The news that health facilities in Uganda have received notification to stop enrolling new patients in PEPFAR programs confirms what we have suspected and reported on since mid 2009—that the Obama administration is curtailing its commitment to PEPFAR.Ambassador Goosby’s optimism regarding increased funding in the coming years and the Obama Administration’s commitment to nearly doubling the number of patients receiving drugs, to at least 4 million by 2014, is somewhat reassuring. Unfortunately this is likely to be too late for the patients who need treatment now and yet are being turned away. A Lancet study on maternal mortality found AIDS to be a leading cause of death for mothers in Africa—and a leading driver of the terrible maternal mortality rates there. With access to ARVs, these mothers’ lives could be saved.We realize that the program may appear expensive and that national governments also have a responsibility. However, seeking to control the costs of the program by capping the number enrolled is a short term strategy that will lead to greater human and financial costs in the longer term. It is essential that the US fulfill its promise to scale up global AIDS programs and do what is right for those in greatest need.

Over the past 2 months, PHR activists have sent more than 2200 emails to their Senators and Congressperson, urging them to condemn Uganda's horrific Anti-Homosexuality Bill.Yesterday, the Senate took a stand. Thanks in part to your advocacy, the Senate passed a resolution (S.R. 409) that not only condemns Uganda's anti-homosexuality law, but also calls on governments around the world to reject and repeal similar laws that criminalize homosexuality.Said Senator Russ Feingold, who introduced the resolution:

I am glad that so many political, religious and civic leaders in Uganda and around the world have spoken out against this hateful and dangerous bill before the Ugandan Parliament.? Sadly, this legislation is just one example of actions taken around the world to restrict the rights of people just because of their gender or sexual orientation. We need to speak out consistently against all such discrimination. The Senate's passage of this resolution begins to move us in that direction, and I will continue working with my colleagues and the administration to continue to address this issue.

The Ugandan government has heard you too—whether or not they'll admit it. The Bill is currently stalled in Parliament—we believe because of the incredible global backlash against its hateful premise. We will keep you updated of any movement in the bill, which has been condemned by human rights and health activists world-wide.Check out the press release from Senator Feingold's office below, which includes the text of the resolution. And thanks again for calling on your Senators to act. The Senate heard you this week and made a powerful statement in suppot of the human rights of all people.

FOR IMMEDIATE RELEASE – April 14, 2010Contact:????????? Zach Lowe (202) 224-8657SENATE PASSES FEINGOLD RESOLUTION CONDEMNING UGANDA ANTI-HOMOSEXUALITY BILL AND SIMILAR EFFORTS WORLDWIDEBipartisan Resolution Urges All Countries to Reject and Repeal Laws Criminalizing HomosexualityWashington, D.C. – The U.S. Senate has unanimously passed a resolution introduced by U.S. Senators Russ Feingold (D-WI), Tom Coburn (R-OK), Ben Cardin (D-MD) and Susan Collins (R-ME) calling on members of the Ugandan Parliament to reject the so-called "Anti-Homosexuality Bill." The bill, which was introduced in the Ugandan parliament in October 2009, would expand penalties for homosexuality in Uganda to include the death penalty, and require citizens to report information about homosexuality to the police or face imprisonment.? In addition to condemning the proposed legislation in Uganda, the bipartisan resolution also urges all countries around the world to reject and repeal similar laws that criminalize homosexuality, and encourages the United States Department of State to closely monitor human rights abuses based on sexual orientation.? In addition to the proposed bill in Uganda, there are laws on the books in nations around the world criminalizing homosexuality.In several countries including Iran, Nigeria, Saudi Arabia and Sudan, the penalty for homosexuality includes the death penalty."I am glad that so many political, religious and civic leaders in Uganda and around the world have spoken out against this hateful and dangerous bill before the Ugandan Parliament.? Sadly, this legislation is just one example of actions taken around the world to restrict the rights of people just because of their gender or sexual orientation.? We need to speak out consistently against all such discrimination.? The Senate's passage of this resolution begins to move us in that direction, and I will continue working with my colleagues and the administration to continue to address this issue," said Feingold, Chairman of the Senate Foreign Relations Subcommittee on African Affairs.The resolution reads:RESOLUTIONCalling on members of the Parliament in Uganda to reject the proposed ''Anti-Homosexuality Bill'', and for other purposes.Whereas a bill introduced on October 14, 2009, by a member of Parliament in Uganda would expand penalties for homosexuality to include the death penalty and requires citizens to report information about homosexuality to the police or face imprisonment;Whereas many countries criminalize homosexuality, and in some countries, such as Iran, Nigeria, Saudi Arabia, and Sudan, the penalty for homosexuality includes the death penalty;Whereas the United States, in seeking to promote the core American principles of equality and ''Life, Liberty, and the pursuit of Happiness,'' has long championed the universality of human rights;Whereas religious leaders in the United States, along with representatives from the Vatican and the Anglican Church, have stated that laws criminalizing homosexuality are unjust; andWhereas the people and Government of the United States recognize that such laws undermine our commitment to combating HIV/AIDS globally through the President's Emergency Plan for AIDS Relief (PEPFAR) by stigmatizing and criminalizing vulnerable communities: Now, therefore, be itResolved, That the Senate-(1) calls on members of the Parliament in Uganda to reject the ''Anti-Homosexuality Bill'' recently proposed in that country;(2) urges the governments of all countries to reject and repeal similar criminalization laws; and(3) encourages the Secretary of State to closely monitor human rights abuses that occur because of sexual orientation and to encourage the repeal or reform of laws such as the proposed ''Anti-Homosexuality Bill'' in Uganda that permit such abuses.###

