Analyze

“Since asthma surveillance data were not available at the census tract level for most of Louisiana, we estimated asthma burden using the inpatient discharge data available through LDH.”  (4)

“Case counts are not provided for CTs with a 2018 population of less than 800 to safeguard privacy.” (4)

“To minimize the need for suppression, inpatient discharge data was aggregated for the three most recent years available (2017–2019) and average annual crude rates were calculated for cases where asthma (ICD-10 code J45) was the primary diagnosis, as well as where asthma was any diagnosis.” (4)

“Spearman’s Rank Correlation was utilized to analyze the correlation between various social and environmental vulnerability factors, COVID-19 incidence, and the measures of asthma risk by CT.” (4)

“This was performed by first ranking the values in each dataset using RANK.AVG function in MS Excel 2016, followed by applying the PEARSON function to compare two datasets. Significance was set at alpha less than 0.05 (α < 0.05), with degrees of freedom (df) equal to two less than the total number of data points represented in both datasets” (4)

The research team works for the Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health in Baton Rouge. Team members included Arundhati Bakshi; Shanon Soileau; Collete Stewart; Kate Friedman; Collete Maser; Alexis Williams; Kathleen Aubin; and Alicia Van Doren. 

“Currently, much of the environmental focus of the pandemic remains on PM2.5 levels; however, we noted that higher levels of ozone was consistently associated with higher incidence rates of COVID-19, and it was the only environmental factor that appeared to have an additive effect over SVI on COVID-19 incidence (Fig 1).” (11)

“Specifically, our data show a moderately strong positive correlation between SVI due to minority status/language barrier and three health data variables: asthma hospitalization; estimated asthma prevalence; and cumulative COVID-19 incidence at 3 months (Table 2). Interestingly, SVI measures were either negatively or not significantly correlated COVID-19 incidence at the 9-and 12-month time points, indicating that social vulnerability factors may have played a greater role in COVID-19 spread early in the pandemic, but may have been of diminishing importance as the pandemic wore on (Fig 1 and Table 2).” (9)

Bakshi A, Van Doren A, Maser C, Aubin K, Stewart C, Soileau S, et al. (2022) Identifying Louisiana communities at the crossroads of environmental and social vulnerability, COVID-19, and asthma. PLoS ONE 17(2): e0264336. https:// doi.org/10.1371/journal.pone.0264336. 

This document uses data resources from the Center for Disease Control/Agency for Toxic Substances and Disease Registry (CDC/ATSDR), the Environmental Protection Agency (EPA), and the Louisiana Department of Health (LDH).

These data resources include the Social Vulnerability Index (2018 - CDC/ATSDR), the NATA Respiratory Hazard Index (EPA 2014), PM2.5level (average annual concentration in ug/m3, EPA 2016), ozone level (summer seasonal average of daily maximum 8-hour concentration in air in parts per billion, EPA 2016), indoor mold concerns reported to IEQES program (average annual number of calls, LDH 2017-2019), cumulative COVID-19 incidence rate at 3-, 6-, 9- and 12-month increments (LDH March 2020 - March 2021), asthma hospitalization (average annual crude rate, where asthma was a primary diagnosis among hospitalization cases, LDH 2017-2019), and estimated asthma prevalence (average annual crude rate, where asthma was any diagnosis among hospitalization cases, LDH 2017-2019).

The film looks at the struggles of the doctors in MSF while on missions in third-world countries. These issues stem from lack of supplies, quality of the facilities, and high patient influx. The doctors in the film are burning out quick, with way too many responsibilities to tkae care of. The setting is in Liberia and the Congo during a period of war. The film also examines the tensions developed between the doctors due to differences in style, knowledge, and culture. The clash of personalities and reasons for being in MSF also contribute to the tension. 

The film largely plays on emotional appeals and drama. By documenting the interviews of the doctors, which often are about the other doctors, the viewers see just how hard it is to detach ones self from their work. There is a scene in which the doctors talk about how, despite all the issues they face in the medical setting, everything at the end of the day is about personal relationships. It even briefly touches on sex between the medical staff and how that contributes to the care given. Since the film is based on personal interviews, little to no scientific information is given about the disease and injuries seen; its all based on personal opinion. 

The stakeholders in the film would be the doctors, the local health ministry, and the patients themselves. The doctors were the most focused on, and they were put into a lot of situations in which they were the sole decision makers. However, many times the decisions weren't life or death, but death or comfort. For instance, Davinder was in a situation where a child was inexplicably swelling all over his body. The doctors weren't well equipped for diagnosing his illness, and thus the child was doomed to worsen and die. A nurse informed him that the mother had taken the child and left, to which Davinder remarked that he couldn't blame them. He believed the comfort of the child in somewhere without his care was worth just as much as, if not more than, his care in the hospital. This was quite different than Kiara's opinion that they needed to stay in the hospital. She blamed it on a lack of confidence in medical ability, while he saw it as being human.

Following the time on the mission, the doctors all had to decide what was next. Dr. Brasher left MSF to practice medicine in Paris, while Dr. Gill went to Australia to become a pediatrician, with no plans of returning to MSF. Dr. Lapora was promoted to Emergency Coordinator, and established three more missions in other parts of the world. Dr. Krueger still works with MSF and has been on a number of other missions. All of the doctors continued medicine, but their experiences in Liberia dictated their plans on whether to continue this service.  

Emergency responders as a unique group aren't discussed or portrated in the film. However, the doctors had to take on the role of emergency responders often, while not neccesarily being emergency doctors. The question in the film became whether or not the doctors were prepared for these roles, and if they had the energy to dedicate to them. Some doctors burn out, and others thrive, but regardless they are challenged to make sacrifices that emergency responders often must decide on. 

The film would have the most impact on the general population, like something that would be played on a news channel before prime time. The level of emotional appeal and interpersonal drama is enough to keep anyone intersted for the length of the film. The film does however paint the experience in a negative light, which could discourage professionals from pursuin mission worlk. Thats why the general population would be most receptive to the struggles. Its easy for them to say "I would do something like that if...." without having the ability to do anything. 

The film doesn't look much at the people's experience with MSF. There are no interviews of the patient's themsleves. The film touches on the local health officials' opinons, but not much on the actual patients'. It doesn't highlight their sturggles as much as I believe it should. 

The film provided general facts about MSF and the conditions in Lieria and the Congo, but no detailed medical statisitics. There wasn't any comparison of the issues in this mission versus those on other missions. The film could have included more on the factors that contribute to the diseases themselves, rather than the barriers to treating them. The film also needed more on the exact amounts of supplies that were given relative to what one would have in a clinic elsewhere.