Moving in the right direction: India court legalizes gay sex in landmark ruling

There currently are no official demographics for the LGBT population in India. However according to unofficial estimates submitted by the government of India to the Supreme Court, there were about 2.5 million gay people in 2012. Lesbian, gay, bisexual, transgender (LGBT) people in India face many difficulties, both social and legal. Reports of killings, attacks, torture, and beatings are not uncommon. LGBT people in India also face discrimination in the community and rejection from their families. Continue reading “Moving in the right direction: India court legalizes gay sex in landmark ruling”

Global Health in Conflict: A Weightier Commitment

It is important for early-career professionals interested in pursuing a career in global health to be aware of the realities of working internationally. Although stories of setting up vaccination clinics or fighting Ebola may stir up feelings of excitement, being a part of the action may require additional education and training in conflict resolution and institution building. This is especially true when it comes to conflict-affected areas and fragile states that are the most in need of health care/public health services as a result of the local health system infrastructure being weakened. A different kind of public health professional, one that is willing to risk their life and invest in the indigenous health system, is required in our world today.

I currently work as an epidemiologist at a regional health department in Texas. We serve two main roles for the 30 counties we cover. One of our roles is to function as a local health department and deliver a diverse range of services to 23 counties. The other main role is to serve as an extension of the state health department and provide surveillance/investigation guidance for the reportable conditions that health care providers, schools, and community members are mandated to report. This relationship is seen especially when we work with the 7 counties in our region that have their own local health departments. Before beginning this job, I actually worked at one of these local health departments and was on the receiving end of the interaction described above.

For most of my life, I’ve been interested in pursuing a career in global health or humanitarian work. When I was younger, I thought the only way I could pursue this dream was by being a physician (especially if I wanted to be able to support myself financially). I also believed this to be a great way to help communities that were dying from preventable illnesses. My introduction to public health helped me see that there were many other ways to help achieve the goal of combating deaths due to preventable illnesses. I focused in on epidemiology as a way to combine my science/laboratory background with my desire to serve and entered into an MPH program after completing my B.S. in Biology. Most of my MPH program was spent working hard to obtain tangible experiences in public health practice and deciding which skills would be most necessary for me to have before entering into the workforce. While pursuing my MPH from 2014-2015, some of the hot topics in public health were Ebola, antimicrobial resistance, bioterrorism, anti-vaccination movements, hospital-acquired infections, opioid abuse, tuberculosis trends related to travel, maternal and child health gaps, and continued efforts to end polio and AIDS, to name a few. Towards the end of my program, I began to hear more about the dangers of humanitarian work and global health as stories involving health care and humanitarian workers being targeted in conflict-affected areas/fragile states were highlighted in various media outlets. I also knew of at least one faculty member at the university I attended whose global health team was attacked shortly after the individual returned to the US (after working in the field for a number of years).

When I entered into the public health workforce in 2016, Zika was just becoming a hot topic in public health circles in the U.S. But there were other things for me to learn at my local health department. I received an introduction to the Immunization team and programs such as Texas Vaccines for Children which enable young people in Texas to receive affordable immunization coverage (there is an adult vaccine program too). I also received an introduction to the statewide ImmTrac system that stores vaccine records and learned about some of its strengths and challenges. Ultimately, I was able to see the importance of public health collaborating with healthcare providers, schools, and community members to ensure that a community has adequate herd immunity or, in the case of outbreaks, can deliver effective interventions in response to infectious disease threats. Something else I learned about was the role of immunization clinics or point of dispensing units (PODS) during natural disasters, such as floods, and other public health emergencies.

