USAID Impact Photo Credit: Nancy Leahy/USAID

Archives for Health

A Tale of Two Citizens

Posted by  on Wednesday, January 12th 2011     

By: Clydette Powell, MD, MPH, FAAP

It was the best of times; it was the worst of times.  January 12’s earthquake, epicentered in Port-au-Prince, killed over 200,000 people, but also mobilized one of the largest humanitarian disaster responses in the Western Hemisphere in the last 60 years.  As Medical Officer at USAID/Washington, I was part of that response.

Dr. Clydette Powell on the USNS COMFORT in January 2010. Photo Credit: USAID/Global Health

They lay in adjacent incubators – two of Haiti’s newest citizens – one born in Port-au-Prince, the other born on a ship in the harbor. Both premature, weighing in at some three pounds.   Catherine was born one day before the earthquake. Barely 24 hours old on January 12, 2010, Catherine and her mom were suddenly homeless.  Her mom could not breastfeed, and Catherine became dehydrated and ill. After days of wandering the streets of Haiti’s capital city, Catherine’s mom was found by a medical triage team who sent them both to the US Navy hospital ship, the USNS COMFORT, which had just arrived in the harbor. On board, Isabella Rose, her incubator neighbor, had just been born by C-Section. Her mom had been severely injured during the earthquake, and went into premature labor. Again, another triage team sent Isabella Rose’s mom for emergency obstetrical care on the USNS COMFORT, and Isabella Rose took her first breaths on board a US Navy hospital ship.

On the evening of January 12, I had seen the broadcasts of the earthquake’s devastation and the misery it brought to people of a country where I had worked for USAID on numerous short term assignments since 2001. Without hesitation, I volunteered to be part of USAID’s response to this disaster.  Being the civilian-military liaison for our Health Office within the Bureau for Global Health, the medical officer in the Infectious Disease Division, and a member of the Haiti Health Team provided the foundation for quick deployment.  Invited by the Commanding Officer to serve on the USNS COMFORT, I sailed down with its crew and found myself in several roles, including as neurologist in the Pediatric Intensive Care Unit, when Catherine and Isabella Rose arrived.

Our USAID/Haiti Health team, themselves survivors of the earthquake, and our team on board the COMFORT quickly established communication links. We worked in tandem to triage, transport, and care for the most severely injured.  During the course of two months, the ship-based and the land-based teams collaborated in the care of over 1,000 patients. More than 2,000 helicopter flights transported patients and teams between ship and land. Public health priorities and support for the stewardship role of the Haitian Ministry of Health became daily (and nightly) discussions of both the ship and USAID land-based teams. As the relief effort grew, so did the complexities of patient management, the coordination of care, and the optimization of public health disaster relief responses.  Yet on a microcosm, there were still the Catherines, the Isabella Roses, and other children—the displaced, the orphans, some likely restaveks—and injured adults,  all of whom  sought emergency medical care on board the USNS COMFORT.

As I look back to one year ago, representing USAID in the Haiti earthquake response  generated in me a renewed sense of patriotism, increased admiration for our USAID/Haiti team,  greater esteem for the US Navy,  lasting gratitude for my medical and public health skills, and an even deeper respect  for  the Haitian people.  In the worst of times/best of times perspective, Catherine received her angel wings, to use the Navy parlance, but Isabella Rose bloomed. One of Haiti’s newest citizens, she became a symbol of her people’s resilience, and a tiny testimony to the effective collaboration of USAID, the US Navy, and the non-governmental organizations when all things can work together for the good.

Pharmaceutical Management – Assuring the Quality and Safety of Medicines

Posted by  on Tuesday, January 11th 2011     

By Maria A. Miralles, PhD, USAID’s Senior Pharmaceutical Management Advisor

At the moment of using a medicine, do we trust that the product is of good quality and will not cause us any harm?   For those who live in countries with competent regulatory agencies and functioning systems, the answer is yes and this trust is generally well-placed.  This is pretty amazing when you consider the myriad of opportunities for problems to arise, from product development through to manufacture, distribution and use.  So, not many people were alarmed in April 2010 when the FDA informed the manufacturers of Children’s Tylenol® of violations in its Pennsylvania manufacturing plant affecting several dozens of products. The company immediately issued a voluntary recall, products were withdrawn from the market, potentially related morbidities and deaths were subsequently monitored.[i] Unfortunately, many developing countries lack the capacity to protect their citizens in this way, much less to protect them from unscrupulous drug manufacturers and vendors. What should be a matter of trust is more like a tragic game of chance with devastating odds.

