Global Health News Last Week

SECTION NEWS
The Advocacy/Policy Committee would like to invite you to participate in our first Advocacy Day, led in partnership with the Global Health Council. The day, scheduled for Thursday, November 3rd, 2011, immediately following the annual meeting in Washington, D.C., will be an opportunity for us to voice support for a continued focus on international health to our elected officials. With the intense Congressional pressure to cut the budget, our voices can make a real difference. As a participant during this exciting day, you will be provided with training materials on effective advocacy techniques to ensure your message is clearly heard. Even if you do not have advocacy experience, you need not hesitate to sign up because you will be teamed with others. Please consider joining your fellow International Health Section members on Thursday, November 3rd, 2011 on Capitol Hill to advocate for a healthy globe.  Interested parties should register here.  Please note that registration will close on October 14th.  Any questions should be directed to Peter Freeman, Advocacy/Policy Committee Chair, at pffreeman@gmail.com or 773.318.4842.

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POLITICS AND POLICY

• GOP Presidential hopeful Michelle Bachmann has been slammed by scientists, doctors and others for claiming that the HPV (human papilloma virus) vaccine can cause mental retardation. An ethicist has now put up money behind his challenge to her claim.
• A commitment by G20 nations to strengthen agricultural research in developing countries will help reduce food insecurity as long as it focuses on small farmers and their needs, officials and experts said at a G20-backed conference this week.

PROGRAMS

• The Gates Foundation is often, not always fairly, criticized for being a techno-fix bunch. Melinda Gates heralds the value of community health workers in poor communities and their powerful, inexpensive ability to save lives.
• One of the international community’s goals is to eliminate mother-to-child-transmission of HIV by 2015 by expanding access to drugs for HIV-infected mothers and pregnant women.
• A primary school in the South African city of Port Elizabeth has given girls a contraceptive injection to prevent early pregnancies, angering some parents.
• Andrew Harmer reflects on what will happen to the MDGs as the original 2015 deadline draws nearer and draws some parallels to the traditional Cooper’s Hill Cheese Rolling.

• The Gates Foundation has presented the Harvard School of Public Health with a $12 million grant to support its maternal health task force.
• USAID is teaming up with former President George Bush to reduce cervical cancer deaths by 25% in five years for target developing countries.
• The magic number may be $6 billion to make a real dent in ending the spread of AIDS.
• A collaboration between UK and US funding agencies has announced more than £3.5M new funding for research aimed at controlling the transmission of diseases amongst humans, animals and the environment.

RESEARCH AND INNOVATION

• The number of African countries with national policies on traditional medicine increased almost fivefold between 2001 and 2010, according to a report on a decade of traditional medicine on the continent.
• The recently published results from two malaria vaccine trials appear to show that scientists are getting closer to developing a vaccine against the mosquito-borne illness.
• Effective nursing is the backbone of a high quality health care delivery system. GHDonline’s nursing community will discuss how ongoing mentoring and training programs can enhance nursing in an expert panel discussion September 19-23.
• The number of young women with breast cancer has more than doubled worldwide since 1980, say researchers at Seattle’s Institute for Health Metrics and Evaluation.
• After 2 years of analyzing the results of the largest AIDS vaccine clinical trial ever held, the so-called Thai prime-boost trial, and the only one so far to show some protection against HIV, researchers say they have discovered insights that could lead to an effective vaccine.
• IUDs can prevent cervical cancer, finds a study published in the Lancet.
• Reducing the incidence of malaria could also drastically reduce the number of deaths from bacterial infections among children in Africa, a study has found.

DISEASES AND DISASTERS

• Authorities worry that tropical mosquitoes found in San Gabriel Valley could spread disease if they gained a foothold in Southern California.
• A human rights investigator for the United Nations says up to a quarter of the world’s trash from hospitals, clinics, labs, blood banks and mortuaries is hazardous and much more needs to be done to regulate it.
• A report from UNICEF and the WHO shows the decrease in the rate of deaths for children under the age of five.
• The WHO warns that thousands may die if multi-drug resistant and forms of tuberculosis continue to spread throughoutEurope.
• One of the scientific advisers to the new blockbuster movie “Contagion” says the “risks are very real — and are increasing drastically… Our vulnerability to such diseases has been heightened by the growth in international travel and the globalization of food production.”

FOCUS – NON-COMMUNICABLE DISEASES

• Cancer, cardiovascular disease, respiratory illness and diabetes account for 63 percent of all global deaths, yet up to half could be prevented, according to a new report, Noncommunicable Diseases Country Profiles 2011, released Wednesday by the  World Health Organization.
• The WHO released a 207 page “global score card” on the prevention of chronic illness, one week ahead of the NCD summit at the UN.
• Eli Lilly and Company has committed $30 million to the Global Health Initiative. The Lilly NCD Partnership will work to identify comprehensive, sustainable approaches to patient care. Initially it will concentrate on diabetes.

Thanks to Tom Murphy and Mark Leon Goldberg, Tom Paulson, Isobel Hoskins, and Public Health Newswire.

