Malawi, a nation in southeast Africa, faces a severe shortage of health care professionals with less than one working physician per 1,000 Malawians. Dental care in Malawi is similarly underdeveloped, with only 43 practicing dentists in the country in 2021, with most located in private clinics in cities despite less than 20% of the population living in urban areas.

On the bright side, dental care in Malawi is improving as dental associations and charities from the United Kingdom (U.K.) increasingly fund dental programs in the country. One of these organizations is Smileawi, a Scottish charity founded by two dentists, Vicky and Nigel Milne, in 2012 after witnessing the nation’s lack of dental resources during a visit.

Smileawi’s Work

Smileawi runs a portable dental clinic in rural areas of Malawi, providing dental care to those who are less likely to have access to dentists. The charity also funds Malawian dental students and conducts dental conferences to empower and support local dentists in improving dental care in Malawi.

Although Smileawi prefers to send qualified dental practitioners to Malawi, many volunteers have no background in dental care and receive training from the organization. These volunteers self-fund a 16-day trip to Malawi to work in the charity’s “pain clinics,” which provide free tooth extraction services for diseased teeth. The clinics have also helped thousands of individuals suffering from toothache in the nation.

Smileawi’s services are available to vast numbers of people due to their portable clinics that are set up in public spaces such as classrooms and churches. Using money from donations, Smileawi invested in an eight-chair portable clinic that has served patients all over the rural areas of Malawi. Furthermore, Smileawi is developing a dental van that will help them travel around the entire nation and continue providing dental care to those in remote locations.

Smileawi Funding: Empowering Malawian Health Professionals

Smileawi aims to improve oral health in Malawi by directly providing dental services and empowering local health professionals. In 2017, Smileawi founders, the Milne family, assessed the equipment and facilities of dental therapists in Malawi and spent several months in the U.K. purchasing high-quality, second-hand dental chairs and equipment to send to Malawi. The charity was able to provide eight working dental chairs in six locations, and staff received training on how to maintain new equipment.

Since 2017, Smileawi has funded 21 dental therapy students, including Lusekero Kyumba, who studied at the College of Health Sciences in Malawi. The charity covers tuition fees, accommodation and general maintenance, which is vital because many academically gifted students cannot afford tuition fees and drop out as a result. Smileawi enables prospective Malawian dentists to focus on their studies and graduates are offered jobs at pain clinics following the completion of their studies.

Smileawi Conferences: Connecting Malawian Dentists

To ensure Malawian dentists are at the forefront of improving dental care, Smileawi hosts conferences twice a year in Mzuzu, where dental professionals can exchange information and discuss how to improve their practices. The conferences regularly see the attendance of international speakers, representatives of the Malawian government and medical professionals. Smileawi volunteers, partners and Malawian dental therapists agree that the conferences are highly beneficial because they create a space for dentists to build connections and share ideas on how to make accessible dental care in Malawi a reality.

Looking Ahead

Although there is still a long way to go before quality dental care is accessible to everyone in Malawi, Smileawi is making significant progress in improving oral health among the rural population. The charity’s work directly helps the Malawian people and encourages the improvement of dental care nationally.

– Mohsina Alam
Photo: Flickr

Cardiovascular diseases (CVDs) are some of the most prevalent threats to global health. This is certainly the case for vulnerable populations, especially refugees and other migrant groups. Heart disease affects Syrian refugees in particular at a significantly high rate. These asylum seekers face overwhelming poverty and a variety of other risk factors that contribute to these illnesses across multiple countries, particularly in places like Jordan and Lebanon. Several international organizations, such as Doctors Without Borders, continue to tackle this issue, although it still persists and poses a serious public health threat to those in these communities.

Prevalence of CVDs

Although CVDs are a real threat to all people globally, they can tend to affect certain demographics more than others. Heart disease in Syrian refugees is a cause for concern for a number of reasons. According to Wasim Maziak and others, the morbidity rate for CVD among Syrians is about 4.8%, with the mortality rate being 179 per 100,000.

