Summit on Mobile Health

The Military Health System Blog

Wednesday, December 17, 2008 – A Great Summit on Mobile Health!
Posted by: Akhila Kosaraju, M.D.

Today, Dr. Akhila Kosaraju, special assistant to the assistant secretary of defense for Health Affairs, reports on our recent Mobile Health Summit.

Last Thursday the MHS, led by Butch Anderson’s International Health team and the Telemedicine and Advanced Technology Research Center (TATRC), held a wonderful event on mobile health technology. Energy in the room at the MITRE headquarters in McLean, Va., was palpable as speakers and attendees engaged in enthusiastic, frank and open dialogue about how mobile technology can be used by the Military Health System to promote health care around the world.  After a whole day of presentations and discussion, it became clear that the potential for cell phone technology is limitless when it comes to health care.

For instance, a presenter spoke of an experience he had with providing a consultation with data made available to him via a cell phone. Another told of how a medical professional in the Congo without access to training in some of the more modern or complex medical techniques was treating a severely injured patient. By using SMS messages, the medical professional was able to reach a colleague in the UK to obtain instructions – 12 steps for amputation – in order to save the young man’s life.

We convened this first Mobile Health Summit to enable the health care community to hear these kinds of stories and spark more talk about the many possibilities for mobile technology in improving and innovating health care. We were so excited to have experts from the State Department, the CDC, the VA, academia, industry, NGOs and the World Health Organization at the event. It was the first conference its kind as far as the level of expertise and breadth of representation, with AFRICOM surgeon Col. Skyler Geller, SOCOM surgeon Col. Rocky Farr, SOUTHCOM surgeon Col. Miguel Cubano, CENTCOM surgeon Col. Bryan Gamble, and USNS Mercy Commanding Officer Capt. James Rice among the many leaders contributing to the dialogue.

With this first Mobile Health Summit we have helped create further awareness and potential partnerships for what will be a critical component in the future delivery of health care. Materials from the summit will be available on health.mil shortly—including details about the current state of global mobile medicine in specific continents and countries, challenges faced, technology being developed, and next steps for the MHS.

Improving Access to Medicines

December 10, 2008

A WHO Committee is Negotiating with Drug Manufacturers in order to Improve Access to Medicines

Posted by Mead Over at 09:17 AM on Global Health Policy Blog

“Igwg on Phiip” sounds like a rural Welsh village on the River Phiip, named to eulogize a local notable named Igwg. In fact, with a different capitalization, it’s the cumbersome acronym for a working group that is attempting to improve the poor’s access to pharmaceuticals while maintaining incentives for innovation.

Since the CGD is a member of the “Global Health Technology Coalition”, I’ve just received the minutes of their event on November 18 at which Dr Gaudenz Silberschmidt delivered the attached PPT presentation . It is full of acronyms, but most can be deciphered from the previous slides and the context. For example, “IGWG on PH, I, IP” means “Inter-Governmental Working Group on Public Health, Innovation & Intellectual Property”.

The IGWG on PH, I, IP was created by the WHO “World Health Assembly” in 2006. The minutes of their meetings can be found on the WHO website. This working group has generated a “Global Strategy” and a “Plan of Action” submitted to, and adopted by, the World Health Assembly in May 2008. The formal name of the submitted document is “Resolution WHA 61.24: Global strategy and plan of action on public health, innovation and intellectual property.” Presumably this resolution should eventually appear on the WHO website that displays such items, but at the time of this writing it has not yet appeared.

According to Dr Silberschmidt’s presentation, resolution 61.24 empowers the “IGWG on PH, I, IP” to “negotiate” with industry on measures that firms might take to increase access. It’s not clear how the working group can make much headway. What do they have to offer firms in exchange for concessions?

Among the “upcoming challenges” which Dr Silberschmidt lists on his penultimate slide are the following which link to various aspects of CGD’s work:

• How to deal with differential prizing (sic) in emerging economies with legitimate markets and legitimate demands for access for the poor?
• Links to challenges in pharmaceutical policies of industrialized countries (e.g. lack of research in antibiotic resistance)

The typo on Dr Silberschmidt’s which replaces “pricing” with “prizing” is ironic, because I see no mention of prizes or “advanced market commitments” (like those promoted by the CGD based on the work of another working group) anywhere in the PPT. Perhaps AMCs are in the negotiations, but there is no sign of them in these slides.

