Better to Best: Thoughts on Global Health Care Systems

Pharm Stuff. In ze news.

Posted in Human Rights, PharmFree by reshmagar on July 26, 2011

Read this:

The Bin Laden vaccine: Yes, vaccinations are a CIA plot | The Economist.

Then, read this:

KENYA: People Dying Because of Lack of Anaesthetics

And this:

Companies Shut Down HIV Drug Discount Programmes In Middle-Income Countries, Where Prices Can Be Over Ten Times Higher

Finally, read this:

Pfizer Breaks Psychological Need To Always Seek FDA’s Approval
(Thanks Alissa!)

And because the above stuff is mostly depressing, you should listen to this to cheer you up. It’s cheering me up from studying for my shelf! YAY!

The State of Pharmaceuticals (in pictures!)

Posted in Medical School (General), PharmFree by reshmagar on June 19, 2011

Last week, I was sent this awesome infographic via AMSA PharmFree regarding the incentives that doctors receive from drug companies to prescribe expensive brand-name drugs. I agree with the first statement here that drug costs were not really brought up during the healthcare reform debate. In fact, when Dr. Ezekiel Emanuel came to Brown this past year to talk about how healthcare reform would impact our current system in terms of costs, he glossed over the issue of rising brand-name drug costs and the newly (and sneakily) added evergreening legislation that extend patents for brand-name biologics stalling the entry of cheaper generics into the market. When asked further about this, Dr. Emanuel called the legislation “unfortunate”. Womp womp.

Needless to say, it is true that doctors do have the power to decide what to prescribe to their patients. Working in the psychiatry unit, this was very apparent as there was a Walmart $4 prescription list available throughout. We had one patient who was prescribed brand-name antipsychotics by his PCP. The patient was on Medicare and when he went to the pharmacy, he was told that the medication was not covered and he would have to pay a full price of around $1000. Needless to say, after a month the patient stopped taking his medications, became again psychotic and was admitted. Now he’s on the $4 brand but suffers from some motor side effects. On the list, there’s only one anti-psychotic available so we didn’t really have a choice in the matter and can only hope that his outpatient provider will keep an eye on him to see that these side effects don’t get worse. We wondered why his outpatient provider prescribed him this brand-name medication, especially as it was the most expensive one available. Perhaps, they just didn’t realize he was on Medicare…or perhaps, they were getting some nifty kickbacks from Big Pharma. While there have been laws passed banning pharmaceutical companies from even giving out pads and pens to doctors, we see them in offices all the time. The incentives are still there and unfortunately, there’s little to no regulation of them.

In JAMA this past week, an article was printed stating that while two-thirds of medical students think that drug companies’ educational materials are biased, at least one-third find the information used and half or more would like to receive ADDITIONAL materials from manufacturers. The most shocking finding, I think, is that as medical students advance from their preclinical to clinical years, they are more likely to find the incentives from pharmaceutical companies to be “ethically permissible”. Seriously? Yikes.

Clearly, this shows that these incentives and the biases of doctors as a result are not just a policy issue but also a cultural one. So long as medical schools in their curriculum and practice do not preach or practice to their students the importance of being independent and unbiased in their prescription practices and have a discussion about the impact their decisions will have on drug costs and in turn, the healthcare system, this issue will continue in the eyes of many students to be ethically ambiguous.

Medical Students’ Paradox: Drug Company Materials Biased Yet Helpful, They Say

Rebecca Voelker

Medical students appear to be a paradoxical lot in their views of pharmaceutical companies. A new review shows that at least two-thirds of students surveyed think the companies’ educational materials are biased. But at least one-third say the information is helpful, and half or more would like to receive additional materials from drug makers (Austad KE et al. PLoS Med. 2011;8[5]:e1001037). The findings also show that as medical students advance from preclinical to clinical training, they are more likely to view gifts from pharmaceutical manufacturers as ethically permissible.

