Latest Entries »

DownloadedFile-13

On April 13-14 Unite for Sight hosted its 10th Annual Conference on Global Health and Innovation.  Participants representing 50 states and 50 countries gathered on the Yale Campus to share ideas and experiences related to social entrepreneurship and global health. I have been to a number of global health conferences this year, but this one gets highest marks for new ideas and energy. This is a great gathering for students, scholars and innovators!

img-article-verghese-rosenberg_161652666543

Tina Rosenberg gave the opening keynote, drawing on insights from her recent book, Join the Club: How Peer Pressure Can Change the World.  Identifying behavior change as a major public health challenge, Rosenberg challenged the conventional wisdom of public health approaches that provide sound, evidence-based information about behaviors such as drinking, smoking and poor eating habits.

The problem with public health experts, said Rosenberg, is that they have no idea how non-experts think..

Rosenberg went on to outline some key communication principles that have many implications and applications to Global Health.

  • Focus on motivation, rather than a flood of information.
  • The best messenger is “someone like me who has made the change.”
  • Marginalize unhealthy behavior –don’t emphasize the magnitude of the problem.
  • Tell people about their peers who have adopted the positive behavior.
  • It helps to support change by having a mentor AND being a mentor.
  • And Finally –small groups are powerful engines for behavior change!

DownloadedFile-14

We also heard from economist Jeffrey Sachs, Director of the Earth Institute at Colombia University and author of The End of Poverty. He talked about the amazing promise of information technology for global health – ehealth, mhealth, smart phones, dumb phones, GIS systems – how they can all conspire to reach people with needed information and health services.  Sachs boldly pronounced that the Post 2015 Development Agenda could end extreme poverty and eliminate  hunger and preventable disease. He also encouraged us to join the club  — by engaging with the newly developing UN Sustainable Development Solutions Network (www.unsdsn.org).  Visit the site, register as a follower, and stay up to date on state of the art solutions to development challenges in 12 thematic areas ranging from health care to food systems to sustainable energy.

images-12Pediatrician Dr. Sonia Ehrlich Sachs  talked about the One million Community Health Worker Campaign (http://1millionhealthworkers.org/) for Sub-Saharan Africa. And yes, she wanted us to join the club, too! During the final 1000 days before the end of 2015 this effort (by a coalition of established global health actors) aims to put one million new community health workers into service.  These would be salaried jobs for (mostly) young women, who are given 3 months of training and ongoing supervision and refresher training.  They will be formally linked to the Ministry of Health, assuring reliable supply chains and referral mechanisms.   Here’s what the program looks like, and there are lots of ways to get involved.

1 MILLION HEALTH COMMUNITY WORKER CAMPAIGN VIDEO:

http://www.youtube.com/watch?v=_W5hns_huyY&feature=youtu.be

Lauren Redniss, author of “Radioactive,” UW-Madison’s GO BIG READ will speak on campus on Monday, October 15th.

It was a great weekend to stay inside and read the 2012 UW-Madison Go Big Read, Radioactive, by Lauren Redniss.  Put forth as a “Tale of Love and Fallout” that explores the lives and science of Marie and Pierre Curie, the book delivers on what is promised.  Then it heats up and starts to glow, shedding quiet light on other themes, such as the nature of spiritual love, the way gender roles shape what aspects of ourselves the world allows us to express, the experience of parental loss and migration, the truth of war, and the way human genius simultaneously creates beauty, awe and the capacity for self-destruction.

Marie and Pierre fell in love with each other and science in a way that cannot be disentangled.  Together they made careful measures with the sensitive instruments of physics, and spent  years sorting through tons of rock to achieve their goals.  They celebrated life with bike rides, adorning their handlebars with flowers in the springtime, and they enclosed themselves for long hours and years in a toxic laboratory environment that would hasten death for both of them.  They made remarkable scientific discoveries, and they participated in seances (also studying them with the physical sciences) with the seekers of their day.  They passed on a complex legacy to their children, who followed them to make significant contributions in the sciences.  Does anyone feel ordinary yet?

Identifying the genre of a literary work is usually straightforward, but Radioactive defies categorization.  Is it a children’s picture book, a science text, a biography, a philosophical treatise on ways of knowing, or a history book?  Is it fact or fiction?  Is it an entirely new genre — or simply an artsy scrapbook?   While a case can be made for all of these labels, I would classify it as non-fiction.  While it reads like a storybook, a closer look at the the narrative reveals that it is actually nothing more than a chain of of small verifiable truths.  By creatively assembling the facts, and citing scientific fact, letters, Marie’s dissertation, newspapers and the scientific journals of the day, Redniss creates a truthful and poetic space for readers to explore the meaning of life, love and science.

I look forward to discussing the book with students and colleagues throughout the year.  If you are in Madison, Wisconsin on Monday, October 15, 2012, you can hear Lauren Redniss talk about her work at 7:00pm in Varsity Hall, Union South.  Admission is free and tickets are not required.

Next Post

Half the Sky, the movie, just came out and can be seen at

Part 1-available till October 8th
http://video.pbs.org/video/2283557115

Part 2-avalable till October 9th
http://video.pbs.org/video/2283558278

L DiPrete Brown's avatarReflections

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…

View original post 663 more words

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.

SAM_0808

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!

