I was in the frenetic Nicaraguan capital of Managua. Managua is a compromise city, chosen as the capital as Leon and Granada couldn't agree to the other's capitalhood. It is sprawling and fastpaced, with pockets of avarice and destitution. I had been wandering through some bad neighborhoods, on my way to check out some 5,000 year old footprints encased in volcanic mud and precariously located in one of the worst neighborhoods in the capital.
On my arrival back uptown, I noticed a tent city on the side of the road.
Curious, I walked over because it seemed a little out of place in the Metro Centro shopping district and next to the jug-like roofed Nuevo Catedral. As I passed, I saw a sign that floored me with irony and truly caught my interest.
A "wall" of a tent structure was constructed from an advertisement for a fancy christmas dinner at the fancy Hilton Hotel. The richness of irony was profound.
I began chatting with the residents of this tent city, and snapping a few pics of the fellows sitting on tree stumps.
As they began telling me their story, I had my eureka moment. This was my public health apotheosis and the singular most apropos moment of my journey. The tent city was a protest city, a public health protest against the Flor de Caña company by the workers of their San Antonio factory for the public health degradation that they had experienced.
I sat with the gentlemen in the warm afternoon as grey clouds shielded us from the afternoon sun. Gustavo Martinez, the vice president of ANAIRC- the organization representing the workers affected and now suffering from chronic kidney disease due to the chemicals used in the Flor de Caña distillery and factory.
Vice President Martinez shared with me the information on the workers situation, which I will now share as well. The former workers in the Flor de Caña had left their homes in San Antonio to bring attention to the fact that Flor de Caña and its parent group Pellas had been using pesticides that had contaminated the water supply in the western region of Nicaragua. The former workers mentioned that the company had harmed the regional environment by burning vast tracks of land as well as using agrochemicals that had contributed to the poor health of thousands of former workers. Mr. Martinez also mentioned that these pollutants that had entered the water supply and had caused the deaths of nearly 3,500 people. Many former factory workers as well as those in the region were suffering from chronic kidney failure due to the chemicals in the polluted water.
They had been living just under the shadow of the giant Flor de Caña sign in the middle of the city to bring attention to their plight and raise awareness for the ongoing difficulties faced by those in the region. The former workers had left San Antonio and had been living in the protest tent city, trying to gain a meeting with the government so they could have a hearing on the situation. They had been living in the tent city- constructed from tree branches, thick garbage bags and various signs, for more than ten months. Vice President Martinez said the group was fighting for their loved ones and their children who are now so sick from the environmental degradation. They are campaigning for a boycott against Flor de Caña and its parent company.
The organization has a Facebook page, where those interested can get more information and offer their support for the workers' protest.
In my support, I post my photo album of their protest in the hopes to bring more attention to their plight. This is the closest intersection of public health and public diplomacy- the use of new media platforms to make foreign publics aware of public health issues. You can be sure that their struggle will be looming large in the photos for my upcoming exhibit on the world of public health.
I was moving a little quick so I had to shelve a few of the blogs I wanted to write. Now that I am home, I am going to work backwards. The story picks up in Panama.
I was on the last bus of my long, long journey, some 3,000 miles or so. I had just boarded the MarcoPolo cruiser and switched my seat to the very front of the double-decker coach so that I could sit in the very front seat with the giant glass windows like Charlie's elevator. My spirits were exuberantly buoyant at crossing the Panama border and the triumphant ride from the city of David to the capital and final spot on my adventure. I was chatting amiably with the girl next to me on the bus, and mentioned the public health aspect of my trip. She laughed and said she was studying to be a nurse to deal with public health. Serendipity smiles upon me.
Ana Yancie was studying in the third year of a six year medical program. She told me a little about the public health system in Panama. She mentioned that everyone in Panama has health insurance. The health system is free and there are free hospitals to treat all Panamanians, including those who cannot afford to pay. In her opinion, Panamanians received quality medical care and access to medicine for basic medical needs.
She noted that while not all hospitals and clinics were able to handle all types of medical problems. "There aren't hospitals that have everything," she said, "but you can find everything throughout the whole of the medical system." Certain clinics and hospitals specialized in some aspects of medical care so all care was covered for the most part. This social system of healthcare was meant to cover the most basic coverage of people's needs. She said that if you are sick, you are fortunate enough to always find basic care. Meanwhile, those who are more affluent also often purchased private insurance that offers more comprehensive care and better service.
I asked Ana Yancie what she made of the US healthcare system. She found it almost incomprehensible that people would be denied care simply because they didn't have insurance or couldn't afford it. She said that while Panama surely didn't have the level of coverage that was available in the US, at least everyone had access to the basic necessities. I told her that I had gone nearly two years without medical coverage while I was doing freelance journalist work, she found this shocking. She was proud of the Panamanian medical system and its availability to all citizens of the country regardless of their socioeconomic status. I wish I could say the same of our own. Yet I still have hope that President Obama will remedy this situation.
