Thanks to Kashif Khan (who is in Rwanda right now!) for this article:
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Monday, June 29, 2009
Why More Africans Don't Use Human Rights Language
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Update from Laura Spece in India
Namascar! (same as Namaste, just another version of hello)
So I'm going to start this e-mail off with a bang: Cricket. That crazy British game, quasi-resembling baseball that India, Pakistan, Bhutan and other countries can not get enough of. And has been rendered nearly impossible for Americans to understand, especially the scoring. But here are a few basics:
1. There are 2 sets of 3 wickets that the batting team runs in between to score runs.
2. There are 2 batters of the same team running between the wickets at one time. Only 1 receives the pitch. They are called "batsmen"
3. The man who pitches, or rather LAUNCHES a very hard, small ball is called a "bowler."
4. The rest of the bowler's team is in the outfield.
5. The rest of the extremely complex rules do not apply to the rest of my story...
So we decide, as a class of around 12, that we should try to play a round of cricket. One of my classmates, Jayendra, is from Bhutan and therefore quite knowledgeable of the sport. We start off with Jayendra bowling, in a amateur-friendly slow pitch fashion, to one of my male classmates (Eldon from UNC). Everything's going pretty well, except Eldon soon discovers that a cricket bat is an exceedingly heavy and awkward version of an American baseball bat. So his brilliant idea? Let's let Laura give it a go. By now, we've accumulated a few spectators. The male, Indian staff of the CRHP has started to come out to see what the crazy Westerners are up to. Now I'm OK at baseball. So with Jay pitching slowly, I was pretty successful. And many of the Indian men watching have NEVER seen a female play cricket, or any other sport. So they were surprised and commented in Marathi (translated later by Dr. Arole's son, Ravi), that this white, American girl is pretty good. To top things off, I launched a long ball over the squat building they use to build artificial limbs, securing my bragging rights. However, I should also describe our "field." It's a back lot to one of the main CRHP compound buildings, that's littered with leftover bricks, tiles and other rummage aaaand a line of latrines. You can only guess what happened. When retrieving my long ball, one of the very kind, young Indian men stepped over a bunch of tiles, covering the septic tank, and landed in a pool of human sewage. Awesome. He was fine, without injury except possibly his pride. But oh wait, it gets better. I'm appalled and promptly give up the bat, banishing myself to the outfield. But after awhile, I decide to get up again to bat. I launch ANOTHER ball over the same artificial limb hut, and a *NEW* CRHP staffer runs to get it. Now my Marathi is pretty terrible... but I still attempt to shout STOP, STOP, STOP!! (Thamba, Thamba, Thamba). But to no avail. I sent two Indian men into a large pile of crap, chasing after cricket balls. Maybe I'll give cricket a rest for awhile. :)
Back to health. I think it might be interesting to talk about... Diarrhea. Especially since it melds with the cricket story. So as many of you are already aware, diarrhea is a massive cause of infant morbidity and mortality in developing countries, like India. However, it's also one of the most common reasons for hospitalizations of infants in the United States. What's the big deal, it's just diarrhea? Well, the main problem is not necessarily the infection (though Salmonella, E. Coli, rotavirus and other nasties that cause diarrhea don't help when multiplying out of control in your gut). It's rather the extremely rapid loss of water and salts that get expelled from your GI system. Compound the loss of water and salts onto the fact that the vast majority of children in developing countries are malnourished to start, and you've got a really dangerous situation. Not to mention, that here in rural India, it was sometimes thought that a ghost or other form of black magic had grabbed hold of the child presenting with diarrhea. And how to you get rid of a GI ghost? Well, the mantrik (witch doctor/healer) says you must starve the ghost and thus the child. Which of course ends poorly for the sick child. Remind me to tell you how the mantrik "cures" tuberculosis. You'll love that one. So in the end, American infants and children don't die from diarrheal illness because we are pudgy, well-fed kids. Plus our American moms and dads were educated in the importance of maintaining adequate nutrition and hydration, AND can afford Pedialite. But here, CRHP has more of an uphill battle to fight infantile diarrhea. But here are a few ingenious ways:
1. Installing tube wells for drinking water. The CRHP worked with a German NGO to ensure that the villages stopped drinking the water they were washing in. You see, most diarrhea-causing bacteria and viruses are spread through the fecal-oral route. These tube wells reach the water table ranging from 75-200 feet below the ground surface. This depth ensures the water has been naturally filtered from contaminants. But I'll have another e-mail on water... it's a huge focus here as you can imagine.
2. A Latrine campaign. Like I've mentioned before, much less than half of the village members use a toilet. Dropping trow (spelling?) in the fields or outskirts of town is the cultural norm. Furthermore, even when the CRHP teams up with the Farmer's Club in the village to build a whole bunch of latrines, most people end up using them for grain storage!! The Village Health Workers, women's groups and Farmer's Clubs of the village end up having to hold whole village meetings to stress the use of the new toilets. Also, we're not talking western toilets that flush. I'm talking little pit-like, latrine toilets.
With little imprints for your feet on the sides. (see photo) But the campaign is working. People are starting to want latrines, especially after they see the upper crust members of the village with them. A rather interesting take on "Keeping up with the Jones' " One elderly village man in a turban approached us on our last visit, saying, "Please! Build me a toilet!" He thought our very obviously foreign group were engineers, were building toilets.3. The most ingenious, and my personal favorite. Educating the adolescent girls and also the young children. The CRHP had the Village Health Workers come up with little songs about the importance of nutrition, and how to make "limbu pani." Nutrition will be it's own e-mail, but limbu pani is quite interesting. It's rural Maharashtra's Oral Rehydration Solution (ORS)!! ORS is a life-saver for developing nations, as many of you already know. It's a balanced combination of salts, sugar and water to ensure that rehydration occurs while also re-establishing electrolyte balance. The science behind it is ingenious, the glucose (sugar) is used to "carry" the other salt ions across your gut wall, into the bloodstream. The girls and kids are taught a song about the ingredients of limbu pani, which is simply homemade ORS of lime juice, sugar and salt with water. Since measuring cups are hard to come by, they are told that the mix should be no sweeter than a banana, and no saltier than your tears. They are instructed to start limbu pani at the first signs of diarrhea, and to continue feeding the child. This method has drastically reduced infant mortality. Plus, the village health workers came up with an alternate recipe for some of the new villages joining CRHP. These villages are significantly farther from Jamkhed, and limes are harder to come by. The VHWs thus substituted rice water. Brilliant! This is cheaper than manufactured ORS tablets, and much easier to access. Maybe this is something that could be useful in the states, for more impoverished areas?? The use of ORS solution would save a lot of healthcare $$ in the US, by preventing hospitalizations for IV fluid rehydration... hmmmm.
