Book Report: House on Fire

I am a part of a global health bookclub and we just finished reading House On Fire by William Foege (a global health guru!) which is about the eradication of smallpox.

The book is compelling, well written, and captivating. It is largely set in India during a several-month-long effort in the 1970’s to find and treat smallpox cases, vaccinate those close to the patients, and convince authorities that the novel plan would work.

We talked a lot about one quote in the book….

People with wealth and education in a country like the United States can read about a new idea in the New York Times in the morning and be applying it in the afternoon. Those without education or money, whether in the United States or in Africa, cannot. Lacking the resources to change their future, they fall prey to a certain fatalism. Through the years I have come to see fatalism, the assumption that you can’t really change your future, as one of the great challenges in global public health.

We talked a lot about how fatalism isn’t a challenge just to public health but to all advancement, development, and positive growth and change. What do you think? IS fatalism the great challenge?

Is the antidote to fatalism optimism? If so, how do we grow and share our optimism? How can optimism overtake the fatalism to allow for a growth mindset? What has worked for you?

Book Report: The Betrayal of Trust

The Betrayal of Trust, by Laurie Garrett, is another must-read for those of you who have a deep interest in global public health and a deeper interest in wanting to see improvements in the practice of public health.

First, praise for Laurie Garrett as an author. Her writing is compelling. She weaves beautiful stories out of tragedy and paints a picture with her carefully chosen words. I have read other books by Garrett and will keep coming back for more. I did not mind the length of the book, coming in at a hefty 768 pages, but then again, I am an avid reader and this is my field of interest.

Garrett outlines how public health interventions, such as the public supply of clean water, have brought us this far. We are living longer than our ancestors and, arguably, we are living “better”. However, she posits that the world’s public health organizations are in a woeful state with disastrous preparation for “the BIG one”. Collectively and globally, she warns of a lack of preparedness of public health agencies. However, the public health agencies, as underfunded and resourced as they are, are our best defense against microbial threats (through efforts to vaccinate large swaths of the pubic, maintenance of sanitation systems, and responses to actual or perceived threats).

In each chapter, she dissects a different public health threat….

  • The first chapter investigates the pneumonic plague panic of 1994 in India.
  • The second chapter scrutinizes the Congolese Ebola epidemic of 1995.
  • The third chapter documents the collapse of Soviet/Russian public health, with particular attention to drug-resistant tuberculosis.
  • The fourth describes the decline of public health efforts in the US under its `managed care’ and `medicine for profit’ health system.
  • The fifth chapter is titled “Biowar”.
  • And the last chapter is Garrett’s epilogue.

She builds the case that we need public health not only to stay safe and healthy now, but to ensure that we are ready for a superbug, a biological threat, and even to ensure that our water supply stays clean. Public health so often functions in the shadows….we are the ones who count disease, who test the water, who make sure your food is safe, and who occasionally remind you to get vaccinated. It is the work that helps to build optimism around the elimination of polio or smallpox. And, importantly to me, that work, builds equality and cuts through some of the injustices we see in our world. So, the next time you hear about funding to the CDC being cut or funding to your local health department being diverted, pick up the phone and call your representative to protest. We need public health!

UNICEF Maldives: Adolescent HIV Prevention

I just wrapped up work with UNICEF and the Ministry of Health in the Maldives to train health care workers on adolescent HIV prevention.

The main struggle that many health care workers in the Maldives face is a tension between their personal beliefs, prevailing religious beliefs, what is legal, what is moral, what the community expects, and what the young person thinks is best. We worked together over the course of the week to build their skills to communicate with young people about HIV and reproductive health, to build a foundation for this work on a human rights platform, and to carefully examine the role they can play to advocate for young people in their communities.

I was also advised that talking about these topics–HIV, sex, reproduction, drug use, and homosexuality, among others–was highly taboo. I thought long and hard about how to ease the participants into the subjects and build their trust in me. One of the strategies I used was to have several activities where they responded to “taboo” questions anonymously. For example, I put several fishbowls at the front of the room and asked them to answer the questions taped to the front with a paper that only said “yes” or “no”.

During the break, I tallied their responses and posted the results. I did take a calculated risk that these figured would come out as I thought they would. For my purpose was to try to build empathy and compassion–as we discussed these topics, I wanted each person to recognize that despite the “taboo” nature of these topics, nearly everyone was affected by them.

Nearly everywhere in the world, young people rarely come to health centers for preventative care, advice, or tools to keep healthy. As such, we also focused on building their skills in community outreach and assessment. I was able to then go and support some of the health care workers as they started their community-based work.