Video: Unidos contra las enfermedades no transmisibles (Español)

Getting to equal through inequality?

This week, the World Bank is hosting an open forum on gender equality, dubbed “Gender – Getting to Equal,” as a part of their “Think Equal” campaign.  I had recently seen their video associated with this campaign, referenced in the comments section on Duncan Green’s From Poverty to Power.

The original point of Green’s post was to compare Nike’s “Girl Effect” video

to a similar video by the Commonwealth Countries League Education Fund (apologies – I am unable to post it here).  He then presents a parody for contrast purposes.

These videos (and the ensuing discussion) recalls an ongoing debate about both the effectiveness and the ethics of specifically targeting women in development programs, whether that be through microloans, cash transfers, or simple food aid.  Tom Murphy presents a good summary of the debate on his blog, A View from the Cave:

The microfinance pendulum is starting to swing back from the extreme of focusing on only girls. As the methodology of the Pitt study that was seen as evidence for the focus has come under fire and more studies show the effectiveness of men growing businesses at a higher rate the debate is getting lively.

Aid Watch provided their own commentary on the same Nike video earlier this year. They make the points that this approach may be doing more harm than good: it misdirects energies that could be used to educate people to level the gender playing field; funds should be used to improve governance and the larger economic conditions that drive growth; targeting women may in turn make them a target for increased gender violence; and, of course, it reinforces the stereotype that poor girls in developing countries need “saving.”

Personally, I have never really been on board with the idea of “targeting women” with microloans or aid in general, for that matter.  It villainizes men and gives the impression that they are the oppressors of their wives and families who are only interested in maintaining their dominance and the social status quo.  It is the same faulty logic that is used to promote contraceptive methods that a wife can take “discreetly” – i.e., without her husband’s knowledge.  The development community comes into the family home where the man has the power and tries to equalize the playing field by wrestling control from him and giving it to the women instead.

Since when did fighting sexism with sexism become a good idea?

The attention of the development community has recently turned from “vertical” strategies – i.e. using funds to target specific diseases like HIV/AIDS or to launch large-scale independent vaccination campaigns – to “horizontal” ones that focus on strengthening health systems.  In my opinion, we should be applying the same logic to gender issues.  Instead of targeting women with aid programs (to the exclusion of men), educate the men to see women as partners and fellow workers.  It is essential to involve both parties in development efforts, whether they are for reproductive health and family planning, poverty reduction, or entrepreneurship.  We can never get to equal if we only focus on one side.

Save the Date: Knowledge Crossing Borders Conference, May 30-June 1, 2012 (West Chester University)

West Chester University, along with Universidad Nacional at Heredia, Costa Rica, is organizing an international conference on higher education to be held May 30-June 1, 2012 at West Chester University campus. The official CIESUP/Knowledge Crossing Borders conference website can be accessed here.

Pre-Conference learning institutes: May 29, 2012
Conference: May 30 – June 1, 2012
Cultural Exchanges/Programs: June 2 – June 3, 2012

Updated:Proposals are due by November 1, 2011. The call for proposals is posted below.

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In an increasingly global and technological world, geographic and intellectual borders are being blurred, reconstructed, and reinstituted. The resulting paradigm shift is creating opportunities and challenges for nations and for institutions of higher learning. Political, economic, and socio-cultural issues surrounding the production, dissemination, access, ownership, and consumption of knowledge are receiving ever-increasing scrutiny across all academic disciplines.

The International Higher Education Congress sponsors seek to build a sustainable future through transformative global partnerships in higher education. The conference theme—Knowledge Crossing Borders: Building a Global Future through Research and Innovative Practices—is both broad and timely and includes the research, pedagogical, outreach, and administrative functions of institutions of higher education. The conference will examine how knowledge transactions across regional and international borders create both difficult challenges and transformative opportunities for cooperation, change, creativity, and innovation.

Conference participants will actively explore and develop common interests and intersecting scholarly work linking two or more of the participating countries and institutions.

We are seeking conference workshop papers that focus on border-crossing perspectives in broad contexts. Topics may include, but are not exclusive to, the following tracks of inquiry:

• Technology and Science
• Sustainability
• Best Practices in Higher Education
• Globalization and Transnationalization in Higher Education
• Funding Models for Higher Education

More detailed descriptions of the tracks are found here.

Proposals may be submitted for the following structures:

• Individual presentations not to exceed 20 minutes
• Entire concurrent sessions or workshops that may be structured with up to three presentations for a total of 60 minutes of presentation and 20 minutes of audience response
• Poster sessions which will include at least 60 minutes of presenter’s scheduled presence, for dialogue with conferees concerning the project portrayed

Global Health News Last Week

September 5 was Labor Day.

