http://viewchange.org Videos from ViewChange.org (Filtered by topics: Médecins Sans Frontières) en-us Mon, 11 Jun 2012 08:04:00 +0000 Copyright 2011 Link Media, Inc. http://www.viewchange.org/videos/the-health-show-container-hospital Jermain Romeize is suffering complications during childbirth in post-earthquake Haiti. Fortunately, she is being looked after in a maternity hospital, which was built entirely out of shipping containers as a rapid response to the earthquake. Mon, 11 Jun 2012 08:04:00 +0000 http://www.viewchange.org/videos/the-health-show-container-hospital Health, Haiti, Médecins Sans Frontières, Maternal health, Hospital, Maternal death, Hypertension, Blood bank, Cold chain, Head of Mission >> VOICEOVER: Jermain Romeize has been in labor for six hours. She has preeclampsia -- high blood pressure, dangerous for both mother and baby. >> DOCTOR: Breathe, breathe. Now push, push. >> JERMAIN ROMEIZE: Wow, mercy, mercy. >> VOICEOVER: Fortunately, she safely delivers a healthy baby boy: Stanley. Giving birth in Haiti is risky. It has the highest maternal mortality rate in the Western Hemisphere. Skilled medics supervise only a quarter of births. But Jermain and her baby are lucky. She's being looked after in a specialist maternity hospital. It's built entirely out of shipping containers. It was created as a rapid response to the devastation caused by the earthquake, which put many health centers out of action. >> SYLVAIN GROULX [Head of Mission, Medecins Sans Frontieres, Haiti]: There was a need; the hospital in which we were in prior to the earthquake, unfortunately the structure was no longer safe. >> VOICEOVER: This one hundred and twenty bed facility is one of four container hospitals built by Medecins Sans Frontieres in Haiti for local doctors and nurses. A container hospital like this can be set up in five or six months. >> SYLVAIN GROULX: All of the electrical furnishings that you see, the air conditioning units for example, all of the plumbing as well, this all came as part of the package. >> VOICEOVER: These services create safe, hygienic workspaces for the Haitian staff. >> SYLVAIN GROULX: It's very, very important for us to have proper working conditions for our lab techs. It has cold chain, so fridges, and freezers, for example here we have our blood bank. >> VOICEOVER: The hospital specializes in caring for mothers whose lives, or those of their babies, are in danger. This woman has complications in her pregnancy, so her baby is being carefully monitored using ultrasound. >> NURSE: Your baby is normal. He looks okay on the scan. When he is born, we'll have to take him for tests, to check that he doesn't have any respiratory problems. >> VOICEOVER: Over three hundred babies are born here every month. Many of them are small and weak, so this neonatal ward is designed to give them the special care they need. >> SYLVAIN GROULX: These children are all born premature. They really need intensive care 24 hours a day. >> VOICEOVER: Basic incubators have replaced the more sophisticated ones that were lost in the earthquake. Life remains extremely challenging in Haiti. But for today at least, Jermain is able to just enjoy her first moments with her baby. http://www.viewchange.org/videos/kiberatv-life-beyond-hiv Agneta Olouch, a primary school teacher in Kibera, was left alone to raise her children when her husband died of AIDS-related complications in 1995. When her health began to deteriorate rapidly, she discovered she was HIV positive herself. Out of this pain and hardship, she summoned the strength to start the Stawi Center, a community center for people of all ages living with HIV. Fri, 26 Aug 2011 08:41:00 +0000 http://www.viewchange.org/videos/kiberatv-life-beyond-hiv Kenya, HIV, Health, Vertical transmission, Education, Health education, Kibera, Médecins Sans Frontières, KiberaTV, Hot Sun Foundation >> TITLE: KiberaTV >> AGNETA LUTA OLOUCH [Founder, Stawi Youth and Adult Center]: My name is Agneta Luta Olouch; I'm about 59 years old. I'm going to celebrate my 60th year this year. I am HIV positive, and I got healed when I went for medication because I used to be sick. But now when I got healed, I thought of starting a small project like Stawi. Stawi means, "to grow and prosper." At least bring people together. >> BENTA AGOLLA [Stawi Group Member/Teacher]: Stawi is composed of many groups. I'm in two groups at Stawi. I'm a member of the Post Test Club, that's a club that meets to share how they're living positive. >> AGNETA LUTA OLOUCH: Bring children together who are orphaned because of HIV and AIDS. >> BENTA AGOLLA: Also to play a role as teacher to the young children. I knew my status ten years ago when I was expecting my fourth child. There was a mandatory test for women who were expecting. So after that, I was just told, "you are positive." I broke down, I was in tears, and I thought I would die. >> AGNETA LUTA OLOUCH: There were aims of bringing people together to educate them on health education and treatment literacy, because some of the people, when they take medication they may not adhere. But when we come together for psychological support, we teach each other how to take medication. Those who have challenges, we share together. >> BENTA AGOLLA: After meeting Mama Agneta she counseled me, we talked together, and she took me for medication where I did prevention for mother to child transmission. >> AGNETA LUTA OLOUCH: The challenge we are facing so far with the group is that some of these PTC [Post Test Club] members, they are very weak and cannot afford things like nutrition to eat well. So if it could be my wish, we could have something to give them, like nutritional support. Some of them have many children who they cannot support. >> BENTA AGOLLA: ...I'm a mother of six. >> AGNETA LUTA OLOUCH: That's why we take them into the Stawi Children's Group, who come on Saturday to eat, and we give them psychological support. >> BENTA AGOLLA: The students are aged between two months and ten years. They feed here, they learn here. The basics: how to go to school, how to brush their teeth, how to comb their hair, the alphabet, the domestic animals, we do a lot. >> AGNETA LUTA OLOUCH: And that is not enough, because by the end of the day these children go back home. Usually, we are connected with MSF [Medecins Sans Frontieres] Belgium, the health clinic. They refer patients to us. We have achieved a lot, because I have seen people waking up from their sleeping beds and taking their medication without fear, without stigma. That's what makes me happy. >> BENTA AGOLLA: My daughter now is ten years. She's negative. >> AGNETA LUTA OLOUCH: I am a mentor to many of these people. They see that I was HIV positive, my husband died and left me with the children, and I educated them up to university level. So I tell them, why not you? And that one encourages them a lot. http://www.viewchange.org/videos/one-in-six One billion people in the world face hunger and malnourishment on a daily basis. The international community has long sought to tackle this problem. But what if everything we thought we knew about how to erase hunger was wrong? Concern Worldwide and Valid International brought their innovative ideas and faced off against entrenched interests to change people's perceptions of this problem. The result was a sea change in how the world looks at hunger. Tue, 12 Apr 2011 08:52:00 +0000 http://www.viewchange.org/videos/one-in-six Malnutrition, Agriculture & Food, Concern Worldwide, Africa, Water & Sanitation, Foreign Assistance, Non-governmental organization, Tom Arnold (economist), Community Therapeutic Care, Food security >> VOICEOVER: Every night, almost one billion people go to bed hungry. Global economic chaos and ongoing climate change is pushing that figure even higher. But in the last decade, thanks to the efforts of a group of courageous and determined people, the lives of those worst affected by starvation have been transformed. Hundreds and thousands of lives have been saved. Of all the continents, Africa carries the heaviest burden of hunger, and of all the people, African women bear by far the heaviest load. To most of us this is wrong. But to some, it is simply unacceptable.