Adventures in Health

The end of AIH...

2009-01-15T10:17:00.000-08:00

but the beginning of something even more wonderful!

I won't be posting any more on Adventures in Health. It's been a great experience and I've been able to learn some blogging skills and have had a lot of fun too. From now on, I'll be blogging with my good friend and global health whiz-kid Peter Luckow at the Students for Global Health Equity blog (sghe):

ghequity.wordpress.com.

Please check us out!

100 Global Health Blogs

2009-01-04T13:38:00.000-08:00

USPharmD+ provides a list of the top global health blogs on the net. AIH didn't make the top list... but GlobeMed did (#76)!!

Lots of great resources to check out!

Creating a global health student-led seminar

2009-01-03T09:18:00.000-08:00

As part of a commitment made to attend the Clinton Global Initiative University (CGIU), myself and a team of students are currently working to develop a student-led seminar designed to get students to think more deeply about the role that they can play in global health as well as to think critically about the ethics and potential negative effects of their actions.

Today, university students have an unprecedented awareness of growing health disparities throughout the world. Not only are students aware, but they are eager take action to address these observed disparities. Along with taking advantage of academic programs on university campuses, students more than ever are traveling to underserved communities and taking part in medical service delivery. While global health volunteerism can be accomplished in ways that are sustainable, culturally sensitive, and positive for the recipient communities, we worry that too often students are thrust into situations where they are ill-prepared to make actual positive impact. Worse still, without proper training and preparation, volunteer efforts could unintentionally result in significant harm to vulnerable populations or health hazards for the volunteers themselves.

We believe that students can create positive change in global health by being culturally competent, striving for sustainability, and understanding the ethical implications of our actions. Therefore, we seek to develop a student-led seminar that will engage students in critical thought about effective student involvement in global health. By addressing the root causes that drive global health inequity we hope to frame a discussion which creates discernment amongst participants about their own motivations to be involved in this movement. Using models of existing, student-led organizations, the course will explore issues of global health service, such as cultural competency, asset-based community development, medical ethics, and extending one's impact beyond their stay. Upon completion of the course, students will be better able to maximize the impact of their global health volunteerism and be equipped with the skills and judgment to be tomorrow's global health leaders.

Here is a brief outline of the topics we hope to cover in the seminar:

Week #

1.Global Burden of Disease

An introduction to major trends of the distribution

2.Root Causes of global health inequities

Structural violence, neoliberal economic policies, etc.

3.Discernment, motivations, and goals

Asking the question: Why do we really want to be a part of this movement?

4.Students can cause harm

Reading such things as Duffel Bag Medicine, by Maya Roberts and To Hell with Good Intentions, by Ivan Illych

5.The 4P's: Power, Privilege, Position, and Posture

Based on a discussion by PIH Director of Development, Ed Cardoza

6.Cultural Competency

7.Long term vs. short term engagement

Developing tools to measure impact

8.Sustaining your impact

Case studies of effective/ not effective student-led organizations

9.Reflection/Moving Forward

I'd love for an comments/ideas for resources/criticism of what we've got so far. I'll keep you posted about our progress!

Not just any hemorrhagic fever: ebola in the DNC

2008-12-29T13:56:00.000-08:00

I've always been fascinated and horrified by the ebola virus. It is one of those diseases that seems like it belongs in a science fiction movie rather than real life. Unfortunately, it exists and a new outbreak has been recorded in the Democratic Republic of Congo.

Here are a few reports on the situation:

Two more dead from ebola outbreak in DR Congo: MSF - WHO

Ebola -- in people, DRC - Aetiology

Death Toll Up in DR Congo - BBC News

Democratic Republic of Congo: MSF Responds to Ebola Outbreak in Kasai - MSF

Ebola in the DRC - MSF Blog

Christmas Lessons and Social Justice

2008-12-25T17:09:00.000-08:00

Nathaniel Whittemore, the founding director of Northwestern's Center for Global Engagement has a really great blog post about what Charles Dicken's 'A Christmas Carol' can teach us about social justice. I had the opportunity to go see a play at an adaptation of the play at a local Portland theater on Christmas eve. For me, it was an excellent reminder of the things that matter most.

Merry Christmas everyone!

This I Believe

2008-12-22T10:45:00.000-08:00

This I Believe: Health is a human right. Here is a moving essay by Paul Farmer read on NPR.

http://www.npr.org/templates/player/mediaPlayer.html?action=1&t=1&islist=false&id=98460202&m=98566591

Propagating structural violence

2008-12-22T10:06:00.000-08:00

Really disheartening news that the United States recently was the only voting nation to vote against "the right to food" for the world's poorest in the UN General Assembly.

UN General Assembly press release:

"Draft resolution XX on the right to food, approved on 24 November by a recorded vote of 180 in favour to 1 against (United States), with no abstentions, would have the Assembly reaffirm that hunger constitutes an outrage and a violation of human dignity, requiring the adoption of urgent measures at the national, regional and international level, for its elimination. "

It is really sad to me that the United States would vote against something like this, but I can't say that it is surprising. It highlights the need to change the way we look at rights in the United States. We need to adopt a mindset about rights which is broader and includes social and economic rights in addition to civil and political rights.

Human rights matter. I can't wait to have a President and an administration that agree.

I'm on twitter!

2008-12-21T11:04:00.000-08:00

I'm still pretty new to the whole thing, but it does seem like a useful tool to exchange quick global health links, blog entries, and news stories.

You can follow me at: http://twitter.com/jonshaffer

GlobeMed at Northwestern Quarterly Newsletter

2008-12-14T12:23:00.000-08:00

The Fall Quarter GlobeMed at Northwestern Newsletter is finally finished. Check it out here. It includes articles by students (including myself) who traveled to the HOPE Center this past summer as well as guest articles by Professor Kearsly Stewart and Peter Luckow, amongst others.

I think it turned out really well. Many thanks to Carol Park and Tiffany Wong for editing the content and layout!

health care systems at home and abroad

2008-12-09T15:55:00.000-08:00

PLoS has some interesting dialogue about what will increasingly become an important discussion. Will global health be mostly driven by a private, profit driven model? Or, will it largely be funded and organized by public sector national governments? My problem here is that this dialogue is being driven by us, the wealthy donors, rather than the countries that will ultimately have ownership over the systems. Shouldn't we be letting the developing nations create systems which will work for them? Why should we dictate the way they organize their health systems? It stinks of subtle colonialism.

Back on the home front, in a recent blog post Paul Farmer discusses some of the opportunities and challenges Obama will face while trying to overhaul the crippled US health care system. Money quote:

"Listening to Drs. Kim, Berwick, and Jarman reflect on what ought to be done gave me hope. They’ve made the right diagnosis—all agreed that it’s the system itself that is broken and tinkering won’t fix it—and had some smart prescriptions. Policies and plans won’t suffice, warned Jim Kim, who’s made a long study of the gap between aspirations and the care that is actually delivered. We need a social strategy, one that will engage Americans eager for a major overhaul of the system."

"... Are Americans today really opposed to FDR-style social insurance? We can learn something from the British on this score (OK, maybe not as regards dental plans) and from groups like IHI and visionaries like Kim. Patients (and who is not one, as some point?) and doctors alike may need to dig deep to find our inner New Dealers, but it’s high time we built a real social movement for a proper health service worthy of the American people."

Finally, the American Prospect has a great article discussing the cost of not seriously reforming our broken system. With leadership from Tom Daschel, Jeanne Lambrew, and Obama, hopefully this time around we'll have a better shot at securing the right of equitable health care for all Americans.

Webinar with Dr. Joia Mukherjee

2008-12-09T13:45:00.000-08:00

Sorry for the recent lack of student-global-health-blogging-goodness. Now that exams are largely done for the quarter, I should be able to jump back into it full force.

A good start:

I just got off of a very interesting webinar with Dr. Joia Mukherjee who is the medical director of Partners in Health. It was put together by GlobeMed as a part of its globalhealthU, health and structural violence theme.

The discussion touched on some extremely important themes that are too often not addressed by those who make policy decisions regarding global health. The fact is that health is structured by social forces. Decisions that affect an individuals health - whether or not to engage in transactual sex, to go see a doctor for an infection, to wash hands - are shaped by social conditions. Wealth, race, gender, all play a part in determining an individuals agency in decision making.

One of the most poignant examples of structural violence came from a simple slide with two photos: one of Keith Richards and the other of fouryoung Rwandan children. The children were orphans, and the oldest, age 9, was the head of their household. She posed the question: what are the risk factors for becoming infected with HIV? We rattled off the standard list of promiscuous and unprotected sex, injection drug use, and other "risky" behaviors.

Why then, she asked, is Kieth Richards not the poster child for HIV? The reality was that these four children had a far greater risk than Kieth Richards (who has participated in every risky behavior in the book) of becoming infected with the virus. Their risk factors for acquiring HIV were not "risky sexual choices" but instead were simply trying to survive and exist in a situation that was deeply unjust. The children's risk of becoming infected with HIV was structured by the same violent forces that allowed a 9 year old girl to be the sole provider of a family of four.

This raises another question: How is it possible that a 9 year old child is allowed to be solely responsible for 3 small children?

It's basically unfathomable for a little 9 year old girl in Evanston, Illinois to raise her siblings by herself. Goverment or nonprofit agencies would step in and provide much (although not perfect) assistance. Yet, for some reason we aren't easily rattled by the same exact circumstance occuring to these African children. Its not easy to dismiss the fact that we almost expect these circumstances for African children. By expecting it, we learn to accept it. And, by accepting it we expose the fact that we too are immersed in and contribute to structural violence.

More that anything, I hope that GlobeMed can contribute to developing a culture of self criticism and the awareness of structural violence amongst students devoted to improving global health. Webinar events such as this will continue to go a long way to expose students to these powerful and important ideas.

Institutional review for student service?

2008-10-31T20:19:00.000-07:00

My good friend Peter Luckow recently said one of the smartest things I've ever heard about the ethical implications of students engaging in global health work. He said to consider the fact that any research conducted in affiliation with a university - including social science and biomedical research - must be approved by an institutional review board to ensure ethical work. For example, anthropology research is checked to make sure that interview questions are culturally sensitive and will not in any way harm the research participants. This review process is essential to protecting research participants and insuring that the sciences are ethically sound.

His point however, was that no such attention is given to students who engage in international service, especially global health work. There are numerous student groups on the Northwestern campus which send students on "medical mission trips" where medicine and direct medical care are given. Unfortunately, no one regulates this work. No one evaluates the actual costs or benefits to the communities of the students actions. As I've mentioned before on this blog, there is a large potential to inadvertently cause harm through these short term medical volunteer trips.

I think that one could argue that the potential for harm and the ethical implications are far greater for direct medical care than they are for anthropological or other social science research. Yet, the university provides no way to regulate the actions of Northwestern student groups doing global health work.

Should there be an institutional review process for international (or perhaps even domestic) service projects? Is it the university's responsibility to regulate the service work conducted by student groups?

I'd love to hear what you think.

Generation WE

2008-10-29T12:45:00.000-07:00

Sorry for the lack of posts recently... I've been stuck in the biomedical engineering land of never ending lab reports and exams.

Anyway, I saw this great video that I think captures a lot of the optimism that I see amongst my peers. The reality is that my generation will have to deal with some pretty big problems: religious radicalism, a tanking economy, and global disparities in health. But, my generation realizes that if we can find innovative ways of working together, we really can begin to tackle them. I think that the success and expansion of GlobeMed at college campuses across the US is a testament to the drive that young people feel to think deeply about these big problems and to build a better world.

The theme of the week:

YES WE CAN.

Backing it up

2008-10-16T12:52:00.001-07:00

Here is some data that reflects my previous claim that the despicable US infant mortality statistics are at least in part driven by high inequity.

