Archive for 'Health'

Myanmar’s Women Desperate for Health Care After Decades of Neglect

Posted on June 25, 2012, by Hanna Ingber, under Burma, Health, International, women.

MAE SOT, Thailand — Maw Lwin Khine lives with her husband in a small wooden home with a thatch roof. They don’t have electricity, running water or a phone. The couple sells flowers, earning roughly 2,500 kyats (US$3) a day.

They were managing fine until Maw Lwin Khine, eight months pregnant, went into labor.

Maw Lwin Khine’s aunts packed up food, loaded her into a horse cart and took her to a hospital in eastern Myanmar’s Karen State. Her husband followed on a bicycle. At the hospital, the doctor determined that Maw Lwin Khin, 28, had high blood pressure and needed a Caesarian section. The doctor performed the operation, but the baby had already died.

The difficulties did not end there.

The government-run hospital charged 200,000 kyats for the operation and another 300,000 for medicine and supplies. The couple pulled together their life savings and borrowed the rest – about 455,000 kyats – from friends.

Two weeks later, Maw Lwin Khine became sick again. She had a high fever and her body swelled up. The couple couldn’t afford to return to the hospital. Instead, they decided to visit a clinic in neighboring Thailand that offers free health care and serves Burmese. They borrowed 26,000 kyats and traveled 11 hours to Mae Sot, a border town in Thailand.

Recent news coverage of Myanmar has focused on promising developments in this long-suffering nation: the nascent political reforms, the election of Nobel laureate Aung San Suu Kyi to parliament, and the West’s suspension of sanctions.

However, little attention has been paid to a more immediate need: affordable, decent health care.

Thanks to restrictive policies and a lack of investment, Myanmar’s current health care system is a disaster. Patients like Maw Lwin Khine are so desperate for affordable, quality medical attention that they travel long distances to cross an international border to get it.

Continue reading at GlobalPost.

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Journey Through Nepal

Posted on January 10, 2012, by Hanna Ingber, under Health, International, women.

I used Storify to put together my tweets, blog posts, photographs and articles from my trip to Nepal last August. Check it out and let me know what you think.

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Special Report: Child brides

Posted on December 10, 2011, by Hanna Ingber, under Health, women.

I traveled to Nepal in August through a grant from the Pulitzer Center on Crisis Reporting to cover child marriage in the country. Here is the two-part series I wrote for GlobalPost.

Child marriages burden young Nepalis

DOLAKHA, Nepal — Suntali Thami grew up in a tiny village here in this remote district set in the foothills of the Himalayas. Her family, destitute farmers, did not have the money to send her to school. So when she was a young girl, about the age of 13, they sent her down to the capital, Kathmandu, to earn money washing dishes at a hotel. Alone in the big city, Suntali’s life took a turn for the worse.

Within a few months, the much older hotel manager took a liking to the pretty young girl with a sweet smile and decided to marry her. Suntali did not want to marry him, she says, but she felt she had no option as it appeared to be the man’s choice.

As she talks, she sits on a straw mat outside her in-laws’ home as her baby named Durga sleeps under a blanket nearby and another baby, her niece Sita, with a head of thick, disheveled black hair, begins to cry. Suntali runs her hand through Sita’s hair as flies land around the infant’s eyes.

Suntali is among the 51 percent of Nepalese who marry as children, according to the United Nation’s Children’s Fund (UNICEF).

Continue reading and see the slideshow at GlobalPost.

Early marriage precludes education for young Nepalis

KATHMANDU, Nepal — When Shyam Balami was a teenager, his aging parents decided they needed more help around the house. They told him it was time to get married. They looked around and settled on a girl in a nearby village outside Nepal’s Kathmandu Valley.

Sanani was two years younger than Shyam. She came from a big family, and there was not enough money for everyone to go to school. Sanani’s parents took her out of school at age 12 and had her work in the fields and care for her younger siblings. She hoped to one day go back to school.

But that never happened.

When Shyam was about 16 and Sanani 14, their parents decided to marry the two, ending the girl’s dreams for an education and sparking a spiral of poverty that has no end in sight.

“I was very interested in education, but as soon as my marriage took place, how could I leave all this household work behind?” Sanani says as she sits insider her in-laws’ home, a mud house with a corrugated metal roof and goats tied to posts out front in Kagati village on the outskirts of the capital, Kathmandu.

