Hi all,

Today I thought I'd take the chance to introduction y'all to one of my favorite global health NGO's (other than U-Tena of course!) called Nyaya Health. Nyaya Health is also the partner organization for Tuft's Globemed chapter so it's relevant in more than one way. They are a 'for purpose' health organization that dedicates themselves to working for the right to health in rural Nepal. One of the reasons Nyaya sticks out in my mind is because of their dedication to transparency. Nyaya Health founded itself on the principle of "being transparent until it hurts". They want to end the age-old image of the perfect aid organization that is secretly collecting money and allocating large portions to overheads. To do this not only does Nyaya have a public wiki with all financial and day to day activities of its staff, but they also write blog articles about both their failures and successes. Today I want to share with you one of my favorite such pieces, entitled "Walls and Flies" and written by their co-founder Duncan Maru.

http://www.nyayahealth.org/blog/walls-and-flies/

Kenya's Health Care System

Hey everyone,

Just thought it would be a good idea to kind of just take a step back and get a little background knowledge about what the health care system is like in Kenya. Just to look at the basis of the system and its main goals and funding, and compare it to our system. I found this link with the general info:

http://www.allianzworldwidecare.com/healthcare-in-kenya

Enjoy!

-Rachel

Songs/Cheers: Meeting Kuza

Hey everyone,

One of the things I looked forward to most was bringing the Kuza Project back to Brown. I've been a bit slow about it (forgive me), but I'll be starting a multi-part series on some of the highlights and thoughts from our GROW trip.

To start, I wanted to share a treat from our very first week in Nairobi. After a few days of getting acclimated to our humble home of ~2 months, the six of us set out for our very first Kuza Project event, a gender-based-violence workshop for some of the teens in the community and their parents. Among the teens were some of our very own Kuza girls, and Brienne, Anna and I had the pleasure of meeting them.

Lydia, Maurine, and Caroline (from left to right in the video below) are 14-16 years old and have been in Kuza for its entire existence. They are talented at so many things: Lydia's a blossoming professional hair stylist (literally--she went to beauty school for it!), and Maurine loves singing. The three of them were generous enough to sing a little song for us after we found out they all love to sing and dance, and they got so excited for us to take this back to you guys. Without further ado...



If anyone happens to know the name of the song, I'd love to know. It's the one thing I forgot to ask them!

-Elaine

Chronic Kidney Disease in the developing world

Annabel Lemma

Chronic Kidney disease (CKD), also referred to as chronic renal disease, is a progressive loss of kidney function over a period of time.  The natural course of CKD extends from being susceptible to the disease, exposed to the risk factors and to development of CKD that progresses to End Stage Renal Disease (ESRD). The fast progression of the illness together with the very high medical costs associated with it makes Chronic Kidney Disease one of the most dangerous diseases worldwide. Chronic kidney is now the cause of hundreds of thousands of deaths every year.¹ It is highly pronounced today because of the rapid increase in its prevalence, the enormous cost of treatment, and most importantly, because of its major role in heightening the risk of cardiovascular disease and other complications. Especially in developing nations where the health care system is not very advanced, these effects can be highly aggravated.

It has been suggested that as many as 100 million individuals may be affected by chronic kidney disease globally.⁴ Provision of care for patients who require dialysis or transplantation is a major and growing healthcare problem in both developed and emerging nations in terms of cost, premature mortality and economic impact. It is estimated that over 2 million patients with ESRD worldwide are currently on renal replacement therapy (RRT), at a global cost of around one trillion dollars.¹ 90% of all treated ESRD patients reside in the West, as the prohibitive cost precludes renal replacement therapy in most developing nations. Though there is not an official registry for renal disease cases in most developing countries,¹ it is undeniable that its effect is more pronounced in the part of the world where health care is at its worst.

Chronic kidney disease is at least 3-4 times more frequent in Africa than in developed countries. Hypertension affects approximately 25% of the adult population and is the cause of chronic kidney failure in 21% of patients on renal replacement therapy in the South African Registry. The prevalence of diabetic nephropathy is estimated to be 14%-16% in South Africa, 23.8% in Zambia, 12.4% in Egypt, 9% in Sudan, and 6.1% in Ethiopia.⁵ The current dialysis treatment rate ranges from 70 per million population in South Africa to < 20 pmp in the most of sub-Saharan Africa. The transplant rate in Africa averages 4 pmp. ⁵

The unavailability of medical supplies, physicians, technology are all contributory factors to this reality. There is so much that could be done to decrease the severity of the problem starting from creating awareness in the community about the disease and how it can possible be prevented, campaigns for early treatments are also another options.

