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Archive for the ‘Global Health’ Category

Tobacco control letter sent to Pakistan Prime Minister Shahid Khaqan Abbasi

Posted in Global Health, pakistan, smoking, Tobacco on March 23, 2018| Leave a Comment »

 

 

 

Tobacco control letter PM Abbasi 1

Tobacco control letter PM Abbasi 3+

Tobacco control letter Chief justice 3

Tobacco control letter PM Abbasi 4

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Human trafficking – what should our public health response be?

Posted in Asia, Children and young people, Global Health, HIV, human trafficking, India, poverty, prostitution, slavery, women on October 3, 2017| Leave a Comment »

By Dr Tina Maddison, CCDC PHE West Midlands Team

Human trafficking is the acquisition of people by improper means such as force, fraud or deception, with the aim of exploiting them (1). Sexual exploitation is by far the most commonly identified form of human trafficking (2), with women and girls disproportionately affected (3). This is a problem that is not diminishing.

Indian brothel

Inside an Indian brothel

My husband and I are currently volunteering in South East Asia for an NGO that rescues and rehabilitates children from human trafficking and sexual exploitation. My husband has recently returned from India where he witnessed first-hand the prolific nature of this trade. Many of the women and children are subjected to sexual exploitation either by the families into which they are sold or in the public brothels that line the backstreets of countless cities.

 

In New Delhi, home to a myriad of brothels and massage parlours, children as young as 12 are sold to men up to 40 times a day. This abuse is beyond comprehension. The damage to the individual, both physically and emotionally, is catastrophic. Babies born to these girls are also used for the gratification of perverted minds.

Abha was just 12 when she was trafficked into a brothel in Delhi (4). “I was kept day and night in that place. They made me go with men all day and all through the night. If I resisted the owners would cut my arms, burn my face with cigarettes and scald my body. They would open up my wounds the next day to remind me not to disobey. They would inject me with drugs and force me to drink alcohol to make sure I did what I was told.
Whilst I was there I caught TB from the other girls. Seven men escorted me to hospital; they did not let me out of their sight. I was a prisoner, and I lost all hope of ever escaping. Eventually I tried to kill myself by cutting my wrists. They stitched me up so I could carry on making money for them.”

Across South East Asia, in the poorest of towns and villages, families are forced to make agonising decisions just to survive. Fathers will sell their oldest daughters to feed their younger siblings. The fundamental human rights of a child have no meaning in a world of extreme poverty.

Cultural issues in some countries contribute to the problem. Women and girls are viewed, by many, to be of little significance or worth. This diminished social standing is exploited by organised criminal gangs who view young girls as objects to be bought, auctioned and sold. To them women have a high value but for all the wrong reasons.
The crisis in India, where woman and girls routinely face sexual exploitation, harassment and lack of human worth has, in recent years, been amplified by the availability of pornography on the internet. One exasperated Indian social worker put it like this: “Pornography has intensified the lack of respect for women here. The problem has become much worse in a short space of time.”

Where does our public health duty lie in response to the appalling reality faced daily by girls such as Abha? Poverty, disregard of a woman’s worth and the prevalence of pornography are all underlying factors in this human tragedy. Should our response be to attempt to deal with these fundamental problems?

If these root causes are just too enormous a challenge, then should our public health response be to deal with the aftercare of individuals directly affected? Children rescued from the brothels have been broken mentally, physically and spiritually. Many suffer with rejection, they cannot reconcile the fact that their own families could have sold them. For others, the shame they burden for the abuse they have suffered is a barrier to ever being reunited with loved ones. They become outcasts.

Those still trapped within this insidious industry suffer with even greater self-degrading effects. A sense of hopelessness inevitably leads to depression. Many try to take their own lives as their only means of escape. Others develop a dependency upon the drugs and alcohol they are plied with in an attempt to block out the fear and pain they have been sentenced to.

Our public health response could be to identify and develop services to deal with these devastating emotional effects on young lives. Or as public health practitioners we could respond to their physical needs; screening and treating TB, HIV and other STIs, improving their poor nutrition and working to ameliorate their squalid living environments.

However, within India and neighbouring countries, for many there is still an unwillingness to admit that such problems exist. On the flight into Delhi one Indian passenger was adamant there were no issues with prostitution in India. “You will not be able to show me even one woman or child in prostitution. There is no problem here, this does not happen!”

