Villages Without Doctors

An excellent article in the NYTimes discusses moving beyond doctors to provide healthcare to communities. Here is an excerpt:

But are doctors and nurses necessary to improve rural health? Two very successful programs in desperately poor parts of India’s Maharashtra state say no. SEARCH (the Society for Education, Action and Research in Community Health), in the district of Gadchiroli, and the Comprehensive Rural Health Project, in the district of Jamkhed, both recruit ordinary women to take care of their villages’ health. They have had a huge impact on the health and prosperity of their villages.

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Today there is no more infant mortality, and TB and leprosy are gone. Mothers eat better — the average birth weight of a baby has gone from about four and a half pounds to six and a half. New mothers are taught how to feed and care for their babies. Children get regular immunizations. Now almost every mother knows how to treat diarrhea and fever.

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SEARCH, by contrast, focuses on more traditional medicine. Like Jamkhed, SEARCH was founded by a husband-and-wife team of Indian doctors who studied public health at Johns Hopkins University in Baltimore, Abhay and Rani Bang. But there are differences. SEARCH is newer, founded in 1985. It requires its health workers to have more education —literacy at least, and some of the women have finished 10^th grade. SEARCH trains them to work with mothers in their homes to have healthy children. The health workers visit pregnant women repeatedly, attend births, teach mothers about how to keep their babies healthy and check in on the children often. They diagnose and treat illnesses, and even administer injectable antibiotics to treat blood infections.

200 Countries, 200 Years, 4 Minutes

I really loved this video on human development in global communities over the last 200 years. It's a great way to depict development [or lack of].

Measuring the Health of the Public

The Institute of Medicine released the first of three Robert Wood Johnson Foundation-commissioned reports on public health today:

The United States spends more money on health care than any other country in the world, but there's much more to good health than getting health care from doctors and hospitals. In fact, life expectancy in the United States ranks 49th among all nations, and infant mortality rates are higher in the United States than in many less-affluent nations. A new Robert Wood Johnson Foundation (RWJF)-commissioned Institute of Medicine (IOM) report argues that America’s less-than-stellar standing in these population health measures stems in part from inadequacies in the country’s system for gathering, analyzing and communicating health information that focuses not just on clinical care data but on the underlying factors that contribute to poor health, such as health behaviors and social determinants. The IOM report, For the Public’s Health: The Role of Measurement in Action and Accountability, reinforces the urgency to address health not just in the doctor’s office but where it starts—in our homes, schools, jobs and communities.

Read more here.

Using Cash to Slow Population Growth in India

An article in the NYTimes discusses a new pilot program being implemented in parts of India to slow population growth. Young couples are encouraged to delay pregnancy and are told that they can finish school and even get paid by the government if they wait to have children.

Waiting also would allow India more time to curb a rapidly growing population that threatens to turn its demography from a prized asset into a crippling burden. With almost 1.2 billion people, India is disproportionately young; roughly half the population is younger than 25. This “demographic dividend” is one reason some economists predict that India could surpass China in economic growth rates within five years. India will have a young, vast work force while a rapidly aging China will face the burden of supporting an older population.

The program in Satara is a pilot program — one of several initiatives across the country that have used a softer approach — trying to slow down population growth by challenging deeply ingrained rural customs.

“An educated girl is your best contraception,” said Dr. Amarjit Singh, executive director of the National Population Stabilization Fund, a quasi-governmental advisory agency. He said that roughly half of India’s future excess population growth was expected to come from its six poorest states.

Healthy Americans = Less Costly Americans

While much of the debate surrounding the new healthcare bill speaks to changes in insurance coverage for uninsured and underinsured Americans - a more noteworthy benefit of the overhaul is the (much overdue) focus on prevention. Under the new law, insurance companies will be required to provide preventive services - such as immunizations and check-ups - as part of the patient's insurance coverage. Patients will not be required to pay additional out-of-pocket charges for these services.

“This is transformative,” says Helen Darling, president of the National Business Group on Health, a nonprofit organization for large employers. “We’re moving from an insurance model that was based on treating illness and injury, to a model that’s focused on improving an individual’s health and identifying risk factors.” [link]

Public Health professionals have long known that focusing on preventing illness is much more cost-effective than treating illness. For example - it's much more cost-effective to encourage hand hygiene in healthcare workers than it is to treat a healthcare-associated infection. It's promising that this is also the direction healthcare reform is heading.

