Category Archives: OpenForum

Children’s Database: Help or Hindrance?

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The tragic death of eight-year-old Victoria Climbié in 2000 from abuse and neglect by her guardians led to major changes in child protection policy in the UK, among them the launch of the controversial ContactPoint database in England this year. Victoria had been seen by doctors, nurses, police, and social workers who noted her injuries, but failed to coordinate and act to stop the abuse. In response, the database was set up in order to improve communication between services about the needs of children, and holds basic information about each child, including name, address, gender, date of birth, school and health provider. On May 18, ContactPoint entered the next phase of roll-out when it became available to workers in 17 authorities in northwest England, before it is fully rolled out to the rest of the country.

While the government’s efforts to ensure children’s protection rights are laudable, the approach is problematic. ContactPoint infringes on the right to privacy, and more importantly, may not be the best way to improve child welfare. The UK Joint Committee On Human Rights questioned in a 2004 report whether universal database coverage of children at the expense of privacy is justified in order to achieve such a “general aim” as ensuring the well-being of all children. Instead, the committee had suggested a more targeted registry aimed at protecting vulnerable children. Chris Mills also argued in the Guardian that since ContactPoint does not include children who are temporarily residing in England, children like Victoria Climbié ironically would not benefit from the database anyway.

Popular opinion since the database’s proposal has been that it will only create extra problems. The Joint Committee On Human Rights voiced concerns over the inclusion of contact details of service providers; although no medical or personal records can be included in the database, sensitive information may still be revealed, such as a referral for a teenager to family planning services. Even children themselves are worried. A 2006 report found that children fear the database will expose them to harm, and do not trust the government to keep the database secure. Many felt they would not use sexual or mental health services for fear of disclosure to their school or parents, and some even pledged to evade being entered into the database.

It will be interesting to see whether the unpopular database will actually be able to better coordinate children’s services, or if the critics are right.

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China’s HIV/AIDS Prevention Efforts Are Ambitious, But Many Are Left Untreated

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As many as 10,000 Chinese children may be HIV-positive, reports Reuters, with many of those going without specialty care or treatment. While China guarantees free AIDS treatment, a combination of prohibitive costs associated with complications from the disease, distance from a hospital, and a continued emphasis on four front-line drugs (to which some people are resistant), has deterred many patients from seeking treatment. More patients have gained access to care since 2003, when the Chinese government launched China CARES (China Comprehensive AIDS Response), a community-based HIV treatment and prevention program. According to AVERT, an international AIDS charity, the WHO estimated in 2007 that China was supplying 19% of those in need of treatment with antiretroviral therapy. Although the treatment itself is free, patients often have to pay for associated clinical tests and other expenses related to healthcare. In 2004, the government also launched a national program with the goal of actively testing certain high-risk groups, including intravenous drug users and prostitutes. In the Yunnan province, a hub for drug trafficking, 3.2%  of the individuals tested were found to be HIV-positive.

Despite China’s recently implemented HIV prevention and treatment efforts, the country has a long history of discrimination against HIV-positive individuals. The same Reuters article reported that many people “have been turned away from hospitals and schools that fear contagion from AIDS patients.” Although the government has attempted to incorporate mass HIV/AIDS education campaigns into local communities, AVERT notes that a lack of qualified teachers for HIV/AIDS prevention education (especially in rural areas) and lack of HIV/AIDS education material in minority languages may be hindering efforts.

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Bangladesh Faces Diarrhea Outbreaks Due to Rising Temperatures, Power Outages

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Severe heat waves and power cuts are exacerbating the already endemic problem of diarrheal diseases in Bangladesh. The number of patients seeking treatment for diarrhea in the months of March and April has nearly doubled from this time last year, according to the International Center for Diarrhoael Disease Research, Bangladesh (ICDDR, B) where 42,000 patients have been treated in two months. Meteorological Office director Sujit Deb Sharma told the BBC that the temperature in Dhaka on Monday April 27 was 39.6C, the highest in the city for 35 years. The rising temperatures have led to a shortage of clean drinking water, made worse by the fact that power cuts of 8-12 hours a day have affected water pumps. While 80% of the population has access to improved drinking water sources in normal conditions, only about one third of the rural population and one half of urban residents have sustainable access to improved sanitation, reported WHO in 2006. Dhaka’s poorest populations are left to drink from sources of water contaminated with E. coli and rotavirus, including cheap sherbet drinks made from contaminated water.

