Global Pulse Blog

In response to a 2010 World Health Organization report Working to overcome the global impact of neglected tropical diseases, this week, the Bill and Melinda Gates Foundation, the World Bank, 13 pharmaceutical companies, the governments of the U.S., U.K. and U.A.E. and other global organizations committed to a new, coordinated effort to advance progress towards controlling 10 neglected tropical diseases by the end of the decade and improve the lives of the 1.4 billion affected by such diseases globally. Guiding this effort, the World Health Organization released targets and a strategy, Accelerating work to overcome the global impact of neglected tropical diseases—A roadmap for implementation.

These neglected tropical diseases include:

• lymphatic filariasis
• blinding trachoma
• sleeping sickness
• leprosy
• soil-transmitted helminthes
• schistosomiasis
• river blindness
• Chagas disease
• visceral leishmaniasis
• guinea worm

Check out the related webcast and infographic

The following infographic from USAID graphically illustrates the ways in which investments in females have wide-reaching and significant impacts.

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

On Monday, Nov. 21^st 9:30am EST, Research!America will be webcasting a briefing on USAID and the agency’s impact on global health research and development.  The panel will be moderated by Susan Dentzer, Editor-in-Chief of Health Affairs, and will include representatives from USAID and several global health R&D partners from the public and private sectors (representing Product Development Partnerships – or PDPs).  Panelists include:

• Hugh Chang, Director of Special Initiatives, PATH
• Rick King, PhD, Vice President, Vaccine Design, IAVI
• Emily Moore, Vice President for Business Development, Temptime Corp.
• Wendy Taylor, Senior Advisor for Innovative Finance and Public Private Partnerships, Bureau of Global Health, USAI

The U.S. Agency for International Development (USAID) is marking its 50th anniversary as the main U.S. humanitarian relief and international development agency. This conversation regarding USAID and its global partenrs will shed insight into instrumental partnerships in global health work.

This important event will be webcast live at http://bit.ly/vWwx9o where you can also submit questions. You can also join the conversation on Twitter under the hashtag #GHPDP.

With Secretary Clinton’s recent speech calling for an AIDS-free generation, one important question revolves around funding for this bold and enthusiastic plan. Pertinently, Funders Concerned About AIDS (FCAA), with support from Joint United Nations Programme on HIV/AIDS (UNAIDS), has released a report which shows that both the number of private U.S. funders and amount of funding has decreased this past year. The U.S. Philanthropic Support to Address HIV/AIDS in 2010 report shows which philanthropic organizations have been, and continue to be, leaders in the HIV/AIDS field.

Recently, ranking Minority Member Howard Berman released a draft of a revised Foreign Assistance Act (FAA) to take the place of the original legislation introduced by John F. Kennedy in 1961. At that time, Kennedy proposed such legislation to address the multitude of problems facing aid including the varied and numerous programs, short-term financing, overlapping jurisdictions and bureaucratic fragmentation. The reasons for modified legislation today are not so different. The proposed updated act would permit policymakers to come to an agreement about the priorities of the US when implementing foreign aid including adjustments to aid policy that would help it survive in the aftermath of the debt deal. The Center for Global Development recently also commented on the issue of why we need a new FAA.

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.

The Kaiser Family Foundation will hold a live, interactive webcast tomorrow, Thursday April 21, 2011 at 11am EST on Congress and global health as part of their U.S. Global Health Policy: In Focus webcast series. This hour-long interactive session will feature three global health policy experts:

• Beth Tritter, Managing Director, The Glover Park Group; Former Legislative Director for Congresswoman Nita Lowey, Ranking Member of the House Appropriations Subcommittee on State and Foreign Operations.
• Todd Summers, Senior Advisor for Global Health, ONE Campaign.
• Allen Moore, Senior Advisor for Global Health Security Program, Stimson Center, and Adjunct Professor in Global Health, George Washington University; Former Deputy Chief of Staff and Policy Director for Former Senate Majority Leader Bill Frist.
• Jennifer Kates, Moderator, Vice President and Director, Global Health & HIV Policy, Kaiser Family Foundation.

They will examine the new legislative landscape of the 112th Congress and the ways in which recent changes will impact global health programs and foreign assistance.

You can watch the live studio webcast on kff.org. Viewers can also email questions before or during the live webcast at infocus@kff.org.

Kaiser Family Foundation recently held a webcast on “The Future of US Multilateral Engagement on Global Health“ as part of the Foundation’s US Global Health Policy: In Focus live webcast series. This question and answer format webcast featured an expert panel including Mark Abdoo the director for Global Health and Food Security, Natasha Bilimoria the president of Friends of the Global Fight Against AIDS, Tuberculosis, and Malaria, and Jennifer Kates the vice president and director of Global Health Policy & HIV for the Kaiser Family Foundation, moderated by senior analyst Josh Michaud.

This discussion explores the approach taken by the United States to address Global Health funding historically and looking into the future. Discussions on global health funding often involve a division between bilateral approaches to funding versus multilateral funding engagement. Bilateral funding involves the provision of direct assistance from one government to, or for the benefit of, one or more other countries, with the donor having significant control over the target, approach and content of assistance. On the other hand, multilateral organizations such as the World Health Organization, the United Nations and the Global Fund, bring together global stakeholders to develop and collaborate on global health targets.

Historically, the US has commonly supported global health priorities via bilateral funding and programs but the focus on promoting multilateral organizations is growing. For example, the US was the first and is currently the largest donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and a key component of the Obama Administration’s Global Health Initiative includes a renewed and increased commitment to multilateral engagement. The shifting approach has led to questions regarding the appropriate focus for US global health engagement, the proper balance between multilateral and bilateral funding efforts and the appropriate role of the US government and other organizations in international treaties and other collaborative agreements.

Check out this and more global health-related webcasts and other valuable resources on global health policy at the http://www.kff.org/ website. A more detailed discussion on the US Government’s Global Health Policy Architecture is also available.

A recent article in the Christian Science Monitor by the SEVEN Fund’s Michael Fairbanks explores a potential approach to addressing Haiti’s need for long-term economic support. While several different groups have contributed to relief efforts after the devastating January 12th earthquake, many are looking to develop a more long-term solution. A challenge to building private-sector support is the atmosphere in a country where the elite and wealthy have often supported business initiatives which favor big business and are not developed to lend support to those most in need.

In order to create prosperity for the average Haitian citizen, innovative solutions are needed to develop “attractive export market segments to serve with unique products, building new distribution systems, lowering energy costs, and providing skills to Haitian citizens who will be compensated for the high value they create” according to Pierre Marie Boisson, a Harvard-educated, Haitian international banker.

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

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

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