Things to ponder:
The book, Freakonomics. It's short and written by a very young, un-traditional economist. He's considered quite brilliant, yet controversial for many reasons. He became a Harvard Society fellow at the age of 26. I better get a move on, my 27th birthday is right around the corner. :)
The Bollywood movie, Lagaan. It's fantastic. Albeit, 3.5 hours long. :) But it's chock full of dancing, singing, love and cheesiness. And the villian: the BRITISH!! The subtitles are often interesting. Whenever there was a scenic interlude between dialogues, the caption read "vanilla." But no one was speaking. :) We have yet to figure out what on earth the caption writers think vanilla describes.
I've attached 3 photos. The "adolescent" is one of the many girls who swarmed me for photos while they were visiting. Many of them have never seen a white person with blue eyes before. If you notice, there is a Bic mechanical pencil tucked into her blouse. It's one of many that I dispersed of the donations I was given by the lovely ladies of the primary care office. I had to teach them how to push out and retract the lead. They were a huge hit, these "American pens." The 2nd photo is of Yamunabai, the village health worker with 2 of the girls from her village. As you can see, they have quite a bond. Yamunabai is lovely, and so kind. She is of the untouchable caste and has had an extremely hard life. She loves big hugs and tries to talk to me in Marathi... but we have a pretty good sign language, head bobble thing going to communicate. :) And the 3rd is of the infamous "Indian toilet." You can figure out for yourself what the little buckets are for...
Well that's all for now! I have to get to class. Hope all is well back home. Keep in touch! Bare yete (see you later in Marathi)!
Wish you were here,
Laura
Saturday, June 27, 2009
Moving forward with maternal health and human rights
An article from The Lancet on the recent UN resolution regarding women's health:
500 000 women die each year as a result of pregnancy or
childbirth. Eff orts are being made to reduce these deaths
by three quarters by 2015—Millennium Development
Goal 5. But many countries are not making substantial
progress towards this target. Can the human-rights
community help?
Last week, the UN Human Rights Council passed a landmark
resolution that recognises preventable maternal
mortality and morbidity as a pressing human-rights issue
that violates a woman’s rights to health, life, edu cation,
dignity, and information. The move is important because
a human-rights approach to maternal health places
specifi c legal and ethical obligations on states, such as the
establishment of eff ective mechanisms of accounta bility
(ie, maternal death audits or reviews). The approach also
reinforces equity, so it insists on disaggregated data on
maternal mortality and morbidity rates to see if vulnerable
groups are benefi ting from health programmes.
The resolution signals an increasing trend by the
human-rights community to take health issues as
seriously as they have taken issues such as torture, the
death penalty, and the right to a fair trial. For example,
in May, Amnesty International—the world’s largest
international voluntary organisation dealing with human
rights—launched, for the fi rst time, a global campaign to
address maternal mortality.
These eff orts should be welcomed by the health
community. As well as increased attention and resources
for maternal health, a human-rights approach to maternal
health can strengthen policies and programmes and make
them more equitable. But this movement needs the active
support and engagement of more health professionals
to succeed. The diffi culty is that the health community
has often misunderstood human rights to be solely
about whistleblowing, lawyers, and litigation. The health
community must be willing to learn about human rights,
realise the common ground, and work with human-rights
professionals in a respectful, constructive, and practical
partnership to prevent the unacceptably high number of
maternal deaths that occur each year. ■ The Lancet
500 000 women die each year as a result of pregnancy or
childbirth. Eff orts are being made to reduce these deaths
by three quarters by 2015—Millennium Development
Goal 5. But many countries are not making substantial
progress towards this target. Can the human-rights
community help?
Last week, the UN Human Rights Council passed a landmark
resolution that recognises preventable maternal
mortality and morbidity as a pressing human-rights issue
that violates a woman’s rights to health, life, edu cation,
dignity, and information. The move is important because
a human-rights approach to maternal health places
specifi c legal and ethical obligations on states, such as the
establishment of eff ective mechanisms of accounta bility
(ie, maternal death audits or reviews). The approach also
reinforces equity, so it insists on disaggregated data on
maternal mortality and morbidity rates to see if vulnerable
groups are benefi ting from health programmes.
The resolution signals an increasing trend by the
human-rights community to take health issues as
seriously as they have taken issues such as torture, the
death penalty, and the right to a fair trial. For example,
in May, Amnesty International—the world’s largest
international voluntary organisation dealing with human
rights—launched, for the fi rst time, a global campaign to
address maternal mortality.
These eff orts should be welcomed by the health
community. As well as increased attention and resources
for maternal health, a human-rights approach to maternal
health can strengthen policies and programmes and make
them more equitable. But this movement needs the active
support and engagement of more health professionals
to succeed. The diffi culty is that the health community
has often misunderstood human rights to be solely
about whistleblowing, lawyers, and litigation. The health
community must be willing to learn about human rights,
realise the common ground, and work with human-rights
professionals in a respectful, constructive, and practical
partnership to prevent the unacceptably high number of
maternal deaths that occur each year. ■ The Lancet
Cash Transfers and the Millennium Development Goals
This is a quick synopsis on "cash transfers" related to child health:
Accumulating evidence from large-scale programmes
is starting to show positive eff ects of cash transfer
programmes on many levels. A new report by Save the
Children, Lasting Benefi ts, highlights the importance
of regular cash transfers, such as child benefi ts or
pensions, as one crucial intervention to get Millennium
Development Goal 4—reduction of mortality in children
younger than 5 years by two-thirds—back on track.
Currently, child mortality levels are either not
decreasing or actually increasing in 27 countries. And
even in those countries that are making progress, the
poorest are left behind. National fi gures hide great
inequalities. The report argues that three complementary
approaches need to be taken to have the greatest eff ect:
strengthening and improving health care; access to
clean water and sanitation; and poverty reduction.
