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Dalit Women: Health care Access and Health Outcomes

Dalit womenThe caste systems found in countries such as India and Nepal are socially hierarchical systems that divide people into five primary groups: Brahmin, Kshatriya, Vaishya, Sudra and Dalit. Those in the Dalit caste rank as the lowest and are considered societal outcasts. As a result, they suffer harsh treatment and discrimination. Due to the patriarchy in these societies in addition to widespread support for caste systems, Dalit women face high levels of discrimination. This reality creates great disparities in overall life and health outcomes.

Access to Care

Dalit women’s health outcomes largely depend on their access to health care. This access, however, is limited considering Dalit women’s low socioeconomic status. For example, in the southwest Indian state of Karnataka, which is home to over 61 million people and is the eighth-largest state in India by population, about 74.4% of Dalit women reported having issues regarding health care access. This number is about 70% at the national level, according to 2018 India’s National Family Health Survey. Partially due to this struggle in accessing health care, Dalit women have a 15-year shorter lifespan on average than upper caste women.

When they do have access to care, it can be very costly. Asia-Pacific Journal of Public Health revealed that some unlicensed private doctors exploit Dalit women and other lower-caste women by charging them high fees, forcing many of them to take out loans for treatment. This practice contributes to the cycle of poverty among Dalit women and can make access for many extremely difficult. These issues with health care access often lead to negative health outcomes considering women’s greater vulnerability to diseases such as malnutrition and anemia, as well as maternal mortality.

Mental Health Disparities

Two main issues face Dalit women in terms of mental health: firstly, mental health issues are more prevalent in their caste than for those in higher-ranking castes, and secondly, these women have less access to care. In 2020, the Journal of Global Health Reports conducted a study in which 12 Dalit participants from Nepal talked about their experiences with mental health. From the outset, the researchers made it known that Dalits in Nepal “face the greatest discrimination and have a greater prevalence of depression and anxiety when compared with high castes.”

In terms of the actual results of the study, a number of the participants stated they believe that gender-based discrimination in Nepal makes issues of mental health for Dalit women more difficult, as it causes them to “receive more stigma for mental health conditions.” The stigmas that these women receive can lead to dangerous outcomes for them. Two participants in the study stated that Dalit women are at considerable risk when they are cast out from their families, as they become homeless and therefore are more vulnerable to exploitation, rape and abuse.

Some research also indicates that Dalit and other low-caste women may have experienced worsening mental health outcomes as a result of the COVID-19 pandemic. According to a 2022 study, lower-caste women tended to have a greater fear of COVID-19 than higher-caste women. The study also found that Dalit women and women of other backward castes (OBCs) suffered from more severe anxiety and stress symptoms than higher-caste women.

Feminist Dalit Organization (FEDO)

In light of the continuing discrimination against Dalit women, several organizations are taking action to create better opportunities for this underprivileged community. Perhaps one of the most prominent is the Feminist Dalit Organization (FEDO), which is a nonprofit organization that was founded by a group of Dalit women in 1994. The organization works to address and fight back against the various inequalities experienced by affected women in Nepal.

FEDO is present in 56 of Nepal’s 75 districts, seeking to improve the lives of Dalit women by advocating for human rights and economic empowerment initiatives. This includes helping Dalit women become financially literate so that they can have opportunities to own small businesses and break the cycles of poverty found in Dalit communities throughout Asia. The work of organizations like FEDO could bring about upwards social mobility for Dalit women, therefore giving them greater access to health care services and improving their overall quality of life.

– Adam Cvik
Photo: Flickr

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Deglobalization During COVID-19

Deglobalization Amid COVID-19COVID-19 has disrupted trade markets throughout the world. Due to this, many are speculating that the world is in a state of “deglobalization.” Deglobalization is a term that holds two meanings. One propagates the idea that local manufacturers are in danger of foreign competition. The other describes “periods of history when economic trade and investment were in decline.” Moments of deglobalization include World War I, World War II and the 2008 financial crisis in the U.S. Both events led to economic downturns in many other countries, which led to periods of distrust toward globalization.

Deglobalization in India

India has experienced more than 50,000 deaths due to COVID-19. In addition, India has many unreported COVID-19 cases due to poor surveillance infrastructure. The country has also experienced a rise in unemployment, destructive floods and a falling GDP. India has seen the world’s second-highest virus infections and there is still uncertainty about when the country can go back to normal. However, the government’s new trade policies are predicted to help India’s economy bounce back. India’s Ministry of Commerce and Industry expressed, “A key driver for India to achieve the USD 5 trillion mark in an expedited time frame would be boosting exports, both merchandise and services.” Reaching this goal would improve domestic manufacturing and service sectors through the addition of efficient infrastructure funded by the government.

