When they studied child mortality, they found that in the villages that received azithromycin, the rates had been cut in half for children between the ages of one and five."
In these remote Ethiopian villages, scattered across a sweeping landscape with few roads, it’s difficult for health workers to make an impact.
Many of the villages are extremely poor, and living conditions are as basic as they get.
As a result, Ethiopia has one of the highest child mortality rates in the world.
Dr. Tom Lietman of the University of California, San Francisco, has been studying the area for some time. “The most common causes of deaths in children, in pre-school children, are the infectious diseases: they’re malaria, they’re respiratory disease, they’re diarrhea. As a matter of fact those three account for more than half the deaths in children.”
But two studies co-written by Lietman are raising hope.
There’s strong evidence that the antibiotic azithromycin has benefits far beyond its primary objective.
Azithromycin is taken orally to fight trachoma, an eye condition that is the leading cause of preventable blindness, affecting more than 40 million people worldwide.
The drug is given as part of a trachoma-control program administered by the Ethiopian government along with the Atlanta-based Carter Center and other partners.
Teshome Gebre, an Ethiopian working with The Carter Center, says, “This is a very strong antibiotic given once a year for those above five. The number of tablets is between two and four.”
Here in rural Ethiopia, trachoma is a common disease that can be detected by redness and painful scratching beneath the eyelid.
Dr. Paul Emerson, Director of The Carter Center’s Trachoma Control Program, says, “Children get infected with ocular chlamydia, which causes trachoma, at a very young age in this environment, probably months old. And they contract it from their elder brothers and sisters in the house.”
In the first study by the University of California team, people in some villages were treated with azithromycin, while others did not receive it until a year later.
Trachoma takes years to develop, so the delay was not considered a problem.
However, when they studied child mortality, they found that in the villages that received azithromycin, the rates had been cut in half for children between the age of one and five.
Dr. Lietman says, “The rates you’d expect in this area of Ethiopia may be eight or 10 deaths per thousand children per year, and we found eight and a half deaths per thousand children per year in the clinical trial, so exactly what we expected. Now the children who were in communities that were randomized through azithromycin distribution had about four deaths per thousand people per year. So it’s about half as much.”
A second study, conducted in other villages, and using a different technique, gave the same results.
It’s not clear why azithromycin had such a significant effect on child mortality in the studies, but the research showed that children were less likely to die of an infectious disease.
But even with these encouraging findings, some people in the global health community are opposed to mass distribution of antibiotics as a kind of ‘catch-all’.
They fear that over-use could lead to resistance to the antibiotics.
An alternative, or a strategy that could be used in conjunction with antibiotics, is a program to improve sanitation and in turn reduce fly and mosquito breeding grounds.
Efforts like this are well underway, promoting face-washing regimens and the construction of latrines.
But clean water and sanitation campaigns can be costly and difficult to implement, so research into widespread use of antibiotics will continue.
A three-year study is being planned for the West African nation of Niger involving 600-thousand people. That’s 10-times the size of the Ethiopia studies.
Researchers hope that effort will shed more light on the benefits – and any possible negative effects – of the use of antibiotics to save many young lives.
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That is our fight, to make the victim understand that you don't have to be ashamed."
Violence against women is an issue that people in Haiti are all too familiar with.
Two years after the country’s devastating earthquake, the UNHCR reports an alarming upsurge in rape cases against women and children of all ages in the squalid refugee camps. But there are some who have had the courage to take on the system and become crusaders for women's rights.
Jocie Philistin has been fighting to criminalize rape and stop violence against women in Haiti for 15 years. A first victory was making rape a crime in 2005.
"Violence against women and young girls in Haiti has always been taken for granted,” says Jocie. “It's been a huge victory in Haiti, that now it is considered a crime under Haitian law."
Jocie runs Kofaviv, one of the first women's rights organizations in Haiti founded by rape victims. She says it took time to effect change, but becoming a victim of violence herself galvanized her efforts.
In 1994, as a law student, Jocie was on a routine student committee meeting with the military government.
"One of the officials called me into his office. The door slammed shut. It was one of those doors that could only open when pressing a button. He took my clothes off and I fought him off. Thank God the penetration was not all the way, but the atrocity of his violence was hard to fight. He finally let me go."
Jocie says she kept he assault a secret, even while working as an advocate for other rape victims. “I had reconciled myself to the fact that my virginity had not been completely violated. And thought it could be forgotten."
Still, she filed a complaint, never expecting to see him again. "I was working in prisons… preaching. When I saw him in jail, I relived all the atrocities of that day. That's when I realized the post-traumatic conditions were still very much alive."
It proved a turning point for Jocie. Today she coordinates Kofaviv, providing one of the few “safe houses” in a dilapidated capital that remains dangerous territory for unprotected women and children living in appalling conditions in the refugee camps.
Despite the change in the law, few rape cases have been brought to justice, especially in a country where human rights groups say poverty and weak state institutions foster a climate of impunity. Jocie told us, “There's always a problem applying the law when you have a dysfunctional justice system that instills fear among the population, especially the victims who are the most vulnerable and live in marginalized conditions."
But while she will never forget, she still has hope.
“One can, over time, maybe heal a little, self-channel. But it's an act you can never forget. Because you don't want a rape to diminish you, to marginalize you in society. And that is our fight, to make the victim understand that you don't have to be ashamed."
It was around seven at night. The man came up from behind and put a gun to my head."
Getting food, clean water and medical treatment in Haiti's refugee camps is challenging enough for families displaced by the earthquake.
But now, the U.N. High Commissioner for Refugees is reporting an alarming increase in rapes and violence against young girls and adult women in these camps.
One refugee told GHFN, “It was around seven at night. This man came up from behind and put a gun to my head.”
Another rape victim told us, “You can try to resign yourself, but you can never forget. An act like that, one can never forget.”
Still another said, “I felt my life was finished. That I would never again be able to function in society again.”
