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VECTOR

14 COVER

May 2012 - http://ghn.amsa.org.au/index.php/vector/ - vector@agh.amsa.org.au

in this issue

Vector OFFICIAL MAGAZINE OF THE

AMSA GLOBAL HEALTH COMMITTEE

Q&A WITH THE AMA PRESIDENT

Dr Steve Hambleton discusses refugee healthcare 4

DISCUSSION WITH DR JILL BENSON The day-to-day life of a migrant health worker 32

ALSO THE HAPPIEST REFUGEE / NSW REFUGEE SERVICE / MANDATORY DETENTION / MSF LETTER FROM THE FIELD / PHOTO STORY / WHO INTERNSHIP / GHG UPDATE / CODE GREEN / CROSSING BORDERS / GLOBAL HEALTH NEWS

S E EKING REF U G E The refugee & asylum seeker health issue

“Doctors can be very good advocates, because medicine is a respected profession...I think doctors should have a role in speaking up.” 16

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Australian General Practice Training

Looking for a rewarding career in general practice? For information on training opportunities visit www.agpt.com.au or talk to the GPSN Ambassador at health your university today! vector magazine amsa global committee page 2


Contents Editor’s Note Andrew Lees (University of Notre Dame Fremantle)

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Q&A with the AMA President Andrew Lees (University of Notre Dame Fremantle)

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Mandatory Detention in Australia: problems and alternatives Iain Law (Flinders University) and Prashanti Manchikanti (Monash University)

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The Heart of Darkness: A Snapshot of Displacement in Africa Carly Hayman (Flinders University)

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Words with Mitchell Smith Yu Shan Ting (University of New South Wales)

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Primary Prevention in Asylum Seeker Health Genna Verbeek (Monash University)

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AMSA Global Health Committee Update Bridget Williams (Monash University)

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State of the Nation AMSA Global Health Group Updates

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Code Green Week Kitty Soutar (University of Sydney)

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Crossing Borders for Health Rachael Purcell (Monash University)

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A discussion with Dr Benson about working in Refugee and Aboriginal Health Carly Hayman (Flinders University)

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Médecins Sans Frontières Letter Home from Central African Republic Eline Whist

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The Happiest Refugee Excerpt Anh Do

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World Health Organization (WHO) Internship Program Mikhaila Lazanyi

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Global Health in the News Yu Shan Ting (University of New South Wales)

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Editor’s note Mobility has become a defining characteristic of contemporary life. For many, this has meant increased opportunities to travel, engage with, and explore opportunities in places far from home. For others, those who have fallen between the fissures of globalization, a life uprooted and relocated with little prospect of return has had disruptive repercussions for their identity, economic engagement, and wellbeing. In this issue of Vector we explore the implications of Seeking Refuge upon the health of those individuals and families who have taken such a journey, the communities in which they embed, and the capacity of healthcare systems to adapt to their movement. In the Australian context, divisive debates over “who comes to this country and the circumstances in which they come” [1] have frequently overshadowed critical issues of health and welfare, not just for those detained on arrival, but for those who remain within the Australian community. As the United Nations High Commissioner for Refugees recently released report on Asylum Levels and Trends in Industrialised Countries

explains, where the proportion of those claiming asylum in industrialized countries between 2010 and 2011 increased by twenty percent, the number of asylum-seekers coming to Australia in the same period declined by nine percent from 13000 to 11800. [2] Distracted by such figures we often forget, as Dr Hambleton explains in his interview, that “a lot of these people end up being Australian citizens” anyway and consequently the “health impacts are really felt by everyone”. Articles in this issue range from the positive experiences of doctors working with new arrivals to the grim reality of mental health under mandatory detention. From further afield, we bring you stories of refugee camps in the Central African Republic, internships in Geneva, photography in Somalia, and a very personal journey from Vietnam by comedian Anh Do. Not to mention boatloads of updates from AMSA’s Global Health Committee, Global Health Groups nationally, Crossing Borders, DEA Code Green, and wave after wave of medical student contributions invading the beachhead of your mind. Enjoy!

Andrew Lees, Editor-in-Chief 1. Prime Minister John Howard’s Policy Speech, Election Campaign Launch 2001, available 10/04/2012, <http://www.australianpolitics.com/news/2001/01-10-28.shtml> 2. UNHCR 2012, Asylum Levels and Trends in Industrialized Countries: Statistical overview of applications lodged in Europe and selected non-European countries 2011, UNHCR, p.2, available 11/04/2012, <http://unhcr.org.au/unhcr/ images/2011%20Asylum%20Trends-FINAL_EMBARGOED.pdf>

Vector: The Official Student Publication of the AMSA Global Health Committee AGH Publicity Officer: Bridget Williams (Monash University) Editor-in-Chief: Andrew Lees (Notre Dame Fremantle) Co-Editors: Carly Hayman (Flinders University) and Yushan Ting (University of New South Wales) Design and Layout: Katherine Watson (University of Adelaide) IT Officer: Sugapriyan Ravichandran (Deakin University) Editorial enquiries: vector@agh.amsa.org.au AGH enquiries: publicity@agh.amsa.org.au For past issues of Vector and more information on the AGH visit www.ghn.amsa.org.au vector magazine

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Q&A with the AMA President The Australian Medical Association recently updated its Position Statement on the Health Care of Asylum Seekers and Refugees. The President of the AMA, Dr Steve Hambleton, spoke from Canberra with Andrew Lees, the Editor-in-Chief of Vector, on the direction of these amendments and the organisation’s thinking on refugee healthcare more generally. The issue of refugee and asylum seeker arrivals has been a political issue in Australia for many years. As future medical practitioners why should students care about this issue? It is a very important issue that we recognize already that students are very engaged with. We know that most of the people who are seeking asylum end up becoming Australian citizens, and we know the longer they stay in mandatory detention the worse their medical health gets, there is poor access to physical and mental health, and that impacts upon the Australian Health System ultimately. The Australian government has internal rules that target a maximum three month detention time, but we have got people who have been in there for over fifteen months, and we’ve got kids that were born in detention, we’ve got unaccompanied minors in detention, and as I say, a lot of these people end up being Australian citizens, and so those health impacts are really felt by everyone. You mentioned in your speech at the AMA Parliamentary Dinner in August 2011, which was about many things other than detention as well, but you also suggested that you considered mandatory detention to be “inherently harmful”, and that is the standard position of the AMA, and you have just mentioned some of the reasons why. What is it about mandatory detention that is inherently harmful, and what has the response been to those comments? The fact that people are already damaged, in terms of inherent harm, they’re already damaged. They have actually left their country of origin, they have actually struggled to get here, the thing about inherent harm are the uncertainties about what is going to happen to them, and the length of time people are there as part of that uncertainty, in that it seems to be forever. The other thing is that they’re exposed to other damaged individuals, you have got children exposed to that as well, you’ve got self-harm happening, you’ve got attempted suicide, a lot of stuff that we’re not hearing about that’s happening that we’re not getting access to.

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Given that the AMA is calling for a reconsideration of that approach on health grounds, what do you think the preferred approach would be from the AMA’s perspective?

There has been a lot of commentary around how the impact occurs for children. What do you think it is about the impact upon children specifically that is most concerning?

Look, I think we’ve got to talk about the health aspects. A lot of this stuff is in remote locations where there just isn’t access to medical care, so the remoteness is the first issue. If they weren’t so remote we would be able to get people in and out much better, we would be able to get better access to general practice services, better access to health assessments, and better access to psychiatric support. Part of the problem, I suppose, from the previous answer is the remoteness. We’ve got to recognize that this is a damaging environment and therefore we have got to actually provide people with access to proper medical care, that’s the point we are making the loudest. Politicians have got to decide the bigger issues, but we have to focus on health because that’s our role.

The children really are at great risk. They often witness psychological distress in adults so that the accompanied children see their parents being very distressed, they often see violence and self-harm. For the ones that are unaccompanied obviously the separation from their immediate family, but also separation from their extended family. There are opportunities and risks of sexual violence, particularly for unaccompanied children, and we don’t think unaccompanied children should be in detention in the first place. Now, sometimes the government will say they are not in detention they are in a different place, but it is still detention, it is just not the same place. An unaccompanied child, clearly they have got to come in, but a month is more than fair to give an opportunity for either identification of an adult relative, and if you can’t do that, then community centred care should be available. There is going to be ethnic groups that can actually look at providing a culturally appropriate support structure for these people, and we have really got to be compassionate about this.

The AMA recently updated its position statement on the Healthcare of Asylum Seekers and Refugees. How long has the AMA been following this issue in public health terms, and what recommendations and observations have you made? We have been looking at this for a number of years. Initially in 2004 and then 2006, and certainly before that we have been looking at issues about hunger strikers as far back as 1992, so I guess the AMA has been in this space for some time and the current numbers of asylum seekers really does focus the mind and that’s why the AMA chose to update this. In fact, they had finished the update before my commentary at the Press Club. I think the prolonged detention is really the issue that we have been talking about. It should be for the shortest practical time, and it is the indeterminate amounts of time that is so damaging.

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What has been the response from members of the AMA themselves to the approach of the AMA to this issue recently? Look, we have had very heartening levels of comment and support from AMA members, particularly from our psychiatrists and paediatricians. This is the one topic I would say where we have had more non-members congratulate the AMA for taking a stand than any other topic. Even more importantly, some of those people have said “give me the name of my local AMA I am going to join on the basis of what you are doing, I thought you were focused in other areas but I am really heartened to see the AMA is looking at some of these issues.” I must say, I was vice president for two years and I’ve been president for, how long is it, it feels like years now, and out of all that exposure at the executive level this is the topic that has given us more outside support than any other. Putting aside the question of mandatory

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detention, there is a much larger group of refugees who are already members of the Australian community and they use the health system on a regular basis. What are some of the barriers faced by those people that the AMA has identified and what recommendations have you made to address some of those issues? Well, obviously the health status of refugees coming from other cultures and other environments is that they are to exposed to different levels of infectious disease and the rates of malaria are significant, the rates of TB and that sort of long term chronic infectious disease. But, they’ve also often got mental health problems, often post-traumatic stress disorder, depression, and all the other medical and physical illness that you can imagine are spread through asylum seekers as well. But in particular, the ones I have mentioned are quite high. Now, the AMA was instrumental through the Medicare Benefits Consultative Committee (NBCC) in getting up a health assessment for asylum seekers and refugees, which is a Medicare rebate to spend extra time and get a comprehensive review of what their health status is. The other thing is that the immunization rates in our refugees who do settle in the country are very different to the local population, and we certainly go to great lengths to try and take a history about the immunization rates and bringing the children up to speed, and even the adults. Things as simple as tetanus and diphtheria, and whooping cough vaccines, are often absent in people who have come to this country in these circumstances. There are many areas within the health

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system that I am sure you can identify where there is need. Which needs do you think are the ones of greatest impact upon those refugees who are already within the community? We haven’t even spoken about the language barriers, the cultural barriers, and they’re real as well. If you said which one of the medical problems is the greatest, I think the mental health issues. It is easy to see the risk of TB, it is easy to see the risk of malaria, they’re fixable, they are hard, but they’re fixable. It is the mental health issues that are subliminal, that are a bit in the background, that are not easy to talk about, and that are subject to the cultural difficulties of communicating. These people are hurting in many cases and it is hard to get to that point, and get the confidence of people to actually be able to talk to you.

VECTOR would like to thank Dr. Hambleton for his time. The current version of the AMA Position Statement on the Healthcare of Asylum Seekers and Refugees can be found here: http://ama.com.au/asylum-seekers

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Mandatory Detention in Australia: problems and alternatives Iain Law (Flinders University) and Prashanti Manchikanti (Monash University)

“Everyone has the right to seek and to enjoy in other countries asylum from persecution” -Article 14 (1), Universal Declaration of Human Rights The United Nations’ 1951 Convention Relating to the Status of Refugees (the 1951 Convention) is the principal international treaty that establishes a framework for protection for refugees and asylum seekers. A critical insight of the 1951 Convention is the expectation that asylum seekers may need to contravene immigration laws of potential host states in their search for asylum and that they should not be punished on account of their illegal entry or presence. Australia is signatory to the 1951 Convention and has made a valuable contribution to the protection of refugees. However, continued mandatory detention for all asylum seekers arriving by boat stands in contrast to the obligation described above. Asylum seekers that arrive by air, usually on a travel or some other visa, are allowed to remain in the community while their claim for refugee status is evaluated. For those asylum seekers that may have no choice but to undertake the dangerous boat vector magazine

crossing from Indonesia and other nearby islands, what should be the end of a journey in search of freedom is instead prolonged, usually for 6-18 months [1], in one of Australia’s immigration detention facilities. Mandatory detention of asylum seekers is an entrenched component of immigration policy. This commitment to mandatory detention persists despite continued criticism by national and international organisations that mandatory detention violates the rights of asylum seekers established under the Universal Declaration of Human Rights and the 1951 Convention. Added to these criticisms is mounting evidence of the detrimental impacts of prolonged detention on detainee health, mental health in particular. [2] Furthermore, the cost of current detention and interception programs will exceed $800 million in the 2011/2012 financial year. This amounts to about $90,000 for every asylum seeker who comes to Australia. [3]

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The persistent criticism and human and financial costs of detention demand careful evaluation of the reasons for its continued inclusion. A variety of justifications resonate throughout the debate. These include the health and safety of Australian citizens and detention as a deterrent to asylum seekers and people smugglers. A principal justification for mandatory detention is concern for the health and safety of Australian citizens. This is a reasonable concern but only legitimizes detention of sufficient length to undergo health and security checks, but not the lengthy duration of application processing currently employed in Australia. Justification for prolonged detention focuses on its function as a deterrent: a) to ‘protect’ asylum seekers from undertaking the dangerous boat crossing to Australia that has tragically cost many asylum seekers their lives; b) to prevent Australia from being ‘overrun’ with refugees; or c) as a way to disrupt people smugglers operating in the region. Take the first two justifications for mandatory detention as a deterrent to asylum seekers. Proponents often cite trends in boat arrivals following the introduction by the Howard government of the “Pacific Solution”, which included mandatory detention. In the year following its introduction the number of boat arrivals did decline rapidly and fell to close to zero. However, not only did this drop in boat arrivals coincides with a major decrease in refugee numbers globally, but mandatory detention was only one component of the Pacific Solution and therefore the effectiveness of mandatory detention is impossible to isolate and evaluate. [3] Furthermore, interviews with asylum seekers reveal that they are usually unaware of the detention policy in a potential destination country; they tend to expect a period of detention as an inevitable part of the journey and therefore vector magazine

not avoid it; and rarely communicate with their origin country to discourage others from seeking asylum based on their treatment in detention. [3] This emphasizes the significance of the hostile and intolerant conditions experience by refugees in their country of origin over the challenges they must overcome in the search for safety and freedom. Although it may be reasonable to deter people from undertaking a journey that could cost them their life, the lack of evidence that mandatory detention is an effective deterrent suggest it is poor protection for future asylum seekers. The second justification suffers from another flawed assumption that immigration of refugees seeking asylum in Australia is excessive. In comparison to other countries, Australia receives and accepts very few applications for asylum. Refugees only comprise 1.04% of annual immigration to Australia. In a worldwide comparison conducted in 2010 Australia ranked 69th in terms of refugees hosted relative to population size, 70th in terms of refugees hosted relative to national wealth (GDP per capita), and 51st in terms of applications for asylum relative to population size. [4]

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To put these rankings into perspective, in 2009, top ranking industrialized nations, including Denmark, Sweden, Norway, Finland, and Iceland, which have a combined population approximate to Australia, received and processed 51,120 asylum claims. Australia received and processed 6,500. [3] Finally, mandatory detention is justified as a deterrent to people smugglers. However, if mandatory detention does not discourage refugees from seeking asylum in Australia, it is unlikely that it will have any affect on demand for boats. It is poor policy analysis to expect that punishing vulnerable asylum seekers will affect the operation of people smugglers. The evidence for mandatory detention is not sufficient to justify the inclusion of mandatory detention at least not in its current form. A recent report by the Centre for Policy Development (CPD) outlines a collection of policy reforms that would increase the effectiveness of Australian immigration policy and minimize the harms caused by detention. [3] The backbone of the CPD recommendations is implementation of risk-based detention across the entire detention system. It recommends detention sufficient to conduct mandatory health, identity, and security checks to protect the health and safety of Australian citizens. After clearance is granted asylum seekers would be allowed to live in the community while waiting for their application to be processed. Asylum seekers in this community based detention are free to move about the community, but remain administratively in detention. This is an attractive option considering that the necessary policies

â&#x20AC;&#x153;...policy must be rights based with the intention of treating asylum seekers with the dignity, respect and compassion they deserveâ&#x20AC;? and systems already exist. Risk-based detention already exists for asylum seekers that arrive by plane on a valid visa. Also, following pressure to remove minors from detention centers, more and more children and vulnerable families are being released into community detention following their health checks and community screens. All that is needed is for these programs to be scaled up to be applied to all boat arrivals. Other important recommendations of the report include scaling up of the annual refugee intake in an effort to bring Australiaâ&#x20AC;&#x2122;s contribution in line with similar countries and engaging with regional governments to better control people smuggling. Immigration policy remains a politically contentious issue. The way forward demands a careful evaluation of the evidence for mandatory detention, consideration of the substantial social and financial costs, and thorough consideration of alternatives. Crucially, policy must be rights based with the intention of treating asylum seekers with the dignity, respect, and compassion they deserve.

1. Department of Immigration and Citizenship. Immigration Detention Statistics Summary: 30 September 2011. Canberra: Commonwealth of Australia; 2011. 2. Green, J.P. and Eager K., The health of people in Australian immigration detention centres. Medical Journal of Australia, 2010, 192(2): p. 65-70. 3. Menadue, J., Keski-Nummi, A., Gauthier, K. A New Approach. Breaking the Stalemate on Refugees and Asylum Seekers. Sydney: Center for Policy Development; 2011. 4. Asylum Seeker Resource Centre. Australia vs the World. Melbourne: Asylum Seeker Resource Centre; 2011 [cited December 2011]. Available from: www.asrc.org.au/media/documents/how-we-compare-internationally_.pdf

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The Heart of Darkness:

A Snapshot of Displacement in Africa Carly Hayman (Flinders University)

The drought, hunger and insecurity in the Horn of Africa has caused the displacement of more than 900,000 Somalis who sought refuge and asylum in neighbouring countries.

Somali refugees assemble for relocation (UNHCR/B. Bannon/2011)

New refugees from Somalia wait outside the Dagahaley reception centre, vector magazine Dadaab, Kenya

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A mother cools her child with water as they wait in the heat outside the reception centre in Dagahely refugee camp, Kenya (UNHCR/B. Bannon/2011)

Children and elderly members of the community most often feel the impact of such humanitarian crises.

Health screening clinic in Dagahley With no family, a 70 year old Somali refugee who is refugee Kenya. blind relies on an elderly friend to care for her.13 vectorcamp, magazine amsa global health committee page (UNHCR/B. Bannon/2011) (UNHCR/B. Bannon/2011)


From droughts to floods, the United Nations stepped in to assist those displaced by the severe flooding that hit parts of southern Pakistan in 2011.

The family of these two sisters opted to stay in their flood-damaged home to tend to the livestock. (UNHRC/S. Phelps)

Women and children crowd into trucks destined for the relief camp in Sanghar district of Pakistanâ&#x20AC;&#x2122;s Sindh vector province magazine (UNHRC/S. Phelps)

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Kakuma Refugee settlement is located in the northwest region of Kenya and is populated by around 84, 000 refugees. Refugees who have been displaced by conflict seek the shelter, food, water and health services provided in this camp.

As more and more refugees arrive resources are stretched thin. The number of children who attend the school outweigh the number of available teachers meaning that classrooms are always overcrowded. (UNHCR 2011)

Tens of thousands of Somalis seek refuge in their capital Mogadishu after fleeing drought and famine. For the first time in 5 years, UNHCR were able to airlift in supplies to help aid with this humanitarian crisis. The UNHCR estimates that there are currently around half a million internally displaced people in the city. Entire families were forced to leave their homes due to the drought and settle in the Al Adala settlement. This Somali family tells how they had to leave their home because there was nothing left. (UNHCR / S. Modola)

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Children at the Al Adala settlement await the supplies of the airlifted aid. amsa global health committee (UNHCR / S. Modola)

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Words with Mitchell Smith

Yu Shan Ting (University of New South Wales)

Dr. Mitchell Smith, director of NSW Refugee Health Services, has been at the helm of this organisation since its inception, plays an influential role in refugee health and policy and has published widely on the

subject. He was also my supervisor during my public health term at NSW Refugee Health, so for this issue of Vector, I had a chat with him about his personal journey and views regarding refugee health in the past, present and future.

The NSW Refugee Service was founded in April 1999 as part of the NSW Department of Health’s strategy for Refugee Health and runs free clinics for refugees and asylum seekers. The service also plays an important role in health education and health professional training through administration of programs such as the Fairfield Refugee Nutrition Project and the Refugee Health in General Practice project. Tell us a bit about yourself and how you ended up working in Refugee Health?

What do you enjoy the most about being in refugee health?

I graduated from Sydney University, did some hospital work on graduation and then worked as a GP locum. After that I went overseas to do some travel – ended up working overseas in Pakistan where I worked with Afghan refugees and taught Afghan medics. Subsequently, I worked in Hong Kong with Medicins Sans Frontiers.

I like it because it’s based in social justice and largely preventive health. I find public health and prevention at the community level in a way, more useful than one-on-one healthcare. Refugee health entails mostly working with population groups rather than individuals. Of course, there are also clinical encounters. In addition, the variety in refugee health appeals to me too as it crosses over different disciplines – ranging from oral health to paediatrics, psychiatry and infectious disease, etc.

What made you decide to work in Pakistan? I guess I had the advice from a number of people to work overseas. I was also interested in travel, so I thought combining travel and work was ideal. I didn’t really plan to work with refugeesI feel almost as if the job picked me. I spoke English, so was recruited by MSF to work with Vietnamese refugees- they had refugee camps there in the early 90s. After that, I continued to work with MSF, coordinating health services in a number of refugee camps in Hong Kong. Eventually, I returned to Australia and did a Masters of Public Health (MIPH) at Sydney University – and have continued to work in public health and refugee health in Sydney since that time. vector magazine

How is it different from caring for patients in mainstream medical services? At NSW Refugee Health, the sorts of clinics we run are different because they are assessment clinics, different to hospital medicine and general practice. Doctors are funded so that they are able to spend longer time in consultations and have interpreters for as long as they like. It makes the interaction with refugee patients easier. Our nurses also have an advocacy role where they make sure patients receive the treatment they are entitled to from other services.

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You set up the NSW Refugee Health Service in the 90s. Did you meet with any significant difficulties then? What was refugee health like then, and how does it differ from now? Well, part of my job in public health was as a doctor in refugee screening. At the time the new service was funded and I got the job as director. The main difficulties were that we were starting from scratch and had to gain credibility as we were the first such service in Australia. We also had a limited budget. There weren’t that many people interested in refugee health then, not like how it is now, and in the early years it was difficult to recruit doctors. There is a lot more interest now in refugee health, with services all over the country that are similar to NSW Refugee Health, and I now have a network of colleagues in every state and territory in Australia. Has that made it a lot easier? A lot more support and sharing of information and discussion – it’s now a very significant issue and international interest means that I now also have contacts in Canada and the US. There are more policies and guidelines to improve refugee health and to help doctors work with refugees. Now the needs of refugees in terms of health care have become more widely recognized. This is in contrast to how 25 years ago refugee health used to be limited to mental health. The first services set up were formal counselling services whereas now there is recognition of a whole host of refugee health needs. What do you see as the most important issues in refugee health in your practice area (Sydney, greater Australia as a whole, even internationally) today? What are the main barriers to progress and how may we overcome them for better care delivery? The most important issues are equitable access to health services and health knowledge. Many refugees don’t have good health literacy – which is really people’s knowledge and understanding of health and what makes you healthy. In the context of Hepatitis B or influenza, if people don’t understand what a virus is – then it makes it harder for them to care for themselves and doctors to treat them. If people don’t believe that tap water is healthy and always drink bottled water it makes them miss out on chloride. If you are not able to address those beliefs, people will have continued reduced health knowledge. The other issue I mentioned was limited healthcare access. This is compounded by health knowledge and language barriers which mean that people can’t get access to health care- one of the important issues we aim to address in our health service. There are also a number of barriers to progress. I would say one of the large barriers is a lack of flexibility in the health system in Australia. The health system caters to English speaking individuals who are knowledgeable about the health system and fit into it. Additionally, lack of interpreters can be a barrier to access, for example, the refusal of GPs and other healthcare professionals to use interpreters. Some of these are big system issues that are very difficult to change, but hopefully better education of medical students and nurses, hospital administrators, and GP registrars can increase ongoing education, and cultural awareness can help to overcome some of these barriers.

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Many medical students and junior doctors are very interested in playing a part to better refugee health in Australia or overseas. Do you have any suggestions as to how we can help contribute in a way that would make a difference? I have made a list for all of you that are interested in this area.

The area of refugee health is often complicated by political agendas and external regulations, for example the recent ‘Malaysian solution’ instituted by the Gillard government. As a healthcare practitioner, what kind of role do you think doctors should play in this crossfire where the idea of better healthcare for refugees may conflict with political motives? Doctors can be very good advocates, because medicine is a respected profession. And particularly in terms of policies that are bad for health, then I think doctors should have a role in speaking up. So that’s one aspect of it. And there are organisations that doctors can be a part of, such as the Medical Association for the Prevention of War (MAPW). Groups like that make statements about asylum seeker issues, as does the AMA, or the Public Health Association of Australia. So you don’t think that doctors’ say are sometimes limited in these issues? Sometimes it can be limited, for example myself as a State Government employee, I can’t speak out. But there are others that can do so, such as some working in universities. But even if you can’t speak out, you can make a difference through participating in the discussion some of the groups above have to influence policy. I actually sit on a subgroup of the detention health advisory group, so through that I can have a voice in the matter through a formal channel. vector magazine

1. Be informed 2. Join relevant groups e.g. MAPW, Amnesty International, MSF 3. Advocate for patients, in other words take an interest in cross cultural healthcare and challenge your teachers, specialists, registrars if they don’t use interpreters when needed, or if they don’t show sensitivity to those of refugee backgrounds 4. Volunteer for organisations that help refugees and asylum seekers 5. Do clinical placements with refugee health services 6. Experience in Aboriginal health and experience with cross cultural health is especially useful if you want to work overseas 7. Do additional study e.g. have a public health masters, or MIPH and then there’s also relevant training courses at James Cook University in Queensland For those that have limited contact with refugee patients, if we are faced with a refugee patient in our everyday practice, what should be the issues running through our minds? 1. Communication – ask the patient if he/she needs an interpreter 2. Be aware of the context – how long have they been in the country? Is their presentation related to their context as a refugee or asylum seeker, or is it unrelated? This is important especially if you think there are psychosomatic elements to the presentation. 3. This should go without saying, and should be applied to all patients, but show respect and sensitivity. 4. Be aware that some people have been mistreated or even tortured overseas, so be wary of that before you start connecting up to a whole lot of machines – check with the patient that it’s alright.

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The Role of Primary Prevention in Asylum Seeker Health

Genna Verbeek (Monash University)

What is it that you value in life? Is it your friends, family, occupation, possessions? But, do you value freedom of speech, the vote, freedom of movement, the right to protest, access to Centrelink? Do you even think about it, or is this taken for granted? Having lived in a beautiful peaceful country such as our own, where democracy reigns and politics can be discussed freely publically and among friends, it is often difficult to understand life in a country without these privileges. Imagine being born during war time in Sri Lanka – a new Tamil citizen of the minority ethnic group. Your farming family treads on soil between the Sinhalese government forces and the rebel Tamil Tigers (LTTE). The government exterminates the minority whilst the LTTE fights for independence utilising suicide bombers, guerrilla warfare and violence. For your family, the civilians in the crossfire, you hope for food and water, for the sun to rise each morning, for the war to end, and for your family to be safe. There is limited access to education and as the national language is now Sinhala, it is difficult for you to continue. However, you are Tamil and the LTTE believe your family must join them or you are treated as the enemy and shot. You have heard that the LTTE is taking all young boys to build their army, as one of your friends was taken only after his mother and sisters were raped and his entire family shot in front of him, due to their resistance to his recruitment. You are most probably recruited, or if you are lucky, you escape. But, either way, throughout the early and developmental years of your life you are to experience violence, death, destruction, starvation and overwhelming fear which will remain etched in your mind even once the war has ended.

This is a common story for Sri Lankan asylum seekers currently in Immigration Detention Centres. They have arrived by boat or by plane, usually after a period of time spent in Malaysia or Indonesia before they risk travelling to Australia instead of joining ten million displaced people worldwide currently in United Nations refugee camps awaiting visas. On arrival in Australia, most Sri Lankan asylum seekers do not have to wait long before being granted refugee status; however some still wait beyond two years as the Australian Security Intelligence Organisation (ASIO) processes their claims. Currently, ASIO deems those who are Tamil asylum seekers to be ‘potential terrorists’ as there is a high likelihood they were recruited to fight with the LTTE, and therefore despite having refugee status, they remain in detention without a defined end date. When Australian soldiers returned home from the Vietnam War after being conscripted, some against their will, there were extremely high numbers wtih post traumatic stress disorder. [1] Eventually, the Australian public recognised the atrocities experienced by the soldiers and support was provided, particularly from a mental health viewpoint. This support is ongoing in the Australian Defence Force, even among those volunteering and training in defence. [2] In the case of the Sri Lankan men, it is people who have been recruited also against their will, the only difference being that they are fleeing their country and not returning post war. Rather than terrorism, it is perhaps the basic instinct of survival which was required in extenuating circumstances. People are arriving in Australia not only from Sri Lanka, but from Myanmar, Iran, Iraq and Afghanistan, among many other nationalities (Figure 1), all sharing similar stories of war, famine, minority extermination, and loss of basic human rights. They arrive with dreams and aspirations of a new life in Australia, full of promise, only to remain in detention facilities or on restrictive community visas.

“...do you value freedom of speech, the vote, freedom of movement, the right to protest, access to Centrelink? Do you even think about it, or is this taken for granted?” vector magazine

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People in Immigration Facilities and Alternative Places of Detention as of 31 October 2011 Adult

Children (<18 years)

Nationalities

Total Female

Male

Female

Male

14 134 11 2 8 44 3 8

1119 849 402 342 170 100 82 36 47 21 413 3581

4 43 7

109 69 4 32 11

Afghanistan Iran Sri Lanka Indonesia Iraq China, Peoples Republic of Pakistan Vietnam Burma Syria Other Total

48 272

3 1 19

9 86

7 27 1 1 23 284

1246 1095 424 376 192 144 93 90 48 22 493 4223

Figure 1: Nationalities of people currently in immigration detention facilities Accessed from Immigration Detention Statistics Summary - http://www.immi.gov.au/managingaustralias-borders/detention/_pdf/immigration-detention-statistics-20111031.pdf

If you arrived by boat or plane in a new country of boundless plains and a reputation for hospitality and multiculturalism, ready to leave the horrors of your earlier years behind you, why should you be forced to languish in detention facilities under lock and key? Why, after all you have experienced, do you wait for years in the community always with a fear of being sent home? Whilst you wait for months or years for news, what can you do? What can you think about? It is no wonder that mental health issues surface. Without a sense of purpose or a sense of belonging, with memories of horrendous experiences, and for some combined with a fear of being sent back to certain execution or torture, any person would be at extreme risk of mental health problems. This is where the medical system becomes involved from a secondary and tertiary prevention viewpoint, due to depression, post traumatic stress disorder, self harm, voluntary starvation and suicide attempts (Figure 2). Reported Medical and Mental Health Incidents in Detention Jul 2010 – June 2011 Deaths Psychiatric hospital admissions Voluntary starvation Injury requiring hospitalization Self harm attempts Self resulting in injury

6 93 1320 112 336 312

Reported Medical and Mental Health Incidents in Detention July 01 – Sep 30 2011 Deaths (25/10/2011) Actual self harm (not including starvation) Threatened self harm Attempted serious self harm

1 288 639 289

Cases of Mental Illness in Detention Diagnosed with mental illness Number on antipsychotic medication Psychologist consultations - Jul 01 2010 – Jun 30 2011 - Jul 01 2011 – Sep 15 2011

451 228 12062 3873

Pacific Solution 2001 – 2007 Number of asylum seekers sent to Naura and Manus Island Voluntarily returned (plus one death) Resettled to Australia Resettled to New Zealand Resettled (other)

1637 484 705 (61%) 401 (35%) 47 (4%)

Figure 2: Statistics, Asylum seekers and detention Accessed from Asylum Seekers Resource Centre - http://www.asrc.org.au/media/ documents/statistics___.pdf

vector magazine

What became of the people first applying for asylum, so hopeful for a life in a new and safe country? It is the detention facilities and the lack of answers which causes the deterioration. As medical practitioners, we learn that primary prevention is the most useful strategy for our patients in disease prevention. In an article published in The Age in October 2011, Sister Brigid Arthur (teacher and asylum seeker advocate) and Professor Louise Newman (psychiatrist and psychologist) agree that “mandatory detention has contributed in a direct way to a generation of asylum seekers in our country who are suffering from mental disorder” [3]. Therefore, in order to prevent long term health impacts in our asylum seeker population, support and appropriate services (such as the Asylum Seeker Resource Centre, Melbourne) are required, but particularly with reference to expediting claims and minimising time spent in mandatory detention. References: 1. O’Toole BL, Catts SV, Outram S, Pierse KR, Cockburn J. The physical and mental health of Australia Vietnam veterans 3 decades after the war and its relation to military service, combat, and post traumatic stress disorder. Am J Epidemiol. Aug 2009. 170(3):318-30.). 2. Mental Health Program, Australian Defence Force. Accessed at [http://www.defence.gov.au/health/DMH/idmh.htm] 3. Gordon, M. In Harm’s Way. The Age Newspaper, Oct 29, 2011. Accessed at [http://www.theage.com.au/ national/in-harms-way-20111028-1moif.html]

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AMSA Global Health Committee Update Bridget Williams (Monash University)

It has been a busy summer for the AMSA Global Health Committee. Since the last issue of Vector was released the 2011/2012 committee has been hard at work with campaigns, projects, policy updates and more to help to promote global health issues to you, the medical students of Australia. Here’s a brief rundown on what has been happening! Campaigns The campaign to bring medical education in line with changing ideas of 21st Century Professionalism continues. The aim is to ensure that all Australian medical graduates have the skills they need to be a doctor in our modern healthcare system. AMSA believes that this not only includes in-depth clinical knowledge and skills, but also an attitude of social accountability, a knowledge of systems, an ability to act as an advocate for health and a connection to healthcare around the globe. In addition to conversing with faculties to update medical school curricula, AMSA is preparing a series of FutureMed workshops. With an exciting array of high quality speakers, these two-day workshops will focus on the evolving roles of doctors, advanced advocacy training, and mechanisms for influencing curricula. As part of the Code Green campaign to promote action on climate change, AMSA collected your signatures to send a message to world leaders that Australian medical students are concerned about the effects of climate change on health and want action taken to make Australia’s healthcare system sustainable. Over 800 of you signed the petition which was presented to the office of Prime Minister Julia Gillard in time for the Commonwealth Heads of Government Meeting in Perth. Policy At the most recent AMSA council, a new policy on Refugee and Asylum Seeker Heath was passed by the AGH Committee. The policy

was formed as the result of a number of AMSA ThinkTanks which were held at universities around the country, including Deakin University, Flinders University, Monash University, University of Notre Dame, University of Western Australia and Sydney University. The policy recognizes that refugees and asylum seekers have poorer health than other Australians, and have less access to health services. This position statement helps to promote change in the treatment of refugees and asylum seekers, so that they can better access healthcare services and live healthier lives. The AGH committee is currently researching and writing a set of guidelines on overseas aid for medical students and student groups. It is hoped that these guidelines will help medical students to be involved in aid practices which are ethically sound. Projects In October 2011, the Crossing Borders for Health project went national. This project originated in the United Kingdom. It was first run in Australia by Monash University and aims to link medical students with refugees, educate about asylum seeker and refugee health, and advocate for improvements in access to healthcare for this group. To read more about this exciting project jump to page 31. The Red Party project had a hugely successful year in 2011. Twelve universities held Red Parties helping to raise awareness of HIV/AIDS and funds to help in the fight against AIDS. The University of WA’s party alone raised over $40,000!

To find out more about what the AGH Committee gets up to, make sure you subscribe to the AMSA mailing list (visit www.amsa.org.au) and tick the box for receiving AGH material. And be sure to visit our website and like us on Facebook as well! vector magazine

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State of the Nation

AMSA GHG Updates ASPIRE (University of New England) Maddie Gramlick

ASPIRE has had a very successful year, with more events and fundraising being possible due largely to the increased involvement from first year students. In 2011 we have raised approximately $3500 for the Burnet Institute, whose aim is “to achieve better health for poor and vulnerable communities in Australia and internationally through research, education and public health”. This amount was achieved through pancake days, BBQs and ASPIRE’s inaugural Red Party. Our first attempt at Red Party was quite a success! It was held in UNE’s bar, and was attended by students from UNE and members of the wider community. Over $3000 was raised through ticket and merchandise sales. Next year we are looking at having a Red Day to both promote Red Party and educate the public about HIV/AIDS. We also hosted our first ever 40 Hour Famine group, which comprised 25 students (both medical and other) and raised approximately $3500! ASPIRE is very excited to continue fundraising in 2012, and to build on the success of last year’s events. Our plans include BBQ and pancake days; ring top collection (used for prostheses in Thailand); an International Health night with guest speakers; 40 Hour Famine; and of course, Red Party!

EnSIGN (Australian National University) Cameron Maxwell

After being trained from the Laughter Doctor masters, Mickey Lee and David Brown, the young apprentices Shrikar Tummala and Cameron Maxwell had to take over. With many new clowns-in-training appearing after the success of the beginning of the year Laughter Doctors, medicine had to sit on the back burner for a week (here’s hoping cardiology isn’t that important). So we got out our juggling balls, coins, never-ending scarfs and decks of cards and began a hard week of training in preparation for the big performance. The whole event ended up being a huge success with the kids, clowns, families and staff having a blast. After the Laughter Doctors we thought we better get back to medicine, at least for a week or so until Red Party occurred. The event was held at Moosehead and it was a great night with around $6000 being raised for the Hope for Cambodian Children. Finally after partying and acting like clowns we stretched our intellectual might in the 2nd annual Med v Law debate. Medicine was represented by Morgan Sheridan, Nimeka Ramanayake and Michael Marginson. We debated the Bolam Standard and whether doctors should have full control over what the standard of care is. It was a hard fought battle with witty remarks from both sides, including our judge Professor David Hardman, but Law won the debate by a single point. All in all it has been a good couple of months with partying, clowning around and intellectual debate (and a sprinkle of medicine). vector magazine

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Global Health Awareness Western Sydney (University of Western Sydney) Abraar Abdul Gafoor

GHAWS began its year by completing its handover to the newly elected 2012 Executive, as well as making a general plan of the upcoming year’s events. • Continue long-term projects from last year, including Auction Night and Birthing Kit Assembly, High School Mentoring Program, Autism Social Groups, Red Party and awareness for Refugee and Asylum Seeker Health. • Develop and implement new projects such as Teddy bear Picnic Day and a long-term Vaccination Project and Awareness campaign.

