Let’s #BreakTheChains

Break the Chains
Source: Human Rights Watch.

“I used to be chained around the waist and one ankle. My waist used to hurt because the chain was so heavy. My leg used to hurt, I would scratch it and cry. I felt relieved when the chain was removed.”

–Rose, Kenya

An estimated 792 million people globally – that is 1 in 10 people, including 1 in 5 children – have a mental health condition. Despite this irrefutable fact, governments spend less than two percent of their health budgets on mental health. The absence of proper mental health support and knowledge of how to cope with a mental health condition has lead to thousands of people being shackled in inhumane conditions.

“People in the neighborhood say that I’m mad [maluca or n’lhanyi]. I was taken to a traditional healing center where they cut my wrists to introduce medicine and another one where a witch doctor made me take baths with chicken blood.”
—Fiera, 42, woman with a psychosocial disability, Maputo, Mozambique, November 2019

This brutal practice is an open secret in many communities, according to Kriti Sharma, the senior disability rights researcher at the Human Rights Watch. Sharma and her team compiled a 56-page report titled “Living in Chains: Shackling People with Psychological Disabilities Worldwide,” shedding light on the conditions in which people with mental disabilities are bound by families in their own homes or in overcrowded and unsanitary institutions against their will. This is due to the widespread stigma and taboo of mental health issues within governments and health institutions in several countries. In state-run, private, traditional, and religious institutional “healing centers,” people with mental health conditions are often forced to fast, take medications or herbal concoctions, and face physical and sexual violence.

Afghan
“A mentally ill patient is chained in a cell at Mia Ali Saeb Shrine in Samar Khel, Afghanistan on Nov 12, 2008. Patients, usually brought here by family members, are only given daily rations of bread, black pepper and water, and are kept in their cells for 40 days. With mental illness widely misunderstood, many Afghans believe God will cure the patients with such treatment.” Source: Yahoo Images.

The Human Rights Watch’s study of 110 countries unveiled evidence of shackling people with mental health conditions across age groups, ethnicities, religions, socioeconomic levels, and urban and rural areas in about 60 countries. Countries that indulge in these types of practices include Afghanistan, Burkina Faso, Cambodia, China, Ghana, Indonesia, Kenya, Liberia, Mexico, Mozambique, Nigeria, Palestine, Yemen, and several more.

Though a number of countries have started to acknowledge mental health as a real problem, the inhumane act of shackling remains largely out of sight. There is no data or coordinated effort at either international or regional level to eradicate the binding of people who are mentally ill. The act of shackling impacts both the mental and physical health of someone who is already ill. Some effects include post-traumatic stress, malnutrition, infections, nerve damage, and cardiovascular problems, not to mention the loss of dignity. The #BreakTheChains Movement is an organization devoted to bringing awareness of shackling to nations and increasing access and awareness of mental health services in countries where shackling is a common problem. The movement has been successful in Indonesia where its country-wide interviews and advocacy led the government of Indonesia to deepen its commitment to #BreakTheChains. Over 48 million households in Indonesia now have access to community-based mental health services.

Laymen can also assist the movement by following two easy steps: sign the pledge, and share the movement on social media to promote awareness. It is time to acknowledge that mental health is a real issue that affects millions of people, and shackling and ignoring the issue will not resolve any issues, nor will it reduce the stigma associated with mental health. If we, as global citizens, have learned anything from this pandemic, it is how deathly and dangerous the invisibility of a disease is. Mental health is invisible like COVID-19, but there are always symptoms. Make an effort to educate yourself, and take the opportunity to check in on people by simply asking how someone has been. It really is that simple.

Brief Video about the Chained

World Diabetes Day

A hand pointing to text underneath it which reads "World Diabetes Day"
World Diabetes Day. Source: Ashley Huslov, Creative Commons

World Diabetes Day is recognized globally on November 14th. It’s important to recognize the progress we’ve made in managing diabetes. In the past, a diagnosis of diabetes was devastating in many ways: type I and insulin-dependent type II diabetes were often fatal until the discovery of insulin in 1921; gestational diabetes drastically worsened pregnancy outcomes for women and their babies; and other types of type II diabetes resulted in severe complications. Diabetes now has become known as a serious, but treatable, disease. While medically we’ve come a long way with the treatment of diabetes, there are still improvements that need to be made in relation to the social treatment.

