Category: Health & Wellbeing

Haiti After the Quake begins with an image of Haiti rising, as it always has, to free itself from suffering and shackles, both real and metaphorical.  How many people know that Haiti was the first country to abolish slavery, and that it’s national sculptural icon Neg Mawon  (“the free man”) survived the quake and still blows into a conch to call others to freedom?

Today the University of Wisconsin welcomes Dr. Paul Farmer to its Distinguished Lecture Series, so it’s a good time to post a review of his most recent book,  Haiti After the Earthquake.  Many are familiar with Mountains beyond Mountains, Tracy Kidder’s award-winning account of Farmer’s work in Haiti.  For those inspired by that book,  I recommend reading some of Farmer’s own writing.  Well-researched and meeting every academic bar, they are also written in an intelligent accessible voice that does not apologize for its passion or its bias –a preferential option for the poor, and all those who suffer or are voiceless. Titles include Pathologies of Power, Partner to the Poor, and Infections and Inequalities.

Farmer’s 2011 Haiti account is true to what he is and has been.  He takes the reader with him through the days after the quake at an hour by hour pace, as he sees patients, tries to engage constructively in the policy development process, and even as he succumbs to fatigue, lying in bed rather than going to safe ground outdoors during strong aftershocks.  Thankfully, he cannot resist weaving in Haiti’s history,  and lessons from his experience in post-genocide Rwanda.  The book does not have the flavor of distilled wisdom, it is too soon for that.  Instead Farmer honestly walks us through complex issues, sharing his own questions with us, trying to imagine realistic scenarios of success, and, perhaps most importantly, channelling the Haitian spirit, insisting on hope as a moral imperative.

In addition to Farmer’s own story the book includes the voices of others who know and love Haiti.  Nancy Dorsinville brings us close to Haiti and its evocative language as she recounts the various ways people named the cataclysmic event.  The earthquake “tranbleman te,”  that thing “bagay la, “ and finally “goudou goudou,” which needs no translation.  One can hear the earth shake.   Walking around the camps with Didi Bertrand Farmer,  seeing her own daughter in the faces of girls who risk rape and abuse when fetching water or walking to the latrine, one is shaken from the protective distance we create between ourselves and disaster.  It could be us, it could be our children, and in a very real sense, it actually is.

Those engaged with Haiti have become familiar with the term “Build Back Better.” Before reading this book I was uncomfortable with the chop chop of that — it seemed to celebrate erasure for the Haiti that was, in the name of progress.  I worried that master plans would bulldoze local places and the small dreams of people who wanted to restore their own homes, streets, schools and churches.  But the voices of Haitians that come through in the book (particularly in the chapter by Michele Montas Dominique, where she summarizes the Voice of the Voiceless project), seem to embrace this idea as a way of making meaning out of the loss, and, provided that they have a say in the plans and designs, it is something that gives them hope.

Haiti Afer the Earthquake is a collection of voices.  People who have worked together for years, come together around a tragedy, and humbly try to record and make sense of it for the rest of us.   These are wise people, people who, I suspect, think and pray together. The book is a first step toward learning what it means to accompany Haiti, to walk with those who suffer, and to be a healing force when we encounter brokenness in our world.  Let’s build back better.


Lori DiPrete Brown, Njekwa Lumbwe, Jim Cleary, and program leader from African Palliative Care Association.

 During August of 2012, The UW Madison Global Health Institute was privileged to welcome Njekwa Lumbwe, that National Coordinator of the Palliative Care Association of Zambia, for an exchange visit to Madison where she participated in a Pain Policy training session led by  GHI Program Director Dr. Jim Cleary.  Dr. Cleary works with leaders from around the world to develop and scale up effective state-of-the-art policies and programs related to pain management.

Mrs. Lumbwe made valued contributions to the meeting and also gained insights about the way forward for Zambia, as she learned from the experiences of 9 other countries from Africa, Eastern Europe and Asia.  Engagement with global experts and national leaders from around the world helped Lumbwe to envision policy options and implementation strategies that could be applied in Zambia.

