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PBS Blog Features Stories Looking At Mobile Technology And Health In Africa

It’s an exciting time for people who care about global health and want to learn more. The last few months have seen the launch of new resources, including three new journals. I am especially excited about this first one. Global Health: Science and Practice is aimed especially at global health practitioners, with a focus on bringing grey literature into general access. In terms of providing high quality science that’s immediately useful, this could be a game changer.

Original article - 

Tomorrow’s Tools: New Global Health Resources

Can you tell me about yourself and your work a bit?

I’m British, I worked for 10 years in Chad for SIL. I now live in Kenya, my wife and I live there. My current role is that I do international relations, external relations. I spend a lot of my time talking to international and intergovernmental organizations, to try and help them think about the language and culture components of development.

Tell me something about SIL, and how you all became so involved in advocating for minority language communities.

We started out as a group of Christians who wanted people to be able to read the Bible in their own language. However, in order to do that, they had to develop a whole load of other skills and competencies related to analyzing how a language works. So we developed a whole load of linguistic skills, and then other people wanted to acquire those skills. So we started running training schools. But it’s grown from that into a language development NGO.

It does seem like of your work is focused on developing literacy tools for minority language. What about languages (or groups of people within a minority language community, such as women) for whom their native language might be mostly oral?

Women in particular usually have less social mobility, particularly in socially conservative societies. Women—-girls—-usually get less exposure to official languages than boys and men do. Therefore women and girls benefit more from local language literacy and opportunities than boys do, because boys can generally make more of the official educational system, if it’s in the official language.

Again, we’re primarily speaking to a global health audience here. So, with that in mind, why do languages matter? From the standpoint of someone who wants to reduce child mortality rates, for example.

Well the obvious first answer is the communication aspect. If the mothers can understand the message about, say, oral rehydration solution for babies that have diarrhea, they are obviously going to be better equipped to follow the instructions.

I think also there’s the question of trust. You are more likely to trust a health professional if they speak your language and understand your culture. So the more trust there is between patient and provider, the more likely you are to get compliance.

Do you think that some of the charges of “non-compliance” in global health are really just lack of understanding and language/culture barriers?

I also have to say, it’s a bit of a cop-out for health professionals to say that these people don’t care for their children. Every funeral I’ve been to, the mother cries for the child. It’s not that they don’t care.

I remember my wife telling me, she had a conversation with a new mother in Chad. This new mother was expressing the [colostrum], because she wanted to get rid of [it] to get to the good stuff. When my wife explained, no that’s the good stuff, that’s what they really need, the mother said, “Why does no one tell us these things?”

When we lived in Chad, 90% of women were illiterate, which had a huge impact on the amount of information they had. One of the major motivations for women’s literacy classes is that they really want to understand better how they can look after themselves and their families. It’s a basic desire that every parent.

With the materials that UNESCO and SIL have developed about MDGs and language development, how has that message played to the development community? Do the people you talk to get it?

It’s beginning to play well. I’ve been surprised at how long its taken for these things to catch on. It seems that the development community is rapid and fast-moving. However, at the same time, new ideas are relatively slow to catch on.

We published this booklet, Why Languages Matter, in 2008, linking the role of language to achieving the MDGs. Also, with UNESCO we’ve come up with another similar booklet, which gives a strong impression.

I think that development agencies have tried to introduce concepts that are too foreign for the people they are trying to reach. Different cultures understand the world in different ways. There’s an aboriginal group in Australia, the Kuuk Thaayore,, who have a highly developed feel for ordinal directions. So rather than say “my right ear hurts” they’ll say “My NW ear hurts”. Or if they were facing the other way they’d say “my SE ear hurts”. And the way they think about space also affects the way they think about time. Whereas English speakers tend to conceptualize time as running from left to right (because we read that way), the Kuuk Thaayore visualize time as running from East to West. The more alien a development intervention appears to a people the less likely they are to trust it and own it. The closer it fits with their sense of how the world works, with their language and culture, the more likely it is that they’ll commit to it and try to make it work. I read a good quote from UNESCO this morning,

“Cultural approaches to development increase the relevance, sustainability, impact and efficacy of interventions by responding to local values, traditions, practices and beliefs”

So that’s why we are trying to make explicit the connections between language and culture and development goals.

This all seems so obvious and straightforward, and yet as you say its been slow to play. I wonder why this is? My own experience with this has been that language is always a minor technical appendix to any larger development implementation plan.

