Interview: Clare Hanbury, CEO and Founder CHILDREN FOR HEALTH

IN A NUTSHELL
Editor's note
With 38 years of international education and development experience, Clare Hanbury has collaborated with esteemed organizations including DANIDA, UNICEF, UNESCO, Save the Children, and the UBS Optimus Foundation. Her career began in the classroom, teaching in Kenya and Hong Kong, and evolved into leading impactful programs that promote children’s active participation in their health and education. 

On 13^th July, 2013 She founded Children for Health - CFH to deliver essential health information directly to children, enabling them to share knowledge within their families, schools, and communities. 

Her passion lies in creating practical tools and innovative strategies that make health education accessible, engaging, and transformative, ensuring that children become active agents in building healthier, more resilient communities. 

In this connection, PEAH had the pleasure to interview Clare Hanbury relevant to her experience and strategy implementation to secure and enhance Children for Health success

By Daniele Dionisio

PEAH – Policies for Equitable Access to Health

INTERVIEW

Clare Hanbury

CEO and Founder, Children for Health – CFH

–PEAH: Clare, as CFH website makes it clear, many hundreds of thousands of children die each year because their parents and others lack basic health information and skills. At the same time, millions of older children throughout the world play a key role in caring for younger ones.

On this matter, informing, recognising and praising older children helps improve this care. They can, indeed, learn, collect and share basic health ideas and skills to keep healthy themselves, and help others.

In this connection, what about the Mission of Children for Health?

–Hanbury: Our mission at Children for Health is to provide young adolescents (9-14), either directly or indirectly – with simple, memorable, shareable health education messages, stories and activities that connect new knowledge, skills and attitudes with their real lives. We aim to mobilise children as health activists among their friends, in their families and in their communities. Sharing knowledge, saving lives! That’s our work.

–PEAH: As written, “At Children for Health it is our dream that, before children leave primary school, every child will have learnt and shared 100 important health messages.” Please, let us know in depth about these messages

–Hanbury: The 100 Health Messages for Children to Learn & Share are simple, reliable health education messages aimed at children aged 9-14. We feel that it is especially useful and important to make sure that young adolescents aged 9-14 are informed because this age group are often caring for young children in their families. Also, it’s important to recognise and praise the work they are doing to help their families in this way.

The 100 messages comprise 10 messages in each of 10 key health topics: Malaria, Diarrhoea, Nutrition, Coughs Colds & Illness, Intestinal Worms, Water & Sanitation, Immunisation, HIV & Aids and Accidents, Injury and Early Childhood Development. The simple health messages are for parents and health educators to use with children at home, in schools, in clubs and in clinics.

All our health messages have been developed and reviewed by health educators and medical experts. They can be translated and adapted provided that the health message remains correct. Great care has been taken to ensure that the health messages are accurate and updated and now most of our ten sets of ten messages have been visualised and can be downloaded as full colour posters from our website! I say ‘most’ as we are just completing the series, and we should have ten posters with ten messages on each – completed by July 2025. This is a real achievement as it takes ages to go through our process! And to find funding of course!

Health educators use these health messages to structure health education activities in their classrooms and projects, and to stimulate discussions and other activities.

We want all children to learn and share 100 health messages – 10 messages in 10 topics – before they leave primary school. Just like they learn their times tables…These could be our carefully created messages OR adapted versions for different countries and communities

–PEAH: Knowing that literacy levels in many parts of the world are low, Children for Health has developed a series of posters for health that provide the visual starting point for fruitful discussions on health issues and disease and the role that children can play in their prevention and treatment. Below are some examples including one that illustrates Children for Health’s 100 messages, as well as posters for Oral Health, Malaria.

https://www.childrenforhealth.org/wp-content/uploads/2017/01/CfH_Poster.pdf

Can you, please, add information on that?

–Hanbury: The idea to visualise our health messages didn’t start with us — it came from the teachers and health workers themselves. They asked us to turn the messages into pictures so that children (and adults!) could understand them easily.

We began by creating a poster on malaria. The response was incredible. As soon as people saw the images, they immediately got what Children for Health is all about — and how powerful children’s participation can be.

From that day on, we knew that visual storytelling was key to making our work clearer, stronger, and more inspiring.

–PEAH: How does CHF work in a scalable way while empowering children to become agents of change through free-of-charge health education materials for them and their educators?

–Hanbury: We’re already scaling in two key ways:

Through Our Health Education Materials

Our co-created materials are downloaded globally every month and used in training courses, school curricula, and health clinics.
Some organizations adapt our messages for videos in clinics, calendars, or as core content when developing new health resources (e.g., HIV education for children).
Our materials act as a shortcut for educators and health workers, helping them quickly develop effective tools.

Through Partnerships & Government Programs

We work directly with projects, like one in Mozambique, where we helped integrate our nutrition approach into the school curriculum—alongside teachers and children.
Involving children in these processes shows adults how capable they are, often challenging underestimations about their role in health education.
By partnering with government programs, our approach reaches more schools and communities, ensuring sustainability and long-term impact.

By combining these approaches, we’re making sure our work continues to scale and reach more children worldwide.

–PEAH: What through is CHF funded?

–Hanbury: Funding, like for many organisations, is challenging and always ongoing. Our work is primarily supported in two key ways: through programmatic partnerships and content creation.

Programmatic Partnerships

We are employed as curriculum designers, trainers, mentors and advisors by existing programmes and invited to bring our approaches, materials, and expertise to strengthen those initiatives. Our role varies based on the needs of the programme and can include:

Programme Design: Helping organisations develop health education programmes from the ground up.
Children’s Participation Integration: Assisting in embedding meaningful children’s participation within existing programmes.
Training and Capacity Building: Conducting training sessions, including training of trainers.
Monitoring & Evaluation: Designing indicators and frameworks to assess programme impact.

This programmatic work is typically funded by the entity financing the broader programme, with our services integrated into the overall structure.

Content Creation

We also develop educational materials, sometimes as part of a programme or in response to pressing health issues. Some of our content creation approaches include:

Programme-Linked Content: For example, in Eswatini, we are helping schools develop anti-bullying messages, safe school surveys, and related content. While our work is funded within this specific programme, the content produced is made more widely available for general use.
Response to Emerging Health Priorities: During major health crises, such as the COVID-19 pandemic or Ebola outbreaks, we were employed to create educational materials, including storybooks, posters, and teacher’s guides.

Given the broad range of topics we address, our funding landscape is diverse and requires continuous engagement with donors, partners, and stakeholders to sustain and expand our work.

–PEAH: Children for Health collaborates with other organisations and programmes to build capacity, offer technical advice, mentoring and training, and create teaching materials and programme strategy. In this respect, how many partners does CHF currently engage with?

–Hanbury: We focus on working with partners who share our mission and values, ensuring that our expertise in children’s participation in health education is used effectively and is sustainable. By collaborating closely with a few partners at a time, we provide tailored support, co-create impactful materials, and help sustain long-term initiatives. Rather than leading projects, we aim to support others in achieving their goals.

