July 1, 2010 | www.mcc.gov

When Water Flows, Economic Growth Follows

Ashot Abrahamyan is a farmer in Armenia whose apricot orchards lie beneath picturesque purple mountains. His farm is 30 meters above the closest public canal; so in order to irrigate, he had to pump water for more than seven hours every day. For decades, less than three kilometers of the canal system were operational. Beginning late 2009, to respond to the irrigation needs of Mr. Abrahamyan and hundreds of other Armenian farmers, the Millennium Challenge Corporation (MCC) funded the reconstruction of gravity-fed irrigation systems as part of its compact with Armenia.

Mr. Abrahamyan describes his situation prior to and after the reconstruction, "The water in the old canal was limited and much of it vanished through the cracks in the concrete and the broken flumes. Thanks to the new canal, I will be able to save money and irrigate for two to three hours instead of eight. This will also increase the number of peaches I can grow and harvest."

MCC is funding $113 million in repairs to gravity-fed irrigation systems as well as the rehabilitation of canals, pumping stations, and drainage systems throughout Armenia. Major construction and rehabilitation have begun on 17 critical water pumping stations and five gravity-fed irrigation systems throughout Armenia.

  • $36 million investment in pumping stations will provide reliable water for irrigation and improve agricultural productivity for 100 Armenian communities in six regions.
  •  $7 million investment in gravity-fed irrigation systems will increase arable land and reduce electrical consumption.

A $16 million investment in the Ararat Valley Drainage System will reduce ground water levels in 35 communities of the Ararat and Armavir provinces and will increase crop productivity in the biggest agricultural zone in Armenia, while also maintaining an optimally balanced ecosystem in the wetlands.

Mr. Abrahamyan is one of the lead demonstration farmers for MCA-Armenia, which is managing the compact’s implementation. His orchards will benefit not only from improvements to the gravity system, but also from a more stable irrigation system that he developed after receiving training from MCC-funded on-farm water management experts. He learned ways to modify his system to improve its efficiency and save both water and energy. He will access water though the pipe outlet installed on the siphon of the canal, which will feed his pump. With construction completed in the areas near his farm, Mr. Abrahamyan is excited about the new irrigation season.

A year from now, more than 61,000 farmers in 23 communities in the Ararat, Armavir, Gegharkunik, Lori, and Shirak provinces of Armenia will see their own irrigation systems completed and precious water supplied to their lands without losses and at a lower price. MCC and MCA-Armenia look forward to making a difference in the lives of farmers like Mr. Abrahamyan, who are counting on the water, the technical expertise, and the hope that this program brings. After work is completed, even farmers at the farthest ends of the canals will be able to access water and farm lands that had been deserted.

MCC’s total investment in the agricultural and water sector in Armenia will be approximately $180 million when the program ends in September 2011. The Irrigated Agriculture project will benefit over 420,000 people by improving the quality of irrigation and increasing agricultural productivity. By rehabilitating and constructing main canals, gravity-fed irrigation systems and pumping stations; strengthening the capacity of local and national water supply entities; and providing technical and rural credit assistance to farmers, MCC expects farmers to shift from low-value to high-value crops and income from agriculture in rural areas to increase.

Press Release

Harvard School of Public Health

Operating Theatres and Essential Surgical Equipment Often Unavailable in Developing Regions

For immediate release: Wednesday, June 30, 2010

Boston, MA -- More than two billion people worldwide do not have adequate access to surgical treatment, according to a new study from the Harvard School of Public Health (HSPH). The researchers also found that people living in high-income regions have far greater access to operating theatres (surgery sites) than those living in low-income regions and that surgical facilities in low-income settings often lack essential equipment.

A substantial amount of the global burden of disease comes from illnesses and disorders that require surgery, such as complicated childbirth, cancer and injuries from road accidents. The burden of treating surgical conditions is especially acute in low-income countries. The wealthiest third of the global population undergoes 75% of the estimated 234 million surgical procedures done each year, the poorest third just 4%.

“Our findings suggest that high-income regions have more than 10 times the number of operating theatres per person than low-income regions,” said Luke Funk, research fellow in HSPH’s Department of Health Policy and Management and a surgical resident at Brigham and Women’s Hospital in Boston.  “Addressing this disparity will be a huge challenge, but global public health efforts have had a profound impact on other major sources of morbidity including malnutrition, infectious diseases, and maternal and child health. The same could be accomplished for surgical care.”  

The study appears online July 1, 2010, on the website of the journal Lancet and will appear in a later print issue.

