Guest Blog

Q & A with Ambassador Goosby

2009-11-05T18:23:18+00:00

Ambassador Eric Goosby, MD, became the U.S. Global AIDS Coordinator in June. He talked with GLOBAL HEALTH magazine in late October about the fragility of health systems, the need to build capacity in ministries of health in the developing world, and what the Obama administration’s Global Health Initiative will look like. Here is an edited excerpt of his interview with journalist John Donnelly. Q: Do you see a time ahead in which countries will ration antiretroviral drugs? A: I think that if countries go to 350 (CD4 count), there will have to be rationing because they do not have enough resources to cover people below 200 or people below 150. If they now say anybody 350 and down are eligible, they are going to have to figure out a way responsibly to put those people who are most ill on drugs first. I think the challenge globally to us at this moment is to acknowledge this unmet need in treatment - we’ve gotten about a third of the way there. It’s (time) for the world dialogue to change and start to engage around our shared responsibility in response to this epidemic. Is it just the responsibility of one country to mount a treatment response, or is it something that we really as all countries on the planet should try to share as a responsibility? I’m very interested in facilitating that dialogue before we get into rationing.

President Carter Calls for Partnership in Hispaniola

2009-10-26T21:31:43+00:00

It’s 8:30 at night. The smell is unmistakably bovine as we find ourselves next to a sea of cattle enclosed by a scrap-metal fence. It’s mosquito-catching time in the Dominican Republic. Armed with plastic tubing and Styrofoam cups laced with netting, three of the country’s seven entomologists are hunting for Anopheles albimanus, the country’s prevailing malaria vector, to test for resistance to insecticides that have been used to treat bed nets. Unlike their African counterparts who prefer to feed on humans, the malaria vector in the Dominican Republic is decidedly zoophilic, which is why we find ourselves here. This is all part of a bi-national pilot project to eliminate malaria in Hispaniola.

Doctor to Honduras� Garifuna Persecuted for Work

2009-10-25T18:44:36+00:00

On Oct. 6, Honduran military police invaded the only Garifuna hospital in the country, located in remote Ciriboya on the Atlantic coast. According to eyewitnesses, 15 armed military police broke into the hospital in the early morning hours, later claiming they were searching for illegal drugs. No one was injured in the raid, which was timed during a hospital shift change. The military raid follows a series of measures by the defacto government of Honduras in its attempt to shut down the hospital. The hospital was inspired by Dr. Luther Castillo and other Garifuna doctors. Garifuna are an ethnic minority group in Latin America. The institution serves surrounding indigenous communities, whose members were active in the construction of the hospital. “The community feels great ownership in this project,” said Dr. Castillo. “We are not just providing health care to a forgotten people. We are creating a new model of free health care, an example for other poor regions in Latin America.”

Why We Should Care about COPD

2009-10-23T20:11:59+00:00

Chronic Obstructive Pulmonary Disease (COPD) is a global public health problem of growing concern. Data from the World Health Organization Global Burden of Disease Project indicates that COPD is a leading cause of death worldwide, surpassed only by heart attack, stroke, and acute lung infections. COPD kills more people than cancer and as many people as HIV/AIDS. Use of tobacco products and - especially in developing countries - exposure to biomass fuels, and fumes from indoor cooking and heating are the reasons for the increased morbidity and mortality from COPD. Another reason for the increased number of people diagnosed with COPD is the worldwide increase in the age of the population. COPD is a lung disease characterized by airflow limitation (lung damage) that is usually progressive and is associated with an inflammatory response of the lungs to noxious particles making breathing difficult. Symptoms of COPD include coughing, bringing up phlegm or mucus, and shortness of breath.

Pneumonia: A Problem of Perception

2009-10-23T18:33:24+00:00

Ask anyone which disease kills more children than any other, and odds are you’ll hear malaria or HIV/AIDS. Fewer than 5 percent of Americans will give you the correct answer: pneumonia. America’s perceptions are more closely aligned with spending priorities than on-the-ground realities. Pneumonia kills 2 million children under five every year, more than HIV/AIDS and malaria combined, yet it receives only 1/50th of their combined R&D funding. How is it possible that such a large cause of childhood mortality persists despite affordable, effective interventions? The answer has a little to do with science and everything to do with perception.

