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HIV and Syphilis Transmission: A Cuban Success Story

HIV_and_Syphilis

With education and preventative measures, sexually transmitted diseases such as HIV and syphilis can be stopped. For unborn children, however, a voice is not heard and a choice cannot be made. Cuba has eradicated the transmission of these diseases from mother-to-child.

The World Health Organization (WHO) has validated Cuban success in eliminating mother-to-child transmission of HIV and syphilis, making it the first country in the world to do so, and, according to WHO’s director-general Margaret Chan, one of the greatest public health achievements possible.

HIV/AIDS is a disease that affects the human immune system. AIDS is the final stage of Human Immunodeficiency Virus (HIV). Syphilis is a sexually transmitted disease that can cause damage to the infected person’s internal organs. Both conditions without treatment are deadly and have a high likelihood of transmission from the mother-to-child during birth.

It is estimated that every year globally, 1.4 million women infected with HIV give birth to children. If left untreated, the rate of disease transmission from mother-to-child during birth is 15-45%, resulting in thousands of children born only to have their lives cut short by a debilitating virus that with proper care could be prevented.

The diseases are transmitted during pregnancy through labor, delivery or breast feeding, but can be greatly reduced with the administration of antiretroviral medicines to both mothers and children throughout the stages when infection can occur. In fact, the transmission rate plummets to just over 1%. Since 2009, rates of transmission have been cut nearly in half, dropping from 400,000 cases to 240,000 cases in 2013, still well over the global target of just 40,000 by 2015.

Worldwide, nearly a million pregnant women live with syphilis, which can cause a spectrum of dangers for the mother and child including early fetal loss and stillbirth, neonatal death, low birth weight infants and serious neonatal infections. By early screening and treatment with medications such as penicillin, most complications can be wiped out.

As a part of an initiative, Cuba has worked tirelessly with the WHO, ensuring widespread HIV and syphilis testing for both pregnant women and their partners, early access to preventative and prenatal health care, Cesarean deliveries and breastfeeding substitutions, successfully curbing the disease transmission rate. In 2013, only two babies were born with HIV in Cuba, and only three babies were born with congenital syphilis.

The services are a part of an accessible and universal health care program in Cuba, and according to Pan American Health Organization (PAHO) Director, Dr. Carissa Etienne, “Cuba’s achievement today provides inspiration for other countries to advance towards elimination of mother-to-child transmission of HIV and syphilis.”

The WHO’s validation process is outlined in its 2014 publication Guidance on global processes and criteria for validation of elimination of mother-to-child transmission of HIV and syphilis. In Cuba, the process consisted of an international cooperative mission in March 2015 involving experts from Argentina, the Bahamas, Brazil, Colombia, Italy, Japan, Nicaragua, Suriname, the United States and Zambia.

Cuba should serve as a model to the rest of the world, demonstrating the potential of accessible healthcare and the power of humanitarian efforts. As the rest of the globe tries to catch up, Cuba, a small speck of an island off the coast of one of the greatest policy-leading countries on the planet, can enjoy the results of their hard work and HIV-free children for years to come.

– Jason Zimmerman

Sources: The Health Site, WHO 1, WHO 2
Photo: YouTube

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Redeeming Redemption Hospital

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Redemption Hospital is the only free general hospital in Liberia’s capital city. During the Ebola outbreak of 2014, it became the epicenter of the contagious virus. At its peak, the outbreak in West Africa killed 5,000 people in Liberia alone.

The hospital in Monrovia was unable to manage the flood of ill patients. It lacked adequate supplies and suffered a staff shortage after workers refused to come to work for fear of contracting the virus. In total, 12 workers at Redemption Hospital died from Ebola.

As a result, instead of quelling the outbreak, the hospital began to exacerbate it until Redemption was forced to close its doors.

Up until the Ebola disaster, the hospital was used to treating dire cases with very little resources. Liberia had just 51 doctors to treat the entire population of 4 million people. As a free hospital, the staff could not bring themselves to turn anyone away.

When Ebola hit, this did not change. Redemption had only 205 beds but they housed 400 patients, squeezing two—sometimes three—patients into a single bed. This was a lethal decision and one of the reasons that the Ebola outbreak that struck West Africa became the world’s biggest.

