Global Health Discussion Topics

Global health news, discussion topics, and a place for general questions/thoughts/ideas. All are welcome to post and respond. 

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  • One of the more common questions we get is how to safely and legally transport medications and medical supplies into a country. I would like to hear from others what has been helpful for their teams when transporting medication or medical supplies. I know it is country-specific, but it would be nice to get some general guidelines as well as any country-specific information posted here. 

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    • Micaela Theisen Micaela, it's definitely "country dependent".  Our teams hand-carry approximately 2200 lbs. of medications and supplies into Honduras each year. The bags must be carefully sorted so we don't exceed weight limits. We spread out the different medications so that if a bag goes missing, we won't lose our supply of a specific type. 

      Each bag has an inventory list and we keep a master list of what is in each bag so that we can easily locate it when setting up on site.  Over 25 years, we have never had an issue at customs in Tegucigalpa or San Pedro Sula. Most non-govermental or business travelers in the country are with "missions" and the customs agents are well aware of that. NGOs provide primary health access to much of rural Honduras. 

      We have heard recently that we may be taxed on goods we bring in. This was true for dental equipment we just shipped in, even though the municipality acted as our "consignee". Since we are a partnership and the equipment was so valuable, the mayor agreed to assume the steep tax. Nevertheless, it is a hardship on their meager budget.

      Our organization is in the process of becoming a registered NGO with the government in order to avoid an ugly surprise (taxes). We're keeping our fingers crossed! 

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  • Interesting article on the factors that have hindered global access to medications for noncommunicable diseases and policy recommendations: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.0375

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  • Hi all,

    How do your teams approach the topic of the medical ethics of short-term medical missions? This is always a hot topic in global health and it would be interesting to hear your perspectives.  There are many research articles and guidelines available online (just one linked below), as well as at the Americares Medical Outreach Exchange: https://medicaloutreach.americares.org/en/resources/building-in-country-partnerships/ 

    A review of aggregated guidelines and studies published in Globalization and Health (linked below) noted broad consensus on six core principles for effective and ethical STMMs (short-term medical missions). These are:

    1. appropriate recruitment, preparation and supervision of volunteers

    2. a host partner that defines the program, including the needs to be addressed and the role of the host community in directing and teaching the volunteers

    3. sustainability and continuity of programs

    4. respect for governance and legal and ethical standards

    5. regular evaluation of programs for impact

    6. mutuality of learning and respect for local health professionals

    Lasker, J. N., Aldrink, M., Balasubramaniam, R., Caldron, P., Compton, B., Evert, J., … Siegel, S. (2018). Guidelines for responsible short-term global health activities: developing common principles. Globalization and health, 14(1), 18. doi:10.1186/s12992-018-0330-4
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  • I'm excited to share powerful presentations from the Health at the Center Americares Partner Summit with TED style discussions about global health from speakers such as Sanjay Gupta, MD, https://www.americares.org/en/events/partner-summit/partner-summit-event/

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  • A systematic review of pre-departure training. The good news is that pre-departure training is becoming more of a focus among outreach groups (this article focuses primarily on med student/resident training), but still quite a bit of work to be done to educate students and other volunteers. 

    Free full text here: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-019-1586-y

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  • World Hunger Day was this past week so I wanted to take a moment to highlight a couple nutrition  resources. I’m including this  piece from the Washington Post because it has some thought provoking ideas and good links to info: https://www.washingtonpost.com/politics/2019/05/28/its-world-hunger-day-its-day-ask-why-malnutrition-still-affects-so-many/?noredirect=on&utm_campaign=28c55854d6-EMAIL_CAMPAIGN_2019_05_30_12_54&utm_medium=email&utm_source=Global%20Health%20NOW%20Main%20List&utm_term=.4f0be7c22bbc

    You may also want to check out Scaling Up Nutrition for some positive country case reports: https://scalingupnutrition.org/

    And, finally, check out some of the WHO recommendations and guidelines for nutrition here:

    https://www.who.int/publications/guidelines/nutrition/en/

    https://www.who.int/nutrition/publications/guide_inpatient_text.pdf

     

    Please feel free to share any work your teams are doing towards eliminating hunger and improving nutrition, and other guidelines that may be helpful. 

