When Colombo University's Community Extension Center in Sri Lanka uncovered mistreatment of tsunami survivors, the researchers went straight to the country's Human Rights Commission to right the wrongs.
Anawim Trust researchers studying good practices among Indian non-governmental organizations (NGOs) in empowering women didn't settle for documenting what they saw: soon the NGOs were implementing new, more women-friendly policies in their organizations that reflected what they'd learned from the Trust.
And long before the Institute for Policy Studies had published its study on Sri Lanka's disaster management systems, researchers had already helped reshape the key national disaster agency.
This is research at its liveliest, where the findings get results before the ink is dry.
"The studies we're supporting aren't destined for a dusty shelf somewhere, and they're not carried out by academics from faraway places," says Russell Miles, an Oxfam humanitarian specialist. "We're partnering with local researchers who are dedicated to solving problems in their own countries."
The Oxfam program involves a process known as participatory action research. The "action" part of the name has to do with its purpose: getting immediate results, rather than studying issues simply for the sake of learning. And it's participatory in that focus groups and other interactive activities in the communities take precedence over Internet searches and leafing through books at the library.
"Reducing disaster risks is a complex process that requires continuous learning," says Miles. "We've found a way to ensure that community members are at the center of that learning process."
]]>The companies – Novartis, Merck and Pfizer – are resisting moves by India, Thailand and the Philippines respectively to use safeguards that are written into World Trade Organization (WTO) intellectual property rules in order to protect public health. Each company is trying to impose its patent monopoly on a big-selling medicine to stop the countries from exercising their rights to trade in cheaper generic equivalents.
"The industry is fighting hard because developing country markets, especially in Asia, are vital for its future growth and these medicines under dispute are so valuable," said Celine Charveriat, head of Oxfam's Make Trade Fair campaign. "These disputes put monopolies and profits over public health, which is exactly what world leaders promised would never be allowed to happen under WTO intellectual property rules."
Pharmaceutical sales across the world's four biggest emerging markets, including India, grew by 22.3% in 2005 compared to single digit growth in the US, Europe and Japan. Of the medicines in dispute, Novartis' anti-blood-cancer drug Glivec is worth $2.1 billion in annual sales and its patent begins to expire in 2013. Pfizer's hypertension drug Norvasc is worth $4.7 billion in annual sales and it wants to extend its patent that has already begun to expire in some countries.
In a statement prepared for Oxfam, Constant Gardner author John le Carre said yesterday:
"Here is what I wrote five years ago in the Afterword to The Constant Gardener: 'As my journey through the pharmaceutical jungle progressed, I came to realize that, by comparison with the reality, my story was as tame as a holiday postcard.' The reality today is worse. By imposing one-to-one deals on individual governments, Big Pharma is dishonoring hard-won international agreements designed to allow lifesaving generic drugs to be produced and marketed in countries where there is urgent and demonstrable need. The present posture of Novartis in India is a classic example of Big Pharma's unbeautiful priorities. With unlimited legal resources Novartis is challenging India's sovereign right under international law to supply cheap, non-patented drugs in situations where the public health is at risk. If the case succeeds, Novartis will have protected the health of its account books at the expense of those who will die because they can't afford the drugs that could save them. "
"Since India is the main supplier of inexpensive medicines to the developing world, a victory for Novartis will also curtail access to affordable medicines in Africa and Asia," Charveriat said. "These three disputes show that the intellectual property system cannot work to protect public health if companies can continue to undermine developing countries from using legitimate health safeguards. In two cases, we have a legal battleground where poor people are losing out to vested interests."
Some companies, including Merck and Novartis, say they can discount prices or donate medicines to poor patients instead. Oxfam says that this is not the long-term solution to sustainable access to affordable medicines and does not cover all patients who need them.
"Donations can help poor people in specific situations, such as disease eradication programs,' said Charveriat. "However, discount programs keep all decisions about who can get medicines and for how long in the hands of the companies. A sustainable and proven way to get affordable medicines to people is by generic competition."
