Happy, prosperous, healthy, peaceful 2014 to all
UNIVERSAL Health
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Tuesday, December 31, 2013
Saturday, November 30, 2013
HIV community groups & networks demanding for high quality TB services – let the dream come true
WORLD AIDS DAY 2013 - Experiences of Universal Health
In the recent International
Congress of AIDS of Asia-Pacific/ICAAP in Bangkok I couldn't find traces of
concern around HIV-associated TB deaths except few ad-hoc basis discussions on
HIV related co-morbidities with TB being a small component. The speakers and
participants across the Congress spoke volumes on rights, stigma,
discrimination, legal issues, access and mobilization but kept mostly quiet on
the burning TB/HIV issues of the Asia-Pacific regions.
The statistics of South-East Asia[1]
say, every year more than 50,000 people die due to HIV-associated TB, less than
40% TB cases know their HIV status, less than 40% PLHIV get screened for TB and
access of PLHIV to INH prophylaxis is more than negligible.
Demand for newer diagnostics for
rapid diagnosis of TB/DR-TB was not heard in the voices of community networks
who otherwise made their presence strongly felt across ICAAP.
A prominent member of
Asia-Pacific TG network told me, ‘The problem of TB lies in your overall poor
advocacy.’
A known friend of the PLHIV network
of an Indian state commented, ‘I am really not bothered much about HIV now, but
TB scares me hell of a lot, almost every time.’
‘Why don’t you discuss about TB within
your group?’ I asked her.
‘I really don’t know what to say
except cough for more than 2 weeks.’ She replied pessimistically.
The ICAAP experience made of
aware of the fact that we are failing miserably to sensitize people, providers
and policy makers on TB and its implications in the background of HIV. It is a
grave problem and we must find the solutions.
Limited sphere of advocacy where
the advocates don’t really want to venture out of their comfort zone is a big
issue in TB. As far as international conferences are concerned the advocacy
efforts, in true sense are yet to cross the boundaries of the World Lung
Conferences.
Working with HIV community networks might be
highly challenging to many TB professionals and advocates, but the fact is 'need
for appropriate TB care' is maximum with those networks. When mobilization is their
operational expertise these networks need proper guidance to know the right
path for consolidating their mobilization and demand generation activities on
TB. That’s exactly where we are repeatedly failing to produce any impact.
It is important to bring TB in
the agenda and action plans of the international, regional, national and local
level HIV community networks (Sex Workers, IDUs, MSM, TG and PLHIV). Let
community people speak freely and firmly about their TB problems together with HIV and
demand for health facilities enabling rapid TB diagnosis and early treatment. Let
there be stronger demand from the community groups for ready access to 3 Is
(Intensified TB screening, INH prophylaxis and Infection Control), ART for all
HIV-infected TB patients and combined screening of the pregnant mothers for TB
and HIV.
TB/HIV collaboration in its true
sense can only happen when HIV community groups and networks will play their
advocacy cards of TB and HIV on the same table to ensure the right placement of
the right package of services for them.
This is the high time we, the not-so-visible
TB advocates in the AIDS Conferences, facilitate the process, with utmost sincerity and
dedication.
Sugata Mukhopadhyay
Universal Health
Violent love story of a sexy disease and an unsexy disease – We need to find its end, forever
WORLD AIDS DAY 2013 - message from Universal Health
Being primarily an air-borne
infection TB has lost the glamour of a ‘sexy disease.’ But the naked truth is,
TB is not selective as HIV and can affect anyone in the society. Unfortunately,
those infected by HIV have greater chance of TB infection or active TB disease
from a latent infection. The intimacy with the sexiest disease on earth makes
TB more noticeable over last couple of decades. And in today’s world
Drug-Resistant TB has already spread the dread across the globe the way HIV did
decades back before the emergence of ART.
The fact is, the love-story
between a sexy disease and an unsexy disease is still going strong. Both the
diseases carry tons of stigma. While HIV looks for specific openings like
unprotected penetrative sex, needle/syringe sharing and pregnancy, delivery
& breast-feeding of an infected woman to trigger and maintain its transmission,
TB has the potential to hit anyone, particularly those lying within the
territory of poverty and marginalization with poor access to health services.
Actually, both the diseases, most
of time target the same groups of people – poor, illiterate, living in
unhealthy living conditions, having limited livelihood options that often lead
to migration or sex work or trafficking, injecting drugs as the last resort of
poverty-struck recreation and those having no/inadequate access to services due
to various reasons including those identifying them in different gender.