The researchers, led by Funk and senior author Atul Gawande, associate professor in HSPH’s Department of Health Policy and Management and a surgeon at Brigham and Women’s Hospital, obtained profiles of 769 hospitals in 92 countries participating in the World Health Organization’s Safe Surgery Saves Lives initiative, which aims to reduce surgical deaths and is led by Gawande. Based on the profiles they calculated ratios of the number of functional operating theatres to hospital beds in seven geographical regions worldwide. The researchers used pulse oximetry, a monitor that measures the amount of oxygen in patients’ blood during surgery and an essential component of safe anesthesia and surgery, as an indicator of operating theatre resources.

The results showed that all high-income regions had at least 14 operating theatres per 100,000 people. In contrast, those in low-income regions had less than 2 operating theatres per 100,000 despite having a higher burden of surgical disease. In addition, pulse oximetry was unavailable in nearly 20% of the operating theatres worldwide and absent more than half the time in low-income regions. The researchers estimated that around 32 million surgeries are performed each year without pulse oximetry, a basic standard of care that is available in more than 99% of operations done in high-income regions.

According to Gawande, “It is not news that the poor have worse access to hospital services like surgery. But the size of this population is a shock. Our findings indicate that one third of the world’s population remains effectively without access to essential surgical services--services such as emergency cesarean section and treatment for serious road traffic injuries. Surgery has been a neglected component of public health planning and this clearly needs to change.”

The study is an important step in understanding the critical need for better access to surgical services and for safer operations in low-income settings worldwide. “It is important for the public health community to close the gaps between rich and poor regions if it wants to address the burden of surgical disease in developing countries,” said Funk. “This will become even more important in the next several decades as chronic diseases—which are often surgical conditions—increase with the aging of the global population.”

Support for this study was provided by the World Health Organization.

“Global Operating Theatre Distribution and Pulse Oximetry Supply: An Estimation from Reported Data,” Luke M. Funk, Thomas G. Weiser, William R. Berry, Stuart R. Lipsitz, Alan F. Merry, Angela C. Enright, Iain H. Wilson, Gerald Dziekan, Atul A. Gawande, Lancet, online July 1, 2010, vol. 375.

Visit the HSPH website for the latest newspress releases and multimedia offerings.

photo: iStockphoto/veronicadana

For more information:

Todd Datz
617.998.8819
tdatz@hsph.harvard.edu

###

Harvard School of Public Health (http://www.hsph.harvard.edu ) is dedicated to advancing the public's health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children's health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu

July 2, 2010

by Brittany Latimer
East Tennessee State University: College of Public Health
Namwianga, Zambia

    1.  Learn how to Knit

Most of the older ladies here know how to knit.  I wanted to learn how to knit so I could master this skill during my time here.  Luckily one of my aunts was kind enough to help me get started on this endeavor before I left.  After starting over twice, I am finally making progress and my scarf is coming along quite nicely.  Hopefully it’ll be finished by the time I come back. 

  1. Use your head

A lot of the women here transport their goods on their head.  This is the ultimate etiquette lesson.  The other day when John, Joseph, and I were coming back from Livingstone, we decided to walk the 7 km back to the house.  I had bought some things that were quite heavy so this was not the easiest walk.  After about 1 km, Joseph suggested that I carry the bag on my head.  This worked for about 5 minutes before I convinced them to take a cab. 

  1. Master tying a chitenge

A chitenge is a wrap that is worn around a woman’s waist.  They are also used to tie a baby onto the mother’s back.  Obviously since I don’t have any children I was using it for the former reason.  I am not a girly girl, so having to wear a skirt everyday has been quite difficult for me.  I would much rather wear jeans and a t-shirt, however it is very important to respect the culture.  So as they say, “when you’re in Rome do as the Romans do.”  It is very difficult to tie one unless you have some put onto the chitenge.  Unfortunately I found that out the hard way.  The first day I wore one without the ties, the chitenge constantly kept coming open.  The Zambian women can effortlessly tie them without any ties made and a baby on their back.  Maybe I can get some tips from the women and actually master this before I leave. 

  1. Learn Tonga

In the southern region where I am staying Tonga is the main language spoken.  Many people can speak multiple languages, especially since there are seventy-two languages spoken within the country of Zambia.  I can’t talk the talk, but apparently I can walk the walk.  I say this because I’ve already had a couple people come up to me speaking in Tonga, but all I could do was stare at them blankly.  So far I’ve mastered about five words in Tonga, so I have a very long way to go. 

      5.  Start a family

The majority of the people here get married quite young and start a family almost immediately.  Everyone will ask me questions in this exact order.  1) How many children do you have?  2) Are you married?  This nurse Freddie told me the timeline for getting a spouse, which ironically sounds just like the philosophy that most Lipscomb students follow.  For those of you who don’t know what that is, it is to get engaged by your senior year and married the summer after you graduate.  Well I’m just going to have to nix this step because I don’t plan on accomplishing this before I leave.    