One might ask, “what ELSE is worth doing if the group isn’t able to make progress on differential pricing?” Perhaps the answer lies in the “Access to Medicine” or ATM index, displayed on the last of Dr Silberschmidt’s slides. The index has eight components, only one of which is pricing. The index is thus suggesting that excellence on many other dimensions could offset failure to aggressively pursue differential pricing. I find this rather a stretch. Differential pricing has the advantage of engaging the full power of both the private and the public drug distribution networks in expand sales to everyone who can pay more than the marginal cost of production. Where the distribution networks are well developed, it would take a lot of “drug donations” and “philanthropy” to make up for any reduction in use of differential pricing. (This observation leads to the suggestion that these three components of the ATM index could be usefully collapsed into a single component, defined as the dollar value of concessions in these three areas.)

The second bullet is too abstract to understand until one gets to the example. Ahhhh. They think industrialized countries are to blame for the fact that private pharma does little research on antibiotic resistance. That seems a very big stretch to me. The fact that drug resistance is an international public bad should maybe come first in the list of causes of insufficient research. Not only does no firm have sufficient incentives. No country does either. In fact the only body that has at least a partial mandate to regulate an international bad in the public health domain is the WHO – which has failed to take a strong stand on the issue so far.

Meanwhile the CGD is currently hosting a working group on drug resistance, which will publish recommendations on policies that WHO and the donors might follow to reduce the danger of drug resistance and lengthen the usefulness of our existing pharmaceuticals. Once the recommendations have been announced, perhaps this IGWG on PHIIP will endorse and help implement them.

HHS Applauds Global Health Accomplishments in Latin America and the Caribbean

The U.S. Department of Health and Human Services will host a briefing with the Department of Defense and Project Hope, celebrating the accomplishments of Operation Continuing Promise 2008 and other global health initiatives within Latin America and the Caribbean.

Among accomplishments to be discussed are those that strengthen health systems and the diplomatic ties between the U.S. and the Americas. The briefing will celebrate the establishment of the U.S.-led Regional Healthcare Training Center in Panama, which trains government and health professionals in public health matters, and other global health success stories from Ecuador, Nicaragua, El Salvador, Guatemala, Peru, Colombia, Dominican Republic, Trinidad and Tobago, Guyana, and Haiti.

Representing the Military Health System will be Ms. Ellen P. Embrey, deputy assistant secretary of defense of Force Health Protection and Readiness.  The event will take place on December 12, 2008, 10 a.m. – 11 a.m. EST, at the University of Miami’s Miller School of Medicine.

Global Health Policy

December 09, 2008

The public versus private debate: inching toward the middle….

Posted by April Harding at 11:35 AM

An exchange in the pages of PLoS Medicine underscores a promising trend in global health: a shift toward more pragmatism and less name-calling on the role of the private sector in developing country health systems.

Discussions of the private health sector in developing countries have long been dominated by dogmatism on both sides. For public-sector-purists, the existence and rapid growth of the private sector in the 80s and 90s was a symptom of what was wrong with developing country health systems, and good policies were those that would strengthen the public sector in such a way as to lead to the fading away of the private sector. For the private-sector-believers, the growing private sector revealed the unfixable problems of the public sector, and made it clear that to achieve sectoral goals you’d have to engage the private sector. The public-sector-purists thought the private-sector believers were anti-poor, since they believed only the public sector could look after their interests. The believers though the purists were in denial about the fixable-ness (and pro-poorness) of the public sector.

For years, this, rather sterile, debate raged – with relatively little benefit. In the past 2 years, this debate has moved on. Both the purists and the believers have shifted to the middle, with growing consensus on the need to work with the private sector (broadly defined), if not where this ranks in the long list of health policy priorities for developing countries

Signs of the growing pragmatism, and desire for constructive debate include:

• an editorial written by two WHO staff, presenting a number of illustrative cases of successful public-private engagement, who concluded

“These cases show that without engaging private providers, poor quality and sometimes harmful care will continue, they show that private providers can help expand access in rural, as well as urban, areas…”

• the very practical position taken by the World Bank in their 2007 Strategy for the health sector which states

“improving HNP(health, nutrition, and population) results requires the Bank to provide sound policy advice to client countries on how to ensure effective regulation to enhance equity and efficiency as well as synergy and collaboration between the private and public sectors to improve access to services for the poor”

• And most recently, the interesting debate in PLoS Medicine (LINK above), which presents a number of growing areas of agreement, and, naturally, some areas where disagreement persist.

While there is still much that the two camps disagree on, notably the appropriateness of engaging the for-profit sector, the growing pragmatism is definitely a positive development.

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Promoting Peace by Promoting Health

The Military Health System Blog

Monday, December 08, 2008 – Promoting Peace by Promoting Health
Posted by: S. Ward Casscells, M.D.

