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International Health

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Title: International Health


1
International Health
  • Whats Happening on the Field

Nikhil Pai, Amane Abdul-Razzak, Hinal Sheth,
Sarah Hynek, Baldeep Chera, Megan Arthur, Saira
Nawaz, Jessica Liauw, Katy Smali
2
Goals of Todays Presentation
  • Offer you a whirlwind look at whats happening in
    International Health today
  • Whos involved
  • Access to Essential Medicines Campaign
  • Engineering Public Health The West Bank Iraq
    Case Examples
  • Whats happening at McMaster University
  • Questions for discussion
  • Please write on cue cards during presentation

3
Organizations Operating Today
  • Overseas medical aid isnt a new concept
  • Numerous stories of World War army medics
    treating the enemy
  • 1929 Geneva Convention duty exists to respect
    the sick and wounded, regardless of nationality
  • Today, over 195 organizations exist that need
    medical personnel for their humanitarian
    operations
  • Oxfam
  • International Rescue Committee
  • Originally set up at the request of Albert
    Einstein to assist opponents of the Nazi regime
    fleeing persecution
  • Operation Smile (reconstructive surgery)
  • United Nations Volunteer Corps
  • World Vision
  • UNICEF
  • MSF
  • Red Cross

4
Red Cross and MSF
5
Red Cross and MSF
  • Inside besieged Biafra (contd)
  • Attacks on Biafran hospital workers by the
    Nigerian Army
  • Civilians murdered
  • Thousands of children starved by the blockade
  • Red Cross required volunteers to sign agreement
    to uphold the organizations neutrality
  • French doctors saw this as a gag order
  • Publicly criticized Nigerian government and Red
    Cross for its complicit behaviour
  • In 1971 Médecins Sans Frontières was born
  • we will ignore political/religious boundaries
    and prioritise the welfare of victims
  • Today, MSF fosters the concept of témoignage
    (witness)
  • acting and speaking out are not two inseparable
    elements of relief
  • MSF will firmly speak out when it sees that those
    it is trying to help are being abused by
    violations of international humanitarian law and
    medical ethics.

6
Safety of Internl Health Workers
  • Stray bullets, landmines, epidemic diseases
    always a concern
  • Kidnappings and politically motivated attacks on
    the rise
  • In the past, this was mediated by aid
    organizations being perceived as exclusively
    helping the enemy
  • War on Terror has generated attitudes in
    US-occupied countries that NGOs are allied with
    Coalition forces
  • US labelling its operations as humanitarian
    actions
  • Military planes dropping care packages M/W/F
    and bombs T/Th/F

July, 2004 MSF in Afghanistan evacuated after 5
volunteers were killed in an ambush May, 2005
MSF volunteer arrested in Sudan for reports on
the rapes by pro-government Janjaweed militias
7
  • Emblems that once were proudly emblazoned on
    vehicles and base-camp flags as protection, are
    now seen as targets

8
Access To Essential Medicines
  • One-third of the worlds population lacks access
    to essential medicines in the poorest parts of
    Africa and Asia this figure rises to one-half.
  • Why?
  • Many existing/new drugs too expensive.
  • Increasing resistance to older medicines.
  • Discontinued production of effective medicines.
  • Very few new drugs developed to tackle major
    diseases of poorest countries.

9
Access To Essential Medicines
  • Market Prospects vs. Health Needs

10
Access To Essential Medicines
  • Drug Development Outcome

1975-1999 1393 new chemical entities marketed
11
Access To Essential Medicines
  • International Campaign Started in 1999
  • 3 main objectives
  • Stimulating research and development for drugs
    and neglected diseases.
  • Overcoming barriers to existing medicines
    (patents and prices).
  • Lobbying to overcome trade barriers.

