If you have a moment, please check out my blog post on KevinMD.
This post provides a more concise explanation of a neglected issue that requires policy and provider attention when addressing pandemic levels of death and disability due to violence against women. I wrote it because vulnerable women experiencing violence in resource-poor settings face the greatest barriers to accessing life-saving emergency and essential surgical care.
Special thanks to Dr. Kevin Pho and KevinMD for posting this: Violence against women: save her life and treat her injuries first.
Wednesday, June 26, 2013
Tuesday, June 25, 2013
A tour of the Palais de Nations
After over a month of interning, my fellow interns--James Murphy (a MPH/MD student in his first year at Yale/Mt. Sinai), Farooq Khan (an emergency medicine resident in his final year at McGill)--and I took an afternoon away from the WHO Emergency and Essential Surgical Care office for a guided tour of the Palais des Nations.
The United Nations Office of Geneva (UNOG) receives about 100,000 visitors each year. Though I had traversed some of the Palais halls and meetings rooms during the 66th World Health Assembly, the UNOG guided tour included more historical context to appreciate the views.
The Palais is a beautiful art deco building in Ariana Park and overlooking Lake Geneva. Nearly one kilometer long, the Palais is a legacy of the League of Nations, the world's first global organization created to keep the world safe and at peace after WWI. Though the League failed when it was unsuccessful in countering forces that led to WWII, the United Nations succeeded it when founded in 1945 in Geneva, as a tribute to the city of peace's humanitarian history. While the meeting rooms of the Palais des Nations can seat a total of more than 8,500 people, it is also a "living museum" and home to art donated by Member States, foundations, and individuals as expressions of solidarity for improving international peace.
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| Source |
The guided tour also offered some new views. Particularly breathtaking was the Human Rights and Alliance of Civilizations Room, with its domed ceiling sculpture by artist Miquel Barcelo.
I also particularly enjoyed the tour of Ariana Park, the 46-hectare park home to various species of majestic trees, and its memorable Monuments.
The iconic Celestial Sphere was donated in 1939 by the Woodrow Wilson foundation to commemorate the US President's work in creating the League of Nations.
The sphere originally featured 85 gilded constellations and 840 silvered stars and was equipped with a motor to revolve slowly around an axis turned to the Pole Star, though the motor no longer works and needs restoration.
Family by Winston Churchill's granddaughter, Edwina Sandys, was a gift from Anthony and Penny Oppenheimers to UNICEF.
The 4.6-meter high bronze sculpture uses the space between the mother and the father to depict the child.
The red brick Tower of Loneliness was a gift by the Danish artist Per Kirkeby. Standing inside the tower, one is said to experience the alternating contrasts of opening and closing, presence and absence, and light and shade.
Given to the UN for the Dialogues of Peace exhibition, Kirkeby described the themes of the tower as "an eye raised to the sky and a tear which flows."
The two-part monument represents the projection of a spacecraft with a 28-meter tall arrow-shaped plinth, as well as a bronze statue of an astronaut with arms reaching toward the sky, symbolizing human desire for space exploration.
But of all the monuments, the Great Centaur was my absolute favorite.
The Great Centaur by Ernst Neizvestny, a gift from the Russian Federation, is a 4.5-meter high bronze sculpture.
The artist, at the inauguration of his sculpture, said, "Man must struggle to become himself."
The Great Centaur is a wounded giant--rising from a base, representing death, destruction, and chaos, and reaching upward, with his face bare, unmasked.
If you are interested in learning more, I would suggest checking out the UNOG Virtual Tour.
Friday, June 21, 2013
Save her life and treat her injuries first
According to a report on responding to violence against women released this week by the WHO Department of Reproductive Health and Research and partners[1], more than a third of women experience sexual or physical violence around the world.
At such pandemic proportions, violence against women is a serious global health threat and public policy problem.
Violence increases women's vulnerability to many social and health problems, including depression, alcohol use disorders, unsafe abortions, pregnancy related complications, and STIs, including HIV.
Importantly, intimate partner violence against women is a significant cause of death and injury. Particularly in resource-poor settings and low- and middle- income countries (LMICs), many factors work against women and lead to staggering rates of death, injury, and disability from violence.
