Category: GHC Staff

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GHC Fellows and Alumni GHC Staff

The Potential Harms in Helping Others

Several weeks ago, my driver’s license fell out of my pocket during a rainy outreach shift with HIPS, a harm reduction organization that works with injection drug users, sex workers, and their communities in Washington, D.C.  I assumed that it was lost forever to the storm drains of D.C., until I received a call from my father stating that someone had found my license and sent it to his home with the following note:

Initially, I felt deeply validated by this note. Upon further reflection, I realized that perhaps a more appropriate response would have been to thank this community member for welcoming me into their neighborhood. This incident led me to revisit an internal dialogue I have taken up from time to time while engaging in direct service. In our attempts to “help others”  as service providers, can we fall into patterns that do more to make us feel like we’re making a difference, rather than create paths to holistic health and wellbeing for those who lack access to the resources, power, and privileges we already possess?

In posing this question, I can’t help but think about critiques of voluntourism or the Teach For America program. Such programs often emphasize what an individual from outside a given community does for marginalized individuals without recognizing leadership and innovation already present within that space. In a 2012 article for The Atlantic entitled “The White-Savior Industrial Complex” Teju Cole writes, “There is much more to doing good work than “making a difference.”… There is the idea that those who are being helped ought to be consulted over the matters that concern them.” Cole’s words highlight the power dynamics intrinsic to many service provider- client relationships. Service providers often determine the who, what, where, when, and how of an encounter without incorporating the goals or desires of a client. When service provision occurs entirely on the provider’s terms, unforeseen boundaries to access can arise and providers can become gatekeepers despite their best intentions.

With this in mind, I believe it is time to start re-imagining service provision. Instead of treating service provision like an exchange between two entities where one side possesses what the other needs, we can incorporate models that invite collective participation and honor the decision-making processes of everyone involved.

Working at HIPS has offered the opportunity to see new ways of approaching service provision that destabilize the provider-client status quo. One of the ways HIPS does this is by having outreach workers ask people what they “want,” rather than what they “need.” This may seem like a small linguistic tweak, but it can have profound implications for how we think about service provision. Using a term like “need” reinforces a one-way power exchange between a provider and a client, where the client relies on the provider for something they cannot acquire on their own. In this case, the validation one might feel from helping someone “in need,” might also produce feelings of powerlessness or shame for the individual on the other side of that equation. Employing the term “want” acknowledges and values someone’s personal decision-making, shifting control over the outcomes of a service provision encounter from the provider to the individual seeking services. Wanting or desiring something is a universal experience, and using language that evokes this truth creates space to uphold the humanity of both individuals involved in a service provision encounter.

HIPS also encourages its staff and volunteer base to interrogate their own understandings of health and safety as they pertain to the lives of the people who utilize HIPS’ services. Conceptions of health and safety can be extremely situational; police presence might seem to enhance public safety in one neighborhood, but be considered a threat to one’s everyday existence in another. Using heroin might not seem like a health maintenance practice for one individual, but it could be an effective option for someone feeling extremely sick due to withdrawal. While it might feel uncomfortable to hear that someone is engaging in activities that run contrary to what we have been taught constitutes healthy behavior, I would argue that causing discomfort around or alienation from services for a client who feels that their choices are being judged or deemed harmful is far worse. Leaning into the discomfort of difficult conversations has pushed me to be more attentive and creative when it comes to identifying resources and strategies that might work for someone who has different goals and lived experiences than myself.

One of the most valuable models for service provision I’ve seen at HIPS has been its peer educator and secondary syringe exchange programs. Rather than solely hire people with professional public health/social work backgrounds, HIPS strives to include both current and former drug users and sex workers on its staff and volunteer roster. These individuals use their unique skill sets and community knowledge to perform a variety of functions at HIPS, such as running support groups and distributing syringes to people who don’t feel comfortable visiting the mobile services van or office. Instead of viewing service providers as “qualified” by virtue of their education or professional experiences, a peer model acknowledges the value of working with someone who perhaps has shared or similar experiences to a client, offering new opportunities to break down entrenched power dynamics in favor of a more mutual and participatory exchange.

There is nothing wrong with feeling affirmed by working in service provision.  However, the intent of this post it to emphasize the importance of thinking critically about how privilege and power function to lift one person in a service provision encounter and not the other, and then identify ways to mitigate the subsequent deleterious effects. I am very grateful that I’ve had the opportunity to start working through my own validation hang-ups and service provision faux-pas this year, and I look forward to continuing this reflective process long after my Global Health Corps fellowship comes to a close.

