In-country Programs Research Articles

Building capacity and promoting health through online volunteering

Purpose Significant changes to in-person volunteering were necessary during the COVID-19 pandemic. Health Volunteers Overseas (HVO) responded to the pandemic by developing an online education platform and pivoting to online volunteering. This qualitative study explores the dynamics of online volunteering and provides visibility to this novel trend in the training of health professionals in resource-scarce countries. Methodology/approach Barriers and facilitators, actual and potential outcomes, and recommendations for online volunteering were addressed through a comparative case study approach focusing on three HVO global projects: physical therapy in Rwanda and Ghana, oral health in Nepal, and anesthesiology—a multi-country collaboration between Bhutan, Cambodia, and Laos. Findings A total of 15 participants, including project directors, host country representatives, and teaching volunteers, were interviewed online. Three themes emerged through the online interviews with HVO volunteers, project directors, and host country directors: Creating Space, the Future is Hybrid, and Geographical Expansion. Research implications Online volunteering provides a new opportunity for volunteers to expand their networks, learn new skills, and meet the needs of the host country participants. There is also an opportunity to expand projects beyond national boundaries, but logistical, cultural, and linguistic challenges must be considered. Practical implications Online volunteering is a feasible approach for building teaching and research capacity globally, and volunteer agencies should consider a hybrid model combining online volunteering with in-person volunteering. Originality Online volunteering provides support to meet the needs of both volunteers and in-country program participants. Limitations This study focused on the volunteer, project director, and host coordinator experience and not on the learner. More research is needed to investigate how online and in-person dynamics coalesce.

The benefits of virtual learning abroad programs for higher education students: A phenomenological research study

BackgroundHigher education institutions offer in-country learning abroad programs to provide healthcare students with the opportunity to gain the intercultural and global competencies they need to work in a globally interconnected world. During the Covid-19 pandemic, institutions offered virtual learning abroad programs as an alternative to the in-country programs, however, little is known about whether they provide comparable benefits to students. ObjectivesThe purpose of this study was to investigate, and identify, the benefits gained by higher education healthcare students through their participation in a virtual learning abroad program. Design/MethodsThis research implemented a qualitative approach, conducting semi-structured interviews with four higher education students enrolled in the final year of their healthcare studies. Data were analyzed using interpretative phenomenological analysis. ResultsThe results revealed that virtual programs provide a range of benefits students can use in their future careers. They also provide students with a positive learning experience and an opportunity for personal growth. However, although the benefits students gain from virtual learning abroad programs are similar to those they gain from in-country programs, they are not identical. While virtual learning abroad programs are a viable alternative for in-country programs and offer many benefits, they fail to replicate the intercultural and global competencies that in-country programs offer to students. ConclusionThis study focusses on virtual learning abroad programs and whether the benefits healthcare students gain from them are comparable to the traditional in-country programs. Students gain personal and professional benefits from these programs without the risks and costs associated with international travel. However, the identified lack of increased global awareness has implications for how the benefits of virtual learning abroad programs should be promoted to students.

Going Remote: Evaluating a Global Health Practicum Program During COVID-19 Travel Restrictions

Short-term experiences in global health (STEGHs) are an important part of global health degree programs. Due to the COVID-19 pandemic, travel was not possible for students planning to participate in the Johns Hopkins Center for Global Health's Global Health Established Field Placement (GHEFP) program in 2020. Working with willing faculty mentors, in-country collaborators, and students, the Center allowed students to complete their practicums remotely so that students could gain practicum experience despite not being able to travel, and faculty and collaborators could receive the planned support on their projects. This evaluation aims to describe the experience of pivoting the GHEFP program from an in-person, in-country program to a remote practicum. We analyzed program evaluation data from 30 students, 20 faculty members, and 10 in-country collaborators. Surveys for each group consisted of multiple choice, scale rating, and open-ended questions. The quantitative data was analyzed using Microsoft Excel to calculate survey response frequencies. The open-ended responses were analyzed for emergent themes. The remote GHEFP experience enabled students to gain practice working on global health projects from a distance, but it came with challenges related to preparation, communication, shifting scopes of work, and contextualization. All participants would have preferred an in-person experience if given a choice, but most agreed that a remote practicum was better than not participating at all. The remote program served its purpose during the height of the pandemic. Given the hybrid nature of global health today, many aspects of the remote practicum experience are helpful for global health training. Future iterations of remote STEGHs should initially be designed for remote work to ensure meaningful scopes for students that are helpful to faculty mentors and collaborators. Hybrid models may also be useful. Mutually beneficial twinning relationships should also be incorporated into remote and in-person STEGHs to foster a more equitable global health training environment.