Counterfeit ampicillin discovered through the PQM monitoring program in Southeast Asia. Photo Credit: Christopher Raymond (PQM/USP)

Many of us can remember the deaths of 138 Panamanians who consumed tainted cough syrup in 2006 and the 84 children in Nigeria in 2008 that were exposed to a teething medicine made with a counterfeit ingredient.  In both cases, investigations determined that these deaths could have been avoided had the responsible systems and authorities been vigilant and the systems sufficiently responsive.[ii] Deaths are not the only sign of potential product quality and patient safety problems.  Antimicrobial medicines with sub-therapeutic quantities of active ingredients have contributed to the rise in resistant strains of various infectious diseases rendering existing cheaper products useless and prolonging treatment periods. There is no question that there are likely to be many others cases we will never know about because they have occurred in places where there was no system in place to properly document them.

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Supporting Sustainable Livelihoods and Nutritious Meals

Posted by  on Friday, January 7th 2011     

By: Jessica DiRocco

Food and nutrition are important elements across all cultures. In America there is a renewed sense of instilling good nutritional habits in children through the First Lady’s campaign against childhood obesity and the newly signed Healthy, Hunger-Free Kids Act. At USAID, we are concerned with not only feeding those in need around the world, but making sure they have access to healthy and nutritious meals on a regular basis, as well as a sustainable livelihood.

But for many people living with HIV/AIDS (PLWHA) like Thabit Obed, a farmer from Uganda, managing one’s health is no easy task. The infection causes or aggravates malnutrition through reduced food intake, increased energy needs, and poor nutrient absorption. Malnutrition weakens the immune system, which can hasten the progression of HIV, increase susceptibility to opportunistic infections, and reduce the effectiveness of treatment. Since food and nutrition support is such a critical component of successful HIV/AIDS care and treatment, USAID has an invested program to help those in need.

Mr. Thabit Obed, has mobilized fellow PLWHA to produce groundnuts for therapeutic food to treat malnourished PLWHA. Photo Credit: Mary Nabisere/NuLife

Thabit is a recipient of support from the USAID-funded program, NuLife—Food and Nutrition Interventions for Uganda, a program managed by University Research Co., LLC (URC) that works to improve the health and nutritional status of people infected and affected by HIV/AIDS through integration of nutritional assessment, counseling, and support (NACS) into HIV/AIDS services.

In addition to producing and prescribing food, such as RUTAFA a ready-to-use therapeutic food, the program also works to provide opportunities for farmers in Uganda to expand their businesses.

Through a partnership with RECO Industries, Ltd, a local manufacturer which produces RUTAFA, Thabit was able to expand his small coffee bean farm and begin growing groundnuts.

Thabit, an active community volunteer, became one of more than 4,000 farmers to grow groundnuts as input for RUTAFA. He was trained to support other PLWHA and raise awareness about HIV testing, counseling and treatment.

Through this program and similar partnerships, USAID NuLife has been able to help ensure HIV positive individuals who have recovered from malnutrition through treatment with ready-to-use therapeutic food are being offered an opportunity to earn a living, support their families’ and maintain a healthy nutritional status.

USAID/Uganda designed a program that not only reaches HIV positive clients with critical services and supports local industry and individual farmers, but connects those clients to sustainable livelihood opportunities producing inputs for the very product, RUTAFA, which can support their health and that of their fellow PLWHA.

“Helping Babies Breathe” Global Development Alliance Results in New Innovative Company

Posted by  on Thursday, January 6th 2011     

By: Lily Kak, Senior Maternal and Newborn Health Advisor

Sixty seconds – that is all it takes to breathe life into a newborn that is gasping for air.  This is the golden minute that can mean the difference between life and death for a newborn who is not breathing.  Jubaida, the community midwife, from Bangladesh was trained and equipped to act rapidly and appropriately when she heard no cry and felt no breathing when Baby Shifa was born.  Jubaida gently dried and rubbed the baby and, as the family looked on, she used a bag and mask and helped Baby Shifa breathe as the hands of the clock ticked by.

