This year people who rarely receive recognition or accolades are being honored – health workers around the world – with a REAL Award. 

According to the Frontline Health Workers Coalition and Save the Children, founders of the REAL Awards, they are a ‘first-of-its kind awards platform designed to develop greater respect for and appreciation of the life-saving care provided by health workers around the world'. The objective of the REAL Awards is to demonstrate the universal and urgent need for more trained, caring health workers on the frontlines. By some estimates, the world is short more than five million health workers including one million frontline health workers. Existing health workers are often overworked and under-appreciated.  REAL Awards should remind the public that people everywhere depend on health workers every day’.

At AMREF, we were thrilled to learn that one of the thousands of health workers we train or whose skills we upgrade through our eLearning, mHealth or onsite programs, was recently selected to receive one of the first, global REAL awards for the work they do as a REAL person on the frontlines of health care.

Esther Madudu, an AMREF-trained midwife working in rural Uganda in a remote health center, was presented last week with a REAL Award to celebrate and honor the life saving work she performs day in and day out.

In a small, poorly equipped health center, often under harsh conditions, Esther and her one midwife colleague are among the few skilled and trained professionals able to deliver babies and look after Moms who come not only from the immediate area, but often walk for miles from surrounding villages. 

This past week though, Esther’s health center was a place of celebration and support for frontline health workers.  The Ugandan Minister of Health herself, the Hon. Dr Christine Ondoa, presented Esther with her REAL Award which was presided over by Uganda’s Deputy Minister of Health and AMREF’s own Country Director in Uganda, Dr Abenet Berhanu, along with our Deputy Country Director, Dr Susan Wandera.   There were also a number of individuals from AMREF’s senior management team who attended the event, including many representatives of regional and local district government offices, with whom AMREF Uganda works hand-in-hand to implement our programs. 

The REAL Awards celebration in Uganda last week was just that – a lot of dancing, refreshments and overall jubilation to pause and take a moment to honor and celebrate frontline health workers everywhere whose dedication and commitment to their work is literally life-saving.

  >> Read more about Esther and her work saving mothers

  >> Watch a TV report from NTV Uganda on the REAL Award ceremony

Thanks to the global commitment and huge investment in malaria control and elimination, much progress has been made by some malaria-endemic countries.  Unfortunately these advances are increasingly threatened by a shortfall in funding which could lead to a resurgence of the disease and jeopardize all current efforts and past investments. As an international African-based health organization, AMREF is concerned by this situation that will put million of lives at risk.

The theme of World Malaria Day Thursday, April 25, ‘Invest in the future: defeat malaria’ is a timely one. Innovative ideas and approaches for funding are urgently needed to overcome this threat and stay on course. In this regard, AMREF believes that over and above global aid, African countries also have the responsibility and potential to expand domestic financing for malaria programs through mechanisms such as community initiatives, optimal management of local resources and community-based health insurance schemes.

Defeating malaria also means giving poor countries a leg up.  Malaria’s economic toll creates major losses in productivity resulting in the inability of poor countries to experience economic growth.  According to Roll Back Malaria, the costs of the disease amount to USD 12 billion per year in direct losses and a loss of 1.3% of GDP growth rate per year for Africa, not to mention the real difficulties malaria imposes on families in general, such as the inability to work and generate a household income.

One of AMREF’s significant accomplishments in tackling malaria lies in taking a community’s most valuable resources – its people – and training these volunteers to identify, prevent and refer patients for treatment.  Equipped with basic knowledge, these individuals comprise ‘Village Health Teams’ (VHTs).  They go door-to-door distributing insecticide-treated nets, identifying and referring cases of malaria to local health centers and generally educating communities about how malaria is contracted and how it can be prevented. 

Mary Nabirye, a 35-year-old married woman in Njeru Village in Uganda, is a community member whose life was changed by one of the Village Health Teams trained by AMREF. Her three children, 10-month-old twins and a boy of four, frequently suffered from malaria and from diarrhea caused by poor sanitation.  When the VHT approached Mary through door-to-door mobilization, it was evident that she did not have mosquito nets and lacked basic knowledge about malaria and diarrhea.

Mary didn’t have the money to travel the nine kilometers to the nearest health facility, let alone the funds to access health services.  So instead, she used local herbs and traditional medicine which wasn’t preventing her children from getting ill.  When the VHTs made their rounds in the village, Mary told them that she spent most of her time taking care of her sick children, limiting the time she could dedicate to productive work for her family – which drove her family further into poverty.

Mary was immediately included in the community education sessions and was also among the 10,000 people who received long lasting insecticide treated mosquito nets from AMREF.

Since she joined the program in June 2012, Mary’s twins have not suffered from malaria or diarrhea. All her children are sleeping under mosquito nets and Mary regularly cuts the grass around her home to remove potential mosquito breeding areas.

Mary is just one example of the thousands of individuals affected by AMREF’s malaria programs.  With such encouraging results and progress towards eliminating the disease, AMREF is calling upon the international community to accelerate efforts and invest more in malaria control and elimination to sustain the gains already made. We are also advocating for greater focus on malaria control and elimination in the current post 2015 discussions.

Knowing that investing in malaria means saving the lives of future generations, AMREF is working side by side with governments and communities to implement malaria prevention and treatment strategies and to ensure malaria elimination remains top-of-mind on the global health agenda.  By working towards eradicating malaria, AMREF’s real impact continues to be on improving the health and wellbeing of African families and communities.  

Read AMREF's complete World Malaria Day Statement.

For the past 10 years, the African Business Club and the Pan-African Network of Columbia University have produced the African Economic Forum to discuss the present and future of the African continent. Organized by two of Columbia’s premier graduate programs: the School of Business and the School of International and Public Affairs in conjunction with the School of Law and the Mailman School of Public Health, it is the only collaboration of its kind at a top tier institution.  

This year’s theme was “Africa Ignited: Exploring Ideas, Shaping Outcomes” – a nod to the idea of embracing “the momentum of Africa on the move and sharing opportunities to dive in.” The goal of the forum is to convene thought leaders, practitioners, experts and entrepreneurs to discuss key issues and connect around meaningful strategies for increasing development and engagement on the continent.

We were honored when the organizers asked AMREF USA Executive Director Lisa Meadowcroft to be on the healthcare panel entitled “Healthcare Delivery: New Formats, New Infrastructure, New Results?”. Other panelist included Bright Simons of Accra-based think tank IMANI and President of the mPedigree Network, Dr. Rolande Hodel, Founder and President of AIDSfreeAFRICA, Dr. Michelle Inkley of the Millennium Challenge Corporation and Okey Okuzu, Founder of InStrat Global Health Solutions. The panel was moderated by Dr. James Phillips of Columbia University.

Following the panelists’ introductory remarks, five themes emerged across the board regarding healthcare delivery in Africa. The first was phase development. Sustainable healthcare delivery must start small, and you must gain knowledge through evidence-based trials and then manage that knowledge efficiently, effectively and responsibly.

The second theme was that context matters. You have to look at the situation around you and adapt to the complexities of various environments in developing countries. Where and how people live is the prime force that shapes their health. Healthcare delivery is not the same across the board, especially in the African context.

Next, frugal innovation is important. In line with the other themes, it is best to start out small with the understanding that you will potentially need to shift your response and eventually work your way up to bigger and better initiatives. Take for example AMREF’s e- and mLearning programs.  Starting from traditional nursing classes, AMREF was able to adapt curriculum and burgeoning technology to develop educational programs enabling nurses throughout Kenya to upgrade their professional levels through eLearning. Students and current nurses can now gain certification in half the time it used to take in a regular classroom.   With the success of eLearning, we’re now looking at mobile phone technology to upgrade midwifery skills as well.  These initiatives would not have worked years back as the context had not evolved.

The fourth theme is that systems matter. Healthcare delivery in Africa must take an open systems approach, as Lisa Meadowcroft said, “there are no magic bullets.”  There cannot be parallel systems created.  For example, to be effective in delivering healthcare in Africa, civil society organizations and NGOs must work within existing government structures and Ministries of Health. You must also balance interests, particularly where public/private partnerships are involved, and appreciate the political economies.

The last theme is that clients matter.  For successful and sustainable healthcare delivery, not only do you need to take an open systems approach, but you have to also take a people-driven approach. It is necessary to come to situations and look at the actual needs of the people, as opposed to attempting to impose Western style solutions. In international development, there often seems to be a battle between perception and what really exists on the ground.

As an expert in the field of healthcare delivery in Africa, AMREF is always pleased to participate in opportunities such as the African Economic Forum.  Through ongoing discussion and collaboration with our partners in global health, we can all work towards a deeper understanding of the formats, infrastructure and resources needed to create lasting health change in Africa.
  

For media and speaking opportunity inquires, please contact Sharon Rainey.  

I’m delighted to tell you that The Stand Up for African Mothers campaign is off to a good start! Launched in the USA in July 2012, the campaign has a dual aim: to bring the world’s attention to this tragic and unnecessary loss of life, and to train thousands of midwives to provide the basic but quality care that will reduce the unacceptably high rate of
maternal mortality in Africa.

Midwife Meter

Be sure to watch the progress of our midwife meter at www.amref.org as we advance towards 15,000 newly trained midwives by 2015. 

Through the end of January, 2,845 midwives at various levels in 5 different countries have either graduated or begun their training. This means that this year alone more than a million more African women will receive vital health education and trained assistance while giving birth. 

 Midwifery Student-In-Training

Nalumu Scovia Duku, 24, Registered Midwifery Student, National Health Training Institute, Maridi, South Sudan

“I became interested in midwifery when my aunt died during childbirth. When she went into labour, her parents insisted she have the baby at home with the help of a traditional birth attendant (TBA). But it was a complicated delivery. The TBA, who had never received any formal training, was not able to stop the bleeding.  My aunt died before she had the baby.

I first trained to be a community midwife. Now with AMREFs support, I am upgrading to become a registered midwife. It is important for our country to have more skilled midwives. Too many women die from complications that could have been avoided if there was a qualified person to help them. With this training, I will be able to make a great impact in my community and my country to reduce the deaths of mothers.”

JC Decaux Donates Ad Space to Campaign
Raising Awareness of Maternal Health Issues

Last November, JC Decaux, a world leader in outside advertising, generously donated advertising space on PATH Trains, which connect NYC and NJ. With a daily ridership of over 250,000, the ads yielded two substantial benefits: it raised awareness of African maternal health issues, and it brought in mobile donations for our campaign.  Our thanks to JC Decaux.

Esther Madudu, Midwife & Stand Up for African Mothers Spokesperson
Wins Global “REAL Award”

Esther Madudu, AMREF’s nominee for the 2015 Nobel Peace Prize, was among 10 frontline health workers worldwide to win a REAL Award.  The Awards honor local community health workers and the life-saving work they do, often in harsh conditions. Our campaign’s spokesperson, Esther, has been visiting African and European nations to inform the public of the dire need for basic medical care to transform childbirth in Africa from “the riskiest thing a woman can do” into a joyful experience.

Please donate to our campaign, and learn more, by visiting www.amrefusa.org/standup. While there, you can sign the petition to nominate Esther for the 2015 Nobel Peace Prize!
- Lisa

Caroline is responsible for the development and implementation of AMREF’s eHealth programs, including e(electronic)Learning and m(mobile)Learning, across sub- Saharan Africa.  She leads the team that implemented the pioneering eLearning program for nurses in Kenya, which significantly impacted the delivery of sustainable, cost-effective training for health workers in remote and low resource settings.

Over 60 per cent of Africans live in rural areas, far from any health facility or hospital.  Most of them will never see a doctor in their lifetime.  Instead, they depend on the care of community health workers, nurses, traditional birth attendants and midwives, if they are lucky enough to have one who lives nearby and is qualified to deliver effective health care. 

The lack of health workers is one of the key barriers to improving health in developing countries.  Begun in 2005, AMREF’s eLearning program in Kenya aimed to upgrade the skills of certificate level nurses to that of Registered Nurse over two years.  At that time, there were four nursing schools in Kenya with a total of 125 students, an enrollment rate of 100 students per year, and an additional 20,000 nurses in the wings waiting to get in.  

In both panel discussions, Caroline spoke about the seemingly overwhelming challenges of building this program.   How to set up electronic learning when less than 30% of Africans have access to electricity?  There was no infrastructure, no mobile phones and no computers.  How do you motivate a health worker in isolation – how do you support her? How to introduce nurses to infectious diseases like HIV/AIDS or the multiple mutations of malaria treatment, when none of that existed in their former training?  What technology partners were willing to take on the challenge and how could the outcomes be beneficial to all stakeholders?   With more nurses trained, would there be adequate clinical practice facilities?  Could the newly certified nurses expect pay increases when they graduated?  The questions were endless.

The program was a public private partnership led by AMREF, the Ministry of Health, the nursing regulatory body in Kenya, and funded by Accenture, a global management consulting firm. It involved setting up a national eLearning platform, development of the eLearning curriculum and content, building the capacity of nursing schools to use the eLearning approach to teach nurses, 98% of whom had never used a computer before, setting up supporting and supervisory mechanisms to ensure learning of both theoretical and practical skills and creating a monitoring and evaluation framework to enable all partners to track the key performance indicators (KPIs) in which they were interested.

Slowly, the program took off and the health impact has been quite remarkable.  From four schools with a total of 125 students, there are now 34 eLearning centers enrolling 1,400 students each year.  Over 7,000 nurses have graduated since the inception of the program, which was handed over to the Ministry of Health and the Nursing Association in Kenya, thereby assuring its long-term sustainability.  In fact, that ability to develop local capacity in creating lasting health change that is sustainable by local communities is a hallmark of AMREF’s work.  It is also what sets us apart from other organizations.

AMREF gets a talented, dedicated individual who knows the workings of government inside out and the Ministry in turn will benefit from Grace’s new knowledge of how to work more efficiently with health development NGOs.  Not to mention that she is also familiar with US health curricula after having completed a six-month ‘sandwich’ Masters in Public Health at Harvard, on a scholarship no less. 

Dr. Grace Makembe at the launch

Oh and by the way, her first baby was five months when she packed her bags for Boston.  And did I mention her husband is now completing his masters in neurosurgery in Durban, South Africa while Grace looks after their gorgeous children, a delightful eight-year-old girl and a very chatty young boy of five?  She also told me that she would like to have one more baby.  Hmmm no lack of talent here…

Grace has three phones in her office.  During our meeting, each of them rang at least twice and she was almost talking on two phones at once.  A slight, willowy thing and a fast talker, Grace is maybe 5’4, but once she lays those big, brown doe-like eyes on you, there’s no escaping her passionate grip.

Grace has invited me to join her for the launch of the new USAID funded, TUJUMUIKE Project, a new AMREF youth, girls and women’s empowerment capacity building program in Mtwara and Lindi in southern Tanzania, about an hour’s flight from Dar.  TUJUMUIKE, or TUunganishe JUhudi za Malezi na Uwekazaji kwa mIKatati Endelevu, a Kiswahili acronym meaning, “let’s join efforts for nurturing and investing through sustainable strategies” is a program to develop and strengthen the skills of local self-help groups to support youth, girls and women’s empowerment in these key areas.

Mtwara and Lindi have the highest rate of teenage pregnancies in all of Tanzania.  According to the Tanzania Demographic Health Survey (TDHS 2010), 23 percent of women aged 15-19 have started childbearing, while 44 percent of them were either mothers or pregnant with their first child by 19 years of age. 

Mostly due to long-standing cultural norms, poverty and lack of education, girls and women are particularly marginalized in this area.  Traditional practices such as early and forced marriages and sex initiation ceremonies put girls at high risk for early pregnancies, sexually transmitted infections and HIV.   This also results in gender inequities at home and in the community where girls drop out of school with no consequences, lack quality health services and struggle to attain any kind of financial independence.

