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A diverse look at global health issues.

Southern African countries commit to address mineworkers’ TB

Following World TB Day, regional ministers signed a framework to address a century-old crisis that crosses borders
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A medical worker is pictured at a mobile testing facilities for tuberculosis (TB) at Driefontein Gold Mine in Carletonville, South Africa on March 24, 2012. Deputy President Kgalema Motlanthe launched a national TB control plan amongst gold miners, beginning with a programme to test workers. (Alexander Joe/AFP/Getty Images)

In 1902, Lord Alfred Milner, Britain's administrator in South Africa, appointed a commission to find out why so many workers in the territory’s lucrative gold and diamond mines were developing tuberculosis. Breathing in silica dust — abundant in mines and quarries — was the main culprit, the commission found. It said there was “urgent need” for reform to protect workers.

More than a century later, the fatal infectious disease has not eased its grip in the region. Miners in South Africa and neighboring countries have the highest TB infection rates in the world. In South Africa, the incidence of the disease was more than 1,000 out of every 100,000 people in 2012, and the country’s 2.5 million current and former mineworkers are most at risk. 

But new efforts are underway to tackle the epidemic at a regional level and involve more mining companies in addressing the crisis.

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Global health aid to fight HIV/AIDS boosts US’s image abroad, says new study

PEPFAR has improved public opinion across the developing world, according to a recently published paper.
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U.S. Secretary of State John Kerry speaks during the 10th Anniversary Celebration of the Presidents Emergency Plan for AIDS Relief (PEPFAR), at the State Department, June 17, 2013 in Washington, DC. The Presidents Emergency Plan for AIDS Relief is a U.S. Government initiative created to help save the lives of those suffering from HIV/AIDS around the world. (Mark Wilson/Getty Images)

As Congress debates the global health budget in coming months, some will argue that the funding improves security. Many will call it a moral imperative. And others will say that it boosts the nation’s image abroad.

Until now, there hasn’t been much solid data to back up the last claim. But a new study provides strong evidence that at least some forms of global health aid improve public opinion about the United States in the countries that receive it.

The study, published earlier this month in the Quarterly Journal of Political Science, found that the government’s main program for addressing HIV and AIDS has significantly improved public perceptions of the US across many developing countries.

The program, known as the President’s Emergency Plan for AIDS Relief (PEPFAR), was launched under the Bush Administration in 2003. Since then, it has channeled more than $52 billion to more than 80 countries to address the HIV/AIDS epidemic. It’s the single largest expenditure in the US government’s global health budget.

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To end hunger, global policy can't be 'business as usual'

Analysis: As the UN leader on the right to food steps down, he urges policymakers to think about sustainability. Will a new model for food security arise?
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UN Special Rapporteur on the right to food, Olivier De Schutter speaks during a press conference on April 5, 2012 in Nairobi following a meeting of more than 45 food experts in the Kenyan capital Nairobi that discussed food security in Africa. De Schutter said that incorporation of a right to food in national constitutions was a necessity in the fight against food insecurity in Africa. "Food insecurity is not only due to climatic events that have increasingly affected the region adversly in the last decade", he said adding that it is also due to lack of accountability of governments, and the inability of non-governmental or parliamentary controls that governments put in place to reduce food insecurity." (TONY KARUMBA/AFP/Getty Images)

International food prices have fallen since 2008, when agricultural commodity prices doubled, pushing millions around the world from bare subsistence to hunger and raising the number of food insecure people to nearly one billion

Is the crisis over, then? Far from it, according to Olivier De Schutter, the UN Special Rapporteur on the Right to Food. As he told the UN Human Rights Council earlier this month, global policymakers have yet to address the structural causes of the crisis. In particular, they have failed to recognize that industrial agriculture is not the ultimate solution to global hunger — and that it is, instead, part of the problem.

In part, De Schutter drew his conclusions from his official mission to Malawi last year. As I toured the country last month, it was easy to see what he saw: the promise and allure of hybrid seeds and synthetic fertilizer, as well as their limits.

