Archive for category: Health

Information and stories on health topics.

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Improving Healthcare in Albania

Healthcare in Albania
Albania became highly secluded following Enver Hoxha’s communist reign from 1908-1985. Medical staff would often make house calls for patients that were severely ill because there was only one hospital per city. The paucity of the country’s healthcare offset the highly skilled and thoroughly trained professors at the Mother of Teresa School of Medicine. This school emerged in 1959 and was the first school of medicine in Tirana. The doctors had the skill, but they lacked the proper tools to go about daily operations. The lack of resources during this time had a damaging effect on healthcare in Albania.

The Concerns

While professors who were to teach at the Mother of Teresa School of Medicine received training in other European countries, Albania still gave little to no personal freedom regarding matters of end-of-life to its patients. Documentations have determined that the nutrition of Albania became scarce under Hoxha’s rule. In fact, infant mortality rates supposedly increased; they are currently at 10.83 per 1,000 births (9.49 for females per 1,000 and 12.08 for males per 1,000). While the population began to dwindle, the communist regime led a movement in which women received the promise of a cow in addition to the title of “heroic mother” if they had six or more children.

Birthing units would hold five to seven pregnant patients per room: no husbands or other family members could fit or enter. Albania currently meets compliance with global labor standards regarding maternity protection. Mothers in the country can enjoy the benefits of a full maternity leave duration, full amounts of maternity leave cash benefits and breastfeeding breaks with breastfeeding facilities. The country also established that the government was the source of the cash benefits and not individual employers.

Lack of Freedom

Not only could “heroic mothers” not have their husbands or other family members around as they gave birth, but Albanians are still unable to deny poor medical treatment from hospital doctors and medical staff. The coverage for healthcare in Albania for citizens during communism mimicked the Soviet-type Semashko model and was free of charge. The Albanian government owned and directed the healthcare plan.

Today a combination of healthcare contributions from the state, employees and employers pay for Albanian public healthcare spending. In fact, the employer and employee each contribute 3.4% with employees’ portion coming from their salaries. The state subsidizes and pays for the rest. The fact that Albanian healthcare does not address the withdrawal of treatment gives Albanians little power to make healthcare decisions.

The WHO

Despite Albanians’ lack of healthcare freedom, the country is doing much to raise the quality of healthcare in Albania. The World Health Organization (WHO) mentioned the 2013-2022 Albanian Plan for Mental Health Services Development. The WHO highlighted the plan to protect the rights of individuals with special needs and mental health problems. The 11th National Report on the Implementation of the European Social Charter for Albania stated that as a part of its 2013-2022 plan, it built nine community mental health centers and 13 supported homes.

The idea behind supported homes is to deinstitutionalize psychiatric wards with high populations and transition these patients back into society. The method before this was to simply hospitalize mentally ill citizens. Albania is also home to Different and Equal, an NGO that assists victims of human trafficking, domestic violence and sexual abuse.

Moving Forward

Albania is not only developing mental health centers or supported homes; the government has also promised to revolutionize and increase financial output towards the health sector. The government believes that the need for medical devices will increase. Increased spending will lead to new technology in hospitals. It also maintains the idea that increased spending on the health of its country will cause investments in public hospitals to rise. According to the Albanian Ministry of Health (MoH), public healthcare spending in 2018 reached 48.6 billion Leke ($450 million). Expectations determine that more recent spending statistics should be higher than reports state.

In 2018, the WHO reported that during visits, its team noticed that the healthcare buildings were old but that they had received good maintenance. Also, the MoH developed a general medical check-up for everyone between the ages of 40-65 in 2016. The idea behind this check-up was that it would give individuals the motivation to visit their family physician. Albanians enjoyed this innovative solution to healthcare advocacy for free.

The Albanian government has chosen a route of seclusion in the past. Communism allowed citizens to have free healthcare but at the cost of the freedom to choose the right health options for themselves. The citizens of Albania are now helping to fund their own healthcare. Nurturing mothers have become a larger focus, which will hopefully lower the infant mortality rate. Albania is also addressing mental illness and future government healthcare spending is set to increase.

– DeAndre’ Robinson
Photo: Wikimedia Commons

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Mass Incarceration in Colombia: Facts and Solutions

Mass Incarcerations in ColombiaThere is currently a problem of mass incarceration in Colombia. This South American country has a population of nearly 50 million people as of 2018. Currently, Colombian prisons have a capacity of 80,928 people. However, as of May 2020 the incarcerated population reached 112,864, or 139.5% of capacity. The Colombian prison system is known to be very overcrowded. Overcrowded prisons infer and amplify broader social issues. These prison environments amplify the spread of infectious diseases like HIV, tuberculosis and, most recently, COVID-19.

