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

Things to Know About Healthcare in Equatorial Guinea

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

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

Mathilde Venet
Photo: Flickr

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

Eye Foundation of America

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

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

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

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

Early Intervention Prevents Blindness

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

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

Disparities Between Access and Affordability

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

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

Vision Impacts Global Poverty

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

Maya Gonzales
Photo: Flickr

After the war
Bosnia and Herzegovina, more commonly known as Bosnia, used to be a part of former Yugoslavia and went through one of the most horrific genocides in 1992. Since the war, Bosnia has had one of the highest poverty rates in the world and an unemployment rate of 15%.

This article examines the perspectives of three Bosnian women from different generations and how difficult it is or was for them to get a good education, proper healthcare or make a comfortable living after the war. Naska is a 64-year-old retired house cleaner who has lived in Bosnia all her life. Elma is 40-year-old working as a dialysis nurse in the Nakas General Hospital in Sarajevo. And finally, Adna is a 20-year-old currently attending The Academy of Fine Arts in Sarajevo.

Living in Bosnia Now

Naska was only 38 when the war started. She was born and raised in Sarajevo and still lives in her old childhood home in the middle of the city. She says living on a pension fund in Bosnia is very difficult. She receives only 300 marks, which is equal to $182 a month. “If I didn’t receive help from my sister back in the United States I would not have enough to pay for all my groceries. I’m really lucky because my friends do not have family away to help and it gets really hard, especially in the winter.” The retirement age in Bosnia is 60 years, but due to health issues Naska was forced to retire early. In our interview, Naska explained that there was a train she used to take on her way to school when she was young. The station she used was bombed during the war and has not been repaired or rebuilt since 1995. She says that times felt happier before the war; her and her neighbors are tired of seeing constant reminders of the worst time of their lives.

Elma was in elementary school during the Bosnian War. She attended class in a basement with her friends. In Bosnia, after secondary school students are required to pick a specialty in high school that they carry on through university. Elma has been studying medicine since she was 16 and works in one of only two state hospitals in Sarajevo. A registered nurse for close to 10 years now, Elma believes that the healthcare system is not the same as it was before. Bosnia has a shortage of good healthcare professionals, and the private sector for medical supplies has taken over hospitals causing treatment to become more expensive for residents. Not only has the healthcare system gotten worse after the war, the possibility of finding a decent job has also worsened. “I have been applying for a job at hospitals for five years now. I could not even get an interview. [My mom] called me a year ago to tell me that her friend has an open position in his hospital. I honestly believe that if it was not for him I would not have a job right now.” Elma thanks her mother for a lot of the good things in her life. She says before finding a long-term job, she worked part-time night shifts at a nursing home and her husband’s job wasn’t stable either. They both live in the apartment her parents had bought previously so they have the luxury of not worrying about paying rent, only utility and groceries. Elma feels her life right now is good, but she worries this could change at any moment.

Adna was born in Sarajevo in 2000. She doesn’t know much about life before the war, only what her parents have told her. She told me in the interview that students in Bosnia don’t learn about the war in schools and everything they know about it comes from stories that get passed down. Her parents tell her it’s because the country is still in mourning and it’s hard for people to talk about what happened. The education system is very different in Bosnia compared to the United States. Primary school lasts for nine years while high school lasts for four. University education can take up to three to five years depending on the college. When I called her to talk one of the first questions I asked was if going to college was worth it. She said, “It depends. It is hard to find a job here with a degree, but it is also hard to find one without. Everybody knows that you need connections to find long lasting jobs. I have plenty of friends who have graduated college and work waitressing job for three years now. My cousin graduated with a sports medicine degree and had a friend who worked at this clinic in the city, but after six months she was let go because it was too expensive to keep her.” Her cousin now works at a boutique in the city’s mall.

COVID-19 in Bosnia

Working in a hospital during COVID-19 hasn’t been the easiest for Elma, but she does applaud her hospital for taking the necessary precautions. At her job, it is mandatory for workers to enter a tent before they enter the building to have their temperatures checked and get sterilized. Then workers must put on a suit complete with additional masks and gloves before being allowed to begin their shift. The only time workers can take the suit off is while they’re eating and after their shift when they are required to take a mandatory shower, change clothes and exit the hospital from the opposite side. Every night she comes home she is exhausted and says that there is too much work to do, but just not enough people to help. However, Elma, Naska and Adna all agree on one thing: the government is too corrupt to do anything that will help the people. And there is evidence that backs them up.

