global health

why we need to change the ebola paradigm

A doctor has just been diagnosed with Ebola in New York City. Last night, a man ranted for 30 minutes to everyone on the subway car about how we’re all going to die from Ebola, right then and there, but luckily I had my big headphones on so I’m not really sure what he said. Anyway, now what?

According to NPR, 75% of Americans believe that banning travel from and to West Africa is the appropriate next step. This policy, however, is misguided. A travel ban would likely exacerbate the effects of the Ebola outbreak on various levels. It may not only worsen the spread of Ebola, but also engender xenophobic, racist, and prejudiced attitudes toward African immigrants. Sharpening the physical and philosophical divisions between the U.S. and West Africa will only broaden the chasm between “us” and “them,” when in reality there is only “us.”

We need to fight prejudice, not perpetuate it

The mainstream media, especially at the outset of the outbreak, told this story in a way that characterized Africans as primitive, dirty, sick–ideas that stem from a deep legacy of colonialism and racism. Africa was historically viewed as the “Heart of Darkness,” a place of savagery and backwardness. For some, it still is. The expression of these ideas is now more subtle, but nevertheless present. The narrative that the West has created still paints the African, the black person, as Other. Someone to be feared, a life of lesser value. This idea is extremely problematic. Now that Ebola has arrived in the U.S., people’s blame on Africans may only increase. Yet placing the blame on Africans ignores the fact that the broken health systems in which this all began exist as remnants of colonialism.

The association between poor Africans and disease becomes apparent in the way that people speak. Many are saying, “keep Ebola out” when they mean “keep people with Ebola out,” as if they are the same thing. But if we think about the difference between those two statements, the question of human rights quickly comes into our field of vision.

“Twenty-two years ago, in a decision rooted in fear rather than fact, the United States instituted a travel ban on entry into the country for people living with HIV/AIDS. Now, we talk about reducing the stigma of this disease—yet we’ve treated a visitor living with it as a threat.” President Obama said this in 2010 when he lifted the travel ban on people with HIV. While his administration’s response to the Ebola outbreak has been less than ideal, his point demonstrates that a comparison to the AIDS crisis is absolutely relevant. Stigma was and still is a tremendous problem in response to the AIDS epidemic–now, we face a serious need to prevent stigma in regards to Ebola. Stigma and discrimination jeopardize human rights and put people’s lives at risk.

Exclusion is not a sound strategy

Those in favor of excluding people from West Africa claim that this would work to protect “national security.” As Vox has clearly outlined, there is no evidence that travel bans are effective public health measures. Laurie Garrett writes that “many nations have banned flights from other countries in recent years in hopes of blocking the entry of viruses, including SARS and H1N1 ‘swine flu.’ None of the bans were effective, and the viruses gained entry to populations regardless of what radical measures governments took to keep them out.”

Leaders like Paul Farmer of PIH, Thomas Frienden of the CDC, and other experts have explained that a ban would likely make the problem worse. If people are barred from the U.S., they will seek other ways to get here and their movement will be harder to track. Further, the work of NGOs and other aid groups, who are doing a lot on the ground, will be much more difficult. While some propose a selective travel ban in which only certain health professionals could get in and out, this would be complicated and counterproductive.

At the end of the day, the calls for a ban are entrenched in politics rather than sound public health policy. The majority of politicians, both Democrat and Republican, who are making the loudest calls for a travel ban are those on the campaign trail. Everyone wants to “keep Americans safe.” But if we are going to talk about “saving American lives,” perhaps we should discuss gun policies, the tobacco industry, or the structure of our food system. The language around public health always reflects political motives and social norms, and Ebola is no different.

There is a better way

Instead of focusing on how to keep the “problem” out, we should focus our efforts on the immediate containment of Ebola at its source. The U.S. and the international community must support the long-term improvement of the health systems in these affected countries. This requires things like strengthening government health facilities, building the capacity of local health workers, and improving access to care. These tasks are most effective when done through years of partnership with local people in country. This is nothing new.

While containing Ebola represents a major challenge, it is also an opportunity in which to act. This is the chance to collaborate for the sake of fundamental rights, social justice, and human dignity. Rather than revert to stereotypes grounded in racist phobias and a disregard for the Other, it’s time to lean toward a new attitude of pragmatic solidarity.

That seems intangible for those of us at home, but we can help mobilize resources by donating to worthy organizations like PIH, Wellbody Alliance, and Last Mile Health. We can be more conscious media consumers, call out dehumanization when we see it, and change the broader conversations that we are a part of.

Instead of choosing exclusion, we need to choose inclusion. We cannot afford to think of collective responsibility as a choice–if anything, the spread of Ebola illustrates that this is the world we live in. Global health is our health.

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global health

Advocating for grassroots women

(Disclaimer: I’m writing this so it’s online in a place that is not on my proud dad’s Facebook.)

The last few days in New York, the center of the world this week, have been incredibly exciting.

A few days ago, I had the honor of representing Barnard College in an event sponsored by the Women in Public Service Project called “A Global Conversation: Women Leaders Respond to the United Nations General Assembly.” I spoke on a panel with power women from the State Department, other students from women’s colleges, and several female heads of state. You can read about the event here, as well as the Columbia Spectator’s coverage of it. There’s also a webcast here and a Storify. The question I posed was about bringing rural women to the decision-making table. Special Representative Pandith gave an interesting response about her job description, which is to engage with people and build community at the grassroots level. Didn’t know the State Department did stuff like that.

At the Clinton Global Initiative, I saw so many world leaders that I lost track. Although I was working during the meeting, I got to listen to/casually walk past every Clinton, Barack Obama, Jim Kim, Ban Ki-moon, Jacqueline Novogratz, Paul Farmer, Queen Rania, Nick Kristof, Madeleine Albright, Ngozi Okonjo-Iweala, many heads of state, the first man to go into outer space, and other random people like Anthony Wiener, will.i.am, and Petra Němcová. What.

