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A diverse look at global health issues.

The lingering wounds of Liberia’s 14-year civil war

Tackling post-traumatic stress disorder and mental illness, one case at a time.
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Liberian Mike Otis Myers, 29, former child soldier and PTSD patient in Nimba County, February 2014. (Molly Knight Raskin/Courtesy)

NIMBA COUNTY, Liberia — In Nimba County, northeastern Liberia, the most visible signs of the country’s 14-year civil war are finally fading. Ethnic tensions have calmed, bombed buildings are being rebuilt and the economy is showing modest growth.

But the deepest wounds of the conflict are difficult to see and slower to heal. They are the psychological scars of war, and even after a decade of peace they are crippling people this small African nation.

“When I think about the war I just cry,” said 29-year-old Nimba resident Mike Otis Myers. “I survived, so I’m lucky. But when I think about what happened I feel so bad.”

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A common cause of blindness in India is preventable, but treatment is not always accessible

Prescription eyeglasses can correct ‘refractive error,’ which causes blindness for nearly 8 million people worldwide.
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Paras, an 11-year-old boy, reads a book by moving his fingers along the text in Braille at the school for the blind, Central Khalsa Orphanage, Amritsar India in January 2014. (Harman Boparai/Courtesy)

AMRITSAR, India — Harpreet Kaur, 13, prefers to sit in the front row of all her classes. She likes playing with her friends and watching her favorite shows on TV, like any teenager in her hometown. But in January, she noticed that she was not able to make out the images on the TV, even when she sat right in front of it. Her father took her to the eye hospital, and there doctors found that her vision was seriously impaired, and probably had been for a few years.

In most of the world, the leading cause of blindness is cataract, usually affecting people over the age of 60. But 8 million people are blind due to what’s called ‘refractive error,’ when the eye cannot clearly focus images, a condition that usually crops up in childhood. It is a very common visual impairment that is entirely preventable by wearing the right eyeglasses or contact lenses, but worsens without appropriate correction. If corrective lenses are not prescribed early, there can be irreversible loss of vision.

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Doctors Without Borders still excluded from Myanmar's Rakhine state

The government has said restrictions on the organization are a result of a broken agreement with the capital. A leaked document suggests there is more to the story.
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Displaced Rohingya Muslims carrying bags of aid after they collected from a humanitarian center at a camp on the outskirts of Sittwe in Rakhine state, western Myanmar on February 26, 2014. For Muslim communities eking out an existence in segregated camps in Myanmar's Rakhine State, aid groups provide a lifeline but their work is coming under threat from Buddhist nationalist campaigns that have pushed the government to eject Doctors Without Borders (MSF) from the region. (SOE THAN WIN/AFP/Getty Images)

YANGON, Myanmar — Last month’s decision by the government of Myanmar to suspend the operations of the medical aid charity Médecins Sans Frontières (MSF) prompted widespread concerns about the impact the organization’s withdrawal would have on the tens of thousands reliant on the support they provide.

Since that time, the temporary ban has been revised, and now only covers Rakhine state, on the country’s western coast.

In the wake of the announcement, government spokespersons stressed that the chief reasons for this decision were that MSF had breached the terms of a memorandum of understanding with Naypyidaw—the capital city of Myanmar—and had shown favour unduly toward one ethnic group in Rakhine.

However, documentary evidence and testimony obtained by GlobalPost appears to contradict this publicly stated rationale and instead suggests that the action may be punitive, linked to MSF’s response to a massacre that occurred at the end of January in northern Rakhine state—the same area where the charity's ability to operate remains frozen.