POLITICS AND POLICY

• The State Department has announced the official US Delegation to the UN High Level Meeting on NCDs, which will take place September 19-20.
• Access to affordable lifesaving medicines will be threatened where they are needed most—in parts of the developing world—if the U.S.insists on implementing restrictive intellectual property policies in the Trans-Pacific Partnership (TPP) trade agreement, says Médecins sans Frontières (Doctors without Borders).
• Sarah Boseley shares the great news that Kenya has officially made female genital mutilation illegal.
• A federal appeals court in Virginia has dismissed two lawsuits challenging the constitutionality of President Barack Obama’s health care overhaul.
• United Nations chief Ban Ki-moon singled out sustainable development as the top issue facing the planet with the world’s seven billionth person expected to be born next month. Key to this was climate change, and he said time was running out with the population set to explode this century.
• Thousands of proposed cuts in the US Congress could lead to significant cuts to USAID.
• The Philippines reproductive health bill is still making its way through the senate.  Meanwhile, 7 villages in Bataan, the Philippines have banned “artificial contraception” amid national debate over the bill.
• A report co-authored by an Australian academic highlights the need for healthy ecosystems as the basis for sustainable water resources and stable food security for people around the world.

PROGRAMS

• Sometime this fall, the world’s population will reach 7 billion people. Experts now forecast that by 2050, the population could be 10 billion. Some say those numbers should force policy makers to focus more intently on making family planning much more widely available in the developing world.
• The Institution of Mechanical Engineers has put together a one day conference bringing together innovators and health workers to share ideas about ways to more easily deliver interventions.
• It has been commonly held that insecticide treated bed nets reduce the rate of malaria for people who use them. Now there is hard evidence to back up that assumption.

RESEARCH AND INNOVATIONS

• A new study shows that less than three doses of the vaccine against cervical cancer can effectively protect women in the developing world where 80% of global deaths due to cervical cancer take place.
• Only three African countries are on track to achieve MGD 5, according to an African Institute for Development Policy study.
• Most efforts in the Western world seeking to find solutions for developing world problems tend to think of inventing new technologies or, at least, using the tools we typically use to fix things — modern drugs for diseases, improved seeds for crops, a better mousetrap. Sometimes, all you need is a newly geared donkey. 
• Scientists may have developed a new TB vaccine after tests showed the elimination of TB from infected tissue in mice.
• A socially active lifestyle can dramatically speed up weight loss through the burning of fat in mice, a study shows. Researchers at Ohio State University in the US identified a link between the amount of social interaction in a mouse’s environment and its weight.
• An easy-to-use diagnostic chip for HIV could “give results in minutes” and be a game changer in the field of cheap diagnostics for remote regions, claim the researchers who developed it.

DISEASES AND DISASTERS

• Having to contend with U.S.army drones and the crossfire between the Taliban and the Pakistani army, the residents of Pakistan’s tribal areas find access to treatment for HIV/AIDS harder than in most other parts of the world.
• Three-quarters of a million people are facing death by starvation in Somalia according the United Nations, who declared Monday that famine had spread to a sixth southern region of the beleaguered Horn of Africa state.  Meanwhile, an investigation has revealed that masses of food meant for famine victims in Somalia are being stolen. There have also been reports of rioting and killings during food distribution at camps for famine victims.
• A magnitude 6.6 earthquake struck 100km southwest of the city of Medan, Sumatra and 110km beneath the earth’s crust.
• A New York Times editorial castigates the international community’s response to the cholera outbreak in Haiti.
• The CEO of insulin manufacturer Novo Nordisk says the WHO should buy low cost diabetes drugs in bulk for the developing world.
• Messages of good health and positive self-esteem for girls aren’t hard to come by in kid lit, so what’s the deal with all the attention for a not-yet-published rhyming picture book about an obese, unhappy 14-year-old named Maggie?

INFOGRAPHICS AND OTHER MEDIA

• Interaction has published an online “Horn of Africa Aid Map” showing 98 aid and development projects working on immediate famine relief as well as long-term development in East Africa.
• There may not be any zombies, vampires or mutant monsters wreaking bloody havoc on innocent people, but the fact that “Contagion” has a premise that experts say is all too plausible may make it the scariest movie of the season.
• A new index from Save the Children establishes the safest – and most dangerous – places in the world for a child to fall sick, which correlate closely with their chances of getting to see a health worker.

Stories from the Field: Clínica Tzanabaj (San Pablo, Guatemala)

by Deborah Flores, RN, Ed.D, MBA E-mail

Lake Atitlan is a large lake approximately 340 meters deep, situated in the Guatemalan highlands. It is flanked by several volcanoes and surrounded by towns and villages inhabited by descendents of Mayan people. They are proud and strong people. The lake itself is one of the most beautiful in the world.

This lake supports coffee and farm crops. Most of the indigenous population survives on very little money as they make a living from the land. The lake is a major life force in their lives. There is cyclical contamination from fertilizer run off, etc. which leads to bouts of cyanobacteria in the lake.

Although the weather is temperate, the rainy season brings mudslides and flooding, which has been known to destroy homes, commercial property and lives.

There are several small hospitals around the lake; one is public, and the others are private. There are also many clinics which provide basic medical and dental care. These are supported by churches and/or by locals, and some of these are private as well. Providers are predominately volunteers who either come in to the area from Guatemala City or are on short assignments from US, Europe or other parts of Central or South America. Much of the equipment is donated either through medical companies or churches. This in itself can be a challenge.

