IMHO 2012 Annual Convention souvenir program

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The International Medical Health Organization (IMHO) proudly presents‌

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Return to Our Roots ! ! ! ! ! ! ! ! !

9th Annual IMHO Convention Toronto, Canada April 27 & 28, 2012 www.TheIMHO.org

www.IMHOEU.org

* www.IMHOCanada.org *

www.IMHOLanka.org

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2012 Convention Agenda…………………………………………………………………………………………3 Welcome Note from Dr. Eric Hoskins, Minister of Children & Youth Services………………4 Welcome Note from Sir Sabaratnam Arulkumaran…………………………………………….………5 Welcome Note from IMHO International Board of Directors……………………………….……..6 Welcome Note from Toronto Convention Organizers…………………………………………….…..7 Welcome Note from IMHO Canada President……………………………………………………….….8 Overview of IMHO’s Mission, History, and Programs…………………………………………….….9 International Relief & Development Efforts 2011-2012……………………………………………..11 IMHO USA Annual Report on Activities & Finances…………………………………………………14 IMHO Canada Annual Report on Activities & Finances…………………………………………….17 IMHO Photo Gallery of Efforts 2011-2012……………………………………………………………….18 “Towards Improving Cancer Care Services in the Northern Region of Sri Lanka: Where Help Inspires Hope” by Dr. N. Jeyakumaran……………………………………………….20 “Cancer Services at the Batticaloa Teaching Hospital: Targets to be Achieved and the Role of IMHO” by Dr. A. Parthiepan & Dr. S. Parthiepan…………………………….22 “IMHO’s Continuous Support towards a Model Diabetic Centre in Jaffna”

by Dr. S. Sivansuthan……………………………………………………………………………………………24 “Milestones of the Jaffna Teaching Hospital Cardiology Unit & Cardiac Cath Lab”

by Dr. Lakshman………………………………………………………………………………………………….26 “Progress of the Cardiology Unit at the Batticaloa Teaching Hospital”

by Dr. K. Arulnithy……………………………………………………………………………………………….27 “Empowerment Projects in the Resettled Areas” by Dr. Judy Jeyakumar………………….28 “Strengthening People’s Minds: Community-Based Mental Health Promotion in Batticaloa” by Dr. Dan Soundararajah……………………………………………………………….30 “Step Forward: Establishing a Neonatal Intensive Care Unit (NICU) at the Jaffna Teaching Hospital” by IMHO Team………………………………………………………………33 “Resettlement: Iyanankulam Village, Mullaithivu District & Their Needs”………………….34 A Reflection on our Roots………………………………………………………………………………………39 “Strengthening Health Services & Capacity-Building Efforts in Ethiopia”

by IMHO Team……………………………………………………………………………………………………..47 “Human Immunodeficiency Virus (HIV) Infection: Challenges & Impact on Women’s Health in Western Asia” by Dr. Sujanthy Rajaram…………………………………….49 Gratitude to our Family Sponsors………………………………………………………………………..….53 Program Sponsors……………………………………………………………………………………...………….54

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Medicine, Biomedical Sciences, Health and Social Care Sciences ! !

Cranmer Terrace 20! March 2012 London SW17 0RE !

Switchboard + 44 (0)20 8672 9944 ! www.sgul.ac.uk ! ! !

Dear Friends, !

My ! very best wishes and congratulations to the members of the International Medical Health Organisation for the enormous work carried out in different countries. I pay tribute to the ! sacrifice and service made by members of your organisation. It is a credit to each and every ! one ! of you for your immense help to improve the quality of human life. It is creditable that you are undertaking these tasks in the countries that need it most like Sri Lanka and several African ! countries. It is important for the â&#x20AC;&#x2DC;big societyâ&#x20AC;&#x2122; of those who are doing well to provide and look ! those who are unable to do so because of less resources or political situation. The main after ! focus for any community should be to provide nutrition, health and education. It goes without ! saying that housing, good sanitation and water supply are essential for the society to thrive. As ! medical professionals you are in the right position to identify these needs and to provide them without any political or religious considerations. Working with several grass-root organisations ! provides you with the information of what needs to be done. Collaborative work with people ! on the ground makes the work you are doing sustainable and reproducible in other areas. As ! time evolves you have to involve the government machinery so that the sustainability is ! maintained. This is the case with work done by voluntary organisations, hence the ! responsibility should be slowly sifted to the government and the local people. ! !

There are several voluntary organisations and nongovernmental organisations that work in ! different countries with variable resources. It is important for the voluntary organisations to ! work along with the other likeminded charities in order to enhance the benefit to the people.

Collaboration and cooperation is likely to benefit everyone. I wish each and every one of you ! success in your own life and also success with your organisation in bringing about real change ! to! people who need it. ! ! !

Yours sincerely, ! ! ! ! ! ! SABARATNAM ARULKUMARAN SIR !

PROFESSOR & HEAD OF OBSTETRICS & GYNAECOLOGY ! ! ! !

Professor S. Arulkumaran, DCH FRCS FRCOG FAMS MD PhD Hon: FACOG FSLCOG FSOGC Tel: + 44 (0)20 8725 5956 Fax: + 44 (0)20 8725 5955 Email: sarulkum@sgul.ac.uk

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International Medical Health Organization (IMHO) !"#$%&'()*%+(,-.%/0123%$"+.%/2)23*%45()*-.%67%$8"89% :3(;%<"=>?%98$@$"9=%%%A)B;%<>$#?%CC=@$>!"% DE)1(;%FG*2)F2H2I31EIGJGKL% % International President S. Raguraj, MD (Maryland) International Secretary Thavam Thambipillai, MD (South Dakota)

USA President Kanaga N. Sena, MD (Connecticut) Secretary S. Nanthakumar, PhD (Texas) Treasurer Rajam Theventhiran, MD (New York)

Directors Murali Ramalingam, CPA (Ohio) N. Nanthakumar, PhD (Massachusetts) Sujanthy Rajaram, MD (New Jersey)

Legal Counsel Ahilan Arulanantham, JD (California)

Advisory Council K. Devacaanthan, MD (Florida) K. Sivakumaran, MD (Florida) Elizabeth Finigan, MD (New York) Romesh Anketell, MPH (California)

Programs Coordinator

Dear Friends, Welcome to Toronto! Now in our 9th year of operations, we are so pleased to be able to hold our 9th Annual IMHO Convention in Canada for the first time. The IMHO family of organizations continues to grow and expand our collective efforts by strengthening our teams and programs at IMHO Canada, IMHO USA, and IMHO European Union. Thanks to your support, IMHO has now directly channeled roughly $2.8 million in support and equipment since 2004, predominantly to war-affected and impoverished communities in Sri Lanka. However, in 2011 & 2012 we have continued to explore new partnerships and respond to requests for health and medical relief & development efforts in other countries as well, including Ethiopia, Haiti, India, Japan, Egypt, and Somalia.

Following the resettlement of war-affected persons across Northern and Eastern Sri Lanka over the past 3 years, there remains much to be done in rebuilding the health and medical infrastructure of this region, strengthening health systems and services, and restoring livelihoods and hope for these communities that have endured so much. As we look to the future, IMHO intends to put a special emphasis on a number of important projects this year, including the establishment of a Neonatal Intensive Care Unit (NICU) at the Jaffna Teaching Hospital, development of a Palliative Care Center and provision of an ambulance at the Batticaloa Teaching Hospital, and a continued commitment to supporting livelihoods and microfinance efforts amongst struggling, resettled families.

Our convention this year will focus on concrete ideas for â&#x20AC;&#x153;building stronger communities & ensuring a healthier tomorrowâ&#x20AC;? for all persons. As always, we are thrilled to be joined by visiting physicians from Sri Lanka who are the true change-makers and visionaries as they update us on the most pressing needs and share examples of our shared accomplishments. We hope you will take away a sense of hope and enthusiasm from this convention, and encourage you to get involved, share our message, and unite other allies behind this collective commitment to humanity.

We are grateful for the ongoing commitment of our supporters and your shared belief in our mission to help improve and develop healthcare services and infrastructure in under-served communities worldwide. Moving forward, we hope you will continue your support of IMHO as we strive to improve the lives of those in need. Together we can move mountains.

Warm Regards, The IMHO International & USA Boards of Directors and Team

Gregory Buie, MA (California)

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President Lambotharan Ramanathan, MD ! !

Secretary Meera Kandeepan, CMA ! !

Treasurer Sanjutha Balasunderam ! ! Youth Program Director ! Sivaseelan Sivapalan, MD ! !

Directors ! Nagalingam Rajakumar, MD ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

International Medical Health Organization I.M.H.O.—Canada A non-political, non-profit, humanitarian organization A registered not-for-profit organization in Canada April 28, 2012 Dear Friends, It is my honor and pleasure to welcome, on behalf of the IMHO Canada Board and its volunteers and supporters, all of the attendees to the 9th annual convention of IMHO held for the first time outside the USA. Apart from Sri Lanka, the Greater Toronto Area has the largest Sri Lankan population in the world and it is only fitting that IMHO holds its convention in our home from home. For the visiting medical professional, Toronto has a number of top-notch hospitals such as Mount Sinai, St. Michaels and the world-renowned Sick Kids Hospital that over the years has served as the gold standard of children’s medical care. For the female health professional and/or the spouses attending the convention Toronto offers an unparalleled selection of fine retail establishments owned by our community that offer the best in sarees, jewelry, traditional Sri Lankan food and food products. But as attractive as they are, the delights of Toronto are not limited to the Sri Lankan community, this is perhaps the most multi-cultural city in North America, and for the foodie it offers a culinary smorgasbord that ranges from Abyssinia to Zimbabwe.