The study’s authors say they conducted the review in response to ongoing controversies about the role of pharmaceutical companies in undergraduate medical education. With an understanding of how physicians’ attitudes toward the pharmaceutical industry develop during their training, the researchers say, medical schools would be better equipped to teach students about interactions with pharmaceutical companies and to develop institutional policies on industry contact with students.

The review is based on 32 studies of 9850 students at 76 medical schools in the United States, Canada, Australia, Russia, and several countries in Europe and the Middle East. The data show that by the time medical students reach their clinical training years, up to 90% have received some form of educational materials from pharmaceutical companies. Students who had contact with pharmaceutical sales representatives were more likely than those who did not to have positive perceptions of industry marketing practices. Students exposed to more marketing were less likely to view promotions as inappropriate or an attempt to influence prescribing patterns.

“Interventions that decrease students’ contact with industry and eliminate gifts may have a positive effect on building the ‘healthy skepticism’ that evidence-based medical practice requires,” the authors wrote.

From children to adults.

Posted in Medical School (General) by reshmagar on June 13, 2011

Two weeks ago, I finished my 3 week stint in child psychiatry. I found myself feeling very sad to leave the adolescents, even the ones who had just been admitted and wondering how they were going to do afterwards. During the following weekend, I would think of some of my patients and the questions I wanted to ask them on Monday before realizing that I wouldn’t be seeing them anymore. I’m sure that the next set of students that rotate through will do a wonderful job but on Friday at 5 pm, I couldn’t help but think about all the notes I had written about a particular patient and how much of a rapport I had built with them and whether or not the next student would be able to do the same. It’s funny how when we find ourselves really invested in something, we think that when we step away, it’ll fall apart when in reality, it just goes on fine without us. Everything in the end has a strange way of working out.

From the rotation, I did determine a few things. First off, I am not emotionally capable of being a child psychiatrist. I really enjoyed working with the adolescents who came through the unit and found myself able to connect with them well. Maybe it was because I had lots of shared interests with them such as drawing, comic books, sports, television shows and also almost infinite time to talk to them about anything and everything, but regardless I was able to provide some pertinent clinical information to my team that would help create a better treatment plan. I was, however, unable to not think about them after I left the unit. At night, I would come up with more questions to ask them and mull over the stories they told me. Seeing some of the kids who came to the unit to escape being at home killed me – they were willing to stay in a hospital with strangers who asked them invasive, personal questions rather than being at home with their “loved” ones. Some of the kids never wanted to leave or thought life outside would never get better. Those cases left me feeling helpless at times. I don’t think I would be able to handle having that feeling for more than 3 weeks.

Secondly, we were never really only treating the patient. We were dealing with their families and more often than not, the families usually contributed to why the patient was admitted to the hospital in the first place. I saw mothers leave their children in the unit, not visit them over the weeks they were admitted, and instead, go on vacation. Everyday I saw our team’s social workers struggle to contact the patient’s caregivers, schools, and therapists only to get frustrated by a lack of response or caring. They did amazing work, coordinating all the family meetings and packaging together the patient’s discharge plan with not only the psychiatric component but also the educational plan, family plan, and sometimes even providing afterschool activities the patient might be interested in. The social workers were definitely overworked in the unit each handling around 10 cases at once. The doctors were also overworked often having other responsibilities outside of the inpatient unit including outpatient services. There were so many pieces that needed to be fit together and often, we had to compromise to make sure the patient would be even safe. Other times, we let the patient go in hope that they might even be readmitted so that they and their families would confront the reality of the situation.

