Women trying to regain dignity by ending fistula

Djantou

This blog was originally published on Global Health TV on May 27, 2015.

BAMAKO, Mali — Djantou came here from Fangala, her village northwest of Bamako, to repair her fistula, a hole between the birth canal and the bladder or rectum caused by prolonged, obstructed labor without adequate treatment. Djantou’s fistula occurred while she was in labor during her first pregnancy. Her child was stillborn. She wants to have children in the future but she is afraid — both of the operation and of childbirth. Djantou is 15 years old.

Rokia

Rokia is from the village of Tarasso, near the border with Burkina Faso. Twenty years ago, she also developed fistula during her first pregnancy. The baby was stillborn. “The urine would not stop,” she said. Rokia has had two operations but both failed. She is now awaiting her third operation. Although she is 40 years old, she still very much wants to have children.

Fistula is a tragic condition that leaves women leaking urine, feces or both. It can lead to chronic medical problems and cause social exclusion. Women are often abandoned by their husbands and sometimes by their own families because of their incontinence and unpleasant smell. They face depression and social isolation — either self-imposed or by their sometimes unforgiving communities.

New development goal falls short of protecting those most at risk of HIV

This ISHTAR wellness center in Nairobi works to ensure that gay men have access to non-discriminatory HIV and sexual health services. Credit: Corrie Wingate for the International HIV/AIDS Alliance.

This blog was originally published by The Huffington Post on May 8, 2015.

Dominique, 26, realized he was gay in his early adolescence and now sells sex to other men to survive and to support his relatives in Kisii, in western Kenya. He goes regularly to a drop-in center outside Nairobi run by the Kenya AIDS NGO Consortium (KANCO) where he gets a holistic package of HIV and sexual and reproductive health services.  As a result, he is HIV-negative.

Dominique is a good example of why we need to support people most vulnerable to HIV. Yet the language currently proposed in the Sustainable Development Goals (SDGs) falls short of prioritizing the most marginalized and vulnerable groups (the SDGs are the new development goals replacing the Millennium Development goals which expire later this year).

Goal 3 of the SDGs is to “ensure healthy lives and promote well-being for all ages.” Target 3.8 under this goal commits to Universal Health Coverage (UHC). Unfortunately, the UHC target and indicators do not meet the specific needs of the most marginalized, stigmatized and underserved people in the world — like men who have sex with men (who are 19 times more likely to contract HIV than the general population) and transgender women (who are up to 49 times more likely to acquire HIV than all adults of reproductive age).

How Mali conquered Ebola

These signs — which say “Stop the Ebola virus: Wash your hands regularly with soap” are still ubiquitous around Bamako three months after WHO declared Mali Ebola-free.

This blog originally appeared on Global Health TV on April 28, 2015.

BAMAKO, Mali — In the year-old Ebola epidemic, most of the attention has justifiably been focused on Guinea, Liberia and Sierra Leone, where the vast majority of the cases (26,044) and deaths (10,808) have taken place. But what about those countries that have successfully controlled Ebola — Mali, Nigeria, Senegal, Spain, the UK and the US — which account for only 35 cases and 15 deaths? 

I am spending two months in one of those countries and wondered how Mali conquered Ebola. Even though the World Health Organization (WHO) had declared Mali Ebola-free in January, I had barely stepped off my airplane at Bamako–Sénou International Airport on March 14 when I encountered Ebola control: I was scanned for a fever and offered hand sanitizer before entering the airport terminal.

Mali went on high alert after confirming its first case of Ebola in late October of last year, when a 2-year-old girl who had traveled from Guinea to Mali died. The country moved quickly in what the government considered an emergency situation. The child, who was symptomatic upon her arrival in Mali, had traveled extensively in the country using public transportation. Aggressive contact tracing was undertaken but none of the contacts showed symptoms.

It looked like the country had dodged a bullet, with only one death. But then an imam from Guinea was admitted to Bamako’s prestigious Pasteur Clinic with a diagnosis of acute kidney failure, and died on Oct. 27. That case set off a chain of transmission that led to seven additional Ebola cases and five deaths, including a doctor and nurse who had treated the imam. He was buried with full traditional rites, including washing of his highly contagious body, which may have exposed mourners to the virus.

Three world-changers: Drones, sanitary pads and schools

This blog originally appeared on Humanosphere on April 20, 2015.

