Safe Surgery
In 2010, 16.9 million people in developing countries died from surgically treatable conditions. If 2015 is anything like 2010, the death toll this year will be higher than that of malaria, HIV/AIDS and tuberculosis combined.

According to a study done by The Lancet in 2012, about two-thirds of the world’s population do not have access to even basic surgery. Where the average amount of surgeons per 100,000 people in the United States is 35, the average in developing nations typically lies anywhere from 1.7 in Bangladesh, to 0.1 in Sierra Leone (before the Ebola outbreak). Even those countries that have access to the surgeons are often lacking in anesthetic and sanitation, which opens up an entirely new world of problems including infection and psychological trauma.

President of the World Bank Jim Young Kim and Dr. Paul Farmer, founder of Partners in Health, are calling surgery “the neglected stepchild in global health.”

Surgery’s subservient status is turning commonplace conditions into killers. Complications like obstructed labor, hernias, and cataracts—the cures to which are readily available in any surgeon’s toolkit—will take over 28 times more lives than cancer this year.

“People are dying, and living with disabilities that could be avoided if they had good surgical treatment,” said Andy Leather director of the King’s Centre for Global Health in the United Kingdom during an interview with the BBC.

While surgery may still be the “neglected stepchild” in a global health family that includes AIDS and Ebola, the problems facing surgical conditions in the developing world are much more straightforward than finding a vaccine for Ebola or a cure for AIDS. Researchers Halie Debas, Richard Gosselin, Colin McCord, and Amardeep Thind have outlined four “surgically significant interventions” which could reduce the preventable death toll overnight. They recommend focusing efforts on providing “competent initial surgical care to injury victims,” dealing with obstetrical complications (like obstructed labor), competent management of abdominal life-threatening conditions (like Peritonitis), and providing services for simple surgical conditions like cataracts and clubfoot.

In addition to these four areas of interest, the World Health Organization has compiled a “safe surgery checklist” to help reduce mortality caused by unsafe surgery. Complied in three parts, the checklist provides sets of instructions for the pre-anesthetic procedure, pre-incision procedure and proper sanitation. This checklist was developed by doctors from the WHO in collaboration with surgeons and anesthesiologists from Botswana, Kenya, Malawi, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe.

In general, the local experts agreed that the checklist addressed the poor organizational culture, lack of effective communication and negative personal attitudes that have acted as barriers to safe surgery in Africa, specifically. The checklist has been administered to 198 facilities in Africa and is looking to expand its dissemination in the coming months.

Health officials have warned that as disease prevention becomes more advanced, a new focus of global health initiatives must be dealing with these easily preventable deaths. There is no reason that clubfoot, which can be easily cured by surgery, should kill more than AIDS, an illness where a cure may be years in the making.

– Emma Betuel

Sources: WHO 1, BBC, The Lancet, WHO 2, The Irish Times, National Center for Biotechnology Information
Photo: Flickr

global_conflict

Peter Maurer, president of the International Committee of the Red Cross (ICRC), recently warned the public that the consistent growth of several regional conflicts has encumbered the organizations efficacy in responding to such global crises.

Noting that the operational budget of the ICRC has surged by nearly 50% in only the last three years, Maurer cited the “extraordinary period” of persistent humanitarian emergencies as the leading cause for such large increases in operational costs.

Maurer also stated that the inability of diplomatic and government officials to secure political resolutions for the ongoing violent conflicts within the Middle East, Sub-Saharan Africa and Eastern Europe led the ICRC to spend an additional $1.1 billion last year in efforts to strengthen their global response to such crises.

Referring specifically to the failure of diplomatic talks within the embattled country of Syria, Maurer questioned, “Isn’t it a bit of a symbol that high-quality negotiators have not been able to move anything significant in the Syrian context?”

Maurer has openly contemplated how the failure of such negotiations has resulted in a “striking absence” of political progress towards ending the current “proxy war” within Syria, a region which has been strife with conflict since civil war broke out in 2011.

Physicians for Human Rights, a healthcare monitoring agency, reported last year that within Syria, a healthcare worker was killed at least every other day and a medical facility was attacked at least every four days. This report highlights the increasing prevalence of violent attacks towards medical personnel and facilities, and has caused Maurer to publicly express warnings for the future of humanitarian aid delivery.