Now I am working fulltime with adults in an inpatient unit. At first when I walked in, nothing seemed too familiar. The unit was a drab white unlike the yellow, blue and green of the adolescent unit. There was no psychologist on staff to do psych testing or run groups. Patients were cramped into smaller common areas. Private spaces for doctors to meet with patients were limited. Most of our patients also had previous diagnoses and were alone. Many were alone – not having any visitors, single, and having very unsupportive families who did not want to take care of them. Later on though during interviews, I realized that my adult patients were very much like my child patients in the ways they handle situations and the lack of insight into their condition. It struck me how much my adult patients had reverted back to their childlike defenses in light of their mental illness or social situation. Patients would often pick their favorite staff in terms of how much the staff gave them what they wanted. If a staff member was stern with them, the patient would immediately paint them to be an enemy and tell other staff members sometimes even dishonest things about the “evil” staff member who had wronged them. They threw temper tantrums launching food, their fists, or even all of themselves at people or at walls. The doctors in the unit of course treat them as they act, taking away items they “rented” such as radios or pencils, speaking them to calmly and slowly, and sometimes just ignoring them and isolating them from other patients.

In the adult unit, I was still left with the same feeling as when I was with adolescents. We would ensure they were safe, give them medications, and send them to a long-term provider for them to get help for the underlying issue that brought them to the hospital. It’s an unsatisfying feeling…watching a patient walk away and wondering what will happen to them, wondering if we had made a difference, and wondering if they would be okay.

I’m not sure yet if this feeling is more pronounced or specific to working in an inpatient psychiatric unit. I’m not sure if the feeling will ever go away either.

Child Psych Week 1

Posted in Medical School (General) by reshmagar on May 18, 2011

I have now completed my first of six weeks of my psychiatry rotation. Half of the time I’m at a hospital that specializes in Child and Adolescent Psychiatry and the rest of the time I’ll be in an inpatient unit in an adult hospital. For my first three weeks, I’m in the Adolescent Inpatient Unit where teenage kids are admitted usually from the ED for suicide ideation, self injurious behavior, or trying to commit suicide. Coming into the rotation, I was told by my fellow fourth years that it would be a light, fun experience where I would get to play with kids, interview them, and work with my attendings to help manage their medications and therapy. While it has been fun sometimes, it definitely has not been a light experience.

Before coming into the rotation, we had the option of expressing our interest in child psychiatry or not. I chose to as I really love working with kids (and as evidenced by my strange habit of taking pictures of them running around although now in New Jersey, I can’t do that anymore or else I’ll be arrested…). During our psychiatry block, we had a few sessions on child psychiatry but most of the material was geared towards adults and I was interested to see how the physicians would work with the family to manage the care of children. To be honest, while I love kids, I was a bit apprehensive about working with teens as they’re toeing the line of trying really hard to grow up fast and be recognized as older and still staying a kid. Also, my child psychiatric viewpoints especially in the realms of teens were shaped by Law and Order: Special Victims Unit and not so much actual academic material. From that show, I did know that there were a lot of players in the management of children other than their parents – there were their teachers, school counselors, social workers, outpatient therapists and depending on what their diagnoses were, a whole host of other people specialized in those individual areas such as learning disabilities and specific types of therapy. In the AIU, I constantly see the interplay of all these people and how complicated it can be. Many of the teens that come through have seen a slew of providers and depending on their own preferences, their parents’ preferences, their insurance, and sometimes even their age, they jump from one person to another. Cohesive continuity of care is essential for these kids.

While the kids have been great to work with and sometimes fun, I find my heart breaking for them a little everyday. These kids are coming in for acute treatment in order to ensure they do not harm themselves and figure out coping mechanisms to deal with the stressors in their life. Unfortunately, most of them come from homes that are either abusive (physically, verbally, emotionally, and/or sexually), burdened by the parents’ own mental health issues, and sometimes on the lower end of the socioeconomic totem pole. During talk rounds in the morning, there is an insurance representative present to inform the doctors when the last day of their stay in the unit will be covered. I have seen patients come in and leave in less than 3 days due to lack of coverage. The doctors and social workers have to coordinate together to ensure family meetings as quickly as possible as well as the most effective strategy for the kids to not harm themselves and to receive outpatient treatment. I have yet to see a child who has been fully treated once they leave the unit. Many of them return to stressful homes and relationships and consider being at the hospital a small vacation from the real world. They become behind in school for weeks, months, and even years and many are second or third time returners.

