#Doctor of Public Health Administration in Sub-Saharan Africa

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Explore career prospects in Sub-Saharan Africa with a Doctor of Public Health Administration. Learn about opportunities, challenges, and program benefits.

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Canada requires air passengers to wear masks to curb coronavirus (Reuters) Transport Canada said on Friday that all airline passengers would be required to wear a non-medical mask or face covering during travel to curb the spread of coronavirus. The regulator said travellers must cover their mouth and nose during the boarding process and flights. The rule goes into effect at noon ET on Monday.

Record government, corporate debt could lead to ‘tipping point’ after pandemic passes (Washington Post) The federal government is on its way this year to spending $4 trillion more than it collects in revenue, analysts say. The reliance on so much debt will leave scars after the pandemic passes, economists say, making it difficult for policymakers to withdraw support and leaving the economy more vulnerable than before this crisis began.

Pandemic provokes spike in demand for food pantries in US (AP) Brooklyn Dotson needed food. Her first unemployment check had yet to arrive after she was let go by the warehouse where she used to work. So the 25-year-old Nashville woman scrounged up some gas money and drove 30 miles (48 kilometers) to the GraceWorks Ministries food pantry in Franklin. There, at the pantry’s new drive-thru, workers wearing masks and gloves loaded her van with about $350 worth of groceries. “I don’t have any income coming in, I don’t get any food stamps, so it’s just hard to get any help right now,” Dotson said while waiting in line at GraceWorks. Food pantries stay busy even in the best of economic times; the coronavirus pandemic has prompted a spike in demand as millions of people like Dotson find themselves furloughed, laid off or with businesses that have suffered huge financial blows. “About 50% of the people coming through our lines have never been here before,” said GraceWorks President and CEO Valencia A. Breckenridge.

Zoom marriages are now legal in New York, Cuomo says (AP) In the coronavirus pandemic, there are Zoom happy hours, Zoom concerts, Zoom classrooms--even Zoom “Saturday Night Live” episodes. And now, in New York, there will be Zoom weddings. Gov. Andrew M. Cuomo (D) on Saturday issued an executive order allowing residents to get marriage licenses remotely and permitting clerks to perform ceremonies via video conference. “There is now no excuse when the question comes up for marriage,” he said at a coronavirus press briefing. “You can do it by Zoom.”

Teachers on TV: Classes hit the airwaves during pandemic (AP) Using his cat’s blanket as green screen, history teacher Bill Smith recorded himself teaching a lesson on New Jersey’s underground railroad, taking student viewers on a tour of sites including a river where slave hunters would try to reenslave people attempting crossings. The lesson was broadcast over television airwaves for the state’s homebound students, part of an effort to keep children engaged in learning during the coronavirus outbreak. Teachers have begun recording classes at home, using whatever technology they can, for television in places including New Jersey, Nebraska and New Mexico, where officials have partnered with broadcasters to help students feel connected and to overcome hurdles with access to the technology needed for distance learning. It’s one approach among many that public media stations around the country are taking to boost the availability of educational programming while schools are closed.

Virus snarls global drug trade (AP) Coronavirus is dealing a gut punch to the illegal drug trade, paralyzing economies, closing borders and severing supply chains in China that traffickers rely on for the chemicals to make such profitable drugs as methamphetamine and fentanyl. Associated Press interviews with nearly two dozen law enforcement officials and trafficking experts found Mexican and Colombian cartels are still plying their trade as evidenced by recent drug seizures but the lockdowns that have turned cities into ghost towns are disrupting everything from production to transport to sales. Along the 2,000-mile U.S.-Mexico border through which the vast majority of illegal drugs cross, the normally bustling vehicle traffic that smugglers use for cover has slowed to a trickle. Bars, nightclubs and motels across the country that are ordinarily fertile marketplaces for drug dealers have shuttered. And prices for drugs in short supply have soared to gouging levels. “They are facing a supply problem and a demand problem,” said Alejandro Hope, a security analyst and former official with CISEN, the Mexican intelligence agency. “Once you get them to the market, who are you going to sell to?”

Coronavirus outbreaks at Mexico’s hospitals raise alarm, protests (Washington Post) The coronavirus outbreak in Mexico’s steel capital started at the very place that was supposed to help stop it. Social Security Hospital No. 7, a towering 240-bed facility, is the main public medical center in the northern city of Monclova. But when a 42-year-old truck driver arrived with pneumonia-like symptoms last month, the hospital didn’t isolate him. Within two weeks, he was dead of covid-19. Soon, a doctor and administrator had also perished. Ultimately, 41 employees of the hospital wound up testing positive for the virus. It was the first in a series of outbreaks at hospitals that have rattled Mexicans and raised questions about the Social Security Institute, the country’s biggest public health network. Nurses and doctors have held protests around the country. The governor of Baja California, Jaime Bonilla, lashed out at federal authorities for the lack of protective gear in his border state, saying doctors were “dropping like flies.” Medical personnel in other pandemic hot spots, such as Italy and Spain, have also expressed outrage about working without proper equipment. But Mexico is particularly vulnerable, because it has many fewer doctors and nurses per capita.

Pope Francis says ‘selfish indifference’ in pandemic response would be worse than virus itself (AP) Pope Francis, the leader of the Catholic Church, ventured outside the Vatican for the first time in more than a month to give a sermon this Divine Mercy Sunday. At the Santo Spirito in Sassia church in Rome, the pope spoke at length about the coronavirus pandemic and inequality, warning that forgetting the less fortunate during a recovery would be a “worse virus” than the outbreak itself. “The risk is that we may then be struck by an even worse virus, that of selfish indifference,” Francis said, according to a translation from Crux. This attitude is spread “by the thought that life is better if it is better for me, and that everything will be fine if it is fine for me,” he continued. He added that the “time has come to eliminate inequalities, to heal the injustice that is undermining the health of the entire human family.”

10 African Countries Have No Ventilators. That’s Only Part of the Problem. (NYT) South Sudan, a nation of 11 million, has more vice presidents (five) than ventilators (four). The Central African Republic has three ventilators for its five million people. In Liberia, which is similar in size, there are six working machines--and one of them sits behind the gates of the United States Embassy. In all, fewer than 2,000 working ventilators have to serve hundreds of millions of people in public hospitals across 41 African countries, the World Health Organization says, compared with more than 170,000 in the United States. Ten countries in Africa have none at all. Many experts are worried about chronic shortages of much more basic supplies needed to slow the spread of the disease and treat the sick on the continent--things like masks, oxygen and, even more fundamentally, soap and water. Clean running water and soap are in such short supply that only 15 percent of sub-Saharan Africans had access to basic hand-washing facilities in 2015, according to the United Nations. In Liberia, it is even worse--97 percent of homes did not have clean water and soap in 2017, the U.N. says. “The things that people need are simple things,” said Kalipso Chalkidou, the director of global health policy at the Center for Global Development, a research group. “Not high-tech things.”

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First, this agenda was never—and still is not—based on a historically-informed analysis about the actual causes of service delivery gaps in specific low- and middle-income countries. The movement implies that the main cause of inadequate service delivery to the poor is government corruption, although often it does not explicitly say it, and it rarely provides concrete evidence about the link to service delivery.

For example, the 2004 WDR asserted that the main cause of inadequate service delivery to the poor was government corruption, without actually providing persuasive empirical evidence. Although it noted that a survey of a primary health care facility in Bangladesh found a doctor absentee rate of 74 percent, it provided neither context nor analysis to explain the reasons why workers were not showing up. Some form of corruption was just assumed. For all the discussion of teacher or healthcare worker absenteeism in various studies cited by researchers associated with the movement, I have yet to see a reference to a survey or case study in which they actually asked people why they didn’t show up to work.

Practitioners and activists have an “action bias” and often race ahead of both theory and evidence—in this case building a global movement on an untested theory that government corruption is the main cause of service delivery failures in all low- and middle-income countries. While this may be the reason in specific places and times, as this 2018 investigative New York Times article on corruption at a primary school in Mpumalanga, South Africa makes clear, the precise nature of the phenomenon needs to be described and proven, rather than merely asserted. Without a nuanced causal analysis, as former Carnegie Endowment fellow, Sarah Chayes, noted, “Many attempted remedies prove ill-adapted to local realities and achieve little.”

The complicated reality is that, as Levine herself said in an interview, there are many possible reasons for the failure of governments to deliver quality services to citizens, and corruption is just one of them. In many countries in sub-Saharan Africa, where liberalizing governments adopted decentralization reforms in the 1990s, local governments are primarily responsible for the delivery of basic services such as health, education, and water and sanitation.

But these local governments had to be created from scratch, and in the rural areas, where the data clearly shows that access to services is the worst, this challenge was made even more daunting by the phenomenon the Africanist Mahmood Mamdani describes in his pathbreaking book, “Citizen and Subject”: the remnants of a form of late colonial governance in rural areas he called “decentralized despotism,” which relied on tribal and customary power and the reproduction of ethnic identities.

This recent study of the post-Apartheid state’s delivery of “built” public services to the black majority argues that the failures in the former rural “homelands” are mainly a result of the fact that local governments in these areas had to be created from scratch and overcoming this deficit of technical and administrative capacity is a gargantuan task. Building capable local governments in rural areas while at the same time confronting the institutional legacy of customary despotism remains the paradigmatic challenge to achieving meaningful democratic and development outcomes in sub-Saharan Africa.

Moreover, building government capacity, especially at the local level, requires a completely different set of solutions than the transparency and accountability movement is prescribing. The movement’s preferred agent of change—civil society, which after all is concentrated in urban areas—may actually be marginal, if not irrelevant, to solving this problem. Perhaps the focus needs to shift from civil society to investing in civil servants, especially at the rural local government level.

The flawed approach of the transparency and accountability movement is hardly news at this point. By 2015, the bulk of the impact evaluation evidence suggested that social accountability interventions—in which civil society and citizens directly monitor service providers—have not improved service delivery outcomes. The studies cited in the main text of Hewlett’s own strategy documents are pretty consistent about the limited evidence base, such as these contributions by Johanna Speer in 2012 and Boydell and Keesbury in 2014.

Even researchers at the World Bank, in this 2016 report, have now revised their assessment of the 2004 WDR, and argue that the focus on social accountability was misguided because it popularized the idea that politics could be bypassed. The 2016 revision argues that the movement’s focus should shift to the “long route” of political accountability and altering the incentives of political leaders, not only through voting and elections, but also through internal government accountability mechanisms, such as checks and balances and robust audit institutions.

Although the governance sub-strategy suggests Hewlett will address political accountability, it limits its focus to tools such as journalism, digital media, and community radio, that can “influence governance beyond the ballot box.” But here lies the conundrum: Real political accountability obviously requires a focus on voting and elections, and the types of mass-based organizations that are not professionalized civil society groups—such as political parties, especially opposition parties, and mass movements such as trade unions and other types of social movements. 

