Archive for Global Health

Starting Out Early

It is a hot, humid day in mid-June, 2011 in this remote village in Niger state, Nigeria. The state is in a low development region with poor health indicators. I am a newly qualified doctor and have just concluded a Lot Quality Assurance Sampling (LQAs) assignment for the state office of the World Health Organization (WHO). The LQAs is a method of assessing the vaccination coverage after the supplementary polio immunization campaigns. I am at the home of Mallam Adamu, a middle aged, poor peasant farmer. Adamu is married with 6 children, 3 of which are under the age of five and therefore eligible for the polio immunization.

He is visibly angry and in a loud voice yells “tefi” in Hausa, the local language to myself and my translator. “Tefi” means “go away”. My translator tells me that for the past 6 months, he has barred his 3 eligible children from receiving polio immunization. He has been reported to the Mai angwa (the local community chief) but he is adamant.

When he learnt I was a doctor, he visibly relaxed and we sat down on a mat in front of his mud house to chat. He has 6 kids and they have all received routine immunization. However, he wonders why the need for the yearly polio immunizations and wonders when they will cease. He has heard the rumours; these polio vaccines were created by the West to cause sterility among his people and he would never compromise the safety of his children. “Lekita, do you have kids?” he asked and I replied “no”. He shook his head slowly.

I proceeded to explain that the rumours are untrue. The vaccines are safe and nobody would deliberately administer a vaccine that can harm kids including myself. Perhaps I answered his questions satisfactorily or he believed me as a medical person but I learnt that on the next round of polio immunization he had allowed his kids to be vaccinated. The encounter however made me realise that I did not have enough answers myself!

As a healthcare provider, just how well did I know these vaccines that I confidently recommended for babies? How is their safety and effectiveness assessed? Yes, while undergoing paediatrics and family medicine training in medical school, I had received lectures on vaccination but there was a knowledge gap that could impact my ability to perform in this field. Three years after this encounter another incident would motivate me to gain more expertise in vaccinology.

This time, I was working at the paediatrics department of a large district hospital in another state in northern Nigeria. One morning a neonate who had been delivered at the hospital, given his first dose of birth vaccines which included the Bacillus Calmette Guerin (BCG) vaccine against tuberculosis and discharged home the previous day was rushed to the paediatric emergency room where I was stationed. His parents were visibly distraught- their son had a fever and a large swelling on his left upper arm, the BCG vaccine injection site. My team had admitted the baby for observation and he was discharged home 3 days later. Before being discharged, his father, a teacher in one of the state owned secondary schools confided in me that he may be unwilling to let the child receive further childhood vaccination and I had to spend considerable time reassuring him. Vaccines are administered to healthy people, usually kids, so there is a low tolerance for any risk and moreover, despite being generally very safe, an Adverse Event Following Immunization (AEFI) can occur, although not usually caused by the vaccine.

Vaccination has been a useful tool in the control of infectious diseases. It led to the eradication of small pox, the first disease to be eradicated through vaccination. Equally, progress is being made towards the elimination of another disease, polio. However, these feats recorded by vaccination paradoxically are beginning to lead to a tendency from the public to question the need for further vaccination and in some cases have led to outright refusal of parents to have their children vaccinated. Tragically this could lead to the resurgence of previously controlled diseases, for example, measles is resurfacing in some high income countries.

All of this must be a wake up call for Global Health. Across Africa, there are instances where rumours have derailed vaccination campaigns requiring intense advocacy to regain public trust and restart the campaigns.  Derailment is not only a political problem, derailment is a matter of life and death.

There is a need for a pool of well-trained local scientists in all spheres-research and development, academia, national regulatory agencies to engage with their communities and advocate for vaccination. Everyone has a right to know and to hear in their own language.  The public will need to be constantly reassured by their own sons and daughters. We cannot afford to wait until it is too late.

 

Dr Edem Bassey is an online scholar of the MSc in Global Health and Infectious Diseases at the University of Edinburgh. He works at the Medical Research Council, Unit the Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM) as a research clinician where he is involved in the clinical trial of life saving vaccines for the developing world. 

 

La Caravana: retos en salud, desplazamiento forzado y respuestas humanitarias en Centroamérica

Please note: this is a translation of the blog post published on 3rd December.

Desde mediados de octubre de 2018, más de 7.000 centroamericanos han están recorriendo el trayecto a la frontera de EEUU a pie y en vehículos sobrecargados. Han viajado juntos en la denominada caravana de migrantes desde el Triángulo Norte (Honduras, Guatemala, El Salvador). Aquí usamos la palabra migrante una vez y con serias reservas. Las palabras importan y la semántica en torno a la caravana esconde y permite discursos anti-migración discriminatorios (por ejemplo yuxtaponiendo la necesidad de prevenir la migración económica al derecho a protección de solicitantes de asilo ‘legítimos’). Este desplazamiento masivo de personas ha reavivado la atención sobre las vulnerabilidades que empujas a los centroamericanos a un viaje peligroso en busca de una vida más digna y segura. En este blog buscamos reflexionar sobre algunos de los desafíos en materia de salud a los que han afrontado, afrontan y podrían seguir afrontando en el camino.

family travelling with the caravan

Fanny Cortés, de 23 años, lleva a su hija, Escarlett, de dos años, mientras que su compañero, Jonny Ramírez, de 22 años, lleva la única maleta con las pertenencias de la familia. La pareja comenzó su viaje en San Pedro Sula. Crédito de la foto: Simone Dalmasso, Plaza Pública “

 

Breve Contexto en Centroamérica

Centroamérica es una región hermosa y diversa entre México y Colombia. Aunque pequeña en extensión, tiene una gran densidad de población y diversidad etno-lingüística. La región, con una larga historia de conflicto armado, autoritarismo y política excluyente, fue ‘pacificada a finales de los 80 y 90 con la desmovilización de combatientes guerrilleros y un proceso de democratización de sus regímenes militares. Sin embargo, la violencia sigue desenfrenada, constituyendo uno de los muchos desafíos de salud que conducen al desplazamiento y afectan a los que se quedan.

La mayoría de centroamericanos de la caravana viene de El Salvador, Honduras y Guatemala donde los niveles de homicidio llevan décadas a niveles de ‘epidemia’. Estos países son el 2º, 4º y 17º más violentos del mundo, respectivamente. La tasa de muertes violentas en los tres países llega a 99,7 (El Salvador), 67,7 (Honduras) y 32,7 (Guatemala) por 100.000 habitantes. En este blog, nos enfocamos en Guatemala, principalmente porque el país guarda un lugar especial en nuestro corazón, pero sobra decir que las circunstancias son insostenibles en toda la región.

