In case anyone is interested, we have for the last 6 years run an annual ‘Crash Course in Tropical Medicine’ and I am attaching details here (pasted at end of email)  for anyone interested.  Any profits go back to the Kambia Appeal charity (http://www.kambia.org.uk/news/latest/post/42-crash-course-in-overseas-medicine).  Please feel free to circulate as you see fit.  All modules are delivered by experienced NHS professionals who have worked in challenging environments in developing countries.  Here are some recent testimonials:

I just wanted to say how much I enjoyed the course last week. I thought it was an excellent balance of very well presented subjects & the whole thing seemed very organised & ran very smoothly. The opportunity to do some of the simulated procedures was fantastic too.

I think we all felt inspired & hopefully gained a bit of confidence whether about to go off for a year or just at the pre-planning stage.

So thank you very much for organising it – a great success.

Dear Mr Whyman

Just a quick note to thank you for organising the Crash Course.  It was a fascinating course, really informative teachers who had relevant experience.  I’d be very interested in going out to Kambia if my E.D sills could be useful.

I am writing on behalf of myself and my brother to thank you for arranging and facilitating such an excellent course.

It was only after a period of ‘reflection’ (something we are supposed to be doing these days apparently) that I realised how much we had got from the course and how it had made me think about what, why and for whom any work in Developing Countries is about.

The course contents was excellent; the most important and relevant issues being covered and anything not specifically timetabled was probably discussed informally over coffee or lunch. These interactions were a very important part of the course from my perspective.

The mixture of clinical medicine and practical procedure was well balanced. You used Consultants with first hand experience of this type of work and knowing that there is someone with an interest at the end of the phone or email is a comfort. There is a danger of giving too much information and missing the important practical advice, eg in microbiology.

I was able to create a list of useful things to take on the trip; this was extracted from the individuals as they spoke and may be could form part of the ‘book’ that you have planned for next year.

I particularly enjoyed your own personal experience of trying to operate under such conditions; using head torch and daughter! Your own altruism and wish to give back by helping others comes across very strongly. This was more relevant for us, however the MSF and VSO contribution balanced it well. Grania was inspirational.

“Overall a brilliant course, very well organised – thank you”

“What a brilliant course, Ab Fab!  Please do it again, keep it up it’s brilliant”

“A great course overall.  Would recommend this to anyone going abroad to a low income country”

“Hugely useful, relevant, inspiring and interesting course – thank you”

“Fantastic Course, really interesting”

CRASH COURSE IN OVERSEAS MEDICINE

(3 days)

Monday 8th – Wednesday 10th February 2016    

Sandford Education Centre, Cheltenham General Hospital,

Keynsham Road, Cheltenham, Glos GL53 7PX

This intensive course is for:  doctors or senior nurses/midwives who are considering working overseas in a developing country

We aim to cover all of the following (subject to speaker availability):

Personal Preparation

Ethical issues with working in developing countries

Trauma/immediate care/Fracture management

Hands-on workshops: Airway; cut-down/central venous/intra-osseous access; chest drain; plastering

Malaria

HIV and AIDS

Malnutrition

TB, leprosy

Reproductive health and illness

Obstetrics and emergencies, Caesarean section, Ventouse delivery, The Kiwi cup

Basic dentistry

Eye problems

Dermatology

Altitude Sickness

Ebola

Included:  Meal at a local restaurant Monday 8th February 2016 at 8pm

Delegate fee: £375.00

For further information or to reserve a place please contact

Mrs Alex Townsend, Secretary to Mr Mark Whyman, Consultant Vascular Surgeon,

Cheltenham General Hospital, Sandford Road, Cheltenham, Glos GL53 7AN

Tel: 0300 422 4391 or email alex.townsend@glos.nhs.uk

Best wishes,

Shona

“Are you mad?” “Your head is not correct!” “Possessed by the devil!”

These are phrases often spoken within the Nigerian culture. Although these words are sometimes said harmlessly, they are commonly not well informed. Information on mental healthcare in Nigeria is lacking, and there is significant neglect and lack of a good understanding of mental health issues and healthcare in Nigeria.

