Cooking with solid fuels, household air pollution, and health in the Tibetan Plateau, China

Sierra Clark

Background and research:

Almost half the world’s population cooks with biomass fuels in inefficient stoves that emit high concentrations of toxic pollutants (Bonjour et al. 2013). The resulting household solid fuel combustion is thought to be a major contributor to ambient pollution with regional and global climate impacts and is a leading environmental health risk factor (Lim et al 2013, Amann et al 2008). Notably, use of solid fuels in China is the leading environmental health risk factor and contributes to an estimated 37% of the country’s total ambient Particulate Matter (PM2.5)emissions (Amann et al 2008). Ambient air quality in China and the surrounding regions have rapidly deteriorated in recent decades with high concentrations of ambient PM and other health and climate-relevant air pollutants (Zhang et al 2011, Heald et al. 2006). Further, black carbon aerosols from household solid fuel use in the Tibetan Plateau are thought to significantly contribute to glacial melting (Xu et al 2009).

Cleaner-burning stoves and fuels can potentially reduce household air pollution concentrations and exposure (Ezzati 2002). My research measures the potential environmental and health benefits of transitioning households to low-polluting semi-gasifier stoves and processed biomass fuels in a study site located on the eastern edge of the Tibetan Plateau, China.

Photo 1

Photo 1: Water is heated on a traditional chimney stove in Shanxi Province, China. Coal is used as fuel which, when burnt, can release a large amount of toxic air pollution into the home through inefficient combustion.

Photo 2

Photo 2: A traditional chimney stove in a rural village in Sichuan Province, China. These traditional stoves use biomass (wood and/ or crop residues) as fuel for burning in an open chamber which release smoke into the kitchen.

Photo 3

Photo 3: A woman in a small village in Sichuan collects wood (fuel) to burn in her traditional stove. Harvesting and collecting firewood can put an additional burden on households as it requires time that could have been spent doing other things.

Photo 4

Photo 4: Myself and another researcher go into homes to talk with women about their household cooking practises. Above me, smoke is being partially vented out of the kitchen by a chimney, but the unvented smoke remained in the kitchen with the cook.

Photo 5

Photo 5: Household burning of solid fuels for cooking and heating contributes to about 30% of China’s ambient air pollution.

Photo 6

Photo 6: A woman participant is having her blood pressure taken by a member of our field staff. Research shows that chronic as well as acute exposure to air pollution is associated with both short and long-term changes in blood pressure, which is a known risk factor for adverse cardiovascular events.

Photo 7

Photo 7: A woman participant is having her pulse wave velocity taken by a member of our field staff. Some research indicates that exposure to air pollution is associated with increases in pulse wave velocity, which is an indicator of cardiovascular health.

Photo 8

Photo 8: A woman participant in our study is wearing a waist pack with a Personal Exposure Monitor (PEM) inside. The PEM actively collects 48hrs of PM2.5 mass on a filter which is later analysed. Woman are often the most exposed to household air pollution, particularly in this setting, as they spend the most time near the sources of pollution (i.e., cooking-heating stoves).

Photo 9_1

Photo 9: Young children are particularly vulnerable to the health impacts of indoor air pollution. Not only are they biologically more vulnerable than adults, but they may also spend more time near the sources of pollution – indoors and alongside women in the household who are cooking.

 

 

sierra clark

Sierra Clark is a second year Master’s student in Epidemiology and an Institute for Health and Social Policy graduate intern at McGill University. She is currently in rural China collecting data for her thesis on the air pollution and health impacts of a clean cook stove intervention which is aimed at reducing household sources of pollution. Sierra received her BA (Hon) in Geography from McGill, focussing her research on climate change and infectious disease in rural Uganda. Sierra is currently a National Geographic Young Explorer and a Mitacs Globalink International research award holder, and she is an active member of the Baumgartner Research Group at McGill. 

 

Ethics and consent for photos: Ethics approval was granted (10-05-2016) in a REB amendment for a consent procedure which gave participants the opportunity to give oral informed consent for their photo to be used in presentations or media pertaining to this research project (REB A01-E01-14A). All identifiable person’s featured in this photo journal have provided informed oral consent.

