Health Care Teams Addressing Poverty and Determinants of Health

March 16, 2016 Maria Wilson Leave a Comment

The Dalhousie Global Health Office, in collaboration with the Healthy Populations Institute, The National Collaborating Centre for Determinants of Health and Upstream, hosted the “Health Care Teams Addressing Poverty and Determinants of Health” event on March 3^rd. This event featured three speakers, who shared stories of addressing the social determinants of health in their work, and participated in a panel discussion.

Dr. Hamilton-Hinch, Dr. Forbes and Dr, Meili, our panel for the Healthcare Teams Addressing Poverty and Determinants of Health event.

Dr. Ryan Meili, the Executive Director of Upstream and a family doctor in Saskatoon, shared his experience as both a doctor treating patients in inner city Saskatoon affected by poverty, and as an advocate for health equity. Dr. Cindy Forbes talked about her experiences in advocating for health equity as the President of the Canadian Medical Association. Dr. Barb Hamilton-Hinch provided local context to this global issue, by discussing the barriers to healthcare faced by the African Nova Scotian population. All three speakers had common themes in their work: the need for policy change, the importance of story sharing to drive impact, and of course, the priority of addressing the social determinants of health in healthcare.

Dr. Meili speaking at the Healthcare Teams Addressing Poverty and Determinants of Health event.

Dr. Meili sharing stories from his work with Upstream at the Healthcare Teams Addressing Poverty and Determinants of Health event.

Dr. Meili shared the story of one of his HIV-positive Aboriginal patients who was facing several barriers to proper healthcare access. “She’s not sick with HIV,” Dr. Meili said after introducing us to her story, which was initially puzzling. However, if you take a moment to ponder this statement, it makes a lot of sense. By listening to her story, we learned that his patient has been sick with poverty, historic marginalization, poor living conditions, low education and addictions throughout her life. These factors have contributed to her HIV infection, and subsequent difficulty accessing care. This way of thinking is the fundamental to addressing the social determinants of health, and to the upstream approach. For a refresher on the social determinants of health in Canada, see our blog post from January. To learn about the upstream approach, check out this video created by Upstream, where Dr. Meili acts as the Executive Director. Upstream thinking requires us to reframe the public discourse around addressing the social determinants of health. We should be focusing more resources on the things that have the greatest influence on our health, including income, education, housing and nutrition, rather than pouring our resources into the healthcare system down the line.

Dr. Cindy Forbes, President of the Canadian Medical Association, at the Healthcare Teams Addressing Poverty and Determinants of Health event.

Building a body of evidence, and sharing these findings are both important pieces to guiding policy change. But as Dr. Forbes noted “evidence doesn’t make people feel empathy.” Upstream also aims to share stories through a variety of media in order to creatively engage citizens, showing them they have a personal stake in the social determinants of health. Citizen engagement can lead to a political push for evidence-based, forward-looking policy innovations to address these determinants so people can live longer, fuller and healthier lives.

Dr. Hamilton-Hinch highlighted the importance of not only addressing policy change, but ensuring that power dynamics shift to reflect the diverse makeup of our Canadian population. Dr. Hamilton-Hinch is involved with PLANS (Promoting Leadership in Health for African Nova Scotians) at Dalhousie. PLANS seeks to improve health outcomes within the African Nova Scotian community (about 2.3% of the NS population), while creating mentoring and outreach opportunities. In order to facilitate access to healthcare for African Nova Scotians, Dr. Hamilton-Hinch discussed the need for change in our healthcare system. Change to the way healthcare professionals are educated by challenging curriculum, change to the way healthcare professionals practice in order to reflect cultural proficiency, and most importantly, change in the disparity between the small numbers of African Nova Scotian healthcare professionals and the much larger population they serve.

Dr. Barb Hamilton-Hinch of Dalhousie University, discussing the health of African Nova Scotians at the Healthcare Teams Addressing Poverty and Determinants of Health event.

The Global Health Office would like to thank Dr. Meili, Dr. Forbes and Dr. Hamilton-Hinch for sharing their stories with over 80 attendees. The stories you have shared will go on to impact the way that we approach our learning, practice and advocacy.

World Tuberculosis Day Part I – What is TB?