Ebola is known as the “caregiver’s disease” because it spreads when people take care of ill family members. Plus, often funerals in that part of the world require touching corpses still carrying the deadly virus. Because many people in West Africa do not know important aspects about the spread of contagion, many blunders were made.

With help from the USAID and the International Rescue Committee, a non-governmental organization, Redemption Hospital reopened its doors in January 2015. It has been equipped with proper supplies and staff members who are trained to adequately use them.

Each patient admitted into the hospital must undergo screening for any chance they could be sick with Ebola or other infectious illnesses. Anyone with suspicious symptoms are moved immediately to the hospital’s new isolation unit.

Staff have also been provided with proper training on how to prevent and control infectious diseases. The pediatric and emergency ward have each been renovated and new washing machines have been installed for effective disinfection. An industrial incinerator to rid of waste was added to the hospital as well.

Health care workers are hoping that Liberia is able to bounce back with similar improvements that the hospital has, with more people, more training and more preparation for a health crisis.

“This does provide an opportunity to take a big step forward,” explains Justin Pendarvis who specializes in public health with USAID.

Elizabeth Hamann was involved in the IRC’s initiate to reopen Redemption. “The same way that HIV changed the way you practice medicine in the U.S., Ebola should change the way we practice medicine here,” she says.

Liberia now has 4,000 health care workers equipped with special training and are able to work in Ebola treatment centers. Redemption Hospital now treats 1,000 people per week.

– Lillian Sickler

Sources: The Atlantic, USAID,
Photo: USAID

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Mexico’s Health Care Expansion Reaps Benefits for Poor

mexico's health careA little over a decade ago, only half of the Mexican population had health insurance, while more than half of health care expenditures were paid for out-of-pocket. Employed legal residents obtained insurance through a health care social security system known as IMSS, while those unemployed, self-employed or underemployed either paid hefty co-pays for public care or else paid in full for private health services.

In 2004, the Mexican government responded to the inefficiencies by introducing Seguro Popular, a health insurance program financed by the federal government that provides voluntary public insurance without co-pays to people not affiliated with other social security institutions.

In 2009, Seguro Popular underwent an expansion in response to the global economic downturn.  Despite some lingering inefficiencies, that expansion has allowed over 60 million previously uninsured Mexicans to obtain coverage, and has laid the groundwork for reform of the health care system overall.

Thus far, the World Bank reports that the expansion has resulted in the following gains:

  •  “The percentage of poor individuals that benefited from Seguro Popular, as a percentage of those not affiliated to a contributory social security system, grew from 42.3% in 2008 to 72.32% in 2012.”
  • “Between 2006 and 2012, the gap in insurance coverage rates between indigenous and non-indigenous populations was virtually eliminated, and significant advances were made in narrowing service utilization gaps and even health outcomes, even though there remain significant service utilization differences.”
  • By 2013, 22.8 million people had received a screening for a new program that tests new beneficiaries for a variety of conditions including high blood pressure and diabetes.
  • “Between 2009 and 2013, the number of individual beneficiaries of Seguro Popular grew from 31.1 million to 55.6 million.”

Despite the reforms, there remains room for improvement. In particular, The New York Times has raised concerns about efficiency and transparency at the local level.

Within the Seguro Popular system, the federal government allocates funding to the state governments based on how many people each state enrolls. From there, the state government has wide discretion on how it spends the funds. This is a source of concern for critics, who believe that a lack of oversight and accountability at the local level leads to sub-standard health practices in some states.

Back in 2011, The New York Times quoted then-Mexican health minister José Ángel Córdova as stating, “(eight) percent of the country’s municipalities still lacked any kind of health facility.” He went on to acknowledge, “There is still first-, second- and third-class medicine.”

Moreover, concerns arise with funding. When Seguro Popular was first designed, participants were supposed to be charged a yearly fee based on income. However, due to the fact that many participants are low-income or impoverished, in practice very few participants pay.

Nevertheless, organizations like the World Bank have fronted a portion of the cost of Seguro Popular. Meanwhile, Mexico’s government in collaboration with others continue to focus on strengthening the program’s organization, functioning, and oversight of state health operations in order to better serve Mexico’s health care needs.

