Announcement: American-Iranian Academic Exchange

Section members and other interested professionals! Please see the following announcement from Taraneh Salke, who is leading an effort to organize a public health exchange to Iran. This exchange, while modeled after APHA’s sponsored delegation to Cuba, is not directly affiliated with APHA. If you are interested in learning more, please contact her at taranehsalke@yahoo.com.

If you would like to publicize commentary on the exchange described below, you may do so in the Comments section here, or contact me directly at jmkeralis [at] gmail [dot] com.


Dear colleagues,

My name is Taraneh Salke, an APHA member. I am writing to invite the APHA community to join an academic exchange trip to Iran tentatively scheduled for October of 2014. The American Iranian Academic Exchange is the first of its kind in nearly four decades, presenting a historic opportunity for public health professionals to bridge the distance of culture and politics, taking advantage of new openings created by high level dialogue between the American and Iranian governments. The exchange aims to support global academic cooperation through scientific exchange with our Iranian colleagues. This exchange is open to all professionals from all health and medical fields.

The visit will help us gain an understanding of the Iranian medical care structure, its integration with public health systems. The country’s successful family planning and reproductive health programs have led to maternal mortality rates at levels comparable with the United States, a total fertility rate of 1.6, and rates of contraceptive use that are among the best in the world. Iran’s public health establishment has also pursued a rigorous immunization campaign, reaching 99% coverage rates for most indicators tracked by UNICEF.

To learn more about Iran’s health care system, we will visit hospitals, clinics and medical universities. Also on our itinerary are visits to the Pasteur Institute of Iran and a generic pharmaceutical manufacturing plant in Isfahan.

In joining this project, we also join in the prospect of fostering collaborative research and the sharing of ideas, culture and values between American and Iranian health communities. There is a strong desire among Iranian professionals of all fields and many government officials to improve relations with the United States. During our travels, we will also be exposed to Iran’s rich culture–including Persian culinary arts, a storied architecture and the country’s famous rug crafts–which had the Huffington Post calling Iran a top tourist destination for 2014.

This trip is led by myself, Taraneh Salke, and my team. Since 1999, I have been working to promote women’s health and rights in the Middle East, founding the nonprofit organization Family Health Alliance (FHA) in 2005 to carry out my vision. In my position as FHA’s Executive Director, I have designed and implemented over 30 capacity building programs in Afghanistan, training hundreds of local health providers on strategies to reduce maternal and infant mortality. I have also studied Iran’s health care system extensively, coordinating two previous projects with Iranian medical universities and public hospitals.

More information on me and the work of Family Health Alliance is available at the following links:
http://www.taranehsalke.com/
http://www.familyhealthalliance.org/

The American/Iranian Academic Exchange is modeled after an APHA-sponsored delegation to Cuba that I had the good fortune to be a part of. The APHA community has helped build bridges between the scientific communities around the world, and this is an opportunity to continue in that tradition.

In November 2013, I traveled to Iran meeting with university officials and medical professionals who have eagerly agreed to participate in and host the academic exchange. There is a great deal of excitement over this trip among members of the Iranian scientific community. I have been asked to convey their desire to establish connections with their counterparts in the American public health community. They are hopeful that interactions during the exchange will serve as a springboard for collaborative research and joint publications, as well as leading to American academics teaching in Iran, and vice versa.

They have also invited exchange participants to present before our Iranian colleagues at a major medical university in Tehran, an opportunity available to those joining us in the October. The deadline for submitting abstracts is in June.

I am approaching APHA members’ to explore your interest in participating in this historic trip. The deadline for submitting visa processing documents is April 30th. This will reserve applicants a spot to be considered for the exchange trip. The deadline for making a final decision and submitting a security deposit is in June. We have requested for an extension on the visa application, please let me know if you require additional time for the visa application.

Please, if you have any other questions, feel free to contact me.

Sincerely,
Taraneh Salke
Executive Director, Family Health Alliance
taranehsalke@yahoo.com

Innovative Malaria Research in Southeast Asia: a UCI GHREAT Initiative (Video Review)

by Niniola Soleye

The University of California, Irvine (UC Irvine) recently released the first video in their four-part series showcasing the success of their Global Health Research, Education and Translation (GHREAT) Initiative. The initiative is headed by IH section member Dr. Brandon Brown. The goal of the video series is to demonstrate how GHREAT projects are enhancing health and saving lives all over the world. This first video was shot in Thailand and focuses on malaria research in Southeast Asia.

Myanmar has the largest number of malaria cases in Asia. Due to the poor economic conditions in the country, people immigrate to neighboring countries, including Thailand, to look for employment opportunities. Additionally, there has been an increase in drug-resistant malaria and an influx of counterfeit drugs. That, coupled with poverty and people not having funds to travel to the hospital or buy medicine, has resulted in malaria becoming a major public health problem in the region.

