Archive for category: Health

Information and stories on health topics.

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Friendship: Support To Remote Communities in Bangladesh

Remote Communities in BangladeshBangladesh is situated in South Asia on the Bay of Bengal. It is the eighth most densely populated country in the world, with a population of more than 175 million in an area of 148,460 sq km. It is a country of striking contrasts: rich in culture and resilience, yet acutely vulnerable to the impacts of changing climatic conditions. Most of the country is situated only nine meters above sea level.

An estimated 3.5 million people in the low-lying delta region face increasing threats from rising sea levels and more intense monsoon seasons. Indeed, in 2022 alone, historic floods devastated northern regions like Sylhet and Sunamganj, displacing millions and severely disrupting transportation, electricity, health care and access to education.

Despite the risks, many of Bangladesh’s neediest communities live in low-lying coastal and riverine areas, lacking sufficient income to live in lower-risk regions. These zones are fertile and agriculturally productive. However, when floods occur, it is children and low-income families who suffer most, facing destroyed homes, lost livelihoods and health crises with little support.

From One Floating Hospital to a National Lifeline

In 2002, Runa Khan founded Friendship, a nongovernmental organization (NGO) with a radical yet simple mission: delivering support to remote communities in Bangladesh with reduced access. The initiative launched a floating hospital on the Jamuna River in northern Bangladesh. This aims to provide essential health services to isolated communities living on “chars”― sandbar islands that vanish and reappear with the tides.

Since then, Friendship has evolved into a wide-reaching, holistic organization. Today, its 5,000 employees ― more than 70% of whom come from local communities ― work to break cycles of poverty and increase resilience to the regional climate crisis. Its integrated approach includes health care, education, disaster preparedness, economic development and clean energy and water access.

Health Care and Remote Communities in Bangladesh

Friendship operates a unique three-tier health care system:

  • Tier 1: Two floating hospitals and two land hospitals bring lifesaving services to remote areas. The Shyamnagar hospital alone provided emergency services to 317 patients in recent years.
  • Tier 2: Two cervical cancer screening centers tackle Bangladesh’s second-most prevalent form of cancer, offering prevention and treatment in areas where such services are rarely available.
  • Tier 3: About 680 Friendship Community Medic-Aides, local women trained in basic medical care, offer antenatal, postnatal and child health services.

Powering Livelihoods and Clean Futures

Friendship’s Sustainable Economic Development program supports long-term resilience. In its innovative solar villages, 291 households, 62 shops, four schools and two mosques are now powered by 24-hour solar energy. This has enabled families to extend working hours, refrigerate food and medicines and improve safety and security at night. Clean water access is another priority. Friendship has also supplied more than 700,000 liters of clean drinking water to hundreds of families, drastically reducing disease.

Meanwhile, the organization’s farmers’ club provides sustainable farming training. It empowers more than 1,400 farmers to grow climate-resilient crops like sweet potatoes and mustard. Romesa Khatun, a club member, began using earthworms to make fertilizer in 2022, selling the product and using it in her vegetable garden. She says that the support of the club and Sherazul Islam, project officer at Friendship’s Sustainable Economic Development Sector, empowered her to embrace innovative farming techniques to support her family, especially when her husband is away for work.

These programs boost food security and provide more adaptive livelihoods to environmental challenges.

Hope from Within

In Bangladesh’s flood-prone coastal and riverine communities, poverty and climate vulnerability often go hand in hand. But through Friendship’s work with remote communities in Bangladesh, hope is taking root. What began as a floating hospital has become a nationwide lifeline. It delivers support to remote communities and uplifts them with health care, education, economic opportunity and climate resilience.

Rather than relying on top-down aid, Friendship invests in people ― training local women as community health workers, equipping youth with education and leadership skills and helping farmers adapt to a changing climate. Indeed, Friendship’s impact shows that locally led, community-focused development can help vulnerable populations chart a path toward safety, dignity and lasting change even in the face of rising waters.

– Holly McArthur

Holly is based in Somerset, UK and focuses on Good News and Global Health for The Borgen Project.

Photo: Pexels

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The Reality of Nepal’s Poverty Crisis

Nepal’s Poverty CrisisNestled among the towering peaks of the Himalayas, Nepal continues to battle a deep-rooted poverty crisis, with more than 25% of its population living below the national poverty line. In the 2024 Human Development Index (HDI), the country ranked 146th out of 193, placing it among the lowest in South Asia. Although its HDI value improved to 0.601, this progress remains uneven and fragile. Indeed, national indicators may suggest advancement, but they often mask the stark internal inequalities.

This article will focus on Nepal’s poverty crisis and precisely those left furthest behind in communities in western regions and near borders, where poverty is deeper and millions still struggle to access even the most basic necessities. In these areas — such as Karnali, Sudurpashchim and remote parts of Lumbini Province — many experience acute multidimensional poverty, facing overlapping deprivations in education, health and living standards.