Helping baby Shifa breathe in Bangladesh. Photo Credit: Tore Laerdal

Every year, 10 million babies require help to breathe immediately after birth. Simple means to stimulate breathing, including drying and rubbing, and ventilation with bag and mask, could save the majority of these babies. Such lifesaving care is currently only available for less than one out of four newborns.  Scaling up newborn resuscitation is challenging because it requires provider skills, appropriate equipment, and systems strengthening.  In order to meet the Millennium Development Goal 4, birth attendants in large numbers must acquire the basic skills and equipment to help newborns breathe.

Challenged by this, USAID searched for a feasible and effective approach to scale up newborn resuscitation and found the answer in the Global Development Alliance model.  On June 16, 2010, USAID launched a Global Development Alliance (GDA).  The objective of the GDA is to reduce newborn mortality by expanding access to high-quality, affordable newborn resuscitation training materials and devices, improving the competence of birth attendants to resuscitate newborns, strengthening health systems and promoting global commitment and resources for life-saving newborn care.  A seemingly impossible task of scaling up newborn resuscitation became programmatically possible by bringing together diverse partners in an alliance.

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From Lab to Communities: Pioneering Low-Cost Approaches to Prevent Death and Treat Severe Illness

Posted by  on Thursday, January 6th 2011     

The third installment of the 2010 Health Research Report to Congress is newborn health. Today, we look at USAID’s seminal role in working to focus global attention on the issue of newborn survival as well as its investments in establishing the research foundation for action in this area.

By: Neal Brandes, Health Advisor

USAID works to accelerate innovations through the complete development cycle — out of the labs and through a massive scale-up, into the communities to directly benefit the world’s poor. Our goal is to develop ways to save more lives and reduce the burden of diseases as effectively and efficiently as possible.

Of the estimated 8.8 million children under 5 that die each year – 3.7 million are newborn infants who die within the first four weeks after birth. Up to two-thirds of these deaths can be prevented through existing effective interventions delivered during pregnancy, childbirth and in the first hours, days and week after birth. USAID develops and tests simple, low-cost approaches with the greatest potential to prevent death and treat severe illness in low-resource settings with limited access to quality facility-based care.

An Afghan nurse checks a crying newborn boy who was born that morning in the maternity ward of a hospital in Kabul on March 15, 2010. Afghanistan has one of the highest maternal mortality rates in the world with an estimated 1,800 maternal deaths per 100,000 live births. Photo Credit: AFP PHOTO/BEHROUZ MEHRI

A growing body of knowledge has shown that home visits by appropriately trained workers to provide newborn care can significantly reduce neonatal mortality even where health systems are weak. Building on an evidence review, WHO/UNICEF released recommendations in 2009 providing new guidance on the importance of home visits in a baby’s first week of life. USAID is promoting and supporting partner country adoption of these recommendations into national programs, encouraging further investment in this area and assisting with capacity building efforts for health care providers and community cadres providing home-based care.

In countries with high mortality rates and weak health systems, high impact community-based approaches such as diagnosis and treatment of child pneumonia and newborn sepsis must be as accessible when it is needed to the people who stand to benefit the most. Approximately one-third of newborn deaths can be attributed to infections caused by birth in unhygienic conditions. A multi-country trial supported by USAID, in partnership with the Bill & Melinda Gates Foundation’s Save the Children/Saving Newborn Lives program; and WHO, is researching different combinations of oral and intramuscular antibiotic regimens for simplified treatment of newborn sepsis in the community.

Each year, 10 million babies suffer from birth asphyxia; 10 percent of these newborns do not survive. USAID has supported the development and validation of newborn resuscitation training materials and devices used to develop the American Academy of Pediatrics’ Helping Babies Breathe (HBB) training curriculum. The Helping Babies Breathe Global Development Alliance (GDA), a public-private partnership launched by USAID along with several partners, is introducing HBB in multiple countries and offers evidence-based training and technical support on newborn resuscitation and high quality, affordable resuscitation devices to birth attendants in low-resource settings.

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Photo Essay: Riding for Health in Lesotho

Posted by  on Monday, January 3rd 2011     

The USAID-supported Horse Riding for Health program engages pony riders and motorcycle riders to transport blood tests, drugs, and supplies to Lesotho’s remote mountain health clinics.