Her commitment to palliative care defines her as a leader, and the participation in the meeting reinforced this commitment.  “The meeting opened up a whole different perspective of the global state of pain control.  I pledge to use this experience to bring out the desired change.  I look forward to stronger future collaboration,”   said Lumbwe in her report to the group.

Soon after in November of 2012, we found that Njekwa Lumbe was following through on her promises, working nationally as a change leader, and collaborating with the First Lady of Zambia to make palliative care more accessible. We look forward to welcoming Njekwa back to Madison in the future!


It has been a wonderful week and a great privilege to collaborate with leaders from Zambia and Botswana ton plans to improve the quality of health and social services.  At the invitation of the  CDC-funded American International Health Alliance Twinning Program, and with the collaboration of their Zambia Country Director Ann Mumbi, I led a QI implementation workshop with a team of UW facilitators that included doctoral candidate, Jason Paltzer, and UW alumna and Global Health Institute staff member, Sweta Shrestha.

One challenging and exciting aspect of the program was that we brought together some very different types of organizations –  believing that the concepts about quality, the practical problem-solving tools, and the leadership principles would be relevant for all.  The partners in the group included the Palliative Care Association of Zambia, several Zambian teaching hospitals, leaders from ZAMCOM, which provides health communications expertise for the country, and leaders from the Zambian military health services.  From Botswana we had faculty members from an academic medicine setting,  leaders from an NGO umbrella organization that serves highly vulnerable children, and directors from two programs that do voluntary counseling and testing for HIV/AIDS.  They all worked in small group to develop improvement projects, giving each other feedback and encouragement along the way.

Did it work?  We think so ….. By the end of the week the participating leaders presented their strategic plans to each other and an audience that included national leaders, representation from the CDC, and the AIHA Twinning Program leaders.  We tried not to let the radio and TV crews go to our heads, but it was nice to see the work of the participants noted and celebrated!  Of course, this was not the end, but rather the beginning of the quality improvement efforts, since everyone hoped to go back to their organizations to carry out the planned changes as soon as possible.

While geography often conspires against us, this meeting is, thankfully, not our last time together, as many of the participants will be coming together again in July 2012 in Madison, Wisconsin to continue this work together!

Lori DiPrete Brown, Associate Director, UW Global Health Institute.

April 2012

I am 35,000 feet in the air, moving at 550 miles per hour toward Lusaka, Zambia. It is -47 degrees Farenheit outside. Although I have been travelling for 27 hours, it is only now, on this final 9 hour leg of the trip, that I begin to seriously contemplate the freefall that is possible from here.  During the first 4 legs of the journey I had been distracted by a missed flight, several reroutes, 2 “flying pills,” and 4 compensatory glasses of wine. But now that I have procured the desired place in the air, I am hit with the realization that I am seriously and dangerously far from everything I know and love.

The other passengers seem nonchalant, even confident, completely unaware of how helpless and absurdly unfit for life we are up here. None of us could withstand the cold temperatures at this altitude for more than 30 seconds, we could not breathe without the pressurized cabin, and there is only enough food and water for a day or two. We are physically incapable of getting ourselves home, both in terms of physical endurance and temporal feasibility. None of us would know the way home anyway.

I am so far away from my children! This thought makes the vertigo the most profound. I try to put down what I feel in my veins, turning my attention to the numbing mechanical buzz of the plane. But the mental and emotional clarity lingers. This trip which I have chosen, not just once but as a regular part of my life, is completely contrary to the instinctual logic, be it maternal, human or animal, that is hard wired  into me. Better to measure things in time than distance, I reason. It is only 10 days. They go to camp for a week in the summer…Going 7000 miles away to a landlocked country in Africa is sort of like that, isn’t it?

