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March 2, 2012

A Pivotal Point In Global Health

quam

Lois Quam had just returned from Uganda the night before her Feb. 28 visit to the Johns Hopkins Bloomberg School of Public Health, full of news from the frontlines of global health. Capping an afternoon of get-acquainted meetings with an hour-long talk in Sheldon Hall, the executive director of the U.S. Global Health Initiative impressed upon faculty and students the need for their leadership.
International challenges and domestic financial pressures make this a pivotal moment, she said, relating stories from Uganda that personalized the ways in which global health has succeeded as well as describing areas of “utter stagnation.” 

Having met recently with Tadesse “Tad” Wuhib, director of CDC-Uganda, she lauded Johns Hopkins for playing transformative role in his life—he is an alumni of the medical school—as well as in the lives of the millions served by the multiple agencies that Quam organizes and coordinates; notably USAID, PEPFAR, and CDC.

On a more somber note, she told about a 34-year-old Ugandan woman who, at end of a normal pregnancy, delivered a healthy baby girl by cesarean section and died hours later from complications ; her  death was unremarkable because many women in sub-Saharan Africa  die from childbirth complications. However, Dr. Cecilia Achadu Otim was indeed remarkable in that she was the youngest heart surgeon in Uganda. Her death, Quam said, left not only an orphaned infant but thousands of people mourning the loss of the country’s only female cardiologist who, despite being trained to perform difficult medical procedures, died for painfully ordinary reasons.

Saving women in the critical 24-hour window of labor and delivery is a priority, Quam explained: “We know how to save mothers; we know what can be done to prevent their deaths. It’s quite straightforward and so very, very difficult.”

The challenges of global health, which include dependency, lack of capacity and corruption in countries, are apt to get a whole lot more challenging in the face of significant budget constraints, according to Quam: “We’ve been warned we are at the high water mark in terms of Congressional appropriations in this area. It has been significantly protected, but hard to believe we will continue to be fully cushioned.” 
Quam impressed on the crowd that there is an immense responsibility to determine how “we” can reach our rightfully lofty goals in global health; how “we” can prevent the spread of disease or the resurgence of the AIDS epidemic in an environment of financial pressure.

“I don’t think the U.S. will ever be out of (the business of) global health,” she said, though she emphasized the importance of shifting from the development of parallel health care systems in partner countries to the investment in technical and strategic assistance, ultimately allowing for health care to be financed and operated by the governments, religious organizations, companies, and civil societies in those countries. 

Quam enlisted the help of her audience in the prevention of a situation where the U.S. faces a cliff in terms of funding and causes a great deal of suffering as a result.

“The planning and strategizing for the creation of locally sustained healthcare systems,” she said, “takes the leadership of an institution like Hopkins.” —Maryalice Yakutchik