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Of injustice, rage and genocides. A PAN poem for Ahed Tamini

For #ahed_tamimi

Award winning Zimbabwean Poet, Philani Amadeus Nyoni writes a moving poem for Ahed Tamini, a young Palestinian young woman that speaks of an observed injustice, a global grief and our restlessness for a better future. Zimbabwe in conversation with Palestine.

PAN Ahed


There is a fire in your palm
That speaks for all injustice;
It is the rage of genocide
From Rwanda to Gukurahundi,
From power to power
The plight of the innocent
Tower to tower. Fire to fire,
Your palm against fire power.
There is a fire in your palm
I wish was in mine for see:
The pen would be mightier
Than gunpowder and I’d free you
Back to the dunes you call home.
But there is fire in your name;
It burns of promise.

Ahed Tamini 2

Philani A Nyoni was born in Bulawayo, Zimbabwe sometime in the last century. He has authored four books: “Once A Lover Always A Fool” (2012), “Hewn From Rock” (2014) with John Eppel, “Mars His Sword” (2016) and ‘Philtrum’ (2017)

Ahed Tamini

-PAN,18

PAN Picture credit of KB Mpofu

Dorcas Gwata

Director of Tribal Sands 2018

All rights reserved.

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South of Africa: Ubuntu: Styled by Fikile Mqhelekagogo Dube

 

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It is often said that the beauty of African fashion comes from the   authentic hands that craft it, the innovation that turns a worn out maize sack into a head turning figure-hugging skirt, the visionary eyes that see beyond our everyday waste, and the delicate hands that put finishing touches to wearable arts fit for grand ceremonies.

African fashion is actively participating on the global stage, we are shaping the global fashion industry with our bold colours, tribals prints and wraps that have no beginning or ending. 

Fikile Mqhelekagogo Dube hails from Southern Africa, her world is wrapped in all things African, she is as unclaimed as her brand, there are no cliches here, there is nothing ordinary about Fix, as I call her. Her jewellery has clout, it is loud and bold yet grounded in a deep cultural presence that our collective ancestors would approve. I love her unique accessories designs, she embodies strong Southern African themes that have a strong sense of belonging, yet not tied to any particular country or tribe. Fikile is present, she is here and she is not afraid to ‘go there’ and disrupt our cultural norms. She whips up our usual culturally themed styles into mesmerising garments, the kind that acclaims remarks wherever you are. I love that she continuously pays homage to her roots and honours the origins of her inspirations, that she sources her materials from the continent and  actively supports local women to produce materials, collaborating with them to improve their participation in showcasing the best from Southern Africa. 

I caught up with the ever vivacious Fikile  Dube on my blog, Tribal Sands, and she shared her journey on how it all began with your brand, South of Africa.

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‘I have always been unapologetically afrocentric and in the 90s when I arrived in the UK African accessories and clothes were not easy to find (unlike now), and because I enjoyed working with indigenous mediums in Zimbabwe I was more than eager to make my own rather than to abandon wearing my African clothes and accessories . A friend of mine came to visit me one day and said “these shoes are Dope! why don’t you just make these to sell?” and the rest is history,’ Fikile smiled.

Fikile’s ethnographic approaches embody the ethos of Ubuntu culture, she has a way with fabrics, kaftans, shawls and rems of mouthwatering jewellery. I wondered what grounded her so firmly in her roots.

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‘I like to think I was raised in the spirit of Ubuntu and it’s importance for our ability to thrive and grow as a people. It’s something that was ingrained in me from childhood and up to this day I believe, live and practice it. I therefore believe that it translates naturally into my brand.’

‘My inspiration is without a doubt drawn from the African continent and her traditional cultures, her colours, her smells, her vibrancy, her people, her pain. My emphasis on Southern Africa is mostly because of my diverse heritage from the region. I have Ndebele, Sotho, Shona, Swati and Zulu blood and influences from those cultures have been constant in my life’

As an Analyst and Global Mental Health Specialist, I see synergies between art and mental health, I love supporting African artists. I am all too aware that we are documenting African fashion at a time when the continent is rising, and the African Diaspora is keen to play its part in the continents development. African women in particular are defining their own narrative through spectacular designs. This is an exciting time to engage in  African Fashion. African designers too have social responsibilities and can leverage and amplify cultural impacts in the community.

