Information and stories about developing countries.

Child Labor in DjiboutiLocated on the Horn of Africa along the Bab el-Mandeb, an important maritime chokepoint is the small African nation of Djibouti. With a population of one million but high levels of poverty and limited funding for social welfare programs, child labor in Djibouti has been widespread historically. However, efforts from the government and international actors over recent years have started to reverse this phenomenon.

The Nation of Djibouti

According to Humanium, an NGO focused on protecting children’s rights across the globe, 42% of Djibouti’s population lives in extreme poverty. Child labor is primarily caused by extreme poverty, as parents force their children to work so that they can survive. Therefore, Djibouti’s children are some of the most vulnerable to child labor due to poverty throughout the nation.

As a result of their families’ financial situation, over 12% of children ages 5-14 work. Working can isolate children socially or prevent them from having the time to pursue their academic interests. Only 60-65% of children complete primary education in Djibouti. With many children unable to obtain an education due to work or other circumstances, child labor in Djibouti perpetuates the cycle of poverty generation after generation.

Government Efforts Toward Child Labor

Djibouti’s government has taken an active role over the past decade in reducing child labor. The active role is shown through establishing workgroups and various programs focused on identifying the contributing factors of child labor. One of the main projects is the Anti-Trafficking Working Group, which has improved cross-agency government collaboration to counteract human trafficking. The Prime Minister leads the National Council for Children in its efforts to secure birth certificates for immigrants, ensure education for refugees and reunify separated migrant families. Furthermore, the Council successfully established a temporary shelter for children living on the street in 2018. Therefore, it made these at-risk kids less likely to be coerced into child labor. The government established the National Family Solidarity program to decrease child labor. They supported Djiboutian households in extreme poverty via cash transfers. These programs represent a start to ending child labor in Djibouti, something that future leaders of Djibouti can continue to prioritize.

Despite the government’s efforts, various legal loopholes remain that benefit those who exploit child labor. Many of the statutes only apply to children working in the formal business sector. Therefore, Djibouti’s laws are less comprehensive than international standards. This is especially problematic because most child labor cases occur in the informal business sector. Some examples are working in small shops, selling items on the street and working in family-owned businesses in rural communities. Without true legislative changes, Djibouti’s laws will continue to fail in identifying and eliminating most child labor cases.

Additionally, there were only five labor law inspectors in Djibouti as of 2018. This means that Djibouti’s labor force of almost 300,000 has approximately one labor law inspector for every 60,000 workers. Without the resources or personnel necessary to expose and eradicate child labor, child labor will continue. This brings harm to Djibouti’s long-run humanitarian situation, living conditions and economic growth.

International Support

Yet, despite the shortcomings so far to end child labor in Djibouti, UN-sponsored efforts and aid from various countries/NGOs, present an optimistic future. UNICEF currently works with the government of Djibouti, the United States and the Humanitarian Action for Children Project to increase access to education for the most vulnerable Djiboutian children (orphans and those in poorer areas). This program has helped over 4,500 children obtain pre-primary, primary or secondary education in Djibouti. The U.S. government has also funded a $500,000 program to train law enforcement and expand communication capabilities between the private and public sectors, regarding ending forced labor/human trafficking. Finally, the World Bank oversees numerous programs that deal with the root causes of poverty and child labor in Djibouti by promoting human capital development and education.

Cooperation and a Promising Future

Going forward, it will be pivotal for the government to continue focusing on lowering the extreme poverty rate. Reforming legislation to meet international standards, then enforcing it as well as protecting children of all ages and backgrounds, is the next step in Djibouti’s fight against child labor. Improving human rights means better access to education. This will likely help the economic situation of Djibouti by breaking the cycle of poverty. However, the international community plays a crucial role in helping Djibouti. Some of the most successful initiatives have come from international partnerships and UN-sponsored programs. Cooperation is critical in Djibouti, whereas complacency will be catastrophic.

– Alex Berman
Photo: Flickr

Healthcare in Equatorial GuineaIn the small Central African nation of Equatorial Guinea, the healthcare system is lacking in many ways. According to a report by Human Rights Watch, “45 other countries in Equatorial Guinea’s per capita GDP range spent at least four times as much on health and education during the same period.” A study by the Pan African Medical Journal has reported a “lack of resources and trauma care facilities” and that  “training and informational programs for both healthcare workers and the general public may not be effectively transmitting information to the intended recipients.” Overall, it can be said that healthcare in Equatorial Guinea is in a dire state that certainly calls for assistance.

