Voice of America, June 2014
At the second anniversary of USAID's Child Survival Call to Action, USAID...
On January 12, 2010, life was forever changed in Haiti. It wasn’t only the earthquake damage – the deaths, the destroyed buildings – it was the disaster that ultimately introduced cholera into Haiti. On October 17, 2010, the first cholera death in Haiti’s history was recorded. The impact was felt beyond Haiti’s borders; the lack of water and sanitation and the quick transmission of the cholera bacteria meant that Haiti’s neighbors in the Dominican Republic felt the effects too. Since, more than 500,000 Haitians have been sickened by cholera; death tolls climb into the thousands, heightened during the rainy season. Tens of thousands of Dominicans have fallen ill.
Amid the death and sickness, the governments of Haiti and the Dominican Republic have come together to combat the world’s worst cholera epidemic. Just a day before the two-year anniversary of the earthquake, January 11, 2012, the Governments of Haiti and the Dominican Republic announced a call to action for major investment in water, sanitation and hygiene, with particular focus in Haiti. The government leaders, along with PAHO, CDC, UNICEF, and other partners, are calling for the elimination of cholera and the promotion of sustainable development in both countries. The Coalition acknowledges that “improving water and basic sanitation would significantly reduce the prevalence of many water borne illnesses,” cholera included.
And I couldn’t agree more. The solutions to cholera – and other diarrheal diseases – aren’t glamorous. They are things that I take for granted; clean water and a flush toilet. Yet in Haiti, these simple solutions are virtually nonexistent. Clean, safe water, improved toilets and latrines, and good handwashing practices in Haiti and the Dominican Republic could save thousands of lives. The Coalition that formed in January officially launched the “Declaration to Eliminate Cholera in the Island of Hispaniola” in June.
The commitments and the pledges are promising, but I believe the people of Haiti and the Dominican Republic deserve more. Government, donor, and NGO support must translate into action; realistic plans for infrastructure improvements must be developed and funded in the long term. Access to safe water and improved sanitation facilities must be unequivocally available. In the short term, we have to ensure that simple, cost-effective diarrheal disease prevention is available: safe-water solution to enable families to treat their water at home, and soap to ensure handwashing at appropriate times.
Before that fateful day in October 2010, no Dominican or Haitian ever suffered or died from cholera on Hispaniola. And the fact is that we have the tools to return Hispaniola to a cholera-free place. I think the Coalition and its new Declaration are a beginning. I believe the progress is good and the vibe is positive. However, the positive vibe must translate into accountability and action. The Coalition governments and partners are responsible to the people of Haiti and the Dominican Republic, and I would like them held accountable. We have solutions for the short term and a plan for the long term – it is time to make good on the promise and return Hispaniola to a cholera-free island. The clock is ticking for a Cholera-free Hispaniola by 2022.
Photo credit: PATHRead more
Precious sleep. From birth, it is essential to our health and well-being. And no one knows this more than a new mother: the sleep her infant needs, and the glorious—albeit inadequate—hours she can snatch in the seemingly endless cycle of waking, resting, changing, feeding, and soothing.
Precious, yet precarious. So little can make so big a difference in the restful and restorative sleep a baby needs. From colic, teething, the slightest change in a routine, or a tiny tummy’s ache, a new mother knows the perils that threaten a sound afternoon nap or a solid night’s sleep all too well. But she also quickly learns her best defenses. Lullabies, teething rings… and vaccines?
Rotavirus vaccine is the latest child health hero, and it can go a long way toward restful nights, by ensuring stomach and intestinal health as well as reducing a mother’s anxiety. Rotavirus is the leading cause of severe childhood diarrhea, and it does not know geographical or socio-economic boundaries. It is virulent and resilient—nearly all unvaccinated children worldwide will have at least one rotavirus infection by age 3. But when vaccination is routine—with new vaccines introduced as recently as 2006—rotavirus infections plummet dramatically, and clinicians and researchers also note a marked reduction of infant diarrhea from any cause.
But though rotavirus diarrhea crosses all boundaries, equity is not universal when it comes to rotavirus vaccination. The sad irony is that access to vaccines is lowest in settings where disease burden is highest. If we work together to get them in practice at every clinic worldwide, rotavirus vaccines stand to make a lasting impact far beyond a restful nap – and far beyond the health benefit to the children vaccinated.
