Water is Life by Mary Louise Tatum

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Water is the essence of life. Your body is mostly composed of water, approximately 60% (water.usgs.gov/edu/propertyyou.html).  As a result, without water you would cease to exist. Yet, 1.1 billion people lack access to safe drinking water (World Health Organization). The World Health Organization (WHO) and United Nation’s Children Fund (UNICEF) Joint Monitoring Programme (JMP) for water and sanitation defines drinking water as: water with microbial, chemical, and physical characteristics that meet WHO guidelines and are used for drinking, cooking, and personal hygiene. The collaboration further defines access to safe drinking water as a source that is less than 1 kilometer away from place of use and reliably supplies 20 liters per household member daily (http://www.who.int/water_sanitation_health/mdg1/en/).

One of the natural wonders of the world, Victoria Falls, located in Zambia, has approximately 625 million liters of water flowing over its edge per minute (www.victoriafalls-guide.net/facts-on-victoria-falls.html). During the peak flood season, the Falls create a thunderous roar and drench all that is near. Nevertheless, UNICEF reports 4.8 million—approximately one third of the population— Zambians are without access to clean water. Moreover, insufficient drinking water and poor sanitation in the country have contributed to over 800,000 deaths related to diarrhea alone (not including other illnesses related to water issues) (World Health Organization).

In another part of the world, in the mega-city of São Paulo, Brazil, residents go days at a time without water. How did this happen to a country with access to the Amazon River, industry, a bustling tourist industry and sandy beaches? The Amazon River, the world’s largest river by volume, supplies  Brazil its fresh water, yet due to urban growth, poor city planning, leaking water reservoirs, destruction of forest and wetlands, and pollution, there is a lack of safe water for drinking, cooking, and personal hygiene (Nations, 2015) . As a result, water is now being rationed and some residents may be allowed access to water only biweekly.

Unfortunately, the extent of water issues is not limited to merely a few, but is increasingly becoming a global issue impacting many—including the developed nations. Case in point, the western region of the United States of America, specifically California, has been experiencing increasing drought issues for years. In fact, it has gotten to the point that policy and regulations are being considered and implemented to limit use of water with fines for noncompliance.  It will be interesting to observe how the United States, who manages numerous water programs in developing nations, resolve this issue.  This is a nation of people who, for the most part, are used to having free access to water for not only basic needs, but also luxuries. And now many Americans may have to face not only regulations restricting their use of water for swimming pools, lush green lawns, washing cars, skiing, and other recreational activities, but they may also have to deal with the more serious issue of having affordable foods as the water shortage impacts the agriculture sector. It has already been estimated that California will lose $2.7 billion this year due to the current drought issues (U.C. Davis Research Project). In addition, they may have to deal with the possible increase of disease, such as West Nile Virus, and the difficulty of dealing with wildfires due to water shortages.

Of course there is much discourse regarding who or what is to blame for the impending water shortage in the US.  Is it the pollution distributed into the air from numerous factories, vehicles, and farms or is it just a natural occurrence which would occur regardless of human action? Is it archaic water regulations that have not kept up with the diminishing supply of water, or is it our disregard and misuse of what we think is a never-ending supply? Regardless, we are no longer hypothesizing about the lack of water. At least 40 million Americans are actually experiencing the reduced availability of water.

Now that the problem is no longer afar, but at our front door, what do we do?  This issue is not just an issue out west in the US. It is a global issue that will continue to worsen as the population of the earth increases. So now is the time for everyone, whether directly affected or not, to wake up and to encourage not just policy makers, but each of us to make behavioral changes and be more conscientious on our use and waste of this precious resource.

Guest Blog: The DevelopmentXChange Pitch Competition

Guest Blogger: Amanda Hirsch


Saving Lives at Birth, along with the U.S. Agency for International Development (USAID), hosted DevelopmentXChange, the fifth annual pitch competition held by the partnership to call upon innovators from around to identify and scale up groundbreaking prevention and treatment approaches for pregnant women and newborns in poor, hard-to-reach communities.

