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New Social Compact

To Realize Universal Health Coverage, Surgical NGOs Must Play a Crucial Role

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Authors: John L. Dutton, Desmond T. Jumbam and Libby Bunker

The COVID-19 pandemic has eroded and exposed fragile health systems globally.

Health care workers have been overwhelmed by the sheer numbers of patients needing intensive care, which has devoured already limited resources, stretched tenuous supply chains and spread thin the efforts of those one the front lines.

Sadly, essential surgical services, including live-saving surgeries to repair cleft lip and cleft palate, cesarean sections and many more, which were already in strikingly short supply, especially in low- and middle-income countries, have been made worse by the pandemic.

Much progress and change need to be made so that reactive health care systems can become proactive in the face of crises. That paradigm shift is also essential if we are to achieve the U.N.’s lofty goals for universal health coverage – access to the health services that all people need, when and where they need it without experiencing financial hardship – by 2030.

Surgical nongovernmental organizations (NGOs) must play a key role in achieving these goals.

COVID-19 has directly led to significant disruptions in surgical care. Data from 112 countries shows that half of these countries are providing 70% less surgeries than before the pandemic with the greatest reduction in low-income countries. Most of these interruptions have been justified, as evidence from The Lancet has shown that half of patients who become infected COVID-19 before or after surgery develop pulmonary complications and are more likely to die after an operation.

Prior to the pandemic, more than 100 million additional surgical procedures were needed annually in low- and middle-income countries. Current surgical delays exacerbate this unmet need: Even more mothers needing cesarean sections due to obstructed labor, more children needing their appendix removed due to infection, and more people requiring trauma surgery to repair severely fractured bones are without access to life-saving procedures.

Tragically, these and millions of others are at risk of death or disability because health systems lack adequate infrastructure and skilled health workers to address the surgical needs of their people. 

In the past, investing in surgical systems – from equipment to supplies to training more skilled health workers and operating rooms – were thought to be too expensive, too complex or too daunting. However, many essential surgeries are among the most cost-effective health services as highlighted by the World Bank’s Disease Control Priorities, Vol. 3. 

Moreover, as shown by the Lancet Commission on Global Surgery, we now know that reliable surgical infrastructure can strengthen an entire health system, promote economic productivity, and help hospitals weather unexpected shocks like COVID-19.

Unfortunately, in countries where those investments are most needed, progress has been slow.

In 2015, the World Health Assembly (WHA) unanimously passed resolution 68.15 and, for the first time, recognized emergency and essential surgical care and anesthesia as an integral part of universal health coverage. Dr. Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO) stated that “no country can achieve universal health coverage unless its people have access to safe, timely and affordable surgical services.”

Several countries including Tanzania, Zambia, Pakistan, Ethiopia and others are developing and implementing National Surgical Obstetric and Anesthesia Plans (NSOAPs), national policies for improving a country’s surgical system for the long term, to begin implementing the WHA resolution at the country level.

Despite these meaningful efforts, WHA resolution 68.15 and NSOAPs have yet to transition from policy into action in a meaningful and sustainable manner.

Surgical NGOs, with their direct links to communities and policy makers, are well-positioned to enact these policies. They can and must take a leading position in bringing these plans to fruition.

Working alongside local stakeholders, surgical NGOs will need to expand their services to include infrastructure development for hospitals, increasing research capacity and training local surgical providers. This approach strengthens overall health systems rather than solely focusing on surgeries for a specific patient population.

Some notable examples include KidsOR, which has been able to outfit 25 pediatric operating rooms in 11 countries; LifeBox, which has provided more than 22,000 pulse oximeters to over 100 countries; and Jhpiego, an organization that has trained over 275,000 health care workers globally.

Recognizing the broad social reach that surgical NGOs seek to have, it is important for them to align their services with the health needs and priorities of international governments as outlined in those countries’ NSOAPs.

Operation Smile, a surgical NGO with four decades of experience providing comprehensive cleft care to children around the world, is doing exactly this. Through projects such as the ongoing Global Essential Surgery Project, funded by the UBS Optimus Foundation, Operation Smile is improving surgical systems at hospitals in Nicaragua, Madagascar and Vietnam in collaboration with ministries of health and front-line providers.

To date, the project has trained more than 1,000 health care workers, constructed new operating rooms, implemented safe surgical protocols, trained local biomedical technicians, and engaged local communities so that their residents are aware of conditions that can be treated by surgeries offered at those hospitals.