12
Access To Essential Medicines
  • Campaign Strategies
  • To lower drug prices on a sustainable basis
  • Encouraging generic competition
  • Local production
  • Increased research into neglected diseases
  • Investing in RD in developing countries
  • Bring back production of unprofitable but
    medically necessary drugs

13
Access To Essential Medicines
  • Campaign Achievements
  • 1) Access to medicines now an international
    concern.
  • 2) Price of AIDS drugs fallen dramatically,
    leading to international push to treat HIV in
    LDCs
  • - 1999 US 10,000 per patient/year
  • - 2001 300 per patient/year
  • 3) Critical analysis of institutional policies
    and practices WHO, WTO. GFATM, UN
  • 4) Established the Drugs for Neglected Disease
    Initiative a new model for drug development
    (www.dndi.org).

14
The Importance of Accessibility The West Bank
Example

BBC News bbc.co.uk
15
(No Transcript)
16
Background on the Wall
  • Construction began in June 2002
  • Will span 622 km when completed1
  • System of 8-metre concrete slabs, fences, barbed
    wire, regularly groomed trace sand, patrol roads,
    electronic monitoring
  • Cost 4.7million/kilometre (USD)2
  • Tangible representation of the multitude
  • of barriers that Palestinians have faced
  • in the occupied territories

17
Impact of the Wall on Access to Essential Health
Care
  • The wall has regularly disrupted access to
    hospitals, private doctors, specialists,
    laboratory services and other forms of health
    care for roughly 200,000 Palestinians3, according
    to 2002 statistics
  • As the project nears completion, an estimated
    32.7 of all West Bank Villages will be denied
    free access to health care4
  • Residents of the West Bank need a medical permit
    in order to receive treatment from hospitals in
    Jerusalem
  • Long, arduous procedure
  • Valid for only a limited period of time
  • Provides no guaranteeaccess to Jerusalem is
    dependent on the judgment of soldiers at
    checkpoints, who lack medical knowledge

18
Impact of the Wall on Access to Essential Health
Care
  • Average transport time by ambulance from the
    Aizaria and Abu Dis area to Jerusalem has
    increased to 1 hour and 52 minutes (versus 5-10
    minutes prior to the wall)1
  • Long-term outcomes for some common medical
    situations (e.g., stroke, heart attack, allergic
    reaction, asthma crisis) are largely dependent on
    time to treatment
  • Significant impact on trauma cases
  • Health Care workers regularly face access
    difficulties
  • Ambulances prevented from traveling to Jerusalem,
    despite Israeli civilian administration orders
    (decision rests in soldiers hands)
  • Doctors denied access to their clinics case
    reports of doctors being forced to do physical
    exams and administer treatments across fences

19
Other Impacts
  • Lack of access to
  • Laboratory tests, diagnostic tests
  • Specialists
  • Other forms of tertiary care (e.g., dialysis,
    cancer treatment)
  • Drinking water 50 wells have already been
    annexed1 difficulties in accessing clean
    drinking water will worsen as the wall is
    completed
  • Mass majority of men living near the wall
    depended on Israel for their income
  • Now cut off from employment sourcesaffects
    patients ability to pay for treatments and
    medicines
  • Patients often forced to choose amongst their
    prescriptions or to purchase only a portion of
    the pills

20
Aid for Palestine
  • MSF (since 1988)
  • Medecins du Monde
  • Canadian International Development Agency (CIDA)
  • International Committee of Red Cross (ICRC)
  • Palestinian Red Cross Society (PRCS)
  • Palestine Childrens Welfare Fund
  • Limitations/Obstacles to aid are significant and
    include checkpoints, limited access across
    borders.

21
Importance of Infrastructure The Iraqi Example
  • Complex issues in Iraqwill focus on a single
    dimension
  • Since the Gulf War in 1991, there is a dramatic
    regression in overall infrastructure
  • Communications systems
  • Roads
  • Power supply
  • Schools
  • Water Supply
  • Sewage
  • Etc

22
The Transition
  • Previously (1990), standard of health care on par
    with western Europe
  • Health budget cut by 90 during sanctions
    reduced life expectancy, surge in malnutrition,
    dramatic reduction in available medical
    treatments, infectious disease epidemics
  • Today, basic needs remain unmet
  • wartime damage to water treatment facilities gone
    largely unrepaired6
  • 46 of households lack access to drinking water5
  • food availability still sparse for many

