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Sharma lives in a small farming village in South Asia, but she could just as well be living in Haiti, Ethiopia, Nigeria, or several dozen other countries classified by the World Bank as low-income economies. Her home is a small hut, and she works daily with her mother to gather firewood for their small indoor fireplace, which acts as the kitchen stove. The smoke often makes her eyes water because there is no chimney or other ventilation.
At night, she sleeps with her extended family in a room where mosquitoes bite her regularly. Despite the fact that Sharma lives in a rural community, the villagers live in crowded quarters. The water the family drinks is carried by the women from a well several hundred yards from their home. The water sometimes tastes bad, but it is all they have to drink.
The family farms a small plot of land on the hillside, which had become eroded from years of cutting trees. The last big monsoon to hit the area created a landslide, which left the village underwater for several weeks, creating mold in nearly every home. Most of the adults have goiters from the lack of iodine in the soil. The addition of iodine to salt has prevented goiters in the children.
Pesticides are used widely to control mosquitoes and agricultural pests, but the farmers receive little education on their safe use. Recently, a new road was built, connecting her village with the neighboring towns. Despite the advantages of having the new road, cars, and trucks now speed through her village, rarely stopping to let people cross the road.
In Sharmas village, the life expectancy is 49 years. Babies often die of diarrheal diseases in the first year of life, and mothers occasionally die in childbirth. Malaria is widespread and hookworm disease is present among those who farm the fields and in children, whose ability to learn is often affected. Malnutrition is also widespread despite the fact that farming is the major occupation in the village.
Chronic lung disease among adults and asthma among the young is surprisingly common, even though cigarette smoking is rare. Tuberculosis is widespread and a major cause of death, despite the fact that until recently, there have been few cases of HIV/AIDS in the area. Unexplained neurological diseases among farmworkers occur regularly. The most common cause of death among teenagers is motor vehicle injuries along the new road, even though there is only one truck in the village.
You are expected to:
- Read the case carefully several times. Become absorbed in the situation in such a way that you see yourself intimately involved with the personalities, problems and conflicts.
- Determine what the major problem(s) is (are) and apply reasoning to how and why the problems developed.
- Decide what actions you would take.
- Prepare a written report of the case using the following format (your paper should be divided into sections with the following headings):Be sure to include keywords from the e-text chapter readings
- Background statement. What is going on in this case? Summarize the scenario in your own words without rewriting the case.
- Major problem(s).What environmental risk factors contributing to disease and other health conditions are illustrated in this case?
- Strengths and weaknesses. Discuss at least two examples of how disease or other conditions found in the village can be explained by the environmental risk factors. What public health strengths have been brought to the situation? What weaknesses need to be addressed?
- Resolution. What strategies would you recommend to help solve the issue? State what should be done–why, how, and by whom.
- Evaluation. How will you evaluate the success of your suggested resolution(s)?
- Specific Questions. 1. What environmental risk factors contributing to disease and other health conditions are illustrated in this case? 2. Discuss at least two examples of how disease or other conditions found in the village can be explained by the environmental risk factors. 3. What changes do you expect to occur in this village as social and economic development take place?
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