Global Health Programs Draw on Lessons from Early 20th-Century Deworming Initiative in Southern United States

By Mark Rosenberg, President and CEO, The Task Force for Global Health

Mark Rosenberg, MD, MPP, President and Chief Executive Officer, The Task Force for Global Health

Mark Rosenberg, MD, MPP, President and Chief Executive Officer, The Task Force for Global Health

Outside of global health circles, there is limited awareness or understanding about neglected tropical diseases or NTDs. These diseases are typically associated with developing countries and don’t affect people in the United States. But some NTDs, specifically intestinal worms, have occurred much closer to home. In fact, an intestinal worm called hookworm was once a major public health concern in Georgia and across the South.

In 1910, 40 percent of the population in the southern U.S. was infected with hookworm, which can cause anemia and other disabling health effects. American philanthropist and business magnate John D. Rockefeller was troubled by the toll that hookworm was taking on the South, specifically on agricultural productivity and economic development in the region. In what would become one of the largest public health campaigns ever conducted, Rockefeller donated $1 million to create a commission focused on eradicating hookworm from the South.

An intestinal worm called hookworm was a common problem in the southern United States until the advent of widespread treatment programs. Here children line up for free treatment at a county dispensary in Alabama. Source: Rockefeller Foundation, “County Dispensary,” 100 Years: The Rockefeller Foundation, accessed July 28, 2015, http://rockefeller100.org/items/show/1676. Courtesy of Rockefeller Archive Center.

An intestinal worm called hookworm was a common problem in the southern United States until the advent of widespread treatment programs. Here children line up for free treatment at a county dispensary in Alabama. Source:  Rockefeller Foundation, “County Dispensary,” 100 Years: The Rockefeller Foundation, accessed July 28, 2015. Courtesy of Rockefeller Archive Center.

The commission launched a “co-operative movement of the medical profession, public health officials, boards of trade, churches, schools, the press, and other agencies for the cure and prevention of hookworm disease.” Following a public health approach that is still used today, commission health workers conducted health surveys, distributed medication, and educated people throughout the South about prevention and sanitation. They worked with county health departments where they existed and helped create county health departments where they didn’t exist. By the end of 1914, the program had successfully eliminated hookworm from the South and led to the creation of a public health network across the South.

The South’s experience with hookworm eradication has many parallels with global health programs that are working to control intestinal worm infections, particularly in developing countries where the disease is common due to warm soil, high humidity, and poor sanitation. Intestinal worms–called soil transmitted helminthiasis, or STH for short–are among the most common infections worldwide, affecting more than one billion people. Approximately 875 million children worldwide are at risk of intestinal worm infections, which can cause a cascade of health and developmental problems, including reduced absorption of nutrients and vitamins, anemia and stunted growth, and impaired cognitive development.

Children Without Worms partnered with Nicaragua’s government to support STH control activities. The country’s health workers distributed the mebendazole during the country’s annual health campaign. Source: Children Without Worms/Johnson & Johnson

Children Without Worms partnered with Nicaragua’s government to support STH control activities. The country’s health workers distributed the mebendazole during the country’s annual health campaign. Source: Children Without Worms/Johnson & Johnson

Across the world, programs to fight intestinal worms are using many of the same collaborative, public health approaches employed by the Rockefeller-funded hookworm program in the South. Children Without Worms (CWW), a program at the Decatur-based Task Force for Global Health, is one of many groups leading the charge to stop intestinal worms.

CWW started in 2006 as a partnership between The Task Force and Johnson & Johnson. At first, the program was primarily responsible for making sure deworming medications donated by Johnson & Johnson reached children in STH-endemic countries. As more partners joined the fight against STH, CWW expanded work to a variety of fronts – through mapping and data collection, assisting with the distribution of medicine, and creating and presenting workshops and trainings focused on water, sanitation, and hygiene (referred to as WASH) in affected countries. In 2014, CWW started managing the STH Coalition, a multisectoral group of partners committed to creating a world where children are free from intestinal worms.

As the Rockefeller hookworm initiative realized all those years ago, fighting intestinal worm infections requires a multi-pronged approach. Members of the STH Coalition bring together expertise from a wide range of sectors, including public health, education, water, sanitation, hygiene, maternal health, nutrition, and global development. Partners have committed significant resources – including hundreds of millions of doses of deworming drugs, funds for research and program implementation, and the ability for members to collaborate across extensive organizational networks. They are working together to meet the World Health Organization’s target of treating at least 75 percent of children in STH-endemic countries by 2020. More importantly, they work to create a world in which children are healthy and able to reach their full potential.

There are many challenges when it comes to controlling intestinal worm infections. But, as the success of hookworm eradication in the South demonstrated, STH can be controlled. Members of the STH Coalition will continue their work together until control is achieved and children are free of this debilitating disease.

 

Posted in Uncategorized | Leave a comment

Finding Hope through the Eyes of a Buruli Ulcer Patient

By Katie Pace, Marketing & Communications Officer at MAP International

Katie Pace is the Marketing & Communications Officer at MAP International and is based in Atlanta.  Below she tells us about their experiences in the field this week in Ghana and what inspires them to continue their work.

