Medicaid and Community Living

Medicaid and Community Living

• Community living, for people with disabilities, means having autonomy and control over daily life, like having health aides or avoiding institutionalization.
• Medicaid access varies by state, creating difficulties for those moving.
• Obtaining Medicaid often requires meeting strict poverty requirements due to complex bureaucratic processes.

Disability Discourse

• Medical Model: Views disability as a personal problem to be overcome. The focus is on the individual's body and fixing it.
• Social Model: Views disability as a result of societal barriers. Focus is on creating a more inclusive and accessible society.

The Pastoral Clinic - Intro and Ch. 1

• Setting: New Mexico's Espanola Valley, focusing on heroin addicts.
• Nuevo Dia's services: Detox, often court-ordered. Patients stay for a time determined by the courts or leave earlier.
• Chronicity model: Addiction is a persistent, lifelong condition.
• Drug court: Shapes lives by dictating treatment, including mandatory therapy or recovery programs.
• Garcia's role: Minimum wage detox attendant, working overnight, dealing with withdrawal symptoms.
• Detox experience: Painful and challenging.

The Pastoral Clinic - Ch. 2

• Mourning vs. Melancholy: Mourning is temporary, while melancholy is prolonged sadness, often associated with historical events.
• Melancholy reasons: Historic land losses.

The Pastoral Clinic - Ch. 3

• Addiction transmission: Chapter discusses the intergenerational impacts of addiction.

The Pastoral Clinic - Ch. 4

• Intentional overdoses: Beatrice (ER nurse) observes some overdoses may be intentional but not always recognized.
• Inevitability of overdoses: Related to the chronicity model, suggesting treatment limitations given addiction's longevity.

The Pastoral Clinic - Ch. 5

• Medicaid reform's impact: Medicaid implemented managed care models, increasing the cost to the states, which then cut costs in response.
• Family caregiving: Families often provide care when the state support systems fail.

General Questions

• Heroin epidemic's roots: Historic melancholy, poverty in the region.
• Complexity of solutions: Multifaceted challenges, requiring a combination of strategies.
• Blamed parties: The inadequate support of the broader system with both insufficient facilities and a lack of well resourced treatment plans.

Film: The Waiting Room

• Long ER wait: Doctor shortages, lack of prioritization, some patients needing dialysis.
• Healthcare system insights: Shows a demanding system, unsustainable for many, especially those without significant financial backing.

Presentation: Iana Castro

• Food insecurity characteristics: Availability, access, and affordability
• Brightside Produce's approach: Making healthy, affordable, organic food accessible in various locations.

Film: Bending the Arc

• Paul Farmer's goal: Equitable high quality healthcare for the poor and vulnerable, specifically addressing HIV/AIDS and TB.
• Accompaniment system: Local support for patient care, improving treatment adherence and patient wellness.
• Public health skepticism: Skepticism about the success of treatment programs, sometimes prioritizing prevention over treatment.

Video: The Problem with Race-Based Medicine

• Bi-Dil: A heart medication initially marketed only to Black people.
• Problematic race-based prescribing: Reinforces stereotypes, overlooks individual variation.
• "Correcting" for race: Adjusting algorithms and protocols, which is inaccurate in its implementation for it reinforces racial bias.

Podcast: Code Switch: Finding a Perfect Match

• Donor match disparities: European ancestry has a higher representation in bone marrow registries.
• Non-biological barriers: Medical mistrust, socioeconomic challenges and a lack of general awareness make access difficult for marginalized groups.
• Different health care experiences: Exposure to different levels of bias and access across identity backgrounds, impacting chances for medical support.

Article: Genetic Ancestry in Precision Medicine

• Race vs. Ancestry: Race is a societal construct, while ancestry is measurable.
• Relevance in precision medicine: Genetic ancestry is more relevant than race when considering treatment outcomes.
• Examples: Genetic marker associations of diseases and their impacts by ancestry.

Lecture: Stress and Health

• Sympathetic response: Fight-or-flight, physical responses.
• Parasympathetic recovery: Counteracts the sympathetic response, normalizing physiological functions.
• Chronic stress and health problems: Contributes to diabetes and heart disease.
• Stress benefits: Adaptive, preparing for immediate threats.
• Human maladaptation: Unique thought processes and social structures affect the stress response. The environment and inequalities contribute to stress.

Article: Something About Being Black is Bad for Your Body

• False explanations for racial disparity: Age, socioeconomic status.
• Author's explanation: Chronic stress from racism negatively impacts Black women's health and pregnancy outcomes.
• Weathering: Cumulative effects of chronic stress.
• Allostatic load: Cumulative health problems caused by chronic stress.
• Microaggressions: Contribute to weathering due to continuous stress and feeling disrespected.

Article: Of Men and Messages

• PTSD symptoms: Variable but often include avoidance, emotional numbness, flashbacks, and hypervigilance.
• Hegemonic masculinity: Societal pressure for men to be assertive, strong, and stoic; leading to emotional suppression in response to stress.
• Family reactions: Families may not recognize or address the symptoms of PTSD due to norms around emotional expression in men.
• Latino men responses: Different responses to trauma than other groups.
• Difficulty seeking help: Stigma, societal expectations, a lack of treatment options.

Podcast: The Retrievals

• Yale fertility clinic incident: A specific issue, potentially involving improper handling.
• Women in healthcare: Illustrates unique challenges for women in healthcare settings.

Podcast: Tested

• Intersex: Variations in physical sex characteristics.
• Mboma: Forced to undergo hormone treatment.
• Excluded groups: Intersex, transgender, those without the financial means to undergo hormone treatment.

First Half of Semester Review

• Theoretical approaches (medical anthropology): Biological, ecological, ethnomedical, meaning-centered.
• Medicalization: Process of labeling problems as medical issues.
• Hegemony: Power of dominance, dominance in belief systems