Global Pulse Blog

Despite being one of the world’s poorest nations, Rwanda has had national health insurance, know as health mutual, for the past 11 years. With two dollar a year premiums, an overwhelming 92 percent of the nation’s 9.7 million people are currently covered. While the coverage is not extravagant, it covers the major causes of illness and death in the region including diarrhea, malaria, pneumonia, malnutrition and infected wounds. Further, this basic health insurance provides access to local health centers which usually have all the medicines on the World Health Organization’s list of essential drugs as well as laboratories providing routine blood and urine analyses, in addition to tuberculosis and malaria tests. This access to health care has had a measurable impact on average life expectancy, which has risen from 48 to 52 years of age since the introduction of health mutual despite a continuing AIDS epidemic.

In order to achieve such coverage for only two dollars a year, the government of Rwanda must receive supplemental help from outside organizations such as Partners in Health, The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US government. Additionally, the plan requires co-pays which can be cost prohibitive for many patients. For example, a Caesarean section requires a five dollar co-pay which many patients cannot afford.

For more on this issue check out the New York Time’s recent article, this info sheet from the World Bank and this article in the bulletin of the World Health Organization.

The New York Times has an excellent short video in its library on child soldiers in Somalia.   Interestingly, the NYT video points out that many of these young soldiers actually work for the Somali government, which receives financial support from the US.  You can read more about child soldiers in this 2009 Global Pulse article by Laura Janneck, Girls and Boys Gone to War: Gender and Mental Health of Child Soldiers.

For a look at the US government’s role in improving global maternal, newborn, and child health check out the Kaiser Family Foundation’s recently released report entitled “The U.S. Government’s Efforts to Address Global Maternal, Newborn, and Child Health: The Global Health Initiative and Beyond.” The report discusses US efforts towards improving child and maternal health including the recently heightened focus placed on these issues by the Administration’s Global Health Initiative. It provides a detailed overview of the U.S. government’s response thus far, looks at U.S. funding trends for maternal and child health, examines international and domestic agencies’ activities related to maternal and child health, explores U.S. participation in international multilateral efforts and identifies key policy issues surrounding the future of the U.S. involvement in such health issues.

A related webcast and fact sheets on maternal and child health and family planning are also available.

The National Library of Medicine currently features an online exhibit called “Against All Odds: Making a Difference in Global Health,” which can be found here: http://apps.nlm.nih.gov/againsttheodds/exhibit/index.cfm The exhibit offers a wide range of historical material on subjects such as HIV/AIDS, Global Development, the Legacy of War, and Community Health. These exhibits display the legacy of global health from around the world, for example charting the discovery of HIV in the lab and following the story of 13 year old hemophiliac Ryan White, or the 1990 Cosmo article that described how heterosexual women were not at risk from HIV, and following up with AIDS education in Thailand. The website offers a wide variety of historical information and is well worth browsing.

http://apps.nlm.nih.gov/againsttheodds/exhibit/index.cfm

In an anti-drug conference held in Moscow recently, Russian President Dmitri Medvedev called for an a more globally unified effort to end the drug trafficking of opium from Afghanistan and the social problems that are a direct result from its trafficking. With over 90% of the world’s opium originating from Afghanistan, President Medvedev believes that that current efforts by international organizations such as the United Nations, NATO and Shanghai Cooperation Organization, are not enough. Opium poppies are the raw material used to make heroin.   According to the U.N. Office on Drugs and Crime, heroin has created a market worth $65 billion and caters to 15 million addicts world-wide.

The effects of Afghanistan’s 375 ton per year opium and heroin export are also felt at home through direct use and passive exposure such as  second-hand and third-hand exposure.  A new study that will be finalized this summer is expected to show that in Afghanistan 1.5 million people out of a total population of 30 million are addicts and that a quarter of those users are thought to be women and children.

