mHero: the mobile communication platform saving lives in West Africa

As a country already struggling to rebuild itself after a second civil war, Liberia may well have been one of the least well-equipped countries to deal with the reality of ebola when it first struck in 2014, certainly in terms of health care provision. But thanks mHero, a collaboration by IntraHealth and UNICEF, a new platform for communication was established, allowing real time contact between ministries of health and health workers across the country.

mHero is not a new technology; it is a mobile communication platform that allows health workers, government authorities and key stakeholders to communicate in real time via SMS, interactive voice response, and direct call service. In the case of Liberia and as ebola began to spread at an unprecedented rate, mHero allowed the Ministry of Health and Social Welfare to establish where health workers were located in the country – many having fled to protect themselves against the disease. This was crucial in establishing what help could be provided and where, and empowering health workers to carry out their jobs with a support system in place.

Millions of people die every day from diseases that could be prevented, and although vast numbers of health workers and governments work tirelessly to address these problems, there has always been a problem concerning real time communication. mHero allows a timely response to crises, targeted communication and information exchange regarding current health systems, assessment of health workers needs relating to the work environment, and identifying inactive workers and re-engaging them to resuscitate critical health services.

Since the declaration of Liberia as ebola free, mHero has continued to extend its services as officials realised the flexibility and merits of the platform. New uses have included the collection of data on mental health illnesses, and maternal, neo natal and child health services. mHero in Liberia is also planning a decentralisation process whereby county human resource officers will be able to communicate with health workers in facilities, vastly extending its reach and effectiveness.

mHero has scaled up to deliver its services to other countries in West Africa, too. In July of this year, Sierra Leone successfully tested the mHero platform, sending a validation message to more than 8,000 health workers across the country. An overwhelming response from health workers in each of Sierra Leone’s 14 districts showed the wide reaching capabilities of mHero, and the information collected was used to update the human resources information system used by the country’s ministry of health. Pilot programmes are also scheduled for Guinea and Mali in 2016.

mHero is a story of collaboration, forward-thinking, and the utilisation of available data – it is not cutting edge or pioneering technology but simple and effective, and its future for revolutionising communication within the health industry is bright.

 

Half The Sky in short; 6 of the biggest dangers women face around the world. 3. Barriers to education

In Half The Sky, Kristof and Wudunn present startling trends in access to education for girls worldwide. Although the implementation of the Millenium Development Goals has seen levels of education rise and the gender gap decrease in many countries, there still remains a huge disparity in access to education, and too many girls are being left behind. UNICEF findings state that 31 million girls are still out of primary school education worldwide, hindering critical development and limiting their potential to contribute to society.

Exploring the gap in educational inequality is sometimes difficult, as stated by Kristof and Wudunn, because the need for equal access to education is so obvious that research can often be weak. However, the statistics on this topic speak for themselves. In Sub-Saharan Africa, the literacy rate of boys aged 15+ between 2005 and 2013 was almost 70%, with the rate of girls only just hitting 52%. In South Asia this stands at 76% and 57%.

So what is keeping so many girls out of education across the world? In many societies, where men are the sole provider of the household’s income, a girl’s education can be the very last thing household income will be invested in. If a family can afford to educate one or more of their household, the male offspring will be the ones sent to school, deemed more important and valuable to the future livelihoods of the family. Girls, in societies where gender roles are so deeply ingrained, will be detained at home in order to undertake vital chores and to ensure the smooth running of the household.

The reasons for improving access to education for girls may seem obvious to most, but there are further reasons that may not always be so explicit. During extensive research on the expansion of primary school education in Nigeria, Bridget Long of Harvard University concluded that an extra year of primary education leads a girl to have .26 fewer children, highlighting a strong link between education and and fertility. Remaining in school can also offer many health benefits; school feeding programmes cost approximately 10 cents per child per day, and have proven to considerably improve nutrition and reduce stunting. Quite often these meals are the main source of nutrition for children living in poor rural areas.

Kristof and Wudunn identify many cost effective ways to keep girls within education, highlighting how it is not always the high-cost aid programmes that are the most successful in improving access to education. Health barriers are one particular obstacle that need to be overcome, and there is a high correlation between school drop out rates and the presence of worms; this is a health issue that on its own causes 130,000 deaths per year worldwide. Not only do these ordinary worms kill so many people, intestinal worms also affect children’s physical and intellectual growth. The authors write that where increasing school attendance by building more schools costs approximately $100 per year for every additional student enrolled, boosting attendance by deworming a child costs only $4.

