Information and news about disease category

tuberculosis in madagascar
Madagascar, a country off the southeastern coast of Africa, comprises of tuberculosis cases among its citizens of low socioeconomic status. In 2012, 70.7% of the Malagasy population was living below the poverty line and in 2017, the incidence rate for tuberculosis in Madagascar was 233 cases per 100,000 people. Encouraged and perpetuated by poverty, this disease makes Madagascar the perfect candidate for an outbreak.

Tuberculosis, commonly known as TB, is the most infectious fatal disease in the world. Although it is a very treatable illness, it kills more than 1 million people annually across the globe. The vast majority of TB diagnoses and deaths derive from individuals residing in poor, developing nations.

Risk Factors

Lack of quality living conditions, nutrition and healthcare amplify the risk of getting tuberculosis in Madagascar. Limited access to toilets and handwashing facilities for the majority of Malagasy people have left many at risk. According to CIA World Factbook data, sanitation facility accessibility in Madagascar was unimproved for 88% of the total population in 2015. TB is also the leading cause of death for people with HIV. As of 2018, there were roughly 39,000 Malagasy people diagnosed with HIV but only 20,865 known TB cases that also had documented HIV statuses. Without quality systems in place to document HIV and TB rates across the country, solving the epidemic in Madagascar will not be easy.

The Global Fund Support

The added historical stigma surrounding TB makes matters worse. While already struggling financially, patients often fear that exposing their diagnosis will cause them to lose their jobs. This stigma is combated through support systems like The Global Fund, an organization that provides relief for epidemics through fundraising and education for those affected by TB. The fund’s employees act as a support system, thus debunking the shame that infected patients may feel due to their diagnosis.

In 2018, The Global Fund’s donations and work helped cure 33,000 patients with tuberculosis in Madagascar. For 2020-2022, the organization projects that a total of $18,045,448 will go toward tuberculosis management in Madagascar. In 2017, these funds helped increase Madagascar’s TB treatment success rate to 84%.

Biotechnological Solutions

Although TB is preventable and curable, Madagascar lacks the necessary medical tools to diagnose and treat this disease. Not only are there minimal supplies, but there is also a need to expand and strengthen Madagascar’s ability to analyze TB samples according to Niaina Rakotosamimanana, the head of the mycobacteria unit at the Health Institute of Madagascar.

Researchers from the Health Institute of Madagascar, Stony Brook University and Oxford University are also collaborating to find solutions for this issue. These institutions are working together to grant access to a portable and affordable tool, the MinION. The MinION helps to diagnose and efficiently test the resistance of TB strains to antibiotics, while at the same time being a cheap, affordable option that is accessible to Malagasy people.

Tuberculosis is still one of the top 10 leading causes of death in Madagascar, but the country is making significant progress towards the eradication of the disease. The efforts Madagascar is taking in tracking TB are positive steps that contribute to the fight against this epidemic.

Sophia McGrath
Photo: Pixabay

Benin's Health Care
The Republic of Benin is located in the western region of the African continent. The sub-Saharan country possesses a tropical climate and a population of approximately 12 million people. Benin’s economy highly relies on agriculture. Its production of cotton provides 40% of Benin’s GDP and 80% of its exports. Unfortunately, Benin is an impoverished nation with about one-third of the population living beneath the international poverty line. The citizens of Benin also experience many different issues regarding the handling of healthcare in Benin.

Lack of Resources

As of now, the government spends only 3.3% of the GDP on services relating to healthcare in Benin. The average life expectancy is around 60 years old. However, the infant mortality rate stands at 63 deaths per 1,000 births, while the maternal mortality rate stands at 500 deaths per 100,000 births.

Despite Benin’s relatively large size (about 110,000 square kilometers), there are only four hospitals within the national borders. A survey conducted in 1999 reported that for every 1,000 patients who arrived at hospitals to receive treatment, only 0.1 doctors and 0.2 beds were available. As a result, one of the primary methods to improve Benin’s health care is to hire and train more doctors.

Diseases

The Joint United Nations Program for HIV/AIDS states that anywhere from 38,000 and 120,000 individuals in Benin may be infected with the HIV/AIDS virus. These figures are comparatively lower than in other African countries, but the virus is still spreading among young adults. Waterborne diseases such as tuberculosis, cholera and meningitis have high risks and rates of infection. Typhoid Fever poses a highly dangerous threat in Benin, as only 23% of the population has access to adequate sanitation services. Further efforts need to emerge to improve the quality of drinking water. Until then, the citizens of Benin have to rely on boiling their water to remove bacteria.

