Smallpox has been globally eradicated since 1980, so why is the eradication of Polio so much more difficult? The World Health Organization (WHO) recently released that the Global Polio Eradication Initiative (GPEI) would be conducting a new targeted 15 country effort to vaccinate 72 million children in Africa. The new campaign follows numerous failed efforts of the past and reemerging outbreaks. Why does the African continent remain prone to Polio outbreaks that spread rapidly? Why did the organized campaign to eradicate Smallpox take only 21 years while Polio is going on almost 40 years?

Since 1796, when cowpox was used to protect humans from Smallpox, eradication efforts have taken place. It wasn’t until the WHO intensified the eradication of smallpox in 1967 that efforts were coordinated around the world. The Smallpox Eradication Program (SEP) was jointly run by the WHO, CDC, and National Ministries of Health in various countries. Doctors and epidemiologists from the US volunteered to help with the efforts. In many instances US volunteers were overbearing and controlling of their local counterparts. A report by Paul Greenough documented the use of intimidation and coercion in the final stages of the SEP. Foreign volunteers were sent to kick down doors (literally), force vaccination of those who refused, and fix the mistakes of local staff members (1995). These coercive tactics evoked resistance from local communities, but the SEP prevailed. The SEP was run in a structured, militant fashion, where individual human rights were overridden for the global public good. Similar issues with resistance have been seen in Polio eradication efforts, but responses to resistance have not been as militant. Could this be why Polio has continued to resurface?

The earliest documented case of Polio in Africa is traced back to 1580 B.C. in Egypt and still the virus continues to spread across the continent. The eradication of Polio relies heavily on National Immunization Days (NIDs), but these events are ineffective because they aren’t comprehensive vaccination efforts, positive cases are missed and some children aren’t vaccinated causing continued Polio outbreaks. Organized Polio eradication efforts began when the World Health Assembly launched the Expanded Programme on Immunization (EPI) in 1974, a program implemented through the NIDs . In 1988, the World Health Assembly said that by the year 2000 Polio would be eradicated and they launched the Global Polio Eradication Initiative (GPEI) to make it happen. Many prominent people and organizations put their support behind the program including Rotary International and Nelson Mandela, who in 1996 launched the “Kick Polio Out of Africa” campaign which vaccinated 420 million children. In the 90s, the UN Secretary General negotiated peace treaties to vaccinate in war-torn Liberia and Sierra Leone. Most recently in 2004, 23 African countries coordinated NIDs focused on Polio vaccination.

After all these efforts, Africa remains the only continent where Polio remains alive and well in multiple countries. A series of studies completed across West Africa showed that due to misconceptions about the vaccine, lack of adequate funding and corruption at the local level, and ineffective immunization campaigns, Polio has persisted on the African continent (Melissa Leach & James Fairhead, 2007). The year 2007 marked an outbreak of 25 cases in Angola which spread to 28 cases in the Democratic Republic of the Congo (DRC). In 2008, after an outbreak in northern Nigeria, where there have been vaccination conspiracy theories, spread to a dozen other countries, the WHO made Polio eradication their “top operational priority.”

Armed with a “more effective” version of the oral vaccine, the new GPEI organized effort across 15 countries hopes to eradicate Polio for good. However, just yesterday the New York Times wrote that the WHO reported 104 deaths and 201 cases of paralysis from Polio in the DRC. Is the renewed GPEI effort, launched Oct. 28, 2010, even working? Is eradication even a desirable goal at all, if past experience with Smallpox Eradication Program requires militancy?

Crossposted from the Americans for Informed Democracy Blog where I am writing as a Global Health Analyst.

(Photo credit: Dominic Chavez/ WHO)

This week comes with controversy and numerous calls for the eradication of various diseases by the WHO. Health workers in go on strike in another African country after South Africa’s months long strike. Liberian doctors said they would only treat “critical” patients. Tuberculosis is becoming more resistant among young people and HIV positive individuals, but more effort is being put into research.

WHO sees end to TB

Last week TB was discussed as a “forgotten disease for forgotten people,” but now it seems that the WHO has released a plan that identifies gaps in research to create faster treatment regimes. “There is an urgent need to scale up action against TB – 10 million people, including 4 million women and children, will lose their lives unnecessarily between now and 2015 if we fail,” Dr. Margaret Chan, the WHO director-general, said.

