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FIRST LADY HILLARY RODHAM CLINTON
VIDEO MESSAGE FOR 25TH ANNIVERSARY CELEBRATION:
ORAL REHYDRATION THERAPY IN THE UNITED STATES
NOVEMBER 14, 1996
Good afternoon. Last March, I was delighted to accept an
invitation to be Honorary Chair of this important conference. I
am sorry I can't be with you today as you launch your nationwide
campaign to promote oral rehydration therapy. I would
particularly like to thank the Johns Hopkins School of Public
Health for spearheading this initiative.
On my trip to Bangladesh two years ago, I visited a center
supported by Johns Hopkins and USAID where doctors have saved
millions of lives through their pioneering use of oral
rehydration therapy. I also watched mothers and fathers and
sisters and brothers administer this therapy to family members
seriously ill with diarrhea. I saw a simple yet effective
treatment give health and hope to children and families.
While I was in Bangladesh, I met a doctor from Louisiana who
had come to learn about oral rehydration therapy. He told me
that back home he was seeing increasing numbers of children
hospitalized and dangerously ill because of diarrhea. So he had
travelled to a country that we think of as less developed to
learn a basic, cost-effective method to treat our children.
This simple therapy, costing only cents a dose, now saves
the lives of millions of infants around the world every year.
The therapy was developed in this country and has been proven
safe and effective for use here, but we have failed to teach
health care providers and families to use it as the first line of
treatment for diarrhea.
Today, 300 to 400 babies in the United States die each year
from diarrheal dehydration. At least 200,000 children are
hospitalized. And our failure to use oral rehydration therapy
costs more than $1 billion each year.
As we mark the 25th anniversary of the introduction of oral
rehydration therapy in the United States, it is so important that
we educate and reach out to health care professionals and parents
in our own country about the use of one of the best and most
basic tools to prevent disease and death. Twenty-five years ago,
the White Mountain Apache Tribe had the foresight to enter into a
partnership with Johns Hopkins to use oral rehydration therapy,
and they reduced deaths from diarrheal dehydration to zero.
Every community in America can and should follow in their
footsteps.
The campaign you are launching today will mean that doctors
in our country will no longer travel thousands of miles to learn
about a therapy that was developed right here. Because of your
determination and expertise, we can look forward to the end of
unnecessary suffering, disease and death from diarrheal disease
and dehydration.
Thank you and best of luck.
###
2
First Lady Hillary Rodham Clinton
Honorary Chair, ORT Symposium
Draft Video Message
November 14, 1996, 2:25 pm
The Johns University School of Public Health
Good afternoon.
Last March I was delighted to accept Johns Hopkins' invitation to be Honorary Chair of
this important conference. We are here to celebrate one of the best and most basic
tools known in the world today to prevent disease and premature death.
Today we gather to mark the 25th Anniversary of the introduction of the WHO-
recommended Oral Rehydration Solution in the United States and to increase its use
among our medical practitioners and families. This simple therapy, costing only a few
cents a dose, now saves the lives of millions of infants around the world every year.
While the therapy was developed by US scientists, and proven effective for children in
the U.S., we have failed to teach our parents to use it or our medical students to
apply it as the first line of treatment for common diarrhea. Today, three hundred to four
hundred U.S. babies die a year from diarrheal dehydration. At least 200,000 children
are hospitalized. Tweny-six hundred (2,600) elderly die. Added to this toll of human
suffering, our failure to promote ORT wastes more than 1 billion health care dollars per
year.
You who have gathered here today have the determination and know-how to stop this
intolerable waste of lives and resources.
When I was in Bangladesh 2 years ago, I saw little babies who would have died from
diarrhea being saved by this miracle solution -- ORS. There is no reason why our own
children should not benefit from this simple technology.
I am delighted that you who are international experts have met over the last two days to
formulate a plan to stop the unnecessary death and suffering from diarrheal disease
and dehydration. The nation awaits your wisdom and strategies.
In closing, I must commend the foresight and courage of the White Mountain Apache
Tribe, who 25 years ago, entered into a partnership with Johns Hopkins to measure the
effectiveness of ORS among their children. It was at a time when no other medical or
lay community was willing to test this solution, given the alternative of "high tech"--and
high cost-intravenous care.
14 AAP recondencined wond sme on 1990,
xwased
commitment to use recommit ORT
I also add my personal congratulations to Johns Hopkins School of Public Health, and
the conference coordinator, Dr. Mathu Santosham, for spearheading this initiative to
prevent unnecessary death and suffering among our most vulenerable populations.