UC Irvine faculty, staff, and students partnered with the ministry of health, hospital workers, local health workers, and academic researchers in China, Myanmar, and Thailand to study malaria control in the border regions, and develop solutions for containing the malaria outbreak.

The video shows the UC Irvine team observing local health workers as they perform diagnostic blood-tests for malaria in Thai villages. Their observations led them to focus their efforts for this project on developing an innovative, non-invasive diagnostic test using saliva instead of blood.

Untreated, malaria can lead to death two to three weeks after infection, so early diagnosis and treatment are key. Blood testing requires workers to send samples away daily, delaying the start of treatment. Using saliva would allow for a fast, portable, low-cost diagnostic tool, all critical factors in a developing country setting.

One scene that stood out showed a young child getting tested for malaria. She was crying because she didn’t want to get her finger pricked, and also because she was afraid of the health worker. In situations like that, the new test would be quite beneficial.

Overall, the video does a good job of emphasizing how direct, firsthand experiences and observations are important when trying to innovate and solve problems in global health. I would have liked to hear more about the technique behind the saliva test, their border control efforts, how they plan to deal with the counterfeit drug problem, and how they’ll address drug-resistant malaria but the video doesn’t go into detail on those topics.

Click here to watch the video.

Global Health Vaccines: Shaping Policy to Accelerate R&D (ASTMH/GHC Lecture in Philadelphia, PA)

Featuring the 4th Annual Beth Waters Memorial Lecture
Date: Thursday, December 8, 2011
Time: 12:30-5pm
Location: Philadelphia Marriott Downtown
1201 Market Street
Philadelphia, PA
Franklin Hall 11 & 12

At Global Health Vaccines: Shaping Policy to Accelerate R&D, public and private stakeholders will examine current barriers to vaccine research and development, especially those that disproportionately affect vaccines for use in developing countries. Discussions will focus on regulatory issues, innovative financing and incentives, and partnerships. The event will serve as an opportunity for stakeholders to collaboratively identify common obstacles and propose unified solutions to stimulate vaccine R&D for global health vaccines.

Dr. Peter Hotez, President, ASTMH and Founding Dean, National School of Tropical Medicine at Baylor College of Medicine, will begin the summit by delivering the 4th Annual Beth Waters Memorial Lecture. This will be followed by an interactive panel discussion and breakout groups that will develop policy recommendations surrounding vaccine R&D issues. The recommendations will then be presented to all attendees for discussion.

This event is open to all ASTMH Annual Meeting registrants and Global Health Council members. Please register using the link below.

Lunch will be provided at 12:30pm and the Beth Waters Memorial Lecture will begin promptly at 1:00pm.
To register, click here: http://my.globalhealth.org/ebusiness/events/default.aspx?pid=573

Public Health’s “Benevolent Dictator”: Is Gates ruling us, or are we just ruled by money?

Last week, Laura Freschi and Alanna Shaikh published a piece in Alliance magazine that raised some interesting and thought-provoking question about the role of the Gates Foundation in setting the global health agenda.  They conclude that Gates is becoming a “public health dictator” because of his financial resources and the power and influence that come as a result.  They are, of course, not the first to complain about Gates’s focus on technological solutions to global health challenges.  Some of the most recent grumblings were in response to the Foundation’s “reinvent the toilet” campaign this year, but similar concerns have been voiced for years.  The Foundation places too much emphasis on technological innovation and “quick fixes”; their undue influence diverts funding from other priorities; their goals are not realistic.  These are all valid concerns which deserve to be voiced (heck, we have already written about it here), particularly in a field where nearly everyone has a different opinion on how problems should be solved.

But a dictator?

Bill Gates.
A dictator? Nah. Look at that face.
The Gates Foundation is directed by the priorities of Bill Gates, an entrepreneur who made obscenely large piles of money and who now wants to use some of it to make the world better.  Those piles are accomplishing just that by funding the initiatives that he likes, thinks are important, and/or believes will work.  After all, Gates made his money through technological innovations, so it is perfectly logical that the same types of ideas would be close to his heart – and, to be fair, it is his money.  It is also fair to criticize those initiatives, particularly if the interventions are ineffective or do more harm than good.

But now pundits are demanding accountability from the Foundation, calling on it to justify what it does:

If expensive polio and malaria eradication efforts, pursued not just by Gates but by the entire global health community at Gates’ urging, fail, to whom will
Gates be accountable for that failure?

We demand accountability from our governments because they spend our money – we have the right to demand that our tax dollars be used effectively.  But why, exactly, should Gates be accountable to anyone for wasting his own money?  More importantly, why would the “entire global health community” do something just because he told us to?