AMREF’s new program will equip youth self-help groups with the skills and leadership to mobilize at least 10,000 young people (60 percent girls) to access sexual and reproductive health information and services over the two year duration of the project.

The program in Lindi launches with much fanfare at the local press club.  The stage is draped in black, red and white satin and covered with bows.  Microphones line the seven or eight places carefully prepared for AMREF and its local government partners to deliver remarks to an audience of students and community leaders.

The ceremonies begin with a series of dances performed by an AMREF youth group – dazzling in the strength and power of movement framed by a throbbing drum beat.  Youth theatre groups also mounted plays illustrating how harmful stigma can be for HIV+ individuals, followed by a rap performance and a chorus of singing and dancing children who welcomed all the guests of honor.

Following the speeches, in which the highest ranking Regional Commissioner praised AMREF for its terrific work in the community, a light snack was distributed and everyone gathered to chat before returning to their offices and schools. 

On our way back to the airport, Grace not only stopped the car so we could stock up on cashews, the biggest cash crop of the region, but she also managed to buy two huge sacks of local mangoes from a roadside stand, even though we’d been picking them up off the ground in every village we visited.

Never one to miss an opportunity, Grace enthusiastically questioned the two 18-year old girls selling the mangoes whether they were engaging in sexual relations and if so, were they using condoms and protecting themselves against disease? 

Grace can’t help herself; it’s what she does…

Click here to see some of the other posts I wrote during my trip to Tanzania. 

In the morning, the driver Peter picks up Elly and I, AMREF’s recently hired communications officer and my new best friend.  AMREF drivers are a key component of rural operations here where public transit is rare.  They also have to safely navigate both paved and unpaved roads in all types of weather and harsh conditions.   Peter brings us to the AMREF Moshi office, a small dwelling behind what appears to be a private home.  I later learn from the all knowing Agnes Ndyetabula, AMREF’s Angaza Zaidi Project Coordinator in Kilimanjaro, that the property is owned by the Lutheran church, which rents to AMREF.  I also learn throughout the day that the Lutheran church is actually a very enterprising business, owning restaurants, shops and a great deal of land in this area.  Their prosperity and management savvy has led to this partnership in Moshi where AMREF’s star Angaza clinic is actually part of the Lutheran hospital facilities, with a resident surgeon, 80 beds and a variety of available health services.

AMREF's Angaza Zaidi Marangu HIV clinic within the Lutheran hospital site

Known as ‘Mama Agnes’, she runs both the Moshi and Arusha Angaza area support offices and is one of the original six founders of this project from 2001.  A nurse by profession, Agnes’ best moments in the clinic are when she sees how happy people are to see her.  “I’m so happy when I see them happy,” she enthuses about her clients. 

Located in Marangu, about 25 miles outside of Moshi, this ‘integrated services’ clinic is more than just a voluntary HIV testing and counseling site.   Clients are also able to benefit from the available services offered by the hospital for any complications associated with HIV, such as herpes, sores and infections that don’t heal, or testing for other chronic conditions.   This Angaza Zaidi clinic also offers a support group for people living with HIV AIDS.  Known as a post-test club, PTC or in this case, MARAPHA, (Marangu People Living with HIV AIDS),  this support group offers members a forum to share their stories and find compassion and understanding amongst other HIV+ individuals. 

Angaza Zaidi HIV Counselors Costansia and Anna Lin

MARAPHA is chaired by Mr. Omandi, a 55-year old person living with HIV AIDs who has been coordinating this group and ensuring that all its activities run smoothly for the last three years.  There are currently 97 people in the support group, up from seven when it first started in 2007.  Mr. Omandi found out he was HIV+ in 1995 when he donated blood for his sick child.  He was so mortified by his status that he couldn’t bring himself to even share plates with his children nor tell his wife, until about a month later. 

Inevitably he infected his wife and the two of them lost all of their savings traveling around East Africa seeking a cure – which of course they found in abundance from fraudulent marketers and ill-informed traditional healers.  An imposing man now of about 6’2, he was down to 120lbs before he was able to get on ARVs in 2010 and start turning his life around. 

As Chairperson of the Marangu PTC, Mr. Omandi travels about 30 miles from his home to run the monthly meetings.  His challenges are many.  New arrivals to the club come because they think they’ll be given money.  It takes a lot of effort and time to change members’ behavior to a point where they understand they need to contribute to the meetings in terms of energy, dedication and work as opposed to gaining something personal from their attendance.  They need to understand that the rewards will come later.  That said, most members are very poor and often very sick, so it’s difficult for them to contribute anything at all. 

PTC Chairperson - Mr Omandi 

The majority of PTC members are women.  According to Mr. Omandi, the women are much more open about their condition, talk about it easily and are actively looking for ways to support themselves and their families.  Men on the other hand tend to visit the Angaza clinic late in the afternoon, when they know they won’t be seen by anyone.  Men seem to suffer a lot more stigma about their condition and don’t want others to know. 

How did Mr. Omandi come to be so open about himself?  He was ready to change.  He educated himself as much as possible about HIV and had supportive relatives, some of whom were actually health care professionals who counseled and assisted him. 

When speaking about the future of the Angaza Zaidi clinic, he’s concerned about the need for more funds and how to ensure the sustainability of this post-test club that has helped so many people.  But then he smiles and says, “if you empower women, you will educate the nation.”

Then he adds rather wryly, “and if they make it, then I’ll get some too.”

Next week a look at how AMREF’s Angaza Zaidi post-test club actually helps members make money.

Meeting 17-year old sex worker Veronika in the slums of Tandale in Kinondoni district just outside of Dar was an eye opener. I found out that Veronika had come to Tandale on the advice of a friend from her village.  She was told about available work in housekeeping and babysitting and that she could make money if she came to Dar.  Coming from a poor family clear across the country in Bukoba and without knowing what she was getting herself into, Veronika quit school, left her village and followed her ‘friend’ to the slums of Tandale into a life she could never have prepared for. 

I first laid eyes on Veronika in the bar, the central meeting place in this community.  Flanked by a long alley of concrete, one-room huts called ‘kibanda’, the local bar is essentially where sex workers come to meet clients.   In fact, they are so well known in this bar that AMREF actually ran an HIV seminar there to reach as many women as possible.   The sex workers either rent rooms at the back of the bar, which the owner, Fauzia, discourages as she notes, “one rents a room and six of them pile in”, or rent a kibanda where they work and live for about $5,000 TZS/day ($3.00US) or $150,000 TZS/month ($94.00US).   The huts are dark, with dirt floors and no sanitation facilities.

Not only did this beautiful young girl look no more than 13 years of age, she was also seven months pregnant.   And with little money and no idea of how she was going to look after the baby and make ends meet.  Her plan was to give birth at the government run clinic here where fortunately she had been receiving regular prenatal checkups – which in of itself is a major accomplishment.  Most women in Tanzania are unable to access health workers due to distance and transportation issues, or simply a lack of knowledge about the importance of regular checkups during pregnancy. 

Vero, as AMREF’s Project Assistant, Lilian Msaki called her, didn’t seem to understand that if she had left home because her parents were too poor to look after her, it would be even tougher to return to her family and expect them to look after her baby as well.  But that was only the beginning of her worries.  First she had to deal with the immediate problem of earning enough money to survive and pay her rent between now and the delivery, as her clients were decreasing as her pregnancy advanced. 

Lilian was quick to intervene.  She’s been with AMREF’s ‘Angaza Zaidi’ project, meaning in Kiswahili ‘shedding more light,’ for the past eight years.   A USAID funded program, Angaza Zaidi is the largest HIV AIDS counseling and testing program in AMREF Tanzania’s portfolio.  It has been expanded and decentralized throughout all of Tanzania, stemming from an earlier HIV counseling and testing project, Angaza, which focused mainly on Dar es Salaam.  The project was so successful in promoting testing and conducting counseling for those who tested positive, that it is currently being implemented across the country.   Key objectives of this newly expanded program are to boost the number of people getting tested, increase access to treatment and strengthen the capabilities of the local implementing partners to deliver quality services.  

An imposing woman, Lilian’s fiery demeanor belies her huge, warm heart.  You could just tell from how she spoke with Vero and from the welcoming look on her face, that this young girl’s fate was hanging on a shoestring, and somebody needed to do something about it.  After some animated conversation with Vero, Lilian had already arranged to pick her up next week, bring her to the clinic first for an HIV test, then connect her with AMREF’s Stand Up for African Mothers campaign director to identify where and how Vero could get some support to see her through the rest of her pregnancy and delivery. 

Lilian knows her clients well.  She also knows that, due to Vero’s young age and inexperience, she was probably  unable to impose condom use on her clients and was most likely already infected with HIV.  She also knew that getting Vero tested and, if positive, on treatment right away, was not only key for her own health, but also to prevent transmission of the virus to the unborn child.

By the end of my first week in the Dar es Salaam office, I’m slowly starting to get a sense of the priorities and type of work carried out by AMREF here in this city, a chaotic and enchanting meeting of Muslim and Christian traditions.   Next week, my communications colleague Elly and I will be travelling north to Kilamanjaro to document more of the innovative programs in the Angaza Zaidi project. 

But what really stands out for me so far, is the amazing team of knowledgeable and passionate individuals that make up AMREF Tanzania.  And how important that is for Veronika’s future. 

More on the Angaza Zaidi program next week…

We have a lot to be proud of. 

According to the WHO’s 2011 Progress Report on Global HIV/AIDS Response, “access to antiretroviral therapy in low and middle income countries increased from 400,000 in 2003 to 6.65 million in 2010, treatment resulting in substantial declines in the number of people dying from AIDS related causes during the past decade.”

As an African-based, African-led health development organization partnering with communities and African experts to find solutions for lasting health change in Africa, the challenges of HIV/AIDS are ever present.  Whether it’s encouraging testing and counseling, providing treatment, facilitating care for those living with AIDS or educating about prevention, AMREF works in all areas of HIV/AIDS.

And still, we’ve added yet another dimension.

While a major barrier to treatment in Africa has been the stigma surrounding HIV, it has long been understood that men who have sex with men (MSM) is an even bigger taboo.  Not only is sex between men stigmatized, it is officially denied and criminalized in many parts of the world, particularly in sub-Saharan Africa.

Of the groups that are at high risk of HIV infection, men who have sex with men are particularly vulnerable, as they are unable to access treatment and care due to social, religious and political stigma. This discrimination only serves to add to their vulnerability, making it nearly impossible to carry out relevant HIV prevention, treatment, care and support activities.

In places where homosexuality is not tolerated, MSM often hide their same sex relations from their friends and families to avoid persecution. Many have wives and children, or have sex with women as well as men.  As a result, those who are infected with HIV are likely to transmit it to their female partners.  The effects of the stigma around MSM impacts more than simply the individuals who can’t access treatment, it also has dire consequences for entire families in Africa. 

This year AMREF has taken a courageous, public stand on this issue by advocating a human rights-based approach in providing access to HIV/AIDS prevention, treatment, care and support of MSM without stigma and discrimination.     

Based on medical ethics and the right to health, AMREF strongly supports the principle that health services should be inclusive and easily available to MSM. Creating inclusive health services requires strategies to sensitize and educate frontline health workers and other staff members in health care and social service settings, keeping in mind that safe and inclusive public services, and the underlying principle of non-discrimination, are vital for the community’s health, well-being and dignity.  MSM living with HIV should have the same access to anti-retroviral therapy as any other population.

I encourage you to read AMREF’s position statement, in which AMREF requests that African governments, health providers and development partners help break the barriers that prevent men having sex with men from accessing the same care and treatment for HIV/AIDS as anyone else.

I am proud to belong to an organization that takes such a courageous stance on such a contentious issue.  My only hope now is that others stand with us.

Until next time, Lisa

Learn more about AMREFs HIV/AIDS programs.

The girls sing traditional songs that everyone has practiced. The mothers give them life lessons in the privacy of their huts. The rite concludes with the girls walking through a ceremonial arch formed by tribal elders as the surrounding community welcomes them as women. It is indeed a beautiful ritual.

Cutting away the clitoris and labia in girls as young as seven to 15 years of age represents the centerpiece of this most important rite of passage in the life of a Maasai girl -- at least until a few years ago. A dangerous, life-threatening and extremely painful ritual, cutting is against the law in most African countries.

Photo Credit: Anja Ligtenberg

However, it continues in many nomadic societies and is typically performed by a traditional healer or 'cutter' without anesthesia, in an unhygienic environment and without medical knowledge. The cutter uses the same knife for several girls and often stitches the labia over the vagina, leaving only the smallest of openings, causing untold complications in adulthood and childbirth, often resulting in obstructed labor and potential death of both mother and child.

Female genital cutting causes not only physical health problems, but as soon as a girl is 'cut,' she is considered a 'woman' and typically no longer listens to her mother. She is now ready for marriage -- no matter how young she is. As she is now a woman, she is also expected to leave school, leading to fewer opportunities for girls and creating major barriers to gender equity.

'Uncircumcised' girls are often rejected by their circumcised peers and refused marriage by men who are taught to marry only girls who have been cut.

Women have virtually no voice in Maasai society. They are subject to the intricate hierarchy of the powerful men in the clan known as Morans. For most girls, the coming of age passage represents the only real, significant moment in her life where she takes center stage and is recognized by her family, relatives, peers and fellow clan members.

So it was particularly significant and singularly courageous, for Nice, a young Maasai girl who was orphaned at age nine, to run away from home when her uncle and grandfather wanted her to be cut. She ended up living with her older sister (who is cut) and her brother. They built their own hut/home and lived on their own.

Nice eventually encountered AMREF working in one of the Maasai communities. Having long been present helping the Maasai drill water wells and delivering health services, AMREF has earned their trust and respect -- two essential conditions that underpin our current work in changing traditional attitudes towards female genital cutting.

For the past several years, AMREF has helped girls and women play a larger role in the community, specifically in eliminating female circumcision. By working in the African tradition with much patience, empathy and involvement of the decision-makers, AMREF has slowly brought about great change.

The dialogue began with the tribal elders who were convinced of the advantages of eliminating female circumcision. With the elders' approval, the young men were approached, learning that it was alright to marry an uncircumcised girl and -- not unimportantly -- that sex is better with an uncircumcised wife!

The Maasai themselves designed the alternative rite of passage to traditional circumcision. The girls participate in a three-day long session about sex education, self-confidence and human rights, a critical part of the ritual as it promotes the girls' feelings of self-worth in view of their lower status compared to boys. In addition, girls are encouraged to continue with school and the elders, mothers and fathers, to invest in the girls.

The alternative ceremony not only eliminates circumcision, but supports further schooling and delayed marriage. Together with the Maasai and with respect for all parties, AMREF has succeeded in finding a way to make tradition and progress join hands. To date, this modified ritual has taken place three times in Loitokitok and Magadi, Kenya with over 800 girls, 135 parents, 86 tribal elders and 16 female circumcisers. They celebrated the rite of passage from girl to woman without bloodshed.

And Nice? She trained as a peer educator with AMREF. Nice brings girls together to talk about their bodies and their rights. She realized early, though, that to make real progress she had to speak with the Morans as well. It took her two years to break down the barriers, but eventually, through persistence, she was accepted and they now listen to her. According to Nice, "we form a well-organized community that solves problems on its own as much as possible, in a way that everyone can agree with."

Nice has even been honored for her work with an 'oringo orok' -- a Maasai leader's talking and walking stick -- and a cultural symbol for leadership.

To find out more about AMREF's work with women, click here.

This post originally appeared in the Huffington Post on 11/14/2012.  

This year things might be a little different though.  First of all, so many families were badly hit by Hurricane Sandy in New York, New Jersey and Connecticut.  Many people have lost their homes or have been forced to move while their homes undergo major repair.  I’m afraid these difficult times will continue well into December and beyond into the new year.