>> TOM ARNOLD [CEO, Concern Worldwide]: I think for most of us, who actually have never really been hungry for a sustained period of time, it can be hard to convey how awful this is as a daily reality. But it is a daily reality for maybe close to a billion people in the world. Everybody, as a basic human right, has a right to food. It's almost as basic as life itself.>> DR. STEVE COLLINS [Director, Valid International]: All I know is that starvation is an obscene fact in the modern world. People should realize that people are starving unnecessarily. There's enough food in the world. We can put probes on Mars, you know, we can definitely treat hunger with basic food, you know, it's not rocket science.>> TITLE: One In Six>> VOICEOVER: Over the past 20 years, Steve Collins, a medical doctor who specializes in nutrition, has worked in every major famine emergency in Africa. Nowadays he works from a small farm on the southwest coast of the last European country to have experienced famine: Ireland. >> VOICEOVER: In 1998, Steve was awarded an MBE for his work in adult malnutrition. But it was when he teamed up with Concern Worldwide in 2000 that the way the world viewed and treated malnutrition was challenged and changed for good. They sought a new way to treat an old problem, and they found it in the form of Community-based Therapeutic Care, CTC. It is a remarkably simple, yet revolutionary, idea that restored the treatment of malnutrition to African mothers.>> WOMAN 1 [Mother]: I become anxious when there's no food in the house. I don't have enough money, I wander here and there and then I give up and I can't do housework. I have no energy.>> WOMAN 2 [Mother]: I feel bad when my child is ill and refusing food. I don't eat either because I feel sad.>> WOMAN 3: It's miserable when you're hungry and there's nothing to eat. Your vision is blurred and even your heartbeat changes.>> VOICEOVER: Until recently, these mothers and their babies would have been treated in centralized feeding centers. Traditionally, these centers were set up to administer famine relief to starving people, and were considered the gold standard in treating malnutrition. To overturn this system, Steve Collins and Concern would have to take on the medical and aid establishment and prove that their approach was more effective. In 1996, Steve Collins went to Liberia to set up a traditional feeding center. What followed was an outbreak of cholera, which was to herald the end of these centers for good.>> DR. STEVE COLLINS: Liberia was a difficult situation. We were trying to set up nutritional treatment centers across two front lines. There were so many factions in Liberia -- it was 1996 -- so we arrived to lots of death, lots of destitution, and we started setting up a center. At the beginning I asked, you know, "Is there cholera?" and people said, "No, there's no cholera." And I actually asked the wrong question. I'd asked a sort of close-ended question. I asked, "Is there cholera?" and they said no because there wasn't cholera that week. But actually cholera's endemic there. Had I asked, you know, "What do people usually die of?" They would have said, "Oh, cholera." But I hadn't asked the right question. And that one mistake meant that I didn't-- because can't do everything at once, you prioritize different things-- so I prioritized the feeding-- because I'd seen people dying of malnutrition-- over putting more effort into the water and sanitation. So, when people arrived for the treatment, it meant that you had a lot of people who didn't know the village, they didn't know where people normally drank, so they started to drink downstream of the village, of course getting all the polluted water. And so, the day it started we had two cases; the next day, I think we had ten. And then we were treating about thirty cases the next day. And the war started up, and we could actually hear the shooting in the background, and we had to leave. And we couldn't go back for two days. And when we came back, I think there were twenty dead people. And that made me realize there are so many dangers involved in having centers that I started to try and look for a different way of doing it.>> VOICEOVER: Around the same time, Anne O'Mahony, who has worked in emergency situations with Concern since the 1980s, was struggling with the shortcomings of feeding centers in Sudan.>> ANNE O'MAHONY [Concern Worldwide]: Our dilemma was that if we set up centers to cater for these malnourished, we would be open to aerial bombardment. We were also worried about ground attacks, and we felt that by setting up a center it would be an attraction in itself to insecurity. And I suppose more and more, it became clear that center-based care wasn?t the solution. Up to then, I suppose, the big constraint to having community care or enabling women to feed their babies in their homes, malnourished children, was the fact that there wasn't suitable food that could be used in this circumstance. Anything we were giving out had to be mixed with water.>> VOICEOVER: In 1996, a French nutritionist, Andre Briend, invented a product called Plumpy'nut, a peanut butter-like supplement rich in vitamins and minerals. This was a major breakthrough in the fight to prove the value of the community-based approach.>> DR. ANDRÉ BRIEND [Nutritionist]: My hope when I was developing this product was to start a revolution in the management in acute malnutrition, because the solution before that was quite unsatisfactory. So this is what we wanted, to have something that could be used at home. Developing the food was not enough. It?s a little bit like inventing the computer without adapted software. We needed some program adapted to that, and Steve Collins was very much involved in program management, and he was a key person to change the approach.>> DR. STEVE COLLINS: I think the invention of Plumpy'nut was a key breakthrough. It's an oil-based product, there's no water in it, and so bacteria can?t breed in it, and so having this perfect nutritional product that could be used safely at home really facilitated CTC.>> VOICEOVER: But in order to develop a more community-based approach, Steve Collins knew he needed to have a thorough understanding of the people, and in particular the women, he wanted to help. If the mistakes of Liberia had taught him anything, it was to ask the right questions.