Its Time to End the Double-Standard of Food Aid

Tido von Schoen-Angerer, Executive Director of Doctors Without Border’s “Access to Essential Medicines Campaign” wrote on Huffington Post about how the US government continues to send sub-standard food supplies to areas in need. The United States, the world’s biggest food aid donor, continues to send the corn-soy flours that do not address childhood malnutrition. You would be hard pressed to find these foods in American grocery stores, because it’s food we would never feed our own children.

More: Can the story on US food aid get any worse from Aid Watch posting Financial Times

“Paradigm” Shift Needed in Health Care, Experts Say

In Africa there needs to be a greater focus on prevention and treatment of noncommunicable diseases like diabetes and hypertension and not just infectious diseases like HIV/AIDS, health experts told the 2010 U.S.-Africa Private Sector Health Conference October 6. “Health is as critical as institutions, infrastructure and education for Africa’s economic competitiveness and growth. It is a prerequisite for human energy, entrepreneurship, dynamic markets and a productive society,” said Haskell Ward, vice-president of Seacom Corporation and chairman of the Global Health Strategic and Advisory Committee of the American Cancer Society.

Ending Africa’s Hunger Means Listening to Farmers

Africa is hungry – 240 million people are undernourished. Now, for the first-time, small African farmers have been properly consulted on how to solve the problem of feeding sub-Saharan Africa. Their answers appear to directly repudiate a massive international effort to launch an African Green Revolution funded in large part by the Bill and Melinda Gates Foundation. “Food and agriculture policy and research tend to ignore the values, needs, knowledge and concerns of the very people who provide the food we all eat – and often serve instead powerful commercial interests such as multinational seed and food retailing companies,” said Michel Pimbert of the International Institute for Environment and Development (IIED), a non-profit research institute based in London.

African cholera outbreak kills 2000

A preventable disease that is linked to the need for clean water sources has continued to kill people in a number of countries. WHO officials report that, as of October 3, there have been 40,468 reported cases of cholera and 1,879 reported cholera deaths in four countries, including Cameroon, Chad, Niger and Nigeria. The outbreaks started a few months ago, officials said.

Obesity: an underestimated “silent killer”

There is a new “silent killer” in town. It joins the ranks of malnutrition, malaria, hypertension, diabetes, HIV/AIDS, etc. It is obesity. “We are eating our way to the grave’’ and “obesity is rising in rural areas.’’ Adults are overweight or obese, while children are malnourished – a paradox. In the men still look at a potbelly as a badge of pride and success.” The World Health Organization reports that more than one-third of African women and a quarter of African men are estimated to be overweight, and predicted that it will rise to 41 percent and 30 percent respectively in by 2016. Once considered a problem only in high income countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings.

Reducing poverty with water!

“Water is more valuable than oil, more precious than gold,” said Amy LoPresti, co-founder of Africa Water is Life. “It is the essential ingredient of our life, our culture, our history, and our future. Yet, 1.2 billion people in the world do not have access to clean, consumable water.” Unsafe water and a lack of basic sanitation cause an estimated 80 percent of all diseases in the developing world and together kill more people than all forms of violence, including war.

Modified bananas to fight child and maternal mortality

This is a story that really invokes our organization’s name. High rates of chronic malnutrition and micronutrient deficiencies of Vitamin A and iron among women and children remain Uganda’s most common malnutrition problems. However, an edible banana could solve this problem.

How fight against Guinea Worm was won

Africa Water News highlights a CNN article that suggests we are close to eradicating the disease. Once called the “forgotten disease for a forgotten people” the Carter Center believes that every country in Africa except Sudan will be rid of the disease.

Healthcare is a Moral Obligation

The ANC’s National Health Insurance scheme has yet again opened up the deep economic divisions in South Africa. The economic divisions are best represented by access and quality of health care. Doctors are very difficult to find in poor, crowded townships and settlements, but major towns with many wealth have centers for plastic surgery. 60% of funds for health services are directed at the 15% of the population which is covered by private health insurance. Only 40% of the funds are used to pay for the public sector that serves 85% of the population.

Medical Education in Africa to receive $1.3million in American Grants

Over the next five years and in partnership with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the department is awarding grants to African institutions in a dozen countries under its Medical Education Partnership Initiative (MEPI), which works with U.S. medical schools and universities to form a network that includes about 30 regional partners, country health and education ministries, and more than 20 U.S. collaborators.

Ghanaian belief and Healthcare

This article is being featured because of the subject matter. Voice of America (VOA) has a habit of generalizing, especially in Africa and about African people. I suggest reading the interview transcript on how traditional beliefs guide health practices in Ghana, something that I studied during a 6 week study abroad covering disparities in health care. The US health care system could learn a thing or two from the Ghanaian health system.

