Department of Community Health
Arnold Lab Room 496
BIC-214: Health of Women
Spring semester, 1999
Wednesday 9:00 am – 12:00 pm

Clinical Advisor: Sudeep Aulakh, MD Dept. of General Internal Medicine Rhode Island Hospital
Partnership: The National Women's Health Network, Washington, D.C.
Staff partner: Brooke Grande

Objectives:
1. To develop a theoretical framework for conceptualizing what drives population patterns of health, disease, and well-being of women and girl children in relation to social and economic divisions related to race/ethnicity, class and gender.

2. To apply conceptual and methodological principles of study design and data analysis to evaluate epidemiologic and medical literature on women's health.

3. To research and write a monograph for the National Women's Health Network (NWHN) on the epidemiology, diagnosis, and treatment of a specific health or disease experience affecting women.

4. To communicate information affecting health of women ways that are accessible to people with a range of educational and cultural experiences.

This class uses a "service-based" curriculum, with an objective of involving students in public health activism. Working in small groups, students will identify, evaluate and summarize scientific research on a specific topic pertaining to health of women with a goal of moving this knowledge to forms useful for private and public action. Students will write about what is known and not known about a particular health or disease experience for a readership that includes social and political advocates for health of women, local and federal politicians, and women wanting information for themselves. In partnership with the National Women's Health Network (NWHN), the class will produce reports on up to 8 specific topics. These topics, requested by the NWHN, come from the follow list:

1) Tamoxifen as prophylaxis for breast cancer: Reviewing the controversies
2) Abortion: Epidemiology, access, social and historical context in which abortion occurs
3) Chronic Vulvar Pain: Epidemiology, Diagnosis, and Treatment
4&5) Breast implants: (packets: saline and silicone): Legal issues, epidemiology, indications (primarily as prosthesis because of mastectomy, or for breast augmentation for "cosmetic" reasons).
6) Health insurance and lack of access: who are the women who do not have health
insurance; [this is not about managed care, focus is on how women organize to get health coverage; what resources are available!; describe Women Health cooperatives; women's clinics, pay as you can afford services.
7) Diabetes, juvenile and adult-onset.
8) Onatology: lifespan perspective: starting in adolescence
9) Scoliosis

Key questions to address in your research:
I. Epidemiology: What is the distribution of this condition among U.S. women? Describe recent data on incidence and prevalence in relation to social class, race/ethnicity, gender (if applicable), age, time trends, and geographic region. Describe known or suspected risk factors. What evidence is there that this disease is preventable? What proportion of incidence might be reduced if certain causal factors were no longer operative? Does the extent of public visibility about this disease/condition seem appropriate in terms of its impact on women's lives? Generate ideas about plausible risk factors that have not yet been adequately studied, for example, experiences of discrimination.

II. Diagnosis: How is this condition diagnosed (what tests and procedures are used)? What are the diagnostic criteria? What are the barriers that women face in getting a prompt diagnosis (in relation to sexism, racism and social class)?
For discussion (and possibly for inclusion in the monograph): How did this disease or condition come to be named? Is there a history that would be relevant to bring in when thinking about barriers that women face in being recognized as having this particular condition. How have the diagnostic criteria evolved over time?

III. Treatment: What are the debates in management of this condition? Who has access to treatment? What is the prognosis for this condition. Describe the "disease course", that is, what happens if this condition is left untreated'? What happens with various therapeutic regimens? What alternative therapies (as in non-biomedical) have been used for this condition? How do social class, race/ethnicity, age, and gender affect your answers to these questions? For example, what kinds of resources are necessary for women to have access to these therapies?

IV. What are gendered experiences that women have who: 1) Make a conscious effort to avoid/prevent the disease experience you are describing? 2) Have symptoms that eventually lead to a diagnosis of this disease? 3) Have been (or currently are) living with this disease or condition?

"Gendered experience" refers to how a particular biologic experience (in this case, usually disease) affects gender roles, relations and conditions; and, in turn, how gender roles, expectations, relations and conditions affect women's experience with prevention, diagnosis, treatment and prognosis of the disease.

V. Policy recommendations for private and public use:
Private-use: What can women do to be effective advocates for themselves and others? Summarize prevention and treatment guidelines as well as questions that would guide their care in working with health providers.

Public use: How much attention in media and medical journals does this condition receive? Who is doing and funding the research? Who are the research subjects? How do you think research funds should be allocated? What messages should local, state and federal policymakers gain from this report?

Readings: Two books are required for this course. These are available at the Brown Bookstore. One copy of each will be on reserve in the Sciences Library:

1. Evelyn White, editor. (1994) The Black Women's Health Book: Speaking forOurselves. Seal Press.
2. Paul Farmer, Margaret Connor, Janie Simmons (eds). 1996 Women. Poverty. and AIDS. Common Courage Press.
Additional articles will be distributed.

Evaluation: All students are to use the S/NC grading, option for this class unless departmental regulations require otherwise.

Receiving credit for this course will be based on assessment of the following:
a. Demonstration of completing reading assignments through participation in class discussion and integration of reading research publication.

b. Group presentation in class of epidemiology, diagnosis, treatment, and policy implications of health or disease experience affecting women (NWHN publication group assignment).

c. Submission of usable report on specific health/disease topic for NHWN publication.

Writing assignments:
Due January 28, February 4 and February 11, 1997: Bring to class a one-two page written response to the readings for that week. Your writing should be reflective andspontaneous. For example:
What kinds of thoughts came up for you as you read? Were you challenged by the reading? In what ways? What questions do you have?