At AMREF, more than half of our staff were without electricity for a week and some were unable to come anywhere near work due to the transit issues.  We were all touched however by the many well wishes sent to us from our AMREF colleagues in Kenya, South Sudan, Ethiopia, South Africa and elsewhere  – everyone concerned about our welfare here in New York and how we were all managing.

Imagine that!  Our African colleagues who live with such hardship on a daily basis and in many cases in remote communities, without electricity at all – were writing to us offering their good wishes and wanting to know how they could help.  It really was incredibly heartwarming to receive such kind greetings that are so generous and typical of African hospitality.

Secondly, there’s a new ‘day’ popping up on everyone’s calendars this month as we move towards the Thanksgiving weekend.  #GivingTuesday takes place on November 27th this year and it’s a chance to move beyond the retail events of Black Friday and Cyber Monday.  Instead of the traditional shopping spree for our loved ones where we buy more electronics or another sweater for them, why not give a gift that actually makes a difference? Something they might actually always remember - The gift of life for another human being. According to the #GivingTuesday website, “We have a day for giving thanks. We have two for getting deals….Wouldn’t it be great to have a day for giving back?”

The idea started with New York City’s 92nd Street Y, and they have been the catalyst and incubator for #GivingTuesday. 

Then the United Nations joined as founding partners followed by a huge list of corporations, non-profits, organizations, friends and leaders who have all come together to create their own giving initiatives and help get #GivingTuesday off the ground in this, its inaugural year.

At AMREF USA, we have asked our Goodwill Ambassador, Mena Suvari to help us initiate #GivingTuesday by creating a video request to all of our generous supporters to give back this season.   Mena has chosen to honor her mother by giving a donation to AMREF’s Stand Up for African Mothers campaign, a global initiative designed to reduce the high rate of maternal deaths during pregnancy and childbirth in Africa, by training 15,000 additional midwives before 2015.

And a bonus – any gift to AMREF USA on #GivingTuesday will be generously doubled by an anonymous donor.

We at AMREF recognize these are hard times, and that many families in the US are struggling.   Still, we Americans are a giving people. Lets help provide the same hope to African Families that we have for our own. This  #GivingTuesday, November 27th, we encourage you to Stand Up for African Mothers – give a child in Africa a chance at life: their mother.

Please make a donation to AMREF, today.

Until next time, Lisa

We all know that the global economic climate is tough and it’s unreasonable to expect any increases in foreign aid.  But what we can expect and hope will come to pass no matter who is elected President next month, is that foreign assistance for global health and humanitarian aid will not be cut disproportionately.

Such drastic cuts would be ruinous.  In fact, they would cost lives.  

In their July 2012 issue brief on the human impact of potential, substantial budget cuts on global health, The Foundation for AIDS Research (amfAR) found that, “applying sequestration cuts to US government global health programming would have minimal impact on deficit reduction, but would be devastating to the lives of many thousands of people globally.”

In the key areas of HIV/AIDS, TB and malaria alone, which are high priority for AMREF, the amfAR brief notes that cutting by US government support of just 8.2 percent: 

• HIV/AIDS treatment for 276,500 people will not be available, potentially leading to 63,000 more AIDS-related deaths and 124,000 more children becoming orphan
• An additional 100,000 people will not be treated for HIV/AIDS
• 2.2 million fewer insecticide-treated nets will be procured, leading to nearly 6,000 deaths due to malaria; 3.6 million fewer people will receive treatment
• 88,000 fewer TB patients will receive treatment, leading to 11,000 more TB deaths.

And the list goes on.

Compare this though to the great strides AMREF, along with other NGOs operating in the global health arena in the developing world, have made over the last 10 years.   Strides in both improving health outcomes and creating sustainable change by working with communities to give them the skills, knowledge and means to improve their own health. 

As a result of the U.S. commitment to health in Africa alone, according to USAID’s Africa Bureau, “more children are living to see their first birthday, fewer people are dying from curable diseases like malaria and tuberculosis, and more communities have access to safe drinking water.  Two million Africans now benefit from life-saving HIV treatment and another 10 million people living with AIDS are receiving care through PEPFAR.” 

Health improvement in developing countries is not only critical to the populations of African countries, it’s also key to US interests abroad.  Improved health results in larger labor forces and greater educational opportunities, leading to more stable economies and the potential for growth.   Stronger economies usually promote more stable political systems.  Stable political systems and strong economies in Africa are in the strategic interests of the US to promote peace overall and increase our trade opportunities around the globe.  

What’s more, Americans are genuinely moved to help ameliorate human suffering – and according to a recent poll by the Better World Campaign, three out of four say that international issues influence their vote.  We Americans want and expect the US to do its fare share around the world.  In the next Presidential administration, we can’t cut foreign aid.  We will all feel the consequences.

At AMREF, we see the impact of US aid in our work in Africa on a daily basis.

Because of the support of the US government, midwives like Esther Madudu in Uganda receive advanced training to upgrade her skills, enabling her provide the emergency obstetric care needed to reduce preventable maternal deaths.

We see education programs in Tanzania that teach adolescent girls about their sexual and reproductive rights – helping create more gender parity and reduce unwanted teenage pregnancies.

Young Maasai women in northern Kenya learn that there are alternative rites of passage to female genital cutting, which in the past has led to so much trauma and even death for those women when they reach childbearing age.  

And we see senior health care professionals from all over sub-Saharan Africa participate in advanced management training provided by AMREF and partners so they can master the skills needed to run hospitals and busy health care facilities.

And the list goes on.  In fact, this is the list that we should all want to go on and on and on.  

Until next time, Lisa

Of the many ‘MDG’ activities around town this past week, I was thrilled to be part of a panel hosted by one of our partners, Johnson & Johnson, entitled ‘Innovative Solutions on the Frontline: How Healthcare Workers Are Saving the Lives of Women and Children’. With colleagues from organizations like the American Academy of Pediatrics, IntraHealth, Freedom from Hunger, mothers2mothers, Pro Mujer and Save the Children, we addressed some of the high impact solutions our respective organizations bring to the table to strengthen health systems and suppDr. Babatunde Osotimehin, ED, UNFPA; Congresswoman Barbara Lee, Ms. Ertharin Cousin, ED, UNWFP,ort frontline health workers in developing countries.

It was terrific to speak about our partnership with J&J in developing the managerial talent of senior health professionals, because I don’t think many people are aware of the essential link between leadership training and effective health care provision. I mean think about it. These professionals are totally comfortable delivering health services – that’s their life’s work. But when it comes to actually managing a large hospital for instance, these usually capable individuals are like fish out of water. Without proper managerial training, how can a health care professional be expected to ensure proper supply chain management of essential HIV drugs, or that staff are adequately supervised and motivated, timesheets and patient records well kept, that relevant information is linked to the Ministry of Health and above all, quality service is provided?

In tandem with the Anderson School of Management at the University of California at Los Angeles (UCLA) and J&J, AMREF created the Management Development Institute (MDI) program in Kenya to provide health professionals with the managerial skills to effectively run health programs and facilities. The MDI is delivered by instructors from UCLA, AMREF and by outstanding faculty from several African universities.

Jane Wathome, CEO Beacon of Hope, a community-based HIV care and treatment agency in Nairobi founded in 2002, is typical of MDI participants. In 2002, Beacon of Hope operated with two part time nurses and served about 120 clients per week. Overnight in 2008 her program grew ten-fold to fifteen full time staff serving about 1,200 clients per week. Jane was simply overwhelmed. However, after attending MDI and participating its mandatory year-long Community Health Improvement Project, Jane had reached a new level of expertise.

MDI Graduate - Jane Wathome

In her words, “because of the quality of information we learned from MDI, we have improved the quality of care to the point where we’ve become a referral center for other clinics in the area that have complex cases.”

Since 2006, there have been 665 graduates of MDI from 27 African countries.

The week before in Washington, DC at the annual Congressional Black Caucus conference AMREF had another opportunity to talk about our work. The US Congresswoman, Karen Bass, a strong supporter of global health and Africa, presented, ‘Africa Rising: A Continent of Opportunity.’ Divided into three forums: ‘Africa’s Growing Economy’, ‘Health Investments for Africa’s Future’ and ‘Emerging Threats to Political Stability’, the panel discussion spanned the entire day.

AMREF was honored to be the only NGO to address the health forum, represented by Dr Peter Ngatia, AMREF’s Nairobi-based Director of Capacity Building. Dr. Ngatia emphasized the need to invest in proven high impact solutions that result in less death, growing life expectancy and ultimately, ‘Africa rising.’ Of course Peter spoke to AMREF’s overall approach to health systems strengthening where we look at challenges holistically – not one-off quick fixes – but instead, a systemic approach to all elements that create a strong and effective health system.

This includes trained, motivated and compensated health workers, efficient governance, development of responsive health information systems, ensuring optimal supplies of provisions (especially drugs), a comprehensive monitoring and evaluation system and of course, solid leadership. Peter also highlighted AMREF’s ongoing battle cry – that we must invest in and support the development of skilled health workers if we want to realize our vision of lasting health change in Africa.

Moderator from USAID, Dr. Babatunde Osotimehin, Executive Director, UNFPA; Congresswoman Barbara Lee; Ms. Ertharin Cousin, Executive Director, WFP; Dr. Peter Ngatia, Director of Capacity Building, AMREF

I have to say, what really impressed me about the day’s events was the level of enthusiasm, optimism and support for Africa rising! Participants and panelists alike were overwhelmingly positive in their assessments of Africa’s future and how much positive change has occurred on the continent in the last 10 years. Equally impressive was the commitment of the African Diaspora to not only continue to support their family and relatives in their home countries, but also to invest in businesses, the economy and health development organizations like AMREF all across the continent.

That African spirit of ‘when I pull myself up, I lift everyone else with me’ was pervasive the entire day through. And it was a beautiful thing…

Until next time, Lisa

Read my other blog posts, here

With Dr Guerma’s visit to New York being both short and rare, we made sure to take advantage of every moment she spent with us.  Her most important task here was to launch the US arm of our global campaign, Stand Up for African Mothers, an introduction to which you can see as soon as you visit our website www.amrefusa.org.  

This global campaign aims to create awareness around the plight of the over 177,000 mothers in sub-Saharan Africa who die each year in pregnancy and childbirth.  To combat this high rate of maternal mortality, AMREF has committed to train 15,000 African midwives by 2015.   To draw attention to and celebrate the extraordinary work of African midwives who every day save the lives of so many mothers and children, AMREF also invites all its supporters to sign a petition to symbolically nominate Ugandan midwife, Esther Madudu, for the 2015 Nobel Peace Prize.  Click here to watch a lovely video about Esther’s lifesaving work. 

Using the launch of the Stand Up for African Mothers campaign as a platform to reach out to the African Diaspora, AMREF held a breakfast event at the Cornell Club in New York featuring Dr Teguest Guerma, Director General as keynote speaker. Dr Guerma is a strong believer in connecting with the African Diaspora around the world. As she said at the event, “there is great potential for Africans in the diaspora to make contributions beyond their families that will have a wider and longer-lasting impact on the development of their communities, their countries and the continent.”

The event targeted influential members of the African Diaspora in New York and beyond, by virtue of a live feed that reached out to other diaspora associations throughout the country and abroad. According to Liz Ngonzi, Founder and CEO of Amazing Taste, and a member of the African Diaspora herself, “this is one of the first times that a global organization such as AMREF has actually reached out to the African Diaspora and created an event specifically for this important and influential community.”  

The breakfast was essential for AMREF to develop stronger relationships within this important community. In fact, we’re pleased to announce a media partnership with Applause Africa Magazine, a leading resource for entertainment, business, fashion, politics and cultural affairs for Africans. For over a decade, Applause Africa has presented the voice of the socially responsible and upwardly mobile young generation of Africans around the globe and we’re thrilled to work with them. For their summer issue coming out at the end of the month, they have already donated the back page to our Stand Up for African Mothers campaign poster, as well as a portion of their editorial to introduce the campaign.

We’re looking forward to working together with like-minded organizations to further AMREF’s vision for lasting health change in Africa. More to come on that…

We were particularly pleased with the media coverage garnered for both the diaspora event and the launch of Stand Up for African Mothers in general. Dr Guerma was interviewed by Bloomberg TV, regarding her perspective on HIV/AIDS in Africa and spent time with the renowned National Public Radio (NPR) broadcaster, Michel Martin on her show Tell Me More, talking about African solutions to HIV/AIDS.

The media at the diaspora launch also provided AMREF and the Stand Up campaign with excellent visibility through their terrific coverage in

The Huffington Post Black Voices,

blackgivesback,

Sahara TV,

Voices of Anakazi

among others.

Dr Guerma also provided a small crowd of key AMREF supporters with an intimate version of our efforts to reduce maternal mortality and an up close glimpse at the new Stand Up for African Mothers campaign.

July was definitely one of our busiest times and over the next few months we’re looking forward to solidifying the partnerships we developed, as well as creating more awareness around our global campaign.

 In the meantime, we’re counting on you to visit our website and help us Stand Up for African Mothers.

Until next time, Lisa

I was visiting Addis Ababa to attend a meeting, visit communities where AMREF is active, and spend time with the hard working, highly dedicated AMREF Ethiopia staff.  On Tuesday, we visited projects in and around Kechene.  A short drive of about 20 minutes took us to our first stop.  After a short walk up a slippery muddy path (remember, it’s the rainy season) we reached an open space where modest tin-roofed homes surrounded a new small cement structure that had been recently built.  That’s where a group of about 25 residents had gathered to welcome us for our visit to the water and sanitation project in their community.       

Kechene district in Addis Ababa is home to over 50,000 people and has high levels of poverty, poor housing, and illiteracy. Sanitation is a particular problem as only 15% of residents have access to clean drinking water. For several years, AMREF, with support from government, foundations and corporations, has been building water kiosks (small cement buildings) in Kechene.  Each kiosk, with some variations, includes five to sixtoilet rooms, two to three shower rooms, two to three water taps, and a 5,000 liter water storage tank. These compact, multi-purpose kiosks are bringing water practically to the doorstep of people’s homes.  This represents a life-altering change for residents (mainly women and children) who used to travel long, time-consuming distances each day to collect water.  In addition to receiving a new local source of water, community members have been trained on how to maintain the systems and how to teach and promote better personal and community hygiene.

This is where I met 36-year-old Addisalem Getechew and her daughter (pictured above).  Addisalem is a single mother with three children (her husband died three years ago).  Her sister also lives with her.  She supports her family by selling injera, the traditional Ethiopian bread. 

In January 2012, she was elected by her neighbors as chairwoman of the local water project.  AMREF provided her with training to help educate and involve the community in sustainable water, sanitation, and hygiene activities, all behaviors that would help improve their health and well-being.  Addisalem told me, “it was a hard time, especially for women and children, without toilets before this kiosk was constructed.  Our kids were suffering from intestinal problems, diarrheal diseases and eye disease."

I couldn’t begin to imagine how difficult and demoralizing that must have been.  But that was then.  Now, as Addisalem stood by me gently holding her daughter’s hand, she said, “we are safe and we are happy.  I cannot remember any diarrheal diseases after we started using the new structure."

After a self-guided “tour” of the water kiosk, Addisalem invited our group to sit on benches and chairs that had been set up nearby for coffee.  A coffee ceremony in Ethiopia is considered an important social occasion in many villages and it’s a sign of respect and friendship.  Our coffee ceremony was a shorter, pared down version of what typically takes place but it was just as meaningful.  One woman fanned hot coals while a second tended the coffee pot which boiled away (and sometimes boiled over). 

Men, women, and children joined us.  When I asked a group of children if I could take their photo I received shy, embarrassed smiles that turned into bursts of laughter when they saw their picture on my camera. 

