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Towards a New Health Politics in Kenya: Labor Organizing and Strikes by Health Workers in the Public Health Sector
Get PDFThere has been insufficient attention by global health scholars to labor organizing by health workers, including when and why organizing occurs, what forms and strategies it takes and its implications for governance and policy. These questions are critical but largely absent in research on what has been called the “global health workforce crisis.” Kenya represents an important case study. A new constitution in 2010 expanded institutional spaces for labor organizing and decentralized governance of the health system. Both reforms had significant implications for the health workforce and strikes by health workers have been pervasive. In 2017, nationwide strikes by public sector doctors and nurses lasted for 100 days and 150 days, respectively, massively disrupting health services across the country.
This dissertation explored labor organizing by health workers, specifically doctors and nurses working in Kenya’s public health sector, including what motivates labor organizing efforts, the characteristics of organizing in the public health sector (including unionization, collective bargaining and strikes) and its impacts on working conditions, governance and policy. A political economy-based conceptual framework and Walt and Gilson’s health policy triangle guided the study approach and analysis. Three methods were employed: in-depth interviews in Kenya with 81 public sector doctors and nurses, labor union officials, and government health officials; a database of strikes that included 155 strike events by health workers using systematic searches of media reports; and primary and secondary document analysis.
Findings revealed that doctors and nurses increasingly viewed employment in Kenya’s public health sector as precarious, characterized by frequent delays in pay and benefits, understaffed and under-resourced facilities and employment on short-term contracts. The roots of this precarity were framed in highly political terms, including public corruption, poor accountability and de-prioritization of public health in newly decentralized spaces, and were perceived to threaten the public sector workforce and motivated labor organizing. Unions secured improvements in working conditions through collective bargaining and strike actions at local and national levels but organizing was highly contested by public employers and gains made through organizing were often insecure. The impacts of organizing on health governance and policy were subtle but important, and despite their limitations health workers’ unions emerged as legitimate actors in Kenyan health politics.
The dissertation makes three key contributions. First, it shows that health worker organizing in Kenya extends beyond wages and working conditions to challenge corruption, mismanagement and systemic neglect that operate across local, national and global political economies and that are rarely taken up in global health scholarship. Second, it demonstrates how unions have become vital political actors, using strikes, bargaining and public advocacy to claim justice, professional recognition and state accountability for public health. Third, it exposes both the challenges and opportunities of organizing within decentralized, resource‑constrained institutions, highlighting health workers’ agency in fragile governance environments. In doing so, the study captures a pivotal moment in Kenya’s health sector and offers a novel framework for viewing health systems as contested political arenas. The dissertation lays the groundwork for theory building and comparative research on the political economy of labor movements in public health sectors that can contribute to global health scholarship
Cannibalizing the Starving: Poverty and Disability in the Late 19th and Early 20th Century America
Get PDFCannibalizing the Starving analyzes how the American ruling class and their institutions perceptually disabled people in poverty alongside the repercussions of this disablement within the late 19th and early 20th century. This thesis deploys an anarchist framework of understanding hierarchies, the state, and violence is utilized alongside critical disability studies to understand how disability was socially constructed in the context of poverty. Further, much of the framing involved is from the context of labor or those who could not or did not labor. At the heart of the issue is understanding seemingly innocuous language used to denigrate those in poverty as violent alongside the use of institutions such as the workhouse or almshouse