‘Africa is trending,’ Fikile insists,  ‘African influence is at the forefront of not only the fashion industry but a vast majority of other disciplines in the creative world. This is our moment as fashion and accessories designers to not only tell our story about Africa but also to influence how people dress. This is our opportunity to influence how people perceive Africa and how us Africans perceive ourselves. It’s an opportunity for our young girls to realise the beauty of Africa and the beauty of being African’ she adds.

Although many African women are progressing well,  the issues of domestic violence, which are further complicated by our cultural beliefs and practises continue to affect us all at all in the continent and in the diaspora, I wondered how Fikile was using her brand and voice to advocate on these challenging issues.

‘South of Africa works with women who have been affected by issues of abuse. We source and sell products on their behalf. We also work with a team who proactively work with these ladies to make sure they have access to information and knowledge on how to access resources for women who may be abused. In addition, we at South of Africa have been proactively vocal on issues of abuse. In this day and age no type of abuse should be considered acceptable,’ Fikile says with a passion that is clearly seeking for a better tomorrow for us all.

‘You are out and about and unapologetically bold about your accessories, how does this reflect your personality,’ I asked Fikile. She smiles, broad red lipsticked, adjusts her bold signature squared glasses and whisperers, ‘I am unapologetically African, vibrant, vivacious, and a non conformist’  Our spirits mingle and I breath into a timeless friendship.

Fikile’s craftsmanship skills are fascinating, she dyes her own materials to enhance her designs,  I wondered why is it important to her to maintain the traditional skills of design, even with all the technology that we have today.

‘For me the perfection of Africa is in its imperfections,’ she says. ‘The flaws in my design give them character and the traditional skills best reflect this beauty. Whilst technology might be quicker and more efficient I don’t believe that it can adequately capture all the skills of design that we’ve acquired over years and years.’

Fikile has been awarded for her work. ‘I have  had many happy moments,’ she said ‘but being recognised by my peers as a fully fledged designer rather than someone who just makes accessories for fun in her living room was a very happy moment for me, she adds.

‘There have been challenges too’ she says ‘challenges that I’m sure many other African designers face too. The economic challenges in Zimbabwe make it difficult to import and export our crafts, we hope that this improves and opens up greater opportunities for the local producers and the diaspora, the scope for development is immense’

Fikile maintains a ground footing in a number of community projects in Zimbabwe. ‘It is important for the diaspora to support home based brands,’ she says, ‘because Zimbabwe is home and whether we like it or not it has moulded each and every one of us into who we are today and where we end up. It’s only right that we give back to the earth that has given us so much,’ she adds.

Young and experienced designers look up to Fikile, I wondered what advice she would you give to a young person who may be considering a career path in African fashion today.

‘Believe in yourself, she says, believe in your talent and don’t ever create anything that you would never publicly endorse. Don’t let your fears inhibit your goals. Embrace your fears,’ she concludes.

Fikile Dube thank you for talking to me on Tribal Sands.

 

Dorcas Gwata

Director of Tribal Sands

Photo’s credit to Fikile Dube

Thank you to Dalia Majongwe, Manager at Tribal Sands

January 2018, all rights reserved.

Mental Health and Migration at Global Health Cafe

The Global Health Cafe community met again recently and explored issues of mental health, migration and economies of migration with special guests, Turkish Psychiatrist,  Dr Vesile Senturk and Kenyan Economist Agnes Gitau. The context:

Despite the notable public health improvements across Africa, there are still significant challenges that remain. All the current global health initiatives; SDGs including UHC (Universal Health Coverage), GHSA (Global Health Security Agenda), One Health, provide optimism for sustainable health solutions in Africa. However, if Africa is to truly improve the health of its population and attain the desired goals of these initiatives, collective and African-led efforts are needed. Local leadership has proven vital in disease outbreak response and is a strong example of the effective and sustainable benefits of African-led approaches to public health improvement across much of the Continent.

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The Global Health community in Britain is growing and those with a passion for Africa are increasingly seeking to amplify their voice and ability to remedy these problems. There is a sizeable community of Africans outside of Africa and they too have a role to play in ‘Africanled’ approaches. The Global Health Cafe is a new platform formed by Global Mental Health Expert, Dorcas Gwata and Global Policy Expert Ade Adeyemi with great support from Dr Titilola Banjoko (Director of Performance, Planning and Informatics, NHS) and Professor Aliko Ahmed (Director of Public Health England, East of England), the founders of Better Health for Africa. Our regular Global Health Café meet-ups take place in Westminster, London. Enthusiasts come from a wide range of backgrounds and experiences to meet and discuss Global Health issues, with a view to stimulate progressive dialogue that can inform innovation, health policy, evaluation and practise. Progress so far Recently, we have explored the impact of Brexit on Global Health, career opportunities in Global Health and this month we will be discussing the relationship between mental health and the economics of migration with special guests Turkish Psychiatrists Dr Vesile Senturk and Kenyan Economist Agnes Gitau.