Fifty-three finalists from the pool of innovators joined this year’s DevelopmentXChange in Washington, DC to participate in the final stage of the competition. They gathered to actively network their ideas with innovators, investors and partners, display their innovations in an open Marketplace, and compete for grants to make their innovations reality.

Amongst the 53 finalists, the first to present was a representative of the Pumani by 3rd Stone Design. Half of premature babies struggle to breath upon birth. This product expands upon the existing Bubble Continuous Positive Airway (bCPAP) technologies that are commonly used in the developed world to treat neonates with compromised respiratory systems by maintaining positive airway pressure during breathing, preventing airway collapse and improving oxygenation.

The Pumani, named after the Malawian term for “breathe restfully,” is as cheaper, easily-transportable version of the original bCPAP. The Pumani is currently being used by 700 clinical staff in 40 hospitals in Malawi and surrounding African countires. 2,000 patients have been treated with 170 Pumani devices to date and have seen survival rates of 64.6% with usage compared to rates of 23.5% from the use of oxygen alone. Creators of the Pumani hope to receive sufficient funds to manufacture hundreds more devices and to develop a sales and distribution team.

Next, innovators of Emory University pitched their Skin Immunization Microneedle Patch. Each year 1.5 million babies and children die of vaccine-preventable diseases. Low socioeconomic status, little-to-no access to healthcare facilities to receive vaccinations, and difficulty transporting and storing vaccines to remote and rural populations have severely impacted vaccination rates in hard-to-reach communities.

The vaccination patch, a small square covered in microneedles that will vaccinate a subject against one or multiple diseases within minutes is proposed to be the solution to this problem. The Skin Immunization Microneedle patch can be stored in unfavorable elements, transported easily, requires minimal storage space, and eliminates the burden of biohazard sharps. So far, the patch has successfully provoked immune responses to H1N1 and tetanus. Innovators of the Emory University team wish for funding to begin conducting human studies for the patch.

Third, innovators from the University of Toronto sought to address iron deficiency in pregnant women, particularly in Southeast Asia. Iron deficiency causes 150,000 maternal deaths each year. To address this problem, the Toronto teamed proposed food fortification- to fortify tea with iron. Tea was chosen to be fortified because it is the sole product that is universally purchased across Southeast Asia. People from all walks of life- rich, poor, urban, rural, must go to purchase tea.

Mimicking the iron fortification of salt which has cured one million people of anemia, it was proposed that iron be microencapsulated into tea that can be processed in the body. Innovators of the iron-fortified tea seek funds to work on managing the taste, distribution, and exploration of their product.

The remaining of the 53 innovators also presented at the DevelopmentXChange pitch competition. To learn more about the innovators, products, competition, and organization, visit http://www.savinglivesatbirth.net.


twitter photoAmanda Hirsch is a summer Global Health intern for APHA. She is starting her final undergraduate year at the GWU Milken Institute School of Public Health. Her passion for global health began in rural Honduras, and she is particularly interested in disparities in healthcare systems that affect the Latino community. She intends to pursue an MPH degree with a dual concentration in Community-Oriented Primary Care and Global Health. You can follow her on Twitter at @amandahirsch12.

Amnesty International votes to decriminalize sex work; controversy ensues

Note: This was cross-posted to my own blog.


At its International Council Meeting in Dublin on Tuesday, human rights organization Amnesty International adopted a resolution allowing the organization to develop a policy toward the decriminalization of sex work, with the goal of strengthening human rights protections for sex workers around the world.

The resolution recommends that Amnesty International develop a policy that supports the full decriminalization of all aspects of consensual sex work. The policy will also call on states to ensure that sex workers enjoy full and equal legal protection from exploitation, trafficking and violence.

The research and consultation carried out in the development of this policy in the past two years concluded that this was the best way to defend sex workers’ human rights and lessen the risk of abuse and violations they face.

The violations that sex workers can be exposed to include physical and sexual violence, arbitrary arrest and detention, extortion and harassment, human trafficking, forced HIV testing and medical interventions. They can also be excluded from health care and housing services and other social and legal protection.

