Haitian cholera causing diarrhea as "clear as water"

The latest statistics from OXFAM say that there are now 641 cholera deaths in Haiti. Hospitals have treated 9971 cases total since the outbreak began. The cholera is beginning to be found in the capital of Port-au-Prince where there are still a million homeless people.

From the UK's Independent, writer Guy Adams tells us about the latest activity in Haiti.

Health officials confirmed their worst fears of the disease spreading to the capital, when tests revealed that it had infected a three-year-old boy from the Cité Soleil neighbourhood who hadn't left the city since cholera was first recorded in Haiti just over a fortnight ago.

Previously, the handful of cases in Port-au-Prince came from citizens who had recently arrived there from the mostly rural central region, where the current outbreak is thought to have started at the end of October. Nationwide, the official death toll has now passed 500, and reports coming in from small towns around the country suggest that many hospitals are struggling to cope with the influx of victims of the water-borne disease, which causes severe diarrhoea and can kill through dehydration in a matter of hours.

In Raboteau, a seaside slum in the north of the country, rubbish trucks were patrolling the streets clearing up unclaimed bodies. Doctors had run out of rehydration drips, so were referring patients to the hospital in Gonaives, where a reporter from the Los Angeles Times spoke of scores of patients lying outside on stretchers, expelling diarrhoea "clear as water" into buckets.
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At the La Piste camp in Port-au-Prince, Amanda George, an aid worker from the British Red Cross, said her medical team had already treated roughly 40 people who were suspected of having cholera. "A couple of days ago, we saw the first ones arrive in our observation centre," she said. "We haven't heard back from the lab, but we just know it's cholera. We've got people losing fluids everywhere. Some of the patients, particularly children, look very ill. Their eyes have rolled back and they have white pupils from dehydration."

Video: Human trafficking in the Netherlands

From Al Jazeera, the story of a human trafficking survivor from the Netherlands.

Human trafficking in Texas

Occasionally we take a break from world poverty to link to a story about human trafficking.

The state of Texas has one of the main trafficking routes in the United States. Texas authorities have recognized the problem and have established some of the toughest laws against human trafficking found in the states..

From this Texas Tribune story, writer Julian Aguilar sheds some light on the problem and also explains how those laws can sometimes go too far.

Human trafficking now exceeds all illegal enterprises except for illicit drug and weapon smuggling in terms of profits derived, which can be as high as $32 billion annually. And Texas has the dubious distinction of sharing a large slice of that pie.

The state is home to one of the busiest routes for trafficking humans: the stretch of Interstate Highway 10 that runs from El Paso to Houston. The most recent data from 2007 indicates 30 percent of calls made to the National Human Trafficking Resource Center hotline to report cases of alleged human trafficking were made from Texas, according to the Polaris Project, a Washington-based nonprofit that operates the National Human Trafficking Resource Center hotline and lobbies for stronger state and federal anti-trafficking legislation.

Legislators and law enforcement officials aren’t sitting idly by, however. Texas has a reputation as one of the country’s leaders in attacking the problem: The Polaris Project considers the state one of the most proactive in curbing the practice, as it meets a majority of the 10 criteria the group has set forth as a barometer to measure success. Penalties for trafficking children here are also among the most severe in the nation. A person found guilty of pimping a child, which is what happens to the majority of children trafficked, faces a second-degree felony charge, punishable by up to 20 years in prison. Pimping an adult, by comparison, is a Class A misdemeanor.
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Texas’ record of being tough on crime has often meant harsh penalties for child victims of human trafficking, as they have historically been charged with criminal acts of prostitution despite being forced to engage in sexual acts against their will. But lawmakers are encouraged by a Texas Supreme Court ruling in June that reversed a lower court's decision to charge a 13-year-old female with a misdemeanor crime of prostitution.

In a 6-to-3 decision, the court ruled in The Matter of B.W. that a minor child, known only in court documents by her initials, could not be charged with prostitution due to her age. The initial charge of prostitution was filed after the teen consented to sex with an undercover officer during a sting operation in Houston. She received 18 months of probation, a sentence that was upheld on appeal before being overturned by the high court.

“The Texas Supreme Court recognizes that Texas will treat these [children] as victims and not offenders,” says Houston attorney Ann Johnson, who was appointed to represent B.W. on appeal. “This is the first case like it in the nation, so Texas is leading the way and saying that we’re going to address this issue and we’re going to protect these children.”

Black market for kidneys has slowed in Pakistan

From IRIN, a story on how new laws have changed the black market for kidneys in Pakistan.

Rehmat Masih, 35, who lives in the predominantly Christian Youhanabad suburb of Lahore, capital of the eastern province of Punjab, is facing hard times.

On a monthly income of around Rs 6,000 (US$70) which he earns by selling sweet drinks from a stall, he can barely provide food for his family of six. To make matters worse, his wife is sick with hepatitis and, to help meet the costs, his two oldest children, Saleem aged 13 and Sumera 11, are forced to work as garbage collectors. High food price inflation has added to their difficulties. Consumer prices rose by 15.71 percent in September, according to official figures.

A few years ago Rehmat would have known just what to do: He would have sold a kidney to gain at least temporary respite from poverty. But though he has approached two middlemen who arrange for hospitals to sell kidneys to wealthy clients requiring transplants, he has not yet received any guarantee he will be able to find a buyer.

Things had been quite significantly different until three years ago. Pakistan had gained a reputation as an international marketplace for kidneys, with around 4,000 kidney transplants taking place annually and only around 25 percent of the organs coming from related donors.

Around half of those receiving kidneys came in from other countries to receive an organ they had bought, usually from impoverished people in Punjab.

“Around 2,000 transplants took place each year, with about 1,500 of these involving foreign buyers who travelled to Pakistan to buy a kidney,” Maj-Gen (retd) Abdul Qadir Usmani, administrator of the National Human Organ Transplantation Authority (NHOTA), told IRIN.

