May 28 2013
(The Hill, May 28, 2013)
By Rep. Barbara Lee and Bill Frist
A Democratic Congresswoman and a former Republican Senator aren’t afforded many opportunities to work together. Especially at a time of fiscal crisis when every dollar is scrutinized and fought over, partisanship pushes us into opposite corners. But we agree on a program that truly has bipartisan support, saves millions of lives a year, and contributes directly to stability, security and economic growth worldwide.
Ten years ago this May, when the AIDS pandemic was at its worst, ravaging many African countries and a sure death sentence for millions, our country responded in an unprecedented way. We both, along with the late Republican Congressman Henry Hyde and the late Democratic Congressman Tom Lantos, worked with the Congressional Black Caucus and a bipartisan group of legislators to address this enormous problem. Soon after, in 2003, then-President George W. Bush instated PEPFAR, the President’s Emergency Plan for AIDS Relief, pledging $15 billion over five years to combat the spread of HIV, prevent further infections and improve access to care for millions of people across the globe. Each year since then, Congress, with bipartisan support, has stood behind the program, providing critical funding to enable PEPFAR to truly help change the trajectory of the AIDS epidemic.
Now, a decade later, PEPFAR’s success isn’t just measured in dollars spent, but in lives saved and communities improved. The Institute of Medicine called the program “transformational” in global health.
PEPFAR has directly supported life-saving antiretroviral treatment for nearly 5.1 million men, women and children around the world, and is helping prevent hundreds of thousands of mother-to-child transmissions, an essential step toward achieving an AIDS-free generation. Engaging women is crucial to the broader goal; about half of the people living with HIV worldwide are women, and their empowerment is critical to beating this disease. PEPFAR supported HIV testing and counseling for more than 11 million pregnant women in 2012 alone.
Because of PEPFAR, we’re not just working toward an AIDS-free generation, we’re achieving an AIDS-free generation.
All around the world, PEPFAR is caring both for the health of the individual and the health of communities. The medications and programs supported by PEPFAR are so effective that people living with HIV/AIDS are doing just that — living. Infected individuals can care for their families and hold jobs. Communities enjoy economic stability. The United States earns a positive reputation.
But we are at a tipping point to truly realize this vision. If we back away now, the gains we’ve made will evaporate; the success we’ve had will disappear. Support of PEPFAR now is as important as it was 10 years ago.
HIV is a virus, not an ideology. Democrats and Republicans should be proud of PEPFAR’s legacy and continue to support it moving forward, providing the program with the robust funding it still needs to help achieve an AIDS-free generation.
Lee serves on the House Committee on the Budget and the House Appropriations subcommittee on State, Foreign Operations, and Related Programs, and is founding co-chair of the Congressional HIV/AIDS Caucus and represents the United States on the United Nations’ Global Commission on HIV and the Law. Frist is adjunct professor of surgery at Vanderbilt and Meharry medical schools and former majority leader of the U.S. Senate.
May 22 2013
(The Hill, May 22, 2013)
By Senator William H. Frist, M.D.
On June 8, the United Kingdom, under the leadership of Prime Minister David Cameron, will host “Nutrition for Growth,” a high-level meeting where donor governments, including our own, will pledge funding and other commitments to address undernutrition and its devastating impact on the long-term health and productivity of millions of people in developing countries.
Sitting side by side with donors and foundations will be representatives of developing country governments, the private sector and civil society organizations, demonstrating the truly complex and multi-stakeholder nature of nutrition.
Malnutrition is one of the world’s most serious, yet least-addressed, development challenges. It contributes to almost 2.5 million young child deaths annually. Malnutrition is a serious drain on economic productivity, costing countries as much as 11 percent of GDP.
Close to 200 million children throughout the world are chronically malnourished and suffer from serious, often irreversible cognitive damage. Physically, undernourished children are stunted—smaller in stature than their well-nourished peers, more susceptible to illness throughout life, including noncommunicable diseases such as heart disease, cancer and obesity.
