International Health
Section Newsletter
Fall 2010



--Greetings from the Chair

--From the Editor

--Reports from Membership Committees and Working Groups

--World Breastfeeding Week

--The Importance of Evaluation

--Integrated Health Strategy in Border Colonias of Texas

--Stories from the Field


--Other Information

--Access to 2010 Leadership

CHAIR: Miriam H Labbok, MD, MPH
Telephone: (919) 966-0928; Fax: (919) 966-0458;


EDITOR: Josefa Ippolito-Shepherd, PhD

Telephone: (202) 363-2369; 



Dear Colleagues:

As this is my last missive to you as chair, I am pleased to note the extraordinary work of our Section over the last years, and my belief that it will continue with Malcolm Bryant as chair. We have seen the strengthening of committees, including the recognition by the executive director of the work of our Global Health Committee, work led by Gopal, the recognition by executive staff of the Policy and Advocacy Committee, work led by Jirair and Amy before him. Our Program continues to be outstanding thanks to Omar and Mike. Further, we have made real progress together on a strategic plan, which will be presented for consideration to the leadership at the Annual Meeting and will be shared for comments by the membership over the next year.  In addition, there has been a very positive response to our e-mails to all membership asking for their input; this has increased inquiries, as have the other electronic efforts, including the website, blog, newsletter, and other outreach to increase involvement and to ensure that members feel more a part of the Section, as we, more than most, are scattered around the globe. We are launching a new Committee on MCHN and consolidating others, while our strong Community-based Primary Health Committee continues its extraordinary work. Finally, while all Sections are losing members, we are holding strong in comparison, thanks to our dedicated Membership Committee and related efforts.


Please allow me this opportunity to thank you, one and all, for your ongoing efforts to keep the International Health Section the outstanding organization that it is, and for your enthusiasm for Health for All.



--Miriam Labbok, MD, MPH, Chair IH Section, Telephone: (919) 966-0928; Fax: (919) 966-0458;



It is again a pleasure to present the Fall Issue of the APHA-IH Section Newsletter.


We hope you enjoy reading the materials contained in this issue and that in doing so you consider authoring or co-authoring future pieces for inclusion in the Spring Issue of the Newsletter. We do encourage you to write about your ideas and especially about your international and global health experiences, which will certainly enrich us all, both at the professional and personal levels.


The APHA-IH Section Newsletter is a great platform to present our experiences addressing and tackling international and global health issues, as well as to present innovative ideas to better the health and quality of life worldwide.


The IH Section Newsletter is published twice a year.  The deadline for the Spring Issue is April 15 and for the Fall Issue is Aug. 15. Submissions should be about 400 words, to be presented as Verdana, Font Size 10. You are invited and strongly encouraged to submit material for inclusion in the next issues of the Newsletter. Most submissions are included as presented, except for minor editing.


Opinions, views, and information published represent the authors and not necessarily APHA or the IH Section or the Editor.

--Josefa Ippolito-Shepherd, PhD, Editor, APHA-IH Section Newsletter, (202) 363-2369,




Note from the Editor: Detailed description, accomplishments, and future work plans for each of the Membership Committees and Working Groups that have been presented in earlier issues of the APHA-IH Section Newsletters are not repeated here. Only new information is included in this issue. Readers are encouraged to read earlier issues of the Newsletter at:

--Josefa Ippolito-Shepherd, PhD, Editor APHA-IH Section Newsletter, (202) 363-2369,



Chair: Paul Freeman,

Assistant-Chair: Padmini (Mini) Murthy, 

Members:  H. Azzam, T. Baker, G. Berggren, M. Bryant, E. Coates, M. Forzley, N. Pielemeier, W. Reinke, G. Sankaran, R. Schneider, L. Smith, C. Swezy


Each year, the International Health Section of APHA recognizes outstanding contributions of its members through several awards. The 2010 year awardees, to be presented at the 2010 Annual Meeting, are:


  • Carl Taylor Lifetime Achievement Award in International Health: Dr. Dory Storms
  • Mid-Career Award in International Health: Dr. Matthew R. Anderson
  • Distinguished Section Service Awards: Dr. Josefa Ippolito-Shepherd and Dr. Jirair Ratevosian
  • Certificate of Recognition for their Dedicated Service in Support of the International Health Section: Morgan Taylor & Vina Hulamm
  • Gordon-Wyon Award: Dr. Rajanikant Arole
  • Posthumous Gordon Wyon Award from the Community Based Primary Health Care Working Group: Dr. Carl Taylor
  • Student Award: To be determined

--Paul Freeman,




See piece on Integrated Health Strategy in Border Colonias of Texas, presented below. 

--Josefa Ippolito-Shepherd, PhD, Public Health Scientist,



Chair: Paul Freeman,

Co-Chair: Malcolm Bryant,  

Past Chair: Henry Perry

Secretary: Yana Sigal

Listserv Administrator: K. Chitnis

Members: T.Hall, I. Aitken, R. Martin, L. Altobelli, J.  Capps, A Hershberger, S. Hoar, E. Kleinau,

S Lamstein, R Mataya, J Mouch, E. Peca, S. Ruiz, Williams, P.Ulrich, C. Teller, T.Reichel,  J.Mukair, J.Dettinger, D.Barry, C.McLaughlin.  We also have many additional members through our List server.