Katie Pace is the Marketing & Communications Officer at MAP International and is based in Atlanta. Below she tells us about their experiences in the field this week in Ghana and what inspires them to continue their work.

It took two flights and over 24 hours to reach Ghana from Atlanta, then another flight and a 3.5 hour drive to reach Sunyani, Ghana.  Sunyani is in the northwest region of Ghana and is home to nearly 300,000 people and MAP International’s headquarters in Ghana.

MAP has been working in Ghana for 7 years now and focuses on Neglected Tropical Diseases, including Leprosy, Buruli ulcer and Soil-transmitted helminthiases (worms).  We also have multiple clinics and communities that we work with to treat everything from Malaria to Elephantiasis.

We’ve spent over 60 years working to provide health and hope to those in need in the developing world through medical aid and have expanded our focus to Neglected Tropical Diseases in the past 10 years.

This is an early photo of Sarah being treated for Buruli ulcer.

This is an early photo of Sarah being treated for Buruli ulcer.

In Ghana, MAP International partners with American Leprosy Missions and Effect:Hope to reach the largest population possible with Buruli ulcer and Leprosy awareness campaigns in order to not only stop the diseases but to prevent disability.

A few hours north of Sunyani in Kukuom we met Sarah, a 25 year old single mother with three of the cutest little boys I’ve ever seen.  Our Buruli ulcer team has been working with her since late 2012 after unearthing her case while performing a case detection program with American Leprosy Missions based out of Greenville, SC.

I began receiving photos of Sarah in 2013 from our team in the field, it was hard to believe she was only 23 at the time – her expression was always disheartening and the photos of the disfigurement that Buruli ulcer had caused to her foot and arm looked excruciating.

She lived in a remote region of Ghana and her case had gone undetected since she was young causing issues with her arm and her foot to turn up like a warped piece of wood.  Our team made sure she received the eight week course of antibiotics to cure her of Buruli ulcer, but her case was much more severe.

In additional to the obvious physical pain and struggles that the deformities caused, there was now a stigma surrounding her family and many in her village believed that she was cursed by a witch.  Eventually her husband left, not wanting to take on the responsibility of caring for her.  She was left with three young children and no source of income.  Her elderly parents were the only ones willing to help and her mother searched for a way to support her daughter and grandsons.

This is Sarah’s right foot, it is deformed into this position because the Buruli ulcer was not caught early.

This is Sarah’s right foot, it is deformed into this position because the Buruli ulcer was not caught early.

One day her mother heard of MAP International and American Leprosy Missions work in a nearby village.  Sarah received the course of antibiotics that she need to be cured of Buruli ulcer, but then there were the deformities.  Our teams joined together and decided that this young vibrant woman needed a chance to have a good life and making a living for her family, so we’ve created the Project for Empowering Buruli Ulcer Related Disabled Persons, now called Sarah’s Project.  Through this partnership with American Leprosy Missions and Effect:Hope we have helped Sarah to open a small mini mart in Kukuom.  Our teams are training her on the items that will sell in the local community and how to manage inventory.  This has given her the opportunity to work to support her family.

This week I had the privilege of meeting Sarah, I honestly didn’t recognize her.  This is a very changed woman from 2012, she even looks younger – there’s hope in her eyes.  We drove on a rough road to Kukuom where we expected a small ribbon cutting ceremony for her new mini mart.  We were very surprised

Sarah and her mother in her new store in Ghana, she’s very proud of this store.

Sarah and her mother in her new store in Ghana, she’s very proud of this store.

to see the community had come out to support her with a huge celebration, there was music, dancing and even the village chiefs were there.  They were not only happy for Sarah, but they were grateful that our partnership with American Leprosy Missions and Effect:Hope is allowing us to train local health workers and community health volunteers to stop Buruli ulcer and Leprosy early – preventing disability.

Our goal through this partnership is to prevent people like Sarah from getting to the point of disability, training health care workers and volunteers to recognize Buruli ulcer and Leprosy early on and end it is key.  Our team is now working to find surgery options for Sarah’s foot so that someday she can lead a normal life.  Through all the patients we’ve seen this week I have seen so much hope in their eyes, in Sarah’s case the change is so dramatic and I am thankful to be a part of something that provides so much health and hope to those less fortunate in the developing world.

This is Sarah and her three boys this week, there is so much hope in her eyes now.

This is Sarah and her three boys this week, there is so much hope in her eyes now.

You can learn more about MAP International at www.map.org American Leprosy Missions at www.leprosy.org and Effect:Hope at www.effecthope.org

Posted in Uncategorized | Leave a comment

Expanding and Accelerating Response to Calls for Ambulances and Burial Teams for Sierra Leone’s Ebola Outbreak

By Marsha L. Vanderford, PhD, Associate Director for Communications, Center for Global Health, CDC

Operator Mabinty Tarawally at the 1-1-7 call center in Freetown. The 7-1-1 number is used for Ebola vaccine trial participants, while the 1-1-7 number is the national Ebola hotline. The CDC Foundation provides support to both centers.

