Wednesday, June 27, 2007

Two for the Road: In Africa With Nick Kristof

June 27, 2007, 12:14 pm
What We Can Do to Help
By Leana Wen

One of the most common comments we get goes: “What can I do to help? You guys talk so much about the problems, and now I want to do something.” I don’t like to bring up problems without proposing solutions. In this second-to-last entry, I propose concrete action steps to channel passion and idealism into activism and action.

Be forewarned that I don’t think that giving money is usually the best way to help. I believe that education, awareness and tangible actions multiple many times over. They are actions that, during your lifetime, will far outweigh infrequent monetary contributions. An aid worker at HEAL Africa summarized my thoughts when she said, “It’s too easy to give money and feel like you’ve helped. Doing something shouldn’t be about relieving your guilty conscience.” That said, there are many humanitarian organizations doing great things that rely on donor funds, and I do hope that you consider supporting them. I am just proposing other ways to help beyond monetary contributions.

1) Educate yourself

Exposure to and understanding of issues is the most important, and most fundamental step, of “doing something” to help. Broaden your understanding through reading and traveling. Your voice as an activist will be much stronger if assertions are backed by evidence, and if your passion and conviction is grounded in reality.

Keep the big picture in mind. I agree with Dr. Paul Farmer that too many HIV/AIDS activists ask only for more money for HIV/AIDS while neglecting related issues like malaria, malnutrition, and primary healthcare. HIV funding should not be decreased, but rather, funding should take into account the big picture to develop a “horizontal” approach to improving overall healthcare.

Spend time abroad if you can. Nick often says that a college education is not complete without spending some time in a developing country: “How can you consider yourself educated if you do not know how 1/3 of humanity lives?” For young people, there are many opportunities to volunteer or work abroad. Consider programs like the Peace Corps and National Security Education Program. Seek out internship opportunities at an U.N. agency, NGO, or religious charity organization. Study abroad. Teach English. For those past college-age, there are similar types of opportunities available with NGOs.

2) Educate others

Once you understand the issues and have spent time abroad, use your social and professional networks to educate others and share ideas. You have more networks than you might think. Forward articles to help educate family and friends. Join discussion forums. If you worked abroad or spent time researching an issue, seek opportunities in your community to give talks.

Join associations. Consider professional organizations that focus on service and advocacy. For physicians-in-training, groups like the American Medical Student Association and National Physicians Alliance are organizations that promote discussion of international health issues, service opportunities, and advocacy and lobbying. Groups like these also provide a forum for you to bring up ideas, and to receive advice from others about opportunities to assist and contribute.

3) Take action

Assist existing humanitarian aid groups. There are many excellent aid organizations worthy of your investment or volunteer time. We have listed some of the groups in the “blog roll”, and encourage that you check these out and look into other options as well. The projects I am most inspired by include ones that focus on capacity-building, peace and reconciliation, long-term economic development, community-oriented public health, education, and women’s empowerment. Horizontal programs that don’t pinpoint only one disease or only one intervention are relatively rare, but particularly effective, in addressing systemic problems.

I am also impressed by organizations that take a need-based approach to critically examine community needs. Aya Shneerson of the World Food Program talked to us about her frustrations with groups that start with the opposite approach, “It should not be about what aid groups can offer. It’s all about what the people need.” Rwanda’s President Kagame also had mixed feelings about NGOs, and said that while their overall benefit is positive, they often bring in their own agendas.

Lobby your legislators. It’s not because of politicians that the U.S. is not doing enough to help Africa or to stop the war in the Congo. It’s because we have not, as a country, expressed interest in global issues. Let’s show our legislators that we care about international health, ongoing wars, and global poverty. Let’s place public health and international development as top priorities in our foreign policy agenda. My next blog entry will mention more specifics about what our government should do; ultimately it is us who will propel our government to action.

Finally, remember that problems don’t exist just in Africa; ­injustices exist everywhere. Social activism is not limited just to the places “over there”; there are many opportunities to assist no matter where you are. Insecurity is not limited just to war-torn areas; there are destructive people and destructive values that exist in our own backyard. There is a lot we can do by assisting our own communities. Part of being globally conscious involves striving to help all those around us, to the best of our abilities, every single day.

I welcome your comments, thoughts, suggestions, and contributions.


June 27, 2007, 11:07 am
By Will Okun

My lasting image of Rwanda, the Democratic Republic of Congo and Burundi will be the children and the jarring contrast between their poverty and their beauty.

