World Health Organization

Nursing Week: Women's health advocate Sheila Tlou on breaking barriers in the fight for global health equity

siddiq22 — Mon, 08 May 2023 14:15:02 +0000

Nursing Week: Women's health advocate Sheila Tlou on breaking barriers in the fight for global health equity

siddiq22 Mon, 05/08/2023 - 10:15

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Sheila Tlou, Botswana's former minister of health, will give a keynote address on May 9 as part of National Nursing Week at the Lawrence S. Bloomberg Faculty of Nursing (supplied image)

Rebecca Biason

Topic

Global Lens

Africa

AIDS

Lawrence S. Bloomberg Faculty of Nursing

Nursing

United Nations

Women's Health

World Health Organization

The University of Toronto's Lawrence S. Bloomberg Faculty of Nursing will mark National Nursing Week with a keynote address by Sheila Tlou, Botswana's former minister of health.

Over the past few decades, Tlou – a professor, nurse, HIV prevention advocate and artist – has merged her talents as a leader in health policy and community theatre to bring about lasting change in health outcomes in eastern and southern Africa.

“Nurses are a formidable and passionate force, and I say to all the young nurses out there, 'We can make an impact anywhere and everywhere we go,'” Tlou says.

Tlou will speak on May 9 at Innis College, sharing stories of her own experience as a changemaker in global health through her work with the World Health Organization (WHO), UNAIDS and the International Council of Nurses (ICN), where she has tackled issues around HIV transmission and prevention – particularly in women and children.

Of her many accomplishments, which have included being a member of parliament for the Republic of Botswana and director of a WHO nursing and midwifery initiative for anglophone Africa, Tlou says that she is most proud of her work saving the lives of children and their mothers by significantly lowering rates of HIV transmission in communities in Botswana.

When Tlou first became Botwana's minister of health in 2004, the rate of mother-to-child HIV transmission was very high. To address this urgent issue, Tlou created a comprehensive HIV/AIDS prevention strategy that included engaging with community members and leaders prior to rolling out an education and awareness campaign focused on HIV testing for pregnant women, as well as treatment with antiretrovirals.

By speaking with women and those supporting them in child-rearing – including partners and mothers-in-law – Tlou and her team of nurses, nurse practitioners and midwives were able to change the stigma around HIV and encourage early testing, shifting the community’s perspective and focus onto efforts that helped women birth healthy babies.

This community-engaged approach successfully reduced the rate of mother-to-child transmission of the disease from 30 per cent in 2003 to 8 per cent in 2008.

“This success was really saying to the world, 'Look at what can be achieved in a resource-limited area through the intervention of nurses,'” Tlou says. “Now the rate of transmission is less than 1 per cent, and the stigma is so low that many women continue to get tested. However the rates of infection of HIV among women remain very high, and that is still something that needs to be addressed.”

Tlou's advocacy has always been centered around issues of gender and empowering women to improve their health through education. Before she became a nurse, Tlou was passionate about theatre, originally planning to become an actor or interpreter for the United Nations because of her love of languages.

However, with only health sciences scholarships available to her as a young university student, Tlou entered the nursing program at Dillard University in New Orleans, opting to take public health and theatre as electives to foster her knack for engaging with people.

After completing her master’s degree in nursing education and instruction from Columbia University in New York City, Tlou returned to Botswana to teach community-health nursing and also co-directed a travelling theatre group that performed plays – some which imparted health-focused messages about family planning and spacing out pregnancies.

“Being able to take this practical public-health message out into the communities and villages was uplifting for the nursing students involved, because they could see the impact of community engagement from a nursing perspective,” Tlou says.

Though now retired, Tlou – who taught at the University of Botswana for decades – continues to work as a consultant on health promotion strategy for organizations such as the African Union, the United Nations and the WHO on efforts to reduce deaths from malaria, in addition to her work on HIV/AIDS.

During Nursing Week and beyond, Tlou wants nurses around the world to remember the importance not just of bedside care, but of community impact – and the ability of nurses to break down barriers that contribute to inequity in health care.

“My advice to current and future nurses is to look at the UN Sustainable Development Goals in your region, meet with nursing associations and find your niche,” Tlou says.

“As nurses, we need to make ourselves visible – and that includes in how we mentor the next generation."

