Month: May 2013

In 10 months since GHC Fellows started the work with the Rwandan Human Resources for Health (HRH) team as Analysts , over 100 American health management, medical, midwifery, and nursing faculty members from 23 different institutions have partnered with doctors, nurses, and students at 22 sites in Rwanda. The diligence and commitment of American and Rwandan faculty members has helped realize the goal of the HRH program to create a trained cadre of world-class doctors, health administrators, midwives, and nurses.

The program is now to become a presidential fellowship Kagame – Clinton in the near future and it will generally run 13 months beginning in July or August. The program is currently slated to run for  7 years, benefitting physicians in select subspecialties who may be eligible for 2-3 month contracts as Rotating Subspecialists.  The HRH Program team is now developing a comprehensive strategy to support Year I US Faculty as they leave Rwanda and Year II US Faculty as they start work with HRH. This strategy addresses many of the onboarding/transition challenges faced by Year I faculty and incorporates feedback and suggestions shared during the Mid-Year review also by launching the presidential fellowship in the years to come.

My Co-fellow and I are so excited as we are looking forward to see the fruitful and success of this program in the years ahead.

Greetings

 

“You’re going to butt heads with a lot of people in med school,” she said to me once Jonathan and I had finished our presentation to the residents taking an elective in community health.

She most certainly meant it in a positive way – praising our alternative take on what it means for people to keep themselves healthy and safe – and she seemed very like-minded so I wasn’t offended in the least, but it got me thinking.

I’m thinking about how I can translate this experience into other realms of life, and how I can do so in a way that causes me to “butt heads” with people in productive, not destructive, ways. One of my biggest concerns is thinking about how I’m going to incorporate my year with GHC and HIPS into what comes next. I’m so scared of losing it. How to explain to a class of overachieving med school students that some of the sagest advice I’ve ever received is not from my professors at college or some multi-paginated academic article, but from my clients who belong to one of the most marginalized and stigmatized populations in our society – injecting drug users? How to share that I’ve learned the most innovative and resourceful safety tactics from our endlessly wise sex working clients? How can I share these experiences in a compassionate, useful, non-exploitative way?

At our past few quarterly retreats, we’ve been talking about our personal story and how to make it accessible; how to have it bolster our message, our movement, our cause. This is all well and good, but when that cause is one that is already sensationalized or romanticized or misunderstood, I get nervous to post those personal stories (even if I’m mostly relaying my thoughts and responses) for fear of perpetuating common assumptions. Assumptions such as “Sex work IS demoralizing” or “Sex work IS empowering,” paint the landscape in extremes, when in reality for most of our clients it seems to be a grey area somewhere in between.

So that brings me back to wrestling with the notion of introducing the grey areas into diverse fields that are structured in black and white. How do we “butt heads” to promote curiosity and innovation, not to push people away and turn people off from our cause? Here is where HIPS’ harm reduction mentality of “meeting people where they’re at” comes in. Yes, I would love for everyone to hop on the harm reduction bandwagon and dole out tons of safer sex supplies, endless amounts of new needles, etc., but we have to realize that some people might be more receptive to a gentler introduction. Reading when forcefulness is useful versus when a softer approach may be best suited for a situation is a tough line to toe, but one that will undoubtedly lead to greater success in the future.

Until then, I’ll keep up the condom-doling and syringe exchanging. And gently, or forcefully, argue my case at every chance I get.

 

Children’s Health Fund kicks off every spring with a conference in Washington, D.C. that brings together the medical directors from the entire national network and staff members from CHF’s headquarters in New York City. This year, my co-fellow and I were lucky enough to tag along. The purpose of the meeting is to brief the medical directors, most of whom are doctors, on critical policy issues related to the health of medically underserved children in the U.S. After collaborative meetings with CHF’s policy team, the doctors head to Capitol Hill to serve as advocates.

The medical directors hold lobbying meetings with Members of Congress (or legislative aides) representing their states and the districts where their programs are located. In some cases, CHF-supported programs span multiple districts due to the mobile nature of their care. This year we focused on immigration reform’s potential impact on health insurance coverage for unauthorized immigrant children. Last month CHF released a white paper detailing why consistent coverage throughout childhood is extremely cost-effective as well as critical for preventive care and the diagnosis and treatment of chronic conditions.