This rotation has been particularly trying for me in some ways. When talking to the kids and hearing their sad story, I immediately feel sympathetic. When one teen tells me about their mother and the horrible things they say or do to them, I want nothing more than to make sure that the parent does not harm the child again. Afterwards, when reporting this interview to my attending or the social workers, I find out often that the teen has either lied or exaggerated the story, which shocks and scares me at times. Sometimes it’s pretty elaborate and I marvel at the creativity of these young kids. Other times, their story is true and their parents have a completely different take on the situation. Sometimes the parents even exaggerate or misconstrue situations for their own ends. Sometimes, the kids rather stay in the unit than go home and are forced to due to lack of insurance or other reasons. In the adolescent unit, the patient is never treated alone.

I often have to fight the urge to say something placating to the kids or even offer advice. The things they bring up in their lives remind me of when I was a teenager struggling with similar issues. I have to refrain from doing so and instead ask “why?”. I have to remind myself that even though they’re in the unit and are patients, they like I was as a teenager loved telling people, “You don’t know me.” Advice to me as a teen was never much appreciated and as their physician, dishing out advice for their school or family issues as someone who is not trained to do so is bad idea. Plus, they don’t want that. They want someone to really listen and help them with their underlying problem that got them admitted. Some want to just do enough to get out.

The worst and most devastating to see are the kids who don’t think they need to be hospitalized after trying to harm themselves or threatening to harm others. They are adamant they don’t need help and after a while, the doctors are powerless to do anything especially if the parents agree with the teens. Watching them leave is horrible – it’s as if we’ve strapped a ticking time bomb to someone without any idea when it’ll go off. Most of the staff predicts that they’ll be back soon. Most of the time, they turn out right.

I’m back!

Posted in Uncategorized by reshmagar on May 9, 2011

I am now a 3rd year. This past week, our class had orientation. I think all of us became very aware that not only were we done with hours of studying and exam after exam after exam, but that we were going to be interacting with patients full time. We weren’t pretending anymore. This was the real deal. I think most of us were scared. At least, I hope so. Cause I sure as hell am.

I start with child psychiatry tomorrow. I have no idea what to expect and am trying to refrain from thinking of the various Law and Order: SVU episodes I’ve seen with Dr. Huang interviewing a traumatized child victim of abuse. Right now, school seems pretty surreal. I just came back from studying for hours on end each day and then went on a brief vacation to Barcelona and Paris coming back the night before orientation. The jet lag has been helpful though, forcing me to sleep early and wake up early which will be useful for the coming weeks when I have to be at the hospital at 7 am, if not earlier.

This upcoming year is filled with lots of exciting new opportunities such as being involved with the AMSA PharmFree Campaign (check it out – ), another patient safety conference, and figuring out what I’m going to do between my 3rd and 4th year (more on that later).

Right now, I can barely fall asleep from excitement and fear for tomorrow. I washed my white coat, found my name tag, and packed lunch. I also cleaned my room. I’m actually a bit sick right now and am hoping that my DayQuil/NyQuil combo will stave off the intense mucus production I’m experiencing. What could be a worst first impression than getting snot on my new attending? Yeah, don’t want that.

I’ll write more later this week. Wish me luck. I’ll need it.


Posted in Uncategorized by reshmagar on March 16, 2011


Just wanted to let you know that I’ll be on a short break from my blog until May! But then, I’ll be back in full force – promise.

In the meantime, please do not hesitate to donate money towards the Japanese Tsunami/nuclear meltdown.

Here’s how to help Japan.

Until May and hopefully, some more sunshine,


‘Glass ceiling’ exists for women surgeons – Surprise, surprise?

Posted in Medical School (General), Uncategorized by reshmagar on February 24, 2011

‘Glass ceiling’ exists for women surgeons | Research News @ Vanderbilt | Vanderbilt University.

