Tuesday, March 18, 2014

FGM in Egypt

For the first time in Egypt, charges are being laid against a doctor for committing female genital mutilation after a 13-year-old girl, Sohair al-Bata, died after allegedly undergoing FGM at his clinic. Sohair's father is also facing prosecution: her family had purportedly asked for the procedure to be carried out.

FGM has been officially banned in Egypt since 2008, but a majority of the country's women are still subjected to it. This Guardian article on the case cites the following statistic: 91% of married Egyptian women aged between 15 and 49 have been subjected to FGM, 72% of them by doctors.' It is claimed by FGM supporters that the practice makes women less likely to commit adultery.

There are also millions of women in other countries who undergo such mutilation, a common practice in many African countries and some others in the Middle East and Asia. It is a complicated issue as often women in the societies practising FGM support it.

Here's the FGM wikipedia page if anyone is interested in reading more,
factsheet on FGM in the US,
and an article on trying to prevent FGM in Britain, perhaps relevant to the US.

- Sarah

Sunday, March 16, 2014

An Update on the Fight Against HIV/AIDS in the Central African Republic

Hey everyone,

Here’s an interesting update on the ongoing global fight against HIV/AIDS. As many of you may know, the Central African Republic is in the midst of their third civil war, which started in 2013.  The general lack of human resources and humanitarian needs being met are contributing factors in the difficulties in fighting HIV/AIDS, but there are also other factors in play.

In recent years, stock-outs of ARV’s have had a detrimental effect, both socially and physically. The stock-out is in part, due to the freeze of funding coming from the Global Fund to Fight AIDS, Tuberculosis and Malaria in response to funds falling into corrupt hands and being spent irresponsibly.  Although this strategy may be more effective in terms of traceability of funds, it has created lasting damage to the patients whose condition depends on these drugs.  In order to make the current prescriptions of ARV’s last longer, patients have taken to trying strategies that may in fact reduce the effectiveness of the drugs and help the virus to become more biologically resistant. 

I thought it was interesting that the article also focused on the fact that the stock-out of ARV’s not only had devastating effects on the health of patients, but also on the social perception of the doctors and organizations working to improve health and standard of living in the area.  The sporadic and untimely freezing of funds has generated a difficult but understandable mistrust of the system put in place.  The interpretation of the situation may also generate problems because people may chalk up the patient’s resistance to the drug regime as simple “cultural reasons”.  This ties in with the discussion we had last meeting regarding how much of the problems being faced in the crossroads of the medical world can be written off as a result of cultural difference and which problems should be analyzed at a deeper level.


Saturday, March 15, 2014

The Role of Culture in Medical Treatment

Last GlobeMed meeting, we read a short summary of Anne Fadiman's, The Spirit Catches You and You Fall Down.  In the book, Lia Lee suffers from epilepsy, but her family's traditional Hmong beliefs and culture conflicts with California doctors' treatment protocols, which ultimately led to an episode that caused her to live the later 26 years of her 30-year-lifetime in a vegetative state.  We began to discuss current-day issues we see with cultural differences in medicine.  There are language barriers, age barriers, religious differences, knowledge gaps, etc. that can prevent people from getting medical treatment they need, or influence them to take on unnecessary medical treatments.

Last year, I took a class on Human Rights for Women and Children in Africa, in which we questioned the foundational definitions of human rights.  Part 1 of Article 25 of the UN Declaration of Human Rights states, "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social service, and the right to sexurity in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."  This sounded great when I first read it; I mean who would disagree with that statement?  But then my teacher brough up some things I had never thought about.  First, in chapter 3 of Politics of the Womb: WOmen, Reproduction and the State in Kenya, Lynn M. Thomas discuses "the girls who circumcised themselves" after FGM was banned in Kenya in 1956 to satisfy Western (particularly British) human rights views.  Then we discussed women who prefer to have at-home births with traditional spiritual (and not medically trained) midwives in certain states such as Chad.  Finally, when we were comparing differences between life expectancies in the US and other Western countries with those in many African countries, my teacher posed a question along the lines of, what if people in these cultures would rather die in the way 'fate' had destined them to die than get operations and take medications that might make them live longer, but not necessarily fuller lives?

