Ruth Kutalek

Geophagy and potential health implications: geohelminths, microbes and heavy metals

The practice of geophagy (soil-eating) is widespread among pregnant and breast-feeding women in sub-Saharan Africa. To assess some of the potential risks accompanying the consumption of geophagic material, we analysed contamination with bacteria, fungi, and geohelminths as well as heavy metals (lead, mercury and cadmium) in 88 African geophagic soil samples, which were purchased in Central, West and East Africa, Europe and the United States. Median microbial viable counts of positive samples were 440 cfu/g (maximum 120,000 cfu/g). The median metal concentrations were 40 mg/kg lead (up to 148 mg/kg), 0.05 mg/kg mercury (up to 0.64 mg/kg), and 0.055 mg/kg cadmium (maximum 0.57 mg/kg). No geohelminth eggs were found in these samples. Our results suggest that geophagic soil samples can be highly contaminated with microbes and may contain high levels of lead. Geophagy, however, is not a cause of adult helminth infection. The periodic consumption of geophagic materials at high dosages might be problematic particularly during pregnancy.

Ebola interventions: listen to communities

In late November, 2014, Liberia’s Ministry of Health and World Health Organization (WHO) Liberia did a rapid qualitative assessment (supported by the World Bank) of the perceptions of selected communities in Monrovia on an incentive scheme that intends to increase the reporting of EVD cases. Participants from various groups living in Monrovia were invited to participate in focus-group discussions: contact tracers, active case finders, community leaders, young people, and women. Participants argued that the following pressing problems have to be solved in order to curb the disease: 1) Provide food for families in quarantine. Although there are steps in place to provide all contacts with food while under follow-up, a substantial number of families who are quarantined do not receive food or they receive it late. It forces families to break the quarantine to buy food. (2) Enable reliable communication between Ebola treatment units and the families of the sick. Families are often not informed to which unit their loved ones are taken or what the condition of their relative is. People see the treatment units as “black holes” where loved ones disappear. (3) Restore and improve basic health services. Very few clinics and hospitals are operational; pregnant women especially are often rejected when they attend for delivery. (4) Provide psychosocial support to families of EVD patients. Supporting families who have lost loved ones should be an essential part of care in any Ebola response. (5) Include Ebola survivors in the teams of active case finders and contact tracers. The investigation revealed some important information from the demand side on how to make sure active case finding and community based EVD interventions work.

Why sub-Saharan African health workers migrate to european countries that do not actively recruit: A qualitative study post-migration

Background Many studies have investigated the migration intentions of sub-Saharan African medical students and health professionals within the context of a legacy of active international recruitment by receiving countries. However, many health workers migrate outside of this recruitment paradigm. This paper aims to explore the reasons for migration of health workers from sub-Saharan Africa to Belgium and Austria; European countries without a history of active recruitment in sub-Saharan Africa. Methods Data were collected using semistructured interviews. Twenty-seven health workers were interviewed about their migration experiences. Included participants were born in sub-Saharan Africa, had trained as health workers in sub-Saharan Africa, and were currently living in Belgium or Austria, though not necessarily currently working as a health professional. Results Both Austria and Belgium were shown not to be target countries for the health workers, who instead moved there by circumstance, rather than choice. Three principal reasons for migration were reported: 1) educational purposes; 2) political instability or insecurity in their country of origin; and 3) family reunification. In addition, two respondents mentioned medical reasons and, although less explicit, economic factors were also involved in several of the respondents’ decision to migrate. Conclusion These results highlight the importance of the broader economic, social, and political context within which migration decisions are made. Training opportunities proved to be an important factor for migration. A further development and upgrade of primary care might help to counter the common desire to specialize and improve domestic training opportunities.