The WHO report offers detailed recommendations for health providers on what to do after a woman that has experienced violence presents to them at their clinic.
The report's Figure 2 summarizes these recommendations, beginning by asking the health provider to assess whether the woman is presenting with injuries that require urgent treatment. If her injuries do, indeed, require urgent treatment, the report recommends the health provider's next step, which is simply: Treat injuries.
That's it.
The WHO report just stops there. It seems to assume that women in resource-poor, often remote, settings in LMICs actually have access to trained health providers and health facilities with the capacity to treat their injuries. This is seriously problematic.
A recent review on the "Care of the Injured Worldwide" by Sakran et al explains the realities on the ground:
At such pandemic proportions, violence against women is a serious global health threat and public policy problem.
Violence increases women's vulnerability to many social and health problems, including depression, alcohol use disorders, unsafe abortions, pregnancy related complications, and STIs, including HIV.
Importantly, intimate partner violence against women is a significant cause of death and injury. Particularly in resource-poor settings and low- and middle- income countries (LMICs), many factors work against women and lead to staggering rates of death, injury, and disability from violence.
The WHO report offers detailed recommendations for health providers on what to do after a woman that has experienced violence presents to them at their clinic.
The report's Figure 2 summarizes these recommendations, beginning by asking the health provider to assess whether the woman is presenting with injuries that require urgent treatment. If her injuries do, indeed, require urgent treatment, the report recommends the health provider's next step, which is simply: Treat injuries.
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| Source. |
That's it.
The WHO report just stops there. It seems to assume that women in resource-poor, often remote, settings in LMICs actually have access to trained health providers and health facilities with the capacity to treat their injuries. This is seriously problematic.
A recent review on the "Care of the Injured Worldwide" by Sakran et al explains the realities on the ground:
- Surgical disease, which includes traumatic injury, is among the top causes of death and disability worldwide.
- Traumatic injury is the leading cause of death under the age of 45 in the US and worldwide.
- These traumatic injuries account for 10% of the world's deaths, more than the number of deaths from malaria, tuberculosis, and HIV/AIDS combined.
The world's poorest people, and among them, marginalized women, particularly those vulnerable women that are victims of violence, face the greatest barriers to accessing life-saving emergency and essential surgical care.
According to Sakran et al and others, the reasons why this is the case boils down to a lack of effective political advocacy and insufficient investment in training frontline health providers and building infrastructure and capacity in primary health facilities, perhaps due to erroneous perceptions that providing emergency and essential surgical interventions are too expensive or complex by population-based measures, even though the World Bank and others have determined promoting surgery to be a cost-effective, life-saving treasure in low-income countries.
The WHO's clinical and policy guidelines report responding to violence against women has gotten tremendous attention by mass media, health providers, and policymakers around the globe. People are feeling the urgency of addressing violence against women, as they should.
It is just unfortunate that the WHO report neglected to offer guidelines on how health providers and policymakers in low-resource settings should actually go about treating and saving women from pandemic-levels of death and disability from violence.
In order to protect women and prevent such astounding morbidity and mortality, clinical and policy guidelines to respond to violence against women can not just focus on prevention, mental health services, and STI management. All of these are important, of course, but equipping frontline health providers with the training and tools to detect and best treat women that experienced injuries from violence is also a critical component, particularly necessary to care for women that are becoming victims at this very minute.
Just as treating patients with AIDS is as important as preventing the transmission of HIV, treating the acute needs of women that are victims of violence is as important as preventing violence against women.
If 42% of women experience injuries as a result of physical or sexual violence at the hands of a partner, and 38% of all murders of women globally are reported as being committed by their intimate partners, should WHO not recommend equipping health facilities that are most accessible to women at risk with the skilled health providers, emergency equipment, and capacities necessary to save their lives? To care for their wounds, burns, life-threatening injuries? To prevent and reduce disability?
Violence against women in many parts of the world often goes unrecognized, underreported, and neglected, particularly in low-resource settings that do not have adequate emergency and essential care capacities at primary or first-referral health centers to care for women experiencing violence, or anyone else, for that matter. Women that experience violence in these settings may not turn to law enforcement or other domestic violence-specific services or centers, whether they are near or far.
