I. Group Mission and Focus

While promoting prosperity in communities of developing nations by addressing the burden of infectious diseases, particularly malaria, remains prominent in our mission, we have re-evaluated some of our initial goals and may broaden our group’s focus in coming semesters. We still strive to create a network of college groups; however, we are no longer working on building a network that is focused purely on malaria, but rather a network of groups interested in global health. This change in our mission has occurred gradually over the past few semesters. We have realized that although many groups have different specific focuses, they often utilize similar techniques and resources, and run into similar problems. Our hope is that by working together, different groups can increase their impact in addressing global health problems. This was the focus of the conference that we held this semester, and of our current efforts to create an electronic platform for collaboration.

In addition, members have questioned whether GHF should continue to remain focused on malaria in its own fundraising and education efforts, or whether it should begin to branch out, perhaps even by addressing local public health issues in the Philadelphia area. We do agree that the field of global health encompasses both distant countries and our own neighborhood.  Although our bed net project has been very successful, we are no longer in close contact with the group we have partnered with, Global Minimum, which is responsible for distributing bed nets in Sierra Leone and educating recipients about their proper use. The last GHF member to have met Global Minimum in person has graduated, and as a result, the group no longer feels as involved in the project. We have not yet made any decisions regarding ending this partnership, but next semester we hope to either try and become more involved with Global Minimum again or perhaps forge a new partnership. One idea brought up in our meeting is that we might be interested in supporting one particular health center in a developing country rather than working on one particular disease. However, we recognize that creating a new partnership and embarking on a new project will require a great deal of research and planning. Next semester, we are planning on discussing these issues in further detail.

II. Meeting Structure and Group Building

This semester, the majority of both general meetings and meetings of the Executive Board were spent planning for our conference, “The Global Health Project: A Conference for Student Collaboration”. We divided group members into teams to be in charge of various aspects of the conference: logistics, speakers, workshops, and contacting students from other schools. We found that this division of tasks worked very well when approaching the somewhat daunting task of planning and hosting a conference. However, as a result of the efforts for the conference, we had less time at our general meetings to discuss news articles and papers regarding global health issues, something we had done in the fall semester, and had found valuable.

One of the problems we faced this semester was the fact that we have not attracted many new members, particularly from the freshman class. We put up fliers and sent out emails advertising our meetings to try and attract new members, but these efforts were not particularly successful. We held an event during the accepted students’ weekend, Ride the Tide, so that new students coming to Swarthmore would already be somewhat familiar with GHF. At the event, we shared water ice with accepted students and discussed our group’s mission and our recent efforts with them. This event seemed to spark interest in GHF among some accepted students, and will perhaps contribute to an increase in membership next semester. We are also planning an event next semester directed towards increasing membership, which is detailed in the Future Plans section.

III. The Global Health Project: A Conference for Student Collaboration

On March 18^th and 19^th, 2011, GHF hosted “The Global Health Project: A Conference for Student Collaboration” at Swarthmore College. The purpose of this conference was to bring together student groups from different schools who are also working in the area of global health, with the goal of creating a network of groups that could potentially coordinate their efforts in order to make a greater impact than any one group could make working independently. Our conference consisted of keynote speeches by Jennifer Staple-Clark and Danielle Butin, and several interactive workshops held over the course of three sessions, led by GHF alumni and others. We had opportunities for attendees to present their work and get to know one another. It was our hope that through listening to the keynote speakers, participating in workshops, and networking with one another, the attendees would be inspired to create a platform for collaboration in order to attack some important issue in global health. Attendees brainstormed possibilities for collaboration in the final session of the conference.

The sections that follow detail the main events of the conference.

Keynote Speech by Jennifer Staple-Clark

In the spring, we invited Unite for Sight Executive Director and Founder Jennifer Staple-Clark to Swarthmore’s campus to present the opening lecture for our conference. One of our members had attended a Unite for Sight “workshop” during the fall semester, of which provided a chance to work with Jennifer in a small-group setting. From there, a unique relationship between GHF and Unite for Sight was formed. Soon after the workshop, GHF emailed Jennifer and asked her to present a lecture with regards to sustainable practices in global health. Coordinating her transport was somewhat confusing, as we had to arrange for a member’s friend to pick her up at 30th Street Station. We reasoned this was necessary because Jennifer did not seem acquainted with the transportation system in Philadelphia. Her Amtrak tickets were $197, her taxi fees were $16, and her Septa ticket was about $6. Even more difficult was paying her honorarium, as she requested that a check not be made out to her, but to Unite for Sight as a $500 donation. Despite the original barriers regarding the payment process (resulting from restrictions of the college’s reimbursement regulations), we were finally able to pay Jennifer with the help of Jennifer Magee.

Jennifer herself was a lovely individual and had a great story to tell about her role in founding Unite for Sight. Jessica Downing and Melissa Frick were able to sit with Jennifer in the hours before her lecture and speak with her about this. The lecture itself was not as well attended as the group would have liked. We suspected that this be 1) because the Tri-Co shuttle schedule did not coincide well with our starting time, 2) fewer Swarthmore students attended than RSVPed, 3) and possibly due to the nature of Friday afternoons at Swarthmore. Jennifer’s lecture addressed global health initiatives, analyzing them for sustainability and efficacy. The examples she used were great and demonstrated how global health initiatives must be carefully orchestrated so that they are effective. However, her lecture was more or less a sequences of examples, rather than a cohesive story with a beginning, middle, and end. She was rushed to leave, as a gap in communication failed to let her know when her train was departing and her presentation went over time. Overall, we appreciated Jennifer’s gratefulness, enthusiasm, and support for her cause and still consider her a future resource for our group.

Keynote Speech by Danielle Butin

Danielle Butin is the Executive Director and Founder of The Afya Foundation. Afya, meaning “good health” in Swahili, was founded in 2007 and partners with donor hospitals, health organizations, corporations, and individual households to collect vital health supplies for Third World nations in dire need of them. These goods include consumables, sustainable equipment, medical office and community outreach supplies. Marjani Nairne (2013), a member of GHF, knew Danielle from a previous experience and was able to contact her to come speak at our conference. Danielle told us the story of how The Afya Foundation began, and the work it does. Her presentation was inspirational, bringing us the message that with enough willpower, an individual or a small organization can make real changes in the field of global health. Danielle’s presentation was well received, and she herself was a friendly and charismatic person, and we will certainly consider contacting her or working with her organization in the future. In fact, GHF is now thinking of collecting pens for The Afya Foundation, since as Danielle explained to us in her presentation, even supplies as simple as pens are often limited in rural clinics in developing countries.

“What Kind of Social Network do you Need?” Workshop

The workshop titled “What Kind of Social Network do you Need?” facilitated by Eric Behrens, Associate Chief Information Technology Officer and Director of Academic Technology at Swarthmore College, offered participants an opportunity to evaluate how to choose and make the best use of social networking tools and engage in a discussion of how to nurture and sustain online communities. During the workshop, participants talked about what people expect out of social interactions and compared the elements of a professional network and a community of practice. Participants were then encouraged to evaluate their own groups to determine what types of social media tools such as LinkedIn, Ning, WordPress/Buddypress, and GoogleGroups would be most suitable to promote their group’s objectives. The workshop concluded with an insightful discussion on effective strategies to cultivate and sustain valuable online networks and “communities of practice.”

“Success in Health Campaigns: A Historical Perspective” Workshop

GHF alumna Maryanne Tomazic was able to lead a workshop giving an overview of the steps necessary to create a successful public health initiative. Tomazic graduated from Swarthmore College in 2009 with a BA in Biology, and is now in her second year of a MPH program at the Mailman School of Public Health at Columbia University. She is currently studying the History and Ethics of Public Health, focusing on the history of public health in New York Chinatown. She has worked in health advocacy and policy planning. Unfortunately, due to an unforeseeable emergency, Maryanne was unable to attend the conference, but rather ran her workshop via video conference. While this may not have worked for a larger group of people, the workshop was successful despite Maryanne’s absence, indicating that webinar-style video workshops may be considered a viable option in further GHF educational initiatives. The workshop was held in Kohlberg 228. Because the classroom is equipped with a projector, we were able to project Maryanne’s slides, while using a GHF member’s laptop to conference with her. Much of the discussion focused on the efficacy and morality of the use of fear tactics in public health campaigns, especially in advertising. This discussion precipitated from Maryanne’s use of some of the current public health initiatives in New York City as examples. Maryanne was also able to answer attendee’s questions about MPH programs, and give insight into the paths that students interested in public health may take after graduation. To thank her for her contributions, we gave her a Swarthmore canvas bag. She is definitely an alumna whom we should call on for similar events in the future.