Once HIV manages to get the entry
into the body, it makes the things easy for TB to show its sting. Similarly TB boosts up HIV in its progression to AIDS.
Where will you find such violent and virulent loves on earth ?
Most of the people infected by HIV get killed
by TB.
TB is an old traditional killer
and it kills more when it makes love with HIV.
Ideally, all persons with known
HIV positive status should have sound knowledge of TB so that they can demand and present for TB screening on slightest doubt. Ideally, rapid and new diagnostic techniques
should be in place for early diagnosis of TB among HIV infected, affected and
vulnerable population groups. Ideally, all the TB affected persons should be
offered HIV counseling and testing services. Ideally, all the HIV-infected
persons should have access to prophylactic services of INH and CPT. Ideally,
all HIV-infected TB cases should be put on ART without waiting for their CD4
results.
Ideally, TB and HIV
professionals, TB and HIV program managers, TB and HIV healthcare providers,
and TB and HIV policy makers should have free, frequent and unprejudiced
interactions at all levels, national, province, district and sub-district.
Ideally, whenever there is a
talk/discussion/debate/seminar/conference/workshop/exhibition on HIV, TB should
be the integral part of that and vice versa.
How much we have internalized
these ideal conditions which mostly exist in the documents? How much we are
geared up to create those ideal conditions? How strong is our partnership to
make those ideal conditions happen in reality?
After all ‘ZERO HIV DEATH’
without stopping TB sounds like a fantasy.
Let’s no more fantasize and get
into some real action to disrupt and terminate the violent love-story of a sexy disease and an unsexy
disease, forever.
The time is right here.
Sugata Mukhopadhyay
Universal Health
Sunday, September 1, 2013
The stolen bag of gold
The moment I stepped in
the office I figured out something grave had happened. Biman was on his desk
with an extremely worried face. Kanak was silently weeping in front of him as
if he fell into some serious trouble. Bharat, the driver of our polio
surveillance unit stood up hurriedly from his seat when he saw me making my entry
into the office.
‘What happens?’ I asked them.
I was equally surprised
to see Kanak back. He left for Lucknow yesterday. How come he has returned so
early? Generally he comes back from Lucknow after 4 - 5 days. Why the hell the
fellow is breaking in so much of tears?
‘Sir, there is a big
problem.’ Biman’s comment carried a strong sense of concern.
‘What is that?’ I took my
seat by that time, ‘What happens to Kanak? Why is he back so early? Is
everything fine with him?’
‘Kanak has made a big
blunder, Sir.’ Biman gave his reply in a hopeless voice.
Kanak was hired to
transport the stool samples of the AFP (Acute Flaccid Paralysis) cases to our
regional laboratory located in Lucknow.
All stool samples
collected from the AFP cases are tested in the lab to know if those samples
have Wild Polio Virus (WPV) or not. If WPV is detected in the stool sample, the
paralysis is caused by polio, if not the paralysis is caused by diseases other
than polio.
WPV is responsible for
polio in children and causes permanent paralysis of their limbs. The paralysis
is incurable and irreversible. The affected child becomes crippled for the rest
of his/her lives. Polio is a disease without cure.
But the WPV can be
eradicated which means the deadly virus can be eliminated from the earth
forever. Most of the countries of the world exterminated polio from their soil
but few countries including India still harbour WPV. We are putting our best
efforts to eradicate polio from our country.
‘What blunder?’ I
exclaimed.
‘The box having the stool
container inside has been stolen from Kanak’s custody in the train.’ replied
Biman in utter dejection.
I was completely shocked.
‘But how? How could Kanak be so careless?’
‘That’s what I was
telling him Sir. He didn’t take proper care of the box in the train. Somebody
must have picked it up taking fully the advantage of his callousness.’
Kanak, all on a sudden,
started crying loudly, ‘Believe me Sir, I was always alert in the train. I was traveling
in the general compartment as I didn’t have reservation and somehow managed to
get a seat over there. The box was on my lap throughout. I dozed off in the journey
little bit. The box was picked up during that time. When I woke up I couldn’t
find it. I asked everyone in the compartment including a cop, but nobody was
able to give me any clue about the box.’
‘Stop crying Kanak. I very
well understand the trouble you had gone through.’ I intervened, then asked
Biman, ‘How many more days we have to collect the additional samples of stool
from that paralytic child? Biman, would you please find out?’
