Author Archives: Jessica Evert, MD

South-South Collaboration

The 19th Annual GHEC Conference and the 1st Latin American and Caribbean Conference on Global Helath

GHEC - INSP Conference 2010 Cuerenavaca, Mexico

Of course, the planning for a conference like this happens more than a year in advance so as we are gathered comfortably here in Curenavaca, Mexico, having important discussions and sharing of ideas, it is important to look back and see all that has happened along the way on the journey to Cuernavaca. Not long after the decision to have the conference, came the outbreak of H1N1 in 2009 and many questioned the wisdom of continuing with the conference plan especially with the fear that a repeat flu outbreak could happen in early 2010.

More fundamentally, the intention of this conference –different, I think, from other South-South conferences– is to have the South participants truly take the lead. “The idea from the beginning was that the North participants are the guests and are primarily coming to learn” said Karen Lam, the Global Health Education Consortium (GHEC) Program Manager. With its almost 20 year history and strong following, GHEC has been able to bring the numbers that frankly support the undertaking of a major conference like this and make it financially feasible. The back story is all the effort to truly make it a success. GHEC has partnered with the Instutio Nacional de Salud Publica (INSP) here in Cuernavaca. INSP is the conference venue and has been a great host for this event. Both INSP and GHEC are to be highly commended for all the hard work to bring this event to a reality and in such a successful way!

“The vast majority of the presentations are by and from the perspective of the South participants,” Lam pointed out. Sessions are covering everything from Ethics and Equity Issues, to Global Health Diplomacy, to Public Policy, and Social Determinants of Health.

It is encouraging to see so many Mexican, Caribbean, and South American students able to be a part of this conference and to see the work of the collaborations of their fellow students and teachers so prominently featured. So far the sharing and exchange of ideas is stimulating and leaves one hopeful for all the collaborations that will now have their beginnings here in Cuernavaca.

Educate Advocate Empower -SNMA 2010

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Report from the Student National Medical Association 2010 Conference

SNMA Conference 2010 Chicago

It is early Spring in Chicago and this is my first visit to the Student National Medical Association (SNMA) annual conference. The SNMA is the oldest and largest independent student-run organization focused on the needs and concerns of medical students of color. CFHI has supported this conference in the past and we have been happy to have the help of the SNMA in increasing awareness of CFHI programs to more and more students. We have been looking forward to actually being here this year and as the conference begins, it is clear that the students who have assembled on this balmy weekend in Chicago have a great deal of interest and wonder about Global Health.

From the CFHI Table at the 2010 SNMA Annual Conference in Chicago

It is only the first day of the conference and the stream of students who have come to learn about CFHI programs has been almost nonstop. This medical education conference carries the title Healthy Impact 2010: Educate, Advocate, Empower. The goal is to further the SNMA mission to support the pursuits of current and future underrepresented minority medical students and successfully train clinically excellent, culturally competent, and socially conscious physicians. The organization of the conference and its program are as impressive as the seriousness of the students.

Not even 24 hours on the ground here in Chicago, and already I have met CFHI alumni from CFHI programs in Bolivia, South Africa, and India. I look forward to the coming days and the sharing of ideas and experiences.

A Dental Program for International Students

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One of CFHI’s newest programs is a Dental Program set in Quito, Ecuador.

CFHI Global Health Dental Program

CFHI is happy to partner with the Sonrie Ecuador Clinics to provide an outstanding program for pre-dental and dental students who want to understand how oral health is approached in a different culture and a different healthcare system.

The “Sonrie Ecuador Clinics” provide dental care and promote oral health in Quito and its surrounding neighborhoods. The clinics have been operating for over twelve years and continually strive to better the services offered to their patients give attention to the dental health. In general, the main dental problem seen by Ecuadorian dentists is cavities. Ecuadorians are considered to be concerned about their dental health, although adequate oral hygiene is not, in reality, reported amongst the majority of the population.

This program will provide a rich and diverse experience for pre-dentistry and dentistry students, allowing them to view local oral health practitioners providing close to world class care in a developing country while at the same time improving their cultural competency and broadening their public health knowledge. Ecuadorian dental professionals who work in a country are interesting and thought provoking as they give context to the real challenges of providing the best possible dental care to the different socioeconomic classes of Ecuador.

Nurses Rule

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Today, I had the good fortune to be at the Oregon Student Nurses’ Association Convention 2010 at the University of Portland. CFHI was happy to be one of the sponsors for the event. Approximately 300 nursing students from across the state assembled for their annual meeting. It was a great reminder for me of the importance of nursing in our own healthcare system and it made me think of the pivotal role of nursing in so many of the countries where CFHI works.

CFHI local Medical Directors from Mexico to India have often taken great care to point out to me the specific and vital contribution of nursing in their own healthcare systems. In New Delhi, for example, CFHI Medical Director Dr. Vimarsh Raina has made a great commitment to raising the awareness of the Indian youth to nursing as a career and for advancing the skills of nurses. CFHI has been happy to assist Dr. Raina in providing some scholarships over the years to help make nursing education available to young people who might otherwise not be able to afford such an opportunity. Then, of course, there is our own CFHI Medical Director in Cape Town, South Africa, Mrs. Avril Whate, who herself is a Nurse Practitioner and a Certified Midwife. With an impressive long career in a healthcare system that has faced many significant challenges, she is very adept a helping international students of all health professions process the profound experiences that they have while on CFHI rotations in Cape Town. She actually has the fan club to prove it. Recently, Avril and the CFHI Local Coordinator for Cape Town, Marion Williams, were able to visit the United States. During a multi-city, cross-country tour, there was an outpouring of CFHI alumni –many who are now nurses and doctors— who turned out to welcome and reconnect and to say thanks.

