Academia? Action? Translation please, pt. 1

This is a four-part mini-series on global health discourse and translating it to be meaningful in the lives of university students. Part 1 - Introduction; 2 - Answers from academia; 3 - Does my action matter?; 4 - Translation. Contact: alina_kung@brown.edu.

Part 1: Introduction

Let's talk about global health inequities.

Firstly, a few questions:
1) How do we understand the relationship between health and inequity?
2) How do we go about building a more healthy and just future?
3) Whose ethical responsibility is it to ensure global health?

We might as well be asking, "How do we bring about world peace?" Before getting overwhelmed, let's just take a moment to marvel in the magnitude of each question. The complexity. The stakes. The implications. The power relations. The faces. The beating hearts.

Finally, let's think about possibilities.

The problem with big-picture questions like this is that it's easy to get lost. Before coming to any reasonable conclusion, we have to coat our statements with layer upon layer of big ideas in an effort to find something that's universal. Before you know it, we've used a lot of words to say nothing at all - obscuring more than we're illuminating. After peeling back layers of verbiage, we are left looking at nothing of substance.

As an university student, I see that issue - of muddling more than making clear - brought up by others when analyzing competing scholarly arguments. And as a senior trying to write a thesis, I still feel uncertain when trying to identify what the author is really trying to say or how everything fits together.

Take this perhaps familiar scene: One sad day at the library, I might be poring over articles from peer-reviewed journals and come with up a new key term I want to run on Google Scholar. Maybe I'll run into an article my school doesn't have access to, and be met with - $24.99 for access to this 7-page article please. It took me three hours of data entry at my first job to make $24.75. Barriers to entry much? While I'm distracted by this thought, I might take the opportunity to find an excuse not to write this assignment by surrounding myself in self-deprecating thoughts. I'm 21 years old. I am sitting in an air-conditioned building on an ergonomic chair intently reading something written by someone I don't know so I can write something for someone else I don't really know. I haven't really done anything of substance, and haven't proven I can even support my own living. Sometimes I can write sentences that sound convincing where I really say nothing at all. Sometimes I'm not convincing. Does this matter? Do my actions matter?

I want to use this blog post as an opportunity to say that our actions, as university students, do matter.

Why?

Because in real human moments, we all have a presence. And whether to your select close circle of people (your mom, your dad, your best friend from middle school, and your roommate in college), to the university administration (ah yes, accepted student 3254/5784 who's currently majoring in Biology), to politicians who want your vote, or to companies that view you as a potential consumer, you count.

Stay tuned for the next post, where we'll read some big-picture answers from persons you're may already be familiar with - Paul Farmer, Jeffrey Sachs, and Jennifer Ruger.

“Charity begins at home”. This is the rarely-questioned assumption that many hold regarding aid, whether medical or otherwise. Evidence of how ingrained this is in the American psyche is seen no more clearly than when the nation stumbles upon tough economic times. Those following the GOP primary debates recently may have noticed a resounding commitment to reassess and reduce foreign aid given out by the US. The same sentiment has been echoed by Congress (both sides of the isle) during its many rounds of stalled budget talks. Now, foreign aid is a nuanced category that includes everything from disaster relief to military support. I would like to focus on development aid: the funds that go directly towards improving the health and general welfare of people in low-income countries. There are a lot of problems here as well, but the fact remains that the US is responsible for helping fund major projects that combat disease around the world. The question is, would it perhaps be better to slash our development aid budgets in order to focus on our own citizens? After all, people are in need of medical aid right here at home; shouldn’t we help them first before worrying about foreign countries? I would like to offer a firm ‘no’. I believe that if we are able to set aside a certain amount of dollars for healthcare aid, it should go to wherever it can do the most good, regardless of the nationality or geographical proximity of the recipients. To me, GlobeMed represents this commitment by partnering with groups in countries with the most dire needs, not just with local American organizations. After all, a dollar in Kenya goes a lot further than a dollar in the US when it comes to reducing disease.