Despite the great strides made in the medical community in regard to diabetes, people with diabetes still face hardships and discrimination in the workplace, the classroom, and in the health sector. Many people with diabetes need accommodations in the workplace that are protected by the Americans with Disabilities Act (ADA). For example, many people with diabetes have rapid drops or spikes in blood sugar—hypoglycemia and hyperglycemia, respectively—and they need to take time to remedy it. If an employer does not accommodate these needs, they are in direct violation of the ADA. There are exceptions, such as when hyperglycemia, hypoglycemia, or the breaks make the employee unable to do the essential function of the job. However, in many workplaces, these breaks are possible.

Kristine Rednour was hired as a reserve paramedic for the Wayne Township Fire Department (WTFD). When she was hired, she let the WTFD know that she had type I diabetes. She was promoted to full time, and during work had two hypoglycemic episodes within the same year, which affected her ability to respond as a paramedic. She was put on paid leave, during which she was required to have the medical director clear her. He cleared her for restricted duties and with workplace accommodations, which the WTFD refused to put in place and instead fired her. She sued the WTFD for violating the ADA and won. This is just one of many examples of workplace discrimination that people with diabetes face.

The ADA also protects children at school that have disabilities, including diabetes. However, like with employment discrimination, discrimination at school still occurs. Schools that receive federal funding are required to be able to make accommodations for students with diabetes, such as allowing them to have snacks and having staff that is qualified to administer care.

Some schools don’t offer these accommodations, especially the latter, which can put children at risk for life-threatening medical complications. Some schools even tell parents that their children will not receive medical assistance from staff even if the complications have become so severe that they are unconscious. Often, parents have to put their jobs on hold to be able to make trips to school to check on their children, potentially placing them under increased financial strain.

Blood Glucose Monitors can send blood sugar levels to an app that the child can download and have more immediate updates on their blood sugar. For some children with severe type I diabetes, they can find out life-saving information about what would otherwise be a severe drop in blood sugar. However, many schools are unwilling to accommodate students by letting those with diabetes access their phones or the Wi-Fi, which puts them at risk for missing a life-threatening drop in blood sugar.

Some children have been denied entrance into schools because they have diabetes, which violates the ADA if the school receives federal funding. Many students are sent to schools that they are not zoned for because the schools closest to where they live do not have staff trained to take care of them, despite the requirement of this accommodation. This means that parents have to drive their students to a school farther away, potentially disrupting their ability to get to work. Some schools participate in this type of discrimination knowingly, while others do not understand enough about diabetes or the ADA. Regardless, denying entry into a school because of a disability is a direct violation of the ADA.

Due not only to the discrimination those with diabetes face, but also the stress and anxiety of not knowing when they’ll have a drop or spike in blood pressure, people with diabetes often suffer from worsened mental health, which according to many sources, including the UN, is a human right. This lessened mental health takes many forms: people with diabetes are two to three times more likely to suffer from depression; diabetes distress can occur when a person with diabetes feels controlled by their illness instead of the other way around; and when physical health gets worse, mental health often follows. It is important for people with diabetes to know they can seek medical attention for their mental health as well as their physical health.

The final place people with diabetes face a violation of their human rights is in the healthcare setting. Healthcare is expensive even without taking into account chronic diseases, especially medication. Insulin is a relatively cheap and easy medication to make. In the 1990s, a one month supply was less than $50, whereas now it’s upwards of $200, which is not accounted for by inflation. For people without insurance, or those that are underinsured, this can put a huge financial burden. This has led to people with insulin-dependent diabetes to ration their insulin, which can lead to death. For example, a nurse, who knew how to manage her diabetes, was found dead due to not using enough insulin. For people with insulin-dependent diabetes, insulin is a human right, which is being denied to many by the sharp increase in prices.

People with diabetes now are able to live happy and healthy lives, especially compared to a hundred years ago. However, they are still set back due to discrimination and human rights violations. It is important as a society to work towards removing the barriers that people with diabetes, among other disabilities, face so that they have access to health, both mental and physical.

STD Rates Among the Poor and Homeless in Alabama

by Kelsey Johnson (guest blogger)

Picture of a homeless shelter with people standing around and lying down, waiting for a meal and a bed
Source: Yahoo Images

As of 2018, approximately 38.1 million people in the U.S. live below the poverty line. Furthermore, on a given night, over 550,000 people experienced homelessness. 

Of those numbers, more than 800,000 Alabama residents live in poverty, making it the sixth poorest state in the U.S. Approximately 3,434 people experience homelessness in Alabama on a given night. 

Poverty and a lack of adequate housing are considered human rights violations, as they interfere significantly with an individual’s ability to live safely and with dignity. For people experiencing poverty and/or homelessness, these situations impact all aspects of their lives, especially their physical health.

