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Issues: Global Health
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We need investment to end tuberculosis
 

Tuberculosis is known to have been in existence since 4000BC but today is the cause of nearly two million deaths, every year. 

 

The disease can affect any part of the body, but usually the lungs. In the past it has been called 'consumption' due to the way in which it consumed those who contracted it. There are treatments for it, but it often claims lives- especially in less developed countries where there isn't access to necessary treatment.
 
 
 
But recently, there has been major progress in preventing the disease.
 
Salmaan Keshavjee and Paul Farmer, two leading doctors who have been fighting tuberculosis for over ten years, sum it up well:
 
“The global AIDS effort of the past decade has shown how much can be accomplished in global health when effective diagnosis and care are matched with funding and political will.

Stinting on investments or on bold action against tuberculosis -- in all its forms -- will ensure that it remains a leading killer of people living in poverty in this decade and the next.”
 
We are now facing a problem. Increasingly, drug-resistant strains of tuberculosis are found in Russia, India and China- but they are on the rise in the West too. 
 
Underfunding has led to ineffective drugs being produced, which has catalysed the rise of these drug resistant strains. And it is these new variants of the disease which are causing so many deaths – and will continue to unless stopped.
 
This problem is particularly prevalent in India, which has one fifth of the world's cases. Drugs known to be resisted by the various strains of tuberculosis are being used-only making the problem worse.
 
Dr. Zarir Udwadia, a prominent scientist in the field, was particularly critical of the “futile exercise” India is embarking upon, which will; “serve to amplify resistance. It is morally and medically disastrous.” 
 
To combat this, it has been advised that patients are tested for whether the drugs given to them would be resisted or not. But in India's case, there simply aren't enough clinics available to do this, due to the lack of investment. We are now reaping the disastrous consequences of not taking this issue seriously enough.
 
These problems just emphasise the need for much more investment- now- to fund research and increase effectiveness of treatment- to end this terrible disease. 
 
Because if we don't, the problem will only get worse. If we don't, tuberculosis could turn into a pandemic once again. 
 
You can find more and take action here.

 
Posted by Philip Corden - GPP in Global Health for column Issue Analysis on Mar 22nd, 01:34
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Let's End Female Genital Cutting
 
Social taboos are always difficult to address, but talking about them is something NGOs, and society as a whole, is getting much better at. Take the issue of sanitation – once a taboo – now a widely addressed issue with a day marking it.
 
A couple of weeks ago, I went to an event on the International Day against Female Genital Cutting (FGC), something which I knew very little about.
 
 
The World Health Organisation defines this practice as 'procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons.'
 
There are many emotional, and mental effects of FGC. In a recent study, nearly half of girls who have undergone FGC met criteria indicating some from of mental disorder. The vast majority of girls describe feelings of 'intense fear, helplessness, horror, and severe pain.' 
 
And it doesn't stop there. Stories such as the one below are only too common.
 
'I lost seven of my nine children in childbirth. Because of the scarring I sustained I was not elastic enough. All seven of them suffocated inside my womb.'
 
For a long time, FGC has been regarded as a cultural issue. It has been considered that we in the West must not 'impose our values' upon those who carry out practices like FGC in the developing world. 
 
But that's simply not true. The movement to end this abhorrent practice is starting within Africa- not the West - community groups are rallying together and starting discussions on this issue, key to ending it. And slowly but surely, Africa citizens are putting down the preconceptions, that, for example, FGC is an issue dictated by religion, and engaging with Human Rights based educational programmes. 
 
So we were delighted to hear that the Department for International Development announced this week a new programme to support the ending of FGC, worth up to £35 million. It expects to reduce the practice by nearly a third in at least ten selected countries over the next five years by working directly within local communities. It also aims to get laws in place in these countries and fund research into the most cost-effective approaches to end FGC, to maximise impact.
 
So, change is being made- starting in communities who carry out the practice and being supported by the West. But, with all problems, the solution has not been reached. We need to do more to get this discussion started in more communities that practice FGC. Organisations such as the Orchid Project's courageous advocacy work raises this issue in important arenas, such as at this recent event in the House of Lords.
 
At this point, cynics would still argue that we in the West shouldn't be involved in African moral issues. But you'd be mistaken in thinking this is just an African issue- 66,000 people are estimated to be living with FGC in the UK alone, with a further 20,000 at risk of being subjected to the practice. 
 
So it's important that we take action here too, and we're so glad the government is taking action.
 
Let's continue to raise awareness of this issue, and end the matter within a generation. Find out more at the Orchid Project.
Posted by Philip Corden - GPP in Global Health, Education for column Decade of Change on Mar 14th, 02:14
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A message from the Young Australian of the Year
 

Michael and Akram

On behalf of the Global Poverty Project, I would like to extend my most sincere heartfelt congratulations to Akram Azimi, a remarkable individual with a truly inspirational story, on his announcement as the 2013 Young Australian of the Year. Akram is no stranger to the Global Poverty Project family, having served as a presenter of our 1.4 Billion Reasons presentation and as an ambassador for The End of Polio campaign.