A scandal hit the news about Bosnia’s Prime Minister Fadil Novalic and his involvement with fake ventilators. The government had given $5 million to the Civil Protection firm of Bosnia to buy a hundred ventilators from China. When the ventilators arrived, officials were quick to learn that they were useless and not equipped to handle the virus. The Prime Minister and Head of the Civil Protection firm were arrested on charges of fraud and money laundering on top of an embezzlement charge.

Life in Bosnia has not been easy after the war. The government is ranked 101 out of 180 countries on the Corruption Perception Index and citizens of Bosnia hold out hope that times will change, especially those who remember life before the war. It is very clear however, that life in Bosnia is a long way away from where it used to be.

Hena Pejdah
Photo: Flickr

Efforts to Eradicate PovertyOn July 29, 2020, Ghana released its Multidimensional Poverty Index (MPI) report, which outlines the various conditions that contribute to poverty in the country. Instead of using a monetary metric, the report looks at education, health and living standards to interpret the rate of poverty and determine the efforts to eradicate poverty in Ghana.

Using data collected between 2011 and 2018, the report found the rate and severity of multidimensional poverty have reduced across Ghana, with significant improvements in electricity, cooking fuel and school attainment.

Overall, Ghana reduced its incidence of multidimensional poverty by nine percentage points from 55% in 2011 to 46% in 2017. This indicates that poverty itself has been reduced and the experience of the impoverished has improved.

Each dimension examined in the report is measured through specific indicators relevant to poverty in Ghana. The government then prioritizes the country’s needs by examining the various deprivations that the poor experience most.

The report concludes that the indicators that contribute most to multidimensional poverty are lack of health insurance coverage, undernutrition, school lag and households with members that lacked any education.

The report also reveals stark differences between poverty in rural and urban populations, with 64.6% of the rural population and 27% of the urban population being multidimensionally poor.

Based on the results of the report, it is paramount that resources must be allocated to the health and education sectors to improve the quality of life for the most at-risk members of Ghana, particularly in rural areas.

Efforts to Eradicate Poverty: Healthcare

The USAID is addressing the need for comprehensive healthcare reform through a multi-pronged approach to improve care for children and women in rural Ghana.

Since 2003, the Ghanaian government has developed and expanded the National Health Insurance Scheme (NHIS), which provides residents with public health insurance. The program has provided many improvements to the healthcare system, but systemic barriers continue to limit the quality and accessibility of care.

In particular, a 2016 study published in the Ghana Medical Journal found that rural hospitals’ lack of personnel, equipment and protocol put women and children at the highest risk. This is attributed to poor nutrition, inability to seek neonatal care and lack of health insurance.

To address barriers to healthcare, the USAID first compiled a network of preferred primary care providers to allow healthcare workers to communicate, educate and synchronize their standards of quality care.

“The networks help connect rural primary health facilities with district hospitals, enabling mentoring between community health workers and more experienced providers at hospitals,” the USAID stated.

The second prong was providing training to government staff and frontline healthcare workers to better understand health data and its uses for maternal and child health decision-making. By using the network of providers and standardizing data, doctors are better equipped to determine whether patients need a referral to a specialized caregiver.

The USAID reports that these improvements have resulted in a 33% reduction in institutional maternal mortality, a 41% increase in the utilization of family planning services and a 28% reduction in stillbirths.

As the healthcare sector has grown stronger and poverty has decreased, the USAID and other outside support have scaled back aid to allow the network of health providers to operate autonomously.

This is a positive indication that the country is moving in the right direction to end poverty and improve the quality of life in the coming years, but it is also a critical moment in its development. The Duke Global Health Institute warns that the country must secure a robust medical infrastructure for the transition to independence to be a success.

According to the Duke Global Health Institute, if global aid is removed too early, the poor will suffer the most. Therefore, they state that it is essential that the government has a firm grasp on funding and organizing principals before they move away from outside aid.

Efforts to Eradicate Poverty: Education

The level of deprivation of education is also heavily dependent on rural or urban residence. The educational dimension is measured by school attendance, school attainment and school lag. In rural areas, 21.1%, 33.9% and 34.4% of the population is deprived of each respective indicator. In contrast, the deprivation is only 7.2%, 10% and 12.8%.

