Global Pulse Blog

As promised, today we bring you another commentary inspired by Secretary Clinton’s recent speech calling for an AIDS free generation by Matthew Basilico, Nworah Ayogu, and Arjun Suri of Harvard Medical School.

As students immersed in the study of biological sciences, and as future physicians anxious to provide care and improve lives, we can be frustrated when public health policy seems based on interests neither scientific nor beneficent. United States programs that fight global AIDS have accomplished tremendous good over the past eight years; however, recent stewardship by President Obama has been disappointing both scientifically and morally. Last fall, many of us at Harvard Medical School protested President Obama because we believed his failure to keep his promises to scale-up the fight against HIV/AIDS was proof that he was ignoring the science and neglecting his ethical obligation to save millions of lives around the world. However, on Tuesday, Secretary of State Hillary Clinton delivered an inspiring address that is at once evidence-based and morally laudable.

When we began our protests last fall, there was a growing body of research indicating that treating HIV also prevents its spread. Evidence from a localized study South Africa indicated that when people with HIV received antiretroviral treatment (ART), their partners were 92% less likely to contract the virus. [1] Initial modeling used this information to theorize that, with universal access to treatment, infections could plummet within 10 years. [2] With this growing evidence (as well as other studies), the phrase “treatment as prevention”—long used by health professionals working at the front lines of AIDS care—resonated in scientific communities. Not only does treatment save lives, but these recent studies show that treatment could dramatically reduce new infections, slowing or even halting the epidemic in the future. It was not until this year, however, that this could be said with such certainty. A multi-site, large-N, randomized control trial showed that ART reduces new infections by 96%. [3]

We have also been encouraged by the growing literature showing that investments in HIV treatment programs improve health systems and eases delivery of other life-saving interventions.[4,5]  Dr. Paul Farmer, co-founder of Partners In Health, described HIV treatment as the “battle horse” to drive the necessary expansion in infrastructure and political will for addressing other global health priorities.

The evidence is clear: now, more than ever, we know that investing in AIDS treatment will save millions of lives and reduce new infections. Yet in the first years of his administration, President Obama fell dreadfully short on campaign promises to significantly improve resources for AIDS funding.  Many fellow classmates from Harvard Medical School, as well as from colleges and medical schools across the east coast, joined in protests encouraging the administration to uphold its promises.  It is impossible to forget the numbers—a year of AIDS treatment costs less than $100, and the treatment program makes up far less than 0.2% of the federal budget.  Yet while hundreds of billions of dollars went to bank bailouts, no new money was found for the meager $1 billion dollar annual rise that was promised during the election cycle.

Secretary Clinton’s speech on November 8^th, therefore, was encouraging.  She declared that for the first time, it will be United States government policy to create “an AIDS-free generation.”  She emphasized prioritizing high impact interventions—prevention of mother-to-child transmission, circumcision, and treatment.  And she lauded the vital role of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has been an innovative and transparent engine for delivering resources where they are needed most.  Secretary Clinton’s speech had much of what is needed, except for the numbers.

To transform the Secretary’s vision into a reality, we will need bold treatment targets and solid commitments to increase funding.  Six million patients on treatment by the end of 2013 would be an appropriate goal for the United States government, which is on track to have four million on treatment by the end of this year.  Congress and the administration have responsibility for the 2012 budget, while the Super Committee debates 2013 and beyond.  We eagerly await President Obama’s address on World AIDS Day (December 1^st).  Lawmakers have the opportunity to transform one of the greatest human scourges of our generation, or to be held accountable for inaction by patients, activists and history books.  As medical students, we have the ability to hold lawmakers accountable by calling and writing our elected officials, and communicating publically the cost of inaction.

-Matthew Basilico, Nworah Ayogu, Arjun Suri; Harvard Medical School

References

1. Deborah Donnell, Jared M Baeten, James Kiarie, Katherine K Thomas, Wendy Stevens, Craig R Cohen, James McIntyre, Jairam R Lingappa, Connie Celum, “Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis,” The Lancet 2010;375:2092-2098.