Ignite (Monash University) Manognya Kamisetty

Over the past four months, Monash University’s Global Health Group ‘Ignite’ has run more than ten events, activities and initiatives. Overall it has been an extremely successful year, raising approximately $7000 for charity. Below is a summary of each of the notable activities Ignite has planned and successfully executed since August. • The ‘Not-So-Trivial’ Night: This event was a preclinical run trivia night which raised funds for the Global Alliance of Vaccines and Immunisations (GAVI) to vaccinate an entire village. The theme for the night was ‘Climate Change and Health’. It was an extremely entertaining night for all, and the total amount that was raised for the GAVI was $2570. • Child Health Now Event: This was an incredible forum held by Vision Generation and Ignite which supported World Vision’s first international advocacy campaign Child Health Now. It was based around MDGs 4 and 5, detailed on how best to achieve these MDGs by 2015. The panel for the evening consisted of Reverend Tim Costello – The CEO of World Vision Australia, Sue England – A consultant midwife with 20 years of midwifery experience, Dr Chris Morgan – A Principal Fellow at the Burnet Institute’s Centre for International Health, Dr Alison Morgan – Who has 20 years of experience in education and training in maternal and child health, Rami Subhi – from the school of Paediatrics at the Royal Children’s Hospital, and Meg Howe – A registered nurse who is working as a community health promoter. It was an extremely valuable and insightful evening. • The Global Health Take Action Seminar was themed ‘Access to Essential Medicines’, and included three speakers and interactive activities for all attendees. All funds went to the GAVI. • The Kolkata Village Project was presented to all medical students by the unforgettable Dr Sujit Kumar Brahmochary, the founder and director of the Institute for Indian Mother and Child (IIMC). He presented his project, which is dedicated to providing free medical care, health promotion, primary education, vocational training, integrated rural developmental projects and economic empowerment to the people of the South 24 Parganas district in West Bengal, India. • Ignite MSF Speaker Evening: Another wonderful evening giving insight into the work done by Medecins Sans Frontiers. Dr Mohamed-Ali Trand gave an informative talk which inspired many. • Experience From The Inside & Practical Approach and Insight Into Refugee Healthcare: Eyeopening seminars on refugee and asylum seeker health issues run by Ignite’s ‘Crossing Borders’. • Crossing Borders National Launch: Crossing Borders IS NOW a NATIONAL INITIATIVE! • Med Revue: An outstanding performance put together by medical students each year, this year raising $2150 for Ignite’s subgroup Friends4Fiji. • Birthing Kits Packing Events: Run at all Monash University teaching hospitals including Southern Health, Eastern Health and The Alfred, these were sent to where they are needed most – countries where maternal mortality due to preventable causes is most prevalent. • Annual Dinner and AGM: A brilliant way to conclude a brilliant and successful year for Ignite. vector magazine

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IMPACT (University of Tasmania) Ginita Oberoi

Fresh from hosting the 2010 GHC, Tasmanian medical students were passionate about global health in 2011. Our members received all IMPACT events with enthusiasm whether it was an educational forum or a social event. The year began as all university years should- with free food. IMPACT provided our famous bright pink, hand spun, fairy floss for students in Orientation Week to encourage memberships and to introduce ourselves to the new lot of Medlets. Students, once caught in our fairy floss web, were offered many programs and events - including those that were a part of IMPACT’s new project, IMPACT aware aiming to have regular speakers, documentary viewings and forums based around awareness of global health issues. This year we had a speaker from the Global Poverty Project, an information night about medical electives, a screening of the acclaimed documentary Frontline’s ‘The Age of AIDS’ as well as a Japanese movie night to raise funds for the devastating earthquakes and tsunami that shook Japan in March 2011. As well as this IMPACTers partook in their fair share of fun and games with our social calendar proving to be both a great way to raise funds and awareness about global health and also universally appreciated by students as a great respite from stress and study. In 2011 IMPACT launched ‘Quiz for a Cause’, raising over $1800 for the Sudan Medical relief project. The event was immensely popular and IMPACT is hoping to make it a regular. Our annual Bollywood night, supporting the Sevalaya Orphanage in South India again was enjoyed by all, raising over $3000. And finally our 4th annual Red Party was a resounding success. As we danced throughout a chilly Tasmanian September night we managed to raise over $3700 for Oxfam HIV/AIDS programs.

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INSIGHT (University of Adelaide) Rebecca Zhao

During the final few months of 2011, Insight showed no signs of slowing down, continuing to host various events. Kicking off in August was our invariably popular Quiz and Talent Night with over 300 attendees, showcasing our brightest students and most talented actors and musicians. Additional focus questions on maternal health were included this year, culminating in both an educational and laughter-filled night. “E2I - Educate Empower Inspire” - Insight’s Global Health Workshop displayed record attendance this year. Mirroring a local mini-Global Health Conference, the event aims to equip students with knowledge and practical skills to make a difference and foster local interest in global health. Leading guest speakers imparted knowledge on key topics such as Indigenous Health, Advocacy and Elective Ethics, with the seminar ending in a heated panel discussion on Climate Change and Health. Commonly encountered medical cases in developing world health were also discussed, including obstetrics cases, trauma management in low resource settings and infectious disease in tropical medicine. Of course, the day would not have been complete without an impressive International dessert buffet! Our Amazing Raise is always a fun, energy-filled event where teams of four race around Adelaide solving clues and tasks to be the first team over the line. This event raises much-needed funds for the Cambodia World Family Aid Project, supplying dental equipment for Cambodian orphans and disabled children. To cap off a brilliant year, Insight hosted a successful Development Fund Dinner raising over $3000 for our Development Fund to support students on their overseas electives. The night featured a delicious 3-course dinner, silent and live auctions, live Indonesian dance performances and an enlightening address from Medicins Sans Frontieres’ Dr Kamalini Lokuge.

Interhealth (University of Western Australia) Daniel Dorevitch and Stephen Paull

After a relaxed summer and a changing of the guard in most committee positions Interhealth has bounced back, and 2012 is looking to be our biggest year yet! Crossing Borders is Interhealth’s newest initiative and aims to remove barriers to healthcare for refugees, asylum seekers, and undocumented migrants. We will be running Q&A sessions, panel talks and other educational components, and we are hoping to also set up a hands-on buddy system where students meet regularly with asylum seekers/refugees and provide care, advice, and companionship. Other than some shiny new projects, we also have all our old favourites returning for 2012. Red Party (proudly WA created) will undoubtedly be bigger than ever, and Teddy Bear Hospital will be kicking off the year with its annual training day on the 4th March. LINCS (our Local and International Needs Contribution Scheme) continues to provide students going on their electives with muchneeded medical supplies for the institutions they will be working at, and our first ZONTA Birthing Kits extravaganza (where sterile birthing kits that we fundraise for and assemble are sent to assist African mothers with a safer and more sterile birthing process) looks to be coming up in April. Although there are so many other things we could mention, we’ll close with how excited we are for the FutureMed conference – aiming to develop 21st Century medical professionalism in our students and shift current educational paradigms.

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Supporting All Nations Towards Equality (James Cook University) Andrew Dawson-Smith

Supporting All Nations Towards Equality (SANTE), named after the French word for health, was founded in 2006 by medical student Riley Savage, who is now a resident at Townsville Hospital. The group has grown both in numbers and influence, with ‘Red Party’ and ‘Run to the Water’ forming the backbone of our events calendar. Funds raised from ‘Run to the Water’ this year will be donated to Water for Ghana, a charity founded by 4th year medical student Nicole Buttner. With numerous academic and social events planned in 2012, as well as Cairns GHC, SANTE and JCU’s extended global health network are in for a busy but memorable year.

Towards International Medical Equality (University of Queensland) Katherine Wyld

Towards International Medical Equality (TIME) is a not-for-profit organisation that is committed to the promotion and establishment of equitable health care at home and abroad. TIME was established in 2005 by a group of medical students at the University of Queensland (UQ) who saw an opportunity to incorporate global health outreach into their elective experiences. From this idea, an organisation dedicated to equitable health care grew. In partnership with a number of professional organisations both in Australia and developing communities, we run projects in Medical Aid, Refugee Health, Rural and Indigenous Health, Maternal Health and Environmental Health. We are also active in advocacy and education on issues in global health, and run a number of fundraising events throughout the course of the year. Students and alumni from all backgrounds, degrees and year levels are welcome to be involved.

Wake Up! (University of Newcastle) James Lawler

2011 saw “Wake Up!” move from strength to strength. First years got their first taste of Global Health at the annual Challenge Day, but we really started off the year with our Birthing Kit Night, where we assembled 1000 birthing kits to be distributed in Kabul, Afghanistan. Fourth year students, who had just completed their Health Equity Selective in different areas around the world, gave a great response to our Photo Competition, with a wide array of photos of high quality displayed through the corridors of the John Hunter Hospital. Red Week also went off, with stalls and events around the university raising awareness for HIV/AIDS. We also managed to raise over $4000 for the African AIDS Foundation. On top of these events, some new projects set the tone for the year. “Wake Up!” ran its first Global Health Shortcourse. For the first time, students were able to tap into the wealth of knowledge which exists within health professionals around the Hunter. The 3-week seminar covered a wide array of topics on Global Health, and students from all faculties and degrees around the university attended. The university community got so passionate that a local food vendor donated food for every student who attended each session. “Wake Up!’s” Library Aid Project was also in full swing. At the time of writing, nearly 450 medical textbooks are on their way to the Patan Academy of Health Sciences, Nepal. We were also lucky enough to meet two students, Anjit and Neeti, from PAHS and hear their description of the Nepalese health system and their university. We also raised money through our annual Fun Run and Jazz in the Park, which will ensure the future activities of the Library Aid Project become even stronger. vector magazine

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Vision MSAND (University of Notre Dame, Fremantle) Jasmine O’Neill and Nick Baillieu

In 2011 we held our first event as a Global Health Group at Notre Dame Fremantle. We endeavored to find a warm spring night to hold an outdoor airing of “A Walk to Beautiful” to raise awareness of the atrocities and hardship of obstetric fistula, but alas we were forced inside due to poor weather conditions. We began the night with a feast of barbecued South African sausages (plus a hearty vegan substitute) and corn cobs in their husks, accompanied with salad and couscous before we ventured inside to escape the wind. The amazing and truly inspiring Margaret Lobo AM, Past President of Soroptimist International who was last year honoured in the Queen’s Birthday Honours and made a Member of the Order of Australia for services as an advocate and promoter of Human Rights and Health of Women, spoke to of her experience visiting the Hamlin Fistula clinic in Addis Ababa during 2009. She told of her project to provide hope, help, love and life to those few young women who were unable to be cured of the condition that otherwise shunned them to the darkest corners of society. This was followed by the screening of Mary Olive’s “A Walk to Beautiful” which follows the story of five women in Ethiopia suffering from fistulas and on their journey to the fistula hospital in Addis Ababa where they find solace for the first time in years, enabling their lives begin to change. The new lease of life afforded to these brave women casts a bright light upon the powerful potential that we fervent, budding doctors possess. Potential that can be harnessed to procure such an immeasurable difference to life those less fortunate parts of our planet. To find out more visit www.hamlinfistula.org.au/ and soroptimistinternational.org/.

us

in www.