Things to Know About Healthcare in Equatorial Guinea

  1. Empty Promises. Following the discovery of oil in Equatorial Guinea in 1991, President Obiang promised investment in social services, primarily healthcare and education. Despite repeatedly saying he would prioritize those two services, financial allocation for funding has been disheartening. According to the World Bank, as of 2017, only 3.11% of the country’s GDP has been spent on healthcare, an increase since 2012, when it stood at 1.26%.
  2. Incorrect Priorities. Instead of allocating money towards improving its healthcare system, Equatorial Guinea has been investing in large infrastructure projects. In 2011, the country spent 82% of its total budget on such projects, a move that was heavily criticized by both the International Monetary Fund and the World Bank.
  3. Treatable Diseases are Deadly. Lack of funding means healthcare in Equatorial Guinea lacks diagnostic tools, trained staff, laboratory supplies, vaccines, cheap medication and condoms. The lack of affordable medicine and resources results in patients being reluctant to seek care and also means the most common treatable diseases become the deadliest. According to the Pan African Medical Journal, diseases like malaria, typhoid, sexually transmitted diseases, diarrhea and respiratory illnesses are the most common diseases, but also have the highest rate of mortality.
  4. Underfunded Healthcare Sector. The lack of funding to the healthcare sector in Equatorial Guinea also acts as a deterrent for people to join the profession and causes many to leave, due to the lack of pay. Data indicates that Equatorial Guinea has only three doctors per 10,000 people. Furthermore, because patient payments are not enough to keep facilities running, many also leave due to the difficulties in their ability to provide care.
  5. Traditional and Modern Medicine Conflict. There is a conflict between traditional and modern medicine, which many healthcare practitioners consider a “negative healthcare outcome.” Indeed, the reluctance for many families to consult hospitals to receive care due to the high cost of medication may drive them to traditional medicine methods instead. Though this conflict has been noted before, not many steps have been taken to help mitigate the gap.

Despite the dire state of healthcare in Equatorial Guinea, research does not indicate that the country is receiving much help from aid organizations or other countries to improve the situation. This conclusion indicates a desperate need for aid to better the country’s healthcare system. With help, healthcare in Equatorial Guinea can be drastically improved.

Mathilde Venet
Photo: Flickr

Efforts to Combat AIDSAcquired immune deficiency syndrome (AIDS) has plagued the world since 1981. The global AIDS pandemic has infected more than 65 million people around the world since its arrival, with more than 30 million deaths from AIDs-related causes. The impact of AIDS has resulted in a worldwide effort to discover methods to treat and cure the disease. To date, significant progress has been made in the fight against AIDS. However, more needs to be done and the United States has shown continued commitment to support efforts to combat AIDS globally.

AIDS and the Global Poor

While AIDS is a global problem, it has disproportionately affected poorer regions since its arrival. Africa in particular has a significant number of people living with AIDS. Out of the 1.7 million newly infected people around the world in 2019, 990,000 people resided in Africa alone. The disproportionate numbers in poorer regions as compared to wealthier nations could be attributed to lack of quality healthcare and preventative education. However, continued efforts are being made to address the global AIDS pandemic.

Congressional Efforts to Combat AIDS

The United States has been a leader in progress against the AIDS pandemic. It has made significant efforts to contribute its resources to fight the AIDS pandemic, and tangible results have emerged. For example, the President’s Emergency Plan for AIDS Relief (or PEPFAR) has contributed over $85 billion since its inception in 2003 to AIDS research and prevention, thus preventing millions of infections.

The United States Government has indicated that it has no interest in slowing down support for the cause through efforts to combat AIDS. For example, the Global Health Programs section of Title III in House bill H.R.7608, the State, Foreign Operations, Agriculture, Rural Development, Interior, Environment, Military Construction, and Veterans Affairs Appropriations Act of 2021 specifically outlines Congress’ plans for AIDS-related contributions in the coming years.

Introduced by Rep. Nita M. Lowey [D-NY] on July 13, 2020, the bill appropriates more than $3.2 billion for USAID through 2022. A portion of these funds will be devoted to programs for the prevention, treatment and research of HIV/AIDS, providing assistance to communities severely affected by HIV/AIDS. The bill also appropriates more than $5.9 billion through 2025 for HIV/AIDS research, prevention and treatment efforts, including a $1.56 billion contribution to the Global Fund to Fight AIDS. This all coincides with the billions of dollars already spent in the last decade to combat AIDS globally.