 

Salud (y otros) desafíos en casa

En Guatemala la malnutrición y la violencia son los factores de riesgo de muertes prematuras más importantes. La malnutrición es endémica, 50% de ninos menores de 5 sufren retraso en el crecimiento, mientras el 28% de ninos en edad escolar tienen sobre peso y la obesidad en adultos va al alza con estimaciones de que un tercio de la población tendrá obesidad en 2025.
Infecciones prevenibles agudas de las vías respiratorias bajas son la mayor causa de muerte. Sin embargo, enfermedades no-contagiosas, como las cardiovasculares, cánceres y diabetes son comunes también, causando aproximadamente un 59% de las muertes totales, asociadas con malas condiciones de vida y acceso insuficiente a estilos de vida saludables.

La brecha entre la población rural y urbana tiene un impacto sustancial sobre la salud. Entre lo más preocupante está el hecho de que los el estado de salud o el acceso a la sanidad están muy asociados con la etnicidad. La población indígena sufre tasas desproporcionadas de pobreza, la destrucción del ambiente con macroproyectos desarrollistas (presas hidroeléctricas o minería), la falta de acceso a servicios públicos y barreras lingüísticas añadidas.

El Estado históricamente ha fracasado a la hora de proveer servicios básicos para superar estos desafíos. Guatemala tiene la recaudación fiscal (en % del PIB) más baja de toda América Latina y es el tercer país con menor gasto social (en % del PIB). Es así que los servicios de salud están infra-financiados de manera crónica, lo cual lleva a repetidas y largas huelgas de personal sanitario por su bajo salario (a veces impago), la más reciente desde agosto de 2018.

 

Desafíos de salud en el trayecto

Este no es el primer desplazamiento masivo en Centroamérica y la situación de los miles de refugiados tampoco es única. Con frecuencia, los centroamericanos arriesgan sus pertenencias, integridad física e incluso su vida en el trayecto hacia el norte. Emprender el camino en grupos pequeños, organizados por coyotes (traficantes), permite avanzar sin ser detectados. Sin embargo, expone a los refugiados a ser víctimas de violencia o abuso sexual, a que los estafen los coyotes o que los retengan contra su voluntad como esclavos modernos.

Desplazarse en un grupo grande probablemente ha permitido reducir la vulnerabilidad de los refugiados, que no han tenido que ponerse en manos de coyotes. El tamaño del grupo ha provocado actos de solidaridad emotivos, como la movilización de organizaciones de derechos humanos mexicanas para negociar un tránsito seguro a través de cordones policiales en la ruta. Aun así, la salud de muchos se ha deteriorado dadas las condiciones durante el trayecto: deshidratación, quemaduras severas por la exposición al sol, ampollas afectan a personas de todas las edades. Los niños sufren golpes de calor e infecciones respiratorias agudas y se ha documentado la muerte de dos adultos al caer de vehículos sobrecargados. La dureza de las condiciones ha podido con los miles que han decidido regresar al país de origen.

 

Desafíos de salud en el destino
A finales de noviembre, los refugiados encaminados a EEUU fueron recibidos en la frontera con gas lacrimógeno. La cobertura mediática de la ‘caravana’ se ha enfocado principalmente en la reacción de EEUU. El presidente estadounidense ha securitizado el problema, azuzando el miedo a una frontera insegura, migración masiva sin control y la llegada en masa de criminales peligrosos.

Como cabe esperar, la evidencia contradice la imagen que el presidente de EE. UU. intenta difundir. Mientras el número de solicitantes de asilo (lo que podríamos llamar, con reticencias, migración ‘legal’) va en aumento, la migración ‘irregular’ (medida en el número de detenciones en la frontera EE.UU. – México) está en mínimos históricos. Asimismo, el presidente actual ha solicitado eliminar las partidas presupuestarias de cooperación al desarrollo al Triángulo Norte, afirmando que estos países generan necesidades humanitarias, en vez de satisfacerlas. De nuevo, esta postura da una impresión errónea de que la ayuda humanitaria es malversada o ineficaz. De hecho, Guatemala y  El Salvador encabezan la clasificación de crisis humanitarias ‘olvidadas’ dada la magnitud de las necesidades, la capacidad para afrontarlas, atención mediática sobre la crisis y la cantidad de ayuda disponible per cápita.

La medida en la que los centroamericanos que lleguen a EE. UU. disfrutarán de mejor salud allí dependerá de sus medios financieros y su status legal. La población latina en EE. UU. tiene un mayor riesgo de indicadores de salud negativos y generalmente son una población con menos cobertura sanitaria, aunque esto varía según el estado. Los problemas de salud mental asociados con las dificultades del trayecto, experiencias de abuso antes del desplazamiento y el estrés asociado con empezar una nueva vida en EE.UU también es probable que afecten sustancialmente a su bienestar.

Ya se ha establecido una respuesta humanitaria a la crisis de desplazamiento de Centroamérica. Sin embargo, la falta de intervenciones efectivas y sostenibles en la región viene de largo. La caravana es un conjunto de poblaciones desplazadas forzadas  que afrontan desafíos que ponen en riesgo su salud, sus medios de vida y supervivencia. A corto plazo, deberían establecerse medidas de protección para los que huyen de la miseria. Para los que sigan desplazados, el acceso a servicios humanitarios de transporte, albergues, agua, saneamiento e higiene (WASH) y nutrición es esencial. Se debería garantizar el acceso a protección legal y un debido proceso para los solicitantes de asilo como exige el derecho internacional (que por ahora, al menos en papel, rige en EE.UU). A largo plazo, urge un reconocimiento de que la mejora de los sistemas de salud requiere inversión, lo que esperamos se traduzca en acciones urgentes de los pueblos y gobiernos centroamericanos.

Evelyn Balsells es doctoranda de la Universidad de Edimburgo. Su investigación se centra en la carga global de enfermedades infecciosas y está interesada en temas que afectan a poblaciones vulnerables y contextos humanitarios. Daniel Herrera Kelly es doctorando de la Facultad de Relaciones Internacionales de la Universidad de St Andrews, donde investiga la violencia colectiva en Centroamérica. Las opiniones en este artículo son a título personal y no representan los puntos de vista de las instituciones a las que están afiliados.

