January 11, 2010

From: PneumoALERT at preventpneumo.org

Call to USAID to Take Action on Pneumonia and Diarrhea

Dear Colleagues,

I am excited to tell you that on January 7, 2010, Dr. Rajiv Shah was sworn in as USAID Administrator. This is a great opportunity to welcome Dr. Shah to his new leadership position and to call on him to take up the cause of pneumonia and diarrhea, the world's two leading causes of child mortality.

Dr. Shah has led and worked with many of the initiatives that are defining best practice in the field of development, including the Global Alliance for Vaccines and Immunization, the Global Fund for AIDS, TB and Malaria, the Alliance for a Green Revolution for Africa, and the Bill and Melinda Gates Foundation. His tireless efforts to immunize children around the world have helped save countless lives.

Please take a moment to sign and submit a letter welcoming Dr. Shah as he begins his important work as head of USAID and to bring to his attention the need to increase support for child health. Dr. Shah is now at the center of the important US aid effort to help families around the world in their struggles against poverty and disease.

Millions of lives can be saved by increasing access to antibiotics and vaccines against pneumonia and diarrhea, the two leading killers of children under five. By taking on these two common and preventable killers, the US can save millions of young lives and send a powerful message to countries everywhere about our ability to protect the health of the world's youngest citizens.

In November 2009, nearly 100 leading global health organizations joined forces to commemorate the first-annual World Pneumonia Day. Close to 100 events took place in over 30 countries across 6 continents. As a partner of the Global Coalition against Child Pneumonia, we urge individuals to capitalize on this momentum by sending this letter to Dr. Shah.

Please click here to sign and submit the letter. Please forward this link http://www.change.org/actions/view/call_to_usaid_to_take_action_on_pneumonia_and_diarrhea  to any colleagues or friends you think might be interested.

In December 2009, we announced the launch of a new International Vaccine Access Center (IVAC) at Johns Hopkins School of Public Health. We are pleased to have the opportunity to bring together a group with diverse skills and perspectives to accelerate access to lifesaving vaccines in populations that need them most through the development and implementation of evidence-based policies. I invite you to continue checking IVAC's new website for information on projects and new findings.

Thank you for your action and support.

Orin S. Levine, PhD
Executive Director, IVAC
Johns Hopkins Bloomberg School of Public Health
Follow me on Twitter @orinlevine
Read my blog at www.huffingtonpost.com/dr-orin-levine



I was welcomed back to the United States with those infamous words, "is there a doctor or a nurse on board" over the loud speaker of the airplane. Though I was the closet to the patient and the first to volunteer, I was happy to hand over my responsibilities to the doctor that eventually came from the back of the plane. Besides, there was not too much that anyone could do for shortness of breath related to pulmonary hypertension in mid-air other than apply the oxygen mask. Until that trip, I never knew how many gadgets and medical contraptions were hiding out in that first overhead bin on the airplane. Though we were met by EMS when we taxied into the gate, the patient walked off the plane without difficulty. Needless to say, it was an eventful homecoming.

It has been about a week since leaving Guatemala and I am still trying to adjust to the reverse culture shock of my return. The clinic will reopen again this week, after being closed for the last two weeks for the holiday. I can't stop thinking about the patients that patients that will be there this week when I am not. In the past 3 months I saw over 50 new patients and 80 patient visits including follow-ups. However, there are the few special patients that will stick out more than most.

Doña Celia's baby is almost a month old now. I am sure that she is already so much bigger than the last time that I saw her. Pretty soon she should be given her name. In Guatemala, the newborns are usually given their name in a ceremony at about 1 month. Last time that I saw her, she was wearing the one-sie that the clinic had given her. Her eyes had turned from jaundice yellow, back to white after a week of sunshine therapy. Their family was the very last that I saw on my way home from clinic, and after over a week of home visits and check-ins, certainly the most difficult and teary good-bye.