AIDS Progress

As with most issues, funding and resources are necessary to make progress in the AIDS pandemic. The vast majority of new infections occur in countries and regions with weaker finances, poorer healthcare and less quality education, such as Africa and Southeast Asia. It is easy to see that these efforts by the United States and other wealthy nations are invaluable to progress. A particular stride made thus far is that the cost of AIDS treatment drugs has decreased from $10,000 a person to $100 a person in the past 20 years. This has allowed more than 8 million people in impoverished regions access to AIDS treatments. This particular result could be attributed to years of research that the United States and other nations have contributed billions of dollars to maintain. Continued funding will improve the good work that has already been done, such as furthering cost reduction measures on AIDS-related drug treatments as well as further quality education on prevention strategies in regions where AIDS education is sparse.

With continued support and efforts to combat AIDS from wealthier nations such as the United States, even greater strides can be made in combatting AIDS globally.

Domenic Scalora
Photo:  Flickr

Malnutrition in India during COVID-19
Amid the COVID-19 pandemic, India’s struggle with malnutrition has been playing out behind the scenes. Despite consistent economic growth, nutritional deficiencies have plagued India’s adults and children for years. Nearly 50% of children do not receive adequate nourishment and more than 50% suffer from anemia and other vitamin deficiencies. Efforts by the state have improved the situation over time, but malnutrition in India remains high compared to other developing countries. Recently, the coronavirus pandemic has made matters worse as India’s cancellation of its school lunch program leaves children, who usually rely on these supplementary meals, at-risk. In addition to damaging the economy and people’s ability to buy food, the COVID-19 lockdown has halted state-run services that previously helped people in need access nutritious meals. Recognizing the severity of malnutrition in India during COVID-19, efforts are starting to ensure Indians, especially women and children, fulfill their nutrient requirements.

History of Malnutrition in India

Malnutrition is not a new issue in India. It has been consistently prevalent despite the country’s economic development. In 2019, India ranked 102 of 117 countries in the global hunger index and its hunger situation was labeled as “severe.” Furthermore, India’s childhood malnutrition rate is twice that of sub-Saharan Africa. In this same vein, 45% of children suffer from stunted growth due to their lack of sufficient nutrients necessary for development.

Though adults also suffer from malnutrition, the issue largely affects children. This is because of the lasting implications of malnutrition occurring during development.

Malnutrition in India’s children is attributable to many factors. These include lack of access to nutritious foods, inadequate care practices and pregnant women’s inability to gain sufficient weight. These circumstances can lead to a multitude of consequences. For example, decreased chances of survival for children younger than 5 years old, increased susceptibility to illness, impaired learning abilities and decreased productivity in children and adults, to name a few.

These effects not only affect individuals but can also become detrimental to the growth and prosperity of a society or country. When childhood development suffers impairment, their education and potential to contribute to India’s productivity decreases. Ultimately, this affects long-term, economic growth. India acknowledges that it is in the state’s interest to solve this issue. Therefore, the Indian government has attempted to address malnutrition by creating several aid services.

Initiatives to Combat Malnutrition

Since malnutrition has been recognized as an issue crucial to India’s development, India has led developing countries in the fight against malnutrition.

India’s Integrated Child Development Scheme (ICDS), a program funded by the central government and UNICEF, formed in 1975. The initiative aims to tackle malnutrition by providing primary healthcare and supplementary food to children between the ages of 3 and 6. Also, their mothers would receive the same care. In 2010, the ICDS expanded with the addition of the Pradhan Mantri Matritva Vandana Yojana (PMMVY) program. This expansion strives to improve health and nutrition for pregnant women.

Another government-led effort to combat malnutrition in children is the National Programme of Nutritional Support to Primary Education. This is also known as the Mid-Day Meal scheme. This program provides children in school with meals. Ultimately, this improves both their food security and nutritional status.

Additionally, the Food Safety and Standards Authority of India issued regulations in 2018 for fortifying common foods like rice, wheat and milk to enhance their nutritional quality.

These programs convey the state’s recognition of the severity of malnutrition in India. Also, the necessity of improving conditions for thousands of residents. Between 1990 and 2019, child mortality decreased from 3.4 million to less than 1 million. However, despite this significant progress, malnutrition persists.

The Impact of COVID-19

The COVID-19 pandemic has impacted access to nutritious meals for all Indians. Yet, this is especially true for children relying on supplementary meals. Under normal circumstances, children were guaranteed at least one nutritious meal under India’s government-funded school lunch program. After the imposed lockdown (to prevent the spread of the virus), about 115 million children, dependent on school lunches to fulfill their daily nutrient requirements, no longer had access to this service. Supplementing its current food program, India planned to use a phased approach to reopen schools in September 2020. The nation has announced it will expand its school food program to include breakfast and midday meals. These initiatives aim to reduce malnutrition in India during COVID-19.