Also due January 28, 1997, in class:
Group statement:

Each project group will submit a statement of their project, including (1) Names, phone numbers and e-mail addresses of group members (2) Identification of person who is group organizer (3) Name of project (health or disease experience to be topic of publication). (5) Schedule of submission of written drafts for each section and name of person responsible for research and writing of each section. (6) Statement of how the group will meet these goals.

Due April 29: Submission of final projects to National Women's Health Network

Guidelines for preparation of information packets for the National Women's Health Network

A. Substantive issues (in relation to writing)

1. Use nonmedical language whenever possible. When medical terms are used, be sure to define them immediately, and include them in the glossary.

2. Simplify even the nonmedical language. For example, instead of "mutate'' write "to change". Instead of ''hormones secrete" write "hormones release".

3. Use second person pronouns when writing ("you may experience''; "you may be advised to have the following procedures".)

4. Be descriptive; not prescriptive.

5. Use drawings and tables whenever possible.

6. Include glossaries.

7. Reference well. Err on the side of over-referencing. Put references at the end of each section that each of you wrote, rather than one big reference section at the end of the entire packet. If you use the Web for information, you will need to validate its authenticity.

B. Technical issues

1. Combine all parts of each topic into one computer file.

2. Save on disk formatted for DOS (IBM or clone) and put in Word Perfect 5.1. If no one in your group has the computer capacity to do this conversion, the CIT has the resources and staff to help you .

3. Use a uniform font for the entire packet.

4. Do not put in page numbers.

5. Spell check and proof read for grammar and other errors that spell-check may have missed.

6. Include any articles that you think would be helpful for the Network to include in their packets.

7. For April 29 class, please bring in disk version and two sets of hard copies for me to send to the Network. Other students in the class may want copies of your work, so get a count before April 29 so you can distribute them at that time. If you are 1ncluding articles provide only one complete set of articles.

YOU WILL HAVE DONE AMAZING. EXTRAORDINARY SERVICE FOR THIS NATIONAL ORGANIZATION. WHATEVER YOU ARE ABLE TO PUT TOGETHER WILL BE HELPFUL. THERE IS ALWAYS MORE THAT CAN BE DONE. THE INFORMATION YOU HAVE COMPILED IS PART OF A PROCESS.

The Staff at the National Women's Health Network is very, very appreciative of all of your hard work. They thank you, and I thank you.

Important note: If I lend out books, articles, videos, and other materials to you, please be sure to return everything to by April 29.

Proposal for Linking Public Service and the Academic Curriculum:
BIC-214 The Health of Women

The Health of Women is a course that inspires students to make a difference in the lives of women through integration of didactic classroom experience and community service. The class itself is a course in leadership in the context of women's health. Students acquire a knowledge base of the major global forces that affect women's lives and consider these forces in relation to race and class. Much of the discussion involves conceptualizing what we mean by structured control and strategies of resistance, and how to generate action that releases this control in a way that honors the cultural and class context in which women strive for healthy lives. The experience this semester, which is the first experience we have had with this course, has been extraordinary. As students realize how effective they are as movers toward social justice, and how easy it is to enroll people in their vision, they express to the class what they have done in the course of a day or a week and what a difference it has made in someone else's life. They are acknowledging how they use language and express to others what is possible, and they are getting that they hardly begin to know how much energy they generate just by speaking about the possibility of a world that offers safety and health for women.

There are five projects going on in this class. I did not anticipate the need for two resources at the time I developed the curriculum. One need is for someone to coordinate the community linkages and to keep projects in momentum. The second need is for funds to support some of the project expenses, since the community service has a goal of being sustaining after the students have finished the course. The projects this semester are:

1. Domestic violence prevention: Five students have linked Dorcas Place and the Women's Center of Rhode Island to produce a literacy class that expresses for women how to protect themselves from domestic violence, and how to access resources in Rhode Island that will support them if they feel threatened or have experienced abuse. There are costs to the production of materials for this curriculum.

2. Accessing alternative childbirth resources: Two students are writing booklets for women to direct them to midwives, homebirth providers, visiting nurses, and other support so that women have control over the birth of their child. Many of the resources are economically more feasible for low-income women and for women without insurance. Two other students are working with physicians, in particular residents, at one of the Brown teaching hospitals, to educate them about childbirth alternatives, about reducing the use of medical interventions in the birthing process that occurs inside the hospital, and about including women in informed ~lecision-making about their prenatal care and labor and delivery experiences.

3. HIV and women: Five students are investigating resources for women living with HIV in Rhode Island for the purpose of writing a directory that accesses information about these resources for women. In the process of writing this directory, students are communicating with social, medical, financial, spiritual, legal and therapeutic service providers, as well as with women living with HIV. The Center for Public Service is providing $500 to support this project.

4. Incarcerated women: Three students are providing services in the Women's prison at the ACI. One of the students is teaching guitar and aerobics and the other two are working with the director of the family program, which works with incarcerated women and their families (primarily their children).

These projects are descriptions of this year's experience. I would anticipate that subsequent classes would have other projects, but the spirit of them remains the same. Assessment is described in the syllabus. This is always challenging. My experience this year has been with mixed success. I have reviewed the students' documentations of their project progress at least once with each student. I have attended many project meetings. My sense (hardly a formal assessment) is that people are doing what they set out to do. Their goals statements testify to this (see the syllabus for clarification of this statement).