3.27.2007
Hard times in Harare
In his old age, Mugabe's losing his grip, and Zimbabweans will bear the brunt. Never subtle, Mugabe drew the world's attention when his thugs attacked, killed and intimidated white farmers off of their land, but not when he drove the economy into the ground and cleared out slums with bulldozers in parts of the city that happened to be heavily suppotive of the opposition. His armed gangs have trashed and closed down the country's free press, have beaten civilians into reciting loyalty oaths, and has done so with impunity because of his status as one of the heroes of Zimbabwe's liberation and his tactic of blaming his country's problems on Western imperialism. By the way, current inflation is 1,700% and everything, everything is under government ration.
This week Mugabe made it into the international pages by sending heavily armed policemen to a prayer vigil led by the opposition, where they brutally beat the leaders of the two factions of the opposition party. Imagine turning on the TV during the 2004 presidential campaign and seeing John Kerry escorted to court with a huge gash on his forehead and an eye swollen shut. The US and Europe already have targeted sanctions on Zimbabwe, and have spoken out, but their words and actions have been dismissed as imperialist rhetoric.
It would seem that Zimbabwe has come to a turning point, but which way will it turn? Mugabe's party is ready to see him go, but he may decide that, in his 80s, he is ready for another term. The opposition party is divided and may spend more time on infighting than on rebuilding the nation. The archbishop of Zimbabwe has called for mass peaceful protest. After years of silence, African leaders are finally ready to condemn Mugabe's government and this Wednesday Mugabe will attend talks in Tanzania. What will happen next? Will the world be watching? 12 million+ Zimbabweans hang in the balance.
This week Mugabe made it into the international pages by sending heavily armed policemen to a prayer vigil led by the opposition, where they brutally beat the leaders of the two factions of the opposition party. Imagine turning on the TV during the 2004 presidential campaign and seeing John Kerry escorted to court with a huge gash on his forehead and an eye swollen shut. The US and Europe already have targeted sanctions on Zimbabwe, and have spoken out, but their words and actions have been dismissed as imperialist rhetoric.
It would seem that Zimbabwe has come to a turning point, but which way will it turn? Mugabe's party is ready to see him go, but he may decide that, in his 80s, he is ready for another term. The opposition party is divided and may spend more time on infighting than on rebuilding the nation. The archbishop of Zimbabwe has called for mass peaceful protest. After years of silence, African leaders are finally ready to condemn Mugabe's government and this Wednesday Mugabe will attend talks in Tanzania. What will happen next? Will the world be watching? 12 million+ Zimbabweans hang in the balance.
3.15.2007
The Thesis
I'm handing in my first full draft tomorrow and had to provide a lay summary. Thought it might be interesting to those of you who have been watching my page count go up (73!)
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HIV can be transmitted from mother to infant during pregnancy, in labor, or after delivery during breastfeeding. In developed countries, mothers who test positive for HIV receive a combination of at least three antiretroviral medications and use replacements for breastmilk to feed their infants. With these interventions, fewer than 1% of HIV infected mothers transmit HIV to their babies. In sub-Saharan African countries, however, only 10% of pregnant women have access to antiretroviral medications or breastmilk replacements. Without interventions, 30-40% of these women will transmit HIV to their infants.
WHO recommendations for prevention of mother to child transmission of HIV (PMTCT) in low resource settings is a combination of two to three drugs taken for a few weeks prior to labor and delivery. This efficacious regimen reduces transmission to below 5% in these settings. But the majority of the women in Africa who have access to PMTCT receive single-dose nevirapine, where they take one pill during labor and the infant receives one dose of liquid medicine after delivery. With this regimen, roughly 8 to 15% of infants will be infected. This thesis asks the question: What policy changes are necessary to move away from the single dose nevirapine strategy towards wider implementation of the more efficacious regimens?
On the international level, there are UN agencies, multilateral donors, bilateral donors, and international non-governmental level. Governments of the countries in Africa also play a key role in policy making and goal setting for PMTCT. Finally, a number of factors affect the effective implementation of the PMTCT programs. By looking at a case study of a change in the choice of primary drugs for malaria in several countries, I will provide analysis and recommendations for each of these levels of action—international, national, and implementation level.
* * *
HIV can be transmitted from mother to infant during pregnancy, in labor, or after delivery during breastfeeding. In developed countries, mothers who test positive for HIV receive a combination of at least three antiretroviral medications and use replacements for breastmilk to feed their infants. With these interventions, fewer than 1% of HIV infected mothers transmit HIV to their babies. In sub-Saharan African countries, however, only 10% of pregnant women have access to antiretroviral medications or breastmilk replacements. Without interventions, 30-40% of these women will transmit HIV to their infants.
WHO recommendations for prevention of mother to child transmission of HIV (PMTCT) in low resource settings is a combination of two to three drugs taken for a few weeks prior to labor and delivery. This efficacious regimen reduces transmission to below 5% in these settings. But the majority of the women in Africa who have access to PMTCT receive single-dose nevirapine, where they take one pill during labor and the infant receives one dose of liquid medicine after delivery. With this regimen, roughly 8 to 15% of infants will be infected. This thesis asks the question: What policy changes are necessary to move away from the single dose nevirapine strategy towards wider implementation of the more efficacious regimens?