I think the main reason is that it is hard work. 40% of the world’s languages don’t have a writing system. Development agencies are under pressure from donors to get results, and they just don’t have the linguistic skills or time. So the simplest thing is just to use the official language. Very often they’ll use a local interpreter. But these interpreters just happen to speak both languages, they’ve never been trained in interpretation or translation, and so a lot of information gets lost in the process.

I wonder if another problem might be the lack of hard data showing that local language implementation has, for example for the global health audience, measurable impact on health outcomes.

When I’ve been doing advocacy with the World Bank, they say to me, well you’ve got lots of nice stories, but it’s all anecdotal, and we can’t base policy on anecdotes. In the particular area that we are interested, which is mother tongue based multilingual education, we are now running longitudinal studies under rigorous scientific conditions to demonstrate this. You are right, there is a lack of hard data. In November 2010, the UN General Assembly passed a resolution calling upon governments, NGOs, and the intergovernmental agencies, to do research to better understand the relationship between culture and development.

In our experience, it’s been hard to run these studies, because it seems so ethically suspect to provide services to a minority language community in the dominant language, that there is no control group.

Yeah, we have a similar problem. One of the reasons that we have had a hard time getting longitudinal data on multilingual education, is that the children in the local language school were enjoying school so much, attendance and tests scores went up, everything was going so well, that the parents in the control school didn’t want to carry on. That in itself is evidence, however.

Where do we stand in terms of examples of good, effective collaborations between the development industry and language and culture advocates?

I would say that it is still in the early days. Two years ago, World Vision decided they needed to pay attention to local languages. They asked us to work with them on that, and our chief multilingual education expert now sits on their education committee. The World Bank also conducted a review of their education programs, and concluded they were doing a good job of improving access but not improving outcomes. So, two years ago, for the first time, they added to their policies that the language of instruction is an important component. So we are seeing these things starting to come to fruition.

Where can global health practitioners interested in local language development learn more about these issues?

We have running training workshops for UNESCO and for UNICEF to help train their staff in these issues. Its beginning, people are beginning to take interest. In the area of health, we’ve produced a lot of content in local languages. Over the last 70 years we’ve produced about 11,000 of those are in local languages. We have recently put this digital archive online. So you can go there and put in the name of a language and pull up a list of all the documents we’ve produced in a Language and Culture Archive. So, for example, there might be a booklet in a local Mayan language about malaria, or what to do when a child has diarrhea, or how HIV gets spread, those kinds of things. In a local language, for local people to read. That might be of interest to your community.

I wanted to end this interview by getting your perspective on language loss, which we haven’t specifically addressed so far. What does it mean for development when languages disappear?

The warning call for language loss was sounded about 20 years ago. In 1992 the linguist Michael Krauss wrote a paper entitled “The World’s Languages in Crisis” in which he likened endangered languages to endangered species. He estimated that as many as 50% of the world’s languages are no longer being learned by new generations of speakers, leading him to conclude that “the number of languages which, at the rate things are going, will become extinct during the coming century is 3,000 of 6,000.”

Parents say, our language is of no value and our children are going to be best served if they grow up monolingual in Spanish. And so they deliberately withhold their language from their children, thinking they are doing them a good turn. You only need to have that happen for a few generations and the language is gone.

Last year SIL published a paper marking the 20th anniversary of Michael Krauss’s paper. We’re a bit more optimistic particularly for African language, because a large proportion are at that vital level. Whereas in the Americas where you are working, 60% of America’s languages are either in trouble or dying. Whereas in Africa only 16% of the languages are in trouble or dying. So language endangerment is a much bigger threat in the Americas than in Africa.

I think the community of people who love human linguistic diversity get these arguments. But say I go to a meeting with a bunch of elite policy folks, and they say, “So what? It would be better and easier if everyone just spoke Spanish or English.”

If language were only a means of communication, I would say absolutely. But language is so much more than just a means of communication. It’s a key component of our identity.

Dave Pearson has worked for minority language development with SIL International for 30 years, including 10 years in Chad. He is based in Nairobi, Kenya and is currently SIL’s Permanent Representative to UNESCO. Dave advocates with governments and international and intergovernmental organisations to create a positive policy environment for linguistic diversity.

The goal of the session is to train leaders to effectively design and manage programs that improve health outcomes for the populations they serve. Applicants should have a demonstrated commitment to global health and experience in global health organizations, with a substantial background in health care or a related field. International candidates are encouraged to apply.

Applications and supporting documents must be received by March 1, 2013.