"The Philippines, Thailand and India have taken important steps to use public health safeguards to reduce the price of medicines and respond to serious public health problems. They should not be bullied when rightfully applying these rules," Charveriat said. "We applaud their efforts. They should remain strong against this corporate pressure and the companies should drop their lawsuits and their objections."
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The declaration states that developing countries must be able to use public health safeguards written into the World Trade Organization's (WTO) intellectual property rules (called TRIPS) in order to access cheaper generic versions of patented medicines. Generic competition is the most sustainable way to keep the price of medicines down, according to Oxfam.
"Rich countries have broken the spirit of the Doha Declaration," said Celine Charveriat, head of Oxfam's Make Trade Fair campaign. "The declaration said the right things but needed political action to work. That hasn't happened. We've gone backwards. People are still suffering or dying needlessly."
Since 2001 things have become worse for sick people in developing countries:
According to the World Health Organization, 74 percent of AIDS medicines are still under monopoly, 77 percent of Africans still have no access to AIDS treatment, and 30 percent of the world's population still does not have regular access to essential medicines.
At the same time, rich countries, especially the US, are bullying developing countries to impose stricter intellectual property rules in order to preserve pharmaceutical monopolies. This is restricting generic competition and keeping prices high.
"Global health statistics are grim but the US continues to negotiate trade deals with stricter rules that limit how a country can use public health safeguards," said Charveriat. If implemented, these deals will result in Colombia having to pay an additional $940 million per year by 2020 to cover the increased cost of medicines, affecting nearly 6 million patients. Similarly in Peru, the price of medicines could increase by 100 percent in 10 years and 162 percent in 18 years.
Other rich countries, particularly those among the European Union, have quietly consented to US actions. Pharmaceutical companies have gone even further by directly challenging countries such as India and in Philippines that have sought to use the safeguards.
In 2005, cancer patient groups in India used Indian intellectual property law to stop a patent application by the Swiss company Novartis for its anti-cancer drug, Glivec. This allowed Indian companies to continue making generic versions at $2,700 per patient a year, as opposed to Novartis having a monopoly priced version for sale at $27,000 per patient a year.
However Novartis recently appealed the court's decision in a direct challenge to India's right to interpret the TRIPS Agreement to protect public health. If Novartis is successful, it could jeopardize India's generic export industry. India is the world's leading exporter of generic medicines, with 67 percent of its exports going to developing countries.
"Novartis has told Oxfam that there is no commercial market for Glivec in India and that it is challenging India in order to align Indian intellectual property law with TRIPS," Charveriat says. "However, India is only trying to use the flexibilities rightfully available to it under TRIPS and Novartis is seeking to block that right."
Meanwhile in the Philippines, the government has conducted tests and issued regulatory approval for a cheaper patented version of Norvasc, a heart disease drug now under patent to the US company Pfizer. The government is doing this to ensure that a cheaper patented version of Norvasc that costs almost 90% less will be available immediately from when the patent expires in June 2007.
Oxfam believes that the government's action is consistent with the TRIPS Agreement and with the Philippines intellectual property law. However, Pfizer is now suing the government. If Pfizer is successful, it will severely limit the government's ability to access cheaper medicines and assert its right to enforce TRIPS safeguards.
"Developing countries have a responsibility to use the public health safeguards but when they try to do so they are put under huge pressure," Charveriat said.
In order to make the Doha Declaration work, Oxfam is calling for:
"Rich countries must live up to their commitments and stop undermining the Doha Declaration with their selfish actions," Charveriat said. "Now more than ever we need a global trading system that puts health before profit and makes medicines affordable for all."