The current focus of IMHO Canada is on expanding its successful livelihoods support programs for resettled families and the needy. One of our primary objectives for this year is to collect enough funds to complete the construction of the Neonatal Intensive Care Unit (NICU) of the Jaffna Teaching Hospital. We are also focused on the provision of Emergency Relief and we hope that the annual convention will facilitate a vigorous discussion on these and other pressing needs.

The Toronto convention also provides a unique opportunity for visiting delegates to interact with each other and identify areas of synergy and potential projects for collaboration. You will also be able to obtain valuable information on future projects of both IMHO International as well as IMHO Canada and possibly get to know our IMHO Canada’s young volunteers who have worked so hard to put this convention together.

What is unique about Toronto is the proliferation of our community and the fact literally all of you who are visiting us have family with whom you will be able to spend time and hopefully have an opportunity to relax and unwind from the stresses of the busy professional lives that we lead. Thank you for coming, and we hope that the IMHO Canada Board and its volunteers will do we can to make this convention a memorable one for you and your family. Welcome to Toronto!!

Best regards, Meera Kandeepan CMA Secretary, IMHO Canada 5637 Finch Avenue East, Unit 7, Scarborough, Ontario M1B 2T9, Canada www.IMHOCanada.org Tel: (416) 321-9555 Email: canada@theimho.org

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President Lambotharan Ramanathan, !

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Secretary !Meera Kandeepan, CMA !

Treasurer ! Sanjutha Balasunderam !

Youth Program Director !

Sivaseelan Sivapalan, MD ! !

Directors !

Nagalingam Rajakumar, MD ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

International Medical Health Organization I.M.H.O.â&#x20AC;&#x201D;Canada A non-political, non-profit, humanitarian organization A registered not-for-profit organization in Canada April 28, 2012 Dear Friends, It is my pleasure and privilege to welcome all the delegates, well wishers, and their families attending the 9th Annual Convention of the International Medical Health Organization (IMHO) to Greater Toronto. Greater Toronto has become the home of largest Tamil Diaspora outside the homeland. Toronto has the great tradition of welcoming new immigrants and refugees and providing a home, support, and opportunities to them as they build their future in this land of hope.

In this spirit, we hope you enjoy the convention together with the hospitality and pleasures offered by the Greater Toronto community and have a memorable stay.

Over the last nine years in total and five years in Toronto, IMHO has grown by bounds and leaps. We have proved ourselves as a leading nonprofit organization that strive its best to enhance the integrated global health care in underprivileged regions worldwide. IMHO responds in times of crisis, such as Tsunami of 2004, earthquake of Haiti and in the peak of civil war in Sri Lanka.

IMHO has primarily focused in helping the marginalized people in Sri Lanka to improve their access to health care. IMHO is committed to rebuilding the healthcare infrastructure and ongoing training and education to health care workers and professionals.

In the recent past IMHO has focused and contributed tremendously both on its own and with other voluntary organizations in serving the urgent and semiurgent relief needs of the displaced people of war in Sri Lanka. As the civilians have been released from the camps and return to their original places with the scars of war and plans to rebuild their lives with hope, our focus is to follow them to help them to rebuild. For these reasons, IMHO has mainly focused this year towards identifying their needs and finding solutions to help them in this crucial time of resettlement. Needs unattended now will result in irreparable damages to their physical, mental and social health.

At this convention, doctors working in Sri Lanka will present the current needs and challenges faced with building up and providing integrated global health care to the people there. Furthermore, an update of all IMHO sponsored activities and overview of the projected needs to meet these challenges will be presented. We will also outline our vision for the next year and years to come.

I wish to thank you all for taking part in our activities amidst your restrains of time and resources even in this time global economic recession. With your support we will move forward in this new era. You have been the pillars of our organization from the inception. Your continued contributions and support help the needy people in the far off land who are working hard to rebuild their life with hope. I hope this convention will help to materialize their hopes.

Once again welcome to Toronto and thank you for your continued support.

Dr. R. Lambotharan President, IMHOâ&#x20AC;&#x201D;Canada

5637 Finch Avenue East, Unit 7, Scarborough, Ontario M1B 2T9, Canada www.IMHOCanada.org Tel: (416) 321-9555 Email: canada@theimho.org

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INTERNATIONAL RELIEF EFFORTS !"##$!"#! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

Responding to natural and manmade disasters worldwide as they occur has been an ongoing commitment of IMHO since inception. To-date, IMHO USA & IMHO Canada have collectively supported relief efforts in 14 countries across Asia, Africa, North America, and the Caribbean, investing more than $144,000 in these life-saving activities, excluding our response to the conflict in Sri Lanka toward which we invested another several hundred thousand dollars in services, medicines, equipment, supplies, and programs since 2009. During times of such distress and chaos, these emergency relief efforts not only help keep people fed, clothed, sheltered, and healthy/alive, they also help to bring a sense of comfort and securityâ&#x20AC;&#x201D;that they are not in this alone. Living true to our name, the IMHO family of organizations has taken a genuinely international approach to our work, viewing human suffering as intolerable, no matter what corner of the world in which it exists. Thanks to your support and generosity, we were able to continue sending this universal message of hope in 2011 & 2012, by supporting international relief and development efforts in Japan, India, Somalia, Egypt, Sri Lanka, Haiti, & Ethiopia.

Japan With natural disasters striking a number of countries in the Pacific Rim in 2011, IMHO Canada decided to step up by supporting the emergency relief efforts of the Canadian Red Cross for earthquake and tsunami survivors in Japan. A $2,500 donation was used to support emergency health and the distribution of relief items to people impacted by this disaster. "The compassion the Canadian people have demonstrated...through their generous support...is incredibly uplifting at a time when we are dealing with such an immense humanitarian tragedy," stated Satoshi Sugai, Director International Relief Division, Japanese Red Cross Society. "This financial support is very much needed and continues to be welcomed to help the hundreds of thousands of lives that will forever be changed by this disaster." !"#$#%&'%$"(%)**#+,-$(.%!/(**%

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India Cyclone Thane, which slammed Southern India on December 30, 2011, came packed with wind speeds of approx. 135 kmph. It claimed 33 lives and left around 200,000 people homeless in the regions of Tamil Nadu and Pondichery. Under its influence heavy rains pounded these areas, throwing normal life out of gear. Thousands of acres of standing crops were submerged across the state. The poor slum dwellers in the city, as well as the poor laboring class, marginal farmers in rural areas, fishermen communities in the coastal areas, and more were affected, having lost crops/food, clothing, and shelter. Responding to the crisis, IMHO USA got behind the emergency relief efforts of SAWED Trust, giving $5,000 to their efforts to serve survivors and help restore normalcy to their lives.

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Somalia ! !

Facing yet another crisis after decades of conflict and the lack of a functioning central ! government, the people of Somalia faced a horrific famine in 2011, which displaced hundreds of! thousands and left millions vulnerable. IMHO USA responded by giving $5,000 to Medicins Sans Frontieres (MSF) to provide emergency relief and medical care to victims of this disaster. ! "#!

Egypt In response to the dire situation in which many struggling families in garbage villages in Egypt find themselves, IMHO USA provided support to a group known as "A Remnant Remains" through a contribution of $5,000 towards their Scalable Solar Electricity Project aimed at providing electricity through solar panels to village homes in Egypt. This goal is to provide solar electricity to every home in the village through a solar node system with shared electricity among homes.

! ! ! ! ! ! ! ! ! ! ! ! ! !Sri Lanka ! !As heavy monsoon rains overwhelmed Eastern Sri Lanka in January 2011, yet another !humanitarian crisis took hold of the island. Almost a million people were affected and an !estimated 400,000+ persons left displaced. IMHO USA & IMHO Canada collectively !committed $19,000 to help provide emergency relief to the flood victims, including !distributions of milk products, dry rations, medicines, basic supplies, hygienic items, !shelter, and mobile medical care. ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

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Cancer Services at the Batticaloa Teaching Hospital: Targets to be Achieved and the Role of IMHO By: Dr. A. Parthiepan, Consultant Oncological Surgeon, Teaching Hospital, Batticaloa & Dr. S. Parthiepan Consultant Histopathologist, Teaching Hospital, Batticaloa The Teaching Hospital at Batticaloa is a tertiary referral centre for the Eastern Province of Sri Lanka, catering to a population of 2 million persons. This region has been battered by 30 years of internal conflict and repeated natural disasters.

The number of patients seeking medical treatment has been steadily increasing following the cessation of the war and stabilization of the region. There has been a steep increase in the detection of cancer patients. Unfortunately many patients are diagnosed at a very late stage of the disease. This fact has been further authenticated by a recent statement released by the Ministry of Health that revealed that the Eastern Province has a high incidence of cancer rates compared to the other provinces.

Oncology services at the Batticaloa Teaching Hospital were established in 2009 in a very small unit. Currently, the oncosurgical and medical oncology units each have 15 beds. These facilities and other available facilities are grossly inadequate in handling the large numbers of cancer patients. According to the government policy of ensuring there is a dedicated cancer unit in every province, the Eastern Province has been fortunate in getting a new Oncology Unit. This new cancer unit is being built and will provide cancer care to patients from across the districts of Batticaloa, Ampara, and Trincomalee.

Features of the New Oncology Unit: Bed strength: 70 Radiation Unit with linear accelerator and the brachytherapy facilities Operation theatre complex Intensive Care Unit (ICU) Current and Expected Future Workload The number of in-patients managed in the oncosurgical ward was 428 in the year 2011. A total number of 384 patients visited the breast clinic in 2011. Workload in the Oncology Unit was about 3 times higher than the Oncosurgical Unit.