Early results are promising: Both the number of surgical patients admitted and the number of surgeries provided within the project’s partner hospitals have increased by more than 60% since 2018. More patients are seeking care, and hospitals possess an increased ability to meet this new demand.

Importantly, the evidence generated through this project will help bridge the gap between policy and practice.

Here is our advice for surgical NGOs as they expand their roles towards universal health coverage:

·       Establish equitable partnerships by equipping local health care workers with the knowledge and training necessary to provide care for the long term, drive economic progress and decrease dependency while recognizing that these efforts will take time.

·       Employ a broadened approach that allows for more patients to receive the care they need while simultaneously investing in surgical systems for more ongoing and sustainable care.

·       Expand funding sources by seeking additional avenues of funding. Social impact investors are ready to support sustainable programs that are measurable, repeatable and scalable.

·       Collaboration with other surgical NGOs is critical and must be performed in a transparent manner. Competition will sequester results; collaboration will achieve them

·       Data is vital for establishing evidence needed for scaling up impactful programs and implementing health policies. Improved data tracking processes can be integrated into local and national practices to strengthen information management systems.

·       Partnering with policy makers is paramount. Universal health coverage cannot be achieved without the collaboration of ministries of health.

As we’ve passed the one-year mark since the first cases of COVID-19 and reflect on a pandemic that has so drastically changed our daily lives, we must look onward to how we will repair the flawed health systems and social inequalities that this virus has exposed.

Moving forward, surgical NGOs must act as catalysts that provide activism, partnership and leadership to drive fundamental change – change that ensures universal access to safe, timely and effective surgical care for health that lasts – no matter where you live or how much money you have. 

John Dutton, MD serves as a Global Surgery Fellow at Operation Smile. He is a graduate of Franklin & Marshall College.

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New Social Compact

Tenzin Choezom – On turning her struggle into her power

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Tenzin Choezom is a Tibetan refugee woman born in exile. Her life has so far oscillated between the borders of India and Nepal. She is also a graduate from Ashoka University and has a Postgraduate Diploma in Advanced Studies and Research (Adv. Major in Sociology and Anthropology). She has had a fair share of experience suffering from tinnitus for almost ten years and Meniere’s disease for the last four years. It has always been an endeavor from her end to spread awareness about the disease and create a more empathetic world for everyone.

Tell us more about the problem you are facing.

The prospect of suffering from meniere’s disease is not just physically debilitating but it rots your mental composure as well over the time. It is an everyday inner battle as an individual. But it gets isolating when that battle is not understood within the larger social setting. Unlike the people suffering from cancer which is very obvious, meniere’s disease on the other hand is a chronic invisible illness. A person with meniere’s hardly has any external visible symptoms and everything might seem normal except for the moment when the attack happens which can come at any point in time and is always uncertain. Imagine giving a presentation and you suddenly have a meniere’s attack. You are fully conscious but you have no control over yourself. You are literally spinning, losing your balance, feeling vulnerable in front of others and helpless with constant vomiting(if the dizziness gets intense) and tinnitus (ringing in the ear) which is there 24/7. Oftentimes, as a victim, instead of expecting people to understand what you are going through, you have to first deal with explaining your condition. This is a repetitive reality and it can get daunting because of the massive gap in knowledge of the disease within the community and the larger South Asian context. It is truly disheartening when people hardly acknowledge the existence of the disease as a debilitating condition of the inner ear and straight up say that it is just a mental condition when I try to bridge the gap. 

When did your issue get diagnosed?

It was during the summer of 2018. I was all ready to kickstart the summer semester at Ashoka University. But the table turned when I started having consecutive dizziness for a few seconds in the morning every time before my 8:30 class. I was fully conscious when the dizziness happened but I had no control over my balance. My friends would often laugh at me respectfully and say that I was using this as an excuse to not attend the morning class.Whatever they said did not bother me because I was naughty in that way. I was a sleepy head in the first place and would do anything to even get an extra five minutes of sleep. In between the moments of labeling it as an excuse to not attending the morning classes to potentially thinking that I was weak to knowing that my blood pressure level was low, the school infirmary nurses gave me ORS (Oral Rehydration Salts) to drink. I drank it for the first few days but no change. Finally, I decided to visit the doctor at the school infirmary who turned out to be an ENT specialist. I owe a lot to Dr. Priyanka and everyone involved at university for always giving me immense support. When I told her about the incident and my past experiences with tinnitus only after she asked, she referred me to a bigger hospital. I went through different tests (P.T.A, MRI Brain, CBC ESR, S.VirB12, T3T4TSH) and that’s how I was diagnosed with Meniere’s disease.