Operator Mabinty Tarawally at the 1-1-7 call center in Freetown. The 7-1-1 number is used for Ebola vaccine trial participants, while the 1-1-7 number is the national Ebola hotline. The CDC Foundation provides support to both centers.

At the 1-1-7 Ebola Call Center in Freetown, over 100 operators work in three shifts to answer questions about Sierra Leone’s outbreak 24 hours a day, 7 days a week. They work at a steady pace, on up-to-date software systems, answering callers’ questions and entering requests for ambulances to pick up people with Ebola symptoms. They also log requests for burial teams to come to homes where they remove the bodies of the people who died to be tested for Ebola and receive safe and dignified burials.

The call center did not always run this smoothly or with current capacity. Before the Centers for Disease Control and Prevention (CDC), the CDC Foundation, and eHealth Africa worked together to upgrade equipment and expand the number of call responders, the call center could only handle 100 calls a day. Until August 2014, only seven people worked in a cramped space taking calls from 8 AM–4 PM. Unable to get though on the call center lines, people were frustrated, frightened, and sometimes angry. Unanswered calls contributed to delayed pick up for bodies and increased, by days, the amount of time before sick people could be transported to medical care. Both types of delays increased the risk of Ebola infection to families and communities caring for the sick or mourning the dead.

With funds from the Paul G. Allen Family Foundation distributed through CDC Foundation, the call center was moved to a larger facility, adding 60 operators. Call center infrastructure improvements were made, including new computers and stations for people answering the phones and up-to-date software. eHealth Africa provided technical and management expertise for the call center. Operators for the 1-1-7 line were trained based on newly created protocols for talking to callers. The protocols helped call center workers respond more quickly and efficiently. CDC’s communication specialists and behavioral scientists created scripts and scientifically accurate content for 1-1-7 operators to respond with empathy to callers’ questions. New partners contributed so that, at its peak the 1-1-7 Call Center was able to answer 80,000-100,000 calls per week.

Marsha L. Vanderford, PhD, Associate Director for Communication, Center for Global Health, CDC

Marsha L. Vanderford, PhD, Associate Director for Communication, Center for Global Health, CDC

The impact of the Paul G. Allen Family Foundation’s investments in the 1-1-7 Ebola Call Center is felt far beyond Freetown. When call center operators enter information from each call into the state-of-the-art database developed by eHealth Africa, it is transmitted simultaneously in real time to eight districts. District call centers have also been built using eHealth Africa equipment and are integrated into the national system. District liaisons, trained by eHealth Africa and funded by the CDC Foundation, use information from the call center alerts and database to notify ambulance, surveillance, and burial teams about potential new cases, triggering specific response activities. District surveillance officers (DSOs), who work closely with CDC’s epidemiologists in Sierra Leone were hired with CDC Foundation contributions. They answer notifications from the call centers. They can react quickly because they know exactly how to reach houses. Having mapped their districts with chiefs who are leaders for each area, the DSOs are familiar with the residential areas, and they know how to find houses which are in rural areas, remote villages, or tucked behind other structures.

The 1-1-7 Ebola Call Center’s integrated alert systems and trained staff have substantially contributed to the dramatic reduction in time from when a call is received to service delivery. Before the system was in place, the average time between notification and ambulance or burial team pick up was 5 days. Now, in 95% of cases, it is less than 24 hours. The reduction in time saves lives. The less time a sick person or a person who died is in the home, the less exposure there is for family and the more hope there is for those who need to reach medical treatment.

The call center collaboration between CDC, the CDC Foundation, eHealth Africa, and other partners increased surveillance capacity in Sierra Leone. Using call center data, eHealth Africa conducts analysis and situation reports on numbers of deaths reported and topics of concern to callers. This provides Sierra Leone’s emergency management system more robust data from which to characterize and respond to the outbreak and for communication teams to develop messages and community engagement strategies to address callers’ concerns.

Six months after CDC and the CDC Foundation responded to the need to rebuild and redesign Sierra Leone’s 1-1-7 Call Center, its success has attracted attention and new donors. The United Kingdom’s Department of International Development (DIFID) and the Bill and Melinda Gates Foundation have made contributions resulting in a doubling of the number of operators and lines available and updating and enlarging the capacity of software to accept and process call data. According to former eHealth Africa Sierra Leone Country Director Susanne Kirkegaard, the government of Sierra Leone and partners are “now talking about turning the Call Center into a permanent resources, the political will to maintain it is there.”

Photos © David Snyder/CDC Foundation

Posted in Uncategorized | Leave a comment

Inspired by the strength of those who have lost everything

By Fatouma Zara Soumana, part of CARE’s Gender in Emergencies Team based in Niger, a West African country where thousands of Nigerians are fleeing to escape attacks of armed groups.  Here she talks about her job and what she’s seen in the field.

Fatouma Zara Soumana is part of CARE’s Gender in Emergencies Team based in Niger, a West African country where thousands of Nigerians are fleeing to escape attacks of armed groups.  Here she talks about her job and what she’s seen in the field.

Fatouma Zara Soumana is part of CARE’s Gender in Emergencies Team based in Niger, a West African country where thousands of Nigerians are fleeing to escape attacks of armed groups. 

