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vector<br />
www.ghn.amsa.org.au<br />
<strong>Issue</strong> <strong>12</strong> Febuary <strong>2011</strong><br />
The Official Student Publication of the AMSA Global Health Network<br />
the<br />
Millennium Development Goals<br />
issue
THANKS TO ALL OUR SPONSORS
contents<br />
4 EDITORIAL<br />
5<br />
8<br />
Reflections on the 63rd UN DPI-NGO Conference<br />
GLOBAL HEALTH IN THE NEWS: AN UPDATE<br />
Feature articles<br />
<strong>12</strong><br />
14<br />
18<br />
20<br />
26<br />
28<br />
30<br />
32<br />
34<br />
36<br />
MDGs not only for Developing Nations<br />
Tipping the Scales<br />
One Step on a Long Path to Much More<br />
The Pains of Labour<br />
Nets, Condoms and Drugs<br />
Going Environmental<br />
Why can’t we just all get along?<br />
Global health, Sustainability and Doctors<br />
Student Selective - Welcome to Samoa<br />
Global Health Conference 2010 Report<br />
a Window into Global Health<br />
A series of powerful photos that visualise and<br />
encapsulate the MDGs<br />
<strong>Vector</strong>: The Official Student Publication of the AMSA<br />
Global Health Network<br />
GHN Publicity Officer Alyssa Fitzpatrick<br />
Editor in Chief Saion Chatterjee<br />
Co Editors Maheshie Dayawansa<br />
Katherine O’Shea<br />
Design & Layout Annjaleen (Anjie) Hansa<br />
Web master Rungrueng (Tommy)<br />
Kovitwanichkanont<br />
Editorial enquiries:<br />
Email vectormag@gmail.com<br />
GHN enquiries:<br />
ghn.publicity@gmail.com<br />
or visit www.ghn.amsa.org.au<br />
We welcome your written submissions, letters<br />
and photos on any global health issue or topic.<br />
Please limit submissions to 500 words or less.<br />
Cover Photography Hiep Pham<br />
Graphics Ralph Bergmann
www.ghn.amsa.org.au<br />
4<br />
A<br />
young child in Ethiopia aspires to become<br />
a doctor, engineer, or teacher one day. She<br />
dreams of earning an income, owning a house<br />
and providing her children with a life she could<br />
never have. But this seems like a futile dream. Her<br />
family is unable to provide her with an education,<br />
as school fees would consume more than one quarter<br />
of her family’s income. Despite her parents’ wholehearted<br />
efforts to send her to school, the reality of<br />
their situation means that she will be entrenched in<br />
the perpetual cycle that has encompassed her family;<br />
editorialcould still<br />
a nomadic life underpinned by the daily struggle to<br />
survive.<br />
On the other side of town, another child can no<br />
longer endure the darkness, waiting for daylight to<br />
arrive so she can get ready for school. She lives in<br />
a small one room abode, abutted by replicas of her<br />
home. Her mother leaves early in the morning to<br />
work in the mill and returns in the late hours of<br />
night. The child must cook and clean for herself,<br />
and make the arduous journey to school every day.<br />
School for her, however, is a secure and nurturing<br />
setting, where she can come early and often stay<br />
late, and is lovingly equipped with the tools to lead a<br />
better life by her teachers.<br />
Education in Sub-Saharan Africa has prevailed as<br />
a ray of hope, in the midst of proliferating political<br />
warfare, and the truculence of disease and inequality.<br />
The 2 nd Millennium Development Goal - to ensure<br />
that, by 2015, children everywhere, boys and girls<br />
alike, will be able to complete a full course of<br />
primary schooling - has been a key focus in the<br />
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s a i o n<br />
chatterjee<br />
editor in chief<br />
m o n a s h<br />
university<br />
countries of Sub-Saharan Africa and Southern Asia.<br />
Education has been identified by experts as the most<br />
sustainable and expeditious means of economic and<br />
social development and to alleviate poverty. With<br />
education, employment opportunities are broadened,<br />
income levels are increased and maternal and child<br />
health is improved.<br />
Countries such as Burundi, the Democratic Republic<br />
of the Congo, Ethiopia, Ghana, Kenya, Malawi,<br />
Mozambique, Tanzania and Uganda have abolished<br />
school fees, which has led to a surge in enrolment: in<br />
Ghana, for example, public school enrolment in the<br />
most deprived districts and nationwide soared from<br />
4.2 million to 5.4 million between 2004 and 2005 1 .<br />
In Kenya, enrolment of primary school children<br />
increased dramatically with 1.2 million extra<br />
children in school in 2003 alone; by 2004, the number<br />
had climbed to 7.2 million, of which 84 percent were<br />
of primary school age 1 . Despite this, the 2nd goal is<br />
not on course to reach its target of universal primary<br />
education by 2015. Currently, 56 million children<br />
be out of school in 2015 and<br />
girls will still lag behind boys in school<br />
enrolment and attendance 2 .<br />
As the 63rd UN DPI-NGO conference<br />
occurred in Melbourne late last year,<br />
with a large medical student contingent from<br />
around Australia putting in their two cents, this<br />
issue canvasses the progress and potential pitfalls<br />
concerning the Millennium Development Goals<br />
(MDGs). The MDGS are a series of resolutions<br />
setting a hard target of 2015 to achieve a range of<br />
specific quality-of-life benchmarks agreed to by 192<br />
countries and 23 international organizations. We<br />
can all play our part to ameliorate our globalised<br />
world, whether it be through grass roots action,<br />
supporting non-governmental organisations<br />
though activism and participation, or influencing<br />
health care in developing nations via research and<br />
student placements. Medical students must show<br />
leadership when it comes to issues such as universal<br />
primary education, as factors like this will play an<br />
unprecedented role in the burden of disease and<br />
quality of life people face, particularly in developing<br />
nations, in the years to come.<br />
1. United Nations Development Programme. Achieve universal primary education (Success stories) [Internet]. 2007<br />
[updated 2007 Nov 1; cited 2010 Aug 7]. Available from: http://www.mdgmonitor.org/story.cfm?goal=2/<br />
2. UNICEF. Press release [Internet]. 2010 [updated 2010 May 17; cited 2010 Aug 7]. Available from: http://www.unicef.<br />
org/media/media_53659.html/
arthur<br />
cheung<br />
university of<br />
queensland<br />
ADVANCE global health ACHIEVE the MDGs<br />
reflections on the 63 rd UN<br />
DPI-NGO Conference<br />
From 30 th August to 1 st September 2010,<br />
Melbourne hosted the largest United Nations<br />
conference in Australia’s history. It was the<br />
third time the UN Department of Public Information<br />
Non-Governmental Organisation (UN DPI-NGO)<br />
Conference was held outside the UN headquarters<br />
in New York, and the first time it was held in the<br />
Southern Hemisphere.<br />
The theme for the 63rd UN DPI-NGO Conference was<br />
global health and achievement of the Millennium<br />
Development Goals (MDGs): eradicate extreme<br />
poverty and hunger, achieve universal primary<br />
education, promote gender equality, reduce child<br />
mortality, improve maternal health, combat<br />
communicable diseases, ensure environmental<br />
sustainability, and access to essential medicines.<br />
With a large contingent of Australian youth in<br />
delegations including those from the World Medical<br />
Association and the International Federation of<br />
Medical Students’ Associations, it promised to be a<br />
great boost to the level of global health engagement<br />
in Australia.<br />
Reflecting on the conference brought mixed feelings.<br />
There is a common belief that we must remain<br />
positive about our experiences, to the extent that it<br />
makes us uncomfortable to criticise that which needs<br />
critique. Regardless, I shall give my honest thoughts<br />
on the conference and its proceedings.<br />
There are three main reasons why a productive<br />
conference was vital. The first is that while we sat<br />
in the Melbourne Convention and Exhibition Centre,<br />
people continued to die of preventable causes in<br />
the world outside. So any diversion of the attention<br />
of the world’s NGO leadership must be for a good<br />
reason. The second is that it is extremely rare for<br />
such a diverse and comprehensive range of NGOs to<br />
come together for the express purpose of<br />
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6<br />
idea sharing, collaboration and co-ordination. We<br />
therefore must make maximal use of such immense<br />
potential to secure the future of our world through<br />
successful pursuit of the MDGs, a duty all the more<br />
important in light of the UN General Assembly<br />
Summit on the MDGs that was held later in 2010.<br />
The third is the many youth who were present at the<br />
conference, who hoped to experience an inspirational<br />
and informative conference, and to gain a glimpse<br />
into the world and NGO community they will inherit.<br />
However, I was both dismayed and frustrated at<br />
the lack of direction, co-operative spirit, forward<br />
movement and learning in the majority of the<br />
plenary roundtable discussions. Many delegates<br />
distracted the conference with questions and<br />
comments that showed a disregard of the topics at<br />
hand, the dire nature of the problems we are trying<br />
to address, and where their contribution sat within<br />
the larger picture of global health efforts as a whole.<br />
To ask a roundtable of world leaders in the MDG<br />
campaign to comment on whether the conference<br />
should be held with Esperanto as the official<br />
language is inappropriate. To ask off-topic predrafted<br />
questions merely to practice public speaking<br />
or to assert your NGO’s presence at the conference<br />
is inappropriate. To have speakers misunderstand<br />
the few questions that were on topic due to lack of<br />
interpreters is farcical.<br />
It was great that there were so many new NGOs,<br />
youth, and others less experienced in global health<br />
at the conference. However, we must let the more<br />
experienced NGOs/WHO/UN have productive<br />
discussion. Pushing of individual agendas only serves<br />
to undermine meaningful discussion of the relevant<br />
topics and stall progress on the overall objectives.<br />
If this is the state of world affairs, it seems our<br />
