Guest Bloggers

  1. Community Health Administration Associations: Community health empowerment for Peruvians

    July 28, 2014 by Kathleen Ferraro
    San Jeronmino CLAS center

    San Jeronmino CLAS center

    I am currently researching the community health worker model in Peru, a project which has necessitated extensive background research on Peruvian health care and the community health worker model’s past, present, and potential in the country. This background research included information on the Community Health Administration Associations (CLAS) program, a program that diverges from the conventional community health worker model but provides community-based primary care nonetheless.

    As a background, the community health worker model is a primary care model wherein local community members are trained to administer basic health services to other members of their community. This model is steadily gaining popularity worldwide, often commended for its potential for community empowerment and accessibility. In Peru, studies of the community health worker programs in place acknowledge the efficacy of the model on paper, but criticize the fact that the bulk of Peruvian community health workers are males with little to no education that exhibit high dropout rates from their community health work (Brown et. al. 2006).

    However, the CLAS program, implemented in 1994, is proving to heighten the potential of efficacious community health work. The WHO defines the CLAS program as a system of “private, non-profit civil associations [(legal non-profits)] that enter into agreements with the government and receive public funds to administer primary health-care (PHC) services applying private sector law for contracting and purchasing” (CITE). These individual community CLAS associations effectively identify local social determinants of health and health inequities, and then reinvest their Ministry of Health-supervised budget in community outreach programs and infrastructure development.

    As it relates to the community health worker model, the CLAS program is essentially a government health initiative with authorized and integral community participation. Health personnel working at CLAS associations are formally hired by CLAS and are held accountable by the community members their center works with, thereby necessitating transparency and communication with service recipients. In that way, community members influence the health services offered, and CLAS associations respond to the needs and health disparities specific to their localities.

    All in all, the CLAS model has proven to have favorable impacts on health, health services development, and community outreach. CLAS association clinics boast significantly higher numbers of staffing physicians in comparison to non-CLAS clinics (and therefore shorter waiting times and more personalized treatment) with a higher average of annual clinic visits among their target populations. The centers also exhibit higher access and more customized primary care, especially for poorer rural populations that tend to be dissuaded by unaffordable fees. They do so by focusing on what the individual community needs and responding to only the relevant inequities and necessary services–in short, affording accessibility by efficient service development and implementation.

    Government and organizational initiatives continue to develop in the hopes of further strengthening the CLAS program by monitoring impact, fostering community-based education, broadening the reach of CLAS centers, and increasing CLAS partnerships with schools, organizations, and other relevant institutions.

    With initiatives like this in place to strengthen a program that already demonstrates significant impact, it is exciting to see where this community-based primary health care system goes in the future. Likewise, it will be interesting to see how non-CLAS community health worker programs interact with, borrow from, and impact the CLAS model to continue to expand the reach of community-based health care in Peru.

  2. Questioning Domestic Violence

    July 25, 2014 by Haley Lillehei

    According to the National Coalition Against Domestic Violence (NCADV), one in every four women will experience domestic violence in her lifetime. This violence is not confined to any one group – it is an epidemic that is affecting individuals from every background, regardless of age, economic status, race, religion, nationality, or educational background. The consequences of domestic violence seep into many areas of life and can have remarkable effects beyond the immediate act.

    The NCADV released a domestic violence facts sheet in 2011 that gives a brief discussion of the issue within the United States. 85% of victims of domestic violence are women, and most of these females are victimized by someone they know. Most cases of domestic violence are never reported to the police and can have lasting repercussions – intimate partner violence is a substantial public health problem in the US. Last year (2013), the House renewed the Violence Against Women Act, which is legislation to offer protection to victims of domestic abuse. In response to the passing of the act, Obama said “Renewing this bill is an important step towards making sure no one in America is forced to live in fear.” This is a measure towards addressing the issue, but intimate partner violence is still a large problem that needs to be confronted to a greater extent.

    The challenge thus remains how to most successfully prevent domestic violence. One of the greatest challenges to overcome is the patriarchal norms in the society we live in. Domestic violence, although most often perpetrated by individual men and boys, is a product of a larger system. Jackson Katz, a gender violence prevention educator, has an interesting perspective on the issue of domestic violence.  In a TedTalk titled “Violence Against Women – It’s a Men’s Issue” Katz explains how the problem of domestic violence is usually categorized as a woman’s issue, but, he says, it is time for a change.

    “They’ve been seen as women’s issues that some good men help out with, but I have a problem with that frame and I can’t accept it. I don’t see these as women’s issues that some good men help out with. In fact, I’m going to argue that these are men’s issues, first and foremost. Now obviously, they’re also women’s issues, so I appreciate that, but calling gender violence a women’s issue is part of the problem for a number of reasons” (Katz, 2012).

    Katz goes on to describe all the problems with calling gender-based violence a “women’s issue” – some men hear that term and tune out.

    Jackson Katz

    Jackson Katz

    Katz uses a linguistic model to illustrate his point. The phrase “John beat Mary” changes, through a few steps, into the phrase “Mary is a battered women.” John has entirely left the conversation, and the violence that was perpetrated against Mary has become her identity. “Mary is a battered woman,” Katz points out that our whole cognitive structure is set up to ask questions about victims. What did Mary do that made John upset? Did Mary forget a responsibility? The questions continue, and they are all focused on Mary. Instead of asking questions about Mary, we need to start asking a new set of questions. “What is going on with men? And then what is the role of the various institutions in our society that are helping to produce abusive men at pandemic rates?” (Katz, 2012). The questions need to shift to focus on the causes of violence, as that is how we will truly figure out how to prevent it.

    Domestic violence is a deeply rooted and systematic social problem. Katz wants to know “how can we change the practices? How can we change the socialization of boys and the definitions of manhood that lead to these current outcomes?” (2012). These questions are hard, because they rock the boat and challenge the status quo, but they are the only way to make a real change. They will be resisted, but the more people that can join the conversation and ask the questions, the more momentum gained.