Maamohelang kisses her son

Maamohelang kisses her son. In August 2008, her baby was born, HIV-free. His name is Rebone, which means "we have witnessed." Maamohelang continues to take HIV treatment, thanks to the support of USAID and the Riders for Health program. Photo Credit: Reverie Zurba/USAID

The system allows people to receive HIV test results sooner, access life-saving drugs, and ensure an uninterrupted supply of medication.

In this photo essay, follow the riders to homes and clinics throughout tiny Lesotho to meet:

Maamohelang Hlaha: An HIV-positive mother of four whose village is inaccessible by vehicles and a three-hour hike from the nearest health clinic

Potso Seoto and Thuso Khanare: Dedicated riders who transport life-saving medicines while supporting their families through a stable job

Dr. Leopold Buhendwa: The Elizabeth Glaser Foundation’s Lesotho country director who works to prevent mother-to-child transmission of HIV

Integrating Family Planning, HIV, and MNCH Services in Ethiopia and Kenya

Posted by  on Thursday, December 30th 2010     

By Ed Scholl, AIDSTAR-One Project Director,  AIDSTAR-One is funded by USAID’s Office of HIV/AIDS, and provides rapid technical assistance to USAID and U.S. Government country teams to build effective, well-managed, and sustainable HIV and AIDS programs and promotes new leadership in the global campaign against HIV.

Alice arrives at a health center in Western Province, Kenya, with her nine-month-old baby girl, who has a recurrent fever. Alice suspects malaria, which is endemic in the area. Two hours later, she leaves with malaria medication and a free insecticide-treated bed net. To the casual observer, Alice got what she came for and had her health needs met. She even received a bed net she wasn’t expecting.

A nurse in Meshualekia Health Center, in Addis Ababa, explains how to use the injectable contraceptive, Depo-Provera. The client will also be offered an HIV test as part of the Ministry of Health's efforts to integrate HIV and family planning services. Photo Credit:Ed Scholl, AIDSTAR-One

But consider what Alice didn’t receive. Had her daughter been weighed, the nurse would have noticed that her growth was faltering because Alice is not yet supplementing her diet with nutritious weaning foods. Her daughter also missed the measles immunization she was due for. Alice was not offered an HIV test, which would have revealed that she is HIV-positive. Finally, no one asked Alice, who has six children and does not want to get pregnant again, if she is using a family planning method or would like information about contraceptives available at the health center. In short, Alice’s immediate need was met, but multiple underlying health needs went undetected by the health center staff.

Alice’s story is unremarkable. Similar scenes play out every day in health care settings around the world. In sub-Saharan Africa, where the burden of HIV, unintended pregnancies, and infant mortality is highest, missed opportunities to meet health care needs, such as those of Alice and her baby, can be deadly.

Fortunately, programs in Kenya and Ethiopia are leading the way in integrating family planning, HIV, and maternal/neonatal and child health (FP/HIV/MNCH) services. In Kenya, the government has made integration of FP and HIV a national policy. USAID/Kenya’s AIDS, Population and Health Integrated Assistance II (APHIA II) project promotes integrated service delivery throughout the country in public, private, and faith-based facilities. Visiting the APHIA II project in Western Province (implemented by PATH), I noted that the Ministry of Health trains nurses and health officers to deliver both FP and HIV services. The project has supported FP/HIV/MNCH integration at 276 health centers and hospitals in Western Province. USAID/Kenya’s new APHIA Plus Project will expand integrated services in 2011.

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Pic of the Week: “A Historical Look Back”

Posted by  on Thursday, December 23rd 2010     

USAID 50th Anniversary Logo

The work of USAID has been far-reaching and long-standing as evidenced by this photo of a Peace Corps volunteer working in the ORT center funded by USAID. In the mid 1970's Joan Wadelton, a Peace Corps Volunteer from Princeton, New Jersey, holds one of the children she helps at a maternal and child health center in Niger. The center is operated by ORT, a voluntary agency, and the Nigerienne Ministry of Health, is financed by USAID. Photo Credit: USAID

Maternal Death Preventable and Treatable with Low-Cost Interventions

Posted by  on Wednesday, December 22nd 2010     

Submitted by Deborah Armbruster, Sr. Maternal and Newborn Health Advisor

In September, the World Health Organization (WHO) reported that fewer women die each year from complications during pregnancy and childbirth than previously estimated, but efforts to sharply cut maternal mortality by 2015 are still off track. A new report found that 358,000 women died during pregnancy or childbirth in 2008, mostly in poor countries of sub-Saharan Africa and South Asia. While the number of deaths is disturbing enough, it is estimated that an additional 15-20 million women suffer debilitating consequences of pregnancy.

