Moral march on Raleigh

moral-march-062Message from Viviana Martinez-Bianchi, Exco Member WONCA World

I was honored to represent the “white coats” today with this speech at the Moral March on Raleigh, an annual civil rights protest in Raleigh, North Carolina. It was an experience I will never forget. To speak from my heart about the health and healthcare needs of our communities. I was inspired by the presence of the large number of medical students and PA students who attended the march today, plus a large number of faculty, residents, and community clinicians. And more importantly inspired by the diverse humanity who passionately attended the march. 

Someone taped my speech, linked below, it is only missing my introduction. At my 5th line, I choked up thinking about the 80,000 people I could see from the stage, still marching in, the mall filled with people all the way from the Old Capitol to the Center for performing arts.  

Thankful to Perri Morgan and the organizers of HKonJ March in Raleigh for having given me the opportunity  to speak.


Patient dies in Elim Hospital after shower

Hospital negligence under investigation after elderly patient dies of burns from shower.

Ongoing complaints of shocking conditions at Elim Hospital in Limpopo have gone unresolved, and now an 83-year-old patient has died of third degree burns after being left to take a shower on her own.

Last Thursday Mujaji Manganye allegedly received no assistance when she went to take a shower. She stepped under scalding hot water and was overwhelmed. After sustaining bad burns she passed away.

This incident follows numerous complaints by the patients at Elim Hospital. Many claimed conditions in general were poor and staff were also negliglent. Now that a patient has actually died, patients in the hospital are in shock and fear….more

#SONA2017: Mbete refuses moment of silence for 94 dead mental health patients

President Jacob Zuma wants national Health Minister Aaron Motsoaledi to have more power over health MECs in provinces. “We welcome the recommendations of the health ombudsman that there is an urgent need to review the  National Health Act of 2003 and the Mental Health Care Act of 2002 with a view that certain powers and functions revert back to the national Minister of Health,” he said in his State of the Nation address in parliament on Thursday.

Zuma was referring to the report of the health ombudsman, which was released last week, on the deaths of 94 state mental healthcare users in Gauteng. They were part of a group of close to 2 000 mental health patients that the Gauteng health department transferred from private Life Esidimeni facilities, for which the state had paid, to unequipped nongovernmental organisations, where many died as a result of insufficient care.

Gauteng Health MEC, Qedani Mahlangu, resigned as a result of the scandal…..more

Do Social Ties Affect Our Health?

Cuddles, kisses, and caring conversations. These are key ingredients of our close relationships. Scientists are finding that our links to others can have powerful effects on our health. Whether with romantic partners, family, friends, neighbors, or others, social connections can influence our biology and well-being.

Wide-ranging research suggests that strong social ties are linked to a longer life. In contrast, loneliness and social isolation are linked to poorer health, depression, and increased risk of early death.

Studies have found that having a variety of social relationships may help reduce stress and heart-related risks. Such connections might improve your ability to fight off germs or give you a more positive outlook on life. Physical contact—from hand-holding to sex—can trigger release of hormones and brain chemicals that not only make us feel great but also have other biological benefits. …more

WHO Geneva-based Internships on Trialect

We have a posting on Trialect soliciting applications for WHO Geneva-based Internships.  WHO offers 6-12 weeks internships with a wide range of opportunities for students to gain insight in the technical and administrative programmes of WHO and global health. To be considered for a internship, applications are accepted before February 28. The application process is very simple and requires filling a questionnaire that covers your education, current studies, language skills and experience. Please feel free to refer your fellows, graduate students, medical students, and residents to this program. The details can be perused at : WHO Internships

Trialect Support

Stroke: Causes, Symptoms, Diagnosis and Treatment

Stroke is the 5th leading cause of death in the US, with one person dying every 4 minutes as a result. For black people, stroke is the 3rd leading cause of death.

Approximately 800,000 people have a stroke each year; about one every 40 seconds. Only heart disease, cancer, chronic lower respiratory diseases and accidents are more deadly.1-3

Strokes occur due to problems with the blood supply to the brain: either the blood supply is blocked or a blood vessel within the brain ruptures, causing brain tissue to die. A stroke is a medical emergency, and treatment must be sought as quickly as possible….more

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Family medicine in South Africa: exploring future scenarios

This paper reports on a workshop held at the 19th National Family Practitioners Conference in August 2016. The aim of the workshop was to describe possible future scenarios for the discipline of family medicine in South Africa and identify possible options for action. The workshop led a group of 40 family physicians from academic, public and private sector settings through a scenario planning process developed by Clem Sunter and Chantell Ilbury. After an overview of the current situation the participants reached a consensus on the rules of the game, key uncertainties, future scenarios and options for action. The main message was that the South African Academy of Family Physicians as a professional body needs to take a stronger role in advocating for the contribution of family medicine to government, health managers and the public.

