HOPE works in more than 35 countries worldwide. Please enjoy our blog as we document the successes and challenges of our work to provide Health Opportunities for People Everywhere.
World TB Day
A century-and-a-half ago tuberculosis (TB) was such a fact of daily life that the tragic romance of a young woman dying from the disease was immortalized in Giuseppe Verdi’s famous opera La Traviata.
No one is writing operas, or their modern equivalent, movies or television shows about TB these days, and most people probably never give it a second thought — even though it is a disease that has afflicted the likes of celebrities like Nelson Mandela, Ringo Star, Sir Tom Jones and Tina Turner.
But would it surprise you to know that the deadly lung disease remains a potent killer of more than a million people a year worldwide in the second decade of the 21st century?
The World Health Organization (WHO) reports that in 2014 there were 9.6 million new cases of TB and about 1.5 million people died from tuberculosis -- more than the population of the U.S. state of Montana or the population of Swaziland.
When I was a young fellow at the Moscow Medical Academy, my senior colleagues told a story about the time when they started to look for another job after Dr. Selman Waksman, microbiologist at Rutgers University, introduced Streptomycin and later new anti-tuberculosis drugs developed in the early 1960s. Thanks to these medicines thousands of patients even with severe cases were cured in six months.
TB sanatoriums where patients spent years were not needed any more. In the U.S. these places, once dubbed “waiting rooms for death” were finally closed. Many doctors and medical students thought there were no longer any meaningful careers to be pursued in curing TB. The disease faded from the curriculum of many medicals schools in the U.S. and Europe — a trend that soon went worldwide. But TB was not gone and it found the conditions it needed to strike back.
First, poor populations worldwide did not get meaningful access and consistent effective treatment with the new drugs – so the disease continued to spread inexorably.
Then, multiple drug resistant forms of tuberculosis (MDR TB) appeared even in wealthy countries where some populations were not correctly treated until fully cured. And third, HIV/AIDS acted as catalyst for tuberculosis to explode among immune-compromised populations from the mid-1980s. Within a decade, the number of TB cases in the U.S. jumped sharply.
The revived threat of TB inspired a new fight against the disease. A strategy of monitoring patients carefully when they took each dose of anti-TB drugs and recording their progress was pioneered by Karel Styblo (IUATLD) and successfully piloted in Tanzania, Malawi, Mozambique and Nicaragua. It showed early promise for wider use.
Richard Bumgarner, leading the World Bank’s health programs in China, invited Styblo and the WHO to build on this approach to design a TB control project for World Bank financing in China where TB was the number one killer, claiming 400,000 lives a year. By the end of 1991 pilot Chinese counties were achieving double the previous rates of cure in tuberculosis. A large World Bank grant was made to China for TB control. Bumgarner moved to the WHO to help expand its tiny TB program and build the WHO Global TB Programme. WHO declared its first Global Health Emergency in 1993 and named the new TB approach DOTS (Directly Observed Treatment Shortcourse). Nearly 80 percent of people were cured, at a cost of less than $10 per life and $3 per new infection avoided (“TB Join the DOTS.” The Economist. May 20, 1995, P.89).
Project HOPE also started its first TB activities in the early-1990s when Richard Bumgarner wrote to and convinced Dr. Bill Walsh, Project HOPE’s founder, to build TB programs, first in the Central Asian Republics, and later in parts of Europe and Africa. After he retired from the WHO, Bumgarner joined Project HOPE to strengthen the efforts of our team.
Today Project HOPE successfully guides TB programs in Europe/Eurasia and Africa with funding by USAID, GFAMT and private donors for more than US$40 million, and provides additional humanitarian assistance for hundreds of millions dollars to save lives of people all around the world.
Project HOPE invests significant efforts to build political commitment in countries where TB programs are implemented and support principles of humanity that started when Waxman brought, almost illegally, a few grams of the new Streptomycin to the USSR to save the life of Ira Zukerman who was dying from tuberculosis meningitis.
