In May 2007, Dr. William H. Frist co-led a Center for Strategic and International Studies (CSIS) delegation to Russia to participate in the first St. Petersburg State University Forum on Global Health. The forum explored bi-national cooperation in health and health care delivery, including the exploration of establishing a public health initiative in Russia.

At the conclusion of the trip, Senator Frist published the paper: “Improving Russian-U.S. Collaboration on Health” (Washington Quarterly, 30:4, 2007, pp. 7-17) which focused on how Russia and the U.S., in a time fraught with tension, could work together to solve public health issues in terms of policy, behavioral change, and chronic disease. Both could emerge as better, healthier, more viable countries, with health partnerships strengthening diplomatic relations. 

Senator Frist, a trustee at CSIS, was instrumental in establishing the Global Health Policy Center, and he served on the advisory board of the Commission for Smart Global Health Policy. This commission created the report, “A Healthier, Safer, and More Prosperous World,” as the product of a year’s worth of study of the long-term U.S. strategic approach to global health. Dr. Frist, in addition, serves as a co-chair of the Eurasia Health Project as a part of the CSIS Russia and Eurasia Program. 

Initiation of the idea of receiving a Russian delegation of high level physicians in Tennessee began with a discussion among Russian and American experts in global health at CSIS in May 2009.  Co-chaired by Senator William Frist, former Majority Leader of the U.S. Senate and CSIS Trustee, and Dr. Nikolai Gerasimenko, First Vice Chair of the Russian Duma’s Committee on Health Protection, the panel weighed new ideas for future Russian-U.S. joint initiatives and generated considerable shared excitement.  CSIS Senior Associate Judyth Twigg played the lead role in conceptualizing and coordinating the session. Approximately twenty additional experts on U.S.-Russian collaboration on health, representing government, academia, and the private sector, contributed significantly to these discussions, which amounted to a brainstorming session for a blueprint for strategic bi-national collaboration on health

Dr. Andrew C. Kuchins, Director and Senior Fellow, CSIS Russia and Eurasia Program, and Dr. Judyth Twygg have been part of this effort to bring Russians to the U.S. from the beginning. On January 31, 2011 the CSIS Russia and Eurasia Program hosted a conference as part of the Eurasia Health Project entitled, "Sharing Health: U.S.-Russian Collaboration in the Health Sector.” Dr. Nikolai Gerasimenko, a long-standing member of the Russian parliament and former chair of its health committee, served as the Russian Co-Chair along with Senator Bill Frist from the U.S. This meeting, which discussed U.S. and Russian efforts in health sector reform, promotion of healthy lifestyles, and regional-level efforts at health reform, was intended to generate momentum toward meaningful communication and collaboration between the two countries at both the governmental and non-governmental levels. Senator Frist’s article, “What the Doctor Orders” (Foreign Policy, 9/11/09) highlights the key findings and conclusions of this conference. 

While serving in the U.S. Senate, Dr. Frist worked alongside Alaska Senator Ted Stevens and Librarian of Congress James H. Billington to establish the Open World Program by an act of Congress in 2000. The Open World Leadership Center conducts the first and only international exchange agency in the U.S. Legislative Branch and, as such, has enabled more than 16,500 current and future leaders from Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Ukraine, Tajikistan, and Turkmenistan to meaningfully engage and interact with Members of Congress, Congressional staff, and thousands of other Americans, many of whom are the delegates’ direct professional counterparts. Senator Frist served on the board of Open World from 2003 to 2010. 

Prompted by Senator Bill Frist, M.D., Senator Lamar Alexander sent a request to James Billington, Chairman of the Board of Open World Leadership Center, to host a health exchange with Russian health professionals in the state of Tennessee. Dr. Billington responded in a Letter to Senator Alexander with enthusiasm: 

     “Having hosted nearly 400 Georgian, Kyrgyzstani, Russian, Ukrainian, and Uzbekistani participants—including health leaders—in Tennessee, Open World has an excellent statewide network of local host organizations and host families there. I am confident that, working with Senator Frist and his staff, you and your staff, and CSIS, Open World can carry out an exceptionally strong program on health care that will benefit both the Russian delegates and the participating Tennesseans.” 