Farmer Suicides in Punjab Continue

A recent article in the Financial Times discusses how the suicide rate among small farmers in Punjab is much higher than official statistics.

The north-western state, the main breadbasket of Asia's third-largest economy, had appeared immune to the wave of suicides by indebted farmers that has swept drier parts of India. Yet research shows that more than 2,000 farmers in Punjab kill themselves each year to escape the shame of chronic debts related to agricultural inputs, such as seed and pesticide, and falling incomes.

Official statistics say that 132 farmers in the Punjab killed themselves in the past five years. Most suspected suicides are attributed to natural causes or alcohol or drug abuse. Inderjit Singh Jaijee, a Chandigarh-based human-rights activist and former state legislator, states that up to 40,000 farmers have taken their lives in the past 20 years. Many of their families are left destitute, receiving no state support.

Punjab benefitted greatly in the Green Revolution, a movement in the 1960s to modernize agriculture with more utilization of fertilizer and pesticides. According to the FT article, "Policymakers stress the need to boost the agricultural economy, which supports the bulk of India's 1.2bn people."

International Princess Project

Here's information and a short video about the International Princess Project, an organization aimed at giving women and young girls new opportunities to restore their lives and empower then to live in freedom.

International Princess Project advocates for women enslaved in prostitution, helping them restore their lives and empowering them to live free. Through various initiatives, International Princess Project both helps partner organizations increase capacity and provides direct support for women in need.

Language and Cultural Barriers in Healthcare

A new study, sponsored by the Robert Wood Johnson Foundation, confirms the need to address language and culture in healthcare.

Nearly half of U.S. physicians say language or other cultural barriers are obstacles to providing high-quality patient care, according to a study released by the Center for Studying Health System Change. Forty-eight percent of all physicians in 2008 reported difficulties communicating with patients because of language or cultural barriers, and said they considered the situation at least a minor problem affecting their ability to provide high-quality care. Less than 5%, however, viewed those barriers as a major problem that could result in a disparity of care across ethnic and racial populations, the study reported. Efforts to overcome the obstacles were
considered modest or uneven. [link]

Healthcare providers have legal obligations to provide needed interpreter services, at least for patients with public insurance. However, physicians in solo and group practices were less likely to adopt measures to address disparities than those in institutional practices, such as hospitals, health insurers, and medical schools, according to the study.

Find an Urge to Help on World AIDS Day

[From The Langar Hall]

December 1st is World AIDS Day. Each year on this day we take the time to consider the impact HIV and AIDS has had on people around the globe. This year’s focus is on Universal Access and Human Rights. For as long as I can remember, the conversation has focused on the growing number of infections and deaths associated with AIDS. This year, however, the United Nations reports a notable decrease in HIV infections in some of the hardest hit areas of the world. It is clear, then, that the enormous amount of effort by HIV treatment and prevention programs have helped to provide education to raise awareness.

A recent NYTimes article discusses how humans may be born with an urge to help, and it makes me consider how very important this attribute is. Our communities rely so heavily on the help of each other – something we often take for granted. If humans are born with an urge to help, then Sikhi provides us with a strong foundation to make this happen. It is up to each and every one of us to seek out those opportunities. While World AIDS Day is a way to raise awareness about HIV/AIDS, it is also a reminder of the potential we each have to make a change. In Guru Nanak Dev Jis words,

In the midst of this world, do seva.

India's sick 'suffer needlessly'

Hundreds of thousands of sick people in India are suffering unnecessary and excruciating pain because of a lack of funds, according to a new report. The Human Rights Watch group says that budgetary constraints result in poor medical training, restrictive drug regulations and poor patient care. The group says that many major cancer hospitals do not provide patients with the painkilling drug, morphine. This is even though it has a reputation as an effective form of pain relief.