– Katrina Beedy

Sources: World Bank 1,  San Miguel Medical Research Directory 1,  San Miguel Medical Research Directory 2,  NYT
Photo: Gaceta Mexicana

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Ebola Outbreak Sparks Debate on Aid

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The Ebola outbreak in West Africa made apparent the brewing issues on healthcare aid in the region. Over the last ten years, aid traditionally allocated to West African governments transitioned toward the private sector. This has left Africa helpless in independently addressing these wide-scale problems at an institutional level, many experts say.

The billions in aid dollars directed toward philanthropy programs and global campaigns steadily decreased disease in Africa over the last ten years. These programs typically work more on a case-by-case basis, leaving the countries battling widespread Ebola weak in their capability to respond.

This private vs. public sector debate on aid is an age-old one. Politics professor from Georgetown University, Carol Lancaster, discussed addressing global health problems in an interview with The Economist in 2009.

“Does anybody believe that the many millions of HIV/AIDS-afflicted Africans now receiving aid-funded anti-retrovirals would be alive today in the absence of public aid funding the delivery of those drugs?” she asked. “Neither charities nor entrepreneurs could or would undertake such ambitious efforts to help those both poor and sick.”

On the other hand, some argue operating aid through governments results in wasted resources. Philanthropic initiatives pegged with the term “philanthrocapitalism,” has been argued to be more efficient and encourage innovation.

“Coming from the business and financial world they, rather than bureaucrats, understand what it takes to build strong businesses,” said co-author of the book “Philanthrocapitalism: How the Rich Can Save the World,” Michael Green.

President of the African Development Bank, Donald Kaberuka, acknowledged the benefits of specific disease-based aid: “It was like the sweet spot, easy to sell and the results are there,” he said.

However, he argued that ultimately this strategy neglected to establish district and community hospitals or help educate local health officials, and it left countries more dependent on outside help. Aid dollars working directly through government programs will better enable these countries to coordinate an effective response, Kaberuka added.

“In a situation like this there are so many little things happening but somebody has to tie it together and that can only be a government,” he said.

President of the World Bank, Jim Yong Kim, agrees that there are problematic gaps in aid work. “If the outbreak had happened in Rwanda my own sense is that because they built district hospitals and community hospitals and have community health workers connected to the whole system, that we would have gotten this thing under control very quickly,” said Kim.

U.N. Secretary General Ban Ki-Moon encouraged a 20-fold increase in international aid toward countries facing Ebola outbreaks, what he refers to as an “unforgiving” disease.

Kaberuka encourages this increased aid but warns of reverting to old strategies that funnel it away from long term solutions. It is clear, according to him, that the countries don’t just need additional funds, they need aid reform.

– Ellie Sennett

Sources: Reuters 1, Reuters 2, Al Jazeera U.S. News The Economist
Photo: Flickr

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Nepal’s Health Care: A Growing Concern

Nepal's Healthcare
Nepal is ranked 157 on the World Health Organization’s 2013 Human Development Index. It is one of the toughest countries in the world to provide health care access. This is due in part to geography as Nepal is situated in the Himalayas and hosts eight of the ten tallest mountains in the world and to the inability of the government to provide adequate services.

With a 25 percent poverty rate to contend with, and a 10-year-long insurgency which spread instability throughout the country and exacerbated poverty, the people of Nepal have had to rely on international aid and community resources for health care.

One nonprofit in particular is working to improve Nepal’s health care and  harnesses the inherent reliance the people have on each other. Mark Arnoldy is the 27-year-old founder of Possible Health, an organization that works to provide health care to people in the most challenging of environments.

“We want to work through a network of partners to build a health care model such that the poor around the world can really have high quality low-cost health care regardless of where they were born,” Arnoldy explains.

Located primarily in Nepal’s rural regions, the organization has connected 173,469 Nepalese people to health care since 2008.

USAID is also working in Nepal through programs created exclusively for the country. For example, the Program for the Enhancement of Emergency Response, or PEER, helps reduce health risks after natural disasters.