Back to Portland, where today’s convention carried the theme: The Future or Nursing,

The Future of Nursing Oregon Student Nurses Association Convention

and clearly, I was able to meet and talk with a real slice of the future of nursing and I was very happy to see a healthy appetite among them for all things related to Global Health. CFHI’s Global Health Immersion Programs have had many many nursing students over the years and we are happy to welcome the new generation. If the passion, motivation, and commitment I saw today in Portland are any indication of the level of interest in Global Health among today’s nursing students in general, then it is indeed a good day for Global Health.

Communication Skills for Medical Students and Other Health Science Students

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Empathic Listening Training for Health Professionals

Professionalism as a component of medical education is something we all know is important but can be hard to effectively impart and even harder to measure. Students who want to improve their professional skills report that it can be difficult to find effective ways to do so.

One of the most obvious ways that the professionalism of a doctor or medical professional is seen by his or her patients, is through the communication skills that are used on a daily basis. Effective communication is a two-way street and becomes ever more challenging each day as our societies become more multicultural. Empathy spans culture, gender, race, age, and socioeconomic factors that can become barriers to effective communication. The need to be understood is a universal human trait and with the right tools, the medical professional can use that energy to charge the healing process in a positive way instead of just letting that energy create stress, confusion and possibly frustration.

Over the years, many CFHI students have commented that the time spent immersed in another culture, has increased their awareness of others and also their awareness of self. Being in a foreign culture and a foreign healthcare system makes a person aware, sometimes awkwardly aware of themselves and of their assumptions about how healthcare should be delivered. Many of the things that we might take for granted on a daily basis are suddenly removed. The experience is one that is new, different, challenging, perhaps uncomfortable and, at the same time, an amazing opportunity for learning. Here too empathy can play a role. The practice of self empathy can help transform the experience to be one of learning and not just stress.

CFHI is thrilled to present, in collaboration with the Center for Nonviolent Communication CNVC, a two-part training focusing on empathy. This will be a live phone-in training. We encourage CFHI alumni and students preparing to go in CFHI programs to register for this free training.

Choose Your Words Professional Edition by Mel Sears

The Professional Edition of Choose Your Words by Mel Sears

Melanie Sears has been a Registered Nurse for more than 25 years and a certified trainer in effective communication since 1991. Her book, Choose Your Words: Harnessing the Power of Compassionate Communication to Heal and Connect, is an excellent workbook designed to help health professionals be more effective in their communication with both patients and colleagues. Joining her as co-trainer will be John Kinyon, also a certified trainer in communication skills since 2000. John has worked in a number of international settings and has worked with many groups to address the challenges of cross cultural communication.

CFHI is honored and grateful to have Mel and John offer their expertise to CFHI participants.

Global Health South/South Collaboration Conference in Mexico

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The 2010 Global Health Education Consortium’s (GHEC) Conference will be held in conjunction with the Instituto Nacional de Salud Publica (INSP) in Cuernavaca, Mexico. This promises to be an engaging conference. The theme of the conference is Alliances for Global Health Education: Learning from South/South Collaboration. More information on the conference can be found on the GHEC website here.

Those who have worked in Global Health for any period of time, will find the idea of a major conference with the focus on South/South Collaboration to be refreshing. Many conferences have had sessions featuring purely South/South partners but we believe this is the first major conference to have this as its main focus. In addition, it is being identified as the First Latin American and Caribbean Conference on Global Health.

We of course all remember that it was almost one year ago that many of the first reported cases of the A(H1N1) Virus were identified as occurring in Mexico. Clearly Mexican health workers and scientists performed heroic work in the face of a mysterious epidemic. Their work helped the world avert a public health problem that could have been significantly worse that we have experienced so far. The location of the conference, at the premiere Mexican public health institute in Cuernavaca, will provide a great opportunity to hear first-hand the story of the crisis and to share the lessons learned.

Everyone Pitching in to Help Haiti and Some Old Lessons Re-Learned

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It is true that Child Family Health International does not have any programs in Haiti. It is also true that we are part of the world community and, in a situation like this, if there is a way for us to help, we will do all that we can do, as we did in the Asian Tsunami and have done in other events over the years. CFHI has actually worked in the past with our friends at VIDA and a Haitian partner, the Consortium for the Development of Haiti, to send medical supplies to a number of grassroots clinics and hospitals. It was a very successful endeavor. And so when news of the earthquake came, we tried to re-initiate our successful partnership and get disaster relief supplies to Haiti as quickly as possible. We sent out a message to CFHI supporters, who were already contacting us to find ways to help, and they responded generously.

