The exhibition audio tour takes listeners on a highlights tour, focusing and expanding on some of the major stories in Against the Odds. Featured speakers include physician Dr. Paul Farmer, journalist Laurie Garrett, former Surgeon General C. Everett Koop, and members of ACT UP, the AIDS Coalition to Unleash Power.

Look for this symbol Audio Tour Icon throughout the online exhibition or download individual tour stops using the links below.

  • Health and Human Rights

    Primary Health Care conference attendees on the front steps of conference site
    Palace of Lenin, International Conference on Primary Health Care, Alma-Ata, September 1978
    Courtesy WHO

    Our story begins with the declaration of Alma-Ata, which defined health as a human right, based on the importance of everyday needs, like clean water and a safe place to live, for a healthy life. Alma-Ata, now known as Almaty, is a city in Kazakhstan.In September, 1978, representatives from 134 countries and 67 organizations met there to discuss how to improve global healthcare ... the largest gathering of its kind in history. Pulitzer-prize-winning journalist Laurie Garrett writes on global health issues.

    LAURIE GARRETT: of the key features of Alma-Ata was to consider health part of well-being; to take it beyond just the absence of disease to the presence of well-being. So you can't have well-being if you're living next to a stream that's full of parasitic diseases and your children drink that water and die of dysentery. You can't have well-being if you have no housing, no place to live.

    Not all of the declaration's goals have been realized, but that does not mean that the meeting at Alma-Ata failed, says Dr. Paul Farmer, who founded Partners in Health, an international health and social justice organization.

    The great thing was that everybody did come together and say, "Look, everybody in the world deserves access to basic health care as a right." It serves as a model of ... what can be agreed upon. And ... then comes the work of civil society, of community organizations, of the movement ... to transform these from documents into reality.

  • Barefoot Doctors

    Chinese public health poster depicting a female Chinese barefoot doctor
    Go to the countryside to serve the 500 million peasants, 1965
    Courtesy National Library of Medicine

    In the 1960s the Chinese government called for thousands of young people to train as "barefoot doctors" or community health care providers. This poster, which reads "Go to the countryside to serve the 500 million peasants" depicts a woman with a medical bag on her way to help. Many Chinese people lived miles from hospitals and health care in villages across the country. After receiving training, barefoot doctors lived and worked in these communities, to bring treatment to all who needed it. Today, Ying Lowrey is an Economics professor, but in 1966, she worked as barefoot doctor. She explains how the Barefoot Doctors got their name.

    Actually it's not really you take off your shoes to be a barefoot doctor. Basically, the term probably from south of China and there's a lot of rice fields and people just go to take off their shoes, work in the rice fields, and then get out and then take care of the patient. So, in other words, it is very practical and very ... it's just very practical doctors. Actually, it's not doctors ... just those people provide certain healthcare and for the poor people. A lot of time they provide necessary healthcare.

  • Sidney Kark and Community-Based Health Care

    Letter from Sidney Kark to the principal of the University of Natal
    Letter from Sidney Kark to the principal of the University of Natal, 1957
    Courtesy The Rockefeller Foundation

    In 1942 South African doctors Sidney and Emily Kark opened a health center in Pholela, a poor region of eastern South Africa. To deal with every aspect of the causes of illness in this community, clinic staff provided vaccinations, gave regular medical check-ups,and taught farming and cooking methods to improve patients' diets. This holistic approach became known as "community-based health care" and was widely adopted across the United States and in other parts of the world. The Karks were able to teach others their methods at the University of Natal, the first South African medical school to train non-white students.

    In 1948, the government introduced apartheid, a legal system of racial segregation. University faculty frequently clashed with the administration over this policy, and in 1957, the minister of education, arts and science tried to take over the department where the Karks taught. In the letter you see here, to the president of the University, Sidney Kark criticized the plan. Soon afterwards, in response to ongoing intimidation by the government and the constraints on their work, he and his wife resigned. They left South Africa, and brought their ideas to other parts of the world, including Israel and the United States. Dr. Jack Geiger, an American physician and activist, visited the Pholela Health Center when he was a medical student. He recalls Sidney Kark's innovative approach.