When a baby is fully vaccinated, the protective effects are immediate, yet the health, educational, social, and economic impacts are long term. A mother misses fewer work days due to a child’s illness. Household and government expenditures for health care costs are significantly lower. When child health is protected, families are more stable, leading to the growth of communities and nations. A nation is strong when it has the resources to ensure that its children don’t die from a preventable illness. In rich countries, episodes of diarrhea that may interrupt a child’s restful sleep are inconvenient. In low resource settings, they can be deadly.
The good news is that the global health community has woken up to acknowledge the threat of rotavirus and the promise of rotavirus vaccines. Ultimately, mothers and their infants will be able to access rotavirus vaccines freely through public sector health systems. First, with support from international donors and coalitions, and eventually with national governments bearing the cost of supply and delivery. Countries in sub-Saharan Africa are beginning to add rotavirus vaccines to routine immunization programs, and emerging-country manufacturers are working on new vaccines that will increase market competition and drive down price. When rotavirus vaccines are included in an integrated approach to diarrhea control that includes both prevention and treatment interventions, children have their greatest chance ever at a healthy start – including precious, uninterrupted rest to nourish the growth of strong bodies. That ought to make mothers worldwide sleep a little easier, too.
-- Deobrah Phillips, Communications Officer, and Hope Randall, Communications Associate for defeatDD at PATH
For more information:
-- Rota-what? Learn more about rotavirus.
-- Zambia is preparing for a national rotavirus vaccine rollout, and the defeatDD team got a first hand glimpse of the preparation.Read more
Children in Zambia are dying from three major killers: malaria, pneumonia, and diarrhea. Until recently, diarrhea was the only disease target without a comprehensive intervention and prevention mechanism in place, a tragic fact recognized by the Zambian National Ministry of Health (MOH), donors, NGOs, social entrepreneurs, and community advocates and champions alike. At this critical time, cross-sector opportunities among multiple stakeholders have prepared the stage for addressing the leading cause of childhood diarrhea with a national rotavirus intervention in Zambia.
Following World Health Organization guidelines advising rota control is needed in Zambia, the MOH decided to introduce a rotavirus vaccine. After community perception tests and pilot testing in Lusaka Province, a national rollout will take place in all districts next year. Such an endeavor called for capacity-building at the facility and community level alike. Rota vaccine cold storage facilities and cold chain capacity are in rapid scale up mode at the MOH headquarters in Lusaka in preparation for the national roll out. Clinician training and community health worker recruitment and education on the new rota vaccine are being conducted, in urban, peri-urban, and rural clinics and communities.
The Zambian MOH describes a three-pronged approach to diarrhea disease intervention: promotion, prevention, and control. Community health workers (CHWs) promote education and disease prevention messaging in the communities they serve, and educate on water safety (such as boiling or chlorinating water, covering boreholes, etc), household sanitation, the importance of giving vitamin A supplementation, exclusive breastfeeding up to 6 months of age, and when to seek treatment. Control is now championed by rotavirus vaccination. Delivery points for information and education regarding water, sanitation, and hygiene and the upcoming availability of rotavirus vaccine include heath care facilities, community health volunteers, local NGOs, churches, and schools.
Awareness and buy-in of the vaccine at the community level is extremely important in order for the intervention to be successful. In community perception testing groups, stakeholders discovered that the word "virus" in "rotavirus vaccine" as planned to be listed on immunization cards triggered negative responses; community members related the word to "virus" as in HIV. Additionally, community members like that is it an oral dose, and tastes sweet, as opposed to polio vaccine, which is bitter in taste. A sweet, oral, "rota vaccine" is not only acceptable, but parents are excited to soon have a vaccine that prevents diarrhea. Members of a community gathering outside Mukuyu Health Clinic, receiving education from their CHW, expressed excitement and eagerness to learn of the vaccine, and said with pride the roll-out should start in their province.
Mr. Vichael Silavwe, Chief Integrated Management of Childhood Illness Officer of the MOH’s Child Health Unit is passionate about diarrhea control and worked first hand treating sick babies suffering from preventable diseases. "It is we [adults] who are responsible to care for the health and safety of the child. It is we who are responsible for them, to protect them from getting sick." Rotavirus vaccination, in conjunction with ongoing water and sanitation education, will help parents throughout Zambia echo Mr. Salavwe’s heartfelt call to protect children from preventable disease.
