
Tuberculosis in the Marshall Islands is one of many health issues decimating the Central Pacific civilization. The country, which encompasses around 1,200 islands, struggles with high poverty rates and little access to sustainable health care and medicine.
General Facts about TB
Tuberculosis is one of the longest-lasting pandemics in modern history. As the deadliest infectious disease in the world, it kills approximately 4,000 people a day and most commonly affects the lungs. Colloquially termed “consumption” in the 1800s, tuberculosis, if untreated, overwhelmingly consumes an individual’s body. The World Health Organization (WHO) estimates the disease affects around one-quarter of the world’s population with latent tuberculosis, but only a small percentage of those cases become active.
Tuberculosis becomes active due to public health issues that accompany poverty, such as malnutrition, overcrowding and lack of accessible healthcare. In the Marshall Islands, 30% of the population lives under “the basic-needs income line,” and more than 75% of the population resides on its two main islands: Ebeye and Majuro. This population density places the country’s population at severe risk for tuberculosis.
Marshall Islands Risk Factors
The PBS documentary, “Unnatural Causes: Is Inequality Making us Sick?” explores the tuberculosis crisis in The Marshall Islands. The sixth episode of the series on the Marshallese explains that the rate of tuberculosis is 23 times higher than in the United States, partially due to overcrowding. Ebeye Island is more densely populated than Manhattan, with Majuro trailing close behind.
In the Marshall Islands, most people cannot afford to go to the hospital. Instead, they rely on public health outreach to hand-deliver tuberculosis medication to them on a daily basis. Although tuberculosis is highly treatable, the cost and strict daily medication regimen lasting from six months to two years also contribute to the Marshallese becoming increasingly susceptible to tuberculosis.
“What tuberculosis needs to flourish in a person’s body is a broken down immune system,” said Jim Yong Kim, MD, a doctor from Harvard University. “The stress itself of poverty can contribute to the likelihood of developing active tuberculosis.”
Multidrug-Resistant TB
Furthermore, if someone stops taking their medication when they have not finished the full course, they are at risk of developing multidrug-resistant tuberculosis. Antibiotics do not affect this strain of the disease and therefore are virtually impossible to treat.
In 2010, the Marshall Islands declared “a public health emergency” due to a sudden rise in multidrug-resistant tuberculosis. While the country made the effort to quarantine the infected, most Marshallese do not have the economic option to quarantine and stay home from work.
Treatment Rate and Projects
Yet, among these harrowing tales of tuberculosis, the global rate of the disease is decreasing at approximately 2% per year, according to the World Health Organization. In addition, the Marshall Islands, as of 2017, has an 83% treatment success rate.
While tuberculosis in the Marshall Islands presents a scary feat, some outside groups are also working in the country to combat the disease.
Notably, a group from the Migrant Clinicians Network (MCN) embarked on an ambitious 24-week project in 2018 to screen every person on Ebeye island for tuberculosis. The group managed to screen 70% of the population, making the project hugely successful considering the amount of time and manpower it takes to test an entire densely populated island.
MCN identified more than 250 cases of active tuberculosis and set all cases into a strict treatment regimen. Dr. Zuroweste, MD, one of the doctors who worked on the project, also noted the extreme need for widespread testing not only for health but for economic reasons. “Anytime you have TB incidence that’s over 1%, it’s been shown to be cost-effective to screen the population for the disease,” said Zuroweste, noting the 1.5% incidence in the Marshall Islands.
In addition, MCN noted that testing and treating the Marshallese would have “downstream effects.” Most active tuberculosis cases in Arkansas, U.S., are from Marshallese immigrants, so identifying the problem at the source can prevent its spread to other nations.
While tuberculosis poses a significant threat to the Marshall Islands, medical missions to the islands and concentrated efforts to reduce dangerous strains of the disease are already underway. Building awareness of the disease and its harmful complications can also encourage more efforts to help the public health issue worldwide.
– Grace Ganz
Photo: Flickr
The State of Hunger in Indonesia
With the population estimated at over 250 million people, Indonesia is the fourth most populous country in the world. It has been enjoying strong economic growth in the past decades and it is the largest economy in the Association of Southeast Asian Nations (ASEAN). Despite the impressive economic growth, however, it is still a lower middle-income country. Hunger in Indonesia continues to be a significant issue.
