16769: Feldman: Fw: [GAA] Newsweek: 'Where Living is Lethal' (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: Janet Feldman <kaippg@earthlink.net>

Dear Friends,
Hello and here is a sobering article with a focus on youth in Haiti (and
mention of Paul Farmer in the context of child health, especially in terms
of lack of access to healthcare and the lethal effects this creates). I also
have a few "success stories" to send about programs addressing HIV/AIDS,
especially in the youth population of Haiti, and will hope to do that soon.
Here's to doing what each and all of us can to create some success stories
of our own, and greatest thanks for all of your invaluable efforts in that
regard! Janet

http://www.msnbc.com/news/966321.asp?0cb=-e1e154894

Where Living Is Lethal
Around the world, millions of kids die needlessly each year. Can they be
helped?
By Geoffrey Cowley
NEWSWEEK

Sept. 22 issue —  To experience childhood as Americans knew it a century
ago, you don’t have to travel very far. Just 700 miles from Miami, on Haiti’
s desolate Central Plateau, obesity and food allergies and attention deficit
disorder are unheard of. In this part of the world, a healthy child is the
one who escapes death from tetanus or tuberculosis—someone like 14-year-old
Noula.

WHEN THE BOY’S FAMILY carried him into Dr. Paul Farmer’s frontier clinic in
the village of Cange two years ago, he had a raging fever and a ballooning
abscess on his back. Farmer’s team saved his life by treating the TB and
other infections that were devouring his spine. But they couldn’t restore
life to his legs—and they knew he wouldn’t survive in his mountaintop
settlement without them. So Noula lives in the clinic now. He wheels around
behind the auxiliary nurses, coaxing moribund children to hang on, and he
seems to feel he’s the luckiest guy alive. When I met him last March, he had
just been given a new wheelchair. His smile could have lit an office
building.

In a sense, Noula is lucky. Kids like him still die in droves in Haiti—and
Angola and Afghanistan and Bolivia and dozens of other poor countries.
Worldwide, nearly 11 million children perish before their 5th birthdays
every year. They don’t die because science has yet to find treatments for
their conditions. Most die for the lack of clean water, adequate nutrition
and the most basic medical necessities—skilled birth attendants, 50-cent
vaccines, antibiotics that were developed eight decades ago. “We know what
to do,” says Dr. Robert Black of Johns Hopkins University’s Bloomberg School
of Public Health. “We have interventions that are proven. What we haven’t
done is commit the resources needed to deliver them.”

Children’s lot is clearly improving by many measures. The overall death rate
for kids younger than 5 has dropped by 30 percent since 1980. Some countries
(Cuba, Brazil, Bangladesh) have made even greater strides. And bold
initiatives by Bill Gates and other philanthropists have helped create a new
sense of urgency and possibility. But obscene disparities persist. Kids born
in South Asia and sub-Saharan Africa still die at 20 to 30 times the rate of
kids in the industrialized world. In fact 90 percent of the world’s
childhood deaths —roughly 9.7 million a year—now occur in 42 developing
countries. And 99 percent of the victims are poor.

What exactly is killing all these kids? Birth complications and neonatal
infections are the biggest scourges, together killing 3.2 million children
in the 42 hardest-hit countries each year. Diarrhea and pneumonia claim an
additional 2.1 million lives each, followed by malaria, AIDS and measles.
But none of these conditions kills at random. In a sense, every one of them
is a symptom of poverty. Poor kids, wherever they live, encounter more than
their share of health hazards—more crowding, more vermin, more contaminated
water—and inadequate diets leave them doubly vulnerable to whatever hazards
they confront. “More than half of the deaths in children can be attributed
to undernutrition alone,” says Black. “What finally kills the child may be
pneumonia, but if the child were well nourished, he never would have
developed it in the first place.” The final blow is a lack of adequate
health services. Kids in poor countries are not only more exposed and more
susceptible to disease. Once sick, they often go untreated.

This dynamic plays out incessantly in the hills of central Haiti. Farmer
started his clinic there in the mid-1980s, while studying medicine and
anthropology at Harvard. His patients were landless peasants who’d been
forced off their farms and onto the barren hillsides by a U.S.-sponsored
hydroelectric-dam project. Thanks to his vision, tenacity and fund-raising
acumen, the Clinique Bon Saveur is now a thriving community center with a
school and a 104-bed hospital. Partners in Health, the relief group he
founded with Harvard in 1987, now operates in seven countries. Traversing
the shaded grounds at dawn, Farmer is mobbed by supplicants who have walked
for days to get there and camped on the pavement once they arrive. “Feel my
stomach,” they plead. “Can you fix my hands?” “Please, look at my baby.”

The medical staff works 16-hour days to avoid turning anyone away, and it
has achieved astounding results. In the region served by Zanmi Lasante
(Creole for Partners in Health), infant mortality now stands at one third
Haiti’s national rate. The interventions that make the biggest difference
are often simple ones: sterile birth kits; antibiotics for typhoid; milk,
zinc and vitamin A to combat malnutrition. Policy analysts estimate that
these and other basic measures could save 6 million children a year—all for
the price of a few aircraft carriers.

Unfortunately, the gap between possibilities and realities is growing ever
wider. As World Bank health consultant Davidson Gwatkin observes, “The more
you need health care, the less likely you are to receive it.” Some 46
percent of children are still born without skilled attendants in the
neediest countries. Fewer than half have access to potable water and only 5
percent of those who are at high risk of malaria sleep under
insecticide-treated mosquito nets. Vaccination rates are actually falling
throughout sub-Saharan Africa. In that region, according to UNICEF, the
proportion of kids immunized against measles fell from 62 percent in 1990 to
50 percent in 1999, as government priorities shifted.

Political will is the key commodity. For all the talk of leaving no child
behind, the United States has yet to commit more than a 10th of 1 percent of
its gross domestic product to foreign health assistance. And as a global
task force noted recently in The Lancet, U.S. development aid for child
survival has declined in the past few years. Even within the United States,
12 million children still live in poverty, 9.2 million lack health
insurance, and federal rules bar immigrant children from receiving
public-health benefits until they’ve been here five years. “The consequences
of this neglect are painful and expensive,” says Irwin Redlener, president
of the nonprofit Children’s Health Fund and associate dean of Columbia
University’s Mailman School of Public Health. “We’ve made a mockery of our
rhetoric. It turns out not to mean very much in terms of real dollars and
services.”

Dollars and services are important. But like many doctors who serve the
poor, Farmer dreams of something more fundamental. The ultimate challenge is
not just to manage the symptoms of poverty, he says, but to change the
social arrangements that perpetuate it. His clinic is set up to handle
35,000 patients a year, but it took in nearly 200,000 destitute peasants in
2002—even as Haiti struggled to meet interest payments on foreign debts
incurred by past dictators. His efforts may inspire awe, but as he is the
first to admit, they are stopgaps.

With Karen Springen

       © 2003 Newsweek, Inc.