Another effective way of boosting girls’ education worldwide is to pay parents to keep children in school and take them for regular medical check ups. The World Bank says that one such programme, Oportunidades in Mexico, which saw payments made to the mother of the household for keeping children in school, raised high school attendance of girls by 20%. Cash incentives may be controversial but have a proven record for achieving targets.

The Sustainable Development Goal no. 4, that is those that pick up where the Millennium Development Goals left off, states that by 2030, ‘all girls and boys should complete free, equitable and quality primary and secondary education leading to effective and relevant learning outcomes.’ If this is to happen then there needs to be, many argue, a great deal more invested in universal education, with a particular focus on access to education for girls. And why should this not be number one priority for development? Educating our women not only makes economic sense, but also empowers women to be leaders of great change. Women who are educated are better able to make informed decisions, become politically involved, educate their own children, and improve the lives of generations to come. Invest in our women, and we invest in a better future for us all.

 

 

Why evidence based aid must be a focus at the World Humanitarian Summit

In less than 8 days time, over 5,000 people from charities, governments and international organisations will gather at the World Humanitarian Summit; the first in the 70-year history of the UN. As humanity faces its highest levels of suffering since the Second World War, action must be taken now to drastically shake up the way the world is responding.

Jeroen Jansen, Director of Evidence Aid, hopes that the summit will provide an opportunity to push forward more evidence based aid approaches.

During the 2004 tsunami, with no evidence based approach, governments and NGOs scrambled to respond to the disaster, often with little collaboration and at times causing more problems during a time of desperate need. Evidence Aid calls for a more streamlined and effective approach to humanitarian responses, through research and data collection, and a shift away from traditional best-practice approaches.

Evidence Aid does not shy away from recognising the difficulties in this, though. Access to data can often be limited due to complexity of evidence, limited sharing, data gaps and reluctance to publish negative outcomes. Responding to an emergency also calls for the timely deployment of researchers, ethics and approval.

The 5 core responsibilities of the summit have been outlined, and some of the priority issues include a new approach to manage forced displacement, empowering women and girls, bridging the divide between development and humanitarian sectors and securing adequate and predictable finance to save lives and alleviate suffering. In a recent article for Evidence Aid, Tom Kirsch and Paul Perrin state that measuring the effectiveness of aid is crucial, rather than just focusing on the outcomes (ie number of tents or food parcels provided) and have devised a Quality Framework to tackle this. This framework focuses on the three components of structure, process and outcomes rather than  just focusing on any one of these, which is often what happens. It also, crucially, places the focus on the recipient rather than the institutions that are implementing them.

In just 8 days time the World Humanitarian Summit will begin in Istanbul. With top officials warning that the global aid system is ‘crumbling under an overwhelming number of crises’ from wars across the Middle East and Asia to natural disasters and earthquakes, we must hope that those who hold the power to make great change will seize the opportunity.

 

 

With thanks to Jeroen Jansen for his informative breakout session at the Global Health and Development Conference hosted by

 

 

Half The Sky in short; 6 of the biggest dangers women face around the world. 2. Trafficking and enslavement

Beyond any doubt, the trafficking of people for enslavement and sexual exploitation is one of the biggest challenges the modern world faces. But the problem appears to be faceless; underground and unknown. Half The Sky’s Kristof and Wudunn estimate that 3 million women and girls (and a small number of boys) worldwide who can be fairly termed enslaved in the sex trade. This is a modest figure, with The Lancet estimating that the total number of prostituted children alone could be as high as 10 million.

To focus on women and girls only is not to ignore or neglect the similar plight of boys and men worldwide, but figures show that without a doubt, this issue affects many more women and girls than their male counterparts and so for the purposes of this post we will focus on the the trafficking of women and girls.

