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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

Natural Indications and solutions of weakened immunity within rampancy of Covid

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Worldwide different approaches have been taken to restrict the Covid-19 virus. Lockdowns have been immensely attributed to reducing the spread of Covid-19 almost everywhere on earth. Since last year lockdown bars people to visit doctors unless there is such a health emergency. Sometimes clinics and health care centers even stood as the hotspot for virus spread, turning the public extra cautious to visit those. People mostly remain confined in the home – “stay home stay safe”, “work from home”, “self-isolating”, “quarantine” are the most adhered phrases for masses irrespective of the boundary of nations, which in turn increases the relevance of self-reliant health care system.

Given the need for the pandemic time’s caution, here lay the refreshing facts to maintain or turn one healthy.  The most efficient tracking system to resist any harmful alien component lays within the human body itself i.e. immune system or immunity. What if someone is empowered to check body immunity except visiting doctors, just with a few basic indications? The solutions that predict humans weakened immunity may caution humans to take better immunity management measures.

In humans, the bodily immune system protects the human body from viral, bacterial, fungal, or protozoan attacks. It defends the lethal pathogens to enter the human body. Sometimes, when a virus succeeds in entering the body, the strong immune system recognizes and manages the capacity to neutralize the same, making the human body even stronger and capable to resist anything odd from outside.

If a person often falls sick or feels down, the reason behind may be the weakened immune system of that person. So someone needs to know the signs that indicate a defective and weakened immune system which calls urgent lifestyle changes.

Persistent Digestive Disorders

Around 70% of the bodily immune system resides in the inward of the body. The bodily inward bacteria fight the pathogen and enhance immune health. These inward bacteria stimulate the growth of T- cells or Army cells, which are in charge of identifying self and non- self-cells and tissues.

Lower counts of these symbiotic bacteria in the human body can increase the risk of viruses, chronic inflammation, and even autoimmune disorders. Due to which the human body might suffer from the frequent occurrence of diarrhea, gas, or constipation.

Solution:

The food and beverages humans eat and drink decide most about digestive health and the balance of good and bad bacteria in the inward of the human body. Lessen quotient of intake of processed, saturated fats and artificial sugar can reduce stomach ailments. Including fiber-rich, proteinaceous, fresh-green, and nutrient-rich diet in daily intake supports the growth of good bacteria. Having an ample amount of probiotics and fermented food contain live and active beneficial bacteria.

Delayed Healing of Wounds

It is the immune resistance that enables the wound inflamed to prevent infections, growing new cells to form over the wound, and formation of scar tissue to heal the wound. However, if someone’s immune health is not strong enough; it will restrict the regeneration of new cells making it difficult for someone’s wounds to heal.

Solution: The immune system in the blood is meant to protect the wounds, control damage, and allow regeneration of the new cells. A balanced level of Vitamin D, C, and zinc trend towards better wound healing. The human body needs collagen from Vit. C and other wound healing supplements from Vit. D and zinc. In addition, the wound must be dressed and wounds heal faster if kept warm. Exposing a wound might slow down the healing process by allowing microbial generation on it.

Frequent Cold, cough, and fever

As per a few recognized research reports, adults on an average face about two to three occurrences of cold and allied symptoms each year. But if someone suffers from more frequent turns of cold and allied symptoms, then it indicates a weakened immune system. This might be because of the person’s compromised lifestyle and adherence to hygiene. When someone doesn’t follow hygiene practices, he/she is responsible for creating an environment that allows recurrent infections like cold to stage up.

Solution:

Include healthy hygiene practices in your daily routine that will restrict the viral particles from entering the body or building up or spreading easily.

Smoker’s Chain

If someone is a smoker or chain smoker (smokes relatively constantly), he needs to understand that smoking directly affects the cells of the immune system and causes damage to the tiny hairs of the respiratory tract that normally help to clear out germs carrying mucus and debris.

Solution:

Smokers of any sort must quit smoking because the chemical found in cigarettes weakens the immune system.

Insomnia

If someone finds it hard to fall asleep, hard to stay asleep, or be compelled to wake up too early and not able to get back to sleep is certainly in the grasp of insomnia. Insomnia chronically makes humans lethargic and susceptive to several diseases. Prolonged insomnia or inability to fall asleep may completely disbalance the human immune system and in turn, increases the risk of being sick. There are proven records that “healthy sleep” stands as the best way to prevent Alzheimer’s disease and there is a prominent connection between sleep and proper functioning of the immune system.

Solution:

The conditions necessary for good sleep, called “sleep hygiene,” are needed to get properly maintained. There are some basic rules to get proper sleep like setting up a healthy bedtime routine i.e. go to bed and wake up every day at the same time, sleep in well-ventilated rooms and arrange circulation of natural air in the room, maintain the temperature, air humidity and pollution of the sleeping room, make sleeping space sound, noise and electromagnetic fields free.

Fatigue and Exhaustion

Even after having enough sleep, someone may experience unexplained fatigue and relapsing exhaustion. Sometimes those may certainly point towards something intense. Since the immune system is directly proportionate to the energy level, it implies that the body is trying to conserve energy to enhance the immune system and fuel immune energy during the battle with the traumatic situation.

