Public Health and Primary Care
Public Health and Primary Care
Imagine you and your family ( a spouse, three children, including a new baby, and one frail elderly relative) live in a rural setting in a country that has entered into violent civil war based upon political and ethnic differences. In the setting of the ensuing complex emergency discuss the factors from your own family’s perspective and needs that will influence your decision to:
1. remain in your home or
2. become internally displaced or
3. seek refuge in a neighbouring country.
Introduce us to your fictitious family, and explain their ‘health needs’. Then you should discuss and debate each option in turn supporting your arguments with relevant evidence
25% Description of ‘family’ and analysis of their needs
25% each for the discussion of the separate options.
1) Mrs. Wellbeing, Wife
Aged 34, Mrs. Wellbeing is a stay-at-home mother but is also working as a typist. Her work is basically home-based and is working for 4 hours particularly between 10 pm and 2 am. She thereby needs quiet times to finish her daily work -- Mondays to Saturdays -- that is why she is doing it after the children are fallen asleep. Because of the nature of her work, however, she is slowly developing acute insomnia without her knowing it.
2) Mr. Wellbeing, Husband
Six years her senior, Mr. Wellbeing is also working as a tricycle driver with routes going to and from within the rural vicinity. He is working from 5 am until past 7 pm but he is going home for dinner to eat with his family. While he is resting on Sundays to prepare for the week ahead of tedious work, he would like to spend the rest of his days doing rounds in the community being an active member of such.
3) Sister, Eldest Child
Sister, who is in her 9th grade of school in a community elementary school, is now 10 years old. She goes to school from 7 am until 12 nn, her father fetching her on the way to school and to home. She is in top of her class since devotes much of her time to her studies other than attending to some of the chores that Mrs. Wellbeing might require her.
4) Brother, Middle Child
Brother is also going to school from 12nn until 5 pm ever and his father is also fetching him to and from the school. Brother is asthmatic and he acquired it since he was two years old, recurring at least once every two years. Brother is now 6 years old. He is especially vulnerable to dust that is why he is wearing mask when he is outside the house.
5) Baby, Youngest
Wellbeing family had welcomed a baby boy two months ago. He was born in the community hospital on a normal delivery. Mrs. Wellbeing is currently on breastfeeding.
Mr. Wellbeing’s mother is living with the family. As she is 72 years old, she is now weak but she is not a bed-ridden. However, she has risks of falling inside and outside the house hence she needs to be guided every time. Mrs. Wellbeing aside from taking care of her baby is also taking care of her. She is being helped by Sister whenever she has the time to do so.
The ongoing war therefore affects the daily routine of the Wellbeing family. Nonetheless, they have the option to stay. If they are going to stay, however, there are risks such that the education of the children and the employment of Mr. Wellbeing might be disrupted, leaving the family with limited budget to come by. As Mrs. Wellbeing’s job is only on a part-time basis, the financial gain from this may not fully support the needs of the family in the long run.
As such, the war may also affect the health conditions of the whole family. For one, Mrs. Wellbeing may not fully concentrate on her job which can eventually lead to anxiety. Mr. Wellbeing, since the war is affecting the finances of the family, may eventually feel depressed, while both may also feel frustrated about the stability in the local education situation since there is a possibility that schools may close because of what is happening.
This has also direct effect on Sister and Brother especially for the latter who prioritises her education so much. Sister may also feel anxious although she may not admit it which is also alarming because a child inflicted by the consequences of war tend to hide feelings and emotions, being traumatized. Their psychological health will be affected by the way they might perceive the things that are happening to them because of war (Clifton-Everest, 2005).
The family could be more traumatized in light of emergencies that may occur within the vicinity. Urgency of the situation requires that the family must be always at close hand so that when these things happen they could easily vacate to another location perhaps like a temporary shelter when necessary. It would be extra difficult is a member of the family will gone missing as this can cause more anxiousness with each member (UNHCR, 2007; WHO).
On the other hand, the family can also travel to another area away from the war inside or outside the country. When they chose to become internally displaced, however, they may also experience trauma and coping up with not be that easy especially that they will be new to the place and adjustment requires that a strong social support should be evident, which may be also difficult initially. If this would be a plausible choice for the family when they can seek the help of WHO and its programs at the country level. With WHO, the family can seek health services to address their current health needs especially since they can be basically considered as a vulnerable group (WHO, 2009; WHO-IASC).
Same goes with when they chose to seek refuge in another country. In addition to the above dilemma, travelling and starting a new life in another country requires financial backup to which Wellbeing family have not readied themselves for. For the children, they will definitely have to have friends so that they can be accustomed to the new environment. Their social health would be affected which may eventually manifest in the way they will deal with the problems, withdrawing to function socially (Garrison, Roy and Azar, 2001).
Physical health of the older members of the family including Grandmother might be also jeopardised since Mr. and Mrs. Wellbeing might be too consumed to think of ways to keep up with the changes. Emotional health, for instance, may directly affect the mood swings and the capability to make decision and act on such decisions made. The relationship of Mr. and Mrs. Wellbeing as husband and wife may be also affected in the process since there could be mood swings and differences in scheme of things that each may prioritise.
This may spring from the fact that Grandmother may be considered as an extra [financial and time] burden particularly by Mr. Wellbeing. Grandmother also may eventually feel excluded in the family and such that may feel depressed also. Since there could be a struggle to be independent, she may do things her way which is not advisable because she is prone to falling (Godfrey and Kalache, 2009).
Clinton-Everest, I 2005, Meeting the Mental Health Needs of Children Who Have Been Associated with Fighting Forces, International and Cultural Psychology Series, pp. 81-96.
Garrison, E G, Roy, I S & Azar, V A 2001, Responding to the mental health needs of latino children and families through school-based services, Clinical Psychology Review, vol. 19, no. 2, pp. 199-219.
Godfrey, N & Kalache, A 2009, Health needs of older adults displaced to Sudan by war and famine: Questioning current targeting practices in health relief, Social Science & Medicine, vol. 28, no. 7, pp. 707-713.
Inter-Agency Standing Committee (IASC), Initial Rapid Assessment Field Assessment Form
UNHCR Handbook for Emergencies 2007, Office of the United Nations High Commissioner for Refugees.
WHO 2009, Essentials for Emergencies.
WHO Health Cluster Guide: A practical guide for country-level implementation of the Health Cluster.