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Revitalization of Traditional Systems of Medicine in Rural Rajasthan

Not all forms of effective medical treatment come in a pill bottle or are administered through a sharp injection to the forearm. Despite economic and medical progress in urban India, many rural villages and communities lack access to any form of health care. Access to healthcare in rural areas is an issue that the U.S. and India share, and the impressive medical advancements in cities provide a stark contrast to the impoverished, resource-poor villages and towns where people still die from preventable and curable illnesses.

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Overlooking fields in the village of Valli

It is easy to romanticize village life when you watch it fly past you from the car window. Rural Rajasthan, a northern state of India, becomes a blur of rolling hills of green, cows churning fresh dirt and women’s saris blowing in the wind against misty-blue mountains. It is monsoon season, so everything in this usually dry and arid land is made green and growing. Only 3 months ago, Rajasthan was suffering from a severe drought, where 17,000 villages were facing a water crisis that required government support. In this region, droughts affect water and food supply as well as people’s livelihoods since farming and drinking wells are dependent on a constant supply of rainwater. The life of a farmer is very physically demanding as well, resulting in many health complications later in life; oftentimes, farmers are unable to afford treatment at a hospital or private clinic due to their insufficiently small income. Last year, due to weather-related crop loss, 11 farmers committed suicide in 45 days, a small reflection of the thousands of farmer suicides that occur in India every year.

In 1989, 15 children in a rural Rajasthan village died from Diphtheria, a highly infectious nose and throat infection that is easily preventable and curable. Jagran Jan Vikas Samiti (JJVS), the NGO that I currently work at through the GESI program, was alarmed by this horrible tragedy and the lack of mobilization by the government to prevent or control it.

It is difficult to provide a successful and sustainable healthcare delivery system for the marginalized of any community, and even more so in rural areas. Healthcare tends to be located in urban and more affluent towns and cities, as healthcare providers tend to set up clinics in areas of social mobility and development where their patients are able to pay for their services, and the doctors have access to more resources and better accommodations. Indian government programs providing healthcare and other necessary services to rural areas have so far been lacking in resources and man-power, and the government has a concerning lack of interest in the welfare of the rural poor. Of the public government clinics that exist in Rajasthan, 56% of them are absent of any health care provider. Often, the closest biomedical, or allopathic, care is hours away by bus, which can become expensive, inconvenient and dangerous in the case of medical emergencies.

Traditional healers, unnoticed and unrecognized, have been treating common illness in rural villages for hundreds of years, passing down knowledge of medicinal plants from generation to generation. Allopathic medicine from a pharmacy or hospital is inaccessible and expensive – medicinal plants, however, grow easily in rural forests and gardens. JJVS, after realizing the dangerous lack of access to healthcare and unjust lack of interest in rural village welfare, has partnered with these traditional healers to improve the health of rural Rajasthan. Titling them as “Gunis”, JJVS identifies, trains, and provides resources to Gunis by widening their knowledge base of medicinal plants and human physiology, teaching them new techniques in Ayurveda, an ancient Indian system of holistic and natural healing, and Myotherapy, a manual therapy that deals with the musculoskeletal system, and building medicinal gardens and Guni treatment centers.

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Guni Roti Bai treating an ear infection with local medicinal plant

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Guni Pratapi Bai setting a broken foot

While collecting Guni Life Histories for my internship with JJVS, I have been able to observe Gunis at work. I was able to watch Pratapi Bai, a renowned female Guni and bone-setter, massage a broken foot back into place with her strong and weathered hands.

These competent healers have a lifetime of knowledge that is now complemented by JJVS resources and trainings and shared with the wider community. By providing safe, affordable and effective care, Gunis, trusted local healers, have the potential to change the health of rural Rajasthan for the better. Through talking with these Gunis, I have gained a new appreciation for what it means to be a healer and the benefits of Ayurveda and Naturopathic medicine in this rural context.