>> DR. STEVE COLLINS: So is the pump broken? How long has the pump that is in the village been broken? One of the key things that struck me when we were developing CTC and looking at life in Ethiopia was the incredible workload that women have. We did lots of studies looking at how women spend their days, because obviously that's vital, you have to know what women are doing. If you're going to say you?ve got to come for a day to a center, you have to know what they're going to miss. >> HEKUAT KAHSAY FANTA: I wake up at about 5 AM and I clean my house. I grind grain until 8 AM. Then I work in the field. Carrying stones, plowing the soil and preparing the land. When it gets dark, I work by lamplight.>> VOICEOVER: Hekuat Kahsay Fanta lives with her family in a remote part of Tigray in northern Ethiopia. She is a mother of six and, like other African women, is busy from before dawn until after dusk working in the fields and looking after her house and family.>> HEKUAT KAHSAY FANTA: My daughter is 14 months old. She started coughing and getting sick last year. Maybe it's because I didn't feed her properly. I worry that this could be the cause of her illness. I think about this all day long.>> VOICEOVER: When one of her children is sick, Hekuat struggles to get them the care they need. The isolation of her home and the fact that she has no form of transport means that any journey she undertakes is long, arduous, and on foot. >> DR. STEVE COLLINS: I realized from very early on that the main limiting factor wasn?t the medical care; it was how people could get into the program. And so to do that you have to talk to people, you?ve got to find out, "where do you live? Are there rivers in the way?" Or, "how many children have you got, what happens if you leave your children behind, who?s going to take care of them?" Obviously if it?s harvest time, people don?t want to have to walk for two days and miss their harvest because someone might steal it, or birds might come in. So all these questions about what are their lives like? What is their reality?>> ANNE O'MAHONY: Well, very often, when we go to visit the villages, we do find that Mother X?s child died last week. You ask her why she hasn?t brought in her child, and she would say there was nobody to look after the children. And we got that, story after story. And that?s quite common. And taking a mother out of their home scene leaves a huge gap. So who's going to feed the other kids? Who's going to provide the care and nutrition and nourishment that the rest of the family needs in the absence of the mother? And very often it doesn't happen. It?s a question of mothers making these decisions that are so difficult, that no mother should be asked to make. >> WOMAN 4 [Mother]: I feel very bad when I see my baby sick, I feel depressed.>> WOMAN 5 [Doctor]: If you go to the hospital with this child, what will happen in your home if you're not there?>> WOMAN 4 [Mother]: My children are very small and there is nobody that can prepare food for them. If I leave my other children at home, I close the door on them. To save one life, I can lose the rest of my children.>> WOMAN 5 [Doctor]: Do you want to ask your husband what to do?>> WOMAN 4 [Mother]: He doesn't care.>> VOICEOVER: With a better understanding of the difficulties confronting these women, it became obvious to Steve why so many mothers did not make it to feeding centers. Plumpy'nut made it possible to develop a program that would allow malnourished children to be treated in their own communities. By using a simple band to measure the width of a child?s upper arm, Steve argued that anyone could tell if a child was malnourished. The child could then be admitted into a CTC program to receive ready-to-use food and drugs. Instead of having to leave their family and livelihood for up to six weeks to stay in a traditional feeding center, mothers could return home and make weekly visits to the health center for monitoring and therapeutic food. Children who had lost their appetite completely could still be admitted to a hospital for care until they too could be sent home with the necessary supplements. This system made it possible to reach and support far more women and children. But many people had put a lot of time, energy and investment into the traditional feeding center model, and were far from convinced by this new approach.>> ANNE O'MAHONY: When children are sick, especially large numbers of children who are sick with malnutrition, there?s a tendency to keep them all together, to give them food, to give them medicine, to bring them back under our care so that they can then be released back into home. And the idea of CTC was, sending these children home with the correct food and the care that went with it so that the mothers could actually take care of them themselves. This was a mind-blowing idea in some ways.>> VOICEOVER: Many of the more clinically minded professionals had ethical problems with the radical nature of what Steve was proposing, people like Professor Michael Golden, a world-renowned nutritionist who lives on the northwest coast of Ireland.>> PROFESSOR MICHAEL GOLDEN [Nutritionist]: To me there is an ethical problem about taking risks. If you know there?s a risk, you do it step by step, and you do it extremely carefully, and you do it with a few children that you know, and then you build on that. You don?t suddenly tear down everything and go out and create a whole structure, involving thousands of children, which may or may not work. I don't think that we have the right to take risks with other people. We take risks with ourselves, but I mean why should we take the responsibility ourselves of taking a risk with someone else's life?>> VOICEOVER: Despite Steve Collins' conviction that his new community-based approach to treating malnutrition, CTC, could save hundreds of thousands of lives, he needed proof. He happened to be working in the Walta region in Ethiopia in 2000, when in the middle of yet another desperate famine he saw an opportunity to try CTC out. The government had banned the setting up of traditional feeding centers, as they believe them to be ineffective. Concern was working in a neighboring district, and when Steve suggested that they try CTC and study the results, they agreed. >> TOM ARNOLD: In a way, when the CTC idea come along, it came along at the right time, because a sufficient number of people were asking questions about the effectiveness of the traditional model of dealing with malnutrition. So then the challenge was that over a period of time, could you actually demonstrate, with evidence, that this was indeed a better way of dealing with it? And that?s what we set out to do.