Saturday, May 23, 2015

Outbreaks: A Natural or Manmade Disaster?

As a public health policy student, I spent the spring semester heavily entrenched in research on vaccination policies in California. During the Disneyland measles outbreak in December 2014, vaccines took over the media as more and more cases of measles arose. This outbreak was not a result of a lack of resources or access, but a manmade disaster. Despite education and availability, vaccination rates are dropping due to misinformed parents’ personal beliefs. The health community pondered why on earth, barring any health restriction, a parent would put their child at risk of a disease that is highly avoidable.

Upon arriving at the WHA68 for my first Assembly, this question buzzed in my head. Sitting in on the Polio Eradication Meeting with delegations from Cameroon, Chad, Equatorial New Guinea, Ethiopia, Kenya, Niger, Nigeria, and Somalia, I listened as these countries spoke of their accomplishments in vaccination programs. International NGOS such as GAVI the Vaccine Alliance, UNICEF, WHO, and a number of governments, including the United States, have invested vast funds into eradicating diseases such as polio. These countries pled for more aid to rid them of endemics that disproportionately jeopardize those born in developing countries.

Chad, Cameroon, Niger, and Nigeria all converge at Lake Chad, where the wild polio virus runs rampant. Polio does not respect borders; it travels fast and loose. When an outbreak occurs, these four countries scramble to contain the virus before it reaches other countries. While UNICEF and WHO committed to a five year campaign to end polio in this region, that’s five years that children in remote areas may be left vulnerable. 

Somalia urged the international community to help increase their vaccination coverage; right now it falls just under 50%. How is it that the United States, a developed country that prides itself on being the world’s superpower, posts similar vaccinations rates in some pockets of the country to that of a developing nation with such meager resources? 

If we do not increase vaccination efforts, we are intensifying the manmade disaster already created in the U.S. As public health practitioners, we need to follow Charlotte Whitton’s sage words that “when one must, one can.” We must, and can, protect the health of children worldwide, and in turn, the health of global society. 

Friday, May 22, 2015

Struggling to Wake Up

My espresso is still too hot as I force down an extra large gulp of the remaining brown, bitter liquid. I’m bleary eyed, grumpy, and curt with my classmate sitting across from me as we rush to write our blog posts before the caffeine wears off. Five marathon days and counting, and a growing sleep deficit has me on edge, but attending the World Health Assembly has been far from a chore. For many of us this will be one of the defining experiences of our graduate education in global health.

The aftermath of a 15 hour day at the WHA
Last night ended with four USC MPH students at a hip, smoky Swiss café, turning heads as we fumed over the reasons universal healthcare hasn’t happened yet in the US. “Solidarity is the common denominator,” I said, “we are too big, too diverse.” “You’re wrong, government mandated social programs are just too difficult to swallow for a country whose culture is synonymous with personal freedoms,” said my friend.

Earlier in the day I listened as one of my international classmates expressed frustration after seeing her own native country interact at the WHA. “Why does it seem like they have nothing to say, like everything is prepared and un-provocative,” she asked Douglas Webb of UNDP. “Remember that countries with the most to gain will always be the loudest, and those with the least to gain will be the quietest…think about what it would cost your country to implement any change,” he replied. It was a brilliant and deeply insightful response, one that forced all of us to look critically at our own countries’ interactions on the global playing field.

Later another classmate vented to me over the political barriers in global health; “it’s in everything, across all levels, how can anything ever get done…it makes me very worried about the future.” I tried to mollify her, saying that "politics have always been around, and that they do exist in everything, but look how far we’ve come." Her distress deeply affected me, and as the week has progressed I’ve seen other classmates uncharacteristically erupt in anger as their beliefs and perceptions were challenged.

An honest discussion with former US ambassador to Botswana

I think for many of us our idealized notions of the “real world” of global health were dispelled this week. Problems that seemed so black and white from the classroom showed their true shades of gray. We are all in public health because we are motivated by something more than personal gain – a desire to improve the wellbeing of others. It’s easy to think that desire is enough to ensure success, and that words such as scalability, sustainability, and equity are merely tools to be wielded. The WHA has shown me that these aren’t just tools, and that desire isn’t enough. Attending the WHA has been a wake up call - these problems affecting global health are hard, really hard, for many reasons that I can’t fully comprehend. I think it is that realization, the sheer magnitude and complexity of these problems, that has shook so many of us to our core. If we want to improve the wellbeing of others, we must be ready for a trek that is much longer and more strenuous than we all thought.