On the international level, there are UN agencies, multilateral donors, bilateral donors, and international non-governmental level. Governments of the countries in Africa also play a key role in policy making and goal setting for PMTCT. Finally, a number of factors affect the effective implementation of the PMTCT programs. By looking at a case study of a change in the choice of primary drugs for malaria in several countries, I will provide analysis and recommendations for each of these levels of action—international, national, and implementation level.
3.13.2007
Goodbye Alice
I won't try to be original in this post. I opened the email entitled "tragic death" idly, not expecting to find a familiar face grinning back at me. Alice was a genius MD-MPH who spent more hours at school than anyone else but was always ready to laugh about it anyway. On a visit home, she was struck and killed by an empty school bus, turning left. So it is that you can be visiting your mom in New York and step into the intersection, beckoned by a walk sign that you'll never reach and that's it, that's your life, thanks for playing. As for the rest of us--mother, busdriver, acquaintances, bystanders--the pieces are ours to pick up and carry as we wake up each morning and step off the curb.
3.12.2007
Teeth
I've been thinking about teeth lately. Other people's, mostly, as I pretty much take mine for granted. Growing up with parents who were federal employees, dental care was always covered, even some of the cost of my braces to close the two matching gaps where no adult molars grew in. At 17, braces seemed a near-universal rite of passage, like taking the SATs.
But in my internship at an outreach center serving Atlanta's homeless population, I've realized what a blessing having lifelong access to dental care is. Most of our guests have had at least one tooth pulled for tooth decay, and many older adults are missing most of them. They may have had dentures at some point but in the chaos of their lives, they have broken or been misplaced. I honestly don't know how you manage when you have nothing to chew with and no way to control where your food comes from and what it is. Having no teeth slurs your speech and changes your appearance. There is an agency that provides free cleanings adn extractions; for too many of my guests, it is too late for that. For anything more serious, you have to pay. So they remain in pain and at risk for worse.
Recently, a young boy near DC died from complications related to an untreated abscess in his tooth, despite the fact that his mother had been trying to obtain care for him and his siblings. Today I heard the story of a working class woman in Atlanta who is struggling with mountains of debt from treatmes for complications from an abscess that she couldn't afford to treat, because she was uninsured. In America, in 2007, people are suffering from conditions that we have been treating since the middle ages.
3.04.2007
A client
8, 6, 4, 1 and 7 weeks. Those are the ages of the children my client, an African-American woman a year older than I am. I am at my twice-weekly internship at a homeless service agency downtown. As we fill out papers I ask if she is currently pregnant, and she laughs out loud and says no, thank God.
She is getting her life back together, living in a transitional women's shelter, recovering from addiction, abiding by the terms of her parole. When I ask her if she likes the place, she gushes: it's clean, it's safe, they have great classes that teach her how to manage her anger and how to fight addiction. She says that if she had known how nice it was, she would have brought her children with her. As it is, they are staying with her partner's family. She has asked so much from them that she feels she can't ask for the $10 she needs to get a copy of her birth certificate. That is why she came to our agency, and I help her fill out the form and send away for the document, to be returned in three weeks.
This is the type of tiny victory the agency specializes in; the administrative tasks that help homeless men and women to reclaim their dignity and their citizenship. With clients like this, we feel like we are succeeding. More to come.
She is getting her life back together, living in a transitional women's shelter, recovering from addiction, abiding by the terms of her parole. When I ask her if she likes the place, she gushes: it's clean, it's safe, they have great classes that teach her how to manage her anger and how to fight addiction. She says that if she had known how nice it was, she would have brought her children with her. As it is, they are staying with her partner's family. She has asked so much from them that she feels she can't ask for the $10 she needs to get a copy of her birth certificate. That is why she came to our agency, and I help her fill out the form and send away for the document, to be returned in three weeks.
This is the type of tiny victory the agency specializes in; the administrative tasks that help homeless men and women to reclaim their dignity and their citizenship. With clients like this, we feel like we are succeeding. More to come.
3.02.2007
Public Health Geeks
Things that happen at the school of public health:
You reach into a pocket of your backpack and a condom falls out because you can't seem to walk into the building without getting handed a free one.
The student government president gets elected on a campaign to provide more free...carrots.
People stay at school until 11 pm just so they won't have to pay for parking. It's not a lucrative field, shall we say.
You're having a sophisticated evening out and the conversation turns to poop, and/or sexually transmitted diseases, and/or the coming plague.
People ask you where, not if, you did Peace Corps.
People don't use hand sanitizer because they're afraid of antimicrobial resistance, and they throw away perfectly good food because they're afraid of food poisoning. Basically, we're terrified of bacteria.
Everyone laughs heartily at jokes that include the words "p-value".
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