Reflections from Paul Rusesabagina 20 Years After the Rwandan Genocide

April 7, 1994 is the date recognized by the international community as the beginning of the Rwandan Genocide.

During his lecture on March 27th at the Rackham Auditorium, Paul Rusesabagina shared why the anniversary of the atrocities is for him, and many other Rwandans and Ugandans, October 1, 1990.  This is the date that exiled Tutsis returned to Rwanda and began killing Hutu civilians, leaving 1 million people in refugee camps.  In 1993, a Hutu president was elected in the neighboring country of Burundi but he was assassinated by Tutsi soldiers.  Following the assassination, a peace agreement was signed by the Hutu government and Tutsi rebels and 2500 UN soldiers were placed in the capital city Kigali. Mr. Rusesabagina said that people who thought the genocide came and disappeared at specific points are mislead and misinformed; there were signs that genocide was occurring and that is was going to continue prior to April 7, 1994.

 

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Reverse Innovation — Hashtags of the Week (HOTW): (Week of March 31, 2014)

Ethnic Box

Reverse innovation is a concept I’ve been tracking closely recently, and which is critical in global health. The idea, in health anyway, is that we have as much to learn from developing nations as they have to learn from us. I heard a story of a visiting faculty member here from Ghana who saved a baby’s life because he knew how to manually reposition babies in the womb during delivery when there isn’t enough time to get the machines that are sometimes used here for the same purpose. That’s just one small, local example. Last week’s Twitter chat on reverse innovation brought up several others. You can find the complete chat and cited articles in this Storify:

Do low-income countries hold the key to health innovation?: https://storify.com/pfanderson/do-low-income-countries-hold-the-key-to-health-inn

Here are a few selected tweets from the chat.

World Water Day 2014: U.N. Focuses Energy on Energy

Today is World Water Day 2014, and the United Nations has chosen to emphasize the link between water and energy. This was surprising to me, because looking at the Millennium Development Goals (developed in 2000), there were no goals specifically related to energy usage or even the mention of global warming. When I think about international development/global health and water, I first think of the prevention of communicable diseases (cholera, guinea worm, etc.) and access to clean drinking water, which are addressed as part of the MDG goals. The United Nation’s reminder is timely and important:

 ”WATER REQUIRES ENERGY AND ENERGY REQUIRES WATER

In the last year, I have gained a better understanding about the successes and the limitations of the Millennium Development Goals, and today’s celebration is a further revelation for me:energy and climate change were completely left out in 2000 as international development goals, even though they are absolutely determinants for the future of people’s health globally. I wonder if the SDGs will tackle the issues of energy, climate change and water?

For more (incredibly timely) information, please check out UNWater’s World Water Development Report, which was released YESTERDAY, 3/21/2014.

ASB @NLM Part 2: Health Without Boundaries-Rethinking Global and Domestic Health Lecture

Being on the NIH campus afforded me some very unique opportunities with regard to access to the NIH Video Cast Archives.  Many of the video casts on the site are available to any interested party but some have location and IP address restrictions.  While on the NIH campus, I was able to view a lecture from the Department of Health and Human Services Secretary’s Global Health Lecture Series by Dr. Julio Frenk, Dean of the Harvard School of Public Health, on Health Without Boundaries: Rethinking Global and Domestic Health.  Much of the lecture’s content comes from a March 2013 article in the New England Journal of Medicine, Governance Challenges in Global Health.   He was a really engaging speaker, and had one of the best Prezi presentations I have seen in a long time, and the material presented challenged public health officials as well as the average Joe or Jane global citizen to reconsider the distinction between the terms global and domestic.

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Global Health and International Day of Happiness: 3/20 2014

      From my perspective, happiness is undeniably a  global health issue, because of the strong evidence for the connection between mental health and well-being and physical health. As many people know, the effect runs both directions; physical health challenges can be taxing emotionally, and mental health stresses can take a toll on your physical health.

       This connection has consequences and implications for global development practitioners, because individuals and communities must be mentally and physically healthy to be able to benefit in the full measure from development initiatives designed to reduce poverty and improve peoples’ lives. This is why it is so important to consider global health from a holistic perspective, taking into account the real and profound connection between mind and body, and the importance of happiness.