I have struggled to come up with any sort of solution to this juxtaposition.  I personally believe that under the law of human rights, Lia Lee should have been given her medication, etc.  People with epilepsy can lead semi-normal lives with treatment, and I think that she had the right to be given that opportunity.  I do think doctors should have been more understanding of Lee's family's beliefs, and maybe should have tried to come up with a way to gain the trust of Lia's parents so that they would give Lia the medication, but I'm not sure that would've changed her parents' behavior very much.  I think it should be a human right for people to choose whether they want to take a medication, seek medical treatment, etc., but this does complicate things when cross-cultural medical treatment is involved.  As I said before, I still don't have answers to this question of how to create culturally sensitive treatments that work for certain medical issues.  Do we ifnore culture in order to treat someone that doesn't want treatment, because we think it's the right thing to do?  Do we completely take away culturally embedded practices and beliefs such as at-home-births or FGM because they may violate our western standards of human rights, or do we find ways to alter the practices to make them a bit safer.  I don't know, but I do think that it is an important question to ask.


Sunday, March 9, 2014

"I asked five questions in Genetics class today, and all of them started with the word 'Sorry.' "

In 1948, the Universal Declaration of Human Rights was adopted by the UN, specifying that everyone, regardless of sex, was entitled to the same rights and freedoms. Nearly 50 years later, the 1997 Human Development Report concluded, "No society treats its women as well as its men." Women face inequalities all around the world, such as the continued barring of women from driving in Saudi Arabia, feticide and infanticides in China and India, and the lack of the right to own land in Chile.

Although conditions are far better in the United States, the patriarchy still exists. In celebration of March and Women's History Month, here are some amazing voices from slam poets around the country. It's interesting to consider the images they paint and how these issues are still prevalent in the Brown community.

"Shrinking Women"
"Ten Responses to the Phrase, Man Up"
"This Is For You"


2014 GROW Institute in Chicago, Illinois

"GROW is when the GlobeMed mission becomes human. It is when "students" becomes replaced with your names, "communities" with your partner, and your MOU becomes real." -Maya Cohen, Executive Director, GlobeMed

Hi everyone!

Over the weekend of February 22-23rd, Ilkania and I attended the 2014 GROW Institute in Chicago, Illinois. It was a weekend of training, inspiration, GlobeMed love, and cold -- that's for sure!

The weekend kicked-off with introductory remarks from the Director of Partnerships, Alyssa Smaldino, and the Executive Director, Maya Cohen, each speaking about their past experiences as GROW interns in Rwanda and Uganda, respectively. Hearing each of these inspirational women reflect fondly on their time as interns and with such passion about the GlobeMed network (all while being in a room with over a hundred other bright-eyed GROW interns, mind you) sent a shot of adrenaline throughout me. Achieving social justice and improving global health are daunting tasks -- it is too easy to feel inadequate or become inactive in the mission for fear of criticism or failure or because the news keeps telling you how bad of a place the world is. But something Maya said resonated with me. She said: "GROW is when the GlobeMed mission becomes human. It is when "students" becomes replaced with your names, "communities" with your partner, and your MOU becomes real." Maya's positive outlook and sincere investment in achieving health care equality was genuinely touching and moving-- I carried this excitement and energy with me throughout the rest of the weekend.

Saturday and Sunday consisted of various workshop activities and small-group breakouts focused on creating Partnership Action Frameworks, common goal agendas, and Monitoring and Evaluating techniques.

One of the main highlights of the weekend was the photo challenge on Saturday night. Led by the wonderful Caroline Nguyen from the National Office, the Humans of Chicago challenge sought to teach GROW interns how to take ethical, aesthetic photos by breaking us up into teams of five, sending us into the city, and giving us two hours to capture a prize-winning photo and caption.

As for the winner of the 2014 Human of Chicago challenge... Team #1! Each member of the winning team received $20 for their respective partner organizations, which means that GlobeMed at Brown received $20 for our partner, U-Tena, in Nairobi! (Check out the winning photo and caption below!)

The weekend wrapped up with an inspiring talk on fostering inclusive teams by Dominique Hazzard, the new Diversity & Inclusion Coordinator. Many fellow GlobeMed peers commented on the diversity present in the room, with one student, Breanna Wilkerson from Spelman College, calling the space "revolutionary." After reflecting on my time in the GlobeMed network, I have to agree with Breanna. The 2014 GROW Institute was, hands-down, the most revolutionary, inspiring, and diverse space that I have been in with fellow GlobeMed peers. I am so blessed to be a part of this network and cannot wait to see where the next few years bring us!

"I talk to cab drivers from Africa - Nigeria, Ghana, Kenya - they tell me that I'm right, that they hate this city too but they can't say anything because they're immigrants."

The MOST GlobeMed love,


Tuesday, March 4, 2014

More on the Grassroots Initiatives for Global Health Conference at MIT

As you all already know Marisa, Meygan, and I attended MIT’s Grassroots Initiatives for Global Health conference some weeks back. Marisa wrote a blog post about the specifics of it.  I wanted to focus a bit more on the main lessons from the conference and about my personal experience.