Perhaps, therefore, our public health duty first and foremost should be to continue to raise awareness about this atrocity so that no one can honestly deny that the problem exists. Unless the issue and scale of human trafficking is recognised and acknowledged by all countries, and political pressure applied at the highest levels to invoke change, then those on the ground who fight daily against such evils will continue to fight alone.

“The only thing necessary for the triumph of evil is for good men to do nothing” – Edmund Burke

References:

1. UNODC. UNODC on human trafficking and migrant smuggling. Available at URL: http://www.unodc.org/unodc/human-trafficking/ (Accessed 8 May 2017)

2. UNODC. Global Report on Trafficking in Persons. Executive Summary. February 2009.

3. International Labour Organization. Summary of the ILO 2012 Global Estimate of Forced Labour. June 2012

4. Abha – not her real name. Notes from a personal conversation with a girl rescued from a brothel in Delhi, May 2017.

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Reflections on a public health trip to Japan

Posted in Asia, Global Health, Japan, Obesity, transport, Urban health, Wales on September 1, 2017| Leave a Comment »

By Claire Beynon MFPH

BACP Travelling Fellowship
Every two years the Faculty of Public Health (FPH) awards a BACP travelling fellowship to assist members of FPH in training to undertake educational travel. This fund was established in 1994, using funds donated by the British Association of Community Physicians (BACP) on its dissolution.

At the FPH Conference in Telford in June I was delighted to receive the travelling fellowship funding based on my application to travel to Japan to experience its culture and make observations about why its levels of childhood obesity were so much lower than those in the UK, and to present my public health work at a conference in Japan.

Observations on Childhood Obesity in Japan
Before I left for Japan I read many articles that explored the differences between childhood obesity rates in the USA and Japan. Their focus was on lifestyle factors including diet and physical activity.

Whilst in Japan I met with several academics who specialised in obesity, physical activity and diet. They were all most welcoming and shared their research and experiences readily.

The key points they raised were:

  • Younger children spend less time in school. As age increases so does the length of the school day. This gives more free time for outdoor play.
  • 90% of children walk to school daily.
  • Children do three hours of physical activity each week in school time.
  • There are no cleaners in Japanese schools; part of a child’s everyday activities includes cleaning their own school – children are active when cleaning.
  • Schools often have before-school sports clubs as well as after-school sports clubs.
  • Between each lesson there is a five-minute break to allow children to run around in the play area. This is in addition to morning break, lunch and afternoon break.
  • There are multiple opportunities in school for competitive sports, with regular competitions and celebrations. Children spend time practising for these with friends.
  • Children have three hot meals a day at breakfast, lunch time and in the evening.
  • Children serve each other a cooked meal at lunch time and sit and eat this hot meal together.

Further Observations
Whilst travelling in Japan I observed a number of additional environmental factors that tip the balance in favour of walking and cycling:

  • Priority is given to the pedestrian, then cyclist, then the motor vehicle. Encouraging walking and cycling. By giving priority to more vulnerable road users speed of motor vehicles is also decreased.
  • Cyclists and pedestrians share the pavement area, which is often separated from the road with a barrier and/or low-level bushes. This makes for a safer cycling experience than the UK where cycle lanes are often shared with buses.
  • There were a number of covered shopping areas, which were accessible only to cyclists and pedestrians and proved very popular thoroughfares.

    Shopping area in Japan

    Covered shopping area where pedestrians and cyclists share space

  • There was consistent and regular signage for cyclists and pedestrians, including details of directions and distances to the nearest public transport options.
Example of road, cycling and walking space in Tokyo

Example of road, cycling and walking space in Tokyo

• The number of employed people working on any urban street was much higher than the UK, with police highly visible, construction staff, cleaners, car park attendants and others all adding to the sense that the street was a safe place.

 

Policeman on the street in Japan

Presence on streets of local police make a space feel safe

• Public art installations make walking and cycling spaces more interesting and appealing.

Street art in Japan

Example of simple art installation

We know from the 2007 Foresight Report that obesity is a complex issue with multiple factors influencing obesity levels in adults and children. My own research looking at the risk factors for obesity in children in Wales using Welsh Health Survey data showed a reduced risk of obesity for children who met the one-hour physical activity guideline.