Government officials in Bangladesh are preventing humanitarian access to tens of thousands of starving Burmese refugees living in its southeastern corner, across the river from Burma.When my colleague, Dr. Parveen Parmar, and I conducted a rapid health survey in the squalid camps in February, we observed that nearly one child in five was acutely malnourished, and we interviewed several people on the brink of starvation who had not eaten for two or more days.

Read more from the op-ed published in the Global Post.

The statistics are shocking.Malawi has only 260 doctors to care for a population of 13 million. The city of Washington, DC — home to 600,000 people — has about twice as many physicians as the entire country of Ethiopia, home to 80 million.Today, as we celebrate World Health Day, the health workforce crisis remains one of the greatest hurdles to realizing the right to health for all in developing countries. Now, the US Government has an amazing new opportunity to support health workers in Africa, Asia and other regions to fight AIDS, malaria, maternal mortality and other medical conditions that kill millions every year.The Global HEALTH Act, introduced in Congress by Representative Barbara Lee on March 24, would provide $2 billion over 5 years to increase the number of doctors, nurses, pharmacists and other health workers in developing countries, and to improve primary care for all. The bill not only authorizes new resources. It also develops a comprehensive vision for a US Global Health Strategy that will complement the goals of developing countries and ensure our aid money is effectively used to save the lives of hundreds of thousands of people.Commemorate World Health Day by taking action. Email your Representative and encourage him/her to co-sponsor the Global HEALTH Act today.Want to learn more about the Global HEALTH Act? Check out PHR’s blog series on the bill. Read the bill, check out our fact sheet, watch videos on the health workforce crisis, and hear from African doctors and nurses as they describe what it is to work in broken health systems.This bill would revolutionize America’s response to the health workforce crisis, and could help save hundreds of thousands of lives: Tell your Representative to co-sponsor the Global HEALTH Act today.

Walked across the desert for three days, with only a canteen of water for subsistence. Arrested and severely beaten for peaceful political organizing, suffering a miscarriage and emergency hysterectomy. Left for dead by a police firing squad, then forced to hide in the wilderness for two months awaiting an opportunity to escape the country undetected.

Statue of Liberty (by flickr user adacao)

The journey to the US, so often fraught with dangers like these, poses grave health risks to many immigrants. It is not surprising that due in part to experiences like these, arriving noncitizens suffer from disproportionately poor mental and physical health. Tragically, immigrants’ health is further imperiled by the treatment they receive at the hands of our own government. Tens of thousands of immigrants annually are taken into custody by the Department of Homeland Security as allegedly deportable, and detained in conditions described by Rep. Christopher Smith of New Jersey as “more like prison.” This criminal-style confinement has a documented harmful impact on the mental and physical health of detainees. In its worst manifestations, the vast and expanding immigration detention system has led to the deaths of noncitizens.