Open World agreed to provide nominations for the Russian delegates, and the Open World Moscow staff worked with the Administration of Kirov Region with approval of Governor Nikita Belykh.

High rates of communicable and chronic diseases, outdated medical equipment and facilities, and inadequate health care financing have contributed to a health care crisis in Russia. Open World provides grants for a Health Care Provision to address the issues relating to the delivery of services for patients with communicable or non-communicable diseases as well as at-risk individuals. Open World hopes that the outcome of this exchange is a medical partnership between the State of Tennessee and the Kirov Region. 

Senator Frist has assisted directly in the organization of the statewide effort to place the Russian physicians in programs across Tennessee consistent with their interests in rural health, academic medicine, information technology, and health service delivery. 

Senator Frist has had a longstanding commitment to “using health as a currency for peace.” Health care partnerships and exchanges of information provide powerful and robust contributions to diplomatic relations between the peoples of two countries. Such health diplomacy contributes to better understanding among nations and leads to dialogue in other spheres of human and government interaction. “Health as a currency for peace” allows individuals to be a part of missions greater than themselves and provides a way for America to begin to think about a long-term vision for building bridges of trust around the world, in both G8 nations as well as developing ones. Building Russian-U.S. collaboration in health care will benefit the foreign and public diplomacy of our nations and a better quality of life for the citizens of both nations.

Last week, the Russian delegates arrived and spent time with the Center for Strategic and International Studies, Kaiser Family Foundation, and National Institutes for Health in Washington, D.C. For the weekend, the delegates separated into two groups to tour both Knoxville and Memphis, Tennessee. In Knoxville, the delegates enjoyed a football game and other festivities and today they will visit De Royal Industries. In Memphis, the delegates visited St. Jude Children's Hospital, the National Civil Rights Museum and Beale Street over the weekend. Today, they will tour the Shelby County Health Department and Le Bonheur Children's Hospital. We are excited to host these health professionals in the State of Tennessee!

We will keep you apprised daily of their activities this week.

by Sina Iranmanesh
Vanderbilt Department of Surgery, Resident
Kijabe, Kenya

sina iranmesh blog

No doubt, working at Kijabe is a once-in-a-lifetime experience.  Upon setting foot on the dirt road leading to the hospital, I knew I would face many hurdles over the next four weeks as a general surgery resident.   Over time, I appreciated subtle clues and changes in each patient’s physical exam to help guide the management of their care without relying on further information.

Lesson number two: I could no longer practice medicine ignoring the financial burden of my treatment plan.  Practicing cost-conscious medicine was not just beneficial on a global sense, but specifically affected each family suffering from an economic crisis.  Even worse, many treatment options (i.e., chemotherapy, radiation therapy, referrals to specialists) were physically or financially inaccessible by our patient population.  For example, unlike women in the U.S. who had the option of a lumpectomy with radiation for breast cancer, our patients in Kijabe underwent a mastectomy because they could not afford radiation. I spent time counseling a young woman on her treatment options after removal of a large tumor from her thigh. I recommended radiation therapy to reduce the chance of the tumor returning, though she decided against it after discovering how much it would cost her.  Such encounters were unfortunately fairly common.

In contrast to the philosophy of utilizing single-use, individually wrapped, and disposable equipment in Western operating rooms, Kijabe’s mantra of maximizing its very limited resources proved surprisingly effective. With the exception of our gloves, every piece of equipment used in the operating room (especially those labeled as ‘single-use’) had been routinely sterilized over and over again. I can only wonder what impact we can have on the US Healthcare Crisis if we learned a few lessons from Kijabe...

Kijabe is renowned for its level of care and medical education. As such, it is home to a number of visiting physicians of all levels of training. I felt fortunate to have encountered a number of these missionary physicians.  My one-month commitment to work in an African hospital paled in comparison to individuals (and their families) who offered years of devotion. Working alongside such individuals was inspiring to say the least.  I am grateful for the opportunity to experience medicine from a different angle, and the lessons I learned along the way.


by Brande Jackson

last stop water hope

After working with over 100 volunteers and getting 5000 new supporters for clean water initiatives, Water = Hope wrapped up another fun summer with the Brad Paisley H2O tour!

Our last weekend started out in rainy Philadelphia, where we were still able to have a great night - Philly was one of our best stops on the 2010 tour! - thanks to a hard working volunteer team that braved the elements to talk to fans and build support. We could not have done it without them!