Child marriage is extremely common in Nepal, which has a population of 30 million. The United Nation’s Children’s Fund (UNICEF) has found that 51 percent of Nepalese married as children. Nepal’s 2006 Demographic and Health Survey found that among Nepalese women age 20 to 49, 60 percent were married by the time they reached 18.

The practice has a deep impact on the educational opportunities for the country’s young. Once girls like Sanani marry they typically drop out of school to begin taking care of their in-laws’ home and start producing children. They have little opportunity to re-enroll as there are few schools in Nepal with such programs, according to Khem Karki, the executive director of SOLID Nepal, an organization that works on sexual and reproductive health.

Continue reading and see the slideshow at GlobalPost.

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India’s Bias for Boys

Posted on September 15, 2011, by Hanna Ingber, under Health, India, International, women.

Listen to my radio story, India’s Bias for Boys, on PRI’s The World. Click on the mp3 below or on the “play” button here.

090820118.mp3

Read the accompanying text on PRI’s The World site.

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GHI’s Missing Piece in Nepal: Abortion

Posted on September 6, 2011, by Hanna Ingber, under Health, International, Politics, women.

LAMAHI, Nepal – United States President Barack Obama set up the Global Health Initiative to take a more comprehensive approach to improving health care in developing nations. In particular, his administration has given great weight to saving the lives of women and to supporting countries’ priorities in health care.

But there’s one exception: abortion.

In Nepal, that exclusion is in plain view, and many say the lack of support disregards evidence that safe abortions can save women’s lives. Nearly all experts here — with the notable exception of those employed by the U.S. government — publicly state that the best way to improve maternal health is by offering a wide range of services that includes more awareness about and access to safe abortion.

In a long-standing U.S. law, stretching back nearly 40 years, Congress has prevented any foreign aid for abortions.

The politics in Washington around the issue of funding abortion have become so heated in recent months that many global health supporters on Capitol Hill won’t even talk about family planning services because so many conservatives falsely equate it with abortion.

Anti-abortion advocates have accused Obama and his administration of using the GHI as part of a larger strategy to link abortion rights to universal access to reproductive health. An article in the New American last year by senior editor William F. Jasper argues that Secretary of State Hillary Clinton has used “‘reproductive health’ and other similar code words … in attempts to camouflage policies that promoted abortion.”

Clinton’s State Department has dismissed such claims and stressed that U.S.- funded programs through the GHI are simply trying to offer comprehensive reproductive health within the accepted health practices of the host countries, including saving a woman’s life if she suffered an unsafe abortion and working on family planning issues that adhere to the accepted health practices of the host country.

Some 7,000 miles from Washington and far from the charged debate around international aid and the question of abortion, there is a more pointed question in the villages of Nepal. That is, whether the unyielding U.S. policy against funding abortions is hurting its efforts to improve health care?

Continue reading and see the slideshow at GlobalPost.

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Political Instability Threatens Nepal’s Health Care Program

Posted on August 13, 2011, by Hanna Ingber, under Health, International, Politics.

My blog from GlobalPost’s Global Pulse:

KATHMANDU, Nepal — Healthcare providers, advocates and academics have told me during my travels in Nepal these past two weeks that one of the biggest challenges to improving the country’s healthcare system is the nation’s political instability.

Nepal is in the process of trying to draft a new constitution and create a new government in the aftermath of a 10-year armed conflict that pitted Maoist insurgents against the state. The conflict ended in 2006 when the Maoists agreed to give up their arms. Nepal’s unpopular monarchy was soon thereafter abolished.

It has been five years since the end of the civil war, but the country still has a barely functioning government. A deadline to draft a new constitution has been delayed twice since 2008, and it looks unlikely that the current deadline of August 31 will be met.

Some political analysts fear that if this deadline is again missed, there will be even more instability in the country.

“In a situation like this, people might even be happy if someone takes control, if a sort of benign dictator emerges,” Lokraj Baral, a political science professor who heads the Nepal Center for Contemporary Studies, told AFP.

The constitution is being held up due to a number of issues including a disagreement over the integration of former Maoist combatants into Nepal’s army.

Nepal’s prime minister has threatened to resign by Sunday if there is not more progress made on the peace process. Prime Minister Jhala Nath Khanal said he will step down if there is not agreement made on the new constitution and the integration of former Maoist combatants.