The intensive summer program consists of three credit-bearing courses led by senior Harvard faculty:

• Epidemiologic Methods for Global Health (2.5 credits): covers introductory level epidemiology and a biostatistics primer introducing basic principles of statistics, with a specific focus on problems related to global health.

• Value-Based Management in Global Health Care Delivery (1.25 credits):educates students in the fundamental principles of organizational behavior, strategy, operations management, leadership and financial accounting relevant for work in leading global health programs.

• Introduction to Global Health Care Delivery (2.5 credits): engages students in the analysis of case studies that describe efforts to improve health care delivery in resource-poor settings. Classroom discussion of these cases will illuminate principles and frameworks for the design of efficient and effective global health interventions.

The program is co-sponsored by the Harvard School of Public Health and Harvard Medical School, under the direction of Harvard faculty on the staff of Brigham and Women’s Hospital. This program is one of many developed by the Global Health Delivery Project at Harvard University.

To learn more about the Global Health Delivery Summer Intensive (GHDI), and for application instructions, visit http://bit.ly/GHDI_Ghh13.

To access the GHD case studies that will be taught, please visit www.ghdonline.org/cases.

You may also contact ghe@globalhealthdelivery.org for more information.

• Heroin dependence treatment reduces HIV infections in Spain
• Methadone treatment among HIV-positive injecting drug users in China
• Systematic review: death rates of injecting drug users 15 times higher than in general population
• WHO database allows cost comparison of methadone
• Opioid treatment in Ukraine risks losing momentum
• New treatment gives hope to East Africa’s injecting drug users
• Interview: is legalization a policy option for governments?
• Malaysia’s methadone programme in prisons
• The pros and cons of compulsory treatment for drug dependence

You can now read the Bulletin on a variety of different formats. The journal is now available on electronic publishing devices, Kindle readers and as a Digital Accessible Information System (DAISY) digital talking book.

Complete list of contents for Volume 91, Number 2, February 2013, 81-156.

Abstracts and other items are available in عربي, 中文, Français, Русский and Español.

Link:
Healthy Dose: New Report Illuminates Changing Global Disease Burden

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3 Ways to Prevent Premature Birth in Africa

Nathan Ford and Philipp du Cros  from Médecins Sans Frontières ask whether it is time for ‘Meta-analysers without Borders’ A couple of sample dilemmas faced recently in the clinical programmes of the medical humanitarian organisation Médecins Sans Frontières (MSF)/Doctors Without Borders: “This HIV-positive woman in her 1st trimester of pregnancy is currently on an efavirenz-based regimen, what should we do?” “The patient I just saw in clinic has HIV infection and is hepatitis C antibody positive; he is doing well on antiretrovirals. His liver function is mildly abnormal – he asked whether we can treat the hepatitis C. Can we treat hepatitis C in this country?” Epidemiology done well asks important questions, and answers them reliably. But for health-care workers in resource-limited settings the evidence base to answer their questions is all too frequently weak. Systematic reviews and meta-analyses are a powerful way of informing policy and practice

Continue at source: 

Gathering the Evidence to Improve Health Care in Developing Countries:…

Background: Economically developed countries have recruited large numbers of overseas health workersto fill domestic shortages. Recognition of the negative impact this can have on health care indeveloping countries led the United Kingdom Department of Health to issue a Code ofPractice for National Health Service (NHS) employers in 1999 providing ethical guidance oninternational recruitment. Case reports suggest this guidance had limited influence in thecontext of other NHS policy priorities. Methods: The temporal association between trends in new professional registrations from doctorsqualifying overseas and relevant United Kingdom government policy is reported.Government policy documents were identified by a literature review; further information wasobtained, when appropriate, through requests made under the Freedom of Information Act.Data on new professional registration of doctors were obtained from the General MedicalCouncil (GMC). Results: New United Kingdom professional registrations by doctors trained in Africa and south Asiamore than doubled from 3105 in 2001 to 7343 in 2003, as NHS Trusts sought to achieverecruitment targets specified in the 2000 NHS Plan; this occurred despite ethical guidance toavoid active recruitment of doctors from resource-poor countries

More here: 

Effect of UK policy on medical migration: a time…

This time around, I’ve updated our table and added a few more journals that regularly publish articles on global health – you can view it below. It’s not an exhaustive list, just the ones I know about. Fingers crossed the excellent journal Global Health Governance gets a mention by Reuters next year.

Global Health Journals 2012

GHHub Journal Track RSS or follow @GHHub for a weekly digest

Thanks to Victoria Fan, Monica Green, Igor Rudan, and Judith Green for their suggestions for journals to include – I’ve added them all to the new table. If anyone has further suggestions for next year, please leave a comment.

