Sadly, I am leaving this wonderful island tonight. I cannot imagine how the time has flown by so fast. The last week was intense; activities included inputting and analyzing the data we collected, preparing for the presentation, organizing the workshop for stress management, and saying goodbye to my dear friends on the island. 

After learning about the culture and lifestyle on this south pacific island by interviewing people, we started to actually collect data with the tailored survey that would give us ideas about the stress status of the people in American Samoa. This survey was designed analyze from multiple angles the stress status of the people, including stress level, stress symptoms, access to releasing stress, risk factors, and effective coping techniques. Also, it emphasizes the fa’alavelave which means funerals, weddings, and other gatherings in which people have to donate money due to social reputation and expectation.

The target population of this research was on students and teachers at American Samoa Community College. We collected a good amount of surveys back and then analyzed the data with statistical software. Although the most common statistical software in the USA may not be available here, we finally achieved preliminary findings. My preliminary findings were presented to the land grant staff, American Samoan Community College faculties, and the people I interviewed previously. I am glad that this research provided the American Samoans a new way to look at themselves.

Although some of the college students did not feel stress from fa’alavelave personally, they did put fa’alavelave as the answer for the question, “what is the most common stressful thing the Samoan people may have?” A possible reason for this is that the all the college students’ funds come from their family; however, their families may suffer from stress of Fa’alavelave. In American Samoan society, the family will support the children economically while they are still in school. Although the economy on the island is not well developed, people donate a large portion of money for fa’alavelave, which creates tremendous stress for them.

In my stress management workshop, I demonstrated some coping techniques such as music therapy, meditation, humor therapy, and other methods to the audience. The stress management workshop provided fresh ideas for the locals and opened a window for them to explore the opportunities to manage their stress in the future. In addition, I designed some programs for the wellness center which will open later this year. The wellness center will be the first integrated place that aims to support the public health for the islanders.

Coming to the island alone is definitely not a lonely journey. I am blessed to have the chance to embrace the culture and diversity. It is a blessing to come to this exotic place and meet friendly people, to experience a different culture and gain working experience, while at the same time contributing my skills to the community. I found myself falling in love with this island, even though my contribution may only make a small difference for the islanders. This experience made me aware of how often I take for granted the ease of access to expertise in the USA. Because the island is so resource-limited, each visiting field has only one expert, one dietitian, one psychiatrist, one entomologist, or no expertise at all in many fields. My preceptor commented on my study, saying it was a unique and promising study, and he would like to continue it as a long term program for the American Samoa population. I am glad to see what I accomplished here, and hopefully I will come back some day.

 

The past two weeks were full of activities. I conducted a series interviews with the people to obtain a better understanding of the culture and guidelines for my research, including professionals in stress and mental health, as well as people who work at healthy food promotion, obesity control, agriculture, and other various areas. After summarizing my findings, I did a presentation to inform my fellows working at land grant, American Samoa Community College, to get the staff involved with this program. The relation between stress and obesity is a novel concept to most of them. Even in Samoan language, there is not a direct word for stress, and they do not conceive of the tremendous influence of stress on health. Therefore, it is of great significance for land grant to incorporate this stress management program for the American Samoa Community College’s Wellness Center when it officially opens later this year.

Communicating with the local community made me aware of the friendly and hospitable characters of the local people. Gradually, I felt myself getting more and more used to the local culture and passionate about corresponding with the locals. Due to the culture difference, the reasons for stress and obesity of the local people vary from those in the United States. Designing tailored questionnaires for the local people provides better understanding of our research.

Diet is extremely important for obesity and stress management, especially for the population which over-consumes food. Every Sunday, Samoan people wake up very early to prepare the umu-- a traditional cooking method in Samoa. The foods from the umu are tasty and served in large amounts. Cooking food in the umu demands time and effort, so people usually overeat after they spend so much effort in preparing it. Last weekend, we had a health affair to promote healthy food and introduce the way to produce healthy food. In our venders, we made healthy smoothies and showed people the method to make it with milk, fruits, cereal, and oats. In addition, we encouraged people to get more involved with physical activities, so we held a dance contest in which people danced and had fun together and at the same time gained the knowledge of healthy behaviors. 

Next week, after finishing our tailored questionnaire, we plan to spread our survey to the target population to collect data.

