United States Leads in Stealing Africa's Doctors

Pediatric doctors at Donka Hospital in Conakry, Guinea

Pediatric doctors at Donka Hospital in Conakry, Guinea

The United States is stealing the world’s doctors — and from the very places that need doctors the most. Dubbed the “international brain drain,” the United States leads the way in attracting international doctors, especially those from Africa.

The United States, with its high salaries, attracts more international doctors every year than Britain, Canada and Australia combined. However, for every 1000 people, Africa has only 2.3 health care workers, while the United States has almost 25. Doctors emigrating in droves from developing countries for “greener pastures” are making an already critical health worker shortage ever more dire.

But this brain drain is not new. In countries like Ghana, some 61% of doctors produced in the country between 1986 and 1994 had already left the country by 1999. The financial loss from emigration like this has been extremely detrimental. The loss from this period of emigration in Ghana alone is estimated at over 5.9 million dollars.

Foreign MDs
Foreign MDs

Not surprising, foreign medical doctors make up a substantial proportion of the doctors workforce in some of the most affluent countries in the world. More than 34% of doctors practicing in New Zealand were from overseas in 2000.  And according to a 2010 report in the Economie Internationale other developed countries have extremely high proportions of foreign doctors, including the United-Kingdom with 31%, the United-States with 26%, and Australia and Canada with more than 20%.

This is in part the result of initiatives like the 1994 U.S. legislation proposed to allow foreign doctors on student visas access to stay in the U.S. if they agreed to work in some of the poorest places in the United States. Since then, over 8,500 African doctors have left Africa and gained jobs at American hospitals that were in short supply.

A sneaky initiative. It looks great from the outside from its ability to give African medical students the chance to work in the U.S. for higher wages but it does nothing but continue to keep those living in “periphery” countries ever more dependent on “core” countries.

This is described by most scholars as the dependency theory — an economic model that became popular in the 1960s as a critic of the way the United States, along with many western countries, exploits those in the “periphery” for their own gain.

Poor countries provide resources, in the form of raw materials, cheap labor, and a market to those countries in the core. While wealthy countries in the core perpetuate their dependence in every way possible — through control of the media, economic politics, banks and finance insinuations like the International Monetary Fund (IMF) and the World Bank, educational initiatives, cultural exploitation, and even sporting events like the World Cup.

Indeed, this exploitation is clearly exemplified by the emigration policies facilitating the exodus of medical doctors from Africa over the past decade. Of the 12 African countries producing the most medical graduates, 8 have seen a 50% increase from 2002 - 2011 in all graduates appearing in the U.S. physician workforce. Cameroon, Sudan, and Ethiopia each had over a 100% increase since 2002.

These policies in place, that are sucking up some of Africa’s greatest doctors, are just further methods of perpetuating the poorest country’s dependence on the wealthiest.

It becomes clear then that while the United States benefits, Africa only appears to benefit. The U.S. gains excess doctors, while Africa looses the few it barely has.

While the United Sates grows its ratio of 2.45 doctors for every 1000 people, countries like Mozambique see a decrease in the already alarming rate of .04 doctors for every 1000 people.

Health professionals around the world agree that human resources is the most key component to solving problems in global health. But it is often one of the most neglected components, with much more emphasis focused on managing disease outbreaks and not the people actually preventing diseases.

Oliver Bakewel, of the International Migration Institute, agrees with this logic in writing that “development practice has commonly seen a reduction in migration as either an (implicit or explicit) aim of intervention or an indicator of a programme’s success" in an 2007 report.

However some scholars at the World Bank disagree with the notion that migration is inversely proportional to success in African development. A 2014 article in The Atlantic headlined "Why the brain drain can actually benefit African countries," outlined their findings that suggest "one additional migrant creates about 2,100 dollars a year in additional exports for his/her country of origin.”

However, this argument does not look closely enough at the brain drain for specifically medical doctors.

The brain drain intersects more than just the medial field — it cross cuts every highly skilled profession. But the effects of the brain drain on the status of health care in Africa is much more harmful than that of the brain drain of — for example — African professors. The average increase of 2,100 dollars in exports will do nothing to solve the critical and immediate lack of medical doctors in almost every African country.

The time is here more than ever for the international community to play a more proactive role in addressing the international medical brain drain. Affluent countries like the United States should be held accountable for exploiting Africa for its doctors, while international policies should be put in place to help African governments increase wages for health workers and retain their much needed doctors.

Contributing Editor: @AustinBryan
LinkedIn: Austin Drake Bryan

To Spite Obama Health Insurance Companies and Pharmaceuticals Choose to Kill Citizens

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WASHINGTON, D.C. – At midnight on December 31st the world retired 2014 to make way for 2015. For many it marked a night of festivities, parties, and insouciance. For others, like me, it was the day which marked the resetting of health insurance premiums, deductibles, and prescription coverages which would inevitably result in increased costs.

In the days prior, I frantically traveled to doctor's offices and pharmacies to get all of our prescriptions refilled before January 1st. In one instance, my son's pediatrician wouldn't authorize refills for his asthma medications without an appointment. Thankfully we were able to be seen by him on an emergency basis on the morning of December 31st. It was with grateful relief that he wrote all of the prescriptions needed and that I was able to get them filled before the pharmacy closed.

