We arrived safely in Nairobi and stayed at the Mennonite Guest House. The next morning we ate breakfast with missionaries from all over the world in different stages of their calling around Africa. Kijabe’s reputation is well known and they wished as well as we were picked up and driven to Kijabe via a road that had terrible slums juxtaposed with sweeping views of the Rift Valley.
As I was packing for my first international medical trip to Guyana, South America, my wandering mind conjured image after image of third-world medicine based on popular notions and dramatic stories I have heard over the years. I imagined a row of soiled cots where emaciated children without IV access spent their final hours. I pictured a sweltering tent full of tuberculosis patients collectively coughing up blood; or a bathroom-sized emergency department packed with fever-stricken, jaundiced, indigenous peoples dying of AIDS, malaria, and other ailments while overwhelmed healthcare workers looked the other way out of emotional self-preservation because they had nothing to offer. As described to me by some physicians who had been there in recent years, some of these were features specific to the hospital I was heading to in the capital city of Georgetown.
I've probably done more than 30 appendectomies so far during my general surgical residency. For all the times I've taken care of someone with appendicitis, rarely, if ever, has the thought that they might die from the illness crossed my mind. Indeed, some of these patients were quite sick; but once they presented to medical attention, we could get them through their illness. Many of these patients were young which help in their recovery.
Sage Whitmore
As I was packing for my first international medical trip to Guyana, South America, my wandering mind conjured image after image of third-world medicine based on popular notions and dramatic stories I have heard over the years. I imagined a row of soiled cots where emaciated children without IV access spent their final hours. I pictured a sweltering tent full of tuberculosis patients collectively coughing up blood; or a bathroom-sized emergency department packed with fever-stricken, jaundiced, indigenous peoples dying of AIDS, malaria, and other ailments while overwhelmed healthcare workers looked the other way out of emotional self-preservation because they had nothing to offer. As described to me by some physicians who had been there in recent years, some of these were features specific to the hospital I was heading to in the capital city of Georgetown.I am delighted to tell you how antiquated and cynical my preconceived notions had been.
Investing in Health and Security
Dec 15 2011
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Politico |
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While Congress remains deadlocked in fiscal debates, American families are holding their own budget negotiations. How much can we spend this year on gifts for the children, home projects or even food for the holidays? Congress and families alike are tightening their belts, cutting costs and planning ahead. This week, Congress is to vote on a drastic reduction of foreign assistance. While most Americans shy away from the language of foreign aid, polls show that despite continuing economic problems, more than half all Americans support funding for health, including education and emergency relief, in developing nations. On World AIDS Day, President Barack Obama, joined by former Presidents George W. Bush and Bill Clinton, spoke about the global commitment to end HIV/AIDS by 2015 and recommitted the U.S. effort to do so. He announced new targets to combat the pandemic — including providing anti-retroviral drugs to more than 1.5 million pregnant women with HIV over the next two years. Obama received a sustained standing ovation when he announced his administration has set a goal to get six million people with HIV on anti-retroviral treatment by the end of 2013. These are worthy targets to celebrate. But to achieve it, we must have the support of Congress. Continued investment in the fight to end global AIDS is more than an investment in the lives of families and communities in developing nations — it is an investment in security, diplomacy and our moral image worldwide. It uses health as a currency for peace. Millions of lives are at stake — literally. Under the current budget cuts, more than.4 million people will likely lack mosquito nets, a cheap way to prevent malaria. More than 900,000 children will lack access to vaccinations for measles, tetanus and pertussis. These numbers are staggering, but real. Yet, as with any good investment, there is need for accountability, transparency and results. The Millennium Challenge Corporation is a good example of promoting aid effectiveness from “input to impact.” There is mutual responsibility for both donor and recipient to achieve the goals agreed on — an expectation that the recipient take ownership, as a partner, of both the aid and its implementation. Washington should and does require seeing results in practice. For example, one of the best investments is providing access to clean, safe water. Every $1 invested in safe drinking water and sanitation, according to the U.N. Development Program, produces an $8 return in costs averted and productivity gained. Children are healthier, girls can go back to school and women can begin to work again. A Millennium Challenge Account compact funding package for El Salvador now invests nearly $24 million to provide access to potable water systems and sanitation services to benefit 90,000 people in the country’s poorest region. This money creates healthier and more economically sound communities with something as basic as clean water. More than 68 percent of Americans in a recent holiday poll said that because of the economy, we should be committed to charity this year more than ever before. With Americans reaching deep into their pockets to fill the coffers of red-hatted Santas on street corners or offering plates at houses of worship, Congress should follow their constituents’ leadership as they consider foreign assistance this week. This holiday season, let’s recommit to investing in global health and development in the parts of the world that need our assistance the most. Foreign aid is less than 1 percent of our national budget, so cutting it would have a miniscule effect on our deficit reduction. But it means the world to a mother whose child’s life we will save. For the hope of greater peace on earth, investments in health and security could be the best bargain in town. Former Sen. Bill Frist, a doctor, served as Senate majority leader. He is the chairman of Hope Through Healing Hands, a nonprofit charity that promotes using health as a currency for peace. |
A Decade of Progress on AIDS
Dec 01 2011
By BONO
New York Times
I’LL tell you the worst part about it, for me.
