Bad data complicates the Ebola outbreak

Tuesday, December 9, 2014

As an epidemiologist and someone who got my start in disease surveillance, this topic is of particular importance to me. While it is obviously terrible that the havoc wreaked by the Ebola outbreak has also hampered data collection and surveillance, I am at least encouraged to see that this is widely recognized as a problem (and making headlines, at least in the disaster news arena). From the AP:
Having accurate numbers about an outbreak is essential not only to provide a realistic picture of the epidemic, but to determine effective control strategies. Dr. Bruce Aylward, who is leading the World Health Organization's Ebola response, said it's crucial to track every single Ebola patient in West Africa to stop the outbreak and that serious gaps remain in their data.
"Decisions about prevention and treatment should be data-driven, but we really don't have the data," agreed Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University.

A week ago, the World Health Organization insisted at a media briefing it had mostly met targets to isolate 70 percent of Ebola patients and bury 70 percent of victims safely in Guinea, Liberia and Sierra Leone. But two days later, WHO backtracked and said that data inconsistencies meant they really didn't know how many patients were being isolated. Then the U.N. health agency also conceded that many of the safe burials were of people not actually killed by Ebola.
In West Africa, where health systems were already broken before Ebola struck, collecting data amid a raging outbreak has been challenging.

"Suddenly you have all these different sources of data that have to be compiled" from different aid agencies, said Ray Ransom, a data expert at the U.S. Centers for Disease Control and Prevention. "The ability to actually collect information is a different challenge than responding to the outbreak, and the energy has been focused on the response."

He said local officials are good at tracking known or suspected Ebola cases and their contacts but not as reliable relaying that information to national authorities.

The software built to track Ebola outbreaks was initially designed by the CDC to have one person entering data into a computer. That "was perfectly fine since the dawn of time up until" the outbreak exploded this summer, said Armand Sprecher, a public health specialist with Doctors Without Borders.
On a more critical note, I am pretty disappointed that the WHO would have been so confident in their initial numbers, only to have to backtrack later. Any aid worker worth their salt knows that data collection is a mess in the outbreak areas. They certainly were not going to fool anybody.

Nifty infographic of the day: the ripple effects of Ebola

Monday, November 17, 2014

For better or worse, Ebola is becoming old news. Aside from the initial case in Dallas that was transmitted to two nurses, there have been no more cases here in the U.S., and panicked predictions of a massive outbreak causing mayhem and catastrophe never materialized (much like public health experts said they would not - funny how that works).

The outbreak in West Africa is ongoing and continues to be a tragedy on a massive scale that is losing public interest. Numerous articles by countless experts and pundits have discussed lost opportunities and the weaknesses in the healthcare systems that the outbreak has laid bare. Now, the MPH@GW blog has kindly provided aninfographic on the outbreak and its collateral damage. They asked me to share it on the IH Blog and told me that I could post it here, too (being the opportunist that I am).

New(ish) report from OCHA on humanitarianism and cyber-warfare

Thursday, November 13, 2014

I set this report aside when I saw it posted on Twitter last month but have not had a chance to read it until now. OCHA has released an "occasional policy paper" (I guess that absolves them from the obligation of publishing one on a schedule?) discussing and providing guidelines for the use, collection, and exchange of information related to humanitarian operations, and the relationship of this information management to security and cyber-warfare threats. As an epidemiologist with experience in both knowledge management and disease surveillance, the report was particularly interesting to me. It is not too long and is pretty interesting stuff.
In 2013, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) examined emerging issues relating to information and communications, particularly the spread of cell phones and connectivity, advanced data analytics and other tools. Humanitarianism in the Network Age, the first UN report to identify information as a basic need in humanitarian response, sketched a vision of a future in which affected people produce and share information in real time with each other and with humanitarian responders, disasters are better anticipated through sophisticated monitoring systems, and accurate data and analysis clear the fog of war.

However, the “Network Age” also comes with risks and challenges. A humanitarian crisis can create a justification for waiving concerns about how information is collected and used, even as cyber-warfare, digital crime and government surveillance rises, particularly in unstable contexts.

To deal with these challenges, Humanitarianism in the Network Age recommended that the humanitarian sector develop robust ethical guidelines for the use of information. It specifically called for “do no harm” standards that clearly address liability, privacy and security. This report looks in more depth at these issues and makes recommendations to ensure that emerging technology is used responsibly.
Here is a screen capture of the key messages:

According to North Korea, North Korea is the second(!)-happiest country on Earth

Wednesday, November 12, 2014

This gem actually popped up on my Facebook news feed via my husband, who is currently in a global policy studies Master's program. Though this is (slightly) old news, I still felt like it was worth sharing: apparently, DPRK's Chosun Central Television ranked the Hermit Kingdom second in a "happiness" index, second only to China, its big brother:
[A] new global happiness index released by North Korea's Chosun Central Television awarded China 100 out of 100 possible points. If the "Gross National Happiness" survey is to be believed, isolated dictatorships are the key to overall well-being, with North Korea reportedly coming in second with 98 points, followed by Cuba, Iran and Venezuela. ...the lowest marks are said to have gone to South Korea, which scored just 18 points to come in at 152, while the United States...fared even worse at 203 with a measly three points...
Here is the actual chart, which should probably be submitted to /r/dataisugly (but I digress).

This from the country that insists that the "human rights" of its citizens consist of freedom from Western imperialism. Delightful.

Catching up: TB research round-up

Wednesday, November 5, 2014

Similar to yesterdaBy's round-up of HIV-focused studies, this is a collection of recently-published studies on TB.

A major global health item this week was a study examining the rising incidence of diabetes in the developing world and its link to TB:
Diabetes rates are rising everywhere; a part of an overall increase in non-communicable diseases. As the world gets better, more people suffer lifestyle diseases. These include diabetes and heart disease, and other ailments that go along with a population that is living longer, like cancer.

The non-communicable diseases burden in low-income countries is expected to increase to 69 percent by 2020, from 47 percent in 1990. That is cause for concern by itself. Some 384 million people have diabetes and it will reach nearly 600 million cases by 2035. The diseases often associated with unhealthy diets, is particularly burdensome in low- and middle-income countries, where more than 80 percent of the 3.4 million annual diabetes deaths occur.

Toss in the potential for increased risk of TB and things get worse. The risk of contracting active TB is up to three times higher for people who have diabetes, also making them carriers of a contagious and potentially deadly infection.

Immediate action is needed to fend off a “looming co-epidemic,” according to a report released by The Union and the World Diabetes Foundation.

A new anti-TB drug, bedaquiline, has shown promise in treating MDR-TB and XDR-TB:
The study population comprised 35 people who were provided with compassionate access to the drug between 2011 and 2013. After six months of therapy, 97% of study participants with culture-positive pulmonary TB at baseline had achieved culture conversion.
Bedaquiline is a new antibiotic with activity against drug-resistant strains of TB. It was approved by the Food and Drug Administration (FDA) in the United States and the European Medicines Agency after it demonstrated efficacy in clinical studies.
The authors note that the efficacy was better than that observed in clinical trials.

Sputum-smear conversion occurred in 48% and 69% of participants at three and six months, respectively.

The median time to culture conversion was 85 days.

An analysis published in Lancet Infectious Diseases showed that increased expenditure on social protection programs (e.g., sickness, disability and unemployment benefits, old age pensions, housing support) is associated with improved TB control:
With this new policy in mind, an international team of investigators looked at the relationship between social protection expenditure and TB control between 1995 and 2012 in the 21 countries that are now members of the EU.
Overall, the authors found a strong relationship between increased per-person expenditure on social protection and lower TB incidence (p = 0.003) and mortality (p = 0.01) rates.

Cross-national analysis controlling for GDP and expenditure on public health showed that each $100 increase per person in social protection expenditure was associated with a fall per 100,000 population in the number of TB notifications (-1.53%, p = 0.01), TB incidence rates (-1.70%, p = 0.02), non-HIV-related TB mortality rates (-2.74%, p = 0.01) and all-cause TB mortality rates (-3.08, p = 0.01).

“Our findings add to the empirical evidence that investing in social protection is justified, not just because it is fair and protects the most vulnerable populations, but also because it contributes to measures to reduce the global burden of tuberculosis,” write the authors. “Social protection programmes are likely to provide a vital component of a robust tuberculosis prevention strategy, especially for vulnerable groups.”

Namibian Supreme Court holds government liable for forcibly sterilizing HIV-positive women

On Monday, Namibia's Supreme Court ruled in favor of three HIV-positive women who had been sterilized without their consent after giving birth.
Chief Justice Peter Shivute ruled that the doctors should not have sterilised the women and ordered consideration of damages for the victims, who each claimed one million rand (about $90,000).