Edinburgh Hosts the Second Planetary Health Meeting 29 May – 1 June 2018

view of Edinburgh

Image of Edinburgh from Wikimedia commons: https://commons.wikimedia.org/wiki/File:Edinburgh_Castle_Rock.jpg

Over four days in May, researchers, academics, policy makers, social entrepreneurs, government planners, non-governmental and civil society actors, and local community leaders from around the world gathered at Edinburgh’s famed McEwan Hall, to discuss solutions to major planetary health challenges. This event also welcomed young advocates from the Children’s Parliament of Scotland, who will talk about their ideas for safeguarding the planetary health. This annual meeting builds on the successful inaugural Planetary Health Meeting held in Boston last year.

What is planetary health? Put simply, planetary health is “the health of human civilisation and the state of the natural systems on which it depends”. While the concept of planetary health has been around for  sometime, in 2015, the Rockefeller Foundation and the Lancet gave this relationship between the environment and humanity a name: planetary health.

The degradation of ecosystems often leads to negative public health impacts. Addressing these grave impacts and achieving global human and environmental sustainability requires urgent dialogue and cooperation between local communities, experts from across different sectors, state and non-state actors and policy makers.

The Global Health Academy, one of Edinburgh University’s five Global Academies, was delighted to  co-organise and host this important conference.

This conference aimed to offer a significant platform for discussion and collaboration, as well as a “much needed space, as Professor Liz Grant, Assistant Principal for Global Health says, “ to think about the values behind how we live and act”

While this global meeting convened in Edinburgh, several of the University of Edinburgh’s alumni clubs across the globe   committed to Planetary Health Pledges.  These are expanding and exciting the reach of the planetary health community. Cyclists in Chile are ascending heights to promote sustainable transportation; alumni in Colorado are organising waste reduction activities; Shanghai alumni are working with social enterprises towards sustainable fashion.

If somebody had a crystal ball: The paradox of a self-defeating health policy.

When I was a new graduate student of health policy, I was once asked by a professor whose class I took, why I had left clinical practice to study health policy. I replied naively, ‘I migrated from clinical practice because I don’t like the idea of working in a place where I can make one mistake and kill a person.’

‘I see,’ he said, ‘so you decided to come over to policy and kill thousands?’

His response, delivered in jest, was tacitly instructive about the importance of getting health policy right, because of the scale at which the impact can be felt. Indeed, one of the central tenets of governance in healthcare is the identification and rectification of problematic policies (WHO, 2017).

Even after learning at graduate school that policy work tends to be an arduous, convoluted and often contentious process, I still intuitively considered policy work to be safer, more elegant and less stressful than clinical work. It was experiences ‘from the trenches’ that revealed otherwise. Within a year of completing my masters, I was battling to pilot an intervention aimed at mitigating the undesirable effects of a well-intentioned health policy that has outlived its relevance in its context; a process which was the diametric opposite of ‘elegant and less stressful’!

 

When a health policy endangers health

Pharmacies in Zimbabwe, a low income country in Sub-Saharan Africa plagued by a protracted economic recession and a dilapidated health system (Meldrum, 2008), are prohibited by law from advertising their inventory to the general public unfettered like conventional businesses do (Health Professions Act, 2004; Medicines and Allied Substances Control Act, 2001; Pharmaceutical Professional Conduct Regulations, 1989). Given the information asymmetry characteristic of a typical healthcare market, and the potential severity of the consequences of such asymmetry, advertising restrictions are rightly intended to protect members of the public from product claims they are unequipped to evaluate objectively. However, to the extent that advertising restrictions interfere with information provision and transparency when accessing health care, they themselves are a health hazard and this is what the medicine advertising regulations in Zimbabwe have become. The fine line between availing information about care and protecting the public from exaggerated claims should be carefully navigated. Interventions which mitigate the deleterious effects of health information control policies can and should be developed.

In well-served health systems, restricting advertising in and of itself does not constitute a problem because a patient can reasonably expect to find the medicine(s) s/he requires after only one stop or at most few stops at pharmacies in his/her vicinity. However, in Zimbabwe today, systemic economic challenges are causing generalised medicine shortages. These challenges are, in the main, beyond the control of the pharmaceutical sector. As a result, the largest referral hospitals suspended elective surgeries (United Bulawayo Hospitals, 2016; Harare Hospital, 2016). Pharmacies that happen to have a particular medicine that is in short supply everywhere else, are precluded from overtly advertising this fact. Patients therefore have to rely on door-to-door enquiries at multiple pharmacies, serendipitous coincidences, intuition and the benevolence of some pharmacists who sometimes offer to help by contacting colleagues within their professional networks on behalf of patients. Electronic prescribing is not yet widely used in Zimbabwe so patients or their carers are the ones tasked with transmitting prescriptions between prescribers and the pharmacies that will ultimately dispense them. They therefore bear the transaction cost of this process and have to trudge from one pharmacy to the next until they eventually get to a pharmacy that can fill their prescriptions. When pharmacists turn away prescriptions but offer no additional information about where patients can get those prescriptions filled, they become the human face of a system that seems unresponsive to the plight of the ill. Once, I remarked to my colleagues, ‘If somebody had a crystal ball, they would be the oracle that informs patients where exactly to go to get their prescriptions filled and reduce the burden of medicine access.’

 

The intervention: Controlled democratisation of pharmaceutical inventory information

Accessing medicines should not depend on unsystematic methods of search and we most certainly shouldn’t have to look to clairvoyance to make health systems more efficient and transparent – especially when advances in health informatics and Web 2.0 coupled with the ubiquity of portable information and communication devices have increased the interconnectedness of actors and rendered faster sharing of information across large networks possible. After a content analysis of the statutory instruments governing the practice of pharmacy in Zimbabwe, with the view to finding a legal workaround for the advertising rules, I discovered a loophole. While advertising inventory to the general public is prohibited in Zimbabwe, advertising to another health professional is not. Therefore, if a vertical search engine that is populated by real-time crowdsourced inventory data from retail pharmacies all over the country was set up, and if the back-end of that search engine was managed by a pharmacist, then it could be used by that pharmacist to advise patients, on a case by case basis, even remotely via the internet, about the exact locations of pharmacies stocking specified medicines. A prototype meant to achieve this was designed and the three statutory bodies that regulate healthcare practice in Zimbabwe were approached for approval before launch.

The unfavourable response received from them, was unexpected. An email communication was circulated to all the registered practitioners, cautioning them against what the chief regulatory institution considered an ‘illegal project’ that was tantamount to advertising. I was explicitly informed that I was risking censure by setting the ball rolling with it and was sufficiently intimidated. Of all the illegal things a health professional in Zimbabwe can do, outside of malpractice, experimenting with advertising is considered the most negligent because it is so easy to avoid. It is seared onto our minds right from pre-qualification training that advertising by health professionals is simply not acceptable, so it is almost a reflex response for healthcare providers to stonewall anything that bears advertising connotations.

