RotaFlash, April 2016
It’s one thing to say “Breast is best.” It’s quite another to undertake the actual work of breastfeeding! As you’ll read below, breastfeeding might be natural, but it’s not always easy. Moms need support from other moms, families, and governments.
Rather than asking a technical expert to write about the health benefits of breastfeeding, we went right to the source and asked moms to weigh in on why they decided to breastfeed, what support made it possible, and any advice for new moms who are breastfeeding.
Here’s what they said. What would you add? Join the conversation on Facebook or Twitter.
I decided to breastfeed my baby because I see breastfeeding as an act of love. I am not only nourishing him but also forming a very intimate bond. I am also providing nutrition that compares to none other, particularly during the first few months of life. And I am aware that the foundation I help lay for my son through breastfeeding will contribute to his health for life. My family and colleagues have been very supportive, including allowing flexible working hours that enable me to breastfeed my son. I would encourage new moms to breastfeed their little ones for at least two years and they will keep the emergency room away.
- Pauline, Kenya
When I did my MPH, I constantly chose research papers or group projects focused on exclusive breastfeeding. I quickly became an ardent advocate for breastfeeding and felt like something of an expert. I knew I would breastfeed when I had children. Then I had my son and actually tried to do it myself, and I realized I was not even close to an expert! Breastfeeding is natural, but it is not easy! The first few months were a struggle, and I do not think I would have made it without the support of lactation consultants and my circle of friends who had been through it before me. My advice to new moms is believe in yourself and ask for help! And enjoy those special moments with your baby, soon they will be a rambunctious toddler with little interest in snuggling on your lap.
- Kelly, United States
I breastfeed because I believe the mother’s milk nourishes and protects the baby. It helps the baby in strengthening the immune system. My mother, a nurse, helped educate me on all aspects that encompass breastfeeding and the importance of it. The message is reinforced by my relatives and friends.
- Gracy, India
The decision to breastfeed wasn’t really one I thought very much about – I knew the health benefits, that it was good for mother and baby, not to mention convenient for a hungry baby on-the-go. How hard can it be, I thought? Millions of women do this all the time! How wrong I was. I didn’t struggle as much as some mamas do, but boy oh boy those first few weeks and months were stressful, painful, and just really hard. I am forever grateful for the support system and resources I had: a lactation consultant and nurse practitioner on speed dial, the ability to do a quick Google search with questions, and several really good friends who reassured me the difficulties pass and it gets better. To all you expectant or new mamas out there, hang in, it will get better. Millions of women DO do this all the time; there is a network of ladies out there cheering you on. You’ve joined a pretty great club!
- Ashley, United States
Breast milk is the best gift a mom can ever give to their little bundle of joy. It has all the nutrients a baby needs, including antibodies to help baby fight off any infections, and one doesn’t have to worry about sterilizing bottles and the risk of contaminating baby’s milk during preparation. I also enjoy the skin-to-skin contact with my baby during breastfeeding. I feel really close to my baby, especially if I’ve been away at work, and I look forward to some bonding time during his feeds.
My family supported me a lot, especially my husband and my mum. Hubby kept the cups of tea coming and my mum prepared delicious meals for me, and I just focused on feeding my baby on demand. My work colleagues gave me useful advice about preparing to return to work, investing in a good breast pump, and also expressing and storing milk supplies while I was on maternity leave, so that there was enough for baby when I was at work.
Advice for new moms: Be patient, sometimes the milk takes a while to come in, it can get frustrating for you and baby, but don’t give up: keep baby on the breast, the milk does come in eventually. The baby can take a while to latch on the breast properly, but practice makes perfect. Keep at it, and eventually you and baby will get the hang of it!
- Yolanda, South Africa
Being a nutritionist myself, I know the power of breastfeeding. It is much more than a food which provides optimum nutrition to the baby; it keeps the child active and infections at bay. I have two girls: Shyla (nine years old) and Sadhya (four years old) and have followed WHO breastfeeding guidelines to the core. Small children fall ill frequently as their immune system is stilldeveloping for their first three years, but I have personally experienced that my kids fell ill less as infants, and even now that they’re older, compared to formula fed children in the neighborhood.
It is because of my core belief in the benefits of breastfeeding and my mother-in-law’s support that made it possible for me to breastfeed my children exclusively till six months and with continued breastfeeding till two years of age. I started working when Shyla was four months old and Sadhya was six months old. I used to express milk at my workplace and at home, which my mother-in-law used to feed them in my absence.
