Conflict, war and medicine (catch all).

[davidbfpo]

Medicine is not a speciality I am familiar with, but reading this thread and mindful of the history that supplying medical care in COIN is often described as a "win, win" option two thoughts came to mind:

a) traditionally IIRC medical care was given on an individual basis, with the host community being aware of what that meant and with very rarely was care given beyond the "village" or local community

b) today there is an emphasis on public health, e.g. clean water and on somewhat sophisticated medical care, way beyond local comprehension, local affordability and out of community sight, e.g. helicopter evacuation to Camp bastion's hospital for an IED injured child

It seems to me that in 'stability operations' we have adapted the traditional approach, which was kept small and in view, added the far more effective public health option - which may not be locally seen as benign and offered medical care that is simply too much.

This issue also appears in civil / NGO provision in medical emergencies, notably after disasters and natural failures, drought comes to mind.

Now back to my "armchair".

[ganulv]

Leaving aside for a moment the relationship to counterinsurgency and allowing me to oversimplify a bit: with public health-related projects greater avoided costs over the long term are associated with greater upfront costs. Rational planning of a public health-related project should begin by asking whether avoiding cost over time is the raison d'être. If the answer is “yes,” the next question should be whether meeting the upfront costs is feasible (not a purely financial matter, as there are political and social realities to take into consideration).

Returning to the issue of counterinsurgency, is there real evidence that providing healthcare is a successful means of winning hearts and minds?* I’m not trying to be a troll here but rather am seriously asking whether the concept can truly be said to rise above the level of assertion.

*Note that my question is not whether providing access to healthcare improves quality of life. I am taking that for granted.

[davidbfpo]

Ganulv posted:

Returning to the issue of counterinsurgency, is there real evidence that providing healthcare is a successful means of winning hearts and minds?* I’m not trying to be a troll here but rather am seriously asking whether the concept can truly be said to rise above the level of assertion.

Certainly in my reading on the campaign in Malaya and especially Oman there are references to the impact of providing basic medical aid in locations that had none.

My impression is that basic medical aid - in Oman - helped secure the loyalty of local people as proof the new Sultan cared before more extensive and expensive options arrived, such as building roads.

[ganulv]

My impression is that basic medical aid - in Oman - helped secure the loyalty of local people as proof the new Sultan cared before more extensive and expensive options arrived, such as building roads.

I don’t know the first thing about that conflict, can you recommend a reading or viewing for beginners? It would be interesting to see whether the initial medical aid was meant to be—or at least to be perceived as—the first step towards a long term medical infrastructure (as opposed to medics periodically showing up to pull teeth and hand out quinine).

[davidbfpo]

Ganulv,

You asked two questions:

I don’t know the first thing about that conflict, can you recommend a reading or viewing for beginners?

If you search SWC on Dhofar (the province) and Oman there are many posts, but for a reading list - not on medicine - there is this now merged thread:

It would be interesting to see whether the initial medical aid was meant to be—or at least to be perceived as—the first step towards a long term medical infrastructure (as opposed to medics periodically showing up to pull teeth and hand out quinine).

My recollection is that medicine appears as a phrase, maybe a sentence and not in detail. It is a long time since I've done any reading on the campaign, so perhaps a Google search might find new sources.

[Madhu]

Here are some other references and sites that I've dug up. No idea if they will be helpful or not. I have no affiliation with the following, but the links seem interesting:


1. Afghanmed.org - Afghan Medical Organization of America

2. TATRC (tatrc.org) - telemedicine

3.

MEDCAP operations recently returned to activity in Iraq and Afghanistan. They started in a rather improvised way before integrating into a strategy aimed to “win hearts and minds.” Whereas their impact on the health of the population remains unknown, military health authorities have been rather enthusiastic about their impact on the perception of the US military by the local population (Cascells 2009). In 2009 the approach developed into a new concept, the Medical Stability Operations (MSOs), which would build on the experience of MEDCAP in a more professional and effective way (Pueschel, 2009). Recognizing the limits of MEDCAP, the new strategy seeks to learn from this experience and to collaborate with humanitarian organizations (SOMA conference, 2009). In order to facilitate collaboration with humanitarian actors, the US military forces have created a guide covering its interaction with NGOs: “The guide shows how the military can work with NGOs that may not want to be perceived as being aligned with people in uniform on the ground” (US DoD, Jan. 2010).

http://www.doctorswithoutborders.org...at=perceptions

4. http://icsr.info/blog/Short-Circuiting-Taliban-Media

5. http://www.globalmedicine.org/GMN/index.asp

6. http://www.huffingtonpost.com/2012/0...n_1344877.html

The aptly named Jungle School of Medicine Kawthoolei may be a far cry from what Westerners would typically consider an advanced school and medical clinic.

Both structures were built by the local Karen villagers using locally grown resources. Blankets on the floor take the place of clinical beds, and instead of desks students complete assignments on metal folding tables. But the facility's very existence means access to a level of health care and health education that was desperately needed.

