Key to reducing maternal mortality is to ensure that, when needed, women have access to emergency obstetric care, including the capacity to surgically deliver her baby. This point at times get lost with the justified focus on family planning, skilled birth attendants, and facility-based births. As I have highlighted on this blog before, the accessibility of safe surgery is poor in many developing countries and is likely limiting the availability of such life saving technologies.
In this past week’s lancet, there is another excellent study that points to the need for increased investment in surgical infrastructure. The metrics available to measure and monitor surgical availability is poor – no surprise – but the authors of a new study have used the availability pulse oximetry as a “proxy for adequacy of operating theatre equipment supply because of this scarcity in low-income settings, and because international organisations such as the World Federation of Societies of Anaesthesiologists (WFSA) and WHO regard it as essential for safe anaesthesia and surgery.” Sounds reasonable.
The estimated number of operating theatres ranged from 1·0 (95% CI 0·9–1·2) per 100 000 people in west sub-Saharan Africa to 25·1 (20·9–30·1) per 100000 in eastern Europe. High-income subregions all averaged more than 14 per 100000 people, whereas all low-income subregions, representing 2·2 billion people, had fewer than two theatres per 100 000. Pulse oximetry data from 54 countries suggested that around 77 700 (63 195–95 533) theatres worldwide (19·2% [15·2–23·9]) were not equipped with pulse oximeters.
Obviously, making a pulse oximetry machine available is not a perfect measure of the capacity to conduct safe surgery (interestingly, it turns out one can even purchase such machines on Amazon should one ever desire one). Surgery is complicated. Not only to you need some basic machines, but you also need a surgeon, anesthesia, a sterile environment, functioning equipment, a reliable blood supply and other items. But if basic equipment is not there, it suggests that the rest is also lacking. This study highlights how challenging, and different, addressing this health priority will be relative to simpler health interventions.
I just returned from an event at the New York Times building called Pneumonia’s Last Syrah – a social event to raise awareness of the problem of pneumonia which featured food, wine, and a beautiful photo exhibit. It was a lovely evening, so I must thank Mala Persaud from +gmmb for inviting me. We academics don’t get out nearly enough.
While at this meeting, I met a woman who formerly worked for a large global health organization and who now works in stand up comedy. I asked her if she had ever considered developing a whole stand up comedy routine about global health. She asked, is there really such thing as a good global health joke? Could we really laugh at disease and disability? Is global health funny?
It turns out, the “pairing” of Syrah and Pneumonia actually grew out of a global health joke once cracked by Eric Asimov, the New York Times wine critic, who once asked:
What’s the difference between a case of Syrah and a case of pneumonia? You can get rid of the pneumonia.
As a lecturer, I sometimes compare my lectures to a comedy routine. I prepare my talks, test a few lines each year on my students, and then once I find that something works I do it over, and over, and over, again. Sad to say it, but University professors are really just very bad stand up comics.
But this got me thinking, are there really global health jokes out there? If so, what is your favorite?Share on Facebook
Earlier this morning, Melinda Gates and others spoke of the importance of branding and marketing to help advance global health goals at the TEDxChange conference in New York City. Amnesty International, an organization that has understood this principle for a long time unveiled the following maternal death clock in New York City this morning:
Two hundred a thirty one women have died in childbirth since I went to work this morning – two in the time it took me to write this blog post. Tragic.Share on Facebook
Yes, Geneva has the World Health Organization, the Global Fund, GAVI and dozens of other global health organizations. Sure Seattle has the Gates Foundation and now the University of Washington – a new powerhouse in Global Health. Of course DC is where much of the power and money for US based Global Health flows. Yes, Boston has lots of fancy Universities and Schools of Public Health. But this week, this week New York City is the place to be if you are interested in Global Health. And that is where I will be.
I’ll be running around town taking advantage of the fact that bloggers are now considered “media” trying to cover a number of the UN Summit on the Millenium Development Goals. Here is where I will be:
- On Monday, I will be blogging live from the Bill and Melinda Gates Foundation organized TedxChange event starting at 11 a.m. EST.
- Also on Monday, I hope to be able to attend the Ministerial Roundtable on Achieving MDG4: Power of Vaccines and Partnerships To Reduce Deaths organized by the GAVI Alliance.
- On Monday night after I lecture in my Global Health Policy Class, I’ll be rushing off to attend the second half of the Pneumonia’s Last Syrah event organized as a part of World Pneumonia Day.
- On Tuesday, and part of the rest of the week, I’ll be attending the UN Week Digital Media Lounge, organized by the UN Foundation, Mashable and the 92 Y.
- On Tuesday afternoon, I will also be giving a guest lecture at Weil Cornell Medical School on the role of donors and the international community in influencing Global Health priorities. I don’t think this is open to the public.
