The green and blue scrubs are the same as on TV, the concentration as intense as in any operating theatre. But beeping high-tech monitors are conspicuous by their absence. In remote areas of Darfur, the ICRC's Flying Surgical Team performs life-saving operations under the shade of a baobab tree, with the simplest equipment.
[snip]
"We can operate anywhere," says Lizzie [a nurse on the ICRC's Field Surgical Team (FST)], "as long as we can hang a mosquito net. And if we have to, we can just hang a mosquito net between our two trucks." Those of us brought up on TV programmes full of high-tech operating theatres will have trouble imagining a surgeon working under a baobab tree, but that is the usual setting for most of the FST's operations.
Adrianna Logalbo, director of Nothing But Nets writes to us from Dadaab, Kenya, where she is handing out insecticide treated bed nets to Somali refugees. Nothing But Nets and its partner the Union of Reform Judaism raised more than $1.2 million to provide long-lasting insecticide-treated nets to more than 273,000 refugees in four camps in Kenya before the summer’s rainy season. The United Nations High Commissioner for Refugees (UNHCR) will distribute the 128,000 nets over the next few weeks. (Readers should check out this post for more on the deadly malari-refugee nexus.) Adrianna has a special message for those who have supported Nothing But Nets, including many Dispatch readers.
Here's Adrianna:
It's been a long, hot, and eye-opening day in Dadaab, Kenya with the UN Refugee Agency (UNHCR). I’m witnessing firsthand the struggles that refugees, UNHCR, and the UN agency’s partners go through each and every day here. Let me set the scene for a moment:
* There are 3 refugee camps in Dadaab: Ifo, Hagadera and Dagahaley
* Ifo was established in the early 1990s
* Nearly 250,000 refugees are living in these 3 camps – 3 times the capacity
* Each month, another 5,000 Somalians enter the Dadaab camps, but with no more room, they are not given their own living space
It is hot and crowded here, but despite these conditions, Dadaab is recognizably a community. And I had the chance to see this firsthand today as we walked around the Ifo camp with community health workers, distributing nets to women and the most vulnerable. The community health workers know exactly whom to target and spend time at each home not only explaining the importance of using the net, but also going so far as to hanging it up for people. Up until now, community health workers and doctors in Dadaab have had to choose which vulnerable populations should get nets, given limited resources. But thanks to YOU, the health workers and doctors no longer have to make these choices. We have been able to fund full coverage for nets (1 net for every 2 people) in the Dadaab camps, as well as Kakuma, the refugee camp in western Kenya. That's 128,000 bed nets! The nets will go a long way in preventing malaria illness and deaths in these camps. And I can assure you, these refugees are grateful for your support.
News trickled out of the usually tight-lipped TED Conference yesterday that Bill Gates let loose a swarm of mosquitoes on the audience during his talk about malaria. Here's the video. Swarming occurs at minute 5, but before and after that there is a lot of insightful commentary about malaria--including his exhortation that bed nets save lives.
President Obama will lift the Global Gag Rule today. Amen! See yesterday's post for more on why international family planning assistance is critical to global health and development.
UPDATE It's official! Plus, President Obama has restored US funding for the United Nations Population Fund (UNFPA). Tim Wirth says, “UNFPA is the world’s leader in advocating for universal access to reproductive health services. It is very clear that working with UNFPA will save women’s lives and help reduce the need for recourse to abortion. For example, the $34 million withheld by the Bush Administration in one year alone, could have helped UNFPA prevent 2 million unintended pregnancies, 800,000 abortions, 4,700 mothers’ deaths, and more than 77,000 infant and child deaths.
“Working in more than 150 countries, UNFPA is on the front lines of reducing poverty, ensuring that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect. Approximately 180 industrialized and developing countries, including all the countries in sub-Saharan Africa and Latin America, contribute to UNFPA. The United States was the only country to withhold funding for political reasons.”
Like I said, elections have consequences.
..train midwives in rural Afghanistan, thereby helping to reduce maternal mortality, empower young women and build up a broken country's health infrastructure.
It's time to abandon Abstain, Be faithful, use a Condom. This is the mantra of PEPFAR, the US-funded President's Emergency Fund for AIDS Relief. All PEPFAR-funded HIV education efforts must follow that formula, and include all three points. 33% of all HIV prevention funds - 20% of the PEPFAR budget - must be - according to the organization's congressional mandate- spent on abstinence only education.
Yes, that's right. We are requiring that 7% of our HIV budget be spent on programs that have been scientifically proven not to work. Oops! Sure, nine out of ten Americans have sex before marriage. But we expect the developing world to do better at that kind of thing, right?
