As some of you know, I’m an avid photographer. Although I primarily rely on the power of words when I blog, photographs have always struck me as particularly influential. In part, it is because of what they add– the color, the reality, the emotion. But at some level, I appreciate photos because of their limitations– unlike video, they only capture a moment, leaving the rest of the story to imagination. Photographs really represent both the mystery and the fragility of the human condition, and they have become a big part of my career in global health.
The last decade has seen an unprecedented growth in the number of students from the United States involved in global health and development projects. Students offer a very unique position and perspective in these disciplines and we must question whether the current paradigm is most effectively using this new development workforce. Many students work for short periods of time (3 months is standard, although some go for even less) and it is difficult to have an impact without proper planning and consideration of important aspects such as future sustainability, local partnership, and optimal contribution.
One area where students have the potential to play a transformative role is in serving as a nexus between academia and activism. There is a dissonance in the fields of global health and development practice because research from elite universities often ends up being poorly translated from the format of highfalutin publications that may never have an impact on the ground where the people are. The irony is that students from these institutions are the same ones who often end up working for NGOs during their summers yet often don’t see the opportunity of leveraging their class work and academic connections to inform their internships or projects. Continue reading
Avenues for participation and presentation in global health are growing rapidly– the following three conferences are ones that I highly recommend and that I will be attending next year.
The UC Global Health Institute conference, formally known as the UC Global Health Day, is going to be held on Saturday, April 26th 2014 at the UC Davis campus in Northern California. The abstract and proposal submissions open on October 14th. The UC Global Health Institute is a collaboration among all 10 University of California campuses to promote global health scholarship and activism. I am serving as one of the members of the student subcommittee that is organizing the structure and function of the event– if there is anything in particular that you would like to see featured or highlighted at the conference, please contact me via email.
The Consortium of Universities for Global Health (CUGH) Conference is being held on May 10-12, 2014 in Washington D.C. Abstracts are due by December 15th, 2013. The CUGH is a collaboration among several academic institutions around the world dedicated to improving global health education and practice through pooling intellectual capital and resources. I’m honored to be serving on the Trainee Advisory Committee of the CUGH which will be responsible for influencing the international global health education agenda. If you have ideas for ways to improve the current global health curricula from a macroscopic perspective, feel free to contact me.
The Unite for Sight Global Health and Innovation Conference, is held annually at Yale University. I’ve attended and presented at the conference for several years and it continues to expand and innovate– last year, the conference brought in over 2,200 participants from 55 countries. Particularly noteworthy, the UFS conference not only features academic presentations, but also social entrepreneurship and activism-related efforts in health and development. Abstracts can be submitted here, and the conference will be on April 12-13, 2014 in New Haven, Connecticut. This year, I’ll be presenting a social enterprise pitch I’ve been developing with regards to improving access to scientific and medical publication for authors from low-income countries.
If you are aware of other reputed global health conferences in 2014, feel free to leave a note in the comments.
A child born to a literate mother is 50% more likely to survive past the age of 5
The #1 cause of death for girls 15-19 is childbirth.
50% of sexual assaults in the world victimize girls under the age of 15.
Statistics such as these are the driving force behind the film Girl Rising, a narrative that follows the stories of 9 girls from low-income countries around the world. I had the privilege of watching the film as part of an event by the UCLA Center for World Health and was impressed by the work’s very unique artistic mastery that gives it both a sense of raw realism and yet a fantastical edge that makes us feel like we are seeing through the eyes of the children themselves.
A few points about the film were particularly interesting, the most notable that the stories of the girls were not spoken by them but primarily voiced over by a host of recognizable names. I don’t disagree that this added greatly to the cinematic appeal of the production, and perhaps it was the right decision in terms of reaching the film’s ultimate objective (which I understand to be for it to serve as a medium through which to educate and allow people to donate to selected NGOs). Still, the dilemma in telling stories through interpretation is a valid and complex concern. Continue reading
Care for undocumented immigrants is an important topic that is especially relevant for those practicing medicine in Southern California. When the Affordable Care Act was revealed in 2010, one of the first circumscriptions I noticed was that expanded coverage did not include those who were undocumented. Given that this group comprises over 11 million people in the US, it’s not an insignificant limitation. As physicians, a deep ethical question is whether our duty to treat and serve all supersedes the interests of American immigration regulation and our country’s laws on this topic.