2. Reuben Granich, Siobhan Crowley, Marco Vitoria, Ying-Ru Lo, Yves Souteyrand, Christopher Dye, Charlie Gilks, Teguest Guerma, Kevin M De Cock, and Brian Williams “Highly active antiretroviral treatment for the prevention of HIV transmission,” Journal of International AIDS Society 2010; 13:1

3. Cohen MS, Chen YQ, McCauley M, et al. “Prevention of HIV-1 infection with early antiretroviral therapy.” New England Journal of Medicine 2011;365:493-505.

4. David Walton, Paul Farmer, Wesler Lambert, F. Léandre, Serena Koenig and Joia Mukherjee, “Integrated HIV Prevention and Care Strengthens Primary Health Care: Lessons from Rural Haiti,” Journal of Public Health Policy 2004:137-158.

5. World Health Organization, “An Assessment of Interactions Between Global Health Initiatives and Country Health Systems,” Lancet 2009;393:2137-2169.

Today’s guest blog post by Anand Reddi was originally published yesterday in The Huffington Post. Anand Reddi was a Fulbright Scholar in 2005, assisting the Sinikithemba HIV/AIDS clinic at McCord Hospital in Durban, South Africa. Currently, Mr. Reddi is a medical student at the University of Colorado, School of Medicine. Here, he reflects on Secretary Clinton’s speech earlier this week and the importance and potential of a Global Health Service Corp.

Stay tuned to Global Pulse Blog for more views on this monumental speech and its implications.

Yesterday, Secretary of State Hillary Rodham Clinton declared the U.S. government’s intent to create an “AIDS-free generation.” Secretary Clinton outlined a bold plan to reduce new HIV-infections, globally, including the eradication of pediatric HIV by 2015. This new strategy builds upon the success of the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. program that addresses HIV/AIDS in resource-limited settings.

A notable feature of Secretary Clinton’s “AIDS-free generation” initiative is to strengthen healthcare systems in sub-Saharan Africa. Clinton stated:

“We know we can’t create an AIDS-free generation by dictating solutions from Washington. Our in-country partners — including governments, NGOs, and faith-based organizations — need to own and lead their nation’s response. So we are working with ministries of health and local organizations to strengthen their health systems so they can take on an even broader range of health problems.”

Strengthening African healthcare systems is a view echoed by many eminent voices in the global health community. Last year, the Institute of Medicine (IOM) of the National Academy of Sciences authored a report entitled: “Preparing for the Future of HIV/AIDS in Africa: A Shared Responsibility.” The IOM report recommended the urgent need to increase African healthcare workforce capacity to address the HIV epidemic.

I offer Secretary Clinton a solution to assist African healthcare workforces and ensure the success of the “AIDS-free generation” initiative. Last year, in an editorial in The New England Journal of Medicine, Vanessa Kerry, Sara Auld, and Paul Farmer reintroduced the idea of enacting a Global Health Service Corp (GHSC). The GHSC, compromised of U.S. healthcare professionals, would provide medical education and technical assistance to enhance the healthcare workforces in low-income countries. The GHSC’s goal would “go beyond that of filling a human resource void to focus on infrastructure development, knowledge transfer, and capacity building.” The GHSC could also offer partial student loan forgiveness for U.S. corps members who engage in service abroad for a specified time period similar to the loan forgiveness offered by the National Health Service Corp.

To address the African healthcare workforce shortage, I encourage Secretary Clinton to adopt the principles of the GHSC. The success of the “AIDS-free generation” initiative depends on the availability of skilled healthcare workers in African resource limited settings. Additionally, the eventual transition from a U.S. to African led HIV/AIDS response requires the U.S. to teach and train healthcare personnel in recipient countries through collaborative partnerships that eventually lead to African ownership of their domestic healthcare needs.

Some may argue that enacting the GHSC, especially in the era of U.S. government austerity measures, is not prudent. However, the funding for the GHSC already exists. In addition to HIV/AIDS prevention and treatment, PEPFAR’s congressional mandate requires the program to “strengthen partner government [healthcare] capacity to lead the response to this epidemic and other health demands.” Last year alone, PEPFAR committed over $734 million in healthcare capacity building initiatives.