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COVID-19 and the Swine Flu - History Repeats Itself

Deja Vu

The 1976 Swine Flu Epidemic

History Repeats Itself

“Those who don't know history are doomed to repeat it.” Edmund Burke This could be the most important information you read during this time of the Corona / COVID -19 pandemic. What we are going through today with COVID 19 is an almost identical replay to the 1976 Swine Flu epidemic in America. The New York Times went so far as to dub the whole affair a “fiasco.” Let this snippet of history guide you to make the right decisions when you are faced with this question; SHOULD I VACCINATE FOR COVID 19? https://youtu.be/f1jV3tJ2Lqw The swine flu epidemic of 1976 in the U.S. CBS ” 60 MINUTES” documentary on the swine flu epidemic of 1976 in the U.S. It went on air only once and was never shown again. Watch this video documentary and listen to testimony of people who caught Gullian-Barre paralysis because of the swine flu vaccine. They sued the US government for damages. 500 cases of Gullian-Barre paralysis, including 25 deaths—not due to the swine flu itself, but as a direct result of the vaccine. At the time President Gerald Ford, on advice from the CDC, called for vaccination of the ENTIRE population of the United States. The difference now, and what is the REAL danger, we have no questioning media. (see below) "A step‐op is one in which the bad guys keep going, one intrusion after another. It isn't just West Nile, it's West Nile, then SARS, then Bird Flu, then Swine Flu. It"s all one package, with the idea, in this case, that they'll slowly wear down the resistance and people will buy in, will buy the story, the lie. They want people to OBEY. That's the whole essence of this op. OBEY. It isn't only about fake epidemics and getting vaccines. It's about operant training in OBEYING. Get it? In general. Obey us. We command, you go along." ~ Ellis Medavoy in interview with Jon Rappoport, from The Matrix Revealed By Catherine Austin Fitts https://home.solari.com/the-creation-of-a-false-epidemic-with-jon-rappoport/?fbclid=IwAR3Q4RblnZSbinFIaMaIjiNHXyGy6HUNE1BjxTBzaspQt38xITvwnPkYx8E

The Creation of a False Epidemic with Jon Rappoport

Part I Wuhan - How it Started https://audio.solari.com/sr20200401/sr20200401_InterviewHQ_01.mp3 Part II EIS - Epidemic Intelligence Service This is the Medical CIA / The Virus Hunters, a Mexican Pig Farm and the Fraudulent PCR Test https://audio.solari.com/sr20200401/sr20200401_InterviewHQ_02.mp3 Part III The True Goal of the Pandemic https://audio.solari.com/sr20200401/sr20200401_InterviewHQ_03.mp3

The Public Health Legacy of the 1976 Swine Flu Outbreak

President Gerald Ford receiving the swine flu vaccine from his White House physician, Dr. William Lukash on October 14, 1976. Image: David Hume Kennerly. Source: Gerald R. Ford Presidential Library and Museum. In the late winter of 1976, a completely novel strain of influenza was causing hundreds of respiratory infections at Fort Dix, an army post located in central New Jersey. Initially, this virus appeared to be closely genetically related to the 1918 flu pandemic that killed over a 100 million people globally, a pandemic that shared the very same Fort Dix as one its points of origin. These striking coincidences, along with the virus’s “sustained person-to-person spread,” prompted global public health officials to start planning for what could conceivably burgeon into a series of large and deadly outbreaks, if not an actual pandemic, in the upcoming winter (1). In late March, President Ford announced in a press conference the government’s plan to vaccinate “every man, woman, and child in the United States.” (1) Emergency legislation for the “National Swine Flu Immunization Program” was signed shortly thereafter on April 15th, 1976 and six months later high profile photos of celebrities and political figures receiving the flu jab appeared in the media. Even President Ford himself was photographed in his office receiving his shot from the White House doctor. But while the World Health Organization adopted a cautious “wait and see” policy to monitor the virus’s pattern of disease and to track the number of emerging infections, President Gerald Ford’s administration embarked on a zealous campaign to vaccinate every American with brisk efficiency. “Get a shot of protection. The swine flu shot.” The video above shows the Ford Administration’s advertisements for vaccinating agianst the swine flu. Within 10 months, nearly 25% of the US population, or 45 million citizens, was vaccinated, but serious problems persisted throughout the process (2). Due to the urgency of creating new immunizations for a novel virus, the government used an attenuated “live virus” for the vaccine instead of a inactivated or “killed” form, increasing the probability of adverse side effects among susceptible groups of people receiving the vaccination. Furthermore, prominent American scientists and health professionals began questioning the campaign’s large expense and its drain on scarce public health resources (2). With President Ford’s reelection campaign looming on the horizon, the campaign increasingly appeared politically motivated. The rationale for mass vaccination seemed to stem from only the barest of biological reasoning – it turned out that the flu wasn’t even related to the virus that caused the grisly 1918 epidemic and, indeed, those who were infected with the flu only suffered from a mild illness while the vaccine, for the reasons stated above, resulted in over four-hundred and fifty people developing the paralyzing Guillain-Barré syndrome. Meanwhile, outside the United States’ borders, the flu never mushroomed into the anticipated public health disaster. It was the pandemic that never was. The New York Times went so far as to dub the whole affair a “fiasco,” damning one of the largest and probably one of the most well-intentioned public health initiatives by the US government (1)

ROBERT F KENNEDY JR DESTROYS

"MESSIANIC" BILL GATES

“Vaccines, for Bill Gates, are a strategic philanthropy that feed his many vaccine-related businesses (including Microsoft’s ambition to control a global vaccine ID enterprise) and give him dictatorial control over global health policy—the spear tip of corporate neo-imperialism. Gates’ obsession with vaccines seems fueled by a messianic conviction that he is ordained to save the world with technology and a god-like willingness to experiment with the lives of lesser humans. Promising to eradicate Polio with $1.2 billion, Gates took control of India ‘s National Advisory Board (NAB) and mandated 50 polio vaccines (up from 5) to every child before age 5. Indian doctors blame the Gates campaign for a devastating vaccine-strain polio epidemic that paralyzed 496,000 children between 2000 and 2017. In 2017, the Indian Government dialed back Gates’ vaccine regimen and evicted Gates and his cronies from the NAB. Polio paralysis rates dropped precipitously. In 2017, the World Health Organization reluctantly admitted that the global polio explosion is predominantly vaccine strain, meaning it is coming from Gates’ Vaccine Program. The most frightening epidemics in Congo, the Philippines, and Afghanistan are all linked to Gates’ vaccines. By 2018, ¾ of global polio cases were from Gates’ vaccines. In 2014, the Gates Foundation funded tests of experimental HPV vaccines, developed by GSK and Merck, on 23,000 young girls in remote Indian provinces. Approximately 1,200 suffered severe side effects, including autoimmune and fertility disorders. Seven died. Indian government investigations charged that Gates funded researchers committed pervasive ethical violations: pressuring vulnerable village girls into the trial, bullying parents, forging consent forms, and refusing medical care to the injured girls. The case is now in the country’s Supreme Court. In 2010, the Gates Foundation funded a trial of a GSK’s experimental malaria vaccine, killing 151 African infants and causing serious adverse effects including paralysis, seizure, and febrile convulsions to 1,048 of the 5,049 children. During Gates 2002 MenAfriVac Campaign in Sub-Saharan Africa, Gates operatives forcibly vaccinated thousands of African children against meningitis. Between 50-500 children developed paralysis. South African newspapers complained, “We are guinea pigs for drug makers” Nelson Mandela’s formar Senior Economist, Professor Patrick Bond, describes Gates’ philantropic practises as “ruthless” and immoral”. In 2010, Gates committed $ 10 billion to the WHO promising to reduce population, in part, through new vaccines. A month later Gates told a Ted Talk that new vaccines “could reduce population”. In 2014, Kenya’s Catholic Doctors Association accused the WHO of chemically sterilizing millions of unwilling Kenyan women with a phony “tetanus” vaccine campaign. Independent labs found the sterility formula in every vaccine tested. After denying the charges, WHO finally admitted it had been developing the sterility vaccines for over a decade. Similar accusations came from Tanzania, Nicaragua, Mexico and the Philippines. A 2017 study (Morgensen et.Al.2017) showed that WHO’s popular DTP is killing more African than the disease it pretends to prevent. Vaccinated girls suffered 10x the death rate of unvaccinated children. Gates and the WHO refused to recall the lethal vaccine which WHO forces upon millions of African children annually. Global public health advocates around the world accuse Gates of – hijacking WHO’s agenda away from the projects that are proven to curb infectious diseases; clean water, hygiene, nutrition and economic development. They say he has diverted agency resources to serve his personal fetish – that good health only comes in a syringe. In addition to using his philantropy to control WHO, UNICEF, GAVI and PATH, Gates funds private pharmaceutical companies that manufacture vaccines, and a massive network of pharmaceutical -industry front groups that broadcast deceptive propaganda, develop fraudulent studies, conduct surveillance and psychological operations against vaccine hesitancy and use Gates’ power and money to silence dissent and coerce compliance. In this recent nonstop Pharmedia appearances, Gates appears gleeful that the Covid-19 crisis will give him the opportunity to force his third-world vaccine programs on American children.” Source Instagram

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Unfolding Rare Health Secrets to Worldwide Audience!

Jonathan Otto is an award-winning investigative journalist who has diverted all his life energies into improving the lives of his brethren across the globe. His premise for research is simple: half of the world at present is starving and the rest half is on diet books and this disparity in terms of food needs to end. If you eat the standard American diet, you are going to get the standard American diseases.There is a serious problem with the way America produces, stores and distributes its food.

It is resulting in more McDonalds, Dominos, KFC being spread across the world. But the flip side is that it is resulting in more wastelands and patients lining up the hospital beds across the world. The reason being that urea used in agriculture is manufactured from the same factories that are dedicated to making chemical weapons.

These companies and their manufacturing facilities were set up as investors thought that the World war would go on in perpetuity and would never end. But it ended in 1945 and these factories devoted to developing chemical weaponsbegan sponsoring agricultural universities and research centres with a view to make them buy the urea that they were producing. This urea has spoilt the agricultural landscape of the entire world.

Add to this the power of Big pharma

In addition to the above scam that was going on, another scam is brewing and going on with a roaring pace in the pharma sector wherein diseases are never cured permanently but only a tight control is exerted on them so that the patient never recovers from a chronic disease and is a slave to the drug regimen offered by the specialist doctor. Patients who are the fulcrum of the healthcare administration system have zero knowledge of how their health is being administered and neither do they have a say in the price to be paid or the method of treatment they prefer.

Doctors fresh, after passing out of medical colleges often work for hospitals funded by these pharma companies and imbibe their unethical practices in order to drive revenue growth. Cost-benefit analysis is often skewed in the favour of the hospital.

Even private practitioners and those working for hospitals funded by the public are lured by medical representatives into prescribing drugs at inflated prices of heavily advertised branded drugs in return for foreign tours and conferences sponsored by these pharma companies. Most monthly meetings of specialist doctors are also hosted at star class hotels to aid in soft marketing of branded pharmaceutical products.