Doña Rosa's c-section that dehisced is totally healed without signs of infection. She is finally able to lift things other than her newborn baby, who also has been given her name since the time that I left. I will miss her younger son who was so giggly and easily amused by rubber-glove balloons and water filled syringes as I cleaned and packed mommy's stitches daily.

Doña Clara's CAT scan came back negative for evidence of pituitary tumor or adenoma and she can now go back to focusing on getting surgery for her daughter with cleft lip and cleft palate. Doña Ramona exams have come back negative for any remaining evidence of endometrial cancer posterior to her radiation treatment in the capitol.

Though I have resolved these patient cases, I can't help feeling a lack of closure. This week I start phone interviews to look for at least a temporary replacement until we can figure out a more permanent solution as to how to staff the women's clinic. We will be holding a large fundraiser and silent auction at Vanderbilt University the February 12th to raise money for free pap smears for all patients in the women's health program. Our next goal is to start a more structured prenatal program as has been the biggest request by the women of the community. Until then we will be able to keep the clinic running with the remaining funds from the Hope through Healing Hands Scholarship. I cannot begin to explain how incredibly fortunate I feel to have been given this unique opportunity. The women of Primeros Pasos have affected my life and practice in a way that seems almost impossible to describe; I will never forget them. Thank you to everyone who has supported me in this endeavor.

The latest in gifts that last a lifetime

Originally published December 21, 2009 at 7:05 a.m., updated December 21, 2009 at 7:05 a.m.



By Bill Frist and Orin Levine


Think it's impossible to find a child a hot, new gift for a modest price? If you're hunting for one of those trendy electronic hamsters, you might be out of luck. But take heart: $10 or $15 can still go a long way - and even save a child's life.

New vaccines at those prices can prevent the two biggest killers of young children - pneumonia and diarrheal disease. As a nation we have a great opportunity to extend a spirit of generosity to the world's children with the highest risk of dying.

In a season when gathering with family is a joyful tradition, reflect on the nearly 9 million families that lost a child under 5 this past year to preventable and treatable diseases.

Almost all these families live in the developing world. Unfortunately, they didn't have access to the new vaccines or the even less expensive treatments - like antibiotics or oral-rehydration fluids - that have been around for years. Yearly, pneumonia and diarrhea kill nearly 4 million small children. Preventable neonatal infections and malaria are the other major killers.

AIDS, the focus of nearly three-quarters of current U.S. global health funding, accounts for less than 3 percent of these child deaths worldwide. It's truly inspiring that over the past several years the United States has granted 2 million people living with HIV and AIDS a new lease on life through access to drug treatments. Amazingly, for just a fraction of the $5.7 billion we'll spend fighting AIDS this year alone, we could deliver life-saving services to tens of millions of children who lack access to basic health care.

We can do both.

We would dramatically reduce the number of children who die needlessly each year.

The United States already has an admirable track record in saving children's lives. We've helped make measles and tetanus vaccinations and life-saving oral rehydration therapy widely available around the world - preventing millions of child deaths. In Bangladesh, Nepal, Mozambique and Ethiopia, broad-based, U.S.-funded programs have been integral in cutting child mortality rates by more than 40 percent since 1990. These programs work, and they have shown that making affordable and effective health interventions available can save lives, even in very poor countries.

Such scientifically proven, remarkably cheap options include oral rehydration solution and zinc, low-cost drugs to treat pneumonia and malaria, and breastfeeding counseling. Add the new vaccines for pneumonia and diarrhea to the mix and we now have the tools to achieve revolutionary reductions in under-5 deaths.

In May, President Obama pledged to emphasize basic health care for mothers and children as part of his new global health initiative. But he didn't ask for much more money this past year, and last week Congress approved only a modest $54 million increase for maternal and child health care, as well as $400 million more in AIDS and malaria funding that will in part benefit children.

Using figures published in The Lancet medical journal, experts estimate that $1 billion in increased funding for child and maternal health could save 1 million children's lives a year. U.S. leadership would inspire other wealthy nations to join the cause. And, by working with developing nations to ensure health interventions reach children and families on the margins, the U.S. would help those countries strengthen their national health systems to improve the children's health for generations to come.