  3. The Pebbles Project: A Reflection

    July 21, 2014 by Emily Drewry

    Emily Drewry participated in the Northwestern Public Health and Development in South Africa study abroad program in Spring 2014. As part of her studies, she spent six sessions working with a local NGO to integrate her understanding of South African health systems with understanding of community development.

    IMG_3026The Pebbles Project is a nonprofit organization whose offices are located on the Villiera Wine Farm in Somerset West, South Africa. Founded in 2004, the organization’s initial goal was to help the children of wine farm workers, many of whom are affected by alcohol abuse early on and throughout life. Children living in the Winelands communities have been identified as high risk for significant instances of Fetal Alcohol Syndrome and developmental delays due to increased exposure to pesticides from living on and near wine farms. Through working with this organization, we were able to integrate our budding understanding of South African health determinants. We were able to spend time with the nurse practitioner, an incredibly knowledgeable woman, as well as  one of the early childhood program teacher at Pebbles during our time there. Ending with a cumulative project about what we’d learned, the time at Pebbles left a lasting impression.

    The day we first drove up to Pebbles, the natural beauty of the Winelands around the office stunned us. We were so excited to meet the staff, tour the location, and get started with our work. It became clear that we would be working on a few projects while at Pebbles, but that our time there would be largely based on their needs on a week-by-week basis. We toured the facilities that first day and were excited to see a new clinic where families of wine farm workers could come to receive care. Because it just opened, the clinic wasn’t receiving many patients, but there’s no doubt that it will be an integral part of the Winelands community in the future.

    IMG_3037The Public Health and Development program focused on a different determinant of health each week, effectively introducing us to the status of South Africa within the realm of health, and creating comprehensive background for us to apply to our time at Pebbles. For example, the week of occupational health especially stood out to me as important progress in my understanding of South African health determinants. I was already familiar with the workings of Pebbles by that point in our time here, but I had never contemplated the occupational hazards present on the wine farms. After a week of coursework related to occupational health, I returned to Villiera with a broader understanding of concerns for employees and the required actions to remain in good health while working in jobs that require manual labor. Things I had never considered before, such as repetitive strain injuries due to long days of repeating motions, became illuminated and further highlighted the need for a clinic on site.

    As part of our work at Pebbles, we were tasked with creating a hygiene project for the young children of the crèches. After observing for a day, we noted that the biggest gap in hygiene came in the process of washing hands. Not only did the children fail to wash their hands at home, according to the teacher, but also when asked to do so at the crèche, they simply dunked their hands in water and considered it done. We worked on creating a presentation that would be understandable by 3-5 year olds that showed them why they wash their hands and how to do so effectively. Using a basic explanation of a germ and demonstrating how long to wash our hands to the tune of Happy Birthday, we presented on our final day at Pebbles and were thrilled with the responses we got from the kids. They sang along with us as we let them practice afterward, and we left the materials behind for the teacher to replicate the presentation in the future. For children so young, it is difficult to explain concepts as difficult as germs, but we hoped to have made a lasting impression on their habits that will greatly affect their health down the road.

    I could not have been happier with the placement at Pebbles; the wine farms were, to me, a fascinating community to learn about for the past ten weeks. Not only was it a group I had previously little knowledge about, I found the determinants were apparent within the community, but also being addressed by Pebbles. The organization offered a comprehensive look into the challenges of a specific community, and I appreciated the chance to identify each program and how the goals matched the health needs of the community. Pebbles offers a variety of programs, from early childhood development centers, to afterschool clubs, to parents workshops about finances, personal development, and positive parenting. The various parent programs, for example, worked well at addressing the psychosocial and occupational health problems seen among adults in the wine farm communities. The development of individuals within the Winelands communities will be forever improved because of Pebbles’ comprehensive goals and programs.

    I left South Africa with a broader interest in health – not only will I continue to seek out opportunities in nonprofits abroad, but I will bring to the table the skills it will take to join and learn about a new community, especially one I’d never considered before. Pebbles is one of those organizations that will stick with me for a long time, not only because of the opportunities we had to become a part of their team, but because of the complex task they have undertaken so positively.

  4. Apna Ghar: Empowering Asian American Victims of Domestic Violence

    July 15, 2014 by Haley Lillehei

    Last quarter I took a class on Asian American women and different issues they face in the United States. One assignment was to look up an organization in the Chicago area serving these women. I chose Apna Ghar, an organization in Uptown Chicago, which tries to fill the gaps in domestic violence relief services in the Asian American community. After this project, I decided to reach out to Radhika Sharma, Community Health and Violence Prevention Specialist at Apna Ghar, to learn more.

    Apna Ghar first opened its door in 1989 with the goal to “provide comprehensive multi-lingual, multi-cultural services, including shelter, for South Asian immigrant women seeking lives free from violence.” Since it’s founding, Apna Ghar has worked to offer assistance to all women, regardless of their racial background, and provides a wide range of services that focus on South Asian immigrant women. Its founder recognized that Chicago shelters did not know how to deal with the issues specific to South Asian women. Their experiences were not the same as in white middle and upper income families, who are often the targets of domestic violence shelter’s services. There was also a need for legal assistance for immigrant women who are undocumented or whose residency in the US is dependent on their abusive spouses.

    Radhika Sharma notes that while gender inequities exist in almost all cultures,

    “the hundreds of distinct cultures within the Asian American category include the focus on the individual as part of a larger family unit. This means that some Asian American Domestic Violence victims refrain from speaking out about their abuse for fear of bringing shame to the family. It also means that the abuse might be perpetrated not just by the spouse but by the spouse’s family” (2014).

    The emphasis on family and traditional values can make the situation especially hard for immigrant women.