In Niger, I talked with a mother of two children who told me how she fled her village in Northern Nigeria when it came under attack by armed groups. She walked all day until she came to a river. An armed man spotted her, but told her, mercifully, that she would be spared if she stayed quiet and hid in the river. So she spent all night in the river, standing, holding her children above the water’s surface, praying to survive. Now she lives in the village of Gagamari, a transit site in Niger. And while she escaped the immediate threat of the river, she and her children still face a challenge to survive. They need food, water, shelter.

Helping refugees like her and her children survive is my job at CARE. I support emergency response efforts in multiple countries where CARE helps stabilize individuals, families and communities reeling from disaster and conflict. As a gender expert, my particular role is to ensure that those efforts meet the assorted needs of men, women, boys and girls.

I recently conducted a rapid gender assessment in east Niger, where CARE supports communities and Nigerian refugees who have found shelter after fleeing attacks from armed groups.

We found that the number of refugees and displaced people has dramatically increased in recent months. Some 192,000 people are displaced in Diffa —150,000 of them have fled violence in Nigeria. They lack food, shelter, proper hygiene and sanitation facilities. And to make a dreadful situation even worse, we were told that rape and prostitution were increasing because there was so little protection against gender-based violence. We’ve also heard that young men who have been freed from armed groups lack the psychosocial support to reintegrate into society – and to reclaim the youth they were forced to abandon.

You might think at first glance that all people have the same basic needs of food, water and shelter. That is true to some degree, but a closer look reveals varying needs according to gender or age. One of my main responsibilities is to help identify those different needs, and to account for them in CARE’s response.

For example, while it is helpful for a family to receive soap and water after losing their home, women and girls also need sanitary pads; men need shaving kits; young children need enriched food, as do pregnant or lactating women.

Meeting these specific needs doesn’t necessarily cost much; we just need to ensure that we are accounting for them at the outset of our planning efforts. Because what can seem on the surface like a small need, can sometimes have severe and lasting ramifications. I’m fortunate to work with CARE to help meet the urgent needs of people in crisis. And I’m both proud and humbled to see that life-saving work deliver lasting change to girls, boy, women, men — entire communities.

Posted in Uncategorized | Leave a comment

Collaboration is Needed to Enhance Georgia’s Leadership as a Global Health Hub

By Russell Medford, MD, PhD, Managing Partner, Salutramed Group

Russell Medford, MD, PhD, Managing Partner, Salutramed Group, is working with stakeholders, including The Task Force for Global Health and the National Health Museum, to explore the development of an alliance of Georgia's global health organizations.

Russell Medford, MD, PhD, Managing Partner, Salutramed Group, is working with stakeholders, including The Task Force for Global Health and the National Health Museum, to explore the development of an alliance of Georgia’s global health organizations.

Georgia has a remarkable number of internationally recognized, top-tier organizations working in global health from the government, academic, non-profit, and private sectors. These organizations are helping to end diseases and improve health and well-being for people in Georgia, nationally, and abroad. Collectively, these organizations have a significant economic impact on both metro Atlanta and the state that likely exceeds tens of billions of dollars annually.

Georgia has the potential to have an even greater impact on global health through leveraging the collective strength of the Georgia-based organizations that contribute to the global health mission. Collaboration is absolutely critical in global health. The problems are far too large and costly for any one organization to solve on its own.

A multi-sector group of more than 30 stakeholders is currently developing an alliance of Georgia’s global health organizations to provide a framework for collaboration within the sector that will be key to its development. This alliance would not only educate policy makers and the broader community about the importance of global health research and programs, but also provide a mechanism for the creation of new partnerships between sectors, including government, non-profits, academic institutions, and private industry.

An alliance of Georgia's global health organizations would help facilitate collaborations among organizations in the state working on mosquito-borne diseases such as malaria. Photo credit CDC/James Gathany

An alliance of Georgia’s global health organizations would help facilitate collaborations among organizations in the state working on mosquito-borne diseases such as malaria.
Photo credit CDC/James Gathany

One of the priorities of an alliance of Georgia’s global health organizations will be to map the sector. This will help build an identity for Georgia’s global health sector and provide a vital resource for identifying new partnership opportunities. A mapping also would also quantify the impact of Georgia’s global health sector, as well as identify business opportunities for Georgia and out-of-state companies in global health. These metrics would allow for better promotion by showing the health and economic impact of the global health sector on Georgia and around the world.

For Georgia, an alliance would have benefits across multiple sectors, including the life sciences where a number of Georgia companies are working to “do well by doing good.” These mission-driven companies have developed products to improve health and well-being, but they lack the expertise or resources to bring them to scale or get them approved. To succeed, they have to collaborate with organizations from other sectors working in global health.

One of these companies is LivFul that has developed AKIVA (formerly known as CleanOFF), an enhanced mosquito repellant and antiseptic wipe that could help reduce malaria transmission in developing countries. To determine how to get its product to the people who need it, the company has been trying to forge partnerships with non-governmental organizations (NGOs) in Georgia that have malaria expertise and experience working in countries where the disease is endemic. “We’ve had to do a lot of work to find these NGOs,” said LivFul President Andy Mahler. “An alliance could help us identify relevant Georgia organizations working in malaria and bring us together with them.”