To combat education deprivation, the current government has vowed to make secondary education free in an attempt to retain students who cannot afford to continue their education past primary schooling.

Before secondary school was made free in 2017, 67% of children who attended elementary went on to secondary school. In 2018, the ministry of education reported that attendance had increased to 83%.

To promote education in rural areas, this past March the ministry of education presented over 500 vehicles, including 100 buses, to secondary schools throughout the country.

Efforts to Eradicate Poverty: Living Standards

Deprivation of proper sanitation ranked highest out of all indicators for living standards, health and education. The report stated that sanitation deprivation affected 62.8% of the rural population and 25.8% of the urban population.

Although more than 75% of the country lacks access to basic sanitation, little improvement has been made. Between 2000 and 2015, access only increased from 11% to 15%.

To encourage private investments in the sanitation sector, the ministry of sanitation and water resources hosted a contest between public and private entities to design liquid waste management strategies for different localities throughout the country.

In 2019, nine public and six private partners were announced as winners of a total prize of £1,285,000 and US$ 225,000 respectively – for excellence in the implementation of urban liquid waste management strategies.

Winning strategies included an aquaponic system that sustained vegetable growth with treated water and the rehabilitation of a treatment center to raise fish.

Overall, the competition provided education about sanitation to rural communities, increased access to private toilets and spurred economic interest in developing the sanitation system in Ghana.

Sophie Kidd
Photo: Flickr

Yemen's Coronavirus Crisis
Yemen’s civil war and the resulting violence considered currently the ‘worst humanitarian crisis in the world,” a crisis that is heavily rooted in the regional divide coupled with resource insecurity. The coronavirus pandemic which broke out at the beginning of 2020 and spread globally has only increased the strain on war-torn countries. Yemen’s coronavirus crisis strained the country’s already heavily underfunded healthcare system and its ability to reach the most vulnerable.

The Conflict in Yemen thus far:

To understand just how urgent the need is to address the coronavirus crisis in Yemen, one must first understand the already raging crisis for Yemeni civilians caught in this conflict.

  • The Civil War:                                                                                                                                                                                                  The civil war in Yemen started in 2015 and has caused an already poor country to continue to deteriorate under the strain of war. The conflict’s main actors are the government on one side and the Houthi led rebels on the other. The civil war has in many ways acted as a front for the proxy war raging between the two hegemons of the region: Saudi Arabia (which backs the government forces) and Iran (which backs the Houthi forces). Most of the conflict occurs on the west side of the country, where many of the major ports are located. This has heavily affected the ability for humanitarian aid to get to vulnerable civilians. These resources vary from food, water, to medical supplies. In addition, the final destination of the aid that is being delivered to Yemen is being contested by major aid donors like the World Food Programme. The organization has accused the Houthi rebels who control the northern part of the country of stealing aid meant for civilians according to a June report by Al Jazeera.

Results of the conflict in Yemen:

Results of Coronavirus in Yemen:

Around 80% of the country is dependent on humanitarian assistance. The United Nations (UN) has projected that there could be more casualties as a result of COVID-19 than have “been caused from the last 5 years of conflict, which is estimated at 100,000.”

Due to COVID-19, the number of children left without access to educated has more than tripled, totaling 7.8 million children. Aden, a major city in Yemen is struggling with a rising casualty count with “roughly 950 deaths in the first half of May” reported by CNN. Yemen is currently fighting two other major contagious diseases, and the rise of COVID-19 as a third has affected Yemen’s ability to distribute funding and medical resources, as they are already scarce due to the conflict casualties and the other viruses. (CNN) Many cities have filled hospitals to their full capacity and cannot admit any more people despite the growing number of cases (CNN).  People are being turned away due to a lack of access to ventilators (with some cities having less than 20 total). (CNN)

Steps being taken to control Yemen’s coronavirus crisis:

The dead are not allowed to be visited and mourned by friends and family to prevent social gathers and spread of the virus.

UN Refugee Agency (UNHCR) is” increasing aid to Yemen” to address the COVID-19 crisis and its effects on civilians affected by the conflict (Al Jazeera). The situation in Yemen is bleak and represents the worst of what a global pandemic can do to a country whose systems and infrastructures are depleted from years of war. The best hope Yemen has for addressing their civilians in need is to use the aid they receive from the Un and similar actors and seek out the most vulnerable populations first and prioritize investing in more medical necessities like ventilators and other essential equipment.

