Showing posts with label IRP. Show all posts
Showing posts with label IRP. Show all posts

Thursday, March 21, 2013

Vaccines and immunisation: don’t leave a fifth of the world’s children behind

“The hospitals are filled with children with vaccine preventable diseases.”
Johanna Sekennes, Médecins Sans Frontières, Head of Mission, Mali

The rain’s falling thickly onto the roads in rural eastern Mali, preventing cars from passing and making travel by foot virtually impossible. Yet – as a beautifully shot yet hard-hitting new short film, A Preventable Fate, by Venetia Dearden, makes clear – the rainy season does not mean a halt to all industry.  Instead, it coincides with the farming season. Hard-working women, many with children on their backs, labour in the fields to ensure a good crop and a good livelihood. Their responsibilities to the land, to their families and to the sustainability of their agricultural practices, combined with environmental and other external factors, are just some of the complex obstacles standing in the way of them accessing adequate healthcare for themselves and their children. In the first year of their lives, children must receive vaccines five separate times – a tough ask for women given the distance that sometimes needs to be covered, the cost or difficulty of the journey and the other labour-demands a woman is subject to for survival.

The images of rural life in Dearden’s film have a liveliness, community spirit and wholesomeness which belie the tougher realities of under-resourcing in the area and generally in rural and economically disadvantaged regions across the developing world. A Preventable Fate is part of a series of six films around the theme of Fatal Neglect, produced by Doctors Without Borders to highlight the obstacles faced by millions of people worldwide in accessing quality healthcare. The series also includes a study of treatment-resistant TB and three neglected tropical diseases.

In looking at the issue of vaccinations and immunisation in Mali we see that the women working so hard in the fields do not have a day to spare to take their children to be vaccinated – a journey which is difficult even by car, let alone on foot. If a woman happens to live in a village where there is no local vaccine campaign, she may have to go even further away. A Preventable Fate features a woman explaining to a doctor at a vaccine project that she has two children and came to visit the project by bike, “and I got a flat tire. So I had to walk. It’s very difficult.” It is too much to demand of a mother or other caregiver that they take each child to a vaccine campaign outpost at least five times within that child’s first year, when shortages of vaccines may mean that repeat visits are necessary, and that trips are made without knowing whether the vaccines will be available. For those children who receive perhaps two or three of their five shots in the first year, few workable systems are in place to record, trace and make up for the vaccines they have missed when they are a little older.

Photograph (c) Medecins Sans Frontieres

 In addition to the challenges of time, distance and work neglected are problems with establishing vaccination campaigns themselves, in terms of personnel alongside the stocking, transportation, safety and sustainability of medicines. More health professionals who can administer the vaccines are needed; the ideal thing would be to have locally-trained, locally active nurses not just providing vaccines by operating as a reliable and stable way of raising awareness amongst communities. The vaccines must also be transported correctly; a challenge when considering that many require something called a ‘cold chain’, that is refrigeration at a specific temperature otherwise they become invalid. This requires the useage and maintenance of refrigerators and icepacks to store and transport vaccines.

Thus the seemingly simple question of providing vaccines becomes complicated in areas where electricity provision and consequently refrigeration is sporadic, healthcare professionals are scarce, distances between services and users are long, natural temperatures are high and road quality is variable. What is required is the development of vaccines which are easier to deliver and easier to administer to children.

In May 2012 the 65th World Health Assembly designed a Global Vaccines Action Plan to kickstart a well-funded Decade of Vaccines project working towards global vaccination. However, as the Fatal Neglect project makes clear, all major health initiatives must be sensitive to the particular challenges and particular contexts in which healthcare initiatives are established and provided – with a particular focus on those who are being left out due to issues to pricing, the adaptation of medicines and logistical barriers. MSF’s report The Right Shot: Extending the Reach of Affordable and Adapted Vaccines explains some of these issues in detail. They suggest that instead of developing countless (and expensive) new vaccines such as those against pneumococcal disease and rotavirus, the basics of existing routine vaccine systems should be perfected and adapted to theenvironments in which they will be used so that they can benefit the most children, especially in remote, rural, civically fragile/unstable or economically disadvantaged areas. In India’s state of Bihar, for example, 60% of babies are not fully vaccinated. The MSF points out that failure to perfect the access, ease, stability and application of the most basic vaccine programmes have resulted in recent outbreaks of preventable diseases, like the 2010 measles outbreak in 28 African countries. In the Democratic Republic of Congo (DRC) alone, 100,000 cases were reported between January 2011 and October 2011. Although there are many factors affecting the pricing of vaccines, a cynical reading could conclude that the basic, inexpensive vaccines programmes are not being perfected because there is little financial incentive for pharmaceutical companies to tailor their vaccines to help those populations who have little purchasing clout as consumers themselves.