>> DR. STEVE COLLINS: And so, we worked together to design another CTC program in the district where Concern was working. And in this one, we put in some extra monitoring, so that we could actually start to produce concrete data. That program ran, I think, for eight or nine months, and was a success. The mortality rates were 4.5 percent, whereas the standard you aim for in emergencies is 10 percent, and the norm in a developing country hospital is 20 to 30 percent mortality rate-- that?s twenty to thirty percent of every child that?s admitted dies-- whereas our mortality rates were only four percent. So it was obvious it was working, and the numbers were quite high. She's feeding him three times a day. And what will she feed them at lunchtime? Will people here still be eating teff? Is there still enough to eat? After 2000, after the two trials we had in Ethiopia, I realized that CTC would work, and that it would be the future. And in a way I became a bit obsessed by it, I think. So I actually went round to all the agencies I could think of-- I went obviously back to MSF [Médicins Sans Frontières], I went to Oxfam, I went to Save the Children, Action Contour la Famme-- all these different agencies saying this is the future, this is what we should be developing. Unfortunately, I think it was too threatening at that stage; it was too much of a change, and probably, to be fair, at that stage there probably wasn?t enough evidence.>> VOICEOVER: But one person who did agree with Steve that there had to be a better way was Concern's director of policy and evaluation, Howard Dalzell.>> HOWARD DALZELL [Concern Worldwide]: I suppose when Steve first put it to us, I don't think he realized the full potential of it. And I don't think he realized what would be involved in actually getting it accepted internationally. And he wanted to do quite a small trial, and I actually said to him, "Steve, I think you're missing the point. I think you're being too conservative. If you really want to make it work, we've got to have loads of evidence in loads of different places, and therefore we need to do big trials, not small trials.">> DR. STEVE COLLINS: He was the first person who really realized the potential for this change. He realized it needed to be a coherent research program. In the month before I'd gone to DIFID, the UK government donor, with a project proposal for a hundred thousand. And they had refused, and it was Howard that saw that actually you need a program, you need a research program.>> VOICEOVER: What Howard understood was that in order to make real progress, they would need more than just nutritionists in the research team. They would need food economists, sociologists, anthropologists, and social workers who could mobilize a community. But Howard believed in Steve's ideas, and agreed to support him in his search for the necessary funding. >> TOM ARNOLD: Well, Howard came to me with this idea about CTC, and he explained it and the principles underpinning it. He was very convinced that this was a potentially important way to deal with hunger, and particularly severe acute malnutrition. And he then had the idea that in order to get further support, we would try and get support from Irish Aid, and he went and spoke to Irish Aid, and said critically we?re prepared to put some of Concern?s money in this, and would you, Irish Aid, put your money in it, and we would work together. And obviously crucially the core idea that was from Steve Collins.>> BRENDAN ROGERS [Director General, Irish Aid]: So when Howard came to me and said, "Look, we have an innovative project here, we think that through CTC we can change the architecture of emergency response," my eyes lit up, of course. In the early part of this century, thousands and thousands of people were coming together because of the results of conflict, or the results of natural disasters, and the UN system and NGOs had put in place a system that was very well-run logistically, providing food, shelter, water and sanitation to thousands and thousands. Yet, there were great dangers in that. People were coming long distances, particularly women and children could have lost their lives in those journeys, and there was the possibility of cross-infection, of communicable diseases, the issues of HIV and AIDS and of sexual exploitation with large amounts of food being distributed in situations of great famine. So we wanted to challenge that, we wanted to determine, "Could we address those issues closer to people's homes, closer to their communities?" But this essentially was a real challenge to the accepted wisdom. We took that risk.>> TOM ARNOLD: Equally important at this time was the support of USAID and the Office for Foreign Disaster Assistance. They had come to the same conclusions as Irish Aid about the potential impact of CTC, and their support at this time allowed the expansion of the program into Ethiopia, South Sudan, and Malawi. So it was the combined effect of the Irish and US funding that really catalyzed the expansion of CTC, and led to the increased acceptance and legitimacy of this program in the wider international community. >> CAROLINE ABLA [Public Health Advisor, USAID]: Once we had enough evidence that this new approach really does work, it was time to bring it up to scale if we could. And we'd been working with Concern on the pilot phase, and having had Concern basically write the manual of how to do CTC, they were the best partners that we had to go ahead and scale it up.>> VOICEOVER: In 1999, Steve Collins had set up Valid International to research and evaluate the effectiveness of aid programs. With the success of the trials in Ethiopia, and with funds from the Irish government and Concern, Valid assembled a team of research specialists who, together with Concern, were finally able to take CTC to Malawi in southern Africa. >> DR. STEVE COLLINS: We started implementing in Malawi. There we had another key person who got involved, Theresa Banda, who was the Ministry of Health nutritionist. She has worked in malnutrition for many, many years, and she'd seen the problems with centers, and she was willing to stake her reputation and take a chance on giving us a district where we could do a pilot.>> THERESA BANDA: We were in the process of reviewing national guidelines. When Dr. Steve Collins came in, we had a meeting with him in the office, and he brought in some evidence from Ethiopia. So that really got us interested. At that time we were looking for innovative ways to improve nutritional status, innovative ways to deal with the influx of malnutrition due to the food crisis. We decided as a ministry that we should use one district to implement this and learn from it.>> VOICEOVER: With the go-ahead from the Malawian government, Concern and Valid had for the first time a real opportunity to gather hard evidence. They were assigned the Dowa district in Malawi, where they treated almost two thousand children within the first year.>> DR. STEVE COLLINS: Has she seen it used before?>> WOMAN 6 [Interpreter]: She has not seen anybody use this.>> VOICEOVER: But it was the work of sociologists and anthropologists that uncovered the most significant and far-reaching obstacles to treating malnutrition.>> EMMANUEL MANDALAZ [Anthropologist]: One main issue was the cultural issues surrounding malnutrition with, for example, people believe that malnutrition is caused by parental sexual behavior. If a father goes out and sleeps with some other woman, that brings a spell on the child. >> DR. STEVE COLLINS: When the child had the problem with the stomach before, she took the child to a traditional healer who burnt the child. What did the traditional doctor say to her? What did the traditional doctor tell her to do about this illness? >> WOMAN 7 [Interpreter]: He said it was abdominal parasites.