Celebrating Passion, Professionalism, Pride

Convention Schedule (use links at top to navigate)

• 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

The study had three aims; (1) to advance current understanding of the interplay of actors in the system; (2) to evaluate its performance; and (3) to identify opportunities for improvement.

The traditional actors on the global health stage, which have traditionally been comprised of governmental agencies, are now being joined by an ever-greater variety of civil society and nongovernmental organizations, private firms, and private philanthropists. This rise of multiple new actors in the system creates challenges for coordination such as determining the roles various organizations should play, the rules by which they play, and who sets those rules in order to avoid waste, inefficiency, and turf wars. The lack of a clear set of rules that constrain distortion of priorities by powerful actors can threaten less powerful ones. Proposals to improve the issues facing coordination include setting global health agendas in ways that build upon the enthusiasm of particular actors and to ensure that financing be equitably shared also is a very important issue to consider.

At the same time this transition in actors and relationships among them are taking place, there are also transformations faced by the health system itself.  For example, the success of child survival efforts has meant that noncommunicable diseases, including cardiovascular disease, cancer, diabetes, and neuropsychiatric disease, are growing in prevalence alongside the continuing threats of communicable diseases. Some of the questions asked are (1) what functions must an effective global health system accomplish; (2) what kind of arrangements can better govern the growing and diverse set of actors in the system to ensure that those functions are performed; (3) and how can past experiences be used to address them and the coming wave of new health challenges?

The authors believe that the biggest challenge facing global health today is to reconcile the ongoing global-level transformation with the need to further strengthen and support national-level health systems. These global health agencies should be concerned with not only assessing the level of health, but also at its distribution, giving equity a central place in assessing a health system and bringing insight to diseases previously neglected on the research community. Neglected disease research should involve building capacity of endemic-country scientists which would lead to the involvement of affected communities not only as targets of interventions but as co-producers of results and integrating the Research and Development and Distribution (R&D&D) communities. Investments in human capacity that began in the 1970s are now bearing fruit as scientists from Africa, Asia, and Latin America take a key role in advancing research, as in the case of malaria. Translating knowledge into action is the critical goal that must not be forgotten in the reorganization process. This integration would not only allow for a more central role for endemic-country researchers in an increasingly globalized research system facilitating the connection of local and international researchers, but also direct funding to local researchers and institutions.

One model for enabling some coherence in the resource allocation process for its mandated diseases is the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). It is a partnership between governments, civil society, and the private sector that supplements existing efforts dealing with the three diseases. The Global Fund has become the main source of finance for programs to fight AIDS, tuberculosis and malaria, and has provided funding of $ 19.3 billion for more than 572 programs in 144 countries. It provides a quarter of all international financing for AIDS globally, two-thirds for tuberculosis and three quarters for malaria. The Global Burden of Disease and Disease Control Priorities Projects have provided country estimates of years of healthy life lost to illness and injury, identified major risks, and estimated the cost-effectiveness of interventions.  However, widely accepted principles on how to translate these figures into resource allocation decisions are lacking.

Coordination is the cornerstone of this integration; however, few organizations wish to be coordinated because of the costs and loss of autonomy entailed. Thus, coordination requires a consensus and to reach this consensus, participants must share a clear set of goals and perceive that they are key participants.

But long time advocacy is finally paying off as the WSJ reports that World Bank and the Indian government are set to spend $4 billion to “to ensure that by 2020 no untreated municipal sewage or industrial runoff enters the 1,560-mile river.”.  The methods proposed also have the benefit of being less carbon and electricity intensive than traditional wastewater treatment plants – key aspects for a country with chronic brownouts in a warming world.  In order to reach their goal, the government and partners will need to engage the most neglected slums which, if done right,  has the potential to create environmental justice at the same time as cleaning the river.

Of course, governments have a tendency of announcing lofty environmental goals which are then forgotten in the next election cycle. The Ganges also had a previous cleanup effort that failed to reach its goals, partly because of lacking public participation. Hopefully things will be different this time, but GP would love to hear from anyone with on the ground insight.

For more see http://www.reuters.com/article/idUSTRE6101AQ20100201

To date, the U.S. has barely begun to address the gravity of what has taken place.  In the absence of a meaningful national response, medical professional organizations and the legislatures of individual states are stepping up to the challenge.  With the introduction of the Gottfried-Duane Bill in the State Assembly and State Senate, New York is posed to become the first state  in the country to explicitly prohibit health professionals licensed in the state from assisting in torture, interrogations, and prisoner abuse, while providing them with strong legal protection to resist any future coercion to participate in such acts.

The bill is meant to stop physician-assisted torture ever becoming a reality again, as well as to help health professionals address abuse and medical neglect of prisoners in domestic jails and detention centers.  Co-sponsored by 30 members of the State Assembly from both parties, the bill was favorably reported by Assembly committees last year, and is currently being revised in preparation for the floor vote.  It is supported by the NY state chapter of the American College of Physicians; by nursing, psychology, and social work associations;  and by civil liberties and human rights advocacy groups.

More on the Gottfried-Duane Bill, and why you should care, after the jump.

Click here to sign PHR’s petition in support of the Gottffried-Duane bill.

(There is a link for out-of-staters to show solidarity, too.)

StopTortureNY.org

Legislation Details:

The Gottfried-Duane bill will prohibit direct and indirect actions which constitute participation, complicity, incitement, assistance, planning, design, attempt, or conspiracy to commit torture or improper treatment of a prisoner.  Partaking in such actions will result in the loss of the provider’s license.  Furthermore, a duty to report suspected cases of torture and prisoner abuse is established, as well as mitigation for compliance with an investigation of alleged torture.  This legislation applies to professionals licensed by the state of New York, regardless of where the conduct takes place.