The CDC reports in Recent Trends in Infant Mortality in the United States that,

"The infant mortality rate for non-Hispanic black women was 2.4 times the rate for non-Hispanic white women. In 2005, the infant mortality rate for non-Hispanic black women was 13.63 infant deaths per 1,000 live births, compared to a rate of 5.76 for non-Hispanic white women. Rates were also higher for Puerto Rican and American Indian women, 8.30 and 8.06 respectively."

And in another paper, Trends in Preterm-Related Infant Mortality by Race and Ethnicity: United States, 1999-2004, they present this data:

This clearly shows significant differences in infant mortality between mothers of different ethnic/racial backgrounds: Non-hispanic black women have the highest rate of infant mortality, followed by Native American Indian and Puerto Rican women.

While I think that it is important to look at these data through a racial/ethnic filter, I think that a more interesting and telling analysis would be to look at it in terms of annual income. I think that there will be a much stronger correlation between income and infant mortality than race and infant mortality. The tragic reality in our nation though, is that one can often act as a proxy for the other...

Again, if anyone has any good data linking socioeconomic status to infant mortality, I'd like to see it!

Infant Mortality Drops in the United States

2008-10-15T08:09:00.000-07:00

Today, the NYT reports that the infant mortality rate in the United States has dropped by two percent, yet still remains much higher than most industrialized nations.

"Infant mortality has long been considered one of the most important indicators of the health of a nation and the quality of its medical system. In 1960, the United States ranked 12th in the world, but by 2004, the latest year for which comparison figures are available, it had dropped to 29th."

This is even more staggering considering,

"In 2006, Americans spent $6,714 per capita on health — more than twice the average of other industrialized countries."

We spend far more on the health of our citizens, yet we get far less in return. The NYT makes some generalized claims for why this irony exists,

"Some blame cultural issues like obesity and drug use. Others say that the nation’s decentralized health care system is failing, and some researchers point to troubling trends in preterm births and Caesarean deliveries."

I think that it most likely has to do with the highly inequitable health care system which is driven by market economics. Although I do not have any data right now (I'll try to find some, or if anyone knows any good research, pass it my way!), I have little doubt that infant mortality statistics are highest amongst minorities and those in poverty. The Social Determinants of Health, a recent WHO report discusses how health outcomes are largely structured by the social position and conditions in which one lives. If we as a nation value a healthy society as a whole, then we should start to recognize inequity as a driving force for these negative health statistics, and work toward to lessening the gap.

Health is structured by poverty

2008-10-14T08:31:00.000-07:00

Here are a couple of great posts over at the Health Care Blog about poverty being one of the largest determinants of the long term health of children as well as adults. Maggie Mahar discusses a new report from the Robert Wood Johnson Foundation titled, “America’s Health Starts With Healthy Children: How Do States Compare?” See the posts here and here. Money quote:

“Most of our efforts to improve health have focused on improving quality, access to and affordability of care. While these are important, support for better health that is associated with resources and community matters as well,” says Commission Co-Chair Mark McClellan. “As a nation, we clearly need to do better…a large body of research shows that the causes [of poor health among children] are complex,” the report observes, “and that medical care interventions are important but not sufficient.”

Equitable access to nutritious foods, high quality education, and clean, sanitary living conditions are just as important as access to high quality medical care. Here are her suggestions:

"We should explore ways to provide jobs that pay a living wage to less-educated workers. For example, in these tough economic times, the government might invest in rebuilding our infrastructure—an investment that also would create jobs.

Investments in safe playgrounds and subsidies for green-markets that locate in poor neighborhoods could help improve quality of life—and the health of children
Low-income and middle-income children also need scholarships to help them go to college. In recent years, federal funding has favored financing loans that only more affluent families can afford; at the same time scholarship programs for low-income and median-income children have been cut. This trend should be reversed.
Finally, we should find new ways to lift the quality of public education for low-income students. Richard Kahlenberg, a colleague at The Century Foundation, has written extensively about innovative programs doing just that."

This sounds a lot like moving toward social and economic rights for everyone. Why is she still against using rights language?

Human Rights: Animated

2008-10-12T20:14:00.000-07:00

Here is a beautiful play on the words written in the Universal Declaration of Human Rights.

Never again? Reflections on Human Values and Human Rights

2008-10-10T11:03:00.000-07:00

This is honestly one of the most powerful pieces of writing that I've ever seen describing why health - along with social and economic justice - should be considered a human right. Paul Farmer is a giant in the field and his writing has definitely influenced my life course.

This is a long, at times painful read, but I think it is a really an important essay.

Never again? Reflections on Human Values and Human Rights. By Paul Farmer, The Tanner Lectures on Human Values

Obama digs health as a right!

2008-10-09T12:28:00.001-07:00

Health is a right?

2008-10-08T13:30:00.000-07:00

Here is a really interesting post on The Health Care Blog by Maggie Mahar who rights on the Health Beat blog. In it she criticizes the use of rights language when talking about health care reform. Money quote:

"I have to admit I often have found the language of healthcare “rights” off-putting. Yet the idea of healthcare as a “right” is usually pitted against the idea of healthcare as a “privilege.” Given that choice, I’ll circle “right” every time.
Still, when people claim something as a “right,” they often sound shrill and demanding. Then someone comes along to remind us that people who have “rights” also have “responsibilities,” and the next thing you know, we’re off and running in the debate about healthcare as a “right” vs. healthcare as a matter of “individual responsibility."

I vehemently disagree with her. Her main thesis is that rights language is not specific enough, and tends to polarize the discussion. In my opinion, it is exactly the type of language that we need to get things moving. The language of human rights is very specific. The only body that can guarantee rights to people are sovereign governments - no private entity can ever grant rights. For that simple reason, we must use rights language to describe health. Health care cannot be bought and sold on the open market because, by economic definition, there will be people who cannot afford the price set by the intersection of supply and demand. By casting access to reasonable health care as a human right, we can move beyond the idea that health is something that can be bought and sold, and move toward universal access.

Is this "shrill and demanding"? I certainly hope so. Guaranteeing all people the ability to see a doctor when they are sick is certainly one of the most pressing issues of our time.

Photo Journalism of XDR TB

2008-10-04T09:04:00.000-07:00

Renowned photo journalist James Nachtwey is building awareness and increased action against XDR TB, or extremely drug-resistant tuberculosis. XDR TB is becoming an ever more dangerous public health threat because it is relatively easy to transmit through the air and is nearly completely untreatable - it is resistant to almost all of the standard drugs used to treat TB. See James' haunting photos here. Here is another great article about XDR TB in Time Magazine titled, The Forgotten Plague.

These maps below highlight the fundamental problem in public health: inequitably distributed resources. The first shows the earth's land area distorted by a mathematical model reflecting the distribution of TB. The second uses a similar model to distort the earth's area, reflecting public health spending.

TB Prevalence:

Public Health Spending:

Based on those maps, it is no wonder that TB - a treatable disease - is most often found in Africa and South Asia. The rise of XDR TB can also be understood by these maps. Underfunded, understaffed medical systems thoughout Africa can drive drug resistance by erratic, inappropriate treatment with antibiotics. Investment in primary health infrastructure in countries throughout Africa and Asia is essential to slowing the spread of XDR TB. It will be important to invest in primary healthcare systems, not only because it is morally the right thing to do, but also because XDR TB - in a global society where people can travel anywhere in the world in a matter of hours - cannot be contained within the "Third World." A person XDR TB could hop onto a plane to NYC at any time and start a massive pandemic. If even for completely selfish reasons, XDR TB is something that we should work to combat by working to build primary health infrastructure and trying to change the inequitable paradigm reflected in those maps.

GlobeMed on the Radio!

2008-10-04T08:53:00.000-07:00

Here's a very short interview I did with WNUR, Northwestern's radio station. Nick Zessis is the interviewer, and a new member of GlobeMed.

Free Medical School?

2008-09-27T11:04:00.000-07:00

The University of Rochester has established a $2 million fund to start the process of making medical and dental education at the university completely free. Here is the article in the Rochester Democrat and Chronicle. How amazing is that?

I've ranted before about the obscene costs of applying to medical school, and I've intentionally avoided thinking too deeply about the costs of actually attending medical school. (I'll worry about getting in, and then I'll figure out how to pay for it.) Its no doubt that the high costs of medical education hurt our health system by dissuading some of the best and brightest students in the US from even applying. There are just so many ways for students to get a better financial return on their educational investment other than medical school and practicing medicine. (Although my econ major friends are seeing their lucrative futures as investment bankers dwindling)

Ultimately, I think that it is in our best interests to reduce the barriers for qualified students to go to medical school. We'll get the best and brightest doctors and work to reduce the shortage of doctors in the US. As I've mentioned before, the shortage of American trained doctors is a driving force for the brain drain of the developing world, and will continue to be a major problem as the generation of baby boomers age. Reducing the barriers to medical school will involve two things: 1) reducing the cost of medical education and 2) increasing the number of spots in medical schools.

I hope that more universities and wealthy donors take note of University of Rochester and consider the social good that would come from making medical education free.

The Ethics of Being a Student in Global Health

2008-09-24T08:16:00.000-07:00

Here is an excellent article in this weeks Journal of the American Medical Association titled: Ethical Considerations for Short Experiences by Trainees in Global Health. (You may have to log in through your institution's library or purchase to read) In it they discuss the ethical implications of sending inexperienced students to places of poverty to gain experience as part of a global health training program. I thought that this was especially poignant since my recent post about the explosion of global health programs at undergraduate campuses across the US.

Money Quote:

"...sending institutions have a moral obligation to ensure that the patients and host institutions in which these programs take place are at minimum not left worse off as a result of this collaboration, but they arguably also have a moral obligation to help improve care and service delivery. Mutual and reciprocal benefit should be the goal."

The authors identify five ways in which sending institutions and students benefit from these short-term global health experiences:

Institutions are better able to draw attention to issues of global health disparity.
For some students, the experience may form the foundation for a career in global health work.
The training experience may allow the sending institution to recruit the most talented trainees who are interested in global health experience.
The experience may allow students to gain cultural and health related experiences in ways that may be impossible at home.
Sending institutions may benefit financially from the interests of philanthropists

The bottom line however for the authors:

"The benefits [to the sending institution] should not trump responsibilities for ensuring that these training programs are beneficial to the relevant stakeholders."

I have thought a lot about the ethics students engaging in medical volunteerism in poor countries. I've linked to them before in this blog, but check out two other short articles that have shaped my thinking about this issue: To Hell with Good Intentions, by Ivan Illich and Duffle Bag Medicine, by Maya Roberts.

Fundamentally, as we work as students in global health we must always be critical of our work. We must always think about the potential harm that we (complete unintentionally) may be doing to the communities that we intend to help.

I think that GlobeMed does a very good job mitigating the risk of ethical breaches by creating partnerships with grassroots, community-driven organizations and institutions. We are not students completely on our own, practicing vigilante global health, nor are we a massive foreign institution coming in with our own agenda and motives. Instead, hopefully we can practically address health issues in poor communities by connecting the assets that we have as students to community-driven institutions working to build the health systems necessary to guarantee health equity.

GlobeMed@NU Leadership Retreat Today!

2008-09-21T09:29:00.000-07:00

I'm pumped for our first official GlobeMed at Northwestern event of the year! This afternoon everyone from our exec team will get together for several hours to talk through our chapter goals and develop concrete objectives to ensure that we reach our goals. The great thing about planning our chapter's school year in terms of goals and objectives is that our top-line chapter goal drives all of our activities. Everything that we do - from globalhealthU workshops to fundraising campaigns to on-site visits - is aimed at achieving our top-line goal.

Our chapter's fall quarter goal:
To diagnose and treat infectious disease through expanded diagnostic facilities for Ho and the surrounding communities.

