OpenForum – a blog by the Health and Human Rights community

The editors of Health and Human Rights: An International Journal invite manuscripts for a forthcoming theme issue on “Health and Human Rights in Disasters.”  NEW DEADLINE: October 31, 2010 (October 15 for manuscripts in Spanish or French).

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A child born in sub-Saharan Africa is twenty-five times more likely to die in the first five years of life than one born in the United States. If she lives to child-bearing age, she is a two hundred times more likely to die in labor. Overall, she will die thirty years earlier than the American child. If this health gap is unfair and unacceptable, then how can the international community be galvanized to make a genuine difference?

To answer this question, Lawrence O. Gostin, Faculty Director of the O’Neill Institute at Georgetown University Law Read more

The Office of the High Commissioner for Human Rights (OHCHR) and the World Health Organization (WHO) recently issued a summary document that defines and explains the Human Rights-Based Approach to Health (HRBA). It can be downloaded here.

[Editor’s note: This guest post was written by Maria Alejandra Cardenas. Her bio and link to her American Comparative Law Review article on this topic is found at the end of the article]

Over the past eight years, the Constitutional Courts of Argentina, Ecuador, Chile, and Peru have issued decisions banning or highly restricting access to emergency contraceptive drugs. These decisions have all followed a similar pattern in their arguments as well as the same order in which such arguments were considered. Prior to these cases, the battleground over the right to life had been limited to the field of abortion law; using birth control laws would have been considered unusual. This post offers a summary of this trend by looking at the structure of the latest of these Constitutional Court rulings, the decision issued by Peru’s Constitutional Court in 2009.

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[Editor's Note: This OpenForum op-ed was written by Abigail Hook, a Harvard College undergraduate currently volunteering with the FXB Center]

The wealth of global response to Haiti’s January earthquake suggests a tremendous sense of global responsibility for a country whose current death toll is over 200,000. Now that Haiti is on the world’s central radar, how might those involved in rebuilding ensure that Haiti become a lasting center of global responsibility? That is, what’s the relationship between empathy for those affected by disaster and an engagement in transformation?

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[Editor’s Note: This two-part entry features a narrative and photo essay by Dan Schwarz. The entire photo series and Dan's bio may be found below.]

Founded on an unwillingness to accept the grave inequities and double standards that are tolerated every day within the world, Nyaya Health, a small NGO in rural Nepal, operates with a mission of health equity and social justice. Nyaya — which means “justice” in Nepali — founded much of their work upon the model of Partners In Health, taking a rights-based, community-based approach to health care delivery. This post tells the story of Nyaya’s work in Bayalpata, and lessons learned in developing a health system in rural Nepal. Read more

[Editor's Note: This photo essay by Dan Schwarz is accompanied by narrative, found in the post above.]

Photo 1: Sanfe Bagar Primary Health Center

Nyaya Health opened the first community free clinic in the district of Achham in 2008. During the 14 months of its operation, Nyaya’s all-Nepali staff of 20 full-time personnel saw over 17,000 patients, providing the first allopathic physician in a region of over 250,000 people. Nyaya closed the clinic and moved all operations to the nearby Bayalpata Hospital in 2009.

Photo 2: Bayalpata Hospital

Today, seven months after opening its doors, Bayalpata Hospital has a continual flow of patients, and is quickly gaining a reputation for being the best available healthcare in the region. As Nyaya continues to expand its services through its partnership with the Nepali Government, it aims to contribute to the broad-based development of a community health system, focusing on health equity for all in a region that has historically been one of the most marginalized in all of Southern Asia.

Photo 3: Dilapidated Bayalpata Hospital buildings

Having sat unused for nearly three decades in a region with little power, water, or transportation infrastructure, the renovation of the hospital has been, and remains, an extremely complicated process. Of the five original staff quarters, only two have been restored, the others far too damaged to ever be functional again.

Photo 4: Bayalpata Outpatient Department

Bayalpata Hospital sees, on average, ­50 to 60 patients per day in its outpatient department. Patients most commonly present with respiratory infections, gastroenteritis and diarrheal illnesses. All services, including Nyaya’s laboratory and pharmacy, are free.

Photo 5: Emergency department

Upon opening, Bayalpata Hospital became home to the first emergency room in the area, providing services around the clock. Patients’ families frequently carry their loved ones in on homemade stretchers, often walking for over 4 to 6 hours to reach the hospital. Beginning in 2010, Bayalpata Hospital will commence emergency transport services to larger referral hospitals in the South of Nepal, with the region’s first ambulance, a recent donation from the Indian Embassy.

