Spotlight on Brazil: The World Cup and More Doctors

The World Cup ended on Sunday and with all the controversy surrounding host country Brazil, I found myself wondering about their health care system. I knew access to basic health services was one of the main points of protest against the Brazilian government’s spending for the World Cup, but I didn’t know all the details.

A few quick searches online provided me with the information I wanted and led me to this video from the Pan American Health Organization (PAHO) documenting the impact of the arrival of doctors in two Brazilian towns that previously had no doctors. According to the World Health Organization, there is a serious shortage of doctors in Brazil with 1.8 physicians for every 1,000 people. Although the Constitution calls for free health care for all citizens, the reality is that there are major inequalities in access to health services with 700 neglected municipalities and a lack of local primary health care.

The PAHO video focuses on Mais Medicos (More Doctors) – a program between the Brazilian and Cuban governments that allows Cuban doctors to work in under-served Brazilian communities for three years. I did some more searching online and learned that the program is part of an initiative by President Dilma Rousseff to import 13,000 foreign doctors in order to address the shortage of medical professionals. The program has been criticized and although I agree with some of the points of opposition (How are their foreign credentials vetted for local standards? How does this translate to a long-term plan to address the larger issues with health care in Brazil?) I think the reception of Cuban doctors by local Brazilian doctors was too harsh.

Despite the controversy surrounding the program, the PAHO video illustrates its positive outcomes through patient testimonials about improved access to health care, fewer journeys to far away hospitals, and increased treatment and service quality. Residents in the two remote communities featured in the video are quite happy with the program and appreciative to have basic health care.

What do you think? Does the program provide enough value to balance costs and outweigh the risks? Watch the video and share your thoughts in the comments below.

IHSC June 19th Conference Call with Dr. Pablo Ariel-Mendez, USAID

Please see the following announcement from Mary Carol Jennings of the newly-formed Student Committee.


The International Health Student Committee of the APHA IH Section is the section’s newest student group. As part of the core group of leaders, I wanted to plan a nationwide series of virtual events and conversations about leadership and career decisions in international health. Another group member, Nila Elison, has recently joined me, and together we’re starting the IH Career Development Sub-Committee.

I believe that organizations like APHA can play a valuable role in introducing new public health practitioners to potential mentors. I myself am not following a perfectly straight career path. I’ve worked in community organizing, policy, clinical medicine, and now am finally, formally, in public health, in my second year of the general preventive medicine residency at Johns Hopkins. Only recently have I started to find mentors in people, who like me, have taken similarly non-linear paths.

To set the stage for the upcoming year, our first guest speaker is going to talk about his own career path and his insight on leading a large global public health organization.

Dr. Ariel Pablos-Méndez is a public health physician who serves as the Assistant Administrator for Global Health at the U.S. Agency for International Development. Appointed by President Obama in 2011,  his work involves implementing the mission of the Global Health Initiative. His impressive resume includes leadership and experience within the World Health Organization, The Rockefeller Foundation, and Columbia University in New York City.

Dr. Pablos-Méndez will join the International Health Student Committee on June 19th from 4-5pm EST, and we hope you’ll take part in the conversation about developing your own career in international health.

We had previously closed registration, but because we want to share the conversation with those who are inspired by this blog post, we have re-opened the RSVP form until June 15th. We also welcome your sharing this with your classmates and school communication forums.

RSVP link: http://bit.ly/1n9J1Xc

A few twitter hashtags: #IHSCspeakers, #GlobalHealthSpeakers #IHSCCareerDevelopment

Details about the conference line number and access code will be sent to your RSVP email.
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APHA connect http://connect.apha.org/group.htm?igid=257321
Facebook https://www.facebook.com/groups/APHA.IHSC/
Twitter @APHA_IHSC

Mass Shootings and Important Conversations

Elliot Rodger, a disturbed rich young man went on a shooting spree in Isla Vista, a wealthy district in Santa Barbara, California. Thanks to the joys of social media, both his written and videotaped “manifestos” were able to go viral. The reasons he listed for his killing tour included his parents’ divorce, lack of luck with the ladies, and being short.

I get the divorce and the sexual frustration, but being short? That one was new.

