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A diverse look at global health issues.

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.


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.


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.


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.


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.


Lebanon's Syrian refugees: 'An entire generation is growing up with PTSD'

Commentary: The region cannot sustain an endless war in Syria.
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Syrian refugees queue up at a UNHCR registration center, one of many across Lebanon, in the northern port city of Tripoli on April 3, 2014. More than one million Syrians have registered as refugees in Lebanon. (JOSEPH EID/AFP/Getty Images)

BERUIT — Refugees are everywhere on the streets of downtown Beirut.

Women and children in filthy clothes beg for money on nearly every street corner. Countless young boys tote shoeshine kits, persistently following foreigners and wealthy Lebanese who pass by. "Min Sooriya" they say, meaning “from Syria.”

As if there was any doubt.


Where would global healthcare be without the private sector?

Healthcare leaders emphasize the importance of private funding for global health.
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A technician scans the eye of a woman with a smartphone application as she takes part in an ophthalmological study and examination near Naivasha, Kenya. The 'Eyephone' app can detect eye diseases and disorders, and could potentially provide low-income Kenyans with an opportunity to get a quick and effective diagnosis of their eye problems. (Tony Karumba/AFP/Getty Images)

CAMBRIDGE, Mass. — Daktari Diagnostics recently launched its first product in Africa — a low-cost handheld device to guide treatment for people with HIV. The portable technology, which monitors patients’ CD4 cell counts by a simple blood test, stands to help HIV infected people in low-resource settings get the appropriate medical care they need.


Q&A with Paul Farmer: Rwanda as a healthcare success story

Twenty years after the genocide, Paul Farmer reflects on how Rwanda became a model of inclusive healthcare.
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A syringe is filled with a vaccination prior to be delivered in Rwamagana district. (Shannon Jensen/AFP/Getty Images)

The rapid recovery of healthcare in Rwanda since the 1994 genocide has been nothing short of historic. Life expectancy has doubled. Child mortality has fallen by more than two-thirds since 2000. In the past decade, death rates from AIDS and tuberculosis have declined at record speed. Vaccination rates for many diseases surpass those reported in the United States. And Rwanda is on track to become the first African country to achieve the Millennium Development Goals for health. 


New US global AIDS coordinator has a roadmap to eliminating the disease

Commentary: US commitment is largest a nation has ever made to combating a single disease.
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Photo taken on November 28, 2013 shows staff members of the Themba Lethu Clinic in Johannesburg, the largest antiretroviral treatment site in the country, posing behind candles commemorating World Aids Day (December 1). South Africa has been hailed as a model for HIV treatment, but some now fear its very success may be breeding complacency and making people less careful about infection. (ALEXANDER JOE/AFP/Getty Images)

WASHINGTON — News broke last week that South Africa has the fastest growing rate of new HIV infections of any country in the world, underscoring the urgency of the fight against HIV/AIDS and the fragility of our progress to date. It also underscores a perpetual truth: leadership matters and we need bold, innovative and affirmed commitment to end this disease.

Early this year, the Obama administration nominated Deborah Birx as the next US Global AIDS Coordinator and first woman to assume the role. Last week, the Senate voted to confirm her appointment. In this position, Birx will oversee the President’s Emergency Plan for AIDS Relief (PEPFAR), the largest commitment a nation has ever made to combat a single disease. Our hope is that she uses this leadership role to work with diverse groups to promote the health and rights of all people and to expand the integration of family planning and HIV services.

We have come a long way in the fight against HIV/AIDS through PEPFAR and other programs. Yet as South Africa’s news illustrates, troubling disparities, stigma, and discrimination persist and women often bear the brunt of the burden. These challenges require immediate programmatic and policy attention.


In fight for gender equality in Africa, clean water plays a key role

Fetching water is a household chore traditionally delegated to women and girls in Africa. Reducing the need for it holds not only health benefits, but also the potential for social change.
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A woman carries heavy jugs of water through a muddy pond where she filled the plastic containers July 17, 2012 in Jamam refugee camp, South Sudan. (Paula Bronstein/Getty Images)

CAMBRIDGE, Mass. — An average woman in Africa spends about 60 percent of her day fetching water for her household. The chore not only forces women to walk miles to the nearest water source—which is highly likely to be contaminated—but it also prevents them from using that time to pursue educational or job opportunities instead.