Poppy's Promise: "What happened next would change our lives forever"

April 2021:

'After my due date passed, I was admitted to hospital to be induced. Labour began and everything appeared normal. As first-time parents, we trusted that our baby was safe and that if something was wrong, someone would tell us. We had no reason to think otherwise.

During labour, opportunities to recognise that Poppy was in distress were missed.

Monitoring that should have taken place did not happen.

By the time concerns were recognised, panic had replaced reassurance.

I was rushed to theatre frightened, confused and not fully understanding what was happening to my baby. ...'

Poppy's Promise read more ...

My source: BBC Radio 4 Today 0736 mins:

https://www.bbc.co.uk/sounds/play/m0032fq8

Paper - 'Women's voices in rural Malawi: antenatal care research and community learning'

Dear HIFA colleagues,

My friend, Ted Lankester, suggested I share my recently published research with this community.

The paper, published in PLOS Global Public Health, explores women’s perceptions of pregnancy and antenatal care in Chizenga village, Chikwawa, Malawi. It arose from my MSc dissertation at the Liverpool School of Tropical Medicine, with co-authors Deborah Nyirenda and Terry Kana.

Through interviews with 14 pregnant women, we explored how understanding of antenatal care interacts with transport costs, distance, nutritional constraints, gender dynamics and experiences of respectful and disrespectful care. Women also expressed a desire for more community-based education and outreach.

The full open-access paper is available here: https://doi.org/10.1371/journal.pgph.0005515

Layton H, Nyirenda D, Kana T (2026) A qualitative study to explore women’s perceptions of pregnancy and antenatal care in Chizenga village, Chikwawa, Malawi. PLOS Glob Public Health 6(9): e0005515. https://doi.org/10.1371/journal.pgph.0005515

Their accounts inspired me to develop the Sangalala Maternal Health Partnership Programme with local partners, through The Reach Foundation UK. Our first cohort (39 women and 1 man) has recently completed the programme in Uganda, and we are now learning from participants’ experiences to strengthen it.

I would welcome members’ experiences of making maternal health information accessible and useful in rural communities, particularly where information needs sit alongside practical barriers to accessing care.

I promised the women who participated that I would help raise their voices. Sharing their perspectives and learning from this community is one way I hope to honour that promise.

Best Wishes,

Helen

HIFA profile [and my source]: Helen Layton is a Nurse and Global Health Consultant; Founder & Clinical Director, The Marula Institute; Co-founder & Executive Director, The Reach Foundation UK/Spain. My professional interests include maternal and child health, global health equity, respectful maternity care, community-led health education, and translating research into practice. As Co-founder and Executive Director of The Reach Foundation UK and Founder and Clinical Director of The Marula Institute, I am particularly interested in strengthening health systems, workforce education, safe care for children with complex needs, and ensuring women’s and families’ voices inform care. 
Helen AT cathcom.org

Hodges' conceptual framework: A model for Narrative Medicine ...

Abstract

The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. Adopting methods such as close reading of literature and reflective writing allows narrative medicine to examine and illuminate 4 of medicine's central narrative situations: physician and patient, physician and self, physician and colleagues, and physicians and society. With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care. By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care. ...

 

Charon R. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA. 2001;286(15):1897–1902. doi:10.1001/jama.286.15.1897 

With my emphasis.

#Identity #Group #Individual #Collective #Mind #Body #TheOdysseyHasBegun

c/o HIFA - Publications re. primary health care & community health

Dear [HIFA] friends and colleagues with an interest in primary health care and community health:

Since my last communication with you more than 6 months ago, the entire field of global health has continued to be upended by our US government, with unconscionable effects on millions of people around the world, on advancements in global health research and its ethical foundations, and on the careers of thousands and thousands of people working around the world in the field of global health. As I said before, and I repeat now the obvious, it will take decades to build back what has been destroyed and to regain respect from the rest of the world for the United States and the values that most of us hold dear.

William Foege, eminent global health leader and former Director of the Centers for Disease Control and Prevention wrote this biting editorial <https://www.statnews.com/2025/08/18/rfk-jr-public-health-threats-william-foege-smallpox/> in which he said, among other things, 

"We will live through this drought of values, principles and facts and again apply our talents to improving global health and happiness. Do not back down.”

Atul Gwande, now one of the foremost champions of primary health care and community health of our time (even though he is, like me, an erstwhile surgeon!) and former Director of the USAID Bureau of Global Health during the Biden administration, gave an eloquent presentation of his perspective on the aftermath of the destruction of USAID on 28 April 2025 at the Harvard School of Public Health.

You can watch this here:
<https://www.bing.com/videos/riverview/relatedvideo?q=Atul+Gwande+presentation+at+Harvard+School+of+Public+Health+April+28%2c+2025&mid=26DA144398CF1F613D0A26DA144398CF1F613D0A&FORM=VIRE>.

Here are a few items of possible interest:

The Fourth International Symposium on CHWs will be held virtually next week.