The director of the Namibian Women's Health Network, Jennifer Gatsi Mallet, applauded the decision, saying the cases were only the tip of the iceberg.

"We have documented dozens of cases of other HIV-positive women who have been forcibly sterilised. The government needs to take active steps to ensure all women subjected to this unlawful practice get redress," she said.

Mallet said the decision proves that "public hospitals in Namibia have been coercively sterilising HIV-positive women without their consent."

The Southern Africa Litigation Centre, which backed the women in their legal challenge, said the decision had far-reaching consequences for HIV-positive women throughout Africa who have been forcibly sterilised.

"This decision sends a clear message that governments throughout Africa must take concrete actions to end this practice," said deputy director Priti Patel.
The ruling itself was hailed as a human rights victory; however, the fact that this is still happening is beyond appalling. Shamefully, forced sterilization of HIV-positive women is not uncommon - just last month, the Inter-American Commission on Human Rights took up a similar case by a Chilean woman.

Catching up: HIV research round-up

Tuesday, November 4, 2014

I am finally emerging from a monstrous load of urgent freelance work, which is why the blog was silent last week. I was finally able to catch up on global health news last week, so I thought I would post groups of similar studies today and tomorrow. Today's round-up will be HIV-related; tomorrow will feature tuberculosis.

I will kick off with results released yesterday: a study conducted in Uganda and presented at the HIV Drug Therapy Glasgow conference found that the ART efavirenz reduces levels of levenorgestrel, which is used in hormonal implants common in developing countries:
Hormonal contraceptive implants are highly reliable forms of contraception, and have been shown to prevent conception for at least five years with a pregnancy rate of less than 1%. As a form of contraception, implants compare favourably in convenience and reliability to the male condom, and do not require regular clinic visits in order to maintain the contraceptive method.

The disadvantage of progesterone-based hormonal contraceptive implants for women living with HIV lies in the interaction between levenorgestrel and antiretroviral drugs which induce CYP3A4 metabolism. Both efavirenz and nevirapine have been shown to reduce levonorgestrel levels, but the impact has been unclear.

However, a retrospective cohort analysis of unwanted pregnancies among 570 women living with HIV using the Jadelle contraceptive implant in Swaziland, published earlier this year, showed that the only factor associated with unwanted pregnancy was efavirenz treatment.
After adjusting for body weight, levenorgestrel levels in the nevirapine group were 32 to 39% higher than those in the control group during the follow-up period, levenorgestrel levels in the efavirenz group were 40 to 54% lower than those in the control group, and in three cases fell below the minimum recommended concentration for contraceptive efficacy.
The research group concluded that the levonorgestrel implant should be used with nevirapine-based antiretroviral therapy.

A meta-analysis published in AIDS asserts that prevalence of transmitted drug-resistant HIV has doubled in low- and middle-income countries in recent years:
An international team of investigators wanted to establish a better understanding of global trends in rates in transmitted resistance and variations according to world region and risk group.

They therefore conducted a meta-analysis, analysing the results of 212 studies conducted between 1999 and 2013 that reported on rates of transmitted drug resistance.

The authors examined trends in industrialised and low- and middle-income countries. They also compared rates between the main HIV risk groups: men who have sex with men (MSM); people who inject drugs (PWID); and heterosexuals.

Overall, North America was the world region with the highest burden of transmitted drug resistance, which was present in 14% of MSM, 9% of PWID and 11% of heterosexuals.

Western Europe was the next-worst affected region, with transmitted resistance present in 11% of MSM, 6% of PWID and 7% of heterosexuals.

There was also a notable epidemic of transmitted resistance in South America, where prevalence in the key populations were 8% for MSM, 14% in PWID and 8% in heterosexuals.

High rates of transmitted resistance were observed among MSM in Oceania (Australia 16%), Eastern Europe/Central Asia (10%) and East Asia (8%).

A study in AIDS and Behavior by researchers from Brown University School of Public Health examines the male-to-male sex trade as a driver of HIV infection in Mexico, specifically focusing on condom use in MSM in Mexico city:
In his research, including detailed interviews and testing with hundreds of male sex workers on the city's streets and in its clinics, his team estimates that the prevalence of the virus among them could be as high as 40 percent. Because of inconsistent condom use and high degrees of infection among many sex workers, about 8 percent of their customers and other partners become infected each year. Infection can spread further from there.

But out of such seemingly bleak knowledge, Galárraga said, there is also hope. In a new study in AIDS and Behavior, Galárraga, lead author João Filipe G. Monteiro, and colleagues project that a 10-percent increase in condom use by HIV-positive male sex workers would reduce an 8 percent annual infection rate among their partners to 5.2 percent. Meanwhile, increasing the number of HIV-positive sex workers on antiretroviral medications by 50 percent would slash the infection rate among clients to 4.4 percent. More aggressive interventions could cut the rates further.

"There is universal access to HIV treatment in Mexico, so if this is implemented, especially among these key populations, it can really make a dent in the concentrated epidemic that Mexico has," Galárraga said.

NYU researchers examine the link between HIV, drug use, and tourism in the Caribbean, specifically in the Dominican Republic:
Insufficient attention has been paid to the intersection of drugs and tourism as contributing factors for the region's elevated HIV/AIDS risk. Caribbean studies have almost exclusively focused on drug transportation. Seldom acknowledged are the roles which drugs play in tourism areas which may be fueling the Caribbean HIV/AIDS epidemic.

Now a new study, "Illicit drug use and HIV risk in the Dominican Republic: Tourism areas create drug use opportunities," published in Global Public Health addresses this gap by conducting in-depth interviews with 30 drug users in Sosúa, a major sex tourism destination of the DR. The study's results suggest three themes: (1) local demand shifts drug routes to tourism areas, (2) drugs shape local economies and (3) drug use facilitates HIV risk behaviors in tourism areas.

The results of a study published in PLoS One detail how an intervention in South Africa reduced mother-to-child transmission of HIV:
The incidence of HIV infection in South Africa tops that of any nation in the world, with some 6 million of the country's nearly 50 million residents infected. Sadly, young women—and particularly young pregnant women—suffer some of the highest rates of HIV infection. More than one-fourth of pregnant South African women are infected with the virus; in some communities, the infection rates are even higher.

But those infection rates might be reduced—and the overall health of children improved—through community-based peer counseling programs...The study found that having specially trained lay community mothers from the Mentor Mother Programme make regular home visits to pregnant women, and later to those mothers and their infants, led to significantly better health outcomes 18 months later in both the mothers and their children.
Among other outcomes, the study found that Mentor Mother home visits led to a 50 percent improvement by mothers in completing tasks designed to prevent mother-to-child transmission of the HIV virus, compared to mothers in the control group of the study who did not receive home visits, just clinic-based pre- and postnatal care.

Fabulous post on Oxfam's #FP2P blog on including sexual health (and pleasure!) in the development agenda

Friday, October 24, 2014

Global health and human rights advocates have worked tirelessly for years against systemic oppression of women and sexual violence that present concrete barriers to women's health. Just this week, the global health community mourned the death of anti-FGM activist Efua Dorkenoo, and on Wednesday, Dr. Denis Mukwege - Congolese vaginal fistula surgeon, women's rights advocate, and all-around BAMF, won the Sakharov Thought Prize for his work. Obviously, all of this work is important. However, Oxfam's Chloe Safier argues that the development industry should focus on sexual well-being - specifically including sexual pleasure - as part of the strategy to combat gender inequality and promote bodily integrity a well-being:
The notion that sexual satisfaction and pleasure is a core aspect of people’s lives hasn’t gained traction amongst international development NGOs, nor in government agendas, donor agencies or in any international protocol. Sexual pleasure doesn’t make an appearance in Bhutan’s Gross National Happiness Index. There’s no ‘pleasure indicator’ in any widely published index, no UN report on who’s enjoying sex and why. This despite a widespread understanding since the 1980s, building on the work of Amartya Sen, that development must go beyond relieving economic poverty and towards an approach that is centered on human well-being, in which freedom of choice and desire fulfillment are fundamental.
Our present reality is that women and LGBTQI people in almost every part of the world have less power, access and voice than heterosexual cisgender men. The ways in which the patriarchy has been manifest in sexual enjoyment and rights is readily apparent. Female genital mutilation is recognized by many as an abuse of women’s bodies and can be directly linked to the ability to experience sexual pleasure; it’s an area of work where women’s right to sexual pleasure is implicit in the discussions, though explicitly it’s largely spoken about as a woman’s right to bodily integrity. Discrimination and ‘corrective rape’ of lesbian women – who pose a threat to men by taking pleasure in each other’s bodies – show how sexual pleasure can play a political and subversive role in a patriarchal, misogynist society (and can put some women and LGBTQI people at risk).
The full post is well worth the read.

