January 28, 2016 3:57 pm

MEDLIFE is expanding to India!

Written by Jake Kincaid

In 2016 MEDLIFE continues to take its mission global! We are thrilled to announce the second of our two new destinations this year, the amazing city of New Delhi, India. India is one of the worlds most fascinating and sought after travel destinations, home to a diverse cultural tapestry of richness and depth unmatched anywhere in the world.

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India is the birthplace of Hinduism, Buddhism Jainism and Sikhism, 22 official languages are recognized in the country, and over a thousand more are spoken. India's roots are deep- its human history dates back over a thousand years before Christ. It is home to some of the most interesting and flavorful cuisine in the world.  In short, there is no place quite like India.

New Delhi, as India's capital city, contains all of the elements that make the vast country of India such a wonder to behold. The first city in Delhi was founded in 786 AD by Tomar rulers, and since then its streets have seen the rise and fall of many dynasties. It was declared the capital of the Mughal empire, the British colonial capital and is now the capital of the modern Indian state. This history is a living presence on the streets of New Delhi, where in the same day one can stroll past an ancient Mughal fortress (one of three UNESCO sites in the area), British colonial architecture and a glittering shopping center catering to India's emerging middle class.

Despite the small emerging middle class, India is still by almost any measure one of the poorest countries in the world.

In 2012 the World Bank reported that India was home to the largest population of people experiencing poverty in the world. Along with its world-class tourist attractions, though the standard tourist generally avoids it, New Delhi also contains vast slums. It is here that MEDLIFE will begin its work in India.

In India around 35% of the population lives below the national poverty line, a statistical measure based on caloric intake that is widely criticised. Many people argue that the current government statistics greatly under represent the true scope of poverty in India.

Access to health care is a serious issue in impoverished communities in India, as there is not much of a public health system. The government spends only 4% of its GDP on healthcare, which is very low. Compare that to the 17% spent by the US, 9.7% by Brazil, 9.4% by Haiti (the poorest country in the Americas) and 8.7% by Honduras.

Poor infrastructure, serious public health problems, low education and lack of access to good healthcare all feed on each other to sustain and exascerbate the poor quality of life that can be seen in India's slums. What follows is a short description of some of the most severe problems, but there are many more issues I will not go into.

Hygiene and sanitation are serious issues in the slums, which of course has a detrimental effect on general health by spreading and in some cases creating disease. Only about 30% of slums in the New Delhi area have septic tanks, while 22% have no latrine facility at all- the others have put something inbetween into place. The problem is so severe that the government declared ending open defecation a national priority, and UNICEF even felt it necessary to create this public service campaign to aid the cause featuring a catchy (you have been warned) song about a poo-party, which I think says more about the gravity of the situation than any number of statistics could.

While poor sanitation ensures there are plenty of hazardous germs in the environment, poor nutrition ensures that people's immune systems are vulnerable to illness. Nutritional diseases create one of the highest burdens of disease in India along with neonatal and maternal. 15.2% of the population fell below the minimum level of dietary energy consumption in 2014. Data about child nutrition is especially grave, in 2011 UNICEF reported that about 20% of children under-age five in India are wasted, a condition akin to acute malnutrition where muscle and fat tissues waste away. 43% of Indian children are underweight, which constitutes about 37% of the total underweight children in the world, and 48% were stunted. 

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These hazardous conditions often have a more serious consequence than stunted growth; in India about 1.83 million children die annually before reaching their fifth birthday – most of them due to preventable causes. India contributes more than 20% of child deaths worldwide.

Many conditions are allowed to worsen unnecessarily because access is so difficult. According to a government survey 52% of slums in the New Delhi area did not have motor access, in case of an emergency transporting a patient would be extremely difficult. While there is some basic free health care available in public hospitals, it is of extremely poor quality, difficult to navigate and often involves co-pay. 80% of health care spending still goes to the private sector.

Non-communicable diseases, primarily heart disease and diabetes make up the second greatest disease burden category in India. Slum residents have a higher incidence than those living in wealthier areas, along with poorer outcomes. Research suggests that education, awareness of vulnerability and risk factors are strong contributing factors along with poor treatment access and adherence.

Preventable conditions affect impoverished populations significantly. India bears the highest burden of Tuberculosis in the world according to WHO statistics, 2.1 million cases of active TB ocurred in India out of a total global incidence of 9 million in 2013. Incedence of HIV, which is often comorbid with TB, is very high as well, with an estimated 2.1 million living with HIV in India. 

Though the scale of the problems paints a bleak picture, things have begun to improve on some measures, for example Malaria incidence was similar to Tuberculosis in 2000, but since then the government and other organizations have helped halve the cases, from 2 million in the year 2000 to 882,000 in 2013.