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In Kenya, sex workers want jobs and protection, but not just condoms

Guest post: A recent master's in public health graduate from Boston University talks with sex workers in Kisumu, Kenya.
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Kenyan sex workers march to protest for the legalization of prostitution on March 6, 2012 in Nairobi. Under red umbrellas and in red T-shirts, the protesters bore masks written with the phrases: "sex workers rights are human rights" and "my body, my business." (BORIS BACHORZ/AFP/Getty Images)

Editor’s note: Elizabeth Daube traveled to Kenya last year as a master’s student at Boston University’s School of Public Health through the Pamoja Together reporting project—a collaboration of students around the world committed to “telling the stories of foreign aid.” Her graduate thesis looked at the tension between the pro-sex worker rights and anti-trafficking movements.

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With birth control, US not alone grappling with reproductive rights and religious freedom

Wider reproductive health care coverage has been one of the more contested outcomes of the new Affordable Care Act. Here’s how other countries with deep religious roots -- Ireland, Argentina, and Israel -- have navigated the tension between reproductive rights and religious freedom.
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Demonstrators protest a requirement that most employers provide health care insurance coverage for contraception and sterilization as part of the federal health care overhaul, during a "Stand Up for Religious Freedom" rally, part of what organizers say will be a series of rallies in over 100 US cities on the second anniversary of the signing by US President Barack Obama of the Affordable Care Act, at Federal Hall National Memorial in New York on March 23, 2012. (Timothy A. Clary/AFP/Getty Images)

When significant parts of the US Affordable Care Act (ACA) went into effect earlier this year, key among the reforms was the expanded provision of free birth control. While many religious organizations were exempted from this mandate, the legislation has sparked protest and outrage, including litigation at the highest level, the Supreme Court.

But the US is not alone in attempting to strike a balance between offering reproductive health care services and respecting religious organization’s rights. In recent months, Ireland, Argentina, and Israel – three countries with deep-seated religious ties – all have tried to better navigate this thorny space as well. 

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When pregnancy is a death sentence for women

A physician-journalist reflects on the stubborn problem of maternal mortality around the world.
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A woman and her baby at the maternity ward in MSF's field hospital in Doro refugee camp in Maban county, South Sudan. (Nov. 2012). (Florian Lems/MSF/Courtesy)

Last December, as intense civil fighting erupted in South Sudan, I spoke with several doctors and nurses about its impact on the health of the 11 million people who call the country home. The problems accessing health care in South Sudan were already vast, and the emergence of violence would only make things worse – perhaps no more so than for expectant mothers.

I was working in New York with the communications team at Doctors Without Borders/Medecins Sans Frontieres (MSF), which provides vital care across South Sudan and nearly 70 other countries around the world. As part of my role, I debriefed MSF aid-workers like Miriam Czech, an American nurse who had just returned from a mission, and considered their experiences for sharing more widely with the media and public.

For three months, Czech had trained local nurses to provide better care for pregnant women. But the challenges were great. Czech told me about a frail 24-year-old woman who had walked three days from her village to the maternity unit in the city of Aweil. The woman was in the ninth month of her pregnancy, and her husband had to carry her part of the way because she also was suffering from terminal tuberculosis. Czech helped the woman give birth to a baby boy, fragile at only 1.2 kilograms — less than half the cutoff for low birth weight. But the mother could not endure the stress of childbirth.

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Malawi's paradox: Filled with both corn and hunger

Analysis: Despite its lush landscapes and growing stalks of corn, more than 10 percent of the country's 16 million people face severe food insecurity. But the right to food movement in Malawi has also been growing.
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A Malawian land worker harvests maize in Masungo village on the outskirts of the capital Lilongwe. (Gianluigi Guercia/AFP/Getty Images)

LILONGWE, Malawi — Visit this small, landlocked country in late January and you will have a hard time believing its people often go hungry.

It is mid-rainy season, and in and around the capital city the landscape is lush and green.