Today marked the last service-learning day of our trip.Our flight would be in the early afternoon tomorrow, so the only thing we had planned was to go to a family friend’s house for a traditional Jamaica breakfast and head to the airport. I thought it was a well-deserved ending, as we had to wake up at 5 AM this morning to leave for Kingston at 6 AM.
The trip to Kingston from Montego Bay was roughly 3 and a half hours. We drove through the heart of Jamaica to get to our destination.It was pouring hard and the roads were windy.At times, we feared for our lives.I wondered how Jamaicans maneuvered on such narrow highways with curves and turns throughout.I hoped we wouldn’t be additional statistics to Dr. Fray’s “unnecessary trauma cases” and understood how easily car accidents could happen.
Dr. Sanchez, one of my professors for Global Medicine, used to say how engineers could often save more lives than doctors.And I could see this to be true, with respect to Jamaica’s roads.If engineers could could simply design safe roads and work with the government to enforce street lights, stop signs, and speed limits, it would make a world of a difference.But unfortunately, even if the roads were paved, many were too narrow for comfort.And there were sparse traffic lights, mainly in bigger cities like Kingston or Montego Bay.There were signs on roads promoting seatbelt use, but they were never enforced.And I don’t think I saw a single crosswalk while in Jamaica.
Our first stop in Kingston was at the University of Technology.We had the honor of meeting faculty from the Pharmacy School, including the Dean herself.We spent an hour speaking with the faculty, asking about the pharmacy program.The University of Technology is in the process of constructing a Doctor of Pharmacy program, so our pharmacy students got a chance to explain their curriculum to give the professors and administrators an idea of what to offer in their program.Then, we got a tour of the pharmacy lecture hall and lab.
Next, we then headed to the University of West Indies, which houses one of the few medical schools on the island.We drove to their hospital and met with the pharmacy staff there.Their pharmacy was quite impressive, with a spacious waiting room and a very organized stockroom with medications.
After speaking with some pharmacy students on the campus, we then headed to the Ministry of Health. We spoke with the Regulations Department, which is the equivalent to America’s FDA.They were all friendly and told us about their typical tasks.Many were pharmacists.Because most drugs authorized in Jamaica are produced abroad, their task is to screen each drug before it enters the Jamaican market.
What impressed me the most about the Ministry of Health was the emphasis it placed on HIV/AIDS awareness.There were posters all over and several pamphlets targeted to teens about HIV and AIDS.We each grabbed a few and read on them while we were in our van.Each pamphlet was a different fictitious narrative about young people, sex, and AIDS.We thought this was an effective way to communicate to this demographic and wished we had them to pass out the day before at our visit to Granville.
After our tour through the sites in Kingston, we headed back to Montego Bay for our last reflection. During our reflection, we drew connections between healthcare in Jamaica and the ongoing campaign for healthcare reform in the US.Several people expressed interest in coming back and refining our trip.As a pilot trip for USC Project Jamaica, we learned a lot with respect to planning and preparing for the trip.In addition, everyone offered suggestions for the trip, if we continue next year.A few suggestions that stuck out to me were to collaborate with the USC dental students and medical students.We had initially opened the invitation to Keck’s chapter of the Student National Medical Association, but later learned that medical school finals would still be going on after our flight was scheduled to leave.With a year’s worth of planning and many lessons learned, we’ll be sure to confirm the finals schedule of all of the different programs at USC before purchasing tickets for our future trips.
Aubrey, one of the pharmacy students, leads a diabetes awareness campaign in LA.He suggested that we add a diabetes and hypertension screening component to the trip, since this initiative wouldn’t require much equipment.I loved his idea because we know that the cases of diabetes and hypertension are growing within the adult demographic in Jamaica. Aubrey recommended that we write to OneTouch, which is a pharmaceutical company that makes glucometers.They’ve donated to Aubrey’s outreach program and we hope they’d be willing to partner with us in Jamaica.
All in all, I’m very thankful that we were able to hold this trip.It couldn’t have happened without the support of the Global Institute for Health and other sponsors.We learned so much about healthcare in a developing nation, health education campaigns, and the need for collaboration from different sectors to meet the variety of needs Jamaica presents.Thank you all for keeping up with the blog.I hope to learn more about global health during my time at USC and look forward to seeing where USC Project Jamaica goes in the future.
Today was quite an eventful day.We visited three different sites and still found time to join Dr. Brown and his family for a discussion on healthcare in Jamaica over dinner.
The first site we visited was the Blossom Gardens Children’s Home.Blossom Gardens is an orphanage that takes in children from infancy to the age of 10 years old.We met with Ms. Hylton, the assistant director of the orphanage, as she gave us a brief introduction and tour of the children’s home.Ms. Hylton explained that her orphanage worked with the social services sector of the government to place the children into homes throughout the region.If the children are not been adopted by the age of 10, she informed, they are transferred to other orphanages on the island, such the SOS Children’s Village that we visited on Saturday.One nurse worked on staff at Blossom Gardens and Ms. Hylton noted that they had a physician come in once a month to examine all the orphans and address any medical needs.I was happy to learn that these orphans had basic needs such as safety, shelter, community, and health accounted for at the orphanage.