Child health is inextricably linked to the environment
in which children grow up. Children in poor households
are more likely to die, more likely to have irreversible
eff ects from poor nutrition, more likely to have poor or
no education, and less likely to benefi t from even a well
functioning health-care system than children from welloff
families. User fees, drug and transport costs, and loss
of parental income are often insurmountable barriers to
seek treatment or use preventive measures.
Emerging data from cash transfer programmes,
conditional or unconditional, largely dispel the counter
arguments that these programmes prevent adults from
seeking work or create a dependency culture which
perpetuates intergenerational poverty. On the contrary,
children—especially girls —from households given cash
transfers are more likely to be in education, are in school
for longer, and have higher incomes as adults. Immediate
eff ects on local trade are also positive in most cases.
Summarising the current evidence and modelling
aff ordability, the report makes a very strong case to
include child and maternal cash transfers, especially
for young children, into the package of interventions
to reduce neonatal and child mortality. Even more
compelling is the argument that the eff ect of lifting
households with young children out of poverty will last
for many generations to come. ■ The Lancet
Accumulating evidence from large-scale programmes
is starting to show positive eff ects of cash transfer
programmes on many levels. A new report by Save the
Children, Lasting Benefi ts, highlights the importance
of regular cash transfers, such as child benefi ts or
pensions, as one crucial intervention to get Millennium
Development Goal 4—reduction of mortality in children
younger than 5 years by two-thirds—back on track.
Currently, child mortality levels are either not
decreasing or actually increasing in 27 countries. And
even in those countries that are making progress, the
poorest are left behind. National fi gures hide great
inequalities. The report argues that three complementary
approaches need to be taken to have the greatest eff ect:
strengthening and improving health care; access to
clean water and sanitation; and poverty reduction.
Child health is inextricably linked to the environment
in which children grow up. Children in poor households
are more likely to die, more likely to have irreversible
eff ects from poor nutrition, more likely to have poor or
no education, and less likely to benefi t from even a well
functioning health-care system than children from welloff
families. User fees, drug and transport costs, and loss
of parental income are often insurmountable barriers to
seek treatment or use preventive measures.
Emerging data from cash transfer programmes,
conditional or unconditional, largely dispel the counter
arguments that these programmes prevent adults from
seeking work or create a dependency culture which
perpetuates intergenerational poverty. On the contrary,
children—especially girls —from households given cash
transfers are more likely to be in education, are in school
for longer, and have higher incomes as adults. Immediate
eff ects on local trade are also positive in most cases.
Summarising the current evidence and modelling
aff ordability, the report makes a very strong case to
include child and maternal cash transfers, especially
for young children, into the package of interventions
to reduce neonatal and child mortality. Even more
compelling is the argument that the eff ect of lifting
households with young children out of poverty will last
for many generations to come. ■ The Lancet
Friday, June 26, 2009
Blog from Laura Spece in India!
Namaste!
It's been an interesting week, for sure. We've started to get a few pre-monsoon rains here... which is really nice. It's a short, but very spirited, shower everyday around 5 or 6 pm. It's cooled things off tremendously, but has added a bit of humidity. But overall, we are extremely thankful for their arrival. As are the farmers, of course. Having these little shower bursts help to soak the ground (perhaps maybe a better term would be ground-level dust piles) and prevent severe run off. One of the main goals of the Comprehensive Rural Health Project (CRHP) here in Jamkhed, has been attempting to teach responsible, and appropriate agriculture to that end. (They really cover so much more than medicine, here!!) And a main tenet for such a drought prone region is proper crop selection and trench placement. While we were visiting one of the model farms the other day, the evening rain began, and we piled back into the bus to head back to the compound. On the way, the roads turned in to rivers and many of the stalls/shops had a solid foot of water collected within. And that shower only lasted about 30 minutes! The official, big monsoon rains will begin the end of July/beginning of August and the rains will be constant throughout the day, lasting for weeks at a stretch. I'll be out of here by then. :)
I went on my first village visit three days ago. Six of us go in a little group with a translator. The people here speak Marathi, since they the Jamkhed project is in the state of Maharashtra. So all of the Hindi I tried to learn via YouTube isn't too helpful. :( We do have a Marathi class, and so far I've learned how to say "hello," "what is your name," please may I have some water," and "where is the toilet." That brings my language count regarding the toilet to 6 different languages. And asking where a toilet is in these villages is pretty pointless. The village I visited was Padali, with a population of around 1,700. That equates to about 200 families, with only 17 of these families having a toilet. YIKES. The rest of the village's population openly defecates in the fields or on the outskirts of town. This frustrates them greatly. When I asked the Village Health Worker (her name is Pushpa), how we can best help her village now that better healthcare has been brought by the CRHP, her response was pretty profound. The first thing she says her village needs is proper plumbing to ensure sanitation. CRHP has worked very hard to try and set up a plumbing system. But many of these people live on around 50 cents per day. To operate a toilet alone costs around 20 cents per day. There's no way a family of 6 can spend half of their income on a toilet. :/ Instead, the CRHP did help them to dig small trenches along the sides of the roads. Human waste doesn't flow through these sewage drains, just wastewater from cleaning and cooking. It does help some, especially with the rains. Pushpa blames the corrupt Indian government for the lack of public plumbing, which she is probably quite correct in doing so. They joke here that if you want $5 to actually reach the poor through the government, you'd have to give the officials $25. Ouch.
The second thing Pushpa asked for, was more universities. Currently, the closest University to the Jamkhed area is in Pune. Which is 4.5 hours away, on a good day. Plus the cost is immense for a small farmer. And it's such a shame, so many of the adolescent girls have been able to now access primary and secondary school, and they yearn for more education. When we've asked them what they want to be when they grow up, so many say teachers, doctors, pilots, and one even said prime minister. I hope one of them makes it. But the harsh reality is, most don't. Another objective of the CRHP has been to increase the age of the girl's at marriage. Currently, 36% of girls in India, aged 13-16, are married and already have one child. As you can imagine, this social practice has resulted in numerous complications. Medically, the most important is that these tiny young girls just don't have a pelvis to deliver a healthy baby, nor carry it even to full term. The nutrition of women in India is a whole other issue, which results in so many of them being very short and extremely tiny... and anemic. These women just don't get a break, but woman's rights is a whole other e-mail. So the CRHP has weekend, overnight programs for the girls to come and learn about proper nutrition, childcare, education, marriage and dowry. They sing songs, learn martial arts and just generally socialize and boost their self-esteem. Things that are not permitted back home in the villages. It's also a chance for the CRHP to feed the girls. The estimated cost for this project is 3 million rupees, around US$67,000. Expensive, but totally worth it. The age at marriage is increasing, albeit slowly. But what has been increasing rapidly, is the number of years of school the girls are attending. Most have finished the 11th standard, same as our 11th grade! As I'm sure many of you know, it's the education level of the MOTHER that is most crucial to producing well-fed, well-educated and adjusted children...