The policy has drawn from an extensive evidence base from sources including UN agencies, such as the World Health Organization, UNAIDS, UN Women and the UN Special Rapporteur on the Right to Health.

It was a pretty big deal – the story has been covered by most major news outlets and was even on NPR this morning – and the decision comes after two years of discussion and debate within the organization.

To call the vote controversial might be somewhat of an understatement. Last week saw a feminist firestorm erupt over the issue, joined by celebrities like Meryl Streep and Lena Dunham on social media, leading up to the vote.

Last week’s internet melee is just the most recent boiling-over of a decades-long debate on the “problem of prostitution.” When I first saw Humanosphere’s reporting on the story in my RSS reader last week, I skimmed over it but did not mentally bookmark it until I came across a post from “Sex Work Research” from the same day. The post links to a 1994 article by Annette Jolin from the journal Crime and Delinquency called “On the Backs of Working Prostitutes: Feminist Theory and Prostitution Policy” (a full-text link to the article is available in the post). It is a decent read, providing the historical background that informs the current debate and breaking down the feminist split on the issue without getting too heavy on feminist theory.

Modern feminists have been unable to resolve questions of this sort: Is it sexual or economic inequality that keeps women from attaining equality? Should protecting women from male sexual subjugation entail restricting women’s ability to make choices?

In fundamental terms…feminists divide into two broad groups regarding the role of prostitution in women’s fight for equality:

  1. Women who stress emancipation from male sexual oppression (prostitute as victim) as the primary equity issue in the prostitution debate – the sexual equality first (SEF) group; and
  2. Women who stress freedom of choice (prostitute as worker) as the primary equity issue in the prostitution debate – the free choice first (FCF) group.

The paper goes on to explain each position in more detail and outline what Jolin sees as the flaws and fallacies on each side. While most of the commentary on the AI vote is shorter and potentially more accessible than the article, it is essentially all a rehash of what Jolin’s paper outlines.

The modern concern with decriminalization (as opposed to legalization, which would allow states to regulate the industry and which AI does not support) is that it will protect traffickers; opponents advocate for what is commonly referred to as the “Swedish model,” in which pimps and purchasers are targeted but the sex workers themselves are not subject to prosecution. However, sex workers and their advocates have pointed out that this model presents a whole different host of problems, including disdain and abuse from police officers (which the model is designed to prevent). What surprised me most was that anti-trafficking advocates and feminists who oppose decriminalizing do not seem to be listening to sex workers themselves, who have very vocally advocated for decriminalization for years – both in the developed and in the developing world.

It can be difficult to strike a balance between principle and “realities on the ground” when it comes to policy, but what ultimately steered AI to its decision was the evidence – mounting research that decriminalization is the most effective way to protect sex workers’ rights to health, work, and choice. As a public health and HIV advocate myself, I cannot help but agree.

Guest Blog: Research, Data and the Risk of Inaction

Guest Blogger: Amanda Hirsch


Research and data are a necessity to execute public health agendas – to identify populations in need, pinpoint existing gaps in healthcare systems, and to track and monitor progress. Data collection exists to ensure these necessary details are documented and not forgotten as every person, health affliction, and need is logged as a number, a figure, a statistic.

Data collection, although crucial, can also become highly counter-productive as this, a vast collection of numerated people and needs, can cause these people and needs to become just that – numbers.

Dr. Binagwaho highlighted the experience of West Africa during the recent Ebola epidemic, one in which the identities of thousands of individuals were lost to the tool most necessary for successful public health interventions.

When the faces and stories of West Africa became blended together through numbers and statistics, the potency of the cause and the intervention became lost. Data can allow people to disappear as their identities take-on a range of figures that highlight their poverty, poor health outcomes, and perceived failures therefore undermining their humanity, discouraging action and perhaps encouraging inaction by those that cannot see the direction nor the importance of the aid that is necessary.

Inaction, when these figures display what appears to be a hopeless and trodden population, is lethal to the real-life humans that the numbers account for.