Global health is the moral litmus test of our time. As Secretary Clinton asserted: “An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future.” The U.S. should enact the GHSC to ensure the success and sustainability of the “AIDS-free generation” initiative.

-Anand Reddi, The Huffington Post

If you are interested in supporting the Global Health Service Corp please sign the petition to show your support. http://www.globalhealthservicecorps.org/index.php/petition/

Additionally, the Medical Student Section of the American Medical Association is considering a resolution endorsing the GHSC at its 2011 Interim Meeting in New Orleans, Louisiana.

Check out our next guest blog series from The Global Health Technologies Coalition. GHTC’s Kim Lufkin traveled to Kenya recently to visit global health research projects going on there and view the impact of these projects on the Kenyan people. Below are some of her reflections, originally published on GHTC’s blog.

Some of the most incredible health research is taking place in Kenya right now. Because of this work, we are on the cusp of the most exciting new tools in global public health in recent years—the first ever malaria vaccine, gels women can use to protect themselves from HIV, new drugs for neglected diseases that affect the poorest of the poor. Kenya is also rolling out an array of lifesaving new health products that research has already made available, like HIV/AIDS drugs, vaccines to protect children from pneumonia, and insecticide-treated wallpaper that prevents malaria inside people’s homes.

During the GHTC’s recent trip to Kenya, I was fortunate to visit several of these global health research projects, most of them run by our dedicated coalition members like the Drugs for Neglected Diseases initiative (DNDi), PATH, the International Partnership for Microbicides (IPM), Aeras, and the International AIDS Vaccine Initiative (IAVI).

We also saw firsthand how the US is making a huge impact in health research in the country, through the work of agencies like the US Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), and the Department of Defense (DoD).

3935 – Siaya, Kenya – Kayla Laserson is the Director of the KEMRI/CDC Field Research Station . Photo: Evelyn Hockstain/PATH.

Although we visited a range of projects, I was left with the lasting impression that much of this research is so close to producing new health tools that can lead to amazing innovations in public health. “We are on the verge of breakthroughs in malaria and in TB and in other diseases,” Kayla Laserson, director of the CDC/KEMRI Field Research Station in Kisian, said. “What we really need is continued support so we can get the job done, we can finish it, we can show the impact, we can save hundreds of thousands of lives here and globally.”

We also saw how past commitments to research are already saving lives. For example, research that led to the development of antiretroviral drugs is one of global public health’s biggest success stories.  Rister Kageha, a woman living with HIV close to the town of Kakamega, told us how these drugs had not only saved her life, but also prevented her daughter Sylvia from contracting HIV. Because of these drugs, “I expect to live long,” Rister said, adding that she also hopes for a long life for Sylvia due to the drugs that kept her daughter HIV-negative.

Rister Kageha says antiretroviral drugs saved her life. Photo: Evelyn Hockstein/PATH.

And while past research has led to some health tools already in use, and current research is producing breakthroughs we could see in next five years, other innovations aren’t as far along down the research pipeline. This is why continued US support is critical to sustain the momentum around these new tools, from discovery to delivery. US support for microbicides, for example, has been vital to recent research successes, and must continue while the research continues over the next several years.

A microbicide “is one of the tools that gives us the opportunity that we could actually end the epidemic,” Elizabeth Bukusi, deputy director at the Kenya Medical Research Institute (KEMRI) who works with IPM, said. “I think we can move towards a complete AIDS-free generation that will completely stop the epidemic in its track using microbicides as part of the armament.” She added that the “US has been a critical partner in providing catalystic funds and also in funding a large number of the trials that have looked at microbicides. So US funding is absolutely critical to moving this agenda forward.”

The same can be said of US support for all global health tools, not just microbicides. Fortunately, if Kenya is any indication, the US has a long history of supporting research for health products like vaccines and drugs.This long history should not end anytime soon. It’s imperative that this historical leadership continues, so the groundbreaking research the GHTC saw in Kenya can produce the next generation of lifesaving health tools.

-Kim Lufkin, GHTC

Continuing our series of guest blog postings from Partners in Health, this piece originally published on the PIH blog by Jenna LeMieux gives insight into the experiences behind the Program Management Guide introduced in the first posting. This former project manager in Malawi experiences are documented in the new guide, and here she shares more about the connections and her work.

