Public Health Initiative in Local Context

This week’s reading, “Sterilizing Vaccines or the Politics of the Womb: Retrospective Study of a Rumor in Cameroon” discusses the historical, political, national, and regional contexts that shaped public opinion of the public health initiative vaccination campaign and lead to the miscommunication and spread of rumors about the effects of the vaccinations. This vaccination campaign was conceived without regard for the cultural context within Cameroon.  At the time of the vaccination campaign, a separate government endorsed campaign promoting family planning was concurrently in effect. The association of these two separate campaigns led to a growing suspicion and mistrust of the vaccinations. Although public health officials understood the agenda of the campaign was to devote resources to widespread vaccination of the public again neonatal tetanus, inadequate attention was given to the education and “sensitizing” of the recipients who perceived the vaccinations as foreign and potentially harmful. Combined with a mistrust of national government and conflicting views between local, regional, and national interests, the rumors surrounding the vaccines caused girls to choose suicide over vaccination and eventually led to the end of this unsuccessful and largely misunderstood public health campaign.

Oral rehydration therapy has been proven to be an effective agent in the fight against diarrheal disease. This simple packet of solution works to hydrate human bodies and immediately improves health conditions. While this treatment is used across the globe, in lecture we discussed why these oral rehydration solutions have not been even more effective. Western views interpret them as a miracle cure-all, however, mothers who endure great hardship to bring their sickly children to hospitals or clinics understand that their children need medical attention yet sometimes this simple solution is not perceived as an adequate measure for the direness of the situation. This website (http://rehydrate.org/ors/ort.htm) provides in depth information about the use and distribution of oral rehydration therapy.

This map illustrates the global distribution of Oral Rehydration Therapy.

Samantha Nelson

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Addressing the Root

The article “All I Eat is ARVS” by I.A. Kalofonos reveals a tragic structural problem in Mozambique.  Kalofonos analyzes the recent prevalence of ARVs- a medication that combats and cures HIV patients.  From a quick glance, this medication is thriving- it is curing people and is free to the public! However, a deeper onlook reveals some disturbing realities. While there is no denying the drug is making AIDS patients healthier, many have tragically died of hunger afterwards. Furthermore, the prevention care center provides food aid to the patients, which -other members of the population argue- is taking the food aid away from them. ARVs are creating tensions in the community. It would be unfair to argue that ARVs are the sole reason for these tensions. Rather, the issue lies with the structure of the society where different social classes are receiving food aid and other are receiving none at all. The issue is that people are starving and while it is great that the government is caring for the HIV victims, in many ways they are neglecting the most fundamental health rights- including nutrition.

Food distribution is a careful, political ordeal in this small town of Mozambiqu- there never seems to be enough. – Sarah Salesa

Lack of nutrition has weighty consequences in spuring on other diseases, such as diarrheal disease.  Malnutrition weakens the immune system and leads to the contraction of many other diseases. Without food, the body cannot fight against diseases. According to E. Schlaudecker “underlying malnutrition is a major risk factor for diarrheal disease.” It would seem silly to find an expensive cure for diarrheal disease and make it free to the public, but do nothing to provide for the population’s daily food intake.  It would be pointless because the root of the problem must be addressed. Likewise, it is somewhat silly to combat HIV with ARVs and neglect providing adequate nutrition for those that are healthy.  Long term change occurs only when the root of the problem is adequately addressed.

 

 

http://www.africastories.org/too-hungry-to-cry/photo-gallery/

Politics of the Womb

While this photo is regarding pro-choice, the rights to your own body, especially females, is a common and contentious issue.