While well-established treatments exist internationally for mental health, and the World Health Organization (WHO) continues to work to make mental health a global development priority, there is still a lack of information in Nigeria regarding mental healthcare.

This webinar will explore the current state of mental healthcare in Nigeria; the state and role of research on mental healthcare development and delivery in Nigeria; the workforce situation in mental healthcare delivery in Nigeria; and the role of Government in mental healthcare delivery.

Saturday, December 12, 2015 | 4:00 p.m. – 5:30 p.m. UK time |5:00p.m – 6:30 p.m. Nigeria time

Register here 

https://attendee.gotowebinar.com/register/2559374268604167938

Ike

www.epiafric.com

http://nigeriahealthwatch.com/

www.tedxeuston.com

Twitter: @ikeanya

Protocol for the development of a CONSORT- equity guideline to improve reporting of health equity in randomized trials

Vivian Welch , J. Jull, J. Petkovic, R. Armstrong, Y. Boyer, LG Cuervo, SJL Edwards, A. Lydiatt, D. Gough and 17 more

Implementation Science (2015) 10:146

First online: October 2015

Abstract / Resumen:

Background:  Health equity concerns the absence of avoidable and unfair differences in health. Randomized controlled trials (RCTs) can provide evidence about the impact of an intervention on health equity for specific disadvantaged populations or in general populations; this is important for equity-focused decision-making. Previous work has identified a lack of adequate reporting guidelines for assessing health equity in RCTs. The objective of this study is to develop guidelines to improve the reporting of health equity considerations in RCTs, as an extension of the Consolidated Standards of Reporting Trials (CONSORT). Methods/design: A six-phase study using integrated knowledge translation governed by a study executive and advisory board will assemble empirical evidence to inform the CONSORT-equity extension. To create the guideline, the following steps are proposed: (1) develop a conceptual framework for identifying “equity-relevant trials,” (2) assess empirical evidence regarding reporting of equity-relevant trials, (3) consult with global methods and content experts on how to improve reporting of health equity in RCTs, (4) collect broad feedback and prioritize items needed to improve reporting of health equity in RCTs, (5) establish consensus on the CONSORT-equity extension: the guideline for equity-relevant trials, and (6) broadly disseminate and implement the CONSORT-equity extension. Discussion: This work will be relevant to a broad range of RCTs addressing questions of effectiveness for strategies to improve practice and policy in the areas of social determinants of health, clinical care, health systems, public health, and international development, where health and/or access to health care is a primary outcome. The outcomes include a reporting guideline (CONSORT-equity extension) for equity-relevant RCTs and a knowledge translation strategy to broadly encourage its uptake and use by journal editors, authors, and funding agencies.

How to obtain this paper / Como obtener este artículo: click here.

http://link.springer.com/article/10.1186/s13012-015-0332-z

__________

Chitambo Hospital, in central Zambia, is making history.  Not only did they establish 2 Facebook pages for emergency healthcare communications last week (one open https://www.facebook.com/Chitambo-Hospital-908021339291268/?fref=ts and one a closed forum for discussing confidential clinical issues) but they have also initiated a WhatsApp emergency care support network.  This was launched on Friday 27th November and so far 2 ‘live’ emergency cases have been discussed.

The first case concerned hemorrhage following an abortion in a 15 year old patient.  The second was a road traffic accident, with 2 victims, one with multiple fractures.

In both cases, staff from Chitambo Hospital and Rural Health Clinics were able to discuss management and obtain support and advice where necessary.  For example, in the case of the abortion, the clinic nurse was advised to determine whether it was a complete or incomplete abortion; assess the patient’s overall condition; establish an intravenous line; give antibiotics; monitor amount of bleeding, and refer the patient to hospital if bleeding was excessive.  The team provided support and invited periodic updates. The bleeding subsided and the patient did not need to be referred.