 If the people of India and the international community work together, a better quality of life can be achieved.

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Come join MEDLIFE as we become part of the change in India with our first mobile clinics! We will be partnering with a local health institute called Mamta, who will provide MEDLIFE with local medical staff, and head into the slums of New Delhi to bring free basic healthcare directly to communities in need.

New Delhi Clinics:

May 7-15

May 14-22

 

Sources:

http://www.aidsdatahub.org/Country-Profiles/India

http://www.tbfacts.org/rntcp/

http://www.who.int/features/2015/india-programme-end-malaria/en/

http://www.mrcindia.org/MRC_profile/profile2/Estimation%20of%20true%20malaria%20burden%20in%20India.pdf

http://www.poverties.org/urban-poverty-in-india.html

http://www.poverties.org/poverty-in-india.html

http://www.who.int/gho/countries/ind.pdf?ua=1

http://apps.who.int/nutrition/landscape/report.aspx?iso=ind

http://www.unicef.org/about/annualreport/files/India_Annual_Report_2014.pdf

http://www.unicef.org/sitan/files/SitAn_India_May_2011.pdf

http://www.delhi.gov.in/wps/wcm/connect/adcd1f0047a86473ab46ffbdc775c0fb/pdf+report+69th+round+slum+final.pdf?MOD=AJPERES&lmod=538772215&CACHEID=adcd1f0047a86473ab46ffbdc775c0fb

http://www.hindustantimes.com/business/india-s-poverty-rate-lowest-among-countries-with-poor-populations/story-UUrEApaBqRZth6EzRdRK6K.html

 

January 21, 2016 11:44 am

MEDLIFE is expanding to Nicaragua!

Written by Jake Kincaid

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Nicaragua is a small country of unmatched beauty. Nicaraugua has not one but two coastlines full of pristine beaches that have not yet developed into tourist traps. The country also boasts some of the best-preserved colonial cities in the Americas, like Grenada.

The country's beauty, however, stands in stark contrast to the extreme poverty experienced by many of the people who reside in it, poverty brought on by a history full of internal conflicts and natural disasters. Nicaragua is the second most impoverished nation in the Americas, with 42.5% living below the national poverty line. MEDLIFE will begin working in Ciudad de Sandino, a city with particularly grave problems that came into being as a refuge for flood victims in the 70s and has continued to take in the refugees of the many subsequent internal conflicts and disasters that have besieged Nicaragua.

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The area, at the time known as OPEN3 was first settled after a massive flood hit Managau in 1970, which caused Lake Managua to submerge a 13 km strip of fishing villages. These people had nowhere to go, and were forced to flee the area with whatever they could carry with them, not much, to OPEN3, a strip of cotton farming land that was then mostly uninhabited. Residents settled there and tried to begin anew from nothing. We see the same story cyclically reemerge throughout OPEN3's history.

In 1972, a catastrophic earthquake rocked Managua leaving 6,000 dead and 20,000 injured. Earthquake victims came to OPEN 3 to begin again. Geraldine O'Leary, a nun who traveled to Nicaragua to work in OPEN3 just after the earthquake, wrote this in her memoir of life in OPEN3 in the early 70s.

“…Epidemics decimated the infant population. Even among us, there was a bout of stomach problems, more from the intestinal parasites that were as common as the dust in the water. OPEN 3 was growing so fast after the earthquake, from some four thousand inhabitants to an eventual 45 thousand, that basic hygiene became a number one priority. The newcomers often did not build latrines but simply used the local vacant lot. This combined with the pollutants already in the soil from the cotton farming, and the lack of water to maintain basic cleanliness made living in this dust bowl a constant threat. ”

Pg. 96 Light My Fire

The international community poured relief funds into Nicaragua. However, it soon came to light that the money was not reaching the victims of the disaster, Somoza Debayle, the then chief executive of the Nicaraguan government embezzled the international relief money.

The disaster had created a huge population of desperate people who no longer had anything to lose and the news that Somoza had embezzled their relief funds angered them, especially since Somoza remained in power. Economic and living conditions worsened as the years passed in Nicaragua. In OPEN3, where many of the most desperate citizens of Managua were trying to begin again, citizens continued to struggle to create a life with almost no support and a lack of basic infrastructure.

Historian Manzar Foroohar writes this of life in OPEN3 in the mid 70s.

“ Not even one paved road existed in the barrio. Most of the houses did not have electricity, and nobody had potable water. OPEN3 was so poor that the inhabitants lacked even a cemetery to bury their dead. By the mid 1970's, more than 50% of the barrio's adult population was unemployed. Malnutrition and lack of health care resulted in a very high infant mortality rate, 330 per 1000. ”

p.136, The Catholic Church and Social Change in Nicaragua

Conditions were ripe for revolution, and in 1978 the Sandinista National Liberation Front, a rebel group that was disenchanted with the Somoza government with ambitions to take control of the country seized the opportunity and launched a violent uprising. After a bloody struggle, they took power in 1979.