    What he had done was say a community health center should be a source of primary care for a defined population; it should do health education; it should do epidemiologic surveillance of that population so that one knew what the major problems were; it should fashion interventions for the major problems; and it should follow up to see what the effects were; and, at Pholela and Lamontville, I know it first hand, that worked with extraordinary success.

  • Jack Geiger and the Lessons of Pholela, South Africa

    Dr. H. Jack Geiger in cotton field
    Dr. H. Jack Geiger in the cotton fields of Mound Bayou, Mississippi, 1968
    Courtesy Daniel Bernstein

    As part of Freedom Summer, the Civil Rights Movement's voter registration drive, Dr. Jack Geiger left Boston where he was in medical school and traveled south.

    ...about fifteen or twenty of us across the country spontaneously formed an organization called the Medical Committee for Human Rights, sending hundreds of physicians, nurses, social workers, psychologists and others that summer to Mississippi to provide medical care not just for the white kids coming down from the north but for all of the indigenous civil rights workers in Mississippi and I served as the field coordinator for that effort.

    In the course of that I took a long look around at what I saw in Mississippi and realized that I didn't have to go to Africa and Latin America or Southeast Asia to do what I wanted to do; that we had all of that here. Not at the same absolute level but certainly at the same relative level to the rest of the population; the southern rural areas, the urban ghettos of the north, Appalachia, the Native American reservations. One could count the populations that lacked medical care, that lived in poverty, that had huge burdens of illness and premature mortality and limited or no access to medical care.

    I kept coming back with my colleagues from Boston to Mississippi that fall and there was a meeting in Greenville, Mississippi on December 11th, 1964 to discuss what do we do now? And, for the first time, I don't know why I had blocked it all, I remembered Pholela...

    Geiger went on to secure funding from the federal government to establish two successful community health centers in Boston and Mississippi. They were based on the model established by the Karks in South Africa, and you can seem them featured in the display to your left.

  • The Delta Health Center

    Two men dig hole for a water pump
    Digging a water pump, 1968
    Courtesy Daniel Bernstein

    Dr. Jack Geiger, former director of The Delta Health Center in Mississippi explains how the center provided much more than medical care.

    We still didn't have a formal advisory board but we met with some community leaders and said tell us what you think of the health services and how are we doing? And they said, "Oh the health services are great, but we wonder if you could do anything about the fact that the kids have no shoes to go to school in and that we don't have any warm clothing and, as you know, it snows and freezes in Northern Mississippi in the winter, and a lot of us are living in shacks with the holes in the roof and no heat and drinking water from the drainage ditch. You think you could do anything about those problems?"

    In response, health center staff worked with local people to install water pumps and sanitation facilities. They looked for ways to improve daily life and build a better future, providing training and job opportunities as well as classes to prepare people for college. The Delta Health Center was also regularly treating infants and children for malnutrition and infection, symptoms of hunger. To treat the cause of the problem, staff established a Farm Cooperative. Community members worked together to grow enough food to feed everyone, and have a little left over to sell for profit.

  • Jackson Medical Mall

    Front entrance of Jackson Medical Mall Thad Cochran Center
    Jackson Medical Mall Thad Cochran Center, Jackson, Mississippi, 2007
    Courtesy National Library of Medicine

    Health centers that serve local communities can be extremely important in disasters, because they work with underserved groups that are often the most vulnerable in a crisis. In August, 2005 Hurricane Katrina destroyed medical facilities across the Mississippi and Louisiana coast, and forced the displacement of tens of thousands of people. The Jackson Medical Mall in Jackson, Mississippi, became a resource for those in need of care. Dr. Aaron Shirley explains:

    We had a significant increase in services for displaced persons; persons from as far away as New Orleans and the Mississippi Gulf Coast. At one time, there were close to about 25,000 people in the Jackson metro area who had been displaced by Katrina. Our clinics were overloaded because most of our clinics they are booked and these were unexpected, this was unexpected demand. So we had to stretch our resources, extend our hours to accommodate many of those refugees.

    Director of the National Library of Medicine, Dr. Don Lindberg, explains the Jackson Medical Mall's unique history.