In the case of the RTA, the team was alerted, through the WhatsApp network, to ready the ambulance and expect 2 victims.  The patients were admitted to Chitambo Hospital and updates were given on their condition.  One patient was transferred to the Provincial hospital the next day and the emergency team gave support to the accompanying nurse during the journey.

This is very innovative work.  The group includes internal and external medical advisors, as well as experienced local clinicians.  My only question is, should the emergency ‘line’ be separated from more general discussions so that responses to real emergencies are not delayed?  What do you think?    

I have signed up for this free online course on Social Media in Health Care, which starts today: https://www.futurelearn.com/courses/social-media-in-healthcare

I hope that I will find time to do it as it seems highly relevant.  The opening message says:

“We believe that social networking is an important trend: health care stakeholders who do not consider how to incorporate social networks in their practice risk being run over on the super-highway of health information sharing.”

Chitambo partners are very ‘switched on’ to social media as a way of sharing information.  No danger of them being run over…..not on that particular highway at least!

Best wishes

Dr Jo Vallis

Research Officer

NHS Education for Scotland

On this World AIDS Day, December 1, 2015?approximately 36.9 million people are living with HIV/AIDS, and of this 20 million are women and children. The USAID | DELIVER PROJECT has produced a large number of publications on the subject of HIV and AIDS and supply chains. Most recently, the project published a brief highlighting the importance of integrating family planning (FP) and HIV services.

Learn more at http://bit.ly/1O1DSeB

Holly Love Deaton KM Program coordinator

USAID | DELIVER PROJECT DELIVER.JSI.COM

‘Interesting and useful resources this week include: SPRING and Digital Green’s ‘Community Video for Nutrition Guide’, which aims to provide organisations and projects using or testing community video for maternal, infant, and young child nutrition (MIYCN) with the information and tools needed to initiate, produce, and disseminate a participatory community-video approach for MIYCN’

https://www.spring-nutrition.org/publications/series/community-video-nutrition-guide

Based largely on experience in India, the guide reminds us of the power of generating video *with* members of the community. ‘The process of producing and disseminating the videos often elevates the role and influence of positive deviants or early adopters, who are the video “stars”. Community-led video has been shown to be highly effective as both a means of conveying information and catalyzing social change and individual behavior change for improved agriculture, livelihoods, and health behaviors.’

Interestingly the guide hardly mentions the role of mobile phones in disseminating video, although we know from Nand Wadhwani’s work that large-scale dissemination of nutrition video via mobile phone is not only feasible, but is already happening – and it is happening in India. Perhaps there is a complementarity here? Community-generated video plus ‘standard’ video for sharing and comparing?

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

If you were unable to join us for yesterday’s webinar, you can view the recording here:

http://www.uksg.org/webinars/researchinformation

Our thanks to UKSG host Maria Campbell and fellow speakers Anne Powell & Ruth Bottomley (INASP) and Tom Mowlam (Ubiquity).

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

See the fill text http://www.uib.no/en/cih/72120/book-neurology-africa

Critical care handbook for global surgery, by jgreigshaw  

An open access, online handbook for use in settings where resources are scarce has been compiled by the editors Jacob S. Dreyer and David R. Ball, assisted by Abebe Bekele & Andrew Howard. It aims to supply essential support for the teaching and training of surgical critical care in sub-Saharan Africa and other regions. Printed copies may be obtained through the publisher for a charitable donation.

http://www.ssethio.org/notes/class11/621072038969829888.pdf

“Climate change has the potential to do serious harm to the health of individuals around the world. But tackling climate change could substantially reduce the risks while also improving human health by, for example, delivering cleaner air and healthier cities. That’s why WHO is asking you to support our call to action, with the aim at raising awareness of the health opportunities we can realise by tackling climate change now.

WHO call to action will be presented at the Paris COP and will demand a climate deal that delivers: Scaling up of financing for adaptation to climate change: including public health measures to reduce the risks from extreme weather events, infectious disease, diminishing water supplies, and food insecurity, and Actions that both reduce climate change and improve health, including reducing the number of deaths from cancer, respiratory and cardiovascular diseases that are caused by air pollution (currently over 7 million per annum).