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  • Thanks, Micaela, for sharing these great resources. For more related resources, please check out our teaching and training section on the Exchange: https://medicaloutreach.americares.org/en/resources/teaching-and-training/

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  • I thought this was a good commentary on the Ebola outbreak in the Democratic Republic of Congo and some general mistakes made in global health response efforts: https://www.wbur.org/cognoscenti/2019/06/06/ebola-global-health-congo-jonathan-lascher. Would be interested to hear others' feedback. Has anyone been part of the response in DRC?

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  • https://www.devex.com/news/health-tech-solutions-for-low-resource-areas-emerge-from-mit-solve-94891

    This short article discusses two of the top innovations to come out of MIT’s Solve forum last month. They are both relatively simple tools that are meant to work in challenging settings, but really could be adopted anywhere.  Many of the medical equipment products available now are simply not feasible to use in many settings (i.e. lack of electricity or power surges, heat/sun/dust, lack of WiFi, etc), so teams were encouraged to create products that could be utilized across settings. 

    I am always intrigued to hear about new global health tools so certainly feel free to link any you may be aware of below, or things you have seen in practice. 

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    • Micaela Theisen Great article. I'm always interested to hear from folks what innovative tools are being used and what's needed.

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  • Hi all,

    I’d like to share this article regarding evidence-based practice in the global health setting. Unfortunately many things  we do in global health settings haven’t been studied and are not guided by evidence-based practice. There are, of course, numerous barriers to research and generalization of results, which makes such practice difficult in some settings. This article highlights some of the efforts being done in South Sudan to have collect data and have more evidence-based or data-driven interventions: https://www-devex-com.cdn.ampproject.org/c/s/www.devex.com/news/humanitarian-organizations-push-evidence-based-response-in-south-sudan-95089/amp?fbclid=IwAR1Y39v5c8Q0hyIWyzjqMzXt9X4s1nrnjXqz0SRjRh-aYqfqXW1pRTlVnYA. I’d like to hear what others think about these efforts and evidence-based practice in global health in general. I think most would agree that doing interventions that have been shown to be effective is ideal, but it can be easy to become overwhelmed or distracted by data collection. 

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  • At a graduation ceremony for HEAL fellows (healinitiative.org) this past weekend I was reminded about a quote that I think is a great guide for global health practitioners. I know I personally have struggled with how to make sure I am not doing harm when I engage in outreach (the intention of course is always to help, but a long discussion could be had about what this means in each setting), and be cognizant of the historical context of the places I am at. Though perhaps an uncomfortable topic, I think it’s important for teams to talk about their privilege to be able to participate in this work and recognize the many issues that have contributed so much to global health inequality such as colonization and structural racism. I will link another article below that is a good overview of this topic.

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  • Nice article highlighting some of the healthcare successes in Mali (https://www.npr.org/sections/goatsandsoda/2019/07/12/740847647/how-one-community-brought-child-mortality-down-from-154-to-7-per-1-000-live-birt). The organization Muso (https://www.musohealth.org/) has made some incredible gains there in recent years (along with other orgs though I am most familiar with  Muso). They have really utilized the  CHW model and have had good success with trained CHWs. May be a model to follow elsewhere. 

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  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586980/

    I found this to be a great article on addressing the ethics of unintended harm in global health including a discussion of the challenges of apology and reparations. I’d highly recommend this as a discussion point for teams engaging in outreach programs. 

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  • This is a good succinct overview about why humanitarian crises disproportionately affect women: https://medium.com/@callister.olivia/why-do-humanitarian-crises-disproportionately-affect-women-532773b88dc8. It is brief, but includes links to other reports, and is a good discussion topic for teams . 

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  • This is UN OCHA 2019 Global Humanitarian Review:  https://www.unocha.org/sites/unocha/files/GHO2019.pdf?source=post_page---------------------------. It is 80 pages, but I’d suggest at least looking at the 2 page “At a Glance” summary at the start for some general context on what improved this year and what new or ongoing problems we are facing.  