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USAID's partnership with GE in Kenya will help health facilities buy high-tech equipment

Under the financing agreement, the medical equipment — including ultrasound and MRI machines — has to be purchased from General Electric.
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A picture taken on December 19, 2013 at a hospital in Nairobi shows a Kenyan nurse attending to four newly born babies squeezed in an incubator due to doctors and nurses strike. Kenya health workers went on strike on December 10 protesting the government decision to devolve services, including their pay, to 47 counties. (Simon Maina/AFP/Getty Images)

Health care providers in Kenya will soon have a much better shot at getting a bank loan to buy high-tech medical equipment — as long as the machines are made by General Electric.

Earlier this year, the US Agency for International Development (USAID) announced a partnership with the industrial behemoth that will make up to $10 million in credit available for Kenyan health facilities to buy its medical products, including ultrasound and MRI machines. It’s the first time the agency has partnered with a multinational company to extend credit guarantees that unlock local financing.

USAID says the partnership will help smaller clinics and hospitals get much-needed equipment to expand diagnostic and other essential health services. 

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In Niger, personal relationships are key to long-term maternal health

Though it's beneficial to send food and supplies to communities in need, it is also important to understand the value of personal relationships in order to implement effective, long-term solutions.
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A picture taken on October 14, 2013 shows a child suffering from malnutrition eyed by his mother at a hospital in Tillaberi, western Niger. Saumya Dave traveled to Niger with New York Times columnist Nicholas Kristof in 2011 and wrote articles on global women's health. (BOUREIMA HAMA/AFP/Getty Images)

Editor's note: This weekend President Bill Clinton, Hillary Rodham Clinton, and Chelsea Clinton will convene more than 1,000 undergraduate and graduate students from around the world at the Clinton Global Initiative University in Phoeniz, Arizona where attendees will work to address global challenges, including health. Saumya Dave will join the group of young leaders. She is a medical student and writer who traveled with New York Times columnist Nicholas Kristof to North and West Africa in 2011 to report on global women's health. As a result of the experience, she founded MoBar, an organization to improve maternal health in the region. 

MOLII, Niger — When I met Miero, I had no idea that she was eight months pregnant.

Unlike the pregnant women I’ve seen in America, Miero’s abdomen was flat and her sharp ribs protruded through her dress. Our conversation was a sharp contrast from the ones I had with women in America. No discussion of prenatal vitamins. No ultrasound dating. No measuring of fundal height. Instead, Miero told me that she hadn’t eaten in one day. Her reason was simple: she gave any available food to her family and counted on having whatever was left.

I was in her village of Molii in Niger because of a trip through Northwest Africa with journalist Nicholas Kristof.

Throughout our journey, we absorbed the stories of many women. I learned about the millet grain, an important food source, and the way women in villages walked to the well every morning to collect water in large buckets.

The women were independent in a way I hadn’t seen in America, occasionally relying on one another if they needed to, but for the most part, embracing all of the responsibilities placed on them. In every community I saw an underlying theme: women were taking care of their families and it was often at the expense of their own well-being.

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The lingering wounds of Liberia’s 14-year civil war

Tackling post-traumatic stress disorder and mental illness, one case at a time.
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Liberian Mike Otis Myers, 29, former child soldier and PTSD patient in Nimba County, February 2014. (Molly Knight Raskin/Courtesy)

NIMBA COUNTY, Liberia — In Nimba County, northeastern Liberia, the most visible signs of the country’s 14-year civil war are finally fading. Ethnic tensions have calmed, bombed buildings are being rebuilt and the economy is showing modest growth.

But the deepest wounds of the conflict are difficult to see and slower to heal. They are the psychological scars of war, and even after a decade of peace they are crippling people this small African nation.

“When I think about the war I just cry,” said 29-year-old Nimba resident Mike Otis Myers. “I survived, so I’m lucky. But when I think about what happened I feel so bad.”

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A common cause of blindness in India is preventable, but treatment is not always accessible

Prescription eyeglasses can correct ‘refractive error,’ which causes blindness for nearly 8 million people worldwide.
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Paras, an 11-year-old boy, reads a book by moving his fingers along the text in Braille at the school for the blind, Central Khalsa Orphanage, Amritsar India in January 2014. (Harman Boparai/Courtesy)

AMRITSAR, India — Harpreet Kaur, 13, prefers to sit in the front row of all her classes. She likes playing with her friends and watching her favorite shows on TV, like any teenager in her hometown. But in January, she noticed that she was not able to make out the images on the TV, even when she sat right in front of it. Her father took her to the eye hospital, and there doctors found that her vision was seriously impaired, and probably had been for a few years.