You can take action today by:

1. Signing the WHO Call to Action. Click here and sign.
2. Sharing it with your professional networks, friends and family.
3. Learning more about how acting on climate change could improve human health.

Please spread the word so all efforts are multiplied to ensure health and climate are intertwined and to show that action on climate can result in benefits to human health”.

The Tools for Effective Research, Monitoring, and Evaluation Webinar recording is now available.

https://slate.uniteforsight.org/register/researchrecording

The free webinar recording includes in-depth discussion about quality research methodology, data collection, culturally-competent and locally-responsible research and evaluation, and pitfalls to avoid.  Please also feel free to forward this message to any friends or colleagues who may also be interested in accessing the free webinar recording.

The webinar’s expert panelists:

• Juan-Carlos Alegre, Results Management Director, Management Sciences for Health
• Liz Chamberlain, Impact Manager, Lwala Community Alliance
• Michael Gyasi, Ophthalmologist and Medical Director, Saint Thomas Eye Center, Ghana
• Lisa Hirschhorn, Director of Implementation and Improvement Science, Ariadne Labs; Assistant Professor of Clinical Medicine, Harvard Medical School
• Kala Mehta, DSc, MPH, Faculty Affiliate, Global Supply Chain Management Forum, Stanford Graduate School of Business, Assistant Professor, Department of Epidemiology and Biostatistics, University of California, San Francisco
• Jordan Levy, Chief External Relations Officer, Ubuntu Education Fund
• Moderated by Jennifer Staple-Clark, Founder and CEO, Unite For Sight
• More Free Webinars: You may access more than 15 past webinar recordings http://www.uniteforsight.org/webinars , ranging from Strategies for Improving Health Outcomes to Applying Lessons in Cultural Competency. You may also register for upcoming webinars, including next month’s webinar about Research and Advocacy Initiatives to Curb the Health Impacts of Environmental Contaminants.

Further Explore Research, Monitoring, and Evaluation: For those interested in exploring the topics in greater depth, you may enroll in the Certificate in Global Health Research, or the Certificate in Monitoring and Evaluation. For those looking to engage in an immersive global health experience, you may be interested in Unite For Sight’s Global Impact Corps, which also includes research opportunities.

HIFA profile: Jennifer Staple-Clark is Founder and Chief Executive Officer of Unite For Sight (www.uniteforsight.org)

Please find below a review of maternal care in low- and middle-income countries, which concludes: ‘evidence of more use, not better outcomes’. As a personal comment, this is an indictment of the quality of health care available in hospital facilities. This low quality of care is largely due to the failure of health systems to empower health workers (in adequate numbers) to deliver the services for which they were trained.

CITATION: Demand-side interventions for maternal care: evidence of more use, not better outcomes. Taylor E. Hurst, Katherine Semrau, Manasa Patna, Atul Gawande and Lisa R. Hirschhorn. BMC Pregnancy and Childbirth 2015, 15:297  doi:10.1186/s12884-015-0727-5

http://www.biomedcentral.com/1471-2393/15/297

ABSTRACT

Background: Reducing maternal and neonatal mortality is essential to improving population health. Demand-side interventions are designed to increase uptake of critical maternal health services, but associated change in service uptake and outcomes is varied. We undertook a literature review to understand current evidence of demand-side intervention impact on improving utilization and outcomes for mothers and newborn children.

Methods: We completed a rapid review of literature in PubMed. Title and abstracts of publications identified from selected search terms were reviewed to identify articles meeting inclusion criteria: demand-side intervention in low or middle-income countries (LMIC), published after September 2004 and before March 2014, study design describing and reporting on >1 priority outcome: utilization (antenatal care visits, facility-based delivery, delivery with a skilled birth attendant) or health outcome measures (maternal mortality ratio (MMR), stillbirth rate, perinatal mortality rate (PMR), neonatal mortality rate (NMR)). Bibliographies were searched to identify additional relevant papers. Articles were abstracted using a standardized data collection template with double extraction on a sample to ensure quality. Quality of included studies was assessed using McMaster University’s Quality Assessment Tool from the Effective Public Health Practice Project (EPHPP).

