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

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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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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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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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