One of the articles this week, Sterilizing Vaccines or the Politics of the Womb: A Retrospective Study of a Rumor in Cameroon, authored among others by Pamela Feldman-Savelsberg, looks at the rumor that spread in Cameroon that the vaccine used to prevent neonatal tetanus was in fact a sterilization injection. One of the believed reasons for this miscommunication is that the campaign took place near the time of talks of family planning and the changes in population policy by the state to legalize contraception. (pg 2)

As the article says, girls were running out the door and jumping through windows to escape from being “sterilized” by those trying to help them. This may sound ridiculous, but in an area where family is so important and the people hear that overpopulation is a problem, it seems natural that women would be wary of a mystery injection. In many places, the people preforming health aid are from the developed world. We must not forget the shared sense of history many developing areas feel in regards to colonialism, because they sure haven’t. To be honest, I think it makes a lot of sense to be hesitant to put so much trust in outsiders when history has shown a disappointing track-record. It slows down progress for health in some ways, because like in this case, the vaccine was for neonatal tetanus, but this shows a need for those administering it to have greater empathy to their worries and understand their misgivings. Communication is most important.

This mistrust of foreign health can be seen elsewhere, like in the cases of people not trusting ORTs (Oral Rehydration Treatments) for diarrheal disease. It may be frustrating to know that if a child were just permitted to take the ORTs, their diarrhea would be drastically reduced and the chance of survival skyrockets. However, it is not an indifference on the part of the mother to refuse these treatments, it is the opposite. They are doing what they believe is necessary to protect their already sick children. We need to improve relations with those people who may believe us to do harm, and promote greater communication across cultures.

Health Epidemics and Structural Causes

“Can the Mosquito Speak” is a study of the structural factors that led to the malarial outbreak that spread from Sudan and along the Nile Valley from 1942-1944. This health epidemic was compounded by man-made environmental changes; dam construction across the Nile River, use of synthetic chemicals, and political unrest. “Dams, blood-borne parasites, synthetic chemicals, mechanized war, and man-made famine coincided and interacted. It is not surprising to see disease brought by environmental transformation, industrial chemistry shaped by military needs or war accompanied by famine.” (Mitchell p.22). These factors interacted to produce an environment vulnerable to the spread of disease. The dam construction led to water shortages and lack of irrigation which decimated crop production throughout the Nile Valley. Synthetic chemicals were employed to combat the mosquitoes. The wartime movement of people to and from foreign places may also have facilitated the transportation and spread of the disease carrying mosquito. Together, these factors contributed to the aggressive transmission of malaria within communities and across vast distances.

Diarrheal disease is also affected by compounded structural factors. Poverty, access to clean drinking water, nutritional education, and access to treatment are some of the most important proximate issues of the global diarrheal disease problem.  Diarrheal disease is treatable; however, solutions such as oral rehydration and plumpy’nut only treat the symptoms and not the underlying issues. Diarrheal disease is a health epidemic specific to developing countries where poverty and lack of access to clean water are often the primary contributors to diarrheal disease. Like the malarial outbreak, optimal treatment must not only address the observable symptoms but, most importantly, must effectively identify and address the ultimate structural and underlying factors.

 

This article http://www.ncbi.nlm.nih.gov/pubmed/18579873 further discusses “disease of poverty” and the especially high risk of mortality for infants and children.

 

 

 

 

 

Be Natural!

This week’s reading Can the Mosquito Speak examines the incident where the Aswan Dam was built in order to navigate the flow of the Nile to more areas and thus expand Egypt’s agricultural and food production.  However the construction of this dam contributed to the spread of malaria by creating a pathway for the malaria carrying mosquitoes. To combat the malaria, DDT was used to kill the mosquitoes.  Although the DDT was found to be harmless, it was continued to be used.  This example epitomizes the cycle of man battling nature and the way that man attempts to manipulate nature fixing one problem but causing new natural problems to arise. Then man again seeks to solve the problem with technology which then creates new problems. Thus the cycle continues.

This resonates with the ongoing cycle where formula milk companies attempted to fix the problem of malnutrition by pushing formula milk products on women in third world countries.  This manmade solution to lack of nutrition created new problems because of the bacteria carried in the water used in the formula milk products. Trying to use technology to solve baby malnutrition actually increased the problem of baby deaths in third world countries because more babies contracted diarrhea disease. The most natural solution- breast milk from the babies’ own mother is actually the safest form of nutrients that a mother can give her child.