With the commencement of radiotherapy and upgrading the oncosurgical and other facilities in the forthcoming cancer unit, a significant increase in the workload is expected. There will be a flux of patients from the Ampara and Trincomalee Districts, which are located a far distance from the hospital.

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Facilities to be Improved or Established 1. Accommodation Most of the radiation treatment is offered as an outpatient service. Therefore, patients from faraway places will face the problem of accommodation. This has been overcome by a transit home in other established cancer units in Colombo, Kandy, and Jaffna. Hence, creating a transit home for these poor patients is one of the prime targets for us in the coming year.

2. Palliative Care Unit and the Home Hospice Services The lack of a Palliative Care Unit is one of the major drawbacks at present. Regrettably, a significant number of cancer patients seek medical help at an advanced stage of the malignancy and thus suitable only for palliative and hospice care. Establishment of a Palliative Care Unit is thus a second major priority. It is a well-known fact that most of the terminally ill patients prefer to spend their last days at their home environment. Home hospice services organized by the cancer team will be a welcome remedy for this.

3. Empowering the Pathology Services There were no histopathology services in the Batticaloa Teaching Hospital for the last 30 years. Fortunately, following the appointment of a Consultant Histopathologist, this service was started last year. Now the pathology lab is well organized and equipped with modern automated machineries and analyzers. Histopathology, Hematology, Biochemistry, Microbiology, and Immunoassay services are now available. However, frozen section procedures have yet to commence. This cryo section and intra-operative consultation facility is an elemental part for offering these services and are frequently used in oncosurgery.

Availability of this service will greatly improve the quality of surgery and prevent the need for second surgeries.

IMHO contribution â&#x20AC;˘ IMHO donated a core biopsy gun and 100 biopsy needles in year 2010 â&#x20AC;˘ Supply of a Pneumatic calf compressor and the 15 calf sleeves in 2011

Apart from the above support to the Oncosurgical Unit, IMHO has been providing various aids and offering a wide range of help to improve the entire health facilities in the Batticaloa Teaching Hospital. Its continuous assistance encourages the specialists in this region to provide the best care possible to their patients.

The hospital staff and the residents of this region immensely value and appreciate the services provided by IMHO and kindly request to lend a hand to improve the above vital cancer facilities in this region as we move forward together. !

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IMHOâ&#x20AC;&#x2122;s Continuous Support towards a Model Diabetic Centre in Jaffna By: Dr. S. Sivansuthan, Consultant Physician & Head of Diabetic Centre, Jaffna Teaching Hospital Visiting Lecturer in Medicine & Pharmacology, Faculty of Medicine, University of Jaffna The Diabetic Centre at the Teaching Hospital at Jaffna (DCTHJ) is successfully in its third year and continues to provide excellent services to the people of the Northern Province of Sri Lanka. IMHO is the main partner that contributed to the establishment and smooth functioning of the Diabetic Centre. The patients, staff, and people of the region faithfully appreciate this humanitarian service to our community.

The Diabetic Centre was established from the contributions of the Government of Sri Lanka and IMHO. IMHOâ&#x20AC;&#x2122;s contribution up-to-date towards the establishment and running of the centre is LKR 5,035,159.62 (or USD $40,330). Out of this LKR 2,148,742.75 (or USD $17,210) was utilized for the establishment and the balance towards the maintenance, awareness, and education about the disease to the people of the region.

The breakup of the amount utilized for the maintenance and other activities are as follows: Maintenance of Diabetic Centre over three years Public Awareness Construction of Stores and Washroom Contributions for Publications

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Rs. Rs. Rs. Rs.

1,744,029.83 650,000.00 392,387.00 100,000.00

In addition, IMHO has allocated funds to purchase a multi-media projector to promote our public awareness activities and also has provided an air conditioner to the diabetic centre.

At present there are 7,053 diabetic patients under the care of this centre. This centre is the only one caring for such a large number of diabetic patients in Sri Lanka. The Diabetic Centre at Teaching Hospital, Jaffna is not only treating the diabetic patients but has also produced several publications and conducts various awareness programmes in order to improve the health status of our community. An incredible 10,500 copies of our publications have since been distributed amongst the public.

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The following are some of the achievements of the centre over the course of its existence over the last three years: 1. Conducted diabetes continuous medical education program for doctors – 253 doctors participated.

2. Released four health education CDs, including “Thiyanam”, “Nimmathi Noki”, “Neerilivai Vetti Kolvom 2010” and “Arokiyamaka Valnthidu”.

3. Published three books, entitled “Neerilivitku Oru Saval”, “Aarokiya Unavu Seivom”, and “Nithiya Suhathai Nokki”.

4. Completed three studies on the disease 5. Conducted annual diabetic day programmes, including: (a) A bicycle race on Diabetic Day 2010 as part of awareness creation, in which 188 people participated. (b) A diabetic day walk on 14 November 2011, with more than 500 participants. (c) A healthy food competition (d) Publication of series of articles and questions & answers every week for the past year on a page called “Vythiya Malar” in the local newspaper “Uthayan” in order to enhance the patients’ and the general public’s knowledge. So far 59 series of articles have been published. (e) Conducted three mass scale public awareness programmes, each one week in duration. About 30,000 people participated in these events! (f) Six screening programs for diabetes (g) Conducted 53 health education group discussions and 19 seminars (h) More than 8,000 blood tests and urine tests were done with the financial support of IMHO. This year we have extended our services to other hospitals in the Jaffna Peninsula. We are also planning to conduct awareness programmes in other districts as well. Our sincere gratitude goes to IMHO for their continuous support, and we are quiet sure that they will continue the same to the needy people in the future as well.

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Milestones of the Jaffna Teaching Hospital Cardiology Unit & Cardiac Cath Lab By: Dr. Lakshman, Consultant Cardiologist, Teaching Hospital, Jaffna The Jaffna Teaching Hospital has become a symbol of resilience. Even though the hospital and the staff members had to undergo and endure difficult periods in the long history of the institution spanning several decades and met with various setbacks, the Jaffna Teaching Hospital continued to be the service provider at the forefront of medical and health care in the region throughout all these years. The specialized units, such as the Cardiology Unit, could not function until 2005 due to various reasons, despite the high demand and great need amongst the war-affected

communities of this region.

The Jaffna Cardiology Unit was eventually established in 2005 and was made possible through the generous assistance provided by IMHO and other donors. The fruitful relationship between the hospital and IMHO has continued thereafter. The cardiac services now provided have greatly benefitted from this continuous relationship.

The Cardiac Catheterization Laboratory (â&#x20AC;&#x153;cath labâ&#x20AC;?) facility was established in July 2011. IMHO contributed towards the cost of the building especially designed for this cath lab. Following the establishment of the cath lab, 610 angiograms have been performed as of the end of March 2012. IMHO contributed an additional USD $5,000 for the purchase of catheters; as a result, nearly 500 patients have benefitted.

Furthermore, nearly 80 pacemakers implantations have been performed since 2008.

The Cardiology Unit received 20 dual chamber pacemakers from IMHO, and 4 of them have already been utilized. In the past, patients had to be transferred to Colombo for further investigations and to have procedures, such as pacemaker implantations, performed in a proper and equipped facility. Now, with the new cath lab, most of the advanced care and surgeries are possible here in Jaffna.

Thus, the poor and underserved peoples from the Northern and Eastern Provinces have greatly benefited. The patients from Batticaloa are sent for Angiogram on every Saturday.

The first ever Angioplasty was performed here on 24th of January 2011. which marked the commencement of new services provided by the Cardiology Unit. A workshop on Cardiac Intervention was organized in collaboration with the Sri Lanka Heart Association on the 10th and 11th of March and during this workshop 8 Angoplasties, 2 ASD device closure procedures, and 3 Mitral balloon valvuloplasties were performed.

We envision the establishment of a Cardiothoracic Surgical Unit in the future, which would enable us to provide complete care for the patients and to utilize the cath lab maximally. It is hoped that we will reach this important milestone sometime in the near future. !

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Progress of the Cardiology Unit at the Batticaloa Teaching Hospital By: Dr. K. Arulnithy, Consultant Cardiologist, Teaching Hospital, Batticaloa First and foremost, we would like to take this opportunity to thank IMHO for its continuous generous support to the Cardiology Unit at the Batticaloa Teaching Hospital.

As our target population is ever growing due to free access, we must continue to improve upon and expand our existing services and facilities. With material and moral support, such as that offered by IMHO, we are able to go farther in providing high quality cardiac care to our patients.

Within the last one year we were able to expand into separate buildings following much needed renovations. Having ample space with this new building gave way to extending and opening new services in a more patient-friendly setting. We successfully initiated the Peripheral Thrombolytic Unit in 2011, and operations are now running smoothly, which has helped to save the lives of many patients who had suffered a heart attack.

Other instruments that we received from IMHO have also helped us to optimize our patient care. The 2D Echocardiography machine was especially useful both at the hospital as well as during mobile clinics. Other instruments, such as the Coaguecheck and ECG machine, brought a new dimension to the care and services we can provide.

The ambulance we are expecting soon from IMHO is going to be a very significant milestone in our patient-based cardiac care as well. Our long-term dream and need is to establish a full-fledged Cardiology Unit with cardiac catheterization lab and cardiothoracic surgery at some point in the near future. With the continuous support of you all, we are very confident that we can achieve that. Above all, the assistance received from IMHO—the motivation, advice, and ideas from all of you—helps us to feel and know that we are not alone…

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Empowerment Projects in the Resettled Areas By: Dr. Judy Jeyakumar, Consultant Psychiatrist & Director of Kalmunai Mental Health Association (KAMHA) With the end of three decades of civil conflict in Mullivakkal in 2009, the people of Kilinochchi and Mullaithivu slowly resettled in their native places. Following the resettlement of these waraffected people in the Vanni, there still remains much to done serving this vulnerable group of people and bringing them to their feet again. The loss of property, livelihoods, residences/shelter, education, and health remains a major obstacle in the way of these persons restarting their lives with confidence and with the tools necessary to succeed. Small-scale livelihoods support and microfinance efforts have helped people worldwide to emerge from poverty and reclaim their lives, nutrition, health, and their future with a newfound sense of hope. Such activities can include engaging in agriculture, animal breeding, poultry farming, mechanics, small-scale business, trishaw taxi driving, and other industrial activities, to name just a few.