-- Lisa Anderson is a Program Assistant for Vaccine Development at PATHRead more
Ten years of development work, and this week marked my first visit to an African health care clinic. The waiting room was tiny, tight, and filled with weary anxiety. The bottom line being that, despite my own excitement, the women and children in here were in attendance simply because they did not feel well. Some worse than others. But knowing smiles spread between benches when a baby cried, comfort offered for both the mother and her little one. Our camera’s flash brought brief respite as the baby wondered where the flash came from in the dim room—curiosity winning the moment over discomfort and suspicion.
Outside on the tiny concrete porch, a mother waited with her four-month-old son. He had been suffering from diarrhea at home and she didn’t want to risk it growing worse. While she waits for a nurse, she breastfeeds. Posters behind her tout rotavirus vaccines and handwashing with soap. She pulls his skin to check for dehydration. Does it spring back or remain stretched, slowly sinking back in place? Her simple practices, plus the encouraging messages surrounding her, tell me that she has been educated on measures of prevention, symptoms to look for, as well as the continued feeding that will be essential as she tries to spare her son from severe illness.
Consistent education is a pillar of clinical care in this facility and others throughout Kafue District in Zambia. From pregnancy through conclusion of routine childhood immunization at around nine months, mothers visiting the clinic learn about sanitation and hygiene, breastfeeding, immunization, and more. Community health workers carry these lifesaving messages into the local villages. They not only educate their peers, they are village members themselves—resources that are available to families all day, every day.
As we drove away, stories captured for the day, children waved and shouted “Bye –bye” to see us off. The gracious and generous nature of the community, including those in the clinic frankly not having the best of days, will stay with me. I am fortunate, so grateful, to have the chance to witness firsthand their quite determination to give their children a safe and protected start at life.
-- Deborah Phillips is Communications Officer for defeatDD at PATH
For more information:
Photo credits: PATH/Gareth BentleyRead more
I don’t think any of us expected to be deeply moved during an informational interview at Zambia’s Ministry of Health, a stop typically made to gather facts and figures rather than inspiration.
In a crowded room with thick binders filling an entire wall of bookshelves, we sat in an ad-hoc arrangement of seats alongside Ministry staff. Our backs were against open-air windows that carried sounds of cold chain storage renovation work: preparation for the rotavirus vaccine rollout to come and a living demonstration of national diarrheal disease control action plans in process.
My pen stilled for the first time during our hour-long discussion when Vichael Silavwe, Chief IMCI (Integrated Management of Child Illness) Officer of Zambia’s Ministry of Health, responded to my inquiry about what inspired him to go into this work. He surprised me when he leaned forward and said quietly, “There is something that comes to mind.”
Recalling his days as a doctor, he went on to tell the story of one mother who rushed to the clinic to get treatment for her sick child. The child died before Vichael even had a chance to examine him, and the distraught mother fell at his feet, clenching his legs and begging him to bring her child back to life. I could only react with silence to so vivid and heart-breaking an image. Vichael said he still thinks about that day. “I felt the pain of losing a child,” he says, “and I want to prevent others from feeling that pain.”
Yesterday, not far from Vichael’s life-changing encounter, I met Catherine and her 4 month old son, Immanuel. She brought him to the clinic because he had a fever and was dehydrated from diarrhea. Thanks to the information that Catherine received from previous clinic visits, she knew to continue breastfeeding and to go to the clinic before Immanual’s condition got worse. As a result of Catherine’s wise decisions, Immanuel’s dehydration was mild, and he was sent him home with a prescription for zinc to help treat and prevent further illness. If only the heartbroken mother that Vichael still remembers knew the basic information that might have saved her child’s life.
Today, thanks to simple education of tried-and-true methods, alongside new technologies, fewer mothers endure the pain of that loss. I learned from his mother that Immanuel was named for a famous Zambian soccer player. He was born 4 months ago on the day that the Zambia soccer team won the Africa Cup of Nations, a proud moment for the country. Catherine says she dreams her child will one day be a famous soccer player, too, and I’m so glad she didn’t have to give up on that dream today. I also hope Immanuel achieves many victories in his life that will make his mother proud, whether it’s on or off the soccer field.
-- Hope Randall, Communications Associate, defeatDD at PATH
For more information:Read more