The case for greater leadership and investments in global nutrition is clear. The Copenhagen Consensus, an expert panel of economists that includes several Nobel laureates, concluded that fighting malnutrition in young children should be the top priority investment for policymakers. In the group’s report, they stated that every $1 invested in nutrition generates as much as $138 in better health and increased productivity. Similar studies have found that undernutrition causes between $20 billion and $30 billion in additional health costs every year to treat the long-term consequences of early childhood malnutrition.
While the problem is complex, the solutions don’t need to be. Cost-effective, evidence-based solutions exist. What we need are the resources and the political commitment to scale up proven nutrition solutions. Political commitment in the form of presidential leadership and bipartisan congressional support works. We have seen it in the Global Fund, the President’s Malaria Initiative, the Millennium Challenge Corporation and the President’s Emergency Plan for AIDS Relief (PEPFAR).
We can do it again — this time to scale up and align nutrition investments. To follow the proven PEPFAR model, we should target resources to benefit the most vulnerable; align resources across all agencies and programs; focus on countries where we have committed partners and country-led strategies; and coordinate efforts internationally.
UNICEF reports that 1 in 4 children under the age of five is stunted and 80 percent of those children live in just 14 countries. The Lancet’s series on maternal and child health and nutrition highlights the 1,000 days from the beginning of pregnancy to a child’s second birthday as the critical window of opportunity for human health and development.
Like PEPFAR, we can target our interventions to benefit those most vulnerable to undernutrition, namely pregnant women and young children. We have commitments from more than 30 countries, which as part of the Scaling Up Nutrition (SUN) movement — a partnership of donors, developing countries, nongovernmental organizations and the private sector — have identified undernutrition as a severe impediment to economic development. A number of those countries have developed national nutrition plans that offer donors an opportunity to build upon and strengthen the country-led aspect of the investments.
We can begin by working with those committed country partners through bilateral and multilateral channels and offer our government’s technical expertise and best practices to galvanize a concrete investment strategy that includes innovative public and private partnerships and financing mechanisms.
There is an emerging international coordination effort for nutrition: the Nutrition for Growth event in London, last year’s G8 commitment to the New Alliance for Food Security and Nutrition, the UK-led Hunger Summit of 2012 and the growing Scaling Up Nutrition movement. These efforts will help the United States to share with other donors the cost of alleviating this global problem.
This is a critical moment for the U.S. to lead on global nutrition. The June 8 summit in London is the perfect opportunity for the Obama administration to announce a bold global nutrition strategy that outlines a multifaceted and multi-year approach to better coordinate and integrate nutrition resources across sectors and agencies, with clearly defined goals and targets, and with the dedicated resources necessary to achieve the strategy’s stated goals. Bipartisan leaders in Congress must step forward and commit to working with the president to make global nutrition a top priority of U.S. development assistance.
The moment for turning the corner on global nutrition is here, and it is time for our elected leaders to demonstrate anew how American leadership is the driving force for building a healthier, safer and more prosperous world.
William H. Frist, M.D. is a nationally acclaimed heart transplant surgeon, former U.S. Senate majority leader, the chairman of Hope Through Healing Hands and Tennessee SCORE, professor of surgery and author of six books. Learn more about his work at BillFrist.com.
May 17 2013
It is with great pleasure that today we announce Global Health Service Corps (GHSC) is changing its name to Seed Global Health. As many of you know, we have been considering a name change over this past year to better capture the full scope and mission of our work and to better distinguish our cause. We believe this new name better represents our efforts to cultivate stronger, sustainable health systems through training new generations of physicians and nurses in countries where they are needed most.
Our name is changing, but not our innovative public-private partnership with the Peace Corps and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) - the Global Health Service Partnership (GHSP). Seed Global Health's role in the partnership is to provide the expertise in medical and nursing education as well as knowledge of clinical education in resource limited countries.
We are extremely proud to be sending our first class of GHSP volunteers -33 doctors and nurses - to serve as faculty in medical and nursing schools in Malawi, Tanzania, and Uganda this July. They are truly an impressive group of nurse practitioners, midwives, pediatricians, OB/GYN's, psychiatrists, anesthesiologists, family and internal medicine doctors who will work with faculty in their host countries to develop curriculum and help train a new generation of doctors and nurses. We will be sharing some of their stories with a bigger announcement in July.