23
The Problems
  • Instability
  • Lack of Experience in Public Health
  • Conflicting priorities
  • money used for building renovation projects
    (ministry of health headquarters, hospitals),
    meanwhile
  • little/limited fund allocation for more pressing
    public health issues (e.g., sewage treatment,
    public health messages, immunisation programmes)
  • Corruption stealing and black market sales of
    medicines
  • Assignment of US Defense department for
    post-occupation humanitarian efforts
  • Assumption that there would be no infrastructure
    loss, no humanitarian crisis
  • The list goes on

24
Whats Missing
  • Better training for health care workers (training
    given by NGOs is too basic for needs of health
    care staff)
  • Better sanitation, water supply
  • Public health training (to allow for more
    effective resource allocation)
  • Mental health (e.g., to tackle post-traumatic
    stress disorder)
  • More insight into the way Iraq society operates
    (cultural sensitivity, norms, etc.)

25
Aid In Iraq
  • International Federation of Red Cross (IFRC)
  • UN Assistance Mission for Iraq (UNAMI)
  • UNICEF
  • War Child Canada
  • Canadian International Development Agency (CIDA)
    (via monetary donations to other NGOs)
  • CARE (out in late 2004 after abduction of
    director)
  • Medecins Sans Frontier (out in December 2005)
  • Medecins du Monde (out in April 2004)
  • Hostile Environment for NGOs

26
Peace Through Health
  • Health initiatives can bring about peace in the
    form of social healing in war zones, humanitarian
    ceasefire and health expertise to restrict
    weapons and war strategies
  • Use of Health Related Superordinate Goals
  • Healing of trauma
  • Contribution to civic identity
  • Contribution to human security
  • Redefinition of the situation

27
Peace Through Health
  • Peace Through Health in Action
  • Butterfly Peace Garden, Sri Lanka
  • -use of play and art therapy to remedy mental
    trauma due to ongoing ethnic conflict
  • Landmine Awareness
  • -Mine Ban Treaty ?Ottawa, Canada December
    1997
  • Afghanistan Peace Education Program
  • -2000-2001

28
On the Home Front
  • What are we doing at McMaster?
  • SIHI
  • Workshops
  • Medical Outreach
  • Peace Through Health
  • Aboriginal Health Conference
  • Overseas

29
Infrastructure in Developing Worlds
30
Infrastructure in Developing Worlds
  • Infrastructure plays an important role in a
    countrys development as it includes roads,
    electricity, water and sanitation, etc.
  • Many sub-Saharan African governments spend less
    than 20 per patient per year on all health care.
    As a consequence, public health systems in
    developing countries are unable to deliver health
    care products and services to the people who need
    them. As a result of this the health care
    conditions are extremely poor in much of the
    developing world.
  • (Health Care in the Developing World).
  • Without proper roads people and medical supplies
    are unable to reach medical facilities.
  • Without electricity vaccines are not refrigerated
    and the general functioning of the facility is
    extremely limited.
  • A lack of clean water leads to the spread of
    disease. In Tanzania, only 49 percent of the
    population has access to safe water. Sanitation
    facilities are available to only 23 percent of
    the population in Mozambique and to 16 percent of
    citizens in India (Health Care in the Developing
    World).

31
Infrastructure in Canada
  • Reasoning Student International Health
    Initiative (SIHI) and the McMaster First Nations
    Student Association (MFNSA).
  • A group of students interested in raising
    awareness of issues pertaining to social justice,
    specifically when it comes to health and First
    Nations issues.
  • struggle for good health through two separate
    events, the Aboriginal Youth Health Symposium and
    the Aboriginal Health Conference.

