Kampuchea Crossings

Bump to baby on the beaten expat track

Work

Commuting and office work in the time of Covid

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After nearly a year of working from home, 10 days ago I started that commute back to an office environment at the hospital. Rapid-fire emergent findings, compounded by active misinformation and sabotage by the trump administration, and now these variants(!) make it very difficult for the average office worker to make sense of how best to protect ourselves.

So here I talk about what I use and what’s recommended: masks (always outside the home), goggles (for public transport, grocery store runs, or other crowded spaces), fans (to maintain air flow in the office) and, if needed, a portable air cleaner with HEPA filter for the workspace.

My commute is in the NYC subways where that ‘rush hour’ is still fairly crowded. In this age of mutant viruses, I am all about the protection cuz we are SO CLOSE to getting a vaccine(!) so here’s what I do on the commute and at the office:

Walking down the street with the wind blowing (usually), I just wear a mask. The double mask guidance is a stopgap, but effective: the surgical mask does not give a good fit so the cloth mask over it gives a better seal. If you can afford it, get yourself a good mask that satisfies three criteria:

  1. Fit – your breath should not fog your glasses or goggles – your breath should go through the mask and not escape out the top or sides of the mask
  2. Filtration – 3 layer tightly woven fabric is the current consensus for best filtration, until official criteria are released
  3. Breathability

Some great resources for masks guidance are below:

Here’s what Joseph Allen has to say about masks (he’s an epidemiology professor at the Harvard School of Public Health:

For that subway ride, I use GOGGLES. These are my favorites for the fit (small face, low nose bridge):

Below are my go-to MASKS for when I use public transport, for the office and any grocery store runs. I have several of each on hand and bring a spare with me when I go out. For work, I use one mask for the commute and switch to a fresh one for the day.

  • Livinguard 3-layer Safety mask with hygiene technology that uses negatively charge ions to trap and destroy germs. They aren’t cheap at $29.95 but their designation and the studies supporting the claims seem legitimate.
  • Rafi Nova 3-layer Performance mask, which comes with toggles to pull tight either the top of the mask or chin. They are 2 for $22.

In a hospital building, regulations require frequent air change so the ventilation systems are good. In an office environment, especially older buildings, we’re on our own. There aren’t many people in our office (all nurses and healthcare staff), and minimal visitors since the pandemic began (also all clinicians). I feel ok just having a variety of FANS moving air around, including this on my desk:

If you can afford a portable air cleaner with HEPA filter for your desk / cubicle / office, it can help cut down on your exposure. Below is what Dr. Allen has to say. And if you

And the tool referenced below, for determining the size of air cleaner needed, is in this link:

The Defense Production Act combined with the work done by the CDC should soon provide standard criteria and guidance, as well as a stable supply of reliable, certified masks at scale.

Stay safe..!

Building Families, Nurturing Communities: The Important Role of Social Workers in Adoption

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As families journey through life together they’ll face important, complex questions at each phase. With over a hundred years of experience, it is now an enormous community of birth parents, adoptive parents and families, and adoptees that Monica and her colleagues at Spence-Chapin have nurtured. ..

Read the rest of the article on the Spence-Chapin blog, where it was written for Social Workers Month.

World AIDS Day at the NASDAQ

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For World AIDS Day 2017, my colleague and I attended the NASDAQ Opening Ceremony, which was followed by a panel discussion on Global Leadership in HIV Testing. The event was hosted by OraSure Technologies and its global partners in the fight against HIV and AIDS – UNITAID, PSI, and UCLA.

 

Photos below are all courtesy of the NASDAQ:

 

 

 

 

The Global Fund has been backing away from efforts to promote generic competition

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Reprinted from original source, Global Fund Observer, Issue 284 6 April 2016:

The Global Fund has been backing away from efforts to promote generic competition 

Fund’s strategy has come under growing scrutiny

by Nathalie Abejero With progressively stricter patent protections, the costs for new treatments continue to rise. It is a global problem that affects countries across income levels, but is particularly challenging for poor and transitioning economies.

Until recently, The Global Fund has advocated for the affordability, availability, and financing of medicines and other health commodities, taking the time-tested position of promoting generic competition as the most effective means for bringing down the price of medicines.

According to The Global Fund’s 2012 Guide to Policies on Procurement and Supply Management of Health Products, the Fund has long supported efforts to “address barriers and practices that prevent access to affordable medicines by promoting generic competition in order to help reduce costs,” including “the use of TRIPS flexibilities [see below] to ensure the lowest possible prices for quality medical products, and allows for grant monies to be used for securing the necessary expertise.”