Our concrete objectives will then logically flow from that goal. For example, our globalhealthU Objective is: to build understanding and generate critical discussion about infectious disease, especially in the context of rural Ghana.

Our fundraising Campaign also follows directly from our chapter goal. This quarter's campaign will be titled: The Path to Equity: Building an infectious Disease Pathology Lab in Ho, Ghana Our Campaign Objective is: To raise $10,000 to build and staff a pathology lab at the HOPE Center.

I'm excited to talk all of this over with our exec team, and use these high-level ideas of goals and objectives to drive a more specific programmatic discussion of our chapter's activities. Stay tuned as we plan the details of our quarter!

More About Global Health Being Hot

2008-09-19T18:43:00.000-07:00

Here are some more great reactions to the Washington Post article about the growth of global/public health programs at universities across the US.

Checkout:

The Pump Handle

The Global Health Report

For a Global Generation, Public Health Is a Hot Field (But we already knew that)

2008-09-19T14:03:00.000-07:00

Check out this awesome article in the Washington Post about the growth of global health programs at universities across the US.

What an exciting article to read while being deeply involved in building a student-led movement for global health equity! It is really incredible to see how GlobeMed truly does embodies so much of what was talked about in the article. In an email exchange, here's what my friend Victor Roy, GlobeMed's executive director took from the article:

"- the comparison between our generation and our parent's: "While the causes of their parents' generation were fueled by protest and relied heavily on symbolic victories, the interest in public health reflects this generation's more communitarian and practical outlook." Very true.

- global health engagement of the past: "Kelly Gebo, an infectious-diseases physician who directs the public health major at Johns Hopkins, said that in the past, college students who wanted to do something about global health were limited to collecting money, sending it to UNICEF and hoping for the best." GlobeMed's chapters work directly with partner organizations to turn into a direct reality!

- being responsible: "A fifth-year senior at William and Mary, Stephens, 21, spent two spring vacations helping deliver medicines to a charity in Ghana. The team of 16 students -- she led one of the trips -- raised money during the year to pay for the drugs. The receiving clinic was run by Ghanaian health workers. "We were not dropping out of the sky with American doctors," she said. Totally our approach with GlobeMed as well - work with local staff to complement and strengthen their efforts.

- only 16% of universities (even higher than I thought to be honest) have global health majors/minors.

What's cool is that we bring all of this TOGETHER in a network, whereas most interest for global health is contained within their campus radius or student club - by being part of a larger network, it's easier to understand and mobilize this energy."

I believe that this generation has a tremendous opportunity to fix some of the really glaring problems in the world. We have unprecedented access to resources. We have web-based tools allowing us to work together and collaborate with peers across the globe. And, as documented in this article, there really is a growing desire to critically tackle issues of health inequity.

I think this is a watershed moment in global health. GlobeMed will play a major role in engaging this growing interest and passion and chanelling the energy through training the next generation of leaders in global health. Lets get it done!

Orgo's out?

2008-09-16T15:42:00.000-07:00

There is a new movement by the AAMC and others to examine the utility of the dreaded organic chemistry as a prerequisite for medical school. Post here. I guess the point would be to increase the amount of biochemistry and more medically focused applied sciences as opposed to massive amounts of organic chemistry. I tend to agree and it will be interesting to see how it all shakes out.

GlobeMed Leadership Institute: Crafting our Campaign

2008-09-15T12:03:00.000-07:00

Here is Ankur describing how we should organize our fundraising campaigns in terms of staple on campus events, individual giving, and small businesses.

I really like the idea of diversifying our fundraising strategy at our chapters and moving away from relying solely on on-campus, one-time fundraisers that have little bearing on the actions of the rest of the chapter. The central idea of the Campaign is to brand all of the activities of the chapter - tying everything we do back the goals and objectives for our partner. I think that it will be hugely successful in helping us clearly communicate what we do.

This week will be really important as our chapter at Northwestern will be working on refining and clarifying our own goals and objectives with the HOPE Center, and then use them to brand our campaign for the HOPE Center. Stay tuned for more updates as we hammer out these details.

Barriers to Access: Medical School

2008-09-14T12:31:00.000-07:00

Here are a couple cool posts about the unreasonably high cost of even applying to medical school, and how the high cost serves as a barrier, blocking many would-be excellent doctors from pursuing their dream. Check them out here and here.

I can definitely relate. Between the almost $300 cost for the MCAT, the minimum $100 application fee per school, and flights to any interviews that I get; it adds up to thousands of dollars. I'm fortunate to be heavily supported by my family, and I could only imagine how challenging it would be to even apply to medical school with very limited financial support.

GlobeMed Leadership Institute: The First Day

2008-09-12T21:20:00.000-07:00

Day one of the GlobeMed Leadership Institute was a great opportunity for us to meet many of the student leaders from the 16 chapters across the GlobeMed network. Each of these students are actively forging new partnerships focused on building the capacity for improved global health through through their partnership with grassroots health organizations around the world. It is always so fun and inspirational to get to meet and talk about global health with students who share my passion for these issues.

This evening was largely "getting-to-know-each-other" and talking about GlobeMed as an organization in broad terms. We got a great presentation from the young up and coming global health phenom, Peter Luckow.

Then GlobeMed's executive director, Victor Roy along with the chapter advisor, Ashley Hagaman, gave a nice presentation, GlobeMed Overview: Past, Present, and Future.

Finally, we worked in groups to deconstruct the work of a couple other student groups involved in global health work. We looked at their strengths, weaknesses, and how GlobeMed addresses those issues.

It was a great first day, and very productive. Stay tuned for more updates and video from the leadership institute!

Update from Ghana

2008-09-12T21:10:00.000-07:00

By Sarah Mihalov

I am writing to you from the internet café in the Accra Airport. It is actually quite nice, very simple, and all the people are very friendly. I left Ho this morning via tro-tro (after waiting for 2 hours), which was definitely bittersweet. I cannot wait for the comforts of home and senior year, but it was difficult to leave all of the wonderful people that I got to know and the awesome things that I got to do.

This last week was focused on running the Nutrition Program. Starting Monday, mothers who I had interviewed, came to the center in the morning to receive a demonstration. Margaret, the head nurse, talked them through preparing a meal called weanimix, which is nutritious porridge that is made from local foods: maize (corn) and groundnut (peanut). Many of the mothers do not save the groundnuts because they sell for a lot in the market. Thus, because children do not get this critical protein, many are malnourished. So we are trying to encourage them to save some during the harvest seasons.

Mothers then stayed at the center until lunchtime when their children would receive another nutritious meal (usually rice and beans with a little tomato stew with fish powder). While waiting, we put on these crazy Nigerian movies. The acting is awful and the plot is always something ridiculous, usually involving something to do with a love triangle, witchery, and getting stuck by lightening. So crazy. They love the HOPE center because they rarely get to watch TV and they get to lay on the carpeted floors. We even have trouble getting them to leave!!!

This process continued for most of the week with some new and some returning mothers. The mothers were so interesting to talk to about their lifestyle and how it compares to running a home and taking care of children back in the States. Also, its amazing that many of them are basically my age and already have one if not more children.

I spent a lot of my time the last couple days revisiting old spots, people that I got to know, and just taking in as much of the city as I could. By the end, I realized I felt so much more comfortable in my surroundings, although no matter how long I stayed I would always have children yelling "yavoo" at me on the streets (basically "white person"). Went for one last RedRed, which was delicious. Said by to the boys at the internet café. They were amazing, so nice, so helpful, and never sketchy. Wisdom, the nicest one, has already written me to say Safe Journey! Amazing. The last day I said goodbye to everyone at the center and they all have many hopes of our return next year. We shall see. Saying bye to Margaret was the hardest one. She was basically my mom here, taking care of me during the malaria thing, cooking our lunches with her in the new kitchen, and just telling us all about Ghana and its culture. She was wonderful and I will miss her terribly.

Okay, my time is about up at the airport. Off to see if I can find any cake to celebrate my big 22! J Hope all is well for you back in the States. I will finally be back home Monday evening after a brief weekend in Amsterdam with my parents… a much different sort of vacation. Can't wait to catch up with all of you soon!

Back in Chi-town

2008-09-12T08:16:00.000-07:00

I'm back early to Northwestern for the first annual GlobeMed Leadership Institute, a gathering of student-leaders and presidents from most of the 16 chapters across the GlobeMed network. It should be a really exciting weekend of idea sharing and structure building to help unify the efforts at each chapter.

I'll probably be posting about some of the ideas and discussions that we have during the weekend... stay tuned!

Iraqi Medical Brain Drain

2008-09-10T14:02:00.000-07:00

Here is an interesting post on blog.bioethics.net about an article in the Houston Chronicle. They discuss the Iraqi medical brain drain due to most physicians and medical workers leaving the war-torn country.

Money quote:

"Does the US have an obligation to help the Iraqis get either its own nationals or physicians from other nations to come to heal the literal wounds of this ravaged nation? I think so. Healthcare is just one part of any nation's infrastructure, and key to its getting back on its feet. So if Iraqis won't come back on their own (and who could blame them?), it may be the obligation of other nations to come to their aid to ensure enough doctors are there to care for the Iraqi people."

Check out some other thoughts about the ethics of physician emigration, in the Ghanaian context, here.

Haiti in the Wake of Ike

2008-09-10T12:28:00.000-07:00

Here is another article in the NYT about the devastation in Haiti, left in the wake of four major storms in less than a month: http://www.nytimes.com/2008/09/11/world/americas/11haiti.html?_r=1&ref=world&oref=slogin

One quote that struck me as odd:

"This time, though, there is talk about whether it makes sense to try to recreate the same old place again. Authorities are talking about shifting some of the population away from the lowest-lying areas.

There is discussion of boosting building codes so the next storm — and everyone knows there will be one — does not so easily level flimsy structures. The local emergency operations center was flooded and, Yolene Surena, its coordinator, vowed that the new one will move to higher ground. “We should have done it before,” she acknowledged with a shake of her head."

It seems odd to me to be talking about building code legislation before dealing with mass food insecurity. It seems like there are probably reasons for the "flimsy structures" besides the lack of building codes...

Does anyone else think that this is a strange way to look at the devastation caused by the hurricanes... what Paul Farmer called "very unnatural disasters?"

Just some thoughts.

"I have never seen anything as painful": Paul Farmer writes from flood ravaged Haiti

2008-09-08T15:20:00.000-07:00

On Saturday, September 6, PIH co-founder Paul Farmer wrote to colleagues and supporters of Partners In Health describing the devastation caused by flooding from Hurricanes Gustav and Hanna in Haiti. The previous day Paul and colleagues from Zanmi Lasante had driven to and through the coastal city of Gonaïves, where tens of thousands of people have been driven from their homes and thousands more are living on rooftops without any access to food, water or shelter. Hurricane Ike arrived the next day with more torrential rains and deadly floods.

6 September 2008

Dear PIHers:


	Zanmi Lasante social workers searching for patients in Hinche, Haiti

I am writing from Mirebalais, the place where our organization was born, having just returned from Gonaïves—perhaps the city hit hardest by Hurricane Hanna, which, hard on the heels of Fay and Gustav, drenched the deforested mountains of Haiti and led to massive flooding and mudslides in northern and central Haiti. A friend of mine said this morning: “I am 61 years old, born and raised in Hinche. I have never seen it under water.” Gonaïves, with 300,000 souls, is in far worse shape, as you’ll see from the other pictures I append. The floodwaters in Hinche are dropping, but as of 5 p.m. last night, when we left Gonaïves, the city was still under water. And hurricanes Ike and Josephine are heading this way as I write.