Other Executive Members: Emily Lavallo, Monica Dyer

Ketan Chitnis (List Server Administrator), H. Perry (Past Chair)

Connie Gates (Administrator of learning resources for CBPHC)



Chair: Gopal Sankaran (, (610) 436-2300

Co-chairs: Hala Azzam ( and Padmini Murthy (
Members: The list is extensive and is available from the chair


Goal 1:  Continue to promote collaboration between IH Section and other Sections, SPIGs, Caucuses, Forums and Student Assembly within APHA


Overseas attendees at the GHCC Business Meeting last year requested that an Expertise Directory be created.  The directory would allow for collaborations to be initiated and nurtured.  APHA too is interested in developing such a directory.  A new working group, Global Health Expertise Directory (GHED), has been formed and is chaired by Jaya Prakash ( Other members are: Jessica Keralis, Sameena Eksambi, Silvia M. Trigoso, Vina HuLamm and Gopal Sankaran. Please join us as we move further with this new initiative.  Contact Jaya Prakash for details.


Goal 2:  Promote collaboration between IH Section and State Affiliates within APHA


This is another new initiative for GHCC. Invitations to appoint Liaisons to GHCC were sent out to chairs of APHA state affiliates. Some of the state affiliates have already appointed liaisons including student members. The new liaisons are now automatically members of GHCC!


Goal 3:  Collaborate with other units within APHA to facilitate joint sessions at the Annual   Meeting


All requests to GHCC for collaboration were channeled to the Program Committee.  During conference calls, the opportunities for joint collaboration are included to raise awareness and facilitate action.


Goal 4:  Continue to keep GHCC members stay connected


Bimonthly conference calls continue. Minutes from the conference calls are circulated to members and posted on the IH Section website.  Note our last conference call before the Annual Meeting. 

Wednesday, Nov. 3         Noon-1:00 p.m.   (East Coast Time)


Connect by calling (719) 867-7624 (Code: 373785).  Please note that this is not a toll-free number.


Goal 5:  Continue to host the International Welcome Desk at the Annual Meeting


Georges Benjamin, executive director of APHA, has kindly agreed to continue having the Welcome Booth and the special ribbon at this year’s Annual Meeting in Denver.  We will require numerous volunteers to staff and greet our overseas members, and we look forward to having your continued support!  Contact Padmini Murthy ( with dates and times when you can volunteer.


GHCC Business Meeting at APHA Annual Meeting

Sunday, Nov. 7, from 11 a.m. to noon at the APHA Annual Meeting in Denver (Venue – TBA).  Please attend.


Reduced registration fee for overseas attendees

GHCC continues to advocate for reduced registration fee for the Annual Meeting for overseas attendees from resource poor nations.  Georges Benjamin is cognizant of our request, but is unable to act on it due to the downturn in economy.

--Gopal Sankaran,, (610) 436-2300



Chair: Rose Schneider,

Co-Chair: Alison Gernand,

Member: Curtiss Swezy



Chair: Mary Anne Mercer

Members: A. Hagopian, M. Fort, S Shannon, M. Labbok, C. Prophete

IH Section Election returns are in!


Congratulations to the newly elected officers for the International Health Section.  They will assume their positions at the end of this fall’s meeting in Denver.  The new officers are:



§  Paul Freeman DrPH, MBBS, MHP, MPH

Section Councilors

§  Gonzalo Bacigalupe, EdD, MPH

§  Christine Tronson Benner, MPH, BA

Governing Councilors

§  Elvira Beracochea, MPH, MD

§  James Pfeiffer, PhD, MPH

§  Maggie Huff-Rousselle, PhD, MBA, MA

§  Gopal Sankaran,  DrPH, MD, MNAMS, CHES

§  Josefa Ippolito-Shepherd, PhD, MA, BA


Best wishes to those who were willing to run for office, and we look forward to working with all of you in the coming years.

--Mary Anne Mercer, Nominations Chair,

--Miriam Labbok, Section Chair,




Chair: Maggie Huff-Rousselle,
Vice-Chair: Annette De Mattos,

--Maggie Huff-Rousselle,

--Annette De Mattos,



Chair: Jirair Ratevosian,



Chair: Omar Khan,

Co-Chair: Mike Bailey,

Committee Members:

Carlos Castillo-Salgado,

Elvira Berocachea,

Malcolm Bryant,  

Josefa Ippolito-Shepherd,

Dory Storms,

We received 407 abstracts for review.

Our program comprises:

  • Nine poster sessions (10 posters each = 90 posters)
  • Forty-one paper sessions (4-5 papers each = approx. 175 papers)

·         IH Business meetings, two sub-group working group meetings, one workshop, one social, one lunch

·         IH film festival (usually three full sessions)


All sessions are staffed, and many IH Section leaders and members have stepped up tremendously to help chair sessions. We hope to provide a high-quality program, which would be impossible without the joint efforts of many in the Section.