March 1, 2016 Maria Wilson Leave a Comment

The World Health Organization (WHO) has declared March 24, 2016 as World Tuberculosis (TB) Day [1]. Over the month of March, the Global Health Office will be publishing a series of blog posts about TB in hopes of raising awareness of its worldwide impact. WHO’s “End TB Strategy” has a goal of ending the TB epidemic by 2030, by targeting poverty, improving testing and treatment, ending stigma and discrimination, and driving research and innovation. Put simply, TB is not yet a disease of the past, but if we unite and focus our efforts, we can make TB history.

Tuberculosis (TB), caused by the bacillus Mycobacterium tuberculosis, is an airborne disease that primarily affects the lungs (pulmonary TB) [2]. This means that when people with pulmonary TB cough, sneeze or spit, TB bacteria are propelled into the air, giving them the potential to spread from person to person via inhalation. TB can affect other sites as well, including the brain, the kidneys and the bones [3]. An ancient disease, TB has affected humans for over 4,000 years [2].

In many cases, the immune system will fight off the TB bacteria, and no infection occurs. If the immune system is not able to completely fight off the bacteria, some inactive bacteria may stay in the body, leading to latent TB infection (no symptoms). If the immune system does not respond sufficiently, active TB infection occurs (TB disease), and symptoms begin to manifest [4]. People with latent TB infection cannot spread TB bacteria to others, but can go on to develop active TB over time. WHO estimates that about one-third of the world’s population is infected with latent TB [5]. Symptoms of TB disease include a persistent cough of 3 weeks or longer, pain in the chest, coughing up blood or sputum, weakness or fatigue, weight loss, loss of appetite, chills, fever and night sweats [6].

The burden of TB is mainly concentrated in low and middle income countries, where 95% of TB deaths occur. In 2014, there were 1.5 million TB deaths, and 9.6 million people developed TB disease [5]. TB is one of the leading causes of deaths from infectious diseases worldwide [7]. The map below, produced by WHO, shows estimated TB incidence rates, by country, in 2014.

Map of the world showing estimated TB incidence rates, by country, in 2014 (Source: World Health Organization).

This map provides a visual representation of the worldwide burden of TB, with the lowest rates in Western Europe, Canada, the United States of America, Australia and New Zealand. This has led to a common misperception in higher income countries that TB is a disease of the past. However, in many countries, including Lesotho, South Africa, Swaziland and Mozambique, rates are still above 500 cases per 100,000 population [7].

Keep reading our series of blog posts on TB to learn more about risk factors, diagnosis, treatment and much more.

Environmental Racism – January Global Health Rounds

January 26, 2016 Maria Wilson Leave a Comment

enrich-callout-to-support-bill-111-small

Photo credit: enrichproject.org

The first Global Health Rounds of 2016 took place on January 20^th in the Sir Charles Tupper Medical Building. 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.

January’s Rounds, led by Dr. Ingrid Waldron, was entitled “Race, Place & Waste: Exploring the Health Effects of Environmental Racism in African Nova Scotian & Mi’kmaw Communities.” Dr. Waldron discussed the Environmental Noxiousness, Racial Inequities and Community Health – or ENRICH – Project, which aims to better understand the effects of environmental racism in African Nova Scotian and Mi’kmaw communities, and to support their struggles against it. Dr. Waldron’s talk drew a crowd of more than forty students, faculty, health professionals and community members. We hope to see just as much enthusiasm for February Global Health Rounds: Health & Wellness of African Nova Scotians. Check out (and share) the Facebook event for more information, and to indicate your interest and plans to attend.

Some of the January Global Health Rounds attendees. We had to open a second room connected by video-conference because there were so many people!

What is Environmental Racism?

The first time I heard about environmental racism was in a 2013 article by Vice News about The Chemical Valley [1]. The Aamjiwnaang First Nations reserve near Sarnia, Ontario, home to about 850 Chippewa, sits surrounded by harmful chemical plants that produce gasoline and synthetic rubbers, among other materials. Why are these plants located next to a First Nations reserve, rather than in the midst of a middle class, primarily white neighbourhood? How do race and class shape where hazardous industries are located?