Food insecurity remains a pressing issue: according to the World Food Programme’s Fill the Nutrient Gap analysis (2021), 23.1% of the population does not consume a nutritionally adequate diet and 33% of pregnant women suffer from anemia. Although stunting rates have declined in recent years, one in four children under the age of five is still affected. Once again, these indicators fail to reflect the full extent of disparities between peripheral regions and urban centers. Here is more information about Nepal’s poverty crisis and measures that are addressing it.

Geographic Isolation

Remote mountain communities are the ones that suffer the most serious consequences, as they often rely on narrow, unpaved roads to reach markets, schools, clinics and other essential services. The United Nations Children’s Fund (UNICEF) reports that many children routinely walk up to several hours to attend overcrowded, under-resourced schools, leading to high dropout rates.

Worsening the situation, heavy rains and winter snowfall can render these routes impassable, isolating villages for days or even weeks. When roads vanish under mud and rock, families must subsist primarily, if not entirely, on their own harvests. But subsistence farmers lack the diversification needed to absorb such shocks. As the United Nations Development Programme (UNDP) warns, unpredictable swings from prolonged drought to sudden downpours throw planting cycles off balance, leaving soils cracked and barren. More frequent landslides then ravage crops and upend local economies, at times forcing residents to start over with nothing.

Health Infrastructure

Improving access to health care remains one of Nepal’s most critical and unresolved development challenges. While the country has made notable advancements in public health over recent decades — reflected in increased life expectancy and reduced maternal and child mortality — many rural clinics continue to operate with outdated, inadequate or even nonfunctional medical equipment, severely compromising the quality and consistency of care.

In pursuit of universal health coverage, the Government of Nepal has launched the National Health Insurance Program (NHIP), a policy initiative aimed at minimizing direct health care costs for individuals and promoting fair access to essential medical services. However, despite its promising framework, the program’s implementation has been uneven and threatens to undermine its potential impact. Enrollment rates remain low, with families either unaware of the program or discouraged by complicated procedures and limited services. A shortage of trained health care workers makes it even harder to provide quality care, especially in remote areas.

A survey that the Asian Development Bank (ADB) conducted across five provinces – Koshi, Madhesh, Bagmati, Gandaki and Sudurpaschim – in December 2024 found that more than half of Nepal’s medical equipment, much of which the country acquired during the COVID-19 pandemic, remains unused or broken. The causes include limited maintenance capacity, poor logistics and insufficient training. Compounding these issues are weak and fragmented data systems that make it difficult to identify who would most benefit from targeted interventions. 

Without a reliable foundation of digital infrastructure and data integration, the NHIP risks falling short of its goal to provide sustainable health protection for all. Strengthening biomedical training, equipment management and preventative maintenance policies will be essential to ensuring that no one is left behind. 

Economic Development and Grassroots Solutions

On the economic side, the International Monetary Fund (IMF) urges reforms to promote job creation, fiscal stability and inclusive growth throughout the nation. In 2023, agriculture accounted for approximately 26.2% of Nepal’s gross domestic product. However, since the 2010s, the sector’s growth has slowed to an average annual rate of just 3%. The agricultural landscape remains dominated by low-value crops and subsistence farming. The absence of facilities like collection centers, cold storage and grain stores leads to significant post-harvest losses. As a result, farmers are unable to shift from low-value cereals to high-value perishable crops like fruits and vegetables, which require proper storage to sell during peak demand at better prices.

In response, the Nepalese government, supported by international aid, is now prioritizing the expansion of microfinance programs and entrepreneurial training to empower local businesses. Promising results are already emerging from localized initiatives. For instance, several communities have adopted small-scale irrigation projects and diversified crop production, helping mitigate the impacts of changing weather patterns while stabilizing food sources. 

Farmer-Managed Irrigation Systems

One notable example is the modernization of more than 100 Farmer-Managed Irrigation Systems (FMISs), supported by the ADB as part of a broader program to enhance irrigation infrastructure across Nepal. These initiatives, aligned with the National Water Plan 2002–2027 and ADB’s Strategy 2030, aim to improve irrigation performance across 17,452 hectares.

The work includes constructing permanent gated water intake structures, selectively lining canals and improving water control systems. These interventions have enhanced water use efficiency and fairer distribution. Just as important, they have created the conditions for more farmers to shift toward climate-smart techniques and mechanized farming tools.

In parallel, the project has also invested in the people who manage these systems — supporting local Water Users Associations (WUAs) and gradually expanding their role into cooperatives with stronger business and governance structures. Moreover, the emphasis on including women and disadvantaged groups has made these efforts more equitable and representative of the communities they serve. These grassroots responses also offer replicable models for other regions facing similar challenges.