--Omar Khan & Mike Bailey,


Note from the Editor: For the most updated IH program please see:


Saturday, Nov. 6, 2010

Saturday | Sunday | Monday | Tuesday | Wednesday | top

8:30 a.m.-5:00 p.m.



Workshop on Community-Based Primary Health Care


Sunday, Nov. 7, 2010

Saturday | Sunday | Monday | Tuesday | Wednesday | top

11:00 a.m.-12:00 p.m.



Global Health Connections Business Meeting (Gopal Sankaran)

2:00 p.m.-4:00 p.m.



International Health Business Meeting 1

4:30 p.m.-5:30 p.m.



Poster Session 1: Innovations in International Health


Monday, Nov. 8, 2010

Saturday | Sunday | Monday | Tuesday | Wednesday | top

6:30 a.m.-8:00 a.m.



International Health Business Meeting 2

8:30 a.m.-10:00 a.m.



Health Workers in Conflict: The Role of Health Workers in Conflict and Post-Conflict Settings



Gedenkschrift for Carl Taylor: His Contributions to Social Justice through the Promotion of Primary Health Care



Monitoring, Evaluation, and Quality Improvement



Nutrition and Malnutrition

10:30 a.m.-12:00 p.m.



The Right to Development and the Millennium Development Goals



Advocacy in Action: Mobilizing an International Public Health Campaign



International Association of National Public Health Institutes (IANPHI) : Lessons Learned



Social Justice in Health and Health Care Delivery: International Perspectives



International Perspectives in Occupational and Environmental Health (organized by IH, OH and ENV Sections)

12:30 p.m.-1:30 p.m.



International Human Rights Committee Student Poster Session

12:30 p.m.-2:00 p.m.



Innovations in International Health



International Environmental Health Issues



Reproductive Health & Family Planning 1



Builidng Partnerships and Coalitions for better International Programs

2:30 p.m.-3:30 p.m.



Global Success and Challenges in HIV/AIDS Research

2:30 p.m.-4:00 p.m.



Emerging Infectious Diseases including Avian & Pandemic Influenza



International Health Communication/ Behavior Change Communication



Child Survival & Child Health 1



Strengthening Health Systems in Developing Settings 1



Act Global, Think Local: Domestic applications of international health lessons



Displaced Populations & Refugee Health

4:30 p.m.-5:30 p.m.



International Issues in Tobacco Control

4:30 p.m.-6:00 p.m.






MDGs At 2015 and Beyond : Lessons For the Future



Global Health Informatics Capacity Building and Disease Surveillance 1

6:00 PM-9:00 PM



International Health Section Awards & Social Event


Tuesday, Nov. 9, 2010

Saturday | Sunday | Monday | Tuesday | Wednesday | top

8:30 a.m.-10:00 a.m.



World Health Organization's Global Alcohol Strategy



Student Practicums in International Health - Experiences, Results, and Reflections



Neglected Tropical Diseases / Neglected Zoonoses (organized jointly by International Health and the Veterinary SPIG)



Leading Innovations in Afghanistan's Health System Architecture



Global Pharmaceutical Issues

10:30 a.m.-12:00 p.m.



Best Practices: Strengthening the public sector and integrating care to improve health in low-income countries



Student Panel



Aid Effectiveness: Accounting and Measuring Effectiveness



Social Justice and International Occupational Health: **Special intersectional track on environmental and occupational justice**



Carl Taylor Memorial Session 2: SEED-SCALE Methodology

12:30 p.m.-1:30 p.m.



Drug Use Across the Globe

12:30 p.m.-2:00 p.m.



Looking Globally to Address Local Community Health



Social Justice, Public Health, and Water: An International Perspective



International Health Programs & Policy



Breastfeeding and Reproductive Health: Supporting Rights and Social Justice Through Scholarship and Translational Research



Child Survival & Child Health 2

2:30 p.m.-3:30 p.m.



International and Cross-Cultural Issues in Mental Health

2:30 p.m.-4:00 p.m.



Community-Based Primary Health Care



Careers in Global Health




4:30 p.m.-5:30 p.m.



Poster Session 2: Social Justice in International Health



Poster Session 3: IH Partnerships & Coalitions



Poster Session 4: HIV/AIDS



Poster Session 5: IH Programs & Policy



Innovative Approaches to Global Maternal and Child Health

4:30 p.m.-6:00 p.m.



Community-Based Primary Health Care Working Group



International Perspective on Health Administration

6:00 p.m.-8:30 p.m.



International Health Business Meeting 3


Wednesday, Nov. 10, 2010

Saturday | Sunday | Monday | Tuesday | Wednesday | top

8:30 a.m.-9:30 a.m.



Poster Session 6: RH & FP



Poster Session 8: Women’s Health



Poster Session 9: Innovations in International Health 2



Poster Session 7: Health Systems

8:30 a.m.-10:00 a.m.