Acknowledgements: Much thanks to all of the subjects in my photos who graciously agreed to allow me to use their images to help highlight and translate my research findings. Funding for my research this Summer was provided by McGill Global Health’s “Norman Bethune Award’, The National Geographic Societies “Young Explorers Award Program” and Mitac Canada’s “Globalink Research Award Program”. Funding for the larger project was provided by the US Environmental Protection Agency (EPA) STAR program.

No Immunity from Cholera: the UN’s Role in the 2010 Haitian Outbreak

Madlen Nash

The United Nations cannot claim to address and prevent human rights violations while simultaneously failing to acknowledge the culture of impunity and alarming lack of accountability within the organization. Immunity should exist solely to ensure the security of UN peacekeepers during their missions. Instead, the UN uses absolute immunity as a bureaucratic tactic to avoid responsibility when their soldiers violate the human rights of the citizens they are mandated to protect. The UN continues to hide behind its shield of impunity despite its recent unequivocal violation of human rights in the case of the cholera outbreak in Haiti.

the-artibonite-river-is-the-suspected-source-of-the-cholera-outbreak-in-haiti-725x482

The Artibonite River: the suspected source of the cholera outbreak in Haiti. Source: Kendra Helmer, USAID.

In October 2010, an outbreak of cholera appeared in Haiti for the first time in nearly a century (1). As of February 2016, there have been 770,000 reported cholera cases and 9,200 deaths (2). The first reported cases coincided directly with the arrival of peacekeepers from the United Nations Stabilization Mission in Haiti (MINUSTAH). The troops were deployed from an area of Nepal, a cholera endemic country, which had just experienced a major outbreak in the month prior to their departure (3). Evidence overwhelmingly confirmed that the source of the Haitian cholera outbreak was due to “contamination of the Méyè Tributary of the Artibonite River with a pathogenic strain of South Asian type Vibrio cholerae as a result of human activity” (4). The evidence not only confirms that the UN was responsible for bringing cholera into Haiti, but that it did so recklessly, allowing human waste from the peacekeeping base to be discharged into the tributary leading to Haiti’s principle water source (5). Despite the knowledge of the recent cholera outbreak in Nepal, the organization only tested symptomatic soldiers for cholera, even though 75% of cholera cases present as asymptomatic (6).

The latest of three class-action lawsuits, seeking compensation and reparations on the behalf of the Haitian cholera victims, was filed against the UN in October 2013. Despite ample, convincing evidence pointing to the UN as the singular cause of this epidemic, the UN Secretary-General Ban Ki-moon, issued a statement saying “the claims are not receivable, pursuant to Section 29 of the Convention on the Privileges and Immunities of the United Nations”. The statement subsequently redirected the narrative to the UN’s commitment to eliminating cholera from the country and strengthening Haiti’s water and sanitation infrastructure (7). The UN leadership blatantly disregarded the rights of the cholera victims to pursue legal action and compensation for the hardship they suffered due to the UN’s gross negligence.

The way the UN has handled cholera in Haiti has not only been a grave miscarriage of justice, but has challenged the very ethos of the organization itself.

 

The UN and the Haitian government signed a Status of Forces Agreement (SOFA) granting broad immunity to MINUSTAH for crimes committed in the country (8). SOFA dictates the establishment of a Standing Claims Commission as the procedure for victims to seek redress from harms committed in the course of peacekeeping (9). The UN’s failure to create such a commission is a breech of its own agreement and has resulted in an egregious violation of Haitians’ human rights. In fact, despite the existence of 32 SOFAs, a standing claims commission has never once been established (10).

Haiti Earthquake Relief

The United Nations Stabilization Mission in Haiti (MINUSTAH). Source: Tech. Sgt. James L. Harper, Jr, USAF.

The true reason for the UN’s unwillingness to take responsibility for its actions in Haiti lies at the heart of the defense, U.S. attorney Ellen Blain argued on behalf of the UN. She argued that the court ruling in favour of the plaintiffs would “create and open up a huge set of claims to the United Nations. Private parties around the world would be able to sue the United Nations for violations of — perceived violations and breaches of the treaty” (11). Yet it is not liability for its actions that will compromise the UN’s ability to fulfill its mandate. Rather it is the UN’s immoral and inhumane denial of the devastation they caused to innocent people that is undermining the integrity of the international body. The cholera case is only one demonstration of the human rights violations for which the UN should be held accountable, including, but not limited to, many reported cases of systemic sexual exploitation and abuse committed by peacekeepers (12).