       Today’s  International Day of Happiness, first observed in 2012, is a reminder to us that experts in global health, international development and human rights at the highest level recognize happiness as a, “fundamental human goal” and a core objective of international development and peace-building. But to me, the United Nation’s work to establish this day is essentially officially affirming something that most of us already know and believe. Is there hope for a “happiness” indicator in the suite of Post-2015 Sustainable Development Goals, I wonder?

So, what makes people happy?

“Happiness may have different meanings for different people. But we can all agree that it means working to end conflict, poverty and other unfortunate conditions in which so many of our fellow human beings live.”

Secretary-General Ban Ki-moon

Message for the International Day of Happiness, 20 March 2014

       I would agree with Ban Ki-moon in the most literal interpretation of his message; for me, working to end conflict, poverty and to promote health in my career is what I believe will ultimately lead to satisfaction and happiness for me. In a broader interpretation, I also agree that this work, undertaken and approached by committed people in a multitude of professional fields (informationists, lawyers, medical professionals, teachers, social workers, human rights advocates, peace organizers, public officials, etc.) will lead to happiness for our fellow human beings all over the world.

       If you need further inspiration, and by some chance you have not experienced the pop-culture Pharrell “Happy” phenomenon, check out the world’s first 24-hour, interactive music video. Tap your toes. Maybe even join in the dance party. Global happiness starts with you.

A Global Policy Perspectives Talk by Paul Rusesabagina: March 27th @ 4:30 PM Rackham Auditorium

On Thursday March 27th, Paul Rusesabagina will be giving a Global Policy Perspectives talk commemorating the 20th Anniversary of the Rwandan Genocide.  Mr. Rusesabagina’s heroic acts during the genocide were captured in the 2004 film, Hotel Rwanda, with Don Cheadle earning an Academy Award nomination for best actor for his portrayal of Mr. Rusesabagina.  Mr. Rusesabagina is the 2005 recipient of the University of Michigan’s Wallenberg Medal.

20th Anniversary of the Rwandan Genocide Lecture Flyer

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Polio Eradication: Shooting for Zero but coming up a bit short

This TED Talk by Bruce Aylward is from 2011 when he was serving as the head of the Global Polio Eradication Initiative (GPEI).  Today, Dr. Aylward is still focused on polio eradication as the Assistant Director-General for Polio, Emergencies and Country Collaboration “which brings together WHO’s work in polio eradication, humanitarian response and country cooperation”. In his talk, he speaks passionately about why we should focus on making “the scientific miracle of this decade… the eradication of polio”.  Numbers have decreased, to be sure, but polio pushed back hard in 2013 and eradication was not accomplished this year.  But global health officials are confident it will be soon, importantly cases of polio have decreased in Afghanistan and Nigeria.  Additionally, for the first time in history, there have only been reported cases of one type of polio (for comparison, type 2 polio was last seen in 1999 and type 3 polio last seen in 2012).

Polio outbreaks in the Horn of Africa and Syria surpassed the number of cases reported in 2012 (223 cases).  The World Health Organization launched a polio vaccination campaign in the Middle East, particularly Syria, in November 2013.

UNICEF spokesperson Marixie Mercado said that inside Syria, the biggest challenge the agency and its partners were facing is how to reach children who have not been vaccinated over the previous two years because they are in areas where violence is taking place and there is limited or no access. (UN News Center article)

The Global Polio Eradication Initiative has laid out four objectives for the Polio Eradication and Endgame Strategic Plan 2013–2018 .

1. Detect and interrupt all poliovirus transmission.

2. Strengthen immunization systems and withdraw oral polio vaccine

3. Contain poliovirus and certify interruption of transmission

4. Plan polio’s legacy.

GPEI is not alone in their goal of eradication.  The Bill and Melinda Gates Foundation is another leader in the battle to eradicate this debilitating disease.  Working to end the spread of polio helps fulfill the 5th United National Millennium Development Goal: Combat HIV/AIDS, Malaria, and other Diseases.   For more information about the UN Millennium Develop Goals, please go to the extensive library research guide curated by School of Public Health student Alyssa Mouton.

 

Global & Health Equity Education

The Chronicle of Higher Education published a timely article, “Some Health Programs Overseas Let Students Do Too Much, Too Soon”, about the ethics of undergraduate health science field students and their clinical experiences abroad.  The article raises concern about the ethics of treating patients before certification, especially at-risk populations, and the global health spectrum of care providing services.  Students write about their clinical experiences abroad in their medical school applications, causing concern for educators and global health practitioners.