But lately the Fund has increasingly taken a very conservative approach or even remained silent when its political weight could have been used to promote the pro-generic policies that many countries rely on to ensure access to quality medicines.

As a result, the Global Fund’s strategy regarding intellectual property (IP) has come under growing scrutiny from rights advocates and health and development partners, including Médecins Sans Frontières (MSF), UNITAID, and Health GAP. They have called on the Global Fund to use its influence to promote the use of generic competition, and to supplement those efforts by leveraging its purchasing power to lower the price of medicines.

This campaign to protect affordable access to medicines is intensifying as the Trans-Pacific Partnership (TPP) – a landmark agreement that will create the world’s largest free trade zone and affect 40% of the world’s economy – undergoes the final legislative processes for ratification.

Besides increasing costs as a direct result of stricter patent protections, trade pacts have generally favored IP rights holders to the disadvantage of competition and consumers. But the TPP goes further than previous pacts in that it threatens future access to affordable medicines. The TPP creates additional forms of monopoly protections – i.e. over and above minimum protections that already been agreed globally.

For example, the TPP expands provisions for monopoly drug patents and grants additional enforcement powers to foreign pharmaceutical corporations to directly challenge domestic public health policies. Activists argue that these longer, broader, and stronger patent protections will result in higher drug costs and longer times to bring generic drugs to market, thus pricing vital drugs out of the reach of millions of people. If ratified, they say, unprecedented monopolies on medicines will undermine the flexibilities negotiated under TRIPS that safeguard a country’s access to affordable drugs.

TRIPS (Trade-Related Aspects of Intellectual Property Rights) is one of the annexes to the agreement establishing the World Trade Organization (WTO), the international body overseeing the global trading system, in 1994. For member countries of the WTO, TRIPS introduced protections for intellectual property (IP) rights.

In response to concerns raised about the damaging impact of IP regimes on public health and development, particularly for developing nations, the DOHA declaration was issued by the WTO in 2001. DOHA stated that IP provisions in trade agreements should not infringe on the human rights obligations of governments. It affirmed the right of WTO members to make full use of TRIPS flexibilities (e.g. compulsory licensing, parallel importing, voluntary licensing, exceptions, and exemptions) to protect public health and ensure access to medicines for the poorest.

Procurements of health commodities constitute 40-50% of The Global Fund’s annual grant disbursements, making the Fund uniquely positioned to influence the price of key medicines – particularly given the Fund’s expressed desire to maximize value for money. But instead, the Fund appears to be backing away from public health friendly, pro-competition policies that it has actively promoted in the past.

An immediate case in point is its silence during global IP debates, and specifically during recent negotiations in which least developed countries (LDCs) requested extensions from the WTO in implementing stricter IP rules. In the end, the WTO granted their request although it limited the extension to 2033 with the possibility of additional extensions.

Another example is the Market Shaping Strategy, which The Global Fund Board recently adopted. The policy attempts to expand the Fund’s role in shaping market dynamics to increase access to health products (see GFO article). Critics charged that an initial draft of the strategy circulated by the Secretariat for comment was too weak on IP barriers and generic competition issues. Members of the NGO and communities delegations of the Board provided hundreds of pages of input to the Secretariat to try to strengthen the language. But the revised text presented to the Board still fell short even though last-minute lobbying at the Board meeting where the strategy was adopted resulted in some improvements to the language.

Although The Global Fund professes to support efforts to address IP barriers to affordable medicines, it has failed to develop strategies for overcoming IP barriers in implementing countries. Moreover, according to activists, the Fund has taken the position that such matters are outside the scope of its Market Shaping Strategy.

Many actors are involved in the fight for more affordable medicines, including development initiatives such as UNITAID and the Medicines Patent Pool, which provide substantial investments to ensure affordable access to medicines. MSF contends that the existing tools and levers to overcome IP barriers can be significantly leveraged with the Global Fund’s market and political power – if only that power were forthcoming.

Another issue raised by MSF is the Global Fund’s approach to centralize key activities, such as bulk procurement and the e-marketplace. Strategies that centralize these activities seek to drive innovation and reduce costs, among other benefits, but they also build near-monopsony power for the Global Fund potentially at the expense of building country capacity to address IP barriers in order to protect their public health interests. MSF says that negotiations to lower the price of medicines lack transparency and oversight mechanisms, reducing country ownership in the process.