One girl handed us a small bouquet of flowers.  In another welcoming gesture, scarves were draped around our necks.  In addition to strong coffee, large trays of bread and popcorn (a traditional snack food) were served.

I hadn’t expected such an elaborate reception and felt humbled to receive gifts of food, drink and friendship from people who have so little.  Expressions of genuine, heartfelt thanks were exchanged all around.  I knew we had to leave soon to visit other projects, but we lingered for a few minutes and I was grateful for this rare opportunity to spend a little more time with this community.

A gentle rain began to fall.  Umbrellas were opened creating a temporary roof over the heads of our closely gathered group.  A spirit of mutual gratitude and goodwill surrounded us.  And on a chilly, dark cloudy day, suddenly there was warmth and light in Kechene.

Click here to watch a video about some of our work with women in Kechene

Click here to learn more about our work in Ethiopia

The diversity of attendees was broad – from individuals, to small nonprofits to large pharmaceutical companies. Featured speakers included UN Secretary General Ban Ki-Moon, Sir Elton John, World Bank President Jim Yong Kim and UNAIDS Executive Director Michel Sidibé, to name just a few. The theme of the conference was “Turning the Tide Together” a reference to the idea that now is not the time for retreat, but that real progress can be made towards ending the AIDS epidemic. As International AIDS Society co-chair, Dr. Diane Havlir said in the opening ceremony:

“We are at a defining moment; it would be an extraordinary failure of global will and conscience if financial restraints truncated our ability to end AIDS just when the science has shown us that this goal is achievable”.

Former US President Bill Clinton pointed out that according to the World Health Organization (WHO), only 5.2 million of the 15 million people with HIV globally received treatment at the end of 2009. “There is no excuse for failing to provide treatment for the remaining 10 million people in need,” he said.

Earlier in the week, US Secretary of State Hilary Clinton had announced that the US government would give $157 million towards efforts to achieve “an AIDS-free generation”, including US$80 million for the elimination of mother-to-child transmission of HIV. The mayor of Washington DC, Vincent Gray, had demonstrated that this goal is possible during his welcome address when he told participants that no baby had been born with HIV in the city since 2009 as a result of concerted efforts to fight HIV.

The highlight of AMREF’s presence at the conference was our role as experts and leaders in the field. Each day began with a daily plenary session featuring some of the world’s most distinguished HIV scientists, policy specialists and community leaders. The morning sessions brought together all conference delegates and set the tone for discussions during the day. AMREF’s Director General, Dr. Teguest Guerma was honored by the opportunity to chair the final daily plenary session “TB and HIV: Science and Implementation to Turn the Tide”.

AMREF Director General Dr. Teguest Guerma chairs a plenary session at the conference

AMREF’s participation at the conference also included an oral presentation by Research Lead, Josephat Nyagero, on “Behavior Change and Associated Factors among Female Sex Workers in Kenya”, and several poster presentations made by Nyagero and AMREF HIV/AIDS and TB Program Lead Dr. Abebe Aberra. AMREF Kenya Country Director Dr. Lenny Bazira Kyomuhangi, AMREF USA CEO Lisa Meadowcroft and US Board Chair Carol Jenkins also attended.

Hundreds of delegates visited AMREF’s booth at the conference, where they received information from myself and my colleagues Sam Hindels and Betty Muriuki on AMREF’s work and the Stand Up for African Mothers campaign. Life at the AMREF booth was never dull – our visitors either already loved us or were eager to learn more. Visitors to our stall included dignitaries such as members of Kenya’s Parliament, Cote d’Ivoire’s Minister of Health and the Vice President of the Gabon Senate Milébou Aubusson.

This year’s conference was particularly special because it was the first time all stakeholders rallied together around the goal of ending AIDS. During the closing ceremony of the conference, the outgoing chair of the International AIDS society, Dr. Elly Katabira, thanked participants for their dedication and commitment to making AIDS 2012 a success and urged them to maintain the momentum.

Listen to AMREF Director General, Dr. Teguest Guerma discuss HIV/AIDS on NPR’s “Tell me More” with Michel Martin (Segment was aired on July 26th, 2012)

Read more about AMREF’s work with people affected by HIV/AIDS.

The 19th International AIDS Conference takes place in Washington DC this year from July 22–27th.  The  theme,  “Turning the Tide Together”, not only reflects the enormous progress the scientific, research, private and development communities have made in diminishing the impact of this epidemic, but it also echoes the hope of finding an actual cure or preventative vaccine.

We have come a long way in the United States since the dark days when testing positive was a horrible death sentence. Today, with proper diagnosis and treatment, people with HIV in the US are living positively for decades.  AIDS is now considered a “chronic disease” which has raised some concerns in the US and many developing countries as there is a slight trend towards lapse in safe sex practices, impacting infection rates.

In Africa the battle still rages on. According to the January 2012 UNAIDS report –Aids Dependency Crisis, Sourcing African Solutions, “sub-Saharan Africa remains the most heavily affected region in the world.  The continent is home to two out of three people living with HIV but only 10% of the world’s population.  AIDS has claimed at least one million African lives every year since 1998.  And today, only half of Africans living with HIV who are eligible for treatment, are able to access it.” 

Above all, let’s remember that these statistics start with a person whose life has been affected beyond comprehension and who needs our compassion and support.  While these numbers seem particularly bleak, there has been considerable progress in stopping new infections and preventing deaths over the last 10 years.  In fact, the report cites that “in 22 African countries the number of annual new HIV infections declined by more than 25% between 2001 and 2009.  In 2010, more than five million people in sub-Saharan Africa were receiving antiretroviral therapy – up from just 50,000 in 2002.”

This increase in access to treatment is heartening.  I have seen its positive impact in my many visits to AMREF HIV program sites in Africa.  But there is a whole bevy of prevention and educational resources needed to bolster our progress in reducing new infections.   Health education for young people, particularly girls, can combat the stigma HIV/AIDS carries, increase testing rates, and encourage safe sex behaviors, such as condom use.

For many Tanzanians for instance, HIV/AIDS testing remains stigmatized, with less than 10% of the late teen and adult population aware of their HIV status.  Young women and girls are especially vulnerable to infection as it is difficult for them to negotiate safe sex or fend off the unwanted advances of older men.  Other cultural norms also create obstacles in combating HIV/AIDS.  Married couples often fail to discuss sexual health despite the fact that half of HIV infections occur within marriage. Parents rarely talk to their children about how to protect themselves from infection. Overall, the lack of openness increases ignorance and creates stigma around discovering one’s HIV status.  

One of AMREF’s programs in Tanzania, the Angaza project, meaning ‘shed light’ in Kiswahili, has made great strides toward reducing the stigma and consequentially, reducing infection rates.  Our work there to date has resulted in over half a million people,  including Tanzania’s President Kikwete himself , being tested at voluntary counseling and testing sites, over 90 additional counselors being trained and a high profile mass media campaign to encourage people to get tested and know their HIV status.

The UNAIDS report I cited earlier exhorts much more sweeping reforms to respond to the AIDS crisis in Africa.  Underlying all their recommendations is, as the report title suggests, a comprehensive search for an African solution to the AIDS epidemic, namely: “1) exploring more diversified funding sources for AIDS (moving away from dependence on foreign aid), 2) creating an African Medicines Regulatory Agency for faster roll-out of drugs and stronger quality assurance, and 3) catalyzing local production of medicines.”

I applaud these recommendations for their bold approach.  As an organization that believes in African solutions to African problems, we at AMREF understand that only by identifying long term, sustainable solutions, will we be able to achieve lasting health change in Africa.  

I’ll have more to report on later at the end of the HIV/AIDS Conference in Washington.  We’re thrilled that AMREF’s Program Leader HIV/AIDS/TB, Dr Abebe Aberra, will be presenting a poster at the conference.  He’ll be accompanied by our Director General, Dr. Teguest Guerma, an infectious disease expert who spearheaded a number of innovative HIV programs during her tenure at WHO.

In the meantime, for a stimulating read on how Africa could be combating AIDS with African solutions, I  encourage you take a look at this UNAIDS report.

Until next time,

Lisa

From stories of the mobilization of 8,000 frontline workers in Haiti to assail a cholera epidemic (they were already located ‘in communities’), to Afghanistan’s tireless midwives, 70% of whom are illiterate and have found ways to communicate ante-natal and HIV prevention information to their communities through illustrations and unique knowledge training, frontline health workers have an enormous impact on improving global health.

Because they’re there, in their communities, speaking the local language and earning the trust of their neighbors every step of the way.

It was amazing to hear about Ethiopia’s successful Health Extension Worker (HEW) program from Dr Hailu Tesfaye, currently a medical practitioner with Save the Children, with extensive experience in Ethiopia’s Ministry of Health.  Imagine giving Grade 10 girls in rural villages a long term career opportunity that allows them to earn a living, provide much needed health services and become well respected members of their communities. 

How did Ethiopia manage to train more than 40,000 HEWs and employ these young women in 15,000+ small villages throughout the country?  According to Dr Tesfaye, it took a very long time and was the result of a combination of factors:  relentless internal pressure on the government from women’s and physician’s groups, never ending perseverance, a need to respond to issues of gender equality and to stimulate employment in rural areas.  The program is now being replicated by neighboring countries in Kenya and Ethiopia anticipates that this program could actually help them attain certain Millennium Development Goals in 2015 – potentially a first among African countries.

I was also impressed by the straightforward, clear thinking of Dr Joia Mukherjee, Associate Professor, Harvard  Medical School and Chief Medical Officer, Partners in Health.  Her main points included the need for a ‘strategic rethinking about getting close to those in need – that proximity – or being embedded in the community – is the key’.  Dr Mukherjee also declared that frontline health workers are not a solution unto themselves – that they must be seen as an extension to strengthen overall health systems – a view echoed in a most comprehensive article in The Lancethttp://t.co/mLiox83F  about how a systemic approach to global health is required – one that includes more health workers, access, strategic leadership, an ability to leverage existing resources and a concerted global political movement for coordination among donors.

Mathew Taylor, a communications strategist from Intel, spoke eloquently about the value of public private partnerships – how they serve to advance the business opportunities of private enterprise by growing the economic potential of citizens in developing countries, as well as driving the agendas of civil society and facilitating their objectives.  In Intel’s case, their work centers around bringing multi-media e-learning content to health workers to exponentially build capacity in remote areas using mobile technology.  Ideally this will eventually lead to electronic health records which will also feed NGO advocacy efforts.  Technology enables incentives and such partnerships can also provide the means to attract, retain, educate and compensate community health workers.

A passionate plea came from Sheena Currie, a midwife educator, for more support of Afghan midwives who with so few resources manage to reduce post partum hemorrhaging and infection, the main causes of maternal deaths globally.  Having worked extensively with midwives there where even going door to door was a security hazard, Sheena found these frontline health workers to be “the most dedicated group of women I have ever worked with”.

Mandy Moore, a tireless ambassador for global health organization PSI not only lent her glow and eloquence to the gathering, but also spoke personally of her many visits to developing countries and her hope that in future visits to Africa, there will be frontline health workers in every community.

And finally, something for us all to think about. Compared to the AIDS movement of the 80s, we as civil societies have not yet galvanized public opinion behind our cause.  We have not yet moved mothers in the developed countries to stand up for their sisters in the south.  One of our key challenges is to get the word out – that there is hope, optimism and enormous potential in supporting developing countries in their efforts to improve health, one community at a time. 

Of course the G8 reiterated its commitment to the Muskoka initiative on maternal, newborn and child health from the 2010 summit.  We are looking forward to seeing how these commitments are progressing when a comprehensive report is issued next year.  In the meantime however, the progress does not look too promising.

According to ‘Trends in Maternal Mortality 1990 to 2010’, a report recently issued by the World Health Organization (WHO), the U.N. Population Fund (UNFPA), the World Bank and UNICEF, while maternal deaths have in fact declined globally from 1990 to 2010, “Sub-Saharan Africa had the highest maternal mortality rate (MMR) at 500 maternal deaths per 100,000 live births.”  The report further states that every two minutes, a woman dies of pregnancy and child birth-related complications caused primarily by severe bleeding, infections, high blood pressure and unsafe abortions.  Ninety-nine per cent of maternal deaths occur in developing countries, most of which could have been prevented with proven interventions. 

At this rate, it’s hard to imagine that we’ll make the Millennium Development Goal 5 – to improve maternal health – through a 75 per cent reduction of the MMR by 2015. 

At AMREF, we know that women are the backbone of their families and their community’s health and prosperity.  That’s why in 2010 AMREF made a conscious decision to focus on improving the health of women and children in Africa’s communities.   Making pregnancy safe and expanding reproductive health is a top priority for the entire organization in our strategic business plan for 2011-2014.  We believe that one of the most effective routes to improving women’s health in Africa is to train more frontline health workers, particularly midwives, whose pre-natal care and assistance at births makes a huge difference for so many women’s well being.    Midwives save lives.    And when a mother lives, her children are 10 times more likely to celebrate their fifth birthday.  It’s really that simple.

To this end, AMREF recently launched a global campaign, Stand Up For African Mothers.  By raising funds to train an additional 15,000 midwives through to 2015, AMREF will contribute towards reducing maternal mortality in Africa.  A skilled AMREF-trained midwife can provide care for 500 mothers each year, including safe delivery of 100 babies.  Ultimately this means these additional midwives can help as many as seven million African women every year!

We have also been very active here in the United States through our participation as a founding member of the Frontline Health Workers Coalition.  This group of 25+ dynamic and influential non-governmental organizations is working together to urge greater and more strategic U.S. investment in frontline health workers in the developing world as the most cost-effective way to save lives and foster a healthier, safer and more prosperous world.  We’ll be introducing the Coalition to senior congressional staffers on Capitol Hill in early June, urging them to dedicate more funds to train 250,000 frontline health workers in developing countries by 2015.

In my many visits to AMREF’s programs in Africa, I am always inspired, humbled and impressed by the passion and tireless commitment of women and men to overcome their enormous challenges – and create better lives for their families.  

To meet a father who tells me about the joy of holding his healthy newborn in his arms because an AMREF-trained midwife was there when his wife needed her simply reinforces for me again and again why I love my job!

Until next time, Lisa

Read more about our work with Women

I spent a week in the country in early April, and had a particularly interesting time in Gulu, a district in the northern part of the country. As we all are aware - a trip really starts before the travel begins. Preparation, thoughts, expectations and wonder fills our minds, not to mention questions from family members and friends. Why are you going to Uganda? Where is that exactly? Is it safe? Can you drink the water? Most of us Americans don't know much about what it’s like in Uganda or in most parts of Africa. After all, why would we? Other than stories of gloom and doom, news outlets just don't cover much about the region.

I must first make clear that while many challenges remain for the people of Gulu, the Lord's Resistance Army (LRA) and Joseph Kony are currently not one of them. Most people have moved back home, no longer forced to live in Internally Displaced People (IDP) camps. 

The day arrived to travel to Gulu and Vincent, my new AMREF friend, picked me up at 5:45 in the morning to start the 200 mile-drive from Kampala.

[Vincent and I]

The drive allowed me to see much of the country, and - I must say holy fruit! - bananas, pineapples, mangos, papaya, and jack fruit, the largest tree fruit in the world which can weigh up to 75 pounds, dotted the countryside. Why is there so much fruit? Well, water is quite abundant in Uganda, in a marked contrast to many other parts of East Africa. The Nile River even flows through the country on its long trek north to the Mediterranean Sea.

Five hours later we arrived - an hour ahead of schedule. The roads were horribly narrow. In fact I saw a bus slide across the road, and almost tip over, as it swerved to miss an oncoming car. But the traffic was better than expected. When we got there, we were told that the AMREF Gulu staff did not expect us so early, and therefore many of them were still over at the District Offices.