Kiahna Stephens

Photo: Pixabay

healthcare in kiribati
The Republic of Kiribati, better known as just Kiribati, is an Oceanic country formed by 33 unique islands, of which 20 are inhabited. The majority of Kiribati’s population is located on the Eastern Gilbert islands, while many islands located in the center function without a permanent population. Healthcare in Kiribati has been a committed work-in-progress, especially after the notification in the late 20th century that its population was at one of the lowest standards of living in Oceania. The disjointedness of the islands and a lack of cohesive national health policy has significantly impacted Kiribati’s ability to effectively provide national healthcare services to all that need it.

In fact, as recently as 2012, there was not an official agency for national health policy, regulation of health standards, assessment of health technology, or management of health technology. However, despite this glaring lack of infrastructure, Kiribati has instituted projects at the national level to improve its primary level of healthcare. The government, along with partnerships from international health organizations, is working to invest in Kiribati’s health infrastructure.

The following five facts about healthcare in Kiribati are integral to understanding the country’s changing health structures and transition out of poverty.

5 Facts About Healthcare in Kiribati

  1. Around 22% of the Kiribati population is living under the “basic needs” threshold, according to the Department of Foreign Affairs and Trade. However, the traditional definition of poverty is not used in Kiribati, as much of the population believes that as long as one can maintain subsistence living, they are not poor. Instead, poverty is related to meet their basic expenses on a daily or weekly basis. This culture has made it so that many residents in Kiribati live in housing without access to clean water, sanitation or other basic hygiene utilities.
  2. Kiribati is at an elevated risk for infant mortality, consistently ranking as the highest country in Oceania by the estimated absolute number of incident cases, with approximately five times the number of cases as Australia. In 2012, the rate of infant mortality stood at 60 deaths per 1,000 individuals. While this statistic was significantly reduced from years past, there is no reason for such a high percentage of the population to suffer from infant mortality. The most common causes of infant mortality in Kiribati are perinatal diseases, diarrhoeal diseases and pneumonia. As a result of inadequate water supply and poor sanitation, water and food-borne illnesses can also contribute to the incidence of infant mortality.
  3. Kiribati also suffers from its lack of developed healthcare infrastructure. Hospital facilities, doctors to assist the population, and trained nurses are all hard to come by in Kiribati. Though they meet standards for routine care, the scarce availability of such facilities makes them hard to access for the general population. With only three district-level hospitals and one referral level hospital, patients often must be sent overseas if serious conditions arise. This remote level of treatment can often make timely access to medicines an issue as well.
  4. In Kiribati, there is a low number of doctors and nurses relative to the population overall. This low number contributes to the relatively high infant and maternal mortality rates of Kiribati. Recently, the government has worked with smaller groups around Kiribati to train more healthcare professionals. By holding orientation courses for all health staff and developing long-term courses for primary care staff, communities on many of Kiribati’s islands could tackle the lack of healthcare personnel issues. As a result of these programs and increased training, the number of individuals that are able to assist with healthcare is rising, and the rates of morbidity from common diseases have been reduced.
  5. Water supply is an issue in Kiribati that most don’t directly associate with healthcare and disease, but can have a significant impact on the health of the population. Outdoor defecation is said to be prevalent in Kiribati, which can lead to contamination of the water supply. Groundwater contamination is often related to a higher incidence of diarrheal diseases. However, outdoor defecation is not entirely the result of a lack of other options, but education is necessary to help the population of Kiribati understand the risks associated with it.

In the fight against poverty and for a healthcare system that can serve its entire population, Kiribati has much work to do. Progress has been made in developing training for healthcare professionals and educational programs for communities, but many services such as sanitation and clean water supply still aren’t up to standards. Still, with a government committed to increasing the healthcare provisions for its people, Kiribati is sure to develop into a country that can provide for its growing population.

Pratik Samir Koppikar
Photo: Pixabay

Building Sustainable Healthcare

Qualified and experienced medical professionals traveling to developing countries and providing necessary healthcare may seem not only harmless but sensible for communities in need. However, if the ultimate goal is to improve sustainable healthcare in these countries in the long-term, the benefits of professional volunteers can be short-lived.