Regulators were re-engaged because their endorsement is crucial. Without this it is not possible to persuade pharmacies to volunteer the essential crowdsourced data needed to populate the vertical search engine that drives the intervention. Although they acknowledged unreservedly the existence of the problem that the advertising policy has given rise to, regulators remained steadfast in their position that the proposed vertical search platform solution was illegal and ‘was not in the best interests of the public’. The judiciary arm of the state was therefore invoked in the hope that it could rule on the legality of the proposed intervention.

The intermediate goal became to obtain a court judgement that would compel the regulatory bodies to allow this intervention to be tried. A High Court application (Herald, 2016a) citing the health minister and all three relevant regulatory entities as respondents, was filed. We currently await a judgement pronouncement but continue to keep the discussion about the matter alive, for example through the press (Herald, 2016b). Meanwhile, one of the regulatory bodies has responded to our court application with a counter-suit for costs because according to it, we ‘brought a case before the Court prematurely.’

 

The Future

Towards the end of 2016 a press announcement notified the public of the healthcare regulators’ intention to relax draconian advertising policies (Herald, 2016c), having recognised the need for the public to access information about healthcare providers and services. I count this a small victory and look forward to the green light to implement the ‘Crystal ball’ project with much optimism. Lessons from its implementation could bode well for health systems facing similar governance problems.

Determined to build my credibility with policymakers and take forward my academic studies, I enrolled for a PhD with the Global eHealth research group at the University of Edinburgh and am now 10 months into a three-year programme. Taking this parallel pathway, whilst continuing to fight the case for better information sharing about community pharmacy stocks in Zimbabwe, has forced me to critically examine my assumptions and proposition and to mentally separate my personas as an objective researcher of eHealth innovation and as an innovator/entrepreneur. It has provided an opportunity take an in-depth look at the technical and legal feasibility of alternative approaches, and their ethical, legal and governance implications, as well as to study a wider range of innovative digital approaches for supporting pharmacy practice and strengthening health systems. This transition has been guided and encouraged by my PhD supervisors Dr Claudia Pagliari and Dr Raluca Bunduchi, who have kept my feet on the ground and combine expertise in health technology assessment, health policy and innovation studies. Our new opinion piece in BMJ Global Health (June, 2017), aims to draw wider attention to the challenges facing Zimbabwe and seeks ideas and opinions from researchers, policymakers and practitioners facing similar problems elsewhere in the world.

 

By Dudzai Mureyi, Global eHealth PhD student

Dudzai Mureyi is a first year PhD student on the Global eHealth programme at the University of Edinburgh, supervised by Dr Claudia Pagliari (eHealth Research Group) and Dr Raluca Bunduchi (Entrepreneurship and Innovation Group).

 

  1. Harare Central Hospital (2016). Internal memo: Suspension of Elective Lists-Drug Shortages. Harare. [WWW] Available from https://zimnews.net/zimbabwe-suspends-surgeries-harare-hospital/ Accessed 06 February 2017.
  2. Meldrum A, (2008). Zimbabwe’s health-care system struggles on. Lancet 371(9615); 1059-1060.
  3. Parliament of Zimbabwe (2001) Medicines and Allied Substances Control Act [15:03]. Harare. Parliament of Zimbabwe.
  4. Parliament of Zimbabwe (2004) Health Professions Act [27:19]. Harare. Parliament of Zimbabwe.
  5. Parliament of Zimbabwe (1989) Statutory instrument 232 Pharmaceutical Professional Conduct Regulations. Harare. Parliament of Zimbabwe.
  6. The Herald (2016a). Pharmacist Seeks Court Order for private pharmacy stocks database. [WWW] Available from  http://www.herald.co.zw/pharmacist-seeks-court-order-for-private-pharmacy-stocks-database/  Accessed 06 February 2017.
  7. The Herald (2016b). When regulation is outpaced by technology. [WWW] Available from  www.herald.co.zw/when-regulation-is-outpaced-by-technology/ Accessed on 06 February 2017.
  8. The Herald (2016c). Zimbabwe: Govt relaxes Medical advertising rules. [WWW] Available from http://allafrica.com/stories/201611280215.html Accessed 06 February 2017
  9. United Bulawayo Hospitals (2016). Internal memo: Cancellation of Elective Surgical Operations. [WWW] Available from http://www.africanews.com/2016/10/15/drug-shortage-hits-zimbabwe-hospitals-suspends-some-surgical-operations// Accessed 06 February 2017.
  10. WHO (2017) Governance. [WWW] Available from http://www.who.int/healthsystems/topics/stewardship/en/ Accessed 06 February 2017.
  11. Mureyi D, Pagliari C, Bunduchi R (2017) Drug advertising riles and the patient safety paradoc in Zimbabwe. BMJ Global Health (Opinions), June 8th 2017 http://blogs.bmj.com/bmj/2017/06/08/dudzai-mureyi-et-al-drug-advertising-rules-and-the-patient-safety-paradox-in-zimbabwe/ Accessed on 10 June 2017

Building Resilience Against Depression

Everyone feels down from time to time but depression is more than sadness or feeling ‘blue’. It is a common mental disorder which affects males and females, young and old, rich and poor. It is a treatable health condition that is found across cultures.

Depression can affect the way you think, move and speak. It can affect your physical health. It can also affect your ability to care for yourself, relate to others and enjoy life. Young people with depression can fall behind with schoolwork, miss out on friendships and struggle to find the energy to keep up with sports and leisure activities. In adults of working age, depression can make it difficult to concentrate at work, keep on top of finances, care for children, and maintain homes in order. Older people who are depressed may become socially isolated, forget important appointments and lose interest in work and hobbies. Some people with depression experience severe loss of appetite or thoughts of suicide and self-harm which can occasionally lead to death.

It is important to recognise and treat depression early to reduce suffering and prevent worsening of the illness. Despite advances in depression care, many people cannot or do not access help and they continue to suffer quietly and alone, hoping and praying the depression will one day disappear. Without additional support, some suffer for much longer than is necessary and later look back on their lives with regret over the lost months and years. This should not happen anywhere in the world.

Today we have a holistic understanding of health and this means people with depression can be helped by a combination of: medication, social support, psychological therapy, exercise, nutritional therapy and spiritual care, depending on the severity of depression and the individual’s needs and preferences. These treatment options address the multiple factors which are associated with depression, such as resilience. While being highly resilient does not eliminate all risk of depression, research findings from both higher and lower income countries show that building resilience can help prevent and treat depression.