Dr. Waldron’s research in environmental racism seeks to answer these types of questions in Nova Scotia, while assessing the health impacts and working toward policy solutions. In Nova Scotia (and globally), there is a disparate location of hazardous industrial polluters in communities of colour, First Nations, in remote areas and among the working poor. The ENRICH project began with community consultations in the spring of 2012. Consultations took place in Yarmouth-Acadia First Nations, Eskasoni First Nation, Membertou First Nation, Lincolnville, and other affected communities. The concerns that were identified among these communities include (but are not limited to) fear of water and soil contamination, high rates of cancer, asthma and fetal anomalies and social nuisances such as loud noises, increased insects and mammals. Some women feel that their reproductive choices are limited, not wanting to expose a child to the aforementioned effects of environmental racism.

Dr. Waldron noted that environmental racism is an intersectional issue. Low income white communities also experience environmental racism, but their issues are often addressed more quickly. When there are multiple factors impacting the lack of power to be protected and heard (race, place and class) due to a history of forced displacement, social marginalization and destruction of culture and language, environmental racism worsens. Despite pushback from these communities who are affected by landfills and dangerous industries, there is a common response: in order to have grounds to remove them, there must be concrete, scientific proof that they are causing harm. The burden of this proof often falls on the communities, but it should be shifted to those responsible for environmental racism.

Bill 111

Communities experiencing the health and social impacts of environmental racism shouldn’t have to wait for 100% proof and validity to have their issues addressed. Dr. Waldron’s work, in collaboration with MLA Lenore Zann, culminated in presenting Bill 111, An Act to Address Environmental Racism, in the Nova Scotia Legislature.

In 2015, Bill 111 made it to second reading, but did not pass. Dr. Waldron is not discouraged, as the bill has introduced to the issue of environmental racism to many who were otherwise unaware. Bill 111 was featured in The Huffington Post, The Chronicle Herald, and is now on the record as being debated in the Nova Scotia Legislature [2]. She plans on introducing the bill again in the near future.

Future Directions

Dr. Waldron’s current work includes working with a dedicated team to develop an all-applicable Environmental Bill of Rights, stating that everyone has the right to clean air and clean water; the right to live, work, learn and play in healthy and sustainable places, among other standard rights that those impacted by environmental racism are not always afforded.

The Global Health Office would like to thank Dr. Waldron for her eye-opening talk about environmental racism, a pressing local and global health issue. To learn more about the ENRICH Project, you can visit their website [3].

International Electives: A Student Perspective

January 18, 2016 Maria Wilson Leave a Comment

PASADA, Area 1 (Photo: Braden Kingdon)

The deadline to apply for a 2016 summer Global Health Elective is February 5 at 4pm. These programs allow you to work on an interprofessional team with one of our international partner organizations, and to be mentored by a Dalhousie faculty member. These programs are available to students in Medicine (first & second year), Health Professions and Dentistry. We offer pre-departure training sessions for all students participating in international electives, and students complete in-country orientation. These elective opportunities (observerships) are available for the summer months in Tanzania, Ghana and Thailand.

The Tanzania Summer Program offers hands-on experience to learn about the Tanzanian healthcare system with our partner, Pastoral Activities and Services for People with AIDS Dar es Salaam Archdiocese (PASADA). While at PASADA, you’ll see an innovative community-based model for providing HIV and AIDS services, while working with highly-skilled Tanzanian staff.

Dalhousie student Braden Kingdon was a PASADA intern during the summer of 2015. In order to give you a better idea of what the PASADA internship entails, we asked him a few questions about his experience.

Bongoyo Island, 20 minute Ferry ride from Dar es Salaam (Photo: Braden Kingdon).

1. How did you hear about the PASADA internship?

The program manager at the time contacted me personally through email about the opportunity. I am President of the Recreation Department Society at Dalhousie; she requested that I spread the word through our program. After spreading the word and thinking hard about it, I decided to apply myself as well.

2. What was your role as an intern at PASADA? What projects did you work on?

I was a part of a wide range of projects while at PASADA. I was initially sent out there with the intent of working with children who were living with HIV/AIDS, running health and safety clinics. This all changed upon my arrival in Dar es Salaam. I was working with the children yes, but only on Tuesdays for half of the day. For most of the other days I was working in the Key Populations (KP) Department, we tested and treated people within the marginalized communities of men who have sex with men (MSM), female sex workers (FSW), and injection drug users (IDUs). The KP department team would travel out into the communities to meet people at their homes with a mobile clinic. While back from the community, in the office I was mainly doing research. I was helping the medical director at PASADA put his dissertation together for publication in the Tanzanian Journal of Health Research. While helping him, I was also developing a research proposal for PASADA to help gain some funding and further their understanding of the MSM community. This was done through focus groups, personal interviews, and questionnaires. The overarching goal was to keep pushing towards increases in access to healthcare for the MSM community in Tanzania.

