Archives For health

Over exploitation of the Totoaba has been driven by demand in China for its swim bladder, a highly prized product known as ‘aquatic cocaine’. And bycatch catch in gillnets used to poach totoaba is close to eliminating the vaquita.

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I recently spent some days in Mumbai with our team there who are working to establish what will be a critical collaborative voice to help combat child sexual abuse (CSA)  in India.

Aarambh will be in first order a National Resource Centre on child sex abuse and, at the same time, will have the capacity to access legal and other support for victims, as well as provide training to communities, relevant government bodies and NGOs on the topic. The Resource Centre, which will gather education materials, promote awareness and best practice, is scheduled for launch in November.

Aarambh is a joint initiative of the ADM Capital Foundation and Mumbai partner, Prerana, which for two decades has provided support to the children of sex workers and is led by Priti Patkar, who is a respected authority in the field.

We are extremely excited to have Prerana as our partner in building Aarambh in a country where a 2007 government-sponsored study that included 12,500 interviews with children in 13 Indian states said 53 percent reported having been sexually abused in some way. Only three percent of the cases were reported to the police.

Last year, a Human Rights Watch report said the government’s response to CSA has fallen short, both in protecting children and in treating victims.  At the time the HRW report was released, Meenakshi Ganguly, the director of Human Rights Watch in South Asia, said in a statement: “Children who bravely complain of sexual abuse are often dismissed or ignored by the police, medical staff and other authorities.”

The government did not dispute HRW charges that India’s child protection system was flawed. The head of one government agency was quoted as saying at a news briefing that frequently police or court officials didn’t accept that rape or incest had occurred.

Besides Prerana’s deep knowledge of CSA in India, Aarambh builds on ADMCF’s long partnership with Philippines-based Stairway Foundation, which has produced excellent training materials and animated films on such topics as incest, trafficking and sexual abuse more generally.

ADMCF helped Stairway foundation translate the films and other materials into several Thai languages and facilitated trainings of NGOs and other groups there before turning most recently to India, where education, discussion and action on the topic is equally critical. The moment for change seems particularly right given India’s two-year old law on CSA known by the acronym POCSO. There exists confusion related to how to implement that law nationwide.

Uma Subramanian, who has led ADMCF in India over the past few years, is leading Aarambh with Prerana. She is building a team and the network of partners that will form the initiative. Indeed, the vision for Aarambh is that it is a collaborative effort, bringing together organizations working on the topic of child sex abuse from many perspectives, beginning with the Mumbai Child Safety Network.

In terms of helping to implement the law, for example, there ought to be specific medical units within hospitals set up to receive children who have been victims of abuse. There also needs to be training and special provision within the courts and police force nationally. At the same time, there will be space to comment on aspects of the law to make sure it functions effectively to protect children.

Some of this work is ongoing regionally, but the Aarambh National Resource Centre hopefully will help to spread best practice throughout the country.

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Angkor Hospital is the spectacular facility in Siem Reap, Cambodia I have written about in previous blog posts. Last year, the hospital offered 157,000 treatments to children free of charge, ranging from physical therapy and dental care to heart surgery. The boy above is an AHC heart patient who prior to surgery could hardly walk. When I came across him with his mother in the packed waiting room – back for a check up – he was running across the courtyard. His mother wanted to show me his scar.

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The hospital includes an incredible team of 49 Cambodian doctors and 149 Cambodian nurses, not to mention an equally dedicated support staff of 130. Although foreign teams do sometimes assist and train in more complicated procedures, there are only two full-time foreign doctors and two full-time foreign nurses at AHC. Above is the ER team comparing notes on patients.

The AHC budget for this year is US$4.5 million U.S., which works out to a cost per child of US$23. This compares to an average cost per child in the U.S. of US$1,853. Throughout this year, an average of 1,400 children were visiting the Emergency room at AHC and its satellite clinic thirty kilometers away, while 290 patients required admission. On average, the hospital’s three surgeons performed seven surgeries daily.

Those numbers have increased over the past few months, however, with a regional dengue outbreak and a larger number of patients seeking quality medical care they can’t find or afford elsewhere. In some cases, patients have had to rest on mats in the corridor for lack of ward space, while others have been sent to other hospitals.