We will explore the mental health outcomes in migrant communities with a particular focus on Turkey and Kenya; looking at the economic, cultural and social impacts of migration on these countries. We will also focus on lessons that low income countries can learn from middle income countries, where we will move to understand the effects of migration on these countries and make representations to the appropriate authorities.

We explore business opportunities and the economies of migration in Global Health, in the paradigm of a politicized migration. Are we missing the business opportunities than can arise from migration, could economies of migration help to develop health care systems and businesses in Africa? The Global Health Café series is an African-led platform, with focus on health in Africa, importantly so because, despite progress Africa continues to carry the heaviest burden of global disease. The future Over time we will be looking to develop these discussions on bigger think-tank platforms, seeking funding to grow our influence in Global Health.

The timing could not be more right with the new appointment of Dr Tedros Gebreyesus WHO Director General, the first African to hold this post. The community that gathers at the Café will serve as the “vehicle” for informed and credible delivery of sustainable public health improvements in Africa, supporting the new WHO DG in its own little way. All efforts to support and magnify our impact are welcome

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Dorcas Gwata, Global Mental Health Expert and

Ade Adeyemi, Global Health Policy Expert

 

Thank you to all our volunteers on the Global Health Cafe series, we very much appreciate your efforts

All rights reserved September 2017

 

Ghosts of Freetown by Philani Amadeus Nyoni

Ghosts of Freetown

You are not Haiti,
You have no Wycleff Jean,
And too far to make your problems our own,
So we can’t hear the crackling of your fires,
Nor smell your smokes of desperation.
The forests are buried as coffins,
Children drowning in mud
While the world chews the cud.
Is it because your skin is muddy
That there’s no humanity for your agony?
And what of those who look like you,
What did they say, what did they do?
How lonely is misery,
Though diamonds bring much much company!
But diamonds are stone they cannot see,
And children are precious beyond measure.
Today your real treasure returns to the dust,
Africa has buried her future again!
Weep not too hard, times death is mercy.
The future is buried again dear Africa,
Buried with hope, not just any hope,
With the hope, and a prayer to the Nile,
That one day we will all be free,
Truly free, as free as death,
Free, as these ghosts of Freetown.

PAN 5

 

Poem by Zimbabwean Award Winning Writer Philani Amadeus Nyoni

Nutrition in Zimbabwe, a Global Health perspective

LSHTM 2017

Global health challenges accelerate in conditions of poverty, poor economies, and geo-political uncertainty. Infectious diseases thrive in poverty, viruses do not respect boarders. It is therefore imperative that we discuss and explore measure to strengthen regional responses to health challenges in Southern Africa and improve health security for all. In analysing Global Health threats and challenges, Zimbabwe must be viewed in the broader context of region, an ecological view across the African landscape. The Cholera outbreak in 2008 in Zimbabwe became a regional challenge, just as the Ebola crisis defied all boundaries as it a spread across West Africa and beyond.

In Zimbabwe poor nutrition particularly in children and women has coincided with poor harvesting, drought and poor economic opportunities, this report draws on information gathered in clinical practices, observations and collaborations with non-governmental organisations in Zimbabwe.

The 2015 Demographic and Health Survey estimated that 27% of children under 5 years in Zimbabwe are stunted (chronically malnourished), with significant disparities between urban (22%) and rural (29%) areas, and between boys (30%) and girls (24%). 3% of children under 5 years are estimated to be wasted (acutely malnourished), with severe acute malnutrition at 1%. The rates of exclusive breastfeeding in the first 6 months currently stands at 48%. Only 8% of children 6–23 months are given a minimum acceptable diet. (Dfid Zimbabwe 2017)

The DFID Livelihoods and Food Security Programme (LFSP) aims to improve nutrition through promoting production and consumption of bio-fortified crops such vitamin A maize, iron and zinc enriched beans and millets; and providing trainings to smallholder farmers on good agricultural practices, various technologies (crops and livestock), good nutrition, and financial literacy. (Dfid Zimbabwe 2017)

There are significant nutritional disparities between rural 29% and urban areas 22%, which could be explained by the fact that people in rural areas have limited access to diverse means of income compared to urban areas, which is further complicated by poor health seeking behaviours, thresholds to seeking help and access to transport to access health care. Clinically patients presenting to health care services with nutritional problems are often presenting with co-morbidities and complex faceted medical complications such as HIV and poor nutrition or Diabetes and poor nutrition.