Nurses International

Nurses International is a non-profit organization that aims to build sustainable healthcare in developing nations by providing resources and education to local nurses in order to become qualified healthcare workers. Some of its work includes:

  • Ameliorating programs that are already in existence by providing necessary courses to complete the nurses’ training
  • Setting up new programs where they are non-existent
  • Removing obstacles, such as affordability, for students
  • Applying a curriculum that utilizes technology to increase productivity and efficiency
  • Educating nurses on their influence on community development
  • Multiple consultation efforts, such as reviewing curriculum, mentoring staff and aiding in policy development

Open Access

Nurses International also provides online courses intended to magnify the instruction for students in nursing programs. The courses may also act as preparation for those entering a nursing program. The online programs have been made available worldwide and include lectures, references for educators and students, assignments and assessments.

With all current courses relocated online due to COVID-19, there is a new course available for students to enroll in that discusses all aspects of the COVID-19 including testing, treatment and trajectory of the disease. Nurses International is also currently developing a teacher’s guide for Open Access and has the “worlds first Open Access BSN.”

Nurses International endeavors to do its work honing an anthropological perspective. Understanding and respecting the beliefs, values, traditions, and language of the patients and the community is at the heart of the organization’s work. Nurses International “respects and values multiple perspectives and finds that diversity allows them to their best work” towards building sustainable healthcare.

Nurses International’s productive efforts can be seen in Burundi, where volunteers teach students and develop learning materials while a new hospital is being built. Nurses International is making a teacher handbook and providing health checkups for women partaking in the program. In China, they are educating clinical instructors in the city of Quijing from 3 different nursing schools. In Egypt, Nurses International is providing a residency program for nurses to help them transition into clinical practice.

Challenges of Medical Tourism

Nurses International has an understanding that the demands of a developing country go far beyond the need for provisional healthcare. There is a growing interest from clinicians and medical students to travel to and temporarily practice in developing nations. The consequences of these visits can be damaging in multiple ways. For instance, countries hosting these international visitors must adapt resources that are already insufficient for their stay. Visitors often bring along supplies that are unnecessary or inapplicable. There is no evidence these missions create a stable healthcare model. By the end of their visits, substantial amounts of materials and money have been dedicated to solutions that are only temporary.

The Best of Both Worlds

Of course, volunteers can be helpful in developing countries. There is still a high demand for medical professionals and urgent care. The best solutions can come from an approach that is conscious of the community’s needs in both the short-term and the long-term. The Project Health Opportunities for People Everywhere (HOPE) and the Ghana Emergency Medicine Collaborative (GEMC) united in 2011 to accomplish this objective.

GEMC recognized the crucial need for specialization in emergency medicine since almost 6 million deaths around the world occur from injuries and acute illnesses. The collaborative realized that sending students away to developed countries for their training was ineffective in sustaining healthcare in the community because many students would remain in the developed countries that they were trained in, instead of returning home. To prevent such issues, GEMC brought emergency medicine specialists from the U.S and U.K. to Komfo Arioke Teaching Hospital (KATH) in Kumasi, Ghana.

The faculty coming from developed countries advise and train students who eventually graduate from the program and become qualified clinicians and instructors, allowing graduates from the local community to then lead the programs. Project Hope joined forces with GEMC’s methods by providing volunteers to perform direct and immediate health care services as needed at KATH, and also to strengthen a program with transitory medical volunteers. These programs work together to form an initiative to build sustainable healthcare in the community.

— Amy Schlagel
Photo: Pixabay

 

Life Expectancy in RwandaAs life expectancy in Rwanda has doubled in the past 20 years, the efforts that helped to achieve this goal are closely tied with efforts to combat poverty. If people are sick but cannot access healthcare, they cannot contribute to the economy. Conversely, if people are living in poverty, they often cannot afford to access healthcare. Ending poverty and providing medical care are closely tied, and Rwanda has made excellent progress on both fronts.

Life Expectancy in Rwanda

In the early 1990s, Rwanda was the site of a 100-day genocide, during which a million Tutsis and Hutus were killed. The genocide decimated the country, destroyed infrastructure and cast millions into poverty. Life expectancy in Rwanda reached a low of 26.2 years in 1993 at the height of the genocide, but by 2018, it had risen to 68.7 years. Furthermore, life expectancy is projected to increase to 71.4 years by 2032.

