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It is 5:30 a.m. on a Thursday morning in the town of Mwene-Ditu, located in the Eastern Kasaï Province of the Democratic Republic of Congo. The skies are still dark as the crieur, the town crier, makes his rounds, calling out to the community that today is the start of the three-day national vaccination campaign against polio.

As the local residents begin their day, health workers are finalizing preparations for the massive door-to-door effort to immunize children under age five years old from this crippling disease. One such worker is Evariste Kalonji, a community mobilization specialist with the Integrated Health Project.

When the Taliban were chased from power in Afghanistan in December 2001, the health system was in shambles---devastated by years of war and neglect. Access to primary care was below 10% and immunization rates had fallen below 20% throughout the country. Less than half the hospitals had both electricity and running water.  Medicines and medical supplies were scarce and the quality was often unreliable. There were essentially no female health workers active in most of the Afghanistan---a country in which cultural sensitivities mean female providers are essential for women’s health. Nine out of 10 women were on their own for labor and delivery, with no trained birth attendant. Not surprisingly, maternal, child, and infant mortality were among the highest in the world.

Blog post updated Dec. 27, 2011.

Taj Bibi learns how to use zinc and oral rehydration salts to treat her child. Photo credit: BASICS/Afghanistan, MSH.

Taj Bibi sits nursing her 5-month-old baby in the kitchen of her home in the village of Sartal in Takhar province in Afghanistan’s north. The room is dark; the only natural light comes from the doorway to the dusty courtyard outside. The sound of her children playing echoes across the small family compound.

Bibi’s first two children died -- one of them from severe diarrhea -- because the family could not afford to take them to the doctor. “Now, if our children get diarrhea or any other illness, I take them to the community health worker,” she said.

Community health workers (CHWs) are the building blocks of the Afghan health system, bringing basic health services to villages across the country.

Providing immunizations to children in Afghanistan.

Many children in Afghanistan can be spared of communicable diseases that can make them ill and even cause death, if they receive routine vaccinations. But in a country of more than 25 million people in a country the size of Texas, where over 80% of the population lives in rural areas, immunizing every child against measles, diphtheria, pertusis (whooping cough), tetanus, and polio is very challenging.

Large scale immunization campaigns have proved helpful, but have been unable to significantly increase and maintain high immunization rates throughout the country.

The US Agency for International Development’s BASICS project (Basic Support for Institutionalizing Child Survival), with support from MSH, is working with the Afghan Ministry of Public Health (MoPH) and UNICEF to demonstrate in nine districts how an expanded program on immunization (EPI) micro-planning can successfully increase the number of immunized children.

The community midwife sitting with Suzanna Ile and her son, Modi, in South Sudan. {Photo credit: MSH.}Photo credit: MSH.

Blog post updated Dec. 27, 2011.

Suzanna Ile is a 26-year old woman from Lokiliri Payam in South Sudan. Suzanna lost her first two babies in child birth. During her third pregnancy, a community midwife at Lokiliri Primary Healthcare Centre -- a health facility supported by the US Agency for International Development (USAID) through the MSH-led Sudan Health Transformation Project (SHTP II) -- recognized Suzanna’s contracted pelvis and identified her high risk pregnancy.

Without access to emergency services and a health facility capable of performing a Caesarean section, the midwife knew Suzanna would likely lose her third child as well. A contracted pelvis often results in obstructed labor, fistulas, postpartum hemorrhage, or the death of the infant and mother. The midwife discussed with Suzanna alternative delivery options during an antenatal care visit.

Today, the Center for Strategic and International Studies (CSIS) released a new video: “Spotlighting the NCD Problem.” This video explains the challenge the world is facing with non-communicable diseases. According to the World Health Organization, about 36 million people die each year due to NCDs, and a quarter of NCD deaths are of people aged under 60; 9 in 10 of these people are from developing countries.

MSH President and CEO Jonathan D. Quick, MD, MPH, recently called on UN member states to take a heath systems strengthening approach to NCDs.

Orou Assoumanou describing the work within his community to Dr. Lola Gandaho, of BASICS Benin.

 

Living in the rural village of Kpagnaroung, Benin, Orou Assoumanou is a dedicated health worker who promoted vaccinations and distributed ivermectin (a medicine used to treat roundworm) within his community before receiving training by the MSH-led, USAID BASICS (Basic Support for Institutionalizing Child Survival) project in community-case management. The comprehensive BASICS training improved his ability to offer care and enabled him to treat children within his community.

With the arrival of a trained community health worker able to prescribe medications, members of his community no longer have to travel long distances to seek medical care for their children. In fact, Orou says that crowds would form at his door to receive care.

 

 

 

 

Discovering MSH blog series graphicOver the next couple of months, as MSH celebrates it's 40th anniversary, reporter John Donnelly and photographer Dominic Chavez will be traveling to several countries to report on MSH’s work in the field. The stories will go into a book due out in the fall on MSH’s 40 years in global health. This blog entry is a post from the road, to give a flavor of their experiences with MSH staff.

Dr. John P. Rumunu, MSH’s Chief of Party in South Sudan. © Dominic Chavez

 

Yesterday the results of HIV Prevention Trials Network (HPTN) 052, a clinical trial funded by the National Institutes for Health, offered definitive proof of what we have long suspected---that treating HIV infected persons substantially reduces the risk of transmitting HIV to uninfected persons.

This is FANTASTIC news and offers very convincing evidence that, at least for heterosexual discordant couples (the study was not able to enroll significant numbers of gay men), if the infected person is on ART, the uninfected partner is protected. And more broadly, it offers significant evidence that treatment is indeed highly effective in preventing transmission of HIV. This can reasonably be described as a “game changer” with respect to how we think about HIV prevention, care, and treatment. We used to talk about “treatment as prevention,” but now we can say “treatment IS prevention.”

Read the UNAIDS report here.

Cynthia Isioma, Nigeria

In the village of Owa Ofie, Nigeria, Cynthia Isioma, a young girl who has survived enormous odds reclaimed her dream of secondary education.

Cynthia lost both parents at the age of two and was left in the care of her grandmother who died three years later. Cynthia’s situation grew more challenging when she was then moved to her blind grandfather’s home at the age of five.

Rather than receive care, Cynthia had to take on the responsibility of caring for her grandfather who could not afford to send her to school.  Cynthia became a child caregiver, providing for herself and her grandpa. Her daily duties included going to the forest to collect cocoyam, palm nuts, snails, and waterleaves to sell and for household use.

Cynthia’s situation changed when she was 13 years old and Rural Linkage Network (RULIN), a community-based organization based in Boji Boji, visited Owa Ofie to identify orphans in need of support. RULIN is supported by the USAID-funded, MSH-led Community Support for OVC Project (CUBS).

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