Strengthening Health Systems in Developing Settings 2



Systems Thinking



Women’s Health



Malaria & Vector-Borne Diseases



Health Promotion in the Academic Setting: International Experiences

10:30 a.m.-12:00 p.m.



Social justice and food security in international settings



Human Rights, Law and HIV: The Neglected Epidemic among MSM and its Global Implications



Tuberculosis (including joint TB/HIV programs)



Training, human resource development and workforce issues



Reproductive Health & Family Planning 2



International Health & Human Rights

12:30 p.m.-2:00 p.m.



International Health Luncheon



GIS Mapping, Global Health Surveillance and Public Policy

-- Omar Khan and Mike Bailey



Hélène Carabin is now compiling a list of all students who had posters or oral presentations at the Annual Meeting. She has also sent emails to all known international health student organizations in schools of public health in the United States letting them know about the IH Section of APHA. Hopefully, this will encourage them to become more involved.

--Hélène Carabin DVM MSc PhD,



Chair: Mary Anne Mercer,

The Forum on Trade and Health, of which the IH Section is a member, was created because of widespread interest and concern regarding the adverse impact of international trade agreements (such as NAFTA, CAFTA, and GATS) on public health, both internationally and within the United States. As a Forum, we work to educate APHA members about the impact of trade issues on public health and to protect public health priorities in international trade policy.


A major activity of the past few months has been an effort to assure public health representation on the advisory groups for the U.S. Trade Representative's Industry Trade Advisory Committees.  These committees are mandated by law to represent a range of public interests in relation to trade issues.  Currently there is wide representation on these committees by industries that influence health: pharmaceuticals, tobacco, chemicals, alcohol, health care services, and processed foods.


There is, however, virtually no representation by public health.  The Forum was instrumental in supporting legislation (HR 2293/S 1644) that would mandate a Public Health Advisory Committee on Trade and the appointment of public health representatives on existing Committees.  A formal comment with these recommendations was submitted to the USTR by a number of organizations and individuals, including several APHA sections, in May 2010. That commentary can be seen at:


Watch for a special "mini-plenary" session at this year's Annual Meeting on Trade and Health that has been organized by the Forum.  The Forum also holds a quarterly teleconference call that includes an informational presentation as well as discussion of business; the August call featured Garrett Brown speaking on efforts to establish a genuinely "no sweat" garment factory in the Dominican Republic. The Forum welcomes new participants from any Section.

--Mary Anne Mercer, IH Section Trade and Health Liaison,



Did you know that communities around the world celebrated World Breastfeeding Week, starting Aug. 1? The theme of this year’s celebration, “Breastfeeding – Just Ten Steps: The Baby Friendly Way,” refers to the 10 practices that, when implemented in maternity care settings, have been shown to enable mothers to achieve their breastfeeding intentions (Declerq et al, AJPH, 2009) and support breastfeeding success. These practices, known as the “Ten Steps,” were endorsed by WHO, UNICEF, USAID and Sida, and approved by 30 countries, including the United States, at the Innocenti Meeting on the Protection, Promotion and Support of Breastfeeding, Aug. 1, 1990.


The Carolina Global Breastfeeding Institute was honored to be invited to prepare the text this year for the annual calendar and the global Action Folder, offering ideas for communities and individuals who wish to enable women to succeed in their breastfeeding intentions.


Why the Ten Steps? Maternity practices can make or break the initiation of breastfeeding. In the United States, the Breastfeeding Report Card notes if hospitals are certified as baby-friendly, but to have impact, it is most important to increase the number of Steps in place.


What else could a community do to support women who wish to breastfeed? In addition to the health care system, breastfeeding support is needed in the workplace, and there is a toolkit to help ( In fact, this year, the North Carolina Breastfeeding Coalition celebrated the week by holding events in each region of the state to recognize those businesses that had mother/baby friendly practices. Chair of NCBC, Dr. Laura Sinai, offered a clear explanation on the news (

Julie Ware led a weeklong celebration in Memphis and all of Shelby County, Tenn., and invited me along to participate in two days of symposia and other events, include two perhaps less formal news interviews on related topics (;


The World Alliance for Breastfeeding Action is also sponsoring a conference this year to commemorate the 20th anniversary of the Innocenti Meeting in October 2010. Your attendance is most welcome! (


This year, we look forward to long anticipated Surgeon General’s new Call for Action on Breastfeeding. Internationally, WABA’s work continues. So, perhaps, next year, we will see an APHA-wide and global celebration of World Breastfeeding Week, and more mothers everywhere enabled to do what is best for their health and the health of their baby, and to breastfeed exclusively for six months, followed by continued breastfeeding with age-appropriate responsive complementary feeding. It is Best for Babes (which is also the name of a wonderful new organization for the new mom, Best for Moms!