Collaboration Easing Nepal’s Poverty Crisis

Collaboration between NGOs, multilateral organizations and community groups can strengthen the country’s social safety net and ensure that vulnerable populations get the support they need during Nepal’s poverty crisis. 

For Nepal, this means not only investing in health, education and infrastructure, but also strengthening governance, fostering civic engagement and rebuilding trust in institutions. For families in remote villages, it offers the promise of a future where they can thrive and create lasting opportunities for generations to come.

– Lucrezia Frascati

Lucrezia is based in London, UK and focuses on Global Health for The Borgen Project.

Photo: Unsplash

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WHO and Africa CDC Work To Curb the Spread of Mpox in Africa

Mpox in AfricaIn August 2024, the Africa Centers for Disease Control and Prevention (CDC) declared that Mpox infections had become a Public Health Emergency of Continental Security (PHECS). To combat the spread, the Africa CDC and World Health Organization (WHO) created a Joint Continental Preparedness and Response plan.

The original plan garnered positive results but not at the rate required to diminish the growth of the infection fully. Together, the Africa CDC and WHO are reworking the plan, hoping to accomplish the goals laid out.

Mpox in Africa

When the original plan was created in 2024, the spread of the disease occurred rapidly from sexual or close contact. It began in the Democratic Republic of the Congo (DRC) and quickly traveled to Burundi, Kenya, Uganda and Rwanda. Today, Mpox is present in 28 countries worldwide. However, outside of Africa, the cases are travel-related and rare.

Inside Africa, it is reported to have spread to the Republic of the Congo, South Africa, South Sudan, the Republic of Tanzania and Zambia. Prior to the PCEHS declaration, Mpox vaccines were not available in underdeveloped or developing countries despite originating in the DRC.

The Joint Continental Preparedness and Response Plan

The Joint Continental Preparedness and Response Plan, in its original efforts, focused on 10 key pillars in its efforts: coordination, risk communication and community engagement, disease surveillance, laboratory capacity, clinical management, infection prevention and control, vaccination, research, logistics and maintaining essential health services.

These pillars have managed to get more than 650,000 people vaccinated within the six countries at the highest risk. Of the vaccinations, 90% were administered in the DRC. Overall, more than one million vaccines were administered over the 10 listed countries and efforts to reduce the spread of Mpox in Africa through the implementation of the vaccination plan have not ceased.

The New Plan

The new plan, which still includes these pillars, intensifies the focus on controlling outbreaks and implementing Mpox prevention into routine health services. After the emergency period ends in August of 2025, the WHO and Africa CDC want the health services to continue. The aim is to prevent the further spread of Mpox in Africa.

To ensure this, the organizations agreed to continue to support countries in continuing the PHECS strategies. Beyond this, they aim to expand community engagement to strengthen the effectiveness of health strategies. Essentially, they will enhance and optimize each pillar, intending to finish the changes by the end of May 2025.

Final Remarks

With the reworking of the Joint Continental Preparedness and Response Plan, the WHO and African CDC hope to garner even more success in curbing and eradicating the spread of Mpox in Africa. Combating Mpox is not just a regional issue; it’s a test of our global commitment to health equity.

– Abby Buchan

Abby is based in York, PA, USA and focuses on Global Health for The Borgen Project.

Photo: Pixabay

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Vaccines in Developing Countries: Victory in Vaccination

Vaccines in Developing CountriesThe World Health Organization’s (WHO) “World Immunization Week 2025” lasted from April 24 to April 30, celebrating the 154 million lives vaccines have saved over the past 50 years. Governments and nongovernmental organizations (NGOs) have united in the mission to end preventable diseases and their efforts have already eradicated smallpox and nearly eradicated polio. Building on this momentum, several countries have successfully rolled out immunization campaigns in the past year alone. Here are four vaccines in developing countries that inspire hope for a healthier future.

Malaria Vaccine in Sudan

The Federal Ministry of Health (Sudan), the United Nations Children’s Fund (UNICEF), WHO and Gavi, the Vaccine Alliance partnered in November 2024 to distribute the first malaria vaccines in Sudan. Indeed, the country is the first in the WHO’s East Mediterranean region to introduce a vaccine for the disease.

Sudan has one of the highest rates of malaria infection in the region, with more than 1.3 million cases in 2023, of which 22.3% were children. Ongoing conflict has caused vaccination coverage to fall to 30% in active-conflict zones. However, the campaign distributed the vaccines to 15 health facilities and 148,000 children. The number of facilities will rise to 129 throughout 2025 and 2026.

Ebola Vaccine in Sierra Leone

Alongside Liberia and Guinea, Sierra Leone was one of the three countries most affected by the 2014 West Africa Ebola virus outbreak. However, it is the first of the three to introduce a nationwide preventive vaccine for the disease. The campaign began in December 2024 and administered the vaccine to 20,000 health care workers across 16 districts.