Giving the Gift of an Education

Thanksgiving has come and gone and the stress of papers, finals and of course the impending holiday season is upon us. In the midst of all that is the end of the semester at Brown, it's hard to think ahead to holiday gift giving. The thought of navigating malls or sifting through the internet in light of all else we have to do is entirely daunting. Which is why I want to introduce Globemed and it's blog readers to an organization that gives the gift of education: the Iqra Fund. 

The Iqra fund(Iqra means 'to read' in Arabic) was created by Jennifer Chabot in 2007 after she spent time doing doctoral research on women's education in Pakistan. Today the Iqra fund is a nationally recognized organization that works with communities and employs local leadership to provide girls with educational opportunities that greatly affect their quality of life and the future of their communities. 

Having worked first hand with the Iqra fund, I've seen the impact they have made on the ground in Pakistan and the way in which they have risen from a small grass roots organization to a powerful voice in the future of women's education in the Middle East. 

This holiday season the Iqra fund is urging us to give the meaningful and unique gift of education. They are accepting donations of any amount and to prove that a little goes a long way they give the example of nine year old Jane who donated $10 with which the Iqra fund was able to purchase texts books and a school bag for a girl in Pakistan. Iqra will make a donation in your friend or family's name and you will be both have the knowledge that you are part of an incredible organization and an extraordinary revolution. 

Here is the link for the website to donate: 

http://iqrafund.org/donate.php

Happy Holidays! 

-Camille

Women's Rights and Health Outcomes

Lately there has been a lot of discussion about women's empowerment in Globemed at Brown. It is interesting to think about how gender roles and women's empowerment directly and indirectly relates to health outcomes. For example, there has been research done in Lesotho, Africa that describes how many AIDS orphans lack caretakers since that is typically a "women's" role, and therefore men are hesitant to take responsibility for care. Issues such as this one really emphasize the fact that gender discrimination and social norms can be devastatingly restrictive in many aspects of daily life. How can these norms be changed or altered in order to better health outcomes? Are health initiatives more or less effective in areas with strong traditional gender roles? I think it is crucial to look at articles and issues written about women rights and the oppression of women and try to put these events in the context of health. How can this societal judgment harm or extinguish the lives of those who give life?

An interesting article to try to read through this lens is one titled "Why Do They Hate Us" by Mona Eltahawy. 

- Megan M.

Public Health Concerns in the Aftermath of Haiyan

Last week, the Philippines were ravaged by what may be the most severe typhoon in history, Haiyan. The reported death toll has risen to almost 4,000 people, and many more have been injured, displaced from their homes, or otherwise affected. 

According to this Popular Science article by Brooke Borel, the immediate public health concern is dealing with the trauma inflicted by the storm itself, including preventing or treating infection in injuries sustained. To address this, mobile hospitals are being set up around the country to treat patients on the ground as well as address their daily health issues. 

Perhaps more difficult to contend with is the public health dangers associated with the loss of infrastructure. With no clean water or reliable sanitation, Filipinos will be extremely vulnerable to diarrheal diseases, like cholera, and vector-borne diseases, like malaria. Preventing the spread of these diseases will be challenging because they they cannot be defeated with medicine alone. To stay healthy, Filipinos will need safe drinking water, sanitation systems, and new housing, even in the most remote areas.

What other public health measures do you think should be taken after natural disasters like Haiyan?

Anna

How should we approach aid?

International aid is a contentious issue. Between the efforts of NGOs and the at times heavy handed influence of developed nations, the realm of aid and relief work is usually a jumbled mess. Progress tends to be iffy, metrics for tracking development skewed, and consistency in methodology and follow-through shoddy at best.

This TED Talk is one of my favorites. My senior year Economics teacher presented it to the class during our development studies and used it as a launching point for the Sachs vs. Easterly debate in development economics (give this a Google search if you have never heard of these guys). Ernesto Sirolli provides a compelling thesis for the reasons behind the failure of much of the developed world's aid work in LDCs. He suggests that rather than coming onto the scene with a predisposed idea of what might be the most effective aspect of life to target, the true potential for success in development comes in true cooperation with those in need. A welcoming ear seems to outdo deep pockets when we look toward true progress.

http://www.ted.com/talks/ernesto_sirolli_want_to_help_someone_shut_up_and_listen.html

