February 6 has been designated by the UN as “International Day against Female Genital Mutilation,” a day to raise awareness about the dangers and health consequences of this traditional practice in sub-Saharan Africa and the Middle East.1 Female genital mutilation (FGM) refers to the partial or total removal of the external female genitalia for cultural, religious, or other non-therapeutic reasons.2 It has no health benefits and frequently causes both immediate and long-term problems for women and girls: in addition to severe bleeding, infection, and problems urinating, it can cause infertility and complications with childbirth.1,3 An estimated 130 million women alive today are currently living with the consequences of FGM.
FGM is entrenched in the cultural and religious beliefs in many communities.4 In many parts of West Africa, this cutting is presented as a religious obligation to Muslim women.5 It is internationally recognized as a violation of the human rights of girls and women: it is nearly always performed on minors,2 and it is sometimes used to facilitate sexual relations with child brides.5 Additionally, FGM is just one component of cultures in which women have no voice in decisions that affect their everyday health and well-being. For example, Amnesty International recently called attention to the high rate of maternal deaths in Burkina Faso, which it ascribes to gender discrimination: many women are unable to access sexual and reproductive health services due to discriminatory attitudes and illegal demands for payments by corrupt medical staff. Burkinabe women have little to no say in when they can seek medical care or the timing and spacing of their pregnancies, and they are still being subjected to early marriages and FGM.6
There has been recent progress by governments, human rights groups, and NGOs in persuading communities to abandon the practice. In Mauritania, 34 imams and Muslim scholars recently signed a fatwa, or religious ruling, against the practice.7,8 Authorities in Niger recently took steps to enforce a ban enacted in 2003 by administering fines and jail sentences to 45 mothers who allowed their daughters to be cut.7 A group called Tostan that works primarily in Sénégal has worked with thousands of villages that have made the decision to abandon FGM: the group educates villagers and then allows them to make their own conclusions. Because the practice is often tied to marriage opportunities, intramarrying groups must make a collective decision to abandon the practice in order for efforts to be effective.4 Since 1997, 4,580 communities working with Tostan have declared their decision to end the practice.
The UN and other international health and human rights groups have campaigned aggressively to end FGM, and more countries are passing laws against the practice. Recent indications that communities in West Africa are moving away from it are encouraging. However, two million girls are still at risk every year.2 As the international community observes this day of awareness, we should be attuned to the need for culturally sensitive approaches to end FGM in order to protect the rights of women and girls.
It would be nice if, for once, Congress could get health reform right.
In his State of the Union address, Obama all but begged Congress to not walk away from health care reform.1 After the election of Scott Brown to the Massachusetts Senate seat formerly held by the late Ted Kennedy, journalists and bloggers have been declaring reform DOA (or, at best, “on life support”2). Ironically, Senator Kennedy – a champion of health care reform – was replaced by a Republican who broke the Democrats’ filibuster-proof 60-seat majority and derailed the party’s plans to streamline – or, as some might say, ramrod – healthcare reform into law, with or without bipartisan consensus. Since then, Capitol Hill has been quiet. Pelosi has said that the controversial Senate bill does not have the support in House needed to pass it there and put it on the president’s desk.3 Other legislative maneuvers are also being considered, but it seems that, at least for now, members of Congress are letting the dust settle before they figure out their next moves.
While the Massachusetts election has been alternately hailed or blamed for de-railing health reform, it could be argued that the White House and Congress were doing a good job of mangling it during negotiation. What Obama promised would be an open process – “broadcast on C-SPAN,” he claimed in his campaign – turned out to be the same old story of Washington back-room deals. The Senate dropped the public option when Joe Lieberman threatened to withhold his vote.4 Ben Nelson managed to upset everybody when he traded his vote for the “Cornhusker Kickback” – an agreement that the federal government would shoulder Nebraska’s Medicaid burden forever. All this wheeling and dealing, combined with Republicans’ absolute refusal to join in the effort and rumors of “death panels” and “socialized medicine,” has driven public opinion away from the whole convoluted process. A recent USA Today/Gallup poll found that 55% of Americans think that Congress should suspend work on current health care bills and start over.5 By the time it was ready to be reconciled, most of the public had no idea what it even said.
Ultimately, it seems our leaders are perpetually more concerned with being re-elected than they are with doing their jobs – passing legislation. Brown’s victory is the latest in a string of recent Republican victories that are making Democrats up for re-election nervous; now that things are cooling off, many of them are reluctant to re-commit to reform effort. Republicans seem to be more concerned with making Democrats look bad so they can regain control of Congress than with working with them to get something done. Even the president has begun to shift his attention to other issues, such as bank reform, to attempt to regain some popularity.6 Those of us who were so looking forward to reform after both Roosevelts, Truman, Kennedy, and Clinton had all tried and failed7 may be disappointed again.