Also today, the Global Health Service Partnership begins accepting applications for 2014 volunteers. We're committed to recruiting the best qualified-candidates for the job. And for those who may have financial constraints to service, Seed Global Health raises and disburses loan repayment and other support to those chosen to serve abroad.
We hope you will share this information with individuals you think might be a good fit for the program. For more information on applicant requirements, visit Seed Global Health.
You can like us on facebook and follow us on twitter to spread the word, too.
facebook link to Seed Global Health or twitter Seed_Global.
We are humbled and excited that just over a year ago we were announcing our collaboration, and just 2 months from now we will have volunteers on the ground and working to build a pipeline of medical professionals in the countries that most need them.
Thank you for your continued support!
Vanessa Kerry, MD MSc
CEO, Seed Global Health
Join the Seed Global Health mailing list to follow our progress.
Senator William H. Frist, MD
Originally published in Roll Call.
A decade ago, as I was beginning my time as Senate majority leader, bipartisan consensus in Washington helped launch a new era of progress in global health just when it was sorely needed. Twenty years had passed since I first saw AIDS patients in Boston, though at the time we didn’t even have a name for this savage disease. Advances in treatment and technology were helping control HIV in the United States, but AIDS was decimating communities worldwide. There were tens of millions of infections, yet only 400,000 people in low- and middle-income countries had access to lifesaving antiretroviral therapy, meaning only a tiny fraction were able to escape death.
World leaders united to tackle AIDS and other scourges through an innovative financing tool — the Global Fund to Fight AIDS, Tuberculosis and Malaria. President George W. Bush and Congress made a founding pledge of $300 million to the international initiative. Bush, with bipartisan support from both chambers of Congress, also established the President’s Emergency Plan for AIDS Relief, the largest program ever to combat a single disease. President Barack Obama has similarly embraced this program and America’s role in eradicating this disease.
U.S. leadership at the Global Fund, and bilateral health programs such as PEPFAR and the President’s Malaria Initiative, signaled a renewed commitment to a core facet of our country’s greatness: compassion for those most in need. Understanding that improving global health is good for national security, economically prudent and — most importantly — the right thing to do, the U.S. taxpayers made an unprecedented investment in the world’s future.
That investment is paying off.
As we mark the 10th anniversary of PEPFAR this year, the number of people on lifesaving treatment has increased more than twentyfold. HIV infection rates are down. The number of malaria cases has plummeted by more than 50 percent. Tuberculosis mortality rates are falling steadily. The Global Fund alone saves an estimated 100,000 lives each and every month, working in more than 150 countries. These health gains were once unimaginable.
A new chapter in global health begins this month as visionary leader Dr. Mark Dybul takes the helm as executive director of the Global Fund. With so much gridlock in Washington, Dybul’s appointment is a reminder of what we can accomplish by reaching across party lines.
Dybul, who began as a physician treating AIDS patients in the early years of the pandemic, helped transform the fight against the disease as the architect and leader of PEPFAR. Now at the Global Fund, he will lead the charge to defeat AIDS, malaria and tuberculosis. Armed with scientific expertise and dedicated to a mission that goes beyond political ideology, there may be no one better suited for the job.
Today there is real hope in this fight — but it’s far from over. We have the science to help people with HIV live healthy lives, but millions still lack access to the treatment they need. We can detect and treat TB, but drug-resistant strains represent a growing threat, and disease respects no borders. And malaria still takes countless lives each year, though it can be stopped with basic, incredibly cheap prevention.
Reporting from Les Cayes, Haiti
I can’t believe my time here in Haiti is over—but it is. I’m
writing this from my guesthouse in Port-au-Prince, in preparation for
my flight home tomorrow.
I would like to thank Senator Frist for forming the Frist Global
Health Leadership Program, and for allowing me to have come to Haiti
to work at HIC. I’d also like to thank the many people at Vanderbilt,
Dartmouth, and HIC who helped me make the needed connections and
organize the details of my trip. Last but not least, I’d like to give
a special shout-out to my boyfriend, for supporting and encouraging me
to leave him—and the U.S.—for three months and go work in Haiti.