The message on vaccines and immunisations is clear, but tough to swallow. At the moment, 20% of all babies born in the world – that is 22 million children born last year alone - are not receiving protection against basic yet potentially fatal diseases such as measles, meningitis, diphtheria and yellow fever.  Underpinning the moral argument that all children born worldwide deserve the basic human right to life, health, protection and the best start in life, since medicine should not be a luxury is the transformative future effect we can envisage on already-pressurised global healthcare initiatives. Universal vaccination would drastically reduce pressure on hospitals, child mortality rates and sickness rates.  Vaccines must be researched,developed, produced and delivered in such a way that they are easier to use, easier to administer, more temperature-stable, easier to transport, adapted to developing countries’ environmental factors and also the medical factors – that is, the specific strains of the diseases found in the countries in which they will be used. Single dose vaccines which do not required difficult multiple visits; vaccines which are administered orally rather than by injected; well-trained, numerous and either highly mobile or strongly rooted and dedicated local healthcare professionals; vaccines which are affordable to all countries in the long run and not just those which rely on finite donor support through the Global Alliance for Vaccines and Immunisation (GAVI)  to pay for them; and vaccines which do not degrade in variable temperatures would be just some of the ways forward, or more that 22 million children will pay the price.

Photo (c) Medecins San Frontieres




Thursday, February 28, 2013

Testimony and development: think globally, act locally, think locally, act globally

(c) IRC maternal health project

I recently covered Untold Stories, a major exhibition of photographs of global urban refugees and a showcase of their testimonies, produced by the International Rescue Committee and featuring images taken by photographer Andrew O’Connell. Since the exhibition closed I’ve been thinking about the placing of these images, in the sleek, double-plus height, busy spaces of King’s Cross International Station. It’s either a striking juxtaposition, stopping Paris- and Brussels-bound travellers and their consciences dead in between eating a cake from Konditor and Cook, having a salmon platter at Le Pain Quotidien and buying overpriced disposable fountain pens from Paperchase. Or it’s just more visual wallpaper, another image from the global ad era, something for the eye to skim over, barely taking in the words or registering the general purpose – tearjerking international pain campaign – before getting on a train bound for somewhere more pleasant. 

As a second generation British Indian, I’ve always baulked at coverage that makes a show of the suffering of global others. Stricken-eyed orphans, hungry looking yet still undeniably cute; survivors and victims gazing out balefully, beseechingly, next to a large-fonted list of bad things that will happen to them if you don’t sponsor them for three pounds a month; a child just about to drink from a plastic tub of brownish water; a dazed toddler gazing up from a hospital bed it wouldn’t need to be in if only the correct vaccines and immunisations had reached it in time. The testimonies are true, as is the scale of each crisis and each issue, but coverage like this reduces each featured person only to the story of their suffering. The individual, although they are made an example of, becomes generic in the telling. The adverts and coverage do not tell us about their strengths and weaknesses, their likes and dislikes, their family, their friends, their locality, their ambitions. Instead, the individuals are broken down into a demeaning, generalized narrative. We know nothing of them but their pain and are shown nothing of their own drive, their own strength and resistance. Instead we are invited to feel like the heroic saviours of the powerless:

The farmer who can’t grow and sell enough crops for her family.

The baby who’ll die by the age of 3 if he doesn’t get the right treatment.

The girl, first name only, trafficked, raped, bought, sold, impregnated, beaten, abused.

The boy stitching plimsolls by the side of the road, forced to sleep on the street.

The girl denied education, doomed to be taken and used for sexual and other manual labour.

The family whose nearest hospital is an eight mile walk away.