Andrew

In the editorials of this special theme issue on e-health, Najeeb Al-Shorbaji & Antoine Geissbuhler (322) discuss how to establish an evidence base for e-health, while JEWC van Gemert-Pijnen et al. (323) look at ways to improve the credibility of e-health technologies.

In the news section, Claire Keeton (326–327) examines ways of measuring e-health impact, while Michael Dumiak (328–329) looks into the future of e-health. In an interview, five leading e-health thinkers (330–331) debate key challenges in the field.

Zambia

Using mobile phones for HIV diagnosis

Phil Seidenberg et al. (348–356) examine how mobile phone texting helped diagnosis in infants.

Brazil

Improving patient care

Maria Beatriz Alkmim et al. (373–378) assess how a telehealth network has helped patients in Minas Gerais.

United Republic of Tanzania

Improving data quality

Jørn Braa et al. (379–384) examine how workshops have boosted data use in Zanzibar.

Madagascar

Keeping track of influenza

Soatiana Rajatonirina et al. (385–389) look at the African island’s ‘real time’ surveillance system.

Africa, Cambodia, Pacific Islands, Ukraine

Humanitarian telemedicine

Richard Wootton et al. (341–347) discuss how telemedicine delivers humanitarian services.

Global

e-health in low and middle-income countries

Trevor Lewis et al. (332–340) present findings from the Center for Health Market Innovations.

e-health boons and barriers

Frances S Mair et al. (357–364) examine factors that promote or inhibit e-health implementation.

Impact of e-health

John D Piette et al. (365–372) discuss the next step for e-health in low and middle-income countries.

Changing behaviour through m-health

Harsha Thirumurthy & Richard T Lester (390–392) see how m-health can be used in resource-limited areas.

m-health: care in your pocket

Alastair van Heerden et al. (393–394) offer a research agenda.

e-health collaboration

S Yunkap Kwankam (395–397) says organized national infrastructure is needed for e-health.

Health research and the public good

John-Arne Røttingen et al. (398–400) examine how to secure research in developing countries.

Don Draper is the brilliant, albeit emotionally troubled, main character. Episodes frequently portray him meeting with potential clients. After listening to clients describe their company, products, and goals, he’ll turn and say, “So what’s your strategy?” The clients look dumbfounded. They don’t realize they haven’t articulated a clear strategy — a unique position to meet a customer’s needs. So before Draper can help a company make money with a clever advertising campaign, he first has to help them figure out their strategy.

For nearly two years, I’ve worked at the Global Health Delivery Project at Harvard University. Our focus here is on studying the delivery of health interventions in resource-poor settings. What we’ve learned is that before an organization can become more effective at delivering programs and interventions, the leaders first need to articulate their strategy.

Leaders of global health organizations often can list their values, their mission statements and why they’re doing good in the world, but less often can they articulate a cohesive and pointed strategy. That doesn’t mean they don’t have one, they just haven’t had anyone like Don Draper come in and draw it out of them.

Effective delivery starts with strategy — choosing which activities to do and making tough tradeoffs about what not to do or whom not to serve. When leaders can articulate their strategy clearly, employees throughout the organization have a compass guiding their daily activities. In writing “Doctors without Orders,” Josh Ruxin described how the lack of emphasis on good management skills in global health impedes progress. Certainly that is true, but a precursor to good management is a solid strategy.

At the Global Health Delivery Project, we write case studies about global health delivery efforts that describe the tough strategic choices leaders face amid incredible complexity. By putting these implicit strategies and practical knowledge on paper, we aim to foster systematic analysis of successes and failures in global health delivery, as well as teach new students.

Twenty-one of these cases are now available for free online via Harvard Business Publishing. Anyone can download them (Though it says you have to be an educator, you don’t to get the case study and only to get the accompanying teaching note). Read more about the cases and how to download them here.

The Global Health Delivery Project plans to build a global faculty network to teach these free case studies and widely disseminate knowledge about strategy and delivery. After completing the case-based course, ideally students would go on to lead global health efforts and have a concrete answer when someone asks, “So what’s your strategy?”

See the article here:
SHOPS e-Conference: Integrating Zinc into Diarrhea Management

The GHhub is starting to experiment with aggregating educational resources from around the web. We are going to be looking for PPTs, YouTube videos, PodCasts, handouts and other forms of educational media. Please email us if you have any suggested sources or other comments. admin [at] globalhealthhub.org

Pediatric Traumatic Brain Injury talk Uganda