Although there were certainly nights that were incredibly difficult,
there were many more that were amazing, and I am so very thankful for
having been able to work at HIC. I was able to learn from so many
experienced, kind, patient doctors and (mainly) nurses. They opened
their hospital and the maternity ward to me, and were willing to teach
me and make me an infinitely better midwife. I know that my time at
HIC will forever impact how I care for my patients, and how I look
upon all of the resources available to my moms and babies back in the
U.S. Additionally, working here has further solidified my desire to
work internationally, and has given me a clearer idea of what that
life will be like.
I sincerely hope that if Senator Frist had come to visit HIC that the
staff and the patients I interacted with would have said I was worthy
of being a Frist Global Health Leader.
This last picture is of me and an auxiliary nurse (kind of like an
LPN) named Mrs. Lorcey. Mrs. Lorcey works most nights, and so I worked
with her more than any other provider during my time at HIC. I was
always pleased when I'd arrive to work and see Mrs. Lorcey there
because we worked well together and respected each others skills as
providers. Although at first Mrs. Lorcey didn't trust me--as she
shouldn't have--as I slowly proved myself and my skills she let me do
more and more on my own, and helped guide me through interventions
that I'd never done/seen before. By the end of my time at HIC I know
that she believed in my abilities, and let me work as independently as
I wanted. I worked with Mrs. Lorcey on my last night at the maternity
and in the morning when it was time to leave she gave me a big hug--
something I didn't see that often in Haiti--and told me she'd miss me.
I will certainly miss her, her smile and her quiet, calm
encouragement when I was stressed or unsure of what I was doing.
Happy New Year!
Apart from working at the maternity this week—and getting to celebrate the arrival of 2013 with laboring women and their new babies—I’ve been busy completing the list of HIV+ women who have been lost to follow-up. From March of 2009 until November of 2012 there were 240 women who started receiving HIV care at HIC, but now no longer are doing so. I really hope that the social worker and the community health workers will make use of this list and that some of them will be found and restarted with their HIV care. I am however, not incredibly optimistic that many women will be located. The social worker and community health workers are already very busy and to try to track down 240 women—with little more than their names, dates of birth, and possible addresses—seems very ambitious. But I feel that if even one or two women are found and are restarted in care that my work on the list was worth it.
Along with the lost to follow-up list I’ve also been working on an “opposite” list—collecting information about those women who are still receiving HIV care at HIC. The hope is that with both lists, providers at HIC will have a better sense of whether or not there are differences between those women who are lost to follow-up (LTF) and those who are active. Maybe it’s the timing of enrollment in the HIV program, or whether or not a woman gives birth at home or in the hospital, or her age that is a significant factor in whether or not she stays in care. With that information the providers at HIC may be able to modify certain aspects of their program (i.e. enrolling women earlier if that was shown to make a difference) or focus on certain “at risk” women (i.e. if older age is show to have increased LTF risk, providing more education/support to those in that age range), thus—hopefully—decreasing the programs LTF rate and ensuring more women (and their babies) receive the important HIV medication and care.
This week I also went into the capital and had the pleasure of meeting a woman who is running GHESKIO’s Nurse Practitioner program. (GHESKIO stands for the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections, and was the first institution in the world dedicated to the fight against HIV/AIDS. It has provided continuous free medical care in Haiti since 1982) I talked to her about what can be done to better define the role of an NP in Haiti—to distinguish NPs from the nurses and doctors, and to make sure that the doctors don’t worry about NPs “taking their jobs”. I also got to meet three women who have already graduated from GHESKIO’s NP program who are working as NPs at GHESKIO. All of the women that I met were amazing. They were all very motivated and open to improving the NP program and striving to provide the best care they possibly can for their patients.
I returned to Samaria with a Clinical Officer, Waweru, in tow to staff Samaria for the week in Susan’s absence. Susan has an obligation to attend training and program review for her participation in Tunza the family planning program supported in part by USAID. If Susan is not able to find a substitute during her absence, then she must close her clinic. In this case it would have been for 4 ½ days, difficult on the patients and Susan’s income. Even so, engaging a substitute adds costs to clinic expenditures, that may or may not be recouped from leaving the clinic open. This underscores the difficulty that private clinic nurses have in taking time away from their practice if they are the sole practitioner. It is difficult to engage in continuing education, a must for any clinical practitioner, if the economics and finding a trusted substitute are onerous.
