Archive for March, 2012

Road Safety in Oman is No Accident

March 16, 2012



Every year, more than 1.2 million people are killed by road traffic injuries (RTIs) around the world; another 20 million to 50 million are injured or disabled. These numbers, which are provided by the World Health Organization (WHO), illustrate the growing magnitude of road traffic injuries.

In the Sultanate of Oman, road traffic crashes also constitute a major public health problem. Between 2000 and 2006, the Royal Oman Police reported close to 5,000 deaths on the Sultanate’s roads. An additional 55,000 were injured during this time. These numbers are alarming for a country with a population only slightly over two million. In 2005, police sources estimated that road crash mortality rate in Oman was 28 per 100,000 population, which is 1.5 times the global average of 19 per 100,000. These deaths represent not only the individual loss of human life, but also familial breadwinners, husbands, wives, sisters, brothers and children.

Clearly the time is now to address this problem. 2011 marks the UN’s Decade of Action for Road Safety and sets the stage for Oman to address this mounting burden. A current intervention being explored in the Omani Majlis Al’Dawla would step-up current police enforcement measures. Additional traffic officers will police Oman’s roads and enforce tougher legislation aimed at drivers and passengers. Seatbelt use would become compulsory for all vehicle passengers and speed limits more strictly enforced. These seemingly small changes have big effects. For every 1km/h reduction in average speed, there is a 2% reduction in the number of crashes while wearing a seatbelt reduces the risk of death among front-seat passengers by 40-65% and by 25-75% among rear-seat passengers.

Contact the Majlis Al’Dawla to show your support for this policy and save lives.  After all, road safety in Oman is no “accident.”


An African solution to doctor shortages

March 14, 2012

Across the developing world, there are simply not enough doctors to go around.  In Indonesia, the world’s 4th most populous nation, the shortage of doctors is disparaging.  Only 2,600 OB/GYNs are available to provide healthcare services to the women for Indonesia (total population – 240 million people).  African nations have long been challenged by low physician coverage which brain drain has prevented from improving.  In Africa alone, a McKinsey studyestimates that 300 new medical schools would need to be built to produce the 200,000 doctors needed for the continent to reach the WHO’s minimum doctor to patient ratio.  This simply won’t take place and many African Ministries of Health have known this for some time.  As a result, Africa has, over the past two decades, become the birth place of a new global movement to innovate our way out of the physician crisis.  Task shifting is the innovation, empowering non-physicians to perform clinical tasks historically reserved for doctors alone.  Interestingly the people fighting for task shifting in Africa are those who used to fight against this change – physicians!

The story of task shifting in Africa started in Mozambique over twenty years ago.  The protracted civil war decimated Mozambique’s public health sector leaving literally a handful of OB/GYNs in the entire country.  A compelling documentary by PBS portrays the challenges and victories of the first midwife in Mozambique to be trained on how to conduct a C-section. Since then, hundreds of midwives have been trained in C-section surgery in several African countries.  At first, the physician associations were reluctant to allow complex diagnostic and treatment tasks to be conducted by anyone lacking the training and credentials of a doctor.  Physicians who led the first class of midwife training had to prove the clinical competence of the midwives and convince the physician associations that task shifting would not erode quality of care or the prominence of physicians in their country.  Two decades later, this “non-physician clinician” model has now been adopted nationwide in Malawi, Tanzania, and Ethiopia.  These brave African physicians have blazed this innovative pathway of task shifting.  We hope physicians worldwide are open to this new model of care.  In Indonesia alone, 130,000 midwives stand ready to embrace task shifting and bring desperately needed services to a waiting populace.  

Together to enforce the Secondhand Smoking control legislations in SA

March 14, 2012

Example of activities that pushed the authorities to enforce the smoking ban in Saudi Arabian Airports

The year of 2003 was a remarkable year in the history Public health in Saudi Arabia. At that year, the public health activists celebrated the signing of tobacco control bill by the Prime Minister of King of Saudi Arabia (the king). The passing of these legislations proceeded by extraordinary activities which associated with the development of this policy within the Consultation Council. It took three years in the Minister Council to approve the Consultation Council anti-tobacco recommendation, which was submitted in 2000.

