Building Resilience: Addressing Mental Health in Morocco

On September 8th, 2023, a 6.9 magnitude earthquake caused immense destruction in the Atlas Mountains region of Morocco, leaving thousands dead and injured and significantly impacted access to remote villages already facing limited resources. While the immediate response from the Moroccan government and international organizations focused on physical medical needs, the need to address the long-term mental health consequences of such disasters is crucial. This ensures that mental health disorders are recognized as a critical medical issue requiring accessible support within these vulnerable communities.

Traditionally, mental health issues haven’t received the same level of political attention as physical health concerns. Creating a nationwide policy can be a turning point, demonstrating a commitment to holistic healthcare and potentially influencing national mental health policies in the long run. During the aftermath of the earthquake in 2023, Médecins Sans Frontières (MSF) made it a priority to provide psychological support to those who were affected, while also training and supporting local groups on psychological first aid. This was done in collaboration with the Moroccan Ministry of Health, which paves the way for long term policies surrounding mental health in the country.

A great example of addressing mental health needs in Morocco was after the COVID-19 pandemic, where many initiatives were undertaken by the Ministry of Health to bring this issue to light. Numerous organizations, such as Moroccan Society of Clinical Psychologists, launched helplines that offered support to doctors, patients, families, and those in confinement. Continuity of care was ensured through specialized hospital units for COVID-19 positive patients with mental health needs, liaison psychiatry in general hospitals, and reorganized addiction treatment services. This comprehensive strategy demonstrates Morocco’s commitment to safeguarding mental wellbeing during the pandemic and well after.

By fostering coalitions and partnerships among these stakeholders, significant improvements can be achieved in public health outcomes. Collaboration between the government and NGOs allows for wider service delivery, community outreach, and training programs for local healthcare workers. Also, engaging with the community ensures culturally sensitive interventions, addresses specific needs, and promotes help-seeking behavior through awareness campaigns. Ultimately, a comprehensive and effective response to mental health needs after disasters in Morocco requires the combined efforts of these stakeholders working together. This collaborative approach ensures the long-term well-being of affected populations and promotes a more resilient mental healthcare system in the face of natural disasters.

Expanding Access of Malaria Vaccinations in Vihiga County Benefits All of Kenya

^{Edith Anjere, Immunization Coordinator in Vihiga County, Kenya, Source: PATH}

Since 2019, significant improvements in death rates and hospitalizations from malaria in young children have been made in Kenya after initiating the pilot malaria vaccine trial, Malaria Vaccine Implementation Programme (MVIP) involving children under 2 years old. Under the leadership and support from WHO, GAVI, and PATH and many other stakeholders, Kenya was able to benefit from the RTS,S vaccine that was developed for over 35 years by GlaxoSmithKline Pharmaceuticals. As the vaccination program continues in Western Kenya, parents in Vihiga County have noted that their children who have been vaccinated are less sick than their older siblings. The 4 part vaccination series typically begins at age 6 months with its completion at 24 months.

^{*Source: U.S. President’s Malaria Initiative}

Malaria prevention must have a multi-faceted approach to be successful in eradicating this terrible disease from the community. This includes using insecticide treated bednets, indoor spraying, rapid diagnosis and treatment of active malaria, and malaria prevention during pregnancy. By using education and collaboration with groups such as the Kenya Malaria Youth Army, community health workers (CHW) are the key to disseminating information to the villages and encouraging mothers to complete the series for their children. CHW are also providing catch up vaccinations for other diseases while supporting the malaria campaign in Kenya by handing out bednets.

Now is the time for the Ministry of Health (MOH) to expand the vaccine program to all children under 5 years of age, some of whom missed out on the initial set of vaccines due to vaccine hesitancy during the covid pandemic. The benefits have been seen by the community in Vihiga County and the attitudes of the mothers are now overwhelmingly positive. Due to the dedication of the CHW and the Immunization Coordinator, nurse Edith Anjere, Vihiga County has the highest rate of childhood immunization coverage in Kenya: up to 96% of children as surveyed in 2022. Vihiga County is the perfect community to capture more children in the vaccination program since the health infrastructure is already in place as well as an openness in the community to continue vaccinating our children. The MOH can support this nationwide campaign against malaria by allowing other vulnerable children access to RTS,S in Vihiga County, serving as a model program for other counties. Kenya has been at the forefront of the malaria vaccination program and will continue to inspire other countries in Africa to work toward this goal of keeping our most vulnuerable citizens healthier.