It is a sheer joy as a new mother to see your baby grow and thrive on your breastmilk alone. What a satisfying feeling! No less than a God’s marvel! Only a woman can enjoy.
- Ruchika, India
I’ve always just assumed that I would breastfeed. My mom is a community health worker in Detroit and her focus has always been on newborn and child health, so she’s been a major source of support for me. She normalized it for me. Then, when I started breastfeeding myself and realized how difficult it can be, I got some great support from other moms I know and my doctors who encouraged me to push through.
To new moms, first I’d say that IT GETS BETTER! Take the time to care for your nipples and practice your latch. People make it seem like just because it’s a natural thing to do that it’s somehow easy and painless, but breastfeeding moms know that isn’t always true. Secondly, I’d tell new moms to do their best and stick with it, but not at the expense of your sanity or your body. It’s not a given that all women are able to breastfeed. Mastitis, thrush and other conditions can take a serious toll on your physical and mental health. Don’t waste the short amount of time you have with baby before going back to work by feeling guilty about it.
- Cristina, United States
Shigella, a deadly bacterial infection that causes diarrhea, may not be a household name, but it quickly became one for the Maier family when Jackie (bottom right in the above photo) became severely ill at nine years old, right around the time this photo was taken.
Efforts to defeat diarrheal disease is truly a family affair in this case; Nicole Maier (Jackie’s sister, center in the above photo) is now a Clinical and Regulatory Coordinator for PATH’s Enteric Vaccine Initiative – currently working on a vaccine against Shigella!
We talked with Nicole’s sister, Jackie, and mother, Roxanne, to hear their firsthand accounts about how they dealt with the sudden onset of the illness and its complications.
Walk us through the timeline of what happened. How did everything unfold?
Jackie: I was nine years old, and I was at a friend’s house for a sleepover. When I woke up in the morning I felt stomach pain. I remember I didn’t want any breakfast, I felt tired and weak, and needed to use the bathroom every 5-10 minutes. In my mind, it happened so suddenly. One day I was fine, playing at my friend’s house, having fun, and the next day I was miserable.
My mom picked me up from my friend’s house and by the time I got home, I couldn’t walk. She and my older sister, Rebecca (age 14), had to carry me. There was so much pain, constant pain in my head, stomach, intestines, everywhere. The most difficult part? Not being able to walk to the bathroom by myself or hold myself up on the toilet because I was so tired and weak.
Roxanne: After twelve hours she started passing nothing but watery fluid with small amounts of blood. We went to the hospital where the doctor asked if she had drunk red Kool-Aid! I told him she was my third child and I knew this was different. He told me to keep her well-hydrated and sent us home.
Having had nothing but Pedialyte and water for a couple of days, her diarrhea became much worse. She was passing nothing but blood and mucous. I collected a specimen and we took her to Walter Reed Medical Center’s Emergency Room.
What happened after you got to the Emergency Room?
Roxanne: The doctors there were wonderful. It was July 4th and the ER was crowded, but they processed us quickly. One of the doctors who examined Jackie had just returned from duty in Somalia, so he was very familiar with diarrheal disease. As soon as he looked at the specimen he said, "This is Shigella." After observation and testing to ensure her kidneys were not affected, they treated her with drugs for tenesmus and with antibiotics.
What do you remember about how you felt emotionally?
Jackie: I think I was too tired and weak to have much emotion in the beginning. I was definitely scared, exhausted, and in pain. After being sick for a couple days, I remember eventually feeling desperate for it to stop, begging for it to be over. As time went on (months and years) and I saw multiple doctors, who were wonderful but only seemed to provide temporary relief from the stomach pain and diarrhea, I started to feel very trapped, sad, and discouraged. At times I was scared to eat because I knew I would have to lie down afterwards because of the stomach pain.
Roxanne: Several memories are hard to forget. The dismissive attitude of the first doctor who asked if Jackie had red Kool-Aid. The distinctive odor of the infection. Holding Jackie on the toilet because she was too weak to sit on her own. The memory of my oldest daughter, Rebecca, who was only 14 at the time, offering assistance and support beyond her years.
Since we never identified where or how she got the illness, I didn't know how to protect the rest of my family and myself. I was concerned about Jackie being reinfected or passing it to someone else, especially her sisters.