Equipped with the knowledge of public health learned from my college and an enthusiastic heart, I came to American Samoa, the southern territory of the USA nearly three weeks ago. There are so much differences here, culture, family structure, work regulations, personal habits, traditional ceremonies, views of the world, just to name a few. Fa’asamoa, which means the Samoan way to do things, influences every corner in this place. In addition, the natural beauty is pristine and fabulous. However, behind the gorgeous attractions, there are tremendous public health problems here. 

From the first time I arrived here, I saw the trash spread around the road. This is not because of the residents, but the stray dogs. The stray dogs are almost everywhere. They knock down the trash can and look for food, leaving a mess and walk away. Also, being scared by bitten by the stray dogs is a main reason that people do not excise outside and do not allow their children to do it. There is one time more than 10 dogs tried to surround me! People here even joke as “if you never get bitten by a stray dog, you don’t really live in American Samoa”.

From my point of view, except for the most salient public health problem—obesity, people have stress behind their normal smiling face. One prominent culture burden is the Fa’alavelave, in which people have an obligation to show respect through gift-giving when involved in an event such as a funeral, a wedding. People here live in a bi-cultural environment that is reflected in the conflict between the traditional Polynesian life style and Americanized procedure. Furthermore, people have much more obligation in church than people in the USA mainland. The changing economy and family chores are other stressors for the local people.

Through talking and interviewing people, I collected valuable information to better know about the local culture and tailor interventions for the community. Dr. Biukoto in Lyndon Baines Johnson hospital is the only psychiatrist on the island (not anymore, because he already left). Last week I did an interview with him to get a depth insight about the mental health on the island. Besides, I went to community with my coworkers, serving food stand, promoting healthy diet and conducting interviews. 

In general, I am glad that my college and Hope Through Healing Hands Foundation provide me this fantastic opportunity to come and help the local people. I am looking forward to my next work.

Oct 10 2014

Schola Prophetarum

Language in the Global Health Arena for HIV/AIDS and Family Planning

Eating lunch outside the refectory of Vanderbilt Divinity School, back around the turn of the millennium, I remember stumbling across the stone etching of Schola Prophetarum, the School of the Prophets. I am sure all who have passed through the halls of the Divinity School may have reflected on their potential role as a prophet in our community, society, and our world. That is our legacy.

I had the unique opportunity during my time at Vanderbilt to work with a prophet-like figure, Bono, the co-founder of the ONE Campaign and the lead singer of the band U2. As he was traipsing across Middle America in 2002 during the Bush administration, galvanizing faith communities with his organization, DATA, I raised my hand to help. I spent the next six years with a brilliant rag-tag team of activists in Washington, DC. working together to promote awareness and advocacy for extreme poverty and disease, namely for HIV/AIDS in Africa. I served as the national faith outreach director. In 2002, less than 50,000 people in Sub-Saharan Africa had access to anti-retroviral medication (ARVs) that could save their lives from HIV/AIDS. Today, more than 12.9 million people have access to ARVs, thanks to the legislation of PEPFAR and the Global Fund to Fight AIDS, TB, and Malaria. More specifically, thanks to the American taxpayers. We have turned the tide.

Bono took a unique approach then by reaching out and pleading that faith communities take the lead on this issue of HIV/AIDS, in spite of the issue being at the heart of the culture wars of the 1980s. He stood outside the walls of the Church as an Irish rock star, but his language and zeal and authentic Christian beliefs allowed him to serve as prophet-esque leader inspiring faith leaders and people in the pews to love our neighbors, albeit an ocean away. And I had the unique opportunity to strategize, implement, and create language for him and the organization that I hope offered a prophetic voice on behalf of some of the most vulnerable populations around the world.

Today, that opportunity to create new language and a fresh perspective for a prophetic voice in the global health arena has arisen again.

Family planning, like HIV/AIDS has found itself in the throes of cultural battles. It is often misunderstood as including abortion, which even today, 40 percent of Americans believe it should be illegal in all or most cases.[1]But planning families doesn’t have to mean abortion. In fact, it makes abortions less likely. When discussing family planning in the developing world, we discuss with the public that the Helms Amendment of 1973 prohibits the use of US foreign assistance to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortion.

