A man who contracted polio walks on crutches in the village of Kosi, 113 miles from Patna, India. Photo by Altaf Qadri / AP.

By Lois Privor-Dumm. This is a moment we have been cautiously optimistic about. Would Friday the 13^th finally be the day? Rather than being an unlucky day this year, it is the day that India has gone one year without a single new case of poliovirus!  Every time I look out the window as I’m driving around India, I witness the all-too-common sight of someone suffering the debilitating effects of the disease.  That image is a reminder about how horrible this disease is and that polio’s impact is not just on the individual, but a whole nation.

The efforts to stop this disease in India have been dramatic and it has been a roller coaster with significant ups and downs.  After 741 new cases in 2009, there were only 42 in 2010 – the country was almost there. And then in 2011, there was just a single new case in 18-month old named Rukhsar from West Bengal. It was a heartbreaking occurrence, but efforts persevered.

I am struck by the level of effort committed to this goal: government, civil society and international organizations including WHO, the National Polio Surveillance Project (NPSP) based in Delhi, UNICEF, CDC and Rotary are all laser-focused on making sure that kids even in the hardest to reach places were immunized. The Bill & Melinda Gates Foundation is also instrumental in these efforts. It was no easy feat, as we’ve seen in other polio-endemic countries including Nigeria, Pakistan and Afghanistan. India was considered one of the toughest countries to tackle, making this effort all the more impressive. (more…)

The following is a guest post by by Dr. Olaoluwatomi Lamikanra, a Public Health Practitioner.

By Olaoluwatomi Lamikanra. Since the introduction of mobile phones in Nigeria, the number of users has increased exponentially and usage is pretty much found in both rural and urban areas.

With regards to the internet, Nigeria has about 43 million users (total population over 155 million) which far exceeds by more than double the next African country on the list-Egypt.¹

 
There are many projects associated with mobile health in Nigeria and with the exponential growth of mobile and internet users; there is an ever increasing market. Different sectors of the economy which have an impact on the health of the populace also stand to gain a lot from the introduction of mHealth initiatives. Water, Sanitation, Agriculture, Finance and Development are a few of the sectors. In Kenya, the introduction of the mPESA, a mobile phone application where moneys can be sent via mobile phones all around the country has solved the problems of money transfers. No longer do people in rural areas have to wait until someone is visiting from the city before money arrives. They receive the money as soon as it is sent from a PESA center. At a recent WaterHackathon event organised by CCHub in Lagos, one o f the tools suggested for Water development was a mobile system to facilitate the sharing of water resources in hard hit areas.²

Examples of some projects already in place include Mobile Community based Surveillance.mCBS is a mobile platform which is given to Traditional Birth Attendants to report vital maternal and child health indicators in real time using mobile phones. Using texts designed for this purpose the TBA can transmit alerts to nearby health officials who can respond immediately thus reducing delays in reaching appropriate care at a facility.³ Other mHealth projects currently being developed in Nigeria  is being collated by Ime Asangasi (@Imeasangasi- twitter handle) here.

REFERENCES:

1. http://www.internetworldstats.com/stats.htm (accessed 26th December 2011)
2. http://www.cchubnigeria.com/watermeetup (accessed 26th December 2011)
3. http://ehealthnigeria.org/where-we-work/list-of-implementations/mobile-community-based-surveillance-mcbs/

By Glenna Crooks. Industries have outsourced jobs, sometimes within the US, sometimes outside. It’s a strategy some say is necessary and some find abhorrent. Others warn it has short-term attractions but long-term negative consequences.  

As it turns out, we not only outsource jobs, we outsource problems. A paper in the Journal of Personality and Social Psychology reviews a number of studies about how adults react to complex social policy issues. Though health issues were not included in the research, surely these qualify – they’re complex and involve social policy, as well.

According to the authors, people – including those who are college educated – react to information differently depending on whether the issue is simple or complex.

If an issue is simple, people are willing to learn more, ‘take charge’ and act on what they know. When the issue is complex, however, people avoid learning more. Rather than learning or taking personal actions, they ‘depend on’ and ‘trust in’ government to do it.  They even avoid information suggesting government can’t do it, and only focus on information that government can. 

If the issue was not only complex but also ‘urgent,’ people are even more reluctant to learn about it.

The authors were stunned, saying all things being equal we should have less trust that someone, anyone (including government) can manage a complex issue. Instead, the studies suggest we psychologically ‘outsource’ management of complex issues to someone else.

