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"If We Don't Do It Then Who?"

"If We Don't Do It, Then Who?" Page 2

PUBLIC HEALTH "VET"

A Ghanaian fireball of energy and enthusiasm, Easmon Otupiri spent the mid-1980s teaching poultry management to women in poor villages in northern Ghana. Otupiri delighted the village women with his sweet talk and easy manner. "I know every corner of the northern regions," he says. "And it gives me a lot of joy when the women recognize me and are happy to see me."

When a family planning campaign was launched in the area, the women balked at taking such personal advice from strangers. They wanted to hear the news from someone they trusted. So Otupiri took on the job, learned about public health and embarked on a new career.

Saddened by the fact that more than two out of ten children there do not make it to their fifth birthday, Otupiri soon focused on child survival and began educating the women about basic steps they could take to improve their children's health. In some villages, colostrum—initial breast milk rich in proteins and antibodies—was traditionally discarded because of its color. Otupiri persuaded them to abandon the practice. He also counseled the women about malnutrition (an underlying cause of many common illnesses), diarrheal diseases, malaria and respiratory infections. "When you help them, it makes a big difference in the whole family," says Otupiri. "When you teach them to manage uncomplicated malaria, it's a big input you make. If she can recognize it early then she can prevent it from becoming a more complicated case and even death. She can pass along that information to family and friends.

"If somebody has a lot of kids and I can help make a difference in that person's life, why not?" says Otupiri.

After earning graduate degrees in public health, Otupiri joined KNUST's School of Medical Sciences faculty. He's now earning a doctoral degree through a program that allows him to study at KNUST and the Bloomberg School, with Gates Institute support.

As a faculty member, Otupiri finds his greatest satisfaction in the MPH program's second semester when his graduate students visit district health centers (where many had worked before entering the program). "They come back and tell you, 'Wow, there's a lot going on that's wrong, that needs to be changed. We didn't see this before,'" he says. "When you get a few skills and competencies, you go back with a different eye."

Otupiri now shares his passionate inspiration with his graduate students and demands the same in return. He tells them, "We want managers who lead and not just manage. Take us somewhere. Take us to the Promised Land! Lead us there!"

A NEW BABY

In a breezy classroom at the University of Ghana's School of Public Health, the benefits of its partnership with the Gates Institute are already manifest. More than 30 new MPH students crowd Professor Fred Binka's course on the history of tropical diseases. Most are taking time from their jobs with the Ghana Health Service or other organizations. The students sit behind flat-screen monitors attached to new PCs linked to the Internet. (Previously, the UGSPH master's program had just a dozen students and 10 computers.)

Binka's booming voice fills the room as he announces the course will be interactive, and students are expected to contribute. He asks them to tell him the earliest reported instances of communicable diseases. One student says, "Edward Jenner and smallpox."

"No, Edward Jenner was recent," Binka says, adding that some of the classic stories of communicable disease are found in the Bible. He asks for the name of the Biblical general cured of leprosy. The students pause and think. "What? Are there no Christians here?" he asks, laughing. When a student raises his hand, Binka says, "Okay, there's a cardinal here. We can make you Pope, if you get it right."

The student correctly answers "Naaman." Binka discusses the dread disease for a moment or two, how lepers walked with a bell to warn healthy people away, how some lost limbs to the disease. Then he fires up his PowerPoint presentation and begins a discourse on the history of cholera by noting a recent outbreak in Ghana. (Binka is not only concerned about the history of disease, but the future. He's executive director of a non-profit research group called the INDEPTH Network. In April, the Bill and Melinda Gates Foundation awarded the group $17 million to assist with malaria drug and vaccine clinical trials.)

Traditionally, UGSPH and the other partner institutions offered a staid environment in which faculty lectured to students who dutifully took notes. That's largely changed now that faculty have visited the Bloomberg School. In Baltimore, the Ghanaians watched students question and challenge professors, make presentations, participate in group projects and meet individually with faculty. Back in Africa, courses that used to be heavy on theory now emphasize real-world problem-solving, practical solutions and collaborative work.

Course offerings have been expanded as well. Fifteen new courses on population and reproductive health alone were added in 2006 at UGSPH. And 12 new full-time faculty have been recruited to teach the graduate courses. Similar gains have been made at the other partner institutions.

