by Krista Ford

November 11, 2009

The end of October marked the end of my first quarter here at Africare and the start of the second quarter seems to have brought with it all types of change.  In the office we are currently in the midst of several big changes, the biggest being the addition of a new CDC funded home-based care project. Africare will work with some small Civil Service Organizations and existing community structures to provide home-based care for people living with HIV/AIDS. The start up of this project has required a lot of time and energy, including interviewing for about 20 new positions. With between five and ten candidates being interviewed for each position, you can imagine that this has been a very time consuming process. Everyone from the Country Representative, to the program's Chief of Party, to the junior staff has been pitching in to assist in the interviewing process. I've been working very closely with the Human Resources Officer to test the candidates' practical skills, compile summaries of interview results, and create briefings of panel recommendations to be reviewed and approved by the Country Representative and our headquarters in Washington, D.C. I even had the opportunity to sit on the interview panel for a few of the positions and it was quite a different experience being the interviewer instead of the interviewee. One of the new staff that has been hired is the new Program Assistant, Gloria.

She and I have worked together to create a new internal monthly newsletter, which was a hit in the office. We're also working together to draft Africare Tanzania's first Annual Report. The Africare organization as a whole puts out an annual report every year and some of the country offices also produce annual reports. Africare arrived in Tanzania in 1994 and has not produced an annual report yet. Gloria and I are very excited to be working on these new additions.

In addition to the newsletter and annual report, Gloria and I will be working with the Admin officer to create a resource center where staff can access reference materials in one centralized, organized space.

So, between the addition of a new project, lots of new staff members, a new newsletter, the creation of a resource center and the first ever annual report, this has certainly been a period of change for Africare Tanzania.

by Danielle Dittrich

November 17, 2009

To be a practitioner in Guatemala, one needs to find harmony between western and traditional medicine. I had never thought about or tried natural herbal medicine before coming to Guatemala. Though I still don't usually recommend it to my patients, I have begun exploring the natural remedies so that I can hopefully help my patients to navigate their own health. The women's program teaches patients that if their symptoms do not improve after two days of at home treatment with herbal remedies, they need to go to the doctor for medication.

Many of the herbal remedies are geared towards symptom relief of aliments for which we do not currently have cures. For example, there are many herbal remedies for the cold virus, specifically for cough. In the states, there are anti-tussives, mucolitics and expectorants, but these don't cure the virus, they just alleviate or mask the cough. Though many patients request antibiotics, these target bacterial rather than viral illnesses and only lead to resistance and de-sensitization to medication. This is a specifically frightening concept when any Guatemalan can go into the pharmacy and buy any medication in any amount with less than the scribbled name of a medication written by their neighbor counting as a prescription. However, with Guatemala being among the poorest of Latin-American countries, the cost of western medications is a major deterrent leading to the preference of herbal medication in addition to its cultural implications. Many patients admit to filling half prescriptions due to the cost of medications or stopping medication regimens when they achieve symptom relief and saving the few remaining antibiotic pills for the next time they start feeling sick (of any sort).

It is terrifying to know that partial regimens is the way we have created and continue to create multi-drug resistant organisms, such as multidrug resistance tuberculosis which has been on the rise recently in Latin America. The fear of drug-resistance is a constant motivator, as we pass by the country's tuberculosis hospital daily on the way to the Primeros Pasos clinic. For this reason it is just as important that we educate the patients as it is to provide medical care. A good medication can be a weapon if used incorrectly; it is important to empower the patients to be responsible for their own health and healthcare, which is largely where herbal remedies come into play.

In the states, most Dr. Mom's would recommend a bowl of grandma's chicken noodle soup, a cup of tea and rest -- symptom relief. The idea is not too different with herbal medicine here -- herbal teas to alleviate the aches and calm the cough. Graced with the same viruses that my patients bring to the clinic, I was personally compelled to try herbal teas for my back to back stomach and cold viruses. I went to the local market with a Guatemalan friend and we sought out all the teas for cough. I was surprised by the number of plants and herbal remedies that exist. There are different teas for dry cough, productive cough and coughs with sneezes. Among the busy, hustling market, the herbal medicine vendor was one of the most popular. I do not claim an instant cure, but the effect was certainly soothing as the virus ran its course.

Balance between hot and cold is very important concept in Mayan health; a warm remedy is used to cure a cold illness. Health is not only viewed as freedom from illness, but also as general happiness and life balance. It has been important for me to begin understanding these concepts, so as to provide patient education and recommendations that complement rather than clash with their worldview.  It has been specifically important for the care of pregnant patients as many cultural concepts, which do not have an equivalent in western medicine, are said to affect the development of the baby. For example, newborn babies get sick when the mothers breast milk becomes cold from eating foods that are considered cold, which does not always correspond to temperature. 