Solution:

Yoga and exercise give a soothing effect to the heart and improves blood circulation across the body increasing the energy flow in the body. Those not only strengthen our nervous system but also stimulate the thyroid gland allowing fatigue and exhaustion to go away.

Anxiety and Stress

When someone is stressed, his/her body releases corticosteroids that suppress the effectiveness of the immune system by lowering the number of lymphocytes in his/her body. Stressed and anxious behavior can lead to unhealthy coping tactics such as smoking and alcohol consumption. stressful times.

Eat a balanced diet and follow a healthy lifestyle including yoga and exercise in your routine. “Laughter is the best medicine.” Laughter relaxes the endothelium of blood vessels to expand, increasing the blood flow. Laughter generates vigorous breathing, which in turn sends more oxygenated blood through the body ultimately reducing stress hormones in the brain.

Solution:

A severely stressed person is recommended to see a psychiatrist. Emotional and social support from family and friends can help a person recover from

Amnesia

Research has begun at the University of California Irvine, on how the lockdown has affected people’s memories. There is the report that even some amazing people who usually remember events like buying a cinema ticket 20 years earlier because they have highly superior autobiographical memory are finding they are forgetting things.  The factor which mostly contributes to amnesia or memory loss is isolation. Lack of social contact affects the brain adversely and the effect of isolation is most serious among those who already experiencing memory difficulties and for patients with Alzheimer’s Disease, levels of seclusion even determine the course of the disease. Though everyone has not felt lonely during the pandemic then there are other factors like insomnia, exhaustion, anxiety which contributing to amnesia. Office of National Statistics in the UK has found that rates of depression have doubled during the lockdown. Both depression and anxiety are known to have an impact on memory and may have a considerable role behind amnesia. 

Solution

Living a healthy, socially connected lifestyle and keeping the mind active through artistic and creative acts may be a way forward to get rid of amnesia

In regular practice walking, even within the confinement of home, will bring the human’s brain back to attention while moving makes a positive difference in memory. Do you have to sit at your desk for every meeting? Or do you work from home? If it’s a phone call within, then walk in the room or balcony sitting on a chair instead. Make sure that weekdays and the weekends are different enough and do not merge them into one sort of activity. Writing and noting down more frequently and practicing Yoga can help lock downbound people to cope up with amnesia. 

Disturbed menstrual cycle for women

A quarter of women are reported suffering from irregular periods. Reasons behind may be cumulative effects of lockdown including stress, anxiety, amnesia, overeating, etc. Most of the women find it difficult to work from home managing children without any domestic help. Financial crises even concern women the most causing adverse effect on their menstrual cycle. The complete isolation and static living create this irregularity.

Solution

Exercise, healthy diet, following hygiene, Self-care, cooperation, and backing of family members may relax women allowing them to enjoy a natural menstrual cycle.

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You could have been black too: Describing racism in Venezuela

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“Black woman! . . . if you were white and had straight hair / My mother told me in distress not to marry a black woman, because when she’s asleep, she looks like a coiled snake / A black woman with a big nose doesn’t cook for me, because she hides the mouthfuls in her nostrils”

The world is in the severe grip of Corona virus, countries are experiencing recession & economic downfall, millions of people are starving vanishing, and environment is abating.  All this together, alarms world for the worsening future that might welcome us tomorrow. But still the capitalist class of developed nations is indulged in the debate of US/them. On the basis of primordial traits individuals are classified as either in-group or out-group. Consequently hatred, animosity and xenophobia is increasing generation by generation towards the minorities around the world. 

Similar is the situation of afro-Venezuelan community around the world and predominantly in Venezuela. The afro-descendant group is target of hate speech, discrimination and racism. They are been called by various names such as vermin, mulatoo, barefoot, rabble, uncultured and inferior; mainly due to their afro-descendant identity. However the Venezuelan government denies the presence of racism, by asserting itself a racial democracy. A land which mixed heritage, embraces its café con leech or coffee with milk characteristic with pride.

 History of afro-descendants in Venezuela dates back to 16th century, this era was significantly underlined for colonization by Spanish settlers. As the land was rich in natural resources supplementary workforces were brought from the third world countries. General belief system of elite of was “blacks have no soul and have very little intellectual capacity, so better if they perform task such as slavery”. This is how African people first came to Venezuela, in order to work in the coca plantation. But no one was aware of the fact, this increased immigration; at one point of time might leads to numerically upsurge of afro-descendants at home. In 1979, customary practice of African slave trade was abolished, but till this time African community made almost 60% of Venezuela’s population.

Afterwards to avoid the racial discrimination and hatred towards minorities. The Venezuelan nation adopted its mestizaje ideology and inculcated racial democracy. Which states that everyone is a mixed heritage, miscegenation. These elementary ideologies of Venezuela contradicts the presence of racism or racial divide in country. But realistically speaking racism is there, and unfortunately it is been masked due the mestizaje ideology. Closing the wounds of racism by making everyone a mixed.