Be assured that the Clinton Administration will do its part to continue to support
humane, accessible, effective and affordable medical treatments like ORS, treatments
that save lives, and improve the quality of life for all citizens of the U.S.
Thank you and best of luck.
studus Mattu bn Apache
did Res.
Transcript
FIRST LADY HILLARY RODHAM CLINTON
REMARKS TO NATIONAL LESSONS WITHOUT BORDERS CONFERENCE
BALTIMORE, MARYLAND
SEPTEMBER 16, 1996
Thank you. Thank you very much. I want to start by apologizing for the delay. It
took a lot longer in the rain to get here than anyone had planned and I'm very, very sorry
that anyone had to wait and I hope you've not been inconvenienced.
But I am delighted to be here and I'm especially pleased because as I look out in the
audience, I see that we have both those who are participating in the Lessons Without
Borders Conference, who themselves are development experts who are working both abroad
and here at home and dealing with the most pressing human needs that we face around the
world, but I'll also note that there are younger students and faculty from Johns Hopkins
who may not be as familiar with what this conference is about. And so I'm delighted that
you have both those involved in it and those who are interested in these lessons, and I look
forward to sharing some of my impressions with all of you.
I particularly want to thank Mayor Schmoke and his wife Dr. Schmoke who are here
for their friendship and support but also more particularly, Baltimore was the first city that
really embraced the idea that the work that the United States had been doing abroad for
decades might possibly have something to teach us here at home. And under Mayor
Schmoke's leadership those lessons have been taken to heart and put into effect.
We're also always pleased to be anywhere with your United States Senator Paul
Sarbanes and his wife Christine Sarbanes. I'm particularly pleased though, on this
occasion, that Mr. Sarbanes has been a consistent, reasonable voice on behalf of American
involvement around the world in the area of development.
Congressman Cummings is here as well and our Ambassador to Bangladesh, David
Zamiro (phonetic). I also want to thank Johns Hopkins. Once again I must say I love
coming and Dr. Brody is always such a delight for me to read about and learn about what
this great university is doing, and I want to thank you for hosting this. But more that for
the role that Johns Hopkins has played in development work and in particularly the work of
USAID for many years.
And then finally I need to thank Brian Atwood, the administrator of USAID, who
has brought a new sense of energy and urgency and common sense to the agency and has
really made a difference under his leadership, not only in making our work abroad more
effective but beginning to explain to those of us who pay for it, the American taxpayer,
why it is a good investment to be doing what we are doing around the world in helping
people to become self-sufficient, understand what democracy means, what the requirements
of citizenship are.
So all in all, it is a great pleasure to be here and thank all of you who are involved
in this conference for bringing so much energy, faith and commitment to the partnership
that is represented by the USAID experience abroad and in our communities here at home.
Since Brian Atwood launched the USAID initiative "Lessons Without Borders" two
years ago, I've been following its progress with great interest. And I've been extremely
pleased to see that the program has already helped improve the lives of thousands of
American children and families.
Now let me just explain to those of who are not development experts what we're
talking about, and I'll do it by giving you a few examples of what has happened abroad
that the United States has helped fund and provide technical assistance for, and what we
have learned which we then have brought home.
For example, here in Baltimore we have seen how grassroots strategies pioneered in
Nairobi, Kenya, can also improve childhood immunization rates and encourage economic
development in America. As you may know, Baltimore has increased its childhood
immunization rates from 62 percent to over 95 percent by adopting a simple strategy of
replacing complicated jargon and brochures that people didn't read with a door-to-door,
person-to-person initiative, so that people in the neighborhoods where the largest numbers
of children not being immunized would find a knock on the door and a neighborhood
worker standing there to say, "Have you gotten your baby immunized?" If not, "Why not?"
and "How can I help you get that done?"
I'd often wondered in the years during which I was involved in trying to increase
the immunization rates of American children why, for example in this hemisphere, the
United States would have the third or fourth worst rate of immunization, while so many
countries that were poor and had a high rate of illiteracy were doing a better job than we.
What were we not doing?
It really boiled down that in many other countries USAID was helping those
countries create infrastructure that would reach out to families to persuade them to bring
their babies in for their shots. And often times it would be a worker who would go up
across the mountains of Peru or through the rain forests of Central America or out into the
savannahs of places like Kenya, finding families and helping them overcome the obstacles
of knowledge and awareness, or transportation or fear or whatever else might stand in the
way to be sure that their children would be immunized.