Since victims are most likely to interact with the health system for acute health needs, health providers are in the unique position to identify abuse and intervene before serious injury or death occurs. The WHO report recommendations also acknowledge that "as much as possible should be done during first contact, in case the woman does not return. Follow-up support, care, and the negotiation of safe and accessible means for follow-up consultation should be offered." Frontline health providers, like those in the emergency room or ones at primary or first-referral health facilities in LMICs, are an important contact with the victims of domestic violence, and timely identification and intervention can save lives.
The WHO report notes: "Ideally, women experiencing partner violence should be identified at the point of contact with health services, although these settings are not always conducive to providing such services." Perhaps it is true that these health settings are not "conducive to providing such services" right now, but it's imperative for the WHO and partners to support health ministries in building health systems that are suited to address violence against women and other emergency and primary care health issues.
Where is the WHO recommendation to build the capacity for emergency and essential trauma, surgical, obstetric, and anesthesia/resuscitation services for these women in primary, first-referral health centers?
Women must be able to access care and services at their most physically-accessible, first-referral health centers, where they are most likely to show up with acute needs after experiencing violence. This is why, in low-resource settings, first-referral health facilities are considered the optimal starting point for effective management of injury. These emergency or primary health centers are also more easily able to integrate care and provisions for women experiencing violence into their routine patient care and clinic services.
If the evidence shows that it's best to integrate emergency and essential surgical care, first-line and continued supports, emergency contraception, and STI laboratory and treatment services into primary, first-referral health facilities to address violence against women, where is the WHO recommendation urging the integration of these comprehensive services into LMICs' national health plans?
By neglecting to recommend or even note the importance of ensuring women's access to emergency and essential trauma and surgical care at first-referral health centers, the WHO missed a major opportunity to have a significant impact on policymakers interested in improving the care and lives of mothers, wives, daughters, sisters, and everyone related to them, particularly in ways that fit into their ongoing efforts to strengthen their national health plans and systems.
At the 66th World Health Assembly last month, I attended a panel with health ministers and representatives from Belgium, India, Mexico, Zambia, the USA, and the Netherlands on Addressing Violence Against Women. As mentioned in a previous post, each panelist briefly shared general progress and interest in addressing violence against women in their respective countries. Health ministry leaders' commitment to address violence against women is particularly important for building the momentum for real change on the ground.
Efforts to comprehensively address violence against women must be integrated into national health plans and social policies across sectors. Building the infrastructure (such as laboratory services and essential equipment/medicines supply chain) and capacity (such as training frontline providers to manage injuries, burns, and resuscitation) to deliver accessible acute care and support services to women that have experienced violence requires political leadership and financial investment. Delivering appropriate emergency services to survivors of violence at first-referral health facilities in resource-poor areas should be an integral component of a national health ministry's health systems strengthening agenda and budget. Strengthening emergency care systems and capabilities for local health facilities to serve women that are victims of violence requires political commitment from all levels.
Perhaps it is not politically correct for me to say this, but I write from my humble intern's perspective -- I am deeply disappointed that there is not more collaboration and communication among the many WHO programs/departments/units. I'm not sure what it will take, but this report brings light to one of the most important issues of our time, one that is particularly personally important to me. It is just unfortunate because the program with which I'm interning within the WHO, the Emergency and Essential Surgical Care (EESC) Program, would have easily been able to help support and fill major gaps in the report's clinical and policy recommendations.[2]
The Director General of the WHO, Dr. Margaret Chan, said in a recent statement, "We see that the world's health systems can and must do more for women who experience violence." Indeed, it is time we all do more to support health systems in caring for women.
---
[1] "About the report: The report was developed by WHO, the London School of Hygiene & Tropical Medicine and the South African Medical Research Council. It is the first systematic review and synthesis of the body of scientific data on the prevalence of two forms of violence against women – violence by an intimate partner and sexual violence by someone other than an intimate partner. It shows for the first time, aggregated global and regional prevalence estimates of these two forms of violence, generated using population data from all over the world that have been compiled in a systematic way. The report documents the effects of violence on women’s physical, mental, sexual and reproductive health. This was based on systematic reviews looking at data on the association between the different forms of violence considered and specific health outcomes." Source.