What is the cure?

There is no cure or scientifically proven treatment till date but there are different measures that would help control/alleviate the symptoms. There are different medications, therapies that one can look at and it can vary for different people but as for me, maintaining a salt/caffeine diet really helps. 

How are you helping other people who have the same issue?

I have always feared being vulnerable in front of others and being judged because of my illness. It has taken me a while to come to terms with it and accept it as it is. It is a part of me that will remain with me forever. But I have turned this into a purpose to make sure that no one has to suffer silently because of the gap in the knowledge. I hope that my story helps each one of you who are suffering out there to be courageous and open up a conversation with your loved ones and as envisioned,  this is a start to bringing more awareness about the disease, empathizing with the individuals, finding the treatment for it scientifically and thriving together as a community for a better tomorrow.

What has helped you to cope with the struggles you are experiencing?

When you see everyone around you enjoying to the fullest, you do not even dare to ruin the moment by having a sudden attack. I had the hardest time accepting this and hence, avoided a lot of social gatherings. But trust me, people are more generous and kinder than you think. So, try a little every day to move past your fear and do what you have always wanted to do. The attack might or might not happen. There is a 50-50 chance. Do not let the uncertainty of attack define your life. Let it come when it wants to come and you will handle it gracefully. It is definitely nerve-racking and it might take a while for you to recover from the trauma of having an attack but you will see a brighter you at the end. It has been a work in progress for me everyday to get  better with it. Seek therapy if you have the option to do it, talk to your friends and family, get your frustrations out and cry if you want to, have a balanced salt diet but most importantly, be there for yourself every step of the way. Because you can only understand the magnitude of what you have gone through.  And do not ever lose your hope even when it feels difficult. I have made this far and I believe you can too. Besides that, reading really helped and has been so therapeutic for me. I would suggest you read ‘In Love with the World: A Monk’s Journey Through the Bardos of Living and Dying’ by Yongey Mingyur Rinpoche la. It has been a savior for me for the longest time and I still go back to it when I feel anxious.

Anything else you want to share?

To those who are suffering out there like me, I see you and can empathize with you fully. I know that it sucks to the core to always be positive when the disease drains your mental and physical energy but life goes on. Living with the fear of attack is the worst thing you are doing to yourself. I know this fact but it is still taking me a while to get over it. But  I hope we can outgrow the fear of attack one day and truly live everyday to the best of our ability. I am always here if you need someone to talk to and let’s together create a better world  to live for everyone. You can always write to me at tenzin.choezom[at]alumni.ashoka.edu.in Also, thank you to Vidhi for amplifying my story of struggle with Meniere’s and giving a hope to thrive for everyone.

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New Social Compact

COVID- a way forward with Sustainability & Biodiversity

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Since the onset of the COVID- 19 pandemic, a new unprecedented situation has arisen many new challenges including social, health, sustainability and world economic issues. COVID -19 is a severe acute respiratory syndrome coronavirus II, first identified in Wuhan city of China on December 19, 2021 and until now this virus has reached its sparks to 218 countries and killed 3.9 million people across the world.  It magnifies the everlasting impacts of inequality, batting the poor the hardest. Periods of fortified unemployment, global shortage critical medical and personal protective equipment including masks, protection sheets, gloves and medicines further afloat economies resilience by foster sustainable economic systems- low- carbon investment and green infrastructure planning.  The G7 and G 20 ensure to finance least developed and developing countries in flattening the pandemic curve along with the extreme focus on sustainable resource development, climate change mitigation measures and fair economies.

Up till now 25% of plant and animal species are on the verge of extinction, therefore, countries should consider biodiversity in their COVID19 response and economic recovery plans because land use changes and wildlife exploitation increase the risk of many diseases by bringing humans and domestic animals closer to pathogens and disrupting disease-sustaining ecological processes.

The economy and human well-being depend on food, clean water, flood protection, erosion control, the drive for innovation, and more. More than half of the world’s national production relies heavily on moderate biodiversity. Thus, decline in biodiversity poses a major threat to society. As part of the policy to respond to COVID19, investing in biodiversity can help mitigate these risks while creating jobs and economic incentives.

