A Global Health Corps Member Starts Her Journey

By Melissa Mazzeo, Global Health Corps 

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I am surrounded by 105 other twenty-somethings at one of the most beautiful college campuses I’ve ever seen. Many of them have backgrounds similar to mine: public health with an international focus and a social justice bent. Others have followed completely different paths: computer science, economics, agriculture. But we share the belief that health is a human right and we are dedicated to ensuring equitable access to health care for all.

We are the fifth class of Global Health Corps fellows, on our way to yearlong placements at health organizations in Africa and the US. Our mission is to apply the skills we’ve developed in our academic and professional careers to improving health care delivery in resource-limited settings. It is a formidable task, but I am ready for it.

After college, I worked for three years at a global health organization in Boston. It was a great experience and I learned more about international development, social justice, and Microsoft Outlook than I ever could have in a classroom. But, after a while, I couldn’t help feeling detached, situated as I was in an office building thousands of miles away from the communities where the organization worked. I was developing skills and gaining knowledge, but I still felt like my understanding of the work was more intellectual than personal. I was inspired by the dedication and passion of my colleagues who worked in the field; I spent my time thinking and writing about global health equity, but they were living it. I wanted to live it, too.

Flash forward to Yale University: my apartment subletted, my passport renewed, and my two fifty-pound suitcases stuffed to the breaking point. My background in fundraising had paid off (pun intended) and I had been selected for a resource mobilization fellowship at Baylor College of Medicine Children’s Foundation, a pediatric HIV organization in Uganda. It’s exactly what I wanted – a chance to use my existing skills and to witness global health work being done first-hand – and I couldn’t be more excited about the challenge ahead of me.

Melissa is living and working in Kampala, Uganda for a year through a Global Health Corps fellowship. Her placement organization is Baylor College of Medicine Children’s Foundation – Uganda. During the year, she will be guest blogging about her experiences.

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The Daily Impact: Hope Amid HIV/AIDS Cure Setback

January 7, 2013

The return of HIV in two patients believed to have been cured is a setback, yet promising development in the effort to cure HIV and AIDS. From Reuters:

True, the news hit hard last month that the so-called “Boston patients” — two men who received bone marrow transplants that appeared to rid them completely of the AIDS-causing virus — had relapsed and gone back onto antiretroviral treatment.

But experts say the disappointment could lay the basis for important leaps forward in the search for a cure.

“It’s a setback for the patients, of course, but . . . the field has now gained a lot more knowledge,” said Steven Deeks, a professor and HIV expert at the University of California at San Francisco.

He and other experts say the primary practical message is that current tests designed to detect even very low levels of HIV in the body are simply not sensitive enough.

As well as having the human immunodeficiency virus (HIV), the Boston patients both also had a type of blood cancer called lymphoma, for which they had bone marrow transplants — one man in 2008 and the other in 2010.

They continued taking antiretroviral AIDS drugs, but eight months after each patient’s transplant, doctors could not detect any sign of HIV in their blood.

In the early part of 2013, both patients decided to stop taking their AIDS drugs and both appeared to remain HIV-free, prompting their doctors at Boston’s Brigham and Women’s Hospital to announce that they may have been cured.

Yet in December came news that one of the men had begun to show signs of an HIV rebound by August, while the second patient had a relapse in November.

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Global Health and Development Beat

Malaria - A new rapid malaria test can determine whether a person has malaria without drawing blood, say researchers.

WASH - Nigerian officials are handing out fines to anyone who defecates in open spaces such as forests.

Polio - Some good news on the polio vaccine effort in Pakistan. A three-day campaign started in the Bajaur Agency on Monday.

CAR - The situation in the Central African Republic continues to worsen, but aid is experiencing a hard path to reach people in need.

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The Players

WHO - Says the fight against malaria has slowed, in a recent report, citing the decline in bednet purchases.