No words or images can prepare you for the poverty of the regions we visited with Nick Kristof. It is all-encompassing and numbing, the framework against which everything else happens.

The children’s clothes are holed and tattered, America’s washrags. If there are shoes, they do not fit.

Some children are mired in filth, dirt permanently clinging to their skin. More agonizing still are the children who emit a tangible aura of undiagnosed disease. You can look into their eyes and tell that they are not well.

And their desperate hunger is incomprehensible. I do not understand why their bellies protrude so fully when they are so abjectly malnourished. And yet I continue to shoo them away, trying not to think about what my eyes are seeing.

But cutting through the darkness of this poverty are the brilliant flashes of the children’s smiles.

I know a smile is only a smile. But for me, their smiles are symbols of hope and also reminders of their humanity.

I do not want to admit that sometimes I forgot that these children, struggling to strive in such bleak poverty, are still people, little different than you or me.

They play games, they sing songs, they love their parents, they desire security, they seek an education, and, most importantly, they have hopes and dreams.

Obviously these children need and deserve serious international attention and assistance so they can obtain the basic rights that should be available to all humans, regardless of where they are born.

And this is why I so respect Nick Kristof and Leana Wen. It is a given that Nick is incredibly intelligent, a gifted writer and an indefatigable reporter. But he is also an activist for global change and equality. He genuinely cares about the people he covers and he wants you to care, too.

Leana matched Nick stride for stride on this reporting trip, from her in-depth questions to her intellectual curiosity to her desire to enact change to her fluency in French to her moves on the dance floor to her tenacious work ethic. These two, seeking to give a voice to the voiceless, physically wore me out the first hour of the first day.

Finally I am grateful to everyone, including my mom, who offered feedback about my photographs on this blog. I hope these photos offer a different perspective of the people who live in the poorest regions of Africa. Beauty exists everywhere.

Next week, I will be posting the best photos from our trip on my photography website in hopes that the young people of Chicago will see the similarities between themselves and the young people of Rwanda, D.R.C. and Burundi. We are all fellow people.


June 25, 2007, 11:39 am
Where Are the Doctors?
By Leana Wen

“Can you take me back to the U.S. with you?”

My friend Dr. Dan Rudasingwa is a general practitioner (GP) at King Faisal Hospital in Kigali, Rwanda. His family returned to Rwanda after 30 years of exile in Uganda to help rebuild the country. Now he wants to leave Rwanda.

Dr. Rudasingwa loves his country. He also cares about his own future. He wants to pursue specialty training in neurosurgery, which is not available in Rwanda. Everyday, he sees patients who need brain surgery, heart surgery, chemotherapy, or other specialized treatments to survive. There is no doctor who can provide these treatments. The best he can do is to watch the patients die. The only person he was able to “save” recently was a high-level official who was airlifted to South Africa after a head injury.

The problems with health care access in Africa are often attributed to lack of resources, but a more insidious and perhaps more difficult problem is the dearth of doctors.

Africa is facing a severe crisis of doctor shortage, on a scale almost unimaginable in the U.S. and Western Europe. Rwanda, a country with 10 million people, has about 500 doctors — a ratio of one doctor per 20,000 people. This is less than 10 percent of the World Health Organization recommendation. The vast majority of the country will not see a physician in their lifetimes. The Congo and Burundi have similarly poor ratios. Suburban U.S. hospitals could have more than 200 doctors on staff, while in Burundi, 165 doctors serve 8 million people.

The shortage of specialists is particularly acute. The only cardiologist in Rwanda is a Kenyan with a two-year contract in Rwanda. There are just 10 specialists for the 5 million people in the North Kivu province of the Congo. Even at the HEAL Africa hospital in Goma, which always has at least five visiting specialists, waits for gynecological and orthopedic surgeries be 60 days.
Where are the doctors? Blame is often — and rightly — attributed to the global brain drain. One-third of practicing doctors in the US trained in non-U.S. medical schools. Lower-income countries supply between 40 to 75 percent of these foreign-trained doctors. While one can hardly fault an individual like Dr. Rudasingwa for wanting to seek new opportunities, the developed world has an obligation to ensure that we are not poaching doctors from areas where they are most desperately needed. To meet American workforce needs, we should be opening more medical schools instead of taking individuals that other governments trained and need.
In Central Africa, the pipeline for doctors hits a kink even before the brain drain occurs.

