Serious Need for Medical Assistance in Libya

More than 600,000 civilians in Libya are in need of humanitarian assistance. Major impediments include medical supply and staff shortages as well as a lack of electricity and running water, all superimposed upon the ongoing violence.

Three days ago, MSF reported that they have resumed operations in Libya, after being forced to leave Benghazi in mid-March due to security issues. The organization has not, however, been able to secure authorization to enter Libya via the Tunisian border.

Caritas has sent two Emergency Response Teams to the Libyan-Egyptian and the Libyan-Tunisian borders and is providing emergency aid. Image: Caritas Switzerland

Last week, the International Medical Corps was able to reach some of the areas of heaviest fighting in eastern Libya, but western Libya is still closed to humanitarian assistance. Caritas has sent two teams to the Libyan-Egyptian and Libyan-Tunisian borders. Across the country, there is a serious need for emergency health relief and supplies.

Donate and/or volunteer here or here.

Obama Appoints New Executive Director of Global Health Initiative

In 2009, President Obama set aside $63 billion under his Global Health Initiative at the State Department in order to help develop health systems overseas, with a special focus on the health of women and infants.

Lois Quam, former executive of UnitedHealth Group, has just been appointed executive director of the Global Health Initiative. She is currently CEO of Tysvar, a private company ‘working towards sustainability and a new green economy.’

Oh, and pro-lifers are already slapping their tails — awesome.

For more see:http://www.minnpost.com/politicalagenda/2011/01/26/25229/lois_quam_to_head_obamas_global_health_initiative

Why Health Professionals Should Be Human Rights Activists

Do a Google News search for ‘health and human rights’. Do it right now.

I just did, and here were my hits:

Gays in Africa face growing persecution, activists say

Ghanaian women deserve the right to negotiate safe sex – Alliance

1,000 Ready to Take Action for Health and Human Rights in South Los Angeles Tomorrow

From the African continent to South LA, human rights violations continue to impact health in profound and immeasurable ways. And these violations range from the huge and undeniable (war, genocide, torture) to the quotidian (access to water, food, arable land, education).

December 10 was International Human Rights Day. It shouldn’t just be a day observed by human rights activists, but health professionals as well.

To anyone who argues that health and human rights are not inextricably linked, I propose the following exercise: write down the word ‘health’, then begin to list all of the words (nouns, adjectives, whatever) that can impact health. You might be stunned, as I was. This exercise transcends social determinants of health and covers vast territories of psychological, cultural, and individual factors.

WHO Linkages Between Health and Human Rights - A Beginning

I think this exercise should be required of anyone entering a health professional school. The determinants of health are so wide-ranging, involving fields with which we typically never concern ourselves (‘leave law to the lawyers, policy to the policy-makers, or human rights to the activists’). It is therefore our responsibility to educate ourselves and comprehend how fragile health is, how susceptible to millions of other currents.

As former UN Secretary General Kofi Annan said, ‘It is my aspiration that health finally will be seen not as a blessing to be wished for, but as a human right to be fought for.’

Breaking news: we are on the frontline of this war for health, and we have to fight.

Haiti Cholera Death Toll Tops 900

It’s just getting worse…

Photo courtesy BBC News

I’m hoping that someone (ahem, Alex Harding) who knows a lot more about water safety, contamination, and cholera than I do will weigh in, but I just had to note the utter TRAGEDY of this situation. Cholera is so easily treatable with antibiotics and oral rehydration therapy. But this, coming atop the devastation of the earthquake and Haiti’s lack of resources, is way beyond the country’s management capacity. More than 14,000 people have been hospitalized, and the death toll continues to rise.  What can we do?

 

The Buck Stops Here

A recent blog post at the Center for Global Development highlights a shortage of dollars at The Global Fund.

Lead donor The United States has issued a “Call to Action,” holding the GF accountable for better distribution and implementation of resources, and asking for specific reforms that will lead to multilateral initiatives.

Will PEPFAR and other US programmes be held to the same standards? What might this mean for worldwide aid, particularly in fighting the three biggest killers in the developing world (AIDS, TB, Malaria)?

Read Nandini Oomman’s post here

Leprosy: The Orphan Disease

“Do we still have leprosy?”

A businessman in Bombay asked me this when I told him about my research. I had a hard time stifling laughter (totally inappropriate, but I was pretty tired), because for the last six weeks, six days out of the week, all I had seen were cases of leprosy: in government hospitals, skin clinics, VD (venereal disease) clinics, NGOs, and even swanky private establishments.

WHO blister packs of multidrug therapy (MDT) for leprosy - Rifampicin, Clofazimine, Dapsone

Leprosy is almost everywhere and simultaneously nowhere in India. The country carries 1/3 of the global burden of disease. In December 2005, India achieved the WHO’s standard of leprosy elimination (less than 1.0 cases per 10,000), with the goal of eradication in 20-25 years. As of 2009, however, the WHO reports India to have a 1-2.0/10,000 prevalence rate of leprosy. And prevalence is often higher in some areas. So, while the countrywide picture is quite good, urban and rural pockets still carry a large burden of disease.

Bombay supposedly has a low prevalence (0.53/10,000), but as R. Ganapati, former head of the Bombay Leprosy Project, states, in areas of poverty — especially the city’s sprawling slums — the prevalence can be much higher (3-4/10,000).  I did some of my research at the BLP, which is close to Bombay’s large Sion government hospital, in the Sion-Chunabhatti district of the city. The expansive Dharavi slum (made famous and notorious in the movie ‘Slumdog Millionaire’) feeds into this area, and many leprosy patients come fom here to BLP and other NGOs for care.

Water, Water Everywhere, Except Where There’s Disease

I spent the summer in India during the peak of monsoon, the rainy season. Everywhere I went were signs like, “know your Lepto,” or “how to identify dengue before it identifies you.” I jest, but seriously. The rains, anxiously awaited by millions across the subcontinent, represent growth, fertility, the harvest, and, unfortunately, disease.  In an economy that is as much agrarian as IT, and as dependent on weather as independent of time zone, monsoons are a blessing and a public health curse. Malaria incidence, too, was unprecedented this year, with public hospitals erecting overflow tents just to accommodate the hordes of patients flooding their grounds.

The flood has left 20 million homeless, and more than half a million suffering from waterborne and other diseases.

And this was just in areas of “normal,” seasonal rain. Imagine the situation in Pakistan. The floods have been catastrophic, not only for the devastation they have wrought, but also for the illness they bring. Diarrheal diseases have already claimed thousands of lives, and skin and respiratory illnesses follow closely. Waterborne diseases such as typhoid, jaundice, and diarrhea are particularly virulent, but higher incidence of H1N1 and other respiratory viruses also seems to be associated with the moist, cool climate.

As the situation in Pakistan evolves, it is increasingly clear that the flood’s chronic pathology will include large-scale infectious and health concerns, which must be addressed as urgently as any epidemic.

Global Pulse Journal: Call for Submissions

AMSA’s Global Pulse Journal

Call for Submissions, Fall 2010

Special Issue: Environment and Global Health

Love to write and share ideas with fellow students?
Care about global health, the environment, human rights, or international health policy?

Have a personal reflection, story about working abroad, or artwork to share?

Submit your work to the Global Pulse, the premier student-run, student-edited journal for global health and international medicine of the American Medical Student Association!

NOW ACCEPTING SUBMISSIONS for the FALL 2010 ISSUE

Special Focus on Environmental Health – Climate Change, Biodiversity, and Environmental Justice

Founded in 2005, Global Pulse (http://www.globalpulsejournal.com/) has consistently provided students of medicine, public health, and related disciplines, with a quality venue for publication and discussion around student experience working across international borders, in countries in the developing world, and with transnational issues domestically.