I have had the privilege of counting Akram as a dear friend ever since we first met at a student conference in Singapore several years ago, and our friendship has deepened over our time together with the Rotary Club of Crawley. Having had the pleasure of witnessing up close Akram's kind character, warm sentiment and colossal commitment to community service, this announcement comes as no surprise. Indeed, you would be hard pressed to find a more deserving and gracious awardee and I have no doubt whatsoever that his example will inspire many Australians to give much more of themselves in time, skills and money.

Yet on the day when his significant contribution to the nation is rightly being celebrated, one would have naturally excused Akram for taking a moment's break from community service to simply bask in glory. He's earned it after all. But that's not in line with Akram's character. Rather he was keen as ever to roll up his sleeves and get to work on one of many upcoming projects he will be helping us out on, and he wanted you - our loyal supporters - to be involved right from the get go. With that in mind we wish to share the below message from Akram.

 Congratulations once again Akram!

Michael Sheldrick - Campaign Manager, The End of Polio 

---

I am living and healthy proof of how foreign aid can transform the life of a person in the developing world. However, you usually don't get the chance to meet them and see what a profound difference your tax dollars have made… until today.

I could thank the Prime Minister today as a healthy young person precisely because I was immunised against polio in war-torn Afghanistan by funds contributed to by Australian tax payers. Reflecting on this, I realise that Australians saved my life well before I set foot on Australian soil.

However, I did fail today to thank someone else: you.

Because if it weren’t for you and the other supporters of this campaign, the Prime Minister wouldn’t have made polio eradication a priority. You’re the reason the Australian Government committed $50 million to polio eradication. And you’re the reason that the PM stood alongside Bill Gates and Ban Ki-moon as a leader in the world of polio eradication at last year’s UNGA.

That’s why I’m so excited to be a part of this incredibly important campaign.

I was born in Afghanistan and spent part of my childhood in Pakistan. I know what it means to live in a polio-endemic country. I even remember receiving the vaccine.

I’ve also seen the research that shows what will happen if we fail – 200,000 children paralysed by this disease every year. On the other hand, success would truly make a statement that every child’s life is as valuable as our own.

So while I thanked the Prime Minister for everything she’s done so far today, I know the Government and our community can do more – together we can fight this through to the end.

I’m planning to make the most of my time as Young Australian of the Year by sharing the inspiring story of polio eradication far and wide. I’ll be doing all I can to make sure our collective voices are heard on this issue, and I’d love to share the platform with you. Join me as I tour the country giving presentations on polio.

And if you're interested in supporting or hosting me on my tour, click here.

Thanks once again for your involvement in this campaign and I hope to see your face in the crowd!

Akram Azimi – Young Australian of the Year
Posted by Michael Sheldrick and Akram Azimi in Aid, Global Health for column Where does my money go on Jan 25th, 04:46
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Amazing Progress, But a Very Real Risk
 

 “The Programme has never been in a stronger position, but how history looks back on 2012 will depend on what happens next. The remaining polio virus now sits on just 0.2% of the Earth’s land mass. Are we seeing its last stand?”

This is the question asked by the Independent Monitoring Board in its latest report, released recently. This group of public health experts, led by Sir Liam Donaldson, the UK’s former Chief Medical Officer, meets quarterly to review progress towards global polio eradication.

So what does their latest report say?

First of all, the IMB congratulates the program on the amazing progress that has been achieved over the past year. Not only has 2012 seen record-breaking low case numbers, but polio has been beaten back to the smallest geographic area in history. As the IMB states, “by this time in 2011, there had been almost three times as many children paralysed, in four times as many countries”.

We really are closer than ever to wiping out polio.

But the IMB also has a warning for the program – don’t celebrate too soon because the virus could still resurge:

“Cries of ‘nearly there’ have been heard before... History cruelly shows that hard-won progress is easily lost. In 2001, the number of polio cases reached an all-time low. In the years that followed, progress went awry and the virus spread once more."

 

 

And spread it did. Check out this infographic from the report, showing how polio spread from northern Nigeria to 18 countries between 2002 and 2005, causing more than 1200 cases of polio:

 

How can we prevent similar outbreaks from happening again? The IMB has a number of suggestions for the agencies running global polio eradication operations, including ensuring strong leadership, high parental demand and robust microplanning – feedback that is being taken seriously by those working on the technical side of things.

While we’ll leave the operational aspects in the capable hands of the likes of WHO and CDC, there is something we can help with – and that’s ensuring global polio eradication efforts are fully funded.

We’ve been incredibly lucky that there haven’t been any outbreaks in 2012, as the funding shortfall has caused the cancellation of vaccination campaigns in many of the same countries that suffered polio outbreaks over the past decade. But unless we can come up with the funding to ensure that no more vaccination campaigns will be cancelled, eventually our luck will run out.