The impacts of CVD in Syrian refugee communities are greater due to increased risk factors. These include but are not limited to hypertension, high blood pressure, obesity, diabetes, firsthand and secondhand smoking and unhealthy eating habits. A 2019 study by the Boston College medical journal Annals of Global Health found strong correlations between cases of CVD and these risk factors in Syrian refugees living in Jordan. Of the nearly 1,000 patients they surveyed at Jordan University Hospital, about 60% had high blood pressure and 31% suffered from diabetes. Additionally, 24% were chronic smokers.

Lack of treatment was also a significant issue for these patients. According to the study, “treatment was offered to 489 patients (49.5%), but only 322 (65.8% of treatment offered and 33.2% of referrals) of them received the intended treatment.” Partly due to the lack of care for over half the Syrian refugee patients, 3% of them died and about half never had follow-up appointments during the timeframe of the study. The study also found that about 13% of the patients who were referred to specialists “were denied any funding,” which primarily came from the Jordanian government and the UN, as well as other charity groups and NGOs.

Risk Factor Causes

One of the possible explanations for why CVD risk factors are so high for Syrian refugees is because of their repeated exposure to conflict and trauma. For over a decade, Syrians have struggled with a violent civil war that has forced over 14 million people to flee the country since 2011. These refugees have been confronted with many traumatic events, including the loss of loved ones. Such trauma can greatly increase risk factors for CVD. As the American Heart Association (AHA) reveals that stress, especially chronic stress, “may lead to high blood pressure, which can pose a risk for heart attack and stroke. Stress also may contribute to such cardiovascular disease risks as smoking, overeating and lack of physical activity.”

This stress comes at even higher levels for Syrian refugees, who have to deal not only with the traumas of the past but also the great challenges they face in starting a new life in a foreign country. The challenges involve not only the struggles of assimilating into another society but also the struggles of overcoming poverty. For example, the U.N. reports that in Lebanon, 90% of the Syrian refugees in the country are “reliant on humanitarian assistance to survive.” Syrian refugees in Turkey also face challenges in meeting their basic needs, as about 90% are reportedly unable to do so.

Preventative Measures

Clearly, heart disease affects Syrian refugees at high rates due to a variety of risk factors such as trauma, displacement and poverty. In responding to this public health crisis, organizations such as Doctors Without Borders (MSF) have prioritized providing free health care to thousands of Syrian refugees in need. MSF’s chronic disease treatment program has provided consultations and treatment for nearly 4,000 Syrian refugees in Jordan over the span of nearly a decade. This includes “treatment for hypertension, diabetes, asthma, cardiovascular diseases and chronic obstructive pulmonary diseases.”

Looking Ahead

The work of humanitarian organizations such as MSF can play a significant role in reducing the rates of CVD among Syrian refugees. Poverty not only leads to increased stress and, therefore, increased risk of CVD but also inhibits access to health care. By providing free medical services to these vulnerable communities, MSF and other non-governmental organizations (NGOs) are actively alleviating one of the most significant public health crises facing Syrian refugees.

– Adam Cvik
Photo: Flickr

Human trafficking in St Vincent and the Grenadines involves forced labor in farming and cannabis production, sexual exploitation of women, arms trafficking and child trafficking by caregivers. Victims usually comprise Vincentians and foreigners from other Caribbean islands, South America and Asia. The Global Organized Crime Index also recognizes that people who work for foreign/international companies that have set up shop in St Vincent may be vulnerable to exploitation.

Although the country has not totally resolved the human trafficking problem, it has made progress in punishing criminals and protecting women and children. The government has taken several steps to combat human trafficking, including the following:

The Punishment

The government of St Vincent and the Grenadines has taken measures to combat trafficking by implementing training programs for law enforcement. The programs aim to give out stricter punishments to traffickers in order to make the consequences proportionate to the seriousness of the crime. This training also covers tips on identifying victims and providing resources for them.

The national police force has an Anti-Trafficking In Persons Unit (ATIPU), and it has been active since 2012. This unit monitors high-risk areas such as bars, airports, restaurants and seaports to swiftly detect signs of trafficking or smuggling of people from overseas.

For border control, the police force has a Special Services Unit that watches people entering and exiting the country. In addition, St Vincent has collaborated with international organizations such as the Regional Security System to control immigration and prevent smuggling within its borders and around neighboring countries. These actions highlight the nation’s willingness to accept external help in its fight against trafficking.