I've attached 1 photo with 3 women is of 3 Village Health Workers. The woman in the center (white and orange sari) is Sakubai Gite. Her hands are gnarled from leprosy, as you can see with the flowers. She was the woman photographed in National Geographic holding the baby. It's hard to get the women to not pose for me, and just relax. With their new self-awareness and pride from their training as a VHW, they've become more self-conscious of how they look. They love to do all sorts of posed photos, and really almost harass me to snap a quick shot And they know the cameras are all digital, so they want to see what they look like after. :) Many of them stay closed lipped because they've lost so many of their teeth. It's a shame, I wish I could tell them that they are just too beautiful. Even if they only have 2 teeth left :)
I have tons more to share, but this e-mail's already gotten pretty long, and bandwidth is at a premium. I'm trying to get a blog going, but with the new rain, has come many new internet complications. One last little funny story... In Hindi/Marati, "tomorrow" doesn't literally mean the day after today. Rather, "tomorrow" just means sometime following this moment. So when we hear, "the internet will be ready tomorrow..." we now know to expect a few days delay. :)
Things to think about:
1. Reading: the book "Three Cups of Tea" by Greg Mortenson. Greg was an American alpinist who got lost on K2 and wandered into a very small and remote Pakistani village, pretty much starved to death in 1993. The villagers, all Muslim practicing, nursed him back to health over the next year. In return, he promised to build them a school. He has since built several hundred schools across Pakistan and Afghanistan, even through 9/11. He wholeheartedly believes America can "wage the war against terror" by building such schools, to provide a balanced education to the beautiful children (both boys AND girls) in the Middle East. I tend to agree. I loved this book, and finished it in about 2 days... it's a great story and easy to read. This man will win the Nobel Prize someday
2. "Thank you" in Marathi/Hindi is "Dhanyavad." Quite a mouthful.
3. Pohoe. The name of an Indian dish made of rice flakes, tumeric, coconut, mint, and peanuts. Delicious. Apparently, it's one of their more simple dishes. But I love it.
4. Congrats to Nikki and Lucas for finishing Step 1 of the USMLE (a doctor's licensing exam)!!! Best of luck, I'm sure you rocked it!
Wish you were here,
Laura
It's been an interesting week, for sure. We've started to get a few pre-monsoon rains here... which is really nice. It's a short, but very spirited, shower everyday around 5 or 6 pm. It's cooled things off tremendously, but has added a bit of humidity. But overall, we are extremely thankful for their arrival. As are the farmers, of course. Having these little shower bursts help to soak the ground (perhaps maybe a better term would be ground-level dust piles) and prevent severe run off. One of the main goals of the Comprehensive Rural Health Project (CRHP) here in Jamkhed, has been attempting to teach responsible, and appropriate agriculture to that end. (They really cover so much more than medicine, here!!) And a main tenet for such a drought prone region is proper crop selection and trench placement. While we were visiting one of the model farms the other day, the evening rain began, and we piled back into the bus to head back to the compound. On the way, the roads turned in to rivers and many of the stalls/shops had a solid foot of water collected within. And that shower only lasted about 30 minutes! The official, big monsoon rains will begin the end of July/beginning of August and the rains will be constant throughout the day, lasting for weeks at a stretch. I'll be out of here by then. :)
I went on my first village visit three days ago. Six of us go in a little group with a translator. The people here speak Marathi, since they the Jamkhed project is in the state of Maharashtra. So all of the Hindi I tried to learn via YouTube isn't too helpful. :( We do have a Marathi class, and so far I've learned how to say "hello," "what is your name," please may I have some water," and "where is the toilet." That brings my language count regarding the toilet to 6 different languages. And asking where a toilet is in these villages is pretty pointless. The village I visited was Padali, with a population of around 1,700. That equates to about 200 families, with only 17 of these families having a toilet. YIKES. The rest of the village's population openly defecates in the fields or on the outskirts of town. This frustrates them greatly. When I asked the Village Health Worker (her name is Pushpa), how we can best help her village now that better healthcare has been brought by the CRHP, her response was pretty profound. The first thing she says her village needs is proper plumbing to ensure sanitation. CRHP has worked very hard to try and set up a plumbing system. But many of these people live on around 50 cents per day. To operate a toilet alone costs around 20 cents per day. There's no way a family of 6 can spend half of their income on a toilet. :/ Instead, the CRHP did help them to dig small trenches along the sides of the roads. Human waste doesn't flow through these sewage drains, just wastewater from cleaning and cooking. It does help some, especially with the rains. Pushpa blames the corrupt Indian government for the lack of public plumbing, which she is probably quite correct in doing so. They joke here that if you want $5 to actually reach the poor through the government, you'd have to give the officials $25. Ouch.
The second thing Pushpa asked for, was more universities. Currently, the closest University to the Jamkhed area is in Pune. Which is 4.5 hours away, on a good day. Plus the cost is immense for a small farmer. And it's such a shame, so many of the adolescent girls have been able to now access primary and secondary school, and they yearn for more education. When we've asked them what they want to be when they grow up, so many say teachers, doctors, pilots, and one even said prime minister. I hope one of them makes it. But the harsh reality is, most don't. Another objective of the CRHP has been to increase the age of the girl's at marriage. Currently, 36% of girls in India, aged 13-16, are married and already have one child. As you can imagine, this social practice has resulted in numerous complications. Medically, the most important is that these tiny young girls just don't have a pelvis to deliver a healthy baby, nor carry it even to full term. The nutrition of women in India is a whole other issue, which results in so many of them being very short and extremely tiny... and anemic. These women just don't get a break, but woman's rights is a whole other e-mail. So the CRHP has weekend, overnight programs for the girls to come and learn about proper nutrition, childcare, education, marriage and dowry. They sing songs, learn martial arts and just generally socialize and boost their self-esteem. Things that are not permitted back home in the villages. It's also a chance for the CRHP to feed the girls. The estimated cost for this project is 3 million rupees, around US$67,000. Expensive, but totally worth it. The age at marriage is increasing, albeit slowly. But what has been increasing rapidly, is the number of years of school the girls are attending. Most have finished the 11th standard, same as our 11th grade! As I'm sure many of you know, it's the education level of the MOTHER that is most crucial to producing well-fed, well-educated and adjusted children...