The opportunity arose in 2010 to initiate this type of effort in the war-affected areas of Kilinochchi in order to assist returnees in ensuring a sense of economic stability. A pilot project was initially implemented in Anandanagar village with the help of IMHO-USA via the Kalmunai Mental Health Association (KAMHA). Those involved took slow but steady steps forward. Now 60 beneficiaries have received livelihoods support through this program. The beneficiaries have paid back the monthly requirement without any interest. This collection of recovered funds is then distributed out to new applicants, as well as deposited into a bank savings account at a rate of Rs. 120/month. In total, 90% of program beneficiaries have either paid back the monthly recovery amounts consistently (80% of all program participants or 42 families total) or have done so at least every other month (10% of all program participants or 6 families total). Only 10% (or 6 families) were unable to pay back the recovery amount due to relocating to their native places.

Three volunteers in different villages help to follow up with the clients at their homes and regularly monitor their activities in the field as well as ensure repayment. A well trained volunteer in animal breeding and poultry raising also assists the clients in giving vaccinations and providing other technical inputs. Currently these livelihoods support projects are being implemented in Anandanager, Vinayakapuram, Jeyanthinager, & Kanagapuram in Kilinochchi District, along with a few beneficiaries residing in the Mannar and Jaffna Districts. Another 50 prospective beneficiaries have applied for the program and are awaiting support.

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Vital Equipment: Egg Incubator and Hatcher Most of the families involved in these efforts have a high level of enthusiasm for poultry raising as a household activity. The eggs and meat help to provide balanced nutrition and to satisfy their protein needs, especially for the children, as well as providing a good income. A request was made by the people, and IMHO-USA extended a valuable hand in support by purchasing an egg incubator (which has a 612 egg capacity), hatcher, and a generator. The generator helps during the power cuts. The first batch of chicken were hatched in March 2012. The target is to provide at least 25 chickens per family. As soon as the chickens mature past one month, they will be distributed to the families as part of the assistance loan provided.

Educational Support For students who lost their father or mother or both parents, their interest in education is very low. The teachers have observed their academic performance and have reported that their performance reflects this unfortunate reality. â&#x20AC;&#x153;Catch-upâ&#x20AC;? education efforts specifically focus on these students and on other slow learners, with nearly 100 students following evening classes in Anandanagar. The students who attend range from Year 5 to Year 11. Five teachers are involved the education project and are paid a small incentive from the microcredit recovery payments collected. IMHO-USA helped us to start this education programme. The first batch of 5 students sat the ordinary (O/L) exam last year and at least one student expects to receive high marks.

Womenâ&#x20AC;&#x2122;s Empowerment Project Dropouts from girls at the O/L and A/L levels have no plans for future activities. The excombatants who have been reunited with their families from the welfare camps after the rehabilitation period have also fallen out of academic activities. These girls in particular are chosen for vocational training in needle and tailoring work. The first batch of 10 girls followed a six-month training course, and 6 of them successfully finished. IMHO-USA helped to provide a sewing machine via microfinance to these beneficiaries, who now have a good, regular monthly income. The second batch of 6 girls is currently following the course now.

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Strengthening Peopleâ&#x20AC;&#x2122;s Minds: !

Community-Based Mental Health Promotion in Batticaloa ! ! !

By Dr. Dan Soundararajah ! !

During! the woeful period of the past four decades, our land and people have gone through many disasters, ! such as famines, cyclones, floods, and the tsunami of 2004, alongside the intermittent destructions caused by the long-lasting war. Recurrences of some of these disasters have also ! been experienced.

These mishaps have done immense damage to our community, causing ! decadence in the social, cultural, and moral patterns, and harm to our sound health and ! ! structures. economic ! !

Many people lost their precious lives, while many others lost their properties and possessions. !

Many others were maimed and crippled. When these calamities fell on the breadwinners, the ! had to bear unbearable hardships. Meanwhile, many families were scattered or families ! displaced. Fellowship, trust, and fidelity amongst the members of the family and the community ! deteriorated. The reason for this can be deduced from the large number of members deserting ! their families and communities, and the rapid rise in the rates of suicide, alcoholism, drug ! addiction, and domestic abuse of women and children. ! !

It was not an easy task for us to build up a good mental health programme to support our ! community at such juncture. With the lack of adequate staff being a major drawback, the ! inability ! to recognize their ailments and problems to approach us for assistance has been a hindrance.

Batticaloa is a wide strip of land with poor transport facilities. The Regional Director ! of Health ! Services (RDHS) covers the entire Batticaloa District, which is comprised of 14 MOH (Medical ! Officers of Health) divisions. These MOH are in charge of preventive care and ! promoting overall health. There are 4 base hospitals for curative medicine and one Mental Health! Rehabilitation Center. Mental health work is mainly shared amongst these main actors. ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

Figure Figure 2: Street drama awareness-raising about ! 1: Home visits by MHU (doctor, nursing officer, & psychiatric social assistant)

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mental health, alcohol addiction, prevention of gender-based violence, and child right promotion.

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Figure 3: School speech competitionâ&#x20AC;&#x201D;announcement Figure 4: Psychiatric Social Assistants conduct of prize winners home visits with vulnerable people (usually in ! remote and disadvantaged areas) ! ! ! !

There ! is no doubt that our mental health community support has been improved. However, assistance is still needed. We developed our current services from our many innovative efforts, ! but !we seek further assistance in mobilizing our Psychiatric Social Assistants (14) and Psychiatric Social Workers (2), and in providing transportation support. The work these staff do ! will !have a very positive effect on overall mental health promotion, protection of women and children from domestic abuse, and prevention of alcoholism and suicide. Community-based ! mental health work is done mainly by Psychiatric Social Assistants (PSAs), and each PSA covers ! a population of 25,000 to 40,000 persons! ! !

The selection of 14 PSAs for each MOH area has been a grand bonanza for us. They went into the ! community to revive hope and trust. It is not a simple task to train them to the level they are at ! now.! They are continuously visiting people at their home, workplace, and schools to screen for mental ! health issues, guiding people to get help and follow up on their progress. In addition to that,! they protect women and children from abuse. They also took many innovative actions to promote mental health through prevention of alcohol and drug addiction. Rehabilitation and ! guidance in economical improvement have also been a major part of their community work. ! ! ! ! ! ! ! !

Figure 5: training ! in gardening ! ! ! ! ! ! ! !

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As an ultimate objective, they are working to bring people together by forming self-help groups. !

This brings more power, trust, and better understanding amongst all of us. BAMHDO and !

Arokya Social Service Organization service were established to optimize the services to people ! who are affected by mental illness and to promote mental health in caregivers and society in ! general.

They are involved in vocational training, food contract, and livelihoods support. !

The !assistance given from IMHO has included Emergency Flood Relief in early 2011, support for land! filling/ground works done around the Mental Health Unit at Valaichchenai Base Hospital, ! and providing motorcycles for workersâ&#x20AC;&#x2122; transportation. These efforts will definitely improve the ! activities of the PSAs and promote stronger mental health across our whole district. We are ! thankful to IMHO and those people who have joined in helping us.

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Figure 6: Cane product training at MHRC/MV Figure 7: Marketing our products

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Figure 8: issuing sewing machine for people who finished training

Figure 9: Distribution of schoolbooks to children who lost their belongings in the floods, thanks to support from IMHO

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Step Forward: Establishing a Neonatal Intensive Care Unit at the Jaffna Teaching Hospital By: The IMHO Team Each year the Jaffna Teaching Hospital in Sri Lanka records about 10,000 deliveries, and in the recent past the number has increased tremendously due to free movement of people from Vanni and other areas. Out of these deliveries, about 20% of the babies need some medical attention after birth.

These babies are currently admitted to the Special Care Baby Unit at the Jaffna Teaching Hospital.

The main problems at the Special Care Baby Unit at present are all related to overcrowding and lack of space. During the year 2010 there were a total of 1,311 babies admitted to the baby unit and 55% of the babies were preterm. More than half of these preterm babies had surfactant deficient respiratory distress. The Jaffna Teaching Hospital does not have surfactant, nor are there facilities to ventilate babies in the baby unit.

Considering the deaths during the neonatal period, 105 babies died in 2010 mainly due to lack of neonatal intensive care. The deaths were particularly high due to sepsis, especially when the total number of babies was high. This also reflects the lack of space and increased risk of cross infection. The babies who need ventilation are admitted to the Adult Intensive Care Unit. In the year 2010 there were about 30 babies admitted to the ICU from the Special Care Baby Unit, and 50% of the babies died due to lack of neonatal intensive care.

With the advancement of medical sciences in much of the world, Northern Sri Lanka is lagging behind. There is a clear need to improve the neonatal services in Jaffna by establishing a Neonatal Intensive Care Unit (NICU). Lack of space, proper facilities, equipment, and trained doctors and nurses are the main challenges, which IMHO seeks to address with this major project. This new initiative will consist of three necessary phases, each costing roughly $70,000: 1) the renovation and addition of building space to house the NICU; 2) the provisioning of vital medical equipment needed to meet the high demand and provide a higher quality of care; and 3) further equipment provisions and facility development We have already made great progress in rallying support for this important project, but we need further support to reach our goal. For those interested in learning more, you can view a short documentary about the project and find much more information on the IMHO USA website (www.TheIMHO.org).