Our great friends at VIDA (Volunteers for Inter-American Development Assistance) were also right on it, and within about 24 hours of the Tuesday quake, they had assembled over one million dollars in urgently needed first aid and disaster medical supplies. Being on the West Coast, we found ourselves at a disadvantage as the access to the airport and other avenues to get supplies in were quickly clogged. It was also only later, by late Friday and Saturday, that the impact of the earthquake on the functionality of the airport and the seaport were really known. Once it was obvious that all avenues to get supplies in would have to go through the military (directly or indirectly) and staging areas in Florida and other close points, we realized that there was no way to get a shipment directly to Haiti.

We found great support from another wonderful NGO, MedShare, which recently opened a warehouse on the West Coast. They were dealing with the same issues, and through their East Coast connections, were able to get shipments into the pipeline for Haiti. We are grateful for all this collaboration and happy to be in such good company. Our role is very small but, as we are seeing, if we all pitch in and do what we can, a big difference can be made.

On a personal note, having spent some time in Haiti in the early ’90s, when I worked for Food For The Poor, I was moved by the earthquake through the memories that I carry. My visits to Haiti gave me an experience that has stayed with me ever since. The overall work of Food For The Poor was refreshingly simple: provide for basic needs, and develop ways for people to pull themselves out of poverty. Expecting to find people beaten down by poverty, I was challenged to reevaluate my assumptions. Sure the poverty was there, and it was among the worst I have seen anywhere in the world, and some of the people were caught in its clutches in a way that made it hard for them to break free. But, as I have seen in other places, that wasn’t the whole story. By and large, I saw, in Haiti, people who did not let poverty define them or their happiness. These are the people that don’t make the news but carry on their lives as best they can. I gained deep respect for people who perhaps had a better sense of the important things in life than I did. It was a lesson I have tried never to forget and one that I am reminded of again as I see images that trigger forgotten memories of sadness and beauty, despair and hope all mixed and juxtaposed in a society so abused by history, and so full of potential. The people of Haiti re-taught me lessons of never making assumptions, of never writing anyone off, and of the richness that comes from allowing another person, another culture, to change the way I think. I carry these lessons to my work today, even as I carry the memories and, too, the hope that the resounding resilience of the Haitian people and their great joy in living will raise them up, once again, from being dealt a terrible blow.

The Great Asian Tsunami Five Years Later

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The anniversary of the great Asian Tsunami is December 26^th. Do you remember where you were on that day in 2004?

The effects of the huge earthquake, estimated at 9.1 or greater, and resulting tsunami were devastating. Some reports say that about a quarter million people in some eleven countries, lost their lives, almost in an instant. For those who were left, they not only had to deal with the grief and loss but also with the fact that their lives and livelihood would be forever changed. Many made their living off the sea and now the trauma of this event made it hard for them to comfortably return to their work.

CFHI’s loyal donors and alumni were quick to respond. Within 48 hours, we had connected with other international organizations and had a disaster relief container with supplies for 10,000 people, on the ground in one of the worst hit areas in Indonesia. Our donors continued to give. We let people know that CFHI did not have any programs in the areas that were directly impacted and suggested several other organizations to which to donate. Many of our donors still wanted to give to CFHI, they said that they trusted CFHI to find the best way to use the donations. So after helping with the immediate disaster response, we started doing our homework.

With many programs in India, CFHI was asked to help in the areas of Southern India that were greatly impacted. CFHI met with local and WHO health officials by conference calls. There was great concern that widespread disease would be one of the effects of the tsunami so we were asked to wait while health officials conducted surveillance to see where disease would most likely occur, along that portion of the Indian coastline. As it turned out, preventative efforts held disease in check so we began looking for other lasting effects of the tsunami. For young children, the trauma was the most significant lasting effect. In a number of small coastal fishing villages, much was lost including the schools. One of the most important things to help children dealing with trauma, is to reestablish a routine that is safe and comforting to them. With the loss of the schools, there was a big hole in the day of every child. CFHI teamed-up with the service organization Round Table India –that was charged by the Indian Government with rebuilding the lost schools. CFHI’s donors were able to support the rebuilding of two schools that were lost in the tsunami, thus reestablishing this most significant daily routine for many children.

Sewing Class at Kovalam

Some of CFHI’s donors have continued to donate to make sure that efforts to help those so devastated by the tsunami would not fade away. As this fifth anniversary approaches, CFHI is happy to be continuing in this effort. Loyola College in Chennai started an outreach program to provide ongoing assistance to people affected by the tsunami. A successful community college effort has been established and is training people in skills to help them find jobs in many fields including culinary work and food service for the tourist industry, website design, mechanical work on air conditioning and refrigeration systems, etc. In addition, the Kovalam Community College is providing general courses in English, general life skills, health education, and working with the large population of widows created by the tsunami doing women’s empowerment workshops and helping the widows develop their skills.

During my visit to India earlier this month, I met Fr. Xavier Vedam, S.J. the Vice Principal of Loyoal College in Chennal and the Director of the Loyola Outreach program. I was very impressed with these efforts by local students volunteering to help in the villages that continue in their recovery from the devastating events of December 262004. I was struck by the passion of Fr. Vedam and the fact that they are not giving up but continuing to provide services, engaging the community, and helping people in real ways. To see that many people are now in gainful employment and that the self confidence and attitude of people in whole villages have been so positively impacted, is a wonderful accomplishment and we applaud these ongoing efforts that bring development based on the strengths of the local people.

