#1 In chapter 11,

Cecil Helman talks about stress and the culture differences stress can have on people. Hans Selye (1936) was the first person to discuss stress. Selye (1936) tells us that "stress is the generalized response of an organism to environmental change."(p288) Selye used the word stressor to describe that environmental change. Selye then came up with the GAS model, General Adaptation Syndrome, to lay out the basics of his understanding of stress.

First our bodies are alarmed, then our bodies attempt to adapt, and finally our bodies hit exhaustion. While most psychologists' agreed with Selye, they all also agreed there was more to stress. They expanded on what exactly a stressor could be saying that it is not only an environmental change that can cause stress but things like illnesses, trauma, disasters, divorce, employment status, war, and financial issues.

Psychologist Parkes mentions that not only can stressors be from negative things but they can also come from positive things like promotions, marriages, births, and winning the lottery. WHO, describes this as "stress is representation of an unsuccessful attempt on the part of the body to deal with adverse factors in the environment". (p290)

Cultural factors that can affect stress on a patient include characteristics, physical environment, social support, economic status, and cultural backgrounds. Individual characteristics are referring to the age, weight, race, sex, and health of a patient. Stress affects everyone differently and if a patient is in good health the stress could have not as major of an effect on their body. Larson, Ahrndt, and Jansen talk about a very common effect stress can have on our bodies. Stress has the potential to cause us to have ulcers. Weinman also tells us that a patients childhood experiences can also affect the way stress appears.

Stress can also be caused but the environment that a person lives in. An example of environment stress can be that if someone lives in an area where they have a lot of natural disasters then the patient might always be stressed by the damage that is done by these natural disasters. Brown and Harris talks about how social support can affect stress. One study they preformed showed someone who had social support was less likely to be affected by depression later in life. Economic status is a stress that most patients seem to be affected by.

Parkes told us earlier that the initial thought it that if a patient has low income then they are stressed, but we also forget that someone with a good bit of money still has some stress. The culture we live in affects our stress levels as well. If a patient comes from a culture that is laid back and just goes with the flow stress can have a lesser affect on them than a patient that comes from a very controlling culture.

Helman, C. (2007). Culture, Health and Illness. Diet and Nutrition. Fifth Edition. p. 288-293.

Larson, A., Ahrndt, S., & Jansen, T. (2016). Stress Ulcer Prophylaxis: Who, When, and Why Stress Out About It?. South Dakota Medicine: The Journal Of The South Dakota State Medical Association, 69(4), 176-177. http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&sid=fd2af64f-b87e-4ed6-b6e8-bcb537ef38d9%40sessionmgr4007&hid=4211

#2 chapter12

What does the migration of healthcare professionals have on global healthcare?

Migration has always been a human trait, movement of people with their resources from one place to another in a bid to finding a better place to settle down. This has been happening as far back as when mankind started inhabiting the earth. I believe that proper documentation did not exist until a few centuries ago.

A number of archeologists had carried out researches on this, coming up with varying claims as to how long ago, and precisely the races involved in these migrations. Gugliotta, G. in his article ‘the great human migration' in the Smithsonian magazine (July 2008), claimed this migration took place 80,000 years ago, when humans set out from their home in Africa to colonize the world. Looking at migration today, the reasons for it are numerous as illustrated by Helman (2007), chapter 12, with particular reference to healthcare professionals (HCPs).

The migration of HCPs for better conditions of service has a disproportionate distribution on the global healthcare system. As Helman (p.312) elaborates, the growth of international labor market paved the way for healthcare worker abandoning poorer countries for the richer ones that pay better wages; resulting in ‘brain drain' and ‘brain gain'.

My country of birth, Nigeria, suffered a huge migration of its HCPs in the 1980s when the policies of the then military regime impacted negatively on the health sector. It is still felt up till now. The health sector was grossly under-funded, medical equipment could not be purchased, infrastructures were left to rot, salaries and allowances did not improve. This led to mass migration of HCPs to the middle east (Saudi Arabia, UAE, Bahrain) and Europe.

This pattern is found in most countries of sub-Saharan Africa. Most of these personnel were trained by the government and on bonded to serve the nation for a certain number of years after training. But such conditions could not hold them back because the atmosphere for meaningful work was absent. Even those in training outside the country, on learning of the harsh working conditions at home opted chose not to return.

According to WHO (2013) in a ‘policy dialogue....' points out that "that many countries of the world, so long as their services are needed and valued better in other countries of the world, this trend of health personnel moving from England to Australia, Canada, Copenhagen and the united states and vice versa will continue".

Within the borders of a country, the drift is to cities and private practice where the pay and amenities are better than in the rural and government-run hospitals. As pointed out by Helman (2007), ‘In 1994, 52% of the doctors in Mozambique were concentrated in Maputo the capital' (p.94).

In the long run, the HCPs, after the laborious training they go through, want to be paid handsomely in compensation. World health Organization (WHO), according to Helman, (p.90), ‘In 1978 issued its famous Alma-Ata declaration of Health for All by the Year 2000'. Did it work? No.

With what I have illustrated and other setbacks caused by natural disasters, man-made disasters and political insensitivity of governments against their people, the declaration is doomed to fail. Nair, M. and Webster, P., (2013) also corroborated the fact that migration as cited by WHO has been the cause of shortage and disparity in the distribution of HCPs among the population in many countries, especially 57 being in sub-Saharan Africa (p. 157).

Now, that we know some causes for the imbalances created by the migration of Healthcare professionals in the global healthcare system; what can be suggested to correct these imbalances?

REFERENCE

Helman, C. G., (2007), CULTURE, HEALTH AND ILLNESS, (5th edition), Boca Raton, FL. Taylor and Francis Group.

Gugliotta,G., (July, 2008) SMITHSONIAN MAGAZINE; ‘THE GREAT HUMAN MIGRATION'

www.smithsonianmag.com/history/the-great-human-migration-13561

Nair, M. and Webster, P., (2013). HEALTH PROFESSIONALS' MIGRATION IN EMERGING MARKET ECONOMIES: PATTERNS, CAUSES AND POSSIBLE SOLUTIONS. PUBLIC HEALTH. Vol. 35: p.157-163. http://www.ncbi.nlm.nih.gov/pubmed/23097260

WHO (2013). WHO POLICY DIALOGUE ON INTERNATIONAL HEALTH WORKFORCE MOBILITY AND RECRUITMENT CHALLENGES: TECHNICAL REPORT. COPENHAGEN: THE WHO REGIONAL OFFICE FOR EUROPE.

http://www.euro.who.int/__data/assets/pdf_file/0007/200698/WHO-policy-dialogue-on-international-health-workforce-mobility-and-recruitment-challengestechnical-

report.pdf