Despite the challenges faced in reducing maternal mortality, USAID has helped to demonstrate that real progress can be made.  Our work proved that many of the major causes of maternal death are substantially preventable and treatable with low-cost interventions.  USAID has sharpened its focus on a set of effective interventions targeting high-mortality complications of pregnancy and birth – hemorrhage, hypertension, infections, anemia, and prolonged labor.  Together, these complications account for two-thirds of maternal mortality.  Hemorrhage alone accounts for almost one-third, and USAID has been in the forefront of promoting “active management of the third stage of labor (AMTSL),” a highly-effective technique for preventing postpartum hemorrhage.

The active management of the third stage of labor is a combination of actions to speed the delivery of the placenta and prevent up to 60% of postpartum hemorrhage cases. Through these simple actions, trained providers can prevent postpartum hemorrhage and play a vital role in saving women’s lives.

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How You’re About to Help Save the Lives of 4 million Children

Posted by  on Tuesday, December 21st 2010     

By Amie Batson, Deputy Assistant Administrator, Global Health Bureau

You may not know that the leading killers of children in the poorest countries are diarrhea and pneumonia.  You almost certainly don’t know that your contributions can help save the lives of 4 million children – many because of the introduction of two new vaccines to protect against those diseases.

Last week, I was in Rwanda, helping the Global Alliance for Vaccines and Immunization plan the introduction of vaccines for rotavirus and pneumococcal diseases, major causes of diarrhea and pneumonia.  With your support as well as corporations, foundations, and countries rich and poor, GAVI, will save the lives of 4 million children in the next five years.

That sounds ambitious, but it’s very doable – and you’re a big part of the reason. With your help, GAVI supported childhood immunization in poor countries over the last 10 years, saving the lives of 5.4 million children, and shielding millions more from the long-term effects of illness on growth and development.

The U.S. has been a leader in immunization, but we can’t do it alone. Working with and through groups like GAVI helps ensure that other donor countries, companies and foundations, as well as developing countries themselves, all contribute their share: a global solution to a global problem. In addition to the U.S., fourteen other countries and the European Union are donors, and The Bill & Melinda Gates Foundation is also a generous supporter.

People have been a big part of that success as well. GAVI has had strong, high-level leadership – the Rwanda meeting marked the last for Mary Robinson, the former president of Ireland who served as chair of GAVI’s board, who deserves thanks for her advocacy. Norway has been a global leader in the fight to immunize children in the poorest countries, and its former health minister, Dagfinn Hoybraten, took over as chair – underlining Norway’s continuing commitment.

U.S. leadership isn’t just a matter of money.  The expertise of people at USAID has been crucial as well.  Since the ‘70s, USAID professionals have worked with partners across the globe to confront the challenge of vaccine-preventable diseases and help immunize children in remote parts of the world.  Working with an efficient partner like GAVI that mobilizes resources from other countries, foundations and companies multiplies the impact of U.S. expertise, as well as dollars.

GAVI is a model for the new approach the U.S. is taking through the Global Health Initiative: an innovation approach, a public-private partnership seeking innovative sources of finance for vaccines for poor countries, investing in children, with a clear focus on measurable results.  GAVI is a true partnership, accomplishing more than any nation could do on its own, and doing it efficiently, with a small staff.

As the U.S. expands the life-saving impact of our global health assistance through the Global Health Initiative announced by President Obama, our support for immunization will continue, because it is one of the most cost-effective ways to save lives and promote health.  Reaching children with this simple, affordable intervention is one of the smartest investments in global health – and the right thing to do.  And we can do it in a way that builds national systems, so they won’t need help forever.

These times demand that we provide more health for the money we invest in global health. Despite the success of immunization programs, vaccine-preventable diseases are still estimated to cause more than 2 million deaths every year.

We will help because compassion is a fundamental American value — and so is efficiency in using the resources we have, innovation to make those resources go further, and realism to know we can’t do it all by ourselves.  Working with and through GAVI, we have changed the future of millions of children and families. That’s effective, efficient realistic compassion, and it’s worth doing more.

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