    By 1995, the once-thriving shopping mall in the heart of downtown Jackson, Mississippi had fallen into disrepair ... the 53-acre shopping complex of 900,000 square feet was abandoned as people moved to the city's suburbs. Dr. Aaron Shirley saw an opportunity. He worked with the University of Mississippi Medical Center and Dr. Wallace Conerly, Vice Chancellor of Health Affairs. They raised the three million dollars needed to buy the mall and funds to convert the building into an ambulatory health center. In addition to providing a lot of badly needed square footage for the medical center for its outpatient operation, the mall seems to please patients more with its informal and familiar atmosphere than the traditional and necessarily formal hospital setting. Some call it: "The mall with it all."

  • Oral Rehydration Therapy

    Cup and packets of oral rehydration solution
    Packets of oral rehydration solution and cup, 1980s
    Courtesy Norbert Hirschhorn, M.D.

    Communities living far from health centers and hospitals rely on "simple solutions" during outbreaks of disease. These packets and the cup to mix them in are from an Egyptian campaign to teach families one of the most effective medical treatments for dehydration: Oral Rehydration Therapy.

    Dehydration can be a deadly condition. It is caused by diarrhea, when the body loses more fluids than it takes in, a symptom of illnesses like cholera. Such diseases can occur where clean water and sanitation systems are limited. Drinking more water is not an effective treatment because the body cannot absorb the fluid and replace the valuable salts that dehydrated patients have lost.

    In the 1970s, researchers recognized that a solution of salt, sugar and water can be effective in replacing lost fluids because sugar helps the body absorb the salt and water needed. Before Oral Rehydration Therapy, hospitals focused on intravenous delivery of fluids to patients. Former Surgeon General Dr. C. Everett Koop explains:

    I have personally ... been called to come and do something about an epidemic of ... diarrhea in ... Caribbean islands. You have to take a team. It's very labor-intensive. You have to have sterile water. You have to have some kind of a way to administer it, and you have the problem of setting up really a young hospital to do nothing but give intravenous fluids.

    In major epidemics, hospitals may run out of intravenous fluid drips, or not have enough people to administer them to patients. People sometimes fall ill far from a hospital or are unable to afford medical care. Oral Rehydration Therapy solves these problems.

    And it had tremendous benefits. First of all it didn't require any of the labor-intense care. Secondly, it could be put together in a home or a clinic or a storefront in the town. And it also was made of things that were frequently found around the house.

  • The Landless Workers Movement

    Landless Workers' Movement coordinators plan encampment
    Coordinators meet to discuss plans for the encampment, Pará, Brazil, 1999
    Courtesy Dan Baron Cohen

    The Brazilian constitution guarantees a series of rights to its citizens, including access to land. Yet large corporations own much of the country's richest farmland, and often leave large areas unused. Members of the Landless Workers' Movement, who lack access to affordable and nutritious food, have begun to take over this idle land to build their own farms and communities. This picture shows members of the group marching towards a settlement in the southern part of the country. Around the world, many small local farmers have been driven out of business. But land and the food it provides are crucial to their health and survival, explains Dr. Paul Farmer.

    ... to be displaced from one's land in a place that's an agrarian society is ... something akin to, you know, a death sentence for some of the people. Um, you know, the vulnerable children, older people, they're ... they're not gonna make it because the families are relying on that land ... to feed the families and also to sell their surplus ... to have things like money to send kids to school or medicines or ... funeral expenses, et cetera. And, so, the stakes are very high ... people are really fighting for access to land so that they can live.

    Members of the Landless Workers' Movement grow beans, rice, coffee and sugar, and build homes, schools and businesses on the land they occupy. So far, more than 350,000 families have been given government permission to remain on their settlements permanently.

  • The AIDS Epidemic

    Morbidity and Mortality Weekly Report
    Morbidity and Mortality Weekly Report, June 5, 1981
    Courtesy National Library of Medicine

    The first cases of what would come to be known as Acquired Immune Deficiency Syndrome, or AIDS, were seen in 1981. In this June report from the CDC, doctors reported unusual illnesses occurring among young gay men. Dr. C. Everett Koop was Surgeon General of the United States in those early days.