Talk about stumbling onto something special - we were handing over medical equipment and drugs to the district. Intended to supplement current government efforts to further build up various health centers in the district, with the goal of improving the health of mothers, AMREF staff was handing over maternity beds, microscopes, blood pressure monitors, antibiotics and more. It was a rather formal affair, with thank you speeches by various government officials including the District Health Officer. Representing AMREF was Dr. Moses Olwenyi, who leads our Sexual & Reproductive Health Project in Gulu (seen below in front of some of the new maternity beds).

Afterwards, we headed over to one of the health centers that will receive some of the equipment to meet the staff and find out more about their work. This health center is very remote – it’s at least a fifteen minute drive off of a paved road. It seems like you are heading into the wilderness yet this facility is here to provide care for a target population of 17,200. 

Even though every staff member I talked to seemed to be very engaged and it was obvious that everyone was doing their best, the health center is battling a huge staffing shortfall, in addition to the lack of equipment. The recommended and desired number of skilled health workers for this particular facility, including midwives, nurses, lab technicians, and physicians, is fifteen, however they are currently employing only five. The primary reason for the low number of skilled health workers? There are simply no applicants – there are not enough people with the requisite skills to fill the open positions.

Across Africa this kind of staff shortage is unfortunately not uncommon. This is why AMREF is training health workers at all levels - from volunteer peer educators within communities to surgical specialists.

I love what AMREF does and has been doing for years to improve people's health - which I believe to be - the first step to becoming a productive member of society. Hearing the government employees and community members speak about us, it occurred to me that we at AMREF are treated like family. Our work with communities across Africa - with the African people themselves– has led to strong relationships and shared interests. They see that we are not in it for them, or us, we are in it for all.

Click here to read more about our work in Uganda

“Our health equals our responsibility.” This is what Ann Mwihia told me is the motto of her fellow Community Health Workers in Gilgil, a town in Nakuru, part of Kenya’s Rift Valley. I was visiting the United States Agency for International Development (USAID) funded APHIAplus Nuru ya Bonde Project (Swahili for “Light of the Valley”) to see this integrated health program that aims to support the Kenyan Ministry of Health in effectively coordinating all health services in the Rift Valley province.

My day began at 5:45 in the morning. We wanted to get an early start to avoid the horrendous morning traffic in and out of Nairobi, which is as bad as any I’ve ever experienced in the U.S. The roads were pretty good by Kenyan standards, but it still took us about three hours to reach Nakuru.

Once there, I was incredibly impressed with the program – the people I met offered a truly heartfelt commitment to improving their community’s health and lives. I really believe that there will be a strong impact on empowering and educating the community to understand they have the right to greater access of quality health services.

One of the barriers to people accessing quality health services in Kenya, and across Africa, is that there are too few health workers, and the ones who are employed are working in health centers in the city centers, far from where communities live. These health workers are very often overworked, don’t receive much supervision or support from superiors, and don’t have the right equipment or a steady supply of drugs to distribute to their patients. The stresses and strains are burdening to both the staff and the patients. I have heard from women and men in several African countries that they rarely go to health centers for many reasons: because of the distance, that many times they don’t feel respected by health workers, that the quality of health services are poor and they too often think of health centers as places people go to die.

Luckily, these are exactly the kinds of barriers that the program, which began in 2011, is trying to ameliorate. APHIAplus is implemented by a consortium of six strategic partners with a key objective to improve health services at health facilities as well as to enable communities to play a bigger role in identifying and solving health problems themselves.

This is where AMREF and Ann Mwihia (see photo below with AMREF USA Executive Director, Lisa Meadowcroft) come in. AMREF’s role in the program is to train, equip and supervise a wide range of health workers, including Community Health Workers (CHWs), like Ann, who are the strong advocates for health – and are effective first providers of health services in their community. CHWs live among the community members, much closer than a health center which can be six to eight miles away. They are volunteers (though they may receive small stipends and tools like bicycles to reach other households) who are trained to recognize basic signs and symptoms of illnesses, as well as when to refer the person to a health facility for treatment. 

What is most important about the APHIAplus program is that it inherently makes the CHWs part of the formal health care system in Kenya. The program strengthens the links between community structures (level 1) and higher level health facilities (levels 2, 3 and 4), where there are nurses and/or other formally trained health service providers.

Now, let me tell you more about Ann Mwihia. Her smile and confidence belie the struggles she encounters every day. Ann is a subsistence farmer – but she says her passion is as a CHW advocating with her fellow Gilgil community members to prevent illness rather than just treat it. When I asked her why she is so committed, she answered: because of the challenges she faces in her own life. She’s the mother of three children and she’s also taking care of two children who lost both their parents to HIV/AIDS. One of the children is herself HIV positive, and Ann ensures the girl takes her medication.

Several times each week, Ann visits members in her community and talks with them about family planning, preventing HIV, malaria and TB, and water catchment. She encourages women to practice pre-natal care and to deliver their babies at health facilities, which she says is a challenge, because of the traditional beliefs and low education levels among women. Ann is most proud of the work she’s doing around women’s empowerment as a CHW. She discusses how rape is not acceptable and encourages women to seek emergency treatment and be counseled for STIs, and most importantly - to report the rapist to the authorities. Best of all, Ann told me with glee how she is convincing her community not to practice female genital mutilation – and when two families recently did, they were taken to court!

Ann Mwihia and her fellow CHWs also collect health data (i.e. number of children vaccinated, number of children born at health facilities; number of women attending prenatal care; number of families with malaria bed nets) and every month the data is given to the Ministry of Health. To engage and serve as a link to the community, the data is publically displayed on a chalkboard at the health facility.

Along with Ann, I met some truly inspiring people while visiting this project. One of these people was Peter Kiuna, a man who once had TB and was so moved by his CHW’s unwavering support that today he is a Community Health Committee supervisor! I already can see a real impact from the APHIAplus project – and left Gilgil truly proud of AMREF’s role.

>> Read more about our work in Kenya

>> Read more about how and why we train Community Health Workers

Despite women’s progress in the political, social and economic realms, there are still areas of grave concern that urgently need the world’s attention. Reproductive health, including gender-based violence, female genital mutilation and the high levels of maternal deaths in developing countries are issues that have been on the global agenda for decades, but in which there has been little progress. It is an indisputable fact that the United Nations Millennium Development Goals (MDGs) cannot be met without improving the health and welfare of women. All the MDGs are closely linked to women’s welfare, and AMREF is particularly keen on helping sub-Saharan Africa move as close as possible to those related to health.

For AMREF, gender is a common denominator without which the organisation’s core values and beliefs cannot be fully realizedd. Discrimination is one of the main causes of poverty, and a major obstacle to equitable and sustainable global human development.  Women and girls in poor and marginalised African communities find themselves further marginalised because of their gender, making them even more vulnerable to poverty and poor health.  For this reason, AMREF strives, in all its programs, to ensure that all human beings – women, men, girls and boys – are treated equally in terms of dignity and rights. 

To help remedy these discrepancies, AMREF’s Business Plan 2011-2014 is focused on transforming the health of communities by improving the health of women and children. In all our programs, AMREF is paying special attention to women’s health. Our water and sanitation programs ensure that women do not spend long hours every day searching for water. Instead, they are able to use the time to take care of their families, and to engage in projects that boost the family’s income.  With improved sanitation, girls do not have to miss school during their monthly periods, improving their school attendance and performance, as is the case in Mkuranga, Tanzania, and Juba, South Sudan. Our HIV and TB programs aim not only to prevent and treat the diseases, but also to empower women and give them life skills to enhance their lives. Take for instance our work in Kechene, Ethiopia, and in Kawempe, Uganda, where AMREF equips community health workers with information and skills to stay healthy if they choose to remain in the trade, and alternative means of earning a livelihood if they choose to change.

AMREF is also placing great emphasis on a growing concern in Africa to which little attention has been given so far – cervical cancer. In South Africa, cervical cancer screening is being incorporated into integrated testing and counseling activities, and in Loitokitok, Kenya, AMREF is training health workers in 12 health facilities to check women for cervical cancer.  Similarly, in AMREF’s new program in Senegal West Africa, the very first outreach mission to that country targeted women who have suffered vesico vaginal fistula, a devastating effect of obstructed labour.

Of particular concern to AMREF is the high rate of maternal death in Africa, where 200,000 women die in pregnancy and childbirth every year, leaving behind 1.5 million orphans and leading to loss of immense productivity potential.  Most of these deaths are caused by preventable causes like HIV/AIDS, bleeding, high-blood pressure, unsafe abortion, obstructed labour, and anaemia as a result of malaria or poor nutrition. Many die because they do not know the importance of seeking professional health care during pregnancy, childbirth and breastfeeding.  

To raise awareness about the plight of the voiceless mothers who are at risk of dying every year, AMREF has launched Stand Up for African Mothers, an international campaign that aims to train 15,000 midwives by 2015. Midwives save lives.  They educate mothers, look after them in pregnancy, assist them during delivery and follow up to make sure that baby and mother are fine. One midwife can look after 500 mothers every year, and safely deliver 100 babies.

AMREF would also like to take this opportunity to encourage all African s to contribute whatever they can to save mothers’ lives. Let us all Stand Up for African Mothers.

Dr Teguest Guerma
Director General, AMREF

Read more about our work with Women

The past year has seen technical and programmatic advances in global health, especially related to the remarkable drop in malaria mortality and morbidity in sub-Sahara Africa. For example, a recent analysis of malaria prevention in 34 African countries estimates that over 730,000 lives were saved between 2000 and 2010, nearly three quarters of them since 2006, when the use of both insecticides treated mosquito nets and artemisinin-based combination therapies (ACTs) became more widespread. Furthermore, according to 2011 statistics, only one out of ten people in the city of Dar es Salaam have malaria parasites. Research scientists from the Ifakara Health Institute (IHI) Dr Stefan Dongus and Prosper Chaki stated that there is also a dramatic drop in infections among households. Dr Chaki explained that in 2009/2010 malaria prevalence was 13 percent, attributing the situation to a decrease in mosquito density by 90 percent. This decrease in mosquito density is due to implementation of various projects over the last five years, including larvicide-spraying. Certainly this is a cause for celebration!

But before we get carried away with today’s advances, it behooves us to pause for a moment and look back on history not to miss the lessons so carefully learned from those heroes upon which our current advances are built. This reminder came home to me on a recent assignment undertaken with the AMREF Kenya country office, which is deliberately cataloging their rich 55-year-old accumulation of documents, reports, films and slides using today’s digitalization technologies. Fortunately, much of this has been carefully preserved, creating a priceless historical picture of not only the organization’s work, but in reality, a rich history of the medical developments in Africa itself. This is an enviable legacy for the relatively young Foundations in my adopted hometown of Seattle, Washington.

Dr. Michael Wood, the Director General of AMREF since its inception, in November 1981 described the early years when resources were extremely lean, but the organization survived on the remarkable generosity and the voluntary spirit of the growing band of committed staff. The pioneering work included establishing a flourishing radio communications network that eventually linked numerous rural health facilities with AMREF’s central office in Nairobi. Local Africans in the bush built air strips for nothing and the first Flying Doctors aircraft arrived in 1960.

Just as today, the Great Debate between curative and preventive medicine went on fiercely. It was obvious that clinical medicine had no chance of catching up with disease unless other efforts were put in at the other end of the problem— namely, increasing preventive medicine and spreading health education. But as occurs today, talk about it was endless and governments and donors paid lip service to the idea. As occurs in many African countries even today, when there’s a squeeze on the national health budget it is the Health Education Department that is the first to be cut back.

Even back in 1980s, Dr. Wood noted the emphasis for health services began to be directed to the right place, namely, at the community level. ACAM continues to champion this same focus today and it is still an uphill battle. Discussions among donors and governments in the comfortable capital cities design programs with little regard for input from the communities themselves. Sustainability is a common buzzword, but the steps necessary to make it happen at the community level are never carefully considered and funded in the budget. The task of developing healthcare is a colossal one, but it can be solved on the spot by the community itself with the help of those who are prepared to go into these uncomfortable places to teach, persuade, immunize, and deal with the medical needs where they exist.

This past year has seen remarkable credit being attributed to the role of community-based health officers and workers for the encouraging success of national eradication of trachoma, malaria, and polio. It is upon this level of care provider that perhaps 90% of the patients present for treatment, and can be adequately attended provided the workers are trained to dispense available medications that are highly effective. A most encouraging example are efforts to address the neglected tropical diseases that sap so much health and energy, especially from young growing children, thus setting the stage for their later demise. Ever true today, taking water as a case in point, as Dr. Mahler, former Director General of WHO, said it was more important to know how many water taps there are per 1000 population, rather than the number of hospital beds. The old dictum persists today, “You get action depending “on what you count”.

Administratively, AMREF eventually needed to address major issues as its reputation and skills in advising governments and other international organizations grew. For example: how to design practical research projects of immediate value to healthcare providers; how to include health behavior techniques as an essential component of health programming; how to scale up and disseminate the ideas and practices that proved worthwhile in practice; what was the correct mixture of medicine and management? These were just a few of the issues confronting AMREF’s Leadership. The Board of AMREF was not shy about calling in management consultants to assist them in revising their management structure as needed. This prevented them from going after too many enticing opportunities, but rather to concentrate its efforts within a defined and agreed strategy. AMREF learned to say “no” when suggested projects did not fit into its program.

The institution evolved, determined to keep bureaucracy at bay— a task that today’s senior staff still resist with skill. The management continues to be participatory, rather than authoritative; it remains flexible, human, and analytic; they are a hard-working dedicated professional group of people who try to remain both consistent and yet innovative. It has continued to maintain a common purpose, a loyalty, and an esprit de corps that holds together the various parts of the organization. Indeed, this “soul” of the organization has recently become identified into a new unit called Heritage. It is responsible for consolidating and cataloging the 55 years of AMREF’s documentation for posterity’s use and “lessons learned”.

Remarkably throughout the early growth years, Michael Wood, as AMREF’s first CEO, never showed signs of a negative attitude toward governments in Africa; rather he recognized that they had been put into an impossible situation, namely, administering health services to mushrooming populations with minimal resources. In fact, he recognized that certain aspects of public health should not be run by governments at all. Dr. Wood back in 1981 was not afraid to ask, “Where are we going?”; “Can we justify our existence?”

Today AMREF continues to use ingenuity to keep going, to change when necessary, and to devise new policies and approaches as needed. Their innovations in the field of healthcare include research, behavioral sciences, and training in both curative and preventive medicine. But the overriding emphasis is on implementation—for them, that’s the only way to find out what is practical, appropriate and possible. Meanwhile today’s major health program implementers/contractors devote considerable budgets for Advocacy activities as they compete for financial resources. But in the words of Dr. Wood, “Exhortation and advice is no substitute for implementation”.

In conclusion, today’s leading Global Health institutions have much to learn from those who forged historical changes in the past. Go forward to address the new challenges, but don’t repeat old mistakes. Rather, make original ones and openly share the wisdom with others as you go. Do as AMREF’s Dr. Wood has done.

Many thanks to Dr. Casazza for allowing us to republish this post. The original can be found on the African Communities against Malaria website.

Click here to learn more about AMREF's history

The students’ hard work is now complete. We have been so impressed with some of the suggestions that we would like to highlight our three favorites.

Alexandra Seegers wants us to develop a broader concept of how to develop and engage a community, regardless of the channel (Facebook, Twitter, Blog) they prefer. She had a few suggestions about how to accomplish this. She encouraged us to make branding consistent across all channels. And, gave us advice on how to use our website more effectively to guide people towards these communities.

Nicole Carroll reminds us that we have won great awards for our on-the-ground work, and have been recognized for our financial efficiency. It is imperative for us to ensure these recognitions are easily seen on all our channels. When an interested party finds us, these awards and recognitions add credibility to our organization, and increase the likelihood this party will become a supporter.