 

The new experiences and culture that I have experienced from this educational trip make me more determined than ever to tackle childhood obesity in Wales. I am looking forward to being involved in the drafting of an obesity strategy for Wales as part of my placement with the Welsh Government and will share my experiences with other registrars and colleagues at every opportunity.

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Public health, but in camouflage

Posted in Asia, Global Health, Health Inequalities, India, maternal health, midwifery, poverty on July 14, 2017| Leave a Comment »

By Andy Beckingham FFPH, Fernandez Hospital, Hyderabad

Giggling Girls!

The scope of our profession gives opportunities to branch out. These may not always look at first glance like ‘public health’.

In 2010, working in India on maternal mortality, someone asked over dinner if I thought UK-style midwifery might be useful in India where doctors provided all the care. “Perhaps if you try the bits that work for women,” I said. “And avoid the bits that the NHS got so wrong.” My dinner companion turned out to be the MD of India’s most famous maternity hospital, and I found myself designing her midwifery pilot programme.

The midwife who had run the UK’s most woman-friendly midwifery service (the Albany Practice, which achieved great outcomes for disadvantaged women) was inveigled into joining us as a mentor. Eight anxious trainees found themselves becoming India’s first evidence-based woman-centred midwives (pictured). They began to develop their own profession, promoting choice about labour and supporting and empowering women to have more natural births. They had to challenge established obstetric practice. Our hospital’s maternity care began to change. Babies had been routinely separated from the mother at birth, although this impedes attachment and breastfeeding. The midwives worked with paediatricians to change that. Now most mothers have immediate contact and breastfeed their babies in the first hour.

Now leaders in their own right, those first eight have since mentored other trainees to become strong professional midwives, supporting thousands of Indian women to have better births.

Like most countries, India has unnecessarily high rates of intervention in childbirth. A local public hospital’s c-section rate is 52%. A local private hospital’s is 90%. But thanks to the midwives, ours has come right down. Instead of epidurals being routine, midwives ask women what pain relief they want. They offer choice. Women get continuity of care. The outcomes are better. Satisfaction rates are high.

In 2017, the state government invited us to train midwives to work in their hospitals too. They want c-section rates to come down. But they also want compassionate, respectful maternity care for the large numbers of women who are mostly ‘below poverty line’. So maybe, just maybe, this could become a model for wider public maternal-health improvement in lower-income countries. I have to assess its impact.

Designing a midwifery programme and curriculum doesn’t at first look like a public health role. But it is starting to address unmet needs, inequalities and disadvantage, improve care quality and effectiveness, show that Indian women and their choices matter. Of course, it will need to be part of wider action on social and economic determinants of maternal health.

And now, this alternative to the medical model is available, and the state government is actively promoting compassionate, effective midwifery care and supporting us to roll out professional midwifery more widely, among very disadvantaged women.

Public health, in disguise.

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The health impacts of armed conflict

Posted in Academic, Global Health, Middle East, Uncategorized, violence, War on March 24, 2017| Leave a Comment »

By Daniel Flecknoe, Co-Chair of the FPH Global Violence Prevention Special Interest Group

The preliminary report of the Lancet/American University of Beirut Commission Health workers and the weaponisation of health care in Syria [Fouad et al, 2017] was published on 14 March, calling attention to the principles of medical neutrality and unhindered patient access that have been so badly neglected in the ongoing Syrian conflict. Systematic targeting of health workers by ISIS, Syrian and Russian military forces is a war crime committed against civil society, and epitomises a disturbing trend of indifference and impunity to international humanitarian law by warring governments and armed groups over recent years. Established norms in the conduct of war, built up over the past century and a half since the founding of the International Committee of the Red Cross, may be irrevocably degrading, and the public health consequences for civilian populations exposed to such deliberate brutality will be correspondingly more severe.

The Faculty of Public Health’s (FPH’s) Global Violence Prevention Special Interest Group (SIG) is committed to engaging with this neglected and worsening cause of preventable morbidity and early mortality. Its members contribute to research into the health impacts of armed conflict (including the Lancet paper referenced), engage and collaborate with other conflict-prevention organisations and conduct advocacy for arms control, economic/democratic reforms, and respect for human rights and the rules of war. We encourage all public health professionals to give parity to armed conflict along with other major global causes of illness, injury and death, and to lobby (both as citizens and medical professionals) for foreign policies that will protect and preserve health.