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National Nursing Week

Lessons learned during Ebola crisis can help manage Marburg outbreak: U of T expert

Christopher.Sorensen — Thu, 23 Mar 2023 15:08:31 +0000

Lessons learned during Ebola crisis can help manage Marburg outbreak: U of T expert

Christopher.Sorensen Thu, 03/23/2023 - 11:08

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A colourized transmission electron micrograph of two Marburg Virus particles (image courtesy of NIAID)

Betty Zou

Topic

Our Community

Emerging and Pandemic Infections Consortium

EPIC

Temerty Faculty of Medicine

Public Health

World Health Organization

Earlier this year, Equatorial Guinea declared its first outbreak of Marburg virus disease, with 11 confirmed deaths so far.

The Marburg virus – a rare but severe hemorrhagic fever which affects both people and non-human primates – belongs to the same family of viruses as Ebola. The disease presents with similar symptoms, including high fever, diarrhea, abdominal pain and cramping, and occasionally severe bleeding.

Rob Fowler, a critical care physician at Sunnybrook Health Sciences Centre and a professor in the department of medicine at the Temerty Faculty of Medicine at the University of Toronto, volunteered with the World Health Organization (WHO) on the frontlines of the Ebola outbreak in West Africa in 2014 and in Congo in 2018. In 2021, he co-chaired the WHO guideline development group that published the first guidelines for Ebola virus disease therapeutics.

He recently spoke with writer Betty Zou at the U of T-based Emerging and Pandemic Infections Consortium (EPIC) about the recent Marburg outbreak and what lessons health professionals can learn from the prior Ebola crisis to help manage this infectious disease.

What do we know about Marburg virus and how it’s transmitted?

Marburg is typically spread from an animal reservoir to other animals or to humans. When it gets into humans, there can be human-to-human spread through direct contact. The direct contact is often through bodily secretions, such as someone vomiting, having diarrhea or bleeding.

Once the virus gets onto a person’s hands, it can enter the body through mucus membranes like your eyes or the inside of your nose and mouth. In rare instances, we’ve seen health-care workers get infected through a needle-stick or sharps injury in the skin that allows the virus to directly enter the blood. And very, very rarely, people have found residual virus in certain bodily fluids that evade the immune response after the acute infectious phase has passed.

How did you react when you first found out that the cluster of people who died of suspected hemorrhagic fever had tested positive for Marburg virus?

Any time there’s a Marburg outbreak, it’s worrisome. Historically, it’s a virus that spreads efficiently from person to person and the mortality has typically been very high.

Like Ebola, this virus often shows up in areas that have underdeveloped health-care systems and a lot of characteristics within society at large that enable person-to-person spread. Tight living quarters is one example. These areas oftentimes don’t have the ability to limit virus spread because of a lack of access to consistent running water. So Marburg or Ebola outbreaks are, of course, very tough for patients and health-care teams, but also very difficult for the health-care system and the population at large to manage.

I feel for the folks that are in the thick of it right now because it’s very, very hard.

What lessons can we take away from the Ebola outbreaks over the past decade to respond to the Marburg virus disease outbreak?

When you have a disease that has a high mortality rate – mortality for Marburg virus disease can range from 25 per cent to 90 per cent – and is very transmissible, we really need to focus on prevention and trying to stop the outbreak from getting larger.

If you’re not living in an area where clinicians are able to send samples for rapid testing, then you can get behind very quickly in an outbreak. Having reference testing laboratories that are geographically nearby is critical. It’s also really important to have a culture of infection prevention and control embedded in health-care settings. The same precautions we use to prevent norovirus transmission in Canada would work well to protect people from more serious viruses like Marburg and Ebola.

If we can provide health-care teams with basic precautionary tools – gloves, gowns, eye protection, medical masks, access to running water and soap – combined with well-practiced infection prevention and control hospital processes, then that will help to prevent spread within health-care facilities.

Another key element is clear and effective messaging to the public about how we can prevent spread in the community. In addition to excellent infection prevention and control practices in hospital, you also need equal engagement in the community where the virus can otherwise spread.

Rob Fowler, second from right, with WHO colleagues, clockwise from bottom left: Sharmistha Mishra, Benon Tumwebaze, Senyonga Muzafalu, Adrienne Chan, Peter Kiiza and Mekonnen Tadesse at the Ebola Clinical Training Centre in Freetown, Sierra Leone (photo courtesy of Rob Fowler)

Where are we with vaccines and treatments for Marburg virus disease?

There currently isn’t an approved vaccine for Marburg virus. However, there are a number of promising early-phase evaluations underway. Having an effective and accessible vaccine is key in terms of prevention of infection.

For treatments, there are nonspecific antiviral medications that may be effective – including repurposed medications such as remdesivir, which has been used to treat people with COVID-19 and tested previously in Ebola virus outbreaks.