While the children ate lunch, we presented our donations of shampoo, soap, body wash, diapers, toothbrushes and games to Ms. Hylton.We all posed for a few pictures and then started our lessons.The first lesson we presented was on Poison Control.We started off with our game “Pick the Poison” and then presented the different types of poisons the children might encounter in the bathroom, kitchen, etc…
We then conducted a puppet show to recap everything the children just learned and transitioned to hygiene.We had bought fake teeth to demonstrate what the children would look like if they didn’t brush their teeth on a daily basis.We demonstrated how to brush teeth properly.Then we taught them about germs and hand-washing.Ruth, one of the pharmacy students, came up with a jingle about washing hands that we sang with the kids.
Afterwards we passed out worksheets that taught about poison control and had the kids color them with crayons we had donated to the orphanage.We all split up and worked with a group of kids.As they colored in the worksheets, we’d relate the illustration to the lesson on poison control.One drawing I worked on with a boy depicted two children with a carton of bleach.I asked my new friend if he knew what bleach was and in his cute Jamaican accent he responded, “poison!”It was so adorable.I asked him what he would do if he or a friend accidentally swallowed poison.And he stated, “call 119,” which is Jamaica’s equivalent of the 911 emergency line in the US.
While the children drew, Aubrey and Saleema, two pharmacy students, slipped out to change into a Santa and Elf costume.When they had changed, we cleaned up our work areas and told the children we had a surprise for them.Saleema, who wore the elf costume, helped us line everyone. We all walked outside to the Christmas tree on the porch of the building and Saleema continued, “Santa Claus is here!And he came all the way from the North Pole!”The kids cheered and we handed out a gift to each person.They soon opened up their gifts and played with their Barbies and toy cars.Toni thought it would be nice to bring ice cream as a treat for the children, so we started to distribute cups of ice cream to all of the children.We had some time to play with the orphans and their new toys. Afterwards, we headed to our next site to drop off some donations.
We drove through a rural part of Jamaica, on our way to West Haven, a home for the physically disabled, such as patients of down syndrome.It was lovely to drive through the jungle-like terrain, seeing plush hills to the left, palm trees to the right.We often encountered cattle or goats on the side or middle of the road.And potholes laced the roads, which were much older than those in the heart of the city.In my Global Medicine courses, we learned how potholes, abandoned tires, and open containers were breeding sites for mosquitoes after rainfall.Fortunately, mosquito-borne diseases, such as dengue and malaria, had been eliminated throughout most of Jamaica.
When we arrived at West Haven, we were greeted by hugs from a group of teens and adults.We met the director of West Haven as she gave us a brief history of the home.West Haven, like SOS, has several homes on their campus.And each home had a nurse “mom” who watches over the family.When we arrived, the patrons of the West Haven were enjoying some free time.One home had a stereo and a group of people were dancing to the music.One girl had gravitated to me and held my hand throughout our stay.She introduced me to her mom and later her driver.The driver told me that he was responsible for driving to the hospitals and clinics when needed.We spent about thirty minutes getting acquainted with our new friends and presented them with stuffed animals. (Over the past few months, the pharmacy students and I held toy drives and collected donations for school supplies, toiletries and the other items we donated in Jamaica.)
After our quick stop at West Haven, we headed to the Granville Home for Girls.Granville is an orphanage for young ladies ranging in age from 12 to 18 (I believe).The pharmacy students had a pretty nifty presentation on HIV/AIDS, but the sites we’d visited thus far had such young audiences so we couldn't present the lesson just yet. Thus, I was really excited that we got the opportunity to present the lesson at this home for girls.We’d learned earlier that a few of the girls were actually HIV positive, so it made the lesson that much more relevant.
After a two hour drive, we arrived at Granville.We met with the director of this home and gave her shoes, clothes, toys, and school supplies that we had raised from both the Health Science and main USC campus.
We started the presentation discussing myths about HIV/AIDS transmission to gauge how much the girls knew about the disease.Then each of us presented a topic from slide show that had been put together earlier.(We didn’t have a projector to display the powerpoint, but hope that we can bring one next year as a teaching aid.)The girls were all engaged by the discussion and I was impressed by how much they knew.In fact, most of the information they stated was accurate.Afterwards, we held an activity to illustrate how easily the AIDS virus can be transmitted from person to person.Ruth filled 10 clear cups with water, but added baking soda to two.