While India’s government has been attempting to combat its persistently high childhood and adult malnutrition rates for years. Unfortunately, the pandemic has made the situation even more urgent. As India loosens COVID-19 restrictions, it is imperative that children and women once again gain access to crucial services. Ensuring their nutrient requirements are met is paramount. Furthermore, recognizing the enormity of malnutrition in India during COVID-19 and beyond, India must push more efforts to protect the health of its people.

 – Angelica Smyrnios
Photo: Flickr

Infertility in Developing CountriesAn estimated 49 million to 180 million couples  suffer from infertility, globally. Moreover, the majority of those affected live in developing countries. The most common cause of infertility in developing countries are STDs and pregnancy-related infections. With the focus of most poverty reduction efforts aimed at lowering overpopulation the health concern of infertility is often overlooked. Women who suffer from infertility in developing countries often face ostracization and struggle to get the healthcare they need. Thankfully, there has been an emergence of programs to help these women.

Causes of Infertility in Developing Countries

The most common cause of infertility in developing countries is untreated STDs since treatment is often unavailable or costly. In Africa, more than 85% of women’s infertility resulted from an untreated infection compared with 33% of women, worldwide. The most common STDs involved are chlamydia and gonorrhea. Other risk factors increasing the chance of infertility are poor education, poverty, negative cultural attitudes towards women. Finally, a lack of access to contraception is a huge risk factor.

The Sexist Effects of Infertility

The burden of infertility in developing countries falls on women although male infertility is the cause in 50% of cases. When a woman is unable to conceive, her husband will often divorce her or take another wife if permitted in the country. Women who are deemed infertile also suffer discrimination from the community.  In some cultures, society views these women as having a “bad eye”, which can pass on infertility from person to person. This results in infertile women missing important events such as weddings and other social gatherings since they receive no invitations.

Combating Infertility in Developing Countries

A campaign initiated by the Merck Foundation, “Merck More than a Mother,” seeks to heighten access to education and change the stigma for infertile women in developing countries. The program has provided training for fertility specialists and endocrinologists with more than 109 specialists trained since 2016.

Also, the foundation has created music videos, songs and fashion shows in African countries to send the message that women should not be blamed if they cannot have a child. More than 14 songs have featured singers from Gambia, Ghana, Kenya, Rwanda and Sierra Leone.

Women Deliver

In 2016, women’s infertility was a topic of discussion at Women Deliver — the world’s largest women’s health and rights conference held in Copenhagen. There were more than 5,500 conference participants, including government ministers, policymakers, business leaders, NGOs and activists. The WHO brought the topic to the conference, with the Director of Reproductive Health and Research giving a speech about the detrimental effects of infertility.

The WHO and Women Deliver, along with the International Committee Monitoring Assisted Reproductive Technologies and the International Federation of Gynecology and Obstetrics have partnered to increase global advocacy for infertility in developing countries. The partnership aims to achieve this through advancing education and research in the field.

Hopefully, with these increased advocacy efforts, the world will start to recognize the health concern of infertility in developing countries.

Rae Brozovich
Photo: Wikimedia Commons

Sanitation Practices in Tanzania
Tanzania has made considerable strides in decreasing extreme poverty. For example, from 2007–2018, the country’s poverty rate declined from 34% to 26% (of the total population). However, this progress in poverty reduction has not translated as successfully when addressing sanitation. Improving sanitation practices in Tanzania directly relates to decreasing infant mortality and malnutrition. Currently, 23 million of Tanzania’s 57 million residents obtain drinking water from potentially hazardous sources. Acknowledging these disparities and the value of potable water in eradicating poverty, the initiative Project SHINE works in rural communities where low access to clean water and poor hygiene practices are common. The organization is on a mission to improve sanitation by inventing cost-effective, simple solutions that enhance hygiene in Tanzania.

Poor Sanitation and Resulting Diseases

Poor sanitation practices in Tanzania contribute to a host of preventable infections in the country. Tanzania suffers frequent cholera outbreaks, which cause extreme diarrhea and dehydration. Diarrheal disease is one of the largest contributors to child mortality in countries facing extreme poverty. Moreover, those who do survive, suffer developmental obstacles. Cholera, as well as the related disease typhoid, can transmit through drinking water polluted with human feces. Open excretion, a widely spread issue in Tanzania, is easily preventable by developing water sanitation infrastructure.