Depression causes suffering and loss for those who live with it and for their family and friends. Depression can also cause death. With modern, evidence-based approaches to tackle depression, no one should suffer in silence without hope. Depression care can be tailored to the individual who should expect to make a good recovery, build resilience against future episodes of depression, have better physical health and enjoy a fulfilling life.

______________________________________________________________________

Dr Anne Aboaja MPH MRCPsych , University of Edinburgh, Global Health PhD Network

Health in the Eastern Mediterranean Region

The vast complexities of the Middle East and surrounding regions cannot be understood without bringing health into the battleground of analysis. In this context, the Global Health PhD Network organised the event “Health in the Eastern Mediterranean Region” on 28th of October, 2016 with the funding of the University of Edinburgh’s Global Health Academy. The event was framed as a series of four short conferences on diverse topics related to Health in the region, and two networking recesses at the venue’s foyer at 7 Bristo Square, where delicious kenafa was served by the University’s Middle Eastern Society.

The first speaker was Dr Runa MacKay. She studied medicine at the University of Edinburgh at a time where it was not usual for women to go this further in their studies. In 1955 after qualifying in medicine, Dr Mackay arrived at the Edinburgh Medical Missionary Society Hospital in Nazareth, now in Israel, which has served the Arab population there for more than 150 years. Dr Runa Mackay spent around fifty years working across Lebanon, Palestine, and Israel for the betterment of health conditions among the Palestinian population who live within Israel, either in health policy or as a practitioner in war torn Beirut and West Bank. Today, back in Edinburgh, she has written the book “Exile in Israel”, where she tells her personal experience throughout those years which have taken her to state, as she did in the event, that she feels more Palestinian than British.

As the second speaker, Khuloud Alsaba, researcher from the Syrian Center for Policy Research and a final-year PhD candidate in International Public Health Policy talked about part of her research project: “War in Syria: Political Determinants of Health”. In a very critical and insightful way she explained how within the discourse of “The War on Terror” health facilities and health care workers have become a legitimate target. However, turning access to health into a weapon of war has brought unexpected hardships for the population. Khuloud argued that polio, once an eradicated disease, has reappeared in Syria as a consequence of a thrashed and weakened public health system. She concluded by stating that these war tactics are not only militarily and economically inefficient, but also (and most importantly) a violation of the human rights of Syrians.

After a short networking recess, the event carried on with the third talk. Via videoconferencing, Ben Clavey, a young medical student and the co-coordinator at Medact Arms and Militarisation Group, gave a concise explanation about this NGO and its work in the Middle East. Medact is an organisation where health professionals can go beyond the clinic and actively engage with the search for solutions to the most pressing global health issues. Through analysis, lobbying, and education, it aims at having an impact in policy on four main areas: peace and security, climate and ecology, economic justice, and health and human rights. Regarding the Middle East, he added that Medact’s activity in the region has been extensive. It has worked in Iraq and Palestine performing in ground analysis and campaigning for the respect of human rights and adequate health policy for the victims of armed conflict in both countries. Recently, it has worked on warning and lobbying against airstrikes by the British military in Syria and also against UK arms sales to Saudi Arabia, who has been involved in the destruction of Yemen’s health system and the targeting of its hospitals and other healthcare facilities. Finally, Ben invited us to become part of Medact’s effort in taking health as a human right into policy either by donating or joining the organisation. A stand with further information for those interested in participating was set on the venue’s lobby as well.

The fourth and last speaker was Parisa Mansoori, a PhD candidate at the Centre for Global Health Research at The University of Edinburgh, who presented her research project on Iranian health sciences and academic literature production. According to recent data, Iran has had a dramatic increase in the amount of health related academic publications in the past few years. This stands out as a unique situation among the emergent economies, due to the quality of the articles produced in Iran, which have found their way into high impact international journals. Moreover, Parisa pointed out that practically a large proportion of this new literature has been produced by a small group of academics in Tehran University of Medical Sciences and few other Tehran-based institutions. By providing a thorough characterisation of this phenomenon, she expects to lay ground for further progress and development of Iran’s health sciences and their contribution to the global scientific arena.

In conclusion, the event managed to assemble in a couple of hours a wide range of experiences related to health in the Eastern Mediterranean region. Just as this region has been traditionally associated with armed conflict and violent political struggle, health has also been a very pressing issue both then and now, as Dr MacKay and Khuloud Alsaba exemplified. However, as Ben Clavey from Medact and Dr MacKay let us see, there are still spaces for hope and resistance, as well as moments for empathy and sharing. Furthermore, in spite of these difficulties, the region hasn’t stopped creating new knowledge. As Parisa Mansoori portrayed, the region is home for highly qualified and capable academics who contribute to the development of science and knowledge around the world. Lastly, thanks to the networking sessions and kenafa tasting we were reminded that, as in any other place, there are people living everyday lives in this region, where the creation and recreation of very rich cultures has made of it a quite unique and special place.

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Bernardo Moreno-Peniche, MSc Medical Anthropology, University of Edinburgh

 

Images taken by: Clàudia Serra Vinardell

Proud to be a dangerous woman – Prof Judith Mackay

Professor Judith Mackay is a member of the GHA and is a Hong-Kong based tobacco control researcher and activist.

She is Senior Advisor, Vital Strategies/Bloomberg Initiative to Reduce Tobacco Use; Director of the Asian Consultancy on Tobacco Control; and Senior Policy Advisor to World Health Organisation.

She has authored 12 atlases on health topics. In addition to many international awards, ranging from the WHO Commemorative Medal and the TIME 100 award to the first BMJ Group Lifetime Achievement Award, she has been identified by the tobacco industry as one of the three most dangerous people in the world.

She recently contributed to the Dangerous Women project, an initiative of the Institute for Advanced Studies in the Humanities at the University, which analyses the dynamics, conflicts, identities and power relations with which women live today.

Read Judith’s contribution here …

“It wasn’t my intention to be a dangerous woman or to find myself in danger, simply by being committed to gender equality and better health.

There was nothing in my medical degree course at the University of Edinburgh in the 1960s to predict that I would be labelled by the tobacco industry as one of the three most dangerous people in the world, or that I would need to be offered 24-hour police protection by the Hong Kong government.

Perhaps the first hint of danger in my life was when I arrived in Hong Kong in 1967 at the peak of the Chinese Cultural Revolution – which spilled over into Hong Kong – with Communist schools and banks barricaded and manufacturing bombs, and big character posters saying ‘Down with imperialists’ and ‘British go home.’ Street riots rocked the colony, bringing with them waves of bombings, looting and arson attacks. British rule became precarious, but held – only just – when Chinese Premier Chou Enlai reined in the HK Red Guards.