Hope Expanded Protection Against TB

With a vaccine and drugs available to treat tuberculosis (TB), you would think that it should no longer be a problem. 1.3 million people worldwide died from TB in 2008, according to the World Health Organization most lived in Africa and Southeast Asia. Is this becoming another “forgotten disease for a forgotten people?”

Before you have anything else, you have your health. Hopefully if you have nothing else, at least you have your health. Unfortunately, for millions across the African continent this is not an absolute fact. Even more unfortunate is the fact that many Africans have no ability to change their health status. They are trapped in a system that is driven by Western market based, profit driven health care systems. As the failures of Western development practices come to light, alternatives to what has been are becoming increasingly visible. These alternatives will form a revolution in African health care delivery. This revolution will be fueled by health care delivery models that will give local communities agency in the provision of their own health care. Community-based models involving cooperative financing, proven para-professional training, new information technology, and social enterprise for the social good will drive the revolution in African health care. People will be able to determine for themselves, their level of health.

What does “Health” mean anyway?
This is a question often left to remain ambiguous. For the purposes of my writing I will provide a comprehensive view of “health” and all that is entailed in sustaining and maintaining health. “Health” in all instances will refer directly to the “basic needs” of a person in regards to health care.

Healing, like health, is obviously rooted in the social and cultural order. [...] To define dangerous behavior, and to define evil, is to define some causes of illness. As the definition of evil changes, so does the interpretation of illness. To understand change in healing, we must understand what it is that leads people to alter the definition of dangerous social behavior. It can easily be accepted that health and healing in Africa are shaped by broad social forces.

As Feierman and Janzen state, health (and healing for that matter) are directly linked to social forces. If a comprehensive understanding of health is to be understood, it must be studied in the context of politics, economics, and other societal structures.

Health is defined by the World Health Organization (WHO) as, “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” The WHO and many other international organizations recognize that this broad and encompassing definition of health. Where this definition becomes ambiguous is what qualifiers meet, “a state of complete physical, mental, and social well-being.” In 1978 the WHO made primary health care its number one objective with the Declaration of Alma Ata. However, even this statement had no clear definition of health or its qualifiers.

Feierman and Janzen provide a more clear definition of the qualifiers of health in the preface to their volume: The Social Basis of Health and Healing in Africa,

[…] it [health] is maintained by a cushion of adequate nutrition, social support, water supply, housing, sanitation, and continued collective defense against contagious and degenerative disease. Such a view is necessary if we are to understand those contexts in today’s Africa where health levels deteriorate, and where they improve.

These authors provide a complete set of qualifiers, or “basic needs,” of health that can be researched further to understand where political, economic, and social structures interfere with sustaining and maintaining health and where health care is inadequate.

Health care should thus be understood as the system and structure that works to provide the above defined “basic needs” to each individual. Often this role falls to governments, but sometimes is taken up by communities and organizations when government’s fail to provide these basic needs.

This blog series will cover four key areas identified that will fuel this revolution in African health care: cooperative financing, para-professional training, information technology, and social enterprise. SCOUT BANANA works to tackle social medicine (social, economic, structures) while enabling others to provide medical services. Be sure to follow closely to learn more!

(photo credit: WHO)

From the UN Declaration to Amnesty International, between Paul Farmer and William Easterly it seems that everyone has a different understanding of what constitutes a basic human right and the cause of its absence. Michael Keizner has been building the discussion on health and human rights on Change.org’s Global Health blog while NYU Professor, William Easterly has recently entered the debate as a response to Amnesty International’s position on poverty related to human rights. This fueled a response from Amnesty International, which stated that Easterly was “pretty off base.” Easterly followed his Amnesty International response with an end to his “human rights trilogy” by asking Paul Farmer who should be held responsible for satisfying the right to health care?

The World Health Organization (WHO) states health as a human right as:

“the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being…”

It seems that Easterly’s human rights criteria is trapped in an old international law paradigm where there must be someone at fault or someone to blame. He also forgets that health is directly linked to food. You cannot have good health and not have food. Effective aid, not seen in today’s aid schemes, based in sustainable practices (not just buzzword reporting) that supports an individual’s right to develop themselves should look comprehensively towards the needs of a community of individuals. The ideas of human rights, foreign aid, and development should be less focused on international systems and more focused on building strong communities that meet their own human needs: health care, food, water, etc.