 --Miriam H Labbok, MD, MPH, FACPM, IBCLC, FABM, Chair IH Section, Professor, Department of Maternal and Child Health, Director, Carolina Global Breastfeeding Institute (CGBI),



In the 2003 article by Jones and colleagues published in The Lancet, information was assembled on a set of low cost, feasible services that if universally available to poor mothers of the world would be expected to reduce the number of children that died by two thirds – some 6 million each year.  This suggests that an effective effort would be one that worked to make such services widely available in a country.  It would not be feasible to try to design one health program that would bring all these services to all mothers.  Rather the needed efforts might proceed as follows, and let us think in terms of how USAID might proceed.


  1. Since in many, perhaps all, poor countries there would be economic, medical, establishments that would be inclined to try to limit the range of efforts they would support, the first thing needed for effective action would be to encourage the creation of a National Health Council (NHC) that would develop plans, with technical assistance of groups like USAID.


  1. Let us consider pneumonia, typically the first or second killer of children. The NHC might develop an experimental program in which mothers would be trained to recognize pneumonia – 50 breaths or more per minute.  For this, mothers would need to be provided with a clock with a second hand.  Mothers would have on hand antibiotic powder, know how to mix it with water, have a dropper and know how to administer to their sick child.  There are obvious problems in all of this, with solutions to be found.  Treatment of diarrhea would be another challenge.


  1. Such experimental programs would need to be evaluated.  This means initiating the experimental program in a sample of villages drawn from a population of villages and comparing child deaths in this sample with the deaths in a control sample drawn from the same population. 


USAID has not carried out these types of evaluations.  We can work with them to improve their effectiveness.  The NHC, being a national group, can play an important role in getting agreement on such evaluations.  We can see the tragedy of the lack of a correct evaluation design in UNICEF’s $27 million effort in Africa.  Experimental and control groups were selected from different populations, so no conclusions on statistical grounds can be drawn. 


The American Statistical Association, in action initiated by its Human Rights Committee, of which I am a member, is planning to try to work with USAID to help them to be more effective. I have made suggestions for the organization of a session on evaluation, which has been done.  I will be chairing the session.  Evaluation in international health is very weak.  Hopefully the session will get us thinking about how we might play a more active role in this area.   

 --David J. Fitch, PhD, Instituto de Investigaciones Económicas y Sociales, Universidad Rafael Landivar, Guatemala



The U.S.-Mexico Border Office has significantly contributed since 2009 to the development of integrated social processes, to reduce the health risks in the most threatened and vulnerable border Colonias in Texas.  It has helped strengthening the inter-institutional collaboration among Texas state government agencies as prioritized in Senate Bill 827 (SB 827) of the 79th Regular Legislative Session of the State of Texas of Sept. 1, 2005, and developing integrated community action plans for two border Colonias that lack basic living necessities. Major efforts include:


  • Collaboration with EPA, COCEF, and others - the U.S. - Mexico Border Office facilitated the development of a bi-national academic technical advisory group in environmental health to support the U.S. - Mexico Environmental Program: Border 2012, coordinated by the U.S. Environmental Protection Agency and the Secretaría de Medio Ambiente y Recursos Naturales of Mexico. With PAHO’s support, the group developed and started implementing an action plan to strengthen the environmental health technical capacity of the Border Environmental Cooperation Commission and other related activities.


  • Disasters/Safe Hospitals - The PAHO/WHO U.S. - Mexico Border Office, in collaboration with local health authorities, organized two workshops to discuss hospital plan preparedness and response models, by applying the methodology, contents and supplied working equipment, in Tijuana (Baja California Norte) and Ciudad Juárez (Chihuahua).


  • The Center of Excellence (COE) for the Prevention of Chronic Diseases on the Border launched activities on World Health Day, April 7, with a walk from the Colegio de Sonora to the Municipality in Hermosillo, Sonora.  The COE is part of a global network of centers with funding from United Health Chronic Disease Initiative and NHLBI to further the prevention of chronic diseases.


  • Prevention and control of syphilis and congenital syphilis among high risk populations in Ciudad Juarez, Chihuahua, México - As a result of this effort, a binational effort has been made under the initiative of the State of Texas to reach a binational agreement to have a permanent collaboration between Texas and Chihuahua.  This effort not only serves pregnant women through prenatal care services, but also fosters outreach work to serve indigenous populations and commercial sex workers who otherwise may have been left aside with no access to medical care.


  • Violence and injury prevention - The Observatory for Safety and Peaceful Co-existence in Ciudad Juarez, Chihuahua, Mexico continues to be an extraordinary experience of collaboration among many academic, private and public sectors to deal with violence and injury prevention.  Violence along the Border continues to escalate; in 2009 more than 2,600 homicides were recorded in Ciudad Juarez. The PAHO/WHO Border Office continues to provide leadership in consolidating the information gathering and analysis process, building capacity among local stakeholders, building evidence to inform public policies and implementation of critical strategies. The data reported is available on the website, which provides information and recommendations for public policies, environmental changes, strategies and programs to prevent violence and injuries in Ciudad Juarez. In March 2010 the PAHO/WHO Border Office submitted and was approved a grant from USAID for violence and injury prevention, to strengthen the Observatory, as well as mental health services in Ciudad Juarez and the development of the U.S. – Mexico Border Observatory Network.