In December 2010, my husband, a general surgeon practicing in the US, decided to retire from medicine. He is from Guatemala, and for many years has desired to return there. He has always been drawn to the lake area, as so many people are. He decided we could contribute if we opened a health center to care for the people, because basic healthcare needs are difficult to meet. For example, basic dental care is in great need, infants suffer from dehydration and the women suffer from early respiratory disease due to cooking over an open fire that often is not vented properly.

After much deliberation and planning, the clinic is now being built in San Pablo, a town with inadequate water and sewage systems.

Most children get a basic education but seldom leave the lake area. It is a closed community and very difficult to earn people’s trust.

We hired approximately 50 local workers and, with the help of a family member who is an engineer and architect, the workers were taught how to create and build using the earth underneath them. All of the materials are made on site, and rock is hauled from the riverbed to use for the rest of the structures. These men have acquired skills that they will now be able to use for the rest of their lives, hopefully to gain future employment after the project is complete. At this writing, this site has been under construction for over two years. The project itself has had an economic impact on the community, as it is the largest construction project that has ever been implemented in San Pablo.

Before breaking ground, a shaman blessed the land, as this was very important to the local workers. We then joined a local parade to advertise the coming clinic. Our workers started a soccer team for “Clínica Tzanabaj” and wear special shirts to denote who they are. We will continue to find ways to advertise the facility, but in reality, you cannot miss it driving through the area between San Pablo and San Marcos.

Until the clinic is finished, my husband travels from town to town to assist with surgeries as needed. When the clinic is complete, I will join him there to provide primary care. We hope in this way we have been able to impact our world far more than if we had stayed in the US and continued to provide care.

Deborah Flores will be joining the faculty of Research School of Nursing, which is affiliated with Rockhurst Univerisity.  Her husband is a general surgeon who retired early and is providing free care in Central America, and she joins him every few months to assist.

Global Health News, Week of August 28-September 3

Global Fund round 11 is now open for proposals.

GREAT LEARNING OPPORTUNITY

A seven-part webinar series, called the “Outstanding Presentations Workshop,” began this Wednesday and is available for free to all who register. Each one-hour seminar will be streamed live over the next few weeks on Wednesday and will be recorded for later viewing.  Take advantage of this wonderful opportunity to improve your presentations and spare your audiences death by PowerPoint. More information is available here, and the schedule can be accessed here.

POLITICS AND POLICY

• In Uganda, the landmark legal case of Jennifer Anguko, a mother who died while she was in labor for 12 hours in a government hospital, will begin in early September.
• Critics of the World Health Organization say it needs to redefine and reposition itself within the increasingly complex and convoluted field of global health. These experts suggest that the world will not suffer if the WHO cuts certain programs while narrowing its focus.
• In the United States, the American College of Obstetricians and Gynecologists are promoting the use of IUDs as the “most effective form of reversible contraception available and safe for most women.”
• The Global Fund may cut its contributions to China by half.
• USAID Admin Dr. Raj Shah announced that $23 million in new aid will be directed towards the Horn of Africa crisis.
• Anonymity is no longer a right of people seeking HIV/AIDS tests in China, and the change has lead to a significant drop in the number of tests being performed.
• The Asian Development Bank has called for Asia-Pacific countries to collaborate on combating HIV/AIDS at the International Congress on AIDS in Asia and the Pacific.
• Tension between the United States and Pakistan will not prevent USAID from continuing to support health, energy and education systems says the USAID Pakistan Chief.
• The epidemics of diabetes, heart disease and cancers that have stricken the populaces of wealthy countries are spreading to the developing world, yet the United Nations lacks an agreement, let alone an overall goal, on how to limit the preventable illnesses and deaths arising from these so-called non-communicable diseases. The British Medical Journal reports many developed countries, including the U.S. and Canada, are resisting specific targets for reduction in fats, sugars and salt in processed foods.

PROGRAMS

• Overall, more newborn children are surviving, but slower progress in cutting death rates among babies in the first weeks of life is putting the global goal of reducing child deaths by two-thirds in jeopardy.
• One expert says as the question of aid effectiveness has moved to the centre of development debates. If donors want to make their aid more effective, then they need to engage strategically with the private sector.
• In the Washington Post, Michael Gerson makes the “pro-life” case for increased support for contraception and family planning worldwide.
• UNICEF and international NGOs are working to raise awareness and encourage West African communities to invest in the construction of more pit latrines. Pit latrines, say advocates, can drastically reduce the spread of diarrhea, cholera and worms.