Depression and anxiety among migrants in Austria: A population based study of prevalence and utilization of health care services

BACKGROUND Although migrants form a large part of the Austrian population, information about mental health of migrants in Austria is scarce. Therefore, we compared the prevalence of dysphoric disorders (depression and anxiety) and the corresponding utilization of health care services of Eastern European, western and other migrants with the non-migrant population in Austria. METHODS We performed a telephone survey on a random sample of the general population of Austria aged 15 years and older (n=3509) between October 2010 and September 2011. Depression and anxiety were measured with the Patient Health Questionnaire-4 and utilization of health care services in the last 4 weeks was inquired. RESULTS 15.0% of our sample had a migration background. Female migrants from Eastern Europe, first and second generation, had a higher prevalence of dysphoric disorders (29.7% and 33.4% respectively) than Austrian women (15.2%) (p<0.001). The prevalence in the other migrant groups did not differ significantly from the Austrian population. There was no gender difference in dysphoric disorders in the Austrian population. After adjustment for age and chronic diseases, having a dysphoric disorder was associated with a higher utilization of health care services among migrant and Austrian women, but not among men. LIMITATIONS Because of the explorative nature of the study multiple testing correction was not performed. The reason for health care utilization was not assessed. CONCLUSIONS Mental health of female migrants from Eastern Europe should be studied in more detail; men could be an underserved group, both in migrants and Austrians.

African female physicians and nurses in the global Care Chain: Qualitative explorations from five destination countries

Migration of health professionals is an important policy issue for both source and destination countries around the world. The majority of migrant care workers in industrialized countries today are women. However, the dimension of mobility of highly skilled females from countries of the global south has been almost entirely neglected for many years. This paper explores the experiences of high-skilled female African migrant health-workers (MHW) utilising the framework of Global Care Chain (GCC) research. In the frame of the EU-project HURAPRIM (Human Resources for Primary Health Care in Africa), the research team conducted 88 semi-structured interviews with female and male African MHWs in five countries (Botswana, South Africa, Belgium, Austria, UK) from July 2011 until April 2012. For this paper we analysed the 34 interviews with female physicians and nurses using the qualitative framework analysis approach and the software atlas.ti. In terms of the effect of the migration on their career, almost all of the respondents experienced short-term, long-term or permanent inability to work as health-care professionals; few however also reported a positive career development post-migration. Discrimination based on a foreign nationality, race or gender was reported by many of our respondents, physicians and nurses alike, whether they worked in an African or a European country. Our study shows that in addition to the phenomenon of deskilling often reported in GCC research, many female MHW are unable to work according to their qualifications due to the fact that their diplomas are not recognized in the country of destination. Policy strategies are needed regarding integration of migrants in the labour market and working against discrimination based on race and gender.

“Why should I have come here?” - a qualitative investigation of migration reasons and experiences of health workers from sub-Saharan Africa in Austria

BackgroundThere are many health professionals from abroad working in the European Union and in Austria. The situation of sub-Saharan health workers in particular has now been studied for the first time. The objective was to explore their reasons for migration to Austria, as well as their personal experiences concerning the living and working situation in Austria.MethodsWe conducted semi-structured, qualitative interviews with African health workers. They were approached via professional networks and a snowball system. The interviews were transcribed and analysed using atlas.ti.ResultsFor most of our participants, the decision to migrate was not professional but situation dependent. Austria was not their first choice as a destination country. Several study participants left their countries to improve their overall working situation. The main motivation for migrating to Austria was partnership with an Austrian citizen. Other immigrants were refugees. Most of the immigrants found the accreditation process to work as a health professional to be difficult and hindering. This resulted in some participants not being able to work in their profession, while others were successful in their profession or in related fields. There have been experiences of discrimination, but also positive support.ConclusionsAustria is not an explicit target country for health workers from sub-Saharan Africa. Most of the study participants experienced bad work and study conditions in their home countries, but they are in Austria mostly because of personal connections. The competencies of those who are here are not fully utilised. The major reason is Austria’s current resident and work permit regulations concerning African citizens. In addition, the accreditation process and the German language appear to be barriers.

The Use of Gyrinids and Dytiscids for Stimulating Breast Growth in East Africa

ABSTRACT The use of whirligig beetles (Gyrinidae) and predaceous diving beetles (Dytiscidae) for stimulating breast growth in East Africa is a unique traditional practice. The beetles are collected by young girls from rivers and pools and held to their nipples where the beetles “bite” in a defensive reaction. Simultaneously the beetles secrete defensive substances which are produced in special glands to discourage possible vertebrate predators. Gyrinids produce, among other substances, norsesquiterpenes. The Dytiscids also possess prothoracic defensive glands, which produce, among other substances, hormone-like steroids. Larvae of antlions (Myrmeleontidae) are similarly used in East Africa.

