The latest session of Global Health Rounds took place on November 18th, 2015. Global Health Rounds is a free public lecture series, focused on highlighting and discussing the global health activities at Dalhousie, as well as contemporary global health challenges, with leaders in the field. These sessions are offered monthly and anyone is welcome (and encouraged) to attend. Speaker and location details will be posted on the Global Health Office Website, Facebook, Twitter and Instagram.
The November session was titled: “Global Health from an International Development Cooperation Perspective: A North-South Approach.” The facilitator was Manfred Egbe, a visiting PhD student-researcher from Universitat Rovira I Virgili in Tarragona, Spain. Led by Manfred, attendees (pictured above) learned about upstream approaches to improving health in rural areas of Mali.
This project is taking place in several communities in rural areas of the Koulikoro region, such as Diedougou, Kolonia and Tyékouméla. The Koulikoro region is pictured below on the map of Mali in seafoam green. Some of the many partners involved in this project include OSALDE (Association for the Right of Health) a Spanish NGO, ASACO (Community Healthcare Association), CSCOM (Community Healthcare Centre), community members and other NGOs in the region.
Manfred’s role within the project has been as a project evaluator and medical anthropologist. His ethnographic portion of the study involved identifying problems and challenges in the community related to health by consulting health directors and community members. As part of this research, he conducted a range of in depth individual and group interviews using both quantitative and qualitative methods, reviewed OSALDE documents and examined WHO data. Through these methods, Manfred was able to identify a tree of problems that needed to be addressed in Mali.
The central problem was identified as high infant and adult morbidity and mortality. To gain a more in depth look, the project next asked – what are the causes of mortality and morbidity? The top three causes of death were identified as malaria, lower respiratory infections and diarrheal diseases. This is accompanied by high costs of medicine, and a shortage of medicine for treating these diseases.
Instead of stopping there, they next asked – what social, cultural and environmental conditions are leading to a high burden of disease and death? These are referred to as the upstream causes of disease. This term comes from a metaphor used in the public health approach to disease prevention. The metaphor describes a dangerous river that runs through a community. Several people have been seen floating down the river, struggling and drowning. Rescue workers try to save those in danger; however, no matter how hard they work, they do not have the resources to save all victims. A straightforward, “downstream” solution to the problem may be to hire more staff, to try to save the people who have fallen into the river. However, traveling upstream to determine why people are falling into the river in the first place may be more effective. Perhaps they need to cross the river to access a food supply, but there is no safe crossing point and they are being swept away in the process. An “upstream” approach would be to build a stable, sustainable bridge, allowing people to cross the river and preventing them from falling in the first place.
Several factors were identified as upstream causes of morbidity and mortality. Environmental factors play a role in the burden of disease in Mali, where there are essentially two seasons: wet and dry. During the wet season, there is extensive flooding, leading to breeding grounds for mosquitoes. Furthermore, extremely wet conditions favor the transmission of waterborne diseases. This is paired with poor access to health care and health services in rural areas. Through the interview process, the community identified their upstream issues as contaminated wells, droughts during dry season, women being undervalued, difficulties accessing education (particularly for women) and poor sanitation in health facilities and the community.
To address the upstream issues, OSALDE has worked with community partners to support training of nurses, improving access to clean drinking water, building capacity by increasing literacy and working to improve the status of women through education.
The project also aimed to improve access to healthcare services (including the elimination of financial barriers) and improve healthcare system quality. In the Diedougou commune this involved offering a minimum healthcare service package including clinical activities, preventive activities, obstetric activities, medico-technical activities, pharmaceutical activities and management activities. They have also improved the healthcare centre, which now has a maternity ward, surgical unit and a general practitioner’s office.
The take home message from Manfred’s presentation: there are many determinants of health. These include, but are not limited to social, economic, genetics, political, and cultural factors. Straightforward approaches such as treating disease to decrease mortality are important when undertaking projects to improve health. However, most projects undertaken in resource poor countries have a fixed term (i.e. two years, five years, etc.). If we do not take the time to address sustainable solutions to health problems, and work with community partners, improvements in health status will not last.
I will leave you with a quote I really enjoyed from Manfred’s presentation: “the platform of global health accommodates people from different disciplines.” Many different minds with many different approaches can and should come together in global health to address issues that affect us all, and arrive at a sustainable solution.
Thank you to Manfred for sharing your experiences at this month’s Global Health Rounds. There will be no Global Health Rounds in December so as to not conflict with holiday plans and exams. We look forward to seeing you in January!