In what ways do you think that investments in females can have an impact?

During the week of October 10-14, 2011, the Botswana-UPenn Partnership celebrated its ten year anniversary with events highlighting the past, present and future of the program. Check out the archives to learn more about this program, its history and where it is going!

Check out the webcast from the recent “The Future We Make” meeting on the Bill and Melinda Gates Foundation website for an engaging and insightful discussion of issues related to the Millennium Development Goals such as child mortality rates, birth rates, literacy, HIV/AIDS and more on a global level.

TEDxChange Webcast

Over the course of my involvement in global health during medical school, I began to narrow my interests toward humanitarian assistance and global health delivery in post-conflict settings. Last year, during my fourth year of medical school, I participated in a new course on social medicine being taught in Gulu, northern Uganda, a region that is recently recovering from a 20 year civil conflict. This course, called Beyond the Biological Basis of Disease: The Social and Economic Causation of Illness was very well organized, with didactics on a range of topics from the health consequences of internal displacement, to the portrayal of Africans in the Western media. We also were able to spend time on the wards seeing patients with a range of diseases and syndromes common in the region. The keystone of this course, however, is the international student body. Half of the medical students study at Gulu University and hailed from around Uganda. The other half were American and European. This enabled fantastic discussions with different perspectives on the issues we were studying, and planted the seeds of long-term friendships between colleagues from around the world. I enjoyed my time there so much that I went back to Gulu for another clinical rotation later that semester.

If you have any questions about the course or are interested in applying, please email the course directors at: social.medicine@yahoo.com. Applications are due July 30, 2010.

Many news articles have been written recently on the increase in the prevalence in chronic diseases across the globe.  Rapid economic development is seen as one possible cause of the swift spread of chronic diseases in the developing world.

Let’s take the increase in the prevalence of Diabetes Type II for example. China has nearly 250 million and India has about 50 million people with Diabetes and prediabetes.  It is estimated that by 2030, 366 million or 6% or the world’s population will have Diabetes. This condition has two different modes of contraction, one for the wealthy, mainly being obesity resulting from over-nutrition, and another for the poor via changes in the amount of exercise and diet that once consisted mainly of vegetables but now has switched to foods that are high in sugar, salt and fat.    The change of diet is a direct result of the increase in the numbers of people moving from villages to cities in search of work.  A study found that the influence of urbanization and change of living habits have a greater influence than genetic predisposition for  determining whether a person develops Diabetes Type II, these migrants were twice more likely to have hypertension and to have higher blood sugar than villagers.

While many chronic diseases that  stem from being obese may be preventable, prevention is not as simple as forcing people to increase their daily amount of exercise, quit smoking, and make healthier choices in the types of food that are eaten.  Right now, only 0.9 percent of the $22 billion in international aid for health is allocated to chronic disease.  I think that this figure should not be too shocking to those who read it because the wealthy nations providing the international aid have not been able to find a solution that works for their own citizens so how can they be expected to fund solutions that do not yet exist?

Some scientists are searching for more clues on the link between the effect of genetics and environment on chronic diseases in an effort to gather enough information to improve disease prevention protocols.  Others  would argue that these changes would take more that one’s sense of personal responsibility because sometimes the only accessible foods contain sugar, salt and fat in the right proportions to make them addictive and that switching to a more healthy diet would trigger withdrawal symptoms that would deter the individual from making these changes permanent.  This makes me wonder whether if New York State’s attempt to tax its residents in an effort to promote healthier alternative would be successful.

Here’s some food for thought:

After all the research has been done, will these addictive foods would still be readily available or would they simply coexist side by side with the healthier options.  Is it possible for this coexistence to exist?

Join Commit in September @ commitinseptember.com

This is my first blog post on the Global Pulse Blog.  My name is Sam Vaghar and I manage the Millennium Campus Network (www.mcnpartners.org), a national non-profit network of university student organizations working to reduce extreme poverty and achieve the UN Millennium Development Goals.  The network spans 17 campuses across four cities and counts Dr. Paul Farmer, Dr. Jeffrey Sachs, and musician John Legend among its Board of Advisors.

I’ll save an explanation of my passion for student activism for another time.