A new four-floor building is now under construction. This will help improve medical care and create an additional 250 sq meters in the main hospital. Among the additions will be a neonatal ward, a new ward for recovering children, an expanded ER and labs (including the research lab, which is a partnership with Oxford University). Beyond the recent pressure from larger numbers of patients, an April medical audit identified a lack of adequate space, the small ER and lack of neonatal unit as the top three weaknesses of AHC.

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AHC works hard to provide the quality of medical care and compassion that a sick child would receive in a developed world context. The type of treatment offered at AHC, which is free of charge, is rare in Cambodia. This includes support to chronically ill patients, physiotherapy and palliative care for very sick children.  A home care program follows up with many such patients and includes a social work team.

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Some patients and their parents who aren’t able to see a doctor on the day they arrive must wait until the next day. The hospital provides cooking facilities, clean water and mosquito netting, which, innovatively, is tied between benches in the waiting area.

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These two children were waiting with their mother and a sick sibling, who needed medical attention.

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Beyond providing medical care and support to government hospitals around Cambodia in developing their medical and nursing protocols, AHC helps educate communities about issues related to health care. Some of the main causes of sickness, the main reasons that patients end up at AHC’s gates, are drinking contaminated water, poor sanitation and poor nutrition. In the context of working in one of Cambodia’s poorest regions where malnutrition is surprisingly still rife, AHC staff teaches children and their families the basics to keep them healthy.

We know that our oceans play a critical role in assuring human wellbeing, providing food, livelihoods and recreation as well as helping to regulate global climates.

We also know that our oceans are in trouble, with many marine species headed for extinction. Ocean acidification, rising sea temperatures, rising sea levels, hypoxia, overuse of marine resources and pollution rank among the greatest challenges. All of these are well-discussed in a Stockholm Environment Institute study, Valuing the Ocean, which makes an important argument for valuing and protecting ocean services.

But how do we gauge the health of our oceans and marine resources – a daunting task given the many interlinked and complex benefits and threats?

Recently responding to this question, a broad group of marine conservationists and scientists released the Ocean Health Index,which is a sort of marine GDP, reflecting the health of our marine environments and how sustainably we are using them.

An account of the Index was published in the Aug. 30th issue of Nature.

The groundbreaking tool is not just a measure of how pristine the waters of any country might be, but rather considers how we humans benefit from our marine ecosystems and how our oceans are faring globally in terms of provision of services to us.

In search of baseline measures, scientists and marine experts calculated standards for the many ways we use the ocean. It comprises ten goals for a healthy human–ocean system in the waters of a country’s exclusive economic zone, which usually stretch 200 mile offshore.

The index now offers hard numbers to show how close or far each  coastal country is to balanced use of the Big Blue.

The country goals for a balanced marine environment include clean water, food provision, carbon capture, biodiversity, coastal protection, recreational opportunities, artisanal fisheries, support of local economies, and a “sense of place.”

Globally, the overall index score was 60 out of 100, with developed countries largely performing better than developing countries. Only 5% of countries scored higher than 70, while 32% scored lower than 50.

Rather predictably, while northern European countries tended to score highly, much of  West Africa, for example, did not score so well.

Researchers hope the Ocean Health Index will build awareness of the state of the world’s ocean, and work as a catalyst and guide for business and government decision-makers to develop effective policies promoting ocean health.

Researchers intend to release an updated version annually that responds to  new data that will overtime refine the index.

The Ocean Health Index was developed with the contributions of more than 65 ocean experts including the National Center for Ecological Analysis and the Synthesis and the University of British Columbia’s Sea Around Us project. Founding partners are Conservation International, The National Geographic Society and The New England Aquarium.

I am constantly surprised that Hong Kong does not pay more attention to its water supply, that something so vital to our city is far from secured by our government.

How many of us know that 75 percent of our water comes from the Dongjiang River, while only 25 percent of the city’s drinking water is supplied by reservoirs from within the territory? That while Singapore has similar water concerns, the island nation is investing in technology to conserve, recycle and desalinate water to ensure adequate supply, yet our government simply is not.

This is wrong for many reasons but here are two of the most obvious:

1) China is experiencing a significant water crisis and is acting aggressively to ensure its own supply. As Civic Exchange’s Su Liu recently pointed out while speaking on a panel, “We in Hong Kong don’t see the big picture – 40 million compared to our 7 million also rely on the Dongjiang. If water tensions rise on the mainland – where is the priority? ” You can more read about the excellent discussion on China’s water stresses moderated by http://www.ChinaWaterRisk.org’s Debra Tan, here.

