Global Health Engagement Month—A Different Perspective

Those of us who work in the international health field are connected in many ways.  We come from a variety of healthcare and public health careers and so approach the needs of global health in different ways. The common thread is strengthening the quality of healthcare and increasing and improving the availability to those in need around the world.

December is designated as Global Health Engagement Month for the US Military communities. All of our branches of service participate in humanitarian assistance and disaster response, and their efforts during times of international need are often the first assistance that some countries receive. In addition to providing care for our military active duty members and their families, our military medical corps from each branch of service provides care, assistance, teaching and disaster response in many different venues. They often work with NGO partners, other countries, and the Ministries of Health and the medical communities of nations in need. It is indeed a “global health engagement” effort that makes a difference. It has been my privilege to work with ASCP laboratory capacity building as a volunteer consultant, and I’ve also had an opportunity to work with the US Navy to build their partnerships with NGOs when they send their hospital ships on humanitarian assistance missions. Seeing global health outreach from several different perspectives keeps me ever mindful of the good work we do, and how much there still is to do in the world!

If you are interested in what our military is doing in providing humanitarian assistance , read about the hospital ships USS Mercy and USS Comfort and see why “Global Health Engagement Month” is so important to our military health colleagues here and here. I’m sure you’ll be amazed and proud of our country and inspired by their stories!

 

???????????????????????????????

Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

 

World AIDS Day

This past Sunday (December 1) was World AIDS Day, a day when the international community recognizes the millions of lives that have been taken by AIDS and the additional millions that are living with the disease. As all lab people know, the lab is a crucial part of the diagnosis and care and treatment of HIV/AIDS. From the initial diagnostic tests to the CD4 monitoring tests, the lab plays a crucial role in individual treatment.  Thus, I’d like to take a moment to recognize World AIDS Day on this blog and highlight important statistics about HIV/AIDS.

In the United States, perception of AIDS has progressed greatly from the initial fear of the unknown, to the AIDS quilt and Red Ribbon awareness raising campaigns, to the understanding and knowledge that many people have today.

There is so much that has been done and there have been huge advances in medicine making it possible for people to enjoy a high quality of life while living with the disease. And yet, as the facts and figures below illustrate, there is still so much more to learn and do.

Following are some Facts and figures obtained from the WHO website:

35.3 million people were living with HIV in 2012. An estimated 2.3 million people were newly infected in 2012. An estimated 1.6 million people died of HIV/AIDS in 2012.

2.1 million adolescents (age 10-24) were living with HIV in 2012. A large portion of those are young people in sub-Saharan Africa where girls are more susceptible than boys.

9.7 million people in low- and middle-income countries were receiving ART (anti-retroviral therapy) at the end of 2012. Over 16 million others living with HIV do not have access to ART.

In 2011 56% of pregnant women received the most effective drug regimens to prevent MTCT (mother-to-child transmission). MTCT is almost entirely avoidable with access to the right care.

People living with HIV have the strongest risk for developing active TB. Over 79% of TB cases worldwide are people living in sub-Saharan Africa.  In 2011 it was estimated that a quarter of all HIV related deaths were due to TB.

For an additional summary of facts and figures you can check out the UNAIDS 2013 Global Fact Sheet.

As a quick, related aside, in my information gathering for this post I came across information on the Red Ribbon campaign that I hadn’t known before and thought I’d share. Most of us know the ubiquitous red ribbon which is a universal symbol of awareness and support for those living with HIV. The red ribbon was the first ever ribbon symbol, now commonly used for awareness of many other causes in a rainbow of colors. The idea came from a gathering of artists in 1991 who were trying to come up with a visual to support a NY arts organization that raised awareness for AIDS. Clearly, they were successful in coming up with a powerful visual that is easily replicated and understood around the world. Cheers to those artists!

-Marie Levy

A Special Thanks

I am watching the sky turn brilliant shades of rose, gold, lavender and light blue as the sun rises over Fargo, North Dakota—(speaking of remote places) and I am reminded of so many sunrises I have enjoyed around the world.  When working in another country I often rise very early, make myself a cup of tea and watch the world wake up.  It is such a special time of day, a time of personal reflection and awe of the beauty in the world around us.  It never fails to remind me that no matter who you are, or where you are, “sunrises and sunsets” are universal and give us the promise of a new day, and the rest and peace of day’s end.

The American holiday of Thanksgiving is my favorite day of the year.  It celebrates friends, family, life’s blessings, and the chance to take time to be thankful for what’s been given, and to give in return.  And this year I am again thankful for the unique and exciting places, challenges, and experiences I have had working around the world, and seeing so many of the world’s most beautiful sunrises!

Pictures of course don’t do them justice…but they often find their way to my desktop as the wallpaper, so if you want to see a few, let me know at bsumwalt@pacbell.net , I’d be happy to share! In the meantime, I hope you had a Happy Thanksgiving, and perhaps I can encourage you to take a moment to enjoy a sunrise!