More than 70% of cancer sufferers in India have an incurable form of the disease, Human Rights watch (HRW) says. It is estimated that more 500,000 advanced cancer patients are left to suffer. HRW health researcher Diederik Lohman says that the main problem is a lack of government leadership. "It just hasn't integrated palliative care - or the alleviation of illness-related pain - into treatment programmes," he said. "And it's not just cancer. People living with HIV are also neglected. Doctors simply aren't trained and in many states, restrictive drug regulations add to the problem. "The irony is that India provides excellent private healthcare. Ironic too is the fact that it's one of the world's biggest legal producers of opium - the raw material for morphine. But almost all of that is exported."

Severe pain is a common symptom among cancer patients, particularly during the last stages of the disease. HRW estimates that there are more than one million advanced cancer patients in India who experience severe pain in any given year. In addition many other patients, including those with HIV, TB or other infections or illness, may face acute or chronic pain. [link]

Learning About Primary Care Shortages

The United States currently faces a shortage of primary care professionals that threatens to develop into a major crisis if not addressed. Primary care comprises four main features:

• A first contact for any new health issue or need
• Long-term, person-focused care
• Comprehensive care for most health needs
• Coordination of care when it must be received elsewhere (i.e. with a specialist)

General practitioners, general internal medicine practitioners, family physicians, and sometimes general pediatricians are considered primary care physicians. Other health care providers, such as physician assistants (PAs), nurse practitioners (NPs), nurses, and health coaches or care coordinators, may also provide primary care. Care delivered with an orientation toward primary care has been found to be associated with more effective, equitable, and efficient health services; residents of countries more oriented to primary care report better health at lower costs.

60 million Americans, or nearly one in five, lack adequate access to primary care due to a shortage of primary care physicians in their communities. Very few new physicians today are choosing to enter primary care: whereas fifty years ago, half of U.S. doctors practiced primary care, just over 30% do today, and just 8% of the nation’s medical school graduates enter family medicine compared to 14% as recently as 2000. People who are uninsured, low-income, members of racial and ethnic minority groups, or living in rural or inner-city areas are disproportionately likely to lack a usual source of care (USC)—a key indicator of access to a primary care provider.

Many experts believe that this skewed distribution contributes to overspecialization of care and fragmentation and inefficiency in the health system; for example, more than half of specialist visits are for routine follow-up, a misuse of expensive care. Furthermore, a higher ratio of primary care physicians to population is associated with lower mortality rates while a higher ratio of specialists to population has been correlated with higher mortality rates, perhaps because patients with a usual source of primary care tend to use more preventive health care and have health problems treated at a less advanced stage.

Learn More.

Knitting for babies in Rwanda

A message from Partners in Health:

In the chilly mountains of rural Rwanda, where last year PIH's partner organization began working with the Burera District Hospital, resources are very limited and the temperature often drops into the 50s. Newborn babies, particularly those born prematurely, often struggle to keep warm. In a country where one in 10 babies dies before her first birthday, hypothermia is a serious threat.   A simple solution that can help save some of these little ones is to provide them all with beanies to keep them warm. 

We are looking for knitters to help us put a warm beanie cap on every baby born in Burer--as is done in American hospitals. The Burera District Hospital welcomes about 100 new babies into the world each month, so our current goal is to provide 100 caps per month. 

All beanie styles and colors are welcome. Hats can be made to fit either premature babies (head about the size of an orange) or full-term babies (head about the size of a grapefruit). We will arrange shipping from Boston to northern Rwanda. 

Hats and donations may be sent to:
Jesse Greenspan
Partners In Health, Attn: Baby hats
888 Commonwealth Ave, 3rd floor
Boston, MA 02215

More information about this initiative and pattern samples can be found at: http://hotheadknitters.blogspot.com/

Pollution and Disease in Punjab

In the Faridkot centre… Harmanbir Kaur, 15, was rocking gently backwards and forwards. When her test results came back, they showed she had 10 times the safe limit of uranium in her body. Her brother, Naunihal Singh, six, has double the safe level.

An article in The Observer discusses the link between the dramatic rise in birth defects in Punjab and pollution from coal-fired power stations. Many of the children are being treated in Faridkot and at the Baba Farid centers for special children in Bathinda, where there are two coal-fired thermal plants. Staff at these clinics had noticed an increase in the incidence of severely handicapped children who were born with hydroencephaly, microencephaly, cerebral palsy, Down’s syndrome and other complications. They suspected environmental poisoning.