2007 law

Much of this changed with the passage of the Transplantation of Human Organs and Tissues law in 2007. The legislation, under which NHOTA was set up, lays down rules that all hospitals and doctors are bound to follow, bars the purchase of kidneys, and restricts donations - essentially to blood relatives.

Action by police, courts and tough monitoring has helped enormously, as has the awareness raising campaign spearheaded by the Karachi-based Sindh Institute for Urology and Transplantation (SIUT), which actively campaigned for years to have the law passed.

Farhat Moazam, chairperson of the centre for biomedical ethics at SIUT, told IRIN there had been a “decline in kidney sales following the law, though the practice has not ended entirely”. She also said the media had played an important part in driving home the message about the ethical and medical issues posed by the exploitative practice of kidney purchases.

Many of those who have sold kidneys in the past have ended up receiving little aftercare. Some suffered a decline in health or serious psychological issues.

Such people can be found everywhere in Youhanabad - till 2007 a favourite recruiting ground for those engaged in the kidney trade. “I have been suffering pain in my side, blood in the urine and other issues since the operation to remove my kidney in 2006. I was also not paid the full amount of Rs 300,000 [$3,529] that I was promised,” Pervaiz Ahmed told IRIN.

“Today we are afraid to approach people openly to obtain a kidney and those who wish to do so are sworn to strict secrecy,” said a middleman who asked not to be named. He said “most hospitals” which had previously bought kidneys had stopped doing so, especially after the high-profile arrest of six people, including five doctors in 2007, for involvement in selling kidneys.

Such measures have also led to people re-thinking about selling organs. “My uncle sold a kidney, but I would never do so because it is wrong for a rich man to buy a part of my body. Besides police can arrest anyone who sells an organ,” said Nadeem Ahmed, 25, a bicycle repairer.

Maj-Gen Usmani said the law had been “very successful” and since 2007 there have “been allegations but no proven cases of violations”.

Courts have also played their part in acting to stop the practice. In June 2009 the Supreme Court of Pakistan sought details of kidney transplants carried out at two hospitals, after a complaint that illegal transplants continued. Both hospitals gave an undertaking that illegal transplants were not being carried out.

But despite such measures, violations are occasionally reported. In October this year an Omani national died in Lahore after receiving a kidney that had been bought from an unknown donor.

“When surgeries take place in backdoor clinics there is a much greater risk of complications for both the recipient and the vendor,” Moazam said. She also told IRIN that only an increase in the donation of organs by those who had died would reduce the demand for kidneys, which fuels illegal purchases. The law lays down procedures for such donations, but these are extremely rare due to social taboos and a lack of awareness.

Rehmat Masih is aware of the new law and says he would “rather not” sell an organ, but says for now he has no choice, because he has no other way to meet his family’s pressing needs.

OXFAM's wish list for tomorrow's G-20

World leaders arrived today in Seoul, South Korea for latest G-20 meeting that begins tomorrow. There has been little said about if any development issues will be on the agenda. It is expected that recession recovery, and debt bailouts will be the focus of the G-20.

From this OXFAM press release, the NGO gives this wish list for the G-20 meeting. OXFAM hopes that the plans for ecomonic recovery will include those who live in poverty.

As the first non-G8 member to host a G20 heads of state summit, South Korea has made development a central part of its agenda with a focus on boosting poor countries’ growth. But Oxfam is concerned that progress towards tackling poverty could be derailed by rows over currency valuations and monetary policies.

Oxfam is calling on the G20 to forge a new Seoul Development Consensus to replace the failed Washington Consensus of the past. The new consensus should combine financial support for health, education and poor farmers in developing countries with action to make the global economy work in the interests of poor countries.

A narrow focus on growth would not be enough on its own to tackle poverty, the international agency warned. From 1981-2001, when the Washington Consensus was at its height, the world economy grew by $19 trillion but people living in extreme poverty received only 1.5 percent of that.

Takumo Yamada, Oxfam Policy Manager, said: “Too often in the past, the poorest have been denied the benefits of growth. The G20 needs to show that this time it will be different.

“Millions of people have been pushed into extreme poverty by the economic crisis and are facing cuts in already threadbare healthcare, education and social support.

“The G20 has the chance this week to make great progress in tackling poverty. It would be a tragedy if poor people became casualties of conflict over currencies.”

The World Bank estimates that the global slump has pushed 64 million more people into extreme poverty, forcing them to live off less than $1.25 a day. Research for Oxfam shows that 56 poor countries face a $65bn fiscal hole in their budgets as a result of the economic crisis.

Oxfam is pressing the G20 to agree a package of specific measures to help poor countries, including:

* A tax on the major OECD financial centers to fund development. A financial transaction tax could raise $400bn per year
* Rich countries to deliver on their aid promises. Investment in health, education and poor farmers is essential to economic development;
* Action to curb speculation on commodity markets that has contributed to almost 1 billion people going hungry;
* Regulation to protect poor people from the adverse effects of ‘land-grabs’ which have seen huge swathes of prime agricultural areas taken by foreigners;
* A real say for poor countries in the global economic decisions that affect them – at least 3 full seats at the G20 and root and branch reform of the IMF.

Yamada said: “The G20 should learn from its own experience of what works. Korea’s recent success in economic development was achieved with the help of billions of dollars of aid which helped fund vital health and education, as well as land reform to ensure fair access for the poor.

“Rich countries must not use the economic crisis or the G20’s focus on growth to wriggle out of their commitments to the world’s poorest at a time when they need help more than ever.”

Senegal's black market for medicine

From IRIN, a story on the black market for medicine in Senegal.

In Senegal eliminating the sale of unregulated or counterfeit medicines will take better laws and law enforcement, but as long as poor people have children getting sick sales will thrive, experts and residents say.

Street vendors across the country sell products of questionable quality smuggled in from other countries - in many cases outright fakes - or hawk medicines sold to them by pharmacists seeking illegal profits. In both cases consumers are at risk.