Fr. Vedam and Students at Kovalam

From Untouchable to Breadwinner, From a Human Waste Disposal Problem to Useable Fertilizer: A Sanitation and Public Health Success Story

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Human waste is always a strange topic to talk about but it is clear that sanitation is one of the biggest public health challenges. The idea of a Toilet Museum may bring a laugh but I was introduced to an organization that, while understanding the lighter side of the issue, has taken this subject very seriously. “This is nothing short of amazing work,” reports CFHI India Coordinator, Hema Pandey, as she has made it an important part of CFHI’s Public Health and Community Medicine Program in New Delhi. Students also report that this experience is very enlightening to them. It is all the great work of an organization called Sulabh International, an NGO based here in New Delhi, that has for all practical purposes, solved a problem as old as the human race: how to effectively manage human waste. Moreover, they have done it in one of the poorest and most populated countries in the world. At the heart of it, was the desire to free the Scavengers, a caste of Indian society who, for as long as anyone can remember, were relegated to cleaning the excrement of others and carrying it in buckets on their heads, therefore being considered untouchable.

CFHI Students Visiting Sulabh International in New Delhi

Sulabh is nothing short of a movement, started by Dr. Bindeshwar Pathak. Dr. Pathak’s outstanding accomplishments can be summed up in two areas, a new technology for waste management and a social revolution for more than a million people to whom society gave no hope for self-determination.

The technology is alarmingly simple. Sulabh’s design of a two-pit, pour flush toilet is an appropriate, affordable, environmentally sound, and culturally acceptable technology. Many United Nations groups including WHO and UNDP have recommended this technology for more than 2.6 billion people in the world. Essentially the pits are constructed in such a way that one side can be used and filled over about a three-year period. Once it is filled, you switch to the second pit. Over the next three years, the pit design allows for the natural breakdown of the waste in the first pit so that after the three year period, the pit can be opened revealing a dried substance with no harmful bacteria, that is 100% recyclable as a high qulaity fertilizer. This design is perfect for rural areas but Dr. Pathak has taken it to the next step by designing a process of dealing with large-scale public toilets. In this process, bio gas is generated in significant portions to power lighting, heating, cooking, and electricity.

CFHI Students visiting Sulabh International

Receiving Instruction on 2-Pit Toilet System at Sulabh

Dr. Pathak is credited with changing the mindset of the Indian people about sanitation and the persons who were required to do the sanitation work. He has done this by example. He went to live among Scavengers learning the affects of the life they were considered destined to and thereby designing a social movement to raise them out of poverty and their unacceptable destiny. Sulabh has schools, training centers and successful assistance programs that are training former Scavengers for everything from light industry, to culinary and food service jobs, and all aspects of computer technology.

This is a terrific success story, making great progress for health as well as a wonderful human story, and one that definitely gets the attention of our students.

CFHI Expands Rural Program in Himalayan Region of India

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CFHI’s program in rural areas of Northern India will expand in 2010 and our student programs will support a local doctor’s dream of increasing access to healthcare in this region. Dr. U.S. Paul has been working in the surrounding areas for many years and he knows well the needs of the people in rural villages. We are happy to help him in this new effort to serve thousands more people in the foothills of the Himalayas who have little or no access to healthcare. The effort is being conducted by a local nonprofit, the Indian Global Health and Education Forum. The village of Sirasu will be one of the areas served. The villages are accessible on foot after crossing the great river. This photo shows the crossing point at Gullar on the River Ganges, about 45 minutes drive north of Rishikesh.

Ganges Crossing Point at Gullar

As we made the drive along mountain roads tracing the edge of the gorge, with sheer drop-offs right next to you that are not for the faint of heart, Dr. Paul spoke of his excitement at being able to operate regular health camps for this remote population. The area around Sirasu is one of several village groupings that will be served Sirasu and its grouping have a population of about 1,500 people. Each village has its own identity and Dr. Paul is an expert at providing care that is respectful of the cultural differences that may exist even from village to village.

Crossing to the East side of the river Ganges in a simple rowboat, I looked over and saw Dr. Paul beaming with joy because he knows how important these services are to the people.

Crossing The River Ganges --Mr. Mayank Vats, CFHI Local Coordinator, and Dr. U.S. Paul board a boat to cross to the East side of the Ganges river

Once across the river, it is a 20-30 minute hike up the East side of the gorge to Sirasu. Dr. Paul meets with village leaders to discuss recent developments. An initial camp was held in November during which Dr. Paul saw more than 150 people in one day. The people ask Dr. Paul to schedule the camps as often as possible. With many other villages to cover, Dr. Paul says he will plan to make monthly visits. While they would wish for more, the people are very happy and express their gratitude.

Local School that serves as a site for the health camp

The camps are conducted at the few local schools as these are natural gathering points and are the largest structures around.

Everything is built on relationships. The local formalities of introductions and meetings to discuss the different aspects are a time to build trust and gain the valuable support of village leaders. These meetings over cups of tea are important times to size everyone up and get a feel for each other. It is the oral culture’s way of completing an application form.

Every meeting has to have tea

We look forward to these additions to our program and to developing these new relationships.

After meeting with local leaders of Sirasu to discuss health camps

CFHI South Africa Alum in the News

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David Liskey (in a photo by Jan Sonnenmair), was a 2008 CFHI South Africa participant that came to us through our Oregon partner IE3.