Health care workers carry a high risk of infection when treating the Ebola virus. Sierra Leone lost 7% of its health care workforce to the disease during the 2014 outbreak. The campaign follows a series of immunization successes in the country. It has also reached 90% diphtheria-tetanus-pertussis vaccine coverage since 2001 and 100% human papillomavirus (HPV) vaccine coverage as of September 2024. Sierra Leone shows that vaccines in developing countries can achieve and sustain results.

Vaccine Education in Trinidad and Tobago

The Pan American Health Organization (PAHO) led a two-day workshop for 79 school nurses in Trinidad and Tobago that covered how to talk to patients about vaccines and correct misconceptions. The country is emphasizing HPV vaccination, which can prevent 70% of cases of cervical cancer, for children 9–14 years old.

In Trinidad and Tobago, there are an estimated 202 women diagnosed with cervical cancer and 127 die from it every year. The nurses found the sessions informative and now have strategies to communicate the safety of vaccines to their patients. This signals a productive future for vaccines in developing countries.

Vaccines in Conflict-Affected Areas of Cameroon

In 2024, the Cameroon Baptist Convention Health Services (CBCHS) partnered with UNICEF to bring vaccines to conflict-affected northwest and southwest Cameroon areas. Non-State Armed Groups initially prevented the health care workers from entering the regions. However, Ful Morine Fuen of CBCHS persuaded them, saying they could not “kill diseases like malaria, diarrhea, etc. with a gun” but with vaccination.

The workers targeted displaced families, assessing the vaccination status of children aged 6 months to 5 years. They referred children needing vaccines to local facilities or administered vaccines through mobile clinics. Twelve families were hesitant about vaccination, but 11 of them agreed to it after workers discussed the benefits. In total, 473 children received the necessary vaccines.

Looking Ahead

Vaccines in developing countries have helped thousands of people in the past year. The continued efforts of local governments and international health organizations will stop the spread of preventable diseases. They will save even more lives by World Immunization Week 2026.

– Tyler Payne

Tyler is based in Allentown, PA, USA and focuses on Global Health and Politics for The Borgen Project.

Photo: Flickr

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Cultural Expectations Shape Men’s Mental Health in Uganda

Men's Mental Health in UgandaIn Uganda, a country in East Africa, men’s mental health is an issue that tends to be ignored and often overlooked. Cultural expectations have left men with little to no room to bring their psychological problems forward. This results in “serious consequences, including untreated depression and increased risk of suicide.”

The Burden of Masculinity

Men in Uganda face the expectations of appearing physically and mentally strong. These expectations can put a strain on their mentality and ability to come forward with emotional struggles. Traditional gender norms view men’s mental health as insignificant. It is seen as a weakness if a man cannot restrain his emotions.

Masculinity in Uganda is traditionally achieved through authoritative attitudes, control and being the provider and protector of their families. The pressure to provide and always appear strong can cause built-up anger or depression, leading to domestic abuse and an absent role in the family. Societal expectations for men to suppress their emotions prevent healthy coping mechanisms, which is worsened by the lack of services available to confront men’s mental health issues.

Mental Health Challenges

Mental health is not prioritized in Uganda, leaving the country as one of the top six in Africa with depressive disorders. Indeed, out of the total 4.6% who live with depressive disorders and 2.9% with anxiety disorders, 3.6% consist of men. The most common mental health challenges among men in Uganda include depression, anxiety and high stress levels.

With a lack of mental health services, some men turn to alcohol and substance abuse, with the possibility of suicide attempts. Alcoholism stems from men’s mental health issues in Uganda. They “are estimated to have one of the highest alcohol per capita consumption levels in sub-Saharan Africa.” The number of men who depend on pure alcohol sits at an estimated 4.2%, with a total consumption of 16 liters each year.

Resources to combat men’s mental health are scarce and mainly based in urban centers. Uganda as a whole has 53 psychiatrists, approximately one psychiatrist per 1 million people. Kampala, the country’s largest city, has a single psychiatric hospital. This lack of access to services highlights the challenges individuals with mental health issues in Uganda face.

Support Networks for Ugandan Men

Multiple steps have been taken in recent years to address Ugandan men’s mental health challenges. Indeed, support groups for fathers in Uganda are one example.  It’s been shown that early involvement in their child’s life challenges stereotypes, creating a better individual and life at home.

Plan International has provided Ugandan men with an environment where they can speak openly about the issues they may be having at home. Furthermore, they advise on better communication and coping techniques. Similarly, local organizations such as StrongMinds are working to supply mental health care and bring further awareness to the cause.

StrongMinds has provided group therapy sessions where comfort is offered to men who go against cultural expectations and choose to express their emotions. Special programs have also been applied in Ugandan prisons and the Ugandan police force. In these programs, relationship issues, struggles with individual or gender roles and grief are discussed, offering empowerment through communal support.