I was most fortunate to be able to attend the second International Conference on Primary Health Care was held in Addis Ababa, Ethiopia, from October 6-10. It was a glorious event, with 750 attendees, mostly from Africa but with strong representation from UNICEF, WHO, Africa CDC, and other international organizations. 

The conference was sponsored by the International Institute for Primary Health Care – Ethiopia. <https://iphce.org/> Directors of PHC from 45 different African countries were present along with at least 50 community health workers from across Africa. There was palpable enthusiasm for the growing momentum for PHC across Africa.

Abhay and Rani Bang are world-renowned champions of community-based primary health care through their work with SEARCH <https://www.searchforhealth.ngo/> (Society for Education, Action, and Research) in Gadchiroli, India, with tribal people. Their seminal publications on the effectiveness of community-based primary health care and community health workers as well as their contributions to India’s national program for reducing neonatal mortality through home-based neonatal care, among others, have gained for them global recognition. Attached is an English translation of an article about their life’s work that was published in April Der Spiegel in the leading German magazine, Der Spiegel.

Nicholas Kristof has continued to share with the world some of the heart wrenching effects of the collapse of the United States Agency for International Development. The New York Times opinion columnist wrote <https://www.nytimes.com/2025/09/20/opinion/trump-usaid-cuts.html> on 20 September 2025 on the human dimension of the shutdown of USAID, citing estimates that 690,000 will die in 2025 and 829,00 will die in 2026 as a result of cutbacks in USAID funding, and 3.1 million children will die during Trump’s second term from these cuts (a PDF is attached if the link doesn’t work for you [mod: HIFA does not carry attachments]).

Two recent publications on novel approaches to reducing child mortality have gained widespread attention.

One study <https://www.nber.org/system/files/working_papers/w34152/w34152.pdf> in Kenya provided a one-time transfer of $1,000 to poor families and observed a decline of nearly half in under-5 mortality as well as in infant mortality. Another study reported that wrapping

A recently reported study <https://pmc.ncbi.nlm.nih.gov/articles/PMC12462887/> from Uganda found that giving mothers fabric treated with permethrin, a long-acting insecticide to protect against mosquito-born illnesses, as a baby wrap dramatically reduced malaria infections in the infants carried in them. There were 66 percent fewer cases among those children compared with babies in the untreated wraps. By the end of the six-month study, only 16 percent of children in the treated wrap group had been sick with malaria, compared with 34 percent in the untreated wrap group, many of whom had multiple malaria episodes.

Now available for purchase on Amazon.com are several important publications related to community-based primary health care and community workers.

Feel free to share this email and these resources with anyone else or with any relevant listserve you may have access to.

You are receiving this email because of your interest in primary health care and community health.

If you know of anyone that you think would like to be included in the listserv, just send me the person’s name and email address.

Warm regards, Henry

Henry B. Perry, MD, PhD, MPH Senior Associate, Health Systems Program Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore, MD, USA 21205 Hperry2 AT jhu.edu

HIFA profile: Henry Perry is a Senior Scientist at the Johns Hopkins Bloomberg School of Public Health, USA. Professional interests: Community health and primary health care. hperry2 AT jhu.edu

Why in the World do I have to walk this way?

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

my childhood - memories
my family, community, home, role models, friends from the neibourhood	Why?

Image: https://x.com/Lowkey0nline

"I'd like to Teach the World to Sing ..."

 

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

intelligence

ARTIFICIAL

Peoples Communities Societies Peace

"Joseph Votel, a recently retired head of the Pentagon's Central Command, said last year he was struck by how Israeli forces mounting strikes in Gaza in May had been integrating AI into their operations and by "the impact that is having on their targeting cycles". He says Israel is using AI to generate a large range of potential targets for surveillance to whittle down. This lets its forces "disrupt enemy attacks without the need for a lengthy development period or a longer campaign."  America's armed forces, helped by Palantir (an AI company which, like Anduril, takes its name from "The Lord of the Rings") and other contractors, is trying to build such technology into a system which can narrow down a huge range of potential targets and pass information about them freely to where it is most needed. Given the finite capacity of communication systems, not to mention the vulnerability, this requires that an increasing amount of processing be done "on the edge" - that is, on the platform carrying the sensor.  In 2016 a Pentagon project called Maven started trying to address the "lots of surveillance but not much to show for it" problem identified by General Ryan. The idea was to automate the identification of people and objects in the petabytes of video footage sent back by surveillance drones. It ended up producing software efficient enough to run on the drones themselves. In Scarlet Dragon, a recent-AI focused American exercise in which a wide range of systems were used to comb a large area for a small target, things were greatly speeded up by allowing satellites to provide estimates of where a target might be in a compact format readable by another sensor or a targeting system, rather than transmitting high-definition pictures of the sort humans look at.  In a world where bandwidth is often the biggest constraint such parsimony is a boon. It speeds up kill chains while reducing vulnerability to jamming. At the same time, it puts a greater burden on the automated parts of the system to provide reliable synopses of what they see, which is a worry for people keen to ensure that fully informed and responsible human beings stay on top of all decisions about where and when to blow things up." p.9.

