The Flying Samaritans is a group of volunteers who provide health care on a monthly basis at the Laguna de San Ignacio Clinic in Baja California Sur, Mexico. The purpose of this study was to gather demographic information about the patients at the clinic as well as to determine why the patients need to use a free clinic, how they use other health care facilities that are available to them, how well they take care of themselves in terms of exercise, nutrition, and care of chronic disease, and how the Flying Samaritans can improve their care for this population. This information was gathered using an extensive patient survey as well as through interviews with both patients and health care providers at this clinic. Based on the data gathered, it was determined that some health problems present in the population could be prevented with education about daily health and dental care. The Flying Samaritans could implement some forms of patient education in order to minimize chronic health problems and to continue to improve the overall health of this population. The data also demonstrated that the patients rely heavily on the Flying Samaritans services, as the town in very isolated and does not offer any other medical or dental facilities. The Flying Samaritans are essential to the well-being of this town and provide services that the patients may not otherwise receive.

The HIV pandemic spawned a global biomedical research effort which continues today. Because of multinational clinical studies, doctors and health officials possess more tools than ever before for the effective prevention and treatment of HIV/AIDS. The relationship between the United States and Sub-Saharan African nations features prominently within this global research effort. More specifically, many of the most significant HIV-related research findings emanate from clinical trials with a unique multinational configuration: the study protocol is largely designed and funded by American sources but executed at clinical research sites in Sub-Saharan African countries like South Africa and Zimbabwe. This thesis investigates the context and ethics of this configuration, with a focus on US-backed trials conducted in South Africa specifically. Using data collected from semi-structured interviews conducted at South African HIV clinical research sites, this thesis uncovers two significant ethical problems: insufficient benefits delivered to South African clinical trial participants, and informal processes occurring alongside formal protocol. By examining scope, effects, and implications of these problems, it becomes clear that although this research system delivers powerful results, there exists room for improvement.

The goal of this pilot study is to capture the lived experiences of racial/ethnic Hispanic breast cancer patients at Yuma Regional Cancer Center in Yuma, Arizona, through video documentary. This unique media gives a "voice" to patients who may otherwise feel underrepresented in healthcare and in social support resources. An analysis of ten interviews with Hispanic/Latina breast cancer patients reveals the intersectional nature of social support and emotional adjustment during the breast cancer experience from diagnosis to treatment. The resulting interviews are analyzed for reoccurring themes that may resonate with a large proportion of the Hispanic breast cancer population. The final result of the pilot study is a video documentary reflecting the unique social support needs of Hispanic breast cancer patients as well as provider education needs. This video will then be broadly promoted throughout Yuma Regional Medical Center and Mayo Clinic.

This thesis critically examines the scientific and ethical dimensions of the novel and controversial technology of mitochondrial replacement therapy (MRT). The first portion provides a background on mitochondrial diseases and examines how these organelles (mitochondria) have left humans vulnerable to disease. The second portion of the thesis examines the technology of mitochondrial replacement therapy and what research contributed to the development of MRT. Finally, the third section responds to the ethical and legal concerns proposed and outlined by the Nuffield Council of Bioethics. After careful consideration of all legal and ethical concerns, it is concluded that the technology of MRT should be pursued under careful foresight with the idea that the technology is already happening and we must move forward in a way that provides the greatest information.

Reproductive cloning is the duplication of genetic material to reproduce a living organism. The sheep Dolly was the first adult mammal to be cloned and her birth unveiled a multitude of questions about the potential for cloning humans and how that might threaten human individuality. Given those questions, my project delves into how reproductive cloning relates to the idea of individuality across three subgroups: humans, utility animals such as those used for research or agriculture, and pets.

Plastics continue to benefit society in innumerable ways, even though recent public focus on plastics has centered mostly on human health and environmental concerns, including their endocrine-disrupting properties and the long-term pollution they represent. The benefits of plastics are particularly apparent in medicine and public health. Plastics are versatile, cost-effective, require less energy to produce than alternative materials like metal or glass, and can be manufactured to have many different properties. Due to these characteristics, polymers are used in diverse health applications like disposable syringes and intravenous bags, sterile packaging for medical instruments as well as in joint replacements, tissue engineering, etc. However, not all current uses of plastics are prudent and sustainable, as illustrated by the widespread, unwanted human exposure to endocrine-disrupting bisphenol A (BPA) and di-(2-ethylhexyl) phthalate (DEHP), problems arising from the large quantities of plastic being disposed of, and depletion of non-renewable petroleum resources as a result of the ever-increasing mass production of plastic consumer articles. Using the health-care sector as example, this review concentrates on the benefits and downsides of plastics and identifies opportunities to change the composition and disposal practices of these invaluable polymers for a more sustainable future consumption. It highlights ongoing efforts to phase out DEHP and BPA in the health-care and food industry and discusses biodegradable options for plastic packaging, opportunities for reducing plastic medical waste, and recycling in medical facilities in the quest to reap a maximum of benefits from polymers without compromising human health or the environment in the process.