Although I am rather far away from my goal of becoming a Zambian and have quite a lot of work to do in the time left here, I look forward to learning more about the Zambian culture.  I love being able to experience another culture from a first hand perspective.  It has been an amazing experience so far and I enjoy every day of it. 

June 29, 2010

by John Sauer

Huffington Post

Sauer WASH in schools

I've been traveling the past three weeks in Bangladesh and West Bengal visiting water, sanitation and hygiene (WASH) organizations and their field programs. I've covered a fair amount of ground and have seen the work of local governments, the UN and international and local NGOs.

Five to ten years ago many villagers did not have safe drinking water or a sanitary latrine -- the situation on the ground has improved. In Bangladesh, deaths caused by diarrhea have decreased significantly in the past several years.

Many folks I spoke with attribute the substantial drop in death rates to the increase in the amount of safe drinking water. In most villages I visited families had their own tube well, though some did share a well with a few other families. Before this rapid expansion of a water source close to the home, many families collected water from the ubiquitous unprotected ponds of Bangladesh and West Bengal. According to Water For People country coordinator Rajashi Mukherjee, "The ponds are absolute death traps; hygiene is the last thing you can associate with them." Fortunately, with the proliferation of tube wells, most people can now avoid collecting water from unsanitary ponds.

This progress underscores the solvability of the problem when there is a convergence of partners -- communities, local government, local NGOs and international donors and NGOs. The tube well example is interesting because it shows how scale can happen when an idea catches on and the private sector (mostly small businesses) gets involved. Nearly 8 million tube wells were sunk in recent years. Roughly 1 million were paid for and installed by the UN, government and other NGOs and 7 million by families/communities themselves by hiring private contractors. The scale of this push for clean water shows how progress was made when stakeholders perceived the need for clean water and took action into their own hands.

However the reality is that each year as many as 70,000 people still die of diarrhea in Bangladesh. In India the figures are astronomically higher, exceeding 450,000. In fact a few days ago there was an all-too-familiar report in the local Bangladesh paper that five people had died of diarrhea. This story demonstrates the significant challenge the people of Bangladesh still face.

One of the unfortunate and unforeseen side effects of the installation of the millions of tube wells is that a fair proportion of the wells are infected with naturally-occurring arsenic. Many programs have emerged to test and mark the wells, but large-scale solutions to rectify the problem are not yet in place. I did see several arsenic removal technologies of varying cost, but the very expensive options would be hard to bring to scale without large donor support. There were also other less expensive arsenic removal technologies that are still being tested that might hold promise in the future.

Overall the successful programs that I did see dealing with arsenic removal came about through contributions from the community level, local government and outside donor support.
Besides the arsenic problem, greatly improving sanitation and hygiene will be essential to further reduce WASH-related disease and sickness and improve the quality of life for the people of Bangladesh and West Bengal. The governments in both countries have made promoting sanitation a priority. Unfortunately, many challenges exist on the ground related to education about sanitary toilets and appropriate hygiene. There was limited use of "infotainment," (using entertainment, such as television shows to pass key health and hygiene messages), even though some "infotainment" pilot projects appeared effective. Also there were an insufficient number of community health and hygiene promoters. The result is that people are not constructing or maintaining toilets or practicing good hygiene (such as washing their hands with soap). I did visit several communities that had achieved 100% WASH coverage. The trend in those communities was strong local leadership, active community health and hygiene workers and effective leadership from so-called "child brigades" to pressure the community into action. One idea being floated is to employ these local leaders as a cadre of "barefoot consultants" hired by other villages and local NGOs to greatly scale up these successes.


Some of the most exciting work I saw in the field was improvements to the quality of WASH in schools facilities. In one of the schools I visited, the children had been involved in the design of their own toilets. The girls demanded a separate changing room where they could have privacy and an adjacent incinerator for safe disposal of sanitary pads during menstruation. Before these programs were in place many of the children missed school, walking home to use the toilet. Girls in particular would often miss three to four days a month of school, sometimes even missing exams.

I feel that it is possible for communities in Bangladesh and West Bengal to continue to improve their WASH conditions if they can enhance community leadership and capacity for WASH. There is a great opportunity to share success stories and best practices. Let's not forget the power of increasing the role of children and adolescents. It's equally important to recognize sanitation and hygiene as a matter of status and use it as a tactic to motivate people towards behavior change. There is a need to embed messages related to status into communities, so people will prioritize sanitation and hygiene.

