http://www.nytimes.com/2009/09/10/world/10child.html?ref=health

-From the personal diary of Brittani Jackson, 9.15.08

Since the 1980s, when the Human Immunodeficiency Virus (HIV) was just beginning to be placed on the global health agenda, the illness has aroused a cornucopia of complex human responses. From the beginning, stigma has been a barrier to HIV prevention and care. The effects of stigma have been devastating—it has negatively impacted people’s ability to access HIV testing, counseling, diagnosis, care, treatment and prevention messages. It is my contention that stigma and discrimination are the true evils behind the spread of the HIV/AIDS epidemic; they are the major obstacles to effective HIV/AIDS prevention and care.

Is stigma truly a health issue? According to the prominent literature and experts on the topic, the answer appears to be a resounding “yes.” Because of its connection to HIV/AIDS, which is arguably the largest health issue currently faced by South Africa, AIDS stigma is a phenomenon that cannot be ignored. At the end of 2007, approximately 5.7 million people were living with HIV in South Africa; almost 1,000 deaths due to AIDS occurred every single day (UNAIDS 2008). It is thought that almost half of all deaths in South Africa, and a staggering 71% of deaths among those aged between 15 and 49, are caused by AIDS (Centre for Actuarial Research, 2006). In some parts of the country, so many people are dying from AIDS, cemeteries are literally running out of space for the dead (Wines, 2004).

But, more important than facts and figures, spending time in the rural, peri-urban, and urban areas of South Africa has allowed me to experience firsthand the toll HIV/AIDS has had on the hearts, minds, and spirits of the inhabitants of this country. In Impendle, I met a handful of energetic children at the local daycare center, full of innocence, and quick to open up to us. Many of them would never have a clear recollection of their parents, as they had been taken by the epidemic. In Cato Manor, where I spent five weeks chatting with the elders, playing games with the youth and getting to know my neighbors, the scrounge of HIV was ever-present. The evidence of stigma lingered in the air when there was talk of funerals, and people dying of “bewitchment”, it lay buried in the voices of mommas who spoke sadly of the children that they’d “lost”; it was etched in the hearts of the gogos (grandmothers) struggling to hold entire households together with meager social grants. In Amatikulu, the effects of HIV/AIDS were even more pronounced. Following NoThula, a community health worker, home-to-home cross dusty roads and wide expanses of land, I stared the disease in the face. Every single person we visit was infected, and on top of that, was living in abject poverty.

Defining HIV/AIDS Stigma

The complex social, psychological, cultural, and biophysical aspects of HIV/AIDS lend to it the potential for multidimensional stigmatization. Indeed, leading social scientists Alonzo and Reynolds describe no less than six reasons why HIV/AIDS arouses such a negative stigmatic response (Alonzo & Reynolds, 1995). Possessors of HIV and AIDS are stigmatized because their illness is:

(1) Associated with deviant behavior—both as a product and a producer of such behavior
(2) Viewed as the responsibility of the individual
(3) Thought to be contracted via a morally sanctionable behavior and therefore thought to represent a character blemish
(4) Perceived as contagious and threatening to the community
(5) Associated with an undesirable and an unaesthetic form of death
(6) Not well understood by the lay community and viewed negatively by health care providers

Interestingly, while other illnesses or character blights can be said to stigmatize individuals differentially, HIV and AIDS are almost completely universal in their negative evaluation (Alonzo & Reynolds, 1995).

“The labeling of persons is about power,” lectures Catherine Burns, an expert on maternal health (Burns, CHS 27: Fluids, Stigma, and Local Knowledge, 10.20.08). As it turns out, women, youth, the elderly, and the poor—people who are socially disadvantage before they even contract HIV/AIDS–are the ones most seriously affected by stigma relating to the disease (Campbell, Nair, Maimane, & Sibiya, 2005). They also have the hardest time challenging or resisting the stigma.

Stigma directed at people living with HIV or AIDS directly interrupts attempts to fight the AIDS epidemic as a whole. AIDS stigma operates at the individual/community, and the nationwide level.

At the Micro Level

Research has shown that AIDS stigma can have a variety of negative effects on HIV test-seeking behavior, willingness to disclose HIV status, health-seeking behavior, quality of health care received, and social support solicited and received (Brown, Macintyre, & Trujillo, 2003).

In a 2008 study by Kalichman & Simbayi, it was found that people who had not been tested for HIV and those who had been tested but did not know their results held significantly more negative attitudes regarding testing than individuals who had been tested and particularly people who knew their test results. Individuals who had not been tested for HIV demonstrated significantly greater AIDS related stigmas. In other words, they ascribed greater shame, guilt, and social disapproval to people living with the illness, held the belief that the people with AIDS must have done something wrong to have AIDS, and were more likely to agree that people with AIDS should not be allowed to work with children (Kalichman & Simbayi, 2008). AIDS stigmas, therefore, negatively impact HIV testing rates. Besides HIV-testing rates, stigmatization and discrimination also affect peoples’ motivation to access prevention services (Chesney & Smith, 1999).

