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Fighting TB in India, One Lab at a Time

Phil Carroll is the Senior Policy Communications Associate at USAID partner organization PATH. He spent two weeks in India last fall visiting PATH programs related to maternal and child health, tuberculosis, immunizations, and safe water and diarrheal disease. Originally posted at the Global Health Technologies Coalition Blog.

India is a country that changes dramatically from place to place, something I experienced firsthand while on a two week trip there this past fall. One day I was listening in on a mothers’ group meeting in one of the poorest villages in Uttar Pradesh state, and less than 24 hours later I was standing in one of the world’s most technologically advanced airports in Hyderabad—often referred to as the ‘Silicon Valley’ of India. It was during this leg of my journey where I was further convinced of the need for sustained investment in research and development.

Man in a lab coat with USAID Logo in the background.

Photo: PATH/Gabe Bienczycki

In a laboratory on the outskirts of the city, I met a handful of Indian doctors and researchers who are doing some pretty amazing, albeit subtle, things in health. Thanks to a small, less than $100,000, investment by the US Agency for International Development (USAID), the Blue Peter Public Health & Research Centre upgraded its tuberculosis (TB) lab to a higher level of biosafety. Improvements like better equipment and infrastructure and enhanced safety measures have enabled researchers here to diagnose a case of multi-drug resistant tuberculosis (MDR-TB) in a matter of days, a process that used to take the same team several months.

This is significant for a host of reasons. Diagnosing TB on the early side can help get patients on treatment faster, thereby reducing further deterioration of their lungs and other organs and ultimately save their lives. Catching TB early on can also curtail the spread of this incredibly contagious disease to others. India, which has the highest incidence of TB in the world, and 20 percent of the world’s burden, needs these sorts of advancements now more than ever. Currently, the government of India, as part of its National TB program, is only reaching 25 percent of MDR-TB patients with diagnosis. However, by 2013, it is aiming for 100 percent coverage, or around 2 million TB patients.

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Picture of the Week

This 3-day old male calf was produced through artificial insemination trainings conducted by the USAID Agriculture Technology Program in Turkmenistan. The breed is a mix between local Brown Swiss (mother) and pure bred Brown Swiss. Photo credit: Zulya Achilova

 

USAID and Peace Corps Partner for Volunteers’ Return to Nepal

USAID joined Peace Corps this month in Washington and Kathmandu to celebrate the return of its volunteers to Nepal for the first time in seven years.

USAID Assistant Administrator for Asia Nisha Biswal (left) and Peace Corps Director Aaron S. Williams (seated, right) signed an inter-agency agreement to re-establish a Peace Corps program in Nepal after a seven-year absence from the country. Nepal’s Ambassador to the United States Shankar Prasad Sharma (center) and Assistant Secretary of State Robert O. Blake Jr. (standing) both spoke at the signing ceremony about the lasting contributions volunteers have had in Nepal. Photo Credit: J. Truong, USAID

In Kathmandu, Nepal’s Prime Minister, Dr. Babarum Bhattarai, said at an event at his offices that “I am very pleased with the return of the Peace Corps to Nepal. From the early 60s, thousands of volunteers have served in districts all across this country. I remember in much of the 60s and 70s the volunteers were a big source of teachers for subjects like math and science. I am very glad that with USAID’s assistance, the volunteers are coming back one more time to help with agriculture and health. Those are areas that need help, and I welcome the decision to redeploy the Peace Corps.”

Among those volunteers who served in Nepal include William Douglass, who now works with USAID. “Serving as a Peace Corps Volunteer in Nepal 45 years ago gave me unique opportunities to meet and work with a wide range of Nepalese villagers, urban dwellers and government officials throughout the country. I came away from Nepal with a strong appreciation for the people and the culture, and together with my wife who was also a volunteer, have taken many opportunities to return. During two assignments in the USAID mission in the 1980s and the 1990s, I was able to promote and support Peace Corps and USAID collaboration on Nepal Government projects. I and the many other former volunteers, including a number working with or for USAID, welcome this renewed collaboration to support Nepal’s development efforts after many years of conflict.”