Let's encourage President Obama to be as bold in exercising U.S. leadership on global health as he has been in responding decisively to the global hunger crisis. In this season when children anxiously await their gifts and we their smiling faces, Americans can all be part of the greatest gift for children everywhere - the chance to survive and thrive.



Former U.S. Senate Majority Leader Bill Frist, a physician, is the chairman of Save the Children's Survive to 5 campaign. Orin Levine is executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health.

This essay is available to McClatchy-Tribune News Service subscribers. McClatchy-Tribune did not subsidize the writing of this column; the opinions are those of the writers and do not necessarily represent the views of McClatchy-Tribune or its editors.


(c) 2009, Save the Children

Distributed by McClatchy-Tribune Information Services

Raj Shah and America's Development Future
Dec. 17, 2009, 12:12 p.m.
By Bill Frist
Special to Roll Call

In most years, Senate deliberations over a nomination for administrator of the United States Agency for International Development, which leads American efforts to fight poverty and disease in the developing world, would pass without note.

This year is different. American efforts to improve the lives of the world's poorest people have never been so important. The Senate Foreign Relations Committee voted last week to refer the nomination of Dr. Rajiv Shah for USAID administrator to the floor for a full vote, which is expected soon. Dr. Shah should be confirmed without delay for three key reasons.

First, successful outcomes to our most pressing national security challenges, including the war in Afghanistan and instability in Pakistan, depend just as much on our ability to provide health services and economic opportunity to struggling people as on our combat operations or diplomatic efforts. Both President Barack Obama's new Afghanistan strategy and the Kerry-Lugar-Berman Pakistan aid package make substantial new commitments based on this idea.

Second, the global fights against HIV/AIDS and other deadly diseases have reached a turning point. U.S.-led programs such as former President George W. Bush's Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria, have helped poor families and communities move from a moment of crisis toward a moment of opportunity. We need to work twice as hard to maintain and build on this progress.

Third, the Obama administration and bipartisan Congressional leaders are in the midst of a transformative debate about how to make U.S. foreign assistance more effective and accountable. The unprecedented momentum in this debate is on the side of those who believe we need a new development strategy and a more efficient foreign assistance system that produces greater returns for recipients and taxpayers alike.

Given the gravity of these issues and the costs of inaction, Dr. Shah's development leadership is needed now. He is a medical doctor and health economist who led the Bill and Melinda Gates Foundation's $1.5 billion vaccine fund and played a key role in launching its global development division, which now disburses hundreds of millions of dollars for agricultural security and financial services for the poor. These experiences, coupled with the fact that he came of age professionally as revolutionary new programs like PEPFAR, the Global Fund, and the Millennium Challenge Corp. drove landmark progress on global poverty and disease, prepare him well to manage America's development future.

If confirmed, Dr. Shah will face resistance from entrenched bureaucrats in USAID and the dozens of other government offices that oversee development programs. With political support from the Obama administration and Congress, he will need to assert himself immediately to gain control of this fragmented system, or risk being swallowed by it. To do so, Dr. Shah should assume a visible leadership role on foreign assistance reform and help drive it to a successful conclusion, but he must also focus on other specific issues.

For example, U.S. support for PEPFAR and the Global Fund has helped create massive new systems for prevention, testing, and treatment of HIV/AIDS, TB and malaria in poor countries. These systems have greatly enhanced the ability of developing countries to meet the needs of their people, and we must figure out whether we can effectively expand them to offer even more life-changing services such as comprehensive family health care, entrepreneurship education and small-business loans. The Obama administration is taking initial steps in this direction through its marquee food security initiative ‹ developed in part with Dr. Shah's leadership at the Agriculture Department ‹ which focuses on linking food security, a development priority, to nutrition, a global health priority. This is a promising sign.