They are all victims of one of the worst forms of violence against women. Yet in Haiti, rape wasn’t even a crime until seven years ago.
Jocie Philistin, a coordinator of an organization running one of the few camp “safe houses” told us, "Violence against women and young girls in Haiti has always been taken for granted. It's been a huge victory in Haiti, that now it is considered a crime under Haitian law."
Jocie Philistin is one of the pioneers of the 2005 law that finally made rape a crime.
A former rape victim, today she is the coordinator of Kofaviv, a Haitian women’s rights organization formed by rape victims. She says the law has helped educate women on their rights, but few cases have been brought to justice, especially in a country where human rights groups say poverty and weak state institutions foster a climate of impunity.
“There's always a problem applying the law when you have a dysfunctional justice system that instills fear among the population, especially the victims who are the most vulnerable and live in marginalized conditions."
In January 2010, a devastating earthquake struck Port-au-Prince, Haiti's densely populated capital, killing more than 200,000 people. With 2.8 million inhabitants mostly living in overcrowded poor neighborhoods, its long-term impact is catastrophic.
A million and a half Haitians were left homeless, finding shelter in tent-cities that mushroomed overnight throughout the capital. Thousands of children, adolescents and adult women were thrust into a no-man's land, with no protection.
Jocie told us, "These are people who lived in low income neighborhoods. Even if they lived in slums, they lived in a community where everyone knew each other.”
Within seconds, that social safety net of communities was leveled and transformed overnight into a chaotic landscape of survivors.
"You find yourself in a camp where you don't know your neighbor. You look around, up, down, to the side, and you don't know a soul. People are living in inhumane, degrading conditions and everyone is exposed. There is no security."
More than two years later, half a million-plus refugees still remain in the decaying camps.
With international emergency aid exhausted, they are among the most vulnerable, no longer receiving basic needs like drinking water, sanitation services or security.
The UNHCR says one of the most notorious camps, where an upsurge in rape attacks has been taking place, is Champs de Mars camp, right in front of the collapsed presidential palace.
In its narrow alleys we found Yuseline Marcellus, a 16-year old girl who says she was gang-raped in the camp last November.
She became pregnant. Without family and nowhere to turn, she says, she turned to prostitution to feed her 4-month old child.
With her head in her hands, she told us, "There were ten of them. It's hard. It hurts a lot, it's always in my mind. I can't forget."
We were led to Yuseline's tent by two young men, Carlos and Ludner, who volunteer to protect her and other young women here.
Carolos told us, "Since I've been living in the camp for two years, I see many little girls been raped, nine-year old girls, young people, old people, they don't care.”
“We try to stop that right now. We made a group, fifty guys, to try to stop the rape, but you know we can't, we just can't."
Philistin says there's been notable progress and help from the Haitian police, pointing to 450 officially registered complaints so far this year. But with a judicial system still in limbo, many of those cases may never see their day in court.
On the other side of town, at Camp Nicaragua, Delna Charlotin is both refugee and president of the camp's women watchdog group, one of sixteen "frontline" volunteer associations working day and night throughout the camps.
Delna and her committee check regularly through the camp to make sure everyone’s flashlight has working batteries, and especially that every female has a whistle.
"We give all the women a whistle so that if any of them feel threatened, they can just blow it and everyone will be on alert and come to her rescue."
When they locate a victim in a camp, they refer her to a place like Kofaviv, which has one of the few safehouses in the capital.
Kofaviv's community workers are for the most part victims of rape or other violence themselves.
Philistin explained, “In a first phase we relocate the victim and her family. The mother and children are placed in a secure setting. During that time, the victim is sensitized to issues of reproductive health, gender-based violence, family planning and community support."
"The second phase is the reintegration of these victims. Once they leave the safehouse, they don't return to the camp."
In the final stages, Kofaviv will ensure up to a year's rent for the woman and her family, and pay for the children's schooling and health.
"We want the assistance to help them get back on their feet," Philistin says.
But for most of these women, it's hard to forget.
Rosamirlande, one of the camp inhabitants, told us she still has hope.
Smiling, she said, “Yes, I think I can have a second life.”
After surgery they go back home with their dignity restored as new ladies and mothers who can go back out there and have a wonderful life ahead of them."
After years, sometimes decades, of living as pariahs in their communities, a group of Tanzanian women finally have something to be cheerful about.
They all suffered from an obstetric fistula, which can occur during prolonged, traumatic complications while giving birth.
The child usually dies, and the mother is left with a fistula, or tear, between the birth passage and the bladder or rectum.
Without corrective surgery, the woman suffers incontinence for the rest of her life, often, ruining her life.
But at a disability hospital called Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), women can get corrective surgery for free, and with it, a new lease on life.
“One World Bank report called them ‘Dead women walking’”, explains Tom Vanneste, the hospital’s Deputy Director. “That’s how horrible their condition is, how they’re completely socially excluded and embarrassed. So they come here very much depressed, very scared, unsure of what their future is.”
Later, says Vanneste, they feel liberated: “After surgery they go back home with their dignity restored as new ladies and mothers who can go back out there and have a wonderful life ahead of them.”
Rukia Shabiby is one woman who’s long journey led here.
26 years ago, at the age of 13, she was married and became pregnant.
At such a young age, with her body still under-developed, the birth was traumatic, and ended in tragedy.
Her baby was still-born, and Rukia herself would soon discover that something else was very wrong.
During the birth she had suffered a fistula, though she had no idea what it was.
Rukia tells us that in the ensuing weeks, months and years, the odor and perception of uncleanliness led to her being shunned by the community.
And the great tragedy is that like so many other women and girls with this condition, Rukia thought she was the only one.
In reality, the United Nations estimates there are more than two million living with the condition.
In Rukia’s case, after years of suffering, she heard about CCBRT and traveled to Dar es Salaam for a successful operation.
She’s now ready for a fresh start.