Unfortunately the insurance company would not authorize the refill of one of my son's most expensive medications until after the new year. One might think, with the figures I am about to report, that the medications to which I am referring are 'Brand Named' versus 'Generic.' However, this is not the case. In 2014, before I met my plan deductible, the generic version of one of his medications was $250 for a 30-day supply, while the cost for the brand name was $491. After I met my annual deductible, the costs of this medicine was reduced significantly to $50 for a 30-day supply of the generic which was a great costs savings for our household.

This reduction from my perspective directly correlated with the enactment of The Affordable Care Act (ACA) which was passed in 2010. The ACA, also known as 'Obamacare' made health coverage mandatory and also provided the means for the uninsured to purchase affordable insurance through exchanges which would help regulate the market prices. For me it was a blessing because it reduced my premiums and enabled me to purchase 'individual/self-pay' insurance without having to pay exorbitant premium fees because of 'preexisting' condition as defined by insurance companies such as Asthma, Cancer, Heart Disease, etc.

The cost to maintain this insurance is expensive, but compared to what I paid for COBRA Continuation Health Coverage in 2012, the 33 percent reduction in premium costs was a welcomed relief. I went from paying $1,660 per month to just over $550 per month for better coverage. The only catch was that my prescription costs increased significantly and thus the net/net was actually more like a 20 percent reduction in costs once this was factored in. However, providing the best healthcare for my son was non-negotiable and often meant that bills remain unpaid, and in some instances I didn't refill my medication or go to see the doctor when I needed.

Then, on November 14, 2014, The New York Times reported that "The Obama administration on Friday unveiled data showing that many Americans with health insurance bought under the Affordable Care Act could face substantial price increases next year — in some cases as much as 20 percent — unless they switch plans." Proponents of ACA asserted that this demonstrated that the legislation was working while Republican opponents pointed to these increases as proof that it is not.

As a parent and someone who is directly impacted by the ACA, I can categorically state that without it neither my son nor I would have insurance coverage. I couldn't have afforded to pay $3,000 a month in premiums and prescription costs because of 'preexisting conditions.' From my perspective the 2015 rate increases coupled with inflation in costs for generic medicines is a ploy devised by the insurance companies and pharmaceuticals to incite an already cash strapped American consumer to work against their own best interest. The premise that healthcare for average Americans was better prior to the passing of the ACA is ludicrous.

Me and millions of other Americans remember the heartache and pain of having to watch one's child suffer because an insurance company informed you that your child's healthcare costs would no longer be covered because of an "annual or lifetime" dollar limit. Other parents were faced with the necessity of mortgaging their homes, working several jobs, and making other sacrifices so that they could pay for expensive cancer or heart disease medicines. We all thought these days were behind us, but it turns out that 'we' have become collateral damage in what has been advertised as a war between the Republicans and President Obama.

In reality it is about greed. Providing access to affordable healthcare and prescriptions is not a luxury, it is a need. Parents like me are not 'lazy ne'er-do-wells' seeking to sponge off of the government. We are hard-working individuals who make difficult choices so that our children may live and grow up to be healthy contributors to society. The ACA provided us with hope for such a future, but insurance companies and pharmaceuticals have found a new way to game the system.

Anecdotally, it appears that since insurance companies are forced to insure people who may cost them money, they will make insurance available but the quality of that service is dependent on one's ability to pay for it. Thus, the better the insurance the greater the costs. However, this doesn't help them to recoup their losses (i.e. executives can't buy a new yacht, jet, exotic car, or mansion), so they turn to the pharmaceutical companies to further pressure consumers into lobbying for the dissolution of Obamacare.

When the media first began to report that generic medicine prices would increase substantially I worried but not much. Then, The Chicago Tribune reported on the rising cost of generic drug prices, and I became concerned but couldn't imagine an increase greater than a few percentage points. Then on January 3rd when I asked the pharmacists to fill the one prescription remaining from 2014, I was shocked to learn that the price increased from $50 for a 30-day supply to $391 for a 30-day supply. That was for GENERIC not brand name! I contacted my insurance company and was given a clearly ridiculous story that the cost of manufacturing the drug had increased.

Asthma can be a life-threatening condition and not taking his medication for a few days though not recommended, is not going to kill him. The same cannot be said of parents who have children with a terminal illness like cancer, in which treatment consists of multiple medications and a single prescription can cost upwards of $1,500 per month. Thus, the title of this article seeks not only to grab your attention, but also to help people understand that by taking away our ability to purchase life-saving medicine so that a pharmaceutical company can increase it's profit margin is immoral, reprehensible, and absolutely inhuman; and like it or not the choice to drastically increase the cost of generic drugs is tantamount to 'killing citizens.'

Follow Nahmias Cipher Report on Twitter Twitter: @nahmias_report Editor-in-Chief: @ayannanahmias

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International Volunteers Series: Infirmary Worker in Montero, Bolivia

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Olivia Elswick, Asia CorrespondentLast Modified: 23:30 p.m. DST, 03 July 2014

Antoinette Moncrieff

MONTERO, Bolivia -- Antoinette Moncrieff, a spitfire of a girl from Michigan, works in an orphanage, or Hogar, in Bolivia with another American volunteer, Natalie Baker. Antoinette was drawn to work in Bolivia because of the opportunity to work in an orphanage and the tropical location.

As the oldest of four children and a second mom to the youngest siblings, kids have surrounded her all her life. She has been a nanny, baby-sitter, teacher’s aide, and has worked at a daycare and summer camp with homeless children.