There are gender differences in poor nutrition, with boys presenting at 30% and girls at 28%, these differences have been observed across other low income countries and the evidence base for the difference is still weak.

In mental health terms, suicides amongst farmers are significantly high throughout the world, and suicides are highest in men, overall farmers are particularly vulnerable at times of poor harvest. Farmers tend to use highly poisonous methods which are at their disposal, eg pest controls which are more likely to be fatal in death. Poor nutrition will have implications on early marriages and gender violence; we are observing an increase in HIV infections amongst young women across the country which may be related with poor literacy and the desire to get married in search of better outcomes. Some patients in mental health hospitals may prefer to stay in hospital long after they are well and dischargeable because the conditions at home might be poorer than in hospital, this is further complicated by their disabilities and stigma and lack of food.

Africa’s middle class society is growing, in what many are coining ‘The Pot Belly Economy’ Globalisation means people are able to access information and model lifestyle behaviours from communities afar, the African middle class is modelling western lifestyles and indulging in fast foods at the cost of their health. In the wake of the HIV crisis, and in a culture where ‘big’ is much preferred than ‘thin’ which is opposite to the western phenomena, non communicable diseases such as diabetes, hypertension, and alcohol related conditions are the new threat and often neglected health challenge in the continent. Poor infrastructure compounds access to health and number of traffic related death and injuries is a public health concern.

More critically in these difficult economic times, poor people having to make tough choices between feeding their children or using the $1 they may have to travel to hospital for treatment. They are many female led households in Zimbabwe, headed by highly resilient and resourceful women, however the lack of economic enterprise compound their health and social outcomes, a growing concern for this highly vulnerable population.

There is a need to strengthen regional responses in the Southern Africa region, the East African region has become increasingly co-ordinated and coherent, economically culturally and socially, all this despite the challenges they continue to face. The Ebola crisis and response brought the West African response even closer and we are encouraged by the launch of the Africa Centre of Disease Control in Nigeria. Southern Africa region needs to be much more robust coherent regional planning and responses, we need to re-define SADC’s role and remit and strengthen where possible. We must leverage on the new appointment of Dr Tedros Ghebreyesus, WHO Director General, the first African to hold this post, an important development given that globally, Africa carries the heaviest burden of disease.

Thank you to Annabel Gerry and Dr Sajil Liaqat of DfiD, Zimbabwe

Nutrition in Clinical Practice, a Global Health perspective.

Dorcas Gwata

Global Mental Health Specialist

Britain Zimbabwe Society Conference 2017

Zimbabwean Fashion Designer Joy-Line Clothing Takes Stage

I have a thing for Africa and African fabrics, when I wear an African designer, I feel grounded and stylish, when I wear anything by a Zimbabwean designer, I feel on top of the world.  Whilst so many  designers stand out, old and new, over time I have been blown away by Joyline Kim Munairwa’s work. Her’s is more than just a love of fabrics, I caught up with Joyline Kim on Tribal Sands, she tells us how it all began.

‘There years ago I had a tragic accident at work that left me seriously injured and out of employment’ Joyline begins, ‘inspired by my family, especially my little girl, I picked up a pencil and pad to jot down my first drawing of a little dress I had been imagining. From there on I enlisted myself into a few weeks basic college of sewing, which taught me from threading the machine to cutting of different materials’ she says.

 

 

‘In order to enhance my knowledge I decided to grab whatever information about the design world I could find and I have been working as hard as I can since then,’ Joyline continues, ‘God has continued to bless me until now and it has been a whirlwind of amazing opportunities coming my way. In the next few years I would like for Joy-Line Clothing to be internationally recognised as a statement for all the women that no matter what size, colour or shape you are ,we are all amazing in our own special way’ she says.

 Joyline’s work speaks for itself, she is unapologetic about her African heritage and her love for long skirts and dresses  peppered with African jewellery. She has the ability to visualise  fabrics in three or four dimensions, then as ever, whip them up with an authentic African angle, quenching our thirst for innovation in fashion.

‘I have worked and met plenty of supportive people on this wonderful journey and would like the continuing growth of our company to be an inspiration to anyone who has ever had a dream, that with hard work and determination you will succeed’ Joyline concludes.