The current situation and the way it will be impacted by the ACA was covered by Harvard’s Dr. Benjamin D. Sommers in his NEJM perspective article last month. Currently, 80% of undocumented immigrants are in the labor force, but most are in very low-income fields that generally don’t offer health insurance. Moreover, their immigration status excludes them from both the traditional Medicaid and Medicare programs. Some, depending on their state and chief complaint, are covered by Emergency Medicaid, which finances cases that are deemed by a medical review board to be “life-threatening” in nature (the most significant being child-birth). However, in reality this covers very few people in very few situations. The health impacts of limited care for these people are quickly noticeable: Dr. Sommers mentions the “immigrant paradox“– the unusual observation that most immigrants to the United States, particularly from Latin America (75% are from this region), are healthier and live longer than their non-immigrant counterparts–and how their health outcomes are quickly worsening due to both lack of access to care and American lifestyle factors.
Do big pharmaceutical companies have a role to play in global health? Yes. Is it a role they want to play? Maybe. When the idea for a new drug is born, it is nurtured by the financial potential and robust future markets that will be there to welcome it. Reasonably so– many drugs, from start to finish, cost over $1 billion. This is why drugs that won’t last for long, such as antibiotics that are constantly at the whim of AB resistance, and drugs that won’t be terribly profitable, such as those for Neglected Tropical Diseases, do not have a strong force driving innovation and research for their development. Continue reading
Even for those relatively well-versed in the “global health” dialogue, it can be excessively confusing to figure out the who, what, where, when, and whys of the field, particularly given the rate at which the paradigm is shifting.
In an opportune paper in the New England Journal of Medicine, Dr. Julio Frenk, the Dean of the Harvard School of Public Health and former Minister of Health of Mexico, along with Dr. Suerie Moon, helps us navigate what he cites as the now greater than “175 initiatives, funds, agencies, and donors” that comprise the system.
While reading a recent CDC fact-sheet on HIV/AIDS in the United States, I was surprised to see how heavily concentrated the epidemic is in sexual, racial, and gender groups, namely men who have sex with men (MSM), African Americans, and heterosexual women. The incidence (rate of new infections) has been relatively stable at about 50,000 new people infected per annum, but the rate of infections in the young gay community has been steadily increasing while that in heterosexual African American women has been decreasing. Continue reading
I recently wrote a piece for PLoS Translational Global Health on the challenges that our team at the CDC Global branch in Maputo, Mozambique faced in conceptualizing a strong HIV/AIDS communications campaign for the country. Fraught with challenges including social constraints, legal infrastructural limitations, shortage of commodities and healthcare personnel, and a lack of consistent evidence-based data on various aspects of the epidemic, we realized that the first step in how to start a campaign is to identify how not to start one.
Ultimately, we decided to focus on the role of national public leadership by various African Presidents, Prime Ministers, Ministers of Health, First Ladies, and important figures from civil society (actors, sports stars, musicians etc.), comparing and contrasting the best and worst practices in HIV communications (campaigns, speeches, public demonstrations etc.) over the past decade or so in 14 different countries.
Given that this has not been widely studied before, we had to create a novel likert scale to assess levels of public leadership and examined various sources, including interviews with relevant governmental officials, literature reviews of academic publications, and an in-depth search through press releases and other forms of public media available in print and on the web.
Some best practices included direct campaign spearheading, relation of familial experiences with HIV by Presidents and Prime Ministers, public testing and disclosure by government officials, and leadership in international organizations. Poor practices included stigmatizing attitudes, ambiguous/false messaging, minimal government involvement, and low international visibility.
The work was presented at the Josiah Brown poster fair (see below) at the David Geffen School of Medicine at UCLA and will be organized into a more formal manuscript.
Imagine your 7-year-old son’s face, abdomen, and legs begin to mysteriously swell one morning. Your initial reaction as a parent would likely be to worry first. However, your second instinct is probably to rush to your computer and search the internet for what might be going on. This is easy enough for the roughly 72% of people in America who have a computer with internet access in their homes. Now, imagine you are no longer in America but in rural Mozambique. And, unfortunately, you are not part of the 3% of the population that has access to the internet. Even if you were able to get online, let’s say that you are also not part of the 47% of the population that is literate, rather the majority that would have no way of navigating a website like WebMD where most of us in America would within minutes find a list of possible causes and could begin to guess that a doctor’s visit was necessary. Continue reading