Overall, I've been amazed at how much is happening on the ground. Despite the multitude of WASH problems, the issue seems entirely solvable here. Sanitary products are available everywhere, at reasonable prices and are accessible to almost everyone, except for the extremely poor and vulnerable. (I actually saw some very good examples of how motivated communities found ways to help out the poorest members of their communities). Communities transform with access to WASH--health improves, new job opportunities arise and more children finish school. I hope that donors take notice of this transformation and work with the people of Bangladesh and West Bengal to put this issue to rest once and for all.

Follow John Sauer on Twitter: www.twitter.com/wateradvocates

 

June 29, 2010

John Deason
Lipscomb College of Pharmacy
Namwianga, Zambia
 

john deason dentist office

As time goes on I am getting more responsibilities in the clinic.  As of late, I have been working with a Zambian dentist named Ba Ian (Ba means Mr. or Mrs.).  He is a wonderfully kind and patient man that is very good at explaining his work.  A small skinny man in stature but hold tremendous respect with his patients; always keeping a smile on his facem, he whistles and tells his patients jokes to keep them at ease.  There is much you can take from his patient-provider interaction. 

He allowed me to assist him in his work, which sadly in Zambia is very simple.  If you have a tooth ache, 9 times out of 10 it a cavity (which gets marked down as chronic pulpitis), and a cavity equals extraction.  So needless to say, Ba Ian often refers to himself as a butcher since he mostly pulls teeth.  In helping him, I have actually pulled some as well.  He likes it if I have a rounded view of the job.  It’s actually no where near as difficult as it sounds (as apposed to the old cliché).  Teeth come out rather easily once you know how to pull; granted Ba Ian only gives me the “easy patients.” 

My chief job in his office is to write down the chief complaint with diagnosis as he goes around checking the patients in the room.  Generally he has four to five patients at a time and interacts with them all at once.  As you can guess privacy isn’t as big for everyone here as it is in the states.  Once he has diagnosed everyone, he gives them each a shot of local anesthetic (generally benzocaine or lidocaine) and has them all wait outside.  He calls them in one by one and does what needs to be done, then has them all wait together again as I collect the medicine they need post-op (which is simply and antibiotic and Panadol, what they call Tylenol).  The biggest reason for me collecting there meds (because they could simply walk to the pharmacy themselves) is that he wants to minimize their overall wait time so they can quickly get home without feeling so dizzy or sick.  Since I have instant access to the dispensary and know exactly what he needs, things go much faster and we can council the patients then and there and send them home knowing they got what they needed.

Besides the clinic, I was able to look in on a rare experience that few Americans get to see.  Sadly, the mother of Ba Leonard (the head cook, but also essentially main person in charge of the estate when the Hamby’s aren’t here) passed while we were here.  It wasn’t a complete shock since she was very old, but the parting was still difficult for the family.  Leonard’s son Harold took over in his stead for awhile.  He is doing a magnificent job.  There is no doubt that we are well fed.

We were invited to the funeral service the following Monday after her passing.  As with many things in Zambia, this service took a long portion of the day.  Throughout the entire time, both in the viewing of the body, traveling to the burial site, and finally laying her to rest, the Kasibi choir (whom I have mentioned in an earlier blog) stayed by her casket and sang church songs in Tonga.  Once the viewing had ended everyone packed into every car available and rode a long way down a rough dirt road to the grave site.  Once we got out (and stretched, since we where in the back of a ford ranger with 9 other Zambians) we walked through a grove of trees and say a large crowd already gathered there singing.  It was simply beautiful.  I’ve said before, everyone in this country was born able to sing and nothing could be more true.  All the men gathered on one side and the women on the other and they formed a large circle around the site.  Every song was in Tonga and in each a four part African harmony.  I’ll never hear the likes of such music again! 

Once the body was buried, which was a task in and of itself since concrete and tin had to be laid upon the casket to prevent any animals from digging anything up, they began speaking in turns.  There was a translator there for our benefit.  The most striking thing said was from one of the church elders.  As he spoke, he said, “Her spirit will not remain on earth as a ghost to haunt us as our grandfathers have taught us.  No, she will go to the place where all spirits go, and that is to heaven with Jesus!  Here at this time you have the choice to accept this or not; accept the truth or choose to believe your grandfathers!”  I was deeply moved at the display of the man’s faith and that here on the other side of the world, God’s people can still be found. 