Who is a CHW?

In thinking about who is a CHW in relationship to their task, education, and professionalization, we worked with policymakers and UNICEF teams to look at what various cadres of CHWs do and how they are not one homogeneous group but rather a mix of typologies:

Some excerpts from the executive summary:

In addition to a comprehensive literature review, the study used a cross-sectional survey with closed- and open-ended questions administered to UNICEF Country Offices and other key informants to investigate and map CHW characteristics and activities throughout the region. Responses were received from 20 of the 21 UNICEF Country Offices in the UNICEF East and Southern Africa region in May?June 20133. Data on 37 cadres from across the 20 countries made up of nearly 266,000 CHWs form the basis of this report. This report catalogues the types and characteristics of CHWs, their relationship to the broader health system, the health services they provide and geographic coverage of their work.

At the global level, CHWs have largely been considered to be a homogeneous class of healthcare worker. A more nuanced differentiation would be helpful to improve policy coordination, strategic planning and implementation of community-based health care. Based on results of the present survey, a post-hoc classification identified four distinct types of CHWs in ESAR countries:

Summary Table: CHW classification model [*see note below]

1. Case Manager

2. Community Liaison

3. Health Promoter

4. Traditional Birth Attendant (TBA)-plus

There was only one TBA-plus CHW cadre reported in this study. However, this may be due to the underreporting of traditional birth attendants, as these are often considered a separate class of healthcare worker rather than a subset of CHWs. Having TBAs engaged in a slightly broader range of reproductive health activities beyond maternal delivery (including family planning) is likely more widespread and would be a low-cost model for expanding CHW care given the high geographic coverage of TBAs in many countries.

In summary, this research documents that CHWs provide a variety of services with a broad range of potential tools. The report presents current training, responsibilities, and the scale of CHW programs in 20 ESAR countries. It also puts forward a potential CHW classification model to improve advocacy for and targeting of appropriate community health interventions (see Summary Table, Table 3 and Annex 5).

Meghan Kumar

REACHOUT Research Manager

+254 733440052

WHO Bulletin: Breaking down the barriers to universal health coverage

The new issue of the WHO Bulletin (February 2017) is themed on Universal Health Coverage and is freely available here:

Below are extracts from the lead editorial:

CITATION: Breaking down the barriers to universal health coverage

Piyasakol Sakolsatayadorn & Margaret Chan

‘The 2030 agenda for sustainable development calls on the international community to prioritize the needs and rights of vulnerable populations, so that no one is left behind…

Models for extending service coverage stress the importance of education, training and community engagement. Enhanced recruitment, training, supervision, and compensation of community health workers rapidly improved coverage with maternal and child health services in rural areas of Liberia.  Brazil has used a package of incentives to recruit physicians to work in remote and deprived areas and to improve the primary healthcare infrastructure, leading to better working conditions and better quality of care…

The inclusion of an SDG target for reaching universal health coverage, including financial risk protection, affirms the power of health to build fair, stable, and cohesive societies while also contributing to poverty alleviation. The target provides a unifying platform for moving towards all other health targets through the delivery of integrated, people-centred services that span the life course, bring prevention to the fore and protect against financial hardship. Universal health coverage is the ultimate expression of fairness and one of the most powerful social equalizers among all policy options.’

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:

‘Many researchers do not use their right to make their papers freely available online’

“Where do you find this “right”?”

The website states: ‘Many researchers do not use their right to make their papers freely available online, in addition to the paywalled version offered by traditional publishers.’

Different publishers (and, for large publishers, different journals of the same publisher) have different archiving rights with regards to what the author is allowed to place in an open-access repository. These different levels are colour-coded by the Sherpa/Romeo initiative and are described here:|&mode=simple&version=#colours

Romeo have compiled some interesting statistics on this, which show that 80% of the 2322 publishers listed formally allow some form of self-archiving. This includes major publishers like Elsevier and Springer.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  

We have often noted on HIFA that most authors do not upload the full text of their papers on open-access repositories, even where the (restricted-access) journal allows them to do so.

With this in mind I was interested to see this new website:

‘Many researchers do not use their right to make their papers freely available online, in addition to the paywalled version offered by traditional publishers.