Could Pittsburgh, PA business vacancies be a potential solution for increasing homelessness?

The image above is showing a homeless encampment along the Allegheny riverfront in November of 2022. At that time, the city of Pittsburgh committed to providing approximately $1.2 million in grants to community groups, such as shelters and other organizations that provide support and assistance to those that are experiencing homelessness. Despite this funding, the number of homeless individuals in Allegheny County, PA has increased by 44% from 2021 to 2024, rising from 571 individuals to 1026.  In the City of Pittsburgh, Second Avenue Commons, a new 43,000 square foot emergency shelter facility, opened with the partnership of many businesses and hospital systems.  This has helped to provide services to a portion of Pittsburgh’s homeless population, but there are still many that cannot get the assistance that they need.  In Pittsburgh, there are only 37 low-income houses per 100 low-income renters, only allowing one third of this population a viable opportunity to live in suitable living conditions.  19% of those that are homeless in 2024 are under the age of 18 and the black population is disproportionately impacted. 

The City of Pittsburgh currently has nearly 30% of its office space unoccupied and is anticipating this number to grow to 46% over the next 4 years. This is a direct result of COVID-19 which perpetuated businesses to embrace a shift to hybrid and remote working arrangements.  On April 11, the Urban Redevelopment Authority (URA) of Pittsburgh approved nearly $5M in loans to convert vacant business space into affordable housing.  “Affordable” is being defined as no higher than 80% of Area Median Income, which means that a portion of the new the housing will be affordable to a 2-income, 2-person family making $64,250 annually.  Pittsburgh continues to have minimum wage at $7.25 an hour, which is less than half of what an individual would need to earn to achieve an income that is 80% of Area Median Income. This approach will not serve to solve our homelessness problem.

A possible solution? The increase in homelessness in Pittsburgh can be addressed by creating affordable living spaces in the vacant office buildings via a long-term housing voucher program.  “Affordable” housing for those that are homeless cannot be defined as 80% or below Area Median Income; a voucher program, support and rehabilitation services need to be put into place, to provide appropriate, long-term assistance to this population. Per the National Low Income Housing Commission, low-income housing does not exist for over two-thirds of the low-income population in Pittsburgh. 

The City of Pittsburgh’s homeless population and business vacancies are simultaneously increasing year over year.  Second Avenue Commons and Light of Life Rescue Mission are perfect examples of the community coming together to use spaces in the City of Pittsburgh to provide living solutions, supportive programs, and services to those in the community.  The Mayor of Pittsburgh, the URA of Pittsburgh, and the Pittsburgh Department of City Planning are trying to find common ground on both issues: how to decrease the homeless population and ensure that downtown Pittsburgh is in a favorable economic state.  These stakeholders must collaborate and use their collective impact to find and implement solutions that can solve for both issues simultaneously.  It has been proven by the Coalition for the Homeless in New York, that long-term housing assistance vouchers put less financial burden on cities over the long term. 

A predetermined percent of vacant office buildings should be converted into housing, allowing for those that are homeless to access assistance to apply for and receive long-term housing assistance vouchers. Each location having onsite medical and mental/behavioral health resources, following successful models like Second Avenue Commons and Light of Life Rescue Mission. Providing access to meal vouchers and on-the-job training opportunities will further address the population health needs and health outcomes of Pittsburgh’s homeless population. The Coalition for the Homeless has created a financially sound roadmap to move in this direction, proving out a business case that this program costs about 50% less than maintaining homeless shelters. It is this author and Pittsburgh resident’s suggestion that the stakeholders in Pittsburgh partner with the Coalition for the Homeless and review the programs and impact that they are making in New York. Through their programs they are impacting food insecurity, providing eviction protection, giving families and marginalized populations long-term housing through 3 innovative housing programs, facilitating job training, and providing children with tutoring and lifestyle benefits.

