When an outbreak of cholera rippled across Ethiopia in the fall of 2006?leaving 477 people dead and sickening 45,090 others--Oxfam America responded to the crisis in a new way: It tracked down the likely source of the outbreak, helped start a local education campaign about the disease, and assisted in setting up treatment centers.
The work is part of Oxfam America's new public health initiative launched by the humanitarian response department. Its aim is to deepen the effectiveness of its emergency programs and to start building a bank of scientific data that the agency can use to advocate for changes that will improve the lives of poor people.
"Public health assessments provide true evidence of a problem, and they are a lot more effective than rhetoric in focusing attention on the issues," said Miriam Aschkenasy, an emergency medicine physician and Oxfam America's first public health specialist.
Hired in July to head the initiative, Aschkenasy will work on a variety of projects as the agency begins to map out its public health priorities and build a network of specialists who could respond in humanitarian emergencies when the need arises.
"Public health was going on, but no one was calling it public health," said Aschkenasy. "Some of the grants Oxfam awarded to partners were addressing problems such as diarrhea, HIV/AIDS, and access to care. All of these are public health issues, but they didn't fall into a particular person's portfolio. As the humanitarian response department did more of this work, it became apparent it needed someone who specialized in this area."
But Aschkenasy is not undertaking this task alone. A key component of the new program calls for collaboration between Oxfam and top medical facilities, many of which are located in Boston, the agency's headquarters. A formal partnership with the Harvard Humanitarian Initiative is the first of these relationships. The initiative, or HHI, is a joint academic program involving multiple entities within Harvard's academic and medical community. It combines expertise in public health, medicine, social science, and humanities to advance research, practice, and policy in the field of humanitarian assistance.
"Here in Boston we have access to some of the most skilled public health specialists in the world," said Michael Delaney, Oxfam's director of humanitarian response. "We give them the history, the politics, and the culture of a situation--the key ingredients to an effective humanitarian response--and they give us the voice of authority on public health matters when we meet with government officials to push for change."
Health concerns in Ethiopia
Twice since last summer, teams from HHI have been dispatched to Ethiopia to quickly study a problem and make recommendations on situations in which people's lives were at grave risk.
In the first instance, an outbreak of ethnic fighting in the southern part of the country had forced tens of thousands of people to flee their homes and seek safety in the bush. Hunger, exposure to the elements, and extremely limited water supplies had begun to take a toll on many of those who had fled. Oxfam and HHI sent a small team?two doctors and a humanitarian response specialis--to conduct a rapid assessment of the situation and offer ideas for improving it.
"The humanitarian needs among the internally displaced people in both the Guji and Borena zones are significant," said Jennifer L. Chan, one of the Harvard doctors, after the visit. "At the time of the HHI/Oxfam assessment, immediate food, shelter, and non-food items were needed as well as establishment of long-term peace building activities." Oxfam had already provided some emergency assistance prior to the assessment.
Three months later, Oxfam and HHI sent a second team to Ethiopia to investigate and respond to the outbreak of cholera.
"The idea behind the assessments is to provide a superior response," said Aschkenasy. "Our affiliation with HHI does that. It provides us with a cadre of cutting edge public health professionals, academics, and their resources. And the evidence they help us gather strengthens our ability to call for change."
Launching an early warning system
Aschkenasy will help lay the groundwork for some of that change when she travels to Ethiopia in mid-January on a prevention mission that may help stop a repeat of the widespread suffering that affected millions of people across East Africa last year. Their lives stood in the balance as a devastating drought gripped the region, killing the livestock on which they depended for food, drying up their water sources, and plunging countless families into debilitating hunger. By the time the extent of the drought became clear to the rest of the world, it had already caused profound damage.
In Moyale, a dusty border town between Ethiopia and Kenya, Aschkenasy and Chan will launch a drought early surveillance system developed by Oxfam America and HHI. Their goal is to help officials in the region track public health trends that will warn them in advance about which droughts could become killers. How much food do families have access to? Are they plagued by diarrhea? Do their children have respiratory problems? Do their goats, cows, and sheep have enough pasture? How much rain has fallen? Is the price of grain climbing?
They sound like simple questions, but their answers--plotted on a chart that can make trends frighteningly clear--could be key to getting people in this drought-prone region, many of whom are herders and extremely poor, the help they need before it's too late.
"If we can determine quickly what the effects of limited rainfall are, then we can start doing interventions long before things get so bad that severe malnutrition becomes widespread and feeding centers are our only recourse," said Aschkenasy.
Following her heart
A fellow at HHI, Aschkenasy keeps her medical skills honed by working four eight-hour shifts a month at the Boston Medical Center. But she knew long before arriving at Oxfam that public health was where her heart was.
"When I was in my second year of residency, I had a chance to go to Nepal and work in the Tribhuvan University Teaching Hospital in Kathmandu. It doesn't take you long to realize that public health has a much greater impact on people than one-on-one patient care. I also realized how much I loved it," said Aschkenasy. "There's a role for one-on-one clinical care, and I enjoy it. But there's something much more satisfying about public health work. It has a broader impact. You're preventing something from happening."
And that's a central objective for Oxfam?s humanitarian response department: preventing events--natural or man-made--from cascading into disasters.
"Public health ties right in with our preparedness and livelihoods work. That triad is what development is all about," said Aschkenasy.