I have never been to Zambia, but as I watch the locator arrow move across the map of Africa I am comforted by the idea of getting there. Right now I am in an unnamed space between Cairo, Addis Ababa and Johannesburg. The Lybian Desert and Darfur Mountains are labeled, but other than that I cannot say where I am with much precision. Zambia, a landlocked country the size of Texas,  is still 2500 miles away.  Formerly Northern Rhodesia, the culture is a blend of Bantu and European influence.  It is one of the poorest countries in the world, per capita income is about $1000/year, life expectancy is 41 year of age,the  infant mortality rate is 119/1000 and the maternal mortality rate is 591/100,000.  The economy is showing hopeful signs of growth, with copper and agricultural as principal sources of livelihoods.  Zambia is home to 13 million people, and 3 or 4 of those people are expecting my arrival. I am going to work with a variety of health and social service programs, and visit a village where my colleague Jason worked and lived for two years. I hope to see a hippo and avoid altercations with baboons, and I am going to stand in the mist of Victoria Falls.

I know I will be able to fall asleep soon, and the flight is beginning to feel normal.  I realize that the noplace between places is always like this. God makes a flash appearance, reminding me that this space, so many miles above everything, is something sacred, to be savored. I am the same distance from everything, and from here the world is interconnected and whole. I will try to enjoy how large and small the world is. I will trust sleep and time to take me where I am going, and home again.

Half the Sky, by Nicholas Kristof and Sheryl WuDunn  documents the hard truths about being a woman on this planet. While some of us choose our spouses, share parenting, and become doctors or astronauts, many are stuck in a cycle of poverty and suffering that includes unfulfilled potential, maternal mortality, slavery and human trafficking, prostitution and survival sex, every  kind of violence, and a lack of choice and safety in relation to their sexual and reproductive lives.  Because I work with programs that address the health of women and children, people often ask me what I think of the book.  Is all this really true?  Did they get it right?

I have read the book three times and each time I am more impressed.  In addition to portraying the lives of women with great dignity and respect, Kristof and WuDunn provide the reader with stories of resilience, cause for hope, and suggested  action that will make a difference.

The first time I read Half the Sky was just before Sheryl WuDunn came to Madison to speak about the book for our local Planned Parenthood chapter in 2011.  I sponsored a table with my neighbor and friend Joyce Bromley, and we decided to invite some of my global health graduate students to join us.  Sweta Shrestha, a “Madison girl” from Nepal,  Aaliya Rehman from Pakistan, Middleton’s own Roman Aydiko, originally from Ethiopia, and Chrstine Kithinji from Kenya.  The topics were difficult, but the evening felt like a celebration — these young women in my circle were saddened but not shocked by these realities. Empowered with education, they are hopeful about being leaders and making change.  As the crowd departed we found ourselves in a circle sharing stories.  Each of these women told of someone who had fought for her: an uncle who defied the family and took his bright young niece to school because he knew she could realize her dream of becoming a doctor, a mother who defied tradition and married for love (and she wore pants!), parents who braved the immigration journey to the US with their children, and a foreign sponsor who kept investing in a young African woman, by providing scholarship support.  All of these young women are leading international lives now, making a difference in public health work here in Madison, and staying engaged in  their home countries.  Sweta leads service learning programs for UW students in her native Nepal,  Roman is engaged in research and quality improvement in Ethiopia, Christine is building a clinic in her home town, and Aaliya, an obstetrician who is proud of her Pashtun origins, is now in Pakistan working to improve maternal mortality.

This fall I assigned the book to my global health honors class for first year students.  “The book made me tremble,” one student told me.  Rereading the book through her eyes somehow made what was already real to me more real.  The raw facts lingered, and the numbers and the truth of the stories sunk in.  Is this really true? I realized it would be almost impossible to tell a false story about the oppression of women and girls, because everything  you can imagine is already happening to a girl–just about every girl you could make up is actually out there.