generation has a lot to fix.<br />
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‘‘<br />
To ask a roundtable<br />
of world leaders in<br />
the MDG campaign to<br />
comment on whether<br />
the conference<br />
should be held with<br />
Esperanto as the<br />
official language is<br />
inappropriate<br />
‘‘<br />
It should be recognised that perhaps it was a<br />
unique set of circumstances that resulted in a less<br />
productive UN DPI-NGO conference than is usual.<br />
The uncertain political situation in Australia postelection<br />
prevented a number of high-profile UN<br />
officials and Australian politicians from attending.<br />
This undoubtedly led to a lack of clear leadership and<br />
vision, and a lesser sense of urgency and importance<br />
that productive discussion need take place.<br />
So did I regret attending the conference? No. There<br />
were undoubtedly some exceptional delegates<br />
present, and the conversations which resulted (on<br />
topics from the mundane to philosophical, from<br />
policy issues ranging from Indigenous health and<br />
access to essential medicines to reproductive health<br />
education) was undoubtedly of great benefit to<br />
the delegates personally, and therefore also to the<br />
people their organisations help. The time allowed<br />
for networking was certainly a useful insight into<br />
the breadth of global health activities, from the<br />
Global Alliance for Vaccines and Immunisation,<br />
to the work of the Burnet Institute based in<br />
Melbourne. The growing recognition that addressing<br />
non-communicable diseases and climate change is<br />
fundamental to achieving the MDGs is a positive step.<br />
The consistent advocacy for strengthening health<br />
systems over running vertical aid programs focussed<br />
on specific diseases was great to see. The observation<br />
that everyone wants to coordinate, but no one wants
to be coordinated, is a poignant indictment and call<br />
for action. To hear Che Guevara’s daughter speak of<br />
the Cuban health and medical education system was<br />
inspirational, if not embarrassing when she suggested<br />
that Cuba train Indigenous doctors free of charge<br />
so that they may return to benefit our communities<br />
in Australia. If the plenaries reached that level<br />
of discussion, it would be a hugely productive<br />
conference indeed!<br />
The point made here is that good process is important<br />
to good outcome. Our activities must have clarity<br />
of purpose, and strong leadership to steer discussion<br />
and ensure we stay on task. Should I be criticised for<br />
criticising the conference? As was emphasised at the<br />
6th Annual Nossal Institute for Global Health Forum<br />
held immediately after the UN DPI-NGO Conference,<br />
evaluation is a crucial aspect of running aid. The<br />
appropriate response to a fear of donors withdrawing<br />
support due to deficiencies identified by evaluation<br />
of aid programmes (or, similarly, voter support for<br />
government initiatives) is not to neglect critique.<br />
It is to educate donors that evaluation is vital to<br />
improving and following evidence for better practice.<br />
Indeed, improvement, not the outcome per se, should<br />
be the framework under which we measure success.<br />
What of the MDGs, and our strategy beyond 2015?<br />
A few observations were especially influential:<br />
you cannot save the most vulnerable infants and<br />
children without first ensuring the health of their<br />
mothers; educating a boy educates an individual,<br />
‘‘<br />
The observation<br />
that everyone wants<br />
to coordinate, but<br />
no one wants to be<br />
coordinated, is a<br />
poignant indictment<br />
and call for action.<br />
‘‘<br />
while educating a girl educates a family; the MDGs<br />
are donor driven and over-sell the significance of<br />
international aid (aid does not progress the MDGs<br />
when funds flow to developed-world contractors<br />
rather than building local capacity); the MDGs focus<br />
on aggregate measures and averages and are poor<br />
indicators of equity; the MDGs do not cover all issues<br />
important to global health; and prevention is not<br />
only better than cure, but is also cheaper.<br />
The MDGs should not be an end-point in and of<br />
themselves, but a benchmark for measuring the<br />
success of initiatives that develop local capacity.<br />
The MDGs are merely a communication tool used in<br />
assessing progress on our commitment to health as a<br />
universal human right. It is important to remember<br />
that the MDGs are both a moral imperative, and<br />
achievable.<br />
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1. the battle<br />
against AIDS<br />
www.ghn.amsa.org.au<br />
8<br />
The AIDS pandemic is almost 30 years old. Sixty million<br />
people have been infected with HIV. However, since<br />
the pandemic peaked in 1999, safer-sex education and<br />
widespread condom use have brought down the number<br />
of new infections by 19 percent, according to a state-ofthe-pandemic<br />
report just issued by UNAIDS, the United<br />
Nations agency charged with leading the fight against<br />
AIDS.<br />
child<br />
health<br />
8<br />
mil<br />
maternal<br />
health<br />
358 ,<br />
000<br />
HIV/<br />
AIDs<br />
vector FEB <strong>2011</strong><br />
estimated<br />
number of<br />
children<br />
under five<br />
who die every<br />
year<br />
estimated<br />
number of<br />
women who<br />
die each year<br />
in pregnancy<br />
and childbirth<br />
67 %<br />
of HIV<br />
infections<br />
are in sub-<br />
Saharan<br />
Africa<br />
2. second hand<br />
smoking<br />
3. TB test<br />
A new speedier test for<br />
tuberculosis has been<br />
endorsed by the World<br />
Health Organization. The<br />
test will shorten diagnosis<br />
time from months to a few<br />
hours. Currently TB spreads<br />
and kills faster than it can be<br />
diagnosed.<br />
More than 600 000 deaths per year<br />
worldwide are caused by second-hand<br />
smoke (SHS) - this is more than 1%<br />
of all deaths. 165 000 of these deaths<br />
are among children.<br />
what’s<br />
been<br />
global<br />
health in<br />
the news<br />
- a quick<br />
overview
http://www.good.is/post/which-countries-are-making-the-most-progress-on-the-millenium-development-goals/<br />
h<br />
a<br />
p<br />
p<br />
e<br />
n<br />
i<br />
n<br />
g<br />
Countries around the world are working hard to achieve the Millennium Development Goals<br />
(MDGs). The Overseas Development Institute’s Millennium Development Goals Report<br />
Card: Measuring Progress Across Countries, recently ranked the countries that have made<br />
significant progress on key targets of the first, fourth, and fifth goals. The rankings are in<br />
terms of absolute progress toward the targets, meaning that countries that have improved by<br />
the largest margins (from first measurement), regardless of initial conditions (and distance<br />
from the targets).<br />
4. needle for<br />
meningitis<br />
‘Tis the season for meningitis in Sub-<br />
Saharan Africa. Starting December<br />
and running through June, the seasonal<br />
drought will once again put more than<br />
450 million people across Burkina Faso,<br />
Mali, Niger, Chad, Sudan, and Ethiopia<br />
at risk of developing meningitis.<br />
But this year, doctors have a new<br />
weapon in their fight; a new vaccine<br />
that works against the group A<br />
meningitis strain that causes more<br />
than 8 out of 10 cases on the continent.<br />
Moreover, it costs less than 50 cents a<br />
dose.<br />
5. Cancun<br />
clinches<br />
a climate<br />
consensus<br />
For the first time the pledges by<br />
developing and developed nations<br />
to cut pollution have been brought<br />
under a UN agreement, despite<br />
vigorous opposition from Bolivia.<br />
A multi-billion dollar Green<br />
Climate Fund was established<br />
for poorer countries to deal with<br />
climate change and progress was<br />
made on deforestation and clean<br />
energy technology.<br />
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aWindow<br />
intoGlobal<br />
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Goal 1: Eradicate extreme poverty and hunger<br />
Miguel Angel Leonardo, 6, licks clean a spoonful of Incaparina, a<br />
powdered supplement distributed by food-aid organizations to<br />
prevent malnutrition in infants and children. Even so, Guatemala has<br />
the highest rate of chronic malnutrition in the western hemisphere,<br />
and continues to have the highest rate of chronic malnutrition,<br />
according to a report from United States Agency for International<br />
Development.<br />
photo by<br />
jeremiah stanley<br />
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Why should Australia be interested in the<br />
Millennium Development Goals (MDGs)?<br />
Despite the fact that focus is indeed on<br />
developing nations, Aboriginal & Torres Straight<br />
Islander (ATSI) communites have health statistics<br />
comparable to poorer countries. So there is much<br />
that is relevant especially with our poor track record<br />
in improving ATSI health and, not only that, when<br />
this country is faced with an unsustainable health<br />
system there is much to be learnt from some of the<br />
successes of the approach.<br />
The initiative was launched in September 2000,<br />
building upon a decade of major United Nations<br />
conferences and summits where world leaders came<br />
together at the United Nations Headquarters in<br />
New York to adopt the United Nations Millennium<br />
Declaration, committing their nations to a new<br />
global partnership to reduce extreme poverty. It is<br />
important to note the time for planning and gaining<br />
a commitment compared to how long this country<br />
takes to plan and implement health interventions. A<br />
series of time-bound targets were set with a deadline<br />
of 2015. Such long term planning and goals are<br />
impossible in Australia thanks to our electoral cycle<br />
and the short term funding of health projects.<br />
The eight goals were assessed for progress and<br />
further resources were allocated to countries that<br />
were clearly not going to achieve their goals without<br />
extra support.<br />
Australia set the National Health Goals and Targets<br />
in 1994 1 ]. What happened to them? We seemed<br />
to have moved to measuring activity leaving the<br />
question open as to whether the activity promotes<br />