Developing Palliative Medicine as an Accredited Medical Specialty in Kenya

PURPOSEMost people living with life-limiting illnesses in Kenya lack access to palliative care. Globally, palliative medicine is a growing specialty that equips clinicians with the training required to improve the quality of life for people living with a wide variety of serious illnesses. Optimal delivery relies on a skilled workforce with specialty-level training, and we identified the absence of board-accredited training programs for clinical officers (COs) and physicians as a barrier to providing high-quality palliative care in Kenya.METHODSWe held a series of stakeholder meetings with expert palliative care clinicians, leaders, and educators from Kenya and other countries to develop and implement a comprehensive, evidence-based palliative medicine curriculum for COs.RESULTSWe developed a higher diploma program that is being administered by the Moi Teaching and Referral Hospital College in Eldoret, Kenya, with faculty from Moi University School of Medicine and affiliated institutions. We have collaborated to create the first diploma awarding program in palliative medicine in Kenya. Our efforts have led the Kenyan CO Council adding palliative medicine to their list of recognized and licensed specialties. COs are now enrolled in an 18-month program that will lead to a higher diploma and national recognition as palliative care specialists.CONCLUSIONEarly building of consensus and educating policymakers, regulatory bodies, and government personnel was an important step to overcome the challenge of palliative care misconceptions. The unique capacity of global partnerships and early and frequent stakeholder involvement is critical in novel program development. Local ownership of such in-country programs is key, and the stakeholders should be included in strategies for sustainability.

Mapping evidence on HIV status awareness among key and vulnerable populations in sub-Sahara Africa: a scoping review protocol

BackgroundHuman immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) continue to be a major public health issue, especially in sub-Sahara Africa (SSA). Literature shows significant HIV status awareness, testing, and treatment have generally improved among the population since the inception of the UNAIDS 90:90:90 programme. Despite this, it is possible literature gaps exist that require future research to inform in-country programmes to improve the gains post-UNAIDS 90:90:90 programme. This study, therefore, aims to synthesize literature and describe the evidence on HIV status awareness among key and vulnerable populations in SSA focusing on the first UNAIDS 90 since it is essential for treatment initiation.MethodThis systematic scoping review will be guided by the framework proposed by Arksey and O’Malley and improved by Levac and colleagues. Literature searches will be conducted in PubMed, SCOPUS, CINAHL, Google Scholar, and Science Direct from 2016 to 2020. A snowball approach will also be used to search for relevant articles from the reference of all included studies. This study will include both published and grey literature, articles that include HIV key and vulnerable populations, HIV status awareness, and evidence from SSA countries. Two reviewers will independently conduct the abstract and full-text article screening as well as pilot the data extraction form. Thematic content analysis and a summary of the themes and sub-themes will be reported narratively.DiscussionsThe evidence that will be provided by this study may be useful to inform in-country programmes to improve the gains made post-UNAIDS 90:90:90 programme from 2021 onwards. This study also anticipates identifying literature gaps to guide researchers interested in this field of study in the future. Peer review journals, policy briefs, and conference platforms will be used to disseminate this study’s findings.

Neurosurgical training and global health education: systematic review of challenges and benefits of in-country programs in the care of neural tube defects.