[2] The WHO EESC Program works directly with ministries of health in LMICs and other partners to advocate for leaders' commitment to a cross-cutting approach rooted in national health planning. The program focuses on integration of emergency medicine and essential surgical care, which includes caring for victims of domestic violence, into first-referral level, primary health care facilities, and the WHO EESC Program's Integrated Management for EESC toolkit includes the Emergency Trauma Care workshop and other useful tools for health providers and policymakers. Reducing death and disability from domestic violence is also a priority for WHO GIEESC members. If you are interested in partnering and collaborating to achieve quality, safe emergency and surgical care for people living in low-resource settings, I'd encourage you to consider joining the WHO GIEESC community today. Also, the 5th Biennial Meeting for the WHO GIEESC will take place on October 14-15, 2013 in Trinidad and Tobago. Registration is free of charge.
The WHO's clinical and policy guidelines report responding to violence against women has gotten tremendous attention by mass media, health providers, and policymakers around the globe. People are feeling the urgency of addressing violence against women, as they should.
It is just unfortunate that the WHO report neglected to offer guidelines on how health providers and policymakers in low-resource settings should actually go about treating and saving women from pandemic-levels of death and disability from violence.
In order to protect women and prevent such astounding morbidity and mortality, clinical and policy guidelines to respond to violence against women can not just focus on prevention, mental health services, and STI management. All of these are important, of course, but equipping frontline health providers with the training and tools to detect and best treat women that experienced injuries from violence is also a critical component, particularly necessary to care for women that are becoming victims at this very minute.
Just as treating patients with AIDS is as important as preventing the transmission of HIV, treating the acute needs of women that are victims of violence is as important as preventing violence against women.
If 42% of women experience injuries as a result of physical or sexual violence at the hands of a partner, and 38% of all murders of women globally are reported as being committed by their intimate partners, should WHO not recommend equipping health facilities that are most accessible to women at risk with the skilled health providers, emergency equipment, and capacities necessary to save their lives? To care for their wounds, burns, life-threatening injuries? To prevent and reduce disability?
Violence against women in many parts of the world often goes unrecognized, underreported, and neglected, particularly in low-resource settings that do not have adequate emergency and essential care capacities at primary or first-referral health centers to care for women experiencing violence, or anyone else, for that matter. Women that experience violence in these settings may not turn to law enforcement or other domestic violence-specific services or centers, whether they are near or far.
Since victims are most likely to interact with the health system for acute health needs, health providers are in the unique position to identify abuse and intervene before serious injury or death occurs. The WHO report recommendations also acknowledge that "as much as possible should be done during first contact, in case the woman does not return. Follow-up support, care, and the negotiation of safe and accessible means for follow-up consultation should be offered." Frontline health providers, like those in the emergency room or ones at primary or first-referral health facilities in LMICs, are an important contact with the victims of domestic violence, and timely identification and intervention can save lives.
The WHO report notes: "Ideally, women experiencing partner violence should be identified at the point of contact with health services, although these settings are not always conducive to providing such services." Perhaps it is true that these health settings are not "conducive to providing such services" right now, but it's imperative for the WHO and partners to support health ministries in building health systems that are suited to address violence against women and other emergency and primary care health issues.
Where is the WHO recommendation to build the capacity for emergency and essential trauma, surgical, obstetric, and anesthesia/resuscitation services for these women in primary, first-referral health centers?
Women must be able to access care and services at their most physically-accessible, first-referral health centers, where they are most likely to show up with acute needs after experiencing violence. This is why, in low-resource settings, first-referral health facilities are considered the optimal starting point for effective management of injury. These emergency or primary health centers are also more easily able to integrate care and provisions for women experiencing violence into their routine patient care and clinic services.
If the evidence shows that it's best to integrate emergency and essential surgical care, first-line and continued supports, emergency contraception, and STI laboratory and treatment services into primary, first-referral health facilities to address violence against women, where is the WHO recommendation urging the integration of these comprehensive services into LMICs' national health plans?
