Huda Zurayk

Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

Harvard School of Public Health, Boston, MA, USA (Prof J Frenk MD); China Medical Board, Cambridge, MA, USA (L Chen MD); Aga Khan University, Karachi, Pakistan (Prof Z A Bhutta PhD); George Washington University Medical Center, Washington, DC, USA (Prof J Cohen MD); Independent member of House of Lords, London, UK (N Crisp KCB); James P Grant School of Public Health, Dhaka, Bangladesh (Prof T Evans MD); US Institute of Medicine, Washington, DC, USA (H Fineberg MD, P Kelley MD); School of Public Health Universidad Peruana Cayetano, Heredia, Lima, Peru (Prof P Garcia MD); Peking University Health Science Centre, Beijing, China (Prof Y Ke MD); National Health Laboratory Service, Johannesburg, South Africa (B Kistnasamy MD); School of Nursing, University of Pennsylvania, Philadelphia, PA, USA (Prof A Meleis PhD); University of Toronto, Toronto, ON, Canada (Prof D Naylor MD); The Rockefeller Foundation, New York, NY, USA (A Pablos-Mendez MD); Public Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

The impact of war on the physical and mental health of the family: The Lebanese experience

This paper addresses the impact of war-related stressful life events on the health of families living through the war conditions prevailing in Lebanon for the past 12 years. Health outcome is represented by indicators of somatization, depression, psychological symptoms, interpersonal relations and marital relations. Associations are described between elements of war stress and the health outcome variables for mothers, fathers and adolescents in a sample of Beirut families. The role of the mediating factors of social support and social class is also discussed.

A population-based survey of loss and psychological distress during war

Research on the psychological effects of war has been conducted on a limited number of population groups and has generally failed to study the experience of particular losses while warfare was still in progress. This paper presents the results of a household surveillance study of 5788 displaced and non-displaced civilians conducted during the summer 1982 war in Lebanon. In order to determine demographic differences in the psychological response to war and help identify population groups possibly at-risk for mental disorder, an interview checklist of symptoms of psychological distress was developed and administered to a key informant in each household. The occurrence of psychological distress symptoms varied significantly by age, sex, nationality, socio-economic status, loss of physical health and economic loss. A more detailed analysis of the psychological effect of displacement or loss of ones home during war is presented. Displacement group differentials suggest that psychological distress may be more frequently perceived post-war and that both social integration and social isolation may play important roles in mediating the perception of psychological distress during war.

Summer 2006 war on Lebanon: A lesson in community resilience

Abstract The internally displaced persons (IDPs) during the July 2006 war in Lebanon exhibited a high level of community resilience, affirmed by relief agencies and public health professionals. Data from personal observations, interviews, meetings and published material were used to examine factors contributing to this resilience. Findings suggested that community resilience is a process rather than an outcome. The sense of a collective identity, prior experience with wars and social support networks have contributed to building up IDPs resilience over time, while community cohesiveness, adequate public health interventions, social solidarity and a connected political leadership helped to sustain it during and shortly after the war. This paper examines implications for public health professionals and argues for a paradigm shift in disaster relief practice.

Health and ecological sustainability in the Arab world: a matter of survival

Discussions leading to the Rio+20 UN conference have emphasised the importance of sustainable development and the protection of the environment for future generations. The Arab world faces large-scale threats to its sustainable development and, most of all, to the viability and existence of the ecological systems for its human settlements. The dynamics of population change, ecological degradation, and resource scarcity, and development policies and practices, all occurring in complex and highly unstable geopolitical and economic environments, are fostering the poor prospects. In this report, we discuss the most pertinent population-environment-development dynamics in the Arab world, and the two-way interactions between these dynamics and health, on the basis of current data. We draw attention to trends that are relevant to health professionals and researchers, but emphasise that the dynamics generating these trends have implications that go well beyond health. We argue that the current discourse on health, population, and development in the Arab world has largely failed to convey a sense of urgency, when the survival of whole communities is at stake. The dismal ecological and development records of Arab countries over the past two decades call for new directions. We suggest that regional ecological integration around exchange of water, energy, food, and labour, though politically difficult to achieve, offers the best hope to improve the adaptive capacity of individual Arab nations. The transformative political changes taking place in the Arab world offer promise, indeed an imperative, for such renewal. We call on policy makers, researchers, practitioners, and international agencies to emphasise the urgency and take action.