On its face, the statistics look good. The number of women graduating from medical schools has nearly doubled since 1979, and those moving on to become surgical residents and surgeons have nearly quadrupled since 1970.

But a closer look reveals a persistent glass ceiling for female surgeons looking to attain full professorship at medical institutions across the country. In fact, women make up less than a third of the surgeons who advance to senior ranks.

While nearly 35 percent of male surgeons earn full professorships, just more than 10 percent of women do so.

This according to new research by Colleen Brophy, professor of surgery in the Division of Vascular Surgery at Vanderbilt. In a paper that will be presented this spring at the annual meeting of the Association of American Program Directors of Surgery, Brophy points to the disproportionate rate of female full professors in surgery, compared to the rate for men.

Potential causes
One common theory has it that fewer women are entering the field. But Brophy’s study suggests that other unknown variables are at play since the number of women in the surgical pipeline is, in fact, growing.

One possible variable links the role of productivity to promotion. But again, Brophy’s research shows no difference in the number of publications men and women attain throughout their careers.

In gathering her findings, Brophy pulled data through 2009 from the American Association of Medical Colleges (AAMC). She has been studying leadership in academic medicine for more than 10 years.

“How we cultivate good leaders, both male and female, is obviously critical in any industry,” said Brophy. “But if leaders in business make a mistake, they lose money, profit-share. If we surgeons make a mistake, someone can lose a limb or his life. How we lead matters,” she said.

Listening for solutions
To address surgical leadership, R. Daniel Beauchamp, chair of the Section of Surgical Sciences, meets quarterly with female surgeons. The group discusses issues relevant to career development, work-life balance, gender bias, perceptions and other issues of importance to faculty members. They also discuss how to recruit, promote and retain more female surgeons.

“Of all the leadership activities in which I am engaged, I see none more important than my involvement with our outstanding women faculty members,” Beauchamp said.

“They have made me much more aware of the issues that are most important to them, and to the unconscious bias that exists in our profession.

“Because many of the most talented medical school graduates are women and because we need to have women represented at every level of academic surgery and surgical leadership, I am committed to increasing the presence of talented women on our faculty and to the development of their careers as leaders in academic surgery,” Beauchamp said.

Gates Foundation Annual Letter: Hit or Miss?

Posted in Health Rights by reshmagar on February 1, 2011

The Gates Foundation released its 3rd annual letter recently. Check it out here:

If you don’t want to read it, here’s a basic overview from the man himself regarding the letter:

The greatest priority, according to Gates, is to eradicate polio.

In a blog post for the Huffington Post, Gates writes:
One of the major themes of the letter is the miracle of vaccines. Last year, Melinda and I announced that we were working together with partners to make this the Decade of Vaccines, and I wanted to use this year’s letter to explain why.

In particular, my letter focuses on the vaccine for polio, since it’s helped the world get to the threshold of something amazing: eradicating the disease altogether. We’re incredibly close and we need to finish the job.

We put together a video, called Vaccines Save Lives, to try to describe why vaccines are a miracle in a vivid way. I hope you enjoy it — and share it with your friends.

The New York Times had an interesting article talking about the response to the letter. Check it out here: Gates Calls for a Final Push to Eradicate Polio

Key points in the article:

Although that battle began in 1985 and Mr. Gates started making regular donations to it only in 2005, he has emerged in the last two years both as one of the biggest donors — he has now given $1.3 billion, more than the amount raised over 25 years by Rotary International — and as the loudest voice for eradication.

However, even as he presses forward, Mr. Gates faces a hard question from some eradication experts and bioethicists: Is it right to keep trying?

Although caseloads are down more than 99 percent since the campaign began in 1985, getting rid of the last 1 percent has been like trying to squeeze Jell-O to death. As the vaccination fist closes in one country, the virus bursts out in another.

In 1985, Rotary raised $120 million to do the job as its year 2000 “gift to the world.”

The effort has now cost $9 billion, and each year consumes another $1 billion.