the health of all Australians.<br />
This is the appeal of the MDGs in that they are<br />
focussed on populations as opposed to individuals.<br />
This is consistent with the well known aphorism<br />
of Dr Geoffrey Rose 2 , ‘... a preventive measure that<br />
brings large benefits to the community offers little<br />
to each participating individual.’ In Australia the<br />
focus is on the customer with a disease and no cost is<br />
spared to bring the benefits of the latest technology<br />
to bring a cure or to palliate. This has led to inverse<br />
care law being alive and well in that the provision<br />
of cutting-edge health services is located where the<br />
need is least 3,4 .<br />
Many strategies included in the MDG approach<br />
are synonymous with the social determinants of<br />
health, ten of which were identified by Wilkinson<br />
and expatriate Professor Sir Michael Marmot (visit<br />
http://www.who.int/social_determinants/en/). He<br />
also emphasised the importance more recently of<br />
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MDGs not only for<br />
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Dr Bret Hart, Head of Public Health Unit , Nort
the need for interventions to be proportionate to the<br />
degree of disadvantage, and hence applied in some<br />
degree to all people, rather than applied solely to the<br />
most disadvantaged 5 .<br />
The impact of comparatively modest interventions<br />
can be seen by reviewing some of the strategies<br />
employed so far in reaching the MDGs. For example<br />
the first goal is to ‘halve, between 1990 and 2015, the<br />
proportion of people whose income is less than one<br />
dollar a day’. Imagine the impact of developing a<br />
program that doubles a person’s income to two dollars<br />
a day. Now reflect on the difference an extra dollar<br />
a day would make to you. This prompts another law<br />
to be considered: the law of diminishing returns.<br />
Applied to Australian health the law suggests that<br />
the more we reach health actualisation (apologies to<br />
Maslow and his hierarchy of needs), the more the cost<br />
to achieve a marginal gain in personal health and no<br />
improvement in population health - in fact there is<br />
the potential for a net loss because of the opportunity<br />
cost associated with the provision of boutique health<br />
services as opposed to providing basic health care to<br />
those who need it most.<br />
Another lesson for us is that when global threats<br />
to health become more manifest during this<br />
decisive decade, there is the need to emulate the<br />
multidimensional approach to ensure that the<br />
factors that determine health are enhanced and<br />
strengthened. Many of these factors included in<br />
the MDGs are summarized in a recent extension of<br />
the Dahlgren and Whitehead model to include the<br />
environmental influences on health [6,7 .<br />
The challenges for health systems across the world<br />
are great but, ironically, it is the developed world<br />
where the dominance of tertiary services has led to<br />
an exponential and unsustainable increase in costs.<br />
Thanks to the MDGs we are likely to see enormous<br />
health gains from investing in the determinants of<br />
health and in primary health services and hopefully<br />
the Australian medical leaders of the future will<br />
take note of where they need to focus their efforts<br />
to achieve the greatest impact on the health of<br />
Australians.<br />
1. National health goals and targets: summary of draft reports. Canberra: Department of Human Services and Health;<br />
1994<br />
2. Rose G. The strategy of preventative medicine. Oxford University Press; 1992.<br />
3. Hart JT. The inverse care law. The Lancet 1971 Feb 27; 1(7696):405-<strong>12</strong>.<br />
4. O’Dea JF, Kilham RJ. The inverse care law is alive and well in general practice (Editorial). Med J Aust 2002; 177:78-<br />
79.<br />
5. Health equity: an election manifesto? (Editorial). The Lancet 2010; 375(9714):525.<br />
6. Dahlgren G, Whitehead M. Tackling inequalities: a review of policy initiatives. Tackling inequalities in health: an<br />
agenda for action. London: King’s Fund Institute; 1995<br />
7. Barton HAGM. A health map for the local human habitat. J R Soc Promot Health 2006; <strong>12</strong>6(6): 252-261.<br />
developing nations<br />
h Metropolitan Area Health Service, WA.<br />
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3 MDG<br />
promote gender equality & empower women<br />
Tipping<br />
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1. UNDP. Goal 3: promote gender equality and empower women. [Internet]<br />
2010 [updated 2010; cited 2010 November 18]; Available from: http://www.<br />
undp.org/mdg/goal3.shtml.<br />
2. UN. The Millennium Development Goals Report. New York; 2010<br />
3. UNSD. Millennium Development Goals: Gender equality and women’s<br />
empowerment progress chart 2010. New York; 2010.<br />
4. UNDP. Keeping the promise: united to achieve the Millennium<br />
Development Goals. United Nations 2010 MDG Summit; New York.<br />
KEY FACTS<br />
MDG 3 seeks to promote gender<br />
equality and empower women. The<br />
empowerment of women has been<br />
linked to long term financial and social<br />
stability in communities across the<br />
globe. This is reflected in the 2000<br />
Millennium Declaration, which states<br />
that the empowerment of women is<br />
an “effective way to combat poverty,<br />
hunger and disease and to stimulate<br />
development that is truly sustainable 1 .”<br />
The achievement of the MDG is<br />
reflected in three key indicators,<br />
including the ratio of girls to boys<br />
in primary, secondary and tertiary<br />
education, the proportion of women<br />
employed in the non-agricultural<br />
sector, and the share of seats held by<br />
women in the national parliament 1 .<br />
The 2010 MDG Review Summit, held in New York in<br />
September, held a spotlight on the progress made<br />
towards achieving equality for and the empowerment<br />
of women. It provided a chance to reflect on what<br />
has been achieved thus far, and the barriers which<br />
remain towards achieving the full political, financial<br />
and social involvement of women on the world stage.<br />
Equality for women, however, is more than just an end<br />
in itself. Kofi Annan, former Secretary-General of<br />
the United Nations, stresses that it is a precondition<br />
for meeting the challenge of reducing poverty,<br />
promoting sustainable development and building<br />
good governance.”In short, not much will happen until<br />
women have the chance to be equal on the playing<br />
field.<br />
Since 2000, documented progress has been made in<br />
achieving the third Millennium Development Goal,<br />
as reflected in greater gender parity in primary<br />
education in some nations. While the greatest<br />
advances have been made in Southern Asia, Sub-<br />
Saharan Africa, Western and Northern Africa have<br />
also documented improvement in female participation<br />
in the education sector 1 . Sadly, in Oceania, which in<br />
conjunction with Sub-Saharan Africa and Western<br />
Africa, has the poorest record of gender equity, there<br />
has been a slight reduction in parity in enrolment<br />
in primary education 1 . Similarly, the percentage<br />
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of women who share in employment in the nonagricultural<br />
sector remains at worryingly low levels<br />
in many African and South Asian nations 2 .<br />
Long-held cultural views of the secondary role of<br />
women in society provide a major barrier to the<br />
active participation of women in educational,<br />
financial and employment sectors. Drought, food<br />
shortages, conflict, failure to register births, child<br />
labour and the rise of HIV/AIDS further cripple<br />
progress by impeding school involvement and<br />
denying girls the opportunity to gain an education 1 .<br />
Beyond immediate crises, however, women are<br />
unable to achieve equal participation in society<br />
in the absence of appropriate infrastructure to<br />
unable to break the cycle of poverty and become<br />
active participants in the labour market 3 . Where<br />
women are denied an education, they are unable to<br />
make choices about the use of contraception, key to<br />
controlling the spread of HIV/AIDS and in enabling<br />
women to choose the timing of their children 3 . And<br />
where women are not empowered to become active<br />
decision makers, their needs continue to be unheard<br />
and unaddressed.<br />
alyssa fitzpatrick<br />
university of adelaide<br />
support their ongoing development. For example,<br />
in communities where water is not available by<br />
pipeline, girls are twice as likely as boys to be<br />
required to collect water, completing multiple<br />
long-distance trips and sacrificing time that could<br />
otherwise be used for education and employment. 3<br />
Women’s economic involvement provides a conduit<br />
for improved livelihoods for themselves and their<br />
families, and improved health and educational<br />
opportunities for the children 3 . Where women are<br />
denied ownership and control of resources, they are<br />
‘‘<br />
investing in women<br />
‘‘<br />
and girls has a<br />
multiplier effect on<br />
productivity, effiency<br />
and sustained<br />
economic growth<br />
review summit 2010<br />
The 2010 Review Summit reiterated its<br />
commitment to promoting women’s social and<br />
economic involvement, stressing that investing<br />
in women and girls has a multiplier effect on<br />
productivity, efficiency and sustained economic<br />
growth” and thus that a focus on women is key<br />
to ensuring continued progress and meaningful<br />
improvements in quality of life 4 . The 2010 Review<br />
Summit placed an emphasis on the continuing need<br />
to target gender equality through the launch of<br />
the Gender Equality and Women’s Empowerment<br />
Progress Chart. Highlighting the promising increase<br />
in aid directed at improving parity in women’s<br />
involvement in recent years, it nonetheless called<br />
for further contributions to address this core<br />
concern 3 . However, the Summit also emphasised<br />
the need to ensure good sanitation and nutrition,<br />
and to combat HIV/AIDS, to facilitate women’s<br />
empowerment. It additionally reiterated the<br />
reciprocal dependency of achieving MDG 3 and<br />
realisation of the other core targets embodied in<br />