The healthcare workers rightfully voiced their concerns about this and wondered, if some children were being treated, how many more were being affected? As with governments’ other dirty little secrets, staff at the clinics were visited and threatened if they spoke out. In addition, a visiting South African toxicologist arranged for tests to be carried out and found that the children had massive levels of uranium in their bodies, in one case more than 60 times the maximum safe limit. The scientist was later warned by the authorities that she may not be allowed back into the country.

Read more on The Langar Hall.

New Book: Strength in What Remains

Many of you first learned about Partners in Health by reading Kidder's bestseller about Paul Farmer and the founding of Partners In Health, Mountains Beyond Mountains. Today, Random House is publishing not one but two works by Tracy Kidder--his powerful new book, Strength in What Remains; and a new, deluxe paperback edition of Mountains Beyond Mountains that features an epilogue updating the story of PIH through early 2009.

Strength in What Remains tells the riveting true story of Deo, a young man from the mountains of Burundi in East Africa. After a hairsbreadth escape from death and a horrifying journey on foot through Burundi and Rwanda-two countries wracked by genocide and civil war--Deo landed in New York City, penniless, speaking almost no English, and living homeless in Central Park. From there, the generosity of people he met and (mostly) his own indomitable determination took him to Columbia University and later to Harvard--where he found work, friendship and a sense of common mission with Paul Farmer and his colleagues at Partners In Health--and, finally, back to Burundi to start a community health project modeled very much along the lines of those he had seen and helped at PIH.

For people who care about global health and social justice, both of these books are must reads. The same goes for people who simply enjoy outstanding writing that opens their eyes, their hearts, and their minds. That's Tracy Kidder's specialty. As Susan Salter Reynolds of the Los Angeles Times wrote in one of many rave reviews and feature articles that have appeared about Strength in What Remains, "With his most recent book, he helps the reader walk in the subject's shoes."

Dengue Outbreak in Punjab

A potential dengue outbreak looms in Ludhiana. Dengue, an infectious disease caused by a virus, can be transmitted via mosquito bites. Cases of gastroenteritis were found first among the community, followed by cases of cholera. The fear of a dengue outbreak is now of concern in the region.

"As for gastroenteritis, illegal water connections in vehras of various areas of the city inhabited mainly by migrant population are the root cause of the outbreaks. It has been taking a toll on the lives of migrant population who live in poor hygienic conditions prevailing in their surroundings," says Dr SS Dhir, district health officer... "We have filed cases against six persons in connection with illegal water connections in the vehras of Punjabi Bagh where habitants fell sick with gastro. Besides, we have constituted a 40-member team which would be responsible for creating awareness in four MC zones and will conduct house to house visits in the disease-prone areas," Dr Charanjeet said.

Humanitarian IQ

Last week I got this in my inbox. Try it - even as activisits - you'll be surprised how much there still is to learn! http://www.humanitarianiq.com/

Humble The Poet

A million here
A million there
Two million dyin from malaria
Who really cares

Happy Mother's Day

The New York Times has a great piece on celebrating mothers around the world. They ask, What Do You Give the Developing World for Mother’s Day? In five different pieces they explore the developments which have helped and have the potential to improve the health and wellbeing of women and children across the globe:

A Birth Pill
An inexpensive medicine could save lives.

A Dose of Care
Counseling should be an important part of food aid programs.

An Education
Make going to school affordable.

A Safer Labor
Provide clinics with the basics to preform Caesarean deliveries.

A Custom Drug
Research to better medicate mothers-to-be.

Happy Mothers Day!

Operation Walk

I was especially proud when I heard about Operation Walk - an organization established by Harpal Singh Khanuja and his wife Maria Khanuja. The non-profit organization is dedicated to providing free knee and hip replacements to underserved people around the world. The concept behind the organization was to perform complicated surgeries on people in developing countries, “where arthritis progresses to its end stages and reconstructing joints becomes technically challenging.” Often times, it is people who are most at need who cannot afford the surgery. A news article discusses Operation Walk’s recent trip to Lima, Peru where they performed 48 surgeries to replace knee and hip joints. Here on TLH we like to highlight examples of seva - this is another important example of what it means to do selfless service.