In terms of parasitic infections, malaria commonly transmits through mosquitoes. This illness and schistosomiasis easily spread due to a lack of proper drainage systems in Tanzania. Finally, skin, eye and oral infections are a common result of the lack of knowledge among Tanzanians regarding proper hygiene practices.

Rural communities in Tanzania learn and influence hygiene practices based on previously established knowledge and cultural practices. Therefore, many children are predisposed to the same habits — and therefore, the same risks as their families. To help combat these norms that often pose significant health risks, Project SHINE is introducing innovations in sanitation and hygiene for Tanzanians.

Sanitation and Hygiene Innovation in Education (SHINE)

Project SHINE uses science to educate children and motivate changes in their hygienic behaviors by cooperating with schools. The program also reaches out to parents and other community members to develop a better understanding of attitudes toward health within this field. Through its educational initiatives, Project SHINE engages pastoralists who, even though many children come from these families, often lack access to resources and are actively involved with livestock. In particular, SHINE highlights the importance of both animal and human health for these audiences.

Education Strategy: Science Fairs

Project SHINE promotes science fairs in its target schools to encourage greater conversation and education about sanitation. These events focus on three subjects: water, sanitation and hygiene. This project’s aim is to help motivate youth, health care workers and community members to adopt improved health care practices. The long-term goal of motivating future generations to permanently incorporate these habits into their daily routines is paramount.

During this process, teachers receive private training in separate workshops where they gain strategies for presenting hygiene and sanitation to students in engaging ways.

Students engage in these science fairs by conducting research and forming hypotheses. One project students can complete, for example, is to create sustainable hand-washing stations using local, low-cost materials. Project SHINE also incorporates a One Health Paradigm that emphasizes the connection between livestock, humans and the environment. Notably, this is a relevant framework for children from pastoral families. Overall, fitting sanitation practices in Tanzania into the school curriculum has become a priority for SHINE.

The Journey Ahead

Progress for hygiene and sanitation practices in Tanzania has been a long, difficult journey for many families who still struggle to obtain clean water. Nevertheless, interventions from Project SHINE have already made significant differences. The initiative is planning to expand to other parts of the community, including out-of-school youth and the disabled. Overall, the work of Project SHINE offers promise for the health and prosperity of thousands across Tanzania.

– Zoe Schlagel
Photo: Wikimedia Commons

Ecotourism Alleviates Poverty in NepalNepal is a small country located between India and China, two of the world’s most powerful nations. Substantial foreign aid is allocated to fighting poverty in Nepal. However, inefficient governments prevent these benefits from reaching the people: one-fourth of Nepalis are living in poverty. Nepal, the birthplace of the Buddha and home to Mount Everest, also has 848 bird species, 600 plant families and over 100 ethnic groups speaking 90 languages. Despite its ineffective leadership, Nepal’s lush natural environment has created a flourishing ecotourism industry providing business and conservation to the region. By fostering this market, ecotourism alleviates poverty in Nepal and improves life for thousands of the country’s residents.

What is Ecotourism?

According to The International Ecotourism Society, ecotourism is defined as “responsible travel to natural areas that conserves the environment, sustains the well-being of the local people and involves interpretation and education.” This definition encompasses aspects from human-environment relationships to understanding landscapes, maintaining species and learning about local cultures.

Whether zoos are to be considered a form of ecotourism has been widely debated. Despite the potential for educational value, practices of capturing and confining wildlife are not considered ecotourism. Wildlife should not endure any suffering from human interactions, and the interest of the animals should be prioritized over humans. Ecotourism allows animals to live independently of human contact, a condition impossible to replicate in zoos.

Environmental Impact

Community-based ecotourism has been immensely successful in Nepal, especially for its rural areas. Due to sparse government regulations, the general tourism industry employs cheap yet harmful practices that have exacerbated poverty in Nepal. Thus, it has become necessary for the country to consider alternative methods of attracting revenue through tourism. With this goal in mind, Nepal has adopted the homestay model of ecotourism.

The primary goal of the homestay industry is to develop economic resilience in rural areas that can work with the environment rather than against it. This cooperation eliminates the need for large infrastructure to accommodate tourists as well as protects the environment from destruction. In a developing country like Nepal, the value of these outcomes is substantial. This system allows community members to become more involved in local tourism. Locals provide lodging, cultural education and history for compensation.

The ecotourism initiative has proven to be fruitful: of the 1.2 million tourists that visited Nepal in 2018, the majority explored natural areas. Across the country, 484 homestay houses are registered around natural sites like Chitwan National Park. These establishments also encourage the improvement of sanitation facilities like clean toilets, filtered water and pollution-free air, which are crucial to reducing poverty in Nepal.