MSF - Says it’s been forced to drastically reduced its medical activities in Bangui airport, Central African Republic, following two days of shooting close to MSF’s clinic at the airport.

Japan - Announced the provision of nearly $100 million in additional aid for Burma to support the country’s peace process.

Europe - The Guardian published a new interactive map of Europe’s development agencies with information about each group.

ECHO - Warns of the problems caused by health disruptions in the Central African Republic for the people who have not been displaced.

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Buzzing in the Blogs

Mission creep in the development sector has seen efforts to improve the conditions of people around the world, lose focus and efficacy. Mark Bellemare makes the case in Foreign Policy and discusses how to get things back in order. He writes:

The development landscape has never been more cluttered than it is today. International organizations such as the UN and the World Bank work side by side with national agencies such as the US Agency for International Development (USAID), nongovernmental organizations such as Oxfam and World Vision, and philanthropies such as the Clinton and Gates foundations. As the number of actors has grown, the definition of development has expanded, leading many in the field to emphasize peripheral goals far removed from the concerns of the world’s poorest. On the New York Times blog edited by Nicholas Kristof, a post titled “Three Things the Development World Could Do Better” put promoting breastfeeding at the top of the list. Some groups even specialize in sending leftover hotel soap to Africa (the Global Soap Project, a partnership with the Hilton hotel chain), teddy bears to tuberculosis-afflicted children (Teddies for Tragedies), and clowns to people in crisis areas (Clowns Without Borders).

But it is not just pundits and those working for niche charities who are shoehorning extraneous goals into the category. Many experts and policymakers consider the following goals among their top priorities: providing universal primary education; promoting gender equality; improving maternal health; and developing “a global partnership for development.” If those aims sound familiar, it is because they are: they are some of the so-called Millennium Development Goals, which the UN announced in 2000 and never really had a chance of achieving by its deadline of 2015. Other organizations have adopted similarly broad agendas. USAID, for example, promotes things as diverse as an independent media, government transparency, cookstoves, ecotourism, and political reconciliation forums.

In all fairness, it is true that the causes of underdevelopment — the market failures leading to persistent poverty — are many and interrelated, so tackling just one problem is highly unlikely to lift villages out of poverty, not to mention regions or entire countries. There are no silver bullets, which is why many development specialists were skeptical of the microfinance fad after Muhammad Yunus and the Grameen Bank shared the Nobel Peace Prize in 2006: even if one could completely eliminate credit market failures by making small loans to the poor, many other market failures would remain that would constrain development. A loan to a poor single woman might allow her to buy a sewing machine and start her own clothes-mending business, but in the absence of insurance markets, she still faces the risk of having to sell off all of her assets (including her sewing machine) to pay for the medical treatment of a sick child.

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Capital Events

Wednesday

9:00 AM - Stories to Watch 2014 - World Resources Institute

12:00 PM - Beneficiary Feedback—Key to Accountability in International Development

Thursday

10:00 AM - Humanitarian Crises in 2013: Assessing the Global Response - Brookings

2:00 PM - Subcommittee Hearing: Will there be an African Economic Community? - Congress

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By Mark Leon Goldberg and Tom Murphy

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Soap will Save Lives, Brands will Increase Use

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Brands might not sound like something that matters for global health. With the approaching Super Bowl, brands are thought of the things that come up with clever commercials to entertain and sell products.

However, that is exactly why they are important when it comes to behavior change, says Sami Singh, Global Brand Vice President for Unilever-Lifebouy. He argues that brands are what grab attention and get people to take action. For example, handwashing is a simple and important way to improve the health of everyone, especially children. Just like Coca Cola and Pepsi will compete to make their cola look cool, soaps should appeal to the everyday consumer.

Then, people will want to buy and use the soap. It is the brand that will help affect change. The soap matters a whole lot, but it has to literally get into the hands of people if it is to have an impact.

That is where brands can make a difference.

