by Kelly Tschida

November 18, 2009

Nyamata, Rwanda: Today

Although the Rwandan genocide occurred fifteen years ago, I see its impacts everyday in the hospital. The region I live in was an area of great violence. There is a memorial site here in Nyamata were 10,000 people crammed into a small church seeking refuge, only to be killed. It is hard to believe that the reserved, kind spirited people I know went through such a horrible event.

I never ask about peoples' experiences, but the genocide is brought up many times a day. Medical histories are incomplete for many young adults because they are orphans. Patients come in with disfiguring scars, old bullet wounds, and HIV as a result of the violence they experienced during that time. Sometimes they say it happened during the genocide, mostly they say it happened "15 years ago". I have been told the mental health floor gets very busy with post traumatic stress disorder during the same months that the genocide occurred. Other stress related illnesses, such as stomach ulcers are common complaints of our patients.

One consequence of the genocide that has made a big impression on me is how the Rwandan people react to death. I noticed when patients die the family members never show outward emotion. There is no crying, no awkward silence or loud outbreaks, and no consoling of one another. They seem to concentrate on packing up the belongings and taking care of business. When I asked one of the nurses about it, she said that is the way Rwandans are. I thought she meant it was cultural, so I said "So it is normal?" She replied "No, it's not normal. It's because we saw too many things in the genocide."

The hospital staff deals with genocide related problems the way they would for anything else; no sorrow is shown or empathy given and no further questions are asked. They take note of the history in a professional manner and together we all simply move on to find the best treatment.

 Inside the Nyamata Church Genocide Memorial. Each bundle of clothes belongs to a victim.

Milles Collines, the real Hotel Rwanda.

by Danielle Dittrich

November 17, 2009

To be a practitioner in Guatemala, one needs to find harmony between western and traditional medicine. I had never thought about or tried natural herbal medicine before coming to Guatemala. Though I still don't usually recommend it to my patients, I have begun exploring the natural remedies so that I can hopefully help my patients to navigate their own health. The women's program teaches patients that if their symptoms do not improve after two days of at home treatment with herbal remedies, they need to go to the doctor for medication.

Many of the herbal remedies are geared towards symptom relief of aliments for which we do not currently have cures. For example, there are many herbal remedies for the cold virus, specifically for cough. In the states, there are anti-tussives, mucolitics and expectorants, but these don't cure the virus, they just alleviate or mask the cough. Though many patients request antibiotics, these target bacterial rather than viral illnesses and only lead to resistance and de-sensitization to medication. This is a specifically frightening concept when any Guatemalan can go into the pharmacy and buy any medication in any amount with less than the scribbled name of a medication written by their neighbor counting as a prescription. However, with Guatemala being among the poorest of Latin-American countries, the cost of western medications is a major deterrent leading to the preference of herbal medication in addition to its cultural implications. Many patients admit to filling half prescriptions due to the cost of medications or stopping medication regimens when they achieve symptom relief and saving the few remaining antibiotic pills for the next time they start feeling sick (of any sort).

It is terrifying to know that partial regimens is the way we have created and continue to create multi-drug resistant organisms, such as multidrug resistance tuberculosis which has been on the rise recently in Latin America. The fear of drug-resistance is a constant motivator, as we pass by the country's tuberculosis hospital daily on the way to the Primeros Pasos clinic. For this reason it is just as important that we educate the patients as it is to provide medical care. A good medication can be a weapon if used incorrectly; it is important to empower the patients to be responsible for their own health and healthcare, which is largely where herbal remedies come into play.

In the states, most Dr. Mom's would recommend a bowl of grandma's chicken noodle soup, a cup of tea and rest -- symptom relief. The idea is not too different with herbal medicine here -- herbal teas to alleviate the aches and calm the cough. Graced with the same viruses that my patients bring to the clinic, I was personally compelled to try herbal teas for my back to back stomach and cold viruses. I went to the local market with a Guatemalan friend and we sought out all the teas for cough. I was surprised by the number of plants and herbal remedies that exist. There are different teas for dry cough, productive cough and coughs with sneezes. Among the busy, hustling market, the herbal medicine vendor was one of the most popular. I do not claim an instant cure, but the effect was certainly soothing as the virus ran its course.

Balance between hot and cold is very important concept in Mayan health; a warm remedy is used to cure a cold illness. Health is not only viewed as freedom from illness, but also as general happiness and life balance. It has been important for me to begin understanding these concepts, so as to provide patient education and recommendations that complement rather than clash with their worldview.  It has been specifically important for the care of pregnant patients as many cultural concepts, which do not have an equivalent in western medicine, are said to affect the development of the baby. For example, newborn babies get sick when the mothers breast milk becomes cold from eating foods that are considered cold, which does not always correspond to temperature. 

