This Year’s Sachs Student Lecture

This Year’s Sachs Student Lecture

Women's Health, A Most Vulnerable Hinderance In Socio- Economic Development.

The United Nation's Women's health report is released.The various aspects of women's health and how it affects the development paradigm are reflected in the initial press release.http://www.un.org/ .The point  I noted most is that no matter what paradigm you see it from, human development and social justice are directly affected and very seriously affected by women's health.

In Pakistan there is a true picture of this reflected in every aspect of a person's life. If the mother is young she is affectted by morbidity ,childbirth complications, anemia,mental health problems like depression, osteopenia etc. Her productivity both as a homemaker and her work like in agriculture,worker in factory, house help etc is severely affected. She is under constant stress to provide income to support the family and now increasingly in large urban areas. The domestic or household help workorce is coming  from  Southern Punjab where poverty is leading the rural population to increasingly migrate to urban areas like Karachi, Lahore, etc to  f ind jobs as domestic help..These women constitute  a major household help workorce and are not registered as such. Their work carries no acknowledgment from the labour department and they get no benefits as a group of workers. For health needs they visit private practitioners ,often quacks in 'Katchi Abadis' or slums where they are residing in overcrowded , unhygeinic conditions. Their water supply is often contaminated and they use unboiled water for drinking and cooking also. It is to be mentioned here that the girl child is equally vulnerable as she often goes to 'work' with her mother and if she stays back often 'looks after' her other younger siblings. The staying back ordeal exposes her to hazards such as child abuse, fire or c ooking accidents and other mental stresses and problems. Not going to school is just one aspect of her deprivation.The irony is that the religious people in Pakistan who are otherwise so vehement in opposing UN and WHO work are not even inclined to acknowledge this problem. They are not concerned with addressing the health issues and neglect and poverty related issues in Pakistan. They can do much to help as they have vast resources, means and influence in Pakistani society.
The health issues faced by poor women in Pakistan are kaleidoscopic. All aspects as mentioned by Dr. Chan are represented here. It is high time that the governments, civil society organisations and religious groups realize the gravity of the situation and address these issues in an urgent basis. The incidence of violence against women, now also in the context of conflicts of terrorism targetting girls education is increasing . This will again adversely affect womens health and thus the health of the nation that is Pakistan.
We need to prioritize and devise a plan o action to improve the health and well being status of Pakistani women keeping in mind the millineum development goals. The UN and WHO are already working to help in Pakistan.We can gain much from them. There is a dire need to take the religious groups and organisations on board and build their confidence in institutions to improve women's health and socio-economic status in Pakistan.

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Millineum Development Goals Report 2009..A Short Synopsis.

As the MDG report is released, the G8 Summit is over in LAquila, Italy.
Mr Ban Ki-Moon in his foreword of this report stressed the need to strengthen global cooperation and solidarity and to redouble our efforts to reach the MDGs and advance the broader development agenda.He urged the global community ,in view of the global economic crises, not to turn its back on the poor and the vulnerable. It seems that the leaders of the G8 have listened to his advice and pledged some aid like $20 billion especially for food growing in Africa.
This economic crises has slowed and reversed progress on some of the eight goals as commented in the report.
Poverty: It was seen that from 1990 to 2005, the number of people living on less than $ 1.25 a day, decreased from1.8 billion to 1.4 billion,but due to the crises ,in 2009 this will be increased to an estimated 55million to 90 million people.This was not anticipated.
Hunger: The earlier trend of decrease in hunger was reversed in 2008 due to high food prices and even falling food prices in 2008 have not been translated into benefit for the poor.
Children: These are the most vulnerable and most in developing regions are underweight for their age, stunting their prospects for survival,growth and long term development.This report emphasises the fact that the child nutrition target will not be achieved and will be eroded by higher food prices and economic turmoil.
Gender Equality and Unemployment: The unemployment in 2009 could reach 6.1 to 7.0 % for men and 6.5 to 7.4% for womenWomen also emain trapped in underpaid and insecure jobs.
Maternal Health and Mortality: This area has made least progress so so far.The reduction in donor funding will further aggravate the situation.
Export Revenues: This has decreased and this will further deteriorate.
Environment: The measures to achieve environmental goals will not improve and deforestation will continue. Water crises looms large.
The lower level of aid may reverse the gains made so far.