PEPFAR is a good idea. More money for AIDS prevention and treatment is a good thing. Wasting limited PEPFAR funds is not. It's time to free the PEPFAR budget from loony congressional restrictions on what can be funded. PEPFAR should be funding the efforts that will do the most good for the least money. End of discussion.
Now, the typical retort is to say: "But Uganda was the vanguard of the ABC program--and it's HIV rates there plummeted by over 30% since the 1990s!" That may be true, but studies have shown that condom use, not abstinence, is largely to credit.
(Photo credit: Me. A picture of a street sign in Addis, Ababa Ethiopia. November 2008)
Writing in the Ideas 4 development blog, Josette Sheeran, the head of the UN's World Food Program, makes the important point that, unlike with the fight against cancer or other deadly diseases, we already have all the technology we need to combat the global food crisis. Still, as her description of a new "smart" nutritional program in India makes clear, a little innovation can't hurt.
This new ready-to-use food is made from ingredients such as chickpeas and dry skimmed milk powder with a range of added micronutrients. There is huge scope for this type of nutritional supplement in India which has the highest prevalence of underweight children in the world, higher even that sub-Saharan Africa. This latest addition to our hunger toolbox can be used not just for rehabilitating malnourished children but for preventing them becoming malnourished in the first place.
This product can be made locally and at relatively low cost - a daily ration costs just five rupees (10 cents). Being oil-based, it does not require water for its preparation, giving it a longer shelf life and making it particularly suitable for use in places with poor sanitation. Nor does it require cooking which makes it ideal for distribution in disaster zones - which is why we deployed it as part of our relief package after the recent cyclone in Myanmar.
It has already excited significant interest in the region and beyond. Afghanistan, Nepal and Bangladesh have all expressed interest in making this product part of their national food programmes. When I produced a sachet at the African Union Summit in Ethiopia not long ago, Prime Minister Meles Zenawi said he wanted to start producing locally it in his own country.
This reminds me of the success of "Plumpy'nut," the peanut butter-esque, Nutella-inspired nutritional supplement that was used to stave off famine in Niger. Sheeran also reveals that WFP is working on an ingenious "rice fortification" project; including just one of these hyper-fortified grains of rice amongst 99 regular kernels will provide crucial micronutrients. Let's hope the folks at FreeRice are aware of this development.
(image of child with Plumpy'nut, from flickr user aheavens under a Creative Commons license)
The brand new Global Health Blog at Change.Org by Alanna Shaikh is quickly becoming one of my favorite blogs. It is certainly must-reading for anyone interested in these issues. Here's Alanna making five global health predictions for 2009.
Antibacterial resistance will get worse
Antibacterial resistance will keep getting worse. Bacteria are evolving at a terrifying rate, because of overuse and abuse of antibiotics. As a result, more and more first-line antibiotics will become useless, in both the developing and developed world. A standard treatment for either malaria or tuberculosis will cease to be effective, and the WHO will remove it from the treatment guidelines.
Malnutrition
Rising world food prices are going to mean poor people go hungry more often. We'll see substantial increases in rates of malnutrition. There will be more UN appeals to help the starving, and they will rarely be fully funded, as cash-strapped governments start to cut their donations.
Improvement in AIDS care
We'll see longer average life spans for people living with AIDS. This will result from better access to HIV drugs because of new funding sources and cheaper generic drugs, better treatment of opportunistic infections, and more focus on nutritional support for people with HIV. The rates of new infections will continue to rise, but the infection itself will be better controlled throughout the world than ever before.
Scandal involving fake or contaminated drugs
A large amount of fake or contaminated pharmaceuticals will be discovered; something that has international reach and is on the scale of the melamine contamination this fall. Drugs and their ingredients travel long distances, with relatively little tracking. A problem with Chinese or Indian manufactured pharmaceuticals could affect most of the planet. While finding the source factory might not be difficult, removing all affected product from store shelves would be impossible. We'll learn that the hard way in 2009.
Tropical diseases on new places
We will see traditionally tropical diseases like malaria, sleeping sickness, and dengue fever spread. The neglected tropical diseases will start to seem a lot scarier. At least one of them will be diagnosed repeatedly in a location that has never seen indigenous tropical disease before. (my money's on Onchocerciasis)
The links will take you to a detailed description of each individual crisis, accompanied by slides and photos of what MSF is up against. It is a powerful reminder that we in politically stable communities with functioning health systems have a lot to be thankful for this holiday season.