RESEARCH

• A study published in Lancet finds that the workers who took part in the efforts to rescue people from the World Trade Center on 9/11 are at a high risk of suffering physical and mental illness.
• A study by the Elizabeth Glaser Paediatric AIDS Foundation in Uganda and Zambia found high rates of syphilis and HIV co-infection among pregnant women, but showed that “integrating rapid syphilis screening and HIV testing for pregnant women was feasible, cost-effective, and helped to prevent transmission of syphilis and HIV from mother-to-child.”
• A genetically engineered virus may be the key to combating cancer, says a group of scientists.
• Believed to only help children under four, researchers have determined that the rotavirus vaccine also reduces deaths in children between the age of five and fourteen.
• Researchers who have tracked Haitian cell phone SIM cards relative to the cholera outbreak are optimistic that their findings will lead to future use of the same technology for other outbreaks.
• Scientists may have found a critical weakness in Plasmodium falciparum, the parasite that causes malaria. Researchers say the discovery provides a promising target for new malaria therapies.
• Engineers at Michigan State University are developing a low-cost mobile phone application that can detect certain types of cancer.
• Danish scientists say mosquito populations are dropping in many parts of Africa, even in parts where there are no human efforts such as insecticide spraying or bed net distributions underway.
• A study published in the British Medical Journal reports a 24% reduction in deaths in children who received vitamin A.
• A new approach to malaria vaccines grows the parasite inside mosquitoes and extracts vaccine components from the salivary gland.

DISEASES AND DISASTERS

• A study published in Nature says that the last three waves of cholera can all be traced back to the Bay of Bengal.
• Despite a massive humanitarian effort after the 2010 earthquake, females in Haiti remain neglected, rights activists say, lacking access to care as they give birth to babies in squalid conditions, often as a result of sex in trade for food or other necessities.
• UN FAO warns that the bird flu is on the rise in Bangladesh, China, Egypt, India, Indonesia and Vietnam.
• Reports from the Libyan capital Tripoli say a humanitarian crisis appears to be emerging following the ouster of long-time ruler Muammar Qaddafi. There is a shortage of medicine, fuel, food, water, and power supplies, and growing piles of uncollected garbage.
• Polio has been reported in China and Kenya.

Thanks to Tom Murphy and Mark Leon Goldberg, Tom Paulson, Isobel Hoskins, and UN Wire.

Community Health Workers: What needs to be done to help these vital workers to be most effective and sustainable? (CBPHC Workshop)

Updated September 10: Below, please find the announcement for the Community-Based Primary Health Care Working Group’s annual workshop. The CBPHC-WG holds this workshop each year on Saturday before APHA’s annual meeting in October/November.

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Community Health Workers: What needs to be done to help these vital workers to be most effective and sustainable?

Community-Based Primary Health Care (CBPHC) Working Group
13th Annual Pre-APHA Annual Conference Workshop
Washington DC Convention Center Room WCC 204A
Saturday, October 29, 8:30 a.m. to 5 p.m.

Currently there is an emphasis on mobilizing community health workers as part of strengthening health services in developing countries in an attempt to help them better meet their health Millennium Development Goals. However, the mobilization of CHWs is not a new approach in itself. Anyone who has worked in developing countries for several years can relate stories about projects that included CHWs that did not motivate CHWs to practice well enough for long enough to produce sustained outcomes. What can we do now so that we can maximize the possibility of success of current projects in this regard?

This workshop is being facilitated through the collaboration of John Snow Incorporated and the CBPHC Working group. Through presentations from current experts from MCHIP and other experienced health practitioners, we will deal with the focal question of this workshop and grapple with current solutions. Workshop presentations will cover key interventions underway through the USAID Health Care Improvement Project, recommendations coming from the Earth Institute One Million Community Health Workers Technical Advisory Committee, recent findings concerning worker motivation and experience from a good cross section of JSI and NGO field practitioners.

Key presenters include Steve Hodgins, Serge Raharison, Ram Shestra and Leban Tsuma from MCHIP; Mary Carnell from JSI; Mary Anne Mercer from University of Washington; and Dory Storms and Henry Perry from Johns Hopkins University. The CORE group and NGOs are well represented through presentations by experienced experts such as Karen LeBan, Judy Lewis, Tom
Davis, Damaris Batista, Laura Altobelli and Connie Gates. Discussion and dialogue both in small and large group sessions specifically designed to stimulate input from participants will be a key part of our program. So please join us for a day of interesting, informative and enlivening discussion. REGISTER EARLY to not miss out.

To register contact: Sandy Hoar, Assistant Clinical Professor of Healthcare Sciences and Global Health, George Washington University (npaseh@gwumc.edu). Please put “CBPHC” in your e-mail heading. The only fee is $25 ($20 for students), payable at the door. To facilitate planning, please
register ASAP (the deadline is October 22nd) and indicate if you will
be joining us for dinner afterwards at your own expense. For further
information contact: Sandy Hoar or Paul Freeman (freeman.p.a@att.net), Chairman of the IH Section’s CBPHC-WG.

How much education does it take to learn to wash people’s feet?

By Barbara Waldorf RN, MPH (candidate)
Boston University School of Public Health
Recently, in a health policy class at BUSPH, I listened to Dr. Jim O’Connell describe how, as a hot-shot young doctor fresh from being the chief resident at MGH, he was told that to start his new job at the Pine Street Inn, he would be washing the feet of the homeless clients at the nursing clinic. The struggle with his (and the medical profession’s) ego was palpable. To his credit and the benefit of thousands of homeless people over the next 20 years, he chose, in that moment, to not know, to trust the nurses and to learn a in new way.