President-elect Obama has signaled that as the next commander in chief he will rely heavily on diplomacy, and I expect he will leverage that the diplomatic potential of the military. He has also made clear that he expects the military to turn its attention to Afghanistan. As a first response to the incoming administration, I hosted a symposium last week that brought together scholars, think tanks health development practitioners and government officials from around the world to discuss the cultivation of health capacity in the Middle East as a diplomatic priority.

The Military Health System brings significant material and intellectual capabilities to the whole-of-government diplomatic tool kit. And although DoD’s role remains ambiguous, Dr. Steve Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies affirmed that a country’s health is linked to its level of stability and peace. And that the U.S. efforts to promote health, such as the PEPFAR effort to treat HIV/AIDS in Africa, pay off with long-lasting positive perceptions and friendliness toward the U.S. As the first guest speaker to address the crowd, Morrison certainly set the tone for the day.

But as the lectures progressed, each speaker illuminated barriers which complicate successful healthcare capacity building. The next two speakers, both leading academics in their fields, explained the complexities of serving in foreign cultures where religious and gender motifs are embedded in the constraints and freedoms of daily life. Dr. Susan Sered, a professor of religious anthropology from Suffolk University explored the role of women in healing in the Middle East, linking diminished women’s health to social disparities. Meanwhile, Dr. Robert Rubinstein, a professor of anthropology and international relations at the Maxwell School of Syracuse University, described the necessity for cultural sensitivity in building health care capacity. He described cultural differences as “horizontal” between agencies and “vertical” between different peoples, and implored the audience to avoid looking at other cultures via a list of “differences”, but rather to see every culture as generating a symbolic framework that orients every behavior of its people.

Dr. Alex Dehgan, senior policy advisor in the Department of State, continued the discussion by highlighting the clear benefits of using health science as a diplomatic tool with Middle Eastern countries, especially Iran. Dr. Kaveh Khoshnood, a faculty member at the Yale School of Public Health, added that those benefits could especially be experienced in the HIV/AIDS arena. Both speakers admitted that despite the waxing and waning of diplomatic relations with Iran, one constant has been the enduring value of scientific exchange, and that this anchor of diplomatic relations can extend far beyond Iran to the outstretches of the Middle East.

Finally, we heard from the unequivocally courageous Baroness Nicholson of Winterbourne who, since the 1990’s, has been working with the Marsh Arabs of Iraq who were attacked by Saddam Hussein after their uprising against his rule. She built on the themes of the day, stressing that we should not diminish health by securitizing it, and that Iraq needs institutions that will be based on core humanist values, which will create the building blocks for their development. Canon Andrew White, vicar of the last Christian church in Baghdad and a self-declared intermediary between Sunni and Shia leaders in Iraq, concluded the day by discussing the many different ways organizations can maintain a presence in Iraq and create conditions for reconciliation and rebuilding, using his own doggedly-courageous life-story to as a reference guide.

The holy Koran says that the best person that does the will of God is the person who loves his neighbors. And while the context of religion cannot be removed from our work in the Middle East, we should consider the ethics of our specific actions. Dr. Adil Shamoo, a member of our own Defense Health Board, and ethics advisor to the board as well as a professor at the University of Maryland, warned that we must clearly orient our actions within an ethical framework before we leap. Should we clearly delineate our actions in ethical terms, we would find legitimacy and therefore more successfully execute our purpose. Looking before we leap is not an easy task, particularly for a multi-agency endeavor such as those before us.

One thing is for certain: As the administration changes, we will find ourselves operating in at least the same number of complex contexts around the world, if not more. Finding the right way forward will take perseverance, wisdom and understanding, not only our partners and allies, but of the complex cultural, political, sociological and psychological realities embedded in other countries. We are beyond the age of superficial and ethnocentric gestures – our continued success, and that of the nation, is contingent upon whether or not we go forth with open minds and open hearts.

Somalia: Situation Report No. 48 05 Dec 2008

Source:

UN Office for the Coordination of Humanitarian Affairs

Key Overall Developments

The 2009 Somalia Consolidated Appeal Process

(CAP) was launched in Nairobi on 1 December

2008 appealing for just over US$918 million in

support of some 200 projects from 14 United

Nations agencies, 32 International NGOs and 39

National NGOs. The increase in scope and

funding size of the Somalia appeal from US$662

million in 2008 to US$918 million for 2009

reflects not only the dramatic increase in the

number of people in need (3.2 million) but

also the sharp rise in commodity and delivery

costs for Somalia.