Profound Encounters with Global Leaders in Public Health

What an honor it has been to attend the 68th World Health Assembly! This past week has been exciting, overwhelming, hectic, and incredible all at the same time! When I think about my life 4 years ago, I would have never even fathomed this amazing opportunity. Four years ago my dream was to help people and change the world, and today I have the pleasure of meeting and listening to those who have and will change the world. The World Health Assembly and the diverse representation it attracts are some of the most passionate, influential, intelligent world leaders and delegates, changing the face of public health and how it is delivered on a global scale.

I feel so thankful to have this opportunity to sit next to and interact with these global leaders. In addition, my public health education and passion propels me into these critical conversations, enabling me to see my dream become a reality as I continue to grow and progress in this field. Although I am still a MPH student with much to learn and experience, I find this week incredibly useful in putting my life in perspective in terms of where I see my passion and work contributing to public health. As I listen to the wise words of those who have invested their lives in this field, and more importantly in the health and well-being of others, and scramble through agenda’s to pick panels and committees to attend, I begin to see more and more the direction my life is taking. This is a critical discovery, as we are all constantly trying to figure out who we are and what drives us, as well as what kind of purpose and impact our lives will have. I owe all my gratitude to my brilliant Professor Heather Wipfli, who works tirelessly to bring select students here every year and thrust them into the heart of public health and global diplomacy.

Here are a couple of experiences I want to highlight so far:

1. I met WHO Director General Margaret Chan (and I didn’t have to stalk her to do this)!

While I was waiting to meet my WHO internship adviser, I saw Margaret Chan interacting with people across the room. I couldn’t believe it (my heart jumped)! What’s even crazier is the moment I noticed her she started walking in my direction. After I passively moved out of her way, I realized I COULD NOT just let her walk by without saying something. So, naturally, I ran to the escalator she was about to get on and told her I couldn’t let her walk by without meeting her. The entire experience was so surreal, and she was just as nice and funny in person as she is in her speeches. This was an unforgettable and amazing moment, especially because of how strong and empowering Margaret Chan is. As a strong, brilliant, independent female leader, she is an invaluable voice for women all over the world. Throughout the assembly, she has constantly emphasized the importance of including women in health programs and decisions and the critical role of female leadership in society.

(MPH student Danielle Pappas with WHO Director-General Margaret Chan)

2. On Tuesday, we were fortunate enough to have the opportunity to meet with Dr. Michelle Funk

Dr. Funk is the coordinator of Mental Health Policy and Service Development, Human Rights and Legislation at the WHO. In this position, she created the WHO framework for providing technical support to countries in the areas of mental health, law, and human rights, with emphasis on how mental health services and policies are delivered. She also specializes in comorbid substance abuse and mental illness, as she works in the Department of Mental Health and Substance Abuse.
Dr. Funk eloquently discussed the critical issues of marginalization and discrimination of those with mental illness, leading to conflicts in human rights and the desperate need to invoke policy and community level action to ensure those with mental illness receive protected, effective, non-discriminatory treatment. In addition, the mere existence of treatment is not enough, as it needs to be of high quality and align with the rights-based approach to health (participation, non-discrimination, right to health, availability, acceptability, accessibility, quality, transparency, accountability).

Dr. Funk also highlighted the problems of mental illness stereotyping and the consequent reluctance of people to self-identify as mentally ill. We discussed how to devise solutions to these issues through tackling discrimination and working to ensure culturally appropriate and sensitive treatment towards the mentally ill. Overall, the crucial need to address mental health issues at a global level demands the fulfillment of non-discriminatory policies and the right to health.

I absolutely loved hearing from Dr. Funk because of my personal experiences with mental health/mental health law in my family, research, and volunteer experiences. Because I have a deep passion and commitment to mental health advocacy and improving health through the lens of law and human rights, meeting Dr.Funk and hearing her perspective on mental health was a dream come true!
(WHO Dr. Michelle Funk discusses mental health, law, and human rights with USC MPH students) 

Wednesday, May 20, 2015

Non-Communicable Diseases as a Development Priority, WHA68

The sixty-eighth World Health Assembly has put forth a great deal of panels and experts to address the global concern regarding Non-Communicable Diseases (NCDs). The message is becoming clear to countries that by acting now to not only treat, but to prevent NCDs, the economic advantages such as having a healthier and longer living workforce can materialize.