However, President Mobi’s movement of taking agriculture sales into the free market has caused massive disruption. India’s agriculture is the largest employer in the country. The government has been controlling wholesale markets, securing food buyers and setting price guarantees. This globalized approach will cut guarantees set by the Indian government and force farmers to go further into debt to secure stability in a competitive field. Farmers who have entered the free market before the bills reported high rates of debt and suicide attempts. Reform to create an open market that doesn’t favor farmers is deeply controversial in India.

Nepal and Trade Restrictions

Just like India, Nepal is looking to reunite with the global market. Nepal’s unemployment rate is reaching 40% on a federal level. The informal sector employs most employed Nepalis, who gain income through unregulated markets and illegal services. An estimated 500,000 people enter the country for work while only 200,000 actually find work. The Federation of Nepalese Chambers of Commerce and Industry has a plan to reduce trade deficits caused by the pandemic by 50% and help Nepalese manufacturers through government-funded projects. President of the federation Shekhar Golchha, claims that “If the vision paper is implemented honestly, there will be an investment of $150 billion in the upcoming decade. Of the total investment, around $108 billion will come from the private sector.”

Trade with China has also been an issue for Nepal internationally. In February, Chinese traders created a blockade restricting 2,000 containers loaded with clothes, shoes, cosmetics, electronics and industrial raw materials. As China holds itself to be the “factory of the world,” it has deeply affected smaller countries. During the blockade dispute, Nepal found itself in violation of the “One China” law. A month later, Prime Minister KP Sharma Oli created the Make in Nepal-Swadeshi campaign. The prime minister intends for this campaign to start taking underemployment out of international hands.

The Philippines and its Relationship with China

The Philippines has been hit very hard by COVID-19 just as the country was beginning to recover. International trade in the Philippines has continuously declined since the beginning of the lockdowns and the overall trade income is 20.2% lower than in 2019. However, aid from foreign countries, such as China, has helped the Philippines during this time of need. On January 16, 2021, Chinese Foreign Minister Wang Yi pledged to donate 500,000 vaccines to the Philippines. Wang has also approved an infrastructure agreement to fund $400 million to the Filipino government for bridge infrastructure and $940 million for a railroad cargo project.

The Philippines has historically been lagging behind other East Asian nations in manufacturing export. Graft, low autocracy and overarching oligarchs controlling agriculture production and property contribute to holding the country back. During the Plaza Accord in 1985, these factors led to the Philippines losing out on a significant wave of Japanese investments. By the 2000s, the country’s GDP became stagnant. Sec. Carlito Galvez Jr., the chief implementer of the National Task Force (NTF) against COVID-19, reflects that the pandemic has shown how vulnerable the Philippines is to the lack of international help, stating, “For 2023, we envision for self-sufficiency and readiness for the pandemic and other disasters with the modernization and integration of our healthcare system.”

As 2021 continues, nations are deglobalizing for one reason or another, and shifting international relationships will determine the future of foreign affairs. While developing countries need economic assistance, international support has been seen to complicate domestic production in certain sectors by allowing foreign influence to dominate industries. Deglobalisation can bring a new form of globalized affairs and political leaders should rethink their investment in free markets, looking more into domestic action to keep citizens off the poverty line.

– Matthew Martinez
Photo: Flickr

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The Suaahara II Project: Improving Health in Nepal

Suaahara II ProjectIn Nepal, 36% of children who are under the age of five remain underdeveloped in terms of growth and health despite progress in recent years. Through cooperation with USAID, the Nepalese Government and local private sector groups, Hellen Keller International (HKI) has provided impactful services that have helped rectify the systematic obstacles causing these health issues. Hellen Keller International is a non-profit organization that aims to reduce malnutrition. The Suaahara II project takes a pivotal role in these efforts.

What is the Suaahara II Project?

One of HKI’s most notable services is the Suaahara II project, which started in 2016 and was initially set to end in 2021. However, it will now extend to March 2023 due to COVID-19. Operating in 42 of Nepal’s districts with a $63 million budget, HKI partnered with these six organizations for the project:

  • Cooperative for Assistance and Relief Everywhere, Inc. (CARE)
  • Family Health International 360 (FHI 360)
  • Environmental and Public Health Organization (ENPHO)
  • Equal Access Nepal (EAN)
  • Nepali Technical Assistance Group (NTAG)
  • Vijaya Development Resource Center (VDRC)

Hellen Keller International’s primary role in the Suaahara II project deals with the technical assistance of child and maternal nutrition. This means that its tasks are oriented around building the skills and knowledge of health workers. This includes teaching health workers how to adequately measure and evaluate assessments; additionally, another technical facet relies on promoting governance that invests in nutrition.

