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The real top killers

13 July 2011

Two days ago I mentioned Hans Rosling, Professor at the Karolinska Insitute in Stockholm and the man behind Gapminder. If you are interested in any sense in global public health has developed and which factor are behind, I suggest that you check out Hans Rosling’s presentations at TED.talk. This one is a good one to start with.

What I’ll write about today is the first time I heard about Rosling and his work. It was through Marian, my upper secondary school teacher in Social sciences. Marian was a great teacher, she’s now retired, and she’s one of the persons that has influenced my career path the most. Anyhow, one day in 2002 Marian was really excited about an article she had read in the paper about Rosling and his work. A couple of weeks later I and my friend Lena were deciding on a theme for a major project. We chose International Public Health.

I learned a lot from that project. Firstly; about good team work, it was great to do that project with Lena. Secondly, I learned about the topic and it’s one of the school projects that I have the most advantage of later. How diseases like HIV/AIDS, malaria and TB are spread, where they are common and have the worst impact, that obesity globally is in numbers of people almost a big problem as under-nutrition and that in average each cigarette that you smoke shortens your life span with that same amount out time it takes to smokes it. We also included how lack of water affects people health and cause scary diseases such as bilharzias.  That project has been the basis for my understanding of international public health ever since, of course I gained knowledge along the years, but it has always been the basis. It was not until I started to read about children health in UNICEF reports that I realized what we had missed. We missed out on two of the top-killer diseases of the developing world, which are also the top two ones for child mortality. Pneumonia and diarrhea. Together they cause the death of around 6.2 million people, which of the almost 90% are children below five years. I honestly don’t believe that the 18-year-olds we were missed out on them because we didn’t do background research. I think the main reason was that the focus within the International Public Sector or the aid community or the media, was not on these rather cheaply preventable diseases, but rather on HIV/AIDS and starvation (and starvation as in shortage of food, not malnutrition which is partly another thing). I’m proud that we found TB on our own.

Somewhere in the AIDS-epidemic and the African famines of the 80’s the basics were forgotten. Prevent children from getting diarrhea, supply rehydration for when they do, vaccinate against measles (6th on the top killer list), polio and tetanus. And WASH-programs.

The list is top killers is:

1)      Respiratory infections (mostly pneumonia)

2)      HIV/AIDS

3)      Malaria

4)      Diarrhea

5)      TB

6)      Measles

7)      Whopping chough

8)      Tetanus

9)      Meningitis

10)   Syphilis

  And the top killers for children:

1)      Pneumonia

 2)      Diarrhea

 3)      Malaria

4)      Measles

5)      HIV/AIDS

 

 

 

And yes, of course HIV/AIDS is a horrible disease, it needs to be both prevented, treated and researched for a vaccine. But there are other diseases that receive much less attention,  funds and action that there are already methods here to prevent, vaccinate and sometimes cure.

As a final not I will mention that me and Lena choose rather different paths in life, she became a fashion designer and her garments and collections can be checked out at her own brand Lena Quist.

Lies, damned lies and statistics

11 July 2011

There’s an expression saying that there are three types of lies: “Lies, damn lies and statistics” And I can see the point of that, statistics can easily be manipulated. But I will tell why I like statistics:

  • That it makes it possible to compare, for example over time. Everything from sales quantities to development of literacy. This one of the reasons I love Gapminder, created by Professor Hans Rosling, which shows the development of the world’s countries in various aspects.
  • It can create transparency.
  • Three words: National Distribution Curve

Two personal reasons:

  • A nerdy part of me likes it. Formulas and graphs, for some it reason it is fun. For a limited amount of time. And I have to have an interested in the data itself. Comparison of completed school years vs  the socio-economical status of the parents: Oh yes. Comparison of the preferred saving gel in Germany and the U.K.: Not so much. (Probability calculations: Oh no!)
  • It takes away some of the horrible stories that are behind the figures. Soviet Union dictator Josef Stalin is supposed to have said “The death of one man is a tragedy, one million dead is statistics”. Stalin wasn’t a role model in any sense, and considering statistics he’s a very good example of how to use it for manipulation. But there is something true in that quote. Large impersonal numbers takes away the tears. I know I lose the personal connection, but at the same time it doesn’t have the same heartbreaking effect. I don’t know if the pro or cons are predominant concerning this in the end.

But something I have realized during the months I have spent here is the necessity of updated development statistics; this is especially true for a country such as India. It is simply not the same country as a decade back. Examples of this are water connectivity, literacy rates and the former practice of child marriage. Child marriage has during the last fifteen year gone from a normal custom not something rare.

However, this is some examples I’ve seen based on usage of old data, which contributes to misunderstanding and in the end probably also mistargeted efforts for change. The worst I have seen was a data source from 1979 in report from the 2000’s. Think about it. 1979. The year of the Islamistic Revolution in Iran. The year then Soviet started its war in Afghanistan, a war very much caused by the political situation of the Cold War. ABBA was on top of the charts with their LP Voulez-Vous. Taste those words. Soviet Union, the Cold War, LP. It feels like a while ago, right? Usage of development data from the 70’s would be the same thing as saying that Iran is ruled by a pro-American government, music is distributed on LP-records that you buy in music stores and the World is under threat of World War 3 between the US and the communistic Soviet Union.

A lot has changed since then, huh? Well, it has certainly in India. So if you don’t have reasonably updated data, the probably best thing to do is to not use it at all. Because the effect can be that focus ends up at the wrong place.
The 1979-case was an extreme example. But it is rather common to see data from ten years back in newly printed reports. Same example again: Music is still bought mostly in music stores but now on CDs, the World Trade Center’s Twin Towers is a popular tourist destination and hot spot of the economy in New York, China is the fifth largest economy of the world and Iraq is governed by the dictator Saddam Hussien. Or maybe not. Still some things have changed, haven’t they?

And how was life back in 1979? I don’t know have a clue; it was five years before I was born.

Kutch 2

30 June 2011

I just realized how bad I have been at updating here. Bad me. I have these ideas all the time about what to write about, but for some reason it never happens.

But now I write. Good me.

OK, time to stop the randomness. I’m currently in the city Bhuj, in Kutch (the northern region of Gujarat) and I am here to do the field work of my internship. Everyday I go out to one village to interview children, adolescent girls, parents, teachers and health workers  how the new water supply schemes, sanitation facilities and hygiene education affect the lives of the children. It’s really amazing to hear the difference it can make.  For example one girl told us that she got rid of her neck pain when the water fetching stop, another that her school results increased, one boy that his mum now have time to help him with his home work and one teen aged girl  that she would not accept to get married into a family without proper sanitation facilities. One group of mothers told that they leave the children, including toddlers, alone for three-four hours a day and one health care workers that that a safe water supply scheme has resulted in that the children no longer are malnourished. I could go on like this forever…

Not everything is found/told in all the villages, not at all, but the WASMO’s work has always done some difference everywhere.

Tomorrow we’ll go close to the the Great saline Rann of Kutch and I don’t know if it will be my last, it’s not yet decided if I will go here a third time.

Where is the soap, bro’?

9 June 2011

Something that I miss at many places here at the public (offices, restaurants, etc) hand washing facilities is soap. Most people wash their hands, but at the same time washing with only water is not enough to stop diseases of spreading. It is not even present in the bathroom or canteen of WASMO, which is an organization that is supposed to promote good hand washing practices. And that was it with that be a role model :S My solution is to drown my hands in hand sanitizer. I know it’s not optimal, so if anyone has any recommendation you’re welcome to tell me.

Every time I think about it, and that is several times a day, I want to start to sing “Var är tvålen, broder?” (Where is the soap, brother?) by the late Swedish artist Povel Ramel.

What I am doing at WASMO

28 May 2011
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Three days back I wrote about what WASMO are doing. Today I thought that I would I’m doing at WASMO.

After some discussions with my bosses it is now clear that I will do evaluation research on how  WASMO different programmes for improved WASH (water, sanitation, hygiene) are affecting children. Bad water and sanitation are the major factors behind diseases such as  pneumonia, diarrhoea and malnutrition, which yearly cause the death of millions of children. Water fetching traditionally takes enormous amounts of time, especially for girls, which means that they have neither time or energy to attend school. Bad sanitation facilities at school lower the school enrolment, especially for girls when they reach the age of menarche. And these are just some of the problem that bad WASH cause children.