Predictably, this has set off all manner of commentary in the public sphere. First and foremost, of course, comes the discourse on gun control. Gun control advocates have pointed out that all of the guns that Rodger used were legally obtained. The Brady Campaign Against Gun Violence has spoken out on the need to tighten controls on obtaining firearms, and one of the victim’s fathers blamed “craven, irresponsible politicians and the NRA” for his son’s death. To be fair, three of the six people who died were actually stabbed to death, but Rodger had plenty more ready in his car that he could have used.

The feminist response to the “manifesto” (can we even call it that? should we?) has been swift and furious, pointing out the misogynism woven through it and drawing attention to his links to the usually peculiar, occasionally violence-embracing “Men’s Rights Movement” (which, by the way, is what exactly?)

But it also denies reality to pretend that Rodger’s sense of masculine entitlement and views about women didn’t matter or somehow existed in a vacuum. The horror of Rodger’s alleged crimes is unique, but the distorted way he understood himself as a man and the violence with which he discussed women — the bleak and dehumanizing way he judged them — is not. Just as we examine our culture of guns once again in the wake of yet another mass shooting, we must also examine our culture of misogyny and toxic masculinity, which devalues both women’s and men’s lives and worth, and inflicts real and daily harm.

Outspoken feminist writers have pointed out that this is not the first time a shooter has claimed similar motives, and Laurie Penny, in her usual no-holds-barred style, has dubbed the attack as the latest example of misogynistic extremism.

Last, and perhaps least, is the quiet conversation about mental health that seems to only experience half-hearted revivals when these tragedies strike. Mental health advocates speak up to point out that mental illness and seeking treatment for it are stigmatized in our culture, so social awkwardness and becomes anger without productive outlets which then warps into repressed rage. The media usually turns its head for a bit, shrugs, and then moves on to montages of grieving members of the community and talking heads interviewing NRA spokespeople on CNN. Unfortunately, this shooting has pitted feminists and mental health advocates against one another – as if Elliot Rodger the misogynist and Elliot Rodger the mentally unbalanced were mutually exclusive.

As both a feminist and a public health advocate, that makes me sad.

However, I think these are all important conversations to have. I much prefer them being featured on prime-time television in shows like Law and Order: SVU and Scandal than to have them forcibly thrust into the spotlight in the wake of a tragedy, but they need our attention nonetheless – and not at the expense of one another. While I’m not quite with the NRA on (lack of) gun control, I do think it’s something of a straw man in this case – California is one of the strictest states when it comes to gun ownership, and preventing mass killings goes beyond cutting off access to handguns (which, for better or worse, cannot be kept from citizens per the Supreme Court) – but conversations about gun violence segue into discussions about poverty and equity, which badly need to be confronted. We need to scrutinize sexism and gender violence as much as society’s assumption that a man’s worth is based on his sexual prowess – all of which hurt men as much as they hurt women, but in completely different ways. And we need to stop sweeping mental health advocacy under the rug, so that people don’t avoid treatment for mental illness for fear of being unable to get jobs in places like the military or the federal government.

Rather than fighting each other for the spotlight, let’s share it together.

Upcoming Panel Discussion: Hunger in the Age of Climate Change (Washington, DC)

When: Wednesday, May 14, 2014, 1-3pm (Lunch available starting at 12:30pm)
Where: 425 3rd St. SW, Suite 1200, Washington DC 20024

 Today the White House will announce the release of the Third National Climate Assessment.  This report is already garneringnational and international press; climate change is one of the president’s primary areas of focus.  What does the report say about climate change in the United States, and what do these findings mean for hungry and poor people in the United States and globally? Join with members of the faith, environmental, and anti-hunger communities to discuss how we can work together to provide adequate nutrition even as the climate is changing in ways that require new methods of growing, storing, and transporting food.

Invited panelists include:

  • Katharine Hayhoe, one of Time’s 100 Most Influential People and author of A Climate for Change: Global Warming Facts for Faith-Based Decisions
  • William Hohenstein, USDA Climate Change Program Office
  • Lewis Ziska, USDA Agricultural Research Service
  • Jan Ahlen, National Farmers Union
  • Sam Myers, Harvard School of Public Health
  • Margaret Wilder, University of Arizona

Please circulate this invitation among your networks, and RSVP by May 9 at www.bread.org/climate.

Questions? Contact Stacy Cloyd at scloyd@bread.org

Bill Gates & Party Tricks: Happy Belated World Immunization Week!