Aboubakrine Sarr, president of the private sector pharmacists’ union in Senegal, said there are no statistics on the impact, but “the free-for-all illegal street sale of aspirin packets wreaks havoc”.

Aspirins, antibiotics, Viagra, painkillers, anti-parasitic pills and many others can be found anywhere - improperly stored and sold by people who cannot advise on dosage or side-effects.

Many Dakar residents are aware of the risks but people IRIN spoke to said they had no choice.

Asked what mothers do when a child falls ill, Adama Ndiaye, a mother of four in Dakar’s Pikine neighbourhood, told IRIN: “We lose our minds. We’ve got no money for prescriptions.”

A neighbour, Mariama Niass, who sells sweets and trinkets in front of her home, said: “You go to the doctor and let’s say you’ve set aside 300 CFA francs [64 US cents] for the consultation. Then the doctor prescribes medicines costing 10,000, 7,000, 3,000 CFA francs [$6 to $21]. You come back home. You see the children. And you haven’t yet prepared dinner. You must use whatever money you have to buy rice and other items for a meal... The medicines that are sold in the streets - we all have been advised not to buy them, but we have to, because we can’t buy prescriptions.”

Efforts fall short

In July the Economic Community of West African States, the World Health Organization (WHO) and the European Union published a guide to help states combat the unregulated sale of medicines, but there is a gap between international manuals and the reality on the ground.

“This is progress on the international scene but on the ground, we are forever taking one step forward, one step back,” the pharmacists’ union’s Sarr told IRIN.

Where pharmacists sell medicines to street vendors, some in the industry are calling for punishments similar to those faced by drug traffickers, but for now wrongdoers face minimal punishments and in some cases none at all, Sarr said.

“Punishments often are not even applied, because of lax enforcement or a kind of protection that exists among colleagues in the industry.” Between 2008 and 2010, five pharmacists were briefly suspended for collaborating with unauthorized sellers.

A bill regulating the pharmaceutical industry awaits debate in parliament.

Senegal does not have enough inspectors, according to Mamadou Ngom of WHO in Senegal.

There are just four official inspectors to check up on more than 1,000 pharmacies, three manufacturers and four wholesale distributors. Effective control would require five national inspectors as well as one in each of Senegal’s 14 regions, Ngom told IRIN.

Despite an apparent crackdown on the sales side - in 2009 the authorities shut down Dakar’s principal market for unregulated medicines, Keur Serigne Bi - sales continue, in that spot and many other marketplaces.

In Touba, one of Senegal’s main cities, several pharmacies have had to shut down because they can no longer compete with street vendors.

“It’s a problem that’s tough to manage,” Sarr told IRIN. “Still, on the positive side, religious authorities are beginning to take seriously the risk these unregulated products pose.”

Meanwhile, health officials are planning “awareness days” - in Dakar and four other regions - to talk with communities about the risk of buying unregulated medicines, according to Pape Amadou Diop, state director of pharmacies and medical laboratories.

Problems with "cash-for-work" programs in Haiti

Some of the hundreds of Non-Governmental Organizations in Haiti have people participating in "Cash-for-work" programs. This program pays people for temporary day jobs in an effort to put money into the disaster area.

An investigative report from Haiti Grassroots Watch shows some of the drawbacks of "cash for work." The story says that there is some corruption within the programs, but that is a small problem compared to what they discovered.

"The main impact of cash-for-work is on the circulation of money," noted Haitian economist Gerald Chéry, adding that whereas the programme was helpful immediately following the Jan. 12 earthquake, today it is having a perverse effect because people use their money mostly to buy imported food, or items – again, mostly imported – to hawk on the street.

Over half of the food Haitians eat is imported. In 2008, Haiti imported almost $1 billion in goods and services from the U.S. alone, spending some $325 million on food.

"We need the money to circulate in Haiti, not leave Haiti to go to another country. The money needs to stay in Haiti so that it will create work," Chéry said, adding that to be useful, job programmes need to be tied into a vertically integrated economic effort.

Another problem is that in the countryside, the programmes – which are supposedly targeting earthquake refugees – appear to be drawing peasants off the land.

Agronomist Philippe Céloi, who supervises a six-month Catholic Relief Services programme in the south, admitted that most of his 468 workers were local peasants, not refugees from the capital.

"After six months there will be benefits – not only the workers have gotten a salary but also the community benefits," Céloi said.

Asked about farmers' fields however, Céloi admitted there was a downside.

"These people are not doing the planting they ought to be doing. Right now it's bean season… And they aren't planting potatoes or manioc or sorghum, so when this programme ends, there is going to be a problem," he said.

Catholic anti-poverty program under fire

The US Catholic Bishops will meet next week in Baltimore. One of the items on the agenda is the anti-poverty program called the Catholic Campaign for Human Development. Some bishops say the program is funding projects that are not in line with Catholic doctrine and have stopped taking collections for the program.

From this Religion News Service article that we found at the Huffington Post, writer Daniel Burke tells us what the controversy is about.

As the U.S. bishops' flagship anti-poverty program, the CCHD is funded through a special collection taken up each year on the Sunday before Thanksgiving. Since 1970, the program has disbursed $290 million in grants, according to CCHD officials.

But the program's practices and guiding philosophy have been sharply attacked by conservatives armed with Internet-enhanced research, a sharp nose for malfeasance, and a deep apprehension for anything that sniffs of socialism.

At the bishops' meeting in Baltimore, CCHD officials will present a 15-page report that details reforms they say will bolster the program's Catholic identity. The new policies will also ensure that groups whose activities conflict with the church's stance on social issues do not receive funding, they said.

Last June, a coalition called Reform the CCHD Now sent a report to bishops in all 195 dioceses detailing accusations against nearly 50 groups that it says engaged in pursuits "antithetical to church teaching."