The challenge is in how to create innovative solutions to improving health systems in rich and poor countries, as well as the culture surrounding some of the goods that cause NCDs like tobacco and sugar. Service delivery in hospital-based health care systems is difficult compared to a primary care model. Countries may not have the economic toolkits to accurately tax the appropriate goods to fuel the models addressing NCDs. There is no one vehicle for funding NCD programs and a holistic approach to health and culture should be considered.

There are many important agenda items at this year’s World Health Assembly, and without an end to the Ebola crisis many health ministries in Africa may not have the capacity to prioritize NCDs. The global community has the opportunity to test the effectiveness of NCD programs across rich and poor countries to provide evidence based solutions for all Member States, so that when they need to access NCD models they are available. Governments need to be challenged and held accountable for their respective NCD issues in an increasingly urbanizing world.

Universal health coverage is one of the Sustainable Development Goals of 2015, and to fund this goal the health systems within nations must be sound. NCDs like hypertension and diabetes may not qualify as national security issues, but they can cripple the structure of a health system trying to sustain itself. Pre-payment health care plans can improve indicators and encourage people to get check-ups from their doctors and prevent NCDs. Technologies are improving and it is feasible to monitor and track the success of NCD programs. Viewing NCDs as a development issue will help convince governments to invest in models aiming to prevent chronic illness. Pay as you go health plans do not provide incentive to patients who could prevent serious illness by a few simple visits to their physician.

A one-size-fits-all approach will not be sufficient to address the global problem of NCDs. Every country has a different economy that will need a tailored model to tackle their respective NCDs. What is universal is the need for a variety of evidence based prevention programs that will ensure the capacity countries need to protect their people from NCDs. This is an exciting topic there is no better place to strike while the iron is hot than the sixty-eighth World Health Assembly.

Exchange With Global Health Leaders Inspires Career Choices

One aspect of our experiences at the 68th World Health Assembly so far has been to meet with brilliant global health leaders - and obtain career advice from them. And in that respect, we all own thanks to our professor Dr. Heather Wipfli, for her tremendous effort in not only having enabled these exchanges to happen which will clearly benefit the professional and personal life of ours beyond, but also in making sure everyone is immersed in that intense atmosphere and able to gather various pieces from people and discussion together that could guide our career path and choices as public health students.

For instance, on our second day at the WHA, we were honored to meet Cary Adams, Chief Executive Officer at the International Union Against Cancer (UICC). During his brief moment with us, Mr Adams spoke with passion and wit, and shared such hope as to see more rising talents – not necessarily with a title-matching CV, but with the dedication, flexibility and universal skill set that are desired by the arena of health. And it is indeed crucial for the health sector to embrace people from business, finances, social sciences, etc, before its instrumental role in almost all mankind activities can be recognized by multiple sectors. It is even more, for the mindset of corporates in terms of seeing public health as one of the many on their (limited) CSR budget versus an essential gene for the survival - to be re-programmed. Adam’s talk resonated with the idea that Dr Stefan Oschmann, Vice Chairman of Merck, stressed during Monday morning’s Panel speech on the booming role and crying need for Public-Private Partnerships in health at the InterContinental. To paraphrase from Oschmann – often people tend to perceive the private sector as greedy, profit-driven, governmentals as sluggish and slow-acting, and NGOs as publicity chasing. In the world of global health, however, all we need to do is break these ideological barriers and work side by side as human.

Another expert we had the chance to learn from yesterday was Dr Claudia Garcia-Moreno, leader at WHO on women and HIV/AIDS and on violence against women. She shared with us how she started as a physician, then developed a specialization in HIV/AIDS intervention in Africa leading to her particular interests in infected women and the cause, and ended up spending 25 years in Africa, Latin America and Asia working on women’s health and gender-based violence. As a champion for women’s rights and empowerment, and a role model for all of us, Dr Garcia-Moreno shared her opinion on how professional, strong and independent woman were often addressed: “people call me difficult which I couldn't understand. But I wouldn't have achieved what I did without that 'difficult part' of me. It now has become a compliment.” In addition, she encouraged us to secure fieldwork and exposures in middle/low income-countries before opting for a position at organizations such as WHO, and never to forget about or avert the real world happenstances/sufferings.