  • U.S-Mexico Border Virtual Health Library (Border VHL) - Officially launched in August 2006, this initiative is based on the need to improve the health conditions of the communities in the U.S.-Mexico frontier, through the exchange of scientific and technical information and knowledge generated by academic and service institutions and by researchers living in border. To learn more about the Border VHL Initiative or to search for border health/public health information, visit


  • Research & Public Policy - Evidence Informed Policy Network (EVIPNet) - In combination with the Border VHL, we are working on the inclusion of the Border Region researchers and policy-makers to the EVIPNet, an Americas region wide initiative, to aid in the establishment of the Border Health Research Agenda and to improve health and reduce health inequities by increasing decision and policy-makers access to, and use of, high quality evidence.

-- Maria Teresa Cerqueira, PhD, Chief, U.S.- Mexico Border Office, PAHO/WHO, El Paso, Texas,

--Josefa Ippolito-Shepherd, PhD, Public Health Scientist,



Patient Care Ethics and Ramifications of Post-Election Violence in Kenya: a Medical Student’s Experience - Part 2 (of 2)

Note from the Editor – Part 1 was presented in the Fall Issue of the IH Section Newsletter (2008).

An elementary school in the border town of Busia, Uganda housed the 2,000 refugees with each packed classroom inevitably creating a ripe environment for disease.  In addition, the threat of violence was still present due to the proximity to the border and the similar tribal demographics in comparison to that of western Kenya. The Red Cross refugee site was located just 1.5 km from the local public clinic.  Thus, without any medical infrastructure, Red Cross personnel were sending all refugees with health needs to the clinic.  As you could imagine, the Red Cross staff was pleased to learn of my medical background and immediately gave me all clinical and public health responsibilities.  I gave health education presentations (sanitation, personal and community hygiene, etc.) and continued to make referrals, in which I would write a brief history and physical description to assist the overwhelmed clinic.  Additionally, I initiated a patient record system.  As a medical student, it is easier to feel competent when the safety net of your attending is always in place, and this scenario was no different.  However, that was all about to change.


I have always pictured the Red Cross to be a medical relief organization with large stocks of food, medical supplies, and other basic necessities in times of crisis.  While I can only speak for the Uganda chapter, the real power of the Red Cross was not the direct supply of resources.  The food stock needed to be carefully rationed per family based upon number of adults and children, and medical equipment and personnel was non-existent.  Our food stock nearly ran dry in just a few days.  Despite a lack of a surplus of supplies from the Red Cross, we were still able to maintain an adequate level of provisions by establishing something far more critical: a collaborative network of NGOs.  I was impressed by the intricately organized effort centered around the Red Cross.  Nine different organizations, including the United Nations, MSF (Doctors without Borders), Ugandan Ministry of Health, and World Vision made diagnostic visits in assessing the needs, and would return a few days later with critical resources. 


Medically, my scrap piece of paper with scribbles, also known as the patient record system, became incredibly vital in allowing me to make specific recommendations to the various NGOs, regarding much needed supplies.  Anti-malarials, mosquito nets, bronchodilators, blankets, rehydration salts, antibiotics, analgesics…and a doctor?   By the end of my first week, a tent and a few medications were available.  This immediate access to medications was invaluable due to the fact that many patients were incapable of walking 1.5 km due to an assortment of lower extremity and back injuries.  Additionally, several clinicians of the nearby clinic had begun turning away refugees due to the overwhelming patient load and possible tribalism.  The arrival of medications and no doctors meant that I would have to be the “daktari.”  My work in Kenya revolved around logistics and programming of patient care projects regarding tuberculosis.  While I absolutely enjoyed the work, I admittedly had no need to pick up a stethoscope.  For the first three days in Busia, I would not even have a stethoscope.  Even more problematic: no safety net. 


Notable challenges included an epileptic boy who fell into a grand mal seizure directly in front of me.  With no anti-epilepsy medications available, he would be sent to a Kenyan hospital just across the border.  He remained stable and returned two days later.  Another challenge stemmed from the TB and HIV patients being reluctant to identify themselves due to stigma despite running out of medications.  MSF was instrumental in desensitization campaigns to identify such patients.  Other chronic patients (diabetes, hypertension, etc.) would run out of medications by the end of my two week stay.  We requested appropriate medications to be sent as soon as possible, and so my temporary treatment plan would be limited to treatment of symptoms and lifestyle changes.  Lastly, one of the MDR-TB patients in Eldoret, Kenya, who was to be among the first patients enrolled into the nearly established treatment program, persistently called me due to his rapidly deteriorating condition.  With limited incoming cargo, closed roads, and my attending in Eldoret not permitting my return, I could only tell him to wait it out and hope for a quick end to the political crisis so that the second line TB medications could arrive and I could continue working to help establish the MDR-TB program.