Late in the curriculum development stage, it dawned on me that this training opportunity could give the participants a chance to develop their community interventions. So, I did a lot of shuffling around and restructured the training. I am so glad that I did! On day one, I split the participants into groups that would work together throughout the course of the week. They had to dive deep into one “key population” (knowing that one person can often “fit” into several “populations”) and prepare a presentation that they would deliver on the fifth day along with their proposed intervention. On day two, we focused on human rights and the need for adolescent-friendly health services. In their groups, they examined ways in which the health system does and does not uphold the rights of young people. On day three, they spent the day in their groups practicing community-based-participatory research methods for them to get to know the young people in their communities. On day four, we practiced motivational interviewing all day and they practiced with scenarios that would be relevant to those in their key populations. Finally, on day five, they presented their work from the week to the rest of the participants along with a suggested intervention that they could implement with minimal need for support/funding or resources outside of what they currently have.

In organizing the training like this, they were able to immediately put their learnings into practice and make the lessons immediately applicable to their lives at home. Plus, they came up with great interventions on their own which will serve to build their commitment to their work.

At the very end of the training, I asked the groups to envision an ideal world, one where their work is successful, where human rights are upheld, and where young people are respected. Here is a representation of their work…

To say it was a great training might be an understatement. It was amazing.

You can read more about it on the UNICEF Maldives website.

As always, I am open to new contracts and to working together. Please let me know how I can help you to build effective, exciting, and practice-based trainings.

Global Health Tidbits

The very, very exciting news of the week is about the so-called London Patient who is, for all intents and purposes, cured of HIV. Doctors and researchers closest to the case are wary to use that term, preferring “remission” instead of “cure”.

I have been working in HIV education, testing, and advocacy since 2001 or so. I am an optimist by nature, but in thinking back to the dark ages, I am not sure I would have believed that we would see this in our lifetimes. And thank goodness we have!

I am hopeful that we can talk about a true, wide-spread cure for all who are living with HIV. In the meantime, let’s deploy what we know works. Let’s strengthen health systems and fight for equality (as HIV affects minorities and the impoverished at far greater rates than would be expected based on population alone). This push for equality extends to immigration, ensuring rights and freedoms to LGBTQ populations and to women, and to holding our government accountable.

In another bright spot, this article highlights the results of a home HIV testing and subsequent treatment program in Southern Africa. Check out the reductions in new infections! I love community-based programs. They work!

Finally, big congrats to my colleagues at PIVOT! This article highlights their great, data-driven work that has had some amazing results. I worked at PIVOT a few years ago on a leadership training–delighted to see old friends in the pictures in the articles!

Global Health Tidbits

Here’s what I’ve been reading about this week…how about you? What’s been the most interesting thing you’ve learned this week?

Acquiescence, Broken Trust and Water Safety in Healthcare Facilities

This was a fascinating and quick read! To sum up, researchers were looking into WASH and were curious about why providers stopped checking to see if they had running water in their facility.

So, the question must be asked—why would these talented, dedicated clinicians stop checking for water and accept water shortage as the norm? One explanation is that it is a coping mechanism that is part of the human condition. Social psychologist Dr. John Jost argues that this phenomenon is routed in system justification, defined as a “psychological processes contributing to the preservation of existing social arrangements.” In his research, Jost finds that people working in low resource settings tend to accept the status quo more often than people with more resources, even if the current conditions go against their own interest. Expanding on Jost’s work, organizational psychologist Adam Grant writes that acquiescence, whether conscious or unconscious, “robs us of the moral outrage to stand against injustice and the creative will to consider alternative ways that the world could work.”

What do you think about that? Do people living in low resource settings accept the status quo more often than people with more resources? I have seen this phenomenon from time to time but I have also seen the opposite–amazing resourcefulness and a desire for something more. Whenever I have seen great activism and a demand for better services, it usually comes with a group that has built trust over time, though.

Are HIV Initiatives Putting Single Mothers Last?

How about this line:

…stop solely blaming patients for difficulties existing in their maintaining consistent treatment and care, and examine how the biases of the medical community are contributing to these inconsistencies.
This failure is also driving single HIV-positive mothers living below the poverty line, who are experiencing co-morbidities relating to their HIV, to fall through the cracks of the current treatment paradigm. These women experience extreme difficulty getting into and staying retained in clinical studies and maintaining medical appointments. In many cases, this is due to clearly defined barriers: transportation, lack of childcare, conflicting schedules, and a lack of support from an economy allotting just enough to survive but not the dignity needed to surpass mere existence.

HIV care, like so many other chronic illnesses, needs a wholistic approach that takes into consideration the life that a person lives–and in this instance, the lives her children lead.