Although government and business leaders have recognized the importance of green recovery, and their focus is now on climate change. As part of the restoration and environmental protection system, they should talk to each other. Many countries have taken comprehensive measures to protect biodiversity in response to their COVID19 policies. Examples of biodiversity measures include changes to regulations on the wildlife trade to protect human health, and employment programs focused on ecosystem restoration, sustainable forest management, and control of invasive species.

Analysts suggest that the amount of potentially harmful costs incurred as part of the economic recovery from the COVID-19 crisis far outweighs the benefits to biodiversity. Governments should take the necessary steps to integrate biodiversity policies into COVID-19 recovery projects, ensure that COVID-19 economic recovery measures support biodiversity without jeopardizing it, maintain regulation, and reduce land use. , wildlife, wildlife trade and pollution and attach the environmental condition to the bailout to improve stability, screen and monitor stimulus measures of their biodiversity effects due to plastic pollution and now due to mask pollution in seas or Covid- 19 poor disposal of protection equipment. In order to combat such drastic conditions, large investments should be made in the conservation, sustainable use and restoration of biodiversity.

There is no socio-economic development in the current global panorama. These problems and challenges directly affect human psychology, leading to the loss of psychological stability and the escalation of the financial crisis. Especially, because people are threatened by so many threats, there are more and more cases of mental crisis because people are locked at home and told to be As a result of people being told to confine themselves to their homes and maintain self-loneliness, someone is more likely to be severely affected psychologically, further affected by a lack of proper guidance or treatment.

When no resources are provided to manage the well-being of the people, the situation becomes profitable and affects mental health. Regarding the effects on sustainable psychology, the importance of better mental health should be discussed as it affects individual development and counters limit personal activities.

We have had many epidemics in the past. Middle East Respiratory Syndrome (MERS outbreak) has hit Asian countries, and West Africa has also been infected with the Ebola virus. They also affected the socio-economic balance, affected public health, and caused numerous similar deaths to what we are experiencing with COVID-19 but the new thing now is that Coronavirus affected us mentally, physically and well-being of the ecosystem with its drawbacks of limiting resources by humans while staying at homes due to partial or national lockdown where they put a burden on economy and ecosystem by overconsumption of natural resources instead at the same time human enclosure at homes give a chance to ecosystem for its resource restoration, replenishing disastrous effects caused by anthropogenic activities like decline in air pollution, soil erosion, mineral leaching, hunting, poaching and wildlife trade. 

Humans are deteriorating the habitat of wild animals and the normal cycle of pathogens and their hosts. In such situations, we are becoming more and more prone to new diseases. Human pathogens such as the coronavirus are not fully understood to date and several other strains or wildlife as host of this virus (and many other viruses and bacteria) in nature that could be a matter of global health in the future. The COVID-19 pandemic is calling into question our ongoing efforts to improve the Earth’s environment. Achieving the Sustainable Development Goals (SDG) is even more important now. Emphasis should be placed on the adoption of strict wildlife trade regulations and comprehensive measures to protect the natural environment. Most importantly, consider comprehensive ways to improve our relationship with the environment that will lead us to sustainability. Agricultural stability and reduction of dependence on animal products is one such example.

There is no doubt in saying that there are some important lessons to learn from COVID-19. It is about our survival, preparedness and responsibility against nature that will lead to the control of future epidemics. Shutdowns are proving to be viable not only in breaking the chain of infection but also in the healing of the ecosystem. Air and water pollution levels have dropped in many parts of the world and nature has begun to regenerate. The important thing is that what we as human beings learn from it. Will we reduce greenhouse gas emissions evenly, will unnecessary travel be curtailed, will we allow the reduction of pollutants in the ecosystem to let nature breathe, and will we promote and adopt sustainable agricultural practices? And stop disturbing wild habitats? Most importantly, will all stakeholders, including governments, organizations and individuals, unite to fight the epidemic that has been going on for decades and resulting in loss of life and biodiversity? There will be a decrease sooner or later, the deadly coronavirus, and one of the most explosive epidemics of the century will be tackled through vaccines or other means through united efforts across borders of countries and continents. But this is not the first novel pathogen that has targeted us, nor the last. There is a need for a fresh perspective to address some of the key issues we have learned from this pandemic.  Therefore, humanity must work together to stop the root causes of these pandemics. The way to deal with such pandemics in advance is to make every effort to achieve the goals of environmental sustainability.

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Anagha Rajesh – Founder of Yours Mindfully

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Undergrad researcher, storyteller, and community builder- that’s Anagha Rajesh, in a nutshell. 