Back to politics. In 2000, The United Nations came out with the “Millennium Development Goals”; these were eight objectives with the aim of improving global welfare, including “Combat HIV/AIDS, malaria and other diseases” and “Eradicate extreme poverty and hunger”. As part of these goals, rich countries were asked to donate at least 0.7% of their GNP (Gross National Product) as development aid. While a few of the Scandinavian countries have surpassed this goal, as of 2009 the United States remains in the bottom five of the twenty three richest countries, pledging a mere 0.21%. The percent of our GDP (Gross Domestic Product) that we spend on all types of foreign aid is around 1%. Most Americans do not know this low number; they believe the percent GDP we are spending is around 25%, and wish to see it taken down to a “mere” 10%. If only we could have such a reduction—to ten times our current foreign aid budget! This discrepancy in knowledge makes it easy to see why politicians who pledge cuts to aid budgets are receiving widespread popular support. Budget proposals submitted by the Senate, the House, and Obama himself all outline reductions to virtually every development aid program currently in effect. And the problem extends beyond the US government: The Global Fund to Fight AIDS, Tuberculosis, and Malaria (an international organization that is the single largest source for grant money to fund action against those diseases) just announced that it would not be able to issue any more grants until 2014. While part of that decision was based on corruption allegations (regarding less than 1 percent of its budget), it seemed that donor countries were all too eager to pull funding. This pattern of healthcare isolationism is simply unethical. Of course we could provide better social services for Americans if we cut our development aid budget. But what would be a paltry sum in the States could have positive effects orders of magnitude greater in the developing world. A government may have a duty to serve its citizens, but we all have a duty to do the greatest good with whatever money we have. Surely there is a better way to get the 1% GDP that would be saved by cutting our foreign aid budget.

There are two solutions to this problem in America. The US could start giving more money as official federal development aid, or US citizens themselves could begin to make up the difference with private donations. Ideally, both will be done. Already, private donations in the US as a percentage of GNP are unusually high for a rich country (though not nearly enough to make up the amount needed to reach our 0.7% UN quota). This is an encouraging trend, and private donations are something tangible that is in the power of every American. On the federal level, it all comes down to an implementation of GlobeMed's own goal of recognizing the equal value of human life regardless of where a person happens to live. Let charity begin wherever it is needed most—and continue until healthcare is accessible to everyone.

Jason Kirschner

Cervical Cancer in Kenyan News

Take a look at this Kenyan news story! Your Story: A Woman's Battle with Cancer

(don't be deterred by the Swahili parts,you can still understand what is going on from the English). It tells the story of a woman suffering from cervical cancer, discussing her lack of access to treatment and the toll that it has taken on her family life. The video was shot in the Mukuru slum of Nairobi where our partner organization U-Tena is based, and its super-relevant to U-Tena’s work for lots of reasons besides the fact that cervical cancer is a huge reproductive health issue. Read on!

According to an article in one of Kenya’s national newspapers, The Standard, cervical cancer is the most common form of cancer among Kenyan women; at least 2,635 women are diagnosed in Kenya every year, and almost the same number die. Millions, however, are at extremely high-risk given that 40% of women nationwide are estimated to have HPV, the virus that causes cervical cancer. Unfortunately, less than 5% of Kenyan women are screened for the cancer regularly, meaning they only receive medical attention after their cancer has progressed to more advanced stages.  

Because access to prevention measures such as the HPV vaccine and education about risks is incredibly restricted by poverty, and since co-factors such as HIV increase the likelihood that HPV will lead to cancer, cervical cancer is very much a social-justice issue. In response to the generally-high prevalence of cancer nationwide, the Kenyan government is seeking to create a Cancer Prevention and Control Institute to better coordinate the monitoring, treatment and care of people living with cancer, and is planning to carry out public information and in-school education campaigns on prevention and treatment. Parliament has also recently passed a bill making cancer treatment free. However, in the experience of the woman in the video, the necessary medical supplies are neither available nor accessible. At the Kenyatta Hospital in Nairobi, a hospital treating mostly low-income Kenyans, a lack of supplies means very long waits and multiple visits—a prohibitive burden for her; seeking treatment at private hospitals or in neighboring Uganda is out of reach.

On a more hopeful note, the high toll cancer is taking on Kenyans has stirred responses in civil society. For example, after his own struggle with cancer a Kenyan dentist has dedicated himself to helping establish a Palliative Cancer Foundation to provide medical, social, and psychological care to impoverished cancer patients. An American NGO has also set up cervical cancer-screening facilities in a different part of Kenya How can community-based organizations such as U-Tena make a difference on these issues? What is our role as students looking on from thousands of miles away?

Here's all the links in case you missed them in the text:

Your Story: A Woman's Battle with CancerWHO Wants War on Cervical Cancer Intensified
MPs Root for Establishment of Cancer Institute
Cancer Experience Inspires Charity
Cases of Cervical Cancer on the Rise<---this is the video that talks about the American organization...really worth a watch too!

Staff member applications due THIS THURSDAY (10/20)! No pressure, we just want to gauge what you think your level of commitment can be. If you didn't get one, e-mail GlobeMedBrown@gmail.com to request it!









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Hello everyone! This is the GlobeMed at Brown Blog's first (test) post. Here, you can read up on what's happening around campus with the club, and how you can get involved. We'll also be sharing stories of interest from time to time.

Coming up: we have our second intro meeting this Thursday (October 13th) in Wilson 309! Come if you couldn't make it to the first one.

-[Jason]