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Guinea Worm Eradication in Nigeria, A Lesson To Learn From

By Gordon Younkin

You may have seen in the news a little over a year ago that the WHO declared Nigeria free of guinea-worm disease. While this may be considered old news, it is still worth examining the campaign that successfully stopped its transmission.

Guinea-worm disease, also known as dracunculiasis, infects people via contaminated waterways, especially in slow-moving streams or stagnant pools. After entering the human body, it stays matures in its host without causing any symptoms for about a year before painfully emerging from the skin of the infected individual. It then releases thousands of larvae, and its life-cycle repeats. There is no vaccine or treatment for the disease—it is most effectively stopped through preventative measures such as water purification and behavioral change.

In 1988, the Nigeria Guinea Worm Eradication Programme was launched in response to a World Health Assembly resolution calling for the global eradication of the disease. At the time, there were around 650,000 reported cases of guinea-worm disease in Nigeria alone. Over the course of the 25-year campaign, thousands of volunteers traveled door-to-door in communities across the county to search for and contain the disease.

What I think is most notable is the use of polio vaccinators to help in the surveillance efforts. The campaign was able to use existing health workers already familiar with the communities and culture to more quickly and efficiently eradicate guinea-worm disease. It is this kind of cooperation between different public health efforts that is crucial to the continuing improvement of health worldwide. Dr. Margaret Chan, Director-General of the World Health Organization (WHO), commended the collaborative guinea-worm disease eradication effort: “This is the kind of joined-up effort that makes the most effective use of our human and financial resources, and has a dramatic and measurable impact.”

The last case of guinea-worm disease in Nigeria was reported in 2008, and the country was declared Guinea Worm free in late 2013. While the polio vaccination campaign is still in progress due to a number of cultural and infrastructural barriers, Nigerian President Goodluck Jonathan is committed to stopping the transmission of wild poliovirus by the end of 2015.

If you are interested in more information about guinea-worm disease eradication efforts in Nigeria, some useful references are:

http://www.who.int/features/2014/nigeria-stops-guinea-worm/en/

http://www.punchng.com/news/who-certifies-nigeria-guinea-worm-free/


Co-Founder Reflects on GlobeMed Beginnings

By Alissa Zhu

With more than 50 chapters spread across colleges and universities across North America, it’s hard to imagine less than a decade ago, GlobeMed was only an idea in Victor Roy’s head.

GlobeMed co-founder Victor Roy Skyped in from the United Kingdom Sunday afternoon to converse with about 20 students. He spoke about the origins of GlobeMed and hosted a lively discussion on the future of global health engagement programs.

When Victor was an undergraduate student at Northwestern in 2004, the global health program was still in its infancy. He and co-founder Peter Luckow were frustrated with the lack of options to make lasting and tangible change in impoverished communities around the world. They realized donating money and medical supplies wasn’t enough, and that a partnership was the best way to promote sustainable growth.

GlobeMed’s first-ever partnership with the HOPE Center in Ho, Ghana had a rocky start. Victor talked about how students from a different organization at Northwestern had donated funds to build a public health center and had hired someone to oversee the development of the clinic. However, the person they hired was an outsider to the community without the connections and resources to build the clinic the students envisioned and the village needed.

The building was lying vacant when Victor visited the grounds of what would eventually become the HOPE Center. He spoke to local director Joseph Achana who expressed his frustration over the lack of progress over the health center due to inefficiencies and lack of communication. When Victor asked why communication issues were so prevalent, Joseph said something the GlobeMed co-founder would never forget.

“We are Africans so we listen to our donors.”

Knowing this isn’t the way things had to be, GlobeMed at Northwestern and Joseph built a partnership on the foundation of cooperation and mutual learning. After the association with HOPE concluded, GlobeMed strived to carry on the tradition of open dialogue with the new partner organization, the Adonai Center for Child Development.

Global engagement at Northwestern has grown by leaps and bounds since GlobeMed was first founded. The Buffett Center, International Program Development, and GESI are a few of the many resources that help students confront global challenges. Even so, we have a lot more to learn on how to make a difference in the world while avoiding accidental harm. Moving forward, our new advocacy initiative will endeavor to raise awareness about just that.