‘Sir, our bag of gold is stolen. It is an
irreparable loss. I don’t think we have much time left to collect the
additional stool samples. Please let me check from the case investigation
report of the child.’ Biman sounded absolutely frustrated.
Bag of gold. That’s exactly what we refer to the stool samples that are
collected from the paralytic children in the polio eradication project.
Polio is a disease where
a child develops sudden onset paralysis of his/her lower limbs (sometimes,
upper limbs as well). Interestingly the paralysis is a loose one and the
crippled limb hangs from the body like a dead branch of the tree. We have a
special name for this kind of paralysis – Acute Flaccid Paralysis or AFP. Polio
affects mainly smaller children, but sometimes it doesn’t even spare the older
lots.
The Wild Polio Virus
(WPV), that we mentioned in the earlier part of the story enters into the human
body through contaminated food and water, subsequently sails into the gut,
multiplies in millions and finally gets out of the body through the stool. A
polio affected child discharges WPV in maximum number in his/her stool during
the period of the first two weeks from the onset of the paralysis. If you
collect the stool samples of the paralytic child particularly during that time
and test it, there is maximum chance of detecting the virus in the stool and
thereafter, you can easily confirm your diagnosis of polio in the paralytic
child. In case the same stool sample doesn’t show any trace of WPV in it, you
can confidently say the child has developed paralysis due to some other illnesses
but not due to polio.
So, timely collection of
stool, that is within two weeks of the start of paralysis in the AFP-affected child
is the most important thing to confirm if the child’s paralysis is caused by
polio or not.
Sometimes, due to delayed
reporting of the paralytic child, his/her stool sample can’t be collected within
that two weeks’ deadline. That reduces the chances of detecting the virus in
the stool of the paralytic child, as the excretion of virus in the stool
drastically lessens after the deadline of two weeks.
The golden rule of polio eradication
project says, ‘Search extensively for all the AFP affected children in the
community, detect them early, preferably soon after the start of their
paralysis, collect their stool samples by all means within the two weeks’
deadline, and ensure in this way that you haven’t missed to diagnose a polio
affected child in your area.’
This vigilance work of
detecting the AFP cases in the community is the most crucial thing in the polio
eradication project. In public health
terminology we call it polio surveillance. Missing an AFP affected child and
subsequently failing to collect his/her stool samples during the period of
first two weeks after the start of paralysis denotes you are not sufficiently
alert in your AFP vigilance activities. That further means, we fail to know
which AFP case is due to polio, which is not.
Without a sensitive
vigilance system of timely AFP case detection and stool collection, polio
eradication efforts remain weak and ineffective.
Our bags of gold were
collected on 6th and 8th day of the paralytic onset of
the child. We further calculated from the case history of the same child that
today was actually the 11th day, and we have only 3 days left to collect the
additional samples of stool to keep the case within the parameter of ‘timely
reported’ category.
I cancelled all my
routine activities and rushed to the village of the child to collect the stool
samples. The child’s residence was in the remote village of Banmankhi block. When
we reached the house a big surprise was waiting for us over there.
The child had been
already transferred to her Nani’s
(maternal grandmother) place in Bhawanipur block. We noted down the address of
the Nani’s village and made immediate
move towards the new place.
Crime, big and small is a
common event in Bhawanipur block. We were repeatedly told by the block
officials not to travel in the block, especially after the sunset.
But we were desperate to
collect our ‘bag of gold’. We had no
option left.
We reached Bhawanipur in the late afternoon.
The route connecting Banmankhi with Bhawanipur blocks was tortuous with a horrific
strip of road filled with innumerable pits of various sizes that consumed a lot
of our precious time.
The next challenging task
in Bhowanipur was to locate the exact place where child is currently residing
and reach there at the earliest.
We took the help of the
local Primary Health Centre (PHC) of Bhowanipur. The Medical Officer of the PHC
Dr R.P.Singh was gem of a person. The moment he heard our tragic story of
stolen ‘stolen gold’ he took no time
to jump into our jeep to accompany us in the most daring ‘stool collection
mission’. He took with us his right hand man of the PHC, Mr Arjun Mishra, one
of the Health Educators. Arjun Mishra knew every nook and corner of the block like
the palm of his hand. Being a seasoned local man he was also a safe guard
against any possible criminal threat en route.