The organization’s goal is to replicate the Peru mission to Panjab where the need is also great (some of which can be attributed to the chemical farming of the Green Revolution).

The goal is to learn the ropes and move on to Punjab, Harpal Singh said. “It’s done more than cross my mind.” To coordinate a trip to India would require an extra week’s stay and extra money for cargo, lodging and food. He was initially ready to go to Punjab this year, but when it came time to select a location last November, the Mumbai bombings scared many of the volunteers. Some of them had not been outside of the state of Maryland before the trip to Peru. Perhaps they needed one more trip under their belt, and wait another year to go to Punjab, Harpal Singh said.

“Our community is very eager to have this done in their own area,” he said. “In some respect, a group of sardars or Sikhs doing seva outside Punjab is more of an education.”

Read more at The Langar Hall.

Nobel Prize for Public Health?

An excellent piece from Nicholas Kristof in the NYT discussing how the recent Swine Flu scare reinforces a flawed medical system.

Think of the 47 million Americans who lack insurance. They are less likely to receive flu vaccines (which might or might not help), less likely to receive prompt care when they get sick, and less able financially to stay home from work — and thus they are more likely both to die and to spread the virus inadvertently.

The larger problem is that we over-invest in clinical care like CAT scans and underinvest in public health. There should be a Nobel Prize for Public Health, so that we might get more great minds wrestling with nonmedical pieces of the health puzzle, like industrial hog farms that can serve as breeding grounds for viruses and bacteria, from swine flu to MRSA.

“If a severe pandemic materializes,” Dr. Redlener said, “all of society could pay a heavy price for decades of failing to create a rational system of health care that works for all of us.”

Read the entire piece here.

Universal Healthcare and Health Disparities

It should go without saying, but now we have a study to confirm it - universal health coverage could reduce health disparities. The Commonwealth Fund conducted a study which suggests that medicare coverage for all provides a dramatic reduction in the level of poorer health among African American, Latino and low-income Americans.

Their research team, led by J. Michael McWilliams, M.D., Ph.D., sifted through medical data for 6,000 people ages 40 to 85 with diabetes or cardiovascular disease. They tracked their conditions from 1999 to 2006.

The researchers found that despite overall improvements in controlling the diseases, black, Hispanic and poor patients under 65 -- those not yet old enough for Medicare -- fared no better, or got worse.

However, at age 65, when people become eligible for Medicare coverage, the differences in health by race, ethnicity, and socioeconomic status declined significantly.

Read more here.

Punjab Farmer Suicides

Hearing about farmer suicides in Punjab is no longer (and quite unfortunately not) a unique thing anymore. It's a topic which i find very disheartening, and it's recurrence in the news reinforces the need to pay closer attention to the root cause of these deaths and who is being impacted by them.

Mandip Kaur, a 29-year-old housewife from a farming family in southern Punjab, guards her husband round the clock. "I fear he may commit suicide," she says... Almost every village in Punjab has witnessed a suicide in their once-prosperous farming families and it is a major issue in the general election.

As a friend recently noted, it is women who often bear the burden of their husband's death. The impact that farmer suicides is having on wives, children, and entire communities cannot be understated.

National Crime Records Bureau statistics say close to 200,000 farmers have committed suicide in India since 1997. Punjab, responsible for producing nearly two-thirds of the grain in India, has faced many economic crises since the the mid-1990s. No comprehensive official figures on farmer suicides in the area are available. But a report commissioned by the government of Punjab this week estimated that there had been "close to 3,000 suicides" among farmers and farm labourers in just two of Punjab's 20 districts in recent years, agriculture ministry sources told the BBC.

There are several issues which have caused the increase in farmer suicides over the last number of years. The Punjab government's website proclaims that "India has gone from a food-deficit to a food-surplus country" largely because of the Green Revolution of Punjab. Is the Punjab we envisioned? Read more about this article here.

Purple Day!

Epilepsy is a medical condition that produces seizures affecting a variety of mental and physical functions. It’s also called a seizure disorder. When a person has two or more seizures, they are considered to have epilepsy. Here is some information on how you can support the cause to bring more awareness to this condition.

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A little bit about Purple Day...