The next day the tour stopped in Bristow, VA, outside of Washington DC. We were joined by a repeat volunteer, Ashley, who brought along her sister this time around, as well as a  hardworking (and very funny!) father-daughter team, and two high school friends who were accompanied by mom. Our team did great, talking to hundreds of fans about the importance of clean water; in fact, two of our volunteers signed up over 300 people all on their own, a very impressive feat. And, for the first time in a looooong time, we had a show with no rain, a change we were very grateful for!

Raleigh was the final stop of the tour this year, and we were excited to wrap things up with a big volunteer crew of 10, including about five volunteers who were joining us for the second year in a row. They worked hard to help us end the tour on a great note.

All in all, it was an amazing summer full of incredible volunteers, supportive fans, and lots of love from the Brad Paisley crew. At the end of the day, going out on tour with an artist is really about the chance to use music as a connecting force, and we were reminded time and time again this summer of the compassionate nature of the country community.  We are excited to see how many lives are impacted by the work of our volunteers and supporters from this summer!

by Omo Aisagbonhi
Vanderbilt School of Medicine
Ogbomoso, Nigeria

omo 2

Today started as usual with ward rounds, visiting my patients: Stephen, baba with DM and Mr. SO whom we operated on for appendicitis. I really feel sorry for Stephen’s dad.

Then we went to the OR where we had one scheduled surgery and one emergent ex-lap. The scheduled surgery was removal of a breast mass; turned out to be a chocolate cyst (grossly). I really enjoyed having scrubbed in. I started the IV line and first-assisted; also got to close the skin. I really do enjoy surgery especially on days like this when I feel competent; when the operation went well, when I closed skin properly, when I feel I helped the team help a patient. 

The second case was interesting. A man in his 60s/70s presented to the hospital after a road traffic accident in which he obtained rib fractures and perineal laceration. He also had an acute-appearing abdomen with left quadrant tenderness, hypoactive bowel sounds and free air on x-ray. We were concerned about stomach/small intestine perforation or splenic laceration. The interesting part of the story is that upon entering his abdomen, what we found was indeed a perforated viscus (small intestine) but there were surrounding adherent exudates to suggest bacterial perforation such as typhoid perforation, not due to trauma. His spleen and other internal organs were fine. We wonder if he was ill preceding his accident; I’d find out from him on rounds tomorrow

After the OR, went to physician conference where Dr. Aremu talked about the responsibilities of family physicians to their patients. There was a post-presentation announcement about ensuring patients pay their bills up-front especially in non-emergent cases. The thing is that this is a small town where many of our patients cannot afford the hospital bills; many go into debt as a result, but the hospital needs funds to run to be able to keep helping patients; there really is a need for a national/state-wide health insurance system.

Overall, I’ve had an excellent experience here in Ogbomoso. The physicians here do so much with very little. I admire the tradition of praying before every surgery and before every clinical encounter. There is obviously room for improvement, need for specialists such as pathologists, cardiologists and ICU physicians, and need for better diagnostic and monitoring equipment such as ECG monitors (there isn’t one even in the ICU) and CT scanners (especially given the volume of patients that present with head injuries). I think though that beyond the hospital and immediate control of hospital personnel, general road safety urgently needs to be addressed. Too many patients present with and die from otherwise preventable injuries secondary to road traffic accidents. Also urgent, is the need for a health insurance system as too many patients end up being turned away or under-treated due to inability to afford medical services.


CRISIS IN THE HORN OF AFRICA - Dr. Bill Frist, former Senate majority leader, telephoned Playbook after returning from a trip with Dr. Jill Biden to a famine refugee camp on the Kenya-Somalia border: "The Horn of Africa is undergoing the most acute food-security emergency in the last 25 years - 29,000 kids have died in the last 90 days. The response to the crisis is improving globally, but the magnitude is outstripped the supplies. ... Two issues that I'm stressing: Number one, lives can be saved by both individual Americans, and taxpayers through our government responding and investing. And, number two, our long-term investments over the last 10 years, through the USAID, in the Horn of Africa, have paid off. ... "Dr. Biden is very effective in listening, observing, listening, asking questions, and representing the United States in terms of concern and commitment of support. Because she's not in the political hotbed, for me, who's out of politics, she was a perfect leader for the delegation. ... I have visited refugee camps in Chad and Darfur ... The striking difference here is the lack of access in Somalia, because of a dysfunctional government. There's no access to the millions of people in Somalia, where the famine is worst. Therefore, the refugees all have to go to Ethiopia and Kenya, where there is economic stress and environmental stress. ... The crowding in the refugee camps has resulted in pneumonia and a very rare skin disorder, ictchyosis. The kids are dying of pneumonia and diarrheal diseases. ... Individuals who do want to invest, the easiest place to go is, which has a list of nongovernment organizations."