The CCHD acknowledged such errors at five of the 270 groups that received funding in 2009; a sixth group's contract was not renewed for the same reason, said John Carr, executive director of the bishops' social justice office. The other allegations were unfounded, he said.
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The vast majority of CCHD grants went to programs such as one in San Antonio that has attracted more than $1 billion for public projects in low-income neighborhoods, according to the report. Such projects, the report implies, are endorsed by Pope Benedict XVI, who wrote in 2009 that the "institutional path" of charity is "no less excellent and effective than the kind of charity which encounters the neighbor directly."

Amount of remittances triples that of international development aid

Remittances from foreign nationals is an under-looked source of income for poor to middle income countries. The people who go abroad for work or school often send back some of the money they earn to their families. A new study from the World Bank finds that these remittances are triple the amount of international development aid from governments.

From the Guardian, writer Claire Provost unpacks the study for us.

According to the Factbook's estimates, documented remittance flows to developing countries in 2010 are expected to reach $325 billion (£203 billion), up from $307 billion (£191 billion) in 2009. The majority of this money (in absolute terms) flows to middle-income countries, though for some of the world's poorest countries these remittances account for up to 25 percent of their GDP and remittances to low-income countries grew by 8.2% in the last year alone.

Jenny Abura argued on the Guardian's Katine site in 2009, that "despite the significance, the contribution made by the diaspora is largely ignored in the formal debate about development. By the same token there are few mechanisms that allow senders and recipients of remittances to engage with development activities at a formal level."

In order to leverage the massive capital inflow represented by these remittances, the World Bank suggests including remittances in countries' credit rating analyses and linking them to financial services such as microfinance and targeted instruments such as the increasingly-popular diaspora bonds. It also argues for mechanisms and new technologies to reduce the variable but often weighty transaction costs associated with remittances: according to the remittance prices worldwide database, sending $200 from the UK can entail an average transaction cost ranging from $7.78 (if sending to Pakistan), to $30.72 (if sending to Rwanda).

However, despite the World Bank's recent excitement, there is little consensus over the relationship between remittances and development.

For example, as remittances are private cash flows, typically from a migrant abroad to a family at home, it is not obvious if and how these individual private cash transfers can aggregate to impact well-being beyond the households which receive them.

It is similarly unclear how much of these remittance flows is used by households to cover day-to-day survival costs, how much is consumed and how much is invested. Though remittances might improve the short-term welfare of a household, and might boost consumption and demand for imported goods, some worry that they can contribute more to dependency than to development.

Psychosocial support for disaster survivors

From IRIN, a story on addressing mental health of disaster survivors.

Psychosocial support (PSS) is about helping survivors of disasters or crisis resume their regular lives. It covers everything from individual counselling to re-opening schools.

IRIN asked people involved in psychosocial work at the UN Children's Fund (UNICEF), Médecins sans Frontières (MSF), the International Rescue Committee (IRC), Save the Children, Columbia University, and the Interagency Standing Committee Working Group on Mental Health and Psychosocial Support to describe what they do, how they determine progress, constraints to delivering this support, and how they measure their success.

"Psycho" and "social"

PSS has been polarized into two camps said Mike Wessells, a professor at Columbia University in the United States who chairs the Taskforce on Mental Health and Psychosocial Support in Emergencies of the Inter-Agency Standing Committee (IASC), a global body.

The 'psycho' approach based on clinical mental health seeks to address trauma, depression, and anxiety. A more holistic ‘social’ method tackles the problems people face in emergencies, like the threat of physical insecurity, displacement, not knowing the whereabouts of loved ones, loss of livelihood, and access to school.

Some NGOs, such as MSF, combine psycho and social. "Our main objective is to restore functioning on an individual or community level ... we try to unite the individual, community and environment perspectives," said MSF's mental health specialist in Amsterdam, Kaz de Jong.

The gap is slowly narrowing as perceptions change. "Mental health support cannot exist without the other forms of support – financial aid, health interventions – if you give people counselling and no livelihood help, it won't take hold," said PSS specialist and psychologist Mirella Papinutto, who has worked for UNICEF, the International Committee of the Red Cross (ICRC), and the Italian poverty alleviation NGO, COOPI.

NGOs often focus on the social side. "There is a general feeling that if we can provide recreation, education and community integration [for children], then some psychosocial issues that may later have developed, can be dealt with early on," Save the Children's child protection adviser, Christine McCormick, told IRIN. Children may also be referred to social workers or health authorities for counselling services.

What are PSS activities?

MSF provides one-on-one support to help people reconnect with their families, communities and friends after a traumatic event; trains local counsellors to continue the work when the agency leaves the area; teaches people to manage stress and distress; helps parents deal with traumatised children; counsels the survivors of gender-based violence.

UNICEF, IRC and Save the Children help re-open schools or support community schools, and train teachers and volunteers to offer emotional support to children.

"The behaviour of attending school every day and the establishment of a routine ... supports children's well-being ... [it] brings back a child's sense of identity, it allows them to interact with their peers, and process what they have gone through," said Deborah Haines, emergency education adviser at Save the Children.

"PSS is the port of entry," said Papinutto. "It's the system through which you ... follow up, with all referrals from medical to legal, social and economic; it is at the heart of everything."

How do crises affect people?

Examples range from loss of self-esteem, depression, relationship difficulties, the development of phobias or physical problems with psychological roots, to community rejection, said Papinutto. MSF's De Jong noted that mothers sometimes stop caring for their children; fathers can become frustrated and angry with their families as well as other people.

Specific groups have their own needs – children associated with armed forces can be stigmatized by their families and communities; they might feel they are spiritually contaminated by the people they have killed; they have fallen behind in their education or lacked schooling; they might be addicted to drugs; girls could have reproductive or sexual health problems, Papinutto said.

After the earthquake struck Haiti in January 2010, many schoolchildren were found to be withdrawn or aggressive, some isolated themselves, and some children had "invisible symptoms", said Haines.

Are there minimum standards?

Yes. The IASC guidelines on Mental Health and PSS in Emergencies were drawn up by some 27 partner agencies in humanitarian, clinical and social work, and published in 2007.

For the first time, they called for psychosocial support to be integrated into all humanitarian sectors, said Wessells. "When planning camp management, the guidelines ask: 'Is there enough privacy? Is attention paid to overcrowding? Are the latrines locked and well-lit? Is there a space where people can bury [dead] bodies?'"

The blueprint is a pyramid with four tiers: the first covers basic needs like shelter, safety, clean water and sanitation, healthcare and food. The second focuses on people who require community and family support to maintain their mental health and psychological wellbeing.

The third covers people who require mental health support from government services, or a combination of counseling and livelihoods support. The top tier represents the three to four percent of people whose intolerable suffering makes daily functioning difficult, and who require specialist psychiatric help.

Is PSS improving?

Practitioners say it is. "There was a more coordinated, systematic and holistic PSS response in Haiti, much improved since the Asian tsunami [in 2004]," said Sabine Rakotomalala, a psychosocial support provider for UNICEF and Terre des Hommes, a child rights organization. Wessells agreed.

MSF’s De Jong noted that "People from different agencies and different professions – social workers, camp planners, psychiatrists - sat around the table." PSS activities began five weeks after the earthquake.

Sue Dwyer, Vice-President of International Programmes at IRC, said sexual and gender-based violence programmes had attracted "a huge increase in funding ... It still remains insufficient in relation to the needs, but compared to 10 years ago, funding streams have significantly increased."

PSS has also been gaining respect. "Nowadays you see more and more mental health interventions ... and the social side of psychosocial is no longer overlooked," De Jong commented. "The field itself has evolved - in the 1980s you went for counselling when you had a serious disorder, nowadays they [mental health services] are everywhere."

Wessells said the 2004 tsunami had turned the tide. "PSS used to be seen as something to do after basic survival needs were met – the tsunami emphasized how mentally affected people are, and support in that realm can be life-saving: if you make people more resilient, they're less likely to engage in high-risk behaviour and be victim to a variety of preventable [problems]."

What are the constraints?

PSS "still has some way to go before the value of education in children's psychosocial wellbeing is really understood," said Save the Children's Haines.

Governments and practitioners often had to be persuaded to take a holistic approach. "A government might put its health ministry in charge of PSS, and the ministry will post a couple of psychiatrists in the field, and you will end up with a purely medical model," said Wessells. The specialized nature of the training meant many psychologists and social workers each took "an inappropriate, silo approach" to providing help.

There is a lack of evidence as to what works and what does not. "In the absence of this [evidence] it can be difficult to convince policy leaders to make it [PSS] as high a priority as many think it should be," said Rakotomalala. "People think it is so important to set up toilets, but they don't necessarily take into account how people are feeling."

It is not always about money, said Papinutto. Although the sector has received more cash, there is still an absence of good needs assessments on the ground, and despite minimum guidelines, agencies offering low-quality, inappropriate responses are still able to operate.

When is your work done?

Emergency interventions are finite, but psychosocial wellbeing could take years to achieve, and implementing the various tiers of the PSS response takes different periods of time. Haines said emergency education should start as early as possible, because a crisis was inevitably a long-term endeavour.

"Communities are not moving on when they are stuck in the past," said MSF's De Jong. "It is like losing someone; you are supposed to feel grief, anger and sadness, but after, say, nine months, you should also want - at least partly - to start to live again."

An intervention was working "When we see a community functioning again, when they are able to direct their energies towards the future, and are able to deal with the issues of the past without revenge or anger," he said.

"When they can look after themselves and others, and their caring capacity is restored; when new or old mechanisms of leadership are re-established or re-started - these are some indicators of recovery."

Haitian government confirms cholera is in Port-au-Prince

The government of Haiti has now confirmed that cholera has reached the capitol of Port-au-Prince. In a news conference televised last night, health officials say that the cholera outbreak is now a matter of national security.

A million people are still living in tent camps after the January earthquake, many of them use or live next to filthy water.

From the Daily Mail UK, we receive the latest news from Haiti.

The aid group Doctors Without Borders has reported more than 200 residents of Port-au-Prince with severe symptoms at their facilities alone over the last three days.

More than 70 other cholera cases had been confirmed among people living in the capital, but those people became infected while outside the capital.

The disease's move into the city was confirmed when a three-year-old boy from a tent camp near Cite Soleil was proved to have contracted cholera before October 31 without leaving the capital.

The hope against hope was that it an isolated incident, but two more cases have now been confirmed at the same hospital where the boy was treated.

Hundreds of people were already suspected of having cholera, suffering the disease's symptoms of fever and diarrhoea while lying in hospital beds or inside shacks lining the putrid waste canals of Cite Soleil, Martissant and other slums.

A confirmed case of cholera had never been seen in this Caribbean country before last month, when it suddenly killed several dozen people and spread across the agricultural heartland of the Artibonite Valley.

Read more: http://www.dailymail.co.uk/news/article-1328321/Haiti-cholera-epidemic-spreads-capital-puts-million-risk.html?ito=feeds-newsxml#ixzz14tCalkCj

Farmland the size of Ireland could be used for EU bio-fuel requirement

The European Union is insisting that member countries increase the total consumption of bio-fuels to 10%.

The increase of food based bio-fuels will mean less food being grown for eating. Even if bio-fuel suppliers compensate for the lost land for human consumption it would need to clear more land to do it. Doing so would expel more emissions into the atmosphere as equipment makes the land suitable for farming.

A study from an environmental policy think tank shows just how much land will be taken away by the new bio-fuel policy, and how much emissions it will create. From the Guardian, writer John Vidal gives us the study details.

Plans to make European motorists use more biofuels could take an area the size of Ireland out of food production by 2020 and accelerate climate change, a study has found.

The report by the independent Institute for European Environmental Policy (IEEP) is based on plans that countries have submitted to the EU detailing how they intend to meet their legal requirement to include 10% of renewable energy in all transport fuels by 2020.

IEEP calculations suggest that the indirect effect of the switch will be to take between 4.1m and 6.9m hectares out of food production. In addition, say the authors, opening up land to compensate for the food taken out of production will lead to between 27m and 56m tonnes of additional CO² emissions, the equivalent of putting nearly 26m more cars on the road.

The study says European countries have chosen to meet the EU renewable energy targets by importing so-called first generation biofuels from African countries or from Indonesia and Brazil, rather than by promoting the use of advanced biofuels, electric vehicles or energy efficiency to reduce the environmental impact of transport.

"The renewable energy directive was adopted to help combat climate change, however, through promoting the use of conventional biofuels with no consideration of indirect land use change impacts it has the potential to actually increase the EU's greenhouse gas emissions.

Changes in how the Gates Foundation donates to global health

Over the years the Bill and Melinda Gates Foundation has changed the principals that decide their giving. The foundation is interested in actions that provide immediate results, which is why it is now focused on vaccines and improving health.

When the Gates Foundation started, it gave money to explore innovative projects such as lab in a card, or mosquitoes with artificial noses. Now that the foundation has changed its strategy, it has left some scientists in a funding vacuum, looking for money elsewhere to continue their ambitious projects.

From the Seattle Times, writer Sandi Doughton explains the change in strategy and how it has hurt some scientists.

Nearly $460 million later, the foundation isn't exactly pulling the plug on the original Grand Challenges in Global Health program. But recession and a sense of urgency have drained much of Gates' enthusiasm for large, speculative research endeavors.

Most of the projects have used up their money and aren't receiving any more. Many with continued funding are receiving far less than before.

Some disappointed scientists say the loss of funding will slow progress on research that has lifesaving potential — but needs more time to mature.

"It's left most of us a bit frustrated about the whole thing," said Brett Finlay, a molecular biologist from the University of British Columbia. With the $8.7 million his team received to develop medicines that boost the body's general defenses against disease, the researchers discovered a potential drug for a severe form of malaria. "Now we're looking at each other, asking: 'How are we going to take this forward?' "

Foundation officials say the program was an experiment that's simply running its intended course. Most grants were for five years. There was never a guarantee of more funding, although many scientists assumed promising projects would be continued.

At the program's final conference in Seattle last week, Gates Foundation global health Director Dr. Tachi Yamada made it clear the megaphilanthropy approach is sharpening its focus on technologies with the biggest health payoffs and near-term applications.

"We've changed the way we work," he said. "In the very earliest days, honestly I don't know if we knew what we were doing. We were giving away money as fast as we could. ... Now we're trying to be more strategic."

Grand Challenges has always represented a small proportion of the Gates Foundation's spending, which now exceeds $2 billion a year. Much of that money goes to support the Global Fund, which distributes AIDS medications and fights malaria and tuberculosis, and GAVI, which provides childhood vaccines. The foundation also funds tightly focused efforts to develop and test vaccines and drugs for malaria, TB and other diseases.

In fact, vaccines are now the foundation's top priority, Yamada said. And it's not enough to develop something new. It must get to the people who need it — the sooner the better.

Video: an inside look at the officlal cholera lab in Haiti

From this Al Jazeera video, a look at the lab that officially confirms cholera cases in Haiti.

Bangladesh caps microcredit interest rates

The government of Bangladesh is going to start imposing limits on the amount of interest that microcredit lenders can charge. The new rules are due to concerns that for-profit microcredit lenders are gouging the poor with excessively high interest rates. Microcredit companies counter that high rates are the only way they can stay viable to extend services to more of those in poverty.

From this AFP story that we found at MSN News, we read more details of the new rules.

The government's Microcredit Regulatory Authority (MRA) has approved new rules banning microfinance lenders from charging more than 27 percent interest on loans, MRA director Sazzad Hossain said.

"Many microlenders have earned a bad name for charging high interest rates. There are also isolated incidents in which lenders have used force to compel borrowers to repay loans," Hossain told AFP.

One out of every five of Bangladesh's 146 million citizens is a micro-credit borrower, relying on one of more than 1,200 micro-finance institutions whose interest rates vary from 20 percent to 51 percent, according to the MRA.

"We oppose the interest rate cap. It will be hard for micro-lenders to stay afloat charging just 27 percent interest," said Mosharraf Hossain, head of the Credit Development Forum, a microfinance industry association.

Hossain said local microfinance institutions have high costs as many borrow money from private banks at around 13 percent interest, then lend the money on, adding that there are extra costs when operating in remote, rural areas.

Cholera has reached Port-au-Prince

From NPR, cholera has reached the Haitian capital of Port-au-Prince. Reporter Jason Beaubien surveys the prevention efforts in the city.

Tomas storm passes Haiti, but a cholera storm could follow

A little silver lining can be found in Haiti, as the the tropical storm did minimal damage to the nation's capital of Port-au-Prince. Only eight people died in the storm, but it is still uncertain if the storm's waters could spread the cholera epidemic.

From Time Magazine, writer Jessica Desvarieux gives us the latest and shares a story of heroism.

"With all the inundation and consequences of the hurricane, the [populace] can become more vulnerable. There are more and more people [ingesting] cholera [through contaminated water]. We must prepare ourselves for the worst," says Dr. Claude Surena, a consultant for the Ministry of Public Health and Population. Surena's ministry first confirmed an outbreak of cholera on Oct. 20 in the bucolic Artibonite region, just north of the capital. Since then, there have been more than 7,700 confirmed cases in the country and at least 500 deaths, according to figures released on Nov. 5. Confirmed cholera cases rose 60% just this past week, ahead of Tomas' feared arrival.
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As Tomas' rains swept through Haiti, anecdotal evidence mounted regarding conditions that could lead to cholera's spread. In the Port-au-Prince district of Delmas 33, canals came close to flooding the fraying blue tents of a camp for people made homeless by the earthquake. The only reason no flooding occurred was that a group of men stood in the canal's murky water, picking up piles of trash with their bare hands to keep the waterway from clogging and overflowing. "We as a community had to band together to clean out the canals ourselves," says Renauld Pollicard, a camp dweller. "A lot of people are scared of getting cholera, so we had to pay those men. Otherwise, no one would go down in that hole." This does not mean, however, that the men who worked the canals were not infected. Or that other areas were not deluged with infected water.(Comment on this story.)

While there have been no confirmed cases in Port-au-Prince, people suffering from cholera who have been through Artibonite have been hospitalized in the capital. It is feared that flooding in southern regions like Léogâne poses an increasing risk of the bacteria contaminating more water sources. About 80% of those infected with cholera do not show symptoms but can still pass on the bacteria and infect others.

"This certainly right now is an epidemic," says Dr. Jordan Tappero, an epidemiologist and Haiti team leader for the U.S. Centers for Disease Control and Prevention (CDC). "We have to keep a mind-set that cholera is likely to spread across the county due to poor sanitation and lack of potable water."

Read more: http://www.time.com/time/world/article/0,8599,2029982,00.html#ixzz14ipar4T8

Medecins Sans Frontieres has this update on their operations in Haiti to prevent the spread of cholera.

As the cholera epidemic continues in Haiti’s northern and central regions, a primary objective is to ensure treatment for affected communities dispersed throughout these areas. With Hurricane Tomas having moved past Haiti, MSF medical teams will be able to expand their support and activities.

As of now, MSF has treated more than 6,400 patients suffering from acute diarrhea, including a large proportion suffering from severe dehydration, symptoms typical of cholera.

MSF is supporting two Haitian Ministry of Health hospitals in the Artibonite Region, where the cholera outbreak originated. Medical teams are working in the main hospitals in St. Marc and Petite Riviere. Relevant medical supplies, such as intravenous fluids, catheters, and oral rehydration solution, as well as chlorine for disinfection, are also being provided. But it is outside more populated areas such as these where assistance is especially needed.

“Outside of the larger population centers, it is critical that smaller, dispersed communities are able to access treatment,” said Kate Alberti, an epidemiologist with Epicentre, MSF’s epidemiological research arm, who is currently in Haiti. "We are very concerned about the spread of the epidemic in rural areas, where transport to existing health structures is difficult. Treatment centers need to be established and existing ones further supported in order to ensure rapid access to treatment.”

An NGO says that access to water for poor Kenyans is unfair

From IRIN, a story on inequality in access to water for the poor people of Kenya.

The poor in Kenya pay more for water than the rich, but even then millions do not have enough, mainly because provision is skewed, an advocacy group has said.

"The absence of a formula-based approach to budget allocation at the Ministry of Water and Irrigation has led to large inequities for water access in Kenya, with the poor paying more compared with the rich, and millions of citizens going without adequate access every day," James Nduko, the Kenya programme manager of Twaweza, an NGO, said on 5 November at the release of a report, It's Our Water Too! Bringing Greater Equity in Access to Water in Kenya.

"Our analysts have aggregated facts from a range of credible sources that demonstrate that persistent inequalities in access to water services in Kenya can be quickly reduced if an approach that links investment and resource allocation to needs rather than political weight is adopted and implemented."

Corruption accusations

On 2 November, Mwangi Kiunjuri, an assistant minister who was recently moved from the water ministry to public works, presented documents to the Kenya Anti-Corruption Commission, which he claimed showed widespread corruption in the Ministry of Water and Irrigation.

However, the Minister for Water and Irrigation, Charity Ngilu, defended herself and the ministry against such accusations. She admitted that the ministry could have lost money in "some deals" but maintained she had stopped all payment of questionable bills.

According to Twaweza, the inequities in access to water are glaring as the privileged get water delivered to their homes often at very low prices while the poor in urban areas pay the highest price and persistently have the worst access.

"The actual budget allocations show startling differences that do not reflect the current rural and urban water needs," Nduko said. "For instance, the planned investment for water in rural areas falls short by close to 60 percent of what is required to achieve the water MDG [the UN's Millennium Development Goals], but exceeds what is required in urban areas by 20 percent."

Poor pay more

Twaweza said the poor in Nairobi's informal settlements paid up to 30 times more per unit of water compared with residents of more affluent neighbourhoods. "Overall, almost 16 million Kenyans, mostly poor, have no access to clean, dependable and easily available water and depend on kiosks, mobile vendors, open streams, wells and rain catchment to meet their water needs," it noted. "Rural areas, where the majority of Kenyans live, are mostly underserved by formal water supply services."

Quoting 2009 World Bank figures, Twaweza estimates that nationally piped water coverage stands at between 42 percent and 59 percent and that rural areas perform consistently worse than urban areas.

In rural areas where 78 percent of Kenya's population lives, only 38-52 percent have access to safe water, according to Twaweza. In urban areas, 59-83 percent have easy access to safe water, although huge differences exist within the urban populations.

"At present, there is only 1 percent per year of citizens accessing improved water services," Twaweza said. "At this rate of change, it will take at least 30 years for rural areas to have acceptable water coverage [estimated at 80 percent] and another 40 years for good coverage [90 percent] to be reached based on service agreement adopted by water sector institutions."

Afghanistan women burning themselves alive to escape

Forced marriages, abuse and neglect is almost commonplace for the women of Afghanistan. For many women there is no easy way out from it. It is taboo to talk about any problems at home and shameful to your parents if you leave a forced marriage. Authorities turn a blind eye to the abuse and medical help for depression is difficult to access.

So for some of these women, suicide is the only way out. With indoor stoves in about every home, the easiest way to commit suicide is by burning yourself.

