FROM Kaiser Family Foundation: The Foundation has issued its latest global health survey, Views on the U.S. Role in Global Health Update, which probes American public opinion about efforts by the United States to improve the health of people in developing nations. According to the poll findings, most Americans support current U.S. spending to improve health conditions in poorer nations despite the economic recession. Two thirds of the public supports maintaining (32%) or increasing (34%) spending on global health, while a quarter say the country is spending too much. More of the public prefers an emphasis on health infrastructure rather than fighting specific diseases. When asked to rank the importance of the two approaches, 58 percent say it is more important to emphasize programs that help countries build their health system infrastructure, under the theory that stronger health systems can better handle a variety of problems. In contrast, 36 percent say it is more important to emphasize efforts to fight specific diseases like AIDS and malaria because efficient methods for treating such diseases already exist and can save large numbers of lives. All the survey materials are available online.

This is interesting and great news given our economic climate that the majority of Americans still care deeply about helping those with the fewest resources worldwide. I find intriguing that the American public has marched forward from embracing the issues of HIV/AIDS and the global pandemic, or malaria and the need for bednets, to realizing the need for health systems, working together, to build infrastructure for smart, efficient use of assistance. Health systems and health infrastructure are far from sexy topics, but that is what is needed and needed now.

by Bill Frist, M.D.

A couple weeks back, the Living Proof Project was unveiled in Washington, D.C. by Bill and Melinda Gates. The goal of this great project is to share the good news of the implementation of assistance. U.S. investments in improving global health are delivering real results. From significant declines in child deaths, to global eradication efforts against polio, to insecticide-treated bed nets that reduce malaria transmission, global health initiatives are working. At you can learn more from their progress sheets. Watch the speeches of these "Impatient Optimists."  I have the pleasure of serving on the Advisory Council.
The video below was shown yesterday at a Save the Children Survive to Five Council meeting in NYC. This is a great example of real results, combating infant mortality. Saving the life of a little one.


The end of October marked the end of my first quarter here at Africare and the start of the second quarter seems to have brought with it all types of change. In the office we are currently in the midst of several big changes, the biggest being the addition of a new CDC funded home-based care project. Africare will work with some small Civil Service Organizations and existing community structures to provide home-based care for people living with HIV/AIDS. The start up of this project has required a lot of time and energy, including interviewing for about 20 new positions. With between five and ten candidates being interviewed for each position, you can imagine that this has been a very time consuming process. Everyone from the Country Representative, to the program's Chief of Party, to the junior staff has been pitching in to assist in the interviewing process. I've been working very closely with the Human Resources Officer to test the candidates' practical skills, compile summaries of interview results, and create briefings of panel recommendations to be reviewed and approved by the Country Representative and our headquarters in Washington, D.C. I even had the opportunity to sit on the interview panel for a few of the positions and it was quite a different experience being the interviewer instead of the interviewee. One of the new staff that has been hired is the new Program Assistant, Gloria.

by Bill Frist, M.D.

Yesterday morning, I had the honor of speaking at both services at Christ Church in Nashville. Over 5000 people attended. The services were dedicated to the doctors and nurses in the community, recognizing all health care workers for their healing care. It was a wonderful opportunity to share the work of Hope Through Healing Hands at home and abroad. As you know, HTHH's selects Global Health Leaders, annually, to travel to underserved clinics around the world to bolster health care and training of community health workers for sustainability. Right now, we have Leaders in Tanzania, Rwanda, Kenya, and Guatemala. We are proud to support their efforts, using health as a currency for peace. As Martin Luther King, Jr. said, "We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly affects all indirectly."

Thanks to all at Christ Church for the warm welcome.



Today, I joined Save the Children, the US Coalition for Child Survival, the World Pneumonia Day Coalition and Vicks at a breakfast reception on Capitol Hill to recognize the first annual World Pneumonia Day, a day for people everywhere to turn awareness into action to control the #1 killer of children under age 5: pneumonia. Each year, a disease which often starts as a cold, claims the lives of nearly 2 million children under age 5 -- more than malaria, AIDS and measles combined. Despite this staggering death toll, childhood pneumonia has never been a global health priority, and the current basic maternal child health programs --that need to be in place to control the disease-- are under-funded.

by Jenny Dyer

November 4, 2009

How can art save the world? Photographers have the gift to capture a moment of beauty. And, capturing moments of beauty for a person who has never known s/he is beautiful, can give life back to the most downtrodden of spirits--proving everyone holds a spark of the imago dei.