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GHC Fellows and Alumni GHC Staff Uncategorized

The GHC Secret Family Recipe

Since I know you have been salivating in anticipation of enjoying your very own GHC experience, I have taken it upon myself to spill the beans about this famous, secret family recipe. For too long, the proud GHC family has developed young change makers in the global health field without revealing the special and loving care they put into the process. As one of the newest members of the GHC household, I recognize that times are changing and we can finally share this scrumptious, life-changing recipe with trustworthy folks outside the family (without fear of other fellowship relatives stealing our tricks of the trade). ***
Scrumptious Change-Maker Topped With Dreams & Ambition
Prep Time: 2-3 weeks (2 weeks training at Yale University; allow 1 week for transition into placement organization)
Cooking Time: 12 months (divided into quarters)
Serving Size: 1 Global Health Change-Maker
Ingredients:
– 1 young, ambitious dreamer (preferably aged for 20 – 30 years)
– Dreams marinated in hope for health equity (increase number of dreams to preferred taste)
– Leadership potential without preference for leadership style (each type will change the flavor slightly)
– A dash of a bachelor’s degree to add mild spice
– Fluency in English to ensure a smooth transition, and help the fellow rise
Cooking Utensils:
– 1 Placement Organization for baking
– 6-month and 12-month fellowship goals’ pans to create structure during baking
– Still Harbor sessions to ensure depth of flavor
– 1 Country Program Manager (per country placement)
– 4 quarterly retreats to allow the ingredients to shift into place and reflect
– 2 public engagement events to flash fry the fellows
– 4 blog posts for plating
– 1 community engagement event (to encourage others to try the recipe)
– 1 large alumni network sprinkled on top
Instructions:
1. Combine all ingredients into a two week training at Yale University (similar to a stand mixer used in bakeries) and stir vigorously. Mold the mixture with a passion for innovation to create a more savory product. Carefully distribute the contents into the placement organization. Allow for transition period with the previous fellows to knead thoroughly.
2. Once your mixture has a Play-Doh-like consistency (i.e. firm yet malleable), set it aside for the first quarter to rise in the 6-month goals pan in the placement organization. (It is very important to use this pan to ensure even cooking and a handsome presentation at the end of baking.) Ensure your mixture can adhere to the co-fellow mixture to ensure smooth rising.
3. Check your dough at the end of the first quarter to see if it has risen. If your dough is not rising, add a check-in with either the Country Program Manager, or Still Harbor, at the first quarter retreat. Provide necessary assistance as the dough continues to rise through the end of the second quarter.
4. At the end of the second quarter, remove the pan from the placement organization for the second quarter retreat and allow the mixture to cool down and sift into place. Sprinkle a Still Harbor session on top (to taste) to enhance the aroma. (A personal note from the chef: I find the Still Harbor session really makes this meal pleasing to the palette.) After the retreat, pour the mixture into the 12-months goal pan to maintain the structure of the final product.
5. Repeat this process two more times, and remove the loaf from the pan during the 3rd quarter retreat to flash fry the fellow in two public engagement events. These public engagement events are required to ensure a crunchy exterior.
6. After pulling the fellow loaf from the fourth annual quarter and allowing it to rest at the fourth retreat, use 4 blog posts to present the fellow as the scrumptious delight that it is. Use the community engagement event to coordinate with other fully-cooked fellows for a balanced, wholesome meal.
7. Lastly, sprinkle a few alumni networking events and a strong GHC community on top to complete your package.
Voila! You have now made your very own GHC fellow – a scrumptious change-maker with realized ambitions and dreams! I encourage you to leave comments below with recommendations and changes you make to improve this recipe for other users.
IMPORTANT: When preparing the fellow, it is best to mix, knead, bake, and plate them beside their co-fellow since this will allow them rise and bake more quickly. The result is a zesty finishing taste that enhances the whole experience.
Optional: This recipe is an intensive process, and is best cooked collaboratively with help from the GHC staff/team. If you have any questions about this recipe, please contact the GHC staff through the following website: https://ghcorps.org/connect/contact-us/.
***If it is found out that you did share our secret recipe with other fellowship organizations, please remember that you will be held accountable in the court of law by our army of lawyers on standby.

 

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GHC Fellows and Alumni GHC Staff

What Drives Me? My Family Curse

Kerala, India in the 1920s. My grandmother was giving birth in what I can only imagine was a hot and unventilated birthing room with low-skilled attendants performing her blood transfusion. That day doomed our family.

Fast forward 65 years to the mid-1980s. My father, a pediatrician working in Saudi Arabia, was the youngest of seven siblings. He was feeling hopeless since he could not understand why two of his brothers had succumbed to liver disease and cirrhosis within years of each other – both untimely deaths. Nevertheless, it prompted my dad to collect blood samples from his siblings to find out what exactly was happening. Subsequent blood testing found that five of the seven children had Hepatitis B, including my dad. I was a baby when this revelation became known and of course did not grasp how much this worry paralyzed the family, even years later.

It was not until my third and fourth uncles died when I was a teenager that I became to take notice in the worry that exuded out of my mother. Death had suddenly become so prevalent in my family. My father completely stopped drinking alcohol, became a yogi, and exercised 5 times a week. Every night after dinner like clockwork, he would take his anti-viral medication and drink a glass of water.