It was the look in their eyes when the nurses gave them the diagnosis — H.I.V.-positive — then said there was no treatment. I saw no anger in their expression. No protest. If anything, just a sort of acquiescence.
The anger came from the nurses, who knew there really was a treatment — just not for poor people in poor countries. They saw the absurdity in the fact that an accident of geography would deny their patients the two little pills a day that could save their lives.
This was less than a decade ago. And all of us who witnessed these dedicated African workers issuing death sentence after death sentence still feel fury and shame. AIDS set off an almost existential crisis in the West. It forced us to ask ourselves the big, uncomfortable questions, like whether capitalism, which invented the global village and kept it well stocked with stuff, could also create global solutions. Whether we were interested in charity... or justice.
The wanton loss of so many lives in Africa offended the very idea of America: the idea that everyone is created equal and that your destiny is your own to make. By the late 1990s, AIDS campaigners in the United States and around the world teamed up with scientists and doctors to insist that someone — anyone — put the fire out. The odds against this were as extreme as the numbers: in 2002, two million people were dying of AIDS and more than three million were newly infected with H.I.V. Around 50,000 people in the sub-Saharan region had access to treatment.
Yet today, here we are, talking seriously about the “end” of this global epidemic. There are now 6.6 million people on life-saving AIDS medicine. But still too many are being infected. New research proves that early antiretroviral treatment, especially for pregnant women, in combination with male circumcision, will slash the rate of new H.I.V. cases by up to 60 percent. This is the tipping point we have been campaigning for. We’re nearly there.
How did we get here? America led. I mean really led.
The United States performed the greatest act of heroism since it jumped into World War II. When the history books are written, they will show that millions of people owe their lives to the Yankee tax dollar, to just a fraction of an aid budget that is itself less than 1 percent of the federal budget.
For me, a fan and a pest of America, it’s a tale of strange bedfellows: the gay community, evangelicals and scruffy student activists in a weird sort of harmony; military men calling AIDS in Africa a national security issue; the likes of Nancy Pelosi, Barbara Lee and John Kerry in lock step with Bill Frist and Rick Santorum; Jesse Helms, teary-eyed, arriving by walker to pledge support from the right; the big man, Patrick Leahy, offering to punch out a cranky Congressional appropriator; Jeffrey Sachs, George Soros and Bill Gates, backing the Global Fund to Fight AIDS, Tuberculosis and Malaria; Rupert Murdoch (yes, him) offering the covers of the News Corporation.
Also: a conservative president, George W. Bush, leading the largest ever response to the pandemic; the same Mr. Bush banging his desk when I complained that the drugs weren’t getting there fast enough, me apologizing to Mr. Bush when they did; Bill Clinton, arm-twisting drug companies to drop their prices; Hillary Rodham Clinton, making it policy to eradicate the transmission of H.I.V. from mother to child; President Obama, who is expected to make a game changing announcement this World AIDS Day to finish what his predecessors started — the beginning of the end of AIDS.
And then there were the everyday, every-stripe Americans. Like a tattooed trucker I met off I-80 in Iowa who, when he heard how many African truck drivers were infected with H.I.V., told me he’d go and drive the pills there himself.
Thanks to them, America led. Really led.