“When she goes back,” says Eric Ndambiri, a nurse at CCBRT who helped Rukia through surgery and recovery, “she’s thinking that she’s going to be a good ambassador, to tell others that even you, who feels the condition is incurable, that somewhere there is a solution for your problem.”
As with other developing countries, many women who get fistulas are from poor, rural areas.
Even if they hear that they can be cured, they often don’t have the resources to even pay the bus fare to Dar es Salaam.
To solve that problem, CCBRT employs what it calls “ambassadors” to look out for ostracized women with fistulas.
When they find a possible case, they contact CCBRT for advice, and bus fare.
“When we are sure it’s a fistula patient,” says Tom Vanneste, “we actually use mobile phone money transfer system technology to transfer the money for transport to the ambassador, who basically gets an SMS that says ‘Look, you’ve received $20 from CCBRT hospital.’ He converts the e-money into cash, collects the cash, buys the bus ticket for the patient, helps the patient get on the bus, and basically we pick up the patient here at the bus station and operate on her the next week.”
After surgery, the women stay for at least two weeks to recover.
During that time they learn new skills, like crocheting.
In addition, 18 women are selected each year to stay in Dar es Salaam to be trained in sewing, printing and jewelry-making.
The Mabinti Training Center also teaches them how to speak English and run a small business.
“When I came here I said ‘Wow this is my new beginning. And I have to stick on this so that I can rebuild my life again,’” says Jane Rugalabamu, one of the trainees.
That new life won’t be alone. Jane plans to join with several of the women here to start a business.
Her other job, she says, will be to spread the word and make sure that women and girls don’t spend years in isolation for a condition that can be cured with an operation in less than two hours.
Let’s ask the mother: ‘How old were you when you got married?’ The chances are she’ll say ‘I was 21.’ So why are you sending your daughter away at 12?”
The disturbing prospect of 100 million child brides in the next decade has galvanized teenage girls in the United States, who are demanding action on behalf of their young counterparts around the world.
The United Nations Foundation’s Girl Up campaign says it has mobilized 150,000 American teens. They say they want the practice of child marriage stopped and have delivered a petition to the White House signed by girls across the U.S.
“It’s a human rights issue,” says Erica Lamberson, who’s one of the teen leaders. “I think it’s a problem when anyone is forced to do anything that they don’t want to do or are not clear about or are not prepared for. Child marriage is huge because once you get married at such a young age, you know, your life’s not over but your life has drastically changed its path.”
Child bride expert Jennifer Redner says the practice of marrying girls off early has profound negative impacts. “When a young girl may come home from school one day and find her bags packed or may find out the next day there may be some sort of ceremony where she’ll be wed – sometimes as young as eight, nine, ten – the consequences can be absolutely detrimental.”
Redner, who serves as U.S. Policy Consultant to the International Women's Health Coalition, says that child brides are also more likely to marry much older men. “Therefore the power dynamics will be even more difficult in terms of her being able to negotiate safe sex, be able to stay in school, to be able to not get pregnant as early as 10, 11 years old, so the consequences are quite, quite strong.”
Elizabeth Gore, Vice President of Global Partnerships at the UN Foundation, says that for the victims of this practice, the stakes are high: “One girl who I met in Ethiopia who is scared and has run away is sitting in a bus depot and is either going to be brokered into sex work or not educated or into domestic labor and she never gets a shot.”
But old habits die hard. Sheila Siwela, Zambia’s Ambassador to the U.S., says education is key in changing deep-seated cultural traditions. “Lets go back to the girl child themselves, let’s go back to the parents and the mothers. Lets ask the mother ‘how old were you when you got married?’ the chances are she’ll say ‘I was 21.’ So why are you sending your daughter away at 12?”
But Siwela believes the practice can be eliminated. “I think it’s nearer than we think. As long as we step up the efforts of encouraging the girl childs to go back to school and finish school, and again as long as we go back to the communities themselves to make their own decisions.”
And at the end of the day, if the Girl Up campaign is to succeed, it must be the adults in the communities who change their thinking, and let the children be children.
Facilities are poor, there aren’t enough trained staff, and even for them wages often don’t come on time, sapping morale and motivation."
The Central African Republic is a country in almost constant crisis.
Decades of political instability, military conflict and ongoing skirmishes with rebels have rendered it one of the world’s poorest and least developed nations.
All this has left the CAR’s health sector in tatters.
Facilities are poor, there aren’t enough trained staff, and even for them, wages often don’t come on time, sapping morale and motivation.
The result is that there are many deaths that could have been avoided. Average life expectancy here is just 47 years.
One of the most vulnerable groups is pregnant women.
Therese Zeba, the UN Population Fund’s Country Representative in Bangui, says far too many mothers are dying in childbirth. “It is almost four to five women dying every day in the Central African Republic. This is too much. It is too much.”
One of the reasons for so many maternal deaths in a country with just four-and-a-half million people is that nearly half of all deliveries take place at home without a doctor or trained midwife.
The government is trying to encourage more women to give birth in hospital, but there’s a fee that many people simply can’t afford.
Shiphra Perriere, a new mother at the age of 17, did give birth to her son Japhet in hospital, but only just. "When the contractions started I had to endure the pain for three days as we did not have money to go to the hospital.”
While Shiphra struggled at home, her mother went from house to house, begging relatives and friends for contributions. “In the meantime,” says Shiphra, “I was praying to god to give me the strength to continue to endure it until my mother collected the required amount of money."
Once the money was in hand, Shiphra was rushed to the public hospital in the capital, Bangui, where luckily she gave birth without complications.
But even though there are rudimentary facilities here, Hortense Gongaye, head of the national midwives association says they need much more. “We have hemorrhages, and we don’t have a blood bank nearby; and having to leave the local hospital to go all the way to the general hospital is the problem. Here we need a blood collection center nearby to save women who are hemorrhaging.”