When I first clicked on this YouTube video link, I wasn’t sure what to expect. But once the video started playing, I quickly realized it’s a scripted (but entertaining) demonstration of vaccine cold chains featuring Hans Rosling with a cameo from Bill Gates. The topic of the video is how cold chains function and the challenges in getting vaccines through an uninterrupted cold chain to those who need them. Using juice, containers, and glasses, Rosling answers the question “What percent of 1 year old children receive basic vaccines?” In the spirit of World Immunization Week, which ended yesterday, take a few minutes to watch the video.

After watching, I did a little digging to find out more about Rosling and the Gapminder Foundation, which produced the video. Turns out this video is the first in a series of “Demographic Party Tricks” that are part of the Foundation’s Ignorance Project. The gist of it is they’re on a mission to cure ignorance when it comes to key global development trends and statistics.

I spent a significant amount of time on their website exploring their various data sets, labs, and interactive graphs. Some of my favorites are:

  • Africa is Not a Country (a personal pet peeve of mine)
  • The Wealth and Health of Nations
  • Stop Calling Them Developing Countries
  • The River of Myths (sound familiar?)

Click here to take a look around. You may learn a thing or two! And let us know which sections of the site you like most in the comments below.

A Request From the Students: Please Remain Firm on Your Commitment to Fight NTDs

On April 2, many of the world’s experts on Global Health met in Paris at the Uniting to Combat Neglected Tropical Diseases (NTDs) event, and pledged to place more emphasis on the diseases that are often overlooked by those who determine policy and hold the purse strings. Billions of people—and the governments and NGOs serving them—suffer from the drastic impact of these diseases on virtually every aspect of medical care and daily life. Neglecting them is no longer an option. As medical students, we often read about the outcomes of these distant meetings in the same way we scan over the stock market closing prices (with $100,000 of education debt) or ask about the final score of the Superbowl (while studying); however, my relationship to this meeting was remarkably different, thanks to a moving experience I had at the Unite for Sight Global Health and Innovation Conference.

The Unite for Sight Global Health and Innovation Conference took place this past weekend, just two weeks after the discussion in Paris. Presenting my poster on soil-transmitted helminthiasis (STH) in the indigenous Panamanian population served by Floating Doctors , I expected a few students to passively glance at my tables as they walked past. Instead, I found myself surrounded by professionals with senior positions in well-known global health organizations.

This surprised me, as my research, which deals with the consequences of conditions seldom experienced here in the US, rarely generates great excitement. With Floating Doctors I found that even treated aqueducts cannot deliver clean water to villages when their cracked PVC pipes run through livestock pastures, and TOMS generous donations cannot prevent STH when school children carry their shoes through the fields to keep them clean. Additionally, the well-intentioned bi-annual school-based anthelmintic distributions are either not happening or are ineffective, because over 50% of children in Floating Doctors clinics continue to present with complaints of helminthiasis.

When asked for a solution, I sheepishly replied, “Well, it seems like an impossible problem.” As soon as the words were out of my mouth a senior research officer from the Bill and Melinda Gates Foundation smiled and firmly said, “No. It is not impossible. That is why we are here. We will help you find a way.” In that moment, the discussion in Paris became less of a distant news story. It brought hope and inspiration to not just me, but to Floating Doctors, a tiny powerhouse of an NGO, and most importantly, to the STH-burdened populations we serve.

My motivation for sharing this experience is to follow it with a sincere request: On behalf of all idealistic and motivated global health students and young professionals, I ask you to please maintain your enthusiasm for tackling these unglamorous and devastating NTDs beyond these first two weeks, and beyond the next few years. Help us turn the fight to reduce and ultimately eliminate NTDs into a challenging, motivating, gratifying, and feasible lifetime career that we can pass on to the students who follow us.

A Yale infectious disease physician made it very clear, as he showed me live hookworm larvae under a microscope in his lab, that the solution to the NTD problem cannot be achieved with plans, protocols, and medications alone. In order to create a truly sustainable fight, young scientists, physicians, and public health professionals must be supported and inspired to research these problems with fresh eyes and open minds.

To those who participated in motivating or making the decision to invest in well-informed steps toward combating the preventable diseases that devastate the health, economy, and educational productivity of people like those served by Floating Doctors, I extend a whole-hearted Thank You!

