3 things US medicine can learn from Doctors Without Borders

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On any given day, Doctors Without Borders (Medecins Sans Frontieres) stations up to 30,000 doctors, nurses and other volunteer personnel in more than 60 countries. In recognition of its pioneering efforts across several continents, the nonprofit was awarded the Nobel Peace Prize in 1999.

Meanwhile the United States is suffering a major health crisis. Tens of millions of Americans live without health insurance while the uncertain future of healthcare policy threatens the coverage and well-being of millions more. Hundreds of thousands of patients die each year from avoidable medical errors, preventable diseases and unnecessary complications from chronic illness. Our medical technology is outdated, our drug prices continue to skyrocket, and our physicians have become so frustrated that most (58 percent) would discourage their children from pursuing a career in medicine.

I am optimistic that our problems can be solved. To that end, I believe Doctors Without Borders can teach us three valuable lessons.

  1. The Power of Mission. On volunteer trips, physicians work 14 to 16 hours each day, often in scorching heat and without pay. Upon returning home, they almost never mentioned the travails. Instead, they spoke of the camaraderie, their sense of purpose, and the memories they will cherish for the rest of their lives. Compared to working in hot, dirty and under-resourced environments, you’d think the American medical office – with its air conditioning and running water – would feel like a vacation. Surveys demonstrate the opposite. One-third of doctors are dissatisfied with their work. Many describe being depressed. They lament all the time spent filling out forms, the isolation of working alone, and their frequent battles with health plans over prior-approvals and reimbursements. Unless physicians can reconnect with the fundamental purpose of their profession – helping patients – the cynicism and “burnout” afflicting doctors today will only worsen. Understanding how Doctors Without Borders has revived and nurtured this sense of purpose in its physician volunteers would be a great place for our country to start.
  2. The Essentials of Organization. Inefficiencies in U.S. medical centers have become the norm. The failings of U.S. healthcare – namely, its high costs and under-performance – aren’t the result of flawed doctors, nurses and staff. They’re the consequences of a broken delivery system, one that lacks operational efficiency and clinical effectiveness. Relief organizations like Doctors Without Borders place great importance on getting the right support in the right place at the right time. If our nation did the same, we could raise clinical quality and make health coverage more affordable for all.
  3. The Importance of Clarity. During volunteer endeavors, all doctors understand what they are doing and why. To a person, the goal is clear: Save as many human lives as possible. It’s hard to imagine a clearer “metric.” We may want to believe the U.S. healthcare system is designed to maximize the lives saved. But if that were true, we would not trail the 10 other wealthiest nations in health outcomes – not when we spend 18 percent of our GDP ($3 trillion annually) on healthcare.

Doctors Without Borders, and its tens of thousands of volunteers, has much to teach American medicine. … I hope my donations to Doctors Without Borders will serve as an investment in the health and medical education of both our country and our planet.

[Excerpts of Forbes article by Dr. Robert Pearl, a clinical professor of surgery at Stanford University]

The human agenda to remove greenhouse gases out of the atmosphere

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The Drawdown project, led by Paul Hawken, details 80 ways we can take greenhouse gases out of the atmosphere.

The project groups the 80 interventions into 7 clusters, and the cluster that can generate the highest reduction – 31 percent – is “food”! (Between 2020 and 2050, food initiatives that are already underway can reduce greenhouse gases by 321.9 gigatonnes.) Food is followed by “energy” at 23 percent.

Surprisingly, “efficiencies in refrigeration management” is the single biggest item in the top ten CO2-equivalent reducers. “Reduced food waste” comes in at number three, with a “plant-rich diet” coming in fourth. At number six and seven on the list is “educating girls” and “family planning.”

For those who feel like climate change is too big for them to have impact, this provides lots of options for action.

What is also encouraging is the optimistic tone of the New York Times Bestseller book, “Drawdown – The Most Comprehensive Plan Ever Proposed to Reverse Global Warming”. Paul Hawken writes: “If we change the preposition, and consider that global warming is happening for us – an atmospheric transformation that inspires us to change and re-imagine everything we make and do – we begin to live in a different world.

“We take 100 percent responsibility and stop blaming others. We see global warming not as an inevitability but as an invitation to build, innovate, and effect change, a pathway that awakens creativity, compassion, and genius. This is not a liberal agenda, nor is it a conservative one. This is a human agenda.”

600,000 displaced Syrians returned home in first 7 months of 2017

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Between January and July 2017, 602,759 displaced Syrians returned home according to reports from International Organization for Migration (IOM), the UN Migration Agency.

Findings indicate that the vast majority of the people returning (84 per cent) had been displaced within Syria. The next highest number of people (16 per cent) returned from Turkey, followed by Lebanon, Jordan and Iraq. Refugees returning from Turkey and Jordan reportedly returned mainly to Aleppo and Al Hasakeh Governorates.

An estimated 27 per cent of the returnees stated that they did so to protect their assets or properties and 25 per cent referred to the improved economic situation in their area of origin. Other factors people gave IOM and partners as their reasons for returning included the worsening economic situation in the place where they have been seeking refuge (14 per cent).