International pharmaceutical giant GlaxoSmithKline announced last Wednesday that the company would release information on over 13,000 malaria drug candidates into the public domain.1,2 The company will also create an “open lab” where independent researchers can use GSK facilities and expertise for their own research projects. The company’s CEO, Andrew Witty, said in a speech in New York that drug companies have to balance social responsibility with the need to make a profit in order to “earn the trust of society.”1,3
While such a move is certainly laudable, and has been cautiously praised by organizations such as Oxfam and Médecins Sans Frontières, it is a small step against the typical business flow of Big Pharma. When Witty announced his plan at Harvard last year to put potential drugs for neglected diseases into a “patent pool” for other scientists to investigate, none of the other major drug companies followed suit.2, 3 GSK has only recently turned over this “new leaf”: only a few years ago, the company was directly targeted by Oxfam’s “Cut the Cost” campaign criticizing the higher prices of medicines charged by pharmaceutical corporations in developing countries.4 The pharmaceutical industry came under fire in 2001 when 39 pharmaceutical companies (GSK included) tried to prevent the South African government from importing generic versions of patented drugs.5 It appears, however, that GSK has been taking steps in the right direction. Oxfam spokesperson Rohit Malpani said that “Big Pharma seems to be realizing slowly that poor people in developing countries face huge and different barriers to good health, and so…the industry must change its existing “strong patents, high cost” way of doing business.”6
GSK’s recent moves are certainly encouraging. However, it will still take a lot of work for such steps to bear any real fruit. Drug discovery is a long and expensive process, so organizations that participate in GSK’s “open lab” initiative will need to figure out how to carry their projects forward after their time in the lab is over.2 Professor Peter Winstanley of the Liverpool School of Hygiene and Tropical Medicine said that while there’s a slight possibility that we may have new drugs from this in the next five years, it is more likely to happen over the next 10 to 20 years, and that will take a lot of work, some luck, and a lot of money.”1
Bodies heaped on street corners. Thousands aimlessly wandering the streets. A once-busy port city strewn with rubble. These are just a few of the images crowding the media coverage of the earthquake that leveled Port-au-Prince, Haiti.
Last Tuesday, a quake registering 7.0 on the Richter scale hit the Haitian capital with such force that it killed over 100,000 people in 60 seconds.1 It was the worst the region had seen in 200 years. This, compounded with the country’s poverty, the poor construction quality and the underdeveloped infrastructure, left the region without power, shelter, or substantial medical response.2 Witnesses described mass chaos and mayhem as aftershocks rippled through the area. The U.N. Headquarters, the National Penitentiary, and the presidential palace had all collapsed.3,4 As rescue and relief operations began, so did violence: by Thursday, gunfire could be heard in the streets at night. The Red Cross estimates that one in three Haitians were affected. 4
The havoc wreaked by this most recent disaster, however, should draw significant attention to the Haitian government’s neglect of its own people. Its land and resources have been repeatedly plundered, and its governance revolves largely around the U.N. relief agency. The Caribbean nation is the poorest in the Western Hemisphere: 80% of its people live below the poverty line, and it has the highest rates of infant and maternal mortality.5 Its poverty and political instability have been repeatedly exacerbated by earthquakes, floods, and hurricanes; as such, it has been the recipient of substantial international humanitarian and financial aid.2 Salvano Briceno, the director of the UN International Strategy for Disaster Reduction, has pointed out that the government seems to suffer from a short memory. He said on Wednesday that while neighboring countries cope better with natural disasters, “the Haitian Government, once the relief effort is over, just wants to forget.”5 This time, however, there can be no forgetting: with the international relief effort must come a re-evaluation of the political and financial aid needed to best help the country. The Haitian people deserve more than to go back to the status quo after the world helps them clean up the rubble.
In Peru, a nose that has been flattened and pushed into the face – the characteristic disfigurement caused by leishmaniasis – is referred to as “the mark of the jungle.” In addition to the damaged self-image it causes in people with leishmaniasis, the “mark” comes with a stigma that leads to ridicule from others, shame, and sometimes even being driven from their own communities.1
Leishmaniasis is caused by a protozoan parasite of the genus Leishmania. Humans are infected through a bite from an infected female phlebotomine sand fly and can develop one of three main types of the disease. Cutaneous leishmaniasis, by far the most common form, causes lesions on the skin; there are approximately 1.5 million cases worldwide each year.2 Mucocutaneous leishmaniasis destroys the mucous membranes of the nose, mouth, and throat and often leads to pronounced disfigurement.3 Visceral leishmaniasis is the most severe, which is characterized by fever, weight loss, anemia, and enlargement of the spleen and liver. This disease, called kala-azar (meaning “black fever”) on the Indian sub-continent, occurs in 500,000 people each year and causes approximately 50,000 deaths.4 Leishmaniasis is present in 88 countries, 72 of which are developing countries, on four continents.5 The spread of HIV has compounded the problem: in cases of co-infection, the leishmaniasis parasite accelerates the onset of AIDS by suppressing the immune system and stimulating virus production. Cases of co-infection have been reported in 38 countries on all four continents where the disease is endemic.6 Unfortunately, the disease is very under-reported: only 32 affected countries require reporting.