One way that these health issues manifest is in the prevalence of sexually transmitted diseases (STDs) and HIV/AIDS among these populations. Overall, rates of STDs, particularly chlamydia, gonorrhea, and syphilis, are at an all-time high in the U.S., according to a 2019 report from the Center for Disease Control and Prevention (CDC). In 2017-18, there were nearly 2.5 million total reported cases of the three STDs, including over 1.7 million cases of chlamydia, 583,405 cases of gonorrhea, and 115,045 cases of syphilis. 

Two urban areas in Alabama, Montgomery and Birmingham, are among the top 20 U.S. cities reporting the highest rates of STDs, including HIV, syphilis, gonorrhea, and chlamydia. Mobile and Huntsville also ranked in the top 100. Alabama has the fourth highest rate of gonorrhea infections in the country. Additionally, as of 2016, there were 12,643 people in Alabama living with HIV. 

While the CDC report examined STD prevalence among various demographics, it did not focus on STD rates among low-income or homeless populations. However, a literature review published in 2018 in the journal Sexually Transmitted Diseases found that STD prevalence ranged from 2.1% to 52.5% among the homeless adult population. 

This study also identified many of the factors that increase the risks of contracting an STD among homeless individuals. A number of these risk factors also apply to individuals living in poverty, even if they have stable housing. Additional studies offer more insight into the recent rise in STD cases, as well as recommendations for how to decrease their spread among all populations.

Factors contributing to STD prevalence among low-income and homeless populations 

There are several factors that contribute to the prevalence of STDs in low-incomes and homeless communities, including lack of access to affordable prevention and treatment options; lack of comprehensive sex education; the comorbidity of issues like mental illness or substance abuse, and the stigma surrounding STDs. 

According to a 2019 report by the National Coalition of STD Directors, “…poverty is both a cause of infection, and a barrier to the ability to seek care. Poorer populations are less likely to receive appropriate sexual health education, suffer higher rates of substance abuse, and may have more trouble accessing sexual health services.”

Poor or homeless individuals are less likely to have health insurance, or resources to pay for out-of-pocket healthcare costs. Many individuals living in southern states, including Alabama, fall into what is known as the coverage gap, meaning they make too much money to qualify for Medicaid, but not enough to pay for health insurance.

Even if individuals have health insurance, their coverage may be limited to certain providers or services, and may exclude STD testing or treatment. The time and money it takes to travel to healthcare facilities, especially in predominantly rural states like Alabama, also present a barrier to care, even for insured individuals. 

Additionally, budget cuts have forced many STD clinics to close or reduce their services. The loss of these clinics is harmful because not only do they often provide STD testing and treatment on a sliding fee scale, they are staffed by individuals with specialized knowledge in diagnosing and treating STDs.  

The other primary factor in higher STD rates is a lack of comprehensive sex education. As the NCSD report states, “States typically define the broad parameters of sexual health education in public schools. Not surprisingly, these parameters vary widely among states.” Studies show a correalation between insufficient sex education and higher STD rates. Kathie Hiers, the CEO of AIDS Alabama, says the state represents a “perfect storm” for the spread of AIDS and other STDs, in part because of its “poor educational systems that often ignore sexual health.”

This lack of education about STDs also perpetuates the stigma surrounding them, which prevents people from seeking treatment, according to Hiers. Other conditions that are prevalent among poor and homeless populations, including mental illness, incarceration history, and intravenous drug use, also make individuals more susceptible to STDs, and present barriers to seeking treatment.

How to prevent the spread of STDs among low-income and homeless populations

The studies and experts cited in this post offer several recommendations for steps that can be taken, nationwide and in individual states, to decrease the spread of STDs among low-income and homeless populations, including: 

  • Removing financial barriers to healthcare, including adopting Medicaid expansion. The Alabama Hospital Association estimates that by adopting Medicaid expansion, an additional 300,000 residents would be eligible for health insurance.
  • Increasing or restoring funding to public health agencies and STD clinics that provide free or low-cost testing and treatment.
  • Improving access to healthcare facilities through transportation and operating on evenings and weekends.
  • Providing comprehensive sex education in schools. In 2019, the Alabama House of Representatives failed to address a bill that would have made the state’s sex education curriculum more scientifically and medically accurate. The bill would have updated the curriculum’s language to address “sexually transmitted diseases” as “sexually transmitted infections,” which is considered less stigmatizing.
  • Expanding resources to support homeless individuals, and increasing their access to stable housing. A 2016 report by the Homelessness in Alabama Project offered several specific recommendations for addressing homelessness in Alabama.

Additional Resources