Utah Valley Global Health Group

A blog about global health for those living in Utah Valley and their friends.

Archive for the ‘Guest Bloggers’ Category

Karl Kirby and Rising Star Outreach: Experiences with Leprosy in India

Posted by chads on April 14, 2009

To introduce myself, I’m currently serving as the medical director for Rising Star Outreach (RSO) in India. Chad has asked that I post something about what I”ve been doing over the past 8 months. It’s very difficult to know where to start, but I’m going to give it a shot and then follow-up with more, depending on the questions that follow. I have no special training in tropical medicine or public health, just a long-standing desire to be involved in improving the health care for those most in need. So, I’ll be happy to hear from others with more experience and/or training who have suggestions and comments. I am a family-medicine trained physician and spent the first four years of my career as the physician of a rural Community Health Center in Na’alehu Hawaii. After that, my wife and I felt it was time to do what we’d always said we’d do – find an organization who needed our services in a developing nation. Through Chad, we discovered a need with Rising Star that fit perfectly with our skills and desires. Rising Star Outreach exists to try to assist those who have been afffected by leprosy (although I’m aware that the term Hanson’s disease is preferred among some, I’ll continue to use the term leprosy in this posting because it is the term commonly used here in India). While I work on the medical side of the organization, my wife (who has an education background) assists at the school.

In India, RSO runs a mobile clinic in an attempt to improve the healthcare for the seven colonies it services. At the same time, RSO administers microloans to leprosy afflicted infividuals and offers a boarding school to some of the children from the colonies. I live with my wife and 3 small children on the rural RSO property which also houses the children’s hostels and school. My responsibilities include overseeing the mobile clinic and medical services on site for the children (and other employees). I work closely with a local physician, who is trained as a general practicioner, and a local nurse.

In India, the rates of new leprosy cases are very low. The Indian government and the WHO have made huge efforts to encourage early detection and treatment which are now paying off. The patients whom I treat are not people with active leprosy, but rather people who acquired the disease many years ago, did not receive prompt treatment, and now suffer various disabilities because of it. Because of the nerve damage that has taken place, many of the patients suffer from chronic ulcers, primarily on their lower extremeties. One of our big goals has been to try to find a better way to help these wounds heal. Having done a little extra training in woundcare before arriving, I had certain ideas about what needed to be done to improve healing. However, I soon realized the difficulty in transferring these techniques – the main barriers were lack of similar materials and also the low frequency of our visits.

About a year ago, I was introduced to a surgeon from Mumbai, Dr. Atul Shah, who was holding “camps” to help similarly afflicted individuals treat their wounds. He was giving instruction sessions and handing out small packets with a callous file, bandages, antisceptic, and antibiotic ointment. He was reporting good results through this self-care program. At first I was a little skeptical that this could really have the impact I was looking for, but after several months of treating these patients with little success, I began to see the wisdom in this program. With it’s focus firmly on self-reliance, it fits in well with our efforts to educate the children of the colonies and encourage financial independence.

So, in January, we put together our own self-care kits, and started rolling out this program to the seven colonies we visit. Each colony is visited every 2 weeks. In the past these visits included consultation with the physician and the dispensing of basic medications for general problems as well as bandage changes for those in need. We also provide transportation to a private hospital in Chennai, Sri Ramachandra Medical Center, two or three times a month for patients needing specialty care, procedures, or hospitalization. (This gives them another option for care outside of the government system.) Now, in addition to the other services provided, we meet individually with each patient to assess their wounds which we are following with digital photos. It allows us to provide specific encouragement and reinstruction as they look at their initial photo on our laptop and view the current wound. We’re currently midway through what should be a 4 month program in several of the colonies, with the larger of our 2 colonies being about a month into it. It’s been very exciting to discover that many of the patients are making very good progress, while I saw very little progress in the months before the program. To me, this is a great example of the effectiveness of a simple program that places responsibility with the patients. Clinically, I believe the program is working because it encourages a gradual removal of old deep callous (through soaking the feet and using the callous file) so that it can be replaced with more viable tissue, and it simply encourages more regular care of the wounds.