Jennifer Dyer speaking with Senator Bill Frist

I now serve as executive director of Senator Bill Frist, MD’s Nashville-based global health organization, Hope Through Healing Hands. Recently, we have partnered with the Bill & Melinda Gates Foundation to build the Faith-based Coalition for Healthy Mothers and Children Worldwide to promote awareness and advocacy for maternal, newborn, and child health with a special emphasis on healthy timing and spacing of pregnancies, or family planning in developing nations. 220 million women around the world say they want to avoid their next pregnancy but they don’t have the education, services, or access to contraceptives to do so. Melinda has made this a priority for her and for her Foundation.  As have we.

Senator Frist and I have been traveling across the United States once again, not unlike what we did over a decade ago for HIV/AIDS, to talk about family planning with faith leaders in churches, nonprofits, and academic communities. We also have been talking with religious and cultural leaders including artists, authors, and athletes. And we are building endorsements for the coalition with momentum.

Our goal is to create a new, more meaningful language to talk about the importance of family planning. Right now, to create a “big tent” approach welcoming Catholics and conservatives alike, we use language like “healthy timing and spacing of pregnancies.” These issues are at the nexus of other global health challenges, including combating extreme poverty, keeping children in schools, promoting gender equality, improving maternal and child health, and preventing mother-to-child transmission of HIV/AIDS. We can all agree that healthy timing and spacing of pregnancies saves lives.

If a woman can better time her pregnancy in a developing nation, between the ages of 18-34, her rate of surviving the complications of pregnancy and childbirth rises dramatically. For instance, she is 10-14 times more likely to survive childbirth between the ages of 20-24. And if she can space those children, just three years apart, the child is twice as likely to survive the first year of life.

Senator Frist and I do not stand inside the church as leaders of faith. But we have longstanding relationships and the expertise to challenge many in the faith community to rethink its stance on family planning, particularly for those in the developing world. We may not have the rock star status of Bono, but the education from the School of the Prophets still infuses my own writing as we create strategy and language for a renewed dialogue across the spectrum of faith communities. We hope to proffer a prophetic voice with a clarion call to save the lives of millions.

We invite you to join us. Learn more at HopeThroughHealingHands.org.

Oct 08 2014

Meet Touch

Have you had a chance to meet Touch? This dog is changing lives and we're so excited to watch what he and Senator Frist are doing for our kids. If you haven't seen it already, watch this video now. This is such a special story:

On Wednesday, September 24, a large crowd gathered at Brentwood Baptist Church in Brentwood, Tennessee, to listen to experts in the field of maternal, newborn, and child health (MNCH) with a special emphasis on healthy timing and spacing of pregnancy (HTSP). The conference hosted speakers from faith, politics, service providers, and other policy experts on these issues to lecture and engage the attendees an active discussion, including a Q & A, on the topic.

Mike Glenn, pastor of Brentwood Baptist Church and a contributor to The Mother & Child Project, opened with a prayer and a short sermon on the inkeeper in the nativity story. Perhaps, he suggests, the innkeeper tried his best to give Mary a private place to give birth to her baby boy. And that we are now poised to stand as Inkeepers to the millions of women worldwide who seek help for their maternal health.

This was followed by a interview led by Jenny Eaton Dyer, PhD, Executive Director of Hope Through Healing Hands, of Senator Bil Frist, MD, also contributors to The Mother & Child Project. Senator Frist laid the foundation for the problems we face in the field of maternal and child health and healthy timing and spacing of pregnancy, or family planning, and he encouraged everyone to advocate with their congressional representatives and senators about the issues.

Frist was followed by the Bill & Melinda Gates Foundations' Gary Darmstadt, Senior Fellow Global Development Program, and Tom Walsh, Senior Program Officer Global Policy and Advocacy. Gary presented a very data-driven survey of MNCH, showing that 11 million births worldwide occur in high-income nations with adequate medical care. But 50 million occur in low-income nations, often at home with no medical care. Sometimes even completely alone. He said, "These inequities [for moms] should not be in the world, and we all have the power and responsibility to change them." 

Tom Walsh reinforced this idea from his political perspective and area of expertise by saying, "Advocacy is letting your representatives know the have support to do what they already know is right to do."

Local and national service providers hosted breakout sessions describing their work, on the ground, in maternal and child health, including family planning. Local groups Lwala Community Alliance and LiveBeyond shared about their work in Kenya and Haiti, and Compassion International, Food for the Hungry, and World Vision discussed their global work in healthy timing and spacing of pregnancies. Their anecdotes, experience, and fresh statistics really made these issues personal.

