Times of India, May 2013
A pivotal clinical study of India's first indigenous rotavirus vaccine...
How can we make an impact on child health in far-away countries for those of us who are working from our desks in the US?
We think this is an incredibly important question, and so do our Facebook friends. In fact, when we recently interviewed Alfred Ochola, our DD program implementer in Western Kenya, one of you asked Alfred for his thoughts on the matter. Here’s what he had to say:
This question is fundamental to child survival and therefore needs more than a one-line answer or solution. The following points may help:
1. The support should be directed to a place where there is need: places where morbidity and mortality from diseases like diarrhea, pneumonia, malnutrition, and malaria are very high.
2. Get a person to represent your interest at the community/implementation level, one who knows how to use the community and work with the systems there to cause a meaningful change through the community’s own participation to solve their problems. The solutions must be homebred.
3. Embrace some combination of all interventions for diarrheal disease: vaccines, ORT Corners with low-osmolarity ORS and zinc, exclusive breastfeeding, safe water and sanitation, and personal hygiene. These should not be done in isolation.
4. Strategies should consider issues of access, costs, and acceptability in areas where culture and poverty may inhibit uptake, and goals set should be reviewed every 6 months to 1 year for possibility of strategy changes.
5. Programs should be child-centered and not Ministry centered. When communicating about your program, do not say, “We are helping the Ministry,” but rather, “We are helping the children of region (x) by doing (y).” It is known, from experiences elsewhere, that some well intended support from people working at desks, like you, have only reached adults but reached very few children and community members, which was the primary target.
What are your program’s perspectives on improving child survival from afar? We’d love to hear your feedback and success stories!
For more information:
Photo credit: Hope Randall/PATHRead more
Two and a half year-old Abdul lay inert on his mother’s lap when we arrived at the Gondama Community Health Centre, a tiny rural clinic in southern Sierra Leone. Abdul’s mother, Aisha Kamara, had just brought him in and, tearful and terrified for her son, she talked to us while clinic staff readied for his treatment.
“He’s been sick for four days,” she told us, “He had diarrhoea and he kept getting weaker. He lost his appetite and stopped playing. Whatever he ate, he threw up. I just didn’t know what to do.”
Aisha earns a meagre living taking in washing for neighbours when she can get the work. She has been alone since her husband left her when she was two months pregnant.
“He is my only child.” She cried.
Abdul is hooked up to an IV line that will deliver life-saving fluids. Rehydration, administered orally, or, in severe cases like this, intravenously, can quickly revive a child, but not all children are lucky enough to live within reach of such help.
Sierra Leone is one of the poorest countries in the world, its economic difficulties compounded by a five year war that ended in 2002. Although the country is making clear strides in its recovery from the war and progress in development, poverty is high and health care and education are at basic levels.
These factors come together with deadly results for young children. For every thousand children born here, 140 do not survive to their fifth birthday; diseases such as diarrhoea, pneumonia and malaria, often combined with malnutrition, take the heaviest toll. Diarrhoea and pneumonia alone account for more than 40 per cent of the deaths of under fives.
Most of the diseases that kill young children are preventable or treatable – or both.
With limited education, mothers frequently do not know the best ways to feed their children, or understand the importance of breastfeeding during the first six months of life; they do not know about how good hygiene can make a difference to health – or, when their children get sick, when to seek professional medical help.
Fortunately, despite her uncertainty about what to do, Aisha had made the right decision in bringing Abdul to the clinic; and she lived close enough to get him there on time. Hooked up to an intravenous drip, the boy was quickly rehydrated and within an hour was sitting up and asking for food.
Mohamed Tarawally, the Community Health Officer at the health centre who saved Abdul’s life, was happy about his patient, but stressed the importance of preventing such illness where possible.
“Diarrhoea cases here are a common, common condition, every day,” he said. “Sometimes, before the parents get here, the child dies on the way.”
After intravenous rehydration, Abdul is soon asking for food and waves while his delighted mother looks on. Vaccination against rotavirus could protect children from the leading cause of severe infant diarrhoea.