The baking soda quickly dissolved and the resulting solution looked just like water.We then asked for ten volunteers to hold a cup.The girls formed two lines of five.Then we instructed the girls to dip some of their water into their partner’s cup.Line A would pour some water and Line B would follow suit.After this exchange, the girls in Line B would move one spot to the left.Then we asked the 10 girls to make a second exchange. Next, we had the girls in Line B to move one spot to the left.After doing so, they conducted the last exchange.We then administered a litmus test to each cup, simply dipping a strip of the paper in each cup.After a few seconds, the cups that had been “infected” would appear blue for the basic character of baking soda.We asked all the girls with “infected” cups to raise their hands.Out of the ten volunteers, eight girls had been “infected.”
We hoped that this illustration would be powerful and stressed that after just three exchanges, the infection rate jumped from 20% to 80%.We reiterated, however, that it takes just one exchange to become infected.After our illustration, we held a brief recap and a mini quiz to determine how much the girls had learned.When we first arrived at the Pediatric Ward of Cornwall Regional Hospital, we had 11 Santa hats, but over the past few days, we donated little by little to the different sites.So, we auctioned off our last couple of Santa hats to the girls who correctly answered our questions.
After saying goodbye, we headed back to Montego Bay for our last activity of the day: dinner at the Browns. (Dr. Brown had given us a tour of Cornwall Regional Hospital earlier in the trip.)His family had prepared an authentic Jamaica meal with different dishes of rice, fish, curried goat, and chicken.We enjoyed the delicious food over a probing discussion.Dr. Brown discussed how life and death relate to the soul.Though more philosophical than anything, the discussion challenged our perceptions of science, religion, and healthcare.Afterwards, a few of us asked Dr. Brown what he thought would be the best thing to invest money in with respect to healthcare.Then we headed back home to get rest for a long journey to Kingston the next day.
Below is some footage from our HIV/AIDS presentation at the Granville Home for Girls. I wish I could have captured the entire scene, but the Director requested that we don't film the girls' faces. Therefore, much of the footage is of my lovely Project Jamaica teammates teaching and leading the HIV/AIDS exercise.
Today we were privileged to meet with the former president of the Caribbean Association of Pharmacists, Dr. Grizzle.She was leaving for a flight later in the afternoon, so it was nice of her to meet with us in light of her tight schedule.She came in pretty early in the morning and we had a lengthy discussion of pharmacy in the Jamaica and the Caribbean at large.
She explained the recent shift in the debate between Bachelor and Doctorate of Pharmacy degrees in Jamaica. While current programs favor Bachelor degrees in Pharmacy, the Caribbean is witnessing the introduction of Doctorate of Pharmacy programs.The Pharm. D. title would require more schooling and a more rigorous curriculum, but would enable the pharmacists to expand their roles as healthcare providers.Dr. Grizzle mentioned that pharmacists tended to be more soft-spoken than doctors and nurses.Consequently, pharmacists were less active in politics.However, Dr. Grizzle was hoping this would change.After all, the more involved pharmacists were, the more likely policy changes would reflect their opinions.
As she discussed this, the pharmacy students chimed in, agreeing with a similar phenomenon in the US.They expressed their goals of serving in Congress or as industry leaders to better represent the pharmacist’s needs.The discussion illustrated how interrelated politics were with healthcare. We then discussed the Jamaica's strides towards healthcare for all. Dr. Grizzle expressed the need for integration between the public and private sectors of health. She explained, “It seems to me that there is some discrimination [against lower classes] because they are poor.”
However, she noted that free healthcare was better than nothing. She was grateful that the poor now had access to what Jamaica's new administration considered a human right. Still, she pointed out that this new policy proved an unexpected burden on doctors and other healthcare professionals. "We call it free, but someone is paying for it," she said. Her comments soon reminded me of similar statements that Dr. Fray made about the long lines and limited supply Cornwall Regional Hospital faced.
As we discussed this issue, Dr. Grizzle introduced a new side of the free healthcare debate we hadn't considered, thus far. She explained that individuals with health insurance often utilized the public healthcare facilities instead of the private facilities they were entitled to. Thus, the government found itself paying for expenses that would normally be charged to insurance companies, if the patients used private facilities. In light of this, and with the growing healthcare demand of the uninsured, Dr. Grizzle felt as though free healthcare could not be sustainable in the long run. At the moment, she informed, the government had been trying to regain money that was allocated for private health insurance, since health insurance companies were profiting by technicalities in policy. (In fact, Dr. Fray mentioned that these health insurance companies had been posting record profits since the inception of the free healthcare reform.)
After our discussion with Dr. Grizzle, we got a chance to attend a Jamaican church service.More than half of Jamaica’s population is Christian, so it was interesting to partake in a tradition so embedded in Jamaica’s culture. We met with Toni's church pastor and donated some clothes and toys we had fundraised throughout the semester. The pastor was quite friendly and told us a little about himself and his career. After the service, we took a couple of pictures with him and, later, enjoyed a Jamaican meal on the beach.