The subject of the book came up with again with students in my global public health class this spring.  We  discussed the book over coffee before class, and someone asked if I would blog about it.  So I gave it another read through yet another lens.  This is a class where we focus on action: What is the problem? What are the root causes? What works? How can we close the gap between the world we are in and the world we want to be in?  That is our public health mantra, and Half the Sky did not let us down.

Educating women, creating livelihoods through mirco-enterprise, providing health care… these things work.  At the end of the book Kirstof and WuDunn suggest 4 ways to support the  women and girls all over the world who are trying to change their own lives.  It will only take about 10 minutes and it probably will cost you less than you spend on dog food or coffee in a month.

1) Make a people to people microlending loan  ( or

2) Sponsor a girl (Plan International or Womenfor Women International).

3) Mmonitor news about global women’s issues through or

4) Become a citizen advocate at  the Care Action Network (CAN)

I hope people will read the book and get involved.  As hard as it is to stare down what is happening to girls in our world, change is possible, and women and girls are surviving and rebuilding their lives.

There is a movie based on the book coming soon.  See trailer at:

What will the world look like in 2015? And how can we make it a place that offers sustainable health and well-being for everyone?  At the Annual Symposium of the UW-Madison Global Health Institute, Ruth Levine described the burgeoning youthful population that is projected to dominate the global south as an asset rather than a liability, provided that we make the right investments, and provided that we “Start with a Girl.”

Levine identified the years from 12 to 14 as a crucial time in a girl’s life, where risks to health and well-being can increase, and her choices, her world, can become increasingly narrow.  If secondary schooling is withheld, a girl is confined to the home, child marriage is encouraged, and she is exposed to abuse and exploitation, she is destined to be trapped in a life of poverty and suffering.  On the other hand, for about a dollar a day, we can provide girls with community-based supported, health services designed to meet their needs, schooling and economic opportunities that can help us realize human rights for girls, and, at the same time,  benefit from a demographic dividend that will enhance the well-being of everyone.  See the keynote presentation here:

If you would like to know more about this effort you can read the complete report,  Start with a Girl: A New Agenda for Global Health by Miriam Temin and Ruth Levine, and review related news and resources at:

Further, you can see what change looks like for individual girls, and join the movement to change things for girls, at  The Girl Effect, where there are stories about girls from a number of countries and lots of ideas about how to get involved.


What about boys, you might be asking yourself?  They don’t experience the same risks and narrowing of choice and agency that girls do, but their needs are important also.  This movement is about extending education and opportunities to girls alongside, not instead of, boys.  To really make change we will have to work with girls and boys, men and women, so that the rights of girls and women are respected, and they are allowed to achieve their potential.

I walked in to the sound of sobs then a long moan.  It was the cry of an African woman, her head wrapped in a blue scarf, I think, lying on a narrow cot in her modest home.  Dying of AIDS?  Dying of cancer?  I wasn’t sure, but I did know that this scene from the the premiere screening of Life before Death was being viewed in 25 countries today, to educate people about the needless raw suffering that is taking place in homes and hospitals all over the world.

Having arrived late,  I took a seat in the back beside Dr. Jim Cleary, a UW physician and a leading global educator and policy advocate for the promotion of palliative care.  He was hosting the event for the UW-Madison Global Health Institute, and had himself been instrumental in developing the film.   I had to ask him, was the scene that I had just witnessed dramatized or real?

“It’s real,”  he said, and the words took on double meaning, because they meant both that this was a real woman, a woman like me, allowing herself to be filmed as she was dying in pain to benefit others, and also because the problem is invisible to so many of us.  We have to be reminded that “it’s real” and it is happening to 1 out of ten people all around the world.  We know how to address this, and it is not too expensive.  We just have to decide, as a human family, that everyone’s quality of life at death matters, and that no one should needlessly die in pain.