By neglecting to recommend or even note the importance of ensuring women's access to emergency and essential trauma and surgical care at first-referral health centers, the WHO missed a major opportunity to have a significant impact on policymakers interested in improving the care and lives of mothers, wives, daughters, sisters, and everyone related to them, particularly in ways that fit into their ongoing efforts to strengthen their national health plans and systems.
At the 66th World Health Assembly last month, I attended a panel with health ministers and representatives from Belgium, India, Mexico, Zambia, the USA, and the Netherlands on Addressing Violence Against Women. As mentioned in a previous post, each panelist briefly shared general progress and interest in addressing violence against women in their respective countries. Health ministry leaders' commitment to address violence against women is particularly important for building the momentum for real change on the ground.
Efforts to comprehensively address violence against women must be integrated into national health plans and social policies across sectors. Building the infrastructure (such as laboratory services and essential equipment/medicines supply chain) and capacity (such as training frontline providers to manage injuries, burns, and resuscitation) to deliver accessible acute care and support services to women that have experienced violence requires political leadership and financial investment. Delivering appropriate emergency services to survivors of violence at first-referral health facilities in resource-poor areas should be an integral component of a national health ministry's health systems strengthening agenda and budget. Strengthening emergency care systems and capabilities for local health facilities to serve women that are victims of violence requires political commitment from all levels.
Perhaps it is not politically correct for me to say this, but I write from my humble intern's perspective -- I am deeply disappointed that there is not more collaboration and communication among the many WHO programs/departments/units. I'm not sure what it will take, but this report brings light to one of the most important issues of our time, one that is particularly personally important to me. It is just unfortunate because the program with which I'm interning within the WHO, the Emergency and Essential Surgical Care (EESC) Program, would have easily been able to help support and fill major gaps in the report's clinical and policy recommendations.[2]
The Director General of the WHO, Dr. Margaret Chan, said in a recent statement, "We see that the world's health systems can and must do more for women who experience violence." Indeed, it is time we all do more to support health systems in caring for women.
---
[1] "About the report: The report was developed by WHO, the London School of Hygiene & Tropical Medicine and the South African Medical Research Council. It is the first systematic review and synthesis of the body of scientific data on the prevalence of two forms of violence against women – violence by an intimate partner and sexual violence by someone other than an intimate partner. It shows for the first time, aggregated global and regional prevalence estimates of these two forms of violence, generated using population data from all over the world that have been compiled in a systematic way. The report documents the effects of violence on women’s physical, mental, sexual and reproductive health. This was based on systematic reviews looking at data on the association between the different forms of violence considered and specific health outcomes." Source.
[2] The WHO EESC Program works directly with ministries of health in LMICs and other partners to advocate for leaders' commitment to a cross-cutting approach rooted in national health planning. The program focuses on integration of emergency medicine and essential surgical care, which includes caring for victims of domestic violence, into first-referral level, primary health care facilities, and the WHO EESC Program's Integrated Management for EESC toolkit includes the Emergency Trauma Care workshop and other useful tools for health providers and policymakers. Reducing death and disability from domestic violence is also a priority for WHO GIEESC members. If you are interested in partnering and collaborating to achieve quality, safe emergency and surgical care for people living in low-resource settings, I'd encourage you to consider joining the WHO GIEESC community today. Also, the 5th Biennial Meeting for the WHO GIEESC will take place on October 14-15, 2013 in Trinidad and Tobago. Registration is free of charge.
Monday, June 17, 2013
Work over the last couple weeks
Over the last couple weeks, we have been busy with a number of projects at the WHO Emergency and Essential Surgical Care (EESC) Program.
Most recently, I've been working on putting together a couple proposals, like one on training frontline health workers in emergency obstetric surgical care in Bihar, and another one on developing innovative EESC-eLearning tools to equip more trainees with these essential skills in low-resource settings.
We have also been preparing for my supervisor, Dr. Meena Cherian's upcoming Duty Travels. Dr. Cherian, directs the WHO EESC Program, for which she often travels to partner directly with Ministry of Health officials in low- and middle- income countries (LMICs) and work on national policies and programs to build health system capacity and deliver quality, integrated EESC.
This week, Dr. Cherian will be in Ghana with Ministry of Health officials, facilitating the WHO Emergency Trauma Care (ETC) Training of Trainers' workshop for government health providers and managers from across the country. The Emergency Trauma Care workshop is one of several important teaching tools in the WHO Integrated Management for Emergency and Essential Surgical Care (IMEESC) toolkit.
