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Archives for Health

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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A Triumph of Coordination:  Eradicating Polio from India

Ellyn Ogden, USAID’s Worldwide Polio Eradication Coordinator, delivers oral polio vaccine to a child in Kolkata, India. Photo credit: CORE Group Polio Project

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

The news out of India this week marking 12 months with no confirmed case of polio is indeed a landmark event.  I have had the good fortune of working with the Pulse Polio Program, as the Polio Eradication Initiative is called here, since 1997, and have seen firsthand the hard work and dedication of the Indian government at the national, state, district, block and panchaiyat levels.  Over 2 million health workers, mobilizers, and volunteers have contributed to this success and deserve to be seen as heroes in their communities.

There have been many challenges over the years, not the least of which was figuring out how many children under age five there really are in India.  When I participated in my first surveillance review in Bihar, there were no surveillance officers assigned yet and the eradication program was in its infancy.  Today, India’s polio eradication program and its surveillance system, the envy of all other polio eradication programs, is often cited as the model to strive for.

With the help of WHO, UNICEF and Rotary international, detailed plans are developed to assure that vaccine reaches every village, data is analyzed and feedback given to constantly improve the work of the teams.  Detailed maps help trace the daily route of the vaccination teams.  Supervisors provide guidance and quality control.  Monitors verify the work of the teams, by checking to see if their fingers are marked and flagging any locations with poor coverage.  Sweep teams go back to find missed children.  Issues are discussed at evening meetings during the campaigns and corrective action taken immediately.  Government accountability and ownership is very visible.

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Meet the Innovator: Jorge Odon

“Imagination is more important than knowledge.” –Albert Einstein

It all started with friendly bet amongst friends – who could get a cork out of an empty wine bottle with only a plastic bag? The friends had seen the trick on YouTube earlier and wanted to re-enact it.

Somehow, Saving Lives at Birth finalist Jorge Odon, an Argentinian car mechanic with no medical background, drew a connection between the trick and obstructed labor, which is a major contributor to maternal mortality.  The idea came to him in the dead of the night. Inspired, he woke up his wife to share his idea.

She told him to go back to bed.

Eventually, his persistence led him to patent the idea. He then worked with national and international partners to further develop a device that is now a reality and being tested. The Odon device is an example of human ingenuity and a keen ability to recognize the practical application of simple scientific concepts.

The Odon Device is made of film-like polyethylene material that can help facilitate the birth process and may provide a safer alternative than forceps and vacuum extractor for assisted deliveries. Moreover, in settings with limited surgical capacity and human resource constraints, it may be a safe alternative to some Caesarean sections since it could be used by mid-level providers or in facilities lacking the surgical capabilities for Caesarean section.

The Odon Device has potential for wide application in resource poor settings. If proven safe and effective, the Odon Device will be the first innovation in assisted vaginal delivery since the development of forceps centuries ago, and the vacuum extractor which was developed decades ago.  By reducing contact between the baby’s head and the birth channel, the device could also prevent infections acquired during delivery.

Visit Saving Lives at Birth for more information on this and other innovations.

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.

USAID in the News

Weekly Briefing (12/12/2011 – 12/16/2011)

December 9: Last Friday, the Global Post highlighted USAID Administrator Dr. Rajiv Shah’s visit to Harvard University. On December 12thThe Guardian’s Global Health Blog also published a post about his trip to Cambridge. Speaking at a dinner, hosted by the Nieman Foundation for Journalism, Dr. Shah recalled his visit to refugee camps in Kenya and the struggle families are currently facing in the Horn of Africa. Shah also encouraged journalists to actively cover the crisis and famine.

December 14: The Guardian reports that during the International Engagement conference for South Sudan, USAID Administrator Dr. Rajiv Shah stated that theconference is an opportunity for the government of South Sudan to lay out its vision for the future of its economy. Shah also stated that the event will “help private companies and investors see the Republic of Southern Sudan as a place where they want to increase their investments, thereby enabling significant economic development and economic growth”. Bloomberg News also reported on the conference, citing Secretary of State Hillary Rodham Clinton’s strong support for the new nation and the promising economic opportunities in farming and oil sectors. ReutersThe Wall Street Journal, and The Washington Times also covered the conference.

December 15: ABC News’ “Million Moms Challenge” blog highlighted an innovative approach USAID is using to help pregnant women and new mothers in Bangladesh. By utilizing a new cell phone program, women are receiving text or calls with potentially life-saving alerts regarding their upcoming due date. After they give birth, themothers continue to receive messages with information regarding healthy nutrition and how to care for their newborn. The USAID initiative is called Mobile Alliance for Maternal Action (MAMA).

Victim of Sex Trade Inspires Others to Adopt Healthy Behaviors

On World AIDS Day, I am reminded of a recent visit to Guatemala where I visited an old stretch of railroad called La Linea, which is now home to sex workers who rent tiny rooms for business each day.