Dictators are people who arbitrarily enforce laws, throw people in jail for criticizing them, and deny their citizens free and fair elections.  Gates does not punish anyone whose global health solutions don’t appeal to him – he just doesn’t give them money.  He never lead any kind of “global health coup” or insist that we all adhere to his development philosophy.  Yes, the Foundation has lots of money, and would-be philanthropist who wants to launch his NGO would treat Gates like a god if he ever saw him on the street – but that is precisely the point: he has undue influence because we give it to him.  To paint Gates as a “global health dictator” because causes are prioritized based on what will get Gates Foundation funding villifies the wrong party.  What does it say about us as a body of professionals if we allow ourselves to be led by the nose by the guy with the most money?

The Economist raised another interesting point when it examined the same debate back in 2008:

At least in part, the gripes against the Gates Foundation are the churlish growls of a jealous crowd of bureaucrats and labourers at less influential charities. Some people at the WHO…openly worry that the foundation is setting up a new power centre that may rival their organisation’s authority. Such conspiracy theorists point to the foundation’s recent grant of over $100m to the University of Washington to evaluate health treatments and monitor national health systems—jobs supposed to be done by the UN agency.

Therein lies an irony. The WHO, one of whose captains now calls the Gates Foundation monopolistic, used itself to hold a monopoly in the fight against malaria, and it did a lousy job as a result.

I do think Shaikh and Freschi (and also Tom Paulson of Humanosphere) are on to something when they question the Foundation’s giving money to media organizations to increase coverage of global health topics.

Among the grantees is a growing list of media outlets including the Guardian newspaper (UK), ABC, PBS and the BBC – all to underwrite coverage of global health issues. While these grants all came with assurances of editorial independence, it’s hard to believe that such partnerships won’t influence the nature of the coverage in some way.

Even if it is objective, it never looks good when you fund your own media coverage.  Somebody probably should have thought that one through.

At any rate, the debate about what Gates is doing (and what he should be doing) with his money will undoubtedly rage for as long as he has money.  But if we believe that the Gates Foundation is distorting global health priorities because of its purchasing power, then we need to take a long, hard look at how we define our priorities.

Reflections on Community Based Participatory Research

Guest Blogger: Xeno Acharya

As an MPH student at University of Washington, Seattle, I have often wondered if Community Based Participatory Research (CBPR) is a philosopher’s stone in the academics’ head. Having worked in Ethiopia and Sudan (as the researcher) and having been born and raised in Nepal (as the researched), I have come face to face with both sides of this idealistic myth.

In short, CBPR is a research method that has three core elements: participation, research, and action. It emphasizes “authentic partnership” between the researcher and the community, in which perspectives, knowledge, resources, and skills of both are combined.

It is important to remember that most of the time it is the researcher that initiates the research, no matter how participatory. For purposes of convenience, let’s call the researcher M and the researched N. M brings in research funding, manpower, technology, and white man’s knowledge. N (hopefully) brings in local experience, networks, subjects, manpower, and consensus to have been intervened/researched. When I was in Sudan and Ethiopia, I was a Caucasian-looking male who was struggling with the language and cultural nuances, but who was also clearly better paid than most staff working in the same company although I neither had the educational background or the experience the local staff members did. My positionality affected the way my colleagues spoke to me about their work and about themselves, and no amount of CBPR could overcome that.

In Nepal, too, the same power dynamics played out. Although I am a native there and speak the language, I look “white,” and the clothes I wear and the way I walk scream the fact that I have clearly not been around in Nepal for a while. I work for a small non-profit based in Portland, Oregon, that runs a school for untouchable refugee children in Kathmandu. When I visit the school every couple of years, I get the attention (I like) from kids and parents alike, not just because I am the founder but also because of the same power dynamics that comes back to bite at me again and again. So I have settled for the fact that the imbalance is always going to be there no matter what. To me, CBPR is a theory that can never fully come to fruition. Like communism, the idea itself is good and is meant to do well, but a hundred percent CBPR is only a goal to strive for, never a reality.

That said, I think CBPR is still an idea to strive for. There are things I (as a researcher) can change to reduce the imbalance of power between myself and the researched/intervened, and they are still important to do. Reflecting on my own positionality and being aware of this power dynamics is something that I can constantly incorporate in my work; so can you!

Xeno Acharya, originally from Kathmandu, Nepal, is an MPH candidate at the University of Washington. In Nepal, he has worked with local NGOs on awareness campaigns on disability among children, taught in mobile schools for displaced populations, and currently runs a school for children of victims of the civil war (1996-2008) through Namaste Kathmandu; he has also worked on short-term projects in Ethiopia and Sudan. He is currently a research assistant in the Health Systems Strengthening division of a Seattle-based non-profit called International Teaching & Education Center for Health (I-TECH) and is interested in infectious disease prevention, refugee populations, and health systems strengthening.