We must also direct our precious development resources to more effective, low-cost health interventions such as vaccines, breast-feeding and increased access to skilled family care in rural communities. And we must invest our development dollars in programs that are showing measurable results, including multilateral efforts such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the GAVI Fund, and the Alliance for a Green Revolution in Africa.

Changes like these are never easy. But we can't let inertia drag us down at this moment in time ‹ a moment when the future of the world's so-called bottom billion, and our own American future, hangs in the balance. Dr. Shah has what is needed to carry on President Bush's global health legacy and fulfill President Obama's extraordinary development vision. The Senate should confirm him, and the Obama administration should give him the political support and resources he needs to succeed. Millions of lives will be affected by this choice.

Former Senate Majority Leader Bill Frist (R-Tenn.), a heart surgeon, is a member of the Millennium Challenge Corp.'s board of directors.


This week one of my prenatal patients that I had been caring for since I first arrived here in Xela had her baby. She was a gestational diabetic, so although she had had her last 5 children at home with a comadrona she agreed to go to the public hospital for the delivery. She borrowed a cell phone from her neighbor to call me when she started went into labor and decided to go to the hospital. I met her there as soon as a finished seeing my patients at the clinic. I couldn't play any major role at the hospital, but I think it was good to see a familiar face; she cried when she saw me at the OB triage station.

The public hospital has a bad reputation, which is seemingly fitting. The hospital looked pretty similar to the hospitals I visited when I interned for the public health department in the Dominican Republic. I assume that most public hospitals in developing countries look similar. The largest problem with that being that due to lack of space and resources, patient rooms are dormitory style with 10-15 patients depending on the unit. In peripartum units this is not as much a problem because women with the same chief complaint, such as postpartum are bunked together. However, I remember this being a huge problem in the Dominican Republic on general medicine floors where lack of resources would lead to immuno-compromised patients being placed in the dorm with respiratory illnesses and other infectious diseases, leading to cross contamination; I have heard that it is the same at the hospital here in Guatemala. But developing countries are called developing for just that reason. The hospital looks like what I might imagine a hospital in the states to look like some 30 plus years ago, and the equipment is just as antiquated as the original building structure.

But despite whatever image or feelings the description may conjure up, it is not the physical building, but the people that work there that gives it its reputation. The majority of the patients that visit the public hospital are indigenous. The hospital is only a last ditch resort after all herbal medicine and traditional healers having failed. It is incredible to me how life just 20 minutes outside the city can be like living in a different world, but it is in fact the way it seems. The indigenous rural women only come into the city to go to the market, to buy or sell their goods or agricultural products. There is a lot of racism that still exists against the indigenous Maya; some of it still remains of the civil war. Most hospital staff including doctors and nurses is not indigenous and therefore this racism seems to permeate the services provided. The patients are often not respected and instead are rather looked down upon, seemingly passed over and ignored.

I remember distinctly, one of my most vivid memories from the time that I lived in the Dominican Republic, one of the other girls that I interned with was told by the doctor to administer an injection. At that point, over 2 years ago, neither she nor I were trained as nurses or in any medical capacity at all. She politely declined giving that reason exactly but the doctor responded, "It doesn't matter he is a Haitian". The overt racism in the Dominican was absolutely unbelievable to me. It's execution easy, due to the blatant difference in skin color. In Xela, this distinction is more difficult and may mostly rely on the preference of indigenous clothing. However, as I spend more time here, it seems that the roots of racism may run deeper than I had imagined.

When I arrived at the hospital the patient had already been laboring for a few hours. The patient did not have any of her prenatal records with her; however I was shocked to find out that the doctors were not treating her diabetes, the exact problem that she was being sent for. I spoke to the doctors for a while, to find out why. Apparently, they had asked her if she took any medication during her pregnancy. She said yes but she did not know the name of the medication because she cannot read. Rather than asking what the medication was for and investigating further, her affirmative answer was just ignored. (There seems to be a very high illiteracy rate among the adults in the Valley of Palajunoj. It makes it difficult to give medication instructions. Often times we are forced to rely on pictures or the assistance of children or neighbors). When I arrived and told them the medication and about her diabetes, they quickly scrambled to pull together the diabetic services previously ignored. Unfortunately, I was not permitted to stay past visiting hours and had to leave the patient, still laboring, at about 4 o'clock.