In over 20 years of TB program implementation, Project HOPE pioneered universal education for medical doctors, nurses, patients, their relatives and communities. The programs have sought to combat the stigmatization of patients in their communities, improve tolerance and empower patient and health professionals to address the needs of TB patients.
Much improved methods of diagnosis such as GeneXpert, developed by Rutgers University where Streptomycin was created, are being successfully introduced by Project HOPE in TB control programs in Africa, Europe and Central Asia
Following the WHO’s END TB strategy and US Government TB control strategy, Project HOPE provides assistance to patients and their family members from the most vulnerable groups of population – women, children, migrants, HIV positive people, injection drug users and former prisoners. This fight has made enormous success, helping to save an estimated 46 million lives worldwide since 2000. It must be continued forcefully so that TB does not again come back in even more deadly forms.
During 2015, Europe witnessed the largest movement of refugees since World War II. Since then, the situation has perpetually escalated, with the number of people fleeing war in the Middle East and arriving in Europe continuing to increase dramatically.
- In January and February of 2015, 11,834 refugees arrived in Europe by sea.
- In January and February of 2016, more than 131,000 refugees have arrived by sea and 418 deaths have occurred in that same short time period.
Despite unilateral action being taken by various countries in Europe, the migrant route has not changed a lot. Migrants arrive by boat from Turkey to a Greek island and then travel to Athens. From there they make their way to the northern border of Greece where they cross into Macedonia. At one point, thousands of refugees and migrants were passing through Macedonia’s two refugee transit centers on a daily basis en route to other European Union (EU) countries. Unfortunately, because of a ‘domino effect’ happening in central Europe, the action of one country at their border affects all other countries along the route.
Macedonia has now had to greatly reduce the number of refugees allowed into the country. This in turn has caused a ‘traffic jam’ at the border between Greece and Macedonia (a non-EU country). There are now more than 7,000 refugees stranded in a camp at the Greek border in Idomeni that is equipped for 1,500 people. Some of the refugees have been at the camp for more than a week. Crowded conditions at the camps are causing frustrations and unrest.
The Greek military have established three other camps near Idomeni. Each camp is equipped to manage 2,000 people. All three camps are already full.
At Macedonia’s northern border with Serbia there is now a camp at Tabanovce with 1,400 refugees waiting to cross into Serbia. Approximately 300 people are being held at the camp because they cannot obtain entry for travel into the EU countries.
Project HOPE has been actively responding to the refugee humanitarian crisis since September of 2015 with the goal of improving health care for the refugees. In close collaboration with the Macedonian Ministry of Health (MOH) and devoted donors and partners, HOPE has delivered five shipments of medical aid, including vaccines, medicines and supplies to be used to support the refugees passing through Macedonia.
Teams of Project HOPE volunteer doctors and nurses have also been deployed to the two border transit centers in Macedonia to provide medical treatment for those in need. Currently, two teams of doctors and nurses are working 12-hour shifts at each of the border transit centers.
From the beginning of 2016, the HOPE volunteers and medical staff supporting the refugees traveling through the country have treated more than 1,000 patients, mostly children with illnesses such as fevers, and head lice, and adults struggling from illnesses such as bronchitis and diabetes. A new volunteer team, consisting of a doctor, nurse and a logistician which began helping at the northern border on March 15, reported treating more than 50 patients on the very first day.
The Macedonian hospitals in the nearest towns next to the refugee transit centers were already struggling with a shortage of medical personnel before the refugee crisis began. The increased need for medical personnel to help manage the medical needs at the refugee transit centers is adding additional stress on the Macedonian health system. Project HOPE is working to secure a third team of local Macedonian volunteers to provide additional support.
One of the challenges the volunteers face is the transport of the patients that need to be hospitalized, because many of the refugees are refusing to leave the transit centers for fear of being separated from their families.
“We are here to help in any way we can and happy to provide care to these people suffering from severe diseases and illnesses,” Project HOPE volunteer, Dr. Angel Trposka told me.