By Jenna LeMieux, PIH Director of Programs

	Construction on Neno District Hospital in 2007.
	Construction of staff housing in Neno, Malawi.

When I began working for Partners In Health in January of 2007 as a program manager, I thought I had a good sense of the scope and responsibilities of the position I had accepted. I was to help launch the new PIH-supported site in Malawi, Abwenzi Pa Za Umoyo (APZU). I spent about two months in Boston before I moved to Malawi, and during that time was able to make valuable connections to colleagues with expertise in finance, procurement, and human resources. Little did I know how valuable those connections would become.

Looking back now, I am amazed by the complexity and volume of work that awaited our team. I had no idea how varied and lengthy my “to-do” list would be. Partnering with the Ministry of Health, we wanted to immediately begin supporting and improving the care available to patients in Neno District. We set to work on substantial renovations at several health centers, with the goal of providing dignified and well-equipped settings in which patients could receive care. We began planning for the construction of a brand new, two-story district hospital. And we began constructing 26 housing units for the Ministry of Health staff and ourselves.

We hired cleaners, guards, nurses, cooks, and administrative staff. We worked with Village Headmen to identify community health workers. We partnered with local community-based organizations to understand grassroots activities already taking place to educate people about HIV transmission and prevention, and to understand how we could support those activities. We established relationships with hospital equipment and supplies vendors in the nearest large city, and began to renovate a large building that would serve as a warehouse.

Explore the Guide

Our long list of goals was informed and shaped by my colleagues at PIH who had engaged in similar start-up activities in Rwanda and Lesotho, among other places. Their collective experience and wisdom guided our work, and helped us prioritize among a dozen urgent and competing demands. When I first began working in Neno, I was fortunate to have access to individuals who could answer the dozens of questions I had on a daily basis. Their advice and counsel was invaluable, and the Program Management Guide represents our effort to share that collective experience with others.

My work in Neno was supported by a robust network of experienced professionals willing to offer their time and expertise to help guide our work. Those same individuals have pored over this guide, adding the content and stories, sharing their knowledge and advice, which is rooted deeply in PIH philosophy and based on decades of field experience. We hope it will serve as a practical and useful tool for program managers, and for others engaged in this work around the globe.

Check out PIH’s new Program Managment Guide.

Malawi’s Neno District Hospital today.

This blog post kicks off a series of Guest Blogs from Partners in Health. This first posting, originally published on the PIH blog, introduces PIH’s “How-To” Guide for Global Health Implementers. Stayed tuned for more!

ORIGINALLY PUBLISHED ON PIH BLOG:

We are thrilled to release the Partners In Health Program Management Guide.

Based on PIH’s experiences, the Program Management Guide offers an approach to starting, revamping, or expanding a program in the field. Its aim is to help program managers solve challenges commonly faced in resource-poor settings. Our goal in releasing the guide is to share our approach, solicit feedback, and spark conversations that will help all of us improve global health delivery.

Please take a moment to read the “Note to the Reader” below or jump straight to the guide overview:

http://www.pih.org/pmg

Explore the Guide

NOTE TO THE READER

As PIH enters the 25th year of providing a preferential option for the poor in health care, we reflect on how much we have evolved since the organization’s inception. What started as a small, grassroots health project in a community of internally displaced people in Cange, Haiti, has grown to an effort that, as of 2011, serves 2.4 million patients in more than 76 health facilities in 12 countries, and compensates close to 15,000 staff.

PIH has progressively built on its approach to ensure health as a human right through community engagement and strengthening of the public sector. Poor communities all over the world (in rich and poor countries) cope with a high disease burden and gross inequities in the social determinants of disease, while being strapped for infrastructure and health workers.

PIH’s track record in building systems that address these complex synergies has gained traction with communities, grassroots nongovernmental organizations, and governments. Given PIH’s experience, we have been increasingly asked to articulate the architecture of this work.

A practical “how-to” manual

To this end, we are pleased and proud to share this guide, a collective effort of PIH leadership from around the world to capture the elements of how our work is designed, implemented, and evaluated.