That evening our reflection was quite interesting.We tried to synthesize everything we had learned about Jamaica’s healthcare system.By now we’d gone to a top hospital and met with some illustrious pharmacists.Over the past few days, we’d all grown to love our driver, Curtis.He had joined us for dinner that evening, which soon transitioned into the discussion.As we talked about the healthcare reform in Jamaica that provided free healthcare and drugs for the uninsured, he chimed in.He reiterated what Dr. Fray had mentioned several days ago: the length of time patients would have to wait to be attended to often cost more than the health insurance would. For example, Curtis had a form of health insurance covered by his driving company, but also paid for private insurance to cover his family.He said it was about $30 US dollars a month, not too expensive for someone with his income.He continued, he’d rather pay for health insurance out of his pocket than wait at a hospital for care, since he could easily make up the money if he were working during the time he’d be waiting.It was profound to hear his input because it was honest, real, and coming from someone outside of healthcare.His testimony only affirmed what we had learned thus far on the trip. And it shed light on the pending healthcare reform the US is about to witness.
With our Barrow Kunda distribution complete and every citizen of that village now having a long-lasting insecticidal treated bednet to sleep under, we had an extra 120 bednets remaining that we had not planned for. Sticking to our goal of delegating as much local control as possible, we asked the leadership of Barrow Kunda to decide what they would like done with the remaining nets. We were pleased when they told us that it was their preference to share the remaining nets with two tiny villages called Mano Koto Forde and Mano Koto Keita, located about 5 km from Barrow Kunda. Within hours we organized a census to see how many nets would be needed to provide blanket coverage to these two villages. As luck would have it, the census revealed that 120 nets would be needed for comprehensive bednet coverage. Thus, on December 20th we mobilized our net distribution team to make the 5 km trek to the Mano Koto villages to conduct two more net distributions. Both distributions went as well as we could have hoped and we had the satisfaction of covering two more villages than originally planed with universal bednet coverage. Below left is an image of the "local transportation" we utilized to move the nets from Barrow Kunda to the Mano Koto villages; at right is an image of the distribution from the Mano Koto Fordge distribution.
I left Barrow Kunda on December 29th with a feeling that we had started something big. There are 6,500 nets currently in Dakar that are awaiting transport to Gambia so that they can distributed to other villages in the Wuli District. Because of school and the high cost of traveling to West Africa, Michelle and I will be unable to return to The Gambia for the distributions that will occur over the next year. But we are satisfied that we have created momentum for a locally controlled model of net distributions that foster a sense of ownership among the community. We look forward to collaborating with the US Peace Corps, The Gambian Malaria Control Programme and other NGO's in the next several months as the remaining bednets are distributed to Gambian men, women and children to help protect against malarial infection.
Lastly, a huge thank you to the USC Office for Global Health. A project of this nature, where you have a couple of poor graduate students trying to do work halfway across the globe, would simply not be possible without the support of the university. We are fortunate at USC to have Dr. Jonathan Samet, Dr. Heather Wipfli, Ivette Flores Guintu and the rest of the Office for Global Health staff that are quickly establishing USC as a leader in global health. Other members of the USC community that graciously supported this project are Dr. Jo Marie Reilly of the Family Medicine Department and Dr. Alice Stek of the Department of Obstetrics and Gynecology.
We will continue to raise funds to achieve our goal of universal bednet coverage in the district of Wuli. There is still a ways to go before we achieve this goal. To see how you can help us, please visit our website at www.sutoyediya.org. Thanks!
After eventually making it across the river and the day-long trip to the large up-country town of Basse Santa Su, we rendezvoused with the 800 bednets that had a long journey from Vietnam, where they are made, to the Senegalese Capital Dakar and finally to The Gambia. On Christmas Eve we hired a large truck to transport the bednets across the river and over the rough 25 km path from Basse to Barrow Kunda. The reception Michelle and I received from old friends in Barrow Kunda was simply incredible. At left is a picture of the hundreds of people that lined the road to the village to welcome us back to Barrow Kunda.
We spent the better part of December 24th and 25th attending village wide celebrations to welcome us back, and much more importantly, to promote malaria awareness and the basic steps that can be taken to protect families from the mosquito-borne disease. During my trip to The Gambia I was taking a malaria prophylaxis that is extremely effective in preventing infection. Unfortunately, in a country where the average working age adult makes less than $1 per day, malaria prophylaxis is simply out of financial reach (and even if prophylaxis was affordable, the wisdom of putting a person on years-long treatment is questionable). What is not questionable is the effectiveness of insecticide treated bednets in preventing malaria.
The village organizations, particularly the woman's group, did an amazing job at using traditional forms of communication to promote the anti-malarial education that was a critical part of of this bednet distribution. Over the course of several community programs, the woman's group and others used song, dance and plays to transmit basic but essential knowledge about the necessity of using a treated bednet every night, the importance of reducing standing water and other essential components of malaria education. Below is a short video snippet of a song the women of Barrow Kunda composed and sang about the catastrophic effect malaria has had on the community and the ways the village can use bed nets and other basic resources to prevent future infections.