to inflict violence against people in poverty. People in poverty had their rights and dignity stripped from them due to their economic position as their poverty was considered an active choice and at times was seen as inherited. The first two chapters heavily utilize archival materials from the Massachusetts State Archives and the UMASS Boston Special Collections, specifically the Massachusetts Society for the Prevention of Cruelty to Children Collection. Key to this work is that the social disablement of people in poverty was not an inevitability but was a choice as socialists fought for the basic respect and recognition for people in poverty. Further to these socialists, specifically the Industrial Workers of the World, is that poor laws and the language of disablement were utilized against them to politically repress, harass, and denigrate them. The dispossession of people in poverty was founded on the idea that poverty was a choice somehow innate to a person’s mind or body which justified their oppression to force labor from them. We as a society never escaped from this mindset and the thesis juxtaposes the present with the past to signify the current day’s repercussions
Improving High Frequency Absorptive Filters For Quantum Computing
Get PDFCoaxial transmission lines in superconducting quantum circuits are subject to infrared radiation (IR) leakage as signals travel from room temperature (≈ 300 K) to low temperature (≈ 10 mK). Current experimental configurations typically include an epoxy based filter on all cables connecting classical devices (pulse generators, VNA, etc.) to the quantum circuit. The epoxy is characterized by its dielectric properties per unit length and acts as an absorber, attenuating IR noise. Historically, such IR filters have been fabricated by the experimentalists who require them, more recently they have become commercially available. This work investigates the performance of filters which were filled with ECCOSORB. epoxy via two different methods: liquid casting and rigid stock
Tienen alas, pero no las pueden usar: Stories of immigrants in search of work credentials
Get PDFThis report presents the results of a qualitative research study, funded by the Latino Equity Fund of the Boston Foundation, aimed at understanding the challenges that highly skilled immigrants1 face when reentering their careers in Massachusetts
The History Matters: Fighting for Equal Education in Lowell, Massachusetts, 1970-1990
Get PDFThis is a story about Southeast Asian and Latino parents in Lowell, MA who confronted the Lowell School Committee in the late 1970s and 1980s, demanding that schools be desegregated and that their children have equal educational opportunities. While the school struggle unfolded, acts of anti-Asian and anti-Latino violence were perpetrated in Greater Boston and around the country, including the tragic death of Vandy Phorng, a 13-year-old Cambodian American in 1987. Following his death, the federal lawsuit that Southeast Asian and Latino parents had filed moved through the federal court for two years before the city settled. However, further racism was exhibited when opponents of desegregation placed a nonbinding question to make English the official language of Lowell on the ballot and it passed easily. Though it may not seem like it at first, this is a story of possibilities, of how a coalition of parents stood up to bigotry and entrenched political power and won. At great personal risk, they improved their children’s schools and, by extension, all schools in the city
Burnout and Productivity: An Action Research Study on Workplace Impact and Mitigation
Get PDFEmployee burnout is a prevalent issue across industries, impacting both individual well-being and organizational productivity. This action research roadmap project examines the impact of burnout on productivity through a qualitative study involving professionals from corporate marketing, higher education, government/public health, corporate analytics, accounting, technology, human resources, and product operations. Participants were interviewed and shared their experiences with burnout. They provided insight into situational triggers, support systems, and the impact of burnout on productivity. Findings highlight that burnout often appears gradually but can reach a critical tipping point, leading to emotional exhaustion, disengagement, and diminished task completion. Organizational support, like leadership behaviors, workload management, and access to resources, plays a large role in either exacerbating or mitigating burnout. The study concludes with recommendations for organizations to implement targeted interventions and suggests future research opportunities to further explore burnout prevention and recovery strategies across a wider range of industries and demographics. Keywords: burnout, productivity, employee well-being, workplace stress, leadership support, flexible work, emotional exhaustion, job performance, burnout recovery