Learning from the Girls of Uganda

By Amanda Blazek

This past summer Neha, Rafa, and I comprised our GROW team. Every summer, the GROW team travels to the site of GlobeMed’s partner organization – the Adonai Child Development Centre in Namugoga, Uganda – to assess the status of previous fundraising initiatives, get to know the staff members at Adonai and the surrounding community, and carry out a research project. As three girls that went on the trip, we were interested in conducting a research project that related to assessing the wellbeing of girls. In Namugoga, as in much of Uganda and Sub Saharan Africa, there exists a large gender discrepancy in the education system, as boys attend and complete school at much higher rates than girls. We wanted to carry out a research project to examine the obstacles that girls face in the community to attending and completing school; our goal is to present our findings to the Adonai Centre, and implement necessary projects or initiatives into our future partnership plans with Adonai.

Due to our research exploring the nature of girl’s education, we spoke to over 20 girls about their experience growing up in the community, diving into topics ranging from school systems to families to community expectations. These significant conversations allowed us to connect with these young women and form personal relationships with community members from the start. Their insightful responses not only aided us in our research, but allowed us to gain a deeper understanding of the culture in which we worked and learned. One young woman in particular stands out – a 15 years old who dropped out of school due to having a baby at the age of 13. She spoke to us of her responsibilities as a mother, of the circumstances that led her to become pregnant, and her inability to return to school after the birth of her child. This young mother embodied many of the issues we were looking to address in our research, and being able to hear of her situation firsthand was moving and meaningful for all of us.

A young mother and her child in their Namugoga home.

It is one thing to hear about Adonai during our meetings; it is a very different thing to visit the center firsthand. Meeting the staff members, children and community members made us so proud of our partnership, and showed us how special Adonai truly is. Aloysious Luswata, the director of Adonai, and his wife Abby were essential in aiding us throughout the trip, especially with our research. Abby helped to set up many of the interviews – as she knows the girls in the community – and came along to translate for us when need be. Their help allowed us to immerse ourselves as much as possible, and connect with people we otherwise would not have been able to.

Aloysious, Abby, Nobel, and Janet Luswata pose with the 2014 GROW team.

I don’t think any of us expected the experience to be as memorable as it was. Through our research and time spent with community members, we all got a sense that GlobeMed’s partnership really is making a tangible impact in the community.

 


Putting Emotion Front and Center Once Again

By Nicholas Wang

We are inching closer to Article 25’s Day of Action on October 25. If all goes according to plan, it will be a monumental day for this brand new organization, which was founded within the past year by university students who had a simple idea for a grassroots global health advocacy organization. From that idea came the long, grueling process of formulating a tangible vision and plan for what this organization would look like and could accomplish. Long meetings both in person and over Google Hangout, hours upon hours of research and organization, aggressive network-building, and coordinated social media blitzes have all led up to a single day: October 25. There are events planned all over the world in more than 40 different countries with thousands of people attending and participating, from accomplished professionals to eager students to families and individuals that lack access to basic healthcare, all united in the belief that health is a human right. Quite the accomplishment for a young organization like Article 25.

But I think that oft-told narrative I outlined above ignores a key point: before there was the simple idea for a grassroots global health advocacy organization, there was a feeling, an emotion. It surfaced during classroom discussions, in assigned readings and documentaries, while traveling to and observing different neighborhoods and cities and countries, during conversations with classmates, friends, family, teachers and faculty, about politics, economics, policy, health, and society. It was the feeling that there was something wrong with the world, that it wasn’t quite fair that some people were born with access to health and others weren’t, that location, income, race, ethnicity, gender, sexual orientation, or religion could become a factor in determining whether you died young or old. And it was the emotion of frustration and anger at the world and the system for allowing this to happen, coupled with an overwhelming desire to do something about it. It inspired enthusiastic conversations between the young students who founded the organization, and permeates all of the events that will occur on October 25. We all feel this same passion, rooted in frustration and fueled by optimism and hope for the future: that there is something wrong and we should do something about it.

I know I felt that passion when I first heard about Article 25 and our Day of Action back in June. As Amee Amin and Jason Pace told me more about this organization and what they were hoping to accomplish, I sensed that this was not just a worthy cause and a worthy use of my time. It was something of a calling, an indescribable force that drew me in and made me want to shout from the mountaintops that health is a human right and we can do something about it. This organization empowered me to take my global health education to the next level, to step up my commitment, to join with these other like-minded individuals and create the change we want to see.