“What we are looking at today is a situation

in which nearly half the population is in

crisis or need of assistance. There is no

doubt it has reached an undeniable level of

immensity,” said UN Humanitarian and Resident

Coordinator, Mr. Mark Bowden. “Without

question, throughout 2008, humanitarian

operations have struggled to address the

widening crisis and support the growing number

of vulnerable populations in an environment of

shrinking humanitarian space. In this

difficult environment, humanitarian

operationshave overall delivered what was

needed where it was needed in a timely manner.

In addition to an integrated response for

health, nutrition, water and sanitation for

immediate life-saving purposes, parallel

livelihood support is urgently needed to

prevent households from falling into

intractable poverty given the high food

prices, loss of assets and lack of access to

food. We can, and we must, do this in 2009.”

The 2008 humanitarian appeal for Somalia was

70% funded as of 4 December 2008. However,

there are some variations in funding levels

between sectors – safety & security for staff

(8%), agriculture & livelihoods (24%), health

(40%), education (42%) and protection (42%).

The latest nutrition surveys conducted by the

UN Food Security Analysis Unit (FSAU) in

October and November confirm the continuing

humanitarian crisis, particularly in central

Somalia where some levels of severe

malnutrition are nearly 6% compared to 3% in

May 2008. The emergency threshold is 4%. FSAU

highlighted the urgent need for livelihood and

humanitarian interventions to save lives and

livelihoods.

WFP reported that some 1,250 mt of food aid in

41 trucks crossed the Kenya-Somalia border

into Gedo, Lower and Middle Juba regions of

Somalia through Mandera and Liboi border

following the reopening of the border posts on

28 November. The Kenya Government had closed

the border even for the passage of relief

cargo due to security concerns triggered by

the abductions of two nuns in El Waaq,

Northern Kenya, on 10 November. Trans-border

deliveries of humanitarian food aid into

Southern Somalia were hampered, causing

decreased deliveries for November

distributions.

On 30 November, a ship delivering 11,000 mt of

sorghum, Corn Soya Blend (CSB) and vegetable

oil safely arrived at Berbera port,

Somaliland. The vessel sailed from Mombasa

through the piracy plagued Somali waters under

NATO escort for ten days on the seas. This is

the first shipment from Mombasa to Berbera in

the recent past. Most shipments to Berbera and

Bossaso ports originate from Djibouti.

Response

During the reporting week, WFP dispatched a

total of 1,366 mt food aid targeting 368,322

beneficiaries in Northeastern and South

Central Somalia.

WFP plans to distribute 27,630 mt of food to

1.6 million Somalis in December across

Somalia. Among the beneficiaries for the month

include 260,860 vulnerable Somalis targeted

under a social support programme (including

nutrition interventions), 656,980 internally

displaced persons and 420,280 vulnerable

Somalis targeted through general food

distribution as well as 111,900 beneficiaries

through Food for Work and training. Insecurity

in some parts of Somalia is the main likely

challenge that may affect the distribution

plan for December.

For further Information in Somali or English,

contact Muna Mohamed on + 254 733 643 737 ?

mohamed26@un.org

Website address:

http://ochaonline.un.org/somalia

DR Congo: OCHA Humanitarian Situation Update No. 17 – North Kivu, 26 Nov – 01 Dec 2008

Source:

UN Office for the Coordination of Humanitarian Affairs

- A total of 90,000 persons were displaced in the Grand Nord.

- 10,000 Congolese crossed into Uganda on 27 November,

bringing the total number of Congolese who have found refuge

in Uganda since August to 27,000.

- Due to new clashes between CNDP and PARECO since 29

November, humanitarian workers have temporarily evacuated

Masisi center

- The transfer of IDPs from Kibati to Mugunga I began on 28

November.

- Cases of looting by armed groups have been reported in

several localities.

Political and Security Context

- CNDP and PARECO clashed in several localities, notably on

25 November in Kinyandoni (Rutshuru), in the evening of 25

and 26 November in the zone of Kalembe (Masisi) and on 27

November in Kinigi (Masisi). Clashes between CNDP and PARECO

around Masisi center, which created panic within the

population and IDPs, were reported on 30 November.

- Due to the clashes, humanitarian workers from various

agencies (CONCERN, SC-UK, NRC and OCHA) were temporarily

evacuated to Goma on 29 November.

- CNDP confiscated a truck from IRC and three from

Solidarities on 27 and 28 November in Rugari, Rutshuru, to

transport military elements on the Rugari ? Rubare axis. The

trucks were returned afterwards.

- Elements from the National Congolese Police (PNC) which

were in charge of security in the Kibati IDP camp shot at

IDPs during a food distribution on 30 November. Four IDPs

were injured and transported to the hospital.

- Reports of armed groups pillaging several localities

persist. On 26 November, local NGOs reported that Mayi-Mayi

ransacked a goat farm in the village of Kambaila, located 17

Km from Butembo. Another NGO reported that FARDC military

looted houses in Mutiri and Rwenda neighborhoods in Butembo.