In regards to the increased prevalence of regional conflicts in recent years, Maurer explained, “The international system is having difficulty getting to grips with those conflicts; countries have difficulty moving to consensus on how to deal with those crises.

He continued in stating, “That seems to open spaces for disorder and conflict and we have those dynamics–which may be distinct and different in each and every country–but together they nevertheless refer us to an international system that does not seem to have international institutions with the ability to negotiate solutions to conflicts or to the big, increasing and accelerating impact of crises. Basically, it increases the necessity for us to respond.”

In a recent speech delivered to the ICRC entitled Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies, Maurer discussed the adverse effects of violent regional conflicts on the success of his organization’s initiatives and operations.

He pointed toward the increasing commonality of assaults on medical facilities, workers, and patients often observed in conflict zones as concerning developments. Such violence significantly compromises the efficacy of aid delivery by the ICRC and similar agencies, and diminishes the overall impact of organizations working to improve healthcare infrastructure within developing regions.

The Health in Danger Project, a collaborative effort formed by the ICRC and Red Crescent Movement in 2011, reported earlier this year that between January 2012 and December 2014 over 2,000 attacks were conducted against healthcare facilities and initiatives. The attacks resulted in at least 500 healthcare personnel being killed. The association of such dangers with healthcare programs in developing regions is complicating the efforts of many organizations to increase community participation, as many residents affected by the violence fear the possibility of facing arrest, harassment, assault or death.

– James Thornton

Sources: The Guardian, International Committee of the Red Cross
Photo: The Guardian

Clean_Energy
The production of and access to clean, renewable energy is instrumental in a variety of global issues. Its role in the fight for global equality, however, is often overlooked.

In recent years, the clean energy sector has offered far more job opportunities for women than in non-renewable energy sectors. In the latter, female employees make up 10 to 20 percent of the sector while women represent over 25 percent of clean energy employees.

The clean energy industry’s support of employment equality is a global push. The Solar Sister Program in Nigeria offers those without access to electricity, specifically women, solar panels and lights. The program creates a work-flow in which renewable energy products are provided to women as long as they opt to sell other renewable energy products themselves.

With the International Energy Agency estimating that 585 million people are currently living without electricity in sub-Saharan Africa, efforts like this are crucial. Many people in such areas are resigned to using dangerous alternatives like paraffin and kerosene, which can lead to respiratory illnesses and potential injuries.

“The greatest surprise is the difference that one light and one empowered woman can make,” Solar Sister’s director of engagement Caroline Mailloux told Tech Republic. “Cost savings, time savings, more hours of light to run a business – the ripple effect is truly impressive.”

Considering that this past June was the hottest on record, the push for renewable energy is getting more pressing every year. The potential domestic economic benefits posed by the clean energy industry are significant. According to EcoWatch, if the U.S. invested heavily in the clean energy industry, the country could see savings up to $40 billion by 2030.

Globally, the equality offered by renewable energy sources is already starting to manifest itself. In 2014, the global clean energy market netted around $605 billion globally. This new income coupled with savings gained from cutting non-renewable energy use can continue to offer job opportunities and income equality for women, people of color and disabled people.

“Sustainable energy can revitalize our economies, strengthen social equity and catalyze a clean energy revolution that benefits all humanity,” said U.N. Secretary General Bai Ki-moon.

The clean energy industry has already proven to be a positive outlet for gender and income equality. The more support we give it, the better.

Alexander Jones

Sources: Huffington Post, Tech Republic, The Energy Collective
Photo: Force of the Sun

iceland_financial_crisis
During the financial crisis seven years ago, while many countries were struggling to stay afloat, Iceland was already at the bottom of the sea. A tiny country with a population of only 320,000, Iceland experienced near-total bank failure in the span of three days and a 95% decrease in stock. While monetary policies in the United States and Europe let large amounts of cash flow into the economy, Iceland let enormous amounts of dollars flow through. When the Icelandic krona crashed in 2008, the country’s three biggest banks had amassed wealth more than 10 times the country’s Gross Domestic Product (GDP). As a result of this “loose money” policy, 85% of the economy tanked. The lack of cash flow regulation in the economy led to its downfall and hindered the rebuilding process.

