March 31, 2016 | The Post and Courier

Mom and baby Africa

South Carolina, and in particular Charleston, has a long history of serving as an international port and point of entry for a panoply of people arriving in the United States from around the world. In the South especially, it has been one of the most cosmopolitan of cities welcoming diverse cultures of influence in architecture, gardens, and food, to name a few.

Today, Charleston is giving back globally, including through its work in developing nations. The city is the home to the Medical University of South Carolina Center for Global Health, the Palmetto Medical Initiative, and Seacoast Church, which houses one of the most robust medical mission programs to developing nations in the country. Together, these organizations have helped thousands around the world.

This week, global health non-profit Hope Through Healing Hands (HTHH) seeks to galvanize the work already being done in Charleston and South Carolina around an important health initiative. HTHH will co-host a luncheon with faith leaders, nonprofit leaders, university leaders, and others in Charleston to discuss how we can better unite on behalf of mothers and children globally, for their health and wellness.

The voices of South Carolinians are very important to this effort, as the state’s senior senator, Lindsey Graham, chairs the Appropriations Committee which determines the level of funding for maternal and child health initiatives in foreign assistance. Sen. Graham has been a strong champion for global health and development, and many other members of Congress in the South Carolina delegation serve on committees where they can support this critical agenda.

Most Americans do not realize that less than 1 percent of the federal budget goes to international affairs, and an even smaller fraction for global health and development. Yet this penny on the dollar is among the most effectively spent government funding, translating into lives saved. We know if we can help keep moms healthy and safe, families have a greater potential to survive and thrive. More specifically, if a woman in the developing world can better time the initial debut of her first pregnancy until after she is 20 years of age, she is five times more likely to survive the complications of pregnancy and childbirth than those just five years younger. And if she can space her children just three years apart, the child is twice as likely to survive the newborn stage.

Healthy timing and spacing of pregnancies reduces mortality rates. Importantly, it also allows young women to stay in school or afford to keep all her children in school. And it enables mothers to go back to work to be able to provide for her family. It’s common sense to fund these efforts as a part of our budget for foreign assistance.

Support for healthy timing and spacing of pregnancies in the federal budget is timely, as Congress is currently considering a piece of legislation that seeks to end maternal and child deaths by 2035 worldwide: the Reach Every Mother & Child Act.

This legislation enjoys strong bipartisan support in both the House and the Senate, and has the backing of 25 diverse NGOs, including UNICEF, the American Academy of Pediatrics, and Save the Children. It aims to accelerate and expand U.S. maternal and child efforts in targeted developing countries in partnership with country governments and the private sector. It also codifies successful initiatives which have helped the United States Agency for International Development (USAID) achieve an 8 percent reduction in deaths of children under age 5 in priority countries, saving 500,000 lives in the last two years. Despite this progress, the U.S. could have a greater impact with more robust funding through foreign assistance.

The United States has led the way in halving infant mortality and maternal mortality since 1990. We need your help to go the last mile in eradicating maternal and child deaths by 2035. Let your senator, congressman or faith leader know you want to see global maternal health and the healthy timing and spacing of pregnancies funded in the foreign assistance budget. We hope you will join us by lending your voice today.

Bill Frist, M.D., is a former U.S. senator from Tennessee, and founder of Hope Through Healing Hands. Jenny Eaton Dyer, Ph.D., is executive director of the faith-based, non-profit organization.

This article originally appeared in The Post and Courier.

I am writing you tonight as I sit on my living room couch eating scrambled eggs for dinner after a full day of travel outside of the city.  Today, three new friends and I traveled to see part of the Mongolian health care system outside of the city.

To give you a little background on the landscape- Mongolia is divided into 21 aimags (provinces), which are further subdivided into soums (rural districts) and bags (villages or communities).  Ulaanbaatar for example is divided into nine districts all of which are divided further into koroos or sub-districts.  The Ministry of Health and Sports is responsible for all public health functions and oversees the management of all tertiary and secondary hospitals.