Cuba shows US up in its response to #Ebola outbreak...leading to a thaw in relations

Cuba, whose health system has been hailed by leftists and public health advocates as a model to follow despite the country's economic setbacks, has put most of the developed world to shame in its response to the Ebola outbreak in West Africa. Unlike most other industrialized nations, which have responded mainly with funding and supplies, Cuba has stepped up and sent 165 medical professionals to Sierra Leone, with 91 about to begin working in Guinea and Libera. There are plans to send about 200 more. From Yahoo!:
The island's response to the epidemic, which has killed more than 4,500 people in west Africa, has won plaudits from humanitarian workers who say the international community's reaction has otherwise been lacking.

"The international response has been slow.... The virus is spreading faster than we're all setting up," said Sean Casey, director of the International Medical Corps' emergency response team in Liberia, where Cuban advance teams have been laying the groundwork for the new medical team's arrival.

"It's good that the Cubans are coming. We need more countries to step up," he told AFP.

Cuba's contribution has also won plaudits on the international stage -- even in the United States, where Cold War bitterness toward the island still lingers, more than 50 years after the Cuban Missile Crisis and the severing of diplomatic ties.

US Secretary of State John Kerry paid Cuba a rare compliment last week, singling out the country for its "impressive" response to Ebola.
These rare displays of warmth have been reciprocated on the Cuban side.

Fidel Castro, the retired father of the island's communist revolution, said Cuba "will gladly cooperate with American personnel" on Ebola, in an article published in state media Saturday.

His brother Raul, who succeeded him as president in 2006, echoed the sentiment at a regional Ebola summit Monday in Havana, the first of its kind in Latin America.
Diplomacy wins through public health! Warm fuzzies all around.

Progress? Myanmar increases HIV funding

Thursday, October 23, 2014

I know this is kind of old news, but as both HIV and Myanmar are areas of interest for me, I am posting it anyway.

Last week, Myanmar confirmed in a meeting with the United Nations Secretary-General’s Special Envoy for AIDS in Asia and the Pacific, J.V.R. Prasada Rao, that it will increase funding for domestic HIV programs by 5 million USD:
There were 190 000 people living with HIV and 6700 new HIV infections in Myanmar in 2013. More than 65 000 people were receiving HIV treatment in 2013 and the Ministry of Health estimates the new funding will enable 40 000 additional people living with HIV to access antiretroviral medicine and will increase the national HIV treatment target coverage to 85%. The Minister of Health has asked his staff to work with UNAIDS to determine the cost of reaching 100% coverage.
The Minister of Health also pledged an additional US$ 1 million to further scale up opioid substitution therapy for 10 000 people by the end of 2016. Studies show that harm reduction programmes such as needle–syringe exchange programmes and opioid substitution therapy are effective in reducing the spread of HIV.

In Myanmar, key populations, including people who inject drugs, sex workers, men who have sex with men and transgender people, are at higher risk of HIV infection. Mr Rao urged the government to amend policies that violate the human rights of key populations and praised the country’s draft intellectual property law, which will help protect access to affordable medicines.
Lovely. Now, if they could just quit throwing journalists in jail and repeal the law that was obviously designed to prevent opposition leader Aung San Suu Kyi from running for president, that would be great.

A new Afghan president: New hope for Afghan women?

The new president of Afghanistan, Ashraf Ghani, made a statement - and waves - when he mentioned his wife in his inauguration speech. The gesture was simple enough - he thanked her for her support of his campaign and promised that she would have an influence in his presidency - but in Afghanistan, a deeply conservative country with an entrenched tribal culture, it has sparked both hope and concern:
Ghani’s public acknowledgement of his wife Rula sends a positive message to Afghan women but makes others throughout Afghanistan uneasy.

The most important issues facing Afghan women today are security, health, and education, as well as social and economic empowerment.

Although the country’s constitution guarantees women’s right to be educated and to work, making advances in these areas still means confronting and challenging the conservative nature of Afghan society and family.
But despite advances in education and political empowerment, Afghan women face a consistent struggle against the fundamentally conservative nature of the country.

Afghanistan has historically been a nation of traditional tribal values and the rise of Islam in the 8th century introduced further conservative beliefs and customs.
Against this historical backdrop, the gains over the last thirteen years during the administration of former President Hamid Karzai have been immense in terms of the empowerment of Afghan women. Women have the constitutional right to work, to be educated, to vote, and to hold public office. Whether a woman wears a veil or not is up to her.
Both President Ghani and his former rival and now chief executive, Abdullah Abdullah, made strong campaign promises to uphold and protect women’s constitutional rights going forward.
But what history shows us is that any progress in the empowerment of Afghan women has to be gradual and participatory.
The VOA article goes into the country's 20th century history a bit and is a decent primer. Rula Ghani sat down with the BBC for an interview shortly after her husband's inauguration that revealed her to have a progressive, but cautious, vision:
During the election campaign of her husband, Ashraf Ghani - the eventual winner of the 2014 presidential race - Rula Ghani was the only candidate's wife to appear in public.

And when the new leader paid an emotional tribute to his wife in his inauguration speech, it became a talking point for the whole country.

Mrs Ghani says it was a revealing gesture which summed up her vision of how attitudes to women could change.

"By mentioning me the way he did, my husband really showed exactly what I mean by helping Afghan women be more assertive, more conscious of their role, more respected."

Mrs Ghani is clearly aware of the sensitivities in Afghanistan's conservative society and says that her vision doesn't contradict traditional values which are a keystone of Afghan life.
Mrs Ghani's own contribution will come from her newly established office in the presidential palace and she says for the first three months she will be in "listening mode" finding out what's important for Afghans.

"I don't necessarily see myself as an activist, running down the street and knocking at every door," she says. "Besides I have reached a certain age where ladies stay at home more. I'm in my sixties and I see myself much more as a facilitator."
But she has a clear goal ahead.

"If I've achieved a higher respect for women and for their role in society then I would be very happy. That would really be my greatest wish."

Sexual violence in South Sudan has gotten really, really (really) bad

Wednesday, October 22, 2014

As if perpetual civil war wasn't bad enough, a UN special representative is now saying that the sexual violence present in South Sudan's conflict has become so widespread and pervasive that toddlers are being raped:
Rape and other forms of sexual violence by all sides in South Sudan's civil war have become so widespread that a 2-year-old child was among the victims, the U.N. special representative on sexual violence in armed conflict said on Monday.
"Survivors and health care workers told me heartbreaking stories of rape, gang rape, abduction, sexual slavery and forced marriage," Bangura said. "Those who try to fight back against their attackers are often raped with objects instead. Some victims have even been raped to death."

She said the victims included women, men, girls and boys, with 74 percent of them below the age of 18, according to South Sudanese hospital officials.
She said both sides in the conflict have committed sexual violence, adding that orders had been given within the military forces to perpetrate rapes on the basis of ethnicity.

Bangura added that said a radio station in Bentiu called Radio Bentiu FM was used to broadcast appeals for men to rape women and girls based on their ethnic backgrounds and what was believed to be their political loyalties.

Bitter Harvest: Amnesty International reports abuse and exploitation of migrant workers in South Korea

Yesterday, Amnesty International released Bitter Harvest, its report documenting extensive abuse and exploitation of migrant workers in the South Korean agricultural industry. VOA reports:
The report said the country's Employment Permit System, or EPS, is designed "to provide migrant labor to small- and medium-sized enterprises that struggle to hire a sufficient number of national workers."
The report, based on interviews with migrant agricultural workers across South Korea, documents a range of exploitation, including intimidation and violence, squalid accommodations, excessive working hours, no weekly rest days and unpaid overtime.

Amnesty said while an EPS employer can terminate a migrant's contract without having to justify the decision, migrants who want to leave their jobs must obtain an employer-signed release form.

Without the release, migrants run the risk of being reported as "runaways" to the immigration authorities by their employers, subjecting the migrants to arrest and deportation.

Amnesty International found that employers responsible for exploiting migrant agricultural workers rarely face any sanctions.
Sadly, this does not surprise me after living and working there for nearly two years. South Korea is a wonderful place in many respects, but racism and xenophobia are very common and can often lead to apathy about these types of abuses. Opposition to "multicultural marriages" (very common for Korean farmers, who often marry Southeast Asian women because they cannot find a Korean bride), is widespread. Although white Westerners enjoy a relative amount of respect and prestige, I knew several English teachers who were deprived of benefits and forced to work overtime (often in violation of their contracts) for private academies, or risk losing their job and visa. Stories of teachers fired so that their employers could avoid paying severance were everywhere, and the legal system is notoriously difficult to navigate for foreigners. For migrant laborers, it is clearly much worse.

