Teaching brain surgery in Africa: Compelling book reveals neglected area of health

Dilan Ellegala (left), the central character in "A Surgeon in the Village," supervising brain surgery in Tanzania. Photo: Tony Bartelme

This was originally published on Global Health TV on August 3, 2017.

“In early 2010 Bill Hawkins, then executive editor of the Post and Courier in Charleston, South Carolina, told me, ‘I met this crazy brain surgeon who opened a guy’s head with a wire saw in Africa. Check him out. Maybe we’ll send you to Tanzania.’ Not many reporters get such an invitation, but thanks to Bill, I was soon on my way.’”

So writes Tony Bartelme in “A Surgeon in the Village: An American Doctor Teaches Brain Surgery in Africa,” an informative and highly engaging book about a neglected area of global health – the dearth of surgeons in low- and middle-income countries. The book, published in March, is based on hundreds of hours of interviews that the author conducted in the U.S. and during five trips to Tanzania between 2010 and 2015.

When I started reading this book, I approached it as an obligation – something I had to do to inform myself, and possibly my readers, about an area of global health I knew nothing about.

But to my great surprise, I not only found it informative, I enjoyed it. The book is written in short chapters and in more of a novelistic style than most pieces of non-fiction. What I thought would be a chore turned into a pleasure. Perhaps that is because Bartelme is an experienced journalist who knows how to tell a good yarn.

Health workers, facilities under attack in 23 nations; UN accused of inaction

This hospital was damaged by clashes during a 79-day curfew from late 2015 to early 2016 in the city of Cizre in southeastern Turkey. Photo: Physicians for Human Rights.

This was originally published on Global Health TV on May 23, 2017.

In 2012, two Pakistani health workers were out vaccinating children against polio when they were both shot by extremists. One of them died. The other, shot in the leg, had 11 metal rods inserted into his leg and was hospitalized for three months.

In November, I met this remarkable man named Latif (his surname is withheld to protect his security). He is now fully recovered and back to work on the polio vaccination campaign. He told me he never considered giving up. Pakistan reported only two cases of wild poliovirus in 2017 as of May 17 and Latif is determined to see the polio campaign through to the end.

The attack on Latif is only one example of a tragic phenomenon that is not getting better – violence against heath workers and health facilities. In 2016, the extent and intensity of such violence “remained alarmingly high,” according to a new report released by the Safeguarding Health in Conflict Coalition.” The report also found that accountability for committing these attacks remains inadequate or non-existent.

The violence isn’t always perpetrated by terrorists. Sometimes it is committed by the police or the country’s military — institutions that should be ensuring tranquility.

A long, hard road to reversing the stagnation of family planning in Nigeria

DKT Bee Lydia, a community health worker, gives Iya Lekan a Sayana Press injectable contraceptive at her house. She has five children and does not want any more, at least for now.

This was originally published on Global Health TV on September 27, 2016.

LAGOS, Nigeria — Lydia, a community health worker for DKT Nigeria, steps carefully as she navigates the grimy streets of Makoko, one of the worst slums of Lagos. She is trying to avoid mud or something worse. The sanitation is abysmal. But Lydia is on a mission — to bring contraception to some of the most disadvantaged women in Nigeria.

This day, she calls on Iya Lekan. Although neither Iya, 36 years old, or her husband have regular work or specific sources of income, they have five children to look after.

“I don’t know how many times I have given birth,” she says in Yoruba, the local language here. “I’m tired.”

Iya told Lydia she was ready to start practicing family planning. Lydia presented various options, and Iya chose a three-month injectable called Sayana Press. Lydia immediately gave her the injection in her upper thigh.

Some people think Sayana Press could be a game-changer. It’s a new version of the well-known Depo-Provera injectable contraceptive, but contains 30% less of the active ingredient and can be administered by lesser-skilled health workers. The United Kingdom has already approved it for self-injection.

Last month, I spent an afternoon with Lydia, a member of the DKT Bees, a group of community health workers (CHWs) who focus on family planning in some of the grittiest parts of Lagos. DKT calls their CHWs “bees” because they are like the hard-working insects that go from flower to flower spreading pollen. But instead of pollen, DKT Bees go house to house counseling, educating and dispensing contraceptives.

The road to greater contraceptive use in Nigeria has not been smooth. It’s shocking that the percentage of married women using modern contraception in Nigeria is only 9.8 percent (Nigeria Demographic & Health Survey 2013). That figure is lower than all countries in West Africa except Gambia, Guinea and Mauritania, according to the 2016 World Population Data Sheet, and has has hardly changed in the last ten years. Nigeria has a population of 187 million, making it the seventh largest country on earth. If current trends continue, it will be tied for third, with the United States, in 2050.

Ebola makes the definitive case for health workers and strong health systems

This blog was originally published by Global Health TV on Nov. 25, 2014.

Since I first wrote about Ebola here at Global Health TV two months ago, the number of Ebola deaths has more than doubled, to 5,459, and the number infected has reached 15,351, according to the World Health Organization. Ebola has caused countless angst and affliction, mostly in West Africa but also in Spain and the U.S.

But there is one good thing that Ebola has done: It has made the case for strengthening health systems and frontline health workers more effectively than we in global health have been able to do. It has shown that weaknesses in health systems in poorer countries can affect people in richer countries. It has made that case not only to the global health community, but to the entire world.

“Weaknesses in West Africa’s health systems do not affect just West Africa – they affect us all,” said Pape Gaye, president and CEO of IntraHealth International, in testimony to the U.S. Senate Appropriations Committee on Nov. 12. “Ebola, HIV and other viruses and infectious diseases do not respect borders. Globally, our countries’ health systems are interconnected, creating one global interdependent health system. Today, that system is woefully precarious.”

Years of investments put health workers on global stage

Two midwives in a low-income area of Jakarta, Indonesia that are part
of DKT's "Andalan" social franchising network.

This article was originally published in The Huffington Post on Sept. 23, 2013.

For almost 10 years, I managed health programs in Africa, Asia, and South America that harnessed social marketing techniques to produce tangible benefits for poor consumers. Our programs made low-cost products such as condoms, contraceptives, and oral rehydration salts available at reduced, affordable prices. We worked mostly through the private sector and were proud of our bottom-line health impact. We didn't think much about underlying health systems or how to improve them. And if we had, we probably would have dismissed health system strengthening as overly ambitious.

But I've been thinking more about health systems lately, as I have seen governments and their nongovernmental partners carefully and patiently nurse ailing systems to health. The payoffs are not immediate -- far from it -- but as we move away from the segmented solutions to global health that prevailed in the 2000s (such as in the cases of AIDS and malaria) and toward greater country ownership, there is a growing consensus that we need stronger health systems to make sustainable improvements in global health.

This means more, better trained, and better managed frontline health workers -- the backbone of health systems.

I've heard that mantra for the last few years but, in 2012 and 2013, I saw it play out repeatedly as I traveled to very different countries in Africa, Asia, and Latin America: