Survival - mother and child

Photo from Flickr/M R Hasan. Creative Commons Licence.

The population of the UK is approximately 60 million. Bangladesh, roughly the same area, has a population of 150 million. People struggle to share resources. Over 90% of births occur at home with a traditional birth attendant whose practices are unlikely to have changed from those of 100 years ago. Her only equipment is a razor blade and a length of string.

Marjana, expecting her second child, lives over two hours away from the nearest hospital. If there is an emergency there will be little that can be done. She is 50 times more likely to die than a woman giving birth in the west. Women are encouraged not to breast feed for the first few days. If there is no other milk available, the baby will in effect be starved.

Four million babies in Bangladesh die within a month of birth, two million within the first day.

But things are improving. While the Millenium Development Goals are off target, the number of deaths in children under five has fallen by 50% since 1990. Microcredit programmes and increased school attendance are empowering women across Bangladesh.

This BBC video (over 10 minutes) gives more encouraging news.

Iness was born with two club feet. They got so bad she eventually could not attend school.

If she had been born with club feet in the UK, as 1 or 2 in 1000 British children are, she would have undergone extensive surgery and possibly been left with scarring and in pain. This sort of surgery and subsequent treatment isn't available in countries such as Malawi, where they just don't have the medical or financial resources to support it. Nor can the patients cope with long drawn out treatments. Iness' mother said, “It was such a burden for me to come every week. I am poor and to find transport money was like struggling for breath.” A different way to treat babies in their first year of life, while it is still possible to avoid complex surgery, was urgently needed.

Photo from Flickr/MikeBlyth

Here in the UK, the BBC is currently showing a series of television programmes (Superdoctors) which looks at various high-tech medical procedures, but one of these programmes is instead looking at the work of Steve Mannion, an orthopaedic surgeon from Blackpool, who spends two out of every four weeks in Malawi in southern Africa. When he first started visiting Malawi, he was one of only two orthopaedic surgeons for a population of about 12 million. He had to find a solution for the children with club feet using the resources available in the area. He found a low-tech method of treating the condition using a type of physiotherapy which would allow non-medical officers, not doctors, to treat patients. The results have been so successful, better than those in the UK, that this low-tech method is being introduced into this country.

The cost of the surgical robots featured in the television programme is about £12 million or roughly $24 million. How many children in the third world could be treated for that sort of money to enable them to walk again, to go to school and earn a living? As opposed to a robot which does work normally performed out by a surgeon. The hospital carrying out this project was built with support from the Beit Trust of the UK, and is managed by the American CURE International, paying the running costs.

I tend to be wary about faith-based charities but this one says it will not turn away a patient due to an inability to pay, ethnic background or religious affiliation. All children are treated free of charge and as a result Iness is now able to attend school again. Chisomo, another patient, and his family are Moslem. His mother said, “I have been encouraged. I think God deserves all the glory. I will leave to testify to people and even tell my son as he grows up that a Christian hospital healed him, a hospital without discrimination.” That warms my heart - a secondary but very important benefit of better trust and understanding.

See also Feet First, a charity set up by Steve Mannion himself in 2004.

"Africa being drained"

I took the title of this post from the BBC report which, like many, many others, implies that African doctors and nurses working abroad are causing major problems in their home countries.

The author, Michael Clemens, of the original paper has said in a blog post that he is very uneasy about these conclusions being drawn and has written another to show that there is little evidence for the assumptions.

The reasons that it may not be a negative picture can be summed up as follows:

• The doctor or nurse may be following up an opportunity unavailable at home.
• The salary may be five or ten times as high as in Africa, enabling support for families left behind.
• The main causes of death in Africa are more dependent on prevention than care, for example: diarrhoea, malaria, HIV.
• Many of the care givers in Africa, sometimes as many as two-thirds, live in or near the main cities, so the majority of people who live in rural areas at great distances from the cities are unlikely to be affected by a doctor leaving to work abroad. Many rural clinics can find no-one at all to fill vacancies.
• The option to emigrate has positively encouraged Africans' decisions to enter the health professions.

Michael Clemens' final paragraph:

If you think that limiting the movement of Ghanaian doctors is justified by the fact that Ghana doesn't have enough doctors, ask yourself: Does Ghana have enough entrepreneurs? Does it have enough engineers? Does it have enough wise politicians? The answer is 'no' across the board, so the logical conclusion of this sort of thinking is that we will somehow develop Ghana if we stand at the airport and prevent all Ghanaians with any kind of skill from leaving, preventing them from accessing the very high-paying jobs to which most of us living in rich countries have access by birthright alone. That is ethically problematic at a minimum, as well as ineffective -- trapping entrepreneurs in Ghana would not produce an efflorescence of investment.

The situation is very much more complex than it seems at first sight.

Tobacco companies meet their match in Nigeria?

Photo by Flickr user lanier67. Creative Commons Licence

From The Guardian

While tobacco sales have been declining in Europe and the USA, tobacco companies have increasingly been targeting the developing world (as mentioned by Elaine in the comments to my post about Procter & Gamble). The World Health Organisation estimates that consumption in developing nations is increasing by 3.4% per year.

Nigeria is now launching a lawsuit against three multinational cigarette companies, accusing them of targeting young people to make up for the declining sales in elsewhere. The government has banned billboard advertising for cigarettes, and radio advertising until after 10:00 pm but little else. By contrast South Africa has strict advertising laws and prohibits smoking in public places. Kenya too has banned smoking in public places.