The Rwandan Experience

In honor of David E. Barmes, renowned public health dentist and epidemiologist, the National Institute of Health (NIH) in Bethesda, Maryland hosted the annual Barmes Global Health lecture featuring Rwandan Minister of Health Dr. Agnes Binagwaho on “Medical Research and Capacity Building: The Experience of Rwanda.”

As the sole presenter, Dr. Binagwaho spoke upon her experience as a physician, researcher, and government health official in her native Rwanda and the country’s substantial improvements in public health following the Rwandan genocide of 1994 that took the lives of over 500,000 citizens.

In need of rapid and effective reconstruction efforts after the end of the civil war, the country was pushed to reinvent its public health systems and infrastructure to make Rwanda a stronger and healthier country than it had ever been before.

Since the genocide, Rwanda, a country smaller than most American states with a population of slightly over ten million, has achieved health outcomes for its people that far surpass those of many developed nations. After reconstructive efforts, the under-five mortality in Rwanda decreased by three-quarters, life expectancy nearly doubled, vaccination rates skyrocketed to 90% for vaccines such as HPV for both young boys and girls, and over 90% of Rwandans acquired health insurance coverage.

“Rwanda is a clear example of what is now possible in sub-Saharan Africa”- Dr. Agnes Binagwaho

How were such great achievements accomplished? An emphasis on resilience- a concept that requires not only a strengthening of health systems, but a focus on strengthening the backbone of those health systems as well- the people.

Research and data collection were key to Rwanda’s reconstruction efforts. In Rwanda, Binagwaho explained that public health workers used this research and data to the population’s advantage, maintaining a scientific and moral responsibility to the people, leaving no one behind and holding research to a new standard: an impact- focused standard that would not allow for inactivity.

The people maintain culture, infrastructure, morale, and economic wellbeing. When the people are healthy and stable, the benefits to the country are immense. According to Dr. Binagwaho Rwanda recognized this connection, encouraging  vast vaccination campaigns, emphasis on maternal and child health, and a reach for universal health coverage to protect the country’s most valuable asset. In turn, Rwanda experienced substantial economic growth, social rest, and improved population health- a feat that would not have been accomplished had the needs of the people not been put first.

You can hear Dr. Agnes Binagwaho’s presentation at the NIH here.


twitter photoAmanda Hirsch is a summer Global Health intern for APHA. She is starting her final undergraduate year at the GWU Milken Institute School of Public Health. Her passion for global health began in rural Honduras, and she is particularly interested in disparities in healthcare systems that affect the Latino community. She intends to pursue an MPH degree with a dual concentration in Community-Oriented Primary Care and Global Health. You can follow her on Twitter at @amandahirsch12.

NYT on the relationship between health and climate change: unraveling the science is “tricky” but the risks are real

Note: This was cross-posted to my own blog.


Last week, the New York Times published a nuanced and thoughtful piece on the complicated scientific relationship between climate change and health outcomes. It lays out several health effects that advocates frequently bring up – vector-borne diseases, natural disasters, and temperature extremes – and examines the strength of the research behind each association.

The article’s tone is cautious, and it acknowledges early on that public health initiatives based on climate risk are politically fraught and, in some cases, the science is not as robust as some would like.

A White House report listed deepening risks. Asthma will worsen, heat-related deaths will rise, and the number and traveling range of insects carrying diseases once confined to the tropics will increase.

But the bullet points convey a certainty that many scientists say does not yet exist. Scientists agree that evidence is growing that warmer weather is having an effect on health, but they say it is only one part of an immensely complex set of forces that are influencing health.

“There’s a lot of evidence showing that extreme weather can hurt people, but what we don’t know is whether those effects are getting worse,” said Patrick L. Kinney, director of the Columbia University Climate and Health Program, adding that scientists don’t have the long-term data needed to pinpoint how climate change is affecting health.

Mary H. Hayden, a scientist at the National Center for Atmospheric Research in Boulder, Colo., who studies climate and health, said of dengue fever, a tropical disease carried by mosquitoes: “I don’t think we can dismiss the role of climate. But can we say there is a direct causal link? No, we can’t. It’s more complex than that.”