3. Was pre-departure training helpful in enriching your experience in Tanzania?

I believe it was helpful in enriching my experience in Tanzania. The material covered in the training was great at outlining safety precautions and travelling tips. The cultural aspect was a brief overview of what I was to expect, but it did not prepare me for the vast difference in way of living. In my opinion, this portion of the experience must be gained from actual exposure to the culture; no book or story will truly prepare you for the greatness that is the Tanzanian culture.

4. What have you learned from your experience in Tanzania? Has this impacted your day to day in Halifax?

My experience in Tanzania has taught me about the importance of living in the moment. Growing up in Canada we are all driven on this straight path towards success, if you fall off it you are often considered a failure. My time in Tanzania opened my mind up to the journey as opposed to just the end goal. If I ever had a bad day, my colleagues would lift me up and make me realize that I can only change what I can control, everything else is not worth worrying about. This has definitely followed me back to Halifax. Without the stress of worrying about uncontrollable factors I am able to focus on the tasks at hand, while enjoying the journey through life.

5. Drawing on your experience partnering with PASADA through the Global Health Office, how would you define a successful partnership?

I would define a successful partnership as one that has continual open communication, trust, and a mutually beneficial outcome. This is definitely something I feel the Global Health Office and PASADA had throughout my internship. I was able to contact anyone from the Global Health Office while in Tanzania, and the team at PASADA was an exceptional group of hosts. From teaching me Kiswahili to taking me to the beach for a sunset, it was a successful partnership inside and outside the walls of the clinic.

6. What advice do you have for Dalhousie students who are interested in the PASADA internship program?

My first piece of advice would be definitely apply because it will be the best summer (or term) of your life! I would also advise them to leave any preconceptions in Canada, it is likely that everyday will be a surprise and different from the last. It is also important to conquer your fears while you are there. Especially if you are in my case and you are by yourself for a while. Leave your comfort zone and go outside, walk around the city, there is so much to do! I found great friends in the American Peace Corp group who is always in Tanzania, and travels through Dar es Salaam regularly. But, do not limit yourself to this group of people. The staff at PASADA is very friendly and love to have fun, go to the movies with them, go to the beach with them, all you have to do is ask.

Local fish and chips on the beach (Photo: Braden Kingdon).

Thank you to Braden for taking time out of his busy schedule to share his PASADA experience with all of us! Braden has also kindly offered to answer any further questions you may have about the internship and his experience via e-mail.

Interested in International Electives? You can find more information on our offerings, as well as apply online, on our website. Remember – the deadline to apply is February 5 at 4pm!

When One Door Closes, Another Door Opens: From the MDGs to the SDGs Part 2

December 20, 2015 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

SDGs-GlobalGoalsForSustainableDevelopment-05

As a follow-up to the MDGs, the UN has developed 17 Sustainable Development Goals (SDGs), which will come into effect on January 1 2016. As with the MDGs, each SDG has specific targets, which can be found on the UN website, and a set of indicators to measure progress, which will be finalized by March 2016. This ambitious agenda has been proposed to shape the policies and actions of UN member states through to 2030:

End poverty in all its forms everywhere
End hunger, achieve food security and improved nutrition and promote sustainable agriculture
Ensure healthy lives and promote well-being for all
Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
Achieve gender equality and empower all women and girls
Ensure access to water and sanitation for all
Ensure access to affordable, reliable, sustainable and modern energy for all
Promote inclusive and sustainable economic growth, employment and decent work for all
Build resilient infrastructure, promote sustainable industrialization and foster innovation
Reduce inequality within and among countries
Make cities inclusive, safe, resilient and sustainable
Ensure sustainable consumption and production patterns
Take urgent action to combat climate change and its impacts
Conserve and sustainably use the oceans, seas and marine resources
Sustainably manage forests, combat desertification, halt and reverse land degradation, halt biodiversity loss
Promote just, peaceful and inclusive societies
Revitalize the global partnership for sustainable development