Himalayan Healthcare is another nonprofit which seeks to fill in the gaps left by unstaffed and undersupplied government programs. President of the Himalayan Healthcare Board, Dr. Robert McKersie, understands the importance of community support in Nepal.

A community center is successful, explains Dr. McKersie by “having input from the local stakeholders from day number one.”

This is a philosophy that Dr. McKersie believes the U.S. could learn from as well in its debate over government involvement in health care.

Himalayan Healthcare’s co-founder, Anil Parajuli, summarizes the situation in Nepal: “Rural Nepal, almost universally, has mostly rudimentary health care services which are inadequate but still go a long way if caring village health providers are available.”

— Julianne O’Connor

Sources: World Bank 1, World Bank 2, Forbes, Business Fights Poverty

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The History of HIV Research

hiv research
Since the first diagnosis back in 1981, the world’s approach to HIV and HIV research has changed drastically. Receiving a diagnosis of the disease that 33.4 million people are currently living with means something very different than what it did 33 years ago.

In 1981, when 26 homosexual men presented with unexplainable tumors and other strange symptoms, researchers and doctors worldwide were at a loss for what to do. As they later identified the disease as HIV, or human immunodeficiency virus, it dawned on them that they were dealing with a virus they were wholly unprepared to tackle.

In its early years, the life expectancy that came with an HIV diagnosis was heartbreakingly short and the answers for how to cure the virus were few and far between. According to Dr. Woodrow Myers, a public health official from Indiana, the life expectancy of someone who had HIV in 1987 was 18 months.

Actually diagnosing people who had HIV was an obstacle initially, seeing as it was a minimally understood virus, especially in areas of the world with a lack of information. Progress began when researchers developed a blood test that could be used to identify those who had contracted the virus, allowing researchers to start focusing on improving the lives of those with HIV.

As researchers gained more of a grasp on the virus, they developed the drug AZT, which was approved by the Food and Drug Administration in 1987 and was distributed to patients in the U.S. Unfortunately, AZT came with its own nasty cocktail of side effects, some of them life threatening, thus ruling it out as a viable solution.

Soon after, things improved when researchers developed a treatment that had multiple drugs in one pill and had some success in saving lives. These treatments were being administered up to 20 times a day, resulting in more unpleasant side effects; also not an ideal solution.

Fast-forward two decades and research has uncovered treatments that have made an HIV diagnosis less of a death sentence. Myers reports that the life expectancy with an HIV diagnosis is now 22 years, putting it along the lines of chronic diseases like diabetes and heart disease.

Though there is still no cure for HIV, the treatments are more manageable with a greater variety of options. Some treatments require only five pills a day and often have minor side effects, making managing the virus less intensive.

Justin Goforth, a 47-year-old who has been living with HIV for over 20 years, believes that in today’s world, an HIV diagnosis should not be restrictive in how you live your life, explaining “You can go to your doctor two, three times a year, get some tests done and make sure everything’s on track, and then just live the rest of your life as you would.”

This is not to say, however, that HIV should be less of a priority. Two million people died of HIV in 2008, with 2.7 million new diagnoses, and many more lives have been lost since then. Impoverished areas like Sub-Saharan Africa and Southeast Asia suffer greatly because they lack the education and resources to prevent and treat HIV, leading to often uncontrollable proliferation of the virus.

The progress shines through, however, as the number of people in poor countries receiving resources to treat people with HIV having increased 10-fold since 2002, and the standards of living have improved. As sexual education, treatment research and resource distribution improve, an HIV diagnosis becomes more and more manageable.

– Maggie Wagner

Sources: AIDS.gov, CNN, Oprah, The Herald News
Photo: Red Hot

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The Relationship Between Aid and Security

aid and security
Since the end of World War II, foreign aid and national security have evolved in close proximity. Indeed, in the decade that followed, United States foreign assistance would range between 1.5 percent and 3 percent of gross domestic product (GDP.)

Since then, foreign aid has played an important role in advancing national security through several of its components: “bilateral development aid, economic assistance supporting U.S. political and security goals, humanitarian aid, multilateral economic contributions and military aid and assistance.”

