By Shannon Haugland
SITKA, Alaska (AP) — Sitkan Nancy Knapp describes the country of Laos as “a different world” from Alaska. However, she found some similarities in the delivery of healthcare to rural areas.
“We train village health volunteers,” she said of Laos. “It’s kind of like Alaska.”
Knapp is taking a year off from her job as Women’s Health Program director at SEARHC Community Health Services to take a post with the Ministry of Health in Laos, as technical adviser for the monitoring and evaluation unit for the Global Fund in Vientiane, Laos.
The Global Fund is a multinational financing institution dedicated to fighting AIDS, tuberculosis, and malaria in 144 countries around the world. Financed by governments from throughout the globe, the Global Fund gets 25 percent of its dollars from the United States. It has received more than $1 billion a year since 2002 in its efforts to fight three diseases that plague developing nations.
“The aim of the Global Fund is to make sure developing countries have enough money to eliminate these diseases,” she said. The actual programs are carried out not by the Global Fund but by agencies in the country, such as the Ministry of Health in Laos.
The success rate since the start of the Global Fund in such countries as Laos has been tremendous in the prevention, diagnosis, and treatment of TB, AIDS, and malaria, Knapp said.
Since the start of the Global Fund, the mortality rate for malaria has dropped by 95 percent in the last eight years. Knapp said that this has been achieved through providing treatment drugs for severe and uncomplicated forms of malaria. Trained village health volunteers learn how to diagnose and treat the disease.
“It’s been really effective,” she said.
Money from the Global Fund has also gone to provide 1.5 million insecticide-treated mosquito nets, which have protected an estimated 3.6 million in Laos.
In the field of HIV, Global Fund money was used for education and condom distribution. Condom use among commercial sex workers went up from 20 percent to 95 percent from 2004 to 2010, and the rate of infection went from 2 percent to half of one percent.
For TB, the focus was on “case detection,” Knapp said. In that area, the World Health Organization set a target for detecting at least 70 percent of the cases. In 2004, the detection rate was estimated at 67 percent in Laos. Today, that figure is 90 percent, she said.
Another emphasis in this area is making sure that TB patients take their medications as directed through “directly observed treatment.” One problem, she said, is that patients have a tendency to stop taking medication as soon as they feel better, which leads to the development of multi-drug resistant TB popping up in the population.
“That’s a huge problem around the world,” Knapp said. “The key to treatment success is that you continue to take the recommended medication for the recommended amount of time.” Knapp said. Treatment success since 2005 has gone from 83 percent to 93 percent.
Knapp said the Health Ministry relies once again on health workers in the communities for this.
“A lot of Global Fund money is to train workers around the country to know the guidelines, to know how to diagnose, and to know how to treat,” Knapp said.
Knapp’s unit in Laos is in charge of making sure the programs are carried out as planned, evaluating the outcomes, and making sure the money is used well.
“The Global Fund has all those levels of accountability to make sure the money is used as it should be,” Knapp said. “Since the Global Fund wants to make sure that best practices are followed, it sets up a model that the rest of the other initiatives learn to follow as the country develops the whole healthcare system.”
In Sitka, Knapp managed a number of Centers for Disease Control grants. “That’s one of the things that attracted me to work for the Global Fund,” she said. “It’s the best way to run public health programs, to evaluate each step along the way and use the data to show how you’re using the money. That’s probably why they wanted me.”
Knapp, 56, has worked at SEARHC for 23 years. She graduated from Knox College in Galesburg, Ill., in 1975 in biology. She served in the Peace Corps in the Philippines right after that. She enjoyed the public health aspects of her work and later earned her master’s degree in public health from the University of Hawaii in 1983. She and her husband, Mark Gorman, spent five years working for a nongovernmental organization in Thailand, before moving to Sitka.
Knapp said that she was grateful to her employer SEARHC for giving her the leave of absence that allowed her to work for the Global Fund in Laos.
Gorman also works in Laos for a project called World Education, a nongovernmental organization. Among the group’s initiatives is a program to educate the rural population about the dangers of unexploded ordnance land mines, bombs, and artillery shells that remain in the ground years after the end of the Vietnam war. Knapp said Laos is the most heavily bombed country in the world, after an estimated 500,000 bombing missions by the U.S. during the Vietnam War.
“There is still [unexploded ordnance] all over Laos and people are still injured and killed by them,” Knapp said.
Gorman is involved in a rural education mission to spread the word in schools and communities about what the various explosive devices look like, and what steps they need to take if they find them. ♦