This “teaser” is a good way to get a sense of wht the film is about:

Life before Death portrays the realities of painful death, but it also shows life near the time of death as it should be and can be, with affordable pain relief, social support and care.  In addition to a longer film that can be purchased at  (proceeds benefit the cause), there are a number of informative shorts on topics such as chronic pain, hospice care, HIV/AIDS, the facts about opioid use, and others.  I hope readers will visit the site and share your thoughts here.

Sitting at the Java Den at University and Mills before class,  I was not sure what to expect.  Students from PHS 370 were invited to drop in to meet me, connect with each other, and talk about local to global perspectives on public health.  I was armed with a computer, a short novel, and the New York Times in case no one showed.  But I did not even get to read one headline….

Maggie arrived first wanting to explore how to make global health work a part of her life.  Relatively new to UW, she is shifting from a political science focus to a public health focus.  She told us a bit about her work in Bulgaria where she worked with the Roma population.  this video portrays the challenges that this ethnic group faces.

Abby had been on the Uganda Field experience led by John Ferrick and James Ntambe and she has done a lot of coursework related to public health and health disparities.   Pascale who joined us later will participate in the same Uganda program next year.   Laura, a global health certificate student,  joined us and shared that she will be working with Araceli Alonso on the Health by Motorbike program this summer.

Tahiya joined later in the hour and very generously shared stories about her summer in Bangladesh where she worked in the Geneva Camp focusing on children with disabilities.  The camp, established in 1972 to meet the needs of Pakistani’s who were still in Bangladesh after the transition, is now a crowded multi-generational community.  The video focuses on the health risks for children in the camp.

Liz, who is doing an  honors project for the class, hopes to consider homelessness in Madison in a global context through case studies or oral histories.  Stay tuned as she may be willing to share her project in  class or discussion section!

I blog as a reflective practice and to share information and experiences with my students, colleagues and friends. Some of the topics that I will cover this semester include my upcoming global health work in Tanzania in March — I will miss a few classes but will make up for it with some blog posts!  Also, I am working with a group of students who are planning to go to Ecuador to do service learning in a community where I have worked for the past six years.  I am going to “back blog” for them from my journals, so I can share some of my favorite memories and photos with them  and introduce them to the community where they will work.  I am going to cover campus events like lectures by Ruth Levine, who is coming on March 14th, to our annual Global Health Symposium.

I am also planning to do some global health-related book reviews.  Coming soon Is Cutting for Stone, by Abraham Verghese, which takes place in Ethiopia.  I am also reading Haiti after the Earthquake by Paul Farmer.  I will review A Sand County Alamanac, by Aldo Leopold, to explore the implications of a his “land ethic” for a new global health ethic.  Finally, I will reread one of my all time favorites, Cry of the Earth, Cry of the Poor, by Leonardo Boff.   I wonder if it will seem as good as it did when it changed my life many years ago….

Please feel free to comment on this post or make suggestions for future topics!

UW Madison Alumna Sweta Shrestha and I visited the Hamlin Fistula Hospital on behalf of our students on Friday, December 2, 2011.

The fistula ward was not what I expected.  For one thing, I thought it would smell.  I had prepared myself to smile, stand close, show no sign of revulsion.  I did not want to add one iota to the pain or shame that these women (many were young girls, actually) had experienced,  having been shunned by their communities, where they were often relegated to an outdoor shack because of the odor and  incontinence related to fistulas the were caused by obstructed labor.

A series of paintings that hang in one of the entrance halls to the hospital (signed Dawit B.), tell the typical story of how these women got to this place. I could not help but think of the stations of the cross as the story unfolded, beginning with a very young bride and early pregnancy, during which time her in-laws expect her to do the heavy work like hauling wood, carrying water and grinding grain. Fasting might also be practiced, for all or part of the pregnancy, further compromising health.  Then, if labor is obstructed (small stature places a woman at higher risk) and no medical care is sought, these young women can suffer for 3-9 days, with a still birth the likely outcome in 96% of the cases.  Another common outcome is a hole in the bladder wall (fistula) that can leave the woman incontinent.  Her husband is likely to leave her.  Then his parents send her home to her own family, where she will sleep outside because of the leaking and odor.

