SOCIAL MEDICINE TEACHING CASES
Open Access
In 2017 we put out a call for social medicine cases through the SMC listserve. Over the past two years, in partnership with the Radcliffe Institute, the Dept of Global Health and Social Medicine at Harvard Medical School, and Harvard School of Public Health faculty members Drs. Nancy Kane, Susan Madden, and Joe Rhatigan, we worked with authors from various contexts to develop several social medicine teaching cases.
Eight of those cases are available to download for free via OPEN ACCESS, on the Harvard School of Public Health case library website linked below
https://caseresources.hsph.harvard.edu/
(teaching notes are available to instructors by request.)
Filtering by author affiliation for “Social Medicine Consortium” will bring up all of the social medicine cases. They will be available through Harvard Business Publishing in the coming months.
CASE ABSTRACTS
Vicodin as a Treatment for Structural Violence
By Ruth Staus
Edited by James Hudspeth
Location: Minneapolis, Minnesota, USA
Abstract: Elizabeth, a middle-aged African American woman living in Minnesota, develops chest pain and eventually presents to a local emergency room, where she is diagnosed with stress-related pain and given Vicodin. Members of a non-profit wellness center where she is also seen reflect on the connection between her acute chest pain and underlying stress related to her socioeconomic status. On a larger level, how much of her health is created or controlled by the healthcare system? What non-medical policy decisions impacted Elizabeth such that she is being treated with Vicodin for stress?
The Coalition to Stop Maternal Mortality: Uganda
By Melissa McCoy and Angella Namwase
Edited by Amy Finnegan
Location: Uganda
Abstract: In 2011, in response to two high profile cases of maternal death during labor and delivery, Ugandan citizens mobilized to prevent maternal mortality by improving the delivery of healthcare services in public hospitals. The Coalition to Stop Maternal Mortality ignited a social movement by utilizing strategic advocacy to hold the Government of Uganda accountable to its constitutional provisions on health service delivery. This case examines the Coalition to Stop Maternal Mortality and its landmark legal initiative, Constitutional Petition No. 16 of 2011, that focused the nation’s attention on the state of health services in Uganda and initiated a nationwide conversation about the role of government in delivering the right to health for all Ugandans. What tactics and strategies can effectively mobilize power to bring about legal and policy change? Would these be enough to achieve the change that the Coalition sought?
Resident Doctors on Strike in Haiti’s Public Hospitals
By Youri Encelotti Louis, Louine Martineau, and Carlo Louis Charles
Edited by Michelle Morse and Annie McDonough
Location: Port-au-Prince, Haiti
Abstract: In 2016, resident physicians organized a strike at the State University Hospital of Haiti (HUEH) in the capital of Port-au-Prince that eventually spread to at least ten other public hospitals in the country, effectively paralyzing the health care system for several months. Through interviews with strike participants and other key stakeholders in the Haitian medical system, this case explores the ethical challenges of health care worker strikes and the far-reaching consequences of the Haitian strike on the nation’s provision of health care and training of health professionals.
SALUDos: Healthcare for Migrant Seasonal Farm Workers
By Irene Guerra, Marce Abare, and Sara Doorley
Edited by Amy Finnegan
Location: Santa Clara County, California, USA
Abstract: The SALUDos program began in 2008 as a response to an influx of migrant seasonal farm workers (MSFWs) at a mobile medical unit serving homeless persons in Santa Clara County in Northern California. The program offered patients free and low-cost primary care services, linkage to resources, and advocacy. As the farm workers involved in this program became more involved in their primary care, they advocated for evening hours, transportation, linkage to coverage programs, and health education resources to better understand their medical and psychological conditions. During continual modifications of the SALUDos program, the team sought to understand and address large-scale social forces affecting migrant health through interventions to mitigate health inequities
The Formerly Incarcerated Transitions (FIT) Clinic: Interfacing with the Social Determinants of Health
By Katelyn Yoder, Anjali Niyogi, and William Vail
Edited by Michelle Morse
Location: New Orleans, Louisiana, USA
Abstract: This case describes and explores the development of the first medical transitions clinic in Louisiana by a group of community members, health professionals, and students at Tulane Medical School in 2015. The context surrounding health in metro New Orleans, the social and structural determinants of health, and mass incarceration and correctional health care are described in detail. The case elucidates why and how the Formerly Incarcerated Transitions (FIT) clinic was established, including the operationalization of the clinic and the challenges to providing healthcare to this population. The case describes the central role of medical students as case managers at the FIT clinic, and how community organizations were engaged in care provision and the development of the model. The case concludes with a discussion of the importance of advocacy amongst health care professionals.
The Story of Esdras: Child Malnutrition as a Social Condition
By Héctor Carrasco, Alexandria Schmall, Clara Perdomo, Melani Villafañez, and Hugo Flores
Edited by Michael Westerhaus
Location: Chiapas, Mexico
Abstract: This case tells the story of Dr. Roblero, a newly-graduated Mexican physician working in the rural community of La Soledad, who cares for Esdras, a young boy suffering from chronic malnutrition and pneumonia. Dr. Roblero and a team of providers subsequently seek to address the structural determinants of malnutrition through numerous interventions including education campaigns, homestead gardens, and poultry husbandry. This case details the challenges they encounter as they explore novel ways to improve child nutrition in La Soledad.
Healthcare as Resistance and Right: Forced Displacement and the Quest for Health in Bedouin Villages in the Negev
By Bram Wispelwey, Nadia Ben-Youssef, Amir Abo Kweder
Edited by Michelle Morse
Location: The Negev, Israel
Abstract: The Palestinian Bedouin of the Negev desert are a minority community within Israel, one that has experienced limits on its rights to land use and health access. The Bedouin claim of ownership of their ancestral lands is disputed by the state of Israel, which has attempted to condition access to state services, like health clinics, on the relinquishing of land claims. After the passage of universal healthcare in Israel in 1995, the Bedouin and their representatives developed a legal strategy to secure a right to health on their ancestral lands. This case explores this legal fight, the historical and health contexts of Bedouin citizens of Israel, the limitations of the law in pursuit of justice, and the role of community organizing in the struggle for fundamental rights to health. It highlights the concept of settler colonialism and the relevance of historical context when striving to secure health. Finally, it also emphasizes the distinction between public narratives about vulnerable populations from actors with power such as the State and the narratives of the vulnerable community populations themselves.
Barriers to Care for Indigenous Women with Cervical Cancer in Guatemala
By Sandy Mux Xocop, Kirsten Austad, Anita Chary
Edited by Scott Stonington
Location: San Juan Comalpa, Guatemala
Abstract: In Guatemala, rural and indigenous women face disparities in access to prevention and treatment of cervical cancer. This case analyzes barriers faced by Mayra, an indigenous woman from a rural community in Guatemala who was diagnosed with cervical cancer. Even though all Guatemalans are entitled to free health care provided by the public health system, economic, geographic, linguistic, and cultural barriers prevent women from obtaining specialized healthcare for complex conditions such as malignancy. Accompaniment and care navigation are potential solutions to overcome these impediments, helping marginalized patients receive treatment and reducing health disparities for indigenous peoples.