In accordance with Article 6, Section 23 of Convention on the Privileges and Immunities of the United Nations, the Secretary General has not only the right but the duty, to waive immunity in cases where it would impede “the course of justice” (13). The way the UN has handled cholera in Haiti has not only been a grave miscarriage of justice, but has challenged the very ethos of the organization itself. The United Nations has undeniably proven that its bureaucratic self-protective instincts painfully outweigh those to protect and uphold the human rights of all.

nash_blogphoto

 

 

Madlen Nash is a U3 microbiology and immunology student at McGill University. Her global health interests are infectious disease prevention and diagnosis in high-burden, low-resource settings and health and social justice. 

 

 

Works Cited

Agreement Between the United Nations and the Government of Haiti Concerning the Status of the United Nations Operation in Haiti. Volume 2271, 1-40460. 261-262. Web. 15 Nov. 2014. http://www.ijdh.org/wp-content/uploads/2014/03/MINUSTAH-SOFA-English.pdf

Carla Ferstman. “Criminalizing Sexual Exploitation and Abuse by Peacekeepers.” Special Report 335. United States Institute for Peace. September 2013. Web 15 Nov. 2014.http://www.usip.org/sites/default/files/SR335Criminalizing%20Sexual%20Exploitatio%20and%20Abuse%20by%20Peacekeepers.pdf

Convention of the Privileges and Immunities of the United Nations. 13 February 1946. 28. Web15 Nov. 2014. http://www.un.org/en/ethics/pdf/convention.pdf

Daniele Lantagne, G. Balakrish Nair, Claudio F. Lanata and Alejandro Cravioto. “Final Report of the Independent Panel of Experts on the Cholera Outbreak in Haiti.” 29-30. Web. 15 Nov 2014. http://www.un.org/News/dh/infocus/haiti/UN- cholera-report-final.pdf

Daniele Lantagne, G. Balakrish Nair, Claudio F. Lanata and Alejandro Cravioto. “The Cholera Outbreak in Haiti: Where and how did it begin?” Current Topics in Microbiology and Immunology. Springer-Verlag Berlin Heidelberg 2013. 1. Web. 15 Nov 2014. http://www.ncbi.nlm.nih.gov/pubmed/23695726

Georges v. United Nations et al. No. 1:13-cv-07146-JPO, S.D.N.Y. 23 Oct 2014. 52: lines 12-15. Web. 15 Nov. 2014. http://www.ijdh.org/wp-content/uploads/2014/10/Oral-Argument_Cholera-Case-10.23.pdf

Ministère de la Santé et de la Population (MSPP). “Rapport Choléra 10 Sept 2014”. 2014. Web.15 Nov 2014. http://mspp.gouv.ht/newsite/documentation.php

Piarroux, Renaud. “Understanding the Cholera Epidemic, Haiti.” National Center for Biotechnology Information. U.S. National Library of Medicine. July 2011. Web. 15 Nov. 2014. http://www.ncbi.nlm.nih.gov/pubmed/21762567.

United Nations Press Release. “Haiti Cholera Victims’ Compensation Claims ‘Not Receivable’ under Immunities and Privileges Convention, United Nations Tells Their Representatives.” 21 February 2013. Web. 15 Nov. 2014. http://www.un.org/press/en/2013/sgsm14828.doc.htm

United Nations Press Release. ”Security Council Establishes Un Stabilization Mission In Haiti For Initial Six-Month Period.” 30 April 2004. Web. 15 Nov. 2014. http://www.un.org/press/en/2004/sc8083.doc.htm

World Health Organization. “Cholera.” February 2014. Web. 15 Nov. 2014. http://www.who.int/mediacentre/factsheets/fs107/en/

Yale Law School Transnational Development Clinic, et al. “Peacekeeping with Accountability: The United Nations’ Responsibility for the Haitian Cholera Epidemic.” 2013. 18. Web 15 Nov. 2014. http://www.law.yale.edu/documents/pdf/Clinics/Haiti_TDC_Final_Report.pdf

Yale Law School Transnational Development Clinic, et al. Peacekeeping with Accountability: The United Nations’ Responsibility for the Haitian Cholera Epidemic. 2013. 27. Web 15 Nov. 2014. http://www.law.yale.edu/documents/pdf/Clinics/Haiti_TDC_Final_Report.pdf


Notes

(1) Daniele Lantagne, G. Balakrish Nair, Claudio F. Lanata and Alejandro Cravioto. May 2013. Abstract.

