October 2012

Esther manages commodity supplies with meticulous record keeping {Photo credit: Y. Otieno/MSH.}Photo credit: Y. Otieno/MSH.

This is the advice that Esther Wahome, a registered community health nurse in a Kenyan health facility, gives to her clients when they come to the tuberculosis (TB) clinic. Within a short time, Esther dispenses the drugs to the patient, provides health care advice and updates her records.

Esther’s TB clinic clients are usually referred to Kayole II sub-district hospital from Toto Bora and other smaller health care centers. Kayole II, located on the outskirts of Nairobi, provides free health services and receives nearly 300 outpatients each day.

During a routine supervisory visit conducted by the USAID-funded, MSH-led, Health Commodities and Services Management (HCSM) Program, Esther, a mother of two, spoke about her work at the Kayole II TB Clinic, which she has been running for the last three months.

“I like serving in the TB clinic because I get to see patients who are weak regain their strength. Sometimes the patients come in when they are so weak and close to skin and bones that at times I wonder where to inject them. Seeing patients thrive fulfills me and is my joy,” says a smiling Esther.

Devex interviews MSH President & CEO Dr. Jonathan D. Quick at the Clinton Global Initiative 2012. {Photo credit: Devex.}Photo credit: Devex.

Devex interviews MSH President & CEO Dr. Jonathan D. Quick at the 2012 Clinton Global Initiative (CGI) Annual Meeting.

"The last decade has been a stunning decade for global health. If you look at what's been achieved in AIDS, TB, malaria, --- less so in family planning, but still progress --- it's been an amazing decade," says MSH President & CEO Dr. Jonathan D. Quick in an interview with Devex.

Luke and volunteers construct a new house. {Photo credit: L. Ross/MSH.}Photo credit: L. Ross/MSH.

In January 2011, Amelia and her partner, Luke --- both HIV positive --- began accessing HIV care and support services at the Agape Network through its community home and palliative care program.

Agape Network is one of the NGOs that receives technical support from the PEPFAR-funded, USAID-implemented, Guyana HIV/AIDS Reduction and Prevention Project (GHARP II), led by MSH.

When the Agape staff first met Luke and Amelia, they were living with their two daughters at Luke’s family’s home. The situation was tense because Luke’s relatives did not approve of his relationship with Amelia.

Finally, in December 2011, the tension escalated and Luke, Amelia, and their family were thrown out of the house.

International Day of the Girl: End Child MarriageInternational Day of the Girl: End Child Marriage

My grandmother married at 8 years old; my mother married at age 15.

I often wonder what their lives --- their potential --- would have been, if they were not child brides.

Today, the same pattern is repeated in villages and cities around the world. Every year, nearly ten million girls are forced into marriage before they reach the age of 18 --- with little or no say in the matter.

That’s more than 25,000 girls a day; 19 girls each minute.

These girls are denied the opportunity to fulfill their potential for healthy and productive lives. When they enter marriage, most drop out of school and enter a world where they work from dusk to dawn to provide labor to the households. From their mothers' care they are transferred to the supervision of their husbands and mothers-in-law, who view them as an additional labor source. Pressured to demonstrate their fertility, they get pregnant when they are still children and face the risk of illness or death when they deliver.

And some child brides are as young as eight or nine.

Seven-year-old Ladi Muhammed. Nigeria. {Photo credit: S. J. Garlora / MSH.}Photo credit: S. J. Garlora / MSH.

Seven-year-old Ladi Muhammed wants to become a teacher. The third of five children ranging 3 to 20 years old, Ladi and her family live in a poor Nigerian village.

The likelihood of Ladi attending primary school is low.

Public primary education is free in Nigeria, but Ladi’s parents can barely afford to feed their children. The children supplement their parents’ income with menial jobs, such as street trading, which leaves little time or energy for schooling.

Her father, Ahmadu Mohammed, wants to send all of his children to school, but does not have the financial means to do so. “It is my heartfelt desire to send my children to school, but I can’t support them due to the meager salary I earn from my work as a gateman. Our situation is tough; we can barely feed ourselves,” says Mohammed.

Without an education, Ladi’s desire to one day become a teacher appeared a distant dream.

