Category Archives: Global Health

The Roots Have Taken Hold –A Follow-up on a Success Story in the Making in South Africa

Ukwanda Logo

Ukwanda Logo

In October of 2009, fresh from a visit to South Africa, I wrote an entry to this Blog called The Roots in Grassroots –Ukwanda Rural Health Program.  I was so impressed with the intentional efforts of the University of Stellenbosch to successfully bring primary health care to Avian Park, an underserved community in the rural areas well north of Cape Town.  CFHI’s work has always intentionally been at the community level so this was the first time that we were helping to fund a project of a university.  On paper, it looked like a serious effort to truly do the relationship building and ground work necessary to successfully establish the first primary healthcare facility for this poor but growing community.  Our contacts on the ground were also very enthusiastic about this initiative and so CFHI chose to help support it.

What I saw in 2009 was an idea beginning to take form.  What had looked so possible on paper, was proving to be a significant challenge to implement.

Avain Park Old Clinic

Avain Park Old Clinic

I saw a very run down set of metal freight containers being used as a makeshift TB clinic.  I saw some initial linkages with the community but everything was still new and tenuous.  CFHI’s commitment was funding that would be used to renovate the freight containers to make them fully functional.  The project was already well beyond its targeted schedule and I could see during my visit that the freight containers were not in good enough condition to be renovated but would need to be replaced.  Stellenbosch was able to get some additional funding as well as some in-kind help to make the new containers possible.  Concerns about acquiring the land where the new clinic would be, the full support of the local political and community leaders, and other logistical details were still not resolved.  Success felt illusive.  Yet, in the face of the many challenges, the Ukwanda team from Stellenbosch chose to dig in deeper, engaging the community, dealing with their concerns and creatively finding the resources to deal with many unforeseen issues that arose.

Freight container being prepared at Cape Town Water Front

Freight container being prepared at Cape Town Water Front

At a stage like this, I am, quite frankly, used to seeing a big university either pull back its funding and  sunset the project, or do an end run around the community and find a maneuver that would give them the legal security they need to move forward even if it does not lead to community support.  Instead of using the university’s paid legal teams to get it out of a jam, the University of Stellenbosch chose to involve its School of Law and get faculty and students from this arm of the university to research creative solutions.

This week, I paid another visit to Avian Park and I met with Prof. Hoffie Conradie, also a medical doctor whose blood, sweat, and tears have flowed into this clinic for years now.  What I saw this time was the brand new set of freight containers fully set up, painted, and functioning at about 80% of the planned use.

Avian Park New Clinic 2011

Avian Park New Clinic 2011

In addition to the original TB clinic, there is now an ARV clinic and a team of home-based care workers based out of the clinic.  Weekly physician clinic hours by Dr. Conradie are well attended and welcomed by the community.  Still to come will be family planning and other health education initiatives.  While a water line has made it to the clinic, electricity is still lacking but this is in the works and seen only as a minor inconvenience.  The clinic was bustling with activity and clearly has become a focal point of the community.

Even more impressive was that I just happened to arrive as a team from the University Of Stellenbosch School Of Sociology was just concluding an intensive study of Avian Park.  A social anthropology professor and his students had made many visits and conducted house to house interviews.  The students made use of volunteers from the community, mostly young people who assisted the students in navigating the unpaved maze of roads and any unfamiliar customs or local norms.  The result is a significant body of primary research data that will now be analyzed and synthesized to produce a profile of the community that will not only help the Medical School in its work in the community but also all the other arms of the university; agriculture, theology, social work, as they also look to begin projects in Avian Park.

Meeting later with Project Coordinator, Lindsay Meyer, in Cape Town, she attributed the tremendous cross pollination of efforts from Stellenbosch at Avian Park to the leadership of the university.   The Rector of the University of Stellenbosch has motivated and guided his faculty across all schools to develop strategic plans that have goals that are connected to the Millennium Development Goals of the United Nations.  All schools and departments are also required to have initiatives that are benefiting the community in some way.  With this kind of guidance, a university that often has so many disparate activities can instead become like an orchestra, each producing their own sound but from the same sheet of music.