Even if they get more staff and equipment, the cost issue remains a major hurdle.
The UN Population Fund is trying to mitigate the problem by providing birth kits with gloves, soap and other items that are needed for a delivery.
But Therese Zeba is frustrated that other costs, no matter how small, are still too much for families to pay. “Women are dying for peanuts, you see, nothing really important.”
Zeba says tragedy can strike simply because a family doesn’t have enough money to make a phone call to the doctor. “It is really unacceptable.”
Henrietta Sounba is another 17-year old who has just given birth to her first child. She’s an orphan whose parents died of what the family calls “a sickness” several years ago. She now lives with her grandparents in a small two-room house.
Her grandfather, Andre Kpamanda, says they had to scrimp and save to get enough to pay for their Henrietta’s pre-natal care at a local health center, plus medication, and the cost of the hospital delivery.
Altogether he says it cost 65,000 Central African Francs, or about $140 US dollars, a huge sum for people here.
“I’m retired,” he says. “It’s costing us a lot of money. With the help of the relatives, and with the help of the little sister, we are trying to collect something to face this problem. It’s quite a challenge. It’s not easy.”
Despite the financial strain, Henrietta did receive care from qualified personnel. But many others aren’t as lucky, either because they can’t afford it or, if they live in remote areas, there simply aren’t enough trained staff and facilities.
This, in a country with only six obstetricians, all of whom are in the capital.
In rural areas, a ‘birth attendant’ with little or no training is often the best option for a woman in labor. But if there are complications, the birth often ends in tragedy.
More trained midwives would help, but many aren’t willing to go because it’s too dangerous and conditions are so poor.
“In the rural areas, we need midwives,” says Nurse Hortense. “But really the problem that we have is the care of the midwives who go into the provinces; the distance traveled and the lack of security are issues.”
The government is well aware of the problems and is attempting to train more doctors and nurses and assign them to rural areas. But they often have to train in other countries with better facilities.
You can’t rehabilitate a child who has severe malnutrition with a plate of beans and rice. There’s just no way."
11-month old Pierre Wisny is painfully thin, with ribs showing and his skin practically hanging off him. He weighs just 11 pounds (five kilograms).
When the circumference of his arm is measured, which is an indicator of deep body fat, he’s well into the red zone. No surprise, Pierre is severely malnourished.
The same applies for three-year old Alcincord Guerviscon. It’s clear even without measurements to see that his growth has been stunted by the same condition. He weighs only 15 pounds (seven kilograms).
In most of these cases, the children got this way due to poverty and a lack of access to good food. If they’re not given emergency treatment, they could die or suffer more effects of malnutrition, including reduced brain development.
For staff at a clinic in northern Haiti, the intervention comes in bright green packets.
They contain Medika Mamba, which means “peanut butter medicine” in Creole.
It’s a ready-to-eat paste, packed with nutritious ingredients, that over a period of weeks gives a jolt to the system and puts children back on track.The paste is made by a US-based non-profit called ‘Meds & Food for Kids’ (MFK).
Thomas Stehl, MFK’s Director of Operations told GHFN, “You can’t rehabilitate a child who has severe malnutrition with a plate of beans and rice. There’s just no way. Their stomachs are too small and their nutritional requirements are too great to ever be satisfied in that way. So the quantity and the density of food is really important and that is why ready-to-use therapeutic food and Medika Mamba is such a great answer.”
At another clinic, where children have been on the therapeutic food for several weeks, the difference is striking. When Guerline d’Haiti arrived three weeks ago she weighed ten pounds. After three weeks in the program, she’s gained two pounds and is far more active.
The clinic’s head nurse, Elcie Thoby, says Medika Mamba is a life-saver.
“If you have children that can’t eat, really eat, that child won’t survive. But with the mamba medication, specially made for little children, if that child starts taking the mamba normally, and regularly, the child will recuperate and start eating again.”
Even though emergency foods like Medika Mamba have been proven to work, the best course of action is to prevent malnutrition from setting in in the first place.
At Fort St. Michel hospital, 350 children who are at risk – but are not malnourished - are enrolled in a study of a supplementary food known as Nutributter. It contains fewer calories than Medika Mamba, and is designed to be taken with regular food, essentially topping up nutrients that are lacking in the child’s diet.
But there are critics of this type of intervention. Marcos Arana-Cedeno is a consultant who’s studied malnutrition in Chiapas, one of Mexico’s poorest states. He says fortified foods can do more harm than good.
“They are promoting dependence. They are promoting these kinds of products. It’s very easy to make a distribution of these products and it requires more energy and more effort to bring people to participate, to understand the messages.”
But MFK says its program does take the long-term interests of the community into account. Rather than simply import the food, the organization makes the product in Haiti and works with local farmers, buying their peanuts and teaching them how to improve their yields.
Jamie Rhoads, MFK’s agricultutral development specialist, says, “Their evolution of
thinking about business, about expanding their peanut production, about how that
translates to other things is really striking and you know, they’re organizing around the
prospect of being able to sell those peanuts.”
MFK has also been testing peanut seeds from as far away as India to see if they will produce better crops than the varieties currently used in Haiti.
While some of the farmers view these strange-looking plants with suspicion, the program has taught them better techniques.
President of the Farmer’s Cooperative, Plovert Petit-Frere, says: “We can say yes, we’ve improved, especially in weighing the crop because we’ve been able to conserve more of it that will last longer.”
MFK also plans to buy a lot more peanuts in the coming years. That’s because it has just installed a machine that produces a new version of its product, called ‘Plumpy’Nut Medika Mamba.’ It follows a deal with Nutriset, the world’s leading producer of ready-to-use therapeutic food.
The new paste will use nutriset’s recipe, which meets the requirements of major agencies like the World Food Programme and UNICEF. Each serving must come in an individual 500 calorie pack, and have a shelf-life of two years.
With the big aid agencies as potential new customers, MFK is scaling up to produce the
new Medika Mamba in far greater quantities. The expansion includes plans for a new factory, which the organization says will create at least 50 jobs.
And once the aid agencies approve local crops for use as the main ingredient, MFK says it will use nearly 1,000 peanut farmers as suppliers.
Stehl says, “It is about children of course, but it is more than that. It has the opportunity
to actually catalyze economic and agricultural development in a country where, you know, it’s needed.”
And in turn, maybe the children themselves will not only survive the effects of malnutrition, but go on to lead a new generation of Haitians that is more self-sufficient.
We’re here to help support the government implement their roadmap and do it effectively and they gave us the space to try new things and to innovate.”
A baby boy, just 10 minutes old, lies on a small bed gasping for air. Despite his strained breathing, he’s alive and well.
That may not have been the case if his mother had not been brought to the new Butaro Hospital in one of Rwanda’s most remote districts. In fact he’s the very first baby born here.
While his mother was in labor, her unborn child had shown signs of respiratory distress: a major problem if the delivery had taken place at home or in a rural health center.
Instead, mother and unborn baby were brought to the hospital, where trained staff and quality equipment ensured their safety.
Dr. Agnes Binagwaho, Rwanda’s Permanent Secretary of Health, is passionate about improving maternal health in her country. But Rwanda still has a long way to go. “There are too many deaths that we could prevent by increasing access to care in a geographic way,” she says, “and also increasing the expertise of health professionals that deliver services, but also the number of health professionals.”
This is what the Butaro Hospital was built for: to provide quality health care that has been lacking in Burera District, which just a few years ago only had one doctor for its 340,000 people.
The spotless facility stands on top of a hill with views of Rwanda’s lush valleys. It’s a beacon of hope in a country with many scars. But the government couldn’t have done it without the help of others.
The U.S.-based nonprofit Partners in Health, which has built hospitals and clinics throughout the developing world, provided expertise and paid more than $4 million for the construction.
The Clinton Foundation also provided support, while the Rwandan government covered the cost of the hospital equipment.
Dr. Peter Drobac, the Country Director for Partners in Health here, says the alliance has worked extremely well. “I think it really represents the way partnerships, public-private partnerships for development, should work. We’re here to help support the government implement their roadmap and do it effectively and they gave us the space to try new things and to innovate.”
The innovation includes effective but inexpensive design features that can be replicated across the developing world.
People gather in the open air instead of confined corridors where diseases like tuberculosis can spread.
In the wards, every detail from the smooth resin on the floor that is easily sterilized, to the type of ceiling, has been carefully considered.
“The ceilings are high and vaulted and at the upper level there are these non-operable louvered windows and that allows air to pass up and out. It’s something called stack-effect ventilation,” says Drobac. “Heat rises naturally so air rises up and it’s continually passing out.”
Floating above Drobac is a large fan that spins slowly and silently while circulating air up and out of the windows. There are also ultraviolet lights that kill TB bacteria and other microbes in the air.
“Those things,” says Drobac, “collectively can actually achieve the same degree of ventilation and infection control as we do in United States hospitals at a fraction of the cost.”
And cost is key in a country like Rwanda, which is still recovering from the 1994 genocide that left an estimated 800,000 people dead.
In order to heal, and develop a better health system, the government is implementing a pyramid-based structure with the district hospital at the top.
At the base level, every village has at least two community health workers. They’re the first link in a chain that connects the villages with the health centers, and the centers with the hospital.
They’re trusted members of the community with rudimentary training to monitor those on medication and spot possible cases of common conditions like HIV, TB, malaria and malnutrition.
If there’s a serious case that cannot be treated at the community level, the patient is referred to the hospital.
For maternal health, the strategy is having a major impact. Until recently most women in Rwanda gave birth at home with no trained health providers on hand. In too many cases a complication resulted in the death of the baby and sometimes the mother as well.
Now, the community workers encourage women to give birth in the nearest health center, which has trained staff who can handle routine deliveries. If there’s a problem, they send the patient to the hospital.
This strategy has drastically reduced maternal mortality in a country with one of the worst records in the world.
“A couple of years ago we had eight deaths a day in Rwanda, and now we are at less than one death a day,” says Agnes Binagwaho, the Permanent Secretary of Health. “Even it’s too much, but that means there’s progress, but we should reach the point where we have zero deaths that we can prevent.”
Had it not been for the new procedures in Burera, a remarkable birth of quadruplets 16 months ago would probably have ended in tragedy.
When Angelique Mukazigama was in labor she thought she was just carrying twins.
Fearing complications, she was taken to the temporary Butaro Hospital, which handled difficult cases while the new hospital was being built. Converted from an old health center, the facility was basic, but it had doctors and trained staff.
After delivering the first two babies, they discovered there was a third. And then, another surprise, not just for the mother, but the doctor as well.
“When I did the last examination in order to deliver the placenta,” explains Dr. Juvenal Musavuli, “I realized that there were two feet – two other feet. Then it was very exciting. We called all the authorities for the hospital and finally the last one came – the fourth baby. It was very exciting and I think it’s one of my best days.”
The days for the doctors and patients should get better still.
Many jobs have been created and new skills learned in a community that built Butaro Hospital on a firm foundation.
The outer walls are made of local volcanic rock, signifying renewal from a tempestuous past.
Inside those walls, preparations are underway for the first Caesarean section. All while the first baby born here lies peacefully nearby, oblivious to the people and machines that are keeping him warm and helping him breath.
But as he grows, his aspirations will be much like the Butaro Hospital itself: to breathe, walk and run independently.
When they studied child mortality, they found that in the villages that received azithromycin, the rates had been cut in half for children between the ages of one and five."
In these remote Ethiopian villages, scattered across a sweeping landscape with few roads, it’s difficult for health workers to make an impact.
Many of the villages are extremely poor, and living conditions are as basic as they get.