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Ebola in Kailahun

On August 8, 2014, the World Health Organization declared a Public Health Emergency of International Concern. Reports of the rapidly spreading Ebola virus in western Africa convinced WHO’s Emergency Committee to alert the international community of impending danger. However, according to Krista Johnson, an assistant professor at Howard University Graduate School, Ebola’s warning signs were clear long before 2014.

“We certainly didn’t prepare the population to respond to this, but the United States government was doing research on this and had samples,” Johnson said. “It was not as though Ebola was off of the radar. In fact, they were looking to implement programs and have strategies that would combat disease–specifically Ebola and other diseases like that.”

Health professionals originally discovered the Ebola virus in Sudan and the Democratic Republic of the Congo in 1976. They considered it a tropical ailment, similar to the Lassa fever discovered in Nigeria in 1969. WHO estimates that more than 1500 people lost their lives to Ebola between the 1970s and 2012. It was not until the 2014 outbreak that Ebola gained international attention.

Johnson specifically researched the outbreak of Ebola in the Kailahun district of Sierra Leone. With her colleagues, she noted the effects of both the virus and the community and international responses to its dangers.

“When Ebola struck in 2014, Sierra Leone was a country that had recently recovered from an 11-year civil war [and] gone through political transition from a one-party state to the reintroduction of multiparty democracy,” Johnson said. “The healthcare system was very weak and ill-equipped to handle a disease of this nature given its rapid spread throughout the country.”

It is difficult to pinpoint the first case of Ebola in the district, but given its close proximity to both Liberia and Guinea, other key hotspots of Ebola, Johnson stated that Ebola probably arrived in Sierra Leona at about the same time as it appeared in the other countries. Yet, the government was slow to respond.

“Although its believed that Sierra Leone had Ebola cases as early as March of 2014, the government of Sierra Leone only declared a national health emergency at the end of May,” Johnson said. “Its initial plans only focused on quick fixes and not addressing the root causes of the epidemic.”

With a healthcare system left in shambles from a civil war that ended in 2002, the country was faced with a lack of basic supplies to fight the disease. Citizens ignored health measures adopted by the government and avoided treatment centers, believing them to be dangerous.

Despite the adverse situation facing the country, President Koroma remained adamant that Sierra Leone would not “export Ebola” to the international community. The illness became an issue of security, as Koroma called on the military and international organizations for help. He also set up NERC, the National Ebola Response Centre, to fight the illness.

“NERC had United Nations and WHO representatives on its highest level,” Johnson said. “It was largely being run out of the international agencies headquarters, so the response was largely ceded to the international community.”

In contrast, response to Ebola in the Kailahun district was local and swift. Doctors Without Borders helped create volunteer task forces throughout the region to alert officials to new cases and deaths. Leaders in the region quarantined certain villages and temporarily banned traditional social gatherings to stop the spread of the virus.

As a result of these measures, the region became one of the first to successfully beat Ebola. Sierra Leone as a whole was not as lucky. According to data from WHO, nearly 4000 people in the country died from Ebola as of March 2016.

Johnson suggested that the high number of deaths from the outbreak could have been prevented if the government had considered more of the strategies used by the Kailahun district.

“The community response really highlights the importance of democratic participation and respect for human rights,” Johnson said. “It’s a long process in terms of gaining people’s trust and getting people on board in terms of what an effective strategy is going to be, but that’s what is required for people to be informed and to understand.”

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Alumni Discuss Post-Graduation Experiences in Panel

The Program in Global Health Studies welcomed back five alumni for a panel discussion to discuss their post-graduation experiences on Thursday, May 19.

“This year, we have one of our biggest graduating classes of minors. We’re in the early stages of developing plans for an adjunct major in global health. In addition, there’s an ongoing conversation with our colleagues in the graduate school about a dual-degree program,” said William Leonard, Co-Director of the Program in Global Health Studies. “The tremendous growth in the global health program reflects on the extraordinary efforts of all our alumni.”

