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A diverse look at global health issues.

Heroin epidemic takes hold of people—and politics—in India’s Punjab state

A widespread problem, with official estimates that more than 50 percent of youth are using drugs, is finally triggering government action.
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(Emily Judem/GlobalPost)

AMRITSAR, India — On a recent sweltering summer day, 27-year-old Gaurav Sharma tossed and turned on a small bed in the corner of a well-lit room. He buried his face in the pillow to try and forget the aches in his legs. A plaque hanging on the wall behind him spoke to his anguished state: “Drug addicts are not bad people who need to be made good, they are sick people who need to be made well.”

Sharma had not had any heroin for 24 hours. The withdrawal symptoms had begun.

“When it is really bad, it feels like I’m drowning and can’t breathe,” he said.

Drug use has become an epidemic here in the city and throughout the northern Indian state of Punjab, with officials estimating that more than 50 percent of people between 18 and 35 are using illegal drugs, including heroin and prescription opiates. More than two-thirds of the state’s rural households have at least one drug addict. 

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Partnering to protect women from HIV

Guest post: Women and girls continue to bear a disproportionate and unacceptable burden of HIV. A new public-private partnership could ensure they have the tools to protect themselves from infection.
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New HIV prevention technologies on the horizon, pursued in the new public-private partnership by International Partnership for Microbicides and the Janssen Pharmaceutical Companies of Johnson & Johnson, include monthly rings and gels that deliver ARVs and that could be combined with contraceptives. (Andrew Loxley/Courtesy) (Andrew Loxley/Courtesy)

The world is making tremendous progress to curb the course of the global HIV/AIDS epidemic. Since peaking in 2005, AIDS-related deaths have decreased by nearly one-third, and new HIV infections in children have fallen by more than half since 2001.

But not everyone is benefitting equally from these advances. Women and girls continue to bear a disproportionate and unacceptable burden of the disease. A new public-private partnership agreement announced last week between our organizations – the International Partnership for Microbicides (IPM), a nonprofit product developer, and the Janssen Pharmaceutical Companies of Johnson & Johnson, a major research-based pharmaceutical company – could help address this and ensure women have the tools to protect themselves from infection.

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How do journalists and policy analysts choose what to cover in global health?

Deputy editor Marissa Miley joined a panel discussion about “the story behind the story” for global health reporting at the annual meeting of the Consortium of Universities for Global Health.
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Elina Makopo, left, and her 12-month-old daughter, Jane, visit with community health worker Elizabeth Kafumo at the Kamupundu Primary Health Care Unit in Lufwanyama, Zambia. (Marissa Miley/GlobalPost)

WASHINGTON — How can a start-up global health NGO get its work featured in the press?

(Answer: Don’t use “academese,” but do send your peer-reviewed paper.)

How can medical students seeking to do video reporting get their foot in the door?

(Answer: Pick a narrow topic, make sure editorial and technical standards are up to par.)

And why doesn’t veteran reporter Don McNeil tweet? (Answer: He’s concerned his candor would be too much.)

These were among the questions raised by audience members at a panel discussion called “How the Media Chooses Global Health Stories” held on Monday at the Consortium of Universities for Global Health (CUGH) meeting

It’s not often I get the chance to step outside of my day-to-day role as journalist and editor to reflect on how I cover global health—or to connect with those who are making similar editorial decisions every day. But participating in the panel, I was able to do just that.

Joining me for the discussion were New York Times global health correspondent McNeil, NPR senior health editor Joe Neel, and Kaiser Family Foundation director of global health and HIV policy Jen Kates. The conference was organized by CUGH, a coalition of universities seeking to share expertise and best practices in order to better address global health problems.

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International Nurses Day: A time to call for medical neutrality

Commentary: It's time that the world’s health organizations and governments adopt and implement protections for all medics — demanding medical neutrality bylaws and amendments to the Geneva Convention of 1948.
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(Emily Judem/GlobalPost)

MANAMA, Bahrain — In February of 2011, when the Bahraini government violently cracked down on peaceful pro-reform protesters in Pearl Roundabout, I immediately knew what I had to do.

