Interview by Timothy C. Morgan
June 29, 2015 | Christianity Today
Melinda Gates describes herself as an “impatient optimist,” something that was nurtured in her while attending Ursuline Academy, the leading Catholic all-girls school in Dallas.
Since Melinda and husband Bill created the Gates Foundation in 2000, they have given away $33.5 billion of their massive wealth from Microsoft and from their close friend, billionaire Warren Buffett. The foundation started the same year as the United Nations Millennium Development Goals, the 15-year antipoverty campaign centered on 8 global objectives. The two programs share many priorities, such as fighting diseases, reducing extreme poverty, and improving maternal health. The foundation partners with a wide spectrum of organizations. Faith-based groups— including Catholic organizations, World Vision, Lutheran groups, and the Salvation Army—are key recipients of more than 125 foundation grants.
This January, Melinda and Bill Gates announced they were “doubling down” on their poverty-fighting efforts. “The lives of people in poor countries will improve faster in the next 15 years than at any other time in history,” they said. But along with the foundation’s big bets and big spending has come big controversy. In 2012, the couple helped launch Family Planning 2020, a global effort to make voluntary, artificial contraception available to 120 million poor women by 2020.
Jun 26 2015
June 26, 2015 | Partners In Health
Partners In Health is launching a new initiative in Rwanda—the University of Global Health Equity (UGHE). A different kind of university, UGHE will harness the best ideas in higher education and integrate cutting-edge technology platforms with immersion in complex health care delivery systems.
Owned and operated by PIH, UGHE is a private institution that will leverage expertise and resources from the government of Rwanda, Harvard Medical School, and key partners to create a forum for delivery-focused teaching, research, clinical care, and implementation. Classes will be taught by local and international experts including Harvard Medical School faculty. Students will learn from a broad network of global policymakers, leading research scientists, community health workers, and social entrepreneurs. UGHE’s academic programs aim to cultivate global health leaders with the vision to tackle consequential challenges and the pragmatic leadership skills to effect transformational change.
“UGHE will train the next generation of Rwandan and global leaders in health care delivery, making Rwanda an international hub for delivery science,” said UGHE Executive Director Dr. Peter Drobac. Drobac will teach an innovative course this September that explores key principles of global health.
PIH has focused on delivering high-quality health care and social services in some of the world’s poorest communities for nearly 30 years. For the past decade, PIH has worked in close partnership with the government of Rwanda, helping to strengthen a health care system that has achieved record improvements in health. This new university is an exciting next step for PIH in Rwanda.
UGHE is actively recruiting students to participate in the inaugural Master of Science in Global Health Delivery (MGHD) degree, which begins in September 2015. The MGHD will be the university’s flagship program, providing a one-of-a-kind learning experience rooted in the principles of global health delivery and One Health, and incorporating policy, management, finance, and leadership. Students with professional experience in health care management and administration, veterinary science, policy, and research will have opportunities to connect and collaborate with global health colleagues and peers throughout the program. Over the coming years, UGHE will add programs in undergraduate medicine, nursing, and dentistry, and graduate programs in veterinary medicine and health management.
Rwanda’s Honorable Minister of Health, Dr. Agnes Binagwaho, a Harvard Medical School senior lecturer and UGHE professor, is passionate about the university’s launch. She looks forward to teaching biological and social determinants of health.
“I have always dreamed that putting academic rigor into health sector management at all levels—local, national, regional, and beyond—would greatly improve the health of the population,” said Binagwaho. “This is exactly what UGHE will do for Rwanda and for the world. I am so excited to be part of this outstanding initiative.”
The two-year, part-time program is designed to complement students’ full-time jobs and scheduled so that students can remain employed. Beginning with a week in residence in Rwinkwavu, the course will meet one night per week in Kigali and one weekend a month in Rwinkwavu, while the first of two state-of-the-art permanent UGHE campuses is under development in Butaro.
Those who wish to apply can visit www.ughe.org.
By Angie Boehmer, Frist Global Health LeaderOnce a week I spend the day following LCA’s community health workers (CHW) from home to home to visit families in the Thrive Thru 5 program. This is probably one of my favorite days of the week.
Jun 11 2015
By Jenny Eaton Dyer, PhD and Jedd Medefind
June 11, 2015 | Christian Post
Those of us who care deeply about human needs often speak as if the one issue we're most passionate about stands alone: hunger, AIDS, poverty, governance, trafficking. We have fallen into that trap at times, too. But here's a vital truth we can't ignore: just beneath the surface, pressing human needs are intertwined. So any aid or development effort that fails to reflect this truth will most always fall flat.
