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Childhood cancers – A child health priority for MENA

  by Hedieh Mehrtash The current, and soon to be expired Millennium Development Goal 4 (MDG 4), is to reduce childhood mortality in under-fives by two thirds. In the past decade, global efforts to reach this goal have focused on scaling up access to childhood vaccines, oral rehydration salts, malaria treatment and prevention, and prevention of mother to child transmission of HIV in Southern Asia and sub-Saharan Africa. Since the inception of the MDGs there has been increasing recognition of the burden of non-communicable diseases (NCDs) globally, not just as diseases of high-income countries. The post-2015 development agenda seeks to accommodate this shift as articulated in roadmaps such as the WHO Global Action Plan for NCDs. This blog post looks at where child health and NCDs intersect in the MENA region, with a specific focus on the burden and available treatment for childhood cancers. The unique epidemiological characteristics of childhood cancers make a strong case for studying them separately from adult cancers. The most striking difference perhaps is that cancer is generally a rare disease among children – annual incidence of all cancer in children under 5 years of age in developed countries is only 0.5% (1). Moreover, adult cancers are associated with modifiable risk factors, whereas childhood cancers are not. Consequently, population based screening and prevention programs are not the best recourse for pediatric cases, which benefit instead from accurate early diagnosis and effective treatment (10). When the data on pediatric cancer is stratified by geographic location, the highest incidence of childhood lymphomas occur in North Africa and the Middle East, while leukemia accounts for a quarter of childhood cancers in the...

Far From Home: The Syrian Trojan Women Project

  by Amina Foda What began as a response to the mental health needs of Syrian refugees in Amman, Jordan has grown into a captivating platform for the world to hear the voices of Syrian refugees. The Syria: The Trojan Women project produced a theatrical adaptation of Euripides’ The Trojan Women on the grounds of the everlasting themes and consequences of war that continue today in the Syrian crisis. The play, performed by a group of Syrian refugee women, embodies the women’s journey with mental anxiety, depression and PTSD. It provides a sobering view into their lived experiences and raises awareness of their challenges. In the words of one of the Syrian refugee actresses, the sentiments of loss and the pain of displacement found in Euripides’ play, The Trojan Women, resonated with their experiences of the modern day Syrian crisis. “War is eternal, just the weapons have changed” — UK based producer, Charlotte Eagar, introduced the Project to an auditorium of Columbia University students in New York City (an evening organized by the Columbia Global Mental Health Program and co-hosted by Columbia College). The New York audience was connected to a group of Syrian refugee women in Amman, Jordan who shared their experiences and hopes to a growing Western audience. Originally scheduled to travel to the United States to perform their adaptation of Euripides’ classic anti-war tragedy, visa denials prevented their physical presence in NYC. As a saving grace, technology bridged the political roadblocks to sharing their story. The women were thoughtful and purposeful in their discussion with the audience. They shared their lived-experiences of building their new community...

Social barriers to mental health services in Arab populations

  by Aseel Hamid Accounting for 13% of the total global burden of disease,1 untreated mental health disorders are one of the leading causes of disability, causing lasting disruptions in mood, thinking and daily functioning. It has been predicted that by 2030, depression will be a leading cause of the global burden of disease.2 As outlined in “Access to Mental Health Care in the Middle East”, mental health is not a strong priority in the Middle East and North Africa (MENA) region and services are not widespread despite efforts made. The lack of prioritization around mental health means that the available resources are rarely translated into policy or planning for action at a population level by governments. The purpose of this entry is to determine which factors lead to underutilization of the few existing mental health services. After all, if governments invest in services and the respective public does not utilize them then it will inevitably lead to further deprioritization: a perpetual cycle.   Where does this cycle begin? It is highly unlikely that underutilization results from a lack of need. Prevalence rates of mental illness in MENA are similar to the prevalence rates worldwide.3 Furthermore, the MENA region has been greatly affected by conflicts, some of which are ongoing such as in Syria, Palestine and Iraq. A recent study found that countries in MENA affected by conflict tend to report a much higher rate of depression,4 and another study carried out in areas affected by conflicts show rates of 17% for post-traumatic stress disorder; 5 this is almost five times the prevalence rate of PTSD found in the...

