NEWSBYALANNA SHAIKH

The effect of climate change on developing nations is clear: more fierce storms and hurricanes, tougher conditions in which to grow crops. But climate change will also require new approaches to development, as agreed by the panel at the 2009 Global Forum for Health Research.

The needs of those likely to be hit hardest by climate change, and effected by the change in geographic distribution of disease, are taken into consideration last. This must change, and climate change will require that make we make the change even quicker. It'll also be increasingly important to ensure that those particularly vulnerable to deteriorating health are helped: those in high mountain zones, and on small island states.

The Global Forum uses climate to demand better balance in funding for reestablishing health among the poorest populations. The coined the '10/90' gap to explain that only "10 percent of the world's pharmaceutical research goes to diseases that account for 90 percent of the global disease burden." With climate change aggravating poverty, the longer we take to act, the more that the gains of the Millenium Goals will be eroded away.

Photo: Nattu

(photo credit: BrianScott)

Today is my last day as global health editor at Change.org. I wanted to take this chance to thank everyone who made this blog happen with me.

First of all, I want to thank you - there is no blog without readers. Your questions and comments were a constant flow of new insight into global health ideas. I am a smarter person because of them.

Michael Keizer shared his rigorous analysis of health and human rights, served as a cheerleaders and a sounding board, and never let me forget why writing a blog like this matters.

Lillian Gu wrote our weekly highlights when I was too self-conscious to do it, and her constant feedback on what was working and what wasn't helped me improve our content across the board. She also put up with an awful lot of my google-chat ranting about kids these days.

Mara Gordon enriched the blog with her media connections and field perspective. She shared unique on-the-ground views, and provided useful insight on global health in the mainstream media.

Mariam Mostamandy, our community development intern, supported dialogue and debate on global health issues. She sought out and spotlighted the comment of the week, and made sure that every got their charity gifts.

Incia Zaffar sought out new ways for us to take action on global health, including protesting the travel ban on people with AIDS, supporting the Millennium Development goals, and pushing our elected leaders to do better.

It's been a real joy writing here, and I will miss it. I have some exciting new opportunities coming up, though, so it's a logical point of parting. If you want to keep up with my new ventures, you can track me through my home page at www.alannashaikh.com.

(photo credit: Scoobymoo)

Learning about - and then working in - global health has given me the tools to remain focused and optimistic in a world that is neck-deep in despair. It has changed the way I think and the way I live. It has given meaning to my career and a structure to my life. I would not be the person I am if I trained in some other field and I am profoundly grateful to have stumbled into employment that I love.

Global health problems have definitions. You can learn to identify their causes, and start to work on solutions. Even when problems have multiple causes and many effects, you can still always find a place to start. There is something you can do to improve things, somehow. Being part of a solution, however small, helps you face the troubles of the world.

When I fill out my expense report for the third time because I keep formatting it wrong, worry about using up my sick days, or go to a meeting so long and so dull that life becomes a Dilbert cartoon, it is more bearable because I am in this for a reason. I have work that saves people's lives. Doing something that has a direct impact on human life makes all the routine job nonsense easier to face.

I don't know for sure what job I will be doing next year. But I know the general outline. I know what health approaches I believe in: primary health care, systemic approaches, building capacity, doing good M&E. I know what work on those topics looks like, and I know how to find that work. I know that when I work for a good project I am happy, and that my exact job description doesn't matter that much.

My love for global health has affected everyone in my life. My husband once got a job in health on the strength of my passion for it; I talk about health issues so much that he knew the vocabulary and major issues. I am well-known among my friends for my ability to advise and troubleshoot contraceptive methods. I have talked more than one fence-sitting acquaintance into getting their child vaccinated.

Thinking, writing, talking about global health is at the heart of my personality. I have had jobs that weren't directly related to health, but the health component always sneaks back in. Somebody always has a question - does this project make sense? Should we really be donating refrigerators? And I end up being known as the person who'll find the answer. I am proud to be that person, proud to know that even when I am not working in health I am still paying attention.

I am proud to work in global health, and I am proud to advocate for this cause. You can't talk people into falling in love, but I don't mind trying.

(photo credit: Daquelle manera)

The China Daily, a government-controlled Chinese newspaper, admitted Wednesday that organ donation in the country was heavily dependent on executed prisoners. This is the first government admission of the link between executions and organ donations.

They made the admission in an article published on August 26 that focused on China's new Red Cross-run national organ donation system. It stated that "China launched a national organ donation system yesterday in a bid to gradually shake off its long-time dependence on executed prisoners as a major source of organs for transplants and as part of efforts to crack down on organ trafficking."