As a result, Ethiopia has one of the highest child mortality rates in the world.
Dr. Tom Lietman of the University of California, San Francisco, has been studying the area for some time. “The most common causes of deaths in children, in pre-school children, are the infectious diseases: they’re malaria, they’re respiratory disease, they’re diarrhea. As a matter of fact those three account for more than half the deaths in children.”
But two studies co-written by Lietman are raising hope.
There’s strong evidence that the antibiotic azithromycin has benefits far beyond its primary objective.
Azithromycin is taken orally to fight trachoma, an eye condition that is the leading cause of preventable blindness, affecting more than 40 million people worldwide.
The drug is given as part of a trachoma-control program administered by the Ethiopian government along with the Atlanta-based Carter Center and other partners.
Teshome Gebre, an Ethiopian working with The Carter Center, says, “This is a very strong antibiotic given once a year for those above five. The number of tablets is between two and four.”
Here in rural Ethiopia, trachoma is a common disease that can be detected by redness and painful scratching beneath the eyelid.
Dr. Paul Emerson, Director of The Carter Center’s Trachoma Control Program, says, “Children get infected with ocular chlamydia, which causes trachoma, at a very young age in this environment, probably months old. And they contract it from their elder brothers and sisters in the house.”
In the first study by the University of California team, people in some villages were treated with azithromycin, while others did not receive it until a year later.
Trachoma takes years to develop, so the delay was not considered a problem.
However, when they studied child mortality, they found that in the villages that received azithromycin, the rates had been cut in half for children between the age of one and five.
Dr. Lietman says, “The rates you’d expect in this area of Ethiopia may be eight or 10 deaths per thousand children per year, and we found eight and a half deaths per thousand children per year in the clinical trial, so exactly what we expected. Now the children who were in communities that were randomized through azithromycin distribution had about four deaths per thousand people per year. So it’s about half as much.”
A second study, conducted in other villages, and using a different technique, gave the same results.
It’s not clear why azithromycin had such a significant effect on child mortality in the studies, but the research showed that children were less likely to die of an infectious disease.
But even with these encouraging findings, some people in the global health community are opposed to mass distribution of antibiotics as a kind of ‘catch-all’.
They fear that over-use could lead to resistance to the antibiotics.
An alternative, or a strategy that could be used in conjunction with antibiotics, is a program to improve sanitation and in turn reduce fly and mosquito breeding grounds.
Efforts like this are well underway, promoting face-washing regimens and the construction of latrines.
But clean water and sanitation campaigns can be costly and difficult to implement, so research into widespread use of antibiotics will continue.
A three-year study is being planned for the West African nation of Niger involving 600-thousand people. That’s 10-times the size of the Ethiopia studies.
Researchers hope that effort will shed more light on the benefits – and any possible negative effects – of the use of antibiotics to save many young lives.
Global Health Frontline News (GHFN) is a special reporting unit of Cielo Productions, Inc., a nonprofit video production company based in the United States.
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That’s a radical change for the population. They finally have access to modern medicine.”
The tiny island of Haiti is one of the most densely populated and poorest countries in the world. Its latest report says that at least half the population lives in the countryside, with no access to safe drinking water and health care. There are just three doctors for every 10,000 Haitians.
But there’s one thing they have plenty of. Sunshine is free and finally someone is tapping into it.
Getting to Boucan Carre is no easy feat. It’s only 45 miles, or 70 kilometers, from the capital of Port-au-Prince, but it takes an arduous three hour drive to get there.
Located in the Central Plateau, Boucan Carre and its mountainous remote communities have been cut-off from the rest of the country for years. Most of its 58,000 inhabitants have never been to Port-au-Prince. There are virtually no roads, and in the rainy season, the smallest path is flooded. Until two years ago, it had a tiny health center that functioned mostly in the dark, even in daylight hours.
Cate Oswald is the program director for the U.S.-based non-profit Partners in Health. She arrived in here five years ago.
“What we found was a small two room clinic, no doctors,” she said. “Not only did we go without electricity because we couldn’t get gas out, but we also had women in labor trying to cross the river and not able to. We ended up losing a number of patients because of that.”
But tucked away in the mountains is its hope for the future: the St. Michel Hospital. Built and run with Partners in Health funding, it’s powered by an abundant resource: the sun.
Driving the jeep on the rocky road to the town, Jean Baptiste Certain of the Solar Electric Light Fund (SELF) told us:“To bring solar panels and fragile electronic equipment and very large batteries on a dirt road for hours is not the easiest thing to do.”
But all 66 solar panels did make it, thanks to the efforts of SELF. Today Boucan Carre has a fully-equipped hospital with power 24 hours, seven days a week.
Certain told us, “That’s a radical change for the population. They finally have access to modern medicine.”
Now young and old patients benefit from a laboratory complete with electron microscope, radiology equipment and a state of the art surgery room.
In the hospital’s crowded waiting area, an ultra-violet light is on to kill the bacteria of coughing tuberculosis patients. The fan circulates the air preventing the infection of other patients and staff.
Dr. Moise Compere told us, “Its a tremendous difference, whether it’s the laboratory where the machines can’t run without the solar panels, radiology, and especially our surgery room.”
Inside the women’s ward, Dr. Compere talks to Narcisse Dieudonne, who brought her daughter to St. Michel Hospital.
Narcisse told us, “Thank the Lord we came here. My little one got to see a doctor right away.”
A bank of solar batteries are the lifeline. They require skilled maintenance and recharging.
Andre Poteau Geles is one of the technicians trained by SELF. He’s been here for 10 years, and as the logistics manager has seen a vast change.
“When we started here with our little health clinic, we didn’t have power. It wasn’t until 2003 that we finally got a generator. Very often we couldn’t get the fuel up here and we had to work in the dark.”