Raising Public Awareness

In St Vincent and the Grenadines, the fight against trafficking extends beyond the police force to include nurses, teachers, students and members of the wider society who have received training from ATIPU’s summer camps. So far, the unit has trained 426 students and 400 nurses and teachers to identify trafficking and prevent it. The government has also launched printed and digital advertisements as well as radio campaigns to raise awareness of trafficking among the citizens and help them recognize the signs of it. To encourage reporting, the government set up a hotline for individuals to report any suspicions of trafficking, enabling everyone to play a role in combating the problem.

Looking Ahead

The government of St Vincent and the Grenadines continues to combat trafficking by not only enacting laws to prosecute traffickers but also helping and supporting victims, as well as training law enforcement and educating the public to be more alert for signs of trafficking. These efforts show promise in eradicating trafficking and creating a future where it is no longer a concern for the inhabitants of the country.

Neonatal Jaundice is a common problem in newborns and it can have life-threatening complications. Traditional treatment is difficult in low-resource settings, as it requires access to a stable source of electrical power for prolonged periods.

What Is Neonatal Jaundice and How Is It Treated?

A build-up of a substance called bilirubin in the blood causes jaundice. The liver is responsible for removing bilirubin from the body. However, newborn babies’ livers are not yet fully developed. Unfortunately, high levels of bilirubin in the blood can be toxic to the brain, thereby necessitating treatment. Every year, approximately 6 million babies do not receive jaundice treatment.

One of the main forms of neonatal jaundice treatment is phototherapy. In this procedure, babies undergo UV light exposure. They are placed into a crib-like piece of equipment that shines UV light onto the skin for around 48 hours. This results in the conversion of toxic bilirubin into a safer form that is not harmful to the brain and can be easily excreted in the urine.

What Is the Global Context of Neonatal Jaundice?

A study from 2010 by the Child Health Epidemiology Reference Group reported that neonatal jaundice was responsible for a mortality rate of 119 per 100,000 live births in Eastern Europe/Central Asia, Latin America, Sub-Saharan Africa and South Asia. In comparison, the mortality rate in high-income countries is around one per 100,000. The study also found the complication of brain toxicity to be prevalent in 73 per 100,000 live births in the aforementioned regions. In high-come countries, the prevalence rate is 10 per 100,000.

Standard commercial phototherapy machines cost around $3,000 and require a constant supply of electricity. As things stand, heavy power usage is a major concern for hospitals in low-income and middle-income countries. Not only is the demand for power costly, but there is also no guarantee of access due to unreliable power supply in these settings. For this reason, the use of traditional phototherapy machines is challenging in low-resource settings.

The Bili-Hut

Dr. Donna Brezinski developed an innovative solution known as the Bili-Hut. It is a portable, battery-operated device that only costs $400 per unit. The design utilizes LED lights that can run on a 12-volt car battery for up to a month. Additionally, it has a lower upfront cost and can run independently, with no need for connecting to a hospital’s power supply source.

The Bili-Hut forms part of a kit, which also includes a “Bili-ruler” and a “Bilistick”. The former measures the degree of jaundice while the latter measures jaundice concentration in a newborn’s blood.

Crib’A’Glow

Virtue Oboro identified the need for more effective phototherapy treatment in Nigeria when her son experienced a delay in receiving treatment due to a lack of phototherapy units. She developed the Crib’A’Glow, a phototherapy unit that runs on renewable energy using a solar panel, a battery and a charge controller. The solar panel powers LED lights in the crib to provide a fully functioning phototherapy unit. It can function in low-resource settings and only costs around $300-$550.

Using solar power is an innovative solution. Apart from minimizing the running cost of the unit, it also ensures the unreliable power supply in Nigeria has no impact on the service process.

Virtue’s solution has helped to treat more than 1250 babies across Nigeria since 2016. Additionally, the Champions of Science Africa Innovation Challenge 2.0 provided additional funding for the project in 2019, with the hopes of reaching 1 million babies.

With the help of innovators like Virtue and Dr. Brezinski, there is hope for overcoming the challenges of delivering phototherapy in low-resource settings.

– Jess Steward
Photo: Flickr