Mother-and-child health challenges persist globally

The Tennessean

This Mother's Day, moms in Tennessee and around the world have more to celebrate than ever before. Infant mortality rates are declining in many communities and many countries. Yet even today, where a woman gives birth determines dramatically different odds of survival for her child. We can, and must, change that.

A baby in Shelby County has a 1 in 77 chance of dying before her first birthday. In some of our rural counties, 1 in 45 babies die. Those frightening rates are on par with Sri Lanka and Mongolia, respectively.

Overall, the U.S. child mortality rate is worse than in 40 other countries. It's one of the main reasons Save the Children ranks our nation 31 out of 43 developed countries on the Mothers' Index of its new State of the World's Mothers report.

Within the United States, Tennessee has long had one of the worst infant mortality rates. But our state's effort to change that is paying off. We've moved up from 46th to 41st in the latest national comparison on child health. That's good news, but I'm sure you'll agree, it isn't nearly good enough.

Even in tough times, state programs making a difference — including Healthy Start, which makes home visits possible for new moms in rural areas — must be protected if we are to improve the health of moms and kids across the state. Healthy kids lead more fulfilling and productive lives. They create jobs and grow economies.

Children's programs face possible federal cuts

Together,we must speak up for mothers everywhere. Federal programs that have helped reduce global child mortality by a third in the last 20 years are in danger of major cuts.

Worldwide, 8 million children still die each year, mostly from preventable causes. Imagine if diarrhea or pneumonia became a death sentence for your child. This is a daily risk for millions of mothers with no access to trained health workers or the most basic, inexpensive medicines. In Afghanistan, one in seven infants dies.

Why should Tennesseans worry about this when we have our own challenges right here at home? First, it's not an either-or proposition. We should save every child's life when we know how to do it inexpensively and so well. It doesn't take much more than political will to give a child a real shot as a long, fulfilling life,

And it's more than that. When we save children's lives abroad, we help countries develop and give them hope. And when we do that, we help create the conditions for growth and prosperity.

That relates directly to Tennessee, where 44 of our 46 export industries are growing and our state benefits from nearly $26 billion in exports every year. U.S. economic growth increasingly depends on growing markets in developing countries. We are living in a world that is increasingly interconnected. Simply put, by helping mothers and their children everywhere, we help ourselves.

So, as we celebrate this day for mothers, let's make a bold commitment to improve the lives of mothers and children in communities across the globe.

Bill Frist, a heart surgeon, served Tennessee in the U.S. Senate from 1995 to 2007. He is co-chairman of Save the Children's newborn and child survival campaign.

by Raynard Jackson

Whenever the U.S. government enters into a state of fiscal austerity, politicians always look for budget cuts from programs they deem to be less important or have little or no constituency. Foreign policy budgets, especially those directed towards Africa seem to always show up near the top of that list.

The left will blame it on the "mean" Republicans who don't care about Africa. The truth is that Africa seems to benefit more from Republican control of Congress/White House than from Democratic control. Isn't it amazing that former President George W. Bush did more for Africa than any president in the history of the U.S.? But, yet, he gets little or no credit for his policies towards Africa.

It was the Bush administration that first labeled what was going on in the Sudan as genocide (made by then Secretary of State, Colin Powell before the Senate Foreign Relations Committee). Bush played a critical role in helping to end the civil war in the Sudan.

Under the Bush administration, development aid to Africa quadrupled from $ 1.3 billion in 2001 to more than $ 5 billion in 2008. The Millennium Challenge Corporation (MCC) was created by Bush. Africa has received in excess of $ 3.5 billion from the fund so far. The MCC was established to reward poor countries that encouraged economic growth, good governance, and social services for its citizens.

The Africa Growth and Opportunity Act (AGOA) was created in 2000 and expanded under Bush in 2004. The bill provides trade benefits with the U.S. for 40 African countries that have implemented reforms in their countries to encourage economic growth.

The President's Emergency Plan for AIDS Relief (PEPFAR) was created by Bush and had $ 15 billion appropriated over five years (2003-2008). I find it amazing that the program has been cut by the Obama administration (though Obama pledged to increase it by $ 1 billion annually during his presidential campaign).

Along with PEPFAR, Bush established the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (or the Global AIDS Act) established the State Department Office of the Global AIDS Coordinator to oversee all international AIDS funding and programming

Bush's policies are credited with saving the lives of millions of Africans.

The political right would argue that America just can't afford to continue some of these programs. They don't question the merits of the programs, just the financial ability of the U.S. to continue to fund them.

I put the blame for this type of myopic thinking on two groups. The first is U.S. supporters of these programs (this includes, politicians, faith based groups, American citizens, etc.). America must do a better job in explaining why and how these programs impact the U.S. If we don't spend the money on the front end (for prevention), we will spend the money on the back end (for treatment, humanitarian intervention, nation building, etc.).