Take the case of Hiu Lui Ng, who complained to no avail of severe back pain for several months, and deteriorated to the point of being unable to stand or walk before he passed away in Immigration and Customs Enforcement custody in August 2008. Mr. Ng was given nothing much more than painkillers as treatment, and was accused of faking his illness by detention officers. But when he was finally admitted to a hospital just days before his death, he was found to have a fractured spine and terminal cancer.

Or, consider the plight of Boubacar Bah. After suffering a head injury while in detention, Mr. Bah was, according to the New York Times, “shackled and pinned to the floor of the medical unit as he moaned and vomited, then left in a disciplinary cell for more than 13 hours, despite repeated notations that he was unresponsive and intermittently foaming at the mouth.” He was finally transported to a hospital, where he passed away after four months in a coma.

In just the past month, advocates have received word of three more immigrant deaths in detention (PDF). While these detainees’ deaths may not prove upon investigation to have been preventable, it is at the least clear that detention facilities were not well-equipped to manage and treat the brain and stomach cancers, blood pressure, diabetes and mental health issues that precipitated them. Moreover, both of the authors of this blog post have personally witnessed the mental and physical health needs of immigration detainees go unmet in prisons in Virginia, an experience that is very likely common and familiar to the hundreds of members of PHR’s Asylum Network who work with immigrant survivors of persecution.

There are two solutions to the “perfect storm” created by the intersection of a traumatized, vulnerable immigrant detainee population and incarceration featuring limited health care services: improving detention health care standards and keeping at-risk immigrants out of detention. Both solutions are addressed in the Refugee Protection Act (RPA), introduced in the Senate in March to mark the thirtieth anniversary of the passage of the Refugee Act of 1980.

The RPA would reduce the number of needlessly detained immigrants by making it far more likely that asylum seekers, ill people and pregnant and nursing mothers remain in the community while their cases are being resolved. The bill also makes strong health care standards binding and the legal responsibility of detention facilities and officials. Upon its passage, detainees would become legally entitled to have their basic health needs met. Noncitizens would be promptly screened upon entry into the detention system, and decisions about requested care would be made by on-site licensed health professionals. Coercive measures such as forced psychotropic medication and use of shackles and restraints would be strictly limited to cases of necessity. Most of us take this degree of care and respect for dignity for granted, but legislation is still needed to guarantee these fundamental rights to all.

With the Obama Administration committed to reforming the immigration detention system, now is the time for Congress to join in the effort and take legislative action to protect the lives and health of the most vulnerable of those who come to our country seeking refuge and a better life. Legislators must act quickly, as each death of an immigrant in detention devastates an entire family irreparably. Just as importantly, our self esteem as a nation and our international reputation demand that we ensure the humane and ethical treatment of anyone inside our borders.

Please urge your Senators to join Sens. Leahy, Levin, Akaka, Burris, and Durbin in supporting the Refugee Protection Act.

Read the report (pdf)

With its Sudan policy review, the Obama administration promised a diplomatic approach based on a clear-headed analysis of the situation on the ground across a variety of indicators.

According to the strategy, the parties in Sudan would be held accountable for their actions, and incentives and pressures would be deployed in response to progress or backsliding on the ground.

Now, almost six months after the policy review, an honest accounting of the “benchmarks” for progress in Sudan suggests how much important work remains to be done if broader conflict is to be avoided. 