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The University of North Carolina at Chapel Hill Program for Ethnicity, Culture, and Health Outcomes (ECHO) 16th Annual Summer Public Health Research Institute and Videoconference on Minority Health is scheduled for Tuesday, June 8, 1:30-4:00pm EDT.  The videoconference entitled “What Will Health Care Reform Mean for Minority Health Disparities?” will feature Mayra Alvarez, M.H.A., Legislative Assistant, U.S. Senator Richard J. Durbin (Illinois); Ralph Forquera, M.P.H., Executive Director, Seattle Indian Health Board and Clinical Assistant Professor with the School of Public Health, Department of Health Sciences at the University of Washington and Tony L. Whitehead, Ph.D., M.S.Hyg., Professor of Medical Anthropology and founding Director, Cultural Systems Analysis Group (CuSAG), Department of Anthropology, University of Maryland. This interactive session will be broadcast with a live audience in the Tate-Turner-Kuralt auditorium at the UNC School of Social Work and can be viewed over the Internet (webcast). Questions will be taken from broadcast participants by email and toll-free telephone.

Check out their website to register and access related materials.

In this week’s issue of NEJM, Dr. Lucas Restrepo from the Barrow Neurological Institute in Phoenix, AZ, articulates concerns over the impact of Arizona’s controversial immigration law, SB 1070, on access to medical care in the state:

It can be argued that health care providers who neglect to report illegal immigrants under their care will violate the law and be considered criminals. The bill provides physicians with no guidance as to what constitutes “reasonable grounds” to suspect that somebody is in the country illegally, leaving the particulars of such scrutiny to anyone’s imagination (although the fact that Arizona shares a border with Mexico rather than a European country suggests that whites will not be “reasonable” suspects).

Dr. Restrepo and colleagues also published a letter in the Arizona Republic earlier:

As physicians, we are concerned about the immigration bill signed by Gov. Jan Brewer. We care for many patients who may appear foreign based on superficial impressions. It is unclear whether health-care professionals like ourselves will infringe on the law if we don’t report patients or their families to the police or immigration authorities based on a vague suspicion of illegality. . . . Senate Bill 1070 tacitly prescribes a break with one of the oldest traditions of medicine: Physicians shall protect patients regardless of nationality or race [emph. added].

In a statement released on May 18, the National Physicians Alliance and CIR/SEIU-Healthcare condemn the law as “an affront to human rights and a devastating step backwards for the health and well being of the entire nation,” and warn that it will “create new obstacles to obtaining needed health care.”

More on Arizona SB 1070:

• Some 50,000 protesters gather in Phoenix on May 29 to demonstrate against the law
• Immigrant groups and workers’ organizations (Hispanic and not) urge a boycott of Arizona
• The Sound Strike, a group of musicians and performers headed by Zach de la Rocha, boycotts AZ

Does Arizona’s law go too far? Do you think it is likely to affect the practice of medicine in the state? Do doctors have a role to play in this debate? Join the discussion by leaving a comment!

As a participant in the May 18th medical student day of action with the New York Coalition Against Torture, I would like to thank our readers for their support — whether in coming to Albany, contacting their NY state representatives, or signing the PHR petition. The event was very successful and inspiring, and  we have received a lot of positive feedback. I look forward to updating the GPJ community on the effort’s progress. In the meantime, I have a more detailed review of the event at the ACLU’s blog:

During the white-coat advocacy day on Tuesday, the medical student group conducted over 25 meetings with lawmakers and staff, met with the bill’s sponsors, and hand-delivered copies of the petition signed by hundreds of their peers and fellow New York State residents. They also conveyed the support of state and national professional organizations for this landmark legislation…(more)

The medical student action event was also mentioned on the Huffington Post and on PHR’s Health Rights Advocate blog. Since then, NYCAT has also released a letter of support for the Gottfried-Duane Bill signed by prominent leaders of medicine in New York state, including medical school deans, hospital CEOs, and Nobel Prize laureates.

Medical students and NYCAT members with Assemblyman Gottfried in Albany

Related reading:

• ACLU’s resources on torture
• The National Religious Campaign Against Torture (NRCAT)
• NRCAT, ACLU, and PHR: Working together against inhumane detention conditions at home?

UPDATE [06-08-2010]: PHR’s newest report, Experiments In Torture, raises concerns that the actions of CIA doctors who participated in waterboarding and other methods amounted to illegal human experimentation. Read coverage of the report in The New York Times and commentary at The Washington Post and The Atlantic.

Looking for ways to get involved closer to home? NRCAT has a list of events across the country for the month of June.

Related: China bans the use of torture in extracting confessions.