    We had never seen anything like this before. We didn't know what to name it, even ... and, um, then when people began to realize that what they were seeing was not a specific disease, but a group of people who had lost their immunity to almost anything, and so they really had an immune deficient disease, and the things they picked up we got to call 'opportunistic infections.'

    A number of key discoveries were made over the next few years. In 1983 researchers first identified the virus that causes AIDS, later named Human Immunodeficiency Virus, or HIV. The discovery paved the way for a test to detect the presence of the virus. The Food and Drug Administration licensed the first blood test for AIDS in January 1985, which you can see in this case on the left. Although the test was an important step in preventing the spread of the disease, receiving a positive diagnosis was challenging for many people who faced discrimination and loss of privacy.

  • Report of the Surgeon General, C. Everett Koop

    The Surgeon General's Report on AIDS
    The Surgeon General's Report on AIDS, 1986
    Courtesy National Library of Medicine

    By 1986, more than 10,000 people were thought to have died from AIDS in the United States. President Ronald Reagan, who had said little publicly about the disease, asked Surgeon General C. Everett Koop to write a report about the epidemic and ways to prevent its spread. In the tense political climate, Dr. Koop worked to ensure that the report he wanted Americans to read survived the review process.

    For example, I walked into a Cabinet meeting ... and ... the first thing that I said is, "Gentlemen, I know that, uh, this room leaks like a sieve and, uh, it would be tragic to the plans that the Public Health Service has for, um, the report I have written on AIDS if this were leaked to the press before it was time to do so. And therefore I have numbered, uh, these, uh, reports that I am handing out. And I know who has what number, and, uh, I will collect them at the door when the meeting is over and I'll be able to follow a path of somebody who doesn't understand what I'm talking about and leaks this to somebody. So please do not do that."

    The final report, later mailed to all U.S. residences, was a frank assessment of the disease, how it was spread, and measures that could be taken to prevent transmission, including the use of condoms. While many applauded Dr. Koop for changing the national dialogue on AIDS, some conservative critics opposed his direct approach.

  • ACT UP, the AIDS Coalition to Unleash Power

    ACT UP members shout protests and hold placards
    ACT UP Members protest
    Courtesy Donna Binder

    In 1987 a group of about 300 people formed ACT UP, the AIDS Coalition to Unleash Power, in response to prejudice against people with AIDS and the rising death toll. This poster features the organization's slogan, "Silence = Death." Journalist Laurie Garrett covered the epidemic.

    I was on the periphery of it. The observer, the reporter watching it. And yet, I had to stop when I hit my hundredth funeral. I couldn't take it emotionally anymore. It was a time of such great despair. It was almost overwhelming. And what you saw was that the homophobia continued in America, so that uh, tragically you were witnessing men abandoned by their own families, left to their own resources to face this horrible, horrible disease for which there was no treatment that worked.

    ACT UP staged dramatic protests against discrimination and campaigned for more research into the disease and possible treatments. Member Ann Northrop explains their approach:

    The goal is public attention. The whole idea was to bring a sense of urgency to the AIDS epidemic; to say, people are dying, we can do something about this, we must do something about this, and at the moment, we're not doing anything about it. So, it was always to make it an emergency, to make people see that this was something we had to deal with, immediately. And to bring all that out into public view, because, otherwise it wasn't being talked about.

    Dr. Rick Loftus, a former journalist and a member of ACT UP, talks about what they achieved.

    I think the greater willingness for scientists and doctors to acknowledge the wisdom and expertise of patients; to involve patients in community groups in scientific and medical projects, and recognize their involvement as being important and valid. So, I think AIDS activism has wrought incredible changes, and I felt really privileged to be involved in it. I mean, it's why I became a doctor. I would have never become a doctor ... otherwise, I'd probably still be working at some newspaper somewhere.

  • Jonathan Mann and the Global Programme on AIDS

    Jonathan Mann speaks at UN podium
    Jonathan Mann, United Nations General Assembly, 1987
    Courtesy UN/DPI Photo by Saw Lwin

    Dr. Jonathan Mann led the global response to AIDS at the World Health Organization. Dr. Mann successfully argued against mandatory testing or quarantine for people living with HIV. He believed that infringing on the rights of patients would make it harder to control the pandemic.