African designers are rising, they are embodying and modernising the African fashion landscape to new heights, they are  embracing a new dimension of creativity with dazzling layers and colours that can light up even the darkest of rooms. I love wearing Joy-Line Clothing.

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Dorcas Gwata

Director of Tribal Sands

June 2017

All images have been posted with the consent of Joyline Kim Munairwa

Chuka Umunna’s calls for knife crime to be treated as a mental health issue

I co-wrote this article with my Clinical Supervisor Dr Tami Kramer in response to MP Chuka Umunna’s  recent ground breaking link between gangs and mental health. The evidence is clear, there is a growing epidemic of knife crime in our inner cities that requires innovation and triangulated approaches to tackle gang crime and improve outcomes in young people. Far too many young people are living with trauma, high exposure to violence and sexual exploitation which increases risk of poor mental health in their adulthood.

 

MP Chuka Umunna  demands that the knife crime epidemic in London should be treated at a ‘mental health’ issue among young people (Evening Standard, 7 June 2017)

Chukka Umunna MP for Streatham is to be applauded for raising the profile of knife crime in London and the link with young people’s mental health. Police reports indicate the frequency of knife crimes have been rising. Scotland Yard reported in the Evening Standard on 19 June 2017 that over 2700 people were charged with possessing knives in the capital in the previous year. Data on serious youth violence, which is also rising, indicates use of a knife in almost half of cases. Presentations to hospital Accident and Emergency Centres following knife crime have increased, resulting in both life changing traumatic injuries and death.  Most of the victims and perpetrators are young, frequently from neighbouring if not the same localities. Every fatal stabbing is a tragedy leaving behind devastated, grieving families and communities.

What lies behind this increase of knife carrying? For some, carrying and use of weapons is part of a broader pattern of serious antisocial behavior, and might be associated with other serious violence, gangs or the drug trade. However according to a Police and Crime Committee report (Serious Youth Violence, July 2016) gang activity accounted for less than 5% of knife crimes  and that following an incident of serious violence, some young people will carry a knife if they feel unsafe. Many ordinary young people believe that they need to be prepared to defend themselves, displaying perception of a feeling of threat combined with a need to respond on their own, possibly indicating that they don’t perceive other means or sources of support to manage the threat.

The links between knife crime and young people’s mental health are manifold. At the one end of the spectrum, young people who develop seriously antisocial behavior suffer high rates of neurodevelopmental and emotional difficulties (such as Attention Deficit Hyperactivity Disorder, specific learning difficulties, anxiety, depression, substance misuse, Post Traumatic Stress Disorder, self harm and suicidality). Vulnerable girls are groomed and exploited by young men in gangs to become agents for drugs, weapons and sex. These difficulties occur most frequently in families facing multiple adversities such as poverty, isolation, domestic violence and parental mental health difficulties. At the other end of the spectrum young people within ordinarily supportive families are experiencing fear and anxiety about their personal safety, and are traumatised by actual or virtual exposure (via social media) to threats, stabbings and even murder. Support needs to be available to these young people and their families.

The police have been visible in launching a number of initiatives to specifically tackle knife crime in the capital, such as Operation Sceptre since 2015, which includes a range of components, from law enforcement to school education programmes. But as implied by Chukka Umunna addressing  the underlying risks and full impact of knife crime  requires broader, bold, innovative measures. This systemic problem requires multiple complex interventions across agencies and services with high levels of cross sector collaboration.

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One such evidenced based intervention, Multisystemic Therapy has offered community and home-based intervention for young people and families in parts of England. It targets factors underlying young people’s involvement in knife crime, or other forms of antisocial behavior including individual, family and community vulnerabilities. Counselling Psychologist, Jai Shree Adhyaru notes that MST endeavors to bring systems together to work collaboratively to reduce risk, for example by supporting families to work with local schools and police, addressing parental and child anxiety using educative as well as psychological intervention.