Natural Disasters

In 2010, Benin experienced the worst series of flooding that it had seen in decades. The floods affected over 800,000 people and wiped away entire villages. Due to the lack of water clean-up and filtration, people were consuming water that overflowing latrines had contaminated. As a result, reports to hospitals determined that there were nearly 800 new cases of cholera. The disaster prompted the U.N. refugee agency to activate an emergency plan to help those the floods displaced.

Malnutrition

Despite Benin’s current progress in healthcare, child malnutrition still remains a critical marker of poverty and improper healthcare. Assumptions have also determined that over 25% of infants and children younger than 5-years-old suffer or die from malnutrition. However, the government of Benin has recently developed an innovative plan for improving child nutrition.

The new Early Years Nutrition and Child Development Project (EYNCDP) is the first step in a series of three operations that aim toward improving the delivery and quality of selected health and nutrition interventions throughout the country. This first project focuses on integrating early stimulation and learning, primary school feeding programs and policy improvement.

Nonprofit Aid

There is further hope toward improving the lives of the people in Benin. Since 1995, the nonprofit organization CARE has been working on projects to help families in Benin receive improved income and education. For example, CARE has organized programs to combat gender-based violence, provide access to better nutrition and improve Benin’s healthcare.

It also provides aid to communities plagued with frequent flooding. Additionally, CARE grants further assistance by helping local farmers in rural communities improve their income via loan associations. By aiding farmers with their loans and savings, CARE ensures that their families are able to make proper investments, and in turn, can buy better livestock, seeds and farming equipment.

Projects like CARE can go a long way to provide aid to people living in difficult conditions like those in Benin. Through its efforts to aid communities experiencing flooding, healthcare in Benin should improve.

Aditya Daita
Photo: Pixabay

Heart Disease in Bolivia
Bolivia is the second poorest country in South America, performing poorly in education, life expectancy, economic strength and overall development. Most alarmingly, it lacks sufficient medical care due to a limited supply of adequate resources. Bolivia’s unique geography advances its tremendous healthcare challenges, causing children to be 10 times more likely to be born with congenital heart defects. These conditions are nearly impossible to treat without trained cardiologists and updated facilities, two things often inaccessible to most Bolivians. Thus, addressing heart disease in Bolivia is quite challenging as a result of these factors. However, Franz Freudenthal, inventor and cardiologist, is improving medical care with a simple technique that utilizes an indigenous hobby to heal holes in hearts.

What is PDA?

Patent Ductus Arteriosus (PDA) is a common congenital heart defect, particularly prevalent in certain parts of Bolivia. The defect is caused by an opening between two major blood vessels traveling away from the heart. The opening is crucial to a baby’s circulatory system before birth, but it should close almost immediately upon exiting the womb. PDA cases, however, present holes in the heart that remain open. Although the exact cause of congenital heart defects like PDA is typically unclear, decreased oxygen levels have a direct impact on fetal heart health. Because La Paz, Bolivia sits at 3,600 meters above sea level, where the atmosphere has lower oxygen levels than most parts of the world. Therefore, Bolivia’s altitude is the likely cause of irregular blood. Also, the mother’s inability to provide appropriate oxygen levels to her child can result in severe complications.

Breathlessness and failure to thrive are the most common symptoms in mild cases, but fatigue and failure to gain weight can also occur because harmed hearts must work three times harder to pump blood than healthy hearts. Children with severe cases of PDA are at a higher risk for pulmonary hypertension, arrhythmias, infective endocarditis, anticoagulation and congestive heart failure. However, each of these symptoms can be relieved by skilled women in the Andes Mountains’ high plains.

Ingenuity to Fight Heart Disease in Bolivia

Aymara women have been knitting clothes and blankets for centuries, but with help from Franz Freudenthal, they are now knitting heart-closure devices to mend PDA. The Nit Occlud is a hi-tech medical advancement modeled after an occluder, an industrially-produced device intended to block holes in babies’ hearts. Unlike a normal occluder, the Nit Occlud’s design cannot be mass-produced due to its intricate design. Therefore, Freudenthal had to search for an alternative production plan. The perfect method, he soon found, was the wonderful weaving skills of the Aymara women.

The Nit Occlud is composed of a super-elastic metal known as nitinol, a nickel-titanium alloy capable of memorizing its own shape. After a doctor inserts the device through the body’s natural channels, it travels through blood vessels, expands to its original shape, plugs the heart’s hole and permanently restores basic cardiac functionality.

Typical treatments for PDA include surgical procedures, cardiac catheterizations, or heart transplants, but these are not available Bolivia and are not welcomed by the Aymara people. Even though the Aymara people have recently adopted Catholicism, they still believe in the power of the Andes Mountains spirits and their effects on human souls. Keeping in mind that manipulating a heart – performing open-heart surgery or a transplant – is considered desecration according to the spirits, Freudenthal created a minimally invasive innovation to respect patient beliefs and to “make sure that no child is left behind.”