A Dangerous Feminist

I became a committed feminist at about the same time (and still am today, 50 years on), and this did not lie easily in colonial Hong Kong, where even senior government figures and judges would joke about rape. People viewed me as dangerous and subversive (and wrote many letters to the press saying just that). This could spill into physical abuse, such as when a friend’s husband twisted a necklace (engraved with the sign for women) round my neck, lifted me off the floor and snarled that “Women will never be the equal of men as they are not as strong,” while I dangled helplessly in the air, powerless. I determined never to let that happen to me again. Even more bizarrely, another woman friend only recently told me that the husband of a mutual friend had tried to rape her, saying ‘This is for Judith Mackay,’ as he perceived his wife was coming under my feminist influence.

A Dangerous Subversive in The Medical Profession

In the 1980’s, I earned the fury of my own medical profession by writing a health series in the South China Morning Post, Hong Kong’s leading English language newspaper. The article broke the then-traditional power mode of doctor-patient relationships by encouraging women, in particular, to keep their own personal health record, and participate in their own health care decisions. ‘When your doctor tells you…’ became ‘When you and your doctor decide…’ A senior gynaecologist stormed up to the hospital where I worked, found me in Medical Outpatients, pinned me against a wall, and said ‘This newspaper series has to stop or you will be in trouble.’ I said that this sounded like a threat, and he said ‘You have powerful enemies in the medical profession, and had better watch out.’ He went on to say that only that morning he was inserting a copper intra-uterine device in a patient, who had meekly asked ‘Is this a copper coil?’ and he was furious – asking her ‘Have you been reading Dr. Mackay’s column in the SCMP?’ – the trigger to his visit.

A Danger to Big Tobacco

I’ve faced the greatest danger since moving from clinical to preventive medicine. There were three main reasons for making the shift from hospital medicine to public health. First, during my work as a physician in the 1970s and 1980s, I came increasingly to feel that clinical work was like ‘a band-aid.’ In fact, we had a maxim on our male medical ward that we never admitted a non-smoker, our wards being full of people with end-stage tobacco illnesses, often too late to prevent morbidity and mortality.

Second was the realisation that although women’s health in those days was defined as reproductive health, tobacco was killing far more women than were dying from birth control – and the tobacco industry was actively recruiting women with promises of beauty, slimness, popularity and emancipation.

What finally galvanised my determination to combat tobacco use was the response to a piece I wrote on tobacco as part of my series on women’s health in the South China Morning Post. One of the British transnational cigarette companies published a booklet labelling me as ‘entirely unrepresentative and unaccountable.’ In contrast, the self-promotional booklet claimed ‘the tobacco industry comprises identifiable, legal, accountable, commercial organizations.’ This booklet, denying the health evidence (‘it has not been proven that these illnesses are actually caused by smoking’) and claiming to be an ‘important source of reliable information’ on smoking, so enraged me that from that moment on I worked on tobacco control, abandoning curative hospital medicine in 1984.

Why was my job so dangerous? It was partly location. The tobacco industry thought they could gallop their Marlboro cowboy into Asia, and it was theirs for the taking. They even said ‘What do we want? We want Asia,’ with the dream of converting the 60% of men who smoked local cigarettes to switch to international brands, and the second dream of persuading Asian women to start smoking. Given the numbers concerned, it would not have mattered if every smoker in the UK had stopped smoking the next day, if they could have captured the massive Asian markets.

There was no career structure and no pay, but I set about thwarting their goals. I was in touch with colleagues in the UK and elsewhere who were unstinting in their assistance, but it was a lonely job in Asia in the 1980s.

This brought me into conflict with one of the world’s most wealthy and powerful industries – and its supporters. I’m frequently subjected to verbal abuse and have been described over the years as sanctimonious, dogmatic, pontificating, meddlesome, heretic, puritanical, hysterical, prejudiced, a ‘Nanny,’ and more recently a ‘jihadist’.

In 1993, a smokers’ rights group in the USA described me as ‘psychotic human garbage, a gibbering Satan, an insane psychotic just like Hitler, using fatuous, smarmy drivel and distortions, and diatribes full of putrid corruption, lies, conspiracy, and total censorship.’ They concluded by stating that I was ‘devoid of any sanity, any morality, or any human-being-ness of any kind’, was ‘nothing more than an evil-possessed, power-lusting piece of meat’ and they threatened to ‘utterly destroy’ me!

The group had made similar threats to a US government health official, so the last sentence – perceived by the FBI as a death threat – had to be investigated by the agency, and I was added-on to that investigation. At this point, I was offered 24-hour police protection by the Hong Kong government.

The industry twice threatened, very publicly, to take me to court. Nothing came of it, of course – I was on rock-solid ground on the facts – but such tactics were attempts to intimidate me, and a ploy to cast doubt on my credibility in the minds of the public.

Such offensive words, the death threat, and the menace of litigation, completely failed to divert me. I said, robustly and publicly, that I was absolutely not a suicidal type, and that if I were to be found ‘knocked down by a bus,’ the tobacco industry was guilty until proven innocent!

That is not hyperbole. I had to give evidence as an expert witness in a major tobacco smuggling trial, involving British American Tobacco cigarettes being smuggled into China. The chief witness was murdered, and eleven others disappeared. Another witness jumped out of a window – on the 22nd floor. I had to report to the Independent Commission Against Corruption that I was being followed. They put a stop to it, but it was an eerie experience, as was being cross-examined by a tobacco industry lawyer.

There have also been clandestine aspects to my work. In 1986, a go between phoned to tell me that a ‘Deep Throat’ associated with US Tobacco had informed him of a plan to imminently launch smokeless tobacco (sucking, chewing tobacco and snuff) in Hong Kong. To this day, I do not know the identity of ‘Deep Throat,’ not even whether it is a ‘she’ or a ‘he.’ Immediately, I contacted the Hong Kong government and helped to plan a ‘pre-emptive strike’ – a ban on the importation, manufacture and sale of smokeless tobacco products. Other whistle-blowers have contacted me from within the tobacco industry, always a sensitive and potentially explosive situation. For their safety, I will say no more.

Working In Dangerous Places

I have also worked in some very dangerous areas in Asian countries, some under martial law, some at war, some under attack by rebels in their own countries. I was in Cambodia giving a slide presentation when there was an almighty explosion and the ceiling started falling down. Everyone else dived under the tables. Perhaps my finest hour as a Brit: I simply said, ‘Next slide please.’ It turned out to be a captured ammunition cache that had been placed in the central square and blown up by the government, but with no notice to anyone.

