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Seminars
OGHG regularly invites speakers to talk to our members on a wide range of global health topics. These small group seminars take the form of a short talk followed by a lively and informal discussion. Also, look out for our practical skills seminars! Seminars usually take place on Monday evenings at 7.30pm. Anybody is welcome to come along, however we would ask that you email us so that we have an idea of numbers! Jump to Previous Seminars Click on the seminar titles to see a summary of the talk and any relevant links. Click again to hide! Cancer in Africa (Professor David Kerr) 25/10/10 Professor Kerr discussed the growing and under-recognised problem of cancer in Africa. Cancer has become the leading worldwide cause of mortality this year. Transmissible causes include HIV, Epstein Barr virus, Hepatitis B & C viruses and the human papillomavirus. Other factors include obesity and smoking. In some parts of Africa, rising cancer rates are therefore a direct result of the HIV/AIDS epidemic, and in others a consequence of economic development and populations that are living longer. In general, there is a lack of infrastructure & resources that must be addressed. Extreme Skin Medicine (Professor Terrence J Ryan) Summary to follow... Belleh Woman, Go de Right Side - maternity care in Sierra Leone (Dr Richard Kerr-Wilson) Summary to follow... Health and Human Rights (Dr Chris van Tulleken) Summary to follow... Hustling for Health: Sex Work in London (Dr Helen Ward) Summary to follow... Experimenting with Humanitarianism in Africa (Harry Verhoeven) by Jack Owen, November 1st Intervention, as of late, has a bad name. Whether on a large scale - the invasion of a country - or a small one - going out to help out in a foreign country, there’s often a sense that it’s not all it’s cracked up to be. When we go out to, say, Kenya, and help out in schools, are we doing it for the benefit of those there, or for ourselves? Does it help? Can we help? These troubling issues must underpin any overseas work, and were addressed by Harry Verhoeven in an exceedingly crowded room (fire regulations be damned) in Worcester College. Verhoeven, a PhD student studying the triggers of warfare in postcolonial Africa, had come to the following conclusion - good intentions do not necessarily lead to good outcomes, and that just because we might go forth with the intention of ‘doing some good’, it doesn’t mean that we will necessarily do good - perhaps even the opposite. As an example of this, he cited Darfur, and the activism surrounding it. Darfur, and, indeed, the whole of Sudan, has been at war with itself essentially since its inception - from a string of civil wars immediately after inception, to countless localised conflicts today, peace has been very rare in Darfur. Furthermore, while Sudan has had 8% yearly growth over the last 5 years - a fairly respectable figure - it has the largest number of IDPs (internally displaced persons) in the world, one in ten children die before the age of five, and literacy rates are as low as 10-20% in some areas. It was clear that something was very wrong in Sudan, and that conditions were ripe for further conflict. This was seemingly confirmed when, to quote Verhoeven, people outside the academic world ‘discovered Darfur’. Enter the Save Darfur Coalition. Reacting to a Janjaweed incursion into Darfur, which genuinely did result many thousands deaths, the Coalition was formed by a group of survivors of genocide, and religious, political, and human rights groups, to protest, in their words, the ‘genocidal, scorched earth campaign’ of the Janjaweed and the Sudanese government, and to ensure lasting peace and stability in the country. To do this, they lobbied and rallied in favour of deployment of an international peace-keeping force, together with an indictment of the perpetrators by the ICC. Their mission goals - to end violence against civilians, to facilitate unhindered humanitarian aid, to stimulate the development in Darfur, to help IDPs to safely return, and to hold those responsible to account. Verhoeven, however, found many of the premises of the movement to be unrealistic. Dr Eric Reeves’ (a researcher on Sudan) oft-quoted estimate of over 450,000 excess deaths is often used as a demonstration of the scale of genocide in Darfur, but Verhoeven cites several examples which would suggest otherwise - the WHO and CRED, the Belgian Centre for Research on the Epidemiology of Disasters, found excess deaths of 70,000 and 63,000-146,000 respectively. Furthermore, in a country with as poverty-stricken as Sudan, ‘excess deaths’ would be largely attributable to starvation and disease, which, while terrible, is not the same as the 800,000 who were killed in Darfur. Indeed, the British Advertising Standards Authority found the Save Darfur campaign guilty of misrepresentation of opinion as fact, when it claimed that ‘400,000 innocent men, women and children have been killed’. This is not to say that Verhoeven did not view Save Darfur coalition’s ultimate goals as laudable - indeed, he agreed that there ‘probably is a case’ for accusing members of Sudanese militias of genocide. Likewise, it is hard to argue that sustainable development in Darfur is a bad thing. His main issue was with their understanding of the conflict, and their resulting attempts to reach those noble ends. Verhoeven argued that the broader issue with the Save Darfur campaign was the way it decontextualised the conflict. What was a tragic, but not particularly unique, event in a long history of conflict between the central government and rebels, was turned into an event of unique proportions. Unwilling to let another