Ruth Stark, in her training manual for working abroad, speaks of the critical importance of learning to listen when in a another country or culture. Her advice to everyone who ventures beyond their boundaries, who wishes to have an impact in a different cultural context, is to spend significant time asking questions rather than assuming prior knowledge, and to cultivate humility.

There is no doubt that facts and figures, economic theory and the scientific process are important. These can be taught. Graduate education in public health gives us the tools for financial analysis, the application of management principles and the rigor of epidemiology and biostatistics. These are the building blocks of the profession.

Yet, without the more intangible skills of listening, humility, curiosity about the unknown and a profound respect for the deep threads of humanity that bind us together, we will not be able to make the right decisions. Paradoxically, the depth of respect for, and willingness to learn from, other people’s wisdom and knowledge is based in the confidence and knowledge of one’s own culture, experience and education. Without grounding in self-respect, how can we access that which needs to be given? In order to become an advocate for real change and have the discernment to make important decisions, we need to know ourselves.

I washed the feet of homeless women at the Pine Street Inn the same year as Jim O’Connell. As a student nurse at UMass/Boston, it was my community health placement. I was young, suburban, and middle class with noe xperience of inner city, drug addicted, alcoholic or mentally ill homeless folks. I was scared and felt I had nothing to give. But as I sat with them, day after day, soaking their feet, listening, being with them as a human being, something happened.

Something was touched that opened my eyes, both inner and outer, to a very different way of being. It changed me in a fundamental way and shifted both the trajectory and context of my professional life. I owe the homeless women who allowed me to wash their feet for an education I have utilized all my life. It has taken me throughout the world, and allowed me to be with people I could not speak with; to work in situations I did not understand and to take risks and move into arenas I did not know.

That thread has led me to now pursue a Masters degree in public health, where new vistas are opening up. Understanding how economic theory explains the provision of care, finding a new perspective on health care systems and gaining the building blocks to decide when and where to intervene in complex emergencies. Something has come together here, which is the place where my education from the university meets my education from the women of Pine Street, from the Tibetan refugees I cared for in the mountains of Nepal and from my schizophrenic clients in Boston.

To answer the question, it takes a lot of education to wash people’s feet, to be present for them, to be a true advocate and to understand when to speak and when to listen.

Barbara Waldorf is an RN and working on her MPH at Boston University School of Public Health with a concentration in International Health. Having lived and worked in Asia, Europe and Australia, her current interest is in the emerging field of Global Health nursing and learning from other nurses who are active in this field.

Video: “It’s a Girl” Documentary Trailer

h/t Amanda Makulec

Public Health’s “Benevolent Dictator”: Is Gates ruling us, or are we just ruled by money?

Last week, Laura Freschi and Alanna Shaikh published a piece in Alliance magazine that raised some interesting and thought-provoking question about the role of the Gates Foundation in setting the global health agenda.  They conclude that Gates is becoming a “public health dictator” because of his financial resources and the power and influence that come as a result.  They are, of course, not the first to complain about Gates’s focus on technological solutions to global health challenges.  Some of the most recent grumblings were in response to the Foundation’s “reinvent the toilet” campaign this year, but similar concerns have been voiced for years.  The Foundation places too much emphasis on technological innovation and “quick fixes”; their undue influence diverts funding from other priorities; their goals are not realistic.  These are all valid concerns which deserve to be voiced (heck, we have already written about it here), particularly in a field where nearly everyone has a different opinion on how problems should be solved.

But a dictator?

A dictator? Nah. Look at that face.

The Gates Foundation is directed by the priorities of Bill Gates, an entrepreneur who made obscenely large piles of money and who now wants to use some of it to make the world better.  Those piles are accomplishing just that by funding the initiatives that he likes, thinks are important, and/or believes will work.  After all, Gates made his money through technological innovations, so it is perfectly logical that the same types of ideas would be close to his heart – and, to be fair, it is his money.  It is also fair to criticize those initiatives, particularly if the interventions are ineffective or do more harm than good.

But now pundits are demanding accountability from the Foundation, calling on it to justify what it does:

If expensive polio and malaria eradication efforts, pursued not just by Gates but by the entire global health community at Gates’ urging, fail, to whom will
Gates be accountable for that failure?

We demand accountability from our governments because they spend our money – we have the right to demand that our tax dollars be used effectively.  But why, exactly, should Gates be accountable to anyone for wasting his own money?  More importantly, why would the “entire global health community” do something just because he told us to?

Dictators are people who arbitrarily enforce laws, throw people in jail for criticizing them, and deny their citizens free and fair elections.  Gates does not punish anyone whose global health solutions don’t appeal to him – he just doesn’t give them money.  He never lead any kind of “global health coup” or insist that we all adhere to his development philosophy.  Yes, the Foundation has lots of money, and would-be philanthropist who wants to launch his NGO would treat Gates like a god if he ever saw him on the street – but that is precisely the point: he has undue influence because we give it to him.  To paint Gates as a “global health dictator” because causes are prioritized based on what will get Gates Foundation funding villifies the wrong party.  What does it say about us as a body of professionals if we allow ourselves to be led by the nose by the guy with the most money?