Importantly, the bill establishes protections for potential abuse against healthcare providers. Improper treatment does not include adverse effects of standard treatments, providers must reasonably know that they are participating in torture to violate the law, and employees are protected if they report any violations of the law.

The full text of the Assembly and Senate versions is available:  A-6665/S-4495.

Ethics Background:

Regardless of one’s political allegiance or beliefs regarding the justifiability of torture, the ethics of the medical profession allow for but one stance on the issue of involvement or enabling it.  The AMA Code of Medical Ethics Opinion 2.067 clearly defines torture in accordance with international standards, and clearly states that:

Physicians must oppose and must not participate in torture for any reason. Participation in torture includes, but is not limited to, providing or withholding any services, substances, or knowledge to facilitate the practice of torture. Physicians must not be present when torture is used or threatened.

Physicians may treat prisoners or detainees if doing so is in their best interest, but physicians should not treat individuals to verify their health so that torture can begin or continue. Physicians who treat torture victims should not be persecuted. Physicians should help provide support for victims of torture and, whenever possible, strive to change situations in which torture is practiced or the potential for torture is great. (AMA)

For a more in-depth analysis of medical ethics, scroll down for a list of cases on the AMA’s Virtual Mentor website.

Politics and Accountability

Although Guantanamo Bay was closed by executive order in the early days of the administration, and illegal interrogation procedures discontinued, the procedural and legal loopholes that enabled torture remain.  The torture investigation commission championed by U.S. Senators Durbin (D-IL) and Whitehouse (D-RI) is currently waiting on a key report by the Department of Justice’s Office of Professional Responsibility, and the Obama Administration sporadically gets called out on stalling on the issue.   (See coverage of Sheldon Whitehouse’s speech on holding high-level officials accountable for torture at the PHR National Conference in Providence last year.)

In order to appreciate what the accountability investigation is all about, I highly recommend the website Torturingdemocracy.org — an astounding documentary project about how a brand-new system for unlawful interrogations came to be created:

Another revealing documentary, Doctors and Detainees, is anticipated in Spring 2010.

Relevance:

Why is it so important for doctors, medical students, and allied health professionals, to come out strongly in support of efforts such as the Gottfried-Duane Bill?  Because our profession’s complicity in acts of torture is not only illegal, but viscerally abhorrent.  Medical knowledge is gathered as the sum of society’s progress, distilled from the dedicated effort of generations of doctors and patients, and taught with reverence.  We receive it as part of an ancient trust, and on the condition that we shall use it for the good of others.  This obligation is codified in the terms of medical ethics, and upheld by medical professional organizations — but its true power is as old as witch-doctors, as old as society’s fundamental belief  in the beneficence of doctors.  It is what lets patients entrust themselves to our knowledge and our beneficence during the most vulnerable moments of their lives.  To use that knowledge purposefully in order to inflict intolerable pain on another human being, or to stand by and knowingly allow it to be used in that way, is a violation that shakes our profession to the roots.  No other compromise we make with our professional conscience — no other quandary of dual loyalty – can even come close.

As a future physician, I urge you to speak your mind on this issue, whether you agree, disagree, or are conflicted.   The worst thing we can do is pretend this chapter never happened.  If you are a resident of New York State, or are interested in similar efforts in your own state, please contact the New York Medical Student Coalition Against Torture, NYMSCAT@gmail.com. You may also find their Facebook group useful.

Further Reading:

For further reading on torture, medical complicity, and the need for public and professional responses:

• Len Rubenstein discusses the complicity and motives of health professionals in torture with AMSA’s Global Pulse Journal in our Fall 2009 issue
• Health and Human Rights Journal’s Open Forum Blog posts on torture
• PHR’s Anti-Torture Campaign and Health Rights Advocate Blog
• The Center for Constitutional Rights website: WhenHealersHarm.org
• Amnesty International’s Spotlight on Torture
• The AMA’s Virtual Mentor ethics journal’s discussions on physician duties in treating war detainees, the role of physicians in interrogations, the history of torture and human rights in medicine, and physicians’ obligations to speak out for prisoners’ health.

To read the reports in more detail:

• PHR’s reports: Break Them Down (2005), Leave No Marks (2007), and Broken Laws, Broken Lives (2008)
• The CIA Inspector General’s 2004 Report is available online from the New York Times.
• The U.S. Department of Defense’s website on detainee investigations.

Note: NYMSCAT leaders will be speaking at the PHR 2010 National Conference on Health and Human Rights Education in Boston next weekend. You may also contact me personally at editorinchief.gp@gmail.com to find out what AMSA is doing on this issue, and how to become involved. — HA

(Movie spoilers, and actual global health relevance, after cut.)

Cameron and crew set out to create a fantastic natural world inhabited by reasonably believable humanoids, the 10-feet-tall, blue-skinned, occasionally phosphorescent Navi.  They throw in some trigger-happy imperialistic humans, some well-meaning-yet-out-of-touch beleaguered scientist humans, and one good-looking befuddled-yet-heroic protagonist human, and the basic plot of Ferngully results.  (That is not a criticism on my part: Ferngully is a lovely movie in its own right.)  The good guys are attractive, the bad guys have horrid dialogue, and the visuals are worth the price of an IMAX ticket.  In the end, the bad guys receive a satisfactory thrashing, true love overcomes cultural barriers and genocide, 22nd-century gender roles look much like late-20th-century American ones, and the white guy saves the day.