Cheers,
Mike

The Increasing Presence of Mental Health in Global Health

Over the past fifteen year, the field of global mental health has emerged. International organizations, such as the World Health Organization, have created departments specifically for mental health. Prominent health focused NGOs (e.g. Partners in Health and Doctors Without Borders) have expanded their programs to address mental health and now employ numerous mental health workers. There are research centers at universities and hospitals dedicated solely to global mental health. Our partner, U-Tena, has actually put mental health on their agenda for this year. This significant push towards understanding and improving mental health has revealed the significant and prevalence and burden of mental illnesses around the world. The WHO estimates that mental illness account for 15% of the global burden of disease and that approximately 4 to 5 million people have a mental illness. See this recent article on the prevalence and burden of depression for example of what this research looks like: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001547. The poor treatment and human rights abuses of individuals with mental illnesses has also come to light. The famous medical anthropologist, Arthur Kleinmen, wrote that conditions and treatment of individuals with mental illnesses are “a failure of humanity” (his 2009 article on this topic: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61510-5/fulltext). The field of global mental health, however, does certainly have its critics and there are legitimate concerns about the over use of psychotropic medications and imposition of western models of mental illness. This article titled “The Americanization of Mental Illness has more information on this topic: http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?pagewanted=all. While debates rage on about the proper ways to address the issue of mental illness globally, it is now clear that there is no health without mental health and that this is an issue anyone interested in global health must confront.

For more information on the field of global mental health check out these videos and articles:

Vikram Patel’s TED Talk “Mental health for all by involving all”: http://www.ted.com/talks/vikram_patel_mental_health_for_all_by_involving_all.html

“Grand challenges in global mental health”: http://www.nature.com/nature/journal/v475/n7354/full/475027a.html

“The Unseen: Mental Illness’s Global Toll”: http://www.cartercenter.org/documents/2407.pdf

- Daniel C.

HCV--silent killer

http://online.wsj.com/news/articles/SB10001424052702304200804579163523170170660

HCV (Hepatitis C Virus), often called the "silent killer," is a virus that causes Hepatitis C which affects the liver, and may lead to various liver diseases including cirrhosis.  HCV is often neglected because it does not have one of the highest rates of infection and mortality rate recorded in the United States.  However, considering that the risk groups, such as IDUs (injection drug users), are not included in national surveys, much higher rate of the disease is highly likely.
Especially, baby boomers are under risk, due to high experiment drug uses in the 1960s and 70s and low surveillance of blood supply used in transfusions.

Push for HCV testing for all baby boomers at doctor's visit may help to catch the "silent killer," and treat it before it leads to liver failure.

-Hwajin

Hilltop 2013

Hi everyone! This past weekend I attended Hilltop at Columbia, which is a global health conference for students in GlobeMed.  I would love to share with you all some of the things I took away from the conference, and how this might help us function as a chapter.  I would also like to touch upon some of the main points of the lecturers and how they pertained to the theme of the conference.  The theme this year was "Politics, Culture and Business: Expanding the Conversation on Global Health."

The main takeaway I got from the combination of lecturers and group forums was that the global health discussion is moving in a different direction.  The use of the private market to make global health projects possible is something that we are seeing more and more.  The first speaker was Mark Arnoldy, the executive director of Nyaya Health.  Nyaya is an non-profit that works in Nepal to provide healthcare for those who cannot access it.  It does so by using the basic infrastructure already there and building upon it.  For example, it works to improve small clinics that are closer to people in rural areas than the major hospital.  Another interesting event was a panel of people who work in global health, but also in the business world.  The connection of for-profit organizations and non-profit global health organizations was discussed.  The notion that businesses can be making a profit while a non-profit also helps to promote health equity is just now being discussed.

The really great element to the conference was meeting people from GlobeMed chapters from around the Northeast as well as a few people from Wisconsin.  My fellow hosted student was actually from the University of Michigan.  We had plenty of discussion about our own chapters and how they differed/compared.  Overall, I was very impressed by other chapters as described by their representatives.  They had some really great ideas for how to raise money, how to unite our chapter, and how to make our name known on campus.  I am going to list some of the ideas I jotted down here so that we can all take a look and see if any would be appropriate for Brown:

-5k (people from many chapters have done this but it may be a bit much for PVD)
-bar crawl (mentioned by a Tufts student)
-Color wars (basically throw paint at each other)
-Gala for GlobeMed
-Karaoke night
-Hosting a party at a club downtown

These are just a few of the ideas I got from the conference! It was a great experience and I think if you get the chance to attend at least one national conference during your time in GlobeMed you should take it! I think that it gave me and Betty a chance to bond and I ended up making a friend all the way from Michigan.  If nothing else, it was a networking opportunity. If anyone has any questions about my experience feel free to talk to me!


GlobeMed Love,

Leah Rivard

Improving health and standard of living

1) http://www.ted.com/talks/ernest_madu_on_world_class_health_care.html

2) http://www.ted.com/talks/andrew_mwenda_takes_a_new_look_at_africa.html

3) http://www.ted.com/playlists/67/the_quest_to_end_poverty.html

I found these TED talks to be interesting, because they relate to the topics we have been talking at our weekly meetings. 