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  • Promising news regarding Ebola treatment: 

    https://www.nytimes.com/2019/08/12/health/ebola-outbreak-cure.html

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  • Hi all

    This case is something I have been following for several months but recently became a topic of discussion among different humanitarian aid forums I follow as it was on NPR and other news sources in the last few days:  https://www.npr.org/sections/goatsandsoda/2019/08/09/749005287/american-with-no-medical-training-ran-center-for-malnourished-ugandan-kids-105-d?utm_source=facebook.com&utm_campaign=npr&utm_term=nprnews&utm_medium=social&sfns=mo

    It has caused me to reflect a lot on my past outreach as a nurse/NP as well as on situations abroad  (and even in the USA) where I have been involved with people who have practiced outside their scope of practice or beyond their experience level, and even with my own actions when I was new to this type of work. Though I don’t wish to debate or discuss the details of this case here, I do think this is a good reminder to review some things that organizations should consider when developing outreach programs in order to avoid potential harm:

    1.) Strive for best practice at all times—culturally appropriate and evidence-based practice whenever possible. There is a paucity of literature for best practice that is inclusive of low-resource areas, but this is changing and we should seek out the available evidence as well as local expertise.  

    2.) All volunteers should practice within their legal scope of practice in the state or country from which they are licensed (and licenses should be verified). In some countries one must obtain a local license before volunteering so please be sure you know what is necessary (and how long the process takes!) before you begin planning a trip.

    3.) Medical and nursing students should have appropriate observation and instruction at all times and organizations must ensure that students are even allowed to participate—many countries do not legally allow this.  Outreach should not be considered an opportunity to practice or engage in invasive skills that one is not proficient at. 

    4.) Work with local stakeholders, medical staff, and community leaders to determine what type of outreach is needed and will be well received.  Ask yourself whether you are filling a true need in the community or simply doing something because you have the funding/resources/volunteers. 

    5.) Outreach must always be culturally appropriate and developed with consideration of cultural context as well as long-term sustainability.  

    This is by no means a comprehensive list, but I think touches on some of the common mistakes among outreach groups. Please feel free to add to the list by replying to this thread. 

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  • We were asked by the Americares staff to share our developing protocols for running a brigade pharmacy in rural Honduras. Our organization, Community Health Partnership-Honduras, works collaboratively with volunteering doctors and dentists from Tegucigalpa. Together with their rural peers and US team members, we are able to deliver true collaborative care. CHPH is embedded in the regional health services system which is highly structured with reach into scores of small villages. The shelves are mostly bare without the resources we bring from Americares and other critical partners. 

    The rural physicians are very isolated and not accustomed to having resources to prescribe. They have no access to the internet, or to consult with their colleagues. Consequently, we were seeing a lot of errors in their scripts. To address this without making them feel inferior we put a system in place which has worked exceptionally well in eradicating errors as well as offering individual and critical patient education. We have also been including  Honduran nurses into the busy pharmacy so they can learn from the volunteering local physicians. Most often, it is the local nurses who are prescribing or dispensing the medications we leave behind to fill the gap between brigades:   

    Our pharmacy is one of the most critical aspects of our work in the clinic. Our patients are not all literate and they are exceedingly humble. They are shy about asking for anything. We have developed a system where we keep a bilingual physician at the entrance to the pharmacy, working in concert with our nurse/pharmacist to review every prescription. Once the prescription has been double-checked and filled, the designated doctor will spend time with the patient to educate them about the medicine, emphasizing the correct dosage and administration. They are given the information in writing, including labels with pictures. We are well aware of the responsibility we have for “doing no harm”, and the importance of educating our patients. We have worked hard to perfect a system that we can replicate each brigade.

    Community Health Partnership-Honduras tjif-chph.org @communityhealthpartnershiphonduras

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    • Jennifer Smith thank you so much for sharing your collaborative work in Honduras. It seems like your organization fills a huge need while maintaining close and collaborative relationships with your Honduran staff and community. This is awesome! I like your pharmacy set -up a lot and hope it is helpful for others to model, especially taking the time and effort in the appropriate language to explain everything carefully to the patients. It really makes a difference. 