 

 

http://www.path.org/diarrheal-disease.php

Continuing Struggles

As I began reading the article for this week, Can the Mosquito Speak? by Timothy Mitchell I was reminded of a website I came across recently. Mitchell’s article reads,

“Long after the armies moved on, moreover, the battle continued to claim its victims. Al-Alamein marked the first use of land mines as a major weapon of war. It was responsible for three-quarters of the twenty-three million uncleared mines Egypt accumulated in the twentieth century, the largest number of any country in the world.”

The website I had come across during my internet surfing, which I predominantly do through StumbleUpon (if you have not used it, please do, but be warned, it may become addictive), is called peaceBOMB and is a project of the fashion/accessories company Article 22. The company has taken upon itself to make the people of Laos a top priority. By reading the information on their website and watching the short documentary they have produced on the subject, you will learn that “between 1964 and 1973 the equivalent of one B52 bomb load showered upon Laos, every 8 minutes, 24 hours a day, for nine years.” It is being called the secret war in Laos, as it is unknown by much of the public, even to many officials within the US government. The continuous bombing for those nine years had more than a crippling affect to the geography of Laos. It killed many and has left a great number maimed. The problem is, that despite the ending of the Vietnam War and the dropping of the bombs, just as Mitchell’s article says of Egypt, the consequences continue. The cluster munitions remain a  danger to the people of Laos, as 1 in 4 bombs did not detonate. This means that children, families, field workers are being killed or left disabled because of a war nearly 40 years ago.

Project peaceBOMB seeks to aid in the recovery of the Lao people by supporting the artisans as they repurpose the metal from the bombs in the market. Their partnership has led to the manufacturing of bracelets and other jewelry, which is then sold in the US for a profit greater than their market price, which subsidizes their income. Some of the money is also used in clearing the munitions from the land. For every (plain) bracelet bought, 3 cubic meters are cleared in Laos.

The following is a trailer for the peaceBOMB documentary.

The clearing of these cluster munitions is of vital importance to improving the state of the Lao economy. Development is impossible when people are too afraid to work the fields for fear of death or severe injury. The nine years in which the bombs fell has left the country fighting to maintain its meager existence, while prosperity is, at present, not feasible. The Lao people need to be acknowledged, as well as the fact that the US has refused to join the many countries around the world who have pledged to ban cluster munitions.

As the burden of disability creates severe roadblocks to development, so too does the burden of disease, such as diarrheal diseases. We must address the vulnerabilities of the people before we can address their need for economic reform.

Humanitarian Aid: not so humanitarian, after all

Rachel Mahoney

Through her anecdotal representation of Tanzanians during the 2006 East African Food Crisis, Kristin Phillips illustrates some of the ways food and humanitarian aid can be disruptive and destructive to receiving communities in the developing world.  Phillips writes that the flawed system food aid distribution in Tanzania — which was “funneled too narrowly to the very poorest citizens”— created new socio-economic stratifications that bred social tension and discontent (Phillips, 24).   Additionally, food aid undermined traditional Tanzanian values and beliefs surrounding gift giving.  One man Phillips interviewed explained how anonymous food do not allow Tanzanians to thank their donors, a vital feature of Tanzanian exchange practices:

“Tell us to whom we are indebted. We must know whom to thank … The gift is therefore at one and the same time what should be done, what should be received, and yet what is dangerous to take. This is because the thing that is given itself forges a bilateral, irrevocable bond, above all when it consists of food.” People were unwilling not to know to whom they were bound and beholden (Phillips, 40)

Phillip’s account of Tanzanian food aid is not unlike Erica Bornstein’s critique of World Vision, a Christian child sponsorship organization that isolates poor African children and connects them to American sponsors.  Bornstein summates the irony of this system: “In effect, new perceptions of economic disparity are produced by the very humanitarian efforts that strive to overcome them” (Bornstein, 595).  She continues to describe the post-colonial “ulterior motives” of many humanitarian aid missions, which effectively fracture and disenfranchise members of developing societies instead of providing solutions for long-term economic development and independence.