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Tackling Tuberculosis in Migrant Populations

On December 19, 2011, the day after International Migrants Day, I found myself on a plane from Almaty, Kazakhstan to Dushanbe, Tajikistan, for a business trip.  I was surrounded by Tajik laborers returning home to celebrate the New Year. Other than my three colleagues and I, the seats were filled with Tajiks bearing electronics, toys, and other gifts for their families.  Had it not been for my ignorance of Tajik or Farsi, I would have struck up a conversation with my neighbor to find out what life was like being separated from one’s family for work.  Instead, I reflected on my own family, descendants of immigrants not unlike my fellow passengers.

Migrants and medical officers discuss the TB situation in the region. Photo credit: Abt Associates,Tajikistan

On December 23, 1909, my 26-year-old great-grandmother, Auyoung Yee Lau, emigrated from China to Hawaii to join my great-grandfather, who had opened a successful shop in Honolulu.  Prior to his wife’s arrival, my great-grandfather sent home $45 each month to feed five adult family members.  I wonder what went through Auyoung Yee’s mind as she boarded the boat from Hong Kong to what she called “the land of the Golden Mountain.”  I would guess that her thoughts were on the unknown country she was about to make her life in and the three children that she had lost in recent years, two of whom died of preventable childhood diseases before the age of 3.

After my great-grandmother’s journey to America, her tragedy was overcome with the subsequent births of five boys, four girls, and finally, my grandfather, whose Chinese name translated into “Happiness Complete.”  Had my great-grandmother and her family been denied access to health care services in Hawaii due to their migration status, I wonder if my grandfather and his siblings would have suffered the same fate as Auyoung Yee’s first three children?  Would my great-grandmother’s happiness have been complete?

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A Triumph of Coordination: To the Last Case in India and Beyond

Ellyn Ogden delivers a polio vaccine in Kolkata. Photo credit: CORE Group

Ellyn Ogden has coordinated USAID’s polio eradication initiative since 1997 and is a frequent visitor to India.

Western Uttar Pradesh was once seen as the world’s largest reservoir of polio virus. Four districts, namely Moradabad, Bareilly, Rampur and Badaun, were considered the ‘Hot 4’ and for many years, people speculated that the last polio cases would be from these districts. But the skeptics were wrong. The districts pulled together, involved all ministries, not just the health sector, and held everyone accountable for performance. The District Magistrates took charge and became personally involved in solving any obstacles that would crop up. Vacant medical officer positions were filled and progress was monitored closely.

Across India messages travelled the TV and radio airways. Celebrities and sports legends lent their support. Rotarians urged everyone to participate, provided much needed financing, and rolled up their sleeves to help out during the campaigns. CORE and UNICEF Mobilizers spent countless hours answering mothers’ questions, and in some places visited every pregnant woman to sensitize her in advance of the need for immunization. When the baby was born, the mother would then receive a ‘congratulations’ card, an immunization card and education on how to protect the child from a range of diseases. These extraordinary efforts make a difference far beyond polio eradication.

The last polio case in India was in Howarah District of West Bengal. It was not in the ‘Hot 4.’ It was in a child who was never vaccinated against polio in the routine system. It was in an unexpected area, demonstrating the importance of a robust surveillance system. The rapid outbreak response by the West Bengal government has been exceptional. The health team in the area knows how fragile the situation is. Still, far too many families refuse vaccination, there are periodic shortages of the trivalent vaccine used in the routine system, there are vacant medical officer posts, and routine immunization sessions happen once a month rather than the needed once a week in many rural areas.

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Picture of the Week

Ms. Le Thi Het (right) received a wheelchair from a USAID-funded project in Danang, Vietnam which enables her to get around. She is able to easily access a nearby community rehabilitation center supported by USAID where she has been able to strengthen her legs to operate a sewing machine and expand her business with her sister, Le Thi Thuong. Photo Credit: Richard Nyberg, USAID

Meeting Needs and Supporting Disaster Management in the Philippines

The people of the Philippines have been hit hard by Tropical Storm Washi (known locally as Sendong.) Heavy rains, storm surges, flash flooding, and landslides have rocked communities on the island of Mindanao, with 1,249 people reported dead as of December 27, nearly 55,000 still in evacuation centers, and hundreds of thousands affected.