]]>Dr. Almendares is a renowned defender of human rights and the environment. He has a long trajectory of work in the poorest communities of his country, providing people with free health care, organizing them, and passing on his knowledge. In his academic career, he has directed research at prestigious universities and institutions, including the University of Pennsylvania, Harvard University, and the Cardiovascular Research Institute in San Francisco. In his own country, he has dedicated himself to the sciences, first as a professor at the Medical School, later as its dean, and eventually as rector of the Autonomous National University of Honduras.
After the award ceremony we spoke with Dr. Almendares:
What does it mean to you to be nominated and then elected for this prize from InterAction?
I accepted this recognition as a noble and generous act by the organizations in the United States, and also as an act of solidarity with the people we are working with to build a better world that is more respectful of human rights and environmental justice. This honor has been a great act of moral support for me in the face of the all the risks we take in order to defend the life and dignity of human beings and to provide for a great love of humanity and our planet earth.
What inspired you to study medicine?
My greatest inspiration was my mother. I call it the theology of dreams. When my mother was pregnant she dreamed she was in paradise and that I worked with plants, the environment, and serving humanity. I come from a poor family. We lived in a poor neighborhood plagued with alcoholism, prostitution, and violence. Thanks to my mother's advice, I didn't get involved in all that. She never physically or psychologically abused me and she taught me a culture of non-violence. But it was a struggle to make it out of that environment. When I was in college sometimes I went hungry. I was malnourished and anemic. When I it was my turn to spend six months in bed, I learned what it meant to be a patient, and that as a doctor, one must be humble. When I graduated from the university with a degree in medicine, I had three callings: to work on behalf of the poor, to educate, and to dedicate myself to science.
These callings led you to establish various projects aimed at improving people's lives...
For many years we have run a clinic for poor people where we provide free medical attention. Mostly we work with the urban poor residents of Tegucigalpa and with indigenous people in some of the most remote communities in the country, where doctors rarely venture. In addition to providing medical attention, we do organizing work. For example, we work with 26 communities in the Tegucigalpa urban areas. We organized the women in these communities into a committee called the Honduran Committee for Peace. Now they have family gardens. Also, with the support of a Canadian organization, we have constructed more than 200 tanks to store the water that they get only once a month. We held natural medicine workshops to teach women how to treat common illnesses themselves. For example, chamomile, mint, and linden flower teas, and massage techniques, can relieve stress and tension. We have taught them how to treat a cough or diarrhea. We are also concerned about the environment and founded the Madre Tierra [Mother Earth] movement. Now we are working on a reforestation project. We asked the kids in the program how many trees they would like to plant. The told us one million trees. So, with the dream of planting a million trees, we are working with them in the poorest neighborhoods. We have already planted more than 15,000 trees and within this movement we have created a school of sorts, where kids are learning how to care for the environment and their health.
How is your work related to Oxfam America's work?
Through our work with Madre Tierra, we have been involved with Oxfam on the issue of mining. Madre Tierra has been studying the health impacts of heavy metals. We have been conducting research for five years in the Siria Valley region of Honduras, where there is a large mine. With the help of a Harvard student, we were able to get baseline data on the health conditions in the community prior to the mine, in order to make a before and after comparison. We go to the communities to conduct research and clinical exams and what we have noticed, interestingly, is that it is mostly the women who are ill, not the men who work in the mines. The women use the water often, to cook, clean, and wash clothes. We have seen many health problems in their skin, eyes, and nervous and respiratory systems. Oxfam America has helped a lot by providing us with information on technical and ethical issues. It has worked on a broad scale in many different areas.
In all these years that you have spent working with the poorest of the poor, have you seen any changes in the people, their situation or policies?
Yes, we have seen changes. The people have a better perception of their situation; they are more aware. This allows them to dissent and make demands of the authorities if they disagree with decisions they make. We also work in human rights. We have a center for torture victims and violence prevention, inspired by the teachings of Gandhi, Martin Luther King, and Francisco Morazán [Morazán, a Honduran politician and defender of democracy, was the last president of the Federal Republic of Central America in the mid-1800s]. We have been able to promote a message of non-violence with government institutions, which we see as directly related to the issue of health. We advocated for the government to incorporate mental health issues in its human rights agenda and women's rights into the health agenda. The government also approved and ratified The United Nations Convention Against Torture.
