Rhitu Chatterjee
Sandamalgama, Sri Lanka
As a journalist living and working in a foreign country (I’m an Indian citizen, but live in the United States), I like to think of myself as being culturally sensitive and aware regardless of where I’m reporting from. But I hadn’t realized that the pressures of being a journalist can dampen some of that sensitivity. At least that’s what happened on my recent trip to Sri Lanka, where I faced a situation very different from what I expected.
I visited the country for the first time this summer to report on a mysterious kind of kidney disease that is affecting thousands of rice farmers and their families.
Inside Haiti’s decaying camps, women like Delna Charlotin are on the frontlines.
Since the 2010 earthquake that ravaged Haiti’s capital, Port-au-Prince, there are still half a million refugees living in squalid, unsafe camps spread throughout the city, including in front of the collapsed Presidential Palace, on the Champs De Mars, the main plaza. The refugees living here are among the most vulnerable. They are the poorest of Haiti’s population, with no recourse but their own resilience in surviving. This is one of the camps that United Nations High Commissioner for Refugees has identified as having an alarming increase in rapes of women and young adolescent girls.
Among the sinuous small alleys that form this tent city, a 16-year old sat on a small stool nursing an infant. Her indolent expression betrayed a deep scar. A sense of loss of identity. She says she was gang-raped by ten men and became pregnant. She tells us she can’t escape the anguish. But worse, her face clouded by an indescribable degree of pain, she says she turned to prostitution to feed her child. Looking up, her eyes begged for a new life, though she didn’t know where to turn to. No family and no income. Her protection is from two strong young Haitian men who have taken it upon themselves to protect the young girls in the camp, disgusted at the extent of rampant violence with impunity. One of them, Ludner, says they are trying to protect all the women here, but they alone cannot. “We can’t, we just can’t,” Ludner says in desperation.
The first delivery room I saw atop the lush, rounded hills in eastern Nepal as a 20-year old made an indelible impression. It was empty, dark, dirty, and housed a homemade-style delivery table carved from wood covered only by a plastic sheet stained red, readied for eventual re-use. The sight stirred one of those moments of exaggerated empathy – where you have a true visceral reaction to the thought of a loved one being placed in that position before your eyes. For me, the thought of my own mom delivering in such a vulnerable environment was far too difficult to imagine, for the environment itself seemed to assist death as an all too possible outcome.
The fight for women’s rights, against violence and rape, and for recognition has been a long struggle in Haiti. Until seven years ago, rape wasn’t even punishable by law. It wasn’t a crime until some very brave Haitian women won the battle in 2005.
In 1994, at the height of the brutal military regime that had overthrown a popular priest turned President, Jean Bertrand Aristide, both soldiers and civilian gangs used rape to terrorize the population. To speak out against abuse meant sure death. Not just the victim, but also the family, friends, acquaintances.
Against these odds, a few women clandestinely started organizing. There were five, and they all had been brutally abused and raped. I was able to meet with them in hiding. They agreed to be interviewed in shadow on tape, at a secret location, which was a small Catholic mission hidden in one of the capital’s sinuous streets. No names, no organization behind them. I never forgot their courage. They asked me not to come back to their neighborhood for a while, to avoid attracting the slightest attention.
Water and water crises will dominate the news this week from Marseille, where the sector convenes for its triennial global meeting, the World Water Forum. Some 33,000 participants attended the last one, in Istanbul in 2009, and similar numbers are expected this year.
There will be plenty of jaw-jaw, from public relations spin to formal negotiations. But the words adopted will be important for whatever replaces the millennium development goals (MDGs).
An obvious topic of discussion will be progress towards the MDG targets for water. In 2000, nearly 200 countries agreed to halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation.
As one worker pounds away at a sheet of thin metal, bending it into shape, a woman nearby dips a large brush into a can of brown paint and slaps it onto a canister in swift, even strokes.
In a building next door another employee molds clay into the same circular shape on a pottery wheel while a colleague pokes holes into the bottom of dozens of pots before they dry.
This is a workshop on the outskirts of Tanzania’s commercial capital, Dar es Salaam. The product: stoves that emit significantly less smoke than traditional open-fire methods of cooking.
According to the World Health Organization, indoor air pollution from cooking and heating homes causes nearly two million premature deaths each year. That’s more than tuberculosis and three times as many as malaria.
It’s easy to see why it’s so damaging. A woman perches on a small stool or tree stump, leans in and puts all her weight into mashing and stirring that day’s meal for her family. Smoke from the fire billows into her face and fills her lungs as she struggles for breath.
With much fanfare, a consortium of governments, non-governmental organizations and pharmaceutical goliaths have launched a $785 million global initiative to eliminate 10 neglected tropical diseases by the end of the decade.
But one condition that didn’t make the list is nodding disease. It’s not only neglected, it’s practically invisible. For mothers who already struggle just to feed their children and keep them healthy, it’s terrifying.
Imagine watching your neighbor’s child suddenly come down with a mysterious disease that robs her of vitality and leads to a slow, confusing demise.
Then it strikes the child of another neighbor, who resorts to tying a frayed rope to her teenage son’s ankle so he can’t wander off and hurt himself or others.
Imagine the feeling of helplessness, knowing that the disease is indiscriminate, with no known cause or cure. It could strike your child at any time. There’s nothing you can do about it.
That’s the case in small pockets of Uganda and neighboring South Sudan, where thousands of children are suffering from nodding disease, or nodding syndrome. There’s no official name for it.
Cutting edge research is underway in Kisumu, Kenya, to find new ways to put an end to deaths from tuberculosis.
“My baby, whose name is Hope, was very ill and could not sit at 8 months of age. When she kept getting sicker, neighbors and friends contributed money to take me and my child to our rural home to await her death. Thanks to the DOT program and TB treatment, baby Hope is now strong and healthy. People still wonder what I did to her.”
This mother is just one person with reason to be thankful for the KEMRI/CDC community-based TB treatment support program known as DOT. This is one of many of the research and program activities underway at KEMRI/CDC, which is a research and public health collaboration between the Kenya Medical Research Institute and the U.S. Centers for Disease Control and Prevention.
It takes more than antibiotics to tackle pervasive illness and disease. It takes more than microfinance to break the cycle of poverty in much of the developing world. It takes more than school supplies to build an education system from scratch.
Even when programs are thoughtful and well designed, the secret of success in global health and international development is simple: build a community of collaboration. Commit to being guided by those you serve and allow local talent to drive the effort forward, then collaborate with compassionate people from around the world.
When Village Health Works was founded, it was these values that ignited our work and we continue to live these values everyday. All four of our talented staff physicians are from our catchment area. All of our nurses are from Burundi. Expats collaborate with local staff on economic development, the design and execution of education programs and agricultural innovation. Experts from around the world—all part of our global community—contribute their knowledge and experience. Simultaneously, the local community shares their expertise and guides the development of new programs.
One of NASCAR’s top drivers, Jeff Gordon, is taking on a challenge that may not move at the velocity he’s accustomed to, but requires the kind of strength, endurance and teamwork that he can relate to. He’s tackling cancer in Africa.
This week Gordon visited three hospitals in Rwanda, including Butaro, a facility that Global Health Frontline News reported on earlier this year.
The hospital has transformed health care in Burera, one of country’s poorest districts. It links rural community health centers with a well-equipped hospital that provides some of the best facilities and staff in the region.
Now Butaro Hospital plans to add a cancer center that will serve children from across Rwanda. It hopes to open its doors in May next year, providing diagnosis, chemotherapy, radiation and surgery. Preventive and follow-up care will also be incorporated.
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.