After a catered lunch and an active Q&A discussion with a panel of all speakers, including John and Avril Thomas of Living Hope Community Center in Capetown, South Africa, Jenny Dyer closed the event with "what you can do," next steps for awareness and advocacy for the Nashville community.

To find out about more events like this coming to your town in the future, follow us at @HTHHglobal on Twitter.

This post was original published at One.org.

I was shocked to learn that the largest previous Ebola outbreak occurred in 1976 in Zaire: 318 confirmed cases and 280 deaths, but the current outbreak in West Africa has exceeded 4,200 cases with 2,200 deaths and growing. According to WHO estimates, 10,000 more lives will be lost before the virus is contained.

This is terrifying, I know. I remember feeling the same urgency over a decade ago. I was working with Bono on the ground in Africa, traveling across the U.S. on a listening tour, and I ultimately went to the White House to inform then-President George W. Bush that the U.S. desperately needed to address HIV/AIDS.

That appeal worked. President Bush boldly announced the unprecedented President’s Emergency Plan for AIDS Relief (PEPFAR) during the State of the Union Address in 2003—a time when only 50,000 people in Africa had access to anti-retroviral therapy.

Today 12.8 million people have access to these drugs, and PEPFAR has provided HIV testing and counseling to 57 million people. In 2011 alone, PEPFAR provided services to prevent mother-to-child transmission of HIV resulting in over 240,000 babies born free of HIV.

This is what the U.S. is capable of.

Today, Ebola is ravaging West Africa thanks to a confluence of circumstances. But the important message is, that we can address these circumstances, and we are not in this predicament for lack of a vaccine or anti-viral drug. The real issue are the significant cultural barriers to containing the outbreak, and lack of medical infrastructure in West Africa.

For example, people are avoiding treatment because of a widespread local doubt that Ebola even exists. There is fear that medical workers—foreign and local—are spreading the virus. Families do not want their loved ones to die in isolation, so they choose to keep them home.

Additionally, when an individual succumbs to the virus, burial practices of washing and kissing the body and then reusing the burial mat further spreads the disease because the recently deceased Ebola victim is actively shedding the virus from her skin.

For these reasons, changing culture by working within the culture will be imperative to our success. With HIV/AIDS, PEPFAR collaborated with traditional medical practitioners to deliver education and training, while also building an infrastructure that was sustainable. With HIV there were cultural practices like using leeches for bleeding that increased transmission of HIV outside safe sex practices or reusing needles. We had to address those practices in a culturally sensitive way.

We are also faced with a tragic lack of resources. The medical supplies and personnel needed to offer the routine intensive care necessary to support someone through a hemorrhagic fever like Ebola simply do not exist in West Africa.

President Obama has just announced an escalation of military involvement in Liberia only. He has committed 1,700 beds, to training of 500 health care workers and sending 400,000 home treatment kits. This will all be deployed by the Department of Defense via “command and control,” meaning they will deliver and direct the use of the resources to treat the sick.

While this is a major commitment, it is only for Liberia, but I suspect once we have boots on the ground, we will escalate even further.

As a former member of the Senate Foreign Relations committee, I have spent a lot of time dealing with the tension between our responsibility to protect and the sovereignty of foreign nations. There are myriad issues at play.

Specifically, military involvement in humanitarian efforts must always be approached carefully. I truly believe that global health is a vital diplomatic instrument to strengthen confidence in America’s intent and ability to bring long-term improvements to citizen’s lives in other nations. The fight for global health can be the calling card of our nation’s character in the eyes of the world.

I also agree that our military comprises brilliant and compassionate minds and state of the art resources. But use of the military instead of an NGO or an organization like USAID comes at a price. There is always a tension between giving aid and the deeply instilled training to maintain order especially in a humanitarian situation when the rules of engagement prevent the military from firing unless fired upon.

We can win hearts and minds with military help, but we must do it in the right way – by building a sustainable infrastructure and empowering West Africans to continue the work. The commitment to build facilities and train local personnel is a good start.

Without containment, this epidemic will become a pandemic. The World community including the U.S. needs to help. However, help needs to be culturally sensitive and build lasting solutions. We cannot fish for them, we must teach them to fish.

Take action. Support these four organizations to help fight the Ebola outbreak. 

