Kiruhura Christian College has continued to allow me to educate all 112 of the students on various health topics. The week of June 21-25, I taught each class about dental health and provided them with toothbrushes and toothpaste. I got this idea from a student who asked me at the end of class one day if I could teach him how to “wash” his teeth. I also gave these supplies to the headmaster, secretary, matron (woman who cares for the girl boarding students), and two teachers who participated and assisted in the education.
For the past week I have been busy both in the community as well as in the clinic, conducting health fairs throughout various communities across the island. As a result we been able to perform 215 blood sugar tests and blood pressure readings over a four week period. Seven of the people screened were referred to Clinica Esperanza due to high blood sugar readings. There are a couple more communities that we are planning to go to within the next week or two.

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
[email protected]

###

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

Building Wells and Writing Senators: Your Support=Lives Saved

Collaboration with charity: water and Living Waters for the World

We are proud to announce that we will be collaborating with charity:water to build three wells in three villages in three African nations: Ethiopia, Liberia, and Uganda. The wells will serve over 1,000 people. The digging of these wells will begin this fall, and we will update you with photos, blogs, and even GPS coordinates so you can follow the development and the life of the villages which will soon have an easier access to clean, safe water.
Over the past seven weeks, I have been conducting wellness assessments among community dwelling seniors served by the agency. The purpose is two-fold: 1) develop a client profile which includes demographic data and risk factors that lead to diminished quality of life and poorer health outcomes, and; 2) identify domains in which the agency’s services can be improved or tailored to meet the needs of this population. I also provide health supportive services, education and referrals to seniors through the information provided during the assessments and through my personal observations.
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

 

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.

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