By contrast, the 14-year drive to wipe out smallpox, according to Dr. Donald A. Henderson, the former World Health Organization officer who began it, cost only $500 million in today’s dollars.

Dr. Henderson has argued so outspokenly that polio cannot be eradicated that he said in an interview last week: “I’m one of certain people that the W.H.O. doesn’t invite to its experts’ meetings anymore.”

Recently, Richard Horton, editor of The Lancet, the influential British medical journal, said via Twitter that “Bill Gates’s obsession with polio is distorting priorities in other critical BMGF areas. Global health does not depend on polio eradication.”

“Fighting polio has always had an emotional factor — the children in braces, the March of Dimes posters,” Dr. Henderson said. “But it doesn’t kill as many as measles. It’s not in the top 20.”

Dr. David L. Heymann, a former W.H.O. chief of polio eradication, said he was still “very optimistic” that eradication could be achieved.

But if there is another big setback, he said — if, for example, cases surge again in India’s hot season — he might favor moving back the eradication goal again to spend more on fixing health systems until vaccination of infants for all diseases is better.

“When routine coverage is good, it’s no problem to get rid of polio,” he said.

Asked about that, Mr. Gates said, “We’re already doing that.” (Actually, one of the main criticisms the Gates Foundation and the MDGs has received was a lack of focus on strengthening and fixing health systems.)

I’m not really sure what to think. I definitely think it’s a noble goal to pursue the complete eradication of polio. But if it means deviating funds away from other issues that also need to be addressed, then perhaps it’s time to streamline priorities a little more.

What do you all think? Should the Gates Foundation be pouring more funds into polio eradication? Is this a realistic goal? What other alternatives are there?

Announcing the Northeast Regional Patient Safety and Quality Improvement Conference

Posted in Patient Quality and Safety by reshmagar on January 27, 2011

For the past year, I have been working on putting together a conference on patient safety and quality improvement. It’s finally coming together and soon approaching in less than 2 weeks! Crazy.

So why should you come?

When I was an undergrad, I had the opportunity to attend a dinner with a patient presentation. Honestly, at the time, I went for the free food but I left inspired and itching to do something. The patient who presented was this woman:

Linda Kenney

Mrs. Kenney was a victim of a medical error. She had an incredible story about what happened and how she channeled her frustration regarding the event to creating an organization called MITSS or Medically Induced Trauma Support Services. Here’s her story from the website:

My name is Linda Kenney and I am a survivor of a medically induced trauma. In November of 1999, at the age of thirty seven, I underwent surgery for a total ankle replacement at a major medical facility in Boston, Massachusetts. Instead of waking up with a new ankle, I awoke several days later to find out the nerve block had been accidentally delivered to my heart and I had gone into full cardiac arrest. Emergency open heart surgery was performed to restart my heart and at that point there was a 50/50 chance I would make it through the night. This incident has had a profound effect on myself, my family and all those involved.

The anesthesiologist reached out to me right away and in time we came to an understanding, a peace and a friendship. The hospital itself was another matter. I made several attempts to contact the hospital seeking support or other patients with similar circumstances and my calls were never returned. I am committed to ensure that support exists for other patients.

I am committed to alerting hospital administrators and staff of the need to follow up and support patients, families and hospital staff after a trauma occurs. Support is crucial to facilitate recovery. MITSS has been founded specifically to provide a network that links those involved with resources that provide and promote healing through a variety of media.

When I heard her story, I was blown away. Here I was, about to finish undergrad and enter medical school…and enter a profession I thought would help people, not harm them. The only encounter I had with patients experiencing medical errors was from seeing commercials from lawyers such as Jim Sokolove – patients who were clearly unreasonable and just wanted to rack up money from malpractice.

When I looked more into medical errors, I found that the statistics were staggering – 98,000 deaths in the United States due to preventable medical errors. That’s equivalent to a plane full of passengers falling out of the sky every day. Another 100,000 patients become permanently disabled due to preventable medical errors. I started to wonder if I was going into a profession where it was inevitable that I would hurt someone. How could I as a potential medical student change the system so that this didn’t happen?