(2) Ministère de la Santé et de la Population (MSPP). 2016. 1.

(3) Yale Law School Transnational Development Clinic, et al. 2013. 18.

(4) Daniele Lantagne, G. Balakrish Nair, Claudio F. Lanata and Alejandro Cravioto. 29-30.

(5) Renaud Piarroux. July 2011. Abstract.

(6) World Health Organization. February 2014.

(7) Haiti Cholera Victims’ Compensation Claims ‘Not Receivable’ under Immunities and Privileges Convention, United Nations Tells Their Representatives. February 2013.

(8) Security Council Establishes UN Stabilization Mission in Haiti for Initial Six-Month Period. April 2004.

(9) Agreement Between the United Nations and the Government of Haiti Concerning the Status of the United Nations Operation in Haiti. July 2004. 261-262.

(10) Yale Law School Transnational Development Clinic, et al. 2013. 27.

(11) Oral Argument Cholera Case. October 2014. 52.

(12) Carla Ferstman. September 2013. 1.

(13) Convention of the Privileges and Immunities of the United Nations. February 1946. 28.

 

Photo Sources:

Helmer, Kendra. USAID. From Public Domain Images. http://www.public-domain-image.com/free-images/nature-landscapes/river/the-artibonite-river-is-the-suspected-source-of-the-cholera-outbreak-in-haiti-725×482.jpg

Tech. Sgt. James L. Harper, Jr., USAF. From WikiMedia. https://upload.wikimedia.org/wikipedia/commons/0/04/Aid_airdrop_over_Mirebalais_2010-01-21_3.JPG

McGill Summer Institute 2016 – An Infectious Series of Presentations!

groups together 1

Patrick Bidulka

And that’s a wrap! The 2nd annual Summer Institute on Infectious Diseases and Global Health has ended after two weeks of exciting discussion covering a variety of topics including TB, HIV, worms, malaria, and more worms. With the addition of two courses to the Summer Institute arsenal, things got pretty busy!

small group

TB Research Methods Small Group Session

As a member of the organizing team for the Summer Institute, I had the opportunity to observe the mechanics of what goes on front and back stage. As participants got to hear from an extensive lineup of top-quality researchers and diagnostic industry specialists, the Institute’s top-notch organizing committee worked tirelessly to ensure operations went as smoothly as possible — easier said than done. Between organising the catering, and dashing between classrooms pretending to be an AV specialist, I managed to slip into a few lectures to get a feel for what the Summer Institute is all about.

The 2016 edition of the Summer Institute offered 5 different week-long courses:

1. Global Health Diagnostics

2. TB Research Methods

3. Advanced TB Diagnostic Research

4. Molecular & Genetic Epidemiology *New*

5. Tropical & Parasitic Diseases (including Ultrasound and Microscopy tutorials) *New*

ultrasound

Clinical Ultrasound course at the Summer Institute

All the courses provided lectures in varying format, including tech pitches from industry specialists, clinical case studies, panel discussions, and small group sessions. During breaks, participants from all different courses had the chance to mingle, and discuss the hottest topics in global health research (all while drinking record amounts of coffee!)

panel

Global Health Diagnostics Course Panel Discussion

Some personal highlights from the Summer Institute:

• Having my entire abdomen, from bladder to heart, examined via ultrasound in front of the Tropical and Parasitic Disease Ultrasound class, held at the Glen Site

• Being reassured that everything in my ultrasound was normal (phew!)

• Seeing my global health-fanatic McGill professors Drs Pai and Gyorkos debating diagnostics and treatment centre stage

• Lunch!