Founded in 2008, by nine-year-old Cassidy Megan of Nova Scotia, Canada, Purple Day is an international grassroots effort dedicated to increasing awareness about epilepsy worldwide. On March 26, people from around the globe are asked to wear purple and spread the word about epilepsy.

Why? Epilepsy affects over 50 million people worldwide. That's more than multiple sclerosis, cerebral palsy, muscular dystrophy and Parkinson's disease combined.

Why purple? Lavender is the international colour for epilepsy.

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The National Walk for Epilepsy will occur on Saturday March 28th 2009.

Each year more and more people gather in D.C. to bring awareness to the third most common neurological disorder in the United States—epilepsy. The National Walk for Epilepsy has grown to an event with 8,000 participants and, over the span of two years, has raised more than $2 million dollars.

India Grows and So Does Child Hunger

While the US struggles with its economy and financial woes, India continues to grow and remain somewhat fiscally stable. In the midst of this growth, it is easy to forget about the various problems that continue to plague this democracy. The issue of malnutrition is covered in a recent NYTimes article.

Small, sick, listless children have long been India’s scourge — “a national shame,” in the words of its prime minister, Manmohan Singh. But even after a decade of galloping economic growth, child malnutrition rates are worse here than in many sub-Saharan African countries, and they stand out as a paradox in a proud democracy.

I was shocked to read that while China reduced child malnutrition to 7% (of its children under 5 years old are underweight), India's comparable number was 42.5%!

There are no simple explanations. Economists and public health experts say stubborn malnutrition rates point to a central failing in this democracy of the poor. Amartya Sen, the Nobel prize-winning economist, lamented that hunger was not enough of a political priority here. India’s public expenditure on health remains low, and in some places, financing for child nutrition programs remains unspent.

India does run the largest child feeding program in the world, however it is inadequately designed with poor infrastructure and has barely made a dent in the ranks of sick children in the past 10 years.

[M]ost experts agree that providing adequate nutrition to pregnant women and children under 2 years old is crucial — and the Indian program has not homed in on them adequately. Nor has it succeeded in sufficiently changing child feeding and hygiene practices. Many women here remain in ill health and are ill fed; they are prone to giving birth to low-weight babies and tend not to be aware of how best to feed them.

The article reports that while hunger persists in destitute states across India, the more "serious" rates of hunger exist in states of great economic growth.

Hat tip to KS for the article.

Child Marriages in India

Nearly half of Indian brides wed before they are 18-years-old, the legal age for marriage since 1978, a survey by the Lancet medical magazine says.

A recent BBC article discusses how child marriage continues to be a problem for rural, poor and less educated girls living in India. Dr. Anita Raj (a fellowship advisor of mine from grad school) led the study which discusses the adverse health consequences of child marriages.

"Child marriage has serious consequences for national development, stunting education and vocational opportunities for a large sector of the population," says the paper, led by Anita Raj, a doctor at Boston University School of Public Health in Massachusetts.

Even with regard to India's existing policies against such practices and the country's economic development, child marriage has failed to be eradicated from rural and poor populations. India first introduced laws against child marriage in 1929 and set the legal age for marriage at 12 years. The legal age for marriage was increased to 18 in 1978.

The survey says:
*Child brides are 37% more likely not to have used contraception before their first child was born
*Seven times likelier to have three or more births
*Three times likelier to have a repeat childbirth in less than 24 months
*Fifty percent likelier to have an abortion
*Six times likelier to seek sterilisation

The reason why there are such high levels of sterilization among young brides is because they have had their desired number of children at an earlier age. Researchers warned that this could reduce condom use in such couples, which would heighten the risk of HIV and other sexually transmitted infections.

Hat tip to KS for the article.

Roads Less Traveled

Humanitourism. Have you heard about it before? Humanitourism is a new catchphrase - a variant on the voluntourism experience. Various organizations are now catering humaitourist trips to those craving adventure and experiences on foreign shores and who don't want to feel guilty about it. It's a new (I guess more trendy?) thing to do - a new wave of philanthropy of sorts.

For years we’ve been dreaming of joining Relief Workers International on its medical trips through India. The work: helping doctors provide medical care to hundreds of people in several different villages. The rest: Accommodations are comfy tents in breathtaking surroundings with visits to ancient towns and old forts. The site will soon list upcoming trips; in the meantime, reading about the work is singularly inspiring.