Universities Form Bond Over Global Health

2009-09-18T17:14:25+00:00

A historic surge of student idealism and funding are coming together to create a historic moment in time for global health and universities across North America have answered the call. Representatives from 58 universities met at NIH Sept. 14-15 for the inaugural meeting of The Consortium of Universities for Global Health, a consortium formed to make universities a transforming force in global health. One of the speakers, former U.S. Rep. John Porter (R-IL), now a high-profile lobbyist, said universities need to put academic assets in great focus and move expeditiously to take advantage of this moment in time when politics are on the side of global health. Porter said the PEPFAR initiative told the world that the United States cares. “We need to build on the lessons learned from PEPFAR,” he said. The overwhelming message from the conference was that solving some of the world’s most complex problems is a priority not only among universities but with the U.S. government.

Half the Sky: Turning Oppression into Opportunity for Women Worldwide

2009-08-28T16:23:10+00:00

At its core, the book Half the Sky Oppression into Opportunity for Women Worldwide (Knopf) by the Pulitzer Prize winning New York Times husband-wife team of Nicholas D. Kristof and Sheryl Wudunn is asking for a worldwide grassroots movement for the women and girls of the world. It does this through riveting and inspiring stories of women who triumph over unimaginable adversity to change their world and ours. Every person who has ever lived has come out of the womb of a woman. When the world takes care of women, women take care of the world. Education, health and gender equality are the cornerstones of women’s empowerment, of a livable planet, and of a more hopeful world. This book puts it all together like no other. Of particular interest to the global health community will be the health-related stories. Part of Chapter Six, for example, shares the story of the much-beloved Dr. Allan Rosenfield, for whom maternal mortality was not only an issue of health, but one of human rights. Buy the book for this chapter alone.

Communities: �Missing Partner� is Local Ingredient

2009-08-27T15:53:25+00:00

An old cliché says that “all politics is local” - that people’s votes are driven more by the quality of local services like garbage collection than by debates on big national issues. That phrase can also be applied to health, since poor health and illness are experienced in the course of daily life: a child lies sick, a pregnant woman needs care, a man is injured on the job, a young couple wants to learn about family planning. Health systems must offer care where people live. Failures may be caused by global or national forces, but the impact is profoundly local. Change, when it comes, occurs in individual lives, families and villages. This doesn’t mean that global and national politics - and health-care policy - are not important. As we in the global health community well know, they are. Policy matters a great deal, which is why so many of us put so much time and effort into our advocacy work. We know that UN, G8 and parliamentary resolutions express commitments to which governments can and must be held; that aid budgets are expressions (or, all too often, fail to be adequate expressions) of those commitments; that fiscal appropriations can represent concrete investments in saving lives. We know that national laws and health policies have profound impacts on the quality of people’s lives, on their ability to exercise and enjoy their human rights, on their safety, security, health, survival.

An Inside Look at How Policy Affects Practice in West Africa

2009-08-13T13:08:42+00:00

From Senegal: Part 1: Looking Inside the Health Ministry Part 2: Short Supply of Rural Health Clinics Brings Toll In Sierra Leone: Part 3: Health Ministry Under Budget and Asks How to Spend the Money Part 4: Health Minister Re-evaluates Plan for Free Health Services Part 5: A Day in the ‘Graveyard for Pregnant Women’ Part 6: What Happened to Isata Swaray? Journalist John Donnelly has spent the last two weeks traveling through Senegal and Sierra Leone to look inside Africa’s health ministries and then going into the field to see how policy decisions are affecting the poor. His remarkable journey provides great insight into how policies are created, implemented and, most importantly, manifested in practice. From the Minister of Health to the mother unsure of how to pay her hospital bill, Donnelly captures the humanity and bureaucracy that is the reality of African health.

HeroRATS: African Rats Trained to Sniff Out TB

2009-07-30T19:55:41+00:00

Training African giant pouched rats to detect pulmonary tuberculosis may sound like an extra-ordinary idea. In reality, it is a novel and alternative tool to enhance case detection in resource limited settings, at higher speed, smaller cost, and lower levels of skills in the operators. Moreover, this approach doesn’t require any hi-tech equipment, or expensive reagents.It began when the rats - HeroRATS - were trained by the organization APOPO to detect landmines. After several years with a proven record for successful demining, HeroRATS now also addresses another humanitarian detection application: TB diagnosis. In ancient history, pulmonary TB has been diagnosed through interpretation of the volatile biomarkers exuding from human sputa. The ancient Chinese and Greek used a hot stone or a flame to burn the sputum of suspected patients and interpret the odour in the fume. Recently, plural research efforts for better TB diagnostic also pursue vapour detection, through the development of electronic noses and other tools, either in sputa or in breath.