>> DR. STEVE COLLINS: Abdominal parasites. I think that the fact that she's waited for a month now... >> EMMANUEL MANDALAZ: Usually, mothers, even if there's treatment at the health center, they wouldn?t bring the child immediately, they would wait. First of all, they would try to consult a traditional healer until they have failed. That?s when they will come back to the program. So, later on, we try to engage with these traditional healers. Say if a mother sees a child maybe in the nearby vicinity, whose child is malnourished, they would encourage them. And that's one of the secrets with CTC: there's mother-to-mother transmission of information about treatment, where to go get it, and all those things, and how best they can take care of their children.>> GRACE NIKHOMA: The child was sick. He was refusing to eat and had diarrhea. He was looking malnourished and my friends helped me to get CTC. There was a great change when he started receiving peanut butter. The loss of appetite and diarrhea stopped, even his malnourished appearance improved. It took the child one month to change.>> VOICEOVER: In the two years following the program in Malawi, the team developed a database of over 23 thousand cases. They had run 21 programs in four different countries. Their mortality rates remained under five percent, but more importantly they reached over 70 percent of those in need, a massive improvement on the old system, which never reached more than 10 percent. They were ready to present their findings to the international community, and push for change in international policy.>> HOWARD DALZELL: We felt we had enough evidence, enough strong evidence to go public. And we obviously needed to convince the rest of the international nutrition community that these results were solid. So we organized a conference in October 2003, to present the results, and to have a discussion with the rest of the nutrition community.>> DR. STEVE COLLINS: The Dublin conference was really the turning point, I think. We really wanted to get the data on CTC to the agencies in a more formal manner, and give them a chance to respond and feedback.>> HOWARD DALZELL: That turned out to be a tension-laden conference. I would have to say it generated more heat than light. There were people who'd worked for two or three decades on refining and improving therapeutic feeding centers, and then there was the new fringe doing the community therapeutic care approach.>> DR. STEVE COLLINS: Treating starving children is a very emotive subject, and here were we, saying that we could actually do so much better, and there's an implied criticism of what was going on before.>> PROFESSOR MICHAEL GOLDEN: I think that there was a resistance by some NGOs for everyone to jump into bed and do the same thing and abandon what they were doing. They wanted to see how the risks that were being taken would pan out before they did the same thing. So there was a reticence for everyone to copy and say, "We're going to abandon everything that we've done in the past, and we're all going to do exactly the same as Concern.">> DR. STEVE COLLINS: A lot of opposition came from large agencies based around volunteers, and I think they probably felt a little bit threatened that we were saying that the volunteer model, as well, didn?t really fit with CTC, where you actually only need one professional, and it?s much better if they're a local person who knows the environment, rather than a lot of enthusiastic volunteers. >> TOM ARNOLD: There were still people on both sides of the argument at that stage. But what was beginning to emerge was that the evidence was beginning to accumulate. And with that, of course, the argument began to tilt towards the CTC.>> DR. STEVE COLLINS: After the Dublin meeting, when they had seen the strength of our data, I think people realized that they could no longer use just ideological objections, and I think they realized in a way that the CTC train was leaving the station, and they were either on board or they were left at the station.>> HOWARD DALZELL: Well, after that conference we continued to do trials, and we also extended the work to other agencies, so it wasn't just Concern doing it: MSF was doing it, Tearfund was doing it, Save the Children was doing it, so other agencies following that conference decided that they were going to give it a real try, and see could it work for them, and it did.>> VOICEOVER: It isn't just children, however, who benefit from CTC. It has also transformed the lives of thousands of people with HIV/AIDS. In 2005, Ortiz Primetime visited Malawi and met Akim, who was then close to death. He had been abandoned by his family and had even been moved to a hut close to the graveyard. >> AKIM BONZO: I go searching on my own for food, my relatives are not interested in me.>> VOICEOVER: Less than three years later, Akim has a new life, thanks to the potent combination of Community-based Therapeutic Care and antiretroviral drugs.>> AKIM BONZO: At first, when I started receiving therapeutic food, I used to have abdominal pains and diarrhea. After taking the food, I picked up and I could feel energized. The difference between then and now is that I can work on my garden and at home.>> MUONERETU BANDA [Akim's Wife]: The happiest time is when we chat together. If there's food, we cook and eat together and spend time in the garden. >> AKIM BONZO: The most important thing is to have love. Loving your partner the way you love yourself. I think that attitude keeps us together as a family.>> VOICEOVER: But the real success of CTC could only be measured when and if the United Nations and the World Health Organization endorsed it. This was the next crucial and defining step. In 2005, a meeting was held at the WHO headquarters in Geneva that would decide whether or to replace the traditional feeding center model. Although some trenchant resistance remained, the majority of those present supported the more community-based approach, but there was still one main stumbling block: the way child malnutrition is measured. >> DR. STEVE COLLINS: The evidence has always been extremely strong that Middle Upper Arm Circumference (MUAC) is a great predictor of mortality in young children. But there is a large group of people who thought, "No, no, we need to do mathematics, we need to do weight and height, basically because that's what we've always done," I think.>> DR. ELIZABETH MASON [World Health Organization]: The factor that you could consider is perfect being the enemy of the good. So if we consider weight for height, and you get Z scores, standard deviation, you've got the the perfect gold standard. But on the other hand, you have a simple upper arm circumference that, yes, it's not perfect, but it is a good measure to use for a community screening. And when we're looking at public health and when we're looking at options for the community, then we will choose the good over the perfect.