by Julie Shelton
Resident, Department of Surgery
Vanderbilt Medical Center
Kijabe, Kenya

kijabe hospital

Photo: Kijabe Hospital

I have been in Kijabe for almost three weeks and today is the first day I received a hard and fast sign that I am in a developing country. No power. No explanation. On one minute then off the next.  It happened in the OR  – just a blink – but serves as a reminder that as much as there is available here in Kijabe, more than in many other hospitals in Kenya, it is still a tenuous resource. One that is dependent on the hard work of so many to keep things running as smoothly as possible so that the lights stay on, the available suture will be strong enough to hold a knot, and blood will be available for the patient with anemia who needs to have his spleen out. 

My first night here I was summoned to “Casualty”, Kijabe’s version of an Emergency Room. There had been an “RTA” (a Road Traffic Accident) and all the victims had been brought to Kijabe. There were 11 total, easily filling the small room that is Casualty. Not quite knowing where to start – which patients had been seen, which had not, I glanced around the room quickly triaging patients. Doing so, I noticed some family members gathered around a stretcher with a young man lying on it. One man in particular looked up from the patient and met my gaze. The look on a trauma family member’s face is unmistakable and is the same no matter where you are from. Grief and sorrow mixed with disbelief and hope - there is hope in there as well. Hope that the news will be good. Hope that the injuries will be minor. Hope that if they are not minor, that their family member will recover quickly and without lasting harm. Hope that you will be able to help. 

I was stopped in the hospital corridor the day following that trauma by that same family member – this family member described the trauma victims as his people. He wanted to thank me for helping his people. He was not satisfied by my simple “you are welcome” but in our mixed conversation of American English, British English, and Swahili I think I managed to convey that it really was my pleasure to be here and to be able to help. 

His cousin in particular was one of the more seriously injured but went home after a few days of monitoring on the wards – grateful to be able to get back to his job and his family. 

This is what Kijabe is able to provide by combining the work of so many – a resource, a place for people to come to heal. A place where it is a true pleasure to be able to help, where one can join with many others to keep the lights on.



by Senator Bill Frist, MD

WHF and Shah

(Senator Frist with USAID Director Dr. Rajiv Shah, 8.7.11)

Yesterday, I visited the Dadaab Refugee Complex in eastern Kenya with Second Lady Dr. Jill Biden and USAID Administrator Rajiv Shah. While there, we heard stories from mothers with their children who had lost their husbands. Families who had journeyed for weeks to arrive at the camp malnourished and in dire need of medical assistance. And, worst of all, parents who had heartbreaking stories of losing children in the flight from famine in Somalia. 

There are two main points, as a doctor and as a former senator, that I want to highlight in the midst of this terrible crisis. 

First, though the United States has provided an enormous contribution of aid (we are providing 47% of the food), we need the help of other nations immediately. The other 53% of funding is being provided by 40 other countries. We need them to step up. We also need private donations to aid agencies as soon as possible. 

For instance, there are over 150 cases of measles, which is huge and can rapidly lead to the death of thousands, in the over-crowded Dadaab camp.  Vaccinations can halt the spread of such fatal diseases.  These children’s health is already severely compromised by malnutrition. Aid agencies need public dollars to fight these diseases, like measles and polio, with vaccinations, oral rehydration, and vitamins, especially in children under the age of five. 

However we do not need to rely on public dollars alone. I have seen firsthand that even the simplest form of aid can save lives and even tiny investments can make a huge impact. A measles vaccination costs under $2 and therapeutic feeding can cost as little as a dollar a day.  A small donation from you can save the life of a child and I am confident that even in our own tough times, Americans will respond generously as they always have when catastrophe strikes around the globe. 