The recognition that neurosurgeons harbor great potential to advocate for the care of individuals with neural tube defects (NTDs) globally has sounded as a clear call to action; however, neurosurgical care and training in low- and middle-income countries (LMICs) present unique challenges that must be considered. The objective of this study was to systematically review publications that describe the challenges and benefits of participating in neurosurgery-related training programs in LMICs in the service of individuals with NTDs. Using MEDLINE (PubMed), the authors conducted a systematic review of English- and Spanish-language articles published from 1974 to 2019 that describe the experiences of in-country neurosurgery-related training programs in LMICs. The inclusion criteria were as follows-1) population/exposure: US residents, US neurosurgeons, and local in-country medical staff participating in neurosurgical training programs aimed at improving healthcare for individuals with NTDs; 2) comparison: qualitative studies; and 3) outcome: description of the challenges and benefits of neurosurgical training programs. Articles meeting these criteria were assessed within a global health education conceptual framework. Nine articles met the inclusion criteria, with the majority of the in-country neurosurgical training programs being seen in subregions of Africa (8/9 [89%]) and one in South/Central America. US-based residents and neurosurgeons who participated in global health neurosurgical training had increased exposure to rare diseases not common in the US, were given the opportunity to work with a collaborative team to educate local healthcare professionals, and had increased exposure to neurosurgical procedures involved in treating NTDs. US neurosurgeons agreed that participating in international training improved their own clinical practices but also recognized that identifying international partners, travel expenses, and interference with their current practice are major barriers to participating in global health education. In contrast, the local medical personnel learned surgical techniques from visiting neurosurgeons, had increased exposure to intraoperative decision-making, and were given guidance to improve postoperative care. The most significant challenges identified were difficulties in local long-term retention of trained fellows and staff, deficient infrastructure, and lower compensation offered for pediatric neurosurgery in comparison to adult care. The challenges and benefits of international neurosurgical training programs need to be considered to effectively promote the development of neurosurgical care for individuals with NTDs in LMICs. In this global health paradigm, future work needs to investigate further the in-country professionals' perspective, as well as the related outcomes.

The neoliberal borderscape: Neoliberalism's effects on the social worlds of migrants along the Thai-Myanmar border

This paper discusses neoliberalism's effects on migrants in Mae Sot, a town on the Thai-Myanmar border inhabited by approximately 200,000 migrants from Myanmar. Most literature on neoliberalism and borders focuses on how borders filter between “desired” and “unwanted” mobilities in the interests of capital accumulation. This paper takes a different approach; it argues that neoliberalism reconfigures the day-to-day social realities of migrants, who are embedded in families, communities, and a larger social system along the Thai-Myanmar border. During the 1980s, when a war economy thrived along the Thai-Myanmar border, migrants in Mae Sot established a semi-legal social system comprising schools, clinics, and community organisations, that allowed migrants to access functions ordinarily provided by a state. However, Myanmar's transition to a nominally civilian government in 2010 resulted in two changes on the border. Firstly, the Thai state is implementing projects to connect Mae Sot to transcontinental transport networks. Secondly, Western donors that funded community organisations in Mae Sot began re-routing their resources to supporting in-country programmes in Myanmar. Neoliberalism is the driving force for both these phenomena. Using the concepts of bordering and borderscapes, this paper discusses their combined effects on migrant children, families, and communities. Migrant children are increasingly denied opportunities to go to school, even as their parents become more deeply integrated into the border economy. Leaders of community organisations decrease their reliance on Western donors, but increase the burdens they place on other community members. The case of the Thai-Myanmar border demonstrates that a comprehensive understanding of neoliberalism's relationship with interstate borders must consider the ways in which socio-spatial identities are produced in dynamic relation with top-down efforts to regulate interstate boundaries. Concepts of bordering and the borderscape are central to this endeavor.

Discourse Analyses of Chinese Visiting Professors at Canadian Universities: Adaptation and Transformation

Chinese visiting professors, as Chinese university educators, are playing both practitioners and conformists in adapting to Western teaching perspectives and pedagogies while maintaining Chinese teaching beliefs. This study attempts to understand the international university experiences (Canada) of Chinese visiting professors. Arguably, Chinese visiting professors might potentially engage in programs aimed at providing an advance preparation for Chinese international graduate students, furthering their successful transition in study abroad. This paper is oriented to a post-structural paradigm in order to remain open to the attitudes, beliefs, and values of participants. The findings of a discourse analysis of Chinese visiting professors at a Canadian university are presented. The findings disclosed specific accounts as provided by this research group (i.e. dual academic and teaching experiences, and bicultural experiences in Chinese and Canadian universities). Using the findings, recommendations were made in bridging potential challenges to studying abroad. Specific to this task is the construction of an in-country program aimed at preparing Chinese undergraduate and graduate students for study overseas (specifically in Canada).