In addition to the work in the colonies, caring for the medical needs of the 125 boarding students has been a treat. They are a fun group of children who always pose the challenge of figuring out whether they have a serious medical problem that day or just want a little more attention. Thus far, we’ve avoided anything catastrophic, although we’ve had our share of fractures, lacerations, common pediatric infections, and single cases of scopion envenomation, slipped capital femoral epiphysis, and clinically significant Hepatitis A, and Typhoid fever. We’ve begun a program, with the kind help of a local pediatrician, to provide immunizations to the children which are not on the government schedule (next up is Typhoid) which I’m very pleased with. Dr. Jayakumar drives about 40 minutes and provides staff and vaccinnes each month to assist us in this project. We became acquainted when I started taking my own son to him for his 1-year vaccinations.

So, overall, this has been a wonderful experience for me. I have no delusions that the service I offer is any greater than the growth I’m gaining through the medical experiences I’m having as well as the personal growth that comes with service. Hopefully, with the help of others, this can be one step toward increasingly more effective interventions as we strive to assist those with the greatest medical needs.

On another note, RSO is very interested in keeping a health-care professional on campus once I leave. I will be coming back to Utah in May. While the local physician and nurse will still be running the medical services, they live about 40 minutes from campus. To manage the urgent, or potentially emergent, problems that arise with the children and employees, RSO would like to keep a healt-care provider on site. This could be a physician, a PA, a nurse practitioner, or an experienced nurse or EMT. They would also get to assist with the work of the mobile clnic. We are looking for someone who could commit to staying for a significant period of time (close to a year or more). If you or anyone you know is interested, please let me know.

Posted in Announcements, Clinical Tropical Medicine, Guest Bloggers, humanitarian aid, Leprosy, NGOs | 4 Comments »

Maternal Mortality by Mallory Peterson

Posted by benjamincrookston on December 10, 2008

Maternal mortality has a huge impact on global health. If a mother dies the likely hood of a child surviving decreases. Also, if a woman is educated her health and her family’s health go up. The most mothers are dying in two regions Africa and Asia. Over three-quarters of maternal deaths are a result of direct complications of pregnancy and childbirth. These problems are not things we cannot prevent or cure, but society of these regions have not decided that women are important and need more care and attention. I think a big part of the solution is to empower women through education. Changing society is long time goal, but there are small things in health care such as training and educating personnel can make a difference. Ultimately I hope that someday the importance of women will be noticed in all societies to make a major change in health. But by our small efforts in health we can spread awareness and hopefully bridge that gap.

Posted in Global Health, Guest Bloggers | 8 Comments »

Give that Rat an MPH.

Posted by chads on September 12, 2008

Guest Post: David Stoker, BYU MPH Alum, Ashoka

The other day at work I met with one of our FellowsBart Weetjens of Apopo.  He has a creative and successful strategy that is not taught in most public health courses:  he is training giant African rats to identify tuberculosis bacteria in human suptum samples.   I was struck by both his innovation and the incredible speed and cost efficiency of his solution.   Taken from his website:

“In 2002, 2 million people died worldwide from TB. The WHO prospects lethal cases to increase to 8 million by 2015. In sub- Sahara Africa, the combination of TB and HIV result in the highest casualty rate per capita, worldwide. The low detection rate of TB cases, which is reportedly only about 1/3rd, is one of the main factors of the spread of TB. The main reason for this low detection rate is the lack of a cheap and reliable diagnostic tool that can handle big volumes of samples.

Trained sniffer rats may offer a solution. A rat can evaluate 40 samples in 10 minutes, equal to what a skilled lab technician, using microscopy, will do in one day. Without requiring sophisticated instruments, this method is non invasive and can handle a high volume of samples, all very important factors in a pro-active screening approach.

APOPO started this pilot research in 2003. The outcome was positive, and the project was awarded by the World Bank for further investigation. In partnership with the leading national TB programs, APOPO set up a sample collection program in several regional DOTS centers. About 900 sputum samples are collected on a weekly base from six health centers in Dar Es Salaam and one in Morogoro. These samples are double checked as a reference for comparative testing, and cultured for training.