    We thought of discrimination as a tragic counterproductive effect of the epidemic of AIDS. AIDS existed, infected people were discriminated against ... and as a consequence public health efforts would be reduced unless we fought that discrimination.

    He came to realize that injustice and inequality also made certain groups especially vulnerable to HIV.

    The epidemic taught us something that we could not have learned in the books ... it led us to understand that social marginalization, discrimination and stigmatization ... in other words a lack of respect for human rights and dignity ... is itself a root cause of the epidemic.

  • The International Campaign to Ban Landmines

    Buddhist monks march with protest signs
    Buddhist monks protesting against landmines, Cambodia 1996
    Courtesy International Campaign to Ban Landmines/John Rodsted

    Cambodia was heavily contaminated by landmines during nearly three decades of conflict, beginning with the Vietnam War, and was one of the first group of nations to join the Mine Ban Treaty. Long after the end of hostilities, landmines prevent the use of farmland and endanger civilians. In 1997, 122 nations agreed to ban the manufacture, stockpiling, and use of landmines. In the years leading up to the treaty, campaigners around the world, including Buddhist monks in Cambodia, pictured here, pressured their governments to sign on.

    Like landmines, modern conflicts strike civilian life with devastating results. Battles fought among communities injure bystanders, damage health care services, and interrupt the supply of food, water, and electricity. Even in peacetime, the costs of maintaining a large army and buying weapons divert money away from programs that could improve the quality of life and prevent illness. Dr. Paul Farmer has worked trying to provide community health care in war-torn regions around the world. He describes the effect conflict has had on his efforts.

    The roads get disrupted because of everything from land mines, uh, to barricades. You can't have a supply line if the roads are... disrupted, obviously. The staff won't come out of their homes ... They're frightened to go outside. There ... are curfews, et cetera.

    But, Farmer says, he and his colleagues work to continue providing services even in the face of such disruptions.

    For example, we sometimes carry surplus stock. And ... we work with community health workers, because they actually don't have to travel on the road to reach their patients. So, we've done our best in difficult... situations. But there are limits to what we can do to prepare for the kind of disruption that accompanies ... political violence and war.

  • Bernard Lown and International Physicians
    for the Prevention of Nuclear War

    Dr. Evgueni Chazov and Dr. Bernard Lown accepting Nobel Peace Prize and plaque
    Dr. Bernard Lown and Dr. Evgueni Chazov accept the Nobel Peace Prize, Oslo, Norway, 1985
    Courtesy IPPNW, photograph by Marvin Lewiton

    Dr. Bernard Lown received this Nobel Peace Prize in 1985 for his work as co-founder of International Physicians for the Prevention of Nuclear War, or IPPNW. By 1978, Dr. Lown already had a successful career as a cardiologist when he was inspired to launch the organization.

    It's a balmy, beautiful spring day. My wife and I are reflecting that we have everything. We have good kids. We have enough to live on. I have a good profession. She has a good profession. Louise turns to me, she says, "Are you happy?" I say, "No. I'm miserable." I say, "Are you happy?" She says, "No, I'm miserable, why? I mean what will we leave to our children?"

    The world is about to be destroyed, the accumulation, the stockpiling of nuclear weapons was enough at the time to provide nearly three to four tons of dynamite for every man, woman and child living on earth equivalent in nuclear weapons. There were about 50,000 nuclear weapons the Russians and the Americans amassed and they kept amassing them more and the whole instability of that because we're now on missiles and it took about 25 minutes for a missile to go from United States to the Soviet Union or the Soviet Union back here and the moment they launched, what do you do? You launch back, so you destroy them because they destroyed us and we leave no world at all. We gotta do something and I said, "I have an idea."

    Dr. Lown started IPPNW with Soviet physician Evgueni Chazov at the height of the Cold War. More than 200,000 people from over sixty countries joined the group. Together, they campaigned against weapons testing and publicized the potential health and environmental consequences of nuclear war.

  • The World Health Organization and Smallpox Eradication

    Dr. D.A. Henderson and colleague adminster a smallpox vaccination to a child as other children watch
    Dr. D. A. Henderson in Ethiopia, administering a smallpox vaccination, ca. 1972
    Courtesy WHO

    The Director of the National Library of Medicine, Dr. Don Lindberg, explains the history of smallpox eradication.