Countries are not producing nearly enough doctors. Rwanda only has one medical school. All graduates become general practitioners, but few have the option of going through specialty training. The few lucky graduates are able to obtain training in just four specialties in Rwanda — to study other fields like neurosurgery or cardiology, they have to vie for fellowship spots in Kenya or South Africa.

What can we do to help resolve the crisis of doctor shortage? I believe the solution lies in both ensuring adequate pipeline from the front end and preventing the brain drain from the bottom end.

To increase production of doctors, we should assist developing countries with building capacity for training both generalists and specialists. GPs are easier to train, and one way to help is to assist medical schools with their curriculum. I was astounded that no textbooks are used in the medical schools of the three countries we visited. Following a standardized curriculum could make medical education easier to expand to more students.

We can increase specialty training by developing short modular training courses. There are many Western doctors who go abroad for health care work. While the medical care delivered by visiting doctors will assist patients, what will help patients more is training local doctors. An intensive 3-month training session might not be enough to teach complex brain surgery, but would be enough for a doctor to be comfortable performing c-sections or managing diabetes.

Capacity building for health care has much longer-lasting and wider-ranging effects than delivering direct care.

To prevent brain drain to developed countries, we should strive to retain qualified and trained doctors to serve their own country. As an immigrant, I certainly understand the desire to pursue a better future, especially if one’s own country is mired in poverty and conflict and offers little prospect for advancement. Restricting immigration is not the best policy. Rather, incentives should be created to retain doctors, such as better pay, more autonomy, and more resources to better assist patients.

There is also a recent trend of an internal brain drain from the public sector to private NGOs. In Rwanda, well over half of the national health spending is from international NGOs, many of which have recruited physicians away from working in public hospitals by offering higher salaries and better benefits. A more responsible policy for NGOs is to tie their work to existing public infrastructure. Dr. Paul Farmer’s clinic in Rwinkwavu, Rwanda, is a good example of private funding to assist a public hospital. All of the doctors in the Partners in Health hospital work for the public sector, yet also receive competitive benefits.

Finally, not everyone needs to see a doctor. We can work to train ancillary staff and community health workers. Just because their abilities are limited doesn’t meant that we should not provide formal training and fair pay, and hold them accountable for their responsibilities.

I believe that most physicians enter medicine for the right reasons, and have a strong sense of social responsibility to provide for their country. Dr. Rudasingwa said that there is no question he would stay in Rwanda if he can get trained as a neurosurgeon and has the equipment to help his patients. We should do what we can to help him stay in his country, and do our best to alleviate the overall doctor shortage crisis in the developing world.


American Medical Student Association From Leana: "The U.S.'s largest independent organization of physicians-in-training committed to training socially responsible physicians who will shape the future of healthcare and medical education."
CARE International Humanitarian oragnization that fights global poverty, with particular focus on women.
Casey Parks: On the Ground With Nick Kristof The first Win-a-Trip winner, Casey Parks, wrote about Cameroon, the Central African Republic and Equatorial Guinea in Sept. 2006.
Doctors Without Borders International humanitarian aid organization that provides emergency medical assistance to populations in danger in more than 70 countries.
HEAL Africa Provides holistic care to people in the Democratic Republic of Congo, through medical services, community-based development, and training of health professionals.
Human Rights Watch Investigates human rights abuses around the world and publishes findings to advocate for changes in policy and practice.
National Physicians Alliance From Leana: "A new organization of physicians committed to advancing the core values of the medical profession: service, integrity, and advocacy."
Norwegian Refugee Council Provides humanitarian assistance to refugees, internally displaced persons (IDPs) and returnees.
On the Ground With Nick Kristof The columnist's blog, where he'll also post about the trip with Leana and Will.
Orphans of Rwanda Helps orphans and vulnerable children in Rwanda work toward university degrees and ultimately become leaders in their communities.
Partners in Health International organization co-founded by Dr. Paul Farmer to provide medical care and social services.
Refugees International Advocacy organization that provides humanitarian assistance and protection for displaced people around the world.
WE-ACTx The Women's Equity to Access, Care and Treatment provides holistic care to women HIV-positive survivors of the 1994 Rwandan genocide.
Win a Trip Contest Read other finalists' essays and learn more about this year's contest.
Women for Women International Assists women survivors of war to move toward economic self-sufficiency through small business deveopment, job training, and rights education.
Working Bikes Group that salvages trashed bikes in Chicago, repairs them, and redistributes the bikes both locally and internationally.
World Food Program The U.N. food agency that delivers food aid to 90 million people in 78 countries.


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