Silence and denial are common reactions to social stigma. For some, fears that HIV testing is not confidential, which could lead to unwanted disclosure to family, employers and the community and ultimately discrimination, prevents them from seeking out the service (Brown, Macintyre, & Trujillo, 2003). This mentally is often set in communities where there is little treatment available for the majority of HIV-positive individuals in the first place. A commenter on the AIDS situation in Zimbabwe summed this up most effectively, saying, “Why should I go and get tested when I know for a fact I won’t be able to get the necessary treatment?’” People who contract HIV/AIDS over their life course (i.e. not born with the disease) are likely to have internalized the widespread stereotypes associated with their illness through the process of socialization prior to contracting it themselves (Wright 53). Because of this, such patients often experience high levels of social isolation and social rejection.

Physical harm of people living with AIDS is also not uncommon in developing countries. One of the most publicized events of this type was the slaying of Gugu Dlamini, an AIDS activist in South Africa. She was stoned and stabbed death by members of her community for openly disclosing her HIV status. This occurred less than two months after Deputy President Thabo Mbeki made the Declaration of Partnership Against AIDS, in which he called for an end to discrimination against people living with HIV (Mbeki, 1998).

On the household level, stigma affects how many conceptualize deaths associated with AIDS. Funerals are a common event for most South Africans. Mama Zodawa, was no stranger to them: “I go to a funeral every weekend it seems like,” she told me once (personal communication, 9.12.08). I can still recall her putting on her dark clothing and preparing for the event. She complained that she didn’t really want to go—however, she felt she must because she wanted to make sure “it [would] be done for her” upon her passing (personal communication, 9.12.08). At the funerals of those who have died of AIDS, kin rarely announce the cause of death (Campbell, Nair, Maimane, & Sibiya 2005). Death of family by AIDS can contribute to financial insecurity (funeral costs, lost of a source of income) and tends to exacerbate situations of poverty.

In the workplace, people living with AIDS may be stigmatized by their co-workers and employers. This could lead to ostracism, ridicule, or other discriminatory practices such as termination or refusal of employment (AVERT Online, 2008).

These and other individual, household, and community stigma-related issues come together to create major health issues at a much larger scale.

At the Macro Level

Beyond the suffering that HIV has inflicted at the individual and community level, the AIDS epidemic, maintained largely because of social stigmas, has substantially impacted the South Africa’s overall social and economic progress. Some of these changes include:

Shortened life expectancy: It is estimated that without AIDS, the average life expectancy would be 64 years. Currently, it is 54 years. Over half of 15 year olds are not expected to reach the age of 60 (Centre for Actuarial Research, 2006).
Slower development: During the period between 1990 and 2003, when HIV prevalence in South Africa dramatically increased, the country fell a tragic 35 places in the Human Development Index, a global directory that ranks countries by how developed they are (UNAIDS/WHO, 2006)
Strain on health centers: In 2006, it was estimated that HIV-positive patients would soon account for 60-70% of medical expenditure in South African hospitals. Hospitals are already struggling to cope with the number of HIV patients they have to care for—patients are often turned away, especially in rural areas (Steve Reid, CHS 28: Expanding Access to Health Care, 10.20.08).

In addition, the stigma associated with HIV can prevent government from taking quick, useful action against the epidemic. Governments can actively discriminate against people or communities with HIV/AIDS. Laws, particularly those that insist on compulsory notification of HIV/AIDS cases or the restriction of an infected person’s right to travel, have been justified on the grounds that the disease poses a public health risk (Avert Online, 2008).

Conclusion

So where do we go from here? Stigma is clearly an issue in the fight against AIDS, but how do we go about eradicating it? Although the visibility of HIV and AIDS has increased in recent years, the amount of stigma attributed to it has not. Because social stigma precedes a slew of psychological, social and economic barriers to health, it is of great importance that South Africa, and the international community at large, pay more attention to this problem—and work to implement create interventions that will help alleviate stigma on a significant scale.

1. WHO. (2008). Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector: Progress report 2008. Geneva.
2. Centre for Actuarial Research, South African Medical Research Council and Actuarial Society of South Africa. (2006).
The Demographic Impact of HIV/AIDS in South Africa: National and Provincial Indicators for 2006.
3. Wines, M. (2004, July 29). South Africa “recycles” graves for AIDS victims. The New York Times .
4. Alonzo, A. A., & Reynolds, N. R. (1995). Stigma, HIV and AIDS: An Exploration and Elaboration of a Stigma Trajectory. Social Science Medicine , 303-315.
5. Burns, D. C. (2008, October 20). CHS 27: Fluids, Stigma, and Local Knowledge. Durban, Kwa-Zulu Natal, South Africa.
6. Campbell, C., Nair, Y., Maimane, S., & Sibiya, Z. (2005). Understanding and Challenging HIV/AIDS Stigma. HIVAN Community Booklet Series . Durban, Kwa-Zulu Natal, South Africa: Center for HIV/AIDS Networking (HIVAN).
7. Brown, L., Macintyre, K., & Trujillo, L. (2003). Intervention to Reduce HIV/AIDS Stigma: What Have We Learned? AIDS Education and Prevention , 49-69.
8. Kalichman, S., & Simbayi, L. (2008). HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa. Sexually Transmitted Infections , 442-447.
9. Chesney, M., & Smith, A. (1999). Critical delays in testing and care: The potential role of stigma. American Behavioral Science, 1162-1174.
10. Campbell, C., Foulis, C. A., Maimane, S., & Sibiya, Z. (2004). Supporting Youth: Broadening the Approach to HIV/AIDS Prevention Programmes. Retrieved from HIVAN: http://www.lse.ac.uk/collections/socialPsychology/pdf/final_hivan_youth.pdf
11. Mbeki, Thabo. “Declaration of Partnership Against AIDS.”Durban, South Africa. 9 Oct. 1998
12. personal communication, 9.12.08
13. AVERT. (2008). Stigma, discrimination and attitudes to HIV & AIDS. Retrieved from Avert: AVERTing HIV and AIDS: http://www.avert.org/aidsstigma.htm
14. Reid, D. S. (2008, October 20). CHS 28: Expanding Access to Health Care. Glenmore, Durban, Kwa-Zulu Natal, South Africa.
15 Campbell, C., Nair, Y., & Maimane, S. (2006). AIDS stigma, sexual moralities and the policing of women and youth in South Africa. Feminist Review , 132-38.
16. Photo Credit: https://www.noedhjaelp.dk/var/storage/images/media/billeder/lande/zambia/zamani_support_group_totredjedel/73356-2-eng-GB/zamani_support_group_totredjedel_totredjedel.jpg
17. Photo Credit: http://www.alertnet.org/thefacts/imagerepository/INhivboy238.jpg