During the Hill visits I had the chance to shadow the teams from the New York Children’s Health Project/South Bronx Health Center and the Harlem Children’s Health Project. All of our meetings took place with staff members rather than the Congresspeople themselves. Considering New York is one of four states (along with Massachusetts, Illinois, Washington) that provide coverage to children irrespective of immigration status and all of the offices we visited were Democratic, it was not critical to explain our perspective on why consistent coverage is necessary. Instead, the meetings allowed providers to speak as powerful witnesses to the perils of letting children’s health fall through the cracks. It’s difficult to disagree with the argument that childhood can’t be repeated and that kids can’t wait upwards of five years for medical coverage. Still, as we’d expected, staffers reflected on the political hurdles facing comprehensive immigration reform and the compromises it might take to get there.

Despite leaving slightly discouraged by this atmosphere on the Hill and the general politicization of health coverage for children, the conference fascinated me. While spending each day busily coordinating programs for patients in the Bronx it is easy to lose sight of the bigger picture of CHF’s policy work. In D.C. I observed the marriage between clinical practice and advocacy and grasped how firsthand accounts like those of the doctors provide an invaluable context for lawmakers. As I near the end of my fellowship, this kind of big-picture national advocacy interests me more and more.  I am fortunate to have ended up with an organization that holds its nationwide programs to incredibly high standards while allowing clinicians themselves to effect change.

 

When I started working with the Monitoring and Evaluation Department at Partner’s In Health/Inshuti Mu Buzima, I asked myself how M&E can contribute to providing a preferential option for the poor in health care, PIH’s mission.

I took time to learn more about M&E and reflect on this question. I found that an easy way to think of it is by using a metaphor — a tree. If PIH is a tree trunk, M&E is its roots, other programs are its branches, and the impact that PIH is making are the leaves and flowers that make our society healthy.

This year, I was happy to attend the “International PIH Monitoring, Evaluation and Quality Summit” held on Feb. 22-25, 2013, in Rwinkwavu, Rwanda, where more than 20 members of PIH’s Monitoring, Evaluation, and Quality team from six countries gathered to share insights on how to improve and use.

 

I was very excited to learn from colleagues from all over the world, and it was a good opportunity to share the big achievements during my fellowship year.

 

I had to present one of the main projects of our Monitoring and Evaluation Program, our quarterly Data Quality Assessments at health facilities.  It was a great opportunity to share my experiences with the team.  With my co fellow’s help in preparing the presentation and practicing before the summit, my presentation was successful!

 

I really love this phrase often used in the GHC community, “Once a fellow always a fellow,” because even when we are done with our fellowship year, we will always be connected to this great community. And we will also always be co fellows.  I’m grateful to Global Health Corps for this opportunity, and the great model of pairing people with different backgrounds to help each other grow professionally.

 

A supply chain is a network of people and processes that will cater to the end user, whom in my case are patients in resource poor settings. I have procured critical components for aircraft and engine systems, to improving the lead time performance of solar modules for retail & municipal entities. When I arrived to my village in Rwinkwavu, Rwanda and I was given a tour of the district hospitals I would be supporting, I immediately knew I was in for an entirely different experience.  These are no longer widgets that I am procuring that will go on the roof of a building, but critical health commodities that will affect human lives.  My work has not only been incredibly challenging, but also very fulfilling. I have learned a lot about supply chain challenges on a global scale and witnessed the effects of not having the right products at the right place at the right time.

The Partners In Health Pharmacy Supply Chain Team had the pleasure of attending the International Association of Public Health Logistician’s (IAPHL) fifth Global Health Supply Chain Summit in Kigali, Rwanda. This is the first time the summit has ever been held in Africa and there were over a 100 participants from over 33 countries. The purpose of the summit was to foster interaction between implementer and academics to build knowledge and learning. Partners In Health sponsored the attendance of three head district pharmacists from Kirehe, Kayonza and Butaro districts.