Our current Partnerships are with organisations in:

Eswatini – Supporting schools with anti-bullying messages, safe school strategies, and resources on sexual harassment prevention. Our work started two years ago – with an HIV/AIDS poster and storybook.
Kenya – Integrating health education into school water and sanitation curricula and community outreach programs.
Pakistan – Partnering with a large organization to adapt our Type 2 Diabetes materials, originally developed with partners in Guam.

Also, we are currently finalizing the last two posters in our 10-poster series and working with new partners to review and refine them.

Even this does not really reflect the true picture as each day I’d probably spend some time engaging with those that contact us looking for resources, support, tips and mentoring. I would not call these ‘partnerships’ but some of these types of lightweight contact then turned into important alliances and strong partnerships.

We welcome collaborations on key health topics such as nutrition, disease prevention, mental health, and life skills—ensuring children are active participants in their own well-being. We are grateful to our partners and networks for their support and look forward to growing our impact.

–PEAH: Children for Health is dedicated to getting valuable information to the people who need it most. Relevantly, is its content being translated into languages other than English? If so, how many so far?

–Hanbury: On our website, you can find our original draft of 100 health messages in 23 languages, made possible by a generous donation years ago. However, managing translations is a significant challenge, and we can only update them when funding allows. Since health messages evolve over time, we include a note in each booklet directing users to our website for the latest English version.

We do maintain some resources more closely. In Portuguese, we have four storybooks, a nutrition guide, and two posters developed in Mozambique. Other translations have come from generous volunteers and specific partnerships. For example:

Lesotho – A special glasses storybook in Sesotho (co-created with children).
DRC – A diarrhoea poster in French (developed with local colleagues working with save the children).

While we do our best to support translations, those needing up-to-date materials in other languages should find their own translators and ideally inform us. We’re always happy to promote translated materials, though we can’t guarantee accuracy. It’s inspiring to see people adapting our work to reach more communities!

–PEAH: What about the CHF Team?

–Hanbury: Children for Health operates with a dedicated but small team. We have four active trustees with diverse expertise, a website manager, and a network of authors we call upon when needed. Our artist has been with us from the start, a collaboration that began during my time at The Child-to-Child Trust before launching Children for Health.

We also rely on a social media expert and volunteers, along with occasional administrative support. As the almost full-time CEO, I work remotely, and so do our team members. In fact, our “headquarters” is essentially a laptop, as we’re often travelling.

But the true heart of Children for Health lies in those who use our materials—teachers, health workers, programme managers, and headteachers—who bring our work to life in schools and communities worldwide. Their dedication and impact make them an essential part of our extended team.

–PEAH: What results have been achieved and how many children and parents have been involved in your activism so far?

–Hanbury: Tracking the impact of Children for Health is challenging. Since 2022, our materials have been downloaded 150,000 times in over 158 countries. However, it is difficult to determine how many teachers, parents, and children have actively used them. Some may explore our resources out of curiosity, while others integrate them into training programs that then reach hundreds of teachers and thousands of children.

For structured programs, tracking growth is more straightforward—for example, we know that in one programme it was expanded from 12 to 15 to 32 schools. Considering that each school serves between 300 and 600 children, and those children share knowledge with their families and communities, our reach is potentially in the thousands per school.

As a small organisation, conducting large-scale research is challenging, but we receive ongoing anecdotal feedback from users who find our materials valuable. Our impact has also been recognised through two awards: the Global Impact Award and the Small Charity Big Achiever Award, where our work was thoroughly assessed.

While quantifying our exact influence is complex, we remain committed to empowering children as health messengers worldwide.

–PEAH: Thank you Hanbury for the excellent work joining humanitarian and entrepreneurial commitment.

Cultural Influences on Health of Migrant Women

IN A NUTSHELL
Author's Note
Cultural backgrounds significantly influence migrant women's health behaviors and attitudes toward healthcare. Traditional practices may take precedence over conventional medical treatments, affecting their willingness to engage with healthcare systems. Many cultures have traditional healing practices and remedies that may take precedence over Western medical approaches

By Sevil Hakimi RM. PhD

Professor of Maternal and newborn Health, Ege University, Faculty of Health Scienc. Department of Midwifery

Izmir, Turkey

Sevil.hakimi@ege.edu.tr

Cultural Influences on Health of Migrant Women

Traditional medicine

Traditional medicine encompasses a wide range of healing practices that have been passed down through generations within various cultures. For many migrant women, these practices serve as vital sources of health care, especially in contexts where access to conventional medical services may be limited or viewed with skepticism. Traditional medicine typically includes the following elements:

Herbal Remedies: Many cultures utilize plants and herbs for their medicinal properties. For example, chamomile, ginger, and turmeric are often used for their anti-inflammatory and soothing effects. Migrant women may rely on these familiar remedies to treat common ailments such as colds, digestive issues, or menstrual discomfort.
Rituals and Ceremonies: Healing rituals, which may involve prayer, chanting, or specific cultural practices, are integral to traditional medicine. These rituals can provide psychological comfort and social support, reinforcing community ties while addressing health concerns.
Spiritual Practices: In many cultures, spirituality is intertwined with health. Practices such as meditation, yoga, or spiritual cleansing can be seen as essential for maintaining both physical and mental well-being. Migrant women may seek out these spiritual practices as a way to cope with the stressors of migration and adaptation to new environments.

Health perceptions

Health perceptions among migrant women are shaped by a complex interplay of cultural beliefs, values, and experiences. Understanding these perceptions is essential for healthcare providers to effectively address the unique health needs of diverse populations. Health is often viewed differently across cultures, influencing how individuals define a healthy lifestyle:

Holistic Approaches: Many cultures emphasize a holistic view of health that encompasses emotional, mental, spiritual, and social well-being, in addition to physical health. For instance, in some Indigenous cultures, health is seen as a balance between the body, mind, spirit, and community. This perspective may lead migrant women to prioritize practices such as meditation, prayer, or community involvement as essential components of health.
Biomedical Focus: In contrast, Western medical paradigms often focus on physical health and the absence of disease. Migrant women from cultures that value holistic approaches may find themselves at odds with healthcare systems that prioritize biomedical explanations and treatments. This can create barriers to effective communication and care.

Cultural beliefs about the causes of illness can significantly influence health behaviors and treatment choices:

Cultural Explanatory Models: Different cultures may attribute illness to various factors, including biological, environmental, spiritual, or social causes. For example, some migrant women may believe that illness is a result of spiritual imbalances, ancestral curses, or moral failings, which can lead them to seek spiritual or traditional remedies rather than conventional medical care.
Social Determinants of Health: Many migrant women understand health within the context of social determinants such as poverty, discrimination, and access to education. They may perceive health as being influenced not only by individual choices but also by broader societal factors. This understanding can shape their health-seeking behaviors and expectations from healthcare systems.