What have you seen in terms of great, supportive, wholistic HIV care?

The deadly truth about a world built for men – from stab vests to
car crashes

This got me super fired up! I’ve long known about the problems around the exclusion of women from medical trials. But this long list of other things that aren’t built for us? Including cars, seat belts, bullet proof vests, phones, the right temperature of our offices! Oh, I am getting fired up just typing this list again. The exclusion of the perspective of women has a huge price (they site that women are 3x more likely to suffer whiplash from a car accident than man because—cars aren’t built with us in mind!).

The article ends with a call to action for designers, but I think that call to action applies to all of us. Ensure that your work takes women into account. Please and thank you.

Bill Jenkins, Who Tried to Halt Tuskegee Syphilis Study, Dies at 73

I always love a story of a good activist. This does not disappoint. Bill Jenkins spoke up when he saw the moral failings of the Tuskegee experiments. And he spoke truth to power. Again and Again. And thanks to his persistence, this egregious abuse ended.

What have YOU been reading about this week?

Experts in their Own Lives

I’ve been working in the Maldives with UNICEF since December on an adolescent HIV prevention project.

I will write more soon, but in the meantime, the main take-away for the participants seems to be…”Adolescents are the expert in their own lives”. They are using that as shorthand to indicate when adults should trust young people. They use it to show that adults should listen to young people. And they certainly have used it to envision a better future!

As always, I am open to new contracts and to working together. Please let me know how I can help you to build effective, exciting, and practice-based trainings.

State of the Union: When Someone Shows You Who They Are, Believe Them

In last night’s State of the Union, 45 announced his administrations plan to end all new transmissions of HIV by 2030.

He said, “in recent years we have made remarkable progress in the fight against HIV and AIDS. Scientific breakthroughs have brought a once-distant dream within reach. My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years. Together, we will defeat AIDS in America and beyond.”

I hope this comes true. It CAN come true. We have so many tools at our disposal that aren’t being used to their fullest potential.

Only about 1/2 of those living with HIV in the US are virologically suppressed. To be virologically suppressed means that the virus is literally undetectable in the blood. If there is no virus circulating, there is no virus to be transmitted. So, obviously, more people need to be on treatment, more people need better follow up, and more people need to get the help that they need to take their meds. Those who are affected by HIV are more likely to be marginalized in some way–predictors of people not taking their meds are what makes folks marginalized–homelessness, impoverishment, joblessness, etc. HIV prevention must take our social environment into consideration.

To give another example, PrEP, which can be given to someone who is at risk of contracting HIV works tremendously well. But, right now, very few people who need it most are getting it.

Color me skeptical for 45s actions speak louder than words. When someone shows you who they are, believe them.

Right now, more than 1 million Americans are currently living with HIV. The effort to end new infections by 2030 will require massive prevention efforts and better treatment for those living with HIV.

It would be amazing.

If successful, the United States will, “become a country where the spread of HIV has been effectively halted, because every American with HIV/AIDS is receiving treatment and every American at risk for HIV is engaged in the right, proven prevention strategy,” said US Health and Human Services Secretary, Alex Azar II.

If this is to come true, which, ohmygoodness, I hope for, it requires backpedaling on 45’s own policies, an end to his horrifically sexist, homophobic, and abusive policies.

It has long been shown that stigma and discrimination are connected to increased HIV rates. Right now, in this country a man between the ages of 13-29 who has sex with men gets infected every 44 minutes. Right now, in this country, 45’s has fueled the flames of discrimination against …45 said “I’m just not in favor of gay marriage”. His administration almost immediately removed all mention of LGBT issues from the White House website; his administration even removed an apology on the State Department website written by John Kerry about the discrimination against the LGBT population.

Right now, in this country trans people are already at high risk of HIV because of the stigma that they face. Stigma that comes from 45 is in the form of a ban of trans people serving in the military and an effort to peel back rights for trans kids in school.

45 has tried to repeal the Affordable Care Act and slash Medicaid. HOW do you improve the health care of 1 million HIV infected Americans so that they are virologically suppressed, healthy, and break the chain of infections without affordable and accessible health care?

He’s sought to put an end to fetal tissue research which could put an end to HIV and cancers. He allowed the AIDS czar position to be vacant for much of his time in office.

This post has become a rant, I fear. It is high time we put an end to HIV. To do so requires every tool we have, a supportive environment, and that we take care of each other.

To end, this is the picture of “the chief architects of the plan” who are advising 45 on the plan. Do you see someone who is missing? Do see anything problematic with this picture?