In the morning, I went to the corner store where her sister works to find out about the baby. She had called her late that night to let her know that the baby was born. I returned to the hospital that afternoon to hold the adorable 6lb baby girl in my arms. The patient was having trouble breast feeding so the baby still hadn't eaten. She had asked for help, but once again it was ignored. I sat there with her while she tried a few more times until eventually successful. I sat around with her and her sister for another hour until visiting hours ended. Unfortunately, no one had made it clear to her that she couldn't eat anything if she still wanted to get her tubes tied that day. I informed the rounding doctor, which meant that she would have to wait a whole other day to have the surgery and go home.

Yesterday I visited the patient at her house. The 5 brothers and sisters seemed very excited about their new sibling. The baby looks a little jaundice so she is taking her out in the early morning and late evening sun for an hour. I promised to visit again today and to check on the baby.



Nyamata, Rwanda

The last few weeks I have been leaving the Nyamata Hospital to work in the community health centers. Getting to the centers often entails a few hours of travel in a four-wheel drive over rough, dirt roads.  There are 11 centers in the Burgessa district and more than 400 in Rwanda

These health centers are the front line healthcare for most Rwandans. Each center is responsible for a population of roughly 20,000 people. Patients using the public hospitals must start at these community based centers. If the case is complicated, they are transferred to a district hospital like Nyamata. The staff care for sick patients, deliver babies, provide vaccinations, distribute food given from the government and non-governmental organizations. They also have daily classes on topics such as family planning, gardening for nutrition, and proper sanitation and food preparation. These centers are truly the best hope the country has in the areas of disease prevention and early intervention. 

Sitting with the nurses to consult the patients has been interesting. The majority of patients have diarrhea caused by intestinal worms or they have malaria. Both are easily treated at the center. I am reminded how different the patients’ lives are from mine every time they leave the room. Because they have lived their whole lives in crudely constructed houses, they have often difficulty figuring out how to use the door handle. 

 I am always amazed by how long patients wait to come to the clinic. I saw one patient who fell down a well. She had a dislocated shoulder and could not see out of one eye because she had hit her head. She told us she was in the well for four days before someone found her. When I asked when it happened, she said 11 years ago! This was the first time she sought treatment. It is common for the patients to try treatment with a traditional healer before coming to the centers. Traditional treatments often involve scarring the body with a red-hot piece of metal. It is sad to see advanced medical cases that could have been avoided if the patient would have come to the center first.  

The centers see 80-160 patients everyday, which means they are usually running at full capacity. I am currently partnering with a member of the Access Project, a non-governmental organization that aids the Rwandan health centers by providing management, training, and infrastructure. Through this collaboration we are searching for a ways to increase the health centers’ capacity without adding more costs.   

The nurses do incredible considering their education and lack of resources, but there is only so much they can do. I feel fortunate to have been able to work with them and teach them some more advanced skills.


December 11, 2009

by Jenny Eaton Dyer, Ph.D.

Do you remember the story of Olken Foncime? He was the Haitian orphan who had congenital heart disease and received surgery from Dr. Christian Gilbert in October.

We just received a photo and an update. His doctor reports that since the surgery, he has gained 10 lbs. and has a remarkable increase in activity. He's doing really well.

Thanks to Dr. Gilbert for the update!

Worlds AIDS Day

Vanderbilt University


December 1, 2009

by Jenny Dyer, Ph.D.

Last night, Senator Frist spoke at Vanderbilt University's Student Life Center to over 250 friends, students, faculty, and guests in honor of World AIDS Day. The title of the talk: "Celebrating Life, Mourning Death: Continuing the Fight against Global AIDS" focused on where we've come from and where we're going, especially in terms of policy. Recounting his personal experiences in Africa with the AIDS pandemic and how he was able to use those experiences to shape and inform President Bush's decision to move forward to commit historic funding to fight a single virus, the Senator relayed the beginning of the President's Emergency Plan for AIDS Relief (PEPFAR) in 2003.