Sexual and reproductive health education: the panacea to teenage pregnancy in the Dominican Republic

Source: UNICEF/Versiani

One in every five teenagers in the Dominican Republic reports being pregnant. It is a significant social and public health problem for the small Caribbean nation, which ranks #5 in teenage pregnancy in the Latin America region and  #2 in the age group of 10-14. The problem disproportionately impacts teenagers living in low-income households, those in rural communities, and Afro-descendants living on the Haitian border. Unfortunately, this perpetuates the poverty cycle, as youth health is crucial to a country’s development and progress.

Girls aged 10-19 are not mentally or physically prepared for pregnancy and childbirth, increasing their risk of severe health consequences: eclampsia, puerperal endometriosis, and systemic infections. Additionally, adolescent mothers are susceptible to STDs and unsafe abortions, and their babies could have poorer birth outcomes, such as low birth weight, preterm delivery, and other adverse neonatal conditions.

Lack of education, unenforced laws and policies, and the overarching power of the Catholic Church are contributing factors to high rates of early pregnancy in DR. In 2003, Law 136-03 was enacted, recognizing the children’s and adolescent’s rights to be informed and receive sexual health and reproductive education. In 2021, the Policy for Prevention and Attention to Early Couple Cohabitation and Teenage Pregnancy (PPA) was issued and aimed to ensure youth rights to access sexual health education in school. Despite the legal framework, only 3 out of 10 students are exposed to an educational program because the Catholic Church, a powerful institution in DR, legally opposed implementing the agreed sexual education program, alleging the curriculum threatens moral values.

The Ministries of Health and Education and the National Council for Children and Adolescents share an interest in reducing teenage pregnancy rates to improve youth’s health and development opportunities. A coalition among these organizations would unite resources and have a greater impact in addressing this long-standing health and social issue. The current laws and the latest policy must be enforced to offer a comprehensive sexual and reproductive health education program in all schools across the country. It would reduce educational gaps, health disparities, early pregnancy rates, and the associated health and socio-economic consequences.

Enforce the law banning female genital mutilation in Ethiopia

Female genital mutilation (FGM) is a procedure involving the partial or total removal of the external female genitals for non-medical reasons. FGM has no health benefits. Complications include urinary problems, excessive bleeding, childbirth complications, infection, and death. FMG is recognized internationally by the World Health Organization and the Ethiopian Human Rights Commission as a human rights violation of girls and women.[i]

Most Ethiopians (87% of boys, and 79% of girls, aged 15-49) believe that FGM should stop.[i] Despite a 2004 Ethiopian federal law banning FGM, Ethiopia has the largest number of girls and women (25 million) who have undergone FGM in Eastern and Southern Africa. Almost all FGM is carried out by traditional practitioners. Where FGM is prevalent, it persists because of sociocultural norms.

The Ethiopian Constitution prohibits	YES	NO
Violence against women and girls		X
Harmful practices	X
Female genital mutilation/cutting (FGM/C		X
National legislation	YES	NO
Provides a clear definition of FGM/C		X
Criminalizes the performance of FGM/C	X
Criminalizes the failure to report incidents of FGM/C		X

https://www.orchidproject.org/wp-content/uploads/2019/02/Ethiopia_law_report_july2019.pdf

Ethiopia’s Legal Framework

The law makes it a crime to perform FGM but does not criminalize failure to report FGM. The law, if enforced, would serve as a deterrent for traditional practitioners performing FGMs. However, enforcement has been weak due to lack of knowledge of the law and reluctance to enforce the law. Amending the law and the constitution to be clearer about violations, protecting victims of FGM from prosecution and making the law accessible in local languages is needed.

Creating an environment to protect the rights of women and girls requires building coalitions and raising legal awareness. NGOs like Action Aid Ethiopia and the Inter-African Committee on Traditional Practices provide training on the law banning FGM. Further action by multiple stakeholders (traditional healers, faith leaders, tribal councils, the Ministry of Women, Children and Youth, Ethiopian Midwives Association) is still needed to address the sociocultural norms.