The Macedonian MOH is truly grateful to Project HOPE for the support provided by the donations of supplies and the volunteer medical assistance that is helping to reduce the huge burden the refugee crisis is having on an already stressed health system.
Project HOPE will continue monitoring this grave humanitarian crisis and providing needed medicines, medical supplies and volunteer support, thanks to your help.
International Women’s Day is a great time to reflect on the advances we’ve made to improve the health women in the developing world and the expertise of health professionals who care for them. In China, Project HOPE has made great strides to promote cervical cancer prevention and early diagnosis.
Cervical cancer is the third most commonly diagnosed cancer and the fourth leading cause of cancer death in women worldwide. The World Health Organization’s Cancer Fact Sheet of 2015 indicates there were:
- 530,000 new cervical cancer cases that accounted for 84 percent of new cancer cases worldwide in 2012
- Cervical cancer represents 7.5 percent of all female cancer deaths or 270,000 deaths among women every year
Project HOPE China has been focused on improving early detection, which can be lifesaving, especially in underserved rural areas. Thanks to the “Women’s Health-Cervical Cancer Prevention Program” funded by BD China, migrant women now understand the need for screenings to prevent cervical cancer. The long-term benefits in terms of the health and awareness of women and health care professionals who took part in the program from 2011 - 2014 endure even today. Together with the Shanghai’s Women’s Federation, we mobilized communities to share knowledge of the cervical cancer prevention program and educated thousands of women who later passed on this information to women in other communities. The program’s achievements include:
- 1200 women from the migrant worker population received free cervical cancer screenings for the first time
- 372 pathologists trained at the cervical screening and diagnosis unit to improve the capacity of cervical cytopathology diagnosis
- 330 gynecologists trained in cervical cancer diagnostic procedure and cytopathology staging and cervical cancer surgery
Ms. Xu C from Shanghai, 53, was a participant in the program. “If my lesions were not detected early, I would be at risk,” she said. “I am very grateful to Project HOPE for my free cancer screening. Now when I meet other women, I tell them to go to the hospital for a cervical cancer screening.”
Another successful project, HOPE’s five-year “Cervical Cancer/HPV Prevention Public Education Program”, sponsored by MSD (Asia) is reaching medical professionals and the media with important cervical cancer messages. The 2013 program has been active in 14 cities and involves 13 local partners throughout China. Program activities include training 1,455 doctors who now have the expertise to make more effective diagnoses and better understanding the linkage between HPV and cervical cancer. One gynecologist said, “Before the training, even if I met a patient with a suspected infection and lesion, I could not make an exact diagnosis.” Another pediatrician indicated that “I can provide a better explanation for parents who seek my suggestion for preventing HPV infection”. In addition, the program also conducted activities in seven regions of China to educate school teachers, parents and adolescents about adopting a positive approach to discussing reproductive health aimed at preventing sexually transmitted diseases.
HOPE also cooperated with the Health Communication Institute at Fudan University to conduct educational activities for journalists to educate reporters about the importance of cervical cancer screenings. One journalist said: “I hope to use the power of the media to promote the correct understanding of preventing HPV infection and cervical cancer in our communities, schools and families.” Educating reporters is an essential approach of the program to ensure the correct cervical cancer prevention information is distributed and reported in the public media to enhance disease awareness and preventive measures.
Project HOPE Applauds the President’s Request to Congress for Supplemental Funds to Combat the Zika Virus Epidemic
Congress simply must act.
If lawmakers in both parties don’t rapidly approve the request the President lodged on Monday, February 22 for $1.9 billion to combat the Zika virus epidemic sweeping the Western Hemisphere, there could be devastating consequences for Americans, especially unborn children.