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FLk;gq;fs; rPuopAk;. r%fKk; rPuopAk;. ,dp v d;d epfo Ntz ;Lk;? ehq;fs; midtUk; ,q;Nf Fwpg;gplg;gl;l gpur;rpidfs; mjpfhpj;Jr; nry;tjid kWg;G epiyapypUe;J tpyfp Vw;Wf;nfhs;tJld;> ,e;jg; gpur;rpidapd; gy;ghpkhzj; jd;ikiaAk; Ghpe;Jnfhs;s Ntz;Lk;. ,e;jg; gpur;rpidf;F gy;ghpkhzj;jd;ik ,Ug;gjdhy;> ,e;jg; gpur;rpidia mZFtjpYk; gy;NtW jug;gpdUk; mh;g;gzpg;Gld; <Lgl Ntz;bapUf;fpwJ. gps ;is fs ;: gps;isfs; vg;nghOJNk jkf;Fhpa topfhl;bahf xU tsh;e;jtiuj; njhpe;Jnfhz;L me;j tsh;e;jtUld; jk;Kila vy;yhg; gpur;rpidfisAk;> rpf;fy;fisAk;> re;Njfq;fisAk; fye;JiuahLk; tof;fj;ij Vw;gLj;jpf;nfhs;s Ntz;Lk;. ,t;thwhd topfhl;Lgth;fs; (mentors) mth;fsJ ngw;Nwhhpy; xUtuhfNth> cwtpduhfNth> MrphpauhfNth> Ch;g; nghpatuhfNth my;yJ njhpe;j xUtuhfNth ,Uf;fyhk;. mt;thW njhpT nra;ag;gLgth;fs; gps;isfspd; czh;itg; Ghpe;Jnfhs;sf; $bath;fshfTk;> tpLg;ghh;tk; Fiwe;jtHfshfTk;> ,ufrpak; fhf;Fk; jd;ikAilath;fshfTk; ,Uj;jy; mtrpakhdJ. mt;thwhd xU tsh;e;jtUld; gps;isfs; njhlh;ghLk; nghOJ> tsh;e;jth;fspd; mDgtq;fSk;> gps;isfspd; ,yl;rpakakhd rpe;jidfSk; ghpkhwg;gl;L ajhh;j;jj;Jld; ,iae;j xU rkepiyg; ghh;it ngwg;gLk;. ,J gps;isfSf;F kpfTk; NjitahdJ. mj;Jld; gps;isfs; jq;fsJ czh;Tfisj; jhq;fNs rhpghh;j;Jf;nfhs;Sk; xU Rakjpg;gPl;L Kiwapidf; nfhz;bUf;f Ntz;Lk;. ehd; czh;r;rptrg;gLfpNwdh? ehd; Fok;GfpNwdh? ehd; mjpfk; ngha; nrhy;fpNwdh? vdJ ,yf;F jpir khwpg; Nghfpd;wjh?

Nghd;w Ratpkh;rdg;ghq;fhd Nfs;tpfs; Ra Ma;itj; J}z;b> csr; rkepiyia Vw;gLj;j ty;yd. Kf;fpakhf> jkJ vy;iyfs; vit vd;gjidj; njspthfj; jPh;khdpj;J> gpd;G me;j vy;iyfisj; jhz;lhky; ,Uf;Fk; cWjpahd kdepiyiag; gps;isfs; ngw Ntz;Lk;. ez;gh;fshf ,Ug;Nghh; kpFe;j nghWg;Gzh;Tld; MNyhridfisf; $w Ntz;Lk;.

‘KRg;ghj;jp ghh;g;gk;’ vd;w vz;zj;NjhNlh “Nrh;j;J itf;fpNwhk;” vd;w ngUikNahNlh> ,d;DnkhUthpdJk; mtuJ FLk;gj;jthpdJk; tho;it ehq;fs; rPuopf;ff;$lhJ. !

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ghPl;rpj;Jg; ghh;j;jy; vd;gJTk;> Kad;W jtwpf; fw;wy; vd;gJTk; gps;isfspd; ,ay;Gjhd;.

MapDk; vy;yhtw;wpw;Fk; mit nghUe;jkhl;lhJ. rpy tplaq;fs; ‘thy;T’ Nghd;wit. mq;F xU top kl;LNk. Nghfyhk; Mdhy; jpUk;gp tu ,ayhJ. ,jid ehk; Ghpe;Jnfhs;s Ntz;Lk;. fy ;tp: gps;isfs; jhq;fs; tpopj;jpUf;Fk; Neuj;jpy; ghjp Neuj;ij fy;tpf;$lq;fspNyNa nrytopf;fpwhh;fs;. fy;tpA+lhf khzth;fs; jkJ tho;f;iff;Fj; Njitahd mwpitAk; jpwd;fisAk; ngw;Wf;nfhs;thh;fs; vd vjph;ghh;f;fg;gLfpwJ. MapDk; ,isa tajpdupy; kpfg; ngUk;ghd;ikahdtHfs;; jkJ tho;f;iff;Fj; Njitahd jpwd;fisg; Nghjpastpy; ngw;Wf;nfhs;s Kbatpy;iyNa vd;gij mtjhdpf;fpd;w nghOJ Ntjidahf ,Uf;fpwJ. ,yq;ifapDila fy;tpj;jpl;lj;jpYk; ghltpjhdq;fspYk;> gps;isfSf;Fj; Njitg;gLfpd;w> cgNahfg;glf;$ba gy tplaq;fs; mth;fspd; taJf;Nfw;w tpjj;jpy; cs;slf;fg;gl;bUf;fpd;wd. rpWth; J\;gpuNahfk; gw;wp@ ghypay;G gw;wp@ fh;g;gkiljy; gw;wp@ fh;g;ge; jhpj;jiyj; jLg;gJ gw;wp@ ghy;tpid Neha;fs; gw;wp vy;yhk; ghltpjhdq;fspy; ,Uf;fpd;wd. MapDk; ghPl;iria ikag;gLj;jpa fw;gpj;jy; nraw;ghLfspy; ,it Kf;fpaj;Jtk; ,oe;J Ngha;tpLfpd;wd. tsUfpd;w gps;isfSf;Fj; Njitg;gLfpd;w kpf mtrpakhd tplaq;fs; fw;gpf;fg;glhky;> Muhag;glhky;> fye;Jiuahlg;glhky; Nghfpd;wd. fy;tpg; Gyj;jpd; J}z;fshf ,Uf;fpd;w Mrphpah;fs; gps;isfSf;Fj; Njitahdtw;iwg; Gfl;Lfpd;w jhHg;gupaKila> jw;WzpT kpf;f> nghWg;ghd Mrphpah;fshf ,Uf;f Ntz;baJ mtrpak;. gps;isfs; jq;fSf;F tUfpd;w ‘vy;yhtpjkhd’ re;Njfq;fisAk; jaf;fkpd;wpf; Nfl;Lj; njspT ngwf;$ba xU ‘ntspia’Ak;> ‘tha;g;ig’Ak; Mrphpah;fs; Vw;gLj;jpf; nfhLf;f Ntz;Lk;. rpwe;j Mrphpah;fs; rpwe;j ngw;NwhuhfTk; ,Uf;f Ntz;Lk;@ ,Ug;ghh;fs;. ghlrhiyfs; ghypay; fy;tpiag; Nghjpg;gJk;> ghJfhg;ghd ghYwTf;F ,stajpdiuj; jahh;g;gLj;JtJk; NjitahFk;. ghlrhiy eph;thfKk;> mjpNy nry;thf;Fr; nrYj;Jfpd;w cs;Sh;> Gyk;ngah; rf;jpfSk; ,tw;iwf; fhpridNahL Muha Ntz;Lk;. ghjpf;fg;gl;l xU gps;isapd; gbg;gpw;fhd tha;g;ig kWg;gJNth? me;jg; gps;isia ‘xOf;fk; nfl;lts;’ vd;W Kj;jpiu Fj;JtNjh? ,uf;fkpd;wp NtW ghlrhiyf;F khw;WtNjh ve;jtifapYk; epahakpy;yhj nraw;ghLfNs. ve;jg; ghlrhiyapy; ,Uf;Fk; nghOJ gpur;rpid Vw;gl;lNjh> mNj ghlrhiyr; #oypy; me;jg; gps;isia MjuTld; mZfp> Neh;top fhl;LtNj jhh;kpfk;. mjid ehq;fs; kwe;JtplyhfhJ. xU gps;is nrhy;top Nfl;ftpy;iynad;Nwh> jtW nra;Jtpl;lJ vd;Nwh ehk; mg;gps;isia NtW jha; jfg;gdplk; Nrh;g;gjpy;iy. n gw ;Nw hh;: ngw;Nwhh;fs; vg;nghOJk; jkJ nghWg;GfisAk;> flikfisAk; kwe;JtplyhfhJ. mth;fs; jkJ gps;isfis> mth;fs; tsh;fpd;w nghOJk;> njhlh;e;Jk; Ghpe;Jnfhs;s Kay Ntz;Lk;. ,t;thwhd Ghpe;Jnfhs;sYf;F me;jg; gps;isfSld; njhlh;e;J njhlh;ghlf;$ba xU ‘ntspia’ itj;jpUf;f Ntz;Lk;. gps;isfspd; cyfk;> fw;gidfs;> tpUg;G ntWg;Gfisg; gw;wpj; njhpe;J itj;jpUg;gNjhL> Njitahdtplq;fspy; vy;yhk; gps;isfs; !