So when we look at what we have done as a country abroad, I thought it was just
common sense that under Brian Atwood's leadership USAID, which cannot fund programs
here in the United States, that is not its mission, would though be able to share its expertise
and acquired experience with cities like Baltimore.
For decades, USAID has supported efforts in developing countries to address the
debilitating problems of poverty: Poor nutrition, poor pre-natal care, disease, illiteracy, and
unemployment. USAID workers and their partners abroad have seen firsthand what is
practical. So how then can we profit from that?
Well that is what this conference is all about. We are bringing together the people
who have done the work on behalf of you and me, through our development efforts with
people who are working in our cities and our rural places here at home.
Over the past four years I have seen firsthand many programs around the world that
really work. I have become somewhat of a cheerleader for USAID and development efforts
because I, like perhaps many of you, am not very knowledgeable about what we actually do
in foreign aid, and many people in our country have an idea that we spend a huge
percentage of our budget on foreign aid. In fact often times in public polls when citizens
are asked, "How much do you think the United States spends on foreign aid?", the answers
range from 15 to 25 percent of the United States budget. And often times then the person
asking the question will follow up and say "Well how much do you think we should spend
to try and deal with problems in other countries, both to help the people there and to stop
the spread of several problems to make the world safer for American interests?", and people
scratch their heads and say "Well maybe ten percent."
Well of course the fact is we spend less than one percent on foreign aid, on the kind
of work that is done not only to keep our embassies going abroad, to take care of you when
you travel and might need some help, but to do this kind of work as well. And I have seen
and became somewhat of a witness about how effective the relatively small amounts of
money so many of our programs abroad rely on are.
We've already heard reference to a dinner that is being held later this evening in
honoring an institution called the International Center for Health and Population Research
in Bangladesh. That center has had lots of help from Johns Hopkins as well as from
USAID. The doctors there have saved millions of young lives through their pioneering use
of something called Oral Rehydration Therapy. That is a method of treating serious cases of
diarrhea with a basic salt-and-sugar mixture. Now I brought up this packet with me to
show those of you who are students here at Johns Hopkins what I'm talking about, because
the others who are working in this field know very well that inside this packet is a mixture,
a combination of salt and sugar that when dissolved in clean water and administered to a
person with diarrhea, particularly a child is most likely the one to be afflicted with perhaps
fatal diarrhea, that child's life can be saved. It doesn't even have to be in a hospital or
intravenous fluid going through the veins if this is administered over a long enough period
of time.
I walked along the beds in this center in Bangladesh and I've seen mothers and fathers
and sisters and brothers administering this combination of salt and sugar to a person
seriously ill with diarrhea. My visit there was meant to highlight the USAID presence and
American support for this pioneering effort.
But while I was there, I met a doctor from Louisiana who had come to study at the
center for about six months. And I asked him why he had chosen that center, and he told
me that at the time I had this conversation with him, a very large number of children in
Louisiana were uninsured children, they were very poor but not poor enough to qualify for
the state's level of Medicaid, and their families did not have jobs that provided health
insurance, and that he was seeing increasing numbers of children hospitalized who were
dangerously ill because of diarrhea. So he had gone all the way across the world, to a
country we think of as a less developed country, to learn a cost-effective, simple method
for helping save children's lives which he then could bring back to Louisiana. It's that kind
of interchange and learning of lessons this conference is meant to promote.
Some of you who know the work of Jim Grant and others of you I'm sure have
heard of UNICEF understand how he took simple ideas like this little packet and preached,
to many of us it seems as though he would never stop, about how these simple
interventions that don't cost a lot of money could really save children's lives. And that's
what we're seeing here in the United States. Oral Rehydration Therapy can be a more
accessible, more effective, and less costly alternative to hospitalization: It costs just $7 a
day, it can be administered at home, compared to the $800 a day it costs to administer
intravenous drug treatments in American hospitals.
The lessons we can learn go beyond health. They also apply to our challenges from
economic self-sufficiency to effective family planning.
Last fall, I visited a poor area of Santiago, Chile, where the schools are open on
weekends to accommodate parents' work schedules. And I met a lot of parents who are
trying to become more involved in their children's lives and to know what to do, how to
take care of their children more effectively. I see in this country similar kinds of parenting
programs, some of them borrowing lessons from what we are seeing what works in other
countries.
One of the most exciting programs that we have brought home at the national level
here as well as locally is what is called microenterprise. That means lending small amounts
of money to very poor people for them to start their own businesses, for them to buy
certain products that they need to re-sell so that they can try to become more economically
self-sufficient.
