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GlobeMed Panel Discusses Health Challenges of the Syrian Refugee Crisis

GlobeMed at Northwestern hosted a panel Monday to discuss the continuing Syrian crisis and its impacts on the health of Syrian refugees as part of its aims to learn about health and social justice issues locally and internationally. The student group invited Sufyan Sohel from the Council on American-Islamic Relations and Dr. Mufaddal Hamadeh of the Syrian American Medical Society for a brief roundtable in Fisk Hall. Professor Peter Locke asked both individuals questions about their work assisting Syrians in the crisis and actions students can take to advocate for Syrians.

Students at the panel enjoying dinner from Mumbai Indian Grill

Students attending the panel enjoyed dinner from Mumbai Indian Grill.

For nearly five years, fighting and unrest has plagued Syria. Hundreds of thousands have died in the conflict, and many more are now displaced, forced to leave their homes to avoid the violence.

According to the United Nations High Commissioner for Refugees (UNHCR), more than 4.9 million Syrians are registered as refugees. Countries like Turkey and Lebanon have taken in the most Syrian refugees to date, but countries in Europe as well as Canada and Australia are also working to resettle displaced people. America’s involvement in helping resettle these refugees has become less certain. Although the Obama administration aimed to increase assistance to world refugees, Trump’s recent executive order banning travel from seven countries including Syria has cast doubt upon America’s dedication to assisting Syrian refugees.

Sohel and Dr. Hamadeh’s firsthand perspectives on the crisis were sobering. Dr. Hamadeh, whose organization provides care for Syrians, said that nearly endless challenges exist for doctors in the country that used to offer citizens a stable health system.

“The regime, and the Russians also, have targeted health care facilities in the war,” Dr. Hamadeh said. There is a deliberate targeting of clinics, hospitals, healthcare workers…using health as a weapon of war. It was used in an unprecedented way in the Syrian conflict and its very unfortunate because it’s led to a total devastation of the health care system.”

Dr. Hamadeh presented slides on the state of health in Syria.

The direct targeting of health care has led to an underground hospital movement, but the doctors still struggle to find adequate resources to care for the Syrian refugee population, which continues to have a high birthrate.

Many refugees understandably attempt to get out of the situation. Working as an attorney in the Chicago area, Sohel deals with the difficulties Syrians face trying to reach America.

“What people don’t understand is the lengthy process it takes for someone who applies for refugee and asylum status before they’re allowed in, an 18 to 24 month process as it is,” Sohel said. “Those who get on a plane and get refuge once they get here, even for them, they’re getting temporary protected status if they qualify and then it’s a multi-year process for them to become citizens so these are individuals who are heavily, heavily vetted by the government already.”

Trump’s recent attempts to ban travel and heighten security will likely make asylum application even more arduous.


Sufyan Sohel discusses the challenges of applying for asylum in the United States

“We’re seeing the real effects of what this executive order created…the empowerment of a lot of our federal agencies to make these anti-immigrant, anti-minority decisions of not allowing people in and speeding into this mentality that certain groups of people are no longer welcome here and that we aren’t this land that is…open for all communities,” Sohel said.

Once in America, things are still far from easy. Though all Syrian refugees are covered by Medicaid, they have few resources and face large amounts of discrimination, according to Dr.Hamadeh.
Locke asked the panelists how Americans, especially students, could make a difference in light of such a negative picture.

“Everybody can do something it can be something simple by donating five bucks or 10 bucks or maybe giving up your…allowance to help a Syrian refugee kid,” Dr. Hamadeh said. “It could be by spreading awareness and talking to your politicians; it could be by volunteering on medical missions or other missions.”

“Share what you are learning today,” Sohel said. “Speak out against injustices and use the power that you have, collectively use your education, use your influence, to really advocate for these marginalized communities.”

With such a bleak picture painted by the presentation, one student asked how it’s possible for humanitarian groups to carry on their mission. Despite the challenges and seemingly insurmountable obstacles to helping all those displaced, Dr. Hamadeh said he believes that organizations will remain optimistic.

“I can tell you from experience…there’s nothing [more] exhilarating and fulfilling than saving a human life,” Dr. Hamadeh said. “When you go there and deal with the people in need and refugees and you see how much relief you give them and what you can do for even one single life you can never stop–you’ll be addicted to it.”

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Participating in the 4th Annual Intramural Global Health Case Competition

Participants and judges of the 2017 Global Health Case Competition.