Many factors have contributed to the dramatic increase in life expectancy and overall social welfare. The Rwandan constitution secured citizens’ right to health in 2003. Accordingly, the government has invested in healthcare systems including primary healthcare systems, HIV/AIDS healthcare systems, oncology services, community-based health insurance and medical education. A dramatic increase in vaccination rates has been crucial in improving Rwandans’ health. After the genocide, fewer than 25% of children had been vaccinated against measles and polio, but today, 97% of Rwandan infants have received vaccinations against 10 diseases.

There have also been declines in deaths from tuberculosis and malaria. There has been a similar decline in maternal and child mortality: after the genocide, Rwanda had the world’s highest rate of child mortality, but today, Rwanda has caught up with the global average. Furthermore, the HIV/AIDS case and death rates have decreased. In 1996, antiretroviral therapy became available, and in the last 10 years, Rwanda’s death rate from AIDS fell faster than it did in the U.S. and Western Europe.

External investment and an increase in foreign aid have also improved Rwandans’ health. In 1995, Rwanda received only $0.50 per person for health, less than any other country in Africa. NGOs like Partners In Health (PIH) have helped increase the population’s access to healthcare and have supported efforts to rebuild public and community health systems.

Poverty in Rwanda

The percentage of people living in poverty declined by 5.8%, from 44.9% to 39.1%, between 2011 and 2014 alone. Factors contributing to the decrease in poverty include:

  • The improved health of the people of Rwanda. Strong healthcare systems can work to combat poverty, because when people are in good health and can access medical care, they are able to work and be more economically productive.
  • The government’s Vision 2020 anti-poverty objective, which fosters privatization and liberalization with the goal of promoting economic growth.
  • A thriving banking system.
  • The expansion of the service sector.
  • Entry into the East African Community, an economic bloc whose other members are Uganda, Kenya, Tanzania and Burundi.

Poverty and Life Expectancy in Rwanda

There is a substantial intersection between Rwanda’s efforts to increase its citizens’ life expectancy and its efforts to pull them out of poverty. The efforts to ameliorate both problems of poverty and life expectancy in Rwanda are linked through public health, and each is improving because the other is. In the words of one public health expert, Rwanda demonstrates that “a nation’s most precious resource is its people.”

Isabelle Breier
Photo: Wikimedia

COVID-19 in AfricaOn a world map of the distribution of COVID-19 cases, the situation looks pretty optimistic for Africa. While parts of Europe, Asia and the United States are shaded by dark colors that implicate a higher infection rate, most African countries appear faint. This has created uncertainty over whether or not the impact of COVID-19 in Africa is as severe as other continents.

Lack of Testing

A closer look at the areas wearing light shades reveals that their situation is just as obscure as the faded shades that color them. Dark spots indicate more infections in places like the U.S. However, in Africa these are usually just cities and urban locations, often the only places where testing is available.

Although insufficient testing has been a problem for countries all over the world, testing numbers are much lower in Africa. The U.S carries out 205 per 100,000 people a day. Nigeria, the most populous country, carries one test per 100,000 people every day. While 8.87% of tests come back positive in the U.S, 15.69% are positive in Nigeria (as of Aug. 4, 2020). Nigeria was one of 10 countries that carried out 80% of the total number of tests in Africa.

As a continent that accounts for 1.2 billion of the world’s population, the impact of COVID-19 in Africa is even more difficult to measure without additional testing. To improve this, the African CDC has set a goal of increasing testing by 1% per month. Realizing the impossibility of reliable testing, countries like Uganda have managed to slow the spread by imposing strict lockdown measures. As a result, the percentage of positive cases in Uganda was only 0.82% (as of Aug. 4, 2020).

A Resistant Population

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

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

Weak Healthcare Systems

Despite these factors, the impact of COVID-19 in Africa is likely high. Under-reporting and under-equipped hospitals contribute to unreliable figures. Most hospitals are not prepared to handle a surge in cases. In South Sudan, there were only four ventilators and 24 ICU beds for a population of 12 million. Accounting for 23% of the world’s diseases and only 1% of global public health expenditure, Africa’s healthcare system was already strained.