Prof Hoffie Conradie addresses sociology & medical studnets and community members at Avain Park clinic

Prof Hoffie Conradie addresses sociology & medical studnets and community members at Avain Park clinic

And so it was in Avian Park. The sociology students and the medical students were each doing their own endeavors but in a way that appeared to the community and to this outsider as a coordinated effort that will build on each other.  Universities can easily become a place of many silos of information growing ever higher and rarely moving horizontally in a way that combines data for richer analysis and in a way that can most effectively benefit communities.  How refreshing it is to see what can happen when the full resources of a university are coordinated and focused to help a community.

Our hats are off to the University of Stellenbosch and its Ukwanda Rural Health Project and the Avian Park Rural Clinic for their dedication and commitment to community-based work done well!

World AIDS Day – What We Can Celebrate

World AIDS Day2010_WHO-EMRO

World AIDS Day2010_WHO-EMRO

World AIDS Day gives us a chance as a world community to stop and get some perspective on this epidemic that has been with us now for three decades.  In the past this day served as a day for us to remember with dignity those we lost to this horrible disease and as a day for carrying out advocacy to improve and better coordinate our efforts at combating this killer.  Today is still a day for us to collectively morn the incomprehensible human toll.  Today is still a day to increase awareness and mobilize efforts that transcend the hurdles of politics, prejudice, and lack of knowledge.  Indeed “Health, HIV, and human rights are inextricably linked,” as the Director General of the World Health Organization reminds us in her statement today.

On this World AIDS Day in 2010, I am struck by the great amount of information we now have.  So today is also a day for us to look back and see from whence we have come in this effort.   There is great loss, and yes, there needs to be more committed to this effort but the work has gone on for more than 25 years now and there are milestones and accomplishments we must not forget.  The numbers are still staggering, over 33 million cases worldwide, and with over  two and one half million newly infected, etc, etc.  And on the face of it, this can be enough to keep someone feeling discouraged.  But there is hope.  There are things to celebrate.

UN_AIDS_Global_Report_2010

UN_AIDS_Global_Report_2010

If we look deeper into the Global Report from UNAIDS, we find that although the greatest burden of disease is still in Sub-Saharan Africa, this is also one of the greatest success stories as the rate if infection has dropped considerably.  The report concludes, “In 22 countries in sub-Saharan Africa, the HIV incidence rate declined by more than 25% between 2001 and 2009.”

The Global Report contains a great deal of information that is well presented, and with little effort, one can gain a great deal of perspective not only on the huge effort that we are still deeply engaged in, but also some real sense of what has been accomplished -like the “Significant progress in the virtual elimination of HIV to babies.”  Make one of your “things to do” this World AIDS Day a visit to the UNAIDS Report on the Global AIDS Epidemic 2010.  It contains an AIDS info Database, Epidemiology Slides, a Global Scorecard, and more.  One thing we have clearly done as a global community is arm ourselves with a wealth of information as we combat this continuing threat.  Spend 20 or 30 minutes today educating yourself about one of the world’s greatest crises.

Finally there is one more thing that must be celebrated today and that is the the tremendous and heroic efforts of healthcare workers on the front lines of this epidemic.  One of the great privileges for me as part of CFHI, is the opportunity I get to visit doctors, nursers, and other healthcare workers in the field.  Finding local health professionals who are dedicated to their own underserved communities and trying to support them in their work is at the heart of what we do.  We see them in hospital wards that are overflowing, we see them on strenuous trips to rural areas to test, educate, and treat -thus making healthcare accessible to  more of the population.  We see them in hospitals where the staff room has become a small ward or infection control area thus leaving them spending long hours with no place to go for a break.  We see them in clinics working tirelessly as as line of patients stretches out the door and down the street, more than a city block.  We see them morn the loss not only of patients but of so many of their colleagues, and yet they continue.  We see them in these situations every day, and we see them more dedicated and more earnest in their efforts each day.  These are the real heroes in this global fight and we salute you on this World AIDS Day and we pledge our continued efforts to help support and champion your work.