‘Dissemin helps researchers ensure that their publications are freely available to their readers. Our free service spots paywalled papers and lets you upload them in one click to Zenodo, an innovative repository backed by the EU.’

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  

Multiple methods in formative evaluation: reflections from a South African study

The science of programme evaluation has grown over the years, particularly in response to the complexity of many programmes implemented within health systems, in which multiple actors, services, interventions and levels of care may be involved. We recently reported on a formative evaluation that used multiple and mixed methods to assess such a programme that focused on using lay or community health workers to support people in South Africa receiving treatment for TB and HIV/AIDS. To inform the field of programme evaluation, we reflect in this paper on each of the methods used in relation to the evaluation objectives, and offer suggestions on ways of optimising the use of multiple, mixed-methods within formative evaluations of complex health system interventions.

Some of the issues we discuss include viewing programme evaluation as a creative and innovative process, in which thoughtful selection of methods may result in a more textured understanding of the programme; the relevance and application of the concept of triangulation; and balancing the range and mixing of methods with the resources and experience available in the evaluation team. As programme evaluations ultimately aim to improve programme implementation and strengthen health systems, it is important that evaluators be mindful of how their methods and findings will inform the policies and practices of the programmes they evaluate. The full paper is available here and we welcome comments and other evaluation experiences from members of the forum:


Arrie Odendaal

Health Systems Research Unit

South African Medical Research Council

Tel: +27 21 9380454 | Cell: 072 8665 173

Francie van Zijl Drive, Parow Valley | Cape Town| Western Cape

Uganda CHWs on WhatsApp

These are the views of Ugandan Village Health Teams (VHTs) from their Whatsapp group discussions.

Participate in planning meetings

“We want health centres to invite us for their planning meetings as some of the issues discussed during these meetings are of our concern such as community outreaches.”

Transport allowances

“When drugs are delivered at the health facilities, VHTs are responsible for picking them. Makerere University gave us motorbikes, however, they are not enough to be used by the whole subcounty. As VHTs we are only volunteers, we should not use our own money for transport, instead we should be given some transport allowances to help us pick drugs from health centres. If not, then health centres should deliver these drugs to us in our villages.”

Sports activities

“We need to engage in sports activities and will be very grateful if they are organised for us. These activities will bring us closer as VHTs.”

Special attention

“As a VHT I do not want to wait in that long line when I visit a health centre with my patient. Health workers should give us immediate attention when we visit health centres.”

Exchange visits

“We would like to visit VHTs from otther districts in Uganda/ outside countries and learn more on how they operate in their communities. We should also get VHTs from other places to come and learn from us too. However, we cannot use our own money for these visits. We need facilitation.”

HIFA profile: Carol Namata is an Environmental Health Officer at Makerere University School of Public Health in Uganda. Professional interests: Health promotion in communities. carolnamata1 AT

Radio, health education and public health communication

‘Since their invention, radios have played a crucial role in public health communications – especially in the event of disasters and public emergencies. That’s why they’re one of our 100 Objects That Shaped Public Health.

‘In fact, the CDC works with health departments to maintain a radio network in case other means of communication fail. And in Malawi, a program called “Life Is Precious” profiles people with public health lessons to impart.’

‘Research has shown that radio shows can reduce stigma associated with and increase testing for HIV, as well as improve outcomes for other conditions in developing nations. In Malawi, a program called Life is Precious showcases role models the audience can identify with and covers topics including maternal health, poor nutrition, and diarrheal diseases.’

I would be interested to hear people’s experience of health education and public health messaging on radio.

Given the failure of public health communication during the Ebola crisis, it seems that radio was relatively ineffective in providing reliable health information to the people, and countering mininformation and myth? Or, perhaps, radio was used appropriately but other channels such as mobile health networks dominated and spread misinformation?

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  

Role of Community Health Workers in attainment of the Sustainable Development Goals

Sustainability: CHW productivity will be determined in large part by the conditions under which they work. Attention to the provision of an enabling work environment for CHWs will be essential for achieving high levels of productivity.

Our model of operation encompasses four essential elements like, workload, supportive supervision/mentorship, supplies and equipment, and respect from the community and the health system, this has greatly improved their productivity. Our project principle, is that if CHWs have a manageable workload in terms of a realistic number of tasks and clients, an organized manner of carrying out these tasks, a reasonable geographic distance to cover, the needed supplies/ equipment, a supportive supervisor, and respect and acceptance from the community and the health system, they can function more productively and contribute to an effective community-based strategy.