It lists the successes so far as:

• Those living in extreme poverty in developing regions has decreased slightly more than a quarter in 2005 compared to almost half in 1990.
• Major accomplishments were also made in education,where primary education enrolement reached 88% in 2007 especially from 83% in 2000.Sub-Saharan Africa and Southern Asia enrolement increased by 15 percentage points and 11 percentage points respectively from 2000-2007.
• Under five mortality rate declined from12.6 million in 1990 to 9 million in 2007.Key interventions like insectiside treated bed nets to fight malaria ,second chance immunisations to fight measles hav e made a remarkable difference.
• Environmental actions like 97% reduction of consumption of substances that deplete Earth's protective Ozone layer by global actions and cooperation.
• Efforts to improve the living conditions of the urban poor must pick up speed and extend even further.As the developing countries' cities rapidly expand this improvement has to keep pace.
• Preservation of natural resource base such as fisheries, forests ,water must be priority.

Carbon Sequestration animated webiosode from Earth Institute.

Carbon Capture, Sequestration and Reuse: The Basics from Earth Institute on Vimeo.

Prevention Of Typhoid in Pakistan

As discussed in seminar on Typhoid in Pakistan. ,Typhoid is a major disease burden in Pakistan. It is almost endemic in urban densely populated slum areas of major cities like Karachi, Hyderabad, Lahore, Rawalpindi.(http://Dawn.com /National).The mechanism of safeguarding the water supply of drinking water is deficient. A new safe drinking water policy is bieng announced ( see pg 3 of Dawn newspaper/National) but let us hope this is carried in its true spirit.
The true picture is that the urban workers be they domestic servants, cooks, resturant and eatery workers are never screened for Typhoid and Hepatitis. Inspite of appearing to look modern no safety precautions, screening , vaccinations are carried out. Most are carriers of Typhoid and these bacilli are secreted in stools . As no standard operating procedures are carried for pre food handling there is abundant carraige under finger nails. The excreta contamination of drinking water supply is also massive as most pipes for fresh water supply and waste disposal are running parallel in urban areas with frequent overlapping and mixing of two streams. Also sewerage and waste is bieng disposed without treatment directly into rivers and streams. This is bieng taken directly into drinking water supply. The chlorination and some substandrd cleaning is bieng done. This is never made public and no public interest group or government agency is monitoring this. This has to be made public so that there is pressure from public for improving standards. Only doing conferences and announcements of policies by ministers will not solve the problem. Our whole attitude to safeguarding health of the people has to be more proactive with open access to cleaning procedures with more awareness of these issues. Also the affluent citizens need to take more of these issues up as causes and help the administration and the public health officials in a more problem solving way.
There is a need to take up public health issues as serious priority and increase the budgetary allocation .Also there is a dire need to be more proactive in fighting Hepatatitis and Typhoid.only a thrust on war footing will help fight theses menaces.

Water An Expensive Commodity.

Pakistan is facing acute water shortages already. Due to climate change the precipitation will decrease in Pakistan. Already there are many areas facing a drought like situation.As each Pakistani city is teeming with millions of people and there is acute shortage of clean drinking water, the conservation measures have to be taught and taken by the municipalities as a priority task.Pakistani cities are bieng polluted by industrial and chemical wastes,all ending up in drinking water reservoirs. there are no laws and no treatment facilities. The water bieng supplied to large cities like Karachi with a population of over 16 million people is not passed through a very stringent or modern treatment plant. The piped water is also supplied to very large worker population which live in large urban slums mainly by hydrants and tanker mafia. the quality of this large water supply is very questionable. non of the tankers are owned by any companies. There is no water testing of the drinking quality of these tankers. The inner tank cleaning is neither checked or tested by any inspector or any administrative authority. The hydrants where these tankers are filled from are also not checked for the quality of water, whether fit for drinking or not. The water supplied to such a large population results in diseases of stomach and intestines both of the men workers and their families. As I work on social basis as doctor with some of these people I have seen over the last 30 years the growth both physical and mental slow down amongst the children of such areas. These children due to repeated stomach and intestinal infections,suffer from malnutrition and anemia. Malnutrition is also due to the fact that an average family size is atleast 8 persons including parents and the GDP is very low and a large number(40%)live below poverty line that is less than $1 a day.There is no food shortage as such but as Roti(bread) prices have increased the food intake is also lessening. Due to anemia and malnutrition especially protein calorie malnutrition ,these children have less resistance to infection and infestation. As the water is polluted and contains worms etc.,there is a vicious cycle of disease and diarrhoea and anemia and malnutrition. The average worker family spends about 40% on medicines and that too preferably on the earning member. The child and the female child especially remains the last priority for medical treatment.
I need to write a seperate post on the health access and services to these families. So the water shortage and its pollution impacts negatively on the these slum dwellers health. This will manifest in so many problems which I will discuss later.
There is a dire need for the city government to link up development plans with access to clean drinking water and health.For providing better water environment and clean drinking water in such communities I have few suggestions:

The idea of water board as a supplier organistaion should be changed and made an user organisation.The areas should be under control of regional communities which should form water clubs at very small areas level. In Karachi we have local bodies such as councils, which are perfectly suitable to manage their water problems. These groups will not only monitor their supply but also be able to check and standardise water quality.These should then have link with local health officer so that the incidence of diarrhoeal diseases is monitored and controlled. This kind of activity does not need a new infrastructure or money input. All these systems are in place it only needs awareness in communities and they will form their own bodies once they know the advantages in combating water pollution and maintaining water quality.
The mayor of Karachi(Nazim) should form water checking team under his direct care which checks the water tankers water quality also.On this he should not compromise anymore as the burden of disease is increasing and taking its toll on the productivity of the city. All social aspects are directly linked to water quality.
These ideas will be further elaborated in later posts.
As a commodity the value of water is not only increasing in the pricing context but as a value for decreasing or affecting other development parameters such as productivity,health index, morbidity, mortality,burden of disease etc. We need to approach this problem in a more holistic and sociological way in order to find solutions in way of human progress and harmony.

Impending Water Crises In Pakistan

As Pakistan faces an impending water shortage, the emphasis should be on conservation and good water management. Some household tips to reduce wastage are as follows:
Keep the physical count of amount of water used for different purposes such as drinking,cooking,kitchen washing, linen washing, lawn watering, porch washing,car washing, toilet flushing .We have installed brackish underground water pumps and seperate storage which we are using for garden watering, toilet flushing, porch washing. Toilet flushing consumes a lot of water so the use of brackish water helps a lot.
It is essential to train children to turn off the tap while applying toothpaste to brush, while brushing teeth, using shower water judisciously like wetting body and head quickly and then applying shampoo and soap over body while the shower is turned of . Rinsing head and then body sytematically. I have seen if water is mixed in a bucket and then used, water is saved much easily.
The children should be shown the water sources and how they are depleted and we should make them realize conservation.
Children should be taught to wash dishes at an early age so that they understand water conservation.

Developing medical record keeping software

The need for keeping short, comprehensive, useful medical records has become so acute that the electronic medical record keeping has become s important as water. The issues are easy user friendly data entry formats, easily transferable information codes,security, standardisation, insurance accessibility and above all completeness of examination and history taking. With the advennt of tele medicine as part of medical care we have to focus on good history taking and physical exam.I have developed a software as part of EMR to use these important inputs.
The culture of meticulous record keeping has to be encouraged especially in Pakistan.

Impending Water Crises in Asia and Africa

The threat of water shortages especially for drinking purposes looms large over the most populated and stressed countries in the world.A sudy carried out by the Global Change Impact Center in Pakistan(govt. sponsored group ) gives an overall perspective of difficulties challenging this country.It states that the economic growth as dependant on agriculture will be affected by water shortages.Unemployment and food shortages will result.Pakistan like other countries in Asia and Africa suffers from pollution of rivers, poor management of water ,silting of reservoirs,no new water resevoirs bieng built.The report emphasizes better use of water but in th e end fails to give practical steps for water management practices in Pakistan as its topic;Water and new technologies suggests. There is no footprint for solutions either technological or better water management practices which are a dire need in a country with a population growth rate as one of the highest in the world.

Lifeline

Water is important for life.Drinking water is in very short supply over Africa and Asia.Conservancy measures are important.Water usage banks should be created for conservation and sustainable usage by communities themselves.Each group should plan thier own programs.
Self help should be the basis ,Orangi Pilot Project example.We should lessen dependancy in planning from foreign donors.Water Banks should be made available to the communities as commodity equities with regulatory controls by th e state itself.