CFHI Joins in Support of Service World

ServiceWorldCFHI is very excited to support the launch of OurServiceWorld.org and the ServiceWorld International Service Declaration. Those of us involved in Global Health are deeply committed to international service.  The ServiceWorld Initiative is an effort to commemorate the 50th anniversary of the Peace Corps by realizing President Kennedy’s original vision of sending 100,000 volunteers to serve abroad each year. Please join us in supporting the future of international service by signing the ServiceWorld International Service Declaration and endorsing ServiceWorld.

As a proud member of the Building Bridges Coalition and the International Volunteer Programs Association, CFHI is happy to join a groundswell of international  organizations in support of this effort.  Please join with us.

CFHI Convenes Forum on the Empowerment of Women

CFHI is proud to convene a Forum on the Empowerment of Women to be held at the United Nations Church Center on September 15, 2010, in conjunction with the opening of the 65th Session of the United Nations General Assembly.

Symbol fpr MFG Number 3 The Forum, entitled Successes and Challenges of Women in Leadership Roles in Traditionally Male-Dominated Environments, is an effort to shed light on the global effort to achieve Millennium Development Goal Number Three.

In government and NGO organizations worldwide, women are increasingly taking on leadership roles.  What are women finding as they assume these roles?  From the grassroots level to the executive level, women are succeeding in roles heretofore held only by men.  Are there common experiences across these different levels?  Are there common challenges?  What cultural issues need to be considered?  What strategies are most successful?

Join the audience along with a distinguished panel including CFHI Medical Director, Jessica Evert, MD, and direct from New Delhi, CFHI India Coordinator, Hema Pandey, as these topics and others are discussed in this lively forum.  Gain insights and share your own story.  Join us September 15th at 1:00 PM at 777 UN Plaza (44th Street between 1st  and 2nd Avenues) 8th floor, Boss Room.  The forum is free and open to the general public but we do ask that you RSVP.   Please click here to see more information here and the email address to RSVP.

CFHI Students make Local Press in Ecuador

CFHI students made the local press in Ecuador this summer.  La Prensa, a local publication in the town of Puyo in the Pastaza Province of Southern Ecuador, carried a full page story of CFHI Students on the Amazon Indigenous Health Program, one of CFHI’s Global Health Immersion Programs.

CFHI Students Make New in Ecuador Summer 2010

CFHI Students Make New in Ecuador Summer 2010

Puyo, a city of about 25,000 people, with its close proximity to the Amazon Jungle, functions as the base for this program that allows students to see the interplay between the government Ministry of Health and the traditional medicine of indigenous populations living in the jungle much as they have for many hundreds of years.  Dr. Wilfrido Torres, a local physician and the Medical Director of several CFHI programs, reports that international students coming to Puyo and to the Jungle Region, “help the local population see that local doctors and community health workers have important knowledge to share with the world.”  CFHI is honored to have local experts like Dr. Torres who are eager to interact with international students.

This summer, the CFHI students were able to participate in a medical conference that CFHI helped support.  The conference, a multidisciplinary conference on the latest treatments and testing for diabetes and hypertension, was part of a series of conferences to educate health professionals and paraprofessionals on these chronic diseases that are relatively new to the local population.

Global Health Down Under -A students’ Conference- Hobart, Tasmania

Map of Austraila and Tasmania

Australia site of Global Health Conference

CFHI is very happy to be at the Global Health Conference in Hobart, Tasmania that is being put on by the Australian Medical Students’ Association (AMSA).   The conference running 1-4 July has a full academic program with impressive topics and excellent speakers. The entire conference is organized by and for students and the level of professionalism is truly outstanding.  CFHI is very happy to be an NGO sponsor here and we find the interest and engagement of the students to be at a very high level.   A CFHI alum from Perth, Samantha Mulholland (2009, Pediatric Health, La Paz), has been present and giving her first-hand descriptions of her CFHI experience.

UTAS

UTAS Site of Global Health Conference Tasmania

The University of Tasmania in Hobart is the site for the conference as some 500 students gather from across Australia and New Zealand, and even from Asia and Africa.

Indeed students all over the world have a growing interest in Global Health.  What is refreshing here is that so many of them are deeply informed on world issues, social determinants of health and many other areas.  Panels of leading experts, student questions and discussions have all been engaging and enlightening.