The new technology is now thoroughly tested and compared with existing methods. In a next phase, APOPO plans to focus on TB detection in an early stage of development, as well as on improvement of the sample and collection method.”
Here is a video of the rats in action, unfortunately there is not a voice over to explain what is going on, but basically there are ten samples in each batch and there is a hole corresponding to each location, the keeper opens and closes the vents, allowing the rat to smell each sample individually, you will see the rat scratch on the second sample and be rewarded.
You can find out more on their website about the evaluative research conducted by European and American universities.  You can also read more about Bart’s main work which involves a fleet of rats that have been trained to identify land mines, there is a great video produced by Animal Planet but there is not a direct link, you must navigate to it in their press room.

Another interesting Ashoka Fellow that came through the office recently with a public health focus was Dr. Gladys Kalema-Kikusoka, founder of Conservation Through Public Health. She is working towards conservation of the mountain gorilla population in Uganda but her strategy is a community-owned public health initiative in the communities surrounding the national park.  Another innovative model.

Posted in Guest Bloggers | 2 Comments »

The Economic Interplay on Global Health by Rachel Milar

Posted by benjamincrookston on August 12, 2008

As I just finished a project on nutrition in Mexico my mind was taken back to a trip I took to Roma Texas, an establishment of no more than 30 people, earlier this year.  Roma Texas is hardly a pueblo in central Mexico, a dry and arid area.  I went with a small NGO to help build a bathroom for a local school–an interesting project that exposed me, more than anything, to the poor people in rural Mexico.  It was my first trip to Mexico, and going into it I assumed that the most shocking part of the trip for me would be the abject poverty the people lived in.  Upon returning home I was surprised to realize that it was the lack of an economy that most stuck out to me.  I was shocked at how little opportunity the people there had, simply because there was no economy in which to showcase whatever education they gained.

In the project I just worked on discussing malnutrition in Mexico, one area of concern was that though the people are improving their education, they have nothing to do with it.  This is a fascinating aspect to any program throughout the world; ensuring that the education people gain through any program will be utilized.  Health organizations obviously have an opportunity that they hopefully regard as a responsibility to educate people on health in general as well as specific health topics.  In doing so they spark an interest in the people in furthering their own education, but they need to be careful in ensuring the people have something to do with that education; my fear and understanding is that there are far too many places across the globe like Roma Texas, where survival from day to day is the way everybody lives.  As health organizations plan what programs they can implement to improve the health of specific groups of people, education and its use in the economy is a crucial characteristic to take into consideration.  I certainly believe that education is a priceless gift for anybody; I now can see why the ability to use that education is also of significant importance.

Posted in Guest Bloggers | 3 Comments »

Don’t Get Discouraged by Jessica Hansen

Posted by benjamincrookston on August 12, 2008

Becoming more involved in an international health class has made me realize the importance of knowing how to implement and manage programs aimed at improving health in developing countries.  There seem to be a lot of organizations that have really great intentions, but lack in the program planning part of carrying out their motives.

A lot of programs fail because they ignore many aspects of the populations and forget that many problems are multi-dimensional and therefore require more in depth research. However, while remembering that a small percentage of programs actually are efficient and reach the end goal, it is important to not let this discourage you from helping others. I think most people in general are really good people and just want to do good, so don’t let the ones out there that aren’t that way ruin your aspirations. A lot could be accomplished in the world if everyone with their different knowledge expertise came together and developed a program for many health disparities in the world.

Posted in Guest Bloggers | Leave a Comment »