What is your job in Bolivia?‬‬

‪My first eight months here, I worked in Santa Maria with the 0 – 5 year olds. I did homework with the kindergarteners, occasionally did activities with them, changed their diapers, bathed them, fed them, played with them, and disciplined them.

Now I help Hermana Paulita in the infirmary. I´m in charge of meds for both buildings, three times a day. I also file, take children to appointments, and take children to the doctor. Additionally, I sometimes take care of cuts and scrapes, burns, etc. and keep a note of who has what so that when Hermana Paulita comes in for the day she can have a look at them.

What is a day in the life like?

Honestly, that´s hard to say! Every day here is so different! Even in the nine months I've been here, my job responsibilities have switched around according to the need of the moment.

Typically, the average day here goes something like this:

  • 5:00 am – The girls get up, get dressed, and do chores. (By default, I am awake too. It´s hard not to wake up when your bedroom is adjacent to a dorm of teenagers).☺
  • 6:00 am – I am officially out of bed and go get the breakfast meds ready.
  • 6:30 am – Breakfast bell, pray Hail Mary with the girls before entering, pass out food to our tables (we each have a table, mine is mainly full of middle school age girls) and I hand out meds to the girls.
  • 7:15 am – The girls who go to school at Maria Auxiliadora, which is across town, leave on our microbus with Don Pancho, our handyman and driver. I am usually still chasing down girls who weren´t at breakfast to hand them out meds. The other girls who go to the public school next door leave on foot.
  • 8:00 am – I hand out meds to Santa Maria, our 0 – 5 year olds, while they eat their breakfast. The school age girls do their homework in preparation for the afternoon session.
  • 8:30 am– It really depends on the day. Sometimes I do paperwork; filing girls´ medical records, keeping track of their meds, etc. Sometimes I need to take care of boo-boos, take girls to appointments, or make unplanned trips to the doctor with sick children.
  • 12:15 pm – I hand out lunch-time meds to Santa Maria.
  • 13:00 pm – Lunch bell. Sometimes Madre Rosario, our director, gives the girls a talk while they wait in line. I dish out food for my table and then hand out lunch meds to the girls in the dining room.
  • 14:00 pm – Afternoon session has started. The girls who go to school in the mornings do their homework in preparation for the next day. Santa Maria is either napping or at kindergarten depending on their ages. My routine is then much like the morning.
  • 18:00 pm – Dinnertime meds with Santa Maria.
  • 18:30 pm – Dinner bell. I dish out food to my table and pass out the dinner-time meds.
  • 19:00 – Officially I don´t have anything going on.

But this is relative. Often Natalie and I will have a cup of tea in the volunteer kitchen. Sometimes I get sucked in to taking care of someone´s boo-boos, which usually means that I end up taking care of ten people because if the girls get wind of the fact that I´m taking care of one person, they´ll all want me to take care of them. Sometimes I read or hang out in the library with Natalie and the homework girls.

  • 22:00 pm – A rough bedtime estimate.

How are you able to handle all of your responsibilities while keeping a healthy work/life balance?‬‬

Honestly, it´s difficult. Because there is no physical separation of work and home, and there are children around constantly, it is hard to keep a proper balance. The nature of your responsibilities also makes this difficult as well. I've found that it´s very important to take a bit of time out for yourself, indeed a necessity… Reading, journaling, art, taking a walk, taking naps, etc. have all helped me. When you´re feeling especially burnt out, taking a few days off is important too.

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Published: 03 July 2014 (Page 2 of 4)

Has there been a defining moment in your life that made you decide to take the direction you did?

A typical day for me starts with morning mass at 6:45. Many of the students attend this mass as well. After mass I take attendance for the Daughters of Mary which is a Catholic group for young women dedicated to living more like Mary and growing in our faith as Christians. After that we have a quick breakfast and morning assembly. Monday, Wednesday and Friday I go with a VSDB sister to a village school that we are in charge of running and organizing.

We conduct assembly there, teach various subjects, get uniforms and other necessary things in order to get the new school on its feet. Those afternoons I teach art and religion at our base school. Tuesday and Thursday I start my day in the secondary school then teach the 5 aspirants we have English and Group Dynamics. The rest of the afternoon after lunch is spent in either art or religion and just being present in the school to assist with conflicts or difficulties that arise. Most afternoons I help a few students practice reading with small books we have here. ‪‬ I've wanted to do mission work since I was knee-high to a duck. I've always been interested in foreign countries and cultures, as well as poverty, human rights and social justice issues.

In college I sat through class and when I wasn't doodling or wishing I was doing something else with my life, I began to be aware of a desire deep inside to go to a foreign country and love the little children who had no one to love them.

It came to a head one fall day when I was supposed to be grocery shopping before work. Instead, I found myself walking through the woods in the park yelling at God.

“What do you want me to do?” I demanded of him.

In my mind´s eye I saw him laughing at me. He popped the question right back to me:

“What do you want to do?”

What were your thoughts about Bolivia before you arrived and how have they changed or stayed the same?‬‬‬

‪‬I think, coming from a first-world country that places a great deal of importance on child safety and development, as well as continuing education, I took it for granted that those I worked with would be of the same mindset. I found that this is not necessarily the case.