“Grant funds can be used to support IP/TRIPS-related work, so countries can put activities related to this in their proposals,” said Brook Baker of Health Gap. “But the availability of GF support for this IP work is not explicit. There should be clarity on this for recipient countries, both in advocacy and in TA. This is a particular concern for countries transitioning from Global Fund support, where it should leave behind a set of policies and practices for effective procurement that will have an impact not just for commodities related to HIV, TB and malaria.”

“All avenues for securing affordable access to medicines should be explored,” asserts Rohit Malpani, Director of Policy & Analysis with MSF. “The Global Fund through its sheer weight can employ a variety of means to enable recipient and graduating countries to protect their public health priorities. That means explicit support for the use, or threat of use, of TRIPS flexibilities in addition to leveraging its procurement options.”

“Further,” he adds, “The Global Fund should encourage wide review of these procurement options to inform its support to specific countries. It should conduct and publish clear analyses on the impact of free trade agreements or other trade policies on generic competition for health commodities.”

Another recommendations put forth by MSF and Health Gap is that The Global Fund should hire an in-house IP specialist as part of its market analysis work. In addition, they said, the Fund should also align with and build on the work of UNITAID and the Medicines Patent Pool on overcoming IP barriers by, for example, negotiating voluntary licenses for key commodities and expanding access to generics to low- and middle-income countries.

There is another problem, according to Brook Baker. “Commercial interests wield substantial influence on Global Fund procurement and pricing strategies,” he said. “It’s the elephant in the room.” The U.S. is the Global Fund’s largest donor, and it has an enormous pharmaceutical lobby that backed the TPP and its pro-industry IP provisions. The Global Fund’s second largest donor is the U.K., also with its own powerful pharmaceutical industry pushing for longer monopolies on brand name drugs, making it harder for generic companies to enter the market.

Touring Cambodia: Assessment of process quality in health facilities

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After 3 years, our quality assessment system was finally endorsed by the Ministry of Health [yey]! Then came the task to collect baseline data in all USAID-supported areas by year’s end [gulp]! That’s 33 questionnaires to administer, 80 enumerators fresh out of medical, midwifery and nursing schools to train, and over 601(!) public health facilities across 9 provinces to assess. It’s an enormous logistical feat, and my team made it happen just in time for tonight’s countdown at Angkor Wat! Having a proud professional moment :-)

Happy new year indeed! [Read more…] about Touring Cambodia: Assessment of process quality in health facilities

Silent courage of mothers in rural Cambodia

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Welcome to the March 2014 Carnival of Natural Parenting: Everyday Superheroes

This post was written for inclusion in the monthly Carnival of Natural Parenting hosted by Hobo Mama and Code Name: Mama. This month our participants have talked about the remarkable people and characteristics that have touched their lives. Please read to the end to find a list of links to the other carnival participants…
Flooding in Siem Reap - September 2011

Nothing against workdays at the office. There’s something to be said for air-conditioned comfort when the blistering sun and uneven roads await activities that donors have pledged tax dollars for. Besides, all the preparatory, follow-up and administrative work is necessary.

But fieldwork is where the action is – where meaningful interactions happen and that flash of inspiration hits, giving you hope that what you’re doing in the bulk of your waking hours matter. So I look forward to these jaunts to the countryside.

Out on the national roads, rice fields stretch into the distance, peppered by swaying palms and coconut trees, and the occasional thatched hut on stilts. Small figures dot the landscape. Through the planting and harvest seasons these fields are full of activity. I instinctively zero in on the women – mothers, some of them pregnant or with a baby slung on their back (or both!) – toiling in the fields. The moment you become a mother you’re initiated into a global kinship that transcends the range of social constructs. We have something big in common. And like each of us surviving our own realities, that mom in the field has her own unique angle on motherhood.

Three years ago, my ten hours of labor ended in an emergency cesarean. I have no complaints. Ours was the most purpose driven pregnancy. My husband and I took birthing courses (plural). I tried yoga and meditation sessions, continued running until I was well over 5 months then kept to an exercise regimen, and ate a balanced, chemical-free diet. My body was in good shape by the time we came to term. Giving birth in Cambodia was out of the question for reasons following, and there were few birthing centers reasonably accessible, so off we flew to Bangkok for the best nearby hospital (baby-friendly!) and obstetrician (low cesarean rate!). We even hired a doula and pre-booked the premier birthing suite equipped with yoga balls, ladders and swings, a birthing pool and Beethoven on the playlist. We did what we could to ensure a smooth delivery, but the medical safety net was in place in case of complications.

