Sept. 2, 2015 | Huffington Post

September is Infant Mortality Awareness Month in the U.S with the goal of bringing attention to our relatively high Infant Mortality Rate (IMR), representing the estimated number of infant deaths for every 1,000 live births.

According to the Center for Disease Control, "the IMR is often used as an indicator to measure the health and well-being of a nation, because factors affecting the health of entire populations can also affect infant mortality rates." The most recent data here in the U.S. shows that for every 1,000 babies born, six die during their first year.

While that seems like a relatively low number, the U.S. ranks 50th in the world in infant mortality. Compared to other developed nations, we fall behind many including most European countries, Japan, Canada, and Australia.

But the good news is that we now have a greater understanding of the main factors affecting fetal health, and we can address key risk factors such as obesity and pre-natal smoking. This number has been reduced over the last 60 years due to medical advances in pre- and post-natal care, and through education, we will continue to drive those numbers down.

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As we promote awareness here in the United States, we also want to hold up the issues of infant mortality in developing nations, where the IRM can be as high as 60 for every 1,000 live births. In many low-income countries, the average age of marriage for young women is 16, as in Ethiopia or Guatemala. And if these young women can delay their first pregnancy until 20-24, they are 10-14 times more likely to survive the complications of pregnancy and childbirth, than if they were pregnant in their late teens. And the child is twice is likely to survive the newborn stage if the mother can space her pregnancies just 3 years apart.

These young mothers need a spectrum of interventions including access to folic acid, prenatal care, nutrition, and skilled attendees during childbirth for themselves and the health of their newborn. We need to provide both education and the resources, including access to contraceptives, to help these women time and space their pregnancies, so that their families, too, can thrive.

In an increasingly globalized world, mothers in the United States have much more in common with moms around the world than we might realize. We all love our children and want them to flourish, and we all deeply mourn the loss of a child in any of our villages and communities. As we promote awareness here in the United States to combat infant mortality rates, let's also consider how we might advocate for women in developing nations to reduce infant mortality rates there as well.

Together, we can build a healthier, happier world for moms and children.

This piece originally appeared on the Huffington Post.

But who is a statistic? A statistic is a person, a mother, daughter, sister, an aunty. She is the nameless woman that gets added to the reports about the problems, the needs, and the gaps to be filled.

Aug. 19, 2015 | CNN

Kano State, Nigeria (CNN) Ahmadu Kanduwa's home is just two kilometers away from the local clinic in Nigeria's northern Sumaila district -- two kilometers from the vaccine that could have prevented his son, Isa, from contradicting polio more than a year ago. It's something Kanduwa thinks about often.

"I have this thought, if he had received say five or six doses, he would have been immune from this ailment," Kanduwa said.

He says Isa received two of the oral polio vaccinations. Painfully close to the four doses recommended for complete immunity.

In a district that now has an immunization rate of around 85%, officials hope Isa's will be Nigeria's last new case of polio. More than a year of being polio-free highlights how close the country is to a major milestone. But Isa's case also shows just how difficult polio can be to fully eradicate.

Standing outside of the clinic, Kulchumi Hammanyero from the World Health Organization smiles when she sees the line of mothers with babies in their laps and immunization cards in their hands, waiting patiently for the vaccine. But her smile is matched by a heavy dose of caution.

"When we see there is no more wild polio virus (WPV) and all indicators are showing us that we have covered the necessary ground, then we can say, ok, we have reached a certain point. But we are not out of the woods, not out of the woods at all," Hammanyero said.

Read the full article on CNN.

Aug. 15, 2015 | Forbes

In the United States, our health system is far from perfect, but we like to pride ourselves on delivering the highest quality and newest innovations in care.  But one area where we lag behind even some African nations is in preventing cervical cancer – the most common gynecologic cancer worldwide.

In Rwanda for example, as breast and cervical cancer rates began to rise in 2010, Rwanda’s Minister of Health, Dr. Agnes Binagwaho, quickly responded by launching a national campaign to vaccinate schoolgirls against HPV—the human papilloma virus that causes nearly all cases of cervical cancer. Among eligible girls, vaccination rates of 93.2 percent and 96.6 percent were achieved in 2011 and 2012 according to the Rwanda Ministry of Health.

The move seems obvious: a proven-safe vaccine can snuff out a virus that we know causes deadly cancer. Yet what was accomplished in Rwanda is still desperately needed across parts of the world—and here at home.