What makes the SDGs different from the MDGs? The most obvious answer is that there are more than double the number of SDGs than there are MDGs, but there are more differences than just that! More SDGs translates to the UN being able to tackle a more broad range of issues related to development. The MDGs were grounded in anti-poverty, however, they often failed to address the root causes of poverty, opting instead to treat the symptoms. The SDGs aim to address the systemic issues that allow poverty to persist, including human rights, governance, peace and stability. The SDG targets also move beyond poverty, examining issues such as climate change and sustainable consumption, which will impact everyone, regardless of their socioeconomic status.

The MDGs were primarily developed by member countries of the Organization for Economic Co-operation and Development and donor agencies focusing their efforts on low and middle-income countries. The process for determining the MDGs barely involved those who were most affected by their targets. The SDGs, however, have come out of international negotiations where low and middle-income countries were granted input. Furthermore, the SDGs are regarded as universal, applying to all countries and actors, rather than creating a divide between “rich donors” and “poor recipients.”

More opportunities for partnership will (hopefully) be a product of, and a driver of, the SDGs. These include public-private partnerships, trade partnerships, global partnerships, local partnerships, and most importantly equitable partnerships. In order to meet the ambitious targets set out in the SDGs, a multidisciplinary and multi-stakeholder approach will be vital.

The MDGs are about to expire, and though there has been considerable progress made on many of the targets, there is still much work to be done. About 1 billion people still live on less than $1.25 per day worldwide, gender inequality persists as women worldwide continue to face discrimination in their everyday lives and over 800 million people still suffer from hunger. The SDGs hope to finish the job of the MDGs, and ensure that this time around, no one is left behind. Over the next 15 years, we are excited to see how the SDGs will impact global health, as health is a key outcome of development.

Photos from the Accessing Safe Deliveries in Tanzania (ASDIT) Research Project Launch

December 8, 2015 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

Monday November 23^rd marked the Halifax launch of the five-year Accessing Safe Deliveries in Tanzania (ASDIT) global health research project. Dalhousie University researchers will collaborate with partners from the Tanzanian Training Centre for International Health (TTCIH) and the Morogoro Regional Hospital in Tanzania to improve access to, and the performance of, emergency maternal care across the country.

The event was held in the newly renovated Tupper Commons. Speakers at the launch included Dean of the Dalhousie Faculty of Medicine Dr. David Anderson, Dr. John LeBlanc, who is leading the Dalhousie team and Zabron Abel of the TTCIH. You can read more about the ASDIT project, as well as Zabron’s time in Halifax, in our last blog post. For now, here are a few photographs from the research launch!

Dr. David Anderson giving opening remarks at the ASDIT launch.

Dr. John LeBlanc, Dalhousie ASDIT project lead, explaining the project outline and goals.

Zabron Abel representing the TTCIH, explaining his role within the ASDIT project (pictured with Said Msabaha of the Global Health Office and Dr. John LeBlanc).

Some of the ASDIT project launch attendees listening to Zabron Abel’s speech.

Members of the ASDIT project team (from left to right): Tanya Bilsbury, Marsha Campbell-Yeo, Doug MacMillan, Gail Tomblin Murphy, John LeBlanc, Heather Scott, Findlay Muir, Chris Wirz, Ron George, Zabron Abel, Shawna O’Hearn, Krista Mallory, Suzanne Sheffield and Chad O’Brien.

For more information on global health at Dalhousie University, check out our Facebook, Twitter, Instagram and Website.

Partnerships in Global Health: The Accessing Safe Deliveries in Tanzania (ASDIT) Project

December 1, 2015 Maria Wilson Leave a Comment

Zabron Abel of the TTCIH pictured on his last morning in Halifax (with snow on the cars).

By: Maria Wilson

Global Health Office Outreach Assistant

Funded by Global Affairs Canada, Canada’s International Development Research Centre (IDRC), and the Canadian Institutes of Health Research (CIHR), Dalhousie University is one of 20 teams of Canadian and African researchers, alongside African decision makers who will join forces to identify, test, and deliver life-saving interventions to secure the future of pregnant women and children.