On September 19, 2011, I received the fateful news from India. My dad had been diagnosed with stage IV liver cancer (the tumor was 10 cm in diameter) and given 3-4 months to live. Grief and panic is all that I remember of that day. It was decided that he would get treatment in the U.S. Several harrowing months later, my dad was sent home from Baylor Medical Center with 90% of his tumor annihilated and stacks of medical bills in his luggage. It was an (expensive) miracle! In time, my father resumed work again as Medical Director at KIMS Hospital in Kochi. He also began his intense fitness regimen, citing how much he had missed the track. We were all convinced that he would live a long life.

In September of 2013, my father began to experience the similar symptoms of bloating and uneasiness that he felt prior to his initial diagnosis. The cancer had metastasized. The return to Dallas was not as hopeful and neither were his doctors. I will never forget the day he died in the very hospital he gave much of his cancer-ridden life to at KIMS; I was standing with my mother next to him holding his hands and whispering how much I love him.

Despite the anguish I felt the day my father was diagnosed and every day thereafter, I realize why I am in this fight to prevent disease and promote quality of life.  While there is no tangible evidence of it, we are convinced the virus infiltrated my grandmother during the blood transfusion which was likely due to the use of unsterilized medical equipment. Granted, this was rural India in the 1920s but even today, millions of people, especially in low- and middle-income countries, are dying due to preventable death – and not just from medical error. I am in public health for this reason. We owe it to ourselves and our loved ones to make health care safe, accessible and affordable to everyone.

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Harlem: Social Determinants of Health, Asthma and the American Dream

Harlem
By Langston Hughes
What happens to a dream deferred?
Does it dry up
like a raisin in the sun?
Or fester like a sore—
And then run?
Does it stink like rotten meat?
Or crust and sugar over—
like a syrupy sweet?
Maybe it just sags
like a heavy load.
Or does it explode?

Langston Hughes, arguably the best-known poet of the Harlem renaissance and important American literary figure used to live on my street.

Most days as I walk to work I pass his house; see the bronze plaque denoting its cultural importance and I consider his poem ‘Harlem,’ which I first came across as a 17-year-old English student.

The poem, which explores the possible consequences of allowing a dream to go unfulfilled, is believed by many to be Hughes’ response to the long-postponed and frustrated dream of liberty, social equality and opportunity (in short, the American Dream) for African-Americans. It is this dream I think about during my commute.

The poem offers an insight into Hughes’ mindset in the period leading to the Civil Rights Movement. Hughes uses similes to symbolize what could happen if this dream is constantly deferred. If it dries up, the suggestion is that it loses vitality and sustenance, the words ‘fester’ and ‘stink’ bring to mind resentment and contempt, sagging ‘like a heavy load’ implies giving up or accepting defeat and finally there are connotations of violence and unrest if the dream explodes.

Although since 1951 when the poem was published, the Civil Rights Movement effectively ended the legal basis for racial discrimination in the United States and secured protection of the citizenship rights enumerated in the constitution, disparities remain. The national ethos that everyone should have the opportunity for upward social mobility achieved through hard work, an ethos heavily rooted in the Declaration of Independence’s proclamation that ‘all men are created equal’ with the right to ‘life, liberty and the pursuit of happiness’ regardless of social class or circumstances of birth is deferred still.

What is liberty in this statement? Is it the state of being free within a society? Or being free from oppressive restrictions imposed by authority? Henry Ward Beecher, the social reformer and abolitionist once said that “Liberty is the soul’s right to breathe, and when it cannot take a long breath, laws are girdled too tight. Without liberty man is in a syncope”[1]. Let us take these words at face value – everyone has the right to breathe, but what happens when the air we breathe is tainted?

Harlem’s air is tainted. Although air pollution is a serious concern across the entire city of New York, Harlem is disproportionately affected.

The placement of industrial and transportation sites that cause air pollution demonstrates a long term, deep-rooted injustice that is undermining the health of Harlem residents, particularly children.

This injustice constitutes a form of discrimination, where differential enforcement of environmental rules and regulations (intentional or otherwise) disproportionately affects minority communities. Environmental justice campaigner Robert Bullard writes that low-income communities, particularly Hispanic and African-Americans, bear greater environmental health risks in their homes, workplaces and schools than society at large. When this is coupled with the exclusion of those community members from public and private boards, commissions and regulatory bodies, these communities may face greater exposure to pollution with fewer means to fight and avoid it[2].

To put this in context, there are at least 18 major air-polluting sites on the island of Manhattan, 13 are based in in the northern half and nine are in Harlem. Of these, six are diesel bus depots, which are near facilities like schools and hospitals.

What is the effect of these air polluting sites? To sum it up: asthma. Harlem bears an excessive burden of the city’s air pollution and its children, predominantly African American and Hispanic, pay with increased levels of asthma.

This sign reads: “Don’t leave your engine running: Asthma-free school zone”

Although asthma can be caused by many sources, diesel exhaust fumes pose the greatest threat. Bus depots produce a vast amount of pollution from the increased concentration of smog when buses enter to undergo cleaning and maintenance and thus raise the risk of asthma in the surrounding community. The closer people live to these pollution sources, the likelihood of developing asthma increases and children are most at risk.