FLzamiba

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

“Is that smoke,” I asked, pointing to the cloudy billows on the horizon as we headed toward Livingstone.  “No,” I was told, “it’s the mist from Victoria Falls.” In Tonga, one of the local languages here in Zambia,  the name for the falls is Mosi-O-Tunya, which means “the smoke that thunders.”  Now, as we approached from a distance, I could see why.  The falls are amazing and grand. The smoke appears first, from out on the highway before you even get to Livingstone.  Then, as you approach the gateway to the falls, you hear the force of water, a thunderous whooshing that is too strong to be taken for wind. As you walk toward the sound  you see and feel the spray, and then, suddenly, or so it seems, an immense wall of sheer gushing water.  The water force is so strong that the thick showers of water falls and rises with a bounce, with droplets breaking off and defying gravity, so that it feels like it is raining from above and below at the same time.

The rushing water, cool mists and sunny skies had me dizzy with delight.  Soon I was hoping for a rainbow, and I was not disappointed.  In fact, it seemed as if every time I asked,  the universe indulged me with colors of reassurance. So many rainbows on demand couldn’t be a coincidence!  Eventually I had to accept that miracles are ordinary and everywhere.  If you are looking. And if you remember to ask for them.

Our stay in Zambia was short, yet we had seen and learned so much.  I had wanted to see the falls, to put my toe in if I could, and now we were here.  Water in abundance,  rushing like thunder, cold sprays, powerful currents that can sweep you away.  The gift of color.  Again and again.

Hiking just above the falls we came to the still headwaters. It seemed impossible to me that I could stand so close the edge without being swallowed.  In spite of the kinetic frenzy just a few hundred feet away, the headwaters were a quiet pond.  There was so much more underneath the still current, and, I knew, so much more below the surface of this country, Zambia.

On the long ride to the Falls I had insisted that our friend and guide, Ali Sad, teach me a Zambian song.  It is an absurdly short visit, I reasoned, there will be no evidence that I was here at all if I don’t at least learn a song.  He taught me the following song/chant which is often sung when people gather.

    Nchale wo wau, nchale chi wau tu,

    Nchale wo wau, Nchale chi wau tu.

It means, loosely translated, “Everything is good.  It should be like this.”  And then it repeats, so there is no mistaking about anything, “Everything is good. It should be like this.”

Zambia — just a toe in….

“You cannot save what you do not love, and you cannot love what you do not know.”

Aldo Leopold said that, or something close, and I think of it as I enter Zambia’s Mosi y Tuna National Park to experience my first safari game drive.   It is  6:30 am, and it is cold. I am wearing a coat, I am under a blanket, and the jeep’s windows are all shut.  As Jason Paltzer, who is driving, tells us about an encounter he had with an aggressive elephant in this very park,  I am both disappointed and comforted by all the layers between me and the animals that we hope to see …. After a few moments, the grimy pane compels me. I open the window, leaving only air between me and wild nature.

Soon we see an impala.  It looks fragile, knowing.  It freezes, but then, at the sound of a camera shutter, it runs.  Its effortless gait reminds me of the way my daughter Kristen runs.  I love the impala for a moment, and then move on.  Next up is a warthog, awkward and muscular.  There is nothing beautiful to recommend this animal, yet we are taking photos and saying his butt bounce is cute. If we can love the warthog as he is, maybe there is hope for us?  We slow down for some guinea fowl who walk in the road in front of our jeep, seemingly unaware of us.  For some reason completely at odds with ornithological precision, I am reminded of Flannery O’Connor and how she loved her pea hens, and saw a map of the world in their plumage.

Next I am struck by the eyes of the giraffe, plaintive and loving, not unlike my golden retriever at home.  Then the zebras amaze me.  They are all perfect specimens, as if a doting zookeeper has been following them around. Their stripes are so contrary to any idea of camouflage. They don’t want to hide.  Instead, they are designed to find each other,  for the purpose of solidarity and survival. Their stripes also cause them to blend into each other, which makes life safer for the young and vulnerable. They have no natural predators in this park.  They pretty much thrive in peace.

I am the first to spot the crocodile.  He is underwater, but I see his long slender nose.  In the face of this fast, sharp-toothed endangered species, loving wild things becomes complicated… He is the reason we cannot swim in the river. I want life for this crocodile, yet the idea of his extinction provokes a whisper of relief in me that I cannot deny.

Baboons are a nuisance, we have been told. A few weeks ago one of them actually fought a tourist for a candy bar (or something), knocking him to his death, near Victoria Falls.  Now several baboons are prowling around our truck.  I am uneasy, and avoid looking them in the eye, afraid I will accidentally send the wrong message.  Then we see one in a tree — likely a female, she has a baby in her arms.  Slowing down for that we see another, also with a baby in her arms.  Once I know how to look, I see that the tree is full of mother and baby baboons, as if it is a scheduled play group!  This incredible act of social organization fills me with awe.  I decide to defend the baboon from now on.  It seems they are judged unfairly.

After an hour or so we arrive at the far end of the park where we can get out and stretch before we head back. There are some guards and another car nearby.   I wish I could walk alone for a bit.  I wish that the cars, and my friends, and even the strip of road that we rode along, were gone.  I would linger here, trust the peace, and accept the occasional predation– which seems to be the price of this particular kind of beauty.  I would live from truce to truce like the animals, abiding by their cautious rules of engagement.  Would I be able to freeze and run and fight at the right times, I wonder? ….  I stand under a tree for a bit, then explore a little ways in each direction, but I don’t stray too far from my tribe.

As I get back in the car I realize that there are things that I will never do–like hang glide, or swim with crocodiles, or walk alone in the wild.

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  (www.globalgiving.org or www.kiva.org).

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

3) Mmonitor news about global women’s issues through www.womensenews.org or www.worldpulse.com.

4) Become a citizen advocate at  the Care Action Network (CAN) www.care.org/getinvolved/advocacy/index.asp

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:  http://www.halftheskymovement.org/