 Signals from Noise. Heads in the clouds. The Economist Technology Quarterly, Defence technology, Hide and seek. January 29th 2022. 442: 9281. pp. 9-10.

https://www.youtube.com/watch?v=mR_7Swtv0XM

Individual - Group and Rights: c/o Bond (1996)

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

"What this means is that it is necessary, or perceived as necessary, for each individual to protect his or her interests against the incursion of others, and the same for each group. Now this would not be possible if each individual did not have his or her own private or personal interests, and if each group did not have its own group interests, and that is undeniably true. Both individuals and groups are undeniably separate and different. Nevertheless, there is a common human interest in individuals and groups being decent to one another and respecting one another, and it would be better for every individual and every group if fear and adversarial competition could be eliminated. It is only because these things can never be completely eliminated, that universal solidarity can never be achieved, that we need the protection of rights, which, as has already been said (p.202 above), are always rights against. ...

SOCIETY - COMMUNITY SOCIAL JUSTICE sense of - SOLIDARITY

Rights are always adversarial, and provide deontic moral grounds for preventing actions or inactions that are contrary to the interests of the person or group whose rights they are. They are needed because such a danger will always continue to exist. This does not mean, of course, that universal solidarity, however unachievable, is not the ideal, for the closer we can get to it the better the interests of all individuals and all groups are served." pp.202-203.

Bond, E.J. (1996). Ethics and Human Well-Being: An Introduction to Moral Philosophy. Cambridge, Mass.: Wiley-Blackwell. p.202-203.

#HelloMyNameIs

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

Peter	Geography Geo-Political
Jones	‘Türkiye’

My source: numerous.https://twitter.com/imathematicians/status/1530724466073952261?s=20&t=eF1XRD9HbkSJ2XWWbIk2qQ

"The day a language died"

individual
|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

Catawba

"This week another language died: Carlos Westez, more widely known as Red Thunder Cloud, the last speaker of the Native American language Catawba, died of a stroke at the age of 76. With him passed away the Catawba language. 

Anyone who wants to hear the war songs, the hunting songs and the religious chants of the Catawba can apply to the Smithsonian Museum, where, back in the Forties, Red Thunder Cloud recorded a series of them for posterity. Some earnest folk might even take the trouble to learn some of them by heart. But Catawba as something that lived and breathed and developed organically is gone for good. Of the creatures alive on the planet, only Red Thunder Cloud's dog, which survived him and understood commands in no other tongue, still presumably has snatches of Catawba rolling around his brain."

 

Popham, P. The day a language died, The Independent, 20th January, 1996, p.15.

https://en.wikipedia.org/wiki/Red_Thunder_Cloud

 

International Women's Day 2014 “Equality for women is progress for all” He for She

8 March is International Women’s Day, #IWD2014! 

This year, the theme is “Equality for women is progress for all”.

In order to achieve gender equality, we have to change what it means to be a man. For International
Women’s Day [@UN Women] highlights in its #HeforShe initiative men leaders who stand up for gender equality.

“Women’s empowerment works for men, too. Where men and women have equal rights and opportunities, societies prosper. I am a He for She.”
-Ban Ki-moon, UN Secretary-General. 

See what other prominent men from around the world have to say:
http://owl.li/ucuvz #IWD2014

Rhinos, evidence based medicine and 'out-reach'

It would be be marvellous to be able to introduce h2cm to the nursing, health and social care communities in Asia, including China of course.

Working in health we are surely aware of the need to base what we do on evidence. Although nurses are not necessarily independent as the patient advocate. Advocacy is still an important part of the nursing role and one requiring specific advice in some instances.

Earlier this month a Guardian article related the ever more precarious position of the South African rhino and how claims about the curative properties of rhino horn as a medicine fuels poaching. The UK is nowhere near South Africa or China so what gives? What gives is the Planet, the tiger too and the biosphere in general. Apparently rhino horn is just compacted keratin and has no medicinal properties.

Nurses tend to be a green, ecologically minded group and the best source of change comes from within. It is never easy to change the beliefs of others, especially when your culture venerates its elders. Belief also remains a powerful factor in health. Despite this do nurses not have a duty to challenge beliefs that are wrong, to educate their communities even while taking tradition into account?

What price true literacy: spiritual, 3Rs, ICT, health, environmental and cultural ...?

There must be a way for nurses to unite on this - 

across cultures, borders, traditions, animal welfare standards,
digital barricades, politics, beliefs ...

As nurses there is always the question of dignity and respect and being non-judgemental and sensitive to cultural attitudes and practices that differ from our own. A 'truth' here is that you do not have to travel far for your own values and opinions to be challenged.

As we make a difference individually with patients and carers ... collectively can we extend our reach to other communities too? While there's still time - and we try not to bite our nails.