As a matter of fact, this legislation addressed the importance of fighting the secondhand smoking in two articles 7 and 14. These articles impose ban of smoking in public indoors and outdoors areas and facilities (article 7) . Furthermore, it gives the authorities the power of penalization of violators with 200 Saudi riyals (50 USD), article 14.

ban smoking at Saudi Airports


In support of the O’Malley gasoline tax

March 13, 2012

Maryland Governor Martin O’Malley has proposed applying the state’s 6% sales tax to gasoline in order to address the transportation budget shortfall. O’Mally proposes to extend the sales tax to gasoline in 2% increments each year for three years.

Current fuel taxes consist of a combination of federal and state taxes.  In Maryland the tax is a fixed $.419 per gallon: $.184 federal and $.235 state. The fact that these values have not changed since 1993 and 1992 respectively contributes mightily to the shortfall in tax revenues. As time passes, the real value of the tax collected has gone down due to inflation (graph). Proposals to tether the tax to inflation have previously failed.

An increase in fuel tax would provide multiple public health benefits: it would fund transportation projects, both road and mass transit. It would encourage use of fuel-efficient vehicles and alternative forms of transportation such as walking and biking, thereby reducing emissions and increasing exercise. This tax would also increase funds for previously delayed or cancelled mass transit projects, decreasing the need for use of personal vehicles.

A key caveat to the new tax is that its revenues be devoted to transportation. In the past, transportation coffers have been raided for use elsewhere, a troublesome practice.

While many drivers and groups including the Maryland Motor Truck Association and the Maryland Republican party oppose the tax, it will generate vital funds in the long run. The proposed stepwise implementation would allow people to adjust their behavior to the new tax over time. While it is understandable that people do not want to pay more for gasoline, increasing tax is necessary for sufficient transportation funding. These funds are needed not only to maintain current systems, but also to design new ones with consideration of public health.

Budget Cuts For Mental Health Services in Arizona

March 13, 2012

In the past two years, Arizona has seen deep budget cuts in its mental health services in an attempt to close the budget holes that Arizona has been facing. Governor Jan Brewer, who has long been an advocate for the mental health system, claims that “dire fiscal realities are forcing them to propose cost-saving measures that carry profound consequences”. According to the National Association of State Mental Health Program Directors estimation, at least 2.1 billion dollars have been cut from state mental health budget in the last 3 fiscal years. These cuts have come in the form of closing adult day treatment centers, eliminating subsidies for outpatient counseling, laying off case managers and closing more than 4,000 beds in psychiatric hospitals. In addition, many patients have been forced to take generic medications even if the brand name medications work better for them as the state no longer pays for brand name drugs. Now Governor Brewer is proposing to help close the Arizona budget hole by scaling back the state’s Medicaid program.

However, it is most likely that these budget costs to mental health services will eventually cost the state much more money than had been saved. As more and more people who have been cut from these programs no longer seek care early on, more and more patients will seek help when they are much less stable. This means more people in trouble with the law, more jail inmates, more ER visits, more people not being able to maintain jobs, and more resources spent on treating people in the advanced stages of diseases. In conclusion, further mental health budget cuts should be disputed as the money saved by the state from these budget cuts are not worth the indirect financial costs and human suffering that they will result in.

Health Care or Violation of Rights?

March 13, 2012

The Obama administration has set out to make health care less costly and more accessible to the American people via the Affordable Care Act.  One item of recent debate has been the Contraceptives Mandate that addresses Women’s Preventive Services.  As of August 2012, employers will now be required to offer insurance plans that provide preventive services for women free of co-pay or charge.  This includes access to contraceptives, which many religious institutions have not offered due to conflict with moral beliefs.  The United States Conference of Bishops, other Catholic Institutions, as well as attorneys general of 7 states have protested against the law, arguing that this law directly violates religious liberty and the First Amendment of the Bill of Rights.