The panel featured Sophia Blachman-Biatch (WCAS ’13), Isabel Garcia (SESP ’15), Divya Mallampati (WCAS ’09), Emery Alden Mathieson (WCAS ’11), and Gene Schwartz (WCAS ’08).

These alumni all embarked on different paths after graduating Northwestern. Blachman-Biatch pursued public relations in San Francisco, Garcia became a fellow of the Princeton in Latin America Program, Mathieson obtained a master’s in public health. Both Mallampati and Schwartz attended medical school._MG_3271

“Sometimes the real meaning of being a doctor gets lost in the rigorous academics of college and medical school requirements,” said Schwartz. “The Global Health minor reminded me why I want to do this and challenged me to think outside the box.”

Schwartz is currently an internal medicine hospitalist physician at Echo Locum Tenens, an affiliate of Sounds Physicians. He is also a candidate for a Master of Science in Clinical and Translational Research.

While Schwartz completed his residency last year, Mallampati just began her OB/GYN residency at the McGaw Medical Center of Northwestern University.

After graduation, Mallampati extended her work in anthropology through a Fullbright Fellowship. Then, she obtained her Doctor of Medicine and Master of Public Health at Harvard University.

“The study abroad component of the minor really makes you take into account the cultural and social factors that influence how primary care is provided. Also, it was an introspective experience for me. My learning from that abroad program has carried me through, even ten years later,” Mallampati said.

Not all global health minors aspire to become practicing physicians. Garcia is currently working in Mexico City at an education policy think tank.

“The minor first exposed me to the idea of being a culturally-competent provider, which was incredibly important to learn before moving to Mexico. It taught me to see people as people, not as subjects or patients. Working with dialogue-based learning was the biggest takeaway for me,” Garcia said.

Like Garcia, Blachman-Biatch did not take the route to medical school. She fused her studies in Integrated Marketing Communications, Psychology, and Global Health into a public relations career in San Francisco. Realizing that agency life is not for her, she is now working at Xerox Community Health Solutions as a Project Analyst in Client Services.

“The creativity and diversity of how health plays a role in today’s society has been instrumental in what I’ve been able to accomplish so far in my career,” said Blachman-Biatch.

Mathieson continued his global health education after Northwestern by obtaining a Master of Public Health at Emory University with a focus on community health and development.

He has worked for the Center for Disease Control and Prevention, Environmental Services group within Delta Airlines, and Evolent Health.

“In my time as a global health minor, I realized this is my no means a narrowly focused field. There are, truly, boundless opportunities.”

The five panelists agreed that global health is a dynamic, interdisciplinary field that opens doors to divergent paths. And seeing these divergent paths come to life through the experiences of alumni was incredibly inspiring.

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Vaccination Crisis: 80% of children under 2 without vaccinations in Guatemala

More than a year ago, I was sitting with my grandparents on the morning of the New Year eating a champurrada and reading the Guatemalan newspaper Prensa Libre. We had celebrated the previous night at a nice restaurant in the colonial city of Antigua where we watched the sky light up with fireworks at midnight. I was reading the newspaper with the intention of practicing my reading comprehension skills in Spanish, as I had not taken a formal class in years, when I stumbled upon an emergency that has largely been ignored in the Western press.

In August 2015, almost 400,000 children under the age of one did not receive vaccination against measles, a disease that was eradicated from Guatemala 20 years ago. There are 328 health posts in the country, however 26 of those are closed, and the rest of them are understaffed and under-resourced at epidemic proportions. I heard about this first-hand from the Guatemalan women who I interviewed for my research project on diabetes this past summer, as they described stories of arriving at the health post at 3 AM and waiting in line to receive medicine that would run out by the time it was their turn. The health post catered to the growing population of diabetics, but only on one day of each month.