“Challenges in Implementing Global Health Initiatives in Underdeveloped Countries” Workshop

Lois Park, a GHF alumna who graduated in 2010, came from Seattle, WA to host a workshop entitled “Challenges in Implementing Global Health Initiatives in Underdeveloped Communities” for our conference.  We contacted her in early January to see if she would give a presentation about her experiences working on malnutrition in Sierra Leone with the support of a Lang Opportunity Scholarship. An alumna of GHF, she was more than happy to contribute.  She even helped us make sure things went smoothly on conference day, once she was here. She presented her workshop twice, using data from her experiences in Sierra Leone and her research.  Many students attended her workshop and she called it a success. She used a PowerPoint presentation, which we made sure to test before the workshop started.  She covered her own travel, even though we had set aside money to reimburse travel for workshop leaders.  She did not require an honorarium, as she was participating in the conference as an alumna of the group.  To thank her for her contributions we gave her a Swarthmore canvas bag.

“Working with Government and Nongovernment Actors to Shape U.S. and Global Health Policy” Workshop

Kate Goertzen, a GHF alumna who graduated in 2009, came from Washington, DC to host a workshop entitled “Working with Government and Nongovernment Actors to Shape U.S. and Global Health Policy” for our conference.  A Research and Policy Assistant at amfAR,The Foundation for AIDS Research, she came to our attention as a potential workshop leader through a job recruitment email sent from Career Services.  We contacted her to see if she would be interested in contributing to our conference with a workshop on influencing health policy in early January.  She agreed to do so and we communicated via email to choose a topic that would be both appropriate for the conference and with respect to her area of expertise.  Her workshop focused on “understanding the structure of policy change, including interacting with congressional offices and government agencies, groups working in coalition, and individuals directly impacted.”  She graciously held the same workshop twice, so that more people could learn from her presentation.  Her presentation was a great success among attendees, who participated actively.  She provided good insights about how policy groups work to lobby Congress.  She herself also enjoyed her time at the conference.  She did not want an honorarium or require reimbursement for travel, which her organization covered.  To thank her, we gave her a Swarthmore canvas bag.

“The Psychology of Social Change: How to Open Hearts and Minds” Workshop

Nick Cooney is the author of Change of Heart: What Psychology Can Teach Us About Spreading Social Change. He has formerly worked conducting inner-city nutrition education programs with the University of Pennsylvania’s Urban Nutrition Initiative. He contacted GHF via email early in the semester, as we were planning for the conference, asking us if we would like him to speak to our group. We realized that the topics Nick was interested in speaking about would fit in very well as a workshop at the conference. We asked him, and Nick was happy to come to our conference to host a workshop entitled “The Psychology of Social Change: How to Open Hearts and Minds”. In the workshop, which was held during two of our three workshop sessions, Nick spoke about how social activism groups, such as groups interested in global health, could increase support for and participation in their causes using knowledge of human psychology. The workshop provided participants with very interesting insights and tools for increasing the effectiveness of their groups. Nick himself was a very good speaker, and conducted his workshop professionally. At the end of the workshop, he was happy to speak with individuals who had further questions for him. Nick was paid a $200 honorarium for hosting the workshop, and we also thanked him with the gift of a Swarthmore water bottle. All members agreed that the workshop was a success.

Final Session

In the final session at the end of the conference, all participants joined in a discussion on where we as a group are headed. Our goal in this session was to address the questions of what we are, what we can do, what barriers we have to face, and where we are going. We started by assessing the effectiveness of the workshops and what we learned from them. We learned from these workshops that we have to keep in mind each of our roles as a unified group and what our goal is when we plan any projects, and how we will go about reaching our goal while interacting with others. Using this information, we proceeded to come up with ideas for potential forums to continue collaboration. We settled on the idea of an online network or database, where groups and individuals can share resources and information relevant to global health. Through this online forum, we will be able to maintain connections and have ongoing conversations about global health issues and what we as groups or individuals can do. While the construction of this website is in progress, we will have a Facebook page in which conference participants can stay connected and share ideas. Our idea was that if and when a final website is up and running, we would be able to transfer over to this and start with local connections such as other groups at Swarthmore, Bryn Mawr, and Haverford to maintain face to face contact, and slowly grow to include other schools.

IV. Website and Electronic Media

Initially, we had planned that after the conference, we would begin the creation of a website on which the different student groups that had attended the conference communicate with one another. We envisioned this website as the platform for collaboration among a network of students groups, a medium on which we could update each other on events and campaigns, ask for and offer resources from one another, and perhaps even work on a global health campaign that we could coordinate at many different schools. This idea required that we get feedback from other groups about what they believed would be useful in a website, because we wanted this to be a truly collaborative effort rather than our own project.

Unfortunately, there were many barriers to creating the website we had initially envisioned. One was that sadly, many of the groups which had RSVPed to the conference did not actually attend. Another was that many of the attendees, although very enthusiastic, were not part of student organizations. Therefore, we realized that it would be difficult to implement a campaign in a school where we only had one individual as a contact. In addition, we did not receive many responses when we sent out a questionnaire to conference attendees asking which features the attendees would like to see in a website. Given these difficulties, we decided that, at least for the present, we can edit the current GHF website to include more interactive features with which other groups we are in contact with can comment on our own updates and also communicate with us. As stated earlier, we are also hoping to first strengthen collaboration with TriCo groups before we expand our network, which will not even necessarily require a website. It is our hope that eventually, once we have a stronger network of student groups, we can create the website that we had initially envisioned.

V. Conferences Attended and Networking Efforts

The primary focus of GHF’s networking efforts during the 2010-2011 school year was to generate interest in our own conference among student groups at other schools. Throughout the fall and early spring semesters we contacted public health groups throughout the mid-Atlantic, reaching out to groups that we had worked with before and also approaching previously unknown groups.  We partnered with GlobeMed to advertise our conference and are excited about future collaboration. Throughout the conference preparation process we strengthened our connection with Haverford students. In fact, after the conference, we participated in the TriCo event “Stand With Haiti: A Charity Event”, which was organized by an enthusiastic conference attendee from Haverford.

In addition to normal networking, GHF members also participated in the 4th annual Clinton Global Initiative University(CGIU) Conference in San Diego.  CGIU provides an unbelievable opportunity to network with student groups from across the country and share ideas about how to address global issues.  The Dean of Stanford’s Global Health Programs in Medicine, Michele Barry, was kind enough to personally meet with the Swarthmore students attending the conference and discuss the agenda of GHF and offer advice on GHF’s future focus.  The Swarthmore students attending CGIU also had an opportunity to meet with Kaiser Family Foundation representatives and discussed the possibility of partnering in the future to create a more effective network for connecting student groups

VI. World Malaria Day

On April 25th the Global Health Forum hosted a parlor party commemorating World Malaria Day.  We screened the film “Malaria: Fever Wars” and prepared a spread of fresh fruit slices. Throughout the evening we had approximately 70 different students attend. Many of the students opted to join our mailing list and expressed interest in participating in future GHF events.  The parlor party was a great opportunity to speak with students about what GHF does and will hopefully increase membership in the group.

VII. Evaluations, Challenges, and Future Plans

One problem that we have faced this year is that we have not attracted very many new members. This is difficult, especially in light of the fact that we are losing many dedicated leaders with the graduation of the class of 2011. However, many of the new members this year have stepped up to fill these leadership positions, and thanks to the help and advice of the graduating seniors, the underclassmen are now ready to take on their roles in the coming years. Yet, the fact remains that we hope to recruit more members, especially freshmen, next year. So, we are planning on hosting a Pancake Breakfast fundraiser for bed nets (an event we have held more than once in the past) in the first week or two of the Fall 2011 semester, so that freshmen will hear about our group and get to know some of the work we are doing. We think that this might be an effective way to attract new members. We also hope that some of our efforts this semester, such as the Ride the Tide event and the Parlor Party, might also serve to increase membership next semester.