December 26th was the big day, the date of the actual distribution of nets. Personally, there was a lot of excitement, but also anxiety about this day. We had worked for a year to lead up to this moment. This would be the first of many bednet distributions and it was important that we start out this project with a competent, organized distribution with enthusiasm from the villagers. It turned out my anxiousness was unwarranted, as the distribution was a complete success. The leadership shown by the village heads was exceptional. Michelle, myself and the current Peace Corps Volunteer serving in Barrow Kunda (Brendan Loula) intentionally played a backseat, logistical role so that the villagers would take ownership of this project and its long-term implications.
Over the course of a 5 hour period our team of village leaders distributed 680 bednets to 75 compounds. This was neither easy nor simple. In Gambian society it is acceptable for a male to marry up to 4 wives. There were instances of one wife collecting nets for an entire family, and not sharing with the other wives and her children. Also, there are "mega compounds" where up to 4 men and their many wives live as a collective unit. The individual family units that make up these compounds often feud, which resulted in some families not initially receiving their fair share of nets. Luckily, the exceptional leaders of Barrow Kunda were able to mediate these disputes where necessary so that each citizen of the village was guaranteed the protection of a long lasting insecticidal treated bednet. It is also important to note here that some people in the village already slept under a quality, treated bednet. With the help of the community health nurse, we were able to take a bednet census so that nets would only be distributed to people that needed a new net.
Below is a video of the entire process of nets being distributed for a single compound. First, we look at the census to see how many nets a particular family is entitled to. We then go to collect the nets from the young men that ensure the security of the nets. The appropriate number of nets are then marked with the name of the compound using a permanent marker (this helps to fight sale of nets on the black market). Finally, the nets are distributed to a representative of the family, along with a reminder about the proper use and upkeep of the nets. This final educational component is particularly important and supplements the many other educational messages about proper net use that we had propagated throughout the campaign.
Hi and thanks for your interest! My name is Amin Ramzan and I am a second year student at USC Keck School of Medicine. This is the story of how I spent my winter break. *During the bulk of my trip I was away from electricity, let alone internet access. Thus these blog posts are adapted from notes taken throughout my 2 weeks in The Gambia.
In January 2009 my partner Michelle Nicolas (a graduate student in education at Antioch University) and myself created a group called Suto Yediya (meaning “sweet dreams” in Mandinka, the predominant language in The Gambia). Our initial goal was modest: raise funds to purchase enough malarial bednets to provide universal protection to the people of Barrow Kunda, a medium sized village that is far upcountry (i.e. “the bush”). I had lived in Barrow Kunda while serving as a Peace Corps Volunteer about 5 years ago. Michelle (also a former Gambian Peace Corps Volunteer) and myself formed strong and lasting relationships with the people of Barrow Kunda village and this project was an effort to give back to a place that had given so much to us while we were visitors in this very foreign country. I have an especially close relationship with my former host family, the people I lived with, ate with and worked alongside on a daily basis. Near the end of my service we experienced the tragedy of four year old Ustapha Barrow, my host brother, dying of malaria. This project is dedicated to the memory of Ustapha, pictured below with me, in the hope that completely avoidable deaths such as his can be eliminated through the use of $4 bednets and sensible anti-malarial eduction.
With the enthusiastic support of the US Peace Corps in Gambia and the UK NGO Against Malaria our project morphed from a small scale undertaking to provide bednets to a population of 1,600 villagers in Barrow Kunda to an ambitious long-term project to provide universal bednet protection to the entire district of Wuli (population 18,000+). I am proud to report that through hundreds of small donations made mostly by friends and family of current and former Gambian Peace Corps Volunteers, we have raised enough money to cover half of the Wuli District. This is possible because the amazing folks at Against Malaria allow us to purchase long lasting insecticidal treated nets at the lowest possible price on the world market. We were also fortunate to partner with NetLife Africa, an organization founded by former Peace Corps Volunteers that provides bednets to people in Senegal. Netlife Africa was kind enough to cover the shipping costs on the initial 7,300 nets for our Gambian project. You can visit our website at www.sutoyediya.org to learn more about our 0% overhead fundraising structure (and make an easy online donation if you are so inclined!).
We arrived in The Gambia on December 21st minus two pieces of luggage (which would eventually reach us 12 days later) and ecstatic to return to a place that held so many wonderful memories. We had a brief stay in the capital, Banjul, where we met with Peace Corps, local NGOs and Gambian government officials involved in the distribution to discuss logistics. On December 23rd we set off to our up-country destination. As anyone that has spent time in The Gambia knows, if anything proves Murphy’s Law, its transportation in this country. The condition of roads has improved considerably since I was last in The Gambia. However, you have to cross the river Gambia where it meets the Atlantic Ocean to get to the “good” road. It is necessary to take a giant Ukrainian built ferry to make this 10 km crossing. And sometimes your ferry breaks and has to be towed across the river by another ferry with nothing but two big ropes and hope.