Experts among the WHO Global Initiative for Emergency and Essential Surgical Care (GIEESC) membership have developed and reviewed the content of WHO IMEESC toolkit, which includes guidance on policy, management, research for evidence based planning (WHO EESC Situation Analysis Tool and WHO EESC Global Database), training (including instructional videos), and monitoring and evaluation in low-resource settings. Access to clinical safety protocols to protect health workers and patients from HIV and infections, functional equipment, and medicines are also vital to improving emergency surgical, obstetric, trauma, and anaesthesia service delivery. The WHO IMEESC toolkit also includes essential equipment and anesthesia supply inventory lists, quality and safety tools, and best practices and standards to support emergency and essential surgical and anesthetic interventions and management at first-referral level health-care facilities in low-resource settings.
Preparations for the 5th Biennial Meeting for the WHO GIEESC, which will take place on October 14-15, 2013 in Trinidad and Tobago, are also in full swing here at the WHO Head Quarters.
Making emergency and essential surgical care a political priority within primary health care and universal health coverage in LMICs requires organizing multi-disciplinary stakeholders including policymakers, health providers, and media towards investment in research and sustainable EESC services.
Here's an excellent Global Pulse article that explains more about the WHO GIEESC, which was established in 2005 to facilitate collaborations and partnerships with health ministries, academia, NGOs, professional societies, and local and international experts to support surgical care systems in LMICs.
The WHO GIEESC Biennial Meeting brings together a global forum of stakeholders for improving basic surgical and emergency care and systems in low- and middle-income countries. This year, the WHO GIEESC Biennial Meeting will precede the World Congress of Surgery, Obstetrics, Trauma, and Anesthesia.
Dr. Cherian's Duty Travel to Ghana will also involve discussions with Ministry of Health officials on health systems strengthening and planning for comprehensive EESC.
Integrating surgical care initiatives in national health plans in LMICs requires both public and political commitment. The WHO EESC Program and its Global Initiative for EESC works with partners on efforts to build and achieve those commitments.
If you are interested in partnering and collaborating to achieve quality, safe emergency and surgical care for people living in low-resource settings, I'd encourage you to consider joining the WHO GIEESC community today.
Most recently, I've been working on putting together a couple proposals, like one on training frontline health workers in emergency obstetric surgical care in Bihar, and another one on developing innovative EESC-eLearning tools to equip more trainees with these essential skills in low-resource settings.
We have also been preparing for my supervisor, Dr. Meena Cherian's upcoming Duty Travels. Dr. Cherian, directs the WHO EESC Program, for which she often travels to partner directly with Ministry of Health officials in low- and middle- income countries (LMICs) and work on national policies and programs to build health system capacity and deliver quality, integrated EESC.
Why is this work important?
 |
| Source: http://www.who.int/surgery/en/ |
Integrating emergency and surgical care initiatives in low-resource settings is a critical and growing need to address pregnancy-related complications and injuries from road accidents, burns, and falls particularly among the aging population, which significantly contribute to death and disability. Health systems in LMICs are further strained during disasters, when communities’ acute needs add to the existing burden of obstetric and other surgical conditions. Surgically-treatable blindness, diabetes-related wound care and amputations, tropical diseases like Buruli ulcer and filariasis, and female genital mutilation also require safe surgical care.
Experts among the WHO Global Initiative for Emergency and Essential Surgical Care (GIEESC) membership have developed and reviewed the content of WHO IMEESC toolkit, which includes guidance on policy, management, research for evidence based planning (WHO EESC Situation Analysis Tool and WHO EESC Global Database), training (including instructional videos), and monitoring and evaluation in low-resource settings. Access to clinical safety protocols to protect health workers and patients from HIV and infections, functional equipment, and medicines are also vital to improving emergency surgical, obstetric, trauma, and anaesthesia service delivery. The WHO IMEESC toolkit also includes essential equipment and anesthesia supply inventory lists, quality and safety tools, and best practices and standards to support emergency and essential surgical and anesthetic interventions and management at first-referral level health-care facilities in low-resource settings.