2) The Lower Dongjiang River Basin is becoming intensely  industrialized and urbanized meaning industrial pollution regionally is a real concern. At the same time, agriculture further inland has intensified and pollutants from farms, such as pesticides and fertilizers are just as dangerous in drinking water as industrial materials. So How safe is our water in reality? Clearly local testing shows that currently the water we drink meets health standards but can we be sure that will always be the case?

To my first point, China registers a 50-billion-cubic meter water shortage annually, with two-thirds of cities having trouble accessing water, according to a China Daily article last week quoting Chen Lei, the country’s minister of water resources. In all, China’s water consumption apparently has exceeded 600 billion cubic meters, accounting for 74 percent of the country’s exploitable water resources.

In January, the central government issued a document asking the entire country to limit the scale of water exploitation, improve the efficiency of water usage and curb water pollution. According to the article, China aims to reduce water consumption per 10,000 yuan ($1,597) industrial value-added output to less than 40 cubic meters by 2030, raise the effective water use coefficient of farmland irrigation water to above 0.6 and improve water quality.

Chen also has said the nation will set water consumption quotas for local governments and continue to perfect the water price formation mechanism in order to promote water resource conservation and protection.

So it sounds as though Su Liu has the right idea – the Chinese government priority won’t be to keep prices low and supply constant for the 7 million Hong Kongers drawing ever higher upstream on the Dongjiang.

And we are vulnerable. Our water agreement with Guangdong was renewed in late 2011 but only for another three years, until 2014 and for a maximum supply of 820 million cubed meters from the Dongjiang, a major tributary to the Pearl River, 83 kilometers north of Hong Kong. Our current accord commits to this supply regardless of drought.  But the river also supplies fresh water to seven other cities, including Guangzhou, Dongguan and Shenzhen. All of those cities, however, have seen allowances decreased during drought years so will Hong Kong continue to receive privileged treatment?

At the same time, we would be ill-equipped for any water rationing. As China Water risk has pointed out here, Hong Kong uses more water per capita than Paris, London, Singapore or Melbourne and over 50 percent of our water is for domestic use. This compares to just 15 percent of water usage in China being for municipal use.

Part of the problem is that our tariffs are among the lowest in the world. As CWR points out, the first 12 cubic meters of water used every four months is free for all domestic users. Countries with comparable GDP per capita such as Netherlands, Switzerland and the U.S. all have higher water tariffs.

But tariffs are also low in China and the expectation is that with a push on the mainland toward water conservation, pricing will likely at some point rise to a water tariff level of 2-3 percent of average household income. That should also translate to higher prices in Hong Kong.

Turning to pollution, I have written several blogs on the lack of enforcement of water quality standards in China. The intense industrial development throughout China, but particularly in the south, has helped fuel annual GDP growth in the double digits but it has also rendered many rivers, lakes and reservoirs, indeed much of the country’s groundwater, essentially useless for agriculture or consumption.

Of the country’s 26 key lakes and reservoirs monitored, only 23 percent fall within grade 1-111, while 19 percent of China’s seven major river basins monitored are  considered essentially useless. Finally, almost 74 percent of groundwater is considered grade IV-V standard, or excessively polluted. More information on China’s water pollution can be found here.

We should remember that a river collects the water in its basin and that means that all the pollutants within the Dongjiang Basin could potentially end up in Hong Kong’s water supply – not a pleasant thought. Will we have to wait for a major accident on the Dongjiang or its feeders before the Hong Kong government wakes up to our vulnerability?

For now, Hong Kong water quality data, although only through September last year, can be found here, on the Water Supplies Department website.

Hong Kong consumers have the ability to sustain a significant tariff hike.  That would help us move toward greater water conservation and at the same time provide  the resources for the city to invest in making options such as desalination and water recycling economically viable. What are we waiting for?

I recently spent a week at Angkor Hospital for Children in Siem Reap, Cambodia with Francesco Caruso, director of ADMCF’s Children at Risk program and Ryan Glasgo, our new finance director. Both are working hard to help bring the hospital to the point where it can become a fully Cambodian institution.

When the hospital was founded in 1999 by Japanese photographer Kenro Izu and then was nurtured into being in partnership with an American board as a free pediatric hospital, Cambodia was a very different place.

Now there is a growing middle class, many of whom would be fully able to pay something for medical care. AHC for now, however, is still entirely free to any Cambodian child.