About 60 kilometers outside Ulanbator (UB)  there is a small village or soum that has approximately 3,000 people.  We visited the hospital that serves this population plus the surrounding areas- mostly a primary care facility.  While there, we were able to speak to the director who gave us a tour of the facilities and answered our many questions.  The facility has 10 patient beds and serves in total patients within 102 kilometers around.  There is one doctor for about 3-4,000 people.  The majority of the illnesses that this hospital sees are respiratory (especially during the winter season Dec-March), heart disease, stomach issues, migraine and urinary complications.  This hospital is not allowed to deliver children unless it is an emergency- those mothers delivering are to go to the district hospital for birthing.  In the case of emergency delivery (which happened the week before we were there) doctors from the district hospital 60 kilometers are able to come to preform a C-section on the mother if necessary.  The hospital has no indoor plumbing- it is currently broken so patients have to go outside to the outhouses and water for hand washing is brought in.  This is something FIRE is hoping to help with in this location.

This hospital has a lot of success with local public health events.  In the event they had recently 7,000 people participated which is very impressive.  You can seem pictures below of the soum hospital below.

Triage location in the hospital

Vaccination Chart (The one on the bottom is in English) FYI this is what Mongolian Cyrillic looks like

The Pharmacy for the Soum Hospital

Maternity room

Today, we also drove further to a district hospital (Baganuur I believe) and were given a tour around a much larger facility.  The population of the city is approximately 30,000 and this hospital serves a total of 50,000 through neighboring soums.  There are a total of 216 beds and 315 health care workers within this hospital.

Because of the work we are doing on viral hepatitis, we had many questions about hepatitis treatment available at this hospital.  Currently, there are 15 people who are under hepatitis C treatment.  Patients are monitored by a specialist who tracks their viral load every four weeks (this is based on the Ministry of Health Guidelines in Mongolia).  Hepatitis C treatment for those not familiar recently is available and is extremely expensive.  Here, priority patients are those over 40 with highest viral loads. Many have to depend on family members or loans to receive the treatment.  This is a three to six month extremely costly treatment process. 

Based on a recent study done in Mongolia, it was approximated that the total number of hepatitis positive subjects is 379,427.  Within this same study, the incidence is higher in rural areas compared to the urban cities.  Mongolia has one of the highest incidences of hepatitis C in the world and it continues to be a pressing public health issue for the country.  Often times, the population does not go to the doctor unless they are showing severe symptoms of a disease and in the case of hepatitis C, it is often too late to be resolved.  In Mongolia, 78% of those with liver cancer are diagnosed within the 3rd or 4th stage of the disease.  

Thanks to vaccination law in Mongolia since the 1990s, approximately 96-97% of newborns are vaccinated for viral hepatitis so they likely will not face this issue themselves.

This district hospital mostly sees cardiovascular, respiratory, and urinary illness.  I was very impressed with the district hospitals public health programs.  In a separate building from the hospital there is an adolescent health program and reproductive health center where various information sessions are held about pressing and general health issues in the community.

Dialysis room

Outside of hospital

Public Health Center and Pharmacy for the hospital

In the district hospital we were able to see their medical waste management process- which involves burning their syringes, glass bottles and gloves a few meters away from the hospital building (see images below).  This is something FIRE is hoping to help with.

After all the hospital tours we went for Mongolian food – which was actually really good. Just a lot of meat – they claim that because Mongolians eat a lot of fatty meat they don’t have alzheimers? I am not sure if this is a real thing or not?

Then on our way back to the city stopped at the largest statue of Chinggis Khaan in the world.

So far, work has been great. I have made a lot of progress on the Knowledge, Attitude and Practice Survey and have recruited local students to help with the cultural aspects of this project.   I have really enjoyed myself so far.  I hope you enjoyed reading.  I appreciate you taking the time to do so! If you feel inclined feel free to leave a comment below! Have an awesome day!

March 14, 2016 | Outreach Magazine

Mother’s Day is the perfect time to kick off a new set of small groups for women interested in helping mothers across the globe. Encourage your women to invite their friends and neighbors to join a small group. For curriculum, consider The Mother and Child Project: Raising Our Voices for Health and Hope (Zondervan)—a book (and discussion guide) that promotes a movement to increase healthy pregnancies and decrease death rates worldwide.

Hope Through Healing Hands, a nonprofit working to educate women about newborn and child health, timing and spacing of pregnancies, clean water, HIV/AIDS, etc., compiled the book and offers helpful ideas and resources to get involved.

This post originally appeared on Outreach Magazine

Yesterday International Women Day was celebrated by giving cakes, sweets, flowers in appreciation of women around the country.  It kind of reminded me of Valentines day in the states- I was walking around towards the downtown square and passed countless men carrying flowers or cake boxes home. So naturally- I got myself a cupcake to celebrate :). It actually was pretty tasty! The day was also celebrated with no work- so I got a holiday on my second day.