In fact, not only is the thought of breast reduction surgery becoming more prevalent in the minds of men, but it has become a reality in the UK.2 Between the years 2007 and 2008, there was a 44% increase in male breast reduction procedures. 2 This is staggering, and could suggest several things. It might illustrate the results of an increasingly obese population, the consequences of media scrutiny on political figures and actors alike, or a generally more tolerant global community when it comes to issues of male identity.2

Gynaecomastia is an excess of male breast tissue that can lead to the formation of pockets of breast tissue and fat resembling breasts, sometimes called man boobs or moobs. Obesity has certainly become a factor in the increasing number of plastic surgery cases being sought to correct this overdeposit, but how much of a factor?2 In the UK alone it is estimated that 67% of all men are either overweight or obese.5 This is a huge number, but even in light of a statistic as dramatic as that one, it is believed that it has only accounted for one-third of the breast reduction surgeries in men.2

More and more, it is common to see critiques of the male physic. Critics are no longer bringing out the red pen for women only, or for people in only certain kinds of professions. We are constantly bombarded with billboards, television commercials, and magazine covers showing men with chiseled bodies, well defined muscles, and less than 5% body fat. These pictures send a message about what the ‘ideal’ male body looks like, or at least the body the media will applaud. So, when politicians like Prime Minister Tony Blair are laid out on the chopping board to show the public what not to look like, mobs and all, the public is sent a clear message. But the media also offers people a solution by publically highlighting stories on plastic surgery, crash dieting, and other instant fixes as the ‘magic bullet’ to all their problems.

Obesity and the media’s sting aren’t the only influences on a man’s decision to resort to plastic surgery as a solution to their moobs. Today, more than say fifty years ago, there is a larger community willing to publically discuss their concerns on what is considered a feminine characteristic. The internet offers a plethora of opportunities for men to seek answers, information, or support. Blogs, chat-rooms, and discussion boards allow men to here the stories of others that have trod the same path, and carefully examine all the options. Fifty years ago, men facing crises about their body were often ridiculed by classmate, peers, and society, but today they have something that wasn’t available before: a place to talk, read the stories of men ‘just like them’, and research possible solutions, including plastic surgery.

But this negative feedback loop between identity crisis and plastic surgery, strongly perpetuated by the media, is not limited to the UK. It is prevalent both across the Atlantic pond and in mainland Europe. A study conducted by Pope et. al. tested a hypothesis that men from Western nations would prefer leaner more muscular body builds than the ones they had or thought they had.1 The studies featured college-aged men from the US, France, and Austria. Researchers measured the height, weight, and body fat percentage of each man, and then asked them to use a computer program to create a man depicting their body, the ‘ideal’ body, and the body they would like to have. Interestingly enough, their results showed that the participants from all three countries chose an ideal body with approximately 28 pounds more muscle and that women liked a man with about 30 pounds more muscle than they themselves had.

The area of women and body image has been studied relentlessly. Entire books and multitudes of journal and magazines articles have been written on the matter. Few studies, like the one made by Pope et. al., have been completed;it is a relatively recent area or interest, but the field is beginning to grow. The research currently in development and the studies to be designed in the future give us an insight into the role body image stigma plays on the actions and thought of men. This will not only help bridge the gap that has long divided the sexes but will also link the world intercontinentally. It elucidates a similarity between our nations, putting us on common footing with a common language, and encourages us to fight the battle of body image together.

1. Harrison G. Pope, Jr., Amanda J. Gruber, Barbara Mangweth, Benjamin Bureau, Christine deCol, Roland Jouvent, and James I. Hudson. Body Image Perception Among Men in Three Countries. Am J Psychiatry, Aug 2000; 157: 1297 – 1301.
2. Roher, Finlo. “Just what is it about mobs?” BBC News Magazine. 28 January 2009. 11 March 2009. .
3. Schooler, D., & Ward, M. (2006). Average Joes: Men’s relationships with media, real bodies and sexuality. Psychology of Men & Masculinity, 7, 27-41.
4. The Media Assault on Male Body Image. Seed Magazine. 15 September 2006. 11 March 2009. 11 March 2009. .
5. “Obesity General Information.” Department of Health. 20 February 2008. 12 March 2009. < http://www.dh.gov.uk/en/Publichealth/Healthimprovement/Obesity/DH_078098>.
6. “Statistics Related to Overweight and Obesity.” Weight-control Information Network. May 2007. 12 March 2009. < http://www.win.niddk.nih.gov/statistics/>.

