march madness

while i missed out on college basketball this year, march was still a pretty crazy month filled with a vast amount of both work and travel.

work last month centered on ebrms: the eastern burma retrospective mortality survey. before i got here, surveyors were trained to go to villages inside eastern burma and administer a survey that asked people about their family's health and any human rights violations they may have endured.

this is not an easy task! surveyors had to use random sampling techniques within villages, code each question correctly, and follow specific protocols when traveling to preselected villages was deemed unsafe. obviously, problems arose and will need to be sorted out in the data.

i've been working with the burma medical association to develop systems to both clean and enter the data into access so that we can analyze it. this is otherwise known as "fun" for a nerdy person who loves organization. after much training, system and form development, flowcharts, and illustrative examples, the data has been processed. the best part is yet to come - the analysis! all i can say is stay tuned.

adding to the craziness that was march, i also spent a week in vietnam. i visited hanoi and halong bay in addition to doing some work and picking up some supplies for our malaria programs. after that, cathy came from dc for a visit and we traveled around thailand together. sweet! we visited bangkok, koh chang, chiang mai, mae sot, and sukhothai. it was amazing.

pictures to follow.

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his tot pilot success!

saturday marked the first his (health information systems) tot's (trainers of the trainers) workshop. (see sufficiently nondescript picture from the training on the right.) decoded this is part of a program that trains high level data staff at the different public health organizations on the border so that they, in turn, can train other staff. the hope is that this will create a sustainable solution for staff development at the different organizations while also to encouraging collaboration across the different groups. we submitted it to apha as an abstract, so maybe it'll get presented at the next conference in november (which would be a good opportunity to spread awareness about burma and to connect with potential donors.)

on a less technical note, the trainers did such a great job! it was a really big deal for them to be the teachers since teaching is held in such high esteem in burmese culture and they were super nervous about it. i was also really pleased because they implemented quite a few ideas from the teaching training i did a few days before.

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send the spdc to the icc

public health school calls for investigation into burma's handling of cyclone recovery

"A report led by the Johns Hopkins Bloomberg School of Medicine has called for a United Nations investigation into Burma's handling of aid and assistance to cyclone hit regions last year, accusing the military government of crimes against humanity. Relief groups are calling on Asian countries and the international community to press Burma's military government towards greater transparency and accountability in receiving assistance.

The report, a joint project of aid workers from the Thai-Burma border and Johns Hopkins Bloomberg School of Public Health, charges Burma's military government with abuse and corruption in its handling of aid and recovery to the devastated Irrawaddy Delta region hit by last year's cyclone Nargis."

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witnesses

today, training in martus data storage:

Martus is a secure information management tool that allows you to create a searchable and encrypted database and back this data up remotely to your choice of publicly available servers. The Martus software is used by organizations around the world to protect sensitive information and shield the identity of victims or witnesses who provide testimony on human rights abuses. Martus is the Greek word for witness.

timely as one of the organizations i work with is likely getting raided by the police today. they've backed up their data, hidden all sensitive material, including themselves, and their leaders going into hiding for a few days as a precaution. they were tipped off by an informant in the thai police and it's most likely nothing to worry too much about, but still...

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updates

so we're thinking the whole 73% lf prevalence thing (that was initially really shocking) is likely due to user error in the rdt's. the problem however, since no one collects this kind of data or provides health care in these regions of burma, it's not a number that's wholly out of the question. we're hoping its due to the testing though...

the backpack field-in-charge meeting is now over and at the closing ceremony, i had two firsts:

1. sky wine cooler. quite popular here and quite nasty. (je ma ko dowt da sky ma jite bu. = i don't like to drink sky. i think...)

2. personal contact with my closest coworker there. oh that's right, we high fived. it was purposeful touching across genders. i feel like our relationship's on a whole other level now.

tee hee.

