Zambia’s healthcare system in need of an MOT as road accidents increase

Published in the Guardian on September 14, 2012 .  Read the full article here.

On a sunny Wednesday afternoon, 16-year-old Vasco Mzanda limped into a district health centre in Zambia‘s southern province, accompanied by his father, Listen. Three weeks earlier, Vasco had been riding his bicycle near his village when a car hit him, causing him to fly off the dirt road. When he stood up, he had trouble walking and could not put any weight on his left leg.

Vasco’s injuries were exacerbated by Zambia’s healthcare system. Listen immediately took his son to the nearby rural health post. But it did not have any diagnostic equipment, so Vasco was referred to the district health centre, 60km away. Having saved money for the 60,000 kwacha (£7.50) round-trip fare and paid for an X-ray once there, Listen learned that his son’s femur had been fractured; in the three weeks without care, the bone had partially “malunited”. The district hospital did not have the surgical equipment to fix it, so the attendant doctor told them to find their way to Livingstone general hospital, another 130km away.

There are more than 20,000 road traffic accidents every year in Zambia, resulting in an estimated 3,000 deaths and exponentially more injuries and disabilities. The country has less than 0.02% of the world’s registered vehicles, but almost 14 times the proportion of fatalities from road traffic accidents. Many injuries, like Vasco’s, are technically simple to treat. But without adequate emergency care, transportation or referral systems, many patients experience unnecessary complications. Some suffer from neglected physical trauma, some become permanently handicapped, and others die needlessly.

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Tackling gun violence, one block at a time, in New York

Published in the Guardian on August 24, 2012 .  Read the full article here.  Video report – by Sarika Bansal, Katie Bowman, Ashley Morse, and Julia Ritz Toffoli – and excerpt below.

The summer of 2012 has sadly been colored with several high-profile mass shootings. Friday morning, nine people were injured in a shooting at the Empire State Building in Manhattan, New York. Nineteen were shot in Chicago last night. Earlier this summer, seven were killed in a mass killing at a Sikh temple in Wisconsin; three were killed at a shooting at Texas A&M University; and a massacre in a Denver-area movie theater resulted in 12 killed and 58 injured.

These high-profile shootings, though, are only a drop in the bucket of gun-related violence in the US. There are approximately 100,000 shootings in the US every year, and nearly 9,000 of those are fatal. Homicide is, in fact, the leading cause of death among non-Hispanic black male adolescents: these are gun crime‘s less visible victims.

Most gun violence receives far less media attention than the mass shootings have this summer. Friday’s shooting near the Empire State Building in the heart of the tourist zone of midtown Manhattan made headlines, but in other boroughs the toll of shootings and fatalities continued with no mayoral press conference: a 13-year-old boy wasfatally shot Thursday night in Brooklyn, in the same neighborhood where a 15 year-old was arrested last week for shooting four teens in a playground; and two men were shot on Thursday over a “food vendor turf war” in the Bronx.

These individual incidents, often in poorer urban neighborhoods, are generally overshadowed by more sensational mass shootings in city centers or suburbs. In absolute numbers, however, they are the real mass shootings – forming the vast majority of fatal gun violence cases.

The finer points of the second amendment and the gun control debate are remote from these areas, and policing methods like “stop-and-frisk” have provided no lasting solution, so several communities have started organizing themselves to prevent gun violence in their neighborhoods. One such, a non-profit organization named Snug (“guns” spelled backwards), works to reduce gun violence in a 72-block section of central Harlem, in upper Manhattan. The area, which contains three housing project buildings and approximately 60 gangs, has long been a hotbed for violent crime. Snug mediates conflict among “high-risk youth”, helps young people find employment, and when necessary, intervenes in violent situations.

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Bumpy ride towards reducing HIV in Zambia through male circumcision

Published in the Guardian on August 15, 2012 .  Read the full article here.  An excerpt is pasted below.