Effects of Mass Incarceration in Colombia on Health

  1. Capacity Rates: There are 132 prisons in Colombia with a total maximum capacity of just over 80,000 people. Despite this capacity, Colombian prisons have reached 139.5% of occupancy, or just over 112,000 people. Women make up about 6.9% of this number—about 7,700 women. Currently, there are no incarcerated in Colombia. Congress has actively fought against the release of prisoners, instead choosing to keep the prisons full.
  2. Effects of COVID-19: Prison riots are becoming increasingly common in Latin America with the spread of the COVID-19 virus. Mass incarceration in Colombia has created panic amongst prisoners, who have demanded more attention to their conditions. The Colombian Minister of Justice, Margarita Cabello, has not outwardly acknowledged the prison riots as demands for better care against COVID-19. Rather, Minister Cabello stated that the riots were an attempt to thwart security and escape from prison. Furthermore, due to the scarcity of doctors, prisoners continue to contract and/or die from complications of COVID-19.
  3. Infectious Diseases: Besides COVID-19, mass incarceration in Colombia has allowed the spread of diseases such as HIV and tuberculosis. Many Colombian prisons have a designated cell block for those who contract HIV, as it is common for prisoners to engage in sexual relationships with guards. Healthcare facilities are not readily available in prisons and condoms are in scarce supply. Active cases of tuberculosis also correlate with mass incarceration in Colombia. Approximately 1,000 per 100,000 prisoners have been diagnosed with tuberculosis. Unfortunately, mass incarceration has further limited prisoners’ access to affordable care.

Striving for Improved Conditions

Local citizens Mario Salazar and Tatiana Arango created the Salazar Arango Foundation for Colombian prisoners. After being imprisoned on fraud charges in 2012, Mario Salazar’s experience drove him to find ways to make prison sentences more tolerable. Salazar and Arango Foundation provides workshops for prisoners in the city of La Picota and puts on plays for fellow inmates. Prisoners have found the organization to be impactful to their self-esteem and their push for lower sentences.

Mass incarceration in the Colombian prison system is both a result and driver of poverty. Issues of food shortages and violence have created poverty-stricken conditions within prisons. Despite these conditions, organizations such as the Salazar Arango Foundation seek to improve the lives of prisoners. Hopefully, with time, external forces will help to reduce the rate of incarceration in Colombia. In essence, efforts to due so would have considerable impact on the lives of prisoners and their families.

– Alondra Belford
Photo: Flickr

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The Process of Improving Healthcare in Puerto Rico

Healthcare in Puerto Rico
Puerto Rico is a United States territory located east of Cuba with the Atlantic Ocean and the Caribbean Sea surrounding it. This beautiful tropical paradise is a land of wonder with picturesque landscapes for tourists and residents alike. However, behind this convincing guise is the reality of poverty and illness that plagues the country. With 43% of Puerto Rico living in poverty, the healthcare system is a system of great importance as it acts as a crutch to those living in poverty. Here is some information about healthcare in Puerto Rico.

Medicaid in Puerto Rico

Medicaid in Puerto Rico serves approximately half of Puerto Rico’s population of 3.2 million people. The Medicaid program in Puerto Rico is an outlier in comparison to other U.S. states, having to supply healthcare to those in need while facing shortages of doctors and funds. The annual healthcare budget in Puerto Rico is $367 million as of 2019, however, estimates determine that expenditures are closer to $2.8 billion.

Additionally, the Medicaid program operates on a Managed Care system. This system helps to manage cost, utilization and quality, making healthcare in Puerto Rico more affordable and offering better utilization of health resources.

Additional Funding

The Affordable Care Act, section 2005, provided the Medicaid program in Puerto Rico with $5.4 billion in additional Medicaid funding from July 1, 2011, to Sept 30, 2019. Puerto Rico also received an additional $925 million in funds to establish a healthcare market. The country had to exhaust Previous Affordable Care Act funds before it could use additional funds. The Affordable Care Act is a health reform law that passed in March 2010. The law has three goals including increasing the availability of affordable health insurance, expanding the coverage of the Medicaid program to cover adults below 138% of the federal poverty line and supporting innovative methods of medical care delivery to decrease costs of healthcare.

Doctors Leaving the Country

While medical professions receive respect and high pay in the U.S., this is not necessarily true for Puerto Rico. In fact, many Puerto Ricans enter the medical field so they can one day migrate to the mainland U.S.A. According to the Economic Research Institute, the annual average income for a Family Doctor is $194,307, while the U.S. average is $237,000.

Another issue that doctors in Puerto Rico are facing is the scarcity of medical equipment and personnel, often resulting in prolonged waiting times for appointments. According to Vox, the waitlist can take “as long as four to six months to see professionals,” a direct result of Puerto Rico losing approximately 15% of all medical personnel on the island.

Puerto Rico College of Physicians and Surgeons

Shortages in medical personnel and lack of funding have increased wait times and created shortages of medical supplies in Puerto Rico. Thankfully, the Puerto Rico College of Physician and Surgeons is working to combat these challenges. This organization emerged through Law 77 in 1994 and is mandatory for all students pursuing a career in the medical field. The Puerto Rican government uses it to provide doctors where people need them most. The Puerto Rico College of Physicians and Surgeons ensures that doctors studying in Puerto Rico serve there for sometime before finding opportunities elsewhere. As of 2016, the organization has lost approximately 4,000 members to the “temptation in accepting one of those lucrative job offers,” shrinking the number of members from 14,000 to 10,000.

