Diarrhea deaths are falling but ORS use still stagnant

This was originally published on Global Health TV on October 28, 2015.

I’m grateful to Chelsea Clinton for her admission that she is “obsessed with diarrhea,” and her total lack of embarrassment in bringing it up repeatedly. In an interview with Fast Company, it was the first thing she wanted to talk about.

I’m grateful to her because she is, as far, as I know, the only well-known public figure to champion the prevention and treatment of diarrhea, the world’s second biggest killer of children under five years old, even though we have cheap and effective ways of dealing with it.

“It’s completely unacceptable that more than 750,000 children die every year because of severe dehydration due to diarrhea,” said Clinton last year. “I just think that’s unconscionable.”

We need more champions of the diarrhea issue.

Four years ago, I wrote a blog bemoaning the fact that oral rehydration therapy (ORT) seemed to be on life support, even though The Lancet once called it “the most important medical advance of the 20^th century.” ORT and its practical application, oral rehydration solution (ORS), have long been found to be both effective and cost-effective in treating the dehydration caused by diarrhea.

How does global health fare in the Sustainability Development Goals?

This originally appeared on Global Health TV on Sept. 28, 2015.

Last weekend in New York City, world leaders formally approved the Sustainability Development Goals (SDGs), which will guide development efforts over the next 15 years. They replace the Millennium Development Goals (MDGs) that were signed in 2000 and expire on Dec. 31, 2015.

The MDGs were terrific for global health, both in raising money, and raising its profile on the global agenda.

Eight goals made up the MDGs, and three of them were entirely focused on health. In addition, two other goals included health-related targets. Eight (38%) of the 21 total MDG targets were health-related, and seven of those targets were numerical (i.e. reduce maternal mortality by three quarters).

Between 2000 and 2014, $228 billion was allocated to address the three health-related MDGs, according to the Institute for Health Metrics and Evaluation (IHME) 

More importantly than how much was raised, serious progress was made on many of these health fronts. For example, two weeks ago, the World Health Organization announced that malaria death rates have plunged by 60% since 2000 and that the malaria target to have halted and begun to reverse the incidence of malaria by 2015 has been met “convincingly.” Most people think the Target 1A to halve the proportion of people living on less than $1.25 has been met.

But where is health in the SDGs? The answer to that question contains both good and bad news for global health advocates.

It's too soon to declare victory over Ebola

This was originally published at Global Health TV on Aug. 24, 2015.

There has been a welcome spate of good news coming out of West Africa in recent weeks on the apparent demise of Ebola, which has caused the region nothing but misery, illness (27,952 reported cases) and death (11,284 reported deaths) for over a year.

Ebola cases continue to fall. For the week ending Aug. 16, no new cases were reported in Liberia and Sierra Leone, for the first time, has gone one full week without any new cases. Guinea was the only country to report any new cases — but just three.

And The Lancet published “interim results” from research on the efficacy of an Ebola vaccine in Guinea showing a vaccine efficacy of 100%.

The news is undeniably good. In the last week, I read these headlines:

Associated Press: “UN official: Ebola epidemic could be defeated by end of 2015.”

Scientific American: “Does This Ebola Vaccine Herald the End of the Virus?”

National Public Radio: “Zero Ebola Cases Reported in Sierra Leone as Epidemic Peters Out”

This is all welcome news but if you go beyond the headlines you quickly realize that this epidemic is not yet over.

Global health funding: Huge increases since 2000, but also huge disparities

This was originally published on Global Health TV on July 27, 2015.

As the end of the era of the Millennium Development Goals (MDGs) (2000-2015) draws near, we who work in global health can look back with some satisfaction at the $228 billion that was allocated to address the three health-related MDGs during that time.

Although spending grew rapidly in the first ten years, it was stagnant between 2010 and 2014, and actually decreased by 1.6% between 2013 and 2014. Global health funding in 2014 amounted to $36 billion in 2014 (of which $1 billion was for Ebola).

That information comes from Financing Global Health 2014: Shifts in Funding as the MDG Era Closes, the annual report of global health funding published last month by the Institute for Health Metrics and Evaluation (IHME).