Gender and sexual health in clinical practice in Lebanon

This study examines the readiness of obstetricians/gynecologists (Ob/Gyns) in Lebanon to provide sexual consultation, their degree of comfort when discussing issues of sexual health, and their attitudes regarding assessment, treatment, and referral. Data on these concepts were collected through face‐to‐face interviews with 286 randomly selected Ob/Gyns. Most Ob/Gyns reported feeling comfortable discussing sexuality during consultations, which they attributed much more to professional experience than to training. Most Ob/Gyns reported giving proper time for management of sexual health issues and follow‐up, as these issues are brought up frequently by their women clients. However, results suggest that only one‐third (31%) of Lebanese Ob/Gyns nearly always take the initiative in asking patients about their sexual health. Moreover, almost 45% of participating Ob/Gyns did not recognize a strong relationship between reproductive health and sexual functioning. Gender was not found to be an important predictor for any of the indicators measured in the present study. Ob/Gyns in Lebanon are significant consultants on various sexual issues, and they need better postgraduate training, continuing medical education, and access to medical congress resources on the topic of sexuality and its relationship to reproductive health.

Beyond reproductive health: listening to women about their health in disadvantaged Beirut neighborhoods.

In this article, we aim to contextualize gynecological problems within a broader health and social context, expanding the lens beyond reproductive health. Questionnaires were administered to 1,869 ever-married women aged 15 to 59 that included questions on living, general health, and gynecological problems. These questions were open-ended, allowing women to respond in their own words. Women reported a multitude of health problems, indicating competing priorities. Musculoskeletal complaints emerged as the most prevalent and most important health problem. One in four women reported a gynecological problem, mainly reproductive tract infections (RTIs), when asked directly. Selected quotes provide clues about the complex relationship between womens lives and health.

The trend away from breast feeding in a developing country: a women's perspective.

The objective of this discussion is to investigate changes in practices of infant feeding among women living in a rural area of Lebanon in relation to changes occurring in the environment in which they live. In trying to explain trends in breast feeding focus will be on issues related to breast feeding which affect the woman herself. The data base in this investigation comes from 2 surveys conducted in the south of Lebanon with similar objectives of examining contraceptive and breast feeding practices in the area. The 1st survey used was a retrospective investigation conducted in the villages of the Nabatieh district of South Lebanon in August 1976. It is based on a stratified sample of 1054 married women 15-44 years of age. The 2nd survey was a prospective survey of 253 married women 15-44 years of age. These women were followed up for 18 months starting July 1977. Only a small proportion of women in both studies reported not breast feeding their last child. In both studies there was a definite trend towards breast feeding on schedule rather than demand. The mean duration of breast feeding estimated for the rural group by the prospective survey was slightly lower than the retrospective estimates particularly for the women who had completed primary education. The mean duration of breast feeding has fallen for all groups to below the recommended level of 4-6 months. The most important factors found that could have contributed to the breast feeding decline are: 1) women seem to perceive breast feeding to have a negative effect on their health; 2) an inadequate milk supply was an important reason given by the women for early weaning; 3) a majority of educated and urban women reported having been delivered by a trained midwife or by a physician but the trained health personnel did not seem to be taking advantage of the contact they have with the mothers at delivery to advise and support them in the establishment of lactation; and 4) some women mostly rural women reported weaning their infant prematurely because they got pregnant while breast feeding.

Care-seeking behavior of women with reproductive health problems from low-income areas of Beirut

To examine the patterns of care‐seeking behavior and provider choice of women with self‐reported reproductive health problems from 3 urban communities in Beirut.

The relaxation exercise and social support trial- resst: study protocol for a randomized community based trial

BackgroundStudies suggests a possible link between vaginal discharge and common mental distress, as well as highlight the implications of the subjective burden of disease and its link with mental health.Methods/DesignThis is a community-based intervention trial that aims to evaluate the impact of a psycho-social intervention on medically unexplained vaginal discharge (MUVD) in a group of married, low-income Lebanese women, aged 18-49, and suffering from low to moderate levels of anxiety and/or depression. The intervention consisted of 12 sessions of structured social support, problem solving techniques, group discussions and trainer-supervised relaxation exercises (twice per week over six weeks). Women were recruited from Hey el Selloum, a southern disadvantaged suburb of Beirut, Lebanon, during an open recruitment campaign. The primary outcome was self-reported MUVD, upon ruling out reproductive tract infections (RTIs), through lab analysis. Anxiety and/or depression symptoms were the secondary outcomes for this trial. These were assessed using an Arabic validated version of the Hopkins Symptoms Checklist-25 (HSCL-25). Assessments were done at baseline and six months using face-to face interviews, pelvic examinations and laboratory tests. Women were randomized into either intervention or control group. Intent to treat analysis will be used.DiscussionThe results will indicate whether the proposed psychosocial intervention was effective in reducing MUVD (possibly mediated by common mental distress).Trial RegistrationThe trial is registered at the Wellcome Trust Registry, ISRCTN assigned: ISRCTN: ISRCTN98441241