La crisis del todo

En los últimos años hemos visto (y vivido) crisis en todos los ámbitos, casi simultáneamente, crisis económicas, políticas, y sociales.

Uno de los problemas más importantes actualmente ha sido la crisis económica que ha tenido grandes efectos en varios países del mundo, con mayor efecto en Europa y Estados Unidos, esta crisis ha tenido un gran impacto en la salud de la población, caracterizado por aumentos en los niveles de desnutrición, desahucios, desempleo, drogadicción, depresión, problemas de salud mental, aumento en el consumo de psicofármacos, injusticia social, y en algunos casos disminución del acceso y disponibilidad de los servicios sanitarios.

A pesar de todos los intentos por frenar los efectos de las crisis, vemos que siguen creciendo las desigualdades en salud, definidas por OMS en 2008 como "el resultado de la situación en que  la población crece, vive, trabaja y envejece, y del tipo de sistemas que utilizan para combatir la enfermedad. A su vez, las condiciones en que la gente vive y muere están determinadas por fuerzas políticas sociales y económicas”. Resulta interesante analizar el impacto de la posición social de las personas y los contextos sociales sobre la evolución de las desigualdades en la percepción de la salud y algunos determinantes sociales.

Las crisis políticas por otro lado, terminan afectando la salud de la población, debido a fallos en reformas de los sistemas sanitarios, los cambios durante las crisis conllevan riesgos, incluyendo los de malas políticas, sea por ignorancia, por interés o porque la urgencia de reaccionar a los problemas a corto plazo relegue las grandes cuestiones, priorizando el crecimiento económico para salir de la crisis sobre las consideraciones de sostenibilidad y equilibrio a largo plazo, aunque toda la responsabilidad política se ha visto de alguna manera desplazada al ámbito económico, señalando que cualquier fallo es debido a los problemas económicos.

Todo apunta a que los principales efectos de las crisis son sobre la salud mental de las personas, la situación actual de muchos países, está caracterizada por un alto nivel de desempleo mantenido y el crecimiento del empleo precario, que facilita la aparición de una forma de estrés laboral donde adquiere especial relevancia tanto la inseguridad del presente como el miedo al futuro (perder el trabajo, no encontrar uno nuevo), resultando tan estresante la preocupación por el riesgo de perder lo que se tiene como la pérdida en sí.

Risks of Tolerance

When everyday there is a new perceived crisis, sometimes people stop taking them seriously.  The same thing happens when there is an ongoing crisis that may not be a sudden natural disaster, but in every way is as potentially dangerous and far reaching.  What do you call a crisis almost 50 years in the making?  What do you do about it? What steps to you take to manage it? Well, unfortunately local governments and health officials worldwide just waited and hoped that the crisis would just go away.  That is the crisis of Ebola.

In 1976 there were two simultaneous outbreaks of Ebola in Sudan and the Democratic Republic of Congo. At that time there were 318 cases of Ebola and 280 deaths.  In the beginning of the outbreak very little was known about the disease.  Information about the mode of transmission, susceptible population and other factors were not known at that time.  However it was observed that pregnant women seemed to a population at high risk and that there was an apparent link between the disease and exposure to hospitals and funerals.  Despite the infection arose from contact with products of animals (which is reservoir for the disease), it was not discovered until later that the use of unsterilized needles and local ritual burial practices was crucial in the spreading of the disease during the first outbreak. Fortunately through changes in health practices in regards to use of needles and public health measures (such as isolation and contact tracing), the epidemic was controlled.

Over the decades there have been subsequent outbreaks, each being controlled but depleting local health care systems each time. During March 2014 the first cases of Ebola were notified in West Africa; however it is believed that there were isolated cases as early as December 2013.  Unlike previous outbreaks, what lead to there being more than 20000 reported cases was a combination of failures in decision making and avoidable errors.  The outbreak came at a time when health care systems in Africa were weak from previous epidemics and countries recovering from Civil War.  Political instability along with the initial denial by governments, allowed the problem to grow.  This compounded by the indifference of the international community of another “crisis in Africa” only made the situation worse.  Even when public health officials began to address the problem, due to local beliefs and lack of confidence in conflicting information from local governments, local communities were not receptive public health initiatives.

Not until Ebola had swept across several countries in Africa, claiming countless lives was it taken seriously.  Despite pleas from NGOs such as Doctors without Borders and others, the WHO did not raise alert levels until much later. It was not until, Ebola seemed to become a potential risk to Europe and the Americas did the international community saw a need to “help” and seemed interested in controlling it.  However over a year and the crisis continues, even though the situation has somewhat improved, it appears that controlling Ebola mainly meant confining it to Africa as the rest of the world looks towards another crisis.

Crisis 4 Dummies

Refusing to Remain Black

The black box. What is the black box exactly? The black box is a concept that refers to any sort of system in which one can observe the inputs and outputs, the stimuli and responses, however, the inner workings of the system are unknown. As the observer we are ignorant as to how the system works and are thus only able to examine what is done and the reactions that result. We are left guessing as to the hows and the whys and have to base our assumptions on what we can observe. The process itself is black.  

The human mind is often described as the black box. We use this metaphor as a way to explain our actions and behaviors that we don’t understand, don’t want to understand, or are perhaps taught not to understand. We go about our daily lives reacting to our surroundings without really ever recognizing why. It may be that we believe it is too complicated to analyze, deem it as unimportant, or don’t even realize what we are doing. And for most of us we manage our lives in this way, in the black. But what happens when we face hardships?  What happens when we find ourselves in unfamiliar surroundings and can no longer gauge our behavior? When we are tested? How are we able to manage through these times? How do we react when we find ourselves in crisis? Where do we begin to make changes if everything is black?

Living in Granada I find myself in such a crisis.  I turned 30 (yes I know still young), made the decision to change careers, move half way across the world to a different culture with a different language, leave loved ones, and live truly by myself for the first time. I frequently stop to ask myself, “What the hell was I thinking?” And the truth is, sometimes I don’t know.  But the decision is made, and I do believe I made the right step, albeit a challenging one, towards building a better future for myself.  So now what I’ve realized is that the more pressing question is not what was I thinking but what am I thinking?  And not only what but how and why?

Because what I’m realizing is that this step is more than difficult; clearly this comes as no surprise. But there is something about being so far away, in the quiet of your own apartment, left alone to deal with your own emotions, that really sheds light on how you think and behave. It truly calls into question, what is going on in our little black box? Therefore I challenge myself to understand and address the way I perceive certain situations. Why do I wake up thinking negatively and how can I change that into a positive?  What do I need to do to prepare myself for any given day of the week? What motivates me? What angers me? What calms me? And why? If my behavior is not mechanical, how can I exert control over how I act or how I react? And maybe the most important, how do I create new ways of thinking?  

How do I manage through this personal crisis?

I refuse to remain black.              
             

** Blog post inspired by Professor José Bimbela with his lectura “Yo CONmigo” and all my classmates who encouraged me with their new ways of thinking. Below is a list of some of their thoughts:

Gimnasio emocional: Una práctica diaria
¿Has sonreído hoy?
Por todos mis compañeros, y por mi primero
Hoy no es tan mal, mañana menos
Las llaves de la felicidad
La utopía es posible mientras caminamos hacia ella
Tu propones, yo decido
28 días para un día mejor
La lucha contra el miedo