There is a corrupt bureaucrat-politico-police-hospital nexus that protects the accused in all capitalist economies where patients are fleeced of their hard-earned money in the name of tertiary care.

Unlock the secrets of reversing autoimmune diseases through great food!

Autoimmune diseases ‘occur when the body and its immune system start striking itself and killing each cell down, one by one. Dermatitis, Crohn disease, IBS are some of the chronic diseases that can be called as autoimmune owing to degeneration they cause in the internal and external parts of the body. Dermatitis sometimes occurs through weight gain but at times, it can trigger weight gain also.

Let us understand, how they are different from other diseases. The primary goal of a healthy immune system is to protect itself from any pathogen, bacteria, viruses or antibodies attacking the body including parasites. Autoimmune is life-threatening as the body starts attacking itself and requires great care, dedication, and the right kind of knowledge to reverse it.

The body issues an inflammatory response to such a condition and it can appear as rashes, sores, scales and lichen planus on the skin. Identifying the trigger is the key to containing the autoimmune disease. Scientists, researchers, medical professionals have found the following triggers that can kickstart autoimmune diseases in your body:

Electromagnetic radiation

Everyday chemical exposures

Fatty liver

Genetic expression/allergens

Genetically modified organisms and poor diet.

Heavy metals

Hormone imbalances,

Intestinal permeability or “leaky gut,”

Lyme disease

Mental and emotional stress

Mould

Parasites

Pharmaceuticals

Good food that tastes well often does not offer the nutritive value that we require to reverse the autoimmune diseases that plague mankind. Anything that tastes well should not be chewed and put aside is what nutritionists say for weight loss. 

Weight gain is also a challenge and a bigger one as sometimes, nothing works, and you need the help of plant-based supplements. Dairy products do not really offer the efficacy to fight autoimmune diseases that are hell-bent on destroying your immune system.

How Jonathan work can help

In his multipart documentary that is being released on the web from time to time, Jonathan outlines his belief in the medium of film to deliver the message across to a worldwide audience. Inspite, of being an investigative journalist, he has devoted much of his life to improving public health as that is the core of any developed society that aims to occupy pole position on the global arena. He is ably supported by his wife in all his ventures and can count on her for her opinion regarding diverse subjects affecting mankind.

Very early in life, he was moved by the plight of the disadvantaged in sub-Saharan Africa and coaxed his mom to donate to charity. Later, in life, he took the baton himself and delved deep into learning more about food, medicine, and the complex interrelationship between the two. He concluded that food is the bedrock on which his fight against Depression, Anxiety, Alzheimer, auto-immune diseases will lie and that some foods are better than others in reversing auto-immune diseases.

Going in for a plant-based diet is the best way to avert and reverse auto-immune diseases that occur in men and women at any age. Some get cured, others can’t, and the patient suffers the loss of time, money and energy in the process. If only patients know about his documentary series offering free advice to millions across the globe then the world will be a better place to live in.

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SCHOLARSHIPS FOR INTERNATIONAL STUDENTS BY GERMANY

Germany is well known for owning the highest rank in having world’s top renowned higher learning institutes. It is the best option for the students who desires to study and stay back for couple of years after completing their degree. For foreign students looking for an international education, Germany has always been a popular destination. Compared to UK, USA or Australia, internationally recognized programs are offered at relatively cheaper cost by the German Universities.

The country aids students the opportunity to choose between 14500 bachelor and master degree programs and not only this but there are also many scholarships opportunities offered for the international students to fund their studies. There are also some significant scholarships available that allows the foreign students to study in Germany for free.

Scholarships offered on the basis of title for the international students in Germany is divided into three categories =

Government-funded scholarships to study in Germany

·       DAAD Scholarships –

The German Academic Exchange Service or DAAD offers many scholarships for international students of various level degrees, who wishes to study in Germany. DAAD scholarships are primarily aimed at graduates, doctoral students and postdoctoral students and are awarded for study and research visits to universities and non-university research institutions in Germany. In some programmes, internships are also funded.

 ·       Erasmus Scholarship –

Erasmus is an integrated, prestigious, international study programme offered by an international consortium of higher education institutions. The largest provider of scholarships for study in the EU, Erasmus scholarship is led by the European Commission, funding international students to study in Europe. When participating in an exchange program to study in Europe, Erasmus provides ease towards living costs.

Non-government scholarships to study in Germany

·       Einstein International Postdoctoral Fellowship –

Einstein Foundation sponsors fellowship for postdoctoral research students at the university in Berlin. 

 ·       Heinrich Boll Scholarships for International Students –

This programme offers scholarships for international students at all levels wishing to study in Germany at an accredited institution.

·       Humboldt Research Fellowships for Postdoctoral Researchers –

Humboldt Research Fellowships provides Postdoctoral scholarships for scientists and scholars of any subject and nationality. International Students from developing and emerging countries can might apply for a Georg Forster Fellowship.

 ·       Konrad-Adenauer-Stiftung (KAS) Scholarships –

International applicants who are under 30 years of age and have completed a university degree in their home country can apply for this Monthly master’s and PhD scholarship. One will just need to provide evidence that shows the applicant is above-average academic performance and that tells the student have been actively involved in voluntary works for the benefit of society in their home country, and have an interest in political issues.

 ·       Kurt Hansen Science Scholarships –

It is a Science scholarships to study in Germany that is funded by the Bayer Foundation and is open to students who are training to become educators in the field of science.

 ·       Marie Curie International Incoming Fellowship (IIF) –

International students wishing to study in Germany can apply for this Marie Curie International Incoming Fellowship. It is funded by the European Commission.

 ·       Mawista Scholarship –

Mawista Scholarships are provided for those studying abroad while taking care of a child, including those pursuing to study in Germany.

 ·       Deutschland Stipendium –

Deutschland Stipendium basically are the Merit-based scholarships of €300 a month are available to highly talented students enrolled at German universities. Nationality and personal income do not mostly matter here.  

 ·       The Helmholtz Association –

These aids the doctoral and postdoctoral students from all around the world to get Annual fellowships. The Helmholtz association gives one the chance to do paid research at the Helmholtz centre in Germany.

University-specific scholarships to study in Germany

 ·       DRD Scholarships for Sub-Saharan Africans –

DRD is mainly a Merit-based scholarship that is available for the students from developing countries in the Sub-Saharan Africa who are pursuing master’s degree in development studies, public administration and development management at Ruhr-University Bochum. Program twinned with UWC in South Africa. More scholarships for African students are available here. 

 ·       Doctoral Tuition Waivers at Frankfurt School of Finance and Management –

International students are provided with fully-funded study places and a generous monthly stipend for up to five years. Tuition waiver scholarships are available for doctoral students studying an English-language program at the Frankfurt school within finance, accounting, mathematics and business administration. 

·       FRIAS Co fund Fellowship Programme for International Researchers –

International students gets the chance to study at Universitat Freiburg on a research-level program through this German scholarship.

 ·       Hamburg University of Applied Sciences Scholarships –

Here, this scholarships is delivered to the international students of any subjects excluding design, public health and public management who are enrolled on a master’s program at the Amburg University.

 ·       Heidelberg University –

A range of scholarships are provided for the international students by the Heidelberg University, such as the Amirana Scholarship that aids students from developing countries to study medicine or dentistry. 

 ·       HHL International MSc Scholarship –

International Students are provided with some of the great scholarship opportunities to study management at master’s and PhD levels at HHL Leipzig Graduate School of Management.

 ·       Humboldt University International Research Fellowships –

International students pursuing research in history, anthropology, law, sociology, political science, geography, economics or area studies are provided with scholarship opportunities at Humboldt University. 

 ·       Graduate School of East and Southeast European Studies Doctoral positions for International students –

This avails the applicant to study at the graduate level within Ludwig-Maximillian’s-Universitat Munich or Universitat as a research fellow of East and Southeast European Studies.

·       KAAD Scholarships for Developing Countries –

It’s basically a scheme that offers scholarships for international students from developing countries like from Africa, Asia, the Middle East and Latin America to study at master’s or PhD level in the German university. Candidates must have good command over German-language and has to be of Catholic-Christian denomination.

   ·       Kofi Annan MBA Scholarships –

This Scholarships aids up to five international students from developing countries to study full-time and have one-year MBA at the European School of Management and Technology (ESMT) in Berlin. The School provides some other MBA scholarships which includes the ESMT Women's Academic Scholarship for female candidates.

 ·       Max Planck Institute for Chemical Physics –

Through this the Post-doctoral fellowships are available to study solid state chemistry at the university.

 ·       Ulm University Scholarships for International Students –

Ulm University scholarships are basically the Need-based scholarships for international students of Ulm University but here the funding is granted for 1 semester only.

 ·       Universitat Hamburg Merit Scholarships –

All the outstanding international students of any degree levels and subjects, who have already been enrolled in their program for at least two semesters can apply for this scholarship. This aids the students in their financial needs.

 ·       RWTH Aachen University scholarships –

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A never-ending cycle of doctors’ strikes and funding debacles leaves Nigerians at the mercy of the pandemic

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A never-ending cycle of doctors’ strikes and funding debacles leaves Nigerians at the mercy of the pandemic

Nigerian doctors earn miserable wages, while politicians get fat allowances

Doctors walk past women with lying in a ward of the Lagos Island Maternity Hospital in Lagos, Nigeria, via Flickr photo by Sunday Alamba/Commonwealth Secretariat / CC BY-NC 2.0.

Doctors in Lagos State embarked on a three-day strike from July 13 to 15, to protest the absence of adequate safety and welfare measures for doctors working with COVID-19 patients.  The Premium Times online newspaper reported that Oluwajimi Sodipo, head of the Lagos Doctors Guild, announced the strike at a press briefing on July 12, in protest of the disparity between COVID-19 hazard allowances for Lagos doctors and their colleagues in federal hospitals. Doctors working in Lagos coronavirus isolation centres also lacked sufficient Personal Protective Equipment (PPE), health insurance and were also owed two months’ salary, Sodipo said. The Guild exempted doctors working in the state isolation centres from joining the collective action. As of July 21, Nigeria had recorded 37,225 confirmed cases of COVID-19, 15,333 recoveries and 801 deaths. Lagos State, the country’s most densely populated state, is the epicentre of the disease, with 13,538 confirmed cases, 1,964 recoveries and 176 deaths. The Lagos State government on July 13 appealed to the frontline medical workers to return to work. The doctors suspended their strike on July 16, due to the “positive disposition” shown by the Lagos State government to their demands.  

An unending cycle of rinse and repeat

Strike action by Nigerian medical doctors has become an annual occurrence in Africa’s most populous country. Their grievances are always the same: a demand for increased welfare measures and protection in order to do their jobs better.  The sequencing of the government's response is equally predictable: initially, it’s high -handed, with a threat to sack the striking doctors if they don’t return to work. Then it usually backfires, forcing the government to back down and concede to the doctors’ demands.  This pattern of events has remained consistent even in the face of a global public health crisis.  In mid-2014, Nigerian resident doctors (those undergoing specialist training) went on strike during the Ebola epidemic over welfare demands. The Nigerian government responded by terminating their appointments, then later soft-pedaled and blamed the media for misrepresenting the facts of the matter.    