Jaideliz Moreno

The state and quality of healthcare in Puerto Rico have fallen as the years pass by, proving to negatively affect the population. On a seemingly average day in Vieques, a small island off the coast of mainland Puerto Rico, Jaideliz Moreno developed flu-like symptoms. This is a common issue that people face on the mainland U.S.A., but it was a life or death situation for Jaideliz. This was because Vieques, recovering from the destruction that Hurricane Maria caused in 2017, lacked a proper hospital. A small clinic for veterans alongside a labor and delivery room has replaced the hospital that Hurricane Maria destroyed. The small clinic named Susana Centeno Community Health Center lacked the medical supplies necessary to cure 13-year-old Jaideliz Moreno. A helicopter rushed her to mainland Puerto Rico but she died on the way there.

FEMA —Federal Emergency Management Agency— is an agency that strives to support citizens and first responders to show that as a nation we work better together in the face of adversity and disaster. As of January 2020, FEMA has approved $39.5 million to fund the Susana Centeno Community Health Center until a permanent hospital in Vieques is built. As of now, there is no projected completion date of the Vieques hospital.

Healthcare in Puerto Rico is a developing system in need of vital resources and proper funding. This kind of support is key to the growth and improvement of Puerto Rico’s medical work.

– Ernesto Gaytan
Photo: Flickr

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Tackling Tuberculosis in Cambodia

Tuberculosis In Cambodia To the nearly 17 million people living in Cambodia, tuberculosis is no stranger. In 2007, it was the seventh leading cause of death in the country. In 2012, it caused nearly 8.6 million Cambodians to fall ill. Today, despite the ongoing threat of tuberculosis in Cambodia, eradication efforts continue to prove that solutions to complex health problems can oftentimes start with the simplest of interventions—take, perhaps, a new washing machine.

A Clean, New Discovery

For the staff at the Khmer Soviet Friendship Hospital in Cambodia’s capital, such a realization came around because of Nhib Chhom. Nhib Chhom, the Deputy Infection Control Coordinator, asked nurse educator Kareeen Dunlop to test the bacterial residue of hospital linens. She discovered an extremely minor reduction in the amount of bacteria on washed laundry. This was a surprising finding no doubt, but to the hospital’s many employees, less than so.

“Staff have been pleading with me in regards to their laundering,” describes Dunlop in a 2019 report. “Nhib Chhom again said how the washing was coming back from the laundry dirtier than it went.”

Seeing as the hospital specializes in the treatment of infectious diseases, the nurses’ frustration is particularly understandable. Without the proper means to sanitize linens, curbing disease transmission is made unnecessarily more difficult. Furthermore, the lack of sanitization unnecessarily ignites yet another outbreak of tuberculosis in Cambodia.

What to Know About Tuberculosis in Cambodia

Globally, the WHO approximates that 1.8 billion people have TB. Cambodia in particular is still home to one of the largest TB infection rates in the world. Cambodia has approximately 13,000 TB-related deaths per year. Cases of tuberculosis in Cambodia have decreased by 45% between 2002 and 2011. Despite this decrease, however, Cambodia continues to remain among the world’s 22 high-burden tuberculosis countries. The Pasteur Institute in Cambodia estimates a TB prevalence of 36,000 cases out of a population of 16 million in 2015 alone. Coupled with an estimated 40% TB under-diagnosis rate according to research at the National University in Singapore, the TB threat in Cambodia is certainly far from passed.

Thankfully, however, such staggering numbers have not gone unchecked. In fact, together the national TB program and international partners have achieved an 85% TB treatment success rate. They continue to address eradication efforts. In the case of the Khmer Soviet Friendship Hospital’s laundry problem, the officials involved were Michael and Jodie Flowers. Michael and Jodie Flowers, managers of Commercial Laundry Solutions LTD., who volunteered to install four washing machines and donate a drier to the hospital. Aided by $6,000 worth of spare parts from Electrolux, the Flowers spent three weeks refurbishing their washing appliances. They ultimately granted nurses the ability to deliver sparkling clean laundry for the first time.

How the Cambodian Health Committee is Combatting Tuberculosis in Cambodia

Many others works to empower healthcare providers with the materials necessary to deter global health threats. A nonprofit NGO, the Cambodian Health Committee (CHC), has also been working long hours to eradicate tuberculosis in Cambodia. Additionally, they also strive to eradicate HIV/AIDS from Svay Rieng, Kompot and Kandal, three of Cambodia’s poorest and most war-affected provinces.