Once everyone has spoken they began to call those in the family and others that were close family friends to come up and place flowers on the grave.  I was honored to have my named called with the rest of the Americans staying at the mission.  Once the flowers had been placed, a truck (lorry) pulled up carrying a good number of Zambians.  They instantly ran for the grave and began wailing and falling to the earth beating it with their fists.  Some in the crowd joined them.  I had never seen the likes but certainly wasn’t offended by the gesture.  Just as in all other things, it shows the outward expression of emotion that these people display.  I wish more people could be more like that.  It gives great peace of mind to see how someone is feeling so clearly.

After all the wailers stopped, a few personal effects of the deceased were placed amongst the flowers and we parted.  The rest of the day was rather somber.  I was exhausted emotionally along with everyone else and turned in early that night.  I was able to still take in the words the elder said which comforted me greatly.  

The more I see into the lives of these people, the more I find that I love them.  From the kind jokes to cheer a patient to the broken hearted cries in the middle of an African savannah, these people show you sincerely who they are and welcome you into their lives to share in their struggles and joys.  God has greatly touched me with this opportunity to know people so open and kind.  Again, as always, I pray I can do my best to play a role in His great works.

June 28, 2010

Jennifer Hunt
ASPIRE Appalachia scholar
College of Public Health - East Tennessee State University

hunt 2 health fair

Since the start of my internship, I have already experienced so much about health administration from a rural health perspective and have had the opportunity to be involved with some amazing projects that assist the county’s rural population.

My internship is located in Cocke County, Tennessee with Rural Medical Services, Inc (RMS).  RMS has clinical centers located in both Cocke and Jefferson County and serves the surrounding counties.  While the Appalachian region, which RMS serves, is rich in cultural heritage and traditions, it is also often plagued by high levels of poverty and low levels of education.  In April 2010, the Newport Micropolitan Area reported 2,190 people unemployed resulting in a 13.4% unemployment rate, down from the March unemployment rate of 15.7%. According to the most recent estimates from the State of Tennessee, Cocke County has an average high school graduation rate of 61.2%, under the state average of 75.9%; Cocke County also has only 6.2% of the population that holds a Bachelor’s degree or higher.  Cocke County has  a population o 7,426 of 20.6% of its population is below the poverty level.  

My first day at Rural Medical Services (RMS), I was able to attend the both the monthly staff meeting and the Board of Directors meeting.  The staff meeting included all providers from each of RMS’s five clinical centers, along with the CEO, CFO, Operations Director, and the Human Resources Director.  Although RMS is a health system, the clinics are run with an element of autonomy at each center (the CEO jokes that he calls each center his “little fiefdoms”).    In addition to clinical responsibilities, providers are charged with the administration of their clinics.  Reports were given from the Medical Director, the CEO, CFO, and Operations Director.  Following these reports, a roundtable type discussion was held that let each provider from each center discuss any topics with which they were concerned.  An interesting topic that was discussed at the meeting was the passage of the new health care reform bill.  The CEO, as well as other providers, voiced concerns about the impact to their patient population as a results of the bill’s passage.  RMS experienced decreases in patient population with the changes in TennCare, RMS  and is concerned about the effect this bill may have on their patients.   It was stressed that RMS must continue to strive to be patient friendly.

The Board of Directors consists of two representatives from the patient population from each center, the CEO, CFO, Human Resources Director, and the Operations Director.  The Board meeting is run similarly to the staff meeting, but in a more formal matter with a call to order, motions, quorum, etc.  At the first Board meeting, provider patient-visit goals were discussed as well as the bid process for remodeling the Newport Center. It was interesting to learn about the bid solicitation process RMS must go through in order to remodel a facility. 

Another interesting administrative aspect that I was able to participate in was the walk-through of the Chestnut Hill Center remodeling project.  The Chestnut Hill Center is located in Jefferson County, TN across from Bush Brothers, Inc.  In May 2010, Bush Brothers, Inc. bought the facility that housed both the RMS Corporate Office and the Chestnut Hill Center.  As part of this purchase, Bush Brothers offered to relocated the clinic to an old school house located approximately half a mile down the road from the current RMS facility.  Bush Brothers, Inc.  agreed to pay for renovation of the old school to convert it into a brand new health center facility for the patients of the Chestnut Hill.  The new center will contain 7 examination rooms, a nurse’s station, 3 doctor/provider offices and lounge, a clinical laboratory, patient waiting room, billing center, and a procedure room.  RMS will lease the building from Bush Brothers, and Bush Brothers (in addition to paying for the renovations) has forgiven the first year lease payments for the facility.  RMS and Bush Brothers has a long standing relationship in the community and Bush Brothers viewed this remodeling project as a way to give back to the residents of the Chestnut Hill community.

