Caring for the Underinsured: The Structure of HealthCare Organizations in Indiana

Megan McLaughlin, University of Notre Dame

Abstract
Reliable health care is not always accessible to patients who are underinsured or uninsured including ten percent of all patients in Indiana.  Many of them rely on emergency room services or forgo medical care altogether.  This study is an ethnographic comparison of two health care clinics to understand which systems minimize barriers to care and improve care for underserved patients in the state.  The Sister Maura Brannick Health Center (SMBHC) in South Bend and the Saint Joseph Health Center (SJHC) in Plymouth both provide care for this population. SMBHC provides medical and dental services to uninsured patients in Saint Joseph County.  Approximately 70% of their population is Spanish speaking and many patients are undocumented.  SJHC was originally opened to serve only the uninsured in Marshall County, but has begun accepting both uninsured and insured patients. Observations focused on workflow protocols, patient experiences, services provided and staff cohesion.  At both sites, forward-thinking leadership and continuity of care were critical to providing effective care.  Differences between the offices stemmed from adaption to the needs of the surrounding community, but this was also critical for success.  As communities continue to be impacted by national policies and migrant populations, more research will be needed to understand the most effective and critical components of successful health care to improve on current models.

Antiretroviral Adherence in Shalom Delhi's Home-Based Care Program

Caroline Willett, Wheaton College Illinois 

Abstract
HIV/AIDS has plagued India since 1986. The National AIDS Control Organization (NACO) was founded in 1992 to slow the spread of HIV/AIDS in India. By 2004, NACO offered free antiretroviral treatment (ART) to all people living with HIV (PLWH) in India. Due to the program’s success, there was a 71% drop in HIV related mortalities between 1995 and 2017.1 However an estimated .21 % of people in India are still living with HIV as of 2017.2Despite the provisions of ART throughout India, many patients do not adhere to their treatment. HIV patients generally must have a > 95% adherence rate to maintain a satisfactory quality of life.3 In Delhi, NACO provides nine centers where patients go to receive their ART medication. Shalom Hospital is a palliative care organization in Delhi has a unique Home Based Care program where trained staff members visit patients throughout Delhi regularly to assess their health and wellbeing. My study was conducted by surveying 80 patients from Shalom’s Home Based Care program. I assessed the correlation between low adherence and HIV regimen, ART side effects, ART related stigma, and lack of HIV education. My research shows that patients generally have a reason for low rates of adherence. The purpose of this research project is to raise an awareness of the complications that PLWH taking ART face and to better understand why patients do not adhere to their ART regimen. Taking these factors into consideration, NGOs like Shalom Hospital can modify care protocols to better serve this marginalized population.

When 'Number Two' is Public Enemy #1: A Study on how Women Experience the Consequences of Open Defecation in Rural North India

Colleen Ballantyne, University of Notre Dame
(2020 Bartell Prize recipient)

Abstract
The practice of open defecation continues to be a global public health concern. The practice is a direct risk to health, safety, and psychosocial well-being. Women are especially vulnerable in regard to safety and stress related to open defecation but are not often focused on in research related to open defecation. This project was undertaken to study how women participate in and are affected by the practice of open defecation in Haryana, India, with a specific focus on a comparison of how women in different rural settings, either progressive or more traditional, experience open defecation. 100 women were surveyed across 2 villages on their sanitation infrastructure, defecation practices, health, and stress levels. It was found that women from higher castes and those in the more progressive village were more likely to have latrines, exclusively use a latrine, and have better health and stress outcomes related to their defecation practices. The most vulnerable women were from those in the lowest caste designations and women of lower socioeconomic status. This research can help to fill a gap that helps identify those most at risk of practicing open defecation, and it can help identify barriers still in place that prevent the total eradication of the practice of open defecation in India.

HIV among Migrants in Switzerland and the United States: A Comparative Analysis of the Far-Reaching Consequences of Migrant Healthcare Access

Jessica Rosenblum, Washington University in St. Louis

Abstract
The Human Immunodeficiency Virus (HIV) has lead to the death of more than 35 million people since the emergence of the epidemic in 1981.  HIV disproportionately affects vulnerable populations, such as migrants, due to structural factors that heighten their risk for HIV acquisition.  Historically, migrants lack access to general and HIV specific healthcare services. There is a lack of research holistically analyzing the plethora of obstacles to migrant HIV/AIDS care. Through a comprehensive literature review and interviews with six relevant experts, this paper aims to compare HIV/AIDS care for migrants in Switzerland and the United States within the context of the global effort to eradicate HIV/AIDS by 2030.  This paper identified the existence of legal, financial, cultural and language barriers to HIV/AIDS care for migrants, in addition to powerful stigma and discrimination.  Findings indicate that substantial, evidence-based changes need to be made in the U.S., Switzerland, and worldwide in policy, migration, and healthcare sectors in order to achieve the UNAIDS goal of AIDS eradication by 2030. This will not be possible until leaders of all relevant sectors work together to design a more holistic approach to the provision of HIV/AIDS care for migrants.