The disease burden is exacerbated by the social stigma in response to the effects of the parasite. Many affected are ostracized from their communities because of their disfigurements. In Pakistan and Afghanistan, cutaneous leishmaniasis is called Kal Dana (“the year-long sore”). Affected children are isolated, women are considered unsuitable for marriage and mothers are separated from their children.7 The problem is particularly bad in Nepal, where the caste system prevents “untouchables” from being treated. 1 Ultimately, poverty and ignorance are at the root of leishmaniasis. It is poverty that drives people in Peru into the jungle to cut lumber or pan for gold, to sleep without bednets, and to delay treatment so they can earn for their families.1 Dr Robert Killick-Kendrick, a leading parasitologist, recently said in an interview with the WHO that while progress in controlling leishmaniasis is slow, there have been encouraging recent developments.4 He lists five key factors that are important in controlling all vector borne diseases: peace, long-term political commitment, finance, sound control methods likely to succeed, and public health education. “It’s easy to sit in our armchairs and list the problems for the control of VL – or any other vector-borne disease,” he says. “But I am optimistic: with adequate funding, long-term political support and energy coupled with a little imagination, it must be possible to tame this disease, if not get rid of it altogether.”
To most, the Rwandan genocide that began in 1994 is a page in the history books, and the resulting instability in the Kivu region of eastern DRC is old news. But for Dr. Denis Mukwege, a surgeon who specializes in the repair of vaginal fistulas, the atrocities of Congo’s “second war” are a harsh, every-day reality. Vagina fistula, a condition in which the tissue wall between the vagina and the bladder and/or colon is torn, is a common result of the systematic rape to which the women of this region of the Congo are subjected.
During Rwanda’s civil war and genocide in 1994, thousands of refugees and armed militant groups fled to the eastern region of the Congo, generating a climate of political instability and local anarchy. A “second war” began in 1998, in which Rwanda and Uganda organized and fostered armed bands to terrorize the local people and maintain the insecurity to justify militarization that enables them to plunder the resource-rich region. This conflict has been the deadliest since World War II, and more people have died than in Iraq, Afghanistan, and Darfur combined. Intermingled with the high death toll is the widespread calculated rape of women of all ages. It is used to physically and psychologically terrorize: the women are raped or gang-raped in broad daylight and in plain view of their families and neighbors. As a result, social networks are destroyed and family ties are fragmented. The widespread sexual violence has taken its toll on public health both physically and socially. Sexually assaulted victims outnumber wounded soldiers 4 or 5 to one and civilians with gunshot wounds 2 or 3 to one. Medical sources estimate that between 19 and 30 percent of the victims test positive for HIV. Half of them have syphilis. The women are virtually destroyed, often abandoned by their husbands, and their children are traumatized. Those that survive become outcasts.
In the midst of such atrocities, Dr. Mukwege has been called the “angel of Bukavu.” He typically performs ten surgeries per day, often working 14 hours or more. To the women he heals, he is more than just their doctor: he is their brother, their counselor, their confidant. He has been featured by CNN, the New York Times, and Glamourmagazine, and has been given numerous awards, including the Olof Palme Prize and the UN Human Rights prize. But while Mukwege is grateful for the attention drawn to the conflict and money for the hospital, what is truly needed, he says, is a political response to the violence. “Visitors come from the international community. They eat sandwiches and cry, but they do not come back with help. Even President Kabila has never put his foot here. His wife was here. She wept, but she has done nothing.”
Interview with Cécile Mulolo Kamwanya, psychologist at Panzi hospital:
On December 3, 22 people were killed while at a graduation ceremony for medical, engineering, and computer science students at Banadir University in Somalia. The ceremony was the target of a suicide bomber. Among the dead were were medical students, doctors, and three government ministers, including Dr. Qamar Aden Ali, Somalia’s Minister of Health. The WHO has described Dr. Ali as a “tireless, energetic and influential advocate for health in Somalia who was determined to improve health standards and care for her fellow Somalis” and who worked closely with the World Health Organization to improve her country’s health system.
The attack is a devastating blow to both the small Somali medical community and the UN-supported government, which cannot even guarantee safety within the few square miles of Mogadishu it controls – less than three months ago, people were killed in an attack against the African Union mission (AMISOM) in the capitol. These events serve as a painful reminder that the violence and political instability in Somalia oppress its people and deprive them of their basic needs for food, hygiene, and health. The Afgooye Corridor, a 20-km strip west of Mogadishu, saw a population of 520,000 refugees uproot and move earlier this year. The displaced are at risk for cholera from poor hygiene and sanitation. Vaccination campaigns are extremely difficult, and staff face constant dangers. Medical equipment is not maintained. Both the WHO and the African Union have re-affirmed their commitment to helping the citizens of Somalia, but it is not just the government itself that is being attacked: both the Minister of Education, Ahmed Abdulahi Waayeel, and the Minister of Higher Education, Ibrahim Hassan Addow, were also killed. The bombing on Thursday was a calculated attack against the Somali education community. How effectively can humanitarian aid be administered in a country that has had no effective government for almost 20 years?
