Jiashu Li - Medika Life

Reflecting on the Native Americans’ Vaccination Success

Jiashu Li — Fri, 07 May 2021 03:48:49 +0000

With about 145 million people having received at least one dose of the vaccine, the United States is now one of the top vaccinated nations in the world¹. To help reach president Biden’s July 4th goal, many states are currently coming up with additional ways to help to boost vaccination rates². These methods include but are not limited to allocating additional vaccine doses for heavily affected regions, setting up call centers for people who may not have easy internet access or are inept at navigating online signup, and clarifying upfront on the free-of-cost aspect of the vaccine, etc.

However, looking at the current data, it is not hard to notice that racial disparities in vaccination across the states are still an issue despite the current climbing inoculation rate and effort³ ⁴.

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It is important to note that both Latino and Black Americans have made major vaccination progress since the beginning of March 2021. There were only about 5% Latino and 7% black Americans who received at least one dose of the vaccine back then³. Within a little over a month, these numbers improved to 22% and 21.8% respectively⁴. However, when comparing to the national average vaccination rate, there is still a significant lag. To further address this lag, various barriers such as vaccine hesitancy and access issues need to be overcome.

Screen Shot by Author/Reference 4

Why is it helpful to learn more from Native American’s vaccination experience?

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Being gravely impacted by COVID-19, the Native American community’s mortality rate reached an all-time high just about 2 months ago⁶. In fact, the Native American’s COVID mortality rate was the highest among all ethnic groups in March. The tragedy has transformed into great motivation and the Native American communities are doing a great job at rolling out vaccines for their people.

Over 30% of the Native Americans were vaccinated with at least one dose of the vaccine⁴. In some communities, nearly 90% of its elders were vaccinated and the communities are extending eligibility to even non-Native adults outside of the community⁸.

With about 18% of Native Americans without broadband internet access, 26.8% living below the poverty line, 75% of its existing roads unpaved, many native Americans are living in harsh conditions that are not ideal for vaccine outreach. Therefore, the vaccination rate is even more impressive than the number alone suggests⁷. Though many Native Americans had traumatic experiences that led them to be skeptical of the medical community due to incidences such as the law that led to mass sterilization in 1970, survey suggests that over 75% of the Native Americans were willing to receive COVID vaccine thanks to the community’s relentless effort⁹ ¹³.

The Native American’s difficult living conditions that lead to vaccine access issues and the precursors to vaccine hesitation can be found in many of the American Ethic groups¹⁴. The Native American’s success at overcoming these barriers can help to address the current racial disparities in vaccination⁷.

So how have the Native Americans been addressing the challenges and inoculating their community so quickly?

1. Spending upfront effort to build trust.

Many native American communities had their esteemed elders getting vaccinated on TV to help to advocate for the vaccine. Additionally, sharing culturally relevant messaging such as the rationale behind vaccination and its effect on protecting others in the community helped to boost the sense of duty that people cherish[10]. This helped to avoid people thinking that they are not vulnerable to the effect of infection, and therefore vaccination is not needed.

2. Addressing vaccine-related questions frequently and publicly

Townhall meetings have been used to address questions that people have about the vaccine. Additionally, there are open hotlines on the radio to address additional concerns that anyone may have and share the knowledge publicly. Some native American communities also brought in experts, such as Dr. Fauci to help further address people’s questions.

3. More efforts to avoid wasting vaccine and to deliver to as many people as they can daily

The Native American communities are going the extra mile to deliver the vaccine to their people, literally¹¹. Many Native Americans don’t have internet access or are living in very remote places that have extreme temperature conditions. The tribe’s vaccination task force would drive the vaccine to them and come up with creative solutions to maintain the appropriate storage temperature for the vaccine or provide vaccine under uncommonly cold temperature¹². These efforts not only extended their reach but also decreased the number of wasted vaccines.

4. Using familiar community gathering places and respecting people’s needs

Many Native American communities are choosing their common community gathering facilities to inoculate people so that people in need can also get a warm meal in the process and feel more comfortable being in a familiar place. Additionally, some of the vaccination centers and task forces such as the Indian Health Service allow people to follow traditional practices that are important to many people¹³.

To ensure the safety of the community, Native Americans had made a great effort to ensure fast and effective vaccine rollout among their people. Despite the difficult situation as a result of their harsh condition and traumatic past experience, creative and diligent task force combined with culturally relevant campaigns and outreach methods led to an impressive success story. Learnings from this success story can be implemented for other minority groups who are currently lagging in terms of their vaccination rate to help protect additional people who are at great risk of the COVID infection quickly.

References:

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Have You Tried Exercising to Reduce Your Menstrual Pain?

