Global Pulse Blog

In this 60-Second Health podcast from Scientific American, Paul Farmer purports that equity is the best approach to evaluating and addressing global health issues.

What are your thoughts on framing international health issues in terms of fairness and equity?

Today, the second annual International Conference on Family Planning (ICFP)  in Dakar, Senegal began. This conference is co-hosted by The Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Ministry of Health and Prevention in Senegal to bring together participants to share research, best practices, and progress on national strategies to deliver family planning services, with the ultimate goal of universal access to family planning.

Currently, over 215 million women worldwide want but do not have access to family planning tools. “We’ve made a lot of progress in putting maternal health on the global agenda; now we must call on leaders to put family planning on their to-do list. Every individual deserves this – women, men, and young people,” said Jill Sheffield, President and Founder of Women Deliver.

These speakers reinforced the importance of the demographic dividend – the concept that health and social development, enabled by full access to contraception, are inextricably linked with strong economic growth. They provide examples of success in Asia, where declining fertility, spurred by rising contraceptive use, have led to increased education, improved health, and market-driven economic policies which have allowed for significant income growth.  With an expanded world population of over seven billion, “Now is the time to prioritize family planning – as a strategy to reduce maternal mortality, to improve the lives of women and their families, and ultimately, to enable broad and enduring economic development,” said Dr. Amy Tsui, Director of the Gates Institute for Population and Reproductive Health, Professor at Johns Hopkins Bloomberg School of Public Health, and a lead conference organizer.

To proceed into the future, investments must be made in the health sector maintaining adequate numbers of midwives, OB/GYNs, facilities, etc. and examining past successes around the globe. As Hon. Stephen O’Brien stated, “having a child should bring joy” not dying in childbirth and women must be able to plan for the future. Family planning is smart and cost-effective. As Dr. Osotimehin stated, we must empower young people to take control of their futures along with the future of their countries and make sure that economic and social justice drives this process. Issues of family planning are issues of human rights.

According to Judy Manning from USAID, their priorities include: 1) Improve existing methods to make them more acceptable, easier to use and more affordable like injectable forms of contraceptives. 2) Develop new contraceptives to fill gaps such as duration of effectiveness between 3 month injectables and 5 year inserted rings. 3) Develop technologies that simultaneously prevent pregnancy, HIV & other STDs like the silk diaphragm which delivers tenofovir.

Clearly there is an immense need for family planning access, affordability, and effectiveness. Fortunately, there are also attainable solutions. Meetings such as ICFP brings together a wealth of scientific knowledge, family planning experience, and critical discussions to help ensure that universal access to family planning becomes a reality.

Today, September 26, 2011, marks the 5th annual World Contraception Day. This multinational campaign aims to draw awareness to the need for contraception access globally, targeting teenagers between the ages of 15 and 19, as they are often the most inexperienced in using contraception. This year’s theme is “Live Your Life, Know your rights, Learn about contraception” strives to bring attention to the right of young people to access accurate and unbiased information about contraception in order to prevent an unplanned pregnancy or sexually transmitted infection (STI) As USAID states, “every individual that wants them should have access to contraceptives and condoms for family planning and for HIV/AIDS prevention.”

Share

Youth Task Force: Who is who

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.

This event is organized by the New York Medical Student Coalition Against Torture (NYMSCAT@gmail.com). Email to learn more, request materials, and get involved!

As I have written previously, medical professionals, students, and human rights groups in New York State are teaming up for action to pass the nation’s first law holding medical professionals accountable for assisting torture and abuse of prisoners.  AMSA is proud to join the list of organizations putting their support behind the proposed legislation:

• National Physicians Alliance
• Committee for Interns and Residents
• American College of Physicians-NY
• NY State Nurses Association
• NY Civil Liberties Union
• Center for Constitutional Rights
• Human Rights Watch
• Amnesty International
• Physicians for Human Rights
• I Have A Dream Foundation
• Metro NY Religious Campaign Against Torture
• (full list and statements at whenhealersharm.org/)

ANTI-TORTURE LOBBY DAY in Albany: Join AMSA and PHR with medical students from across the state in our first Anti-Torture Lobby Day in Albany on May 18th!  This is our chance to meet with our local lawmakers and tell them that ending torture is important to us as ethical medical professionals and Americans.  We will meet at 9AM for a white-coat press conference and advocacy training with experts from the Bellevue/NYU Program for Survivors of Torture, and follow up with advocacy meetings.  If you are a NY State resident and a medical or pre-medical student, don’t miss this chance for real-time local action for human rights!

Don’t forget to sign the petition: Stop Torture NY.org

Read AMSA’s statement of support after the cut:

Read the rest of this entry →

Global Health Watch 3
Examining the World’s Health from an Alternative Perspective
Call for Case Studies and Testimonies
Contribute to the Alternative World Health Report

The Global Health Watch provides a platform for activists  to share experiences and inform each other with practical examples and theoretical analyses  to strengthen local, national, regional and global campaigns towards  Health for All!

This is a great way to get involved with the People’s Health Movement from a research/academic standpoint.

How you can voice your views:

The Global Health Watch is putting out a call for the submission of country or region specific case studies and testimonies. These case studies and testimonies will form part of the electronic platform of the alternative world health and selected case studies shall also be incorporated into the final document of Global Health Watch 3 – scheduled for publication in 2011.

Some suggestions: Read the rest of this entry →

This month’s issue of Academic Medicine includes a series of essays addressing the question, “How should academic medicine contribute to peace-building efforts around the world?” This timely question is especially compelling in the United States, as national discourse continues about troop levels in Afghanistan, military strategy in Iraq, and whether and how the US should help stop the genocide in Darfur. Read the rest of this entry →

Sisters Vidalia, left, and Maribel Agustin, who suffer from malnutrition, sit at a shelter in Guatemala in August.

Read the rest of this entry →

From the University of Pennsylvania Press, comes a new book titled Reproductive Health and Human Rights: The Way Forward.  Edited by Laura Reichenbach of the Population Council and Mindy Jane Roseman of Harvard Law School, the book reflects on the past fifteen years of international efforts surrounding health, poverty, and gender inequality, with special focus on the consequences of the 1994 United Nations International Conference on Population and Development (ICPD) and its resulting Programme of Action.

From the publisher’s website:

The book grapples with fundamental questions about the relationships among population, fertility decline, reproductive health, human rights, poverty alleviation, and development and assesses the various arguments — demographic, public health, human rights-based, and economic — for an against ICPD today.

A number of the chapters address institutional challenges to ICPD and consider how the challenging political, religious, academic, and disciplinary contexts matter.  Other chapters engage operational and conceptual issues and whether ICPD has been able to move the reproductive health agenda forward on topics such as maternal mortality, abortion, HIV/AIDS, adolescents, reproductive technologies, and demography.  Finally, several chapters examine how ICPD has been sidelined by emerging health and development agendas and what could be done in response.  Unlike any book yet published, Reproductive Health and Human Rights: The Way Forward examines the state of the arguments for reproductive health and rights from a multidisciplinary perspective that provides policymakers, scholars, and activists with a better understanding of how reproductive health and rights have developed, their place in the global policy agenda, and how they might evolve most effectively in the future.

To read an excerpt from the book, click here.