Vaccine opposition is a growing problem in developed countries where dropping vaccination rates threaten general public health by laying the foundation for resurgence and reemergence of previously eradicated infectious diseases. This thesis argues that the current movement is only the most recent incarnation of opposition that has co-evolved with vaccine practices for the duration of their mutual histories. Part one provides a historical context for the current movement using the example of the development and deployment of the smallpox vaccine as a representative timeline of vaccine acceptance and opposition. Part two describes the current movement in the United States and the United Kingdom, interprets the reasons for the conclusions drawn by vaccine-concerned parents, and provides a framework for public health officials to approach the issues.

The first global estimate of maternal mortality in 1985 revealed that over half a million women die each year due to pregnancy related causes. Although a relatively small figure compared to the deaths attributed to such diseases as malaria and HIV, this was new data. New data meant attraction from powerful international agency leaders, which eventually led to the formation of a global effort called the Safe Motherhood Initiative (SMI). In turn, the global SMI provided the framework for the World Health Organization's (WHO) Millennium Development Goal 5 (MDG 5). Both of these global campaigns, which were largely implemented through advocacy efforts, adopted time sensitive goals aimed specifically to decrease maternal mortality. Although the placement of maternal health on the public health agenda was an extraordinary accomplishment for women's health advocates, a historical examination of safe motherhood efforts will reveal that these advocacy techniques would not keep maternal health on the public health agenda. Over two decades of unsuccessful efforts to reduce maternal mortality have shown that advocacy efforts are not the answer to actually decreasing maternal mortality ratios. Due to the intrinsic difficulties in measuring maternal mortality, and the public health sector's emphasis in prioritizing the political agenda based on such measurements, maternal health has arguably fallen in last place on the agenda. This thesis will explore how the concern for mothers influenced the formation of MDG 5, and how MDG 5 has been translated into local practices. A case study of the Pan American Health Organization's advocacy effort also called the Safe Motherhood Initiative explores the underlying, culturally complex problems that are hindering progress of MDG 5. The results show that the lack of comprehensive reproductive health services for women is not only due to poor health systems in place, which is what many safe motherhood 5 efforts have attempted to address, but also due to cultural traditions and laws on sexual and reproductive health forbidding women to obtain the care they need to survive.

The United States is experiencing an increase in the prevalence and influence of complementary and alternative medicine (CAM) in patient healthcare, reflecting the increasingly positive public and professional attitudes on the use of CAM therapies. Despite the growing presence of CAM in U.S. healthcare, there are still many barriers to integration. This study aims to reveal the attitudes of conventional, integrative and CAM practitioners concerning the major challenges of CAM's integration, explore their proposed solutions, and reveal any discrepancies in these attitudes among different types of practitioners. Twenty-eight practitioners were interviewed on the challenges in the five facets of CAM's integration: integration into hospitals, integration into medical schools, insurance coverage for CAM, licensing & regulation of CAM practitioners, and clinical research in CAM. The overall positive attitudes on the benefits of CAM's integration support previous research on the subject; however, the conventional practitioners were unable to extend these benefits to real-world application, and they were unaware of many of the challenges facing CAM's integration. The CAM practitioners attributed many of the problems facing integration to the inability of CAM's philosophy to comply with the current ideology of medical academia, health insurance model, and laws that govern the licensing and regulation of medical practitioners. The CAM and integrative practitioners perceived there to be a large resistance from conventional practitioners, specifically concerning the integration of CAM into education, providing insurance coverage for CAM, and the licensing and regulation of CAM practitioners. They attributed this to a perceived lack of research on safe and effective treatments in CAM. The conventional practitioner responses reflected this weariness of treatment effectiveness in their responses. However, the CAM and integrative practitioners believed these claims to be largely inaccurate, and constructed by the influence and manipulation of large-scale medical corporations and organizations. The participants believed that more evidence-based research in CAM, and increased public awareness in CAM therapies will force conventional practitioners to increase their knowledge in CAM, helping to alleviate their fears and skepticism of CAM therapies. By easing these concerns, dialogue can occur among practitioners of different modalities that will help to ensure a smooth integration of CAM and will raise the quality of patient healthcare by providing safe and effective resources for alternate forms of treatment.