An HPV viral infection causes cancer in over 400,000 women globally each year. In developing countries, a woman dies every two minutes from cervical cancer, with 230,000 lives lost annually.  In sub-Saharan Africa, it is the number one cancer-killer of women.

Screening programs, such as the Pap test, have been effective in industrialized countries at catching precancerous lesions before they develop into cancers—thus saving us from the alarming death rates. But a Pap test does nothing to clear the underlying viral infection and prevent cancerous cells from growing in the first place. And as a screening tool, it is hard to enforce in the developing world due to high costs and lack of patient follow-up.

Groups such as the public-private partnership Pink Ribbon Red Ribbon have been seeking to reduce cervical and breast cancer deaths in underdeveloped regions. Soon after Dr. Binagwaho launched the vaccination program in Rwanda, Pink Ribbon Red Ribbon began working to vaccinate over 42,000 girls Zambia and Botswana and perform cervical cancer screening for over 180,000 women for cervical cancer in Zambia, Botswana and Tanzania.

Yet only thirty-five percent of American girls and young women receive the vaccination.

The current vaccine routinely used in the United States, Gardasil, can prevent up to seventy percent of new cases of cervical cancer, and is approved for children and young adults ages 9 to 26.  A newly developed European vaccine, effective against nine variants of HPV (the so-called “nine-valent” vaccination) hopes to improve on this further, with an estimated prevention rate of ninety percent. Gardasil has been available in the U.S. for nearly a decade and has been shown to be both safe as well as exceedingly effective. In Australia, for example, uptake rates are as high as 80%.

Why, then, is the U.S. so hesitant to accept a vaccine that could save hundreds of thousands of cancer diagnoses each year? The reasons include safety concerns propagated by the anti-vaccine movement and worries that a cervical cancer vaccination will increase promiscuity.

Neither argument is compelling. The vaccine has been shown to be exceedingly safe with minimal side effects, and is supported by the pediatrics community and the American College of Obstetricians and Gynecologists. It works so well at clearing viral infections that it has also been approved for boys as well, and can prevent penile and anal cancer caused by the same viral infection. The advent of the new 9-valent vaccine from Europe has the potential to truly cure this cancer and eradicate it—a first in human history. Fears of increased promiscuity are a strawman argument at best. The vaccine only addresses one sexually transmitted virus, and protecting women from HPV would in no way suggest other protections.

The U.S. shouldn’t take its access to this cure for granted; we must change our attitude and health practices here at home.

Various programs have been instituted to help in the uptake of the cervical cancer vaccine. The Vaccines for Children (VCF) program, for example, is a federally funded program that offers free vaccines for low-income families, including the Gardasil vaccine.  But we need to reach beyond the demographic targeted by VCF.

An educational approach including both schools and healthcare professionals should elucidate what the health benefits of the vaccination are, their indications for administration, and the proven safety data. The lack of education about the advantages of receiving the vaccine among healthcare providers remains one of the greatest barriers to increasing compliance rates.  Health care workers must be educated and trained to inform the young women in their care of the availability of a vaccination against HPV.

We also need increased coordination between our nation’s regulatory bodies, such as the Centers for Disease Control (CDC), the National Institutes of Health (NIH) as well as state and local health care agencies. The lack of harmonization in health-care policy among the states, further engenders misinformation and decreased vaccination rates. A coordinated national policy would alleviate these issues.  New York is in the process of passing legislation to offer the vaccine through the public school system, while Hawaii and Texas are attempting to  legislate an increase in HPV education vaccine awareness as a matter of policy. While these remain important and promising steps in the right direction, more work remains to be done.

In truth, the eradication of cervical cancer from the United States is low hanging fruit. We now have a cost effective, easy method of cancer prevention, and the time for excuses has come to an end. We must ensure that our young women have the chance to enter this century free from preventable diseases such as cervical cancer, so they can realize their maximum potential.

Read the original article on Forbes.

It is an interesting thing reflecting on the nature of care I saw in Guyana. I found myself struggling to keep up with state of the art techniques while practicing in a setting having to comply with the status quo. My favorite mental exercise while practicing down in this resource poor environment was “what drug can I give this patient today”. So much of the time in the states the answer is fairly easy and has a protocol behind it. Often the hospital in Georgetown would run out a typically used drug, which forced me to stop and think. I feel this made me a better physician.

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