32
Infrastructure in Canada
  • Canadas Performance in 2005 Aboriginal Peoples

1. Health improved health of Aboriginal
peoples 2. Lifelong learning maximized
participation and success in early learning,
education, training, and skills development built
on Aboriginal heritage 3. Safe and sustainable
communities Aboriginal communities are safe,
stable, and sustainable 4. Housing Aboriginal
people have improved access to suitable,
adequate, affordable housing and related
support 5. Economic opportunities sustainable
wealth creation and participation in the economy
6. Lands and resources sustainable use and
management of First Nations and Inuit lands and
resources by First Nations people and the Inuit
7. Governance and relationships sound
Aboriginal governance and support of
institutional capacity and clarification of the
respective roles in the relationship
33
On the Home Front
  • McMaster School of Medicine
  • McMaster Medicine Faculty
  • Samantha Nutt Eric Hoskins (War Child Canada),
    James Orbinski (MSF), Lynda Redwood-Campbell,
    Saleem Yousef, Ally Prebtani, Joanna
    Santa-Barbara, Brian Cameron
  • Student International Health Group

34
On the Home Front
  • McMaster School of Medicine (contd)
  • Students
  • International Elective Opportunities for
    Undergraduate Medical Students, and Medical
    Residents
  • AFRICA (Uganda, Ghanda, South Africa, Zimbabwe,
    Kenya, Angola) ASIA (Malaysia, Nepal, India,
    Israel, Hong Kong) EUROPE (Ireland, England,
    Finland, Scotland) SOUTH AMERICA (Dominican
    Republic, Cuba)

35
On the Home Front
  • One students international elective experience
  • Worked 1 month in small district hospital in
    Livingstone, Zambia 1 month in national public
    hospital in Nairobi, Kenya
  • Came away with so many new perspectives
  • An exceptionally motivating experience for a
    young idealistic student
  • A disturbing reminder of why so much of this work
    is mired in a sentiment of hopelessness

36
On the Home Front
  • Personal reflections
  • The uphill struggle to prevent apathy in patient
    care in the developing world
  • Market-oriented economics of the pharmaceutical
    industry defining priorities over genuine health
    needs
  • Lack of provision of mental health services
  • The frightening callousness of publicly funded
    health care in a two-tier health care system
  • Glimmers of inspiration in a place of
    frustration, lawlessness, and corruption

37
(No Transcript)
38
A Fair Share of Controversy
  • Discussion
  • What is the goal of International Health?
  • Are we just offering band-aid solutions that
    dont change anything in the end?
  • Is enough being done for prevention, and health
    promotion?
  • Is there any economic worth to saving human lives
    (and how do we convince governments to believe
    there is any?)
  • How do we convince pharmaceuticals to make their
    medications more universally available?
  • Are drug trials in developing countries ethical?
  • Nevirapine drug trials in Africa

39
References
  • Medecins du Monde The Ultimate Barrier
  • Israeli Ministry of Defense at
    www.seamzone.mod.gov.ll/Pages/ENG/questions.htm
  • HDIP, 2002
  • Btselem
  • Labonte, Ronald. Iraq doctor tells of health
    crimes. BMJ 2005331252.
  • Dyer, Owen. Infectious disease increase in Iraq
    as public health service deteriorates. BMJ 2004
    329940
  • Medecins sans Frontieres http//www.msf.org/
  • Access to Essential Medicines http//www.accessme
    d-msf.org/

40
  • There are limits to humanitarianism. No doctor
    can stop a genocide.
  • No humanitarian can stop ethnic cleansing, just
    as no humanitarian can make
  • war. And no humanitarian can make peace. These
    are political responsibilities, not humanitarian
    imperatives. Simply put, the humanitarian act is
    the most apolitical of all acts, but if actions
    and its morality are taken seriously, it has the
    most profound of political implications. And the
    fight against impunity is one of these
    implications.
  • Despite grand debates on world order, the act
  • of humanitarianism comes down to one thing
    individual human beings reaching out to their
    counterparts who find themselves in the most
    difficult circumstances. One bandage at a time,
    one suture at a time, one vaccination at a time.
    All this in the hope that the cycles of violence
    and destruction will not continue endlessly.
  • Dr. James Orbinski, December 10, 1999
  • excerpt from Nobel Prize Acceptance Speech
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