The SIG will be represented at the FPH conference in June, and members will be happy to discuss our current workstreams with anyone who might be interested in getting involved.

References:
Fouad FM, Sparrow A, Tarakji A, Alameddine M, El-Jardali F, Coutts AP, El Arnaout N, Bou Karroum L, Jawad M, Roborgh S, Abbara A, Alhalabi F, AlMasri I,  Jabbour S. 2017. Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet–American University of Beirut Commission on Syria. The Lancet. Published online 14/07/17 http://dx.doi.org/10.1016/S0140-6736(17)30741-9

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What impact will Brexit have on public health and health services in the United Kingdom?

Posted in Academic, Ageing, Brexit, Europe, Global Health, Healthcare on March 6, 2017| Leave a Comment »

By Professor Azeem Majeed, Head of the Department of Primary Care and Public Health, Imperial College London

The departure of the UK from the European Union (EU) will have wide-ranging consequences for public health. The UK first became a member of the EU in 1973 and as a member of the EU for over 40 years, the UK has played a full part in European-wide public health initiatives. These have covered many areas, including food regulations, road safety, air pollution, tobacco control and chemical hazards.

Cross-national approaches to public health are essential when dealing with issues that do not stop at a country’s borders (eg. air pollution) and when dealing with large, multi-national corporations over which any single country will have only limited influence. Although EU public health initiatives have had important positive effects on health in the UK, there will be strong resistance from pro-Brexit politicians in participating in future programmes, as they generally view them as unnecessary interference in the UK’s internal affairs. The UK will also find that it is no longer able to lead such programmes or have much influence over their content, which will inevitably damage the leading role that the UK has played in public health globally.

The NHS will also find itself facing major challenges because of Brexit. With over one million employees and an annual spend of over £100 billion, the NHS is England’s largest employer. For many decades, the NHS has faced shortages in its clinical workforce and has relied heavily on overseas trained doctors, nurses and other health professionals to fill these gaps. This reliance on overseas-trained staff will not end in the foreseeable future. For example, although the Secretary of State for Health, Jeremy Hunt, has announced that the government will support the creation of an additional 1,500 medical student places in England’s medical schools, it will be more than 10 years before the first of these extra medical students complete their medical courses and their subsequent post-graduate medical training.

The recruitment of overseas-trained health professionals has been facilitated by EU-legislation on the mutual recognition of the training of health professionals. This means that health professionals trained in one EU country can work in another EU country without undergoing a period of additional training. For example a cardiologist or general practitioner trained in Germany would be eligible to take up a post in the NHS. Moving forward, it’s unclear that this cross-EU recognition of clinical training will continue. As inward migration to the UK looks to be the most politically contentious area in our post-Brexit future, we will need to take urgent action to ensure that the NHS has sufficient professional staff to provide health and social care for our increasingly ageing population.

The UK’s government will also have to address the issue of access to healthcare, both for EU nationals living in the UK and UK nationals living overseas in countries such as Spain. Currently, all these individuals are entitled to either free or low-cost healthcare. It’s unclear what will happen in the future, and this is particularly important for the UK nationals living overseas, many of whom are elderly and who will have a high level of need for healthcare. As the NHS has never been very effective in reclaiming the fees owed to it by overseas visitors to the UK, the UK may find itself substantially worse off financially when new arrangements for funding cross-national use of health services are put in place.

In conclusion, Brexit will have important impacts on public health and health services, with scope for wide-ranging adverse consequences for health in the UK. It’s therefore essential that public health professionals engage with government to ameliorate these risks and also gain public support in areas such as the benefits of participation in EU-wide public health programmes and the continued recruitment of health professionals from the EU.

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The colour of health: Vitamin D and its relevance to us all

Posted in Genetics and public health, Global Health, Health Inequalities on October 27, 2016| Leave a Comment »

vitamin-d

By Dr Amrita Jesurasa

Ever since our most ancient ancestors left Africa to populate the rest of the world the appearance of their descendants has changed.

