Collaborating to support people with NCDs in Uganda

By Greg Paton, Technical Advisor, Uganda NCD Alliance.  Kampala, Uganda

“What could I have done to prevent my cancer?”

UNCD Premises

This question was posed to me by a mother living in a small hut on the outskirts of Kampala, Uganda. The nurse informed me that the women had advanced colorectal cancer and was no longer responding to treatment. I found myself at a loss for words.

I was accompanying the mobile palliative care team at Hospice Africa Uganda on their weekly rounds to distribute free morphine. As the nurse shared key cancer prevention strategies – early screening, avoiding tobacco, eating healthy and regular exercise – the woman pledged to educate others in her village, offering hope that her experience with cancer could be used to empower and educate her peers.

Eight months after moving to Uganda, the overwhelming statistics that framed my perception of these conditions have been replaced by human stories. Poverty is the narrative of these stories, and the poor and vulnerable are the central characters.

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One Year Later: From Promise to Action on Ending Preventable Child Deaths

By Nicole Schiegg, Former USAID Senior Advisor; Strategic Comms Consultant

2013-06-13-430045_10151726897765992_1502893062_n.jpgThis week we celebrate the one-year commemoration of the Child Survival Call to Action held in Washington, DC. Working at USAID at the time, I have a unique insight into the organization of this milestone event, and will always remember the experience fondly. Not only did the Call to Action unite and reenergize the global health and extended community towards a common goal — to end preventable child deaths — it catalyzed momentum at country-level that has been nothing short of extraordinary.

A few months before the Call to Action, USAID turned a conference room into a team room that became the center of the Agency’s activity – one wall was covered with hundreds of 5th birthday photos and the other was entirely dry eraser depicting ideas, logistics, and anything else that was the task of the day. About 6 of us virtually lived in this room, but it packed in 30 staff when we had our all-hands meetings. What inspired me about the team is that it consisted of people who had worked in development for their careers and folks who were brand new to the field. Everyone had a laser-like focus towards June 14-15 and what it represented. No one was committed more to this goal than USAID Administrator Raj Shah who frequented the team room for meetings and updates.

The Call to Action was a special and surreal experience when it finally arrived. A few days after it ended, I had to re-watch the webcast to grasp the enormity of what had transpired. Over 70 countries signed a pledge to accelerate action towards ending preventable child deaths. Private sector leaders committed to new partnerships – as did faith and civil society organizations.

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Why non-state education and why CEI?

By Nicholas Burnett, Managing Director for Education at Results for Development Institute, leader at the Center for Education Innovations

I was in Ghana earlier this year, where as many as two-thirds of the children living in slum areas outside the capital of Accra are estimated to attend private schools, quite a few of which I visited.  Though some think it unfortunate, the poor are increasingly enrolling in non-state schools in Africa and in South Asia, as they have for many decades in Latin America.  These non-state schools include those run by non-government organizations and those owned and operated by private proprietors.

Why do I say some think it unfortunate? We believe far too many people come to the table with preconceived notions about what works and what doesn’t work in education, all too often based on labels such as “public” and “private,” and too rarely based on evidence and results. But, as we move toward 2015 with the Education for All and Millennium Development goals clearly not going to be met, in terms of either enrolment or quality, it is time to move beyond ideology and focus pragmatically on harnessing all parts of the education system and on what works in practice.

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Cross Post: Winning the Fight Against Malaria at All Costs

By ZP Heller; This originally appears in The Interdependent

Recently, Dr. Mark Dybul, the newly appointed executive director of The Global Fund to Fight AIDS, Tuberculosis and Malaria, wrote an impassioned plea in The Huffington Post, underscoring the urgency of funding disease prevention and treatment programs throughout the world.

“When health professionals working in cities, towns and rural areas in countries around the globe can take action to actively limit the spread of infectious disease, everyone benefits,” Dybul contended. “Not just the patients, who maintain or regain their health, and not just their families which are immediately affected. It is also the larger communities and regions and countries whose economies and social fabric thrive on a healthy population.”

Dybul’s article comes on the heels of the World Health Organization’s World Malaria Report 2012, which revealed an alarming reduction in global funding for malaria prevention and control between 2010 and 2012. A mosquito-borne disease, malaria impacted 219 million people globally in 2010, killing 660,000, mostly children under five. Yet both WHO and anti-malaria campaigns remain convinced that malaria can be both prevented and treated.