The Maier family and their three daughters, left to right: Rebecca (age 14), Nicole (age 10), and Jackie (age 9). This photo was taken one month before Jackie got sick.
Jackie: My parents were amazing, especially my mom. She slept with/near me the entire time, helped me walk to/from the bathroom, held me up on the toilet because I just wanted to sleep, carried me (at age 9!!) to/from the car when we went to doctor’s appointments. She ran around fetching water, cold towels for my forehead, and tirelessly calling doctors offices for appointments. My parents were so kind and gentle, understanding, encouraging, accommodating, loving, and unbelievably strong – the perfect patient advocates. They gave up a lot of sleep and took a lot of time off work to take care of me and never once seemed frustrated or annoyed with me. I know they were worried, and at times sad, but that was rare. What I remember most is their patience and always seeming to know what to do or who to call next (even if that wasn’t the case, they faked it well).
Have you had to deal with any long-term complications?
Roxanne: Jackie developed ulcerative colitis and chronic gastritis after her infection. Her family physician, a pediatric gastroenterologist from Georgetown Hospital, and gastroenterologists from INOVA treated Jackie for the following 15 years for these issues.
Jackie: I had to continue daily medication until I was in my early 20s to regulate acid levels, minimize diarrhea, and help with stomach and intestinal pain after eating and/or using the bathroom. Currently, at 32, I am very lucky and don’t have many physical complications (knock on wood!), but my digestive system will always remain sensitive. I am prone to stomach aches and diarrhea from stress and from eating too much fatty food. If I do get a stomach flu or food poisoning, it takes longer for my body to recover – usually at least a week before I go back to a regular diet.
Who would have thought that your sister/other daughter would be working on a vaccine against Shigella?
Roxanne: I'm not surprised Nicole has taken an interest in diarrheal disease. She is only 16 months older than Jackie, so for much of her formative years she watched Jackie cope with relapses, special diets, and medication regimens. She developed a fascination with poop. For a while, I thought she might become a gastroenterologist, but I think she made a much better choice. It's important to prevent the infection so we don't have to treat the illness and it complications. I'm really proud to think she's a part of this effort.
What would you say to policymakers considering investing in a vaccine against Shigella?
Jackie: I would strongly encourage all policymakers to invest. Diarrhea may seem temporary, simple, and common, but in some cases it’s severe and has horrible, lasting effects on the digestive system. The vaccine would reduce health care costs related to treatment of the disease and resulting complications, like my gastritis and colitis.
Roxanne: A vaccine would benefit our country's defense and economy. It would protect our soldiers deployed in areas where diarrheal disease is prevalent. It would reduce time lost at work due to sick employees or their sick children. In other countries, a vaccine could be life-saving. Too many believe that diarrhea is a common ailment with no long term consequences. Unfortunately, that's not always the case.
Is there anything else you want to add?
Roxanne: I want to thank everyone involved in seeking solutions to address diarrheal disease. After my experience, I have a special appreciation for their efforts.
Jackie: Like my mom, I’m grateful that there are scientists like my sister, Nicole, and others who are doing work to prevent and ease the burden of diarrheal disease. The disease is frightening, for those who have it and those around you trying to help. I do feel like getting sick defined a portion of my life and although I realize I was extremely lucky, there was a time when I was very unhappy because of my health. So, thank you!
Children join the procession during the launch of the MNCH Advocacy Alliance in Kakamega, Kenya.
After a while, the preventable deaths became too much to bear.
For many years I worked as a midwife at different hospitals, and most days on the job were rewarding. I got to know many amazing women and provide them with compassionate care during their pregnancy, labor, childbirth, and postnatal period. Most importantly, I was able to support them in nurturing and safely bringing new life into this world. This was very satisfying.
However, it didn’t always happen this way. Every so often, I would lose a woman or her baby during pregnancy, childbirth, or a few days after delivery due to entirely preventable causes. For example, sometimes, lifesaving supplies and medicines were out of stock—like resuscitation devices to help newborns with difficulty breathing, or oxytocin to prevent and treat excessive bleeding after birth. Other times, a lack of basic infection prevention supplies would expose mothers and babies to serious postnatal infections that turned fatal.