Conclusion

Mental health remains a complex and often stigmatized issue for men in Uganda, however, meaningful progress is being made. Indeed, through support groups, therapy sessions, and targeted programs, more men are finding safe spaces to express themselves, challenge harmful stereotypes, and build healthier relationships.

– Sarina Francis

Sarina is based in Tallahassee, FL and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Poshan Abhiyaan: India Advances Toward SDG

Poshan AbhiyaanIndia — known for its vibrant culture and Holi festivals — continues to make progress on the 17 Sustainable Development Goals (SDGs) under the United Nations’ 2030 Agenda. The country improved its SDG Index score from 57 in 2018 to 66 in 2020–21 and reached a score of 71 out of 100 in 2023–24.

Closing Gaps in Health Care

Health care coverage remains a core focus in India’s SDG efforts. In April 2025, the country experienced a health care affordability crisis that impacted many low- and middle-income citizens. Rising medical costs led a significant number of individuals to postpone or decline treatment. India conducted a report surveying citizens to call for any insurance reforms that need to be addressed. According to the India Fit Report 2025, one in five citizens reported denying medical care due to high costs. The same report noted a 3.84% gender gap in access, with many Indian women facing greater health challenges, including diabetes, high blood pressure and cholesterol. While 40% of indian men also reported experiencing some of these conditions.

To address these inequalities, the Indian government introduced the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) on Sept. 23, 2018. By 2025, the program expanded its reach, offering free health insurance to citizens living in poverty. It focused on supporting women and children by providing diagnostic and treatment services. The policy enrolled more than 120 million people and helped reduce the financial burden of health care. Although the initiative made measurable progress, challenges such as financial protection and full utilization still require attention in underserved areas.

Poshan Abhiyaan

India established the National Nutrition Mission or Poshan Abhiyaan in 2018 to improve nutrition among children under age 6, adolescent girls and expectant or nursing mothers. The program aimed to reduce child malnourishment, low birth weights and anemia. Malnutrition continues to affect around 13% of the population, with an estimated 195 million citizens affected in mid-2024. Children represent a significant portion of this crisis, with 35.5% experiencing stunted growth. To strengthen food access, the government also enacted the National Food Security Act. In 2023–24, the program reached 99% of qualified recipients. Together, these nutrition initiatives support healthier outcomes in high-poverty districts and contribute to long-term development goals.

The Clean India Mission

Efforts to improve clean water access and reduce waste have become a critical part of India’s sustainable development strategy. Improper waste disposal has led to the spread of waterborne illnesses. More than 377 million Indians live in areas where waste, including hazardous, plastic and biomedical materials, remains poorly managed. Projections reveal national waste levels could reach 165 million tonnes by 2030.

The Swachh Bharat (Clean India) Mission, launched in 2014, introduced new sanitation policies. The government constructed toilets in public areas and ran nationwide campaigns encouraging safe hygiene practices. These efforts reduced open defecation, improved women’s access to private sanitation and supported public health improvements.

Looking Ahead

India’s efforts in health care, nutrition and sanitation reflect meaningful progress toward achieving the SDGs. Programs such as AB PM-JAY, Poshan Abhiyaan and Swachh Bharat have addressed core poverty-related challenges. Continued investment and community engagement could help the country reach its 2030 targets and improve the quality of life for its citizens.

– Janae Bayford

Janae is based in Centennial, CO, USA and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Vulnerable Communities: Yellow Fever in Peru

Yellow Fever in PeruThe Amazon rainforest offers amazing natural landscapes, but the dangers of diseases transmitted by tiny mosquitoes, like yellow fever, lie within them. Since early April 2025, Peru has seen an increase in yellow fever cases, mostly in vulnerable populations in the depths of the jungle and agricultural areas.

About Yellow Fever

Yellow fever is a disease transmitted by day-biting mosquitoes. It is considered a “High-threat disease” by the World Health Organization (WHO). Yellow fever does not have a specific antiviral drug to fight it once the virus is in the body. The best way to fight it is by preventing it with vaccination.

In early April, Peruvian authorities reported an outbreak of yellow fever cases in the regions of Amazonas, San Martín and Loreto. Yellow fever could reach a high 60% mortality rate in these regions because only a few people have been vaccinated in the past years.

The reach of vaccination campaigns shrank and vulnerable populations in less accessible areas like the jungle were affected. Twelve people died by the end of the month, all of them from vulnerable areas and without any records of previous vaccinations.

Effects on Vulnerable Populations in Peru

Mortality rates are higher among vulnerable populations, with 37 people already infected. Further, the U.S. Embassy in Peru and the Centers for Disease Control and Prevention (CDC) issued health alerts about the yellow fever outbreak, advising people to avoid areas affected by the disease. These warnings could result in reduced tourism, leading to a loss of income for many businesses that rely on it for their livelihood.