Human trafficking is identified by the UN office on drugs and crime (UNODC) as the ‘fastest growing means by which people are enslaved, the fastest growing international crime, and one of the largest sources of income for organised crime.’ Girls and women are disappearing all over the world at an alarming rate. Kidnapped and trafficked across borders, they are taken against their will and enslaved in underground sex work. Srey Rath, a teenager from Cambodia, found herself enslaved in the sex trade in Malaysia at the age of fifteen. Facing regular beatings and rape, she worked alongside other captives in a brothel fifteen h0urs a day, seven days a week, with no hope of escape.

In Half The Sky, Wudunn and Kristof present the collapse of Communism in Eastern Europe and Indochina as one reason for the rise trafficking for sexual servitude. They write that ‘The subsequent economic distress in many countries allowed criminal gangs to fill the power vacuum. Capitalism, whilst creating markets for foods and other goods also created a market for female flesh.’ Another reason identified by Wudunn and Kristof is rising prevalence of AIDS. Many customers fear older girls and women, who might have been sexually abused for longer periods of time, may be more likely to carry the infection and therefore have a preference for younger girls. This keeps the demand for younger girls in these brothels high. Moreover there is a prevailing belief in many parts of the world that virgins are a antidote for AIDS, which means many children are kidnapped from towns and villages to ‘cure’ infected men.

‘These girls are sacrificed so that we can have harmony in society. So that good girls can be safe.’

Terrifyingly, when Rath eventually managed to flee from the brothel to a police station in Malaysia, she was imprisoned for a year, for in the eyes of the law she was an illegal immigrant. When she was released, a Malaysian policeman drove her to the Thai border and sold her to another trafficker. The enslavement of women is quite clearly not just a problem relating to criminal gangs. Girls and women worldwide are being let down in a very serious way by deeply ingrained misogynistic societal attitudes.

Researching human trafficking and border controls in India, Kristof crossed to Nepal where thousands of woman are trafficked into to India, desirable because of their being foreign. Here he found similar, startling values placed on women. When conversing with an Indian officer responsible for monitoring people and goods crossing into the country, the officer openly stated that there was no interest in identifying trafficked girls. ‘Prostitution is inevitable. There has always been prostitution in every country. And what’s a young man going to do from the time when he turns eighteen until when he gets married at thirty?’

The belief shared by many in this part of the world is that upper-class girls should be able to keep their virtue and men, being men, should be provided with an outlet for their sexual desires. And so brothels are filled with peasant girls and women, girls and women with little education and from lower classes, who exist for no reason other than to sexually gratify men. The officer went on to explain that ‘These girls are sacrificed so that we can have harmony in society. So that good girls can be safe.’ When Kristof challenged that surely many of the Nepali girls being trafficked are were good girls too, the officer merely answered ‘Yes, but those are peasant girls. They can’t even read. They’re from the countryside. The good Indian middle-class girls are safe.’

Although we may struggle to imagine the ordeal faced by Rath and millions of other women and girls across the world, this problem is by no means something only happening far from home. We may perceive ourselves as well protected by law, kept safe by  a fairer society where women are viewed less as sexual objects and more as human beings but trafficking and enslavement for sexual servitude is a serious issue in this part of the world.

In 2011 Marinela was arrested in Manchester for prostitution related offences, the police not initially realising she was an innocent victim of a Romanian trafficking team. Marinela had been kidnapped from her home in Alexandria, Romania, and trafficked to England where she was held captive, given a new identity, and forced to work as a prostitute – raped by different men 50 times a week on average. A recent report by the UNODC notes that an estimated 70,000 women are trafficked within Europe for sexual exploitation,

Rath was eventually able to escape from the Thai brothel and return to Cambodia, Marinela freed by police, but most women and girls are not so lucky. Amartya Sen, nobel prize-winning economist, writes that ‘More than 100 million women are missing,’ due to gender inequality and discrimination, including a large portion of women and girls lost in the sex trade. And so we must continue to champion gender equality around the world, challenge prevailing gender stereotypes, work to remove the labels of women and girls as objects of sexual gratification, giving them the equal place they deserve in society. We must do more to protect our women.