Let's make this personal. Jedd Medefind leads the Christian Alliance for Orphans, working to see orphaned and vulnerable children well cared for around the globe, and Jenny Dyer directs the Faith-Based Coalition for Healthy Mothers and Children Worldwide and Senator Bill Frist, MD's Hope Through Healing Hands, which seeks to empower women in the developing world to better time and space their pregnancies.
Many would see these as widely differing undertakings. That couldn't be further from the truth.
Let's start with this question: "What causes a child to end up an orphan in the first place?" Of course, there are myriad roots to what UNICEF has called the "global orphan crisis" – from disease and disaster, to abuse by parents, to adults feeling forced by poverty to abandon their children. These vexing problems defy simple solutions, so caring for orphaned children will likely remain an immense need for decades to come.
But it is also clear that if these causal factors can be reduced, the number of future orphans can be significantly decreased. Consider the fact that pregnancy and childbirth are the leading cause of death for girls age 15-19 worldwide. Yet even small cultural shifts can alter this reality.
For example, the average age of marriage in Ethiopia is 16. Becoming pregnant between ages 15-19 creates twice the risk of death to a mother as becoming pregnant between 20-24. Likewise, if a mother becomes pregnant within two years of her previous delivery, she is more likely to die or have a miscarriage. Simply delaying pregnancy until age 20, and spacing pregnancies to two or more years apart, can greatly decrease maternal deaths.
Of course, the impact of saving a mother's life ripples outward. When a new mother dies, her infant is up to ten times as likely to die before its first birthday. If the mother has other children, they also become orphans. Studies consistently show that these orphaned children are far more vulnerable to virtually every known evil, from disease and malnourishment to human trafficking. This is true even when they are "single orphans" with a living father.
In short, healthy timing and spacing of pregnancies (HTSP) is a simple, powerful way to protect children from becoming orphans and all the vulnerabilities that come with it.
Grasping the ways these issue intertwine helps inform strategy. When we understand how the timing and spacing of pregnancies impacts orphan issues, we see how significant it can be to combine HTSP with other initiatives intended to protect and care for vulnerable children and their families.
That's not to say there is no place for focus on caring for orphans…or on specific diseases, poverty, governance, trafficking or any other distinct issue. On the contrary, the most effective organizations and initiatives often carry a highly disciplined focus on their core mission and strengths. They provide deep solutions to one need rather than shallow solutions to many. Too often, organizations that try to "solve it all" often end up solving nothing.
But even while keeping strong focus, the best organizations also always keep the bigger picture in mind. They are students of how economics, medicine, governance, superstitions, social mores, and countless other factors interplay as both causes and effects of the more visible needs-at-hand. They see how a comprehensive response demands a wide spectrum of actions simultaneously. While well-honed in their own primary mission, they cultivate effective partnerships and coordinate actions in ways that address multiple issues simultaneously.
In short, we could say that wisdom calls each of us to a wide perspective and a narrow focus.
For us, this means continuing to promote excellence in our respective areas: orphans and HTSP. But it also means exploring together how these seemingly-dissimilar issues are interrelated…and acting on that knowledge to cross-pollinate "best of" solutions between the two fields.
When we see how intertwined human need issues really are – and align strategies accordingly – we believe we can bring far more good to children and families around the world than any isolated endeavor ever could.
Jun 09 2015
By Jennifer Quigley, Frist Global Health LeaderOur last clinic and teaching are back in Limbe! Clinic St. Jean is a large hospital that sees about 250-300 patients a day. The directors wanted the majority of their staff to receive the education, so we did training over two days and taught over 50 providers and nursing students.
By Jennifer Quigley, Frist Global Health LeaderToday was a busy but productive and gratifying day! We started the day at Second Mile Haiti ministries. This is a wonderful organization started by two young Americans, one a nurse and the other with a business/engineering background who saw the need for family education with malnourished children. The ministry has several rooms that house malnourished and underdeveloped children, siblings and their moms (sometimes dads!).
By Joel Musee, Frist Global Health LeaderA Kenyan nurse anesthetist asked me what it was like to work at Kijabe. After my first week here, I thought, it’s just like being at Vanderbilt, but with less resources and all African patients. The care provided at AIC Kijabe is likely the best in rural Kenya and likely the best care you can receive outside of Nairobi.
By Senator Bill Frist, M.D.
Jun 08 2015
June 8, 2015 | Forbes
When you think of Cuban exports, you might think of sugar, or perhaps its famously sought-after cigars. But one of the nation’s most profitable exports is actually its own healthcare professionals.
The Cuban government reportedly earns $8 billion a year in revenues from professional services carried out by its doctors and nurses, with some 37,000 Cuban nationals currently working in 77 countries. The socialist regime allows the government to collect a portion of the incomes earned by Cuban workers abroad.