That is happening here in Baltimore. With microenterprise lending, small loans are
given to start very small microbusinesses. I've seen the difference that can make in the
lives of people from India to Nicaragua. I have stood in some of the poorest places in the
world and have listened as women told me how their lives had changed because somebody
had believed in them enough to see them as credit-worthy. When all of a sudden they had
some resources which they used to create a business.
As we begin to implement welfare reform, I think one of the most important aspects
of our efforts will have to include a very large-scale commitment to microenterprise.
Because if we intend to not only help people get off welfare, but to change the
environments and communities in which people have become economically trapped, there
has to be more economic activity. If we think that is a challenge, then imagine how it must
have seemed to the very first person in the world to devise the idea of microenterprise.
His name is Dr. Muhammad Yunus, he is also from Bangladesh, he was trained in
the United States as an economist and when he returned home he looked for ways to try to
take the ideas he learned about the economy and put them into practice in his own country.
He realized that although the millions and millions of very poor people in Bangladesh had
skills, those skills were not considered economic skills. They weren't considered market-
worthy. And yet he could see how with a little bit of investment, those skills could create
entrepreneurs and businesses that would create economic activity, that would help lift not
only individuals but whole communities out of poverty.
I visited one of the villages where the bank that got these started, the Grameen
Bank, is working. And I looked at this village, it was a Hindu village that was a village of
untouchables. My schedule was such that I could only go to one village, and the people
arranging it wanted me very much to go to a Muslim village, as Bangladesh is a
predominantly Muslim country. But we couldn't work it out and so the Muslim women,
and all the borrowers were women, came from their village to the Hindu village where we
had a big meeting, where the women stood up and told me how their lives had changed.
One woman had stood up and told me that she borrowed the money to buy a milk
cow. With that one milk cow she was able to produce enough milk which she then sold so
she could buy another milk cow. And then as a proud owner of two milk cows she was
able to take the money that she made and buy a rickshaw for her husband, so that he could
begin to try to be a taxi driver in the village where they lived.
I went into a home that had been built because of the Grameen bank's lending
policy, and I saw firsthand how the entire village had been transformed and as importantly,
how the lives of these women who were borrowers had changed from destitution to
inspiration, not only for themselves but importantly for their children and the rest of us.
I visited a similar microenterprise effort at a community-based bank in Managua,
Nicaragua, one of the poorest areas of that city that has seen civil war, earthquakes and
many different kinds of challenges. At the FINCA Village Bank, "Mothers United," a group
of women located in that neighborhood, had borrowed money and had worked with each
other by creating a unit of borrowers who supported each other's economic activity. I
heard how those very small sums had started businesses that were sewing and selling
clothes or baking bread and pastries, selling auto parts door to door, mosquito netting. The
kinds of things that were needed in the community but would otherwise, perhaps, not be
available.
And finally, on my visit to Santiago, Chile, I met a seamstress who told me that for
years she could barely make a living. She had an old, beat up sewing machine that was
always breaking down. With a small loan she got a brand new, fast-speed sewing machine,
and she told me "I felt like I had been released like a bird from a cage." She got that
sewing machine and began to kiss it over and over again because she knew what a
difference it would make in her life.
We have seen in our travels so many instances of how USAID, with a little bit of
money, has been able to spawn a great deal of local support and community effort and has
been able to, with technical assistance, train people in the local areas to carry on the work.
So as we look at the lessons that have been learned from our work overseas, I'm convinced
that many of those lessons can be learned and applied here.
One of the most important areas is in family planning and prenatal care for children.
And particularly for at-risk children and their mothers because we still have a very high
rate of infant mortality and maternal mortality around the world. And in some of our inner
cities our rates of infant mortality are as high as some third world countries.
In Indonesia I saw how the whole community had come together to support families
in their choice of family planning and in the care of their children. In Brazil I met very
courageous health officers who had committed themselves to family planning efforts
because the hospital where I visited with them has an admission rate that is 50 percent
women giving birth and 50 percent women who are appearing at the hospital after self-
induced abortion with serious physical problems. And those health officers knew that
sensible family planning access had always been available to the rich women in Brazil, but
not available to poor women.
Certainly many of the problems that we see around the world are exacerbated by
incredible population pressures, and one of the things that I would hope is that when our
Congress looks at USAID's work, they would understand how important family planning is
internationally. That American assistance to try to help countries deal with their population
pressures is in America's interest economically, environmentally, politically and every other
way I can think of.