An estimated 67 per cent of the returnees returned to Aleppo Governorate (405,420 individuals).

According to reports, almost all (97 per cent) returned to their own house, 1.8 per cent are living with hosts, 1.4 per cent in abandoned houses, 0.14 per cent in informal settlements and 0.03 per cent in rented accommodation.

Access of returnees to food and household items is 83 per cent and 80 per cent respectively. Access to water (41 per cent) and health services (39 per cent) is dangerously low as the country’s infrastructure has been extremely damaged by the conflict.

[International Organization for Migration]

Let compassion heal us and others

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As part of my ServiceSpace summer internship, I interviewed various people about their relationship to pain and suffering. The individuals I talked to were willing to reflect on pain and suffering, unfold decades of their lives and share insights with a young stranger whom they had never met before.

In a conversation with John Malloy, he said, “Sharing is our nature. When we share, we heal suffering.” John’s life is dedicated to tending to people who suffer. After working as a counselor for prisoners and troubled youth, to leading The American Indian Spiritual Marathon for nearly four decades, John said, “None of the kids had criminal minds. I was never fooled by the personality of the kid — it’s a veil to the soul. I always went for the soul.”

Towards the end of our conversation, I asked John how he faces his own sufferings while always serving others. John revealed that he had experienced a great deal of loss in his life, including the passing of his only son and the loss of sight in his left eye. However, “we have an innate capacity to heal”. After two years of grieving, he grew stronger through his losses, not weaker. “As we face our pain and suffering, we see what we are supposed to do is to care for others,” said John.

When we hurt others, we are not only responsible for ourselves or the ones we hurt, but also for the ones they are going to hurt. If instead we choose compassion, this world turns brighter. As Audrey Lin beautifully puts it, “In the end there is only kindness. At the end of the day we are all going to go, but what stays behind are those small acts; those are acts maybe paid forward by so many others. […It’s] what inspires me to keep living.”

Sharing makes us more human; becoming more human leads us towards the compassion that is inherent in our nature.

[Daily Good]

Smiles amid desperation in South Sudan

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South Sudan has suffered from nearly four years of conflict. Millions are lacking the very basic necessities to survive – clean water, food, shelter, medicine.

The conflict has left many unable to work their land. There has also been an influx of people made homeless by fighting in other parts of the country. Many lost all their belongings when fleeing.

Cecilia Tabu, 12, is waiting under a tree with her mother Vajda. “Normally, our only food is leaves that we cook with salt and water,” says Vajda. “Usually, we have nothing, so today we are happy. We can finally eat something different.”

Cecilia fled her village with her mother and four siblings one year ago. Her father was killed while he was collecting food for the family. After this her mother decided that their home was not safe anymore. Simple things, like a hoe for cultivation, will help her family get back on their feet.

In this recent distribution, the International Committee of the Red Cross (ICRC), working with the South Sudan Red Cross, focused on distributing seeds and tools to help people get back into farming so they can provide for themselves.

They were also given food to tide them over until they can harvest their crops. Around 13,000 people received seeds, tools and food in Rokon.

“Before the crisis, life was good. We had no hunger. Because of the drought we lost all our crops and were left with no seeds,” Jennifer explains. She was first in line on the second day of the distribution and got support for her daughter Alice and her other children. Like many across the country, this lady had resorted to eating leaves to survive.

[ICRC]

Why refugee doctors end up driving taxis in the US

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Layla Sulaiman served as a primary care OB/GYN for 17 years before she left Iraq in 2007. But in this country, her medical license is no longer valid. Sulaiman is one of many refugees — though no one knows exactly how many — who practiced medicine in their home countries, who are now working in low-skilled jobs, driving taxis and working in grocery stores.

“The brain waste is appalling,” said Dr. José Ramón Fernandez-Peña, an associate professor of health education at San Francisco State University who studied medicine in his native Mexico. He is also the founder and director of the Welcome Back Initiative, which has helped foreign-trained providers get health care jobs in the United States since 2001. “These are individuals who could be taking care of children with asthma, and instead are working at a car wash,” he said.

Sulaiman had originally hoped to be relocated to Australia, where her sister-in-law lives and where there are accelerated paths for foreign doctors. Had she gone to a country like Canada, she could have practiced with some restrictions while obtaining a full license.

But she ended up in the United States, where she must start her training from scratch. Refugees may have additional struggles, advocates say. For example, many must leave their home countries on short notice, making it difficult for longtime doctors to track down old transcripts and records.

Within the United States, there are more residency slots than medical students to fill them. This year, more than 22,000 American-educated students vied for nearly 29,000 first-year residency slots, according to the National Resident Matching Program.  The rest of these positions were filled largely by foreign graduates.

Some experts predict a doctor shortage of 40,800 to 104,900 by 2030, according to an analysis commissioned by the Association of American Medical Colleges.

Fernandez-Peña said that putting foreign-trained doctors to work in America is a no-brainer. “Why not invest in this freebie?” he asked. “They’ve already been trained. We would be reaping the benefits that (another) country has spent money in training their work force.”