We viewed the conference we held this semester as a success in the sense that the logistics went smoothly, the workshops and keynote lectures exceeded our expectations, the attendees were enthusiastic, and we made some new contacts. However, we were disappointed by the general lack of attendance at the conference, especially since many more people RSVPed than actually attended. Unfortunately, this forced us to change our initial plans of forming a website and a network of student groups at many schools from the attendees of the conference. We have learned a lot from hosting the conference, and we are in the process of deciding whether or not we want to hold one again next year or not. If we do, we have thought of some ways to increase the commitment of those who RSVP. One is to charge a small registration fee, with the thought that if student groups pay some money to attend the conference, they will be more invested in coming. Another is to run a van shuttle for Haverford and Bryn Mawr students, as transportation seemed to be a barrier for TriCo attendees since the TriCo shuttle schedule did not coincide well with our schedule of events. In general, we recognized that transportation might have posed difficult for many prospective attendees.

Despite the fact that attendance at the conference was lower than expected, we did make some valuable contacts, especially at Haverford College. We are hoping to strengthen our ties with student groups at Haverford and Bryn Mawr over the next year, since proximity will facilitate working together. Our idea is that we can start small, gaining experience about how best to work with other groups. With this knowledge, we will gradually be able to expand our network to include a variety of other schools.

VIII. Position Changes

Renu Nadkarni (2013), the current Director of Education, will be going abroad for the Fall 2011 semester, and so Mondira Ray (2013) has been appointed the Director of Education for next semester.

IX. Budget

The budget is in a separate document.

X. Thanks

The members of Global Health Forum would like to thank the Pericles Foundation and the Lang Center for their continued support of our campaigns and initiatives. We would particularly like to thank Jennifer Magee for her advice, assistance, and encouragement throughout the semester.

Haiti was a country untouched by cholera until the current epidemic proliferated throughout its virgin landscape. In being a novel experience, the cholera epidemic does not recall pre-existing myths and beliefs about the infection and allows a unique opportunity to witness how a profile of disease is created by the affected society. The outbreak has demonstrated how both historical events and the current social environment has the ability to shape perceptions of and responses to disease. For example, historical outbreaks in other nations have informed the public health response, yet economic disparities confound attempts to reform health behaviors. The physical environment, scavenged by Hurricane Katrina and the January 2010 earthquake, has placed a fatalistic view upon the incidence of cholera. The existing “disease-environment” characterized by high morbidity and mortality has influenced a loss of trust in the national government.  Past experiences with colonial powers and imperialist rule have created an atmosphere of malcontent with foreign forces. Furthermore, the recent election plagued by corruption, fraud, and underrepresentation, in combination with the wrath inflicted by cholera, has exaggerated socio-economic disparities. Although cholera is essentially a biological phenomenon, it is defined by the social underpinnings of the society in which it infects.

For a quick overview, cholera is an acute illness that occurs after infection of the intestine by Vibrio cholerae bacterium. Severe infection can result in profuse watery diarrhea, vomiting, and cramps; a resulting loss of body fluids can lead to dehydration, electrolyte loss, and shock. Left untreated, this infection can kill. About 3 to 5 million people are infected every year and 100,000 die – most of these cases are seen in developing countries where conditions are favorable for infection.

In some respect, Haiti is lucky that there is such a volume of discourse about and experience with cholera in the international sphere; therefore, education campaigns could be created quickly by world health organizations and spread to Haitian communities. As quoted from Hôpital Albert Schweitzer (HAS) – one of the first hospitals to receive cholera patients – “the public information program by the Ministry of Health, the local Rotary clubs, and by the HAS field staff appear to have been effective, as patients come to the hospital early in the course of the disease.”[1] Additional health promotion activities have been provided on the community level, often in the well-established networks of churches, to reinforce these public information campaigns.[2] The measure of this success is demonstrated by the frequent and accurate explanations of cholera from several newspaper outlets and even the young-adult Internet blog, VwaJen.[3] Sadly, though, Haiti is unlucky because the dire straits of poverty and inaccessibility to sanitary water restrict the effective uptake of these messages, as nearly 70% of the population does not have access to potable water.[4] Furthermore, newspapers and blogs are able to demonstrate that they’ve accommodated the messages of sanitation but also explicitly recognize the population does not have the means to make substantial changes, “the living conditions in Haiti are almost medieval. There is no electricity, no drinking water, public transport is in a state of extreme dilapidation, and housing problems have reached the limits of hell, especially in the city of Port-au-Prince.”[5] Whereas the novelty of this disease has allowed the commonplace to accommodate the standardized health messages, it’s inherent poverty and unsanitary conditions confound the potential benefits of this variable.

The physical environment and, more specifically, the occurrence of natural disaster also appeared to have held influence over the general response of the Haitian majority. The chilling memory of the January 12^th earthquake, which killed over 230,000 citizens and displaced 1.5 million, is frequently recalled within the Haitian dialogue. The more recent hurricane Tomas also inflicted a great deal of damage upon an already hurting population. A Haitian reporter suggests there is an “inability of the Haitian popular consciousness to understand and explain the phenomenon of the earthquake as being purely natural and not the expression of the will of any spirit of a god or God Almighty who punishes sinners in general.”[6] The repeated occurrences of natural disasters have imposed a fatalistic mood upon the population and called into question their belief of an otherworldly deity. Their dialogue and questions reveal a sense of defeat, doubt, and pessimism; “Haiti still unable to get up, to cope with the unleashing of nature… How is it that a country like Haiti can never get out, rain or shine, and that we have the distinct impression that the country is regressing rather than moving forward?”[7] The population has been primed with a fragile sense of confusion; upon invasion of the cholera bacilli, the stability of the public’s consciousness has fractured. As a result, the response of the population oscillates between anger and despair, resignation and rage, all while trying to place blame and find security. The unprecedented magnitude of the previously discussed reactions, such as malcontent with national governance and violence directed towards international force, has been the direct response of a population primed with fatalistic views and a brittle spirit incurred by repeated natural disasters.

Haiti’s response to the cholera epidemic receives impetus by its previous and ongoing struggle with disease and public health.[8] The concerns of greatest relevance to the locals are that of premature death, malnutrition, and deadly infections diseases, as conveyed through this opinion, “While in this country even thousands of children die at birth and thousands more never reach their fifth birthday; while plagued by hunger and death that follows, before the disastrous earthquake.”[9] Haitians understand that these issues are caused by deficient sanitation systems, poor nutrition, and inadequate health services – their country ranking last in the western hemisphere in care spending. As a result, Haitians interpret their poor disease-environment to be a consequence of national governmental ignorance. They express,  “History has bequeathed to Haiti inequality, dictatorship, corruption, and extreme and persistent poverty, which all contribute in their way for the Haitian government’s failure to provide clean water to the population.” The population, therefore, views cholera as another reason to believe in the failure of the government, expecting that the government will maintain status quo and do little to relieve the symptoms of the populace; “The consequence: a vicious cycle of contaminated water consumption, ineffective public hygiene, health crises and recurrent underlying all the foregoing, chronic poverty and deeply rooted (24 Dec, pg 15, HL). “ Upon recognition of a poor disease-environment and understanding it as the fault of governmental disregard, the population responds with a heightened campaign that carries criticisms of current politicians and election candidates. A reporter claims that they, the local citizens, have been ignored by the politicians and are “people trampled by leaders who promote their own well-being,” and later suggests that, “Maybe other more lucrative targets are being pursued by our leaders, and [this ignorance] contributes to the Haitian genocide.[10]” Additionally, a recent anti-imperialism movement, representing large swaths of Haitians, has voiced similar concern. This organization criticizes the corrupt and greedy government of allowing first-world countries to develop neo-colonialist regime within Haiti and to rape it of it’s natural resources, while simultaneously preventing development of important infrastructure that would benefit the indigenous population. Furthermore, this movement threatens the imminent presidential election with boycotts – despite the desperate need for it’s complete representation if the movement’s favored presidential-candidate is to win.