As a midwife, there was only so much I could do to save women and children’s lives. I realized that in order to change the situation, the health care system needed to be strengthened. I saw that advocacy for maternal, newborn, and child health (MNCH) funding and policies would be critical, as this would help address broader challenges such as stock outs of essential medicines and supplies, as well as health work force shortages. The presence of a health facility does not automatically translate to availability of quality MNCH services.
Earlier this year, I joined PATH as a county policy and advocacy officer, serving Kakamega and Homa Bay counties. I discovered that it is an interesting time for health advocacy in Kenya. The Constitution of Kenya 2010 not only guarantees every citizen the right to the highest standard of health, but also devolves to the counties health services including policy implementation, service provision, and budgeting.
This new structure brings health care decision-making much closer to citizens, and has provided fresh opportunities for civil society and other county-level stakeholders to engage in budget and policy processes. The Constitution provides for citizens to hold their county governments accountable—even in budgeting processes. This is critical for counties like Kakamega and Homa Bay, where too many women, newborns, and children get sick or die needlessly because they lack access to basic services like skilled birth attendance, clean water, malaria prevention, or childhood immunizations.
To mobilize citizen support in Kakamega, PATH helped form an Alliance of twenty civil society organizations (CSOs) to take collective action. Among the Alliance’s goals are to: increase investment in MNCH through enhanced citizen participation in the county budgetary process; ensure that national MNCH policies are adapted at the county level and that county MNCH policies are implemented at various levels within the county; and advocate for equitable distribution of lifesaving MNCH equipment and supplies in all sub-counties; and augment the number of health workers at the community level.
Kakamega’s First Lady, Mrs. Priscillah Oparanya hands over a certificate to members of the Alliance during the launch event.
The Kakamega CSO MNCH Advocacy Alliance was formally launched in late May, and galvanized numerous commitments. We brought more than 150 high-level officials, health practitioners, and community leaders from different sectors. The County's First Lady officiated the event and was joined by the County Minister for Health in pledging to support the MNCH agenda in the county. Several County Assembly budget committee members committed to prioritize health in the budgeting process, with the chair emphasizing that “we should have zero deaths of children in Kakamega County… when a child or mother dies in Kakamega…that is carelessness on policy. Whatever budget you bring, I will make sure it goes through.”
Although our Alliance is in its infancy, we have already made important gains. For example, we have increased engagement between relevant decision-makers and stakeholders. The Alliance discovered that there had been little dialogue between the technical staff at the Ministry of Health (MOH) and the members of the budget and health committees of the County Assembly, resulting in low prioritization of MNCH by these officials. Through the launch event and subsequent meetings, the Alliance has actively convened both parties to spur policy discussion, and now both the MOH and county assembly members see the Alliance as an important link in the health budgeting process.
Another key role of the Alliance has been to bring new sectors to the table. We invited the Minister for Water to the launch event. At first, the Minister had trouble understanding why he needed to attend an MNCH function. The alliance made the case that clean water is essential for MNCH from the facility to the village—from preventing infection in women and newborns during labor and delivery, to avoiding diarrheal disease among children. Now, the Minister of Water is a new ally in our quest to increase prioritization of MNCH in budgets and policies.
The Alliance’s most important work lies ahead. We must build on the momentum from the launch and hold county government officials accountable for their commitments to MNCH. At the end of the day, I am inspired by the progress we are making in Kakamega, and will soon make in Homa Bay—where PATH and partners are building a similar CSO alliance. While I will always be a midwife at heart, I am proud to be part of a group of committed citizens who are actively influencing decision-makers to improve funding and policies so that no mother or child dies from a preventable death.
Photo credits: PATH / Elvis Lemiso.Read more
Long-term gut damage, called environmental enteropathy, catalyzes a chain reaction that limits the chances of children and communities to overcome a cycle of poor health.
There’s a plot twist in the global landscape of diarrheal disease, and the news is good and bad.
The good news is that fewer children are dying from diarrhea than ever before, proving the global investments are making an impact. The bad news is that many of these surviving children who struggle with repeated bouts of diarrhea are wounded for life by an unforgiving domino effect of physical and cognitive stunting. This is partly due to long-term gut damage caused by enteric pathogens, a condition known as environmental enteropathy (EE) and the subject of our new infographic.
EE explains why WASH is fundamental for combating malnutrition; pathogens from unsafe drinking water and limited sanitation and hygiene cause changes to the gut structure that prevent nutrient absorption. When this happens during a child’s first years of life, the long-term impact is devastating.