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busy sunday

guess who was woken up this lovely sunday morning at 7:30am by her absentee data friend who, on the day data analysis finally came due, was magically "free"? oh, it was me. lucky for him, he's really adorable and sweet so i couldn't be angry.

recently every time i've gone to the office, he's been at "the playground." mae tao clinic's 20th anniversary is this thursday and there's going to be a large party and a sports tournament. past year's trophies line the backpack office, so i guess it's serious business for them. i'm in favor of any form of stress relief they can get, just maybe not when we have meetings to finish program analysis before the field medics disappear back inside burma for another six months. again refer to adorable comment.

he's really shy to speak english and we've developed an entire system of nonverbal communication involving nondescript noises and hand gestures. it must look ridiculous. the phone conversation this morning was really strange since it underminded the framework our entire system of interaction is based on.

must to learn burmese now, jenn.

now, if only my lesson for tomorrow would magically plan itself...

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sri lanka war zone update

Near Sri Lanka's War Zone, Wounded Civilians Struggle to Cope

Associated Press

By THOMAS FULLER

Published: February 12, 2009

TRINCOMALEE, Sri Lanka — The ravages of Sri Lanka’s civil war were on full display on Thursday in the crowded wards of the municipal hospital in this eastern port city, 40 miles from the front line. Catholic nuns with bullet and shrapnel wounds, infants as young as a week old, and men with amputated legs were arrayed on beds or lay on the floor. Thomas Fuller/I.H.T.

The names of the wounded were listed in Trincomalee.

A total of 368 injured civilians were being treated in the hospital, and more were on the way. A boatload of 160 patients chartered by the Red Cross was scheduled to dock here late on Thursday.

“We don’t know what happened to our family,” said Mohan Raj, 22, whose arm was shattered by shelling on Feb. 8. “I don’t know who attacked us,” he said. His mother and two siblings disappeared after a loud explosion, he said. His father stood at his bedside on the verge of tears.

The Sri Lankan government has barred reporters and most foreigners from the conflict zone, so the accounts of the injured here in government-controlled territory provided a rare glimpse into the predicament of at least 100,000 civilians trapped behind the front lines.

After intense fighting over the past several weeks, government troops have cornered separatist rebels from the minority Tamil ethnic group on a narrow strip of land in the northeastern corner of the country.

S. G. Muhunthan, chairman of the Trincomalee municipal council, estimated that as many as 350,000 civilians could be trapped in the war zone. “They have been squeezed by both sides,” he said. Human rights organizations put the number at around 200,000; the government says the figure is half that.

Mr. Muhunthan is bracing for an influx of wounded civilians.

“A lot more people are expected to come,” he said. “We can’t say how many. But a lot.”

Crossing over to government-controlled territory exposes civilians to gunfire and shelling. The jungles are mined in many areas; on Monday, at least eight civilians seeking to reach the government side were killed when a woman exploded her bomb-laden vest at a checkpoint.

Patients said the Tamil Tigers, who are formally known as the Liberation Tigers of Tamil Eelam, tried to bar civilians from leaving the war zone. That is consistent with United Nations accusations that the Tamil Tigers have refused to let some of its staff members leave the conflict area.

People here appeared to have wounds inflicted by both the government and the Tigers...

Full text:

http://www.nytimes.com/2009/02/13/world/asia/13lanka.html?ref=asia

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lf update

more data analysis today - lf prevalence in less stable regions of eastern burma is almost 75%? i've spent the last few hours making sure i calculated the indicator correctly. i'm pretty sure i did... this is a disease that, literally, should not exist.

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m&e to the rescue

after a heated debate with one of the backpack medics about whether or not it was possible for a field medic to prescribe an incorrect malarial treatment plan that ended in a consultation with the original paper form, it turns out that a medic in one western state was giving out three days of artesunate/doxy combination therapy rather than the seven days that were needed.

if that doesn't make you really excited about data, i don't know what would.

it took me a long time to get across in english the idea that it could be a mistake in the field rather than in the database. because the medic i was working with knew what the treatment should be, it just didn't make sense to him why someone wouldn't give the correct dosage.

when he understood what i was getting at, there was this really intense flash of recognition tinged with horror that came over his face (not finishing malarial meds breeds resistance.) that i will never forget.

yay, monitoring and evaluation!

the backpack health worker team, by the way, is a group of medics that provide primary health care in ethnic armed areas of burma where healthcare is otherwise unavailable. they carry in medical supplies purchased in thailand and provide a range of care, health education and prevention services, maternal and child health services and human rights documentation to idp's in burma. oftentimes, they find people as they're fleeing their villages as the spdc is burning them down and help them to reach safety.

everyday i'm there i sit in total awe of them.