All of which is almost enough to write off the movie as yet more flashy sci-fi, but here is why, issues of narrative aside, the thing works:

By making the Navi visually believable, Avatar reminds us that destroying the earth’s remaining healthy ecosystems for temporary profit is wrong not just because it represents a sin against the planet, mass murder of endangered animals, and irresponsible squandering of the very biodiversity that ensures the resilience of life on earth (including that of potential future human generations).  This sort of behavior also has the well-documented property of destroying in real time the lives, culture, and yes, health, of whatever indigenous human populations have managed to hang on to that ecosystem and live in reasonable balance with it.   Having developed cultures for thousands of years, controlled resource-rich lands across continents, and generally thrived for most of human history, indigenous tribes have been reduced over the past 500 years or so to under 5% of the world’s population — but currently represent 30% of its 900 million residents who subsist in extreme poverty — “relocated” to some of the world’s most depleted and polluted lands, subjected to systematic disenfranchisement, and suffering from disproportionate burdens of low education, ill health, and injury (State of the World’s Indigenous Peoples; Injury and trauma in indigenous populations). Which, I suppose, is too depressing to think about with actual human people in the picture.  The blue humanoids are here to help get the message across.

While the movie focuses on acute effects from forced population displacement (musculoskeletal trauma, burns, and psychological shock), the real-life effects from the loss of tribal lands and culture are just as devastating in the long term.  The chronic burdens of Type II diabetes, depression, and substance abuse are particularly well documented.  If you have seen Unnatural Causes, either when it first aired on PBS in 2008 or since, you probably remember Bad Sugar, which connects the dots between loss of culture and land, impoverishment, and chronic health outcomes:

As other bloggers and critics have pointed out before (again, see io9), Avatar’s biggest problem is not the predictability of plot, but the troublesome power relationship it reproduces — which is a rather familiar problem for students of global health.  For those of us looking for an alternative way to engage local/indigenous populations in future planning regarding ecosystem management and land use, I recommend starting with this article, which describes the use of community-based participatory research (CBPR) methods: Dakubo C. Ecosystem approach to community health planning in Ghana. EcoHealth. 2004; 1:50-59.

Stay tuned for:

• Later this month, I will be blogging from a conference on indigenous health in NYC.
• The 9th Session of the U.N. Permanent Forum on Indigenous Issues will be meeting in New York in April 2010.

Q: Roxana Rogers, USAID’s South Africa health team leader, said recently in South Africa that, “US government funding is going to come down dramatically over the next five years.” True?

A: No, it’s not true. Every year there’s been an overall increase in funding for PEPFAR, and we’ve also not been in a situation where we’ve had a decrease in any country, certainly not in South Africa. Our funding for South Africa is over a half billion dollars a year. Our resources that go into South Africa are having a huge impact, and I’m not understanding that (comment by Rogers).

We also committed to $120 million recently over two years to specifically address an unexpected shortage of funding for antiretroviral drugs in South Africa in nine provinces. The South African government asked us to be silent (about it during that time.) … It made a lot of sense for us to fund it for the simple reason that we not allow services to be interrupted and allow South Africa to respond to the increase in demand.

Roxana’s statement is based on the fact – I think – that she was used to PEPFAR funding that went up in huge increments every year — so much so they scrambled to find meaningful applications to use the funding for programs. Now we are in an economic crisis, with nowhere near the increase in funding like that, so on a relative level it may feel like a drop in funding.

Q: What happened in South Africa’s shortfall of funding for treatment?

A: PEPFAR has not run out of any antiretroviral drugs in any country, including South Africa. .. But for multiple times we’ve been asked to bail out a country for one or two months (because of drug shortages in the national program or funding shortages). South Africa had run out of resources to pay for the medication in nine provinces, starting in November. It was a significant outlay of resources for us and a real example of cooperation. In addition, we were able to work with the government to ensure their Treasury picks up the bill thereafter, so it doesn’t happen again.

Be sure to read the entire interview.

In the face of this expanding pool of people in need, US government funding seems to be staying stable. For example, at the same time that the Obama administration has announced plans to expand HIV treatment to at least 4 million by 2013, they have also signaled no increases in funding budgets through fiscal 2011. Defending the administrations commitment to fight the global pandemic, Eric Goosby, the President’s AIDS czar, stated that “our commitment to universal coverage hasn’t wavered.”

For more on the global fight on AIDS and particularly the fight in Uganda, check out the Wall Street Journal’s January 30th article and slideshow.

Visit http://www.pbs.org/now/sched.html for more information on air times or the documentary will be available online starting Friday night January 29th at http://www.pbs.org/now/.

On December 22, New Zealand and Belgium became the 25^th and 26^th nations to ratify the Convention on Cluster Munitions (CCM). The convention needs only four more ratifications to achieve the 30-state minimum to enter into force. Once in force, it will enact a ban on the use, stockpiling, production, and transfer of most cluster munitions, which include bombs, missiles, or rockets that open midair to scatter tens to thousands of small submunitions over a wide area. The CCM also requires that states destroy their stockpiles in eight years, clear contaminated land within ten years, and provide victim assistance.

This convention is necessary due to the wide, indiscriminate, and persistent effects of cluster munitions on civilians and communities. Ninety-eight percent of all recorded casualties of cluster munitions are civilians. In several countries, children account for roughly 60% percent of the victims. In 2007 alone, 5,426 casualties were reported due to cluster munitions. Conservative estimates suggest that unexploded submunitions have caused at least 55,000 casualties, though the number may be well over 100,000.

Victims of cluster munitions require medical, mental health, rehabilitation, and vocational services. They sustain burns and blast and shrapnel injuries, often to multiple limbs as well as their chest, abdomen, and face. Victims should also receive rehabilitation services, including mental health care, physical therapy, and prostheses if needed. Many of these services are unavailable or scarce in conflict zones, and the added burden of these patients can overwhelm an already strained health system, especially in post-conflict settings.