The central point of the article is that the science examining climate and its effects on health is (as most scientists will cheerfully admit) quite complicated, and the data that the scientific community has on the subject is incomplete and patchy for many countries and geographic regions. The upside to this, however, is that we now have much more data than we used to, in no small part thanks to increased political will and a greater sense of urgency.

Evidence is accumulating, however. In 2000, the first National Climate Assessment, a government document weaving together the best evidence on climate change, had just 21 pages on health. The most recent assessment included a special section on health that filled more than 400 pages.

Two peer-reviewed British journals — Philosophical Transactions B and The Lancet — have dedicated many pages to the topic this year. Europeans, unburdened by the level of political controversy over climate change in the United States, often give more conclusive interpretations of the science.

“We are in a far more certain place now,” said Nick Watts of the University College London Institute for Global Health and a co-author of the Lancet analysis. “We feel very comfortable talking about direct effects of climate change on health.”

One thing that the article pointed out was that the effects of climate health – particularly with regard to temperature extremes – is that they disproportionately affect the poor because they are more vulnerable to the elements. This is one thing that we focused on in the health chapter of Climate Risk and Resilience in China (which I co-authored) and why I like the idea of working to reduce climate-related risks to the most vulnerable populations, as that may be a less politically controversial option. No one can argue that many lives are at risk from a heat wave when so many have no access to AC.

Rose Schneider, the IH Section’s Climate Change Working Group Chair, agreed on that point of the article. “It makes sense to be ‘skeptical’ and it is true that especially in developing countries most is written about ‘projections’ of the effects on health, but it is true that the toll is much worse, especially on the poor, if from nothing else than major climate events like floods, windstorms, crop damage from drought, and sea rise. I liked the last line of the article; I’m not waiting.”

As Dr. Kinney noted, “if we wait for the health evidence to be ironclad, it may well be too late.”

WHO Video: Touchy-feely response to harsh international criticism?

Note: This was cross-posted to my own blog.


Yesterday, the WHO released a short YouTube video, “If you can beat Ebola, you can beat anything,” featuring the story of a Liberian doctor who contracted Ebola and recovered with the help of his family. After some dramatic music and musing from Dr. Philip Ireland, the video goes on to interview several other clinicians who provide hopeful reflections on how to better prepare African countries to respond to future outbreaks.

The video’s description reads:

When Ebola hit West Africa the healthcare systems of the region were under-financed and poorly equipped. Liberia had only 130 doctors for a country of 4.5 million people. Many of those doctors died of the disease. As Liberia, Guinea and Sierra Leone look to the future and to rebuilding their countries, recruiting and training doctors, nurses and other health professionals will be key to avoiding another devastating crisis. Dr Ireland, a Liberian doctor who has recovered from Ebola, says in the video that if
you can beat Ebola you can beat anything.

Ensuring quality healthcare and protection from disease outbreaks for the people living in Ebola affected and other poor countries is possible and our Number 1 health priority.

It’s safe to assume that the video is part of WHO’s PR response to the damning assessment of its handling of the persistent Ebola outbreak that is still (yes, still) going after over a year. While MSF began calling for outside intervention fairly early on, the WHO intentionally delayed sounding its own alarm and even contradicted MSF’s assessment of the severity of the outbreak due to political pressures:

Among the reasons the United Nations agency cited in internal deliberations: worries that declaring such an emergency — akin to an international SOS — could anger the African countries involved, hurt their economies or interfere with the Muslim pilgrimage to Mecca.

Those arguments struck critics, experts and several former WHO staff as wrong-headed.

In public comments, WHO Director-General Dr. Margaret Chan has repeatedly said the epidemic caught the world by surprise.

“The disease was unexpected and unfamiliar to everyone, from (doctors) and laboratory staff to governments and their citizens,” she said in January. Last week, she told an audience in London that the first sign that West Africa’s Ebola crisis might become a global emergency came in late July, when a consultant fatally ill with the disease flew from Liberia to a Nigerian airport.

