Commentary: Women and the Zika Virus

Image from www.nytimes.com

With the rapid spread of Zika virus in Brazil and the links to complications in newborns, the World Health Organization has stated that the situation meets the conditions for a Public Health Emergency of International Concern. Due to the serious nature of the virus, Partners in Health Canada recently discussed with Dr. Joia Mukherjee, Partner In Health’s chief medical officer and a renowned infectious disease expert, to get the “need to know”. Dr. Mukherjee discussed how there are many unknowns, such as how little is known about the effects of the Zika virus on newborns.

While many organizations expand access to innovative women's health services, women in poor communities too often lack access to family planning tools. Clinics are too far away, fees for obtaining medical care are too high, and transportation costs are beyond their means. If family planning services were available to all women who want them, maternal mortality in poor countries could be dramatically reduced. This has serious implications for the women and children who are infected with the Zika virus.

So while there is some understanding of birth defects on children, something to consider is that there is even less known about the effects on the child-rearing mothers after birth.

While short-term symptoms of the Zika virus disease can include: fever, rash, joint pain, and red eyes, for both men and women, the long-term effects are not well-known. In addition to unknown physical implications on child-rearing women, it is important to consider implications in other domains.

For example, raising a child with birth defects in a developing nation can have implications for the mental health and well-being of the mother. And how will these potential mental health implications play out at the population level? If there is an effect, will this play into the health of generations to come?

So if the best thing for young women in Brazil to do is avoid pregnancy at this time, what about the implications on reproductive rights? In Brazil, abortions are not encouraged amongst pregnant women, however now that there is an outbreak, how will this impede on the abortion debate and the care provided to women?

The aforementioned questions raised should be considered in shaping development work and priorities in upcoming months in contributing to women’s health, given the extensive impact of the Zika virus in impacted countries.

Winter came... Were you PREPARED?

Toronto and the GTA continues to welcome warmer than usual temperatures. When we officially welcomed winter during last year's holiday season, we didn't see much snow. We’ve continued to gear up accordingly with flu shots, vitamins and warm clothing.  But are we prepared to respond to an emergency as a family? Are we prepared to care for our families in such emergencies that present in the immediate environment? It is important that those families affected be able to support each other for up to 72 hours after an emergency as the time for incident response may vary (1).

It all begins with knowing! Only then can you create a plan and finally produce an emergency kit.

Environmental emergencies can range from winter storms to spring floods. Consider the following example of a winter snow storm that overwhelms the local region’s ability to react competently. The massive snow fall cuts out electricity/power to various neighbourhoods. Additionally, the heavy weather conditions make it difficult for securing safety in shelters and attaining additional resources.

Are you prepared to care for your family members in these circumstances?

Since emergencies will vary by region, severity and form, your preparedness begins with getting to know what you are locally susceptible to. Visit the getprepared.ca website and connect with applicable social media platforms such as Twitter (@Get_Prepared) for LIVE updates (1). Our provinces take charge of the response to emergencies and here in Ontario with the exception for Pandemic Influenza, Emergency Management Ontario will mobilize its resources to protect the health of communities (2).

Your next step is to “make a plan”! Why make a plan? If you’d like to ensure the safety and wellness of your family, it is imperative that you make a plan. You can create your individualized emergency preparedness action plan by using the beprepared.emergencymanagementontario.ca platform. The website will help you create a plan that’s tailored for you and your loved ones. Consider the aforementioned situation and that you own a pet? It’s important to note that emergency shelters may not take in pets. So do you know of appropriate assistance programs? In addition to this, if you’re unable to contact a family member; is he or she aware of the safe meeting place location that everyone picked in advance? These are all important informed decisions to be made when one is not in crisis. (3)   

Once you’ve prepared yourself you must create an emergency kit that’s capable of supporting your entire family. For an entire list of contents, use the following LINK. Take a few minutes to watch this short video on building an emergency kit. Such a checklist is crucial to surviving an emergency. For example, the emergency kit may instruct you to get 4 liters of bottled water per person per day. Remember that you need to make this kit viable for 72 hours. (4) These preparedness tools will ensure that your social unit is fully equipped to handle an emergency situation. Use the same virtual resource to sign up for alerts in the region to keep you informed. (5)

 Your health and that of your family members is very important! During an emergency this is directly proportional to your level of preparedness. So be prepared!