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Failures of Brazil's universal health care plan offer lessons for the US

In 1988, Brazil passed a law guaranteeing every citizen the right to health care. More than 25 years later, however, it is still struggling to meet that ambitious pledge.
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Medical and health workers protest against the working conditions in the public hospitals and the hiring of foreign doctors for the SUS health care system, in Rio de Janeiro, Brazil, on July 3, 2013. (VANDERLEI ALMEIDA/AFP/Getty Images)

SÃO PAULO -- Health is a legal right in Brazil. Ever since the country's constitution was rewritten after the fall of the military government in 1988, Brazil has guaranteed every citizen—and indeed anyone who sets foot in the country—the right to access health care services, at least in theory. Twenty-five years after passing universal health care, however, the country still hasn’t kept its promise.

With a population of 200 million spread across the world’s fifth largest country, the enormity of Brazil means that services aren't the same across the board: São Paulo, for example, has plenty of hospitals, but even ill-equipped clinics are few and far between in backwater states in the Amazon. Geographical distribution is just one barrier. Financial and technological gaps also have many saying that the universal health plan—dubbed SUS (Sistema Único de Saúde)—hasn’t fulfilled its guarantee to cover everyone in Brazil. 

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Standing still won't stop measles

Guest post: From South Sudan to sporting events like the Sochi Olympics, measles is a disease that doesn’t respect boundaries. But it can be prevented with a vaccine, and the international community needs to do more to ensure that everyone gets it, says UN Foundation President and CEO Kathy Calvin.
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UN Foundation President and CEO Kathy Calvin meets a mother with a sick child during a February 2014 visit to Kakuma 1 Hospital in the Kakuma refugee camp, Kenya, where many South Sudanese have fled after weeks of turmoil in their home country. There have been 82 cases of measles infection among South Sudanese refugees in Kakuma. (Alex Kwameru/UN Foundation/Courtesy)

KAKUMA, Kenya – Last week, I traveled to the Kakuma refugee camp in northwest Kenya, where many South Sudanese have fled after weeks of turmoil in their home country. The camp offers refuge to more than 130,000 people – mostly women and children who had to leave nearly everything behind. During my time at Kakuma, I was humbled by the important work that is being done by United Nations humanitarian workers and their partners to provide food, shelter and safety for the refugees. 

While visiting Kakuma 1 Hospital, I saw many children suffering from malaria and malnutrition. But I was most struck when the head community health worker there told me about a one-month-old baby girl who was admitted with a severe case of measles, brought by refugees arriving from South Sudan. The baby was so ill that the health worker feared she would not make it.

Many refugees around the world flee their homes to escape insecurity and violence, but the sad reality is that they also face the deadly threat of infectious diseases like measles. This threat often emerges in conflict zones as routine immunization breaks down and humanitarian aid is restricted. 

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Violence in South Sudan overwhelms an already fragile health system

Despite a ceasefire, NGO workers say security concerns have not eased and impede humanitarian aid to 900,000 displaced South Sudanese.
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A patient waits to be treated by Medecins Sans Frontieres (MSF) staff at a temporary clinic in a church of Malakal on February 5, 2014. Recent fighting in the country has seen waves of brutal revenge attacks, as fighters and ethnic militia use the violence to loot and settle old scores, with the United Nations and rights workers reporting that horrific atrocities have been committed by both sides. Many fear the conflict has slid out of the control of political leaders, with ethnic violence and revenge attacks between the Dinka people of Kiir and the Nuer of Machar, the country's two largest groups. (CARL DE SOUZA/AFP/Getty Images)

The United Nations is calling for $1.27 billion to support humanitarian efforts in South Sudan, where increasing violence paired with an already weak health system has created an incubator for disease.

Nearly two months after fighting erupted between supporters of President Salva Kiir and former Vice President Riek Machar, more than 3 million South Sudanese are in acute need of food, the UN reported Tuesday. An estimated 900,000 people have fled their homes in the country, which declared its independence from Sudan in July of 2011.

The UN is sheltering some 85,000 in crowded displacement camps on former peacekeeping bases, and about 123,000 have fled to neighboring countries. Most, though, are living in spontaneous settlements in the bush, where, without food, clean water, sanitation or shelter, aid workers say they are particularly vulnerable to communicable diseases like malaria, measles and diarrhea. 

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