Deborah Silver's suggestions were quite specific. Rather than just telling us that we should be doing A or B, she provided tactics to accomplish the suggested strategies. Her ideas about improving the donor experience on our website were particularly helpful.

Learning from the next wave of great fundraisers helps ensure AMREF USA is able to continue bringing better health to the people of Africa. We want to thank Liz, Dick and all of the students - not all of which have been mentioned. We greatly appreciate all of their hard work.

“Frontline” is an apt descriptor of the people who are the first and often the only point of contact to the health care system for millions of people in developing countries. They are community health workers, midwives and rural health practitioners, but they can also include local pharmacists, nurses and doctors.

These frontline workers deliver babies, give pre- and post-natal care, administer life-saving vaccinations, counsel families on the importance of mosquito nets and clean water and hygiene, and provide prevention and early diagnoses of a wide range of deadly and health-sapping diseases and infections — HIV and AIDS, pneumonia, tuberculosis, diarrhea, malaria, measles and malnutrition to name a few. They truly are the backbone of most developing country health systems.

Today AMREF joins 14 other non-profit organizations in launching a new campaign - the Frontline Health Workers Coalition — in calling on the U.S. government to invest in frontline health workers as “the most cost-effective way to save the lives of mothers and children, address AIDS and other global health threats and help advance U.S. economic and strategic interests.”

Dr. Peter Ngatia, director of training at AMREF’s headquarters in Kenya, is one of the speakers at the launch at the Kaiser Family Foundation today in Washington, D.C., and will talk about what it means to be a frontline health worker in Africa.

“The frontline health workers are the unsung heroes of the health system in Africa,” said Dr. Ngatia. “They are multi-skilled and selfless providers of health care to the poor and underserved populations, particularly women and children, who live in isolated and remote rural Africa. Their training is comprehensive, shorter and at a fraction of the cost of training higher level health professionals, yet they easily attend to more than 75% of the disease burden in Africa.”

The Coalition, which also releases a policy briefing focusing on the need for frontline health workers today, is calling on the U.S. administration to train and support an additional 250,000 new frontline health workers — as its contribution to addressing the global shortage of a million workers — and to better support the capacity and impact of existing workers where the need is greatest.

There are humanitarian and moral justifications for providing these 250,000 frontline health workers. But it also makes economic sense. In fact, investing in frontline health workers is the most cost-effective ways to save lives, and the report gives four reasons why frontline health workers are a good U.S. investment.

The Coalition says that despite the fact that a child’s death is prevented every three seconds somewhere in the world thanks to care provided by a frontline health worker, there are still too few health workers to reach the millions of families who need them: Nearly 21,000 children die every day, mostly from preventable causes, and 1,000 girls and women die every day in pregnancy and childbirth.

Closing the health worker gap in Africa is AMREF’s highest advocacy priority, according to its website: “AMREF considers the health worker shortage, particularly in rural areas, one of the major challenges facing effective health care in Africa. Health systems strengthening calls attention to the need for capacity building at all levels in order to close the gap of more than 1 million health workers needed for Africa to meet the Millennium Development Goals.”

If you are reading this, you are likely already a global health supporter. But we ask you to go beyond being a passive supporter and help us get out the word on frontline health workers. There are several things you can do to raise the visibility of the issue and the Coalition. Here are a few:

• Comment on this blog below.
• Read the coalition's new policy brief , released today.
• Check out the Coalition’s new website.
• Let your representatives and senators know you want them to support funds for expanding the number of frontline health workers in the developing world.
• Write a blog or letter to the editor of your local newspaper, and link to the website.
• Tweet about the issue using the hashtag #frontline.
• Become a fan on the Coalition's new Facebook page, and share the stories photos, and encourage your friends and fans to visit and sign up.

Please join our effort to convince the U.S. government that meeting one-quarter of the 1 million new frontline health workers that are needed would save millions of lives and be money well spent.

Read my previous AMREF blog on frontline health workers from Oct. 4, 2011.

To learn more, please listen to a Field Call with Dr. Peter Ngatia, AMREF Director of Capacity Building. Dr Ngatia discusses the new Coalition and speaks about AMREF's training programs, and why new health workers are so critical to better health for Africa.

“One of the patients, a 17-year-old girl, Madina, touched my heart,” Dr. Weston, a Kenyan, says. “We just celebrated the 7 billionth baby, but what this girl went through is so shameful that looking at her would make you cry.”

Madina was pregnant when her family and other villagers left Somalia for the refugee camp. She went into labor somewhere between Somalia and Dadaab, which is near the Somali border.

“She can’t remember exactly, but she told us that she was in labour for about 15 days,” Dr. Weston says. “She couldn't push due to exhaustion and her baby got stuck in the birth canal for days.”

A villager helped her deliver, but the baby, a boy, was born dead. “The birth was followed by hemorrhage, and by the time they reached the camp she was in shock,” Dr. West explains. “Her sister told us that they almost abandoned her on the way, but her husband voted against it.”

When Madina reached Daadab, she was immediately referred to the Garissa hospital, a three-hour drive away. In Garissa, she was attended by a visiting gyneacologist from the Rotary doctors.

“The family tried to suffocate her, a common practice in some nomadic cultures when one is too sick and can't migrate with the rest of the group,” Dr. Weston says of Madina’s trek to Dadaab. “Had it not been for the hospital staff, she would be dead by now.”

While Madina was examined under anaesthesia for the bleeding, the doctor who examined her found an extensive fistula and uterine atony, a condition in which a woman's uterine muscles lose the ability to contract after childbirth. Fortunately, the bleeding was controlled and doctors were able to stabilize her with a blood transfusion.

Later, she received a colostomy to ease the healing of her birth canal. However, this treatment failed and she had to be transferred to the Kenyatta national hospitals, an eight-hour-drive from Garissa. After some time there, she was returned to the camp.

At that point, Madina was looked at again. “When I examined her, I found an almost empty pelvis,” Dr. Weston says. It turned out that Madina had an extensive double-fistula with hardly any tissue left. It took the doctors four hours to repair her urethra and her rectum. Madina also has foot drop in both legs, a consequence of nerve damage sustained during obstructed labor, leading to an inability to use the lower limbs. As a result, she can’t walk without help.

Madina’s story is a sad reminder of how poor access to reproductive health can negatively affect women in many developing countries.

“It is not enough to shout that we need safe motherhood,” Dr. Weston says. “It demands much more. Unnecessary conflicts, early marriages and no education, compounded with extreme poverty and lack of access to health care, especially for pregnant women, today, in this century is a shame.”

“Madina is dry and healing, but we pray that she remains that way and women no longer have to endure the same ordeal,” he adds.

Thanks to Relief Web for the post. 

The WHO defines task shifting as “the rational re-distribution of tasks among health workforce teams. Specific tasks are moved, where appropriate, from highly qualified health workers to health workers who have fewer qualifications in order to make more efficient use of the available HRH [human resources for health].”

AMREF strongly supports the role task shifting can play in helping fill the gaps left by the health workers shortage, and has just released this Position Statement on Task Shifting.

In Dakar, Senegal this week, the second International Conference on Family Planning — the largest gathering of family planning practitioners, advocates and supporters in the world — is also looking at task shifting in the context of family planning (FP) and reproductive health: We found five of the 121 abstract-driven sessions addressed task-sharing. Much of what we found supports the positions AMREF lays out in this statement, namely our positions that:

• Task shifting in Africa is a reality in health care service delivery.
• Task shifting presents a viable solution for improving health care coverage by making more efficient use of the human resources already available.
• A systematic approach to ensure harmonized, standardized and competency-based training is needed.
• Successful task shifting requires training and changes in laws and policies to accommodate workers with improved skills.
• Appropriate supervision and support in task shifting is crucial for quality assurance.
• Task shifting needs to be flexible to the opportunities and constraints on the ground.
• Clear regulation is needed to protect the public by providing frameworks within which the scope of practice, standards of education and codes of conduct for regulated professions is set out.
• Performance-based incentives or other methods by which to retain and enhance the performance of health workers with new or increased responsibilities are needed.

Several Dakar conference abstracts presented on-the-ground experience with different aspects of task shifting. The presentation entitled “Task Shifting for Family Planning” shared the following examples:

• ETHIOPIA: Pathfinder International supported the training of 1,000 health extension worker (HEW) supervisors and clinical providers in long-term FP methods, especially intrauterine devices (IUDs). Later, these supervisors and providers trained 2,500 HEWs. A total of 40,000 insertions were performed during the first year after training by trained HEWs. The study showed that task shifting can rapidly increase service coverage, quality and client satisfaction.
• RWANDA: An IntraHealth study showed that a project to provide nurses with training in long-term methods, emphasizing IUDs, greatly increased adoption of IUDs in the four districts studied.  Task shifting with nurses improved women’s access to FP, helped decrease unmet demand and may have freed up physicians to dedicate more time to urgent cases.
• KENYA: A FHI 360 and Jhpiego pilot project trained community-based distributors (CBDs) in the use of the DMPA injectable who, in turn, reached 1,245 women with a range of FP services. More than two-thirds of those women either initiated or continued using DMPA through the CBDs. The pilot produced evidence that confirms the safety, acceptability, feasibility and effectiveness of the CBDs.
• NIGERIA: This Pathfinder International project used female Muslim and Christian religious leaders to reach women in their homes and provide them with information about FP in a religious context. Prior to the intervention, only 9% of the 147 women reached used a modern FP method. After the intervention, 73% of the women reported current use of a modern method. Data from this project suggests that “effective programs reach women with firsthand messages that directly challenge the religious and cultural dogmas within their homes.”

In a separate presentation entitled “Shifting tasks and facilities: Making long-term family planning methods more accessible in Senegal,” an IntraHealth pilot project trained 190 health post nurses on long-acting methods. These trainings contributed significantly to increased FP service delivery in 243 health posts. In Dakar, FP use increased from 6.6% to 13.7%. In other regions, it increased from 4.4% to 7.7% on average. This pilot showed that nurses, when trained in a range of FP methods, can help increase contraceptive prevalence.

AMREF has been actively involved in capacity-building in South Sudan since 1972 and began training clinical officers during the war (a clinical officer is a cadre between physician and nurse that is trained for half the time and at one-fifth the cost and can carry out 70% of the work a physician does). This work offers a good example of task shifting.

AMREF did a study of the graduates of the Maridi National Training Institute, which trains 80% of all clinical officers in South Sudan, to determine the proportion of graduates still working in South Sudan and what they were doing. The study showed that 99% of the 213 graduates studied were still working in the country and that these officers have been accepted and acclaimed as “the Doctors of South Sudan.”

After the peace agreement of 2005, AMREF developed standardized curricula for the training of community midwives, clinical officers and community health workers and also worked with the Government of South Sudan to integrate task shifting into the standardization of all training curricula materials for clinical officers, as described in AMREF’s paper “Shifting tasks to save lives: The example of AMREF-trained clinical officers in Southern Sudan.”

AMREFʼs technical support to the Government of South Sudan played a key role in the creation of an enabling environment through good government policies on human resources, including task shifting. For task shifting to be successful, policies that support it must be encouraged in order to make essential health services more widely available, particularly in post-conflict settings like South Sudan.

Follow David on twitter @davidjolson 

AMREF’s recent Position Statement on Community Health Workers stated that CHWs’ role is “imperative in achieving the health-related Millennium Development Goals, especially those related to HIV and AIDS, malaria, tuberculosis, maternal mortality and childhood diseases.”

Their role in family planning (FP) and reproductive health is equally critical, as is being made apparent this week in Dakar, Senegal, where the second International Conference on Family Planning — the largest gathering of family planning practitioners, advocates and supporters in the world — has placed CHWs high on the agenda. CHWs feature front and center in at least four major abstract-driven presentations as well as a luncheon roundtable and reception honoring the health worker, both organized by IntraHealth, one of our main partners in the new Frontline Health Workers Coalition.

Many of the case studies and findings from the front lines of global health being presented at the conference support AMREF’s position statement on CHWs. In that statement, AMREF stated its belief that: 

• CHWs are the most affordable and available category of human resources for health in Africa.

• Much of what a nurse or midwife does can be done as effectively, or sometimes even more effectively, by CHWs operating in the community and providing home-based care.

• Strong linkages and referrals between the community and the formal health system are imperative.

• Community participation needs to be continuously developed and supported.

• CHWs need to be integrated into the revised Human Resources for health strategic framework, including new strategies that enable CHWs to contribute more effectively.

• CHWs should be adequately compensated for their efforts.

• CHWs’ use of modern technology, especially the mobile phone, is critical to improving access to health care.

All of the CHW-related presentations at the Dakar conference show either the indispensable role played by the CHWs or innovative programs that are being implemented to address the issues raised above:

• KENYA: In a presentation entitled “Peer mentoring methodology for capacity building integrated HIV and FP/PNC services,” the Population Council tested the feasibility and acceptability of using an onsite peer mentorship program to improve the knowledge and skills of first line health workers to provide quality integrated HIV and postnatal/FP services. Eighty-seven percent of the “mentees” achieved the required level of competence in knowledge and skills over one year. During this time, an increase in use of long-term FP methods from 3.1% to 7.4% was noted.

• UGANDA: In a presentation entitled “The role of community-based organizations in expanding access to injectable contraception,” Save the Children US and FHI 360 demonstrated that the provision of injectables by CHWs was feasible, safe and acceptable. Save the Children is now exploring opportunities to expand community-based provision of injectables to other countries, including Francophone West Africa.

• NIGERIA: In a presentation entitled “Supportive supervisory visits (SSVs): A key tool in ensuring quality in family planning interventions,” the Society for Family Health showed that SSVs by doctors, nurses or midwives to community and service providers have proven “to be an invaluable means of on the job coaching for providers and through on-going series of SSV, providers have been found to exhibit more confidence and proficiency in providing quality family planning services.”

• INDIA: In a presentation entitled “Is there any effect of health workers' visits on women's contraceptive use in Uttar Pradesh?” a Futures Group study found that health workers' visits to married women in their homes helped increase contraceptive use from 35% in 2005 to 44% in 2010, which is highly significant. “One of the key findings is that health workers' visits significantly boosted the update of contraceptive use, which implies that grass roots level workers are keys to the FP program,” according to the abstract.

• EL SALVADOR, GUATEMALA AND NICARAGUA: In a presentation entitled “Women's experience using a certified network of IUD providers,”  PSI hired and trained a group of community-based health providers (CHPs) to promote FP services, specifically to insert and remove intrauterine devices (IUDs). Overall, women reported a positive experience with the CHPs. Most women reported the intention to continue using the IUD and would even recommend it to other women.

These presentations and others in Dakar this week show clearly that if community health workers in Africa and parts of the developing world are properly trained and supported, they can play a larger and more effective role in helping provide family planning to the 215 million women with no current access.

 Follow David on twitter @davidjolson

Please click the photo to see pictures from the event

By Kitty Reddington and Sam Hindels

On October 25, 2011, AMREF USA hosted a reception featuring Dr. Asrat Mengiste, Head Surgeon of AMREF’s Flying Doctors.  Introductions were made by AMREF USA’s Executive Director Lisa Meadowcroft and Chair of the Board, Carol Jenkins.  Dr. Mengiste started the evening by extending an invitation to everyone at the event to come visit Africa and see all that it has to offer, as he said the “memory will stay with you for a long time.”  He then spoke about the work of the Flying Doctors and how in 2010 their clinical outreach program provided services to more than 20,000 patients in remote locations across Eastern Africa. 