Making Impact

Although congenital heart defects remain the fourth leading cause of premature deaths in Bolivia, the rate has dropped 36% since 2007. Freudenthal’s Nit Occlud has saved more than 2,500 children in nearly 60 countries after experiencing immense success in Bolivia. The country is also succeeding in its fight against poverty. The number of Bolivians living on less than $3.20 a day is projected to decrease by 35% in the next 10 years. Additionally, more children are being vaccinated and more prenatal care opportunities are becoming available to mothers. With these advancements in healthcare and poverty reduction, the economy will soon flourish and rates of heart disease in Bolivia are sure to drop .

Natalie Clark
Photo: Flickr

Tuberculosis in BangladeshTuberculosis (TB) is an airborne disease; common symptoms include cough with sputum and blood in some cases, chest pains, weakness, weight loss, fever and night sweats. TB can lead to the death of an infected person when left untreated. According to the World Health Organization (WHO), TB has caused about 2 million deaths worldwide, and 95% of deaths were recorded in developing countries. Bangladesh ranked sixth among high TB burden countries. The National Tuberculosis Control Programme (NTP) has attained more than 90% treatment success and more than a 70% case detection rate. Despite these successes, tuberculosis in Bangladesh remains a serious public health problem.

Reasons for Higher Infection of Tuberculosis in Bangladesh

  1.  Delays in the Initiation of Treatment: Patients in Bangladesh often receive late treatment. Delays in treatment increase chances of negative treatment results, death and community transmission of TB. A study on 1,000 patients reported that, on average, there were 61 days of delay in the treatment of women and 53 days of delay in the treatment of men.
  2.  Role of Informal Health Practitioners: Most of the impoverished people in Bangladesh prefer to go to their local practitioners due to the ease of accessibility and low cost. A recent survey showed that approximately 60% of the Bangladesh population prefers to go to these uncertified doctors. However, such doctors typically lack formal training. This may lead difficulties in accurately diagnosing and treating TB.
  3. Lack of Awareness: Directly observed treatment short-course (DOTS) has been recognized as one of the most efficient and cost-effective approaches for treating TB. In 1998, the DOTS program became an integrated part of the Health and Population Sector Programme. The inclusion of the DOTS strategy in the Programme helped TB services transition from TB clinics to primary level health facilities. These health facilities typically incorporate GO-NGO (government-organized non-governmental organization) partnerships, and the NGOs have advocated for work on literacy, social awareness along and health care development. As part of the Health and Population Sector Programme, DOTS is freely available to the public. Unfortunately, many remain unaware of the treatment option.  As a result, detection of new TB cases has stagnated at around 150,000 cases per year since 2006.
  4. Poverty: A large portion of the country is still suffering from poverty. Poverty can often lead to overcrowding and poorly ventilated living and working conditions. People with less income also cannot afford food, leading to higher incidences of malnutrition. The culmination of these factors typically make the impoverished population more vulnerable to contracting TB.

The Effort to Combat TB

Tuberculosis is a major public health problem in Bangladesh. However, continuous efforts by the NTP and various NGO organizations have played an important role in decreasing the spread of the disease. DOTS, for instance, demonstrated a 78% cure rate in 1993. Due to its success, a phase-based treatment plan was implemented in 67 million rural populations in 1996.  Since implementation, the NTP has attained a 90% treatment success rate. Further efforts to combat the disease include development of the FAST program (Find cases Actively, Separate safely and Treat effectively). The program intends to detect active TB cases and decrease spread of the disease in healthcare facilities. However, despite efforts by the NTP and a number of NGOs, significant delays in care-seeking and treatment initiation still exist as major hindrances to the program’s goals. 

Challenges to TB Programs

Tuberculosis in Bangladesh kills more than 75,000 people every year. Despite free services like DOTS and other NTP programs, limited access to quality service, lackluster funding and insufficient screening prevent adequate detection and treatment of the disease. The lowest quartile of the population is still five times more likely to contract TB, potentially due to a lack of awareness of TB-treatment programs among the general public. Adding to the problems for TB programs, private health professionals are typically inactive in national programs. While NTP programs have made progress in addressing the disease, these challenges persist, and tuberculosis remains a major health problem in Bangladesh.