I've attached 1 photo with 3 women is of 3 Village Health Workers. The woman in the center (white and orange sari) is Sakubai Gite. Her hands are gnarled from leprosy, as you can see with the flowers. She was the woman photographed in National Geographic holding the baby. It's hard to get the women to not pose for me, and just relax. With their new self-awareness and pride from their training as a VHW, they've become more self-conscious of how they look. They love to do all sorts of posed photos, and really almost harass me to snap a quick shot And they know the cameras are all digital, so they want to see what they look like after. :) Many of them stay closed lipped because they've lost so many of their teeth. It's a shame, I wish I could tell them that they are just too beautiful. Even if they only have 2 teeth left :)
I have tons more to share, but this e-mail's already gotten pretty long, and bandwidth is at a premium. I'm trying to get a blog going, but with the new rain, has come many new internet complications. One last little funny story... In Hindi/Marati, "tomorrow" doesn't literally mean the day after today. Rather, "tomorrow" just means sometime following this moment. So when we hear, "the internet will be ready tomorrow..." we now know to expect a few days delay. :)
Things to think about:
1. Reading: the book "Three Cups of Tea" by Greg Mortenson. Greg was an American alpinist who got lost on K2 and wandered into a very small and remote Pakistani village, pretty much starved to death in 1993. The villagers, all Muslim practicing, nursed him back to health over the next year. In return, he promised to build them a school. He has since built several hundred schools across Pakistan and Afghanistan, even through 9/11. He wholeheartedly believes America can "wage the war against terror" by building such schools, to provide a balanced education to the beautiful children (both boys AND girls) in the Middle East. I tend to agree. I loved this book, and finished it in about 2 days... it's a great story and easy to read. This man will win the Nobel Prize someday
2. "Thank you" in Marathi/Hindi is "Dhanyavad." Quite a mouthful.
3. Pohoe. The name of an Indian dish made of rice flakes, tumeric, coconut, mint, and peanuts. Delicious. Apparently, it's one of their more simple dishes. But I love it.
4. Congrats to Nikki and Lucas for finishing Step 1 of the USMLE (a doctor's licensing exam)!!! Best of luck, I'm sure you rocked it!
Wish you were here,
Laura
Wednesday, June 24, 2009
China's Health-Care reform plan
The latest edition of The Lancet includes a letter from China's Minister of Health, Zhu Chen. The Chinese government seeks to cover 90% of its people. The Minister of Health outlines 5 elements to the 'action plan':
1. Cover more than 90% of the Chinese people with basic medical insurance
2. Develop a national essential drug sustem
3. Develop the 'three-tier network' at county, town, and village levels.
4. Promote basic public health, including the expanded immunization program.
5. Reform public hospitals.
The letter follows:
The Chinese Government recently approved guidelines
for reform of the health-care system and published an
action plan of targets for reform in 2009–11.1,2 Estimates
suggest that governmental investment (both central
and local) of CNY850 billion (about US$124 billion) will
be injected into the health-care system in the coming
3 years, doubling the average annual governmental
expenditure compared with 2008.
Since China adopted its “Reform and opening up”
policy in 1978,3 the medical care system and health
of residents has developed rapidly. Nevertheless,
because the main orientation of health-care reform
in the 1980s and 1990s was to give autonomy to
hospitals without contribution of public fi nance, the
disparity between urban and rural areas and between
diff erent regions was increased and health-care
expenditure grew too large. Facing these challenges,
the Government decided, in 2006, to prepare new
guidelines for health-care reform. The main aim was to
ensure the basic health-care service works for the good
of the public.4
By absorbing input from ten think-tanks and
integrating experiences from both at home and abroad,
the new guidelines consider reasonable distribution
of health-care resources and core issues of equity and
accessibility. The draft guidelines were available for
public comment from Oct 14, 2008, to Nov 14, 2008,5
and more than 30 000 responses were received. As a
result, major revisions were made and, in particular, the
action plan for tangible targets was developed, which
received strong public support.6
The fi ve major targets in the action plan are
fundamental. First, wide medical insurance cover will
be provided for more than 90% of Chinese people. This
initiative includes basic medical insurance for urban
employees and for residents of cities (elderly people
without previous employment, university students,
children, and migrant workers without a stable labour
contract and their relatives), the new rural cooperative
Medicare scheme for farmers, and the Medicaid system
for urban and rural poor people. The funding level will
also be raised for urban residents and farmers, with
governmental allocation increased to CNY120 per head
in 2010.
Second, a national essential drug system will be
established to meet the basic need for treatment and
prevention of diseases and to ensure safety, quality, and
supply. All drugs on the list will get a high reimbursement
rate by the distinct medical insurance systems.
Third, the medical care and public health service
system will be improved at grassroots level. In rural areas,
emphasis will be on infrastructure and human-resource
development of the three-tier network at county, town,
and village levels. In urban areas, community medicine
centres (stations) will be reinforced. This move will not
only substantially reduce workload in overcrowded
city hospitals but also allow the “health-gatekeeper”
system—ie, family doctors and nurses providing services
at community medicine7 level—to be enhanced for
disease prevention and health promotion.
Fourth is promotion of the basic public health service.
This objective will be realised through: establishment of
health archives for all citizens; provision of screening for
major diseases for elderly people, women, and children;
management of chronic non-communicable diseases;
and health education. Furthermore, major projects
will be launched, including an expanded programme
of immunisation for 15 vaccine-preventable diseases
(eg, against hepatitis B virus for children younger than
15 years), prevention and control for major infectious
diseases (HIV/AIDS and tuberculosis) and geochemical
endemic diseases, and delivery in hospital for all
pregnant women.
