And so it begins

My first day of class is also the day of my 1^st speech to my Rotary club.  Yikes!  I wake up at 6am for a 9am class, petrified that I have forgotten to do something, that I didn’t prepare fully enough, that I somehow missed an assignment emailed to my student account, which I have neglected to check.  By 6:30, I realize none of this is true.  I go back to sleep.  By 8, I am awake again, and realizing that it is an hour long walk to class, because it’s located past the university, in the hospital.  I throw on clothes, run to catch the bus, miss my stop and end up in the Octagon, a 10 minute walk from where I need to be.  I practically run to my class and arrive to find the doors still locked.  It is 8:35.  I really need to get a watch.            

My epidemiology class, usually filled with no more than 25 students, has 37 in attendance.  In the back, there is a man with a very large camera, recording the lecture for the students in Christchurch, whose classroom has been marked as “potentially unstable.”  My professor, a slim woman with an extremely quiet voice, is clearly unused to the camera, and keeps glancing at it and addressing the Christchurch students as if they were here with us.  And soon, many of them will join our class in person, choosing to leave their damaged homes in order to continue their studies.  We are going to need a bigger room.

The students in the class are the most diverse group I have ever seen.  I am one of the youngest people there, but certainly not the only American.  My RAS twin, Chase, an Ambassadorial Scholar from Kentucky also earning his DPH (and taking every class, all year, with me), sits beside me.  Across the room there are at least 2 other Americans, and several Canadians.  There are also students from Zambia, Samoa, China, the UK.  There some are recent graduates, with degrees ranging from anthropology to physical therapy to veterinary studies, but there are also doctors and nurses and mental health professionals.  Just hearing all of the credentials makes my head spin.  And my professor told me I would find the course less challenging than most of the other students.  Hah! 

The introduction to epidemiology, however, is a lot like an introduction to statistics.  Boring.  True, the case studies are much more interesting (studies that determined the causes/treatments of scurvy, cholera, plague, etc, are MUCH more up my alley than the examples I had to put up with in Stats 101), but the ideas are the same.  Randomization, observational vs. analytical, sample selection: important, but oh so obvious ideas.  Oh well.  At least the homework should be easy.

The “Comparative Health Systems” class, however, fascinated me from the start.  After reading the first two assigned articles, I was beginning to wonder if the American health care system is the worst possible system in the world.  By the end of the 6^th article (this was before the 1^st class started), I was convinced.  15% of the population is not insured (and therefore, basically have no access to health care), and we spend upwards of $7300 per capita, per year, on medical care.  New Zealand spend $2454 pc/year.  Not only is our system overly expensive and inequitable, but the quality of care, reliability of services, efficiency and coordination of care, is abysmal.  We have one of the lowest life expectancies, and the highest infant mortality rates, of any industrial countries.  Many “developing” countries have higher quality care than we do.  Before this class, I knew some of these things (the high percent of unemployment, the high cost of health care), but I did not know its extent.  Furthermore, I did not know that so many other countries were so much more advanced than us.  I knew the Netherlands, the UK, Canada and France have excellent health services, but did not know that Singapore’s health care system is rated far above our own.  I did not know that the US is the only industrialized country to continue to use the market-driven model of health care.  Our health care system is on par with that of Ghana, Thailand and Nepal.  Reading these statistics, for myself, in scholarly, published journals, was shocking.

Another aspect of this class that shocked me was my own ignorance about other health systems.  To be fair, many of the students in the class had worked in the healthcare system for most of their lives, or had at least lived in New Zealand for more than 3 weeks.  But when the professor asked for examples of primary health in a secondary or tertiary setting, or for models of a health promotion scheme, my answers were met with an uncomfortable pause and a “well, maybe that is how it works in the US.”  Next class, I am going to sit on my hands.