Jiashu Li — Sat, 01 May 2021 04:36:58 +0000

For a few years, I was in a state that can only be called alive. If I got more than six hours of sleep, it was considered a miracle. Additionally, I was mostly relying on a quick bite of fast food for most of my meals. Exercising was pretty much out of the question because when I did have some free time, I was too exhausted to move. The only form of exercise I had was running late.

During that time, I suffered from painful primary dysmenorrhea (menstrual cramps without other underlying diseases). It was especially bad on the first day of menstruation. Without a pain reliever and heating pad, I would have been rendered debilitated in a fetal position and unable to carry out most of the daily activities.

In recent years, I made an effort to live a healthier life. Besides sleeping more and eating more balanced meals, I also started exercising again. I started small, with short jogs a few times a week, and worked up to additional full-body exercise sessions accompanying longer runs most days of the week. Since I started exercising, within 1 month or two, I started noticing various improvements, such as improved energy level, better concentration, better mood. On top of all that, I also noticed that my dysmenorrhea symptom has become so minor that it was barely noticeable at all.

Pleasantly surprised and curious, I did some reading on published research in this space to see if exercising can really significantly alleviate menstrual cramps or I have simply ‘outlived’ my dysmenorrhea. Below, I will share my findings with you.

Menstrual Cramp is very common, and most who suffer from it suffer severe pain.

What struck me first was how common primary dysmenorrhea (menstrual cramp) is among women. Usually starting anywhere from 1–2 years to 6–12 months after the first period and remaining until around 40 years of age, this issue is affecting close to 80% of women worldwide, and about 60% of women have severely painful dysmenorrhea¹²-¹³.

This means, if you are currently suffering from a painful menstrual cramp, about 2.3 billion women worldwide are suffering along with you¹⁴.

There are treatments for it that are well studied.

NSAID (such as Asprin, Advil, ibuprofen, Pamprin, etc.) and oral contraception are two well-studied treatments that have shown significant pain reduction in most women¹². Most of the NSAIDs that were studied and are effective can be found over the counter. The downside of NSAID is that it does not have a preventative effect. Although it provides a significant pain reduction, NSAID does not always decrease the pain to an extent that normal daily activities can carry on uninterrupted. Additionally, the common side effects that come with the medication are applicable. Oral contraception on the other hand are prescription medications, so you will only be able to acquire them with your doctor’s prescription. Since it is hormonal-based contraception with side effects, not everyone sees it as the best option.

Neither are good options for you or looking for an alternative way to manage the menstrual cramps? Maybe give exercise a try!

Many studies currently have been published in this space. When there are a few studies that did not show a clear effect, the vast majority of the studies’ results showed significant positive effects of exercise on period pain reduction¹.

What else do you need to know about exercise as a treatment for menstrual cramps?

You don’t have to limit yourself to a single form of exercise. The methods of studied exercise are diverse, and the ones that have shown positive effects include stretching, isometric exercises, yoga, running, and other aerobic exercise¹-¹¹.
You may have to keep up the exercise for 8 weeks to see significant results. Several studies have shown that when it is possible to show a significant effect in 4 weeks, starting from 8 weeks and on is when additional improvements start to show²-³ ⁸ ¹¹. Therefore, if you are giving the exercise a try, try doing it consistently for 8 weeks.
You may not need to spend a lot of time exercising each time. When the duration of the exercise regime being studies varies from 10–40 minutes, most studies that have shown significant improvement have employed 30 minutes sessions with a frequency of 3 times a week⁷.
The lightest exercise regime studied and shown effect involves pelvic stretching for 10 minutes, 3 times a week⁹.
If it is not comfortable to exercise during the period, you can choose to only exercise during the luteal phase (the time before your period)⁴ ⁶.

Other things to consider or to rule out

Secondary dysmenorrhea can also manifest as painful periods, but the cause is different from that of primary dysmenorrhea. If you suspect that you may have secondary dysmenorrhea, it would be important to get it properly diagnosed and treated.

Some points to consider are the onset timing of the dysmenorrhea, pelvic abnormality, infertility, heavy or irregular cycles, or the pain has little to no response to NSAID or oral contraceptive medications¹². If you are in doubt, it would be important to consult with your physician.

Other methods have been studied and shown some effects as well, such as massage, aromatherapy, TENs units, herbal remedies, etc.