From these homestays, tourists can travel to various nearby sites. At these sites, they can engage in activities including hiking, mountaineering, cultural immersion and rafting. These efforts propel afforestation projects and preserve biodiversity by preventing forest conversion. Community-based ecotourism has kept ancient cultures alive, protected the environment and provided economic and cultural stability to local communities.

Economic Impact

Oftentimes, the environment and the economy are thought of as mutually exclusive; however, ecotourism in Nepal has challenged this mindset. Ecotourism contributes to about 4% of Nepal’s total GDP and provides varying forms of employment to about 200,000 people. These opportunities are growing for people like Pratiksha Chaudhary, who runs a homestay in the village of Dalla near Bardia National Park.

The thirty-three-year-old reflects on her initially timid nature when she began hosting guests, concerned that her rooms were not clean enough or that her food was not good enough. However, after a decade in the business, Chaudhary has found confidence in herself and in her work. She can now afford home renovations and has added two bigger rooms, tiled flooring and hot water. These additions help her remain competitive in her village’s ecotourism industry, which has experienced a doubling of homestays in the last decade. Through the income she earns, Chaudhary can also provide her son a quality education and protect her natural environment.

Protected areas across the country have created a substantial decrease in inequality and poverty in Nepal. Studies found increasing the number of protected areas in Village Development Committees from 10% to 70% led to increased prosperity for those villages. Additionally, protected areas with high tourism rates reduced the overall poverty rate, demonstrating that ecotourism alleviates poverty in Nepal.

The social and economic benefits of ecotourism do not stop there. In a study of homestays operators in Nepal, 83% reported feeling empowered. Additionally, 88% reported improving their lifestyle after opening their business. The local and tourist support these owners receive has also enabled them to maintain their cultural identities, adding further intrinsic benefit to the homestay field. These positive outcomes challenge the assumption that ecotourism only benefits the elite: data shows that homestays offer potential paths out of poverty for even the most remote villages in Nepal.

The Future of Ecotourism in Nepal

Ecotourism provides great potential for entrepreneurship and economic resilience that will ultimately help combat poverty in Nepal, especially for women. Qualitative data from a 2017 study shows that women tend to be more self-confident, financially independent and better educated in family decision-making when involved in homestay businesses.

Ecotourism and homestays have proven to be effective steps in boosting local economies and involving remote villages. However, establishing completely eliminating poverty in Nepal will require assistance from governments through policy. By expanding the availability of tools for conservation efforts and using ecotourism as an aid for other sectors like agritourism and transportation, the government could boost the economy and reach more people sustainably. As an industry, ecotourism alleviates poverty in Nepal and serves as a role model for developing countries pursuing similar endeavors.

– Mizla Shrestha
Photo: NeedPix

Childhood BlindnessFounded by West Virginian Doctor VK Raju, the Eye Foundation of America responds to the ubiquity of childhood blindness. Though less common in industrialized nations, blindness affects many societies throughout the world. Globally, 2.2 billion people cope with cases of vision impairment or blindness, 12 million of which are preventable. According to the foundation, combating childhood blindness may be the most cost-effective health intervention.

Eye Foundation of America

Most instances of vision impairment result from eye conditions. When eye conditions obstruct the visual system and one or more of its functions, if not treated quickly and effectively, vision impairment leads to permanent blindness.

Dr. Raju, the creator of Eye Foundation of America (EFA), grew up in Rajahmundry, Andhra Pradesh, India. His medical career in ophthalmology brought him to his current residence of Morgantown, West Virginia. Following his journey from east to west, Dr. Raju strengthened his ties to India and other developing countries through EFA.

Childhood vision impairments have an impact on education as learning is done 80% through vision. Therefore, EFA revolves around a singular mission: eradicating childhood blindness. The principles of service, teaching and research, underscore operations of the foundation. EFA sets up medical clinics across the world focused on training staff on ophthalmological procedures, screening local populations for eye conditions and maintaining a functional vision for the youth.

In four decades, EFA made notable strides in combating childhood blindness and overall blindness. In 30 countries across the world, EFA trained and educated more than 700 doctors and medical staff, conducted three million vision screenings and saved the vision of more than 350,000 people through essential procedures.

Early Intervention Prevents Blindness

In an interview with The Borgen Project, Dr. Raju affirms the importance of proper sight for children, without which “the child becomes a problem to themselves, a problem to the family and a problem to society.”