Your work presents you with some of the toughest situations in your country. What motivates you to keep going?
Despite it all, I always maintain great optimism and a love for the earth. I appreciate the cooperation from the international community. I have found great human beings in all the continents: Africa, Europe, Asia, and America. I am very grateful for this. We must always have love and compassion among us and with all that we do.
]]>One of the remarkable things about Darfur is the number of people who are still volunteering with health committees after three years of living in Abu Shouk and Al Salaam camps outside of North Darfur's capital of El Fasher.
About 60 percent of the original committee volunteers at Abu Shouk have continued with their work. At nearby Al Salaam camp, the number is 80 percent. Their help is pivotal to the success of Oxfam's public health work in the camps. Every week they spend several hours visiting households in their allocated blocks and inspecting the surrounding areas.
They go shelter to shelter talking with families and sharing information on good hygiene. They check latrines for cleanliness and wear. And they instruct families on how to keep their water clean by making sure the jerry cans in which they store it are scrubbed with powdered soap and chlorine.
"We wanted to serve our people and to raise the awareness of the population so that everyone's at the same level," says Kaltoum Ali Asad, a volunteer at Abu Shouk.
"If we don't volunteer to do something the people would suffer and there'd be outbreaks of diseases and illnesses," adds Namma Saed Haroun at Al Salaam camp. "If we didn't volunteer it would be us who would eventually suffer, so we will continue to volunteer."
Their efforts win high praise from the agency.
"The volunteers work really hard," says Hussaam Eddin Mirghani, Oxfam's team leader at Abu Shouk. "They volunteer because they're afraid of diseases, especially diarrheal diseases, spreading throughout the camp. The volunteers really feel the necessity to support their communities and their people, who are really suffering in this dreadful situation."
Camp life is bleak. Ahmed Eysa, who has lived at Abu Shouk for three years with is family, makes that clear.
"Life here is horrible," he says. "It's full of difficulties, and we don't have any solutions in our hands. There are no choices for the people living here in the camp."
But Eysa has made one choice—an important one that will make a difference to others in the camp. He chose to volunteer, and he has continued giving his time for three years.
"We have to adapt to our situation and we really need to respond," he says. "There's no way we could give up."
Soon, the rains will come and fall heavily. Living conditions in the camps will deteriorate, and the threat of diseases like cholera, malaria, and diarrhea will rise. Then, the job of the health committee workers will be even more vital.
]]>According to an Associated Press story, President Correa publicly pledged government support for the case, which began nearly 10 years ago in the United States and was thrown out on appeal in 2003. Since then the court in Ecuador has been conducting judicial inspections of polluted areas, gathering evidence a judge will use to make a decision, possibly in the next year.
During the same week, indigenous leaders representing the people affected by the pollution in the Orellana and Succumbios region of Ecuador attended the annual meeting for shareholders of ChevronTexaco in California. Humberto Piaguaje, a leader of the Secoya indigenous people, called for the company to resolve the case and help clean up the environment. "We want you to give us back our lives," Piaguaje said. "We want you to let us live in peace and harmony with nature. We want you to repair the damage so that our children do not have to continue suffering."
Oxfam America has supported the Amazon Defense Front's legal case for nine years, and assisted in the creation of the Assembly of Delegates of Communities Affected by Texaco, a community-based organization that has ensured those most directly affected by the pollution have a voice in the legal strategy.
"We think it is positive that President Correa has declared his support of those affected by pollution in the Lago Agrio region," said Javier Aroca, who coordinates programs related to indigenous rights for Oxfam America in South America. "We consider this is a signal that the government is interested in investigating and sanctioning those who are responsible."
