ideas about the PACEMD Oaxaca Project

1. Some NGOs believe that improving maternal mortality and reproductive health can lead to better access to contraceptives and reproductive planning, as well as an eventual delay in the beginning of the reproductive period. Ideally, this delay would decrease overall fertility and would lead to economic and social advances. However, my question is whether this is a testable assumption. Do NGO funded programs designed to increase reproductive health actually lead to decreased fertility and the desired advances? How can we measure such a claim?

2. The premise of life-history theory is that species must make trade-offs in available resources and thus, there is likely some ideal level of fecundity which correlates to the highest possible fertility of a reproducing female. How do programs that are explicitly designed to decrease fertility become adopted into human groups that maintain traditional practices aimed at increasing inclusive fitness by maximizing quantity of viable offspring?

3. What is the current demographic characteristic of the southern Mexico region? What pattern do we see in this region and are changes to this pattern likely to follow in the coming decades? Is a demographic transition occurring within this group? Does such a transition make adoption of a model that improves reproductive health more likely?

4. Is a training program organized by "outsiders" sustainable? Can sustainability be maximized by making use of a few key target individuals within the culture of interest? Will using those individuals allow the program goals to proliferate without a continued presence of the "outside" entity?

5. Recently, an emerging field within the confines of emergency medicine has grown in popularity. Fellowships in "international medicine" can now be found at multiple graduate medical programs. However, the underlying goals and methodology within these programs is not clear. If this field is too survive and contribute to medicine and other disciplines, an overarching purpose should arise. What type of implications does this program have for the future of the emerging field of "international medicine"?

6. There are multiple fields in other disciplines that address global health questions and examine the impact of system changes worldwide. For example, medical anthropology looks at how cultures integrate and respond to various models of health and illness while applied anthropology often focuses on ways to improve health by designing and examining programs grounded in public health principles. Of course, public health and social epidemiology also examine the risk factors of individuals and groups in regards to their health status. Medicine has not played a large academic role in these questions and has, instead, focused on providing short term care to a small amount of individuals in need during a given point in time (i.e. medical missions). An integration of these disciplines may lie within the new field of international medicine.