Across New York City over 200,000 children suffer from this affliction, however more than 20% of Harlem’s children have asthma compared with 8% in the rest of city. Asthma rates in Harlem are five times the national average and asthma is the main reason children are hospitalized. Death due to asthma is more likely in the South Bronx and Harlem than almost anywhere else in the United States [3].

To relate this to Langston Hughes and the American Dream, imagine pursuing life, liberty and happiness when you’re wheezing and short of breath.

These both comprise the long term health effects of asthma, as well as: a greater risk of developing obesity due to inactivity and scarring of the airways, which also causes daily chest tightness and fatigue. All of which become progressively more serious later in life and could affect an individual’s ability to study, work and live. If you are from a low-income background, breaking the revolving cycle of poverty is hard enough without a chronic disease caused and exacerbated by breathing the air in your own neighborhood.

Asthma is also the primary reason children miss school in Harlem. Aside from health effects, when a child misses school only 10% of the time, their grades drop by 67%. When grades drop, opportunities to continue further education may lessen and there may be a domino effect reducing access to well-paying jobs and subsequent opportunities for prosperity.

Harlem’s children are being failed. Their dream is being deferred. Their childhood is one characterized by shortness of breath and trips to the emergency room becoming a normal part of growing up. Despite promissory notes of an indiscriminate society, the disparity in something as fundamental as breathable air reveals an incredibly unjust social determinant of health.

It doesn’t have to be this way. Asthma is a manageable disease. To reduce this disparity, government policymakers, health professionals, researchers, and community groups need to work together.

As the Programs and Evaluation fellow at Single Stop I work with a number of partner sites, one of which, Harlem Children’s Zone, started an asthma initiative known as A.I.R Harlem to help families cope with asthma and advocate for clean air.

The initiative works by providing home visits from community health workers who create custom asthma action plans. They also educate communities to the risk and symptoms in school-based programs tailored for children, parents and educators. In this manner the initiative increases knowledge of asthma which aims to lessen the effects, thereby reducing emergency room visits and missed days of school.

Importantly the initiative also provides essential legal support for families requiring counsel in the face of significant housing problems and carries out important environmental mitigation advocating for healthier living environments.

It is through this combined approach of education, personalized medical care and legal advocacy that Harlem can end its asthma crisis and help generations of its children pursue their dreams.

 

For more information about asthma in Harlem or environmental discrimination, please see the following websites:

http://www.harlemasthma.org/

http://www.cdc.gov/nchs/data/series/sr_10/sr10_258.pdf

http://www.rootsofhealthinequity.org/polluting-sites-in-manhattan.php

http://www.tandfonline.com/doi/abs/10.1080/13549839908725577#.VOd6RPnF_as

[1] Thank you Matt Damon in ‘Good Will Hunting’

[2] Bullard, Robert D. (1999). “Dismantling Environmental Racism in the USA“. Local Environment 4: 5.

[3] www.harlemasthma.org

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African Development and Public Health

A month ago, I attended the African Development Conference hosted by the Harvard Kennedy School of Policy. The conference’s theme was, “Looking South – Moving Forward – Fostering Development collaboration within the Global South.” The main emphasis throughout the conference was private public partnerships, talent and resources for development within the African continent. The conference included panels on ICT, logistics, health, personal narratives, legal labyrinths, oil and mining. As a result attendees were from diverse professional backgrounds and seemed to share a common passion for development within Africa. The conference created a platform and environment that enabled discussions and partnership opportunities across sectors and within Africa. Intra-regional trade in Africa is estimated to be between 10% and 12% which is much lower than other continents, but is critical to African development.

Sitting in the first session of the conference it dawned on me that, over the past ten months I had been focusing entirely on global health issues somewhat in isolation of other ‘market forces’. Attending the conference gave me a different perspective on a possible way forward to achieve better health outcomes for the future of health in African countries in a sustainable and cost effective way. My perspective till then had been limited to activities within the global health space excluding other factors in the economy and environment which have a direct impact on health and healthcare.

I was also able to reflect on other sectors that have collaborated and what gains have come from such thought processes within the African context. An example that quickly came to mind was how mobile technology revolutionized availability of banking services in Africa. Africa is the second largest mobile technology market after Asia, with an average of 5% annual growth in mobile technology use. The telecommunications sector tapped into this growth to resolve challenges around traditional banking. This resulted in mobile banking hosted by various telecommunication network providers for example, Zimbabwe uses  Ecocash hosted by Econet Wireless, whilst, South Africa, Tanzania and Kenya use M-Pesa hosted by Vodafone among many other service providers within the respective countries and the African continent.