Founded by research immunologist Dr. Anne Goldfeld, in collaboration with healthcare professional Dr. Sok Thim, the CHC has treated more than 32,000 people with tuberculosis in Cambodia since its founding in 1994. The CHC has also screened over 2,000 people for drug-resistant TB infection. With an integrated emphasis on healthcare, clinical research and education, the CHC implements a community-based healthcare model to provide direct TB care, in addition to investigating the effectiveness of new innovations.

For example, the CHC designed a research study regarding the effects of treatment timing in outcomes for TB and HIV-infected patients. The study, CAMELIA, found that beginning TB drug therapy two weeks prior to administering AIDS medications decreases mortality by 34%.

The Borgen Project recently spoke with Dr. Sarin Chan, a clinical investigator for CAMELIA. According to Dr. Chan, the study has since progressed out of the experimental phase and into the clinical one. The study is involved with early ARV treatment for co TB and HIV-infected patients now recognized in the national guidelines for clinical care of HIV patients. The National Center for Tuberculosis and Leprosy Control’s development of a TB prevention strategy is similarly a promising step forward in the fight against tuberculosis in Cambodia, says Chan.

Looking Ahead

At the end of the washing cycle, much good can be said about the progress against tuberculosis in Cambodia. Despite the country’s high TB infection rate, increased access to community-based healthcare as provided by the CHC and improvement of hospital sanitation practices all point towards a brighter future.

– Petra Dujmic 
Photo: Flickr

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6 Facts About Healthcare in Ethiopia

Healthcare in Ethiopia
Located in the horn of Africa, Ethiopia is a developing country that has struggled to obtain structured and stable healthcare in the past. However, in recent years, the country  has made several attempts to provide healthcare improvements. Here are six facts about the efforts to improve healthcare in Ethiopia.

6 Facts About Healthcare in Ethiopia

  1. The number of healthcare facilities in Ethiopia has increased immensely. Within the last decade, the number of healthcare facilities and small clinics have quadrupled from 4,211 to 14,416. Public hospitals have grown in numbers from 76 to 126. With an increase in healthcare facilities, citizens living in rather rural areas will have easier access to healthcare and assistance. Although the country is still making improvements daily, the increase in statistics regarding healthcare facilities exemplifies the overall improvement of healthcare in Ethiopia.
  2. Installation of Social Accountability (SA) has improved service delivery in healthcare centers. In 2006, Ethiopia’s government introduced Social Accountability (SA) to its citizens as a new initiative to promote healthcare transparency. The Ethiopian government desired a transparent healthcare system in which citizens would receive full awareness of healthcare rights and standards. Before the introduction of SA, healthcare in Ethiopia was not easily accessible for the disabled and exemplified poor sanitation, a lack of certain medical supplies and mediocre facility service. Through SA, citizens are now aware of the service standards that healthcare systems must reach.
  3. Reforms within health finance have changed within the last decade. The government has also created several reforms to direct more attention to healthcare systems. The Health Sector Development Plan emerged in 2003 and desired an efficient way of providing extensive healthcare in Ethiopia. The increased funding allowed the healthcare sector to place more emphasis on healthcare governing, healthcare employment and additional equipment. From 2007 to 2011, Ethiopia increased expenses towards healthcare from 4.5% to 5.2%.
  4. Ethiopia’s development plan towards healthcare focused on extensive organization and management. In 2006, the development plan enforced specific facility governing boards that had overlooked healthcare facilities. Approximately 93% of facility government boards emerged in healthcare centers in 2013 in hopes of providing better management.
  5. The Institute of Healthcare Improvement (IHI) provided assistance in advocating better quality healthcare. IHI partnered with a few organizations, one of them being the Ethiopian Federal Ministry of Health, to create an initiative plan that emphasized quality. Through the assistance of IHI, Ethiopia’s goals consist of testing and launching a model of a desirable healthcare system that portrays improved healthcare facilities and communities. In all, it hopes to create an efficient and simple strategy that will allow for a sustainable healthcare system in Ethiopia.
  6. Established in 2020, Ethiopia’s Health System Transformation Plan (HSTP) has created several goals to improve healthcare in the future. HSTP is an intricate plan that includes several targets the Ethiopian government is hoping to achieve. These targets include a lower infant mortality rate, a decrease in HIV contraction, a decrease in tuberculosis-related deaths and a depletion of cases regarding malaria deaths. By setting these goals, Ethiopia’s government aims to have a clear and distinct outlook on the future.

These six facts about healthcare in Ethiopia exemplify a few of the effective actions that the Ethiopian government took through the use of development plans and organizations. While there is still plenty of work for the country to do, several actions have taken place in attempts to improve Ethiopia’s overall healthcare.