This month, PHR is examining the health workers shortage in Africa ahead of the introduction of the Global HEALTH Act, which would provide $2 billion over five years to strengthen the health workforce in developing countries.Today, we want to highlight an organization that is working right now to fill health worker vacancies in rural areas in Southern Africa. If you are a doctor or nurse, Africa Health Placements (AHP) needs your skills to support rural health in South Africa, Lesotho, and Swaziland—contact them today for more information.Africa Health Placements originated in South Africa and now works in several other countries in the region to increase the public sector health workforce through recruitment from the private sector and through recruiting foreign health workers who are looking for the excellent work experience and unrivalled lifestyle that is offered through such an opportunity.?AHP’s support is aimed specifically at those provinces and areas where there are major shortages of doctors, nurses, and other health professionals.AHP’s focus is on patients and equity in healthcare for rural and disadvantaged communities—communities that are suffering high burdens of AIDS and other diseases, including malaria and TB.These efforts are having far-reaching results. In 2009, their foreign recruitment efforts placed approximately seven times more doctors in rural South Africa than the long-term rural placements of all 8 South African medical schools combined. Learn more about their work by watching the film Bush Doctors.AHP delivers support to health workers by offering a way of smoothing the application and registration process, matching interested health workers with available?opportunities, and by providing clinical, cultural and logistical orientation and ongoing support throughout a recruit’s placement. AHP also supports the strengthening of human resources in health in the region through consulting, advocacy and knowledge-sharing with relevant partners and government bodies.AHP recruits into rural areas, where health workers are asked to commit to at least 12 months of services. Many renew their term of service—for one year, two years, even longer. Since its founding in 2005, AHP has placed more than 1,500 health professionals in Southern Africa, half of whom are from abroad.Check out AHP’s website,?and consider working with them to deliver health care to the rural poor in Africa. If you have friends or colleagues who might be interested in this critically important opportunity, please spread the word!

Yesterday, Representative Barbara Lee (D-CA) introduced the Global HEALTH Act (House Resolution 4933)?in Congress. We are thrilled at this opportunity to transform America's global health policy and provide billions more in aid to develop health systems in poor countries.Take 10 minutes to read the bill (pdf)—there is a lot to learn:

• What the HEALTH in Global HEALTH Act really stands for (This one I'll give you: Global Health Expansion, Access to Labor, Transparency, and Harmonization Act of 2010).
• The overall goal of the bill (This one you get too—the rest you have to look up: To establish a strategy to coordinate all health-related United States foreign assistance, to assist developing countries in improving delivery of health services, and to establish an initiative to assist developing countries in strengthening their indigenous health workforces).
• The GHA's vision for a new United States Global Health Strategy (page 2).
• Which Millennium Development Goals the new Strategy would target (page 4).
• The ration of health workers to population the Strategy will aim for (page 12).
• How the Global Health Strategy will really work—what it will support, what it can do (page 8).
• How the US Global Health Strategy will support National Health Strategies in developing countries (page 30).
• How the new Global Health Workforce Initiative? fits in to the Global Health Strategy (page 39).
• How many countries the GHWI will target (page 40).
• The criteria for selecting these countries (page 40).
• What the GHWI will do to support health workers in developing countries (page 43).
• How much money the Global HEALTH Act will provide for all these critical global health capacity building programs (this one I have to tell you—$2 Billion over 5 years. Amazing. See the yearly breakdown on pages 64-65).

Read the bill, and get ready to take action. On April 7th, World Health Day, we'll ask you to email your Congressperson and urge them to co-sponsor the Global HEALTH Act. And spread the word—this is a transformative bill, and you can make a difference.[download id="23"]

Over the past month, PHR's Health Rights Advocate blog has highlighted the health workforce crisis in Africa, and how the about-to-be-released Global HEALTH Act can help.

Now, we want to hear from you.

What is your experience with the health workforce crisis in Africa? If you are from Africa or another developing country with a health workforce shortage, tell us about your experience in giving or receiving health care in your country. If you are a health professional who has left your country to practice in the US or elsewhere, we'd love to hear your story: your experience in the health system at home, why you left, and what it is like where you are now.For those of you not from a developing country, have you visited or worked in Africa and seen the impacts of the health workforce crisis first hand? Have you met doctors and nurses from developing countries who are working in the US or going to school and plan to stay here? What have you learned from their experience?Some African health workers have already offered their own insights into the health workforce crisis, its impact on themselves and on their patients, and their advice to policymakers.