"It is important to remember that the people affected are demanding compensation for almost 10 years now," Aroca said. "The pollution has affected the health of indigenous peoples and peasants... there have been cases of skin diseases and cancer. Furthermore, the lands are not as productive as they used to be, which has affected the agricultural economy. From our point of view, the government of Ecuador should support the affected population to complete the legal procedures, which are very expensive."
A win for the Amazon Defense Front in this precedent-setting case could change the landscape of the oil industry, and further establish the rights of communities to be compensated for negative social and environmental effects of oil operations.
]]>But once they know this they take serious action, learning how to prevent the disease by sleeping under nets treated with insecticide, and filling in puddles and other places where mosquitoes can breed. They take special care to help pregnant women get access to government-sponsored prenatal care, which includes a free mosquito net.
A recent survey of villages where Saving for Change groups have been formed is showing that 75 percent of members understand that mosquitoes transmit malaria, while only half of non-members in the communities know this. Seventy percent of members knew that mosquito nets are an effective way to prevent malaria, compared to only 40 percent of non-members. More than half of members said they slept under a bed net the previous evening, compared to just 30 percent of others in the community. And more than 40 percent of Saving for Change members said they had purchased a bed net since joining a group, evidence that the availability of information about the value of bed nets contributed to changes in behavior.
Overall, malaria killed 22,000 people in Mali in 2005, and ranked third among all causes of death after respiratory infections and diarrheal diseases, according to the World Health Organization's latest figures. The death toll for children is particularly severe. Mali ranks 175 out of 177 countries in the rate of death from all causes of children under five, at 218 per 1,000, and malaria causes about 17 percent of those deaths.
"Malaria is a crucial problem in Mali," says Macky Doucouré, president of the non-governmental group CAEB, one of Oxfam's Saving for Change partners in Mali. "The majority of deaths of pregnant women are due to malaria. More women in Mali die from malaria than they do from AIDS...as many as die in childbirth."
The death toll is heavy, but so is the price to stay alive, as many families struggle to find money to transport sick people to clinics, and buy medication. "Some families have to spend as much as 60 percent of their income on health care," Doucouré said. This is why malaria is an important topic when it comes to community finance programs: nothing will destroy a family's assets like chronic illness.
Once women are organized into Saving for Change groups it is easier for them to work together to educate people in their village about malaria and take steps to prevent it. "It is a really big change for people to understand that there are things they can do in their own villages to prevent malaria," Doucrouré said.
He described one village where women in a Saving for Change group took some extraordinarily active steps. "They decided to create their own committee to help women prevent malaria, and encourage the use of insecticide impregnated mosquito nets at night while people are sleeping. Each night members of the committee would visit homes to make sure women and their children were sleeping under their mosquito nets, and they would even fine women not using the nets 50 CFA or maybe 100 CFA [10 or 20 cents]."
"Creating a committee to prevent and help people treat malaria is a significant innovation for these families and their village, and it was made possible by the Saving for Change group financed by Oxfam—it is something the women created themselves to deal with the problem, it did not come from outside the village."
]]>The Kenyan government, international donors, and aid agencies must all immediately take action to address the crisis, Oxfam said.
Dadaab is one of the world's largest concentrations of refugees. Its population now stands at more than 250,000—almost three times its intended size. Up to 100,000 more people are likely to arrive by the end of this year as Somalis continue to flee violence and seek refuge in Kenya.
A new Oxfam assessment of the humanitarian situation in the camp has uncovered a serious public health crisis caused by a lack of basic services, severe overcrowding and a chronic lack of funding. More than 20 cases of cholera have been confirmed. Kenya recently closed its border with Somalia, yet refugees continue to arrive daily and the border closure is actually exacerbating the crisis, the report found.
"Conditions in Dadaab are dire and need immediate attention. People are not getting the aid they are entitled to," said Crosland-Taylor. "Half of the people in the camp do not have access to enough water. Women and children—who make up over half Dadaab's population—very rarely have access to adequate latrines."