Thereafter, we landed
into the problem number three.
Polio virus is a funny
virus. It can only survive in very low temperature. Slight increase of
temperature in its environment can destroy the virus in no time. After
collection, the stool samples should be kept inside the frozen ice so that the virus,
if present in the stool samples can remain viable there. The stool samples are
sent to the lab with adequate and proper ice packing to keep the required
temperature intact throughout the shipment process.
Whenever we go out to the
field to collect our ‘bag of gold’ we
always carry a vaccine carrier with four frozen ice-pack inside. After
collection the stool containers with the stool samples inside are placed within
the inner space of the vaccine carrier that is surrounded by the four ice-packs
and brought to our polio field office; there after transferred immediately to
the deep freezer of the office and kept till they are transported to the regional
lab for testing to detect the wild polio virus in the samples.
If your air conditioning
system for the ‘bag of gold’ is not
proper, your gold might not remain gold till the end, channelizing all your
hard efforts into the water.
It was middle of the
summer. When we checked our ice-packs they were half melted. The chances of
replacing them with frozen ice packs from the Bhowanipur PHC were bleak.
There is a need of uninterrupted
electric supply to freeze the ice-packs adequately inside the refrigerator. But
that always remained a dream in a place where power cut for hours was the most
common phenomena.
Dr RP Singh had finally come
out with a solution of the acute problem. We stopped the jeep at a rural
ice-cream factory on the way and bought a big chunk of ice to fill up the
vaccine carriers to freeze our half-melted ice-packs.
We reached the village on
the verge of the sunset and somehow managed to locate the child’s house with
the help of some kind hearted villagers.
Fortunately, the child
was present in the Nani’s house with
her mother.
‘We have to hurry up a
little bit.’ Arjun Mishra put an instantaneous alert on us, ‘the place is not
safe after the evening.’
And then emerged the
challenge number four of the day.
The mother informed us
the child has become severely constipated, so ready stool sample is very
unlikely. We need to wait. But how long?
‘Give the child some milk
and biscuits. That can produce some stool.’ suggested Dr RP Singh.
‘The child is not taking
her food properly since her illness.’ complained the mother. She had already
been giving us frequent suspicious looks by that time.
‘Why these guys are so much after my child’s stool?’
How did the poor woman
know that it was not stool but the bag of
gold for us?
Worries were clouding in
Arjun Mishra’s face with time. He was much more concerned about our safety than
collecting stool from a constipated child.
The child was given milk
and biscuits but she refused them on the spot. All attempts to feed her had
miserably failed.
I suddenly remembered my
jeep has a flatus tube which can be used to collect stool from a constipated
paralytic child. Bharat immediately brought the tube.
We told the mother that
we would make the child pass stool with this tube which will be inserted in her
anus. Her suspicion became deeper and she refused our proposal straightway.
‘Let me try with my
little finger.’ Dr RP Singh again came forward to suggest another option to get
out of this unexpected crisis.
He convinced the Nani (maternal grandmother) first and
thereafter the mother and other members of the family.
When the child passed
stool, it was half past eight. My happiness knew no bounds irrespective of Arjun’s
Mishra’s repeated words of caution, ‘We are very much late Sir. We must leave
now. This is not at all a safe area to travel at these hours.’
And we faced the fifth and
final challenge of the day, on our way back to Bhawanipur PHC.
After about fifteen
minutes of leaving the village with a successful ‘stool collection’ mission
under our belt, when we were enjoying the bumpy ride on the uneven and
constricted village road, about 10-15 masked horse-riders blocked our way. We
just couldn’t figure out how and wherefrom the bandits appeared so fast to stop
our jeep.
They were carrying guns,
and some of them were AK 47 – our jeep’s strong headlight made them clearly
visible.
‘That’s what I continuously
feared about.’ I heard Arjun Mishra’s fretted voice.
‘Don’t look at their eyes
when you talk to them and for God’s sake don’t argue with them if you really
value your life.’ cautioned Dr Singh.
One of the horse riders
waved his hand to tell us switch off the jeep’s headlight. Bharat helplessly
reciprocated.
Three of the horse riders
gradually neared our jeep. Their silhouettes looked no less than haunted
walking spirits under the clean moonlit sky. One of them pointed his finger at
us to get out of the jeep.
‘Are they going to shoot
us?’ I murmured.
‘I hope not.’ Dr Singh
pacified me.