What are your hobbies and community involvement at your site?‬‬‬

Once a week, Natalie and I get to eat lunch with the nuns who run our orphanage at their convent. We also take part in the different celebrations at the Hogar. Bolivia has so many celebrations. Often we join the other staff members in putting on a dance.

We've also put on Dia de La Bruja (Halloween), Christmas, Easter, and Mother´s Day celebrations. The staff take turns putting on one major celebration every year; this year our turn was Mother´s Day.

Natalie and I enjoy making cups of tea, hanging out in the Plaza, and watching movies too. Personally, I enjoy reading, writing, journaling, drawing, painting, photography, dancing, and petting my cat. ☺

What are the hardest parts about living there?

I think one of the hardest parts about the Hogar is that there´s just kids around all the time. The noise is constant. You really can´t walk anywhere without running into someone. Even when you try to go somewhere for a little space, like the volunteer kitchen (which ends up feeling like a giant fishbowl) they often find you and spy on you, bang on the windows, etc. Someone´s always yelling, talking or laughing really loud, crying, etc. Even taking showers, going to the bathroom, etc. don´t always have the luxury of privacy. I have had numerous conversations through the shower door. ☺

Food has been interesting. The government only gives eight bolivianos a day (less then $1.50 U.S.) to the Hogar for each child for ALL of her needs. (By the way, this is the same amount that the prisons get.) Food is often very limited and almost always unappetizing. When there´s food we eat and when there´s not we don´t. While there´s always something to eat, there´s usually not enough and what there isn't very nutritious.

We eat a lot of donated things. It´s not unusual for us to eat a small baggie of outdated cookies leftover from the school snack for breakfast or dinner. Once we went through a whole week where the main meal, lunch, was only a bowl of soup. Feeling hungry is often just something you suck up and deal with.‬‬‬

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Published: 03 July 2014 (Page 3 of 4)

‪‪Do you ever feel unsafe?‬‬‬

‪‬Sometimes. Going anywhere at night is often kind of scary and it gets dark really early here because we´re closer to the equator. Our neighborhood is kind of bad and an especial target for robbers because the market´s right there and people always have money on them. Two months in Natalie and I were robbed at gunpoint and her purse was stolen. That was scary but we learned from it and came out okay in the end. Most of the time we´re pretty safe though. The key is to go out during the day. ‬‬‬‬

What is the most rewarding part about living there?‬‬‬

‪Knowing that you´re making a difference in the lives of the kids. Seeing the small changes in them, as they grow, heal and learn is priceless. I've had the opportunity to build positive relationships with many of the children over the nine and a half months I´ve been here. Every once in a while it blows my mind that I can positively interact with a kid I never thought I would. ‪ ‬‪ ‬‬‬‬ ‪‬What is your best memory so far?

‪‬‬I have so many good ones that it´s hard to choose one! Getting electrocuted by the showers, the day Melani learned to walk, Sandra and Natalie getting stuck up in a tree, Yudid and Emily dancing around in gigantic costume feet, getting my hair tangled up in the wheel of a cart during an impromptu race with a bunch of middle school girls, finding my boyfriend sopping wet during a water balloon war with a bunch of teenage girls and then bringing him to the personnel meeting where he left a gigantic puddle on the floor… There´s so many! ☺

What is the most heartwarming experience you’ve had and the most heartbreaking?

‪I've  had a lot of heartwarming experiences and a lot of heartbreaking ones. Hearing Leidy tell me she wanted to die, the kids not having enough food, having Etcel spill into my lap crying telling me her dad told her she has to stay here always, holding screaming Nataly during her transition into Santa Maria, the day Deimar's adoptive family returned him and seeing how changed he was as a result… those are some of the heartbreaking ones.

Getting peppered in hugs and kisses by Santa Maria, watching Paz turn from a smelly scabies-infested street animal into a loving pregnant kitty, watching Silvana go from a depressed and sick little girl to a smiling joyful girl who can use a pencil and count to ten consecutively, getting a picture from Emily on a really rough day, getting called “Mama,” how excited Francisca was about reading “Bread and Jam for Frances”, Belen's cute secret hand waves as she walks down the hallway. Those are definitely the heartwarming ones and they make it all worth it.

Can you tell me about one child that you feel you’ve impacted or about one child who has impacted you?

I think Silvana was the guiding thread through my first several months of being here at the Hogar. When I first came here she was eight years old but living with the 0 -5 year olds in Santa Maria. She was very sad, withdrawn, depressed and sick. In my first few days of working in Santa Maria, I got Silvana to smile. Gradually she came out of her shell.

In January she started kindergarten. She had difficulty doing simple pencil tracing exercises and the concept of colors was completely lost on her. I talked to our psychologist and social worker and learned that Silvana grew up in the country wandering the streets with her schizophrenic mother.

When she first came to the Hogar, Silvana could not use the bathroom by herself. She just sat and did not interact with anyone. In the year-to-year and a half since then, Silvana has come such a long way. The psychologist felt that Silvana was capable of learning but because of poor nutrition she would come about it in her own timetable and not when we expected her to. He thought being in Santa Maria was the best medicine for her because the children would talk to her; she would learn from her peers.

I kept working with Silvana. Slowly but surely she got the hang of using a pencil. She was able to do all of her homework, even making letters of the alphabet. She even named a color once without my asking her to. She needed constant affirmation but was very pleased with herself as she made progress. I remember the day she counted her numbers and actually started with one instead of two. I was so excited!

