T. Dickerson; D. Fernandez; Topgyal; A. Samen; Gelek; Nyima; G.Pelto; S. Craig; T. Dye


Modernization in developing regions affects local diets and nutrition. Using qualitative rapid appraisal methods, we examined the effect of dietary delocalization on food preferences and procurement sources and dietary diversity in rural Tibet. The diets of Tibetans are being both positively and negatively influenced as the region modernizes. For example, greenhouses and chicken rearing represent local adaptations which could improve micronutrient consumption. At the same time, the recent introduction of calorie-rich, nutrient poor commoditized foods could insult nutrition but are increasingly popular among children. Multimodal public health interventions can minimize harmful and maximize beneficial effects of the nutrition transition in Tibet.



 Vincanne Adams, Sienna R. Craig  & Arlene Samen


Efforts to augment accountability through the use of metrics, and especially randomised controlled trial or other statistical methods place an increased burden on small nongovernmental organisations (NGOs) doing global health. In this paper, we explore how one small NGO works to generate forms of accountability and evidence that may not conform to new metrics trends but nevertheless deserve attention and scrutiny for being effective, practical and reliable in the area of maternal and infant health. Through an analysis of one NGO and, in particular, its organizational and ethical principles for creating a network of safety for maternal and child health, we argue that alternative forms of (ac)counting like these might provide useful evidence of another kind of successful global health work.



Vincanne Adams, Sienna Craig, Arlene Samen, Surya Bhatta


This story, told by the director of a small NGO devoted to safe motherhood in Nepal’s Himalayan communities, offers some key insights about the challenges and achievements of working in mountain communities anywhere.  One Heart World-wide began its program in the Baglung and Dolpa Districts of Nepal in 2010, after having successfully developed similar programs in the Tibet Autonomous Region, China, over the previous decade.  Recognizing the particular obstacles facing women in remote mountain regions, OHW developed an approach called the “Network of Safety” which responds to these particular challenges.  This report from the field offers a concise overview of how the network of safety works, and how it sometimes produces unexpected outcomes arising from the challenges of working in mountain communities.



Lisa Menning


Gender rights transformative social challenges inspiration crisis management voice. Kony 2012 readiness relief social impact Arab Spring vulnerable citizens making progress. Global network, carbon rights; minority equal opportunity, vaccine underprivileged catalytic effect human potential. Country policy dialogue, economic independence crisis situation catalyze planned giving fairness public-private partnerships.



Joseph R Fitchett, Surya Bhatta, Tenzing Y Sherpa, Bishwo S Malla, Elizabeth J A Fitchett, Arlene Samen and Sibylle Kristensen


Pelvic organ prolapse (POP) is a major cause of morbidity in Nepal, particularly affecting women in the rural communities. Women with POP in Nepal may suffer from symptoms for decades. At present, the Government of Nepal advocates surgical intervention but access to surgical care is inadequate. This report evaluated the feasibility of a non-surgical public health programme in rural Nepal, and describes risk factors associated with POP in this setting.



S. Miller, C. Tudor, Nyima, V.R. Thorsten, Sonam, Droyoung, S. Craig, P. Le, L.L. Wright, M.W. Varner


To determine the outcomes of vaginal deliveries in three study hospitals in Lhasa, Tibet Autonomous Region (TAR), People’s Republic of China (PRC), at high altitude (3650 m). Methods: Prospective observational study of 1121 vaginal deliveries. Results: Pre-eclampsia/gestational hypertension (PE/GH) was the most common maternal complication 18.9% (n=212), followed by postpartum hemorrhage (blood loss ≥500 ml) 13.4%. There were no maternal deaths. Neonatal complications included: low birth weight (10.2%), small for gestational age (13.7%), pre-term delivery (4.1%) and low Apgar (3.7%). There were 11 stillbirths (9.8/1000 live births) and 19 early neonatal deaths (17/1000 live births). Conclusion: This is the largest study of maternal and newborn outcomes in Tibet. It provides information on the outcomes of institutional vaginal births among women delivering infants at high altitude. There was a higher incidence of PE/GH and low birth weight; rates of PPH were not increased compared to those at lower altitudes.