A Multi-Sectoral Approach

Kenda Cunningham, a senior technical adviser for Suaahara II who works under HKI, told The Borgen Project that the Suaahara II consortium has taken a “multi-sectoral approach.” She believes in the importance of this as it pushes individuals to “learn and think beyond their sector.” The Suaahara II Project’s demonstrates its integrated strategy in the initiatives below:

  1. The WASH program focuses on water, sanitation and hygiene through WASHmarts, which are small shops dispersed across districts that sell sanitary products like soap and reusable sanitary pads. Kenda explained how this has helped “bridge a gap” so that poorer households can access hygiene enhancing products. This also allows assistance from private actors, who can expand their markets in rural areas.
  2. The Homestead Food Production program (HFP) encourages households to grow and produce micronutrient-rich foods through vegetable gardening and raising chickens, for example. As a result, 35 districts have institutionalized HFP groups.
  3. The Bhancchin Aama Radio Program is a phone-in radio program that runs twice every week. It hosts discussions among marginalized communities and demonstrations for cooking nutritious foods. It has encouraged the Nepalese to socially and behaviorally alter their health habits.

Advancements from Suaahara I

The Suaahara II project’s contribution to improved health and nutrition in Nepal is also illustrated in its progression from the Suaahara I project’s framework. In addition to understanding the changes made in household systems and at a policy level from Suaahara I, Cunningham told The Borgen Project that technological developments have elevated the Suaahara II Project’s impact in Nepal.

Specifically, smartphones expedite the data collection process when studying trends pertaining to the 2 million households across the districts. The development of new apps provided more households with access to smartphones and key information. This therefore allowed officers to transition from pursuing “a mother-child focus to a family focus” in terms of the Suaahara II project’s accommodations and services.

Challenges with Suaahara II

While the Suaahara II Project has led to institutional and social enhancements regarding health and nutrition, some districts had access to the project earlier. This created a dissonance in the rate of health improvements amongst the districts. Cunningham reported that “far western areas are much more remote and therefore disadvantaged and food insecure.”

This inconsistency was largely due to the “Federalism” that took place in Nepal in 2017, which was a decentralization process that created 42 municipalities for 42 districts. Since every municipality has a different political leader, some districts had the advantage of assistance from foreign NGOs while others did not because their leaders rejected involving foreign NGOs. In these cases, as Cunningham explained, it is like “you are creating your own NGOs from the ground up.”

Suaahara II Achievements

These obstacles, however, have not been pertinent enough to counter the consortium’s efforts in fulfilling the Suaahara II project’s objectives. For example, a primary objective for Suaahra II is to increase breastfeeding amongst babies under six months of age. Exclusive breastfeeding of children under six has increased from 62.9% in 2017 to 68.9% in 2019, according to data that Cunningham shared with The Borgen Project.

Expanding children’s access to diverse and nutritious foods is another objective that has been achieved under the Suaahara II project. The dietary diversity among women of reproductive age (WRA) has increased from 35.6% in 2017 to 45.3% in 2019, according to Cunningham. Given the efficient rate of improvement in women and children’s health, governance and equity in only the first two years of the Suaahara II project, it can be inferred that the consortium will continue to progress in achieving its targets among the Nepalese in the three years that remain.

Regarding how HKI has responded to challenges with the Suaahara II project, Cunningham said  “[We] don’t use a one size fits all approach.” The advancements in Nepal’s health and nutrition systems can be largely attributed to HKI’s multifaceted and integrated strategy, a model that could yield prosperity in the rest of the developing world.

– Joy Arkeh
Photo: Flickr

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Menstrual Taboo in Nepal: What is Chhaupadi?

ChhaupadiChhaupadi, a form of menstrual taboo, plagues the country of Nepal. Although it is a social taboo in Hindi tradition, the practice of chhaupadi is often practiced in the far-western region of Nepal and in Himalayan regions. This is because the event of menstruation, although a normal and healthy bodily function for females, is considered a form of sin and impurity. Although menstrual taboo exists in other regions of Nepal and in other South Asian countries, it is most prevalent in the Himalayan regions. Here, it is called chhaupadi, “Chhau” meaning menstruation and “padi” referring to women.

What is Chhaupadi?

Chhaupadi occurs during the female menstruation cycle. While women and girls are menstruating, they are considered impure, intouchable, and even perhaps, harbingers of bad fortune. During the menstruation cycle, any object a woman touches is deemed impure, including livestock, water resources and plants. It is believed that if touched, these objects need to be purified in some way. As a result, in regions where Chhaupadi is practiced, women are banished from their homes. During this exile, women and girls are often sent to a “chhau” shed, which is essentially a livestock shed, and the menstruating female will remain there for about four days. Girls who are experiencing menstruation for the first time may need to stay in the “chhau” for up to 14 days. Unfortunately, girls who may experience difficulties or health issues while menstruating must wait until their cycle ends before seeking medical care, which can worsen possible health problems and symptoms.

Even if women are not directly practicing menstrual exile, a 2018 study by sociologist Saruna Ghimire at Miami University found that 100% of girls are restricted by menstrual taboos during their cycles. These women are not allowed to touch food, touch the water tap or participate in normal family activities. The menstrual taboo restricts the resources available, limiting the autonomy of women and possibly damaging their self-image. Additionally, the Ghimire study found that 72% of females are subjected to menstrual exile due to Chhapuadi.

