Doctor Steve Berman is one of our most prominent lecturers in this course. He holds an endowed chair in pediatrics at the University of Colorado School of Medicine and is director of the Center for Global Health in the Colorado School fo Public Health. Doctor Berman is a past president of the American Academy of Pediatrics. He served as special advisor to the World Health Organization, The Pan American Health Organization, and the United States Agency for International Development. He is the editor of the disaster course manual, Pediatrics in Disasters. Which was developed and is being disseminated in collaboration with the American Academy of Pediatrics and the World Health Organization. Today he's going to outline one of the major efforts in global health this century, the millennium development goals. These goal's were set in 2000, and due to be achieved now in 2015, and have been a benchmark for governments, organizations, and donor's to prioritize their activities for the past fifteen years. Then, Dr. Burman will speak of the incredible work done at the Center for Global Health at the Colorado School of Public Health on how to engage sustainably and responsibly with communities abroad. >> Hello, I'm Steve Burman. I'm the director for the Center for Global Health, and as you can tell by my bow tie, I am a pediatrician. I'm going to talk to you today about the interface between the Millennium Development goals and community engagement. Millennium Development goals were developed starting in the early 1990s, and the goals were to be all accomplished by 2015 which is right now, and there are eight Millennium Development Goals. And what's important to understand about these goals are, what they are, how they're measured, and how useful are they going to be. So these eight goals were, and you'll see on the slide eradicate extreme poverty, achieve universal primary education. Promote gender equality and empower women, reduce child mortality, improve maternal health. Combat HIV, AIDS, malaria and other diseases, ensuring environmental sustainability, and work to improve sustainable development, especially in an era of climate change. So, why are these important, and what do they have to do with community engagement? Well, the next slide shows a cycle of what happens when communities live in extreme poverty. Remember that these are often more rural places, although they can also be urban, and when you have parents that, are living in extreme poverty, they're more likely to have large families. They have large families because their children are their insurance policies. And because there's high child mortality rates, and because you have to spread over the cost of supporting them when their no longer able to work, over many children. It's important that they have a large family size, because they have a larger family, they can't afford even the meager school fees to educate everyone. So they tend just to educate the boys rather than the girls, and the lack of primary education for girls is a major problem. This lack of education lead's to a lack of opportunities and job growth. And you have a situation where they're living in communities with poor water sanitation, food insecurity, lack of adequate nutrition which leads to malnutrition, a lot of infections. Poor access to health care, and this leads to maternal mortality, and excessive childhood mortality. And you get into a cycle and the cycle's depicted on the slide, and so you have high maternal mortality, high childhood mortality, a sense of hopelessness in the community and fer, futility. This breeds violence, corruption, failed communities, political instability, and conflict. So the millennium development goals were really developed to interact with this cycle, and interrupt this cycle at the eight points that they refle, the eight points that reflect the eight millennium goals. Now, the real challenge is, how do we reach these goals? What do countries and communities need to do? To really make a difference and what we have learned is that we need to develop transformative interventions. Interventions that are based on new information and new technologies, have new N users. Like cell phones, and what cell phone technology and mobile technology enables us to do. They have to be multidisciplinary. We can't be siloed, so they have to look at healthcare, and education, and nutrition, and economics, and creating job opportunities. That if you don't do all of these things together, integrated in the same way, your likelihood of achieving success is a lot less. So what we want to do is we want to disrupt current practices that aren't working. And exchange them with these more transformative solutions that are multidisciplinary and can impact the community not at one point, but at several points. Now how do we do this? Well, we take these new, transformative interventions. And we apply them in a way that engages the community and respects the community and understands the cultural concept, context of the community. So the first thing we have to do is we have to say okay what's the community that we want to deal with? How do we define that community? Sometimes it's important to actually map and use GPS technology to map that community. And then we have to carry out a needs assessment so that we understand what those community needs are. And then, we have to say, okay. Given those needs, what are the transformative solutions that can address those needs? And then there's a very important piece to this, we have to re-engage the community, share the solutions with them. Share those problems first, get their feedback and what they see a solution, share our solutions with them. So that together we can move forward to implement these solutions. If we don't have this community engagement process, the likelihood of success is greatly diminished. And then we have to work through the political and the cultural context to implement these solutions. And very importantly we have to develop a system of monitoring and evaluating what is the impact of implementing these solutions. Often times, when we have this monitoring system and we develop a kind of rapid quality assessment or rapid response. We can then modify those solutions so that they're more effective. That's the process that we've been using here at the Center for Global Health. We've taken the responsible for a community of extreme poverty that's in southwest Guatemala, it has about 25,000 people. We've carried out a rapid needs assessment. We've gone back and engaged the community, and discussed with community leaders and in community forums what we saw as the problems. We found out that the major problems were lack of clean water, sanitation. Limited access to health care services, high maternal mortality, high child mortality, lack of access to family planning, and we've developed a program that addresses many of those problems. And that program included a family clinic, transportation to that family clinic, and also transportation to a hospital that's an hour, hour and a half away. A birthing center, a laboratory, a pharmacy, and a community program in which community health workers who are nurse assistants, provide pre-natal care. Visit newborns the first few days after birth, and then at two weeks, and then a month. And program for mothers with their children that meets monthly after two months through three years, of care groups that integrates health, and nutrition, and hygiene, and child development. And we found that this type of comprehensive program is the best way to begin to address the problem of extreme poverty in this community. And what we hope to do in addition to that, is to work on the water problems. To work on economic opportunities and to create businesses in the community and opportunities for people to get advanced training. We hope to have programs in which, people who are living in that community can learn to be nurses, can be skilled birth attendants. Can go on to university, and so that people feel that there are options for them, and that there's a hope. They, there are, there's a hope for a better future. We, we're really about providing communities with a future, that's really what global health is. So that people who live in these impoverished communities can feel that there's a better future for their children, for themselves, that their community will be developing. If you're interested in learning more about our work in Guatemala. Or some of our other programs, our centers at WHO Collaborating Center for Maternal and Child Health. We're one of two WHO Maternal and Child Health Collaborating Centers in the Americas. We focus on vaccines, on improve, reducing maternal and child mortality. On saving newborn lives through helping babies breathe, and on preparing communities to respond to disasters in a way that helps the most vulnerable population. The young and the elderly get the services that they need. Those are our four areas. So, you can find out about our programs on our website, and our website address is shown below. And you can also find out about our online pediatrics disaster training course which is currently available free of charge. And which really provides nurses, and doctors, and first responders, and policemen, and firemen with the basics of how to organize planning and response. And make sure that, that planning addresses the really unique needs of children and the elderly. Thank you.