The biggest clinical challenge by far was the anxiety and other psychiatric issues related to the horrors of the post-election violence.  With no psychiatric medications available, psychosocial counseling and anxiety-reducing lifestyle modifications were all I had to offer.  Each heart-wrenching story made me feel useless.  These were families who were burned out of their homes and attacked with machetes by their neighbors.  Beyond the traumatizing escape, they now had virtually no hope for a peaceful return home.  Many said that they would never trust their neighbors again.  I can only hope that listening to their stories provided at least a grain of comfort in their lives.


Excerpts from e-mails:

I keep waking up in the middle of the night, and I can feel my heart beating so hard, so fast....I'm so worried and anxious about my "daktari" role.  I think I'm doing fine, but still....These refugees deserve the best clinical care available…I'm just physically and mentally exhausted....


These kids have no toys or anything (a soccer ball is coming tomorrow), and they've obviously been through a lot (one child told me that he never wants to go back to Kenya, many came with no parents, and several witnessed their parents murdered).  Today I taught them “duck, duck, goose,” and then we played some Kenyan games....they loved it and so did I.  In college, "crowd control" with the kids was my specialty on medical trips...but I've forgotten its significance since gaining more medical experience.  But today, being able to put a smile on these children's faces was probably the most useful thing I could've done, especially given recent events in their lives...and it didn't require a single pill. 


That first week, a Ugandan doctor from Friends of Christ Revival Missionaries (FOC-Rev) made a brief visit and gave me advice on diagnosing malaria amongst other regional illnesses.  Thankfully, he would return in the second week as a daily clinician at the refugee site.  Together, we would see almost 500 patients.  He also brought an extra stethoscope.


After two weeks at the refugee site in Busia, the violence in Kenya had subsided, although tension remained high.  The camp was to be re-located further interior into Uganda due to constant threats of violence infiltrating into the camps.  Meanwhile, my attending in Eldoret had decided to permit my return.  With plenty of patient care responsibilities and rebuilding needed in Kenya, I eagerly returned.  The trip back to Eldoret was like driving through a bizarre battlefield: burned cars and stores, but civilians going about their daily business as usual.  I could only think of how the vast majority of an entire tribe of people no longer lived in these lands.  Instead they were living at a refugee camp full of helpless despair.


Just last week, we were able to start treatment for that patient with MDR-TB; however, time will tell if his condition has already deteriorated beyond recovery.  I can only wonder what would have been if there were no political violence and we were consequently able to start treatment one month earlier, along with so many other “what if’s” for other patients.  While my experience provided many valuable lessons, tools, and experiences that have been permanently scarred into my mind, for me the most significant principle has been the reinforcement of the idea that we should never underestimate the impact of the ramifications of our choices.  Whether it is imperializing and fabricating national borders while teaching divide and conquer politics for self-gain or pushing a friend to reassess his utility, a single choice can ultimately create a seemingly endless cycle of violence, destabilize an entire health care infrastructure, or provide comfort to refugees entrenched in pain and suffering.

--Paul H. Park Indiana University School of Medicine,



  • In April Mary Anne Mercer was elected to the Board of Directors of the Partnership for Maternal, Newborn and Child Health (PMNCH), as an NGO representative with a special interest in newborn health.  This is a Geneva-based organization that aims to support the global community to achieve MDGs 4 and 5.  The PMNCH Partners Forum will be held in Delhi in November immediately following the APHA Annual Meeting.  PNMCH member organizations that are not able to attend the meeting are encouraged to contact Mary Anne at with any issues or concerns they would like to have voiced at the meeting.

--Mary Anne Mercer,


  • Dr. Gopal Sankaran will be serving the West Chester University in Pennsylvania in a new capacity until June 30, 2011.  He has been appointed the interim assistant vice president for international programs for the extended academic year.  Since this is a full-time administrative assignment, he will not be teaching during this period. 

--Gopal Sankaran, MD, DrPH, Interim Assistant Vice President for International Programs, Center for International Programs, West Chester University, PA, P: (610) 436-0536, F: (610) 436-3426,


  • The new book titled Health Promotion: International Experiences in Schools and Universities (Editorial Paidos) was launched in Buenos Aires, Argentina, on Sept. 30, 2010. This book contains, in addition to the scientific foundations of health promotion, successful experiences from Asia, Europe and Latin America. This first edition is in Spanish and is expected to be translated in English and other languages soon.

--Josefa Ippolito-Shepherd,PhD,



The Fifth International Conference on Health-Promoting Universities is planned to be carried out in Costa Rica in 2011. For background information about this upcoming event see: 

--Josefa Ippolito-Shepherd, PhD,



A number of IH Section members, some new and some continuing, want to know how they can “get involved” with the Section. Since much of our organizing work originates during the Annual Meeting, attendance at that meeting is a unique opportunity and a first step in further engagement with the Section.