The main focus of Dr. Mengiste’s discussion was on reconstructive surgery, particularly cleft lip and palate. Dr. Mengiste, and his team perform a large majority of these surgeries in very rural and hard to access areas.  The conditions that the doctors operate in are very extreme; the doctors are responsible not only for the surgery, but also for the local anesthetic and post-op care. There are limited medical supplies and often the conditions are not very sanitary.  The doctors travel out to remote locations, and then spend up to a week doing surgeries from early in the morning until late at night.  While they perform the surgeries, they are also training the local physicians to do the same.  This creates an important multiplying effect.

Cleft lip and palate surgeries are important particularly in Africa for at least two reasons. In many communities deformities are not recognized as simple birth/genetic anomalies, they are seen as taboo, or a punishment for an ancestors bad actions. This leads to the person with the cleft lip/palate being ostracized by their community and often leads families to hide children effected in the home, not letting them go outside. If they are not treated at a young age, many children can die because they are unable to get proper nutrition due to an inability to suckle.  People were curious as to why it appears that Africa has more cleft lip/palates than other parts of the world; Dr. Mengiste explained that Africa has a similar ratio as many as Western countries, but that the problem was the back-log of patients who were not treated at birth.  The current back-log is suspected to be about 100,000 patients. Many individuals in Africa do not realize that a cleft lip/palate can easily be corrected through surgery and so if the children survive their first year of life without complications, fixing the cleft palate becomes less of a necessity; however, the change it creates for the patient is enormous.  Dr. Mengiste mentioned that since the operation is not a priority for most countries, it is an area where AMREF can make a large impact.

Dr. Mengiste spoke of one patient who was much older than the children they normally focus operating on.  The man was in his 50’s and insisted on the surgery.  After six months when the doctors returned to this particular hospital for follow up, he actually returned, which is uncommon for most patients.  He came with a group of people from his village who also had cleft palates.  The surgery had changed his life so significantly that he wanted to ensure others were able to have the same opportunity.  Word of mouth is important in the areas where Dr. Mengiste works because they are so rural, it is impossible to reach all the small communities.

Dr. Mengiste also acknowledged the significance of the partnership with Smile Train, an important funder of the AMREF cleft lip and palate program, and personally thanked them for their important contributions to this area.  Before working with Smile Train, AMREF was doing about 200 cleft surgeries a year (2005), since we started working together AMREF has been able to do about 1,200 surgeries a year. 

Dr. Mengiste concluded by saying that international collaboration is the way to move forward in order to tackle this life altering birth defect.  More financial investments are needed in this area from both the U.S. and other countries.  

Read more about Dr. Mengiste, and his work.

Read more about the work of AMREF's Flying Doctors

AMREF USA’s Director of Programs William Yaggy, Grants Manager David Chase and Associate Grants Manager Beth Oppenheim were joined in our offices in New York by Dawn Betteridge from AMREF Netherlands, Paola Magni from AMREF Italy, and Anne-Marie Kamanye from AMREF Canada.

Each national office presented information about their country’s experience in fundraising for AMREF programs in Africa, analyzed best practices, and addressed concerns and possible solutions for potential future obstacles. Being able to compare and contrast experiences was incredibly helpful for all of the participants. It was a wonderful opportunity for us to not only generate thoughtful discussion and support for each other in our work, but also to develop even deeper face-to-face relationships that will continue to strengthen as our offices place an even larger focus on collaboration.

Capitalizing on the opportunity to have national offices here in the U.S., Dawn and Paola were able to join the rest of the AMREF USA Program staff at the CORE Group Fall Meeting. The CORE Group is an umbrella organization that encourages learning and collaboration among organizations working on community health worldwide. AMREF USA regularly attends these meetings in both the fall and spring, and this time was able to bring our international colleagues along.

The theme of this year’s meeting was “Windows of Opportunity for Health & Well-Being,” allowing each of us to explore whichever area of community health was most relevant for us and our work. Topics discussed incorporated many that were of great interest to AMREF, including maternal and newborn health, child survival programs, and discussing the CORE Group Polio Project, of which AMREF Ethiopia is a partner organization. We were also able to listen to a presentation by The White Ribbon Alliance, of which AMREF is a member. The presentation focused on generating increased awareness of safe motherhood in all organizations working on community health.

Being able to share this type of experience with our international counterparts – both in a global context as well as in an AMREF one – has been invaluable. Through exchanging ideas, AMREF USA and other national offices will be able to grow and pursue more comprehensive institutional fundraising opportunities – ultimately allowing AMREF to strengthen our programs - worldwide. As we move toward a more unified structure, these opportunities will become more and more important for our success in a competitive fundraising environment, and have been an interesting way to learn about working together more effectively in support of better health for Africa.

   >> Click here to learn more about what we do

The maternity ward at Kagando Mission Hospital is a busy place. Despite three large rooms with beds, there are mats all along the corridors, on the floor between beds, and in the center aisles, brimming with women and babies. With their female friends and relatives there to give support, and their tiny newborns wrapped in brilliantly colored cloths, called bithenge, they all present an encouraging tableaux of progress. Even though there is a shortage of space, the fact that they are near doctors, nurses, midwives and ultrasound machines is a modern day miracle.

Maternal deaths are an epidemic in sub-Saharan Africa: every year more than a quarter of a million women attempting to have their babies--alone, or with unskilled help and miles away from a hospital--do not make it. Sometimes the babies die, too. And sometimes the mothers survive, but their bodies are destroyed by fistula, a tearing of internal organs. AMREF's Director General, Dr. Teguest Guerma, believes that saving mothers is at the heart of stabilizing health for all Africans and has taken it on as our primary initiative.

Bwambale (the name means 2nd born boy) made his entrance into the world today just as he was supposed to. We were in the room--a no-nonsense tiny space with a sheet hung to create a little privacy from the laboring mother in the next bed--at about 4PM when his mother Josinta pushed, and there he was: caught and swaddled by a midwife, essentially unscathed by the experience. No more than 20 minutes later his mother walked herself from the birthing room to their bed in the maternity ward. Her baby was handed to her and he immediately began nursing.

Bwambale was lucky enough to be born here at Kagando, lucky enough to be healthy, lucky that his mother sailed through the delivery and will return to her husband and three other children. AMREF estimates that every year 1.5 milllion African children are not so lucky. Their mothers die in labor.

Today we visited some of those children, ones with no mother or father--residents of the Nzirambi Orphans Talent Development Center, run by Kagando Hospital. Here we see children given a second chance--like 15 month old Alice Kabugho, whose mother died of delivery complications when she was 4 days old. The aunt who cares for her two sisters in a remote village could not take her in--and so she came here--her home, as aides confidently, even cheerfully report-- for the rest of her life. We find that the option, the hope of adoption is not even a part of the discussion here.

There are 84 children at the Center--including 13 babies who have arrived over the last few months, who live in the "Baby House." There are six new houses in all, neat and inviting as an American suburban neighborhood with a "senior mother" in each who oversees their care. That care is covered straight through University through donations of funders in Canada and the UK.

Of course, most African children and mothers are not so handily rescued.

These mothers, these children are the focus of AMREF's work. Our campaign Stand Up for African Mothers is meant to bring attention to the desperate conditions of Africa's mothers--and the need for health centers like Kagando (rated the 4th best in all of Uganda) where pre-natal care is provided, and where interventions like C-sections are available. In our two days here so far we have seen 8 C-sections--on track for the average of four a day.

Yesterday Marian Night was one of the mothers who delivered by C-section. Her son is in the neonatal care intensive care unit--on oxygen. We visited him today. As one of Marian's sisters sat beside his tiny bed, a nurse said his condition was only "fair." But because Marian delivered in a hospital, his chances are immeasurably better than they would have been.

Maureen Rose is an 18 year old we met in the fistula ward at Kagando. She was in labor for two days in May waiting for transportation to a birthing center. She lost her son and in those two days was rendered incontinent. The surgery here in Kagando's special fistula unit will restore her body, but perhaps not her life.

Our visit here is part of AMREF's Outreach program in which we bring physicians and experts into hospitals in more than six countries, including Uganda, for week long intensives. But we also have a Ugandan country office, and through it many programs in this country, spending $7 to $8 million dollars a year (by comparison, we invest $25 million in Kenya and $15 million in Tanzania)--working in HIV, malaria and TB, water, sanitation, education of children in cleanliness, among other areas. 

While Drs Davis and Enemchukwu are performing urological surgeries on this outreach, AMREF has previously provided technical assistance to Kagando: Rev. Benson Baguma, who runs the hospital, profusely thanked AMREF today for a technician who came and repaired the hospital's X-ray machine. It had been broken down for six months.

AMREF (The African Medical & Research Foundation) is the largest African health organization on the continent. Based in Nairobi and global in scope, it works in some 35 African countries and has offices in twelve countries, including the United States. Winner of the Bill and Melinda Gates Award for Global Health and the Conrad Hilton Humanitarian Prize. www.amrefusa.org

But at the end of the week — in an event on Capitol Hill celebrating and promoting the frontline health worker — we heard another statistic that raised our spirits: Every 3 seconds a life is being saved by a frontline health worker.

But there are not nearly enough of them: One billion people will never have access to a health worker, according to Adam Taylor of World Vision, who moderated the event, and there is a global deficit of about 4.2 million workers.

Just imagine how many more lives could be saved if that gap could be closed.

That was the inspiration for the briefing, “Championing Health Workers: The Best Way to Improve Global Health and Save Lives for Less,” organized by IntraHealth and Save the Children in conjunction with the Congressional Global Health Caucus. 

The event was the precursor of an incipient movement whose vision is “that everyone has access to basic preventative and curative health care by skilled, supported and motivated frontline health workers — the Frontline Health Workers Coalition. Founding members include AMREF, CARE, Earth Institute, Family Care International, IntraHealth, Millennium Promise, ONE, Partners in Health, RESULTS, Save the Children, UN Foundation, White Ribbon Alliance and World Vision. 

The main goal of the Coalition — which will be launched formally before the end of the year — is to get the U.S. Global Health Initiative (GHI) to support an additional 250,000 new frontline health workers, and to better deploy, train and support existing workers where the need is greatest. Amie Batson, the assistant administrator for Global Health at the U.S. Agency for International Development, said that GHI already has an explicit mandate to “train and retain” 140,000 workers, leaving a gap of 110,000.

Mugara Joseph Mahungururo, a real life frontline health worker and midwife from Muhimbili National Hospital in Tanzania, was there to make the case.

“It’s so challenging to be a pregnant woman in my country,” she said. But she cited a variety of ways the U.S. government is already helping — by training midwives, educating pregnant women, providing voluntary HIV counseling and testing, providing bednets and eradicating malaria in Zanzibar, among other things.

“Keep on helping us [the health workers] protect pregnant women,” was her appeal to the U.S. Congress.

Ms. Batson gave examples of what the U.S. government is already doing to support health workers but she said the countries themselves are leading the way. In Afghanistan, the government has introduced a contract with girls to be trained in midwifery on the condition that they return to their villages and apply their new skills. In Ethiopia, the government has expanded the concept of health extension workers and task-shifting. And Rwanda is experimenting with performance-based financial incentives.

Maurice Middleberg, vice president for Global Policy at IntraHealth, said that although a revolution in service delivery has been equally responsible for improved health outcomes as better vaccines and technologies, too little progress has been made on increasing and supporting health workers. He called it a “failure of implementation.”

Mr. Middleberg outlined IntraHealth’s philosophy on frontline health workers: They should be “present, ready, connected and safe.” Achieving that, he said, is a shared responsibility, and more should be expected of developing country governments, the World Health Organization, the World Bank, the Global Fund and the GAVI Alliance.
Mary Beth Powers, campaign chief for Newborn and Child Survival at Save the Children, called on the Global Health Initiative to deliver three things:

•     A comprehensive and detailed workforce strategy.

•     Funding for 250,000 additional health workers, the U.S. commitment to address the shortage of at least 1 million health workers in the developing world.

•     Greater accountability on the training of the health workers with measurable indicators.

An audience member posed a crucial question: How do we make the case for more U.S. government investment in health workers in such an adverse budget environment? Ms. Batson said we need to go beyond citing the number of health workers trained and get to the real impact of those health workers: How many children’s lives were improved and saved as a result of those health workers?

After all, healthy mothers and children should be a bipartisan issue.

“Health workers are key to maternal and child health, and will be the focus of a lot of the attention and new money being pledged,” according to the PovertyMatters Blog funded by the Bill & Melinda Gates Foundation.

For more information about the Frontline Health Worker Coalition, call Betsy Kovacs, director of Communications and External Affairs, AMREF USA at (212) 768-2440 or Mary Beth Powers of Save the Children at (203) 221-4269.

>> Read about AMREF's programs which train health workers.

>> Learn more about the new coalition.

AMREF USA was also actively engaged throughout the week on our priority issues of drought and famine in the Horn of Africa, maternal health and frontline health workers.

Drought and Famine
On the first day, AMREF organized a panel discussion to call attention to the problem in the Horn of Africa and to identify ways of mitigating the effects of the drought and resulting famine now affecting three countries, including Kenya, where AMREF is based.

Twelve million people are affected by the worst drought in that region in 60 years, and the majority are women and children. According to Werner Schultink, the Director of Nutrition at UNICEF – 300,000 children are suffering from severe acute malnutrition and are likely to die at a very high rate and very very quickly. 

The discussion produced a number of important points, one of them being that drought is inevitable, but famine is not. Humanitarian responses, while absolutely necessary, do not substitute for long-term and sustainable solutions. And one of those solutions has to be investing in adequate training, motivation and retention of health workers.

Maternal Health and Frontline Health Workers
On the second day, AMREF USA participated in the Every Woman Every Child reception hosted by U.N. Secretary-General Ban Ki-Moon. One of the commitments several governments and corporations announced that evening was to close the gap in the shortage of health workers, especially in sub-Saharan Africa. The newly-formed Frontline Health Workers Coalition announced the commitment of ten large global health non-governmental organizations to closing the gap. 

Angela Nguku, a midwife, the AMREF regional manager of Maternal, Newborn and Child Health for East Africa and national coordinator of the White Ribbon Alliance for Kenya, spoke eloquently and passionately about the difficulty of working as a midwife without the resources to do her job.

On the third day, the Social Good Summit at the 92nd Street Y held a roundtable discussion on maternal mortality. The moderator reminded us that globally, 500,000 women still die in childbirth every year, while 215 million women want family planning services but don’t have access. 

One of the panelists was AMREF’s Angela Nguku, who talked both about progress made and challenges remaining. “We have blood donations,” she said, “but we don’t have blood banks, supplies and equipment” to perform blood transfusions safely.

What’s working in maternal health in Kenya? Angela said there is more and better media coverage of the problem, a necessary pre-requisite for securing the commitment to solve it. And there is increased use of e-learning to improve the skills of midwives. She cited the success of an AMREF e-learning initiative that seeks to upgrade the skills of the 22,000 nurses (16,000 already in process) in Kenya to registered level without them having to leave their communities.

“We don’t need more inaction,” she said. “We know what works and we have the tools to do the job. “ 

On Friday, the last day of U.N. Week, the scene shifted to Capitol Hill in Washington, where AMREF USA attended a briefing, “Championing Health Workers: The Best Way to Improve Global Health and Save Lives for Less.” 

AMREF is taking on frontline health workers as one of our major issues this year. Although a health worker saves a life every three seconds in the world, there are still not nearly enough of them. Globally, one billion people will never have access to a health worker, and there is a need for an estimated 4.2 million more health workers. 

AMREF USA is a founding member of the Frontline Health Workers Coalition, whose mission is that everyone should have access to basic preventative and curative health care by skilled, supported and motivated frontline health workers.  The main goal of the Coalition — which will be launched formally before the end of the year — is to get the U.S. Global Health Initiative to support an additional 250,000 new frontline health workers, and to better deploy, train and support existing workers where the need is greatest. 

So those were the main issues on which AMREF USA worked during our very busy U.N. Week. But this work is just beginning, and we hope we can count on your support as we move ahead in making this world a better, healthier and safer place for the millions of vulnerable people that we serve in Africa.