“Having traveled numerous times, I was accustomed to having my viewpoints and beliefs challenged by other cultures and different ways of life. However, this trip in particular opened my eyes to the lifestyle of those who have just enough to get by to survive in a Latin American country.”
- Gaby Rocha

“Project Panama gave me the opportunity to embrace a culture far different from my own. Traveling in the Diablo Rojo, learning the traditional songs and dances, and sleeping under a mosquito net were just a few events that made my experience very memorable.”
- Suganthi Kandasamy

“I learned that small actions can have a big impact. The people we met recalled visits from the Red Cross and NGOs that had occurred years ago. The people appreciated that we cared enough to give our presentations, and were curious to learn more about us. The people approached us with such interest, that I am sure they will talk about our visit for many years to come.”
- Scott Hayes

Holloway’s short and concise memoir is a quick and intriguing read that delves into the many issues associated with international maternal health care. Holloway spares the reader no details of the trauma and suffering that the people in her host village endure. It would be impossible for Holloway’s readership not to come away with an understanding of the pain and sickness that engulfs this African country.

Her story is centered on Monique Dembele, the young midwife in the village of Nampossela, who is the sole healthcare worker in the surrounding area. The experiences in the “birthing house” bring into sharp focus the differences between western and African maternal care. Rubber gloves, clean sheets, and individual beds – these are all commodities we in America take for granted but are hard to come by in Mali.

The book also chronicles a number of women and men close to Monique or in need of her care. We get a glimpse into the lives of every type of person in the village. We learn about how they store medical records of children: a sheet of paper that the mother of the child must keep and bring every time she visits the clinic.

The gruesome facts about what women must endure during pregnancy and labor are enough to make any person cringe. It might be unsurprising that the health care in an underdeveloped country such as Mali isn’t up to par, but hearing the stories from someone who has experienced them is a fascinating way to feel more connected to what is happening.

Holloway brings us into the story on a personal level that is often hard to accomplish when the reader is so far removed from the actual situation. The quality of life in Mali is undeniably low, but Holloway often removes her opinion about the destitution and lets the story speak for itself. When she does include her own thoughts, they are full of emotion and careful consideration for the people she has encountered.

Holloway not only discusses maternal health in Mali, but also delves into the overall lack of respect for women in Mali, a theme seen in many developing countries across the globe. She relays a horrifying description of female circumcision, also known as female genital cutting (FGC), a practice done on young girls almost exclusively in Africa for religious, cultural, and traditional reasons. FGC has serious complications associated with it, including infections, bleeding to death, and infertility. It is often done poorly and “in dark huts with a razor blade, scissors, a knife, or a broken piece of glass” (128-9). However, in the village where Holloway stays, a female cannot choose to forego this mutilation without being shunned along with her family.

Holloway concludes her book with a visit back to the village of Nampossela eight years after her service has been over. Unfortunately, she comes to pay her respects to Monique and “mourn her death in childbirth.” (3) The very thing that Monique had worked so hard to prevent for so many other women, in the end took her life.

This is a thoughtful and interesting book; it will bring you on a great journey to Africa and when you have read its final page you will yearn to learn more about the important issues it raises concerning women’s health.

Holloway, Kris. Monique and the Mango Rains. Waveland Press, 2006.

The Salubrion: How did you become interested in joining the Peace Corps after college?

Kris Holloway: I heard stories from my mother’s friends… some of the first [Peace Corps volunteers] who went in the 60s. Then, I was studying [in college] and learning a lot about how the environmental problems that the developing world faces has a lot to do with the developed world pulling out resources in an unhealthy way. I realized that the way I was living here in the United States wasn’t sustainable, so I didn’t want to start my path as an adult without knowing the world. That’s on the deepest level what it was for me.

The Salubrion: When you got your assignment, did you have any idea of what the nature of your work would be in Mali?

KH: I knew that I would be a natural resource manager, so I was going to be planting trees, doing agroforestry projects, doing anti-erosion stuff. If you read my book, you will know that I did not do a ton of agroforestry!

The Salubrion: How did you end up working with Monique, a midwife?

KH: Monique, the midwife, was assigned as my host, someone that would welcome me to the village…It didn’t take me long to realize that she was really amazing, and a real thought-leader for her village, as a woman. I saw pretty quickly that the impact I could have by working with her and supporting the ideas that she had would have a much greater impact than if I were just to continue my own projects.

The Salubrion: Your Peace Corps story is so unique because it’s a story of friendship. Do you have any tips for people who want to go abroad and bridge the cultural gap and form a lasting relationship as you and Monique did?

KH: I think the biggest thing is cultural humility. We can’t know everything about another culture, and know ‘oh, am I supposed to only shake with my right hand while standing on my left foot and only if my hair is combed to the left side?’ We can’t be cultural experts. But if we always are humble and aware of our own culture, that’s all it takes. In terms of friendship, if you can get over the cultural differences,-we’re all human beings.We all want the same things really: enough food, decent shelter, a healthy family and a meaningful life. Also, knowing the language is a huge leg up.

The Salubrion: How long did it take for you to learn the local languages?

KH: I would say six months. Because I had French, I could really concentrate on my Bambara, but honestly my Bambara never got more than a five or six-year-old’s English… In terms of the depth and the intimacy that Monique and I were able to achieve, I don’t think I could have if we didn’t have a common language (French).

