Yale Students Return from Ecuador

This summer, we, a team of five undergraduate and Public Health students, tested 1011 patients and spoke with over 3,000 Ecuadorians from 83 rural communities surrounding Manglaralto Hospital in the coastal province of Santa Elena. Furthermore, we undertook a collaborative public health research project, completing 512 surveys to determine HIV testing barriers.
Over seven weeks, we conducted daily educational talks and testing at Manglaralto Hospital, building and improving upon protocol tested during the Yale-Ecuador HIV Clinic Initiative’s March 2011 trip. In addition, we expanded these services to reach at-risk demographics at medical satellite clinics, high schools, nurseries, and brothels always in collaboration with Ecuadorian medical staff.

To address previously determined HIV/AIDS misconceptions we accompanied every testing session with a pre-test educational consultation. We created an informative, comedic 10 minute charla which focused on HIV transmission, the difference between HIV and AIDS, discrimination of HIV patients, and the importance of regular testing. At Manglaralto Hospital, we assisted patients through the testing procedure and followed up with a post-test consultation to review the concepts presented in the charlas and to provide the patient with their test results. In accordance with Manglaralto Hospital protocol, patients with reactive rapid test results were guided to trained hospital staff for a lengthy one-on-one post-test consultation and referred patients to Santa Elena or Salinas AIDS Clinic for confirmatory testing, ARV treatment and psychological support.

During the course of the summer, we noticed that the highest risk demographics—working men, teenagers and sex workers—were simply not present at Manglaralto Hospital. So, we launched an outreach program targeting these groups. In the afternoons, we packed up our supplies, hopped onto a hospital ambulance or local bus and conducted testing sessions in the rural towns. With the help of Ecuadorian medical professionals, we organized testing sessions at three satellite clinics, and even went door-to-door in San Antonio, a town we had identified with a significantly higher than average prevalence rate.

Besides the charlas presented to patients during HIV testing interventions, the YEHCI summer trip goals also included an educational component for local youth. Our summer team members sought to increase HIV/AIDS knowledge in the area by traveling to high schools in Manglaralto and Valdivia, twice independently and once with a professional team from Fundación VIHDA, to give presentations on HIV/AIDS which covered transmission methods, distinguished HIV from AIDs, emphasized the need to combat discrimination and stigma against HIV/AIDSpatients, and explained the importance utilizing prophylactic measures in preventing transmission of the virus. These presentations were given to youth from ages 11 to 20. Each school trip consisted of multiple visits to 4-5 classrooms of 30-40 students. In total, YEHCI was able to reach around 600 high school students through its summer educational outreach measures.

Equally important, our colleagues in Ecuador informed me that the YEHCI team created a comfortable and safe environment for HIV/AIDS education and conversation, improved quality-of-care, and connected professionally with previously unreached demographics such as sex workers and men who frequent brothels. Subcentro doctors took time out of their hectic schedules to help us conduct door-to-door HIV testing, publicized a testing session in a local community center over loud speaker to the entire town, and took us and our HIV tests to distant brothels in the fading hours of sunlight.

Each morning, Manglaralto families waved to us and young children gleefully greeted us with shouts of “Hola Ve-ee-ah-chay!” (HIV in Spanish) on the streets. The people we interacted with and tested truly welcomed and embraced us, making us feel like we had become a part of their cherished communities. As well, it appeared that the doctors had taken partial ownership of the project because we sought to work with them, not around their pre-existing schedules and preferences.

In the future, YEHCI will continue to send teams of students to Ecuador to build upon the successes of this past summer. There is much work left to be done in achieving widespread availability of HIV/AIDS education, testing, and treatment for all living in the rural, coastal Ecuadorian population. Future HIV testing interventions will seek to reach out to larger percentages of men, expand to those towns and communities with unusually high prevalence rates, and work with the Peace Corps to ensure year-round testing and educational services.

We thank all of our contributors, especially Fundación VIHDA and Manglaralto Hospital for their continued help and support of our Initiative!

LYME DISEASE: THE HEALTHCARE CRISIS AND THE RESTRAINT OF SCIENCE AND MEDICINE

LYME DISEASE is the fastest-growing infectious disease in America. The Center for Disease Control reported about 35,000 new cases in 2008, but estimates that the actual number of cases to be 6-12 times higher. Ticks carry the disease, which is a spirochetal bacteria like syphilis. Early signs of Lyme include fever, headache, fatigue, and an “erythema migrans” (EM) rash. Late-stage Lyme can cause “severe permanent physical complications” involving the joint, heart, eye, and nervous systems.