The Haitian public readily admits “the cholera victims come from the destitute slums and huts of peasants – dispossessed, impoverished, and lured by false hopes to work at the capital.”[11] However, they place little, if any, blame on the “paupérisée,” and instead, seek a source of higher authority to blame for the introduction of the disease. Such speed and strength of such blame can be traced back to years of suppression by colonial forces and the more recent neo-colonial occupations. The common peoples blamed the peacekeeping forces from the United Nations Stabilization Mission in Haiti (MINUSTAH) for bringing the disease to their country.[12] The specific military contingent being blamed is based in Mirebalais and a majority of these peacekeepers come from Nepal; coincidentally, this is a country who has also recently been plagued with cholera.[13] The public voice, via local newspapers, has adamantly expressed current discontent concerning neo-colonialism, especially about the recent occupation of foreign military forces: “These events that engulf the capital city, prove that people understand the situation as an imperialist occupation regime, which received wide blessing from the lackeys of the country.”[14] Public politicians are hesitant to blame, and even defend, MINUSTAH forces in the dialogues offered by newspapers; yet, they have failed to silence the majority’s opinion of placing blame on a group of higher authority.

In Haiti, cholera has inflicted pain upon the poor of both the urban slums and the rural hinterlands. As cholera has become understood as a disease of the masses – a disease of the poor, the squalor, and the dirty – the population has come to the recognition that they cannot rely on their national government to provide them with necessary resources. In response, the population has taken up the response to rely on international governmental organizations and aid groups to provide them with the financial and provisional resources to combat this disease.[15] In the blogs released from hospitals within Port-au-Prince, there are constant pleas for assistance, specific requests of supplies, and unceasing thanks for donations already made. A recent blog states, “ it takes about $22 to save the life of a child from cholera… I think you will agree that $22 is not very much money to keep a child alive and give her back to her mother… Let’s splurge. It’s the right thing to do.”[16] It is obvious these pleas for help are not being made to the Haitian population, as $22 is about half of the average Haitian’s monthly salary; instead, such requests reflect a desperate hope that outside donors are their only source of materials. Haiti not only expresses an expectation of individual philanthropy, but also of the supply of medical professionals, whether through non-governmental institutions or informal volunteer networks. They have expected, and since received, a large battalion of Cuban doctors who treat 40% of all cholera cases and “make benefit not only to patients, but also the Haitian medical staff, [the Cuban doctors] having their medical skills at the highest level. They are even helping the campaign of prevention of disease, held in schools by the government and in collaboration with UNICEF.”[17]^,[18] Ironically – and almost hypocritically – it is this response that delivers Haiti into a perpetual cycle of international reliance, although the population simultaneously demands independence from colonial and neo-colonial bounds.

In his article Cholera and Colonialism, David Arnold presents:

“Like any other disease, [cholera] has in itself no meaning: it is only a micro-organism. It acquires meaning and significance from its human context, from the ways in which it infiltrates the lives of the people, from the reactions it provokes, and from the manner in which it gives expression to cultural and political values.”[19]

In conclusion, the Haitian experience has demonstrated how historical and present-day governmental rule (or lack thereof), combined with inherent poverty, exacerbated with recurrent and abusive natural disasters, and a diversity of other contextual variables has endowed a certain profile upon the cholera bacilli. The responses to this disease have included a failed uptake of educational hygiene messages, not limited by traditional beliefs but by deficient resources; violent episodes between the Haitian majority and UN forces; a continued reliance on international aid; a criticism of nation government; and an unstable, victimized social consciousness.

[2] Some PAHO health bulletin, MAYBE the first

[3] “VwaJen,” (Jen’s Voice) is the first virtual hub in Creole created for the youth of Haiti, developed in close collaboration with the UNICEF Youth Section in New York and the Children’s Radio Foundation, and is meant to transmit the voices of the Haitian youth and provide them with valuable information. The radio pieces, short essays, photos, and videos included on the website were produced over the course of several mini-series hosted by UNICEF, which allowed youth to acquire skills to express opinions and learn about dynamics of policy-making and democratic representation. Starting on Octboer 25^th, blogposts have frequently preached the importance of basic hygienic behaviors and of seeking medical treatment. Taken from: http://vwajen.voicesofyouth.org/. Accessed December 12, 2010.

[4] Varma, Monkia Kalra. “Woch nan soley: The denial of the right to water in Haiti.” Health and Human Rights Journal: 10(2):68-89.

[5] Bruzzone, Roberto. “Un bout d’Afrique Noire pauperisee au centre de l”Amerique Latine. Haiti Liberte. November 15, 2010. 7.

[6] Michel, Herve Jean. “Le cholera poursuit ses ravages en Haiti!” Haiti Liberte. December 9, 2010. 14.

[7] Lanctot, Jacques. “Vivement une revolution a Haiti!” Haiti Liberte. 15 November, 2010. 8.

[8] Haiti is a country beset with a host of health related issues: in 2002 it was ranked 101/127 countries based on quality and quantity of potable water, in 2007 it had the lowest life expectancy in the Western Hemisphere, an had appallingly high infant and maternal mortality rates when compared to the rest of Latin America and the Caribbean (57 per 1,000 live births and 630 per 100,000 live births, versus 22.2 per 1,000 live births and 82.8 per 100,000 live births, respectively). The rate of HIV/AIDS incidence, although on the decline, is still the highest in the Latin America with 1.9% of the population having been infected in 2008. Tuberculosis is endemic to the country and is one of the highest causes of death, second behind HIV/AIDS.

Great source which summarizes statistics:

[9] Brazzone, Roberto. “Un bout d”Afrique Noire pauperisee.” 7.

[10] Michel, Herve Jean. “Le cholera poursuit ses ravages en Haiti!” Haiti Liberte. December 9, 2010. 8.

[11] Dupont, Berthony. “L’ieqgalite devant les catastrophes!” 24 November 2010. Haiti Liberte, November 24, 2010, 2.

[12] Mission des Nations Unies pour la Stabilisation en Haiti (MINUSTAH). In June 2004, this mission was authorized after the president of Haiti was exiled as a consequence of several armed conflicts occurring in various cities throughout the country. The original goal was to secure a stable environment, promote clean politics, strengthen governmental institutions, and protect human rights. After the January earthquake, however, MINUSTAH forces and goals were expanded to support quick recovery, reconstruction, and stability efforts. Taken from: “MINUSTAH Background,” United Nations Stabilization Mission in Haiti, lasted modified 2010, http://www.un.org/en/peacekeeping/missions/minustah/background.shtml

[13] A piece published in the New England Journal of Medicine on December 9^th by a team of U.S. and Haitian scientists have confirmed that cholera was probably imported by the Nepalese peacekeepers in MINUSTAH. Taken from: Walton, David and Louise Ivers. “Responding to Cholera in Post-Earthquake Haiti,” New England Journal of Medicine, accessed December 11, 2010, http://www.nejm.org/doi/full/10.1056/NEJMp1012997.

[14] Ces événements qui on embrase la cite capoise, prouvent que le people comprend très bien la situation dans laquelle il vit sous ce régime d’occupation impérialiste, ayant reçu la très large bénédiction des laquais du pais.”

[15] In the previous paragraphs about other variables, the inequalities experienced by the cholera epidemic have already shown to implicate a multitude of responses. It has contributed to political discontent, to violent responses against international forces, and has limited the implementation of educational messages. Clearly, the social incidence of cholera does not insinuate one specific response. In this paragraph, I seek to offer a novel response of the population that derives from the unequal incidence of cholera and has not yet been discussed within the framework of previous variables.

[16] Frechette, Rick. “Cholera and Riots.” NPH Saint Damien Hospital Haiti. November 22, 2010. Accessed December 11, 2010. http://saintdamienhospital.nph.org/

[17] Busseien, Tony. “Haiti: jusqu’ou ira l’arrogance des Etats-Unis?” Haiti Liberte. December 8, 2010. 7.

[18] On November 14^th, 2010, Cuba provided 800 additional doctors and nurses to Haiti, in addition to the medical forces already present in response to the January 12^th earthquake. Taken from: Auken, Bill Van. “Manifestants abattus en Haiti.” Haiti Liberte. November 24, 2010. 8.

[19] Arnold, David. Cholera and Colonialism in British India. Past and Present. 1986; 113(1): 118-151.