I then learned about the Institute for Healthcare Improvement Open School, American College of American Quality, and other organizations that offered resources for students to become involved in building a system that would be safer and ensure quality healthcare.

This year at Brown we’re hosting an amazing conference to bring these resources to students and to provide mentorship from people who have been working on specific patient safety projects. I invite you all to come to the Northeast Regional Patient Safety and Quality Improvement Conference on February 5th at Rhode Island Hospital:

February 5, 2011 8:00 – 5:00 PM Rhode Island Hospital – George Auditorium
593 Eddy Street, Providence, RI 02903 (map)
Registration for NE Region PS/QI Conference

Each year, 100,000 patients die of preventable medical errors. As the burgeoning generation of healthcare professionals, it is our responsibility to ensure quality and safe medical care.

Join other students and residents from around the northeast region in a series of interactive workshops to learn about patient safety and quality improvement. Workshop topics include healthcare policy, medication errors, root-cause-analysis with real case studies, the WHO Safe Surgery Checklist, and more.

Through the conference, participants will acquire tools they need to start quality improvement projects at their institutions and will be directed to resources such as the Institute of Healthcare Improvement and American College of Medical Quality.

Free to everyone! Breakfast and lunch included.
Facebook event link

Rhode Island Hospital – George Auditorium
593 Eddy Street, Providence, RI 02903

Featured speakers include:

Linda Kenney
Medically Induced Trauma Support Services

Meredith Rosenthal, Ph.D.
Associate Professor of Health Economics Policy
Harvard School of Public Health

David Lindquist, MD
Clinical Assistant Professor of Emergency Medicine
Warren Alpert Medical School of Brown University

Gordon Schiff, MD
Associate Director of Center of Patient Safety Research
Harvard Medical School
Brigham and Women’s Hospital

Mary Reich Cooper, MD, JD
Senior Vice President and Chief Quality Officer
Lifespan Coorporation

H. John Keimig, MHA, FACHE
President and CEO
Quality Partners of Rhode Island

Joseph Couto, PharmD, MBA
Assistant Professor
Jefferson School of Population Health

Shawn Rangel, MD, MSCE
Staff Surgeon – Department of Surgery
Children’s Hospital Boston

Thomas Miner, MD
Associate Residency Director for General Surgery
Warren Alpert SOM at Brown University

Check out our amazing schedule as well:
NE Regional PSQI Schedule

I hope whoever is in the area reading this can come and attend. It is up to us, patients and providers, to ensure the most basic right in healthcare – safety. By attending this conference, you can take the first step to ensure “do no harm”.

What does secession mean for Southern Sudan?

Posted in Human Rights by reshmagar on January 10, 2011

Yesterday, the people of Southern Sudan voted on independence referendum to create a brand new country in the world. So far, so good.

(courtesy of Long lines formed Sunday at polling places in Juba, in southern Sudan, for a referendum on independence. The voting, which will continue through the week, was reported to be going smoothly.

To read more about this historic event, go here: In Southern Sudan, a Jubilant Vote on Secession

But what does this all mean? I came across this great Q&A with Jonathan Temin, senior program officer on Sudan at the U.S. Institute of Peace from PBS Newshour.

Q&A: South Sudan’s Independence Vote

Residents of southern Sudan vote Sunday in a long-awaited referendum on whether to split from the north and form their own country. Analysts expect the oil-rich south will choose independence in the Jan. 9 referendum, which lasts a week, possibly triggering clashes between militias tied to both governments.

Jonathan Temin, senior program officer on Sudan at the U.S. Institute of Peace who travels regularly to the region, provides insight on the historic vote:

When will we know the results?

JONATHAN TEMIN: Vote counting is expected to take several weeks, so results will not be immediate. Current estimates are that results will be finalized in the first half of February. So some patience will be required as the counting process plays out — the authorities will be careful to stick to the provisions for vote counting and appeals in the legislation that govern the referendum.