At the same time, the hospital in 2012 has a talented and dedicated medical and administrative staff that is fully capable of taking the hospital forward.

There is now an almost entirely Cambodian staff of 149 nurses and 46 doctors, including AHC’s executive director. Only two doctors and two nurses are foreign.

Last year, the hospital treated more than 150,000 children for illnesses ranging from acute diarrhea to tuberculosis. The Outpatient Department sees between 400 and 600 patients daily, while the Inpatient unit of 40 beds is almost always full.

An emergency room has eight beds, four of these in a separate isolation ward. There are plans to build a separate neonatal ward since on any day 10 of the patients are babies and many have suffered birth trauma or are premature.

Surgeries in the one operating theatre range from hernias to heart repair.

A pediatric Satellite clinic that is part of the government hospital in Sotnikum, 35 kilometers from Siem Reap, last year treated 12,300 Children. The Satellite staff works closely with the government hospital to build the quality of care offered there, with a focus on assisting the lab, X-ray unit and pharmacy, which the clinic shares. The clinic also has  installed an emergency button in the delivery room to summon a Satellite  doctor to assist any baby in distress.

AHC  also has become northern Cambodia’s premier pediatric teaching facility. The Medical Education program includes a three-year residency program for every doctor who joins and then on-going internal education and fellowships abroad.  ME also offers internships and trainings  for medical staff  from other hospitals.

“What we are developing is to be shared,” the hospital’s executive director, Dr. Bill Housworth emphasized, explaining the hospital’s full engagement via the AHC External Program with both the Ministry of Health in Phnom Penh and directly with many of Cambodia’s government hospitals.

The AHC Capacity Building program works with rural Health Care Centres and communities to provide education on nutrition, hygiene, sanitation and relevant disease – some of the main challenges for the AHC patient population.

The hospital, Satellite, Medical Education and  CB programs together cost US$4.5 million last year. This amount is covered almost exclusively by donor funding and is a challenge for the hospital to raise each year.

Consequently, AHC is of necessity looking at revenue-generating programs and already for a fee provides hospital services to the children of some local NGO workers and airport staff in Siem Reap.

Although public hospitals are not free in Cambodia, about 30 percent of the rural population has what is known as a Health Equity Card, which establishes that they are poor and reimburses some of the medical costs and travel expenses to get to the hospital. But even then, it is not uncommon for doctors and hospital administrators to ask patients for payment ahead of treatment.

Private clinics are expensive and don’t necessarily provide a better quality of care, underlining the importance of a hospital like Angkor for the population that just cannot pay medical costs.

Research shows that the most common reason for impoverishment in Cambodia remains emergency healthcare costs, which force families to enter an often unending spiral of debt. For families who have a child with a chronic disease, healthcare costs can be devastating.

In Cambodia, an average of one in 20 children die before their fifth birthday, compared to a rate of one in 120 found in developed nations, according to UNICEF. And four children out of five live in rural areas, where the mortality rate is much higher at 64 deaths per 1,000 live birth.

Government census data shows that in 2010, 40 percent of children under five were too short for their age, stunted by malnutrition. Roughly 30 percent of Cambodians live on less than $1.25 per day, which the World Bank has established as the poverty threshold.

Indeed, Siem Reap province, better known abroad for its 11th century temple complexes and lavish hotels replete with Western tourists, has the third-highest poverty rate among the Cambodian provinces at 52 percent.

For a province of 1 million people, the total health budget of Siem Reap this year is about $2.8 million, according to provincial health officials, and almost two-thirds of that represents support from large foreign government donors.  None of that makes its way to AHC.

Clearly, part of the problem with provincial hospitals is that the government can afford to pay only low salaries to its health workers. Thus doctors, who might earn as little as $100 a month, often supplement their incomes with private clinics that take precedence over any hospital care.

Still, Cambodia is making headway in medical care on offer, in part with the support of AHC.

Part of the problem is the legacy of destruction leftover from the 1975-1979 Khmer Rouge rule, when medical professionals and other educated people were singled out for slaughter. In all, an estimated 1.7 million people were killed or died from forced labor, starvation or disease over the period.

When they marched into Phnom Penh and other cities, the Khmer Rouge emptied the hospitals, eliminated the doctors and then left the care of sick and injured to untrained young soldiers who favored traditional Cambodian remedies over Western medicine.  By the time the Vietnamese ejected the Khmer Rouge from power, there were only an estimated 40 doctors left in the country.