So these are the kinds of issues that we have brought home with us and this is what
this conference is all about. There are many more examples that will be discussed at this
conference, from the hospital that I saw in Manila where one day-old babies are being
taught to drink from cups because they cannot be taught to breastfeed, so they cut down on
infection from bottles that can't be sterilized in slums, to the kind of work that I saw in
Central and Eastern Europe that are teaching people what democracy really is, what a free
press is. All of it is part of America's commitment to take our own ideals and give other
people the chance to learn how to live democratic, free enterprise lives in this complicated,
new challenging world.
Now in the grand scheme of things America's investments in social development
abroad are minuscule. But the differences that they have made in our global economy, in
world peace and prosperity and the lives of men, women and children are immeasurable.
America's ideals and interests cannot be worse than the political, economic and
social (inaudible). As this conference demonstrates, our engagement represents
opportunities for ourselves at home, not just obligations abroad. I would hope that every
American who hears about this conference will understand that it is a two-way street. The
money being invested in social development abroad is being brought home in the sense that
we are learning what works and applying to solve our own problems here.
These lessons, I believe, are valuable and will more than pay for themselves. They
are proof that this country, the strongest nation on Earth, cares about the smallest child, the
littlest problem, because we understand how interconnected we are today. And we
understand that ultimately, the kinds of futures those of you who are students at Johns
Hopkins now can look forward to will in some measure depend upon what we do to take
care of the last and the least among us. What we do to solve our own problems in
Baltimore or Boston, and what we do to help solve problems in Bangladesh.
Because as we look toward the 21st century, as we understand how each of us is
going to have to work and be educated to fulfill our own potential, we also, I hope,
understand that our potential will be enhanced the better educated and the better the
economy is in places very far from here, and that at its heart, America's interests lie in
making sure that not only our own people but many of the people on this earth go to bed
looking forward to waking up in the morning, because they're going to have some control
over their own destiny.
So Lessons Without Borders is a way of saying we have learned from what we have
done and we want to continue leading the world, and showing the way to how our
problems can be solved so that we can build a better future for everyone.
Thank you. Thank you very much.
###
JOHNS HOPKINS
UNIVERSITY
School of Hygiene and Public Health
Department of International Health
615 North Wolfe Street
Baltimore MD 21205
(410) 955-6931 / FAX (410) 955-2010
Center for American Indian
and Alaskan Native Health
To:
Sabrina Corlette
From:
Allison Barlow Bova
MEMORANDUM
Subject: ORT Information
Date:
October 24, 1996
Please find attached information to explain the thrust and purpose of the 25th Anniversary
Celebration of the use of Oral Rehydration Therapy in the United States.
Mrs. Clinton's video message will be shown at a large Public Forum (250-500 attendees) on
November 14 at approximately 2:25 pm. It will be introduced by Alfred Sommer, MD,
MHS, Dean of the Johns Hopkins School of Public Health. A draft script for the video
message is attached. Stapled to it is the agenda for the Public Forum. In addition, I have
attached a 30 second script for a PSA that would be sent to all major networks, local stations
in DC, MD, VA, and if funds permit, the nine major media markets throughout the US.
Additional background information | have attached for you and Brenda Costello includes:
Overview of the purpose of the event
Information about ORT (fact sheet)
Agenda for the symposium culminating with the public forum
Draft of consensus statement to be read at the Public Forum
List of symposium participants
Invitation to public forum
Thank you for your help and interest. We can only imagine what a busy time this is for the
White House staff, and we are grateful for you time. If we can answer additional questions,
please do not hesitate to contact me (410-614-2072) or Liz Pettengill, Division of Public
Affairs (410-955-6878).
Sabrina Corlette
Page 2
October 24, 1996
List of invitees to Oral Rehydration Therapy 25th Anniversary Celebration:
- World experts in ORT, Pediatrics, Health Care Economics and Policy
- Representatives from USAID, UNICEF, WHO, American Academy of Pediatrics, US Health and
Human Services and the Indian Health Service
- Symposium Participants
- Johns Hopkins Medical Institutions
- Faculty, staff and students, University of Maryland Medical System
- Faculty, staff and students, Pediatric Infectious Disease and GI departments in medical schools in
New York, New Jersey, Virginia, DC, West Virginia
- Representatives of manufacturers of ORT: Wyeth-Ayerst, Ross, CERA, etc.
