Western Regional International Health Conference - Day 1

I am in the mountains of BC, spending the weekend immersed in health rather than medicine. Conversations around global health, and more specifically around the inequities and the violence that continue to oppress the movement towards justice, security, and health are engaging and overwhelming, so much so that I often come away with so much energy and spirit, but never knowing where to start, or how to even continue, when the problems are so endlessly immense. However, here are a few "pearls" from the conversations that I have been fortunate to have, and hope to continue to be a part of in the future.

The Context: This is the 6th annual conference, and is put on as an ongoing partnership between the Pacific Coast universities: University of British Columbia, Simon Fraser University, University of Washington, and Oregon Health Sciences University. The mandate of WRIHC gathering is to provide a truly interdisciplinary forum to understand the fuller and grander picture of global health, beyond the pictures and stories of students, researchers and aid relief workers at the front line. I say truly because since I've been really workin' the global health conference circuit this year, too much time is spent dwelling within the domain of medicine in global health, and not enough on the processes that give rise to the travesties that global health hopes to address.

The plenary addresses are always fun, because they help me to refocus my intentions in this 'movement'. The first was Dr. Julio Montaner, a veritable landmark researcher in the utility of HAART in HIV/AIDS, and in the advocacy of therapies in poor countries ravaged by this virus. I am somewhat familiar with the immense body of his work, but found the topic of his plenary address somewhat misplaced, since he focussed solely on the hard scientific facts illustrating the reductions in morbidity and mortality with regular usage of HAART. Individuals with HIV/AIDS are now living near-normal life expectancies with these therapies. Tremendous!!! What a technological and scientific coup!!! Now, it's just all a matter of access . . .

There were a couple of studies that he highlighted through his talk that stuck out in my mind the most, the Phambili arm of the HIV/AIDS Vaccine trial being one of them. A quick Google review revealed that it was the Americas/Australia arm (N = 1500) that was stopped early, in the fall of 2007, due to a marginally statistically significant increase in the rate of infection of the subjects (predominantly MSM, and some serodiscordant heterosexual couples) within the treatment arm versus the study arm. It was difficult to find the actual number of subjects who became infected with HIV, and although this did not occur through direct infection via the vaccine itself (which only contained fragments of the HIV genome), but through a mechanism that is still baffling researchers and scientists today. The fact that the initial analyses showed an increased susceptibility to infection once exposed to the virus paints a ethically unsavoury picture of the research process . . . the era of scientifically-sanctioned iatrogenic HIV infections. Which compels me to ask: What is the human cost of HIV research? Although it is a 'failure and scientific disappointment' in research terms, has there been any consideration of the sheer devastation and grief that has been bestowed upon the subjects now infected with HIV in the name of science? The press release from Merck-Frosst, I believe, states that those newly infected will be given due care and treatment, which is great and I would certainly expect no less, but does that include reparations for the relationships that are now irrevocably altered, the sense of self and destiny that is now changed as a result of this now life long and fatal diagnosis?

Dr. Samantha Nutt was the second plenary speaker of the evening. I was happy that I had yet another chance to hear her speak; the first time I was so star-struck. Now, I am a little less inclined to buy into this new fleet of "global health celebrities" (if you've been to enough of these global health conference, you know who I'm talking about). I won't sully the immensity of this woman's work, I think a quick Google search would suffice in this case. But her core message was simple, and her delivery powerful: she implored us to step back a little, from the front line issues that get so much press, and look at the policies that enable these crises to be perpetuated. To be critical of the politics, the economies, our consumer demands and practices that fuel the first two items, and our environmental uses that render these poorer states and populations tied to our material comforts and lifestyles. She urged that our roles as global health practitioners should always serve two purposes: first, to attend to the immediate needs of the people right in front of us, then second, advocate and agitate for changes in the oppressive policies that give us reason to be involved in global health in the first place.

She then proceeded to spend most of her time recounting stories from her times in conflict zones, the absurdity and abject instability of war, failed states where teenage boys rule with impunity, violations of the rules of war and the neutrality of the aid process prevail, where insecurity and the arms trade that supports it, beyond food, hygiene, vaccinations campaigns, etc. are the biggest threat to achieving true health globally.

She left the students with FOUR ways to sustain involvement in global health activities:

1. education, networking, exposure: stay involved with connecting with groups that work locally.
2. regular donations to NGOs
3. critically analyze our own indivdual consumer practices, to determine how we can mitigate our unwitting and inadvertent detriments abroad.
4. never allow life abroad be valued less that our own here in North America.

Take from that what you will.