GeoVax is another Georgia company that sees significant value in a global health alliance. The Smyrna-based company has developed a promising HIV vaccine that is poised to move into phase 2b clinical trials. At least $25-50 million, however, will be needed to fund the trial. GeoVax has been actively seeking philanthropic and governmental support, but they have yet to raise enough money to get the trial started. “There’s a huge global need for an HIV vaccine,” said GeoVax CEO Robert McNally, PhD. “Even with a promising candidate, it’s very expensive to conduct a clinical trial. We really need a Georgia-based group that can help advocate for the global health sector with foundations and other potential funders.”

An alliance of Georgia’s global health organizations is expected to play a strong advocacy role for the global health sector by articulating the value of this sector, shaping public policy that’s favorable to its growth and development, and building effective national and international partnerships with sister organizations such as the Washington (Seattle) Global Health Alliance. While providing a framework for collaboration, a Georgia alliance will also help organizations work better together and aid in identifying traditional and non-traditional sources of funding.

An alliance of Georgia’s global health organizations is crucial for the state to enhance its reputation and recognition as a global health hub that leads the country and the world with innovative models of collaboration, funding, and finance to solve global health problems.

Posted in Uncategorized | Leave a comment

Focusing on Early Infancy Can Create Sustainable Societies and Prevent Chronic Disease

By Dr. Jose Miguel De Angulo, Regional Director for Latin America, MAP International & Luz Stella Losada, Bolivia Community Health Specialist, MAP International

Dr. Jose Miguel De Angulo, Regional Director for Latin America, MAP International & Luz Stella Losada, Bolivia Community Health Specialist, MAP International

Dr. Jose Miguel De Angulo, Regional Director for Latin America, MAP International & Luz Stella Losada, Bolivia Community Health Specialist, MAP International

Health paradigms keep evolving through history.  In the 21st Century we are witnessing the emerging of a new health Paradigm.  Neuroscience is showing how the brain architecture of the person is established during the intrauterine period and the first two to three years of life. This brain architecture is what determines the capability of the organism to self-regulate its biological, emotional, cognitive, and interactional processes with the environment. The more robust this brain architecture is in an individual, the more potential and capability that individual has to enjoy physical, emotional, and mental health at the personal level as well as his/her capacity to contribute through his/her life to the health and wellbeing of others. The new understanding of the key determinants of the development of infant brain architecture is generating a profound shift toward focusing on early infancy as the best strategy to invest resources to foster development of healthy and sustainable societies. The emergence of this health paradigm to achieve healthy and successful societies is making a shift from what is happening on systems to what is happening in a very specific arena: early infancy development.

To see the critical role that infants´ experiences play not only in their future life, but also in the wellbeing and health of society, it’s important to read J.P. Shonkoff’s The Foundations of Lifelong Health.  Through research and after reviewing a broad spectrum of the evidence accumulated in the last decade Shonkoff says it best.

moms“A vital and productive society with a prosperous and sustainable future is built on a foundation of healthy child development. Positive early experiences provide a foundation for sturdy brain architecture and a broad range of skills and learning capacities…  Advances in neuroscience, molecular biology, and genomics have converged on three compelling conclusions: Early experiences are built into our bodies, creating biological “memories” that shape development, for better or for worse. Toxic stress caused by significant adversity can produce physiological disruptions that undermine the development of the body’s stress response systems and affect the architecture of the developing brain, the cardiovascular system, the immune system, and metabolic regulatory controls. These physiological disruptions can persist far into adulthood and lead to lifelong impairments in both physical and mental health.

This new paradigm implies that governments and society will need to focus on infants and how families and society can better care for and protect them.  Because brain architecture is constructed during pregnancy and especially during the first two years of life, parents play a critical role in the generation of a robust brain architecture. Now parents need to understand and be equipped for a new radically different way of seeing, listening to and interacting with their infants. Early childhood is the most vulnerable period of human life, as well as the period with the largest potential for development. On top of that, research is showing how the infant’s brain powerfully transforms the parent´s brain and equipping them to become sensible and responsive to the infant`s brain expressions of need for her development.

Dr. Jack P. Shonkoff, the Chair of the National Scientific Council on the Developing Child, made a presentation to Westchester Children’s Association in, New York on March 24, 2006. In this presentation, “No Time to Lose: Closing the Gap between What We Know and What We Do,” he presented the conclusions of multiple years of research into the science of early childhood development. These were his main points:

“The healthy development of all young children benefits all of society by providing a solid foundation for responsible citizenship, economic productivity, lifelong physical and mental health, strong communities, and sustainable democracy and prosperity. Relationships are the “active ingredients” of early experience. Nurturing and responsive relationships build healthy brain architecture that provides a strong foundation for learning, behavior, and health. When protective relationships are not provided, elevated levels of stress hormones (i.e., cortisol) disrupt brain architecture by impairing cell growth and interfering with the formation of healthy neural circuits.”