In the first video Ernest Madu uses the Heart Institute of the Caribbean in Jamaica, as an example of what can be done in Nigeria to improve the treatment of cardiovascular diseases. He points out that efficient treatment is possible and does not have to be expensive. 

In the second Andre Mwenda suggests that the international world not just view Africa as a charity case, but should help the continent become self-efficient. The continent needs opportunity and has potential. Africans need wealth, in order to treat the causes that create disparity. 

In the third video Jacqueline Novogratz explains Jane's escape from poverty. Jane lived in a slum outside of Nairobi, but was able to provide for her family and move into low-cost housing. This third link also has 7 other videos, which all relate to the quest of ending poverty. 

Got Community?

This past Sunday, our Community Builders organized a small group of staff to decorate a box that will be used to collect winter clothing donations for the needy. Brown students will get to see our handiwork outside the doors of campus's main dining hall and donate their unwanted clothing to a good cause.

Camille and Megan adorn the clothing donation box with drawings of winter
clothes and other winter-themed items like snowflakes and snowmen :)

So far this semester, Community Building has done a wonderful job planning events to get staff to know each other. Several weeks ago, the Community Builders prepared a scavenger hunt that pitted the staff (divided into 3 teams) against each other in heated competition to hunt for campus's primary landmarks (and others that were not so well-known or obvious!). In two weeks, the Community Builders will hold a movie screening and potluck meal so staff can gather and socialize one more time before the Thanksgiving break.

GlobeMed at Brown is just as much about creating community among staff as it is educating staff about global health issues and fundraising for our partner, U-Tena –– so thank you Community Builders for all the fantastic work you're doing!

Marisa M.

Cancer is Only For Rich People, Right?

For a class this semester at Brown, one of the assigned texts included Julie Livingston’s Improvising Medicine. One of the discussions in the book revolved around cancer in Botswana that discusses how the world outside of Africa does not usually correlate the specific disease of cancer with Africa. Most people believe that Botswana has not yet undergone the epidemiological transition we see in wealthier states, and that infectious disease, rather than chronic disease, is overwhelmingly the single most important cause of morbidity and mortality. Livingston’s ethnography elucidates, however, how not only does cancer exist in Botswana but it takes on an entirely different form. As opposed to the pre-screening and testing that characterizes cancer in the United States, in Botswana, because hospitals are considered the last possible option for most people, cancer arrives at the hospital as irreversible and the patients essentially cadaveric. The reason I bring this up is because Livingston helped remind me to back away from assumptions regarding global health. I feel like it can be easy at times, especially because we as GlobeMed at Brown often focus on AIDS and HIV, to forget that health problems that people around the world actually suffer from are not always what we assume and expect them to be. At the same time, we also have to be wary of assuming that certain diseases and conditions have universally common lived-experiences and etiologies. The book as a whole was an eye-opening and interesting read for anyone interested!

Shyam

Privilege Discussion

Last week, our group discussed the effects of privilege in society and how to better foster discussion about the disparities resulting when one person or group is more privileged than another. A circular diagram, displayed during the meeting, presented different kinds of privilege and emphasized how being privileged can have many different meanings. For example, a Brown University student has educational privilege but not necessarily monetary privilege. We then discussed what are the challenges when trying to talk to others about privilege. Some members stated being able to talk openly about socio-economic differences depends on whom you are discussing the issues with. My intro to public health class is also looking at the difference privilege has in accessing adequate health care. Our guest speaker this week, Dr. Buka, discussed the effects that race has on infant and maternal health in the US. In the past, researchers questioned whether black women were genetically more likely have infants with lower mortality rates than white women. However, further research concluded, that genetics has nothing to do with it. Instead, racial and economic disparities are the leading causes of infant and maternal health risks. The findings caused researchers and public health officials to put more emphasis on providing adequate health care to minority mothers. I think that when looking at global health issues, although sometimes uncomfortable, the discussion involving privilege is necessary to promote change. It was great to be in the GlobeMed meeting where everyone was willing to discuss the issues and possible solutions to the disparities caused by privilege.

Josette

We are family.

When I walked into the bar on Tremont street, surrounded with Northeastern students also sporting their finest Halloween garb, I was immediately handed a condom with the number "55" hastily scribbled across the back. 55? I thought. Oh my goodness. 55 what? 55 WHAT?!

As it turned out, 55 was to be my raffle number when the coordinators raffled off prizes later than evening. (I know--phew.) And, as it turned out, the coordinators organized a selection of other really interesting and fun activities for the evening's participants. (Again--phew. When you're dressed up as a fairly convincing pirate in a costume made from your everyday plainclothes, you really hope for some form of distraction. I was waiting for someone to tell me, "KC, I think I've seen you wear that belt before.")