We all got a chance to engage in conversations with many other participants from all over the world. We shared supply chain challenges from the field and collaborated with academics who also presented on their various research theories and ideas in regards to supply chain. Three key topics were discussed during the scheduled workshop sessions— 1) understanding and managing risk in the supply chain, 2) taking supply chain innovations to scale, and 3) bench-marking supply chain performance.

A huge highlight during the conference was meeting Dr. Noel Watson, founder of OPS MEND. He met with the PIH Pharmacy Team for a full two hours and discussed strategies on implementing performance metrics. He stressed the importance of having key performance indicators especially for those of us working in hospitals to measure how well we are doing as a team. It was incredibly refreshing to meet him and others from around the world who share my passion for process improvement and supply chain. In fact, as a result of the session, I am proud to say that alongside my manager and other teammates, we were able to draft our own key performance indicators (KPI’s) for what we would like to measure and see improve in our global supply chain at Partner’s in Health.

Strategic supply chain activities are often times put on the back-burner, but in order to deliver high quality health care to patients, it is important that we continue to educate ourselves and others on how critical it is to strengthen health systems by developing sustainable supply chain strategies. Having the right products at the right time and at a competitive price, especially for our cancer medications and medical equipment, will ensure that we are giving patients in rural areas the best access to health care. I am very happy and excited to be on this mission to transform global health, one patient at a time. I look forward to continue to sharpen my skills as a supply chain professional so I can continue to make that possible.

World Water Day is held annually on March 22nd to recognize the importance of water in our world and advocate for the sustainable management of water resources. SALTWASH (Saving lives through water sanitation and hygiene) in Nyaruguru district is a project of Health Poverty Action. We celebrated World Water Day at Raranzige cell, Rusenge sector. The theme of the day was “Let’s join hands to promote construction and repairing of springs in order to access clean water.”

Community members watching and listening to messages and skits from”urunana” soap opera on hygiene and sanitation.

SALTWASH works with vulnerable communities in seven sectors of Nyaruguru district to address unique water challenges in locally appropriate and innovative ways. With the help of members, we plan to start construction of water springs so that the community may have access to clean water.

On this particular day, we had the opportunity to teach the importance of managing water resources. When there is no proper management of water resources, diseases may arise, such as diarrhea, bilharzia, cholera, dysentery, typhoid fever, intestinal worms and other waterborne diseases. These diseases disable and debilitate victims, keeping children out of school and preventing parents from working. We should all join hands to fight these diseases because of the horrific impact they have on poor communities, especially children, since they can be prevented.

These lessons were taught through theatre performances by a famous Rwanda radio soap, “urunana,” who provides teachings twice a week on radio Rwanda and BBC focused on sexual and reproductive health. The show’s actors attracted so many people, as most of them were curious to see the actors that they hear on radio, with their own eyes. There was so much excitement, especially among youth. Most of them wanted to stand in front so that they can get a good sight and clear view of the theaters. There was also music, which attracted people from all over the neighborhood.

”Urunana” performig a skit on hygiene and sanitation.

One of the skits was about a family in the village and their daughter. The family would send their daughter to fetch water and she would drink the dirty water from rivers and lakes. The family never bothered to boil drinking water and also stored the water in dirty containers. One day, the daughter became sick. She started vommitting, felt weak, and could not go to school. The parents thought that she was bewitched by her neighbors and took her to a traditional healer. He gave them some herbs and told them that she was bewitched by neighbors who did not like them. After taking the herbs, she became even more sick each day. One morning, a community health worker was visiting homes in villages and came to their home. She found the daughter was very sick and in pain. She quickly told the mother that they should take her to the nearby health center, but she refused saying that she was bewitched. The commnuity health worker insisted and they finally took her to the health center. She was then transferred to the hospital because her pain was so severe. She was suffering from typhoid fever and was admitted to the hospital for some days and later recovered. The community health worker taught the family about the bad effects of drinking dirty water. With continued follow up, the family learned how to boil and store drinking water safely.

Me with young people watching the famous ”urunna”   performing a skit.                       