In order to be respected as a practitioner, one must respect the viewpoint and frame of reference of the patient. Respect however, does not always mean agree. I believe that one of the most important things that I can learn in my investigation of natural medicine is to understand what herbal remedies may be dangerous to pregnant women. Certain herbal remedies are actually known to be incredibly potent. Something about this approach and mind-set has been successful, as my patients rapidly continue to increase in number. Though as a foreigner, my recommendations of herbal remedies would ever be taken too seriously, my warnings are generally heeded. Thankfully, there are many other traditional practitioners to provide these recommendations and I am seeking partnerships with them in order to incorporate their work into a more holistic model of patient care.

November 13, 2009

by Jenny Dyer

FROM Kaiser Family Foundation: The Foundation has issued its latest global health survey, Views on the U.S. Role in Global Health Update, which probes American public opinion about efforts by the United States to improve the health of people in developing nations. According to the poll findings, most Americans support current U.S. spending to improve health conditions in poorer nations despite the economic recession. Two thirds of the public supports maintaining (32%) or increasing (34%) spending on global health, while a quarter say the country is spending too much. More of the public prefers an emphasis on health infrastructure rather than fighting specific diseases. When asked to rank the importance of the two approaches, 58 percent say it is more important to emphasize programs that help countries build their health system infrastructure, under the theory that stronger health systems can better handle a variety of problems. In contrast, 36 percent say it is more important to emphasize efforts to fight specific diseases like AIDS and malaria because efficient methods for treating such diseases already exist and can save large numbers of lives. All the survey materials are available online.

This is interesting and great news given our economic climate that the majority of Americans still care deeply about helping those with the fewest resources worldwide. I find intriguing that the American public has marched forward from embracing the issues of HIV/AIDS and the global pandemic, or malaria and the need for bednets, to realizing the need for health systems, working together, to build infrastructure for smart, efficient use of assistance. Health systems and health infrastructure are far from sexy topics, but that is what is needed and needed now.

HTHH addresses the issue of health infrastructure through our support of training community health workers through our Frist Global Health Leaders program, offering health professional students and residents the opportunity to serve and train in underserved clinics around the world. We know strengthening health systems is key to moving toward the millennium goals.

by Bill Frist, M.D.

A couple weeks back, the Living Proof Project was unveiled in Washington, D.C. by Bill and Melinda Gates. The goal of this great project is to share the good news of the implementation of assistance. U.S. investments in improving global health are delivering real results. From significant declines in child deaths, to global eradication efforts against polio, to insecticide-treated bed nets that reduce malaria transmission, global health initiatives are working. At http://www.gatesfoundation.org/livingproofproject you can learn more from their progress sheets. Watch the speeches of these "Impatient Optimists."  I have the pleasure of serving on the Advisory Council.
 
The video below was shown yesterday at a Save the Children Survive to Five Council meeting in NYC. This is a great example of real results, combating infant mortality. Saving the life of a little one.

 

by Bill Frist, M.D.

Yesterday morning, I had the honor of speaking at both services at Christ Church in Nashville. Over 5000 people attended. The services were dedicated to the doctors and nurses in the community, recognizing all health care workers for their healing care. It was a wonderful opportunity to share the work of Hope Through Healing Hands at home and abroad. As you know, HTHH's selects Global Health Leaders, annually, to travel to underserved clinics around the world to bolster health care and training of community health workers for sustainability. Right now, we have Leaders in Tanzania, Rwanda, Kenya, and Guatemala. We are proud to support their efforts, using health as a currency for peace. As Martin Luther King, Jr. said, "We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly affects all indirectly."

Thanks to all at Christ Church for the warm welcome.

 

 

World Pneumonia Day Reception Remarks

By Senator Bill Frist, M.D.

Today, I joined Save the Children, the US Coalition for Child Survival, the World Pneumonia Day Coalition and Vicks at a breakfast reception on Capitol Hill to recognize the first annual World Pneumonia Day, a day for people everywhere to turn awareness into action to control the #1 killer of children under age 5: pneumonia. Each year, a disease which often starts as a cold, claims the lives of nearly 2 million children under age 5 -- more than malaria, AIDS and measles combined. Despite this staggering death toll, childhood pneumonia has never been a global health priority, and the current basic maternal child health programs --that need to be in place to control the disease-- are under-funded.

Pneumonia is easy to diagnose and treat if you have the right tools, but most children in developing countries don't get the care they need. We could save more than one million young lives each year with affordable health measures -- like proper nutrition and breastfeeding, antibiotics and vaccines. It's a matter of making these solutions more available to the children who need them.