    In 1967, the World Health Organization asked Dr. D. A. Henderson to lead its Global Smallpox Eradication Campaign. At this time, more than 60,000 people a year contracted the disease. Historically, of course, Smallpox has existed in humans for thousands of years and has killed millions.

    Henderson and his colleagues had the advantage of two technical innovations. The first, a new freeze-dried version of the smallpox vaccine. This lasted a month, instead of the older liquid version that lasted two days. Second was the availability of new bifurcated immunization needles.

    But most to Henderson's credit was his invention of a brilliant new strategy against smallpox, which called for surrounding and isolating outbreaks of the disease in villages. This strategy turned its back on the traditional and futile efforts of mass immunization of entire populations. The team learned to watch for outbreaks and contain the disease before it could spread. They offered rewards for information about new cases, and then responded quickly, isolating the infected person and vaccinating their close contacts. As Dr. Henderson recalls, some situations required a special effort.

    It wasn't working in India. And we didn't know why until we finally started looking at the cases in more detail and what we found was that there were many times where people would come in, a man would come into work in a city, bringing his whole family; one of the members of the family gets sick and they'd immediately go back to their home village and start more cases so that we were always behind in trying to stop the outbreaks, so we decided the summer of 1973 that we would do a search of all the villages of India in a ten-day period and so we mobilized 120,000 health workers who, in the ten days, went to every village in India and immediately they found cases. Then teams would go out to control those outbreaks.

    After ten years of work smallpox was eradicated ... the only human disease to be successfully eliminated. The last known case was diagnosed on October 26, 1977. It was in man in Somalia.

  • CANDHI, the Central American Network for Disaster and Health Information

    Aerial view of damaged buildings and road
    Damage caused by earthquakes on Las Delicias Colony, Santa Tecla, El Salvador, 2001
    Courtesy Jorge Jenkins, M.D.

    The National Library of Medicine has partnered with the Pan American Health Organization to launch a disaster response network, to deliver vital information to Central America during an emergency. Dr. Lindberg describes the program:

    Central America is particularly vulnerable to natural disasters— it is located in the path of large-scale meteorological systems and on the fault-lines of tectonic plates. In the past twenty-five years, over twenty natural disasters per year occurred in this region. During many of these disasters, health facilities and communication services collapsed. The public health impact of these disasters showed the need for reliable health information, for a library of successful responses to emergencies in the region and of course, for better communication systems.

    In 2000, the Central American Network for Disaster and Health Information, called CANDHI, was launched. CANDHI is managed by a partnership of the U.S. National Library of Medicine, the Pan American Health Organization, the UN International Strategy for Disaster Reduction, and the Regional Disaster Information Center in Costa Rica. This network of ten Disaster Information Centers in six countries provides health information, news, maps, weather reports, advice and alerts. Their goal is to make up-to-date information available throughout all of Central America in an emergency.

  • Getting Involved in Global Health

    Dr. Paul Farmer sits with a young boy.
    Dr. Paul Farmer
    Courtesy Partners In Health, Photography by Moupali Das-Douglas

    People just like you are making a difference in global health. They're working to tackle poverty and inequality, to solve the root causes of disease. And they are fighting for health care for all. Dr. Paul Farmer, pictured on the right, began his career in global health when he was still in medical school, founding an organization called Partners in Health to provide health care for Haiti's rural poor. He understands that global health issues can seem insurmountable at times, but invites each of us to get involved.

    The thing that I'd like to tell ... someone who asked me, "Well, I'm just one person. This is too big," is ... "You're right. You ... are one person, and it is too big for one person to do. That's why you have to work with other groups. That's why I keep making lists of, you know, groups with whom we can work. You certainly can't have a movement if it doesn't have lots of people in it. You certainly can't change policy if you're not willing to talk to legislators. You certainly can't change health behaviors if you're not willing to work closely with families and ... communities."

    I'm pretty confident that ... that individual who's worried about his or her ability ... to make a difference ... if they are able ... to insert themselves into these movements, that's when they'll really see a difference.

Have your say on the issues you care about. Explore these opportunities to get involved.