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The Daily Impact: Afghanistan Faces Inexplicable Hunger Crisis

January 6, 2013
A worsening hunger crisis is developing in Afghanistan and the reasons are under dispute. From the New York Times:

Afghan hospitals like Bost, in the capital of war-torn Helmand Province, have been registering significant increases in severe malnutrition among children. Countrywide, such cases have increased by 50 percent or more compared with 2012, according to United Nations figures. Doctors report similar situations in Kandahar, Farah, Kunar, Paktia and Paktika Provinces — all places where warfare has disrupted people’s lives and pushed many vulnerable poor over the nutritional edge.

Even the capital has seen an increase. “In 2001, it was even worse, but this is the worst I’ve seen since then,” said Dr. Saifullah Abasin, head of the malnutrition ward at Indira Gandhi Children’s Hospital in Kabul.

Reasons for the increase remain uncertain, or in dispute. Most doctors and aid workers agree that continuing war and refugee displacement are contributing. Some believe that the growing number of child patients may be at least partly a good sign, as more poor Afghans are hearing about treatment available to them.

What is clear is that, despite years of Western involvement and billions of dollars in humanitarian aid to Afghanistan, children’s health is not only still a problem, but also worsening, and the doctors bearing the brunt of the crisis are worried.

Nearly every potential lifeline is strained or broken here. Efforts to educate people about nutrition and health care are often stymied by conservative traditions that cloister women away from anyone outside the family. Agriculture and traditional local sources of social support have been disrupted by war and the widespread flight of refugees to the cities. And therapeutic feeding programs, complex operations even in countries with strong health care systems, have been compromised as the flow of aid and transportation have been derailed by political tensions or violence.

Perhaps nowhere is the situation so obviously serious as in the malnutrition ward at Bost Hospital, which is admitting 200 children a month for severe, acute malnutrition — four times more than it did in January 2012, according to officials with Doctors Without Borders, known in French as Médecins Sans Frontières, which supports the Afghan-run hospital with financing and supplementary staff.

One patient, a 2-year-old named Ahmed Wali, is suffering from the protein deficiency condition kwashiorkor, with orange hair, a distended belly and swollen feet. An 8-month-old boy named Samiullah is suffering from marasmus, another form of advanced malnutrition in which the child’s face looks like that of a wrinkled old man because the skin hangs so loosely.

Médecins Sans Frontières helped Bost Hospital nearly double the number of beds in the pediatric wing at the end of last year, and there are still not enough — 40 to 50 children are usually being treated each day, mostly two to a bed because they are so small. Nearly 300 other children, less severely malnourished, are in an outpatient therapeutic feeding program.

Now, M.S.F. is planning to open five satellite clinics with intensive feeding programs in Lashkar Gah to take the pressure off the overcrowded hospital.

Despite the increase in the malnutrition caseload, doctors and health officials are not sure there has actually been a sharp rise in child malnutrition that can be attributed to any single factor.

“It’s quite an unusual situation, and it’s difficult to understand what’s going on,” said Wiet Vandormael, an M.S.F. official who has helped coordinate with Bost Hospital.

In part, expansion of the hospital’s facilities has acted as a magnet, drawing more cases, Mr. Vandormael said. Unlike at other public hospitals in Afghanistan, patients and their caregivers do not have to pay for their own medicine and food at Bost. And M.S.F. has been able to ensure that it gets regular deliveries of Unicef-provided therapeutic foods used to treat malnutrition.

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Global Health and Development Beat

Poverty - The 50 year war on poverty in the US has produced a mixed bag of results, reports the New York Times.

The Plague - Officials confirm new cases of the bubonic plague in Peru. (in spanish)

Polio - A report from the Inter Press Service describes how the Taliban is a stumbling block to polio eradication in Pakistan.

Measles - The measles outbreak in the Philippines is a threat to many parts of metro Manila, warns the Department of Health.

Polio - Polio vaccines remain on hold due to a lack of agreement between political administration officials and polio workers in Pakistan’s Khyber Agency.