The second week of my internship included helping with the annual RMS Health Fair held at the Lincoln Ave Baptist Church in Newport, TN and La Gran Commision Baptist Church in Morristown, TN.  These health fairs bring a number of services to the community that they would not otherwise have access to such as lab work, physical exams, pap smears, prostate exams, mammograms, eye exams, bone density scans, spinal screenings, and hearing exams in addition to health resources from other area organizations.  All these services are provided free of cost to the community!  Although the fair didn’t start until 9am, many people were waiting in line as early as 6 am to make sure that they could be seen and it was apparent that many of these people relied on this health fair to receive their health care. 

My main project for the summer is to conduct both patient and employee satisfaction surveys.  The patient survey asks a variety of questions to determine the overall patient satisfaction with both their respective clinical center and the RMS system as a whole.  For example, one question asks patients to assess the level of satisfaction of the centers was “Please rate the treatment received at this facility.”  Patients completing the survey rate their level of satisfaction on a scale of one to five, with one being very satisfied and five being very dissatisfied.
           

I have been collecting the surveys periodically since the start of my internship, but the final collection date will be July 1, 2010.  I will record and analyze all the data and will present my findings to both RMS staff and the Board of Directors in a PowerPoint format.  I will also include an analysis of the rating percentages for each facility on a separate handout sheet.  The purpose of this survey is to help the community by showing RMS and the centers what the patient population perceives as most important and will in turn to use this input to identify and implement quality improvement initiatives.

The employee survey is set up in a similar manner, with the goal of the survey being to assess the employee satisfaction at RMS.  I will begin collecting and inputting this data during the week of June 27th, 2010 for a presentation to the staff and Board of Directors at their monthly meeting.  I think that this employee survey will be extremely beneficial to RMS because they have never done an employee survey and it will provide a good indication of the overall morale of the staff. I am anxious to see how my presentation of the survey results to the staff and Board of Directors will be accepted.  I hope the results will encourage staff and providers reevaluate reconsider how things are running administratively within their center.

June 22, 2010

Frist Global Health Leaders Arrive in Zambia


Two Lipscomb College of Pharmacy Students Send Their First Impressions of Namwalia, Zambia

Global Health Leaders Brittany Latimer and John Deason arrived in Zambia last week. This is Brittany's first time in Africa, and this is John's first time outside the United States. Though both are dealing with a touch of culture shock in Namwianga, Zambia, they report a warm welcome at the local church, a fun time with kids over food and dancing, and a challenge with the local clinic to understand how best they can translate their knowledge of clinical care given the limited resources available for the patients.

We invite you to read their blogs and see their photos!

Brittany Latimer
21 June 2010: Arriving in Zambia: Understanding Health Care Limitations in Namwianga

John Deason
21 June 2010: Sunday Morning Church and a First Look at the Clinic: John Deason in Zambia

Water=Hope Campaign at Darien Lake and Philadelphia: End of the First Leg of the Tour with Impressive Results!

Philly Vols 

Brande Jackson is keeping us up to speed with blogs and photos from each stop on the tour. We are excited to see the numbers of volunteers continue to increase as well as the new members and donations! We had our best night ever in Philly -- with wonderful volunteers, fans, and activists. Read the blog:

22 July 2010: Water=Hope at Darien Lake and Philly: Bringing the First Leg of Tour to a Close!

We need your donations. Donate today to Water=Hope Campaign. We will be using your dollars to build wells around the world, and we will be announcing which countries those wells in which those wells will be built in the next few days.

Follow the Water=Hope crew and volunteers on the road on our Facebook page.

Yours,

JED signature 

Jenny Eaton Dyer, Ph.D.

June 23, 2010

by Brittany Cannon
East Tennessee State University: College of Public Health
Roatan, Honduras

This past week I was involved with the coordination and follow through of community health fairs on the island. These health fairs are vital for the public in that they enable us to reach out to those living on the island and perform various health screenings for people who do not understand the importance of and/or do not have the funds to get these health screenings on their own. 

Blood glucose tests and blood pressure readings are administered at the health fairs.  Diabetes and high blood pressure are prevalent on the island.  I was able to perform over 200 blood sugar tests and blood pressure readings last week.  In addition to testing I was also able to inform people who came to the fairs on the importance of monitoring their blood pressure and ways in which they can manage high blood pressure.  Likewise, I was able to educate those with high blood sugar about diabetes and ways to keep their blood sugar level in control.   If either test turned out to be extremely high I referred them to Clinica Esperanza where I am currently working so they can be more thoroughly examined and when appropriate receive further care or medication.  At Clinica Experanza, no one is turned down due to their inability to pay so if they can get transportation (another barrier) they will be seen by a doctor at the clinic. 