Nigerian Resident doctors @nard_nigeria are starting their strike today,after weeks of trying to get the government to act Support them ,put your tweets where your mouths are They are the lifeblood of our hospitals , especially for specialised services. — Femi (@0gbeni) June 15, 2020

Six years later, on June 15, resident doctors again went on strike during a major public health crisis to protest poor working conditions and inadequate — or unpaid — welfare measures provided for those working on COVID-19. Twitter user Dr. Nma Halliday sarcastically compares the ridiculously low monthly health hazard allowance given to Nigerian doctors (60,000 naira, or about $144 USD per year) with the annual newspaper and hardship allowances paid to Nigerian legislators, which amount to 1.2 million naira ($3,000 USD) and 1.24 million naira ($3,200 USD] respectively: 

Before you remind doctors to take quaker oat for breakfast, just remember that the newspaper allowance for the lawmakers is 1.2 million naira & Hardship Allowance is 1.24 million naira. But a doctor’s hazard allowance with covid19, HIV, Hepatitis B etc is 5,000 naira only Wawu — Nma Halliday MD (@nma_halliday) June 20, 2020

True to form, the government threatened yet again to sack the doctors when negotiations ended in a deadlock on June 17. But the doctors resisted the intimidation and stood their ground. The strike was eventually called off on June 22, following the intervention of state governors and federal legislators. 

Controversy over funding for COVID-19

University College Hospital, Ibadan is the first teaching hospital in Nigeria via Hizick27 / Wikimedia Commons / CC-BY-SA-4.0.

During Nigeria’s COVID-19 crisis, some government funds, allegedly given to a teaching hospital in southwestern Nigeria, became an object of controversy. What started as a routine press briefing about the matter quickly degenerated into denials and counter-accusations.  On June 23, Akinola Ojo, health commissioner in Oyo State, southwestern Nigeria, announced that the state government had spent 2.7 billion naira ($6.9 million USD) in their fight against COVID-19. According to the financial daily BusinessDay, Ojo stated that part of the expenditure included the 118 million naira ($304,000 USD) “given” to the University College Hospital (UCH), Ibadan “as support.” But the following day, on UCH’s Facebook page, the hospital denied having received any COVID-19 funding from the Oyo State Government. Spokesperson Toye Akinrinlola suggested that due to confusion between the names of the College of Medicine Ibadan and UCH, the College of Medicine Ibadan was the likely recipient of the government funds.  This suggestion was “emphatically and categorically” rejected by the College of Medicine’s management, which stated that it had not received any such funding from the state government.  Though separate institutions, the College of Medicine and UCH are intertwined. The College is part of the University of Ibadan, while UCH falls under the supervision of the Federal Ministry of Health, but students from the College of Medicine and other healthcare specialists from sub-Saharan Africa undertake clinical training at UCH.  On June 24, the Oyo State government insisted that the funding in question had gone to UCH’s virology department, and described attempts by UCH management to “disown” its own clinical virology department that also provides “teaching and research” services to the College of Medicine as “self-serving, artificial and contemptuous.”  The following day, the media office of the governor of Oyo State tweeted a screenshot of a press release in which the head of UCH’s Department of Virology acknowledged receiving financial support from the state government for the fight against COVID-19. 

COVID-19: Virology Dept affirms Oyo govt's support, appreciates Makinde …As govt insists total support to UCH, Virology Dept stand at N118.9m pic.twitter.com/oGZIvjMHGR — GSM MEDIA OFFICE (@GSMMEDIATEAM) June 25, 2020

A tale of two testing labs

The controversy stems partly from the fact that there are two laboratories approved by the Nigerian Centre for Disease Control (NCDC) to conduct coronavirus tests in Ibadan, Oyo State: the laboratory of UCH’s Virology department, accredited on March 28, and the College of Medicine’s Biorepository and Clinical Virology laboratory, approved on June 9. Both laboratories are based in the same facility.  The Biorepository laboratory was commissioned on April 17. This molecular pathology lab was initially conceived as a tissue bank, and its foray into the coronavirus testing appeared to signal internal wrangling — possibly a battle for supremacy between the College, UCH and its virology unit.  [youtube https://www.youtube.com/watch?v=Y1zbuvxZLzc] It has since been confirmed that UCH’s virology department was the recipient of the state government funding but the entire process lacked transparency.  The fact that UCH management and the College “disowned” the virology department suggests that they were not privy to the funding.  Why did the virology department act independently? Into which department’s bank account was the said donation from the state government deposited? We may not have heard the last on this controversial donation.   In the final analysis, scenarios such as doctors’ strikes and funding debacles are bound to recur until the root cause of the problem — inadequate funding —is exorcised from Nigeria's public health system.  It is untenable that doctors and healthcare workers on the frontline of a pandemic should be paid peanuts while politicians who risk little or nothing earn fat allowances. 

Same people that cut the healthcare budget in the middle of a pandemic, and are threatening to sack doctors for going on a strike? Nigerian politicians are unrepentant money embezzling thieves and not even a public health crisis can change them. Know this and know peace. https://t.co/Xlho01UOLV — Mmek (@Simmbie) June 18, 2020

Also indefensible is the fact that some public hospital administrators seem uninterested in serving the common good, choosing instead to engage in petty rivalries, to the detriment of the health of their patients.  Until something gives, ordinary Nigerians are left at the mercy of a ravaging pandemic.

Written by Nwachukwu Egbunike · comments (0) Donate · Share this: twitter facebook reddit

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South Africa's TB, HIV history prepares it for virus testing

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South Africa's TB, HIV history prepares it for virus testing

JOHANNESBURG — South Africa, one of the world’s most unequal countries with a large population vulnerable to the new coronavirus, may have an advantage in the outbreak, honed during years battling HIV and tuberculosis: the know-how and infrastructure to conduct mass testing.

Health experts stress that the best way to slow the spread of the virus is through extensive testing, the quick quarantine of people who are positive, and tracking who those people came into contact with.

“We have a simple message for all countries: test, test, test,” Tedros Adhanom Ghebreyesus, director-general of the World Health Organization and a former Ethiopian health minister, said recently.

South Africa has begun doing just that with mobile testing units and screening centres established in the country’s most densely populated township areas, where an estimated 25% of the country’s 57 million people live.

Clad in protective gear, medical workers operate a mobile testing unit in Johannesburg’s poor Yeoville area. In the windswept dunes of Cape Town’s Khayelitsha township, centres have been erected where residents are screened and those deemed at risk are tested.

While most people who become infected have mild or moderate symptoms, the disease can be particularly dangerous for older people and those with existing health problems, such as those whose immune systems are weakened or who have lung issues. That means many in South Africa — with world’s largest number of people with HIV, more than 8 million, and one of the world’s highest levels of TB, which affects the lungs — are at high risk of getting more severe cases of the disease.

“Social distancing is almost impossible when a large family lives in a one-room shack. Frequent hand-washing is not practical when a hundred families share one tap,” said Denis Chopera, executive manager of the Sub-Saharan African Network for TB/HIV Research Excellence.

“These are areas where there are high concentrations of people with HIV and TB who are at risk for severe symptoms. These are areas that can quickly become hot spots,” said Chopera, a virologist based in Durban.

But years of fighting those scourges has endowed South Africa with a network of testing sites and laboratories in diverse communities across the country that may help it cope, say experts.

“We have testing infrastructure, testing history and expertise that is unprecedented in the world,” said Francois Venter, deputy director of the Reproductive Health Institute at the University of Witswatersrand. “It is an opportunity that we cannot afford to squander.”

The country imposed a three-week lockdown March 27 that bought it some time, said Venter.

“Now is the time to test and track. We must get out into the community and find out where the hot spots are,” said the doctor. “With testing we can strategically focus our resources.”

South Africa was one of only two countries in Africa that could test for the new coronavirus when it began its global spread in January. Now at least 43 of the continent’s 54 countries can, but many have limited capacity.

Widespread testing has even been a challenge in North America and Europe, where some countries with large outbreaks resorted to only testing patients who are hospitalized.

Currently able to conduct 5,000 tests per day, South Africa will increase its capacity to more than 30,000 per day by the end of the April, according to the National Health Laboratory Service.

That would make its capacity among the best in Africa and comparable to many countries in the developed world, say health experts.

At first in South Africa, COVID-19 appeared to be a disease of the rich, as the first few hundred cases were virtually all people who had travelled to Italy and France and who could afford to go to private clinics.

But as local transmission of the virus takes hold, the public health service must take testing into the country’s most vulnerable areas: the overcrowded, under-resourced townships.

South Africa has thousands of community health workers experienced in reaching out in these areas to educate about infectious diseases as well as to screen, test and track contacts to try to contain the spread.

South Africa is already testing by taking swabs and using conventional means.

And it is also expecting to receive new kits that will allow rapid test results. South Africa has for several years been using a TB testing system that extracts genetic material and produces results within two hours. That system, known as GeneXpert, has developed a test for COVID-19 that was approved last month by the U.S. Food and Drug Administration, and South Africa is expecting delivery of those test kits within weeks.

“This will dramatically shorten our testing time, and the smaller machines can be placed in mobile vehicles, which are ideal for community testing,” said Dr. Kamy Chetty, CEO of the National Health Laboratory Service.

South African Health Minister Zweli Mkhize said the country must find out “what is happening in our densely populated areas, in particular the townships” where he said health workers would “continue to venture forth in full combat by proactively conducting wall-to-wall testing and find all COVID-19 affected people in the country.”

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Publications

“The war in northwest Syria has spared no one. All segments of society struggle to cope with the resulting displacement, violence, and economic collapse, with each facing specific vulnerabilities.” Losing their Last Refuge, Inside Idlib’s Humanitarian Nightmare. Sahar Atrache. Refugees International. September 2019. 

“[T]he increase in asylum applications that the country experienced during 2015-2016 became a cause célèbre for resurgent xenophobic political forces, who used the issue to rally support for numerous controversial policies and agendas. These developments have translated into persistent increases in detention numbers long after the “crisis” ended,” Immigration Detention in Austria: Where the Refugee “Crisis” Never Ends. Global Detention Project. Country Report 2020. 

“The purpose of this report is to analyse the situation of women in Syria, focusing mainly on the general situation of women in the country while also paying special attention to area-specific features in those parts of Syria under the control of non-state armed groups,” Country of Origin Information Report, Syria: Situation of Women. Finnish Immigration Service. European Asylum Support Office. February 2020.

“This report presents country of origin information (COI) on Sudan specifically in relation to the situation in Khartoum and Omdurman from 10th July2018 to 10th December 2019 on issues identified to be of relevance in refugee status determination for Sudanese nationals.” Sudan Query Response. Asylum Research Centre. 5 February 2020.