Having worked on the DefeatDD team for several years, there that are days when the statistics roll off my tongue (or keyboard) and I forget that each one represents a child’s life. But pouring over the latest research on EE kindled a renewed sense of urgency because after a certain point, the damage cannot be undone.
Our full infographic shows that the consequences of stunting extend beyond grade failure to also include an increased risk for chronic diseases and diminished income-earning capacity.
As Dr. Roma Chilengi said at PATH’s Vaccines against Shigella and ETEC (VASE) Conference, “We are saving more lives from diarrhea, but what is the future of kids who grow up sick much of their lives?” I’d hoped that the research I read on EE would offer some hope for ameliorating some of its consequences, but it is unequivocal about the irreversible nature of stunting. For me, that’s the toughest pill to swallow, and one of the most compelling cases for immediate action.
Behavior-change communications specialists will tell you that it is important for people to understand why they should adopt a certain behavior; it helps motivate change. The same goes for policy decisions, too. While learning about the consequences of EE was sobering for me, it was also gratifying to see a new angle in why investing in WASH makes an impact on nutrition and growth. The “Aha!” moment of the infographic is brought to you courtesy of digestive system biology:
I hope you’ll take the time to “digest” our new infographic and use it to help us spread the word about an integrated approach to diarrheal disease. Researchers are continuing to uncover new knowledge about the mechanisms behind EE, but we know enough to know that we can’t afford to wait. We have to continue to deliver and invest in tools to prevent the vicious and inter-generational cycle of stunting and poor health.
Special thanks to Dr. William Petri at the University of Virginia for sharing his expertise on EE!
For more information:
-- Scientists as advocates: researchers reflect on the stories behind the numbers.
-- Good nutrition and strong minds: hear experts weigh in on the connection.
-- Peruse and share data points from our message map on malnutrition and diarrheal disease.Read more
Last month, PATH bid a fond farewell to an irreplaceable colleague—one who just so happened to be the architect of the integrated approach that DefeatDD champions today. Evan Simpson is an optimistic advocate, a consummate collaborator—and an undercover comedian to boot! That potty humor you know us for? Evan is the inaugural inspiration.
Thirsty? This mug is legendary at PATH and a testament to Evan’s unique combination of wisdom and wit.
Evan is also now president of VillageReach, a Seattle-based NGO that ambitiously and effectively trains its focus on the hardest to reach communities. Before we could let him go, DefeatDD raised a glass to this globetrotter and asked for his reflections on the early days of integration, the next frontiers for children’s health, and the relationships at the heart of impact.
Describe the moment you realized that diarrhea is your life’s passion.
Well, I was on a train and...
No, seriously – It was in Malawi, with WHO and CDC. We’d been invited to give a presentation to the ministry about rotavirus vaccines. This was around 2007, when we were trying to identify who would be the early adopter countries.
We sat with the ministry and they just were stone-faced. They had never heard of rotavirus, and they wanted to know: Why weren’t we talking about diarrhea if we were talking about rotavirus. And it was then that I realized, we are talking about the wrong thing.
It was the same everywhere else: Kenya, Zambia, Ghana, Cambodia, El Salvador, Nicaragua. No one had heard of rotavirus. Nobody. And I remember thinking, one day the world is going to look up from rotavirus and say, wow, we need to do something about diarrhea. Everyone was very siloed: vaccines, WASH, nutrition, ORS. Even though we all had the same objective, nobody was talking to each other. I realized that, if we wanted to talk about rotavirus vaccines, we had to frame this in the context of an integrated approach that included all the tools that we know work to prevent and treat diarrhea. Integration could have much more impact than a single intervention.
I remember a stakeholder meeting in Nicaragua to talk about rotavirus vaccine introduction. And it was the community health workers, who specialized in nutrition but also knew about a seasonal diarrhea that came around every spring. So it was the nutrition workers who were the ones most supportive of a rotavirus vaccine, and it was representative of the broad spectrum of people who are touching this issue. At the patient care level, there’s no silo. A kid comes in for diarrhea and no one may know what the pathogens are but they know what you have to do to treat it and prevent it from striking again.
It sounds like, when it comes to really making these advances, that it comes down to particular people or particular relationships.