Meant as a practical “how-to” manual, there’s a storyline that’s familiar even though the settings—and people—change. The opening scene: a team organizes with a local community and public sector workersto improve health services in a catchment area that has been chronically understaffed, under-equipped, under-trained, and under-resourced for years.

The team works around the clock to identify and treat patients while also trying to get medicines and supplies through customs, manage finances, secure clean water for the site, set up power and an Internet connection, hire clinic-based and community staff, locate an ambulance and driver, identify potential partners—and the list goes on. A program manager’s extensive “to-do” list inevitably gets longer as more challenges arise.

Sharing what worked for us, not a set of answers

Partners In Health is founded and named on the belief that health inequalities are best addressed through a movement for social justice involving a multitude of partners working on behalf of the destitute sick. Every day, we are inspired by the work of other like-minded organizations, and buoyed by the sharing of knowledge within this community.

We’re acutely aware and grateful that we’re not alone in this work. We wrote this guide not to provide set answers, but rather to share what we’ve done and how we’ve done it over the past 25 years. To get this right, we undertook extensive background research, sifted through stacks of documents, carried out over a hundred interviews with staff in Boston and at PIH-supported sites, and had long discussions about how we tackled many difficult situations.

The beginning of a conversation

Documenting PIH’s experience in implementing programs with as much internal candor as possible is one way to preserve institutional memory, but it’s more than simply an introspective exercise. We believe that detailed analysis and self-reflection is necessary for us to continue to improve the quality of our programs and services.

In this way, the guide serves as a roadmap for the organization as we continue to strengthen services in the countries where we work. But we also wrote the guide for those who are beginning health programs in resource-poor settings: those who seek ideas and suggestions on how to manage the myriad challenges in this work.

Above all, we see this guide as the beginning of a conversation with all those whose work champions the needs of the world’s poor. We look forward to refining all of our best practices as other practitioners—seasoned in this struggle or new to it—engage in a pragmatic discussion.

The importance of listening to the poor

Staying true to our mission of providing health care in solidarity with the poor is a difficult, ongoing process. It demands taking a hard look at the challenges that we’ve confronted, mistakes that we’ve made, and hard lessons we’ve learned from Haiti to Peru, Boston, Rwanda, Malawi, and the mountains of Lesotho. During the process, we’ve realized the importance of the many, often mundane, details on which the success of our work depends.

If there is a common thread that runs through all the units of this guide, it’s the importance of listening to the poor, and with them, designing programs and services that address their needs.

Ted Constan
Chief Operating Officer, Partners In Health

Joia Mukherjee
Chief Medical Officer, Partners In Health

Access, Cost, Quality

In a country like Nicaragua that is the 2^nd poorest country in the western hemisphere, poverty impacts every aspect of life especially health care.  According to the U.S. Library of Congress,  Nicaragua has a three tiered health care system where; 1) The upper 1-2% of the population receive care in private clinics and private hospitals and often go abroad for specialized care. 2) About 8% of the population has government health insurance. This includes mostly government workers, military personnel, and part of middle class who receive the insurance through their employer. 3) The remaining 90% of the population relies on the free public hospitals, health centers, and health posts. Now, this doesn’t sound so bad until you realize that the 8% of the population that has government insurance receives 40-50% of the nation’s health care budget and the public system that serves 90% of Nicaraguans, though it does provide low-cost/free care, lacks quality and access.

For example, I have been working in Nicaragua where I have had the blessing of knowing a 16 year old young woman with Ewing’s Sarcoma. One day when going to visit her in the hospital, I encountered several realities of the Nicaraguan public hospitals. The following is a personal account embedded with the perceptions of the Nicaraguan people that I spoke with about the situation and realities faced at every public hospital/health center/health post in the country.

When I arrived at the hospital her mother told me that before giving this young woman her third dose of chemo for this cycle, she became very pale and was gasping for breath. They debated intubation but instead gave her some medicine and oxygen. She was now left with her mother in a sparse ill-equipped hospital room. The young woman still had a 103 degree fever, was vomiting and was very pale.