SALTWASH manager addressing the community members.

The official event in Nyaruguru ended with asking the community members the lessons they learned from the speeches and skits played by ‘’urunana’ soap opera. Many people answered them correctly. Those who answered all the questions well were given presents of different T-shirts of SALTWASH projects and they were motivated. Different members said they will try to put into practice what they learned that day such as washing hands with soap and clean water before eating, before preparing meals, before breast feeding for nursing mothers, after visiting the toilet and after cleaning babies. They also promised to boil drinking water and to store it in clean containers to avoid waterborne diseases. The children and young people also promised tell what they learned to their parents. The adults promised to teach their neighbors and friends about hygiene and sanitation so that people could change their behaviours in different villages. The event ended by sharing drinks and snacks by all the community members, invited guests and SALTWASH staff.

“Imagine if blood spilled by women in childbirth, unpaid labor & violence against them collectively mattered like war.” On May 3^rd , ‘Women Under Siege’ retweeted this post written by a woman named Lauren Wolfe; she is a perfect stranger to me, but these 140 characters shook me. Maybe, I thought, we were looking at gender inequity in the wrong framework. Maybe if we looked at it in terms of tactical strategy, the battles waged by and against women every day would gain the attention and resources that they need.

The numbers are all there. Globally, 287,000 maternal deaths occurred in 2010.1 Between 15-71% of women aged 15-49 (depending on where they lived) report physical and/or sexual abuse by an intimate partner at least some point in their lives.2 And between several percent to over 59% of women report experiencing some form of physical violence at least once in their lives.3 These statistics are only more dramatic in situations of conflict. Modern slavery- including forced sexual labor and human trafficking- disproportionately affects millions of women and girls, and has reached a scale never seen before in the history of the modern world. Child marriage persists, subjugating young women to a life externally pre-determined by their 15^th birthday (11% of women between 20-24 were married before reaching the age of 15.2).4

Clearly, the barriers to health and opportunity are enormous and wide-spread. I won’t compare this suffering to that induced by our world wars, but it is comparable and deserves as much attention as our military casualties. Then why doesn’t it garner the same attention? The same moral imperative? The same urgency as other instances of violence?

Perhaps it’s because those horrific statistics seem far off, affecting distant cultures plagued by cultural backwardness and a lack of development. And they’re just data points, not our community members, not our mothers or sisters. So let’s look more closely at the United States’ pristine record.

There are over 207,000 instances of sexual assault and rape committed every year in the United States. That means that by the time you finish reading this post, more than two people will have been sexually assaulted in the United States.5 In 2011, women still only earned 77 cents for every 1 dollar men earn in the United States, perpetuating a gender wage gap of 23 percent.6 Slavery exists in the United States, too: according to the FBI, 83% of sex trafficking victims (including the 293,000 American children at risk) in the US are American citizens.7 In 2010, 12.7 women died in child birth in the United States out of every 100,000 live births, and African-American women were 3.2 times more likely to die due to maternal complications than white women (34.8 deaths per 100,000 live births).8 In fact, the US maternal mortality rate has DOUBLED in the past 25 years, despite exorbitant health care spending.8

These are not ‘third world’ problems.

At the same time that these trends of gender inequity are perpetuated within our society, ‘women’s empowerment’ ideology has gained momentum. Short of calling it a fad, I do want to point to the importance of celebrity attention paid to gender discrimination. Warren Buffett, the United States’ resident financial genius, brought recent attention to the importance of investing in women; in his recent Fortune Magazine article, he embodies the practical economic approach and calls women ‘the key to America’s prosperity’.  While Sheryl Sandberg, COO of Facebook, calls on women to ‘Lean In’; I have not yet read Ms. Sandberg’s book, but it has certainly captured headlines, calling on the need for more women in boardrooms.

So while gender equity has started to gain more attention and as health care expenditure catches up to defense spending, are we seeing any real change? It’s hard to say. While I believe that any attention paid to the needs of women is important, these ‘calls to action’ might dangerously skim the surface.