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Every Birthday Starts with the Golden Minute

Members of the Helping Babies Breathe Global Development Alliance

Every child deserves a fifth birthday. To reach five years, though, a child must take his or her first breath of life in the first minute following birth. The World Health Organization estimates approximately one million babies die each year from birth asphyxia, a condition in which babies do not breathe on their own immediately following delivery.

Developed by the American Academy of Pediatrics, the Helping Babies BreatheSM (HBB) initiative was designed to equip birth attendants in developing countries with the skills they need to successfully resuscitate babies who do not breathe on their own. At the center of HBB is the concept of The Golden MinuteSM: within one minute of birth, a baby should be breathing well or should be ventilated with a bag and mask.

The effectiveness of the HBB curriculum is evident in the lives saved for babies like little Job in Kenya and Shakila’s baby in Afghanistan.  Both were born without a cry and in desperate need to breathe.  When both Shakila’s baby and Job were born, their mothers thought they were dead.  Thankfully, Dr. Shifajo in Afghanistan and Nurse Mary Wekesa in Kenya were trained in HBB, and knew hope was not lost.  They vigorously rubbed and dried the babies. When that did not stimulate them to breathe, they used a suction bulb to clear their mouth and nose, and used a bag-and-mask device to help push air into their lungs until they took their first glorious breaths.

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Living with Tuberculosis: A Personal Note

The following post is by Bryn Sakagawa, Deputy Director, Health and Education Office, USAID Central Asian Republics. It originally appears on the USAID Impact blog.

World TB Day has a special meaning for me, and it is not just because of my job as a USAID Health Officer in Kazakhstan.  It is because every morning for the past four months I have taken a daily isoniazid pill to treat my latent tuberculosis.

Tuberculosis, or TB, is a contagious chronic bacterial infection that is spread through the air and usually infects the lungs. More than 2 billion people—one-third of the world’s total population—are infected with TB bacilli, the microbes that cause TB, but do not show symptoms (latent TB). In the United States, between 10 and 15 million people are infected with latent TB. In other parts of the world, like in Central Asia, this number is much higher.

I found out that I had latent TB at the exam to get my first medical clearance as a foreign service officer. I suspect that I was exposed to TB while I was a volunteer in Indonesia years before. Although I was shocked and worried when I got the diagnosis, the nurse reassured me and explained that latent TB is widespread in many developing countries and that there are options for treatment. I was pregnant then so isoniazid treatment—what I’m taking now—was not an option.

I learned soon after I was diagnosed with latent TB that anyone—grandparents, fathers, mothers, and children—can be exposed and infected. In the three minutes that it will take you to read this blog post, nine people will have died from TB. Although my chance of becoming sick with active TB in my lifetime is only 1 in 10, I felt that it was important to mitigate this risk and undergo the six-month treatment regimen. Every year, approximately 2 million people die from TB.

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In TB Fight, a Call for More Teamwork

Joanna Breitstein is the Director of Communications at the TB Alliance. This post orignally appears on the USAID Impact blog.

Robert Clay speaking at the Kaiser Family Foundation. Photo: TB Alliance

At an event heralding the launch of a new clinical trial that tests tuberculosis drugs in combination, Robert Clay, Deputy Assistant Administrator in USAID’s Global Health Bureau, said that he wants researchers and those who oversee programs in countries to work more closely together.

Clay told a packed audience at the Kaiser Family Foundation in Washington, D.C. that “past polarization of research and implementation is really something that we have to overcome.”

“The researchers have to understand the barriers that implementers are facing to work through these programs, and the implementers have to understand the kinds of studies that are being carried out, and looking at these results to translate that in real time to policymakers,” he said. Clay said these kinds of working relationships were especially important in a time of tight financial resources. Speaking about efforts to fight TB, he said, “No one group can address this alone. … We’re going to have to be working together to grow the pie.”

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What’s Next for Saving Face After the Academy Awards?

The following post is by Abraar Karan, Yale Parker Huang Research Fellow, and originally appears on his blog.