One of the biggest challenges preventing the disease is the logistical difficulty of distributing vaccines to remote areas. Vast distances and difficulty maintaining the cold chain in hard-to-reach regions significantly hinder vaccination coverage.

What Is the Government Doing?

The Peruvian government is trying to reactivate its vaccination campaigns, making resources available for people to find the closest vaccination centers. Peru’s Ministry of Health has announced a free vaccination campaign throughout the summer of 2025.

The Ministry of Health also sent 30,000 vaccines to the Amazon region in the past month, while volunteers are going town by town to vaccinate communities far from the few existing vaccination centers. However, Peru is not fighting the outbreak alone.

Since yellow fever also affects neighboring countries like Colombia and Ecuador, the Peruvian Ministry of Health joined forces in late April to launch a joint vaccination campaign along the border to prevent the disease from spreading between countries.

Final Remarks

Even though yellow fever has already claimed some lives in Peru, the government is taking action to prevent further spread and protect more people. Certain regions will inevitably face the consequences of this outbreak and the full economic impact, especially on families and businesses affected by the drop in tourism, remains uncertain until the epidemic is under control. 

– Luis Felipe Rios

Luis is based in New York, USA and focuses on Good News and Global Health for The Borgen Project.

Photo: Pxhere

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Diseases Impacting Sri Lanka

Diseases Impacting Sri LankaDiseases impacting Sri Lanka are divided into three categories: endemic, epidemic and pandemic. Notifiable diseases include cholera, diphtheria, yellow fever, malaria and tetanus. Below are some diseases impacting Sri Lanka.

Dengue

One example of an endemic disease that impacts Sri Lanka is dengue. Mosquitos transmit dengue. The same type of mosquito also transmits the viruses that cause zika and chikungunya. It exists in tropical and subtropical climates worldwide. According to the World Health Organization (WHO), heavy monsoon rains, piles of damp garbage, standing pools of water and other breeding grounds that attract mosquitoes all cause dengue. 

“Dengue tends to seek out the poor who live in densely populated places where sanitation is inadequate, rubbish piles up, water pools and mosquitoes thrive,” says Gerhard Tauscher, the operations manager of the International Federation of Red Cross and Red Crescent Societies.

Two of the largest dengue epidemics occurred in 2002 and 2004. During these epidemics, 8,931 cases and 15,463 cases were reported.

Rabies 

Sri Lanka is on the list of high-risk countries for rabies. The bite, scratch, or lick on broken skin of an infected animal is what spreads rabies. Rabies thrives from contact with warm-blooded animals because it is a viral infection. It is a serious and frightening disease, and once developed in humans, it is fatal.

Fever, headache, weakness and paralysis are all symptoms of rabies. People travelling through remote regions are especially at risk. The symptoms can take 5 days to 25 years to develop.

Infected dogs are one reason why 20 to 30 deaths occur annually due to rabies. The main reasons for these deaths are not vaccinating dogs and not getting post exposure treatments.

Chikungunya 

Chikungunya is another virus that mosquitoes spread. In the 1960s, Sri Lanka reports its first chikungunya epidemic. This happened again in November 2006. This virus is spread through the bite of infected female mosquitoes, which also infect their victims with dengue. Symptoms of chikungunya usually appear 4-8 days after a bite from a female mosquito.

“The main symptoms include a sudden high fever, severe joint pain, muscle aches, headache, nausea, fatigue, and skin rashes. While most patients recover within a week, joint pain can persist for months or even years in some cases, particularly among older individuals,” says Consultant Physician Dr. Achalya Balasuriya.

In 2007, more than 5,000 people were infected with chikungunya in Sri Lanka’s far north. During that time, residents were living off of aid supplies coming in from abroad.

Diabetes

Of the diseases impacting Sri Lanka, diabetes is prevalent because Sri Lanka has the highest rate of diabetes in Asia. According to a national survey conducted in 2019, nearly one in four Sri Lankan adults had diabetes, and another one in three had high blood sugar.  

Dr. Ravi Ranniyan-Eliya, lead investigator for the study and Executive Director of the IHP (the Institute for Health Policy) explains that “These findings indicate that Sri Lanka has the highest rate of diabetes in Asia, and in fact one of the highest in the world, since there are only a few countries – some small Pacific Islands and places like Egypt and the Gulf States – with higher rates.”

It is hard to reverse diabetes once it develops, but being diagnosed early and getting treatment can minimize outcomes, like heart and kidney disease. The research showed that more than 1 million Sri Lankans do not know that they have diabetes.

Type 2 diabetes rose in 2011 from 7.6% to 11.3% in 2021, signaling a 68.3% rise. The rate of diabetes has risen sharply over the decades.

The Sri Lanka Government’s Efforts

The Sri Lankan government is working to reduce the transmission of diseases in Sri Lanka. In 2017, the Sri Lankan military increased the number of hospital beds for dengue patients as the Epidemiology Unit of the Ministry of Health (MOH) Sri Lanka requested. Army, police and health staff monitored the high risk areas, visiting house-to-house. They were involved in mobilizing communities for garbage disposal, cleaning mosquito breeding sites and health education.