Conference Schedule:

Friday March 18th
2-3:45 pm: Registration, outside of Science Center 101
3:45-5:30 pm: Welcome and Keynote Address by Jennifer Staple-Clark, Science Center 101
6-7:30 pm: Welcome Dinner, Upper Tarble

Saturday March 19th
8-9:00 am: Morning registration/Breakfast/Set-up of Attendee Groups’ Posters, Lang Center for Civic and Social Responsibility
9:00-10:30 am: Poster Presentations By Attendee Groups, Lang Center for Civic and Social Responsibility
10:30-11:30 am: Workshop, Kohlberg Hall, Second Floor
11:30am-12:30 pm: Keynote Address by Danielle Butin, Science Center 101
12:30-1:10 pm: Lunch, Lang Center for Civic and Social Responsibility
1:15-3:15 pm: Workshops, Kohlberg Hall, Second Floor
3:20-4:40 pm: Culminating Session to Create a Plan for Collaboration Between Student Groups, Science Center 101

Workshops:

-The Psychology of Social Change: How to Open Hearts and Minds, led by Nick Cooney

-Challenges in Implementing Global Health Initiatives in Underdeveloped Communities, led by Lois Park ’10

-Working with Government and Non-government Actors to Shape U.S. and Global Health Policy, led by Kate Goertzen ’09,  Research and Policy Assistant at amfAR, The Foundation for AIDS Research

-Success in Health Campaigns: A Historical Perspective, led by Maryanne Tomazic ’09

-What Kind of Social Network Do You Need?, led by Eric Behrens ’92, Associated Chief Information Technology Officer and Director of Academic Technology at Swarthmore College

Swarthmore College’s Global Health Forum invites you to attend The Global Health Project:  A Conference for Student Collaboration, to be held on Friday March 18th and Saturday March 19th at Swarthmore College.

At this conference, we strive to increase the effectiveness of student global health organizations though conversation and collaboration. We aim to establish relationships on which we can build in the future to help further the goals of participating groups. There will be an opportunity for each participating group to present its work to the collective conference. Through workshops, lectures, and student presentations we will learn who we are, how we can work together, and what we plan to accomplish in the field of global health.

Keynote Speakers

Jennifer Staple-Clark, Founder and Chief Executive Officer of Unite for Sight. Ms. Staple-Clark founded Unite For Sight in her dorm room while a sophomore at Yale University in fall 2000. With Jennifer’s leadership and vision, Unite For Sight is now a leading global health delivery organization that provides cost-effective care to the world’s poorest people. By investing human and financial resources into the social ventures of eye clinics in developing countries, Unite For Sight has provided eye care to more than 1,100,000 people living in extreme poverty, including more than 40,000 sight-restoring surgeries. Jennifer is also the recipient of the American Institute of Public Service’s 2009 National Jefferson Award For Public Service, which is regarded as the “Nobel Prize” for public service. In 2007, Jennifer was awarded a BRICK Award, which honors and funds change-makers who identify problems and do something to change the world, and has been dubbed by CNN as “the Oscars of youth service awards.”

Danielle Butin, Executive Director and Founder of Afya. Ms. Butin founded Afya, meaning “good health” in Swahili, in 2007. The organization partners with donor hospitals, health organizations, corporations, and individual households to collect vital health supplies for nations in dire need of them. These goods include consumables, sustainable equipment, medical office and community outreach supplies. Ms. Butin received her Masters in Public Health with a specialization in Geriatrics and Gerontology at Columbia University and her B.S. in Occupational Therapy from New York University. She maintains Afya along with her own private practice where she specializes in the comprehensive assessment and treatment of older adults and their caregivers. Afya has, to date, sent over 2,000 tons of medical equipment around the world. The foundation sent over 600,000 pounds of medical equipment and humanitarian supplies to Haiti alone, since the January 2010 earthquake. Ms. Butin has been recognized in a number of media outlets, including More magazine and The New York Times, for her extraordinary contributions to the global health community.

Registration

Click here to fill out the registration form

Please RSVP by February 25, 2011 (This is an extension of our initial deadline.)

Email globalhealthproject@globalhealthforum.org with your questions about the conference.

Find us on Facebook - The Global Health Project: A Conference for Student Collaboration

Conference Schedule:

Friday March 18th
2-3:45 pm: Registration, outside of Science Center 101
3:45-5:30 pm: Welcome and Keynote Address by Jennifer Staples-Clark, Science Center 101
6-7:30 pm: Welcome Dinner, Upper Tarble

Saturday March 19th
8-9:00 am: Morning registration/Breakfast/Set-up of Attendee Groups’ Posters, Lang Center for Civic and Social Responsibility
9:00-10:30 am: Poster Presentations By Attendee Groups, Lang Center for Civic and Social Responsibility
10:30-11:30 am: Workshop, Kohlberg Hall
11:30am-12:30 pm: Keynote Address by Danielle Butin, Science Center 101
12:30-1:10 pm: Lunch
1:15-3:15 pm: Workshops, Kohlberg Hall
3:20-4:40 pm: Culminating Session to Create a Plan for Collaboration Between Student Groups, Science Center 101

Workshops:

-The Psychology of Social Change: How to Open Hearts and Minds, led by Nick Cooney

-Challenges in Implementing Global Health Initiatives in Underdeveloped Communities, led by Lois Park ’10

-Working with Government and Non-government Actors to Shape U.S. and Global Health Policy, led by Kate Goertzen ’09,  Research and Policy Assistant at amfAR, The Foundation for AIDS Research

-Success in Health Campaigns: A Historical Perspective, led by Maryanne Tomazic ’09

-What Kind of Social Network Do You Need?, led by Eric Behrens ’92, Associated Chief Information Technology Officer and Director of Academic Technology at Swarthmore College

]]> http://www.globalhealthforum.org/conference-on-student-collaboration-in-march.php/feed 0 http://www.globalhealthforum.org/hattrick.php http://www.globalhealthforum.org/hattrick.php#comments Sat, 27 Nov 2010 15:02:14 +0000 melissa.frick http://www.globalhealthforum.org/?p=1126 Within a week, three important announcements broadcast various successes in the fight against HIV/AIDS. Here - a quick review. ]]>

Earlier this week, three announcements about HIV/AIDS lent an optimistic view towards the regression of this nearly-30-year-old world-wide pandemic.

The first was a report issued by UNAIDS (The Joint United Nations Programme on HIV/AIDS). In just six years, global death rates from HIV/AIDS have fallen by 20% – largely due to the increase of new and more available treatments. It also recognized that “ virtual elimination of mother-to-child transmission of HIV is possible.” If true, this feat would have an exponential effect in preventing transmission by eliminating an entire generation of HIV patients that are capable of transmitting the virus their entire life.

The second glimmer of hope was an article, published in the New England Journal of Medicine, which announced the success of a pre-exposure prophylaxis (PrEP) against prevention transmission of the HIV virus. This large international clinical trail, conducted specifically among men who have sex with other men, concluded that using a daily oral antiretroviral drug (currently in use to treat infection) reduced the risk of HIV infection by an average of 43.8%. Even better – the men who dutifully followed the daily dose regime (rather than falling out of the pattern, like some patients inevitably do) experienced a 72.8% rate of effectiveness. The next step of this trial is to extrapolate it to other populations, like women and heterosexual men.

Figure 3. HIV Incidence among Subjects Receiving FTC–TDF, According to Subgroup from "Preexposure chemophylaxis for HIV prevention in men who have sex with men." The efficacy of emtricitabine and tenofovir disoproxil fumarate (FTC–TDF) is 1 minus the hazard ratio. Hazard ratios of less than 1 indicate efficacy, and 95% confidence intervals (shown by horizontal lines) that do not cross 1 indicate significant evidence of efficacy. All subgroup analyses were prespecified except for testing for herpes simplex virus type 2 (HSV-2) at screening and pill use at the rate of 90%. P values for the intention-to-treat analysis and the modified intention-to-treat analysis apply to the hypothesis of any evidence of efficacy; P values for other comparisons refer to the hypothesis that efficacy differed between the two strata. NA denotes not applicable, and URAI unprotected receptive anal intercourse.