She is the Founder and CEO of Yours Mindfully, a youth-led organization on a mission to make mental health resources accessible to 1 million young people by 2030. 

She has worked as an advocate for the Girls in Science 4 SDGs platform that works closely with the United Nations to make STEM accessible. In addition, Anagha has served as a facilitator for the Digital Exchange program empowering middle and high school students to collaborate beyond borders to achieve the UN SDGs. 

As a researcher, she is working on a project to identify biomarkers for endometriosis, a painful uterine condition. 

Tell us more about your initiative, Yours Mindfully? 

Growing up, I saw my uncle suffer from schizophrenia and how the stigma around this condition prevented him from seeking medical support. When I was accepted into the 1000 Girls 1000 Futures mentorship program of the New York Academy of Science in 2019, I shared my uncle’s story with other young people in the program. We realized that mental health is a stigma in most parts of the world and decided to do something to smash that stigma. 

We then went on to create e-magazines to create awareness about mental health. That’s how Yours Mindfully was born. We were called MindChamps back then. The popularity of our e-magazines encouraged me to grow our team and focus on areas beyond the e-magazine. 

Yours Mindfully is now a team of 30+ young people worldwide, focusing on addressing awareness, inclusion, and accessibility in the mental health space. We create inclusive content, organize webinars, spearhead social media campaigns, and conduct contests to bring more stakeholders. 

We have partnered with a range of organizations, including UNICEF, 6 Seconds (UK), Spill the Beans (Australia), Spikeview (USA), Manzil Center (UAE), and Road to Nepenthe (India). In addition, we work closely with mental health professionals to create our resources and partner with educators to get this across to young people. 

Over the last three years, our initiatives have impacted 5000+ young people. We are currently piloting a program offering personalized mental health resources to youth organizations and schools. 

What is the Ashoka Changemakers program all about? 

Ashoka is the world’s largest network of Social Entrepreneurs and Changemakers. Error! Hyperlink reference not valid. is a carefully selected network of young people who have found their power to create change for the good of all and are ready to take on their next big role as co-leaders of the global Everyone a Changemaker movement. 

13 young changemakers were selected for the Indian cohort out of 18,000+ applicants globally. Selected changemakers get access to mentorship, digital resources and a volunteer marketplace to further the impact of their initiatives. In addition, young changemakers get involved in getting more young people to become changemakers through focused initiatives. 

How did you get selected for this? 

The selection process was a 6-8 month long process with the following stages

1. Submission of the nomination form – This involves a detailed description of my changemaking idea – I spoke about Yours Mindfully, the impact I have created so far through the organization and how I plan to co-lead the changemaker movement.

2. National Review – 4 to 5 hours of conversations with Ashoka India Team

3. International Review – 2 to 3 hours of conversations with Senior Leaders and existing Ashoka Young Changemakers from the global network

4. Selection Panel – an in-person pitch to an esteemed jury explaining what the future potential of my changemaking idea is and how invested I am in implementing it

What are you planning to do in the next 5 years? 

I plan to grow Yours Mindfully to impact more young people worldwide. I am currently exploring research in biochemistry, entrepreneurship and public policy. I hope to pursue a career at the intersection of these fields in the next 5 years. In addition, I want to explore writing and traveling in a way that helps me grow. 

What other programs and fellowships are on your list that you’d like to engage in? 

Dalai Lama Fellowship, Clinton Global Fellowship and Rhodes Scholarship (super ambitious!) are some programs that I am hoping to get into

Tell us more about your work at Force of Nature. 

Force of Nature is a non-profit working to mobilize young people’s potential to combat the climate crisis.

 I completed a three-week introductory program on becoming a force of nature, where I learned about eco-anxiety, the power of narratives in addressing the environmental crisis, and how I can utilize my unique skills to contribute to the climate movement.
Following this generic training, I joined the Canopy pathway to train as a youth consultant to help businesses create and implement solid sustainability strategies
– Under the guidance of experienced youth consultants Clover Hogan and Sacha Wright, I am working on understanding concepts like greenwashing, identifying greenwashing in the sustainability strategies of Fortune 500 companies, and figuring out ways to engage meaningfully with corporate leaders on these issues. I have been on-boarded as a consultant and am looking forward to my first project in the upcoming months. 

Anything else you’d like to share about yourself?

I am the first woman from my family and community to get into a top-tier university in India and to kick-start a non-profit. I am super passionate about helping girls and women access networks and mentorship to get ahead on their journeys. 

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