If there’s one thing I’ve learned in the past 15 years, it’s that this is all about relationships. It’s about finding the people who can get things done, those “key stakeholders,” and getting them motivated. If you don’t have a relationship with, if you’re not talking to the right people on the ground, nothing sustainable happens. In Kenya, they were reluctant on the rotavirus vaccine early on but they wanted to re-establish ORT corners. We knew a champion for it in the country, and it was that relationship that really made those take off.
So now 80+ countries have introduced rotavirus vaccines, many in Africa and many through integrated programming. If you talked to ministers and champions today, how would the conversation shift? What are the priorities that countries now should be thinking about?
The broader clean water and nutrition discussion has to amplify. This is interesting to me about what VillageReach does, focusing on that persistent 20% of kids who don’t get vaccinated, live in squalor, don’t have clean water. They are stunted, and their mothers don’t have access to any health care. For those kids, clean water is the critical next step. For kids who ingest dirty water, it’s not just about diarrhea, it’s about stunting, malnutrition, many other things that affect their ability to thrive.
If I had stayed fumbling around with the diarrhea work—
“Fumbling around with diarrhea!” I think you just titled this blog.
Right! Fumbling around with diarrhea… or in it ….
But no, I really would like to have gotten into work on the gut biome. We’ve got to figure out what’s going on in the guts of these kids. The role of gut health in stunting is a huge public health issue in India, for example. On my last assignment with PATH, I was in India for several months, and I saw the effects all around me. Children seemed really lethargic, really small, listless. They didn’t have the energy that kids should have. What I think is an 8 year old is a 14 year old. It’s overwhelming. And it’s not just India, it’s in Bangladesh, Nepal; in Africa. I think that’s the next frontier, the nutrition and the water environment these people are living in that is contributing to their condition.
Even if you have the most nutritious food, if your body is fighting infection, it can’t absorb the nutrients properly. And once it starts this cascading effect, you’re in big trouble.
Yes. And it goes on for generations. You could see those same effects in these children’s mothers, too.
Happier thoughts: What was your favorite trip to the field, or favorite moment on a trip for PATH?
I remember one trip to a village in Cambodia. The rainy season had just passed, and they had lost half a dozen kids to diarrhea. The grief still showed in the psyche of the community. These villages are far-flung, mostly 10-20 rice-farming families on 100 acres. I remember sitting with a community health worker as we were delivering zinc, ORS, and vitamin A; going through the flipbooks to teach the community. They were so appreciative of the district health official who was with us; satisfied that their government was doing something long-term for them, in response to the tragedy they had just suffered, losing so many children. I felt like this is what we’re supposed to do. It wasn’t just PATH doing great work and then we’d go away. They built something. The government now procures zinc and ORS and Vitamin A and routinely delivers it to villages. It’s policy, and it’s working. PATH is not involved anymore, and that is what it’s about.
In Duan Tom village in Cambodia, a village health volunteer builds awareness of diarrhea and pneumonia among mothers. PATH piloted the integrated approach to caregiving here, and the Government of Cambodia ultimately implemented it nationwide.
We know the diarrheal disease work that you’ve done. But you’ve also done a lot of other things at PATH. Can you give us a rundown of all of the things you’ve done here?
Haven’t worked in the mail room, and I haven’t been CFO—both of which are good things. Nobody wants me doing math.
I was the first communications director for PATH, and then I moved to the Rotavirus Vaccine Program, traveling with CDC and WHO to identify and work with the early adopter countries. The diarrhea work started to grow and expand to champion an integrated approach. Later, I started to work with researchers on a new ORS solution, with clinical studies in Bangladesh. It ultimately wasn’t the game-changer we thought it would be, but I learned a lot. It was really interesting and inspiring.
Then I became interested in how PATH could better connect with our country offices to achieve greater impact. And in mid-2015, we had a need in the India country office and I was able to step in and work as the interim country director. I knew a lot of the team there, and it’s a really interesting place. That worked out to be a really fitting final post.
Given that you had this initial vision of the integrated approach, and where we’ve come now, what is your perception the advocacy movement around diarrhea?
Diarrhea was the big issue in the 90s and it fell off the map with a focus on HIV and malaria. The data are really clear: Without that awareness and attention, countries started backsliding. We felt like, diarrhea needs to get back on the radar. We may not have all the solutions yet but we have to start talking about it again. And that’s what we’ve done.Read more