Welcome, everyone, to F(r)ight Against AIDS, a Costume Party hosted by the GlobeMed chapter at Northeastern University.

I think sometimes we forget the larger GlobeMed network with which we are fortunate enough to be exposed. Here at Brown we work so hard to support and promote U-Tena the best we can; we owe it to them to put our best effort and focus into fundraising and helping such a wonderful organization grow. It was, however, such a treat to be able to meet some fellow GlobeMedders, to experience another set of fundraising tactics, and to sympathize with the goals of our colleagues in a different chapter.

The F(r)ight Against AIDS was a marvelous success: a night of absurd costumes, World-Series-watching, condom trivia, and plenty of shameless plugs. The Northeastern chapter rented out a local bar for an evening, and invited students in costume to come for an evening of drinks, dancing, and prizes--all the while lacing the event with a little bit of Global Health education as well. (Do you know how much liquid the average condom can hold? I dare you to google it.)

NEU partners with Kitovu Mobile AIDS Organization in Uganda to support certain community building efforts. Their emphasis is on sexual health and AIDS awareness, though they also support clean water initiatives and other community issues. I urge you all--GlobeMeddlers (hehe) or otherwise--to check out the cause and the event; both will teach you a little more about the reach and the impact of GlobeMed on the world.

Once pictures come up on Facebook, I'll try to repost with a secondary update on the event, but I'm still waiting on them. (Maybe you'll catch a glimpse of me on the side of the frame. I did have someone tell me, "I can't tell if you're a pirate or just trying to be fashionable." Erm...both?) The event was a wild success, packed to the brim. I won't go into too much detail because, in truth, I want you to learn for yourself. I would love for you to do a search, find an event, and sign yourself up for a GlobeMed fundraiser at a different local school. How cool would it be if we could support the Boston chapters of GlobeMed with joint efforts? How neat would it be to show such collaboration and commitment through our actions? Communicating with other chapters offers us so much room for growth as chapters, and it truly embodies the core values of GlobeMed as an organization.

I just want to remind us all that GlobeMed is so much more than just us and our cause; we are blessed to have so many comrades across the country doing equally great work. If you have a spare moment, peruse the website or follow some of our GlobeMed brothers and sisters on Twitter. Our objectives here are based in growth and learning, and we must never forget that we can learn so much from each other as well. We are all fighting the same fight, and nothing makes for a stronger army than some bonding (and good fun).

Hats off, Northeastern, for a spectacular (spooktacular?) evening! I'm glad I could support you and Kitovu, if only a little bit. Also, thanks for the free condom. Also also, I'm still a little bitter that I lost the costume contest to a human taco.

(Who am I kidding--he deserved it. Human taco? Kudos, bro.)

peave, love and ghouls,
kc caine, '15

(Health care)? in Ethiopia

By Annabel Lemma

A month into my first semester at Brown, I caught a cold. It was a normal cold which was accompanied by somewhat frequent coughing. It was not much different from other colds I acquired at previous times, so I treated myself as I always had; I drank a lot of fluids and got a lot of sleep. But my friends kept telling me that I should go health services and get it checked out as it could be a more serious problem. Even though I knew that their advice was out of concern, my first reaction was that it was just a cold, people seek medical assistance when they are really sick and I was not. I had always made fun of those people that went to the hospital for the smallest things and I definitely did not want to be one of them. Thus, I decided against my friends’ advice to go to health services.

My attitude towards hospitals and my definition of sickness are influenced by the community that nurtured me. I was born and raised in the capital city of the very beautiful eastern African country Ethiopia. Living in a country where cases of HIV/AIDS, malaria, tuberculosis (TB) and other diseases are very common, I unconsciously accepted that common cold, flu, headache, stomach pains and similar ailments were really not sicknesses. The majority of the population in Ethiopia rarely seeks medical assistance unless it is an immediate life threatening illness. There is this mentality that is widely accepted that state hospitals are for extreme medical cases. Even in a family like mine, where both adults are well educated, going to clinics or hospitals is not a common phenomenon. I have never had a general medical check-up, and the only times I remember seeking medical assistance is when I needed vaccinations. My father had a problem on his ankle bone and he did not go to the doctor until he actually was not able to walk. His ankle was fixed and he was back to normal in a couple of days, but I cannot help but wonder, what if it was not fixable? What if he was just too late to get it looked at that he was not able to walk anymore?