Their business is a precarious one. The solicitation of sex in exchange for payment brings inherent and obvious health risks to individuals who engage in this behavior, but also for the community.  For those who make a living in commercial sex work, education is key to ensuring they are able to protecting themselves by reducing the risk of contracting HIV and other sexually transmitted diseases.

Guatemala’s HIV prevalence rate is less than one percent among the general population. HIV in this country is classified as a “concentrated epidemic”, because cases are generally much higher among particular groups of people. One in every twenty sex workers in Guatemala is HIV-positive. Programs that educate these at-risk women on how to protect themselves will be critical to the country’s ability to keep the epidemic from spreading beyond this group to surrounding communities.

I met with a peer educator named Noemi, who works with a USAID-supported education program that is implemented by a PSI affiliate in Guatemala.  Shunned by family after the death of her mother, Noemi was forced from an early age to fend for herself. At fourteen, her grandmother sent her away and suddenly she stood alone in the world.

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World AIDS Day: New Advances Are Critical to Achieving the Vision of an AIDS-free Generation

An activist sets up a red ribbon during the commemoration of the World AIDS Day in San Salvador, on December 1, 2010. AFP PHOTO/ Jose CABEZAS

Featured on Huffington Post

For the first time since the AIDS virus surfaced, devastating communities and overwhelming nations, the world has the tools and knowledge to ensure an entire generation is born free from its scourge. By building on a strong legacy of progress and bipartisan support and relying on proven interventions and new breakthroughs, the United States is leading the world in making real the vision of an AIDS-free generation.

Our efforts at home and abroad have informed each other. HIV prevention and treatment approaches pioneered in Nairobi and Cape Town now benefit communities in the U.S. Thanks to President Obama’s strong support of the President’s Emergency Plan for AIDS Relief—better known as PEPFAR—millions of patients worldwide are able to receive affordable treatment that used to be out of reach.

At the same time, American researchers and pharmaceutical companies have made game-changing discoveries that are helping save millions of lives around the world.

Despite these successes, every day more people become infected than start treatment. Every day, more people—many of them women and children—join the ranks of the already 34 million living with HIV today. In order to end this devastating reality, we have to work faster, more effectively and more efficiently than ever before.

As Secretary Clinton recently said, our efforts must begin with the American people—and our drive for innovation, unfailing sense of generosity and track record of breakthrough research.

To realize the future of an AIDS-free generation, we have to strategically focus our efforts on proven, cost-effective ways to fight against HIV/AIDS: stopping mother-to-child transmission, expanding voluntary medical male circumcision, supporting community adherence and investing in new biomedical tools.

But we also have to focus on propelling new advances.

Just a few months ago we saw new results that demonstrated the effectiveness of HIV medication taken orally, once a day, at not just treating HIV but preventing its transmission.

Discoveries like this may one day change the way we fight AIDS, both in America and in developing countries.

As the head of a federal agency dedicated to improving human welfare, I have seen firsthand the deeply moral, social and economic costs of HIV/AIDS: children who have been born HIV-positive and find the odds in life already stacked against them; businesses close in regions where HIV is rampant while hospitals fill up; and the despair fueled by a single disease.

This reality has always been unacceptable. For the first time, we can confidently say it is also avoidable. With the continued support of a remarkable bipartisan constituency of congressional leaders, faith-based institutions, multilateral alliances and private sector partners, we can build on the momentum of proven results and scientific discoveries.

Today, as we once again mark World AIDS Day, we should do so knowing the world finally has the ability to create a future without AIDS.

Open for Questions: The Beginning of the End of AIDS

As featured on The White House Blog

Tomorrow is World AIDS Day, and President Obama will be marking the occasion by speaking at ONE Campaign and (RED)’s Beginning of the End of AIDS event at George Washington University. You can watch the whole event live on YouTube.com/TheONECampaign.

Later in the day, Gayle Smith, Special Assistant to the President and Senior Director for Development and Democracy at the White House, and Ambassador Eric Goosby, U.S. Global AIDS Coordinator, will be taking your questions on the global AIDS epidemic and what the Obama Administration is doing to bring it to an end.

  • What: Open for Questions: The Beginning of the End of AIDS
  • Who: Gayle Smith, Special Assistant to the President and Senior Director for Development and Democracy at the White House, and Ambassador Eric Goosby, U.S. Global AIDS Coordinator
  • When: Thursday, December 1 at 2:30 p.m. EST
  • Where: Watch live at WhiteHouse.gov/live and submit your questions via Facebook, Twitter using the hashtag #WHChat or our webform.

Managing HIV/AIDS Medicines and Supplies in Tanzania

Jay Heaver is the Director of Knowledge Sharing and Communications for SCMS (Supply Chain Management System).