Within this debate of health and human rights, where does SCOUT BANANA fit. As an organization that makes and stands behind the statement that:

“global health is everyone’s responsibility and every individual’s human right”

Paul Farmer has the right idea, as Easterly quotes from his Tanner Lecture in 2005:

“only a social movement involving millions, most of us living far from these difficult settings, could allow us to change the course of history….troves of attention are required to reconfigure existing arrangements if we are to slow the steady movement of resources from poor to rich—transfers that have always been associated… with violence and epidemic disease… whether or not we can say “never again” with any conviction—will depend on our collective courage to examine and understand the roots of modern violence and the violation of a broad array of rights, including social and economic rights”

This is exactly similar to SCOUT BANANA’s understanding of health as a human right and a responsibility. It is a right where we do not attempt to place blame or hold the past accountable because those become frivolous exercises that produce no results. When we delve deeper into the root causes of issues, for example the driving forces of slavery, we must focus on a responsibility to not repeat the past and make ourselves accountable in the future.

There is no way that the entire European population and its descendants can be held accountable for the evils of the slave trade. While the same ideas of human rights did not exist in the time period of slavery, it is similarly difficult to place blame on systems (and populations) that drive the causes of poverty and lack of access to health care. Many people that I work with on development projects feel guilty that they are so privileged and wealthy compared to the communities that they work with that are so poor. SCOUT BANANA teaches its members to not feel guilty, but instead to feel responsible. Understanding personal privilege related to the oppression of certain populations within societal structures can assist in creating positive impacts. Human rights don’t necessarily have to be about placing blame, but rather developing an understanding of responsibility.

So Professor Easterly when you ask who is responsible for satisfying human rights: it is you, it is me, it is all those who dream of making a difference, and it is also those who lack the very human rights that we hold dear. Placing blame is not a concrete step forward, learning from history and recognizing where our privilege fits can be a first step towards effective actions. I too see Paul Farmer’s vision of a movement of millions, near and far, taking actions to shape a better future where human rights are everyone’s responsibility and every individual’s human right.

From the Article 25 of the Universal Declaration on Human Rights:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

Nyala, Kalma camp, South Darfur - March 2007 (MSF Photo Blog)

The impact of conflict on the environment and then the subsequent, direct effect on human health cannot be overlooked. This internally displaced peoples (IDP) camp in Sudan shows the seriousness of that impact.

Your Old Cell Phone Can Make a Difference in Global Health

Everyone in the global health sector is writing about the incredible reach of SMS technologies working for health in developing countries, and rightly so. Hope Phones has partnered with FrontlineSMS to provide old cell phones to communities in need through SMSmedic partner organizations.
More:
Your Old Phone Can Change the World

TeleMed
A service that I just recently came across is one that is not being as widely talked about. TeleMed is different from FrontlineSMS: Medic because it connects local health care workers directly to patients in need via SMS technology. SMS: Medic is focused on health infrastructure. TeleMed does not have a website up yet, but is definitely one to watch:

Paul Farmer and the US Government?

The other big talk within global health is whether Paul Farmer will take a job within the US government. Some have expressed great hope for potential reform others voice their plea with him to continue his incredible community based work outside the bureaucracies. My opinion is that Partners in Health has developed into a strong organization and does not depend on Paul Farmer to further their work. If he wants to take on the inefficiencies and inadequacies of the US government and global health, then all the more power to him.

Southern Africa: Global Financial Crisis Leads to HIV Budget Cuts

Broken promises abound as the economic crisis deepens and the right to health falters, but activists are coming together to ensure that funding for health and HIV are not cut. International donors are expected to slash budgets for health due to the economic crisis and health experts fear that this will lead to, “less food security and quality of nutrition, which will in turn put more stress on already weak health systems.” Paula Akugizibwe, regional treatment literacy and advocacy coordinator of Windhoek-based AIDS and Rights Alliance for Southern Africa (ARASA) in Namibia demanded, “We need to ensure that African lives do not become a silent casualty of the global financial downturn. Our lives are not cheap or expendable. We expect health to be prioritised over weapons, sports and lavish politics.” Tanzania was the first sub-Saharan country to announce a 25 percent cut of its annual HIV/AIDS budget.
Other budget cut impacts:
Guinea: Medicines Running Out

Zambian High Court to Hear Groundbreaking HIV Case

On Wednesday, the Livingstone High Court was supposed to hear a ground breaking case about whether mandatory testing for HIV and discrimination solely on the basis of HIV status is constitutional in Zambia. Unfortunately two days later news came that the trial was postponed until mid-July. Be sure to keep watching this story.
More:
Trial postponed until 15 July