Ironically, it’s thanks to the dirt road built to transport the solar panels to Boucan Carre, that the Haitian government finally started installing the first electric poles ever here… just two months ago. But with Haiti’s weak and unreliable grid, they might at best come in handy to recharge the solar batteries, says Certain.
“It’s highly unreliable, at best a couple of hours per day.”
Meanwhile, St. Michel is already well on the path to improving and guaranteeing the long-term well-being of these remote communities.
As we left, ominous skies foretold the start of the rainy season. The river of hell, as it’s called, will overflow. Only now Boucan Carre won’t be left in the dark.
That is our fight, to make the victim understand that you don't have to be ashamed."
Violence against women is an issue that people in Haiti are all too familiar with.
Two years after the country’s devastating earthquake, the UNHCR reports an alarming upsurge in rape cases against women and children of all ages in the squalid refugee camps. But there are some who have had the courage to take on the system and become crusaders for women's rights.
Jocie Philistin has been fighting to criminalize rape and stop violence against women in Haiti for 15 years. A first victory was making rape a crime in 2005.
"Violence against women and young girls in Haiti has always been taken for granted,” says Jocie. “It's been a huge victory in Haiti, that now it is considered a crime under Haitian law."
Jocie runs Kofaviv, one of the first women's rights organizations in Haiti founded by rape victims. She says it took time to effect change, but becoming a victim of violence herself galvanized her efforts.
In 1994, as a law student, Jocie was on a routine student committee meeting with the military government.
"One of the officials called me into his office. The door slammed shut. It was one of those doors that could only open when pressing a button. He took my clothes off and I fought him off. Thank God the penetration was not all the way, but the atrocity of his violence was hard to fight. He finally let me go."
Jocie says she kept he assault a secret, even while working as an advocate for other rape victims. “I had reconciled myself to the fact that my virginity had not been completely violated. And thought it could be forgotten."
Still, she filed a complaint, never expecting to see him again. "I was working in prisons… preaching. When I saw him in jail, I relived all the atrocities of that day. That's when I realized the post-traumatic conditions were still very much alive."
It proved a turning point for Jocie. Today she coordinates Kofaviv, providing one of the few “safe houses” in a dilapidated capital that remains dangerous territory for unprotected women and children living in appalling conditions in the refugee camps.
Despite the change in the law, few rape cases have been brought to justice, especially in a country where human rights groups say poverty and weak state institutions foster a climate of impunity. Jocie told us, “There's always a problem applying the law when you have a dysfunctional justice system that instills fear among the population, especially the victims who are the most vulnerable and live in marginalized conditions."
But while she will never forget, she still has hope.
“One can, over time, maybe heal a little, self-channel. But it's an act you can never forget. Because you don't want a rape to diminish you, to marginalize you in society. And that is our fight, to make the victim understand that you don't have to be ashamed."
It was around seven at night. The man came up from behind and put a gun to my head."
Getting food, clean water and medical treatment in Haiti's refugee camps is challenging enough for families displaced by the earthquake.
But now, the U.N. High Commissioner for Refugees is reporting an alarming increase in rapes and violence against young girls and adult women in these camps.
One refugee told GHFN, “It was around seven at night. This man came up from behind and put a gun to my head.”
Another rape victim told us, “You can try to resign yourself, but you can never forget. An act like that, one can never forget.”
Still another said, “I felt my life was finished. That I would never again be able to function in society again.”
They are all victims of one of the worst forms of violence against women. Yet in Haiti, rape wasn’t even a crime until seven years ago.
Jocie Philistin, a coordinator of an organization running one of the few camp “safe houses” told us, "Violence against women and young girls in Haiti has always been taken for granted. It's been a huge victory in Haiti, that now it is considered a crime under Haitian law."
Jocie Philistin is one of the pioneers of the 2005 law that finally made rape a crime.
A former rape victim, today she is the coordinator of Kofaviv, a Haitian women’s rights organization formed by rape victims. She says the law has helped educate women on their rights, but few cases have been brought to justice, especially in a country where human rights groups say poverty and weak state institutions foster a climate of impunity.
“There's always a problem applying the law when you have a dysfunctional justice system that instills fear among the population, especially the victims who are the most vulnerable and live in marginalized conditions."
In January 2010, a devastating earthquake struck Port-au-Prince, Haiti's densely populated capital, killing more than 200,000 people. With 2.8 million inhabitants mostly living in overcrowded poor neighborhoods, its long-term impact is catastrophic.
A million and a half Haitians were left homeless, finding shelter in tent-cities that mushroomed overnight throughout the capital. Thousands of children, adolescents and adult women were thrust into a no-man's land, with no protection.
Jocie told us, "These are people who lived in low income neighborhoods. Even if they lived in slums, they lived in a community where everyone knew each other.”
Within seconds, that social safety net of communities was leveled and transformed overnight into a chaotic landscape of survivors.
"You find yourself in a camp where you don't know your neighbor. You look around, up, down, to the side, and you don't know a soul. People are living in inhumane, degrading conditions and everyone is exposed. There is no security."
More than two years later, half a million-plus refugees still remain in the decaying camps.
With international emergency aid exhausted, they are among the most vulnerable, no longer receiving basic needs like drinking water, sanitation services or security.
The UNHCR says one of the most notorious camps, where an upsurge in rape attacks has been taking place, is Champs de Mars camp, right in front of the collapsed presidential palace.
In its narrow alleys we found Yuseline Marcellus, a 16-year old girl who says she was gang-raped in the camp last November.
She became pregnant. Without family and nowhere to turn, she says, she turned to prostitution to feed her 4-month old child.
With her head in her hands, she told us, "There were ten of them. It's hard. It hurts a lot, it's always in my mind. I can't forget."
We were led to Yuseline's tent by two young men, Carlos and Ludner, who volunteer to protect her and other young women here.
Carolos told us, "Since I've been living in the camp for two years, I see many little girls been raped, nine-year old girls, young people, old people, they don't care.”