USAID responded immediately, providing an initial $100,000 for disaster-relief efforts and putting disaster management specialists on the ground to assess conditions. The Agency is providing an additional $800,000 in emergency assistance to continue to support ongoing emergency relief operations, including the distribution of emergency shelter kits, water purification tablets, water containers, and hygiene kits.

USAID is also supporting logistical operations to ensure the uninterrupted delivery of emergency supplies to the most affected populations, particularly in the hardest hit cities of Cagayan de Oro and Iligan.

However, our investment in addressing disaster risks and impact in the Philippines actually goes back many years, and is more than direct disaster response. Knowing the Philippine islands face continued risks from storms, typhoons, earthquakes, volcanoes and other natural hazards, the United States has been working with the Philippine Government and regional and local groups since 1998 to train and prepare emergency responders.

The Program for the Enhancement of Emergency Response, known as PEER, has been instrumental in staffing Philippine search-and-rescue and first-responder groups like the Philippines National Red Cross, the Bureau of Fire Protection, the Office of Civil Defense, and even the Armed Forces. Graduates of the program must complete standardized coursework in medical first response, collapsed structure search and rescue, and hospital preparedness for mass casualties.

USAID and the U.S. Forest Service also have trained Philippine emergency personnel in what is known as the Incident Command System or ICS, which makes sure responders are “speaking the same language,” or in other words, are working under the same response framework.

The United States continues to be a key partner of the Philippines by providing humanitarian assistance when disasters strike, as well as helping the people of the Philippines strengthen their disaster preparedness capacity and improve communities’ resilience to disasters.

Learn more about USAID’s response in the Philippines.

Partnering with Russia and Kyrgyzstan to Help Disabled Children

December 8 marked a big “wheels down” party in Bishkek. Three countries—the United States, Kyrgyzstan, and the Russian Federation—provided quality wheelchairs to dozens of disabled children, helping them to be more mobile and independent.

The wheelchair project was started by former Kyrgyz President Rosa Otunbayeva at a meeting with the Russian Envoy to the Kyrgyz Republic and the Russian and U.S. ambassadors in the summer of 2010.  The Frank Foundation Child Assistance International, an American non-governmental organization, received funding from USAID to procure 90 wheelchairs. Two Russian private companies, Polyus Gold and Russneft, provided funding for an additional 90 wheelchairs.  The Russian government covered costs for air shipment between New York, Moscow, and Bishkek, and the Kyrgyz government arranged free customs clearance and covered some transportation costs.  Special Envoy of the Russian Federation President to the Kyrgyz Republic Vladimir Rushailo played a leading role on the Russian side, leveraging private sector donations as well as organizing the shipment of the wheelchairs.

The day presented a unique opportunity to showcase U.S.-Russian cooperation in Kyrgyzstan.  Former Kyrgyz President Otunbayeva, Special Envoy Rushailo, and U.S. Ambassador Pamela Spratlen stood together to present the 180 wheelchairs to disabled children.  The Russian Ambassador, USAID/Russia Mission Director Charles North, and USAID/Kyrgyzstan representative Carey Gordon also participated.

“A lot of people think these two countries argue.  I would say that here in Kyrgyzstan a lot of things are done together by these two countries.  Look at this wheelchair project!  The two countries united and a good deed was done,” said President Otunbayeva.

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Listening and Remembering: The Fight against HIV/AIDS in Kazakhstan

Recently, in commemoration with the 30th anniversary of the fight against HIV/AIDS, I had the opportunity to sit down with people who are on the front lines of this struggle in Kazakhstan.  Our informal press round table was a chance for people living with HIV to tell their story about discrimination and access to health care.  The discussion was lively, and each person had a different experience to share.  One thing everyone had in common was deep remorse for the lives lost to this disease.