Finally, against the chagrin of devote Roman Catholics, it looks like the Vatican is suggesting that condoms are a lesser evil than transmitting HIV. Some ambiguity remains as religious conservatives adamantly maintains that condom use is immoral – preventing child birth – and the church is NOT endorsing condoms as a method of birth control of means of AIDS prevention. Let’s be reminded that not even a year ago, the pope had told reporters AIDS was not going to be relieved by using condom and that “on the contrary, it [condoms] increases the problem.”

Swarthmore College’s Global Health Forum Presents its 3rd Annual Minus Malaria Variety Show

WHEN: Saturday, November 6th at 8pm

WHERE: Swarthmore College, Lang Performing Arts Center, Swarthmore, PA

WHAT:

• This event is part of the Global Health Forum’s (GHF’s) Minus Malaria Initiative (MMI), which aims to educate people about malaria, act to eliminate the burden of malaria, and advocate for more action against malaria.

• The show will feature student performance groups that will offer a variety of entertainment, including a capella, dance, instrumental music, and comedy.

• A suggested $5 donation for admittance to the show will purchase an insecticide-treated bed-net to fight malaria in the Kbangba Kabonde chiefdom of Sierra Leone. Bednets are the most cost-effective method of preventing malaria infection. Last year your donations helped achieve complete coverage of the Malen chiefdom in Sierra Leone. For every bed-net purchased, GHF will send a letter to Congress in support of select global health legislation on behalf of our donors.

We invite all members of surrounding communities to come enjoy live entertainment, support our student performers, learn about malaria, and help us to address a serious global issue.

For more information, contact info@globalhealthforum.org

However, Botswana has not escaped perhaps the worst health problem in Africa, HIV/AIDS. While I commend GHF’s emphasis on malaria and other tropical diseases that receive scant attention in much of the developed world despite their pernicious effects on the poorest people throughout much of sub-Saharan Africa, after visiting Botswana the attention surrounding HIV/AIDS certainly seems quite justified. Although HIV is a problem in every country around the world, it is most prevalent in Africa, and particularly in Southern Africa. South Africa has the largest population of HIV+ individuals of any country in the world—over 5 million, and Swaziland, Botswana, and Lesotho lead the world in proportion of their populations with HIV (in the case of Botswana, roughly 25% is HIV+).

As a matter of background, let me expound on HIV just a bit (courtesy of AVERT). Because far from being a homogenous virus, HIV has mutated into a number of different, related viruses. HIV comes in two types, the most common and more lethal type being Type 1. Within Type 1, there are four groups (labeled M-P), with M being the most common. Under Group M, there are currently nine viral subtypes, with subtype C being the most common worldwide and in Southern Africa. It is also considered an especially lethal subtype, meaning that it tends to develop into AIDS and kill more quickly than some of the other subtypes. Thus not only does Southern Africa suffer from a high prevalence of HIV, but those in the region who have HIV suffer from a particularly bad strain.

Botswana recognizes this problem, and has worked hard to solve it. The country has done a much better job than many others in the region at spreading prevention messages, increasing access to confidential testing and counseling services, and providing treatment and support to those who need it. It has received tremendous sums from PEPFAR, which have in turn helped fund some of the much needed HIV-prevention and testing services with very good results. And Botswana continues to work with organizations such as the Harvard-Botswana HIV Partnership, which conducts a great deal of research on HIV in the lab and in the field throughout the country. Two of my fellow exchange students worked at the Harvard lab in Gaborone, alongside newly-minted Harvard PhDs who were engaged in large-scale studies regarding transmission and mutations. Increasingly, the problem in Botswana is multiple concurrent partners. Despite a gazillion public health messages, many funded directly by our tax dollars, many Batswana, especially men, continue to have unprotected sex with several partners without telling their other partners. As you can imagine, the virus easily gets transmitted through this chain, and the result is quite devastating. Moreover, as the country’s public infrastructure continues to be overtaxed, and donors become stingier, it will become harder for HIV patients and their families to get the services and resources they need, potentially exacerbating the problem further.

I want to relate my own experience with the health system in Southern Africa because it wends its way in with Botswana’s continuing HIV challenges. This past March, on a 12-hour overnight bus ride between Gaborone (Botswana’s capital) and Victoria Falls in Zambia, I foolishly slept with my contact lenses in. I had slept with my contacts in before, and nothing bad had come of it, but this time was different. When I awoke at the Kazungula border, I couldn’t see out of my left eye. Though I had also left the contact in my right eye as well, it was only my left one that was infected. My left eye started to swell, and though I was able to get some eye ointment, I hoped that as with many eye irritations, this one would go away after a day or so. Sadly that was not the case. So much of the weekend I spent in Zambia was not too fun (especially the all-day bus ride coming back to Gaborone). I did, however, manage to bungee jump with one usable eye (the Victoria Falls bungee is the ninth-highest in the world, with a drop of over 350 feet!).

On Monday in Gaborone, I saw an ophthalmologist who said I needed to be immediately admitted to the hospital. It was determined that I had a corneal ulcer caused by bacteria. I was able to go to a newly-built private hospital on the outskirts of Gaborone, and get treatment equivalent to what I would receive in the States for a fraction of the price. The ophthalmologist in the hospital was from the Philippines, and many of the other doctors in the hospital were originally from the United States or Europe, but wanted to come to Botswana for a new challenge. Several days later, I went to South Africa for additional treatment and prescription eye drops that are not yet licensed in Botswana. Despite the experience being somewhat of an ordeal, I was able to get the best treatment possible for my eye without having to go home to the States, but at a price. Right now, although the ulcer has healed I still can’t see well out of my left eye due to a layer of scar tissue. I will get a corneal transplant in Philadelphia in late August, soon before school starts, after which my vision should come back to something resembling normal six to twelve months after the surgery (meaning I am hoping to get the graduation present of restored vision—one of the best gifts I could receive).

But the reason I tell this story is not to present a long diatribe of my medical problems, but to illustrate an important trend that is occurring in Botswana, and throughout much of the developing world. The rich have increasing access to first-world medical care in private hospitals surrounded by guards to keep out the riff-raff (that was the case in Botswana, at least, where the private hospital I went to had guards all over the place). Public healthcare systems, on the other hand, are increasingly losing the little funding they’ve received. Had I gone to the public hospital, I would have been served in overcrowded wards with overworked nurses and where supplies run out frequently. Obviously, the staff does the best job they can given the circumstances, and many of the nurses receive advanced training in South Africa. However, educated staff can only do so much when they lack the resources to do their jobs properly, and unfortunately Botswana’s public healthcare system is simply insufficiently funded to meet everyone’s needs.

The work of charities and research institutes to find cures for diseases that plague Africa is extremely important. And in no way do I want to downplay the significance of their efforts because it is not hyperbole to say that their work saves millions of lives each year. But my concern is that this work, and the efforts by governments to help distribute these treatments has a crowding out effect on the rest of the health infrastructure. There is little question that Botswana needs help finding and paying for solutions to its HIV epidemic. But Botswana’s government is now paying almost 80% of the cost of antiretroviral drugs that can prolong patients’ lives. Yet by paying for these treatments, it has the effect of crowding out spending for other healthcare needs, including for public hospitals.

And unfortunately, limited resources combined with heavy spending on treatments for diseases such as HIV affect how others in Botswana live healthy lives. For instance, is it worth extending the life of an AIDS patient for three months with antiretroviral therapy instead of paying for treatment to prevent the sufferer of an ocular infection from permanently going blind? Nobody wants to make that choice, and yet I fear that is the choice being made all too often in Botswana and other developing countries.

This is an argument for prevention, and illustrates why distributing condoms or bednets not only keeps people healthy, but reduces healthcare spending in the long run by reducing the number of ethical decisions that must be made about treatment. And to be fair, while Botswana’s government has made attempts to prevent certain types of conditions, such as HIV, it has done a less effective job at preventing others. For instance, at the government-controlled University of Botswana where I studied, none of the soap dispensers in the student restrooms were filled. That very simple and inexpensive step to improve public health has the potential to improve academic performance as well as reduce health spending, but hadn’t been taken by staff who were preoccupied with more pressing matters. Moreover, the government has done little to promote healthy diet and exercise, despite the fact that the country is increasingly urbanized. Most Batswana used to live out in villages and work in the fields all day, so if they ate their traditional diet of meat and starch (usually maize meal or sorghum meal), with few vegetables, they stayed relatively healthy. Now, people continue to eat their old diets, but work in office parks all day, and you don’t need the intelligence of a Swattie to predict the result.