She is such a different little girl then she was nine and a half months ago. She laughs and talks with the other kids, smiles and climbs all over the playground. I am so happy she's come so far.

What lessons will you take with you?

‪‬‬I've learned how strong I really am. I´ve learned a number of different nursing skills and life skills that I definitely didn't know when I came down here. I also learned that I can go months on end without seeing my boyfriend and have our relationship come out stronger for it.

Do you find that women are treated differently than men at your site?

Yes and no. We don´t have the same gender inequalities and difficulties that many other third-world countries do, but men and women have very different roles in Bolivia. There are a lot more clear distinctions between what men and women do then there are back home. If a little boy wants to play with a doll, they are very adamant that “that's women's stuff” and scold him. Traditionally anything to do with tools, appliances, building, etc. falls under the male's role. I don't really agree with it.

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Published: 03 July 2014 (Page 4 of 4)

What are the most critical problems faced by people in your area?

‪‬‬Poverty and a lack of education. Poverty and ignorance breed each other. Knowledge of child development is often nonexistent. Knowledge that we often take for granted in the United States is not common knowledge here. People have hugely unrealistic developmental expectations of children and thinking outside the box or innovatively or in a problem-solving way is not really done here.

In my particular neighborhood, families are very broken. Many parents are not married. It is not unusual for a father or mother to go off to another country and leave the rest of the family. People tend to have the attitude that orphanages can raise their children; sort of like free daycare until the child is old enough to be useful to the family. Once one of our English volunteers was approached by a single mother who looked to be fairly well-off. She wanted to know if the Hogar could take her children.

Do you ever feel like you really belong in Bolivia at the Hogar?

‪‬‬Yes and no. I think the very nature of the Hogar makes it feel difficult to feel fully part of what´s going on. But I feel like I belong in the sense that I am where I am supposed to be, and I've become part of life here and part of the girls´ lives as well, even for the short time I´m here.

What is the most interesting or surprising thing you’ve observed or been a part of?

Being a part of the outdoor Stations of the Cross that happen in the streets of Montero during Lent has definitely been one of the most interesting things I´ve been part of.

As for surprising… Life at the Hogar is often a surprise. You never know when you´ll be entertaining a group of American visitors, finding a live bat in the library, going to the dairy farm with Santa Maria, having a party, or watching the tortoise trying to get out of the corner next to the computer like I´m doing right now. ☺

What are your hopes for the people you’ve interacted with?

I hope each one of my children goes on to lead a long, happy, and productive life. I hope they make a better life for themselves then the life they were born into, make positive choices and that they find love and healing. I wish I was around to see the kind of people they grow up to be.

What are your plans once you’ve finished at your site?

I'm going to return to Ypsilanti, Michigan. I've got a job waiting for me at home, working with 5-10 year olds as an after-school program leader. I´m also hoping to train as a volunteer Doula working with mothers who have just given birth.

What do you plan to have accomplished in five, 10, 20, and 50-years personally and professionally?

I don't have a time limit for anything. Life takes many strange twists and turns and it's silly to put a time frame on things. I can tell you what I would like to have happen, though. I would like to become a midwife and herbalist.

I would like to get married and have a ton of kids, do foster care and adopt. I would like to be an urban farmer and continue drawing, taking photos, writing, dancing, painting, and non-conventional learning. I'm hoping to spend my life invested in the lives of my family members, friends, and the community around me. And I hope to continue doing mission work in the future.

Anything else you would like to add?

If you've ever thought about doing overseas mission or volunteer work… seriously. DO IT!  It's so worth it in the end. You will be so much better for it, and you will have made a positive impact on someone else's life.

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Follow Olivia on Twitter Twitter: @nahmias_report Asia Correspondent: @OCELswick

Heroin in the Hills

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Michael Ransom, Contributing EditorLast Modified: 07:45 p.m. DST, 11 June 2014

High School Photography, Photo by Nadja RootCINCINNATI, Ohio -- While drug abuse is a long-standing problem in the Appalachia region of the United States, the surge in heroin usage has only been recently documented and is a relatively new phenomena. Most officials attribute the influx of heroin into be rural black-market to be a response to the crackdown on the easy accessibility to prescription pain pills such as OxyContin and Percocet, which rule the drug markets in Appalachia a few years ago.

In any case, heroin usage in the region is increasing at an alarming rate. To address this shift in society, police officers, caretakers and addicts have recently started carrying Naloxone. Could this overdose antidote be the answer?

Naloxone was first introduced in the 1960s, but was often written off as a taboo idea. In the War on Drugs, often addiction is not treated as a disease, and efforts to help people with life-threatening dependencies are not seen as legitimate. Lawmakers often claim that with increased access to clean needles and overdose antidotes, people will be more likely to use the drugs in the first place.

That logic is flawed, as heroin and other serious opiate addictions are fueled by growing issues in society and the personal lives of addicts. I believe that no one in their right mind would start down the path of heroin abuse simply because free needles were offered at a clinic down the road.

Data has shown that Naloxone is very effective in saving lives that are on the brink of overdose. Just last week, two police officers were able to revive a woman who was overdosing on the Staten Island bridge in New York. Examples of the drug's effectiveness are seen nationwide. It is an important tool in the fight against heroin and morphine related deaths.