Iceland’s attempts at becoming an international banking powerhouse also factored into its demise. With very high interest rates, international investors could borrow dollars at 5%, exchange them for krona, and buy Icelandic stock at 9% interest. They would profit off the difference in interest rates. Without any governmental controls on the flow of money, all cash could have exited the country, further depressing the economy. However, with help from the International Monetary Fund, the Icelandic government began to impose strict capital controls, barring krona from leaving the country or residents from buying foreign currency or international stock. In the years immediately following the crash, the government raised taxes and provided debt relief to mortgage holders, but not to social services.

It also did something most developed countries have failed to do: jail bankers.

International hedge funds purchased claims for pennies at the height of the crash. Once financial recovery started, their assets grew, giving them a large share of power over the financial system. Due to continued cash control policy, this control affected the lives of Iceland’s residents as well. Residents were especially limited in the amount of foreign cash they could spend, which became a problem when traveling abroad or investing in international stock. “You have a feeling that there’s a system watching you and telling you what you can do with your money,” noted Gudmundur Kristjansson, a fisherman.

However, cash flow restriction and the devaluation that resulted posed some benefits for the economy as well. Exports became cheaper and imports more expensive, allowing residents to produce more goods rather than depend on foreign manufacturers. Devaluation caused wages to fall, so unemployment did not reach the soaring heights it did in Europe. Tourism increased as more people began to travel to Iceland for its cheap prices and its currency independence from less developed European countries.

However, the bars that once held Iceland in restricted success must soon be lifted. “We are enjoying the longest sustainable growth period in recent history,” commented Minister of Finance Bjarni Benediktsson, but cited lacking international investment and competing foreign companies as reasons for lifting the restrictions that helped foster the country’s success for so many years. “[Such controls] are not a sustainable situation for an economy,” said Prime Minister David Gunnlaugsson.

Today, unemployment in Iceland is at 4%, GDP is expected to grow by 4.1% in 2015, and tourism is a flourishing industry. Despite the uncertain future of the country’s economy, it is certainly faring better than other European countries that suffered under the crash. For Greece, whose citizens voted against a deal with creditors and potentially face a future of exiting the Eurozone and financial security, tight monetary restrictions would not be a likely solution. It has a population of 11 million to Iceland’s 320,000, and a GDP 16 times that of the tiny island. When Iceland was preventing its people from spending money, Greece was throwing it around in all directions. Yet Iceland serves as an example of how unorthodox financial practices—controlling the cash flow, granting influence to international hedge funds—can unfreeze a nation and help it rebuild. Restoring a country to financial security is a process of understanding its government, citizens and industries. For Greece and other struggling countries, it will be a struggle, but not a failure.

Jenny Wheeler

Sources: IMF, New York Times
Photo: The Automatic Earth

access_to_clean_toilets

A new product, launched by a Delhi startup last year, gives women the ability to urinate while standing up.

The PeeBuddy is a single-use funnel created from paper that is both coated and waterproof. The funnel is seen as one possible solution to India’s lack of clean toilets.

The country is one of the worst in terms of access to clean toilets. A study released by the World Bank in 2013 showed that over 600 million people defecate without the use of a toilet. This figure corresponds to over 53% of households.

Even if women can find a public toilet to use, it is often dirty. As a result, it is common for them to drink less water, which can lead to health issues.

A study published in the Journal of Nutrition demonstrated that dehydration was a primary factor in instigating headaches, loss of focus and fatigue.

By using the PeeBuddy and urinating while standing up, women in India are able to create a more hygienic atmosphere in an otherwise dirty bathroom. The startup’s website says the product is ideal for restaurants, nightclubs, public toilets and other popular destinations.

The idea for such a creation was born during a road trip consisting of four couples, according to Deep Bajaj, PeeBuddy’s founder.

During the trip from India’s capital territory to Jaipur, a city to the south in the Rajasthan state, Bajaj said the group made frequent stops to look for clean bathrooms, as only around one in five met the wives’ standards.

When one of the women on the trip commented how she wished she were in Europe so she could have access to a plastic device to use when encountering unsanitary toilets, Bajaj came up with the idea for the PeeBuddy.

The product is favored over others that have been produced because of the relatively cheap cost. A pack of 20 funnels costs 375 rupees (less than $6).