Right now I want to invite you to add your name at www.commitinseptember.com, a new national petition to President Obama and Congress urging action on the UN Millennium Development Goals (MDGs).  We have put in specific asks on global education, global health, and long-term development in Haiti.  Our goal is to generate 25,000 signatures by the end of July and present them to White House and Congressional staff ahead of the UN MDGs Summit this September.

Why this matters: This generation is passionate about global health and development.  When you walk onto most college campuses, you will find a student organization (or five!) committed to raising awareness, fundraising, or engaging in service work overseas in solidarity with the world’s poorest communities.  But our leaders in Washington aren’t always aware of our generation’s passion.  Commit in September is one powerful way for all of us to show them what we stand for. We are calling on students to partner with us this year, signing the national petition, writing a letter to the editor, becoming a Campaign Ambassador (visit the site for info.), and joining with us, the United Nations Foundation, 1,000 peers and leading advocates at our conference this September at Columbia University on the eve of the UN MDGs Summit.

Together, our generation can build a grassroots movement for global development.  But we’ve got to get personal, reach out across our networks, and use all means available to create both social and political change.  I know many members of AMSA are leading the charge for global health equity, and I hope you will partner with us in this effort.  Please leave a comment so I can connect with you in the days and weeks ahead!

PS- It is a real pleasure to be joining this blog community.  I have been impressed by AMSA’s commitment, particularly in the advocacy arena, and the opportunity to connect with all of you means so much to me.  Hana, thanks for the invite!

This is the second in a series of posts for the American Public Health Association’s National Public Health Week.

Today, Wednesday April 7th marks World Health Day 2010. This year, the UN Secretary-General’s Message for World Health Day centers on the theme of urbanization and health with the campaign “1000 cities – 1000 lives.” The theme of Urban Health was chosen in the setting of a world in which the majority of the population is living in urban versus rural areas for the first time in history. At the same time, poverty is also shifting from sparsely-populated rural areas to urban areas especially in developing countries.

Disparities in people’s income, opportunities, living conditions and access to services along with numerous threats to public health including inadequate sanitation and refuse collection; industrial and traffic pollution; infectious diseases that thrive on squalor and crowded conditions; high rates of tobacco use; physical inactivity; unhealthy diets; crime, violence and the use of harmful substances are complex issues depending not only on public health measures but also social policy and governmental structures.

• Jennifer’s introduction: Global Health Ethics at Home and Abroad
• The WHO Staging System for HIV/AIDS by Jennifer Weinberg and Carrie Kovarik
• The Physician-Researcher’s Dilemma by Hana Akselrod
• Global Health Ethics and Professionalism Education at Medical Schools by Sujal Parikh

This New Year as you set down and make resolutions, we at AMSA urge you to make another one. Ghandi once said “Be the change you want to see in the world.” Imagine how much of a difference we could make in our practices, medical schools and in our communities if each of us 30,000 AMSA members made this resolution? Apply for AMSA’s inaugural International Women’s Leadership Institute and BE THE CHANGE.

Read on for details.

2010 does not mark a new beginning for many women and girls in this world that are suffering from gender-based violence and oppression:

1. For Mahabouba in Ethiopia it may be another year that she must live with the obstetric fistula she developed after 3 days of labor. Her 13 year old pelvis was far too narrow to pass the baby’s head and without emergency obstetric care her baby died and she was left with a hole between her rectum, bladder and vagina that constantly leaks feces and urine.
2. For Neth in Cambodia this may be the year that this 10 year old is forced into child prostitution. Her poor family can not afford to send her to school and the recent economic downturn they had no other options but to sell her to become a servant in the city. They thought she was just being sold to a wealthy family that could provide for her but instead she was sold into child prostitution. According to UNICEF, 2 million children are victims of child sex workers and 1.2 million children are victims of child sex trafficking, most of them are girls.
3. Sia arrived at the maternity hospital I interned in with severe hemorrhaging. She was bleeding as a complication of unsafe abortion. According to an article in the Lancet, 97% of all unsafe abortion occur in low-income nations yielding 68,000 deaths and millions more injured.
4. This may be the year that Dina in the Congo continues to waste away from her traumatic fistula. Dina was raped as another casualty for the long conflict in the Congo.
5. Prudence in Cameron died in childbirth last year. According to Word Health Organization data 1/47, 600 women have a lifetime risk of dying in childbirth compared to Niger where women have a 1/7 chance of death.
6. Edna Adan was a victim of FGM. According to the UNFPA, 3 million girls and young women undergo FGM each year.
7. Ethel was a Sioux women in South Dakoata who was murdered by her husband. According to the United States Department of Health and Human Services, rates of sexual and domestic violence are highest in Native American women versus any other group. More over Native women are have a 1 in 3 chance of being sexually assaulted or raped in their lifetime which is more than 2 times higher than that of non-Native women.