Further information drawn from:

http ://www.humantrafficking.org/updates/413

http ://www.stopthetraffik.org/the-scale-of-human-traffiking

http ://www.unodc.org/documents/publications/TiP_Europe_EN_LORES.pdf

http ://www.theguardian.com/uk/2011/feb/06/sex-traffick-romania-britain

 

 

Half The Sky in short; 6 of the biggest dangers women face around the world. 1. Obstetric fistulas

This series of blog posts provides an overview of Nicholas D. Kristof and Sheryl Wudunn’s Half The Sky; How to change the world. The posts will address 6 main gender issues drawn directly from the book and explore organisations dealing with these issues around the world. The book makes for uncomfortable reading in places but it is an important one, being described as ‘a manifesto for advancing freedom for hundreds of millions of human beings.’

The areas covered in the book include obstetric fistulas and maternal healthcare, rule by rape, honor killings, sex trafficking, female genital cutting and educational inequality. None of these issues are easy ones to tackle and the book is not just a compilation of facts and figures; it explores the root causes of these issues, as well as drawing our attention to how it is affecting millions of women worldwide. Moreover, the book is unapologetically critical of how we are currently dealing with these issues and on many occasions presents sound ideas for future development.

My hope for this series of blog posts is to provide an overview of these issues and to provide a place for open discussion on these topics. The importance of these issues cannot be overemphasised; millions and millions of women worldwide are being enslaved, trafficked, face terrifying and dangerous childbirths, are downtrodden, held back from education and sadly, commonly, simply disappear off the face of the earth every day without a trace. This is not just a gender problem. This is a humanitarian problem.

 

1. Obstetric fistulae

Relatively unheard of in developed countries and scarcely reported on, obstetric fistulas pose an immense threat to many women across the globe, especially in sub-Saharan Africa and Asia. These obstetric fistulas are holes formed in between the vagina and the bladder or rectum, caused by obstructed labour and lack of medical care during childbirth. Pressure against the birth canal, often caused by the baby’s head becoming stuck, leads to the restricted or completely halted bloody supply to that area, in turn causing the affected tissue to rot away.

The number of women who suffer from this debilitating consequence of labour is startling. Obstetric fistulas are most common in sub-Saharan Africa and Asia, with more than 2 million women living with untreated fistulas in these two regions alone.

Half The Sky tells the story of Mahabouba Muhummad, who grew up in Western Ethiopia. The divorce of her parents lead to her being handed over to her father’s sister, but after being treated as a servant by him she ran away to work in a town as a maid in exhange for room and board. She was subsequently, at the age of 13, sold for eighty birr (ten dollars) against her will and impregnated by the man who bought her to be his second wife. Beatings were a common feature of Mahabouba’s life even whilst pregnant and after fearing for her and her baby’s life she fled to the local town. There she found that no one would help her and eventually ended up residing in a small hut by an uncle’s house in order to keep herself and her baby alive.

After enduring a seven day labour alone, Mahabouba eventually fell unconscious and when she came round found that her baby had been wedged inside her birth passage for so long, the tissue between the baby’s head and Mahabouba’s pelvis had lost circulation and the tissue rotted away. Mahabouba was 14, and her pelvis had not yet grown large enough to accommodate the baby’s head.

This is a common plight for many girls under 15. Dr Waaldijk, a surgeon working in Babbar Ruga Hospital in rural Nigeria, says that more than a third of his fistula patients are 15 or under, with records indicating that they were married aged 11 or 12.

‘The reason these women are pariahs is because they are women. If this happened to men, we would have foundations and supplies coming in from all over the world.’

Mahabouba’s horrific story does not end there. After enduring a terrifying and solitary childbirth and losing her baby, Mahabouba was ostracised by her community. Unable to walk or even stand due to the nerve damage caused by the fistula, she was taken to a hut on the edge of the village, the doors taken off, where she was left to be eaten by hyenas. To the village, Mahabouba was cursed and this had to be her fate.

Ruth Kennedy, a British nurse-midwife working at the Addis Ababa Fistula Hospital where Mahabouba was eventually treated, describes fistulas patients as ‘the modern day leper…She is helpless, she’s voiceless…The reason these women are pariahs is because they are women. If this happened to men, we would have foundations and supplies coming in from all over the world.’

The extent to which these fistulas can destroy a women’s body cannot be overemphasised. They leave women entirely incontinent, their bodies leaking urine and faeces. Fistula victims are frequently divorced by their husbands who are unable to cope with the terrible smells emitting from their bodies, and like Mahabouba, are often completely ostracised by their communities. According to Medecins Sans Frontieres, women will often reduce their liquid intake in an attempt to reduce the flow of urine, which can result in kidney disease and bladder stones. In other cases, these women will quite simply starve to death.