Poverty and Hunger in Indonesia
Poverty is still concentrated in rural areas, with 14.3% of the rural population living in poverty in 2014, accounting for more than 60% of the total poor. Additionally, challenges of high food prices and unequal access to food remain unresolved, despite increasing trends in food production and availability. As a consequence of poverty and food scarcity, 19.4 million Indonesians are unable to meet their dietary needs.
A 2019 report by the Asian Development Bank (ADB) and the International Food Research Institute (IFPRI) found that about 22 million people suffered from chronic hunger in Indonesia between 2016 and 2018. Despite the strong growth that Indonesia has made in the agricultural sector, many families across the country still engage in traditional agricultural activities that are low-paid. This leads to hunger and stunting in children.
The Double Burden of Malnutrition
The impressive economic growth has brought about substantial improvements in many aspects of human development in Indonesia. The mortality rate of children under five has dropped from 85 out of 1000 births in 1990 to 31 in 2012. The prevalence of underweight children is also low at 5.4%.
However, the stunting rate in Indonesian children remains widespread. Approximately 37.4% of children under five in 2013 suffered from stunted growth. Stunting in children, a sign of chronic malnutrition, comes with lifelong consequences. It interferes with other development processes of the body, including brain development, which has damaging effects on intelligence, performance in school and productivity at work later in life.
Malnutrition can have detrimental effects very early on in life. When children receive inadequate nutrition in the womb, they become more prone to obesity when their body consumes more food. This in turn leaves them vulnerable to other non-communicable diseases such as diabetes and heart disease. This is the double burden of malnutrition that Indonesia faces. It is estimated that 8.9% of adult women and 4.8% of men are obese, while 8% of the women and 7.4% of men in Indonesia have diabetes. Additionally, more than 1 in 4 women of reproductive age suffer from anemia.
The negative effects of malnutrition are not only felt by the individuals suffering from them but also by society as a whole. It is estimated that losses due to stunting and malnutrition account for 2-3% of Indonesia’s gross domestic product (GDP).
Efforts to Decrease Hunger
In an effort to secure food for low-income households, the government of Indonesia set up a program called Raskin to deliver subsidized rice monthly to the most vulnerable households. Under this program, the eligible households could purchase 15kg of rice each month for a fifth of the market price. Each year, the government distributes 3.4 million tons of rice to a target population of 17.5 million people. With the annual budget of $1.5 billion, Raskin is Indonesia’s largest social support program.
The government also coordinates with nonprofit organizations globally to help combat hunger in Indonesia. Due to its size and geography, Indonesia is particularly vulnerable to natural disasters, which cause food security in many communities. The World Food Program (WFP) is working closely with the Indonesian government to improve nutrition and the quality of food. It also helps mitigate the effects of natural disasters on food security by providing policy advice and technical assistance.
Moving forward, it is essential that the government and other humanitarian organizations continue to make hunger in Indonesia a priority. With continued efforts, hopefully the nation will be successful in achieving Sustainable Development Goal 2: zero hunger in Indonesia.
– Minh-Ha La
Photo: Flickr
Food Systems and COVID-19
The Borgen Project has published this article and podcast episode, “Food Tank, Food Systems and COVID-19: A Conversation with Dani Nierenberg,” with permission from The World Food Program (WFP) USA. “Hacking Hunger” is the organization’s podcast that features stories of people around the world who are struggling with hunger and thought-provoking conversations with humanitarians who are working to solve it.
To say Danielle Nierenberg is passionate about food is an understatement. A world-renowned researcher, speaker and advocate, she’s spent her career fighting for food-systems change and is an expert on all things food and ag.
In 2013, Danielle co-founded Food Tank, a global community pushing for food systems change. Food Tank aims to educate and inspire and highlight solutions that will create change.
We’ve been curious to learn more about Danielle and her work for a while. And during this unprecedented time, we wanted to get her expert insight into how coronavirus will affect food systems as well. So, we dialed Danielle up to talk about her career, Food Tank and COVID-19.
Click below to listen to Danielle Nierenberg’s conversation about food systems and COVID-19.
Photo: Flickr
Renewable Energy in Nicaragua
The Emergence of Renewable Energy in Nicaragua
Nicaragua’s government has turned to renewable energy for a few key reasons. One is the country’s natural abundance of renewable resources. Nicaragua experiences powerful winds and large amounts of sunlight on a regular basis. The country is also home to 19 volcanoes—a reliable source of geothermic heat.
The second reason for turning to renewable energy resources is to become energy independent. Nicaragua itself does not produce oil. As a result, Nicaragua has historically relied on imports of fossil fuel resources. While the country still imports foreign oil, the increased production of renewable energy, like geothermal energy from Nicaragua’s volcanoes, has reduced that dependency.