Everyone copied on this note has already heard, most probably directly from PIH, about these storms and their impact on Haiti. I apologize for writing again and for asking my own colleagues and friends to consider sending more resources—we need food, water, clothes, and, especially, cash (which can be converted into all of the above)—so that Zanmi Lasante, and thus all of us, can do our part to save lives and preserve human dignity.


	On the main street of Gonaïve

The need is of course enormous. After 25 years spent working in Haiti and having grown up in Florida, I can honestly say that I have never seen anything as painful as what I just witnessed in Gonaïves—except in that very same city, four years ago. Again, you know that 2004 was an especially brutal year, and those who work with PIH know why: the coup in Haiti and what would become Hurricane Jeanne. Everyone knows that Katrina killed 1500 in New Orleans and on the Gulf Coast, but very few outside of our circles know that what was then Tropical Storm Jeanne, which did not even make landfall in Haiti, killed an estimated 2000 in Gonaïves alone. Logging on this morning from Mirebalais, I see that Ophelia has circulated the essay I wrote about what are, essentially, unnatural disasters.

We’re faced with another round of death and obliteration. Haiti’s naked mountains promise many more unnatural disasters. We know that a massive reforestation program and public works to keep cities safer are what’s needed in the medium and long term. But there’s a lot we can do in the short term to help out with disaster relief.


	People fleeing Gonaïve with what few possessions they could carry

None of us regard PIH as a disaster-relief organization. Together, we’ve built PIH—meaning the network of locally directed organizations working in 10 countries—to serve a different cause. We wanted to attack poverty and inequality and bring the fruits of modernity—health care, education, et cetera—to people marginalized by adverse social forces. It seemed likely, as reports came in this week, that many other institutions and organizations would be far better able to respond to the after-effects of storms and floods. I’d been told, as the American Airlines flight passed over flooded Gonaïves, that the city was cut off from outside help, but even as I heard this, I knew that our own colleagues were there, volunteering what meager resources we had on hand, and a few hours later I was there too. I was hoping that we’d find that the city was receiving the expert attention of organizations trained to do disaster relief. So imagine my surprise, yesterday, when I discovered that very little in the way of help had reached Gonaïves or the other flooded towns along the coast.

Although it’s not true that Gonaïves cannot be reached by vehicle, it is true that the city center is still under water, and that the road into the city is well and truly flooded. Between Pont Sonde—the only way to the coast, since the major bridge between Port-au-Prince and Gonaïves is out, as is that to the north—and the flooded city, we saw not a single first-aid station or proper temporary shelter. We saw, rather, people stranded on the tops of their houses or wading through waist-deep water; we saw thousands in an on-foot exodus south towards Saint-Marc.


	A boy we met on the road to Gonaïves carries a goat. He said he was thirsty so we gave him our last bottle of water.

We saw a couple of U.N. tanks rolling through the muddy water over these streets, some Cuban doctors, and two Red Cross vehicles (one of them stuck in mud at least 10 miles from the city), and heard and saw helicopters overhead. But for the most part the streets were full of debris, upside-down vehicles, and dazed residents looking to get out before the next rains. Our friend Deo from Burundi was there and said it reminded him of nothing so much as what he’d seen there, and in Rwanda, at the time of the genocide in 1994—long lines of people carrying little more than their children, goats, and balancing sodden bags and suitcases on their heads.


	People living on rooftops on Gonaïve's main street, Rue Christophe

A speedy, determined relief effort could save the lives of tens of thousands of Haitians in Gonaïves and all along the flooded coast. The people of that city and others have been stranded without food or water or shelter for three days and it’s simply not true that they cannot be reached. When I called to say as much to friends working with the U.S. government and with disaster-relief organizations based in Port-au-Prince, it became clear that, as of yesterday, there’s not a lot of accurate information leaving Gonaïves, although estimates of hundreds of deaths are not hyperbolic. We had no cell phone coverage there and had to wait until last night to call people in Port-au-Prince. One sympathetic American friend, following up on our distress calls about a lack of relief, told me this morning the retort she’d heard from an expert employed by a U.N.-affiliated health organization: “Three days without water is nothing. People in southern Haiti affected by Gustave went ten days without water.”


	Animal carcasses litter the flooded streets of Gonaïves and threaten the health of people with no access to clean water

No human can go ten days without water. Food, perhaps. But not water. So we can expect that the people you see in these photographs, which I took by borrowing the digital camera of a ZL employee from Gonaïves (whose family, like all those you see, lost everything), are at great risk of falling ill with water-borne illnesses. There is also a lot of dead livestock floating down the streets of the city. The stench is overwhelming.

We are familiar with a lot of the Haitian officials charged with responding to this tragedy, which is, agreed, widespread. They showed up in Gonaïves: the district health commissioner, who is from the city and felt lucky to have avoided drowning; the coordinator of the government’s disaster response; nurses and doctors we’ve known over the years. They are doing the best they can with scant supplies. They are tired, thirsty themselves, hoarse-throated. Even Haiti’s newly-appointed Prime Minister, on her first day on the job, showed up this morning in Mirebalais, keeping a promise she made many months ago, long before she was directly involved in politics. She now has to install a new government, perhaps this afternoon, and respond to multiple disasters at once. These people, who are trying to help their fellow Haitians, deserve our help.

This is an internal appeal to staff, family, and friends. Our co-workers in Haiti are already contributing what services and supplies they can. We will withdraw from Gonaïves (as soon as we get the information we need regarding urgent supplies and as soon as we see more evidence of the mainstream disaster-relief organizations) to Saint-Marc and Petite Rivière de l’Artibonite, where we will run the hospitals and health centers with our colleagues in the Ministry of Health; we will help organized food and some clothing for people in Gonaïves and refugees being brought in today from Gonaïves.


	The site where the bridge connecting Mirebalais to Pont Sonde and Gonaïves was washed away by floodwaters

Mirebalais is going to be under a good deal of stress. As many of you know, the city’s hospital is not really functioning (in January, local protests about the hospital led to its closing, with patients evacuated to Cange, Boucan Carre, and LaColline). To my knowledge, at least 15,000 are expected to arrive here today—and they will come with nothing. They’ll need water, food, and shelter immediately, and the Mayor of Mirebalais, with whom we met this morning, is looking for dry spaces for them (maybe schools, etc) but there’s no bedding or mosquito nets or cots, that I know of.

A U.S. Coast Guard cutter is to arrive in Gonaïve tomorrow with water and supplies, but by report last night’s attempt to dock a U.N. vessel and distribute food was not successful because of “fear of crowd control” (this was from an American friend in Port-au-Prince, so I can’t confirm anything other than what I saw: no widespread distribution of water or food or tents or tarps or anything).

Since ZL is, like all the PIH sister organizations, nimble, we can do a lot by pooling small donations from friends and family members and helping ZL respond in real time to requests from those coordinating the relief efforts. We’ll need to source things like tetanus vaccine (withdrawn from Gonaïves some months ago because of concerns over quality of a certain batch; I don’t know the details), first-aid supplies, oral-rehydration packs, and of course food, cooking oil, and fuel. Again, I know that conventional disaster-relief organizations have greater experience in logistics, and am expecting they’ll have kits prepared for precisely these needs, but as of today these supplies are conspicuous by their absence. Problems with “crowd control,” refugees, and short tempers will only increase as the days go by—especially if more rain falls, as is predicted, tomorrow and Monday.

Over 20 years ago, someone explained to me that “wet poverty is worse than dry poverty.” I wasn’t then sure what that meant, but had a pretty good idea of the misery endured by those living through the rainy season in houses that, as the Haitians say, “can fool the sun but not the rain.” I’ve repeated the maxim often enough to merit teasing from my students, but the Haitians find it neither amusing nor over-used. Trying to sleep in wet clothes, on a muddy floor, is high on the list of degradingly uncomfortable activities. It’s better to simply give up and wait until daylight.

Surveying the devastation in Gonaïves, and the wretched population on roofs or wading through the streets or carrying bundles out of the city, we knew that these floods and the lack of effective response are not so much about the unruly forces of nature. Many of you on the Haiti team recall that we’ve long been based in a squatter settlement formed by the floodwaters of the Artibonite; that we spent years rebuilding lean-tos and shacks that didn’t even fool the sun; you’ll remember our co-worker’s mother swept away in a flash flood; or you’ve been part of a team of health workers watching helplessly as an ambulance is swept downstream before their eyes.

The world is waking up to these threats, but Haitians have long been pulling all-nighters as rainstorms keep them up rather than lull them to sleep. Please give generously to ZL’s efforts to intervene immediately, and share this with friends and family who might give even small amounts via the PIH website.

Paul Farmer

Update from Ghana

2008-09-08T09:55:00.000-07:00

By Sarah Mihalov

This past week was the most productive and exciting so far. First, after many weeks of discussing, planning, and waiting, the nutrition program has finally begun!! The first step is to interview each of the mothers to gain baseline data on their lifestyle, nutritional knowledge, household decision-making, and current feeding habits of their children. This information is critical in assessing what changes we can help these mothers make in their child's diet in order to prevent malnutrition. In addition, I will be using these interviews and the children's height and weight for my thesis this year. Last week we interviewed 25 mothers!! It was so exciting to finally be doing the field-work that was half of the reason I was here and to see such great interest in the mothers to learn more to help their children.

This week, mothers will come to the center so their children can try nutritious meals made from local foods to find ones they like. This is especially important for children that are being introduced to a complementary diet. Also, children already malnourished or underweight, will come daily to receive meals. We outfitted a room at the center to act as the kitchen with GlobeMed funds, including a stove, rice cooker, pots, plates, etc. It looks quite professional…likely one of the nicest kitchens in Ho! On Friday we also started preparing the porridge or koko that is eaten by infants to adults, supposedly its quite good… There are many varieties, but we are making a maize (corn) and groundnut (or peanut) porridge. This is a long process starting from growing the maize, harvesting and then removing the kernels (which I did and have the blisters to prove it!!), roasting the kernels, and finally grinding it into a powder. A similar process is done for the groundnuts as well! Amazing how much more work that is than say, buying a box of Cream of Wheat!

Second, we also have more concrete plans to establish a laboratory at the center. Various Ghana Health Service people looked at the space and discussed its size. We should have a budget this week and be able to plan out our GlobeMed funding! I hope we can see a lab up and running by the end of the year!

Saturday we were lucky enough to be able to visit an HIV support group with a leader of a local NGO called FUGI, which assists HIV+ people in accessing medications, education, and support. Unfortunately, we had to wake up at 530 am (ugh) so that we could travel to the border town of Aflao, which is on the coast. After about a 1.5 hour tro-tro ride, we made it to Aflao to observe support groups at another NGO called Pro-Link. About 30 people per group (2 total) were given a nutrition, spiritual, and medical adherence workshops. Because people often travel long distances to attend these groups (to avoid being seen due to stigma), this group offers compensation for transportation or TNT and food. It seems like they have a great system in place here and we hope to work with them in the future as we develop the HOPE center. Aflao itself seems much busier than Ho. Because it is a border town (with Togo), it has more movement of people and cargo. Image huge trucks about twice the size of our semi's stuffed full of random things like scrap metal or to-go boxes. Also, Aflao is on the coast. Although the waves are very strong and not conducive to swimming, it was an amazing view. Oddly, off the main roads are alleyways between the various buildings entirely made of sand. This grey sand is very hot from the sun and gets kicked up all over your clothes. On our way home, our friend put us on one of the worst looking tro-tro's I've seen and, of course, it broke down on the way out of Aflao. That's Ghana for you!

It is hard to believe that I only have one week left. And this week is sure to fly by as we will be very busy at the center with the initiation of the program and hopefully more interviews for my study. I also hope to be able to visit all of my favorite places and people one more time before I leave. While I am happy to be coming back to the comforts of home (hot water, Internet, supermarkets), I am sad to have to leave the great people that I have met here. Who knows, maybe I'll be back for more…

Haiti Cannot Catch a Break

2008-09-07T21:38:00.000-07:00

NYT story about hurricane Ike here.