However, during the Cold War, this relation began to change. As the U.S. refocused its foreign policy toward containing the Soviet Union, foreign assistance began to drop as a percentage of GDP. But still many development programs remained in place, working toward bringing about political reform and democratization. The dominant logic that political reform and development would create stable and open regimes that could resist communist ideology.

The purpose of many programs did not changed since then: expanding access to healthcare services and education, reducing infant mortality rates, reducing hunger and even protecting the environment. Following the end of the Cold War, the main purpose was refracted; by then, the main target was no longer to contain the Soviet Union but to foment development and economic growth in poor countries.

This also meant that the share of military assistance versus aid also changed. During the Cold War, almost 50 percent of the foreign aid’s budget was allocated to military assistance. By 2001, it had dropped to 24 percent. While the humanitarian and development aid budget increased from 33 percent to 46 percent. The period between the end of the Cold War and the September 11 attacks is characterized by a shift toward prioritizing economic development and opening access to healthcare and education in poor countries. Although no imminent threat existed at the time, national security consideration always remained at the heart of foreign aid.

After the attacks of September 11, this relation between national security and foreign aid changed once more. By 2005, the war on terror had the U.S. engaged in providing foreign assistance to almost 150 countries. Once more the shift was toward containment, but this time of jihadists and extremist activities. Since September 11, the region that has received the bulk of U.S. aid is the Middle East.

Despite the many ups and downs in the road of U.S. foreign aid, the world still looks to U.S. to provide leadership in response to erupting crises around the world. If we are to take a few lessons from this close relationship between aid and security, they are that no matter what the threats are, a key component of national security is a stable world and the best way to achieve is by bringing people out poverty and giving them access to healthcare and education.

Responding to crisis world wide does not have to entail military might. While development and economic aid results can be longer term than military intervention, the long history of the U.S. as a major aid contributor shows that it certainly pays off.

– Sahar Abi Hassan

Sources: Foreign Aid and Foreign Policy: Lessons for the Next Half-Century, The Foreign Policy Initiative
Photo: ForeignPolicy

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Afghan Health Care Crisis Still Underway

Afghan Health Care
In Afghanistan, a woman dies every two hours due to pregnancy related problems. On top of that, each year 1 in 10 children die before reaching the age of five. Afghanistan has one of the highest child and maternal mortality rates worldwide. A large reason for this is the turmoil the country has been experiencing in the last few decades.

Many of Afghanistan’s citizens are refugees and its infrastructure and economy have been severely devastated because of the chronic instability and conflict that it has plagued the region in recent years. Now forming a resurgent force in the Southern and Eastern parts of the country, supporters of the tightly-strung Islamic movement have re-grouped since the fall of the Taliban administration in 2001. The government has been struggling to extend its authority to enhance national unity beyond the capital of Kabul. Despite its mountainous, landlocked terrain, Afghanistan has been fought over for a long time because of its strategic position between India, Central Asia, and the Middle East.

Despite many years of aid, Afghan health care is still extremely limited because of the high casualty rates from violence. The Afghan health care system is still functioning very poorly, but officials are attempting to conceal information on the topic. As Afghanistan is the 15th least developed country in the world, it is a struggle for much of the population just to access basic care. Research from the Medecins Sans Frontieres (MSF) shows just how grave and deadly it is for these people to seek medical help.

When sick, many citizens have to go past the public health facilities nearest to them because of conflict, causing them to travel much greater distances for help. Some people travel 50 miles or more, going through security checkpoints and military roadblocks just to be treated. Once they get to the health facilities that they actually can manage to visit, there is sometimes a shortage of medicine, experienced staff and/or electricity. Additionally, some hospitals are facing high amounts of debt and are unable to pay for better facilities and treatments.

Often times, people wait to go to the hospital until their condition has gotten extremely bad because they do not want to risk making the trek for something that is not that severe.  Some people also wait all night to take their ill and dying relatives to the hospital because they were so worried about their safeties while travelling overnight. According to the MSF, one in five of their patients had someone close to them die in the last year as a result of them not being able to acquire medical care. On the journeys of those who were fortunate enough to make it to the hospitals, 40% experienced land mines, fighting, military checkpoints or harassment.