Cheers,
Beverly Sumwalt

OLYMPUS DIGITAL CAMERA

Reference Ranges

According to Wikipedia, reference ranges in health-related fields are generally defined as “the prediction interval between which 95% of values of a reference group fall into, in such a way that 2.5% of the time a sample value will be less than the lower limits of this interval, and 2.5% of the time it will be larger than the upper limit of this interval, whatever the distribution of these values.”

In other words, reference ranges are important! They provide the necessary context for medical analysis and diagnosis. Without a reference range (also sometimes referred to as reference value or reference interval) medical professionals have no comparison group for which to make diagnosis and advise treatment.

In all instances where reference ranges are used, context is key. In sub-Saharan Africa many labs use European established reference ranges which represent a primarily Caucasian population. This is because reference ranges specific to populations in sub-Saharan Africa do not universally exist. This presents a problem as many factors can contribute to what is considered “normal” in different populations. Genetics, dietary patterns, pregnancy, gender, age, ethnic origin, and prior exposure to pathogens all can influence reference range values.

Establishing accurate reference ranges for a given population takes time and an enormous amount of resources. It is often recommended that laboratories establish their own reference ranges based upon the population that they serve. This is cost and resource prohibitive for many laboratories in the developing world. In absence of region specific reference ranges, it is recommended that each lab validate existing ranges using their own population. However, even this can be prohibitive in resource (both physical and human) limited settings.

This can lead to egregious errors in disease diagnosis and treatment. Clement Zeh, Collins Odihiambo and Lisa Mills write that reference range research thus far reveals that African populations differ from their European/Caucasian counterparts with lower hemoglobin, red blood cell counts, hematocrit, mean corpuscular volume, platelet counts, and neutrophil counts  and higher monocyte and eosinophil counts (see http://www.intechopen.com/books/blood-cell-an-overview-of-studies-in-hematology/laboratory-reference-intervals-in-africa for their chapter on Laboratory Reference Intervals in Africa).

In addition to diagnosis and treatment of individuals, reference ranges are crucial components in drug and vaccine studies. Historically, clinical trials of drugs and vaccines have relied upon ranges developed in the Western world. This can have significant impact upon the research data resulting in health risks to study participants, poor data, and huge amounts of resources wasted.

Thus, while it is costly and time consuming, reference ranges specific to populations in countries in the developing world need to be established. This would help both the treatment of individuals, and the testing, study and development of important vaccines and drugs.

-Marie Levy

Internationally Thankful

Settling into November, fall is “in the air” and in the United States we all start to think about most everyone’s favorite holiday, Thanksgiving. I’ve been fortunate to have traveled to many places both for work, for volunteering, and for pleasure—and I always come home “thankful” for the people I’ve met.

Relationships with people are what matter most to a consultant. And over many years I’ve enjoyed reinforcing my belief that people are the same everywhere—our differences are so small compared to our similarities. We all laugh, we cry, we share with friends, we want the best for our families, we celebrate life and mourn death, we strive to do meaningful and challenging work that makes a difference, we seek to understand life and have moments of personal reflection when we look in the mirror. The fact that we do it in a myriad of languages, wearing different clothing, eating different foods and honoring different holidays and beliefs, coping with different weather and available resources are all just part of the platform.

A feast in any country, any language, any culture is a celebration, a way to say “welcome—come and share—you are friend and family”. Celebrating our holiday of Thanksgiving, it is very easy for me to say “thanks for what international work gives” to all of us! I’d be happy to share some “feast favorites” with you, just send me an email at bsumwalt@pacbell.net . But the real treat is the smiles!

Blog 10 Celebrating with the Batwa
Celebrating with the Batwa

OLYMPUS DIGITAL CAMERA
My good friend Matthew in Namibia

Cheers,
Beverly Sumwalt

Never a Dull Moment

As an international laboratory consultant, there is never a dull moment.  One minute you are working with energized people from another country engaged in spirited dialogue, learning and sharing experiences—and the next you are up very late with your team colleagues in a smoke-filled hotel lounge with multiple computers plugged into walls trying to capture information into an assessment template not designed for the technically challenged.  It’s better than Sudoku for mental exercise!