Birth Control and AIDS/HIV by Kerry Mears

Posted by benjamincrookston on August 11, 2008

Due to the moral and many times religious beliefs of people and countries, teaching condom use as part of a prevention program has become less emphasized.  A typical prevention motto is ABC- which stands for Abstaining from sex until you are older, Being faithful to your companion (and not having sex with many people), and Condom use.  Many people focus on the A and B part, but are leaving out the C part.  Sometimes due to religious and moral reasons, the condoms part of HIV prevention is left out, therefore affecting the people who probably most need them.  PBS did a wonderful series on HIV/AIDS, called the “Age of Aids”.  It can be located at http://www.pbs.org/wgbh/pages/frontline/aids/view/.  In the story we learn about a wonderful passionate woman named Noerine Kaleeba, a founder of Africa’s first AIDS support organization.  Her husband received a blood transfusion in 1983 with HIV infected blood.  By January of 1986, he passed away.  She gets frustrated when countries and policies leave out the C part, because she knows that condoms are what saved her life, not anything else.  Unfortunately the spread of HIV/AIDS has become so big, we cannot forget the large amount of people who already have it.  At the beginning of the HIV epidemic, leaving out condoms might have been a more viable option,  but now it’s one of the most important preventions to stress.  Many people argue that encouraging condom use encourages people to have sex as youth, or with sex workers, yet there are no specific studies that prove that.  Plus, I believe another large moral issue that is being faced is the ability to choose.  Of course programs should do all that they can to encourage and support the A and B part.  We know that strengthened family ties, and stronger communities come from this, and strong HIV prevention.  Yet, our programs don’t have the right to deny people the ability to choose.  That would be dictatorship.  People who already have HIV are already choosing to have unprotected sex.  There is no way to force people to stop having sex outside of a monogamous lifelong relationship.   We should encourage and teach people as much as we can,  but they still have choice.  And while they are still choosing to have sex outside of that relationship, they need to learn about protection.  To me it is a similar principle as self-defense.  If you take a group of women and teach them self-defense in case of an emergency, than some of those women will only use the skill when they absolutely need it, and some might choose to use it when they shouldn’t or don’t need to.  Yet, I think that most of us would agree it would be important to teach the class anyways.  HIV is a disease that is hitting husbands and wives, parents, and now children.  We need to teach everyone about “self-defense” through ABC -especially with condoms.  As Noerine said “…this debate of condom or no condom really makes me angry, because I know for a fact my husband had HIV; I don’t have HIV.  If you ask me to put it on record what actually protected me from his infection, it was a condom.”   Just because we have certain religious or moral beliefs about sexual relations outside of marriage or a monogamous partner, does not mean that we can deny possible health benefits (through the leaving out of teaching of condoms as a prevention) to those who are suffering with, possibly spreading, and at risk for HIV.  After all, isn’t health a human right for all?

Posted in Guest Bloggers | 4 Comments »

International Development by James Fuller

Posted by benjamincrookston on August 11, 2008

Governments, like any steward, are certainly most effective and responsible when they are accountable to their constituencies. Unfortunately for the millions suffering throughout the world, no one is held accountable for failures in global health, but many are willing to take credit for success. I don’t mean to cast stones at the sinners; I simply believe it is important to recognize the inherent flaws in the international system in order to avoid them.
Bilateral and multilateral donors spent over $11 billion in 2005 on health and population projects. A large portion of that comes from American taxpayers. Therein lies the problem. Donors often respond to the wishes and needs of taxpayers, instead of to the wishes and needs of the sick. Can we count on donors to always act in a humanitarian way? The answer becomes clear when we apply the same question to a Congressman or bureaucrat.
The truth is, donors often act in their own self-interest. Aid is too often used as a foreign policy tool instead of a health tool. At present, aid does not provide a voice to the voiceless; when a USAID funded clinic in Kenya is not appropriately staffed or equipped, USAID is not held accountable to Kenyans. USAID is accountable to the American people, and if the taxpayers are indifferent then so too will be USAID.
Though aid is only a fraction of our government’s budget, it must become a more important policy issue. An increase in the quantity of money will not be nearly as valuable as an increase in the quantity of it. Donors must become more transparent, Information on aid projects must become easily accessible to taxpayers, and most importantly, taxpayers need to care! Election time is wonderful for showing what Americans want from their government. Unfortunately, most of those desires are entirely based on material self-interest. Donors will not become more responsive to the health needs of the world, until we the people are ourselves responsive.

Posted in Guest Bloggers | 3 Comments »

Is the empowerment of women the key to many global health issues? by Jay Clark

Posted by benjamincrookston on August 10, 2008

Many of the world’s developing countries are male dominated. Education and employment opportunities are scarce for women in these countries. They are often treated as second class citizens. However, the countries that are at highest risk of major diseases are also the countries that have the lowest literacy rates of females.