The White Elephant in the Classroom: Using Local History and Resource Pedagogies to Remove It
Get PDFYears of scholarship outline the benefits of asset-based pedagogy for all students, especially the culturally and linguistically diverse students who are now the majority student population in public schools. But there is scant research on how experienced in-service teachers modify their practices and beliefs to adequately prepare these students for 21st century leadership. This sequential mixed methods case study examined the efforts of elementary and middle school teachers as they grappled with personal, professional, and systemic barriers that arose as they worked to strengthen their cultural and community responsiveness by centering the local history of a historic great migration town
Getting into Cars with Strangers
No full textThis is a collection of short stories that focuses on a variety of characters that live in and around mainly Salem, Massachusetts. The character of Mariel is featured in several stories as we are presented with the travails she endures while she is at college, trying to graduate while working, as well as navigating through the nuances of many relationships. We start from the first story where Mariel is literally looking at the entire world from the top of a gas tanker at the gas station where she works to the perspective of another co-worker at the same gas station and ends with the final story where Mariel finds a way to put an ending to one aspect of her life and embark into her next chapter. These stories focus on the mundanities of everyday life to reveal that truth and art and class struggles that occur daily that we might not give a second thought to yet giving these characters the attention and closeness these stories present, broadens our understanding of the world at large
ANALYTICAL APPROACHES FOR IDENTIFICATION OF ESSENTIAL GENOMES OF PLASMODIUM KNOWLESI AND BABESIA DIVERGENS
Get PDFApicomplexa constitute a large phylum of single-celled, obligate intracellular protozoan parasites. Notably, Plasmodium spp. and Babesia spp. are apicomplexan parasites that infect red blood cells. Plasmodium species are the causative agent of malaria and are transmitted by Anopheles mosquitoes, affecting large human populations, whereas Babesia spp., transmitted through the bite of Ixodes ticks cause babesiosis.
In this dissertation, we investigate the essential genome of these parasites using high-throughput transposon mutagenesis. Identifying the essential genome is key to finding new drug targets and understanding resistance mechanisms, a crucial pursuit given the rising resistance to frontline antimalarial drugs and the challenges in treating babesiosis. We have developed analytical frameworks and Bayesian methodologies to quantify and predict the essentiality and the fitness of protein-coding genes, transcript variants, and lncRNAs in P. knowlesi and B. divergens. These organisms serve as ideal representatives of the Plasmodium vivax and Babesia clades, respectively, offering robust in vitro systems for genetic studies. Highly saturated transposon mutagenesis libraries enable identification of essential domains within larger, non-essential genes. We introduce a robust mathematical framework to systematically assess truncatability, offering high-resolution analysis of essentiality of protein domains. Our analysis not only confirmed previously known truncatable genes such as PTEX150 but also uncovered novel candidates. Furthermore, by employing Hidden Markov models, we systematically evaluate insertional bias based on sequence composition, ensuring rigorous data quality control.
Leveraging our highly saturated mutagenesis libraries, we conducted drug perturbation experiments to uncover resistance mechanisms to both antimalarial and antibabesial drugs. We present a robust computational framework for analyzing perturbation data, which enables the identification of drug resistance genes through differential insertion analysis. Analysis of these data revealed both previously validated and novel genes implicated in drug resistance. Interestingly, our findings reveal that mitochondrial metabolism genes NDH2 and RFK are enriched under drug pressure in P. knowlesi, and that RFK inhibition by roseoflavin shows an antagonistic effect on DHA activity, pointing to a potential mitochondrial-based resistance mechanism to artemisinin.