Photo 6: Nyaya laboratory tech Drona Awasthi

By offering point-of-care laboratory services, Nyaya is able to provide top-quality healthcare despite the remoteness of Achham. However, in the winter, because of the poor temperature regulation of the concrete buildings of Bayalpata Hospital, our lab technicians frequently have to use portable heaters to raise the temperature of the equipment before turning them on to avoid causing damage to the machinery.

Photo 7: Staff quarters

In order to provide 24-hour emergency services, Nyaya’s on-call staff all live within the hospital premises. As there are not enough quarters for the entire Bayalpata staff, and because Achham is very rural, this means that other staff have to walk up to 2 hours each day, to and from work, to their homes.

Photo 8: Hospital generator system

Because the regional power grid is shut off for several hours each day (“load-shedding”), and often for weeks at a time altogether, Nyaya relies on generators and inverters to power Bayalpata Hospital. But even this remains complicated: because no skilled maintenance technicians exist in the region, when the generator breaks, it must be shipped across the country where trained personnel spend weeks fixing it, at great costs.

Photo 9: Hospital water pipe

Because of the lack of a water source near the hospital, Nyaya has established large reservoirs at the hospital that are fed by a small pipe running over four kilometers away to the nearest reliable and clean water source. Given the distance the pipeline travels though, there are often breaks in the water supply, requiring Bayalpata staff to follow the pipeline backwards until they can find the leak and repair it. In the future, Nyaya hopes to develop a more permanent, underground system of piped water.

Photo 10: Bayalpata communications satellite

In order to maintain communication with local and regional authorities, and also with Nyaya’s extensive network of international volunteers, Nyaya has established a satellite internet connection, providing high-speed wireless internet in even the most remote of regions.

Photo 11: Bayalpata road following monsoon storm

Complicating Bayalpata’s operations even further, the transportation network in Achham is extremely poor. The roads are frequently washed out during monsoon season, isolating the hospital from its supply chain of pharmaceuticals, medical equipment, food, and other necessities, and preventing patients from getting to the hospital for care. The Nepali government is currently working to improve the quality of the road leading to the hospital, but the exact timeline remains unclear.

Photo 12: Nyaya Health Staff

In its mission to strengthen the Nepali public sector, Nyaya employs an all-Nepali staff, while partnering with volunteer clinical and public health experts from all over the world. Nyaya’s staff consists of 23 full-time personnel and is rapidly expanding. Nyaya’s Board of Directors, and all expatriate volunteers, are exclusively volunteer – Nyaya does not pay consultancy fees, and channels over 99% of its funds directly to health care services in Nepal.

Photo by Meredith Baker

[Editor's note: This is a guest post written by Meredith Baker. Her bio may be found at the end of the article.]

This past winter break, I had the opportunity as part of my undergraduate program to travel to Nicaragua and participate in community development work. While I have witnessed considerable poverty before, the community of Nuevo Amanecer, Nicaragua, brought me to a new understanding of what abject poverty can mean.

While the people of Nuevo Amanecer have a variety of basic needs, such as access to clean drinking water (they walk three miles a day to get water because local wells are contaminated), malnutrition amongst children is perhaps the most visibly dire. According to a UNICEF report, iron deficiency impairs the mental development of 40%–60% of children in developing countries. It can not only lead to anemia, but is also estimated to lower the GDP of developing nations by 2% due to lower energies and therefore low productivity of the workforce. Vitamin A deficiency leads to destroyed immune systems in children under the age of 5 and approximately 1 million deaths each year.

One hundred families live in Nuevo Amanecer (meaning “New Sunrise” in English), a community founded only a few years ago with the help of the Long Island student group “Students for 60,000.” The community serves as a permanent residence for “squatters,” or people who would have otherwise settled illegally or on public land. It was heartbreaking to see the kids of Nuevo Amanecer running around clothed only in dirty underwear – the only pair some of them owned. Most of the children were very skinny, with twig-like arms and legs, rotting teeth, and swollen bellies as a result of malnutrition and hunger. A few toddlers I encountered had thinning copper-colored hair (hypochromotrichia), a frequent symptom of protein deficiency.