Today we got to venture outside of Montego Bay.As many schools in the area were out for the Christmas holiday, it was hard to schedule a site for the day. Fortunately, we were able to visit SOS Children’s Village, an orphanage on the outskirts of Montego Bay. Since they had ongoing activities for the children, we made a quick visit.
SOS Children's Villages are an international network of orphanages, with a significant presence throughout the world. On top of the site outside of Montego Bay, another of its campuses is in Kingston, Jamaica’s capital.
When we arrived at SOS, I was truly impressed.It houses 100 orphans from childhood to late teens in 11 houses.Each house constitutes a family, with a house mother, a spacious living room and kitchen, and a room with 5 bunk beds for girls and another with 5 bunk beds for boys.I liked the sense of kinship this environment fostered and the “mother” (the caretaker of the house) we spoke to was so friendly.
After touring the house, we presented SOS with donations.If we hold the trip again next year, I’d like to get in touch with SOS much earlier on and schedule a whole week with them to present a new lesson each day.However, we added SOS after our plans with the Good Shepard Foundation fell through.So it was a last minute addition to our itinerary.
From there, we ventured to Dunn’s River Falls, an attraction that Jamaica is famous for.I wish we were able to secure a time with another orphanage in the area, but realized that becoming culturally competent was just as important as serving a new community. After all, the purpose of this service-learning trip was to both volunteer at different orphanages and to learn about the community we’d be working in.So, we selected Dunn’s River Falls as a team-building exercise. The waterfall park presents different features about Jamaica's rich history. As we walked through the park, we learned about Jamaican culture, such as the saying irie which means "no worries."
We then ventured to the waterfalls. With the aid of two guides, the eleven of us climbed the waterfalls from the bottom to the very top.We held hands throughout and instructed each other as we dodged slippery rocks and fast currents.By this time, our group had bonded rather well.But this trust exercise reaffirmed our sense of team and family.
In this post, I am taking the broad view of global health to encompass the actual health of the globe and the unfortunante but constant scenes of litter I have seen throughout my travels. Stretching down from Mexico through Guatemala to El Salvador and now Honduras, I have seen far too many roads covered with trash and refuse, and rivers filled with garbage. I keep watching in horror as people wantonly litter their bottles and trash out the bus windows or merely drop their garbage in the streets. It makes me cringe, and I chide the offenders as best and respectfully as I can. It is shocking to see people so carelessly toss garbage into fertile fields. The children of those who worhipped the earth as gods now fill her with plastic bottles and trash.
I wrote an earlier post on a Mexican domestic public diplomacy campaign to socialize better environmental awareness. People seem to have simply been socialized not to care or not to think that they shouldn`t toss their litter out. There is some serious work to be done in this regard in this entire region, and I quickly becoming aware of its urgent necessity.
The fact is that the majority of the trash I have seen tossed out bus windows and littering the side of too many roads are plastic bottles. The cheap disposable soda bottles are ubiquitous. Yet irony is that there is nary a glass bottle on the road. In fact, most little stores, shops or kiosks won`t even let you keep the soda bottles, and either dump the contents in a bag to drink or make you drink the bubbly on the spot. That is because there is value for the returned bottles but no value to recycling the plastic bottles.
Perhaps if there were a recycling campaign to provide some return for the plastic bottles, people not only would not toss them casually but spend their time on the roads picking up such sources of wealth. Between an organized recycling campaign to provide a modest return for the plastic bottles as well as a modest public diplomacy campaign to socialize behavorial norms not to litter, there could be some progress to curbing such practices and curing this malady.
Today was an exciting day.Our Project Jamaica team got the opportunity to visit Cornwall Regional Hospital, the 2nd best hospital in Jamaica, and the premier medical center in Montego Bay.We met with Dr. Brown, an obstretrican/gynecologist.Dr. Brown had worked with Cornwall for years, but now led his own private practice in a clinic nearby.He gave us a tour of the hospital and introduced us to doctors and nurses he knew if they crossed our paths.The pharmacy students wanted to check out the hospital’s pharmacy, so we dropped by and got to speak with the Director of the Pharmacy.We also got to speak with pharmacy students interning there and other staff from this department.A few of the pharmacy students compared USC’s pharmacy program with the curriculum offered in Jamaica.It was interesting to learn that only one school in Jamaica, the University of Technology, houses a Pharmacy program.(In fact, there are only five universities on the island.)Learning this made me so thankful for all of the opportunities and schools we have in the United States.Another interesting point is that the University of Technology has a bachelor’s pharmacy program, where students can enter after two years of community college and high scores on their A Levels (a standardized exam that students submit when they apply to universities).In the US, however, all pharmacists must hold a Doctorate in Pharmacy, generally after completing an undergraduate program.Consequently, the role of a pharmacist varies greatly in Jamaica.In the US, the role of a pharmacist is rather broad: they are capable of administering vaccines, conducting screenings for diabetes or hypertension, participate in health fairs and present public health lessons on topics from AIDS to poison prevention, in addition to their clinical roles of administering medication.However, in Jamaica, the role of a pharmacist is confined to the pharmacy.