This refusal of the community to seek early medical assistance has tremendous consequences in both small and large scales. Every day, numerous people in Ethiopia die from curable diseases like TB, malaria and influenza (three of the four leading causes of death in the country. The inability of individuals to seek medical assistance has a significant contribution in realizing this fact. The major cause of the problem, however, is the combined effect of the limited number of health institutions, inefficient distribution of medical supplies and disparity between rural and urban areas. A WHO study  in Ethiopia states that it is estimated that more than half of the population of the country lives more than 10 kilo meters away from the nearest health facility, usually in regions with poor transportation infrastructure. Then the situation changes from ‘I will not seek medical assistance’ to ‘I cannot seek medical assistance’. While the complete unavailability of medical assistance is a major problem in the rural areas of the country, the unavailability of medical supplies, the quality of medical care that is provided and affordability of health care pose as the major difficulties to people who live the urban areas.

A couple of years ago, one of my father’s close friends was diagnosed with End Stage Renal Disease (ESRD). Because he was diagnosed at the very last stage of chronic kidney failure, he only had two medical options that can be carried out in order for him to be able to survive. His first and more preferable option was to get a kidney transplant while his second option was to enroll in a regular kidney dialysis treatment. There are not any hospitals in the whole country that are well equipped to perform transplant surgeries, as thus no transplant surgeries are currently performed in Ethiopia. The cost of getting a transplant surgery in a foreign country together with the cost of travel for the organ donor and receiver is unimaginable to the average Ethiopian with a per capita income of US$370/year (World Bank) and consequently the option of transplant surgery was out of question. The only option he was left with was regular dialysis treatment. Three years ago there were two medical institutions that provided dialysis treatment; the main referral governmental hospital and a private hospital in the capital city. By the time my father’s friend was sick, all the 25 dialysis machines in the governmental hospital were out of order and no dialysis treatment was offered there anymore, and sadly it still remains that way after two years (I visited the hospital during summer 2013).

Without any other options left for him, the ESRD patient enrolled in a dialysis treatment that costs US$120 per session in the private hospital. There is no health insurance system in Ethiopia and we also don’t have a publicly-funded health care system. In our system, individuals pay for the service they are provided at the time of treatment. At the beginning, he attended three dialysis sessions per week, later it was reduced to two and at the end even one. Friends and family helped him morally and economically to their capacity, but there was only so much that they could do. I could not imagine the position he was in when his life suddenly transformed to the worse when he changed from a healthy capable man with a good standard of life to a being dependent on others. It must have had a lot of psychological impact on him. He sold his car and later his house just to see the light of another day. But inevitably the time came where there was nothing he could sell anymore and he was living off of other people. He stopped working because he was too weak to carry out the tasks that were assigned to him. It is so hard to live with just one dialysis per week. He then later passed away.

His case, for me, embodies everything that is wrong with the Ethiopian health care system. The first of all is his failure to get diagnosed earlier, which possibly could have resulted in a different outcome of the story. The second is the unavailability of medical supplies, medical practitioners and health services that resulted in the unavailability of transplant surgery and dialysis. The last one was the unaffordability of the little available medical care in the country which resulted in his economic downturn during his struggle to better his health condition. What makes this case more unbearable is the fact that there is so much that could have be done to better conditions. This is just one of the many cases in the country that are heart breaking, there is so much we can improve—so much we can fix. From small social changes like increasing the availability of clean water and sanitation, to providing education to the community about the early symptoms of widespread diseases and dispersing primary care throughout the country, there are definitely many things that we can carry out to bring change in the general health of the population.

---

Blurred Lines

In humanitarian aid work, one of the largest yet most neglected problems comes in the form of the ethical challenges.

In the past year, doctors working in rebel-controlled northern Syria for the humanitarian organization Médecins Sans Frontiéres (Doctors Without Borders) began seeing signs of neurotoxic symptoms in an alarming number of patients. These were the first signs of the increasing chemical warfare, which began with small-scale attacks earlier this year and and grew to a gas attack in August that killed hundreds. As the leaders of the organization realized what was occurring, they faced another big issue: releasing this sensitive information would be highly dangerous for the group's doctors and their Syrian partners, making them appear to side with the rebels and angering the government. Furthermore, the group feared their words would spark interference from other governments, including the Obama administration.

While Doctors Without Borders chose to take the risk and issue a public statement, many other organizations, including the Red Cross, strictly stick to a neutral state, working in countries only after obtaining approval from the governments and refraining from releasing any information that would put them in danger.

Many ethical questions arise from this seemingly safe, smart decision: When should one draw the line? Is it wiser to stay quiet to keep assisting people on the brink of death, or speak up about situations in which people are being harmed or killed and thus risk being closed down and kicked out? Where exactly is the line?


Countless other moral conflicts exist:

• How far does the humanitarian responsibility extend- is it right for organizations to pull out before peace, economic, and political stability is reached?
• When does cooperation with a warring parties turn into bystanding on human rights violations?
• Can humanitarian relief work focus on a narrow range of problems, or should it address the broad range of challenges facing many health systems around the world?
• What should an agency do if the problem might be magnified with their good intentions, such as food drops that spark violent raids?