Jeremy Cowart wondered how he could give back, offering his gift of capturing the lovely in those who may have never seen that loveliness. His Help-Portrait movement has sparked interest around the world to provide photos to those individuals and families in need. His website provides the tools to do the following:

1. Find someone in need

2. Take their portrait

3. Print their Portrait

4. And Deliver Them.

If you're a photographer -- check out this movement. Your art could change the world. Consider joining the community:

What does Help-Portrait Look Like?


"Henceforth, simply the nappy."

One of the most delightful things about being in Kenya is participating in the odd mix of African bush culture and English propriety. It's what remains of the colonization of this land by the British, I guess. And it is quite nice.

For example, we all have dusty feet peering out of rubbery ‘flip-flop' like sandals in the operating area, yet we refer to the OR's as ‘theatres', and we adjourn to ‘take tea' at the proper intervals throughout the day. The Kenyans put every coffee house in the developed world to shame with their ‘chai': a creamy, sweet cup of goodness scooped from a boiling pot of tea leaves and milk, fresh from the cow, brought to the hospital that morning in a plastic bucket. It is just so very civilized and so very African. And it is mandatory, I am beginning to understand. In this picture, you can see me having tea with some of the nursery and maternity nurses. I had just given them a lecture about neonatal warning signs in the delivery room, and I was prepared to whisk away to the days doctoring tasks. They insisted that I sit and have tea. It's the proper, Kenyan way.

The influences of the Queen's English and Kiswahili also manage to trip me up on a daily basis. Example 1: intern says to Dr. Amy, "this preterm is receiving 8ml feeds, two hourly, and is retaining." Dr. Amy blinks thinking, "retaining? Is retaining good or bad?" Example 2: same intern pouts over a squeaking, stridorous baby. "Oh, he is lamenting," she says. And I think, "man, I wish I used the word lamenting." Example 3: A few days ago I noticed that there was an odd pile of gauze taped around baby Hawa's ostomy which was causing the liquid stool output to severely irritate his skin. So I asked one of the nurses, "could we stop using the dry gauze and only use a diaper from now on?" The nurse replied, "So, henceforth, simply the nappy?" "Uh, yeah, simply the nappy. Thanks."

Perhaps my favorite experience yet should have a photo but I must try words instead. I was chatting with Dr. Gary in the hospital corrider, and as we were talking, a Masai grandmom walked past with her infant grandson in a sling on her back. The little guy was healing from a chemical burn of his head, and he had even lost most of his left ear. After multiple skin grafts he still had bright pink under-flesh covering most of his head. It was a patchwork that looked like freshly groomed farm land: little squares of different soils in pinks and browns. His grandmom was covered in beads, ear lobes hanging low from a piercing type process, dark black feet flat against the hospital floor and the little guy, peering up to catch our eyes... then he giggled and hid from us in the folds of his grandmother's clothes. His happiness took over the air around us. I could not understand how such a little boy (two years old) could have so much pain-- so much to cry about -- and yet so much joy! Later I found out that this patient, Ralian, is Jim's patient. Jim is his surgeon, and he is Jim's favorite. Ralian's grandmother has said that she wants to return to visit us before we leave so she can give Jim a reward for taking care of her grandson.

So far, I have been blessed to enjoy my time here in ways I could not have foreseen. It is simply "well with my soul," as the old hymn says. And still, I am a creature of luxury, and I miss all the lavishness of my home in Colorado. Gary Finke, the pediatrician of the past 2 years, leaves roughly the same time we do. So as the days march forward and we get closer to hugging our families, our friend Stephany gets closer to being the sole pediatrician at this busy children's hospital. Her fear of taking on this mighty task is always behind the scenes. She is weary, and it is hard to leave her behind. I am asking now, reader: please pray for reinforcements for Stephany. Pray for courage and joy and wisdom and sleep for her. If you are a pediatrician - consider coming to help her. Even just a few weeks would lessen the load and give little lily pads of rest during her 2 year commitment. You will be a blessing and you will be blessed!