David Liskey photo by Jan Sonnenmair

David was featured recently in the Oregon State University President’s report. Read about his experience and “how race, culture and poverty affect health care in a country with one of the highest HIV infection rate in the world.”

David participated in an 11 week program with CFHI and received credit from his home institution. From his first-hand experience, he wrote a University Honors College senior thesis. David was perceptive and able to see how culture impacts health.

In the president’s report, he reflects, “The different experiences and topics I studied had an effect on how I see the world.”

The Roots in Grassroots -Ukwanda Rural Health Program

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Ukwanda is a Xhosa word meaning to grow and develop. It is also the name of a rural health project run from the Tygerberg Medical Campus of Stellenbosch University in Cape Town. CFHI, with a generous grant from the Dickler Family Foundation, has helped to fund part of this project to bring more healthcare to Avian Park, an underserved community near Woster in the rural area well north of Cape Town.

Long story short, they are building on the success of a TB clinic, which was the only healthcare in this community. Once people saw their neighbors responding to TB treatment, the numbers of patients willing to come for treatment began to climb. Now they are increasing visits to homes in the community and beginning distribution of antiretroviral medication (ARVs) for the treatment of HIV/AIDS. The hope is to add more regular visits by a doctor and bring primary care to this community.

While it is still a work in progress and well on its way to success, the story behind the story is fascinating. Stellenbosch University was a bastion of Apartheid. Among its graduates are a number of the country’s prime ministers during the Apartheid regime. It still has a majority white student population but the diversity of its student body is increasing. Even for years after the change to majority rule, to think that Stellenbosch University would be successful leading an initiative to build strong relationships with multiracial rural communities would simply not have made any sense. It is wonderful to see the progress that has been made here. The university has hired a diverse team and has supported their efforts to build the relationships necessary for successful collaboration at the grassroots level. Working to earn the support of the local Rotary Club, local politicians, community leaders, and even seeking out the strongest voices block to block, the university has committed its time, talent, and funding to truly engage the community.

I met with Lindsay Meyer, who is coordinating the community engagement on this project for the university, and it is easy to see that her heart and soul are completely committed to its success. By building the support that she has, she managed to find the creative solutions when road block after road block surfaced along the way. She has taken her guidance from the leadership of the university as all the resources of the university have been made available to this project. From agriculture, to education to law and even theater, the various parts of the university have had a hand in this project. The process of acquiring land for the project has been assisted by the legal faculty; the soil was tested and found suitable for a community garden by the agriculture faculty and students; education programs have been set up and educational storytelling through drama has engaged the community even more.

Lindsay sees her work as cutting edge and it truly is. We congratulate Lindsay, her team and Stellenbosch University for doing what it takes to make this project a real part of the community and not just a satellite office of the university.

Report from Kwazulu-Natal: Filling a Need for Forty Years –The Islamic Medical Association of South Africa

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Dr. Ebrahim Khan is a family practitioner with a private practice in the Kwazulu-Natal Province of South Africa and serves as Medical Director of the CFHI program based out of Durban. As with most doctors in South Africa, the demands on his time are great. Dr. Khan’s daily schedule is easily enough for two or three men. His long and distinguished career has earned him the respect and confidence of the local community, and even at this point in his career, his desire to be of service and give back is as vibrant as I have seen in twenty-year-old students, so he is a good match for the many CFHI students from around the world who choose the Durban program. I especially sensed a love for teaching medicine in a way that guides the students to make their own discoveries.

Among the many hats Dr. Khan wears is that of being the Vice President of the Islamic Medical Association of South Africa. In the early 1970’s, a few Muslim Doctors, noting with concern the disparate health services under the Apartheid government of South Africa, embarked upon the establishment of a modest Sunday clinic on the south coast of Natal in Eastern South Africa, where there were virtually no services for the black rural community. This was the birth of what would be called the Islamic Medical Association. With such a deeply personal mission, it did not fade away after the end of Apartheid. Now almost 40 years later, IMA has set up various healthcare and crisis relief centers operating full time in various places in the country where there is dire need for such facilities; social work and counseling are happening for families and children as well. The IMA mission challenges them as healthcare professionals to “establish and project a value system that is a living entity in our own lives, and in the practice of health care solely for the service and the pleasure of the Almighty. ” The health professionals who give their service are truly dedicated to improving primary care for the underserved.

Avril Whate, Vusi Ngcobo, Steve Schmidbauer

One of the many programs that IMA provides here is a small community clinic in Marianhill outside of Durban, a favorite site for CFHI students. One of the services that has been happening for some time now is voluntary counseling and testing (VCT) for HIV. Vusi Ngcobo is the counselor who is responsible for the success of the VCT program here. In an area with such a high prevalence of HIV, it is important that voluntary testing happens so that the virus can be detected as early as possible. For those found to be HIV-negative, they will still receive valuable information about HIV prevention.

The clinic here and the many other projects of IMA are the continuation of a very long tradition of providing healthcare and teaching medical students. I learned that in ancient times, medical education was flourishing in Islamic society as evidenced by written case studies for teaching that date to the seventh century!

South Africa –Local Hospital Takes Courageous Stand Against New Menace

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During a program visit to South Africa, I continue to be amazed by the dedication, commitment, and resourcefulness of the healthcare workers. I find examples everywhere I go –this one, I wasn’t ready for:

With HIV rates among the highest in the world, you’d think there may be no higher priority in South African health services than addressing this disease and working to prevent it. Meet the new menace, “Tik.”