So off Susan went Monday afternoon to a suburb of Nairobi for her meeting. And then the rains began! Waweru and I were busy with patients until it was time for him to head home to Nyeri. I realized that this relative “city boy” came to Samaria without gum boots or an umbrella. He trudged out in the rain in his dress shoes for what turned out to be a 4 hour commute back to Nyeri. This trip in dry weather is about an hour. Happily Waweru showed up the next day despite the rain and the convoluted travel requirements to avoid impassable roads.
Waweru and I established a good rhythm in seeing patients and had time to share reflections about our respective training and commonalities and differences, which I will address another time. It is still raining!
Eight am the next morning I am called by Waweru that due to a family emergency he would have to go to his family home in Nakuru. He was trying to find me a substitute but to no avail. Hmmm. Given my knowledge of Kikuyu, it was going to be a real challenge alone in the clinic. Susan made some noises about coming home but in the end, it was me with the frequent translating services of her sister Nancy for those patients who remained perplexed by my words. There is nothing like being thrown into the deep end to bring you up to speed. Oh yes it is still raining, so realistically Susan would be hard pressed to make it home.
Fortunately no real emergencies arrived at the clinic. Patients were gracious and patient with my attempts at Kikuyu and communicating with them. Others were forced to use their English skills that otherwise might not have had Susan been there. Oh yes, it is still raining- I introduced the term “raining cats and dogs” to the local colloquium that week. It is very impressive rain.The first two days alone were busy despite the rain and while I tried to establish a rhythm of seeing patients, assessing for health complaints, being the pharmacist to fill the medications I prescribed, collecting payments, and entering patient visit information in the various registers, as required by the Ministry of Health.
The MOH required registers
The “Well Child Visit” crib is a good perch after a long day.
I did use the early morning re-reviewing the MOH guidelines for managing childhood illnesses for under 5 years and various reference books on treating worms, amoebas, malaria, and typhoid. I was very glad that I also brought my Sanford Guide to Antimicrobial Therapy. During nursing school I did not fully appreciate the wealth of knowledge this guide supplied, despite its impossibly small 4 point character font! My roommate during the summer also recommended a midwife’s pocket guide that proves to be illuminating for this family nurse practitioner.
Susan returned home Friday night after an adventurous travel home that required hitching a ride with an ambulance on the main road which in fact got stuck and required 13 young men to push it out, after Susan promised to pay them each 50shillings the next day.
I was asked by one of my male blog readers what do the men. Well, in this area many young men wait along dirt roads waiting for vehicles to get stuck. Once stuck the men negotiate a fee, usually 50 shillings, and then push the vehicles out of the mud and muck. Kenya’s unemployment is estimated at 40% (of 39M) of which a large percentage is “youth”, resulting in many idle young men. As you may recall, I was told by more than one man that the construction work on the dirt road that was causing all the stuck cars was too back breaking to be worth the 250 shillings a day for men, however apparently not so for women. Pushing vehicles pay more with less effort. Others are using motorcycles to provide taxi service for people and goods in the smaller communities, that has improved some men’s income. I have asked whether there are co-ed groups or men groups engaging in micro-lending projects as an alternative. In this area there is beginning to be interest by men but it is a challenge I am told to build trust among the male participants. I see lots of entrepreneurial opportunities for men and women, however, there perhaps a lack of mentoring by successful men or men in leadership roles to pursue some of those opportunities.
Back to Susan’s journey: Susan was dropped off by the ambulance to walk about a mile up a hill across farms and along the so called road to Samaria without gum boots. She made it by 10:30 PM. And yes, it is still raining. In fact, I was to return to Mariine Maternity Home and Josephine on Sunday the 3rd and was delayed until Wednesday because of the rain. I did manage to take advantage of a break in clouds on Saturday and Susan volunteered to add a little color to my hair.