1. The room has six patients in metal beds some with sheets, run down equipment, blank faces, no pillows, no water, no utensils with which to eat, paint chipping off the walls, and a window open to the hot air outside.
2. One of the other women in her room had traveled 2 days to get to the hospital. Many people from the area of the country she is from never see a doctor in their whole lives because they do not have the financial means, physical strength, or time to travel.
3. There was one nurse for all 60 patients in the medical and orthopedic units.
4. The oxygen that they gave this young woman was not working…there was nothing flowing through the tube!
5. Her labeled IV was supposed to be changed 5+ hours ago and the IV site was now red, warm to the touch and blood was infiltrating the tube about 5 inches!
6. Her mother told us that she had not seen the oncologist in 15 days! Somehow in these 15 days of not seeing the patient, the oncologist decided that the patient was okay to have chemo.
7. They had not run any urine tests that her mother could remember despite the fact that the young woman, who is on chemotherapy, was initially admitted with a kidney infection.
8. The young woman looked the weakest I had seen her. She quietly told her mother that she needed to go to the bathroom and her mother got the bedpan from under the bed and moved it under her to urinate. The entire process was very painful for the young woman since her hip/tumor site had to move to have the bedpan under her.
9. There is no toilet paper in the hospital.
10. I asked the residents who were about to pass into the room to wait until after she was done urinating just a moment to give her a little privacy/dignity. They, without saying anything, turned away from the room and chatted in the hall for a moment. I told them when she was done and they could pass into the room, but instead they continued to chat and then LEFT without looking at her or any of the other women in her room.
11. I asked a Nicaraguan doctor I am working with why they would just leave like that and she said… “that is what it is like here. That was the patient’s only chance to see a doctor today and they don’t care if they skip a room or not.”
12. Then, the cleaning lady came to mop the floor of the young woman’s room/hall with chemicals that were making even me nauseated. Ammonia and apple. The young woman, like most patients on chemotherapy, immediately started vomiting at the smell.
13. I tried to tell the nurse that the IV needed to be changed and that the oxygen not working. She was in the middle of preparing the medicines for her 60 patients and she didn’t have time to care.
14. Then , when I went to the social work office to tell them of her IV and oxygen, they said it was not their problem and that we needed to speak with the Medical Director of the hospital.
15. There was a long line outside the Medical Director’s office and he was not there. Luckily, the doctor I was with knew one of the doctors working there and told him of the situation with the hope that he will look into it.
16. The young woman’s mother/primary caregiver was tired and crying more and more frequently
17. The family members/friends, if patients are lucky enough to have them, are really the ones that know what is going on with the patients. They are doing the positioning of the patient, feeding, advocating, and doing assessments (not clinical ones…but still asking questions to rate/evaluate how patient is doing.)
18. The doctors rarely talk to the patient, the patient’s family and the nurses…they work pretty independently and do not look at much more than the patient’s chart to see how the patient is doing….only the super busy nurse and doctor write in the chart, so it doesn’t reflect what’s really going with the patient only what treatment was received/ordered
19. If a family member is to ask for something or offer information to a doctor such as “my daughter has vomited 10 times in the past hour” the doctor often doesn’t listen and instead is annoyed. The family member and patient are then labeled as problematic and their care if affected.
20. The longer a patient stays in the hospital the worse the patient’s care becomes…this young woman had been in the hospital for 17 days.
21. Many patient’s in the hospital die of dehydration (from not changing IVs) and hospital born infections. So many patients do not trust the hospital to help them.
22. There is even less medical care at night and on the weekends.
23. There are also many medication error and neglect and no accountability.
24. I learned that they do not require teaching medical ethics in all the medical schools here and bedside manner is rarely a topic that is taught.

There are many angles to look at the injustices of this young woman’s care, and the role of every person involved in creating an effective health delivery system. However, no matter what angle you look at or whether you are in the poorest or the richest country, the fundamental attribute of any health care system needs to be a balance between cost, access, and quality.