GoGirl, for example, is a reusable device made of silicone, but costs $9.99 each. Pee Pocket, also a disposable, coated-paper funnel, costs $24.99 for a 48-pack.

While some stores have been slow to put PeeBuddy on shelves, possibly because of the unusual product name, 20,000 packs had been sold through April of this year, due in large part to Amazon India.

The startup is also currently working with several corporations to help make the PeeBuddy more widely available.

Matt Austin Wotus

Sources: PeeBuddy, The Huffington Post 1, The Huffington Post 2, The Huffington Post 3, YourStory
Photo: My Choices

Fasting_During_Ramadan
Most Muslims who fast during the month-long Islamic festival of Ramadan do so under direction from the Quran, but those who abstain from eating, drinking and smoking during daylight hours may also experience health benefits as a result.

If done right, those who participate in fasting during Ramadan can not only see a rise in spirituality and giving, but also health benefits such as weight loss and overcoming addictions.

It’s possible to see benefits from fasting during Ramadan because food consumption is often different from usual diets, as malnutrition and insufficient calorie intake are avoided during the religious holiday.

Fasting during Ramadan can help lead to weight loss because the body’s energy is replaced during the eating periods. Instead of using glucose as the principal source of energy, the body instead turns to fat, which prevents muscle from breaking down for protein.

Using fat as energy instead of glucose preserves the muscles, in turn reducing cholesterol levels, helping with weight loss. In doing so, blood pressure can improve and be controlled better.

A study by the Annals of Nutrition Metabolism in 1997 showed just this. Results of the study revealed that, by fasting, LDL cholesterol levels, the bad lipoproteins, dropped by 8%, whereas HDL cholesterol levels, the good lipoproteins, rose by 14.3%.

Such a phenomenon can be explained by the eating and exercise behaviors of those who fast during Ramadan. Studies have shown that people often turn to healthier options during the holiday, which reduces saturated fat consumption.

Such studies have also seen an increase in physical activity during Ramadan, as exercise from the night prayers, known as “tawarih,” may be equivalent to moderate physical activity for some.

Fasting can also help those with addictions. Though self-restraint, another teaching of Ramadan, the body goes through a detoxification process, which in turn can help those who fast overcome additions such as smoking.

By understanding the teachings of self-restraint and learning from them, those who fast may find it easier to forget addictions during the day when fasting occurs.

Matt Wotus

Sources: Al Arabiya News, Mosque of Tucson, European Journal of Clinical Nutrition, National Health Service of England
Photo: Flickr

western_diet

As worldwide poverty rates are reduced, it is expected that a decrease in malnutrition rates follow suit. However, new findings have shown that as people come out of poverty, a new type of malnutrition could take hold, with new and dangerous risks to their health.

The world of public health continues to change with populations and communities when new causes for concerns arise. Oftentimes, as countries become more developed, they become more urbanized. As people come out of poverty they often migrate to cities to find work. The most recent data estimates that by 2050, 70% of the global population will be living in cities. With such a high rate of urbanization, concerns for not only infrastructure, but also for health come up. The traditional health concerns for rapidly urbanized areas include issues of air pollution, overcrowding, trash, water use and infrastructural capacity. Recently, researchers are looking at a new health concern–the adoption of a western diet.

The western diet is characterized by major consumption of refined sugars and fats, animal products and overly processed food in conjunction with less consumption of plant-based foods. Basically, this means people consume more fats, sugars, salts, and meats, and less fruits and vegetables. This translates to more calories with less nutritional benefits. The United States has been coping with this problem for years now, as this type of diet leads to a plethora of health problems including obesity, diabetes and even cancer. We have seen in the United States how instances of “food desserts”—areas with little access to fresh, healthy foods, are related to lower income and urbanization rates and have been battling the outcomes of such. Now the problem has spread to become an even larger global health concern.

As developing countries become more urbanized, though poverty may be reduced, malnutrition and quality of life may remain stagnant, for other reasons. The programs in place that are aimed at alleviating these problems in poverty stricken areas are not targeting this new version malnutrition, which could lead to new dangerous trends. As large corporate fast food chains invest in markets abroad, populations coming out of poverty and into the city will likely be enticed by low prices and availability, similar to developed countries. Often times in developing countries people rely on subsidence farming which provides people with fresh fruits, vegetables, meats and grains. When these people no longer need to farm to survive but are still at fragile income levels, they are likely to fall victim to the cheaper, high caloric, low nutrition foods that will end up harming their health.