“We try to stop that right now. We made a group, fifty guys, to try to stop the rape, but you know we can't, we just can't."
Philistin says there's been notable progress and help from the Haitian police, pointing to 450 officially registered complaints so far this year. But with a judicial system still in limbo, many of those cases may never see their day in court.
On the other side of town, at Camp Nicaragua, Delna Charlotin is both refugee and president of the camp's women watchdog group, one of sixteen "frontline" volunteer associations working day and night throughout the camps.
Delna and her committee check regularly through the camp to make sure everyone’s flashlight has working batteries, and especially that every female has a whistle.
"We give all the women a whistle so that if any of them feel threatened, they can just blow it and everyone will be on alert and come to her rescue."
When they locate a victim in a camp, they refer her to a place like Kofaviv, which has one of the few safehouses in the capital.
Kofaviv's community workers are for the most part victims of rape or other violence themselves.
Philistin explained, “In a first phase we relocate the victim and her family. The mother and children are placed in a secure setting. During that time, the victim is sensitized to issues of reproductive health, gender-based violence, family planning and community support."
"The second phase is the reintegration of these victims. Once they leave the safehouse, they don't return to the camp."
In the final stages, Kofaviv will ensure up to a year's rent for the woman and her family, and pay for the children's schooling and health.
"We want the assistance to help them get back on their feet," Philistin says.
But for most of these women, it's hard to forget.
Rosamirlande, one of the camp inhabitants, told us she still has hope.
Smiling, she said, “Yes, I think I can have a second life.”
Brunson says many water projects in developing countries fail for obvious reasons - money runs out, or machinery breaks down."
Access to safe drinking water is a global problem for nearly a billion people.
For about 200 million, many in Africa, high levels of naturally occurring fluoride in the water causes disfiguring dental and skeletal disease.
“Dental fluorosis is a darkening or mottling of the teeth,” says Laura Brunson, an environmental scientist at the University of Oklahoma in the United States. “There is a sort of social stigma attached to it, maybe a poverty stigma. Skeletal fluorosis is much more physically debilitating.”
But Brunson is on the case. She's developing fluoride-filtering devices that use cheap materials that are readily available in the villages. A resident with a kiln, for example, could create the char from eucalyptus wood, or bones.
The low-cost filter would treat the water, which can then be sold for a minimal cost. That would both provide fluoride-treated water to the community and give the person who's running that business a job.
During recent field work in Ethiopia, Brunson and her team set up a lab in a local guest house - and started experimenting.
“Are there things we can add,” asks Brunson, “or ways we can alter the bone char either through some sort of oxidation process, or through adding something like aluminum to the material, that would make it even more effective?”
Brunson says many water projects in developing countries fail for obvious reasons - money runs out, or machinery breaks down.
“Of the seven or eight communities we visited, there only were maybe two that were actually functioning as far as treatment systems.”
But equally important, she says, are cultural factors. Figuring out how to get the community behind a water filtering project.
The team spoke to a lot of people, and asked a lot of questions.
“How do you use water, where do you get it from, what do you think about the current treatment system, is there something you would prefer to have?”
Brunson, who also teaches in the college of business, says getting communities committed to water treatment could also be a money-making opportunity for local people.
“If you can set up a business so that the char you are selling that is helping people get treated water is making enough money so you can be self sustaining, then you can keep going,” says Brunson.
Science and social entrepreneurship coming together to make affordable, safe water available to millions.
The World Health Organization says this type of pollution causes nearly two million premature deaths each year."
An estimated three billion people - nearly half the world’s population - still use an open fire as the primary source of energy for cooking and heating.
But there’s a problem: the smoke.
“You have respiratory issues, lung disease, you’ve got pneumonia and you’ve got longer-term issues like cancer and heart disease as well that can result from exposure to indoor air pollution,” says Radha Muthiah, Executive Director of the Global Alliance for Clean Cookstoves.
The World Health Organization says this type of pollution causes nearly two million premature deaths each year. That’s more than tuberculosis and three times as many as malaria.
Everline Kihulla is one of the people trying to do something about it. She works for TaTedo, which manufactures and sells so-called ‘clean cookstoves’ in Tanzania.
TaTedo’s stoves are made with clay liners, which along with other simple design features, emit far less smoke and pollutants. And they use a fraction of the fuel.
Kihulla crouches beside one of them: “This one we have improved it and it currently uses almost 50 percent compared to the traditional one,” she says. “So the charcoal consumption here is less compared to the traditional one.”
Another benefit is that these stoves are made locally.
A nearby workshop employs 21 people and churns out 400 to 500 stoves each month.
Each person follows a cookstove through every stage of production, from pottery to painting. This teaches each worker a variety of skills.
Producing locally also boosts the economy and keeps the costs down, but the price-point is still an issue.
Cookstoves start at about $6 (U.S.). That’s a lot of money for many families in developing countries.
But subsidizing the price, or even giving stoves away free with the help of aid agencies, doesn’t necessarily work.
“There’s something about, you know, having to allocate a portion of even your small wallet to something that ensures that you value that and use that, and so that’s what we’ve seen in some of the other models that are out there,” says Muthiah.
“The fact that yes, people don’t have that much money at all, but if they spend even a few cents a day, you know, towards that stove, that they actually value and use it much more.”
Sitting alone on the steps of her home in Dar es Salaam, Lillian Njuu stirs a large pot of stew, which rests on a clean stove that she has used for two years.
She feels the expense is worth it for the health of her family, and plans to buy another.
In addition, while the upfront cost to buy a clean cookstove is higher, the fuel costs are lower because it burns less.
That in turn has an environmental impact. Burning less charcoal or wood means there’s less deforestation, which has caused major problems like flooding in many countries.
“It’s one relatively simple intervention that has a multitude of impacts that can really address the development agenda within a particular country as well,” says Muthiah.
Now the challenge is to get clean stoves into enough homes to really make a difference.