The Dangers of Menstrual Exile

Not only is the stigma associated with menstruation a problem within these communities but the actual practice of Chhaupadi poses many health risks for the women and girls involved. For instance, the temporary shelters used during Chhaupadi are unhygienic, which increases the risk of health complications such as urinary tract infections, diarrhea, dehydration and hypothermia. Additionally, women and girls living in these sheds are subject to the dangers of snake bites and other animal attacks.

Each year, at least one woman or girl dies during menstrual exile. These cases often go unnoticed by the media, leaving the beliefs of community members unchanged. Moreover, the isolation that comes with Chhaupadi poses dangerous consequences to the mental health of these females. Oftentimes, these women and girls will feel abandoned, insecure, guilty and embarrassed.

Law Prohibiting Chhapuadi

In 2017, the Nepali Government enacted a new law that prohibits Chhapuadi. Any family member that forces a female to practice Chhaupadi can be punished with a jail sentence of three months or fined 3,000 rupees, which translates to about $30. Although the Nepal Supreme Court previously banned Chhapuadi in 2005, the practice has been difficult to disintegrate as it is deeply rooted in traditional beliefs. Besides the legislative component, local police are given the task of destroying Chhapuadi shelters. At the same time, some activists argue that Chhapuadi, although rooted in the patriarchal aspects of Nepali culture, will be difficult to stop as many women choose to practice it. Yet, with the new law, women who choose to practice Chhapuadi are required to do so in a safer way, by isolating themselves from their families in a separate area or room and not a shed.

The Road Ahead

Although Chhaupadi stems from Hindu scripture, the practice is one that has existed for centuries. Thus, the actual practice of menstrual exile may not stop right away. Luckily, the Nepalese Government has made strides in reducing Chhaupadi through the law and police action, and if Chhaupadi is practiced by choice, it will be done in a much safer way.

– Caitlin Calfo
Photo: Flickr

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Goliathon: Safe Drinking Water for Those in Need

GoliathonGoliathon is a nonprofit organization located in New Jersey, that uses obstacle courses to raise money for another organization, charity: water, which is based in New York. These two organizations jointly work to bring clean and safe drinking water to people in developing countries.

Water: A Universal Human Right

In 2017, 2.2 billion people worldwide did not have access to clean water, which is roughly one in 10 people. The lack of access to clean water is due to the contamination of water as well as the location of water. With 144 million people sourcing their drinking water from untreated lakes, ponds and streams, disease is a massive concern. Unsafe and untreated water is responsible for the transmission of diseases like cholera and dysentery. Diarrhea alone claims almost 485,000 lives a year. The matter of location is equally vital. Efforts to create safe water sources mean little if they are not easily accessible for those in need. More than 200 million people must walk more than half an hour to reach a safe water source.

The U.N. recognizes access to water as a universal human right. In the effort to solve this crisis, the General Assembly argues that water must be safe, acceptable and affordable and has to be within 1,000 meters of the home. The value of water is a key reason why Goliathon has chosen to work with charity:water.

charity: water

Founded in 2006, charity: water is committed to providing clean drinking water to developing nations. The majority of its work has been centralized in Asia and Sub-Saharan Africa, with a few projects located in Central America. These projects include well construction, water purification systems and rainwater harvesting.

Founder and CEO, Scott Harrison, recognizes the opportunities offered by technological advancements. He sees the solution to the water crisis as a possibility. He believes “It’s just a matter of getting the right resources to the right people.”

Charity: water prides itself on transparency, promising that 100% of proceeds go toward hands-on development of the projects.

Goliathon

Goliathon was founded by a group of friends who value athleticism and altruism. Their mission statement is “It’s not a race. It’s a mission.” This mission statement reflects that the water crisis is not one problem to fix but a collective mission to undertake. Goliathon’s fundraising for charity: water has resulted in several completed water projects in Bangladesh, Nepal, Ethiopia, Cambodia and Malawi. Three more water projects have been funded and are currently under construction.

By signing up to take part in Goliathon obstacle courses, participants raise money for charity: water efforts. The courses are not a competition but a challenge that encourages everyone to be an advocate for global issues like water access.

The obstacle courses are open to all and vary in difficulty to appeal to both beginners and the more experienced. The Goliathon team has created several different obstacles for participants to overcome, each unique in design and requiring equally clever solutions. A particularly notable challenge in the course is the water carry challenge, which has participants cart jerrycans full of water as a way of connecting to those in developing nations who must do the same.

Impact of Goliathon and charity:water

Goliathon’s October 2017 event resulted in $50,000 raised for charity: water efforts in Ethiopia. Completed in September 2019, the project oversaw water spring protection and the creation of safe pipe systems. Over 1,600 people in Ethiopian communities were helped.