Shortly after that article was published, Prensa Libre published another article describing how 602,357 vaccinations were lost in the transition between the Ministry of Health and the health posts due to robbery, improper refrigeration and lack of coordination in 2014. This resulted in a loss of almost a million dollars, but more than anything, it created a growing risk for thousands of infants now vulnerable to dying of preventable diseases in the near future. The incoming Director of the Ministry of Health, Luis Monterroso, said that 45% of children in Guatemala were not vaccinated in 2014. Data shows that the most rural and impoverished regions of Guatemala did not receive any vaccinations for the entire year.

Prensa Libre

Prensa Libre

Fast forward to April 2016. It is now one year after the former President of Guatemala, Otto Perez Molina, was impeached and arrested for insurmountable charges of stealing money from the health system, several months after the national hospital ran out of food for their patients, the same month in which six newborns died at the National Hospital of Sololá due to lack of medical attention, and the same month when the recently elected president, Jimmy Morales, failed his promise to fix the health system crisis within 100 days of being in office. In Guatemala today, 800,000 planned vaccinations were not completed in 2014 and 2015. According to the Alliance for Nutrition (Alianza por la Nutricion), 81.5% of children under two years old do not have the recommended vaccinations. On top of everything, the Guatemalan government owes millions of dollars to the Pan-American Health Organization – a sum that rivals what is needed to immunize the thousands of children lacking vaccinations in Guatemala today.

While local actors are combating this national emergency, I could not find any information about this crisis in an English-speaking source. In fact, this emergency has only received attention from Prensa Libre, the Guatemalan newspaper that I happened to read on a dining room table in Guatemala two years ago. Both UNICEF and WHO had data on vaccination coverage for Guatemala. The percentage of coverage was in the 90’s for most of the immunizations on UNICEF’s profile of Guatemala. Looking closer, I noticed that the data on the home page was from 2013, and more recent data showed vaccinations had fallen by 10% across the board. Going back to the Guatemalan newspapers and a report published by the Ministry of Health, Hepatitis B and Pneumococcal vaccine were administered to 21.86%, and 59.87% of children in 2014, respectively. Statistics from the WHO matched these results. Rotavirus vaccine, which prevents vomiting and severe diarrhea in infants, had percentages of immunization coverage varying from 81% in 2013 (UNICEF) to 54.27% in 2014 (Prensa Libre and WHO). The international standard for all vaccinations is 95% – so no matter, Guatemala is very much below the standard, and with each passing year this problem becomes more dangerous.

A family walking outside Antigua, Guatemala

This past summer, I saw two cases of Hepatitis B – one in a private pediatric clinic in Guatemala City, and the other in an NGO-funded health clinic open once a week in rural San Martin Jilotepeque. They were both boys no older than five with scared brown eyes and thin limbs. The boy from the urban private clinic had just returned from Disney World and was accompanied by his two parents, both dressed in American brands, while the boy from the rural public clinic was accompanied by his mother, dressed in a Mayan huipil with his younger baby sister strapped to her back. Looking back, I found it a strange coincidence that I had seen two Hepatitis B cases in boys of nearly the same age but from vastly different worlds. And yet, how much of a coincidence was it in a country where only 22% of children were vaccinated against Hepatitis B in 2014? Hepatitis B has a higher likelihood of resolving itself in children above the age of 5, but for younger children and infants there is a 50/50 chance of chronic life-long infection of the liver. For a family living in poverty, this is devastatingly costly condition in a young child. Thus, like most health problems in the world, the vaccination crisis in Guatemala falls most heavily on the most vulnerable in society – children, and the poor.

In a crumbling health system in crisis, 80% of children under the age of two cannot afford to be without all the necessary vaccinations. Amid debate on national sovereignty and governmental requirements from international bodies, what is to be done about this national emergency, and by whom? While some parents in the US benefit from the luxury of “herd immunity” and do not vaccinate their children, Guatemalan parents have neither the choice to vaccinate their children nor are able to prevent their children from dying of preventable causes. What can be done against the systematic invisibility of long-term global health emergencies in Western media? Without proper attention to this public health emergency, nothing will be done in the near future.