the Millennium Development Goals to achieve<br />
improvements in quality of life for all. At the<br />
heart of it, however, is the deep understanding that<br />
without equal opportunity for women, there will<br />
be continued barriers to achieving long-lasting and<br />
meaningful development.<br />
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16<br />
Goal 4: Reduce child mortality rate<br />
Reducing child mortality is<br />
not as simple as increasing<br />
immunisation rates. A burn<br />
like this one can mean a life<br />
of disability, and increased<br />
susceptibility to other<br />
diseases. It's important to<br />
recognise the importance<br />
that rehabilitation also plays<br />
in helping those children<br />
who have suffered a serious<br />
illness or injury to remain<br />
free of further problems.<br />
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photo by<br />
Zhi Lin Kang
aWindowintoGlobalHealth<br />
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17<br />
www.ghn.amsa.org.au
educe child mortality<br />
ONEStep<br />
university of<br />
melbourne<br />
on a long path<br />
towards much<br />
www.ghn.amsa.org.au<br />
4 MDG • growth monitored<br />
The story of what is today global or international<br />
child health had its beginnings in the aftermath<br />
of the violence of World War II. Much as the War<br />
abolished and redefined borders, the boundaries<br />
of responsibility for the world’s children were<br />
to progressively expand. The United Nations<br />
International Children’s Emergency Fund (UNICEF)<br />
was created in 1946 by the United Nations General<br />
Assembly to provide relief to children affected by<br />
World War II; and this heralded an approach that<br />
called for international collaboration to improve the<br />
health of children.<br />
The 4th Millennium Development Goal, to reduce the<br />
rate of child deaths (expressed as deaths per 1000 live<br />
births) in each country by 2/3 of what it was in 1990 by<br />
2015, is a continuation of approaches adopted over the<br />
last three decades. The idea is that most child deaths<br />
are preventable. Despite advancement in the science<br />
of medicine, pharmaceuticals and technology, the<br />
major killers of children are still pneumonia, malaria,<br />
malnutrition, diarrhoeal diseases, and complications<br />
of birth or infections of the newborn. In the 1980s,<br />
UNICEF introduced the GOBI initiative, focussing on<br />
trying to ensure every child has their basic needs of<br />
medical care.<br />
more<br />
GOBI initiative(198o):<br />
• oral rehydration solution<br />
access if diarrhoeal<br />
disease occurs<br />
• breast feeding<br />
• immunisation<br />
This had remarkable results, and emphasised<br />
an important lesson: what needs to be done is<br />
already known, and the majority of child deaths<br />
can be averted by focussing on a few simple,<br />
highly effective interventions, and doing them<br />
well.<br />
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It would be simplistic to assume that<br />
MDG 4 is sufficient for improving<br />
child health. We know that health is<br />
much more than preventing deaths.<br />
Children need a safe environment to<br />
prosper in, a future and the chance to<br />
become what they aspire to, without<br />
being hindered by race, gender or place<br />
of birth. If we achieve MDG 4 – which<br />
would be the case for most countries<br />
in Latin America and some countries<br />
in South East Asia – that would be<br />
encouraging, but still not enough.<br />
Today, the greatest determinant of<br />
a child’s future is the country they<br />
are born in. Addressing this inequity<br />
requires more than reducing death<br />
rates.<br />
it can target high density areas, and<br />
neglect scattered rural communities.<br />
Such details will never be reflected by<br />
one national figure for child mortality.<br />
And then there is sustainability, and<br />
the effect that global support for<br />
particular areas can have on the health<br />
system. Generous external donors can<br />
identify HIV and malaria as a problem,<br />
and fund initiatives to address these<br />
at a scale that engulfs other ongoing<br />
health programs. And hence, the<br />
bigger picture can become clouded<br />
with multiple, well funded diseasespecific<br />
programs that are highly<br />
dependent on external support and<br />
management.<br />
The Millennium Development Goals<br />
are a remarkable step forward. But<br />
we do need to be cognisant of their<br />
constraints. What is the problem with<br />
focussing on reducing national death<br />
rates? The most obvious problem is<br />
data. Most developing countries do<br />
not have vital registration systems,<br />
i.e., no population records of births<br />
and deaths. Therefore, indicators,<br />
like child mortality, are calculated<br />
using indirect methods, such as<br />
surveying a representative sample<br />
(much like political opinion polls).<br />
The inaccuracies in these methods are<br />
obvious when we compare mortality<br />
rate estimates from say WHO and<br />
UNICEF, which can be significantly<br />
different depending on the methods<br />
used to derive the estimate.<br />
The more worrying problem is equity.<br />
Within every society, there are the rich<br />
and poor; the privileged and underserved.<br />
But within the under-served,<br />
there is a continuum. A country can<br />
reduce its mortality rates by targeting<br />
a large population of marginally<br />
disadvantaged groups, neglecting<br />
smaller populations of extremely<br />
disadvantaged minority groups. Or<br />
annual<br />
number<br />
of child<br />
deaths<br />
has<br />
dropped<br />
from<br />
<strong>12</strong>.5<br />
million<br />
in 1990 to<br />
8 million<br />
in 2009<br />
There is much to be hopeful about.<br />
For one, the annual number of child<br />
deaths has dropped from <strong>12</strong>.5 million<br />
in 1990 to 8 million in 2009. We are in<br />
an era of increasing global awareness<br />
to the plight of people in every corner<br />
of the globe, and increasing interest<br />
by health professionals in engaging<br />
in global health. The science of just<br />
how to reduce child deaths, support<br />
the development of health systems<br />
and work towards health is gradually<br />
improving. However, it is important to<br />
always emphasise that MDG 4 is the<br />
right step on a long path towards much<br />
more.<br />
1.UN. Summit on the Millennium Development Goals. [Online]. 2010 [accessed 1st<br />
November 2010]. Available from: URL http://www.un.org/millenniumgoals/<br />
2.UNICEF. The State of the World’s Children. New York: United Nations Children’s<br />
Fund; 1984<br />
3.UNICEF. Progress for children: MDG4. [Online]. 2007 [accessed 1st November 2010].<br />
Available from: URL:http://www.unicef.org/progressforchildren/2007n6/index_41799.<br />
html<br />
4.You D, Jones G, Hill K, Wardlaw T, Chopra M. Levels and trends in child mortality,<br />
1990-2009. The Lancet. 2010; 376(9745):931-33<br />
www.ghn.amsa.org.au<br />
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5 MDG<br />
improve maternal health<br />
KEY FACTS<br />
MDG 5 focuses on<br />
maternal health and has<br />
two targets. The first is to<br />
reduce by ¾ between 1990<br />
and 2015 the Maternal<br />
Mortality Ratio (MMR),<br />
defined as the number of<br />
deaths of women who<br />
are pregnant, giving birth,<br />
or up to 42 days postpartum,<br />
per 100,000 live<br />
births 1 . The second is to<br />
achieve universal access to<br />
reproductive health care.<br />
www.ghn.amsa.org.au<br />
20<br />
the Pains of<br />
Labour<br />
samantha<br />
sundercombet<br />
university of sydney<br />
vector FEB <strong>2011</strong>
Progress to date:<br />
MDG5 is the worst performing MDG 2 . Since 1980,<br />
the world MMR has declined 1.3 percent (CI 1.0-1.5)<br />
annually to 251 deaths/100,000 live births in 2008 3 .<br />
Similarly, there has been a 1.5 percent annual decline<br />
in the gross number of deaths, from 526,300 to 342<br />
900 (CI 302 100-394 300) 3 . These figures are smaller<br />
than the 3 percent annual decline necessary to meet<br />
the MDG5 target between 1990 and 2015.<br />
Over half the maternal deaths in 2008 occurred<br />
in just 6 countries: India, Nigeria, Pakistan,<br />
Afghanistan, Ethiopia and the Democratic Republic<br />
of the Congo. Afghanistan has the highest MMR, at<br />
1575/100,000 3 ]. For comparison, Australia’s MMR is<br />
5/100,000 3 .<br />
‘‘<br />
MDG 5 is the<br />
worst performing<br />
millenium<br />
Access to modern contraception is an effective<br />
primary prevention strategy against unsafe abortion,<br />
which causes 8 maternal deaths an hour [9 , and<br />
maternal mortality generally 10 . Modern contraceptive<br />
use has increased in all regions 11] , however remains<br />
so low that 76 million unintended pregnancies occur<br />
each year <strong>12</strong> : 41 percent of pregnancies globally are<br />
unwanted and 22 percent result in induced abortion 13 .<br />
Access to safe, legal abortion has been shown to<br />
reduce abortion mortality 10 .<br />
‘‘<br />
development goal<br />
World Global Monitoring Report 2010<br />
Maternal mortality progress from 1980-2008 3<br />
Reasons for high maternal mortality:<br />
The most common immediate causes of maternal<br />
death are post-partum haemorrhage, sepsis,<br />
hypertensive disorders, unsafe abortion, and<br />
obstructed labour 4 . The majority of deaths occur<br />
around labour, delivery, and 5-48 hours post-partum 5 .<br />
Broader socio-economic factors contributing<br />
to maternal deaths include poverty 6 , which is<br />
improving 2 , disempowerment of women, and HIV 3, 5 .<br />
Solutions:<br />
Ensuring access to skilled attendance at delivery, and<br />
emergency obstetric care for birth complications,<br />
can potentially prevent 250,000 maternal deaths per<br />
year 7 . A strategy where women deliver their children<br />
in a health facility attended by midwives, with other<br />
attendants such as doctors available if complications<br />
arise, is the ‘best bet’ for reducing maternal<br />
mortality 8 .<br />
In India, a scheme where women are given cash<br />
incentives to deliver their babies at health facilities<br />
has increased the number of in-facility births 14 . If<br />
adopted globally, this scheme could reduce maternal<br />
deaths due to poverty.<br />