HumaniTourism states that it

aims to develop new models of ethical global tourism by combining travel with community development, entrepreneurial education, and environmental stewardship to foster sustainable, community-based economic development while preserving cultural integrity.

Sounds like a great way to participate in social development, contribute to the local economy, and actually made a difference on a community.

A Powerful Noise

In honor of the upcoming International Women’s Day (March 8th), last night the documentary film A Powerful Noise was screened simultaneously in 450 theaters nationwide. A panel discussion followed the film, and included five individuals involved in some capacity in humanitarian work: Helene Gayle, President and CEO of Care; Natalie Portman, actress and activist; Nicholas Kristoff, New York Times columnist and author, Christie Turlington Burns, model, businesswoman, and CARE advocate; and former Secretary of State Madeline Albright. It was a wonderful event and the town hall meeting allowed for some great discussion around women, health, education and poverty.

The event was sponsored by CARE, an organization focused on fighting global poverty by putting women at the center of the effort to improve the quality of life for themselves, their families, and their communities.

The film profiled three women who personify the belief that, in developing nations, it is women who hold the keys to fighting poverty, improving economic circumstances, and real community activism.

To learn more about the documentary, click here.
To learn more about CARE, click here.

Fire a major killer of Indian women

A recent Lancet study discusses the use of fire against women in domestic abuse situations. According to the study, more than 100,000 young women were killed in fires in India in a single year. Read on,

Young Indian women are more than three times as likely to killed by fire as their male compatriots, according to an article published on the Web site of the British medical journal, The Lancet. The victims largely fell within a 15 to 34-year age group.

Domestic abuse is a serious problem in India. Women are sometimes killed in disputes over dowries; often in such disputes the victims are doused with gasoline and set ablaze, and their deaths are claimed as kitchen accidents.

In the first study of its kind and using the most recent data available, The Lancet analyzed death registrations, official questionnaires in rural areas and census figures to arrive at an estimate of 163,000 fire-related deaths in 2001, or 2 percent of all deaths. That number is six times higher than the number of such deaths reported by police. More than 106,000 of those, or 65 percent, were women.

You can read more about this article here.

Open Forum - Addiction and Mental Health in Malton

For our Canadian readers, this seems like a great forum to participate it.

The question is: why is our Desi community not using social services offered within the Malton community?

Open Forum on Mental health and addictions needs in Malton. It’s time to help make things work better for members of the Malton community who have mental health and addictions needs.

We need to hear from you about:
• How to make sure people with mental health and addictions issues can find the services they need
• What kind of mental health and addictions services need to be available
• What special concerns there might be in Malton because of the diversity of the community
• How to build on the strengths of the Malton community and the services that are already here
• What people need to stay healthy!

Hope To See You There!
Where: Hall B at the Malton Community Centre
3540 Morningstar Drive,
When: Wednesday, February 25th
6:30 – 8:30 p.m.

If you have any questions, or special needs (e.g. transportation) please contact Randip Singh at rsingh@reconnect.on.ca or at 647.286.4323 or Jenny Carver at 905.836.2032

Sponsored by the Central West LHIN and the Malton Mental Health and Addictions Integrated Planning Project

From Outrage to Courage

I'm currently reading a book on women taking action for health and justice by Anne Firth Murray. The book, titled "From Outrage to Courage" discusses the various elements affecting the health of women around the globe. Here is an excerpt from the book. I would highly recommend the book.

Being born female is dangerous to your health. This reality may not be true for many readers, but for most women living in poorer countries around the globe, it is devastating.

The dangers start before birth. Sex-selective abortion is widespread, as parents decide for various reasons that they cannot bring another girl into the world. Hundreds of thousands of girls have "disappeared," unbalancing sex ratios in countries like China, India, and Korea. Every person in poverty is at a disadvantage, but the gender differences are staggering. Ninety million girls worldwide, compared with twenty-five million boys, do not go to school... More than half a million women die each year from almost completely preventable childbirth-related injuries and illnesses. One fourth to one half of women worldwide suffer violence at the hands of an infinite partner.