– Elisabeth Balicanta
Photo: Wikimedia

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Healthcare in Costa Rica

Healthcare in Costa RicaCosta Rica is a Central American country located between Nicaragua and Panama. It has a population of more than five million people. Healthcare in Costa Rica ranks among the best systems in Latin America. The level of medical quality matches even that of more-developed countries, such as the United States. In a 2000 survey by the World Health Organization (WHO), Costa Rica was ranked No. 36 for the best healthcare system in the world, placing it one spot above the U.S. at the time. Other statistics from the WHO show that Costa Rica has a high life expectancy — 77 for men and 82 for women. For comparison, the United States’ life expectancy is 76 for men and 81 for women. There are two Costa Rican healthcare systems — the government-run system and the private system. Both of these healthcare systems are constantly improving, with developments in equipment, clinics and staff training.

Public Healthcare

Costa Rica’s government-run public healthcare system, Caja Costarricense de Seguro Social (CCSS), often called “Caja,” has 30 hospitals and over 250 clinics throughout the country. Though the public sector can have waiting lists, like any other healthcare system, it offers citizens and permanent residents full coverage for all medical procedures and prescription drugs. A small percentage of one’s income funds Caja. It is relatively inexpensive, especially in comparison to the costs of treatments in the United States.

Private Healthcare

Private healthcare in Costa Rica is more expensive than public healthcare, but it is of considerable quality. Doctors in private healthcare facilities generally speak English and have received professional training in the United States, Europe or Canada. CIMA hospital in Escazu, Clínica Bíblica in San Jose and Hospital La Católica in Guadalupe (San Jose) are the three most well-known private hospitals in Costa Rica and they are also internationally accredited.

Medical Tourism

The beautiful scenery and relatively low costs of healthcare in Costa Rica have turned the country into a popular spot for “medical tourism.” Medical tourism is defined by the Centers for Disease Control and Prevention (CDC) as “traveling to another country for medical care.” Each year, more than 40,000 Americans travel to Costa Rica annually to seek healthcare. In 2016, Costa Rica welcomed 70,000 medical tourists according to the Costa Rican Health Chamber, PROMED. The primary procedures for medical tourists in Costa Rica are dentistry and cosmetic surgery.

Both citizens and medical tourists can attest that healthcare in Costa Rica is of great quality and is low-cost in comparison to other systems. With the constant improvements to the universal and private health sectors, Costa Rica rightfully deserves its ranking as one of the best healthcare systems in Latin America.

– Emma Benson
Photo: Southcom

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How COVID-19 Has Impacted Artisanal Gold Miners in Burkina Faso

How COVID-19 Has Impacted Artisanal Gold Miners in Burkina FasoThe COVID-19 pandemic has disrupted gold supply lines around the world. That disruption, along with the recent uncertainty around global health security, has dealt the artisanal gold miners of Burkina Faso a severe blow. Prior to the pandemic, local gold prices in Burkina Faso were 94 percent of international gold prices. After COVID-19 hit the nation in March, local prices fell to just 55 percent of international gold prices.

Artisanal gold mining has continued in Burkina Faso, though more slowly than before the pandemic. Measures to control the spread of the virus, such as curfews, social distancing and even police violence and raids by national security guards, have slowed the pace of gold panning. This means the miners have even less opportunity to make a livable income.

Why It Matters

Of the over 20 million people in Burkina Faso, over 430,000  are directly employed in the artisanal gold mining industry. Most of the miners have little education and rely on mining to provide for themselves and their families. The miners include both men and women, with studies estimating that between 40 and 50 percent are female. Women run most of the hangars in which the gold is processed. These women are known as Tãngpogse and have enjoyed more economic freedom than many women.

The disruptions caused by COVID-19 put all of these artisanal gold miners at risk. Even before the pandemic, 45 percent of people in Burkina Faso survived on less than the U.S. $1.25 per day. Artisanal mining is an industry employed by people trying to escape poverty. Now, instead of realizing that dream, miners are facing uncertainty and hunger.

To make matters worse, the COVID-19 crisis is piling on top of other crises in Burkina Faso—jihadist violence in the north, and drought throughout much of the country. In the face of this complicated situation, many gold miners are struggling to feed themselves and their families. Many find that they must sell their gold at low prices to predatory buyers, in order to generate an income. If the situation worsens, the miners could find themselves increasingly desperate, and willing to turn to banditry or prostitution for income.

How World Agencies Are Helping

Two world agencies have stepped in to provide relief for artisanal miners. The first, the World Bank, has created an emergency relief fund for artisanal miners around the globe. According to Reuters, the fund already has $5 million in donations, with a goal of $15 million. This money will aid miners of various materials in different countries, not just Burkina Faso. Still, the World Bank’s effort is an important one. World agencies rarely aim for emergency relief at artisanal miners specifically.

The second world agency, the Artisanal Gold Council, is an NGO based in Canada. The Artisanal Gold Council has focused specifically on the artisanal gold miners of Burkina Faso and has purchased gold directly from them at the pre-pandemic rate. This business provides miners with much-needed income and should help to ease some of the economic stress they are under. As with the World Bank’s emergency relief fund, the Artisanal Gold Council’s actions are rare for an NGO; other organizations consider the money and effort necessary to bring artisanal gold into formal channels of the trade too high of a price to pay.