Health screenings are an important component of public health.  By planning and implementing these health fairs I am able to reach a number of communities and interact with people that are far from the clinic and might not otherwise seek out these sorts of tests or even know the significance of such tests.

Many of the people I spoke with did not understand what diabetes is much less how to control it. This is a real problem on the island because much of the diet consists of fruits and non-complex carbohydrate (white flour) products which are known to contribute to spikes in blood sugar levels.

 I am organizing and will conduct three more health fairs this week and have also put together a program on nutrition. I will be conducting this class at the clinic to inform people on the importance of making health conscious food choices.  For example, soda (soft drink) consumption is huge here so hopefully through this class I can help people understand how what they put in their body relates to their health.

 

June 22, 2010

by Brande Jackson

Our show at Darien Lake - located between Buffalo and Rochester - had us a little concerned about being able to recruit volunteers, since it is a bit of a drive from either city. We were excited to have a great crew of volunteers come out and join us: a mother, daughter & aunt team of Susan, Carol and Melissa, as well as Corey, Chelsea, Cary and Lyndsey, who are a combination of friends, sisters and fiances that all drove into from Rochester!  Our team did great, helping us sign up lots of new supporters and raising lots of money for our well building projects, working all night to talk to Brad fans about the importance of clean water.

Darien Lake Vols

We got a lot of support from the crowd from the minute the doors opened until the very last fans left the venue; Nick and Francis, pictured below, kept talking to us long after security ushered everyone out and loaded up on Water = Hope materials to help spread the word among their friends in Buffalo.

Nick and Francis_darien lake

An overnight bus trip brought us into Philly in the morning. On a personal note, I’ll admit to some bias: I love doing shows in Philadelphia, I’ve always gotten a lot of support for the campaigns I’ve worked from the fans there, and everyone seems to be in a perpetually good mood! Our show Saturday night lived up to my expectations, giving us the biggest night we have had yet on the tour.

Our night in Philly was a direct result of an AMAZING volunteer crew that we can’t thank enough: Bill and Brianna are high school students and friends who worked so hard all night that it felt like we barely saw them, LeeAnn is a huge Brad Paisley fan and supporter of water initiatives like this, and was a huge help at our busy booth, Neil and Yang are cousins; Neil is an exchange student from China and Yang took a train up from Washington DC just to join us and help out!

Philly Vols

Then we had ‘the girls’: Angelina and Danielle are old friends who frequently volunteer together, and Sara, Angelique, Samantha and Rebecca are all friends and in high school. Both groups of ladies took to the parking lots to talk to the tailgating crowd before the doors opened, and they took on our ‘friendly challenge’ of which volunteer could sign up the most volunteers with a passion. Early on, it looked like Angelina and Danielle would take home the Water = Hope hoodie prize (together, the two of them signed up well over 300 new supporters!) but the sister team of Sara and Angelique edged them out; they signed up 200 new supporters EACH, a record for the tour! 

The crowd in Philly was full of love for Water = Hope; fans are really excited about our well building project, loving the idea of country fans working together to bring water to a community that needs it. We had our biggest night yet both in new Water = Hope supporters and in the money we were able to raise for the wells, and we also signed up lots of new Philly volunteers to join our incredible team of campaigners!

In the meantime, there are all sorts of ways to support Water = Hope: text H2O to 25383 to give $10, and you can sign up and a part of one our amazing volunteer teams by http://waterequalshope.com/volunteer/. You can also check out more photos from the tour (and tag yourself if you are in them!) on our Facebook pagehttp://www.facebook.com/hopethroughhealinghands.

June 21, 2010

by Beth O'Connell
East Tennessee State University
College of Public Health
Cygera, Rwanda

beth_rwanda photo_family

Health Education            

Health education has been quite a success at the local high school. The Senior 3 class was very interested in and had many questions about the previous HIV/AIDS education. I based the next class on their questions. The following week I chose malaria as the topic because of its prevalence in the area. The students were misinformed about transmission of malaria. They thought that it was transmitted through unsafe drinking water, as so many of the other common diseases. I think that this may have been a communication error in previous education about removing stagnant water which breeds mosquitoes.  I continued health education in the general paper (essay) classes which I mentioned in my last update.   Students have turned in the required information on their selected health topics. The topics they could choose from were as follows: malaria, food contamination, safe water, community safety, and HIV/AIDS .  The students’ personal experience stories are educational for me and very eye-opening to the severity of these community health problems. The quality of their work varies widely. Ensuring that each student learns has involved individual study sessions after school hours. The students know where I am staying and come to visit me for help, sometimes voluntarily, sometimes by my request. I am in the process of grading the papers and discussing the topics with them. It has been helpful to the students to spend so much time discussing major health concerns in their community. This education has served a total of 112 students. Teachers also learn and ask questions.