Our Trust, CNWL NHS Foundation Trust is at the forefront of providing mental health interventions for young people affected by gang culture within Westminster Integrated Gangs Unit (IGU), a unique multi-agency team which has contributed to reduction of serious youth violence. The IGU team incorporates police, probation, youth workers, employment specialists and  Clinical  Nurse Specialist, Dorcas Gwata with Consultant Child Psychiatrist supervision. Dorcas works outside traditional settings using innovative methods to access young people affected by gang culture. Her work challenges the notion of ‘hard to reach’ groups by seeing young people wherever they are, in youth clubs, schools and prisons. Dorcas added ‘We have taken what works in the clinic onto the streets. We are working to divert vulnerable young people from the dangers of knife crime and supporting parents who are otherwise struggling to parent their children whilst validating their efforts and appraising their values within their culture and religion. We are looking to expand our outreach and run community based mental health support in areas of high exposure to knife crime’. The role of the Child Psychiatrist is to offer support with understanding the needs of very complex young people and families; identification of specific mental health needs;  and advising on the most appropriate intervention approaches. Those who offend will face enforcement but gang involved young people are also helped to address their difficulties and  supported to find healthier lifestyles.

While Child and Adolescent Mental Health Services need to offer intervention for more serious psychiatric disorders, involvement from Public Health is required to develop interventions which reduce the background risks for involvement with knife crime, i.e. targeting the strengthening of family resilience and the cohesion and safety of local communities. Schools, youth services, youth justice and Local Authorities are essential partners alongside voluntary sector organisations such as Redthread ( who work specifically with youngsters in gangs). Innovative approaches which are sensitive to the cultural diversity of our population are urgently needed.

Chukka Umunna’s call to action should be heard by all who believe that London remains a relatively safe city, that should be enjoyed by all, free from fear, most especially by our children and young people.

Dr Tami Kramer, Consultant Child and Adolescent Psychiatrist

Dorcas Gwata. Clinical Mental Health Leader, Intergrated Gangs Unit

Westminster CAMHS

June 2017. All rights reserved.

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Global Health Cafe: The Role of Cultural Practices

The Global Health landscape is changing and its community is as enthusiastic as ever. In May we gathered at the Health Foundary and discussed the role of culture in Global Health. London School of Economincs student Dalia Majongwe presented on her work in Global Health Policy and then played us some delightful Mbira. London School of Hygiene and Tropical Medicine Masters student, Tarik Endale beautifully wraps the evening up in this guest blog.

“Both traditional healers and health facility can treat Degedege [local term for seizures] effectively. Sometimes we [traditional healers] instruct our patients to go to health facility when they suffer blood deficiency [anemia] and dehydration; but also there is a time that a patient from health facility is advised to come to traditional healers because there might be a scenario when the condition of the patient is seen as more spiritual than scientific; hence needs a spiritual intervention”

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The passage above is from an interview with a traditional healer in rural Tanzania. As one of many who were interviewed for my research regarding knowledge, attitudes, and practices surrounding febrile convulsions, his response was not at all uncommon. In fact, it was illustrative of many of the key points presented by London School of Economics student and Global Health Policy researcher Dalia Majongwe (Twitter: @Dali_Lamah) on May 2 at the second session of the newly founded Global Health Café. Mainly that in Global Health, culture is inextricably tied to behaviors and policies, including:

  • Access and utilization of health services
  • Health-seeking behavior
  • Interactions between communities and formal or informal/traditional systems of healing
  • Marginalized/abused groups
  • Designing programs, policies, and advocacy strategies

From healing, such as in Haitian Voodoo Rituals, to HIV/AIDs among Malawian “Hyena Men” and from substance use and “Flash Blooding” in Tanzania all the way to the containment of Ebola in Sierra Leone, to ignore the role of culture is to miss some of the most interesting and important intersections of Global Health. In discussing the challenges and opportunities created by these interfaces of culture and health, the topic of hard to reach communities arose, a notion which special guest Dr. Titilola Banjoko promptly challenged by asking “Are they hard to reach or are you not reaching hard enough?”

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Lively discussions like these are the lifeblood of the innovation and new connections that we need to build sustainable solutions for better health in Africa. This is what global health experts Dorcas Gwata and Adebusuyi Adeyemi sought to promote with this new platform and why the emerging community that is the Global Health Café is so exciting. Follow along at @TheGHCafe and we hope to see you at the next session on June the 27th at the Health Foundary

 

Tarik Endale (@the_etheropian)

LSHTM Candidate – MSc in Global Mental Health

Researcher at the Mental Health Innovation Network

Blog hosted by Dorcas Gwata. Director of Tribal Sands

 

Thanks to the Global Health Gang, Ade Adebusuyi, Dalia Majongwe and Tarik Endale

From A Hospital Cleaner To A Global Health Specialist. My Story

The Nursing Times kindly featured my career journey as a role model in nursing. I weep as I reflect on this journey, many challenges all of which I embraced as opportunities for a better tomorrow.