An advertisement taken from worldvision.org.

Food Scarcity and Aid Distribution

Phillip’s article discusses the “semiotics of food in Tanzanian politics.” Food is available to Tanzanians through several processes. Phillips explains that “food of wealth” is associated with political reciprocity, while “food of the farm” is associated with reciprocity among group members. The resulting relationships are gendered; women control “food of the farm” and men control “food of wealth.” This power dynamic creates familial relationships that leave women largely responsible for the nutrition of their children. Singidans also receive food through the distribution of food aid by their government. The politics that dictate who receives this food aid is differentiated among economic groups where the poorest families often receive the majority of the aid. As a result, families that fall in the middle and are still plagued by hunger often go without aid.

Water as a scare resource.

Diarrheal disease, malnutrition, and dehydration are intrinsically related problems and coupled with a drought create a situation of vulnerability. The linked article discusses the relationship of international food prices to hunger. http://blog.bread.org/2008/04/index.html

Samantha Nelson

A Dirty Mess

Annie Heathorn

AS we have discussed before, the root of the problem with Diarrheal Disease is the lack of access to nutritiona and water. Malnurioushed people have weakened immune systems that lack the ability to combate diarrheal virusues. It seems that the giving food aid would be the primary solution in combating diarrheal disease. Yet, providing food is much more complicated than just handing a loaf of bread over to the hungry.

Kristin D. Phillips discusses the politics of involved in giving aid in “Hunger, Healing, and Citizenship in Central Tanzania” and the problems that arise when giving aid to the poor. Essentially she claims that politicians gain people’s allegiances by giving them food, and even if the people don’t agree with their policies they are under those politicians power and authority. When people are starving, and people are willing to go to any extreme to get a bite to eat, politicians that give aid are viewed with an unearthly awe. This devotion gives them power. And when are politicians ever absent of corruption? In countries where people dwell in desperation, governments are especially corrupt. The aid-givers can easily keep a portion for themselves, sell the aid at whatever rate they determine to be appropriate, and manipulate/ deceive donators. So while, nutrition may greatly reduce diarrheal disease, we must be aware o fthhe politics that go into providing aid. It can quickly become “A Dirty Mess”.

http://www.globalhealthcommunication.org/tool_docs/76/behavior_change_perspectives…-_chap._4_-_diarrheal_diseases.pdf

The Desperation of the Vulnerable

In Kristin Phillip’s article entitled Hunger, Healing, and Citizenship in Central Tanzania a “local legend” is quoted regarding the stress and shame of not being able to provide for the family. The narration tells of a mother that is unable to provided food for her children. The first day, she was able to find fruit, but it was not enough. The second day, she could find nothing and went home and told her children she had found potatoes. Tricked, the children played happily outside as they waited for their mother to finish dinner. Upon realizing that the pot was simply filled with stones, the children went to look for their mother, whom they found hanged in her bedroom.

It is not as uncommon as we would wish that the heads of households in financial crisis succumb to suicide. Farmers during famines are among the most common of this tragedy. The role of being a mother is extremely stressful, even under comfortable circumstances. In the cases of severe poverty, malnutrition, poor health, and social crisis, the stress becomes exponential. It is unimaginable to many of us in the developed world what a woman must go through when she knows she cannot feed and protect her children. Even if some food is found, like in the narration, not all food is equally nutritious. Some areas, where there is a cash crop, such as rice, children are malnourished and can developed serious illness. For example, Vitamin A deficiency in many impoverished populations. Food is not enough. A balanced diet is necessary.

In certain cases, food, no matter what kind, has little effect, as in the case of diarrheal disease. The issue is not the lack of food, it is the inability of the body to absorb the nutrients from it. The food passes through, as if not at all, until proper treatment can be issued.This can cause extreme distress for a mother who many not understand why the little food they have is not enough.