To begin with, I would like to mention, again, that I love going to GlobeMed events hosted by other chapters and the national office! They are great for networking with public health professionals I look up to, learning about various issues, and meet great people our age with the same interests.  I have also found that talking to others involved with GlobeMed has increased my passion for our mission and I’ve received some great advice about how to improve our chapter from members of other chapters.  GlobeMed events/conferences are great for collaborative learning!  Moral of this post; attend these events!

One of the great, new opportunities I learned about is PIH Engage.  PIH Engage is a new project launched by Partners in Health that focuses on brining people together to discuss global health issues and to advocate for the social justice and health equity.  This program goes hand-in-hand with GlobeMed’s mission to give voice to the voice-less.  Check it out, here’s the link http://act.pih.org/page/content/community-organizing.

Another important point of the conference was to highlight the fact that we don’t have to dedicate our lives/careers to global health in order to make a difference, we just to contribute however we can.  There are so many different ways to contribute (if you have any questions about how your interests/major fit into the fight for global health equity and social justice in general, let me know and I’ll try to give some guidance).  However, if you guys are interested in devoting your lives to the fight for global health the speakers (global health practitioners) gave some great advice as to how to enter a career in global health.  I know this is a question I’ve asked many times, global health’s multi-faceted so it is hard to know a exact career path.  Most of us think medical school is necessary, but this is not the case! We need economists, politicians, scientists, humanitarians, public health practitioners, etc on our side! All of these fields are imperative for the fight for global health equity and global justice.

Here’s a link from Columbia that describes some career paths in global health:


Lupita Nyong'o and the Oscars

So I'm sure most of y'all were like me and spent your time this Sunday night glued to the tv watching the 2014 Oscars. And if you did this for even 5 minutes you probably saw 12 Years a Slave winning every award possible. What you might not know is that Lupita Nyong'o, the winner of "Best Supporting Actress" for her role as Patsey, actually started her career in the Kenyan TV show, Shuga.

Shuga is actually a show produced by MTV with the goal of using popular entertainment as a vehicle for communicating and promoting messages about healthy sexual behavior among African Youth. Not only was Lupita an actress in the series, but she is also a co-director. After the Oscars ceremony, the president of Kenya went so far as to tweet that Lupita is the "Pride of Africa", demonstrating just how much Lupita means to the country

If anyone wants to check out this incredibly entertaining TV show- that also has a great public health message- here's the link to the first episode! http://www.youtube.com/watch?v=Jo4l1VJUFkQ

I know I actually watched some episodes in the U-Tena office this summer and would strongly recommend it!

- Maggie

Sunday, March 2, 2014

Some Reflections on Ugandan HIV/AIDS...

Hey guys!

So last week in ghU, Annabel, our lovely coordinator, brought in a TED talk to share (http://www.ted.com/talks/emily_oster_flips_our_thinking_on_aids_in_africa.html). Emily Oster, a UChicago economist, presents data to show that HIV prevalence relies on more than success or failure of prevention campaigns. She focuses solely on Uganda to show the correlation between economic well-being and decreases in HIV prevalence; coffee exports in Uganda increased with decreased HIV levels.

Our discussion last Tuesday brought up some key points. Clearly, as Oster states, high HIV prevalence should not be completely attributed to prevention campaigns themselves. Cultural and economic well-being should be considered as well. However, the example of Uganda may just be a unique case study that does not provide blanket statements on how other countries should handle the HIV problem.

This TED talk was filmed in 2007--therefore some of Oster's data is outdated. According to the AIDS Indicator Survey conducted by Demographic and Health Surveys, rates of HIV infection increased from 6.4% to 7.3% from 2004 to 2011. Though this increase may not be as statistically significant as the drop in rates from the 1990s to the 2000s, this is significant nonetheless. Uganda may not be a success story at all. According to Oster's position, one may blame this on the recession in the latter part of the decade. However, this increase was not significant enough to have it linked to such a large economic problem. Uganda is a large portion Christian, and church-goers have voiced negative opinions on prevention campaigns. Stigma and risky sexual behavior (see AIDS Indicator Survey in 2004 and 2011) has also increased.

Therefore, each case of HIV/AIDS is different, and to solely attribute the prevalence rates to one reason may need some reconsideration. There are many factors, and addressing all the nuances of individual countries might tackle the HIV epidemic more effectively than what Oster has managed to suggest.

Hopefully this triggers some thought on a relevant public health concern.