Solutions

To stop the growth of tuberculosis in Bangladesh, community organizations such as the Bangladesh Rural Advancement Committee (BRAC) have shown impressive results in lowering the percentage of those afflicted by TB. Effective treatment of TB includes investment in medicine, local health services and diagnostics. To ensure full recovery, social protection of patients is also required. Multidrug-resistant TB (MDR-TB), for instance, requires two months of drug treatment and a four month continuation period. If treatment programs can satisfy requirements investment and social protection requirements, the chance of curing TB patients reaches 92%. The application of a more successful method will help in curing the most complex TB cases, such as drug-sensitive TB, with improved results. With the implementation of proper and effective treatment strategies, we can eliminate tuberculosis in Bangladesh and the benefit even the poorest members of society.

– Anuja Kumari

Photo: Pixabay

Trypanosomiasis in the Central African Republic
Trypanosomiasis, a parasitic infection that is transmittable to humans through bites from the tsetse fly, is an illness common only among those living in sub-Saharan Africa. People living in rural areas and those who depend on agriculture, hunting or fishing for their food are most exposed to the infection. Poverty, war and failed healthcare systems can contribute to the spread of trypanosomiasis. Proper diagnosis requires a skilled staff and early treatment can help prevent the infection from worsening. The Central African Republic (CAR) has the highest number of cases of the disease in the world. Trypanosomiasis in the Central African Republic is a pressing health issue, which demands sustained funding for treatment and medical training.

About the Infection

Also known as human African sleeping sickness, trypanosomiasis is most prevalent in the 36 sub-Saharan African countries, including the CAR. There are two types of trypanosomiasis. Depending on which parasite causes the disease, an infected individual could have Trypanosoma brucei rhodesiense or Trypanosoma brucei gambiense (the more common of the two). If an individual becomes sick with the latter, symptoms can go unnoticed for months or years before the infection begins to affect their central nervous system. Symptoms include fever, headaches, confusion, poor coordination and irregular sleep patterns. Transmission of trypanosomiasis can occur from mother to child, a tsetse fly bite or sexual contact with an infected person.

If trypanosomiasis goes untreated, an individual can experience worsening symptoms and can eventually enter a coma — hence the infection’s nickname (sleeping sickness). People in the CAR are especially susceptible to contracting the disease from doing agricultural work. Much of the population of the CAR lives in rural areas, depending heavily on subsistence farming to survive. More than 55% of the nation’s GDP stems from agriculture and 80% of the workforce is in the farming industry. Since citizens are dependent on farming and hunting for their food, they are at a higher risk of exposure to the tsetse fly and thus, have an increased rate of contracting trypanosomiasis.

Treating Trypanosomiasis

Infected individuals’ symptoms often go unnoticed or untreated. The CAR’s political climate, high poverty rate and lack of proper healthcare centers all facilitate the spreading and worsening of the infection. As of 2018, more than 71% of the population lived below the world’s poverty level, meaning that medical staff and treatment were inaccessible to most citizens living with trypanosomiasis in the Central African Republic. The country is also recovering from the violence of late 2013, which left many hospitals and offices ransacked or closed. Due to these various factors, citizens suffering from trypanosomiasis in the Central African Republic have few options for testing and medication.

There is one well-known medication that can treat the disease, called nifurtimox-eflornithine combination therapy (NECT). Though NECT can significantly help patients with trypanosomiasis, the treatment includes multiple injections and close monitoring of the symptoms — both of which are usually unavailable or difficult to follow through to completion.

The Good News

However, with combined efforts from the government and other organizations, more patients suffering from the illness are receiving treatment. With help from the World Health Organization (WHO), CAR’s government is monitoring the cases and number of deaths from trypanosomiasis and working to provide more clinics, healthcare professionals and medication. The WHO and CAR’s health sectors aim to eliminate transmission of the disease by 2030. With only 997 cases and 164 deaths reported in 2018 (the lowest number in the 80-year battle with the disease), the CAR is on track to reach this goal partially due to consistent outside aid.

One notable international organization, Médecins San Frontières, mobilizes doctors and nurses throughout the CAR to provide free diagnoses and medication for those who have trypanosomiasis. Citizens are made aware of the free medical care and the organization can screen thousands of patients.

Over the next few years, help from organizations like the WHO and Médecins San Frontières can lead to adequate testing and medication for citizens with trypanosomiasis in the Central African Republic. It is imperative that organizations and countries in a position to help — contribute trained medical staff, funding and medicine to aid in the CAR’s fight against trypanosomiasis.

Danielle Kuzel
Photo: Flickr

Documentaries About Healthcare
During quarantine, many people resort to watching Netflix shows and movies. Though the pandemic has freed up more time for binging meaningless films, one can also use this time to learn about how impoverished countries are handling the COVID-19 pandemic. While documentaries have a reputation for being boring, many documentaries about healthcare are the opposite. Here are five documentaries about healthcare around the world.