And two weeks ago, the Kaiser Family Foundation and UNAIDS issued a report that showed that although there was only a slight increase in funding for HIV in low- and middle-income countries in 2014 (less than 2%), seven of 14 donor countries actually decreased funding despite the recent gains made against the epidemic.

In Africa, gap between need and funding of mental health is huge

Adolescent boys in talk therapy group near Kampala, Uganda. Credit: StrongMinds

This was originally published on Global Health TV on June 29, 2015.

Sean Mayberry has spent his entire life surrounded by mental illness. As a child and an adult, people close to him have endured this affliction. But he had an epiphany when he happened upon a young man behind a farmhouse in Uganda, sitting in his own excrement and digging in the dirt.

“It was a turning point for me,” he recalls. “I left that young man knowing that I had to do something for the mental health of that continent.  He gave me the courage to try to make a difference for some of his mentally ill brothers and sisters.”

Pauline Muchina is dealing with mental illness in her family in Kenya. Her 50-something sister lost her job due to depression and had to come home to live with her mother. She is now on medication and attends counseling.

Muchina also has a nephew suffering from depression. While in a government hospital, he was chained to a bed for one week and his condition got worse. Now the family has found a private rehabilitation center for him. He is getting better but it is costing the family $2,500 for six months. Muchina’s family is middle-class and can pay the treatment (with difficulty), but the vast majority of Kenyans could never afford such expensive treatment.

Mental disorders and substance abuse are the third greatest contributor to the global burden of disability with 23% of the burden – greater than cardiovascular disease or cancer.

Women trying to regain dignity by ending fistula

Djantou

This blog was originally published on Global Health TV on May 27, 2015.

BAMAKO, Mali — Djantou came here from Fangala, her village northwest of Bamako, to repair her fistula, a hole between the birth canal and the bladder or rectum caused by prolonged, obstructed labor without adequate treatment. Djantou’s fistula occurred while she was in labor during her first pregnancy. Her child was stillborn. She wants to have children in the future but she is afraid — both of the operation and of childbirth. Djantou is 15 years old.

Rokia

Rokia is from the village of Tarasso, near the border with Burkina Faso. Twenty years ago, she also developed fistula during her first pregnancy. The baby was stillborn. “The urine would not stop,” she said. Rokia has had two operations but both failed. She is now awaiting her third operation. Although she is 40 years old, she still very much wants to have children.

Fistula is a tragic condition that leaves women leaking urine, feces or both. It can lead to chronic medical problems and cause social exclusion. Women are often abandoned by their husbands and sometimes by their own families because of their incontinence and unpleasant smell. They face depression and social isolation — either self-imposed or by their sometimes unforgiving communities.

New development goal falls short of protecting those most at risk of HIV

This ISHTAR wellness center in Nairobi works to ensure that gay men have access to non-discriminatory HIV and sexual health services. Credit: Corrie Wingate for the International HIV/AIDS Alliance.

This blog was originally published by The Huffington Post on May 8, 2015.

Dominique, 26, realized he was gay in his early adolescence and now sells sex to other men to survive and to support his relatives in Kisii, in western Kenya. He goes regularly to a drop-in center outside Nairobi run by the Kenya AIDS NGO Consortium (KANCO) where he gets a holistic package of HIV and sexual and reproductive health services.  As a result, he is HIV-negative.

Dominique is a good example of why we need to support people most vulnerable to HIV. Yet the language currently proposed in the Sustainable Development Goals (SDGs) falls short of prioritizing the most marginalized and vulnerable groups (the SDGs are the new development goals replacing the Millennium Development goals which expire later this year).

Goal 3 of the SDGs is to “ensure healthy lives and promote well-being for all ages.” Target 3.8 under this goal commits to Universal Health Coverage (UHC). Unfortunately, the UHC target and indicators do not meet the specific needs of the most marginalized, stigmatized and underserved people in the world — like men who have sex with men (who are 19 times more likely to contract HIV than the general population) and transgender women (who are up to 49 times more likely to acquire HIV than all adults of reproductive age).