As the weeks went on, and the logistics got more and more complicated, and my mind started drifting towards the ever-approaching start of my senior year of college, I admit that the passion waxed and waned, often replaced with the dull regular reminder that I needed to get work done for Article 25. It was routine and often clerical and not as exciting, thrilling, or romantic as I had secretly envisioned it to be. To make matters worse, we are a team that is spread out all around the country, from Boston to Los Angeles, and bonding and building community via Google Hangout is difficult.

But now more than ever, with the Day of Action upon us, I think it is time for us to rekindle the spirit and passion and enthusiasm that we all once had. That is the core of what drives us to spend hours planning events and detailing logistics and sending dozens of emails. When you strip everything else away, what remains is that feeling that something is wrong, and that coinciding emotion that tells us to be both angry and hopeful. Our emotions are what will make the Day of Action meaningful and memorable, and are what will help this incredible organization continue long past October 25. If you are not yet part of our movement but feel the way we do, we encourage you to join us on our Day of Action, wherever you might be. You, like me, should feel excited, enthusiastic, and empowered about being able to make a tangible difference in our world.


Health Briefing: Uganda

By Michael Zingman

Key Statistics and Health Indicators:

Sources: WHO Uganda Statistics Summary, UNICEF Uganda Statistics, and MIT Global Health Uganda Country Briefing – Health

Total Population – ~36,346,000
Median Age – 15.7 years
Population Living in Urban Areas – 16% (Global average – 53%)
Healthy Life Expectancy at Birth – 49 years (Global average – 62 years)
Probability of Dying Between 15-60 Years (per 1000 people) – 389 male, 360 female
Population Over 60 – 3.7%
Per Capita Government Expenditure on Health (US $) – 10.4
Per Capita Total Expenditure on Health (US $) – 43.6
Total Expenditure on Health (% of GDP) – 8%
Prevalence of HIV (Adults 15-49) – 7.2%
Maternal Mortality (per 100,000 live births) – 435 (worst in Africa)
Degree of Infectious Diseases Risk: Very High
Top Food or Waterborne Diseases: Bacterial Diarrhea, Hepatitis A, Typhoid Fever
Top Vectorborne Diseases: Malaria, Plague, African Trypanosomiasis (Sleeping Sickness)
Top Water Contact Disease: Shistosomiasis

Ugandan Health Priorities

Recently, a survey report was published by the Pew Research Center’s Global Attitudes Project titled “Public Health a Major Priority in African Nations.” This survey used face-to-face interviews with people (at least 750 each) from Ghana, Kenya, Nigeria, Senegal, South Africa and Uganda. This widespread research was conducted over a one month period from March-April 2013 and has very interesting findings regarding public health priorities in each country.

Due to GlobeMed at Northwestern’s partnership with the Adonai Centre in Uganda, this article will focus on the surveys of Uganda. There, 800 adults were selected by varying regions and urbanity and interviews were conducted in seven different languages – English, Luganda, Rukiga, Luo, Lugbara, Ateso and Runyoro. The study showed that these adults thought that the most important priorities for the government include (in order of importance): building and improving hospitals and health care facilities, preventing and treating HIV/AIDS, improving access to prenatal care, improving access to clean drinking water, preventing infectious diseases, increasing child immunizations and fighting hunger. Across all countries surveyed, building and improving hospitals was the highest priority overall.

This article will focus on the two top priorities listed, hospital facilities and HIV/AIDS prevention and treatment.

First, the Uganda Ministry of Health has reported that there are 1.1 hospital beds per 1,000 people, 5.5 nurses per 10,000 people and 1.17 physicians per 10,000 people. Uganda’s healthcare performance is one of the worst in the world, ranked 186th out of 191 countries in the WHO ranking. That being said, health investment and hospital coverage have both increased dramatically over the past 5-10 years and the outlook is generally positive.  Utilization has also increased tremendously as the government eliminated user fees for health facilities in 2001, causing an 80% visit increase. Potentially the greatest issue regarding healthcare in Uganda is the poor distribution and inequity of health infrastructure. In some rural areas of Uganda, there is just 1 healthcare facility per 20,000 people, as compared to 1:5, 300 in Kampala, the capital city. Also, 16 out of 80 districts of Uganda have no hospitals at all. For the rural population, skilled health personnel is lacking too. While 80 percent of births in urban areas have skilled health personnel present, the rural areas only average 38 percent. On another positive note, however, the government is now focusing on poor areas to increase health spending. That being said, it does not seem to be enough yet – the poorest 20 percent gets 24 percent of health spending, while the wealthiest 20 percent gets 17 percent of health spending. It is important to note that the government is also not the only factor in healthcare of Uganda, the private sector is also crucial. In a survey from 2006, just 29 percent of Ugandans who sought healthcare went to public facilities, which make up 71 percent of all facilities. Therefore, private clinics, drugstores and NGO facilities are getting more usage.

Second, HIV/AIDS is a huge problem in Uganda due to 7 percent of the population having this infectious disease and due to the difficulties of prevention and treatment. Uganda, however, has been extremely successful in its HIV/AIDS responses, particularly due to early action when the epidemic struck in the 1980s. The percentage of HIV cases has decreased a large amount since the 1980s – at one point they were at 29 percent in urban areas. HIV/AIDS control programs, education campaigns, free antiretroviral (ARV) sources, and outside sources of HIV/AIDS funding such as from the World Bank, the Global Fund and President’s Emergency Plan for AIDS Relief (PEPFAR) have been tremendous in these efforts. NGOs have also played a significant role in the AIDS response. Uganda’s national strategic plan has an ambitious goal of reducing HIV infections by 40 percent over five years.

Both of these health priorities – building new hospitals and healthcare facilities and HIV/AIDS treatment and prevention – highlight the largest problems facing Uganda in terms of health. At the same time, they are ones with fairly positive outlooks and the government has generally done a very good job in improving healthcare. In line with government efforts, however, nongovernmental organizations can have a key role in countries like Uganda, working with communities to improve drinking water sources, sanitation facilities, immunization coverage, education on health issues, condom use promotion, etc. Organizations like GlobeMed can lead the way in working alongside the Ugandan government to focus on these health priorities, reduce health inequities and improve the quality of life for the 36 million people of Uganda.


Member Spotlight: Tiana Hickey

By Gordon Younkin

Hometown: Chicago, IL

Major: Cognitive Science

Minor: Global Health Studies

Siblings: Two sisters, who are 12 and 19, and one brother, who is 11.

Favorite food: “PIZZA! I love pizza so much it’s only a tad bit ridiculous.”

Favorite place she’s ever been: Anchorage, AK

Involvement on campus: Tiana is on ASG’s Diversity and Inclusion Committee, works in a children’s thinking lab, and teaches swim lessons at SPAC.

Ideal Saturday: “My ideal Saturday would be completely spontaneous. Nothing would be planned, no alarms would be set, homework would not exist, and I would do whatever came to mind.”

When she grows up: “I don’t have a specific career/profession in mind, but if I had to choose, I’d want to get involved with crisis management. Hopefully that would let me travel the world and help a lot of people.”


“Helping Students Who Give”

By Amanda Blazek

NSH Impact Week here at Northwestern kicked off Sunday night, with the seven opposing teams joining for a dinner of Indian food and team rallying before the week of rivalry ahead. GlobeMed had a strong turnout and (I would say) the loudest cheering section.

Impact Week stretches from May 4th to May 10th and is hosted by Northwestern Student Holdings – an entrepreneurial student group that launches and finances on-campus businesses. For NSH Impact week, each NSH business has been paired with an on-campus philanthropy to raise money and awareness for each club and cause.

GlobeMed has six strong competitors this week including Peer Health Exchange, Best Buddies, Tufaan, NCDC, Applause for a Cause and Mimo. Each team made a video representing their organization and the work it does. As with all things in today’s world, the competition boils down to the number of votes, or “Likes”, on social media. Whichever video is most popular will receive the grand prize.

As of now, NSH has donated $2500 for the Impact Week prizes, ranging from  $1000 for the grand prize to $100 for the 7th place prize. But this week is also about fundraising. Donations can be made online to increase the monetary prize for each philanthropy, providing even more support for each cause.

Most importantly, this week is about raising awareness for each organization and their work. As the token orange balloons of Impact Week appear all over campus, NSH hopes to encourage others to reach out and get involved. Although the NSH money will tremendously help each organization, the long-term support from the NU community will be even more impactful.