It was an ordeal, and when I think of courage, I think back to this time and what all mothers go through. (On this note – how did the tradition of celebrating the child in birthdays start? Isn’t mom the hero on this anniversary?)

Contrast my experience with the birthing reality of the women in those rice paddies. A decade ago, maternal deaths were so common that everyone knew someone who died in childbirth. Most births weren’t even attended by skilled attendants. “Giving birth is like crossing a river,” goes an old Khmer proverb; it was so dangerous that families prepared for the likelihood of losing the mother, the baby, or both.

With concerted effort, significant gains were made in decreasing maternal mortality, but the proverb still holds. The country is recovering from decades of war, so the building blocks of a functional medical system are still being laid. Maternal care in the capital is improving, but standards are generally low in rural areas.

Imagine bouncing over unpaved country roads in a steel wagon pulled by a motorbike – while in labor – to get to the one health facility in tens of miles. When you arrive, the facility might not have sufficient drugs (like anesthesia), supplies (like soap, water, a sterile delivery kit), or power (because electricity is at a premium). You assume the health staff can handle a normal birth (at least), but the likelihood of her being current in emergency obstetric and newborn care is abysmal (clinical training is poor). Not only is income for health staff so low it doesn’t cover her family’s basic needs but, worse, salaries are routinely months behind in payment. This means staff rely on multiple income generating activities (will there even be anyone at the facility when you arrive, in labor?).

With every delivery I witness here, I’m left deeply impressed at how women – not just Khmer, but all over the developing world – enter motherhood in full realization it might literally be the death of them. The possibility of death from obstetric complications or from a vaccine-preventable illness before baby’s first birthday never crossed my mind. My biggest worries were sore nipples, how to keep the baby latched during takeoffs and landings, and finding spare parts for my Medela Pump-in-Style here in Southeast Asia.

Most pregnancies end in a natural process with a healthy mama and baby. Through factors beyond our control, our first birth happened to be in the small percentage that resulted in complication. What would have been our outcome had I been one of these women, whose odds of surviving childbirth (or baby surviving the first year) can be like rolling dice?

There are no bounds to the strength of motherhood. We all put our heroic best forward. But I am deeply humbled by the courage and heroism of mothers in the figurative global “South”. In this day and age, that childbirth is so dangerous for millions of women is a remarkable commentary on humanity and the idea of progress. Born in a developing country myself, I count my blessings every day. Courage? It’s all relative, and sometimes I feel like I know little about it.

Photos from the field
Facilities are open air, so animals routinely wander into health centers and hospitals. Infection control standards were introduced in the health sector only as recently as 2010.
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Few health professionals were left after the wars, so cadres of youth were hastily trained to fill demand. Training was applied with little coordination by the government and aid community, with each donor using their own curriculum, training materials, and value system for interventions (cultural approaches to health and medicine differ by region eg Spanish vs French colonies, Europe vs Asia, etc). To be fair, it can take years of collaboration across sectors to agree on protocols and regulation –  a luxury Cambodia didn’t have immediately following the wars.

The challenge today (and bulk of development work) is in the ongoing training of these clinicians while they’re in their post. It’s an inefficient use of resources but a necessary task for the Ministry of Health and its partners.
Healthcare Practitioner consulting an expectant mother at Treal Health Center in Baray-Santuk Operational District

Transportation through provincial roads are by motorbike or “rumorque-moto” – essentially a wagon pulled by a motorbike. With unpaved roads continually molded by flooding and heavy rains, traveling by rumorque-moto or motorbike is not comfortable in the best of circumstances.
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Many complications can be managed through simple, low-tech interventions, but staff are poorly trained to recognize the signs and act quickly on them.
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Cambodia and Laos have the highest infant mortality rates in the region, due to illnesses easily preventable through better nutrition, immunization and proper sanitation.
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Malnutrition is also prevalent, making growth monitoring very important. This is possible because, with high immunization coverage, every contact provides opportunity for health staff to check the child’s growth (eg measuring and charting height/length and weight). But this woman is lucky if the nurse in charge of vaccination bothers to take the baby’s measurements, or gives advice on proper nutrition and growth.
Patient at Kampong Thom Health Center in Kampong Thom Operational District

(This topic on Khmer mothers was chosen to commemorate International Women’s Day 2014, whose official theme is “Equality for women is progress for all.”  Thanks for reading..)
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Carnival of Natural Parenting -- Hobo Mama and Code Name: MamaVisit Hobo Mama and Code Name: Mama to find out how you can participate in the next Carnival of Natural Parenting!