Despite valiant efforts, aid missions to Somalia are hindered by limited availability of funds and, more importantly, the political crisis. Until stability and peace can be brought to this country torn by civil war and violence, its people will continue to suffer.
A new scandal has added new fuel to the already-blazing fire of the global warming debate. On November 17, a hacker calling himself “FOI” (Freedom of Information) released an archive of stolen e-mails, data files, and source code from the Climatic Research Unit (CRU) of East Anglia University in Norwich, England. The CRU is one of the major institutions conducting research on anthropogenic (human-caused) climate change, and its data has been a major contributor to the work of the UN’s Intergovernmental Panel on Climate Change (IPCC). The e-mails show CRU scientists discussing how to manipulate data, dodge freedom of information requests, discredit scientists with opposing views, and influence the peer-review process of scientific journals. One message in particular shows Phil Jones (the head of the CRU) discussing how to exclude certain articles from the IPCC’s report, which has been used to inform and drive policy decisions in the U.S.
The global warming debate extends into nearly every research field, and public health is no exception. Climate change may increase the frequency of hurricanes and other natural disasters by affecting weather patterns and increase the range of disease vectors. Hurricanes can cause the spread of water-borne diseases such as cholera and salmonellosis. Vector-borne diseases of concern include leishmaniasis, dengue fever, and, in particular, malaria. Malaria, which infects approximately 500,000 people and can cause more than two million deaths per year, has received significant attention as a public health threat that could be exacerbated by global warming, though there is some debate on exactly how much climate plays a role in its range.
With so much at stake, the need for good-quality, transparent research on the extent and preventability of climate change is crucial. In the preface of the UN book Climate change and human health, the editors emphasize the need for “ rigorous and balanced evidence not only of the breadth and magnitude of climate change effects, but also of how they are distributed across populations, and over time” from the scientific community. Unfortunately, the release of the files from the CRU and the ensuing scandal, dubbed “climategate” by global warming skeptics, provides the exact opposite. The pettiness and unethical behavior of these scientists damages the credibility of their research. In particular, their influence on the IPCC’s reports calls its integrity into question. All of this distracts attention from the central question of exactly how much human activity influences the climate and what can be done to remedy what, if any, adverse affects it has.
If human activity is really driving global warming, then our governments and world leaders need to do something about it. If not, then the question needs to be put to rest so that scarce resources can be directed to where they’re needed. Unethical practices and petty squabbling among climate scientists accomplishes neither and does nothing to guide us in this debate that affects so much of what we do. When science is compromised to influence a cause, both are lost.
Figure compliments of http://www.who.int/globalchange/climate/en/
Rotavirus—the most common and lethal form of diarrhea—is one of the most deadly diseases facing children
By Dr. John Wecker, director of the Vaccine Access and Delivery Global Program at PATH
Whether you have heard of rotavirus before or not, it may surprise you to know that you’ve probably had it. Nearly everyone in the world will have at least one rotavirus infection by age 3.
In wealthy countries, ready access to medical care means that few children will die from rotavirus. And with the recent availability of vaccines, the risk of dying, or of ever having to be hospitalized because of rotavirus, has dropped dramatically.
In the developing world, the situation is completely different. Rotavirus—the most common and lethal form of diarrhea—is one of the most deadly diseases a child will face.
This global health crisis can be solved by making rotavirus vaccines widely available in the developing world. The World Health Organization recommends that these vaccines be included in every country’s immunization program. What is lacking is the political will at all levels to make this happen.
Raising awareness about the toll of this disease and the promise that vaccines hold to save lives is critical for building political will. Recently, the scientific Journal of Infectious Diseases released a special supplement on rotavirus, Global Rotavirus Surveillance: Preparing for the Introduction of Rotavirus Vaccines. It provides a comprehensive review of the latest information about rotavirus disease and the role that vaccination can play.
Not only is rotavirus not well known as a major killer of children worldwide, but the fact that diarrheal disease is responsible for the death of 1.5 million young children each year in developing countries is lost on a world that takes for granted access to sanitation, clean water and basic health services. In a recent New York Times story the chief of health at UNICEF, Mickey Chopra, was quoted as saying, “All the attention has gone to more glamorous diseases, but this basic thing has been left behind. It’s a forgotten disease.”
Included below is a short release on the special rotavirus supplement.
Last week, the World Health Organization (WHO) released a report entitled Women and Health: Today’s Evidence, Tomorrow’s Agenda. The report reviews evidence on health issues that affect women in all stages of life, from childhood, through adolescence and adulthood, and into advanced age. The report found that across the globe, women are societal and cultural inequalities that make them more vulnerable to health disparities. They die younger, and face challenges in mental health, malnutrition and lack of education. And while women are the primary caretakers of the sick and elderly all over the world, health systems are ill-equipped to support them and often fail them when they themselves need care.