Questions asked: Experiences of an Iranian at an oncology ward in Malawi

  by Hedieh Mehrtash As members of a globalized world, our communities are increasingly connected by the shared burden and challenge of non-communicable diseases, cancer one of chief among them. My personal experience with family members plagued by cancer has driven a personal commitment to the global cancer care arena and #closingthecancerdivide. [1] After several observational experiences of cancer care in Iran, France and the United States, it is clear that cancer is a disease where finding the appropriate care and treatment is a global challenge. The next step in my journey led to me to Malawi this summer to work on my MPH summer practicum through Global Oncology, an NGO in Boston, and its ongoing collaboration with the oncology ward at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi.    Arriving in Malawi     “What have I done?”  Having landed at the “fun-sized” airport, without the fancy jet bridges one sees elsewhere, and having completed the paper work, I was on my way to Blantyre city. As we passed through all the villages on the way, I was shocked by the degree of visible poverty, worried and ready to turn back. Questions kept running through my head: should I really be here? Would my presence as a foreigner be accepted? Will I be able to communicate with people? Once I arrived at the lodge, things took off as I met other students and my coworkers at the hospital; my fears soon forgotten.   Oncology ward 2A at QECH     Here I was, at one of the only public referral hospitals that consult cancer patients in the country....

Part III – Arab Americans in health: How do we get involved?

  Part III in a 3-part series on Arab-American health and national engagement. By Serena Rasoul, Amira Mouna, and Reem Ghoneim The first article in our series, ‘Why are we missing?’, discussed the absence of Arab-American health data in the national dialogue on minority health and the repercussions of not being represented. The second article , ‘Why are we important?’, explored how our unique social determinants of health affect our health outcomes and, consequently, the diseases that we disproportionately suffer from- highlighting the need for specialized representation and targeted programming for Arab-Americans both on  the federal and state levels. Here, in the last article of our series, we will outline steps community leaders can take to ensure Arab-Americans are represented in national conversations, policies, and minority health initiatives. These steps are targeted towards members and leaders of the Arab-American health community, as well as those outside of the community that shape and advocate for minority health on a national level. Step 1: Identify Stakeholders The initial step to developing comprehensive representation of the community is to identify stakeholders, both within and outside of the Arab-American community, that are actively engaged in shaping health policies on all levels, from grassroots leaders to legislatures. Within the community, it is important to partner with established community organizations (health related or otherwise) and their leaders to participate in the conversation and leverage their influence for outreach activities. Additionally, as we pointed out in article 2, many of the health determinants of Arab-Americans are influenced by cultural and religious norms. Thus, approaching religious institutions and leaders would also be advantageous to gain a grassroots...