Dr. Adam has been head of G. F. Jooste Hospital for a little more than a year and in his short tenure, he has witnessed an explosion of drug use in the surrounding community that at times has crippled the functioning of this district hospital. These are the Cape Flats, just ten minutes from the beautiful city center of Cape Town, and there is a real fight here to stop this menace from spreading. The drug is crystal meth, and the impact is devastating. Dr. Adam has had a long and distinguished career as a practicing physician and in more recent years, adding a degree in public health, he has been the doctor/administrator at various facilities in South Africa but he has never seen anything quite like this. They thought they had a challenge seeing 40 or 50 patients per month in the ER who were out of control, high, and totally unpredictable, but now these patients number more than 180 per month, and this is in addition to all other patients seen in the facility. The psychiatric effects of tik (which gets its name from the noise made when the crystalline structure is heated) are severe, and Dr. Adam explains that the ER is not a psychiatric ward. Instead of adding medical equipment, they have been forced to add bullet-proof glass and a metal detector to the entrance area. Patients can arrive in a wild state, combative, and completely noncompliant. “The only choice we have is to sedate them until they calm down and we can begin to help them,” Dr. Adam says, noting that recently one female doctor had to be rescued from underneath a male patient who simply jumped on top of her. This 184-bed hospital is already stretched beyond capacity most every day, and sees 4,500 patients in its emergency room every month. But the evidence suggests things may get even worse. In today’s edition of the Cape Times newspaper, a story by Anso Thom reports that “Tik is the most commonly abused recreational drug in Cape Town…,” and that a new study shows one in ten pregnant women are using tik.

“Tik is holding us hostage in this hospital,” proclaims Dr. Adam. But he is not sitting still. He has formed strong alliances with neighborhood and community groups to help coordinate a positive response from within the community to reclaim its streets and build a network of neighborhood watch and support. He opens the hospital auditorium on Saturdays for community meetings and to provide a safe place for children to come for organized activities. He is most proud of getting approval and funding for an outpatient substance abuse program that will begin very soon. The relentless cycle of treating patients, releasing them, only to have them return in a worse state in only a few days can finally be stopped. Armed with a psychiatrist, an addiction recovery expert, and a local public health masters student to document the progress, Dr. Adam is putting together a team that will take a stand against the menace. Dr. Adam knows that the only way to really fight this new epidemic is to break the cycle of addiction. A holistic approach will aim to help strengthen the family unit as well as the patient. Strengthening the community by strengthening individual families is a plan for wellness in the face of an almost hopeless situation.

“We’ve got to start somewhere,” says Dr. Adam. Reflecting on the toll it has taken on his hospital, Dr. Adam says it would be tempting to say that the hospital is simply not equipped to treat these patients and send them elsewhere. But there is really nowhere else, and Dr. Adam is not the kind of person who could turn a blind eye to a problem like this. You can sense the conviction and commitment in his voice as he says, “Our core business is the health of the community.”

New Technology Brings Efficiency and Increases Capacity for Department of Hospital Civil in Oaxaca, Mexico

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Computer being received at Hospital Civil in Oaxaca, Mexico

CFHI is proud to announce the donation of a Macbook computer to one of our partner sites in Oaxaca, Mexico– the teaching department of Hospital Civil. The donation to the subdireccion de ensenanza department came after the hospital requested this equipment from CFHI as a useful tool in improving operations there. The replacement for the manual typewriter, also in the picture, is a welcome addition to this very busy facility.

The computer will serve in many capacities including logging various activities occurring within the department and in managing the coordination of medical residents working at Hospital Civil. In the photo above from left to right: CFHI Oaxaca Medical Director Dr. Tenorio, Dr. Gabriel Augustin Velasco, the head of Hospital Civil’s teaching department, and CFHI Program Manager Nick Penco, alongside the new computer. CFHI would like to thank the participants of our Global health Education programs as well as support from our donors in making such contributions possible.

Hospital Civil is an outstanding facility with a dedicated staff. CFHI has enjoyed a long relationship with this excellent teaching hospital. This municipal facility is an anchor of the community and has seen everything from the increase of chronic diseases, to the fallout of civil unrest. And Oaxaca was one of the initial detection points of the Novel H1N1 Virus this past year. We commend them on their quick and professional response to what was an unknown crisis. The quality of their work has helped to blaze the trail for everyone working to treat and stop this pandemic.

Learning From South-South Collaboration, April 2010, Cuernavaca, Mexico

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Alliances for Global Health Education: Learning from South-South Collaboration, has been announced as the theme for an upcoming conference to be held April 9-11, 2010, in Cuernavaca, Mexico. The joint collaboration represents the 19th annual conference on Global Health Issues for the Global Health Education Consortium (GHEC), based in the United States and the 1st Latin American and Caribbean Conference on Global Health hosted by the Instituto Nacional de Salud Publica (INSP), based in Mexico.

A White Paper and call for abstracts can be found on the GHEC website here.

This promises to be an exciting conference addressing current issues and even leading edge ideas, research, and practice. The Call for Abstracts is through November 1, 2009. The website reports that all aspects of Global Health and Global Health Education are welcome for submission and there is a special request for “progressively-minded projects that take into consideration the ideals of global health that embrace: Social Justice, Ethical Practices, Community Ownership, Equity and Fairness, True Partnership, and Bilateral Exchange.”