With Octobers Commonwealth Heads Of Government Meeting (CHOGM) being held in Perth we supported the End of Polio campaign. Ambassadors flash mobbed in Perth CBD and Fremantle CBD before gaining signatories on the petition for the End of Polio, and raised awareness of further initiatives at the End of Polio Concert. The petition called on World Leaders to support and fully fund the critical work of the Global Polio Eradication Initiative. An initiative that provides vaccines for hundreds of millions of the worlds poorest children and supports health workers, in hope of protecting future generations from debilitating disease. During the concert Prime Minister Julia Gillard pledged that the Australian Government would contribute $50 million to global polio eradication efforts. The following day, 5 world leaders and Bill Gates pledged a further $118 million, in addition leaders of Nigeria and Pakistan committed to addressing the spread of Polio in their communities – Monumental feats through local advocacy. To find out more visit www.theendofpolio.com/home/category/blog/ and www.facebook.com/theendofpolio.

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DEA Students bring you...

CODE GREEN WEEK 2011 with Kitty Soutar (University of Sydney)

Australia’s future doctors are informing themselves, their colleagues and the wider world about climate change and health. 2011 has been a big year for DEA. Our successful national conference in Sydney in April was followed up by a strong presence at GHC 2011. The first week in August saw the most broad reaching and comprehensive DEA activity of 2011, which was Code Green Week. The Code Green campaign was born at the inaugural iDEA conference in Melbourne 2009, and now co-ordinates most of DEA’s student activities. This year, for the first time the campaign created a focused week of activities, combining our efforts for a big week of action with events across Australia. In my state of NSW, the week’s events were kicked off with DEA attendance at a public meeting about proposed Coal Seam Gas bores to be introduced in Sydney. DEA member Dr Helen Redmond spoke as a panel member at the meeting and the next day was quoted on the front page of the Sydney Morning Herald. Tuesday continued the highly topical Coal Seam Gas theme with a screening of the film Gaslands at the University of Sydney, while on Wednesday there was a great turnout at a Grand Rounds hosted by UNSW, presented by DEA member Dr Ben Ticehurst and Greenpeace CEO Dr Linda Selvey. On Thursday, the University of Notre Dame hosted a letter writing workshop. The highlight of the week was a bush regeneration session organised for the Saturday of the campaign. In Sydney’s Inner West more than 30 students turned out on a beautiful morning to help regenerate a corridor of native bushland. This event was especially exciting because it was attended by the local Mayor of Leichhardt as well as the local Greens MP Jamie Parker. Mr Parker was so impressed by the student’s efforts that he acknowledged the event in a subsequent speech to NSW parliament. He spoke at length to his fellow parliamentarians about the importance of health and climate and acknowledged the work of DEA and its students members in bringing this issue to the public’s attention. How rewarding to have our message taken straight to parliament – a big congrats to the events organisers, and a big win for DEA students in NSW! Tree planting events were not limited to NSW, with events in Victoria, South Australia, Tasmania and Western Australia resulting in over 100 trees and shrubs being planted. Tassie students hosted a low carbon lunch and at Monash Uni a trivia night had a huge turn out. Members from Deakin University met with their federal member Darren Cheeseman. Letter writing, grand rounds, advocacy workshops and many other events were also held. DEA students continue to inspire and mobilise their fellow students to raise their voices and get active about climate change, the biggest global health issue of our time. More and more Aussie students are realising the importance of our environment to their future practice – and realising that as doctors and community leaders, we can make an important contribution to shaping the future. It has been great to watch DEA students grow. If you’d like to find out more, check out www.dea.org.au vector magazine

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an update on

Crossing Borders for Health with Rachael Purcell (Monash University) 2011 has seen an exciting start for Crossing Borders for Health in Australia. Crossing Borders is a student group which

aims to decrease barriers of access to health care for refugees and asylum seekers. Currently in seven

countries, the Australian Crossing Borders Branch began at Monash University this year. Crossing Borders has three focus areas: • Education • Direct Assistance • Advocacy An education series involving seminars and tutorials focusing on refugee and asylum seeker health has been popular with students across Victoria and has seen students from Deakin and Melbourne Universities become involved. Sessions have also been streamed to Rural Clinical Sites which has been an exciting way of involving rural students who would otherwise have been unable to attend. In the Direct Assistance program a partnership with the Edmund Rice Asylum Seeker Resource Centre (ERASRC) has been established, and students are involved in a buddy program where students and asylum seekers meet at the centre on a Sunday afternoon to socialize. The aim of the program is to create a further support network for asylum seekers who may be isolated within the community. Crossing Borders would like to thank the ERASRC for their support this year and for enabling us to join their fantastic initiative. vector magazine

In conjunction with members from the ERASRC and the Amnesty International Group from RMIT Crossing Borders students have also been visiting Maribrynong Immigration Detention Centre (MIDC). MIDC has been both a wonderful and a difficult experience. Often on a weekend a group of twenty volunteers and asylum seekers would join together and share food, play card games and laugh at each others attempts to communicate in a mixture of English and exaggerated hand gestures. Despite difficult circumstances, the people we have met at MIDC have been welcoming and understanding of our often limited knowledge of where they have come from and what they have experienced. Sometimes visits to MIDC have been difficult. Sharing a person’s story with them and learning about their experiences in what were often horrifying situations incomprehensible when compared to our life here in Australia, is a privilege. Furthermore, understanding how to cope with these stories, both personally and in how you respond to the person who owns it is often challenging. The Advocacy focus has been coming together with the support of the AGH and AMSA. ThinkTanks across Australia have written a policy on Refugee and Asylum Seeker Health which at the October 2011 Council was adopted by AMSA. This has been an exciting step in engaging students across the nation. Crossing Borders held a National Launch in October in Melbourne. The night was a great success with students from multiple universities in attendance to hear from two inspiring speakers. Congratulations to those who attended the night and whose efforts raised funding for the Asylum Seeker Resource Centre to feed a family for two months. If you would like to become involved in Crossing Borders in Victoria or support in starting a branch at your university, please contact us at: crossingborders@ignitehealth.org.au.

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A discussion with Dr Benson about working in Refugee and Aboriginal Health Carly Hayman (Flinders University)

Dr Jill Benson worked as a general practitioner for 30

years before circumstances changed and she considered a

11 years she has dedicated her practice to working in refugee and Indigenous health. Dr Benson is currently the Senior Medical Officer at the Migrant Health Service change in the direction of her career. For the last

in Adelaide, a state government funded service that provides health care to refugees and supports healthcare workers. In discussing her career and recent work, Dr Benson tells me

“I feel as though I have arrived at my future”.

What motivated you to start working in Refugee and Aboriginal Health? I’ve had a privileged life. I was lucky enough to be born into a loving family, go to school in Australia and study to become a doctor. I think there are lots of people who, through no fault of their own, were born in places without such privileges available to them. I feel a responsibility to share my privileges with others. Can you share with me a normal day for you at the Migrant Health Service? At the clinic I have an administrative role and I see patients here in the clinic. In my administrative role I organise meetings, I do advocacy, I write protocols, I do research, and I support the doctors here. For example, if there is a question like “Should we being doing lead levels on people under 13?” I’ll go and look at the literature, I’ll look at what the rest of the refugee services are doing around the country, I’ll ring IMVS and I’ll write up the protocol. I can then share these protocols with national networks such as the Refugee Health Networks of Australia. I also spend some of my time working at the clinics run here at the Migrant Health Service. We run two different sorts of clinic: the New Arrival Clinic and the Follow-Up Clinic. The New Arrival Clinic is run by the nurses for newly arrived refugees who have a series of blood, urine and stool tests done. When the vector magazine

results come back, the patients are booked in to see the GPs here. This is usually done within the first month of arrival in Australia. So for those people who have come from a developing country or refugee camp, they come with a huge variety of unpronounceable worms, infectious diseases and are more likely to have nutritional deficiencies. They are things that you just don’t see here in Australia. On top of all that you have to look at the mental health issues because part of coming here as a refugee is about being afraid for your life, afraid for your family’s well-being, and dealing with experiences of torture and trauma. You have to look at the enormous social issues from their past as well as the difficulties of settling here. At the Follow-Up Clinic we see people who need to be reviewed and discuss with them chronic diseases because for a lot of people we see chronic disease is not a health priority. They present with diabetes, heart problems and hypertension that has never been treated, so we need to get on top of that. The nurses here also run a huge variety of other clinics including immunisation, women’s health, and transition clinics, as well as drop-in services. Part of the team here also includes a counselling group and health workers from Bhutanese, Middle Eastern and African backgrounds.