I would put most of the responsibility on the second group

How many African diplomats can pick up the phone right now and get Congressman Chris Smith (at home, on his cell, or in his office)? Smith represents New Jersey's 4th congressional district and is one of the biggest supporters of Africa that most people have never heard of. He also happens to be a member of the House's Committee on Foreign Affairs and chairs the Subcommittee on Africa, Global Health, and Human Rights.

African diplomats constantly complain about what the U.S. is not doing for them or their country's interests. They hire high powered lobbyist who have little ability to translate their needs into a language that is understood in the political arena. They rarely engage the American people as to why their country is important to the U.S and why they should care. They have no media strategy, no advocate within the halls of the U.S. Congress, and they lack the "friends in high places."

Africans must understand that it is important to engage the American people whether there is a crisis going on in their country or not; whether there is an adverse policy percolating through Congress or not.

The new Congress convened in January and there are many new members in both the House and the Senate who are new to their respective African committees. African diplomats have made little, if any, effort to establish relations with these new members beyond any perfunctory meet and greet.

There will most definitely be across the board budget cuts for the foreseeable future. How deep they are relative to Africa will depend on how well the African diplomatic community communicates their country's importance to the American people and relevant members of both the House and the Senate.

Based on my private conversations with members of Congress, the White House, members of civil society, and NGOs, Africa doesn't make the cut in terms of understanding how to make things happen in the U.S.

Raynard Jackson is president & CEO of Raynard Jackson & Associates, LLC., a D.C.-public relations/government affairs firm. He is also a contributing editor for ExcellStyle Magazine (www.excellstyle.com <http://www.excellstyle.com> ) & U.S. Africa Magazine (www.usafricaonline.com). —African heads of state and their designated U.S. ambassadors! African leaders and their ambassadors show very little understanding of how to get things done through our political process here in Washington, DC. Most African ambassadors have no relations with relevant members of Congress on the African committees of the U.S. Senate and House of Representatives.

by Shannon Langston, MD
Department of Emergency Medicine
Vanderbilt Medical Center
Georgetown, Guyana

Physiologically, people are essentially the same no matter where you go.  Yet, when I first arrived in Guyana, I was surprised at how quickly death came for many.  Infections, head injuries, road accidents, malaria…they all take their toll.  There is no fanfare, drama, or ceremony.  The body is covered and taken away and another patient placed in the bed.  Relatives grieve, but they don't seem surprised.  It is as if the boundaries between life and death are much narrower.  Life seems much more fragile. 

So used to medical technology and medications, the gulf between the living and dead seems large from an American viewpoint.  We take for granted the public safety campaigns that protect the majority of our children from threats ranging from lead poisoning to traffic hazards.  Things we assume are intrinsic knowledge are often due to the foresight and hard work of others.  Critical care units, advanced chemotherapy drugs, nearly unlimited blood supplies, dialysis, we could not imagine not having them at our disposal if ever needed.  Yet, much of the world has no access to these modalities.  Often, in remote villages, people have access only to the most basic of medicines while their contact with nature puts them at increased risk for injury and disease. 

In my short time in Guyana I have seen several people die from snakebites, something I had never before witnessed.  Most of them come from the remote interior region.  They call the deadly snake Labaria, we know it as the Fer-de-lance.  It is well known in Guyana and feared by most people, including myself.  Although effective antivenin for the snakebite is made, it is not always effective or available at the public hospital.  Recently, a young boy came into the hospital complaining of bleeding.  Any place on his body that had a small scrape started to ooze blood.  Nurses had to refrain from drawing blood as it took hours to stop the bleeding from the puncture.  Even his gums were bleeding. He told me that he was stung by a worm, a black hairy worm, that he touched by accident. 

He showed me little red spots on his hand that had mostly faded from view, spots he claimed were caused by touching the worm.   The physicians, myself included, all assumed it was a baby Labaria bite, since he came from the interior where the bites are common. The boy insisted, ”It was a worm.”  Once admitted, they treated the boy with plasma and vitamin K in an effort to stem the bleeding.  A pathologist, interested in the case, did some research.  Sure enough, there is a caterpillar, mostly found in Brazil, that is known to have one of the most potent toxins known to man.  Simply brushing against the caterpillar is enough to cause bleeding and death.  When I questioned the boy’s mother, she recalled a neighbor that died of something similar the previous year after touching an insect.  Being rare in Guyana, and being present for only three months per year in caterpillar form before it turns into a moth, most people are not aware to be cautious of the deadly caterpillar.  It lurks, unassuming, on a tree branch. 

The boy was given fifteen units of fresh frozen plasma (at my last count) and some vitamin K, which eventually stopped the bleeding.  Thanks to an interested pathologist, aggressive care, and a good dose of luck, the boy was saved.  Living in a place where the odds can be stacked against you, something so beautiful as a caterpillar can be deadly.

by Senator Bill Frist, M.D.

If you are a health professional, what can you do to influence global health? How can you get involved in health care around the world? What does health diplomacy mean?

This short video serves as an introduction to a lecture on health diplomacy and global health for those who currently serve in medicine in the United States. We invite you to watch and let us know what you think.