1.Carroquino-Garcia, P., Jiménez-Rejano, J. J., Medrano-Sanchez, E., De La Casa-Almeida, M., Diaz-Mohedo, E., & Suarez-Serrano, C. (2019). Therapeutic Exercise in the Treatment of Primary Dysmenorrhea: A Systematic Review and Meta-Analysis. Physical Therapy, 99(10), 1371–1380. https://doi.org/10.1093/ptj/pzz101

2. Samy A, Zaki SS, Metwally AA, Mahmoud DSE, Elzahaby IM, Amin AH, Eissa AI, Abbas AM, Hussein AH, Talaat B, Ali AS. The Effect of Zumba Exercise on Reducing Menstrual Pain in Young Women with Primary Dysmenorrhea: A Randomized Controlled Trial. J Pediatr Adolesc Gynecol. 2019 Oct;32(5):541–545. doi: 10.1016/j.jpag.2019.06.001. Epub 2019 Jun 11. PMID: 31195099.

3. Kannan P, Chapple CM, Miller D, Claydon-Mueller L, Baxter GD. Effectiveness of a treadmill-based aerobic exercise intervention on pain, daily functioning, and quality of life in women with primary dysmenorrhea: A randomized controlled trial. Contemp Clin Trials. 2019 Jun;81:80–86. doi: 10.1016/j.cct.2019.05.004. Epub 2019 May 7. PMID: 31071464.

4.Rakhshaee Z. Effect of three yoga poses (cobra, cat and fish poses) in women with primary dysmenorrhea: a randomized clinical trial. J Pediatr Adolesc Gynecol. 2011 Aug;24(4):192–6. doi: 10.1016/j.jpag.2011.01.059. Epub 2011 Apr 21. PMID: 21514190.

5. Kannan P, Claydon LS, Miller D, Chapple CM. Vigorous exercises in the management of primary dysmenorrhea: a feasibility study. Disabil Rehabil. 2015;37(15):1334–9. doi: 10.3109/09638288.2014.962108. Epub 2014 Sep 22. PMID: 25243766.

6. Yang NY, Kim SD. Effects of a Yoga Program on Menstrual Cramps and Menstrual Distress in Undergraduate Students with Primary Dysmenorrhea: A Single-Blind, Randomized Controlled Trial. J Altern Complement Med. 2016 Sep;22(9):732–8. doi: 10.1089/acm.2016.0058. Epub 2016 Jun 17. PMID: 27315239.

7. Dehnavi ZM, Jafarnejad F, Kamali Z. The Effect of aerobic exercise on primary dysmenorrhea: A clinical trial study. J Educ Health Promot. 2018 Jan 10;7:3. doi: 10.4103/jehp.jehp_79_17. PMID: 29417063; PMCID: PMC5791467.

8. Kirmizigil B, Demiralp C. Effectiveness of functional exercises on pain and sleep quality in patients with primary dysmenorrhea: a randomized clinical trial. Arch Gynecol Obstet. 2020 Jul;302(1):153–163. doi: 10.1007/s00404–020–05579–2. Epub 2020 May 15. PMID: 32415471.

9. Shirvani MA, Motahari-Tabari N, Alipour A. Use of ginger versus stretching exercises for the treatment of primary dysmenorrhea: a randomized controlled trial. J Integr Med. 2017 Jul;15(4):295–301. doi: 10.1016/S2095–4964(17)60348–0. PMID: 28659234.

10. Motahari-Tabari N, Shirvani MA, Alipour A. Comparison of the Effect of Stretching Exercises and Mefenamic Acid on the Reduction of Pain and Menstruation Characteristics in Primary Dysmenorrhea: A Randomized Clinical Trial. Oman Med J. 2017 Jan;32(1):47–53. doi: 10.5001/omj.2017.09. PMID: 28042403; PMCID: PMC5187401.

11. Mohebbi Dehnavi Z, Jafarnejad F, Sadeghi Goghary S. The effect of 8 weeks aerobic exercise on severity of physical symptoms of premenstrual syndrome: a clinical trial study. BMC Womens Health. 2018 May 31;18(1):80. doi: 10.1186/s12905–018–0565–5. PMID: 29855308; PMCID: PMC5984430.

12. Duigan, C. V. (1999). Primary Dysmenorrhea. Australian Journal of Physiotherapy, 12(2), 55–56. https://doi.org/10.1016/S0004-9514(14)60961-2

13. Heidarimoghadam, R., Abdolmaleki, E., Kazemi, F., Zahra Masoumi, S., Khodakarami, B., Mohammadi, Y., & Moghadam, H. R. (2019). JRHS Journal of Research in Health Sciences journal homepage The Effect of Exercise Plan Based on FITT Protocol on Primary Dysmenorrhea in Medical Students: A Clinical Trial Study. J Res Health Sci, 19(3), 456.

14. https://countrymeters.info/en/World

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