The people of Nuevo Amanecer had a community vegetable garden. However, there were never enough fruits or vegetables to go around. The diet for most consisted predominantly of rice: good for carbohydrates, but lacking many other essential nutrients. This made me wonder if there weren’t an inexpensive, easy way to provide fortified foods to help these kids meet their daily dietary needs. Perhaps if the people of Nuevo Amanacer were educated on the necessary macro and micronutrients their bodies needed, and perhaps if aid organizations were able to provide fortified food or multivitamins in greater supply, the community’s emaciated children could at least begin to look and feel like healthy children their age.

Coincidently, my favorite columnist, Nicholas Kristof of The New York Times, was also in Central America at the time, writing a column about malnutrition in Honduras, with suggestions for simple, cheap ways to supply people in developing countries with necessary nutrients. In his article, Kristof reminds us that lack of vitamins and minerals and nutrients can have dire consequences and that it is cheaper and easier to prevent nutrition related birth defects than to treat them.

According to the UN Food and Agricultural Organization, the cost of fortifying food staples, such as sugar, salt, and flour with supplemental nutrients and vitamins can cost as little as 30 cents per person per year. One vitamin A capsule provides enough vitamin A for up to 6 months and costs around 2 cents. A three-month supply of iron pills is only 20 cents. This is a small price to pay for big returns.

Do you read our blog regularly, have good management/editing experience, a background related to health and human rights, and want to get more involved? The FXB Center for Health and Human Rights, located at the Harvard School of Public Health in Boston, seeks an intern to serve as OpenForum manager, available immediately. Must be able to work at least 25 hours per week during regular business hours. More information available here.

Liberia, a country whose identity is bound tightly to a history of unrest and violence, is attempting a new project in Montserrado County (the region that includes the capital city of Monrovia) in an attempt to confront the increasing problem of food insecurity. In an area where only 1% of residents grow their own food, the project’s promotion of “market gardens” has already made a difference for thousands.

Headed by the Food and Agriculture Organization (FAO) and funded by the Swedish International Development Cooperation, the new project is providing training sessions, agricultural education, and seeds to a fortunate 5,000 who own small portions of uncultivated land on the outskirts of Monrovia. The outcomes have so far been favorable. An individual, or more commonly a family enrolled in the program, can make around US$200 per season from red peppers (a fairly common crop in the area). For one young man participating, this meant a chance to go back to school. And the long term health benefits — not only to the individual but also to the community — that come from an increase in produce consumption are desperately needed: almost half of all children are affected by malnutrition.

The market gardens program, it is hoped, will encourage people in the areas surrounding a poverty stricken city to spread the once prevalent farming land back into communities. Seventy percent of the population in Montserrado once farmed their own land, but due to years of civil unrest, Liberia is currently utilizing a mere one third of the land available.

Food security is thus not a new problem, and although there are currently many valuable interventions in operation, the problem is reinforced daily by the overwhelming presence of slums within the region. Perhaps one of Liberia’s greatest challenges, the increase in slum population — now the greatest percentage in all of sub-Saharan Africa according to the UN–Habitat report — is inexorably linked to the country’s political climate and social dynamics. Liberia has been in civil war intermittently since 1980, when a military coup led by Samuel Doe ushered in a decade of authoritarian rule. Since then, relatively brief patches of peace alternated with unrest, with the situation settling down in 2005 with the democratic election of the current president, Ellen Johnson Sirleaf. The country is still reeling from years of instability and is attempting to recover from shifts in every area of society, most notably in a debilitating mass migration into Monrovia that has severely impacted food availability.

FAO’s current attempt to reinstate small farms is limited in its reach. For now, those included in the program are the relatively well-off that own land in the first place, and thus the entire slum population is counted out. The goal that the idea will “catch on” may be working, as it is laying a base for an increase in food production that could later benefit the entire region, including those living in slums. So far there have been positive outcomes not only for crop yield, but also for the personal goals and changed lives of the women and men involved.

For more info on the urban garden project: http://www.irinnews.org/report.aspx?ReportId=87798

For more general information on Liberia: https://www.cia.gov/library/publications/the-world-factbook/geos/li.html

For more info on food insecurity in sub-Saharan Africa: http://www.kahawacafe.com/pubs/ASR/12No1/Clover.pdf

For information on the housing crisis and prevalence of slums in Liberia: http://www.theperspective.org/articles/2007/0123200703.html