Height, facial features, hair type, body size and shape, and invisible genes that can protect from or predispose to disease have developed and differentiated racial groups. But the most profound (and superficial) change has to be in the colour of our skin as people migrated and settled around the world.

Skin colour forms a strong part of our physical and social identity, at times unifying people but more distressingly, causing division. The legacy of this evolutionary change has left its scars on human history in the last few hundred years and continues to cause tension in the present. Ethnic inequalities in health are well recognised and yet we perhaps fail to recognise the true message from history: why did skin colour change?

Current theory suggests that this phenomenon arose as a result of our need for vitamin D. As our early ancestors migrated to northern latitudes, they experienced the severe consequences of vitamin D deficiency. These included bone deformities that affected their ability to walk, breathe and – crucially – to give birth (the latter the result of changes to the female pelvis).

In Europe, natural selection began to favour lighter skin that allowed ultraviolet radiation to be more readily absorbed, vitamin D to be synthesised and ultimately our species to survive in Europe and other northern climes.

Fast-forward to the 21st century and rapid technological advances have transformed the way we live. Some of these developments, including air travel, have facilitated evolutionary shortcuts, enabling the humans of today to live in environments that are totally different to that of even the previous generation. But other advances have affected the behaviour of us all by encouraging a more indoor lifestyle than that of our ancestors, creating fear of the adverse effects of the sun and altering our dietary habits.

This perfect storm has allowed vitamin D deficiency to become a population-wide issue, but one which has the greatest impact on those with darker skin. The irony is that this disproportionate effect within the population marginalises the issue of vitamin D deficiency, creating an ethnicity-related health inequality.

To raise the profile of vitamin D deficiency, universal issues need to be addressed and universal solutions provided. While improving access to vitamin D supplements must be part of this strategy, there are worrying common pitfalls associated with an exclusively medical approach.

Instead, a simple message may resonate more with both the public and policy-makers. This could mean promoting a basic principle that “like plants, we need food, water and sunshine to thrive”. With a more holistic approach we can relate prevention of vitamin D deficiency to other important and well-recognised public health concerns, thereby raising the priority of this historically important issue.

  • Dr Jesurasa is a Specialty Registrar in Public Health Medicine/ Honorary Clinical Lecturer in Public Health, University of Sheffield

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COP Postcard from Paris: progress and action

Posted in Climate change, Global Health, Uncategorized, tagged , on December 10, 2015| Leave a Comment »

  • by Professor Sue Atkinson
  • FPH Health and Sustainability SIG

I am in Paris – for COP 21.

COP 21 (21st Conference of the Parties) of the UN Framework on Climate Change (UNFCCC) are the negotiations between the 195 countries attending, to make a deal to curb emissions and keep global warming below 2°C.

I am not at the main COP negotiations in Le Bourget but at the Global Climate and Health Alliance (GCHA) Health Summit and other parallel health meetings.

Unfortunately the timing of the Summit means I missed the FPH ‘Sustainable development and health’ SIG meeting in Nottingham on 4th December which followed the instigation of the SIG at the Faculty Conference in June.

People are starting to recognise the importance of health, climate change and sustainability and accepting what the Lancet commission identified in 2009, that ‘Climate Change (CC) could be the biggest global threat of the 21st Century’.

The Health Summit was the buzziest conference in ages. Over 500 people and oversubscribed, it was chaired (amusingly and with clear insights) by John Vidal (Environment Editor for the Guardian) and attendees included Health Ministers, the Deputy Mayor of Paris, WHO and GIZ (Deutsche Gesellschaft für Internationale Zusammenarbeit, the German equivalent of DFID), who both supported the conference (thank you), representatives of health and climate change groups and alliances from across the globe.

The presentations, parallel sessions and panel discussions were informative, interesting, lively, amusing, challenging and enjoyable with many interesting discussions taking place around the edges with an exchange of shared ideas and experiences to take back home.