العنف ضد المرأة

تبرز لنا سارة اللمكي في تدوينتها هذه الوضع الحالي للعنف ضد المرأة ضمن جدول أعمال الصحة العالمية، وتناقش الحاجة للتركيز على نقاطٍ نوعيةٍ تستهدف “العنف” ضمن أنظمة العمل لما بعد عام 2015، للتوصل إلى تحقيق المساواة بين الجنسين. (ترجمتها للعربية: زينة المحايري) العنف ضد المرأة…هل يكفي ما قوم به؟ مع ختام الدورة السنوية الثامنة والخمسين للجنة المعنية بوضع المرأة (CSW58) لا يسع المرء إلا أن يتساءل عن سبب عدم ذكر العنف ضد المرأة بشكلٍ محدد، ولماذا لم يحتل الصدارة موضوع العنف ضد المرأة في جدول الأعمال. وانصب التركيز هذا العام على “التحديات والإنجازات في تطبيق الأهداف التنموية للألفية من أجل النساء والفتيات”، وعلى الرغم من اعتراف الأمين العام للأمم المتحدة بأن الأهداف التنموية للألفية “محدودة وتنحرف عن الرؤية الكاملة لحقوق النساء والفتيات المنصوص عليها في الاتفاقيات العالمية الرئيسية”؛ فقد ظلّ المؤتمر متجاهلاً ولم يرتكز بشكل مرجو على أحد العناصر الأساسية في هذا الانحراف، ألا وهو العنف ضد المرأة. ولم يمر هذا الإغفال دون أن يلحظه أحد، بل قوبل بموجةٍ من التعليقات في المدونات والمقالات ومن متابعي المؤتمر. 2,8,9وطالبت منظمات متنوعة بأهداف نوعية وأكثر استهدافاً للمساواة بين الجنسين، تركز بالتحديد على العنف ضد المرأة، للتأكد من عدم ضياع هذه النقطة الخاصة في خضم الانشغال بمهمة ضمان حقوق النساء والفتيات الشّاقة. خارج المؤتمر توُجد وفرةٌ من الحملات، والبرامج، ومطالبات التحرّك، والأدبيات والأبحاث حول العنف ضد المرأة، وجميعها ضمن نطاق واسع لا نهاية له من المصادر الساعية لإيجاد الحل الإصلاحي الأمثل، لكن بدون جدوى. وبقيت الأرقام خلال العقود القليلة الماضية في حالة ركود، وبصورةٍ صاعقة توقعت منظمة الصحة العالمية أن 35% من النساء حول العالم سيواجهن نوعاً من أنواع العنف ضدهن. 2 إن ذلك كله يطرح تساؤلاً: كيف يمكننا التقدم في حين...

Youth empowerment: investment, inclusion & information

  Sara Al Lamki looks at the obstacles facing youth around the world, and outlines how programs aimed at youth inclusion, investment and education are breaking the barriers to youth empowerment. There are roughly 3 billion young people in the world today. People aged 10 to 24 comprise roughly one quarter of the world’s population. It is the largest youth generation in history. They will shape the future, and not understanding what is necessary for this population to thrive would be a large oversight. According to recent figures from UNESCO, 63 million adolescents around the world were not enrolled in either primary or secondary school in 2012. And in 2013, young people aged 15 to 24 were almost three times more likely than adults to be unemployed.  In the Arab world alone, unemployed youth make up 25% of the total. In 2011, UNAIDS statistics showed that 41% of newly diagnosed HIV patients were between the ages of 15 – 24. These numbers point to just a handful of the myriad challenges faced by today’s youth, all with consequences on health and long term development. Figure 1 summarizes other barriers faced by young women in particular, and highlights how meaningful youth participation, education including comprehensive sexuality education and rights, and access to targeted health services can address these barriers.   Youth inclusion During the course of this year’s summer summits, assemblies, and conferences across various development agendas, from disaster relief to sustainability, there has been a single common thread: a call for youth voices. Youth inclusion is not a novel idea, but it has received a new lease of life in the last 5 years. Specific programs have begun to target youth, empowering...

Part II – Arab Americans in health: Why are we important?

  Part II in a 3-part series on Arab-American health and national engagement. By Reem Ghoneim, Serena Rasoul, and Amira Mouna The first article in our series explored the absence of Arab-American health data in the national dialogue on minority health due to a lack of a minority status designation.  In this article, we will define the importance of differentiating Arab-Americans from the general population and other minority groups, focusing primarily on conditions and health behaviors that affect our community. There are several contributing factors, or health determinants, that separate the needs of Arab-Americans from the general population. Part I in our series mentioned the major social determinants that affect this population’s ability to access services, including, but not limited to: recent immigration, the effects of cultural and religious behavioral norms, and marginalization of the community due to increased media attention. These factors, along with others (see Table 1), make Arab-Americans an at-risk population for health disparities, requiring targeted attention outside of the general population. Specifically, Arab-American immigrants and subsequent generations are at-risk for health conditions like PTSD or hypertension due to trauma associated with immigration, acculturation, loss of social support, and limited knowledge of the complex US health system.[1]  “They lack the knowledge that is needed to prevent, detect, and treat diseases. This population faces many barriers to accessing the American health care system. Some barriers, such as modesty, gender preference [2], and illness causation misconceptions, arise out of cultural beliefs and practices. Other barriers are related to the complexity of the health care system and the lack of culturally competent services,”[3] writes Odeh Yosef in the Journal...