When we disembarked, two
of the horse riders were already on the ground from their horses. I could see
their third companion targeting his gun at us on the horse. My heart almost
stopped that moment.
We were very much within
their firing range. It is just a matter of pressing the triggers of those
deadly killing machines to put the complete full stop to our lives.
‘Who are you and where
are you coming from?’ one of them asked harshly.
‘Let me handle them. None
of you should respond to their queries.’ mumbled Dr Singh once again.
‘We are from the polio
department. We went to the near- by village to see a paralytic child.’ he
replied in extreme politeness.
‘Search the jeep. If
anyone tries to play smart, don’t hesitate to shoot.’ instructed the same
person to his fellows.
Two of the men got into
the jeep. After sometime, they came out with the vaccine carrier which had our
most valuable ‘bag of gold’ inside.
I felt I was equally
worried about the most valuable stool sample which had been collected after a
whole day’s inhuman efforts.
‘What is there inside
this box?’ asked one of them.
‘Stool sample.’ replied
Dr Singh smoothly, ‘We collected from the paralytic child.’
‘Open the box.’
Dr Singh looked at me,
smiled and knelt down to open the box.
‘Please have a look
inside.’ he told the bandits after he opened the vaccine carrier.
One of them switched on
the torch to look into the vaccine carrier and took the stool container out.
‘What is this?’
‘This is the stool sample
as I told you about.’
The man immediately
dropped the container on the road. ‘Shit, its stool, damn it.’ he said in utter
disgust. His fellows burst into sudden laughter.
I immediately put the
container with stool sample back to the vaccine carrier. I just couldn’t afford
to lose my bag of gold once again.
‘Why there is so much of
ice inside your box?’ the man asked again.
Dr RP Singh gave the
bandits a small but solid lecture on polio, stool sample collection, two weeks’
deadline etc etc.
They were probably not
ready for a polio session like this.
‘Let them go. They are
harmless polio people.’ We heard him instructing his men.
We had a big sigh of
relief.
The rest of our journey
was eventless except a very special comment of our good friend Mr Arjun Mishra.
‘Sir, your stool sample
actually saved our lives today.’
‘Remember, we have to
collect one more sample of stool after 24 hours.’ I gave him a mild reminder.
‘No problem Sir,’ Arjun
got back to his usual enthusiastic mood once again, ‘We can take hundreds of
those samples now. Nobody will dare to touch us anymore.’
From the story-book 'Eradicators' by Sugata Mukhopadhyay
Friday, August 23, 2013
Scaling up of STI services in the third phase of National AIDS Control Program of India
ABSTRACT ID : ICAAP1400-00448 |
Sugata Mukhopadhyay |
Issue: STIs are the major co-factors of HIV transmission. An estimated 30 million of STI episodes occur in India. The third phase of National AIDS Control Program of India targeted to reach about 10 million STI episodes annually. |
Project or Activities: Designated STI/RTI clinics increased from 916 in 2008-09 to 1112 in 2011-12. 45 national and 587 state resource faculties from all states were trained on STI management by National AIDS Control Organization (NACO) of India during 2007-08. Those resource persons trained 2224 healthcare providers in 2008, 7511 in 2009, 5224 in 2010 and 6496 in 2011. 7 STI training, reference and research centres were established to augment training and research in STI case management across the country. In 2007, STI Clinics were branded as Suraksha clinic within the National Communication Strategy on STI/RTI Service Delivery. 776 STI counselors were appointed in the program in 2007-08 which was scaled up to 955 in 2011-12. Preferred private providers who treat HRGs in their localities for STIs were identified and trained on national STI treatment protocol, 5744 in 2009-10, 3891 in 2010-11 and 3942 in 2011-12. Pre-packed colour coded STI/RTI kits were provided for free supply at all designated STI/RTI clinics. |
Results: 2.6 million, 6.67 million, 8.49 million and 10 million (till Jan’12) STI episodes were treated in 2008, 2009, 2010 and 2011 respectively. HRG members who had been treated for STIs showed gradual increase from 158,973 in 2007 to 632,151 in 2008 and to 1,057,577 in 2009. It was also observed that number of STI/RTI cases in HRGs declined from first to third quarter of 2011-12 by 2.5% though the clinic attendance went up to 18%. During April-June, 2011 38.5 percent of HRG had utilized regular medical check-up services of TI (Targeted Intervention) clinics which increased to 45.9% during Oct.-Dec 2011 showing improvement in health-seeking practices in HRGs. Though syphilis testing has improved but still below 40 percent against the target as country average. |
Lessons learned: : India’s experience is one of the most prominent examples of scaling up of STI services through optimal resource allocation and strategic implementation of action plan of STI control. (Selected for E-POSTER) |
Friday, August 16, 2013
Child sexual abuse in India – a situation analysis
Author:
Sugata Mukhopadhyay
Background:
19% percent of the world's children live in
India, which constitutes 42 percent of India’s total population (430
million).