The most recent Goliathon event held in October 2019 had $34,000 raised for BioSand Filters in Cambodia. These BioSand Filters offer a simple and low-cost solution as a form of filtration. Their effectiveness is amplified by charity: water committing to educating the families that use them, ensuring a healthy cycle.

COVID-19 has prevented Goliathon from hosting any events in 2020. However, the Goliathon team is optimistic and is planning for a possible event in June 2021, with protocols in place if necessary.

– Kelli Hughes
Photo: Flickr

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Photography Fights Child Marriage

Photography Fights Child MarriageTwelve million girls a year—or 23 girls every minute—are married before their 18th birthday. The most common factors that contribute to child marriage are poverty, lack of education and gender norms. Around the world, 21% of young women were married as minors. The prevalence of child marriage is even higher in sub-Saharan Africa, at 37% of young women. Various art forms, including photography and music, have been used to advocate for the eradication of this harmful practice. Photography fights child marriage by raising awareness for this pressing issue and empowering women to take action.

Costs of Child Marriage

When young women and girls are forced to marry, they are less likely to attend school. They are separated from their family and friends, and they are also more likely to experience life-threatening complications during pregnancy and childbirth, suffer domestic violence and contract HIV/AIDS. Furthermore, child marriage traps these girls in a cycle of poverty, in which they and their children are less able to access opportunities for education and economic empowerment.

Photography Fights Child Marriage and Empowers Girls

Too Young to Wed, a nonprofit founded in 2012 by photojournalist Stephanie Sinclair, uses photography to raise awareness of the prevalence of child marriage. This organization creates media campaigns focusing on child marriage and uses compelling photojournalism to show that the practice is a violation of human rights. The photographs have been seen by billions, and one media campaign that focused on child marriage in Nepal reached more than 9.7 million people. The photographs, alongside firsthand accounts from girls at risk of or impacted by child marriage, “inspire the global advocacy and policy-making communicates to act,” according to Sinclair.

In addition to organizing photo workshops, this organization provides leadership scholarships, vocational training and other support. The Leadership Scholarship program is especially crucial because education is vital to preventing child marriages. In the last eight years, Too Young to Wed has directly helped 600 girls, and much more indirectly, in its fight against child marriage. Sinclair told Global Citizen, “[Girls] can do all kinds of things that they can bring back to their community and then also bring them out of a level of poverty where the most extreme forms of child marriage are definitely happening.” When young women are educated, their children are more likely to be educated as well, which helps take the family out of the cycle of poverty.  Overall, Too Young to Wed uses visual evidence and storytelling to highlight the harmful impacts of child marriage, empower girls and inspire change.

Tehani Photo Workshop

Since 2016, Too Young to Wed has provided a week-long photography workshop that also functions as an immersive art therapy retreat called the Tehani Photo Workshop. Partnered with the Samburu Girls Foundation, Too Young to Wed held the first workshop in Kenya, where about 1 in 4 girls are married before the age of 18. During this workshop, 10 girls who had escaped their marriages learned how to shoot portraits, and they were able to form friendships and reclaim their narratives. To conclude the workshop, the girls presented their photographs and told their stories to more than 100 members of their community.  According to Sinclair, the workshops aim to “help [the girls] better realize their self-worth and the value of their voice.”

Music as a Tool in the Fight Against Child Marriage

In Benin, where more than 25% of girls are married before they are 18 years old, artists collaborated in 2017 to release a song and music video that highlighted this issue. UNICEF’s Goodwill Ambassadors Angélique Kidjo and Zeynab Abib, along with seven other artists, composed the song as part of the national Zero Tolerance Campaign against child marriage. The song is titled “Say No to Child Marriage” and includes multiple languages so its message resonates with people within Benin and in neighboring countries. “Child marriage is a negation of children’s right to grow up free,” said Kidjo. “Every child has the right to a childhood.”

In 2019, the United Nations Children’s Fund worked with music producer Moon Boots and vocalist Black Gatsby to produce a music video to speak out against child marriage in Niger, where 76% of girls are married before the age of 18. Also, according to UNICEF, Niger has the world’s highest rate of child marriage. The song, titled “Power,” promotes education as a positive alternative that can empower girls and reduce poverty in their communities. According to a Félicité Tchibindat, a UNICEF representative in Niger, it also fights against the practice of child marriage by raising awareness that “ending child marriage is possible,” even though it is a long-held social norm.

Conclusion

Although the rates of child marriage are gradually declining worldwide, it is estimated that 120 million more girls under the age of 18 will be married by 2030 if current trends continue. The coronavirus pandemic has also put up to 13 million more girls at risk of child marriage because of rising poverty rates, school closures and hindered access to reproductive health services and resources.

Twenty-five million child marriages have been prevented in the last ten years, and UNICEF attributes the decline of the practice in part to “strong public messaging around the illegality of child marriage and the harm it causes.” While photography fights child marriage, further far-reaching and powerful art initiatives, along with the work of national governments and international organizations, can continue to raise awareness, empower girls and reduce the prevalence of this practice around the world.