 

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Dorcas Gwata started as a hospital cleaner, and now she’s a clinical nurse specialist who works with young people affected by gangs

Dorcas Gwata’s career has been nothing short of impactful. In addition to her current work in the UK, Ms Gwata has worked in healthcare on a global scale in order to address poor access to healthcare in low-income countries. She worked on the Friendship Bench Project in Zimbabwe, an evidence-based programme that uses problem solving to address mental health issues in the community.

Ms Gwata’s current role is very much community based. She works with Central and North West London NHS Foundation Trust’s Westminster Integrated Gangs Unit where her team uses innovative methods to engage with young people who are involved with or affected by gangs.

“We meet them wherever they are – in schools, youth clubs, prisons or hospitals,” she tells me.

Adolescents affected by gang culture have high exposure to trauma and are often shunned by society, resulting in isolation, Ms Gwata explains.

She has been in this role since 2013. The Integrated Gangs Unit was set up when strong evidence emerged of the effects of gangs and gang culture on the mental health of adolescents.

Although her specific role is within a specialised unit, Ms Gwata works with a multi-agency team, which she says helps broaden her perspective in helping young people affected by gangs.

“Adolescents affected by gang culture have high exposure to trauma”

“The greatest value of this role is the innovation and clinical skills that I am able to bring to the team, while also understanding the roles that different agencies play in keeping the community safe from gang culture,” Ms Gwata says.

She is someone who has worked hard to reach her current role. Ms Gwata started out as a hospital cleaner at the Edinburgh Royal Infirmary. She then worked as a healthcare assistant.

As a healthcare assistant, Ms Gwata was looking after a woman with anorexia, a condition she says she didn’t fully understand at the time. But they developed a good therapeutic relationship, and one day the patient asked: “Have you ever thought about becoming a nurse?”

It struck a chord with Ms Gwata.

“I always thought that was powerful coming from a patient, and I started my training soon after,” Ms Gwata says. She started training as a nurse in the late 1990s.

“In each role, I have learned so much about humanity and the challenges that people face, particularly about people from low-income communities,” she says.

310315 30th March 2015 Dorcas Gwata - Clinical Nurse Specialist with model posing as gang members (Joseph Amuah (male in first cafe shots, and in hoodie for external shots) & Rachel Ryan ( female in 2nd set of cafe shots & with hooded jacket, and wool green hat for outside shots). Pictures include one or both of the two models named.
310315
30th March 2015
Dorcas Gwata – Clinical Nurse Specialist with model posing as gang members (Joseph Amuah (male in first cafe shots, and in hoodie for external shots) & Rachel Ryan ( female in 2nd set of cafe shots & with hooded jacket, and wool green hat for outside shots). Pictures include one or both of the two models named.

Ms Gwata worked in various roles after getting her nursing qualification, including time at an A&E and working for the charity Africans Unite Against Child Abuse (Afruca). It was then that she was approached to take on a role in the Integrated Gangs Unit.

“I have learned so much about humanity and the challenges that people face”

“It was a great opportunity to get involved in adolescent mental health and address the trauma they face due to high exposure to violence and sexual exploitation,” she explains.

Ms Gwata says that studying public health and gender violence prepared her well for this role, as did her role with Afruca. This position allowed her to come into contact with survivors of human trafficking, female genital mutilation and witchcraft branding. Her experiences have all helped in her role working with adolescents affected by gangs and gang culture.

“Nursing is a unique role”

Ms Gwata has received a number of honours for her role in healthcare, including the Zimbabwe International Womens’ Humanitarian Award in 2016. But in the end, it’s the support from family and friends that “kisses her heart”, she says.

“Nursing is a unique role that puts us in contact with people at their most vulnerable times,” she says. “I have learned so much about myself and humanity through nursing.”

Dorcas Gwata

Director at Tribal Sands

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Africa at LSE: Dr Tedros Gebreyesus, a new dawn at WHO

Global Mental Health Specialist, Dorcas Gwata and Tarik Endale analyse the top priorities for Dr Tedros Gebreyesus as he takes over the leadership of the World Health Organisation.

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The global health community is alight in African colours, the continent’s voice has been amplified with the appointment of Dr Tedros Ghebreyesus as Director General of the World Health Organization (WHO), the first African to hold this post. Dr Tedros brings a depth of experience in public health given his previous role as Ethiopia’s Health Minister (he was also Foreign Minister from 2012-2016). He understands the global health platform, and with Africa carrying the world’s heaviest burden of disease with increased vulnerability to outbreaks, the Ethiopian will need to draw on his knowledge and experience to address the global health challenges that sit heavily on the African continent and beyond. His competence will be measured on his ability to deliver on core and emerging issues. He comes into office against the backdrop of a catastrophic Ebola crisis in which WHO was criticised for a slow response, he will need to rise above the challenges and deliver on elements that he specified.