Victims of cluster munitions also need assistance with integration back into society. In many affected areas, people living with disabilities face stigmatization, marginalization, and a lack of economic opportunity. Efforts to promote the rights of the disabled — such as those spearheaded by Handicap International — are essential to any long-term approach to addressing the effects of cluster munitions.

Though cluster munitions are often compared to landmines in that they both litter areas after a conflict is over and pose a threat to the health and human rights of individuals and communities, there are notable differences in their effects. Cluster munitions are more likely than landmines to cause multiple injuries per incident, and they are more likely to kill or injure children under the age of 14 due to their small size and bright coloration.

Unexploded cluster submunitions slow humanitarian, recovery, and resettlement efforts after overt hostilities have ended. Humanitarian and relief workers may be unable to enter an area due to cluster munition contamination. In Kosovo, Laos, Vietnam, Afghanistan, and Lebanon, casualties peaked as populations returned home after the conflict ended. Returning populations are injured while attempting to access their houses, farms, pasture land, water supplies, and health facilities. In Afghanistan, many people have been injured by explosive remnants of war (of which cluster munitions are one form) in the past decade, and these deadly devices have deterred people from accessing health services and from sending their children to school.

The short- and long-term effects of armed conflict and political violence continue to undermine the health and human rights of populations around the world. An international ban on cluster munitions will be an important step toward protecting and promoting health and human rights and toward allowing those whose lives are ravaged by wars to farm their fields and walk the streets of their communities without fear.

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Earthquake Crisis in Haiti

Original post by Wilnise Jasmin [01.14.2010 @ 6:53 AM EST]

As you may have already heard, a 7.0 magnitude earthquake struck about 10 miles southwest of Port-au- Prince, Haiti at about 5 pm Tuesday night. The quake ravaged the infrastructure of Haiti’s fragile government and destroyed some of its most important cultural symbols.

“Parliament has collapsed,” Mr. Préval told The Miami Herald. “The tax office has collapsed. Schools have collapsed. Hospitals have collapsed. There are a lot of schools that have a lot of dead people in them.” He added: “All of the hospitals are packed with people. It is a catastrophe.”

President Obama promised that Haiti would have the “unwavering support” of the United States.

Haitian authorities and humanitarian aid organizations are struggling to respond amid devastation.

A Red Cross field team of officials from several nations had to spend Wednesday night in Santo Domingo in the Dominican Republic to gather its staff before taking the six-hour drive in the morning across the border to the earthquake zone.

Here are some various ways to help with the recovery:

• American Red Cross
• Center for International Disaster Information
• On this website, there have been posts containing information about missing relatives. If anyone can possibly account for anyone please do.
• Partners In Health, and their partner organization in Haiti, Zanmi Lasante, are familiar to many of us from Tracy Kidder’s book Mountains Beyond Mountains.  They have been working in Haiti for over 20 years, in times of emergency as well as in a long-term commitment to improving the health infrastructure.  They are currently looking for qualified surgeons and nurses.
• More organizations
• Build a fundraising page with MercyCorps

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Updated [01.14.2010 @ 3 PM EST]: Key news items and op-eds:

• Barack Obama: “Unwavering support”
• U.S. grants temporary protection status to Haitians; sends troops
• Red Cross: 45,000-50,000 dead
• Tracy Kidder: Country Without a Net
• Bill Clinton: What we can do to help Haiti, now and beyond
• Nicolas Sarkozy: Time to end Haiti’s “curse”

Updated [01.14.2010 @ 11 PM EST]: US Military Plan of Action Established and Underway

Secretary of Defense, Robert Gates has shifted all of the resources of the US Department of Defense towards providing relief. General Douglas Fraser of the US Southern Command publically announced the Haiti relief plan on Thursday at a press conference held at the U.S. Southern Command Headquarters in  Doral, Florida. The main areas addressed by Douglas focused on improving life sustaining capabilities and to provide assistance  in the relief efforts in order  to mitigate the suffering as soon as humanly possible. Some of the areas discussed:

• An  initial Commander and  Control  has been set up until communication capability has been reestablished
• Opening the air field and making it operate on a  24/7 schedule
• 4 Coastguard cutters to provide helicopters and any additional support it can
• A navy destroyer will also be providing helicopter support as well as the fuel needed to keep all the helicopters running.
• A Threat and Disaster Relief assessment team has been organized in order to  get an accurate survey of the extent of the damage
• Paratroopers have been dispatched
• Carrier USS Carl Vinson is scheduled to arrive on the morning of the 15th to provide additional helicopters and serve as the platform that will alleviate the organization problems faced due to the poorly established infrastructure that currently exists in Haiti
• Marines are scheduled to bring the heavy equipment necessary to provide capacity and capability on the 19^th
• USNS Comfort hospital ship is is scheduled to arrive on the 22^nd

Updated [01.15.2010 @ 12:30 PM EST]: The Big Picture

Two days later, the extent of the damage is seen in these harrowing photographs at the Boston Globe.  Click on the image to see the photo-essay of devastation and rescue.

Updated [01.15.2010 @ 4 PM EST]:

• The U.S. military reopens the Port-au-Prince airport

Updated [01.15.2010 @ 8:30 PM EST]:

• Port-au- Prince is not the only area in Haiti that needs help.

Updated [01.16.2010 @ 10:30 AM EST]:

T-Mobile USA Waives Call Charges to and From Haiti

• T-Mobile USA is enabling phone calls for current customers to Haiti without charges for international long distance through January 31, 2010, and retroactive to the earthquake on January 12, 2010. Additionally, T-Mobile customers who may already be in Haiti will be able to roam on T-Mobile’s partner networks in Haiti (operated locally in Haiti under the names Voila and Digicel) free-of-charge through the end of the month.