BIG INSURANCE COMPANIES follow guidelines created by the Infectious Disease Society of America (IDSA), which rejects doctors’ ability to use clinical diagnosis methods, and gives only a short 28-day treatment of antibiotics. (See: CT ATTORNEY GENERAL’S Announcement: http://www.ct.gov/ag/cwp/view.asp?a=2795&q=414284 ). As a result, doctors in hospitals are simply presented with the IDSA guidelines by the insurance providers, and patients often find that their insurance companies only provide short term treatment.

YET, MANY DOCTORS WHO SPECIALIZE IN LYME CARE prefer to include clinic diagnostic methods and treat their patients longer, until they get better. Many of them belong to the International Lyme and Associated Disease Society (www.ilads.org), which made its own guidelines to better recognize and provide treatment for Lyme disease.

IN 2008, CONNECTICUT’S ATTORNEY GENERAL investigated how the IDSA made its guidelines, and discovered problems like conflicts of interest with insurance companies and failure to consider a range of research. The Attorney General found grounds for an Anti-trust action. The IDSA settled by agreeing to make an independent panel to review its guidelines. (CT AG’S Announcement: http://www.ct.gov/ag/cwp/view.asp?a=2795&q=414284 ).

IN RESPONSE TO THE ATTORNEY GENERAL’S FINDINGS, THE IDSA MADE A REVIEW PANEL that was chaired by a former IDSA president, and excluded any doctors who had treated long term Lyme. In 2010, the IDSA REVIEW PANEL decided unanimously that the IDSA guidelines needed no change.  But in a complete contradiction, the same panel’s report was evenly divided about whether the IDSA guidelines’ diagnostic criteria needed to be changed. The panel had other problems, like minimal discussion of opposing points of view. (Final Panel Report:
http://www.idsociety.org/Content.aspx?id=16520.).

Consequently, the Connecticut Attorney General should enforce his settlement agreement with the IDSA, and continue to seek a review of the IDSA guidelines that actually is independent.

In the article “Connecticut’s Antitrust Action against the IDSA’s Lyme Guidelines”, attorney Hal Smith reviews: the IDSA’s restrictive diagnosis and treatment guidelines, the Attorney General’s investigation into the guidelines, and the problems with the IDSA’s supposedly “independent” review panel that re-approved them.

The article is available on:

https://docs.google.com/document/pub?id=1_Ln6NbVI50nGdJ2rt4jFQf4ITPWLmInXEaZxFtxUmxU

and

http://groups.google.com/group/coma-ct/browse_thread/thread/2324bd45d52ac8f7/273aa9fe920dce12?hl=en&lnk=gst&q=lyme#273aa9fe920dce12

The Five Biggest Global Health Stories of 2010

From the UN.

Corporations invest in global health

Less than 10 years ago, Coca-Cola was hiring two workers for every one job opening it had in Africa.

That’s because “they knew that one would get sick and die,” said John Tedstrom, chief executive of the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria. “Talk about high overhead.”

But after investing millions of dollars in education and prevention, employees are healthier, and the company’s Africa business is thriving and a big part of its growth strategy.

http://seattletimes.nwsource.com/html/businesstechnology/2013410811_fireconference12.html

The Ultimate Guide to Public Health Internships

Looking for public health internships?  Thinking about getting an MPH one of these days?  This site can substantially help direct you and aide in your search.  Do check it out!

http://mphdegree.org/articles/public-health-internships-the-ultimate-guide/

52 eye-opening global health videos on youtube

http://mastersofpublichealth.org/52-eye-opening-global-health-videos-on-youtube.html

Whether you are new to public health or a seasoned expert, these videos will likely teach you things you never knew and inspire you to take on the world.

Project HMC Welcome

Since January 2007, Fundación VIHDA has completed 129,000 HIV tests of pregnant women who receive prenatal care and/or give birth at the Guayaquil Maternity Hospital and have detected 640 positive cases, which they have helped treat in collaboration with the Maternity Hospital and the Ministry of Health’s HIV program. All detected patients have received anti-retroviral (ARV) treatment prior to birth, c-section for delivery, and ARV treatment for the babies after birth. So far all pregnant women who underwent treatment in their program, and have given birth, have had HIV-free babies.