The yearly occurrence of this type of diarrhea outbreak points to underlying problems with the water and sanitation infrastructure in the country. UNICEF has implemented programs to encourage the construction of sanitary latrines, to raise the very low percentage (36%) of individuals who have access to them. UNICEF and the government have also cooperated to install more than 20,000 safe water points within communities. More efforts of this type, along with programs to promote awareness about hygiene and water safety are necessary to mitigate or even prevent outbreaks of this magnitude in the future.

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In the News

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“Airborne” Highlights MDR-, XDR- TB Cases

Airborne: A Journey into the Challenges and Solutions to Stopping MDR-TB and XDR-TB is a powerful new book written by John Donnelly that features interviews and images to put a human face on the TB epidemic across the world. In her foreword, WHO Director-General Margaret Chan wrote, “I urge you to read the personal stories collected in AIRBORNE. These are human tragedies that should never have happened. But these are also stories about the uplifting success possible when the right elements are in place.”

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Australian Abortion-Aid Ban Lifted

A thirteen-year ban in Australia on providing foreign aid for abortions has been lifted and Australia will provide  funding of up to $15 million for reproductive health activities to help reduce maternal deaths across the world.

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$50 Million US Contribution to UNFPA

President Obama has recently signed legislation to provide $50 million to the United Nations Population Fund (UNFPA) to improve the health of women and children and reduce poverty throughout the world.

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US Capital Blighted by HIV/AIDS

The U.S. Capital has an HIV/AIDS rate on par with or worse than some African nations the city’s health department reports.

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US Urged to Fix Iraqi Refugee ‘Mess’ It Created

As the Iraq war enters its 7th year, the United States is urged to provide aid to Iraqi refugees displaced by the fighting.

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A Response to Dr. Claudio Schuftan

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Dr. Claudio Schuftan’s response to my article advocating that HIV-positive mothers in resource-poor settings bottle-feed according to acceptable, feasible, affordable, sustainable and safe (AFASS) criteria rather than breastfeed their infants employs the same line of reasoning used in the late 1990s to not treat HIV-positive Africans with antiretroviral drugs. In fact, we can see his argument unfold below by replacing the terminology about bottle-feeding (crossed out) with ART (antiretroviral therapy, indicating access to triple therapy) terminology (added in red italics):

  • “Economic access to six or more months of infant formula supplies ART is not realistic for poor mothers people living with AIDS in poor countries — nor, either, is access to clean water.”
  • “Of course we need to set the same human rights objectives for ourselves in the global South as those set in the North. However, as public health nutrition infectious disease experts, it is our obligation to acknowledge the local reality of HIV and AIDS affecting important segments of the poor population in our respective milieus. That reality shows us that economic access to infant formula ART does not exist for vast numbers of affected women people living with AIDS.”
  • “But the choice of whether to bottle-feed take ART or not is not really at the forefront for a woman person living with AIDS who cannot afford adequate food, has no adequate housing or access to safe water and sanitation, employment and education, let alone a right to gender equality health care.”

At that time, this was the same type of controversy, with good people and good intentions on both sides of the discussion. But thank goodness we didn’t listen to the majority of those who believed that the lack of financial resources and lack of education would prevent Africans from being able to take their ART medication correctly. We can now see that in fact these same uneducated, poor Africans are more adherent than Western populations. History has proven that the faithful activists, who believed that lack of financial resources was no excuse for providing substandard care, were right. Continue reading →

Book Review: Torture and health professionals

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Interrogations, Forced Feedings, and the Role of Health Professionals: New Perspectives on International Human Rights, Humanitarian Law, and Ethics (2009)
Eds. Ryan Goodman, Mindy Jane Roseman

The American public has been bombarded by news articles, memos, and reports about the horrors of torture committed by the U.S. government in their name. The tragic role of health professionals involved in human rights violations in detention centers has also been well documented. Although international human rights law, humanitarian law, and professional ethics codes prohibit the participation of health professionals in torture, such laws and codes are clearly insufficient in practice. What we need now is to reexamine the institutional and structural pressures that have allowed abuses to occur, and move forward from there.