[CNN]

Haitian asylum seekers flocking to Quebec

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Kathleen Weil, Quebec’s Minister of Immigration, confirmed that the number of asylum seekers in Quebec had tripled in the past two weeks. She said that between July 1 and 19, some 50 applicants arrived in Quebec every day, “Now it’s an average of 150…”

According to Jean-Pierre Fortin, the President of the Customs and Immigration Union, nearly 500 asylum seekers illegally crossed the border on Monday alone near the Lacolle customs post, 90% of whom were Haitians, who feared as nearly 60,000 of their compatriots in the United States stand to lose their Temporary Protection Status in the United States

In the first six months of 2017, Québec had already received more than 6,500 asylum seekers.

The entry of these waves of refugees at the border forced Canadian authorities to find a solution on the accommodation side. So far housed in university residences, reception centers (Salvation Army, YMCA, etc.) or hotels, asylum seekers are now so numerous that part of the Olympic Stadium is being transformed into a refuge for asylum seekers.

Stéphane Handfield, a lawyer specializing in immigration says “In 25 years of practice, I have never seen this. It is clearly not ideal for families, but it is better that to leave these people under the bridge.”

Denis Coderre, the Mayor of Montreal, said that Montreal would help those newcomers who were afraid of being deported from the United States and refused to return to Haiti, saying “You can count on our full cooperation.”

[HaitiLibre]

Germany’s involvement in settling South Sudanese refugees in Uganda

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The civil war in South Sudan has taken its toll on neighboring country Uganda, with the number of South Sudanese refugees in Uganda now reaching the million mark.

Many of these refugees make the journey across the border, not just because of the Uganda’s proximity, but also as a result of the country’s welcoming approach to hosting refugees. Based on a concept of self-help assistance, refugees receive land and materials on arrival to put up their own shelters, as well as seeds and hoes to grow their own food. This concept aims at ensuring a self-reliant life for the refugees in the long term.

“Uganda is however beginning to reach the limits of its capacity. One million people need space and support,” said Alexander Tacke-Köster, Program Coordination for Malteser International in Uganda. “We offer support by providing improved supply of clean drinking water for 30,000 refugees. Although the number of arrivals are declining, an end to the influx of refugees is not in sight.”

Roland Hansen, Head of the Africa Department at Malteser International has also pointed out Germany’s significant role in the aid intervention. “By providing aid for these refugees, we are reducing the strain on Uganda’s resources”, he said. The German Federal Foreign Office has released an additional one million euros to upscale Malteser International’s ongoing aid projects for South Sudanese refugees in Uganda. And Foreign Minister Sigmar Gabriel will visit Uganda tomorrow, August 9, to personally gather an on-site impression of the current situation.

[ReliefWeb]

Christians protest as new report shows devastating impact of Trump’s refugee policies

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The global standing of the US when it comes to the world refugee crisis has dramatically slipped in the past six months, according to a new report released by Human Rights First, a leading non-profit, non-partisan advocacy organization.

As a result of changes in US policy under Donald Trump’s presidency, global refugee resettlement is now predicted to fall by 30-40 per cent in 2017 as compared to 2016. The refugees most affected by this decline are women and children, including those who have suffered sexual and gender-based violence, as well as survivors of torture.

Emily Gray, the senior vice president for US ministries of the Christian charity World Relief, said: ‘In addition to women and children, the decision of the United States to allow fewer refugees also means that the US will accept the lowest number of refugees who have been persecuted for their Christian faith in a decade.’

Scott Arbeiter, World Relief‘s president, added that ‘we must appropriately balance security and compassion. This report clearly shows that we are not achieving that balance, and that people are suffering as a result.’

‘Through our work in Jordan, we see very directly the impact of the refugee crisis there, and these actions by the administration are compounding the struggles of refugees who are trying to find safety in countries that are already struggling,’ said World Relief CEO Tim Breene.

[Christian Today]

UN reveals Saudi Arabia blocking humanitarian aid to Yemen

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The humanitarian situation has been growing ever worse in northern Yemen for months, with a Saudi blockade keeping aid out of the only port still controlled by the Shi’ite Houthis. The UN has been trying to get emergency aid into the capital city of Sanaa through the airport, but that seems to be no easier.

The United Nations has attempted to operate two humanitarian routes into Sanaa, but there is no jet fuel available in the Yemeni capital for the humanitarian aid planes to then make the return trip.

Auke Lootsma, the country director of the UN Development Programme in Yemen, said, “We have difficulties obtaining permission from the coalition …. to transport this jet fuel to Sanaa to facilitate these flights,” explaining this to reporters by video-link from Sanaa.

Lootsma also reported an outbreak of meningitis in Yemen, compounding the cholera epidemic and the risk of famine in the world’s worst humanitarian crisis. The UN warns the situation is increasingly bleak, with no real ability to get vital aid into parts of the country that are afflicted with a huge cholera epidemic, and are now on top of that facing an outbreak on meningitis.

Yemen is a country that imports more than 90 percent of its food in peacetime. And now during war time, the Saudi blockade has had a terrifying impact on Yemen, raising growing concerns from human rights groups that they’re using access food and medicine as weapons of war.