For example, in 2013 Cuba inked a deal with the Brazilian Health Ministry to send 4,000 Cuban doctors to underserved regions of Brazil by the end of the year – worth as much as $270 million a year to the Castro government. By the end of 2014, Brazil’s Mais Medicos program, meaning “More Doctors,” had brought in 14,462 health professionals – 11,429 of which came from Cuba.
Over the past 50 years, Cuba consistently used the export of its doctors as a powerful and far-reaching tool of health diplomacy. The island nation has built good will and improved its global standing with emerging countries around the world during its years of isolation. It sent its first doctors overseas as far back as 1963, and to date has sent physicians to over 100 countries.
In my travels doing medical mission work to underserved regions in over a dozen African nations, the most common nonindigenous health personnel I run across are doctors and nurses from Cuba offering frontline primary and emergency care. They serve and cure, building trust in Cuba’s name globally.
Why is the medical expertise of this impoverished nation in demand? And why is it home to a population whose life expectancies rival those of much richer countries? Researchers have called this phenomenon the Cuban Health Paradox.
On two health-oriented trips to Cuba in the past year, what struck me was a systematically planned and organized primary care delivery system that captured the doctor-patient relationships of my father’s era of medical practice. Cuba treats healthcare as a human right, specifically stipulated in its constitution. Cuban nationals receive care for free, and have a neighborhood primary care physician who often knows them by name and sees them regularly.
The doctors are paid paltry amounts, many having second jobs. But in my conversations with them, they reflect love for their work and a palpable passion about caring for their patients. In turn, the patients trust and respect their conveniently-located and easy-to-reach doctor, go to them early in the course of an illness without financial barrier, and are likely to follow their recommendations.
Through easy accessibility of frontline doctors who can intervene early in a course of illness, Cuba has effectively implemented preventive medicine, something we as Americans are just now trying to incorporate into a new culture of health. Indeed, Cuba boasts some of the highest rates of childhood vaccinations, and its citizens are much more likely to die of cancer or heart disease than the communicable diseases associated with other poor countries. As I previously observed:
The [Cuban] system works well, and it’s easy to see why. An overweight or genetically-vulnerable 33-year-old may have early signs of hypertension and a creeping blood glucose level. In the U.S.—with lack of access to or emphasis on preventative primary care—this patient may not even begin seeing a physician regularly until he starts to feel overly fatigued at 42 or has his first heart attack at 49. At that point, the damage is well underway. He will start multiple blood pressure medications, a medication for diabetes, and may need procedures as well. But catching a pre-hypertensive blood pressure in the patient’s early 30s, initially trying weight loss followed by a single blood pressure agent and titration over the next decade will likely prevent that first heart attack. The patient may still go on to die from heart failure, but it might be at 85 instead of 65 and he may largely avoid many of the medical complications of his disease by catching and intervening early.
As we rapidly move toward normalization of relations with Cuba, we have much to learn from its effective primary care model successfully implemented under severely constrained financial resources. Part of Cuba’s success can be attributed to having the world’s largest number of physicians per capita. Physician office locations are centrally planned, with each physician team responsible for the health of the citizens within a geographic area.
But we must also look at the bigger picture when considering the Cuban Paradox. In addition to investing in accessible primary and family healthcare, the Cuban government has focused on providing access to education, housing, and nutrition—key non-medical or social determinants of health. Cuban citizens may be driving cars from the 1950s and have a meager average monthly wage of $20, but they boast “first world” population health status because of a combination of attention paid to social and environmental factors of health paired with planned, accessible primary care.
We also have the potential for the exchange of ideas and research in the biomedical field, in which the Cuban government has invested heavily. Shortly after President Obama’s administration announced the beginning of normalization of relations with Cuba, news reports of a Cuban-developed lung cancer vaccine were widely circulated. In April, Cuba’s Center for Molecular Immunology signed an agreement with the Roswell Park Cancer Institute in Buffalo, New York to import the cancer vaccine, known as CimaVax, to begin U.S. clinical trials.
Of course there is much we won’t emulate. I, for one, would not want to get seriously ill in Cuba. Cuba’s medical system lacks effective tertiary care, is sorely deficient in specialized care, and has only limited access to important drugs. Rationing of care and years of embargo means shortages of medicines and even aspirin and band aids require a prescription from a doctor. Hospitals can face acute shortages of everything from urinary catheters to the more effective second- and third-line antibiotics. Medical technological advances have either not reached the island nation or are beyond the government’s financial means.
But as the U.S. healthcare system struggles with cost, financial barriers to access, a shortage of primary care physicians, and too little attention paid to prevention, Cuba holds some fundamental lessons for us. Focusing on health outcomes will hopefully encourage a more holistic approach here at home that looks at all determinants of health – not just acute treatments provided in a doctor’s office.