To target rabies, Sri Lanka has increased dog vaccination, enforced responsible dog ownership, strengthened surveillance for animals and humans and conducted mass awareness programs.

Other Initiatives

In 2006, the International Medical Corps (IMC) set up mobile clinics, supported an information campaign and gave syringes to help fight Chikungunya in Sri Lanka.

The World Diabetes Foundation has organized workshops to strengthen the connection between maternal and child health services, primary health centers and government-established healthy lifestyle clinics in detecting and managing diabetes, diabetic foot and GDM. Sri Lanka has built new health care facilities and facilitated the training of health care professionals. This helps to improve the impact of diabetic care. It has also implemented awareness and prevention activities in schools and workplaces.

Looking Ahead

In 2022, during Sri Lanka’s economic crisis, the shortage of medicine and essential equipment became life-threatening. This has challenged Sri Lanka’s health care system. According to Amnesty International, “From shortages of gauze, intravenous antibiotics and insulin to requests to re-use catheters or endotracheal tubes, the last few months have brought shocking challenges to Sri Lanka’s healthcare system.”

Sri Lanka’s rich ecosystems, biodiversity and close human-animal interactions create an environment in which zoonotic diseases can be dispersed widely. Many diseases in Sri Lanka have their origins in animal populations. Sri Lanka has unique environmental and agricultural practices, which make it challenging to manage diseases. The government is taking steps to ensure that human, animal, and environmental health are managed and maintained.

– Abirame Shanthakumar

Abirame is based in Ontario, Canada and focuses on Global Health for The Borgen Project.

Photo: Unsplash

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Mental Health in Palau

Mental Health in PalauPalau is a small country in the western Pacific Ocean and one of the first west-pacific islands that people settled, specifically those from Southeast Asia. It is a relatively isolated area surrounded by the ocean, with most of its islands lying within a large, extensive lagoon. With about 17,600 people, there is a great sense of community on the island, the people well-known for their hospitality and welcoming nature. Although the island is very healthy with a great ecosystem and marine environment, and the people have created a strong, invigorating community, mental health in Palau is still unstable due to the lack of specialized care.

The Facts 

Depression affects 5.2% of Palau’s adult population, including 6.7% of young adults and 6.5% of elderly adults suffer from depression. This makes up about 920 people out of Palau’s entire population. To put this into perspective, 5.2% of the United States of America’s population is about 16.3 million people.

Anxiety affects 4.3% of adults, 10.5% of young adults and 4.3% of elderly adults suffering from anxiety. Anxiety is significantly more prevalent in young adults compared to any other age group. 4.3% of Palau’s population is about 760 people.

About 2.3% of adults in Palau suffer from suicidal ideation, being significantly more prevalent in young adults. Meanwhile, about 8.5% of young adults and 0.6% of elderly adults suffer from suicidal ideation. Palau also has a high rate of schizophrenia, according to the National Library of Medicine.

Links Between Poverty and Mental Health

While it is often hard to recognize, depression and anxiety have a huge influence on a person’s work ethic. Depression often leads to a lack of motivation, exhaustion, careless attitude and reclusive tendencies. This behavior can prevent a person from keeping a job or pursuing a career, leading a person towards financial issues, and if not helped, can cause a person to slip into poverty.

Anxiety also creates challenges that affect work ethic. Anxiety tampers with energy, concentration and sleep. Oftentimes, it is difficult to make a decision or pay attention to the task at hand, lowering a person’s quality of work. Anxiety may also prevent a person from attending work due to fear of commitment or embarrassment. Similar to depression, this can manifest financial instability and lead to poverty.

Schizophrenia, among all other mental health conditions, is one of the most connected mental illnesses to poverty. A big part of this is due to schizophrenia’s impact on a person’s social life, such as reclusive behavior, trouble communicating and negative effects on social cognition, making employment a difficult task.

Those with poor mental health are more likely to have addictions to drugs and alcohol, another major influence on poverty due to low work performance and work ethic. While poor mental health can be a leading cause for poverty, oftentimes poverty is the cause of poor mental health, increasing stress and hopelessness, often resulting in social rejection and loneliness, making it hard to re-establish financial stability.

Lack of Services

As the country is small and isolated, accessible mental health care is sparse. Psychology is an ambitious field to pursue, and there are only so many people on such a small island who have the ability or desire to join a career in psychology. The further from the main island, the less the population, which further decreases the number of people who are interested or knowledgeable about mental health.

While it is difficult to pinpoint the exact number of behavioral health care professionals in Palau, an interview in 2019 of 17 health care professionals showed that there was only one in behavioral health care.