So stop by the arch this week, where a tent will be set up every day selling raffle tickets and handing out orange balloons. But most importantly, go to http://www.nshimpact.com/#start and VOTE for your favorite video (i.e. GlobeMed). Voting will help the philanthropy of your choice (i.e. GlobeMed) to win Impact Week and the $1000 prize. This could have a huge impact on organizations (i.e. GlobeMed) and the work they are doing (i.e. saving lives). Impact Week has officially started, so vote now by clicking the “Like” button on the left of the linked page! (For GlobeMed.)


Vaccines, Herd Immunity, and Disease Re-Emergence – What’s the Deal?

By Michael Zingman

We hear about immunizations in the news. We are encouraged to get vaccinated. We hear friends and family talking about how they just “never got vaccinated” for something.

We then hear about outbreaks and re-emergence of vaccine-preventable diseases. So what is causing this re-emergence exactly?

Vaccines are one of the most crucial global health resources and are significant tools that can be utilized to protect large populations in both developed and developing nations from disease. Many diseases are vaccine-preventable, meaning if hypothetically everyone were to be vaccinated, the disease would become eradicated.

One of such eradicable diseases is measles. Measles was once “eliminated” from the United States; however, recently, there has been extensive media coverage over a measles outbreak within the country. Measles was eliminated but not eradicated because of a slight minority of people who went unvaccinated, and this number has increased and allowed the disease to return. These cases were found to be from parents who chose not to vaccinate their children, which ultimately harmed others.

Other parts of the world have also seen a re-emergence of vaccine-preventable diseases. One interesting case is that of Syria and the re-emergence of polio this past October. Polio had come extremely close to eradication in that area of the world; unfortunately, it has re-appeared. This was due to two key factors: 1) because of the ongoing civil war, the normal childhood vaccination routines have been altered or disrupted, and 2) polio has spread from Pakistan (which is one of the three remaining countries in which polio is still active), particularly through children, including those in refugee camps and those displaced in Syria. Polio has even spread to Iraq from Syria, and there is growing fear over proliferation of the crippling disease.

So why can just a handful of unvaccinated people lead to a wide-spread re-emergence of these preventable diseases? The key is herd immunity.

Herd immunity is defined by the Centers for Disease Control as when “a sufficient proportion of a population is immune to an infectious disease to make its spread from person to person unlikely; even individuals not vaccinated are offered some protection because the disease has little opportunity to spread within the community.” This concept of herd immunity is why widespread vaccination is necessary for prevention of these diseases. In an ideal world, everyone would be vaccinated for all of the vaccine-preventable diseases. However, that is not a practical situation (at least not at the current time). Herd immunity can be very effective in protecting large populations from these diseases, but often can be difficult to achieve as some diseases require greater than 90% of the population to be vaccinated. This threshold is frequently not met and populations are left vulnerable.

With a growth of anti-vaccination movements in the United States and around the world, some parents have stopped vaccinating their children. This has led to a decrease in herd immunity for these vaccine-preventable diseases, permitting their re-emergence. These movements have surfaced due to a growing fear that vaccines can have adverse effects on children. This fear has been augmented by conflicting information regarding vaccinations, as well as personal accounts of negative vaccine effects, including those by physicians. Misinformation has even led a significant portion of the U.S. population to believe that autism can be caused by vaccines. This belief became prominent in the 1990s and was one of the reasons cited for the growth of this anti-vaccination movement.

Two key aspects of the debate over vaccinations include a lack of information (or misinformation) and a mistrust of governments, health institutions and research agencies. These are major problems in the United States, but also in many countries throughout the developing world, including those countries in which GlobeMed partner organizations are located. A lack of research to disprove these supposed negative vaccine effects has made it hard for the public health community to convince people that no link exists. Furthermore, much of this research comes from pharmaceutical companies, leading to mistrust of this research due to potential biases. An overabundance of information also has prevented people from receiving direct information from health institutions regarding vaccine effectiveness and has caused them to educate themselves from other sources that are less reliable. On a similar note, there is a lack of public understanding about vaccinations that stems from a mistrust of health institutions. It can often be more difficult to vaccinate people in developing countries in which people view vaccinations as a corrupt government program. Some people even believe that required vaccinations for schools are done for the economic benefit of the government.