This report, while sobering, comes in an era where the perception of women’s health is changing. U.S. Secretary of State Hillary Clinton and WHO Director-General Margaret Chan, two of the most prominent women in the international spotlight, have both made women’s health a priority, and both have made it clear that it is an issue that they feel passionate about. In an interview with Lisa Ling on the Oprah Winfrey show, Secretary Clinton stated that she believes that women’s rights are a national security issue. “[I]f you look at terrorism and extremism and abject poverty and a lot of the effects and the causes of instability, you more likely than not will find places that try to limit women’s roles and rights. And so often, those who stand against us stand against the rights of women. So we do have to integrate this into our national security.” When Dr. Chan took the office of WHO Director-General in 2007, she asked that her performance be judged in part on progress in women’s health. In her forward to the WHO report, Dr. Chan states that promoting women’s health is crucial to the health and development of the current and future generations.
In her address at the International Health luncheon at the 2009 APHA annual meeting, Dr. Susan Brems, the deputy assistant administrator of the Bureau for Global Health at USAID, emphasized the need to focus on women’s health – not simply as a means to access certain groups or target specific health indicators, but for the sake of the women themselves. While progress is being made in improving women’s health around the world, the WHO report underscores the fact that much work remains to be done.
The theme of APHA’s annual meeting is Water and Public Health. During the opening general session Dr. Mirta Roses Periago, Director of the Pan American Health Organization (PAHO) underlined the effects of climate change on human health, the new challenges faced by global health and the importance of access to safe water. Dr. Periago reinforced that combining water, sanitation and hygiene interventions can reduce up to 80% of the preventable water borne and related disease. The Millennium Development Goal target for 7c isto reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation. Dr. Periago stated that a one dollar investment in water and sanitation provides a $46 savings in social and development cost. The ideal would be to have water, climate change and equity addressed in a combined sustainable approach.
Celine Cousteau reinforced the importance of the connection between people and the environment. Ms. Cousteau is a story teller whose passion preserving our natural resources is equaled by her passion to bring health care to the indigenous people of the Vale do Javari reserve in Brazil. The film Amazon Promise is a celebration of one organization’s goal to bring health care to those in need…. the same passion found in so many of our public health workers around the globe.
The 2009 Annual APHA meeting has officially begun! The International Health Section has assembled a list of sessions and meetings related to international health for your use. Our blogs from the conference will provide a glimpse into the vast knowledge shared by our colleagues. The conference will continue through November 7, we hope you enjoy it.
Although this is a great venture, it is surprising to see that this is the first campaign of its kind. Being the leading killer of children, it is outrageous to know this disease is not only treatable, but preventable. It leads me to wonder: “Why hasn’t more been done?” Mary Beth Powers, Campaign Chief of Save the Children said in an interview about pneumonia, “The sad thing is this is a disease that is largely preventable, and highly treatable.” This is not a disease that requires decades of scientific research to find a cure. Watch the movie.
According to leading public health organizations such as the World Health Organization (WHO) and UNICEF, many deaths can be prevented through early vaccination, proper medication (antibiotics) and nutrition, and vitamin supplements, such as zinc that is not typically found in a lower-income diet. Read more about the cause, prevention and treatment of pneumonia at the World Pneumonia Day website.
I would encourage everyone to spread the word about World Pneumonia Day, so greater awareness is made. The coalition firmly believes these deaths can be avoided, and encourages others to join the fight against pneumonia by:
“ The administration inherited a basket of bad apples from its predecessor: the budget deficit, the recession, a week economy and unemployment to mention a few. Among the problems, the health care crisis is the worst by far”
This quote is not recent since I published it on February 7, 1993 in the St Pete Times, an article titled “Health Care: Painful Remedies are needed”
I was referring to the Clinton administration and the President’s promise to produce his Health Security act within the first administration 100 days. As a reminder, at that time Republicans raised the issues of big government, increasing the deficit, government taking over health care, eliminating choices, more taxation, hurting the private sector and the rest of the same old story. Moreover, they introduced 6 more health plan proposals to the Congress until the whole reform issue faded away and was dropped. This was paralleled with an aggressive heavily funded campaign lead by the Republican Party, insurance companies, the pharmaceutical industry and others. Since then, and until 2008, every Democratic presidential candidate, learning the lesson the hard way, dropped the health insurance and universal coverage from his agenda.
In 1994, I published an article in the Florida Journal of Public Health (vol VI, no1) on “Reforming Health Care in the US and Europe: Why we Fail and They Succeed? “ It said: “Why health reforms succeed in all western countries? They established concrete health policies of universal access and user-friendly systems in the 30s and the 40s, guided by a solid commitment to national welfare and social solidarity. Second, the voice of interest groups is not so loud, and if it becomes so, its impact on policy-making is minimal since policy makers’ behaviors are put under stringent scrutiny of their well-informed voters. Third, the government and the elected representatives, who are elected by the watchful voters, are more trusted, and the government is allowed to govern, and elected representatives make decisions in the public interest”
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- * Samir Banoob, M.D, D.M, DPH, Ph.D. is a professor of international health policy and management and consultant to WHO, World Bank and international agencies who consulted with 76 countries.