Flu - Reports of a human case of the H7N9 flu in eastern China.

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The Players

World Bank - Questions are being asked over whether World Bank activities in Honduras are causing more harm than good.

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Buzzing in the Blogs

A New York Times board editorial remarks on the health crisis in Syria. They write:

Immunization coverage in what are now mainly opposition areas was already below accepted standards in 2011, but the situation has deteriorated. Data on routine immunization from the World Health Organization reveal that over the past two years a large proportion of the Syrian population has gone without vaccination.

Across Syria, coverage went down to 60 percent in 2012, and was as low as 50 percent in the embattled eastern city of Deir al-Zour, a front line between government and rebel forces. The latest W.H.O. figures from 2013 show that the level is now down to 36 percent in largely rebel-held Deir al-Zour Province, although it has remained at 100 percent in government-controlled areas such as the western stronghold of Tartus.

Given these conditions, it was no surprise to medical practitioners that a polio outbreak occurred. The question is why the international community did not prepare better for this eventuality. A disturbing part of the answer is that the United Nations itself has aggravated the situation.

Like other United Nations agencies, the World Health Organization works directly with the Syrian government. The W.H.O.’s Syria office is in the Ministry of Health building in Damascus; many of its staff members are former ministry employees. A recent Reuters report on how the Assad government uses red tape and threats to prevent the provision of aid in opposition areas has raised doubts about the ability of the W.H.O. to act with impartiality.

The W.H.O., working with the Syrian government, excluded Deir al-Zour from a polio vaccination drive that began in December 2012. According to the W.H.O., the province “was not included in the campaign as the majority of its residents have relocated to other areas in the country.” Ten months later, this was the province where polio re-emerged.

There is no evidence that most of the province’s one million residents had, in fact, migrated. The United Nations World Food Program continued to distribute food there throughout 2012 and 2013 (with occasional interruptions because of worsening security conditions). In December 2012, the agency reached 69,000 people in Deir al-Zour.

Last month, an investigation by the German weekly newsmagazine Der Spiegel charged the W.H.O. with obstructing the testing of polio samples from the Deir al-Zour region. These samples had been presented by an agency working under the aegis of the Syrian National Coalition. It took nearly a month to get the test results — positive for poliomyelitis — and then only from an independent provider in Turkey. By that time, thousands of displaced people had moved within Syria or fled as refugees to neighboring countries, most likely spreading the disease.

The latest draft of a W.H.O. situation report for Syria reveals that it took three months for the W.H.O. and the Syrian Health Ministry to confirm a polio case detected in Aleppo in July 2013. It was then some weeks before a nationwide vaccination campaign began.

The consequences of these delays and failures now reach well beyond Syria’s borders. Lebanon and Jordan, where a large proportion of Syrian refugees have fled, are particularly at risk. Their public health systems are already overloaded and underfunded. Unicef figures for immunization from the Lebanese Health Ministry indicate that only 77 percent of the population had been routinely covered for polio in recent years, placing thousands of Lebanese children at risk. “If the Unicef figures are correct, then this would be far too low to keep an introduced infection at bay,” said Professor Martin Eichner, a disease expert at the University of Tübingen, Germany. “With 4,000 Syrian refugees a day leaving the country, and the majority entering Lebanon, the virus is already in Lebanon or they will get it sometime soon.”

There is also no discernible plan for delivering vaccination coverage to the hundreds of tented settlements that house as many as 200,000 Syrian refugees across Lebanon.

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Capital Events

Monday

3:00 PM - Korea’s Growing Influence in the Global Economy

Wednesday

9:00 AM - Stories to Watch 2014 - World Resources Institute

12:00 PM - Beneficiary Feedback—Key to Accountability in International Development

Thursday

10:00 AM - Humanitarian Crises in 2013: Assessing the Global Response - Brookings

2:00 PM - Subcommittee Hearing: Will there be an African Economic Community? - Congress

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By Mark Leon Goldberg and Tom Murphy

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Integrating HIV prevention and family planning for a better future

“My children are my main motivation. The most difficult thing I’ve ever done is raise them on my own”, says Rocío, a 27 year mother of two children working in a brothel in San Salvador.