Chikungunya in the Caribbean: Jamaica declares a state of emergency

Tuesday, October 21, 2014

Well, this is bad news. The global health blogosphere has been following Chikungunya ever since its jump across the Atlantic to the Caribbean at the end of last year, and then to Florida this summer. However, apparently it's gotten so bad now that Jamaica has declared a state of emergency in response to it.
Jamaican prime minister Portia Simpson Miller announced that the island nation is in a 'national emergency' this week over the outbreak of Chikungunya.

The mosquito-borne virus shares similar symptoms to Dengue, often leading to fever and joint pain that can last from days to years.

"I want to stress that we are in a national emergency," Simpson Miller said, "I have therefore, assumed a lead role in mobilizing the nation and national resources."

Earlier this month the Jamaican government launched an Emergency Response Team to coordinate national actions to contain the Chinkungunya virus and reduce the number of cases. The government designated US$4.5 million in state resources for the team's efforts.
I traveled to St. Lucia this month, and the local people are definitely concerned; I even met an unfortunate Canadian women who had contracted both dengue and Chikungunya at the same . Lucky for us, a vaccine is in the works and has shown promise in early clinical trials.

We have lost an anti-FGM warrior: Efua Dorkenoo dies of cancer

Efua Dorkenoo, "mother" of the African-led movement against female genital mutilation (FGM), has died of cancer at age 65.
Dorkenoo – known affectionately to many as “mama Efua” – was a leading light in the movement to bring an end to FGM for more than 30 years, campaigning against the practice since the 1980s.

The girls’ and women’s rights campaigner saw the progression of the movement to end FGM go from a minority, often ignored, issue to a key policy priority for governments across the world. Proof of this arrived with the launch of The Girl Generation on October 10 – a major Africa-led campaign to tackle FGM across the globe, run by a consortium of charities and organisations and funded by the department for international development. Dorkenoo – the natural choice to lead the consortium, wrote simply on the day of its launch: “ Finally, The Girl Generation: Together to End FGM is here, and I hope you like it.”
In 1983 she co-founded FORWARD (The Foundation for Women’s Health, Research and Development), which became a leading organisation in the battle to raise awareness about FGM. The procedure, which still affects more than 125 million girls and women worldwide and is widely practised in 29 countries in Africa and the Middle East, was outlawed in the UK in 1985. She published a seminal text on FGM – Cutting the Rose: Female Genital Mutilation: The Practice and Prevention, in 1994.

What ground my gears (and otherwise irritated me) this week: Ebola hysteria, infection control terminology, and the US abortion wars

Friday, October 17, 2014

I was posting often when I launched this blog at the beginning of the year, but then things got slow during my travels and after I came back to the states and was job searching. Now that I have settled into my new position, I am able to post here more frequently and am beginning to wonder if I should set some routines or designate certain days for regular features, like so many other global health blogs do. Fridays seem to be popular (e.g., WhyDev's Last Week Today and my personal favorite, Wronging Rights's WTF Friday). I'll have to meditate on establishing a "Peeves of the Week," or "What Ground my Gears This Week" routine, but a preliminary assessment confirms that it suits my character pretty well.

Maybe I'll go with the "Gears" option; after all, I love memes.

Gear Grinder #1: Ebola hysteria and the media's inability to use "isolation" and "quarantine" correctly
I sometimes wonder if public health professionals are doomed to a lifetime of exasperation with crappy media coverage of health topics. Global health bloggers already constantly bitch that the media's m.o. is to ignore diseases until they become relevant, and then to immediately transition into full-blown PANIC! mode. On top of the overal doomsday tone, however, I have noticed that most news stories seem to use the terms "isolation" and "quarantine" interchangeably, when they actually mean two very different things:
  • Isolation separates sick people with a contagious disease from people who are not sick.
  • Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.
Get it right, people. It's not that hard.

Gear Grinder #2: The ongoing US abortion war, otherwise known as "the never-ending public debate in which people scream past each other"

I make it a point to pretty much never get into this topic, because most people can't seem to stay rational while discussing the issues of abortion and contraception. But today conservate troll blogger Matt Walsh (along with a zillion others) offered his take on the woman who posted an open letter to the "little life [she] won't get to meet" to Reddit. Cue controversy. What consistently frustrates me, among other things, is how it doesn't occur to anyone that young women who become pregnant unexpectedly might not feel so trapped if the relatively commonplace life event of having a child in America didn't cost a fortune or severely damage women's career prospects. In fact, this image of a hospital bill following a C-section birth in Philadelphia went viral this week:

Remember, my fellow Americans, we live in one of the only countries in the developed world without any kind of guaranteed paid maternity leave or subsidized childcare. Perhaps pro-life advocates who want young pregnant women to "choose life" should make it so that pregnancy doesn't have to be such a bloody crisis.

Nifty Infographic of the Day: Are [US] Hospitals Prepared for a Natural Disaster or Emergency?

The answer, as you might have guessed, is that they are not: most hospitals, like many agencies, are simply not ready for a disaster.

Dallas Presbyterian on #Ebola: "Our bad, guys! Sorry about that."

Thursday, October 16, 2014

In a very quietly arranged Congressional hearing that almost nobody heard about until after it started, officials at Dallas Presbyterian Hospital, the hospital that screwed the pooch on treated America's first Ebola case (resulting in infecting two of its own nurses due to its shoddy infection control practices and utter lack of training and emergency preparedness), issued an official apology as part of their testimony.
The chief clinical officer of the Texas hospital system that treated a Liberian Ebola patient apologized for what he said were mistakes made by the hospital in Dallas in the original diagnosis of Ebola and in providing inaccurate information.

The remarks, part of prepared testimony for a congressional hearing later Thursday, came a day after a second nurse in Dallas was found to have Ebola. Her diagnosis came after she had taken a flight, prompting health officials to track down other passengers and include them in a growing list of people being monitored for symptoms.
In the prepared remarks, Dr. Daniel Varga, the chief clinical officer for Texas Health Resources, the medical group that oversees Texas Health Presbyterian Hospital, said that “unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team we made mistakes.”

He added: “We did not correctly diagnose his symptoms as those of Ebola. We are deeply sorry.”
Well, I guess that's settled - now that the hospital has said they're sorry, we can all go home now.

Meanwhile, National Nurses United, a nurses' union, published an anonymous statement compiled and submitted by nurses from the aforementioned hospital. The statement, contrasting sharply with confident and rosy proclamations from the hospital about how it was doing everything it was supposed to, paints a disgraceful (lack of) response when the CDC has been warning hospitals to prepare themselves and publicizing infection control guidelines for months.
The statement alleged that when Duncan was brought to Presbyterian by ambulance Sept. 28 with Ebola-like symptoms, he was “left for several hours, not in isolation, in an area” where up to seven other patients were. “Subsequently, a nurse supervisor arrived and demanded that he be moved to an isolation unit, yet faced stiff resistance from other hospital authorities,” they alleged.

Duncan’s lab samples were sent through the usual hospital tube system “without being specifically sealed and hand delivered. The result is that the entire tube system … was potentially contaminated,” they said.

The statement described a hospital with no clear rules on how to handle Ebola patients, despite months of alerts from the Centers for Disease Control and Prevention in Atlanta about the possibility of Ebola coming to the United States.

“There was no advanced preparedness on what to do with the patient. There was no protocol. There was no system...nurses were essentially left to figure things out on their own as they dealt with “copious amounts” of highly contagious bodily fluids from the dying Duncan while wearing gloves with no wrist tapes, flimsy gowns that did not cover their necks, and no surgical booties, it alleged.

“Hospital officials allowed nurses who interacted with Mr. Duncan to then continue normal patient-care duties,” potentially exposing others, the statement said.
So much fail.

Nifty Video of the Day: What in the Health Is Public Health?

The following short animation, written and animated by Fielding School PhD student Adam Carl Cohen explains the role of public health in preventing disease. It's not super in-depth or anything, but it's a nice short overview for the general public.

What in the Health Is Public Health: Treatment vs. Prevention from UCLA Fielding SPH on Vimeo.

HIV stigma in Africa is not getting better, according to recent studies

Wednesday, October 15, 2014

Despite public education campaigns and progress in expanding availability of HIV medications in countries with high burdens, two recent studies have shown that HIV-related stigma in Africa is not going away. From this week's NAM aidsmap newsletter:
Many people hope that as HIV treatment becomes more widely available, people’s fear of HIV might decrease. But a study from rural Uganda, conducted between 2006 and 2012, is not encouraging on this point. Annual surveys with people living with HIV showed that concerns about disclosing HIV status and measures of internalised stigma had increased during this time. And surveys done with the general population showed that an increasing number of people said they would expect people living with HIV to experience stigma when disclosing their HIV status.