– Rachel Powell
Photo: Flickr

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USAID Saves Thousands of Babies

USAID Saves Thousands of BabiesRoughly 2.76 million newborns die each year, with preventable infections causing at least 15% of those deaths. For instance, a baby’s cut umbilical cord could allow bacteria to enter their body, leading to life-threatening newborn sepsis. To avoid neonatal deaths like this, cord stump care at birth is critical, particularly in settings with poor hygiene. Thankfully, with national assistance, USAID saves thousands of babies in Nepal and other countries around the world.

There is a low-cost, easily manufactured and easily distributed life-saving solution that the World Health Organization (WHO) recognized in 1998 as a suitable antiseptic for cord care. Commonly found in mouth wash and hand sanitizers, chlorhexidine is an antiseptic gel that USAID helped produce for nations with the greatest need since 2002. Nepal was the first nation to adopt chlorhexidine on a large scale. USAID’s efforts, as well as cooperation with the Government of Nepal and its private sector, are responsible for lowering the infant mortality rate significantly. USAID saves thousands of babies around the world.

Chlorhexidine “Navi” Care Program

USAID’s Chlorhexidine “Navi” Care Program, implemented by John Snow Inc. (JSI), provides technical assistance to the Government of Nepal to scale up the use of chlorhexidine through resources and education. The six-year, $3.9 million program had two phases. The first phase occurred from October 2011 to September 2014 in 49 out of 75 of Nepal’s districts. Phase two started in October 2014 and brought chlorhexidine to all districts. The program found funding as a part of USAID’s “Saving Lives at Birth: A Grand Challenge for Development.”

The Nepali government strongly advocated for this scale-up. The administration incorporated single-use chlorhexidine tubes into its maternal and child health packages. In addition, it also trained health care workers for use of the antiseptic. Nurses began to use chlorhexidine at birthing centers across the country. They apply the antiseptic to the umbilical stump immediately after the cut. Its use in Nepal decreased newborn infections by 68% and decreased newborn deaths by 24%. Chlorhexidine for cord care thus became an integral part of maternal and infant health programs. Through the implementation of its new programs like this, USAID saves thousands of babies.

According to the Bill & Melinda Gates Foundation, Dalberg Global Development Advisors and the Boston Consulting Group, it usually takes more than a decade for global health innovations to develop in low and middle-income nations. In Nepal, it took around five years.

The success of USAID’s Navi Care Program is attributed to its partnering with the Government of Nepal and various organizations. USAID’s partners include MoHP, Save the Children, Plan International, Health For Life (USAID), UNICEF, One Heart Worldwide and PSI. Future initiatives should replicate USAID’s coordinated effort due to this program’s monumental success.

Nepal’s Success Serves as a Model for Others

Other nations have taken notice of Nepal’s health improvements and how USAID saves thousands of babies. Many nations sent their leaders and officials to speak with those who worked on the program to expand the use of chlorhexidine in their own countries. Following Nepal as a model, these nations have planned trials with the antiseptic gel. All program-related materials are public, supporting the global trend. As a result, Nigeria, Bangladesh, Pakistan and the Democratic Republic of Congo have begun the process of scaling up chlorhexidine to reduce newborn death rates. In particular, Nigeria has made substantial progress.

USAID’s efforts to lower infant mortality rates yielded fruitful results from a single and simple solution. As a result, it inspired efficient innovation elsewhere. This program was a tremendous global success, as USAID saves thousands of babies and makes the world a healthier place. USAID’s programs will hopefully continue to work with the governments and organizations in low- and middle-income nations to achieve the optimal adoption of healthcare initiatives.

– Mia McKnight
Photo: Wikimedia Commons

 

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Himalayan Cataract Project Combats Blindness and Poverty Around the World

Himalayan Cataract ProjectIn 1995, Dr. Geoff Tabin and Dr. Sanduk Ruit launched the Himalayan Cataract Project to eliminate curable and preventable blindness in under-resourced Himalayan communities. The two founded their innovative campaign after recognizing that cataracts account for 70% of unnecessary blindness in Nepal. Cataracts, or cloudy, opaque areas in the eye that block light entry, occur naturally with age. Poor water quality, malnutrition and disease tend to exacerbate the issue in developing countries.

For years, Dr. Tabin and Dr. Ruit had seen Nepalese villagers take blindness as a death sentence. “It was just accepted that you get old, your hair turns white, your eyes turn white, you go blind and you die,” Dr. Tabin told the Stanford Medicine magazine. But after Dutch teams arrived in Nepal to perform cataract surgery, he explained, “People came back to life. It was amazing.”

The Strategy

The Himalayan Cataract Project delivers sight-restoring cataract surgery at a low cost. Dr. Ruit’s groundbreaking procedure lasts 10 minutes and costs just $25. Today the organization has succeeded in providing permanent refractive correction for well over 500,000 people.