In 1990, I was held at gunpoint by armed Mongolian palace guards who, seeing me appearing out of the dark at the Government guest house after an evening walk, had no idea who I was or what to do. I had to gently talk them down, in a language they did not understand. Incidentally, the Minister of Health in Mongolia told me that during that first visit, they held a cabinet meeting as they thought I might be a spy sent from the west. They had prepared a school project to present to me, but I was much more interested in the tax, economic and political issues regarding tobacco, even their border security in preventing smuggling. He said the cabinet had concluded I was not a spy, and instead I had highlighted the breadth of issues involved in tobacco control.

More recently, I have worked with the North Korean (DPRK) government on tobacco control on three occasions, but am probably safer there than in London.

Promoting Gender Equality

Less dangerously, I have been able to push for equal gender representation in public health policy-making, including data collection and in the wording and clauses of the WHO Framework Convention on Tobacco Control. I have been able to promote women for various international awards, to serve on international committees and to be invited to speak at major conferences. For example, when invited to assist the 10th World Conference on Tobacco or Health held in Beijing in 1997, I stipulated that I would work pro bono as long as at least half of the keynote plenary speakers, chairmen, and committee were female. Despite initial uncertainty from the organisers, the event turned out to be the “best conference ever” and set the standard for subsequent conferences.

I promote women because if women are not in those positions, then the issue of women and tobacco gets ignored. This resulted in some resentment from male (never female) colleagues in the early days, some of which I found very hurtful. Ultimately, though, I have found it useful being female. Some countries embarking on tobacco control found it less threatening to invite me to be an Advisor – and it’s my knowledge, experience and expertise, valued in Asia in both sexes, that gets results. In addition, being based in Asia and knowing Asia, but being British rather than Asian, helped me to be seen as politically neutral.

I have wondered if working in tobacco control today is as dangerous as it was. I think not. It does require a certain type of interested and involved person to go into the field, but public health has now moved to the mainstream of health sciences. There are also many more people working in the field – it is not as isolated as it was 40 years ago. Personally, I intend to work until I am 100 – I practice Tai Chi (taiji) and reserve my two sword programmes’ cut and thrust for continuing to fight the tobacco industry.

I have worn the ‘dangerous’ label as a badge of honour, but hope the day is near when women aren’t labelled “dangerous” simply for standing up to advocate for issues like health or gender equality. We wait.”

Read Judith’s original blog here: http://dangerouswomenproject.org/2016/08/11/judith-mackay/

Proud to be a dangerous woman – Dangerous Women Project
dangerouswomenproject.org

Today we hear from Dr Judith Mackay, identified by the tobacco industry as one of the three most dangerous people in the world.
Prof Judith Mackay’s GHA profile:

http://www.ed.ac.uk/global-health/communities-practice/members/global-members/professor-judith-mackay

Uganda July 2016 – the Global Health Academy Summer School

Earlier this month, I was extremely fortunate to take part in the Global Health Academy summer school held this year in Makerere University, Uganda. For the first time, this year, invitations were extended to our program, fulltime Infectious Diseases by research masters students –in addition to the part-time online global health, eHealth, wildlife conservation, public health and infectious diseases master’s students. Tempted by the idea to get out of the lab and meet fellow students studying from distance, I immediately seized the opportunity, and, despite being close to the hand-in deadline for my thesis, it was totally worth it! Since it all happened really quickly and last minute, I didn’t really have time to create any expectative but had I had any, the experience definitely went beyond: what an experience!

The event and subsequent discussions that came up during the study sessions were a perfect illustration of the concept of One Health: sharing everybody’s opinions and point of view on different topics approached differently by students from different fields and disciplines, seeing how interconnected we all are and how interdisciplinary approaches are the best way to solve global issues. This highlighted the need for more communication and collaboration between disciplines: environment, health, technology, conservation, everything needs to be linked and if we can bring all those fields together towards a common objective, we can reach a much wider audience and raise awareness much more easily, hence solving problems a lot more efficiently.

Additionally, it was extremely inspiring to hear about other students’ projects and listen to the stories of alumni students; realise how their master’s program empowered them to set up their own projects and use the skills and knowledge they learnt to practically benefit their communities and make a difference. As the quote says: a picture is worth a thousand words, in this case, having the chance to see first-hand some of the great things some students are achieving was worth a thousand lectures. I was very encouraging to see how, despite being students, we can already start making a change and, through this kind of opportunities, network and get our classmates involved, support each other sharing our skills or spreading awareness and share ideas.

The trip to Budongo was the best example: seeing how Caroline is leading a dedicated team to fight for the protection of endangered species such as chimpanzees and build a strong hub of research on the species to better understand and design conservation strategies. The long walks patrolling in the search for snares also showed us how challenging and complex it can be to open the dialogue with traditional communities and find for them alternative ways of subsistence that do not harm the wildlife and surrounding ecosystem.

There is still a lot to be done, but this is the proof that with hard work and dedication, alumni of the University of Edinburgh are directly contributing to making a positive change across the world.



Elena Perez Fernandez, MSc Global Health: Infectious Diseases, University of Edinburgh

My Ugandan Global Health Academy, Summer School Experience!

When I received the invitation for the Global Health Academy summer school in Uganda, I have to admit I was hesitant.

After just finishing my first year on the MPH course, I wondered if I could muster the motivation to do one more minute of work until the next term. However, after re-reading the course itinerary numerous times, I finally persuaded myself it was the right decision to go.  The itinerary was just too tempting; 4 days of summer school and 2 bonus days of chimp tracking in the forests of Budongo?

With flights booked, I ran over the checklist for Kampala and Budongo again and packed my things. Budongo was going to be quite different from Kampala and we needed to be prepared for that environment. We were given the link to the Budongo Wildlife website beforehand which gave full information on where we would be staying and everything we needed, including how to behave whilst visiting the forest.

The university discussion page went over accommodation and transport in both Kampala and Budongo and all my questions were answered quickly and informatively.

To be honest, I didn’t know what to expect from the school. I felt quite out of my depth at first, with my limited global health experience, and having only just completed my first year? However, my fears were soon put to rest as this scary bunch actually turned out to be some of the friendliest and motivational, individuals I have had the pleasure to share a room with, staff and lecturers included.

Makerere University pic 1 Makerere University pic 2

 

 

 

 

 

 

 

 

My co-students were a group of professionals, from all over the world, studying a number of different disciplines at various stages in their studies, however, it soon became evident that no matter what background we came from, we all shared a passion for making the world a better place.   I felt immediately at ease.