Mobile banking has resolved challenges that an individual living in a resource limited settings could possibly face such as, transport fees to travel to the bank, high monthly bank charges and the availability of services limited to specific time periods. However, there is a striking similarity between challenges in the financial sector and the health care sector in Africa. I believe there are many other similarities in challenges and possibly solutions between the health sector and other sectors. For instance both logistics companies and healthcare organizations are affected in areas with poor roads. Logistics companies may fail to meet delivery deadlines and damage cargo on poor roads resulting in less profitability. On the other hand the healthcare provider may not be able to get medications delivered on time or blood samples transported to the nearest clinic on time, resulting in delayed treatment, which unfortunately in some cases may end in the demise of a patient.

I feel the health care sector in Africa is still catching up on harnessing the inventions of many other sectors including mobile technology. However, my hope for the future is that as development within Africa progresses across the sectors, main actors within healthcare will be able to take strategic steps to identify opportunities for partnership with others. And that the healthcare sector may utilize partnerships for the attainment of access to health and design long-term sustainable solutions to public health issues that communities face.

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Health policy activism

Policy activism is now gradually appearing in the public health lexicon. Though still embryonic in professional practice, there appears to be a modest conceptual foundation that supports many of today’s public health policies and programs designed for expansive community engagement. Like many newly minted Masters in Public Health (MPH), I was also lost when I first heard the concept and only through unlearning and re-learning did I get a hold of it as I walked through the exciting field of community health. I have a feeling too that global health work may be fertile ground for health policy activism in the near future.

Boston is known for its progressive policies and the level of activism in the community may have something to do with it. In this beautiful port city, policy activism goes beyond the deafening noise of angry protesters but instead is a distillery of ideas that shapes voices into doable policies. At the heart of it are the enduring public health professionals who are collaboratively working with neighborhoods and political leaders. But what really constitutes health policy activism? Is it just about people, voices, action, violence, anger or consensus?

Sometimes but not always I like to think like a nerd and so maybe digressing a little to give way for a bit of gedankenexperiment (thought experiment) will be helpful in examining health policy activism in its granular form. As I previously learnt and lived, activism had fascinated me as a student who was schooled in a progressive left-leaning liberal environment. But we change our views and we should not be afraid of challenging our limitations while we experience discovery learning and professional growth. As I am maturing with wisdom, I take activism as a by-product of increased understanding that our passive emotions (or passions) may become active. For sure this adds to the confusion! To carry this line of argument one step further, passions exist when we are in disagreement primarily due to different interpretations of reality. Consider working in a policy world, like a fractural field, where dynamic interactions of people’s interests tend to have disagreements and through open dialogue we arrive to a consensus. In Boston, town hall meetings are essential in enabling passageways for our passions to transform into knowledge-based policy activism. On most occasions, discussions are evidence based that yield strong consensus for everyone. Along this process, collective understanding translates into activism that we are deriving power to advance public health. Through the intricacies of the activism process, we attain wider ownership with greater accountability of health policies and programs, hence more sustainable results and of higher impact.

I passed by the red-painted Boston Tea Party Museum situated at the banks of Fort Point Channel one late summer afternoon. This iconic landmark constantly reminds me of how disparaging policies can ignite chaos, in fact a revolution. As Fellows, we are bound to change policies so they may respond to the evolving realities of time; however we have to fill ourselves first with knowledge so that we become more robust to stand passionate criticisms and achieve those winnable battles through dialogue and sustained collective action.

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Naloxone: Another Tool in the Toolbox

Every day in the United States, 120 people die as a result of drug overdose.

Deaths from drug overdose have been rising steadily over the last two decades and are now the leading cause of injury death in the United States [1]. In particular, deaths from overdose involving heroin have almost quadrupled from 2000 to 2013, with the majority of the increase occurring after 2010. A recent study using data from 28 states reported that the death rate for heroin overdose doubled from 2010 through 2013, whilst deaths from prescription painkiller overdose in the US was recently described as an epidemic by the CDC.

But there is a drug that can help stem this tide.

Naloxone is a non-addictive opioid antagonist and is the only proven method that works to reverse the effects of an opioid overdose. In the United States, naloxone is classified as a prescription drug. Whilst it is legal to prescribe naloxone in every state, dispensing the drug by licensed prescribers at point of service is governed by rules that vary by jurisdiction, and is heavily influenced by stigma, prejudice, ignorance and a general lack of understanding and education around substance use and the behaviors associated with it. This is often the same stigma, prejudice and ignorance which bolster a lack of support for syringe exchange programmes, despite their proven record of reducing rates of HIV and Hep C amongst injection drug using populations.

HIPS provides low barrier harm reduction focused health resources and wraparound case management services to sex workers, injection drug users and their communities in Washington, D.C. The Mobile Services Department at HIPS runs one of only three syringe exchange (DC NEX) programmes in the District of Columbia – an area with one of the highest HIV rates in the US, with an estimated 3.2% of the population living with HIV. The prevalence of injection drug use in the District and in the neighboring states of Maryland and Virginia is also high, whilst viral hepatitis C is considered ‘a major public health problem’ in the District. In the last eight months at HIPS, we have distributed over 700,000 condoms, handed out approximately 165,000 new syringes, and registered over 580 new people for the Washington D.C. syringe exchange programme.