Some of the snippets I picked up included:

  • Wales has a ‘Wellbeing of Future Generations Act’ and a commissioner to make things happen. It is one of only two countries with sustainability in its constitution.
  • California showed the importance of political leadership in Senator Kevin de Leon, who is introducing a variety of relevant bills and noted that air pollution is not just a public health issue but also a political and civil and human rights issue because of its inequities.
  • Air pollution is worst in poor areas and African American children have a 50% higher risk of being hospitalized and Latino children a 40% higher risk of death from asthma.
  • Health care systems are part of the problem. In USA they account for 8% of emissions. Hospitals across the globe are increasingly taking action to reduce energy usage (and costs) but much more needs to be done.
  • Reducing red meat consumption (and its procurement by hospitals and institutions) is good for health and the planet. The Buddhist Dalin Tzu Chi Hospital in Taiwan has moved to a plant based diet to improve health and the environment.
  • Cities are increasingly taking action on reducing emissions where states and countries are unable to reach agreements. In Paris over 100 mayors came together with the Paris Mayor Anne Hidalgo calling for them to unite and work together to mitigate climate change. London has reduced its carbon emissions by 14% since 2008 but I am sure Bristol and elsewhere may be doing better.
  • The Paris Deputy Mayor – Bernard Jornier – clearly understands well the relationships between health, climate change and inequalities.
  • Goldman Sachs decreed in September 2015 that “Coal is in terminal decline”.
  • Using fossil fuels means there are more than seven million extra deaths per year.
  • The co-benefits of addressing health and climate change together are clear – e.g. increasing active travel – walking and cycling – is good for your health and good for the planet.

And much much more …

We have come a long way since COP15 in Copenhagen in 2009, when those of us interested in health and climate change could fit around one small coffee table and it now feels as though the importance of health in the climate change negotiations is starting to make its mark.

CC science is real but it is often difficult to get our heads round and some of the environmental and other impacts seem like a long way off and we know that politicians and all of us (including teenagers) find it hard to recognise and take action on threats that are in the more distant future.

Health brings home the real story of the impact of climate change – imperative, immediate and life changing.

Families displaced because of floods and typhoons, children starving as a result of drought resulting in failing crops, older people dying in heat-waves, even as recently and as nearby as 15,000 deaths in France in 2003.

With 500 people still dying annually of Malaria, the 2.5 million people suffering from the disease could increase again to over four million with the spread of mosquitos due to climate change.People are sick and dying from lack of clean water as a result of either drought or destruction of infrastructure by severe storms and tsunamis.

Closer to home, just this weekend the floods in Cumbria have caused distress and destruction as well as the financial costs of these storms.  And of course the important links between climate change, disasters and water shortages, refugees and terrorism.

IMG_0867

Recent floods in the north of England (like York City Centre, pictured) have brought home the reality of climate change to the UK

The latest Lancet Commission (2015) identified that ‘Tackling CC could be the greatest health opportunity of the 21st century’.

The health summit felt both daunting and optimistic. We must act now.
The spoken word poet – Sophia Walker – captured it in her piece written for the Health Summit as “…we aren’t just talking about the weather” and suggested that nine billion people on the planet could work ‘miracles’ if they all did their bit.

We in public health must do ours, not just individually but in whatever ways we can through our building it into our daily work, e.g. identifying the co-benefits of improving health and the environment. It seems that at last the penny may be dropping that climate change and health are inexplicably linked.  What’s good for health is good for the planet.

References
Lancet Commission. 2009. “Managing the health effects of climate change”. Lancet and UCL Institute for Global Health Commission. April 2009.

Lancet Commission.2015. “Health and Climate Change: policy responses to protect public health” Lancet. June 2015.

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From Africa to Glastonbury: global health protection

Posted in Africa, Global Health, Health Protection, India, Mental Health, Uncategorized, tagged on July 25, 2012| Leave a Comment »

Health protection is a global issue – and there are lessons to learn and share from all incidents, wherever they occur. That was the message from the global health protection workshop at FPH’s annual conference in Cardiff on 19 July.

Delegates heard how the Health Protection Agency (HPA) has built a worldwide reputation for its work, in part because the global nature of health protection means that planning needs to go beyond national borders. The World Health Organisation has 10 collaborating centres in the UK, while the HPA has sent teams on international secondments to South Africa, India and Australia. One of the speakers talked about how the HPA had been involved in giving high-level advice to government agencies after the earthquake and nuclear power failure in Fukushima.