Through WASMO’s programme the majority of the rural Gujarati population now have a piped household water connection, the number of household toilets are increasing drastically and almost all schools does today have sanitation facilities that also are separated for boys and girls.

So what I will do is to research how this has affected different age groups of children from newly-borns to adolescents. This in terms of health, possibility to attend school, but also if they have and have more time time to play and how teenage girls think that it might impact their future married life.

So why children? I am not a child-loving person. I’m rather quite sceptical to especially toddlers that I don’t have connection to. (On the other hand children usually like me, and then it becomes a good relation in the end anyway). So why? Firstly, I’m not an engineer, so I can’t really study the technical aspects of water and sanitation provision. Secondly, WASMO has two special target groups for their programmes. One is women and one is children. The impact on women has already been studied several times. So I saw a knowledge gap about the affect on the  other target group. So here we go.

What WASMO are doing

25 May 2011
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I just feel that I need to clarify what the organization that I do my internship at WASMO are doing. WASMO was created in 2002 as a special purpose vehicle to mainly implement the Swajaldhara programme in Gujarat. Swajaldhara programme is a decentralization programme of the Indian water supply schemes from the Indian Government. The main work of WASMO is to facilitate the process of the villagers taking over the water supply schemes.

Broad overview of the process:

1) A Pani Samati (Water & Sanitation Council) is founded as an entity under the Gram Panchayat (Village Council) , the most local unit in the Indian government structure. The Pani Samiti needs to consist of 1/3 women, to make sure that their voices are heard in the process. Especially since it’s traditionally the duty of women & girls to fetch the water for the household. So it’s both for the purpose of women empowerment and to include the women’s knowledge about the water resources.

2) A Village Action Plan for the  is created were it’s decided what type of water supple scheme the village in question needs and can afford. The villagers need the contribute with 10% of the cost themselves. It’s also decided how the construction will be done and how high the water tariffs will be for different villagers. Before the water has been free of charged, but out of bad quality and a far distance away.  Tariff based supply is especially beneficial for underprivileged, since they are usually the people that previously paid  for water from tankers and in the system the cost is often very low for them.

3) The Village Action Plan is implemented. The construction is done and the village take the mandate over the water schemes  in a special ceremony.

The why WASMO was created, but it has also other purposes:

•  to inform and educate about water and sanitation, especially through awareness campaigns for school children.

•  to work with water supply the areas the were hardly damaged by the earthquake in the region Kutch in January 2001.

•  to ensure secure safe, reliable and sustainable water supply and quality. There are some severe problem with too high levels of salinity and fluoride in the water.

•  to especially work with the population in the Tribal Belt, partly due to low degree of development in the area, partly due to that a different type of a society structure requires a different approach.

•  to promote improved sanitation and the individual household level as well as on the village level (I’ll write much more about that another time).

So no, WASMO not any small struggling NGO, but a autonomous entity of the Government of Gujarat. I have also realized that it’s rather recognized, it has been awarded with both the Prime Minister’s Award for Excellence in Public Administration in 2008 and the prestigious “United Nation’s Public Service Award” in 2009 and the lastest I’m aware of was the Commonwealth Association for Public Administration and Management-award in 2010.

Now I’m going out for tea!

Water poetry

11 May 2011

A poem that is on the inside of the paperback of one of WASMO’s information books:¨

“Ode, On the General Subject of Water”
Water is far from a simple commodity,
Water’s a sociological oddity,
Water’s a pasture for science to forage in,
Water’s a mark of our dubious origin,
Water’s a link with a distant futurity,
Water’s a symbol of ritual purity.

Water is politics, Water’s religion,
Water is just about anyone’s pigeon.
Water is frightening, water’s endearing,
Water’s a lot more than mere engineering.
Water is tragical, water is comical,
Water is far from Pure Economical,
So studies of water, though free from aridity
Are apt to produce a good deal of turbidity.
– Kenneth Boulding; Feather River Anthology

I just hope it’s possible to overcome that turbidity.