I sit on the Tube and cringe: is this what people in this country think of us?And by us I mean all the non-whites, the former colonised, the far-away, the different-from-them. It’s humiliating to see one’s own (historic) country and those of many others represented as backward, violently misogynistic, agonisingly poor, superstitious, class-ridden, corrupt, intractably problematic, unable to help itself. It’s embarrassing to think about the way other cultures are so often misrepresented, in Western art, culture and media, as depraved, eroticised, exoticised, criminal, subjugated, chaotic, oppressed, self-sabotaging, primitive, violent and more. And it’s easy, being bi- or multicultural, living in a city as visually diverse and mixed as London (even if, if you look at who really holds power in all sectors, the image is strongly un-diverse in terms of sex, race and class), to forget how little people know of the many different societies beyond their own national borders, how few people get under the skin of other countries through equal friendship with others, how few people speak or read other languages. The solicitations, which are meant well, are targeted at people who often know little about other countries or cultures except what they have seen on the news, what they are fed in entertainment-industry films and novels or simply what they have heard in the air – a mixture of myths, fantasies, suppositions and stereotypes which are insulting at worst and limiting at best. The adverts and campaigns often replace people’s ignorance with extreme, galling patronage. We are invited to feel for survivors and victims but not feel outraged, as we should, about the deliberate actions of the perpetrators or the extreme injustice and exploitation which underlie inequality. The help the adverts elicit is accompanied by a sense of personal smugness and cultural superiority. Yet the only way you can understand a culture and drop your own sense of superiority is to participate in it fully and as an equal, not a patron, exploiter, client or dominator.

It’s also easy to point to finger at other nations’ problems without recognizing that many of those same problems are strongly prevalent within the UK too and that the prejudices and inequalities which keep them in place are common across seemingly different cultures. Gender prejudice, gender violence, racial prejudice, racial violence, class prejudice, class violence; these are present to a greater or lesser degree in all cultures regardless of the predominant colour, religion or language of the majority of the people. The terrible consequences, in terms of opportunity, treatment and advantage, as a result of the gap between richer and poorer; the scale of sexual violence including endemic harassment, sexual exploitation and the consequent ignoring or denying of victims and excusal of perpetrators; endemic levels of women killed by current or ex partners; trafficking; labour exploitation, low pay, unstable employment and inequality; problems of hunger; problems of housing; problems of literacy. These are all issues here in the UK, as elsewhere.

And so, in the morass of pain, suffering and need, we return to the power of individual testimonies, specific case studies and concrete examples as a way of making issues which are so widescale as to be overwhelming feel real at last. Humanity needs to put names and faces to social problems; we need to attach a story to an issue; we need to be convinced emotionally and not just factually. And so there’s testimony after testimony, home-made video after witness photograph exhibition, statements, confessionals, documentaries, archives. It’s only through putting a human face onto inhumane circumstances and treatment, adding flesh and blood to advocacy and arguments, that grassroots change really happens.

There are many obstacles. In the case of sexual violence in particular there is widespread and tragic denial of the existence, reality and scale of the issue; the disbelieving, denial, punishment and ostracisation of victims; leniency, excusal and condoning of perpetrators; and a denial about the way entire cultures collude across the board in the undermining and sexual objectification of women and girls, from our extreme under-representation as speakers, leaders and experts in all areas of powerful public life to our over-representation as silent objects used to sell consumer goods from yoghurts to shampoos and the way our bodies are used, bought, sold and bartered as sources of sexual, domestic and other labour for others’ benefit; and so on and so forth, as I’ve written in a million articles a million times. Even when survivors of sexual violence are believed, people have a hard time facing the reality of the scale of the problem, the truth of the situation and its systematic, entrenched, values-based origins. They prefer to recast sexual violence as either a tragic anomaly; an inevitable consequence of war which will never change; or a private, ambiguous, personal, shadowy, domestic matter whose mysterious truth none can fathom. At the heart of all this is an absolute inability to face the reality of what perpetrators choose to do, how many of them there are, how common it is, and what that says about how much and how violently women are hated. For more on the most extreme and distressing examples of this, with a trigger warning, look at Women Under Siege.