According to supporters of the Mandate, this new law’s benefit is that it will help protect health and keep women healthy.  Pregnancy is a natural state that a woman’s body undergoes to produce offspring, not a disease or morbidity.

The debate about whether employers should be mandated to offer contraceptives is not a matter of being Catholic or not, it is a matter of protecting the constitutional right to religious freedom.   The new law requires employers to provide services that may conflict with their religious beliefs and conscience.  The law allows exception to churches, but not to other religious institutions such as universities and charities.  Although the Obama Administration claims that this law is protecting women’s health, the administration needs to reevaluate the new law with respect to protecting the American people’s basic constitutional rights.

Fighting cervical cancer in India

March 13, 2012


Cervical cancer (CaCx) is the second leading cause of cancer-related death in women in developing countries, and about one in four of these deaths occur in India. This high death toll is primarily because India does not have a CaCx prevention program with routine screening to detect early lesions. Two recently licensed vaccines against the most common strains of HPV, the virus that causes cervical cancer, have the potential to save hundreds of thousands of lives. These vaccines are commercially available in India in the private sector, but they are expensive and will not be accessible to a large proportion of the population without a government-sponsored vaccination program. The WHO recommends that countries incorporate these vaccines into their national immunization programs if it is programmatically feasible and cost-effective. In addition, GAVI has announced it will purchase the HPV vaccines to support their introduction in eligible countries, including India.

In 2009, the global health NGO PATH began a study in two states in India to determine the feasibility of a policy for universal vaccination of adolescent girls. After seven of the nearly 24,000 teenage girls participating in the study died, the study came under fire. Although investigations revealed that the deaths were clearly unrelated to the vaccine (one girl drowned, for example), they uncovered irregularities in the ethical conduct of the study. Human rights groups, women’s groups and others petitioned the government to halt the trial, and the media sensationalized the story, adding fuel to the flame. The government yielded to the pressure and halted the trial in 2010.

With no progress being made on the HPV vaccine front anymore, the problem of CaCx in India has once again been shifted to the back burner. Indian activist groups such as Sama and the People’s Health Movement need to recognize that promoting women’s health is a goal that they share with PATH, and that fighting within the camp will only serve to weaken their cause. On the other hand, PATH must respect the concerns of these groups and learn how to partner with them. All the stakeholders need to converse openly and transparently, without pre-existing biases and hidden agendas, on how to best proceed with feasibility studies to build the evidence base necessary for policy makers. If they do not, millions of adolescent girls will never have access to these lifesaving vaccines.

Community Health Workers: Tackling the triple threat of Diarrhea, Malaria and ARI in Chokwe District Mozambique

March 12, 2012

CHWs Working for their community

Diarrhoeal disease, Malaria and Acute Respiratory Infections constitute the significant bane of Mozambique’s poor health indices. Integrated community case management (CCM) has proven to be particularly effective in reducing the burden of these ailments through the use of community health workers in delivering low cost oral rehydration therapy, antimalarial and antibiotics to treat acute cases of these diseases at the community level. Calls to implement a scale-up policy in order to provide coverage for the entire country remain to be heeded. Low access to health care remains a significant challenge to the population with about 30% of the population live in communities that are beyond a 5km walking distance to a near-by health facility (such as in the Chokwe District of the Ghaza Province).

Statistics reveal Mozambique has one of the worst health indices in the world. Inadequate human resources has also been identified as a major problem, with only 500 physicians available for an over 18 million population. In most community-based programs, the volunteers were overwhelmed by the ratio of those seeking care to each volunteer. However, in this case, the program was unique, in being able to train an extensive pool of 2,300 volunteers who delivered services, each to only ten households thereby promoting the concept of universal coverage for every child.

Like every policy/program, a number of challenges exist. The benefits however outweigh these. Providing incentives to motivate community workers and sustaining their services are major concerns.  Other challenges include the issue of medication amongst other supplies from central level to district and the management of these commodities by community workers. Key stakeholders such as UNICEF, USAID and the Health Ministry are firmly behind the full implementation of the policy (CCM scale-up).