Second, the good news is that we have learned that the famine is not an intractable problem for the region. Though Somalians are having to flee their country and drought is occurring throughout the Horn of Africa, Kenya and Ethiopia are much better prepared to withstand the low rainfall. Our American dollars over the past ten years have paid off. Our investments in agricultural and livestock advancements have prevented the drought from becoming a famine in these two countries. 

The Dadaab camp is a humanitarian crisis and we need your support. Please consider a donation today. We will support those aid agencies who is on the ground providing medical and food assistance to those suffering from the effects of famine. 

Africa: Briefing on Dr. Jill Biden's Recent Visit to Kenya
Tue, 09 Aug 2011 12:50:32 -0500

Briefing on Dr. Jill Biden's Recent Visit to Kenya

Eric P. Schwartz
Assistant Secretary, Bureau of Population, Refugees, and Migration
Senator Bill Frist, and Special Assistant to the President Gayle Smith
Via Teleconference
Washington, DC

August 9, 2011

MR. TONER: Thank you, and thanks to all of you for joining us this morning. As you know, East Africa is facing the worst drought in 60 years, and the UN has declared that famine now affects five regions in Somalia and predicts that it could expand throughout the southern Somalia.

Over the weekend, Dr. Jill Biden led a delegation to Kenya to view firsthand the situation on the ground. And joining us this morning to discuss that trip as well as our overall assistance efforts in the region are several members of the delegation – Special Assistant to the President Gayle Smith, Senator Bill Frist, as well as Assistant Secretary of State for Population, Refugees, and Migration Eric Schwartz.

Just a reminder that this is an on-the-record briefing this morning. And so with that, I’ll hand it over to our first speaker, Gayle Smith.


MS. SMITH: Sure. Thanks, Mark. Good morning, everybody, and thanks for joining us. We were also joined on the trip by USAID Administrator Raj Shah, who is on a plane right now. Otherwise, he’d be on the call with us.

Dr. Biden wanted to do this trip – and thankfully, Senator Frist agreed to join us very early on – to highlight the crisis in the Horn of Africa and basically help mobilize both an American response, but also a global response to a crisis that is acute – I’m sure you’ve all heard the figures of 29,000 kids dying in the last 90 days – but to also underscore the fact that there is a lot we can about it; that we can get assistance to people; that the people in Kenya and Ethiopia, while adversely affected, are in a better position today than they might have been because of things that have been done over the last 10 years; and importantly, that in the long range, we can also support food security.

We visited the Kenyan Agricultural Research Institute, which is supported by the U.S. Government, as a way of highlighting, again, that there are things we can do to reduce the prevalence of famine in the future. We traveled to the Dadaab refugee complex, where Dr. Biden, Senator Frist, and the rest of us were able to both see the relief operations that are going on and meet with many of the Somali refugees that have recently walked to Kenya from inside Somalia.

What we’d like to do this morning is hear from Senator Frist and my colleague Eric Schwartz. I can help address any questions that may come from – for AID given that Raj Shah is unable to be with us. And then we’d like to open up to questions.

So Senator, if I could turn over to you first, and thank you again for joining us on the trip.

SENATOR FRIST: Gayle, thank you. And I’ll be brief. People over the next couple of days are going to ask again and again why in the world did Dr. Biden and all of us take this trip. I went at the invitation of Dr. Biden with a real purpose of helping – in addition to looking to the healthcare needs, which I as a physician do, but really drawing some attention so that the world better understands the size of this catastrophe, the needs, and the fact that in spite of the U.S. stepping up and the world stepping up, the demands and the needs are growing even faster than what is being provided. So it’s not just to learn, but also to help mobilize a domestic response, but also an international response to what a lot of people don’t realize, especially in this environment, of what’s happening in terms of the economy here and at home, but this is the most acute food security emergency anywhere in the world now and in recent years.

As a physician, I did spend time looking at the health and the health needs of the people of the Horn of Africa in part because through our past experiences and as underscored by USAID by focusing on the health needs and therapeutic feeding, we really engage one of the most effective ways of lifting people up in times of need. Food is very important, response in terms of food security, critically important, but the health needs themselves, also very important, and some would even say a prime area of importance.