GH Conference Hobart

Panel discussion at the Global Health Conference Hobart Tasmania July 2010

Expectations –When Helping is Complicated

Kim McLennan, an accomplished physical therapist, and long-time CFHI volunteer, is now in Haiti and has been communicating to us some of the complexities of just trying to help.  A veteran of many humanitarian missions, Kim knows that to lend a helping hand is not always as easy as it looks on the surface.  The crisis in Haiti, and the

Some of the many peopel who have volunteered their time going to Haiti in the aftermath of the 7.1 earthquake

This is a U.S. Navy photo of some of the many vounteers who have gone to Haiti to help after the great earthquake

outpouring of volunteers to give assistance has amplified the Grey Areas of coordinating and managing international aid.  The questions of culture,  ethics, passion, compassion, and the realities of unexpected complexities are raised in her moving, first-hand account.  Dr. Evaleen Jones, CFHI’s Founder and President, asked Kim if we could share her writings through this Blog.  Kim gives us her experience alongside her on-the-spot reflections which are informed by her years of cross-cultural work in some very challenging situations.

We are grateful to Kim for her permission to present her observations and thoughts here.  Unfinished and raw, they give us an unvarnished view of reality with no easy answers –much as the real situations in Haiti, and elsewhere in the world.  You are welcome to click on the “Read More” button to leave a comment.

Expectations

Here in Haiti, 5 months after the devastation of a 7.1 earthquake, volunteers are coming in droves.  I am one of them.  By the end of my stay, I will have been here 7 weeks.  Most of my fellow volunteers come for one week or two if they’re lucky.  Professionally, the greatest number are doctors, nurses, emergency room specialists, pediatric and wound care specialists, prosthetists and physical therapists. The majority have never been to a developing country or to Haiti before they arrive.

They come with the expectation of being welcomed for their concern and service, everyone paying their own expenses and hoping their week of selflessness will do some lasting good.  Most leave, probably feeling that their mission was accomplished, even if in some small isolated way.  This morning, at the hospital I’m working in, there are 20 American doctors, nurses and other hopeful people wanting to do something useful.  They’re surprised when they realize how different the system is here, how charts and notes and procedures that are standard in the US are hardly used here. They are surprised that the Haitian nurses don’t speak English or seem happy to share their small desk or coveted stash of medical supplies.  Many come with their own supplies of state of the art medical technology and toys and blankets and shoes.  Most of it is very useful and appreciated by the patients.  The Haitian staff seems to disappear when the volunteers arrive to see the rare and unusual patient injuries that have occurred here.

There have been many surgeries and interventions that would have never occurred without the volunteers being here.  External fixators and wound vacs are found throughout the hospital, and the meticulous care given to the patient’s wounds is without parallel.  But this is precisely the problem. The nurses here do not have the training to change the dressings or change the wound vacs and no one is training them. There will be no physical therapy or discharge planning when the NGOs pull out for good.  For all their good intentions, the volunteers seem to ‘take over’ when they arrive and then complain that the Haitian staff doesn’t seem interested.  Cultural differences aside, who likes it when someone new arrives on the scene, walks in,  starts to do your job and then leaves, making you feel less than adequate after witnessing such expertise.

As you know, this is a touchy subject.  Everyone who comes here has the best intentions, simply wanting to help.  The problem is when they come, they come in groups with their own comfortable systems in place, just in a new setting.  Most of the Haitian hospitals are not equipped to house or feed these additional visitors and the plumbing in Haiti already is barely serviceable.  They often don’t seem to try to learn a few words of Creole, or go outside the compound to meet the Haitians and share a local meal.  It probably feels like a vacation except that the food is scarce and the air-conditioning doesn’t work.

The first time I went overseas to volunteer 12 years ago in South Africa, I stayed for one month and it took me almost three weeks to feel I was accepted a little by the local staff and they still did not seem keen to have me in their midst.  I have been looking ever since for better ways to interact and contribute to poor people in need of basic healthcare.  I believe the answer is recognizing the potential of the local people….