CFHI Granted Consultative Status at the United Nations

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Just prior to the opening of the United National General Assembly this year, I was fortunate enough to be at the UN to represent the small but powerful global family of Child Family Health International (CFHI). Recently CFHI was granted Special Consultative Status with the Economic and Social Council of the United Nations (ECOSOC). This is a great honor that speaks to our unique collection of dedicated professionals and students who truly work at the grassroots level to improve the health of the world community.

As the Executive Director of CFHI, it was indeed a high honor for me to represent our organization and I came prepared to explain our work and our efforts in Bolivia, Ecuador, India, Mexico, and South Africa. To my great surprise, I did not have to do any of that. I found the staff at the NGO Section of ECOSOC wonderfully welcoming and accommodating, and also found they had done their homework and already were quite aware of CFHI and our work. They had read the documents we had sent more than a year earlier in the process of being granted consultative status and they also brushed-up by reading our website prior to my arrival.

What with the UN being such a huge organization, I expected everything to be very bureaucratic and fairly impersonal. Sure it is a big place and with the leaders of the world, about to arrive, there was quite a bit of bustle all about, so it was a surprise to find such personalized service and attention. My meetings with the Deputy Chief of the NGO Section and the Program Officer were cordial and productive.

I learned that there are about 3,200 NGOs around the world that have been granted consultative status. Many are more associated with a cause while they see CFHI as a more “practical” organization. The grassroots nature of our work is appealing to them as well as the diversity of our global family along with the close, long term relationships with CFHI partners who are at the front lines of the delivery of healthcare in so many places. To a large extent, we have our finger on the pulse of global health at the grassroots level and so we have much to share, especially the CFHI model of empowering local communities. Of those more than 3,000 organizations, only about 800 are really active. Work is going on to improve the website of the NGO section and the hope is that there will be much more online functionality to allow for sharing and collaboration.

Flags of the CFHI Global Family now including the United Nations

One official told me, “The international community has looked at your organization from top to bottom and the feeling is that it is a good organization and has a model that is important. We actually hope that it can be replicated in areas of health yes, but also in other areas.” So as we add the UN flag to the flags of nations comprising the CFHI Global Family, we do so with great honor and great pride, and with responsibility for the role that we have assumed through this honor.

Just What Global Health Needs … Geometry!

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As Dr. Calvin Wilson began his plenary presentation at the Sixth Annual Family Medicine Global Health Workshop in Denver earlier this month, he said to the audience of physicians, “Now class today we’re going to learn geometry.” As he began talking about the vertical approach, and the horizontal approach, Dr Wilson was joking but he was also making a point. As disparities related to health continue to be significant and much more is needed to be accomplished in order to achieve the Millennium Development Goals set by the United Nations, it is clear that a different approach is needed to address global health issues. Dr. Wilson, an associate professor of family medicine at the University of Colorado School of Medicine, and the director of the Center for Global Health of the Colorado School of Public Health, was attempting to deal with a controversial issue in global health today: the debate between vertical and horizontal funding of health initiatives. The vertical initiatives are programs that address a single area of focus, such as a disease like HIV/AIDS, or malaria. The horizontal initiatives are programs that attempt to improve aspects of the health care system in an area or a country. Dr. Wilson gave a careful and balanced approach to this issue and pointed out pluses and minuses to both sides. His presentation can be found through the website of the American Academy of Family Physicians.

Dr. Julio Frenk, the Dean of Harvard’s School of Public Health, and former Minister of Health for Mexico used examples from his home country to illustrate the importance of the diagonal approach when he was interviewed in the June issue of Global Pulse. Dr. Frenk sights, how work on HIV/AIDS in Mexico was designed to also enhance the healthcare system. “By starting with AIDS, we were able to build an entire insurance system that was then in place to start covering other diseases.” Dr. Frenk’s interview with Global Pulse can be found here

It is unfortunate that this debate has gone on for so long and that there is still no clear resolution to it. Perhaps two next steps are helpful in this process.

Cease the Competition: It is sad that any debate has developed regarding this issue at all. Even more counterproductive is that at times there seems to be a competitive nature to the debate from one side or another. From the grassroots perspective, it is often obvious that these approaches are much more in concert with each other rather than in competition. Resources are needed for programs that implement specific treatments and for specific prevention methods but these programs are usually only as good as the infrastructure available to make things happen on the ground. The reality is that vertical strategies will, at some point, need to hit the ground and their implementation will involve: public health education, vaccination, or training to increase the competencies of treating healthcare workers. To utilize the existing infrastructure, no matter how lacking it might be, is preferable to starting from scratch or to creating parallel infrastructures. Building on the existing infrastructure allows the lessons of past implementation experiences to inform the future and, if done well, allows for culturally appropriate adaptations to be made for each setting that can improve the effectiveness of any implementation, while reducing the potential for inflicting unintended harm. In most resource-poor settings, when you bring in relatively small amounts of cash, you can make many things happen. Unfortunately when you pull out the cash, it often has the effect of inhibiting the local input.
A workable Construct: While there has been a lot of talk about the need for a more balanced approach, there has not been a lot of action. It is hard to move forward without a method of implementation. Since we are talking about a very broad spectrum of health initiatives, it is unrealistic, and frankly not very helpful to propose anything that is too specific. One option has been proposed that appears very promising. 15 by 2015 is an initiative proposed by a partnership of the World Organization of Family Doctors (WONCA), Global Health through Education, Training and Service (GHETS), and the European Forum for Primary Care (EFPC). In an article published in the British Journal of General Practice in January, 2008, they make their proposal, “We propose that by 2015, 15% of the budgets of vertical disease-oriented programmes be invested in strengthening well-coordinated, integrated local primary healthcare systems and that this percentage would increase over time. 15 By 2015 is a very helpful construct. It raises the awareness of the need for both vertical and horizontal approaches that complement each other and creates a simple framework that allows customization as needed. The 15% threshold is not meant to be the highest possible for the horizontal component but it is a conservative number that can surely be an agreed upon minimum. In this way, new initiatives can build on the existing knowledge and experience, and leave the community with an incrementally improved infrastructure.