On February 18, 2017, Northwestern held its 4th Annual Global Health Case Competition (NUGHCC). Graduate and undergraduate students from various disciplines come together and respond to 21st century global health challenges by developing innovative solutions. Every year, a different “case,” is presented: these could range from infant HIV testing in Tanzania to drug crimes in Honduras. The purpose of this competition is to cultivate awareness about the issue as well as encourage creative thinking and interdisciplinary cooperation. The 2017 Competition brought together 30 students from 8 schools divided up into six teams. The teams then presented their solutions to a panel of judges: Kara Palamountain, MBA (Research Associate Professor at the Kellogg School of Management), Sera Young, PhD (Assistant Professor in Northwestern’s Department of Anthropology) and Maxwell Akanbi, MBBS, MSCI (Center for Global Health International Fellow at the Feinberg School of Medicine).

The 2017 case focused on reducing neonatal mortality in Nigeria by adopting widespread use of an antiseptic gel called chlorhexidine. The case was authored by Kara Palamountain, one of the judges in the panel. Infection and sepsis are among the top leading causes of neonatal death in Nigeria, and the umbilical cord is a major entryway to infection. Because chlorhexidine is cheap, locally manufactured and proven to be effective, the goal was to integrate this drug into Nigeria’s healthcare institutions, culture, and maternal care regime. The six teams each developed a range of solutions, from implementing mass distribution operations to launching marketing campaigns.

The winning team was made up of five members: Maria Clark (WCAS), Sedoo Ijir (WCAS), Emmanuel Darko (WCAS), Max Wang (FSM) and Courtney Zhu (Medill).

This year, I participated in the Case Competition and had the experience of being part of an incredibly diverse, dynamic team. My teammates all came from varying backgrounds with different areas of expertise, and my most valuable takeaway was getting to learn from them. Together, we educated ourselves on the issue of neonatal mortality in Nigeria as well as the sociocultural forces that perpetuate this high rate of neonatal death.

After many group meetings and a mentor session with Peter Locke–an Assistant Professor of Instruction in Global Health Studies, we were named the winning team of the 2017 Competition. Our team’s approach centered around the creation of a birth kit, a unified package of essential items necessary for home birth including chlorhexidine. Sustainability was one of our core values: creating a demand for the birth kit and normalizing chlorhexidine in Nigeria’s maternal care culture. The three-year implementation timeline included tactics such as capturing interest of Nigeria’s key stakeholders, establishing a partnership with a non-profit, non-governmental organization, utilizing effective marketing strategies and finally, launching the production and distribution of birth kits.

From this experience, I gained insight into the mechanism of tackling modern health challenges and realized just how valuable collaboration is in a multidimensional field like global health. The Case Competition–in its entrepreneurial and energetic form–gave me knowledge a traditional classroom could never provide. I learned that every global health operation is like a machine: there are many gears and components working simultaneously in motion.

NUGHCC pushes every participant to put their existing knowledge to practice. It encourages everyone to think imaginatively about global health challenges and how to approach them. There is no single “right” answer. Rather, it is through collaborating that real innovation is born.

The Case Competition is co-sponsored by the Program of African Studies, Program of Global Health Studies, Feinberg’s Center for Global Health, Pritzker School of Law’s Center for International Human Rights and the US Department of Education.

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From Policy to Practice: Body Autonomy and Breastfeeding in the Workplace

WHO Breastfeeding Campaign Poster

How do policies surrounding breastfeeding affect women in the workforce? It is not hard to imagine the difficulties – or rather, impossibility – of breastfeeding without the proper facilities, privacy, or policies in the workplace. According to the Centers for Disease Control and Prevention (CDC), 79% of women breastfeed after giving birth, however only 49% exclusively breastfeed 6 months later (2014).

The Affordable Care Act (ACA) and Family Medical Leave Act include policies that address breastfeeding access in the workplace. The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life. Breastfeeding has a strong correlation with the lifetime trajectory of individuals and populations, lowering the risk of childhood-related diseases and chronic diseases later in life. The Family Medical Leave Act indirectly supports breastfeeding by mandating unpaid time off for a short period of time postpartum. Yet, low-wage workers and unmarried women are less likely to be eligible for unpaid leave and more likely to be unable to survive on little to no income. The ACA includes a “Reasonable Break Time for Nursing Mothers” which states that workplaces are required to provide a private space (not a restroom) for women to take unpaid breaks to pump breast milk. While this amendment was created to assist women working for hourly wages, studies have shown that these women are least likely to have access to ACA accommodations.