Oxfam's report recommended that the Kenyan government re-open the Kenya-Somalia border, and provide additional land near to Dadaab for a new site to ease the overcrowding. The report also recommended that international donor governments urgently respond to UNHCR's appeals for more funding to deal with the crisis, that UN and aid agencies ensure that recent increased efforts to address the crisis are sustained, and that local Kenyan communities near Dadaab are not neglected.
The Kenyan government's decision to close the border has not stopped refugees coming, but it has made conditions much worse for them and their Kenyan neighbors, and has added to health risks in the camp. Reception centers on the border run by the UN High Commission for Refugees (UNHCR) used to give health checks to new refugees. However, as a result of the border closure, these centers were closed down, meaning new arrivals no longer receive the health checks before reaching the camp. In such overcrowded conditions, even a single case of cholera can spread rapidly.
"Until there is a lasting peace in Somalia, many more people will continue to flee. The Kenyan government must address this humanitarian crisis, rather than ignoring it. An open but managed border will allow Kenya to meet its legitimate security concerns, but also allow refugees to receive the assistance to which they are entitled under international law," Crosland-Taylor said.
The situation in Dadaab has led to increased tensions between Somali refugees and the local Kenyan community, particularly over rights to land and resources such as water and trees.
"Dadaab is in a very poor region and the needs of the local communities must not be forgotten," explained Crosland-Taylor. "More funds are needed for aid agencies to help local people as well as refugees. Scarce natural resources have to be shared by everyone, and projects are needed to explore alternative technologies and ways of ensuring that those resources are managed in an equitable and sustainable way."
]]>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."
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."
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.
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.
]]>In 2005, cancer patient groups in India used Indian intellectual property law to stop a patent application by Swiss company Novartis for its anti-cancer drug, Glivec. This allowed Indian companies to continue making generic versions at about $2,700 a year, as opposed to Novartis having a monopoly priced version for sale at about $27,000 a year.
Novartis recently appealed the decision in a direct challenge to India's right to use safeguards contained in trade rules agreed by the WTO in 2001 in the interests of public health.
What is Glivec?
Glivec (Gleevec in the US) is an important drug that means the difference between life and death for cancer patients suffering from leukemia (CML), stomach tumors, and other conditions. Glivec is a significant improvement over other forms of treatment and should be as widely available as possible, at affordable prices.
Why is Novartis enforcing its patent on Glivec in India and in other in developing countries?
Glivec is a key drug for Novartis worldwide. It's the company's second best selling drug with sales reaching $2.8 billion in 2005 and accounts for 9.6 per cent of Novartis's estimated share value. Research indicates that there are multiple diseases that respond to the drug. In only five years, Glivec is now approved in the US for seven different diseases. There is a danger that the company could apply for a new patent based on these "new uses" elsewhere, which would extend its monopoly and delay availability of affordable generic versions of Glivec for people who need it.
Novartis says that there is virtually no commercial market for Glivec in India and that it is taking the case in part to "align Indian IP laws with TRIPS", The World Trade Organization's agreement on intellectual property. This action is one that will affect India's right to produce not only generic versions of Glivec but also for other new medicines in the future.
What would happen if Novartis were successful in its appeal?
Not only would it increase the price of the drug it would also jeopardize India's generic export industry. India is the world's leading supplier of inexpensive generic medicines to developing countries with approximately 67 percent of its exports going to developing countries. As a result people needing cheaper versions of medicines in many developing countries would lose out.
Oxfam believes that generic competition reduces the price of many patented medicines and makes them much more affordable to poor people in developing countries. Lower prices via generic competition could ensure free or subsidized medicines for millions of poor people through increased public sector funding for health, through health insurance and because many poor people are willing to pay out of pocket for medicines because the health and well being of themselves and their family a top priority.