I wonder how much global health would improve if governments and NGO’s focused mainly on empowering women in developing countries. It’s true that women have the primary responsibility of caring for their families, and many NGO’s focus on women’s groups to improve health and education of women. However, in cultures where women are not treated equal to men, the learning of mothers can easily be overcome by the authority of the men. For example, there are programs in South Africa  that teach mothers the importance of exclusive breastfeeding for the first 6 months yet the country has a low rate. This is because men exert the authority they have and dictate the feeding practices of their children. If women could be empowered they would be able to receive better education on how to raise their families, have better opportunities, and be able to put into practice things that they are taught will improve the overall well-being of their families.

Posted in Guest Bloggers | 6 Comments »

Addressing Dengue Fever in Paraguay by Kaitlin Carruth

Posted by benjamincrookston on August 6, 2008

Dengue fever is a viral disease spread by the Aedes mosquito that causes fever, rashes, and almost unbearable bodily aches and pains. I have also heard the illness referred to as the “bone-crushing” disease because of the severe joint pain that it causes. I lived in Paraguay in 2007 when more than 100,000 people were affected with dengue. I saw victims lie helplessly in bed for days, unable to do anything but wait for the symptoms to pass. What I found most disturbing was that majority of the people were helpless and did not have any means to protect themselves from catching the fever. While a cure for dengue will probably remain unavailable for many years to come, Paraguay and local NGOs need to enhance the prevention efforts for the people.

I think the best way to prevent people from getting dengue in Paraguay is by having a government-sponsored program to provide repellent to all those who need it. The repellent could be distributed in the local clinics and pharmacies. While mosquito nets are an effective way to help stop mosquito bites and avoid diseases such as malaria, I am not convinced that they would be as successful with avoiding dengue. A specific mosquito that comes out only when sun is setting spreads the dengue fever. This is not a common time for people to be under a mosquito net in Paraguay. For this reason, I think that it would be a better idea to use a repellent such as DEET in order to prevent mosquito bites. Repellent should be applied to skin and clothes should be treated with the repellent to maximize its effectiveness. Focusing efforts in providing repellent rather than nets would be more beneficial for the people of Paraguay. This would prevent outbreaks such as the one that occurred in 2007.

Posted in Guest Bloggers | 1 Comment »

Needle/Condom Exchange vs. Moral & Ethical Behavior, should it conflict? by Natasha Antoniak

Posted by benjamincrookston on April 15, 2008

I often say “should” is a funny word. It denotes an expectation or assumes that there is a “right/wrong” with whatever the situation is. However, in my opinion, this thought process detracts from what is most important in terms of treatment and prevention, specifically among the situation of Needle & Condom exchanges. Some think theses exchanges goes against moral and/or religious belief. Some think ethics are involved because of the use of resource & seemingly “controllable behavior” and therefore, it conflicts with ‘correct conduct of life.’ Others take into account the age of responsibility (i.e. it would seem ok to give out condoms and needles to people 18+ yrs (say in community health centers) but that it would be wrong to distribute to anybody younger (such as in schools) since it is under the parents jurisdiction because the kids are still considered minors). We also know the risk of HIV/AIDS and many other STD’s could significantly be decreased because of these distributions, not to mention the cost of health care would decrease because of the prevention and treatment going on. I think it is a matter of learning how to view the situation and discerning what is best vs. what people think is right/wrong. Joseph Smith, a religious leader, once said, “Teach correct principles & let them govern themselves.” Meaning, we can do our best in educating but what it comes down to is that it doesn’t matter who, how, what or why these people are doing what they are doing. We have a stewardship, as part of humanity, to take care of each other and not judge each others actions & behaviors. Yes, we can educate, encourage, and seek to prevent but it would be to global health’s detriment if we withheld our support and resources. I understand that this can be a controversial subject as it becomes a matter of judging. But how grateful we can be for our ever-growing knowledge and use of resource! For ex., this type of thought process can be carried down to the smallest & quite typical example of the girl in school or the church group that gets pregnant. Her peers or members of the congregation have a choice to make in whether they will support or shun her because they don’t want to seem to condone her behavior. Rather, this isn’t the most relevant issue at all. Let us look past the behavior and realize the health of the girl and the baby is what becomes most relevant. My point with all this is that this same principle and perspective parallels the needle and condom exchange controversy. It is about being humane and understanding the worth of a soul and the worth of its body and our stewardship over such gifts & people. May we seek the greatest quality of health for all people.

Posted in Guest Bloggers | 2 Comments »