“New migration policies imposed by the United States and Mexico are trapping many Central Americans in dangerous conditions, with severe consequences for their physical and mental health.” No way out: MSF report shows damaging health impacts of US-Mexico migration policies. Doctors Without Borders/Médecins Sans Frontières (MSF). 11 February 2020 

“Over the last two decades, South Korea has implemented increasingly restrictive asylum and migrant worker policies. Although the government does not provide adequate data about immigration detention, making it challenging to assess trends in the country, observers have reported that in recent years this crackdown has grown in scale and intensity.” Immigration Detention in the Republic of Korea: Penalising People in Need of Protection. Global Detention Project. 26 February 2020.

“The Netherlands places increasing numbers of foreigners—including asylum seekers, families, and children—in detention. The country’s Caribbean territories—specifically, Aruba and Curaçao—have also ramped up their removal efforts in recent years as thousands of Venezuelans have sought refuge on the islands.” Immigration Detention in the Netherlands: Prioritising Returns in Europe and the Caribbean. Global Detention Project. February 2020. 

“India is a non-signatory state to the 1951 Refugee Convention which hosts over 200,000 refugees within its territory. With lack of domestic asylum frameworks and clarification of identity, the existence of refugees in India is governed by a loose gathering of ad hoc executive policies, complementary legislations and judicial pronouncements, which are often influenced by the political considerations of the government in power. As a result, access to services from financial institutions for refugees is not made possible.” Financial Inclusion for Refugees in India: A Study on Practical Access to Banks and Financial Services. Migration and Asylum Project, an Initiative of the Ara Trust. March 2020.

“Brexit, the European immigration and refugee situation and the Grenfell and Windrush scandals are just some of the recent major events in which issues of migration have been at the heart of British social and political agendas.” Social Scientists Against the Hostile Environment (SSAHE) (2020). Migration, racism and the hostile environment : Making the case for the social sciences. Social Scientists Against The Hostile Environment. March 2020.

“Cash can be effectively used to facilitate access and retention in primary and secondary education. The Egypt education cash grant is an example of using cash to facilitate inclusion of refugees in the national education system.” Cash for Education in Egypt: A Field Experience. UNHCR. March 2020

“Having experienced substantial international migration since the 1970s, countries in East, South, and Southeast Asia have developed laws, institutions, policies, and programs to govern various aspects of international migration. Children, however, who comprise a significant share of the world’s international migrants, have not received as much policy attention as adults.” Not for Adults Only: Toward a Child’s Lens in Migration Policies in Asia. Maruja M. B. Asis, Alan Feranil, Scalabrini Migration Center. Journal on Migration and Human Security. March 2020.

“This paper provides the incoming Council Presidencies with key recommendations for areas of possible action to strengthen the implementation of the EU acquis on asylum and to forge common ground among member states on evolving issues of asylum and migration, in line with the Global Compact on Refugees and the Global Compact for Migration.” UNHCR’s Recommendations for the Croatian and German Presidencies of the Council of the EU. UNHCR. January-December 2020.

“The 2020 JRP seeks to strengthen protection and solutions for Rohingya refugee women, men, boys and girls; deliver quality, life-saving assistance to people in need; foster the well-being of communities in Ukhiya and Teknaf Upazilas; and work towards achieving sustainable solutions in Myanmar.” 2020 Joint Response Plan, Rohingya Humanitarian Crisis, UN Strategic Executive Group, Bangladesh. March 2020 

“In Canada, rejected refugee claimants do not enjoy unfettered access to judicial review of the decision denying them asylum; it has long been the case that they (and all immigrants, for that matter) must first seek “leave” of the Federal Court. [...] The leave requirement remains an obstacle to fair and accurate refugee status determination in Canada.” Not Just the Luck of the Draw? Exploring Competency of Counsel in Federal Court Refugee Leave Determinations (2005-2010). Jamie Liew, Pia Zambelli, Pierre-André Thériault, Maureen Silcoff. SSRN (formerly Social Science Research Network). November 2019.

“While States may put in place measures which may include a health screening or testing of persons seeking international protection upon entry and/or putting them in quarantine, such measures may not result in denying them an effective opportunity to seek asylum or result in refoulement.” Key Legal Considerations on access to territory for persons in need of international protection in the context of the COVID-19 response. UNHCR. 16 March 2020.

The Council of Europe published a new study entitled concerning gender-based asylum claims and non-refoulement. ‘The study aims to support the implementation of Articles 60 and 61 of the Istanbul Convention by providing policy makers and border and immigration officials with practical advice, information and examples of forms of gender-based violence that may be recognized as persecution. The study also identifies how the gendered dimensions and protection needs of women seeking international protection have been largely overlooked, leaving significant gaps in protection.’ Gender-based asylum claims and non-refoulement: Articles 60 and 61 of the Istanbul Convention’. Council of Europe. 10 February 2020.

“A new report that provides expert guidance to those working on Female Genital Mutilation (FGM) laws has been launched for International Women’s Day.” Press Release: New Female Genital Mutilation (FGM) Law provides a a comprehensive legal framework to protect women and girls across Africa. Trustlaw, Reed Smith LLP, Cleary Gottlieb Steen & Hamilton LLP and Latham & Watkins LLP. March 2020.

“On 5 March 2020, US Citizenship and Immigrant Service (USCIS) published changes to Chapter 6, Submission of Benefit Requests of the USCIS Policy Manual which contains provisions related to rejections of immigration applications (Volume 1 - General Policies and Procedures. Part B - Submission of Benefit Requests, Chapter 6 - Submitting Requests).” Policy Alert: Changes to USCIS Policy Manual. ASISTA. 17 March 2020.

“The petition for a writ of habeas corpus is an important tool in the arsenal of immigration attorneys who seek to fully represent their clients. Going to federal court in an attempt to obtain habeas relief may be the only remaining remedy after all other administrative options have been exhausted”. The Habeas Petition, And Other Options for Immigrants, in the Federal Courts. Curtis Doebbler, Geoffrey A. Hoffman, Javier Maldonado. 19 March 2020.

“The practice alert discusses how COVID-19 may qualify certain asylum-seekers, because virus concerns are "other serious harm" to which they should not be returned. "Other serious harm" is specified in regulation as a way to establish asylum eligibility for claims where past persecution is established but the presumption of well-founded fear is rebutted by changed country conditions or internal relocation. No nexus to a protected ground or to the past persecution is required. BIA and court of appeals precedents include analysis of health conditions in destination countries when determining "other serious harm." Practice Alert: Coronavirus Asylum Claims Based on “Other Serious Harm”. National Immigration Project of the National Lawyers Guild. 19 March 2020.

“This paper from SIHMA examines the prospects for implementation of the GCR in sub-Saharan Africa. It argues that, given increases in the number of forcibly displaced people in recent years, responses to refugee crises need to shift from a humanitarian system of “care and maintenance,” to more comprehensive and effective development responses. It discusses how best to promote a resilience-based development approach. It recognizes that many development initiatives that have been implemented or that still need to be implemented under the normative framework of the GCR and the Comprehensive Refugee Response Framework (CRRF), are subject to a multi-year planning and implementation cycle.” Building Blocks and Challenges for theImplementation of the Global Compacton Refugees in Africa. Sergio Carciotto (University of the Western Cape, South Africa) and Filippo Ferraro (Scalabrini Institute for Human Mobility in Africa). Journal on Migration and Human Security. March 2020.

“Concerns about systemic cruelty and arbitrariness in Australia’s immigration detention system raised with two United Nations bodies ahead of their visits to Australia”. The implementation of OPCAT in Australia. The Australia OPCAT Network. January 2020.

“This report, based on fieldwork and in-depth research on immigration and immigrant integration policies in Latin American 11 countries; Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Guyana, Mexico, Peru, Trinidad and Tobago, and Uruguay, yields several conclusions about the changing policy context in the region”. An Uneven Welcome, Latin American and Caribbean Responses to Venezuelan and Nicaraguan Migration. Andrew Selee, Jessica Bolter, Migration Policy Institute. February 2020.

“The proliferation of armed groups and the expanding footprint of jihadist groups fuelled violence in Burkina Faso in 2019. The government should adopt a more integrated approach to security and tackle the crisis in rural areas by resolving land disputes.” Burkina Faso: Stopping the Spiral of Violence. Report no. 287 - Africa section, International Crisis Group. 24 February 2020.

“Temporary Protected Status (TPS) became part of the US protection regime in 1990 to expand protection beyond what had been available under the US Refugee Act of 1980, which had limited asylum to those who met the refugee definition from the United Nations’ 1951 Refugee Convention. The TPS statute authorized the attorney general to designate foreign countries for TPS based on armed conflict, environmental disasters, and other extraordinary and temporary conditions that prevent designated nationals from returning in safety. While providing blanket protection that very likely has saved lives, TPS has nonetheless proven to be a blunt instrument that has frustrated advocates on both sides of the larger immigration debate.” What’s Wrong with Temporary Protected Status and How to Fix It: Exploring a Complementary Protection Regime. Bill Frelick, Human Rights Watch. 26 February 2020.

“Over 6000 men, women and children fled to Tinatown and Karnoi locality in North Darfur due to fighting between different groups of the Zaghwa tribe on the other side of the border, in Tina, Chad. In addition, some 2,300 people were displaced from Chad into the Jebel Moon area in West Darfur. UNHCR, the UN Refugee Agency and partners are providing urgently needed assistance while an assessment of the evolving situation is underway”. Intracommunal conflict in Chad pushes some 8,300 people into Darfur –and counting. Sudan Flash Update, UNHCR. 24 February 2020.

“This Annual Report on the Protection of Civilians in Armed Conflict in Afghanistan documents the plight of civilians in the Afghan conflict during the past year, and makes recommendations to all parties concerned for reducing civilian casualties. With more than 100,000 civilians killed and injured since the United Nations began systematic documentation of civilian casualties in 2009, the time is long overdue to put an end to the human misery and the tragedy.” Afghanistan: Protection of Civilians in Armed Conflict 2019. UN Assistance Mission in Afghanistan & UN Human Rights Office of the High Commissioner. February 2020.

“The role of international organisations in international lawmaking tends to be downplayed in this largely State-centric world. The practice of UNHCR, however, is reason enough for a more sophisticated appreciation of the role that operational entities can play in stimulating State practice, and of how they may interact with and guide domestic courts in treaty interpretation and application”. The Office of the United Nations High Commissioner for Refugees and the sources of International Law. Guy S. Goodwin-Gill, Cambridge University Press for the British Institute of International and Comparative Law. January 2020.

“This report is part of the Asylum Information Database (AIDA), funded by the European Programme for Integration and Migration (EPIM), a collaborative initiative by the Network of European Foundations, and the European Union’s Asylum, Migration and Integration Fund (AMIF). Country Report: United Kingdom. The Asylum Information Database (AIDA), coordinated by the European Council on Refugees and Exiles (ECRE). 19 March 2020.