My fear of visible diseases such as AIDS crowding out other health spending was confirmed in a lecture given to my exchange student group by former health minister (and current UB professor), Sheila Tlou. Ms. Tlou made wonderful strides in combating HIV throughout the country, for instance reducing the maternal-child transmission rate from 40% to 3% during her four years in office. Yet when I asked whether tradeoffs in health spending had occurred because of the emphasis on HIV, she replied in the affirmative, but said that it was an inevitable consequence of living in a country where a quarter of the population suffers from an incurable fatal disease. Still, though, I wonder whether even small changes can be made in how health dollars are spent that would improve the health of the other 75%, without materially making the HIV-sufferers worse off.

But despite the best efforts of our organization and other well-meaning governments and NGOs worldwide, people will still succumb to illness in spite of preventative efforts. We can try to prevent the necessity of tradeoffs having to be made, but all too often, regardless of the amount of dollars pushed into prevention; those tradeoffs will still have to be made, and nobody wants to make them.

I wholeheartedly stand by the statement I made above, that the work GHF does regarding malaria awareness and prevention is incredibly important. But we cannot forget, nor can we let the wider public and NGO community that we work with forget that Africa is a continent where people suffer from tropical diseases like malaria and deadly retroviruses such as HIV in addition to the full spectrum of health problems that human beings encounter throughout their lives. This may seem obvious or trite, but it is a point that seems to be underemphasized in discussions about improving health in the developing world. We must work to apply the best available methods in combating all illnesses in the continent, not merely those that command attention because of their uniqueness to Africa or their widespread effects on vulnerable groups such as infants.

Charisma has much to do with the popularity of a health problem. People often donate to the World Wildlife Fund because they see a picture of a charismatic megafauna (eg. a sad-looking panda bear) and ask themselves what they can do to help the poor defenseless pandas. In fact, the plight of the pandas is a problem, but it is only one of many facing the animal kingdom. If WWF gave all its money to support pandas, each one could in theory eat many tons of bamboo for the rest of their lives and be plump and jolly. Yet the other animals in the ecosystem which help support the panda’s plentiful bamboo supply would obviously face real challenges and this in turn could hurt the panda.

A similar analogy can be made in healthcare delivery. People in Botswana still get eye infections, they get cancer, they have heart attacks, they break bones, etc. And all these health problems that we in the West may be more familiar with can still have very devastating consequences for the quality of life of those living in Botswana. Westerners are more familiar with these problems arguably because we don’t have to deal with widespread and deadly conditions such as malaria and HIV on an everyday basis. But the presence of HIV and malaria doesn’t make the other deadly health problems that people experience in the developing world any less real or any less prevalent. In fact, I suspect that for some conditions, such as cancers and broken bones, the incidence in the developing world is higher due to lax laws about product, worker, and road safety. (Don’t get me started on the problems with DUI in Botswana…)

I would argue that such a holistic approach starts with institution and capacity-building—ensuring that systems of public health delivery are equipped with the technical knowledge and resources to solve Africa’s health challenges. Locals obviously need to be trained, and NGOs need to provide funding to address a wider spectrum of health problems than simply one disease. This is why the Global Fund has started emphasizing the importance of developing entire healthcare systems (see points 9 & 10) instead of targeting resources only to specific diseases.

Systemic healthcare can ideally address health problems from people who don’t have much of a voice. The plight of the disabled in the developing world is often horrific, yet their cries for help get drowned out along with many others. The plight of women who need access to birth control or protection from abusive husbands, or of girls who need access to sanitary pads which allow them to stay in school after menarchy continue to be ignored all too often by a male-dominated health establishment. Even countries such as Botswana which publically promote equality of sexes continue to marginalize them through the healthcare system.

Integrated and systemic healthcare delivery has the capability to empower caregivers, mostly women, who are often burdened with the long-term care of an HIV patient or an aging relative. Providing some sort of training and support to these individuals has the potential to improve health care outcomes as well as improve the quality of life for those shouldered with this responsibility. Protecting the physical health of one individual should not come at the expense of the mental health of the caregiver. Perhaps some form of hospice or other community-based care where the burdens are shared among many is a way of easing the challenge of care. It is often the most marginalized individuals who must access care outside the traditional hospital or clinic setting due to lack of transport, payment, or an inability to get to the care facility due to ill health. Thinking about care that takes place outside these formal settings necessarily means thinking about those who are most socially marginalized as well as those who are not receiving care but providing it to a loved one.

A systemic approach to healthcare in the developing world also considers many means of healing that are often-marginalized from discussions about global health. One is the role of local or traditional medicine. Traditional healers are still popular in Southern Africa and becoming more so, as they can be more affordable than going to a formally-trained doctor. Some of what they practice is nonsense, or even dangerous. For instance, one healer my exchange group got the chance to visit promised that if caught early, his herbs could cure someone of HIV. Obviously, this raises a whole host of complications and dangers that I don’t want to elaborate on, but must be addressed if traditional healers are more closely integrated into mainstream healthcare systems.

Yet at the same time, there are aspects to traditional medicine that can be backed by Western science. Some herbs or other plant parts used in such medicine do contain antioxidants or other compounds which have demonstrated healing effects. Moreover, even if the plant contains few healing properties, it does have the power of the placebo effect, and the psychosocial experience of healing as opposed to pill-popping may be just as powerful for some conditions as taking drugs. Traditional healers are often distinct from the formal healthcare delivery system in Botswana, but I would argue that by integrating the two in a responsible manner, it has the power to enable developing countries to provide healthcare more independently of western donors and their medicine while delivering similar or better health outcomes.

My plea for integrated systems of healthcare should not in any way suggest that we should not take care of the problems that are most deadly and pernicious in the developing world, and that includes malaria and HIV. But for better or worse, we live in a world with lots of health challenges. To give someone a bed net and protect them from malaria is a wonderful act. But if that person dies a year later because of a mild flu, I don’t know whether we’ve really done our job.

As students, we face innumerable barriers to action and while I present a vision for examining problems systemically, it’s one that is obviously difficult for a student group such as GHF to carry out. But that doesn’t mean we can’t do anything. In looking towards the future this year at GHF, it may be advisable to see whether we can look at ways the NGO sector can supplement public health spending through efforts which include marginalized individuals and problems into the discussion about healthcare spending and delivery. What can we do to support caregivers and family members? How do we get people to make better decisions about their own health, and that of their family members? Is an issue such as domestic violence one that we should examine as a group promoting better global health? (And can we even do anything about that issue?) Does providing insurance or some form of community-based support, as in Rwanda, create a moral hazard problem, or provide an important safety net?

To conclude, I must apologize if this piece seemed like a rant. I was in a situation where I had to be treated for a serious but non-lethal health problem in an environment where others in my situation very well may have lost vision in one eye because most of the health dollars are going towards spending on a very serious, very lethal health problem, but one affecting a minority of the population. This experience has impressed upon me the importance of viewing global health challenges holistically, not merely through the lens of specific (albeit serious and widespread) diseases. You are free to disagree with my conclusion. But I hope that this essay generates discussion about what it really means to promote global health, and whether it should be part of the prerogative of NGOs or donors to use funds for systemic healthcare delivery that addresses more routine health matters which often continue to be serious problems in donor countries themselves.

- Sam Sellers

HIV/AIDS, tuberculosis, and malaria, or “the big three,” are the three most recognized and targeted diseases afflicting developing countries. These diseases have high mortality rates, killing millions of people each year, and most international efforts to control infectious disease focus on these diseases.

I would like to address some tropical diseases which, although extremely common in developing countries, have lower mortality rates and receive far less international attention. These diseases, which are the 5 most prevalent Neglected Tropical Diseases (NTDs), are not as deadly as HIV/AIDS, tuberculosis, or malaria. However, these parasitical diseases have a great impact on child growth and development, have serious socioeconomic consequences, and can be chronically disabling and painful.

