantation.

Age Factors↗
PubMed1994

[Social and psychological aspects of the war in Bosnia and Herzegovina 1992-1993].

Every war is the deepest compassion of political fightings turned out with weapon in purpose of biological, economic, social, political and culture destroying of people. This aggression has all these components. Aggressors are Serbia and Monte Negro, and Croatia, and extreme Serbs and Croats living in Bosnia and Herzegovina, and their purpose is the destroying of Bosnian State, and its division into ethnic rules, and making great Serbia and Croatia. This inormal dirty war (war against the civilians, there are no two armies, genocid war, destroying one population) makes injuries, illnesses. It makes hard social economic changes, which change the whole life of the population, making striking changes of spirit and life of people. The most important fact which the people have in war is fear for own family and social survival. Main characteristics of the war is the horrible violence: killing people, raping, kidnapping and torturing in the concentration camps, robbing everything that worth, and making people refugees. This is the war against the civilisation. The last consequences of all these are deep emotional changes in people and groups, and this is the biggest social and medical problem of the community. That is the theme of this project.

Bosnia and Herzegovina↗
PubMed1994

The post-traumatic response in children and adolescents.

Mental health professionals are becoming increasingly aware of how violence--be it in the home, media, street, school, genocide, or war--can leave an indelible signature on the human psyche and on brain function and structure. They have challenging roles to play in preventing malignant memories and subduing their pernicious effects as well as examining the dramatic cascade of interactions among environment, brain, and behavior initiated by trauma.

Adolescent↗
PubMed1994

Conspiracies, contagion, and compassion: trust and public reactions to AIDS.

AIDS educational programs can be effective only to the extent that they are perceived as credible by their target audiences. In this study, public trust associated with AIDS was assessed in a national telephone survey. African-Americans were more likely than whites to express distrust of doctors and scientists concerning HIV transmission through casual contact, to believe that AIDS is being used as a form of genocide against minority groups, and to believe that information about AIDS is being withheld from the public. Individuals high in distrust did not differ from those low in distrust in their exposure to AIDS information. Higher levels of AIDS-related distrust were not related to self-reported personal risk reduction, but were related to inaccurate beliefs about HIV transmission through casual contact and greater willingness to avoid and stigmatize people with AIDS. The importance of overcoming distrust in AIDS education programs is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Morbidity and mortality surveillance in Rwandan refugees--Burundi and Zaire, 1994.

In April 1994, resumption of a longstanding conflict between the Hutus and Tutsis--the two major ethnic groups in the central African countries of Burundi and Zaire--resulted in civil war and mass genocide in Rwanda. An estimated 63,000 (primarily Tutsi) refugees subsequently moved from Rwanda into northern Burundi, and 500,000 refugees fled to Tanzania (Figure 1). In early July 1994, as armed strife subsided, many Tutsis returned home to Rwanda, and an estimated 1 million Rwandan Hutus fled to Zaire, and 170,000 fled to Burundi. To monitor the health status of the refugees, the Office of the United Nations High Commissioner for Refugees (UNHCR) and nongovernmental organizations (NGOs) working in refugee camps in both countries established systems for rapid surveillance of morbidity and mortality. This report presents the findings of these systems during May-September 1994 (the period of the most intensive population migration) and indicates that mortality was high among refugees in camps in both countries.

Burundi↗
PubMed1996

[Psychological consequences of the 1994 massacres in Rwanda].

A research program on the prevalence of reactions of posttraumatic stress is described in this article. The program is specifically centered on the psychological consequences of the April 1994 events in Rwanda and the genocide that followed. It includes three psycho-epidemiologic studies: 1) a study of non-accompanied Rwandan children; 2) a study of a small group of belgian cooperants; and 3) a study of an important sample of belgian civilians and militaries having been through the rwandan events. The psychological impact of the rwandan events is described in terms of prevalence of symptoms of posttraumatic stress.

Adolescent↗
PubMed1998

Challenge of goodness: twelve humanitarian proposals based on the experience of 1991-1995 wars in Croatia and Bosnia and Herzegovina.