• And finally, being introduced to so many accomplished global health professionals, and hearing the energetic debate these people brought to the conference

lunch SI

Lunch at the Summer Institute

Boasting about 400 participants from 46 different countries, the Summer Institute was a huge success. The conference fostered a welcoming environment for global health experts and novices alike, to engage in academic discussions centred around pertinent global health issues the world faces today. See the Summer Institute 2016 Dashboard for a brief overview of the conference statistics.

I’m glad I had the opportunity to be a part of such a fast-paced and information-packed two weeks! Taking part in the conference gave me valuable insight into the many different facets of global health, and allowed me to envision which stream I would like to pursue as I move towards my own post-graduate education.

Planning is already underway for 2017’s Summer Institute – stay tuned at the Summer Institute and the McGill Global Health Programs websites for more details to come!

patrick

 

About the author:

Patrick is a recent graduate from the undergraduate pharmacology program at McGill. Now working at the GHP office, Patrick is happy to be immersed in the field of global health. His interests include infectious diseases, learning languages, and ‘The Office’.

The Biography of Malaria: Sonia Shah and “The Fever” Book Review

Vaidehi Nafade

It bears no explaining that malaria is a major global health issue today. According to WHO, in 2015 there were over 200 million cases, and 400,000 deaths, mainly in Sub-Saharan Africa (1). WHO has set ambitious goals for the elimination of malaria, but it is a difficult disease for many reasons – and it has always been.

"The Fever" by Sonia Shah

“The Fever” by Sonia Shah

Sonia Shah says it aptly in her novel, “The Fever: How Malaria has Ruled Humankind for 500,000 Years”: “Despite the fact that we’ve known about malaria since ancient times, and have the drugs, killing chemicals, and know-how to avoid it, something about this disease still short-circuits our weaponry” (2). “Fever” tells the story of malaria, from its evolution into a parasite from a photosynthesising predecessor to its unrelenting presence in today’s world and the public health problem it poses.

Despite being factually dense, “Fever” does not read like a typical nonfiction. The editorialized style of writing can seem jarring at first, especially in comparison to academic texts or articles – but Shah’s journalistic style brings the book to life, making it into a true biography of Plasmodium. The result is a genuinely enjoyable, relatively light read, despite its heavy topic, that remains accessible to the global health professional or enthusiast alike.

However, even malaria experts will likely find some new information in “Fever”, as its greatest strength is its thoroughness. In true investigative journalist style, Shah’s research for the novel is expansive. While she covers the basics of malaria, such as the different species of the parasite and its clinical features, Shah does not stop there. The novel also describes malaria’s effects on shaping the Roman Empire or colonial America (greater than you would expect), its contributions to humankind’s genetic evolution (much more than just the infamous sickle cell gene), and the pharmaceutical struggle from quinine to artemisinin. It provides a long history of public health interventions and a persisting cultural divide between Western health authorities and malaria-afflicted countries that makes public health interventions so difficult.

Ultimately, “Fever” provides a captivating and detailed story of malaria that will leave any reader with a greater appreciation of a very formidable parasite, and an intellectual concern for how public health will tackle this parasite next.

vaidehi cropped

 

Vaidehi is an U3 pharmacology student and an avid reader and writer. Her passion for global health stems from an interest in immigrant and refugee health and cross-cultural medicine.

 

References

1. “Malaria Fact Sheet,” WHO, accessed June 13, 2016. http://www.who.int/mediacentre/factsheets/fs094/en/

2. Sonia Shah, The Fever: How Malaria has Ruled Humankind for 500,000 Years (New York: Picador, 2010). 9.

How Drug-Resistance TB Can Show The Path To Tackling Antimicrobial Resistance

Madhukar Pai

India, TB, MDR-TB, XDR, drug resistance, tuberculosis

Antimicrobial resistance (AMR) is a global health threat, and it is estimated that by 2050, 10 million lives a year and a cumulative 100 trillion USD of economic output are at risk due to the rise of drug-resistant infections, if we do not find solutions to tackle the rise of drug resistant pathogens.