Improving care for people with asthma: building capacity across a European network of primary care organisations – the IPCRG’s Teach the Teacher Programme

# Background The International Primary Care Respiratory Group (IPCRG) is a global network of organisations committed to improving assessment/treatment of chronic respiratory disease (CRD) in primary care. As a charity IPCRG supports improvements in health systems within member countries by disseminating research evidence and offering evidence-based resources, such as the U-BIOPRED (Unbiased BIOmarkers in PREDiction of respiratory disease outcomes) research into different phenotypes of asthma and IPCRGs desktop helper - which is short practical guidance distilled from the evidence on structured asthma review -- termed SIMPLES. # Methods We ran a pilot educational programme -- called Teach the Teacher: Difficult to Manage Asthma designed to build capacity for teaching knowledge and skills in asthma management to primary healthcare workers in eight member countries. We used a cascade approach, which allowed for adaptation to local contexts to address local challenges, overcome barriers and optimise facilitators within various political, financial and healthcare systems. We explored impact using an educational evaluation framework. # Results Seven in-country programmes were delivered within project timescales March - December 2015. An important feature of the programme level evaluation shows considerable variation in the design and focus of in-country events. Over 230 health professionals participated in these educational events in seven countries, including specialist nurses, physiotherapists, general practitioners (GP), early career GPs, and GPs with a special interest in respiratory disease. Findings from a survey of in-country leads showed the importance of local needs assessment to ensure it was responsive to local social and healthcare context and allowed local variation and needs to be highlighted. Needs assessment also engaged the potential audience and ensured their buy-in to the programme at an early stage. Evidence based resources were adapted to different contexts which allowed them to be integrated to the routine training of primary care clinicians thus ensuring sustainability. # Conclusions Variation in the design and focus of in-country events was crucial to local implementation. Teams encountered, and found local solutions for, challenges in assessing learning needs, setting up education programmes and in supporting clinical practice change. Project funding enabled national programmes, but sustainability will require additional resource and a longer-term strategy.

Teacher reform in Indonesia: can offshore programs create lasting pedagogical shift?

ABSTRACTRegional and national interest in reforming teaching in Indonesia has seen governments, NGOs and education specialists combine to drive pedagogical changes among school teachers there. Results of these programs have been indifferent at best. This paper reports on teacher reform programs in Provinsi Papua, one of the most marginal societies in Indonesia. The Papuan Provincial Government, AusAID and an Australian University focused on bringing cohorts of secondary teachers and Principals for professional development to Australia. An evaluative, survey inquiry was conducted into the effectiveness of a series of AusAID (now DFAT Australian Aid) Scholarship programs on changing capacities and approaches of teachers and Principals at least eighteen months after their off-shore experience. Findings revealed significant changes in teaching practices, improved quality of teacher-student relationships and improved interactions with colleagues. We argue that our findings demonstrate an appetite for student-centred approaches to teaching and that off-shore programs may have important outcomes that larger scale, in-country programs fail to realise. This has implications for DFAT Australian Aid-funded and similar Scholarship programs.

Communications, Immunization, and Polio Vaccines: Lessons From a Global Perspective on Generating Political Will, Informing Decision-Making and Planning, and Engaging Local Support.

The requirements under objective 2 of the Polio Eradication and Endgame Strategic Plan 2013–2018—to introduce at least 1 dose of inactivated poliomyelitis vaccine (IPV); withdraw oral poliomyelitis vaccine (OPV), starting with the type 2 component; and strengthen routine immunization programs—set an ambitious series of targets for countries. Effective implementation of IPV introduction and the switch from trivalent OPV (containing types 1, 2, and 3 poliovirus) to bivalent OPV (containing types 1 and 3 poliovirus) called for intense global communications and coordination on an unprecedented scale from 2014 to 2016, involving global public health technical agencies and donors, vaccine manufacturers, World Health Organization and United Nations Children’s Fund regional offices, and national governments. At the outset, the new program requirements were perceived as challenging to communicate, difficult to understand, unrealistic in terms of timelines, and potentially infeasible for logistical implementation. In this context, a number of core areas of work for communications were established: (1) generating awareness and political commitment via global communications and advocacy; (2) informing national decision-making, planning, and implementation; and (3) in-country program communications and capacity building, to ensure acceptance of IPV and continued uptake of OPV. Central to the communications function in driving progress for objective 2 was its ability to generate a meaningful policy dialogue about polio vaccines and routine immunization at multiple levels. This included efforts to facilitate stakeholder engagement and ownership, strengthen coordination at all levels, and ensure an iterative process of feedback and learning. This article provides an overview of the global efforts and challenges in successfully implementing the communications activities to support objective 2. Lessons from the achievements by countries and partners will likely be drawn upon when all OPVs are completely withdrawn after polio eradication, but also may offer a useful model for other global health initiatives.