moms2Research conducted and published by the CDC on “The Relationship of Adverse Childhood Experiences to Adult Health Status” pushes us to completely rethink the traditional way of understanding the “history of diseases” (from the moment of exposure to causal agents until recovery or death). This research is opening the door to a new way of understanding why diseases are present in society. Dr. Vincent J. Felitti and Robert F. Anda are the authors of The Adverse Childhood Experiences (ACE) Study. This was the largest study of its kind ever done to examine the health, social and economic effects of adverse childhood experiences over the lifespan (18,000 participants). The findings showed that an individual’s childhood experiences shape the epidemiological profile of that child in his/her adult life, as well as the epidemiological profile of the entire nation. Some of their conclusions are:  “Adverse childhood experiences determine the likelihood of the ten most common causes of death in the United States;” “Adverse childhood experiences are the most basic cause of health risk behaviors, morbidity, disability, mortality, and healthcare costs;” and “Many chronic diseases in adults are determined decades earlier, in childhood.”

Adverse childhood experiences are also clearly related to mental health. For example the conclusion of this study related to prescribed psychotropic medications in adults states: “The strong relationship of the ACE Score to increased utilization of psychotropic medications underscores the contribution of childhood experience to the burden of adult mental illness. Moreover, the huge economic costs associated with the use of psychotropic medications provide additional incentive to address the high prevalence and consequences of childhood traumatic stressors.”  Empathy underlies virtually everything that makes society work, such as trust, altruism, collaboration, love, and solidarity. Failure to empathize is a key part of most interpersonal and social problems, including-crime, violence, war, racism, child abuse, inequity, among others. Empathy is associated with prosocial behavior, and this relationship has been found to be mainly due to environmental effects through the expressions of sensitivity and responsiveness of parents. Empathy is experienced and developed through secure attachments with the father and mother. Insecure and disorganized attachments seriously obstruct the cultivation of empathy, which—on a broad social level—can easily lead to a society in which no one would want to live because of the cold, violent, chaotic, and terrifying interactions of all against all. Parental sensitivity. Responsiveness and proactive involvement with infants and toddlers play a key force in their capability to express empathy and prosocial behaviors in future stages of their lives.

global healthAppropriate interactions with infants cannot only generate changes at the society when they will become productive citizens, but they also generate changes in the brains of the father and mother, bringing plasticity and new way of thinking, interacting and engaging with the world.  For example, research show the importance of paternal caring behaviors to establish strong bonds, and how this is dependent on appropriated postnatal offspring interactions. In bi-parental mice this has been associated with increased neurogenesis in the paternal olfactory bulb and hippocampus.  These male mice can even recognize their offspring as adults if they interacted with their infant pups.  Research today presents exciting new ways of understanding parenting as this research conclusion:  “The brains of parents are clearly different from those of non-parents, having been changed by the presence of offspring and corresponding hormonal fluctuations. Available evidence suggests that structural reorganization occurs in the hippocampus and PFC of mothers and fathers”. The book `Sex and the Brain the Neuroscience of How When Why and Who We Love´ clearly shows how the baby’s brain interaction with the father “rewires the daddy brain” and how “Love spurs the very growth of the parental brain and even causes new brain cells to develop… Those parental impacts on your brain begin long before birth, setting into motion major factors for your future relationships.”

We must focus on children in early infancy to change society and create sustainable societies with less chronic disease.  MAP International’s uses this cutting edge evidence based approach to comprehensive Early Childhood Development in all their Focus 1365 Early Childhood Development Programs in Bolivia and Ecuador.  This new concept of care, cognitive development, freedom and autonomy for children and their caregivers is changing the marginal, rural and urban communities that we work in.

Posted in Uncategorized | Leave a comment

The Road to Zero

By Charles Stokes, president and CEO of the CDC Foundation

Charles Stokes, president and CEO of the CDC Foundation

Charles Stokes, president and CEO of the CDC Foundation

Last year at this time, the World Health Organization had just announced a cumulative total of 844 cases of Ebola and 518 deaths from Guinea, Sierra Leone, and Liberia. One year later, there have been 27,609 cases of Ebola in West Africa, and 11,261 deaths.

The U.S. Centers for Disease Control and Prevention (CDC) released an Ebola One Year Report that highlights the stories, faces and facts behind CDC’s one-year anniversary of when the agency activated its Emergency Operations Center for the response. The international public health response to this epidemic is unprecedented for the agency, with more than 1,200 CDC employees that have traveled to Guinea, Liberia and Sierra Leone to assist with efforts on the ground. While the CDC’s report has many incredible stories, I found several quotes to be particularly pertinent in recapping the response to date:

  • “We’re learning in this outbreak that Ebola is not always a death sentence. We’re learning how to care for patients so more people can live through it. Getting to people early before they are so sick that they can’t be treated will not only improve survival rates but also prevent the virus from spreading.” –Dan Martin, CDC responder, Sierra Leone
  • “Burial teams told me over and over how they had to sit and talk to families for hours before the family would let them take the corpse away for safe burial. And they would sit and talk for hours just to make a family understand why it was helping the whole community to allow their loved one to be buried without the usual ritual.” –Leisha Nolen, CDC responder, Sierra Leone
  • “I learned a powerful lesson during my Ebola work, and that is the power of fear. Fear is a natural emotion; it’s supposed to protect us from injury or infection. When you see that lion, you run! But too much fear can be a bad thing. It was our responsibility to understand the science behind Ebola and use that to encourage positive action, not panic.” –John Brooks, lead for CDC’s Ebola Response Medical Care Task Force
There is still a long road ahead, but CDC’s tremendous response is helping bring West Africa closer to zero cases of Ebola.