The thesis is organized as follows. In chapter one, we review the background on Plasmodium spp., Babesia spp., transposon mutagenesis, and current essentialomes in Apicomplexan parasites. Chapter two details the application of our mathematical models and computational approaches to P. knowlesi, revealing its essential genome and identifying novel resistance genes and synergistic mechanisms associated with the frontline antimalarial drug DHA and the investigational compound GNF179. In chapter three, we present optimized protocols for generating transposon mutagenesis libraries in B. divergens and apply our models to construct a preliminary essentialome for this organism. Chapter four provides a comparative analysis of the essentialomes across major Apicomplexans, including P. falciparum, P. berghei, P. knowlesi, and T. gondii. We close the thesis with concluding remarks and future directions. Overall, this thesis delivers a novel computational toolbox for transposon-based essentialome analysis in Apicomplexan parasites, paving the way for innovative therapeutic strategies and applications in diverse organisms
Physical Activity and Body Image in Early Onset Cancer Patients
Get PDFAbstract: Cancer is the leading cause of death among Americans under the age of 85 (Brown et al., 2012). There are increasing rates of cancer diagnoses in adults aged 18-49, which is described as an early onset (EO) diagnosis. Despite high survival rates (Lewis et al., 2021), EO cancer patients are at increased risk for long-term physical and psychological challenges associated with both the disease and its treatment (Haque et al., 2023). Cancer diagnosed during these critical periods of life can significantly impact self-perception and body image, which are critical to identity formation and quality of life (Castonguay, et al., 2017). Understanding the complex interaction between cancer and psychosocial factors in EO populations is essential to addressing the survivorship challenges that are unique to this population. In older adults, physical activity during and after cancer treatment has been associated with physiological benefits, including reduced risk of mortality, adverse effects, and cancer recurrence (Bélanger et al., 2011; Baumann et al., 2013; Cormie et al., 2017). There is also evidence to show that physical activity can improve body image, especially aspects that can be affected by cancer and its treatment, like physical body shape and perception (Dana et al., 2022, Mahdifar et al., 2021). However, this research remains less established in early onset cancer patients, highlighting the importance of this study.
Methods: This study is a secondary analysis from the Reproductive Health after Cancer Diagnosis and Treatment Study (REACT). REACT is a cross-sectional study of adults diagnosed with a first primary cancer between the ages of 18-49. It was a self-administered confidential questionnaire, that covered sociodemographic, cancer and cancer impact, reproductive health and fertility, sexual health and energy balance topics. Participants were recruited using methods such as community organizations, patient advocacy connections, survivorship groups, community newsletters and social media. Our secondary analysis examines the relationship between various sociodemographic factors—such as age, gender, origin of birth, , obesity status, and ethnicity—within the cohort and how these factors correlate with participants\u27 self-reported physical activity levels and body image perceptions. This study uses a relatively novel approach by examining the relationship between distinct types and volumes of physical activity and self-perception tools in cancer patients. The ability to analyze these specific activity patterns alongside self-reported measures offers a unique and valuable perspective, contributing to a deeper understanding of how physical activity influences body image and psychological outcomes in this population.
We extracted this PA data from questions such as “In a typical week on how many days did you walk or cycle for at least 10 minutes to get to and from places?” and “How much time do you spend walking or cycling for travel on a typical day?”. From this raw data, we calculated the average time spent commuting by bike or foot by multiplying the days by time to get average minutes per week. We calculated this data for every type of PA, before using the quantifiable data to perform analyses.
Results: There were no significant differences in leisure time physical activity or total moderate and vigorous physical activity levels based on sex, age, race, country of origin, cancer type, treatment type, or active treatment. However, BMI was identified as a significant factor influencing both LTPA (p \u3c 0.0001) and total MVPA levels (p = 0.0016). Higher levels of LTPA (p = 0.0013) and total MVPA (p = 0.0016) were associated with significantly more positive body image scores (BES), with this relationship being particularly strong in males engaging in higher levels of total MVPA. Additionally, obesity status was a significant factor, as higher BMI was consistently linked to lower BES scores across both sexes (p \u3c 0.001).
Whilst Stunkard scores for body image perception were not significantly associated with total MVPA levels overall current (p = 0.485), diagnosis (p = 0.763) or ideal (p = 0.023), they were significantly different among females currently engaging in LTPA (p = 0.0002) and at diagnosis (p \u3c 0.0001), with significant negative trends among females, and insignificant positive trends among the males. Additionally, obesity status had a strong impact on Stunkard scores, with higher BMI being consistently associated with greater body dissatisfaction across both sexes (all time points, p
Conclusion: Our findings reveal significant relationships between PA, obesity status, and body image perception in EO cancer patients, with notable sex differences. LTPA was strongly associated with improved body image, particularly in females, while total MVPA showed a weaker and less consistent relationship, especially in males. Higher BMI correlated with lower body image satisfaction across sexes, reinforcing these trends