~Ayla Landry, BSN,RN

From the Author: Ayla Landry

My name is Ayla Landry. In May 2010, I graduated from Texas Christian University with a Bachelors of Science Degree in Nursing (BSN) and I am a Registered Nurse (RN). I have been involved in Nicaragua on a voluntary basis since 2008 originally assisting with a campaign against cervical and breast cancer, which are the #1 and #2 causes of death for Nicaraguan woman under 60 years old. The campaign is Nicaraguan-led and developed world-supported with several organizations from the US including NGOs, MD Anderson Houston, and MD Anderson Madrid supporting the efforts. I traveled to MD Anderson in Houston to learn as much as I could about the cancer care model and nursing role there. I helped set up a cancer registry, helped organized training conferences for physicians and nurses, helped in advocating the role of nurses in the pilot clinics created by the campaign, translated education materials (Spanish/English), and presented conferences in Spanish about the basics of oncology nursing care.

Most recently, for the past 5 months I have been living in Nicaragua to work/volunteer with a non-profit organization called Nicaraguan Resource Network (NRN). The organization has set-up churches in 26 different communities, 4 of which have schools, and 2 of those schools have special needs programs. In January 2011, NRN hired a wonderful Nicaraguan Pediatrician to provide primary healthcare to the nearly 1,800 children in their schools. I have been here in Nicaragua supporting and working alongside the physician in setting up a program to attend to these kids.

I dream to positively and significantly impact women’s and children’s health in the developing world and to promote global health education among nurses. While I was in Nicaragua, I was accepted into Johns Hopkins University for the MSN/MPH (Masters of Nursing/Masters of Public Health) program which will prepare me to accomplish those dreams, and I couldn’t be more excited to start the program at the end of this June.

Coinciding with the United Nations Climate Change Convention held in Cancun last month, the non-profit organization, Development Assistance Research Associates (DARA) released the first definitive study measuring the impact of climate change on global health and human development. The Climate Vulnerability Monitor (CVM) predicts that climate change could contribute to as many as 5 million deaths by the year 2020. The CVM also suggests that if global warming isn’t slowed an additional million will die every year by 2030.

DARA’s study accumulates leading research on climate change in order to give a global assessment of its effects. The CVM demonstrated that global climate change impacts human development in 4 different ways health, habitat loss, weather disasters, and economic stress. In terms of human health, climate change has strongly affected the spread of life-threatening, climate-sensitive diseases like diarrhea and malaria. The rise in sea level and the effects of desertification have contributed to habitat loss, while weather disasters like hurricanes and flooding have directly caused the loss of many human lives. Economic stresses, like the loss of agricultural productivity resulting from droughts, were another climate impact that the CVM measured and accounted for. The study showed that almost every single country is vulnerable to the effects of at least one identified impact.

Asian and Sub-Saharan African countries are by far the worst affected, and women and children are the groups most vulnerable.  The study reported that 80% of climate-related deaths are exclusively children living in either of these areas, and 99% of mortalities occur in developing countries. The CVM estimated that at the current rate, climate change contributes to some 350,000 deaths each year. In addition to estimates of human loss, the CVM estimates that climate change costs the global economy about 150 billion dollars. What’s more, half of this economic loss has occurred in industrialized countries.

Based in Madrid, Spain, DARA is an organization that works to improve the quality and effectiveness of aid given to the world’s most vulnerable populations that are effected by climate change, armed conflict, and other disasters. In preparing and funding the study, DARA worked in tandem with the Climate Vulnerable Forum, a global partnership founded by the president of the Maldives, Mohamed Nasheed, which brings together the countries most adversely affected by climate change. The countries included in the partnership are Bangladesh, Barbados, Bhutan, Ghana, Rwanda, Tanzania, Vietnam, the Maldives, Kenya, Kiribati, and Nepal.

The purpose of the DARA/Climate Vulnerable Forum study was to demonstrate the alarming effects of human-induced climate change such that policy-makers around the world will be more committed to urgent change. The study also included a set of 50 suggested changes that can be implemented cost-effectively in order to stem the rising tide of climate-related human loss. The entire study, including findings, country profiles, methodology, and recommendations, can be viewed in PDF format here.

This guest post is contributed by Alisa Gilbert.  She welcomes your comments at: alisagilbert599@gmail.com.

Today’s guest post by Anand Reddi was originally published on Huffington Post earlier this week.