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Ghpe;Jnfhs;sf;$batifapy; rhpahd> ajhh;j;jj;jpw;Fg; nghUj;jkhd fUj;JfisAk; $wp itf;f Ntz;Lk;. ngw;NwhHfs; jkJ gps;isfspd; Mirfs;> tpUg;gq;fis kjpj;J mtw;iwg; G+h;j;jpnra;a tpioAk; mNjNtis> mit cz;ikapy; mtrpae;jhdh vd;gjidAk; ghh;j;Jf;nfhs;s Ntz;Lk;. mNjNghy; jkJ gps;isfs; gad;gLj;Jk; etPd njhopy;El;gq;fisg; gw;wpg; ngw;NwhUk; mbg;gil mwpitg; ngw;Wf;nfhs;Sjy; ey;yJ. Jujp\;ltrkhf gps;isfis vt;thW ey;ytpjkhf tsh;f;fyhk;? vd;gJ gw;wp ahUk;> ahUf;FNk fw;gpg;gjpy;iy. mit gy re;jh;g;gq;fspy; Kad;W jtWjy; KiwapD}lhfNt nraw;gLj;jg;gLfpd;wd. mjdhy; ‘jtWfpd;w’ re;jh;g;gq;fspy; vy;yhk; jhf;fq;fs; mjpfkhfp tpLfpd;wd. ngw;Nwhh;fs; jkJ gps;isfs; gw;wpj; jq;fSf;Fs; fijg;gJTk;> fye;J Ngrpj; jPh;;khdq;fisnaLg;gJTk; NjitahdJ. ,aYkhdtiu je;ij> jha; ,UtUk; gps;isfSld; $l ,Ug;gJ rpwe;jJ. jha;> je;ij> my;yJ ,UtUk; ,y;yhj nghOJfspy; gps;isfSf;F me;jthwhd tfpghfq;fis ahuhtJ toq;FtJ mtrpakhdJ. MrpupaHfs; epr;rakhf me;j ,ilntspfis epug;Gtjpy; jkJ fhj;jpukhd gq;if Mw;w KbAk;. rKjhaj;jpy; cs;s ngw;Nwhh;fs;; jkJ mDgtq;fisj; jq;fSf;Fs; gfph;e;Jnfhs;tJk;> xUtUila mDgtj;jpypUe;J kw;wth;fs; fw;Wf;nfhs;tJk; mtrpakhdJ. Njitaw;w kiwg;Gfis tpl;Ltpl;L> tir ghly;fis epWj;jptpl;L> jpwe;j kdJld; gpur;rpidfis mZfp> mtw;iwg; Ghpe;Jnfhz;L> nghUj;jkhd jPh;Tfisf; fhz cjt Ntz;Lk;. r pWth;fS f;fhd m ikg;Gfs ;: rpWth;fSf;fhd mikg;Gfs; nghJthf ghjpf;fg;gl;l gps;isfis ,yf;fhff;nfhz;L ,aq;Ftjidf; fhzyhk;. MdhYk; ,e;j mikg;Gfs; rpWth;fSf;F tuf;$ba ghjpg;Gfisf; Fiwf;Fk; tz;zKk; njhopw;gl Ntz;Lk;. mur mjpfhuk; cila rpWth; mgptpUj;jpf; FOf;fSk;> cyfshtpa kl;lj;jpy; nry;thf;Fila mikg;GfSk; ‘tUKd; fhj;jy;’ njhlh;ghfr; rpe;jpg;gJk;> nraw;gLtJk; Kf;fpakhdJ. rpWth;fSf;Fg; ghjpg;Gfis Vw;gLj;Jk; jdpegh;fSk;> mikg;GfSk;> epWtdq;fSk; Gjpa ghHitfis cs;thq;fp> jFe;j topfspy; jpUj;jj;jpw;Fs;shtjidAk; ,t;tikg;Gfs; cWjpnra;a Ntz;Lk;. mj;NjhL ,t;thwhd rk;gtq;fshy; ghjpf;fg;gl;l gps;isfs; ,dpNkYk; mt;thwhd Mgj;JfSf;Fs; mfg;glhJ fhg;gjw;Fhpa njhlh; epfo;TfSk;> tYT+l;Lk; tFg;GfSk; mtrpakhdJ. Gdh;tho;tspf;Fk; jj;Jtq;fis mbg;gilahf; nfhz;l ek;gpf;ifahd ,y;yq;fSk; Njitg;gLfpd;wd. r l;lk; xO q ;F kw ;Wk; ePjpj;Jiw : ghjpf;fg;gl;l gps;isfSf;F ePjp fpilg;gjidAk;> njhlh; guhkhpg;Gf; fpilg;gjidAk;> Gdh;tho;T fpilg;gjidAk; rpWth; ghJfhg;G> rl;lk; xOq;F kw;Wk; ePjpj;Jiwrhh; mikg;Gfs; cWjpg;gLj;j Ntz;Lk;. ,t;thW tPl;iltpl;L ntspNaWtjw;Fk;> ghJfhg;gpy;yhJ cwT nfhs;tjw;Fk; gpd;dhy; gyUila gq;fspg;G my;yJ nghWg;gw;w jd;ik fhzg;gLfpwJ vd;gjid ,e;epWtdq;fs; Ghpe;Jnfhs;s Ntz;Lk;.

MfNt> ntWkNd jdpahs; rhh;e;J ,e;epiyia Nehf;fp> me;jj; jdpahSf;F jz;lid nfhLg;gJ gpur;rpidfSf;Fj; jPh;thf mikakhl;lhJ. rpy Ntisfspy; ghjpf;fg;gl;l ngz;gps;is tPl;ilapoe;J@ jhd; gbj;j ghlrhiyapoe;J@ ‘xOf;fq; nfl;l’ gps;isahf ‘rPh;jpUj;j’ ,y;yq;fSf;Fg; NghFk; mNjNtis> mjpy; rk;ge;jg;gl;l ‘Mz;kfd;’ !

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gpizapy; ntspte;J Rje;jpukhf elkhbj; jdJ tho;itf; nfhz;L NghtjidAk; fhzyhk;. ,J kpfTk; NtjidahdJ. ,J gw;wp ehk; NkYk; gilg;ghf;fj; jpwNdhL rpe;jpf;f Ntz;baJ mtrpakhdJ. Clfq ;fs ;: Clfq;fs; ,e;j tplaj;ij kpfTk; nghWg;Gzh;Tld; ifahs Ntz;Lk;. mjp\;ltrkhf gy Clfq;fs; ,e;j tplaj;ij kpfTk; ftdkhfNt ifahStJ mtjhdpf;fg;gLfpwJ. ghuhl;Lfs; chpj;jhFf. MapDk; rpy Clfq;fSf;F r%fg; nghWg;G rk;ge;jkhd kaf;fk; ,Ug;gJ njupfpd;wJ. mt;thwhd Clfq;fSk; jkJ nghWg;Gzh;e;J ,e;j tplaj;ijf; ifahs Ntz;Lk;. tpLg;ghHtj;jpw;Fj; jPdp NghLtJk;> tpy;yq;fq;fis tpsk;gug;gLj;JtJk; tpUg;ghd tpisTfis Vw;gLj;jh. r %fk;: xU r%fk; ,t;thwhd elj;ijfis Cf;Ftpf;fNth> rfpj;Jf;nfhs;sNth $lhJ. ,t;thwhd elj;ijfSf;fhd jFe;j vjph;tpidiar; r%fk; fhl;l Ntz;Lk;. “ahUila gps;isf;Nfh VNjh elf;fpwJ” vd;fpwtpjkhd mZFKiw ghjfkhdJ. me;j ‘ahNuh’ ‘ehkhf’ khWtjw;Ff; fhyk; vLf;fhJ. vdNt> ‘vd;dNth elg;gJ elf;fl;Lk;’ vd;w epiyapypUe;J tpLgl;L> r%fkhdJ ,t;thwhd elj;ijfis ntt;NtW kl;lq;fspy; $l;lhf vjph;nfhs;s Ntz;baJ mtrpakhdJ. cile;JNghd r%ff; fl;Lkhdq;fis kPsf; fl;bnaOg;GtJ RygkhdJ. Mdhy; r%fg; ngWkhdq;fs; rpije;JNghdhy; mtw;iw kPsg; ngWtJ ,ayhjjhfptpLk;. r%fg; ngWkhdq;fisAk;> tho;f;ifapd; ,ay;GfisAk; epiyepWj;JtjpYk;> tpsq;fpf; nfhs;tjpYk; kjq;fs; epiwag; gq;Ftfpf;fyhk;. vkJ kjq;fspy; $wg;gl;bUf;Fk; ey;y fUj;JfSk;> vq;fs; flTsuhy; vOjg;gl;l vy;yh tplaq;fSk; fhyj;jpw;Fg; nghUj;jkhd tifapy;> jw;fhy cjhuzq;fNshLk;> ctkhd ctNkaq;fNshLk; kWthrpg;Gr; nra;ag;gl Ntz;Lk;. mjd; %yk; jhd; kjq;fspd; %yk; $w tpioe;j tho;f;ifj; jj;Jtq;fis ,Ugj;Njhuhk; E}w;whz;L kdpjh;fspilNa gutyhf;f KbAk;.