The Salubrion: What was it like to experience some cultural norms in Mali, such as female circumcision, as a westerner?

KH: Because I was so immersed in [the culture], it was a lot less shocking than when you read about it from this culture you understand how complicated it is and tease out what’s awful about it, and what’s beautiful about it, and it’s done by mothers and grandmothers out of the deepest love for their kids. It’s hard to hate and have crazy averse reactions to something you understand like that, and yet I still don’t think [cutting] should be… I think within the culture is where [change] will come from.

The Salubrion: Your life was influenced from your time in Mali in a way that is not always the case for international volunteers. Why was it that you let your experience shape your life so much?

KH: I think it’s being in closer relationships where our deepest changes come from, and I had such a strong friendship with Monique…. the power that comes from that is really huge: the cultural divide and yet the close relationship.

The Salubrion: What’s the next step on your journey?

KH: I work for the Center for International Studies, which is a study abroad organization that I adore…I think when you’re younger, you’re more open to change, so I want to use my passion to get students overseas as soon as possible. I think the next step for me eventually will be to write another book about a woman who needs her story told. And John and I will do the Peace Corps again.

As Kris Holloway and I spoke, a central idea regarding community emerged that resonated with me, as I’m sure it will resonate with others who have spent time immersed in the culture of a developing country. Speaking about cultural differences between Mali and the United States, Kris explained that compared to the U.S., there is significantly less depression and violence in Mali. When I asked her why she thought that was the case, she replied:

KH: I think it’s because they’re connected to each other [in Mali]. Their community, their human relations are what they have; they don’t have material items that separate them from their humanity. We [in the United States] tend to rely on a material item rather than on a neighbor, and so we get further and further away from what is human and what makes us connected together. They don’t have that luxury, so the human relationship is an art. [Everyone’s held by] the greetings and the sharing of the meals and the rituals and we’ve lost that in a lot of ways. And sometimes we remember, but we don’t have to rely on other people very often. It’s a tragedy, I think. I still feel such a connection to Mali because that community’s always ongoing and alive and [in the U.S.], who has time for community? Even [with] the technology, we aren’t in the presence of other humans that much. And I think something fundamental is getting lost in that.

Obama also demonstrated his dedication to improving global health outside of the Senate when in August 2006, he made a two-weeklong trip across Africa. In South Africa, Obama met with local HIV/AIDS activists, (4) and was publicly tested for HIV/AIDS in an effort to decrease stigma and increase awareness about the importance of testing (5).

Throughout the 2008 presidential campaign, Obama came out as a strong advocate of development and global health. His campaign supported, among many other actions, allocating an additional billion dollars to the President’s Emergency Plan for AIDS Relief to address the epidemic in Southeast Asia, India and Eastern Europe, and increasing funding for the Global Fund to Fight Aids, Tuberculosis and Malaria (4). He also proposed a “Health Infrastructure 2020 plan,” an “initiative at the G-8 that [would bring] together public and private partners in a coordinated effort to improve health systems globally” (6). Obama’s proposals demonstrated the high priority that global health issues would hold in his agenda, as well his eagerness to work collaboratively with many different countries, international organizations and other important global health players. Now that he is in office, Obama faces ever-increasing challenges to fulfilling his noble campaign promises. The grim state of the United States’ economy will, without a doubt, make his many ambitious and often costly global heath goals even more difficult to meet. Many politicians and other public officials have expressed doubt that the new president will actually be able to deliver on several of his global health-care proposals. Shortly before Obama took office, Congresswoman Betty McCollum (D-MN) commented on the topic of United States foreign aid, including aid for global health programs abroad: “We are facing tremendous challenges both economically and fiscally right here at home, and there is going to be a lot of pressure to be focused on domestic issues and put foreign assistance on the back burner” (7). McCollum went on to emphasize the dire importance of not succumbing to this pressure and not only maintaining, but increasing the United States’ commitment to foreign assistance for global health, poverty eradication and other aims (6). But the pressure to do otherwise, considering the state of our economy, has indeed been substantial. In December, 2008, twelve House Republicans signed on to a letter encouraging Obama to freeze the amount the US spends on foreign aid at the current level for at least the next two years (8).

Nonetheless, although we are currently less than two months into Obama’s first term as president, it appears hopeful that his administration’s commitment to global heath will not waiver, despite the many economic and political challenges he faces. One of his first actions as president was to repeal the Mexico City Policy, which was first instituted by Reagan in 1984 and was revived by President George W. Bush in 2001 (9). This policy forbade international health groups that performed abortions, or even provided counseling about abortions, from receiving US funding, even if the money the US provided would not be used to fund abortions themselves (8). And despite the growing budget deficit, Obama’s budget proposal for the 2010 fiscal year allocated $51.7 billion to the State Department and foreign aid, representing a nearly 10% increase over the $47.2 billion included in the budget for fiscal year 2009 (10). In its budget proposal, the Obama Administration pledged to “build on its commitment Lawmakers watch as Obama signs legislation for stem-cell research. to save lives through increasing investments in global health programs, including areas such as maternal and child health, family planning and other core health programs, while also emphasizing a commitment to HIV/AIDS, malaria, and tuberculosis through successful programs, such as the President’s Emergency Plan for AIDS Relief and the Malaria Initiative” (11). This proposed increase in funding for global health initiatives proved reassuring and hope-inspiring for many advocates of global health. Smita Baruah, who is the director of government relations at the Global Health Council, commented that “We were prepared for flat funding, and we feel optimistic” (12).

