Tuesday, October 29, 2013

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.


Monday, October 28, 2013

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

Sunday, October 27, 2013

(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.

Monday, October 21, 2013

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!


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!


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!



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)


Tuesday, October 15, 2013

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


Monday, October 14, 2013

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 ~*~

Friday, October 11, 2013

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

Sunday, October 6, 2013

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.

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.


Manal al-Sharif: A Saudi Woman Who Dared to Drive


This TED talk by Manal al-Sharif starts off by asking the question, "Which is harder, battling oppressive governments or battling oppressive societies?" Although there is no law in Saudi Arabia that bans women from driving, it is a societal norm to discourage this. This norm is so strong that, when Manal posts a video of her driving as a part of her campaign to encourage female drivers, she receives threats to be killed or raped and is eventually detained for a short amount of time. Her campaign, in retaliation, begins to publicly mock the wide-held (and oppressing) belief that allowing women to drive would promote adultery, rape, illegitimate children, drug abuse, and prostitution, "...and only then did [they] realizing that it is so empowering to mock [one's] oppressor, it strips it away of its strongest power: fear". Manal emphasizes that oppression is the worst when women begin to believe in their inferiority. As I will let the viewer watch the video and form their own opinions, I think the question posed at the beginning of this TED talk would be a good discussion topic for a GlobalHealthU session, and how it relates to U-Tena and Kuza's work.

- Alicia

The United Nations' Millennium Development Goals

On September 23, the United Nations hosted a "high-level forum" to discuss its Millenium Development Goals. These MDGs, as they're abbreviated, were adopted in 2000 and have a target date set for 2015.

So what are these Goals anyway? They are a set of goals focused on improving basic areas of health, including the eradication of extreme poverty and hunger, reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria, and other diseases in all areas of the world. And though there have been some improvements in these areas, we have a ways to go until all the Goals are met.

For example, maternal mortality related to childbirth has declined to 210 maternal deaths per 100,000 live births in 2010 from 400 deaths per 100,000 births in 1990. Sounds pretty promising, right? Well, the bad news is that there is still a long way to go to meet the 2015 goal of only 100 maternal deaths per 100,000 live births -- partially due to the fact that many countries with high maternal death rates continue to struggle with lack of prenatal care, assistance during childbirth, and broad contraception use.

Another partial success is the decline of death rates for children under age 5, which dropped to 51 deaths per 1,000 live births in 2011 from 87 in 1990. Still, nearly 7 million such children died in 2011, mostly from preventable diseases, and as many as 1 in 9 children in sub-Saharan Africa die before age 5. The goal to reduce the death toll to 4.3 million deaths may be achievable; after all, Bangladesh and Liberia have reduced their death rates to meet their 2015 goals. But clearly, there is still work to be done.

Finally, the goal to provide retroviral therapy to all people infected with HIV has not been easy to reach: 10 million people today are in treatment, and the goal is to treat 15 million people. Even this, though, is less than the 26 million in less well-developed countries who could use the treatment.

Some of the longer-term goals like eradicating extreme poverty and protecting the environment through sustainable development of natural resources, which are set for 2030, may not even reach their halfway mark unless more efforts are made. Still, we do seem to be moving in the right direction, so these goals may someday be attainable. Now's the time to make a difference!

Marisa M.