I spent the holiday walking to the central square – Chengis Khan Square (once it reached 3 degrees outside). I promise I have never felt cold until yesterday.  I think it took about an hour to actually warm up after walking for 20 minutes.  I think it is supposed to warm up to the 30s next week so I am definitely looking forward to that!

Monday and Wednesday of this week have been mostly familiarizing myself with FIRE and what I am supposed to start working on here.  I mentioned briefly in the previous post that I will be working on a Knowledge, Attitude, and Practice (KAP) survey as well as helping plan for a community awareness campaign for Viral Hepatitis and liver cancer- two huge issues in Mongolia.  I have been familiarizing myself with the epidemiological features of the country through various documents given to me by mentors at FIRE.

On Monday we met with the World Health Organization Representative in Mongolia (FIRE has a strong relationship with WHO) which was very informative towards future project plans for the organization.  For those interested in the epidemiological features of the country, I will attach a document with descriptives to this blog (click on interested)- be sure to check out this information from WHO.  I will keep you updated on the progress of each project.  I will be apart largely of the planning for each project- I have a goal of piloting the KAP survey before I leave.  I am planning to coordinate with other Public Health Students here in Mongolia so they can implement the final KAP survey.  I am very excited about this opportunity to collaborate and learn with local students!

*if you click on the blue underlined words it will take you to a link with more information about what is mentioned 

My Living Room

Walking towards my apartment after getting groceries

Walking near city center on International Women Day

City Center

Travel helps me better understand and appreciate the world around me.  Public health has become my passion. Follow me as I learn to bring the love of travel and public health together through my Master of Public Health field experience in Ulaanbaatar, Mongolia.

This adventure will begin on March 2nd as I begin my two day trek from East Tennessee State University to my temporary home for two months.  There will be many lessons learned, knowledge gained, and many pictures to share with you throughout this experience.  I look forward to sharing this journey with you.

"One may observe in one's travels to distant countries the feelings of recognition and affiliation that link every human being to every other human being." – Aristotle

At the age of nineteen I scribbled this quote on the inside cover of a journal I kept while interning at an HIV/AIDS clinic in Kampala, Uganda - a one month experience that I, in my naïvety, had assumed would shine light on answers to the world's problems and provide me with direction in my future studies and career choices. Not so shockingly, I returned home with more questions than answers about the all-too-exhaustive list of social injustices in this world and how I could possibly play a role.

March 4, 2016 | Relevant Magazine

Considerations of contraceptives in light of the Zika virus
Zika Virus
From ancient times until today, childbirth remains one of the most fearful and oftentimes painful moments in a woman’s life. Complications from pregnancy to postpartum, even today, can mean death for both mother and child. In fact, over 300,000 women die every year from preventable, treatable complications during pregnancy and childbirth, and for those newborns whose mother does not survive, they are 10 times more likely not to survive their first two years.

And now, the epidemic of the Zika virus is bringing issues of maternal and infant health to the front and center in many developing countries. Zika can be spread from a mother to a fetus, and is know to cause a birth defect known as microcephaly.

To date, the Zika virus has been associated with over 4,000 cases of microcephaly in Brazil and Latin America. More than 4 million people are expected to contract the virus within the next year.

Already, the CDC issued advisories for the Americas calling for postponing travel to the region, mosquito bite avoidance and safe sex practices. The Public Health Agency of Canada is even suggesting that women wait at least two months after travel before trying to get pregnant. Even Pope Francis has condoned the use of contraception during this period.

But what about the women who live in the undeveloped parts of those countries where Zika is spreading? Hundreds of thousands of women in many developing countries may not have access to quality health care or the proper prenatal counseling and care during and after pregnancy and childbirth.

More than 220 million women around the world say they want to avoid getting pregnant again but lack the information or the access to contraceptives to do so. This doesn't just affect maternal health during outbreaks such as Zika; studies show that if the woman’s first debut of pregnancy is at or after 20 years of age, she is five times more likely to survive complications of pregnancy and childbirth than someone 15 years of age or younger.

Contraceptives can be a tricky subject for Christians. The Roman Catholic Church has traditionally opposed contraceptives, encouraging parishioners to practice natural family planning instead. Some protestants also personally oppose the use of contraceptives, while others see no problem with them. But, whether a woman wants to space out her pregnancies using natural family planning or a form of contraceptives, access to both information and contraceptives is limited in many Latin American countries. Prescriptions are required for birth control, pills are overpriced and the supplies are often not stocked properly in local pharmacies.

