A Just Walk (run, hike, etc…)

"…to the Rock that is higher…"


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Birth defects: truth and consequences

I noticed an interesting article in a recent China Daily about the cause of birth defects in China, which is the first time I’ve seen anything officially reported that admits a strong link between the horrid environmental conditions and birth defects. Compare this with a March 2008 article that correlates the falling rate of premarital checks with and increasing rate of congenital deformities. A September 2007 article blames later age pregnancy and unhealthy lifestyles behind the more than 1 million babies born with a defect every year.

Birth defects constitute a huge health problem in China and this is not news to China. “Measures” and “blueprints” to address birth defects have been reported and implemented in this country, but the rate continues to rise. China reports some statistics, such as every 30 seconds a baby is born with a birth defect and that the rate of defects has risen 40% since 2001. Of the children born with a birth defect, 30-40% do not survive the neonatal period, according to the article. I’m not exactly a big fan of statistics reported by official mouthpieces in China, and even trustworthy statistics can be twisted and turned, but this is really something of concern.  I won’t editorialize about the birth/death rate or the death rate among infants with birth defects in China except to say that there are all kinds of ways to get out of a tough situation and even have it reflect positively upon the country.

Although I haven’t seen this reported, my experience tells me that the rate could be higher than reported as children with congenital deformities make up a very large proportion of children in orphanages (up to 90% according to our stats in Henan province). There is no law against aborting babies with birth defects, but popular opinion has weighed in against it at least one case. This article,  where a woman documented her decision to abort her 6 month fetus because the child had a cleft lip abortion, reports that “the majority of readers condemned her decision”. Although the numbers of abandoned babies in orphanages is astounding and tragic, it is amazing that so many survive pregnancy and birth at all.

Part of why I’m here is to help treat children with deformities, and that includes the prevention of of birth defects. Environmental toxins are well-known teratogens and exist everywhere here. I’m glad to see that officially China is linking the two. Hopefully this may lead to some public health sleuthing. Preventive health is really in infancy here (no pun intended), but I hope that more and more people catch on and begin to see the value in it.

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Human Trafficking 101 part 2.1

As I wrote in my last post, part 2.0, the health consequences of human trafficking have been either largely ignored or underestimated in magnitude. This issue has not been seen as a health issue by health professionals. To help you get a better idea of why addressing health is so important to fighting against trafficking. Health professional or not, you will find this post helpful in understanding that the burden of trafficking is so much more than a legal and immigration issue.

Health professionals can be an important point of identification of people who are trafficked. Practitioners at public health clinics, emergency departments, or urgent care centers are are probably seeing trafficked people as they slide in and out of the health system unnoticed. It is important for practitioners to receive some training in recognizing trafficked people, and what to do if a patient is suspected as being a victim of trafficking.

Previously, I outlined seven categories of health consequences that trafficked/prostituted people face and I’ll outline a few more details in the following paragraphs.

Infectious diseases include HIV, and all the sexually transmitted infections, which we would think of first – especially when considering a person trafficked for sex work. Even so,  a person who is NOT trafficked specifically for the purpose of sex work is often sexually abused as a way of inducing submission. Tuberculosis is also common, and is one of the first opportunistic infections of AIDS. Skin infestations, pneumonia, malaria, and vaccine-preventable infections are also common.

Non-infectious diseases: untreated chronic problems include diabetes and asthma. Dental problems are also significant problem as proper preventive care is often non-existent. Poor nutrition is nearly universal and also it weakens the immune system Occupational injuries from unsafe working conditions and repetitive use are common.

Sexual and reproductive health: This issue relates to the high rate of sexually transmitted infections, but is also a reflextion of the person’s overal health. One of the most common dreams of a prostituted woman is to have a family of her own. Unfortunately, the havoc wreaked upon her reproductive system can often render her infertile. Other long term consequences include cervical cancer from untreated HPV infection, and

Mental health problems are probably the leading contributor to morbidity and mortality.This issues are chronic, difficult to delineate and treat, and can complicate all other interventions. Common disorders include major depression, dissociative states, emotional disorders are common and severe. Suicide is a common consequence.

Substance abuse is extremely common as drugs are used to either self-anesthetize themselves from the horror of their lives, or sometimes given to the trafficked people. Mothers have reported giving sedatives to their young children so they sleep through the night while they work. Children living in such circimstances start using due to availability and need to escape their reality.

Violence is common in the forms of physical, emotional, sexual abuse. Many women are more concerned about dying at the hands of a client than contracting a chronic disease such as HIV. Structural and systemic violence refers to the ways in which society, culture, and laws ignore and overlook the real plight of people at risk of being trafficked or allows trafficking to exist unnoticed.

Children of trafficked people are the unseen and unheard victims of human trafficking. Behind every healthy mom is a healthy child and the inverse is generally true. These children are growing up in toxic environments suffer as much or more than adults. They are less able to secure food, shelter, and clothing and are often left to wander on their own. Due to discrimination or restrictive circumstances, they are not able to go to school or day/night care facilities. Pregnant women with poor health and substance additions give birth to unhealthy babies. These innocents get caught up in this generational cycle of violence.

There is some progress in creating awareness about the health consequences of human trafficking and getting more heath practitioners involved in combating trafficking. The United Nations Global Initiative to Fight Human Trafficking (UNGIFT) and International Organization of Migration (IOM) convened an expert health group to draft the first document providing recommendations for health practitioners on recognizing and caring for trafficked people. My colleague Brian Willis and I have been invited to serve on this group of experts. The document is scheduled to be published in early 2009.

Global Health Promise was formed by Brian and I to address the health consequences of human trafficking. Our vision is a world where no woman must prostitute herself to feed or care for her children. We are involved in prevention of trafficking, mitigation of the hell experienced by prostituted/trafficked people, and release of these people out of the trafficked situation.We are straddling the spectrum of human trafficking – one foot in the brothel (working with local organizations), and one foot in international policy. It is both a privilege and a responsibility, but we can’t do it alone – only together, working on all sides can this horror be overtaken.

The public health axiom, “no data, no problem” is sadly true for this issue.  A problem recognized gets attention and funding, which means funding for research. Research generates solid data, which drives informed interventions and best practices. Better-informed interventions helps more people in more holistic ways. Best practices drives policy and larger interventions. Global Health Promise needs your help to not only mitigate the health problems suffered by these victims of all forms of violence, but to prevent people from getting into that hell at all. Please write to me for more information.



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Medical Conferences

Part of the bonus about being in the States this summer is the opportunity to participate in some cool continuing medical education (CME) courses. I’ve just completed a couple courses that I HIGHLY recommend to those who have ever been interested in something like what I’ve done.

The first was the Advanced Wilderness Life Support Course in Moab, UT May 28-31. Half of the program was in the desert with practicals and clinics on climbing, hiking, rafting and hiking. I learned a lot and had a lot of fun!

The second was the Management of Humanitarian Emergencies, Focus on Children and Families at Case Western Reserve University School of Medicine 16-20 June. The lectures were great, but were also interactive. Several times a day, we split into small groups for problem-solving excercises related to various problems often encounterd in this setting. It was great to network with so many people with various international experiences.