Conclusions: As more countries look to scale up CHW programmes or shift additional tasks to CHWs, it is critical to pay attention to the elements that affect CHW productivity during programme design as well as implementation. An enabling work environment is crucial to maximize CHW productivity. Policy-makers, programme managers, and other stakeholders need to carefully consider how the productivity elements related to the work environment are defined and incorporated in the overall CHW strategy. Establishing a balance among the four elements that constitute a CHW’s work environment will help make great strides in improving the effectiveness and quality of the services provided by CHWs.

Muhereza Chrisestome

Community Health Worker Manager,based in Karamoja-Uganda. Qualification: Medical Clinical officer,Social Worker and Public Health and Leadership Specialist. Community Health Worker Program Manager,


‘More than 1 billion people suffer from Neglected Tropical Diseases’

The WHO website states:

‘Neglected tropical diseases (NTDs) are a diverse group of communicable diseases that prevail in tropical and subtropical conditions in 149 countries and affect more than one billion people, costing developing economies billions of dollars every year…’

and the CDC website confirms:

‘Neglected Tropical Diseases (NTDs) are a group of parasitic and bacterial diseases that cause substantial illness for more than one billion people globally…. More than 1 billion people—one-sixth of the world’s population—suffer from one or more Neglected Tropical Diseases (NTDs).’

I find this figure surprisingly high, don’t you? I looked in vain for evidence to back it up.

I wrote to WHO who kindly pointed me to two publications on NTDs:

“We call it the mortuary” An Eastern Cape father’s traumatic experience with local public health facilities

Babsy’s family is amongst the 40 million or so mostly poor black South Africans who, as the economy collapses and unemployment rockets, are increasingly forced to rely on a crumbling public health system. The government is clearly not interested in providing adequate health services for poor people. Babsy Mpheshwa was introduced to me by a Glebelands community leader, as a friend from the same area of the Eastern Cape. I was told Babsy wanted to speak of his experiences with the Eastern Cape Health Department and the treatment his two sons and nephew received after they were involved in a serious car crash just over a week ago.

This is Babsy’s story:

At about 04h30 on the morning of Saturday 28 January, Babsy’s two sons and nephew, aged between 21 and 27 years, had been travelling from Flagstaff to Bizana, when, at a place called Magusheni, they were involved in an accident and their vehicle overturned. All three young men were badly injured and sustained head injuries, a broken jaw, ribs and arm, a badly lacerated tongue, severe bruising and other cuts and abrasions.

They were in considerable pain and suffering from shock when taken by ambulance to the Casualty Department of Bizana’s St Patrick’s Hospital. Once in Casualty they sat on a wooden bench awaiting medical treatment where they waited and waited and waited….more

Gauteng health head suspended after mass deaths of patients

Gauteng health department head Dr Tiego Ephraim Selebano was placed on precautionary suspension by Gauteng Premier David Makhura on Wednesday. Director of mental health Dr Makgabo Manamela was given 48 hours to give reasons why she should not be dismissed.

Makhura suspended Selebano following the recommendations of health ombudsman Prof Malegapuru Makgoba in his report, No guns: 94 silent deaths and counting, on the deaths of 94 psychiatric patients…..more

Finger Infection

Finger Infection Overview

Injury or infection to a finger or fingers is a common problem. Infection can range from mild to potentially serious. Often, these infections start out small and are relatively easy to treat. Failure to properly treat these infections can result in permanent disability or loss of the finger.

Early recognition and proper treatment of the following main finger infections will help prevent most of the serious outcomes.

  • Paronychia: A paronychia is an infection of the finger that involves the tissue at the edges of the fingernail. This infection is usually superficial and localized to the soft tissue and skin around the fingernail. This is the most common bacterial infection seen in the hand…..more

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Prevention and Treatment of High Cholesterol

Too much cholesterol in the blood can lead to cardiovascular disease. Heart disease is the  No. 1cause of death in the United States.Over 2,100 Americans die of cardiovascular disease each day, an average of one death every 40 seconds.

The good news is, you can lower your cholesterol and reduce your risk of heart disease and stroke.

Working with your doctor is key.  It takes a team to develop and maintain a successful health program. You and your healthcare professionals each play an important role in maintaining and improving your heart health.

Work with your doctor to determine your risk and the best approach to manage it. In all cases, lifestyle changes are important to reduce your risk for heart attack and stroke. In some cases, cholesterol-lowering statin medicines may also provide benefit.

Learn how to make diet and lifestyle changes easy and lasting. Also make sure you understand instructions for taking medication because it won’t work if you don’t take it as directed.