Project HMC is initiating collaborative efforts with Yale University organizational partners REMEDY, the Public Health Coalition, and UAID. Furthermore, I hope to begin working closely with Yale’s recently-founded Jackson Institute for Global Affairs to institutionalize Yale’s relationship with Las Guayas, Ecuador.
If you would like to support Project HMC, join the Yale- Ecuador HIV Mobile Clinic Team, or simply would like to learn more, please do not hesitate to contact me at ProjectHMC.Yale@gmail.com.

Best,

Sam Vesuna
Executive Director

Public Health Lunch with Elaine O’Keefe

Public Health Lunch with Elaine O’Keefe, Center for Interdisciplinary Research on AIDS Office of Community Health

Silliman Dining Annex

Friday, October 1
12:30pm

Meet Elaine O’Keefe, Executive Director of the Center for Interdisciplinary Research on AIDS and the Office of Community Health at the Yale School of Public Health. She created the City’s first dedicated AIDS unit in the New Haven Health Department during the early days of the epidemic and was responsible for developing and managing a spectrum of HIV services .Elaine has held various state and national leadership positions. She is a former president of the CT Association of Directors of Health. Elaine has received various awards over the years for her contributions in the AIDS/HIV and broader public health practice milieu.

Gender Based Violence in Haiti

Six months after the earthquake in Haiti, we see a continued crisis of safety and security in the displacement camps that has exacerbated the already grave problem of sexual violence.

In May and June, delegations coordinated by the Lawyers’ Earthquake Response Network (LERN) traveled to Haiti to investigate the problem of rape and other gender-based violence in the camps. They found that women are being raped at an alarming rate—every day—in camps throughout Port-au-Prince. The Haitian Government, the UN and others in the international community have failed to adequately address the situation. Women, especially poor women, have been excluded from full participation and leadership in the relief effort.

IJDH, MADRE, TransAfrica Forum, and the Universities of Minnesota and Virginia law schools released yesterday this Report Our Bodies Are Still Trembling: Haitian Women’s Fight Against Rape in an effort to bring to light the crisis and guide governments, international organizations, and other stakeholders in providing for even more effective protection and promotion of women’s human rights in Haiti.

Gender-based violence  (GBV) or violence against women is a global public health and human rights problem. Please join me in sending this report to colleagues, students, and organizations. And please contribute your comments and public health expertise online to The Institute for Justice and Democracy in Haiti.

Sincerely,

Samantha Diamond

Yale University

BA/MPH 2011

Unite for Sight Conference: Call for Abstracts

GH/Innovate 2011
Global Health & Innovation Conference
Presented by Unite For Sight, 8th Annual Conference
Yale University, New Haven, Connecticut, USA
Saturday, April 16 – Sunday, April 17, 2011

http://www.uniteforsight.org/conference

“A Meeting of Minds”–CNN

Unite For Sight’s must-attend, thought-leading conference convenes leaders, changemakers, and participants from all fields of global health, international development, and social entrepreneurship.  The conference convenes 2,200 people from all 50 states and from 50 countries.

Conference registration is now open. Register during July to secure the lowest registration rate. The registration rate increases after July.

Interested in presenting at the conference? We have two types of presentation opportunities.

• Call For Abstracts: Do you have an abstract for oral or poster presentation?  Submit your abstract for presentation.  The first abstract deadline is August 15, 2010.  Complete details are on the conference website.
• Call For Social Enterprise Pitches: Do you have an innovative idea or a new program in development?  Submit your idea for presentation.  Social enterprise pitches are accepted on a rolling application deadline, and the first quality pitches will be accepted for oral presentation.  When the social enterprise pitch spots are filled to capacity, applications will no longer be accepted.  See social enterprise pitch instructions on the conference website.

Confirmed Keynote Speakers

Jeffrey Sachs, PhD, Director of Earth Institute at Columbia University; Quetelet Professor of Sustainable Development, Professor of Health Policy and Management, Columbia University; Special Advisor to Secretary-General of the United Nations Ban Ki-moon

Sonia Ehrlich Sachs, MD, MPH, Director of Health, Millennium Village Project, Earth Institute at Columbia University