- Officers and CEO's, managed Care and Health Maintenance Organizations, nationwide
In the United States, 300-400 children die each year due to dehydration from diarrheal disease.
While diarrheal disease in this country, compared with that affecting children in developing
countries, is mild, it accounts for 4.5-5.5 million outpatient and emergency room visits, and an
excess of $1 billion hospital costs. Oral Rehydration Therapy (ORT), in use in developing
nations for the past twenty-five years, saves children's lives as well as health care dollars. Using
ORT instead of an IV to rehydrate a child with diarrheal dehydration is both humane and cost-
efficient, and parents can be trained to recognize the signs of dehydration and initiate treatment
in the home, before a child becomes moribund.
In November, 1996, at Johns Hopkins School of Public Health in Baltimore, leaders in public
health, pediatrics, managed care, preventive medicine and the insurance industry will come
together to inaugurate a nation-wide campaign to promote ORT as first-line treatment of
diarrheal disease and dehydration in the US medicine. A public ceremony on November 14,
1996, with appropriate significant media coverage, will launch an intense public effort to alter
the practice of using high-tech, high cost medical procedures, when simpler treatments are as
effective, less expensive and less traumatic, particularly to children.
As stated in the ORT Consensus statement, to be signed by representatives of the American
Academy of Pediatrics, the World Health Organization, UNICEF, Centers for Disease Control,
and pediatric infectious disease faculty from across the country at the November 14 event, the
proximate goal is to reduce diarrheal mortality and hospitalizations in the US by 50% in
the next four years -- by the Year 2000.
These goals can be accomplished by:
1.
Encouraging the use of ORT promptly to correct dehydration from diarrhea
2.
Distributing guidelines set forth by the AAP (3/96); ORT should be used as first line
therapy for all children with mild-to-moderate dehydration.
3.
Making sure that medical facilities treating children have Oral Rehydration
Solution readily available.
4.
Teaching new parents about the use of ORT.
5.
Providing all pediatric practitioners with continuing education opportunities regarding
management of diarrhea.
6.
Utilizing well-baby visits to educate parents about the management of diarrhea and the
use of ORT.
7.
Educating the general public about the use of ORT and management of diarrheal disease
by developing and widely circulating appropriate materials.
8.
Developing regional ORT demonstration and training centers throughout the country.
Dr. Mathuram Santosham, Professor of Pediatrics and International Health at Johns Hopkins,
and Director of the Center for American Indian and Alaskan Native Health, is the co-ordinator of
the Anniversary Celebration. A quarter century ago, Dr. Santosham was a researcher on the
White Mountain Apache Reservation in east central Arizona. Infant mortality rates due to
diarrheal disease on the reservation rivaled those in the Third World. Introduction of ORT
to the community through the use of "fieldworkers" resulted in an almost immediate reduction
of death due to diarrheal dehydration to zero. The White Mountain Apache Chairman, Ronnie
Lupe, will offer an opening blessing at the public portion of the 25th Anniversary Celebration,
and, on behalf of the tribe, accept an award recognizing the contribution that Indian people
played in confirming the importance of ORT in US medicine.
Dr. Santosham will act as facilitator of the the scientific symposium and welcome participants
and guests to Johns Hopkins for the celebration. A recognized world authority on ORT and
diarrheal disease, Dr. Santosham is responsible for much of the interest in the medical
community in altering current treatment of diarrheal disease.
ORT FACTSHEET
There are more than 20 million episodes of diarrhea in American children each year.
Each year 4.5-5 million children are seen in emergency rooms and outpatient settings for
diarrheal dehydration. Of those children seen, 180,000 -200,000 are hospitalized.
Between 300-400 children die each year in the United States because of diarrheal disease
and dehydration. It costs $1 billion each year to treat diarrhea and dehydration in
American children using the current protocol of intravenous therapy.
Childhood diarrhea accounts for 20% of acute care visits in city hospitals in the
United States.
Diarrhea is responsible for approximately 10 percent of preventable deaths of
children in the United States.
Fewer than 25 percent of children in the United States receive the benefits of ORT
when ill with diarrhea.
Antibiotics and antidiarrheal drugs have little role to play in combatting childhood
diarrhea. They are ineffective and may have damaging side effects on small
children.
ORT is labor intensive: small amounts of rehydrating solution are fed to children
over a period of several hours to days. It is not a "quick fix", but it is as effective
as IV therapy, less invasive, and far less expensive.
The technique for the administration of ORT can be taught to those with no
medical background.