Women are gradually becoming more empowered.<br />
Girls were attending primary school at the same<br />
rate as boys in almost 2/3 of developing countries by<br />
2005 2 ]. Educated women marry later, have greater<br />
decision-making power in households, and have<br />
fewer, healthier and better-nourished children 15 .<br />
Furthermore, more women than before are able to<br />
earn income through access to small business loans,<br />
known as microfinance.<br />
Maternal mortality progress from 1980-2008 3<br />
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21<br />
www.ghn.amsa.org.au
Results from the UN MDG summit:<br />
At the UN MDG Summit 20-22 September 2010<br />
the Global Strategy for Women’s and Children’s<br />
Health was launched 16 . This document encourages<br />
governments, NGOs, universities, health workers,<br />
philanthropists and business partners to join forces<br />
to integrate and scale-up interventions and services<br />
proven to work. It emphasizes supporting country-led<br />
health plans, delivering packages of integrated care<br />
and building capacity in health workforces.<br />
More investment is needed to meet MDG5 - US<br />
26 billion dollars in <strong>2011</strong>. More than 40 million<br />
dollars was pledged at the summit. If implemented<br />
successfully, the strategy will provide access to<br />
modern contraception for 43 million more women,<br />
and enable 19 million more women to deliver their<br />
children safely, with a skilled birth attendant by 2015.<br />
This will prevent 33 million unwanted pregnancies,<br />
and save 570,000 women who would have otherwise<br />
died of birth or pregnancy complications.<br />
The 6 countries in which half the<br />
maternal deaths in 2008 occurred, with<br />
number of national maternal deaths (in<br />
1000s) 3 68.3%<br />
15.4%<br />
18.2%<br />
20%<br />
36.7%<br />
20.1%<br />
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22<br />
[1.] United Nations General Assembly. United Nations Millennium Declaration. A/RES/55/2. New York: United<br />
Nations, 2000<br />
[2.] World Bank. Global Monitoring Report 2010. The MDGs after the Crisis. Available: http://web.worldbank.org/<br />
WBSITE/EXTERNAL/EXTDEC/EXTGLOBALMONITOR/EXTGLOMONREP2010/0,,contentMDK:22529228~pagePK:64<br />
168445~piPK:64168309~theSitePK:691<strong>12</strong>26,00.html<br />
[3.] Hogan MC, Foreman JK, Naghavi M, Ahn SY, Wang M, Makela SM et al. Maternal mortality for 181 countries, 1980-<br />
2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet. 2010; 375:1609-1623<br />
[4.] Potts M, Hemmerling A. The worldwide burden of postpartum haemorrhage: Policy development where inaction is<br />
lethal. Int J of Gyn and Obst. 2006; 94(2):S116-S<strong>12</strong>1<br />
[5.] Ronsmans C, Graham WJ. Maternal mortality: who when, where and why. Lancet. 2006; 368: 1189-<strong>12</strong>00<br />
[6. World Health Organisation statistical information system. World Health Statistics 2008. Available: http://www.<br />
who.int/whosis/whostat/2008/en/index.html<br />
[7.] Save the Children. Women on the front lines of health care: state of the world’s mothers 2010. 2010 IS BN 1-888393-<br />
22-X<br />
[8.] Campbell OR, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;<br />
368:<strong>12</strong>84-<strong>12</strong>99<br />
vector FEB <strong>2011</strong><br />
[9.] Singh S, Wulf D, Hussaid R, Bankole A, Sedgh G. Abortion worldwide: a decade of uneven progress. New York:<br />
Guttmacher Institute. 2009<br />
[10.] Haddad LB, Nour NM. Unsafe abortion: unnecessary maternal mortality. Rev Obst and Gyn. 2009; 2(2): <strong>12</strong>2-<strong>12</strong>6<br />
[11.] United Nations. The Millennium Development Goals Report 2010. Available: http://www.un.org/millenniumgoals/<br />
pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdf<br />
[<strong>12</strong>.] United Nations Population Fund. State of the World Population on Climate Change, Population, and Women. 2009.<br />
Cited in Save the Children. State of the World’s Mothers Report 2010.<br />
[13.] The Alan Guttmacher Institute. Sharing responsibility women, society and abortion worldwide. New York. 1999.<br />
Cited in Campbell and Graham 2006<br />
[14.] Lim SS, Dandona L, Hoisington JA, James SL, Hogan MC, Gakidou E. India’s Janani Suraksha Yojana, a conditional<br />
cash transfer programme to increase births in health facilities: an impact evaluation. Lancet. 2010; 375:2009-23<br />
[15.] UNESCO. Reaching the Marginalised: EFA Global Monitoring Report. 2010<br />
[16.] UN Secretary General Ban Ki Moon. Global Strategy for Women’s and Children’s Health. 2010. Available: http://<br />
www.who.int/pmnch/topics/maternal/20100914_gswch_en.pdf
aWindowintoGlobalHealth<br />
Goal 3: Empowering women and promoting gender equality<br />
Empowering women means ensuring they<br />
have the same opportunities in education,<br />
employment and politics as do their male<br />
counterparts. It means giving them a voice.<br />
In Bangladesh, the Female Secondary<br />
School Stipend programme has provided<br />
money directly to girls and their families<br />
to cover tuition and other costs, ensuring<br />
many more girls bear the radiant smile of<br />
this lady.<br />
photo by<br />
sophie white<br />
www.ghn.amsa.org.au<br />
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aWindowintoGlobalHealth<br />
www.ghn.amsa.org.au<br />
24<br />
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Goal 6:<br />
Combat HIV/AIDS,<br />
malaria, and other<br />
diseases<br />
The sheer number of<br />
people in this picture is a<br />
powerful reminder of the<br />
difficulties of controlling<br />
communicable diseases.<br />
In India, tuberculosis kills<br />
an estimated 330,000<br />
people per year, but<br />
there is hope! Since 1997,<br />
the Revised National<br />
Tuberculosis Control<br />
Programme has provided<br />
treatment to more than<br />
11 million patients and<br />
saved more than two<br />
million lives.<br />
photo by<br />
tim whittick &<br />
penny brussen<br />
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2<br />
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26<br />
6 MDG<br />
Up to 2 million people die from AIDS related<br />
illnesses every year, many of whom are in<br />
southern Africa (38%). Increased access to<br />
antiretroviral drugs in poorer countries means this is<br />
decreasing; however over 5,000 people still die each<br />
day from AIDS. Running a close second in global<br />
mortality is tuberculosis, responsible for 1.8 million<br />
deaths in 2008, about 500,000 of whom were HIVpositive.<br />
90 per cent of malaria deaths also occur<br />
in Africa, where it accounts for a fifth of childhood<br />
mortality (equivalent to the death of one child in the<br />
world every 45 seconds) 1-3 . [ ]<br />
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combat HIV/AIDS, malaria and other diseases<br />
Challenges to achieving the targets<br />
1<br />
Education and knowledge of HIV is unacceptably low<br />
Knowledge about HIV and its modes of transmission<br />
is the first step to preventing its spread. However,<br />
less than a third of young men and one fifth of<br />
young women in developing countries have received<br />
education about the illness. Condom use also remains<br />
low globally, especially among developing countries.<br />
With many young people in Africa unaware of the<br />
risks and modes of transmission for HIV, the UN’s<br />
goal on comprehensive HIV knowledge of 95 per cent<br />
of people in developing countries is still far from<br />
being achieved 1,2,4 . []<br />
Antiretroviral treatment has expanded but HIV<br />
prevalence rates continue to rise<br />
When antiretroviral therapy was launched in 2003,<br />
only 400,000 people were able to access it. By the<br />
end of 2009, more than five million people were<br />
receiving treatment. However, for every two people<br />
starting HIV treatment each year, five new people<br />
are infected. Access to antiretroviral therapy needs<br />
to be expanded for pregnant women, as most of<br />
the 2 million children younger than 15 living with<br />
HIV were infected by vertical transmission (in the<br />
womb, at birth or via breastfeeding). In 2008 alone,<br />
over 60,000 HIV infections among at-risk babies<br />
were prevented because their HIV-positive mothers<br />
received treatment. However, less than 50 per cent<br />
of HIV-positive expectant mothers currently receive<br />
treatment 1,2,5,6 . []<br />
3<br />
HIV/AIDS is becoming a chronic disease in many<br />
countries<br />
The survival rate of HIV/AIDS is growing in many<br />
countries due to the increasing availability of<br />
antiretroviral drugs in the developing world. As<br />
a result, HIV/AIDS is being transformed into a<br />
chronic disease, with a model of care that also needs<br />
to transform to focus on multidisciplinary models,<br />
continuity of care, long-term adherence support, and<br />
social support 1,4,7 . []<br />
4<br />
HIV/AIDS may not just affect poorer populations<br />
Contrary to evidence for other infectious diseases,<br />
HIV may be more prevalent amongst higher-income<br />
demographic populations than previously thought.<br />
In a large study looking at eight African countries,<br />
wealthier men and women had a higher prevalence<br />
of HIV than poorer ones and were at least as likely<br />
as poorer adults to be infected. If this is in fact a<br />
common pattern, a broader approach needs to be<br />
taken in the prevention of HIV/AIDS in developing<br />
countries 8 . []<br />
What is being done worldwide?<br />
The UN is coordinating global efforts to achieve<br />
these targets in reducing communicable and largely<br />
preventable deaths. Several UN programs aim<br />
to prevent these diseases and enhance access of<br />
treatments according to the following strategies:<br />
•Increase technical support for HIV/AIDS<br />
• The Joint United Nations Programme on HIV/<br />
AIDS (UNAIDS) coordinates the resources of ten<br />
organisations assisting developing countries with<br />
technical support in the implementation of their<br />
national AIDS plans [1 .]<br />
•Prevent mother-to-child transmission of HIV/AIDS<br />
• The UN Children’s Fund (UNICEF), the World<br />
Health Organisation (WHO), the UN Population<br />
Fund (UNFPA) and UNAIDS have assisted countries<br />
to develop and implement programmes aimed at<br />
preventing vertical transmission of HIV, including<br />
training, funding and technical expertise [1,2 .]