The fi nal aim of the action plan is to launch the
pilot reform of public hospitals. This project includes
substantial increases in public investment, restructuring
of the hospital management system, and correction of
the tendency for commercialisation.
In a country with 1·3 billion people, to achieve the goal
of health for all is by no means an easy job, particularly
at a time of global fi nancial crisis and economic
downturn. Our major challenges are to enhance the
working and living conditions of 6 million health-care
workers, to improve the doctor–patient relationship,
and to establish a platform for health records for
all. However, we are determined to transform these
challenges into opportunities. By applying the policy of
prevention fi rst, focusing on rural and grassroots level
service, and paying equal attention to both Western
medicine and traditional Chinese medicine,8 we should
be able to pave a cost-eff ective way for health-care
development.
1. Cover more than 90% of the Chinese people with basic medical insurance
2. Develop a national essential drug sustem
3. Develop the 'three-tier network' at county, town, and village levels.
4. Promote basic public health, including the expanded immunization program.
5. Reform public hospitals.
The letter follows:
The Chinese Government recently approved guidelines
for reform of the health-care system and published an
action plan of targets for reform in 2009–11.1,2 Estimates
suggest that governmental investment (both central
and local) of CNY850 billion (about US$124 billion) will
be injected into the health-care system in the coming
3 years, doubling the average annual governmental
expenditure compared with 2008.
Since China adopted its “Reform and opening up”
policy in 1978,3 the medical care system and health
of residents has developed rapidly. Nevertheless,
because the main orientation of health-care reform
in the 1980s and 1990s was to give autonomy to
hospitals without contribution of public fi nance, the
disparity between urban and rural areas and between
diff erent regions was increased and health-care
expenditure grew too large. Facing these challenges,
the Government decided, in 2006, to prepare new
guidelines for health-care reform. The main aim was to
ensure the basic health-care service works for the good
of the public.4
By absorbing input from ten think-tanks and
integrating experiences from both at home and abroad,
the new guidelines consider reasonable distribution
of health-care resources and core issues of equity and
accessibility. The draft guidelines were available for
public comment from Oct 14, 2008, to Nov 14, 2008,5
and more than 30 000 responses were received. As a
result, major revisions were made and, in particular, the
action plan for tangible targets was developed, which
received strong public support.6
The fi ve major targets in the action plan are
fundamental. First, wide medical insurance cover will
be provided for more than 90% of Chinese people. This
initiative includes basic medical insurance for urban
employees and for residents of cities (elderly people
without previous employment, university students,
children, and migrant workers without a stable labour
contract and their relatives), the new rural cooperative
Medicare scheme for farmers, and the Medicaid system
for urban and rural poor people. The funding level will
also be raised for urban residents and farmers, with
governmental allocation increased to CNY120 per head
in 2010.
Second, a national essential drug system will be
established to meet the basic need for treatment and
prevention of diseases and to ensure safety, quality, and
supply. All drugs on the list will get a high reimbursement
rate by the distinct medical insurance systems.
Third, the medical care and public health service
system will be improved at grassroots level. In rural areas,
emphasis will be on infrastructure and human-resource
development of the three-tier network at county, town,
and village levels. In urban areas, community medicine
centres (stations) will be reinforced. This move will not
only substantially reduce workload in overcrowded
city hospitals but also allow the “health-gatekeeper”
system—ie, family doctors and nurses providing services
at community medicine7 level—to be enhanced for
disease prevention and health promotion.
Fourth is promotion of the basic public health service.
This objective will be realised through: establishment of
health archives for all citizens; provision of screening for
major diseases for elderly people, women, and children;
management of chronic non-communicable diseases;
and health education. Furthermore, major projects
will be launched, including an expanded programme
of immunisation for 15 vaccine-preventable diseases
(eg, against hepatitis B virus for children younger than
15 years), prevention and control for major infectious
diseases (HIV/AIDS and tuberculosis) and geochemical
endemic diseases, and delivery in hospital for all
pregnant women.
The fi nal aim of the action plan is to launch the
pilot reform of public hospitals. This project includes
substantial increases in public investment, restructuring
of the hospital management system, and correction of
the tendency for commercialisation.
In a country with 1·3 billion people, to achieve the goal
of health for all is by no means an easy job, particularly
at a time of global fi nancial crisis and economic
downturn. Our major challenges are to enhance the
working and living conditions of 6 million health-care
workers, to improve the doctor–patient relationship,
and to establish a platform for health records for
all. However, we are determined to transform these
challenges into opportunities. By applying the policy of
prevention fi rst, focusing on rural and grassroots level
service, and paying equal attention to both Western
medicine and traditional Chinese medicine,8 we should
be able to pave a cost-eff ective way for health-care
development.
Wednesday, June 17, 2009
Note from Rwanda
From Kashif Khan:
Dear Friends,
Muraho! I am in Rwanda.
I work with Partners In Health and with the Rwandan Ministry of Health,
mostly throughout the District of Burera (northern Rwanda). Butaro Hospital
in Burera District is located in an absolutely stunning place amongst lush
hills and valleys. It's been beautiful weather nearly every day. At just
under 7,000 feet, the air is crisp and there are no skeeters to speak of.
Hikes are common. What is less common is a spirited futbol match between
the hospital and the Rwandan Military. Yeah, I played. There were
approximately 700-800 people crammed around the wildly uneven playing
field. It was glorious. We lost 4-2. It's about building friendly
relations, what? (Sorry that slipped out - I'm reading some P.G.
Wodehouse).
When not performing rigorous calisthenics prior to hikes and futbol, I help
to set up and run a nutrition program in a district of 14 health centers.
This involves coordination of various programs, including financing,
procurement, storage, distribution of food packets to health centers, supply
chain management, ensuring delivery of food packets to people who fit
certain criteria for malnutrition, reporting back to various organizations,
among other things.
I am conducting a video project which will illustrate - I hope - the
motivations of, and challenges faced by, health care workers, students, and
researchers (Rwandan and expat) as they pursue the work of health care
delivery in a resource poor setting.
I am working on a couple research papers evaluating the success of certain
models of health care delivery.
And, I am gaining some clinical experience, rounding with doctors here and
observing surgical procedures - c-section and tubal ligation thus far! I am
getting a good handle on my vasovagal issues. I know, I surprised myself a
little.