Al Jazeera is now reporting about an interesting dynamic within the small-town America plight of heroin abuse. Cincinnati, Ohio has long been a hub of powerful painkillers, previously pills and now heroin. Neighboring Kentucky is home to some of the highest opiate overdose rates in America. Both of these Appalachian states are passing laws to help those afflicted with drug dependency. Kentucky has increased pedestrian access to Naloxone and offered amnesty to those who need medical treatment after a heroin overdose. Ohio has gone one step further, allowing those people are not users themselves to carry Naloxone, in the hopes they can administer to loved ones in a time of need. Other people distribute the antidote to churches or other religious networks in order to address the growing problem.

Approximately five people die from opiate overdoses every day in Ohio. The problem in Kentucky is slightly worse, with an estimated three overdoses overdose fatalities each day. The problem spans from cities such as Dayton and Cincinnati, to some of the most rural areas in modern America including many communities in Kentucky.

In the last 20 years, approximately 10,000 people have been brought back to life using the prescription Naloxone. While Ohio's efforts seem to be helping many people living with drug dependency, the difference in laws between Ohio and Kentucky are also encouraging people to cross over the Ohio river in order to score drugs in Ohio. Kentucky will often hold alleged heroin users in jail for months before their trial, while Ohio does not. Therefore, the Ohio initiative has created a dynamic where nearby addicts flock to cities like Cincinnati.

There is hope for the growing problem of heroin trafficking and addiction. Project Lazarus, for instance, is a multi-faceted nonprofit organization that is challenging the growing virus. Using a multifaceted approach that reaches out to those people at high risk of overdose, overdose survivors, various community organizations, doctors, nurses, police, and policymakers, Project Lazarus educates communities and healthcare workers, and helps users practice damage control by giving them the antidotes and tools they need in order to live a healthier life. The issues of heroin dependency throughout the country are indisputable, and I believe that it is both cynical and defeatist to condemn those who are trying to help people in need.

Follow Michael on Twitter Twitter: @nahmias_report Contributing Editor: @MAndrewRansom

International Volunteers Series: Healthcare Workers in Maridi, South Sudan

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Olivia Elswick, Asia CorrespondentLast Modified: 08:07 a.m. DST, 19 June 2014

"Goma sykestue 64" Photo by: Endre VestvikMARIDI, South Sudan -- For this edition of the international volunteer interview series, I spoke with Theresa Kiblinger and Ariel Zarate, American volunteers living in “the bush,” of Maridi, South Sudan.

Despite South Sudan’s prevalence in international news these day, and obstacles like two hours treks through six-foot-tall grass to get to a mobile clinic, and bouts of malaria, it is clear from talking to these two extraordinary women, that there is nowhere else they’d rather be.

What were your thoughts about South Sudan before you arrived and how‬ have they changed or stayed the same?‬‬

‪TK: I knew basic facts like it is the newest country in the world but I didn’t know much more about the historical background of this‬ newly founded nation. I was just excited to be heading to Africa, and‬ I figured I would learn while I am here. And I’ve done just that. My‬ eyes have really been opened to the struggles that these people have‬ endured through decades of war, and how they are working to overcome‬ their past to create hope for the future.‬‬‬

What prepared‬ you for this job?‬ Has there been a defining moment in your life that made you decide to‬ take the direction you did?‬‬

AZ: I went to Lewis University in Romeoville, Illinois and I graduated with a Bachelors in Social Work in the fall of 2013. I have been drawn to international social work since high school when I decided that social work was the field I want to go into. I attended Lewis University primarily for the international service opportunities they offered. The primary extracurricular activities I participated in during my college career were social justice or social service oriented.

After participating in my first overseas mission trip to Bolivia in 2010, I was hooked. Traveling, serving and learning about new cultures brought peace and joy to my life. I continued with my mission work throughout my four years, going to the Philippines twice and participating in multiple domestic service projects.

As graduation approached and the time to answer the question of what are you going to be when you grow up came closer I was faced with a decision. Do I go to grad school or do I serve for a year. It was a huge decision to make and one of the deciding factors was some advice a friend gave me. He said to do whatever I would regret most not doing in 5 years. If you will look back on it and wish you had done it, then you have to do it. And that is what I did. I knew in my heart that coming to Africa was what I was meant to. No matter where I travelled I was always drawn here.‪ ‬‬‬

‪TK: I went to Rockhurst University, a Jesuit school in Kansas City,‬‬ Missouri, where I got my Bachelor’s of Science in Nursing. I think my whole schooling has helped prepare me for this‬ mission work. My clinical rotations in nursing school definitely‬ prepared me for the skills that I have been using at the clinic. I‬‬ also have volunteered in Africa previously, so the transition to South‬ Sudan was made much easier by my other experiences in Africa.‬‬ I’m very passionate about public health and health education. I also‬ am extremely interested in maternal and child health (MCH).