Though the Carter administration initially decided to work with the Sandinista government, the Reagan administration began to see them as a communist threat after they began to undertake some wealth redistribution projects and were caught distributing arms to Salvadorian rebels. The Reagan administration authorized the CIA to begin supporting antiSandinista rebels known as the Contras. This created a violent internal conflict that lasted for a decade.

During this time, conditions in OPEN3 improved little and the community continued to grow. In 1998 Hurricane Mitch devastated Nicaragua along with several other countries in the region and Managua was hit particularly hard as the lake swelled once again swallowed communities along its shores. Again residents flooded OPEN3 and founded the community of Nueva Vida, or New Life in Spanish, directly naming their community after the ethos that lies behind OPEN3.

Today Nicaragua is politically stable, no longer a hot topic in the news cycle and by many measures the safest country in Central America. However, after decades of internal conflict and natural disasters it is still the second poorest country in the Americas, with 42.5% of the population living below the national poverty line, and 8.5% of the country living on under 1.25$ a day. During the decades of near ceaseless turmoil, the underlying issues that keep these community in poverty have never been adequately addressed.

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Infrastructure and public services remain very underdeveloped in rural areas and in poor urban slums like OPEN3, which is now a large city known as Ciudad Sandino located not far from the Managua city center. For many of the poor residents of Ciudad Sandino, living conditions are much the same as they were for the refugees of the early 70's.

The healthcare system in Nicaragua is unable to adequately meet the substantial need of the population. According to a World Bank report, a very small portion of the population is insured, 24% of Managuans and only 5% of Nicaraguans who live below the poverty line. Because of this, out of pocket expenditures are a serious barrier to access for the poor, constituting 86% of all private health care expenditures. Access still remains a serious obstacle as well.

A sampling of the many significant public health needs highlighted by World Health Organization statistics includes a high rate of preventable diseases like malaria, parasitic diseases, and tuberculosis. Infant mortality is high, 31 per 1000 for infants under 5, and in the impoverished areas is associated with respiratory diseases, neonatal sepsis, congenital malformations, diarrhea, malnutrition, and meningitis. Maternal mortality is high in rural and indigenous populations, the poor, adolescents, and women with low levels of schooling.

Some 22% of children living in the poorest quartile of urban areas suffer from malnutrition versus 0.4% in the richest quartile. 23% of children under 5 showed stunted growth as of 2006.

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Although many illnesses are preventable, only 3.7% of all individuals receive preventive health care in Nicaragua.

There is a lot of work that needs to be done to bring quality healthcare to the people of Managua! Become part of the change and come work with MEDLIFE in Nicaragua. MEDLIFE's first round of clinics in Managua seek to take the first step in addressing the significant healthcare needs of Ciudad Sandino by providing free basic healthcare services in our Mobile Clinics.

Sign up here!

Trip Dates:

March 5th - 13th

March 12th - 20th


 Sources

http://hdr.undp.org/sites/default/files/hdr_2015_statistical_annex.pdf

http://www.envio.org.ni/articulo/16

http://news.bbc.co.uk/2/hi/americas/269619.stm

http://web.stanford.edu/group/arts/nicaragua/discovery_eng/timeline/

http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/CortezNicaraguaHealth.pdf

https://www.youtube.com/watch?v=CyCqJzBFJnI

http://www.fsdinternational.org/country/nicaragua/healthissues

O'Leary-Macias, Geraldine. Lighting My Fire: Memoirs between Two Worlds. Place of Publication Not Identified: Trafford, 2013. Print.

Foroohar, Manzar. The Catholic Church and Social Change in Nicaragua. Albany, NY: State U of New York, 1989. Print.

Like we always do, last week we hosted an educational workshop in the community of "Nadine Heredia" where we will work during this upcoming Winter Mobile Clinics. Check out the amazing photos our communications intern Edward Doherty took during that day!

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September 21, 2015 3:48 pm

Riobamba Area Photo Gallery

Written by Jake Kincaid

 Riobamba is situated high in the mountains at 9000 feet in the shadows of Mt.Chimborazo, the tallest peak in Ecuador. It surrounded by even higher elevation rural farming communities. MEDLIFE has had many clinics in these areas, and is currently working with patients there. This collection of photos shows some of these families and the places they live.

1MEDLIFE patient Hugo´s older borther. Hugo is getting a heart surgery with MEDLIFE.

2Hugo´s father Jose Manual show us their guinea pigs after meeting with MEDLIFE. He supports his family working in agriculture, keeping animals like these. Hugo looks in in the background.