>> VOICEOVER: In 2006, only six years after the initial trails were carried out by Concern and Valid in Malawi, CTC received the ultimate endorsement from the United Nations. This achievement was the culmination of years of work by the staff of Concern and Valid, and of many other agencies, such as Medecins Sans Frontieres, Save the Children, and the Tearfund. The pressure was now on African governments to adopt the new approach. Malawi was the first to take up the challenge. But Concern and Valid realized that local manufacture of ready-to-use food was critical. To achieve this, Concern supported the setting up of Valid Nutrition, a new kind of charity based on ethical business practices. With no shareholders, all profits are reinvested into local production and economies. >> DR. STEVE COLLINS: We want to produce a whole range of ready-to-use food, both for treating severe starvation, but also for treating moderate starvation and preventing malnutrition, from this factory, made locally in Malawi, by local Malawi people, using ingredients grown by local Malawian farmers. Effectively, you've got a local system to address malnutrition rather than having to depend on external interventions. >> DR. MARY SHAWA [Department of Nutrition, Malawi]: The advice I can say to everybody who is interested in this is traditionalize the CTC program, have the highest political commitment, and make sure that the private sector is also given room to take part in the production of the product. We have 201 facilities running the CTC program. Our target is to cover the whole country. And we believe if we can do that, we'll reduce the problem to zero. And that's our target: we want zero malnutrition in Malawi.>> VOICEOVER: Community-based Therapeutic Care, the radical new approach pioneered by Dr. Steve Collins and championed by Concern Worldwide, has transformed the treatment of severe acute malnutrition throughout the world. Although this required conviction, courage, and dedication, and has saved hundreds of thousands of lives, it is only part of the picture. Severely acute malnourished people make up only 10 percent of the world's hungry. The other 90 percent, the chronically malnourished, are far less visible. These are the hidden hungry, people who may not be in immediate danger of dying, but who are nonetheless suffering the effects malnutrition. Apart from the daily torment of going without food and all that entails, these people are also burdened with the life sentence of stunting, the affects of which only become apparent later in life.>> DR. STEVE COLLINS: When a child is born, its nervous tissue grows fastest. And if you don't have the right nutrients in the first couple of years of life when the brain is being wired, then the brain never reaches its full potential. So a child that was born to be an Einstein ends up not being able to cope with primary school. And once you miss that two years, and you miss that brain development, it's gone forever. You can't get it back by good nutrition.>> DR. ELIZABETH MASON: In the Western countries, we're now used to opening a jar or putting a whisker in the food and actually having energy-rich complementary feeds. So the first feeds the child gets are very energy-rich. Whereas the first feeds that the baby gets in many African countries is diluted porridge.>> PROFESSOR MICHAEL GOLDEN: There are 40 important essential nutrients, at least 40 essential nutrients. You need every one of them, all 40 of them, to be healthy. All you do is miss one of those 40 out, and you will not be able to resist disease, you will become sick, you will lose your appetite. You just sit there like a zombie. One of the worst things about malnutrition is that the child doesn't cry. How do you know if your child is hungry? He cries. How do you know if he's thirsty? He cries. If your child doesn't cry, and you think, "Oh, I'm a wonderful mommy, I love my child but my child doesn't need for anything, I can go about my other work, I can go and collect the wood, I can prepare the food," and the child just sits there. So the mother doesn't stimulate the child. So you have these two things. You have the stimulation, and you have then the nutrients that have to make those connections in the brain. But the connections won't be made if it's not stimulated, so you need both. You need good food, and you need stimulation.>> TOM ARNOLD: Stunting is something that I don't think enough is known about. Stunting means you're cutting off somebody's life prospects. You're reducing the economic future of many of these countries. And countries themselves need to know that, unless they've worked to prevent stunting, they're actually putting a burden on their own potential for decades to come. >> WOMAN: I ask God to give my children and me a healthy life and for the means to feed my family, to give me grace, health and to help me lead a decent life.>> TOM ARNOLD: Preventing hunger is actually a good investment for individuals and for countries. Now what to be done, where should the policy focus be? It should definitely be on better nutrition for pregnant women and children under two, massive intervention programs to deal with that problem.>> VOICEOVER: CTC provided a window into the world of the severely malnourished, and in doing so revealed the shocking reality of the daily lives of many African women. Most importantly, it highlighted how their unequal status is contributing to their own and their families' vulnerability to hunger. Not only are they fully responsible for the care of their children and home, they also do 80 percent of the agricultural work. They have few rights and even less choice. They are usually the last to eat at meal times, and the first to go without food when it is scarce. They are often anemic during pregnancy and breastfeeding, and their babies are frequently born underweight, perpetuating the vicious circle of malnutrition.>> ALICE GANDIWA [Concern Worldwide]: Most mothers, they work very hard in the fields, and they grown enough food, probably in the end that food may be sold and the children may not be fed enough. They suffer inwardly. They wish they could have done better for their children, but probably they don't have the means or they don't have the knowledge to do it. At times it's the feeding practices. At times it's the cultural practices. But inwardly, the mother would want a healthy child. Every mother would want a healthy child.>> BRENDAN ROGERS: There's no doubt about it, African women are very much second-class citizens. That's the fact. And while at the UN we pay lip service to equality and gender equality and gender empowerment, it's not happening underground. And there is that gap, and it's being increasingly recognized at every level of society. But if we want to improve the lives of women, if we want to improve the lives of children, if Africa wants to produce enough food to sustain itself, there has to be a refocus on agriculture and rural livelihoods. >> DR. STEVE COLLINS: Most of the hungry people are actually living on small farms. So one key way to get around it is not that the state comes and brings food to them, it's that they are enabled to produce the food themselves. And that requires big changes in the importance of agricultural policy, in government giving more support to farmers and to the rural areas so that farmers can produce and can trade. >> HOWARD DALZELL: The development of CTC has been unusual in that a private sector research organization (Valid International), an NGO (Concern), and a public sector body, such as the Irish government, work together to make it happen, and none of us could have done it by ourselves, but the public-private partnership worked.