I have a tendency to count down days until the end of different periods of life. A physician in Nashville once advised a group of us not to wish away our lives during residency, and I hate to admit that I sometimes have that tendency, although not just in residency. Recently I have been simultaneously struggling to not count down the days until I return to my own indulgences (warm bath, constant electricity, reliable phone line to call mom and dad) and dreaming of returning to live out my days here.

I said in a previous post-my first post from Kijabe in fact-that life here is simple, hard and lovely. It is simple, and it is hard in many ways. That is true. But in the end and above all, life here is lovely.



Time For Renewed Global Action Against This Forgotten Killer Of Children

The Lancet

October 31, 2009

by Former U.S. Majority Leader William H. Frist, M.D. and Minister of Health of the Republic of Rwanda, Richard Sezibera

Whether a political leader or a physician, one of the cruel ironies we face is that we are losing children we know how to save. The heart-breaking truth is that financial barriers—not medical or scientific ones—are preventing 9 million children every year from reaching the age of 5 years.

Take, for example, pneumonia, labeled as the forgotten killer of children by WHO and UNICEF. It surprises most people to learn that pneumonia kills more children than any other disease, taking more than 2 million young lives annually. Nearly half of these deaths could be prevented with existing vaccines and most cases could be treated with inexpensive antibiotics. Yet, lives continue to be lost from this preventable and treatable disease, and, until recently, there was little outcry. There are growing signs that the global community is ready to take action to fight childhood pneumonia. The recently formed Global Coalition against Pneumonia, nearly 100 members strong and counting, is an international network of organisations dedicated to fighting childhood pneumonia. On Nov 2, 2009, advocates from around the world will commemorate the first-ever World Pneumonia Day to raise awareness and mobilise efforts to fight this disease. The enthusiasm of this diverse group from dozens of countries gives hope that this deadly disease is finally going to get the attention it deserves. On Nov 2, WHO and UNICEF will release a road map, the Global Action Plan for Prevention and Control of Pneumonia (GAPP), which represents a turning point in our global approach to fighting childhood pneumonia. GAPP outlines a 6-year plan for the worldwide scale- up of a comprehensive set of interventions to control pneumonia. These interventions fall under a three- pronged framework: protect children by providing an environment where they are at low risk of pneumonia; prevent children from developing the disease; and treat children who become ill. Key interventions include exclusive breastfeeding during the first 6 months of life, use of pneumococcal and Haemophilus influenzae type b vaccines, and management of illness in clinics and importantly at the community level. 

These recommended interventions are based on rigorous scientific evidence, accumulated over the past 20 years, which shows efficacy in controlling pneumonia. This evidence was reviewed in 2008, and specific estimates of the projected benefits of implementing these interventions are available. These advances have helped the global community reach a unique point where we now know which interventions will have the most benefit in controlling pneumonia. Each of these interventions is safe and available now. GAPP’s projections are that, by 2015, the scale-up of existing interventions can substantially decrease mortality from pneumonia in children. This dramatic decline is not only a substantial contribution, but a critical step towards meeting Millennium Development Goal 4. Although meeting the costs of fully implementing GAPP will be a challenge, the good news is that many countries are already beginning to implement recommended interventions. For example, in April of this year, Rwanda was the first developing country to launch a national immunisation programme against the pneumococcus,12 a major cause of severe pneumonia. The GAVI Alliance, a global health partnership that helped Rwanda introduce these vaccines, plans to do the same in a total of 42 low-income countries by 2015. This addition to the national immunisation programs is crucial; whilst infant mortality is dropping in Rwanda, further decreases depend on addressing pneumonia, which is responsible for one in four deaths of children under 5 years of age.

We live in a world with infinite possibilities. Hearts are transplanted, DNA is decoded, and new medical discoveries are made every day. Yet we continue to be stymied by how best to reach those in resource-poor settings with the most basic care and medicines that we take for granted. What could break through this conundrum? The answer is a committed community in both donor and developing countries to make the health of children a priority, combined with a simple package of interventions that address the greatest challenges to survival. Resources and political will are standing between children and their futures. With the right tools, we should not fail the next generation of leaders and doctors. 