A woman receiving antenatal care in South Sudan. {Photo credit: J. Warren/Save the Children.}Photo credit: J. Warren/Save the Children.

On a dark August night in rural South Sudan, Linda Kenneth felt the swift kick of labor pains begin. Having previously delivered five children, Linda recognized the pains and immediately called for the nearby skilled birth attendant, as it was too late in the evening for her to travel safely to the health facility. In her previous two pregnancies, she had experienced heavy bleeding after delivering, and worried similar complications might arise this time.

South Sudan has the world’s worst maternal mortality ratio (2,054 deaths per 100,000 live births), and roughly one third of these deaths can be attributed to postpartum hemorrhage (PPH). Administration of misoprostol or another uterotonic (a drug that reduces bleeding after childbirth) could prevent the majority of these deaths. Misoprostol does not require a cold supply chain, and is cheap and effective, making it a perfect candidate for community-based interventions.

Upon the birth attendant’s arrival, Linda presented the three misoprostol pills she had recently been given by a home health promoter. Several days prior, a home health promoter had visited Linda and discussed with her a birth preparedness plan, informing her of the benefits of taking misoprostol immediately after delivery to prevent excessive bleeding.

Dr. Jonathan D. Quick of MSH at Washington Post Live's forum on noncommunicable diseases. {Photo credit: Jeff Martin / for the Washington Post.}Photo credit: Jeff Martin / for the Washington Post.

The Washington Post Live panel on October 17 featured high-level noncommunicable diseases (NCDs) experts from around the world discussing how to tackle the global epidemic of NCDs.

We've compiled key moments from the panelists in a "Storify" story, told through tweets.

The panel featured some twenty high-level chronic diseases experts from around the world discussing how to tackle the global epidemic of noncommunicable diseases (NCDs).

http://storify.com/MSHHealthImpact/washington-post-live-high-level-panel...

The convoy faced many challenges, including the rainy climate en route to Mulungu. The vehicles often got stuck in the mud, requiring the help of many people to get them moving again. {Photo credit: MSH.}Photo credit: MSH.

The Democratic Republic of the Congo’s Sud Kivu province has been an area of armed conflict for many years, with various rebel factions fighting for control over the resource-rich region.

The continued fighting has disrupted health services --- which were weak to begin with --- due to geographic isolation and poorly supported health workers.

In the health zone of Mulungu, there had been no delivery of medicines or supplies for more than six months. More than 105,000 people live in the remote area, where health issues include malaria, malnutrition and anemia. In April 2012, the USAID-funded Democratic Republic of Congo-Integrated Health Project (DRC-IHP) deployed a team of health workers from Bukavu to Mulungu, to transport more than 2,640 pounds of medicines and supplies; 2,700 insecticide-treated mosquito nets; and 50 containers of petrol to supply cold chain storage units for vaccines.

Children in Yogyakarta, Indonesia, a community supported by TB CARE I volunteers. {Photo credit: D. Collins/MSH.}Photo credit: D. Collins/MSH.

Each year, as many as 64,000 people die from tuberculosis (TB) in Indonesia. Although the Ministry of Health’s (MOH) National TB Program (NTP) has made great progress over the last few years, the country is still one of twenty-two high TB-burden countries in the world. Indonesia is also one of the twenty-seven countries considered to have a high burden of multi-drug resistant TB (MDR-TB). In 2011, the nation reported 6,100 cases of MDR-TB.

Donor funding has been a major factor in the success of Indonesia’s TB program over the last few years, especially The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) grants.  Indonesia has, however, progressed economically and is now a relatively low priority for Global Fund grants, which are expected to end or reduce significantly by 2015.

Despite Indonesia’s economic growth, the sustainability of the TB program will be a major challenge without support from this critical donor, especially during the funding transition period.

A Rwandese woman shows her child's community-based health insurance card. {Photo credit: C. T. Ngoc/MSH.}Photo credit: C. T. Ngoc/MSH.

Eugénie, a widow in Rwanda, farms to provide for her children. In January 2012, she had surgery to remove a tumor, a procedure that would have devastated her family economically if she did not have insurance. Rwanda’s health insurance program is the most successful of its kind in sub-Saharan Africa: it supports the health of more than 90 percent of the population, including the most vulnerable, like Eugénie.