Since the introduction of antibiotics, microbes have evolved a variety of methods to resist antibiotics. We are now dealing with ‘superbugs’ that are virtually untreatable, including colistin-resistant E. coli, drug-resistant gonorrhea, carbapenem-resistant enterobacteriaceae, methicillin-resistant Staphylococcus aureus, extensively drug-resistant tuberculosis, and extended-spectrum-beta-lactamase producing strains. The antibiotic pipeline is running dry, and AMR is threatening to undo major gains made in the control of infectious diseases.

AMR is driven by several factors, but major causes include over-use of antibiotics, poor adherence to standard treatment protocols, over-use of antibiotics in livestock, poor infection control in health facilities, poor sanitation, and challenges with new antibiotic R&D.

According to the State of the World’s Antibiotics report (2015), antibiotic consumption is increasing globally, with 20-50% estimated to be inappropriate. Countries like India and China are rapidly becoming the most important consumers of antibiotics.

Drug-resistant tuberculosis (DR-TB) is a prime example of the threat posed by AMR. The most common form drug-resistant TB is multi-drug resistant TB (MDR-TB), which refers to TB that is resistant to two key first-line antibiotics – isoniazid and rifampicin. Globally in 2014, WHO estimated 3.3% of new cases and 20% of previously treated cases to have MDR-TB. Drug resistance surveillance data show that an estimated 480 000 people developed MDR-TB in 2014 and 190 000 people died. Even children are impacted by DR-TB, with recent estimates suggesting that MDR-TB in children may be far more prevalent than previously understood.

It is much smarter and cheaper to prevent DR-TB than treat it.

Extensively drug-resistant (XDR-TB) strains are resistant to at least four of the core anti-TB drugs [i.e. isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin)], and XDR-TB has been reported by 105 countries in 2014. About 10% of people with MDR-TB have XDR-TB. Some studies have also reported totally drug-resistant strains of TB, resistant to all antibiotics tested. This scary form of TB takes us back to the pre-antibiotic era, where TB patients were managed in sanatoria, and mortality rates were extremely high.

Why should we care about DR-TB? Drug-resistant TB requires extensive treatment (for 2 years or longer) with multiple, potentially toxic drugs and outcomes are poor. One in two patients with drug-resistant TB die because of it. Treatment of DR-TB is also very expensive because of the high cost of second-line TB drugs. Thus, it is much smarter and cheaper to prevent DR-TB than treat it.

WHO has proposed 5 priority actions to tackle the global DR-TB crisis:

1) prevent the development of drug-resistance through high quality treatment of drug-susceptible TB;

2) expand rapid testing and detection of DR-TB cases;

3) provide immediate access to effective treatment and proper care;

4) prevent transmission through infection control; and

5) increase political commitment with financing.

Unfortunately, high TB burden countries are yet to seriously address these priority actions to tackle DR-TB. In many countries, not even half of all patients with DR-TB are on second-line drug therapy. Quality of TB care for even drug-susceptible TB remains suboptimal in many countries, especially in countries with large numbers of private health care providers. In such settings, doctors prescribe irrational drug regimens, and adherence monitoring is poor.

TB is a low priority for many developing countries, and current TB budgets are insufficient to make progress in addressing DR-TB.

Empirical antibiotic use is widespread in many countries with weak regulation, and healthcare providers tend to use antibiotics as diagnostic tools; this further increases the risk of AMR. Also, over-the-counter (OTC) antibiotic abuse is widespread in many high TB burden countries. OTC use of fluoroquinolones, a widely used antibiotic, can delay the diagnosis of TB, and also increase the risk of DR-TB. This is particularly relevant, since some of the emerging new TB drug regimens contain fluoroquinolones (i.e. Moxifloxacin).

Xpert cartridges [1032133]

Xpert cartridges

While highly accurate and rapid molecular tests such as Xpert MTB/RIF are now available to quickly detect TB as well as drug-resistance, most high-burden countries are still reliant on sputum smear microscopy, a technology that is not only insensitive but also incapable of detecting drug-resistance. This means patients are often managed with no information on drug-susceptibility test results. This approach of treating TB ‘blindly’ is no longer tenable in places such as Mumbai, where DR-TB is a widespread problem.