On a recent trip to Tanzania, I made several site visits in and around Mwanza, a beautiful city along Lake Victoria, about 1200 km from the capital of Dar es Salaam. My tour guide was Eric Shoo, one of the growing team of supply chain monitoring advisors (SCMAs) hired by SCMS to work in Tanzania’s nine Medical Store Department zonal stores.

Based out of the Medical Stores Department (MSD) in Mwanza, Eric travels around the region training staff in a range of skills, including data gathering and reporting, ordering of supplies from MSD per established timelines, and stock management. He also follows up with local mentors who were trained by SCMS so that when trained staff leaves, new staff will be trained to take over their duties. (As in many PEPFAR-supported countries, staff turnover is high.)After a long day of site visits to the MSD offices in Mwanza, the Sengerema District Council and the Sengerema Designated District Hospital, we ended our tour at the Katunguru Health Center.  The Center is one of a growing number of small health facilities bringing HIV/AIDS care and treatment services closer to patients in Tanzania.  Facilities like these treat the hardest-to-reach patients, and for Tanzania’s HIV/AIDS program to succeed, health centers like Katunguru must carefully track their supply of medicines, report their usage rates to MSD and place quarterly orders with the MSD warehouse.

Eric had hoped to introduce me to two staff members at the center whom SCMS had trained.  However, since we arrived late in the day, the only person still there was Zawadi Makopa, a medical attendant who cheerfully offered to show us around.

Part of Eric’s job is to review the logistics forms that are essential for a fully functioning treatment program: documents with names like the daily dispensing register, stores ledger and quarterly reporting and requisition forms. He was delighted to see that all the forms at Katunguru were up-to-date and filled out correctly.  In the small medicines store room, Zawadi showed us medicines neatly arranged on shelves with hand-lettered labels and bin cards correctly filled out to track daily inventory levels.

After a bit of discussion with Zawadi in Swahili, a smile spread over Eric’s face.  For my benefit, he translated: Zawadi had told Eric that, in July, her supervisor had trained her how to fill out all the forms and manage the store room. Eric had just seen proof that SCMS’s training of mentors was working.  In this corner of Tanzania, the country is moving towards ownership of its HIV/AIDS supply chain. And that will mean all the difference to people who rely on this isolated clinic for their supply of life-saving medicines.

The Supply Chain Management System (www.scms.pfscm.org) is a project of PEPFAR and is administered by USAID.

USAID Epidemiologist Q & A on Hormonal Contraception and HIV

This post was originally featured on the International Conference on Family Planning blog.

In October, The Lancet Infectious Diseases published a study by Renee Heffron and colleagues suggesting that HIV-negative women using hormonal contraception (HC) might be at increased risk for HIV infection. The study also suggested that HIV-positive women using HC might be at increased risk of transmitting HIV to an uninfected male sexual partner. These new findings will be a topic of conversation at the 2011 International Conference on Family Planning later this month in Dakar, Senegal.

Chelsea Polis is an epidemiologist at USAID who received her PhD in reproductive health from the Johns Hopkins Bloomberg School of Public Health (JHSPH) in 2009, and holds an associate faculty appointment in the JHSPH Department of Epidemiology. Working with colleagues at CDC and WHO, Polis is leading two systematic reviews of the evidence to address HC and HIV risk. She offered her perspectives in the following emailed Q&A.

Should women reconsider their HC use in light of this study?

No; at this time, women need not reconsider their HC use in light of this study alone. For the time being, USAID and WHO have not recommended any change to current contraceptive guidelines. Careful evaluation of the Heffron study is underway. This study has several strengths, but also has limitations that complicate the ability to draw definitive causal inference between HC and HIV risk. In addition, previous studies have found inconsistent results. The scientific community is intently focused on understanding and incorporating new evidence in a thorough but rapid manner, and is working to establish consensus on interpretation of the new findings.

It remains critical that known risks and benefits of various contraceptive methods are clearly communicated. If it is ultimately determined that HC increases HIV risk, this will need to be communicated. People should also be informed that HC is not intended to protect against HIV or other sexually transmitted infections (STIs), and that dual protection against unintended pregnancy and STIs/HIV may be achieved by using condoms along with a highly effective contraceptive method.

Why is HC use important, particularly in settings of high HIV risk?

HC methods are highly effective at preventing pregnancy, and are among the most commonly used contraceptive methods in sub-Saharan Africa. Unintended pregnancy is associated with multiple adverse outcomes, including maternal and infant mortality. HIV-positive women report high rates of unintended pregnancy, and helping these women access voluntary contraceptive services could contribute to reductions in perinatal HIV. Furthermore, unanswered questions remain with respect to the relationship between pregnancy and risk of HIV acquisition in women and transmission to men. Competing risks must be carefully considered.

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