HIV Prevention and Behavior Change

Mara Gordon writes on Change.org’s Global Health Blog about a direct campaign in Tanzania discussing behavior change. “This campaign is partially paid for by the President’s Emergency Plan for AIDS Relief, U.S. government money to fight HIV that’s notoriously had lots of conservative strings attached. Had I seen this ad a year ago, I probably would have dismissed it as unrealistic abstinence-only propaganda. But behavior change works. Behavior change – in combination with access to condoms, comprehensive sexual education, open discussion about HIV and sexually transmitted infections in general, all that good liberal stuff.”
More:
Changing Human Behaviors: Sexual and Social
During a course on Africa’s environmental history I wrote about the need for changing human behavior in both the sexual and social arena to make a real impact in HIV prevalence. The major social change is the response from Western institutions and organizations in how they talk about HIV/AIDS and Africa while seeking to change sexual behavior.
Lesotho: Cultural Beliefs Threaten Prevention of Mother-Child HIV Transmission
Health workers note an encouraging response to the PMTCT program. The number of facilities providing PMTCT has risen from nine in 2004 to 166 by the end of 2008. The number of women who received PMTCT and subsequent antiretroviral (ARV) treatment increased from 421 in 2004 to about 5,000 by end of last year, according to 2009 National AIDS Council statistics. “The primary health care coordinator at St. James Mantsonyane Mission Hospital, Khanyane Mabitso, says stigma and cultural beliefs make it difficult for medical personnel to follow up on HIV-positive mothers and their babies.”

Progress on health-related MDGs mixed

Many advances have been made in health. Some argue that these advances have been dwarfed by the HIV/AIDS epidemic, the economic crisis, or the failures of African governments. The WHO report shows that the only statistic with concrete results was the number of children dying before the age of five. Is this a solid example of the failure of big plans and blanket goals for development?

Sierra Leone: ACC Recommends Reform At Health Ministry

The Anti-Corruption Committee report provides a number of recommendations for reform all focused on improving the health care delivery services in Sierra Leone and eliminating the risk of corrupt practices in the health services across the country.
More on health service scale-up:
Chad: Paving the Way for Better Obstetric Care
Government meetings with UNICEF to help scale-up of health services for better obstetric care across the country.

Ten Things You Can Do to Fight World Hunger

The Nation provides an interesting set of things you can do in your everyday life to fight world hunger. They properly focus on how food, a basic human need, has been commodified in our global capitalist structure. “Our planet produces enough food to feed its more than 960 million undernourished people. The basic cause of global hunger is not underproduction; it is a production and distribution system that treats food as a commodity rather than a human right.” When in February I wrote that agricultural experts had said the food crisis of the last year was over evidence from this past week point to the contrary.
More:
Tanzania: Food Shortage Unnecessary
“Tanzania has since independence sang the song of ‘Agriculture is the backbone of the economy’, but little has gone into strategizing and implementing viable actions towards surplus food production.”
Kenya: UN Agency Makes First Local Food Purchase from Small Scale Farmers
The United Nations World Food Programme (WFP) has for the first time bought food from small-scale farmers in Kenya under a new initiative aimed at boosting agriculture by connecting farmers to markets.
Zimbabwe: Another Year Without Much Food
Rwanda: Nearly Half the Country’s Children Are Malnourished
Kenya: Over Three Million Face Food Shortages

Africa: High Level Engagement with Continent Has Started

Speaking at a gala reception in Washington marking the beginning of “Africa Week,” Carson said: “Most of the Obama administration’s Africa team is in place, and we are gearing up. We will continue to build on and strengthen the strong bipartisan consensus in Congress and among the people of America that has motivated U.S. policy towards Africa. Over the next four years, we will be focusing our efforts on strengthening democracy, promoting sustainable development, resolving or mitigating conflict, and dealing with transnational issues such as climate change and agriculture,” he pledged. While Obama has built a great team, the White House has yet to announce any Africa Policy, greater control and influence for the Bureau of African Affairs, or take any serious (or effective) action for the continent.
More:
Tanzania: Obama, Kikwete Meet in Oval Office on Africa’s Conflicts

World Bank Resumes Zimbabwe Aid

Zimbabwe owes the World Bank and the African Development Bank more than $1bn, how much potential does renewed aid really hold for the country. If the debt is not forgiven there will be no way the country will be able to rebuild necessary infrastructures for health, water, etc. There are countless case studies to show this historical fact. It must also be noted that Western sanctions were a huge detriment to a country in need, maybe this marks a turnaround?