The Racist treatment of afro-Venezuelan community is quite evident from their economic exclusion, social and political deprivation, hate speech directed towards them in popular music and lastly from their treatment in media.  In short the state has been narrow-minded in providing social, economic, political and cultural values to its non-white majority.

Systematic exclusion of afro-Venezuelans from the economic system and job opportunities intensify the grievances of Afro-Venezuelans. Lack job opportunities for blacks, and fortunately if there are some jobs; even in those places they are driven out of their offices or are target of continued racism. Quoting the example of former president of Hugo Chavez Perez who was been called as Negro and monkey due to his afro-descendant identity. Another case of discrimination was heralded was an ice cream parlor franchise, situated in Caracas published a digital advertisement asking for hiring of employees. But the job criteria confused people, as it represented a clear discriminatory stance towards non-whites, requesting employees with ‘white skin’ and a height of 1,70m.  Representation of blacks in media is also pitiful. There are only a few black faces in media, anchor person, television celebrities even the Miss Venezuela are invariably white or off white. It also causes whitening of popular culture; and a stigmatization in society those who are whiter are better off & socially acceptable.

Social grievances of afro-Venezuelans are evident from the customary practices of Non-documentation, denial of birth certificates, denial of nationality, and lack of information on social security issues; such as access to pensions by older people for almost past 40 years. Apart from that only references to black people in school texts is of historical aside during slavery. Further stereotyping afro-Venezuelans and perpetuating racism. This is not only wicked but alarming, how a state can constantly discriminate its citizens. How a group of people can be denied of their fundamental human rights by the states and authorities.

Political grievances of Afro-Venezuelans are in the form of exclusionary nationalist ideology, African descendants are deprived of self-right, freedom of expression, self-determination, political and human rights. Taking into account the recruitment procedure of blacks in army, was also biased and in the interest of elite. As it that would provide elite the man power for army.

The core of the problem lies in the problematic group histories of Afro-Venezuelans as they being a product of slave trade. Historically deprived of rights and treated unfairly further generates the concept of degraded community. Labelling them as the one who lack soul, not born to live rather to practice slavery as lack in intellectual wellbeing further generates dishonored sentiments and exacerbates racism. The problem cannot be solved, as long as it is considered a problem of black community only. Discrimination against any community reflects humanity at its worse, and the norm keeps on expanding in other parts of the world as well. Therefore it is necessary to consider racism a problem of humanity. Strict measures must be taken to root out racism, to help humanity. If today you are silent on the matter, it means you are showing consent towards racism. So speak up against racism, if you think it’s not right. Otherwise it will become a norm.

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New Social Compact

Educating Women in Pakistan: A Necessity For National Development

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Photo: UNICEF/PAKISTAN/Asad Zaidi

Education is fundamental to the success of any nation. Almost every developed nation recognizes its importance and lays great emphasis on its availability to every human being.

Education brings out the meaning of life and enables a person to make sense of the world around him. While on the other hand, an illiterate person fails to comprehend the essence of life and lives in ignorance.

Pakistan, the sixth most populous country in the world has grappled with the grave situation of illiteracy almost from the time of its existence and has one of the lowest literary rates on the continent. To put it narrowly, approximately 40% of its female population has not even received education at all. Thus, the major chunk of its population remains backward, which otherwise if educated could have proven to be a major source of social and economic development.

Women’s education is inextricably linked to the well-being of society. A society comprises of both male and female members, and equally needs the contribution of women nearly as much as of men in maintaining and regulating its functions. However, women in Pakistan face great challenges in accessing education and are confined to play domestic roles only. Also, certain societies consider the education of women as taboo. This results in gender inequality and social disparity which ultimately impedes the growth of a nation.

Women, as a child bearer, not only holds great responsibility of proper upbringing of the child but also of a whole generation. This aspect can be underscored by the African proverb which says,

“If you educate a man, you educate an individual but if you educate a woman, you educate a whole nation.”

Therefore, an increase in the education of women can profoundly improve human development outcomes such as child survival, health, and schooling. Education can bring phenomenal change in women’s life as it increases their confidence and raises their status in family and society. It lends her voice which she can use to advocate her rights and also helps her to participate in political and social sciences. Pakistan cannot afford to neglect the education of women if it wants to modernize itself and until or unless its female population remains uneducated, it will continue to undermine the ideals of democracy that it so cherishes. There is no doubt that Pakistan is a country whose youth is imbued with great talents and if given adequate knowledge they can properly channel this talent to the country’s advantage. This can only be achieved if gender disparities in literacy and education attainment in rural and urban areas of Pakistan are removed.

Women are also regarded as the weaker segment of society but through education, they can change their weakness into strength. It is also seen that women’s education has a positive relationship with women’s labor force participation rate which can play a significant role in reducing poverty and can contribute to sustainable growth in a developing country like Pakistan itself. Therefore, the government should invest in the education sector and especially in women’s education. This should be on its priority list as it is necessary for national development and progress.

Hence, concrete steps should be taken to empower women by granting them equality and education so that Pakistan can set itself upon the path of success.

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