The government estimates that 40 percent of India's
children vulnerable to sexual abuse, trafficking, homelessness, forced labor, drug abuse, and crime, so needs
protection.
Methods:
The
abstract aims to do a situation analysis of child sexual abuse in India by
collecting relevant information including case-studies through net-surfing,
interviewing local NGOs working to protect children and interacting with some
abused children.
Results:
The ‘Study on Child Abuse: India
2007’ of Govt. of India sampled 12447 children, 2324 young adults and 2449
stakeholders across 13 states with the following key findings: 53.22% of children reported sexual abuse.
Among them 52.94% boys and 47.06% girls. Andhra Pradesh, Assam, Bihar and Delhi reported highest percentage and incidence
of sexual abuse. 21.90% of children faced severe forms of sexual abuse, 5.69% sexually
assaulted and 50.76% reported other forms of sexual abuse. Children on street,
at work and in institutional care reported the highest incidence of sexual
assault. 50% of abusers were known to the child or are in a position of trust
and responsibility. 94% children had not reported to anyone.
According to studies conducted by Civil Society Organization,
·
9000 children estimated to go missing annually
·
500,000 children estimated to be forced into sex trade annually
·
Children form 40% of total commercial sex workers’ population
·
80% of these children found in the five metros – Delhi, Mumbai,
Kolkata, Chennai, Bangalore
·
71% illiterate.
Conclusion: Recent rapid rise of
child abuse cases across the country is the outcome of escalating degradation
of social values and growing desperateness to make mockery of law and
administration. The crisis should be responded with large scale advocacy &
social awareness to restore children’s rights and exemplary judicial decisions
against abusers.
(Selected for poster presentation in SVRI Forum 2013 (14 - 17th Oct'13, Bangkok, Thailand)
Sunday, July 28, 2013
UGLY CIRCUMCISION RITUAL TREND IN SOUTH AFRICA
Uchenna Anozie,
Nigeria
Male circumcision (from Latin circumcidere, meaning "to cut around") is the surgical removal of the foreskin (prepuce) from the human penis. In a typical procedure, the foreskin is opened and then separated from the glans after inspection.
Nigeria
Male circumcision (from Latin circumcidere, meaning "to cut around") is the surgical removal of the foreskin (prepuce) from the human penis. In a typical procedure, the foreskin is opened and then separated from the glans after inspection.
This
procedure is obtainable in many races of the world and it was on biblical
record that circumcision is a sign of covenant between the Israelites and
Yahweh. Apart from the Jews other races practice this, especially African
races.In the western world circumcision is done at childhood and done medically
with anaesthesia in some cases, this medical procedure is safe and sound
without any negative impact, and in fact recent discoveries show that circumcised
males stand a reduced risk of contracting HIV than the uncircumcised.
Other
sources confirmed that women prefer men with circumcised penis than the
uncircumcised penis, reason being that the uncircumcised penis has an ugly
aesthetic view and often very pointed, well there is no theory that proves to
us which penis is better.
It
will interest us to know that various races round the world see circumcision as
a ritual but today I am going to focus on South Africa where this ritual of
male circumcision is taken serious and it is becoming a public health concern
because lot of lives have been lost in
this ritual performances while some males have permanently lost their penis or
are still battling with a rotten penis due to acquired infections associated
with their procedure of circumcision. Also HIV has been a great concern because
unsterilized instruments are used during these rituals.
According
to inquirerdotnet, Agence France-Presse. Monday, July 8th, 2013. Botched
circumcisions killed 30 young men and landed almost 300 more in hospital during
traditional initiation rites in a South African province, the health department
said Sunday.
The
30 deaths in rural Eastern Cape province occurred during the annual season when
young males undergo a rite of passage into manhood.
Ten
other youths were hospitalized after being rescued from a forest on Sunday,
said provincial health department spokesman SizweKupelo in a statement.