• T- Mobile also pledge to assist in wireless restoration.

Updated [01.17.2010 @ 10:30 AM EST]: Prevention and Rebuilding

Many are asking if this tragedy that resulted from the earthquake could have been prevented. Back in 2008 two geophysicists who study fault lines in the Caribbean predicted that the fault line that Haiti sits upon called the Enriquillo fault could produce a 7.2 magnitude quake.  The plates of the fault had been slipping past each other at about 7 millimeters per year for the last 250 years and the geophysicists predicted that it was time to snap.

While the earthquake could not have been prevented, the scientists believe that there was enough forewarning to implement emergency plans for when the earthquake would occur.  While the limited resources of Haiti did not allow it to upgrade every single building standing, some buildings , such as hospitals and governmental buildings, could have been designated as critical and plans to strengthen these could been made.  These areas could have served as the base from which all rescue efforts could be organized.

Unfortunately these plans were not made and to dwell on the errors of the past will not resolve the current problems that exist today.   Once all rescue efforts have been exhausted, we can take learn from the errors that were made and not repeat them.  When the reconstruction phase begins, NGO’s like Architecture for Humanity can work to ensure that another tragedy like the one that occurred this week will not recur.

Updated [01.17.2010 @ 11:30 AM EST]: Earthquake on Ocean Floor

On Sunday morning, a 6.3 magnitude earthquake was detected by seismologists In the Drake Passage on Atlantic Ocean floor between South America and Antarctica.  The quake had no effect on nearby lands.

Updated [01.17.2010 @ 10:00 PM EST]

The CDC has deployed staff to Haiti to assist in the emergency response and guide the efforts to minimize public health impacts in the coming months.  It has also updated several relevant resources for health care providers and responders:

• Guidance for Relief Workers and Others Traveling to Haiti for Earthquake Response
• Emergency Wound Management for Healthcare Professionals
• After an Earthquake: Management of Crush Injuries & Crush Syndrome
• CDC’s Earthquake Webpage
• Health Recommendations for Relief Workers Responding to Disasters
• Public Health Issues and Priorities for the Haiti Earthquake
• Travel Health Warning
• CDC Emergency Twitter account
• Haiti Disaster Volunteering

Updated by Jennifer Weinberg [01.19.2010 @ 9:00 am EST]

Partners in Health (PIH) is one of many organizations from around the globe dedicating efforts to the earthquake victims in Haiti. As this organization has been working in Haiti for over 25 years, they are in a unique position to understand the multitude of factors contributing to this tragedy.

Watch a PIH Executive Director Ophelia Dahl discuss the importance of long term rebuilding efforts with CBS’s Katie Couric.

Read an op-ed by PIH co-founder Paul Farmer focusing on the importance of building back better.

Updated [01.20.2010 @ 2:20 PM]:

As inquiries about volunteering in Haiti keep pouring in, while after-shocks rattle the island and life-saving supplies are turned away for lack of logistics support, the World Journal of Surgery shares some thoughts on the “cardinal sins” of humanitarian medicine.

Updated [01.20.2010 @ 8:30 PM]: More ways you can help

• If you are a health professional interested in volunteering to help, the American Academy of Family Physicians can link you organizations that are in Haiti.

• The Pan American Health and Education Foundation’s is an independent philanthropic organization working to build public health expertise to be able to innovatively lead development of healthier generations of people in the Americas.  It has set up a  Disaster Relief Fund to help bring critically needed emergency supplies for affected families and to support recovery efforts in Haiti.

• Habitat for Humanity has worked with Haiti for over 26 years and will continue to serve the people there by helping to rebuild.

• Nine Medical Teams International volunteer physicians and nurses are hard at work at various hospitals in Port au Prince. At Kings Hospital, a 350 bed inpatient facility that survived the earthquake the physicians are providing  care to those who would have died without the help of the volunteers.

Updated [01.21.2010 @ 11:30 PM]: When Good Intentions Make Things Worse ;   Record Donations; and Mass Movements

Haitian government figures relayed by the European Commission put the death toll at 200,000, with 80,000 buried in mass graves. The commission now estimates 2 million homeless, up from 1.5 million, and says 250,000 are in need of urgent aid. The countless number of untreated injuries that many Haitians still have will continue to add to the earthquake’s death toll. Lack of food and water will also contribute to the death toll.  .”  Partners in Health, an organization that has been providing health care in Haiti for two decades, estimated that 20,000 Haitians were dying daily from lack of surgery.

In an effort to prevent the loss of more lives, health experts have arrived in Haiti from Israel, Cuba, Portugal and other countries, many with stocks of medicine and supplies as well as extensive experience in disaster conditions. And the United States Navy hospital ship Comfort pulled up off the Haitian coast to handle the worst-off patients.

One of the problems with the relief effort is that there is a lack of organization and communication between the various aid agencies. “Nobody knows how many doctors, how many nurses have come to Haiti,” said Dr. Henriette Chamouillet, head of the World Health Organization in Haiti. “No one is providing the government with the data it needs.

Disaster organizers say good intentions gone wrong are another hindrance to the recovery effort.” Some examples include volunteer medical teams who have gone to Haiti on their own, without the support of established organizations that have the prior experience in disaster relief and working in developing nations, may actually use up the resources that could have been used to help the victims of the earthquake.  Contacting one of the many organizations listed in the earlier updates of this post can help the individual healthcare worker allocate his or her skill sets in a way that will not take away from those that need aid.