I recall one trip where the biggest challenge was keeping our notes and information straight.  We were scheduled to visit two laboratories on the same day; small but relatively full service labs, so there was much to review, discuss and digest in order to understand their capability and progress.  Some people can type notes into a laptop, but I find that a pencil and paper are the most useful tools. Working with people, making eye contact and facilitating interactive discussion provides a backdrop for what you are able to observe.  After a walk-through and overview, questions and comments, log reviews and notations it is imperative to elaborate on your notes and add comments immediately after an assessment visit.  Believe me, after 6 laboratories in 4 days covering >1000 miles, they can very easily “all run together” if you are not careful and diligent.  Laboratorians  tend to be overly organized and a bit obsessive about documenting things—it’s the nature of the beast, since we live our career lives in data production and information dissemination—and it has to be correct, all the time, for every patient. I smile as I remember many nights on that trip with my ASCP colleague Wendy, plugged into the wall in a deserted hotel lobby and barely able to see the computer screens as we compared and contrasted assessment scores late into the night before getting up before dawn to take off and do it all over again.  Well, it was all in a day’s work!  She and I will both admit to wishing we’d had a little more sleep, and we would also tell you we wouldn’t have missed it!

So if you find yourself up late at night studying, preparing for a presentation, catching up on journals or even waiting for a teenager to get home at the appointed hour, I recommend keeping a hot cup of tea and some local chocolate near at hand.  I can highly recommend chocolate from Kazakhstan, and also from Namibia— contact me at bsumwalt@pacbell.net and I’ll send you the name of my favorite brands.  But even if you can’t read the label, the pictures are all you really need!

Blog 9 Working Late

 

Cheers,
Beverly Sumwalt

Adventures in Travel–A Very Spooky Moment

Coming up to All Hallows Eve reminds me of a very “spooky” moment with my passport; one that illustrates the odd and scary things that can happen when you are overly “travel tired.”

It’s said the longest flight on the planet is flying from the east coast of the United States to Johannesburg, South Africa.  I’d have to agree; no matter how you book it the flight is over 19 hours in the air, non-stop. It’s a bit of a flying marathon, and makes you a little mentally and physically fatigued just getting there.

I was on my way to Namibia with very tight connections (always a little stressful) and on arrival in Jo’burg I had less than an hour to catch the last flight out to Windhoek.  Our schedule for two weeks of laboratory assessments had been carefully arranged and there was no room for error in the schedule—so I HAD to make that flight.  If I missed it, I would be responsible for throwing the entire schedule off and so the pressure was “on.”

As I got off the plane there was a bright young man in an airport vest asking if he could help anyone.  I told him I had a very close connection and didn’t know where I was going, but had to catch the flight to Windhoek.  His eyes got big as he looked at my boarding pass, and said, “Come this way madam, you must hurry, they will be leaving and we have a long run ahead”.  Of course!  He grabbed my suitcase and headed out, I followed with a fuzzy brain and very wobbly legs from sitting so long.  We reached the ticket gate (me gasping for air) and they said “Sorry, we have closed the desk for that flight.”  I was obviously ready to come un-glued, and he said quietly, “Do not worry madam, I have another way to get you there—give me your ticket and passport, and I will run ahead and be sure they don’t leave you—please follow me as quickly as you can!”  In a stupor of exhaustion, I handed him my boarding pass and passport.  He jogged ahead and out a side door marked “Do Not Enter—Tarmac Employees Only” and held it open for me to follow, then ran.

Now you might be saying, “Are you kidding me? You handed a young man built like a Kenyan marathon runner your PASSPORT and BOARDING PASS? And went running across the restricted tarmac??  Which South African jail will we find you in?!”  Well, yes, I did…and when that realization found its way to my conscious brain I kicked it up a notch and ran harder, determined to keep him in sight even if I couldn’t catch him!  We jogged under the belly of two huge planes, around luggage carts, through a garage and a tunnel, and headed straight for a large bus just closing the doors to take a load of passengers to the Windhoek plane.  He waved and shouted and ran in front of the bus…forcing them to stop, waving my passport and boarding pass wildly over his head.  He and the security guard on the bus had a robust and heated discussion while he blocked the closing door and threw my suitcase on the bus. Just as I breathlessly caught up he said, “Madam, they are taking this group to your plane, please hurry to get on…are you OK?”  Completely breathless, I could not answer but shook my head “yes” and could have hugged him.  In some moment of clarity, I reached into my vest pocket and handed him the two twenty dollar bills that I keep there—he refused, saying “No, no madam, this is my job to get you safely to your destination!”  I pressed them into his hand and said, “You have helped me more than you know, thank you for your kindness, do something nice for you and your family, please!”  The bus door closed, the security guard frowned and called me some Swahili name I have yet to translate, and we chugged to the plane.

Suddenly realizing what just happened, I scared myself enough to be very wide awake all the way to Windhoek…

So travel fans, if you are ever on the long journey to Jo’burg, I recommend a very strong cup of coffee on the last leg of the flight.  I personally like coffees grown and harvested in Africa…but any cup will do to help you avoid a fatigue-inspired “spooky passport adventure.”  If you want a few recommendations on wonderful coffees, contact me at bsumwalt@pacbell.net, and let’s have a round of applause please for a young man who works in the Johannesburg airport for his integrity, his smile and his unparalleled customer service!

Cheers,
Beverly Sumwalt