Communicative Language Teaching And Its Achievements: A Study Of In-Country Program In Indonesia From 2013-2015

<p>This paper aims to discuss the result of the study on the implementation of communicative language teaching and its impact on the language achievements of the students. In this study, the data is collected from classroom observation, interview, and examination of various Indonesian curricula, syllabi, and teaching materials. The subjects of the study are students, peer tutors, and instructors involving in the CLS Malang programs in the summers of 2013–2015 at Indonesian for foreign speakers (or locally known as <em>Bahasa Indonesia bagi Penutur Asing</em> (BIPA)), State University of Malang. The result of the study shows that the implementation of communicative language teaching approach is very effective when it is combined with extracurricular activities. The combination of these two can significantly increase students’ skills in Indonesian language as the students are able to use it effectively and meaningfully in “real-world” contexts afterwards. Moreover, based on the results of OPI (Oral Proficiency Interview), this approach enables students to practice Indonesian language through real-life interactions. Higher levels of students’ achievement are predicted to result from this approach because the OPI interviews emphasize oral proficiency based on communicative and cultural skills in real-life settings. The limitation and suggestion for further research will also be discussed.</p><p> </p><p><strong>Keywords: </strong><em>communicative language teaching, achievement, Bahasa Indonesia, in-country program, Indonesia</em></p>

Paediatric cardiac surgery in low-income and middle-income countries: a continuing challenge

Despite advances in surgical and catheter-based treatment for congenital heart disease (CHD), there remain wide disparities across the globe. Ongoing international humanitarian and in-country programmes are working to address these...

Pharmacovigilance for single low-dose primaquine: a practical approach

Establishing and strengthening pharmacovigilance in resource-limited settings provides a valuable opportunity to identify, quantify and address pertinent safety concerns regarding the use of single low-dose (SLD) primaquine. While it is understood that primaquine causes dose-dependent hemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals with P. falciparum and P. vivax malaria, the extent of this risk when using low doses of primaquine remains to be defined. Prospective pharmacovigilance methods are needed to confirm or refute these safety concerns that have likely hindered the uptake of the new WHO policy for SLD primaquine. Pharmacovigilance in resource-limited settings is challenging, especially when attempting to identify unknown or poorly understood adverse drug reactions over weeks of follow-up. In contrast, the objectives of a pharmacovigilance program for SLD primaquine are specific, measurable, and attainable within a short time frame. The nadir of primaquine-induced hemolytic anemia, measurable by hemoglobin concentrations, has been shown to occur on or near day 7. Thus, it is expected that adverse drug reactions related to primaquine can be captured within a week of drug administration by active surveillance methods involving patient follow-up. Furthermore, dark urine is a characteristic sign of acute hemolytic anemia, an easily identifiable and documentable symptom of hemolysis. Numerous pharmacovigilance efforts are ongoing, supporting individual countries in the collection of standardized SLD primaquine safety data. These efforts seek to establish the expected fall in hemoglobin from baseline levels before treatment to levels seven days post-treatment and include G6PD testing and recording of adverse events using standard data collection instruments. Each participating in-country program or study site aims to collect data on 100-400 subjects depending on malaria endemicity and expected G6PD prevalence. We plan to collate data across these countries in a global database of individual patient data, contributing to the evidence-base for benefit-risk assessments of SLD primaquine. As other 8-aminoquinoline drugs such as tafenoquine come to market, we will be faced with related safety concerns of dose-dependent hemolysis in G6PD-deficient individuals. Active pharmacovigilance and the establishment of a standardized database for SLD primaquine not only provide opportunities to harmonize efforts, address unanswered questions regarding the safe use of SLD primaquine, and assist programs planning widespread roll-out of SLD primaquine in routine malaria case management they can also serve as a common platform for other current and future pharmacovigilance needs. The methods used in these efforts and the composition of this database will be described.