In addition to our four-person Mobile Services team, we are supported in this work by a base of 80+ volunteers and four ‘secondary exchangers’. Secondary Exchangers are members of the local DC community who receive a small stipend in return for exchanging large quantities of used syringes and registering new participants for DC NEX on a monthly basis. Secondary Exchangers are often well-connected to the communities in which we work and are viewed as peers by many of those they serve. As such, they have a unique relationship with the individuals we work with. By removing the service provider/client barrier, they are invaluable in reaching individuals who either cannot access HIPS services, or who we cannot reach due to issues of trust, accessibility, fear of discrimination, or simply a scarcity of resources. Through their work we are able to expand our reach to those who frequent neighborhood shooting galleries in private houses, underground clubs and local parks with high-density injection drug use where professional ‘hitters’ inject others for money.

During my GHC fellowship year at HIPS, I developed and delivered a programme to increase awareness of, and education around, opioid overdose and prevention and to increase access to naloxone, in conjunction with other Mobile Services staff and Robin Pollini, an epidemiologist whose research focuses on reducing the adverse health effects of injection drug use. The purpose of this project initially was to train staff and secondary exchangers to recognize the signs of opioid overdose, to equip them to better engage the community in harm reduction focused conversations around opioid use and overdose, and to encourage access to Naloxone.

Following a training on opioid overdose and prevention, each member of the Mobile Services Team and our four secondary exchangers traveled to Bread for the City’s Northwest DC center – which is the only place in DC where Naloxone is readily available – to collect their individual supply of Naloxone. Over the next month, our secondary exchangers replicated this training with members of their communities across DC. Through funding from HIPS secondary exchange programme, they were provided with a small cash incentive and transportation vouchers for each member of the community that they trained and accompanied to Bread for the City to collect a supply of Naloxone. By the end of the programme, 24 members of the community in total had visited Bread for the City, received training on opioid overdose and prevention and had been supplied with Naloxone.

In January 2015 we replicated this training for the team leaders on HIPS’ Night Outreach service and again in March for 20 members of HIPS’s 80+ volunteer corps. The hope is that in the future, HIPS will be able to distribute Naloxone to those who participate in our syringe exchange programme, adding another tool to our harm reduction toolbox and enabling participants to reduce the risk of the ultimate harm: death through overdose.

Naloxone saves lives. The reality behind the stigma is that those who die from opioid overdose do not fit a simple, clearly defined profile – according to a 2014 CDC report 46 people die every day in the US from an overdose of prescription painkillers including opioid or narcotic pain relievers such as Vicodin (hydrocodone+acetaminophen), OxyContin (oxycodone), Opana (oxymorphone), and methadone. Naloxone could be instrumental in preventing these deaths if it were included as standard in every first aid kit, just as it could prevent the death of a child who accidentally ingests their parent’s supply of codeine, or the death of an injection drug user who overdoses on heroin. Regardless of the face, the cause or the circumstance of an opioid overdose, no individual should have to die when that death might have been preventable.

Naloxone is another tool by which we empower the individual, regardless of their behaviors, choices or circumstance and another tool in our toolbox in the fight to promote and safeguard public health and the well-being of our communities.

 

[1] Drug-poisoning Deaths Involving Opioid Analgesics: United States, 1999–2011

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“Invest in the future: Defeat malaria” – Using Bicycles to Combat Malaria

Malaria continues to be the most serious mosquito-borne disease in the world today with the greatest burden occurring across sub-Saharan Africa. In this region alone, it is estimated that more than 250 million cases are recorded and nearly one million deaths each year (Kelly-Hope and Mckenzie, 2009). In Zambia, the burden of malaria was estimated at close to 4.5 million clinical cases and more than 7,737 deaths in 2011 (Ministry of Health, 2012). This year’s World Malaria Day with the theme, Invest in the future: Defeat malaria, reflects the highly ambitious goals and targets set out in a draft post-2015 strategy.

Among the key interventions of controlling malaria is the prompt and effective treatment with artemisinin-based combination therapies (ACT). So strong is this commitment that according to the current malaria control strategy, Zambia aims to treat 85% of patients within 24 hours of symptom onset (Ministry of Health, 2012). But how can this be achieved, particularly in the vast rural areas where malaria prevalent rates (by microscopy patterns) continue to be as high as 14% among children under the age of five? Take for example, Chinini village in Sinazongwe, Southern province. The nearest health facility to this village is Siansowa Rural Health Centre, more than 24km (14.9 miles) away with a road mostly on rugged terrain. Further, the Siansowa Rural Health Centre is manned by a single nurse and one Environmental Health Officer. Another example is Kalimbize which is 25km (15.5 miles) away from Kafwambila Rural Health Centre. Kafwambila itself is over 150km (93.2 miles) away from the main town of Sinazongwe.