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Published: 19 June 2014 (Page 2 of 3)

We have‬ been working to start a MCH unit at our clinic, so it has been great‬ to help with the building blocks of this program.‬‬ When I’m finished with my year in South Sudan, I’m planning on volunteering at another site in Africa, the place is‬‬ still to be determined. I want to get more experience, and then‬‬ hopefully I will go back to school to get my Masters in Public Health‬ and possibly Tropical Medicine or Maternal and Child Health. I see‬ myself doing global health at least for the next few years of my life and then we will see where that leads me!‬‬‬

What is a day in the life like?‬‬

TK: Each day in South Sudan is jam-packed with activities and‬‬ responsibilities. I work as a staff nurse at the Don Bosco Health‬‬ Center every morning until the afternoon. We see a variety of cases‬ and average around 40 patients each day. I’m in charge of taking‬ vital signs, giving injections, dressing wounds, and dispensing‬ medications. In the afternoons I teach English Composition to classes‬ 7, 8, and the Salesian aspirants. After school I coach the girls‬ football team. Every evening we have rosary with the kids followed by‬ evening prayer, dinner, and finally bedtime. I wake up the next day‬ and repeat it all.‬‬

AZ: A typical day for me starts with morning mass at 6:45. Many of the students attend this mass as well. After mass I take attendance for the Daughters of Mary which is a Catholic group for young women dedicated to living more like Mary and growing in our faith as Christians. After that we have a quick breakfast and morning assembly. Monday, Wednesday and Friday I go with a VSDB sister to a village school that we are in charge of running and organizing.

We conduct assembly there, teach various subjects, get uniforms and other necessary things in order to get the new school on its feet. Those afternoons I teach art and religion at our base school. Tuesday and Thursday I start my day in the secondary school then teach the 5 aspirants we have English and Group Dynamics. The rest of the afternoon after lunch is spent in either art or religion and just being present in the school to assist with conflicts or difficulties that arise. Most afternoons I help a few students practice reading with small books we have here.

How are you able to handle all of your responsibilities while keeping‬ a healthy work/life balance?‬‬‬

‪‬TK: I have really stressed “self-care” since I got to South Sudan. We‬‬ are staying in a very remote village with minimal chances to get out‬ and do things to separate mission life and our personal lives.‬‬ However, I always try to take time each day to do things that I need‬ to do to reflect and process this experience. Usually this comes in‬ the form of running in the early mornings. It is such a peaceful time‬ to be by myself and forget about everything else.‬‬‬

AZ: After a long day, it’s usually a huge glass of water, marking, class prep, oratory or some self-care Jillian Michaels with Theresa. Our days are super packed and even when we are not in class the kids are always around so our days have a routine but are always different.

How have you adjusted to simple living?‬‬‬

‪‬TK: It actually has been really nice and refreshing to embrace the simple‬ living aspect. Time and material possessions are not the basis of‬ life. It is the relationships that you have with one another that are‬ important. It has been completely different from my life in the‬ States, but definitely a good kind of different.‬‬‬ ‬‬‬

Do you ever feel unsafe?‬‬‬

TK: ‬‬I have never felt unsafe even with the recent political instability.‬‬ Maridi is such a peaceful place and the tribe that lives in this area‬ are extremely peaceful people. It also has helped that I’ve been here‬ for a while now, and people in the community know who I am and my role‬ here.‬‬‬

‪Do you find that women are treated differently than men at your site?‬‬‬ ‬‬‬ TK: Definitely. It is extremely evident in the way people talk and act‬‬ towards women that they are not viewed as equals to men. The boys in‬ school don’t understand why the girls need to have a football team.‬ They say that the girls need to go home right after school to cook and‬ clean. Even as a teacher, I feel like the kids don’t fully respect me‬ or listen to me as they do towards a male teacher.‬‬‬‪

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Published: 19 June 2014 (Page 3 of 3)

What are the most critical problems faced by people in your area?‬‬‬

‪‬TK: These people have so many obstacles that they have faced in the past‬ and are still trying to overcome. They have lived through decades of‬ war. Many of the kids have lost one or even both parents and this‬ county, specifically the village where I am working, has the highest‬ rate of HIV in the entire country. These people are trying to‬ overcome all these obstacles to have a hopeful future, but their past‬ struggles are still extremely evident in everyday life.‬‬‬‪ ‬‬‬

What is the most rewarding part about living there?‬‬‬

‪‬TK: The relationships that grow deeper each and every day. The kids that‬ I work with are the most incredible group of kids that I have met. I don’t think I’ve loved a group of kids as fully and deeply as these‬ little mischievous, crazy kids. They make this experience completely‬ worth it.‬‬ My best memories are every moment I am with the kids. There is‬‬ nothing better than holding a baby in my arms as I pray the rosary as‬ the sun sets, or when a little girl grabs my hand and we skip down the‬ dirt road singing songs. Its the little moments each day that warm my‬ heart and remind me of the reason I’m even here in the first place--to‬ love these kids.‬‬ ‪ ‬‬‬‬

Can you tell me about one child who has impacted you?‬‬‬

‪TK: There is one 10-year old boy named Santo who has epilepsy and also has‬ special needs. But this little boy constantly teaches me how to love‬ unconditionally. Every day I hear him screaming my name across the‬ compound and then he takes off and greets me with the biggest hug. He‬ asks how I am, then he goes through all the members of the community‬ asking how they are and where they are. This happens at least 3 times‬ each day. Even days when I don’t have patience to go through this‬ same conversation over and over, he never stops loving me or going out‬ of his way to give me a giant hug. It has been a huge lesson in‬ loving each person as they are, and I have the best example of how to‬ imitate this unconditional love through the life of Santo.‬‬‬ ‪ ‬‪ ‬‬‬‬ ‪‬Have you ever had a “this is my home” feeling? ‬‬