Rwandan genocide - where the world stood by, activists sprang into action in favour of some form of military, armed intervention. Verhoeven cited this willingness to spring in, without pause to analyse, and work out the best option, as the key error in the humanitarian community’s response. Not only did this stymie efforts to actually help, Verhoeven also contended that it worsened the situation in Sudan - by casting the conflict strictly as ‘Arab Janjaweed killing black African farmers’, the campaign ignored the complicated tribal affiliations involved among victims and perpetrators, and, by quickly apportioning blame, may in fact be fueling the very conditions it describes - feelings of resentment between the two groups. Furthermore, it impedes already existing attempts to restore peace and stability in Sudan - many rebel militias saw the widespread global sympathy for them as a justification for ending peace talks, on the grounds that they shouldn’t have to ‘negotiate with a war criminal’. This inevitably escalates the conflict, and makes the job of preventing war, and restoring stability, more difficult - even drawing attention away from areas where Verhoeven argued that there is a stronger case for genocide, such as in Jonglei, another Sudanese province. His conclusion was that the ‘Save Darfur’ movement may have been having precisely the opposite effect on the region, by destabilising it and worsening existing rifts. This is not to discard the work of the various aid and relief movements, however - the large Medecins sans Frontiers contingent present in the audience put forward, in the after-lecture discussion, a strong cases that many organisations, MSF included, were perfectly justified in carrying out their work in the area. It was even put forth that the increasingly tense calls for intervention outside Sudan were hindering efforts on the ground to actually make a difference - MSF and the Red Cross, for example, were both reported to have been treated much more cautiously by the government, following the campaign’s pressure on it - with one MSF reporter, Paul Foreman, being arrested for his work. What are the implications of this, then, for us? Verhoeven was talking about a specific activist movement, concerned with a specific region of a specific country - what effect does that have on any volunteering that we do? A great deal, arguably. Just as the Save Darfur Coalition might rush in, with preconceptions and a lack of circumspection, we should always be careful about what we do. If you’re going to go out to another country, or even working locally, it always pays to look into it, to research it, to find out what the issues are, and then consider how best you can be of benefit. ‘Raising awareness’ is counterproductive, if you don’t have awareness to begin with. It’s not a matter of not getting involved, not at all - only of getting involved in the right way. Once we know the history, understand the tensions, and have a plan to help solve them - then, and only, then, are we in a position to help. The University of Oxford Centre for Tropical Medicine (Professor Nick White) It was a great privilege to have Prof. White talk to us about the history of the Oxford Centre for Tropical Medicine. We discussed the role of Oxford in Tropical Medicine research, as well as the evolving face of clinical research both at home and abroad. Schistosomiasis and the NTDs of Africa (Professor Alan Fenwick) Another seminar in the series of Neglected Tropical Diseases, Prof. Fenwick told us about these chronic, parasitic diseases which affect some 2 billion people worldwide. Rather than killing those who are infected, they cause for instance chronic pain and anaemia, preventing children from going to school and getting a job later on. In essence, they are poverty-promoting. And yet we have cheap (free!) and safe drugs available to eradicate these diseases.... Fair and Ethical Trade (Mahmood Bhutta) Summary to follow... Metabolic Diseases in the Developing World (Professor Andrew Neil) Summary to follow... An insight into new directions in the control of TB, one of the "big three" infectious killers worldwide. Professor Lalvani trained in internal medicine and infectious diseases in London, Cambridge, Oxford and Basel. After his D.Phil. as MRC Clinical Training Fellow at the Weatherall Institute of Molecular Medicine he became Clinical Lecturer in the Nuffield Department of Medicine, John Radcliffe Hospital and has been a Wellcome Senior Research Fellow and Consultant Physician since 2001. His research has shaped international TB control and provided insights into immunity against intracellular pathogens and the action of TB and malaria vaccines. The FDA-approved, NICE-endorsed interferon-gamma release assay (IGRA, ELISpot, T-SPOT.TB) which he invented and validated is the first advance in diagnosis of latent TB in 100 years and forms the basis of new guidelines for TB screening and prevention. Since his recruitment to Imperial in 2007, he founded and directs the Tuberculosis Research Unit, a world-leading multi-disciplinary research group that investigates ! a broad spectrum of fundamental questions in tuberculosis from immunology and microbiology to epidemiology, public health and policy. Over the last 12 years Helen McShane's group has developed a new TB vaccine, called MVA85A, which is designed to enhance the protective immunity conferred by BCG. This strategy improves BCG induced protection in preclinical models. Since 2002 the group has conducted a series of Phase I and Phase IIa clinical trials with MVA85A in the UK, The Gambia, South Africa and Senegal. In all of these clinical trials we find that MVA85A is safe and highly immunogenic. In April 