“In my capacity as United Nations Special Rapporteur on the human rights of internally displaced persons (IDPs), I have had the honour to carry out an official visit to Iraq from 15 to 23 February 2020 at the invitation of the Government of the Republic of Iraq. My visit followed those of my predecessors Chaloka Beyani in 2015 and Walter Kaelin in 2010.” End of Mission Statement by the United Nations Special Rapporteur on the human rights of internally displaced persons, Ms. Cecilia Jimenez-Damary, upon conclusion of her official visit to Iraq – 15 to 23 February 2020. United Nations Human Rights Office of the High Commissioner. March 2020.

“This report on Labour-related experiences of migrants and refugees in South Africa is part of the project “The Future of Work, Labour After Laudato Sì", a global initiative the connects Catholic-inspired and other faith-based organizations in order to help promote and implement Pope Francis’ encyclical in areas related to work. The initiative brings together international, regional, state and local actors to improve global governance and lift up best practices on these issues.” Labour-related experiences of migrants and refugees in South Africa. Marinda Weiderman, Scalabrini Institute for Human Mobility in Africa. 16 March 2020.

“Children, women, older people, men, youth, people living with disabilities and people from marginalised groups all experience internal displacement differently. This thematic series investigates the various ways in which people’s lives can be affected in relation with their pre-existing characteristics”. Women and Girls in Internal Displacement. IDMC, IMPACT and Plan International. Thematic Series ‘Hidden in Plain Sight’. March 2020.

“This report is written for policymakers and practitioners who work in the fields of criminal policy, crime prevention, asylum and migration policy as well as integration. We hope that the empirical evidence we present will lead you to take concrete steps and make structural and legal changes to improve the position of refugee women who have experienced gender-based violence. We will present concrete recommendations on how to achieve this at the end of this report. We are looking forward to a dialogue with our readers.” Unseen Victims: Why refugee women Victims of Gender-Based Violence Do Not Receive Assistance in the EU. Inka Lilja, Elina Kervinen, Anni Lietonen, Natalia Ollus, Minna Viuhko, Anniina Jokinen, European Institute for Crime Prevention and Control, affiliated with the United Nations. 

“This statement has been drafted in consultation with, and is delivered on behalf of, a wide range of NGOs, particularly those working in the Asia Pacific region. It reflects the diversity of views within the NGO community. In most countries of the Asia Pacific region, NGOs remain deeply concerned by the overall lack of protection for asylum seekers, refugees, Internally Displaced Persons (IDPs), stateless persons and other people in need of protection, and the absence of legal protection frameworks at national level.” NGO statement on Asia and the Pacific. Executive Committee of the High Commissioner’s Programme Standing Committee 77th Meeting. 10-12 March 2020.

“On 10 February 2020, the Council of Europe published a new study on Gender-based asylum claims and non-refoulement: Articles 60 and 61 of the Istanbul Convention. The purpose of the publication is to support the implementation of these articles by providing policy makers, border and immigration officials and practitioners with practical advice including definitions, information and examples of gender-based violence that may be recognised as forms of persecution or other serious harm. It also illustrates how to ensure that a gender-sensitive interpretation is given to each of the convention grounds, what are the requirements of gender-sensitive reception procedures and gender-sensitive practice and procedure in respect of refugee status determination, and applications for other forms of international protection. It discusses the additional protection of the non-refoulement principle and concludes with a checklist which summarises the requirements of the provisions affecting asylum-seeking and refugee women in Articles 60 and 61 of the Istanbul Convention.” Gender-based asylum claims and non-refoulement: Articles 60 and 61 of the Istanbul Convention. Louise Hooper, Barrister for the Council of Europe. 10 February 2020.

“Drawing on qualitative interviews that are complemented by the analysis of government policy documents, this study examines statelessness in Ghana. It addresses a range of policy, legal, institutional, administrative, and other politico-socio economic matters attendant to the concept. The study defines statelessness in its strict legal sense. It recognizes populations at risk of statelessness that may be restricted from benefiting from the protection and privileges of their host state. Persons identified by the study as stateless or at risk of statelessness include persons from traditionally nomadic migratory communities, former refugees, persons residing in border communities, members of Zongo communities, trafficked persons, and those affected by gaps in previous constitutions. The study also identifies the consequences of statelessness, including lack of access to healthcare, education, justice, and work. The study offers several recommendations to prevent and reduce statelessness in Ghana.” Statelessness in West Africa: An Assessment of Stateless Populations and Legal, Policy, and Administrative Frameworks in Ghana. Raymond A. Atuguba (Harvard Law School and University of Ghana School of Law), Francis Xavier Dery Tuokuu (Keene State College), Vitus Gbang (Central University). Journal on Migration and Human Security. 2020.

“This study informs programming and policies in relation to refugee returns and, specifically, with regards to their (re)integration within urban areas, with a focus on Afghanistan, Somalia and Syria. While millions of refugees return to poverty, conflict and insecurity in all three settings, a tunnel focus on returns rather than on (re)integration has limited value for long-term planning. Stakeholders, including communities and returnees themselves, have been unprepared for what happens post-return”. Unprepared for (re)integration. Lessons learned from Afghanistan, Somalia and Syria on Refugee Returns to Urban Areas. Samuel Hall for the Danish Refugee Council in partnership with the International Rescue Committee, Norwegian Refugee Council, Regional Durable Solutions Secretariat, Durable Solutions Platform and Asia Displacement Solutions Platform. 3 February 2020.

“Lebanon is at a crossroads. Violence is rising, as is the use of excessive force against protestors and activists. The increasing drift toward repression threatens to further destabilize the country and undermine the situation of all people in Lebanon, including refugees. The current crisis has largely overshadowed the issue of Syrian refugees and pressures for their return. However, such a return will almost certainly be a priority for the new government. Despite its massive challenges, the crisis should serve as an opportunity to radically change Lebanon’s approach toward refugees and its most impoverished citizens.” Lebanon at a Crossroads: Growing Uncertainty for Syrian Refugees. Sahar Atrache, Refugees International. January 2020.

“This briefing paper looks at the UK's refugee resettlement schemes which are operated in partnership with the UNHCR. It also looks at the future of refugee resettlement in the United Kingdom.” Refugee Resettlement in the UK. House of Commons Library. 6 March 2020.

“The 2020-2021 Regional Refugee Response Plan for the DRC situation is covering the inter-agency response in the countries of asylum for Congolese refugees neighbouring the DRC: Angola, Burundi, Republic of the Congo, Rwanda, Tanzania, Uganda and Zambia. By the end of 2020, RRRP partners aim to provide life-saving humanitarian assistance and protection to 912,069 Congolese refugees.” The Democratic Republic of Congo Regional Refugee Response Plan (January 2020-December 2021). UNHCR. 5 March 2020.

“Since the Egyptian army forcibly removed Egypt’s first elected president, Mohamed Morsy, in 2013, the government of President Abdel Fattah al-Sisi has greenlighted a nationwide crackdown on protesters, dissidents, political opponents, independent journalists, and human rights defenders. Egypt’s security apparatus has arbitrarily arrested and prosecuted tens of thousands of persons. Human Rights Watch has found that torture crimes against detainees in Egypt are systematic, widespread and likely constitute crimes against humanity. The United Nations Committee against Torture found in June 2017 that that the facts “lead to the inescapable conclusion that torture is a systematic practice in Egypt.” “No One Cared He Was A Child”: Egyptian Security Forces’ Abuse of Children in Detention. Human Rights Watch. 23 March 2020.

[stephenmccull]

Five Years Later, HIV-Hit Town Rebounds. But The Nation Is Slow To Heed Lessons.

AUSTIN, Ind. — Ethan Howard cradled his prized Martin-brand guitar, strumming gently as he sang of happiness he thought he’d never find.

More From The Midwest Bureau

View More

With support from his family and community, the 26-year-old is making his way as a musician after emerging from the hell of addiction, disease and stigma. The former intravenous drug user was among the first of 235 people in this southern Indiana community to be diagnosed in the worst drug-fueled HIV outbreak ever to hit rural America.

Now, five years after the outbreak, Howard counts himself among the three-quarters of patients here whose HIV is so well controlled it’s undetectable, meaning they can’t spread it through sex. He’s sober in a place that has new addiction treatment centers, a syringe exchange and five times more addiction support groups than before the outbreak.

But as this city of 4,100 recovers, much of the rest of the country fails to apply its lessons. The Centers for Disease Control and Prevention deemed 220 U.S. counties vulnerable to similar outbreaks because of overdose death rates, the volume of prescription opioid sales and other statistics tied to injecting drugs. Yet a Kaiser Health News analysis shows that fewer than a third of them have working syringe exchanges. Such programs, which make clean needles available to drug users, have been found to reduce the spread of HIV and hepatitis C and are supported in the Trump administration’s national effort to end the HIV epidemic within a decade.

Still, local backlash often stymies efforts to start such exchanges, even in Indiana, where only nine of 92 counties have one, and with federal funding up for grabs that could help them expand. And rural places in states such as Missouri, West Virginia and Kentucky are still plagued by the raw ingredients that led to Austin’s tragedy: addiction, despair, poverty, doctor shortages and sparse drug treatment.

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All this threatens to stall the administration’s HIV goals, which are championed by two prominent figures who responded to Austin’s outbreak: Indiana’s former governor Vice President Mike Pence and the former state health commissioner, Dr. Jerome Adams, now the U.S. surgeon general.

Since Austin’s 2015 crisis, drug-fueled outbreaks have occurred in more than a half-dozen other communities, some with syringe exchanges and some without.

“When you have these outbreaks, they affect other states and counties. It’s a domino effect,” said Dr. Rupa Patel, an HIV prevention researcher at Washington University in St. Louis. “We have to learn from them. Once you fall behind, you can’t catch up.”

Hard Lessons In The Heartland

Fields of corn and soybeans surround Austin, located just off Interstate 65 between Louisville, Kentucky, and Indianapolis. The city has been battered by decades of economic blows, but it retains a quaint charm, with a shop-lined, one-stoplight Main Street.

Before the outbreak, addiction to the potent opioid painkiller Opana swept through the community. People took to melting down pills and injecting them, and needle-sharing was common. Local women were caught up in sex work to pay for drugs. In some homes nearby, health officials later discovered, three generations had shot up Opana together: young adults, their parents and grandparents.

Yet help was scarce. Austin had no addiction treatment centers and just one doctor. Dwindling government funding in 2013 led Planned Parenthood in nearby Scottsburg to close after years of providing HIV testing and education.

Howard was among the first of 235 people to be diagnosed in the worst drug-fueled HIV outbreak ever to hit rural America.(Luke Sharrett for Kaiser Health News)

So, for residents like Howard, addiction led to infection with HIV. After he was prescribed the painkiller Lortab for a football injury in high school, the teen began craving opioids. Eventually, he discovered Opana, which was plentiful on the streets of Austin and surrounding Scott County.

His mom sent him for addiction treatment during his senior year, and he got sober. But after his girlfriend gave birth to a stillborn boy in 2014, he turned back to drugs. He tested positive for HIV in March 2015. He cried with his mom in her car.

That was the month after Indiana health officials said they’d identified 30 HIV cases in the county, which previously reported three within a decade. Austin was the outbreak’s epicenter.