Hannah Elsevier, MD/MPH Candidate, APHA International Health Student Committee Co-Chair

Contagions, content, and confusion in the digital age of health information

SeymourHeadshotGuest blogger: Brittany Seymour, DDS, MPH

Sixteen years ago, a study alleged an association between the MMR vaccine and autism. The authors disclosed in their publication that they could not claim a causal link, and the paper was eventually found to be faulty and was retracted. Nonetheless, flaws and all, the information was made visible and still today, anti-vaccine sentiments continue to rekindle the paper’s alarming claims, plus additional concerns. Anxious parents persistently echo one another’s worries through blogs, video-sharing websites, and other social media platforms, which too often contradict scientific consensus and current knowledge. A small but mighty group of doubting individuals are dismantling decades of life-saving research and successful health policy.

Disturbingly, content errors and false information tend to linger, even following subsequent correction. Particularly in the face of highly charged and emotional topics, individuals can become even more unwilling to revise their beliefs. When virtually anyone anywhere can publish anything online, people have little difficulty finding support to back any belief, creating a digital “corrupted information environment” one blog, share, and tweet at a time. We are entering an age of digital pandemics: rapid spread of misguided and incomplete online health information that has resulted in unsubstantiated confusion around some of public health’s greatest achievements, such as vaccines, contraception, and fluoridated drinking water.

We are witnessing an accentuated Kruger and Dunning effect, namely that unskilled people are also unaware that they are unskilled. Individuals are crafting convincing and persuasive arguments riddled with empirical citations and links to scientific studies. However, they ultimately lack the sophisticated skillset required for deeper interpretation of their own sources within the context of the larger issue. Without formal expertise, they are unable to move from the basic stages of knowledge, comprehension, and even application to advanced strategies for accurate analysis, synthesis and evaluation of the subtle yet significant complexities embedded in the scientific method. Put simply, a clever compilation from Google does not qualify one as a health expert any more than possession of a fine camera makes one a photographer.

These shortcomings go unnoticed while their confidence motivates readers to action. Ultimately, they are unable to recognize the larger harm their social media “publications” are causing in the absence of information porters such as the peer-review process or expert consensus. Now that over half of adults turn to the internet for health information, including using social networking sites, the hosts of these digital pandemics are becoming easily accessible and their content is proving contagious. Conversely, the most competent experts often underestimate their own competence, the “burden of expertise;” in part because scientific competence requires open acknowledgment of limitations in order to discover accurate truths. But on a public forum, citing any limitation, even as a requisite for the scientific process, attracts the naysayers who predictably share it across the web without context, and thus without accurate meaning. When searching #fluoride on Twitter for example, we discover, at surface level, an evenly matched digital Clash of the Titans: the proficient yet restrained domain expert versus the unskilled but vociferous lay person touting content that is masquerading as science but is actually nothing more than shallow advocacy. It’s no wonder the public has become confused and distrustful.

Clearly, social media is an expanding worldwide phenomenon. Yet, little is known about the precise mechanisms at play at the interface of social media and high-level global health strategies. Why does some content “go viral” when others don’t? Key findings include factors like an innate desire to share, emotion, storytelling, and public access- aspects that are perfectly ripe for success across social media. Yet, these aspects are also in direct conflict with the gold standard for acquiring, conveying, and applying scientific knowledge: objectivity, avoidance of conclusions based on anecdotal accounts, and publication in private peer-reviewed journals.

Despite its shortcomings, social media can provide public health experts with answers that once were private yet now are public: individuals, along with sharing misinformation, are also sharing their most intimate sentiments about that information.  In the past, interviews and conversations would have been necessary to uncover the numerous and highly nuanced reasons why individuals oppose particular public health interventions. Today, on the very websites publishing information that infuriate the experts also exist literally thousands of personal concerns made public for all to see, and minus researcher bias. The public nature of social media is perhaps our utmost barrier to information accuracy and yet a tremendous untapped resource for public health research, innovation, and intervention.

Brittany Seymour is an Instructor on Global Health at the Harvard School of Dental Medicine’s Department of Oral Health Policy and Epidemiology and the Inaugural Harvard Global Health Institute Fellow. Her research includes interdisciplinary global health curriculum development and pedagogy, capacity strengthening for oral health delivery systems in resource-challenged regions, and digital information transfer and impacts on health.