Yesterday, the international donor community pledged $11.7 billion over the next three years to fund The Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria. The fund had hoped to raise $20 billion. This shortfall in necessary funding will put at risk the 2015 goal to: eliminate HIV mother-to-child transmission worldwide, prevent the spread of multidrug resistant TB, and eradicate malaria as a public health issue.

A pressing question amongst global health advocates is how to finance global health in the midst of this global economic recession?

One solution proposed is the enactment of a financial speculation tax on the currency transactions market. The proceeds raised could fund global health initiatives such as the Global Fund and the President’s Emergency Plan for AIDS Relief (PEPFAR).

Read the rest of this entry →

The following is a guest post by Farheen Qurashi, AMSA’s Jack Rutledge Legislative Director 2009-2010.

U.S. student activists

Just a few days ago, we celebrated World Health Day – the progress we’ve made in providing aid to patients around the world, the diseases prevented and the treatments admitted. But, we still have a long way to go, and as we celebrated, we also remembered that there is much to accomplish and continue in global health aid.

Two weeks ago, Rep. Barbara Lee (CA-9^th) introduced HR 4933, the Global HEALTH Act of 2010. This is a key piece of legislation that makes bounds towards creating a comprehensive and integrated global health aid strategy, focusing on strengthening health systems of developing countries to provide comprehensive primary to tertiary care as well as expanding the vital health care workforce – including doctors, nurses, midwives and community health workers—in needy areas. There is a dire international shortage of all kinds of health workers, and this is a bottleneck to providing sustainable and adequate care to patient populations – strengthening the health workforce is a key part of strengthening an overall health system.

Importantly, the Global HEALTH Act:

• Creates the Global Health Workforce Initiative, which emphasizes training, retention, and support for needed health workers
• Mandates the creation of a multi-year, in-depth strategy for health systems strengthening, and authorizes necessary support for this strategy
• Ensures country-ownership and accountability to health strategies
• Authorizes support for health strategies to ensure the swift achievement of US global health goals
• Prioritizes the needs of marginalized and vulnerable populations like women and girls, sex workers, etc.

On the cusp of the US’s own health system reform movement, we must also remember our patients in need around the world. The Global HEALTH Act makes a much-needed and bold step forward for global health aid, and AMSA is proudly one of its original supporters, along with Physicians for Human Rights, Health Alliance International, Health GAP (Global AIDS Project), and other organizations.

The Global HEALTH Act, HR 4933, is currently awaiting discussion in the Foreign Affairs and Financial Services Committees of the House of Representatives. For the ideas within the bill to receive recognition, support, and success, we must ask our Congressmen to show their support by co-sponsoring the legislation.

To send your Congressman a message, click here.

To find out more about the Global HEALTH Act, click here.

To read the full text of the bill, click here.

This is a guest post by Daniel Rhee, AMSA Global’s Health and Human Rights coordinator.  It was originally posted on the Global listserv in honor of Human Trafficking Awareness Day on January 11, 2010.

“To some, human trafficking may seem like a problem limited to other parts of the world. In fact, it occurs in every country, including the United States, and we have a responsibility to fight it just as others do. ” - Secretary of State, Hillary Rodham Clinton (full article here)

Good afternoon, Global!

Today is National Global Human Trafficking Awareness day, and for those who are unfamiliar, human trafficking is “the recruitment, transportation, transfer, harbouring or receipt of persons, by means of threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation.” (UN Protocol to Prevent, Suppress, and Punish Trafficking in Persons)

It is one of several forms of slavery that exist today (click here to learn about modern slavery), and as our Secretary of State stated so clearly, it is not just an international issue, but a domestic one as well.

Here are some quick facts from freetheslaves.net and the US DOJ:

• there are more slaves now than ever before in human history – approximately 27 million around the world
• the cost of a slave has decreased from $40,000 in 1850, to $90 in 2008
• it would cost $40 per family to buy all bonded laborers in the world – Americans spend this much on chocolate each Valentine’s Day
• 17,500 slaves are brought into the United States every year
• sexual exploitation of minors is lawfully considered human trafficking – approximately 325,000 children in the United States are subjected to sexual exploitation every year
• the average age of entry into the commercial sex industry within the United States is 11-12 years old

So for those of you who want to learn/do more, here are a few things for today: Read the rest of this entry →