Aid from these world agencies should improve the artisanal miners’ economic situation. Still, the high poverty rate and continuing cases of COVID-19 in Burkina Faso remain causes for concern. As of July 1, Burkina Faso had reported a total of 962 cases of COVID-19, and 53 deaths from the virus. As the pandemic’s effects linger on, the miners will need more help to finally achieve their dreams of climbing out of poverty.

– Emily Dexter
Photo: Flickr

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Treating Tuberculosis in Liberia

Tuberculosis in Liberia
As COVID-19 spreads across the world, it is still not the leading cause of death from a single infectious agent. According to the CDC, that title belongs to tuberculosis, a respiratory illness that the bacteria species Mycobacterium tuberculosis causes. It usually targets the lungs but can attack any part of the body. Tuberculosis in Liberia, among other impoverished countries, remains a predominant issue that the country needs to address.

While tuberculosis is largely curable, it can be lethal if left untreated. The disease still affects populations of developing nations due to their lower capacity health care systems. According to the CDC, tuberculosis is the eighth leading cause of death in Liberia. The disease infects over 300 people per 100,000 Liberians.

Poverty in Liberia

 An article in the Lancet explains that tuberculosis is the “archetypal disease of poverty,” remaining prevalent largely in developing nations such as Liberia. Over 90% of the Liberian population lives under the international poverty line of $5.50 per day. Poverty not only makes treatment costs excessively burdensome for many people, but it also contributes to risk factors that further the spread of the infection.

According to Dr. Saurabh Mehta, Associate Professor of Global Health, Epidemiology and Nutrition at Cornell University, conditions that weaken the immune system are risk factors for tuberculosis transmission. These conditions include HIV infection, diabetes and malnutrition, all of which correlate with a lower socioeconomic status.

Dr. Mehta explains that overcrowding is another risk factor that facilitates TB transmission. In a crowded setting, a person infected with tuberculosis has a higher potential to interact with susceptible people.

Both malnutrition and overcrowding could contribute to the impact of tuberculosis in Liberia. One in three Liberian children experience stunting due to malnutrition, and over half of Liberia’s urban population lives in slums. The World Food Program is working to alleviate hunger in Liberia by providing meals in schools, supporting refugees through direct food aid and creating food reserves in food-insecure communities. The World Food Program provided over 66,000 pounds of rice as an initial reserve, which community members can access at a low-interest rate.

Rebuilding Health Care System Capacity

In order to treat tuberculosis in Liberia, the Liberian government needs a robust health system. However, civil war and outbreaks of other illnesses, such as Ebola, have weakened Liberia’s health system leaving fewer than four physicians per 100,000 people.

From 1989 to 2003, a civil war wreaked havoc throughout the nation, killing more than 250,000 people. Because many either died or fled, the number of trained doctors in Liberia declined from 237 to less than 20 by the end of the war.

While training programs that the country established after the war helped increase the number of nurses, Liberia only had a few dozen of its own doctors at the outset of the 2013-2016 Ebola outbreak. Ebola killed 4,809 people and further damaged Liberia’s health systems, among other West African countries. In a few years, the disease killed at least 600 health care workers across Liberia, Sierra Leone and Guinea.

To expand and safeguard its health care system’s capacity, Liberia collaborated with the WHO and other organizations to invest in Ebola treatment units as well as training for over 21,000 health workers.

Multidrug-resistant Tuberculosis Treatment

Drug-resistant pathogens are a serious public health concern globally. As existing medications become less effective, previously treatable illnesses become more deadly.

Over 2.5% of people with tuberculosis in Liberia have a multidrug-resistant form of the illness, making their condition higher risk and their treatment more expensive. Additionally, according to Mehta, treatment for multidrug-resistant tuberculosis is less effective and takes two to four times as long to complete as the treatment for tuberculosis that is not drug-resistant.

Taking an incomplete course of tuberculosis treatment increases the risk that someone could develop multidrug-resistant tuberculosis. This risk would decrease, however, if patients had more affordable treatment options.

The Liberian National Leprosy and Tuberculosis Control Program has worked to expand access to the international standard of care for tuberculosis, DOTS (Directly Observed Treatment Short courses). Although the treatment success rate for those who received treatment was at 80%, less than half of people with tuberculosis obtain treatment.

Tuberculosis Comorbidity with HIV/AIDs

The World Health Organization reports that 53 out of every 100,000 people in Liberia have a particularly lethal combination of tuberculosis and HIV/AIDs. People who have both diseases face a higher risk of their tuberculosis becoming active rather than remaining latent/asymptomatic. This is because HIV/AIDS weakens the immune system. As a result, tuberculosis causes 40% of deaths in HIV/AIDS patients.

While treatment to prevent tuberculosis for HIV/AIDs patients exists, only 21% of HIV positive patients receive such treatment. Expanding access to preventative treatment has the potential to significantly reduce mortality for people with tuberculosis in Liberia who also have HIV/AIDs.