ORT can and should be made the first line treatment of diarrheal disease and dehydration
National Symposium
Celebrating 25 Years of ORT Use
in the United States
ORT: We have the Solution.
What is the Problem?
November 13-14, 1996
Hosted by The Johns Hopkins School of Public Health
Baltimore, MD
Goals:
Review current status of ORS globally
Review diarrhea morbidity and mortality and economic impact in US
Review ORS knowledge and attitudes among US health care
Review ORS use rates
Make recommendations for increased ORT rates in the US
Sponsors:
Ross Products Division, Abbott Laboratories
World Health Organization
Wyeth-Ayerst Laboratories
American Academy of Pediatrics
US Agency for International Development
UNICEF
Scientific Symposium
Day 1
November 13, 1996
12:00-1:15 pm
Welcome and Opening Remarks
Mathuram Santosham, JHSPH
Robert E. Black, JHSPH
Special Guest Speaker
LUNCHEON
1:15-1:45 pm
Development of ORS:
Bradley Sack, JHSPH
Physiologic Basis and Early Studies
1:45-2:15 pm
First use of WHO-recommended ORS
Bert Hirschhorn,
in USA: Apache Studies
University of Minnesota
2:15-2:45 pm
Current Status of ORS and New,
Jim Tulloch, WHO
Improved Formulations
Olivier Fontaine, WHO
2:45-3:15 pm
Clinical Trials of ORS in the
Chris Duggan
United States
Children's Hospital, Boston
3:15-3:30 pm
BREAK
3:30-4:00 pm
Morbidity and Mortality from
Roger Glass, CDC
Diarrhea in the United States
4:00-4:30 pm
Feeding Issues in Diarrhea
Ronald E. Kleinman
Massachusetts General Hospital
4:30-5:00 pm
Problems with Diarrhea in
William Greenough, JHH
AIDS Patients and the Elderly:
Use of ORS in Special
Populations
5:00 pm
Distribution of Draft Consensus
Statement
Scientific Symposium
Day 2
November 14, 1996
8:00-8:30 am
BREAKFAST
8:30-9:30 am
Adoption of Consensus Statement
9:30-10:00 am
Physicians and Parents:
John Snyder
Knowledge, Attitudes and Behaviors
UCSF
Toward ORS
10:00-10:30 am
Parent Compliance with Provider
Anita Chawla
Recommendations for Treatment
MEDSTAT
In Pediatric Diarrhea
10:30-10:45 am
BREAK
10:45-11:15 am
Implementation of ORT Program
Julius Goepp, JHH
In Pediatric Clinics and Emergency Rooms
In the United States
11:15-11:45 pm
Economic Impact of Diarrheal Disease
Gerard Anderson,
In the United States
JHSPH
11:45-12:15 pm
General Discussion
Mathuram Santosham,
Concluding Remarks for Symposium
JHSPH
12:15-1:30 pm
LUNCHEON
The Scientific Symposium is funded by a grant from Ross Laboratories, Columbus, Ohio and
the World Health Organization.
25th Anniversary Celebration:
Oral Rehydration Therapy in the United States
Public Forum and Campaign Launch
November 14, 1996
2:00-2:10 pm
Introduction and Welcome
Mathuram Santosham, M.D.
2:10-2:30 pm
Blessing Ceremony
Ronnie Lupe, Chairman
White Mountain Apache Tribe
Presentation of Recognition
Everett R. Rhoades, M.D.
Award to White Mountain
Former Director, Indian Health
Apache Tribe
Service
Special Message from the
First Lady Hillary Clinton
Honorary Chair
2:30-2:50 pm
Keynote Address
J. Brian Atwood, Administrator
USAID
2:50-3:00 pm
Reading of Consensus Statement
Antonia Novello, M.D., M.P.H.
3:00-3:30 pm
Panel Discussion
David Brandling-Bennett M.D.
WHO
Denis Broun, M.D.
UNICEF
Edward Keenan, M.D.
AAP
3:30-3:45 pm
Concluding Remarks
Mathuram Santosham, M.D.