Would the split occur immediately?

TEMIN: No, if there is a vote for secession it will occur at the conclusion of the Comprehensive Peace Agreement, which will be July 9, 2011, six months after the referendum. So patience will also be required in waiting for that date. The fact that there will be six months between the referendum and possible secession is not widely understood in many of the more remote parts of southern Sudan. But those six months will be important to the ongoing negotiations between northern and southern authorities on outstanding post-referendum issues, such as future revenue sharing, division of Sudan’s debt, and citizenship rights.

What changes would southern secession bring to people’s daily lives?

TEMIN: Significant changes may not be immediate. Many people in southern Sudan have high expectations that secession will quickly bring significant dividends, but this is not likely to happen. The Government of Southern Sudan remains nascent and in need of substantial capacity building; its ability to bring much-needed services to its constituents, especially in rural areas, is minimal.

Of the services (food, health, education, etc.) that are available in southern Sudan, many are delivered by nongovernmental organizations and United Nations agencies. Managing expectations in the post-referendum period will be essential, because if citizens maintain high expectations, and the Government of Southern Sudan continues to struggle to deliver services, the discontent created can be dangerous.

Will we see mass movements of people either to the north or south?

TEMIN: It is possible; the most likely movements are of southerners living in northern Sudan moving back to southern Sudan. Estimates vary widely, but many people agree that there are approximately 1.5 million to 2 million southerners living in northern Sudan, many of them in and around Khartoum.

Already a significant number of southerners living in the north — possibly up to 100,000 — have returned to the south in recent months. There are concerns that southerners living in the north may be targeted for violent attacks or deprived of some of their rights if there is a vote for southern secession. This is why ongoing negotiations on post-referendum citizenship rights are so important — those negotiations will define what rights and status (dual nationality, permanent resident status, etc.) will be enjoyed by southerners living in the north and northerners living in the south. The safety and security of northerners living in the south is important as well, but there are significantly fewer of them than southerners living in the north.

Would the split have any impact on Darfur?

TEMIN: This is an important question that doesn’t get enough attention, especially given recent accusations by the north that the south is supporting Darfur rebels. There has been periodic cooperation between southern authorities and Darfur rebels over the years (fighting through proxies is a common practice throughout Sudan).

But if the south secedes peacefully I expect it will limit support for northern opposition groups and turn inwards, focusing on internal challenges (and when President [Omar] al-Bashir visited Juba on Tuesday the southern leader, Salva Kiir, publicly promised that the south would not support any armed northern opposition).

The Darfur rebel movements are likely in a holding pattern, waiting to see what happens in the referendum process and whether it is peaceful or violent. If there is violence, they may see an opportunity to try to force the northern army to fight on two fronts, something it is not eager to do.

You’ve been there in the lead-up to the vote. In your view, what are the chances that violence or even civil war will break out?

TEMIN: I am cautiously optimistic that the referendum process will proceed relatively smoothly and peacefully — and this is a change from my expectations six months ago, when I thought there was a significant likelihood of a southern unilateral declaration of independence and substantial violence.

Preparations for the vote have been impressive and recently the international community, including the U.S., has done a good job sending a unified message that the referendum should happen on time and the results should be respected.

There likely will be some local violence around the referendum process, as Sudan can be a violent place, but what will be essential is not allowing that local violence to escalate and become politicized. Ultimately, it is up to the leaders in northern and southern Sudan to ensure that doesn’t happen.

I too would like to be “cautiously optimistic” and hope that through this referendum there may be a start of a decline in violence and death in the region. It’s uncertain to me though what will occur with prized resources such as oil being primarily in the South. It is certain though that the country born out of this vote will be one of the poorest nations in the world – how will the new government of Southern Sudan fare in tending to its citizens? All eyes around the globe should be trained on the nation and be ready for whatever is to come.

President Obama offers another optimistic view on the vote: In Sudan, an Election and a Beginning