As a nurse who had spent 18 years training and working in the United States, I decided to go and assist in the emergency room at Salmaniya Medical Complex, the main public hospital, which was flooded by injured protesters hurt by government forces during the demonstrations. Although, at the time, I was an assistant professor and head of an emergency nursing program, president of the Bahrain Nursing Society and not a staff member at Salmaniya, I saw that the doctors needed all the help they could get.

Many of my colleagues and I could not have known that our decision to uphold our medical duty would place us in danger. Several weeks later, I was blindfolded and handcuffed upon entering a government building. During the nightmare days of my five months of detention I was beaten, shocked with stun guns, sexually harassed and threatened with rape.

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A Daughter's Journey: Reflections on Mother's Day

Moms making a difference when it comes to HIV
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(Emily Judem/GlobalPost)

I remember the day my mom died. The night before, we’d fallen asleep together in her room. I was wrapped up tight in my Princess Jasmine sleeping bag at the foot of her bed as she slept delicately next to my grandmother.

Then everything changed.

I woke up the next morning in a panic on the floor of my own bedroom, still zipped in my sleeping bag, while my dad slept on my bottom bunk. When I got up and ran for the door my dad suddenly awoke. He tried to stop me, but before he could say a word, I’d already run down the hallway into my parents’ room. She wasn’t there. I stared at her empty bed for what seemed like forever.

No one had to say a word. I knew she was gone.

Today is Mother’s Day. It is also my 25th birthday. And it is 20 years since I stood in the doorway of my parents’ bedroom not understanding why my 35-year-old mother had just died from AIDS.

Even now I can’t say that I fully understand why she died or why my father and I are HIV free, but I can say that I am learning to answer questions about the life my mother may have lived had she been diagnosed at a time when HIV wasn’t a death sentence.

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How humanitarian crises impact maternal and child health

This year's Save the Children's State of the World's Mothers report profiles four countries — including the US — that have seen particularly poor health outcomes for the most disadvantaged women and their children following crises.
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Women hold babies in their arms at the maternity ward of Binza, outside Kinshasa, in The Democratic Republic of Congo. (Junior D. Kannah/AFP/Getty Images)

It’s not often that you see the United States grouped together with the Democratic Republic of the Congo, Syria, and the Philippines – particularly when it comes to health care.

But in the 2014 Save the Children’s State of the World’s Mothers report, published Monday, those four countries were the featured subjects of an in-depth look at how humanitarian crises are negatively impacting maternal and child health.

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When life-saving surgery turns life-threatening

Of the 234 million major surgeries that occur around the world each year, 31 million lack a simple, but crucial, device to monitor blood oxygen levels.
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(Emily Judem/GlobalPost)

AMRITSAR, India—On my first day in an operating room as a medical student here in my home city in 2007, I studied our professors as they prepared a 34-year-old man for shoulder surgery. As part of the pre-operative steps, I watched closely as the anesthesiologist clipped a small sensor on the patient’s fingertip, and within seconds a nearby monitor lit up with a blue line and the number 97.

The simple clip, called a pulse oximeter, was checking the level of oxygen in the patient’s blood and would sound an alarm if it detected even a minor, unsafe change—typically, anything below the number 95, which reflects the blood oxygen saturation level. Dips in blood oxygen are risks during surgery because there is a change in the normal mechanics of breathing, especially with a co-existing illness. In school, we had learned that brain damage and heart failure could occur after just three minutes of severe lack of oxygen, usually below 85 percent, leading to permanent damage or even death.

Early detection was critical, and this device did the job.