These two reasons have led Nicaragua to increase its consumption of renewable resources over the past few years. Much of the renewable energy that is produced in Nicaragua is sugarcane biofuel, which accounts for 33.2% of the renewable energy sector. The second most used form of renewable energy is geothermal, which comes in at 24.6%, followed by wind energy at 22.5%. The least used forms of renewable energy are solar energy at 0.5% and hydroelectric energy at 0.25%. As the percentages show, Nicaragua is using more renewable energy leading to a diversification of its energy sector. Nicaragua also has the potential to expand the amount of renewable energy produced, particularly from wind. Wind alone produces over 1,000 megawatts.
Benefits of Renewable Energy in Nicaragua
Nicaragua is an extremely poor country with high poverty rates, especially in rural areas. Fortunately, renewable energy has the potential to help the impoverished people of Nicaragua and provide a model for other impoverished nations.
People who live in poverty tend to have a harder time gaining access to electricity because of their inability to afford it. Some forms of renewable energy are becoming more affordable than fossil fuels. Take geothermal energy for example—the second largest form of renewable energy in Nicaragua. This form of energy is 80% cheaper than fossil fuels. Solar energy is on its way to becoming cheaper than fossil fuels as well. While installation of the technology needed to produce renewable energy is initially expensive, once installed, it lowers the cost and increases the accessibility of electricity for impoverished people.
Nicaragua is continuing to develop its renewable energy sector. The reward of this action will be a cleaner environment and cheaper electricity for its impoverished citizens.
– Jacob E. Lee
Photo: Wikimedia
5 Facts about Poverty in El Salvador
El Salvador is the smallest country located in the Southern part of Central America. With a population of almost 6.5 million people, the country has the largest population density for its size in the region. The country is famous for its exports, primarily coffee and sugar, which are ideal crops for a tropical climate. The gorgeous weather also makes it an alluring vacation spot and draws tourists seeking sweeping palm trees, breathtaking views and glistening beaches from across the globe. However, just outside the paradise of the resorts is a much different world. Here are five facts about poverty in El Salvador.
5 Facts About Poverty in El Salvador
Looking Ahead
These five facts about poverty in El Salvador are grim, but also solvable. Fortunately, Habitat for Humanity, an organization that strives to improve living conditions for the impoverished, has committed to helping. The organization has built homes for around 25,000 Salvadorans. To support the community, the volunteers also build public structures such as new schools, health centers, business suites and much more. In addition, the volunteers teach citizens job skills, money management and disaster preparation in order to give them the tools needed to thrive. With continued relief efforts by humanitarian organizations, a better future can emerge for current generations and generations to come.
– Samantha Decker
Photo: Flickr
10 Facts About Sanitation in Mauritania
Mauritania is the geographic and cultural bridge between North African Maghreb and Sub-Saharan Africa. The Islamic nation has a population of around 4 million people. Located in northwest Africa, the coastal country includes 90% desert land. Mauritania is infamous for being the last country to abolish slavery — in 1981 — and slaves still make up 4% to 10% of the population. Meanwhile, Forbes ranked Nouakchott, the capital of Mauritania, the 20th dirtiest city as it lacks proper water management, which leads to famine and disease. Here are 10 facts about sanitation in Mauritania.
10 Facts About Sanitation in Mauritania
Improving sanitation in Mauritania can potentially have wide-reaching benefits — from raising incomes and boosting the national economy, to improving education and lowering mortality rates. It is imperative that the government and other organizations focus on providing sanitation resources to the people of Mauritania.
– Zoe Chao
Photo: Flickr
The War Against Tuberculosis in Lesotho
On May 13, 2020, Lesotho confirmed its first case of COVID-19, making it the last country in Africa to contract the virus. The country now has to make a difficult decision on how to take charge of the situation. In short, the government has its work cut out for it.
But COVID-19 is not the first disease that the country has had to fight off. For years, Lesotho has been at war with tuberculosis, an incredibly infectious disease that acts similarly to COVID-19. Although Lesotho’s fight with TB may not be over, it has certainly made great strides towards ending the epidemic its citizens are living in.
Tuberculosis in Lesotho
Lesotho is a country in Africa that South Africa surrounds on all sides. It is a developing country home to approximately 2.11 million people. Currently, Lesotho ranks second in the world for people with tuberculosis, with an estimated 724 cases per 100,000 people—about 15,276 people in total. In Lesotho, tuberculosis is particularly harmful to those with HIV, as 73% of people who contract tuberculosis also have HIV.