The good news is that these developing countries are experiencing economic growth, and individuals are coming out of poverty. Hopefully, as today’s world health leaders are much more aware of the very real risks that a western diet poses on one’s health, the threats to the health of these people and of these nations can be improved without the risk of falling back into a new kind of malnutrition.

– Emma Dowd

Sources: CNN, Huffington Post
Photo: CNN

global_middle_class

Although one billion people have risen out of extreme poverty in the past 15 years, concerns still remain. Amid the success in this impressive reduction, there are new concerns over how those who have risen up out of extreme poverty are transitioning into a working middle class.

A new study from the Pew Research Center found that, despite slight growth in the population living on between $10-20 per day (middle income), the growth was largely concentrated in specific regions of the world. These hot spots of growth include China, Eastern Europe and South America. In areas where extreme poverty is extremely concentrated, such as in India, Southeast Asia, Africa and Central America, growth was minimal. Furthermore, there are still large inequalities in wealth distribution, as demonstrated in the areas that have the majority of middle and upper income populations—North America and Europe.

The study also notes that even in these specific areas of improved prosperity, the improvements in their standards of living and qualities of life did not improve as much as may have been expected. Another reason for small middle class growth, despite larger reductions in extreme poverty, is the volatility of climate change. Of the many factors that push people back into poverty, climate change is increasingly understood as the true threat, as changing weather brings its effects to light.

The lack of growth in the middle class has huge implications on individual countries and globally. The middle class was predicted to have grown, which would have increased national economic and political participation and boosted health outcomes.

Many experts associate the development of the middle class with a certain advantageous social structure that benefits the country as a whole. The middle class is generally able to focus less on strictly surviving, which enables them to make certain choices about the kind of lives they want to live, and to demand rights to make those choices, which leads to, all around, more developed nations.

Still, over 70% of the world’s population lives in poor to low-income levels, and progress still needs to be made. The disparities seen, despite progress, are calls to action. One of the biggest public health and developmental challenges we face today is that of inequality and inequity. Seeing such discrepancies on a global level is further proof that this is a problem that needs global attention.

The report brings attention to the fact that, although poverty reduction has been successful in some cases, on a more global and long-term level, changes need to be made. There need to be more effective strategies aimed at not only helping people come out of poverty, but also helping people stay out of poverty. We now know that the effects that we had hoped to see as a result of poverty reduction have many intermittent steps and barriers that also need to be addressed in order to see the kind of results that were predicted. The benefits of a growing middle class are achievable and progress in poverty reduction is the first step, but until the other barriers that new global middle class members face are also addressed, people, their nations, and the world will not see the maximum benefits.

Emma Dowd

Sources: BBC, Pew Global
Photo: Deccan Chronicle

education_pakistan_reform
As Malcolm X once said, “education is the passport to the future, for tomorrow belongs to those who prepare for it today.” Those words have resonated with countless people around the world. The NGO Zindagi Trust has taken on the task of reforming education in Pakistan, a country plagued by corruption and poverty.

According to the World Bank, in 2013 Pakistan had an enrollment rate of 92% when it came to students in primary schools. Unfortunately, that number drops to 38% when enrollment is in regards to secondary schools.

In a nation with a population of 185 million people, the United Nations Children’s Fund (UNICEF) estimates that there are currently 73.8 million Pakistani children under the age of 18. With 40% of the population lacking adequate schooling, educational reforms are more important than ever.

Zindagi Trust works by reforming public schools, educating working children and lobbying the government to improve education policies. They believe these three foci are the best way to improve children’s education.

Their focus was developed to combat what they assess as the primary failure of the educational system. Most Pakistani children (85%) currently attend public government-run schools. According to Zindagi Trust, these schools are plagued by low teacher attendance, deteriorating buildings, inadequate learning facilities, and a curriculum and teacher culture that lacks any sort of creativity.

Their philosophy is that reforming existing schools is the best business proposition for an education provider because the expensive infrastructure (land, building, fixtures, basic furniture) are already present. By creating a successful model for reform in government schools, they can have more impact than 100 private schools would and save a lot of money that can be used for other projects.