البدانة في الشرق الأوسط

تقدم هيديه ميهتراش موجزا عن الكلفة الاقتصادية والبشرية للبدانة في الشرق الأوسط، وتدعو إلى ضرورة إدخال سياسات سليمة والقيام بتدخلات في مجال الصحة العامة تحدّياً للجمود الحالي القائم في المنطقة. (ترجمتها للعربية: زينة المحايري) خلال الشهور القليلة الماضية نُشرت العديد من التقارير، مثل تقريري WSJ و Bloomberg ، التي عرضت التحدي المذهل للانتشار الوبائي للبدانة في الشرق الأوسط. العبء الثقيل: ساهمت البدانة وزيادة الوزن بشكل كبير بمشكلة الأمراض غير المعدية (NCDs) في الشرق الأوسط. ومن المثير للاهتمام أن الدراسات المسحية قد أظهرت أن النساء في المنطقة مصابات بالبدانة أكثر من الرجال. 1 وبصورة غير متكافئة يتأثر الشباب أكثر بوباء البدانة. وفي حين أن المنطقة تعدّ أكثر المناطق شباباً في العالم، يزداد انتشار نمط حياة الكسل وقلة الحركة، مع تغيرات في نمط الغذاء مما أدى إلى معدلاتٍ متزايدةٍ من البدانة بين الأطفال واليافعين. 2 وبالتوازي مع انتشار البدانة ارتفعت معدلات الإصابة بالداء السكري وارتفاع الضغط. وقد أشارت التقارير أن منطقة الشرق الأوسط وشمال أفريقيا تعاني من أعلى معدلات للداء السكري بين البالغين في العالم تبلغ حتى 10.9%. تلعب العادات الغذائية السيئة وقلة النشاط الجسدي الدور الرئيسي في البدانة في أي مجتمع. 3 أما في العالم العربي فتُتصف التغيرات الغذائية بازدياد مدخول السعرات، وباستبدال الوجبات الغذائية التقليدية بأخرى معالجة ومعدلة بحيث تحوي نسبةً عاليةً من الدهون والملح. 4 يضاف إلى ذلك نتائج دراسات مسحية في دول مختلفة من المنطقة (مصر، والأردن، والعراق، والكويت، والسعودية، وقطر، وسوريا)؛ والتي تؤكد أن أكثر من 80% من البالغين يتناولون أقل من الحصص الخمسة المنصوح بها من الخضراوات والفواكه يومياً. يترافق هذا النمط الغذائي مع أعلى معدلاتٍ لقلة النشاط البدني في العالم. ومع أنه من المعروف أنّ قلة النشاط البدني بات مشكلةً حقيقية، غير أنّه لا...

Part I: Arab Americans in health: why are we missing?

  Part 1 in a 3-part series on Arab-American health and national engagement. by Amira Mouna, Serena Rasoul and Reem Ghoneim, Guest Contributors As the United States attempts to implement the first health care overhaul bill in decades – the Affordable Care Act (ACA) – minority health groups nationwide are gearing up to use this opportunity to address their communities’ health disparities. My colleagues and I were no different until we attempted to obtain national health disparity information on Arab-Americans; similar to what exists on the South Asian or East Asian communities within the US. What we found was alarming: although Arab-Americans are an underserved health population, they are not included in the national dialogue on minority health. In fact, the ACA recently implemented an initiative to improve data collection and quality on minority populations in the United States, but it did not include Arabs or Arab-Americans as a racial or ethnic group on the new Data Standards form.[1] Additionally, a recent search using the U.S. Department of Health and Human Services Office of Minority Health (OMH) website yielded zero results for multiple terms pertaining to Arab-Americans. The same was found across several other government agencies, research institutions, and national minority health initiatives. But with a population estimated over 3.5 million and growing every day, why are Arab-Americans missing?[2] The answer is complex, but one contributing factor may be due to the lack of a designation of Arabs or Arab-Americans as a minority group on the US Census or CDC National Center for Health Statistics forms. Having a distinct minority status is vital for research opportunities, funding allocation, grants...
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