Cultural beliefs also dictate what forms of treatment are deemed acceptable:

Preference for Traditional Remedies: Migrant women may prefer traditional remedies and practices that resonate with their cultural backgrounds. These may include herbal treatments, massage, acupuncture, or spiritual healing practices. Such preferences often stem from familiarity and trust in these methods, as well as a belief in their effectiveness.
Skepticism towards Conventional Medicine: Many migrant women may approach conventional medicine with skepticism, particularly if they have experienced discrimination or have had negative encounters with healthcare providers. This skepticism can lead to reluctance in following medical advice or adhering to prescribed treatments, especially if they feel that their cultural beliefs are not acknowledged or respected.

As migrant women adapt to new environments, their health perceptions may evolve:

Cultural Hybridity: Many migrant women blend traditional health practices with new information and treatments learned in their host countries. This cultural hybridity can lead to the development of unique health practices that reflect their experiences and needs, combining the best of both worlds.
Empowerment through Education: Exposure to new health information and education can empower migrant women to reassess their health beliefs and practices. Educational programs that respect and incorporate traditional knowledge while providing evidence-based information can facilitate this process, enabling women to make informed health decisions.

Strategies for Improvement

Culturally Competent Care

Culturally competent care is essential for effectively addressing the unique health needs of migrant women. As healthcare providers encounter increasingly diverse populations, understanding and respecting cultural differences becomes paramount. Here’s an in-depth exploration of what culturally competent care entails and its significance in improving health outcomes for migrant women:

Awareness of Cultural Differences: Providers must be aware of the diverse cultural backgrounds of their patients, including differences in beliefs, values, and health practices. This awareness helps create an inclusive environment where migrant women feel understood and respected.
Knowledge of Cultural Contexts: Understanding the historical, social, and economic contexts of different cultures can provide insights into the health challenges faced by migrant women. For example, awareness of how migration experiences impact mental health can shape a provider’s approach to care.
Skills for Effective Communication: Developing skills for effective communication is crucial. This includes not only language proficiency but also the ability to utilize interpreters and cultural brokers when necessary. Providers should be trained to ask open-ended questions and listen actively, ensuring that women feel comfortable sharing their health concerns.

Training and Education for Healthcare Providers

To implement culturally competent care, healthcare organizations should prioritize training and education for their staff:

Cultural Competency Training: Regular training sessions should be conducted to educate healthcare providers about cultural diversity, health disparities, and effective communication strategies. This training can enhance providers’ ability to deliver compassionate and respectful care.
Workshops and Simulations: Interactive workshops and role-playing simulations can help providers practice culturally competent interactions. These activities encourage empathy and understanding of the unique experiences faced by migrant women.
Ongoing Education: Cultural competency is an ongoing process. Providers should be encouraged to engage in continuous learning about different cultures, health practices, and emerging issues affecting migrant populations.

Creating a Culturally Competent Healthcare Environment

Creating an environment that fosters culturally competent care involves:

Diverse Healthcare Teams: Employing a diverse healthcare workforce can enhance cultural understanding and improve patient-provider relationships. Diverse teams can offer varied perspectives and insights into the experiences of migrant women.
Patient-Centered Care Models: Implementing patient-centered care models that prioritize the individual needs and preferences of migrant women can enhance satisfaction and health outcomes. This includes involving women in decision-making processes regarding their care.
Community Engagement: Establishing connections with community organizations that serve migrant populations can facilitate outreach and support. Collaborating with these organizations can help providers better understand the cultural contexts and health needs of their patients.

Conclusion

Culturally competent care is vital for addressing the diverse health needs of migrant women. By understanding cultural beliefs, recognizing barriers to care, and fostering effective communication, healthcare providers can create an inclusive and respectful environment. Training and education in cultural competency not only enhance the quality of care but also empower migrant women to engage actively in their health journeys, ultimately leading to improved health outcomes and well-being.

References

Shansky RM, Murphy AZ. Considering sex as a biological variable will require a global shift in science culture. Nature neuroscience. 2021 Apr;24(4):457-64.
Greenhalgh T, Helman C, Chowdhury AM. Health beliefs and folk models of diabetes in British Bangladeshis: a qualitative study. InHealth Psychology 2016 Dec 5 (pp. 362-371). Routledge.
Shishehgar S, Gholizadeh L, DiGiacomo M, Green A, Davidson PM. Health and socio-cultural experiences of refugee women: an integrative review. Journal of immigrant and minority health. 2017 Aug;19:959-73.
Kalaitzi S, Czabanowska K, Azzopardi-Muscat N, Cuschieri L, Petelos E, Papadakaki M, Babich S. Women, healthcare leadership and societal culture: a qualitative study. Journal of healthcare leadership. 2019 Apr 12:43-59.
Shorey S, Ng ED, Downe S. Cultural competence and experiences of maternity health care providers on care for migrant women: a qualitative meta‐synthesis. Birth. 2021 Dec;48(4):458-69.

—

By the same Author on PEAH

Refugee Women’s Healthcare Accessibility: What We Should Know

Shadow Pandemic: Women’s Health in the Time of COVID-19

Beyond the Waives: Indirect Effects of Covid-19 on Mothers in Low and Middle-Income Countries

News Flash 612: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Brown meagre (Sciaena umbra)

News Flash 612

Weekly Snapshot of Public Health Challenges

BOOK REVIEW: MY JOURNEY WITH COMMUNITY MEDICINE – A MEMOIR by Tanushree Mondal

Can Managed Entry Agreements Help LMICs Navigate the Rising Cost of Medicines?

Pharmaceutical Tariffs: Potential Impacts And The Need For Vulnerability Assessments

Critical Medicines and Priority Medical Products should not leave anyone behind

IP: Delhi High Court clears path for generic risdiplam availability in India

Trump ends SA’s HIV and TB research grants

WHO calls for urgent action to address worldwide disruptions in tuberculosis services putting millions of lives at risk

Turning the Tide on Tuberculosis: Ensuring Access, Treatment, and Prevention for All Communities

TB Aid Cuts Endanger Africans Despite Sharp Drop in Deaths, Cases

Promising Phase 3 Trial of Tuberculosis Vaccine is Running Ahead of Schedule

Life-saving services in TB response

Poliovirus detected in sewage samples from 18 districts

NEJM Outbreaks Update — H5N1: A View from the States

Types of data requested to inform May 2025 COVID-19 vaccine antigen composition deliberations

Global and national actions to prevent trade in substandard and adulterated medicines

Reforming humanitarianism can’t be left to today’s decision-makers

Beyond the Stigma: Supporting Mothers with Disabilities

Breaking the Cycle of Early Marriages and Early Motherhood in Roma Communities

Refugee Women’s Healthcare Accessibility: What We Should Know by Sevil Hakimi

Tackling racial discrimination in the EU

Migrant deaths in Asia hit record high in 2024, UN data reveals

‘Trapped populations’ need help to escape climate risks

People’s Health Dispatch Bulletin #97: Birthing under capitalism, healing under sanctions

Decades of progress in reducing child deaths and stillbirths under threat, warns the United Nations