Tuberculosis is the leading fatal infectious disease in the world, and it kills more than 1.6 million people worldwide each year. TB is an airborne disease: it transfers when a person breathes contaminated air droplets from an actively sick person. If untreated, active TB can be lethal. However, 90-95% of infected people do not actually show symptoms. Most tuberculosis is treatable, as the success rate of treatment in Lesotho is around 77%, but the country has seen a rise in MDR-TB or multidrug-resistant tuberculosis. As the name suggests, multidrug-resistant tuberculosis is immune to the common medications for TB. According to the National Center for Infectious Diseases, MDR-TB affects about 10% of people with smear-positive TB or around 1,000 people. The stronger strain of the bacteria requires that doctors develop more creative treatment options.
Treating Tuberculosis
Although the tuberculosis epidemic has significantly impacted life in Lesotho, the country has not stopped its ongoing war with it. Trained community health workers treat and supervise several patients from the patients’ homes. These workers give injections as well as monitor the side effects of treatments. Patients who become dangerously ill go to Botshabelo Hospital, a place that specializes in MDR-TB in the capital of Maseru.
The CDC also partnered with Lesotho in 2007 to help fight the infection. Since then, it has been working diligently to bring peace. The CDC helps the Ministry of Health and Social Welfare’s efforts towards HIV and TB treatment by improving health information systems, preventing transmission of HIV between mother and child, increasing the capacity in laboratories and giving counseling and testing for those HIV has affected. It also works with the ministry on diagnosis and treatment of the many variations of TB infecting the country. Altogether, the CDC has lowered the TB mortality rate to just 46 deaths per 100,000 infected.
Global Resilience
As a whole, the world has made phenomenal progress in its fight against tuberculosis. Global efforts have saved more than 50 million lives since 2000. Furthermore, global aid is actually is one of the best investments in the public health industry, as each dollar that goes towards TB relief yields $43 back.
Even though Lesotho is facing much loss, including those from its new COVID-19 cases, the country has stayed resilient amid hardship. Lesotho continues its ongoing war with TB, and it will not stop until there is no disease left to fight. The people of Lesotho show the world each day what true bravery looks like as they work towards a new, tuberculosis-free era.
– John Pacheco
Photo: Flickr
7 Facts About Poverty in Cyprus
Cyprus is an island country in the Mediterranean Sea, just south of Turkey, with a population of 1.2 million. The Republic of Cyprus, the country’s only internationally recognized government and part of the European Union, controls 60% of the southern region of the island. The Turkish Republic of Northern Cyprus controls 36% of land in the north region of the island. The division between the North and South republics of Cyprus has created a power struggle of high tension, leaving the island politically unstable. Despite this instability, Cyprus has seen an improvement in decreasing poverty rates, as well as an expanding economy. Here are seven facts about poverty in Cyprus.
7 Facts About Poverty in Cyprus
Concluding Thoughts
Despite Cyprus’s political tensions between the southern and northern regions, the country has expanded its economy, increased tourism and implemented programs that encourage business relationships. These factors have allowed for an overall decrease in poverty in Cyprus. Hopefully, this progress will continue in the coming years.
– George Hashemi
Photo: Wikimedia Commons
Tuberculosis in the Marshall Islands: A public health emergency
Tuberculosis in the Marshall Islands is one of many health issues decimating the Central Pacific civilization. The country, which encompasses around 1,200 islands, struggles with high poverty rates and little access to sustainable health care and medicine.
General Facts about TB
Tuberculosis is one of the longest-lasting pandemics in modern history. As the deadliest infectious disease in the world, it kills approximately 4,000 people a day and most commonly affects the lungs. Colloquially termed “consumption” in the 1800s, tuberculosis, if untreated, overwhelmingly consumes an individual’s body. The World Health Organization (WHO) estimates the disease affects around one-quarter of the world’s population with latent tuberculosis, but only a small percentage of those cases become active.
Tuberculosis becomes active due to public health issues that accompany poverty, such as malnutrition, overcrowding and lack of accessible healthcare. In the Marshall Islands, 30% of the population lives under “the basic-needs income line,” and more than 75% of the population resides on its two main islands: Ebeye and Majuro. This population density places the country’s population at severe risk for tuberculosis.