>> DR. STEVE COLLINS: In the world today, there are 300 million children with chronic malnutrition. We know that that can be prevented with just 40 grams of a high-quality food complement each day, given over a period of 18 months. So this is a problem that is treatable.>> HOWARD DALZELL: And we are convinced that the sort of principles of food signs that are in our ready-to-use foods can be used to make not just therapeutic foods, but supplementary and complementary foods that can go into the marketplace and that parents can buy for their children. It'll keep them growing, it will keep them healthy, and it will prevent malnutrition. >> DR. STEVE COLLINS: I think to date, large companies haven't really targeted the so-called bottom of the pyramid, the poorest of the poor, because I think they felt that these people just haven't got enough money to buy the kind of products they want to sell. But when you get to a really simple, low-cost nutritional supplement, the market is so big (300 million people) that if they each spend 10 dollars a year only on a quality nutritional product, that's a market of three billion dollars a year. Now that's a substantial market. If multinationals start to create properly designed nutritional products, and they price them at an affordable level, you're going to have a whole generation growing up who are capable of using their brains better, and capable of helping themselves more. So, as a foundation for development, the changes that are now happening are profound, and can have real implications in the alleviation of poverty.>> HOWARD DALZELL: It surprises companies when they hear that an NGO and a not-for-profit humanitarian company are actually following business principles. They don't expect us to want to manage costs very clearly, to want to show a surplus that then gets reinvested. They see charity and business as very different, and this whole concept of a not-for-profit company, Valid Nutrition, with a humanitarian mission following best business practices, is just unusual.>> TOM ARNOLD: We are clearly moving into a more difficult economic situation, where people have many legitimate fears about their future, about their future livelihoods. But at least so far, people in this part of the world are not at least fearful of going hungry, and long may that continue. But that is not the reality for a sixth of the world's population. And I think those of us who have escaped that fear of going hungry do need to think about that sixth of the world's population who still have that fear and that daily reality.>> VOICEOVER: The Irish government taskforce report, published in the autumn of 2008, stated clearly that there had been a collective failure at international and national levels to prioritize ending global hunger. Community-based Therapeutic Care demonstrated that when there is a genuine desire for change, solutions can and will be found. And yet, every night, one in six go to bed hungry.>> DR. STEVE COLLINS: This idea that we're doing it because we're compassionate-- that's not-- people have a right to health, a right to good nutrition, they have a right to education, they have a right to security. It's not doing good to ensure those rights are maintained and upheld. It's their rights! So it's a work, you know, you have to do it. I don't want people to do it because they're such nice people; I want people to do it because they can create change and because that's what they should do.>> HOWARD DALZELL: Child death through serious malnutrition is probably the greatest blasphemy in the world today. It simply shouldn't be allowed to happen. It's morally unacceptable. And I think what will actually stop it happening is moral indignation. Slavery was seriously tackled 180 years ago. It wasn't tackled because women in America had dishwashers, and Hoovers, and fridges, and microwaves, so that they didn't need slaves in their kitchen. It was blown out the water because people said this is wrong, our fellow human beings shouldn't be treated like this. It was a moral victory, not a technical victory. We have the technical answers to malnutrition. But to get rid of that blasphemy requires conviction and advocacy, and acceptance of everybody's right to food. It's as simple as that.>> TITLE: Tonight, almost a billion people will go to bed hungry. Most of them are women and children. We have the power to change this. Visit www.concernusa.org http://www.viewchange.org/videos/the-bicycle <p>In many rural parts of Africa, people live far from their nearest medical centers and have no means of transportation. This is why groups like Dignitas International are promoting a community-based approach to administering drugs and treatment to HIV patients, a technique that's already paying dividends.</p> Fri, 09 Jul 2010 17:57:00 +0000 http://www.viewchange.org/videos/the-bicycle Dignitas International, HIV, James Fraser, Malawi, Zomba District, James Orbinski, Antiretroviral drug, Médecins Sans Frontières, World Health Day, Tuberculosis >> TITLE: National Film Board of Canada presents The Bicycle >> TITLE: 1 in 5 people in Zomba District, Malawi are infected with HIV. >> TITLE: But only 3 in 100 know their status. >> PAX CHINGAWALE [Dignitas community-based volunteer]: We are going to see a patient who is very, very ill, but has not been given counseling in HIV activities. Her village thought it was due to witchcraft. So they started consulting traditional healers. The strings around the ankle and the wrists are tied by tradition healers. They believe those will drive out the evil spirits. I have seen many people dying. Unfortunately, it was before the availability of ARVs. >> TITLE: Anti-retroviral drugs (ARVs) treat AIDS and are affordable. >> PAX CHINGAWALE: It's my job to convince everybody and to tell everybody so that they can go and get themselves tested. We cannot disregard the traditional healers. Three-quarters of the people in this area believe in the traditional medicine. Traditional healers use razor blades for cutting tattoos. It's also a medium of transmission. So we educate these people that they shouldn't use one razor blade for several people. We have to work with them to cooperate with them to advise them that, if they suspect a patient to be HIV-infected, they cannot see that kind of disease. It's better for them to refer back to the central hospital. >> BRUNO JAMESON [Dignitas Prevention Officer]: Traditional healers, the chiefs, all the influential people in the community, people that are at the heart of the spread and at the heart of the prevention of the disease, it's a job that really involves the roots of where this epidemic is spreading from. >> TITLE: Pax rides his bike over 20 km a day seeing patients, from house to house. >> TITLE: Pax discovers Doreen lying in her hut. >> TITLE: Her family has disowned her. >> TITLE: Pax asks for our vehicle to take her to hospital 23 km away. >> PAX CHINGAWALE: Doreen's case is worrisome. It's common around the surrounding area that if you are HIV positive, you are sick, they feel you deserve it. It's somehow like a punishment. I feel very sad knowing that I'm also HIV positive, knowing that I could also be facing the same kind of situation. >> TITLE: Zomba District Central Hospital >> DR. KEVIN BEZANSON [Dignitas Head of Mission]: So she's had this wound for three months? Two