This was smart power. Genius, really. In 2007, 8 out of the 10 countries in the world that viewed the United States most fondly were African. And it can’t be a bad thing for America to have friends on a continent that is close to half Muslim and that, by 2025, will surpass China in population.
Activists are a funny lot. When the world suddenly starts marching in step with us, we just point out with (self-)righteous indignation all that remains to be done. But on this World AIDS Day I would like you to stop and consider what America has achieved in this war to defend lives lived far away and sacred principles held closer to home.
The moonshot, I know, is a tired metaphor; I’ve exhausted it myself. But America’s boldest leap of faith is worth recalling. And the thing is, as I see it, the Eagle hasn’t landed yet. Budget cuts ... partisan divisions ... these put the outcome in jeopardy just as the science falls into place. To get this far and not plant your flag would be one of the greatest accidental evils of this recession.
Bono is the lead singer of the band U2 and a founder of the advocacy group ONE and the (Product)RED campaign.
New York Times
I’LL tell you the worst part about it, for me.
It was the look in their eyes when the nurses gave them the diagnosis — H.I.V.-positive — then said there was no treatment. I saw no anger in their expression. No protest. If anything, just a sort of acquiescence.
The anger came from the nurses, who knew there really was a treatment — just not for poor people in poor countries. They saw the absurdity in the fact that an accident of geography would deny their patients the two little pills a day that could save their lives.
This was less than a decade ago. And all of us who witnessed these dedicated African workers issuing death sentence after death sentence still feel fury and shame. AIDS set off an almost existential crisis in the West. It forced us to ask ourselves the big, uncomfortable questions, like whether capitalism, which invented the global village and kept it well stocked with stuff, could also create global solutions. Whether we were interested in charity... or justice.
The wanton loss of so many lives in Africa offended the very idea of America: the idea that everyone is created equal and that your destiny is your own to make. By the late 1990s, AIDS campaigners in the United States and around the world teamed up with scientists and doctors to insist that someone — anyone — put the fire out. The odds against this were as extreme as the numbers: in 2002, two million people were dying of AIDS and more than three million were newly infected with H.I.V. Around 50,000 people in the sub-Saharan region had access to treatment.
Yet today, here we are, talking seriously about the “end” of this global epidemic. There are now 6.6 million people on life-saving AIDS medicine. But still too many are being infected. New research proves that early antiretroviral treatment, especially for pregnant women, in combination with male circumcision, will slash the rate of new H.I.V. cases by up to 60 percent. This is the tipping point we have been campaigning for. We’re nearly there.
How did we get here? America led. I mean really led.
The United States performed the greatest act of heroism since it jumped into World War II. When the history books are written, they will show that millions of people owe their lives to the Yankee tax dollar, to just a fraction of an aid budget that is itself less than 1 percent of the federal budget.
For me, a fan and a pest of America, it’s a tale of strange bedfellows: the gay community, evangelicals and scruffy student activists in a weird sort of harmony; military men calling AIDS in Africa a national security issue; the likes of Nancy Pelosi, Barbara Lee and John Kerry in lock step with Bill Frist and Rick Santorum; Jesse Helms, teary-eyed, arriving by walker to pledge support from the right; the big man, Patrick Leahy, offering to punch out a cranky Congressional appropriator; Jeffrey Sachs, George Soros and Bill Gates, backing the Global Fund to Fight AIDS, Tuberculosis and Malaria; Rupert Murdoch (yes, him) offering the covers of the News Corporation.
Also: a conservative president, George W. Bush, leading the largest ever response to the pandemic; the same Mr. Bush banging his desk when I complained that the drugs weren’t getting there fast enough, me apologizing to Mr. Bush when they did; Bill Clinton, arm-twisting drug companies to drop their prices; Hillary Rodham Clinton, making it policy to eradicate the transmission of H.I.V. from mother to child; President Obama, who is expected to make a game changing announcement this World AIDS Day to finish what his predecessors started — the beginning of the end of AIDS.
And then there were the everyday, every-stripe Americans. Like a tattooed trucker I met off I-80 in Iowa who, when he heard how many African truck drivers were infected with H.I.V., told me he’d go and drive the pills there himself.
Thanks to them, America led. Really led.
This was smart power. Genius, really. In 2007, 8 out of the 10 countries in the world that viewed the United States most fondly were African. And it can’t be a bad thing for America to have friends on a continent that is close to half Muslim and that, by 2025, will surpass China in population.