Dr Ricky Okwir, University of Edinburgh Alumni

Dr Ricky Okwir, University of Edinburgh Alumni

 

 

 

 

 

 

 

 

To briefly summarize: The lectures were inspiring; the activities were thought provoking and the teamwork brilliant! Everyone got stuck in and shared all they had to share.  There were many brave people who stood up to give presentations on their topics, (myself not included, but I will certainly be on the list for next year) and we received lectures from faculty ranging from epidemiology to simply how to reference properly.  There were many questions and many discussions, but we always had time for a laugh, cup of tea and deep fried cup cake!!

The summer school not only taught me a great deal academically, but also gave me the opportunity to learn from other cultures and nationalities, the value they put on their environments, from a social, medical and environmental perspective. There were so many ideas and all added something to the wealth of knowledge the summer school brought about.

Of course, our experience in the Makerere University was just the start of our adventures. We still had the trip to Budongo to look forward to.

Accommodation at Nyabyeya Forestry College

Accommodation at Nyabyeya Forestry College

Accomm Budongo 2

After a few hours bus trip (stopping off to investigate the local culture on the way) we arrived at what I would describe as a little haven, right out of a holiday magazine. Our very basic but comfortable accommodation set amidst the luscious forest at the Nyabyeya Forestry College. It was certainly a sharp contrast to the hustle and bustle of Kampala.

We travelled a little way to the Budongo Wildlife Reserve after settling in, where we were welcomed with dinner, tea and coffee, a very informative introduction to the reserve and a briefing on what we could expect from the next couple of days.

What a couple of days we had! We participated in monkey and chimp tracking with highly skilled staff who also gave us an introduction to the whole ecosystem of the forest.  We met other visiting teams who were studying the forest and the surrounding areas and enjoyed discussing their experiences, having been based there for the last 4 weeks.

We were not just treated as passive visitors, but expected to report back on the day’s findings. Our feedback was very much valued and gave us a chance to really get thinking in groups, about things that would contribute to the continued success of the research centre and surrounding areas.  We discussed improving awareness and promotion of the project, and ways that would promote the engagement of the community.  I suddenly found myself utilizing a number of concepts we had learnt throughout the MPH course and the lectures we had received earlier in the week.
Budongo 1Budongo 2

 

 

 


 

 

 

Following this we followed our guides into the forest for a spot of snare patrol, where we were taught how to find and identify snares often set by hunters. These ranged from small wires to huge mantraps, all an extreme hazard to creatures living in the forest, and also forest rangers.

Budongo 5

 

We later visited local villages where we were given a talk about the on-going battle bco-existence of humans and wildlife. We learnt about sustainable crop development and the setting of buffer zones in order to control the disruption of local communities by the chimpanzees and other animals living in the forest, which frequently visit to crop raid when food levels are low in the forest.

Only too soon, it was time to return to Kampala and make our way home to our respective countries, to take back all that we had learned and apply it not only to our studies but to our everyday lives and those around us.   I couldn’t wait to get started!

To say I have learned a great deal would be an understatement and it is with great pleasure that I write to inspire others to join in the next one.


 

Seonaid Biagioni, Masters of Public Health, University of Edinburgh

Summer School 2016 – Uganda

I am currently a Year 2 student in the MSc Global eHealth course from the University of Edinburgh. eHealth is an emerging field at the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through internet and related technologies. Each year The University of Edinburgh runs a Summer School Programme which draws together cohorts of Masters level students studying across the domain of One Health and Global Health: Innovation and Education. I was eligible for the programme and jumped on the occasion to meet friends which I encountered virtually only. This year’s Summer school took place in Uganda at Makerere University in July.

Uganda was a pleasant surprise for me. I reached the airport and happy to have good WIFI to talk to my family. The roads are loaded with vehicles and Ugandans are hard workers. They never seem to sleep. I was told that every day nearly 2 million people move to and from Kampala for work. Whoa! Mauritius where I am from is only 1.3 million people. Uganda has a population of 39 million with GDP growth of 5% (Source: Wikipedia). This is pretty impressive and promising African country.

The Summer School programme kicked off with a discussion on One Health and Sustainable Development Goals (SDGs). It was great to see the lecturers in action. We have been discussing a lot on the discussion boards and it was clear that we are not strangers but friends on a mission for better good. There were workshops on presentation skills and I got the opportunity to pitch my work and receive valuable feedback. The sessions on epidemiology have been made simple and I could grab the concepts better. Day 1 was pretty heavy but I seemed to get a better grip of the structure of the programme as the days went by.

The great thing about Online distance learning is that all the students are busy working professionals in their own fields. This programme provided a platform to network and talk about potential synergies. Each one of us is contributing in our fields and learning the best practices from different areas is pivotal to acquire the multi-disciplinary skills of future leaders.

We had a comprehensive data analysis workshop with Professor Michael Thrusfield. It was the first time I truly understood the meaning of p value and t-test. The workshops ended daily with inspirational talks from alumni and students.

Professor Michael Thrusfield

Team building workshops were interesting and allowed us to know our friends better. From writing press releases to data analysis on quantitative studies, a wide variety of activities fostered a challenging yet fun environment to learn.

I finally managed to meet Dr. Liz Grant. She signed my scholarship letter in 2014 and I am indebted for the support she has given me since then. This MSc has challenged me to step to the next level and move ahead in my career.

Amal Bholah and Liz Grant

 

 

 

 

 

 

 

The final day of the workshops, the students gathered up and went for dinner. We had 1.1 million Ugandan Shillings worth of food and it was really tasty (1 GBP = 4451 Ugandan Shillings).

dinner receipt

The University of Edinburgh organized a trip to the forest of Budongo were research is conducted to understand the relationship between biodiversity, forest management practices. We stayed in a lodge which was far better than I expected. We spent two nights there and I was impressed by the hospitality of Ugandans. On day 2 we went chimpanzee tracking. We walked nearly 3 hours in the deep forest of Budongo appreciating the wildlife. It was surprising to see how the chimpanzees were undisturbed by humans. I saw a really balanced wildlife ecosystem. Our guide could identify the chimpanzees from far and even called them by name. Wow. These guys are doing an amazing job to preserve wildlife and also maintain a peaceful balance between humans and wildlife. I enjoyed these two days in Budongo and it’s recommended to all those visiting Uganda.

Budongo

The key aspect of the Summer School Programme is that I made great friends from different fields who are leaders of tomorrow.


 

Dr Leckraj Amal Bholah, MSc Global eHealth, University of Edinburgh

Dr Leckraj Amal Bholah