Why the world and America needs Paul Farmer

I remember very clearly in March 2004 arriving into Kingston Jamaica. I was just tapped to be a Volunteer Country Director for the Clinton Foundation. The task was to work closely with a team of clinicians, business personnel, and ministry officials to help finalize the HIV/AIDS treatment and scale up country proposal for the Global Fund.

I remember during the first week on the job driving past a local prison. Our guide described the prison as a place where only ‘The Lord” smiles upon. It was known as a place where HIV/AIDS was rampant from drug use and unsafe sexual practice. However, for a variety of reasons was a population where no one cared to provide access to treatment.

It seems everyone has an opinion about Dr. Paul Farmer. The Far right question America’s role and tax payer dollars to help in the fight against poverty and strengthening health care abroad with over 40 million uninsured in America. The left promote Dr. Farmer as the world’s ambassador against poverty and disease. But without question, quite simply, Dr. Farmer has dared to go to those places where only ‘The Lord” smiles upon.

Paul (Dr. Farmer prefers both strangers, myself included in this first category, and close colleagues to avoid formal titles) has dedicated his life to improving the lives of those forgotten in the global economy. Regardless of whether you support his work, one cannot deny him full respect and admiration. He will be the first to admit he is not someone to be worshiped. Just a doer, who loves to do. Through his actions and doing, Paul and Partners in Health have directly impacted the lives of millions around the globe.

The world is a much better and enlightened place because of Paul and his ability to inspire many to think less about themselves and more about how they can help others.

Currently the Obama administration is working to convince Paul that he should become their global health ambassador. If this ultimately becomes reality, let us all be thankful. Because not withstanding the inevitable political minefields that await and budget battles to be fought, Paul will assuredly exponentially raise America’s stature in the world as a serious advocate for human rights, poverty reduction, and global health.

Happy Mothers day and Reflection

We wish you a very happy, wonderful, and happy mothers day.

Appropriately Mr. Nicholas Kristof from the NYT has given us a gift of reporting on a condition that effects both mothers and children, yet remains largely under funded with few direct advocates. Mr. Kristof reports that childhood pneumonia is an illness that is easy to treat, yet more than two million children die each year in developing countries. Thanks again to the herculean advocacy efforts of Lance Laifer the world is becoming better acquainted with a condition that Mr. Kristof states will kill almost twenty children in the five minutes it will take to read his column or my blog.

Though we are reminded that part of the challenge of advocating for childhood pneumonia is typically the condition can be a secondary infection caused by a primary underlying condition such as upper respiratory disease, HIV, malaria and malnutrition. Actually many scientists and health officials will argue that malnutrition or under nutrition and health illiteracy by parents are the biggest root causes of disease.

This highlights the challenge of advocating for a disease versus channeling the energy and funding dollars to strengthen health systems and increase health literacy to improve primary health care services and tackle root causes of disease. Otherwise, if we target a specific disease, yet do not thoughtfully look to apply needed attention to strengthen the health delivery system, we may get a disproportionate investment in treating one disease versus improving overall health services for mothers and children.

For example I’ve worked with local health workers in Tanzania to help develop primary prevention programs to eradicate rheumatic heart disease (RHD) over the last 5 years. RHD is thought to be an entirely treatable and preventable condition (it was a leading primary and secondary cause of cardiovascular death in the US prior to the discovery of penicillin), yet we have millions of children and adults in the developing world suffering from this disease. However, my colleagues and I have learned that the root cause and treatment for RHD goes beyond screening for streptococcus A and handing out penicillin. The inability to eradicate RHD in the developing world also has also been effected by traditional focusing on disease specific programs versus strategic strengthening of systems to detect and prevent diseases among infants and children.

Lance and Bill; We know your reporting and advocacy work are making an amazing difference for mothers and children the world over. The world needs more people like you bringing attention to these conditions. Lets hope that the tremendous advocacy and resulting funding dollars are spent wisely to also focus on root causes of disease and strengthening primary care and prevention services. Otherwise, the world will continue to follow the treatment of one disease at a time strategy versus creating a system that promotes wellness and health for an entire community and village.

Happy Mothers Day to all!

Beware of the Elephants – Common Sense guide for International Social Impact Field Projects

In the last several years there has been an exponential increase in the number of graduate and undergraduate students working on social impact projects in developing country settings. Many of these programs are short term engagements that last between 2 – 8 weeks over winter, spring, or summer intersession. Often times many of these students have never traveled to the destination site and are unaccustomed to the local cultural differences. While setting up a field program, a successful project is best driven by an experience field based mentor and supervisor. However the following are some tips for the traveling student to avoid unnecessary delays or impediments to having a successful experience:

Do not be a hero

If in an area that is endemic for malaria, TB, or other infectious diseases, do not hesitate to contact a local health worker or go to the nearest health clinic. Delaying care by a few hours can cause serious consequences. Before leaving for your destination make sure you have some form of international health insurance plan such as iSOS. Also, it is very important to remember to continue taking your malaria prophylaxis medications after your return from your destination as indicated by your prescription.

Your time is short, you can never plan enough

Do your best to gather as much information as possible to understand the context of the local problem and key stakeholders on the ground. Try in advance to schedule site visits and interview schedules before your arrival date. Be absolutely sure you have all the appropriate permissions and authorizations to collect and publish results.

Expected the unexpected, be flexible

The reality on the ground in global health is that most staff from junior to senior clinicians and administrators are over worked and have little extra time for new projects, regardless of the priority or importance. Often times an unexpected situation may occur. This might be work related – critical care emergency, or act of nature – heavy rains, flooding, or infrastructure related –email is not available, massive traffic congestion. Try to remain calm and work within the system. Use your mobile phone and SMS in advance to confirm appointments and maintain follow-up. Do not rely upon email as a primary tool for communication. Always have a back up plan.

Humility is critical

Too often I have see students intentional or not discussing details about an upcoming safari or upcoming job offers including salaries from summer internship positions. Remember in most instances one is working in an environment where there are vast structural differences and limitations to both educational and employment opportunities. Be appropriate and think before speaking. Remember that most of the professionals you are working with are mostly constrained by context, not by intellectual capacity or desire for advancement. If local partners sense you are insincere or in-country for a resume building exercise then the chances of accomplishing your goals for your project will be greatly limited.

Be smart, use common sense

When in doubt, don’t do it. Things that are most common that cause serious illness or worse include: 1) Eating or drinking from unsafe sources of water or uncooked food, 2) Traffic accidents. If the care or transport looks unsafe or the driver seems incapacitated due to alcohol or something else, just say NO!. It is better to be late than the alternative. 3) Unsafe pursuits. Most places of travel are endemic for HIV/AIDS. Unprotected sexual activity is playing Russian roulette. Also do not rely upon local safety standards for national parks and extreme sport activities. Double check all rented equipment, terrain vehicles as well as arrange activities through a recommended local travel agent. Saving money by seeking out unverified deals can cost you dearly beyond a hit to your savings account.

Create a weekly reporting system with interim and final deliverables

As described under the ‘humility section’ most officials you will be working with on the ground are extremely busy. Also chances are that most principle investigators or faculty members from your home institution will also be very busy with many other responsibilities. Manage both yourself and your ‘boss’. Prepare in advance meeting agendas that outline critical issues as well as a weekly summary of accomplishments, upcoming activities, and challenges or bottlenecks for action. Unless you carefully document your experiences and communicate effectively and concisely both accomplishments and challenges on a weekly basis, chances are that when your stay is over and you will have missed accomplishing many important milestones.