(Susan Hagos, Dr. laudia Garcia-Moreno)

(Dr. Claudia Garcia-Moreno, Sarah Truby, Danielle Pappas)

Last, I feel lucky to be on the USC delegation too! We work closely as a team. Each of these bright, young public health professionals brings in a unique approach/perspective to the discussion. And through the exchanging process we learn from one another, too, which completes and accelerates my overall learning experience!

More Sessions, Less Jetlag

WHA68 Day 2 started off with a powerful discussion at a breakfast meeting at the Intercontinental hotel in Geneva. The meeting a discussion on Transforming Global Health through Private-Public Partnership(PPP): from concept to impact. The Food Network must have been consulted for he menu that morning, the break fast menu was everything you would expect from a Five Star Hotel, and more. The first gentleman I had the opportunity of chatting with was one of the top administrators at Johnson's and Johnson's, and many other sits in the room were filled with movers and shakers in the business world. Some of the speakers included Seth Barkley (CEO GAVI), Khawar Mann (Managing Director, The Abraaj Group), Michel Sidibe (Executive Direcotr, UNAIDS). One of the most outstanding discussions were from a delegate from the South African team who explained the significance of PPP in setting up an Electronic Medical Record Systems in health Centers in South Africa and pointed out areas that the Public and Private Sectors stand to learn about each other.

This was Day One of my WHO Summer internship  with the Global Outbreak Alert and Response Network (GOARN) which my Supervisor recommended that I should have running concurrently with the WHA68. The morning meeting was informative and showed and insider's perspective of the Ebola outbreak. We later headed back to the Palais Des Nations for a technical briefing on the Ebola outbreak. The briefing addressed the need for WHO to better its structure and capacity to fulfill its mandate in emergency response. There was extensive discussion on status of and priorities of the Ebola crisis in West Africa. The speakers included ministers of countries affected by the crisis, responders and donors. The Director General gave opening remarks and one comment she made about discrepancy in what the media reports prompted the media to make noise that sounded like they were booing her. The DG gracefully carried on with her remarks. The politically correct finger-pointing  was very refreshing compared to some of the scripted policy readings we listened to on Day One.

The FCTC side event had a theme; Strengthening the synergy between WHA and the Conference of Parties (COP) organised by the degations of the Brazil, Panama, and Russian Federation. Speakers repeatedly reminded the audience that FCTC was the only treaty that WHO has drafted and put into practice since its existence. It's in that way considered the 'only child'. The speakers expressed that they were amazed at how the FCTC was being considered above legislation in most countries. The speakers expressed their concern that FCTC was no longer getting the attention it deserves to ensure that countries implement it. While at this event, my peers had an opportunity of attending an event with Koffi Annan and the Secretary General.

I found it much easier to interact with WHA delegates on Day Two. My Internship supervisor introduced me to WHO employees at WHA along with all other Global Health people we came across in the Serpentine bar. There was a significantly greater resilience within my peers with the schedule and activity at the WHA along with the jet-lag we had all been battling.

Below is a picture was taken at the Ebola WHO Technical Briefing.

Incredible Day In 68th WHA ! (For 19 May 2015)

      My 2nd day at the 68th World Health Assembly, I was excited to attend "Transforming Global Health through Public-Private Partnerships: from Concept to Impact." This gave me a brand new view of the collaborations between government, company and organizations (PPPs). Sustainable resources and the restructuring of finance systems and are required in order to implement PPPs.    
       The briefing on "Women and Health" was organized by delegations of 6 countries (Chile, India, etc.), and discussed the implementation of the policies of the Beijing Declaration and Platform for Action. This includes women's health and human rights, and issues such as equal access to resources, gender disparities and gender-based violence.
       The interesting thing is, I used to think human rights were just someone's ability to make a decision for them selves. Thus, I neglected the significant role that related-policies play in protecting human rights and creating pathways for individuals to have opportunities. I realized that disparities exist in access to health resources within different areas. The availability of health resources around me prevented me from realizing that opportunity is not equally distributed.