Why is policy not translating into practice in both of these cases? Dr. Elizabeth Dalianis explored this issue for her doctorate in Public Health at Drexel University. She analyzed the relationship between state laws and enforcement of the above federal laws with breastfeeding practices among working women, with a particular focus on racial disparities in breastfeeding practices. She utilized the CDC survey on infant feeding, the first of its kind, and she stratified the data into three separate categories for analysis: states with regional law on breastfeeding in the workplace that include enforcement mechanisms (California, Minnesota, and Connecticut), states with regional law on breastfeeding with no enforcement mechanisms (n=28), and states which only have the ACA federal requirement (n=19). Across the board, longer duration of breastfeeding was associated with regional law on breastfeeding and active enforcement of these laws. In California, for example, the Labor Commissioner investigates complaints from workplaces that do not uphold the standards of the ACA and the state law. If the claims are proven true, there is a $100 fine assessed per infraction. This is not a perfect solution, however, because it places the burden and responsibility on women to self-report on their employers. For those states without any enforcement specified in the law, it was as if there was no law protecting the basic rights of breastfeeding women at all.

The lack of breastfeeding policy enforcement across the United States (in 47 out of the 50 states), according to Dr. Dalianis’s work, leads to a disparity in breastfeeding practices among working women, particularly for low-income and hourly wage-working women. Without the conditions necessary to breastfeed in the workplace, women are denied the choice to breastfeed their children. Body autonomy is an important aspect of any discourse on Women’s Health. Institutions continually under-prioritize women’s rights to body autonomy– by writing laws that are never enforced, or by creating laws that make it near impossible for women to access the health resources that they need. Many women across the United States are forced to choose between breastfeeding and their career, or between breastfeeding and their livelihood. Women with low-incomes do not even have the luxury of that difficult choice due to the institutional devaluation of women’s body autonomy.

While establishing women’s body autonomy is argument enough to support better enforcement of breastfeeding accessibility laws and policies in the workplace, in terms of public health, breastfeeding a baby provides numerous health benefits that last into adulthood. Thus, low-income women’s inability to choose to breastfeed their children can become a powerful form of structural violence that perpetuates social and health inequalities on the population level.

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Can human milk deactivate Zika virus?

On February 1, 2016 the WHO officially declared the Zika virus a Public Health Emergency of International Concern after microcephaly and other neurological disorders became associated with the latest outbreak of the virus. Fifty-three countries have reported an outbreak since 2015, and the CDC reports that there have been 4973 total cases in the United States.

While the virus itself gives cause for alarm, one of the major fears connected with Zika is its ties with microcephaly and other neurological disorders for infants in utero. Pregnant women with Zika have the chance of giving birth to babies with congenital Zika virus syndrome, which can cause anything from malformation of the head to seizures, to hearing and sight problems. 
 With all the health concerns connected to Zika, as well as the growing number of reported cases in the past year, scientists have been busy researching different aspects of the disease, especially in relation to mothers and infants.

A study recently published in Virus Research took a look into the the presence of Zika virus in human breast milk. 
 Previous studies established that Zika virus is present and active in the breast milk of mothers infected with the virus. Despite the revelation, this past June the WHO recommended that mothers continue breastfeeding. According to the WHO, breast milk’s numerous benefits outweigh the risk of passing Zika to the infant. Researchers from the Virus Research study, including Dr. Stephanie Pfänder, a group member of the Virology and Immunology Department of the University of Bern in Switzerland, wanted to dig deeper into the relationship between the breast milk and the Zika virus within it. To do this, they examined the stability of the Zika virus in breast milk to explain its stability over time and find ways to inactivate the virus to make breast milk even safer for infants.

The scientists infected breast milk from three healthy mothers with different strains of Zika. They then stored the breast milk for a period of several days at 4°C. Within one to three days, depending on the donor, the virus became inactivated and no longer able to infect the baby. Researchers hypothesized that fatty acids within the milk damage the viral envelope protecting the virus.

“During the storage process over several days, free fatty acids are released which act [as an] antiviral against the virus,” Dr. Pfänder said in an email. “With our storage, we mimic the release of free fatty acids artificially, however, the same process happens in the stomach of the infant where free fatty acids are being released upon milk digestion which could then act [as an] antiviral against the virus.”

Although the finding indicates that breast milk will deactivate Zika on its own, the researchers also wanted to determine a quick, relatively cheap method to ensure breast milk is safe. They found that pasteurizing the milk at 63°C for 30 minutes made the virus unable to infect the baby.

“We sometimes hear [from] the critics that our approach is quite artificial, as milk is not routinely stored at 4°C for longer time periods,” Dr. Pfänder said in an email. “We do not suggest that mothers should routinely store their milk samples before feeding the infants. However, if a mother has a suspected or confirmed infection with Zika we provide information of how stable the virus could be in the milk sample and how to inactivate it to prevent a possible transmission to the infant.”

The recent findings could prove very important as more of the world faces the threat of Zika, and could help prevent the spread of the virus.

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The Trump Administration’s Global Gag Order: What Lies Ahead for Abortion and Gender Equality

Trump and the Global Gag Rule

In Donald Trump’s presidential campaign, he promised to wage a war on abortion rights. He did indeed keep that promise; one of his first executive actions in office was reinstating the Global Gag Rule, which defunds international nongovernmental organizations (NGOs) that provide abortion services or even discuss abortion with their patients.