HRR763. FROM INJUSTICE THE IDEA IS BORN AND FROM HUNGER AND THE HUNGRY THE ACTION IS TO COME. (pamphlet circulated at the Instituto Pedagógico, Universidad de Chile in 1966)

MSF warns of a crisis as the numbers of malnourished children rise in Yemen

Food Security and Water, a Priority for Border Towns in Central America

Optimal dietary patterns for healthy aging

The Dilemmas of Localization for Climate Action: The Struggles of Local NGOs in Accessing Global Platforms in Countries Like South Sudan by David Odukanga

More Trees BANES-Grow Yourself-Community Tree Nursery Project

Glacier meltdown risks food and water supply of 2 billion people, says UN

Refugee Women’s Healthcare Accessibility: What We Should Know

IN A NUTSHELL
Author's Note
…Healthcare accessibility for refugee women varies significantly based on geographical location, legal status, and the availability of resources. In host countries, healthcare systems may be overwhelmed, underfunded, or ill-equipped to handle the influx of refugees. Additionally, language barriers and cultural differences can complicate communication, leading to inadequate care. In some regions, refugee women may have access to specific programs aimed at addressing their health needs, such as maternal health services and mental health support. However, these programs are not universally available and often depend on the funding and policies of host countries…

By Sevil Hakimi RM. PhD

Professor of Maternal and newborn Health, Ege University, Faculty of Health Scienc. Department of Midwifery

Izmir, Turkey

Sevil.hakimi@ege.edu.tr

Refugee Women’s Healthcare Accessibility

What We Should Know

Introduction

As a result of persecution, armed conflicts, inadequate healthcare, and human rights violations, over 100 million people worldwide were forcibly displaced from their homes by the end of 2022. Refugee women represent a vulnerable population facing unique health challenges due to their displacement. Access to healthcare services is crucial for their well-being. Women often play a central role in maintaining family health. By ensuring that refugee women have access to healthcare, the health of entire families can improve, leading to better health outcomes for children and partners. Ensuring that refugee women have access to healthcare also benefits public health in host countries. It helps prevent the spread of infectious diseases and contributes to healthier communities overall. Ensuring that refugee women have access to healthcare services aligns with global human rights standards and obligations.

Overview of Refugee Women’s Health Needs

Refugee women often experience a range of health issues, including reproductive health concerns, mental health disorders, and chronic diseases exacerbated by their experiences of trauma and displacement. Many suffer from conditions such as maternal morbidity, sexually transmitted infections, and mental health issues due to the stress of displacement and uncertainty about their future. The trauma of fleeing their homes often leaves refugee women grappling with significant psychological impacts, such as anxiety, depression, and post-traumatic stress disorder (PTSD). These mental health challenges can be compounded by the lack of social support and the stigma associated with mental health in many cultures. Furthermore, the disruption of their lives and loss of community can lead to feelings of isolation and helplessness, making it even more difficult for them to seek help. Access to reproductive health services is also a critical concern, as many refugee women may face barriers in obtaining necessary care during pregnancy and childbirth. Complications can arise due to inadequate prenatal and postnatal care, leading to increased risks of maternal and infant mortality. Additionally, the prevalence of sexual violence in conflict zones leaves many women vulnerable to sexually transmitted infections (STIs), including HIV, yet they often lack access to essential screening and treatment services. Chronic diseases such as diabetes and hypertension can also be exacerbated in refugee populations due to stress, poor nutrition, and limited access to healthcare services. Many refugee women may have pre-existing conditions that go untreated due to the lack of continuity in care and the complexities of navigating healthcare systems in host countries.

Healthcare accessibility for refugee women varies significantly based on geographical location, legal status, and the availability of resources. In host countries, healthcare systems may be overwhelmed, underfunded, or ill-equipped to handle the influx of refugees. Additionally, language barriers and cultural differences can complicate communication, leading to inadequate care. In some regions, refugee women may have access to specific programs aimed at addressing their health needs, such as maternal health services and mental health support. However, these programs are not universally available and often depend on the funding and policies of host countries. The legal status of refugees affects their access to healthcare. In many countries, refugees are entitled to some form of healthcare, but the extent of this access can vary widely. Some nations provide comprehensive health services, while others impose restrictions that limit refugees’ ability to seek care.

Facilitators of Healthcare Access

Community Support Networks

Community organizations and NGOs play a critical role in facilitating access to healthcare for refugee women. These organizations often provide vital resources, including information about available services, transportation assistance, and language translation support. By fostering a sense of community and belonging, these networks can encourage refugee women to seek the care they need.

Culturally Competent Care

Healthcare providers who are trained in cultural competence can significantly enhance healthcare accessibility for refugee women. Understanding cultural beliefs and practices helps providers deliver more effective care and build trust with patients. Culturally sensitive services can lead to better health outcomes by ensuring that women feel respected and understood.

Integration Programs

Government and NGO-led integration programs that focus on refugee women can improve healthcare access. These programs may include health education, advocacy for rights, and navigation assistance for the healthcare system. By empowering refugee women with knowledge and resources, these initiatives can lead to increased utilization of health services.

Barriers to Healthcare Access

Language and Communication Barriers

Language differences pose a significant barrier to healthcare access for refugee women. Limited proficiency in the local language can hinder their ability to communicate effectively with healthcare providers, leading to misunderstandings and inadequate care. This barrier often results in a reluctance to seek help, especially in urgent situations.

Financial Constraints

Financial barriers, such as lack of insurance or high out-of-pocket costs, can prevent refugee women from accessing necessary health services. In many cases, refugees may not be eligible for state-funded healthcare programs, leaving them to navigate a complex system that may require payment upfront.

Stigma and Discrimination

Refugee women often face stigma and discrimination within healthcare settings. Fear of being judged or treated unfairly can deter them from seeking care, particularly for sensitive issues like reproductive health or mental health. This stigma can be amplified by cultural differences, leading to a reluctance to engage with the healthcare system.

Legal and Policy Barriers

Restrictive immigration policies and legal barriers can further complicate access to healthcare for refugee women. In some host countries, refugees may face challenges in obtaining necessary documentation or may be subject to policies that limit their eligibility for health services. These barriers can exacerbate existing health disparities and lead to poorer health outcomes.

Conclusion

Accessing healthcare is a fundamental right, yet refugee women face numerous challenges that hinder their ability to receive the care they need. While community support, culturally competent care, and integration programs can facilitate access, significant barriers remain. Addressing these issues requires concerted efforts from governments, NGOs, and healthcare providers to create an inclusive and supportive healthcare environment for refugee women. Ensuring equitable access to healthcare services is essential for promoting the health and well-being of this vulnerable population.

References

Yeshitila YG, Gold L, Abimanyi-Ochom J, Riggs E, Daba TT, Le H. Effectiveness and cost-effectiveness of models of maternity care for women from migrant and refugee backgrounds in high-income countries: A systematic review. Social Science & Medicine. 2024 Aug 23:117250.