    To address all of the barriers Asian American women face while attempting to find relief from domestic violence, including cultural and linguistic ones, Apna Ghar aims to be a culturally specific space. This helps the abused women, who, according to Sharmila Rudrappa, often feel “a strong sense of wanting to be in a familiar cultural space where they could reconstitute their lives in ways that were culturally comprehensible and within their control.” Asian American survivors of domestic violence needed a space where they felt comfortable, and not like outsiders as they are receiving care and assistance. Apna Ghar provides a space with more flexible policies – one in which women can cook their own food and speak with the multilingual staff.

    Most importantly, Apna Ghar focuses on helping domestic violence survivors become self-sufficient and empowered. It offers a wide-range of services to accomplish this goal, including education, transitional housing, counseling, and legal services. For example, the organization provides a 24-hour hotline which addresses immediate safety concerns and provides referrals and information to callers. It also provides an emergency shelter with 15 beds, transitional housing for 18 to 24 months for those who are working to rebuild their lives, counseling to help women and children work through trauma associated with abuse, and legal advocacy geared towards helping both residential and non-residential clients through the United States legal system. Likewise, Apna Ghar has a Supervised Child Visitation and Safe Exchange Center, in which children are able to interact with a non-custodial parent under supervision.

    Apna Ghar’s website includes a section that discusses “success” stories of women who have utilized their services to escape abusive home situation and rebuild their lives. There are stories of women, like Maria, who was tricked into coming to the United States and becoming a sex slave, and Vijaya, who came to Apna Ghar to escape violence in her home while she was pregnant (names changed to protect confidentiality). The stories are touching and powerful, and show the good work Apna Ghar is doing within the community. To find out more about Apna Ghar or become involved, see their website at http://www.apnaghar.org/.

     

  5. The Growing Crisis in Guatemala: Why Coffee Rust is a Pressing Public Health Issue

    July 1, 2014 by Elizabeth Larsen

    Agriculture Landscape (1 of 1)
    You may have noticed this week that your usual Starbucks coffee costs a bit more than usual (1). This slight price increase is, in part, a consequence of Roya, a fungal plant disease that is attacking coffee plantations around Guatemala and the rest of Central America. What you may not have known is that Roya is not only decimating coffee crops, but it is also having profound effects on the health of thousands of Guatemalans.

    Guatemala’s history with coffee is long and complex. It begins around the 19th century when Spaniards began stealing large plots of land from indigenous Mayan communities, converting them into plantations, and forcing the indigenous populations to work for them. Through colonial trade and tax laws, the Spaniards restructured Guatemala’s agricultural economy to be heavily dependent on coffee. In this way, coffee became the principal export of Guatemala, reaching 90% of the countries’ exports before 1900 (2).

    Throughout the 20th century land reforms and civil war in Guatemala, the coffee industry exacerbated the narrative of poverty, racism, and inequality among indigenous populations that had begun centuries earlier. Today, coffee production throughout the country continues to be marked by rich coffee finca owners using indentured servants and migratory farm workers to harvest their beans. As coffee remains Guatemala’s largest export to this day, there are thousands throughout the country that depend on the crop for their livelihood.

    The importance of coffee exports in the country is precisely the reason that Roya has been so detrimental to the health of Guatemalans. Roya is an airborne, fungal disease, sometimes referred to as coffee rust. It spreads quickly in humid environments, causing coffee leaves to become speckled with rust colored spots, before drying up and falling off. The only potential cure for the harmful fungus is multiple applications of expensive fungicides that are often ineffective.

    Since the 1970s, Roya has been a problem in the warm and wet Central American countries, such as Costa Rica and Nicaragua, but has left the cooler, mountainous Guatemalan coffee farms alone (3). However, in recent years, the region has experienced the effects of widespread climate change. The fungus began afflicting Guatemalan farms around 2012 and was recently declared a national emergency by the Guatemalan government (4). The fungus is estimated to have caused over $1 billion in damages since 2012 (5). It is now estimated that 70-80% of coffee crops are affected by the disease. This is among the highest rates out of any Central American country.

    Roya is affecting everyone involved in the coffee distribution chain — from Starbucks consumers to the rich coffee finca owners to the poor farmers working in the fields. Coffee harvests of Guatemalan plantations have plummeted to 1/20th of what they used to be (3). The only solution is to trim back the foliage of old plants in hopes that they will sprout new, healthy leaves. Even with this strategy, the plants will not produce the valuable coffee beans for two to three years. Because of this, many farmers have taken to planting new trees that are more resistant to the fungus, but will take years to become productive.

    The consequences of this plight of coffee rust reach far beyond increased Starbucks prices. Throughout the many coffee growing regions of Guatemala, including Sacatepéquez, Sololá, Quezaltenango, San Marcos, and Alta Verapaz, hundreds of thousands of people are now without work. Coffee planters and pickers have tried to switch to new crops such as plantains and bananas, but the value of these commodities is far less than that of coffee. Because a large portion of Guatemala’s population struggles with food security, this substantial amount of job loss from the economy will have widespread health effects.

    Employees of organizations that work with the indigenous poor around the highlands, such as Mayan Families, state that they’ve seen in increase in families struggling to feed their children. Given that the first two years of a child’s life are crucial for their long term development, one hard season can have devastating consequences on child growth, leading to impaired mental and physical development. In a country where 49.8% of children suffer from stunted growth already, the coffee fungus has the potential to undo much of the nutritional progress that has been made over the last decade.

    So far, the response to the epidemic has been varied. Since April, the World Food Program has been providing emergency food assistance to 14,000 families across Guatemala (6). While admirable, this is a small portion of the hundred of thousands Guatemalan families that are suffering from the outbreak.

    Then, just  two days ago, The U.S. Agency for International Development (USAID) launched a $23 million dollar fund in partnership with Keurig Green Mountain, Cooperative Coffees, Starbucks, and Root Capital to support the thousands of coffee farmers affected by the devastating fungus (3). The fund will be used to “provide on-farm, agronomic trainings on climate-smart, resilient practices to coffee farmers and farmer organizations” and to rehabilitate ”disease-affected fields and… stabilize coffee supply chains in Latin America and the Caribbean (3).” Though this support is crucial for the coffee industry, these solutions will take years to return farms to full productivity and do little to alleviate the immediate suffering of families.