months? Can she sit ... Can she sit forward a bit? You told her it's going to hurt a bit, yeah? Yeah. Yeah. Sorry, my ... It's straw, yeah, straw-colored. Again, it's typical of tuberculosis. If she had been identified earlier, sent earlier, worked up properly earlier, she'd be on TB treatment. Probably by now we could start her on ARVs. >> TITLE: Dignitas runs an ARV clinic at this hospital. >> DR. KEVIN BEZANSON: We have a team that's working in the clinic. It works ... Everything works imperfectly, but it works. And we have three nurses who are absolutely dedicated. We have two clinicians who are working very hard. We've got 700 people on treatment, 700 people, and not all of them have done perfectly, but more than 600 of those are alive and well. >> PAX CHINGAWALE: We had some of them written off as dead. But the ARVs have reversed the situation. There is tremendous change. >> TITLE: Timothy is Dignitas' 230th ARV patient. >> TIMOTHY [Dignitas ARV patient]: I am one of the beneficiaries of the ARVs. I feel very, very great to be back to my working place. Because I didn't dream of going back to my working place, knowing the situation in which I was. But this time there's a very big improvement. >> LUCY [Dignitas ARV patient]: Now I'm looking healthy. At first I was not like this. I was very thin and I was even failing to walk even to uphold myself if I wanted to stand, yeah. But now I can take everything, I eat everything which was impossible for me to eat. Yeah. >> ALICE KADZANJA [Dignitas nurse]: When I come to them and I speak to them that I'm also HIV positive, and you know, I carry my drugs in my bag every day and I just pull my bottle ... >> INTERVIEWER: Did you tell them about your status? >> ALICE KADZANJA: Yes, I did. She knows. You can see, she's laughing. She knows. That was the first thing I told. Now this one, has brought the elder sister to come. Because after seeing me, how healthy I am, then she was encouraged. >> PAX CHINGAWALE: Now if we have so many people counseled to go for VCT testing and they do not access the ARVs, it would be disastrous to them. Their hope, only hope of survival, is the availability of ARVs, which are being provided here at the central hospital. >> DR. KATHERINE ROULEAU [Dignitas Medical Advisor]: We have a huge role to play in the distribution of ARVs and the treatment of patients within the hospital setting. But in fact what we hope to, what we intend to do is actually bring the care of patients with HIV to the community where they actually live, rather than expecting them to come to hospitals where the resources are so stretched to begin with. >> JAMES FRASER [Dignitas Executive Director]: Health care systems on their own will not be able to respond. We have 50 percent of all health care posts there vacant. You have nine nurses in the whole hospital for everything. You have, I think you have one doctor for a whole hospital, a central hospital, a referring hospital for four of the districts surrounding Zomba. >> DR. KEVIN BEZANSON: There's no way Dignitas can do this alone. From the village through to here everyone, we have to start working at this together. >> TITLE: Pax visits another one of his patients at the hospital. >> PAX CHINGAWALE: There is a very good connection because Dignitas actually relies on us in the field. And we also rely on Dignitas to assist our patients. >> DR. KEVIN BEZANSON: Someone like Pax or the people working with him are in the village. They're the ones going house to house to house to house looking at patients. >> JAMES FRASER: Groups that are made of people like Pax are the ones who are actually going to be supporting people in their communities and he actually plays a central role in the model of community-based care. >> PAX CHINGAWALE: Since ARVs are supposed to be taken for life, the role of the community home-based care is very vital because we will be looking after these patients right there at home. >> TITLE: Pax is responsible for more than 20 villages. >> TITLE: Dr. James Orbinski accepted the Nobel Peace Prize for Médecins Sans Frontières in 1999. >> TITLE: Now he is the president of Dignitas International >> DR. JAMES ORBINSKI [President, Dignitas International]: I think the next big, important question is community-based care. What specifically can we do to help home-based care workers do a better job? Are there problems with incentives, for example? This is always a problem. >> PAX CHINGAWALE: I was coming to that. >> DR. JAMES ORBINSKI: I'm sure you were coming to it. [laughter] >> VOICE: Just mention the word ... >> PAX CHINGAWALE: But the biggest problem with home-based care is the transportation system. >> DR. JAMES ORBINSKI: Transportation. If you had one ambulance, one bicycle ambulance, how would you get that to the various places in this catchment area? >> PAX CHINGAWALE: In this catchment area, the people would be aware that there is coming the bicycle. >> DR. JAMES ORBINSKI: And then they would go to Zomba and you would bring it back. >> TITLE: Without a bicycle-ambulance, many patients can't get to the hospital at all. >> DR. JAMES ORBINSKI: So are we going in the vehicle now? Okay, let's go. It would be nice if it would be as simple as opening a bottle of pills and giving the person the pill and watching them swallow the pill. That is a very, very important part of community-based care. It's treatment. It's a very, very important part, but it's not everything. It's everything around that. So you already knew that you were getting sick. And your second husband, where is he now? >> TRANSLATOR: He's dead. >> DR. JAMES ORBINSKI: He's also dead. You've had a very tough time, eh? Over the years. Yeah. So you're very, very precise in terms of when you take your tablets. >> ROSALINA [Dignitas ARV patient]: Yes. >> DR. JAMES ORBINSKI: And how do you feel now? >> ROSALINA [Dignitas ARV patient]: I'm very good. >> DR. JAMES ORBINSKI: I'm very good. That's great. That's great. It means building networks of people like Pax. It's really the next big revolutionary idea in terms of containing and controlling the epidemic in a way that respects people. Community-based care is about finding, using, and supporting existing structures. >> JAMES FRASER: Everyone has friends, families, neighbors who have died from the disease. What they're doing is they're helping their friends and their families and their neighbors die more comfortably, because they don't have the technology, they don't have the drugs that will actually keep people alive. If we can harness this energy, organize it, train it, and then link it to the health care system, and then we do research so that we can figure out what aspects of the model can we take from Zomba, bring it to South Africa, bring it to India, bring it to Nigeria, wherever. This will be the next key, the next big step forward to be able to increase access to treatment and keep people alive. >> PAX CHINGAWALE: Every minute of my life is full of HIV activities and I've seen a change in many people now. They respect me, and they themselves are questioning whether they have HIV/AIDS or not. So there is a very big impact. >> TITLE: Doreen died two days later. >> TITLE: She was 24 years old. >> TITLE: Dignitas is ordering a locally made bicycle-ambulance for Pax. >> TITLE: [end credits]