In a Converging World, Keep Talking
The events in Paris last week captured the attention of the world, sparking sharp debate about freedom of expression, violence, the role of world religions, and what sometimes looks like a clash of cultures. There were marches of unity that embodied universal values, and news spreading in every direction. Yet many public conversations also descended into destructive notions of “us” and “them.” In a world where blossoming access to common information suggests a broad convergence, unexpected shocks still rattle our consciousness.
The partnership of the Global Fund believes in the power of dialogue. We see it healing disagreements. We know it leads to constructive compromise. In our work supporting health – which knows no borders or ideological divisions – we rely on scientific advances. Yet we also recognize that medical work is part science and part humanity. Dialogue is an essential part of the solution.
The global discussion about Paris reminded us of Maimouna, a social worker at a treatment center that we recently visited in Dakar, Senegal. She works with humility, and she is passionate about her ability to serve others through dialogue on a person-to-person level. We found her work inspiring. She’s at a treatment center that supports more than 4,000 patients with HIV, offering primary care, psychological and social counseling, mediation, and community activity. In Maimouna’s view, the most important dynamic is preserving the dignity of each person. And that means talking with them, listening to them as individuals, and answering them with generosity.
"Fifty-seven percent of all patients here are women,” said Maimouna, whose embroidered headscarf glistened as she spoke. “They often refer to me as their sister. They sometimes ask me questions about the Koran and think that their illness is a kind of punishment. They think that religion no longer wants to have anything to do with them and that they are lost.” She is not passive in such conversations: “I speak to them about the Koran and its fundamental values of tolerance and respect, which must be passed on, and I tell them that their illness is not in any way a form of punishment. AIDS is a disease and it can be treated. The Koran tells us that all diseases must be treated so that symptoms can be relieved and people can continue to live. AIDS is no different than any other disease.”
Maimouna feels a strong calling to her work. “Because of what the Center stands for, it is the ideal place to help others who are suffering, in need and facing uncertainty. AIDS patients need support, they need to have people around them. HIV too often deprives people of their family and the comforting words of those they are close to. My role is to try to compensate for that by respecting and listening to them.” Her mindset, and her method, are like little golden keys that we need on a global level. Keep talking.
Reaching Key Populations
Partners in the fight against HIV in El Salvador inaugurated a new health clinic this week that expands services for key populations, particularly sex workers, transgender populations and men who have sex with men. The clinic, located in a health center in Santa Tecla outside San Salvador, offers prevention, care, diagnosis, treatment and counseling for HIV, and adds a human rights approach. “This project is changing people’s lives within the key populations. It is unprecedented,” said Karla Guevara, from a Salvadoran civil society group. “These new spaces are important for our people because it is the only way we can provide a better response and reduce the prevalence of HIV and STIs in our country.”
The HIV epidemic in El Salvador is highly concentrated. Estimated prevalence is 0.6 percent in the general population, but much higher among the transgender population (25.8 percent), men who have sex with men (10.4 percent) and female sex workers (3.1 percent). The government of El Salvador aims to reach 80 percent coverage of services for those three groups by 2016. The new clinic is the seventh specifically geared toward treating Sexually Transmitted Infections in El Salvador. A total of 14 are planned. El Salvador was one of the first three early applicants to participate in the Global Fund’s new funding model, and has expanded efforts to fight stigma and discrimination, essential to controlling and defeating AIDS. On the walls of the new clinic in Santa Tecla, posters read: “Ground 0 For Discrimination.”
“Many times we are asked why we are providing services to ‘those people’,” said Dr. Ana Isabel Nieto, head of the HIV-STI program at the Ministry of Health. “We tell them that ‘those people’ are as Salvadoran as the rest and that they have dignity and rights and that they deserve quality care like anybody else. That is what these clinics are for.”
Building Peace in Myanmar
For decades, they sat on opposite sides of an ethnic divide that unleashed war, forced displacement and poverty in Myanmar. Today, Dr. Aung Kyaw Htwe, a Burmese, and Dr. Ed Marta, a member of the Karen ethnic minority, are fighting together against a common enemy: malaria. Enlisted in a regional initiative to combat drug resistance supported by the Global Fund and many partners, the two men are also contributing with their work to building peace and reconciliation in Myanmar. Since a 2012 cease-fire was signed between the central government and the Karen National Union (KNU), former foes are now collaborating in the field and sharing information in the fight against the insect-borne disease in Kayin state, a hilly and densely forested region in southeastern Myanmar that borders Thailand. The government’s National Malaria Control Program has donated 20,000 malaria treatment doses to the Karen Department of Health and Welfare (KDHW), the medical arm of the KNU, and expanded health care to communities that in the past were not able to participate. Government health workers, armed with microscopes and malaria kits, are becoming a common sight in villages in ethnic areas, where violence raged only a few years ago. With peace, villagers are also seeing the benefits of more health volunteers and of mass distribution of insecticide treated nets, sharply bringing down mortality and morbidity rates in the state. In meetings that would have been unthinkable before the peace accords, officials from the government’s Vector Borne Disease Control, Kayin State Health authorities and the KDHW have held orientation sessions on the national guidelines for malaria treatment to improve services, and have discussed setting up joint training programs. “We fought against each other for many years. Now Burmese doctors and Karen doctors are working together with one single objective: to serve the people,” said Dr. Marta, a senior consultant for the KDHW. “Health can bring people together. We are building peace. Maybe our politicians can learn from this.” Dr. Kyaw Htwe, the government’s health director for Kayin state, echoed that spirit. “People need peace. Health is neutral. It benefits poorly educated people and highly educated people. Health is a meeting point for all stakeholders. Maybe health can be a building block for peace.”
But many challenges remain. An estimated 70,000 people out of Kayin state’s 1.5 million remain uncovered because they live in hard-to-reach areas in the jungle or due to funding gaps and lack of human resources, including poor maternal and child care. Migrant workers who toil at mosquito-infested rubber plantations add to the risk of transmission. Low-quality malaria medicines sold at village stores are also a problem. Government health workers are still not allowed to operate in some ethnic areas, where distrust simmers. All these factors make fighting artemisinin resistance, a rising global health threat, even more challenging. “We are still struggling with the effects of the conflict in terms of health care and development,” said Dr. Kyaw Htwe. “If the peace process succeeds we will see more development in our state, including in the fight against malaria.”
Under a $100 million, three-year, regional initiative, the Global Fund to Fight AIDS, Tuberculosis and Malaria will invest $40 million in Myanmar to fight resistance to artemisinin, the main drug used to fight malaria. The initiative, the result of a collaborative effort between external funders, multilateral agencies, technical partners, the Ministries of Health of five countries and local communities, aims to achieve elimination of P. falciparum malaria by 2030. In Myanmar, artemisinin resistance containment activities will be implemented in 52 townships across six states along the eastern border. UNOPS, the regional Principal Recipient for the initiative, is working with international organizations, the National Malaria Control Program, several NGOs and non-state actors.
Dr. Kyaw Htwe and Dr. Marta are keenly aware of the size of the enemy they are facing, and say the need to collaborate is more pressing than ever. If resistance were to reach neighboring India or sub-Saharan Africa, where most world malaria cases occur, the public health consequences could be disastrous. “Everybody has to participate,” said Dr. Marta, a former high-ranking official of the KNU who fled violence to the United States and returned to Myanmar after the peace accords. “We have to work hand in hand, only then there will be success in our program.”