“The
ten initiates’ private parts are rotten. They are badly damaged. Their
condition is scary,” he said.
A
further 293 young men were undergoing hospital treatment for dehydration,
gangrene and septic wounds, Kupelo added.
Some
had lost their genitals.
Teenagers
from ethnic Xhosa, Sotho and Ndebele groups typically spend around a month in
secluded bush or mountains areas for their initiation to manhood.
This
includes a circumcision as well as lessons on masculine courage and discipline.
Traditional
surgeons perform the procedure in the bush, sometimes with unsterilized
instruments or lacking in technique.
Botched
circumcisions leading to penis amputations and deaths are an annual tragedy.
In
May around 34 deaths in two other provinces were reported.
Needless
giving more history on these sad events, it has been a regular occurrence in South
Africa but the question is what can we do about this public health problem,
this is an ugly trend and yet we need to respect people’s culture and
tradition.
We
public health activists should do our best to convince the south African
government to carry out a strong advocacy on safer ways of practicing this
circumcision ritual, it will be better off if these males are circumcised as
children, not waiting till the grow up to 16 years and above. Also if medical
practitioners are involved in the procedure with anaesthesia and sterilized
instruments being used, then we can encourage this ritual, but these
traditional surgeons are endangering people lives, young and promising fellows.
It has been reported severally that people witch hunt their enemies during these
ritual by doing a bad procedure on the children of their presumed enemies.
Let
us spread this campaign and who knows the South African government might have
the political will to face this ugly ritual trend.
Monday, July 1, 2013
Mahila Mandals: Case Studies from Mumbai, India
Sarah
Simpson, University of Medicine & Dentistry of New Jersey, MPH-Epidemiology
Candidate
Home to more than
18 million people, India’s most populous city, Mumbai, continues to be an
attraction for millions looking for a better life for themselves and their
families. Migrants from different parts of India, religions and cultures end up
in the crowded slum communities around Mumbai. This past winter I had the
opportunity to learn about urban health issues in these slum communities along
with 20 other students from around the US and the world for three weeks at the
Tata Institute of Social Sciences (TISS) in Mumbai.
My project group
and I sped around town in rickshaws, trudged through sludge, and dust to study
urban health issues in the slum areas of Shivaji Nagar. Located in the M Ward and home to some of the
largest slums in India, about 600,000 people live in this area, which is
located near the Deonar dumping ground, a man-made mountain of debris and
trash. The health of the urban poor is complicated by many issues ranging from
waterborne illnesses to infectious and communicable diseases, and when
compounded by inadequate nutrition and overcrowded and poorly constructed
living conditions makes for a dire situation for millions of people.
During our first day, we were
introduced to the “Mahila Mandals” or women’s groups there are instrumental to
addressing these public health issues. Parts
of Shivaji Nagar are plotted slum areas recognized by the government; however
they have minimal access to facilities and services provided by the
Brihanmumbai Municipal Corporation (BMC). Imagine sharing 28 bathroom stalls
(14 for men, 14 for women) with 1,000 other people and as you can imagine they
quickly become unsanitary. The breakdown of government services has lead to the
organization of community based organizations such as Mahila Mandals.
Instead of using a needs-based or
problems-focused approach which would highlight only the worse aspects of a community,
we decided to highlight the community’s assets by writing a case study using
SWOT (Strengths, Weakness, Opportunities and Threats) Analysis to help us
investigate how to best utilize these important community assets. We
interviewed 6 Mahila Mandal groups consisting of some registered and
unregistered groups and varying in size and number of members. We concluded that not only do the Mahila
Mandals work to solve issues with sanitation, but they also promote immunization
of children, maternal and child health education and resolve domestic violence
issues. However, their impact is limited mostly due to funding and support from
the local community.
At the end of our study, we recommended
that the government provide more funding and implement community-based
participatory research programs which would allow the communities to identify,
support, and mobilize existing resources to create a shared vision of change
and encourage greater creativity in solving community issues.2 Community
organizations like these groups and community engagement are important for
continued public health and social change. Further research is needed on how to
best utilize these valuable community assets.
Our
internship presentation can be found at: http://prezi.com/i0lbgveimbyc/copy-of-indian-urban-slums/
References:
1. Mili, D. Migration and Healthcare Access to Healthcare
Services by Migrants Settled in Shivaji Nagar Slum of Mumbai, India. TheHealth
2011; 2(3): 82-85
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