There are 9000 new cases of fistula every year in Ethiopia, according to Dr. Gordon Williams, who kindly gave us the tour, and this year 2500 got care through this and affiliated fistula hospitals.  While they can accommodate  4000 patients/year (only enough to meet 1/2 the need) this capacity is not realized because the women who need care are isolated.  They do not know that other women are living with the same problem.  They do not know that there is a cure.   The journey of the “Fistula Pilgrims,” a term that  founders Reg and Catherine Hamlin used to refer to these women who came to them for help, is portrayed in a moving award-winning  documentary called “A Walk to Beautiful” (see trailer at which tells the story of 5 women who make the journey to the Hamlin Fistula Hospital to seek care.

Fistula Patient –photo from Hamlin Fistula Hospital Website

When women arrive at the hospital they are given a clean gown and a brightly colored patchwork blanket that will be theirs to keep.  It provides warmth and comfort, and  later it is a reminder to them to tell others about the care and cure that is possible for women who suffer from obstetric fistulas. These blankets are donated by people who care from a distance all over the world.  I saw women in their beds, in the clean well-lit ward, urine bags in place, patches of color everywhere. They were at rest, comfortable, some smiling, a few reading (either because they are just learning or because they already had rudimentary skills). There is a garden on the grounds, and a “house” where they can go for a traditional coffee ceremony, and also hear taped stories in their own languages (since many speak languages other than Amharic).

Surgery will cure most of these women, but 25% of patients will need to try other strategies or continue to live with the incontinence.  To provide choices for women who can’t go home, the Hospital has also developed a rehabilitation center that includes a farm, a simple restaurant, and other income generating activities.   It was wonderful — and a lesson in what beauty truly is– to witness the healing of  these women, and to see them treated with such dignity and care.

Women with their blankets relax in the Garden at the Hamlin Fistula Hospital (from official website)

Of course I wish I could do more than just walk through the ward, smiling and saying “salaam.”  And thanks to my students I can ! Sweta Shrestha and I made this visit on behalf of our freshman honors global health students, who had learned about fistula and watched “A Walk to Beautiful” as part of a film series that Sweta has been leading for the past year.  The students  wanted to go beyond merely studying the problem — they wanted to do something personal for the women, to send a message of hope and care across the world.   Dr. Williams assured us that blankets and/or financial donations from UW-Madison students would be welcome, and we made sure we got the specs before we left.

For people from the Madison area: the UW-Madison students are organizing a showing of the film Walk to Beautiful  on campus on February 5th, 2012 (time and location TBD — check back here).   We hope to discuss the film, learn more about obstetric fistula, and make some blankets to send to Ethiopia.  There will be materials to work with at the event, but if you knit or crochet feel free to make some squares (10″x10″) in advance and bring them to the film showing.  We will patch things together and deliver them to the Hospital. The brighter the colors the better!   This is another way to celebrate and participate in the Wisconsin without Borders initiative.

More information about obstetric fistula and the Hamlin Fistula Hospital in Addis Ababa can be found at: . Also, there is a chapter devoted to this site and work in a book I highly recommend,  Half the Sky, by Nicholas Krustof and Sheryl WuDunn (see Chapter 6: Maternal Mortality: One Woman a Minute, p. 93-102).   Dr. Catherine Hamlin (with John Little) has also written a book entitled, The Hospital by the River: A Story of Hope.  It is a straightforward narration of her life and work, and a very interesting read.

Would you like to go to the ICASA 2011 conference in Ethiopia?  It’s not too late…..

It was such a privilege for me to be at the conference and hear presentations from researchers from around the world.   This post is a gateway to that meeting for my students and readers.  I am providing a summary of some of the bolder plenary remarks, as well as highlights from some sessions that I attended.  Most importantly there is a link that will allow readers to browse the full program and all the presentations.