The partner agencies of the Global Polio Eradication Initiative are currently putting the finishing touches on a strategy to end polio in the next two years and to make sure that it can’t come back. We need to help them come up with the money to fund their activities until polio is finally gone. So get set for a whole new wave of campaigning in 2013!

 

Some highlights of the report:

·       In Afghanistan, trials of Permanent Polio Teams have proven the strategy to be hugely successful. This strategy, which involves vaccination teams made up of local people, travelling from house to house, vaccinating children in their community on an ongoing basis (ie. not just during country-wide vaccination campaigns), has resulted in polio vaccine being provided to 146,000 children, including almost 9000 who had never before received a dose of the vaccine.

·       Helicopters are being used to reach children in the Lake Chad area who are normally entirely cut off from other health services.

·       In Nigeria, 1500 nomadic settlements have been identified for the first time.

·       Direct disbursement mechanisms in Pakistan are ensuring that vaccinators receive the money they are due, on time - an incredibly important step in ensuring these frontline workers are motivated to go the extra distance to vaccinate every child.

 

      This blog was originally published here.
Posted by Lauren O'Connor - GPP in Polio, Global Health for column Success Stories on Jan 4th, 02:58
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Lessons from a Pirate for Newborns
 

You never hear anyone talking about scurvy any more unless they’re telling a bad pirate joke. Scurvy, usually associated with long sea journeys of centuries past, has gone by the way side because we now know that sufficient vitamin C can prevent it. But the history of its disappearance is a storied tale that has important lessons for public health today.

 

During the era of the great naval explorations, literally boatloads of sailors would die of scurvy during those long periods at sea. When Vasco de Gama sailed around the Cape of Good Hope in 1497, he lost 100 of his 167 sailors to scurvy. They knew they had scurvy by a sense of malaise and lethargy followed by spots on the skin, jaundice, losing teeth and eventually death. As the story goes, in 1601, the British Navy Captain James Lancaster ran a study between his ships that were sailing from England to India. The crew members on one of the four ships got lemon juice every day. I’m sure you know the ending of this story—40% of the crew members on the other three ships without the lemon juice died of scurvy, but none of the crew getting the lemon juice got scurvy.

Captain Lancaster had discovered a miracle! A simple intervention that can save lives. And what happened with this new found knowledge? Besides its early adoption by James Cook, one of history’s greatest explorers, unfortunately, it sat on a shelf for almost 150 years until a Navy physician, James Lind, did the experiment again– public health’s first randomized controlled trial. And yes, with the same result.

Did this irrefutable evidence then lead to the immediate adoption of lemon juice by all sailors of the high seas? Well, it took another 48 years until the British Navy finally decided to make citrus part of the diet on ships, and then another 70 years to be brought to merchant marine vessels and actually become part of the British preventive policy.

All said and done, it took 264 years to get lemons, limes and oranges to sailors. It is mind boggling to think about the lost time, health and lives simply because of the disconnect between evidence generation, knowledge sharing, and behavior adoption.

I would like to say that we have learned from the great British navy how not to introduce a new health intervention. But, unfortunately, health care is still notoriously slow to gain new knowledge and actually put it to use.

One example is Kangaroo Mother Care, when a mother wraps her baby to her chest, skin-to-skin, to provide warmth, love and breast milk. It’s a very simple method that has been proven time and again to save premature newborns, those born before 37 weeks of pregnancy. Holding a baby skin-to-skin promotes breastfeeding, reduces neonatal infection, and significantly improves the odds of survival. Recent estimates suggest that if we could scale up this behavior worldwide, the lives of 450,000 preterm infants would be saved each year.

The benefits of Kangaroo Mother Care have been recognized since it was first introduced in 1978. That was 34 yearsago, and doctors, nurses, midwives, frontline workers, and moms around the world still do not know about this lifesaving method. It’s only practiced with any consistency in a few countries (South Africa, Malawi, Brazil and Colombia). And there are no clear indicators to even measure the coverage and quality of care.

Why is this great intervention so underutilized? Some doctors prefer complicated technology, calling Kangaroo Mother Care inferior and not appropriate for hospitals. Some health administrators don’t even know it exists. Family members may not believe it works or are nervous to be holding such a tiny baby so closely. It is also a major commitment—most babies should be continuously held, making it difficult for the caregiver to carry on with other life activities.

But the evidence is clear: preterm babies have a better chance of survival if held skin-to-skin.

Which boat would you rather be on? If we go back to scurvy and Captain Lancaster’s experiment, I bet the crew members on the ship that got the lemon juice were really happy to be on that ship where their chance of survival was much higher than the others.

Shouldn’t a baby born too soon have that same chance to be on the right boat?

This blog was originally posted on Impatient Optimists, the blog of the Bill and Melinda Gates Foundation.

*Picture: Simon Tong
Posted by Gary Darmstadt, Wendy Prosser in Global Health for column Issue Analysis on Dec 7th 2012, 02:57
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