One way that the Ministry of Health and its partner, Malaria Control and Elimination Partnerships in Africa (MACEPA) at PATH are investing in the future is by empowering trained community health workers (CHWs) with bicycles. These volunteers are at the frontlines of combating malaria, often travelling many kilometers each day to reach people in rural areas who otherwise might not be able to access basic health services. Below, I share pictures of the joyous experiences of CHWs receiving bicycles meant for fighting malaria in Sinazongwe, Southern province of Zambia.

A Noble Line of Work

Sinazongwe District Community Medical Officer, Dr. Brian Ng’andwe, addresses community health volunteers receiving bicycles. Photo: Kochelani Saili/PATH

During the bicycle distribution, we continued to receive support from the Ministry of Health (MoH) and the Ministry of Community Development and Mother and Child Health (MCDMCH). Dr. Brian Ng’andwe, the Sinazongwe District Community and Medical Officer (DCMO) took time off to accompany us and address the recipients. Throughout the bicycle distribution (and certificate giving ceremony) in the various catchment areas or zones of Sinazongwe, Dr. Ng’andwe emphasized one key message, “The line of work you have chosen is noble.”

He assured the volunteers that their every effort to serve the community was appreciated, not only by the district health office, but importantly, by the communities they serve. He highlighted that the fight towards malaria elimination could not be achieved without their support and commitment. “The number of cases for malaria has significantly reduced because people no longer come to the hospital to seek treatment; they come to you or you go to them. You are bridging a big gap. . . You are helping many people. Thank you”. He encouraged all to put the bicycles to their intended use i.e. the prompt and effective treatment of malaria.

We can say “bye” to malaria

Community health workers in Siatwiinda, Sinazongwe figuratively say bye to malaria. The newly acquired bicycles will help these committed men and women travel from centrally-located health facilities to far flung rural households where people sick with malaria may need their help. Photo: Kochelani Saili/PATH

Is malaria elimination really possible? In the absence of a vaccine, perhaps not just yet. However, we need to continue doing all we can to drive towards that destination. One of my favorite quotes is from Duncan Earle, MACEPA director in Africa: “We should continue to use the shot-gun approach; cover everybody with everything”. Covering everybody with everything includes effective vector control strategies, insecticide- treated bed nets (ITNs), indoor residual spraying (IRS), early diagnosis and early treatment. Effective case management in many rural areas relies heavily on healthcare workers going door-to-door, visiting every single household to help drive malaria out of a community. The bicycles are critical to helping them ensure that they are able to bring healthcare services even to those furthest away and in a relatively shorter period.

Certified!

A jump of joy! Community Health workers in Siansowa jump with happiness after receiving their certificates of competence. Photo: Kochelani Saili/PATH

In order to roll out the large scale malaria test and treat campaign, Malaria Control and Elimination Partnership in Africa (MACEPA) teamed up with the Ministry of Health to train a formidable number of Community Health Workers in rapid diagnostic testing using the Rapid Diagnostic Test (RDT) test kit. They also were trained to follow up with treatment of positive cases with artemisinin-based combination therapies (ACT), namely Coartem. To be certified competent, one had to not only attend the five day training but also had to complete a clinical attachment at the nearest health centre were these skills were demonstrated and assessed by a trained health worker, e.g. nurse. By the beginning of 2015, many had qualified and earned their certificates of competency. As shown above, the occasion was marked by lots of joy. “It is a motivation . . . an honor to be recognized in this manner by the Ministry of Health and its partner MACEPA. We feel appreciated,” mentioned Joyce Siyamangamo, a community health volunteer from Gwembe Valley Development Centre (GVDC) in Sinazongwe.

In the absence of a vaccine, it is important that we remain committed and persistent in the fight against malaria and other mosquito borne diseases. And as Duncan would say, “use the shot-gun approach, cover everybody with everything.” One worthwhile investment for the future, as has been shown in Sinazongwe, is the use of bicycles to combat malaria.

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GHC Staff

A journey to achieving a dream!

Throughout my childhood I dreamed of being a medical doctor and being able to save the lives of people suffering from diseases. I had a special interest in cardiology, hoping to become a heart surgeon. I was encouraged by my parents and teachers, and told that all it takes is hard work and determination to be a doctor. This resonated deeply with me from primary to high school. Unfortunately my academic standing wasn’t enough to allow me to enter medical school; however I had the opportunity to join a veterinary school for five years where I found satisfaction both as a student and in my work. In my career as Veterinary Public Health Tutorial Assistant at the University of Rwanda and everyday animal life saver, especially in rural parts of the country, I continuously met people who needed to be served as well. These experiences, gleaned during different field visits, my public health education, and my upbringing in poor rural settings have all contributed to my decision to join the global health movement, to contribute towards fighting health inequity. Today, as a Community Nutrition Educator with Partners In Health I have the great opportunity to continuing serving those in need.