There is still a long road ahead, but CDC’s tremendous response is helping bring West Africa closer to zero cases of Ebola.

The CDC Foundation continues to support CDC’s response efforts in West Africa, as new cases continue to be reported in all three countries affected. There is still a long road ahead, but CDC’s tremendous response is helping bring West Africa closer to zero cases of Ebola.

Posted in Uncategorized | Leave a comment

South Sudan Marks Four Years of Independence but Few Find Cause for Celebration

July 9 marks South Sudan’s fourth birthday. After decades of war, the break from Sudan was celebrated across the country. From tiny villages to the new capital Juba, expectations were high.

Today the country remains mired in conflict that has displaced more than 2 million people and left more than 7 million without enough food.

Below, two CARE staffers describe their expectations for independence, and their hopes for their country’s future.

Mary Andrew Ladu

Mary Andrew Ladu

My name is Mary Andrew Ladu. On Independence Day in 2011, I was at home, six months pregnant with my daughter, Amito. It was too hot to join the crowds celebrating in the streets of Juba, but I was just as excited and just as happy.

I didn’t always live in Juba. We had a university in the south, but the war made it difficult to stay in school. Like many South Sudanese, I went to Khartoum to complete my degree, which is in food and nutrition. After I graduated, I joined CARE as a Nutrition Coordinator, and since have worked in South Darfur, and in camps that serve refugees around Khartoum.

When the vote for independence came, I knew it was time to return to Juba — which I did.  I knew I was home, that I was safe and no longer the second-class citizen I felt I had been in the north.

We had our own country at last. There would be no more suffering, and good things were coming. We had our own leader, one of us who understood the pain and suffering it took to make us free.

The future looked bright.

But I was wrong.

Gone are those hopes of a better life, better health services, better education for our children. The future of this country is once again dark. We are fighting ourselves, killing each other. Where will all this fighting, this death,  this destruction lead us?

Chol Majok

Chol Majok

My name is Chol Majok. On Independence Day in 2011, I was in Panyagor in Jonglei state where I worked as a Health Officer with CARE. It was one of the most exciting days of my life.

I thought then that all of South Sudan would be free, that we would have a better life. I had been a child soldier growing up during the war, and I didn’t want my children to grow up the way I had. We had our own country now, the promise of a better future – no more insecurity.

Now there are no hopes, the future is so bleak. People are dying – from war, disease, hunger. I didn’t think this could happen again. I fear we are no longer a nation, that tribalism and ethnicity are all that matter.

This is not the South Sudan we had at Independence. We need to think of our future and not be stuck in the past. We need to know our rights and to act on them. We need leaders who will take us forward. We are looking now at the international community, because our leaders will not find peace.

Posted in Uncategorized | Leave a comment

What an International NGO does when the Disasters Fade

By Katie Pace

- Katie Pace, MAP International Public Content Specialist

Katie Pace, MAP International Public Content Specialist

While headlines about Ebola in West Africa and the earthquake in Nepal have faded, the need for relief to those areas has not. Global health relief organization MAP International continues to provide critical medical supplies to those in need in Africa and Nepal, as well as the Middle East and South America. Supplies range from bandages and pain relievers to vitamin B and antibiotics. In May and June alone, the value of the shipments to those in need totaled more than $13 million in Wholesale Acquisition Value, impacting the lives of hundreds of thousands of people.

“Major disasters and disease outbreaks capture the public’s attention and generate a strong donor response, but in between those high-profile events, the need to supply medical relief around the world doesn’t stop,” said Steve Stirling, president and CEO of MAP International. “A $1 donation allows us to ship $60 worth of essential medicines and supplies to those in most need.”

DSC01032Stirling notes that the nonprofit’s pharmaceutical partners, which include Johnson & Johnson, AbbVie, 3M and many more, donate medicine and supplies or provide them at reduced cost, which allows any donation to go much further.

In the Middle East:

For the first time, MAP is partnering with United Palestinian Appeal (UPA) to provide medical aid to more than 625,000 people in Gaza. The 6,000 lb. shipment left the U.S. on June 18 and is funded through an ongoing partnership with nonprofit International Relief Teams. It is expected to arrive in mid-July and includes bandages, respirators, eye drops and antibiotics. The shipment is valued at $1.3 million (wholesale acquisition cost).

DSC01031In Asia:

MAP continues to provide assistance to those injured in the April 25th earthquake in Nepal. So far, more than $1 million in assistance has been sent to the area. The supplies sent include antibiotics, oral rehydration salts and first-aid items that will treat an estimated 95,000 people.