This process has already begun. In January 2008, the Human Rights Program at Harvard Law School held a workshop for scholars and practitioners from the military and civilian sectors, including World Medical Association president Yoram Blachar, career intelligence officer Steven M. Kleinman, Physicians for Human Rights president Leonard S. Rubenstein, and others. This book compiles the different perspectives of the workshop participants, providing interdisciplinary analysis and suggestions for institutional reform on two specific and important practices: forced feedings and coercive interrogation. The authors examine cultural frameworks and social situations that affect the faculty of health professionals,  provide ethical and policy analysis, and offer practice guidelines. This book is a must-read for anyone concerned with the participation of doctors and psychologists in torture, and the changes that must be made to ensure that they are held accountable and that abuses do not happen again.

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Religious Leaders Help Spread Critical Health Messages in Pakistan

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Pakistani mother seeks charity from motorists

Pakistani mother seeks charity from motorists

Local religious leaders are proving to be a crucial resource in the fight against infant and maternal mortality in Pakistan’s southern Sindh Province, where a new Health Ministry initiative is in progress.

“In the communities here, the word of a cleric carries more power than anyone else. Why not use their influence and clout for a healthy cause,” says Ahsan Akbar Dhani, district coordinator of the National Programme for Family Planning and Primary Health Care in Pakistan. Leaflets, distributed at local madrasahs (Islamic religious schools), urge Imams to incorporate messages stressing the importance of good hygiene, TT (Tetanus Toxoid) inoculations for mothers and immunizations for infants.

According to USAID, one in 23 Pakistani women dies in childbirth, compared to one in 5,000 women in developed countries, while in the Federally Administered Tribal Areas (FATA), 135 out of every 1,000 children under the age of five die from curable illnesses. By involving the religious leaders in the health awareness campaign, the Health Ministry hopes to counter misconceptions about vaccinations and even oral rehydration salts, which some people believe may cause impotence. The leaflets contain the footnote “May Allah always give us the strength to stay clean and protect ourselves and others from diseases as well as disseminate information with regards to health and hygiene, Amen.” By using both religious language and the mosque’s pulpit to spread public health messages, the Health Ministry has initiated an effectual method of creating better health outcomes in local communities.

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Curbing Rape on Tribal Lands

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Watson’s Atlas Map of Indian Territory (1886)

Watson’s Atlas Map of Indian Territory (1886)

A startling 1 in 3 American Indian women will experience rape in her lifetime, according to the US Justice Department. Yet only federal attorneys can prosecute felonies like rape committed on tribal land – attorneys that are also responsible for terrorism and drug cases. The result: US attorneys decline to prosecute 75% of American Indian rape cases every year, according to NPR. Even if tribal authorities were able to prosecute rape cases, they would still only be able to prosecute members of federally recognized tribes. This poses a severe dilemma, since 86% of assailants are reported to be non-Indian. To address these issues, Congress is now attempting to strengthen the control of tribal authorities and increase the accountability of responsible federal agencies with the Tribal Law and Order Act of 2009.

While tribes maintain sovereignty through tribal police departments and tribal judiciary systems, the federal government holds the purse strings, and federal law still preempts tribal law in civil rights and criminal jurisdiction. Tribal law enforcement officials can’t prosecute non-Indian offenders, and even if a crime is committed by an American Indian, they can’t prosecute felonies like rape. Underfunding has also led to inadequate tribal law enforcement; in 2007, the Standing Rock Sioux Reservation had only 5 Bureau of Indian Affairs officers patrolling an area the size of Connecticut.

This may change — if the new bill passes. Introduced by a bipartisan group of senators, the bill would increase the authority of  tribal police by allowing them to make arrests for all crimes committed on tribal land, and to transfer prisoners to the Bureau of Prisons where the tribal government reaches an agreement with the Bureau.  It would also increase the accountability of federal agencies by establishing an “Office of Indian Country Crime” dedicated to enforcing federal criminal law committed on tribal land, among other provisions.

The bill specifically addresses the epidemic of domestic violence and sexual assault in that it would require the Indian Health Service (IHS) to implement policies and procedures for victims, establish concurrent jurisdiction to prosecute sexual assaults at the request of a tribe, and require the development of victim training programs for law enforcement and IHS personnel. The bill may not be a panacea, but giving tribes the authority to arrest non-Indians for federal crimes such as rape is an essential step in the protection of American Indian women against sexual violence.

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