The crisis is growing fast, and we saw that firsthand on the ground and talking to individual families as they were coming into refugee camps who literally have walked for 15 and 16 days – a mom with her four children, a husband, a father who is absent who is still in Somalia; they don’t know whether or not he’s alive. I think the things we can do is two things – make sure the world knows this is unfolding and know that people’s help and investment, as they have responded in the past here in America, can make a huge, huge difference.

Now with that, I’ll sort of stop because that’s the purpose. Our observations – now it’s up to us to share with the American people and with the world. It’s a nonpartisan issue. I think my presence, in part, demonstrates that. It is everybody coming together in the United States, at a time that many things are very fractured, around a common good and a common cause where past investments have paid off – and we saw that in Kenya, and we saw that in Ethiopia – and where if we continue to invest in the future, we know that these catastrophes don’t reach the threshold that they have today in being one of the great famines of the last 50 years, one of the most tragic famines of the last 50 years.

Now, with that, let me turn to Eric. Again, we had a great team on the ground. We were able to look at these issues from a medical standpoint under Dr. Biden’s leadership putting this team together, under a USAID standpoint, and a State Department and refugee standpoint. With that, let me turn it over to Eric.

ASSISTANT SECRETARY SCHWARTZ: Thank you very much, Senator Frist. And let me also say – join my colleague Gayle in thanking you for your willingness to participate in this trip, and we were honored and extremely – your participation was extremely valuable. We – and let me talk a little bit about Kenya if I may.

The Dadaab refugee complex in the – in northeast Kenya is the host to – was already the host to a very large and protracted refugee population on the order of 300,000 refugees or more. And for that and the management of that relief effort over many, many years and the assistance of the management, we’re very grateful to the Government of Kenya that has provided refuge to Somalis.

But what they’ve seen in recent months is an enormous increase in the numbers. Right now, the numbers of refugees in the Dadaab complex is estimated at over 420,000. There are probably about 477,000 Somalis in camps throughout Kenya, but in Dadaab it’s well over 420,000. The refugees from Somalia are coming in at a rate of late of about 1,400 to 1,800 per day, although that number obviously changes as the situation changes. And the challenges are substantial. People are coming in in very, very difficult conditions. The rates of malnutrition are very, very high. It has severely taxed the registration capabilities in the camps.

At the same time, it’s very important to note that the Somalis who are coming in with all of those difficulties are receiving basic food and sustenance when they get in to the camps and that the United Nations is hard at work with the involvement and support of the Government of Kenya on the expansion of this facility. There are three camps in the Dadaab complex, and one of those camps is being expanded substantially. In addition, they’re building a fourth facility as well. So efforts are hard – are underway and are moving forward in terms of expanding the capability of the camps to handle this inflow of Somalis.

Similarly, we are making substantial efforts to provide assistant to the Government of Ethiopia, which is providing about – assistance to about 160,000 Somali refugees, as well as our efforts to provide assistance to those areas within Somalia which we can reach with assistance. So the effort is full on and will continue in the days and weeks and months to come.

The visit, I think, was important in terms of shedding light on the important efforts that are underway and the importance of continued support from the international community. With that, I guess I’ll turn it back either to Gayle or to Mark. I don’t know who our moderator is right now.

MR. TONER: Great. Thanks, Eric. Mark here. Thank you all. And, operator, we’re ready to open it up to questions now. Again, just a reminder this is an on-the-record briefing, and if you could just state your name and media affiliation, that would be a big help.


OPERATOR: Thank you. We will now begin the question-and-answer session. If you would like to ask a question, please press *1. To withdraw your request, press *2. Once again, if you would like to ask a question, please press *1. One moment, please, for the first question.

Our first question comes from Mina al-Oraibi. Your line is open.

QUESTION: Good morning. I’m with Asharq Alawsat newspaper, Arabic language paper. Thanks for doing this. I wanted to ask you in terms of international response, I know there is a UN appeal out at the moment, but if you could speak a little more about what can be done on an international scale to support those in Somalia but also those in Ethiopia and Kenya.

MS. SMITH: Sure, I’m happy to take a first cut at this. Eric, you may want to add. This is Gayle Smith.