Lifestyle Changes
Your diet, weight, physical activity and exposure to tobacco smoke all affect your cholesterol level.

Know Your Fats
Knowing which fats raise LDL cholesterol and which ones don’t is the first step in lowering your risk of heart disease.

Cooking for Lower Cholesterol
A heart-healthy eating plan can help you manage your blood cholesterol level.

Understand Drug Therapy Options
For some people, lifestyle changes alone aren’t enough to reach healthy cholesterol levels. Your doctor may prescribe medication.

Avoid Common Misconceptions
We have created a list of the common misconceptions, along with the true story, about cholesterol.

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High concentrations of dust mite allergens are a significant risk factor for the development of allergies and related diseases such as asthma and rhinitis (hay fever). Eighty percent of children and young adults with asthma are sensitive to dust mites. And studies at the National Institute of Environmental Health Sciences (NIEHS) suggest that more than 45 percent of U.S. homes have bedding with dust mite concentrations that exceed a level equated with allergic sensitization.


Dust mites are microscopic creatures (smaller than 1/70 of an inch) that thrive in warm, dark, moist places with temperatures of 68° to 84°F and humidity levels at 75 to 80 percent. They thrive in bedding because that is where they find their biggest meals: They thrive on sloughed-off human and animal skin.

Under the microscope, dust mites appear as sightless, spider-like arachnids. They breathe through their skin, and while in dormancy, they are impervious to poisons, so insecticides are worthless if you choose to use them.

You can also find dust mites in dust ruffles and bed curtains (because they trap dust easily) and on feathers, furs, protein-based textiles, and other organic fibers. Polyester bedding is also a well-known haven for dust mites because it traps moisture from perspiration.


It’s the feces and body parts from the dust mites that are the allergens, so simply killing the mites won’t remove the allergen, although reducing populations is always a considerable help. To minimize mite populations, you need to make changes in your daily living and cleaning routines. While you may not be able to do all of these things, just implementing a few of these techniques will reduce the number of mites in the bedroom.


Direct sunlight kills dust mites, so hang bedding in the sun whenever possible. (Be mindful, though, that outdoor allergens can collect on bedding hung outside.)


Dust mites die when the humidity falls below 40 to 50 percent; use a dehumidifier if the weather is humid.


Wash bed linens once a week in hot water — the water temperature should be 130°F or higher — to kill mites.


Steam-cleaning carpets considerably lessens dust mite populations and deters population growth. A study in Glasgow, Scotland, found an 87 percent drop in the concentration of dust mites per gram of dust after carpets were steam-cleaned.


Vapor steam-cleaning (using a small machine that heats surfaces with dry steam) kills fungus, dust mites, bacteria, and other undesirables. This is a good way to clean bedding that you can’t launder, such as mattresses. Vapor contains only 5 to 6 percent water (conversely, most steam cleaners use lots of warm water to clean), so the vapor steam doesn’t contribute to a moist environment. Vapor steam deeply penetrates whatever it is cleaning, and it is great for upholstery, couches, carpets, and mattresses.


The natural lanolin in wool repels dust mites — another reason to buy wool bedding.


Studies at NIEHS found significant reduction of dust mites when allergen-proof covers were combined with properly laundered bedding, dry steam-cleaning, and vacuuming. Vacuuming alone didn’t work as well as the combination of vacuuming with dry steam-cleaning of carpets and upholstery.


Buy a new pillow every 6 months (dust and dust mites live in pillows).


Eliminate wall-to-wall carpet (especially over concrete floors because concrete generates moisture/humidity). Decorate with washable throw rugs instead.


Freeze stuffed animal toys in the freezer (in a tightly closed plastic bag), and shake vigorously outside after removing them from the freezer. Or, wash stuffed toys often.


Keeping a bedroom clean is important for mite control. Use a HEPA vacuum in the room, and run a HEPA air filter near the bed when the room isn’t occupied. Make sure the bedroom curtains or window coverings are washable. Horizontal venetian blinds can be wiped clean with a damp cloth (but they do collect a lot of dust), and if you have shades that can’t easily be washed, they should be of a type that’s easily vacuumed. Be sure to avoid fuzzy fabrics and bed linens and fluffy pillows; they’ll attract and capture dust.

Cut the clutter. It is very hard to dust well when surfaces are covered with dust-collecting objects. Rough, raw pine and fabrics are also hard to keep free from dust. If you can’t bear to get rid of certain possessions, use covered storage containers for papers, magazines, and other bric-a-brac to reduce dust-catching surfaces….more

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