However, there has been a lot of progress in the country with over 60% of citizens now living within an hour walk to their nearest health clinic (a significant increase from the 9% in 2002). Mortality rates are also being lowered with the child mortality rate having decreased by 62% and the infant mortality rate by 57%. Maternal mortality rates have also lowered substantially because of the increase in trained professionals. The international interest in Afghanistan is dwindling, meaning they are facing less aid, even though the country still has a long road of development to come.

– Kenneth W. Kliesner

Sources: BBC, USAID, BBC
Photo: TIME

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Revolutionize Healthcare, Revolutionize the World

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In order to improve and manage community health, health advocates help organize a plethora of services ranging from health events to educational experiences. Advocates come in many different forms and settings. For instance, health advocates are generally doctors and nurses though other health advocates may come from a different professional background, such as social work. However, health advocates can also come from a background unrelated to medicine, so long as the individual is burgeoning with a passion that centers on raising awareness of health-related issues.

Individuals who work as health advocates will typically aid clients in improving their health care experience by ensuring that clients not only learn about but also have an opportunity to access available programs and resources. According to SoCal Health Advocates, individuals in this field often endeavor to improve the lives of clients by breaking down barriers that prevent people from access to quality healthcare in order to prevent serious illness or prevent relapses.

However, health advocacy is not limited to only physical health. Due to its nature of stigmatization, great effort has been expended into improving mental health advocacy as well. According to the World Health Organization, it is crucial for advocacy efforts to continue educating the public about mental illness in order to truly revolutionize not only the manner in which mental health is perceived but also improve access to mental health treatments.

As part of its mental health advocacy efforts, the WHO has created MiNDbank, an online resource that has pooled together information regarding global policies and services regarding mental health. One of the goals of MiNDbank is to facilitate open debate and discussion about mental health topics in order to promote human rights for mental health patients as well as improving the mental healthcare system as a whole.

It is imperative for advocates to work towards eliminating the stigma and ignorance regarding mental illness, particularly since individuals with mental disabilities are subject to maltreatment and discrimination on a daily basis. Unfortunately, in many parts of the world, legal institutions have been unable to protect the basic human rights of these individuals.

Although the United States struggles with the burden of a stigmatized and under-funded mental healthcare system, many countries, lack adequate mental health facilities due to even greater stigma and a general lack of awareness. Therefore, mental health advocates strive to inform society about mental illness in order to reverse the disagreeable image of mental health patients, and ultimately, construct a more efficient, more understanding and more accessible global mental healthcare system.

– Phoebe Pradhan

Sources: SoCal Health Advocates, World Health Organization
Photo: IIR Healthcare

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Small Healthcare Programs in Uganda

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Uganda is heavily underfunded where it matters -healthcare. Hospitals are costly and for those who can’t afford it, they are shown the door. Patients are left to search for cheap herbal remedies or wait until their pain subsides, if it even does.

Most of the health issues that arise in Uganda can be linked to the lack of water available for families. Without a proper source of clean water, Ugandans are at risk of contracting various illnesses or parasites that can potentially lead to death. More than 50% of Ugandans have no clean water source, which means they are at a higher risk for waterborne diseases.

Various small health care programs in Uganda have been implemented to help with these issues including, The Water Project, which construct wells in rural villages. Aside from bringing a reliable source of clean water, they give lectures on sanitation. UNICEF Uganda has also implemented a similar program that serves to inform the family of issues from unclean water sources and offer health services for free.

This program called Family Health Days is one of many that are currently being put in effect with the partnership of faith-based organizations. Family Health Days is offered at various places of worship, advertised on the radio and spread through word of mouth. Several families bring in their children to get immunizations or de-worming checks. Mothers are able to get assistance with antenatal care and blood pressure readings. Counseling is also given to foster a healthy lifestyle for the entire family.

Programs such as Family Health Days and The Water Project truly make a difference in the lives of hundreds in the rural villages of Uganda. They work with the community and bring awareness to health issues of the poor. The Water Project, Family Health Days and numerous small programs offer hope for a country who’s own government has repeatedly been under scrutiny for misusing international relief aid.

– Maybelline Martez

Sources: FSD International, UNICEF, The Water Project
Photo: Borgen

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