Based on the 1991-1995 war experience of peoples of Croatia and Bosnia and Herzegovina, I made twelve proposals regarding the following aspects of health, humanitarian work, and human rights: 1. Broadening of the WHO definition of health by including spiritual well-being (absence of hatred) in it, 2. Inclusion of the term genocide into the Index Medicus (MeSH), 3. Establishment of concepts of prevention of hate, 4. Right to a home, 5. Right of civilians to participate in defense and renewal, 6. Right to deliberation from enslavement and right to find out the fate of missing persons, 7. Global hospital, 8. Monitoring of prisoner-of-war camps, 9. Refugee camps, 10. Providing of care for the abandoned - a new category of people suffering in war, 11. Introduction of the Helping Hand concept, 12. Organization of the Red Cross Forum after the cessation of hostilities. The fundamental objective was to establish the legitimacy of honesty in practice, regulative social mechanisms, and science.

Bosnia and Herzegovina↗
PubMed1998

DOTS in Cambodia. Directly observed treatment with short-course chemotherapy.

SETTING: Since the 1970s, Cambodia, a country of 10 million people in South East Asia, has experienced war, genocide and the virtual dismantling of the health system. It has a severe tuberculosis (TB) problem, with a new tuberculosis case notification rate, all forms, of about 150 per 100000 population and a tuberculosis programme, established in the early 1980s, achieving cure rates of only 40-50% in the last decade. OBJECTIVE: To describe the implementation of a DOTS programme (directly observed treatment with short-course chemotherapy) under difficult conditions and its rapid success on a nation-wide scale. DESIGN: The World Health Organisation's recommended strategy was implemented in a phased manner throughout the country from 1994. The resources for TB drugs and running costs came from 13 sources. The DOTS strategy was gradually introduced after training and with regular supervision into 120 TB units inside general public hospitals at provincial and district level, after a mapping exercise; 75% of tuberculosis cases, all forms, are hospitalized during the entire initial phase and 85% of the total number of tuberculosis cases received free food from the World Food Programme. RESULTS: Two and a half years after the start of the new programme, DOTS was implemented in 85% of all public hospitals. In 1996, case-detection rates had reached 127 smear-positive PTB (pulmonary tuberculosis) and 149 PTB all forms per 100000 inhabitants; 90% of all tuberculosis patients received DOTS. From January 1994 to June 1995, 4164 new cases started category 1 treatment (2ERHZ/6EH). Of these, 89% were cured or completed treatment, 5% defaulted, 3% died, 1% were treatment failures and 2% transferred out. CONCLUSION: The DOTS strategy can be successfully implemented in even very difficult conditions such as those found in Cambodia.

Adolescent↗
PubMed1998

Violence in a violent society.

The descriptive epidemiology of violence in the United States is presented. The reasons for the high homicide rates are explored by describing the historical development of violence in Colombia, a developing country with very high homicide rates, and in the United States, which has extraordinarily high homicide rates in comparison with other highly industrialized countries. The historical factors in the United States that contribute to the high violence rates include the genocide of the Indian population, the slave system, and the increasing militarization of the country's economy, ideology, and governmental policy. It is clear that "the United States is a high-violence environment," that it is indeed a violent society.

Cause of Death↗
PubMed1998

Multiple forms of stress in refugee and immigrant children.

The effects of genocidal warfare reverberate long after the bloodshed has stopped. This article focuses on one aspect of the aftermath or war and violence: the transformation of families and children into refugees and immigrants.

Adolescent↗
PubMed1997

Documented homicides and excess deaths: new insights into the scale of killing in the USSR during the 1930s.

"Getty, Rittersporn and Zemskov recently claimed that no more than 2 million people could have perished from collectivization, famine, execution, terror, and forced labor in the USSR during the 1930s. Prior demographic confirmation of this estimate was provided by Anderson and Silver who contended that killings were unlikely to exceed a few million and could not be more than 4.8 million victims. This essay disproves both these contentions by introducing new demographic evidence proving that Stalin killed at least 5.2 million Soviet citizens 1927-1938, with a best estimate in the vicinity of 10 million."

Cause of Death↗