And once a woman gets pregnant, she may not have access to proper care during and after childbirth. It is also important to note the high rates of sexual violence, particularly in the Central America-4 region (El Salvador, Honduras, Guatemala and Nicaragua). Many women are victims of rape, causing unintended pregnancies. For instance, in El Salvador, unintended pregnancies account for over half of the pregnancies across the nation.

In the face of the Zika epidemic, sexual violence and maternal mortality, what is our responsibility as Christians in terms of advocacy for these women, girls and mothers-to-be?

In Proverbs 31, King Lemuel’s mother offers him some guidance in his ruling: “Speak up for those who cannot speak for themselves, for the rights of all who are destitute. Speak up and judge fairly; defend the rights of the poor." We are called to advocate on behalf of vulnerable populations; we are called to provide a compassionate response to individuals in the face of violence, disease and extreme poverty. And in this case, part of the response may be to advocate for voluntary access to affordable, modern contraceptives so women can safely time, space and delay having children if they wish to do so. This should also include good counseling about natural family planning, or fertility awareness, if that is the desired method of choice.

Times of emergency rouse compassionate responses and a sense of urgency to address the perilous situation. In this situation, the Zika virus provides a clarion call to rethink the critical role of contraceptives in the lives of mothers and children and families not only in Latin America, but also around the world. Not only can contraceptives be life saving, but they also allow for a family to flourish—to emerge out of poverty, to feed every child, to send children to school and to allow moms to go back to work.

Let’s use this moment to reopen the discussion around family planning (not including abortion) for women in developing nations. Our U.S. government spends less than 1 percent of our budget on foreign assistance, and less than a fraction of that attends to maternal and child health and healthy timing and spacing of pregnancies. As Christians, this is a moment to speak up on behalf of mothers and children worldwide to protect or increase this funding. For less than a penny to the dollar, lives are saved—and changed.

This article originally appeared in Relevant Magazine

The Aspen Institute, an educational and policy studies organization based in Washington DC, holds a monthly speakers luncheon for Congressional staff interested in the various topics related to foreign assistance. Its mission is to foster leadership based on enduring values and to provide a nonpartisan venue for dealing with critical issues.

Hello Friends and Family,

I have never been so thankful for a shower! I am happy to say that after a two day journey and a lot of jet lag I have made it to Ulaanbaatar, Mongolia.  I arrived late last night around 3AM here to meet wonderful hosts who welcomed me to this beautiful city.  I can honestly say I had no idea what to expect, or what it would look like coming in. I feel very comfortable here so far and have enjoyed walking (not too far) around my apartment.

It is quite cold here, around 7 degrees Fahrenheit today- it sounds terrible, but honestly with a warm jacket, boots, and sweater you are good to go.  My apartment is great- it has everything I need including a washing machine and microwave which is awesome! These are things I was not really expecting- I feel like my hosts are giving me the royal treatment! Any issue (which was really minor- lack of running water at first) were solved within a few hours thanks to my hosts.

Who are my hosts you ask? I am interning with Flagstaff International Relief Effort (F.I.R.E) and my future coworkers come Monday have been helping me get around and comfortable with the area.  I am staying near the City Center- close to Chinggis Khaan (yes, we say it wrong in the states- I had no idea until yesterday) Square and have any amenity I could need at my finger tips.

I begin work on Monday.  I am set to work with F.I.R.E and the World Health Organization (WHO) on a planning project for community based education for viral hepatitis and liver cancer- two large health problems for Mongolia.  Mongolia has the highest rate of liver cancer and viral hepatitis C in the world as well as one of the highest rates of hepatitis B.  The liver cancer rate alone is six times higher than the international average.  This high rate is often due to late diagnosis of viral hepatitis and other related liver diseases such as cirrhosis.  78% of liver cancer patients are not diagnosed until stage III or IV and 85% of liver cancer patients die within one year of diagnosis according to the Center for Health Development in Mongolia, 2014.  The goal of this project is to raise awareness and influence change by directing the general population on testing and treatment.

In addition, I will be helping with a Knowledge, Attitude, and Practice Assessment with WHO and the National Cancer Center.  I am definitely looking forward to each of these projects and will continue to share throughout the two months I am here.

Feel free to leave any comments and questions you may have! I would love to hear from you!

The picture above is near my apartment.  I am staying to the right behind the crane.  The first building you see on the right with the cars in front is a shopping center right across the street from my apartment.