Dalhousie University researchers are collaborating with partners from the Tanzanian Training Centre for International Health (TTCIH) and the Morgoro Regional Hospital in Tanzania. The 5-year project entitled “Accessing Safe Deliveries in Tanzania (ASDIT)” aims to improve access to, and the performance of, emergency maternal care across the country.

The team of Dalhousie University researchers is led by John LeBlanc and comprised of Doug McMillan, Heather Scott, Ron George, Marsha Campbell Yeo, Gail Tomblin Murphy and Shawna O’Hearn. The project has incredible support from Pat Rodee, Jennifer Morawiecki, and Chris Wirz with International Research and Development and Suzanne Sheffield at the Centre for Teaching and Learning.

TTCIH is a health training institution, established under a public-private partnership between the Ministry of Health and Social Welfare, the Novartis Foundation and the Swiss Tropical and Public Health Institute. The main goal of the TTCIH is to support the Tanzanian government’s national health reform policy for strengthening human resource development through providing quality health training, facilities and services.

Each month, the Global Health Office blog will be profiling one of our partners. We were fortunate enough to have Zabron Abel from TTCIH join us in Halifax for two weeks. I had the opportunity to have lunch with Zabron last week and asked him a few questions about the ASDIT project and his time in Halifax. I am including some of the information from our discussion, as well as from the launch of the ASDIT project on Monday November 23rd.

Could you briefly describe the history of the TTCIH?

TTCIH is the Tanzanian Training Centre for International Health located about eight hour drive from Dar es Salaam in a town called Ifakara. Established 50 years ago, TTCIH provides quality training programs, facilities and support services for the strengthening of human resource development in Tanzania

What is your role with the TTCIH?

I am the e-Learning and Marketing Manager which involves coordinating marketing, promoting the TTCIH and attracting new partnerships. The e-Learning part of my role includes designing, developing and delivering training using information and communications technology. We use these materials to train health workers in a variety of disciplines.

You have partnered with Dalhousie before. How would you describe your previous experience?

TTCIH has had a long-standing partnership with Dalhousie University since 2005. TTCIH believes that the driving force of success is partnership. There have been a number of successes in this partnership, including training through faculty development, microresearch, and hosting Dalhousie medical, nursing and pharmacy learners as part of their training.

Could you describe the current ASDIT project and your role within the project?

The ASDIT project is focused on maternal and newborn child health. The project aims to evaluate the scale up of a training program for emergency obstetrical and neonatal care in Tanzania. The training upgrades the skills of associate clinicians, midwives and nurses to perform emergency care. The project will explore the barriers and enabling factors to scaling up CEMONC which will assist in policy and planning at the regional and national level. My specific role is to provide post-training support and mentorship by creating e-learning resources for the health care team to use when they return to their rural clinics.

What is your favorite thing about Halifax, and Dalhousie University?

Halifax is a really cool city. The people are humble and there is not as much pressure as you see in bigger cities. As for Dalhousie University, I like the organization, faculty and programs.

Other than seeing snow (the last time Zabron visited was in the month of April so he didn’t get to experience Halifax in the winter), what are you excited for on this trip?

The TTCIH believes in partnerships, and I am excited to be able to explore more areas of partnership, and expand our current partnership with Dalhousie University.

Is there anything else you would like to add?

I would like to thank Dr. Pemba (Director of TTCIH) for his vision, and believing that partnerships are instrumental to success. He has been key in the success of both the TTCIH and myself. Dalhousie University should keep thinking of developing countries for open collaboration, partnerships, visibility and benefits for students on both sides.

Thank you to Zabron for having lunch with me (at Pete’s in the SUB – yum), participating in an interview, and for braving the cold to take a brief tour of Dalhousie upper campus.

Safe travels back to Tanzania, and hope to see you again in the future as the partnership between the TTCIH and Dalhousie University grows!

For more information on what we at the Dalhousie Global Health Office do, visit our Facebook, Twitter, Instagram or Website.

International Development Cooperation in Global Health – Global Health Rounds

November 24, 2015 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

November Global Health Rounds attendees.

The latest session of Global Health Rounds took place on November 18^th, 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.

A map of Mali for all the geography buffs, with the Koulikoro region pictured in green.

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!

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