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

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

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

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.