According to his  Vision Statement, Dr Tedros’ has put forth five major leadership priorities for his tenure as  WHO Director General, the first of which is “Health for All.” A key underpinning of this priority is the push for Universal Health Coverage. Former Director General Margaret Chan once said that Universal Health Coverage is “part of her DNA.” In this, Dr Tedros is following in her footsteps by stating that “all roads lead to universal coverage.” This includes commitments to strengthening primary health care, which comes just in time for the 40th anniversary of the landmark Alma-Ata Declaration on primary healthcare, and increasing access to life-saving products as demonstrated by his support of the recent United Nations High Level Panel on Access to Medicines report.

This ties neatly into his second priority of public health emergencies. Mirroring the language and aims of the International Health Regulations, this means strengthening the ability of member states to prevent, detect, and respond to public health threats. Ensuring a proper defense against outbreaks also requires the WHO to strengthen their own ability to lead and coordinate effective and rapid responses through the reformed Health Emergencies Program. The importance of these improvements were made painfully clear during the Ebola outbreak in West Africa, where weak country health systems could not cope on their own and the sluggish and poorly-coordinated global response led to countless more deaths.

Women, children, and adolescents feature strongly in his top priorities for the future direction of the WHO. Across the spectrum of health, women, children, and adolescents often suffer from a lack of access to services, increased vulnerability in humanitarian settings, inattention to their unique health needs, unbalanced representation in leadership, and a dearth of data at the intersection of gender and health needed to develop appropriate programs and policies. Dr Tedros has stated that he plans to “re-orient the WHO’s approach” on the matter, to which advocates for women’s health such as Shannon Kowalski of the International Women’s Health Coalition have rebutted with demands such as expanded access to safe, legal abortions (particularly important in the face of the “Global Gag Rule” imposed by the US), robust attention to ongoing Zika transmission, and ensuring that universal health coverage does not leave women and girls behind.

Fourth on the new Director-General’s list of priorities is addressing the impact of climate and environmental change on health. Currently, 12.6 million people die each year due to unhealthy environments and if trends continue as they are, climate change is expected to cause approximately 250,000 deaths per year between 2030 and 2050. The WHO board endorsed a work plan on climate change and health in 2015 to push the development of partnerships, awareness, evidence, and public health responses to reduce contributions to future harmful climate change and reduce health vulnerabilities to the damage that has already been done. The continued commitment of the organisation under the stewardship of Dr Tedros will be crucial to improved implementation of the Paris Agreement on climate change, which so far has been ratified by 147 of the 197 parties to the convention.

Finally, Dr Tedros has promised to deliver a “transformed WHO” as “we live in a changing world, and WHO must be able to change with it.” He hopes to regain the world’s trust in the body’s ability to lead the effort towards a healthier planet by reforming how the organisation runs, responds, measures performance, and attracts talent and funding. This looks to be the most critical and by far the most daunting piece of his proposal. The WHO has recently come under fire for spending more on travel expenses than on any disease program other than polio, which is particularly pertinent as the possibility of polio eradication closes in, putting the massive amount of funds generated by polio programs at risk. The World Health Assembly just approved a 2018-2019 budget of US$4.4 billion. However, this money has to be fundraised and the leading donor, the United States, has proposed massive reductions in global health funding while the second leading donor, the Bill and Melinda Gates Foundation, have stated that they will not compensate for any of that lost funding. To address this, Chelsea Clinton and Devi Sridhar have proposed that he quickly cement this vision into clear and transparent policies in order to win back confidence and potentially gain increased dues and voluntary contributions. He has already put forth plans for a professional fundraising office, similar to that of UNICEF.

When asked how he intended to approach looming funding issues, Dr Tedros concluded that “we have to make our case. We have to use champions to help countries and donors understand the benefits of WHO. We have to prepare, just like a court case.”


Dorcas Gwata (@zambezi40) is a Global Mental Health Specialist, and a visiting lecturer at the London School of Hygiene and Tropical Medicine.

Tarik Endale (@the_etheropian) is an MSc student at LSHTM and visiting Researcher at the Mental Health Innovation Network.

 

Dorcas Gwata

Director at TribalSands. June 2017

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