1. “The Final Inch” (2009)

Rating: PG-13

Where to Watch: HBO

In the late 2000s, polio spread through India, Pakistan and Afghanistan. “The Final Inch” focuses on efforts to eradicate polio in these countries (it has since seen elimination in India, but there are ongoing efforts to reduce the numbers in Pakistan and Afghanistan). Produced by the philanthropic division of Google, this documentary aims to increase awareness of the outbreak of polio in these countries and the efforts of healthcare workers to eradicate the disease. This documentary follows numerous workers and volunteers in their efforts to administer the polio vaccine in these vulnerable places. While dangers arose in Afghanistan while filming, this documentary about healthcare provides a raw outlook on the polio epidemic and its effects on these countries.

2. “Sicko” (2007)

Rating: PG-13

Where to Watch: Amazon Prime Video

Directed by Michael Moore, “Sicko” is a political documentary that investigates healthcare in the United States. Centered around the American pharmaceutical industry, this film compares the non-universal U.S. healthcare system to systems in Canada, France and Cuba. “Sicko” follows Moore’s journey to understand the difference in how the United States and other countries around the world handle the same problems. Moore considers issues of health insurance and money, revealing horror stories behind healthcare policies. Moore effectively combines tragedy and comedy in this raw film and exposes the truth behind American healthcare. 

3. “Living in Emergency: Stories of Doctors Without Borders” (2008)

Rating: Unrated

Where to Watch: Amazon Prime Video

Doctors Without Borders is a nonprofit organization that provides medical care in impoverished countries around the world. Set in the Congo and post-conflict Liberia, Oscar-nominated documentary “Living in Emergency” follows four doctors and their efforts to provide emergency medical care to the public. Through the chaos, this documentary about healthcare follows these volunteers as they confront many challenges and make tough decisions. The doctors often face limited resources, personnel and poor living conditions. “Living in Emergency” provides a new, more realistic perspective for those privileged enough to access proper healthcare.

4. “Period. End of Sentence” (2018)

Rating: TV-PG

Where to Watch: Netflix

While menstruation is a shared experience across the world, it is a taboo topic in India. In rural communities in this country, sanitary products are out of reach, as proper healthcare is often available only in urban areas. “Period. End of Sentence” follows a group of women in the Harpur district outside of Delhi, India as they create sanitary products. Throughout the film, these women not only learn how to produce pads, but they also rid their community of stigma against menstruation. Nominated for an Oscar, this documentary about healthcare in India has severely changed the view on periods in healthcare systems and rural communities as well. Beyond changing the way people view menstruation, “Period. End of Sentence” has also yielded significant praise as a documentary.

5. “Cervical Cancer in Uganda: Three Perspectives” (2014)

Rating: Unrated

Where to Watch: YouTube

In sub-Saharan Africa, the most prominent form of cancer is cervical cancer. Research from the National Center for Biotechnology Information concludes that cervical cancer causes the most cancer-related deaths in Uganda. While cervical cancer is common in this country, however, it does not get mainstream attention. This documentary follows Sascha Garrey as she travels through the country to understand the prevention and treatment options for women in Uganda. Produced by the Pulitzer Center, this documentary on healthcare educates viewers on cervical cancer and its prevalence in impoverished countries.

While these five documentaries may not all be the most recent, watching them during the pandemic can provide valuable insight into healthcare in impoverished countries. Instead of watching mindless films to pass the time, consider watching an informative and interesting documentary about healthcare conditions around the world.

Aditi Prasad
Photo: Flickr

Tuberculosis in BotswanaBotswana is a southern African country with just over 2 million residents living inside its borders. Every Batswana lives with the threat of tuberculosis, an infectious disease that remains one of the top 10 causes of death on the African continent. Tuberculosis has a 50% global death rate for all confirmed cases. Investing in tuberculosis treatments and prevention programs is essential. Botswana has one of the highest tuberculosis infection rates in the world with an estimated 300 confirmed cases per 100,000 people, according to the CDC. Preventative and community-based treatment shows promise in combating tuberculosis in Botswana.

Treating Tuberculosis in Botswana

Tuberculosis treatment cures patients by eliminating the presence of infectious bacteria in the lungs. The first phase of treatment lasts two months. It requires at least four separate drugs to eliminate the majority of the bacteria. Health workers administer a second, shorter phase of treatment to minimize the possibility of remaining bacteria in the lungs.

Early identification of tuberculosis is a crucial step in the treatment process and significantly reduces the risk of patient death, according to the Ministry of Health. Preventative treatment methods are vital because they inhibit the development of tuberculosis infection. They also reduce the risk of patient death significantly.