]]>Many experts thought these tight-knit communities were relatively safe from the AIDS epidemic, but with the death and displacement of hundreds of thousands, the social landscape—like the coastline itself—was recreated in a moment.
The rumors reached Jose Michael, director of Oxfam's HIV program in India—that people living in crowded temporary houses and communities were experiencing new pressures that could increase their risk of HIV infection.
"There were many possible triggers, but we had no evidence," says Michael, so while he continued the Oxfam HIV/AIDS awareness program, he and Hari Krishna, an Oxfam disaster response specialist, engaged a well-known Indian health research organization to determine whether and how the tsunami disaster and its aftermath was increasing the vulnerability of the coastal communities to HIV infection.
"We did not set out to determine actual rates of HIV infection in the villages," says Hari Krishna. "That would have revealed very little about the changes precipitated by the disaster and even less about how and why they took place." Instead, the research focused on how people felt their own HIV-related behavior had changed since the tsunami, and what brought about those changes.
The central difficulty in carrying out the research is obvious: who wants to talk about your own behavior if it's something dangerous or strongly condemned in your community? But the inventive staff of the Swasti Health Resource Center, Oxfam's research partner, came up with a plan and a new research tool, which they call the polling booth.
Eight women sit in a circle, each with a cardboard box in front of her to conceal the choice of cards she places in a jar. In the center of the circle stands a facilitator who asks a set of questions aimed at determining how vulnerable these women are to contracting HIV.
This is a demonstration of the polling booth technique. The equipment involved is simple: a jar, a cardboard box, and a stack of numbered cards—green to indicate yes and red for no—are all it takes to build a "booth." But with willing participants—and researchers who have earned their trust—it can be used to carry out the very delicate task of eliciting honest answers to tough questions.
After the polling booth survey, the facilitator and participants tabulate and discuss the results. In a real-life situation, the facilitator might begin by saying, "Two people answered that they use condoms and six said they don't. Why do you suppose people in this village might choose not to use condoms?" Such a question could launch a valuable discussion of community perceptions of condom use and the spread of HIV—with no one having to reveal his or her own personal decision.
"What we share in a polling booth is fact," says S. K. Shashikala, who participated in the Swasti research and later helped demonstrate the technique to observers. "In this process, there is no inhibition."
Researcher Manoj T.J. led groups of men in these polling booth sessions. "The participants had a chance to talk about issues that they might otherwise be silent about," he says. "The discussion often revealed realities on the ground. When you know those realities, you can plan accordingly."
A research participant named Vasanthamma added a gender dimension: "This is good for women where we come from a culture of silence."
Although the researchers were successful in their mission, they had bad news to report. After interviewing around 1,000 people in 30 tsunami-affected communities, they determined that in 10 out of 11 of the temporary shelter settlements studied, HIV vulnerability rose in the aftermath of the tsunami. (Read a summary of the report.)
The lingering trauma of the tsunami disaster combined with life in the crowded temporary shelter settlements and disruptions in employment triggered changes in sexual behavior which, in the absence of strong knowledge about safe sex practices, put men and women at risk. Strict community standards of behavior were unenforceable when villages were scattered into temporary camps, and many survivors were drawn to alcohol and extramarital relations—including commercial sex—as a means of coping with stress, boredom, and overwhelming grief.
Now that the tsunami recovery is well underway, many of the conditions that caused HIV vulnerability to spike have been resolved. The need for AIDS education and services remains acute, but most people can report that they've moved out of temporary shelters and are back to work, and that the trauma of the tsunami has subsided. But for emergency aid providers, the research has implications far beyond the coast of India.
"If aid providers don't supply enough water or food or shelter after an emergency, it's clear to everyone what's wrong, but a rise in HIV risk after a disaster can go undetected until it's too late," says Mike Delaney, Oxfam America's Director of Humanitarian Response. "Now we know much more about how responders in future emergencies can help communities reduce their vulnerability. This is research that could save lives."