Healthcare workers have the most risk of infection in every country. In Africa, the shortage of masks, equipment and capacity increases the infection rate further amongst healthcare workers. Africa also has the lowest physician to patient ratios in the world. As it can take weeks to recover from COVID-19, the recovery of healthcare workers means less are available to work.

Additionally, those that are at-risk and uninsured can rarely afford life-saving treatment in Africa. For example, a drug called remdesivir showed promising results in treating COVID-19. However, the cost of treatment with remdesivir is $3,120 – an unmanageable price for the majority of Africans. These factors will determine the severity of COVID-19 in Africa.

Economic and Psychological Factors

Strict lockdowns have helped some nations in controlling the spread of COVID-19 in Africa but at a very great price.

Lack of technology often means that all students stop learning and many lose their jobs. More than three million South Africans have become unemployed due to the lockdown. The lockdowns have also resulted in much higher rates of domestic violence, abuse and child marriage. Many such cases go unreported and mental health services for victims or those struggling through the pandemic are unavailable. In Kenya, the U.N. has appealed for $4 million to support those affected by gender-based violence.

The slow spread of COVID-19 in Africa has allowed the continent and leaders to prepare, and the young population will lessen the impact. Although there’s reason to be hopeful, there’s no doubt that there will be an impact on Africa’s economy and future. This calls for the need of foreign assistance – not only in controlling COVID-19 in Africa but in the recovery of the continent for years to come.

Beti Sharew
Photo: Flickr

Healthcare in TunisiaThe North African country of Tunisia is sandwiched by two relatively unstable nations, Algeria and Libya. However, Tunisia has had consistent development in human wellbeing for the past couple of decades, ranking among the best nations in Africa. In part, this success can be attributed to Tunisia’s relatively strong healthcare system. According to a World Health Organization report, Tunisia possesses a “national health strategic plan” as well as a relatively high life expectancy at 75 years. Healthcare in Tunisia is a promising sign that the country can adequately support its population and promote longer, healthier lives for its citizens. Here are six facts about healthcare in Tunisia.

6 Facts About Healthcare in Tunisia

  1. More than 90% of the population is covered by health insurance. While some citizens use private insurance, others are covered by programs in place to assist the most disadvantaged in society. However, Tunisia still lacks truly universal coverage. One of the top complaints about healthcare in Tunisia is gaps in payment for important medical procedures, which can burden families.
  2. Tunisia’s 2014 constitution granted healthcare as a human right. The government is still working to make this a reality and provide universal, effective healthcare in Tunisia. Specifically, the government is trying to improve the dilapidated health infrastructure in the south of the country. This manifested in a 9% increase in the healthcare budget in 2016, which went toward improving infrastructure in remote areas.
  3. Private healthcare in Tunisia is booming. In recent years, before the COVID-19 pandemic, the number of private clinics built in the country was expected to surge. Seventy-five new facilities are set to be completed by 2025, doubling the number of hospital beds in the country. These improvements should help make access to quality healthcare more readily accessible to the general population.
  4. Tunisia successfully combated many diseases in the past. Most importantly, Tunisia has been able to eradicate and control many deadly diseases that put a strain on its healthcare system. Malaria, polio and schistosomiasis are well under control. In addition, Tunisia’s healthcare system has worked to address HIV/AIDS.
  5. During the COVID-19 pandemic, Tunisia has done relatively well. Sitting at 1,327 confirmed cases and 50 deaths as of July 2020, the country is positioned to recover economically from the virus, which is devastating in other parts of the world. Though it is still early in the pandemic, it appears that the healthcare system in Tunisia was able to absorb the influx of cases in order to slow the death rate.
  6. Robust preventative measures enabled Tunisia’s positive response to COVID-19. Seeing the potential for a rise in cases early on, the government, as advised by healthcare experts, quickly went into a rigorous lockdown that lasted for months. This was especially difficult considering that tourism accounts for 10% of the country’s GDP. According to a WHO spokesman, a strong sense of community and respect for the lockdown measures eased the country’s caseload and death toll. Because the Tunisian population was willing to make sacrifices for the broader community, they are now in a comparatively better place than some other nations around the world.

Healthcare is a critical issue for any nation. While there is always room for improvement, Tunisia has succeeded in using its available resources to ensure medical coverage for its people.

Zak Schneider
Photo: Pixabay