– Tamara Kamis
Photo: Flickr

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10 Facts About Healthcare in Sweden

Health Care in SwedenSweden has the highest income tax rate in the world. More than 57% is annually deducted from people’s incomes. However, Sweden placed seventh out of 156 countries in the World Happiness Report 2019, and its healthcare system is one of the best in the world.

In 1995, Sweden joined the European Union and its population recently reached over 10 million people. Healthcare is financed through taxes and most health fees are very low. Sweden operates on the principle that those who need medical care most urgently are treated first. Higher education is also free, not only to Swedes, but also to those who reside in the rest of the European Union, the European Economic Area, and Switzerland. Like healthcare, it is largely financed by tax revenue. Here are 10 facts about healthcare in Sweden.

 10 Facts About Healthcare in Sweden

  1. Sweden has a decentralized universal healthcare system for everyone. The Ministry of Health and Social Affairs dictates health policy and budgets, but the 21 regional councils finance health expenditures through tax funding; an additional 290 municipalities take care of individuals who are disabled or elderly. To service 10.23 million people, Sweden has 70 regionally-owned public hospitals, seven university hospitals, and six private hospitals.

  2. Most medical fees are capped and have a high-cost ceiling. According to the Swedish law, hospitalization fees are not allowed to surpass 100 kr (Swedish Krona), which is equivalent to $10.88, a day and, in most regions, the charge for ambulance or helicopter service is capped at 1,100 kr ($120). Prescription drugs have a fee cap and patients never pay more than 2,350 kr ($255) in a one-year period. In the course of one year, the maximum out-of-pocket cost is 1,150 kr ($125) for all medical consultations. If the person exceeds the cap, all other consultations will be free. Additionally, medical services are free for all people under the age of 18.

  3. The cost for medical consultations not only has a price cap, but is generally low. The average cost of a primary care visit is 150 kr-300 kr ($16-$33) and the cost of a specialist consultation, including mental health services, ranges from 200 kr-400 kr ($22-$42). The cost of hospitalization, including pharmaceuticals, does not exceed 100 kr ($11) per day and people under the age of 20 are exempt from all co-payments. Healthcare services, such as immunizations, cancer screenings, and maternity care, are also free and have no co-payments.

  4. All dental care for people under the age of 23 is free. When a person turns 23, they no longer qualify for free dental health care in Sweden and must pay out of pocket. However, the government pays them annual subsidies, or an allowance, of 600 kr ($65) to pay for dental expenses. In Sweden, the cost of a tooth extraction is 950 kr ($103) and the cleaning and root filling for a single root canal costs 3,150 kr ($342). If dental care costs total anywhere between 3,000 kr-15,000 kr ($326-$1,632), the patient is reimbursed 50% of the cost. If it exceeds 15,000 kr, 85% of the cost is reimbursed.

  5. To battle its large medical waiting lists, Sweden has implemented a 0-30-90-90 rule. The wait-time guarantee, or the 0-30-90-90 rule, ensures that there will be zero delays, meaning patients will receive immediate access to health care advice and a seven-day waiting period to see a general practitioner. The rule also guarantees that a patient will not wait more than 90 days to see a specialist and will receive surgical treatment, like cataract removal or hip-replacement surgery, a maximum of 90 days after diagnosis. Sweden’s government also committed 500 kr million ($55 million) to significantly decrease wait time for all cancer treatments. In 2016, Sweden developed a plan to further improve its health services by 2025 through the adoption of e-health.

  6. In 2010, Sweden made private healthcare insurance available. The use of private health insurance has been increasing due to the low number of hospitals, long waiting times to receive healthcare, and Sweden’s priority treatment of emergency cases first. In Sweden, one in 10 people do not rely on Sweden’s universal healthcare but instead purchase private health insurance. While the costs for private plans vary, one can expect to pay 4,000 kr ($435) annually for one person, on average.

  7. Sweden’s life expectancy is 82.40 years old. This surpasses the life expectancies in Germany, the UK, and the United States. Maternal healthcare in Sweden is particularly strong because both parents are entitled to a 480-day leave at 80% salary and their job is guaranteed when they come back. Sweden also has one of the lowest maternal and child mortality rates in the world. Four in 100,000 women die during childbirth and there are 2.6 deaths per 1,000 live births. There are 5.4 physicians per 1,000 people, which is twice as great as in the U.S and the U.K, and 100% of births are assisted by medical personnel.

  8. The leading causes of death are Ischemic heart disease, Alzheimer’s disease, stroke, lung cancer, chronic obstructive pulmonary disease and colorectal cancer. While the biggest risk factors that drive most deaths are tobacco, dietary risks, high blood pressure and high body-mass index, only 20.6% of the Swedish population is obese and 85% of Swedes do not smoke. The Healthcare Access and Quality Index (HAQ Index) also estimates that, in 2016, the rate of amenable mortality, or people with potentially preventable diseases, were saved at a rate of 95.5% in Sweden. The HAQ Index estimates how well healthcare in Sweden functions; the index shows that it is one of the best in the world.