The second study was conducted with nearly 40,000 schoolchildren, aged 12 to 14 years, in nine southern African countries in 2007. In four countries, one-in-five children said that they would “avoid or shun” a friend who revealed that they had HIV. In three countries, over a third of students believed that children living with HIV should not be allowed to continue to attend school.

Children from poorer families and children living in rural areas were more likely to have stigmatising attitudes.
Interestingly, the first study - examining both internalized stigma among people living with HIV (PLHIV) and attitudes among the general population - found that while internalized stigma among PLHIV increased over the five-year study, attitudes regarding HIV among the general population actually improved:
Overall, participants in 2011 were more likely to have accepting attitudes towards HIV (59 vs 46%, p < 0.001).

However, in 2011 a higher proportion stated that they would expect people living with HIV to experience stigma when disclosing their status (61 vs 47%, p < 0.001).

The investigators offer two suggestions for this apparent disparity in their findings. First they suggest that answers about feelings of stigma towards HIV may have been affected by social desirability – participants provided researchers with the answers they thought they ought to. Alternatively, the authors suggest that attitudes towards HIV genuinely had changed among the study participants, but they perceived that the attitudes of others in their society had not.
The second study examined attitudes related to HIV among schoolchildren in Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. Generally, the study found that students with more accurate knowledge about HIV and its modes of transmission were less likely to have discriminatory attitudes, and there were major differences in knowledge and attitudes between rich and poor students, and also between students in urban and rural areas, with rural and poorer students more likely to have discriminatory attitudes.
The two countries with the lowest scores for discriminatory attitudes, Malawi and to a lesser extent Swaziland, are small countries with high HIV prevalence that have mounted particularly strong public awareness campaigns and more recently have concentrated on providing access to antiretroviral therapy and, in the case of Malawi, especially to testing.

The researchers comment: “Our study points towards the need for early interventions (age 13 or before) to reduce stigma and discrimination among children, especially in schools in rural and poorer areas. In particular, interventions should aim to correct misconceptions that HIV can be transmitted via casual contact with people living with HIV.”
This should come as little surprise - similar studies have demonstrated that the better informed a population is about HIV, the less likely they are to have negative attitudes about it. Both studies underscore the continued need for public education campaigns about HIV, and that increasing the availability of medications, while important, should not take away from the need to inform the population.

Mandy Moore heads to Tanzania for PSI to promote recognition of the importance of #healthworkers

Thursday, October 9, 2014

Note/disclaimer: I am drawing attention to this trip, which I do honestly believe highlights an important group, at the request of one of my colleagues and fellow bloggers who works for PSI, though I am not getting paid for it.

Though the issue of celebrities foraying into global health and development is somewhat controversial (and occasionally scandalous), I maintain that it is not necessarily a bad thing. IMO, it all depends on who they are working with and what they are doing. Thus, starting your own charity like Alicia Keys or Madonna is probably not the best approach, signing on as ambassadors can, I think, draw attention to important issues and groups by putting a celebrity face on an organization's efforts.

Which is why I'm happy to point out that Mandy Moore is back in Africa with PSI, this time in Tanzania, to draw focus on the importance of a critical but vastly underappreciated resource in global health: health workers.
A robust and effective global health workforce must be a top priority for the international community, and Mandy Moore is helping to champion this cause along with Jennifer James, founder of Mom Bloggers for Social Good, a coalition of more than two-thousand mom bloggers who currently span twenty countries who care about spreading the good news about the amazing work nonprofit organizations and NGOs are doing around the world. They’re visiting health workers in Tanzania with us along with IntraHealth International, with whom PSI partnered to produce the latest issue of Impact Magazine, focusing on the global health workforce.

Follow @TheMandyMoore, @JenniferJames, @SocialGoodMoms, and @IntraHealth as well as @PSIImpact and PSI’s @MarshallPSI, @Mandy_McAnally and @regaroni, who will be tweeting and Instragramming the trip all week using #HealthWorkersCount. We’ll be creating a Storify every day to collect some of the best photos, tweets, and commentary from Mandy and the group in Tanzania. We would love to include your thoughts and tweets about the value of an empowered global health workforce.
As a side note, I had no idea that there was "a coalition of more than two-thousand mom bloggers who currently span twenty countries" dedicated to giving press to nonprofit action, though I'm not surprised. Based solely on my experience on Facebook, I have concluded that "mommy bloggers" are a terrifyingly influential collective and a force to be reckoned with.

#Globalhealth insight on Reddit

Wednesday, October 8, 2014

My entry into global health blogging, which was due to joining APHA's International Health section and eventually led me to becoming the chair of its Communications Committee, has also taken me to some very interesting social media and other internet community platforms. Along with my generation's love-hate relationship with Facebook, the questionable attempt to gain utility from LinkedIn, and the standard activist's presence on Twitter, I have recently forayed into Reddit's health-related communities (including /r/globalhealth, /r/doctorswithoutborders, /r/publichealth, /r/epidemiology, /r/humanrights, /r/worlddevelopment, and /r/internationaldev), some of which are more active than others. Most of what is useful comes in the form of news articles posted, although there are opportunities for mentorship, giving and receiving education and career advice, and even a weekly journal article discussion.

However, you occasionally find public health gems on other, less serious boards, including the occasionally inane /r/adviceanimals. For example, yesterday I stumbled onto some rather apt commentary on the ethically dubious rush to develop Ebola treatments:

US waives child soldier sanctions on six nations - again

Friday, October 3, 2014

H/t to fellow global health bloggers Mark Leon Goldberg and Tom Murphy who point this out every year - as they should, because it is even more disappointing every time it happens.
President Barack Obama on Tuesday fully waived sanctions and lifted bans on international military, education and training assistance to Yemen, Rwanda and Somalia applied under the Child Soldier Prevention Act, said deputy assistant secretary Michael Kozak.

Central African Republic, the Democratic Republic of Congo and South Sudan were also given partial waivers for specific military purposes, while sanctions were maintained on Myanmar, Sudan and Syria, found guilty of the widespread recruitment of children into their armies.

Waivers did not mean the United States was turning a blind eye to the use of child soldiers or providing an "unlimited flow of security assistance," Kozak said.

"The waiver doesn't mean that they are not guilty of recruiting child soldiers. To the contrary, it means they are, and therefore the sanction in law would apply but for the waiver," Kozak said, adding the idea was a bit like "a doctor treating a patient."

"You don't want to do something that's going to kill the patient. If you have al-Shebab take over in Somalia because we couldn't support the government at all, that's not going to help the child soldier problem or any other human rights problem."
I'm pretty sure that waiving sanctions to allow the Somalian government to recruit child soldiers year after year hasn't really helped with the al-Shabab problem; last I checked, it was still a failed state. I suppose we can just add it to the list of this administration's failures, along with closing Gitmo and living up to a prematurely-awarded Peace Prize.

All eyes on #OccupyCentral in #HongKong: Where will China go with its latest pro-democracy uprising?

Tuesday, September 30, 2014

This exploded over the weekend: in what is alternately being called #OccupyCentral, #UmbrellaMovement, and #UmbrellaRevolution, pro-democracy protesters in Hong Kong, one of China's semi-autonomous regions, took to the streets to protest a recent move by China's central government to limit the region's self-governance. Hong Kong is somewhat of an anomaly in China - unlike most of the rest of the country, the region retained a free press and an independent judiciary after the UK handed the territory over to the People's Republic in 1997 - and they have exercised their right to assembly and peaceful demonstration at least once a year since then. The formal expression is "One China, Two Systems"; practically speaking, it is a small enclave of economic prosperity, sky-high cost of living and property value, and open internet access, not to mention a place where Americans (and perhaps others, though I can't speak to the experience of citizens of other countries) can visit without paying for China's exorbitantly priced tourist visa.

This time, though, it looks like shit may go down for realz - the demonstrators have taken the streets en masse, and there are whispers of the possibility of a Tiananmen square repeat.
Downtown Hong Kong turned into a battlefield of tear gas and seething crowds on Sunday after the police moved against a student democracy protest, inciting public fury that brought tens of thousands of people onto the streets of a city long known as a stable financial center.

Hours after the riot police sought late Sunday to break up the protest, large crowds of demonstrators remained nearby, sometimes confronting lines of officers and chanting for them to lay down their truncheons and shields. Police officers were also injured in skirmishes with protesters.