All-in-all, only time will tell if the Obama Administration’s dedication to global health aims will enable it to surmount the overwhelming difficulties it faces in implementing its proposals and achieving its targets during this time of economic crisis. However, so far things look promising. Obama’s actions seem to suggest that he will not abandon his commitment to at least working towards increasing the United States’ role in and monetary support of many important global health initiatives.

1. “Barack Obama & the Millennium Development Goals.” THE BORGEN PROJECT. 13 Mar. 2009 .
2. “United Nations Millennium Development Goals.” Welcome to the UN. It’s your world. 13 Mar. 2009 .
3. Marke, Roland B. “Sen. Barack Obama Tours Africa.” Worldpress.org – World News From World Newspapers. 11 Mar. 2009 .
4. Bristol, Nellie. “Obama vs McCain on global health.” The Lancet 372 (2008): 521-22.
5. “Barack Obama: A Pledge to End Deaths from Malaria by 2015.” www.BARACKOBAMA.com. Obama for America. 11 Mar. 2009 .
6. Kelemen, Michele. “Hopes High For Foreign Aid In Obama Presidency.” NPR : National Public Radio : News & Analysis, World, US, Music & Arts. 11 Mar. 2009 .
7. Graham-Silverman. “Advocates Urge Obama To Increase Global Health Spending, Others Call for Freeze on Foreign Aid.” Kaisernetwork.org – Health Policy, News Summaries, Webcasts, Interviews & Public Opinion – Kaiser Family Foundation. 18 Dec. 2008. 11 Mar. 2009 .
8. Stein, Rob, and Michael Shear. “Funding Restored to Groups That Perform Abortions, Other Care.” The Washington Post 24 Jan. 2009.
9. “Obama’s FY 2010 Budget Emphasizes Commitment to PEPFAR, Increases Resources for Domestic HIV/AIDS Prevention.” Weblog post. Kaisernetwork.org. 27 Feb. 2009. 11 Mar. 2009 .
10. “FY 2010 Budget: Department of State and Other International Programs.” Http://www.whitehouse.gov/omb/. Office of Management and Budget. 11 Mar. 2009.
11.“Global Health Advocates Respond to Obama’s FY 2010 Budget Proposal.” Kaisernetwork.org. 3 Mar. 2009. The Henry J. Kaiser Family Foundation. 11 Mar. 2009 .
Picture Credit: http://blogs.suntimes.com/sweet/Obama_Stem_Cells.jpg
Picture Credit: http://www.daylife.com/photo/03fI7S43sa1tu

What was the initial inspiration for the foundation of “… a little help”?

The large aid organizations have large projects that they need to focus their efforts on, but that leaves a lot of work left to be done at the grassroots level. Women and girls are often left behind when large projects get all the attention. A little help tries to reach women and girls who otherwise might not get the help they deserve.

What was the organization’s first project/goal?

Our first project was the reconstruction of the interior of a few rooms housing women prisoners in the Kabul prison.

“…a little help” seems to have broad-reaching goals and numerous projects dealing with various different aspects of improving the lives of women and children. Is it difficult for the organization to have such a diversity in projects?

We don’t have a particular set of goals and our projects are small and distinct. We do as many projects as we have the money and time to do.

It seems the NGO has been quite successful and expanded its efforts, but according to the website, “…a little help” has been able to do small direct projects where the big players can, or won’t go.” How does the organization hold on to the values of a small NGO as it continues to experience success and grow?

We are a very small organization and haven’t grown significantly but have gotten a bit more effective in doing projects just by virtue of experience in the country. The website says the organization has been in Afghanistan a long time- what would you say are the major changes the organization has witnessed in the culture or society since its establishment?

The incredible optimism that was present in the first few years after the fall of the Taliban has now faded. Afghans’ hopes for security and prosperity have been diminished by corrupt government, return of local warlords and increasing civilian casulties.

Have you met any resistance to your efforts in the Afghanistan area, and if so, how have you dealt with it?

We try to focus our work in areas and with people who are supportive of the projects we are involved with. We design our projects around the expressed needs and desires of the communities we work with so there isn’t any fundamental resistance.

In partner projects with people in Afghanistan, how does “…a little help” aid the people in their individual projects? Is the help solely financial, or is their education and guidance involved as well?

We work in a variety of roles. Most often the partner is providing financial support for a project that they would like to see accomplished and our experience leads them to ask our help in implementation. We have the local presence to make sure that projects are accomplished effectively and in line with what the real needs are.

How many employees does “…a little help” have, and how many are directly involved with the ground work in Afghanistan?

We have no employees, everyone is a volunteer. Our office in Kabul is staffed with young Afghan women who volunteer their time helping to administer the programs. We hire workers as needed for specific projects on an ad hoc basis.

In the Kabul Women’s Prison project, it seems many basic necessities are provided to the women. Do they generally not have personal hygiene supplies while in prison, and what is a main cause for the imprisonment of women in Afghanistan?

The women are supplied personal hygiene items by a local NGO with funding from the Italian government. We try to fill in other areas, as in our current project supplying yogurt twice a month. The majority of women are in prison for offenses against family honor such as refusing an arranged marriage or marrying without the family’s consent. More and more women now however are in jail for drug-related offenses, generally after having been caught transporting drugs for male relatives.