Historical Parallels, Ebola Virus Disease and Cholera: Understanding Community Distrust and Social Violence with Epidemics.

In the three West African countries most affected by the recent Ebola virus disease (EVD) outbreak, resistance to public health measures contributed to the startling speed and persistence of this epidemic in the region. But how do we explain this resistance, and how have people in these communities understood their actions? By comparing these recent events to historical precedents during Cholera outbreaks in Europe in the 19th century we show that these events have not been new to history or unique to Africa. Community resistance must be analysed in context and go beyond simple single-variable determinants. Knowledge and respect of the cultures and beliefs of the afflicted is essential for dealing with threatening disease outbreaks and their potential social violence.

Diversity competence in medicine: equity, culture and practice

Diversity in medicine is a concept that aims at improving the health care of patients and at enhancing health equity. Ethnic and racial disparities have been documented in many contexts, thus diversity competence is specifically relevant when regarding the health of migrants, ethnic minorities and other vulnerable groups. Diversity competence considers socio-economic factors in health care, as well as the influence of ethnic and cultural background on how health and illness are perceived. It should therefore be a core concern for all health practitioners and a central focus in any health institution. Das Konzept von Diversität in der Medizin hat zum Ziel, die Gesundheitsversorgung von PatientInnen zu verbessern und Chancengleichheit zu ermöglichen. Kompetenz im Bereich Diversität ist besonders relevant, wenn es um die Gesundheit von MigrantInnen, ethnischen Minderheiten und anderen vulnerablen Gruppen geht, weil sich gezeigt hat, dass gerade diese Gruppen im Gesundheitssystem oft benachteiligt sind. Dieses Konzept ermöglicht es sowohl sozio-ökonomische Faktoren zu berücksichtigen, als auch mögliche Einflüsse des ethnischen und kulturellen Hintergrunds auf Vorstellungen von Gesundheit und Krankheit. Die Berücksichtigung von Diversität sollte deshalb ein zentrales Anliegen aller Akteure und Institutionen im Gesundheitsbereich sein.SummaryDiversity in medicine is a concept that aims at improving the health care of patients and at enhancing health equity. Ethnic and racial disparities have been documented in many contexts, thus diversity competence is specifically relevant when regarding the health of migrants, ethnic minorities and other vulnerable groups. Diversity competence considers socio-economic factors in health care, as well as the influence of ethnic and cultural background on how health and illness are perceived. It should therefore be a core concern for all health practitioners and a central focus in any health institution.ZusammenfassungDas Konzept von Diversität in der Medizin hat zum Ziel, die Gesundheitsversorgung von PatientInnen zu verbessern und Chancengleichheit zu ermöglichen. Kompetenz im Bereich Diversität ist besonders relevant, wenn es um die Gesundheit von MigrantInnen, ethnischen Minderheiten und anderen vulnerablen Gruppen geht, weil sich gezeigt hat, dass gerade diese Gruppen im Gesundheitssystem oft benachteiligt sind. Dieses Konzept ermöglicht es sowohl sozio-ökonomische Faktoren zu berücksichtigen, als auch mögliche Einflüsse des ethnischen und kulturellen Hintergrunds auf Vorstellungen von Gesundheit und Krankheit. Die Berücksichtigung von Diversität sollte deshalb ein zentrales Anliegen aller Akteure und Institutionen im Gesundheitsbereich sein.

Geophagy during pregnancy: Is there a health risk for infants?

ABSTRACT Prenatal lead exposure is a public health concern. Geophagy, the practice of soil eating, is documented for pregnant women of sub‐Saharan Africa to treat pregnancy‐related malaise. The soils however can contain substantial amounts of lead. In an exploratory study on 48 mother‐child pairs in the Democratic Republic of Congo, we found striking site‐specific differences in prenatal lead exposure, i.e., higher lead levels at Kisangani than at Isiro. Kisangani women consumed 1/ more often soil during the first trimester of pregnancy as well as 2/ a different type of soil compared to Isiro women (P<0.05). We conclude geophagy may be a potential source of prenatal lead exposure. HighlightsHealth implications of geohagy are poorly understood.Soils consumed by pregnant women often contain substantial amounts of lead.We studied soil consumption habits and blood samles of 48 mother‐child pairs.We found striking site‐specific differences of blood lead concentrations.Geophagy is a potential source of lead exposure.