The heavy-handed police measures, including the city’s first use of tear gas in years and the presence of officers with long-barreled guns, appeared to galvanize the public, drawing more people onto the streets. On Monday morning, protesters controlled major thoroughfares in at least three parts of the city. A few unions and the Hong Kong Federation of Students called for strikes, and the federation urged a boycott of classes.
The escalation of the protests, and the unusually strong response by the police, pointed to the possibility of a long confrontation between a city government pressured by the Chinese Communist Party’s demands for top-down control and residents’ demands for a city leadership chosen by democratic means.

The protest at the government offices was started by students demanding such electoral changes. Beijing last month proposed that the public would be able to vote for the city’s chief executive, beginning in 2017. But a committee dominated by people loyal to the Chinese government would be able to screen out candidates who did not have Beijing’s backing.
In addition to the NYT, all of the usual suspects - Reuters, CNN, USA Today, BBC, and the Guardian - have constant coverage. Vox has drawn parallels between these protests and the riots in Ferguson. Obviously, it's trending on Twitter, and Reddit has a live stream. Mashable's got a summary so far, and Gizmodo reports that Instagram has been blacked out (big surprise there). Political scientist Jay Ulfelder has some great commentary on some possible outcomes and whether or not the government's response will constitute a "mass atrocity."

I am, of course, always inspired by such peaceful demonstrations, but I am also concerned about the ripples this may have, both in HK and on the mainland. My best friend works in Beijing, and another expat friend from Korea is currently living in Shanghai (I think); the PR China government has used protest activity as an excuse to crack down on foreigners before, and I have already seen Westerners in some of the pictures of these demonstrations. For now, all we can do is watch.

Accepting the #IceBucketChallenge as Someone Who Worked on ALS in Public Health

Friday, August 22, 2014

When people say it's a small world, they're sure as hell not kidding.

Before I left the U.S. to work in South Korea, I worked on a federally-funded ALS Surveillance Project for the state of Texas. I was employed by a federal contractor and assigned to work as an ALS Surveillance Specialist at the Texas health department. The project, which collect ALS data in designated states and metropolitan areas, is designed to strengthen efforts to build and evaluate the national ALS Registry currently being built by ATSDR, a federal health agency under the US Department of Health and Human Services that works closely with CDC. The three state-based projects have wrapped up, but the metro area projects are ongoing. ATSDR published its first paper related to the national registry last month.

Naturally, I learned a lot about ALS in the two years that I coordinated the project. I built relationships with stakeholders such as local ALS Association chapters (which merged to form one Texas chapter in 2012) and worked closely with specialised ALS treatment centers in Dallas, Houston, and San Antonio. I read a great deal about the clinical presentation, common treatments, and ethical considerations in treating patients and counseling caregivers. I visited with neurologists about the disease at conferences as we tried to get the word out about the project. I followed news, kept up with developments in research, and listened to academics and health professionals debate at meetings, often clashing verbally.

I lived and breathed ALS for two years. Similar to my colleagues on the Texas project team or in other states, however, I found that, aside from ALS advocates and healthcare professionals that were dedicated to treating neurological disorders, nobody seemed to know what it was.
"So where are you working?"
"I've taken a position at the health department."
"Oh, that's great! What do you do there?"
"I'm working on an ALS project for the state of Texas."
"ALS? What's that?"
After getting a few puzzled stares, I eventually started including a description of the disease with my job description. A few more people were familiar with it when you described it as "Lou Gehrig's disease," and sometimes I would get a "Oh yeah, I have an aunt who died from that." Occasionally I had the chance to explain how registries and epidemiological studies can be really helpful in understanding the causes of disease (it is still unclear what exactly causes ALS, and there is a genetic component in only about 5-10% of cases), but for the most part people's eyes just kind of glazed over before we went back to talking about football or how the Texas summer is so damn hot.

Which is why, at least to me, the "Ice Bucket Challenge" that has gone viral this week is such a positive thing. Many people have openly admitted to not knowing what ALS was until they took the challenge (some remain clueless, but for the most part I have seen that people who took it on have educated themselves). I have seen a lot of complaints that it is just another form of "clicktivism," and many have compared it to Kony 2012 or the use of the Arabic letter "nun" as a Facebook profile picture to draw attention to the persecution of Christians in the Middle East, but I disagree. "Making a difference" in the Great Lakes region of central Africa or the Middle East is difficult, given the complexity of the geopolitics in those areas. But ALS is different - it's an established neurological disorder with a defined epidemiology, unknown etiology and no effective cure or treatment. The way to address it is to raise awareness and fund research, and the fundraising power of this campaign speaks for itself: as of today, $53.3 million has been raised for the ALS Association.

After the challenge started making news headlines, I began to watch it with some interest, thinking back to the project that I worked on. Before I knew it, the challenge had entered both my professional and personal circles: several of my colleagues that worked on one of the other state projects, plus several expats that I knew in Korea, had been challenged - and soon I was challenged.

The current temperature in Austin, Texas is a blistering 97 degrees Fahrenheit (36 degrees Celsius). I accept.

Media Wars: #Ferguson, American Hypocrisy and a Hint of Spring

Wednesday, August 20, 2014

America has experienced an ugly spotlight reversal with the eruption of popular discontent into violence in its own backyard. Just a few weeks ago, international media was buzzing with reports of ISIS steamrolling the Iraqi military and Russian-supported separatists in Ukraine shooting down passenger airlines. Now, the US squirms uncomfortably under international scrutiny of Ferguson, Missouri, where the shooting of a young black man by a white police officer has once again raised the specter of racism and police brutality.

Obviously, the incident itself is complicated. Eyewitnesses - who have given conflicting testimonies - are the only window into what happened, since there was no dashboard camera. The initial description of Michael Brown, the victim of the shooting, as a "gentle giant" about to start college clashed with video footage of him stealing a box of cigarillos from a convenience store. Commentators have drawn parallels with the case of Trayvon Martin, whose mother has now reached out to Brown's mother. Peaceful protests have given way to violence and looting, reporters have been arrested, and witnesses have complained of excessive use of force by the police.

Social media, which played a major role in bringing media attention to Ferguson in the first place, has played host to the battleground of ideological responses to the incident. The primary complaint from conservatives is that the uprising in Ferguson, and the underlying racial tensions it has exposed, don't deserve our consideration because some of the protesters have been looting and vandalizing stores...

...including a few gems that actually blame the community for the excessive force used against it.

Meanwhile, people used the Twitter hastag #IfTheyGunnedMeDown to spar over which photos of Brown were used by traditional media (wearing a cap and gown vs. striking a "thug" pose) and post their own side-by-side pictures. Still others are expressing frustration at the fact that the vandalism and looting has been used as a straw man to distract from ongoing widespread racial profiling and policy brutality against blacks, including one refreshingly blunt protester at a rally in DC:

What has been the most interesting to me is the global shock and horror at the incident and resulting fallout. The international community sees what many Americans are apparently missing: that the protests and unrest in Ferguson are the manifestation of a minority group sick of being oppressed and ignored. The UN High Commissioner for Human Rights drew parallels to South African apartheid, while several countries have been using the situation to take shots at America's own human rights record when we so often criticize other countries. One might expect Iran and Russia troll the US over civil unrest, but as one friend of mine pointed out on Facebook, "When Egypt calls you out for human rights abuses, YOU'RE DOING IT WRONG."

American police brutality, and the unwillingness of many police departments to be held accountable for their actions, have also been focal points. What happened to Michael Brown will unfortunately always be shrouded in mystery, since the Ferguson police department apparently prioritizes riot gear and tear gas over cameras for officers or police cruisers. They also seemed to have forgotten the meaning of "free press," as they arrested and harassed several reporters who were trying to cover the protests. Interestingly, Obama was quick to condemn the bullying of journalists "here in the United States of America," despite his own administration's secrecy and aggression toward the press, including prosecuting a journalist who refused to identify the source of an intelligence leak.

Indeed, many observers have been quick to point out America's hypocrisy at fingering human rights abuses outside our own borders when we have threads of discontent, similar to those found in the Arab Spring and other global protest movements, woven throughout our own society. When protesters in Egypt, Turkey, Bahrain, and the Ukraine were throwing Molotov cocktails and breaking shop windows, observers viewed it as the natural - and understandable - result of the collective frustration of the oppressed and disenfranchised. The same commentators that were quick to decry autocratic governments for dismissing the protesters as "thugs" are now using the same language to describe Ferguson residents. A lovely little piece of satire from Vox portrays how American media might describe the events in Ferguson if they happened in another country.

When everything is said and done, America doesn't look so much like a shining beacon of democracy and human rights - we just kinda look like everybody else.