All these stories are true. Most of them came from the Nicholas Kristof and Sheryl WuDunn book Half the Sky about international women’s empowerment, the story about Ethel came from Marianne Perl (A Mighty Heart) and the story of Sia came from my own personal experience in Liberia (name changed). Are you willing to step in and say “NO” to this situation and make a difference in the lives of these women and girls?

JOIN US ON JAN 30 – FEB 1ST AS WE HOST AMSA’S FIRST INTERNATIONAL WOMEN’S HEALTH LEADERSHIP INSTITUTE. Training will be provided on clinical skills, advocacy and on the pressing topics of international health. We will also provide you with resources for global health mentoring, electives and how to hold great, interactive service or awareness building programs at your school. Let us use the privilege and power that we have in getting an education and having a response government to advocate on behalf of these women. They could be our patients one day.

The application deadline has been extended to January 9th. Please apply early so that you can write your Dean of Student Affairs to help pay for the $150 program fee. This institute is offered to ALL AMSA members. Please visit our website to enter your application! We will get back with you in 5 business days. We look forward to hearing from you!

Thanks,
Vanessa

The role of medical students in limiting the spread of antimicrobial resistance

Adam Castaño‡, Sujal Parikh‡ and Eunice Yu, medical students at the University of Michigan Medical School, Ann Arbor, Michigan, USA (‡ These authors contributed equally to this post). Contact Adam Castano on acastano@umich.edu.

Nowhere in the world is free from the spread of drug-resistant bacteria, parasites and viruses.  The World Health Organization (WHO) Global Alliance for Patient Safety has recognized the dual problems posed by the increasing incidence of drug-resistant bacteria and the decline in antibiotic innovation.  For the past two years, a working group of policy makers, scientists, epidemiologists, and economists have assembled at several international meetings to outline an international strategy to address antimicrobial resistance (1). Policy recommendations, to be launched in 2010, will establish new roles for governments, public health departments, industry, and physicians as primary stakeholders in AMR prevention and alleviation.  Physicians prescribe antimicrobials, contribute to the spread of pathogens (particularly hospital-acquired infections), educate patients about appropriate use of antimicrobials, perform research, and set research agendas.  Medical students are being trained in an era where the toll of antimicrobial resistant infections is evident on a daily basis.  As future physicians, they have the potential to help to address this problem.  Here, we describe new leadership roles for medical students within their medical schools, hospitals, communities, states, and countries to alleviate the problem of AMR.

The role of medical students in medical schools

Medical schools, in particular the preclinical years, offer time for extracurricular activities that could be devoted to student forums dedicated to educating peers and discussing antimicrobial resistance with faculty members from a wide variety of disciplines.  Medical students can form a student group, such as a chapter within their medical school of Antibiotic Defense , an organization of doctors, scientists, and professionals dedicated to conserving the availability and efficacy of antibiotics.  Initial meetings dedicated to discussing fact sheets and publications from experts and opinion leaders would build the knowledge base needed to understand core issues in the field.  Initiatives at the World Health Organization (2), ReAct: Action Antibiotic Resistance,(3) the Alliance for the Prudent Use of Antimicrobials,(4) and the Global Health Education Consortium (GHEC) contain useful information.  Antibiotic Defense, in conjunction with GHEC, has published an open-access online module that medical students can utilize to educate themselves about the global nature of antimicrobial resistance (5).

Once students have attained a baseline understanding of the field at the local, community, national and international level, they can help educate fellow students in health professional schools in their region.  GHEC accepts modules written by medical students designed to educate peers about issues pertaining to global health.  Medical students can also work with faculty in their medical school to identify and fix gaps in their curriculum.  Medical students should be informed of relevant international, national, and local policies affecting antimicrobial resistance, in addition to epidemiology, pathophysiology, and treatment.  It should be emphasized to medical students that they play a role in containing AMR (figure).