I hope that powerful people calling on their powerful friends to engage in a discussion will continue to heighten awareness. However, to generate sustainable change, we have to consider the roots of the disparities, we have to use more hard-hitting strategy. In other words, while Ms. Sandberg’s plea might transform the dynamic for the elite edges of society, we have to make sure that all women have the same opportunity to succeed. To put it simply, women must first be able to see the table before they can sit at it.

As gender equity begins to gain momentum in global conversation and as a domestic policy issue, let’s not forget the graphic impact of this disparity or the enormity of the structural violence. While the percentage of female board members may be a reflection of the larger shift in cultural norms, and while it’s a critical change, we must also consider the basic human rights of all women to realize their potential: a right to health and freedom of equal opportunity (whether that be educational, professional, etc.). I don’t advocate ‘fighting’ because that implies violence, but I believe that we must change the way we talk about women’s rights. Gender-based violence and discrimination is unacceptable and should be considered with the same urgent attention we pay security threats. Let’s #changethenorm.

¹ UNFPA
² WHO
³ UN Statistical Division
⁴ UNICEF
⁵ RAINN
⁶ Institute for Women’s Policy Research
⁷ Think Progress
⁸ Huffington Post

 

On the first day of the Quarter Three meeting in Uganda, we (fellows) were asked to dream for a minute and share our dreams beginning with perhaps the most consequential and historical line of all time– I have a dream…by Martin Luther King Jr.

We all had and shared big dreams. I am an environmentalist at heart and I dream of a world where humanity respects the environment we live in enough to give it a chance to nourish us.

“I have a dream that I am a part of something big that inspires goodness and the need for humanity to actively participate in creating a world where we not only respect each other but also respect the environment we live in and give it a chance to nourish us,” I shared with other fellows.

Five days later when everyone was settled back at their placement sites and as the world celebrated International Labor Day; parts of Kasese district – where I am placed – were experiencing a heavy downpour.

It was different from usual. The banks of Rivers Nyamwamba and Mubuku burst and ferociously carried with them downstream rocks bigger than cars, uprooted trees and everything else that stood in their way.

Downstream, the old mine town of Kilembe barely survived. The community was torn to pieces. People’s houses and bridges that connected families were washed away. Parts of the historical Kilembe Mines were destroyed too. Kilembe hospital was flooded and parts of it destroyed.

So far eight people have been confirmed dead, 3, 500 people were displaced, 1,000 acres of gardens destroyed and immeasurable amounts of property and livestock destroyed.

It is hard to imagine the extent of the damage until you have been on location. What remains of the old mine town are broken bridges, destroyed houses, uprooted trees, fallen electricity poles and wires, sand, hundreds of big rocks littered everywhere and of course sad faces of people devastated by the aftermath of the downpour.

Like me, some of them are still in disbelief.  As I was walked through the destruction a day later, I could not stop wondering about what happened in connection to how we (humans) treat the environment we live in. And how largely because of our actions, Mother Nature reacts the best way she knows how – most times harshly.

Until two days ago, I did not know that the now destroyed mine town of Kilembe was built on a river-path. One of the old men I spoke to as I walked through the rubble said that sad as it may seem, humans were at fault. He said that the rivers were simply reclaiming their rightful territory.

One of my Idols, the late Professor Wangari Maathai once said that Mother Nature can be unforgiving in her revenge and times have proven this. However, even with this knowledge, it is sad to note that a number of survivors are considering resettling back in Kilembe. And government has no plans to resettle people out of the rivers’ natural paths.

Quite often in pursuit of happiness and success, we (human beings) end up destroying the very things that keep us alive especially the environment. We strip so much from it and yet give back so little to allow it to nourish us.

I am a part of ACODEV’s team that is working together with government of Uganda and other national and international NGOs to mitigate the effects of the floods.  Of course top of the agenda is addressing the immediate needs of the displaced including provision of clean water, blankets, food, medicines, counseling, health education etc.

And as we look to rebuilding the community of Kilembe, it is my dream that the long term settlement plans are in harmony with Mother Nature. And as a documentations and communications fellow, I am utilizing my expertise to ensure that history does not repeat itself in Kilembe.