Current Solutions

Since 2008, when the United Nations Development Programme (UNDP) signed a Standard Basic Assistance Agreement, the UNDP has strengthened health systems, helped address the impacts of COVID-19 and rehabilitated three community health centers. These produce positive influences on mental health in Palau through the creation of stronger, more reliable health centers and helping those who COVID-19 impacted get back on their feet.

UNICEF Pacific Islands heavily focuses on children’s education and health care. It originated in 1997 and has made strong efforts to help children lead a good life. It helps not only Palau but also the entirety of the Pacific Islands. UNICEF Pacific Islands provide mental health assistance in emergency settings, and is working to integrate mental health into education and have established the Global Coalition for Youth Mental Health.

Since Palau gained its independence in 1994 and established diplomatic relations with the United States of America, the U.S. has provided a lot of government and economic assistance. Currently, the United States provides financial aid through the Compact of Free Association (COFA), which can be used to fund health care systems, education and take care of Palau’s architecture and environment, crucial for Palauans’ mental and physical health.

Looking Ahead

With the current help of these organizations and Palau’s already thriving community and healthy environment, the people can continue to improve and stabilize mental health through community support, providing a sense of belonging and safety that encourages people to speak out and advocate for mental health in Palau.

– Sevyn Whatley

Sevyn is based in Toronto, Ontario, Canada and focuses on Global Health for The Borgen Project.

Photo: Unsplash

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Vaccine Coverage in Malawi Goes Solely Solar

Vaccine Coverage in MalawiIn 2010, the World Health Organization (WHO) approved the first solar direct-drive (SDD) refrigerators. It transformed how vaccines are stored in rural, remote areas worldwide. The Gates Foundation assisted in funding and supporting the spread of this innovation in Malawi; with the help of other organizations like UNICEF and Gavi, the Vaccine Alliance, WHO installed this in all 29 district-level vaccine storage facilities.

SDD Refrigerators

SDD refrigerators are solar-powered devices used to store vaccines at the proper temperature. Before the introduction of SDD refrigerators, earlier models were less reliable and more costly. Ice-lined refrigerators, which had been used for more than 20 years, were considered the most economical option.

Alongside absorption refrigerators and water-pack freezers, people found these units less efficient than solar-powered alternatives. They operated using gas, kerosene or batteries, which required frequent replacement and incurred high operational costs.

SDD Fridges in Malawi

Remote areas such as Malawi have been the top priority for the Gates Foundation due to their previous reliance on gas-powered refrigerators. Around 40% of community health clinics in Malawi are not on the electrical grid, making costly and outdated refrigerators their only option.

However, in 2015, Malawi received its first grant to implement only a few SDD fridges. After about three years of reliability, Gavi and UNICEF helped fund the installation of about 600 more in 2018. Since then, Malawi has replaced all gas and battery-powered fridges with solar-reliant fridges.

SDDs proved to be successful and sustainable. It is cutting carbon dioxide emissions significantly and giving cold chain managers the ability to track the maintenance of each refrigerator to confirm it is at the proper temperature. The equipment is also long-lasting and reliable, creating a concrete solution for Malawi.

Vaccine Coverage in Malawi

In addition to improving storage, Gavi and UNICEF are trying to bridge the gap between urban and rural access to vaccines. These organizations have specifically targeted communities with high rates of zero-dose children and developing equity-focused programming in collaboration with local governments.

The Expanded Programme on Immunization (EPI) from UNICEF shows that “across all antigens, Malawi is missing approximately 10% of children, with a significant portion of these zero-dose children in urban areas.” Providing adequate staff to recognize these patterns and advise immunization can catch these concerns promptly.

Impacts

According to Gavi, vaccine coverage in Malawi has shown impressive progress compared to a decade ago. This advancement has been supported by substantial funding and the availability of trained professionals in both rural and urban clinics, enabling effective vaccine storage and distribution.

Inclement weather is another factor in vaccine storage strategies. Malawi is particularly prone to extreme weather events such as cyclones and floods. When Tropical Storm Ana struck in 2021, significant damage was caused to the hydroelectric system, resulting in widespread power outages across the electrical grid. In previously vulnerable rural areas, health workers successfully kept vaccine doses cold using SDD refrigerators. At the same time, they had to move facilities relying on electricity-powered to avoid spoilage.

As a result, cold chain managers began re-evaluating the effectiveness of electric refrigerators compared to solar-powered ones. They transferred all vaccine doses from urban centers to more remote storage facilities. Solar refrigerators became the standard due to their strength and durability. 

Conclusion

The benefits of SDD fridges are vast, including bettering the environment and lowering long-term medical equipment costs. Cold chain management has taken a step in the right direction, with the Gates Foundation and more creating the possibility for success in countries like Malawi.

– Rachael Wexler

Rachael is based in Chicago, IL, USA and focuses on Technology and Global Health for The Borgen Project.

Photo: Unsplash