The political situation affects Nepal’s healthcare system in a number of ways. First, the frequent turn over of ministers creates a situation where little progress can be made because much time is devoted to convincing each new minister of a particular program or approach, Bidhan Acharya, an associate professor in the department of population studies at Tribhuvan University, told GlobalPost.

The political system also exerts great influence on the health sector as some politicians put people from their own party, whether the most qualified or not, to fill top positions.

There is a strong feeling of frustration with the government in Nepal, and critics argue that the politicians are so busy fighting among themselves they have little time to work on the nation’s development.

See the accompanying photo.

Follow Hanna’s trip to Nepal on Twitter: @Hanna_India

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Maternal Health and Rural Development in Nepal: One Woman’s Fight

Posted on August 10, 2011, by Hanna Ingber, under Health, International, women.

For GlobalPost’s Global Pulse Blog:

GHORAHI, Nepal — Asmani Chaudhary grew up dirt poor in a village in Nepal’s Terai region, which runs along the border with India. A member of a long-disadvantaged Nepali community called Tharu, Chaudhary was raised in a mud hut that housed her entire 30-member extended family.

Now, at age 37, Chaudhary walks around the office of the organization she founded with a sense of confidence and pride. She points out the framed photographs and letters hanging on her wall: one shows her with UN Secretary General Ban Ki-moon, another is a letter from U.S. Senator Chuck Schumer thanking her for her hard work.

The photographs and letter are from when the Americans for the United Nations Population Fund recognized Chaudhary as a “2008 International Honoree for the Health and Dignity of Women.” The award honored Chaudhary’s community-based efforts to improve the health and well-being of some of Nepal’s poorest women.

Chaudhary was close to spending the rest of her life as one of those women. She was born and raised on the small lane outside her office in Ghorahi in Dang district. She took me on a walk down the road this afternoon, explaining that much remains the same for these people three decades later. The villagers living there, all from the Tharu community, are still dirt poor. She pointed out the tiny, one-room mud homes with thatch roofs as kids played in the street and roosters wandered over the grass. The people of this area continue to be disadvantaged and uneducated, she said.

When Chaudhary was a child, Tharus typically only sent one of their many children to school as the rest were needed to farm and help in the house. Most families sent their son to school. But Chaudhary got lucky – her brother was too young, and her parents therefore chose her. They sent Chaudhary to the nearby government primary school and kept her four sisters and little brother home.

Chaudhary, a slender woman with long brown hair that she wears in a braid that almost reaches her waist, finished not only primary and secondary school but also went on to university. Her sisters, who stayed home farming, were illiterate. Like most uneducated Nepali women, they got married by the time they were 16 or 17 and started having children. Chaudhary did not marry until she was a few years older and waited until she was 24 to have the first of her (only) two children.

After university, Chaudhary decided she wanted to help the women of her community and formed the Rural Women Development Centre in 1993. It now has six branches and focuses on providing rural women empowerment and employment opportunities, health education and social awareness.

Chaudhary has also worked to bring attention to and treatment for women affected by uterine prolapse, a maternal health condition common in Nepal. Chaudhary visited a village where she met two women who had suffered from the condition; their uteri had shifted from its normal position and gradually extended outside of the body. The women tried to solve the problem by putting their own bangles inside their vaginas to hold their uteri in place. Chaudhary brought a team of doctors to the area to provide the women with safe medical treatment in the form of a ring pessary inserted into their vaginas.

Chaudhary says that she has seen a lot of improvements in Dang since she was a child, but a lot more needs to be done for marginalized and uneducated groups like the Tharu.

Addressing the health needs of Nepal’s disadvantaged, poor communities is now one of the primary objectives of President Obama’s Global Health Initiative in Nepal, USAID staff told me this week. Tomorrow, I will visit some of these villages in Dang district to learn more about their needs and see how GHI is addressing them.

Follow Hanna’s trip to Nepal on Twitter: @Hanna_India

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Nepali Villagers Forced to Travel Treacherous Roads to Nearest Hospital

Posted on August 10, 2011, by Hanna Ingber, under Health, International, travel, women.

My blog for The Pulitzer Center on Crisis Reporting:

The ride there was actually quite lovely. It was coming back when we realized just how harrowing doing something as basic as driving to town can be for the people of Nepal’s rural areas.