    Clearly, the effects of the Roya fungus have rippled throughout the country of Guatemala. No one solution will mitigate the repercussions of this epidemic plant disease, but multifarious efforts that address both household income and food security, as well as large scale agricultural and economic factors will continue to make progress towards overcoming it. Though the challenges are great, in the words of longtime Guatemala resident and coffee shop owner, Michael Roberts, “Guatemala has been through a lot. What’s gotten them through is the resilience of the people.”

    (1) Wagner, Meg. “Starbucks Hikes Prices on Brewed Coffee, Lattes, Bagged Beans.” NY Daily News. N.p., 24 June 2014. Web. 27 June 2014.

    (2) “The Culture of Coffee in Guatemala.” Coverco – Commission for the Verification of Codes of Conduct. N.p., n.d. Web. 27 June 2014.

    (3) ”Devastating ‘coffee Rust’ Fungus Raises Prices on High-end Blends.”OregonLive.com. N.p., 31 May 2014. Web. 27 June 2014.

    (4) Davidson, Kavitha A. “Guatemala Declares National Coffee Emergency.” The Huffington Post. N.p., 09 Feb. 2013. Web. 27 June 2014.

    (5)  ”USAID, Texas A&M Invierten $5 Millones Para Combatir La Crisis Causada Por La Roya Del Cafe.” U.S. Agency for International Development. N.p., 19 May 2014. Web. 27 June 2014.

    (6) ”Guatemala: WFP Assists 16,000 Families Affected by Coffee Rust and Drought.”World Food Programme. N.p., 30 May 2014. Web. 27 June 2014.

    (7) ”USAID, Keurig Green Mountain, Cooperative Coffees, Starbucks and Root Capital Launch $23 Million Resilience Fund to Help Farms Fighting Coffee Rust Crisis.” U.S. Agency for International Development. N.p., 19 June 2014. Web. 27 June 2014.

  6. Food for Thought | In search of solutions

    June 20, 2014 by Elizabeth Larsen

    IMG_8624

    Hey, everyone! My name is Elizabeth Larsen, and I’m a rising senior, studying Economics and Global Health.

    This summer, thanks to the Circumnavigators Travel-Study Grant, jointly funded by Northwestern University, the Circumnavigators Club – Chicago Chapter, and Weinberg Colleges of Arts and Sciences, I will travel to six countries across the world to pursue a research project entitled, “Tackling Childhood Malnutrition: A global study of scaling up grassroots approaches to catalyze world progress.” I aim to study how high impact grassroots nutrition programs can be scaled up to catalyze progress across wider populations.

    This project was born out of two experiences that I had last summer. First, I was able to travel to Uganda with the support of NU’s International Program Development Office. I attended the 2013 GlobeMed East Africa Forum, in which I met many grassroots change-makers from across Africa. After returning from Uganda, I spent two months in Guatemala with the support of the Global Health Initiative, conducting a research project examining the impact of a nutrition recuperation program in a nonprofit clinic called Primeros Pasos.

    These two experiences vastly expanded my knowledge and views on global development, but left me with many questions. One that especially stuck with me was, why is childhood malnutrition still so prevalent in our world when there are many grassroots programs achieving enormous success? The solutions are clearly out there, but they aren’t reaching a global audience. My project this summer investigates the implementation science behind these grassroots programs to better understand the key to their success.

    After months of planning and preparation, I can’t believe the trip is finally here! I will be beginning with case study sites in Guatemala and Peru, crossing the ocean to Uganda and Rwanda, and finishing with organizations in Nepal and Cambodia! I am so excited for the journey, and I’m looking forward to sharing my research, experiences, and thoughts with all of you!

    With endless gratitude and excitement,
    Elizabeth

  7. The 10 Twitter accounts you should follow this summer

    June 16, 2014 by Arianna Yanes

    Wherever you find yourself this summer, if you can find Wi-Fi, you can get the latest on global health. Twitter has established itself as a valuable way to stay in touch with the global community and be in the know the instant something happens domestically or internationally. In a world more connected than ever, it’s possible to be a part of the conversation from around  he world. To follow-up on a recent post by my fellow blogger @EmilyDrewry2015, here are 10 additional Twitter accounts you should be following this summer to make sure you are in the know:

    1. @WHO – “Official account of the World Health Organization, the United Nations’ Health agency.”
    2. @BBCHealth – “Health news, features, analysis from the BBC, via an automated feed of website headlines.”
    3. @UNAIDS – “The goal of UNAIDS is to lead and inspire the world in getting to zero: zero new HIV infections, zero discrimination, and zero AIDS-deaths.”
    4. @JohnsHopkinsIH – “The Johns Hopkins Bloomberg School of Public Health’s Department of International Health is the oldest and largest global health department in the world.”
    5. @Laurie_Garrett– “Sr Fellow @CFR_org. Pultizer Prize Winner. Author: I Heard the Sirens Scream (2011), The Coming Plague & Betrayal of Trust. Views here are my own.”
    6. @MSF –“Médecins Sans Frontières is an international, independent, medical humanitarian organization.”
    7. @nprGlobalHealth – “News, trends, & conversation about global health & development.”
    8. @PIH – “Health is a human right. We provide high-quality health care to poor and marginalized people around the world and inspire others to do the same.”
    9. @agnesbinagwaho – “Minister of Health of Rwanda (moh.gov.rw); Senior Lecturer, Harvard Medical School; Clinical Prof of Pediatrics, Geisel School of Medicine.”
    10. @GlobalHealthOrg – “The Global Health Council is the world’s largest membership alliance dedicated to saving lives by improving health throughout the world.”

    Once you’ve followed these few, you will get suggestions to diversify your Twitter feed. Stay updated, retweet, and keep the conversations going through the summer and beyond.

  8. Mainland Chinese “Birth Tours”

    June 2, 2014 by Haley Lillehei

    Source: New York Times

     

     

    In the past thirty years a phenomenon of “birth tourism” has arisen, describing Mainland Chinese mothers and their families traveling to Hong Kong to have their children. As the world has globalized, individuals have more access to information and more mobility. Medical tourism has stemmed exchange, as people become interested in seeking out healthcare in other areas of the world. It is primarily the result of the globalization of healthcare and the globalization of tourism. The observed phenomenon of birth tours fits within this categorization – in 2009, 50% of the births in Hong Kong hospitals were to Mainland Chinese women.

    It is argued in current literature that there are several reasons for why this is happening: the higher quality of Hong Kong’s hospitals, evasion of the One Child policy, and so that the birthed child receives the benefits of Hong Kong citizenship. These reasons are enough to attribute to the increase of births, but the cost side of the equation explains why Hong Kong’s hospitals, both public and private, are also benefiting from the occurrences.

    Local residents in Hong Kong giving birth at a public hospital pay about HK$100 (US$13) pr day, while a non-local resident will pay up to 33 time more (US$423 per day). In a private hospital, a delivery can cost up to $110,000. Hospitals have a lot of economic incentive to keep the flow of birth tourism coming.

    Despite benefits hospitals in Hong Kong are receiving, there has been a huge public outcry towards Mainland Chinese mothers who are seen as overcrowding the obstetric facilities. In a New York Times article, Sharon LaFraniere describes the experience of Maggie Wong, a 31-year-old Hong Kong resident who felt as if she had been pushed aside by Mainland couples. She tried to schedule a delivery at a public hospital near where she lived when she was three and a half months pregnant. According to Ms. Wong, she had to spend her husband’s savings and borrow from her parents because the public hospitals were too full of Mainland Chinese women. “I am a citizen of Hong Kong. I pay Hong Kong taxes. I kept thinking, what is this? How can this be? Of course it create bad feelings.” Hong Kong people, especially those attempting to use the obstetric services in hospitals, are increasingly irritated with the lack of room in public and private hospitals.

    In response to the continual public outcry, in January 2013 the Hospital Authority, responsible for the management of public hospitals, general outpatient clinics and specialist outpatient clinics, instituted a “zero-birth quota” that did not allow Mainland Chinese mothers use Hong Kong’s obstetric facilities.

    This restriction has done more than open up beds for Hong Kong women. The exclusion has significantly reduced the overall number of births taking place in Hong Kong. Baptist Hospital, which has one of Hong Kong’s biggest private obstetrics wards, reported a loss of more than HK$200 million and an 80% drop on delivery rate.

    There clearly is a mismatch between public opinion and what is most practical for the state and hospitals. With a large number of high quality obstetric services and a declining Hong Kong fertility rate, the hospitals have a larger supply than Hong Kong citizens can fill. They are now pushing back against the ban that popular opinion so eagerly pursued. The government has not yet lifted the ban, but due to pressure the restrictions have loosened. It remains to be seen whether economics or popular opinion will win this battle.

  9. HIV/AIDS Learning Institute: An Interdisciplinary Perspective on Important Health Issues

    May 30, 2014 by Janka Pieper

    Guest Post by Kate Klein. This post was originally published on the Northwestern Public Health Review Blog.

    Screen Shot 2014-05-30 at 11.10.04 AMFor the past year I have been working with the Interdisciplinary Health Network (IHN), a collective of public health and medicine students from all over the country, interested in creating free courses on important health issues from an interdisciplinary perspective. The IHN was founded on the core belief that an integrated approach across disciplines to combating disease is needed. IHN’s mission is to create a training program that addresses this need and to develop a network across different academic sectors.  The goal of the IHN is to empower students to achieve their goals as future global health professionals by providing a holistic educational environment that allows for innovative thinking in global health.

    As someone who has worked on HIV prevention issues, I was particularly keen to develop a course that would bring together lecturers from a range of disciplines all working on HIV/AIDS. I was able to recruit and record lectures from leaders in the fields of advocacy, laboratory work, social entrepreneurship, clinical care and operational research. I was lucky to bring in leaders in these fields who, collectively, provide a fantastic history of HIV/AIDS, what we know, how we are fighting it (in the lab, the hospital and the field) and where vaccine and prevention research is going.

    Besides the HIV/AIDS Institute, my colleagues are developing Institutes on Tuberculosis and Neglected Tropical Diseases. Each Learning Institute will be a three-week online course, with lectures that you can view at your convenience and live interactive Q&A sessions. Dates and links to the full curriculums can be found here:

    AIDS Learning Institute: June 23rd – July 12 Curriculum

    Speakers Include:
    ▪    Mitchell Warren, Executive Director, AVAC: Global Advocacy for HIV Prevention
    ▪    Alice Gandelman, MPH, Director, California STD/HIV Prevention Training Center
    ▪    Dr. Shannon Galvin, Director of Clinical Programs and Training, Center for Global Health, Northwestern University
    ▪    Dr. Laila Woc-Colburn, Director of Medical Education, National School of Tropical Medicine and Assistant Professor, Infectious Diseases, Baylor College of Medicine
    ▪    Dr. Joseph Tucker, Assistant Professor, University of North Carolina School of Medicine, Director UNC-China Programs
    ▪    Dr. Dorothy Lewis, Professor of Infectious Diseases, Internal Medicine, University of Texas-Houston

    TB Learning Institute: July 7-July 25 Curriculum

    Speakers Include:
    ▪    Dr. Amy Bloom, Senior Technical Advisor, USAID
    ▪    Colleen Daniels, TB/HIV Project Director, TAG Zeroes Campaign

    NTDs Learning Institute: (pending -TBD in July) Curriculum

    Speakers Include:
    ▪    Dr. Peter Hotez, Founding Dean, National School of Tropical Medicine

    These courses are meant for just about anyone with an interest in the topic. If you are would like to apply, the application can be found on the IHN website, http://www.ihealthnetwork.org.