Please take time to read the submissions by the other carnival participants:

(This list will be updated by afternoon March 11 with all the carnival links.)

  • I Am A Super Hero — Jennifer at Hybrid Rasta Mama shares how she learned the hard way exactly what it means to be a real super hero and not a burned out shell of a human simply pretending to be one.
  • Quiet Heroics — Heroism doesn’t have to be big and bold. Read how Jorje of Momma Jorje is a quiet hero…and how you probably are, too.
  • Not a Bang, but a Whisper {Carnival of Natural Parenting} — Meegs at A New Day talks about the different types of “superheroes,” ones that come in with a bang and ones that come in with a whisper.
  • Silent courage of motherhood in rural Cambodia — Nathalie at Kampuchea Crossings marvels at how rural Khmer women defy the odds in childbirth.
  • Super Pappy — Mother Goutte‘s little boy met a superhero in checked slippers and Volkswagen Polo, his grand dad: Super Pappy!
  • An Open Letter to Batman — Kati at The Best Things challenges Batman to hold up his end of the deal, in the name of social justice, civic duty, and a little boy named Babe-O!
  • My Village — Kellie at Our Mindful Life reflects on the people who helped her to become her best self.
  • 5 Lessons My Kids Taught Me — Children are amazing teachers, when we only stop to listen. They remind us to choose happiness, to delight in the small things, to let go and forgive. There is so much we can learn from our children. Justine at The Lone Home Ranger shares a few of the lessons she’s learned.
  • Could you use some superpowers? — Tat at Mum in search shares a fun activity to help you connect with your own superpowers.
  • Like Fire Engines — Tam at tinsenpup tells the story of the day she saw a surprising superhero lurking in the guise of her not entirely mild-mannered four-year-old daughter.
  • Everyday Superheroes — Erica at ChildOrganics shares her list of Walker Warburg Syndrome Superheroes that have touched her life forever.
  • My Superhero of the Week: Nancy Gallagher — Tribal Mama muses about the transcendent things her superhero mom has done.
  • My choice in natural birth does not make me a super hero — Bianca, The Pierogie Mama, discusses her thoughts on her experience with the perception of natural birth and putting those mamas on a different level. Does giving birth naturally give cause for an extra pat on the back? No! All mamas, no matter how they birth, are superheroes.
  • Someone’s Hero — Sometimes being a parent means pretending to be a grown-up, but it always means you are someone’s hero. Read Mandy’s lament at Living Peacefully with Children.
  • Growing into a Super Hero — Casey at Joyful Courage shares how owning our behavior and choosing to be a better parent, a better person, is an act of courage.
  • A Math Superhero — Kerry at City Kids Homeschooling writes that her 7-year-old daughter’s superhero is an MIT-trained mathematician.
  • It Starts With Truffula Trees And Tulips — Luschka of Diary of a First Child takes a hard look at the realities of her relationship with her mother, and through this post goes on a journey of discovery that ends in a surprise realisation for her.
  • We Don’t Need an Excuse — Maria Kang (aka “Hot Mom”) asks women #WhatsYourExcuse for not being in shape? Dionna at Code Name: Mama asks Hot Mom what her excuse is for not devoting her life to charity work, or fostering dozens of stray dogs each year, or advocating for the needs of others. Better yet, Code Name: Mama says, how about we realize that every woman has her own priorities. Focus on your own, and stop judging others for theirs.
  • It’s not heroic when you’re living it — Lauren at Hobo Mama knows from the inside that homeschooling does not take a hero, and that much of what we choose as parents is simply what works best for us.
  • Superheroes, princesses and preschoolers — Garry at Postilius discusses why his preschool-age son is not ready for comic book superheroes.
  • The Loving Parents of Children with Special Needs – Everyday Superheroes — Deb Chitwood at Living Montessori Now shares posts with resources for parents of children with special needs along with posts to help others know how to support parents of children with special needs.
  • Everyday Empathy — Mommy Giraffe of Little Green Giraffe shares why her secret superpower is everyday empathy.
  • The Simplicity of Being a Superhero — Ana at Panda & Ananaso explains what superheroes mean to her wise three-year-old.
  • My Father, The Hero — Fathers are pretty amazing; find out why Christine at The Erudite Mom thinks hers is the bees knees.