UNDSS spoke about the pillaging of houses in the locality of

Bulotwa, South Lubero, by FARDC militaries. Local NGOs in

Kibirizi reported that CNDP elements looted in Kashalira,

Rutshuru.

Population Movements

Kibati

- The transfer of IDPs from Kibati to Mugunga I began on

Friday 28 December, with 92 families and ended on Sunday 30

November when the operation was suspended following a

shooting incident in the camp. On Tuesday 2 December, 150

families from Kibati should have been on route to Mugunga I.

In the meantime, construction work for the Mugunga III site

continues.

- According to Caritas, approximately 9,000 displaced

families were recorded in Kibati. Other newly displaced

families are expected to arrive in the area as a result of

recent clashes in Kiwanja. Certain families live in sheds in

Kibati I or in public areas. Their registration is under

way.

Rutshuru Territory

- On 30 November, local sources reported the return of

populations from Ishasha through the Nyamilima?Ishasha axis.

These returns are believed to be motivated by the current

crop season. ICRC/RRM reported the presence of 9,000

displaced families in Rubare, Kako and Kalengera. Their

registration is in progress.

- MSF-F, in mission on 25 November in Kibirizi, reported the

return of approximately 50% of the locality’s inhabitants.

In Rwindi, on the other hand, no returns have occurred.

Grand Nord

- An estimated 90,000 persons that fled towards the Grand

Nord region are currently situated between the region of

Lubero and Beni. The majority came from the territory of

Rutshuru or the region of Ituri.

- Local NGOs reported that 84 displaced families were

recorded in Kyavinyonge on 26 November. 36 families also

arrived in Lukanga, southeast of Butembo. Their registration

is under way.

Masisi Territory

- Since the beginning of November, a progressive return has

been witnessed in the locality of Bihambwe. As a

precautionary measure, some of the population had moved

towards the localities of Mushaki, Matanda and Kirolirwe

while others went to Buguri, Katale, Lushebere and Masisi

centers.

- Local authorities reported the presence of 3,906 displaced

families staying in Masisi with host families, in schools or

churches. Others have fled from Kinigi, Kaniro, Shugi, Luke,

Muhanga, Buabo and from other localities due to constant

clashes between CNDP and PARECO and are now in Loashi and

Nyabiondo.

Uganda

- Approximately 10,000 Congolese crossed the Ugandan border

on 27 November, after a prior wave of 3,000 persons had

crossed in the previous two days. According to UNHCR, this

carries the total number of Congolese refugees in Uganda

since August to about 27 000. The majority of the newcomers

are from the city of Rutshuru and the villages of Kafeguru,

Kiseguru, Kiwanga and Kinyandonge, which are located between

50 and 70 km from the Ugandan border. Today, Uganda shelters

approximately 50,000 Congolese refugees which are among the

150,000 refugees within the entire country.

Gaps

WASH

- The water installations in the village were destroyed

during a clash between different armed groups, leaving the

returned populations in Bihambwe facing a grave water

scarcity.

- Once again the IDP site at the Kilmani School in Masisi

center experiences a problem of latrines. Only one block of

5 door latrines is currently functional out of the 9 blocks

that were previously constructed. NRC asked IDPs to start an

excavation of pits in exchange for monetary compensation.

- Oxfam-GB reported an inadequate usage of the health

facilities that are at the disposition of IDPs in the Kibati

site due to lack of health information and education.

Health/Nutrition

- Returned populations in Bihambwe (Masisi) need healthcare

assistance. The Health Center has not been re-stocked since

September. The Kitsule Health Centre, in the health zone of

Masisi, ran out of medical supplies earlier this week.

- Cases of diarrhea (and suspected cholera) were recorded

among the populations from the region of Kinyandoni, and

among the displaced in Rugarama and Kabirizi. According to

FAO, a dozen fatalities were recorded.

- 223 of 2,206 children examined in the Masisi Health Zone

demonstrated signs of acute malnutrition.

Protection

- The Territorial Conflict Commission against Sexual Acts of

Violence (CTVS) recorded 45 cases of rape during October

2008 and 49 cases until 28 November in the territory of

Walikale. Both civilians and armed men are among the

perpetrators.

Education

- In the territory of Rutshuru, schools remain closed due to

insecurity.

- Eleven schools in the city of Goma are still occupied by

IDPs at night, creating an unhealthy educational environment

for children due to the high risks of cholera. Out of the

si- schools in Kibati, one is being occupied by militaries

and three by IDPs.