Expecting mothers and their mother-in-laws learn about how to safely sever the umbilical cord of a newborn at a Sure Start facilitated Mothers’ Group Meeting in Sabji Village, Rae Bareilly District, Uttar Pradesh, India
By Tania Lal
A report by UNICEF India in January 2009 found that about a million neonatal deaths occur in the country each year. Uttar Pradesh (U.P.) has the largest population of any state in India and continuing problems with neonatal mortality. In an effort to tackle this problem PATH India with funding from the Bill and Melinda Gates Foundation has initiated Sure Start, a five year project that works with a population of roughly 25 million. The program is described on our website at http://www.path.org/projects/sure-start.php.
A major contributor to these death rates is the lack of literacy and awareness that exists in the rural areas of the country. For example, the benefits of immediate and exclusive breastfeeding are not well understood. For this purpose Sure Start in U.P. works with community health workers and facilitates the functioning of village health and sanitation committees. Read the rest of this entry »
Within the public health community, Community-Based Primary Health Care (CBPHC) is a common point of discussion. But rarely has the story been told by a Pulitzer Prize-winning author or captured in pictures for the National Geographic Magazine. The December 2008 edition shared with the world the story of The Comprehensive Rural Health Project (CRHP) in Jamkhed, India. “Necessary Angels” was the fitting title to a story of history and hope for village health workers who have healed communities, saved lives and transformed the place of the untouchable caste in the process. Read the rest of this entry »
I was surprised when I first heard about Dr. Sanjay Gupta’s possible appointment to US Surgeon General by president elect Barack Obama. What type of message did it send to young people in the field of public health that the pathway to leadership was through the lens of a TV camera rather than toiling in the trenches of public health programs? Read the rest of this entry »
Solihin asks the crowd whether anyone wants to drink a cup of feces-contaminated water.
Project Concern International (PCI) is the first NGO in Indonesia to fully implement Community-led Total Sanitation (CLTS) and offer no subsidies to communities. Watch the video here (and listen to some cool music):
This video is about 18 minutes in length and shows how CLTS gets started in a community. The CLTS method emphasizes the importance of “natural leaders,” community members who emerge during the triggering session and demonstrate strong motivation and resolve to help their village become “open defecation free.” Read the rest of this entry »
As a lifelong international MCH professional, as a faculty member, and as citizen of the world, I am so excited about chairing IH Section this year. To me, what is so special about international health is that it is a transdisciplinary field. The term “transdisciplinary” may be new to some of you, so here’s the definition, developed by Piaget (yes, the same Piaget), translated by yours truly: “concerning interdisciplinary discourse, we hope to see a higher level emerge, “transdisciplinarity,” which would not settle for interactions or reciprocities between specializations, but which would internalize such interaction within an overall construct, and break down the walls between disciplines.” Read the rest of this entry »
There was much to appreciate about the APHA 2008 meeting in San Diego, but two sessions that started off the meeting will stand out in my mind for a long time.
On Saturday we were supposed to have a Trade and Health tour of Tijuana, but because of increased violence there the trip was called off. Instead, Tijuana came to us. Over the course of three hours we heard from some inspiring environmental health efforts (a successful community effort to clean up a disgusting toxic waste dump) and occupational health work (a maquila worker-turned-activist). The last hour was a fantastic film that I highly recommend to anyone interested in either or these topics:
Are we really making a difference? Should we account for our work and present transparent results, good and bad to our peers, host country partners and funding agencies?
This year the IH section hosted the second panel on “Aid Effectiveness and Accountability.” This panel is a follow on to the one we had last year. I am happy that the topic of Aid Effectiveness is raising more attention. I want to thank two guest presenters: Michael Hammer, Executive Director of the One World Trust, who came from the UK for this panel and Elisabeth Sandor of the OECD, who came from Paris for this panel.
One World Trus (www.oneworldtrust.org) is a fifty-year old non-profit organization in the UK evaluating and holding accountable organizations such as DfID, Aga Khan Foundation, etc. Their accountability report is a must for those working in IH. Last year the OECD decided to include health as its tracer sector and is monitoring progress towards the MDGs and the commitments made in Paris Declaration. Read the rest of this entry »
A visiting UK editor’s impressions of the APHA conference….
I didn’t attend that many scientific sessions at APHA this year, being preoccupied with meetings about Global Health database and visiting exhibitors in the vast exhibition but those I did go to seemed to keep bringing up sanitation and hygiene as the key to so much disease prevention. Its really part of next years’ theme, Water and Health.