It happens in health care often, when management of serious disease is outsourced to the clinician or when a person fails to use reasonable self-care measures believing that the health care system will fix whatever eventually ails them. Apparently it also happens in the case of social issues, in which case we outsource to the government. To make matters worse, not wanting to shatter our faith in government, we shun information that suggests the government can’t manage it. (more…)

The following is a guest post by Ms. Nasreen Sulaiman a Senior Instructor at Aga Khan University School of Nursing. She  has worked with palliative patients.

By Nasreen Sulaiman. Palliative care is an urgent humanitarian need for people worldwide with cancer and other chronic fatal diseases as it provide comfort and ease suffering. Nearly 80 % of the cancer patients in Pakistan present late in stages 3 & 4 with terminal disease.  In Pakistan, the concept of palliative care is in its infancy stage and need to be strengthened. In Karachi, one of the mega cities of Pakistan, only two hospices each of 20-25beds provides palliative care services where the health care professionals’ main focus is on providing the physical aspects of care. Pain management, a crucial aspect in the palliative care still remains partially addresses due to lack of narcotic supplies and other medications.  Furthermore, I strongly feel that other than providing pain and symptom relief measures, the social, emotional, and spiritual needs of the patient should also be given prime importance in order to provide holistic care to the patients. Nurses need to learn to utilize various non-pharmacologic measures such as therapeutic communication techniques, use of humor, guided imagery, therapeutic touch, relaxation exercises, religious songs and other diversional activities in order to ease the suffering, emotional distress and provide optimal comfort and support to the patients including their caregivers. Moreover, in palliative care settings, caregivers hold a great importance as they are the ones who are providing the total care and most of the time with the patients. Caregiver role strain is an essential area to be looked at. Caregiver support is another area to be looked upon. We need to establish caregiver self-help groups or other avenues to support the caregivers as they go through lot of emotional pain and need immense help and affection which may assist them to perform their roles effectively with the patient suffering from the disease.

By Magaly Blas. Gender inequalities have persisted over decades across all continents. Whenever we hear about gender inequalities we think in women who have lower access to education, jobs and health care compared to men. Women are also more prone to domestic violence, human trafficking, gendercide, and sex-selective infanticide.

So far we have seen women as victims of gender inequalities, but how about the role that women have as perpetuators of these inequalities? In many developing countries mothers, wives and teachers have a high acceptability of behaviors that maintain disparities between genders. For example, in some countries mothers teach their daughters that they have to cook and clean the house while their sons can keep playing. So when these daughters become mothers they assign their children the same roles, perpetuating this cycle. Mothers in some settings decide to favor her son over her daughter to attend the school and university. In some areas this is also true for health. In rural areas parents may sell their cow to pay the medical treatment of their sick son but they will not do this if their daughter gets sick.

Studies have shown that women with lower socioeconomic status and education are more likely to hold on to traditional ideas that perpetuate gender inequalities, and also more likely to perpetuate such ideas in the younger generation. For all of these reasons, it is important that in future awareness campaigns we place women not only as victims of inequalities (which gives them a passive role), but also as perpetuators of these inequalities.

My question to all of you is…Are we (as women who work for women’s rights) working to end the cycle of women as perpetuators of gender inequalities? Should we start by changing our own minds and own approaches towards interventions to decrease these inequalities?

The following is a guest post by Saundra Pelletier the CEO of WomanCare Global, a UK-based charity.  Saundra is an international marketing expert, published author, keynote speaker and executive coach.

By Saundra Pelletier. Big numbers always make people stop and think. Big birthdays, anniversaries or milestone are moments to reflect on what once was, and what could be.

Over the last few months, media coverage of the population reaching seven billion people has been especially ponderous, causing wonder about what the pressure of so many people will do to our planet. Questions abound. What will the carbon footprint of seven billion plus people be? Will there be enough food to feed everyone?  What can we do about population growth? How many people can the planet manage?

One of the ways we can help our planet is by investing in family planning. Family planning is one of the most cost-effective, high-yield interventions that exists today. Countries that invest in family planning can reap immediate health benefits, investment savings in health and education sectors, and social and environmental benefits that extend well beyond a single generation.

As I wrote in an earlier post, the ability for women here in the U.S. to use birth control to prevent or delay pregnancy gave every woman  the power to decide if and when she wanted to have children, and how many to have. And with the ability to keep families smaller, came the ability to provide for their present and future well-being. (more…)

By Ufuoma Lamikanra. Why do many people fear death? I believe that it is a fear of the unknown. If you do not know what will happen to you at the end of life, it is a normal feeling to be afraid. This fear appears to be common among both young and old persons. When my then four year old daughter (she is now about 33 years old) was bitten by a dog, she kept on asking if she was going to die. A colleague told me of a man who always left a gathering of friends whenever the discussion turned to issues on or related to the end of life. Others took advantage of his fears and regularly excluded him from their midst by discussing such “unpleasant” issues.