Men travel up to four hours by bike to get circumcised in Zambia’s Central province. Zambia has become increasingly active in fighting HIV. Photo credit: Sarika Bansal

In Zambia‘s Central province, men have started cycling long distances to undergo a traditionally stigmatised procedure: circumcision. According to Fred Mbewe, who performs circumcisions at Nangoma Mission hospital, men bear the pain – both from the surgery and the bumpy bike ride the following day – to protect themselves against HIV.

Zambia has become active in fighting HIV, largely because of the toll the disease has taken on the country, which has the sixth highest infection rate in the world, at 13.5%. It is estimated 200 Zambians become infected with the virus every day.

In addition to distributing condoms and sterile needles to prevent transmission, experts are turning to male circumcision as an HIV prevention strategy. According to some – though, importantly, not all – scientific studies, male circumcision can reduce female to male transmission by up to 60%. This means that the risk of a man contracting the disease from an HIV-positive woman decreases by more than half if he is circumcised. The procedure is relatively inexpensive, which is attractive for donors.

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Repairing the surgery deficit

Published in the New York Times on August 8, 2012 .  Read the full article here.  An excerpt is pasted below.

A two-year-old girl with a third degree burn at Kalomo District Hospital in the Southern Province of Zambia; she would have to travel more than 25 miles for her surgery. Photo credit: Sarika Bansal

LIVINGSTONE, Zambia

Late one June afternoon, Angela Chibwe was heading home on a bus on this city’s main road when she noticed an elephant on the side of the road.  This would not have normally been cause for alarm, as elephants are a common sight here.  This one, however, behaved unusually: it charged at the bus and caused it to flip upside down.

Several hours later, Angela woke up in Livingstone General Hospital.  She was the only passenger who had been badly injured.  Both of her legs were broken, and a piece of metal had cut through her forehead and left eye.  The hospital’s surgeon had been able to restore sight in her eye, though it would unfortunately remain disfigured.  When I met her, three weeks after the accident, she seemed to be in pain but grateful to be alive.

Angela was perhaps luckier than she realized.  If the accident had occurred in a distant rural area instead of the city of Livingstone, which has more than 130,000 people and a relatively sophisticated medical system, she may not have woken up in a hospital.  She may not have gotten the surgery required to restore vision in her left eye.  She may have been permanently disabled, or worse.

Across Africa, countless people die or become disabled because they cannot obtain necessary surgeries.  It is conservatively estimated that 56 million people in sub-Saharan Africa — over twice the number living with H.I.V./AIDS — need a surgery today.  Some need cesarean sections or hernia repairs, while others require cataract surgery or treatment for physical trauma.

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Tasintha sets Zambia’s sex workers on a better path

Published in the Christian Science Monitor on August 9, 2012.  Read the full article here.  An excerpt is pasted below.

A Tasintha member models a necklace she created. Tasintha helps young women in Zambia learn trades from tailoring and catering to jewelrymaking, giving them a way out of the sex trade. Photo credit: Sarika Bansal

“I never thought I would become the woman I am today,” says Constance, as she slowly beaded a necklace. “I was a bad character before.”

Constance (a pseudonym), aged 24, speaks matter-of-factly about her teenage years as a sex worker on the streets of Lusaka, Zambia. She entered the world through peer pressure and remained in it for several years. “I would see four, sometimes five clients a day,” she says. “It’s difficult unless you also do some drugs.”

Soon after Constance’s 18th birthday, in 2006, a representative from Tasintha visited the street where she would often pick up clients. Tasintha, which means “deep transformation” in the Chewa language, is a nonprofit organization that helps prostitutes reform their lives. The organization started in 1992 with the hope of curbing the HIV pandemic. Since then, it has touched the lives of more than 6,000 sex workers in four locations in Zambia.

The first step in Tasintha’s approach is recruitment. Volunteers – many of whom are reformed sex workers – visit the bars and streets where sex workers
often line up for clients on weekend nights.