I’ve shared some of my experience working at the local level because it gave me a tangible picture of how public health functions in stable environments or areas that are not weakened by natural disasters. In conflict-affected areas or fragile states, public health efforts may be fragmented at best. For example, in August 2015 Nigeria was removed from the World Health Organization’s list of countries with endemic Wild Polio Virus (WPV). This was the result of global efforts aimed at eradicating polio through targeted immunization campaigns. Nigeria went two years without WPV cases before, in August 2016, two cases were reported in Borno-a conflict-affected state. Two additional cases were reported in September 2016. The cases were from inaccessible areas of the state with limited security and indicated that prolonged transmission had gone undetected as a result of armed conflict. Although the number of areas held by insurgents, and therefore without access to vaccines, eventually decreased, the conflict in Borno prevented timely vaccination campaigns and posed a risk to Nigeria as a whole. Specifically, migration between Internally Displaced People (IDPs) camps and refugee communities resulted in a higher potential for WPV cases to be reported in states not directly tied to the conflict. A similar trend was noticed with the Ebola outbreak that occurred in West Africa from 2014-2015. The disease posed an increased risk in fragile states and areas affected by conflict. For example, prior civil wars in Liberia and Sierra Leone severely weakened the countries’ infrastructure in the 1990s. The conflicts also affected surrounding countries and resulted in millions of displaced people. In some of instances, countries had the resources needed to respond to public health emergencies caused by conflict. However, groups of people or areas deemed to be inaccessible as a result of conflict continued to undermine the effectiveness of immunization clinics and infectious disease response efforts.

A comparative analysis conducted by Bourdeaux et al. in 2015 assessed the effect of conflict on health systems in Haiti, Kosovo, Afghanistan and Libya.  Health systems were defined as, “the organized network of institutions, resources and people that deliver health care to populations” and was based on the World Health Organization’s (WHO) Framework for Action (2007). The framework highlights financing, leadership/governance, information, medical products/vaccines/technologies, health workforce, and service delivery as essential components of effective health systems. When this organized network is destroyed as a result of armed conflict, high levels of morbidity and mortality occur and can have negative effects that persist even after the conflict is over. The analysis found that the building blocks most affected by conflict and security forces were “governance, information systems and indigenous health delivery organizations.”  In order to address these gaps, a suggestion provided by the authors is to deploy Health Security Teams comprised of individuals with training in public health and institution building to conflict-affected areas and fragile states. The teams would support indigenous health systems instead of creating parallel or temporary systems, and not be involved in serving military interests. Additionally, these teams would know how to guide security forces as they engage with health systems in diverse political climates.

At this point in time in my career, most of my work is done in an office on a phone or computer. When I started my journey in public health, I pictured something different. I still have the long-term goal to work internationally (or financially support myself while volunteering internationally). However, I am sobered by the fact that if I want to serve those who are truly in need (especially as it relates to conflicted-affected areas and fragile states) I will have to be at peace with laying my life on the line. I will also have to be prepared to navigate the challenges presented above. This includes learning as much as I can about conflict resolution and negotiating to protect health systems. In general, I feel that public health has much to do in terms of educating and re-assuring those we serve (both domestically and internationally). As a result, part of my journey in public health will include developing skills as a connector of people and someone that can see both sides of an issue. I think that all public health professionals interested in working in a global health or humanitarian worker capacity should consider this. At the same time, immigrants or refugees that have left their homes due to conflict or in search of better opportunities can also develop the skills needed to resolve conflict and rebuild institutions. The success of the suggested Health Security Teams could depend on this.

 

Photo: Diane Budd, M.D.

conflict

Global Health Weekly News Round-Up

Politics and Policies:

  • The Food and Drug Administration has announced that it will begin exercising its authority given under a 2009 law, power to regulate cigarettes and other tobacco products that they believe pose public health risks.
  • In an effort intensify campaign to publicize new health insurance options and to persuade consumers, the White House is recruiting mayors, county commissioners and other local officials.

Programs:

  • A health check program has been launched in Accra, in order to reach out to the people of Ghana who are challenged with non-communicable diseases (NCDS), in an affordable and effective way.
  • The United Kingdom (UK) is starting a rotavirus vaccination program to protect the babies from infection which causes diarrhea, vomiting, abdominal pain, fever and dehydration.
  • Ben & Catherine Ivy foundation grants more that $9 million for brain cancer research.