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What are the most rewarding aspects of your work with refugees? You have the opportunity to meet people that you would never meet in your regular life. You witness the amazing resilience, courage, loyalty and spirituality of people. I find there is something very special about being able to relate to people from such enormously different backgrounds. It’s amazing that you can sit with someone who has never been to school, speaks some remote language, has never seen a toothbrush and yet you can laugh at the same jokes. Can you tell me what you think are the biggest challenges working in this area? Social issues, particularly housing. There just aren’t enough houses and people are crowded into really small houses. There are also a lot of difficulties with transitioning into a completely different culture. People often feel a lack of support, especially when they have come from societies where lots of extended family are around and now they are here having their baby by themselves. This type of work is hard. You have to make sure you don’t push yourself beyond what you are capable of and you have to protect yourself from burnout.

Obviously language is a big challenge. The language barriers mean it’s difficult to go shopping, to use transport, to go to school. Finances also cause problems. Some people who come here are really poor and they are paying off however they got here. Meanwhile the family that is left behind have an expectation that now they are in Australia, they are rich and should be sending money home. Often people do send money home and leave themselves short. How do you overcome some of the differences in the cultural expectations of medicine and health services? With time and patience. It’s really important to try and assess what it is that the patient believes is happening. You need to ask them a series of questions: what they think is happening to them, what they think has caused it, what they think will help them get better, how they know that they will be better. It’s important to recognise that people come from different cultures where spiritual and traditional ways of interpreting symptoms are the only ways, particularly for chronic diseases and mental health. I know that if they think the illness is spiritual I can give the very best evidence based medication but it’s not going to do anything. It takes a lot of health promotion, patience, diagrams and explanations.

What are some of the barriers for refugees in accessing healthcare services and resettling in Australia?

How has your work impacted on you personally and professionally?

Here at the centre, everyone has a half hour appointment and a face to face interpreter. Often people aren’t used to appointments and we have the option here of being a bit more flexible, where as in regular general practice that’s too hard for a lot of people.

I love infectious diseases. I know that’s weird but I really do love it. It’s a really nice thing to be able to cure something in medicine. You feel like you are doing something really useful, and you really feel as though you are giving them a hand up. Both professionally and personally that is a real joy.

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Professionally it’s made me learn a lot more things. You have to learn to understand the bigger picture of people’s health that includes their social and spiritual health, so you are no longer just focusing on their physical health. Personally this kind of work is very challenging and exhausting, but I find it fulfilling. What skills do you think are required to work effectively cross-culturally? When I started working in refugee and Aboriginal health I realised that my medical degree hadn’t really equipped me very well. It was very focused on western medicine and it was evidence base, and it just looked at physical diseases. So I decided to do a masters of public health and studied infectious diseases which helped to broaden my horizons. Working overseas in developing countries also helped as I became familiar with the environment and can now pronounce all the different worms. There wasn’t a lot out there to really help me. I found it was something you had to learn on the job and like anything, you learn from your mistakes. I don’t think I could have every learnt it all by myself either. I learnt a lot of it in the context of people I saw as my mentors, whether they were my professional colleagues or my patients. The skills are not the skills you would expect. They are things like patience, flexibility, and the ability to swallow your pride and say “I don’t know what I’m doing”. You need to be aware that there are no absolutes and have an awareness of your own cultural beliefs of what you believe to be normal and good. You really need to spend time listening to those cultural differences. You also have to recognise that Western evidence-based medicine isn’t necessarily able to be extrapolated to people from non-Western environments with different standards of living. For refugee patient who come from ethnicities vector magazine

that have never had research done on them, we just don’t know what is going to happen. I think the other important skill to recognise is the need to look after yourself because working in refugee and Aboriginal health can easily lead to burnout. You said that you had to do a lot of learning on the job. Can you think of a time where you just got it so wrong? When I first started I was used to quick medicine. When a woman comes in with nausea, a bit of vomiting in the morning and their period is late, you know you say “do you think you are pregnant?” The patient did not speak to me for the rest of the consultation. After she left, I called the interpreter back in and said “I did something wrong didn’t I?” And the interpreter said “Yes, you just asked her straight out like that, are you pregnant? It’s a really personal thing. They have to know that they can trust you, and that there is a relationship happening.” So you really have to ask them about themselves, ask them about their families, and where they’ve been. From that situation, I learnt the hard way that you really need to develop a relationship with your patient otherwise they probably won’t listen to what you have to say and won’t take your medication. What advice do you have for medical students who might be interested in pursuing a path in refugee health? Becoming passionate about refugee health is the first thing you need to do! If you are passionate then you need to start acting now. For example, teach English to women who have trouble when they leave their homes.. You also learn about the bigger picture of health and make yourself aware of the cultural differences and potential barriers. You do stuff with your heart. You just need to be keen and excited!

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Médecins Sans Frontières

Letter Home from the Central African Republic Eline Whist, a Medical Doctor from Newcastle, NSW, has recently returned from her second field placement with Médecins Sans Frontières. Eline spent four months in Mongoumba, Central African Republic, where Médecins Sans Frontières has been running an emergency healthcare project in response to an influx of refugees fleeing violence in the Democratic Republic of Congo (DRC). Imagine a country in the heart of Africa; a country bordering places like Chad, Sudan and the Democratic Republic of Congo; a country that has been plagued by intermittent internal instability for decades, has been surrounded by external instability for even longer, and where a large proportion of the population lives in utter poverty. Imagine a country where every fifth child will die before they reach the age of five – often from diseases such as diarrhoea, malaria, HIV/ AIDS and respiratory tract infections. And, even if you’re one of the lucky ones to reach adulthood, your life expectancy is only 48 years. [1] Imagine a healthcare system that will not give you a blood transfusion unless you or your family can pay for it – even if you’re dying from acute blood loss or malaria-related haemolysis. Imagine that what little there is of health care services will cost a lot more than you or most others can afford. Imagine that even if you did have the money, you most likely wouldn’t have access to health care facilities anyway, and if you did, the health care staff are scarce. Now imagine you’re a refugee, and this is the country you’re fleeing to. Welcome to Central African Republic. vector magazine

This was the situation for approximately 18,000 refugees from northern DRC, when they fled across the Oubangui River to seek refuge on the shores of Central African Republic at the end of 2009. And this is the reason for Médecins Sans Frontières’ presence in Mongoumba, a village in the south of Central African Republic, and now also the temporary home to thousands of Congolese arrivals. Médecins Sans Frontières set up an emergency medical program in Mongoumba in late December 2009 to support the pre-existing health structures and now offers free emergency healthcare to the local population as well as the 18,000 refugees. The local people include a high proportion of Aka (Mbenga) pygmies, a people who face an increasingly threatened existence. The main health centre in Mongoumba, where I’ve been spending most of my time, now has a 60 bed inpatient capacity—with additional tents erected—including adult medicine, tuberculosis, intensive care, malnutrition, paediatric and maternity wards. In addition, Médecins Sans Frontières works out of four outpatient health clinics close to the refugee camps, where nurses see a total of 6,000 patients a month. In the initial phase of the program, Médecins Sans Frontières carried out a measles vaccination campaign as vaccinating against this disease is a key priority in preventing epidemics among a newly arrived refugee population. As the doctor in our little team of international staff my role was to supervise all the medical activities, both in the form of hands-on work in the hospital, consulting with and supporting the outpatient staff at the refugee camp sites, running weekly teaching sessions, analysing morbidity and mortality statistics, and providing health care for our staff and their families.

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Dr Eline Whist in Mongoumba, Central African Republic, where Médecins Sans Frontières established an emergency medical program in response to an influx of approximately 18,000 refugees who had fled Democratic Republic of Congo at the end of last year following an increase in violence in the north of the country. Credit: ©MSF

!

Although the hours are long, the isolation challenging and the work sometimes stressful and heartbreaking, it never ceases to amaze me how such an incredible difference can be made by bringing some very simple medical resources to a distressed population that has very little to begin with. Despite a lack of laboratory tests or high-tech medical equipment, people’s lives are saved daily, simply by providing free and accessible treatment with oral rehydration solution, anti-malarial treatment, antibiotics or a blood transfusion. Despite its problems, Central African Republic has left me with plenty of fond memories: the friendly and helpful locals, the tongue-twisting words of ‘Sango’, the peculiar taste of maniok, falling asleep to the hypnotising sound of drums in the humid African night. But most importantly, I’ve been left with a quiet sense of optimism. Because even though the work we’re doing is only a small drop in the ocean of humanitarian efforts, I know that it is an important drop. Every day, thanks to the work Médecins Sans Frontières is doing, children are given a chance to survive past their fifth birthday. Provide something where there is nothing and the results can be striking. 1. WHO, World Health Statistics 2008

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The Happiest Refugee Anh Do, a Vietnamese Australian and one of our best-loved comedians, shares with us an excerpt from his acclaimed autobiography, “The Happiest Refugee”. In 2011, Anh’s book received the Indie Book of the Year, the Non-fiction Indie Book of the Year, the Australian Book Industry Awards Book of the Year and the Australian Book Industry Awards Newcomer of the Year. He was also the joint winner for the Australian Book Industry Awards Biography of the Year and shortlisted for the NSW Premier’s Literary Awards. The German ship took us to a refugee camp in Pulau Bidong, an island in the Malaysian archipelago. As soon as we landed we were surrounded by other refugees. We made friends, traded stories and shared experiences, and realised that our boat had been incredibly lucky. Many others had been through far greater suffering. The second day on the island, American helicopters flew overhead and dropped bags of food. The drop contained a number of items, including lots of tins of corner beef – a practical and long-lasting food. For the first few weeks, our family indulged on this canned meat and, to this day, it is my mum’s favourite food. Every second Christmas she still rolls it out and I curse those choppers for not dropping something tastier. I mean, after bombing the hell out of Vietnam, the least they could’ve done was thrown us some lobster. One day a local Malaysian man came to the camp and offered to buy gold off the refugees. Mum sold her small gold cross for 30 US dollars. She got a good price after telling him that it had ‘been through a very difficult passage’. Our family feasted on that sale – Khoa and I got to eat apples and drink Coca-Cola for a week.