Health workers detect tuberculosis with a bacteriological examination in a medical laboratory. The U.S. National Institutes of Health estimate that a single treatment costs $258 in countries like Botswana.

Involving the Community

Botswana’s Ministry of Health established the National Tuberculosis Programme (BNTP) in 1975 to fight tuberculosis transmission. The BNTP is currently carrying out this mission through a community-based care approach that goes beyond the hospital setting. Although 85% of Batswana live within three miles of a health facility, it is increasingly difficult for patients to travel for daily tuberculosis treatment. This is due to the lack of transportation options in much of the country.

Involving the community requires the training and ongoing coordination of volunteers in communities throughout the country to provide tuberculosis treatment support. Community-based care also improves treatment adherence and outcome through affordable and feasible treatment.

The implementation of strategies such as community care combats tuberculosis. For example, it mobilizes members of the community to provide treatment for tuberculosis patients. The participation of community members also provides an unintended but helpful consequence. For example, community participation helps to reduce the stigmas surrounding the disease and reveals the alarming prevalence of tuberculosis in Botswana.

A Second Threat

In addition to the tuberculosis disease, the HIV epidemic in Africa has had a major impact on the Botswana population, with 20.3% of adults currently living with the virus. Patients with HIV are at high risk to develop tuberculosis due to a significant decrease in body cell immunity.

The prevalence of HIV contributes to the high rates of the disease. The level of HIV co-infection with tuberculosis in Botswana is approximately 61%. African Comprehensive HIV/AIDS Partnerships (ACHAP), a nonprofit health development organization, provides TB/HIV care and prevention programs in 16 of the 17 districts across the country in its effort to eradicate the disease.

Fighting Tuberculosis on a Global Scale

The World Health Organization (WHO) hopes to significantly reduce the global percentage of tuberculosis death and incident rates through The End TB Strategy adopted in 2014. The effort focuses on preventative treatment, poverty alleviation and research to tackle tuberculosis in Botswana, aiming to reduce the infection rate by 90% in 2035. The WHO plans to reduce the economic burden of tuberculosis and increase access to health care services. In addition, it plans to combat other health risks associated with poverty. Low-income populations are at greater risk for tuberculosis transmission for several reasons including:

  • Poor ventilation
  • Undernutrition
  • Inadequate working conditions
  • Indoor air pollution
  • Lack of sanitation

The WHO emphasizes the significance of global support in its report on The End TB Strategy stating that, “Global coordination is…essential for mobilizing resources for tuberculosis care and prevention from diverse multilateral, bilateral and domestic sources.”

– Madeline Zuzevich
Photo: Flickr

Poverty in Sierra Leone
Since establishing independence in 1961, Sierra Leone, a country located in West Africa, has suffered from various conflicts and injustices including a civil war that lasted from 1991 to 2002. As a result, Sierra Leone lacks significant development as a country, ranking 181 out of 189 on the 2019 Human Development Index. The nation remains impoverished. In fact, according to the United Nations Development Programme, approximately 60% of people live in poverty in Sierra Leone.

Factors Contributing to Poverty

Experts believe that four primary factors contribute to Sierra Leone’s overwhelming levels of poverty: government corruption, a lack of an established education system, absence of civil rights and poor infrastructure. These factors make poverty difficult to beat. With the unestablished infrastructure for roads and electricity, high transportation costs pose barriers to trade and limit economic growth.

Additionally, an absence of funding for educational programs leaves Sierra Leone behind in terms of gaining knowledge about civil rights or responsibilities. This contributes to gender inequality and the marginalization of women. The effects of gender inequality include women’s inability to join the workforce and a cultural view of women as servants for men. These ideas inhibit Sierra Leone’s development in a world that values education and women’s rights.

Reducing Poverty in Sierra Leone

Despite these ongoing issues, there have been various efforts to reduce poverty in Sierra Leone. The Free Healthcare Initiative (FHCI) launched in 2010 in Sierra Leone. This initiative provides pregnant women, new mothers and young children with access to basic healthcare in order to reduce infant mortality rates. Although the FHCI is not a solution to poverty in Sierra Leone, it led to several healthcare reforms, including adequate pay for healthcare workers. Robert B. Zoellick, former president of The World Bank Group, expressed his support for such efforts in a press release in 2010, explaining that addressing poverty in Sierra Leone would help lead to peace.