SNAPSHOT<br />
33 million people are<br />
currently living with HIV<br />
worldwide. Two thirds of<br />
these are in Africa (mostly<br />
women) and this number<br />
continues to grow, despite a<br />
decrease in new infections<br />
(as those infected with HIV<br />
are now surviving longer).<br />
There are also 11 million<br />
people currently suffering<br />
from tuberculosis, and a<br />
staggering 240 million cases<br />
of reported malaria in 2008 1,2 .<br />
nets<br />
condoms &<br />
drugs<br />
minh nguyen<br />
flinders university<br />
Widespread HIV/AIDS prevention and care programs<br />
• The UN Development Programme (UNDP) has<br />
engaged over three million people in prevention<br />
activities over the last five years. In Burkina Faso,<br />
an African country in West Africa, this programme<br />
provided regular support to nearly 36,000 people<br />
living with HIV, including home visits, meals and<br />
assistance to set up small-scale enterprises 1,2,5-7 . [<br />
Increasing access of mosquito nets to prevent malaria<br />
• Global production of mosquito nets has increased<br />
500% since 2004 to 150 million nets in 2009. Nearly<br />
200 million nets were delivered to African countries<br />
between 2007 and 2009. However, nearly 350 million<br />
are needed to achieve universal coverage and this<br />
effort needs to be intensified 1,2,9 .]<br />
•<br />
The first scoping study, on HIV prevention initiatives<br />
targeting men who have sex with men in Asia and<br />
the Pacific (with a focus on Vietnam Cambodia Burma<br />
Philippines and PNG), was completed in 2009. A<br />
second study on greater involvement of people living<br />
with HIV was completed in November 2009 and the<br />
final study on HIV legal and policy frameworks was<br />
completed in March 2010. Initial responses to the<br />
recommendations include 3 million dollars of funding<br />
over three years (2009-<strong>12</strong>) to support programs for<br />
men who have sex with men in Indonesia, PNG<br />
and Burma, and 1.5 million dollars over three years<br />
(2009-<strong>12</strong>) to PNG and the Solomon Islands for legal<br />
and policy development activities. Further work on<br />
incorporating recommendations from these studies<br />
into longer-term HIV programming is underway 10 .]<br />
Australia’s role in achieving MDG 6<br />
The Australian Government has a focussed strategy<br />
aimed at helping partner countries address MDG6.<br />
The main focus for Australia’s support to the global<br />
HIV/AIDS effort is based in the Asia Pacific region.<br />
In Africa, Australian support is channelled through<br />
the Global Fund and UNAIDS. Currently,<br />
AusAID, Australia’s aid program, has focussed its<br />
global research efforts into three areas:<br />
• HIV prevention for men who have sex with Men;<br />
• greater involvement of people living with HIV;<br />
• and legal and policy enabling environments for<br />
effective HIV responses.<br />
1.United Nations. 2010. The millennium development goals report 2010. New York: United Nations.<br />
2.UN Development Programme (UNDP). 2010. What Will It Take to Achieve the Millennium Development Goals? An<br />
International Assessment 2010. New York: United Nations.<br />
3.WHO. 2009. Global Tuberculosis Control: A Short Update to the 2009 Report. Available from http://whqlibdoc.who.<br />
int/publications/2009/9789241598866_eng.pdf (accessed 13 November 2010).<br />
4.Center for Global Development. 2004. Millions Saved: Proven Successes in Global Health. CGD Brief. October 2004,<br />
3:3.<br />
5.MARCO. 2009. Five-Year Evaluation of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, Synthesis of Study<br />
Areas 1, 2 and 3, Marco International Incorporation.<br />
6.Nunn, A. S., da Fonseca, E. M., Bastos, F. I. and S. Gruskin. 2009. AIDS Treatment in Brazil: Impacts and Challenges.<br />
Health Affairs, vol. 28, no. 4, pp. 1103-1113.<br />
7.Janssens, B., et al. 2007. Offering integrated care for HIV/AIDS, diabetes, and hypertension within chronic disease<br />
clinics in Cambodia. Bull WHO, Vol. 85, pp. 880-885.<br />
8.Mishra, V. et al. 2007. A study of the association of HIV infection with wealth in sub-Saharan Africa. DHS Working<br />
Papers.<br />
9.WHO. 2007. WHO Releases New Guidance on Insecticide-treated Mosquito Nets: Recent Data from Kenya “Ends the<br />
Debate” About How to Deliver the Nets. Available from http://www.who.int/mediacentre/news/releases/2007/pr43/<br />
en/index.html (accessed 20 November 2010)<br />
10.AUSAID [homepage]. 2010. HIV/AIDS: Australia's response. Available from http://www.ausaid.gov.au/keyaid/<br />
hivaids/default.cfm (accessed 22 November 2010)<br />
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28<br />
7 MDG<br />
Millennium development goal (MDG) seven<br />
is to ensure environmental sustainability 1 .<br />
To help us understand how this is defined,<br />
the goal is broken down into several ‘targets’.<br />
The targets pertain to things like optimising the<br />
percentage of land area covered by forest, protecting<br />
biodiversity, improving the efficiency of energy use,<br />
reducing per capita CO 2<br />
emissions and consumption<br />
of ozone depleting chlorofluorocarbons, improving<br />
population access to clean water and sanitation,<br />
and access to adequate housing for the most<br />
impoverished. The achievement of these targets<br />
would not only improve the health of our ecosystem<br />
but also directly improve human health and assist<br />
ensure environmental sustainability<br />
in the mitigation of climate change. We can assist<br />
in making MDG reality by applying these global<br />
targets to the local communities in which we<br />
participate. Perhaps most appropriately, as future<br />
health professionals, we should consider the ways in<br />
which we can assist the health sector to acknowledge<br />
the ecological footprint of its business, and duly take<br />
steps to rectify this blight.<br />
‘‘<br />
‘‘<br />
scientific consensus that, as a consequence of human<br />
vector FEB <strong>2011</strong><br />
our nation has made<br />
minimal progress in<br />
lifting its ecological<br />
game<br />
In the ten years since then Australian-PM John<br />
Howard was signatory to the United Nations<br />
Millennium Declaration in the year 2000, our<br />
nation has made minimal progress in lifting its<br />
ecological game. This is despite knowing that there is<br />
activities, the earth’s climate is warming. During the<br />
twentieth century Australia’s average surface air<br />
temperature has increased by 0.7 0 C and rainfall has<br />
substantially reduced 2 . The rise has been attributed<br />
to our reliance on the combustion of fossil fuels for<br />
energy generation and transport and the concomitant<br />
rise in atmospheric concentrations of carbon dioxide<br />
and other greenhouse gases 3 . Disheartingly, we are<br />
locked in to a further warming of at least 0.2-1.0 0 C<br />
by the year 2100 2 , however much larger rises are<br />
likely to be in store if we are unable to dramatically<br />
reduce greenhouse gas emissions in the next decade 2 .<br />
In addition to this, extreme weather events such as<br />
tropical cyclones, heat waves, and floods will become<br />
more frequent. In this way climate change will have<br />
detrimental impacts on the environment, economy,<br />
and public health.<br />
Rich countries such as Australia are better placed<br />
than many other nations to be able to fund climate<br />
mitigation and adaptation strategies. Mitigation is<br />
essentially primary prevention to contain a rise in<br />
surface air temperature through cuts to greenhouse<br />
gas emissions, whilst adaptation is a form of<br />
secondary prevention to allow us to live with the<br />
inevitable changes in weather patterns; tertiary<br />
prevention is tantamount to disaster response to the<br />
predicted increase in extreme climate events. As in<br />
medicine primary prevention, although unpopular, is<br />
a much more cost-effective approach than having to<br />
deal with a series of emergencies.<br />
It is in this context that the Australian healthcare<br />
system is gradually adopting a triple-bottom line<br />
approach to evaluation, thereby moving away from an<br />
arcane system that treated environmental impacts as<br />
an ‘externality’ with little mandate or incentive for<br />
hospitals, universities and other large institutions<br />
to reduce their carbon footprint . By targeting waste,<br />
staff and patient transport and utility (water, energy)<br />
consumption some such facilities are starting to<br />
make moves. Actions are starting to pop up - ride<br />
to work days, waste reduction programs - all<br />
contributing to the broader tapestry of sustainabilitypromotion.<br />
With the knowledge that there is no health, or<br />
economy, without the environment many current and<br />
future health professionals such as ourselves realise<br />
that to concern for population health necessitates<br />
taking action to ensure environmental sustainability.<br />
Thus to take care of the the environment is not<br />
merely a case of “doing the right thing, it is also an<br />
opportunity to make cost savings, experience health<br />
co-benefits and mitigate some effects of climate<br />
change.
PLAY A<br />
PART AND<br />
MAKE A<br />
DIFFERENCE<br />
Understand the threats<br />
by educating yourself and<br />
your colleagues 1about the<br />
links between ill health,<br />
environmental degradation, and<br />
climate change and mitigation<br />
strategies such as promotion of<br />
active transport and increasing<br />
teleconferencing to reduce<br />
unnecessary car and plane<br />
travel.<br />
Campaign for the<br />
integration<br />
4<br />
of<br />
education on climate<br />
change into the<br />
medical curriculum<br />
at your university.<br />
Help to build networks of like-minded<br />
people within your university, hospital<br />
or community by joining the your local<br />
green group, student 2division of Doctors<br />
for the Environment Australia (www.dea.<br />
org.au) and/or the climate code green<br />
project for Australian medical students<br />
(www.codegreensite.com). Consider<br />
participating in the national gathering for<br />
medical students on climate change and<br />
other environmental health issues called<br />
‘iDEA’ which will be held in Sydney over<br />
the weekend of April 29-May1, <strong>2011</strong>.<br />
Environ<br />
GOING<br />
liz o’brein<br />
university of<br />
notre dame<br />
west australian<br />
student member<br />
for doctors for<br />
the environment<br />
australia (DEA)<br />
Advocate local and national<br />
policies to improve health both<br />
now and for 3future generations.<br />
Educate those in positions of power<br />
(e.g. local politicians, hospital<br />
administrators, academics) about<br />
the health risks of climate change<br />
through meetings, articles in<br />
public forums such as your medical<br />
school paper and suggest ways<br />
they can incentivise sustainable<br />
practice.<br />
1. United Nations. 2007. Millennium development goal seven: ensure environmental sustainability. United Nations<br />
Development programme. Accessed online October 18, 2010 at http://www.un.org/millenniumgoals/environ.shtml<br />
2. Preston BL, Jones RN. 2006. Climate Change Impacts on Australia and the Benefits of Early Action to Reduce Global<br />
Greenhouse Gas Emissions. A consultancy report for the Australian Business Roundtable on Climate Change. CSIRO.<br />
Canberra, Australian Capital Territory. Accessed online on October 18, 2010 at http://www.csiro.au/resources/pfbg.<br />
html<br />