These are all dilemmas we must consider as an organization dedicated to addressing health disparities around the world. I would love to hear your thoughts on these issues, and get some discussions and debates going on around campus!




-Betty

A Great Public Health Organization to Check Out!

Hey everyone!

So my post is also kind of a shameless plug. Basically I wanted to share about a nonprofit that reminds me a lot of GlobeMed! It is called AYUDA, which stands for American Youth Understanding Diabetes Abroad. I volunteered with them for the past two years and it is what got me interested in public health! Basically, AYUDA works with partner organizations in Latin America to create sustainable and educational Type 1 Diabetes programs for kids. My twin sister has Type 1 Diabetes so that is how I became interested, but the more I learned about public health in general as well, the more passionate I became. 

The three guidelines/beliefs I think are all really amazing and parallel GlobeMed's mission:

1. A lack of education is as dangerous as a lack of insulin. AYUDA was founded in reaction to seeing children with diabetes who had access to insulin and medical treatment, but still suffered complications and early death because they did know how to manage their condition. AYUDA programs address the severe lack of education by implementing our innovative youth-to-youth education model.

2. Youth can serve as powerful agents of change. Youth empowerment is the fundamental principle for AYUDA, and is also exemplified by the members on the AYUDA team. Our educational and youth leadership programs increase interaction among youth, develop awareness of their ability to impact change in their communities, and provide them with the tools and skills to do so.

3. Understanding is just as important as doing. AYUDA partners with local communities and organizations in order to better understand their issues and to help create innovative solutions. Learning and understanding cultural context is critical to developing solutions prior to taking action.


Basically, education, youth empowerment, and cultural understanding are at the heart of the organization! 

Here's a video of AYUDA and their partner organization in the Dominucan Republic, Aprendiendo a Vivir. This video will automatically make you happy!

http://www.youtube.com/watch?v=bFDILWv4BKA

Shameless plug time: AYUDA is accepting applications for volunteers! Below is the link to their website if you want to find out more, but also feel free to ask me questions!

http://volunteers.ayudainc.net/site/PageNavigator/homepage.html

Thanks!
Madeline

Medical Reductionism... :(

My Culture and Health class is reading a book called Our Bodies Belong to God by Sherine Hamdy, which gives a very detailed analysis about controversy over organ donation in Egypt. One of the topics dealt with in the book is the concept of medical reductionism, where a health issue is reduced to its most basic physical impact on an individual. While this point of view might be tempting for medical professionals who just want to treat an illness and move on, it ignores the vast and complex set of factors that influence health outcomes. I think especially when looking at global health issues, it’s not enough to only consider treatment at the level of the individual. We need to look at how larger social issues, like inequality and exploitation, affect people’s health in negative ways, and work to make it easier for people to be healthy in the first place. This means looking at everything from food systems to family dynamics to labor practices. There’s so much knowledge to integrate and explore! ...I get really excited about this stuff for some reason. 

Anyway, the problem with medical reductionism on the part of doctors and other organ transplantation supporters in Egypt is primarily that it neglects patients’ concerns about how they got sick in the first place and whether this costly (both economically and socially, as organs are primarily procured either from organ sellers or family members), risky, and possibly sinful (there is much debate among Islamic religious authorities) procedure will even benefit them that much in the long run. There is an alarmingly high rate of liver and kidney disease in Egypt, which people believe is due to unchecked pollution and food contaminated with pesticides. Where some see only a spare part that needs replacing, these patients see a much more complicated issue. 

If you’re interested in reading the book I would highly recommend it, it’s written by my professor and she’s incredibly detailed and insightful. (Our Bodies Belong to God: Organ Transplants, Islam, and the Struggle for Human Dignity in Egypt, by Sherine Hamdy)

<3,

Anna

PEPFAR in transition

I was browsing around while working on my research paper, and read that PEPFAR (President's Emergency Plan for AIDS Relief) was in transition; they are cutting down the funding for AIDS in Sub-Saharan Africa.  What implications would this change have in HIV care in these countries?  How would their government provide adequate care?  How much responsibility should the United States carry for patients who are currently in care?
It is disturbing and frightening in a way to see how U.S.'s financial state can make so much difference in healthcare abroad, and it is necessary to ask how global aid is distributed--which countries and diseases receive aid and why.

Article: http://www.nejm.org/doi/full/10.1056/NEJMp1310982#t=article

-Hwajin

Haiti vs. the UN: Cholera Edition

Haiti's lawsuit against the United Nations might be actually getting off the ground--but can it?