It's been simply an amazing privilege to work on the difficult problems of
the creating, doing, and making that successful implementation requires as
well as evaluation of projects. Everyone has welcomed me onto the wonderful
team here. I'm eating a lot of rice and beans. And I'm learning a few
phrases in Kinyarwanda.
I hope you are well. I would love to hear how you are doing!
More to come...
Jambaho (fist bump of solidarity),
kashif
Dear Friends,
Muraho! I am in Rwanda.
I work with Partners In Health and with the Rwandan Ministry of Health,
mostly throughout the District of Burera (northern Rwanda). Butaro Hospital
in Burera District is located in an absolutely stunning place amongst lush
hills and valleys. It's been beautiful weather nearly every day. At just
under 7,000 feet, the air is crisp and there are no skeeters to speak of.
Hikes are common. What is less common is a spirited futbol match between
the hospital and the Rwandan Military. Yeah, I played. There were
approximately 700-800 people crammed around the wildly uneven playing
field. It was glorious. We lost 4-2. It's about building friendly
relations, what? (Sorry that slipped out - I'm reading some P.G.
Wodehouse).
When not performing rigorous calisthenics prior to hikes and futbol, I help
to set up and run a nutrition program in a district of 14 health centers.
This involves coordination of various programs, including financing,
procurement, storage, distribution of food packets to health centers, supply
chain management, ensuring delivery of food packets to people who fit
certain criteria for malnutrition, reporting back to various organizations,
among other things.
I am conducting a video project which will illustrate - I hope - the
motivations of, and challenges faced by, health care workers, students, and
researchers (Rwandan and expat) as they pursue the work of health care
delivery in a resource poor setting.
I am working on a couple research papers evaluating the success of certain
models of health care delivery.
And, I am gaining some clinical experience, rounding with doctors here and
observing surgical procedures - c-section and tubal ligation thus far! I am
getting a good handle on my vasovagal issues. I know, I surprised myself a
little.
It's been simply an amazing privilege to work on the difficult problems of
the creating, doing, and making that successful implementation requires as
well as evaluation of projects. Everyone has welcomed me onto the wonderful
team here. I'm eating a lot of rice and beans. And I'm learning a few
phrases in Kinyarwanda.
I hope you are well. I would love to hear how you are doing!
More to come...
Jambaho (fist bump of solidarity),
kashif
Short video on Clean Water
Here is a short and potent little video put out by ONE.org:
This past week I had opportunity to speak at a local church about my work in Pestel, Haiti. I again had to say one of the most ludicrous statements: "Even drinking dirty water is better than no water."
I will be so glad when I no longer have to talk that way about Pestel.
This past week I had opportunity to speak at a local church about my work in Pestel, Haiti. I again had to say one of the most ludicrous statements: "Even drinking dirty water is better than no water."
I will be so glad when I no longer have to talk that way about Pestel.
Monday, June 15, 2009
What is Global Health?
What does the term "Global Health" mean, and how is it different than "International" or "Public health"? A group of researchers from the Consortium of Universities for Global Health (COGH) have developed a definition of global health to encompass its multi-faceted nature which was published in the June 6, 2009 edition of The Lancet.
The authors state that:
" Without an established definition, a shorthand term such as global health might obscure important differences in philosophy, strategies, and priorities for action between physicians, researchers, funders, the media, and the general public. Perhaps most importantly, if we do not clearly define what we mean by global health, we cannot possibly reach agreement about what we are trying to achieve, the approaches we must take, the skills that are needed, and the ways that we should use resources."
Koplan, J. et al. Towards a common definition of global health. The Lancet, Vol 373, Issue 9679, Pages 1993-1995.
The authors state that:
" Without an established definition, a shorthand term such as global health might obscure important differences in philosophy, strategies, and priorities for action between physicians, researchers, funders, the media, and the general public. Perhaps most importantly, if we do not clearly define what we mean by global health, we cannot possibly reach agreement about what we are trying to achieve, the approaches we must take, the skills that are needed, and the ways that we should use resources."
The authors go on to develop a definition of global health that is dependent upon the scope of the problem, not simply the location (or geographical region) of the problem:
"What is global? Must a health crisis cross national borders to be deemed a global health issue? We should not restrict global health to health-related issues that literally cross international borders....global health should also address tobacco control, micronutrient deficiencies, obesity, injury prevention, migrant-worker health, and migration of health workers. The global in global health refers to the scope of problems, not their location."
Finally, they conclude with the following definition of global health:
" Global health is an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasises transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population based prevention with individual-level clinical care."
What do you think? Do you agree with the authors' definition of global health? How does your work fit into the broader scope of global health?
Koplan, J. et al. Towards a common definition of global health. The Lancet, Vol 373, Issue 9679, Pages 1993-1995.
Saturday, June 13, 2009
Washington DC and HIV
Based on a report just published, "The District of Columbia HIV/AIDS Epidemiology Update 2008":
Overall, 3 percent of all District residents are currently known to be living with HIV/AIDS. To put that in context, the United Nations Joint Program on HIV/AIDS (UNAIDS) and the U.S. Centers for Disease Control and Prevention (CDC) have historically defined an HIV epidemic as generalized and severe when the overall percentage of disease among residents of a specific geographic area exceeds 1 percent. The overall proportion in the District is three times higher. This calculation is based on the number of cases already diagnosed and reported and U.S. Census figures of our population. Moreover, based on new targeted studies of behavior that indicate between one-third and one-half of residents may be unaware of
their infection, we know that the true number of residents currently infected and living with HIV is certainly higher. In the District, nearly every population group and age is experiencing a substantial epidemic."
To put that in national perspective, the US prevalence of HIV is about 0.6%.
You can see a list of countries by HIV prevalence here.
Vaccine Initiative
A new funding/supply mechanism has been developed to provide vaccines to developing countries This is called "Advanced Market Commitments for vaccines".
This AMC is an intriguing and big-scale system that, if I understand it correctly, takes up-front dollars from interested developing countries to provide financial down-payments to provide lower cost, set-priced vacccines. The down-payment is subsidized by other organizations (i.e. World Bank, Donors). In this way the manufacturers receive a financial guarantee and they in turn guarantee production of a certain # of vaccines (i.e. pneumococcal) to be sold at a fixed, lower price.