- In Mugunga, Action Aid is in the process of finishing the

construction of si- classrooms made of durable materials.

UNICEF will assist with the provision of school supplies but

it lacks the necessary funds for blackboards.

Assistance

Food

- Humanitarian organizations distributed 292 tonnes of food

on 1 December to 35,195 IDPs in Jomba. IDPs in the vicinity

of this locality, that is 24,905 persons, will benefit from

another food distribution on 2 December.

- WFP concluded its distribution of food in the camps of

Kibati. This week, the agency plans to concentrate on IDPs

located east of Rutshuru and on the Nyanzale axis.

NFI

- Between 24 November and 1 December, IRC and Solidarities

distributed NFI kits to 19,866 families in Rutshuru and

Kiwandja, 4,903 in Tongo, 9,000 in Kako, Kalengera and

Rubare using RRM funding.

- ICRC provided 500 NFI kits to the Red Cross/Butembo for

IDPs that newly arrived in Butembo from South Lubero. The

NFI cluster requested local NGOs to distribute 1,500 kits to

IDPs that will not receive ICRC kits.

Health/Nutrition

- On 26 November, MSF Switzerland reported the disinfection

of houses in which suspected cases of cholera were recorded

in Kasindi and Kasindi Port. The NGO also supported two

health structures with the provision of medical supplies. On

the same day, MSF-F went to Lunyasenge, on the west coast of

the Lake Edward, to provide technical support to the local

health post. Beforehand, the NGO had sent medical supplies

after suspected cases of cholera had been reported in the

area.

- Starting 1 December, Save the Children UK will provide

nutritional assistance to eight locations in Butembo, Katwa,

Musiene and Lubero. The nutritional screening carried out on

a sample of 428 children indicated rates of 0.2% of severe

malnutrition and 3% of moderate malnutrition.

- UNICEF is pursuing emergency vaccination against measles,

including vaccination against polio, the supplementation of

vitamin A and parasite removal for children of less than 5

years of age on the Massi?Kitshanga?Mueto?Kilolirwe axis.

UNICEF also provided medical supplies to the Health Centers

of Kirosthe and Mweso to ensure free of charge health care

for IDPs and other vulnerable populations.

Protection

- On 28 November, SC-UK reported the presence of 45 children

separated from armed forces and groups in the Transit and

Orientation Centre in Beni. Ten other children separated

from armed forces and groups and four unaccompanied children

have been accommodated with host families.

Education

- Since 24 November, 66,828 primary school students and

1,119 teachers have benefited from the distribution of

school kits in 162 schools throughout the territory of

Masisi, around Kibati and in the area of Mugunga. All

schools that accommodate more than 20% of displaced students

received pupils/teachers kits.

- JRS, with financing from UNICEF, intervened in the Mugunga

area for emergency education, training of teachers and

distribution of school kits.

- RRM financed the construction of latrine posts in schools

in Ishasa and Nyamilima. They also provided black boards and

desks. Classrooms were rehabilitated or reconstructed.

WASH

- RRM financed the construction of latrines posts and

showers as well as the installation of bladders and water

chlorination points in Rutshuru, Kiwandja, Sake, Mubambiro,

Nzulu, Lunyasenge, Kitchanga, Mweso, Ishasa, Nyakakoma,

etc..

Logistics

- South African engineers and UNOPS began the rehabilitation

of the damaged portion of the Sake?Masisi road. An

interagency mission (WFP, UNOPS and MONUC) went on 28

November to Masisi to evaluate the situation.

Minova (Sud-Kivu)

Education

- 12,278 students benefited from a distribution of

scholastic supplies in Minova where there are 5,300

displaced children of school age. Only 21% of these children

are accommodated in 21 schools throughout Minova and its

surrounding areas. UNICEF and Save the Children will

intervene to set up five accelerated learning centers which

will receive 1,450 students.

Coordination

- During the course of the Liaison Committee Meeting,

chaired by OCHA, in Kitchanga on 28 November, a

recommendation was made to advocate with CNDP authorities

against their practice of confiscating humanitarian

vehicles.

For more information, please visit our humanitarian website

: http://www.rdc-humanitaire.net

Contacts :

- Gloria Fernandez, Head of Office, OCHA RDC,

fernandez11@un.org, +243 813 330 146

- Christophe Illemassene, Information Manager, OCHA RDC,

illemassene@un.org, +243 819 889 195

- Noel Tsekouras, Desk Officer, OCHA New York,

tsekouras@un.org, + 1 917 367 93 67

Attachments:

Full_Report.pdf:

http://www.reliefweb.int/rw/rwb.nsf/retrieveattachments?openagent&docid=5F3506B3FC4889A5492575140006010F&file=Full_Report.pdf

Age of Pandemics from the Herald Tribune

In age of pandemics, human and animal health intersect

By BRUCE KAPLAN GUEST COLUMNIST

Published: Tuesday, December 2, 2008 at 1:00 a.m.
Last Modified: Monday, December 1, 2008 at 5:40 p.m.