The Global Pulse is currently accepting submissions in the following categories:
1) Research*
2) Personal Reflection
3) Art

All work submitted to the Global Pulse should represent original work by the author and should be of professional quality.  For further information regarding our review and editing process, please see our FAQ athttp://www.globalpulsejournal.com/submissions.html.  Please contactsubmissions@globalpulsejournal.com with further questions and to submit your work.

* Research pieces should deal with the social and cultural aspects of health and medicine.  Unfortunately, we are unable to accept basic science research articles.

Check out our current global health events blog at
http://www.globalpulsejournal.com/blog/

Bureaucracy

A while ago, I was sitting in the office of a major clinician and researcher at one of the largest and most well-regarded hospitals in Mumbai, India. The room was expansive, cool, comfortable. Just outside the door, however, patients sprawled on benches and the floor, sweltering in the heavy heat of the monsoon season.

It wasn’t this radical contrast, however, that troubled me most. I had come to the meeting filled with enthusiasm and ideas. My study, already approved through several institutional IRBs and deemed non-human subjects research, attempted to observe physician practices and standard-of-care in the treatment of previously rare, but increasingly common, leprosy/HIV coinfections. But none of this mattered. I was foreign (I’m Indian-American, but nevertheless…), a woman, and (gasp) attempting to talk about medicine with a male professor. This, apparently, rounded out the trifecta. He barely made eye contact, almost refused to shake my hand, and sneered at the idea that I could do research.

And then came the red tape. He cited organizations I had never heard of — an alphabet soup of acronyms: approval boards, governmental regulatory groups, watchdog associations. He suggested I send applications to three different agencies. When asked how long approval would take, he merely shrugged. I told him that I had never heard of these agencies, nor had other scientists mentioned them. Again, a shrug. In a final effort, I asked if he wanted to look over my study protocol (since it would then become apparent that it required no further approval). This time, a point-blank “No.” I left, frustrated.

This anecdote does not do justice to the many wonderful scientists I’ve met and worked with in India — it merely highlights an issue that might be as troubling as corruption in the developing world, the point Alex raised a while ago. The useless bureaucracy and entangled red tape that go hand in hand with said corruption are just as problematic and obstructive.

Yeah, the CIA doctors violated the Geneva Conventions…

…but what about the Nuremberg Code? Or human research protocols? Or that most intangible of standards, the Hippocratic Oath?

It was Greek, originally

As a refresher, the original HO, reproduced below:

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art – if they desire to learn it – without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

One could argue many points in the traditional Hippocratic oath, particularly the “I will not give to a woman an abortive remedy” bit.  So much so, that the modern version dispenses with some of its tenets entirely. The underlined ones above, however, seem pretty universal. And while it would take a superhuman doctor to fulfill all of these ideals, it should be our aim as physicians at least to strive for them.

The behavior of the CIA doctors, who not only monitored interrogations and helped conduct waterboarding sessions, but also gathered data (as yet unconfirmed by the CIA) to “improve” said interrogations, has come under scrutiny from a variety of media and human rights organizations. Most egregious is the fact that their function was to serve “no therapeutic purpose”.

In the past few months/weeks/days, their actions have been widely decried on international and historical grounds. Comparisons have been drawn to the horrifying experiments of Nazi doctors; the specter of eugenics has once again been raised; and, reaching back even further, this recalls the ways in which scientific research allied itself with the imperialist project.

As future medical professionals, we must consider all of these things. But we must also consider the widespread ethical implications of international human subjects research and our roles as physicians. We will all conduct research, many of us abroad. And while the Guantanamo Bay detainees were a unique population, their situation has interesting parallels to other research subjects –international patients, populations that should be protected, or populations whose standard-of-care is lower than our own. The CIA fracas is an extreme example, a crystallization of these questions. It bothers us precisely because it summons the specter of our murky medical past.

PHR’s John Bradshaw interviewed on the organization’s allegations against the CIA: http://www.dailymotion.com/video/xdmt9q_cia-doctors-torture-assistance-inve_news