It is high time we all speak up…because we CAN put an end to HIV. I need to be heard, you need to be heard, and everyone who is affected (i.e. just about every single one of us) needs to be heard, respected, and validated.

Book Report: Getting to Yes

Getting to Yes: Negotiating Agreement without Giving In by Robert Fisher is a classic. It was first published in 1981 and reissued ten years later.  Here is a PDF of the book for easy reading (and sharing!).

If you are about to ask for a raise, promotion, or buy a used car, this book is for you!

Getting to Yes offers a framework for “principled negotiation” for two or more parties to work together to best address their mutual interests with creative, objectively fair solutions.

In many ways, the method of “getting to yes” is similar to the practice of nonviolent communication.  The goal is to remain neutral and objective while negotiating; Fisher uses the expression “separating the people from the problem” to describe it.  Another element of the models encourages a focusing the negotiation on interests at hand.  Unlike typical visions of hard-headed negotiations, this element encourages thoughtful questioning of the rationale behind positions instead of a quick response which may be presumptuous or charged.

The stand-out element, for me, in this model is the process by which the parties are encouraged to brainstorm possible options for mutual gain.  The book offers suggestions for how to encourage looking a problems from varied perspectives and even suggesting outlandish options to encourage generation of more logical ones.

Fishers partner, William Ury, has a (well done) 30-video that covers the basics of the model.  Check it out!

Book Report-Eat the Frog


If you are anything like me, you constantly fight the bad habit of scrolling through social media and emails first thing in the morning.  I like starting my workday with a sense of feeling up-to-date; the downside, of course, is that my email can dictate what I accomplish for the day as opposed to my prioritized to-do list….and there is a hack for that!

I recently did a training for a group of senior leaders who wanted to generate some ideas and brainstorming about how they, as a group, could set some norms around productivity.  They have the mindset that if everyone followed some of the same guidelines, it would be a whole lot easier for everyone. For example, they were considering having so called “quiet periods” where emailing each other and setting meetings were off limits so that they could all chip away at their to-do lists and accomplish some of their bigger projects.

Before the training, I did some more reading to help them along with their brainstorming. I landed on the book Eat That Frog!: Twenty-one Great Ways to Stop Procrastinating and Get More Done in Less Time by Brian Tracey.  

The title comes from the brilliant Mark Twain who (may or may not have) said “If your job is to eat a frog, eat it first thing in the morning, and if your job is to eat two frogs, eat the big one first.”

Tracey encourages readers to stop multi-tasking and stop spending time on fruitless tasks (even if they are ticks off of a to-do list). What he encourages is a mindfulness, although he doesn’t call it that, about how we spend our time, what we wish to accomplish, and why.

The main premise is built on the Eisenhower method, which is also similar to a favorite from The Seven Habits of Highly Effective People.

Consider all that you have to get done and then put each item into one of the following categories:

Things you don’t want to do, but actually need to do.
Things you want to do and actually need to do.
Things you want to do, but actually don’t need to do.
Things you don’t want to do, and actually don’t need to do.

Your “frog” is in the first category. It is the challenging task, it is the one that can be hard to be motivated to do, it is the one that you desperately want to put off.

Once you know what your “frog” is…the next step is to take action. Like many other productivity experts, Tracey suggests breaking down the “frog” task into multiple small “chunks” of work. He suggests that the endorphin rush you get from ticking off your to-do list is a motivator in and of itself (he does not cite any evidence for his claim). I can’t fight that notion that once the big, ugly task is over, the rest of the day can feel like a cakewalk!

As a fun reminder to tackle their frogs, I got everyone in the training these little froggies to keep at their desk.

What are some of YOUR favorite productivity hacks?


Book Report: Feminist Fight Club

Not only did I read Feminist Fight Club, I was a founding member of a club! So, to say that I am a fan is an understatement.

This book is deemed the “Lean In for the Buzzfeed Generation”.  The aspects of Lean In that didn’t resonate for me (the assumed wealth, position, and even ability to organized one’s own schedule) are all absent from this book. It is part guidebook for establishing ourselves professionally, helping to raise up women around us, and a troubleshooting resource for pay negotiation, office politics, and the like.

It is cheeky. It is irreverent. And it is so unlike so many other career management books (ie: written for women and by a woman), it is focused on advice for those early in their careers.  It will likely not be the best advice for those of you who are even in your 30s.  I found the advice to be not-quite-fitting for me, but wished I read it when I was 22. For those of you who are well into your career, consider giving this as a gift to a younger woman. For those of you who are early in your career–get this book, talk about it with your friends, gift it to someone else, and in a few more years, read Lean In.