Sierra Leone applied to the GAVI Alliance for a vaccine that will protect children against the leading cause of severe infant diarrhoea – rotavirus. Rotavirus is most dangerous in countries where access to basic healthcare is limited.
“Abdul is one of the lucky children, he is now recovering from diarrhoea,” says Mohamed, “but unfortunately, not all children recover. The rotavirus vaccine would be perfect if it is introduced in our country.”
-- Doune Porter, Accelerated Vaccine Initiative, PATH
Editor’s note: At a pledging conference in London on June 13, GAVI asked international donors to pledge the US$3.7 billion needed to introduce rotavirus vaccines and vaccines against pneumococcal disease (the leading cause of pneumonia) in 40 of the world’s poorest countries, including Sierra Leone, by 2015. Donors went above and beyond this call, committing $4.3 billion to accelerate new vaccine introduction for the developing world.
For more information:
-- Unprecedented clinical studies show promise of rotavirus vaccines for Africa and Asia.
Photo credits: Doune Porter, PATHRead more
Having worked in global health for almost 10 years and travelled widely in Africa and Asia during this time, I’ve become well-acquainted with the occasional bout of “travelers’ diarrhea.” What I never expected was to recently return from India with such severe diarrhea that I would be debilitated for days. This left me with a little bit of time to stop and reflect on some of the basics we take for granted in most Western countries today.
Flushing toilets, for example. Clean running water. Access to medications that won’t leave us with catastrophic debt.
Today there are still 2.5 billion people in the world who defecate in open spaces, of which some 660 million live in India. In the developing countries of Africa and Asia, inadequate sanitation, unsafe water and limited medical care are the reasons why 4,000 children lose their lives to diarrhea each day. This is simply unacceptable.
We have the knowledge and tools at hand to prevent diarrheal disease and the fatal dehydration it causes. Whether it is investments in infrastructure and behavior change, a combination of established interventions such as breastfeeding and oral rehydration therapy, or new rotavirus vaccines, there are multiple opportunities to accelerate diarrheal disease control.
Let’s not forget how life-threatening illnesses can happen so easily and so frequently in other parts of the world. And it shouldn’t take a bad spell of travelers’ diarrhea to trigger these reflections. Our own awareness of the health of children in Africa, for example, can ultimately help bring solutions to where they are needed most.
If we make it a priority to consider whether a farmer who grew the bananas was fairly paid, or whether we should take a reusable bag to the supermarket to carry groceries, then why is it not equally routine to think about global health and to acknowledge the fact that something as ordinary as diarrhea still kills 1.3 million children annually? Let us encourage a world where global health equalities are a daily reflection.
-- Lisa Menning, Country Advocacy Officer, Accelerated Vaccine Initiative at PATH
For more information:
-- You'll find staggering statstics in the World Bank's report, The Economic Impacts of Inadequate Sanitation in India
Photo credit: PATHRead more
For years, I used to say that I never win anything in random drawings, so why should I even try to participate? With persistence and optimistic encouragement of my colleague and a good friend, I decided to take part in an interactive scavenger hunt, titled “What’s Your Poo IQ?” that took place at this year’s Global Health Council conference in Washington, DC. Boy, was I glad I did!
I flew to the conference from San Francisco, CA, on behalf of a nonprofit research and development organization OneWorld Health (OWH). Our mission is to provide innovative solutions to neglected diseases afflicting the world’s most vulnerable populations, with diarrheal disease program being our flagship initiative. It seemed appropriate that I test my knowledge with the Poo Quiz.
The scavenger hunt structure of the quiz was engaging and the content was sharp and pertinent. With some questions, I learned new information, like how health workers can promote access to safe water, sanitation and hygiene (WaSH) in developing countries, or how WaSH can improve the quality of life for people living with HIV. With others, I tested my knowledge, like the fact that pneumonia, diarrhea and malaria are the top three killers of children under the age of five. Whether I knew the answer or not, the quiz gave me a chance to think about these critical global health issues and meet colleagues at PSI, PATH and JSI.