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[i] Ministry of Women, Children and Youth, Gender Equality, Women’s empowerment, and child wellbeing in Ethiopia: https://www.unicef.org/ethiopia/media/2811/file

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[i] World Health Organization: https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation

[ii] Ethiopian Human Rights Commission 2023 Report: https://www.state.gov/reports/2023-country-reports-on-human-rights-practices/ethiopia/528267_ethiopia-2023-human-rights-report/

The Missouri Right to Reproductive Freedom Amendment Belongs on the November 5, 2024, Missouri State Ballot

In Missouri, the right of women to control their reproductive health and access safe abortion care has been an uphill battle. Despite the Roe v. Wade (1973 to 2022) US Supreme Court Decision, which established a federal constitutional right to abortion, access to abortion care in Missouri has been limited due to decades of targeted regulation of abortion provider (TRAP) laws. Further eroding reproductive rights, Republican (GOP) lawmakers in Missouri enacted a near total ban on abortion, with no exceptions for rape or incest, moments after the US Supreme Court overturned Roe V. Wade in 2022.

This dynamic exists in a state where maternal mortality rates exceed the national average, nearly half the counties are considered maternity care deserts, and almost 23 of the remaining counties have low to moderate maternal care access, Additionally, a Missouri law effective August 28, 2024, will block Medicaid funding to facilities associated with abortion care. In Missouri, this affects Planned Parenthood, and will limit their ability to provide contraceptive care, cancer screening, STI testing, and wellness services, and will force thousands of their current patients into Missouri’s already strained public health safety net system. The lack of reproductive freedom, especially to safe abortion care, has far reaching effects. According to the Turnaway Study, women who are denied an abortion were 4 times more likely to live below the federal poverty line, have lower credit scores, higher debt, more bankruptcies, poorer maternal bonding, and more pregnancy complications.

To advocate for the reversal of the abortion ban and fight for reproductive choice rights, abortion rights activists formed the well-funded and influential Missourians for Constitutional Freedom coalition, which includes Abortion Action Missouri, Planned Parenthood, ACLU Missouri, and concerned citizens. Their mission is to bring the issue of reproductive freedom, including safe abortion access directly to the voters via the addition of The Missouri Right to Reproductive Freedom Amendment to the November 5,2024 state ballot. They have raised more than 5 million dollars and utilize volunteers and paid canvassers to advocate and gather signatures. Planned Parenthood, a powerful, influential organization, provides monetary and legislative support, and health services. Abortion Action Missouri is a venerable organization that supports legalized abortion. Active, influential ACLU Missouri provides legal and advocacy support.

On May 3, 2024, Missourians for Constitutional Freedom delivered more than 380,000 signatures, twice the required number, to the Secretary of State to add Reproductive Freedom Amendment to the ballot. Although the signatures were delivered, obstacles remain. In February 2024, the Missouri Senate introduced a resolution to make constitutional amendment initiatives more difficult to pass. The resolution has yet to pass. Abortion opponents including Missouri Right to Life, an influential organization with a dedicated PAC that raises funds to counter pro-choice legislation and defund Planned Parenthood, and Coalition Life, an organization with limited influence whose volunteers attempt to block women from entering abortion facilities, have formed a pro-life campaign entitled Missouri Stands with Women, whose stated mission is to defeat the attempt to reverse Missouri’s pro-life laws.

I am strongly in favor of the addition of The Missouri Right to Reproductive Freedom Amendment to the Missouri ballot on November 5,2024 and hope that the amendment passes with an overwhelming majority. In the event the Reproductive Freedom Amendment does not get added to the ballot due to GOP attempts to make it harder to change the constitution through ballot initiatives, or does not pass, The Missourians for Constitutional Freedom should continue to expand, fundraise, and advocate until the right to reproductive freedom including safe abortion care is memorialized as a right in the Missouri State constitution, and women are free to make decisions on reproductive health without interference from politicians.