                                                                                        

   References

(1) Government of Canada. (2015, December 25). Home - Hazards and Emergencies - Regional Hazards - Ontario. Retrieved from Get Prepared: http://www.getprepared.gc.ca/cnt/hzd/rgnl/on-en.aspx

(2) Government of Canada. (2015, December 25). Your Emergency Preparedness Guide. Retrieved from Get Prepared: http://www.getprepared.gc.ca/cnt/rsrcs/pblctns/yprprdnssgd/index-en.aspx#s1

(3) Ministry of Community Safety and Correctional Services. (2015, December 25). Be Informed. Retrieved from Be Prepared: http://www.emergencymanagementontario.ca/english/beprepared/Step3BeInformed/Step3_be_informed.html

(4) Ministry of Community Safety and Correctional Services. (2015, December 25). Be Prepared. Retrieved from Emergency Management Ontario: http://www.emergencymanagementontario.ca/english/beprepared/Step1MakeAPlan/Step1_make_a_plan.html

(5) Ministry of Community Safety and Correctional Services. (2015, December 25). Build a Kit. Retrieved from Be Prepared: http://www.emergencymanagementontario.ca/english/beprepared/Step2BuildAKit/Step2_build_a_kit.html

Human Trafficking: Do You Really See Me?

Theresa Flores is a human trafficking survivor.¹ If you have not watched her TED Talk², I urge you to do so now.  

As I listened to her heartbreaking story, I was overcome by three terrifying realities:

1)      at some point in my life, and without knowing it, it’s possible that I lived next to, went to school with, or worked with someone who was being trafficked.
2)      many of us are clueless about domestic trafficking within our own communities.
3)      human trafficking does not just affect its victims. From a health perspective, it has the potential to harm whole communities.

The International Labor Organization (ILO) estimates that globally, about 21 million children, women, and men are victims of human trafficking (2012).³ These ILO statistics show the most vulnerable populations, business sectors where exploitation is most prevalent, and the illegal profits annually earned by traffickers.⁴

The Institute for Trafficked, Exploited & Missing Persons (ITEMP) states that 100,000 children in the U.S. are trafficked each year, and 1,000 between the ages of 13 and 17 are trafficked internationally.⁵

Let’s look at trafficking from a health perspective using a fictional victim named Anna. While being trafficked across state lines to a brothel for sex work, Anna contracts TB disease that becomes active, but goes undiagnosed and untreated.

She is in contact with other workers, 10-20 clients daily, and periodically frequents public venues, all the while talking, coughing, and sneezing.  She is also likely having occasional unprotected sex.

Anna’s clients could be single, married, with children, and have jobs. How many people will eventually be infected with, and spread, TB disease and STDs? What happens when those with active TB disease travel (via cars, trains, planes, buses) to other cities and states without a proper diagnosis and treatment? How much would it cost each community to test and treat patients, and trace the origin and spread of the disease?

Theresa’s story made me ask myself these questions:

- Why are so many of us ill-informed about domestic human trafficking?

- Would I know where to find the resources to help them?

- Would I recognize the less obvious signs of a trafficking victim?

The Ohio Human Trafficking Task Force’s June 27, 2012 report highlighted something crucial -  domestic human trafficking has flown under the radar for a long time, because much of the data (especially at the federal level) has, for years, been more focused on international human trafficking.⁶ As such, many of us may associate human trafficking with foreign nationals being shipped against their will across borders and state lines, without considering the possibility of our neighbors, family, and friends becoming victims of this illegal trade. In addition, as seen in Theresa’s case, many believe that these young women choose to become prostitutes, and as such, they cannot be trafficking victims.

The Ohio Department of Health⁷ states that, “Ohio has ranked as high as fifth among all states in total reported human trafficking cases with Toledo being identified as the fourth highest ranking city in the nation for recruiting victims into the illegal trade (2016).” Fortunately, Ohio now has various organizations that: (i) research the prevalence of domestic trafficking, (ii) provide resources to raise awareness, and (iii) provide services for victims and survivors.

To name a few, organizations like the Central Ohio Rescue and Restore Coalition⁸ and the Ohio National Human Trafficking Resource Center⁹ work with service providers and other professionals, law enforcement, and volunteers, etc by offering education, training, advocacy, and legal representation. Nonprofits like The Daughter Project¹⁰ and Grace Haven¹¹ offer rehabilitative group homes for trafficking victims (girls). Others like Freedom A La Carte¹² give survivors training and jobs, which is critical for their integration back into society.