In Africa:

Over $3 million in general medical relief to Ethiopia left MAP’s Brunswick headquarters in mid-June and will arrive in late July. The Central African Republic has received 90 MAP Medical Mission Packs that will treat 60,000 people in this devastated region, this $2 million shipment was sent in partnership with nonprofit American Leprosy Missions. MAP continues to restock clinics in West Africa that saw their supplies of medicines exhausted during the Ebola outbreak.

ALM Packs for CARIn South America and the Caribbean:

MAP’s partner, Hope for Haiti received a shipment of 35 MAP Medical Mission Packs. Each pack will treat 700 people with antibiotics and other essential items. Honduras has received $4.3 million (wholesale acquisition cost) in medicines and general medical needs from May through July. While an additional $1.3 million in medicines and other medical needs has been shipped by sea to El Salvador and will reach those in need by mid-July.

U.S.:

More than $114,000 in personal hygiene supplies were provided to partners in the United States for use at shelters and other areas in critical need.

16375830107_3ced140cf4_oAbout MAP International: MAP International (www.map.org) is a global health and humanitarian organization that delivers medicines, medical supplies and health services around the world. Each year, MAP International provides more than $330 million in essential medicines to 10 million people in more than 100 countries. The organization has 10 offices worldwide, serving people in the United States, Africa, Asia and Latin America.

Posted in Uncategorized | Leave a comment

Global Health Means Health At Home Too

By Mark Rosenberg, President & CEO of The Task Force for Global Health

Mark Rosenberg, president and CEO of The Task Force for Global Health

Mark Rosenberg, president and CEO of The Task Force for Global Health

Traditionally, there has been a dichotomy between U.S. health (“health at home”) and global health (“health over there”). The pervasiveness of American exceptionalism drives much of this belief that the United States is better and separate from the rest of the world, despite glaring evidence that our health system performs poorly on many measures, especially cost, compared to health systems in other countries. But as the world has flattened and become more interconnected, we can no longer afford to approach global health with an “us” and “them” mentality. Our experiences with infectious diseases such as HIV and most recently, Ebola, have demonstrated that global health does not stop at U.S. borders.

We are now in a golden age for global health. Unprecedented levels of resources are being devoted to global health programs that are providing new opportunities for health improvements. Improved health, in turn, has led to increases in life expectancy and quality of life for people in the developing world, helping to fuel economic development. Over the next three years, six of the 13 fastest growing economies will be in Africa. Programs to arrest the HIV epidemic, reduce deaths from malaria, and improve maternal and newborn survival have succeeded in part because of innovative approaches to health. But despite clear evidence of their potential applications for “health at home,” these approaches have not yet been imported back to the United States.

Healthcare workers in 49 developing countries are using specially equipped smart phones to collect and analyze data about the prevalence of neglected tropical diseases. Photo courtesy Neglected Tropical Diseases Support Center.

Healthcare workers in 49 developing countries are using specially equipped smart phones to collect and analyze data about the prevalence of neglected tropical diseases. Photo courtesy Neglected Tropical Diseases Support Center.

Mobile devices, particularly smart phones, offer powerful solutions to challenging global health problems. Programs in African and South Asian countries are using a technology as simple as text messaging to report new cases of infectious diseases, births and deaths, and even health facility utilization statistics. In 49 developing countries where people are threatened by neglected tropical diseases, the Decatur-based Task Force for Global Health has deployed more than 1,000 smart phones to aid healthcare workers in the field as they collect and analyze data about the prevalence of these diseases. Smart phone applications also are being developed that will alert to outbreaks of diseases that could affect people globally such as Ebola, Severe Acute Respiratory Syndrome (SARS), and Middle East Respiratory Syndrome (MERS). Mobile technologies are low-cost tools that could support an improved global disease surveillance network and also help strengthen our domestic surveillance network.

Mobile devices also have the potential to capture important health data that can be used to inform better health choices and assist public health professionals in responding to problems. An estimated 90 percent of Americans own cell phones and among those 64 percent were smart phones. Smart phone adoption continues to increase worldwide. However, the developing world and European countries have already taken leads in showing how these technologies can be used to prevent the spread of diseases, empower individuals to make healthy choices, and demand effective government. Best practices and lessons learned from these experiences could be used to improve “health at home.”

Georgia organizations have the potential to help make “global health at home”–a concept developed by Dr. Howard Hiatt, a former dean of the Harvard School of Public Health–a reality. Diverse global health approaches could be applied to help address at least two urgent public health issues facing Georgia today–high maternal mortality and HIV infection rates. In 2011, Georgia had the highest rate of maternal or “pregnancy-related deaths” and the fifth highest rate of new HIV diagnoses, levels on par with some developing countries. A Georgia Global Health Alliance could bring to bear members’ expertise and solutions that have worked in other countries to address these health issues in Georgia. The Washington Global Health Alliance has been sharing their experiences with the program “Global to Local” with Georgia as it works to build its own global health alliance–and I look forward to sharing with you more updates about its development.

Posted in Uncategorized | Leave a comment