Awareness is Power: A Push to Expand the National Lung Cancer Screening Policy to Include Nonsmokers

By Lisa Gill and Armida Valles

Source: https://www.leehealth.org/getmedia/8142636d-ffab-4ad9-8e63-a28a26006b7a/Lung-Cancer.jpg

The Need:  Lung cancer in the United States (US) is the second most common cancer and is the leading cause of cancer deaths. In the past decades, rates for Americans have been on an incline. A new study found that out of 100 people in the United States who were recently diagnosed with lung cancer, (12%) had never smoked cigarettes. Unfortunately, the symptoms may be subtle and go unnoticed. Once a nonsmoker is finally diagnosed, the cancer may have progressed to the most advanced stages.  Although the U.S. Preventative Task Force (USPTF) has a National Lung Screening Policy, it limits screening to individuals who have a smoking history. There is currently no policy or guidance for screening individuals who have never smoked.  Expanding the policy to include nonsmokers can save lives by catching the disease at its earliest stages.

Proposed Engagement:  Lobbying the USPTF, the National Institutes of Health and the Centers for Disease Control, in collaboration with U.S. Representative Derek Kilmer (WA-06), who recently introduced a bipartisan bill to improve access to lung cancer screening, could drive change in expanding the policy to include nonsmokers. Given their combined interest in research and advocacy towards driving public change, their efforts could be lifesaving. On the other hand, groups such as the American Medical Association (AMA) may be hesitant as the issue is complex and benefits would have to outweigh potential harm.   On the other hand, groups such as the American Medical Association may be hesitant as the issue is complex, and benefits would have to outweigh potential harm. Through a collective impact approach led by the NIH and CDC, research coupled with additional testing methods (I.e. genetic testing) and education, would garner support from the AMA to expand the national policy to include the nonsmoking population.  

Awareness is Power: The excellent news for nonsmokers is that promising advancements in biomarker testing have been made, advancing screening at the earliest stages. The time for action is now. Our advocacy efforts must match the advances in science.  Championing the expansion of the National Lung Cancer Screening policy to include nonsmokers is a crucial step in our fight against lung cancer. 

Driving Change in Wisconsin’s Drunk Driving Culture

Brian East and Becky Vest

The culture of drunk driving in Wisconsin needs challenging. In 2022, over 7500 crashes involving impaired drivers led to 184 deaths and 3,556 injuries. One in five drivers has been convicted of drunken driving (OWI) in the state. Erin Payton, of Mothers Against Drunk Driving (MADD) characterizes the situation a “roadway safety crisis.” OWIs and associated death rates are higher in Wisconsin than the U.S. overall.

Wisconsin State Senator Chris Larson, D-Milwaukee is attempting for a seventh time to pass a bill requiring all drivers convicted of an OWI to use ignition interlock devices, or IIDs. Unlike 35 other states, Wisconsin does not enforce the use of an IID in a first OWI unless the driver has a blood alcohol concentration (BAC) of 0.15. Sen. Larson claims that WI drivers facing their first OWI have successfully plea bargained their BAC below 0.15 to avoid an IID.  The CDC reports that IIDs have reduced repeat drunk driving by 67%. IIDs implemented for repeat OWI offenders have prevented over 400,000 drunken driving attempts in the state in the past 16 years.

Larson faces an uphill battle. State assembly republicans, who dominate the legislature, have opposed the bill, lobbied by opponents such as the Tavern League of WI and Wisconsin Counties Association (WCA); these organizations claim laws around non-alcohol related driving distractions WI laws are lax and that passing this bill will require more manpower and resources to enforce.  

However, OWIs and their sequelae are already costly as Local fire chiefs have commented that OWI crashes put a strain on the department’s resources. This time, there is an opportunity to leverage new data to counter the oppositions’ interest and build a stronger coalition to lobby for change. MADD partners with many nationwide auto insurance companies; joining these forces with Smart Start Wisconsin, an IID provider that stands to gain financially from this bill, could wield stronger lobby power.  

Sen. Larson believes that if a first-time OWI will result in an IID, the social implications and stigma of this could spur a culture shift, causing Wisconsinites to think twice before drinking and driving.

Bystander Naloxone Access and Education in the United States

The opioid crisis in the United States is a serious public health emergency. Over 107,000 people died from drug overdoses in 2021, with over 75% of those deaths involving opioids. This number has skyrocketed since 1999, with overdose deaths involving opioids increasing tenfold. Naloxone, a medication that can rapidly reverse an opioid overdose, is essential in combating this crisis.