After checking out the pharmacy, we got a chance to meet Dr. Fray, the Senior Medical Officer of the hospital.It was an honor. And in retrospect, it was definitely the pinnacle of my experience in Jamaica.Over the past month, Dr. Fray and I had been corresponding to confirm our tour of the hospital and our volunteering assignment with the Pediatric Ward, so it was nice to finally meet him. We then spent the next thirty minutes discussing healthcare in Jamaica.We asked Dr. Fray, “What would you focus on, if you could invest money in one thing regarding Jamaican healthcare?”He responded, “public health education,” such as pamphlets, seminars, and tv programs informing the population about ways to stay healthy and prevent illness.
Dr. Fray then identified leading causes of hospitalization in Jamaica.He explained, “We have the best food in Jamaica,” but noted that this wasn’t an excuse for the increasing diabetes and cardiovascular-related illnesses Jamaica witnessed.In addition, Dr. Fray noted that car accidents were a frequent cause of hospitalization.He labeled car accidents as the unnecessary trauma, since injuries could be prevented with seatbelts, driving at safe speeds, and pedestrians crossing at designated points.
I asked about the partnerships between the government, policy-makers, engineers and doctors in the hopes of implementing traffic lights, cross walks and so on.Dr. Fray felt that even with those policies, people would still jaywalk.I stated that we could introduce education policy programs, more thorough requirements for obtaining a license, driver’s training courses, and crosswalk education in school curriculums.Dr. Fray said that with time, Jamaica’s traffic laws would adopt more Western-like policies.He projected that things would improve over the next ten years.But in the meantime, he acknowledged, you could get anything you wanted in Jamaica if the price was right, including a driver’s license.
Dr. Fray continued that Cornwall was often inundated with patients.Because of the unnecessary trauma of car accidents and other preventable illnesses, Cornwall splits its resources between cases that require grave treatment and cases that can be easily prevented.In fact, Cornwall holds 400 hospital beds, but accommodates 500 patients at any one time.This is because Cornwall is a public facility.Upon the inception of Jamaica’s new administration 2 years ago, healthcare and education became universal services funded by the government.While eliminating barriers to healthcare, this shift in policy overwhelmed public institutions, such as Cornwall, which cannot turn anyone away.Interestingly, Jamaica’s healthcare reform also called for free drugs at public hospitals.But Dr. Fray noted that these freedoms have come at a cost: the patient’s time.In fact, it could take all day for patients to get their prescriptions filled. And he attributed the wait to the shortage of pharmacists in the hospitals. As Cornwall is a public hospital, the pharmacists here get paid 1/3 of the pharmacist salaries from the private sector.Talking with Dr. Fray was both insightful and humbling.Dr. Fray’s position gives him quite a bit of influence, so I felt honored that he gave up some of his precious time to meet with us.
Later that afternoon, we returned for our Poison Control Presentation in the Pediatric Ward, wearing our Santa hats and USC Project Jamaica shirts.We got to meet the pediatric patients and walk them to the multi-purpose room, while a few people helped set up for the presentation.As we walked down the halls of the Pediatric floor, I noted the vibrant colors and welcoming paintings of familiar cartoons, such as Spongebob, Winnie the Pooh, and Mickey Mouse.However, beds that the patients stayed in were old, the floors dirty, the overall atmosphere unkempt.Most patients didn’t have shoes, and I noticed sores on their hands and feet as they scurried to the playroom.While shoes aren’t the gravest necessity, they do protect feet from wounds and exposure to pathogens.
We then started the poison control lesson.We started with the game “Pick the Poison,” where the audience has to choose between two similar looking objects and select which one is a pill and which one is candy.The purpose of this activity was to illustrate that candy and medications look so similar, that oftentimes one can’t differentiate between the two.I was really thankful that all of the patients were energetic and engaged in this activity.From there, we explained why they should be careful when putting items in their mouth.We emphasized that they should always ask an adult before eating anything they can find around the home or the hospital.And we discussed different types of poison one can find around the house, such as oil in the garage or perfume in the bathroom.
After our presentation, we rewarded the children for their efforts and gave them each a toy for Christmas.All in all, I thought it was successful first lesson in Jamaica.
Follow the Trojans as they engage in global health projects at USC and beyond. Using the world as their campus, USC’s transdisciplinary students and faculty work together with colleagues worldwide to improve global health by educating future and current global leaders, carrying out trans-disciplinary research, and assuring that the evidence collected impacts policy change to make a difference.
Diana Reichenbach and Kendra Ryan, graduate animation students: Animated global health messages to illustrate the Institute’s core themes: Chronic Disease; Environmental Health; Globalization, Business, and Health; Health Communication, Entertainment and the Arts; and Capacity Building and Training.
Posts