All of these issues discussed have increased fear of vaccines in many locations around the world, including in those places with GlobeMed partner organizations. Vaccine education needs to be expanded and effective national vaccination action plans need to be both developed and carried out to increase herd immunity. GlobeMed and its partner organizations, as well as similar global health organizations, need to empower communities around the world in order to enhance vaccination efforts. Education through vaccine information is necessary to present to the public why population immunization is essential and why a decrease in herd immunity can have tremendous negative effects.


Adonai Teacher Spotlight: Lukwago Gideon

Gideon is a teacher at Adonai. He is the assistant head of the childcare department. Gideon welcomed the 2013 GROW Team to the Adonai center on their second day in Uganda by leading student skits, dances, and other musical performances. He served as the GROW Team’s primary translator when they conducted health surveys around Namugoga.

Age: 25
Teaches: Math and Science
Favorite sport: Volleyball
Dreams of: Coming to the US to become a teacher.
Other: Loves watching Gossip Girl and One Tree Hill.


Finding inspiration at the 2014 GlobeMed Global Health Summit

By Matthew Zhou

From the sandy beaches of California to the metropolitan areas of Washington D.C, GlobeMed chapter members flooded into Evanston from across the nation for the GlobeMed 2014 Summit. Co-presidents, chapter members, speakers and panelists of all different walks of life gathered during this dreary forty-degree Evanston weekend for the purpose of sharing their experiences and ideals and reaffirming their commitment towards achieving global health equity through partnership and collaboration. In seven years, GlobeMed has achieved rapid expansion to 55 chapters, 2000 college students, 1.4 million dollars raised, and over 200 projects in water sanitation, disease prevention, nutrition programs, and a vast diversity of other issues. As a student summit delegate, it was a lot to take in.

My GlobeMed summit experience was a powerfully inspiring experience, a space where intelligent and ambitious students and professionals all gathered to seriously deconstruct and discuss the million dollar question: how do we achieve global health equity? There were plenty of interesting and constructive panels and speakers, but the overarching theme was one familiar to every member of GlobeMed: partnership. More specifically, negotiating power and privilege relationships to make true collaboration possible. From Dr. Prabhjot Singh, a professor at Columbia University, utilizing his experiences as a victim of hate crimes as a platform to advocate for structural change or GlobeMed at Morgan State GROW Coordinator Kayla Walker leveraging her minority status as a black woman for better opportunities in education, one crucial theme emerged from reframing disadvantages to your own advantage. These are not passive populations that we are trying to support – they are strong men and women hindered by structural obstacles that we are helping to empower. We talk a lot about global health in abstract terms – it’s how we brand and present ourselves. What we really work with and what we need to emphasize, however, are human relationships. We work with women, children, fathers, mothers, across races, genders, sexualities, professions, and varying levels of education. It’s more than treating sickness and poverty – it’s about hearing these people’s stories, empathizing and caring, and then coming up with concrete, relevant programs to address these people’s specific needs. These people deserve better than to be generalized – their nuanced stories demand the more intimate understanding and partnership that GlobeMed has recognized as crucial in resolving health disparities.

This instinct for empathy is essential in any future global health leader. It is something that GlobeMed actively cultivates within each and every member. As health professionals, we will be responsible for the next generation of public health and medical advancements; Lawrence Summers, former Harvard President and U.S. Treasury Secretary, claims that:

“We could achieve universally low rates of infectious, maternal and child deaths by 2035.”

Global health equity possible within our generation at 2035. As emerging young professionals, there is a great pressure on us to lead future global health initiatives in the correct direction. As college undergraduates, there is also a great pressure to think pre-professionally in terms of resume-building and executive positions. Many students are uncertain about their futures and obsess over jobs, internships, and their general future. We need to stop putting our faith in degrees and jobs, and start putting our faith in ourselves. No person can control the future, nor should we try to make the future safe or predictable. It is not possible. The one secure fact in one’s life is that you can prepare yourself to handle any situation that comes your way. Develop yourself, empathize with others, and live in the moment and the future will change from scary to exciting. If there is one thing that summit has taught me, it is that no person or situation is unchangeable. It is simply a matter of reframing disadvantages into advantages. Utilize the current opportunities around you to grow, and success will follow in your footsteps.