First, the speech by the US Assistant Secretary for Health Joxel Garcia reminded us that the major impacts on public health last century in the developed world were achieved by vaccines and sanitation. I was thinking- is enough effort now being applied to doing this for the developing world? Or are more glamorous projects getting the money. The Millenium Development Goal for sanitation is apparently behind where it should be. Read the rest of this entry »
Attending the Community-Based Primary Health Care (CBPHC) workshop on Saturday, October 25 at the 136th annual APHA conference, I was reminded of how there truly can be “power in numbers”.
Having worked in domestically in tertiary care at a well-funded institution (basically the opposite of CBPHC) for almost a year now, I searched for common ground with the international community-based primary care group, relying on my relatively brief but highly educative experiences in international public health. I of course am still interested in community health and primary care, but as others noted in an earlier blog entry from this conference, the funding for positions in that field is minimal.
At the workshop on Saturday, I realized just how many dedicated people there are focused on this area, and that our strength is in combining efforts to accomplish our goals. I often witnessed how a group’s synergy can greatly improve its effectiveness and creativity. At the workshop, we split into 3 groups, each one discussing the major actions needed to further the field of CBPHC, including, documentation and dissemination, raising awareness, and finding funding. My group was charged with discussing how to create or find more resources to implement programs in CBPHC. Read the rest of this entry »
Where have international nutrition and health sector leaders been during this serious 2008 crisis of spiraling food crises that are worsening food and nutrition insecurity among the most vulnerable in the world?
At a lively, standing room only session (#3302) on the 2008 Global Food Crisis Monday at the APHA meetings, the 4 panelists and moderator agreed that it was much more than a crisis. It reflected a longer term structural and systems issue related to food poverty, international trade, climate change, energy and environment. Case studies on India and Ethiopia helped to contextualize the intra-country discrepancies in undernourishment, stunting and wasting.
On my Ethiopian case, I contrasted the apocalyptic press statements in September 2008 of the UN ( FAO, WFP,Humanitarian Affairs) with my Oct. 20th interview with the well-informed Minister of Health of Ethiopia who felt that overall high inflation and energy costs, as well as drought, were more serious shocks to health and nutrition of his people. In presenting the long and short-term trends in food access and malnutrition in Ethiopia, I found that this discrepancy in information reflects the lack of representative and reliable data on the evolution of the situation, causes and immediate effects. Read the rest of this entry »
Participants Trying to keep up with the flow of ideas
By Janine Schooley
Sometimes I get the question, “So what’s new and innovative in CBPHC?” The answer is that there isn’t anything new, and that’s the point! We already know what we need to do. We have the bullets, as someone said, but the gun seems to be elsewhere or malfunctioning. I think it isn’t that we don’t have the gun. I just think we have misplaced it, or it needs some tinkering to get to work, or we need to remind ourselves how to pull the trigger. I really dislike this analogy for it’s militaristic and violent connotations, but I couldn’t come up with anything better….So, to continue this horrible analogy, we have several bullets and they are inexpensive, tried and true. We know the power of exclusive breastfeeding, good antenatal care, immunizations, long lasting insecticidal nets, good nutrition, and other low cost, low tech interventions in terms of saving lives and improving quality of life. We’ve been talking about this for decades, not just amongst ourselves, the practitioners in the field, but at the highest policy levels. As the September 13-19, 2008 Lancet reminds us, a major milestone, the Alma-Ata Declaration, was issued 30 years ago. So what’s new isn’t the need for what the Alma-Ata Declaration so eloquently calls for, but perhaps it’s the realization that we still haven’t gotten there. In other words, we don’t need innovation. What we need is inspiration and, as Nike so aptly puts it “Just do it!”. Read the rest of this entry »
Attending the Community-Based Primary Health Care workshop yesterday was one of the most invigorating experiences I have had in quite a long time. It was so fantastic to meet people carrying out work that I have been constantly thinking and talking about the need for. As my colleagues and I struggle to establish a comprehensive community health center in Gatineau, Haiti we are constantly trying to figure out whether or not we are actually implementing best practices. While we all value the importance of making decisions based on evidence and learning from others’ mistakes, it is incredibly challenging to find detailed information. Through this process and past research, I have been made especially aware of the need for more accessible and thorough documentation of both effective and ineffective practices and implementation experiences in global health.
This is not to be unexpected as organizations carrying out this work are usually so over-extended and resource constrained that documenting their processes and practices often becomes low-priority unless it is to meet the requirements of funders. However, when this is the purpose of such documentation the tone changes from factual reporting of successes and failures to trying to demonstrate efficacy so that a donors will keep sending money, so financial survival is not the best motivating factor for the objective documentation needed. In my own experience so far, although we have said that documenting and sharing the entire process of establishing a community health center would be a very useful activity that we would like to do, we have thus far been unable to follow through while dealing with all of the day-to-day logistics of running a clinic, seeking/maintaining funding and the planning of future programs and community organizing. If we had a volunteer historian or could work with students to take the documentation process on as a project for course credit, it might be much more feasible. However, with limited time to coordinate such efforts and so many critical activities competing for our resources, this honestly falls relatively low on our hierarchy of needs.