3:45-5:45 pm
RECEPTION
List of Scientific Symposium Attendees
Gerard Anderson - JHU
Susan Baker - University of South Carolina
Richard Cash - Harvard University
Anita Chawla - MEDSTAT Group
Robert Clay - USAID
Larry Croll - IHS
Chris Duggan - Harvard Medical School
Olivier Fontaine - WHO
Stephan Foster - IHS
Steve Garrett - IHS
Mark Gilger - Texas Children's Hospital
Roger Glass - CDC
Julius Goepp - JHU
William Greenough - JHU
Joyce Harper - MD State Health Department
Norbert Hirschhorn - Minnesota Department of Health
Maurice Keenan - AAP
Ron Kleinman - Harvard Medical School
William Klish - Texas Children's Hospital
Alan Lake - JHU
Alan Myers - Boston City Hospital
Caryn Miller - USAID
David Nalin - Merck Research Laboratories
Antonia Novella - NIH
David Oot - USAID
Robert Parker - Washington County Health Department
Nate Pierce - JHU
John Ryan - Health Officer, Talbot County
Bradley Sack - JHU
David Sack - JHU
John Snyder - University of California
Jim Tulloch - WHO
Ron Waldman - BASICS
Consensus Statement
Oral Rehydration Therapy (ORT) is a well established form of therapy for the treatment of dehydration due to
diarrhea. The principles of ORT are: early adequate rehydration therapy using an appropriate oral rehydration
solution (ORS), replacement of ongoing stool losses with ORS, and frequent feeding of appropriate foods as
soon as dehydration is corrected.
Diarrhea is a major cause of morbidity and an important cause of mortality in the US. Each year,
approximately 300 to 400 children die as a result of diarrhea and 180,000 to 200, 000 are hospitalized.
Among the elderly (60+ years of age), there are approximatley 2,600 diarrheal deaths per year. There are 4.5
to 5 million clinic visits for diarrhea resulting in a total estimated cost of more than one billion dollars for
children alone.
The effective use of ORT has saved millions of lives around the world. However, in the US, ORT is often not
used optimally. Contrary to the recommendations of the American Academy of Pediatrics (AAP), pediatric
practitioners overuse IV hydration, prolong rehydration therapy, delay re-introduction of feeding, and
inappropriately withhold ORT especially in children who are vomiting. The experts gathered at the Scientific
Symposium on November 13, 1996 would like to propose the following measures that could reduce diarrhea
mortality by 25% and reduce hospitalizations by 50% in the next 5 years:
I. Implementation of AAP guidelines:
a) The guidelines published by the AAP in March 1996 that recommend ORT as the first line of therapy for
all children with mild to moderate dehydration secondary to diarrhea should be widely distributed.
b) All general pediatric and emergency departments, clinics and pediatrician offices should have ORS readily
available and implement its use according to the AAP guidelines.
c) Parents of infants seeking medical care for diarrhea should be provided education about the use of ORS
and early feeding.
II. Prevention of dehydration:
a) Educational material about the prevention and treatment of diarrhea, emphasizing the importance of early
hydration with home available fluids and ORS, should be developed and widely distributed.
b) All providers should be encouraged to educate and provide materials to parents during well-baby visits
about the management of diarrhea, particularly the appropriate use of ORS. Families should be
encouraged to have ORS available at home.
III. Training of Providers:
a) Continuing education opportunities regarding the management of diarrhea, should be provided to all
pediatric practitioners, nurses and health care providers to infants.
b) Regional ORT demonstration and training centers should be established at several sites around the country,
to act as training centers and for ongoing development of strategies and skills to implement ORT
programs.
4. Third party payment for services:
a) All third party payers should be encouraged to reimburse physicians and hospitals appropriately when ORS
is used for the treatment of diarrhea.
List of Scientific Symposium Attendees
Gerard Anderson - JHU
Susan Baker - University of South Carolina
Richard Cash - Harvard University
Anita Chawla - MEDSTAT Group
Robert Clay - USAID
Larry Croll - IHS
Chris Duggan - Harvard Medical School
Olivier Fontaine - WHO
Stephan Foster - IHS
Steve Garrett - IHS
Mark Gilger - Texas Children's Hospital
Roger Glass - CDC
Julius Goepp - JHU
William Greenough - JHU
Joyce Harper - MD State Health Department
Norbert Hirschhorn - Minnesota Department of Health
Maurice Keenan - AAP
Ron Kleinman - Harvard Medical School
William Klish - Texas Children's Hospital
Alan Lake - JHU
Alan Myers - Boston City Hospital
Caryn Miller - USAID
David Nalin - Merck Research Laboratories
Antonia Novella - NIH
David Oot - USAID
Robert Parker - Washington County Health Department
Nate Pierce - JHU
John Ryan - Health Officer, Talbot County
Bradley Sack - JHU
David Sack - JHU
John Snyder - University of California
Jim Tulloch - WHO
Ron Waldman - BASICS