The Guardian on relief efforts here.

Really bad.

A New GlobeMed Health Partnership!

2008-09-06T11:48:00.000-07:00

GlobeMed at Northwestern is excited to announce it's new partnership with BEHIV, Better Existence with HIV, a Chicago area nonprofit focusing on free HIV testing and support services including case management, mental health, prevention, and housing.

As a student organization devoted to health equity and based at Northwestern, near Chicago, we felt like we were missing an important aspect of "global" health by not addressing the health issues prevalent in our own backyard. An estimated 22,000 Chicagoans are currently living with HIV/AIDS, and more than 1,000 Chicagoans are believed to be infected with HIV each year. (AFC) Its obvious that HIV is a major epidemic in urban areas and Chicago is no exception.

Over the summer, we have been engaged in extensive dialogue with the management of the organization. Just last week, Fizza, GlobeMed at NU's director of local health partnerships, had a meeting with BEHIV's volunteer coordinator, and he is really excited about the possibility of a long-term partnership. We see our partnership initially consisting primarily of weekly volunteer opportunities for GlobeMed at NU members. The GlobeMed volunteers would be trained to do simple tasks around the organization, while also trying to digest how the organization runs, and thinking about what types of more advanced projects GlobeMed could work on in the future.

Most importantly however, we are excited about the potential fascinating linkage between Colleen and the HOPE Center's work developing VCT services for Ghanaians and BEHIV's work serving the citizens of Chicago with HIV. There could be a lot of added value, shared experience, and interesting lessons to be learned by comparing the two organizations, their operations, and results. Hopefully by linking these partnerships, we can improve our efforts with the HOPE Center and vice versa. Stay tuned for updates about this still evolving partnership!

Wli Falls Video

2008-09-06T11:33:00.000-07:00

As promised, I finally figured out how to get this video up! Here is my previous post about that day. Check it out:

An easy way to help relief efforts in Haiti

2008-09-05T14:21:00.001-07:00

Update from Ghana

2008-09-05T09:41:00.000-07:00

By Colleen Fant: colleenfant.blogspot.com

This past week since Jon and Nikita left has been very busy. On Monday, mother's began coming to the Center to be interviewed by Sarah for the nutrition center that will begin this coming Monday. Since the GlobeMed money came in, all of the cooking supplies have been bought for the Center. Beginning next week, mothers will bring children that are underweight or are having difficulty with complimentary foods will be able to come to the Center and learn how to prepare and introduce a variety of balanced foods to their children. Every mother in the program was given a day to come and some, those children that are severe cases, will come more often than others. The nearby village of Ando has been pretty incredible. Two of the mothers stayed all afternoon at the Center helping us sort through the beans, roast groundnuts, and peel the groundnuts. We are now all prepared to begin on Monday.

Yesterday Dr. Eleeza stopped by the Center. We are almost ready to create and submit the Laboratory proposal to GlobeMed. After some stressful and expensive phone calls home we got a potential budgetary figure from the NU students to base the Laboratory proposal on. Hopefully Monday we will have something finalized to send to the NU students. But its Ghana, so by Monday, I mean it'll probably be done sometime before Friday. Its pretty incredible how much just being here has catalyzed the program development at the Center. When GlobeMed received the potential 3-year plan from Margaret and Dr. Eleeza in February the top 3 goals were: Nutrition Project, Diagnostic Laboratory, and HIV testing facility. Right now all of the goals on that list are in the works.

My individual work on the VCT is also going well but slow. It's really good that I'm staying for as long as I am because I realize how incredibly long it takes to build up that level of comfort and discretion that I'm going to need to bring in this VCT. It's really great that the GHS wants to put one at the Center and I get to have a role in making that a reality, but I think that in terms of my contribution, I'm starting to realize that I can be more useful if I am able to look into how to make this VCT more incorporated into the Center for it to be successful. The direction that I think I will be heading in (and I think I get to spend this weekend hashing out a revised "project proposal" for my fellowship) will be in examining how HIV testing fits into the overall scheme of sexual and reproductive health and how that will look for actual program design and implementation at the Center. I think it will be important to not just have HIV testing at the Center, but if we're testing for that, I'd like to look into other STD prevalences, testing, and treatment alongside overall sexual health. The trick I think, and I haven't really figured this part out yet, will be to bring in overall sexual health in a way that's not just women since the Center already has such a strong emphasis on women. We shall see how that goes.

Three other new developments. First, Sarah and I met with the program director at Future Generations International, and he agreed to help me when the VCT is established. His organization provides support groups, ARV access, and is looking into income-generation and nutrition for HIV+ people - so basically the perfect collaborator as long as he proves to be genuine. In addition, tomorrow at 6:30am Sarah and I are meeting him and we will be going to an HIV support group in Aflao (2hrs away). So that should be very interesting. The second thing is that Margaret's NGO, Strength of Women, got accepted to attend the Friends of Africa Conference sponsored by UN fund for AIDS, Tb, and Malaria in Accra in 10 days. This is such a huge honor for her. They called her yesterday when we were in the car and she was so happy. Yelling, smiling, and hugs all around. I'm so happy for her. And the really exciting part is that I get to go with her!

Sarah leaves on Friday and then I'm officially on my own. I actually pretty excited for that. A bit terrified, but excited. This afternoon we stopped by a student hospital near the university where I will likely be moving to. By myself. I'm looking forward to learn more Ghanaian cooking, have my own room, getting myself around, and finally being able to put my specific "project"tasks and needs first. Not really looking forward to overwhelming loneliness or having someone to talk to about the experiences of being a yeavou in Ghana.

Haiti in Shambles

2008-09-05T08:00:00.000-07:00

The situation is dire in Haiti after being directly hit from both Hurricane Gustav and tropical storm Hanna. Hundreds of people have been directly killed by the two storms and tens of thousands (over 100,000 by some estimates) have been displaced due to the flood waters. Most of the roads throughout the western hemisphere's poorest country are washed out, tying up food aid. As a result, this is the norm:

''I haven't eaten since Monday,'' 12-year-old Srita Omiscar said as she waited in line with about 50 others. (NYT.com)

Heres the news roundup:

NYT: Aid Can't Reach Haitian City After Hanna

Boston Globe: Hanna Leaves Behind Despair in Haiti

PIH: Hurricanes' One-Two Punch Inundate Haiti Donations Needed to Support Relief Efforts

Time: Haiti Gustav Food Impact

BBC Video

If you feel compelled to help, please check out the Partners in Health and Global Giving websites.

Ghana and the "Brain Drain"

2008-09-02T17:52:00.000-07:00

Check out an article by a friend of mine from NU, Daniel Bohl, in the journal, Consilience: The Journal of Sustainable Development. It's titled, The Ethics of Physician Migration And the Implications for the United States, and he discusses the issue of the drain of medical talent from developing countries into wealthy countries such as the United States. In it he sites Ghana as a specific example:

"When, in a classroom of Ghanaian medical students in Accra, students were asked how many of them would like to go abroad for further study after graduation, virtually every hand went up. When they were asked how many thought they would later return home, half of the students’ hands went back down. A great number of the student-physicians in which Ghana invests do not intend ever to practice in Ghana; instead, they envision their futures in New York, London, and Chicago. A total of one half of Ghanaian physicians practice abroad, with 20% in the United States and another 10% in the United Kingdom."

This reminds me of a poignant conversation that I had with Dr. Eleeza, the Ho district health director of the Ghana Health Service. On one of our last nights in Ghana, over a dinner of Banku and tilapia, I asked him whether he had personally experienced the result of the "brain drain." Had he seen doctors, nurses, and health professionals pulled from the difficult job of serving patients in their developing nation to the possibility of more lucrative work in North America or Europe?

"Yes," he said, "many of my classmates are practicing abroad in the UK or the US." This fits with Daniel's observation that "one half of Ghanaian physicians practice abroad." And, as he spells out in the rest of his essay, it fits with a growing and disturbing trend across Africa and the developing world.

"... 70% of physicians trained by Zimbabwe in the 1990s have since left. 60% of Liberia’s physicians practice in the United States or the United Kingdom. 120,000 doctors currently address the needs of the 900 million people on continent of Africa, physician to population ratio of 13 to 100,000. The number of physicians in the United States, the United Kingdom, Canada, and Australia per 100,000 population are 293, 231, 220, and 271, respectively, approximately 20 times higher than the African physician population ratio."

Is it simply the prospect of more money that is drawing doctors to the developed world? Or, are there larger forces at play?

Dan makes a really interesting point: that we cannot only look at the forces "pushing" doctors from the developing world - forces including the lack of reliable infrastructure, equipment, and medicines necessary to do their job. He says we should also look at the forces pulling physicians and nurses to wealthy nations such as the United States and the UK.

He sites the dramatic and growing shortage - and thus demand - of doctors in the developed world as a necessary component of the "pull."

"This demand exists in developed nations including the United States, the United Kingdom, Canada, and Australia because these countries consistently train fewer physicians each year than their healthcare systems require. They do so because allowing already trained physicians to cross their borders is less expensive than training physicians domestically. The influx of already-trained physicians represents an influx of human capital with no monetary exchange. This induced shortage draws in physicians from less developed nations all over the world."

The fact is, there already is and will continue to be a growing shortage of doctors in the United States. Why? Because training home-grown doctors is expensive for all countries, and it is much less expensive than importing doctors from abroad. The crux of the problem is that the physician shortage has been created through a concerted effort by the government to correct for an anticipated physician surplus during the 1970's and 80's.

"The federal government responded by drastically cutting funding for medical education. Medical schools stopped growing their class sizes and the number of enrolled students entered a period of zero growth that would last for the next twenty years."

The problem is that the anticipated surplus of physicians never occurred, and instead, there has been a steady shortage of physicians in countries such as the US, Canada, and the UK. In order to meet the growing demand of the healthcare sectors of the wealthy world, doctors in the developing world not only feel the pressure of dealing with the difficulties of practicing medicine in their own countries, but are also faced with excellent job prospects abroad. You can't fault the physicians for wanting to improve their economic situation; we must look at the forces that structure their decision to stay or go.

Here is the ethical dilemma:

"No country wants to train doctors. For wealthy nations, it is cheaper to allow them in from poorer ones; for poorer nations, it is extremely costly to have them leave for wealthier ones. With demand for physicians high in both groups, the wealthier nations with the thicker pocketbooks receive a major influx. In contrast, developing nations are left to train a higher number each year in order to retain a suitable workforce....

While it may be ethical for developed nations to fill unanticipated physician shortages because of their right to self-service in a time of need, it is not ethical for them to use physician immigration as a long-term, cost-cutting solution....

The emigration of physicians, unlike that of other professionals, causes a direct and immediate harm to individuals. Physicians are direct caregivers. When a physician leaves, individuals who desperately need treatment go without the very services they need. The people of developing nations are directly and immediately harmed by the action of the free market."

It is unethical to intentionally import physicians on the free market because it directly harms the people from countries on the losing end.

The solution of course: for countries like the United States, Canada, and the UK to use their own abundant resources to train the physician they know they need. This is especially urgent as the baby-boomers continue to age and will put an even greater strain on our already strained medical system. It will take investment from the federal government in new universities as well as an increase in funding and class size at our existing institutions.

I see no reason why the United States cannot train its own physicians. And, after seeing Ghana's overburdened and understaffed medical system, it is easy to see how problematic it is to have to train twice as many doctors as it ends up with. With 50, even 20 more doctors per year, the GHS would be able to reach more and more patients in rural areas, perform more life saving surgeries, and diagnose and treat more infectious diseases such as HIV and tuberculosis.

For me, it comes down to an issue of rights. For my friends in the under served community of Ando, economically structured physician emigration to the wealthy world contributes to the violation of their human right to health.

A few pictures...

2008-09-01T23:27:00.000-07:00

I didn't take too many pictures myself (since I didn't have a digital camera), but you can check out some pictures from our trip to the HOPE Center on Colleen's blog here. Soon, I should be able to get some of the pictures that both Sarah and Nikita took. As soon as I do, they''ll be here too!

Documentary Film: The Director's Cut

2008-08-31T15:50:00.000-07:00

Here is a very rough draft of a short film we worked on with a Ghanaian filmmaker named Jacob. Yes, the music is a little hokey, my part probably shouldn't be there, and some of the Margaret's (the head nurse of the HOPE Center) discussion of the HOPE Center's activities needs to be cut out.

But, I think that it's a really good start, and something we can use the raw footage from to piece together a couple of videos for different purposes. I think a short one - 3 to 5 minutes tops - will be very useful for our GlobeMed and Global Giving websites. Then, perhaps we can create a couple of longer versions for use during presentations to student groups, churches, or other venues.

Again, this is only a first draft. But, let me know what you think. What's good and what needs to go?

Quote of the Day

2008-08-31T13:34:00.000-07:00

Paul Farmer, addressing the Skoll Foundation World Forum after being named a Skoll Foundation Social Entrepreneur.

"Part of me winced when I acknowledged that: yes, we live in an era in which simply seeking to provide high quality medical care to the world's poorest is considered innovative, and entrepreneurial. Thus the diagnosis comes with both honor and shame. Shouldn't we have offered such services to those who need them long, long ago? Shouldn't we have designed systems to get around or solve the health problems faced by the world's bottom billion?"

Home, Sweet Home

2008-08-30T00:40:00.000-07:00

Finally, after well over 24 hours of airport - airplane madness, I'm finally back in my own room in Portland, Oregon.

It's great to be home.

Over the next few days, I'll be figuring out exactly what I want this blog to be going forward. I definitely want to keep it going, but I'm not exactly sure what the content will be now that I'm not in a cool place like Ghana. I'll probably just post cool things related to global health, human rights, and development that I find across the net, as well as continue to update about progress on HOPE Center projects.

Any suggestions?

More Good Discussion

2008-08-28T15:34:00.000-07:00

I got a lot of work done today, cooped up in my hotel room with air conditioning and blazing fast wireless. I also stumbled upon a cool discussion on the GlobeMed discussion board about a recent article titled, "Doctors Without Orders" by Josh Ruxin.

Check out the article here and the discussion here.

Here are some of my thoughts after reading the article and thinking about it in relation to my experiences in Ghana and at the HOPE Center:

After spending the past 3 1/2 weeks at our health partner, the HOPE Center - a rural medical clinic in Ho, Ghana - I've gotten a very small glimpse of some challenges very similar to those Josh Ruxin mentions in his article: challenges of management. The HOPE Center currently is staffed by four full time nurses, all of whom do an incredible job treating sick patients, but none of whom have had any formal management training. To no fault of theirs, the medical records files are largely kept in rather disorganized stacks, there is little constant daily routine or schedule, and there tends to be too much (in my, obviously limited opinion) idle time between patient visits. On days of child welfare clinics or nutrition workshops, the Center is abuzz with activity as hundreds of local mothers come to learn about proper, balanced nutrition and to have their children weighed, immunized, and treated for infection. On other days however, a slow trickle of patients come to be treated primarily for malaria, respiratory infections, and diarrheal diseases. There are certainly sick people in the community: Why don't they come in droves? I think there could be two main causes: 1) barriers to receiving care for the poorest, and usually sickest members of the community, such as long distances to the Center, or lack of money and insurance and 2) lack of services demanded by people in the community such as a path. lab, imaging, maternity ward, etc.

Unfortunately, there is no way that the Center's current clinic management systems could handle a large influx of new patients. Our team from GlobeMed at NU talked often about how, what the HOPE Center really needed was a medical director - someone good with computers, scheduling, budgeting, and effectively allocating the precious human resources provided by the nurses. Unfortunately, right now, we do not have the resources for a professional clinic manager. So, what can we do in the mean time?

Here is where, I think, GlobeMed health partnerships have the exciting possibility of going beyond boring old fundraising. Depending on the type, size, and nature of the partner organization, I believe that students could take on roles similar to consultants. Basically, consultants are hired by companies – and increasingly both large and small nonprofits – to analyze and create solutions to business problems. Consultants add value to businesses by bringing in a fresh set of brains with different problem solving and analysis tools. While staff members and management must juggle many balls, consultants are able to narrow their scope and focus on a smaller subset of problems at one time. Although students are not professionals, I do believe that we have valuable skills, analytical minds, and a growing body of knowledge fueled by our university education. Exactly as Victor just mentioned in “Recruitment for GlobeMed Chapters,” we should be engaging students from a wide variety of fields – engineers, economists, sociologists, and anthropologists. Each of these unique perspectives will allow health partnership projects that go deeper than fundraising, allowing students to use their growing specialty knowledge to improve the systems that ultimately allow the expansion of health care capacity.

In Ghana, I tried to improve the way the HOPE Center managed their patient records by installing an open source medical records software on one of their computers. I was semi-successful. I probably underestimated the challenges posed by the infrastructure and overestimated my own computer abilities. The open source software didn’t work, but we set up a functional excel database which will hopefully act as a stepping stone to a more permanent system.

As a next step, I think that this project could be awesome to think of in terms of consulting. Here is one where we could engage some of our computer science whizzes at NU in using their expertise to build a more formal EMR system for the Center. I think that it would be very possible to assess the needs and limitations of the HOPE Center context and then use the knowledge and enthusiasm of students to fit those needs and limitations with a functional solution.

Of course, students need the tools to enable them to effectively analyze problems and then apply that analysis to developing solutions. While working with the HOPE Center, I often drew from my experiences with campusCATALYST (check it out: www.campuscatalyst.org). CampusCATALYST gives students the opportunity to work in teams on a consulting engagement with a small nonprofit. Each team works with the leadership of the organization, identifies a problem of appropriate scope, applies consulting analysis, and uses that analysis to create a viable solution. The brilliant thing that campusCATALYST does is that they pair the consulting work with an actual class through Northwestern which teaches the fundamentals of the consulting problem solving process. That way, students are well prepared and can more effectively analyze and solve the problems. I’m excited to see the “resource packets” that the Central staff will be unveiling this year to all of the chapters. Perhaps also though, a partnership with campusCATALYST could be struck in which some of their teaching materials and lesson plans could be morphed into modules or “resource packets” specifically designed to teach the basics of consulting analysis and problem solving strategies.

It is always important to realize that we are students and not professionals. It’s a frustrating position when we all want so badly to just jump in and help, but are prevented by our lack of medical training. Although not as “sexy” as going on “medical missions,” I think that students can really make a huge impact analyzing and proposing solutions to management issues. Here are problems that we can engage with less fear of breaching medical ethics.

Sorry for the rambling rant, but these are just some ideas – spurred by that interesting article and discussion – that I’ve only started to piece together. I’m still here in Accra, waiting to get on a plane after being bumped due to Delta overbooking my scheduled flight. All of my thoughts and emotions are still very fresh and unprocessed, so I’d love responses to this.

delta sucks

2008-08-28T15:06:00.000-07:00

Right now, I should be somewhere over the midwest on my way back to Portland, Oregon. Instead I'm sitting in a really nice hotel in Accra (definitely the swankiest place I've been to this entire trip) and have a stand by ticket for a flight tomorrow morning. Basically, Delta overbooks every flight from Accra to NY JFK airport (which only leaves once a day) and so 30-40 passengers get bumped from every flight. Then those try to get on the next flight, the next day, and a continuous cycle of plane bumping continues indefinitely. It sucked this morning when we found out that we actually weren't going home today, but they ended up putting us in this nice hotel, with blazing fast wireless internet - what luxury!

Also, I met some really cool people who are in the same boat as me as far as getting bumped from the flight. I met a cool college student from Montreal who has been doing some volunteer work in the Northern region of Ghana and her Ghanaian friends who were also college students. Over a nice American dinner of a club sandwich and french fries - paid for by the hospitable Delta Airlines - we talked about all sorts of things such as global health, volunteerism, and American and Ghanaian politics (Ghana is going through an election year as well, they vote in December). It was a great discussion, and it was really fun to get to hear what a Ghanaian student, exactly my age, thought about American politics, the influence of volunteers in rural communities, and especially why he loves Barack Obama so much! We all exchanged emails, and I hope that we can exchange emails about thoughts on a range of issues.

It was a bummer not to fly home today, but it turned out well. You never know how things like this will end up!

Long time, no blog

2008-08-26T05:42:00.000-07:00

Hey All,

I can only imagine your withdrawal! The internet - yes the entire thing - has been down throughout the entire Volta Region of Ghana for the last 5 or 6 days. I've heard that it has something to do with recent legislation requiring the Ghanaian government owned Ghana Telecom to change hands to a private firm. Anyway, its back now. Still slow, but at least usable.

Its hard to believe that I'm in my last days in Ghana. I've definitely had an awesome experience and its going to be very sad to leave. I'm beginning to regret not planning this trip for 6 weeks instead of 3. The first week was mainly becoming acclimated to Ghana, getting settled into Joseph's accommodations, and meeting the Center staff.

During my second week, I was able to start on my project to improve the computerized medical records database. I got a lot accomplished; I was able to install the open source OpenEMR onto the one functional computer at the Center, I got almost all of the patient data inputed into the system when... a power outage caused the entire system to crash and corrupted some the necessary files to run the program.

So, last week has been mainly damage control, reassessing the needs and capabilities of the Center with regard to technology, and creating a solution to fit those needs. I decided to stick with a slightly improved version of an excel spreadsheet database for all of the patients, which was started by a previous GlobeMed volunteer. It still has fairly high functionality - nurses are able to search for patients by name, address, diagnosis, treatment, or insurance - and is very simple for the nurses, who have minimal computer training.

In fact, I have spent the last couple of days training the nurses to update patient information, add new patients, and search the database. Bertha, one of the original nurses at the Center took to learning the software right away, and I feel confident that she would be able to maintain the system completely without any more help from us. Luckily, Colleen will be her for another 8 months, and she will be able to continue to monitor the nurse's use of the system, answer questions, and ensure that updating the database becomes part of their daily routine. I hope that once the nurses feel confident using the computer and see the huge benefit to having that information stored digitally, a transition down the line to a more permanent, professional type of computerized medical records will be much easier.

Our last couple days have been some of the most exciting and inspiring for me to be a part of. Yesterday, we had a big meeting with Dr. Eleeza, the district health director and the head regional nurse for the Volta Region in which Nikita and I prepared presentations about our work completed over the past three weeks. We also had an excellent discussion about the GlobeMed - HOPE Center -GHS (Ghana Health Service) partnership. Basically, Dr. Eleeza is extremely happy with the dedication that GlobeMed has shown to the partnership and with the tremendous growth that the Center has seen over the past year. I think he realizes that GlobeMed is much more that a "Projects Abroad" type organization that just sends students without much thought or guidance to distribute medicine. He realizes that we want to work within the GHS system, and supplement their efforts with resources that we can develop from the US.

We have some exciting new ideas for the coming year, and now, much more work than ever to make sure we can get it all accomplished.

my response to being-self-righteous-know-it-all-yeavou

2008-08-19T03:27:00.000-07:00

Colleen, my partner in crime this past year as co-president of GlobeMed at NU and the one who will be spending 9 months at the HOPE Center this year working to develop an HIV VCT (voluntary testing and counseling center), has some important analysis of her experiences so far at the Center. See here for her blog post.

I completely agree with the fact that the HOPE Center is not the community transforming, daily life-saving medical center to which people flock from miles around. It's not Zanmi Lasante. But I think that it is important to remember that the HOPE Center is still new, just a little over a year old, and in reality, we are still working to put the routine systems into place such as patient intake and record keeping that I've mentioned earlier. And although the HOPE Center is not an all encompassing primary health care clinic where people can be treated for all ranges of infectious diseases and injuries, it is still providing treatment for Anthony's open sores, antimalarial medication for hundreds of local villagers, antibiotics for babies with diarrheal diseases, and family planning for many local women.

This not nearly enough, the poor communities surrounding the HOPE Center deserve much more to address their human right to health. But I think that the HOPE Center is an important start and first step towards health equity for these communities.

I remember Joia Mukherjee's (medical director of Partners in Health) talk at the 2007 GlobeMed Global Health Summit, where she discussed the challenges PIH faced when trying to scale up the services offered at their new hospital in rural Haiti, Zanme Lasante. She discussed the frustration she felt when, despite a brand new, beautiful building, with modern medical tools and trained doctors and staff, only a small trickle of patients entered on a daily basis. She knew that there were thousands of desperately sick patients in the surrounding communities. What was stopping them?

Her thesis was that PIH had not yet addressed the immense barriers which blocked poor rural Haitians from seeking medical attention. Barriers that required dialogue and anthropological research to unearth. They realized that most of their patients lived several hours walk from the hospital. In many cases, it was simply impossible for the peasant farmers to pull themselves from their fields, on which they depended for their next meal. Structural economic barriers blocked their health equity.

While many health NGOs have stopped at that point - not wishing to address the more pernicious issues of social and economic rights in addition to the right to health - PIH dove in to tackle the economic barriers which were preventing their patients health from improving. While interviewing a patient with TB about his/her symptoms, they would also ask: How much do you eat? Do you have a roof over your head? Do you sleep on a dirt floor? In addition to treating the TB patients with complex chemotherapeutic regimens, they attacked poverty by building homes and providing food assistance. To address the barrier of large rural distances, they hired a small army of community health workers. These health workers - all Haitian, and hired from a population with greater than 50% unemployment - were able to go to the distant towns and villages, check on patients receiving ARV, and directly observe TB patients receiving their medicine.

Obviously, PIH is in a different stratosphere with regard to scale and scope. But, I think that their hard learned lessons will be instructive as we ask: "Where do we go from here?"

We too, need to address the barriers which are preventing sick patients from surrounding communities to come to the HOPE Center. First, what are we charging for use of the medical services provided by the Center? I know that we accept the Ghana Health Service's National Health Insurance Service (GHS NHIS), which is highly subsidized for the rural poor, and only costs the equivalent of $7 per year for an adult. Perhaps the answer is a push to get all people in the communities that we serve covered by the NHIS, those who could not afford it would be offered coverage paid for by the HOPE Center. Even better, would be to provide completely free service to those who could not pay. While this would cost a significant amount of money, I think that the alternative is worse. Children and adults continuing to die of preventable diseases.

Another barrier to the health of these communities is the limitation of the Center's currently offered services. We currently lack a diagnostic lab to diagnose infectious diseases, so the nurses must refer most patients to the district or regional hospital, which too are underfunded and understaffed. We must ask, why would patients come to our clinic if they thought they would likely just be referred? Once the lab is installed and functioning, a doctor would enable the clinic to greatly expand the scope of disease treated at the Center.

Over the next year, with Colleen here and able to work collaboratively with Margaret (the head nurse), Joseph, and Dr. Eleeza (the regional health director), I hope that we can draft a 5 year plan with interventions aimed at addressing the barriers to health for the communities around the HOPE Center. It will be a long process, and one that should have been done before the Center opened. But, working through our progress to this point as a stepping stone, I believe that the HOPE Center can become a true access point for health equity.

System: crash

2008-08-19T03:15:00.001-07:00

Bad news...

A power outage at the Center yesterday seems to have caused a problem with the records database giving me the error:

Error: insert failed: insert into log(date, event, user, groupname, comments) values(NOW(), 'login', 'admin', 'HOPE Center', 'success') (Can't open file: 'log.MYT'(errno:145)),

when I try to log into the system.

I emailed the moderator for the OpenEMR website, and he mentioned that "sudden power outages can corrupt the MySQL tables." He directed me to run the function, myisamchk, which is supposed to quickly repair the tables and should allow me to log back into the system.

I really hope that this works, or else I could be, in a word, screwed.

Again, this highlights why doing global health work in poor countries is difficult. It is really easy to take for granted 24 hour tech support, computer gurus galore, and even simple infrastructure such as a reliable electricity source. As always, I'll keep you updated as to the progress, but I'm afraid that it might not work.

In any event, going through all of the records has forced me to look at the nurse's systems for intaking patients, taking records, filing them, and recovering them when the patient returns. Over the next couple of days, along with working on the computer, I hope to be able to work with the nurses to create a more formal patient intake and record keeping protocol which will be beneficial after I leave whether the computer system pans out or not.

Wli Falls

2008-08-18T08:57:00.000-07:00

What an incredible weekend! I never cease to be amazed by Joseph's (our host's) friends and contacts. When he was having car trouble early Saturday morning, he called up his friend at the Ho police academy, and asked one of them to spare an SUV for the long dirt-road trek through Ho Hoe to Wli Falls. So, finally, up rolled a massive military outfitted Land Rover and a six foot five inch police officer to drive us and a group of Rotarians (more of Joseph's friends) from the UK to the renowned water falls!

On the way we stopped and visited many villages with projects that Joseph has catalyzed. Its really amazing to see the impact that he has had on so many communities surrounding Ho by building water bore holes and schools. We also stopped at a cocoa farm (Ghana is one of the world's top producers of cocoa) and tasted some of the fruit. It has an interesting flavor and tastes nothing like chocolate.
Unfortunately, I took some great video of our Jeep trip, hike to the falls, and the falls themselves, but for some reason my camera won't let me post them... Hopefully I can figure it out when I get back.

random local marching band du jour

2008-08-15T08:54:00.000-07:00

Tour of the Ando Village Farm

2008-08-14T06:40:00.001-07:00

Here is a short video of our trip to the Ando village demonstration farm. The farm is part of the HOPE Center's community nutrition project, and will serve to train and acclimate the local community to soy beans, which are not traditionally grown in this region. Severe protein deficiency is the norm for children in this village as well as the others surrounding it. Our hope is that soy beans (a great source of balanced protein) will become a staple food for the region and will accompany the traditional foods of maize, cassava, and yams.

A brief tour of the HOPE Center

2008-08-13T12:52:00.000-07:00

Don't worry. Much more to come...

Check it out!

2008-08-13T11:46:00.000-07:00

Thanks to the work of Peter Luckow and others, the official GlobeMed at Northwestern Chapt er Page is up and fully operational. This will be the home site for all things GlobeMed at NU; we'll be able to post event dates and meeting times, generate discussion on our new blog page, as well as generate interest and raise funds via links to our globalgiving.com page.

If the link above doesn't work, try copying and pasting the URL below:

http://www.globemed.org/northwestern/

I can't wait to use this tool to continue to build passion for global health in students at NU.

Great Success!

2008-08-12T04:55:00.000-07:00

After about a full day of struggling with the code, I was finally able to install the medical records software on one of the computers at the Center. Now begins the real work of inputing all of the data that the Center has collected about its patients on paper records into the system and then, the difficult task of training the nurses how to use the relevant features of the software in such a way that they see the utility of actually using it on a daily basis. I think that one of the worst things that could happen would be for me to install this software, get all of the current patient data inputed and working well, and then have it sit completely unused as soon as I left.

I think that making a case for the everyday usefulness of the software will be as important as teaching the nurses how to use the software. One idea that I've had is to have a day-long training session for each nurse on the software. The training day could include first, a brief overview of the software and why it will be useful to the nurses in their everyday lives. Then, I was thinking, I could devise a series of "drills" with the main goal of gaining some repetition on some of the most common maneuvers that the nurses will need to make daily such as logging in, checking their schedule, pulling up patient data, editing patient data, and logging out. After the nurses seem relatively proficient with those tasks, I was thinking that they could go through a couple of "role plays" with me being a new patient with the typical symptoms seen at the clinic and they could go through the complete process of adding a new patient to the system, as well as adding clinical symptoms, age, weight, BP, etc.

Onces the nurses are all trained on the software, we will pick a date to roll out its use. Hopefully, I'll be able to train all of the nurses and still have a little bit of time left to monitor the use of the software for about a week before I leave. In addition, Colleen Fant (who I will have to train as well) will be here for about 9 months, so she can be involved in the monitoring/follow-up effort as well.

So, the major parts of the training program are:

Overview of software, main menu page, and why the software will be useful to the nurses and make their work easier.
Series of drills on common maneuvers within the software
Role playing in which nurses will go through the entire processes as they would happen on a normal day at the HOPE Center.
Follow-up

Does that plan sound good? What am I missing, and what else do you think I need to do to make sure that using the software becomes part of the daily routine at the Center? I'd love input.

If you just can't get enough...

2008-08-10T08:19:00.000-07:00

Here is the link to Colleen Fant's blog: http://colleenfant.blogspot.com/.

She has a great, new post about her feelings about another volunteering group that has been insistently trying to work at the Center and about her own conflict about volunteer work in general.

Another great blog post on the subject of volunteerism is written by Peter Luckow on the GlobeMed webiste blog. He discusses and links to a couple of great articles titled "Duffel Bag Medicine" and "To Hell With Good Intentions." I think that both do a good job of showing why it is important to be self-critical (perhaps even hyper-critical?) when engaging in global health volunteering. It's important that we understand that we do have the capacity (although inadvertently, and with the best of intentions) to cause harm to these communities. Somehow we need to find ways to connect the growing number of students eager to improve global health to responsible opportunities that channel their enthusiasm in productive directions. I think GlobeMed does a pretty good job at this, but we definitely need more organizations that look at these issues in a self-critical manner.

Hopefully over the next couple of weeks, I'll be working on a short essay about my ideas on volunteerism and its affects (both positive and negative) on the HOPE Center specifically. These are big, deep issues and it will take me a while to formulate my thoughts. I'd love to hear what your thoughts are on these issues and what you think about the two article linked from Peter's blog post.

Into the Bush

2008-08-10T08:14:00.000-07:00

Here is some more of my poorly shot video... It's from our Saturday trip into some of the more remote villages where Joseph works to install bore holes for access to clean drinking water, and builds schools for the children.

Check it:

Video of the HOPE Center in action is soon to come. I promise.

Weekend

2008-08-10T07:45:00.000-07:00

We had an excellent first weekend in Ghana! Friday, we had the opportunity to visit the HOPE Center again in the morning and we had a short meeting with Margaret, the head nurse of the Center. We finalized our plans to officially start working on our projects at the Center on Monday. Margaret also updated us on the work that has been completed on the community nutrition project. The work that has been completed already is impressive: a large demonstration farm consisting of soy beans, maize, cabbage, and okra, immediately surrounding the HOPE Center is ready for harvest, demonstration farms of soy beans in many of the poorer villages outside of Ho have been planted and are nearing harvest, and several community outreach events have occurred, aimed at educating mothers about how to prepare and incorporate these new staples into their diet. After leaving the HOPE Center in the afternoon however, some serious rains started. We needed to get some dinner in town, so we ended up trudging out into the rain and into town.