As chair of Save the Children's Survive to 5 campaign and in my work with other humanitarian organizations, I've traveled to community-based health projects in Asia and Africa. I've seen firsthand how U.S. government investments in training community-based health workers in pneumonia prevention and treatment have significantly improved child health and saved lives.

In countries as different as Bangladesh and Mozambique, families face virtually the same obstacles to getting care for their children. Vaccines that we take for granted here to protect our children are not available in many of the countries that most need them. GAVI needs significantly greater resources to help countries integrate the new vaccines against pneumonia as well as diarrhea. A community-based approach to child health works. But if we are to make progress in combating pneumonia and other childhood illnesses, we need to scale up these efforts.

World Pneumonia Day is a call to action from national leaders, donors and international health organizations to rally their forces to control this disease. The time is ripe for action. Thanks to WHO and UNICEF's Global Action Plan against Pneumonia (GAPP) released on World Pneumonia Day, November 2nd, we will have a realistic six-year plan for the worldwide scale-up to control pneumonia, based on the following:

· protecting children by creating lower-risk environments;

· preventing children from developing the disease through vaccination; and

· treating children who become ill.

The United States has played and must continue to play a leading role internationally to save the lives of mothers, newborns and children through the protection, prevention and treatment of pneumonia. Current U.S. spending on maternal and child health, which includes spending on pneumonia, is just $495 million a year. The U.S. should at least double that investment, encourage other industrialized nations to do the same at next year's G8 summit in Canada. G8 leaders should declare that no country with a credible plan for newborn, child and maternal health should be thwarted for lack of donor resources.

We are pleased to see that child survival is a strong priority for the U.S. Congress. The Global Child Survival Act (S. 1966) was just introduced in the Senate, and the Newborn, Child and Mother Survival Act of 2009 (HR 1410) has 80 cosponsors in the House. What can you do? I strongly encourage you to call your congressional representatives today and ask them to cosponsor these important bills.

by Jenny Dyer

November 4, 2009

How can art save the world? Photographers have the gift to capture a moment of beauty. And, capturing moments of beauty for a person who has never known s/he is beautiful, can give life back to the most downtrodden of spirits--proving everyone holds a spark of the imago dei.

Jeremy Cowart wondered how he could give back, offering his gift of capturing the lovely in those who may have never seen that loveliness. His Help-Portrait movement has sparked interest around the world to provide photos to those individuals and families in need. His website provides the tools to do the following:

1. Find someone in need

2. Take their portrait

3. Print their Portrait

4. And Deliver Them.

If you're a photographer -- check out this movement. Your art could change the world. Consider joining the community:

What does Help-Portrait Look Like?

 

by Amelia Wood, M.D.

November 3, 2009

"Henceforth, simply the nappy."

One of the most delightful things about being in Kenya is participating in the odd mix of African bush culture and English propriety. It's what remains of the colonization of this land by the British, I guess. And it is quite nice.

For example, we all have dusty feet peering out of rubbery ‘flip-flop' like sandals in the operating area, yet we refer to the OR's as ‘theatres', and we adjourn to ‘take tea' at the proper intervals throughout the day. The Kenyans put every coffee house in the developed world to shame with their ‘chai': a creamy, sweet cup of goodness scooped from a boiling pot of tea leaves and milk, fresh from the cow, brought to the hospital that morning in a plastic bucket. It is just so very civilized and so very African. And it is mandatory, I am beginning to understand. In this picture, you can see me having tea with some of the nursery and maternity nurses. I had just given them a lecture about neonatal warning signs in the delivery room, and I was prepared to whisk away to the days doctoring tasks. They insisted that I sit and have tea. It's the proper, Kenyan way.

The influences of the Queen's English and Kiswahili also manage to trip me up on a daily basis. Example 1: intern says to Dr. Amy, "this preterm is receiving 8ml feeds, two hourly, and is retaining." Dr. Amy blinks thinking, "retaining? Is retaining good or bad?" Example 2: same intern pouts over a squeaking, stridorous baby. "Oh, he is lamenting," she says. And I think, "man, I wish I used the word lamenting." Example 3: A few days ago I noticed that there was an odd pile of gauze taped around baby Hawa's ostomy which was causing the liquid stool output to severely irritate his skin. So I asked one of the nurses, "could we stop using the dry gauze and only use a diaper from now on?" The nurse replied, "So, henceforth, simply the nappy?" "Uh, yeah, simply the nappy. Thanks."