World Pneumonia Day

Nov 02 2009

November 2, 2009

World Pneumonia Day News Conference Audio: Bill Frist, Mary Beth Powers, and Orin Levine


Eileen Burke, Save the Children

+1 203-221-4233

[email protected]


Lois Privor-Dumm

Johns Hopkins Bloomberg School of Public Health

+1 484-354-8054, [email protected]


Mala Persaud +1 202-841-9336

[email protected]


Leading Organizations Join Forces to Launch First Annual World Pneumonia Day,  Fight World's Leading Child Killer

WHO and UNICEF Release Global Action Plan to Combat Pneumonia as Part of Historic Effort

"Resources and political will are standing between children and their futures,"

Write Senator Bill Frist and Rwandan Minister of Health Dr. Richard Sezibera


WASHINGTON, D.C. (November 2, 2009) - Nearly 100 leading global health organizations from around the world joined forces today to recognize the first-annual World Pneumonia Day and urge governments to take steps to fight pneumonia, the world's leading killer of young children.  The first steps in this fight are outlined in the Global Action Plan for the Prevention and Control of Pneumonia, released today by the World Health Organization (WHO) and UNICEF.

"It surprises most people to learn that pneumonia kills more children than any other disease - taking more than 2 million young lives annually," write former U.S. Senate Majority Leader and Save the Children Board member, Bill Frist, MD and co-author Dr. Richard Sezibera, Rwanda's Minister of Health in this week's edition of The Lancet.   "Nearly half of these deaths could be prevented with existing vaccines and the vast majority of cases could be treated with inexpensive antibiotics.  Yet, lives continue to be lost from this preventable and treatable disease, and, until recently, there was very little outcry."

Pneumonia takes the lives of more children under 5 than measles, malaria, and AIDS combined.  The disease takes the life of one child every 15 seconds, and accounts for 20% of all deaths of children under 5 worldwide. While pneumonia affects children and families everywhere, it has the most deadly impact in South Asia and sub-Saharan Africa, where 98% of pneumonia deaths occur. It can be prevented with simple interventions, and treated with low-cost, low-tech medication and care.

"Today the world is coming together like never before to address the number one threat to the world's children," said Orin Levine, executive director of PneumoADIP at the Johns Hopkins Bloomberg School of Public Health. "Together we call on country governments to implement life-saving pneumonia interventions for those that need them most."

Global Action Plan for Prevention and Control of Pneumonia

The Global Action Plan for the Prevention and Control of Pneumonia (GAPP), released today by  WHO and UNICEF, outlines a six-year plan for the worldwide scale-up of a comprehensive set of interventions to control the disease.  Countries are urged to implement a three-pronged pneumonia control strategy that:

  • protects children by promoting exclusive breastfeeding and ensuring adequate nutrition and good hygiene; 
  • prevents the disease by vaccinating them against common causes of pneumonia such as Streptococcus pneumoniae (pneumococcal disease) and Haemophilus influenzae type b (Hib); and
  • treats children at the community level and in clinics and hospitals through effective case management and with an appropriate course of antibiotics.

The GAPP estimates the cost of scaling up exclusive breastfeeding, vaccinations and case management in the world's 68 high child mortality countries. Together, these countries account for 98% pneumonia deaths worldwide. With this investment, the GAPP projects that by 2015, the scale-up of existing interventions can decrease child pneumonia mortality substantially. 

Ensuring Treatment, Achieving Prevention

Studies show that implementing pneumonia prevention and treatment interventions worldwide could save more than one million lives each year and significantly reduce the burden of families and communities that must cope with pneumonia-related illnesses and deaths.  Pneumonia can be treated effectively with antibiotics that cost less than a dollar, but less than 20% of children with pneumonia receive the antibiotics they need, according to WHO.

Safe and effective vaccines exist to provide protection against the primary causes of pneumonia, Streptococcus pneumoniae (pneumococcal disease) and Haemophilus influenzae type b (Hib).  However, use of Hib vaccine has only recently expanded to low-income countries and pneumococcal vaccine is not yet included in national immunization programs in the developing world, where children bear the highest risk for pneumonia and where most pneumonia-related child deaths occur.   

As the result of collaborative efforts by WHO, UNICEF, the GAVI Alliance, academia, foundations, vaccine manufacturers, and donor and developing country governments, low-income countries can now access existing and future pneumococcal vaccines with a small self-financed contribution of as little as US $0.15 per dose.  To date, 11 countries have received GAVI Alliance approval for support to introduce pneumococcal conjugate vaccine (PCV) and 12 additional countries have submitted applications. 