Hand Washing and Water Treatment

My hand washing campaign has transitioned from group audiences at the school and church to individual homes in the village.  Each home visit has involved education through a translator and giving of written instructions in the local language and providing soap. I have also been providing each home I visit with a water treatment liquid produced by U.S. Aid. This treatment kills many of the biological contaminants in the local water. Some people are familiar with the product and its use, but are unable to afford it; others have not seen the product before.  I have provided an amount which should treat drinking water for an average family for one month.  This is only an estimate, because the bottle does not say how much water it will treat.  The instructions only say how much to use one cap-full for twenty liters of water.  Also, family sizes vary largely.   The education at each home includes information about boiling water as a method of killing contaminants.   They do not have a word for boiling, so I have explained that they must cook it until bubbles cover the surface for several minutes. This outreach into the community required the permission of the village elder, Anastasie Mukabashanana. We met and discussed my plan, after which she gave her blessing for the home visits. I then began the campaign with the village leader, giving her the items and education. She or one of her aids has been accompanying me on the home visits. The people in the village have been very receptive and thankful and this has been a rewarding experience.  A day of visits involve several hours of hiking at a time in significant heat; the terrain is hilly and the footpaths are rough.  The living conditions and lack of education are staggering and these visits have been incredibly educational for me.  We have visited 72 homes, which housed 332 people.   The local church congregation was also given this water treatment product.  There were 115 participants at the church, many of whom will share the liquid with families at home. This is a total of 554 participants in the safe water education. There have been a total of 706 participants in hand washing education to date. The difference in the two numbers is 112 high school students.  They are benefiting from bio-sand filters, and therefore were not given the water treatment liquid.

Bio-sand Water Filtration

Following up on the bio-sand filter installation project, I have overseen the “feeding “ of the bio-layers daily.  The Rwandese Health and Environment Project Initiative (RHEPI) that originally installed the filters has been helpful in continued maintenance. On Tuesday June 8, a RHEPI representative returned at my request to investigate slow flow rates of four of the filters. Other minor maintenance has been required, which I have performed with guidance from RHEPI.   Four of the filters are currently working well, with flow rates of about 0.7 liters per minute.  RHEPI will be returning soon to replace the sand in the one that is still flowing poorly.  After I leave, the school secretary has promised to maintain the two located at the school. The administrator at the children’s home will maintain the three there. The major maintenance is required during the initial setup, and further maintenance should be as simple as using the filters daily. Should there be problems, the school and children’s home have my contact information and the contact information of RHEPI.  On Friday, June 18, I travelled to Kigali to visit the RHEPI office to investigate options for future projects through partnership with them.

Malaria Prevention

I continue to work toward protecting the children and caretakers of the Faith and Hope Children’s Home from the hazards associated with mosquitoes and other insects.  I again sprayed the homes again with insecticide one month following the initial treatment as recommended by the manufacturer.  Also, I paid for and arranged the replacement of two broken windows to avoid insect entry into the homes. Communicating with a technician for such a project to specify exactly what needs to be done and how much it will cost can take several hours. I will spray the homes again in one month and have instructed the home administrator about using the insecticide after I leave. Also, to make the screening over the windows more permanent, I have hired a local technician to put wooden frames around the screening. Spiders have become more prominent with the change of seasons, so the efforts to avoid mosquitoes have also been useful in avoiding the spiders.

Conclusion

In doing all this, I have educated myself as well. The interventions and education that I have done in the last two weeks have been predominantly beyond what I have learned in classes at the College of Public Health at East Tennessee State University. I have used my skills on how to find information, which I learned in various classes while doing papers and projects. The World Health Organization and Centers for Disease Control and Prevention websites have been excellent resources for lesson plans at the school. I just happened to notice the water treatment liquid at a store one day and then looked into it. Communication has continued to be a necessary and difficult skill to use. This includes communication with the people I am educating with community gatekeepers and people all helping me.  I have learned that attitude and creativity is very important in accomplishing a task.  Many times, it has been up to me to come up with ideas and find a way to make them happen.  Motivational skills and a positive attitude have been necessary to do this.

My field experience has been very busy and successful so far. I look forward to seeing the results of some of the interventions that will produce tangible results soon. For example, the bio-sand filters will be producing drinkable water beginning July 4. I also look forward to continuing health education at the school. Despite challenges, this experience has been very educational and rewarding. I am excited to see what the rest of the internship holds in store for me and for the village of Cyegera

 

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