Decades of war and isolation followed, leaving the medical infrastructure in shambles. In the 1990s, NGOs simply took over the health care system without trying to build anything indigenous, and change only began in earnest with the end of the Cambodian Civil War in 1998.

Angkor Hospital is working hard to be part of the solution.

Five Chinese environmental groups have named 48 global fashion brands using polluting factories in China and suggested consumers make a “green choice” when buying clothes.

A report  led by Ma Jun and his Institute for Environmental and Public Affairs  and released this week lists 6,000 water pollution violations by manufacturers  of goods that ranged from sports apparel to luxury handbags.

Brands were linked to the factories over seven months of painstaking review of official websites, financial reports, recruitment ads and procurement bids, among other documents, according to IPE.

Over the past eight years the Institute has gathered a database of over 90,000 air and water violations from official government  sources. IPE now works with many brands to make sure they are not using polluting suppliers and to help clean up those that are illegally dumping untreated toxic waste water into rivers.

Between march 22 and March 29  the five environmental groups wrote to the CEOs of each of the 48 brands linked to factories with repeated environmental violations. They asked the brands to ensure their Chinese suppliers would not pollute the environment while manufacturing their products.

While some of the brands named immediately responded to queries from the environmental groups, acknowledged the issues and detailed how they would address the issues, about two-thirds have not yet engaged, Ma Jun said.

Notably, Spanish clothing retailer, Zara, responded by saying that it was not the company’s policy to answer questions about its business model.

Nike, Walmart, Esquel, H&M, Levi’s, Adidas and Burberry were among the companies that responded positively, saying they would work with their Chinese  contractors to improve their environmental performance. Many of these brands were  already working with NGOs to clean their supply chain, IPE said.

Another 32 brands including Marks & Spencer, Esprit, Calvin Klein, Carrefour, Armani and China-based Anta and Youngor have yet to respond, according to the report.

Besides IPE, the other authors of the report, “Cleaning up the Fashion Industry,” were, Friends of Nature, Green Beagle, Envirofriends and Nanjing Greenstone.

China is a global leader in textile manufacturing, responsible for nearly half the world’s fiber and exporting 34 percent of the garments we wear.

This production has contributed significantly to the country’s GDP but has also taken a heavy environmental  toll locally. Ma said that fashion manufacturers discharge 2.5 billion tons of waste water and chemicals into rivers and the ocean, while 80 percent of effluent is generated in fiber dying.

This has a serious impact on the country’s water supplies and is compounded by the fact that the re-use of water in the textile industry lags way behind that of many others, creating a situation where water efficiency is incredibly low, IPE said.

Among the 6,000 violations, a number of factories were given administrative penalties. Many were told to rectify problems such as illegal effluent emissions via secret discharge pipes, directly discharging waste water into waterways, improper use of waste water treatment facilities and pollutant discharges in breach of standards.

Previously, IPE targeted the IT sector, also with information gleaned from the institute’s violations database. We have written about Ma Jun’s efforts here and here.

After five reports looking at the environmental performance of IT sector contractors, most of the brands named had responded to requests for information disclosure and action.

Among the last hold-outs was Apple, which was the focus of the last two reports. The company has since agreed to disclose its connections to suppliers and provide information on contractor environmental performance.

Clearly, Ma Jun and his colleagues hope for a similar response from another industry that is widely credited with some of the worst environmental performance in China.

With IPE and others watching, retailers and brands will no longer be able to hide behind stated ignorance about how a product is manufactured. They will no longer be able to refuse to divulge lists of suppliers or deny responsibility for egregious environmental emissions locally.

Part of the problem for the apparel sector has been the quantity of suppliers used to manufacture just one item of clothing or shoe. This is a problem we have written about here. 

While many brands are getting better at understanding and working with the factories actually putting together the clothes, they tend to know less about the dyers, the spinners and the knitters who cause much of the environmental damage.

yet engaging with polluting contractors in any part of the supply chain has become a serious reputational risk and thus business risk for global brands hoping to squeeze their suppliers on cost.

It is also a wake up call for consumers hooked on cheap product made at huge environmental expense abroad. It’s about time we all made careful choices about how we consume, make sure that brands are using responsible suppliers.

For companies, the argument turns back to fiduciary duty and redefining what that means, something I have written about here.