What is the current situation in Afghanistan with regards to girls education? (i.e. percentage of girls in school, literacy rates, etc.)

I’d refer you to the UNICEF site for specific statistics. The basic current situation is that girls’ education has almost completely stopped in the south of the country but enjoys continued support in the center and north.

Is there a big discrepancy between the educational and medical services available for women and children in rural and urban areas?

Yes. Most urban areas provide school attendance for all children who are in the area, although often their resources are limited with insufficient books and other school supplies. Health care is free and available to women in urban areas but again, there is often insufficient medicine or other medical supplies to get the best treatment. In the rural areas there may be educational and medical infrastructure, such as newly built schools and clinics, but there is rarely a sufficient pool of trained personnel so new buildings don’t have the teachers and doctors and nurses that are needed to make them meaningful.

In regards to the Wardak Projects, what is the current situation with orphans? How many are there, and how acceptable is the culture to adoption (foreign or
internal adoption)?

Orphans are children whose father is dead, and they often have mothers or other extended family who simply don’t have the resources to care for them and place them in orphanages. The numbers vary all the time based on what children are there at any given time. Islam and Afghan law prohibits adoption. Afghanistan has recently implemented a guardianship law which allows Afghan Muslims to take a permanent guardianship of an abandoned child.

The scholarship funds are giving women the opportunity to pursue new careers, but currently, what professions are acceptable for the women of
Afghanistan?

Teaching in girls’ schools, nurses, doctors to women, midwives, tailoring. In rural areas women may weave rugs or other jobs that can be done primarily in the household. There are of course exceptions, but this is the generally accepted set of options.

Has “…a little help” done much with regards to microfinancing? If so, how successful has it been?

There are many great microfinancing groups here so we have never felt the need.

From your own personal participation, what experiences or events have influenced you the most? What makes you so passionate about the organization and its goals?

My continued passion for this work comes from maintaining a realistic perspective. We aren’t here to change a country or a culture. Focusing on working with individual women and accomplishing small, direct projects helps fend off the burn out that too many folks succumb to working in this environment.

The Mexico City Policy was first enacted in 1984 by President Ronald Reagan, and demanded that the United States Agency for International Development (USAID) withhold federal funding directed to NGOs that performed or encouraged abortions as a means for family planning. This policy was an extension of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(f)(1)), which prohibited NGOs from using federal funds to pay for or promote abortions.(2) The Mexico City Policy remained in place until 1993, when President Bill Clinton rescinded it, but was reinstated by President George W. Bush in 2001. In 2003, President Bush further expanded the policy to include funds from the U.S. State Department.

The proceedings of the Mexico City Policy are important because they dictate the way in which the U.S. government will aid the fight to reduce maternal deaths. Maternal mortality is a major health concern worldwide, and this rising issue was addressed during the Millennium Summit in 2000, where the Millennium Development Goals (MDGs) were established. The fifth of these goals is to improve maternal health. More specifically, this MDG seeks to lower the maternal mortality ratio by three quarters and achieve universal access to reproductive health care by 2015. This is because each day, roughly 1,500 women die due to pregnancy or child-birth related complications.(3)

Ninety-nine percent of these maternal deaths occur in developing countries, where women are more likely to have several pregnancies. Often times, many of these pregnancies are unwanted and unpreventable, because the women reside in cultures where male dominance persists. They have no power in their relationships, and are thus subjected to the whims of their partners or spouses. Furthermore, malnutrition and a lack of accessibility to adequate health care often persist in developing countries. All of these factors combine to create a breeding ground for high maternal mortality rates.

Since 2000, maternal mortality ratios have gone down in certain areas of the world, such as South Asia. However, it continues to be a dire problem particularly in Sub-Saharan Africa, where the majority of the countries have maternal mortality ratios around 500-999 deaths per 100,000 live births.(4) Thus, there is a need to find quicker and more effective methods in order to reduce maternal mortality ratios if this MDG is to be accomplished by 2015.

One such solution is by providing and promoting safe abortions as a method of family planning, which is what the repeal of the Mexico City Policy supports. The World Health Organization (WHO) states that, “the first step for avoiding maternal deaths is to ensure that women have access to family planning and safe abortion.” Performing safe abortions can prevent several of the leading causes of maternal death. One example is eclampsia, which is a life threatening hypertensive disorder that causes seizures during pregnancy and, which is responsible for twelve percent of maternal deaths.(5) Initially, this complication can be detected by pre-eclampsia, which is a condition characterized by high blood pressure and high protein in urine that develops after the twentieth week of pregnancy. Early delivery, the start of labor, or a safe abortion is advised to treat eclampsia and pre-eclampsia.(6)

Furthermore, promoting safe abortions can impact maternal mortality rates in a more direct way by reducing the number of unsafe abortions, which currently contributes to thirteen percent of maternal deaths.(7) Unsafe abortions are induced using horrific methods, which more often than not kill both the mother and the child. During the enforcement of the Mexico City Policy under the Bush administration, more than 500,000 women worldwide died of unsafe abortions because they did not have access to safe abortions.(8)

However, while providing and promoting safe abortions seems like a feasible and efficient solution to reduce maternal mortality rates, abortion is an extremely divisive issue both in the U.S. and across the world. After all, while a safe abortion can save the life of the mother, it is done so at the expense of a potential child, which results in the ethical dilemma of whose life – that of the mother or the unborn child – is more valuable.