Time is not on our side. Yes, we need better science around what is going on with Zika virus, but in the meantime millions of pregnant women and unborn fetuses are at risk and need support now to avert a further disaster. The virus can cause microcephaly, a tragic, irreversible condition, which depending on its severity, can be accompanied by a range of complications, including mental retardation. Thousands of cases of this heart rending disease, which can deal a crushing blow to the hopes of expectant parents, have already been recorded. And there are major societal implications as the integrity of the reproductive process — which underpins humanity itself, is at risk.
The CDC once estimated that the lifetime costs of caring for a child suffering from mental retardation topped a million dollars. So averting less than 2,000 cases of microcephaly and mental retardation would offset the President’s request. And this is an investment that will deliver returns many times over. In fact, if Congress approves this investment, Americans will be getting a bargain. An important knock on effect of funding this program will also lead to lasting control of mosquitos that can spread disease and stronger public health systems that could prevent other outbreaks of disease from reaching America’s shores.
There is no time to lose because the Zika virus is already on its way. With 26 countries and territories in the Western Hemisphere already reporting cases, with thousands of cases of microcephaly already identified, and with the mosquito vector already in America, the conditions are ripe for the U.S. mainland to be increasingly affected as we move into the spring and summer months.
But while the threat is serious, history is on our side. In the 1940s the United States faced major mosquito-borne outbreaks of malaria and yellow fever in the southern states that were brought under control through public health investment and hard work, leading to the formation of the CDC in Atlanta.
But before we can tackle the Zika outbreak, we need Congress to do its part. It is being suggested that the quickest way of funding the President’s request would be to divert resources currently being used to contain Ebola in West Africa. But this makes little sense — in fact it would be like diverting the fire hose from a house fire that is smoldering, to one that is in flames. It only takes a puff of wind for the original conflagration to ignite again.
Does Congress really want to run the risk of having BOTH Ebola and Zika virus cases in the mainland U.S. in the coming months? Really? Time will tell, but this is not the time for Congress to belabor this issue.
Global health crises require constructive involvement of our diplomats abroad and policymakers at home, as we have seen with the global HIV pandemic, as we saw with the Ebola epidemic last year, and as we are seeing now with the Zika virus epidemic in our own hemisphere. So it was very timely to have the opportunity to address this topic on a recent panel discussion in Washington D.C., “Securing HOPE”, sponsored by our young professionals’ leadership board, the NextGen of HOPE, and the Young Professionals in Foreign Policy.
The panel included experts from the Department of State, USAID, the Department of Defense, and NGO sectors to provide a range of viewpoints on strengthening the response to epidemics and how to engage the next generation of leaders in global health security (GHS), an issue that is going to be increasingly important as their careers progress.
Of course, HIV, Ebola, and the Zika virus are very different from one another, but they have their own sinister way of creating a crisis, affecting society, and threatening security. Ebola kills rapidly and is scary. The Zika virus, so we think, strikes in a tragic way at reproductive health, which is at the very core of our existence. And the global HIV pandemic, which now spans 30 years and has claimed the lives of 40 million people, is a clear example of how unresolved global health challenges are going to be passed on to the next generation.
Partnerships are crucial to achieving progress in the fight against Ebola, HIV, and now the Zika virus, which threatens communities in the Americas and has been detected in the U.S. These and others (H7N9, MERS, Chikungunya, etc) are prime examples of how insecure we really are when it comes to containing disease outbreaks. The UN Security Council has even taken the unprecedented step to declare Ebola and HIV as threats to global security. The goal of GHS, through investment in public health systems strengthening, is to prevent outbreaks of disease from escalating into wider scale epidemics and pandemics and to better prevent, detect and respond. But to fulfill its potential, GHS needs a seamless partnership between government, the private sector, and where we come in — NGOs.
When outbreaks occur, which is often unavoidable, governments must provide funding, leadership, coordination, communications with the public, support for research and development, and carry out disease surveillance so we know the extent of the problem. We need the private sector to develop and distribute effective and affordable diagnostics, vaccines, and therapeutics. And the non-health sectors are critical in keeping transport, commerce, and communications systems up and running.
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