Our nation voted for change in the last presidential election. The world community appears to approve. A strategy for fast-forwarding health care change is also receiving a heavy and favorable voter turnout globally in the scientific electorate. Unfortunately, very few in the general population are aware of this dynamic process and its great potential.

The “One Health Initiative” is a movement to forge co-equal, all inclusive communications and collaborations between physicians, veterinarians and other scientific-health related disciplines. This has been limited or absent for much of the 20th century.

When properly implemented, the sharing of scientific information will help protect and save millions of lives in present and future generations. The One Health concept is a worldwide strategy for expanding interdisciplinary interactions in all aspects of health care for humans and animals. The synergism achieved will accelerate biomedical research, enhance public health efficacy, expand the scientific knowledge base, and improve medical education and clinical care.

In the past two years, “One Health” has expanded exponentially in the scientific communities of the U.S. and many other countries. Nearly two dozen international organizations have endorsed the project, including the American Medical Association, the American Veterinary Medical Association, the Centers for Disease Control and Prevention and the American Society for Microbiology.

Several public health officials at the Florida State Department of Health have worked diligently to support and promote this endeavor. In fact, their division of environmental health publishes a quarterly One Health Newsletter online doh.state.fl.us/Environment/community/One_Health/OneHealth.html. This Web site has gained increasing attention.

This concept has worked with extraordinary synergistic results in the 19th and 20th centuries. Three examples are:

1. A physician and veterinarian research team in 1893, Drs. Theobald Smith and F.L. Kilbourne, discovered the cause of cattle fever, Babesia bigemina, and that it was being transmitted by ticks. This work helped set the stage for the discovery by Walter Reed and his colleagues of the transmission of yellow fever in humans.

2. The Ebola virus was identified as the cause of Ebola hemorrhagic fever in the 1970s through the collaboration of veterinarian Fred Murphy and physician Karl Johnson. These two made history by working closely together at the CDC on this and other topics. Hemorrhagic fever viruses are now designated by CDC as bioterrorism agents.

3. Rolf Zinkernagel (physician) and Peter Doherty (veterinarian) working together as immunologists, discovered how the immune system tells normal cells from virus-infected cells. For this, they received the 1996 Nobel Prize for physiology or medicine.

In the early 21st century, emergence of deadly diseases classified as zoonoses, i.e., diseases of animal origin transmissible to humans highlighted the need for “One Health.” In fact, nearly 75 percent of recently emerging infectious diseases affecting humans are zoonoses. Examples are acquired immune deficiency syndrome, SARS (severe acute respiratory syndrome), West Nile virus and Avian Influenza H5N1. These present the urgent need for human and veterinary medicine to renew and increase collaborative efforts.

Other research on conditions such as cancer, heart disease, diabetes, biomechanical devices and obesity offers golden opportunities for interdisciplinary collaborations.

In 2006, Ronald M. Davis, then-president of the AMA, and AVMA president Roger Mahr struck up a unique liaison between their respective organizations. This resulted in adoption of a historic AMA One Health resolution in June 2007. Several other international health care and scientific organizations followed their lead.

An AVMA One Health task force recently formulated plans for implementing this life protecting/lifesaving strategy. The eventual formation of a “National One Health Commission” is being carefully considered. More information about this project is available on the One Health Initiative web site at onehealthinitiative.com.

Bruce Kaplan is a veterinarian who lives in Sarasota. He has held positions in public health with the Centers for Disease Control and Prevention as an epidemiologist and the USDA’s Office of Public Health and Science in Washington, D.C.

This story appeared in print on page A10

Health Literacy a priority for the Medical Reserve Corps

Health Literacy

Surgeon General’s Priorities Workgroup

Health literacy is described as the degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions. Health literacy includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor’s directions and consent forms, and the ability to negotiate complex health care systems. Health literacy is not simply the ability to read. It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations. Individuals must be able to ask pertinent questions and fully understand the available medical information.

These activities rely on adequate health literacy skills, yet studies indicate that individuals and families lack the information needed to understand their health issues and the skills to use the information fully to their benefit.

Current Status

Results of the 2003 NAAL (National Assessment of Adult Literacy 2003) (Office of the Surgeon General, 2006b)

1. NAAL estimated that 30-34 million Americans are in the lowest

levels of health literacy

2. Based on the survey findings, Dr. Whitehurst provided the following

interpretation of the NAAL data:

• The majority of adults (53 percent) had Intermediate health

literacy.