For many organizations, donating money, rather than goods, is the better way to provide aid.  Jeff Nene, a spokesman for Convoy of Hope, a Springfield, Mo., agency that feeds 11,000 children a day in Haiti, urges cash donations that allow his group to buy in bulk from large suppliers and retailers. “When people give $1, it translates into $7 in the field,” he said. “If they spend $5 for bottled water, that’s nice and it makes them feel good, but probably it costs us more than $5 to send it. If they give us $5, we can get $35 worth of water.”

According to the Chronicle of Philanthropy’s recently released a survey, donations to relief groups working in Haiti are breaking fund-raising records. The survey was based on a tally on proceeds reported by the nation’s 22 largest charities and it showed that US charities raised more than $150 million in the four days after the quake. The Chronicle’s survey doesn’t include the sums raised by smaller charities, such as the $25 million by Partners in Health. Among the biggest recipients was the American Red Cross, which has raised $87 million for Haiti so far. Small texted donations account for $16 million of the $150 million raised so far.

Despite the slow progress in coordinating the communications between the organizations providing aid in Haiti, the Haitian government has been able to begin the process of moving 400,00 earthquake victims to new settlements outside of the haphazard camps in Port-au- prince that have been set up in the days following the earthquake. The United Nations supports this move because the consolidation of the nearly 450 homeless encampments in Port-au-Prince alone will help to streamline food distribution.

Updated [01.30.2010 @ 1:20 PM]:  Surveillance for Disease, and Advocacy for Investment

• Dr. James Wilson’s epidemiology surveillance of infectious disease outbreaks in Haiti: Operational Biosurveillance
• Dr. Paul Farmer’s testimony before the Senate Foreign Relations Committee: Video | Transcript

Updated [02. 18.2010 @ 9:30 AM]:In President Preval’s Own Words

The president of the Haiti talks about his initial response to the crisis.

Visit msnbc.com for breaking news, world news, and news about the economy

“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:

statement in the Global Pulse by our Hana Akselrod:
http://www.globalpulsejournal.com/blog/index.php/2009/10/27/human-trafficking-part-i-introduction/

some local events:
http://humantrafficking.change.org/blog/view/national_human_trafficking_awareness_day_events_near_you

a poster to share:
http://www.bridgetofreedomfoundation.org/NGHTAD_Letter-1.pdf

a Facebook group:
http://www.facebook.com/group.php?gid=209640181028&ref=mf

powerful article regarding chocolate slavery in the ivory coast: http://vision.ucsd.edu/~kbranson/stopchocolateslavery/atasteofslavery.html

Department of State 2009 Trafficking in Persons Report:
http://www.state.gov/g/tip/rls/tiprpt/2009/index.htm

an article on modern slavery:
http://www1.voanews.com/english/news/a-13-2009-08-21-voa49-68706537.html

an organization working to end slavery:
http://www.freetheslaves.net

a great list of links/resources:
http://traffickfree.org/educate.html

More details on the study can be found in the January 5, 2010 issue of Annals of Internal Medicine.

Physicians for Human Rights National Conference
Health and Human Rights in 2010
Saturday, February 20^th, 2010
Boston University Medical School in Boston, Massachusetts

Register now at www.PHRStudentConference.org!

Physicians, nurses and public health specialists in the U.S. and abroad face a daunting task: building, and often rebuilding, health systems that are accessible to all; fighting infectious pandemics like HIV/AIDS; preventing and treating disease; providing humanitarian relief to people facing natural or man-made disasters; and more.

The last 20 years have shown the world that brilliant bio-medical advances cannot alone bring health to the world’s poorest people. Medicine must go hand-in-hand with human rights to eliminate health disparities and ensure a healthy population.

This year’s Conference aims to change the paradigm of medicine to one which embraces human rights by empowering student leaders to introduce human rights into their school curriculum. The Conference is the first of its kind to solely focus on bringing students and faculty together to discuss how to integrate human rights into medical education. This jam-packed day serve as a springboard for future health and human rights initiatives and support students to make lasting change at their university and in their profession.

Highlights include:

• Network with National Leaders: Renowned experts in the field of health and human rights who will share their knowledge and expertise with you.  This conference provides a rare chance to meet and network with health professionals interested in human rights from all over the US.

• Build Your Skills: A dynamic lineup of workshops, panels, and strategy sessions that will address the need to integrate human rights more completely in medical education and cover the best strategies for planning electives for credit and garnering faculty support.

• Take part in the Student Expo: An Education Expo when students who have designed courses for credit, created extracurricular activities and started clubs to further awareness will present their projects and provide advice and ideas for their peers hoping to spearhead similar initiatives.

• Change Policy: Hear from US Representative James McGovern (D-MA, Invited)—Chair of the Congressional Human Rights Caucus and health reform expert— about human rights and health reform, and ask him the tough questions about how to make sure health is recognized as a human rights in the Us and abroad.

• Join us for a Jazz Reception: Join student leaders, faculty, and PHR staff and Board members for a jazz reception Saturday evening. Enjoy music, hors d’eourves, drinks and conversation overlooking Boston’s stunning skyline.

Attendees will leave with concrete guides to follow to help further their goals on campus, and will have the opportunity to meet personally with faculty from their schools to discuss future initiatives.

Join PHR at the National Conference – a unique opportunity for passionate health professional students and faculty to come together for a remarkable day to harness their knowledge for health and human rights.

Questions about the National Conference?  Email Hannah.