Rocío was first contacted by PSI’s Central American affiliate, the Pan American Social Marketing Organization (PASMO) under the Combination Prevention Program for HIV, funded by the United States Agency for International Development (USAID). Aracely Corado, PASMO El Salvador’s outreach worker, met Rocío when conducting behavior change communication activities in her workplace.

Under the combination prevention approach, PASMO also provided referrals to biomedical services such as HIV counseling and testing and STI screening, in addition to referrals to other complementary services such as the prevention of violence, alcohol and drug abuse, and referrals to family planning services.

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The Daily Impact: Berlin Hospital Treats FGM/C Victims

January 3, 2013

A new medical facility in Berlin is helping out and treating victims of female genital mutilation/cutting. From NPR:

Mama Afrika’s Kaba says most of the women in this sewing class had part or all of their external genitalia cut off years ago. The practice is a long-standing tradition across religious lines in most of Africa and in parts of Asia and the Middle East.

The World Health Organization says about 140 million women and girls are living with medical issues like incontinence or abnormal growths called fistulas, as well as psychological consequences of the procedure.

Proponents of the practice – most of whom are women – argue that cutting girls in this manner enshrines their purity and virtue.

Kaba says her clients may live in Berlin, but they are still firmly entrenched in the culture of the countries they left behind. So when she tells the women about the medical facility a short drive away that can make them whole, most of them change the subject.

One student in the sewing class eventually admits that she’s interested in getting the reconstructive surgery. She’s the wife of an African diplomat and, fearing retribution from relatives, asks NPR not to name her.

She hopes that if the doctors rebuild her genitalia, sex will be easier and more enjoyable for her, she says.

But the diplomat’s wife says she hasn’t gone to the center because she’s afraid her husband won’t approve. She’s also worried about her young daughters. Their relatives are already talking about circumcising them when they return to Africa.

The older daughter is 9 — the same age her mother was when she was circumcised.

Kaba explains that in many African nations, a woman is considered unclean if her genitalia are intact.

It’s that belief — plus her aunt’s promise of gifts and a big party – that Berlin resident Jenny says drove her to get circumcised more than two decades ago in Sierra Leone. She agrees to be interviewed, but asks that her last name not be used.

Jenny says she was 19 at the time she was cut, making her older than all of her friends who had the procedure done.y

“They were laughing at me, saying: ‘Look at her,’ ” Jenny explains. “They were telling me I’m unclean, I’m dirty — so you are tempted to do it.”

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The Daily Impact: WHO warns of Disease Outbreak in South Sudan

January 2, 2014

Warns of a looming risk of disease outbreaks in South Sudan, where violence has displaced more than 190,000 people since mid-December. From the AP:

The World Health Organization is warning of a looming risk of disease outbreaks in South Sudan, where violence has displaced more than 190,000 people since mid-December.

WHO said in a statement received Wednesday that there was a shortage of health care workers, with many fleeing their homes for safety in areas hit by violence.

Although the warring factions said Tuesday they were ready to start peace talks mediated by Ethiopia, fighting persists in Jonglei, the country’s largest state.

Foreign Minister Barnaba Marial Benjamin said Wednesday that a government delegation would arrive in Ethiopia later Wednesday for peace talks.

South Sudan’s government insists unrest across the country started when forces loyal to former Vice President Riek Machar, who now commands renegade forces, mounted a failed coup attempt on Dec. 15.