Pulitzer Center intern Anna Tomasulo and I arrived Monday night in Dolakha, a district in Nepal’s mountain region with picturesque mountains and lush green rice paddies. We set off Tuesday morning to visit a small village up in the hills. The area mostly consists of the Thami ethnic group, and the majority of those in this village marry their girls off as young as 12 or 13. We wanted to talk to one of these young women about her experience with early marriage.

Our team included a media officer from the non-governmental organization SOLID Nepal, a Kathmandu health journalist and two local community workers.

We drove as far as we could without getting stuck in the mud and then set off by foot. We only covered about 10 kilometers, but the journey took three hours given the rough terrain – and our fair share of chai stops.

As we trekked, we edged along the mountain, viewing terraced fields and small red homes in the distance. The sky looked like one large cloud, hovering above the mountains. One of our team members pointed to a school on the opposite mountain, explaining that kids in this village had to walk three hours to get to that high school.

We hiked down steep rock paths, carefully watching each step. In front of me, a villager dressed in a red sari and sandals walked down the rocks carrying a baby wrapped in a blanket on her back.

Eventually, we reached the village and found a line of women squatting in a field planting rice paddies. Our female community worker went to talk to the women and try to convince the one who married at 14 to share her story with us. We stayed on the dirt road, enjoying the crisp air and mountain scenery.

The community worker returned: the young woman is busy planting and doesn’t want to talk. If we can give her health care, great, but otherwise, she’s busy.

Thirty minutes later, after the community worker and our NGO media officer convinced the village’s health officer, who convinced the other village women, who convinced the young mother to talk – and after Anna and others from our team offered to help plant – she agreed to sit with us.

The young mother told us she had three children soon after marrying. During her third birth, her labor lasted 48 hours, and her family then decided to take her to the hospital in town. They put her on a bus, but the bus broke down.

Follow updates on the project page to learn this young woman’s story.

Meanwhile, we finished the interview and decided to head back to town. We met up with the others, who did not want to walk back because it would take four hours given the hills. We had tea and waited at the village’s one-stop shop-restaurant-home-bus stop. We waited and waited. The bus didn’t come.

The villagers decided to try to fix a massive truck that had broken down near the shop-restaurant-home-bus stop. Anna and I watched as men squatted on the ground and stuck various tools under the truck. Boys in school uniforms gathered to watch. A bad sign came when the SOLID Nepal media officer, who had no auto mechanic experience, also squatted on the ground and played with the tools.

Will they ever fix this truck, we wondered. And how will it be safe driving along the mountain’s edge back to town? We remembered the waterfalls we passed on the way here. We had watched in horror as a bus crammed full with villagers drove through the waterfall, bouncing back and forth against the rocks and water. How will this truck drive through the waterfalls? I laughed, finding the situation a bit too crazy to believe.

After two hours of waiting at the shop, the bus arrived. We jumped up with glee. Men jumped on top; we crammed inside. The bus was packed full with people, giving us barely enough room to fit.

We set off for town but quickly realized the bus was a horrible decision. We rocked back and forth as it tried to maneuver the muddy road and deep tire tracks. Anna accidentally looked down the mountain, and saw the green rice paddies and fields far below. She forced herself not to look down again. We gripped the railings above. I leaned my body towards the mountain and away from the cliff as I noticed the other passengers’ expressions. One woman in a seat miraculously slept, or at least pretended to, but another standing behind me looked as horrified as I felt. She clenched her teeth and closed her eyes with each turn. I remembered the countless news stories I had read about road accidents involving overcrowded buses in India, and I prayed this would not be one more such story.

Soon, Anna and I decided this was too much. Atul, we need to get off this bus, I said to the Kathmandu health journalist. Don’t worry, he said, we’ll be fine. No, Atul, we really need to get off this bus.

The others insisted we’d stop at the waterfall and get off there. No way were we going to drive with this bus along that waterfall. Don’t worry, the team said again and again, we’ll get off before the waterfall.

But as the waterfall approached, it became clear we weren’t getting off. It was too slippery to stop the bus.

Eventually, after what was probably 10 minutes but felt like an hour, the road improved, and we successfully convinced the driver to stop.

Our team jumped out – relieved we were still alive – and began to hike back to town. And then, it began to pour.