In an effort to leave a more sustainable impact, the project works from a “train the trainer” model that empowers community health providers and enhances local eye care centers. Rather than simply treating patients in need, specialists introduce new methods and technology to strengthen the practices of existing clinics.

As a result of these and other advances, the blindness rate in Nepal has plummeted to 0.24%, similar to that of Western countries. The Himalayan Cataract Project now operates in India, Tibet and Myanmar. Dr. Tabin has also initiated training programs in Sub-Saharan Africa, particularly in Ghana and Ethiopia. He hopes to see the same successes here as achieved in Asia.

The Link Between Blindness and Poverty

Addressing blindness is a critical step in the fight against poverty. Blindness prevents able-bodied workers from supporting themselves, shortens lives and reduces the workforce. Children of blind parents often stay home from school as they scramble to fulfill the duties of household caregivers and providers. In short, blindness worsens poverty, while poverty magnifies the risk of blindness.

The Himalayan Cataract Project aims to break the cycle of blindness and poverty. Studies have shown a 400% return on every dollar that the organization invests in eradicating curable and preventable blindness. Their procedures stimulate the economy by helping patients get back to work.

Individual success stories continue to power the organization. Adjoe, a 40-year-old mother from Togo, traveled to Ghana for surgery when she determined that her blind eye was hurting business. As a street vendor selling beans, she saw customers avoid her stand for fear of contagion. She consulted Dr. Boteng Wiafe, a partner of the Himalayan Cataract Project, who performed oculoplastic surgery and gave her a prosthetic eye. Carefully matching the prosthetic to the size, color and shape of her good eye, Dr. Wiafe ensured that Adjoe could return home to provide for her family once again.

Response to COVID-19

In recent months, the COVID-19 pandemic has brought a halt to live clinical training and elective surgeries, but the backlog of blindness continues to grow worldwide. Meanwhile, concerns about the virus may dissuade blind patients from seeking treatment for the next several years.

While eye care has been suspended, the Himalayan Cataract Project is using this time to redesign and restructure their programs so as to emerge even stronger than before. The organization is also working to equip partner clinics with information and resources to keep their patients safe. Some communities have even taken part in the shift to remote education and implemented a virtual training system.

Despite the uncertainty of the months ahead, the Himalayan Cataract Project remains firm in its commitment to fighting blindness and poverty. Its partner clinics around the globe have been tireless in their efforts to affirm that the poor and vulnerable will receive the eye care they need once patients can receive in-person treatment again.

– Katie Painter
Photo: Flickr

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4 Facts About Maternal Health in Nepal

Maternal health in Nepal Nepal, a landlocked country bordering India and China, has a population of approximately 30 million. In 2015, close to 41 percent of births occurred at home in Nepal. Of those home births, just under half were carried out without a trained professional. Due to the alarming rate of maternal deaths seen in the early 2000s, maternal health in Nepal has been a focal point for many years. Even though complications during births at health centers still occur, the presence of trained professionals during birth remains the best way to avoid preventable deaths. Many organizations have partnered with the Nepalese government and are working hard to bring these numbers down even further every year.

4 Facts About Maternal Health in Nepal

  1. Nepal’s maternal mortality rate decreased about 71 percent between 1990 and 2015. The decline is attributed to free delivery services and transport in rural areas, access to safe delivery services and medicines that prevent hemorrhaging. In rural parts of Nepal, it has historically been much more difficult to receive proper healthcare. Through the combined efforts of various organizations and the Nepalese government, the number of facilities in remote areas has increased. Additionally, the incentive to travel to these facilities has risen. In 2005, the government began giving stipends to pay for transportation costs. Four years later, the government passed the Safe Motherhood Programme, which allowed free delivery services to pregnant women. In 2011, the government continued to promote safe pregnancies by adding another incentive of $5 for attending antenatal checkups. Through these efforts, the government has had an enormous impact on the development of maternal health in Nepal.
  2. Midwifery is one of the most important services for maternal health in Nepal. Fast intervention and postnatal suggestions from a skilled midwife allows for better postnatal care for both mother and child. In Nepal, only about 27 percent of women receive care within 24 hours of giving birth. This increases risk of hemorrhaging and heavy-lifting related injuries shortly after giving birth. It also increases risk of possible complications for the baby during and directly after birth.
  3. Midwifery education ensures that midwives are up to date on the most current practices and procedures for successful pregnancy and birthing. Institutions have partnered with the United Nations Fund for Population Activities (UNFPA) to offer combined education for nursing and midwifery. In 2011, Nepal and the UNFPA committed to training 10,000 birthing attendants. However, in a report about midwifery authored by the UNFPA, midwives do not have specific legislation for their work. Midwives are not completely recognized under the law nor are they regulated, which results in issues with proper training and resources. Therefore, greater recognition and accessibility will allow midwives the resources, training and encouragement that they need for success.
  4. Women of lower socioeconomic status have more complications surrounding maternal health. The National Medical College Teaching Hospital in Nepal published an extensive report of the challenges surrounding maternal health in Nepal. A specific challenge mentioned in this report includes the socioeconomic influencers of maternal health. Due to poor nutritional health in women of lower economic status, issues such as anemia can cause mortalities. Additionally, rural areas record about 280 birth complications per day. Although there has been significant work since then to expand access to cesarean sections and birthing centers in rural areas, there are still around 258 women dying per 100,000 live births.