Thus, with abortion being such a hotly contested issue, one must question whether President Obama’s decision to rescind the Mexico City Policy is the appropriate way for the U.S. to help prevent maternal deaths, especially if there are other ways to reduce maternal mortality rates. One alternative option is to allocate the funds to train and distribute more skilled health workers and traditional birth attendants.

Currently, in most developing countries, less than sixty-two percent of women give birth in the presence of a skilled health professional. However, many maternal deaths are avoidable when skilled health workers are available to administer antenatal care and are ready to provide rapid treatment at birth, if necessary.(9) Furthermore, this alternative is also sustainable, as once people are trained, they can help educate and pass their knowledge onto others.

Therefore, although the overturning of the Mexico City Policy may help to reduce maternal mortality rates, promoting and providing safe abortions is not the only way to achieve the fifth MDG. There are other potential options that may be as equally successful, but not as controversial, that the U.S. can support.

1. “Statement released after the President rescinds “Mexico City Policy” The White House Blog. 24 Jan. 2009. The White House. 7 Mar. 2009 .
2. “The Global Gag Rule: Undermining Women’s Health and US Foreign Policy.” Advocacy: Fact Sheets. Pathfinder International. 7 Mar. 2009
3. “Goal 5: Improve Maternal Health.” Millennium Development Goals. United Nations Development Programme. 7 Mar. 2009 .
4.Tracking the Millenium Development Goals. MDG Monitor. 7 Mar. 2009 .
5.“Maternal Mortality.” Making Pregnancy Safer. The World Health Organization. 7 Mar. 2009 .
6 “Pre-eclampsia” Medical Encyclopedia. Medline Plus. 7 Mar. 2009 .
7. The World Health Organization.
8. “Ipas calls on U.S. president-elect to be global leader for women’s rights.” 5 Nov. 2008. Ipas. 7 Mar. 2009 .
9. The World Health Organization.

Until now, we have known very little about the virus that makes us feel so icky so often. Adults catch a cold about four times a year, while smaller children can have eight to ten bouts annually.(3) For college students, with late nights at the library, it seems like a perpetual state.

Besides making us sniffle, the cold’s economic implications are enormous. Missed work days for parents taking care of sick children total approximately 126 million per year in the United States, and missed work days for their own illnesses total 150 million.(2) This along with the health costs, such as over the counter medicine and wrongly prescribed antibiotics, brings an annual figure of about sixty billion dollars in losses.(2)

The common cold is caused by many viruses, but the biggest culprit by far is the rhinovirus. On Thursday, February 19, 2009, scientists of the University of Maryland and the University of Wisconsin-Madison published their results after having successfully sequenced the genomes of ninety-nine strains of rhinovirus.(2) They have used genetic mapping techniques to pool the viruses into a family tree.(2)

The sheer number of viruses found, along with their varied capsid protein surfaces and their ability to easily mutate, dashes hopes to create an all-in-one vaccine or antiviral, although, several drugs for different groups could be developed.(1)

While the economic losses are staggering, and while having a cold is annoying, the fact that it, in most cases, will go away with a little bed rest takes away incentive for pharmaceutical companies to fund further research.(1) Dr. Alan Glatt of the Infectious Diseases Society of America put it best when he said,

“It’s not a killer for most people. It’s a nuisance. It’s not something that people are going to want to invest a tremendous amount of new additional costs in to get minimal gain […] Until you come up with a very, very simple treatment, you’re not going to go anywhere with it […] It’s going to always be the poor orphan in terms of research. It’s going to be the poor orphan in terms of public health support for it.(1)”

Whether or not the research yields new results immediately, we must all admit to the impressive scientific gain. Having the knowledge creates the opportunity, whether or not the market is ready for it. Until then, here are some facts that may help you avoid your next dance with the rhinovirus.

1. This may seem super obvious, but wash your hands! You have to realize that not everyone around you does the same, so be aware of your surroundings. Also, use soap. It works better than alcohol based products like Purel. Scrub for at least 15 seconds.(4)
2. Giving your sick sweetie a smooch is not such a bad thing. The rhinovirus likes mucous membranes in your eyes and nose, but rarely passes from mouth to mouth. Plus, it will brighten both of your moods, and that can’t hurt!(4)
3. This is a toughie, but try to relieve your stress. Happy people get sick less often and get over colds faster.(4)
4. If you are really terrified of those nasty coughing fits, stop by Gannett to get a surgical mask. You may get
some strange looks from the people in your lecture hall, but at least you won’t be coughing along with them.(4)

Beyond that, to truly avoid a cold, you would have to make like Jake Gyllenhaal and live inside of a plastic bubble. Here’s wishing you a happy and healthy school years.

1. Genomes of the Common Cold Decoded.” Fort Francis Times Online. 17 Feb. 2009. Fort Francis Times. 1 Apr. 2009.
2. Hanovice, Nicholas. “Health & Science: Breakthrough in understanding the cold.” BCHeights.com. 26 Feb. 2009. Boston College. 1 Apr. 2009.
3. “Researchers Decode the Common Cold.” CTV.ca News. 12 Feb. 2009. CTV.ca. 1 Apr. 2009.
4. Thompson, Andrea. “Common Cold DNA Deciphered, Congestion Continues.” Live Science. 12 Feb. 2009. Live Science. 1 Apr. 2009.