Fake AIDS Cures: Apparently Still a Thing

Tuesday, August 19, 2014

The Egyptian military is the latest government that's in hot water over making ridiculous claims of "miracle cures" for HIV/AIDS - among them, that electromagnetism can detect the virus and that they had a "complete cure device" (whatever that means). The saddest part, however, was that they received 70,000 inquiries about it.

Outlandish claims of cures for HIV/AIDS, while tragic and destructive, are by no means new. This article from NPR outlines the history that we apparently still fail to learn from:
The bogus theories of Peter Duesberg, a professor of biochemistry at the University of California, Berkeley, were responsible for a global setback to HIV treatment. Duesberg argued that combinations of drug use and promiscuous behavior caused the virus, and passed his advice on to South African health officials in 2000.

"The biggest disaster imposed on us was Duesberg with his statements that HIV did not cause AIDS," says Max Essex, chairman of the Harvard School of Public Health AIDS Initiative. Essex has been conducting research on AIDS since 1983, including field research in Botswana and Southern Africa.

Between 2000 and 2005, as neighboring African countries were ramping up HIV prevention programs, South Africa stubbornly stuck to the notion that HIV was not the cause of AIDS. "I think Duesberg played the biggest role in giving [former South African President Thabo Mbeki] a convenient excuse to avoid supplying drugs," says Essex.

Researchers including Essex examined the human toll of those lost years of treatment. Their results, published in 2008 in the Journal of Acquired Immune Deficiency Syndrome, estimated that 330,000 South African adults died because of lack of treatment, and 35,000 infants were born with HIV.

If that was the biggest disaster, no doubt the cruelest of the AIDS false cure claims was the virgin cleansing myth that took hold in sub-Saharan Africa, as well as parts of India and Thailand. Some men believed they could be cured of AIDS by having sex with a virgin. That reportedly led to the rape of younger and younger girls — even babies, by some accounts.

Other unproven AIDS "cures" have kept people from seeking life-saving treatments: herbal remedies, potions to rub into the skin, chemicals like Virodene (derived from an industrial solvent), oxygen therapy and electronic zappers.

North Korea Tourism Video Goes Viral, Despite its Horrendous History of Human Rights Abuse

Monday, August 18, 2014

Apparently a video advertisement for travel to North Korea, "Enter Pyongyang" has been making the rounds on social media. It's a three-minute time-lapse video of several central locations in the Hermit Kingdom's capitol, ostensibly to "provide a glimpse" into a "mysterious city" and - because it was produced in part by a North Korean tour company - to attract potential travelers to an "off the beaten path" destination.

As Amnesty UK points out, there is zero mention of North Korea's hideous human rights abuses (obviously, because that's not how you attract tourists):
People must look beyond the propaganda. North Korea is a country in a league of its own. There’s no nod here to the country’s brutal punishment system of prison camps, where innocent people face starvation, forced labour, misery and death.

Marvel at the aesthetics by all means, but then watch people talking about their life in the camps, where thousands upon thousands of people are still rotting away.
When we lived in South Korea, my husband and I briefly toyed with the idea of taking a tour there, because a tour is the only way you can go - the kind of meandering, go-where-the-wind-takes-you style of backpacking that we and our fellow expats adored is most definitely not allowed. The tours have a very specific itinerary that only takes visitors to "polished" places in the capitol, where you see statues, Starbucks, and famous buildings - but no unfinished roads, villages, or starving farmers. At the end of each day, you are dropped off at your hotel, from which you cannot leave - not even to grab a bite at a local noodle joint. You are escorted everywhere by a tour guide who spouts off propaganda. Despite its rigid nature, Westerners who have gone say it is a fascinating experience - including one of our college friends who has now gone twice. Looking at the price tag attached the tours was enough to dissuade us - particularly since, in addition to being able to spend a month in Japan on the same budget, the thought of giving so much money to support the ailing economy of a horrendous totalitarian regime left a bad taste in my mouth.

Despite the glossy picture they paint, North Korean travel agencies warn potential travelers in no uncertain terms to not try to start discussions with their tour guides about the country's repressive practices, human rights violations, or even poor conditions in the country. In addition to endangering you, such questions can also put the tour guides themselves at risk.

Frankly, I am surprised that no one who passed on the video noticed how few cars there were on the streets for a capitol city. Or how there were absolutely no foreigners. Or how short (and underfed) most North Koreans looked. But then again, I guess we personally have Seoul for comparison.

Chikungunya vaccine shows promise in early clinical trials

Friday, August 15, 2014

An experimental chikungunya vaccine developed by the NIH's National Institute of Allergy and Infectious Diseases (NIAID) has shown promise in early clinical trials:
In the newly reported trial, 23 healthy volunteers received three injections (two other volunteers received two injections) of vaccine at one of three different dosages (10, 20 or 40 micrograms) over a 20-week span. Antibody production was measured at multiple time points following each injection. Investigators detected chikungunya neutralizing antibodies in all volunteers following the second injection, with a significant boost of neutralizing antibodies seen following the third injection. Vaccine-induced antibodies persisted in all volunteers, even those who received the lowest dosage, for at least 11 months after the final vaccination, suggesting that the vaccine could provide durable protection against disease.

“The candidate vaccine prompted a robust immunological response in recipients and was very well tolerated,” noted VRC scientist Julie E. Ledgerwood, D.O., principal investigator of the trial. “Notably, the levels of neutralizing antibody produced in response to the experimental vaccine were comparable to those seen in two patients who had recovered from a chikungunya virus infection acquired elsewhere. This observation gives us additional confidence that this vaccine would provide as much protection as natural infection.”
This is great news, particularly considered that the vector-borne disease just arrived in the US this year.

Nifty Infographic of the Day: Child Marriage and Human Rights

Nifty Infographic of the Week: West African Ebola Outbreak (from Reuters)

Wednesday, August 13, 2014

Okay, so it's not really that nifty, but as Ebola (and frankly not much else) is in the news, this seemed like a fitting infographic to feature. Reuters has compiled a map of the outbreak, plus a line graph and a bar chart of Ebola cases and deaths by country (not including Nigeria, where the outbreak is still fairly new):

Investigation Uncovers Potential Medicare Fraud Involving HIV Meds

Thursday, August 7, 2014

I normally stick to blogging about global health topics, but since the U.S. is part of the globe (obviously), and HIV/AIDS medications are such an important topic in global health, it felt natural to comment on this story.

U.S. Health and Human services just published the results of an investigation into possible fraud involving ARVs (antiretrovirals, or HIV medications) that were paid for by Medicare's Part D. Medicare is America's health care program for the retired and disabled; Part D is the part of the program that covers prescription drugs. What makes this story unusual, however, is that it focuses on beneficiaries as the ones possibly committing fraud. From NPR:
  • In Detroit, a 77-year-old woman purportedly filled $33,500 worth of prescriptions for 10 different HIV medications. But there's no record she had HIV or that she had visited the doctors who wrote the scripts.
  • A 48-year-old in Miami went to 28 different pharmacies to pick up HIV drugs worth nearly $200,000, almost 10 times what average patients get in a year. The prescriptions were supposedly written by 16 health providers, an unusually high number.
  • And on a single day, a third patient received $17,500 of HIV drugs — and none the rest of the year. She got more than twice the recommended dose of five HIV drug ingredients.
The inspector general's report raises new questions about Medicare's stewardship of Part D. A ProPublica series last year showed that Medicare's lax oversight enabled doctors to prescribe massive quantities of inappropriate medications, wasted billions on needlessly expensive drugs and exposed the program to rampant fraud. Part D cost taxpayers about $65 billion in 2013.

Previous inspector general reports have criticized the way Medicare oversees doctors and pharmacies, but this one focuses on patients, who are not usually the focus of inquiries into fraud and abuse.

The investigation flagged 1,578 Medicare beneficiaries who received HIV medications worth $32 million in 2012.
Government-provided healthcare has been under intense scrutiny, and has come under a lot of fire, with the (sometimes botched) implementation of the Affordable Care Act over the last two years. Personally, I hope this doesn't generate too much negative publicity - after all, fraud will happen in programs this size, which is why these types of investigations are undertaken. I am at least encouraged by the fact that they published the results - unlike the CDC, whose laboratory safety slip-ups over the last decade only came to light when the anthrax incident blew up.