I was especially glad to see that the quiz organizers chose to spotlight WaSH and the link to child survival, undernutrition, and efficacy of HIV/AIDS treatment, and ensure that these critical health issues have a voice at this global health conference. I was thankful that through this quiz, conference attendees turned their attention to the fact that 1.5 million children die from diarrhea diseases every year, and that each one of these deaths is preventable.
I commend WASH Advocacy Initiative, UNC Water Institute, WaterAid, PSI, WSSCC, PATH, and JSI for putting together this advocacy initiative. What a way to engage conference participants in a conversation about some of the most pressing global health issues today!
I am grateful for this incredible iPad 2, and I will be sure to put it to good use.
-- Elena Pantjushenko, OneWorld Health
For more information:
-- We snagged a few minutes with Ben Picillo, winner of the Kodak Camcorder, at the GHC Conference. Find out how he plans to use his prize!
-- Even if you missed the conference, you can still improve your poo IQ. Read our introduction to the issue, Understanding the Crisis, and you'll be a poo guru in no time!
-- Learn about worldwide efforts to defeat diarrhea through safe water and sanitation programs.
Photo credit: Hope Randall/PATHRead more
I was thrilled when I learned that Alfred, our diarrheal disease control program implementer in Western Kenya, was going to take his first trip to the United States to speak at the Global Health Council Conference. He had been a tireless, gracious host during my two trips to Kenya, and I was excited for the opportunity to return the favor.
Throughout the week, I bombarded Alfred with a broad range of compare/contrast questions. I expected our conversations to focus on the differences between his work in the field and our work in the U.S. office, but instead, Alfred consistently reinforced just how connected we really are.
On the day before the conference ended, we ate lunch at Open City Diner, a restaurant that serves American-style food with American-style Coca-Cola (not as sweet as the Kenyan version), and I gathered Alfred’s thoughts about his trip to Washington, DC.
This was your first trip to the United States. Did anything surprise you?
I wasn’t expecting such receiving and welcoming people. To have realized that Chris Elias [president and CEO of PATH] had heard about my work, the work of an employee in a rural office in Western Kenya – that really stuck with me. I think that it is great that PATH organized a reception for staff that came to the Global Health Conference, because suddenly I didn’t feel like I was in a new country; I was among colleagues like myself. I felt like I was home. And these are the things that move me. If all of us network positively, then the magnitude of change will be greater.
You had the opportunity to tour our nation’s capital, too. What did you think of Washington, DC?
It is a beautiful city. The roads and traffic are very organized, and if someone accidentally bumps into you, they say “sorry.” I enjoyed the tours and visits of historic places, but my favorite was the Air and Space Museum. Reading stories about astronauts who risked their lives, and some who died in the process, was moving, but it was also inspiring.
Participating in meetings at Global Health Council Conference is certainly a departure from the type of work you do in the field every day. How do you like the conference?
There are those that are interested in the policy level, but I was pleased to see that there were sessions for program implementers as well. I was also happy to see the cross-sectoral representation of WASH, which is so important. That’s the emphasis now, and there’s no going back.
And the panel on which you spoke, “WaSHing (Water, Sanitation, and Hygiene) to Improve Health in Developing Countries,” was a big hit!
For people to come to a global conference to listen to a man from rural Kenya – it moves me quite a lot. I was humbled: that’s the only word I can use. It gives me motivation to work more and to prepare more should the opportunity arise again.
The large turnout is a sign that that what we are doing touches people. I knew that our diarrheal disease control program was saving lives in Western Kenya, but I didn’t know it was touching people who weren’t seeing it firsthand.
Alfred talked a lot about how his week in DC moved and challenged him. It challenged me, too, to make certain that we continue to touch people with stories about his great work. When Alfred presented the results of his work to PATH staff earlier in the week, he said, “The story is not over.” Let’s all work together to make certain this story has a happy ending!
-- Hope Randall, Communications Associate for the diarrheal disease communications/advocacy team, PATH
For more information:
Photo credits: Hope Randall/PATHRead more