3Jose Manuel walks down the street in Laime where he lives while talking with MEDLIFE nurse Valeria about his sons surgery.

4El Diablo Waterfall in Baños, a popular tourist destination near Riobamba.

5A mainstreet in Flores, where MEDLIFE patient Rodrigo lives with his family.

6Rodrigo near where his family keeps animals and grows crops. Flores is an agricultural community.

7Rodrigo standing in the field next to his home. MEDLIFE is building his family a new home.

8Sunset over Riobamba, where MEDLIFE Ecuador is based.

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We stood on the hillside over looking the valley in Nueva Esperanza, a community on the outskirts of Lima where MEDLIFE works. Hundreds of tiny orbs of light spread out across the valley below us, floating in the mist that thickened the air. This was the first time this group of interns had been into the hills at night. There was a tangible sense of excitement in the air around us; we didn't know what to expect from the community we were about to meet.

But it was refreshing to stand on that hillside breathing the brisk, wet air; it was refreshing to see something so beautiful in the pueblos jovenes, even if it sharply contrasted the stark poverty that went on as far as the eye could see.

During the daytime when the deplorable living conditions here are in full view, most would not describe the pueblos jovenes as beautiful. Pueblos Jovenes are the slums in the hills surrounding Lima. During the day, it was hard to imagine that the surreal beauty I saw at night would emerge with the darkness at sundown.

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They are a maze of disorganized shacks and dirt paths spread across the hillsides; there is no city planning here. The slippery, steep dirt paths are coated in the feces of the countless stray dogs, perpetually chasing the mysteriously clean cats that somehow manage to find something to live on even when there is so little for the people here.

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We are in the community of Virgen De Candelaria, waiting for a meeting to start about the construction of a staircase. Pueblo Joven translates to young town, and Virgen De Candelaria is literally that. People settled at the base of the hill 60 years ago, and the people near the top of the hill have been there for only about 15 years.

 In the late 1940's a rapid influx of migrants from other parts of Peru settled here and made do with what they had- basically nothing. Most of them still don't even own the land they live on. The name of the district, Nueva Esperanza, New Hope in English, reflects the reason people came.

However, the name is ironic, based on the informal nature of their settlement, pueblos jovenes like Virgen de Candelaria of the places we work lack the basics: access to clean water, sanitation, education, lighting, a safe community infrastructure, all of the ingredients necessary to put together a community, all the things needed to put together a community. Each of the places we work is missing something different, all of them are missing a lot. 

Best-selling books and academic literature are riddled with examples of how aid that is not specifically targeted to engage a community and to meet their needs is ineffective at best, and oftentimes harmful.

How do we make sure we are giving communities what they actually need, and not what we think they need?

On the dark hillside in Nueva Esperanza, we were about to see a critical part of the process that MEDLIFE uses to engage communities.

We walked in, there were about fifty people seated in the open-air shack under a corrugated iron roof. We stand in front of the audience and introduce ourselves, all 14 of us.

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While the community member who is running the proceedings speaks with a megaphone and a sheet of paper for reference, Carlos addresses the audience using only his voice, cutting through the interference of crying infants and reactionary murmuring, maintaining constant eye contact. Carlos is the director of Med Programs- he has done this countless times.

He finds the need for, and coordinates MEDLIFE's projects along with the help of our community leaders. Community meetings are a critical step in any project that affects the community at large. He explains what MEDLIFE does since this is our first project in this community apart from the recent mobile clinic and not everyone knows who we are.

Mobile clinics are often used as a test of community organization and participation before a project. If enough people do not show up at a clinic, MEDLIFE will not move forward a project. Participation was good enough at our mobile clinic in Virgen De Candelaria to move forward, but not great. Carlos tells the audience he is going to need greater participation for the staircase. Carlos said that the most important thing before any project “is too converse and coordinate with the people and to come into agreement.”

Carlos asked for people to stand and share their opinions on the project.

One women rose and described the dangers and difficulties of the climb up the loose hillside. “It's a great idea,” she said. “Especially for the children when it rains. I don't care if we have to work all day from Monday to Friday, we can do it.”

Everyone else seemed in agreement, the staircase was a good idea. The congregation agreed to work on the project, the men would carry the construction materials up at night, and the women would help with construction during the day.

They thanked us profusely and served us hot chocolate. It was delicious, and to our pleasant surprise, did not make us sick.

The meeting was a success- the community was taking ownership of the project and had committed to working on it alongside MEDLIFE, not just receiving it. If MEDLIFE cannot get this kind of support, we don't move forward with a project. If the need isn't great enough for the community to want to help, we probably aren't working on the right project. When the community engages with us on a project, we help them move themselves forward. 

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