Over the past month, I’ve had a few experiences that don’t have much to do with public health business planning, but something to do with public health. I traveled to Greece for two weeks, spending time in the Cyclades islands of Folegandros and Santorini, and in the capital, Athens. Greece is an interesting mixture when it comes to public health:
1. They have a very good health care safety net system, paid for by the state. A couple of cab drivers told us how proud they were of their public health program. One was less enthusiastic because, although he himself, who has significant health issues, has never had a problem getting care, he “had heard that some people have some bureaucratic hassles.” He doesn’t realize the “bureaucratic hassles” we have in the states – even if you have health insurance, but especially if you do not!
2. Everyone smokes. Greece is Europe’s biggest-smoking nation: more than 40% of adults smoke. I don’t think we realize what a job we’ve done in this country to curb smoking, until you go to a nation where everywhere you turn – restaurants, stores, taxi-cabs – people are smoking. Greece is attempting to impose anti-smoking laws now – as of July 1, new laws banning smoking from hospitals, schools, and public places are going into effect. But restaurants can avoid the ban if they create smoking sections and they will also be allowed to ban non-smokers if they don’t want to have a smoking section! This is the third attempt in 10 years to curb smoking in Greece: it will be a hard habit to break.
3. Greek highways and roads are not for the timid. Greece ranks among the highest European countries in terms of road traffic accidents per kilometer traveled. Athens has done a great job of making itself more pedestrian friendly in recent years, although the narrow streets, lack of attention to speed limits, and lack of attention to parking regulations makes it difficult in places to get around on foot and it would be impossible in a wheel chair.
4. On the other hand, compared to my suburban American home I was able to walk much, much more in Greece than I am at home. Exercise came naturally and easily, built in to every day just getting from here to there. In one place we went, cars weren’t even allowed within the town limits. There’s something to the idea that “car culture” destroys the chance to live an active life.
5. When they tell you not to drink the water, don’t drink the water. They know what they’re talking about!
And, finally, the first thing I did when I got back to the states was get the flu! "Welcome Home!"
They say traveling is a great way to see your own home in a new light. It helps me to appreciate what we do well in the states, and what we could do better.
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We never leave public health behind do we? My spouse and I traveled to Antigua for our honeymoon 10 years ago. From the airport to the resort I admired the numerous concrete walls sporting paintings of mosquito-borne disease warnings and prevention steps rather than the active volcano and exotic fruit trees. When we went to the harbour, I ended up in a discussion with the merchants about HIV testing and prevention rather than looking at the colonial buildings and ships. Traveling away does help me bring perspective and gain appreciation for the advances we have made. Welcome home! Shirin Scotten
I was thinking about this last night and it reminded me of a conversation I had with a woman from the Dominican Republic last weekend in Craven County. I started talking with a woman working behind the counter at a convenience mart. She didn't speak English very well at all so we communicated in Spanish. (It may be an insult to the Spanish language to say we "talked".) She started telling me about her teenage boys and how she wanted a daughter more than anything in the world. She said she had miscarried a girl at 4 months because there was no heartbeat. She said her friends back home (D.R.) asked why she didn't get the heart problem fixed so she could have had a healthy daughter. She said her friends had said "You live in the United States! They can fix anything!" She and her friends and family back home have this perspective that our medical establishment has the ability to fix anything and everything! (She didn't say to me that she thought the doctors didn't fix her pregnancy because of her insurance or immigration status but I'm sure the potential for thinking it exists. I DID address her misunderstanding among other things.)
This experience reminded me that people who are not native to the US don't have just a language and cultural barrier. It also reminded me of how much we ourselves take for granted in terms of our own health. We expect to have healthy toddlers from positive pregnancy tests. We expect our children to outlive us. If we expect the medical community to fix our pregnancies and newborns, what does that say for preconceptual health and early prenatal care? If we expect the medical community to be able to fix us with replacement parts, medications and injections, or implanted equipment - what implications does that have for prevention and healthy lifestyle choices? And what does this say about how the world views us as medical leaders against the novel H1N1 flu? Shirin
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