The initial response was slow. Pence, then governor, opposed syringe exchange programs, which were illegal in Indiana. It took him 29 days after the outbreak was announced to sign an executive order allowing a state-supervised syringe program. By then, HIV cases had risen to 79.

“He waited till it was too little, too late. These needle exchanges were put into place in the most grudging manner,” said Gregg Gonsalves, an HIV researcher at Yale University. “It was a disaster that didn’t need to happen.”

Five years after Indiana’s HIV outbreak, Howard counts himself among the three-quarters of patients whose HIV is so well controlled it’s undetectable, meaning they can’t spread it through sex.(Luke Sharrett for Kaiser Health News)

Gonsalves cited a recent Brown University study that found having a syringe exchange before the outbreak could have decreased HIV incidence there by 90%. A study he led, published in 2018, estimated that simply testing for and tracking HIV when hepatitis C spiked around 2010 could have kept HIV cases there below 10.

Instead, cases skyrocketed. The rate of infection was so high that Dr. Tom Frieden, then the CDC director, said at the time Austin’s HIV incidence rate exceeded those of countries in sub-Saharan Africa. He estimated lifetime treatment costs — even before all 235 people were diagnosed — would reach $100 million.

What ultimately curbed the outbreak were solutions rooted in the community. Scott County’s syringe exchange was part of a “one-stop shop,” where people could also get drug treatment referrals, free HIV testing and other services. More people were referred to Medicaid, which had recently been expanded in Indiana. Police, health and recovery workers, community activists and faith leaders joined forces.

“More connections are being made,” said Jacob Howell, a former drug user who is now pastor of the Church of the New Covenant in Austin. “The message to other communities is to tear down your walls, put your prejudices aside.”

Surgeon General Adams said lasting change happens locally. When he traveled to Austin as Indiana’s health commissioner, he listened to the sheriff’s concerns about needles littering public property and met with church leaders to ease worries that syringe programs might enable drug use.

Dealing with the outbreak was more about relationships than science, he said during a January talk at the CATO Institute, a Washington-based free-market think tank. “I knew we’d never be successful without ensuring that those trusted community leaders and advocates were invested in part of the solution.”

Lessons Learned — And Not

Austin’s outbreak became a catalyst for action in some places. Kentucky’s legislature voted to allow syringe programs in 2015, and Ohio subsequently made it easier for local health boards to develop them. Officials said that helped them respond to a cluster of HIV cases in the Cincinnati-Northern Kentucky area in 2018.

Cabell County, West Virginia, by contrast, recently pulled back on its preventive efforts.

Cabell was among counties that the CDC deemed vulnerable to an outbreak. Dr. Michael Kilkenny, physician director of the Cabell-Huntington Health Department, said Austin’s experience spurred his community to open a syringe program in September 2015 that eventually averaged between 1,000 and 1,200 visits a month.

In 2015, Austin, Indiana, was the epicenter of an HIV outbreak when 235 people tested positive for the virus.(Luke Sharrett for Kaiser Health News)

But after political backlash halted a program in nearby Charleston, Cabell imposed restrictions on its program in 2018 to stave off a similar closure. People could no longer pick up needles for others or use the exchange if they lived outside the county or the city of Huntington. Visits dropped by half.

Looking back, Kilkenny said it was “the worst time we could’ve done that.” Cabell wound up with more than 75 HIV cases, one of the biggest rural outbreaks other than the one in Austin, Indiana.

Officials then lifted the restrictions, scaled up efforts linking people to testing and treatment and launched an HIV anti-stigma campaign.

Other places on the CDC’s vulnerable counties list have so far escaped an outbreak. Missouri, for instance, has 13 vulnerable counties and a ban on syringe exchanges. Washington University’s Patel said Missouri’s failure to expand Medicaid leaves some at-risk people uninsured.

Missouri health officials said they are taking several steps to prevent HIV, such as counseling residents in vulnerable counties, providing HIV testing at health agencies and having disease intervention specialists connect people who are tested to additional help.

But legislation to allow syringe exchanges was unsuccessful in Missouri last year, as were similar bills in Iowa and Arizona.

Avoiding another HIV crisis is not rocket science, Gonsalves said. “We need to use everything we have that we know works.”

In Austin, that multipronged approach is underway as those affected reclaim their lives.

Howard is well enough that he can practice his music every day until his voice gets hoarse and his fingers hurt. He performs around the region and dreams of touring honky-tonks nationally. And he’s writing a song about moving through addiction and toward hope.

“I feel I’ve proven a lot of people wrong,” he said, fiddling with his guitar pick. “I’m making my grandpa happy and my grandma happy. They’re both in heaven now, but I know they’re proud of me.”

Five Years Later, HIV-Hit Town Rebounds. But The Nation Is Slow To Heed Lessons. published first on https://smartdrinkingweb.weebly.com/

[gordonwilliamsweb]

Five Years Later, HIV-Hit Town Rebounds. But The Nation Is Slow To Heed Lessons.

AUSTIN, Ind. — Ethan Howard cradled his prized Martin-brand guitar, strumming gently as he sang of happiness he thought he’d never find.

More From The Midwest Bureau

View More

With support from his family and community, the 26-year-old is making his way as a musician after emerging from the hell of addiction, disease and stigma. The former intravenous drug user was among the first of 235 people in this southern Indiana community to be diagnosed in the worst drug-fueled HIV outbreak ever to hit rural America.

Now, five years after the outbreak, Howard counts himself among the three-quarters of patients here whose HIV is so well controlled it’s undetectable, meaning they can’t spread it through sex. He’s sober in a place that has new addiction treatment centers, a syringe exchange and five times more addiction support groups than before the outbreak.

But as this city of 4,100 recovers, much of the rest of the country fails to apply its lessons. The Centers for Disease Control and Prevention deemed 220 U.S. counties vulnerable to similar outbreaks because of overdose death rates, the volume of prescription opioid sales and other statistics tied to injecting drugs. Yet a Kaiser Health News analysis shows that fewer than a third of them have working syringe exchanges. Such programs, which make clean needles available to drug users, have been found to reduce the spread of HIV and hepatitis C and are supported in the Trump administration’s national effort to end the HIV epidemic within a decade.

Still, local backlash often stymies efforts to start such exchanges, even in Indiana, where only nine of 92 counties have one, and with federal funding up for grabs that could help them expand. And rural places in states such as Missouri, West Virginia and Kentucky are still plagued by the raw ingredients that led to Austin’s tragedy: addiction, despair, poverty, doctor shortages and sparse drug treatment.

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Subscribe to KHN’s free Morning Briefing.

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Please confirm your email address below:

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All this threatens to stall the administration’s HIV goals, which are championed by two prominent figures who responded to Austin’s outbreak: Indiana’s former governor Vice President Mike Pence and the former state health commissioner, Dr. Jerome Adams, now the U.S. surgeon general.

Since Austin’s 2015 crisis, drug-fueled outbreaks have occurred in more than a half-dozen other communities, some with syringe exchanges and some without.

“When you have these outbreaks, they affect other states and counties. It’s a domino effect,” said Dr. Rupa Patel, an HIV prevention researcher at Washington University in St. Louis. “We have to learn from them. Once you fall behind, you can’t catch up.”

Hard Lessons In The Heartland

Fields of corn and soybeans surround Austin, located just off Interstate 65 between Louisville, Kentucky, and Indianapolis. The city has been battered by decades of economic blows, but it retains a quaint charm, with a shop-lined, one-stoplight Main Street.

Before the outbreak, addiction to the potent opioid painkiller Opana swept through the community. People took to melting down pills and injecting them, and needle-sharing was common. Local women were caught up in sex work to pay for drugs. In some homes nearby, health officials later discovered, three generations had shot up Opana together: young adults, their parents and grandparents.

Yet help was scarce. Austin had no addiction treatment centers and just one doctor. Dwindling government funding in 2013 led Planned Parenthood in nearby Scottsburg to close after years of providing HIV testing and education.

Howard was among the first of 235 people to be diagnosed in the worst drug-fueled HIV outbreak ever to hit rural America.(Luke Sharrett for Kaiser Health News)

So, for residents like Howard, addiction led to infection with HIV. After he was prescribed the painkiller Lortab for a football injury in high school, the teen began craving opioids. Eventually, he discovered Opana, which was plentiful on the streets of Austin and surrounding Scott County.

His mom sent him for addiction treatment during his senior year, and he got sober. But after his girlfriend gave birth to a stillborn boy in 2014, he turned back to drugs. He tested positive for HIV in March 2015. He cried with his mom in her car.

That was the month after Indiana health officials said they’d identified 30 HIV cases in the county, which previously reported three within a decade. Austin was the outbreak’s epicenter.

The initial response was slow. Pence, then governor, opposed syringe exchange programs, which were illegal in Indiana. It took him 29 days after the outbreak was announced to sign an executive order allowing a state-supervised syringe program. By then, HIV cases had risen to 79.

“He waited till it was too little, too late. These needle exchanges were put into place in the most grudging manner,” said Gregg Gonsalves, an HIV researcher at Yale University. “It was a disaster that didn’t need to happen.”

Five years after Indiana’s HIV outbreak, Howard counts himself among the three-quarters of patients whose HIV is so well controlled it’s undetectable, meaning they can’t spread it through sex.(Luke Sharrett for Kaiser Health News)

Gonsalves cited a recent Brown University study that found having a syringe exchange before the outbreak could have decreased HIV incidence there by 90%. A study he led, published in 2018, estimated that simply testing for and tracking HIV when hepatitis C spiked around 2010 could have kept HIV cases there below 10.

Instead, cases skyrocketed. The rate of infection was so high that Dr. Tom Frieden, then the CDC director, said at the time Austin’s HIV incidence rate exceeded those of countries in sub-Saharan Africa. He estimated lifetime treatment costs — even before all 235 people were diagnosed — would reach $100 million.

What ultimately curbed the outbreak were solutions rooted in the community. Scott County’s syringe exchange was part of a “one-stop shop,” where people could also get drug treatment referrals, free HIV testing and other services. More people were referred to Medicaid, which had recently been expanded in Indiana. Police, health and recovery workers, community activists and faith leaders joined forces.

“More connections are being made,” said Jacob Howell, a former drug user who is now pastor of the Church of the New Covenant in Austin. “The message to other communities is to tear down your walls, put your prejudices aside.”

Surgeon General Adams said lasting change happens locally. When he traveled to Austin as Indiana’s health commissioner, he listened to the sheriff’s concerns about needles littering public property and met with church leaders to ease worries that syringe programs might enable drug use.

Dealing with the outbreak was more about relationships than science, he said during a January talk at the CATO Institute, a Washington-based free-market think tank. “I knew we’d never be successful without ensuring that those trusted community leaders and advocates were invested in part of the solution.”

Lessons Learned — And Not

Austin’s outbreak became a catalyst for action in some places. Kentucky’s legislature voted to allow syringe programs in 2015, and Ohio subsequently made it easier for local health boards to develop them. Officials said that helped them respond to a cluster of HIV cases in the Cincinnati-Northern Kentucky area in 2018.