In conclusion, community case management remains the best approach and for the portuguese speaking nation, this is indeed the need hour. Mozambique with its teeming population already faces severe shortage of health care providers and the best solution is “task-shifting” and involving the community health workers and the community in their own health care. This way the community will be active partners in health service delivery, which will in turn help the country to take action and ultimately improve her poor health indices.

A Sound Decision? Virginia passes mandatory ultrasound House Bill 462

March 12, 2012

In what falls under “informed-consent” legislation, there is a proposed Virginia state bill that would require women seeking an abortion in early stages of their pregnancies to undergo an invasive type of ultrasound. This procedure would be mandated in order to receive an abortion. In some states it is even stricter, requiring that the woman listen to the heartbeat and look at the ultrasound (Texas). Opponents of the bill state that the procedure is unnecessarily invasive. Six other states that currently mandate ultrasounds and offer the opportunity for women to view the image include: Alabama, Arizona, Georgia, Kansas, Louisiana and Missouri (a seventh state, Texas, requires that women receive both receive the ultrasound and view the image, then wait 24 hours).

On February 21, 2012, Governor McDonnell asked lawmakers to revise the bill in order to mandate that “abdominal” ultrasounds, instead of “transvaginal” ultrasounds, be performed before an abortion. This additional requirement must be financially supported by the women seeking abortions and increases the cost of the procedure. Women of lower socio-economic status may be subject to financial discrimination. To date, no professional medical organization recommends such a mandate in order to improve patient health and safety measures.

Virginia Governor Bob McDonnell Flip-Flops


At first, Gov. McDonnell supported the bill that mandated all women seeking abortions to undergo an invasive transvaginal ultrasound to determine how far along the pregnancy was.
However, that didn’t go over well with his platform base and as it is an election year he withdrew his support. He cited that it was too “intrusive” and that “No person should be directed to undergo an invasive procedure by the state, without their consent, as a precondition to another medical procedure.”

The Sad Outcome
On Wednesday March 7, Gov. Bob McDonnell signed the revised controversial bill into law despite four protests outside the Virginia State Capitol and a petition with 33,000 signatures. Executive director of NARAL Pro-Choice Virginia, Tarina Keene, had this statement: The bill is an unprecedented invasion of privacy and government intrusion into the doctors’ offices and living rooms of Virginia women.”

You Can Still Take Action
Although this amended bill just passed it is never too late to overturn a bill that puts unlawful restrictions on women and their medical rights. In an election year, if a senator gets enough calls citing outrage over an issue that he supported, it could make its way to the top of his priority list.

Intimate Partner Violence: a silent public health problem

March 12, 2012

Intimate partner violence ( IPV), which includes actual physical or sexual violence, threats of violence, or emotional abuse,  is a significant problem in the United States. 3 out of 10 women and 1 out of 10 men have experienced rape, physical violence and/ or stalking by someone they were close to.   Data available reported 2340  IPV related deaths in 2007 – 70% women and 30% men.  A more recent 2010 survey reports more than 12 million women and men were affected by IPV in 1 year. This included 1 million rapes in the previous 12 months. NISVS_Report2010-a  The overall magnitude of  the problem is likely underestimated.  Most cases are not reported to law enforcement.  IPV however, may  have a significant effect on the health of the victim.   The health care system maybe the victim’s first and only contact with professionals that can  provide help.  Acute physical signs and symptoms such as broken bones, bruises as well as chronic  complaints such as headaches, gastrointestinal symptoms, sleep disturbances, anxiety and depression must not be overlooked as potential signs of abuse.  The same, sometimes overzealous, ER personnel who reports suspected cases of child abuse to authorities must not neglect  giving the same care to adults.  Primary care  physicians must remain the patient’s advocate.    Like any other public health concern, the medical community must be an integral part of the solution.  Physicians and other health care providers have to report abuse cases when they become evident during the treatment of patients, but law enforcement and social services must be available to protect and assist the victim.   Physicians may have received little medical school training in dealing with IPV, but medicine has always been a   continuous learning experience.

(link to data source and podcast, ” when closeness goes wrong” –,  graphic from Denbighshire Domestic Violence Abuse Forum, Wales)