The UN has issued an appeal, but the biggest need, quite frankly, right now is for cash contributions. That enables folks on the ground, both UN agencies and NGOs, to provide whatever may be needed the most effectively, whether it is food, whether it’s therapeutic feeding, whether it’s access to water and so on.

We’re seeing already, although the response is not as large as it needs to be to keep up with the spread of famine in Somalia and ensure that we are able to prevent conditions from getting worse in Ethiopia or for Kenyans in Kenya and to manage the refugee flow, there are donors contributing from all over the world. But what we need really from everybody is to increase those donations as quickly as possible, again, so we can keep pace.

Eric, do you want to say something about the appeal itself?

ASSISTANT SECRETARY SCHWARTZ: Well, the appeal is – the United States has been a generous contributor to the international appeal. It’s an appeal – a multi-donor agency appeal. I don’t have the specific figures of how much of the appeal has been subscribed, but we’re – but at this point, we’re calling on other governments to really kind of step up to the plate here and give generously to all of the UN agencies.

But a number of the UN agencies also accept contributions from the public, such as UNICEF and others, and contributions from the public in these kinds of situations can be extremely valuable. The nongovernmental community, I should say for example, in the tsunami response a couple of years ago, of the entire amount that was contributed, about 5 billion of the 13 billion that was spent on the tsunami response came from the nongovernmental community supported by private donations. So the role for private donors can be quite substantial in these circumstances.

SENATOR FRIST: Eric, let me pick up on that just a little bit, though the question is really about the international community, only because I’m totally in the private sector now and this is important, especially for everybody on the call. There’s a great need. All of you know that. The data is there. We saw it. The big thing that I want to share with people is that everybody can make a difference, not just the governments per se. And we saw firsthand over the last 36 hours, just how effective these donations can be to improving health and literally, literally saving lives.

People say, well, where to go, and the easiest thing to do is to send people to, In there, on the website, there’s a listing of all the nongovernment organizations, many of whom we saw on the ground working side-by-side in partnership with governments. We really do hope speaking here at home, or I hope and what I really want to be stressing, is that we know that Americans act – we’ve seen it in the past, we saw it at the tsunami, we saw it at the tragedy in Haiti – and to really do what they always do to help those in need. And the big thing is these tiny donations can make a huge difference. And again, the easiest site is the USAID site because they’ve taken the time to put a lot of the nongovernment organizations that we depend on, and you can see which organizations are doing this sort of work.

So yes, the government is important. The support for our past investments we saw firsthand at the agricultural center, but also individual donations to these sites saves lives.

MR. TONER: Thank you. I think we’re ready for our next question.

OPERATOR: Thank you. The next question comes from Lachlan Carmichael. Your line is open.

QUESTION: Hi. Yes, as far as Kenya is concerned, do you think the Kenyan authorities are measuring up to the scale of the disaster facing them in their own country? I mean, the government spokesman said, I think just last month, that not one Kenyan had died of – as a result of hunger. And apparently, there are harvests in parts of the country that are good but nothing distributed to the areas hit by famine.

MS. SMITH: Let me just say something about that. That’s a – it’s a good question. I think one of the very good things we’re seeing, although obviously more can be done, is that for Ethiopians in Ethiopian and Kenyans in Kenya, as Dr. Frist said, there are a lot of things being done to assist them because they can be reached. Now, there’s more that can be done to make sure that grain stocks available in the region are more accessible and can be moved more freely. We and others are working on that with those two governments to make sure that where food stocks are available, they can be purchased and moved to people who need them.

I think that what we’re seeing – and again, I want to be careful here – is that we don’t have enough assistance even for the people of Ethiopia and Kenya that are affected. But in those cases, for two reasons, we’ve got a slightly better shot than we do with the difficulties we face in Somalia. The first, as Dr. Frist said, is some of the programs that have been put in place by USAID, by other donors, by those governments, to make sure those people are less vulnerable to droughts of this scale. And the second is, again, because they are accessible.

So I can’t answer to whether a single person has died or not. I do think that what we’ve got there is a case that with sufficient assistance, with the agility of those markets to which you point, we really can help get these people through a very bad year of drought and to the next set of rains.