In 2007, they implemented their strategy by taking over a government-run school in Karachi called the SMB Fatima Jinnah Government’s Girls School. It comprised of eight schools on one campus with independent teachers and administrators who were not working together. They honed in on five factors to reform the institution.

Infrastructure Rehabilitation

This included laying down a new football pitch, paving the school grounds and updating the fences and securities measures, providing filtered drinking water taps, and even cleaning out stray animals such as dogs that lived in the classrooms.

Administration Changes

The lack of competent administrators and teachers led to a situation where regulations were not properly being followed and a culture of student neglect was thriving. Zindagi Trust merged all the administrators into one unit, creating rigorous protocols for teacher and student attendance and performance. They also banned outsiders from throwing parties on the then deteriorating football grounds.

Academic Innovation and Planning

Previously, teachers were unorganized and textbooks were outdated. Zindagi Trust implemented modern thought-provoking textbooks and hired academic coordinators for English, mathematics and science to plan syllabi with learning outcomes and timelines, design tests, monitor progress, and observe and train teachers.

Teacher Reforms

To combat the teachers’ culture of inconsistency, Zindagi Trust began monitoring teacher attendance and penalized staff for unreported absences, lateness and shirking duties. This helped to bring consistency to the classrooms and better learning outcomes for students.

Student Affairs

Creativity is one of the greatest strengths of education. Students were given access to facilities they previously had never seen. Learning modules were created to allow students to explore art and sports such as cricket and Taekwondo. The school provides modules for sexual health and abuse awareness. There is even a chess club on campus.

The Zindagi Trust school model has been a success. Students have been successfully completing coursework and the government is currently taking notice. In July of 2011, the Sindh Education Secretary issued a notification approving the School Consolidation Policy that aims to merge adjoining and nearby schools into one campus under one administration, based on the Fatimah Jinnah Girls School model.

Recently, at the Oslo summit on Education and Development, Pakistani Prime Minister Nawaz Sharif committed to the vision of the Oslo leadership and said he shared that vision in educating all Pakistani children. He met with Ms. Malala Yousafzai and spoke about their shared responsibility to provide universal education to their country.

The United States must continue to provide aid to organizations such as the Zindagi Trust as they rebuild the Pakistani education system. Pakistan is a strategic ally to the United States and an established trading partner in the textile industry. The country’s uneducated population is living on pennies which is preventing the nation from becoming larger consumers of American exports. Coupled with their geographical location in regards to Afghanistan, it is in the best interest of the United States to support Pakistanis in receiving education, as they hold the passport to the future relationship between the United States and Pakistan.

– Adnan Khalid

Sources: New Delhi TV, UNESCO, UNICEF, World Bank 1, World Bank 2, Zindagi Trust
Photo: Al-Mehran Public School High

South_Sudan
Representative Thomas Rooney of Florida recently introduced the South Sudan Peace Promotion and Accountability Act of 2015, urging U.S. leaders to recognize their leadership failure in the war-torn nation.

Specifically, the bill states that the United States will recognize that there has been a failure of leadership in South Sudan that has left the country’s civilians in a state of suffering, and will urge all parties to find a peaceful resolution. The bill furthers calls for the President of the United States to submit to Congress a strategy for further engagement with South Sudan.

South Sudan, a ascent nation that arose in 2011 from the civil unrest that had divided Sudan for years, has been plagued by conflict since it gained independence. In 2013, tensions between new political leaders sparked a civil upheaval that killed tens of thousands, displaced an estimated two million people, and left nearly five million needing food and other humanitarian assistance.

In 2005, the United States helped broker the Comprehensive Peace Agreement, which would ultimately set the framework for South Sudan establishing their independence. Since the separation, the United States, along with the United Nations, has worked to help the new nation establish itself.

However, despite the outpouring of international support and its integral role in the new nation, in 2015, the government of South Sudan expelled the United Nations Humanitarian Coordinator in charge of overseeing the massive humanitarian effort in the country. Since then, the South Sudanese government has continued to place restrictions on foreign aid workers in the country, calling for the majority of humanitarian aid to come from within the country.

The South Sudan Peace Promotion and Accountability Act of 2015 urges the administration to prioritize promoting peace and human rights, as well as establishing freedom of association and expression.

Gina Lehner

Sources: Congress, Wikipedia
Photo: UN Multimedia