3. Intergovernmental Panel on Climate Change. Climate change 2007: the physical science basis—summary for policy<br />
makers. Accessed online October 18, 2010 at: http://www.ipcc.ch/publications_and_data/ar4/wg1/en/contents.html<br />
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MDG<br />
develop a global partnership for development<br />
w h y<br />
can’t<br />
WE<br />
just<br />
All<br />
get<br />
What’s it all about? What’s it supposed<br />
to do? And can’t we all just get along!?<br />
Perhaps the most varied, and least<br />
understood of the UN MDGs, this<br />
MDG is designed to tie the other seven<br />
together, by taking steps towards<br />
strengthening trade, political and<br />
health systems.<br />
?<br />
along<br />
www.ghn.amsa.org.au<br />
30<br />
nick watts<br />
university<br />
of western<br />
austraila<br />
vector FEB <strong>2011</strong>
key goals<br />
1. Raise the commitment of Official<br />
Development Assistance (ODA) to 0.7% of<br />
the Gross National Income (GNI) of donor<br />
countries.<br />
2. Develop an equitable finance system, by<br />
allowing the Least Developed Countries<br />
(LDC) access to markets of developed<br />
countries, and through tariff reductions<br />
benefiting these countries.<br />
3. Ensure that in an increasingly globalised<br />
world, we address the needs of the LDCs<br />
and Small Island Developing States (SIDS)<br />
4. Manage the heavy debts of low income<br />
countries (think Live-Aid… kind of).<br />
5. Provide access to essential medicines, life<br />
saving drugs through a variety of patent and<br />
trade-related mechanisms.<br />
6. Set in place structures which allow<br />
the spread of new Information and<br />
Communication Technologies (ICTs) –<br />
internet & mobile phones – to the global<br />
South.<br />
Ten years in, where do we stand? Well, only 1<br />
billion of the world’s 6.88 billion have access<br />
to the internet, debt levels (whilst still high)<br />
are falling rapidly, and ODA stands at roughly 0.34%<br />
of GNI of developed countries, a little under half way<br />
towards the 0.7% we’re aiming for.<br />
Australia (one of the lucky few who has kept a budget<br />
surplus throughout the recession) has recently<br />
committed to increase our ODA to 0.5% of our GNI by<br />
2015, falling significantly short of our 1970 promise<br />
(renewed in 2002 Monterrey Consensus). Meanwhile,<br />
the UK - a country which is literally hemorrhaging<br />
from the results of the global financial crisis - is well<br />
on track to achieve their commitments.<br />
Achieving these targets will require partnership…<br />
in fact… it requires “global partnerships for<br />
development. We’ll need all countries (of high and<br />
low incomes) to work with behemoths such as the<br />
Bretton Woods trio (the International Monetary<br />
Fund, the World Bank and the World Trade<br />
Organisation), three bodies charged with managing<br />
the trade and finances of the world. We’ll need<br />
unprecedented Public Private Partnerships (PPP)<br />
between governments and privatised pharmaceutical<br />
companies and ICT companies to ensure global<br />
access to essential communication technologies<br />
and medicines. We’ll need donor countries to work<br />
together to coordinate their aid, ensuring that<br />
evidence based assistance is delivered to the parts<br />
of the world where it is needed most. We’ll need<br />
non-governmental and organisations (NGO) such as<br />
Médecins Sans Frontiéres (MSF) and Oxfam to assist<br />
with aid coordination and distribution. But most of<br />
all, we’ll need a partnership between civil society,<br />
a roar from the public, telling the governments of<br />
the world that there is support for action on poverty,<br />
‘allowing’ them to act.<br />
Each and every partnership takes us one step closer<br />
not only to achieving MDG 8, but to the eradication of<br />
extreme poverty. After all:<br />
“It is not in the United Nations that the Millennium<br />
Development Goals will be achieved. They have to be<br />
achieved in each of its Member States, by the joint<br />
efforts of their governments and people”<br />
- Kofi Annan, Former UN Secretary General<br />
1. United Nations Development Programme. MDG Monitor. Geneva2010 [26 Oct 2010]; Available from: http://www.<br />
mdgmonitor.org/.<br />
2. Australian Agency for International Development (AusAID). Australian Partners. Canberra2010 [26 Oct 2010];<br />
Available from: http://www.ausaid.gov.au/.<br />
3. UK Department for International Development (UKDFID). Governance and Social Development Resource Centre.<br />
London2010 [26 Oct 2010]; Available from: http://www.dfid.gov.uk.<br />
4. UN MDG. Millennium Development Goals - 2015. New York2010 [26 Oct 2010]; Available from: http://www.un.org/<br />
millenniumgoals/global.shtml.<br />
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31
Introduction<br />
The world’s first major conference on the global<br />
environment was held in Stockholm, in 1972.<br />
At that time few doctors seemed aware or<br />
concerned about the global environmental dimension<br />
to inequality 1 , though the medical profession had<br />
by then a long history of working to promote health<br />
in low income settings [2 , exemplified by Albert<br />
Schweitzer, who divided his time between Europe<br />
and the hospital he had established in French<br />
Equatorial Africa.<br />
In 2009, as the world anticipated the biggest<br />
climate change summit since Kyoto in 1997, the<br />
issue of climate change appeared to almost head<br />
the international agenda. The health literature also<br />
published many papers on this issue [3-5] . Yet, since<br />
then, developed nations including France, the U.S.<br />
and Australia have retreated from the rhetoric which<br />
briefly raised hopes of leadership from the rich<br />
world. This is not because of any weakening in the<br />
evidence or scientific consensus, but a possibly fatal<br />
weakening in the political support. The current year<br />
has been the hottest on record, and the drought in<br />
Russia and the Ukraine (during July to August 2010)<br />
has triggered the sharpest rise in grain prices seen in<br />
30 years [6 . Speculation is undoubtedly a major cause<br />
of this rise, but the market is likely sensing and<br />
reflecting increasing global concern and volatility.<br />
This heat wave is consistent with climate change.<br />
Health effects of<br />
climate change:<br />
primary, secondary<br />
and tertiary<br />
The list of health conditions associated with climate<br />
change can seem bewildering; from the fairly obvious<br />
to the obscure, such as gastroenteritis caused by<br />
Vibrio Parahaemolyticus [7] . One way to categorise<br />
these diverse manifestations is by grouping the most<br />
obvious effects as ‘primary’ and less obvious effects<br />
as ‘secondary’. Primary effects include heat waves,<br />
heat stress, and the physical impacts from extreme<br />
weather effects such as storms and fires. The latter<br />
group includes ecologically mediated vector borne<br />
diseases, such as malaria, and other communicable<br />
diseases whose epidemiology will be altered by<br />
climatic and associated ecological variation, from<br />
plague [8] to hantaviruses 9] .Many more details of these<br />
effects are available elsewhere [10] .<br />
There is one more level of effect that must be<br />
considered, here called ‘tertiary’ 10, 11 .Ultimately,<br />
these effects should cause the greatest anxiety, to<br />
society and therefore to health. Yet, among the vast<br />
literature concerning climate change very little<br />
discusses the likely impact upon global health from<br />
the bleak social and physical conditions to which<br />
much of the world appears to now be heading. It<br />
perhaps takes courage rather than imagination to<br />
contemplate a nuclear-armed world in which sea<br />
level has risen by a metre, and where the grain yield<br />
in South Asia has declined by 18 to 22% <strong>12</strong> , ven though<br />
global health,<br />
www.ghn.amsa.org.au<br />
32<br />
sustainability and<br />
doctors<br />
vector FEB <strong>2011</strong><br />
colin david butler<br />
national centre for epidemiology<br />
and population health,<br />
australian national university
several hundred million additional South Asians<br />
are then predicted to be alive. Yet such conditions,<br />
interwoven with many other difficulties, are likely to<br />
occur within 70 years.<br />
THE FUTURE<br />
Beyond the health literature, frank discussion of the<br />
likely conditions in which humanity will live in 2100<br />
is also rare, and where it exists, it is generally biased<br />
towards the optimistic [13 . Official socio-economic<br />
forecasts and scenarios are excessively hopeful,<br />
perhaps because humans cannot bear too much pain,<br />
or perhaps because authorities are concerned that<br />
bleak forecasts will become self-fulfilling. However,<br />
in addition, a good deal of woolly thinking, ‘group<br />
think’ and frank denial is occurring, evidenced, for<br />
example, by the way the global financial crisis caught<br />
governments and their elite economic advisers by<br />
surprise. This disconnect between prediction and<br />
reality likely extends to the size of oil supplies [14 and<br />
to other critical limits to growth [15 .<br />
Irrespective of the reasons for this optimism [13 the<br />
health consequences of future global climate change<br />
are likely to be severely underestimated, without<br />
consideration of tertiary effects. Such effects are<br />
likely to exceed the other impacts, even if combined,<br />
perhaps by one or even two orders of magnitude.<br />
Apprehension of these tertiary effects, though poorly<br />
articulated, appears to be a rational explanation<br />
not only for many concerns expressed by youth<br />
about the future 16 , but also for the level of concern<br />
about climate change in both the health and wider<br />
literature.<br />
Linking the global<br />
climate and global<br />
health inequality<br />
crises<br />
That humanity appears to be nearing an abyss<br />
might surprise some readers. However, another<br />
immense problem has co-existed with our increasing<br />
prosperity, since at least World War II 17 . This is<br />
the problem of apparently intractable Third World<br />
poverty, and of the resultant health gap between<br />
privileged and poor populations. In fact, the parallel<br />
problems of global health inequality and of our<br />
trajectory towards dangerous climate change can<br />
each be considered as manifestations of an intelligent<br />
species, a clothes-wearing primate, who is not quite<br />
as smart as s/he thinks. History is replete with<br />
civilisations that have collapsed 18, 19 . Even before<br />
humans had developed cities violent conflict among<br />
humans has been documented, from the end of the<br />
Pleistocene 20 .<br />
Although there it is legitimate to be troubled by the<br />
future, hope should not be lost. Humanity has faced<br />
great stress before. Seventy years ago the Allies<br />
fought a bitter war against the Japanese and Nazi<br />
Germany. A quarter century after that, many fears<br />
were expressed concerning impending famine in<br />
the 1970s 21 . [ In both the early 1960s and again in the<br />
1980s, great fear was held about a nuclear war. So<br />
far, we have escaped these fates. If humanity is to<br />
traverse this future it will do so in part because of<br />
the contribution of doctors, together with many other<br />
actors and new ways of social organisation 22 .<br />