Marshall Islands Risk Factors
The PBS documentary, “Unnatural Causes: Is Inequality Making us Sick?” explores the tuberculosis crisis in The Marshall Islands. The sixth episode of the series on the Marshallese explains that the rate of tuberculosis is 23 times higher than in the United States, partially due to overcrowding. Ebeye Island is more densely populated than Manhattan, with Majuro trailing close behind.
In the Marshall Islands, most people cannot afford to go to the hospital. Instead, they rely on public health outreach to hand-deliver tuberculosis medication to them on a daily basis. Although tuberculosis is highly treatable, the cost and strict daily medication regimen lasting from six months to two years also contribute to the Marshallese becoming increasingly susceptible to tuberculosis.
“What tuberculosis needs to flourish in a person’s body is a broken down immune system,” said Jim Yong Kim, MD, a doctor from Harvard University. “The stress itself of poverty can contribute to the likelihood of developing active tuberculosis.”
Multidrug-Resistant TB
Furthermore, if someone stops taking their medication when they have not finished the full course, they are at risk of developing multidrug-resistant tuberculosis. Antibiotics do not affect this strain of the disease and therefore are virtually impossible to treat.
In 2010, the Marshall Islands declared “a public health emergency” due to a sudden rise in multidrug-resistant tuberculosis. While the country made the effort to quarantine the infected, most Marshallese do not have the economic option to quarantine and stay home from work.
Treatment Rate and Projects
Yet, among these harrowing tales of tuberculosis, the global rate of the disease is decreasing at approximately 2% per year, according to the World Health Organization. In addition, the Marshall Islands, as of 2017, has an 83% treatment success rate.
While tuberculosis in the Marshall Islands presents a scary feat, some outside groups are also working in the country to combat the disease.
Notably, a group from the Migrant Clinicians Network (MCN) embarked on an ambitious 24-week project in 2018 to screen every person on Ebeye island for tuberculosis. The group managed to screen 70% of the population, making the project hugely successful considering the amount of time and manpower it takes to test an entire densely populated island.
MCN identified more than 250 cases of active tuberculosis and set all cases into a strict treatment regimen. Dr. Zuroweste, MD, one of the doctors who worked on the project, also noted the extreme need for widespread testing not only for health but for economic reasons. “Anytime you have TB incidence that’s over 1%, it’s been shown to be cost-effective to screen the population for the disease,” said Zuroweste, noting the 1.5% incidence in the Marshall Islands.
In addition, MCN noted that testing and treating the Marshallese would have “downstream effects.” Most active tuberculosis cases in Arkansas, U.S., are from Marshallese immigrants, so identifying the problem at the source can prevent its spread to other nations.
While tuberculosis poses a significant threat to the Marshall Islands, medical missions to the islands and concentrated efforts to reduce dangerous strains of the disease are already underway. Building awareness of the disease and its harmful complications can also encourage more efforts to help the public health issue worldwide.
– Grace Ganz
Photo: Flickr
5 Facts About Tuberculosis in Mozambique
5 Facts About Tuberculosis in Mozambique
– Will Sikich
Photo: Flickr
10 Facts About Poverty in Pakistan
Founded during the partition of India and located in South Asia, the Islamic Republic of Pakistan has the fifth-largest population in the world, with a population of more than 220 million. Cornerstones of Pakistani culture include incredible cuisine, iconic architecture and the popular game of cricket. However, like so many nations across the globe, Pakistani citizens must confront the harsh reality of extreme poverty. Here are ten facts about poverty in Pakistan.
10 Facts About Poverty in Pakistan
With continued efforts, poverty in Pakistan will hopefully decrease. The Citizens Foundation is one of many nonprofits that have been working to improve the quality of life for underprivileged Pakistani citizens. In 25 years, the Citizens Foundation has created 1,652 schools, providing proper education to more than 266,000 children who would not have had it otherwise. These schools also combat gender inequality in Pakistan, as they have all-female faculty and a 50% student gender ratio.
However, there is still work that is necessary to combat poverty in Pakistan. In Pakistan, gender disparities compound the unjust realities of poverty. Poverty rates in rural areas are more than five times higher than those in urban areas. Yet, similar to global trends, the amount of people living in poverty in Pakistan has clearly been decreasing in recent years. This is in large part due to individuals and organizations dedicating themselves to the cause of ending poverty. These continued efforts will help fight and eventually end poverty in Pakistan, and in turn, will make the Republic a more just and equal country for all those who call it home.
– Ehran Hodes
Photo: Flickr