Local citizens can get access to these resources at their local library, online, or from departments that offer human services, and be a part of the process in raising awareness, while providing support for victims and survivors.

There is one absolute truth that we cannot ignore – anyone can be a victim of human trafficking. Anna could be you or me. It just takes the wrong person to see the right circumstances and opportunity to destroy your life.

References

1.      TraffickFree – About TraffickFree (2016). Retrieved February 16, 2016: https://www.traffickfree.com/about.php 

2.      TEDx Columbus – Theresa Flores – Find a Voice with Soap (2011). Retrieved February 16, 2016: https://www.youtube.com/watch?v=5QW_nsAjweE

3.      Forced Labor, Human Trafficking, and Slavery. (2012). Retrieved February 16, 2016: http://www.ilo.org/global/topics/forced-labour/lang--en/index.htm

4.      Statistics and Indicators on Forced Labor and Trafficking. (2012). Retrieved February 17, 2016: http://www.ilo.org/global/topics/forced-labour/policy-areas/statistics/lang--en/index.htm

5.      Institute for Trafficked, Exploited & Missing Persons (ITEMP) (2016). Retrieved February 19, 2016: http://www.itemp.org/humantrafficking101/humantraffickingfacts.html

6.      The Ohio Human Trafficking Task Force (2012). Retrieved February 18, 2016: http://humantrafficking.ohio.gov/OhioHumanTraffickingTaskforce.aspx

7.      Ohio Department of Health – Human Trafficking Resources (2016). Retrieved February 18, 2016: http://www.healthy.ohio.gov/sadv/htraffick.aspx

8.      Central Ohio Rescue and Restore Coalition (2016). Retrieved February 18, 2016: http://www.centralohiorescueandrestore.org/

9.      Ohio National Human Trafficking Resource Center (2016). Retrieved February 18, 2016: https://traffickingresourcecenter.org/state/ohio

10.  The Daughter Project (2016). Retrieved February 18, 2016: http://thedaughterproject.org/#/welcome

11.  Grace Haven (2016). Retrieved February 18, 2016: http://gracehaven.me/

12.  Freedom A La Carte (2016). Retrieved February 13, 2016: http://freedomalacart.org/news/

Image

The Medina County Coalition Against Human Trafficking. (2015). Human Trafficking By The Numbers [Image], Retrieved February 19, 2016: https://traffickjamming.wordpress.com/2015/06/24/june-2015-meeting-agenda/

The case of OJ vs. the Orange; The jury trial

Your honor... Today this glass of orange juice or OJ you see before you is on trial for causing several humans to become overweight. Take this boy, Tommy for example. He’s 12 years old and doctors have prescribed more physical exertion to bring his body weight to a healthier level. Tommy would consume about 2 glasses of orange juice every morning. Generally, juices are full of free sugar (glucose, fructose, sucrose etc.) which are often added by the manufacturer to enhance flavor. According to a Press Release dated 4^th March 2015, the World Health Organization outlined a guideline recommending adults and children to reduce their daily intake of free sugar to less than 10% of their total energy intake (1).

Consider Tommy’s breakfast table...On one end is an orange and on the other is a glass of orange juice.

Constituents	OJ/Orange Juice (100ml)	The Orange (Fruit diameter: 8 inches)
Calories	47	62
Sugar	8.81 grams	12.25 grams
Dietary Fibre	0.2 grams	3.1 grams
% of Recommended Daily Intake	4%	3%

The Orange is roughly 8 inches in diameter, a proportionate fruit carrying 62 calories, 3.1g of fiber and 12.25g of sugar (2). The glass holds 100ml of Orange juice carrying 8.81g of sugar, 0.2g of dietary fiber and 47 calories (3). Now the brand of the juice has a direct impact on the exact caloric constituents. Given the above stated values, one could assume that after consuming one orange you are more likely to feel fuller. On the other hand after one 100ml glass of orange juice, you are more likely to seek out the fridge for a second serving.

So it’s like that at breakfast Tommy could have just one orange which makes up for 3% of his Recommended Daily Intake (RDI) (2). Or he could have about two 100ml glasses of orange juice which accumulates to 4% of his RDI (3). It is important to note that we are still referring to his breakfast table and that additional juice may be consumed at lunch and dinner. However the juice is more accessible and easy to consume. The orange on the other hand requires peeling and additional preparation.