Preparations for the 5th Biennial Meeting for the WHO GIEESC, which will take place on October 14-15, 2013 in Trinidad and Tobago, are also in full swing here at the WHO Head Quarters.
Making emergency and essential surgical care a political priority within primary health care and universal health coverage in LMICs requires organizing multi-disciplinary stakeholders including policymakers, health providers, and media towards investment in research and sustainable EESC services.
Here's an excellent Global Pulse article that explains more about the WHO GIEESC, which was established in 2005 to facilitate collaborations and partnerships with health ministries, academia, NGOs, professional societies, and local and international experts to support surgical care systems in LMICs.
The WHO GIEESC Biennial Meeting brings together a global forum of stakeholders for improving basic surgical and emergency care and systems in low- and middle-income countries. This year, the WHO GIEESC Biennial Meeting will precede the World Congress of Surgery, Obstetrics, Trauma, and Anesthesia.
Dr. Cherian's Duty Travel to Ghana will also involve discussions with Ministry of Health officials on health systems strengthening and planning for comprehensive EESC.
Integrating surgical care initiatives in national health plans in LMICs requires both public and political commitment. The WHO EESC Program and its Global Initiative for EESC works with partners on efforts to build and achieve those commitments.
If you are interested in partnering and collaborating to achieve quality, safe emergency and surgical care for people living in low-resource settings, I'd encourage you to consider joining the WHO GIEESC community today.
Sunday, June 16, 2013
Weekend Trips -- A Series of Touristy Posts: Part 3
Chamonix -- Mont Blanc
On June 15, a group of my favorite fellow interns from WHO/UN and I traveled to France to visit the beautiful town of Chamonix and Mont Blanc, the highest mountain in the European Union.
Here are some photos that capture the specialness of this place and our time there.
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| All of these awesome photos are courtesy of Chenxi Yu. |
Monday, June 3, 2013
Weekend Trips -- A Series of Touristy Posts: Part 2
Cailler Chocolate Factory - Charmey - Kandersteg - Oeschinen Lake - Thun
On the weekend of June 1-2, a few interns, including Braveen Ragunanthan and Adrian Diaz, who are also fellow medical students at Virginia Commonwealth University School of Medicine (Medical College of Virginia), and I were lucky to join a bus full of friendly WHO officers and staff for their HOPE Team Trip to Kandersteg.
Our first stop along the way was my favorite: the Cailler Chocolate Factory.
After tasting the delicious chocolates, we stopped in the scenic town of Charmey. We then arrived in Kandersteg, and stayed at Kandersteg International Scout Centre (KISC).
After dinner at KISC, a group of us joined the rest of the Kandersteg townsfolk as they hosted a huge Swiss brass band music festival, where 1800 musicians and 50 bands were expected.
The next morning, after breakfast at the KISC, we took the cable car up to Oeschinen Lake. Though the rain and fog kept us from seeing the mountain or lake, postcards sold at the local souvenir shop (or a google image search) made it clear that we were in the midst of some of nature's finest beauty, even if we could not see it with our eyes. And as we hiked down the mountain, the fog started to lift, and we were privileged to behold some of the natural beauty all around us.
We then visited the town of Thun.
And there, the sunshine finally joined us as we enjoyed the scenes along the boardwalk.
On the weekend of June 1-2, a few interns, including Braveen Ragunanthan and Adrian Diaz, who are also fellow medical students at Virginia Commonwealth University School of Medicine (Medical College of Virginia), and I were lucky to join a bus full of friendly WHO officers and staff for their HOPE Team Trip to Kandersteg.
Our first stop along the way was my favorite: the Cailler Chocolate Factory.
 |
| Photo Courtesy of Braveen Ragunanthan |
The next morning, after breakfast at the KISC, we took the cable car up to Oeschinen Lake. Though the rain and fog kept us from seeing the mountain or lake, postcards sold at the local souvenir shop (or a google image search) made it clear that we were in the midst of some of nature's finest beauty, even if we could not see it with our eyes. And as we hiked down the mountain, the fog started to lift, and we were privileged to behold some of the natural beauty all around us.
 |
| Photo Courtesy of Braveen Ragunanthan |
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