Get to Zero

Today is World AIDS Day! On this date last year this blog had its first post commemorating the global day of solidarity in the fight against HIV/AIDS and in the last year – when the world marked 30 years of AIDS – I’d like to hope that I’ve contributed, in very small ways, to our communal effort of getting to zero.

With the Trust for America’s Health and amfAR I collaborated on research and policy development for structural and environmental prevention innovations for gay and bisexual and other men who have sex with men in the U.S. – changing the risk environment and the national structures that are inhibiting prevention for that population.

With the Organic Health Response(OHR) and the Ekialo Kiona Center(EK) I’ve continued my connection with the communities of Mfangano East, Lake Victoria, Kenya – primarily through assisting community grant writers to improve the well-being of those living with HIV – to turn the tide of HIV in this corner of the World. Through social solidarity, biomedical and agriculture innovations, and community driven vision, OHR and EK are changing the standards and definition of a “community-based organization”. And transforming the way people live with HIV.

So it wasn’t much, but something…

Now it is time to get to zero. Zero new infections; zero discrimination; and zero AIDS-related deaths. Getting to zero takes prevention and treatment and policy and community. It takes Health in All Policies and nutrition and the built environment and linkages to NCDs and sexual health and biomedical innovations and cultural competency. It takes many small contributions, from just about all of us.

*Want to make your own small contributions? Check-out the Whitman Walker Clinic and OHR for volunteer opportunities!

Image: Author’s own. Ekialo Kiona Center, Mfangano East, Lake Victoria, Kenya.

Not Your Average Donation

Sunday is Mother’s Day (in the U.S.) and if you haven’t gotten at least a card for your mom already, you should get on that.

If you’re looking for a gift idea, might I suggest making a donation to the Organic Health Response. OHR, my “other” job, is a young and rapidly growing CBO on Mfangano Island, Lake Victoria, Kenya (the EK Center) and a U.S.-based non-profit. Rooted in HIV/AIDS, OHR’s ethos centers on harnessing new technology, supporting social and community solidarity, and promoting sustainability. Many of our programs revolve around the women and mothers of the community: a craft co-operative for HIV+ women; CHW training and support; full involvement of women in EK and organizational leadership; and a safe and accessible space for HIV testing and treatment.

OHR has accomplished an extraordinary amount in just 4 years, but all types of support are needed to keep these efforts moving forward. This is not your average donation – my own mother got a donation in her honor for Christmas (and if you ask me, she loved it) – it will directly support a community charting their own course towards well-being!

Global is Local

Happy New Year!

Earlier this week I came across a report about a new initiative in and around Seattle, Washington. A local health care system (think hospitals, physicians, medical homes, etc.) is launching a new program aimed at improving local communities’ health. This new initiative is not based on the newest, evidenced-based pilot from the CDC, but rather on practices and programs that have proven effective not in the U.S. but in parts of Africa and elsewhere.

Global to Local (love the name!) is based around a “new” paradigm for community health workers (CHWs). As stated on their website: “The Global to Local initiative is a new approach in applying global solutions to local healthcare challenges in underserved populations.”   CHWs have become a staple in the “global” health community – an invaluable tool in communities around the World – but are relative newcomers in our enigma of a health system (there are roughly 120,000 CHWs currently in the U.S.).  However, with the ongoing implementation of the Affordable Care Act* this year, further programs for CHWs will be established.

The basic element behind CHWs (which can span a spectrum of training and services) are individuals from the community working in the same community to educate, treat, and navigate their neighbors. In many communities CHWs have been instrumental in the promotion and adoption of bed-nets and enabling individuals to maintain their ARV treatments (e.g. OHR in Kenya has worked closely with CHWs to promote HIV VCT).   An equally important role that CHWs play is that which anthropologists call “gate-keepers” – a window into a specific community and culture.

Global to Local is aiming to do just this by employing local nurses and CHWs (and working with community colleges to train them!) who understand the local culture – structurally and linguistically. By looking at people’s whole environments (financial, housing, and educational services are going to be provided as well), Global to Local has the goal of promoting nutrition, changing health behaviors (and the structures which guide them), and providing people with greater access to health services.