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  • Thank you so much Jennifer Smith for sharing about the thoughtful and important work your team is doing!

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  • https://www.un.org/en/events/humanitarianday/

    Today, August 19th, is World Humanitarian Day.   I'd like to thank all of you for all the time and energy you invest into the work you do, and please pass along an especially huge thank you to your colleagues in the field that continue the work day in and day out, often in their own communities and often under very difficult circumstances. 

    The particular focus this year is on women humanitarians.  From the UN: "We honour the work of women in crises throughout the world. We focus on the unsung heroes, who have long been working on the front lines in their own communities in some of the most difficult terrains, from the war-wounded in Afghanistan, to the food insecure in the Sahel, to those who have lost their homes and livelihoods in places such as Central African Republic, South Sudan, Syria and Yemen. And we salute the efforts of women aid workers from across the world, who rally to people in need." 

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  • I just became aware of a site which helps with lower cost humanitarian airfare prices for " Anyone who works for, volunteers with, or is an immediate family member of an employee of a registered nonprofit organization involved in international humanitarian work".  The site was Fly for Good.    I was wondering if airlines provide those humanitarian airfare rates without going through a travel agent?  

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    • Ann Colbert thank you for sharing this resource. I have never inquired directly with the airlines about a discount before, but I know others who have had some success with this in the past (particularly going to Haiti after the earthquake in 2010). 

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  • Interesting blog post regarding failures in global health: "Global health seeks to solve big problems. We're bound to fail. Although failures can help us learn, we rarely seem to publish or discuss failed products and strategies in global health. This blog post aims to crowd source and compile a list of failures in global health."  Each "failure" is linked to an article. I found it thought provoking and realistic...not everything we do (despite good intentions) works out well. 

    It is good practice to assess each project or outreach activity that you/your teams do and see what could improve and what may have not worked so well. I have certainly participated in various projects that unfortunately weren't particularly successful, but have learned and adapted and my current practice is much different than what it was when I began global health work 10+ years ago.  Do any of you have formal assessment tools that you use? How do you evaluate the success of your projects/outreach? 

    https://naturemicrobiologycommunity.nature.com/users/20892-madhukar-pai/posts/51659-archive-of-failures-in-global-health

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      • Ann Colbert
      • Physician
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      Micaela Theisen   This is an interesting though depressing blog.  Seems that the list includes two groups- major health problems that have failed to be addressed and other problems that have actually been caused by interventions.  Sad in many ways. 

      I am more convinced that Program Evaluation is the most important part of all these projects.  Meaning it should be addressed even before the program is implemented.  I really like the Preceed-Proceed Model  (PPM) of program planning which works backwards from first establishing long and short term goals to a community assessment and identification of the factors involved and  then research on specific measures that change those factors .  Within the entire framework is a system of evaluation and revision of the program.

      As I have changed my focus from one-on-one clinical medicine to a public health perspective, I see that most interventions/approaches start with an activity that sounds good and intuitive but often does not address the "predisposing, re-inforcing and enabling factors" in a population. 

       This link demonstrates an example of using the PPM in Myamar to change the way physical therapists treat patients and address treatment of NCDs.  It is quite interesting and shows how more time needs to be spent on the front end of projects.  

      https://www.frontiersin.org/articles/10.3389/fpubh.2019.00114/full

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    • Ann Colbert thank you for sharing the PPM and the Myanmar example.  I agree that most interventions seem to start with an intuitive idea and often we get a bit of tunnel vision from there. The PPM seems simple enough to apply to small projects and teams, which is great. For me it can feel  overwhelming to think about program evaluation when you are part of a small group or organization, but it really is imperative.  One of the things I have had some difficulty with, though,  is how to implement a model such as PPM when one is engaged in emergency response. I remember during my HEAL Fellowship training initially feeling really frustrated because it seemed like few of the principles of good public/global health projects (in program eval as well as design and implementation) really weren't feasible in a rapid response situation which was the area I was most familiar with. Do you, or does anyone else, have ideas or resources for these scenarios? 

      Take for example something simple like the implementation of an EMT Type 1 (mobile clinic) after a hurricane. 

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