Conversations start casually. “We don’t tell the girls that we don’t like what they are doing,” says Clotilda Phiri, the organization’s coordinator. “And you usually have to go back several times. Some of them can be quite nasty. Over time, some will start to tell you that they’re not happy.”

When Tasintha first approached Constance, she was skeptical but intrigued.Several days later, she decided to visit the office to find out more. She learned that Tasintha offers psychological counseling, spiritual healing, educational support, and practical trainings in a range of income-generating activities. International donors, including The Global Fund, provide anti-retroviral drugs to women living with HIV.

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How Should Journalists Write about Africa?

Published on Dowser.org on July 3, 2012. Read the full article here or below.

Schoolgirls in Soddo, Ethiopia. Photo credit: Sarika Bansal

The latest debate on how (not) to write about Africa – this one between New York Times columnist Nick Kristof and Ugandan entrepreneur Teddy Ruge – has caused quite a stir.  Ruge criticized Kristof for focusing too heavily on Africa’s problems in his columns, which he believes leads readers to believe the “whole continent is a misery basket.”  Kristof said that while journalists need to cover rising Africa (as he recently did), they should also remember that tragedies in “Sudan, Congo, Mali, Somalia, Ogaden are under-covered, not over-covered.”

In truth, neither approach will do the continent justice.  Focusing on what Ruge terms the “basket case narrative” will only perpetuate long-held images of sad African children who cannot survive without foreign assistance.  It ignores the entrepreneurs, politicians, and systems that are improving life on the continent.

The opposite approach may be equally dangerous.  Initiatives like See Africa Differently andAfrica Good News highlight individual country successes (e.g., “Rwanda has the largest proportion of women in parliament in the world”), acknowledge development achievements, and celebrate individual African heroes.  In one sense, these websites are a needed break from Kristof’s gutting articles about the “slaughter of innocents” in South Sudan.  However, they rarely critique or qualify the successes.  In celebrating increased female government participation in Rwanda, they do not ask whether this has a positive effect on gender relations at home.  In mentioning impressive mosquito net distribution figures, they do not ask whether the supply chains are working as efficiently as possible.

Africa deserves better than a series of unqualified success stories.  While these stories are a needed response to media’s coverage of African corruption, poor governance, and poverty, they will likely not change the public’s opinion of the continent.

There is a more moderate path journalists can follow.  Part of the media’s job is, and always will be, to spotlight wrongdoing.  If thousands are dying from a man-made famine in Ethiopia, the media is right to call attention to it.  When doing so, however, journalists should acknowledge initiatives that are working to reverse it.  If an organization has successfully rolled out a food voucher program, perhaps the journalist could discuss how it works and could be expanded.  If new laws are being developed to prevent future famines from occurring, perhaps the journalist could discuss how those could alter the Ethiopian landscape in the next decade.

There are several differences between this and a traditional “good news” story.  First, it lends itself to critique and qualification.  Journalists can and should talk about some of the limitations of expanded food voucher programs.  Second, it focuses on the power of an idea to solve a problem, rather than on an individual protagonist hero.

This kind of journalism – optimistic but cautious, positive but critical – may finally shift the needle on how the public views the continent.

Shopping for a Better World

Published in The New York Times on Wednesday, May 9, 2012. Read the full article here. An excerpt is pasted below.

To be successful in business today, a company must do more than just sell a good product.  According to a recent study (pdf), 80 percent of Americans are likely to switch brands, if comparable in price and quality, to one that supports a social cause.

In response, many businesses have changed their practices to be — or at least appear to be — more connected to social causes.  Some companies give a percent of their profits to charity. Others host lavish philanthropic galas.  More recently, some companies have begun adopting a charity model known as “buy one give one” (B1G1).