It truly does no good to ‘do your thing” as a volunteer, no matter how much it is needed if you don’t teach someone else how to do it also.  Volunteering in Haiti can contribute to the Haitian infrastructure only if we volunteers think about the consequences of us being here.  Are we willing to be patient and work alongside someone whose future may improve from our training?  Are we willing to trust that they may know a better way than the way we’ve been taught?   We are influencing an entire system by our presence and we should be including them every step of the way…..”

Interview with CFHI’s Medical Director –Audio Post

I had the chance to sit down with CFHI’s Medical Director, Dr. Jessica Evert, at our offices in San Francisco,  just before she was honored with an award from the Global Heath Education Consortium (GHEC) at their annual conference in Cuernavaca, Mexico.  Dr. Evert began her role as CFHI Medical Director in January.  Her education career includes studies at Emory University, The Ohio State University College of Medicine, and the University of California at San Francisco, where she continues to serve as a clinical faculty member of the Department of Family and Community Medicine.

Jessica Evert MD

We spoke about her introduction to Global Health, how she integrates her work as a physician in the San Francisco Bay Area with her Global Health Activities, and what attracted her to CFHI.  She talks about how CFHI’s model is one that changes the dynamic by empowering local communities through actively building on their strengths in ways that lead to sustainable solutions.

Please click on the links to listen to our conversation and you are invited to join the conversation through adding your comments below.

Dr. Jessica Evert 1

Dr. Jessica Evert 2

Dr. Jessica Evert 3

Dr. Jessica Evert 4

CFHI Medical Director Receives Special Award -Final Report From Curenavaca

Dr. Jessica Evert, the Medical Director of Child Family Health International, received the Christopher Krogh Award at the GHEC – INSP Conference today.

Dr Jessica Evert Receiving Special Award at Global Health Conference in Mexico

Dr Jessica Evert Receiving Special Award from Dr Anvar Velji GHEC Co-Founder and Dr Richard Deckelbaum GHEC President at Global Health Conference in Mexico

The award, honoring the memory of Dr. Krogh, a founding member of GHEC, who died in 1994 in a plane crash while traveling as a physician for the Indian Heath Service, is given to an individual who shows dedication to serving the undersered both domestically and internationally.

Dr. Evert has worked in various places around the world, and also works on a daily basis treating patients in several underserved communities in the San Francisco Bay Area.  Prior to becoming the organization’s global  Medical Director, she volunteered with CFHI for several years so we are well aware of her talents and her dedication.  CFHI extends a hearty congratulations to our new Medical Director as she receives this distinguished honor!

South-South Collaboration -Second Report From Cuernavaca

This is my second report from the Global Health Conference happening in Cuernavaca, Mexico.  The conference is the joint effort of the Global Health Education Consortium (GHEC), based in San Francisco, California,  and the Instituto Nacional de Salud Publica (INSP), here in Curenavaca.  I spoke with Lisa DeMaria, Investigadora en Ciencias Medicas of INSP and she told me about a perhaps lesser known part of the Global Health field. “There is a sophisticated network in Latin America of middle income countries with similar health issues that are working closely together to address common challenges.” “The face of Global Health is changing,” she told me as we discussed that there is much more happening today in Global Health than just the very wealthy countries attempting to help the very poor countries.

The conference this weekend is a good manifestation of this with at least 22 countries represented.  It is also the First Latin American Caribbean Conference on Global Health and so the extensive regional network of health professionals is strongly represented.  INSP and GHEC have championed the effort to establish this first of a kind conference without knowing for sure if there would be a second conference but the momentum that has been created here seems to be sufficient to ensure continuation with countries like Brazil, Chile, and others stepping up to carry on the tradition.

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

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

Report from the Student National Medical Association 2010 Conference

SNMA Conference 2010 Chicago

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

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.

Global Health South/South Collaboration Conference in Mexico

2010 GHEC Conference png

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.

The Great Asian Tsunami Five Years Later

The anniversary of the great Asian Tsunami is December 26th.  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.Tsunami Map India 26-12-2004

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

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. Kovalam_Community College

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 26 2004. 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

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

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

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.

South Africa –Local Hospital Takes Courageous Stand Against New Menace

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

Computer being received at Hospital Civil in Oaxaca, Mexico

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

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

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

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!

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.

  1. 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.
  2. 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.