Challenging words from Stephen Lewis about the Global Fund: Lewis described the decrease in donor funding of the Global Fund as appalling and attributed especially bad behavior to the EU.  Dismissing economic causes, he characterized these decisions as valuing women and children in Europe and North American more than women and children in Africa, favoring fighter jets over human beings, and protecting defense budgets instead of millions of human lives.

Tewodros Melesse was a brave Ethiopian voice for dignity and rights for all:  Melesse emphasized the sexual and reproductive rights of women, children, adolescents and LGBT persons.  Speaking out against stigma and discrimination of all kinds,  he reminded the crowd that  there had to be respect for, and room for, differences of opinion. Melesse words were appreciated by many, especially session co-chair, Miriam Were of Kenya, who dubbed him an honorary woman for his advocacy and willingness to speak out.

The conference papers addressed HIV prevention, testing, treatment(s), co-infection (especially TB), prevention of mother to child transmission, and challenges in reaching and caring for highly vulnerable populations.  Participants reported on many aspects of the diverse and complex epidemic, which Peter Piot described as many epidemics, rather than one.  Researchers presented evidence about the feasibility of lifelong ARV care, male circumcision, microbicides, and care for discordant couples.  I chose to attend sessions that focused on health systems and multi-sector approaches, since that is the emphasis of the Global Health Institute at the University of Wisconsin-Madison.

From ICASA presentation by Fana Abay for Enda-Ethiopia

HIV and Agriculture:  This session, entitled promoting livelihoods for HIV/AIDS affected communities, featured rigorous research, much of it in Ethiopia, related to sustainable agriculture and economic empowerment.  Since I come from a community where local food and urban gardens and farmers markets have gained a lot of attention, I felt at home as I heard about strategies for urban populations that included bio-intensive gardening and small-scale dairy efforts through south-based NGOs.  This study documented improved CD4 counts!  A second study, which reported improved nutritional status, focused on low input gardens and local food production that increased access to eggs, vegetables, and beans. Another study explored the relationship between HIV status and land use, finding that 43% of HIV affected households have lands that they are not able to cultivate.  Strategies that address basic food security alleviate hunger, and they do so much more.  They can enhance the effectiveness of treatment, enable HIV positive persons to be strong enough to work their land, and they can contribute to reduction in transmission by reducing the incidence of transactional sex (girls having sex for money because they are desperate for food).  Community-based HIV efforts are increasingly  going beyond health care services to address hunger.

HIV and Non-Communicable Diseases (NCDs):  There has been much talk in the last few years that vertical programs like those that address HIV/AIDS could  contribute to overall health system strengthening, because of overflow benefits, such as the development of general clinical and management skills,  and the potential for more rapid horizontal integration of services. This session made the case that drug supply and quality assurance systems developed for ARVs could make it easier to develop similar systems for NCDs.  While insulin and asthma inhalers are expensive, many of the drugs needed to treat NCDs are affordable.  Presenters also stated that the MDGs neglect non-communicable diseases — and HIV care and monitoring fail to use the opportunity to detect NCDs, even thought HIV treatment likely increases susceptibility to some NCDs. With modest adaptations, HIV testing facilities could be adapted to test for diabetes, cholesterol, and BMI, and early diagnosis in the context of HIV care and monitoring would be possible.  Presenters also made the case that the trajectory of HIV care was similar to care for people living with NCDs. There is a similar focus on early diagnosis, continuity and multi-disciplinary, family centered care, as well as referral, self-management, and community linkages.  Therefore, the headway made in HIV care could be leveraged for more rapid and effective scale-up of care for non-communicable conditions.

 You can access and learn from the ICASA presentations and proceedings at the link below.  All the presentations are there. To browse the program and find presentations that interest you, scroll down toward bottom left and click on ICASA program book or ICASA pocket program.  Note the date, room and last name author and presentation title.  Then go to the folder and look in the room where the presentation took place for the file with the author and title that you noted (most are power points).

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