  10. Global health: not just for doctors

    May 20, 2014 by Sarah Kollmorgen

    Students entering the world of global health often times have one pretty obvious trait in common: they attend, have attended or plan on attending medical school. Makes sense, right?

    Ananth Bhogaraju, the managing director and the head of Healthcare Services Investment Banking at Deutsche Bank Securities, told students last Thursday that the academic and clinical sides of healthcare are only half the battle. Instead, Bhogaraju put another option on the table: business.

    “Healthcare is really a growth industry worldwide,” he said. Students with a background in medicine, who possess analytic minds and the ability to communicate well, would have a competitive edge entering in on the business side of things, he said. “Ultimately, I think the opportunity and challenge to [students] is to transfer the skills and knowledge [at Northwestern] to non-traditional career paths.”

    Bhogaraju was invited to speak by the Northwestern Public Health Club, the Global Health Studies Department and the Department of Economics.

    The president of the Public Health Club, senior Carolyn Huang, said she thought students would benefit from hearing about the business side of public health, a topic that most undergrads don’t learn much about during their studies. Huang said she hoped the talk would also attract students in the economics department to public health.

    IMG_0831Holding a B.A. in economics and political science from Northwestern himself, Bhogaraju began his career in the healthcare industry at Salomon Brothers. He said he was hesitant to work in healthcare until he realized it would allow him to fine-tune his interests more than entering other industries, such as technology or media.

    At Deutsche Bank Securities, Bhogaraju said he focuses on capital formation, or raising money for clients, who can be businesses, governments, or individuals. He also advises on mergers and acquisitions, which involves thinking through the social and economic implications of big business deals.

    Students also picked Bhogaraju’s brain on a variety of public health topics, including the consumerization of healthcare, the place of telehealth in the future, and the role of grassroots research companies in the pharmaceutical industry.

    Bhogaraju left the group with a last piece of advice: “If you haven’t thought about opportunities in the business of healthcare, put that in the spectrum of things you’re thinking about.”

  11. Doctors Without Borders Vice President speaks

    May 14, 2014 by Arianna Yanes
    Dr. Adi Nadimpalli, Vice President of the US Board of Doctors Without Borders, addresses Northwestern undergraduates.

    Dr. Adi Nadimpalli, Vice President of the US Board of Doctors Without Borders, addresses Northwestern undergraduates.

    Phi Delta Epsilon and MEDLIFE co-hosted an event on May 12, bringing in speaker Adi Nadimpalli, the current vice president of the board of Médecins Sans Frontières, also known as Doctors Without Borders.

    Nadimpalli introduced the students to the mission of MSF and chronicled his experiences with the organization, showing pictures of his trips to Liberia, Mozambique, Sri Lanka, and Nigeria. Specifically, he delved into some of the issues that refugees and internally displaced persons face in Syria with the current civil war, such as chronic diseases, war trauma, and refugee illnesses such as diarrhea and typhoid fever.

    As a physician currently practicing in New Orleans, Louisiana, he feels his clinical practice has changed since before his missions with MSF.

    “The people who are doing MSF that you meet in the field are incredible,” Nadimpalli said. “I gain empathy and passion when I go abroad.”

    The best advice he had for college students was to travel, learn different languages, and follow global politics to be a more connected and experienced candidate for any graduate program.

    “Dr. Nadimpalli emphasized the importance of being worldly and being aware of what is going on outside of Northwestern,” said Weinberg sophomore Jay Mainthia. “There’s a much bigger world outside of our classes.”

    After his talk, students were eager to stick around and ask questions about Nadimpalli’s personal experiences and issues in the global medical landscape. Even after the question and answer portion was over, upwards of ten students approached Nadimpalli, wanting to hear more.

    One student asked how he remains dedicated and determined while confronting medical issues in war-torn and resource poor areas.

    “Even if you solve today’s problems, there are going to be more problems tomorrow,” Nadimpalli responded. “Living in the moment and saying ‘this is what I’m going to do today’ helps a lot.”

     

  12. Running out of Breath: China’s Problem with Air Pollution

    May 9, 2014 by Haley Lillehei

    28-china-master675-v2

     

    In the summer of 2012 I traveled to Beijing on the Northwestern University Public Health study abroad program. I had a phenomenal experience overall and learned a lot about the public health system in China and Traditional Chinese Medicine, as well as the Mandarin language.  Beyond the classroom, I also got to experience so many unforgettable parts of China. I ate my way through Beijing, visited as many tourist attractions as I could, spent a fair amount of time exploring, and practiced my Chinese wherever and whenever possible (including with my favorite popsicle/fruit vendor on the Beijing University campus). Through my experiences navigating the city, both in large and small groups as well as on my own, I learned so much more about the culture of China I had already learned to love. Overall, I thoroughly enjoyed my time spent in China.

    Despite all the positives, there was something that drove me nuts about Beijing: the air quality. Anyone who knows me will tell you I love the outdoors and the sun. So the grey skies, thick with smog, were not ideal. Even more disappointing to me was the fact that I had found the one place where running outside is actually worse for your health than not running at all. I had been warned, but did not fully appreciate the cautionary tales until I ran my usual 6 miles on one of my first days in China, went back to my room, collapsed, and felt like I was never going to breath normally again. Needless to say I found the gym on campus instead of trying another run outside.