Reducing childhood blindness requires early intervention. If health care personnel identify eye conditions in a child’s first two years of life, the visual cortex still has time to develop and function properly. Conversely, if doctors neglect vision problems during this critical period of growth, the brain cells may never learn to see.

Disparities Between Access and Affordability

Dr. Raju traces the pervasiveness of childhood blindness to accessibility and affordability rather than incidence. He offers his home state of West Virginia as an example. In 2018, the U.S. Census Bureau documented the West Virginia poverty rate at 17.8%, which is 6% above the national rate of 11.8%. Despite relative poverty, Dr. Raju asserts that West Virginia residents enjoy excellent health care and ophthalmological treatment, regardless of whether they have insurance.

Two-thirds of the 1.4 million cases of childhood blindness occur in developing countries where Dr. Raju sets up the majority of EFA’s clinics. Accordingly, The World Health Organization (WHO) reports, “The burden of visual impairments and eye conditions tends to be greater in low and middle-income countries and underserved populations, such as women, migrants, indigenous peoples, persons with certain kinds of disability and rural communities.”

Vision Impacts Global Poverty

Mahatma Gandhi once famously declared, “Be the change you wish to see in the world.” For Dr. Raju, the change is to see. Though often taken for granted, vision enables children to read, write and learn through seeing. Vision impacts education and education impacts poverty. Dr. Raju’s foundation addresses overall global poverty by addressing childhood blindness.

Maya Gonzales
Photo: Flickr

covid-19 in africa

On a world map of the distribution of COVID-19 cases, the situation looks pretty optimistic for Africa. While parts of Europe, Asia and the United States have a dark color, indicating relatively high infection rates, most African countries are light in comparison. This has created uncertainty over whether the impact of COVID-19 in Africa is as severe as other continents.

Lack of Testing

A closer look at the areas boasting lighter colors reveals that the situation in Africa is just as obscure as the faded shades that color its countries. In Africa, dark colors indicating high infection rates only mark cities and urban locationsoften the only places where testing is available.

Although insufficient testing has been a problem for countries all over the world, testing numbers are strikingly low in Africa. The U.S. completes 249 tests per 100,000 people per day. In contrast, Nigeria, Africa’s most populous country, only executes one test per 100,000 people daily. While 6.92% of tests come back positive in the United States, 15.85% are positive in Nigeria. Importantly, Nigeria is one of the best African countries for testing: it carried out 80% of the total number of tests in Africa.

As a continent housing 1.2 billion individuals of the world’s population, Africa is struggling to quantify the impact of COVID-19 without additional testing. To improve these circumstances, the African CDC has set a goal of increasing testing by 1% per month. Realizing the impossibility of reliable testing, countries like Uganda have managed to slow the virus’ spread by imposing strict lockdown measures. As a result, the percentage of positive cases in Uganda was only 0.78% as of Sept. 1, 2020.

A Young Population

COVID-19 in Africa has had a lower fatality rate than any other continent. In fact, many speculate that fatality rates may even be lower than reported. Immunologists in Malawi found that 12% of asymptomatic healthcare workers had the virus at some point. The researchers compared their data with other countries and estimated that death rates were eight times lower than expected.

The most likely reason for the low fatality rate in Africa is its young population. Only 3% of Africans are above 65, compared with 6% in South Asia and 17% in Europe. Researchers are investigating other explanations such as possible immunity to certain variations of the SARS-CoV-2 virus and higher vitamin D levels due to greater sunlight exposure.

Weak Healthcare Systems

Despite these factors, the impact of COVID-19 in Africa is likely high. Under-reporting and under-equipped hospitals unprepared to handle surges in cases may contribute to unreliable figures. In South Sudan, there were only four ventilators and 24 ICU beds for a population of 12 million. Accounting for 23% of the world’s diseases and only 1% of global public health expenditure, Africa’s healthcare system was already strained.

Healthcare workers are at the highest risk of infection in every country. In Africa, the shortage of masks and other equipment increases the infection rate among healthcare workers even further. Africa also has the lowest physician-to-patient ratio in the world. As it can take weeks to recover from COVID-19, the infection and subsequent recovery times for healthcare workers imply that fewer are available to work. Thus, COVID-19 in Africa further exacerbates its healthcare shortage.

Additionally, individuals who are at-risk or uninsured can rarely afford life-saving treatment in Africa. For example, a drug called remdesivir showed promising results in treating COVID-19. However, the cost of treatment with remdesivir is $3120. While this is a manageable price for insurance-covered Americans, it is not affordable for the majority of Africans. Poverty therefore has the potential to increase the severity of COVID-19 in Africa.