The first AMC is for Pneumococcal vaccine. Here's an explanation from the website:
"The Pneumococcal AMC Structure
The Advance Market Commitment pilot engages donors (five governments and the Bill & Melinda Gates Foundation), developing country governments, and GAVI Alliance members the World Bank, the World Health Organization, UNICEF and the vaccine industry to provide millions of pneumococcal vaccines to children in the developing world, 10-15 years before these life-saving vaccines would ordinarily been made available."
The graphic shown at this link portrays the arrangement for Pneumococcal vaccine.
This AMC is an intriguing and big-scale system that, if I understand it correctly, takes up-front dollars from interested developing countries to provide financial down-payments to provide lower cost, set-priced vacccines. The down-payment is subsidized by other organizations (i.e. World Bank, Donors). In this way the manufacturers receive a financial guarantee and they in turn guarantee production of a certain # of vaccines (i.e. pneumococcal) to be sold at a fixed, lower price.
The first AMC is for Pneumococcal vaccine. Here's an explanation from the website:
"The Pneumococcal AMC Structure
The Advance Market Commitment pilot engages donors (five governments and the Bill & Melinda Gates Foundation), developing country governments, and GAVI Alliance members the World Bank, the World Health Organization, UNICEF and the vaccine industry to provide millions of pneumococcal vaccines to children in the developing world, 10-15 years before these life-saving vaccines would ordinarily been made available."
The graphic shown at this link portrays the arrangement for Pneumococcal vaccine.
Wednesday, June 10, 2009
Interview with Dr. Paul Farmer
Thanks to Deirdre Weaver for passing this along!! Here's an interview with Dr. Paul Farmer.
"Bringing quality health care to poor populations remains a huge challenge. Hear what Paul Farmer, founder of Partners in Health and subject of Tracy Kidder's Mountains Beyond Mountains,has learned about how to do it right."
"Bringing quality health care to poor populations remains a huge challenge. Hear what Paul Farmer, founder of Partners in Health and subject of Tracy Kidder's Mountains Beyond Mountains,has learned about how to do it right."
News items
A few notes of interest:
1. The Global Health Scholars are currently in San Pablo, Ecuador finishing up their community-based research. Lots of photos to come!!!
2. You can also check out a blog by two of our 1st year medical students, Riva and Sarah. They are in Bolivia collecting data. I'll post their blog on the side-bar to make it easier for you to follow their happenings.
1. The Global Health Scholars are currently in San Pablo, Ecuador finishing up their community-based research. Lots of photos to come!!!
2. You can also check out a blog by two of our 1st year medical students, Riva and Sarah. They are in Bolivia collecting data. I'll post their blog on the side-bar to make it easier for you to follow their happenings.
Tuesday, June 9, 2009
Global Health Council Annual Conference
The 36th annual Global Health Council Annual Conference was held May 26-30, 2009 in Washington, D.C., and represented a diverse cross section of the global health community. Industry, Academia, Government, Private Sector businesses, you name it - all gathered to discuss the central theme: New Technologies + Proven Strategies = Healthy Communities.
A few highlights:
There were many seminars on how to successfully keep abreast of new technologies and fully utilize them in global health research and health systems development. Text messaging, Geographic Information Systems (GIS) and live video lectures are just a few of the technologies being implemented around the globe. Uses range from tracking outbreaks and emerging infectious diseases, maintaining immunization records, to strategically assessing and planning for community-based health centers.
One great resource for epidemiologists and infectious diseases professionals is Health Map. This website traverses several thousand internet sites and foreign language newspapers each hour, providing some of the first indications of emerging infectious diseases around the world. Users can sign up for alerts specific to their country or disease of interest.
Another great use of technology is a live webcasting series on HIV/AIDS care and treatment developed by the International Training & Education Center on HIV (I-TECH). This series is an interactive training session for healthcare providers around the world, who can dial in and directly participate in case studies and various lecture materials. The program's advantage is not only that healthcare providers can receive training from internationally renowned infectious disease specialists, but that they can ask questions, participate, and take ownership of the material.
One key point emphasized throughout the conference was the need to maintain the human dimension in the midst of the rapid development of technology. During a panel discussion on HIV/AIDS and the global financial crisis, the point was made that global health organizations should broaden the traditional definition of health systems. Often the discussion on health systems stops with the health care provider - the community worker or the doctors or nurses serving a particular location or need. However, the point of care provider is often a family member, and any resource committment needs to include family caretakers in the endpoint analysis and treatment strategy (particularly in HIV/AIDS). Recognizing the key role of family members will allow for a more efficient use of resources, as well as fully engaging the community and meeting the needs of the patient.
This conference definitely highlighted the diverse nature of the global health world. Check out this year's conference highlights, and stay tuned for 2010!
A few highlights:
There were many seminars on how to successfully keep abreast of new technologies and fully utilize them in global health research and health systems development. Text messaging, Geographic Information Systems (GIS) and live video lectures are just a few of the technologies being implemented around the globe. Uses range from tracking outbreaks and emerging infectious diseases, maintaining immunization records, to strategically assessing and planning for community-based health centers.
One great resource for epidemiologists and infectious diseases professionals is Health Map. This website traverses several thousand internet sites and foreign language newspapers each hour, providing some of the first indications of emerging infectious diseases around the world. Users can sign up for alerts specific to their country or disease of interest.
Another great use of technology is a live webcasting series on HIV/AIDS care and treatment developed by the International Training & Education Center on HIV (I-TECH). This series is an interactive training session for healthcare providers around the world, who can dial in and directly participate in case studies and various lecture materials. The program's advantage is not only that healthcare providers can receive training from internationally renowned infectious disease specialists, but that they can ask questions, participate, and take ownership of the material.
One key point emphasized throughout the conference was the need to maintain the human dimension in the midst of the rapid development of technology. During a panel discussion on HIV/AIDS and the global financial crisis, the point was made that global health organizations should broaden the traditional definition of health systems. Often the discussion on health systems stops with the health care provider - the community worker or the doctors or nurses serving a particular location or need. However, the point of care provider is often a family member, and any resource committment needs to include family caretakers in the endpoint analysis and treatment strategy (particularly in HIV/AIDS). Recognizing the key role of family members will allow for a more efficient use of resources, as well as fully engaging the community and meeting the needs of the patient.
This conference definitely highlighted the diverse nature of the global health world. Check out this year's conference highlights, and stay tuned for 2010!
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