The Work of Oxfam

Various organizations from the United States have also made efforts to reduce poverty in Sierra Leone. One such organization is Oxfam, which has headquarters in Boston. This global organization aims to provide assistance to people experiencing injustices related to poverty. In Sierra Leone, Oxfam focuses on solving infrastructure-related problems, such as access to water, sanitation and hygiene. Additionally, the organization holds the government and other powerful beings in the country accountable by advocating for gender equality and food security. Oxfam also provides assistance in times of emergency, including during past outbreaks of cholera and Ebola in Sierra Leone.

The Tiger Worms Toilet Project is one of Oxfam’s notable successes in Sierra Leone. This project helped prevent communicable diseases by addressing sewage concerns through enhanced sanitation practices. It also helped prevent diseases by educating those in Sierra Leone about their spread. These actions enable Oxfam to make strides toward accomplishing its vision for Sierra Leone: “A just, inclusive and resilient Sierra Leone without poverty, in which citizens, particularly women and youth demand and acquire access to their rights and live a life of dignity.”

Although poverty remains a persistent problem in this West African country, aid from U.S.-based organizations like Oxfam is a small step toward eliminating poverty in Sierra Leone.

Hannah Carroll
Photo: Flickr

Healthcare in Chile
Healthcare in Chile primarily comes from the state-funded insurance National Health Fund (Fondo National de Salud – FONASA) or from private companies collectively known as Las Instituciones de Salud Previsional (ISAPRE). According to a 2019 report from the Organization for Economic Cooperation and Development (OECD), 78% of the population participate in FONASA and around 17-18% enroll in ISAPREs, while 3-4% receive coverage from the armed forces insurance program. A number of newly implemented government reforms in Chile have challenged healthcare inequity to ensure universal healthcare for all.

Morbidity and Mortality

In the 1980s, a series of successful reforms decreased infant mortality rates (from 33 per 1,000 live births in 1980 to only eight per 1,000 in 2013) and improved communicable disease rates, nutrition and maternal and child health. While the health status of Chileans consistently fell below average among OECD nations in recent decades, the life expectancy in Chile in 2015 rose to 79.1 years in the last 40 years, nearly on par with its OECD peers. Determinants of health status include life expectancy, avoidable mortality rates, morbidity rates from chronic diseases and percentage of the population in poor health.

Non-communicable diseases (NCDs), such as high blood pressure, diabetes and heart diseases are identified as the burden of disease in Chile, accounting for 85% of all deaths. Key risk factors include high obesity rates, heavy tobacco use and increasing rates of alcohol consumption. The infant mortality rate is improving but remains high, as are mortality rates from cancer compared to cancer incidence.

Some Effective Government Measures

The Chilean government has undertaken effective measures to address the nation’s most urgent issues through a multi-intervention strategy that targets different population groups and settings:

  • Obesity: According to a 2016 WHO report, 39.8% of the Chilean population was overweight, and another 34.4% was obese. Childhood overweight and obesity rate is particularly problematic at 45%, with no reduction in prevalence over the past 15 years. Chile has implemented nationwide policies to tackle behaviors that cause obesity, especially inadequate physical inactivity and unhealthy diets. At the national level, mass media, such as websites, Twitter, TV and radio adverts, educates the public on healthy food choices and emphasizes the consumption of vegetables and fruits. The government has also mandated labels on packed foods that indicate high caloric content in salt, sugar and fat.
  • Tobacco Use: Tobacco consumption rates in Chile in 2016 stood at 37% (41% among men and 32% among women) of the adult population. Adult smoking rates have declined from 45.3% in 2003 and 39.8% in 2009, a percentage below average in comparison to other nations. Since joining the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2005, Chile has implemented various tobacco control policies, such as prohibiting smoking in public spaces, requiring health warnings on tobacco products and raising taxes on these products.
  • Cancer Care: The OECD projected that cancer could soon become the leading cause of mortality in Chile. Among men, prostate, stomach, lung, colorectal and liver cancer have the highest mortality rates. In women, breast, colorectal, lung, stomach and pancreas cancer account for high mortality rates. To lessen the burden of cancer, Chile has reinforced its cancer care system and launched nationwide programs focused on cervical and breast cancer and cancer drugs for adults and children. From 2011 to 2015, Chile reduced cancer by 4.1%.

Challenging Inequity

The establishment of the National Health System (NHS) in 1952, subsequent expansions and reforms together enabled Chile’s move towards universal coverage with more than 98% of the population having some kind of health insurance. However, inequality remains one of the main challenges in Chile’s two-tier healthcare system, mainly due to the unequal distribution of resources between the underfunded public facilities and the elitist private clinics. Equity monitoring shows less insurance coverage for less educated people, low-income quintiles, residents from rural areas and those with state insurance.