Important products in development include monoclonal and polyclonal antibodies that are specific to the Marburg virus. In our experience with Ebola, those antibody treatments were incredibly effective in reducing mortality. For Marburg, that probably represents one of the brightest hopes. To develop these antibodies, there has to be a will – not just medical or societal will, but an economic will – to do it. For Ebola, that economic will existed during and after the 2014 outbreak in West Africa. For Marburg, there has been less of an economic imperative for companies to dive into this, but hopefully that changes.

One of the things that the WHO can do is bring people together from academia, industry and other sectors and set priorities that help to send a signal and direct funds. That has happened recently for Marburg and now there are more candidate drugs being tested. I think there’s lots of hope that, as with Ebola, Marburg will have effective therapies.

What’s your outlook on this current outbreak?

It’s hard to share predictions being so far away from what’s happening on the ground, but I think it’s fair to say that we’re never out of a danger zone when an outbreak is ongoing. Sometimes you have an initial surge of cases being diagnosed, followed by concern among the public and people not seeking care or not getting tested out of fear. That can create a lull between the first set cases and the next bump in cases. The incubation period is usually about a week, but can be up to about three weeks.

Theoretically, if you go three weeks without a new case, you might think that the outbreak is clearing. However, that assumes you know about all the new cases – which is almost never true. There’s a relatively large risk that there will be unknown cases. That’s why we generally go through at least two 21-day periods without a new case before we think an outbreak is over.

How can the EPIC community help respond to outbreaks like this one – now and in the future?

There’s so much expertise in the EPIC community – and in the Toronto and Canadian communities more broadly. I think we really have had an outsized influence on vaccine and therapeutic development, diagnostic testing and clinical care.

Canada has been a leader in developing vaccines and monoclonal antibody treatments that were very helpful during the 2014 Ebola outbreak in West Africa. Supporting lab-based diagnostic capacity in Africa was also incredibly helpful. The National Microbiology Lab in Winnipeg has been very good at supporting other countries and helping them build up their diagnostic capacity.

Canadians have helped to build the foundations of excellent acute and critical care for patients with Ebola – this goes such a long way to reduce mortality even when there isn’t a specific therapy available. Yet, all of this requires people to say that it’s not just someone else’s issue – it’s our collective issue that we can bring our expertise and resources to help with. It’s about individual people asking themselves the question, “Do I have something to offer?” The answer is almost always, “Yes.”

Scholars from U of T's WHO Collaborating Centre develop blueprint to combat global corruption in health sector

noreen.rasbach — Mon, 10 Sep 2018 18:44:37 +0000

Scholars from U of T's WHO Collaborating Centre develop blueprint to combat global corruption in health sector

noreen.rasbach Mon, 09/10/2018 - 14:44

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Jillian Kohler is a professor at the Leslie Dan Faculty of Pharmacy and director of the World Health Organization Collaborating Centre for Governance, Transparency and Accountability in the Pharmaceutical Sector

Kate Richards

Topic

Global Lens

Dalla Lana School of Public Health

Health

Leslie Dan Faculty of Pharmacy

Munk School of Global Affairs & Public Policy

Research & Innovation

World Health Organization

When we think about corruption, it is often the political or financial impacts that come to mind. But corruption also leads to significant adverse effects on human health, including higher morbidity and mortality due to the barriers to health services it creates, particularly for the most vulnerable.

A new paper, published in a special edition of the Bulletin of the World Health Organization, recommends that the Sustainable Development Goals (SDGs), adopted by the United Nations in 2015, be leveraged to develop a new approach to anti-corruption governance in the health-care sector.

“We’ve reached a point now where it is recognized that if we want to achieve these development goals, we need to deal with the elephant in the room and that is corruption,” says Jillian Kohler, an author of the paper and professor at the Leslie Dan Faculty of Pharmacy and director of the World Health Organization Collaborating Centre for Governance, Transparency and Accountability in the Pharmaceutical Sector (WHOCC).

Many of the SDGs aim to improve the health of populations either directly through vaccination and clean water programs or indirectly through anti-poverty and education initiatives. While these goals might sound familiar, the fact that the SDGs also explicitly call out corruption as a priority issue to be dealt with is a major step forward and laid the necessary groundwork to focus discussion on health-sector corruption, Kohler says.

“This was really refreshing to see,” says Kohler, who is also cross-appointed at the Dalla Lana School of Public Health and the Munk School of Global Affairs and Public Policy. “It’s been a battle over the years to get organizations involved in this discussion and the fact that health-sector corruption is really on the radar with the WHO, one of the foremost global institutions, marks an important change.”