From the New York Times, writer Alissa Rubin visited a hospital that has treats as many as 10 burning victims a day.

The hospital here is the only medical center in Afghanistan that specifically treats victims of burning, a common form of suicide in this region, partly because the tools to do it are so readily available. Through early October, 75 women arrived with burns — most self-inflicted, others only made to look that way. That is up nearly 30 percent from last year.

But the numbers say less than the stories of the patients.

It is shameful here to admit to troubles at home, and mental illness often goes undiagnosed or untreated. Ms. Zada, the hospital staff said, probably suffered from depression. The choices for Afghan women are extraordinarily restricted: Their family is their fate. There is little chance for education, little choice about whom a woman marries, no choice at all about her role in her own house. Her primary job is to serve her husband’s family. Outside that world, she is an outcast.

“If you run away from home, you may be raped or put in jail and then sent home and then what will happen to you?” asked Rachel Reid, a researcher for Human Rights Watch who tracks violence against women.

Returned runaways are often shot or stabbed in honor killings because the families fear they have spent time unchaperoned with a man. Women and girls are still stoned to death. Those who burn themselves but survive are often relegated to grinding Cinderella existences while their husbands marry other, untainted women.

“Violence in the lives of Afghanistan’s women comes from everywhere: from her father or brother, from her husband, from her father-in-law, from her mother-in-law and sister-in-law,” said Dr. Shafiqa Eanin, a plastic surgeon at the burn hospital, which usually has at least 10 female self-immolation cases at any one time.

The most sinister burn cases are actually homicides masquerading as suicides, said doctors, nurses and human rights workers.

“We have two women here right now who were burned by their mothers-in-law and husbands,” said Dr. Arif Jalali, the hospital’s senior surgeon.

Children in Yemen fear going to school due to old tribal differences

From IRIN, a story about children in Yemen who fear going to school because of crossing tribal boundaries.

Thousands of children in three of Yemen’s 21 governorates have stopped going to school for fear of being targeted by revenge killings, according to international NGO Partners-Yemen (PY).

PY is running an awareness campaign in the governorates of Al-Jawf, Marib, and Shabwa which run from north to south in central Yemen and where the tribal system is paramount in social and political life. The presence and influence of the official authorities here is still limited.

PY has been getting children in schools that remain open to chant the slogan "To those who deprived me of my father; don't deprive me of my education", but thousands of children have stopped going to school for fear of crossing tribal boundaries.

"I haven't gone to school since 2005 when I was in grade six. I fear that armed tribesmen from Hamdan tribe may kill me," said 17-year-old Salim Yahya of the Al-Shulan tribe in al-Jawf Governorate, which has been in conflict with the Hamdan tribe for 40 years now. Dozens of people in the two tribes have been killed in revenge killings over the past 20 years.

The conflict between the two tribes first broke out in the early 1970s over disputed land, with each tribe claiming ownership. "Now, those plots of lands are no longer a problem. The problem is that of complicated revenge killings that continue to kill thousands of tribesmen and keep children out of school," Sheikh Sultan al-Aradah, a chief mediator in the conflict from the governorate, told IRIN.

Dealing with the conflict at this level is very complicated - even through traditional structures - as tribes consider it a "black shame" to remove the threat of a blood feud from the family or tribe of an individual who has committed murder, said a PY situation analysis paper.

According to Judge Yahya al-Mawri, a member of the Interior Ministry-affiliated supreme national committee for addressing revenge killings, revenge killings in the three governorates claimed the lives of 4,698 people between 1998 and 2008. He could not give a more up-to-date figure as no official records of revenge killings and conflict casualties have been released in the past two years.

The three governorates have a high illiteracy rate: "Fifty-six percent of the male population and 70 percent of the female population… are illiterate," he said.

According to 2009 statistics from the government's Central Statistical Organization, 1.3 million people live in these three governorates where the illiteracy rate is 63 percent, compared to the national average of 41 percent.

Schools closed

Revenge killings have led to the closure of several schools, especially in al-Jawf and Shabwa governorates. The situation is not quite so bad in Marib, said PY.

Abdulhamid Amer, chairperson of local NGO Social Development and Peace Association in al-Jawf Governorate, told IRIN that around 20 schools across the governorate are closed. "As many as eight schools in Maraziq and Al Sayda areas have been closed for five years now," he said, adding that thousands of boys and girls had dropped out of education as a result.

According to Naji al-Sammi, conflict management officer with local NGO Brotherhood Society for Peace and Development in Shabwa Governorate, more than a dozen schools in his governorate have been deserted for several years as a result of revenge killings.

"Al-Nabub School in Nisab District, where around 500 students were enrolled, has been deserted for more than five years now. Few students have moved to other safer areas to complete their education; most have stopped going to school since then," he said.

Mediation efforts

Many former teachers have started mediating between warring tribes: "As our school in Al Sayda District has been deserted for five years now, we found ourselves idle, so we started working as mediators to help end long-standing conflicts, district school teacher Khalid al-Qubati told IRIN.

The carrying of guns is commonplace in the three governorates. "Parents teach their kids how to carry and use guns, as well as how to kill… They don't care about sending them to school," said teacher al-Qubati, who is from the central governorate of Taiz, but works in al-Jawf Governorate.

PY’s awareness campaign is designed to ensure a safe environment for children in school and has reached out to over 50,000 local women in the three governorates to promote girls’ and boys’ education and the need to protect students from revenge killings, Nadwa al-Dawsari, PY executive director, told IRIN.

"Our awareness activities have been well received in communities and that is because we frame them in a way that is appealing to local culture and builds on existing positive traditions," she said.

According to al-Dawsari, the ineffective role of government institutions in these remote tribal areas, extreme poverty, and poor infrastructure are the key challenges facing awareness efforts. "If government institutions were involved, our campaigns could be much more effective," she said.