Archive for 2015

EPI in South Sudan

August 25, 2015

The extended program of immunization (EPI) seems clearly positive: it is good to vaccinate children, particularly magnavaccinationin countries with limited resources. However, there are questions of ability to maintain cold chain, cost vs. improvement of living conditions, and lack of accountability.

South Sudan is the world’s most fragile country. Vaccination is difficult. The government receives support from UNICEF  and GAVI. The National Expanded Programme on Immunization Multi-Year Plan was launched in 2012. However, parents often walk for days to reach a clinic, and may come once for vaccination, but mostly do not return for subsequent doses.

The country’s healthcare system is also fragmented amongst various funding agencies and NGOs.

Civil war broke out in 2013. Thousands fled to Protection of Civilian areas. An emergency measles campaign occurred but, due to a broken cold chain, or untrained workers, an epidemic occurred and many children died. No one was held accountable.

MAGNA Children at Risk (the NGO I worked for) launched an EPI program and the epidemic stopped. A subsequent emergency cholera vaccination program also occurred. However, some issues included:

Further Links:

Vaccine Development: Thinking Out of the Cold Box

The Long Walk Through Guit

Big Pharma, NGO Square the Circle on Access to Vaccines



Marijuana edibles a threat to our kids

August 18, 2015


Picture 1

Life is like a box of…chocolates, you never know what you’re going to get. Seriously, families in Washington State are experiencing a real problem with marijuana infused edibles. In 2012, Washington voters approved Marijuana for recreational use and as demand markets have grown, so did the stores offering edible marijuana products. The problem is that an open market for edibles increases children’s accessibility and risk for overdose, addiction and sometimes even death. Take for example the case of Levy Thamba Pongi, who jumped to his death after consuming a large amount of marijuana contained in a cookie. Many studies have reported the detrimental effects of marijuana use and we have seen a spike in emergency room admissions in the state, some involving children, who had accidentally eaten marijuana-laced snacks. These products are purposely made attractive to children, with packaging and names that are deceptive, some of…

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Diabetes Management Policies Lack Proactive Components for Disease Management

August 16, 2015

In 2012, 9.3% of the U.S. population had diabetes according the  Over 27% of this population with diabetes was undiagnosed and not receiving necessary care. 86 Million US citizens over the age of 20 are pre-diabetic. Patients who develop pre-diabetes are extremely likely to develop diabetes. Inevitably even with treatment, diabetics will develop complications. According to, the annual cost of diabetes in the US in 2012 was $245 Billion and the incidence is increasing.

diabetes graph

Currently, there is a VA-DOD clinical practice guideline identified for treatment of patients diagnosed with diabetes in the military health system (MHS). This policy is very similar to the American Diabetes Association protocol and universally accepted by providers. There aren’t outcome measures identified to determine if the guideline is achieving the expected outcomes for the patients treated. There aren’t process metrics identified to assist in measuring provider and patient compliance with the clinical practice guideline. This policy includes guidelines for treating patients diagnosed with diabetes but provides no treatment guidelines for patients diagnosed with pre-diabetes.

The policy should be augmented to include pre-diabetes treatment guidelines to minimize the progression to diabetes. This policy should also require surveillance standards to reduce the current trends for under-diagnosing of pre-diabetes and diabetes. Diabetes is a behavioral disease so therefore, disease management is dependent on implementation of behavioral interventions (also omitted from the policy). Self efficacy is the most important predictor of a patient’s ability to self-manage their disease.  The following TedTalk highlights the benefits of educating patients to increase self efficacy rather than instill fear.

The MHS needs a policy that incorporates patient engagement/behavioral intervention, mandatory screening and pre-diabetes clinical practice guidelines. The MHS has one of two options, augment the current policy or create supplemental policies addressing the missing components.

Alberta Needs Universal Newborn Hearing Screening

August 15, 2015

Upto 3 newborns per 1000 live births are born with hearing loss. Early detection and intervention for these children is critical for future language, cognitive, and social development.