They are, in order of prevalence*:

1. Ascariasis (roundworm), 807 million
2. Trichuriasis (whipworm), 604 million
3. Hookworm, 576 million
4. Schistosomiasis, 207 million
5. LF (lymphatic filariasis), 120 million

*Jotez, Peter. Forgotten People, Forgotten Diseases. 2008

More than one billion people are affected by one or more of these parasitical diseases. But only half a million people die from these diseases each year (as compared to 1 million each from HIV/AIDS and malaria and 1.8 million from tuberculosis). I will talk about each of these diseases briefly, focusing not so much on the medical details, which Wikipedia can supply, but on their socioeconomic impact. While the NTDs are products of poverty, they are also promoters of poverty.

1-3. Roundworm, Whipworm, and Hookworm

These three diseases are caused by soil-transmitted helminths (STHs), helminth being another word for parasitic worm. These worms infect the intestines of humans, and are spread when human feces containing worms are deposited onto soil, where the worms can infect new victims through ingestion of contaminated vegetables or water, or by burrowing directly through the skin. These worms thrive in warmer regions, where they can survive in the soil. The worms grow and mature in the intestines, where they rob the person of important nutrients and impair absorption of protein, fat, iron, vitamins, etc. STH infections can lead to other intestinal problems, such as colitis and rectal prolapse.

By causing malnutrition, STHs stunt the physical growth and cognitive development of children. Clinical studies have shown that STHs negatively affect children’s memory, cognition, and intelligence. They also reduce school attendance. Thus, STHs affect education, which ultimately has a negative impact on economic growth. For instance, studies have shown that “infection with hookworm during childhood is associated with a 43% reduction in future wage-earning capacity” (Jotez, 2008).

While the STHs promote poverty, poverty also promotes STH infections. Places where STH infections are endemic, afflicting much of the population, are also places where people lack sanitation systems and latrines. Dirt flooring in houses and a lack of shoes also allows for easier transmission. In endemic areas in Sub-Saharan Africa, India, and Latin America, anthelmintic drugs are only a temporary fix, because within months the person is usually infected again. Although dosing with anthelmintic drugs has been shown to have the greatest impact on reducing STH infections, economic development also has a great impact. Hookworm infections were once common in the rural Southern United States, but urbanization and economic development, combined with medication, eradicated hookworm.

4. Schistosomiasis

Schistosomiasis is caused by another type of helminth, called flukes. The flukes spend part of their life cycle in snails and are then released into water. When humans come into contact with the flukes, by bathing, swimming, fishing, working in irrigated fields, or drinking un-boiled water, the flukes penetrate their skin and enter the bloodstream, where they cause severe flu-like symptoms, known as “snail fever.” But over time, the flukes penetrate the bladder, kidneys, intestine, or liver, causing organ disease and anemia, and leading to chronic abdominal pain, malnutrition, and weakness. Schistosomiasis reduces a person’s work capacity, and in children, causes many of the same problems as STHs (stunted growth, impaired cognitive development). In many cases, schistosomiasis causes vaginal lesions, which increases the likelihood of HIV/AIDS transmission.

By decreasing children’s ability to learn and succeed in school and the ability of adults to perform both physical and cognitive labor, schistosomiasis, like the STHs, lowers the economic potential of a country. Due to use of praziquantel, an anti-fluke medication, schistosomiasis has been mostly eradicated in Egypt, China, and some Latin American countries. However, in sub-Saharan Africa, schistosomiasis is still prevalent in many countries, largely due to the fact that these countries cannot afford praziquantel (Jotez, 2008).

5. Lymphatic filariasis (LF)

LF is caused by the filarial parasitic worm Wuchereria bancrofti. The worm is spread by mosquitoes, in much the same way that malaria is spread. Unlike schistosomiasis and the STHs, the W. bancrofti parasites do not take up home in the intestines; rather, they infect the lymphatic system, where they release eggs called microfilariae into the bloodstream, so feeding mosquitoes can continue to spread the disease. LF can result in debilitating fever, hdyrocele (swelling of the scrotum), and lymphedema, the most dramatic and apparent symptom. Lymphedema occurs when the worms die, and causes severe swelling of the genitals or legs. Because of the elephant-like appearance of lymphedematous legs, this part of LF is sometimes referred to as “elephantiasis.”

Because the worms die around the time of adulthood, LF has great socioeconomic impact. Young men and women often lose their jobs because they are incapacitated. LF is also stigmatizing, and people with LF are frequently abandoned by their families. In his book, Dr. Peter Jotez describes a young woman with LF who lost her job and was abandoned by her husband.

Like the other parasitic diseases I have described, LF affects some of the world’s poorest people. LF was eliminated by widespread treatment with DEC (a drug that kills microfilariae) in China, Brazil, Japan, Tanzania, Taiwan, and Egypt. Meanwhile, in sub-Saharan Africa, there are many countries who lack the financial means to mass-administer DEC.

The good news is that, with widespread drug treatment, LF could be eliminated worldwide. Humans are the only reservoir for W. bancrofti. A single dose of DEC or ivermectin (another anti-parasitical drug) reduces the amount of microfilariae in the blood for a year. The fact that LF has already been eliminated from several other countries provides hope that one day, with enough drug administration, LF will be eliminated worldwide.

Source: Forgotten People, Forgotten Diseases, by Peter J. Hotez. ASM Press, 2008. Dr. Hotez is President of the Sabin Vaccine Institute in Washington DC, where his team is working on developing vaccines for hookworm and schistosomiasis.

Mobile medical and dental van.

What do you think about when you take a sip of warm coffee, or eat a bowl of blueberries? Six months ago, I would not have answered “migrant workers”. However, through studying abroad in Costa Rica and pursuing a summer experience (funded by the Lang Center for Civic and Social Responsibility) with a mobile clinic outreach program for migrant workers in Oregon, I have been able to learn more about health issues of migrant agricultural workers.

Main street running through a border town. To the right of this street is Panama, to the left, Costa Rica.

Because migrant farmworkers often move between countries and regions, following crop seasons, it is difficult for them to obtain consistent, integrated health care, or to develop ongoing relationships with providers. When providing health care to migrant workers, medical records are usually not available. Near this border town (see picture) in Costa Rica, health workers sometimes set up tents where they vaccinate migrant workers passing through. For vaccines, as with certain other types of medical care, having a detailed record of which ones people have or haven’t received before, and when they received them, would be helpful.

Immigration status can also be a source of fear for migrant workers, since many are undocumented. Even though the organization I am working with this summer is a non-profit organization that is not affiliated with the government or immigration services, people still often give us false personal information such as phone numbers and date of birth. This can make it more difficult to communicate with them and keep accurate records.

There are a host of formidable language and cultural barriers as well. In both Costa Rica and the US, a number of the migrant workers speak indigenous languages as their primary language. Moreover, cultural differences may lead to provider and patient having different understandings of the causes of health and illness, the role of providers, and effective treatments.

These are but a few of the factors leading to the current health status of migrant workers. The average life expectancy of migrant farmworkers in the US is a shocking 49 years old (Moreno). Some of the health issues that have seemed of particular concern in migrant camps that we’ve visited this summer are diabetes and sexually-transmitted diseases.

Particularly with the tension surrounding immigration and migration in the US currently, people may wonder why they should care about migrant worker health. In my opinion, regardless of your views on immigration and what rights and services migrant workers should and shouldn’t be entitled to, health is pretty basic, and the people whose labor we benefit from at almost every meal deserve basic health. Moreover, migration is one example of how global health can easily become local.

There are a number of ways in which people who want to can contribute their energies and talents to help out. Recently, a group of college students at Evergreen State University held a bicycle collection drive, and we are in the process of taking the bikes to the migrant camps. Others volunteer to provide much-needed health education (see picture).

One thing I think would help the health status of migrant workers is reducing their invisibility in our society. Maybe I’m just ignorant, and other people are more aware of migrant worker issues than I was six months ago. But more media coverage, research, and people educating themselves would all help increase awareness. If you ever get the chance, visiting a migrant camp and sitting and having a conversation with the people there will affect the way you think about food.

Moreno, Alberto. Migrant Health Fact Sheet. Oregon Department of Human Services. Web. 4 July 2010. <http://oregon.gov/DHS/ph/omh/migrant/migranthealthfactsheet.pdf>.