Dec 28 2012
As I mentioned in my last post I’ve struggled with practicing as I’ve been taught and believe is best while also trying to respect how my Haitian counterparts were taught and what they believe is best practice.
There was a woman who came in in labor this week and when the doctor examined her he said that she would need an episiotomy (cutting the perineum to make the vaginal opening bigger) in order to give birth (this was long before the baby was even close to being at the perineum when something like that could really be evaluated). I had labored for most of the evening with this woman and thought of her as “my patient,” and was more than a bit frustrated at the prospects of her having an episiotomy. I told the nurses I was working with that I didn’t think she needed an episiotomy—and explained that in the U.S. the literature shows repairing lacerations is better than repairing episiotomies—and that if I caught her baby I wasn’t going to perform one. Needless to say, I was not allowed to catch the baby and she got an episiotomy (and actually had quite severe post-partum bleeding, I believe in part as a result of her episiotomy).
I know that the nurses where just doing what the doctor ordered them to do (as is appropriate), and that they believed that performing an episiotomy was best practice, but it was still very hard for me to watch. I however, see no easy way to reconcile our differences in practice. Although I’ve tried to talk to the nurses about why we in the U.S. don’t perform episiotomies (and various other practices), at least in this type of society behavior change needs to come from the top (i.e. the OB/GYN chief) and not the bottom (i.e. night nurses). And although I feel very strongly about the issue I’m reticent to go to the head of the OB/GYN department and try to lobby for such a change. Part of that that is me being scared and non-confrontational, but it’s also hard given that this is what is believed to be best practice and still taught in the medical/nursing schools, and I’m “just” a visiting foreign new midwife lucky enough to have been allowed to work at HIC for these 2.5 months. So, I’ve done nothing—except never perform an episiotomy and have had many moms with no lacerations (when I was told an episiotomy would be needed) or well repaired ones. I know that’s not enough and that I’m not serving my patients as best I can, but it’s all I feel comfortable with doing at this point.
Reporting from Les Cayes, Haiti
As the providers at HIC (i.e. the nurses) have become more comfortable with me and my abilities I’ve slowly begun to help teach the nursing students who are present during my shifts. This week I got to help a couple of the students do deliveries, which were rewarding experiences, though ones I’m not (yet) totally comfortable with. In many ways I still feel like a student myself—I graduated from nursing school in May 2012 and this is my first job practicing as a “real” (as opposed to “student”) midwife—and so it’s a bit odd for me to already be put in a teaching role. That said, I really do enjoy guiding the students and helping them grow more confident with and skilled in catching babies.
Nursing students in uniform before their graduation
One of the hardest things about trying to teach here is that there are some birthing practices that are standard in Haiti that aren’t viewed as best practice in the U.S./developed world (i.e. they always clamp and cut the cord immediately, in the U.S. it’s recommended to typically wait at least 2 min, they perform perineal massage while pushing, in the U.S. that’s not recommended, they perform episiotomies very frequently, most midwives in the U.S. perform them very rarely). So although I may be coaching a student through a delivery, advising her using recommendations from the U.S., often times one of the nurses will “correct” the student and tell her to do something very different than what I’ve just said. So that is sometimes frustrating for both the student and me. I’ve now started saying, “in the U.S. we do this” and trying to explain why I recommend doing something “my” way versus the “Haitian” way. And after hearing my explanations and watching me practice, some of the providers/students are slowly adopting at least the delayed cord clamping, which I’m happy about.
This week I was doing the admitting paperwork on a woman who came in in labor. I know how to ask some basic questions in Creole (How old are you? What’s your name? How many babies do you have? etc) and so went through those with her. For the more “complicated” question (Where were you born?) I switched to French, hoping she knew how to speak it—which she did. Her reply—Jamaica—surprised me, and prompted for me to ask her if she spoke English—which she did also. So throughout my night laboring with this woman we had conversations in a mix of Creole, French, and English, which made me smile. I know for Haitians and most people around the world speaking multiple languages is nothing exciting—and I mélange French and Creole normally with all my patients—but having that English thrown in (with her great accent to boot) was a treat.