Simeesh Sagaye, a fistula victim who also features in this book, was also unable to receive medical attention after a two day long obstructed labour. Abandoned by her husband, her parents were left to care for her and whilst they supported her, even they struggled to cope with the stench that came from her body – building her a separate hut on the side of their house for her to live in. The psychological damage that can come in part from such isolation is immense. One estimate finds that 90 percent of fistula patients have contemplated suicide, and Simeesh was one of these women. For two years, Simeesh laid curled up in the fetal position in her hut, depression taking over her life. Eventually, thanks to her family selling their entire livestock and assets, Simeesh’s family were able to pay for a private driver to transport Simeesh to a hospital to receive medical attention.

‘The American government allocates only a twentieth of 1 percent of the amount that they spend on their military, to maternal health. This is an inexplicably neglected global issue.’

On arrival at the hospital, the doctors found that Simeesh’s body was wrecked from having been laying this way for so long and it took months of physical therapy, a temporary colostomy (owing to centimetres of her pubic joint that had disappeared due to infection), and intensive physiotherapy and massage before Simeesh could stand again. Finally, Simeesh was ready to have the fistula surgery that would lead to her complete and full recovery.

Both of these harrowing stories highlight a startling problem in global maternal healthcare. Not only can obstetric fistulas completely blight the futures of survivors, but obstructed labour is responsible for up to 6% of all maternal deaths. In Half The Sky, Nicholas D. Kristof and Sheryl Wudunn call for a global campaign to save mothers in childbirth. Despite a Millennium Development goal that focused on maternal health, the World Health Organisation says that between 1990 and 2015, the global maternal mortality ratio (the number of maternal deaths per 100 000 live births) declined by only 2.3% per year. In Niger, a girl or woman stands a 1 in 7 chance of dying in childbirth. Compare this to Poland’s 1 in 19,800 lifetime risk, Italy’s 1 in 26,600 and Ireland’s impressive 1 in 47,600 lifetime risk of dying in childbirth, and serious questions should be asked about why maternal health in certain parts of the world faces such extreme neglect.

It suprises many to find that vaginal fistulas can be successfully closed with simple surgery in approximately 80-95% of all cases. The problem is overwhelmingly simple to solve. And though many might ask how a global campaign can be funded, consider that the American government allocates only a twentieth of 1 percent of the amount that they spend on their military, to maternal health. This is an inexplicably neglected global issue.

Mahabouba’s story, though, does have a happy ending. She survived that night alone in the hut, fending off hyenas all through the night with a stick and when daylight came she was able to drag herself by her arms to the next village for help. There she was taken in by a Western missionary, who found her on their doorstep half dead. Although her fistula was too severe for her to undergo fully restorative surgery, Mahabouba was able to be fitted with a colostomy which enabled her to live again. Mahabouba, needing to reside at the hospital so that she may be properly cared for, initially started working changing linen or helping to wash patients, but a renewed passion for life saw strive for greater things. She learned to read and write and against all odds, Mahabouba climbed the ranks to become a senior nurses aide at the Addis Ababa Fistula Hospital, the very one that had saved her life.

 

 

 

Most of this information was drawn from Half The Sky; How to change the world by Nicholas D. Kristof and Sheryl Wudunn

Further sources include:

http: //forwarduk.org.uk/key-issues/fistula/

http: //www.msf.org.uk/fistula

http: //www.who.int/features/factfiles/obstetric_fistula/en/

http: //www.nytimes.com/2005/09/28/world/africa/nightmare-for-african-women-birthing-injury-and-little-help.html

 

 

 

 

Ebola: What took so long?

It is generally believed that a one-year-old boy later identified as  Emile Ouamouno, who died in December 2013 in the village of Meliandou, Guinea, was the index case of the current Ebola virus disease epidemic. But the stirring of consciousness in the Western world did not come until the following summer of 2014. In this post I question the lack of urgent and desperately needed support for this part of the world suffering an epidemic that would eventually lead to the deaths of over 11,000 people. What role did the western world play in providing support? Who was affected and how do we really view these people? What does this say about our attitude toward the ‘Other’?