I am stunned. This was the stuff of shady rumors and hand-letters signs carried by crackpots. I can't believe that the Chinese government is really admitting this, and I can't believe there hasn't been more outcry from the global community. It's a very canny move by the government of China, I guess. Deny everything until you have a system in place to fix things. Then what can anyone do? You're already trying to fix it. As an added bonus, if the Chinese population doesn't start singing up for voluntary organization donation, then the government can blame the people when they go back to using prisoner donations.

The article does not address some of the darker claims made about Chinese organ harvesting. The worst I have heard is that the Chinese governments advertises to "organ tourists" about clean-living Falun Gong prisoners, and then executes condemned prisoners once their organs are sold. This also leads to an implication that the government of China has an incentive to arrest, condemn, and execute constant flow of prisoners.  (And if you think that sounds paranoid, think how crazy the organ harvesting sounded until the government of China admitted it was true.)

I don't think those darker fears are irrational. If a Chinese government mouthpiece is admitting that "Some just ignore legal procedures regarding organ donations from executed prisoners and make a fat profit," and "organ middlemen have been faking documents in order to make a person who is desperately in need of money be considered ‘emotionally connected' to the recipients," you have to wonder what they're not saying.

(Munch painting. Image credit: Free Parking)

I don't want to be a scaremonger, but if you have a small child, now would be a good time to get very, very serious about teaching handwashing. As a mom of a three-year old, I know how hard it is to keep toddlers healthy. They touch everything, and they put their hands in their mouths constantly. But swine flu is spreading - either still or again, and with school starting again I worry about the little kids.

Statistically small children are a risk group for serious cases of H1N1. Kids under 5 have one of the highest mortality rates from swine flu. And, as everyone who's ever had a kid under five knows, they get sick all the time. Picture a small child. Is their nose running? Yeah, I thought so. We just get used to them always having some kind of virus. In the case, though, the virus is bad enough we need to really work to prevent it.

It's a lot more scary when the virus is H1N1. We don't really know if Tamiflu works in kids, and we're seeing resistance to Tamiflu anyway. We know that swine flu spreads fast in crowded environments like schools. And we still don't have a vaccination that works for swine flu.

Now you're panicking. (Well, I am.) What do we do at this point? How did I calm down enough to sleep at night? Well, like I started out, we get a lot stricter about washing hands. With kids who hate handwashing  (which is all of them) you can use hand sanitizing gel. If your child's school or daycare is closed for flu, keep her at home. Don't send her to a babysitter or use the closing for a trip to the zoo. If your school has identified a need for social isolation, respect that. Finally, once a seasonal flu vaccine is available, get it for your child. No one knows if it helps with swine flu, but it's not going to hurt, and it will definitely protect him from seasonal flu.

This week saw some really outstanding writing and thinking about global HIV advocacy, and some ugly stereotypes. This includes incredible videos, disturbing print graphics, and a blogger training manual for how to write about AIDS

IRIN , the United Nations news network, has produced four amazing videos about HIV. Each films profiles someone fighting AIDS, including an activist, an educator, a Catholic bishop, and a TV presenter. It’s hard to make a film about HIV that contains a sense of hope without being previous or overly romantic. These films manage to do it.

The Sociological Images blog features two print ads about HIV. Both of them seem to blame women for the spread of AIDS, and feature the naked female body. I know the ad featured about is supposed to tell us that HIV can happen to everyone, but I don’t think that is the message it sends. Both images just seem to tell me that women are dirty spreaders of disease, and I doubt I’m alone in that. (This blog post on how cool alone is not a marketing strategy might shed some light on what went wrong.)

Maybe the advertisers could have learned something from the Blogging Positively Guide, which is a resource for how to write about HIV. My favorite piece of advice is to remember that although in practice most blogs only have about twelve readers, anything you write could end up seen by a million people. I also really liked their examples of organizations and individuals who use blogging to fight AIDS.

Bonus related link: This isn’t about HIV, but it is about advocacy. The Aid Watch blog has a post criticizing a new cinema ad campaign from Doctors With Borders. Aid Watch hates the video, and thinks it’s way over the line, demonizing Africa and creating a sense of hopelessness. The Aid Watch commenters disagree.

(photo credit: Matthew Oliphant)

Stacy F wants to know more about where the US based global health jobs are located. Can we help her?

Reader Stacy F asks:

I'm currently looking for positions abroad however these are very difficult to get and I just recently broadened my search to the US. I'm currently in San Francisco and although the nonprofit sector is robust here I find that the global health sector is very small. Some ideas that the post could cover:  What are the top regions for global health outside of developing countries (New York, DC, Seattle, etc.), what are some disadvantages/advantages for each region, and culture, etc.

My Answer:

Honestly, I think Stacy may be in trouble. As far as I know, you get global health jobs overseas, where the field work takes place, or in Washington DC or Seattle. There aren't really other US regions with global health work. I have based my own future plans on the assumption that I'll need to be in DC or abroad as long as I want to have salaried work. If I decide to go consultant forever, I'll base myself somewhere that expenses are lower, but as long as I want to work for one organization, it will be DC. Even Seattle doesn't have enough options to make me feel comfortable.