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

This is a guest post by Leah Bevis and Alison Hayward, MD for Uganda Village Project, an IFMSA transnational project. There are many ways to get involved with UVP, including through summer internships. – Sujal Parikh

Naigaga Florence lives in Bulumwaki Village, a small, extremely rural community in eastern Uganda. A thin, toothless, but smiling old woman, we first sighted her at a village outreach – in her arms was the most malnourished child that any of us had ever seen. The child’s eyes were dull, his hair a few blondish wisps on a dry skull. His tiny limbs were mere bones draped in shriveled skin, and his head lolled on his neck as if about to fall off completely. His name was Alfred, and he suffered from severe malnutrition, since his mother had died and was unable to breastfeed him. Without breastmilk’s protection, babies in the rural villages of Uganda face a grim prognosis. They are fed a thin gruel of flour and water which provides hardly any calories, or the protein they need to grow.  

For 9 thousand Ugandan shillings – about five dollars –we provided Alfred with one large cup of milk every day for a month. Naigaga scrapes together enough money to buy millet, soy, and maize porridge, and a bit of oil, to mix in with the milk after it is boiled. Alfred grew stronger, became the brown color he ought to have been, gained tiny layer of flesh over his bones. His eyes began to focus. His grandmother Naigaga showed up at every single Uganda Village Project event, greeted our staff with hugs and dancing, and thanked us profusely, over and over again, for saving her grandson’s life. Though he is infinitely more healthy than he was, Alfred’s life is still fragile – propped up, as ridiculous as it seems, by five dollars worth of milk every month.

The majority of Ugandan village children are malnourished. Almost all suffer from mild kwashiorkor, caused by protein deficiency and presenting with a distended stomach, thinning and blonding hair, edema, inadequate growth, and edema. Some suffer from iodine or iron deficiencies, many suffer from Vitamin A deficiencies (which causes a prevalence of eye problems), and the children of very poor families suffer from marasmus (protein and carbohydrate deficiency, basically starvation).Twenty percent of Ugandan children are underweight for their age, and this rate is certainly much higher in the rural villages where Uganda Village Project works.

Malnutrition in children can be deadly on its own, but more often it weakens the immune system, causing a higher incidence of malaria, typhoid, skin infections, respiratory infections, and tuberculosis. Malnourished children who escape death often suffer from reduced physical and mental capacity, and may do poorly in school or be less able to provide for their families in the future.

We are working to prevent and treat child malnutrition in a number of ways, including education, subsidized vegetable seeds for villagers, and training for planting small, water-efficient vegetable gardens. We are also providing emergency aid to severely malnourished babies like Alfred by paying for a cup of milk a day.

While Ugandan children face a variety of challenges, both in health and otherwise, malnutrition is one of the most cross-cutting and deeply rooted of these challenges. By working to prevent malnutrition in rural Iganga, we are working for a better future for the children, and a better future for their society as a whole.

The International Cancer Genome Consortium is made up of scientists from 10 countries, with each country designated to focus on cataloging all the possible mutations responsible for cancers of a specific area of the body. For example, UK is looking at breast cancer, Japan at liver and India at mouth, China is studying stomach cancer, and the US is looking at cancers of the brain, ovary and pancreas.

Want to know what the Patent Pool is all about? Read the very recent Global Pulse interview with Ellen ‘t Hoen, Senior Advisor for the Patent Pool at UNITAID.
(PDF)

There has been significant concern over efforts by drug companies to keep middle-income countries out of the patent pool. If such limits are imposed, millions of impoverished HIV patients in India, China, and Brazil will remain unable to afford the drugs.

Read on for more on UNITAID, AIDS, intellectual property, and the Patent Pool.

UNITAID was founded in 2006 with the goal of reducing the world’s burden of the HIV/AIDS, TB, and malaria in middle- and low-income countries. Currently, 93 countries receive UNITAID funding. The founding countries of UNITAID were Brazil, Chile, France, Norway, and the United Kingdom.

From UK’s The Guardian:

“The UNITAID decision is a huge victory for those in need of HIV treatment around the world,” Diarmaid McDonald, the co-ordinator of the umbrella group Stop AIDS, said. “It will help to break down the patent barriers which stop people getting the drugs they need to stay alive. UNITAID and the UK government should be commended for their leadership on this.”

McDonald said the focus “now shifts to the big drug companies”, adding: “It will test the sincerity of their rhetoric on helping the most vulnerable in our world.

“Companies like Gilead and Merck showed real leadership within the industry by speaking positively of the patent pool – they must now go beyond words and contribute their patents to the pool. The pressure will be on others within the industry to follow or to explain why they are willing to turn their backs on an initiative with such huge potential to save lives.”

Last year, 2.7 million people were newly infected with HIV and 2 million people died from AIDS (WAD 2009).

For more information:

• Read about support for the Patent Pool from MSF and political and civil society leaders.
• Read Kelly Morris’s article on the HIV treatment crisis in The Lancet Infectious Diseases.
• Read “The Treatment Timebomb”, the groundbreaking report by the UK government calling for greater leadership on reducing the costs of ARVs (with foreword by Dr. Peter Piot). (Report summary at The Lancet.)

Sheena McCormack, who led the trial, was disappointed in the results because a smaller trial held earlier, indicated that that the results for the current larger trial would be different from what they were. The smaller trial included more than 3,099 women and was funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH. The sites include 6 countries in sub-Saharan Africa and one site in the United States. The results of the smaller trial were presented at the Conference on Retroviruses and Opportunistic Infections in Montreal, Canada in February. These results indicted that the Pro 2000 gel would reduce transmission rated by 30 %. Earliers this year, ENDO Pharmaceuticals purchased the PRO 2000 from Indevus Pharmaceuticals.

Currently, women make up half of all people worldwide living with HIV and in sub-Saharan Africa, women represent nearly 60 percent of adults living with HIV.