On March 11th 2014, Guinea asked Medecins Sans Frontieres for help in identifying a number of deaths from unknown causes. On 22nd March, when the government of Guinea officially declared an Ebola outbreak, 24 MSF doctors, nurses, logisticians and hygiene sanitation experts were already in the country. This immediate response from MSF was in stark comparison to that of the World Health Organisation, who on April 1st, in a response to a press release from MSF describing the Ebola crisis as ‘unprecedented’, accused exaggeration of the situation.

A recent BBC Panorama followed UK doctor Javid Abdelmoneim volunteering in an MSF Ebola treatment centre in Sierra Leone. During his time there, Dr Abdelmoneim witnessed first hand the complications of supporting an infrastructure that was already so close to collapse. During his Ted Talk, filmed a month after his return to England, he reflected on the moment that he and his team awaited the arrival of an ambulance carrying suspected Ebola patients to the treatment centre. Not only had this ambulance had to travel 10 hours across Sierra Leone in order to reach the treatment centre (1 of only 2 then established in the country), but it also contained the dead victims of Ebola amongst people who had not yet been confirmed as infected. Dr Javid described this death sentence as such:

‘If they weren’t already cross contaminated, well they were now – they’ve just spent ten hours with a bio hazard locked in a car. This is how we’re dealing with it.’

That the death warrants of human beings were being signed because of a complete lack of response and aid is something unimaginable to many of us living in developed countries where, on the whole, access to healthcare services is more or less unlimited. And yet this is how the Ebola epidemic, claiming tens, even hundreds of lives daily, was being dealt with. Dr Javid went on to say:

‘…I opened the door and this woman was dead. She looked to be the age of my sister. I was horrified. She’s clearly died an agonising, wretched, painful death on the floor of this ambulance in front of complete strangers[…]She is so overwhelmed by virus she is now a bio hazard. It’s in our training, against all human decency, if she rolled out and fell to the ground then, I would be forced to let her drop like a sack. And I think to myself, at this moment I think a pig, a pig where I’m from, being driven to the abattoir, would have been given more care, more dignity in that drive and in that death, than this woman who is someone’s sister.’

Finally, on the 8th of August 2014, WHO released a statement declaring West Africa’s Ebola epidemic as an ”extraordinary event”, now constituted as an international health risk. But by the time WHO released this statement, the Ebola virus disease epidemic had claimed almost 1,000 lives.

This Ebola virus disease epidemic would go on to kill over 11,000 people. I say that we can almost certainly blame this on the painfully slow mobilization of support from the Western world. But why did we chose to act like this?

Speaking about his time in the treatment centre in Sierra Leone, Dr Javid was struck by the sheer tenacity and courage of the survivors he met. He spoke about them as some of the kindest, most polite and somehow, even in the face of such adversity, happy people he had ever met. Indeed the BBC Panorama shows a group of Sierra Leonean people dancing within the compounds of the treatment centre after receiving news of being ‘all clear’. Some of these people had contracted and fought Ebola. More had lost family and friends. And there are many others in West Africa who will have lost everyone they love to Ebola.

Why then, are we so quick to turn our backs on this part of the world? Perhaps the answer lies in what we can’t see. If this problem is so far away from us, we are less affected by it. How easy it can be to turn a blind eye to something that doesn’t affect anyone we know and bears no immediate consequences for us. It is extremely difficult to imagine that aid and support from governments and institutions of the Western world would have been so slow had this epidemic landed a little closer to our doorstep.

 

 

Referenced in this post:

TedX Talks, (2015). Ebola reflections: them, not us. Available at: https://www.youtube.com/watch?v=ibKo2itlU-Q [Accessed 7 Jan. 2016].

Tiki-toki.com, (2015). Ebola Virus Epidemic in West Africa. [online] Available at: http://www.tiki-toki.com/timeline/entry/431558/Ebola-Virus-Epidemic-in-West-Africa [Accessed 7 Jan. 2016].

Who.int, (2015). WHO | Origins of the 2014 Ebola epidemic. [online] Available at: http://www.who.int/csr/disease/ebola/one-year-report/virus-origin/en/ [Accessed 7 Jan. 2016].