• An additional 12 percent had Proficient health literacy.

• Among the remaining adults, 22 percent (corresponding to 47 million

adults) had Basic health literacy and 14 percent (30 million adults) had Below Basic health literacy (see Table 1).

• 5 percent (11 million adults) were found to be Nonliterate in

English. This includes 7 million adults at the bottom of the Below Basic level who did poorly on the easiest test questions and an additional 4 million adults who could not participate in the study at all because of language barriers.

3. Low levels of health literacy result in lower health outcomes

(Office of the Surgeon General, 2006a).

Barriers to health literacy

(Office of the Surgeon General, 2006c)

1. Those at greatest risk are the elderly, people with limited English

proficiency and those of lower socioeconomic status or less education (Bryan, 2008).

2. People don’t want to admit they can’t read

3. Medical jargon on health forms makes it hard for individuals to

understand them

4. Lack of a national plan of action

5. Most forms of action stem from written word … need other forms of

communication

a. Show pictures (Bryan, 2008)

b. We focus on changing the interaction in doctor’s office

c. Each year in the United States, the average person is likely to

spend:

• 84 hours reading magazines

• 165 hours reading newspapers

• 480 hours accessing the Internet

• 1,248 hours watching television

• less than 1 hour in a doctor’s office (Kline, 2003)

Promising Practices

1. Use of plain language, face-to-face communication, pictorials, and

educational materials

a. Sharing materials on the internet is an example or developing

children/teen programs to teach health in an interactive way where decision making skills are challenged.

b. MRC Volunteers can read child-friendly books to children re:

health/nutrition in the local library: i.e. Berenstain Bears Visit the Doctor, Curious George Goes to the Hospital, Show Me Your Smile: A Visit to the Dentist (Dora the Explorer book)

2. Providing materials in different languages that are part of the

community makeup or developing picture books to override some of the language barriers provides an opportunity to outreach to many different populations. Printed materials need to be written with various factors in mind such as socioeconomics, gender, race, and ethnicity.

a. In Alexandria they used Pan Flu money to create audio CD that talks

about what you need to be prepared for emergencies

3. Organizational commitment to create an environment where health

literacy is not assumed

a. Health literacy practices are most successful when they have been

infused as part of the operating philosophy, in-service training is provided, and perhaps even participated in a research study on health literacy.

b. Sponsor a training class for MD’s or RN’s to review the “teach-

back” technique to review with patients how to take their medications.

Prepared By:

Surgeon General’s Priorities Workgroup

Medical Reserve Corps

December 2008

Send email to this group: sgpwg@googlegroups.com

Literature cited list available upon request Formatted document available upon request

Kentucky Mobile Medical Treatment Center Now Deployable

Kentucky Cabinet for Health and Family Services. “State Health Department Acquires Mobile Medical Treatment Center.” Frankfort, KY: CHFS Press Release, November 12, 2008. Accessed at: http://chfs.ky.gov/news/Mobile+Medical+TreatmentCenter.htm

FRANKFORT, Ky. (Nov. 12, 2008) – The Kentucky Department for Public Health (DPH) announced today that a new large-scale mobile medical treatment facility can now be deployed at or near the scene of a disaster or emergency anywhere in the state to provide treatment for patients on site and reduce the number of patients sent to hospital emergency rooms.

“In the event of a serious public health emergency, health and medical systems might be overwhelmed with people seeking treatment, and the need to meet this demand would be critical,” said William D. Hacker, M.D., commissioner for public health. “This mobile medical treatment center will have the capability of providing medical services to our citizens utilizing local medical reserve corps volunteers without overburdening hospitals.”

The mobile medical treatment center is an inflatable shelter system that can be rapidly deployed to the site of an emergency. The 3,342 square foot structure has a 45-bed capacity and houses separate areas for triage, isolation, administration/nursing station and patient care. The shelter is completely self-contained with two large 45-kilowatt generators and a heating, ventilating and air conditioning system. Supplies such as beds and cribs are also included with the center. Two 28-foot cargo trailers provide storage and transport for the unit.

President of the Kentucky Hospital Association (KHA) Mike Rust said, “The development of a large mobile treatment facility, which can both increase health care surge capacity and disaster response capability, is an important addition to the preparedness resources of the commonwealth. KHA is pleased to have had a role in assisting the DPH Public Health Preparedness Branch in assembling this new asset.”
Funding for the center was provided through a grant from the Centers for Disease Control and Prevention (CDC). The unit will be stored by DPH