    According to the New York Times, only three of the 74 cities monitored by the central Chinese government meet official minimum standards for air quality. Beijing, one of the dirtiest cities, met air quality standards less than 50% of days in 2013. China gets most of its energy through the burning of coal, which not only causes air pollution but also contributes to greenhouse gases and global warming. Although pollution has long been a problem, it was especially brought to public attention in January of 2013, a period of time now referred to as the “airpocalypse.” For several consecutive days, the air was classified as hazardous to human health – pollution was 25 times higher than what is considered safe in the United States.

    beijing_pollution

    Despite discomfort and minor health implications corresponding with air pollution, the World Health Organization also reports that air pollution contributed to seven million deaths worldwide in 2012. In February of 2014, the Shanghai Academy of Social Sciences wrote a report remarking that pollution was going to make Beijing “uninhabitable for human beings.” Recently, this issue has been receiving attention in local media, an unusual feat. Alex Wang, an expert of Chinese environmental law at the University of California, Berkeley, law school, spoke to NPR: “There’s been more clarity as to the severity of the problem, there’s more frequent disclosure of information, but what remains to be seen is whether more aggressive action will be taken to solve the problem.”

    Air pollution in Beijing, and China in general, is clearly a large problem. It’s negative affects range from quality of life to public health to loss of tourism to global warming. It is clear that change needs to be made. Let’s hope China is up to it.

  13. Full bellies: Program created by NU alumni helps African farmers

    by Jennifer Draper

    The origin story for a top international charity begins at Northwestern University, and the director returned to campus on April 23 to talk about the organization’s successes and challenges as a part of the One Book One Northwestern series.

    Matt Forti, NU alumnus and director of One Acre Fund, explains how the program teaches African farmers to plant correctly to four volunteers from the audience in Evanston. Photo by Jennifer Draper.

    Matt Forti, NU alumnus and director of One Acre Fund, explains how the program teaches African farmers to plant correctly to volunteers from the audience. Photo by Jennifer Draper.

    “This really is a very special moment for me,” One Acre Fund Director Matt Forti said. “This is the first chance for me to come back now—I think I was calculating 18 years—after I first stepped on this campus to really recognize and thank the community that made One Acre Fund happen.”

    One Acre Fund is ranked 18 out of 100 of the world’s leading non-governmental organizations last year, according to The Global Journal. It aims to help smallholder farmers in Africa maximize the amount of food produced per acre of land, in an effort to provide hunger relief and economic stability.

    “They’ve been able to work with these farmers and on average doubled their income from their farming activities, which is a remarkable story,” said Bryan Hanson, interim director of the Buffet Center for International and Comparative Studies.

    Since the program’s launch in 2006 by Forti’s classmate at the Kellogg School of Management, Andrew Youn, One Acre Fund has served 80,000 farmers in Kenya, Tanzania, Rwanda and Burundi.

    “I think one of the reasons for One Acre’s great success has been this commitment to continuing to ask the hard questions and come up with new, innovative answers,” Hanson said.

    Malnutrition makes farming families stuck in inter-generational cycles of poverty, Forti said. During the “hunger season,” or months where food supply is low or non-existent, families routinely skip meals or rely on a maize-porridge mixture.

    “In the places that we work, one in 10 children are dying before the age of five,” the One Acre Fund director said. “And if you survive, you’re almost half as likely to have some form of stunting.”

    Poverty in Africa is a rural phenomenon, specifically a farming phenomenon. Most of the world’s poor are farmers, Forti said, adding: “This shouldn’t happen in the 21st century, given the vast amounts of food that are in the world.”

    How can these families get the same yields as farmers with more land?

    “The hopeful part is that one acre of land actually is enough to grow enough food to feed a family,” Forti said. “And it is enough also to have a little bit of surplus food to sell into the markets, to spend on things like education, healthcare and to make other investments to get their family out of poverty.”

    The task is to show struggling farmers new planting techniques. Aside from proper training, One Acre Fund’s program model also provides financial loans for seed and fertilizer, a delivery service within walking distance and enables farmers to access markets for higher harvest sales. As a result, a farm’s income grows by 50-100 percent per planted acre, Forti said.

    Within three years, One Acre Fund may represent Africa’s largest network of smallholder farmers. By 2020, the program expects to reach 1 million farm families, with more than 5 million people living in those families, according to the One Acre Fund website.

    Yet it almost didn’t happen.

    Without the initial financial backing from Forti and Youn’s classmates, the organization would never have taken off like it did. Forti said 95 percent of the Kellogg students that first signed up are still giving today.

    “Truly, truly, Northwestern is to thank for what we have today,” he said.

  14. Traditional healer offers wisdom to NU students abroad

    May 7, 2014 by Emily Drewry

    Students participating in IPD’s Public Health and Development program spent a week traveling along the Garden Route, a scenic area of coastal South Africa. The week focused on the worldviews of health, and students visited various locales to get a thorough understanding of South African traditional medicine.

    IMG_2533Our first day on the Garden Route was spent in an area called George. At the Garden Route Botanical Gardens, we were joined by Richard, a traditional healer who works in the surrounding area.

    Traditional healing is one of the medicinal practices in South Africa. In 2008, a study estimated 190,000 traditional practitioners in the country, who treat a broad variety of medical ailments. As students of public health during our time in South Africa, it was essential for us to spend time investigating the utilization of traditional practices, in an attempt to create a more broad understanding of health systems.

    Richard took us through the central part of the garden, a manmade mound with a winding path that leads to the top. The hill is sectioned into triangular patches, each home to a different plant that Richard is intimately familiar with. The sections are separated by fences of wild garlic (Tulbaghia violacea). The plant is known for its immune stimulatory properties, he tells us. A member of the Alliaceae family, crushed wild garlic fights a wide variety of infections. Richard tells us of a time he experimented with the herb – when left on a surface for a few hours, the garlic killed off the ring of surrounding microbes within a few hours. At this, the explanation of the experiment ends – Richard has a way of telling stories that is definitive, yet somewhat mysterious. We never know the details of his stories, only the conclusive results. He speaks in an almost whisper, works tumbling out one after another in eloquently accented English.