In his address to the Global Health Workshop in Denver, Dr. Wilson used some different language. Instead of consistently using “vertical” and “horizontal,” he used the terms disease focus approach and integrated systems approach. These are terms that seem to fit more logically to the conversation. Perhaps these terms can be seen to be more obviously collaborative than their geometric versions and help us bridge the gap by taking the shortest distance between these two points that should not be divergent at all.

A Definition of Global Health

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Defining global health has been a challenge. This has been especially true in recent years with the increased interest in science, philanthropy, and politics related to global health. In the June 6, 2009 issue of The Lancet, a multidisciplinary and international panel brought together by the Consortium of Universities for Global Health (CUGH), and led by Jeffrey P. Koplan, MD, has taken a bold step in offering the world a definition.

The article entitled Towards a Common Definition of Global Health, represents an important step in bringing together the work, “and priorities for action between physicians, researchers, funders, the media, and the general public.” A thoughtful process is outlined considering the origins of global health in the areas of public health and international health.

The attempt is to be broad rather than limiting, and emphasizes multidisciplinary approaches and mutuality, as well as equity and collaboration.

We applaud CUGH for this effort and recommend this article to all CFHI students. We greatly appreciate that an effort has been made across continents and cultures to find common ground for the advancement of the study and the work of Global Health.

In recent years, at conference after conference, speakers have noted that there is no real agreement on just what is involved in Global Health. This long-awaited work is welcome, especially in its tone –it is not forceful or proprietary but open, inviting, and humble. We hope that it serves as a good starting point for people from all aspects of Global Health to find a workable construct that will be helpful to collaboration in our work and research.

Please go the The Lancet website and find the article.

Equity Should Play a Role in Measuring Global Health

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WHO Director-General, Margaret Chan, called for greater equity in health to be considered as part of how we measure progress as a global community.

“Greater equity in the health status of populations, within and between countries, should be regarded as a key measure of how we, as a civilized society, are making progress,” Dr. Chan said speaking at UN Headquarters in New York.

At the very least, we should all recognize that Dr Chan has a perspective that almost no one else shares. In her role as Director-General, she has been very active in discovering and learning as much as she can from all corners of the world. So when she stands before the world’s ambassadors and says, “The world is in such a great big mess,” it is the considered opinion of the world’s doctor. Of course she was trying to speak in a way that cuts through ceremony and can be easily understood by all.

She went on to give more of her considered opinion, “Pandemic influenza, for example, will hit hardest in developing countries, which have large vulnerable populations. With their weak health systems, these struggling countries will take longer to recover. In many ways, developing countries facing the pandemic are virtually empty-handed,” said Dr Chan.

With calls for systemic change being a big part of recent United Nations discussions, Dr. Chan took the opportunity to advocate for health with the assembled global leadership, “We hear clear calls, from leaders around the world, to give the international systems a moral dimension,” said Dr Chan, “to redesign them to respond to social values and concerns… A focus on health as a worthy pursuit for its own sake is the surest route to the moral dimension, the surest route to a value system that puts the welfare of humanity at its heart. Greater equity in the health status of populations, within and between countries, should be regarded as key measure of how we, as a civilized society, are making progress.”
As noted with her remarks on the WHO website, “One method for achieving fairness, she suggested, would be for more countries to embrace primary health care. As she noted, a primary health care approach introduces greater fairness as well as efficiency, and allows health systems to reach their potential as cohesive, stabilizing social institutions.”

At the Global Health Council conference in Washington, DC, in June of 2008, on Primary Health Care, a discussion involving Dr. Chan at a public session included the notion of conducting a health systems impact study when any significant funding is allocated. Typically large amounts of funding from governments, world bodies or foundations focus on a particular disease or health issue. Too often, in the heroic attempt to eradicate a menacing problem, the impact on, or even the essential contribution of the existing health system and the health workforce are considered only tangentially or perhaps not at all.

The analogy was to an environmental impact report that is often required before any large-scale building or infrastructure projects are conducted. While environmental impact reports have their own problems, the notion of considering all aspects of the health system in a community or a country can be an important way to find the strengths and successes that will be critical to the success of new efforts. Building on the local strengths and knowledge of a community and allowing a new idea to be informed by the local cultural wisdom can go a long way to achieving greater equity, including Primary Health Care in the process, and ultimately more efficient progress.