Markey K, Moloney M, O’Donnell CA, Noonan M, O’Donnell C, Tuohy T, MacFarlane A, Huschke S, Mohamed AH, Doody O. Enablers of and Barriers to Perinatal Mental Healthcare Access and Healthcare Provision for Refugee and Asylum-Seeking Women in the WHO European Region: A Scoping Review. InHealthcare 2024 Sep 1 (Vol. 12, No. 17, p. 1742). MDPI.

Rowe A, Bhardwaj M, McCauley M. Maternal multimorbidity-experiences of women seeking asylum during pregnancy and after childbirth: a qualitative study. BMC Pregnancy and Childbirth. 2023 Nov 13;23(1):789.

Banke-Thomas A, Agbemenu K, Johnson-Agbakwu C. Factors associated with access to maternal and reproductive health care among Somali refugee women resettled in Ohio, United States: A cross-sectional survey. Journal of immigrant and minority health. 2019 Oct 1;21:946-53.

Floyd A, Sakellariou D. Healthcare access for refugee women with limited literacy: layers of disadvantage. International journal for equity in health. 2017 Dec;16:1-0.

DeSa S, Gebremeskel AT, Omonaiye O, Yaya S. Barriers and facilitators to access mental health services among refugee women in high-income countries: a systematic review. Systematic reviews. 2022 Apr 6;11(1):62.

—

By the same Author on PEAH

Shadow Pandemic: Women’s Health in the Time of COVID-19

Beyond the Waives: Indirect Effects of Covid-19 on Mothers in Low and Middle-Income Countries

BOOK REVIEW: MY JOURNEY WITH COMMUNITY MEDICINE – A MEMOIR

IN A NUTSHELL
Author's Note
I have the pleasure of reviewing the Book “My Journey with Community Medicine” as a testimonial to the achievements of Dr M K Sudarshan over the years in his active professional life. The book acts as a powerful instrument of motivation to the students of Community Medicine

By Professor (Dr) Tanushree Mondal *

Editor – APCRI Journal

Professor of Community Medicine, RG Kar Medical College, Kolkata, India

profcmrgkmc24@gmail.com

Book Review

MY JOURNEY WITH COMMUNITY MEDICINE: A MEMOIR

MY JOURNEY WITH COMMUNITY MEDICINE: A MEMOIR

Author Dr M.K. Sudarshan

Publisher: Maiya Publishing

Year of Publication: 2025

Pages: 120

Price: PaperBack (India Sales): Rs.450 (incl GST)
eBook (India Sales): Rs. 100
eBook (Outside India Sales): $5

ISBN No.: 978-93-93194-63-3

I have the pleasure of reviewing the Book, “My Journey with Community Medicine”. The book is a testimonial to the achievements of Dr M K Sudarshan over the years in his active professional life.

The book has 12 chapters spread over 120 pages. The first chapter delves upon his childhood. The next 2 chapters are concentrated on his MBBS and MD days. The Fourth chapter delves into his experience as a faculty in a medical college from April 1981 to October 2014. The fifth chapter describes his incremental interest in Rabies, and how it culminated into several State, National and International ventures and experiences is depicted along with colourful pictures in the other two chapters namely, the sixth and the seventh respectively. Chapter no. 8 states his vital role in the containment period of Covid-19 and his state level experiences in the State of Karnataka.

The book in itself has a neat cover, with vibrant colours with the photo of the author. In a few place, there are spelling mistakes that can be corrected in the following editions, but the grammar and the syntax are well done with proper alignment.

The ninth chapter deserves a special mention, enumerated as “My Mentors”. It is an interesting read in itself, with the pictures of his Mentors, but how these mentors shaped his life, how they were instrumental in his own being, could have been drawn in a more detailed way. This will in fact, render it as a useful textbook for all the teachers out there who are running their “Student Mentorship programme” in their respective colleges under the NMC guidelines. In this connection, a special mention is felt regarding the incorporation of emotional quotient (EQ) which is becoming very important in today’s world.

The final message section underscores professional achievement and staying happy and content in life while pursuing one’s own career.

The book is in itself is a snapshot of the living legend, however, the Summary Section may be forsaken as this would distract the attention of the readers and they would go only through the Summary segment without reading the details inside the book. There can be a section on takeaway messages out of the chapters.

Testimonials may be put in a single place as there is a chapter 12 dedicated for it solely. A special mention may be made to women at the workplace.

Moreover, since it is meant for students of Community Medicine, a special mention of what needs to be done in the future may be incorporated. At the same time, the goal of the national action plan for rabies elimination (NAPRE) needing a flagship may be duly emphasized.

The effort in bringing up such a book in such a compiled fashion and in a comprehensive way is truly laudable. Future plans in bringing out more books highlighting various aspects of his life can be thought of. In a nutshell, the book acts as a powerful instrument of motivation to the students of Community Medicine.

REFERENCE

https://maiyapublishing.com/product/my-journey-with-community-medicine-paper-back-within-india/

* PROF (DR) TANUSHREE MONDAL profile:

MD, FAIMER (CMC-L), ACME (JIPMER), MAPC (IGNOU), PhD
Professor, Deptt. of Community Medicine,
R G Kar Medical College, Kolkata
Former Deputy Director of Medical Education, GoWB
Former State Public Information Officer (SPIO) under Right to Information Act, for GoWB
Former MEU Coordinator, CC Member, GCP Trainer
Co-Investigator, NMHS -Phase II Megacity Survey (NIMHANS)
Member, Penal & Ethics Committee, West Bengal Medical Council
Member, Health Recruitment Board, GoWB
Editor, Association of Prevention & Control of Rabies in India

The Dilemmas of Localization for Climate Action: The Struggles of Local NGOs in Accessing Global Platforms in Countries Like South Sudan

IN A NUTSHELL
Author's Note
Localization in climate action has been increasingly emphasized as a critical strategy for effective and sustainable responses to climate change, particularly in vulnerable regions like South Sudan. However, despite global commitments to empowering local actors, numerous challenges continue to hinder the meaningful participation of local NGOs in international climate discourse and funding mechanisms. 

This article explores the dilemmas surrounding localization, the barriers faced by local NGOs in accessing global platforms, and the implications for climate action in fragile contexts

By David Odukanga

WASH and Climate Change Advisor

The Dilemmas of Localization for Climate Action

The Struggles of Local NGOs in Accessing Global Platforms in Countries Like South Sudan

The Promise of Localization in Climate Action

Localization aims to shift power, resources, and decision-making to local actors who are best positioned to understand and address the needs of their communities. In theory, this approach enhances the effectiveness, relevance, and sustainability of climate interventions. Global frameworks such as the Paris Agreement and initiatives like the Grand Bargain advocate for increased funding and support for local organizations. However, in practice, significant gaps remain between policy commitments and actual implementation.