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Curbing the HIV/AIDS epidemic one wall post at a time

How a new wave of public health workers is using social sites like Facebook to reach communities at risk for transmitting the virus.
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The Facebook and WhatsApp app icons are displayed on an iPhone on February 19, 2014 in San Francisco. (Justin Sullivan/Getty Images)

“Despite 30 years of living with HIV within the gay community there is still MAJOR stigma attached to being poz from neg guys…Welcome to the Scarlet ‘H.’”

“I agree [testing] is a personal responsibility, but on some level I feel it is a social one as well… Let’s just do it!”

“Hope everyone had a ‘safe’ weekend!!! What’s up with this weather?”

These aren’t the usual posts you might see on your Facebook wall when you log in, but for some health professionals and populations at risk for contracting HIV, these conversations are becoming the norm.

While outreach to online dating sites for people who are HIV positive, such as H-YPE, PositiveSingles, and PositiveSaathi, is not new, increasingly, public health researchers and activists are turning to social media sites like Facebook to reach communities at high risk for transmitting the virus.

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Expectations: Brazil's Cesarean section problem

After a young mother is forced to deliver via C-section, tensions flare over a woman’s right to choose how her child is born.
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(Emily Judem/GlobalPost)

This is the third post in a blog series called “Expectations" written by deputy editor of global health Marissa Miley. Expecting a child herself, Miley is reporting in Brazil to better understand how women experience pregnancy and childbirth. Read Part I and Part II.

RECIFE, Brazil—My doctor has not yet broached the topic of my baby’s delivery. She has not mentioned anything about anesthesia or drugs, about doulas or birthing coaches – not about how I’m supposed to train to breathe now that it seems Lamaze classes have fallen out of fashion. I’m not concerned. As I get closer to my due date, I know we — my doctor, my husband, and I — will talk about all of these things and that I’ll be informed and empowered to make the right decisions for me.

One choice I won’t make, though, will be whether to have a Cesarean section. In the United States, this procedure — where the baby is surgically removed from the womb — is generally reserved for medical complications or high-risk pregnancies. C-sections, after all, carry greater risks of infection and complications, and their rapid increase in recent decades has mobilized concerned US doctors to curb the trend with new guidelines. Still, the overwhelming majority of American babies — two-thirds — are delivered by vaginal delivery each year.

In Brazil, however, C-sections are far more common than vaginal births. On the surface, this appears to be because women prefer them. In private hospitals, where an estimated one-quarter of Brazilians receive their care and can afford to pay a premium, more than 80 percent of babies are born by C-section. In the more widely used public health system, this proportion is lower —around half of all births— but that’s still a higher percentage than in the US. And it’s dramatically higher than the World Health Organization’s recommendation that no more than 15 percent of babies be delivered by C-section. 

But dig a little deeper behind the numbers in Brazil and it becomes clear that C-sections are not always something women choose. Nor are C-sections always performed because they’re medically needed, according to many women and doctors I’ve spoken with here. In fact, many believe that there is a pervasive culture of disrespect in the Brazilian health care system for women’s autonomy around this issue.

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Activists to UK's development agency: you’re helping multinationals carve up Africa

A satirical video earlier this month raises serious questions about how the G8 nations' global food security initiative is working
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"Corporations celebrate new scramble for Africa." (World Development Movement/YouTube)

A dozen corporate executives clad in suits descend on the headquarters of the UK’s development agency, DfID. They bear name tags from the world’s largest food and agriculture companies: Monsanto, Unilever, Diageo. They carry a cake in the shape of Africa and ask agency staff to help carve it up.

“With the help of the UK government, we are on course to expand our control of food production in Africa,” boasts one executive, as others raise champagne glasses. “And what better way to say thanks for giving us a slice of Africa than for the Department for International Development to have their piece of the cake as well.”

The celebration, captured in a video on YouTube earlier this month, was, of course, a spoof. The UK-based World Development Movement, an anti-poverty advocacy group, staged the stunt to draw attention to its new campaign against the G8 nations’ global food security initiative.

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