1. Boyden S. The environment and human health. The Medical Journal of Australia. 1972;116:<strong>12</strong>29-34.<br />
2. King M, editor. Medical Care in Developing Countries. A Primer on the Medicine of Poverty and a Symposium from<br />
Makerere. Nairobi: Oxford University Press; 1966.<br />
3. McMichael AJ, Neira M, Heymann DL. World Health Assembly 2008: climate change and health. The Lancet.<br />
2008;371:1895-6.<br />
4. Lim V, Stubbs JW, Nahar N, Amarasena N, Chaudry ZU, Weng SCK, et al. Politicians must heed health effects of<br />
climate change. The Lancet. 2009;374:973.<br />
5. Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, et al. Managing the health effects of climate change. The<br />
Lancet. 2009;373:1693–733.<br />
6. Williams S. Parched Russia warns on harvest, wheat prices surge. Sydney Morning Herald. 2010.<br />
7. McLaughlin JB, DePaola A, Bopp CA, Martinek KA, Napolilli NP, Allison CG, et al. Outbreak of Vibrio<br />
parahaemolyticus Gastroenteritis Associated with Alaskan Oysters. New England Journal of Medicine. 2005;353:1463-9.<br />
8. Stenseth NC, Stenseth NC, Samia NI, Viljugrein H, Kausrud KL, Begon M, et al. Plague dynamics are driven by<br />
climate variation. Proceedings of the National Academy of Science (USA). 2006;103:13110-5.<br />
9. Klempa B. Hantaviruses and climate change. Clinical Microbiology and Infection. 2009;15(6):518-23.<br />
10. Butler CD, Harley D. Primary, secondary and tertiary effects of the eco-climate crisis: the medical response. Post<br />
Graduate Medical Journal. 2010;86:230-4.<br />
11. Butler CD, Corvalán CF, Koren HS. Human health, well-being and global ecological scenarios. Ecosystems.<br />
2005;8(2):153-62.<br />
<strong>12</strong>. Tubiello FN, Fischer G. Reducing climate change impacts on agriculture: Global and regional effects of mitigation,<br />
2000–2080. Technological Forecasting & Social Change. 2007;74:1030–56.<br />
13. Butler CD. Peering into the fog: ecologic change, human affairs and the future (commentary). EcoHealth. 2005;2:17-<br />
21.<br />
14. Kerr R. Splitting the Difference Between Oil Pessimists and Optimists. Science. 2009;326:1048.<br />
15. Hall CAS, John W. Day J. Revisiting the limits to growth after peak oil. American Scientist. 2009;97:230-7.<br />
16. Eckersley R. What's wrong with the official future? In: Hassan G, editor. After Blair: Politics After the New Labour<br />
Decade. London: Wishart; 2006. p. 172-84.<br />
17. Butler CD. Inequality, global change and the sustainability of civilisation. Global Change and Human Health.<br />
2000;1(2):156-72.<br />
18. Diamond J. Collapse: How Societies Choose to Fail or Succeed. London: Allen Lane; 2005.<br />
19. Tainter JA. The Collapse of Complex Societies. Cambridge: Cambridge University Press; 1988.<br />
20. Bowles S. Did Warfare Among Ancestral Hunter-Gatherers Affect the Evolution of Human Social Behaviors?<br />
Science. 2009;324:<strong>12</strong>93-8.<br />
21. Ehrlich PR. The Population Bomb. London: Ballantyne; 1968.<br />
22. Walker B, Barrett S, Polasky S, Galaz V, Folke C, Engström G, et al. Looming global-scale failures and missing<br />
institutions. Science. 2009;325:1345-6.<br />
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Student Electives<br />
a world of experience<br />
whitney<br />
d o w n e s<br />
monash university<br />
welcome to<br />
www.ghn.amsa.org.au<br />
SAMOA<br />
34<br />
vector FEB <strong>2011</strong>
I<br />
recently undertook my medical elective at Tupua<br />
Tamasese Meole Hospital in Apia, Samoa, in the<br />
Obstetrics and Gynaecology Department. I was<br />
involved in providing ante- and post-natal care, as<br />
well as assisting in deliveries.<br />
My first day on the labour ward, I was confronted<br />
by a thoroughfare occupied by at least 15<br />
pregnant bellies, each attached to a woman either<br />
uncomfortably waddling up and down the corridor<br />
or leaning against a vacant doorway, labour pains<br />
acknowledged only through the cessation of<br />
movement. I entered a delivery room (a 4 x 2m space<br />
with room for a bed and a bench for equipment) to<br />
find a woman lying prone with legs apart in the timehonoured<br />
position of birthing, husband pushing the<br />
crown of her head as if he could somehow increase<br />
the force of his wife’s straining uterus, midwife<br />
shouting encouragement in the usually dulcet tones<br />
of the Samoan language, and two Austrian doctors<br />
watching the perineum in anticipation, chatting in<br />
German as the baby calmly crowned. In minutes, a<br />
boy was delivered (their 5th, the husband informed<br />
us), syntocinon administered and 3rd stage of labour<br />
apparently in progress. Fundal massage to assist<br />
placental delivery raised an interesting question, was<br />
there perhaps a second baby, explaining the prolonged<br />
3rd stage?<br />
Calm turned to chaos as I was ordered to get the<br />
consultant, the parents worryingly understanding the<br />
frantic tones but not the English or the German, as<br />
the midwife performed a completely unsterile vaginal<br />
examination in order to determine presentation of<br />
the latest surprise. The consultant calmly entered<br />
the room, delivered the second baby breech, and<br />
left after satisfying himself that both babies would<br />
survive, with just a cursory nod to the bewildered<br />
parents. The Austrian doctors turned to me and said,<br />
‘Welcome to Samoa!’<br />
My experience of Samoa continued in a similar<br />
fashion. Questions posed on ward rounds highlighted<br />
the dichotomy of ideal management versus that in<br />
developing countries, ‘How would you manage this<br />
condition, but how can we best manage it here?’<br />
Antenatal clinics were conducted in an old ward<br />
room, curtains dividing the ‘cubicles’ and providing<br />
the illusion of privacy. The corridors are full of<br />
women waiting to see either midwives or doctors,<br />
most heavily pregnant but often on their first visit,<br />
with only unsure dates or late obstetrics scans to<br />
provide a rough estimate of due dates. Five doctors<br />
attempt to sift through the patients, assessing fundal<br />
height and blood pressure with one tape measure and<br />
one sphygmomanometer shared between them. The<br />
pitter-patter of foetal hearts is barely heard amongst<br />
the electronic whine of a Doppler probe struggling to<br />
operate on failing batteries. Any procedures are done<br />
with the supposed protection of XL gloves, which<br />
are probably a greater risk than help. Women in<br />
labour rooms who have been pushing past the limit<br />
of normal labour wait anxiously for one of the two<br />
cardiotocograph machines to be available for foetal<br />
monitoring. In these labour rooms, meconium liquor<br />
is often the first and only sign of foetal distress.<br />
However, despite the apparent lack of equipment, the<br />
hospital has surprisingly few maternal or neonatal<br />
deaths. The staff, used to not having equipment<br />
available, work incredibly well within the imposed<br />
limits, and the women accept the basic conditions<br />
in which they are required to labour. Delivery is<br />
perhaps returned to its natural state, with the<br />
parents not focused on ‘pethidine versus nitrous<br />
oxide’, ‘Coldplay versus Mozart’, but on having a<br />
healthy child. Having said this, I definitely missed<br />
the comfort of a reassuring CTG or maternal blood<br />
pressure, and learnt the hard way when I delivered<br />
a floppy baby and was chastised by the doctors for<br />
letting the delivery carry on too long, that if I was<br />
in the room with a midwife, I was assumed to be in<br />
control.<br />
My experience of Samoa was a welcome insight<br />
into the world of medicine in developing countries,<br />
of a beautifully strong culture and of people who<br />
are rich in ways we in the ‘developed’ world do not<br />
place enough value on. I look forward to my return,<br />
perhaps in a more senior medical role.<br />
www.ghn.amsa.org.au<br />
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www.ghn.amsa.org.au<br />
global health conference 2010 report<br />
36<br />
vector FEB <strong>2011</strong>
alexandra<br />
f r a i n<br />
& l u k e<br />
hamilton<br />
co-convenors<br />
global health<br />
conference<br />
executives<br />
The enthusiasm and inspiration of over 430<br />
medical students from Australia and the<br />
Asia-Pacific region intersected in Hobart from<br />
July 1 to 4th, for the 6th Annual Australian Medical<br />
Students’ Association Global Health Conference.<br />
The theme was ‘Small Steps, Big Picture’, with a<br />
focus on empowering students with knowledge about<br />
issues that impact on health around the world, whilst<br />
equipping them with practical skills to get involved<br />
in advocacy and activism at a grassroots level.<br />
Delegates were addressed by Dr Helen Caldicott<br />
on the medical implications of nuclear power, by<br />
Reverend Tim Costello on child and maternal health,<br />
and by Professors Tony McMichael and Colin Butler<br />
on Climate Change and Health, just to name a few.<br />
The stream program provided delegates with an<br />
overview on issues such as water quality and access,<br />
refugee health, sexual health, Indigenous health and<br />
resource allocation. With over 66 speakers and tutors,<br />
it is impossible to convey the amount of information<br />
that was packed in to four days at the University of<br />
Tasmania, and even more impossible to describe the<br />
intangible benefits of having 430 motivated students<br />
in one place, with one growing global conscience.<br />
As well as being addressed by some of the most well<br />
respected figures in global health in Australia, some<br />
of the most profound learning came from our peers.<br />
Ten students from developing nations joined us<br />
through the AusAID International Seminar Support<br />
Scheme, and we were enlightened by what they could<br />
share about health in their countries. Workshops<br />
were also run by students, for students, through the<br />
AMSA Training New Trainers and Think Global<br />
initiatives. These programs allowed delegates to<br />
develop skills in leadership, advocacy and project<br />
management.<br />
The conference was also very lucky, with the support<br />
of the University of Tasmania, SecondBite, Scolorest<br />
and the Salvation Army, to be able to contribute to<br />
the local community through a food rescue after<br />
lunch each day. Delegates were so inspired by this<br />
that many of them returned breakfast foods for<br />
distribution after the conference as well.<br />
We certainly learned that the issues facing the health<br />
of the world are undoubtedly huge, and require action<br />
of a similar magnitude. We were powerfully urged<br />
by Nick Bearlin-Allardice in the closing address of<br />
the AMSA GHC to remember that it is not enough to<br />
simply attend a conference. There is so much work<br />
to be done in the realm of global health, as evidenced<br />
by the array of topics covered over the four days of<br />
the conference. If you are interested in putting the<br />
passion and excitement generated at the AMSA GHC<br />
to good use, please consider joining the Global Health<br />
Group at your university, or joining an advocacy group<br />
like World Vision, Oaktree, RESULTS, the Global<br />
Poverty Project or the Doctors for the Environment<br />
Australia. We hope that the AMSA Global Health<br />
Conference will be the springboard for many people,<br />
including you, into making a real, tangible difference<br />
in global health.<br />
www.ghn.amsa.org.au<br />
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