Challenges Hindering Local NGOs’ Access to Global Platforms

Funding Barriers: Local NGOs in South Sudan and similar countries struggle to access international climate finance due to stringent eligibility criteria, complex application processes, and a preference for larger international For instance, according to the 2023 South Sudan Humanitarian Response Plan, only 2% of climate adaptation funding was directly allocated to local organizations, with the majority going to international entities (OCHA, 2023).
Capacity Gaps: Many local organizations have deep contextual knowledge but face technical and operational challenges that limit their ability to engage in global climate platforms. Reports indicate that 78% of South Sudanese NGOs lack sufficient financial and administrative capacity to meet international donor requirements (UNDP, 2022).
Limited Representation in Decision-Making: International climate negotiations and high- level policy discussions are often dominated by governments, multilateral agencies, and well-resourced A review of South Sudan’s participation in COP28 showed that only 5% of the country’s delegation comprised local NGO representatives, limiting their influence on decision-making processes (UNFCCC, 2023).
Power Imbalances and Structural Exclusion: Even when local NGOs are involved in climate discussions, they often face tokenistic engagement rather than genuine decision-making power. Large INGOs and donors tend to dictate priorities, sidelining local knowledge and priorities.
Bureaucratic and Political Constraints: In fragile states like South Sudan, political instability and restrictive policies further complicate local NGOs’ operations. Governmental restrictions, cumbersome registration processes, and bureaucratic hurdles limit their ability to receive international funding and collaborate with global partners.

Impacts on Climate Action in South Sudan

The exclusion of local NGOs from global climate platforms has dire consequences for climate action in South Sudan and similar countries. It results in:

Misaligned Priorities: Climate interventions often fail to reflect the actual needs and realities of affected communities.
Reduced Effectiveness: The reliance on external actors leads to inefficient project implementation, as local organizations are better suited to deliver context-specific
Erosion of Local Agency: The marginalization of local NGOs perpetuates dependency on international actors, preventing long-term sustainability and resilience building.
Missed Opportunities for Innovation: Many local NGOs develop innovative, indigenous climate adaptation strategies, but their lack of access to global platforms prevents the sharing and scaling up of these solutions.

Bridging the Gap

Recommendations for Meaningful Localization

To address these dilemmas, a shift in global climate governance and funding mechanisms is needed. Key recommendations include:

Increasing Direct Funding: International donors should simplify application processes and allocate more direct funding to local NGOs to enhance their capacity and autonomy.
Capacity Strengthening Initiatives: Investing in training and mentorship programs can empower local NGOs to navigate global climate finance and advocacy spaces effectively.
Ensuring Inclusive Representation: Climate summits and decision-making bodies should allocate seats for local actors, ensuring their voices influence global climate policies.
Reforming Bureaucratic Processes: Governments and international institutions should reduce bureaucratic red tape that hinders local NGOs from accessing funds and participating in global discussions.
Enhancing Partnerships and Collaboration: Strengthening partnerships between local NGOs, INGOs, and global institutions can create more equitable power dynamics and knowledge exchange.

Conclusion

Localization is essential for effective climate action, yet systemic barriers continue to exclude local NGOs from global platforms. Addressing these challenges requires genuine commitment from international actors, policymakers, and donors to shift power, resources, and decision-making to those most affected by climate change. Only by overcoming these dilemmas can countries like South Sudan harness the full potential of local expertise to build climate resilience and sustainable development pathways.

References

OCHA (2023). South Sudan Humanitarian Response United Nations Office for the Coordination of Humanitarian Affairs.
UNDP (2022). Capacity Needs Assessment of Local NGOs in South United Nations Development Programme.
UNFCCC (2023). COP28 Participation Report: South Sudan United Nations Framework Convention on Climate Change.

By the same Author on PEAH

The Nexus Between Climate Change, Security Impact on Public Health, and WASH in South Sudan

News Flash 611: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Seagulls

News Flash 611

Weekly Snapshot of Public Health Challenges

Sign on to the letter: Exclude Factory Farming from World Bank Financing

Doge occupies US Institute of Peace headquarters after White House guts its board

With US funding loss, WHO forced to make ‘terrible’ programmatic choices

Scoop: UN migration agency cuts more jobs, shutters lifesaving programs

How Many Lives Does US Foreign Aid Save?

MEPs push for health to be a priority investment in the next EU budget

Regulation of Health and Health Care Artificial Intelligence

Tools for Healing: A Journey Through the Centuries from the Etruscan-Roman Era to the Robot. Testimonies from Tuscan Museums by Esther Diana

Webinar registration: Pandemic Agreement Updates Mar 24, 2025

COVID-19: we’re no better prepared for a pandemic today than we were in 2020

Measles highest in 25 years in Europe, WHO says

Measles Vaccination, Disease Surveillance and Labs Hit Hardest by US Budget Cuts

Five Takeaways and Next Steps from the Immunization Agenda 2030

Is Big Pharma’s pollution deregulation campaign fueling the next pandemic?

FAO warns of ‘unprecedented’ avian flu spread, in call for global action

First vaccine against epizootic haemorrhagic disease recommended for approval

A frightening glimpse into the future of HIV research under Trump

MSF calls for sustained investments to fight against tuberculosis in children

Rate of People With Diabetes in Africa ‘Rising Faster’

EMA qualifies first artificial intelligence tool to diagnose inflammatory liver disease (MASH) in biopsy samples

UN Commission approves WHO recommendations to place psychoactive substances under international control

Epilepsy Patients in Africa Fight Stigma and Neglect

Genocide Watch Report: Hmong at Risk

FIAN International annual report looks back on 2024

HRR762. WHEN ‘GROWTH’ DISPLACED ‘DEVELOPMENT’ AS THE DREAM OF GOVERNMENTS AND ECONOMISTS

Finland again tops global happiness rankings, US falls to lowest position ever

If “Food Is Medicine,” Why Are Hospitals Still Serving Junk?

Restore our Planet – Hunting Animal Traffickers: Tim Santel

South Africa: The Green Connection Welcomes Settlement to Protect African Penguin and Small-Scale Fisher Livelihoods

Nearly 50 million people sign up call for clean air action for better health

The Nexus Between Climate Change, Security Impact on Public Health, and WASH in South Sudan by David Odukanga

The Year 2024 Was Warmest-Ever on Record – Temperature Rise Likely Exceeded 1.5°C

The Nexus Between Climate Change, Security Impact on Public Health, and WASH in South Sudan

IN A NUTSHELL
Author's Note
Climate change significantly impacts public health and security, particularly in fragile states such as South Sudan. Rising temperatures, unpredictable rainfall, and extreme weather events have exacerbated water scarcity, reduced water quality, and increased disease burdens. These environmental stressors intensify conflicts over resources, leading to displacement and further strain on Water, Sanitation, and Hygiene (WASH) services. 

According to the United Nations (2023), over 60% of South Sudan's population lacks access to safe drinking water, while 75% depends on unimproved sanitation facilities. Additionally, with the termination of all USAID-funded projects in South Sudan, the already significant funding gaps for WASH services will further widen, exacerbating the existing humanitarian crisis. 