Feb. 29, 2016 | The Hill

Senator Bill Frist water

As the 2016 primaries unfold, it’s time for candidates of both parties to focus on expanding the big-hearted policies that have made this nation so exceptional.

In recent years, the most effective of those policies has been global health — that is, putting U.S. resources to work saving lives in developing nations by spreading health treatments that work here at home. In a study for the Bipartisan Policy Center last November, we showed how the largest global health project in history, the President’s Emergency Plan for AIDS Relief (PEPFAR), has not only saved millions of lives but also improved America’s national security.

Under PEPFAR, launched under former President George W. Bush and enhanced under President Obama, with bipartisan support in Congress over more than a decade, 9.5 million men, women and children, mainly in Africa, are receiving lifesaving anti-retroviral drugs. Some 68 million have gotten HIV testing and counseling, 5.5 million orphans and vulnerable children have received care and support, and 190,000 new healthcare workers have been trained. In addition, our study found that in PEPFAR countries, political instability and violence have fallen 40 percent (compared to just 3 percent in equivalent non-PEPFAR countries), while economic growth has increased — and so has America’s reputation.

Now, a new survey by the Kaiser Family Foundation, released in January, has discovered that, while Americans are proud of the accomplishments of programs like PEPFAR, a majority (53 percent) believe we are already “doing enough to improve health in developing countries.” And a majority (55 percent) believe that “spending more money won’t make much difference in improving health in developing countries.”

Those are disturbing statistics. They stray far from reality. The truth is that the U.S. has the innovation and the resources to put an end to rampant deaths not only from AIDS but from such scourges as malaria, tuberculosis and hepatitis C. Based on the PEPFAR experience, we have proof that health will be improved dramatically — and Americans themselves will benefit.

The good news is that the Kaiser study provides important guidance on how to persuade Americans that our nation should do more. The starting point is better education about global health.

The public is woefully misinformed not just about the success of U.S. programs but about their cost. The Kaiser survey, taken in December, found that, on average, those polled believed that 31 percent of the federal budget is spent on foreign aid (including health programs). The actual figure is less than 1 percent (correctly estimated by just 3 percent of those polled). Researchers discovered that, when respondents were informed of the correct spending on foreign aid, their support of increased spending on global health improved significantly.

Actual spending on global health by the U.S. government has been steady at between $9.2 billion and $10.2 billion per year since 2009, with the exception of 2015, when an additional $3.7 billion was spent to stem the Ebola crisis that directly threatened the health of Americans. For 2016, global health represents just 0.2 percent of federal spending, or about $10 billion out of $4.1 trillion. Another way of saying this is that just $32 out of the average American’s tax bill will go to global health programs — with about $19 for fighting AIDS, $2 for malaria, $1 for tuberculosis and $2 for maternal and child health.

Kaiser’s national study also asked respondents to give the most important reason for spending U.S. tax dollars to improve global health. In first place, by far, was “because it’s the right thing to do,” chosen by 46 percent. That’s no surprise. This is the most benevolent country in the world. When our 43rd president announced PEPFAR in 2003, he said, “Seldom has history offered a greater opportunity to do so much for so many.”

Our humanitarian instincts are the bedrock of global health programs, but the Kaiser study also pointed to other strong reasons to spend federal money: “to improve our diplomatic relationships,” “to help ensure national security,” “to help the U.S. economy,” and “to improve the U.S.’s image around the world.” In total, these four justifications topped the list for 48 percent of respondents. Another practical reason to improve health abroad is to prevent diseases like Ebola and the Zika virus from spreading through our own population.

As the presidential campaign progresses, we believe that Americans will want to hear candidates appeal to what Abraham Lincoln referred to as “the better angels of our nature.” Wiping out diseases in poorer countries is simply the right thing to do. But Americans are pragmatic people, too, and, as the Kaiser research shows, we want our contributions to be both cost-effective and beneficial to our own nation as well.

As our research has shown, programs like PEPFAR meet all of those tests: humanitarian, practical and self-serving. In this election season, Americans must require candidates for public office who demonstrate the leadership we will need to ensure global — and national — health.

Daschle served in the Senate from 1987 to 2005 and as Senate majority leader from 2001 to 2003. Frist, a physician, served in the Senate from 1995 to 2007 and as Senate majority leader from 2003 to 2007.

This post first appeared in The Hill.

Subscribe to our newsletter to recieve the latest updates.