I had the privilege of attending a private screening of Saving Face, the winner of Sunday night’s Oscar for Best Documentary (Short Subject), followed by a Q & A with one of the directors, Daniel Junge, and one of the documentary’s protagonists, Dr. Mohammad Jawad, a British-Pakistani plastic surgeon whose work the film revolves around. On a quick side note, Dr. Jawad was the also the surgeon who operated on British model and acid victim Katie Piper who recently had her eye sight restored through stem cell therapy. In short, Saving Face is about Dr. Jawad’s journey back to his home land of Pakistan where he works to reconstruct the faces of women who have suffered acid attacks by their husbands, other males of close relation, and sometimes even other women. The reasons cited by attackers in many of the countries where acid violence is an issue are multifold- refusal by the women to accept unwanted marriage proposals, basic petty arguments in the house over minor issues, and even attempts to simplypursue education as a woman. The film interviews several survivors of these attacks, mostly women from rural areas, and focuses on two main characters, Zakia and Rukhsana, who are both victims. One of the sub-plots includes Zakia’s court case against her husband which she eventually wins through the application of a recently passed Pakistani bill that sentences between 14 years and life in prison, as well as a $14,000 fine for men who are perpetrators of acid attacks. Throughout the documentary, several women’s faces are shown, most of which are gruesomely deformed from the attacks and consistently elicited waves of shocked gasps from the audience. I whole-heartedly applaud Daniel Junge and Sharmeen Obaid-Chinoy (the other director) for giving these women a voice to the rest of the world, and to Dr. Jawad for using his plastic surgery skills for something other than breast implants (which he says he also does quite well in the documentary). The government of Pakistan, elated at the indirect receipt of an Oscar, has also declared that Ms. Chinoy will be presented with Pakistan’s highest civil award upon her return.

As always, the question remains: what next? As became more apparent to me at the Q and A, there are far more questions that are still left unanswered. As with all global health and human rights issues, the hope is that these women will still be helped systematically and sustainably after the current publicity has died down. To this extent, Chinoy has announced an anti-acid awareness campaign to begin soon in Pakistan. While I felt that the documentary was great for “awareness,” I still felt immobilized in my seat in an amphitheater in America because of the dire complexity of the issue at hand. Throwing acid on a woman’s face is a symptom of a much larger, more pervasive, more culturally ingrained problem of misogyny and patriarchy in South Asia and the Middle East. While these forces still exist globally, they are more prevalent in the aforementioned regions. At one point, Dr. Jawad characterized the problem as being “local and focal” and unrelated to religion, culture, or the society at large because most people would not condone acid attacks. Sure, if asked directly, most people would probably denounce attacking someone else with acid, but I disagree that society, culture, and as culture’s corollary, religion, are not to blame (I argue not against religion itself but men’s attempts to irrationally apply it to defend culture). I believe the three are closely intertwined and reinforce one another.

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Working Together on Global Health

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Vaccinating Children is a Social Responsibility

The following posts is by Martha Kempner and originally appears on the RH Reality Check Blog. The opinions stated are that of the author and are not necessarily those of PSI.

Vaccines Save Lives: Every Child, EverywhereSo, I am that mom on the playground, the one who—while happy to play with my kids— craves adult interaction and looks for opportunities to strike up conversations with other parents.  It’s actually pretty easy (presumably because other mothers find pushing a toddler on a swing as mind-numbingly dull as I often do). I comment on similarities between our kids, something mine is doing, or something hers just said and nine times out of ten we are deep in discussion about our lives and experiences with motherhood within five minutes.  We trade stories and advice about sleep training, breast feeding, potty training, discipline techniques, daycare, and pediatricians.

Of course, I always try to be careful not to be too opinionated during these conversations.  In my liberal New Jersey town, I can be almost certain that the random playground mom agrees with my politics but parenting issues are so much trickier.  I never know who is going to agree with my stance on sleep training (just turn the monitor off, the kid will stop crying eventually) and who will think I’m barbaric; who will agree with me that jarred food is really just as good as pureeing it yourself and who will think I’m lazy; or who will view the sleep fairy (the one who gave my daughter a present every morning that she slept in her own bed the year she was three) as a cute invention by a desperate mother and who will think I was just too wimpy to get bedtime right.  And, yes, before you say anything, the reason I fear the judgment of other parents is clearly because behind the smiling and nodding I’m judging them as well.

Still, in nearly all of these conversations—even if our parenting styles are radically different—we can find a common ground on which to bond and commiserate. There is one topic, however, that I just try to avoid—vaccines. A friend once described it as the third rail of parenthood.  Just don’t touch it.

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