The paper also identifies and characterizes the main types of health-sector corruption – a necessary step to understanding the effects of corruption on health, but one that has been largely missing from previous research.

“Health care is one of the biggest expenditures for governments and is vulnerable to various forms of corruption, including embezzlement of health-care funds, falsified and substandard medicines, and informal payments to health-care providers, among others,” says Tim Mackey, lead author and director of the Global Health Policy Institute at the University of California San Diego, and fellow at the U of T-based WHOCC.

“We hope that providing a framework leveraging the SDGs will help catalyze international action to combat corruption in health care, especially in areas of the world where there is lack of enforcement and weak oversight.”

Including corruption as a target in the SDGs was path-breaking and presents a genuine opportunity for change because it made it possible for governments and international players to speak about the issue more openly, Kohler explains.

“It’s true that there is still a lot of denial about the pervasiveness of corruption, but having a platform available to introduce it into policy dialogues at global and national levels is the first step,” she says. The next step is to encourage national governments to take a stand and demonstrate that they are supporting the development goals while also working against the corruption that continually threatens to undermine them.

“Unless countries take ownership, there’s never going to be change,” says Kohler. “But we must also provide leaders with the tools they need to take a stand. This is the impact we are hoping to have through this work.”

Together with Taryn Vian, clinical professor and associate chair of global health at the Boston University School of Public Health, Kohler and Mackey will continue their work on advocating for better anti-corruption tools and governance in the health sector.

U of T launches world centre for accountability and transparency in pharmacy

lavende4 — Fri, 06 May 2016 13:36:29 +0000

U of T launches world centre for accountability and transparency in pharmacy lavende4 Fri, 05/06/2016 - 09:36

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Pharmaceutical transparency and accountability is important to ensure that people get the drugs they need, says U of T's Jillian Kohler (Getty Images)

Terry Lavender

Author legacy

Terry Lavender

Topic

Global Lens

Leslie Dan Faculty of Pharmacy

World Health Organization

Munk School of Global Affairs & Public Policy

Dalla Lana School of Public Health

The global pharmaceutical sector is the focus of a new World Health Organization (WHO) Collaborating Centre at the University of Toronto’s Leslie Dan Faculty of Pharmacy.

The WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector was officially launched on April 29 before a standing room only audience at the Faculty of Pharmacy. The centre’s launch was followed by a policy workshop where academics, journalists, representatives of the pharmaceutical industry and others discussed issues of transparency, governance and corruption in the sector.

Associate professor Jillian Kohler is the founding director of the new centre. Kohler told U of T News the centre is important because corruption in the health care sector not only leads to squandered public funds – it can also mean that people don’t get the drugs they need or get bad drugs.

She stressed that the centre will be examining critical governance issues which have an impact throughout the whole pharmaceutical sector.

“It ranges from manufacturing to dispensing. The drug manufacturers are important, but so are health professionals, governments, educators and researchers, and professional associations.”

Pharmacy Dean Heather Boon said the centre is a perfect complement to the other activities of the Faculty.

“We do a lot of amazing things in this building – we discover new molecules, we discover new methods of action, we help to design new policies which impact the care of Canadians and the care of people around the world. But,” she added, “our focus has been on those discoveries and not always so much on the impact of those discoveries; whether on patients, health care providers or the health care system. So the timing of this centre is perfect, because it’s really all about the impact of the decisions we make.”

The centre will conduct research, analysis and training on critical issues related to good governance, transparency and accountability in the pharmaceutical sector. The centre includes faculty from Dalla Lana, Medicine, Law, Munk School of Global Affairs and the Rotman School of Management, along with collaborators from the World Bank, Dalhousie and Carleton universities and the University of California at San Diego.

Kohler has an ideal background for her new position. She’s done pharmaceutical policy work at Unicef, the World Bank, and the Pan American Health Organization (PAHO), where she did field work in a range of countries including Brazil, Bulgaria, Haiti, and Romania. Her own area of research is fair access to essential medicines.

Fair access is definitely a problem in developing countries, she said, but it’s also a problem here in Canada. “Drugs that are available in Quebec may not be available in northern Canada or the Maritimes, for example. There are also examples of people who are relying on life-saving medicines who simply can’t afford them because the prices are well beyond their reach and governments aren’t providing funds for them.” Ironically, too easy access to drugs can also be an issue, she said, noting problems with opioid addiction..

Kohler said she was thrilled to be leading the centre, but stressed that it was a collaborative effort. “This is about making a world-class centre at the University of Toronto in an area that’s really quite new in terms of research and education.”