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A diverse look at global health issues.

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.


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. 


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.


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.


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. 


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. 


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. 


Most African leaders not making promised investments in agriculture

Analysis: 10 years after committing to increase government spending on food production, only seven African countries have consistently met that pledge.
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Kenyan farmers pick through their maize crop in a field in the village of Kapsimatwa near the Rift Valley town of Bomet in western Kenya on September 9, 2008. (YASUYOSHI CHIBA/AFP/Getty Images)

ADDIS ABABA, Ethiopia — The African Union commemorated the 10-year anniversary of the Maputo Declaration on agricultural development with the launch of the “Year of Agriculture and Food Security” last week at its summit in Addis Ababa.

Around the summit, following discussions of the political and humanitarian crises in South Sudan and the Central African Republic, I heard the talk turn to agriculture. And African governments certainly have a lot to talk about.

Since Maputo, which mandated that African governments commit to spending at least 10 percent of their budgets on agriculture by 2015, 20 nations have pledged to do so under the rubric of the Comprehensive African Agricultural Development Program (CAADP). Agricultural spending has doubled across the continent, a notable achievement that has shown solid results in increased food production and economic growth for those countries that have fully invested in the sector.

But there is a long way to go. According to a new report from the nonprofit ActionAid, most governments are not “walking the talk” – they are failing to live up to their CAADP commitments.


India's successful polio campaign a model for other countries

Once home to the world’s largest number of polio cases, India recently celebrated three years free of the disease. The country’s unlikely success story is inspiring leaders in other countries where the virus remains endemic.
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An Afghan health worker administers polio vaccine drops to a child during the first day of a vaccination campaign in Jalalabad, Nangarhar province on December 29, 2013. Polio, once a worldwide scourge, is endemic in just three countries now - Afghanistan, Nigeria and Pakistan. (Noorullah Shirzada/AFP/Getty Images)

With one arm, the woman clutches a sleeping baby to her chest. With the other, she’s waving away a polio vaccination worker who has come to her home in Agwanpur, India.

“We have told you earlier, and we will tell you again: we don’t want the vaccine,” she says. Her whole body is tense, shaking with each emphatic flick of the arm. “Consider this your home,” she says. “Come whenever you want. But never to discuss this vaccine.”

The scene, from a 2009 UNICEF video, illustrates one of the last remaining obstacles in the world’s quest to wipe out polio, a highly contagious virus known for paralyzing its victims. Aggressive global vaccination campaigns have wrangled the number of polio cases down from 350,000 in 1988 to less than 400 in 2013, according to the World Health Organization. Still, polio remains endemic in Afghanistan, Nigeria and Pakistan, where social resistance — often punctuated by violence — and other challenges, such as poor record keeping and mobile populations, have prevented eradication.

India, long considered one of the most difficult places to unroot the disease, managed to innovate its way around such roadblocks by, among other things, switching vaccine formulas and devising a high-tech tracking system. Between 2009 and 2011, the country cut the number of infections from 741 — the largest caseload in the world — to zero. Now India is celebrating three years polio free and its path to success has become a model for global efforts to stamp out the virus for good. It’s early still, but results of the scale up seem promising; in January, Afghanistan, Nigeria and Pakistan reported 40 percent fewer cases than the same time last year. 


Why it's dangerous to trust corporations to lead the fight against world hunger

Analysis: When multinationals get involved, it's often to develop markets for their own products.
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This photo taken on February 29, 2012 shows a farmer transplanting rice on her family's lot of land on the outskirts of Hanoi, Vietnam. After the village-sized collectives were broken up in the mid-1980s when the country began switching from a Soviet-style centralized-economy to market economy, each farm family was given a 20-year land lease. Land disputes with local authorities became an increasingly contentious issue in communist Vietnam where all land is owned by the state and usage rights are not always clear or protected. (Hoang Dinh Nam/AFP/Getty Images)

GENEVA — The world’s elites gathered in Davos, Switzerland last week for the annual World Economic Forum (WEF), paying $20,000 a person for the privilege of offering grand solutions to other people’s problems.

I was down the road in Geneva attending a decidedly low-brow, two-day expert workshop on agricultural trade and development. But downwind we could almost smell their champagne fondue, which no doubt helped the powers-that-be focus on the global food crisis.