On the Pacific archipelago nation of Vanuatu, a “digital humanitarian” has been using drones to carry out a detailed assessment of the damage caused by Cyclone Pam last month.

In Rwanda, a young African woman is improving the lives of other young women by the simple act of providing them with locally made sanitary pads so they don’t miss work and school.

And in Kenya, a man who grew up in extreme poverty, without formal education, is building schools and fighting poverty and gender inequality in the worst slums of Nairobi. New York Times Columnist Nicholas Kristof says he might be the next Mandela.

All of these young people are trying to change the world in very different ways. Along with at least 50 others, they will be in Saxapahaw, North Carolina April 23-24 for the fourth annual SwitchPoint, a global gathering organized by IntraHealth International (which I need to disclose is one of my clients).

West Africa finally starting to embrace family planning

A health worker counsels a client in rural Senegal on family planning options. Photo courtesy of IntraHealth International, © 2014 by Jonathan Torgovnik/Reportage by Getty Images

This blog originally appeared on Global Health TV on March 24, 2015.

BAMAKO, Mali — When my wife and I lived here in the late 1980s and early 1990s, our housekeeper, Korotumu, hid her birth control pills on the top shelf in our kitchen, so her husband would not find out she was using contraception. He was unemployed and they had two children. Koro figured that two was enough, at least as long as her husband was not working.

I didn’t realize it then, but Koro was in a progressive minority of Malian women at that time. The 1987 Demographic and Health Survey of Mali revealed only 1.3% of married women were using modern contraception and the fertility rate (the average number of children a woman has in her lifetime) was 7.1. Koro was part of that 1.3%.

Flash forward a quarter of a century and what has happened in Mali? Use of modern contraception has increased to 9.9% and the fertility rate has dropped from 7.1 to 6.1.

Reaching the unreached with family planning in India

A Janani mobile family planning van registers new users in India.

This blog was first published by Impatient Optimists blog on March 13, 2015.

By the time the brightly colored family planning van pulls into the government health center in a village in northern India, a group of young women is waiting. They have come to adopt a high quality modern method of contraception. They have already been pre-screened and most have chosen either an intrauterine device (IUD) or tubal ligation but the van also offers methods like condoms, oral contraceptives, injectables and emergency contraceptives, according to their needs.

Some of them have three, four or more children, and want no more. For many of them, it is the first time they have practiced family planning. The fertility rate in the states of Bihar and Uttar Pradesh, according to the last India National Family Health Survey 2005-2006, was 4.0 and 3.82 children respectively, the highest and second highest in all of India.

Some 270 such “mobile family planning days” were conducted in 2013 and 2014 in a pilot project with one van, creating 2,800 new IUD clients, and counseling 1,600 women who came for follow-up visits. With support from The Bill & Melinda Gates Foundation — in partnership with CARE, the University of Manitoba and Marie Stopes International — this program has expanded from one to 20 outreach teams that provide IUD and sterilization services for women, and non scalpel vasectomy for men. The operation is run by Janani, an affiliate of the international social marketing organization DKT International.

Stymied by Less Smoking in Richer Countries, Big Tobacco Shifts Focus on Developing Countries

Anti-tobacco demonstrators in Brazil demand implementation of the national Tobacco Control Law. Credit: Aliança de Controle do Tabagismo

This was originally published by Global Health TV on March 2, 2015.

Between 1990 and 2009, cigarette consumption decreased by 26% in Western Europe, but in Africa and the Middle East, it increased 57%, according to the American Cancer Society (ACS). In response, many of these developing countries are stepping up their efforts to fight tobacco with new laws and restrictions. Big Tobacco is using its deep pockets to finance creative attempts to circumvent those laws.

The problem is so daunting that ACS named rising use of tobacco in developing countries as one of it “Three Top Cancer Challenges of the 21^st Century” earlier this month when it observed World Cancer Day. Comedian John Oliver covered the issue very well in this segment from his HBO show “Last Week Tonight.”

An estimated 8 million of the 14.1 million new cancer cases diagnosed in 2012 occurred in developing countries with 82% of the world’s population, according to Global Cancer Facts & Figures, 3^rd Edition. Smoking causes at least 12 types of cancer, according to the U.S. Surgeon General, and accounts for a fifth of all global cancer deaths. Tobacco use is the cause of nearly 6 million premature deaths annually, notes the report.