- Tuesday evening, I will be attending a Tweet-up called ICTinNYC.
- Wednesday, I will be attending an MDG Side Event called “AIDS plus MDGs: Delivering Results towards Shared Commitments”, hosted by UNAIDS.
It is therefore very surprising for me to to learn that this exact area of Connecticut was once the site of a terrible outbreak of malaria that once afflicted thousands. In the late eighteenth century, a man by the name of Elijah Boardman, who eventually became a prominent business man in the town of New Milord (where I regularly visit the excellent Saturday morning farmers’ market), had once been a soldier in the Revolutionary War. When he returned to his home town after the war, he brought with him more than just some bad memories – he also brought some malaria parasites that continued to stream through his veins for years.
After this return home, the Housatonic River, which happened to run through the backyard of the now wealthy Boardman’s mansion in New Milford, was dammed to help generate energy for the expanding industrial base of the region. Soon after the banks of the river were raised, thousands, including Boardman’s own wife and son, fell seriously ill with malaria. The outbreak came and went for years and eventually took the lives of hundreds of people spreading throughout this area of New England. Litchfield County and the Berkshires were no longer known as areas where people went to relax, it was known as a place to get sick from malaria.
This story is just one of the really fascinating stories author Sonia Shah describes in her new – and excellent – book “The Fever“. In this well researched book, Shah chronicles how malaria, which is currently experiencing a resurgence of attention from the global health community, in her words “ruled humanity for 500,000 years”.
I’ve always been a big fan of historical accounts of the interplay of infectious diseases and humanity, but when I think of the diseases that have really radically shaped society through geopolitical struggles, malaria is not on the top of my list. I tend to think first about smallpox, measles, the plague, and now HIV. But Shah chronicles a long history of how plasmodium influenced the world, like how the development of partial immunity against malaria helped provide an advantage to the Bantu-speaking people of Africa allowing them to spread across the continent and forcing their rivals to the peripheral regions. Or how even as recently as WWII, malaria had played a role in weakening armies which led to the Japanese army employing elderly women as “net tuckers” to tuck bed nets around soldiers on the front lines at night.
In one chapter, Shah provides a nearly comical account of the “Global” Eradication program launched by the World Health Organization in the mid 1950s. In retrospect it is always easy to mock the failures of a program as ambitious as this program, such as the irony of trying to eradicate malaria globally without even addressing Africa, but it does make you wonder why there had been such devotion from so many players who should have known better. It also raises some important questions as the international community begins to whole heartedly embark on another effort to eradicate this disease. She also comes down hard on what she sees as the over zealous advocates who are over relying on bed nets to eliminate malaria. Go big or go home, Shah argues. I tend to agree.
In perhaps my favorite chapter of the book, titled the “Karma of Malaria”, Shah raises and attempts to answer a very important question. Why does a disease that has the potential to kill so many people not invoke the same level of fear in people living in malarious areas that it does to us outsiders? She argues that when one lives around malaria one develops a very different attitude to the disease, it becomes part of life, and we need to take this into consideration when developing programs to address the disease. In one memorable story she asserts that in some areas, if a child presents with fever and receives a positive test for malaria it might actually be welcomed – it means the child is not sick with something more serious!
I liked this book – a lot – but some people might find some aspects of her book hard to accept, such as description of a malaria control manager from Panama who only tends to get excited about malaria when donors are around to impress, or her critique of the Western donor communities over reliance on bed nets. I can’t judge the validity of all of her claims, and was frequently irked at some of the generalizations she makes, but overall I think this is an excellent book to add to your global health reading list.
This month’s Malaria Journal has published the findings of a survey of bednet ownership, use and quality conducted in Western Kenya (h/t to @bbbrieger for flagging it). The results may be a depressing to those who are strong believers in the importance of insecticide treated bed nets in the fight against malaria.
The author find:
“Of the 670 households surveyed, 95% owned at least one net.”
Wow, great news. But then they go on:
“Only 59% of household residents slept under a net during the night prior to the survey. 77% of those who slept under a net used an insecticide-treated net (ITN) or long-lasting insecticide-treated nets (LLIN). Out of 1,627 nets in the survey households, 40% were deemed to be of poor quality because of holes. Compared to other age groups, children aged 5-14 years were most likely to have slept under nets of poor quality (odds ratio 1.41; p= 0.007).”
The large discrepancy between ownership and use has been documented elsewhere, but there has been much less documentation of the low quality of the bednets. I am sure that sleeping under a bednet with a hole is probably still better than not sleeping under a bednet, but it does raise one more important issue that must be dealt with when so much focus has been given to bednets for the control of malaria.Share on Facebook