Image Source

https://www.cdc.gov/opioids/data/analysis-resources.html

https://www.cdc.gov/drugoverdose/resources/graphics/overdose.html

Naloxone is an easy-to-use medication which restores normal breathing within minutes of administration. We know that every minute matters during an opioid overdose. With increased access to naloxone and training for bystanders, the window between overdose and death shrinks dramatically.

In March of 2024, the Biden-Harris Administration launched a nationwide call-to-action: the White House Challenge to Save Lives from Overdose. The program urges organizational leaders to equip their workplaces with naloxone, train staff on its use, and make it available to both employees and customers. Additionally, on May 2, 2024, The Biden-Harris Administration announced more than $1.5 billion in funding opportunities for state and tribal opioid response to expand Naloxone access as a key piece of Biden’s Unity Agenda for the nation.

Factors such as stigma, availability and affordability continue to act as barriers to Naloxone acceptance and usage. Stigma often stems from a lack of understanding of opioid addiction, so it is important to improve public literacy of opioid addiction disorders and emergency usage of naloxone. Access to affordable Naloxone products at community pharmacies enables healthcare providers and communities to respond immediately to opioid overdoses, which is especially important in low-income, vulnerable populations at higher risk of opioid fatalities.

Given the complex challenges associated with opioid use, the path to increased Naloxone access requires a coalition of various stakeholders with a common interest in reducing opioid overdose fatalities, eliminating inequities, and advocating for system-level policy changes. Through the collective efforts of multiple organizations, Naloxone is available as two FDA approved, over-the-counter nasal spray products. However, continued education and outreach are crucial for unhindered availability and appropriate usage. Local chapters can ensure that the state and local laws are conducive to the national access expansion objectives. Funding and resources pooled by the coalition can be used to address gaps in affordability for uninsured and low-income groups. To bring about sustainable change, the coalition can be the voice of the community and bridge the gaps with systemic solutions involving multi-sectoral stakeholders.

To continue to prevent needless tragedies related to opioid overdose deaths, we urge this coalition of stakeholders to consider:

• Advancing education to the public on mitigating stigmas associated with drug use/abuse and on how to recognize and respond to opioid overdose.
• Advocating for more affordable Naloxone products and increased insurance coverage options.
• Increasing federal funding to expand Naloxone access and training across various sectors.
• Soliciting state level support.
• Targeting programs within low-income communities and communities of color which are disproportionately affected by the opioid crisis

Reform Mississippi’s HIV Criminalization Laws

HIV is treatable but still stigmatized. Mississippi is one of 34 states that currently have laws criminalizing HIV. These statutes make it a felony punishable by up to 10 years to potentially expose others to HIV. For most, infection does not need to occur for the laws to be enforceable. Although Mississippi’s laws date to a time when knowledge about HIV transmission was lacking, they have not been updated to reflect current, evidence-based information. Since treatments such as anti-retroviral therapy (ART) and pre-exposure prophylaxis (PReP) make transmission impossible, these laws contribute to misinformation and stigma. 

Mississippi has the fifth highest rate of HIV infection in the nation and the highest mortality (tied with Louisiana) for HIV individuals overall. HIV disproportionally infects low-income African Americans, especially men, in the state; although they make up 78% of those infected, they represent only 38% of the state’s population. Strategies to decrease the spread are warranted, so decriminalization of HIV must be considered.  

Continuing to criminalize HIV perpetuates stigma and misconceptions about the virus and feeds into the stereotype that those impacted are criminals or immoral. In addition, it undermines prevention efforts. Individuals who might be infected are less likely to be tested and receive treatment if they know that their status could be weaponized. Because their status is unknown, the potential spread of the virus continues. Because of the social discrimination that many experience, uptake of PreP is low in the state, further contributing to unchecked spread of the virus. 

Criminalizing HIV transmission contributes to stigma and misinformation and undermines public health efforts to control its spread. Organizations such as The Mississippi Center for Justice and The Center for HIV Law and Policy actively fight to repeal these laws and instead advocate for evidence-based HIV prevention, testing, and treatment strategies. Criminalization practices marginalize and discriminate against people with HIV, which hinders their access to healthcare and perpetuates social inequalities. Repealing these laws will empower affected individuals to access essential healthcare services without fear of discrimination or stigma, ultimately promoting public health and social justice.