  9. Sweden’s health expenditure represents a little over 11% of its GDP, most of which is funded by municipal and regional taxes. Additionally, in Sweden, all higher education is free, including medical schools. There are no tuition fees and a physician can expect to have an average monthly salary of 77,900 kr ($8,500).

  10. In Sweden, 1 in 5 people is 65 or older, but the birth rate and population size are still growing. Because Sweden has one of the best social welfare and healthcare systems in the world, people live longer and therefore 20% of the population does not generate income or pay taxes from their salary. This dynamic stagnates social welfare benefits and slows down the economy. Increasing immigration and a rise in births are the two solutions to ensure that the younger generations will receive the same benefits. Swedish-born women have an average of 1.7 children and foreign-born women have an average of 2.1 children. In 1990, Sweden broke the 2.1 children fertility rate but quickly dropped below 2.0 in 2010. Since 2010, Sweden has seen an increase of 100,000-150,000 immigrants and has seen 45,000 citizens emigrate.

In 2018, Sweden reached its record highest GDP (PPP) per capita of almost $50,000. Despite having the highest taxes in the world, the living conditions and healthcare in Sweden are some of the best. With time, its population will continue to grow and the healthcare system will continue to advance.

– Anna Sharudenko
Photo: Flickr

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Biotechnology to Reduce Tuberculosis in Madagascar

Tuberculosis in Madagascar
Tuberculosis, commonly known as TB, is the most infectious fatal disease in the world. Despite the fact that it is treatable, TB kills more than 1 million people annually across the globe. The wide majority of diagnoses and deaths occur in poor, developing nations. Here is some information about tuberculosis in Madagascar.

Tuberculosis in Madagascar

Tuberculosis cases plague Madagascar, a country off the southeastern coast of Africa, especially among the citizens of low socioeconomic status. As of 2012, 70.7% of the Malagasy population lived below the poverty line. As a result, in 2017, the tuberculosis incidence rate in Madagascar was 233 cases per 100,000 people. TB is a disease that poverty perpetuates, making Madagascar a likely candidate for an outbreak.

Lack of quality living conditions, nutrition and health care all amplify the risk of tuberculosis infection in Madagascar. Proper toilets and handwashing facilities are scarce for the majority of Malagasy people. According to CIA World Factbook data, as of 2015, sanitation facility access in Madagascar remained unimproved for 88% of the total population. As for health care, not only is TB deadly in itself if it does not receive treatment, but it is the leading cause of death for people who suffer from HIV. As of 2018, there are 39,000 Malagasy people who receive a diagnosis of HIV, however, only 20,865 TB patients also had documentation of their HIV status. Without quality systems in place to document HIV and TB status, solving the epidemic in Madagascar will not succeed.

The Global Fund’s Support

The added historical stigma surrounding TB makes matters worse. While already struggling monetarily, patients are often fearful that, if their diagnosis is public, they will risk losing their jobs. However, various groups are making progress in reducing this stigma while aiding those with TB. The Global Fund, an organization that assists in funding relief for epidemics, is hiring employees to administer medication and encourage TB patients in Madagascar to stay on track with their antibiotics. These employees act as a support system as well and are working to debunk the shame that patients may feel surrounding their diagnosis.

The Global Fund is continuing to make huge strides in combating this disease. In 2018, the organization funded the cure of 33,000 patients in Madagascar. For 2020-2022, there is a projected $18,045,448 that will contribute to tuberculosis health care in Madagascar. These huge sums of money should significantly diminish the problem. As of 2017, based on the recorded percentage of new cases of TB, the treatment success rate was 84%.

Biotechnological Solutions

Although the disease is incredibly preventable and curable, there is a lack of medical tools in Madagascar necessary to diagnose and treat TB. Not only are there minimal supplies, but the head of the mycobacteria unit at the Health Institute of Madagascar, Niaina Rakotosamimanana, said that “we have a collection of [TB] strains at the Pasteur Institute… about 9,000 strains. We have been thinking about expanding and strengthening our ability to analyze those samples.”

Researchers from the Health Institute of Madagascar, Stony Brook University and Oxford University are collaborating to help grant greater access to a portable and affordable tool, the MinION. The MinION helps to diagnose and efficiently test the resistance of TB strains to antibiotics. It is a cheap, affordable option that is accessible to Malagasy people. While developed countries have the technology to create complex, expensive tools to prevent the spread of TB, low-income countries, where the disease is affecting more people, have considerably less information. Because developing nations often cannot support Western medical technology, tools like the MinION are incredibly beneficial.

Tuberculosis in Madagascar is still one of the top 10 leading causes of death in the country, but Madagascar is making significant progress towards the elimination of the disease. The efforts Madagascar is taking in tracking TB are positive steps contributing to the mitigation of the epidemic.

– Sophia McGrath
Photo: Flickr