On Saturday, we slept in a little, but around 10:00 am, we got a call from my friend Vanessa Lee who was on her way to Ho! She ended up spending the day with us as Joseph toured us around some of the more remote villages surrounding Ho where he is virtually famous for all of the great community organizing, bore hole drilling (for clean drinking water), and school building. We were fortunate to visit many of the bore hole sites and brand new, beautiful schools that Joseph has catalyzed into action. I was very impressed by the great work that he has done, but I was also struck by the level of poverty, which is definitely different than what I've seen in the cities. These people are mainly subsistence level farmers who supplement their income weaving beautiful Kente cloth and selling them to marketers that swing by the remote villages on a weekly basis. I think that they eat mostly what they are able to grow on the land surrounding their villages and have little to no access to medical care because they are outside the reach of the HOPE Center and the rest of the medical facilities in the area. After having such a nice time chatting with the little kids, meeting the chiefs and elders of the community, and witnessing their hospitality, I definitely felt guilty hopping into our Land Rover and driving off, most likely never to return to that same village ever again. It did however, reaffirm the importance of global health and development work.

After our tour of the villages, we made a brief stop in Togo (yes, the country) to sample some of their finest malt beverages. I have to say, I think that Portland could learn a thing or two about brewing from the Togolese about brewing beer.

Monday, now that we all feel comfortable in Ho and are finally settled it, we'll start the major work on our projects. I'm excited to finally get started, and I can't wait to see the impact that our team will have on the ability for the HOPE Center to continue to reach these under served communities.

First Days in Ghana

2008-08-08T08:34:00.000-07:00

Hey yall,

Here is some video of our first days in Ghana. I'm still learning to take good video, so bear with me. But, enjoy what I've taken so far!

Mental Health Break

2008-08-06T09:48:00.000-07:00

A nice, happy video that reflects how I feel today:

First Day in Ho

2008-08-06T08:27:00.000-07:00

We finally made it to Ho! We met the rest of our team (Sarah and Colleen) at the airport, and Joseph picked us up from there like planned. We didn't get to Joseph's (our host and director of the HOPE Center) house until pretty late, close to 1:00 am. We were all very exhausted.

We got up this morning and visited the HOPE Center for the first time. Its even more impressive than I thought! We met all of the staff of the Center, including Margaret Asante, the head nurse at the clinic. She is easily one of the most impressive people I have ever met and she is a powerful advocate for the community and for the HOPE Center. I know that she is going to be essential force for the success of the HOPE Center.

We talked briefly about our project plans, what each of us will be working on, and how the daily flow of the clinic works. It sounds like the EMR software will actually be a big help to the Center, as one of their biggest problems right now is data management for patients and local community members. I think that the EMR software could be a really great way for the staff to simply and easily keep track of the patients that they see. Also, the computer that runs at the clinic uses Microsoft XP, so that should make the install much easier.

After meeting with all of the Center staff, Margaret drove us to meet briefly with Dr. Eliza, the Regional Director of the Ghana Health Services (GHS). The GHS has partnered with us by providing all of the nurses for the Center. Dr. Eliza is another very important and impressive person, and his support and partnership will be essential for the success of the Center. We talked briefly to Dr. Eliza, made introductions, and made plans to meet a bit later in our trip.

The rest of the day has been spent with our friend Rachel Berkowitz who has been doing research in Ho for most of the summer. She showed us where we could buy a couple of things that we needed, we went to the bank, got some food, and finally made our way to this internet cafe.

Its been a blast so far, unlike anything I have ever experienced. I am blown away by the HOPE Center and I am very excited about its future. The people supporting the Center are so qualified and dedicated to its mission. It will continue to grow and improve the health of the community for a long time to come.

Adventures in Accra

2008-08-05T10:03:00.000-07:00

We made it! I don't have much time for a substantial post... hopefully I will tomorrow though.

Today has been an absolute whirlwind. We got to Accra around 8:30 am Ghana time, and met a really nice Northwester Ph.D. student named Eric Johnson who picked us up from the airport and let us store our baggage in his house for the afternoon.

He then gave us a short, but super fast tour of the main Accra market, which he said is one of the largest open-air markets in western Africa. It was honestly incredible; so many people, so many smells and sounds! I took some video of the densely packed market, and I hope to be able to post the video tomorrow. Words can't do it justice.

Tonight, around 6:30 pm, we'll be meeting up with Colleen Fant and Sarah Mihalov when they arrive at the airport. We'll also be meeting Joseph Achana, our host and director of the HOPE Center, who will drive us from Accra to Ho. I'm not sure how far it is, but I heard that it will take about 3 hours to drive.

It's been a looooong day. I started at about 3:00 am Portland time, spent 20 hours traveling to Ghana, and immediately was thrust into one of the most busy and hectic street markets you can imagine. Needless to say, I'm looking forward to a shower and a bed.

I'm off!

2008-08-03T22:24:00.000-07:00

My next post will be from Africa! I leave tomorrow at 6:30 am from Portland, Oregon, fly through New York, and land in Accra Ghana at 8:30 am on Tuesday morning. Hopefully I'll be able to make a short post about my flights and airport experiences sometime on Tuesday or Wednesday!

See you in Africa!

Potential HOPE Center Documentary

2008-08-03T18:09:00.000-07:00

Exciting news!

There's a good chance that we will be working with a Ghanaian filmmaker named Pascal Kpobi to create a short documentary about the HOPE Center and its impact on the health of the community of Ho. Another GlobeMed student named Rachel Berkowitz, currently working in Ghana on her own research project, met him during an interview and put him into contact with us. She has seen his work and says it looks really cool, so it seems like this will be a really great opportunity for us.

We're planning to meet Pascal when we first land in Ghana around 8:30 am, Ghana time, and hopefully we can agree on costs, filming schedule, logistics, etc. Over the next day and a half (mostly while en route), Nikita and I will be putting together ideas for the film, especially what types of content we want the film to contain, what the main points of the film should be, the structure, etc. If anyone has worked on short, non-profit promo/documentary films and has any input or ideas, they would be greatly appreciated!

A few choice photos of the HOPE Center

2008-08-02T21:32:00.000-07:00

These photos were taken by Peter Luckow while in Ghana with Victor Roy and Colleen Fant last summer.

Introducing our team

2008-08-02T16:18:00.001-07:00

Four of us will be traveling to Ghana and the HOPE Center: Colleen Fant, the former co-president of GlobeMed at Northwestern (and a recent grad of NU), Nikita Kohli, the current co-president of GlobeMed at NU, Sarah Mihalov, global project coordinator for GlobeMed at NU, and myself. I'm really excited by the dedication each has shown to GlobeMed and the HOPE Center, and I know that as a team, we'll be able to get a ton done.

Each of us will be focusing on separate projects, but we'll definitely be working collaboratively on each as well. I'll be focusing on installing an electronic medical records system on the two computers currently at the Center. We'll be using an open-source software system available from OpenEMR. The system seems to be really good for the needs of the Center. Its really quite simple, and will be vastly more useful for keeping track of patient information and scheduling appointments. Right now the Center is trying to use Microsoft Excel to keep track of patient information, but this is cumbersome, and will grow increasingly so as the number of patients treated at the Center continues to grow. I'm pretty green, especially with regard to EMR software, so if anyone has any specific expertise or suggestions, they would be greatly appreciated!

Nikita Kohli, co-president along with me of GlobeMed at Northwestern, will be primarily working to collect large numbers of photos, video, and stories to use to create marketing and communication documents to publicize the work of the HOPE Center. She'll also be engaged in doing community asset mapping. This will include creating a geographical map of the region, interviewing community leaders to identify assets within the community, and then creating a useful document for Center staff to use in their community outreach work.

Sarah Mihalov, the global project coordinator for GlobeMed at NU, will be doing research funded by a Northwestern Undergraduate Research Grant. She will be conducting anthropology research on the topic of: Factors affecting feeding practices in the Volta Region, Ghana: The Relationship with Malnutrition. This research will be of direct use to future planning for the Center as we expand the community nutrition project and continue as a Regional Nutrition Center.

Finally, Colleen Fant, who was co-president of GlobeMed at NU with me last year, will be using her funding from the Mind the Gap Fellowship to spend nearly an entire year working at the Center, conducting ethnographic research with formal and informal interviews of community members about HIV needs, and translating that data into the implementation of an HIV voluntary counseling and testing center (VCT) at the HOPE Center.

I am really excited about all of these projects. Everyone on our team is top notch, and I'm confident that we'll be able to get a ton of valuable work done. I'll keep you updated with our progress.

The First Post

2008-08-01T15:28:00.000-07:00

Hi Everyone,

Thanks for checking out my new (and first) blog! I hope to use this space, at least initially, as a daily repository for anecdotes, photos, video, and thoughts as I make my first trip to Ghana during the month of August. I'll be traveling to Ho, Ghana and the HOPE Center, which is a rural medical clinic that I've been working with for a couple years through GlobeMed at Northwestern University.

A little bit of history about GlobeMed and the HOPE Center is probably in order. The HOPE Center was the brainchild of John Broach (then an undergrad at NU) and a dynamic community organizer from Ho named Joseph Achana. The two met when John traveled to the Ghana on a study abroad trip in (I believe) 2005, and together decided that there was a unique opportunity to link the enthusiasm and resources of college students in the United States directly to communities around the world lacking equitable access to health care.

When John returned to NU, he rallied a group of Northwestern students who were also interested in health and human rights. Together with support from the Rotary International and many individual donors, they raised over $40,000 to provide the initial funding for the construction of the Center. Finally, in April 2007, the HOPE Center opened its doors. Currently, there are four full time nurses at the Center, all employees of the Ghana Health Services (GHS). They provide primary health services, immunizations, injury treatment, as well as maternal care to the people of Ho.

GlobeMed as an organization, also grew out of the ideas that students could effectively partner with grassroots health organizations to improve the health of communities. Again, here is the link the GlobeMed website. Here is GlobeMed's mission and vision:

GlobeMed's mission is to connect the assets of a student-led network to grassroots health organizations working in communities around the world. By inspiring and training university students to mobilize resources for global health, we seek to build a movement fighting for a more sustainable and secure world.

Our Vision is to build a world where all people have the opportunity to live a healthy life.

While we see an unjust world of broken systems failing to deliver for its citizens, a different world is possible. This world can be realized only if we encourage and harness the potential of emerging sources of change:

We see students as dynamic leaders: When young people are connected with constructive forms of global health engagement, they can step up to be the leaders of our world both today and into the future. The world demands our generation to deliver critical leadership on issues of global health, and investments in inspiring and developing this leadership are vital.
We see grassroots leaders in underserved communities fighting to build stronger health systems: Grassroots leaders are working to improve the health of their communities in poor areas around the world. By devoting our resources in support of these local leaders and their communities, important contributions can be made in building vital health infrastructure.

So, as you can see, GlobeMed is focused on developing tomorrow's leaders in global health through engaging students in global health projects and by supplementing that experience with practical skills training and fostering an understanding of issues in global health. Since the HOPE Center and GlobeMed at Northwestern was founded, 12 more chapters of GlobeMed at universities across the nation have also joined the network. The model on which GlobeMed as has been based: students partnering with communities to improve global health, has now been replicated at U Michigan, Truman State, USC, and Washington University in St. Louis to name a few. Each university has a health partnership, similar in relation to the HOPE Center and GlobeMed at NU.

For example, GlobeMed at U Michigan has developed a collaborative relationship with Joy Southfield Health and Education Center in Detroit, Michigan. They host weekly health education sessions at the clinic and also volunteer at the Center, doing administrative work and advertising for the education sessions. Truman State has worked with Maison de Naissance, a birthing clinic in Torbeck, Haiti to improve their ability to measure measure and evaluate health outcomes from service programs. There are many more examples of great partnerships across the GlobeMed network, and every year more productive health partnerships are forged.

I hope that this gives some context to my work in Ghana. Over the next couple of days (before I leave), I'll be adding more detailed information about my specific project, as well as the projects that the other members of my team will be working on. Feel free to shoot me an email with any questions or comments.

I'm so excited this is finally happening! Stay tuned for updates!