After a couple more hours, we made it back safely. It was a terrifying experience being on the bus, and difficult to trek in the rain. But as we hiked, one thought returned to my mind over and over: the young woman in the village did that trek nine months pregnant and after 48 hours in labor. I don’t know how she mustered the strength.

Go to the Pulitzer Center site for photos from our trip.

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Will the Elderly Bring Down India?

Posted on July 29, 2011, by Hanna Ingber, under Culture, Health, India, International.

MUMBAI, India — Maqbool Beg has been driving a rickshaw for 42 years. Now, at the age of 62, his children have grown, his beard has turned white, his teeth are red from years of chewing betel nut. And he suffers from high blood pressure. But he keeps on driving.

He needs the money. Thanks to inflation and the high cost of living in Mumbai, Beg has never been able to save. The 4,500 rupees (about $100) he earns a month make him ineligible for even a small government handout. Beg and his wife cannot rely on their sons, who earn even less working as a tailor and mechanic.

“Until I can no longer work, I will work,” he said, waiting outside a mobile health van in Bandra East, a suburb of Mumbai.

Beg is one of India’s 81 million elderly (technically, those over 60). While much of the attention on India’s population focuses on its young, the country also faces a rapidly growing elderly segment.

About half of India’s 1.2 billion people are younger than 25. India’s youth are often touted as the country’s best hope for one day surpassing China in economic growth rates.

Every year, India increases by the size of the population of Australia, and many blame nagging poverty on such stats. In some parts of India, local officials are taking extreme measures to try to curb numbers of children in families. In poor northern states like Bihar and Uttar Pradesh, an average woman still bears four children over her lifetime.

But, as with many things in India, the problem of too many children presents a contradiction.

It turns out that, overall, family planning efforts and rapid social development have resulted in lower fertility rates in most Indian states. Fertility rates have fallen from about six births per woman in the 1960s and 1970s to about 2.6 births in 2008, according to the U.N. Population Fund.

Smaller families and longer life spans have set India on a path to facing a massive population of elderly, say advocates for the aging and demographers.

Due to changes in social norms and the ongoing breakdown of joint families, much of this population of elderly will not have India’s traditional family system to support them. Furthermore, the state has not put into place adequate services for the aging, say advocates. The elderly — long deeply respected and honored in Indian culture — will be left to fend for themselves.

India’s population over 60 is expected to more than triple by 2050, and its 80-plus population is expected to quintuple, according to an article, “India’s Baby Boomers: Dividend or Disaster?” by David E. Bloom, a professor of economics and demography at Harvard University’s School of Public Health.

Activists and experts fear India is not in a position to handle so many old folks.

Continue reading at GlobalPost.

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India: Disabled More Vulnerable to AIDS

Posted on April 4, 2011, by Hanna Ingber, under Health, India, International.

MUMBAI, India — Subash and Vimal Barve live in a 200-square-foot shack deep in the slums of Ghatkopar East, a suburb of Mumbai. Outside their home, rats run over broken cement slabs and children pick through a fly-infested dump that ends at the couple’s doorstep. Inside, Vimal prepares a pot of chai as Subash, blind and HIV positive, stares straight ahead.

Life wasn’t always this hard.

A decade ago, the couple lived a middle-class life. They owned an apartment in Goregaon, a northern suburb of Mumbai, and a shoe shop in nearby Andheri. At one point, Subash employed eight assistants and earned 50,000 to 100,000 rupees ($1,100 to $2,200) a month. They rode around town on a motorbike, and when they went to the market, they never questioned how much food they bought.

“We have gone from a time when we had a lot of money to nothing,” said Vimal, sitting on the floor of her home.

Subash is one of about 320,000 disabled people living with HIV in India, according to a 2007 report by the UK Department for International Development (DFID). There is a higher prevalence of disabled people living with HIV than in the general population because of factors related to poverty, it states. Poverty increases vulnerability to HIV, and people with disabilities are over-represented among the poorest of the poor.

However, despite this correlation, those with disabilities who are living with HIV have not been targeted by assistance programs in India, according to Heather Ferreira, a program officer for the HIV/AIDS program at World Vision India.

Less than 2 percent of those with disabilities living with HIV receive support from HIV programs, the DFID report states.

Continue reading at GlobalPost.

Follow Hanna on Twitter: @Hanna_India

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