In most cases, women become infected with HIV through sexual intercourse with an infected male partner. Manufacturers were hoping that this microbicide would be a potential solution for hose whose partners refuse to use condoms and could have empowered women with a prevention method they could initiate. Even though this microbicide failed to prevent the spread of HIV, scientists have not given up hope, as here are currently dozens of microbicides being tested. A previous post on the Global Pulse Blog discusses the debates that have taken place about the role of microbicides on HIV prevention.

The critically acclaimed film documentary “Living in Emergency: Stories of Doctors Without Borders” is playing nationwide tomorrow evening in select theaters. News anchor Elizabeth Vargas will moderate a LIVE panel discussion with MSF frontline aid workers and award-winning journalists.

Conceived as a “Bill of Rights for Women,” CEDAW sets a common international definition for gender-based discrimination, and establishes an agenda for ending it. States ratifying CEDAW are required to institutionalize gender equality through domestic legislation, repeal and replace all discriminatory provisions in their laws, and establish public institutions of recourse for women who require protection against discrimination.

Discrimination is bad. Women should have equal rights. Surely this is something we can agree on? Not so fast. Read further for the controversial stuff.

CEDAW sets a universal standard as the most comprehensive international treaty addressing women’s equal political, civil, economic, cultural and social rights. Its ratification in the United States would strengthen US laws that ensure women’s equal rights as well as illustrate the United States’ commitment to serve as a global leader of human rights (PHR). As Nora O’Connell and Ritu Sharma put it in the Human Rights Brief:

CEDAW, like any treaty, is not a silver bullet. Just as the 1964 Civil Rights Act did not end racism in the United States of America, this treaty will not end human rights abuses against women and girls around the world. But like that landmark legislation, it will provide a roadmap for those countries that want to improve the status of women as well as legal recourse for victims when needed. By setting an international standard that countries have voluntarily agreed to, CEDAW serves as a powerful self-help tool for supporters of women’s human rights to urge their governments to do better. We have seen this work with other treaties. The U.S. ratification of the UN Convention to Eliminate All Forms of Racial Discrimination in 1994, for example, amplified the U.S. voice in the successful international drive to end racial apartheid in South Africa.

After its adoption by the U.N. General Assembly in 1979, the convention was introduced in the U.S. in 1980 and signed by President Carter. It then proceeded to stall in the Senate multiple times, and despite support from individual state legislatures and major public bodies, has not been ratified to this day — leaving the United States in the company of Iran, Somalia, Sudan, and three small Pacific Island nations who have also held out on CEDAW ratification. I am not informed about Somalia’s and Tonga’s reasons for rejecting CEDAW, but in the U.S. reasons for its controversy have included the following:

• General opposition to U.S. participation in international agreements on human rights, similar to that encountered by the Convention on the Rights of the Child.

• Concern that CEDAW reduces the sovereignty of nations and leads to over-reliance on international law
• Concern that “discrimination” is defined too liberally and could be used in frivolous lawsuits
• Concern that CEDAW de-values marriage and motherhood, and will impose culturally inappropriate practices backed by radical Western feminism
• The belief that CEDAW would sanction abortion and legalize prostitution
• For why these objections are unfounded, see: overview and detailed analysis. Mostly it boils down to the fact that CEDAW cannot impose any specific laws originating from outside a member country, is self-imposed, and aims to reconcile a universal recognition of women’ rights with culturally appropriate implementation.
• Other critics argue that CEDAW is, if anything, too weak and voluntary. However, in the 20 years since its introduction, it has been used in numerous and concrete ways to establish and protect women’s rights around the world.

To date, the United States remains the only developed country to have failed to ratify the convention — while countries where women’s rights are severely bound under religious law (Islamic countries), abortion is against the law (Ireland; Latin American countries), and women are repressed as a matter of tradition (pretty much everywhere else) have at least made the gesture of ratification. With President Obama’s reintroduction of CEDAW to the U.S. international treaty agenda in 2009, we have another chance to put our support behind this key agreement, and to show America’s commitment to the rights of women worldwide and at home.

Assuming, that is, that “we”, as a nation, actually have such a commitment — something I am personally in the habit of doubting. Although Americans individually donate millions of dollars to philanthropic efforts helping women around the world, discrimination against the interests of women — especially those in developing countries, or in urban minority neighborhoods — has been deeply entrenched in U.S. practices and policy. The striking down of the Global Gag Rule in early 2009 was a bright departure from years of backwards policies that shackled the real reproductive needs of women living in desperate circumstances and far away to American internal cultural politics. The current strength of the Stupak and Nelson “anti-abortion” amendments in the domestic struggle over health care reform is more or less a domestic extension of Mexico City Policy. If implemented, these amendments will disproportionately impact the health of poor and minority women — women who are already at tremendous disadvantage in the realm of sexual and reproductive health, as evidenced by current racial disparities in HIV/AIDS infections and maternal mortality. My personal opinion is that both the former endurance of the Global Gag Rule, and the current efforts to institutionalize nation-wide religious limitations on reproductive health care, are expressions of a tacit understanding that somehow, the reproductive health needs of women have little importance beyond that of a political token — especially if the women in question are poor or dark-skinned or both — because after all, sexual victimization and maternity-related suffering have been the lot of women in the natural course of things. And the idea of suffering being “natural” for certain people is an attitude that that ought to make any doctor’s blood boil.

Whether you believe the U.S. is a global leader on women’s rights and should stand up and say so, or that it has always been sadly behind most developed countries in its conceptualization of gender relations and needs to work harder, I urge you to sign the petition in support of CEDAW ratification. Please share your thoughts on gender, policy, and U.S. influence on reproductive health around the world.