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zimbabwe: cholera statistics rise again as new malaria fears grow

Cholera statistics rise again as new malaria fears grow

Thursday, 05 February 2009

The number of cholera cases reported in the country has once again jumped by more than 1000 cases, and according to the World Health Organisation the official figures now stand at more than 65 000 infections since August last year. On Tuesday the UN agency announced the infection rate had risen to 64 701, a jump of more than 2000 cases since the last official figures released on Monday. On Wednesday, the number had risen to 65 739 with 28 new reported deaths, bringing the official death toll to 3 323. The unreported figures have been impossible to quantify as there is no way of knowing how many people are dying in their homes. The critical lack of functioning medical centres means untold thousands are not accessing health services and being treated, and the cholera death toll alone is feared to be significantly higher than what is being reported. The collapsed health system means thousands more people are at risk from illnesses usually treatable in a functioning society, and there are new fears that malaria will now start making an impact on an already suffering nation. Matthew Cochrane from the International Red Cross has been travelling across Zimbabwe to assess the effects of the epidemic, and on Wednesday explained that malaria fears are growing. “Understandably the focus has been on cholera and the food shortage,” Cochrane explained. “But with the persistent rains, malaria is really starting to raise its head too.” Malaria is an endemic problem in the country, but with no medicines, medical facilities or even means to feed the sick, it is yet another disease threatening the lives of thousands. The Red Cross meanwhile has warned it will need to stop its cholera relief efforts in the country in the coming weeks because of funding problems, a move that will be a huge blow to the fight against the disease in the coming months. The devastation as a result of the epidemic has caught the attention of an international Women’s Empowerment NGO, WICO, which is starting a fundraising drive to help those affected by cholera. The group’s founding President, based in Israel, Dr Dalia Steiner, told SW Radio Africa on Wednesday that she is concerned that ‘people don’t seem too concerned by what is happening, and we need to take more action against the epidemic.’ She explained that the Israeli government is planning to take ‘urgent steps’ by raising money to provide medicines and clean water in crisis stricken Zimbabwe, and said she hoped there would be results as soon as possible. “We want these goods to arrive within the next week because people cannot wait anymore for help,” Steiner said.

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eliminate lymphatic filariasis

http://www.filariasis.org/index.htm
http://www.who.int/mediacentre/factsheets/fs102/en/

lymphatic filariasis is a disease that afflicts over 120 million people worldwide. it attacks the lymphatic system and kidneys, and while most people will never experience outward symptoms, over 40 million people suffer from severe lymphoedema (swelling of the limbs and breasts), hydrocele (swelling of the genitals), or elephantiasis. it's a disease that effects the poorest of the poor, wrecking havoc not only on individuals' physical, but also their mental health, causing social isolation and reducing productivity rates.

lf rates in burma are unknown (there are official "reports" but they're gross understatements) due to the fact that no data is collected in many parts of the country, including large areas of karen and shan states.

recently i've been working with several health groups to analyze data recently collected on a pilot lf program inside karen state. using random sampling techniques, it turns out that over 40% of the population in karen state is infected with the disease.

lf is transmitted through mosquito bites and, fortunately, can fairly easily be controlled. lf programs have typically have two main goals:

• interrupt transmission of the infection, and
• alleviate and prevent suffering caused by the disease.

the interrupt transmission bit involves mass drug administration of a drug yearly for about five years. the drugs are really inexpensive, costing less than $1 per person per year, and prevent the disease from being able to transmit from person to person.

the one problem is that the drugs have some slightly nasty side effects that can last for up to a week. the pilot program in karen state started off really well, but ran into an unfortunate roadblock. it seems news of the side effects moved quicker than the medics, and by the third village they visited, very very few people would take the drug.

the lf program coordinator, who is insatiably good humored and always laughing, told me many people even hid in the jungle when they saw the medics coming. "more education is needed," he concluded, a rare seriousness in his voice.

as only about 40% of the population took the drugs, the program as a result was not deemed effective and there will be not be extra funds to expand it this coming year...

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