There are a few places with a concentration of global health jobs out outside DC and Seattle. Research Triangle Park, near Chapel Hill, North Carolina has a concentration of NGOs that do global health work, as well as the nearby University of North Carolina. Atlanta, Georgia has both Emory University and the Centers for Disease Control and Prevention. But none of those really strike me as "regions." Readers, what do you think? Am I missing something? Can you advise Stacy F?

(photo credit: Muffet)

Most of you probably know already that Ted Kennedy passed away today. You probably know that he was called "The lion of the senate," a powerful voice for progressive causes even when the US drifted further and further to the right. What you may not know is that he was a passionate champion of global health.

My very first job in global health was with the Alliance for the Prudent Use of Antibiotics. We advocated for better US policy on the use of antibiotics, and on global precautions to preserve the power of antibiotics. When we despaired of getting congressional support for our cause, we always had one hope: Ted Kennedy would listen to us. Everyone knew that he would always stand up for health, whether health for Americans or health for the world.

Senator Kennedy spent his senate career fighting for better health. 1978, he became a champion of the Alma-Ata declaration, which called for health care for all. He was a powerful supporter of the Global Fund to Fight AIDS, Tuberculosis, and Malaria.  Last December, Physicians for Human Rights presented Senator Kennedy with their Award for Outstanding Leadership on the Right to Health. In July, Foundation for AIDS Research gave him their courage award. Those are just the highlights of a career devoted to supporting human rights, human health, and human dignity.

It's easy to look at other people's achievements and feel lessened by them, to assume that they are somehow special and we're not. But that's not true.  That's what we can learn from Senator Kennedy. He was an ordinary man made great by his passion for justice and the courage of his convictions.

We cannot all run for senator. We can't all be born with the advantages of a Kennedy. But every one of us can find what matters and spend our lives defending it.

(photo credit: tacit requiem)

I had one of those moments today where I was struck by the impossibility of the work we do. We're all bitter, crazy optimists in global health. Because we have to be. But sometimes I am reminded of just how crazy that optimism is.

I was talking to a Tajik acquaintance today. She's a mother of three kids. Her youngest child is two, and suffering from a sore throat. The girl is also running a slight fever. My acquaintance has been getting penicillin shots for her daughter, injected into the throat. She was complaining today, about how her daughter cries and cries about the needles and about the cost of the shots.

Since I am a hopeless meddler, I suggested that she discontinue the shots. There is no earthly reason to give antibiotic injections for an ordinary sore throat. Especially since there has been no throat culture, so we don't even know this is a bacterial infection. I gave my usual pitch about why antibiotics can't cure all illnesses: they only work on a certain kind if microbe called bacteria, and not all illnesses are caused by bacteria.

This is what the young mother told me in return: "But, Gulia is sick! And how will she get better if we don't do anything?" Further conversation made it clear that she actually didn't believe it was possible for the human body to heal on its own. You only get better if you do something.

Every time I slam into a cultural gap like this, I am hit by the sheer challenge of global health work. Should we try to teach people that the body does heal on its own? Should we focus on things like eating healthy food as remedies for sickness? Is it ever our place to have this conversation? Maybe we should leave Tajiks alone to work out their own approach to health and healing. I honestly don't know.

(photo credit: Alexandra Lee)

A few weeks ago, I talked about the multiple meanings of access to health care, focusing on the fact that access is always more complex than you expect. A recent report on abortion access in the US brought that home to me.

The Alan Guttmacher Institute reports that mifepristone for medication abortion was expected to widely expand abortion access in the United States. That promise has not come true. Instead, new research found that "most medication abortions were performed at or near facilities that also provided surgical abortions." In other words, ten years after the abortion pill became available, access to abortion is still linked to being near a medical facility that provides abortions.

What happened? The article doesn't speculate on why mifepristone hasn't improved access to abortion, but I have a theory. I think they misunderstood exactly what the barrier to abortion access was.

The barrier wasn't providers who were capable of providing abortions. Just about every obstetrician is capable of performing an abortion. A vacuum-aspiration abortion is a very easy procedure to perform - one of the easiest. A dilation and curettage isn't much more difficult, and it is called for in situations unrelated to abortion, such as when removing fibroids from the uterus.

The true barrier to abortion access is providers who are willing to perform an abortion. Some providers are morally opposed to abortion provision. Others are unwilling to risk the threats and violence that go along with being an abortion provider. And doctors who are unwilling to provide surgical abortions are also unwilling to prescribe an abortion pill.

So, ten years after the abortion pill was introduced, American women who have access to a health care provider who does abortions can choose between a surgical abortion and a medication abortion. And women who don't have access to that kind of provider are still screwed.