KbTiu : xU gps;is ahUldhtJ Xbg; Nghtjw;Fk;> cwTnfhs;tjw;Fk;> mjdhy; tUk; rpf;fy;fSf;Fk; me;jg; gps;is kl;Lk; nghWg;ghf khl;lhJ. mg;gb me;jg; gps;isia kl;Lk; nghWg;ghf;FtJ vd;gJ mjpy; rk;ge;jg;gl;l vy;yhj; jug;GfSk; jkJ nghWg;GzHtpypUe;J jg;gpj;Jf;nfhs;Sk; xU nghwpKiwahfNt ghh;f;fg;gl Ntz;Lk;. gpur;rpidg;gl;l gps;isfis MjuNthL mZfp> mth;fspd; ghjpg;Gfisf; Fiwj;J> njhlh;r;rpahd Kd;Ndw;wj;jpw;Fk; ey;tho;tpw;Fk; cjTtNj ek; vy;NyhUila flikAkhFk;. ehk; vkJ nksdj;ijf; fisNthkh? r h.r ptNa hfd; cs kU j;JtH

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Strengthening Health Services & Capacity-Building Efforts in Ethiopia By: The IMHO Team

Following an initial visit by a team of 6 IMHO volunteers in October 2010, we have been working hard to diversify and scale up our efforts in Ethiopia, slowly but steadily. Since then, we have collectively sent two medical shipments. IMHO Canada coordinated a shipment of medicines worth several thousand dollars to benefit poor patients at the Gondar University Hospital in the Amhara Region of NW Ethiopia. This shipment of medicines to this highly under-stocked hospital, which serves a catchment area of several million people, contained important antibiotics, antimalarials, anti-hypertensives, and diabetic medications.

Last year when our IMHO volunteer team consulted with members of the administration with regard to the various needs of the hospital, they made a request for 5 voltage converters needed to make functional a number of medical equipments that use a different voltage frequency These items had been donated from another US-based organization and included an ultrasound, Doppler, x-ray viewing boxes, and dental chairs. Without the voltage converters, these machines are not functional. In response to this request, IMHO USA sent a second shipment to the Gondar University Hospital that was comprised of five voltage converters (at a cost of $1,605). When the shipment was received in August 2011, the hospital staff expressed their deep gratitude for IMHO USA's assistance in addressing this chronic shortcoming.

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IMHO USA and IMHO Canada targeted the Amhara Region on account of its long legacy of under-development. Each year Gondar University Hospital sees an incredible 200,000+ outpatients and 20,000+ inpatients. The spread of disease, including maternal sepsis, is high on account of the sheer number of people who are in and out of the hospital. Our combined IMHO USA & IMHO Canada efforts should benefit hundreds of poor patients in need.

Traveling to Ethiopia on her second trip as an IMHO volunteer, Dr. Betsy Finigan handed over $410 worth of medical equipment to the Han Health Center in Bahir Dar, Amhara Region in August 2011. The equipment included gloves, lubricant, a speculum, stethoscopes, gowns, bed covers, bandages, and suture kits.

In October 2011 Ethiopia held its first National Conference on Mental Health, marking an important change in national policy toward mental illness and its treatment. In a country scoring some of the lowest marks on global development indicators where the average GDP per capita is estimated at just $350/year, mental health has taken a back seat until recently. IMHO volunteer Dr. Alan Krohn, who first visited Ethiopia last year on the IMHO-organized volunteer trip, was selected to be part of an advisory board for the conference and to deliver a paper there. At the conference, the local mental health care specialists and organizers adopted the slogan, "No health without mental health."

Additionally, both Dr. Krohn and another IMHO volunteer, Dr. Bill Nixon, spent time working at Gondar University this past October/November, delivering lectures and helping to develop a program in clinical psychology.

At present, medical faculty at the Gondar University Hospital use outdated Western textbooks to study and teach about surgical procedures. These standard textbooks do not effectively address many of the issues common in Ethiopia or how to treat them given local resource constraints, and thus, instructors face a difficult task in teaching medical students with such inadequate resources. Residents and medical studentsâ&#x20AC;&#x2122; seminar presentations are also dependent on these textbooks, and suffer as a result of a lack of locally prepared texts. As such, we plan to support the hospital in preparing a modern, thorough, and locally relevant surgical textbook. Developing a strong and modern surgical textbook that makes specific consideration for the Ethiopian context will ultimately benefit medical students and serve to decrease patient morbidity/mortality rates and improve overall care.

Finally, IMHO is endeavoring to support a deaf education and empowerment project to benefit youth and young adults, along with their families, in Bahir Dar, Ethiopia. Ethiopian deaf children experience discrimination in education, healthcare, job skills training and opportunities, and everyday communication and activities. For this reason, a program is being developed in partnership with local deaf organizations already engaged in serving this vulnerable community. Plans call for establishing a deaf education, training, and service center in Bahir Dar (where there are currently no real services available) that will provide a thoughtful and thorough program of life skills training, Ethiopian Sign Language (ESL) training, job training, public education/outreach, and educational support for the deaf community. IMHO has pledged to match funds in the amount of $5,000 for this project. !

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Human Immunodeficiency Virus (HIV) Infection: Challenges and Impact on Women’s Health in Western Asia

By Dr. S. Sujanthy Rajaram, Assistant Professor of Medicine, Cooper Medical School of Rowan University UMDNJ/Robert Wood Johnson Medical School at Camden, Cooper University Hospital Rajaram-sri-sujanthy@cooperhelath.edu Introduction Is this HIV viral illness curable? This is the major question to many infected people around the world. The negative impact in human health and social life is tremendous and it is escalating in certain parts of the world, especially in Western Asia. This is due to poor education, lack of resources, poor availability of treatment and significant social stigma. In Western Asia several cultural restrictions are implied on women. In rural areas women are not expected to talk openly about safe sex practices and denied access to information or medical treatment due to geographical isolation (Nayamathi 2011).

The positive diagnosis of HIV is a social stigma in many societies and it is considered as a death sentence or pushes the women into an “untouchable” state in some cultures especially in Western Asia (Rahangdale 2010). This article is focused on women in Western Asian countries namely India, Sri Lanka, Pakistan, Nepal and Bangladesh where most of the cultural practices and societal challenges are similar as they share common cultural and moral values. Most of the modern literature, studies and educational resources come from India and the strategies can be applied to other Western Asian nation as well with some modifications.

The negative social and cultural impact of HIV/ Acquired Immune Deficiency Syndrome (AIDS) is huge in developing world, especially in Western Asia, compare to developed world. Discussion and analysis of the social and cultural implications in women, the challenges they face and discussing the potential solutions may give some hope to these women.

HIV/AIDS Epidemic in Indian Women: Risk Factors, Challenges and Cultural Expectations Marriage According to UNAIDS report, 2.2 million adults were living with HIV in India in 2008 and 80% of them were unaware of their disease (UNAIDS, 2010). A large number of women are infected with HIV in India with no risk behavior on their own. More than 90% of women acquire infection after marriage from their husbands. Most women are at increased risk of HIV infection due to their husband’s behavior either they are clients of female sex workers (FSW) or men who have sex with men (MSM) or intravenous drug users (IDU) (UNAIDS 2010). Young women get their infection within the first two years of their marriage and often detected during their first pregnancy (Godbole 2005). HIV infected individuals experience stigma with self-isolation and discrimination from healthcare workers, community members and family (Rahangdale 2010).

This leads to women avoiding antiretroviral prophylaxis during delivery and parent to child transmission occur. Disclosure of HIV status or accessing care was not an option for women in this study and the participants were viewed as having poor moral character and “untouchable” to family or children or to get the blame for failure to fulfill the duties as wives and mothers (Rahangdale 2010). Cultural expectations of women in Western Asia are to hold a high moral character and care for the family and expected to breast feed the baby. Therefore seeking help or even testing during pregnancy or delivery is largely avoided by women. Lack of education and knowledge of transmission is another barrier.

Perception about risk of HIV and exposure to violence from family are some other barriers for testing. Among monogamous women one third of them believed that they are not at risk, 40% of pregnant women the spouse or family would not allow them to be tested and 21% of them thought they were tested during a prior pregnancy and there is no reason to repeat the testing

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(Satyanarayana VA 2009). Family support or refusal is one of the most influencing factors in many women consenting for testing and getting treatment. Empowering women with resources and health education to better negotiate with family, a combined family counseling for HIV testing and re-testing and developing testing policies and practices for low-income monogamous women is an important intervention to help these unfortunate women at risk (Satyanarayana 2009).

Domestic Violence Domestic violence and abusive practices against married women is common and widespread. This is more prevalent when the women are less educated and poor. Men who are abusive are more likely to be alcoholics, engage in extra marital relationship with multiple partners and forced sex within marriage as it is considered as a gender norm. This exacerbates the risk of transmitting STDs and HIV to wives who live with the constant fear of alcohol induced violence (Berg MJ 2010). Women also lack knowledge, are ignorant of their husbandâ&#x20AC;&#x2122;s high risk behavior, and brought up in a culture which makes them to be silent and unable to negotiate safe sex practices including condom use (Ghosh2011).

Other Risk Factors In a recent study which used the National family health survey 3(NFHS-3) in India which tested a large number of women (52,853) and husband and wives (27,556) for HIV. For women being age 26-35, being poor, genital sore during the last 12 months and having more than one sexual partner were associated with HIV. For married women suffering sexual violence, husband having other wives and husbandâ&#x20AC;&#x2122;s education being less than secondary level or higher were significant factors associated with HIV (Ghosh 2011).

In rural areas women living with HIV and AIDS demonstrated avoidance as their coping mechanism due to a higher level of stigma felt, poor availability of adherence strategies and lower level of support for antiretroviral therapy (Nyamathi 2011).

A higher HIV prevalence state in India female sex workers were at high risk to transmit HIV because of low use of condoms. Life time use of intravenous drugs, initiating sexual intercourse before the age of 15 years, having one or more other STDs and being widowed were independently associated with HIV and injection drug use (IDU) was the most potent independent risk factor for HIV in this population (Medhi GK 2011).