Universal Newborn Hearing Screening (UNHS) has been advocated by the NIH, American Academic of Paediatrics, and Canadian Paediatric Society. Some provinces in Canada have even performed cost-effective analysis to demonstrate significant net benefit in terms of educational and vocational savings. Unfortunately, even after a 2013 promise to bring UNHS to Alberta, currently there is no universal hearing screening except for in some select community hospitals. Otolaryngologists, Audiologists, and Speech Language Pathologists in Alberta have urged the government and Alberta Health Services to reconsider their current policy, emphasizing that intervention and treatment should ideally be started before 6 months of age.

Screening is often performed by trained nurse or audiologists by detecting echoes from outer hair cells of an infant’s cochlea. These tests are cheap and easily administered in the neonatal ICU setting or neonatal nursery.


Infants who fail initial testing by this method can then go on to more advanced hearing testing. If a hearing loss is confirmed, the child and family can then be provided timely education, medical/surgical, and educational intervention.

Currently, the average delay in diagnosis of hearing loss in Alberta is 18 to 24 months! Alberta needs to follow the lead of other provinces in Canada and provide an integrated and consistent UNHS program.

The necessity of comprehensive sex education in the United States

August 15, 2015

In 2014, there were nearly 250,000 teen births in the United States, with an average of 24 births per 1000 girls. Billions of dollars are spent on costs associated with teen pregnancy each year – including health costs, child welfare costs, and many more costs with various social implications. Additionally, studies show that only 38% of teenage mothers graduate high school, and children born to teenage mothers are at higher risks of becoming teen parents and not finishing high school, themselves.

Though the number of teen pregnancies each year has recently dropped, significant improvements can still be made. One area that can have a great impact on these statistics is sexual education in public schools, at both primary and secondary levels. Studies performed by the Guttmacher Institute show that there are a number of discrepancies in the efficacy of sex education from state to state. For instance, while 21 states mandate sexual and HIV education, only 17 mandate education on contraceptive use, and 26 states stress abstinence-only education. The most alarming of these findings, however, is that only 13 states mandate that sex education (when provided) must be medically accurate, and 10 states have no requirements for sex or HIV education. This information is especially significant when taking into account the states with the highest teen pregnancy rates.

Image Credit: Kate Prengaman/XlyemBlog

Image Credit: Kate Prengaman/XlyemBlog

In order for these numbers to improve, the approach to sex education in public schools in the United States must change. Comprehensive, medically-based, and factual information should be taught, starting at a young age. Though some may argue that parents have the right and responsibility to teach their own children about sex, it is clear that current methods of sex education are not adequate. By strengthening comprehensive sex education to all children and teens, the teenage pregnancy rate will decrease, which will bring about a number of positive changes: more young women will have the chance to finish high school and will have more opportunities available to them, which will help protect against poverty, and can decrease child abuse and neglect rates, and will minimize the economic burden of teenage pregnancy, as well.

Healthcare Reforms through Liberalizing Physician’s Practice in China

August 14, 2015

China has the largest population of 1.4 billon globally but only 2 million physicians (1.9 physicians / 1,000 population vs. OECD average of 3.2). The healthcare system is dominated by public state-owned hospitals (employing 89% of Chinese physicians) that often offer low pay (average annual salary: US$8,000). There is increasing physicians’ dissatisfaction and difficulty in medical school recruitment, which underscores an urgency to resolve physician shortages.


Physicians in China need two licenses to practice, the medical qualification license (similar to the board exams in U.S.) and the medical practice license – each medical practice license is registered at a single hospital and physicians are allowed to practice in one location only (the employer). As part of healthcare reform in China since 2009, regulations restricting to only one-location medical practice are relaxed. Practicing in multiple locations is expected to help improve physician income and satisfaction, extending healthcare service access and strengthening private hospitals.

However, very few Chinese physicians currently have multiple-location licenses. For example, in Shenzhen (one of China’s most affluent and reform-minded cities), none of the 6,000 physicians registered for multiple-location practice. Potentially a conflict of interests, the current regulations require the employer hospital’s principal to approve physicians for such multiple-location licenses. State-owned employer hospitals are likely to discourage physicians from multiple-location practice in order to avoid losing competitiveness to private hospitals. Despite recent attempts in Beijing to remove such approval process, the public state-owned hospitals have administrative powers to limit changes.