Research:

  • To help avert 3 million AIDS deaths by 2025, the World Health Organization (WHO) through its guidelines is recommending the patients the start medicine at earlier stage of the deadly disease.
  • According to global Diabetes attitudes, wishes and needs 2 study one in five people with diabetes feel discriminated against them because of their condition. About 16% people suffering from this condition are at risk of depression.
  • According to the United Nations Program on HIV/AIDS (UNAIDS), Ghana cuts new HIV infections among children by 76% since 2009. It states that one three in ten children in need of treatment have access to it.
  • A report released by the United Nations state that Nigeria has highest number of children with HIV/AIDS virus in the world. It states that the incidence rate has not increased much but the increase in the prevalence rate has remained stagnant.
  • According to the scientists, new World Health Organization (WHO) test- based approach against malaria does not work everywhere. There must be a hard diagnosis before the disease is treated.
  • According to the research results published in the Journal of Infectious diseases, infant rotavirus vaccine is effective against this disease in Ghana. Results showed a significant response in parameters of efficacy, safety and immune impact of vaccine.
  • A study published in the journal’ Diabetologia’, ethnicity should be considered while making guidelines for physical activity. They state that south Asians need more exercise than white Europeans to reduce diabetes risk.
  • According to a research review published in BMJ, high consumption of fish reduces risk of breast cancer by 14%. It replenishes the body with all omega 3 essential fatty acids which can only be acquired from external sources as body cannot manufacture it.
  •  In a study published in Cell Transplantation journal, type 2 diabetes patients who receive self-donated bone marrow stem cells require less insulin. According to the scientist’s good glycemic control appeared as a critical factor in the transplanted and non-transplanted control group.
  • A study indicates that consuming more than 2-3 standard alcohol drinks per day is linked to deadly digestive tract cancers including mouth, throat, larynx and esophageal. They also warn of risk of bowel, breast and prostate cancers.
  • The scientists have found out that the patients of Crohn’s disease also have a virus – enterovirus in their intestines as compared to those who did not have this disease. It also said that the genes associated with the onset of this disease are vital for the immune response against this virus.
  • According to the researcher’s malaria parasite are full of iron which they cannot digest nor can excrete them. Their invention- hand-held battery operated malaria detector will use the power of magnets to detect them.

Diseases & Disasters:

  • Reports state that Lusaka (Zambia) records approximately 185 new HIV/ AIDS infections every day. It has high prevalence rate of 20.8 percent as compared to the other districts of Zambia.
  • The cholera epidemic in the Democratic Republic of the Congo claims lives of 257 people. Lack of proper sanitation and clear water are stated to be the main cause of the outbreak.
  • Polio outbreak in Somalia jeopardizes global eradication. Before this there was no case of this disease for more than five years. This outbreak is reported in its early stages and WHO experts see more cases coming in next few weeks.
  • A report released by Greenpeace suggests that a Chinese herbal medicine contains a variety of pesticides. It is increasingly accepted in the western countries for medicinal use.
  • Reports have shown a new trend of HIV infection among the youths of Manipur (India). Unsafe sex practice has been indicated to be the major mode of HIV transmission among them.
  • According to the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA). Diclofenac, a common painkiller raises the risk of heart attack and stroke among the patients with serious underlying heart conditions.
  • Health officials are warning that tularemia cases are on rise in New Mexico. Four cases have been so far been reported.
  • Japan and Poland are facing epidemic of rubella. Travel warnings have been issued by the Centers for Disease Control and Prevention for the pregnant females visiting these countries.

Global Health Weekly News Round-Up

Politics and Policies:

  • A partnership between the Government of Benin and the U.S. government was launched to help Benin achieve its objective of eliminating neglected tropical diseases by 2020.
  • U.S. Supreme Court weighs dispute over AIDS funding.
  • HHS announces new digital and mobile health application to help people to stay healthy.