"For the first time in history, we have the commitment from countries and the tools and systems in place to deliver new life-saving vaccines to protect millions of children against the world's biggest childhood killer pneumonia," said Dr. Julian Lob-Levyt, CEO of the GAVI Alliance. "With increased donor support, we can save many more lives and make an incredible leap in progress towards further reducing child mortality in the world. This is an historic opportunity we must not ignore."

World Pneumonia Day: A Global Effort

The Global Coalition against Childhood Pneumonia, made up of nearly 100 influential global health organizations has led the World Pneumonia Day effort.  Events are taking place in more than 25 countries around the world.

"Pneumonia takes a devastating toll on families and communities in resource-poor countries, so it is vitally important that this message be amplified throughout the developing world," said Mary Beth Powers, chief of Save the Children's Survive to 5 campaign. "The involvement of these countries in this effort is an important step toward reducing pneumonia deaths."

World Pneumonia Day events and activities will raise awareness, outline solutions and call upon governments to act to combat pneumonia. In New York City, more than 100 leaders in science, politics and global health will gather for the first World Pneumonia Day Summit.  Other activities will include week-long activities in Nigeria including educational events, policy briefings and rallies; a policymaker roundtable and symposium in Bangladesh; a Run for Survival in Kenya; pediatrician workshops in Nepal; a health symposium in the Philippines; and a briefing in London at the House of Commons.  Additional events are planned in China, the DRC, Ethiopia, India, Malawi, Mali, Pakistan, the Philippines, South Africa, Thailand, and Uganda.  An event list can be found at  These events all underscore the need for urgent action to protect the lives of children everywhere.

"We live in a world with infinite possibilities," write Frist and Sezibera. "Hearts are transplanted, DNA is decoded, and new medical advances are made every day. Yet we continue to be stymied by how best to reach those in resource-poor settings with the most basic care and medicines that we take for granted."  They continue, "Resources and political will are standing between children and their futures. With the right tools, we should not fail the next generation of leaders and doctors."

To learn more about World Pneumonia Day and the Global Coalition against Child Pneumonia, visit  To download the Global Action Plan for Prevention and Control of Pneumonia, visit


About The Global Coalition against Child Pneumonia

The Global Coalition against Child Pneumonia and the World Pneumonia Day Coalition, was established in April 2009. It seeks to bring focus on pneumonia as a public health issue and to prevent the millions of avoidable deaths from pneumonia that occur each year. The coalition is grounded in a network of international government, non-governmental and community-based organizations, research and academic institutions, foundations, and individuals that have united to bring much-needed attention to pneumonia among donors, policy makers, health care professionals, and the general public. Learn more at











1) Patient Beds

2) Hospital Compound where families clean clothes and make food for patients

3) Ingredients for Hand Sanitizer

It has been one month since I arrived in Rwanda and I am continually amazed at the obstacles my patients and coworkers face. The work can be very frustrating. Everyday I see ways to keep people alive and reduce the severity of illnesses, but implementing change is never easy, especially when resources are extremely limited.

One particular frustration is the lack of hand washing by the medical staff. An estimated 60,000 in Rwanda are infected with illnesses in hospital, which are called nosocomial infections. Nosocomial infections are often caused by health providers not having properly washed their hands. They significantly increase patient death rates as well as costs to the patient and hospital. I have seen diseases being spread in our hospital and the staff seems to accept it as normal.

All the nurses and physicians know they are supposed to wash their hands between patients, but it just is not practical. There are no sinks in the patient rooms and the nurses have to move quickly from one patient to the next to provide care for everyone. There is only one sink per floor, and it is located very far from the patients. A great majority of the patients have infectious diseases such as HIV, tuberculosis, intestinal parasites, and infectious hepatitis, so hand washing is especially important.

After two weeks of frustration I found a solution. Hand sanitizer is an effective way of killing most germs and does not require running water; unfortunately it is too expensive for the hospital to purchase. With some research I found some recipes for homemade hand sanitizers that costs a fraction of the price of commercial products yet are effective disinfectants. I tested recipes until I found one the staff members like the most. I am now working with the chief of nursing to ensure that the hospital can afford to make it in sufficient quantities indefinitely. This is only a small change but I believe it will result in a significant reduction of infections passed from patient to patient and to the workers themselves. My hope it that they not only continue to use the hand sanitizer but that this will begin to instill confidence that there are ways we can start to limit unnecessary hospital born infections.



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