As maternal health in Nepal becomes more of a focus in the healthcare system, there are certain policies and programs that must be expanded upon. Midwifery education and access to services are the most important programs for successful maternal health in Nepal. Many experts in the field continue to push for individual programs that focus primarily on methods for successful midwifery education and overall increased care for maternal health in Nepal.

– Ashleigh Litcofsky
Photo: Flickr

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5 Benefits of E-Learning in Developing Countries

E-Learning in Developing Countries
Education is being immensely influenced by the digital world. In the last 15 years, the global internet usage has surged from 5.6 percent to 56.8 percent. Despite the remaining gap in internet usage, there are still a multitude of digital opportunities for people using a variety of information and communication technologies (ICTs). The possibility of using e-Learning in developing countries is not limited by the internet or email, as it can also be disseminated by other ICTs, such as CDs, DVDs, audio and videotapes, satellite broadcasts and television. E-Learning in developing countries has the potential to fill gaps in education access and quality, including a lack of teachers, textbooks and classrooms.

5 Benefits of E-Learning in Developing Countries

  1. E-Learning can help reach people where there is a lack of infrastructure, such as roads or adequate transportation. In Nepal, a barrier to obtaining education and job training has been navigating dangerous terrain in the Himalayas. E-Learning has been a useful tool to combat this challenge. In 2015, USAID and the Nepalese Ministry of Education (MOE) launched a radio teacher training project. The following year, MOE also established a Distance Education Center.
  2. E-Learning compensates for reduced access to teaching information. The majority of people who do not have access to a consistent internet connection are in Sub-Saharan Africa. Learn Appeal, an organization based out of the U.K., found a solution for this challenge through the development of a tool they call “the capsule.” The Learn Appeal Capsule has a Raspberry Pi 3 battery in it, which lasts for at least 24 hours of constant use and is rechargeable with a USB cable. The Capsule also includes a WiFi router and can manage up to 150 to 200 users. The capsule can contain up to 1,000 hours of interactive educational material. It is also useful in areas where they use alternative energy sources, such as wind or solar power. The Learn Appeal capsule makes it possible to disseminate necessary information to remote areas in Kenya, Malawi and Northern Nigeria. Learn Appeal works with non-governmental organizations (NGOs) and schools from each country to implement the use of the capsules.
  3. E-Learning has the potential to reach more people in rural areas. In 2016, Hewlett Packard (HP) implemented a $20 million program called World on Wheels, which aims to install 48 digital labs to bridge the gap in internet access in rural India. The program aims to reach 6,400 villages and over 15 million people by 2022. The program will support digital literacy, entrepreneurship and will connect community members to government aid. A branch of the program called HP LIFE is a free global e-Learning program that helps people start a business.
  4. E-Learning opens up possibilities for access to specialized training. Malawi has one of the lowest doctor to patient ratios in the world, at 1 doctor to every 50,000 people. To change this ratio, the Ministry of Health recognized that alternative solutions were needed to meet the country’s healthcare needs. In 2007, the University of Edinburgh launched a three year MSC program that uses virtual case scenarios to help trainees through the technical aspect of their training. Each Malawi-based enrollee to the program also obtains an e-tutor to guide them throughout the academic year. Outside of Malawi, more than 1,000 students worldwide in 60 different countries have adopted this program.
  5. E-Learning in developing countries can bridge the global gap in educational resources for primary school-aged children. According to the UNESCO Institute for Statistics, the world will need 3.3 million teachers to achieve universal primary education by 2030. UNESCO also reports that 250 million of the 650 million children who are primary school age in the world haven’t learned to read or count. E-Learning can bridge the gap and counter the teacher shortage. One of the largest regions in Brazil is the Amazonas, which is about 4.5 times the size of Germany. Although the area does fairly well in comparison with Brazilian education standards, it is also known to have low completion rates for primary school students (50 percent at age 16 versus the country average of 69 percent). To counteract this, in 2002 the Inter-American Development Bank (IDB) developed a television-based education system using $150 million. The Amazonas Media Center or Centro de Mídias do Amazonas beams remote classes taught by teachers in Manaus through satellite to remote areas. This curriculum, which consists of 10,000 video hours of classes, is accompanied by an in-person tutor who provides further support.

E-Learning solutions in developing countries are rapidly evolving to solve global challenges that widen gaps in access to education. Each country has its own unique challenge, but the benefits of e-Learning can already be seen around the world.

– Danielle Barnes
Photo: Flickr