I am walking away galvanized, engaged, a little dazed, and very behind on my homework.

In all of these conversations, I just kept thinking about all the people whose voices were not being heard. These world meetings need to feature different kinds of people, including the grassroots leaders. This is not impossible — GlobeMed’s doing it.

President Halonen of Finland made me laugh out loud several times. What a character.

*Photo credit: Barnard College/Asiya Khaki

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global health, Uganda 2012

Cooking with Pam: a taste of Tanzania

Pamela usually doesn’t cook for us, but one lazy Saturday afternoon she taught us how to cook a Tanzanian dish (one of Lexa’s favorites). It was kind of like paella meets fried rice. It was really funny to watch Pamela chop vegetables because she cuts them in mid-air. She holds them in one hand and just says to “cut with confidence.” She’s like a human slap-chop.

I didn’t write down the exact recipe at the time, but here’s what I can remember:

Tanzanian Pilau

a LOT of vegetable oil
1 onion (diced)
1 cup carrots (diced)
1 cup green peppers (diced)
3 “cups” rice (I don’t know what this means. There was a LOT of rice.)
5-6 Irish potatoes (steak fries sized pieces cut into thirds)
fresh ginger/garlic
a few tablespoons chicken and/or meat masala
a few teaspoons paprika
4 tomatoes (skinned and chopped)
salt
orange food coloring
eggs (optional)

Prep: Wash rice. Boil, skin, and chop tomatoes.

In a huge pot, sauté the onions, carrots, and peppers in a lot of oil. Add ginger and garlic. Stir in uncooked rice and potatoes. Stir continuously. Add salt and spices. Keep stirring and cook for 5 minutes. Add tomatoes and cook until the tomato juices have become absorbed in the rice. Add the water and cook for around 1 hour, until rice is cooked.

Adding in eggs (scrambled in) and orange food coloring dust optional.

Serves an army.

Did I mention the oil?!

Doreen washing rice

The finished product. Fluffy and delicious.

Fresh passion fruit juice

Next time we’ll show you some local Ugandan food!

– Livy

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global health, Uganda 2012

Field notes: no salary, just soap

GlobeMed and GWED-G trained 20 community health workers, who are out on the front lines as we speak!

Last Friday, we visited the group of 20 community health workers (GWED-G calls them VHTs or Village Health Teams) that GlobeMed funded. There were about 12 of them there, and many of them were HIV positive. They work for free.

Beatrice is the chairperson of the group. During our meeting with them, Franny (the GWED-G staff member in charge of GlobeMed projects & our BFF) began telling Beatrice’s story to all of us.  It was a beautiful example of the relationship between GWED-G staff members and the people involved in their programs.

To show how I experienced it at the time, I posted an excerpt from the notes I took during that conversation below.

Beatrice

Awer Village – meeting with VHTs in Health Center 2

  • GlobeMed funded the training and capacity building of 20 community health workers aka the Village Health Team (VHT)
  • provided them with 3 bicycles for 8 areas, still need more bicycles for transport

Beatrice: people use me as an example of someone who is living positive, when they see how close I’ve come to death

Franny (speaking to the group):

  • when people were still in the camps, they would go to her to cope, for support, to get advice how to keep living even though HIV positive
  • Beatrice told them to not hide and to be careful not to pass on the virus to others
  • Beatrice likes the job, wants to help even though she doesn’t make any money
  • In the beginning, she went to the health center on her own, took the initiative herself to help HIV positive people with testing, counseling, drug adherence, etc.
  • They saw her talking boldly
  • Beatrice was close to death because of AIDS, and I gave her the nutritional supplement that helped bring her back to life
  • Of the people that knew her at the time, for those that could see both the before and after – many of them died, so only a few left would be able to see her today – now see Beatrice as a miracle
  • I feel so happy working with Beatrice, because I feel I have helped. If she were not helped, she wouldn’t be here today. It’s because she first was helped.
  • These VHTs are on the front lines. If disease were to break out, they would be the first to die. You know, if you have doctors, they can spend time thinking about how to treat the situation. But for these health workers, there is no preliminary diagnoses, no waiting, no time. Nobody even cares about them.
  • They are so bold. So hard to go household to household vaccinating children, doing home visits…it is not easy.
  • They became their own agents of change. Beatrice just moved on her own. She felt the pain in herself and didn’t want any other person to suffer the same way.
  • Sometimes, she tells me that she’s not happy, but works every day to see faces of people she is helping

Me (writing to myself): Franny spewing passion and love. So much admiration, awe, appreciation. If I think of what it means to be a hero, I think of someone who does right for the world without asking for any recognition in return. I think of Beatrice.

Franny (translating one final comment): she is saying that they’re not even asking for a salary, but sometimes they could use soap to wash their clothes so that they can present themselves well in the field. You know, sometimes they come home so dirty.

Franny (whispers to me): sometimes I give them airtime for their phones, like 5000 shillings (~2 dollars).

– Livy

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global health, photography, Uganda 2012

Living positive(ly)

Overheard in the field: “I have the courage to stand boldly before all of you because I want you to know that I will not die of AIDS.” – Zainabu, an HIV-positive woman from one of the groups we met with

Photos below: Visiting GlobeMed at UCLA’s partner in Anaka, testing school aged kids (14 and up) for HIV, immunizing babies who were born at home for TB, feeling a baby and helping with an antenatal home visit, meeting with HIV-positive women’s groups/youth groups

The red line indicates a positive test result.

Kristina and Carlos

Lamara! this is at home

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