The Economist raised another interesting point when it examined the same debate back in 2008:

At least in part, the gripes against the Gates Foundation are the churlish growls of a jealous crowd of bureaucrats and labourers at less influential charities. Some people at the WHO…openly worry that the foundation is setting up a new power centre that may rival their organisation’s authority. Such conspiracy theorists point to the foundation’s recent grant of over $100m to the University of Washington to evaluate health treatments and monitor national health systems—jobs supposed to be done by the UN agency.

Therein lies an irony. The WHO, one of whose captains now calls the Gates Foundation monopolistic, used itself to hold a monopoly in the fight against malaria, and it did a lousy job as a result.

I do think Shaikh and Freschi (and also Tom Paulson of Humanosphere) are on to something when they question the Foundation’s giving money to media organizations to increase coverage of global health topics.

Among the grantees is a growing list of media outlets including the Guardian newspaper (UK), ABC, PBS and the BBC – all to underwrite coverage of global health issues. While these grants all came with assurances of editorial independence, it’s hard to believe that such partnerships won’t influence the nature of the coverage in some way.

Even if it is objective, it never looks good when you fund your own media coverage.  Somebody probably should have thought that one through.

At any rate, the debate about what Gates is doing (and what he should be doing) with his money will undoubtedly rage for as long as he has money.  But if we believe that the Gates Foundation is distorting global health priorities because of its purchasing power, then we need to take a long, hard look at how we define our priorities.

ASPH Calls for Comments on its Draft Global Health Competencies

ASPH has recently released a draft of its Global Health Competency Model, a set of competencies recommended for graduates of master’s level programs in global health.  They are based on the organization’s MPH core competencies and are divided in to seven “domains,” or categories.  According to the draft,

…formal educational programs for global health professionals are highly fragmented in terms of the institutions offering such programs and quite varied in terms of the outcomes and qualifications expected of graduates. As the number of institutions offering formal training in global health grows, ASPH has taken leadership in developing a competency model based on the necessary roles and functions of the global public health system of the future. This approach recognizes that global health and public health represent a unified front with a long tradition of bringing scientifically-validated programs, policies, and services to bear upon the world’s most pressing health needs. A Lancet article in February 2010, in which ASPH global health leaders sought to emphasize the common framework of global health, international health, and public health, stated that “[g]lobal health and public health are indistinguishable,” further defining the scope of this initiative.

The document (pdf) can be viewed here.  Below is a screen grab of the competencies.

ASPH is calling for comments on the draft by Friday, September 23.  Comments may be sent to ghcompetency@asph.org.

CDC Evaluation Fellows Program (Atlanta, GA)

Evaluation Fellows Program
Office of the Associate Director for Program, Centers for Disease Control and Prevention (Atlanta, GA)
CDC-OADPG-2011-0032

Project Description:

CDC seeks applicants for the inaugural class of the CDC Evaluation Fellows Program.  This is a new initiative within CDC and represents a major commitment by the Agency to program evaluation and program improvement.  Fellows will be selected and will be housed in the newly-created Office of the Associate Director for Program and collaborate with the evaluation team under the leadership of CDC’s Chief Evaluation Officer.  Fellows selected for this new initiative will be assigned out to CDC programs to help develop and implement program evaluations and evaluation studies.  These host programs will be selected through a competitive process to ensure Fellows are being assigned to important and productive evaluation projects that will build the knowledge base of the program and enhance the professional development of the Fellow.

Fellows will conduct  evaluations and help to build the evaluation skills and capacity of the staff in the program to which they are assigned.  Fellows may be assigned to one program/project for the duration of their fellowship or may rotate to several programs, depending upon the duration of the project.  Fellows will have a  point of contact within the program as well as mentoring and support from AD Program staff. In addition, we have reserved some dedicated resources for training and professional development of Fellows.

The participant will receive a monthly stipend depending on education level and experience. The participant must show proof of health insurance. The appointment will be full-time at the CDC in the Atlanta, Georgia area. Participants do not become employees of CDC or the program administrator, and there are no fringe benefits paid.

Additional details regarding the ORISE Research Participation Program can be found at http://www.orau.gov/cdc

Qualifications:
The ideal candidate has a PhD in evaluation, social sciences, public health, or other relevant discipline plus some experience with applied evaluation projects.  Master’s-level candidates with significant experience in applied evaluation projects are also welcome.  Candidates must have received their degree within the past five years to qualify for this program.

Technical Questions:
The Research Participation Program for CDC is administered by the Oak Ridge Institute for Science and Education. To be considered, send a current resume to Tasha Powell via email at Tasha.Powell@orau.org  or via fax at (865) 241-5219. Please reference Project # CDC-OADPG-2011-0032 in all communications.