However, my grandfather was not afraid to die. He desired death instead. At about the age of 90 years (calculated, since there were no records when he was born), many of his age mates – friends and relatives, no longer visited him and he suspected that they had died.  He was always told that they were alive. Nobody was bold enough to tell him the truth. One of his almost daily wishes was to join them, as he could not understand what he was still doing on earth while all his contemporaries were gone.

Many Africans, especially men, loathe leaving the world without leaving behind certain “achievements”. A man is regarded as a failure, if he is unmarried, does not own a house and more importantly, has no male child at the time of death. The absence of a male heir means the tragic end of a lineage as that family name becomes extinct. The pain of death is somewhat lessened by the fact that the deceased left behind male children, to carry on the family name.

A notable feature of the end of life in many African cultures is the belief that most deaths are not natural, but occur through supernatural means. There is always a strong suspicion that someone, usually a close relative, must have been responsible for a death in the family. Sadly, wives are usually accused of killing their husbands, while husbands are rarely accused of ending their wives’ lives. So, who is responsible for women’s death? According to my auntie, women kill their husbands, while women die as a result of their sins.

The following is a guest post by WomanCare Global CEO Saundra Pelletier. Besides serving as the founding CEO of WomanCare Global, Saundra is an international marketing expert, published author, keynote speaker and executive coach.

By Saundra Pelletier. In 1965, Griswold v. Connecticut gave a married woman the right to use birth control to prevent or delay pregnancy as she saw fit. This guarantee of a basic human right led to other reforms that allowed millions more American women to decide the direction of their own reproductive lives.  This summer, we are proud to see another key reform go through: starting next year, the Affordable Care Act will allow even more women in the United States to be in charge of their own health by requiring new health plans to provide free birth control without a co-payment. These are hard-fought wins for women’s health and for women’s rights of which we can all be proud, but sadly the ability of a woman to choose when and whether to become pregnant is far from assured in other parts of the world.

Pause for a moment and imagine you’re not American, but from Sub-Saharan Africa – Ethiopia for example. You are 20 years old and have four children – the first of which you had when you were 15 and newly married. You’re worried about becoming pregnant again. You tried to get birth control once, but arrived at the clinic only to find the shelves bare and no way to access any form of birth control.  The thought of another pregnancy, whether by a husband who won’t take no for an answer, or by a stranger who might force his way upon you while making your way to fetch water for the family is overwhelming. You’re not in great health, and another pregnancy would take its toll on your weakened body. The chances are high that you might not survive pregnancy or labor to be able to take care of your family.

Globally, 215 million women would like to be able to prevent or delay pregnancy, but do not have access to the supplies that would allow them to take control of their lives. As American women, we know from our own experience that the ability to make our own fertility decisions has made an immeasurable impact on our own lives. For women in the developing world, access to reproductive health supplies would save lives and improve health, as well as the economic and social well-being of families and communities.

(more…)

Women for a Healthy Future

Non-communicable diseases (NCDs), commonly known as chronic diseases, cause two out of three deaths worldwide, and are the leading cause of death for women around the world.

We have a once-in-a-lifetime opportunity to tackle NCDs, considered to be one of the 21st century’s greatest health and development challenges. In September, world leaders will gather at the United Nations (UN) for a historic summit on NCDs. The decisions they make will impact the lives of millions.

NCDs threaten women’s lives and our children’s future. Yet, we know that 80% of cardiovascular disease and diabetes and 40% of cancers can be prevented by avoiding tobacco, increasing physical activity and eating healthy foods. It’s going to take strong commitments from the world’s leaders and sweeping policy changes to reduce women’s and children’s vulnerability to NCDs.  

As a result, organizations representing global health, women’s health, child rights, and youth perspectives have come together to form the Women for a Healthy Future movement. This movement is aligned with UN Secretary-General Ban Ki Moon’s “Every woman. Every child” initiative and is mobilizing women from around the world to demand action against NCDs.

Raise your voices. Sign the petition. Tell your friends.

If we gather 10,000 women’s signatures, we will take them to the media, to world leaders gathered at the UN, and to business leaders. We need your support to show the world how deeply we care, and to ignite action against NCDs.

By Archelle Georgiou.

“So, how was China?”