Toms is probably the largest and best known of the B1G1 companies.  For every pair of shoes someone buys, a second pair is donated to a child in need.  The eyewear company Warby Parker employs a similar model.  Every time it sells a pair of glasses, it sends money for another pair to a social enterprise that then sells them in poor countries. Established brands like Ikea have tested the model, as have nonprofits like One Laptop Per Child and a growing number of start-up companies — including ones that sell vitamins, blankets and children’s clothing.

The B1G1 model holds a lot of intuitive appeal, which has likely contributed to its proliferation. It allows people who may otherwise be disconnected from problems in the developing world to effortlessly engage with them by, say, purchasing a stylish pair of sunglasses.  It is also more tangible than most corporate philanthropy. “You actually feel that there’s someone out there who has a pair of shoes because of your transaction,” said Dean Karlan, a professor of economics at Yale University and a co-author of “More Than Good Intentions.”

B1G1 has the potential to raise funds perpetually, as it encourages philanthropy in everyday purchasing decisions. “To the extent [B1G1] unlocks money that would have otherwise not been available, that’s fantastic,” said Antony Bugg-Levine, chief executive of the Non-Profit Finance Fund.  If the goods are directed to effective organizations, B1G1 companies could give many social causes a boost.

The model could also fail.  Some companies may be interested in adopting B1G1 more to win customer loyalty than to support a social cause and may thus overstate the impact of their charitable activities. Some B1G1 companies may form a partnership with nongovernmental organizations with unreliable track records, impose ill-fitting donations on communities with no use for them or supplant local markets. “To the extent there are local shoemakers, they may not have much of a business if [a B1G1 company] comes and gives away shoes for free,” said Greg Dees, professor of social entrepreneurship at Duke University.

Dees and others also question whether B1G1 handouts can produce lasting change. “There is definitely a need for footwear in underserved markets,” said Valeria Budinich, vice president of Ashoka, a nonprofit that supports social entrepreneurs. “But those markets need new technology, production processes and distribution chains that [are specifically designed for] rural areas. Models like Toms have many great features but aren’t designed to come up with that level of transformation.”

In fact, most development experts refrain from painting B1G1 companies as social enterprises, as some outlets have, and instead consider them philanthropic ventures.  “To me, it’s only a social enterprise if the social impact comes from core operations,” Dees said.  “How you use the money afterward is your choice.”

No matter the obstacles, it should be recognized that the B1G1 model is attractive to consumers and consequently a potentially powerful method to bolster social change — and it’s worth examining whether it can be turned into a long-term solution for populations living without basics like shoes or prescription eyewear. How can products be distributed so they make a sustainable difference in the lives of those whom B1G1 companies are trying to help?

The Healthy Bodegas Initiative: Bringing Good Food to the Desert

Published in The Atlantic on Tuesday, April 3, 2012. Read the full article here. An excerpt is pasted below.

A man ponders a potato chip purchase in an East Harlem bodega. Photo credit: Sarika Bansal

“Healthy food in bodegas?” asked Ibrahim Hilou, owner of a convenience store in Central Harlem. “You’re wasting your time. Go 96th and down. Over here, they like it sweet. I made a coffee today with eight sugars.”

Like most bodegas in New York City, Hilou’s store is relatively small — the customer area measures about 400 square feet — and its shelves are stocked with non-perishable goods like potato chips and canned soup. The refrigerators are filled with artificially sweetened beverages, full fat milk, and beer. A counter sells hot sandwiches lathered with mayonnaise and cheese. The register is decorated with lottery tickets and candy bars.

Meanwhile, in a neglected corner, a self-standing metal shelf contains an assortment of fruits and vegetables. The bananas are overly ripe and the potatoes are of poor quality. Few people buy produce in Hilou’s shop; most of the onions end up in breakfast sandwiches, the store’s most profitable product.

New York City has over 10,000 bodegas like Hilou’s. In some New York neighborhoods, particularly lower income ones, bodegas are often the default option for groceries. In parts of Brooklyn, they comprise over 80 percent of food retail (PDF).