Far too often, experts say, students are providing patient care—conducting examinations, suturing wounds, even delivering babies—for which they have little or no training. Indeed, as competition intensifies for medical-school slots, some students may actually be going overseas for hands-on experience they could not get in the United States, in hopes of giving their applications a competitive edge.

Instead, they could be putting their own health and that of foreign patients at risk, and putting colleges and study-abroad providers at risk of legal liability.

And they may end up hurting, not helping, their graduate applications, because many medical, dental, and nursing schools view such behavior as unethical and irresponsible. (Chronicle of Higher Education, 2013)

Non-profit organizations which support global health community projects, such as Child Family Health International, have seen a rise in applicants hoping to treat patients during their experience.  CFHI Executive Director Dr. Chris Evert says “professional schools need to become better aware of the problem” of unprepared students’ engaging in patient care abroad, and also recommends that “such activities will count against applicants”, stressing that professional schools have to make it clear that this practice is unacceptable (Chronicle of Higher Education) .

The University of Minnesota’s efforts to dissuade unlicensed students practicing on patients overseas is highlighted in the article.  The University of Minnesota’s Academic Health Center created a course to guide their students participating in health sciences focused study abroad programs about medically ethic practices to protect patients and themselves.  The online workshop “Global Ambassadors for Patient Safety” is available  free of charge to students from other campuses.

GlobalREACH Banner

GlobalREACH Banner (2013) from http://globalreach.med.umich.edu/

The University of Michigan Medical School supports a model of bidirectional practice in its global health initiatives and programs.  The GlobalREACH  program supports educational services for UMMS students, M1-M4, who want to participate in an international experience. GlobalREACH activities include students designing international experiences for their M1 summer or choosing to conduct health-related research with U-M faculty and international partners while in Ann Arbor through the Summer Biomedical Research Program (SBRP).

Opportunities facilitated through GlobalREACH include participating in an M4 clinical elective at an international partner institute or overseas research elective or applying to participate in  Global Health and Disparities Path of Excellence.  This co-curricular program was created to “provide students an opportunity to integrate foundational, investigative, and experiential learning to become agents of sustainable change to reduce domestic and global health disparities” (http://globalreach.med.umich.edu/education/students/ghd).    The second Path of Excellence to be made available to UMMS students will be Medical Ethics (website under construction).

If you have specific information resource questions about global health, I’d encourage you to visit the Global Health and Disparities Path of Excellence Information Resource Starter Kit created by Taubman Health Sciences Informationist Gupreet Rana.

New Report: The Global Burden of Disease & the State of US Health

The Institute for Health Metrics and Evaluation (IHME) at the University of Washington has recently released a new report, The State of US Health: Innovations, Insights, and Recommendations from the Global Burden of Disease Study

Significant changes in life expectancy by county, The State of US Health: Innovations, Insights, and Recommendations from the Global Burden of Disease Study page 40, CC BY NC ND 3.0

Significant changes in life expectancy by county, from The State of US Health: Innovations, Insights, and Recommendations from the Global Burden of Disease Study page 40, CC BY NC ND 3.0

“The Global Burden of Disease (GBD) approach…is a systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geography.” The IHME report is based on seven papers from the Global Burden of Diseases, Injuries, and Risk Factors study (2010) that appeared in The Lancet and American results from the July 2013 issue of the Journal of the American Medical Association.

IHME also has a complementary report on GBD evidence to guide policy.

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A tip of the hat to Patricia, for telling me about this publication.

July 11 is World Population Day

According to the World Bank’s Health Nutrition and Population Data and Statistics, the world’s total population in 1960 was 3,036,764,705.0.  In 2012, it was 7,046,368,812.5 and it is estimated to increase to over 9 billion by 2050.

Today, the United Nations marks World Population Day.   All aspects of our the well-being are impacted by population growth – from child survival, poverty, education, finances, infrastructure, to  natural resources – just to name a few.  For an enlightening and engaging commentary on the impact of population growth, check out Hans Rosling’s TEDTalk “Global population growth, box by box”.  

This year, the World Population Day theme being highlighted is the issue of adolescent pregnancy.  According to UN Secretary-General Ban Ki-moon, “[w]hen we devote attention and resources to the education, health and wellbeing of adolescent girls, they will become an even greater force for positive change in society that will have an impact for generations to come. On this World Population Day, let us pledge to support adolescent girls to realize their potential and contribute to our shared future.”(Source: http://www.un.org/en/events/populationday/)