The director of the World Health Organization’s Department of Nutrition for Health and Development had this to say about free sugars...

“We have solid evidence that keeping intake of free sugars to less than 10% of total energy intake reduces the risk of overweight, obesity and tooth decay,” (4)

As human beings we have a tendency to assume that “more” is always better. This is not always the case. Too much of anything is not great for your body. In fact your mantra should be “everything in moderation”. Take sugar for example, too much of sugar in your diet can increase your risk of becoming overweight. This in turn may result in chain reactions that could lead to Type II Diabetes, Atherosclerotic heart disease or a predilection for cancerous outcomes. The orange in its natural state harbors additional constituents such as fiber etc that aid your digestive system’s motility while facilitating a gradual absorption of sugar.

This case is a bit murky, that I am aware of. The choice remains among individuals like Tommy who may go for the healthier fruit option or go for the more accessible glass of OJ. Statistics even show that with increasing age, the consumption of sweetened drinks increases among children and young adults (4). Given this trend and all this information, the question remains... Is there enough evidence to find this glass of OJ guilty?

References

(1) World Health Organization. (2015, November 26). Media Centre; WHO calls on countries to reduce sugars intake among adults and children. Retrieved from World Health Organization : http://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/

(2) Fatsecret . (2015, November 26). 1 Fruit Orange. Retrieved from Fatsecret: http://www.fatsecret.com/calories-nutrition/usda/oranges%3Fportionid%3D33208

(3) Fatsecret. (2015, November 26). 100ml Orange Juice . Retrieved from Fatsecret: http://www.fatsecret.com/calories-nutrition/usda/orange-juice?portionid=1137131&portionamount=100.000

(4) Home - Health Reports - Beverage consumption of children and teens. (2015, November 27). Retrieved from Statistics Canada: http://www.statcan.gc.ca/pub/82-003-x/2008004/article/10715/6500232-eng.htm

Public Health 007

Let's talk about the “three coughs” or three major problems that threaten global health from the perspective of a U.S. Scientist.

He believes the first problem is the emergence of new diseases such as; Middle Eastern Respiratory Syndrome (identified last year), H7N9 avian influenza flu and SARS (which swept the world in 2003). He goes on to express his appreciation of the efforts made by Chinese health authorities in relating all the information about the H7N9 strain and thereby allowing the disease to be considerably contained worldwide. These new infectious diseases pose 2 problems; Health care professionals have no knowledge about them when they develop and we don’t have any natural immunity against them. We can only assume their devastation...

The 2nd “cough” is the ever growing risk of multidrug resistant tuberculosis. And the 3rd global health issue he addressed was the threat of Bioterrorism in today’s world and the need for wide spread surveillance in order to prevent mass disasters. The growing dangers of measles and HIV infection was also cited in the article and ended on a happier note; how the efforts of PEPFAR (the President’s Emergency Plan for AIDS Relief) had saved millions of people from AIDS.

The scientist quoted throughout the article was the director for the Centre for Disease Control, Dr Thomas Frieden from a few years ago...

Infectious disease! Whether it was vector borne dengue or manmade biological weapons, microorganisms continue to rule our microscopic world. On reading the article, the 1st “cough” and the 3rd “cough” caught my attention. With our growing population and the effects of global warming, I would not be surprised if I hear about the emergence of a new avian flu in the months/years to come. It is critical that we pay more attention to the way we interact with our environment and there by aid in the emergence of deadly organisms. As a health care professional it would be ideal to create a upstream solution to this problem. With the current data at hand, one could assume 2 things; that, by invading the natural human free ecosystems, we expose ourselves to organisms that lay dormant and there by disturb the sleeping horrors that lay in the forests. The second possibility is that we create ideal environments in our communities for disease progression and evolution. Either way, it is time to create a vaccine for our arrogance.

If we didn’t have enough problems to start with, we now must protect us from ourselves. Bioterrorism has been the arena for much debate over the years. It started with the study of deadly organisms like Small pox and has now become the reason that nations go to war. As a public health professional, I would ponder on the relevance of bioterrorism to my field. I could argue that it is not my fight, that it is a fight at the macro level. But I believe it is also a major problem that public health would have to face in the future. The world just became more like a James Bond movie.