‪‬‬TK: I have that feeling almost every day. Honestly, I have felt at home‬ since I first stepped out of the car and arrived in Maridi 10 months‬ ago. I was greeted by the sweetest, brown-eyed 'kiddos' and I‬ immediately fell in love. I knew that I was home. I get that feeling‬ when the little kids call me their mother, when I wipe tears away from‬ a child’s face at the clinic, when I snag babies to hold and‬ love...It’s little moments each day that really make me feel like this‬ is my home.‬‬‬

What are your hopes for the people you’ve interacted with?‬‬

‪TK: I hope that they can see past the past and strive for the future.‬‬ They are some of the brightest kids I’ve met, and they have so much‬ potential. I hope they don’t get stuck in the cycle of life here- get‬ married after 8th grade and have kids right away. While that isn’t‬ bad, they just have so much more to offer this country. These are the‬ kids that will really make this country progress in the future.‬‬‬

What lessons will you take with you?‬‬‬

TK: This mission experience has made me learn so much about myself and‬ made me grow in ways I don’t think I’ll fully understand until I get‬ back home. I’ve learned so much about living in the present and‬ loving people in the moment even when it’s difficult. The people here‬ have shown me how to see the world in a different way, with a‬ different focus.‬‬ ‪ ‬‬AZ: Coming here was the best decision I have ever made. Not only have I grown immensely in my faith but I have grown immensely as a person. The lessons I have learned and the ways I have changed for the better will stay with me forever. ‬‬

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HIV Prevention Pill Now Available

HIV Infected H9 T-Cell, photo by niiaid

HIV Infected H9 T-Cell, photo by niiaid

ATLANTA, Georgia -- An HIV prevention pill is recommended by the Center for Disease Control (CDC) for those at risk for contracting HIV.  The pill, called pre-exposure prophylaxis (PrEP, brand name Truvada), works by lowering the amount of the virus circulating in a person's bloodstream.  It has already been used as part of some HIV/AIDS treatment plans, but recently has been approved as a prevention method as well.

Each year in the United States, there are 50,000 new cases of HIV. Currently there are about 1.1 million people in the US who are living with HIV.  PrEP trials have shown that users of the pill can reduce their chance of contracting HIV by up to 92%.

Naysayers of the pill claim that with increased availability of Truvada, at-risk individuals will be less careful with other methods. Dissenters also say that it will be hard for people to remember to take the one-a-day pill.

However, supporters say that there is no evidence that the availability of the pill will lead people to neglect other methods of HIV prevention. The CDC says that for various reasons, there are many at-risk people who have not been using condoms or who do not use condoms correctly. PrEP will provide another option for these people.

A three-city initial trial of the pill showed that 98% of subjects involved had some amount of the drug in their system at the end of the trial period -- disproving fears that people will forget to consistently take the daily dosage.

PrEP, which currently costs about $13,000 a year and is covered by most insurance companies, is not recommended for everyone. Its target group is people who are at a substantial risk for HIV, such as someone with a partner who has tested positive for an HIV, people not engaged in mutually monogamous relationships, people who practice anal sex without regular condom use and people who inject drugs under potentially unsanitary conditions.

Currently a vaccine version of PrEP is being tested in monkeys.  This injectable version would have the convenience of giving several months worth of protection.

Kiss Me, Kiss Me. Kiss Me Not!

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Ayanna Nahmias, Editor-in-ChiefLast Modified: 02:17 a.m. DST, 22 January 2014

Indigo Lips, Photo by Florry One When I came back to the States from Africa in the late 70's, I was thrown into a school system and culture with which, like many people from different cultures and backgrounds, I was quite unfamiliar.

There was the usual lack of cultural sensitivity that routinely resulted in children asking me if I saw tigers walking down the middle of the street, or if I "put a glass up under all those naked, exposed breast, to get my milk."

It was offensive, but not necessarily hurtful. What did become painful were the taunts about my physical appearance. All children face ridicule at some point in their school careers. For some, the taunting, the desire to fit into whatever standard of 'cool' or 'beauty' of the day, and the incessant bullying, causes them to resort to harmful and often tragic measures in search of relief.

I made it through, but not unscathed, as nearly 30-years later, I still recall how hurtful it was when classmates would point out that my lips were 'liver lips', 'big, ugly gorilla lips,' and that my mouth, like the vacuum cleaning brand Hoover, was a dangerous weapon capable of rearranging the face of any boy foolish enough to kiss me.

So, with the recent trend in the entertainment industry, and in America as a whole, to achieve a mythical standard of beauty that now includes large lips, I bemusedly thought back to my childhood days and wondered if any of the girls who once taunted me, were now through some strange karmic leading, pumping, plumping, and outlining their lips to achieve an industry contrived standard of 'today's perfection.'

We all have things that we would like to change about ourselves. I have mine. However, I have come to appreciate my lips, but even more than this, I have come to appreciate my healthy lips, body, mind, and spirit. That said, this post does not pass judgement on those who desire to change something about themselves, but only seeks to encourage due diligence, introspection, and self-awareness before embarking on a journey that can result in Don Quixote's madness of chasing down enemies that do not exist.

We begin aging the moment we take our first breath, to do so with dignity is the greatest testament to a well-lived life. The video below should serve as a cautionary tale.

[youtube=https://www.youtube.com/watch?v=hL0CClIzgEU]

 
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