Results: Five hundred and eighty two articles were screened with 50 selected for full review and 16 meeting extraction criteria (eight community mobilization interventions (CM), seven financial incentive interventions (FI), and one with both). We found that demand-side interventions were effective in increasing uptake of key services with five CM and all seven FI interventions reporting increased use of maternal health services. Association with health outcome measures were varied with two studies reporting reductions in MMR and four reporting reduced NMR. No studies found a reduction in stillbirth rate. Only four of the ten studies reporting on both utilization and outcomes reported improvement in both measures.

Conclusions: We found strong evidence that demand-side interventions are associated with increased utilization of services with more variable evidence of their impact on reducing early neonatal and maternal mortality. Further research is needed to understand how to maximize the potential of demand-side interventions to improve maternal and neonatal health outcomes including the role of quality improvement and coordination with supply-side interventions.

SELECTED EXTRACTS (selected by Neil PW)

Maternal mortality results in approximately 800 deaths every day.. Since 1990, there has been a 45 % reduction in maternal mortality; however, limited access to quality routine and emergency care during pregnancy and delivery leaves a large number of women at risk of preventable death

The three delays model proposes that mortality can be largely attributed to a 1) delay in the decision to seek care, 2) delay in arrival at a health facility, and 3) delay in the provision of care [3].

The weak association between increased uptake of maternal health services and health outcome measures may be explained by the quality and effectiveness of care received in health facilities [28]. Poor quality care will not translate to better health outcomes even if there is increased utilization of services.

Poor quality of facility-based care has been identified as one of the factors contributing to maternal mortality and morbidity, highlighting the need to simultaneously increase utilization and invest in developing health systems that can offer quality care to meet the increased demand for services

in a study in rural Tanzania by Kruk et al., 40 % of women who delivered in a facility bypassed their nearest facility. One of the reasons cited for this choice was perception of poor quality care

more work is needed to understand the contextual factors associated with the variable impact on maternal and neonatal mortality and the potential role of simultaneous investment in supply side factors, [4] such as staff, medical equipment and supplies, referral systems and quality of care delivered.

—

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

In early 2015, clinical trials of a 1000 year-old Anglo-Saxon eye remedy established that it was almost 100% effective at wiping out the MRSA bacteria. The main ingredients of the remedy? Onion, garlic and wine. “We were blown away by just how effective the combination of ingredients was,” said Dr Freya Harrison of the University of Nottingham’s faculty of medicine and health sciences….more

The high cost of treatment makes mental healthcare inaccessible to those using public health services. ….more

African academics are steeped in European knowledge systems. There is a galaxy of African scholarship they can draw from – if they’re brave enough….more

If we are to effectively tackle terrorism, there needs to be some truth-telling, historical perspective and a genuine desire to get to the heart of the beast. We must acknowledge that terrorist organisations are often a product of real or perceived injustices and are borne out of a sense of desperation. And they are often supplied with arms by the very forces that claim to be fighting them….more

The horrendous terrorist attacks in the French capital last week brought the whole world to a stand-still. Yet similar violence elsewhere has not attracted comparable outrage and sympathy. What’s more, the daily deaths of impoverished people condemned to a sub-human existence by White supremacist ideologies hardly make the news…..more

Yes, the attacks in Paris were brutal. But what of the terror that has been instigated in the name of empire? Is it less of terror to bomb cities, villages and country-sides? Is the control and manipulation of the financial world a morally justifiable act? Are ‘free trade’ agreements free when they subjugate poor nations to terms that essentially destroy them? Is the blatant theft of the resources of the Global South moral? ….more

The world is in crisis. The nation-state and the international system have failed to serve the needs of all humanity fairly. While privileging a minority, this unjust system has marginalized most of the world’s people. Global terrorism is a reaction to this failure. A new international political economy is urgently needed…..more

The developed world’s workforce will start to decline next year, threatening future global growth…..more