We recently returned from China and Vietnam and have been asked this question many times by curious friends, family, and colleagues.  Recognizing that we live in a world of soundbites and that no one really wants to hear every detail about our fourteen day trip, I’ve responded by focusing on the experiences and observations that had a lasting impact on how I think.  There were three: one is personal, one is political, and one is professional.

Personal: While “Made in China” is present on everything from chatchkas to clothing labels to housewares, and although China’s thriving economy is a frequent topic in the business world…I simply wasn’t expecting to see their ultra-modern infrastructure.  I went to China with a visual image that was pre-Mao.  Shame on me.  Instead, I saw 14 story shopping malls, a Shanghai skyline best described as “New York on steroids,” an efficient and clean subway system, and construction cranes on every square block. While analysts predict an economic and building bubble that will deflate soon…there is national confidence that China’s  5 Year Plan (for 2011-2015) will address these risks.  Take a look at the well-defined, measurable goals regarding their economic targets, innovation, the environment, people’s livelihood, social management, and reform.  The Plan is translated into action down to the individual citizen level to assure that they achieve their goals.  We may not agree with socialist/communist ideals, but step back for a moment and imagine how much progress the US would make if we had a unified plan regarding our nation’s advancement.

How was China? A strong world power.   Never again will I refer to China as an “emerging economy.” They have emerged, and there are a few things that the US can learn from them. (more…)

By Lois Privor-Dumm. We’ve heard the anecdote that you can find Coke in just about any village in Africa, but not always essential medicines.  Is that really true?  Well, our team at the International Vaccine Access Center (IVAC) at Johns Hopkins set out to find out. 

It’s actually not as easy as you might think to test the hypothesis, as Hopkins PhD candidate Kyla Hayford found out.  We did, however, get enough data to say comfortably that the anecdote is true as you will find in our new IVAC report, Improving Access of Essential Medicines through Public-Private Partnerships.

Photo credit: Tielman Nieuwoudt

First, we found an astonishing lack of available data about stock outs, wastage and other measures that indicate whether essential medicines are available.  Our report compared this to measures of availability of consumer packaged goods – things like candy bars and cola and calling cards – which seem to be stocked in abundance throughout the developing world. 

Why are these indicators important?  The simple truth is that no one dies if there aren’t mobile phone cards at the local kiosk, but the stakes are high if an antibiotic is not available to treat a child with a deadly disease.  Why is it, then, that consumer goods companies have many means to effectively track distribution, while there are very few measures in place to track the availability of essential medicines throughout Africa?

We found that injectable ceftriaxone, for example – a life-saving antibiotic for those with severe infections – was available in Kenyan and Tanzanian hospitals less than half the time, while mobile phone cards were available 90% of the time. 

So what can be done? (more…)

Francis S. Collins, MD, PhD is the Director of the National Institutes of Health and because of  his work and leadership is Disruptive Women in Health Care’s June Man of the Month. Dr. Collins wrote the article below which was originally posted in The Huffington Post on June 15th. This article is a perfect example of why he is our Man of the Month for June.

Broadening Our Global Health Vision

Over the past few decades, global health research has primarily focused on the “big three” diseases: AIDS, TB and malaria. And, thanks in large part to biomedical innovation, we today have better ways to treat these dreaded, infectious diseases and lower the risk of transmission — advances that have saved millions of lives and promise to save countless more.

However, the job of biomedical research is far from over. Given the changing nature of the global health landscape, we must act now to broaden our vision even further. First, we need to apply the power of scientific innovation to more health problems. Secondly, we need to recognize that developed nations are not the only source of such innovation.

While infectious diseases remain a significant problem, low-income nations face many other serious health challenges. In fact, the fastest growing causes of death and disability in the developing world are injuries, such as those caused by traffic accidents, and non-communicable diseases, such as cancer, heart disease and diabetes.

It will be no easy task to identify and implement the right tools to tackle this formidable — and potentially very costly — array of problems in resource-poor countries. To succeed, we will need the brightest minds in all parts of the world, including those from both the public and private sectors, to work together in new and highly creative ways. (more…)

By Jane Sarasohn-Kahn. Over 85% of the world’s population is covered by wireless phone signals. The global proliferation of wireless phones provides a technology platform to move health services to people — broadly referred to as ”mobile health” or “mhealth.” mHealth: New Horizons for health through mobile technologies, the World Health Organization’s (WHO’s) second report on mobile health, summarizes a survey of mobile health developments around the world, published in June 2011 based on survey data from 2009 collected in 114 nations.

