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EMS at 3600 Meters: Exploring Barriers to Emergency Care and Transport in Rural Andean Perú
- Alison H. Vasa, Karen A. Falkenstein, Wayne A. Centrone
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- Journal:
- Prehospital and Disaster Medicine / Volume 36 / Issue 6 / December 2021
- Published online by Cambridge University Press:
- 02 November 2021, pp. 788-792
- Print publication:
- December 2021
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- Article
- Export citation
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Background:
Given the demonstrated success of programs that bolster informal Emergency Medical Service (EMS) systems in other low- and middle-income counties (LMICs), this study aimed to explore formal and informal systems, practices, customs, and structures for emergency response and medical transport in Colca Valley, Perú while identifying possible opportunities for future intervention.
Methods:Twenty-two interviews with first responders and community members were conducted in three mountain villages throughout rural Andean Colca Valley of Perú. Subjects were recruited based on profession and experience with medical emergencies in the area. Transcripts were entered into Dedoose, coded, and analyzed to identify themes.
Results:Providers and community members shared similar perceptions on the most common barriers to emergency care and transport. Challenges experienced equally by both groups were identified as “structural problems,” such as lack of infrastructure, lack of structured care delivery, and unclear protocols.
Incongruities of responses between groups emerged with regard to certain barriers to care. Providers perceived baseline health education and use of home remedies as significant barriers to seeking care, which was not proportionally corroborated by community members. In contrast, 86% of community members cited lack of trust in health providers as a major barrier.
Community members often noted witnessing a high frequency of emergency events, their personal experiences of helping, and the formal utilization of lay providers. When specifically questioned on their willingness to engage in first aid training, all participants were in agreement.
Conclusion:While structural changes such as increased infrastructure would likely be the most durable improvement, future interventions focused on both empowering community members and improving the relationship between the health center and the community would be beneficial in this community. Additionally, these interview data suggest that a layperson first aid training program would be feasible and well-received.
Thirteen - Ending the Persistence of Homelessness
- Edited by Glenn W. Muschert, Kristen M. Budd, Miami University, Michelle Christian, University of Tennessee, Knoxville, Robert Perrucci, Purdue University, Indiana
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- Book:
- Agenda for Social Justice
- Published by:
- Bristol University Press
- Published online:
- 12 March 2021
- Print publication:
- 05 August 2020, pp 127-134
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- Chapter
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Summary
The Problem
Homelessness has been with us for generations and the problem shows no real sign of ending. Despite rapid innovation in homelessness services and indicators of success over the last few decades, hundreds of thousands of people can still be counted on the streets and in shelters in the United States on any given night. Homelessness is also increasingly criminalized. In this chapter, we argue that despite being in an era in which we have a lot of information about homelessness, making a difference will require shifts in thinking and practice. These include broadly viewing homelessness as a social symptom that can be treated, respecting common humanity, prioritizing social equity, coordinating efforts across services and sectors, and improving prevention and coordinated response efforts. Such changes can facilitate better access to and quality within housing, employment, and health and social services. After briefly reviewing the history of homelessness in the United States and describing our current state of knowledge, we further elaborate on our recommendations.
Numerous scholars have described the history of homelessness in the United States alongside changing social factors— industrialization, the great depression, the New Deal, and nuanced contemporary times. Attention has ebbed and flowed, with varied concern and relationships between public and private sectors. The tail end of the era of deinstitutionalization— a period of time in which people were transferred out of the confined spaces of asylums and into community oriented care— is often associated with increased homelessness, but deinstitutionalization as a primary cause is disputed and, importantly, this period coincided with a confluence of additional factors such as reductions to welfare (including the dismantling of social sector housing), wage stagnation, declining union strength, growing income inequality, and rising housing costs. In any event, greater public exposure to extreme poverty and homelessness during this period precipitated a movement of sorts. Organizations such as the Community for Creative Non-Violence, led by the likes of charismatic leaders like Mitch Snyder, conducted hunger strikes, tent-city protests, and housing marches to advocate for housing as a basic human right.
The passage of the McKinney– Vento Homelessness Assistance Act of 1987 was a legislative success. McKinney– Vento funds transitional housing, job training, primary care, education, and permanent housing. Private and public sector funding converged at this time as well.