Bill Frist, M.D is a nationally acclaimed heart and lung transplant surgeon and former U. S. Senate Majority Leader. Dr. Frist represented Tennessee in the U.S. Senate for 12 years where he served on both the Health and Finance committees responsible for writing health legislation. Dr. Frist was the former Co-Chair of ONE Vote ’08 and his leadership was instrumental in the passage of PEPFAR.

Click here to watch our Mother & Child Project video.
The Mother and Child Project:
Helping Families in the Developing World
Keynote Speaker: Former US Senate Majority Leader Bill Frist, MD
Host: Senior Pastor Mike Glenn
This faith-based conference will host dynamic speakers talking about the critical global health issues of maternal and child health, with a special emphasis on the benefits of healthy timing and spacing of pregnancies as a life-saving mechanism in the developing world. Local and national speakers will come together to talk about their special work as service providers in countries around the world, caring for mothers and children worldwide. We will lead a robust Q&A session with all the speakers encouraging further discussion. And the conference will close with practical, simple steps for how YOU can save lies and help families thrive in the developing world. 
Wednesday, September 24, 2014
8:30-2:30 pm, Brentwood Baptist Church
7777 Concord Road, Brentwood, TN 37027
Breakfast and Lunch included
Speakers
Gary Darmstadt, The Bill & Melinda Gates Foundation
Tom Walsh, The Bill & Melinda Gates Foundation
James Nardella, Lwala Community Alliance
Dr. David Vanderpool, Live Beyond
Lisa Bos, World Vision
Rick Carter & Terry Laura, Compassion International
Lucas Koach, Food for the Hungry
Jenny Eaton Dyer, PhD, Hope Through Healing Hands
John Thomas, Living Hope
Questions?
JCrain@HopeThroughHealingHands.org
This conference is free and open to the public. Advance Registration is requested by Thursday, September 18.

Read my earlier Ebola primer and a look at what we know about how the virus behaves.

As the Ebola situation in West Africa progresses, we are dealing with increasingly complex medical and cultural challenges. I addressed some of the cultural issues in a Morning Consult column last month, and highlighted the importance of identifying infected patients:

The only solution is prevention, which relies on containment and isolation. The sick must be rapidly identified and contained. Their contacts must be followed for 21 days so they can be rapidly isolated, should they develop symptoms. Their care must be delivered in a hazmat suit. If the patient dies, and [50%] do, the body must be properly disposed of because a recently deceased Ebola victim is actively shedding the virus from his skin.

But thus far, identification has not been straightforward. In its earliest stages, Ebola looks like other diseases: malaria, typhoid fever, cholera. It’s clear that these patients are sick, but it’s not clear that they are infected with Ebola virus. During the incubation period, the infected individual may not show any symptoms at all.

Currently, public health workers try to work backwards from a very sick patient. Who lives with them? Who is in their community? Where have they traveled? Who may they have had contact with over the past month? Find those individuals. Follow their health for the next month. If anyone gets sick, the process starts over.

An early, precise diagnosis would be a game changer for this process.

  1. We could separate infected from uninfected patients immediately—before they are contagious. Even in locations without sophisticated quarantine facilities, physical separation of Ebola patients from others would cut down on cross contamination within clinics and communities, and better protect one of the hardest hit groups: health workers.
  2. We could dramatically decrease the virus’s geographic spread. Incubation takes 2 to 10 days, and usually that means the person is positive but not yet symptomatic. We believe that a patient isn’t contagious until the fever starts, but a rapid diagnostic test could identify a carrier before symptoms appear, and before they travel and risk spreading the virus.
  3. We could focus on post-exposure drug development. Identifying carriers before they feel ill would let us treat them early. Some drugs have already shown great efficacy if they are given immediately. Zmab is a drug designed as a prophylactic. It’s shown to be 100% effective in primates if given within 24 hrs of exposure and 50% in 48 hours. Other similar treatments could be extremely effective if we know who to give them to.
  4. Health care workers that have been exposed to Ebola can be quarantined for up to 21 days, and often they have not been infected. In an area with a severe shortage of trained medical personnel, the loss of any workers is disastrous. An early diagnostic test would let those medical professionals continue to safely treat their patients if they have not been infected.

The situation in West Africa is complex for so many reasons, and a rapid diagnostic test would not be an ultimate solution, but it could be the tipping point we need to stem the tide of new cases.