~

We spent nearly three months at the Pulau Bidong refugee camp and decided we’d go to whichever country would take us. Australia eventually offered us sanctuary. Mum and Dad were overjoyed. Dad walked around the island asking people if they had any spare warm clothes. He collected a big bundle of jumpers and blankets because he’d heard about Australia – ‘Beautiful country, friendly people, but really cold. It’s right near Switzerland.’ That’s my dad, great at rescues, crap vector magazine vector magazine

at geography. We touched down in Sydney, Australia in thirty-degree Celsius heat and my family were thinking, Geez, Austria’s really hot, man!

~

August 1980. ‘What a great country!’ my parents said to each other. One of the first things that happened was two smiley nuns from St Vincent de Paul came and gave our family a huge garbage bag stuffed full of clothes. No charge. For free! There were several pairs of pants for Mum, including two really nice pairs of jeans. She was in heaven. Mum had only ever seen jeans in posters for cowboy movies, and all her life had only owned two pairs of pants at any one time. Now these wrinkly old white angels came and gave her the wardrobe of a western movie star. ‘Tam! Imagine a country could be so well off they could throw this stuff away,’ she said. This big, black magic bag had other things too: belts and skirts and scarves. And also kids’ clothes. ‘Oh, how beautiful. Little tiny jeans. Tam! These people are geniuses…look at these for Anh!’ Then Mum and Dad turned me into a little Clint Eastwood. Somewhere in the translation, someone had mistakenly written down that we were a family with a boy and a girl. My mother, ever polite and practical, took these kind gifts with a grateful smile and, for the next few months, accepted compliments from strangers about what a ‘pretty little daughter’ she had. If you ever meet my brother Khoa, make sure you mention the lovely photo you saw of him in Anh’s book wearing a lacy dress with gorgeous red ribbons. The Happiest Refugee is available at all good bookstores.

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World Health Organization (WHO) Internship Program

by Mikhaila Lazanyi The World Health Organisation (WHO) is ‘the leader in global public health issues’. It is responsible for ‘providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.’[1] As a junior doctor and current Masters of Public Health student, it was an honour to be offered the opportunity to undertake an internship at the WHO headquarters. After months of anticipation and excitement, I embarked on this amazing experience in August 2011. Arriving in Geneva, a global centre for diplomacy and home to numerous international organisations, I was awestruck by the grandeur of the city. As I entered the impressive WHO building, the endless opportunities and inspiration became apparent.

WHO Headquarters in Geneva. WHO/P. Virot

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My internship was undertaken within the Department of Maternal, Newborn, Child and Adolescent Health. I was primarily involved within the maternal health sector and most specifically with updating the Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines. These guidelines were initially developed in 2000 to address the Millennium Development Goals 4 & 5 in reducing maternal and newborn mortality. Their purpose is to reduce the ‘1,500 women and over 10,000 newborn babies who die each day from the complications of pregnancy and childbirth.’ [2]

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My experience at WHO was not solely based around my project. Each day there was several inspirational speakers from across the globe and workshops open for interns to attend. From an update on the eradication of a polio project, to the health economics of Rwanda, the experiences I had broadened my perspective of the integrated function of the WHO. As my internship comes to an end, I have no doubt this experience and the valuable networks I have developed will continue to influence my development for years to come. For anyone interested in undertaking a similar endeavour, more information can be found on http://www.who.int/employment/internship/en/

(Dr Mikhaila Lazanyi is a RAMUS alumnus. She completed her MBBS at Monash University in 2008 and will be commencing O & G training at the Royal Womenâ&#x20AC;&#x2122;s Hospital, Melbourne in 2012)

1. 1 World Health Organisation 2011, About WHO, Geneva, viewed 11 October 2011, < http://www.who.int/about/en/> World Health Organisation 2011, Making Pregnancy Safer, Geneva, viewed 11 October 2011, < http://www.who.int/making_pregnancy_safer/about/ mission/en/index.html> 2. World Health Organisation 2011, Making Pregnancy Safer, Geneva, viewed 11 October 2011, <http://www.who.int/making_pregnancy_safer/about/ mission/en/index.html>

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GLOBAL HEALTH IN THE NEWS Yu Shan Ting (University of New South Wales)

Infectious Diseases and Vaccination According to the WHO, cervical cancer is the second most common cancer in women globally, and yet they are still not available in mainland China, where cervical cancer takes 40,000 lives every year. Many women travel to Hong Kong every year in order to get the vaccine. Manufacturers of both Gardasila and Cervarix have filed applications to market them in China, but the mainland Chinese drug authorities have yet to approve their use. However, the health authorities have also acknowledged the seriousness of this problem, as they expect the availability of the vaccines to significantly contain the infection. http://europe.chinadaily.com.cn/business/2012-02/10/content_14579156. htm

Promising news from the polio eradication front – India has not reported a single case of the disease in 12 months, which the World Health Organisation has referred to as their ‘greatest public health achievement’.

This is even more impressive considering the fact that in 2009, India had more polio cases (741) than any other country in the world. In 2010, this figure had declined to 42, which most experts agree was aided by the introduction of the new bivalent polio vaccine which induces a significantly higher immune response. Since the start of 2012, Indian authorities have even began to focus on ‘border control’, vaccinating children crossing the border from Pakistan at the Munabao railway station in Rajasthan. This measure has been put in place after 175 cases of polio was found in Pakistan. Unfortunately in Pakistan, Interpress Service has reported an increasing distrust in the public health efforts against polio. This has been attributed to the deaths of more than 125 cardiac patients after receiving defective vaccines in Punjab, which has resulted in scores of households resisting the vaccination. http://globalhealth.kff.org/Daily-Reports/2012/February/16/GH021612-Polio-India-Pakistan.aspx?utm_source=feedburner&utm_ medium=feed&utm_campaign=Feed%3A+kff%2Fkdghpr+%28Kaiser+Dail y+Global+Health+Policy+Report%29 http://articles.timesofindia.indiatimes.com/2012-01-14/india/30627194_1_ global-polio-eradication-initiative-wild-poliovirus-transmission-polioendemic-countries

Technology Diagnostics For All (DFA), a Harvard affliated biotechnology start up is developing a stamp sized diagnostic tool for developing countries that lack healthcare infrastructure and reliable electricity. DFA’s chip can detect, with a drop of blood, any disturbance in liver function. This chip provides at a fraction of the current cost immediate results. Currently DFA is looking at distributing this technology through large pharmaceutical companies that already work with primary health clinics, ministries of health and NGOs in the developing world. Even if the governments do not decide to provide them for free, patients can buy them for fewer than ten cents. In addition to this, DFA is also developing a test to identify aflatoxin, a poison released by mold that grows on crops that can stunt children. http://www.forbes.com/sites/helencoster/2012/02/03/startups-stamp-size-lab-on-a-chip-tracks-disease-in-remote-areas/

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Natural Disasters Two years after the Haiti earthquake, recovery still appears to be years away as thousands still continue to live in makeshift shelters and rubble still lines the streets. But that’s only part of the problem at the moment, as Haiti faces the largest cholera epidemic ever in modern history that is affecting a single country. 7000 people have died of the disease since the epidemic began in October 2010 and 200 new cases are reported daily. Haiti’s neighbour, the Dominican Republic has reported 21,000 cases. Authorities have traced the source of the infection to a mentally ill man that bathed and drank from a contaminated river, the Latem River in Haiti. This was just downstream from the Meye river where raw sewage drained from an encampment of United Nations peacekeepers from Nepal. The outbreak strain has since then been confirmed to be a Nepali strain. http://globalhealth.kff.org/Daily-Reports/2012/January/09/GH-010912-Haiti-Cholera.aspx?utm_source=feedburner&utm_medium=feed&utm_campaign =Feed%3A+kff%2Fkdghpr+%28Kaiser+Daily+Global+Health+Policy+Report%29 http://globalhealth.kff.org/Daily-Reports/2012/January/10/GH-011012-Haiti-First-Cholera.aspx?utm_source=feedburner&utm_medium=feed&utm_cam paign=Feed%3A+kff%2Fkdghpr+%28Kaiser+Daily+Global+Health+Policy+Report%29

Medecins Sans Frontiers has reported that the living conditions in the Dadaab refugee camp in Kenya have been deteriorating as a result of the scaling back of aid work. Dadaab, which is a refugee camp in the desert of Kenya’s northeastern province is the biggest refugee camp in the world that houses up to 500,000 people. Most of the refugees are Somalis that have fled because of last year’s severe drought or the country’s chronic conflict situation. As the camp becomes severely overcrowded, the pressure mounts at Medecins San Frontieres’ 170 bed hospital where free medical care is provided. In June 2011, the maternity ward saw 308 deliveries, 862 children received care for malnourishment and 964 patients received mental health support. Since then, on the 16th of February 2012 MSF reported rapidly declining health conditions due to overcrowding and decreased support for aid agencies that has resulted in cholera, measles and diarrhea outbreaks. http://www.reuters.com/article/2011/11/15/us-cholera-kenya-idUSTRE7AE1LD20111115 http://www.msf.org.au/resources/special-features/dadaab-refugee-camp.html

Non-communicable diseases Do you think the WHO should regulate alcohol use? Devi Sridhar, a lecturer at Oxford University thinks so. She wrote in a commentary published in the journal Nature that 4% of all deaths worldwide can be attributed to alcohol, and argues that WHO recommendations such as prohibiting ‘unlimited drinks’ promotions should be made a legal requirement.

Dr Ihsan Sallosum, Professor of Psychiatry at University of Miami agrees, saying that public health efforts to raise the drinking age and taxing alcoholic beverages have reduced alcohol related morbidity and mortality in the US. Sridhar said that the WHO should move forward with further efforts to make safe consumption of alcohol a public health priority, as it is the only health organisation to proactively promote health through the use of international law.

http://abcnews.go.com/blogs/health/2012/02/15/should-the-world-health-organization-regulate-alcohol-use/

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Vector: Issue 14 (May 2012)