The hospital where I work, which serves 100,000 people in the district, averages 2-3 maternal deaths per week due to delayed operations. The two medical officers cannot adequately cope since they have to attend to other emergencies and referrals from the neighbouring districts.” – Nurse, Homa Bay, Kenya

The shortage of doctors and nurses in our hospital has led to one nurse attending to 40 patients at time, a nightmare for those suffering acute conditions. This had led to the loss of patients who would otherwise be stabilised. The quality of service is highly compromised and bordering on unethical practice. This is inhuman treatment of fellow human beings.” – Medical Laboratory Technologist, Nairobi, Kenya

I have a situation at the moment where about 200 patients have to travel for up to six hours to get their ARVs [antiretrovirals] and access related services. Most antiretroviral treatment (ART) centres are in the cities and there are no qualified healthcare professionals in the towns and villages. ARVs are even expiring in some centres because the inconvenience involved is just too much for patients.”– Pharmacist, Abuja, Nigeria

PEPFAR is focused on urban areas. The rural areas are left behind. Patients can’t afford transit. I’ve had five patients die quietly in the last six months because they didn’t have access to AIDS treatment…There’s no electricity where I work, the roads are bad, there’s no equipment. If I get a needle puncture, there’s no prophylaxis. I’m on my own. I’m on call 24 hours; this leads to fatal errors. This is a classic case of marginalization.” – Physician, Niger State, Nigeria

Communities in rural Uganda have a difficult time accessing a health care worker. For example, at outpatient facilities upcountry, there may be 200 people per day who show up seeking care, but only one health worker and one clinic for 25 km. You may see a doctor or a nurse, but quality of care is unsure. It’s different seeing a patient first thing in the morning versus after many, many patients – my judgment may be impaired after so many consultations.” – Medical Student, Makerere University, Kampala, Uganda

There is nothing more demotivating to a worker than being in an office without any resources to do the work. Many of us have worked in hospitals where we were recycling gloves in this era of HIV. We have worked in labour wards and operating theatres where autoclaves could be broken for days, yet we are expected to provide safe motherhood services.” – Physician, Kenya

African Health Workers’ Prescriptions for Policymakers:

Policymakers at country and global levels have to make a deliberate move to recruit and retain health workers in the right numbers based on needs assessments.

Our capacity to deliver health services would be improved by a conducive working environment with adequate basic infrastructure, proper medical supply management, better and regular remuneration and opportunities for continuing education and training.

Donors need to scale up investments in human resources for health, especially in health care workers. Most donors do not fund salaries, which I find self-defeating. For example, a donor will choose to fund only medical supplies without considering how the supplies will be dispensed and by whom.

Western countries recruit health workers and have made it very easy to acquire entry visas and work permits, especially for nurses. This is like picking from the poor man’s pocket.

A healthy nation is a strong nation politically, economically and socially. Investing in health is not only right but a necessity!

We want to hear from you. Use the comment form below to tell your story.

This week marks Nowruz, or the Persian New Year, in Iran. On this Nowruz, Amnesty International wants to remember several courageous prisoners of conscience in Iran— including Drs. Kamiar and Arash Alaei—with Nowruz greetings. PHR is pleased to support Amnesty’s call to action, which will send a message of hope and solidarity to Kamiar and Arash and other human rights activists in Iran.We encourage you to mail Nowruz greetings to Kamiar and Arash, carefully following Amnesty’s instructions:

We ask you to mail cards with simple Nowruz greetings such as “Nowruz mobarak.” You can add “thinking of you at Nowruz time” or “hoping you are well.” You may send a greeting in either English or Farsi (Persian), but please do not mention Amnesty International (or PHR or any other organization) or specifics of the recipient’s case. Please also refrain from mentioning the political situation, human rights or US-Iran relations.We suggest sending cards with pictures of landscapes, spring flowers or the like, in keeping with the spirit of the holiday and the message of hope and renewal. Please do not choose cards that have pictures of people or depictions of bottles of wine or other alcoholic beverages.

Mail Nowruz greetings to Drs. Kamiar and Arash Alaei:Velenjak St., 16Yasaman 2 BlvdFloor 5, Apartment 3AlaeiTehranIslamic Republic of IranRead more about the Alaeis' AIDS and human rights work and their unfair imprisonment.