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global health

Students are the key to addressing the gap between academia and action in global health

2 Dec, 16 | by BMJ

abraarThe last decade has seen an unprecedented growth in the number of students from England, the United States, and other high-income countries involved in global health and development projects in emerging economies around the world. The barriers that traditionally created significant separation between the classroom and the field in global health and development, such as transportation and the lack of easy access to information, are no longer relevant today. more…

Daniel Whitney: Mental health has still not achieved “parity of esteem”—even among some medical professionals

1 Dec, 16 | by BMJ


It’s late morning; little piles of lists and notes from assessments carried out in the past 24 hours are littered between me and the PC. The assorted paraphernalia that seems to accumulate around me after a night on-call clutters my surroundings: a dictaphone, the British National Formulary, Maudsley guidelines, and the semi-completed audit I glance at guiltily every time I find something more urgent to do.

The medical students enter. I welcome them and realise that I had agreed one could present a history they had taken. I had felt guilty earlier; they had been struggling to find patients who met their tick box quota of “cases,” more…

Tiago Villanueva: Primary care in Brazil’s largest favela

29 Nov, 16 | by BMJ

tiago_villanuevaWalking through Rio de Janeiro’s largest slum, Favela da Rocinha, in the pouring rain is probably not the wisest thing for a foreign visitor to do. But on a recent trip to Rio, I was determined not to squander the one chance I had to visit the Maria do Socorro Silva e Souza Family Health Clinic—one of Rocinha’s three primary care clinics that belong to Brazil’s public “Unified Health System.” I went with a group of about 15 GPs from all over the world. The clinic provides care to about 33 000 inhabitants of Rocinha, which has an estimated population of around 100 000, and covers a very well defined area of the favela.

I had heard about the impressive developments in primary care in Rio de Janeiro over the past few years, where primary care coverage has gone from about 4% to about 70% within a decade. more…

Aser García Rada: Living in limbo in Greece’s refugee camps

28 Nov, 16 | by BMJ

Aser García Rada_BMJFrom late March to late August I worked in two Greek camps for refugees as part of a joint Spanish-French Red Cross deployment to support the Hellenic Red Cross. Providing care to people, many of whom were originally middle class, in the developed but wobbling Greece carried with it certain peculiarities.

I began and finished in Ritsona, a refugee camp located in the midst of a forest area 70 km north from Athens and currently home to around 400 people. The camp is being managed by the Greek Air Force and, initially, when aircrafts performed their exercises some children panicked. more…

Chris​ Simms: Path dependency—Trump, Brexit, and the future Europe

25 Nov, 16 | by BMJ

Chris_simsBarbara Tuchman begins her seminal work The March of Folly by observing that a “phenomenon noticeable through history regardless of place or period is the pursuit by governments of policies contrary to their own interests.” The phenomenon seems relevant to the election of Donald Trump, the Brexit vote, and perhaps to upcoming European national elections that begin in December—all of which are related to the rise of populism, protectionism, and nationalism.

These trends present obvious risks to the finance and delivery of local and global health and, inevitably, health outcomes, and are a concern of healthcare providers. more…

Planning a network for randomised trials in global surgery

23 Nov, 16 | by BMJ

Surgery has been called the “neglected stepchild” of global health. Of the surgical research that is done, virtually none of it is relevant to patients and surgeons in resource limited settings. GlobalSurg is a collaborative of surgeons and methodologists who are developing pragmatic, patient facing research focused on low and middle income countries (LMICs). Since its foundation in 2013, GlobalSurg has run two observational studies in abdominal surgery, involving 25 000 patients from over 100 countries.

One of these preliminary studies found that surgical site infections (SSIs) were twice as common in LMICs compared to high income settings more…

Richard Smith: Working to make cholera a disease of the past

23 Nov, 16 | by BMJ

richard_smith_2014Until last year the Cholera Hospital in Dhaka, Bangladesh, could have a thousand admissions a day before and after the monsoon. On a calm day now it still has hundreds. Not all the patients, many of them children, have cholera but many do. Many of the children also have malnutrition, sometimes severe. In order to cope the doctors used to have to erect a tent in the car park and fill it with cholera cots that were inches apart. A cholera cot has a hole in the middle to help management of the profuse diarrhoea that is the hallmark of cholera. As the tent was dark my immediate thought on entering the tent was of pictures of the Crimea with Florence Nightingale, the lady with the lamp, attending the dying soldiers. But few die in the Dhaka Cholera Hospital as the nurses and doctors are so adept at treating the disease, and tremendous improvements in the hospital mean that the tent hasn’t been needed in 2016.


Dot Sang: This is what success in the Calais camp looks like

22 Nov, 16 | by BMJ

The Calais Jungle is now all but rubble and mud. More than 10,000 refugees who inhabited the camp are dispersed across France. Many of them will be embarking on their new journey to claim asylum and start a new life in France, whilst some will have to face the bitter reality of returning to where they fled from. Amongst these thousands there are still many vulnerable lone children.

The looming demolition of the camp created an urgency that led to hundreds of children finally making it to safety here in the UK, thanks to welcome steps taken by the British government. more…

Aeesha NJ Malik: Integrating child health in Tanzania—where is the vision?

21 Nov, 16 | by BMJ

aeesha_malikI first set foot in Tanzania 20 years ago as a medical student. Rather ambitiously at the time, I came with the intention of conducting an evaluation in Tanzania and the UK of the UNICEF Baby Friendly Initiative, which aimed to promote and facilitate breastfeeding. That work led to an editorial in The BMJ, which focused on how well this initiative had been adopted in the UK, as the UK had the stronger culture of bottle feeding at the time.

We argued that these three improvements would be key to UNICEF’s initiative reaching its full potential: developing the primary care aspects of the initiative so that there was greater support and continuity in the community for mothers, coordinating with other key agencies, and securing government led support. more…

Stuart Brown: Antimicrobial resistance—a local, national, and global threat

18 Nov, 16 | by BMJ

stuart_brownI have presented at many events on antimicrobial resistance (AMR) and come across difficult to treat infections in my own practice, but I had never seen an untreatable infection. That changed this summer when we had our first carbapenemase producing Enterobacteriaceae (CPE) infection, an OXA-48.

A normally difficult to treat infection with limited treatment options, it occurred in a patient with a catheter associated urinary tract infection who could not clear aminoglycosides or tolerate colomycin. Despite considerable efforts from the infection and clinical teams, slowly the patient deteriorated and, unfortunately, passed away. I always knew this day would come but it still shocked me when it did. more…

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