Economic and Psychological Factors

Strict lockdowns have helped some nations control the spread of COVID-19 in Africa, but at a heavy price. A general lack of technology means that, following widespread school shutdowns, students have stopped learning. Many adults have also lost their jobs. More than 3 million South Africans have become unemployed due to the lockdown.

Furthermore, the lockdowns have also resulted in much higher rates of domestic violence, abuse and child marriage. Many such cases are unreported, meaning that the real scope of the problem is probably larger. Mental health services for victims or those struggling through the pandemic are also often unavailable. In Kenya, the United Nations has appealed for $4 million to support those affected by gender-based violence.

The slow spread of COVID-19 in Africa has allowed the continent and its leaders to prepare. Importantly, its young population will lessen the severity of the virus’ impact. Although these circumstances provide reasons to be hopeful, there is no doubt that Africa’s economy and future will suffer from the virus. This potential highlights the need for foreign assistance not only in controlling COVID-19 in Africa but in the continent’s recovery for years to come.

– Beti Sharew
Photo: Flickr

Treat Sickle Cell DiseaseCRISPR gene-editing technology is now being used to treat various illnesses. This holds the potential to be a life-changing development for many people and may treat those plagued with sickle cell disease around the world.

What is Sickle Cell Disease?

Sickle cell disease is most prevalent in African countries, where having one copy of the sickle cell gene helps protect people against malaria. However, having two copies of this gene results in sickle cell disease. Sickle cell disease occurs because of a genetic mutation that causes red blood cells to develop a sickle-shape and this obstructs healthy blood flow. The condition can cause serious pain and negative health effects, usually resulting in early death. When considering children with the disease, 70% are born in sub-Saharan Africa. Unfortunately, these countries do not have adequate resources to properly alleviate the symptoms of this condition, let alone treat them.

A Potential Cure

In recent months, it has been discovered that CRISPR gene-editing technology may be the key to curing sickle cell disease. CRISPR–Cas9 is a naturally occurring defense system that edits DNA sequences to fight viruses in the human body. In the past decade, scientists have discovered how to harness this system’s ability to manipulate DNA in chosen ways. The result of this is CRISPR gene editing is a powerful technology that can correct genome defects and even alter entire genomes.

CRISPR technology works by editing genes, which modifies how the body functions. First, medical professionals remove patients’ bone marrow and treat it. Then, CRISPR allows scientists to “cut and paste” bits of the genome by either cutting or adding a sequence of DNA into the genome. This can correct genetic mutations, ultimately improving a patient’s health.

In the U.S., a trial of using CRISPR to cure sickle cell disease is yielding promising results. The treatment uses CRISPR technology to activate a gene that instructs the body to produce fetal hemoglobin instead of adult hemoglobin. The presence of fetal hemoglobin prevents the blood cells from sickling. In this way, the treatment alleviates the health complications typically resulting from sickle cell disease. The subject of this trial is much healthier and has made exceptional progress in her recovery. These spectacular results have left many people hopeful that CRISPR technology could successfully treat sickle cell disease, with more widespread results by 2022.

The Future of CRISPR Treatment

For CRISPR treatment to reach its full potential, it must become more accessible to those who need it most. Therefore, the underprivileged in sub-Saharan Africa would benefit greatly. One suggested way to overcome accessibility barriers is through a tiered-pricing system. This system would offer gene therapy treatment to patients in developing countries at a reduced price, while patients in high-income countries would be expected to pay for the treatment in full.

There are currently logistical barriers to this solution, as gene therapy can cost thousands of dollars. The cost of CRISPR treatment would have to be greatly reduced (beyond the normal price drops of tiered pricing) to be successfully made available to the underprivileged. Additionally, this treatment requires consistent doctor visits. Much of sub-Saharan Africa lacks access to health clinics and other essential resources, such as refrigeration.

Breaking Down Barriers

Organizations are helping to eliminate the barriers blocking CRISPR treatment for sickle cell disease in developing countries. The National Institutes of Health and the Bill and Melinda Gates Foundation donated $200 million to this cause in 2019. This money will help make gene therapy accessible throughout the world and improve the quality of life for thousands. With the promise of affordable CRISPR gene modification therapy, there is hope for individuals worldwide to treat sickle cell disease. Permanently improving the quality of life is the end goal. Those living in developing countries, the global poor and those vulnerable to falling into poverty will be the most to benefit from this exciting, technological development.

– Hannah Allbery
Photo: Flickr