Since my last report, so much has happened! I have completed my survey project of the employees and patients of Rural Medical Services (RMS). This information will be extremely valuable to the management of RMS in determining the strategic direction of RMS in the future. I also think this information will be very valuable to the patients of Rural Medical Services.
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]

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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.

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