Women's health is so much more than a medical issue; it is cultural, political, economic, and - above all - an issue of social justice.

Investment in Disease Prevention

An important new commentary by Steven H. Woolf, M.D., M.P.H., in the February 4, 2009, issue of the Journal of the American Medical Association argues that in these difficult economic times, our nation can no longer ignore the importance of disease prevention.

Noting that the United States spends on prevention only a very small amount of its annual $2 trillion dollars in total health care spending, Woolf presents convincing reasons for policy-makers, health care providers and the public health community to recognize both the cost-effectiveness and health benefits of proven prevention measures such as screening tests, smoking cessation programs, immunizations and physical activity. With so much riding on our economic and personal health, Woolf persuasively argues that we should invest in these preventive services that are shown to reduce health care costs and improve health.

"Our health care system is geared to treating the sick with expensive tests and procedures. But what we ultimately need is to foster a culture of wellness by stopping bad health before it happens," said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation. "Congress and the President have made health reform a top priority. It is imperative that prevention be an integral part of any reform plan."

California Enacts Interpreter Law for Patients

On January 1st, California became the first U.S. state to enact legislation requiring that all nonpublic managed care health plans cover costs for providing interpreter services to state residents with limited English proficiency (LEP), the Sacramento Bee reports. The law requires health, dental and specialty insurers to provide translators for all languages, either by phone or in person, for subscribers when visiting a physician, pharmacist, ophthalmologist or dentist. Written translation also will be required for select languages.

The article notes that insurers expect to spend a collective $25 million to comply with the new law. However, patients' rights advocates praised the law, saying it will help reduce care quality disparities stemming from miscommunication. California plans to launch a publicity drive in the coming weeks to raise awareness of the new law. Meanwhile, noting that the new law stipulates only that interpreters demonstrate proficiency in interpretation, the California Healthcare Interpreting Association is recommending a certification program to ensure that the interpreters used by health plans are familiar with medical language and how to accurately translate medical terms.

Increasing Organ Donations from the South Asian Community

A Sikh health expert has been awarded £130,000 for a two-year research project which could prove vital in efforts to increase the number of UK organ donations from south Asian and black ethnic groups. NHS Blood and Transport has awarded the funding to Professor Gurch Randhawa, Director of the Institute for Health Research at the University of Bedfordshire. It is hoped his findings will inform strategies for future organ donation appeals. Changing perceptions about organ donation among south Asian and black groups is already part of a campaign to increase donations by 50 per cent in the next five years.

Dr. Randhawa states that the need for organ donors was three or four times higher among black and Asian people than among the general population, but donation rates were relatively low among those groups and this impacts directly upon those communities. His project has the backing of a Sikh family in Luton, close to the Bedfordshire university. In January 2001, Mandip Mudhar, a 20-year-old student, died in London’s Royal Free Hospital six days after suffering severe head injuries in a road accident. Told that he would not recover consciousness, his parents decided to donate Mandip’s heart and two kidneys. The Mandip Mudhar Memorial Foundation was started by Mandip’s family.

Among potential donors the refusal rate for non-white groups is 69 per cent, according to Professor Randhawa, compared with 35 per cent for potential white donors. “Community leaders and religious groups need to engage with their local community to encourage organ donation and we need to identify what would make the gifting of organs relevant to a multi-ethnic and multi-faith society,” said the professor.

The Sikh perspective on organ translation is addressed on a leaflet available at the UK Transplant website. It reads: “Sikh philosophy and teachings place great emphasis on the importance of giving and putting others before oneself” It also stresses “the importance of performing noble deeds and there are many examples of selfless giving and sacrifice in Sikh teachings by the ten Gurus and other Sikhs. Sikhs believe life after death is a continuous cycle of rebirth but the physical body is not needed in this cycle – a person’s soul is their real essence.” (The dead sustain their bond with the living through virtuous deed.” Guru Nanak, Guru Granth Sahib, p 143) Dr Indarjit Singh, Director of the Network of Sikh Organisations UK has stated that: “The Sikh religion teaches that life after death continues after death in the soul, and not the physical body. The last act of giving and helping others through organ donation is both consistent with, and in the spirit, of Sikh teachings.” [link]