A recent report called ‘Out of Step‘ by MSF and Stop TB Partnership surveyed 24 high TB burden countries, to see how already existing TB policies and interventions are being implemented. This survey found major gaps in how TB tools and policies are implemented. For example, only 8 countries included in the survey had revised their national policies to include Xpert MTB/RIF as the initial diagnostic test for all adults and children with presumptive TB, replacing smear microscopy. Six of 24 countries, including India, still recommended intermittent treatment for drug-sensitive TB (which is less effective than daily therapy). Even simple interventions such as fixed dose combination pills to improve treatment adherence are not routinely used in all countries. Such implementation gaps are most definitely generating DR-TB and have to be urgently addressed.

A major reason behind poor TB control is the fact that TB is a low priority for many developing countries, and current TB budgets are insufficient to make progress in addressing DR-TB. Most National TB Programs in high burden countries are seriously under-funded, and, sadly, even emerging economies such as India are not spending enough on TB.

It may be more impactful for DR-TB control to be seen as one component of a comprehensive strategy to address AMR.

In this context, it may be more impactful for DR-TB control to be seen as one component of a comprehensive strategy to address AMR. Unlike TB, AMR is increasingly seen as a global health emergency and a security threat. Policy makers and donor agencies have prioritized AMR as a key issue for the global health security agenda. The door is wide open for the TB community to leverage this interest, and advocate for a well-funded, comprehensive AMR initiative that includes DR-TB as a key component. In fact, DR-TB could well be a pathfinder for successfully tackling AMR in low and middle income countries, and help make the case for greater investments.

The End TB Strategy and the Global Plan to End TB offer excellent blueprints for ending the epidemic of TB, including DR-TB. It is time for the TB community to step up and make sure TB features prominently in the broader agenda to tackle AMR globally, and receives adequate funding and support.

Dr_Pai

Madhukar Pai is director, Global Health Programs, McGill University, Montreal, Canada. Twitter: @paimadhu

Author’s competing interests: None declared.

This blog post was first published on the Huffington Post website.

Jackie in South Africa: Post-Travel Report

 
 
 
 
 
 
 
 
 
Jacqueline Roberge-Dao

Award won:

SPOT Global Health Travel Award

Bio:

DCIM101GOPRO

Jackie in South Africa

I am Jackie Dao, about to graduate from a master’s in Occupational Therapy (M2). I’ve always been fascinated with travelling and meeting new people. A previous trip to rural Peru working at a centre for children with disabilities gave me the travel bug and motivated me to discover new cultures.

Project Overview:

In Cape Town, I had the opportunity to intern in the largest public hospital of the Western Cape, the Groote Schuur Hospital. I split my 8 weeks between 3 different rotations: neurology, paediatrics and general medicine. As the beds needed to be cleared quickly in general medicine, my role was to quickly assess and discharge with outpatient referrals, assistive equipment and/or self-management education. In neuro and peds, cases were much more intense which required intensive daily rehab for remediation of function.

A story I would like to share happened one day on the neuro ward. An elderly woman was admitted displaying total body paralysis, but brain scans revealed everything was working normally; the team didn’t know what to do. I spent three hours just talking to her about her life experiences and my own (therapeutic use of self). I learned that her husband had passed a couple of years ago, that she was carrying an enormous burden of responsibility for her multi-generational family, and that she had just been diagnosed with HIV. As we explored her grief, guilt and attachments, she revealed to me that this was the first time in many years that she was able to express herself and feel heard. The next day, I returned to see her and a miracle happened: slowly but surely, I was able to get her out of the bed – she was no longer paralyzed. We took a walk outside that day, and she cried thanking me. This made me appreciate that no matter where we are born or what experiences we’ve been through, we are, at our core, the same. And sometimes magical things can occur when we remember that love is real and that connection and empathy can go a long way.

Looking ahead:

This field work has influenced my future career plans in that I will be extremely willing to accept an opportunity that takes me abroad. I overcame many personal fears during this trip which helps me move forward and push my boundaries of what is possible in terms of working whilst travelling. I have witnessed disparities in health and realized the immense need for powerful figures that will advance the system and humanity as a whole.

 

See also the McGill School of Physical and Occupational Therapy (SPOT) blog, and their website!
 