In order to be respected as a practitioner, one must respect the viewpoint and frame of reference of the patient. Respect however, does not always mean agree. I believe that one of the most important things that I can learn in my investigation of natural medicine is to understand what herbal remedies may be dangerous to pregnant women. Certain herbal remedies are actually known to be incredibly potent. Something about this approach and mind-set has been successful, as my patients rapidly continue to increase in number. Though as a foreigner, my recommendations of herbal remedies would ever be taken too seriously, my warnings are generally heeded. Thankfully, there are many other traditional practitioners to provide these recommendations and I am seeking partnerships with them in order to incorporate their work into a more holistic model of patient care.

by Bill Frist, M.D.

A couple weeks back, the Living Proof Project was unveiled in Washington, D.C. by Bill and Melinda Gates. The goal of this great project is to share the good news of the implementation of assistance. U.S. investments in improving global health are delivering real results. From significant declines in child deaths, to global eradication efforts against polio, to insecticide-treated bed nets that reduce malaria transmission, global health initiatives are working. At http://www.gatesfoundation.org/livingproofproject you can learn more from their progress sheets. Watch the speeches of these "Impatient Optimists."  I have the pleasure of serving on the Advisory Council.
 
The video below was shown yesterday at a Save the Children Survive to Five Council meeting in NYC. This is a great example of real results, combating infant mortality. Saving the life of a little one.

World Pneumonia Day Reception Remarks

By Senator Bill Frist, M.D.

Today, I joined Save the Children, the US Coalition for Child Survival, the World Pneumonia Day Coalition and Vicks at a breakfast reception on Capitol Hill to recognize the first annual World Pneumonia Day, a day for people everywhere to turn awareness into action to control the #1 killer of children under age 5: pneumonia. Each year, a disease which often starts as a cold, claims the lives of nearly 2 million children under age 5 -- more than malaria, AIDS and measles combined. Despite this staggering death toll, childhood pneumonia has never been a global health priority, and the current basic maternal child health programs --that need to be in place to control the disease-- are under-funded.

Pneumonia is easy to diagnose and treat if you have the right tools, but most children in developing countries don't get the care they need. We could save more than one million young lives each year with affordable health measures -- like proper nutrition and breastfeeding, antibiotics and vaccines. It's a matter of making these solutions more available to the children who need them.

As chair of Save the Children's Survive to 5 campaign and in my work with other humanitarian organizations, I've traveled to community-based health projects in Asia and Africa. I've seen firsthand how U.S. government investments in training community-based health workers in pneumonia prevention and treatment have significantly improved child health and saved lives.

In countries as different as Bangladesh and Mozambique, families face virtually the same obstacles to getting care for their children. Vaccines that we take for granted here to protect our children are not available in many of the countries that most need them. GAVI needs significantly greater resources to help countries integrate the new vaccines against pneumonia as well as diarrhea. A community-based approach to child health works. But if we are to make progress in combating pneumonia and other childhood illnesses, we need to scale up these efforts.

World Pneumonia Day is a call to action from national leaders, donors and international health organizations to rally their forces to control this disease. The time is ripe for action. Thanks to WHO and UNICEF's Global Action Plan against Pneumonia (GAPP) released on World Pneumonia Day, November 2nd, we will have a realistic six-year plan for the worldwide scale-up to control pneumonia, based on the following:

· protecting children by creating lower-risk environments;

· preventing children from developing the disease through vaccination; and

· treating children who become ill.

The United States has played and must continue to play a leading role internationally to save the lives of mothers, newborns and children through the protection, prevention and treatment of pneumonia. Current U.S. spending on maternal and child health, which includes spending on pneumonia, is just $495 million a year. The U.S. should at least double that investment, encourage other industrialized nations to do the same at next year's G8 summit in Canada. G8 leaders should declare that no country with a credible plan for newborn, child and maternal health should be thwarted for lack of donor resources.

We are pleased to see that child survival is a strong priority for the U.S. Congress. The Global Child Survival Act (S. 1966) was just introduced in the Senate, and the Newborn, Child and Mother Survival Act of 2009 (HR 1410) has 80 cosponsors in the House. What can you do? I strongly encourage you to call your congressional representatives today and ask them to cosponsor these important bills.