]]>But, he adds proudly, he does know how to wash his hands properly after going to the latrine—something he rarely did just a few weeks ago. And he proceeds to demonstrate to the group of children, who—like Osman—have started attending Oxfam's child-to-child educational programs that aim to equip the children of Kalma camp with knowledge that could save their lives.
Football matches, songs, volleyball tournaments, and playground games are just some of the innovative ways in which the Oxfam Public Health Promotion (PHP) team here is teaching children how to stay healthy.
Kalma is one of the largest camps in Darfur—mile after mile of tightly packed shelters and rapidly constructed sanitation systems currently home to around 89,000 displaced people. As in most camps, the vast majority of residents are women and children. Two years ago there were just 19,000 people here, but rapid growth since then has created an abundance of health risks, to which children are the most vulnerable.
"Children everywhere need to be taught to wash their hands and keep clean," says Khaled Suleiman, one of Oxfam's PHP officers in the camp. "But here especially so, as the consequences can easily be fatal."
To make sure the messages sink in, Khaled and the team try to make them as fun as possible. Oxfam has built a series of community shelters where child-to-child interactive classes and activities are held.
Songs are enthusiastically sung about how to prevent malaria and diarrhea ("Our food should be washed, our water should be covered," the children sing, accompanied by stomping of feet and clapping of hands).
Other songs encourage children to participate in community clean-up campaigns, and explain how to set up mosquito nets and use the latrines properly. Oxfam has installed around 9,000 family latrines and 1,500 communal latrines in Kalma.
The children in Kalma love to make noise. The merest glimpse of a new Oxfam worker elicits a chorus of hundreds of voices shouting in unison, "OK, OK"—the nickname the children of Kalma have given to foreign visitors and the first English word every child in the camp learns. The welcome is followed by mischievous smiles and laughter all round, and the children's enthusiasm for loud, energetic fun extends into the classroom.
"My favorite is the singing and dancing," says Osman of the child-to-child activities, his arms waving frantically about his head as he mimes the actions to a song about swatting away flies. "And I like to learn new things." He has spent most of his short life in the camp after arriving here with just his mother. Nobody is sure what happened to his father and brothers.
Nine-year-old Hawa also likes to sing. "I enjoy the classes as I can make friends with lots of other children and learn at the same time. We sing the songs when we go home as well. I would like to go to school but so far I have not been able to," said Hawa, who has been in the camp for two-and-a-half years since her family fled their village of Shataya, nearly 100 miles to the west.
The PHP team works with community volunteers to come up with new songs that they think the children will find both educational and entertaining. "Kalma is as big as a city, so it is divided into eight 'sectors,'" says Khaled. "Recently we heard children from sectors 7 and 8—the only parts of the camp where Oxfam does not work—singing our songs! The children at our classes had been singing at home and gradually the songs spread around the entire camp."
The programs have proved extremely popular—almost too popular. The teachers—themselves displaced people living in the camp—say they often have 400 children trying to cram into a single room at the community shelter. "Every time we open the door, another dozen or so burst in," says Khadija, who teaches children in Sector 3 of the camp.
"Having such large classes can make it very hard for us to get the message across successfully," she says. "So we have split them into groups. Group 1 comes between 8:30 and 10:30 and Group 2 between 11 and 1 pm. Of course, some children try and come to both!"
"We are trying to ensure that the children are exposed to our messages at every possible opportunity," says Khaled. "The songs are just a part of our activities and it is clear that children's health has improved since the programs began."
Cartoon drawings explaining how food can breed germs, and how failing to clean latrines will spread disease and attract rodents, are pinned to the walls of the community shelters. Football matches and other events are organized for children to attend, where health-related information is disseminated.
The PHP team is also coordinating its efforts with the four primary schools in Kalma camp. A number of children from each class are chosen as supervisors and join teachers for training in hygiene promotion. The skills and facts they learn are then passed on to their classmates and pupils.
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