For effective national implementation, it is critical that the National Development and Reform Commission (China’s central government unit for economic and social reform) and National Health and Family Planning Commission (China’s Ministry of Health) work together to empower physicians in their participation in multiple-location licensing and push for healthcare reform that better meets healthcare needs in China.


  1. China National Health and Family Planning Commission. China’s health and family planning statistics yearbook 2015. Beijing: China Union Medical University Press.
  2. China Ministry of Health. Notice on physician multiple-location practice policy (in Chinese), 2009. Retrieved at on August 12th, 2015
  3. China Ministry of Health. Notice on expanding the physician multiple-location practice policy (in Chinese), 2011. Retrieved at on August 12th, 2015
  4. Han SX, Ye L. Research and exploration of physician multi-site practice at the stage of new health system reform (in Chinese), Chinese health resources, 2013. 3: 193-195
  5. “Why did hospital heads say ‘No’ to multiple-location practicing?” (in Chinese). People’s Political Consultative Conference Report (2014). Retrieved at on August 12th, 2015
  6. Luo JN, Wang YL, Deng ZY, Bei W, LI LD. Analysis of status and countermeasures of doctor multi-sites practice in Shanghai (in Chinese), Chinese Journal of Health Policy, 2011. 4 (12): 26-31
  7. Yip, W CM, Hsiao W, Meng Q, Chen W, Sun X. Realignment of incentives for health-care providers in China (in Chinese), Lancet, 2010. 375: 1120-1130.

Syndicated Cataract Surgery in the Philippines

August 14, 2015

In the Philippines, cataract removal ranked 4th among the top procedures that the Philippines Health Insurance Corporation (PhilHealth) paid for in 2014. PhilHealth’s mandate is to provide health insurance coverage and ensure affordable, acceptable, available and accessible healthcare services for all citizens of the Philippines. Expenditure was equivalent to P3.7B ($81.95M) out of P78B ($1.73B) total benefit payments.

A recent finding reported in MANILA by PhilHealth had at least 6 health care facilities that conducted cataract surgeries on patient members without their consent. The alleged syndicated practices claimed bigger benefit payments for cataract removal procedures. The Philippine Senate along with PhilHealth is therefore investigating at least 10 ambulatory surgical centers claiming for cataract procedures discovered to have “very conspicuous rise” in claims in 2014, that also coincided with complaints from patients.

In an impoverished 3rd world country like the Philippines with over 100 million inhabitants constituting 1.38% of the world’s population, majority have limited access to basic needs, let alone healthcare services. The government and church are enmeshed in each other’s business and the few educated elite dominate the society. Healthcare is a privilege and people are beset with diseases and sufferings secondary to overpopulation and pollution such as malnourishment, communicable diseases and others. As such, wrongdoings that defraud the already deprived system have tremendous impact to the society’s well-being and to the generations that will follow. The Department of Health, the local Ophthalmological Society, individual health practitioners and the community all play a role in ensuring honest and equity access to healthcare services including cataract surgeries that contribute to improvement of quality of life. Necessary policies should be in place to protect the Philippine constituents of their healthcare privileges, the PhilHealth system so it can continue with its mandate and the healthcare practitioners.

Why California voters should uphold Senate Bill 277

August 14, 2015
Girl getting immunization: Getty Images

Getty Images

On June 30th, 2015, Governor Jerry Brown signed Senate Bill 277 into law. SB277 amended the vaccine requirements for California school children by banning religious and personal belief exemptions of childhood vaccinations. Starting January 1, 2016, students attending California schools must receive all childhood vaccinations as recommended by the AAP and CDC unless they have a medical exemption signed by a physician. The California State PTA and the California Department of Public Health supported this legislature in light of a recent measles outbreak that began in California’s Disneyland. The outbreak was perpetuated by low inoculation rates that decreased herd immunity and led to cases across 24 states and the District of Columbia.