Monday, August 22, 2011
Kasese, Uganda



It is ten o’clock at night. Inside an examining room the X-rays go up on the light box, the patients are queried about their problems, a decision is made about whether they will be operated on tomorrow.


Outside in the hospital courtyard, some 90 men, women and children sit quietly waiting to see the visiting doctors from AMREF. It will be impossible to see all the sick tonight: the two surgeons have been in the operating theater all day,performing six urological surgeries. Six more are scheduled for tomorrow, and with the endless evaluations of the patients who keep on coming, a week of outreach may not enough to treat everyone. Patients have been camped out on the hospital grounds since Sunday anticipating the arrival of these specialists–they will be waiting tomorrow–and beyond, hoping to be seen.


Today we saw babies being born and a child taking perhaps his last shallow breaths, the elderly being treated for deep wounds, patients with leprosy. We are told by Dr. Robert  Oluput, head of the fistula repair program here, that last week he performed 30 operations, including that of a grandmother who had been injured delivering her 8th child–20 years ago.


We have just spent our first day within the compound of Kagando Mission Hospital in Kasese, Uganda, which rests at the base of the Rwenzori mountain range and serves a community of some 400,000 people–800,000 if you count the people who won’t go anywhere else.

Kagando currently has five doctors on staff. Another 120 nurses and a support staff of 116 care for more than 70,000 thousand patients a year. That’s an average of 50 patients per day per doctor. With support from the Anglican church, the Ugandan government and US and UK foundations, Kagando, originally a hospital for lepers, now sprawls across an enviable campus with twelve buildings. Add to that its nursing and midwives school, primary school and housing for staff, it’s a true medical center.


This part of Uganda is lush: while the people tend to live in the mountainside, they farm on the flatlands below, growing maize, cassava, coffee, nuts. An impressive resident elephant, meandering in the trees not far from the main road, was our welcoming committee of one. We are just minutes from the Congo border, having flown and driven nearly 700 miles from our headquarters in Nairobi, Kenya. 

The “we” includes Dr. Rodney Davis (far right), Professor of Urology at Vanderbilt University and a board member of AMREF USA. He has brought a surgery resident with him, Dr. Ekene Enemchukwu(center). Dr. John Wachira (far left), AMREF’s coordinator of clinical outreach–who flies to a different hospital on the continent every week–has arranged  for these American doctors to bring their expertise to this rural part of Africa. The mission is twofold: treat the patients and teach the local health staff of doctors, nurses, midwives and community health workers.


AMREF has done this outreach since 1957. It goes to our founding roots as The Flying Doctors: three surgeons including American Dr. Tom Rees, taught themselves how to fly to deliver services in remote parts of Africa. Last year we were in 150 hospitals in Ethiopia, Rwanda, Somalia, Southern Sudan, Tanzania, Uganda and Kenya, using our aircraft to deliver doctors from teaching hospitals around the world for weeklong assignments.


This time our team in Kasese has an additional mission. AMREF USA board member Christine Grogan is producing a film about our work, and so she has brought cameraman Rick Brandt, Endo Pharmaceuticals executive John Campell, and businessman Mike Desmond to add their expertise. All are AMREF volunteers.


This is the 8th outreach that Dr. Davis has taken in the last three years; Dr. Enemchukwu is the 4th resident he’s brought along at his own expense. His reaction after this first day: adjusting to the sheer numbers of patients. Because the Ugandan government and Kagando Hospital are underwriting this urology visit, the consultations and surgeries are free, unlike other country visits where patients must pay a small amount to their hospitals.  AMREF fully donates its contribution, including the flights.
The doctors here today have had to respond to the absence of  equipment  US hospitals take for granted: for instance, the lack of cauterization tools meant that Dr. Enemchukwu had to manually tie off every vessel; the power in the operating theater went out three times: Dr. Davis’s headband light was the only thing that allowed him to continue to work; even though they saw several children, they are not able to operate on them, because there are no tools small enough.

These are shortcomings of sheer funding needs. Father Benson Baguma, who runs Kagando Hospital, apologized to us in advance  for what we might see on our tour: mothers who have just delivered babies, lined up on the floor along corridors due to overcrowding; the power outtages in an antiquated and collapsing system; equipment that does not work because there are no trained technicians to make repairs. 


But what is accomplished here at Kagando is admirable: today four mothers delivered by C-section, saving their own lives and those of their babies; women ostracized because of fistula complications are on their way back into their families and communities; men diagnosed with prostate cancer were seen and advised.


For Dr. Enemchukwu this first day, she said, was “overwhelming.” She realized that despite the fact that people had traveled hundreds of kilometers to get here, they would most likely not get to see everyone. “We just have to do the best we can.”


A lesson, at Kagando, that we are all learning. 

Read more about AMREF's outreach work.

Twelve million people are affected by the worst drought in that region in 60 years, and the majority are women and children (3.5 million people in Kenya and half of those are children). By some estimates, 300,000 children are suffering from severe acute malnutrition and are likely to die at a very high rate and likely to die very very quickly.

In Kenya, I saw two very different areas — Turkana, in northwest Kenya, very rural with almost no access to clean water and virtually no infrastructure, and Kibera, a hyper-urbanized slum area in the middle of Nairobi. But the effects of the drought were equally devastating to families.  During the past six months, food prices have skyrocketed by 24% alone in the month of July and are beyond the means of most families to pay.

So AMREF organized this panel discussion to call attention to the problem and try to identify options to mitigate such unnecessary human suffering.

We were fortunate to have a distinguished panel and honored guests: Her Excellency Ida Odinga, wife of Kenya’s Prime Minister; the Honorable Amina Salum Ali, Ambassador from the African Union to the United States; Phillipe Lazzarini of the UN Office for the Coordination of Humanitarian Affairs; Elizabeth Lwanga of UN Women; and Werner Schultink of UNICEF. 

Several important points came out of the discussion:

There’s always a constant hum of activity at the AMREF USA offices but this week it’s up an octave. The entire AMREF team is keenly focused on planning meetings and activities around the United Nations General Assembly when Heads of State from around the globe gather in New York.  AMREF’s focus is on improving the health of African families.  We believe that health is a basic human right – and one of the key drivers to improved health services is closing the gap in number and quality of the frontline health workforce.  

AMREF USA will host a side event on the prevention of future drought-related famines in Africa. On top of that - AMREF’s been selected as a partner and community leader for “The Million Moms Challenge” that kicks of on ABC’s Good Morning America next Monday. More on that later. 

AMREF USA is leading the week off hosting a side event on Monday morning September 19 “Mitigate Effects of Recurring Droughts and Famines:  Invest in Health Development”.   I’ll be moderating this distinguished panel and talking about AMREF’s focus on long-term health development and how investment in health can help mitigate the effects of future droughts, lessening or even preventing future food crises. Her Excellency Ida Odinga, the wife of Kenya’s Prime Minister and the Honorable Amina Salum Ali, the Ambassador of the African Union to the United States are our special guests. Panelists include senior staff from UNICEF,UN Women, USAID and others. For the full listing of panelists and to rsvp to this event click here. Please come to hear what strategic investments the global health community and governments must make to lessen the often man-made effects of droughts – widespread hunger and infectious diseases. 

We’re pleased to participate in this year’s Every Woman Every Child event (a global strategy to improve women's and children's health and accelerate progress towards the Millennium Goals), hosted by UN Secretary General Ban Ki Moon.  AMREF’s own Angela Nguku, a midwife and head of AMREF’s Virtual Nursing School, is presenting at this high level event on the need for more frontline health workers. She will be one of two spokespeople for the new Frontline Health Workers Coalition of which AMREF is a founding member and serves on the Steering Group. Angela will describe how frontline health workers are the essential ingredient in meeting the Millennium Development Goals for health and ensuring that every person gets access to the medical care and preventive services they need to lead full and productive lives. 

Here are a few of the other meetings AMREF USA staff plan to attend: The High Level Meeting on Nutrition will address food and nutrition security.  At least 1 billion people globally are food insecure and as many are at risk of malnutrition. 

Another meeting focused on the essential contributions of frontline health workers to maternal health will be held by Family Care International and several partners: Maternal Health in Crisis: Health Workers on the Frontline. AMREF USA staff will participate to add our voice to those advocating for the need for increased numbers of health workers.

An overlooked issue – the health of adolescents who represent one-fifth of the global population- will be the focus at the Adolescent Health and an Opportunity for Action meeting.  On Thursday morning, I will attend the The First Ladies and Health Ministers Forum “Developing Your Action Plan for Women’s Health” involves stakeholders from government, business and civil society organizations advocating for women’s health.

I hope that highlighting some of these key meetings that AMREF will be participating in next week gives you a window into how AMREF is working to give voice to some of the most vulnerable people in Africa, women and children – and focusing on one of the key solutions to inadequate health services:   frontline health workers. 

Look for AMREF on ABC News over the next 100 days starting Monday! AMREF has been selected by ABC News Million Moms Challenge campaign for our exemplary work in maternal and child health. The project connects a million moms in the U.S. with moms overseas to bring global awareness and support for healthy pregnancy and childbirth. The program launches on September 19th on Good Morning America between 8:00 and 9:00 am, and will be the focus of an hour-long primetime special with Diane Sawyer in December. Look for AMREF USA Chairperson, Carol Jenkins and staff in the crowd outside the ABC studio on Monday morning. 

Please share these updates with your colleagues and friends and urge them to join AMREF in our efforts. 

Stay tuned next week for roundup reports on various meetings even if you can’t attend personally.

The air is thick with dust and it feels like we’ve been driving forever, but it’s probably been only about two hours since we left the area known as Kaikor, northwest of Kenya near the border with the Republic of South Sudan.  There are no roads, few people or animals and barely any vegetation.  It’s close to 100 degrees and it’s the middle of winter.
 
We’ve come to see AMREF’s emergency medical camp for people who’ve been suffering from the terrible drought in Napak in the Turkana region, the worst drought Africa has seen in 60 years.  There are about 25,000 people in the Napak region – and until AMREF established the medical camps, only one nurse to serve them.
   
The Turkana, are pastoralist nomads and the drought has reached crisis level for them. They’ve lost most of their livestock (cattle, goats and sheep), which is their main food staple as well as their livelihood.  
 
Even in the best of times, the Turkana have some of the highest maternal and child mortality rates in Kenya. During the drought, AMREF staff have seen the nutritional status of children under five and women worsen dramatically.  Rates of malnutrition and severe malnutrition have doubled since last year – to nearly 37% and 9% respectively.  

As we are driving to the camp our program manager, Eberhardt, tells me about the double-whammy – the pastoralists need pasture for the animals and they now have to walk for days to find pasture – but there aren’t water sources.  There’s an endless cycle of walking for them and their animals – causing further exhaustion and leading to more deaths of the animals, and ultimately more poverty and malnutrition for the pastoralist community.  One of the main interventions that AMREF will be implementing is rehabilitating older, non-working boreholes and building new ones, to provide clean and safe water supplies.
 
We finally arrive at the AMREF medical camp.  People travel hundreds of miles to come to these camps. Today, there are about 200 women, children and men - all patiently waiting to see a health worker.  Pregnant women are receiving pre-natal care.  A little boy about nine months old bursts into tears as he receives his measles vaccination.  According to the health worker, he suffers from malnutrition and so his mother is given food supplements for him.  Nearby an elderly man is being examined for trachoma – an eye infection caused by poor hygiene.  An AMREF health worker, Ali, tells me about the risk of cross-border infections as communities are on the move.  There’s been a recent outbreak of polio, which apparently originated in the Republic of South Sudan.

AMREF workers and volunteers work tirelessly to provide micronutrient-rich food to the weakest community members.  Workers are also screening and providing treatment for water-borne disease and giving demonstrations in basic hygiene.  Ensuring even basic hygiene under these conditions is essential to prevent the further increase in eye infections and the outbreak of diarrheal disease such as cholera.

Throughout the day I meet many people like Akiru – Akiru Akolom guesses she’s between 35-40 years old.  Before the drought, her husband had more than 200 goats, as well as sheep and cattle.  Now they have only 15 goats left.  A mother of six children, she’s been relying on emergency food distributions, which she says are irregular.  Her village is just too remote for most organizations to reach.  That’s why she is grateful for AMREF.  Her children have been treated for trachoma, for upper respiratory infections and for malaria. All are alive, still she worries about malnutrition.

AMREF is working to address the concerns of Akiru and the millions of others like her.  
We have ramped up our activities to mitigate the immediate and medium-term effects of the drought on ravaged communities.  As a first step towards determining a longer-term solution for the water shortage, we will commission a hydrological survey of the region.
 
It’s been difficult to make this trip and to really see the human toll of the drought and its attendant ill health.  Meeting the people whom AMREF has been working with, however, has reinforced my knowledge that AMREF is doing what we can to ameliorate the suffering - and we’re here for the long term to alleviate the effects of future droughts by providing access to clean, sustainable sources of water and basic medical care.

They accompanied AMREF’s Kenya Country Director, myself and our wonderful Kibera staff to see a project funded by the Centers for Disease Control and Prevention (CDC). The comprehensive HIV program, has been operated since 2003 by AMREF at the Kibera health center. The visitors wanted to understand how U.S. Government funds help to save lives and bring better health to African families.

Kibera is home to people from many ethnicities and they are among the most resilient and entrepreneurial people I’ve met. Kibera teems with small businesses selling hand-made furniture, hair-braiding services, mobile phone plans, music and fresh and cooked foods sold out of market stalls. What’s so amazing is that most people here live on less than $1.25 a day.

Since the famine and drought, the population has grown by 10,000 people who’ve come from rural areas in Kenya all looking for food and jobs – both in short supply in Kibera. Particularly for former pastoralists living off herds that graze the land, the drought has been disastrous. They face tough conditions settling and integrating into life in Kibera. They join a hyper-urbanized community that was already facing increasing food prices, over-crowded living conditions and poor sanitation.

With the exception of the perimeter, there are no paved roads in Kibera, only dirt footpaths. The pounding rains had flooded the paths and mud was everywhere. We found our way to the AMREF clinic where women children and men, the young and old, sat in rows waiting for medical care. Some were there for routine healthcare, others for their HIV anti-viral and TB medicines. Children were being vaccinated.

At the Kibera AMREF health center we heard that the number of patients seen at the clinc in the past few months has nearly doubled, to as many as 200 per day. We heard firsthand reports from the maternal & child health staff that they are seeing an increase in malnutrition in children. Malnutrition is dangerous as it makes children more susceptible to illnesses. At the AMREF clinic, every child is screened for malnutrition, no exceptions. AMREF, in collaboration with the Red Cross, is providing emergency nutrition & food aid to these families to prevent further damage and give them the nutrition they need to stay healthy and resist disease. Nearly 70% of the children are malnourished.

Rose, baby Mwemde, and Lisa

We talked with Rose, an AMREF community health worker, who was diagnosed as HIV positive in 2004 and has been taking her anti-viral medications provided by AMREF which are funded by United States government aid programs. She proudly told us about her toddler, Mwemde, born one and a half years ago HIV free thanks to her access to medication, and her understanding of how to prevent mother to child transmission of HIV. Rose shares her knowledge with members of the community – and encourages them to come to the Kibera clinic and be tested. She told us that she understands that she can live positively with HIV – and she can be healthy. She told us AMREF had saved her life. It’s very humbling to hear this – and it makes me even more determined to ensure that AMREF has the resources to continue and to expand our work.

Seeing people suffer is never easy. Still, meeting people like Rose – who has overcome some very difficult odds, and is hopeful for herself and her daughter – is very inspiring.

The delegation left Kibera proud of what Americans have made possible in this area of Kenya. I know I did.

>> To read more about our work in Kibera, please click here