I was encouraged when I recently heard about the Global Health Delivery Online www.ghdonline.org but somewhat disappointed that it thus far only includes HIV, TB and Technology discussion communities. Understandably, these are in the scope of the founding collaborators’ chief interests but I hope they will continue to expand this venue into other important realms in need of increased attention. Read the rest of this entry »
TB can be fatal. It is a worldwide epidemic that knows no borders.
I am a resident in Family and Preventive Medicine, concurrently working towards getting my MPH. I attended the Community Based Primary Health Care (CBPHC) workshop at the American Public Health Association National Conference, which was organized by APHA’s International Health Section on October 25, 2008. Project Concern International (PCI) facilitated the workshop.
We opened by discussing the principles of the 1978 Alma-Ata Conference, which include health as a fundamental human right, equity, and the emphasis on community participation.
We engaged in several spirited group discussions about the role of CBPHC in our own work and ideas for effective behavior change. A highlight was a presentation on the use of TB-Photovoice (http://tbphotovoice.org/tbpv2/index.php?option=com_frontpage&Itemid=1), a powerful means for creating effective messages of change from those who are most affected by the disease. At the end of the workshop we broke into groups to discuss either the documentation and dissemination of work, how to increase funding, and how to advance knowledge of CBPHC. My group was comprised of documenters and disseminatorsand we discussed starting a new journal that is a forum for talking about projects that are in the works or have been completed — this would allow newcomers to avoid reinventing the wheel, would serve as a forum for old hats to bounce ideas off each other around what did and didn’t work in their projects, and would also provide powerful individual stories, photos, videos, etc. that would assist with funding. The forum would be online, open access and free. Start up funding for such a new journal is actively pursued and hopefully we can capitalize on that. Wikipedia sounded like an option as well. Also, we want to try to connect students and young professionals with project managers so that we can recruit writers! Community-Campus listserv may be the way to go for that connection.
Overall, the workshop was stimulating and exciting – an opportunity to gather a collection of dedicated and passionate professionals to share ideas and projects that serve a common goal.
High in China’s western Qinghai province is a small village where project DROLMA is based. The population consists of 2,800 nomadic people who move twice a year, to and from their summer encampments which reach 15,420 feet into the sky. The conditions are harsh with short growing seasons; their traditional diet consists of roasted barley flour mixed with yak butter and salted tea. A centrally located monastery with 52 monks in residence provides the spiritual guidance for this community.It was the wisdom of one of their spiritual leaders that made the project a reality. He reached out for assistance, seeking new ideas for problems that have challenged his people for decades. Read the rest of this entry »
According to the UN, 2.6 billion people around the world do not have access to what we take for granted, a clean and safe latrine. The UN General Assembly declared the year 2008 the International Year of Sanitation, the goal is to raise awareness and to accelerate progress towards the Millennium Development Goal (MDG) target to reduce by half the proportion of the 2.6 billion people without access to basic sanitation by 2015.
According to the WHO, about 2 million people die every year due to diarrheal diseases caused by poor sanitation and hygiene; most of them are children less than 5 years of age.To help combat this, Plan is pioneering new approach in Asia and East and Southern Africa – Community-Led Total Sanitation (CLTS), which educates communities about the importance of sanitation and helps them to construct and maintain their own latrines. Dr. Selina Amin brought to our attention the work of the Jaldhaka Program Unit of Plan Bangladesh.
The Jaldhaka Program Unit is situated at the northern part of Bangladesh. Their target population included 100,000 children and adults in rural communities where lack of appropriate facilities led to open defecation. CLTS was introduced, and a creative approach was added – active involvement of children. They call it the Child-to-Child (CtC) approach, where children became active participants in changing community behaviors. Armed with knowledge, flags and a whistle, children were empowered to participate by alerting the community with whistles when someone was caught not using a latrine.Read the rest of this entry »
FGM is entrenched in the cultural and religious beliefs in many communities.4 In many parts of West Africa, this cutting is presented as a religious obligation to Muslim women.5 It is internationally recognized as a violation of the human rights of girls and women: it is nearly always performed on minors,2 and it is sometimes used to facilitate sexual relations with child brides.5 Additionally, FGM is just one component of cultures in which women have no voice in decisions that affect their everyday health and well-being. For example, Amnesty International recently called attention to the high rate of maternal deaths in Burkina Faso, which it ascribes to gender discrimination: many women are unable to access sexual and reproductive health services due to discriminatory attitudes and illegal demands for payments by corrupt medical staff. Burkinabe women have little to no say in when they can seek medical care or the timing and spacing of their pregnancies, and they are still being subjected to early marriages and FGM.6
Within the public health community, Community-Based Primary Health Care (CBPHC) is a common point of discussion. But rarely has the story been told by a Pulitzer Prize-winning author or captured in pictures for the National Geographic Magazine. The December 2008 edition shared with the world the story of 