For those not in the know, Haiti has been experiencing a devastating cholera epidemic since the earthquake of 2010. Cholera was eliminated in Haiti centuries ago, but has reappeared in Haiti ever since a UN peacekeeping mission from Nepal neglected to build proper sanitation and waste management systems on its campsite, allowing cholera-infected waste (yep, poop) to seep into a nearby stream--a stream that happened to be a tributary for the Artibonite River, a major source of water for many Haitians. Cholera spread quickly through the country thanks to poor living conditions in displaced-persons camps and lack of access to water caused in part by the earthquake. The disease is now endemic in the Haitian population and has killed at least 8,000 people and infected 650,000. The UN discouraged the investigation of the source of the disease and has not accepted responsibility for the spread of the disease, nor has it issued an apology to Haitians. Haiti is now seeking billions of dollars in compensation from the UN, all of which will go to paying for damages and building up infrastructure.

This is where things gets tricky. Under current international law, the UN is immune from legal proceedings within a country's court systems. In this case, the UN refuses to address the damages done to Haiti and Haitians, claiming that this case should be considered in terms of public policy, not law--and the UN will not intercede in a country's public policy. Past cases against the UN held in US courts have been dismissed using the Convention that grants the UN immunity from the law. But despite this precedent and the UN's assertions that it will not pay damages to Haiti, human rights lawyers filed a lawsuit against the UN in New York this week.

So what next? Where does this leave Haiti, or the epidemic? Can an international organization be immune from the law? Does the UN get to make the rules up as it goes along to protect itself and its employees? One thing is for sure: this case is sure to be interesting. Keep your eyes on this case; it might just spur some much-needed change in the international community.

Source: http://www.theatlantic.com/international/archive/2013/02/how-the-un-caused-haitis-cholera-crisis-and-wont-be-held-responsible/273526/

~*~ Brienne ~*~

Nobel Peace Prize 2013

Today, the Nobel Committee awarded a Nobel Peace Prize to the Organization for the Prohibition of Chemical Weapons (OPCW). In a statement released on their website today, OPCW outlined their mission: 'to act as the guardian of the global ban on chemical weapons that took effect in 1997... We have since then worked with quiet determination to rid the world of these heinous weapons – weapons which have been used to horrific effect throughout the twentieth century, and, sadly, in our own time too.' It is likely that recent events in Syria had some bearing on the selection of OPCW as this year's winner. The Nobel Prize website notes that in giving this award, 'the Committee is seeking to contribute to the elimination of chemical weapons'.

A few of the other nominees that were in contention:

• Denis Mukwege - A doctor in the Democratic Republic of Congo, who has spent years treating women gang-raped and tortured during the civil war. Last year he was the target of an assassination attempt but managed to escape.
• Malala Yousafzai - A Pakistani girl shot in the head by Taliban militants for encouraging girls to receive an education. She was touted by many as a favourite to win the award.
• Edward Snowden - An NSA whistleblower, who brought to public attention surveillance programs by the US and British governments. Snowden has managed to elude US authorities thus far.
• Chelsea Manning, formerly Bradley Manning - A US soldier who leaked secret documents to website WikiLeaks. He has been sentenced to 35 years in jail.

Though not of all these are health-related, it is worth us noting the work and impact of many of these individuals or organizations. Hopefully they can serve as inspiration to us as we work towards our goal this year and in the future.

- Sarah

Souces: www.nobelprize.org, www.opcw.org, www.telegraph.co.uk

Data by World Bank

In the midst of researching for a paper a few years ago, I happened upon this awesome website: http://data.worldbank.org

Let me just say, the World Bank is certainly not infallible, but they sure do a fantastic job organizing data. The comparative graphs are my favorite. From time to time I revisit this site to play with the graphs. They provide a striking visual reminder of how unequal the world is. Below you can browse graphs comparing the CO2 emissions, GDP, and prevalence of HIV in people 15-49 years old in Kenya and the United States.

CO2: http://data.worldbank.org/indicator/EN.ATM.CO2E.PC/countries/KE-ZF-XM-US?display=graph

GDP: http://data.worldbank.org/indicator/NY.GDP.MKTP.CD/countries/KE-ZF-US?display=graph

HIV: http://data.worldbank.org/indicator/SH.DYN.AIDS.ZS/countries/1W-KE-US?display=graph

I encourage GlobeMedders et al. to peruse the maps, tables, and graphs that represent the world we live in, and think about their place in it. How do your consumption habits fuel environmental degradation globally? What structures are in place that you benefit from without doing a thing? Are those benefits your rights? Why doesn’t everyone in the world enjoy them? We must constantly be asking ourselves these questions as we engage in international partnerships.

Victoria