This article highlights the urgent need for climate-resilient infrastructure, integrated policies, and coordinated humanitarian responses to enhance South Sudan's adaptive capacity

By David Odukanga

WASH and Climate Change Advisor

The Nexus Between Climate Change, Security Impact on Public Health, and WASH in South Sudan

Introduction

Climate change is a global crisis with profound implications for security and public health, particularly in vulnerable regions such as South Sudan. The country, already grappling with political instability and economic fragility, faces severe climate-induced challenges that impact access to clean water, sanitation, and hygiene. The increasing frequency of droughts, floods, and erratic rainfall patterns exacerbates water shortages, leading to a rise in waterborne diseases and heightened competition over scarce resources. For instance, the 2021 floods affected over 850,000 people (OCHA, 2021), damaging WASH infrastructure and increasing the spread of waterborne diseases. The withdrawal of USAID funding will likely lead to the closure of essential projects, reduced access to clean water, and an increased burden on humanitarian agencies struggling to fill the void. This interplay between climate change, security, and public health underscores the need for comprehensive and resilient WASH interventions.

Climate Change and Its Impact on WASH Services in South Sudan

South Sudan’s climate is characterized by prolonged dry spells and intense seasonal flooding, both of which severely disrupt WASH services.

Water Scarcity and Quality

Reduced rainfall and prolonged droughts deplete water sources, forcing communities to rely on unsafe water supplies. A report by UNICEF (2022) found that 58% of South Sudanese households consume contaminated water, increasing the risk of diseases such as cholera, typhoid, and diarrhoea.

Flooding and Infrastructure Damage

Heavy floods destroy water infrastructure, contaminate boreholes, and spread pollutants, leading to increased health risks. The 2020 floods, for example, submerged more than 70% of Unity State (UNHCR, 2020), rendering WASH facilities non-functional.

Sanitation Challenges

Disruptions to sanitation facilities due to extreme weather events contribute to open defecation, exacerbating disease outbreaks and further straining health systems.

Security Implications of Climate-Induced Water Scarcity

Climate change-induced water shortages contribute to resource-based conflicts among communities, leading to displacement and heightened security threats.

Resource-Based Conflicts

Competition over diminishing water sources fuels intercommunal violence, exacerbating instability in South Sudan. In 2023, conflicts between pastoralist communities over water and grazing lands in Jonglei and Warrap states resulted in over 500 deaths (International Crisis Group, 2023).

Forced Displacement

Climate-induced displacement places immense pressure on host communities and humanitarian agencies, increasing the demand for clean water and sanitation services. The International Organization for Migration (2022) estimated that over 1.6 million people were displaced due to climate-related disasters.

Disruptions in Health Services

Security threats hinder access to healthcare facilities, reducing the effectiveness of WASH interventions and increasing vulnerability to disease outbreaks.

Public Health Consequences of Climate Change and WASH Deficiencies

The deterioration of WASH services due to climate change directly impacts public health outcomes in South Sudan.

Increased Disease Burden

Poor water quality and inadequate sanitation contribute to cholera outbreaks, acute watery diarrhoea, and malnutrition, particularly among children and displaced populations. South Sudan recorded over 3,500 cholera cases in 2022 alone (WHO, 2022).

Compromised Maternal and Child Health

Pregnant women and children are disproportionately affected by inadequate WASH services, leading to higher maternal and infant mortality rates. The maternal mortality rate in South Sudan stands at 1,150 per 100,000 live births, among the highest in the world (World Bank, 2023).

Vector-Borne Diseases

Stagnant floodwaters create breeding grounds for mosquitoes, increasing the prevalence of malaria and other vector-borne diseases. Malaria accounts for 33% of all hospital admissions in South Sudan (MSF, 2023).

Strategies for Strengthening Climate-Resilient WASH Systems

To mitigate the impact of climate change on public health and security, South Sudan must adopt integrated and sustainable WASH strategies.

Investment in Climate-Resilient Infrastructure

Building flood-resistant water systems, rehabilitating boreholes, and improving drainage systems are crucial for sustaining WASH services.

Policy and Governance Frameworks

Strengthening policies on climate adaptation, water resource management, and sanitation can enhance resilience.

Community-Based Adaptation

Engaging local communities in WASH interventions ensures sustainability and enhances preparedness for climate-related disasters.

Humanitarian Coordination

With the withdrawal of USAID funding, urgent efforts must be made to secure alternative sources of funding for WASH services. Collaboration between government, international organizations, and NGOs is essential for effective emergency response and long-term resilience building.

Conclusion

The nexus between climate change, security, and public health highlights the urgency of investing in resilient WASH systems in South Sudan. Addressing these interconnected challenges requires a multi-sectoral approach that integrates climate adaptation strategies, conflict resolution mechanisms, and sustainable health interventions. Strengthening WASH services will not only improve public health outcomes but also contribute to stability and resilience in South Sudan’s fragile environment. With the termination of USAID projects, urgent action is required to fill the funding gap to prevent worsening public health crises.

References

International Crisis Group, Water Scarcity and Conflict in South Sudan.
International Organization for Migration (IOM), South Sudan Displacement Overview.
Médecins Sans Frontières (MSF), Malaria in South Sudan: A Growing Crisis.
OCHA, Flood Impact Assessment in South Sudan.
UNHCR, Climate Displacement in Unity State, South Sudan.
UNICEF, Water Quality Report: South Sudan.
United Nations, Access to Clean Water and Sanitation in South Sudan.
WHO, Cholera Outbreak Situation Report.
World Bank, Maternal Mortality Trends in South Sudan.

Tools for Healing: A Journey Through the Centuries from the Etruscan-Roman Era to the Robot

IN A NUTSHELL
Author's Note
The 14th-century hospital of San Giovanni di Dio in Florence has, since the late 19th century, evolved into a specialized center predominantly focused on cardiovascular surgery. Decommissioned in 1983, the institution now calls for initiatives aimed at its enhancement, protection, and, above all, its conversion to a social-medical-sanitary use that will rescue it from its evident and growing underutilization. 

This impetus to capture the attention of the relevant authorities has been expressed through an Exhibition, complete with a catalog and parallel events. 

The Exhibition, "Tools for Healing: A Journey Through the Centuries from the Etruscan-Roman Era to the Robot. Testimonies from Tuscan Museums", aims to trace the milestones of progress in Tuscan (and interregional) surgery: from Etruscan-Roman and pre-Columbian surgical instruments, through the 18th-century technological innovations that codified the first specialized branches of medicine, to robotic surgery that represents the future of the discipline

By Dr Esther Diana

Architect, Historian of Healthcare and Healthcare Architecture

Tools for Healing

A Journey Through the Centuries from the Etruscan-Roman Era to the Robot

Testimonies from Tuscan Museums

Italian translation HERE

From the display of Etruscan-Roman and pre-Columbian surgical instruments viewers have an opportunity to explore the evolution of surgery from the 19th century to the present.

The Exhibition “Tools for Healing: A Journey Through the Centuries from the Etruscan-Roman Era to the Robot. Testimonies from Tuscan Museums” will be held from February 14 to May 9, 2025, at the Biblioteca Marucelliana in Florence, via Cavour 43.