The role of medical students in hospitals

Medical students in hospitals – as healthcare providers and as inadvertent contributors to the spread of pathogens – play an important role in the containment of AMR.  Hospital-specific resistance trends and drug sensitivities for specific organisms can be learned from antimicrobial stewardship committee lectures and in-house publications.  Familiarity with such resources can inform accurate antimicrobial choices.  Equally important are drug resistance and sensitivity data for individual patients with culture-positive infections.  Medical students can find this data by calling the microbiology lab or contacting outside hospitals for transferred patients.  This up-to-date culture information can influence medical decision-making and ensure rational antimicrobial use.  Finally, medical students can contribute to patient safety guidelines and quality improvement efforts in addition to role-modeling infection control techniques for their patients, residents, and attendings (senior physicians).

The role of medical students in the community

In addition to promoting change in their schools and hospitals, medical students can play a key role as educators and advocates in their local communities.  The first step to fulfilling these functions is learning local patterns of AMR using resources outlined above.    Students can then educate their community by writing opinion pieces and informational articles that discuss the growing problem of antimicrobial resistance and highlight its local manifestations.  Articles specifically outlining steps for community members to limit the spread of resistance will be most applicable to community audiences.  For example, methods highlighted for a community should relate to its unique circumstances in addition to reiterating known containment methods, such as not sharing antibiotics or thoroughly cleaning shared items like gym equipment (6). Students can also determine the extent to which local public health and sanitation regulations limit the spread of antimicrobial resistance and lobby policymakers to change those statutes to protect public health.

As students engage in these processes, they will undoubtedly encounter topics where no reliable information is available.  In these cases, joining a team that researches the biological, clinical, epidemiological, social, or economic aspects of antimicrobial resistance can generate the knowledge required to engage the activities outlined throughout this article.

The role of medical students in their state and country

Medical students can also influence discourse and policy at the provincial, state and national level.  For example, In the United States, state health departments and the National Institutes of Health (NIH) offer opportunities for medical students to work to address the problem of AMR.  Internships at state health departments could be arranged in order to learn epidemiology and public health initiatives involved in AMR surveillance and containment.  At the national level, the NIH offers prestigious year-long fellowships in basic, clinical, and translational research.  Such a program can be pursued to study the latest issues and solutions in AMR (7). Medical students interested in the politics and policies related to AMR can pursue similar internships in the office of a United States Congressperson.  In addition, the collective voice of medical students can be harnessed through organizations such as the American Medical Student Association (AMSA) or American Medical Association (AMA) in support of efforts to strengthen research and development in this sector.  Similar efforts can be pursued in other countries by working with state and provincial health departments, national medical organizations, and the International Federation of Medical Student Associations.  The World Health Organization offers additional opportunities for medical student contributions both at its Switzerland headquarters and at regional offices in the United States, Denmark, the Philippines, India, the Congo, and Egypt.

A fundamental shift is needed in our attitudes to antimicrobials.  What if antimicrobial effectiveness – not just antimicrobials themselves – was viewed as a global public good, much like clean water and forests?  Antimicrobial effectiveness is a depletable resource, accessible to all but limited in quantity.  Every time someone uses an antimicrobial, the effectiveness of that drug is slightly “used up” or “lost.” This continual depletion of antimicrobial effectiveness diminishes our ability to combat life-threatening infections and practice modern medicine.  The spread of resistance by antimicrobial overuse is therefore similar to the problems we face with regard to other resources, such as carbon emission, overfishing, and the exhaustion of oil reserves.   If we view antimicrobials as a global public good, a powerful agent whose effectiveness belongs not to an individual person or institution, but to society as a whole, then innovative efforts and policies become applicable.  These realities must of course be balanced with the benefit of antibiotic use to the individual patient.

Competing interests statement: The authors are members of Antibiotic Defense, an organization founded by medical students at the University of Michigan that aims to preserve antibiotic effectiveness.

Figure : The role of medical students in limiting the spread of antimicrobial resistance

Figure : The role of medical students in limiting the spread of antimicrobial resistance

[2] Cure With Care: Understanding Antibiotic Resistance. ReAct: Action on Antibiotic Resistance: Available: http://soapimg.icecube.snowfall.se/stopresistance/cure%20with%20care[1].pdf. Accessed: 28 October 2009.

[3] Alliance for the Prudent Use of Antibiotics.  Research and Surveillance Initiatives: Available: http://www.tufts.edu/med/apua/Research/research.html .  Accessed 28 October 2009.

[4] Castaño A, Kober M, Jain A, Prensner JR, Haack S, Parikh S (2008)  “Antibiotic Resistance: Challenges and Solutions.” Global Health Education Consortium.  Available: www.globalhealthedu.org.  Accessed: 28 October 2009.

[5] Centers for Disease Control, Interagency Task Force on Antimicrobial Resistance and a Public Health Action Plan to Combat Antimicrobial Resistance. National Center for Preparedness, Detection, and Control of Infectious Diseases/Division of Healthcare Quality Promotion (2006) Available: http://www.cdc.gov/drugresistance/actionplan/index.htm.  Accessed 28 October 2009.

[6] Howard Hughes Medical Institute, Research Scholars Program. National Institutes of Health. Available: http://www.hhmi.org/cloister/.  Accessed 28 October 2009.

[7] Laxminarayan, R and Brown GM (2000) Economics of Antibiotic Resistance: A Theory of Optimal Use. Resources for the Future.  Discussion Paper 00-36.  Available: http://www.rff.org/rff/Documents/RFF-DP-00-36.pdf.  Accessed 28 October 2009.

Steven Kanter presents the series by echoing the World Health Organization’s definition of health as more than the absence of disease and noting that “peace is not simply the absence of war.”

Ali Khan and colleagues point out that “Violence, manifest in myriad forms, exists in our own backyards and clinics. Just as international conflict zones provide an entry point for physicians to rebuild health systems and societies alike, so too do low-income urban neighborhoods, the halls of Congress, and the steps of the United Nations.”

Barry Levy and Victor Sidel, veterans of organizing physicians in support of peace through the group International Physicians for the Prevention of Nuclear War, argue that the medical establishment should begin building peace at home by “(1) fostering cooperation in relationships among themselves and others, (2) preventing conflict by promoting transparency and ethical behavior, and (3) promoting mediation and arbitration to resolve conflicts before they result in serious adverse consequences.” These suggestions may seem far removed from what most of us think as preventing violence, but as peace scholars have pointed out for decades, efforts to construct and sustain peace must begin long before we reach the cultural and societal breaking point of war.

In a another essay, Hagopian and colleagues call on health and medical associations to “change the dominant framework so that failing to act against war would be the more peculiar act of health professionals, rather than the opposite.”

My favorite quote, however, is in Seiji Yamada’s essay, “Academic Medicine Should Start at Home”, in which he exhorts American academics to quantify and expose the morbidity and mortality caused by military, diplomatic, and economic actions of our own government. Yamada writes about some students, “At the mention of history or political economy, our learners groan. We are not interested in politics, they say. But unreflective learners repeat the blather that they are fed by the corporate media. Their interest in politics extends only as far as protecting physician reimbursements. But academic medicine has the responsibility to produce physicians who advocate for the cause of health – in particular for the health of those whose voices are otherwise unheard, whose deaths are otherwise uncounted, unmourned, unopposed, and unorganized against.”

As health professionals, it is our responsibility to raise our voices, to count and bear witness to the deaths and injuries, to mourn with our patients and their loved ones, to oppose injustice, and ultimately, to organize a system that better builds peace.

Dear AMSA,

This last March, a few of our Representatives and Senators stood up to decrease the educational debt burden for future physicians by introducing a bill that would reinstate a pathway to defer loan repayment until after residency for the majority of medical residents.

This May, Congress is writing a huge piece of legislation that will reform our health care system – and impact our chosen career field for decades to come.

Your Senators and Representative need to hear from you that the cost of medical education must be addressed in this legislation.

Click here to send an email to your Congressperson.

Sound pretty good to be able to defer your loans during residency if you’re having trouble paying them? Well, don’t get used to it – as your school’s financial offices should have told you, last summer, the passage of the College Cost Reduction Act terminated this pathway for loan deferment.

As AMSA members, we have a responsibility to do everything we can to make medicine a feasible field for students from all walks of life – we need to remove the burden of intimidating student debt from the equation. Congress needs to hear from you that reinstating the economic hardship deferral pathway is a good thing, and that including comprehensive measures to decrease the cost of medical education in this month’s health reform legislation will be even better.

Thanks – let’s see this through!

– Mary Carol

Click here to send an email to your Congressperson.

Do your part to include medical school debt in the upcoming health care reform.