But internal documents obtained by AP show that senior directors at the health agency’s headquarters in Geneva were informed of how dire the situation was early on and held off on declaring a global emergency.

More recently, an expert assessment commissioned by the WHO to review the organization’s response released its own findings. While somewhat critical, the report was much more muted and also fairly optimistic (as self-assessments are bound to be). In addition to internal reforms, the report calls for a revision of the International Health Regulations; there was a commentary piece calling for the same thing in the most recent issue of Lancet Global Health (I am not sure if the authors of the article were also on the panel). For its own part, MSF responded in its typical straight-shooting fashion:

“MSF has repeatedly raised the alarm on the WHO and global response to Ebola and was also interviewed by the panel. On paper, there are a lot of strong points in the report that reflect many issues MSF is concerned about, but the question how will this translate into real action on the ground in future outbreaks and epidemics and what will Member States do to make sure this really happens?

We have seen so many reports calling for change, with everyone focused on how to improve future response and meanwhile, with 20-25 new Ebola cases per week in the region, we still don`t have the current epidemic under control. On Ebola, we went from global indifference, to global fear, to global response and now to global fatigue. We must finish the job.”

Guest Blog: Sepsis – A Neglected Global Killer (CUGH)

Guest Blogger: Amanda Hirsch


Sepsis can be caused by any serious infection that leads to multi-organ dysfunction. Diseases that most commonly lead to sepsis infection are pneumonia, TB, HIV/AIDS, dengue, diarrheal diseases, etc. Multi organ dysfunction can lead to death if not recognized and treated early.

Every year, approximately 30 million cases of sepsis are documented. However, it is speculated that the 30 million known cases only comprise a portion of the actual incidence of sepsis each year. Recognition and documentation of sepsis cases is lacking and the exact global burden of sepsis remains unknown.

Many deaths that occur due to sepsis are attributed to the original disease. For example, if a patient succumbs to sepsis after contracting pneumonia, their cause of death will likely be recorded as pneumonia. Secondly, late mortality from sepsis contributes to its underreporting. Many sepsis infections occur after a patient is discharged from the hospital. Yet, very few patients return to seek help for their rapidly advanced infection, resulting in a mortality due to sepsis.

The highest burden of sepsis infections occurs especially in low income countries. The lack of resilient health systems, little public education and awareness, costs of healthcare, long distances to healthcare facilities, and poor transportation all make it difficult for individuals to seek and receive care for sepsis. Also in poor countries, low immunization rates, low coverage for citizens, high levels of disease co-morbidity, unprepared or undertrained healthcare workers, a low emphasis on preventative services, few new drugs for tropical diseases circling through the market, and the export of healthcare staff make sepsis significantly more of a threat.

This underrepresentation of sepsis and lacking preparedness and recognition in the healthcare world has pushed members of organizations such as the Global Sepsis Alliance to call for help- bringing public awareness to the unacceptably high current incidence of morbidity and mortality from sepsis, asserting that something must be done.

To curb the incidence of sepsis, a multi-faceted approach is needed. This approach, according to Dr. Ron Daniels includes the following:

  • Vaccinations
  • Strict hygiene
  • Early recognition
  • Aggressive treatment
  • Rational us of antimicrobials
  • Innovations in care
  • Knowledge translation
  • Capacity building
  • Advocacy

On the topic of advocacy, Dr. Daniels spoke of turning sepsis into a political movement of sorts, putting a face and a name to the infection and what it includes. The public must be educated on the signs and symptoms, the media must spread the word, and governments must allow for more data to be collected, support more funding for sepsis research and treatment, and use their power and platform to make sepsis a priority on both the national and international political arenas.


twitter photoAmanda Hirsch is a summer Global Health intern for APHA. She is starting her final undergraduate year at the GWU Milken Institute School of Public Health. Her passion for global health began in rural Honduras, and she is particularly interested in disparities in healthcare systems that affect the Latino community. She intends to pursue an MPH degree with a dual concentration in Community-Oriented Primary Care and Global Health. You can follow her on Twitter at @amandahirsch12.