This rule has been through a kind of political rollercoaster since its inception in 1984. That year, the Reagan Administration implemented it at a population conference in Mexico City. Known as the Mexico City Policy, Reagan declared any NGO that includes abortion or abortion consultation among their family planning services ineligible for U.S. funding.

This policy is different from the Helms Amendment, which prohibits the use of U.S. aid directly for abortion services. The Gag Rule prohibits funding organizations that have anything to do with abortion–which includes a majority of family planning programs. As a result, it is not just abortion that will be affected but every aspect of sexual and reproductive health.

Republican administrations since Reagan have upheld the gag rule, while the Democratic administrations of Bill Clinton and Barack Obama have renounced it.  

But this time, Trump did not merely reinstate this policy. He intensified it by a factor of 15, according to Population Action International. Historically, the gag rule has applied to $575 million in family planning and reproductive health funding. Trump’s Global Gag Rule applies to all global health funding, which amounts to $9.5 billion. This cuts funding from the National Institutes of Health, Centers of Disease Control, the Food and Drug Administration and various agencies of the United Nations.

In the past, international NGOs could still receive funding from the United States Agency for International Development and the U.S. State Department under the Mexico City Policy. Not anymore. Trump offers no exceptions.

This extreme cut in U.S. funding could destabilize health organizations worldwide. HIV prevention and treatment, maternal health care and Zika prevention programs will suffer as a result.

Northwestern Professor Sarah Rodriguez, who is a medical historian specializing in women’s reproductive and sexual health, said other aspects of women’s health will be affected. “A NGO, for example, can provide services beyond those that pertain to pregnancy. It can be doing mammograms, cervical cancer screening, pap smears and more.”

The NGOs that received U.S. funding from the Obama Administration now have to face a choice: cut funding and limit the scope of their care, or receive funding but cut the abortion services they provide.

 

What It Means for Abortion

The Gag Rule aims to cut down abortion rates, but a 2011 study by Stanford researchers found that it actually results in the opposite. Examining the policy’s impact in 20 sub-Saharan African countries from 1994 to 2000, they found that the rate of abortions actually increased. Unsafe abortions, that is.

This correlation could be due to a number of reasons. The researchers suggested that NGOs contributing to contraceptive distribution lost the funding to do so, leading women to become pregnant without wanting to.

Out of desperation, women will still seek abortions, whether they are safe or not. Reducing the availability of abortion services will not change a woman’s desire to terminate her pregnancy. In fact, it makes sense that making abortion illegal–criminalizing it–forces women to turn to harmful practices. In Kenya, women will resort to drinking battery acid, using wire coat hangers and asking others to stomp on their stomachs until they are no longer pregnant.

One of the most frustrating global health issues is the high rate of unsafe abortions; they hugely contribute to the maternal mortality rate even though they are the only entirely preventable cause. 47,000 women die from childbirth-related causes every year, almost exclusively in developing countries.

There are areas in the world where abortion rates have sharply declined: rich countries where abortion is legal. This includes the United States. Since abortion was legalized in 1973, the number of total abortions performed every year has been on a steady decline.

The Gag Rule is a way to satisfy anti-abortion supporters in America, but it is those in remote rural areas of developing countries who suffer most. The policy limits the ability of organizations to increase birth control access, resulting in more unwanted pregnancies. Combined with a ban on abortion, women face horrifying realities.

 

Response and Reparation

“When the policy was first installed in 1984, only a handful of groups refused the money,” Rodriguez said. “By and large in the past, most groups continued to receive funding and chose to limit the kind of services they offered.”

Shortly after Trump put the gag rule in order, the International Planned Parenthood Federation (IPPF) confirmed that they will not abide by these conditions. Their U.S. funding will be cut off, meaning that the organization will lose about $100 million in the next four years for sexual and reproductive health services. When the Gag Rule was in effect under the Bush administration, IPPF said their partners in Nepal, Kenya and Ethiopia had to close clinics and offer fewer contraceptives.

The Netherlands openly opposes Trump’s decision. Lilianne Ploumen, the Dutch international development minister, said they plan to fund family planning programs with about $600 million over the next four years to help fill the financial gap Trump’s Gag Rule will cause. As many as 20 other nations indicated that they plan to do the same.

However, this additional funding may not have as much impact as it seems. Historically, aid from foreign governments tends to fail without serious political pressure from the countries that need it. And with Trump’s version of the gag rule, $600 million would only fill a small portion of a vast gap in funding. To weather the storm of this new administration, civic engagement and commitment to public health advocacy will be more important than ever before. 

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