Sometimes the resistance comes down to cultural prejudice – a feeling of not understanding and not wanting to interfere or get involved with a society which is seen wrongly as ‘other’, subject to its own laws and logic, somehow different and therefore inscrutable. And equally there is a laudable desire not to patronise. Over the last few years, as I’ve been working and writing a lot on the Middle Eastern revolutions, meeting countless female activists who have worked for changed for years, who lead demonstrations and organisations. They bemoan the western media’s obsession with the oppression of Arab women, veiling and not veiling, sexual assault and sexual harassment, as though these latter two issues are not totally endemic in the UK as well as in the Middle East, Latin America, Europe, Northern America, India and wherever else you look. The problems of the world seem to hide in open view, supported by our prejudices, our willful blindness, our excusal of perpetrators and our deep denial.

Sometimes resistance to global appeals comes down to simple apathy, selfishness, insularity or outright pessimism. People do not use their power for change, because they are convinced of their powerlessness. They think an enterprise is doomed to fail before it has begun, and so they doom it to fail with their own unwillingness, tepid support and lacklustre participation.

Yet this pessimism is misplaced. The problems of the world have not arisen by magic or by chance and are not kept in place by magic or chance. They are specific problems which can be solved in specific ways. Those who benefit from inequality, injustice and exploitation rely on the apathy of bystanders. To laugh cynically at the large scale of the problems identified for solution is to behave as though the world can only change for the worse, not the better. During the course of the year, as part of my International Reporting Project fellowship, run by Johns Hopkins University and funded by the Bill and Melinda Gates Foundation, I will be focusing on issues in support of the MillenniumDevelopment Goals for 2015. These are:

  • To end poverty and hunger
  • Universal education
  • Gender equality
  • Child Health
  • Maternal health
  • Combating HIV/AIDS
  • Environmental sustainability
  • Global partnership
Do I believe that it’s possible to save the world? Yes. If it can transform negatively it can transform positively. This requires believing survivors, fighting perpetrators, challenging preconceptions, changing society, educating the very young, supporting the weak, breaking the dominators, investing money, creating lasting infrastructures and forming organisations which are structurally and ideologically different from those created by exploiters and power-holders. To say the world cannot be saved is to give the bad guys a free pass to do exactly what they want, to make a mockery of others’ constructive efforts and to deny one’s own power to influence events. I believe that something good is better than nothing good, that speaking up is better than staying silent to protect perpetrators and that a tidal wave of change starts with the smallest ripple.

There are millions of people in the world – usually, those who have relatively little themselves – who are working and have been working tirelessly for years to transform the lives of people in their own communities. Although they are assisted by the same organisation, they do not get exhibitions in King’s Cross, major funding for their beautiful photographs or international coverage which boosts their career, enables lots more exciting international travel and promises a strong culturally legacy once their working days are done. They are not hailed as intrepid, globe-trotting heroes bearing witness, constructing powerful testimony, standing up for human rights. They have no names, or rather no cultural Name. But here they are:

  • The village women in the South Kivu province in the Democratic Republic of Congo forming groups called village savings and loan associations (VSLAs). The women members put their small household earnings toward the group’s broader goals. When there’s enough cash in the box, a member can take out a loan to start her own business — like a tailoring shop, the purchase of a small plot of land to farm and raise animals. When the business makes money she begins to repay that loan back into the cash box to fund another woman’s ideas.
  • The 30 new health facilities and 2,500 newly trained community health workers supported by the IRC in South Sudan, where the country’s decades long civil war has left the region without a functioning healthcare system and few trained medical personnel. Currently, more than 2,000 out of every 100,000 pregnant women in the new nation die during childbirth.
  • The necessity of bringing healthcare closer to remote communities by enabling trained community health workers to travel with families as they migrate. For example in Turkana, Kenya, is one of the world’s poorest regions, frequent droughts have left inhabitants dependent on food aid. Malnutrition rates are estimated to be around 22 per cent, leaving children too weak to fight off illness. Consequently, many children die from preventable or treatable illnesses such as fever, malaria and diarrhoea. With about 80%of people being nomadic, many families find accessing healthcare difficult due to their mobile lifestyle. These problems are compounded by a severe shortage of facilities and qualified health professionals. 
  • The strengthening of strained healthcare facilities in Syria’s neighbouring countries, like the 2 new health centres in the cities of Ramtha and Mafraq in Jordan, to help the million-plus people fleeing the violence in Syria. As IRC emergency response coordinator Tom McNelly explains, “These people crossed the border with nothing but their clothes. They have no money to pay for treatment or medicine - and we supply both, at no cost to them.”


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