Cabell County, West Virginia, by contrast, recently pulled back on its preventive efforts.

Cabell was among counties that the CDC deemed vulnerable to an outbreak. Dr. Michael Kilkenny, physician director of the Cabell-Huntington Health Department, said Austin’s experience spurred his community to open a syringe program in September 2015 that eventually averaged between 1,000 and 1,200 visits a month.

In 2015, Austin, Indiana, was the epicenter of an HIV outbreak when 235 people tested positive for the virus.(Luke Sharrett for Kaiser Health News)

But after political backlash halted a program in nearby Charleston, Cabell imposed restrictions on its program in 2018 to stave off a similar closure. People could no longer pick up needles for others or use the exchange if they lived outside the county or the city of Huntington. Visits dropped by half.

Looking back, Kilkenny said it was “the worst time we could’ve done that.” Cabell wound up with more than 75 HIV cases, one of the biggest rural outbreaks other than the one in Austin, Indiana.

Officials then lifted the restrictions, scaled up efforts linking people to testing and treatment and launched an HIV anti-stigma campaign.

Other places on the CDC’s vulnerable counties list have so far escaped an outbreak. Missouri, for instance, has 13 vulnerable counties and a ban on syringe exchanges. Washington University’s Patel said Missouri’s failure to expand Medicaid leaves some at-risk people uninsured.

Missouri health officials said they are taking several steps to prevent HIV, such as counseling residents in vulnerable counties, providing HIV testing at health agencies and having disease intervention specialists connect people who are tested to additional help.

But legislation to allow syringe exchanges was unsuccessful in Missouri last year, as were similar bills in Iowa and Arizona.

Avoiding another HIV crisis is not rocket science, Gonsalves said. “We need to use everything we have that we know works.”

In Austin, that multipronged approach is underway as those affected reclaim their lives.

Howard is well enough that he can practice his music every day until his voice gets hoarse and his fingers hurt. He performs around the region and dreams of touring honky-tonks nationally. And he’s writing a song about moving through addiction and toward hope.

“I feel I’ve proven a lot of people wrong,” he said, fiddling with his guitar pick. “I’m making my grandpa happy and my grandma happy. They’re both in heaven now, but I know they’re proud of me.”

Five Years Later, HIV-Hit Town Rebounds. But The Nation Is Slow To Heed Lessons. published first on https://nootropicspowdersupplier.tumblr.com/

[dinafbrownil]

Five Years Later, HIV-Hit Town Rebounds. But The Nation Is Slow To Heed Lessons.

AUSTIN, Ind. — Ethan Howard cradled his prized Martin-brand guitar, strumming gently as he sang of happiness he thought he’d never find.

More From The Midwest Bureau

View More

With support from his family and community, the 26-year-old is making his way as a musician after emerging from the hell of addiction, disease and stigma. The former intravenous drug user was among the first of 235 people in this southern Indiana community to be diagnosed in the worst drug-fueled HIV outbreak ever to hit rural America.

Now, five years after the outbreak, Howard counts himself among the three-quarters of patients here whose HIV is so well controlled it’s undetectable, meaning they can’t spread it through sex. He’s sober in a place that has new addiction treatment centers, a syringe exchange and five times more addiction support groups than before the outbreak.

But as this city of 4,100 recovers, much of the rest of the country fails to apply its lessons. The Centers for Disease Control and Prevention deemed 220 U.S. counties vulnerable to similar outbreaks because of overdose death rates, the volume of prescription opioid sales and other statistics tied to injecting drugs. Yet a Kaiser Health News analysis shows that fewer than a third of them have working syringe exchanges. Such programs, which make clean needles available to drug users, have been found to reduce the spread of HIV and hepatitis C and are supported in the Trump administration’s national effort to end the HIV epidemic within a decade.

Still, local backlash often stymies efforts to start such exchanges, even in Indiana, where only nine of 92 counties have one, and with federal funding up for grabs that could help them expand. And rural places in states such as Missouri, West Virginia and Kentucky are still plagued by the raw ingredients that led to Austin’s tragedy: addiction, despair, poverty, doctor shortages and sparse drug treatment.

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Sign Up

Please confirm your email address below:

Sign Up

All this threatens to stall the administration’s HIV goals, which are championed by two prominent figures who responded to Austin’s outbreak: Indiana’s former governor Vice President Mike Pence and the former state health commissioner, Dr. Jerome Adams, now the U.S. surgeon general.

Since Austin’s 2015 crisis, drug-fueled outbreaks have occurred in more than a half-dozen other communities, some with syringe exchanges and some without.

“When you have these outbreaks, they affect other states and counties. It’s a domino effect,” said Dr. Rupa Patel, an HIV prevention researcher at Washington University in St. Louis. “We have to learn from them. Once you fall behind, you can’t catch up.”

Hard Lessons In The Heartland

Fields of corn and soybeans surround Austin, located just off Interstate 65 between Louisville, Kentucky, and Indianapolis. The city has been battered by decades of economic blows, but it retains a quaint charm, with a shop-lined, one-stoplight Main Street.

Before the outbreak, addiction to the potent opioid painkiller Opana swept through the community. People took to melting down pills and injecting them, and needle-sharing was common. Local women were caught up in sex work to pay for drugs. In some homes nearby, health officials later discovered, three generations had shot up Opana together: young adults, their parents and grandparents.

Yet help was scarce. Austin had no addiction treatment centers and just one doctor. Dwindling government funding in 2013 led Planned Parenthood in nearby Scottsburg to close after years of providing HIV testing and education.

Howard was among the first of 235 people to be diagnosed in the worst drug-fueled HIV outbreak ever to hit rural America.(Luke Sharrett for Kaiser Health News)

So, for residents like Howard, addiction led to infection with HIV. After he was prescribed the painkiller Lortab for a football injury in high school, the teen began craving opioids. Eventually, he discovered Opana, which was plentiful on the streets of Austin and surrounding Scott County.

His mom sent him for addiction treatment during his senior year, and he got sober. But after his girlfriend gave birth to a stillborn boy in 2014, he turned back to drugs. He tested positive for HIV in March 2015. He cried with his mom in her car.

That was the month after Indiana health officials said they’d identified 30 HIV cases in the county, which previously reported three within a decade. Austin was the outbreak’s epicenter.

The initial response was slow. Pence, then governor, opposed syringe exchange programs, which were illegal in Indiana. It took him 29 days after the outbreak was announced to sign an executive order allowing a state-supervised syringe program. By then, HIV cases had risen to 79.

“He waited till it was too little, too late. These needle exchanges were put into place in the most grudging manner,” said Gregg Gonsalves, an HIV researcher at Yale University. “It was a disaster that didn’t need to happen.”

Five years after Indiana’s HIV outbreak, Howard counts himself among the three-quarters of patients whose HIV is so well controlled it’s undetectable, meaning they can’t spread it through sex.(Luke Sharrett for Kaiser Health News)

Gonsalves cited a recent Brown University study that found having a syringe exchange before the outbreak could have decreased HIV incidence there by 90%. A study he led, published in 2018, estimated that simply testing for and tracking HIV when hepatitis C spiked around 2010 could have kept HIV cases there below 10.

Instead, cases skyrocketed. The rate of infection was so high that Dr. Tom Frieden, then the CDC director, said at the time Austin’s HIV incidence rate exceeded those of countries in sub-Saharan Africa. He estimated lifetime treatment costs — even before all 235 people were diagnosed — would reach $100 million.

What ultimately curbed the outbreak were solutions rooted in the community. Scott County’s syringe exchange was part of a “one-stop shop,” where people could also get drug treatment referrals, free HIV testing and other services. More people were referred to Medicaid, which had recently been expanded in Indiana. Police, health and recovery workers, community activists and faith leaders joined forces.

“More connections are being made,” said Jacob Howell, a former drug user who is now pastor of the Church of the New Covenant in Austin. “The message to other communities is to tear down your walls, put your prejudices aside.”

Surgeon General Adams said lasting change happens locally. When he traveled to Austin as Indiana’s health commissioner, he listened to the sheriff’s concerns about needles littering public property and met with church leaders to ease worries that syringe programs might enable drug use.

Dealing with the outbreak was more about relationships than science, he said during a January talk at the CATO Institute, a Washington-based free-market think tank. “I knew we’d never be successful without ensuring that those trusted community leaders and advocates were invested in part of the solution.”

Lessons Learned — And Not

Austin’s outbreak became a catalyst for action in some places. Kentucky’s legislature voted to allow syringe programs in 2015, and Ohio subsequently made it easier for local health boards to develop them. Officials said that helped them respond to a cluster of HIV cases in the Cincinnati-Northern Kentucky area in 2018.

Cabell County, West Virginia, by contrast, recently pulled back on its preventive efforts.

Cabell was among counties that the CDC deemed vulnerable to an outbreak. Dr. Michael Kilkenny, physician director of the Cabell-Huntington Health Department, said Austin’s experience spurred his community to open a syringe program in September 2015 that eventually averaged between 1,000 and 1,200 visits a month.

In 2015, Austin, Indiana, was the epicenter of an HIV outbreak when 235 people tested positive for the virus.(Luke Sharrett for Kaiser Health News)

But after political backlash halted a program in nearby Charleston, Cabell imposed restrictions on its program in 2018 to stave off a similar closure. People could no longer pick up needles for others or use the exchange if they lived outside the county or the city of Huntington. Visits dropped by half.

Looking back, Kilkenny said it was “the worst time we could’ve done that.” Cabell wound up with more than 75 HIV cases, one of the biggest rural outbreaks other than the one in Austin, Indiana.

Officials then lifted the restrictions, scaled up efforts linking people to testing and treatment and launched an HIV anti-stigma campaign.

Other places on the CDC’s vulnerable counties list have so far escaped an outbreak. Missouri, for instance, has 13 vulnerable counties and a ban on syringe exchanges. Washington University’s Patel said Missouri’s failure to expand Medicaid leaves some at-risk people uninsured.

Missouri health officials said they are taking several steps to prevent HIV, such as counseling residents in vulnerable counties, providing HIV testing at health agencies and having disease intervention specialists connect people who are tested to additional help.

But legislation to allow syringe exchanges was unsuccessful in Missouri last year, as were similar bills in Iowa and Arizona.

Avoiding another HIV crisis is not rocket science, Gonsalves said. “We need to use everything we have that we know works.”

In Austin, that multipronged approach is underway as those affected reclaim their lives.

Howard is well enough that he can practice his music every day until his voice gets hoarse and his fingers hurt. He performs around the region and dreams of touring honky-tonks nationally. And he’s writing a song about moving through addiction and toward hope.

“I feel I’ve proven a lot of people wrong,” he said, fiddling with his guitar pick. “I’m making my grandpa happy and my grandma happy. They’re both in heaven now, but I know they’re proud of me.”

from Updates By Dina https://khn.org/news/five-years-later-hiv-hit-town-rebounds-but-the-nation-is-slow-to-heed-lessons/