Global Mapping Exercise of Canadian Maternal,Newborn, and Child Health Initiatives

ObjectiveAccomplishing the ambitious targets set by the United Nations Global Strategy to save the lives of 16 million women and children in low income countries by 2015 requires that governments, development partners, civil society, academics, and the corporate sector create new partnerships and collaborations. The Canadian Network for Maternal, Newborn and Child Health was a pilot initiative to determine possible synergies between Canadian organizations. The main purpose of this project was to develop an online, up-to-date, interactive tool to examine the nature, scope, and type of Canadian maternal, newborn, and child health (MNCH) activities and to promote collaborative efforts among Canadian organizations. MethodsRelevant Canadian organizations and institutions were identified and invited to complete a survey/mapping exercise if they were based in Canada and currently engaged in MNCH programming in low income countries. Google Maps was used to portray MNCH-related activities worldwide, including detailed descriptions of each initiative. ResultsAs of November 2011, 42 Canadian organizations were identified as engaged in 102 MNCH-related initiatives, in more than 1000 regions, in 94 countries. The results of this survey are summarized here and have been shared in more detail through an interactive website mapping tool at the Canadian Network for Maternal, Newborn and Child Health. ConclusionThe mapping exercise of in-country programs represented visually in an interactive website has laid the groundwork for the Canadian Network for Maternal, Newborn and Child Health to facilitate in-country collaboration, share knowledge and success stories, and build more robust mechanisms for monitoring and accountability.

Field vehicle fleet management in humanitarian operations: A case-based approach

Transportation is the second largest overhead cost to humanitarian organizations after personnel. Academic knowledge about fleet management in humanitarian operations is scarce. Using a multiple case research design we study Field Vehicle Fleet Management (Field VFM) in four large International Humanitarian Organizations (IHO): the International Committee of the Red Cross, the International Federation of Red Cross and Red Crescent Societies, the World Food Program and World Vision International. Our field research includes more than 40 interviews at headquarters, regional and national level in Africa, the Middle East and Europe. The paper answers three research questions: (1) How do IHO manage their field vehicle fleets? (2) What are the critical factors affecting IHO Field VFM? (3) How does Field VFM affect in-country program delivery? The contribution of this research is twofold. First, it helps to fill the existing gap in the humanitarian literature regarding Field VFM. Second, it expands the fleet management literature to a new and virtually unexplored area.

Field Vehicle Fleet Management in Humanitarian Operations: A Case-Based Approach

Transportation is the second largest overhead cost to humanitarian organizations after personnel. The international 4x4 Field Vehicle Fleet size is estimated between 70,000 and 80,000 units with a cost above $1 billion per year. Nevertheless, academic knowledge about fleet management in humanitarian operations is scarce. By using a multiple case research design we study field vehicle fleet management in 4 large international humanitarian organizations (IHO): the International Committee of the Red Cross, the International Federation of Red Cross and Red Crescent Societies, the World Food Program and World Vision International. Our field research includes more than 40 interviews at headquarters, regional and national level in Africa, the Middle East and Europe. We aim to answer three questions: 1) How do IHO manage their field vehicle fleets? 2) What are the critical factors affecting IHO field vehicle fleet management? 3) How does field vehicle fleet management affect in-country program delivery? Finally, we suggest further research areas in transportation and fleet management in humanitarian operations.