Significant inequalities due to socioeconomic position and residence area persist. According to a study that PLOS Medicine published, the infant mortality rate among the highest educated women was 2.3 times lower than the least educated, while the ratio was 1.4 between urban and rural residence. Risk factors like obesity, alcohol use disorders and cardiovascular risks also disproportionately affected the least educated segment of the population.

Moving Forward

Despite tremendous challenges, healthcare in Chile has improved thanks to the government’s effort to prioritize health reforms. In 2005, Chile launched Universal Access with Explicit Guarantees (AUGE) program that sought to improve access, timeliness and quality of care in the public sector. The OECD assessed that the system of healthcare in Chile is overall “well-functioning, well-organized and effectively governed,” with a particularly robust public healthcare program that operates efficiently on both the central and regional levels. Although challenges such as rising rates of certain NCDs and inequities between sectors and populations persist, the country’s ambitious reforms demonstrate its preparedness to tackle these issues.

– Alice Nguyen
Photo: Flickr

healthcare in the Democratic Republic of the CongoOne of the biggest challenges facing the Democratic Republic of the Congo is its healthcare system. The country faces many barriers to adequate healthcare, such as low funding, systematic and structural difficulties, poverty, proper treatment and testing, education and more. However, many organizations worldwide are working to improve healthcare in the country through direct aid and legislation.

The Problems with the Healthcare System in the Democratic Republic of the Congo

The healthcare system lacks investment and funding. As a result, it is difficult for the country to combat prevalent healthcare issues, such as infectious diseases. It also provides obstacles to combatting more pervasive issues such as infant and mother mortality rates. According to the CDC, the top causes of death in the Democratic Republic of the Congo are “malaria, lower respiratory infections, neonatal disorders and tuberculosis.”

Many of these issues are preventable. However, as of 2017, the Democratic Republic of the Congo only dedicated 3.98% of GDP to healthcare. In comparison, the U.S. dedicated 17.06% to healthcare. Healthcare in the Democratic Republic of the Congo requires consistent funding and resources to ameliorate and reduce these problems; without increased investment, these healthcare problems will only continue to persist.

Furthermore, the WHO states that another complication facing the healthcare system is a lack of resources. The healthcare facilities that are up and running are “often poorly maintained” and difficult to access. Moreover, many communities throughout the country are isolated and spread out. For example, the WHO states that 80% of cholera patients are displaced throughout the country. With these patients vastly spread out, it becomes harder and harder to treat and reduce the impact of cholera. Additionally, traveling from one area to the next present difficulties because of damaged and underdeveloped roads, which introduces another barrier to proper treatment.

Therefore, it becomes increasingly difficult for citizens to even obtain access to healthcare clinics and/or hospitals. Factoring in violence and displacement, lack of food and healthy drinking water and extreme poverty conditions, healthcare in the Democratic Republic of the Congo’s is in dire need of support and aid.

What Organizations are Doing to Help

With that said, what are other countries and organizations doing to help the Democratic Republic of the Congo? There are many organizations around the world working to reduce global poverty and improve healthcare in the Democratic Republic of the Congo and other struggling countries. The focus herein are direct, firsthand efforts from organizations such as USAID, the CDC and WHO.

  • The WHO is actively trying to obtain accurate information about population and health in order to properly provide solutions for certain problems. For example, the WHO seeks to obtain information about issues, such as infant mortality rate and the necessary vaccines. Then, they modernize this information by implementing new technology and software to ensure that the data is upkept, accurate and transformative.
  • USAID is training local citizens and communities on proper healthcare treatment and issues. USAID helps these citizens utilize “locally available resources” to treat the pervasive health issues specific to the country. Additionally, USAID also seeks to increase education by providing scholarships to people to pursue comprehensive medical education. USAID also strives to increase funding and investment for healthcare in the Democratic Republic of the Congo.
  • The CDC has sent more than two million testing kits and thousands of vaccines/treatments to combat a multitude of issues such as malaria, HIV/AIDS, influenza and infections. Additionally, they have also increased the number of healthcare clinics and other testing and treatment sites across the country. These sites now include five new “sentinel sites for influenza and other infections”.

Moving Forward

Furthermore, advocacy organizations push federal legislation focused on reducing poverty and improving healthcare systems across the world. Equally important, these continual and consistent efforts prioritize allocation of U.S. foreign aid towards these economically struggling countries.

Overall, healthcare in the Democratic Republic of the Congo, underfunded for many years, still requires intense rebuilding and change. However, many organizations across the world are understanding these healthcare issues and taking action to help. While much more progress must occur in order to ensure a stable, successful healthcare system, the progress that is currently underway should not be overlooked.

– Sophia McWilliams 
Photo: Flickr