Global Mental Health Research for Sustainable Development

Sakiko Yamaguchi

The WHO’s global mental health action plan 2013-2020 relies on evidence-based practices. As such, today’s global mental health research is largely focused on the “evidence” to deliver effective mental health interventions in low- and middle-income countries. Although I have no intention to question the need and importance of scientific evidence, we hardly hear about the “sustainability” of evidence-based practice in global mental health despite the fact that “sustainable development” has been a core concept shaping the development agenda since the 1988 Bruntland Commission. Now that mental health and well-being are included in the UN’s Sustainable Development Goals, I would like to explore a question: “How can researchers link global mental health research with sustainable development?”

Sakiko leading a planning workshop in Sudan.

Sakiko leading a planning workshop for a health project in Sudan.

One answer may be found in implementation science, which provides tools and approaches to integrate evidence into health policy and practices (De Silva & Ryan, 2016). An intervention that is found to be effective in the idealized conditions of a research setting may meet a wide range of barriers in a real world context. The exclusive focus on evidence may divert our attention from the role of culture in a specific setting. In this context, global mental health research should find an answer of not only “what works” but also “how it works” by holistically examining the behavioural, organizational, economic, socio-cultural, and political dimensions of the context where evidence is implemented. Furthermore, researchers have the important role and responsibility to share pertinent individual knowledge available with those at the organizational, community, and society levels (Landry, Amara, Pablos-Mendes, Shademani, & Gold, 2006).

The exclusive focus on evidence may divert our attention from the role of culture in a specific setting.

 

While innovative instruments for knowledge sharing still seem lacking, my past work experience in international development reminds me of the notion of “ownership.” With an understanding that the sustainability of the project outcome results from the beneficial output shared among project participants, development partners generally make great efforts to foster a sense of ownership during the project implementation. In global mental health, community-based participatory research may be one possible approach to generate ownership by addressing the unequal power distribution between researchers and community people.

My initial question is still open for discussion. Meanwhile, the consideration of sustainability and ownership in global mental health research may shed light on the ethical aspects of our research process and application of knowledge.

 

About the Author:

Sakiko Yamaguchi is in the 2nd year of her PhD program in Division of Social and Transcultural Psychiatry, Department of Psychiatry at McGill. After working on government projects for social development in low- and middle-income countries, including post-conflict countries (Peru, Afghanistan, Sudan), she decided to pursue her PhD to better understand the long-term impact of violent conflict on mental health, and explore how international community can respond to the unmet needs of the affected people. She is currently in Ayacucho, Peru for her research project on alcohol misuse among the Andean highland population, who is still suffering from the consequence of political violence and the daily hardships rooted in poverty and socio-economic inequality.

 

The new McGill Global Mental Health Program was launched 30 May 2016. Like them on Facebook and learn more here.

 

 

References

De Silva, M. J., & Ryan, G. (2016). Global mental health in 2015: 95% implementation. The Lancet Psychiatry, 3(1), 15-17.

Landry, R., Amara, N., Pablos-Mendes, A., Shademani, R., & Gold, I. (2006). The knowledge-value chain: a conceptual framework for knowledge translation in health. Bulletin of the World Health Organization, 84(8), 597-602.

Welcome to the McGill Global Health Blog!

blog logo 4This blog will feature posts covering many different global health topics, written by a variety of McGill students, faculty, and guest writers.

Today marks the official launch date, with our first post coming from a PhD student from the McGill Division of Social and Transcultural Psychiatry. For the first week of the launch, a new piece will be posted each day. The blog will then continue to make one post every Friday. These posts will give a snapshot of what is happening in the broad field of global health, within and outside of the McGill community. The blog is linked with an Instagram account – photos will be posted along with links to the associated blog posts each Friday.

We encourage submissions from the wider McGill community. If you have a post you wish to share, please refer to our Submit Page for instructions.

Subscribe to the blog and follow us on Instagram to keep up-to-date with the latest posts.

Happy reading!

Blog authors are solely responsible for the content of the blogs listed in the directory. Neither the content of these blogs, nor the links to other web sites, are screened, approved, reviewed or endorsed by McGill University. The text and other material on these blogs are the opinion of the specific author and are not statements of advice, opinion, or information of McGill.