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Northwestern Law Students Present Recent International Fieldwork

The Northwestern Pritzker School of Law’s clinical program, the Bluhm Legal Clinic, provides students with a direct, real-world experience representing clients and serving as advocates. On Thursday, April 14, the Center of International Human Rights–one of the clinic’s 14 centers–held its annual presentation for global fieldwork research. Two of the four works presented were part of the Access to Health Project, an interdisciplinary health and human rights project that integrates the clinic’s Center of International Human Rights, the Kellogg School of Management and Feinberg School of Medicine. Students and faculty, through this project, work with a community in the developing world to assess the health needs of that community and innovate a sustainable intervention.

 

Criminal Justice Reform in Malawi

By Stephanie Ciupka, Margaret Truesdale, and Alice Murgier

This project was rooted in Blantyre, Malawi, and its objective was to reduce homicide backlog. In this area, all homicide offenses are charged as murder because little police investigation goes into homicide reporting. As a result, even manslaughter is often charged as murder. Most shockingly, there are only seven public defenders for a population of 661,444 people. The major consequences of this injustice are overcrowded prisons, where inmates have to sleep back-to-back, and defendants on remand for up to a decade. The students in this project collaborated with prosecutors, paralegals and public defenders in Malawi to identity wrongly convicted individuals. These students had the support of the Paralegal Advisory Service Institute (PASI), which deploys trained paralegals to give legal education, advice and assistance to complement the work of the existing criminal justice system in Malawi. Another method to target the issue of prison overcrowding is establishing camp courts, in which the prosecutor, magistrate and clerk travel to the prison.

 

Landmine Victims in Colombia

By Montserrat Peniche Hijuelos, Flavio Aurelio Wandeck Filho, and Ana Sophia Merlo

The Colombian government has developed a project for the eradication of Cocoa; one of their methods is to employ rural, destitute civilians to manually destroy the plants. Cocoa is typically grown in areas where illegal armed forces are prominent, thus there is little government control. The guerilla and paramilitary troops in this area have planted landmines around the plants in order to protect them; stepping on a landmine results in a massive explosion that injures or kills the victim. The presence of landmines has posed a huge threat to the nation’s rural population. Furthermore, the victims do not have access to compensation and disability pensions. For this project, students partnered with CCM, Congreso Colombia de Mineria, to launch an initiative with the goal of raising awareness for this issue and fighting for victim compensation.

 

Fighting Female Genital Mutilation (FGM) in Mali

By Alice Murgier, Juliet Sorensen, Anna Maitland, and Shannon Galvin

FGM includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. In Mali, 91.4% of women have undergone FGM because it is a social and customary practice. These procedures can cause of a number of severe and negative consequences: excessive bleeding, infections due to unsanitary operations, and scar tissue that lead to complication at childbirth, and trauma. Curbing FGM in Mali was the pilot initiative of the Access to Health Project. Students wrote songs in local dialects about public health sanitation and broadcasted them through radio shows; they performed skits through “Troupe de Haire” and educated through theater.

 

Accessing “Access to Health” Issues in Nigeria

By Farzeen Tariq, Gergana Peeva, Shannon Galvin, and Juliet Sorensen

This project aimed to investigate and target issues of maternal health, water and sanitation, malaria, fire safety, and HIV/AIDS. The presentation primarily focused on the first two issues. Family planning and contraception are major concerns, as well as maternal mortality rates. One root of the issue is the lack of basic reproductive and anatomy education. In addition, there is only one midwife in Otodo Gbame, a community in the Eti-Osa Local Government Area of Lagos State. She is an elderly woman who cannot travel beyond the limits of her own home, so women in labor have to walk a narrow plank to a boat that takes you across a small stream to reach her home. Furthermore, the issue of sanitation is also a serious matter. Open defecation is often the only option due to faults in basic infrastructure. In addressing these issues, the implementation phase is still ongoing; the team is looking into a comprehensive community education intervention.

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