In most of the world, the leading cause of blindness is cataract, usually affecting people over the age of 60. But 8 million people are blind due to what’s called ‘refractive error,’ when the eye cannot clearly focus images, a condition that usually crops up in childhood. It is a very common visual impairment that is entirely preventable by wearing the right eyeglasses or contact lenses, but worsens without appropriate correction. If corrective lenses are not prescribed early, there can be irreversible loss of vision.

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Doctors Without Borders still excluded from Myanmar's Rakhine state

The government has said restrictions on the organization are a result of a broken agreement with the capital. A leaked document suggests there is more to the story.
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Displaced Rohingya Muslims carrying bags of aid after they collected from a humanitarian center at a camp on the outskirts of Sittwe in Rakhine state, western Myanmar on February 26, 2014. For Muslim communities eking out an existence in segregated camps in Myanmar's Rakhine State, aid groups provide a lifeline but their work is coming under threat from Buddhist nationalist campaigns that have pushed the government to eject Doctors Without Borders (MSF) from the region. (SOE THAN WIN/AFP/Getty Images)

YANGON, Myanmar — Last month’s decision by the government of Myanmar to suspend the operations of the medical aid charity Médecins Sans Frontières (MSF) prompted widespread concerns about the impact the organization’s withdrawal would have on the tens of thousands reliant on the support they provide.

Since that time, the temporary ban has been revised, and now only covers Rakhine state, on the country’s western coast.

In the wake of the announcement, government spokespersons stressed that the chief reasons for this decision were that MSF had breached the terms of a memorandum of understanding with Naypyidaw—the capital city of Myanmar—and had shown favour unduly toward one ethnic group in Rakhine.

However, documentary evidence and testimony obtained by GlobalPost appears to contradict this publicly stated rationale and instead suggests that the action may be punitive, linked to MSF’s response to a massacre that occurred at the end of January in northern Rakhine state—the same area where the charity's ability to operate remains frozen.

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In Kenya, sex workers want jobs and protection, but not just condoms

Guest post: A recent master's in public health graduate from Boston University talks with sex workers in Kisumu, Kenya.
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Kenyan sex workers march to protest for the legalization of prostitution on March 6, 2012 in Nairobi. Under red umbrellas and in red T-shirts, the protesters bore masks written with the phrases: "sex workers rights are human rights" and "my body, my business." (BORIS BACHORZ/AFP/Getty Images)

Editor’s note: Elizabeth Daube traveled to Kenya last year as a master’s student at Boston University’s School of Public Health through the Pamoja Together reporting project—a collaboration of students around the world committed to “telling the stories of foreign aid.” Her graduate thesis looked at the tension between the pro-sex worker rights and anti-trafficking movements.

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With birth control, US not alone grappling with reproductive rights and religious freedom

Wider reproductive health care coverage has been one of the more contested outcomes of the new Affordable Care Act. Here’s how other countries with deep religious roots -- Ireland, Argentina, and Israel -- have navigated the tension between reproductive rights and religious freedom.
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Demonstrators protest a requirement that most employers provide health care insurance coverage for contraception and sterilization as part of the federal health care overhaul, during a "Stand Up for Religious Freedom" rally, part of what organizers say will be a series of rallies in over 100 US cities on the second anniversary of the signing by US President Barack Obama of the Affordable Care Act, at Federal Hall National Memorial in New York on March 23, 2012. (Timothy A. Clary/AFP/Getty Images)

When significant parts of the US Affordable Care Act (ACA) went into effect earlier this year, key among the reforms was the expanded provision of free birth control. While many religious organizations were exempted from this mandate, the legislation has sparked protest and outrage, including litigation at the highest level, the Supreme Court.

But the US is not alone in attempting to strike a balance between offering reproductive health care services and respecting religious organization’s rights. In recent months, Ireland, Argentina, and Israel – three countries with deep-seated religious ties – all have tried to better navigate this thorny space as well. 

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