    IMG_2537When we first met him, Richard introduced himself in few words, leaving breaks in his history as a healer but portraying an impressive resume nonetheless. Later, as we sit atop the mound on decorative benches, Richard tells us how he defines his role as a healer. “Healers must know what’s wrong with someone by looking into their eyes,” he tells us. His knowledge of African remedies has been passed down from generation to generation, and will continue to do so; his son sits by his side throughout our lecture, training to continue in his father’s footsteps on day.

    Indeed, Richard knows a lot about a lot of plants. Each triangle on the mound is described in varying detail. For some, we get just a name and are told to move on. Others we hear of various uses, anecdotes from Richard’s own practice, and even personal moments from Richard’s life. Such is the case when we reach the triangle where African Wormwood (Artemesia afra) grows. Richard is currently using the plant for chest pains, he tells us, utilizing the plant’s ability to eliminate infections of the chest. According to a pamphlet released by the South African Department of Agriculture, Forestry and Fisheries, “A afra is one of the medicinal plants used most widely and effectively by people of all cultures in South Africa.” In addition to the aforementioned use, the leaves of the plant can be used to stop nosebleeds or reduce the amount of sugar in someone’s blood.

    In this manner, Richard takes us around the mound, sharing the uses of the Buxus plant, Aloe barberae, the African potato, and many others. He deftly weaves together the practical uses of each herb with the wisdom of many years treating patients. Perhaps the most fascinating aspect of us, as students who have been raised in a world of modern medicine, is Richard’s explanations of how and why his traditional medicine is successful. He is well aware of his audience and our potential for skepticism when learning a new method of medicine. “I cannot say things and expect you to believe me without being scientific,” he says, “but only the healer needs to believe.” The success will follow, we’re told, if the healer is truly attuned to the needs of his patient.

    IMG_2542The utilization of the ancient wisdom passed down to him is only a shred of Richard’s wisdom, as we learned over the few hours we spent with him. Beyond his deep knowledge of medicinal plants in South Africa, he shared with us tidbits about his understanding of life as a whole. Along with the lectures from our professors about the integration of traditional beliefs with medicinal practices, Richard is the perfect individual to round out of lessons about African traditional medicine. It is hard not to be entranced by the way he moves around the garden, gathering leaves from plants here and there, learning an entirely new perspective on medicine in the course of an afternoon. Many of us were fascinated by Richard’s speech, but for different reasons. In many cases, the medical aspects of his livelihood were striking. For others, it was the lifestyle that Richard evoked that got them thinking. For me, it was a combination of both, along with a deep appreciation of his perspective on life.

    “Life is a terminal illness,” he told us. “You are born just so you can die. The question is what you do with your life.”

    Sources:

    http://www.palgrave-journals.com/jphp/journal/v32/n1s/full/jphp201126a.html

    http://www.nda.agric.za/docs/Brochures/ProGuiAfricanWormw.pdf

    http://www.plantzafrica.com/plantab/artemisafra.htm

    http://www.plantzafrica.com/planttuv/tulbaghviol.htm

  15. NU Students to be Community Health Volunteers for Erie Family Health Center

    May 6, 2014 by Chance Cim
    Erie Family Health Center's new location in Evanston/Skokie.

    Erie Family Health Center’s new location in Evanston/Skokie.

    Northwestern students are currently attending weekly training sessions for very exciting work that they will begin with Erie Family Health Center. The volunteers will be working closely with Erie Health Center staff in order to promote Erie health information and health care services.

    Erie Family Health Center delivers high-quality, culturally-sensitive, bilingual health care to more then 50,000 medical patients in Chicago. Communities served include Humboldt Park, Lincoln Square, North Lawndale, and Uptown. Among their central philosophies is the belief that healthcare is a right, not a privilege, and they will offer services regardless of a patient’s ability to pay. Seventy-nine percent of Erie’s patients are Hispanic and 31% are uninsured. [1]

    The organization is a Federally qualified health center (FQHC), meaning it is an organization under Section 330 of the Public Health Service Act. FQHCs receive special benefits including enhanced reimbursement from Medicare and Medicaid. They treat underserved areas, offer a sliding fee scale, and provide comprehensive health services. [2] These efforts are meant to shift medical efforts from treatment to prevention, reducing costs and improving overall community health. The goal of Erie Family Health Center, among other FQHCSs, is to create what is known as a “medical home.” This is a place where a patient’s records are kept confidential, care is coordinated, and a personal physician can establish an ongoing relationship with a patient.
    Screen shot 2014-05-06 at 12.39.24 PM
    The newest addition of Erie Family Health Center’s 12 locations is the Erie Evanston/Skokie Health Center. There is a large demand in the area for comprehensive, culturally-competent care. Skokie is one of the most culturally-diverse communities in the United States, with a high number of immigrants and refugees speaking 87 languages other than English. Many of the area’s low-income families have members that have multiple jobs and limited access to transportation. However, Erie Evanston/Skokie hopes to make family care accessible to such demographics, allowing each member of the family to receive quality health services including women’s health care, prenatal care, pediatric care, and behavioral health care.

    How are Northwestern students planning to help this organization? The plan is threefold:

    • Organize a database of related agencies. Students will create a database of service and community organizations in the Evanston/Skokie area in order to learn how services already present in the community relate to health care. Many of these community resources will be vital for referrals from Erie Evanston/Skokie. Likewise, these organizations will hopefully help spread the word of Erie’s services to their members.
    • Contact local organizations. Students will pair up and contact each of these organizations and use a questionnaire in order to collect this information. Cold calling will also be used to further add to the database.
    • Open up a health information desk at Skokie Public Library. In collaboration between Erie Evanston/Skokie Community Health Center, Skokie Public Library, Skokie Health Department, Evanston Health Department, Evanston Public Library and Northwestern University Global Health Studies, there are also plans to create a volunteer-run health information desk at Skokie Public Library. This resource could be vital for non-English-speaking populations who do not know where to access culturally-competent health services in their spoken language.

    For more information regarding NU Community Health Volunteers, please contact Michael Diamond (michael-diamond@northwestern.edu).

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