7. http://www.ramcjournal.com/past_2011.html (in particular, International Military Medical Engagement with the Indigenous Health Sector - Afghan Security Forces Medical Services, Bricknell, Grigson)

8. http://www.centcom.mil/news/coalitio...-combat-medics

9. http://gh.websedgemedia.com/conferen...r_afghanistan/

The link goes directly to audio!!!!

Global Health TV's Stephen Horn talks with Shainoor Khoja, Director of Corporate Affairs at Afghan telecommunications company, Roshan. Khoja, shares her experiences establishing telemedicine and micro-financing initiatives and explains how these ideas can help other developing countries.

10. http://afghanistan.usaid.gov/en/USAI...cal_University

Higher Education Project Kabul Medical University

11. http://www.jsomonline.org/Publicatio...7148Keenan.pdf

Role of Medicine in Supporting Special Forces Counter-Insurgency Operations in Southern Afghanistan

12. And finally, because I think it matters as background:

https://globalsociology.pbworks.com/...Stratification

Modernization theory and development stuff. I keep being told no one believes in such a linear process anymore, except it still seems to form a sort of basis for some of our interaction with other nations. Help, other council members! Am I off-base with this line of thinking?

http://tinyurl.com/8yhbpxw

(Modernization and Medical Care, Sociological Perspective, Gallagher E, 1988)

The introduction of modern medicine into developing societies is an important topic for social-scientific analysis. Here I draw upon modernization theory to illuminate this topic. Using Peter Berger's notion of "carriers of modernity," I discuss health care as such a carrier. Compared with premodern modes of health care, modern health care has a calculable, "commodity" character. Its production has become a major and increasingly systematized sector of the economy. In addition to its manifest clinical benefits, health care conveys the symbolic meanings of modernity. It participates in the broad though uneven passage of technology and values from Western societies to metropolitan areas in developing societies and thence to the hinterland. Health care as the focus of demodernization strains is also examined, through case examples drawn from Amish and Islamic contexts.

Again, this is not an area I know very well so the references and links I provide are for discussion and education. I have more links that might be of interest and will post as time permits. I am a forever SKEPTIC on the third party development game, but it doesn't hurt to study and learn what can be studied and learned....or something like that.

[Madhu]

Oh, and because I've seemed to have gone off in a different direction from my original comments, an abstract on online medical curriculums:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2823389/

The National Human Genome Research Institute (NHGRI) and the National Coalition for Health Professional Education in Genetics (NCHPEG) have expressed the need for the education of physicians about the ethical, legal and social implications (ELSI) related to genetic testing and counseling. To help address this need, we have developed and assessed an Internet-based curriculum to educate medical students about topics related to the ELSI associated with genetic testing and counseling. We developed content and interactive features for five core modules and evaluated their effect on students' knowledge, attitudes, self-efficacy and intended behavior. Statistically significant increases in knowledge and positive changes in attitude, self-efficacy and intended behavior were observed in all these studies. We believe that this web-based curriculum is a valuable supplement to typical medical school genetics coursework and an effective means of teaching students about ELSI associated with genetic testing and counseling. The modules are available online for review by the general public for free and for use by medical student groups at a nominal charge at www.GeneticSolutions.com.

So, my basic point in linking the above is that lots of stuff is already available online and for free, so if anyone wants to adapt a cell phone medical curriculum or translate it to radio or whatever, the material is already out there. Tons and tons and tons of it.

No need to re-invent the wheel, yada yada yada.

Found other sites of interest, don't know a thing about any of it, but as examples:

http://medicalcurriculum.com/

http://www.acpmedicine.com/acpmedici...wc_prog.action

The ACP Medicine Weekly Curriculum is a convenient email-based program that guides residents through an ongoing study of the key elements of internal medicine and patient care from ACP Medicine, an official publication of the American College of Physicians. The program is simple and economical. Each week, program directors and their residents receive an email alerting them that the new Weekly Curriculum has been published live online. The email contains a tip and goals relating to a chapter and questions published in ACP Medicine. The email also contains a link to the chapter. Residents review the chapter, click on the convenient ACP Medicine link in the email to access the ACP Medicine Web site (provided to you and all your residents as part of your Weekly Curriculum subscription). There they access the Weekly Curriculum tab at the top of the screen, and enter their user name and password. The residents take the weekly test online and receive immediate feedback on their scores, with detailed discussions of the topics and the answers, as well as access to the full text of the related chapters for additional review.

[ganulv]

Modernization theory and development stuff. I keep being told no one believes in such a linear process anymore, except it still seems to form a sort of basis for some of our interaction with other nations. Help, other council members! Am I off-base with this line of thinking?

O país do futuro! E sempre será. The fact that the term “Developing World” continues to be used despite decades of evidence to the contrary says more about the nature of belief than it does about the validity of modernization theory, if you ask me.