While side effects exist for all medications, the risk of vaccination is highly outweighed by the benefit of eliminating suffering and death from vaccine preventable diseases. Serious allergic reaction to the Measles Mumps and Rubella vaccine has been reported in less than 1 out of a million doses given. In contrast, 1 to 2 out of every 1,000 children who get measles will die. In addition, research has thoroughly discredited any connection between childhood vaccinations and neurodevelopmental disorders such as autism.

Despite the fact that research has clearly proven childhood vaccines are both safe and effective, former assemblyman Tim Donnelly filed a referendum to oppose SB277. Opponents of the bill, such as anti-vaccine group the California Coalition for Vaccine Choice, need to collect 365,880 valid referendum signatures in order to delay the implementation of SB277 by bringing the bill to a vote in November of 2016, after the start of the school year.

Young children and persons who are chronically ill or immunocompromised are at increased risk for contracting diseases such as measles and suffering more severe sequelae of such diseases. The California government has the responsibility to protect these individuals, and to do so vaccination rates must be increased to levels sufficient for herd immunity. SB277 is an evidence-based policy that supports the public health of all Californians. California voters need to unite in favor of protecting their neighbors and fellow citizens and uphold SB277.

A Health Promoting Environment; Accessibility and misdirection of “health” food improved in one fell removal

August 14, 2015

The World Health Organization recommends individuals reduce their consumption of added or free sugars significantly, to less than 10% of total energy intake. Within the UK, 20% of adults are obese, which costs the health system £6.4 billion in 2015 (and up to £27 billion with indirect costs). Although the recommendations and burdens are clear, the solutions prove elusive to consumers as prevalence in obesity and weight gain continue to increase each year.

Natural Balance Foods (a British health bar company) educates consumers on recognizing wholefood and processed food based on their ingredients. 

Over time, healthy eating fads come in waves with constantly changing definitions and solutions. With the burgeoning demand for healthy food, masquerading products flood the market and dilute the efforts of the potentially misinformed consumer. However, as health food obtains a foot-hold in the food industry, supermarkets are exerting their power to promote access to healthier products; the supermarket Tesco will remove high sugar foods from checkouts throughout all convenience stores in the UK, matching a policy enacted in their larger stores in 1994 and the general recommendations made in the 2012 UK Responsibility Deal.

Tesco’s product relocation comes closer to drawing clear lines between healthy and unhealthy products, laying false claim to the nutritional label: check out products must meet a series of qualifications based on fruit, vegetable, sugar and calorie content. Thus, Tesco’s checkout space no longer shrouds wolves in un-substantiated nutritional clothing, but instead demands marketing and nutritional responsibility from products if they want the coveted and accessible shelf placement. Furthermore, healthy foods by will cross paths with a larger market, not merely those seeking previously niche items.

Only through promoting increased consumption of honestly healthy foods does the UK and other countries support the everyday choices upon which healthy and sustainable lifestyles are built.

Call for a nationwide ban on female genital mutilation in Liberia

August 14, 2015

Female genital mutilation (FGM) is a form of violence against women that must be stopped. According to Liberia’s demographic health survey, FGM is estimated at 49.8% for women and girls aged 15-49. Initiation into a secret society called Sande is synonymous with FGM and Sande members have shown stronger support for its continuation than had been shown before.

The United Nations General Assembly adopted the resolution ‘intensifying global efforts for the elimination of FGM on December 20, 2012. This marked a ground-breaking milestone in global efforts to end this harmful practice. The political interest is there. Affected women and girls have gained momentum. The global community now sees this as a human rights violation and a manifestation of gender inequality.

It’s also a public health issue. FGM has no medical benefits and can cause medical harm. FGM has immediate health complications which could include severe pain, shock, and sepsis. Long-term consequences can include recurrent bladder and urinary tract infections, cysts, infertility and an increased risk of childbirth complications and newborn deaths.

Despite this, there is no law criminalizing the practice of FGM in Liberia. The Ministry of Justice and Ministry of Gender and Development have avoided speaking on the issue for fear of losing votes or retaliation from Sande members.

It is time for women and girls to reclaim control of their bodies, for the Government of Liberia to recognize FGM as a crime, and for NGOs to adopt culturally relevant programs that support the human rights of the women and girls of Liberia.