Smallpox — the death of a disease

Smallpox — the death of a disease, written by D.A. Henderson, provides a personal accounting of the strategies, decisions, and combined global efforts leading to the eradication of smallpox. Henderson, a recognized smallpox expert who served as the first director of the WHO Smallpox Global Eradication Unit, discusses the events leading to the World Health Assembly’s (WHA’s) decision to commit to a major global eradication effort. He provides a firsthand, behind-the-scenes view of the politics, opinions, strategies, and personalities that enabled or hindered this massive undertaking. Medically oriented and general readers interested in public health and/or smallpox would likely enjoy reading this personal perspective on smallpox eradication. Henderson prefaces the book by describing how his career in public health began by fulfilling a Selective Service requirement to serve in a uniformed service. This led him to a US Public Health Service position with the Epidemic Intelligence Service (EIS) at the CDC. What started out as an assignment to fulfill a requirement, admittedly approached with lukewarm enthusiasm, soon blossomed into a lifelong passion and career in public health. Henderson’s focus on smallpox began while he was chief of the CDC surveillance section. He created a smallpox unit to plan strategies for responding to and containing importations of the disease into the US, where smallpox was, at that point, eliminated as an endemic disease. The unit also initiated a program to eradicate smallpox in 20 African nations where the disease remained endemic. Henderson provides a description of the disease and the virus, a historical accounting of its impact on the population, and a description of the early efforts to combat the epidemic. These early efforts included the use of variolation (intentionally infecting someone with smallpox virus by rubbing it into the skin) to produce a more localized, mild infection. Edward Jenner’s development of a safer vaccine (based on cowpox virus) and the subsequent achievement of larger-scale production utilizing freeze drying to provide heat stability for transportability provided the final tool necessary to attempt smallpox eradication. In subsequent chapters, Henderson walks the reader through the discussions, sometimes heated arguments, and the political turning points for the WHA and WHO that led to a broader, more supported global commitment to eradication. He also describes the challenges during the start-up of the WHO unit charged to lead the effort. These challenges ranged from determining utilization of limited budget and personnel resources to developing overall strategies, multi-country programs, and on occasion, garnering political will and support for eradication in countries with remaining disease. The book provides more detailed descriptions of eradication efforts in Brazil, Indonesia, India, Nepal, Afghanistan, Pakistan, Bangladesh, and multiple countries in Africa, including Ethiopia and Somalia (the final two countries with smallpox). Despite specific challenges in each country, it is clear that eradication was possible only through the efforts of the dedicated, in-country program personnel working long hours for months at a time, identifying smallpox outbreaks in cities and remote villages, administering vaccine, and following up to assure that vaccinations were successful. Henderson closes his book relating his recent experiences in returning his focus to smallpox while helping the US government address the new threat that smallpox virus now poses as a potential bioterrorist weapon. His and other previous eradication experts’ experiences with the disease, diagnosis, vaccine, control strategies, and program development were invaluable planning and policy resources for a government that thought it had closed the book on smallpox almost two decades earlier. This book is well written and provides the reader with a personal look into the smallpox eradication effort from the vantage point of someone who lived the story firsthand. Relating his personal recollections and experiences from a viewpoint that encompasses the entirety of the eradication effort across multiple countries, the author allows the reader to gain an appreciation of the strategic and political nuances of eradicating the same disease in different places. Throughout the book, Henderson readily identifies key individuals who had significant roles in moving the eradication initiative forward and is not shy in identifying those he felt served as passive or, in some cases, active obstacles. His willingness to share these frank perceptions, even if sometimes more forthright than one might expect from a historical perspective, makes readers feel at times they are privy to details more likely to be shared by the author over a cup of coffee rather than in a book. The findings and conclusions in this report are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Building an extension network in Vietnam

Vietnam is a predominantly rural country on the Pacific Rim with a growing agricultural production and trade. It has a limited area for food production and has had to overcome the social and economic ravages of war over most of the last 50 years. In the past decade it has been in transition from a centralized economy to a more market oriented approach. In 1993 a new government extension service was created to provide expertise at provincial district and commune level. It is an ambitious undertaking in a country of which now has a population of 78 million. The structural component of the service has been put in place but there is a need, acknowledged by the Vietnamese Government, to improve both technical and social extension skills. International non-government organizations and multi-lateral agencies have contributed significantly to developing a more participatory approach to extension practice. Their assistance is still needed to support appropriate in-country training programs geared to local conditions and needs.

In‐country language programs: surveying the field (1996 ASAA conference)

Summary The workshop highlighted the vital importance of in‐country language study, not just in aiding language acquisition but in providing students with the social and cultural context for their studies. In spite of the Australian government's policy of promoting greater knowledge of Asian languages and cultures (albeit officially for mostly economic motives), we are still a long way behind many countries in recognising that in‐country experience is an integral component of language learning: something that has long been acknowledged (and indeed has been compulsory) in Britain and other European countries. While the survey revealed the wide range and continuing expansion of incountry programs, the relatively small number of students having an in‐country language opportunity was of concern to participants in the workshop. They generally agreed that this was not because of a lack of interest or enthusiasm on the part of students. Rather the inhibiting factor was the cost involved, both for university departments and for the students themselves. As this report indicates, a few Australian universities have already recognised that in‐country language study is vitally important not just in improving language acquisition and cultural knowledge, but as an integral component of their internationalisation policies and the growing globalisation of education. Obviously the issue of in‐country study for language students is only one aspect of this. But it is a particularly vital aspect because, in addition to the usual advantages to be gained from a study abroad program, a period of in‐country study is essential to producing Australian graduates with the language and cultural expertise necessary for Australia's future role in the Asian region.