Closer to home, the delegates heard from Dr Sarah Finlay about how she and her colleagues from the charity Festival Medical Services dealt with an outbreak of H1N1 at the Glastonbury festival in 2009. The festival had a population of 135,000 ticket holders, and 35,000 artists and staff, many of whom were the kind of healthy, young people most likely to contract the virus. The infrastructure of the event meant that living conditions were poor. People’s behaviour, as would be expected at a music festival, was not typical. The combined circumstances meant that it was easy for communicable diseases to transfer.

Risk was mitigated by following the protocols for managing H1N1, having immediate access to antiviral stocks and good transport to the onsite medical facilities, despite the mud. Good advice was given to festival goers before, during and after the festival, stressing the ‘Catch It. Kill It. Bin It.’ message and the importance of using the hand gels that were available across the site.

Information was circulated via the Glastonbury festival website, music press and general media. Just as the HPA team working on Fukushima had regular updates throughout each day to share information, so the Glastonbury health team relied on situation updates three times each day.

There were six cases of swine ‘flu at Glastonbury in 2009, all of which were confirmed by laboratory test results and each of whom left the site for further treatment. One of these cases was a 16-year old girl who had been sharing a tepee with 12 other people, each of whom had to be tracked down in the chaos of festival life.

In the circumstances, the team felt the outbreak had been well managed, and the lessons learnt from this example of mass gathering medicine were shared with the organisers of the Berlin World Athletics and the Hadj.

Dr Finlay summed up by saying that the success of the festival’s approach to H1N1 was due to having a well thought-through approach, early detection, awareness of the issue and by sharing the lessons learnt.

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Highland things

Posted in Africa, Chronic Disease, Climate change, Disaster relief, Global Health, HIV, tagged , , , , , , on October 31, 2011| 1 Comment »

Gelada baboons
Move along there: Gelada baboons

By Dr Jackie Spiby

We are still here in Addis Ababa. We have survived the rainy season and the sky is blue again.

Many of you will have seen the news about the famine in the south east of Ethiopia where it borders Sudan and Kenya. Sitting in Addis, it is as difficult to understand the whole story here as it is at home. We pick up the news and some of the debate from the BBC when the internet is working. When we travelled to the south recently, everywhere looked really fertile and verdant as it was just after the rains. But at work I do hear about problems with food-aid delivery and families that can’t feed their children.

As recipients of Global Fund money, my organisation has to have pristine financial arrangements. The management audit letter we received recently could have been one found in any PCT. By the way do PCTs still exist? The only difference was that they were querying why a goat had been bought. I recently found myself on an appointments committee for an internal auditor – something I have managed to avoid in the UK. Amazingly my interviewing instincts rose to the fore. I was delighted that my first choice was the same as the finance director’s. It did help that the interviews were in English. So, another country another culture but actually much is the same.

We took a few days off to travel north to trek in the Simien mountains. Ethiopia lies in the East African Rift Valley so much of the north and central areas are hilly in stark contrast to the desert areas bordering Sudan and Somalia. We were walking at three to four thousand metres and were surprised that it was still scattered with villages, and, wherever we went, small children were keeping an eye on the cattle and sheep. They said they went to school but I wasn’t really convinced.

Walking into a BBC crew filming the gelada baboons was quite surreal. We had just stopped to put on our macks as it was raining when we heard a very posh voice asking if we could move please as they were trying to film the baboons running down that particular hill. If you ever see a documentary on these baboons in the Simiens we were there, and we saw the locals on the other side of the hill ‘encouraging’ the baboons to move.

One of my areas of work is developing a volunteers’ strategy. Not international volunteers but local volunteers. PLHIV associations are similar to charitable organisations in the UK so their boards are all volunteers and most of the programmes workers are also volunteers. However they do get expenses. The latter get 206 birr a month for travel. That is £7.60. In the focus groups they tell me they do it for humanitarian reasons. However when I asked if they also had paid work, they said it was hard to get work as they were HIV+. So what is a volunteer? I really enjoy the focus groups: however formal I try to make them, we have to have a coffee ceremony, and they usually end with music and dancing. The highlight last week was meeting a 22-year-old woman who finished school at grade 6 but was carrying a beautiful, chubby smiling baby who everyone proudly told me was HIV negative.

Am I making any difference? Not an unusual question for anyone in public health. I’ve been asking it my entire career. I’d better get back to work and make sure that I am.

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