Somewhere in the history of health care and public health (I don’t claim to be an expert, but I do understand how & why this occurred) there seems that an unspoken rule was established: What happens in the West/developed countries and what happens everywhere else in the World must function in two different spheres – us and them. Global to Local is breaking this rule – to some surprise – and why shouldn’t they?! Just as the anthropological technique of ethnography can be applied both on the other side of the globe and in our backyards, so too can methods for improving health. CHWs are culturally humble and perfectly positioned to apply “global solutions to local healthcare challenges” – improving the health of our global communities.

*As during its passage, this blog will not follow or address explicitly the Affordable Care Act, repeal attempts, or blanket implementation.

Being Part of the Change

This past week, ABC News launched its Be the Change: Save a Life initiative – “stories and solutions for a global health initiative”. The idea, the way I understand it, is to highlight and share real world solutions to the array of global health challenges. One of the components I find fascinating is how these solutions are coming from every sector, not just medicine and public health. There are portable and re-heatable (without electricity) baby incubators from a group of Stanford students; pumps to clean water from a former nightclub owner; and local solutions too, like horses to get HIV tests to labs in time in Lesotho.

Being local, which won’t be a surprise to my regular readers, is key. Nifty tech devises and creative fund-raising are important, we need both for innovative and sustainable solutions. However, to make innovations work a) the local needs, environment, and lives must not just be acknowledged, but understood and b) solutions need to be fostered from within communities and not just presented to them.

This year-long initiative will undoubtedly share with all of us some truly remarkable solutions…for determinants and disease. And hopefully, as with the piece on child nutrition in Guatemala (I know someone involved with this initiative!), medical anthropologists and other community thinkers will be engaged and highlighted. For when all of us are part of the change, practical, simple and human solutions become a reality and lives are saved.

Mechanics of Determining Access

There is a lot of talk about access in health – in the U.S. in regards to our insurance driven culture and in developed countries in regards to basic medical services – as the golden ticket, one of the elements once available to all will solve the world’s health disparities. I completely agree that “little a” access is important to lessening disparities and providing more people with the quality services they need and deserve. Often times, however, discussions of access trump discussions of root causes and determinants – fixing the problems we have now rather than figuring out how to keep them from repeating and spreading. Earlier this week I came across (what I believe) is a new blog series on the NYTimes called Fixes. The tag line reads “Fixes explores solutions to major social problems…” and in its first installment tells the tale of a very simple solution to a very common problem – access.

The problem as they state it is that many in the World continue to be afflicted by diseases which “we” have treatment for, simply because they do not have access to them. True. The solution they highlight (not suggest, but already happening!) is to give CHWs and other community medical personnel a means for getting to the people in their communities besides their feet. In this instance, give them motorcycles.  Tsepo Kotelo, a CHW in rural Lesotho was provided with a motorcycle which has allowed him to go from reaching only 3 villages a week to reaching 20 – and accessing some of the hardest hit areas by HIV/AIDS and TB in the world!

Kotelo riding his motorcycle (NYTimes)

Straight forward solution, yes, but here’s the kicker – not only did the Elton John AIDS Foundation provide him with a motorcycle, they have also linked Kotelo with a mechanic for monthly maintenance checks through Riders for Health. Providing him access to a needed service, that is not health care, but is having a determining impact on the health of many others.

Fixes mentions the other possible topics which the world needs solving…education, energy, clean water, jobs, etc. Listing them just as I have, as individual entities. Yet, as the post so clearly frames, a solution to one problem can be a solution to many. Furthermore, these solutions – when appropriately introduced within a given structure and cultural setting – can effectively address determinants of health. For example, the motorcycle and maintenance of it: Provide training and jobs, giving Kotelo and others with the needed access to the people they help, but also providing stable incomes to everyone involved; Greater economic stability, which in many cases allows for better access to foods; And long-term, these increases in nutrients (hopefully!) can have a positive affect on family and community health.

Education, energy, clean water and jobs all need global solutions and they all have strong determining influences on communities’ health. Access to these solutions as they come along will be important – harnessing them to address determinants, in particular social ones, and disparities can make them health in all* important!

*Health in All Policies — One of my current areas of research/work. Expect more!

Image: Photograph from first Fixes post in the NYTimes — October 18, 2010.