ASSISTANT SECRETARY SCHWARTZ: If I can just comment on a question that – on a question, actually, that perhaps wasn’t asked but is related in terms of the government’s response with respect to the refugee situation, I think we have to give the Government of Kenya substantial credit for its willingness to continue to provide first asylum to this population. After all, if you just take the population of the refugee camps in the Dadaab area, you’re talking about one percent of the entire population of Kenya. And so for the Government of Kenya to continue to provide refuge, as it certainly should – but for the government to continue to do this, I think is – the United States is very appreciative of these efforts and that is why we are doing everything we can to assist the government in its efforts to continue to stay the course on this.

MR. TONER: Thank you. I think we’re ready for our next question.

OPERATOR: Thank you. Our next question comes from Carmen Russell. Your line is open.

QUESTION: Hello? Hi. Sorry. My question is where exactly is the U.S. aid going? Are we able – I mean, how well are we able to track this? How likely is it that the U.S. itself will step up its contributions as the situation gets worse? And what other political action is the U.S. willing to take?

MS. SMITH: We announced yesterday an additional contribution of $105 million to the regional relief effort, including both people who are affected in their own countries and to the refugee effort, bringing us up to over $560 million. We are the lead donor. But importantly there, we will continue to support the relief effort, but we are also aggressively reaching out to other countries because this is of a scale that we certainly can’t do it alone. We need other countries to step up with us. And I think, as I said earlier, we are seeing that other countries are responding. But part of our mission is both, as I say, to respond but also to reach out and use our position as the United States to encourage other donors to ramp up their responses. So we’re certainly willing to keep doing that, and that’s our intention.

MR. TONER: All right. Thank you. I think we’re ready for our next question.

OPERATOR: Thank you. Our next question is from Michele Kelemen. Your line is open.

QUESTION: Yeah, hi. I was wondering – the al-Shabaab pullout of Mogadishu, whether that’s made any difference for access there, and whether you’ve seen any aid agencies taking up your offer to ease restrictions on going into the south of Sudan – Somalia.

MS. SMITH: Again, I’m happy to take this and have others amplify. Hi, Michele.

The move of al-Shabaab out of Mogadishu is a good sign. It’s too early to tell whether it is a good and lasting sign, but it does offer the possibility of getting more assistance in through Mogadishu and to assist people there, because one of the things we’ve seen is the congregation of internally displaced people as Somalis move into Mogadishu in search of assistance.

There are agencies that are moving in to take advantage of that opening. One of the things that we’re very mindful of here is that we want to make sure that NGOs and UN agencies and others that are trying to provide assistance are able to do so in the utmost security, so I’m inclined to be a little bit careful about exactly who is doing what. But one of the very good things we have on hand is some of the most seasoned humanitarian operators in the world, given the complexity of this environment, and they are moving very swiftly to seize every opening that they can possibly have.

USAID is engaged with a number of nongovernmental organizations from around the world, and particularly American NGOs who are looking to ramp up their assistance and are doing that right now. So we are seeing a really, really good response from, as I say, UN agencies, international organizations, and NGOs who are poised and, with our assistance, trying to access every bit that they can as the situation unfolds.

QUESTION: If I could ask just one other question about the aid money that was announced yesterday --

MS. SMITH: Mm-hmm.

QUESTION: Is that specifically going to any country? Is it going mainly to Kenya --

MS. SMITH: Yeah.

QUESTION: -- and Ethiopia or is going into --

MS. SMITH: We can get you a breakdown of that. USAID issued a fact sheet last night, and if you need more information, we’d be happy if you want to check back with Mark. Mark can direct you to one of us who can get you the exact breakdown. But that assistance covers the full range of things for the people of Kenya and Ethiopia, for assistance inside Somalia, and also and importantly, for refugees in both Kenya and Ethiopia, so it’s part of a comprehensive response. But we can get you the specific breakdown after the call if you’d like it.

QUESTION: Great. Thanks, Gayle.

MR. TONER: Yeah. We’ll make sure that we push that out to folks.

Great. Next question?

OPERATOR: At this time, there are no further questions.

MR. TONER: Great. Well, okay, very good, then. Well, I just want to thank all the journalists who joined us this morning and especially thank all of our participants for taking time out to talk about this important issue, and to discuss the trip. So thanks to all of you again and have a very good day.

MS. SMITH: Thank you.


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