The Weird Western Myth of the "Happy Poor"

Saturday, June 21, 2014

After finishing my teaching contract in South Korea, I resolved to get serious about finally launching a (paid) career in global health and started applying for international health jobs in earnest. One of those positions included the Global Health Corps fellowship. Despite my lack of Ivy-league degrees and unpaid internships (because not all of us have money trees growing in the backyard), my French ability is usually attractive to international recruitment programs, so I made it to the semi-final stage in my application for a position with a radio program based in Bujumbura, Burundi. One of my good friends from university, who is currently working in China, was delighted when I told her about my pending phone interview (which contrasted sharply with my family's shock and disdain that I would even consider taking a job in Africa, but I digress). "There is a small Burundian expat community here, and they are wonderful people. A couple of my friends even went to Burundi to visit their families, and they had a great time. The people there are very poor, but they are genuinely happy."

Now, my friend is not a development professional, so I don't hold the comment against her - she was only relaying what some fellow expats had shared with her, after all. But I had to bite my tongue, because these kinds of comments irritate the hell out of me. Not only is it simply not true, but it's demeaning to "the poor" in a way that I couldn't quite articulate until I came across this blog:
Poverty is not just the lack of wads of cash. It is the lack of options, choices, autonomy. It often means disease, children dying young, lack of education, illiteracy, hunger, hard labor, oppression. I don’t know many people in these circumstances for whom ‘happy’ is the primary appropriate adjective.
That the poor are happy is an easier narrative to swallow than that the poor are desperate and will flash a smile, a good attitude, and gratitude when the rich westerner has come around to offer something of short-term benefit.

The other, more nuanced and complicated narrative is that the poor have beautiful smiles and wonderful senses of humor because they are human and fabulously diverse.
Interestingly, when I shared the above blog with the same friend, she made some commentary that was quite profound:
I think what bothers me more than this phrase is when people refer to "the poor." It implies that being poor is not just about how much money you have right now, but a class distinction that is part of WHO YOU ARE. In assigning this as an identity, rather than a condition, it necessarily implies that it can't be changed. It implies an inferior state of being, construing an an imbalance of power in Talking about the "the poor" is alienating--to say that you automatically separate yourself from "those people," and lets face it, the honest truth is that for the majority of people in the world, we have all been "the poor" at some point or other in our lives.
It drives home the point that most people who make these types of comments do it unconsciously - they are just ignorant and, when pushed, are capable of being better. We as a community of development professionals just need to do more of making people aware of ingrained attitudes so they can change them.

Despite her Nobel Prize, Aung San Suu Kyi has always been a politician

Friday, June 13, 2014

Last week, NY Times columnist and foremost white in shining armor expressed his disappointment in Aung San Suu Kyi, Nobel laureate and hero of democracy and peaceful protests in Myanmar. Suu Kyi has been hailed as a champion of human rights and was something of an international hero during her fifteen-year, on-and-off house arrest, during which a handful of movies were made about her heroism. She finally went free for good in 2010, to much international fanfare.

She then proceeded to run for parliament, take a diplomatic tour of Europe, and push to change the constitution so she can run for president so she can do what she did when she was first imprisoned in 1990: get elected.

But Kristoff is disappointed. In his recent opinion piece, he laments Suu Kyi's abandonment of her once-noble human rights aspirations in favor of political ambition.
Aung San Suu Kyi should be one of the heroes of modern times. Instead, as her country imposes on the Rohingya Muslim minority an apartheid that would have made white supremacists in South Africa blush, she bites her tongue.

It seems as though she aspires to become president of Myanmar, and speaking up for a reviled minority could be fatal to her prospects. The moral giant has become a calculating politician.
Apparently he, and the rest of the world, missed the fact that Suu Kyi has always been a politician.
But speaking in an interview with CNN on Monday, Suu Kyi rejected suggestions that she has been forced to transition from activist to politician.

“I’m always surprised when people speak as if I’ve just become a politician. I’ve been a politician all along. I started in politics not as a human rights defender or a humanitarian worker, but as the leader of a political party. And if that’s not a politician then I don’t know what is.”
To be fair, I also find it highly disappointing that she doesn't take a stronger stance against the plight of persecuted minorities like the Muslim Rohingya, whom I've written about before. I personally have admired her for a very long time, and I do wish she would use her influence to take a stand against such violence. But, as Kristoff himself astutely points out, Myanmar is incredibly complicated, and Suu Kyi needs the support of her people - the Burmese majority - to keep her position, from which she can work toward more lasting change. I agree that politicians with influence should not remain silent in the face of injustice, but it's also not fair to paint Suu Kyi as some kind of human rights sell-out.

Kristoff also brings up Obama - another Nobel laureate who, in the view of many, hasn't lived up to his prize - which, I think, drives home a very different, but important point. The lament that the Nobel Peace Prize doesn't mean what it used to is certainly not new. The original purpose of the award, as specified by Nobel, was very specific: it was to go to the person or group who had "done the most or the best work for fraternity between nations, for the abolition or reduction of standing armies and for the holding and promotion of peace congresses." Now it is awarded to democracy activists (like Suu Kyi and Chinese dissident Liu Xiaobo), climate change groups (the IPCC and Al Gore), champions of development and women's rights, and even politicians and governments actively engaged in conflict (President Obama and the EU). All of these laureates have done commendable things, and probably deserve prizes, but do they deserve a peace prize? Maybe not.

In short, I don't object to calling Suu Kyi out on her silence in the face of injustice, but let's not make her out to be something she's not.

Mass Shootings and Important Conversations

Monday, May 26, 2014

This was cross-posted to the IH Blog.

Elliot Rodger, a disturbed rich young man went on a shooting spree in Isla Vista, a wealthy district in Santa Barbara, California. Thanks to the joys of social media, both his written and videotaped "manifestos" were able to go viral. The reasons he listed for his killing tour included his parents' divorce, lack of luck with the ladies, and being short.

I get the divorce and the sexual frustration, but being short? That one was new.

Predictably, this has set off all manner of commentary in the public sphere. First and foremost, of course, comes the discourse on gun control. Gun control advocates have pointed out that all of the guns that Rodger used were legally obtained. The Brady Campaign Against Gun Violence has spoken out on the need to tighten controls on obtaining firearms, and one of the victim's fathers blamed "craven, irresponsible politicians and the NRA" for his son's death. To be fair, three of the six people who died were actually stabbed to death, but Rodger had plenty more ready in his car that he could have used.

The feminist response to the "manifesto" (can we even call it that? should we?) has been swift and furious, pointing out the misogynism woven through it and drawing attention to his links to the usually peculiar, occasionally violence-embracing "Men's Rights Movement" (which, by the way, is what exactly?)
But it also denies reality to pretend that Rodger’s sense of masculine entitlement and views about women didn’t matter or somehow existed in a vacuum. The horror of Rodger’s alleged crimes is unique, but the distorted way he understood himself as a man and the violence with which he discussed women — the bleak and dehumanizing way he judged them — is not. Just as we examine our culture of guns once again in the wake of yet another mass shooting, we must also examine our culture of misogyny and toxic masculinity, which devalues both women’s and men’s lives and worth, and inflicts real and daily harm.
Outspoken feminist writers have pointed out that this is not the first time a shooter has claimed similar motives, and Laurie Penny, in her usual no-holds-barred style, has dubbed the attack as the latest example of misogynistic extremism.

Last, and perhaps least, is the quiet conversation about mental health that seems to only experience half-hearted revivals when these tragedies strike. Mental health advocates speak up to point out that mental illness and seeking treatment for it are stigmatized in our culture, so social awkwardness and becomes anger without productive outlets which then warps into repressed rage. The media usually turns its head for a bit, shrugs, and then moves on to montages of grieving members of the community and talking heads interviewing NRA spokespeople on CNN. Unfortunately, this shooting has pitted feminists and mental health advocates against one another - as if Elliot Rodger the misogynist and Elliot Rodger the mentally unbalanced were mutually exclusive.

As both a feminist and a public health advocate, that makes me sad.

However, I think these are all important conversations to have. I much prefer them being featured on prime-time television in shows like Law and Order: SVU and Scandal than to have them forcibly thrust into the spotlight in the wake of a tragedy, but they need our attention nonetheless - and not at the expense of one another. While I'm not quite with the NRA on (lack of) gun control, I do think it's something of a straw man in this case - California is one of the strictest states when it comes to gun ownership, and preventing mass killings goes beyond cutting off access to handguns (which, for better or worse, cannot be kept from citizens per the Supreme Court) - but conversations about gun violence segue into discussions about poverty and equity, which badly need to be confronted. We need to scrutinize sexism and gender violence as much as society's assumption that a man's worth is based on his sexual prowess - all of which hurt men as much as they hurt women, but in completely different ways. And we need to stop sweeping mental health advocacy under the rug, so that people don't avoid treatment for mental illness for fear of being unable to get jobs in places like the military or the federal government.

Rather than fighting each other for the spotlight, let's share it together.