Global Health News Last Week

SECTION NEWS

The following announcement is from Peter Freeman, chair of the section’s Advocacy and Policy Committee, regarding their first Advocacy Day to take place in conjunction with this year’s Annual Meeting in Washington,DC.

To all International Health Section Members:

The Advocacy/Policy Committee would like to invite you to participate in our first Advocacy Day, led in partnership with the Global Health Council. The day, scheduled for Thursday, November 3rd, 2011, will be an opportunity for us to voice support for a continued focus on international health to our elected officials. With the intense Congressional pressure to cut the budget, our voices can make a real difference. As a participant during this exciting day, you will be provided with training materials on effective advocacy techniques to ensure your message is clearly heard. Even if you do not have advocacy experience, you need not hesitate to sign up because you will be teamed with others. Please consider joining your fellow International Health Section members on Thursday, November 3rd, 2011 on Capitol Hill to advocate for a healthy globe.

Interested parties should contact Peter Freeman, Advocacy/Policy Committee Chair, at pffreeman@gmail.com or 773.318.4842 with their name, phone number and e-mail address. A registration link for the Advocacy Day will be sent out to the section by mid-September; please be on the lookout for it.

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August 20 was World Mosquito Day.

On August 22, the Gates Foundation celebrated its 12-year anniversary (well, sort of).

POLITICS AND POLICY

• Hospitals in Portland and elsewhere are banning elective inductions and c-sections before 39 weeks of pregnancy.  New research suggests that critical organ and brain development is still occurring in developing fetuses during the last weeks of pregnancy.
• 10 Things You Should Know About the State Department and USAID: Do you ever wonder what the State Department and the United States Agency for International Development (USAID) do every day and what it means for you? Well, funny you should ask. They’d like to tell you.
• The Global Fund, which has come under pressure to clean up corruption, has ended its dispute with Chinaand will resume hundreds of millions of dollars in funding for programs to fight AIDS and other diseases.
• Slate examines the growing popularity of the IUD in the United States in light of a health care reform law that will make the device effectively cost-free.
• A group of parliamentarians from six Asia Pacific countries have agreed to advocate for the allocation of Official Development Assistance to sexual and reproductive health programs in their respective countries.

PROGRAMS

• Donor funding for AIDS has decreased by 10 percent during the recent economic recession. The overall decrease in global AIDS funding marks a stark reversal in trends for previous years.

RESEARCH

• Proposals for Round 8 of the Grand Challenge Exploration, a $100 million grant initiative to encourage innovation in global health and development research, are now being accepted.  Proposals can be submitted until November 17, 2011 at 11:30 am Pacific Daylight Time.
• Researchers from Michigan State Universityare working on bringing a low-cost, hand-held device to nations with limited resources to help physicians detect and diagnose cancer. The Gene-Z device is operated using an iPod Touch or Android-based tablet and performs genetic analysis on microRNAs and other genetic markers.
• The problem of obesity is spreading around the world and poses serious health threats.  The finding is part of a new special report on obesity, and how to combat it in the medical journal the Lancet.
• A team of Australian researchers have discovered a breakthrough in the reduction of dengue. By injecting mosquitoes with a bacteria, they were able to block them from transmitting the virus that kills 20,000 people a year.
• Nanotechnology, the science of manipulating tiny particles, has is rapidly finding wide application. Developing countries that embrace nanotechnology should not overlook possible risks and must regulate products that contain nanoparticles.
• A study has found that nasal spray vaccines for influenza delivered to children between the age of six months and three years old are more effective than other vaccines.
• In a study released by the International Journal of Biological Sciences, analyzing the effects of genetically modified foods on mammalian health, researchers found that agricultural giant Monsanto’s GM corn is linked to organ damage in rats.

DISEASES AND DISASTERS

• The current famine in the Horn of Africa has again brought to our attention the interaction between climate change, food prices and extreme weather conditions on the African continent.
• Most of the world’s population growth today is in urban areas creating what some are dubbing unstable, unsustainable “mega-cities.” A new report by the World Wildlife Fund says that by 2050, about 70 percent of the world’s population will live in urban areas creating “horrendous” problems.
• In Sub-Saharan Africa, a combination of inaccurate testing and patients quick to seek treatment has lead to a worrisome trend: treating patients for malaria when they do not have the disease.
• HIV epidemics are emerging among men who have sex with men in the Middle East and North Africa, researchers say. It’s a region where HIV/AIDS isn’t well understood, or studied.  More than 5 percent of men who have sex with men are infected by HIV in countries including Egypt, Iran, Lebanon, Morocco, Sudan and Tunisia, according to a recent study in PLoS Medicine. In one group of men in Pakistan, the rate of infection was about 28 percent.

INFOGRAPHICS AND OTHER INTERESTING VISUALS

• The online international news organization GlobalPost has published this useful interactive map of the food crisis in the Horn of Africa, based on data from the UN’s World Food Programme.
• New this fall, an online Image Library will make over 10,000 Hesperian illustrations available to all.
  

Thanks to Tom Murphy and Mark Leon Goldberg, Tom Paulson, and Isobel Hoskins.