Activists are a funny lot. When the world suddenly starts marching in step with us, we just point out with (self-)righteous indignation all that remains to be done. But on this World AIDS Day I would like you to stop and consider what America has achieved in this war to defend lives lived far away and sacred principles held closer to home.
The moonshot, I know, is a tired metaphor; I’ve exhausted it myself. But America’s boldest leap of faith is worth recalling. And the thing is, as I see it, the Eagle hasn’t landed yet. Budget cuts ... partisan divisions ... these put the outcome in jeopardy just as the science falls into place. To get this far and not plant your flag would be one of the greatest accidental evils of this recession.
Bono is the lead singer of the band U2 and a founder of the advocacy group ONE and the (Product)RED campaign.
An Impatient Optimist
Dec 01 2011
by SENATOR WILLIAM H FRIST MD
In 1981, I was a surgeon in training at Massachusetts General Hospital in Boston. I still remember the day we learned about a strange, new, deadly infection that presented on the West Coast. A little over a year later, we learned it was caused by a virus transmitted in the blood, a vital fact for a doctor performing surgery every day.As I watched the epidemic grow from a handful of cases to a few hundred to several million, I also witnessed the cases grow in biblical proportions in less developed nations, namely across Africa. While I served in the Senate, I volunteered on annual mission trips to do surgery in villages ravaged by civil war. In these forgotten corners of the world, I witnessed how HIV was hollowing out societies.
It’s now been one full week since my arrival in Kijabe, Kenya. Simply speaking, to understand everything I’ve seen and experienced in the past week will take months of careful thought and reflection. I’ve seen the shackling consequences of poverty, the natural history of surgical disease more advanced than I’d ever seen before, a lack of medical resources, and the list goes on; but, overshadowing all of this, I’ve seen the good several committed people can do at one place in time to positively affect patients and their families for a lifetime.
by Bill Frist
Russian-U.S. relations are complicated and, at times, trying. But since we share a commitment to improve the health of our citizens, there is much we can learn through dialogue and collaboration. And there is no better place to do so than Tennessee, the heart of health-service delivery innovation.
Even at the height of the Cold War, U.S. and Russian scientists collaborated closely to eradicate polio and smallpox. Similar collaboration can lead to mutual benefit for today’s shared challenges, chronic disease and obesity, with a byproduct of improved diplomacy. Collaborations on health-service delivery in Tennessee between Russian and U.S. doctors are a powerful example of health diplomacy and a valuable currency for trust and understanding.
Russia has more doctors, health-care workers and hospitals than most countries, but standards remain variable. Prime Minister Vladimir Putin has committed $16 billion over two years to bolster working conditions, training, and national electronic health records with a promise to trim bureaucracy.
The Washington-based Open World Leadership Center invited 30 health professionals from Kirov State, Russia, to come to the U. S., specifically to Tennessee, to study and explore financing, organization and delivery of health infrastructure and services.
The Russian delegation spent a day in Washington to better understand how health policy is formulated at the federal level and to visit the National Institutes of Health. They then came to Tennessee for a week, spending time in Memphis, focusing on research, and in Knoxville, focusing on rural health delivery.
The visit culminated in Nashville, where they observed firsthand our $70 billion global health-care industry. Hosts Nashville Health Care Council and Hope Through Healing Hands welcomed the travelers to the “Silicon Valley” of health care.
Industry leaders citywide opened their doors with sessions on medical simulation at Vanderbilt and HIV research by Meharry. The group also received an inside look at the public health sector’s progress on making communities healthier from state Health Commissioner Dr. John Dreyzehner, Nashville Mayor Karl Dean and Metro Public Health Director Dr. Bill Paul. The day concluded with global disease-management leader Healthways, and focused on the company’s work to improve well-being through prevention.
Most valuable, however, was the opportunity to hear what the delegates found most applicable to their home. Among them were the development of IT for unified e-records, logistics for emergency services, and the great benefit of community volunteerism.
As the U.S. and Russia attempt to address growing health demands, we have much to learn from each other. Collaboration, using health as a currency for peace, will mean healthier societies, better diplomacy and improved bilateral relationships between our nations.
Sen. William H. Frist is a nationally recognized heart and lung transplant surgeon and former majority leader in the U.S. Senate.