HIV/TB Co-Infection Tuberculosis (TB) is a highly prevalent in HIV population in India but female HIV population has a lower co infection rate of TB (12.6%) compare to males (25.6%0 in a longitudinal study (Jeganathan 2011). Further they reported better viral loads compare to males and slow progression of HIV infection is associated with female gender (Jeganathan 2011). There is an increase in number of dual epidemics of HIV and TB. Women are at particularly high risk of coinfection due to social stigma and discrimination (Godpole 2010).

Prevention Strategies in Different Social/Cultural Areas Education and wealth were positively associated with HIV/AIDS awareness about prevention and transmission and less social stigma (Ackerson LK 2011). When mass media was used, television having the strongest effect in awareness, this social disparity got attenuated (Ackerson LK 2011).

This suggests the potential use of mass media to reduce the social disparity in order to get better outcomes in HIV/AIDS in Western Asia.

The intervention strategies should target the young age women who are poor and women who suffer violence in marriage with husbandâ&#x20AC;&#x2122;s behaviors such as extramarital affairs, drug use and alcoholism. Empowering the women to negotiate safe sex practices is fundamental in prevention of HIV epidemic in Western Asia (Ghosh 2011). Young adults aged between 15-29 accounts for 32% of AIDS in India and the number of women living with HIV/AIDS is twice that of young men further suggests, that a gender-based sex education in schools is important (McManus 2008).

There is no significant difference between rural and urban prevalence if disease and this is consistent in many studies suggests the disease has become generalized (Firth 2010).

Educational programs addressed HIV/AIDS awareness of transmission and prevention at

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national and state levels had a dramatic impact on public awareness. This may have accounted for a decline in HIV prevalence in recent years in India (Firth 2010).

Transmission of HIV in India and most of Western Asia is predominantly heterosexual transmission from an infected spouse after marriage. Culturally in Western Asia girls are considered ready for family life after they attain puberty. This places young girls at risk for HIV infection. In a study by Thomas et.al found that 53% of the participantâ&#x20AC;&#x2122;s age of marriage in India was under 18 (Thomas 2007). There is an urgent need for engaging women and men in marital counseling in making decisions about marriage, marriage age, social behavior and education regarding living with HIV/AIDS in order to prevent ongoing infections.

HIV/AIDS intervention in Bangladesh: Social Exclusion of Women It is interesting to note that in Bangladesh, although the country shares similar cultural values like other Western Asian countries of interest and follow Indian culture, HIV prevalence has been less than 1% despite multiple risk factors (Khosla 2009). In this country high risk groups are male injecting drug users (IDUs), sex workers, MSMs and transgender population who are considered as socially excluded groups and many are economically poor. Women in Bangladesh are also socially excluded due to bias against the gender. Women are excluded from formal economy, access to health care and general participation in community life. Because of this social exclusion in addition to the above high risk group, women are also at high risk for HIV/AIDS transmission similar to truck-drivers, dock-workers and rickshaw-pullers (Azim 2008).

Preventive efforts should be targeted towards the socially excluded high risk groups and women to establish socially justifiable programs in the future, not only in this low prevalent country, but also in other Western Asian countries, which are at an imminent danger of an HIV/AIDS epidemic (Khosla 2009).

Intervention Strategies in Western Asia India, Pakistan, Bangladesh, Nepal and Sri Lanka share a similar socio-cultural background and women health issues, including epidemic of HIV/AIDS, India shared the highest reported prevalence and had several programs and publications available. In prevention of HIV/AIDS in these nations, it is imperative to have monitoring policies and programs which address the Womenâ&#x20AC;&#x2122;s health separately, to achieve the goal of gender equality in health care and social welfare (Gill 2011).

Some of the strategies out lined by UN report in 2010 suggested the following broad categories in India and these are applicable to other Western Asian nation as well. Integrated counseling and Testing centers; Prevention of parent to child transmission; Capacity enhancements for staff training and research in sexually transmitted disease clinics with provision of standardized packages; Providing access to preferred private providers, condom promotion by social marketing programs; Condom vending machines; Capacity building; Training and promotion of female condom use; Strategic focus on behavioral change; Mass media campaigns for condom promotion and behavioral change; Interventions with youth in college and school; Multi-sectoral collaborations with political leadership and health care workers; Providing anti-retroviral therapy in public hospitals and cultural centers; Effective treatment of opportunistic infections; HIV-TB collaborative services; Strengthening provider education and state initiatives in services are potential key elements in control of this epidemic (UNAIDS 2010).

So far no cure or a vaccine is available for HIV/AIDS; these nations should focus on prevention and effective treatment in addition to participation in vaccine trials and research with a special focus on womenâ&#x20AC;&#x2122;s health and equality.

Conclusion In Western Asia and particularly in India women are at high risk for contracting HIV after marriage. Marriage is the way society provides legitimacy to women and ensures smooth functioning of family.

Informal family education has been provided by grandparents and extended family members traditionally, and they are not able to provide education and support in HIV due to lack of knowledge and misconceptions about sexual functioning (Henry JA 2010). It is essential to

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embark on formal family life education, marital life education and also focus on avoiding child marriages to protect the young girls contracting the virus before they become aware of the disease and life.

Interventions to decrease the social stigma of HIV diagnosis, education about the route of transmission, preventive measures, and negotiation of safe sexual practices, education regarding the high risk for their children getting infection and educating health care workers are potential strategies. Empowerment of the young women is crucial. Uniform programs and monitoring policies need to be implemented in Western Asian countries in order to assure gender equality of women in health care and social welfare.

References 1. Godbole S & Mehendale S (2005). HIV/AIDS epidemic in India: risk factors, risk behavior & strategies for prevention & control. Indian J med Res 121, April 2005, 356-368 2. Henry JA. (2010). Protecting and fledging families: A case for Relationship-Focused family life education programs. Indian J Community Med 2010; 35:373-5. Retrieved on October 16 2011, from: http://www.ijcm.org.in/text.asp?2010/35/3/373/69246 3. UNAIDS. India: 2010 Country progress report. Retrieved on October 16, 2011 from http://www.unaids.org/en/dataanalysis/monitoringcountryprogress/2010progressreportssubmittedbycoun tries/india_2010_country_progress_report_en.pdf 4. Rahangdale L, Bandandur P, Sreenivas A, Turan J, Washington R & Cohen C, (2010). Stigma as experienced by women accessing prevention of parent to child transmission of HIV services in Karnataka, India AIDS Care 2010 July; 22(7): 836-842 5. Satyanarayan VA, Chandra PS, Vaddiparti K, Cottler LB, (2009). Factors influencing consent to HIV testing among wives of heavy drinkers in an urban slum in India, AIDS care. 2009 May; 21 (5): 615-621 6. Berg MJ, Kremelberg D, Dwivedi P, Verma S, Schensul JJ, Gulta K, et.al, (2010) The effects of Husband’s Alcohol consumption on married women in three low-Income areas of greater Mumbai AIDS Behav. 2010 August 14 (suppl 1): S126-S135 7. Nyamathi A, Ekstarnd M, Zolt-Gilburne J, Ganguly J, Sinha S, Ramakrishnan P, et.al, (2011) Correlates of Stigma among Rural Indian Women Living with HIV/AIDS, AIDS Behav. 2011 Sep 14 (Epub ahead of print) Retrieved on October 12, 2011 from PubMed, PMID: 21940417 http://www.ncbi.nlm.nih.gov/pubmed 8. Medhi GK, Mahanta J, Paranjape RS, Adhikary R, Laskar N, Ngully P (2011) Factors associated with HIV among female sex workers in a high HIV prevalent state of India. AIDS care 2011 Sep 9, (Epub ahead of print) Retrieved on October 12, 2011 from http://www.ncbi.nlm.nih.gov/pubmed 9. Jeganathan L et.al, (2011) HLA-B*57 and gender influence of tuberculosis in HIV infected people of south India, Clin Dev. Immunology. 2011; 2011:549023, Published on line 20110 August 25. Doi: 10.1155/2011/549023 PMCID: PMC3162975 10. Ackerson LK, Ramanadhan S, Arya M, Viswanath K (2011). Social disparities, Communication Inequalities and HIV/AIDS related knowledge and attitude in India AIDS Behav. Aug 26. 2011(Epub ahead of print) retrieved from PubMed on October 12, 2011 from http://www.ncbi.nlm.nih.gov/pubmed 11. Gbosh P, Arah OA, Talukdar A, Sur D, Babu GR, Sengupta P (2011), Factors associated with HIV infection among Indian Women. Int. J STD AIDS. 2011 Mar: 22(3): 140-5 12. Thomas BE, Chandra S, Selvi KJA, Suriyanarayanan D, Swaminathan S (2007), Gender differences in sexual behaviour among people living with HIV in Chennai, India Indian J Med Res 129, June 2009, pp 690—694 13. McManus A, Dhar L (2008) Study of knowledge, perception and attitude of adolescent girls towards STIs/HIV, safer sex and sex education, BMC Women’s health 2008, 8:12 dol: 10.1186/1472-6874-8-12 14. Firth J, Jeyaseelan L, Christina S, Vonbara V, Jeyaseelan V, Elan S et.al (2010). HIV-1 Seroprevalence and awareness of Mother-to-child transmission issues among women seeking antenatal care in Tamil Nadu, India, JIAPAC 2010 9:206 retrieved from http://jia.sagepubmed.com/content/9/4/206 on October 3, 2011 15. Azim T, Rahman M, Alam MS, Chowdhuru IA, Khan R, Reza et al. Bangladesh moves from low prevalence nation for HIV to one with concentrated epidemic in injecting drug users. Int. J STD AIDS 2008; 19:327-31 16. Gill R, Stewart DE (2011), Relevance of gender-sensitive policies and general health indicators to compare the status of South Asian women's health, Women’s Health Issues 2011 Feb;21(1):12-8.

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