Perhaps my favorite experience yet should have a photo but I must try words instead. I was chatting with Dr. Gary in the hospital corrider, and as we were talking, a Masai grandmom walked past with her infant grandson in a sling on her back. The little guy was healing from a chemical burn of his head, and he had even lost most of his left ear. After multiple skin grafts he still had bright pink under-flesh covering most of his head. It was a patchwork that looked like freshly groomed farm land: little squares of different soils in pinks and browns. His grandmom was covered in beads, ear lobes hanging low from a piercing type process, dark black feet flat against the hospital floor and the little guy, peering up to catch our eyes... then he giggled and hid from us in the folds of his grandmother's clothes. His happiness took over the air around us. I could not understand how such a little boy (two years old) could have so much pain-- so much to cry about -- and yet so much joy! Later I found out that this patient, Ralian, is Jim's patient. Jim is his surgeon, and he is Jim's favorite. Ralian's grandmother has said that she wants to return to visit us before we leave so she can give Jim a reward for taking care of her grandson.

So far, I have been blessed to enjoy my time here in ways I could not have foreseen. It is simply "well with my soul," as the old hymn says. And still, I am a creature of luxury, and I miss all the lavishness of my home in Colorado. Gary Finke, the pediatrician of the past 2 years, leaves roughly the same time we do. So as the days march forward and we get closer to hugging our families, our friend Stephany gets closer to being the sole pediatrician at this busy children's hospital. Her fear of taking on this mighty task is always behind the scenes. She is weary, and it is hard to leave her behind. I am asking now, reader: please pray for reinforcements for Stephany. Pray for courage and joy and wisdom and sleep for her. If you are a pediatrician - consider coming to help her. Even just a few weeks would lessen the load and give little lily pads of rest during her 2 year commitment. You will be a blessing and you will be blessed!

I have a tendency to count down days until the end of different periods of life. A physician in Nashville once advised a group of us not to wish away our lives during residency, and I hate to admit that I sometimes have that tendency, although not just in residency. Recently I have been simultaneously struggling to not count down the days until I return to my own indulgences (warm bath, constant electricity, reliable phone line to call mom and dad) and dreaming of returning to live out my days here.

I said in a previous post-my first post from Kijabe in fact-that life here is simple, hard and lovely. It is simple, and it is hard in many ways. That is true. But in the end and above all, life here is lovely.

 

 

by Kelly Tschida

Vanderbilt, School of Nursing

November 1, 2009

  

1) Patient Beds

2) Hospital Compound where families clean clothes and make food for patients

3) Ingredients for Hand Sanitizer

It has been one month since I arrived in Rwanda and I am continually amazed at the obstacles my patients and coworkers face. The work can be very frustrating. Everyday I see ways to keep people alive and reduce the severity of illnesses, but implementing change is never easy, especially when resources are extremely limited.

One particular frustration is the lack of hand washing by the medical staff. An estimated 60,000 in Rwanda are infected with illnesses in hospital, which are called nosocomial infections. Nosocomial infections are often caused by health providers not having properly washed their hands. They significantly increase patient death rates as well as costs to the patient and hospital. I have seen diseases being spread in our hospital and the staff seems to accept it as normal.

All the nurses and physicians know they are supposed to wash their hands between patients, but it just is not practical. There are no sinks in the patient rooms and the nurses have to move quickly from one patient to the next to provide care for everyone. There is only one sink per floor, and it is located very far from the patients. A great majority of the patients have infectious diseases such as HIV, tuberculosis, intestinal parasites, and infectious hepatitis, so hand washing is especially important.

After two weeks of frustration I found a solution. Hand sanitizer is an effective way of killing most germs and does not require running water; unfortunately it is too expensive for the hospital to purchase. With some research I found some recipes for homemade hand sanitizers that costs a fraction of the price of commercial products yet are effective disinfectants. I tested recipes until I found one the staff members like the most. I am now working with the chief of nursing to ensure that the hospital can afford to make it in sufficient quantities indefinitely. This is only a small change but I believe it will result in a significant reduction of infections passed from patient to patient and to the workers themselves. My hope it that they not only continue to use the hand sanitizer but that this will begin to instill confidence that there are ways we can start to limit unnecessary hospital born infections.

 

 

Global Health Essay Contest

October 23, 2009

The Center for Strategic & International Studies Commission on Smart Global Health is calling for essay submissions. The essay seeks to answer the vital question, “What is the most important thing the U.S. can do to improve global health over the next 15 years?”

Essay submissions must be between 500 and 800 words are due at midnight EST on November 20, 2009. CSIS is so dedicated to answering this question that they are offering a $1,000 scholarship for the winning essay.

We encourage you to submit your philosophy and your thoughts on how the U.S. can improve Global Health, ultimate to aid in achieving the Millennium Development Goals.

Spread the word. Tell your friends.

Check out the Smart Global Health website for more details.

Subscribe to our newsletter to recieve the latest updates.