WHO learned that mHealth is most easily deployed into health applications where voice communication via traditional phone networks has been used. Thus, in important applications like surveillance and decision support, mHealth is less likely to be established because these functions require more advanced capabilities and technology infrastructure.

The survey evaluated mHealth services in 14 categories, as shown in the chart. These include health call centres, emergency toll-free phone services, emergencies and disasters, mobile telemedicine, appointment reminders, community mobilization and health promotion, treatment compliance, mobile patient records, information access, patient monitoring, health surveys and data collection, surveillance, health awareness raising, and decision support.

The most prevalent of these services are toll-free emergency applications, mobile health call centres and emergency services, and mobile telemedicine, all available in over 50% of WHO member states. In addition, mHealth-based appointment reminders are available in a plurality of nations.

The most popularly piloted mHealth programs include patient monitoring, treatment compliance, mobile telemedicine, and patient records.

Health Populi’s Hot Points:  Most of the mHealth deployments around the world tend to be small-scale pilots that deal with single issues. The largest scale mHealth programs are usually supported via public/private partnerships. (more…)

By Jane Sarasohn-Kahn. By 2050, the demand for long-term care (LTC) workers will more than double in the developed world, from Norway and New Zealand to Japan and the U.S. Aging populations with growing incidence of disabilities, looser family ties, and more women in the labor force are driving this reality. This is a multi-dimensional problem which requires looking beyond the issue of the simple aging demographic.

Help Wanted? is an apt title for the report from The Organization of Economic Cooperation and Development (OECD), subtitled, “providing and paying for long-term care.” The report details the complex forces exacerbating the LTC carer shortage, focusing on the fact that current policies to address this future are fragmented and piecemeal. Instead, OECD argues, policymakers must smartly weave together a comprehensive approach that addresses the many facets of the problem.

Statistically, in today’s world, 1 in 5 LTC users is under 65 years of age; one-half are over 80. Most of the LTC services paid-for are based in institutions: 62% of total LTC expenditures occur in institutional settings, not at home.

That simple aging demographic is the first aspect to consider: in 1950 under 1% of the global population was over 80. By 2050, that share will increase from 4% in 2010 to 10% in the OECD countries.

Today, it is informal, unpaid caregivers — usually family carers — who bear the brunt of long-term care.

Health Populi’s Hot Points:  The report states, “Family carers are the backbone of any LTC system.” That backbone is breaking in developed countries. More than 10% of adults over 50 living in an OECD country provides help with personal care to people who have limited ability to care for themselves. Without support, OECD says that caregiving is associated with a reduced labor supply for unpaid work, higher risk of poverty, and a 20% greater prevalence of mental health problems. (more…)

By Lois Privor-Dumm. We’ve all heard these words: “There is tremendous need here at home,” or “money in Africa has been wasted for so long.”   This is why this simple video from the ONE campaign struck me. Through a public health lens it is a no-brainer: of course you want to spend on cost–effective interventions that will save lives.  For others, while they admit that it is an admirable goal, the connection is not made.  In times of financial uncertainty, we have to be more careful with our money, don’t we?

One of the best and prudent ways to invest though, is in future generations.  In the US, we provide all of our children the best chance at life, with fewer worries about preventable, devastating disease.  Imagine what that kind of security could do for a family in Africa.  Healthier children in Africa would be able to stay in school.  Families would worry less about the all too common diseases of pneumonia and diarrhea, and their devastating costs.  Rather than accepting the fate that their children may fall ill, they would be thankful that new vaccines are being made available.  Throughout the years, as healthcare improves because of our investment, so would income and productivity. Our investment would return to us through a country’s improved stability, better governance, and more – and all directly relate to our own security. 

The introduction of a new vaccine is not something taken for granted in the developing world.  Up-to-date immunization cards of young children are among a family’s prize possessions.  Throughout Africa, pneumococcal vaccines, once deemed far from the reality of any African village are now being introduced and are offering hope.  Rotavirus vaccines, helping prevent one of the most deadly forms of diarrhea in young children, may soon also be a reality across Africa -  all for a relatively small fraction of the US budget.  How often do we have a chance to save so many lives with such an effective and minimal financial commitment?  Four million lives over a five-year period is a pretty good return on investment!

Let’s make wise investments

Next month, the GAVI Alliance will be holding their pledging conference to encourage donor countries like ours to contribute to providing the most basic and effective prevention.  Please tell President Obama and your local leaders that you care.  Sign the ONE petition, and tell your friends and family to do so. The more they hear from you, the more they know this is an investment we as Americans care about.  Do it for their future – and ours.

Photo credit: Adrian Brooks, Imagewis