The Global Fund and the Millennium Challenge Corporation have also been important components to combat HIV/AIDS and other preventable disease.

The good news? Because of these historic initiatives, over 3.5 million people are now on ARVs (in 2002, only 50,000 Africans were on life-saving ARVs).

The bad news? The number of the globally newly infected continues to rise.

We have learned that the "health systems" approach is the best method. We cannot simply confront individual preventable illnesses in isolation. The world is interconnected, and that demands an integrated approach to global health.

Rooted in this principle, President Obama has put forth a comprehensive Global Health Initiative budget request for $63B over 3 years. This plan begins to focus attention on broader global health challenges, including the following: child and maternal health, family planning, neglected tropical diseases, cost effective intervention for HIV/AIDS, and a more integrated approach to fighting diseases, improving health, and strengthening health systems.

We are excited to announce that Hope Through Healing Hands will be sponsoring four Frist Global Health Leaders for 2010-2011 from Vanderbilt's School of Nursing, School of Medicine, Vanderbilt International Anesthesia, and Emergency Medicine.

World AIDS Day reminds us that there is much work to be done in terms of continued awareness, action, and advocacy. We encourage you to join us in the fight.

This Christmas, consider supporting one of our Frist Global Health Fellows. They are doing amazing work around the world saving lives. We are proud of our students and their care for the world's poorest.

 Sankofa, The Blair School of Music's African Performing Ensemble

December 1, 2009

by Kelly Tschida, Vanderbilt School of Nursing

I have now transitioned to working with the physicians. Each physician is responsible for admitted patients on one of the floors and seeing patients in the outpatient consultation area. This change has been eye-opening.

Each morning starts at 7:00 with prayers, singing, and a short sermon. Watching my colleges sing and dance is an incredible way to start the day. By 7:30 we start rounds. There are usually about 40 patients to see and it has to be finished by 9:30 when the outpatient consulting begins.

Outpatient consulting here is like combining your general practitioner's office and an emergency room. We see seven or eight patients an hour and you never know what will come in next. I've seen snake bites, scurvy, leprosy, severe malnutrition, and even a suspected case of Ebola virus. 

Malaria accounts for probably one-third of the patients. Most are not complicated cases and can be treated easily, but this is not always the case. Malaria patients can come in unconscious, delirious, and in desperate condition. A few days ago a six-year old boy was brought in with malaria. He was unconscious and was barely breathing. We ordered medication and oxygen to improve help him breath. To my horror and dismay, we were told the hospital was out of oxygen.

Probably sixty-percent of the patients have stomach problems, usually due to parasites. Sometimes they come in specifically because their stomach is bothering them, often it is just in addition to another problem.  Sadly, with proper hand washing and food preparation most of these cases could be avoided. The severity of the illness ranges from mildly bothersome to life threatening.

I work with the medical doctors both to learn and to teach. I have been able to see diseases here I might never see in the U.S. I'm also learning how illnesses are treated when there are very few resources. In return, I am able to provide the most current guidelines for treatments, offer diagnoses that are not commonly considered here, and share different assessment techniques.

Perhaps one of my biggest contributions is simply providing a different perspective. For example, an infant with a high fever and having seizures was transferred to us by one of the community centers. The records were unclear as to what medicine had been given already. The physician was torn between risking an overdose and not giving lifesaving medicine. He decided not giving the medicine was safer. When I suggested he call someone at the health center he stared at me blankly for a few seconds before realizing how simple it was. Cell phone coverage in rural Rwanda is relatively new so physicians were unable to contact health centers in the past. In the end the infant received desperately needed medicine and the physician learned a new way to help patients.


Subscribe to our newsletter to recieve the latest updates.