2009, a Phase IIb proof-of-concept efficacy trial commenced in South African infants. This clinical trial will allow evaluation of the protective efficacy of this strategy in humans, and is the first of the new generation of TB vaccines to enter into efficacy testing. Asylum-seekers, unlike other migrants, do not have the choice to return to their countries of origin. They are a vulnerable group at high risk of having experienced torture, sexual abuse and psychological distress. In the UK they are at high risk of poverty and destitution. There is growing concern that the UK government, in fear of “health tourism”, is restricting access to healthcare to asylum seekers, particularly those who have reached the end of the appeals pathway in their application process. But who are the people who really suffer when we restrict access to healthcare based on immigration status? And what about those held in immigration removal centres, outside the radar of the NHS, with healthcare services being subcontracted out to profit-making companies? Can they hope to receive an adequate standard of care in detention? Who will be their advocate? Come and listen to our panel explain the challenges facing the healthcare profession in caring for this desperately vulnerable population and offering their thoughts on solutions which will help us work towards equality in healthcare. Threats to humanitarian intervention in Sudan - a case for divestment? Darfur remains the site of the largest humanitarian aid operation in the world, with more than 80 organizations and 15,000 aid workers providing assistance in a region where 2.5 million have been displaced by conflict (MSF). Aid agencies struggle with unstable frontlines, shifting alliances, targeted attacks on aid workers, and increasing government restrictions on the provision of humanitarian assistance. 11 aid workers were killed in Darfur this year and 189 abducted (UN). Southern Sudan, emerging from decades of civil war, also remains in desperate need of assistance, with some of the highest maternal mortality rates in the world. An evening of 3 talks will discuss the complex politics of this country and their effect on humanitarian work, together with how people in Oxford can have an impact. The ongoing disaster in Darfur, the slow progress of peace and justice across the rest of the country, and the failure of diplomacy have precipitated the issue of economic pressure: Campaigners from across the world including a host of British universities, members of the UK parliament and even President Obama have supported targeted divestment from specific companies providing the Sudanese government significant revenue while Darfur burns and the South and East of the country splinter under renewed violence. Speakers will include: Psychiatry in the Former Soviet Union (Professor Robin Jacoby) Summary to follow. Buruli Ulcer (Dr Mark Wansbrough-Jones) Buruli Ulcer is a skin ulcer caused by Mycobacterium ulcerans, a bacterium closely related to M. tuberculosis. It is present in much of Sub-Saharan Africa, Southern and Eastern Asia, and Latin America. Medical treatment is rarely satisfactory, and surgical intervention is often the only effective solution. Patients are left with extensive skin and bone lesions, as well as disfiguring and disabling scars. Trachoma (Professor David Mabey) Along with vitamin A deficiency and onchocerciasis (river blindness), Trachoma is one of the leading causes of blindness in the developing world. It is a chronic form of conjunctivitis caused by the bacterium Chlamydia trachomatis. Antibiotics, soap and basic hygiene can go a long way in preventing the disease, yet it still leaves tens of thousands of children disabled every year. Polio (Dr Matthew Harris & Manisha Nair) In many regards, the story of polio has been one of great success. Since the development of two effective vaccines in the 20th century, the disease has been eradicated from most of the planet. Yet it is still endemic in four countries, and sporadic cases are still frequently reported. A WHO-led initiative to eradicate polio by the year 2000 has suffered several setbacks but is now receiving enormous support globally. Despite eradication of the disease being within reach, it remains logistically very complicated, and indeed some argue that it is not worth the effort. Financing & Governing Global Health (Dr Devi Sridhar) There is more to Global Health than knowing about the exotic diseases which blight so many people's lives!
Spot Diagnosis in Tropical Medicine (Dr Chris Conlon) A special treat for all the budding tropical medics out there - all you need to know about tropical diseases, from Ascariasis to Ziehl-Neelsen staining! Working in the refugee camps of Sudan (Professor Chris Bulstrode) A fascinating evening with Prof. Bulstrode, who told us about his experience working in an Ethiopian refugee camp in the Sudan. A combination of remarkable anecdotes and interesting insights into what work in the developing world can be like! The Business of AIDS (Dr Elizabeth Pisani) In a thought-provoking evening, Dr Pisani discussed why the world is failing so badly in its fight against HIV. She argued that if we spent more time on sex and drugs and less on politics and money, there would be a lot less HIV in the world. She also challenged AIDS activism, arguing that public health is inherently a fascist discipline. Immunisation and Global Health (Dr Vasee Moorthy) A seminar about vaccine development and vaccine-preventable deaths in developing countries. This included disease-specific case studies: Epidemic Meningitis in Africa, Rotavirus in Africa and Pneumococcal disease in Africa.
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