Serving as a member or chair of a standing committee is one specific way to have input into IH Section activities. Committee chairs are formally appointed by the Section chair in consultation with the Section Council, and committee members are selected by the Section chair and committee chair.  Members are encouraged to volunteer their availability for positions of interest, as most years several committees are in need of members and/or chairs. The best way to investigate these possibilities is to attend the business meetings at the Annual Meeting, and contact the Section chair about your interests.  You can also contact the chair of standing committees and let him/her know that you would like to volunteer to work on that committee. 


The Section Officer positions, in contrast, are elected each year in a Section-wide ballot.  Officers include the Section Chair, Secretary, Section Council members, and Governing Council members.  Service on the Section Council is a good way for new members to find out about how the Section works while the other positions, including Governing Council, are generally held by members who have been involved for some time in other capacities.  The APHA elections are held around May of each year.  If you are interested in running for office, please contact Nominations Chair Mary Anne Mercer.

--Mary Anne Mercer,



·         Section Chairs:

·         SPIG Leadership:

·         APHA Student Assembly:

--Gopal Sankaran,



One wonderful Section member has offered a $2,000 matching grant each year for three years as a challenge to other members to donate to the Section. If you are interested in making a tax-free donation, please send your check or credit card information to "IH Section Enrichment account, APHA" together with the completed APHA Section Donation Form.

Thank you for making a donation to one of the APHA Sections. Your donation will help support our Section’s programs and our ongoing commitment to improve the public's health and achieve equity in health status for all.

APHA Section Donation Form
Section (please circle one): IH
Please accept my gift of:
_____ $25 _____$50 _____$100 _____$500 _____$1,000 ________ $ Other
My contribution is to be applied to: IH Section Enrichment Account
Name: _________________________________________________Degree:_________________
City: _______________________________________ State: ________ Zip: _______________
Phone: ______________________________________ e-mail____________________________
I would like to charge my gift to Visa/MasterCard/American Express (please circle one).
Card # _______________________________________________ Exp. Date: __________
Name as it appears on your credit card_______________________________________________
Signature is required if donating by credit card

Please send your donation to: American Public Health Association
Attn: Natasha Williams, Component Affairs
800 I Street, NW
Washington, DC 20001-3710
(202) 777-2533 (fax)

APHA is classified by the IRS as a non-profit 501(c)(3) organization. Gifts are tax-deductible
to the full extent allowed by the law. APHA's tax identification number is 13-1628688. AC05OL

--Miriam Labbok, MD, MPH, Chair IH Section, Telephone: (919) 966-0928; Fax: (919) 966-0458;



Officers (end of two-year term) :

Chair: Miriam Labbok (2010), 

Chair Elect/Governing Council Whip: Malcolm Bryant (2012),

Immediate Past Chair: Samir Banoob (2008),

Secretary: Carol Dabbs (2011),

Secretary Elect: Jean Meyer Capps (2013),

Section Councilors: (elected to three-year terms):

Hélène Carabin, DVM, MSc, PhD, (2011),
Wendy Johnson, MD, MPH, (2010),
David J. Fitch, PhD, (2010),

Padmini Murthy, Mphil, MD, MPH, MS, CHES, (2011),
Lisa Pawloski, PhD, MA, BA, (2011),

Jirair Ratevosian (2012),


Governing Councilors:

Laura Altobelli, Dr Ph, MPH, (2011),
Elvira Beracochea, MD, MPH, (2010),
Gopal Sankaran, MD, DrPH, MNAMS, CHES, (2010),
Leonard Rubenstein, LL.M., JD, MA, BA (Governing Council Whip) (2010),
James Pfeiffer, PhD, MPH, (2010),

Amy Hagopian, (2011),

Wendy Johnson, MD, MPH, (2011),


Section Committees, Website, and Newsletter (appointed by Chair)

-Awards Chair: Paul Freeman, Assistant Chair; Mini Murthy,

-Communications Chair and Website Manager:  Eckhard Kleinau,

-Global Health Connections: Chair Gopal Sankaran,; Co-chairs Mini Murthy and Hala Azzam,

-Membership: Rose Schneider,

-Newsletter Editor: Josefa Ippolito-Shepherd,

-Nominations: Mary Anne Mercer,

-Policy and Advocacy: Jirair Ratevosian,

-Program: Omar Khan, Chair,; Mike Bailey, Assistant Chair,

-Section Organization and Management: Jean Meyer Capps,

-Students and New IH Professionals:  Helene Carabin,


Section working groups:

-Border Initiative:  Josefa Ippolito-Shepherd,

-Community-Based Primary Care: Paul Freeman, & Malcolm Bryant

-Pharmaceuticals:  Chair, Maggie Huff-Rousselle, Co-chair, Robert  Eilers, <>

-Trade and Health Liaison: Mary Anne Mercer,


APHA wide responsibilities:

-Action Board Representative: Donna Barry,

-Global Health Manager (APHA Staff): Vina Hulamm,

-International Human Rights: Elvira Beracochea,

-Publications: – Carlos Castillo,

-Science Board & Liaison to Publications Board: Omar Khan,

-Trade and Health Liaison: Mary Anne Mercer,