A doctor, Gulzhan Akhmatova, shared the difficulties of getting patients to comply with their medication requirements and how this situation is improving dramatically.  Nurali Amanzholov, from the Kazakh Union of People Living with HIV, gave a strong overview of the many types of discrimination that HIV-positive and most-at-risk people face in Kazakhstani society.  Because infected individuals do not feel safe or free to disclose their status, they remain isolated and unknowingly continue behaviors that facilitate the transmission of HIV.  In this environment, the disease remains hidden and spreads.

I am sure there wasn’t a dry eye in the room when Vitaliy Vinogradov, an HIV outreach worker focused on the men who have sex with men population, shared his experience working with this at-risk population.  He spoke very personally about the loss of friends to HIV as well as the hate crimes that gay people face in Kazakhstan.  The official estimate of gay men living with HIV in Kazakhstan is 1 percent of the total infected population.  However, some NGOs estimate the rate is closer to 13 percent.

As Secretary of State Hillary Clinton brought forth in her Remarks in Recognition of Human Rights Day, we must continue to be leaders in the fight for equal treatment of all people.  I was honored to share a morning with people in Kazakhstan who are bold advocates for HIV-positive groups in their country, and I look forward to a renewed partnership with them in the fight to end stigma and discrimination toward people living with HIV in Central Asia.

New Water Pump Brings Hope in Remote Timor-Leste

I was sitting in the still, hot, and humid air on the porch of a Franciscan nunnery in Natarbora, a four-and-a-half-hour drive from Dili.  In the quiet night, the only noise I could hear was the thump of a bass guitar coming through large speakers. I asked Godwin Kamtukule, an engineer from Malawi who is the deputy manager of USAID’s water and sanitation program in Timor-Leste, how long he expected the noise to persist.

“Oh, they just told me that they are going to play all night in celebration of the inauguration of the new water system tomorrow,” he said.

He was right. The band played until 6 a.m.  After a fully satisfactory breakfast, prepared by the nuns, who, incidentally, are all from Indonesia, we headed to the first inaugural ceremony for the new water system, designed and installed by USAID’s water and sanitation project. Led by U.S. Ambassador Judith Fergin, an enthusiastic supporter of the work of USAID, we went to the ceremony, where we met the Director General, representing the Minister for State Administration, and the new District Administrator, who had just been sworn in the day before in Dili.  The local Chefe de Suco (elected head of the local village) proudly showed us the newly installed generator that will power the submersible pump that will bring water to the surrounding population.

The Ambassador and the Director General cut the ribbon to the grand applause of local residents. We then went to see the bore hole.  It is drilled to a depth of 62 meters (203 feet), and Godwin says that the water supply is guaranteed even in the case of a prolonged drought.

Among the many fabulous attributes of this project is the fact that all families who will benefit from it have agreed to contribute 50 cents a month toward maintenance of the pump, generator, and the system in general.  The maintenance of the system is entrusted to the community facilities management committee, elected by the residents.  There are three such committees in this project area, and I was happy to see that two of the three committee leaders are women.  The local committees are also responsible for guarding the generator and borehole/pump.

This USAID project brings water to some 3,500 people in remote communities near the country’s southern coast.  Powered by the generator, the pump sends water up the borehole and through pipes to 17 new community tap stands that provide people with access, for the first time ever, to clean water for washing and cooking. Previously, available water sources were contaminated by livestock.  The project also includes training in hygiene, clean water usage, and best practices for toileting.

Our next stop was the town hall, where I saw the large speakers that had thumped through the night.  More than 100 people were gathered for a celebratory feast.  Speech after speech emphasized that the water project’s success was the result of close cooperation between the residents and the local and district governments.  We could see clearly the local communities’ seriousness about this project, their hard work in making it a success, the importance of the local facilities management committees, and the necessity of continuing the good work.

We left soon after the celebrations.  On the way out of town, we passed a mother bathing her daughter at one of the tap stands.  The grin on her face was probably even wider than ours.

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