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The Daily Impact: Activists Warn of AIDS Setback in Uganda

December 24, 2013 The recently passed Anti-Homosexuality Bill in Uganda would deliver a major blow to the response to HIV/AIDS if it was enacted by President Yoweri Museveni, warn activists. From IRIN: Civil society activists fear that high-risk groups such as men who have sex with men (MSM) and sex workers – whose HIV prevalence is […]

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The Top 10 Global Health Moments in 2013

By Karl Hofmann, President & CEO, PSI

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The end of each year provides the opportunity to reflect on what transpired and what was accomplished. Global health saw plenty of victories and setbacks in 2013. Drug resistant TB, slowing donor funding, new outbreaks of polio and a devastating typhoon showed how easily progress can stall.

Amid these challenges emerged a changing global health landscape. The old way of doing things is now, more than ever, on its way out. In the next five years, the range of actors that are engaging and making a difference in addressing global health issues will continue to broaden and expand, even as the underlying health challenges narrow, and as The Lancet recently described, converge.

The infrastructure that developed over the last 50 years to tackle global development – the United Nations, donor agencies, international NGOs, other intermediaries and host governments – now finds itself working more and more with corporations, impact investors, next generation philanthropists, and socially networked individuals. This burgeoning ecosystem of development actors generates unprecedented attention and potential resources to address global poverty. Getting the roles right for these and other players might have a lot to do with whether we can end extreme poverty during our lifetime.

These are our top 10 moments for global health in 2013. Top 10 lists inevitably leave lots out. What did our global health and development leaders miss? Let us know what you think and share a few of your predictions for 2014.

1. Typhoon Haiyan

We include Haiyan not only for the unimaginable devastation it caused but as a reminder that when the media attention wanes and the world moves on, the health needs of the people affected will still be great.

“We will continue to serve these communities’ immediate needs, as well as long-term needs including child and maternal health; nutrition; water, sanitation and hygiene; and mental health services.” - Nancy A. Aossey, President & CEO of International Medical Corps

2. Malala Yousafzai’s Ripple Effect on Family Planning

The impact of Malala Yousafzai’s efforts on education is obvious, less so is the impact she will have on the reproductive health of girls and women. If Malala has her way, girls will not only be better educated, they will have healthier families, build stronger communities and contribute to more robust economies.

3. Polio Movement Celebrates Successes, Faces Setbacks

The world is watching how the polio community will overcome conflict and violence to eradicate polio by 2018.

4. Global Leaders Show Unprecedented Support for Maternal and Child Health

In September, The World Bank, UNICEF, USAID, Norway committed $1.15 billion over the next three years to advance progress toward Millennium Development Goals 4 and 5, and to get essential services and medicines to women and children who need them most.

5. Women Philanthropists Align for Health and Rights of Girls and Women

Women philanthropists are catalysts for new, innovative ways to deliver life-saving health products that will improve the lives of girls and women throughout the world. They are engaged and here to stay.

6. Gender-based Violence Movement Sees Tipping Point

World leaders acted on their commitments to eliminate gender-based violence, signaling a tipping point in the fight. Momentum is behind the movement. This is an issue to watch in 2014.

7. Under Mark Dybul’s Leadership, the Global Fund Is Back and Better than Ever

An impressive level of financial commitment from existing and new donor governments sends a strong signal.

8. Global USAID-Walmart Partnership Solidifies Long-Developing Trend

Public-private partnerships are not new. It is the magnitude of USAID’s partnership with Walmart that made us stand up and take notice.

9. Drug Resistance Threatens TB Progress, New Drugs Show Promise

By many measures the world is making great progress against TB – the rate of new cases has fallen worldwide and new drugs are in development – yet drug resistance seriously threatens that progress.

10. Women Deliver Conference Secures Bold Commitments for Girls and Women

More than 5,000 people gathered at Women Deliver in Kuala Lumpur, Malaysia, to promote the health of girls and women, adding additional momentum to what economists, government donors, philanthropists conclude: when you invest in the health of girls and women, you lift.

Read the latest edition of PSI’s Impact Magazine here.

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