Programs:

  • Nigeria may soon relax the criteria for placing people living with HIV on antiretroviral (ARV) treatment in order to increase number of people being treated.
  • Imbuto project has announced its plans to set up a model facility in Bugesera district, Eastern project. It will integrate elimination of mother to child transmission of HIV/AIDS services through its family package project.
  • The Embassy of the Republic of China (Taiwan) and the Ministry of Health and Social Welfare of the Gambia have signed an agreement on maternal health improvement program.
  • The Word Bank has approved a $7 million line of credit to improve the delivery of healthcare services in Djibouti.
  • Smile Train and Operation Smile in collaboration with the Government of the Republic of Rwanda have announced the launch of Rwanda Smiles to create the first-ever country in Africa.
  • A national strategic plan for HIV, tuberculosis and sexually transmitted infections has been adopted during South African National AIDS Council meeting in Secunda, Mpumalanga.
  • A two year maternal health project aimed at promoting community involvement in the assessment of the performance of selected health facilities and providers in the delivery of maternal health services was launched in Koforidua.
  • The UN refugee agency has appealed for millions of dollars to help to meet the needs of Malian refugees including healthcare, water and sanitation.
  • Canada funds IOM humanitarian projects involving emergency health, water and sanitation projects in Zimbabwe.
  • A partnership between Samaritan’s Purse Canada, University of Calgary, Canadian International Development Agency is running a healthcare project that is helping people of South Sudan.
  • To save upto 2 million children every year from deaths caused by pneumonia and diarrhea, the World Health Organization and UNICEF has launched a new Global Action Plan.
  • Cuba’s second round of anti-polio vaccination campaign starts on Friday through April 25 to keep this island free of this debilitating disease.

Research:

  • According to the reports from the municipal public health supervisor over 20 HIV/AIDS positive cases have been reported during the first quarter of this year.
  • According to the reports Kogli (Nigeria) has cases of HIV/AIDS rising since last 2 years. This rise has been attributed to lack of availability of funds for the state action committee on HIV/AIDS.
  • Global fund has increased funding (additional $25 million to 12 states and the Federal Capital Territory) for HIV/AIDS in Nigeria.
  • According to the Kwara State Ministry of Health Coordinator (Nigeria) for HIV/AIDS about 1.8 million children have been orphaned by HIV/AIDS related death in Nigeria.
  • A study states that breast feeding for more than four months lowers mother-to-infant HIV risk through their milk.
  • According to a qualitative research marriages in Malawi are a risk factor for HIV infection in females.
  • Results of a study involving people of Uganda states that food access and diet quality are associated with health-related quality of life.
  • Scientists from the University of Kansas made a discovery that aspirin directly and indirectly suppressed the proliferation of two different breast cancer strains.
  • Statistics from Chinese Center for Disease Control and Prevention states that China now has nearly 120,000 new cases of multi-drug-resistant tuberculosis.
  • According to the scientists DPP-4 inhibitors have cardio-protective effects on type 2 diabetes mellitus.
  • A study finds a relation between endometrial cancer at young age and risk for endometrial cancer.
  • A study reports that highly active retroviral therapy (HAART) may help to protect hearts of young patients.
  • Scientists from Indiana School of Medicine links beer with increased levels of dopamine in the brain.
  • The new U-M National Poll on Children’s health about 40% parents give young children cough/cold medicine that they shouldn’t.
  • According to a research letter published in the journal Emerging Infectious Diseases, some visible signs of Lyme disease are easily missed or mistaken.
  • A study indicates that high salt diet and ulcer bacteria together combine to increase the risk of cancer.
  • According to a study lung cancer mortality rates linked to primary care provider density.

Diseases and Disasters:

  • Plaque draws scientist’s attention as potential terrorism weapon.
  • Death count due to bird flu reaches 20 in China.
  • An earthquake of magnitude 7.0 struck China on Saturday. It is discouraging volunteers in the earthquake zone.
  • Vietnam has announced that special measures have been adopted to prevent the H7N9 avian flu from entering the city.
  • The Department of Health of Minnesota has alerted the doctors to a new strain of influenza  for the patients who have travelled to Asian nation and have flu-like symptoms.
  • According to the scientists, new strain of bird flu virus that has killed 17 people in China has acquired a significant genetic diversity.
  • Honduras reports two deaths from hemorrhagic dengue fever. In addition about 3,000 cases of classic dengue cases have been registered this year.
  • Reports have indicated a presence of a bird flu virus in Norfolk, UK.