The two weeks spent at Yale University for Global Health Corps Training Institute was an eye opener for me. From the different speakers sharing their experiences, the most memorable story for me was Switch by Dan & Chip Heath, which shared the story of Jerry Sternin. Sternin analyzed the complicated and intricate malnutrition problem in Vietnam from a different perspective. Instead of spending too much time on issues that are “True But Useless” (TBU), Sternin searched for bright spots in the community and was able address the malnutrition problem from the root causes. Jerry’s story inspired me to go out there in search of bright spots and work on fixing the thorny root causes of malnutrition which has been reported to be threatening 44% of children under the age of five in Rwanda. Through shared experience, I now realize that I can contribute to saving lives not only through giving injections or drugs, but also by educating the community on health behaviors and building their capacity for self-reliance.

As a Global Health Corps fellow I support the program team with my agriculture and rural development experience to achieve program objectives, and conduct routine visits to vulnerable families identified with malnourished children. On our visits we share experiences and advice with our beneficiaries on how together we can improve their living conditions. In our program, we provide agricultural tools and technical knowhow so that they can improve their agricultural practices, not only for home consumption but also as a source of income. Through our routine visits and grassroots discussions with our community, we have witnessed tremendous improvements towards realizing ideal community nutrition and agriculture levels in just four months since I joined the team.

Smiling faces posing for a photo on “ambilanse” (meaning Ambulance)

Many people have been complaining about reduced agriculture production due to reduced rainfall over the past decade. Over 85% of Rwandans rely on agriculture for both home consumption and income generation; however the technology that was used was insufficient to boost the production desired for both home consumption and income source. It has always been great to see how beneficiaries appreciate the work we do in agriculture through dissemination of new technologies so as to increase production, and preparation of balanced diets at the household level.

The testimonies they give and the visible improvement in their daily life has been my dream. To see myself touching people’s lives, helping the rural people change their nutritional behaviors from under nourished to well-balanced food obtained from their own garden, I know will help many. This alone will help reduce the risk of disease, especially to young children under the age of five in the journey we call Patient to Producer. Visiting them in their self-help groups and participating in brainstorming on how they solve their domestic problems are among the best adventures I have ever had. Seeing how they support each other from the little income generated through agriculture and off farm business to send children to school, buying different home materials, supporting the sick by taking them to nearby health centers and paying off bills; all of this is truly inspiring.

Ever since we engaged them, the journey to food security offered promise. Today in the village when we pass by in the PIH car, children wave to us and shout in loud voices with smiles on their faces “Ambilance” (Ambulance) or “Munganga” (doctor). Today they can’t easily differentiate between ambulances and this resonates with me because we all “save lives.”

          

Community visits and participation in daily activities such as agriculture and strategic planning.

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GHC Fellows and Alumni GHC Staff

Sharing Your Narrative Out of Respect for Those You Serve

Zainab Salbi took the stage at Chelsea Piers in New York City with such poise and grace. With light streaming in the large windows, I sat with the rest of the 2014-2015 class of Global Health Corps fellows in awe – drawn to her experience as she spoke with honesty and humility. Her words had a lasting impact on me and my work, and they continue to challenge me to consider the impact of my work now and in the future.

“You have to show respect by sharing your own story.”

Zainab founded Women for Women International, an organization that serves women survivors of war, at the age of 23. When she first started talking with war survivors about the sexual assault and rape they had suffered one responded saying that if you listen to these stories and don’t do anything about it, it’s like you are committing the violent act yourself.

When someone shares their story, they are giving a part of themselves to you. It is your responsibility to disseminate those words in the most responsible and respectful way possible. As Zainab explained, it’s important to share your own story out of respect for the community that you are trying to serve. It is only fair that you give up a piece of yourself when you are asking to them to do the same.

Zainab’s words still echo in my head ten months later as I contemplate my role in global health and the fight for global health equity. I’ve seen writers, artists and communications professionals share fascinating stories that leave their subjects vulnerable. Most recently, a Humans of New York (HONY) posting (no longer available) featured a young girl making questionable decisions for her well-being. Brandon Stanton, the HONY creator, asked those posting comments to be kind as she shared her story, but many still left messages scolding and shaming her.

In global health, we share stories of survivors. We take the lives of those that have lived through war, disease, HIV, Ebola and environmental devastation, and put them on display for the world on social media, in blogs and in print. Although most of us are respectful and try our best to give voice to those who have been silenced, I can’t help but be conscious that as a story-teller, I am taking their story, their image, and their devastation and sharing it with the world. I am making them even more vulnerable to the world, and I am responsible for making sure it is received and shared in a respectful and supportive way. This is a responsibility that I cannot and do not take lightly.

“Whatever the injustice, when you don’t say anything, you legitimize the injustice.”

Contemplating this responsibility brings me back to Zainab’s talk. It is easy to be intimidated by this responsibility and choose to censor some stories, but we can’t be silent in the face of injustice. Therefore, we have to speak up and respect those that we are trying to serve, by sharing our own personal narrative. We need to stand next to those we are serving and be willing to make ourselves vulnerable too.