The transformation has been dramatic and gratifying, says Kofi Asante, chair of the Department of Population, Family and Reproductive Health at UGSPH. "The collaboration definitely has made all the difference between barely existing and having a viable and active department," says Asante. "It's like having a newborn baby in your hands and watching it grow and develop. That's the excitement you have."

A COUNTRYWIDE DIFFERENCE

Nigeria has one of the highest rates of maternal mortality in the world—800 annual deaths from pregnancy-related causes per 100,000 live births, according to WHO and UNICEF estimates. (Among industrialized countries, the average is 13.)

As an obstetrician, Oladosu Ojengbede has fought to save mothers' lives for 20 years. In 2002, Ojengbede, director of the Center for Population and Reproductive Health at Nigeria's University of Ibadan, added a new dimension to his work. That summer, he came to the Bloomberg School for a Gates Institute-sponsored strategic leadership training course taught by Henry Mosley, MD, MPH '65, professor of Population and Family Health Sciences, and Ben Lozare, PhD, associate director of the Center for Communication Programs. The course is designed to help leaders in government, academia and the private sector develop strategies to make their organizations deal more effectively with reproductive health and public health issues.

Easmon Otupiri tells students: We want managers who lead and not just manage. Take us somewhere. Take us to the Promised Land!

The training emboldened Ojengbede to confront Nigeria's maternal mortality from a new perspective. One of the main causes of maternal death in Nigeria is eclampsia—seizures caused by severe hypertension during pregnancy. The condition can be effectively treated with magnesium sulfate, but in Nigeria the drug is expensive and difficult to obtain. In the past, "everyone was just gaping and looking and not doing much," says Ojengbede.

Ojengbede hit on a solution: manufacture it in Nigeria for one-fifth the cost. Ojengbede persuaded a hospital pharmacy to produce some magnesium sulfate and used it in a small trial. It worked. He is now securing grants to manufacture the drug and distribute it nationwide. "We're hoping that once it's made available nationally, deaths from eclampsia will just come crashing down," he says. "We're just trying to create stylish ideas to confront simple problems."

While Ojengbede was tackling these logistical barriers, the Gates Institute was working on another track. In 2004, it hosted 11 parliament members from five countries at the Bloomberg School. The intent was to raise the profile of reproductive health among government policy makers in developing countries. After returning from Baltimore, the two Nigerian parliament members managed to earmark funds for reproductive health in the Ministry of Health's budget. The money,

among other things, pays for monitoring reproductive health outreach programs like Safe Motherhood and other projects to ensure they are efficient and effective. "Before, they never saw they had a role in health. They thought, I'm not a doctor. I'm not a nurse," says Ojengbede of the two Nigerian parliament members. "After they came back they knew they could make a positive change. Reproductive health is now on the priority list at the Ministry of Health. It's become a regular budget line."

SAVE A MOTHER, SAVE A CHILD

For many people living in isolated parts of Nigeria's far northern reaches, few health care facilities exist and maternal mortality rates are very high.

Worse still, the death of a mother in childbirth is sometimes a tragedy compounded.

"The baby is blamed for the mother's death. They think a baby who kills the mother should not be allowed to live," says Oladoyinbo Olatunde, an MPH student at the University of Ibadan who worked in the region for a missionary health organization. "When the mother dies, the child is buried alive with the mother. It seems to be a communal death sentence on those children. There were seven instances in the last year that we got there late and they had [already] done the burials."

The custom represents a constellation of complex challenges: What are the origins of these deeply held cultural traditions? How can the people be persuaded to spare the children? What is causing the appalling rates of maternal mortality? What interventions need to be brought to the region and how will they be paid for?

"Many people, even decision makers, don't have the kind of comprehensive background needed," says Olatunde. "This course has helped us to begin to see ourselves play a more active role. It's changed the mental models we're operating in. We think outside the box. We are ready to take risks. I feel our organization is set for a very big leap forward."

Olatunde hopes his MPH coursework and leadership training will help him save mothers' and children's lives. "If we can stop the mothers from dying, then there will be no babies to be buried," he says.

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