The Exhibition poster

The history (1380 until today) of the ancient hospital of San Giovanni di Dio in Florence is a case study of the history and progress object of the Exhibition.

It is currently awaiting development that reflects its unique healthcare legacy—especially in the field of surgery, which established its reputation as an institution of excellence during the 19th and 20th centuries.

The Exhibition follows a philological storyline divided into four sections, each serving as an thematic synthesis. The first section, “Surgery in Archaeological Evidence”, highlights historical background of the hospital San Giovanni di Dio.

Entrance to the Exhibition

The Etruscan-Roman instrument room

The second section, “From Empirical Surgery to Vesalius”, highlights the crucial role that anatomical advances have played in the development of surgery and medicine in general. In the same space, the third section, “Military Surgery”, is dedicated to treatises by Ambroise Paré (1510-1590) and Giovanni Alessandro Brambilla (1728-1800), and displays three cases from Brambilla’s Armamentarium Chirurgicum.

Giovanni Alessandro Brambilla, Instrumentarium chirurgicum militare viennense, 1781 and urology tools

Finally, the fourth and most extensive section, “The Surgery of the Future”, acts as a bridge between the advancements achieved in the 19th and 20th centuries in general surgery, orthopedics, urology, and cardiac surgery, and the cutting-edge techniques of today and tomorrow: namely, minimally invasive and robotic surgery.

The scientific project and the curation of the Exhibition are led by Architect Esther Diana and Professor Francesco Tonelli, Emeritus in Surgery University of Florence.

Starting with History

In 1380, the Florentine merchant Simone Vespucci founded a hospital in Florence, near his family residence in the Santa Maria Novella district, intended for the impoverished – primarily wool workers. However, political and economic difficulties hindered the development of the institution, which remained essentially an almshouse until 1587.

Its transformation into a healthcare institution began in 1587, when the Grand Duke Francesco de Medici assigned this semi-abandoned facility to the Fatebenefratelli, a Counter-Reformation Order that was strongly supported by the Church and, as a result, warmly received at the Florentine court. The original “hospitaletto dei Vespucci” dedicated to Santa maria dell’Umiltà opened its doors immediately – as evidenced by the early Libri degli Infermi (Books of the Sick) from 1607 – with a ward arranged for 17 beds.

With the backing of the Church and the devoted care of the Brothers, the institution quickly succeeded, and in 1698 it was dedicated to San Giovanni di Dio in honor of the Order’s founder, Juan Ciudad, who was later canonized.

As a religious entity, the hospital was independent of state authority, a status that allowed it to be exempt from the public health regulations imposed during epidemic crises (notably plague and typhus) and to maintain full autonomy until the dissolution of the Order in 1866. This independence, determined in part by the type of care provided by the Brothers – mainly treating fevers (by reducing fever peaks through bloodletting or herbal infusions and decoctions), wounds, cuts, tooth extractions, and realigning limbs after falls or blows – transformed it into a specialist hospital where careful surgical procedures were largely carried out by the friars themselves.

The 17th century, and especially the 18th, represented the “golden age” of the complex, which significantly expanded its structure according to the architectural style typical of the Order – a style also adopted by other hospitals – characterized by an infirmary on the upper floor and a monumental entrance hall with a double, bi-directional staircase.

Monumental entrance hall of San Giovanni di Dio hospital, Florence

Towards Surgical Excellence

By the late 19th century, the hospital had increasingly emphasized its surgical function, bolstered by the presence of highly skilled medical professionals of both outstanding competence and humanity. By 1901, radiology, dentistry, and laboratory services were already in operation; in 1907, Florence’s first nighttime emergency service was established, paving the way for the creation of outpatient clinics in ophthalmology, otorhinolaryngology, urology, general medicine, and pediatrics by 1940.

During the 20th century, surgical activities intensified, particularly in oncological treatments involving complex abdominal and thoracic procedures. In the mid-1950s, a new frontier was opened – the first in Tuscany and among the first in Italy – in vascular and cardiac surgery. In the subsequent years, San Giovanni di Dio became a center of high specialization in these fields, acquiring a heart-lung machine; at that time, it was one of only two in Italy, the other being at Niguarda Hospital in Milan.

The heart-lung machine, 1957

This machine – now exhibited – enabled extracorporeal circulation, allowing surgeons to operate on a still, open heart to correct congenital defects, treat acquired or traumatic conditions, and eventually perform heart and heart-lung transplants.

Early experimental heart-lung machines were developed by John Heysham Gibbon (1903-1973) in 1937 and later applied in humans in 1953, managing to exclude the heart from circulation for approximately thirty minutes.
The exhibited heart-lung machine was purchased in Paris in 1957 for 890,600 Lire. Its cardiac function (circulation) was achieved through a system of keys (“fingers”) that propelled the blood in a coordinated and continuous manner, while its respiratory function (oxygenation) was provided by rotating discs within a cylinder.

The detailed focus on the heart-lung machine in the Exhibition underlines a pivotal moment in surgical practice – a point of departure from traditional methods. While archaeological artifacts show surgical instruments whose general design remains in use even in the 18th and 19th centuries, the heart-lung machine introduces us to a realm of highly technological surgery.

The fourth section of the Exhibition documents the advances achieved from the 18th century onward: the introduction of anesthesia, the discovery of pathogenic microorganisms, the advent of antiseptic and aseptic techniques, the ability to perform blood transfusions thanks to the identification of blood groups and the Rh factor, improvements in suturing techniques, the discovery of antibiotics, and the testing of biocompatible prosthetic materials – all fundamental in ensuring increasingly infection-free, less invasive, and less painful surgical interventions. Surgery has expanded into previously uncharted territories such as the abdomen, thorax, heart, major vessels, and skull. At the end of the 20th century, further innovations from physics and new materials led to the creation of flexible endoscopic instruments, which, using fiber optics or miniaturized cameras, allowed for effective endoscopic surgeries for biopsies, polypectomies, dilation of stenoses, and stone removal.

And finally, the surgery of today, already looking to the future: since development in 2000 of robotic surgery has emerged. This computerized system of sophisticated laparoscopic instruments, controlled by the surgeon from a remote console, offers enhanced three-dimensional and magnified vision, and movement precision that rivals or even surpasses that of the human wrist.

Introduction to robotic surgery

Conclusion

In conclusion, this Exhibition has a dual purpose. First, it serves to educate – especially young audiences – about a scientific journey of progress that, although largely overlooked, deserves thorough recognition and study as the outcome of extensive research, dedication, and the commitment of many surgeons who over the centuries have made the well-being of the individual a core ethical and moral principle. Second, as noted at the outset, it aims to prevent an institution of significant historical value from falling into oblivion, or worse, being ensnared by political and real estate speculation. San Giovanni di Dio remains a cherished institution among the people of Florence, awaiting only the acknowledgment of higher authorities to resume its rightful role in healthcare.

News Flash 610: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings