Archives For children at risk

Angkor Hospital for Children and the Challenge of Medical Care in Cambodia

Lisa Genasci —  April 21, 2012 — 1 Comment

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.

In children at risk, health, Philanthropy , , ,
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Education for India’s Lowest Caste: The Musahar

Lisa Genasci —  April 3, 2011 — 3 Comments

ADMCF recently spent time in Patna, in India’s Bihar state where we were looking at how we might work effectively with the Musahar community, which ranks at the bottom of the dalit or untouchable caste.

We found that there is apparently relatively little concrete information about or assistance given to the Musahar, whose name translates quite literally as the “rat-eaters.” Estimates of their numbers in Bihar and other states range from 2 million to as high as 5 million.

The Musahar fall so far down the well of the Indian caste system that by all accounts its people live in modern India much as they did 2,000 years ago. In an initiative that was perhaps telling about the regard in which the community is held, in 2008 the Indian government acted to help the Musahar by allowing the commercialization of rat meat.

A brief portrait of their situation gleaned from what is available online and through conversations in Bihar: In the villages around Patna in Bihar state, India, child marriage at 13 or 14 is still common, although illegal in India.

In the rural areas, Musahar are primarily bonded agricultural labourers, but often go without work for as much as eight months in a year.  Children work alongside their parents in the fields or as rag pickers, earning as little as 25 to 30 rupees daily.

The Musahar literacy rate is 3 percent, but falls below 1 percent for the women. Yet it is cast discrimination rather than parents that keep Musahari children away from schools. That said, the schools to which they have access apparently offer so little in the way of education that perception among the community is that schooling doesn’t offer them anything. And it is certainly true that even if they do manage an education certificate, discrimination means few manage to find jobs anyway.

By some estimates, as many as 85 percent of some villages of Musahars suffer from malnutrition and with access to health centres scant, diseases such as malaria and kala-azar, the most severe form of Leishmaniasis, are prevalent.

Besides eating rats, the Musahars are known for producing a good and cheap alcohol so not surprisingly alcoholism is rampant among the community, particularly the men.

Government development programs provide very little support to the Musahars. They are not recipients of housing schemes because generally they do not possess title deeds for their land. They are also the lowest number of recipients of loans from revolving funds within government schemes.  Thus the social support system bypasses them, as do private donations since so little is known about them.

The Dalit community in Bihar as a whole suffers frequent and often unpunished human rights violations. In the ten years before 2003, for example, 4243 cases of Dalit atrocities were registered in police stations, including 694 cases of murder, 1049 of rape, 1658 of severe injury and 842 cases of insult and abuse.

Into this picture walked Sudha Varghese 26 years ago, a nun who wanted to give voice to India’s dalits. The Musahars were the least advantaged of the dalits she could find and she moved into their community to truly understand their needs and way of thinking.

her organization, Nari Gunjan, was born to give voice to the Musahar women in particular. The organization now runs 72  primary education centres and a residential hostel/school for girls. Nari Gunjan promotes social, political, and economic empowerment for the women and girls. Beyond education, some of the centers provide vocational training and assist with micro-credit for Musahar women.

A decade ago, recognizing the need also to represent Musahar women in the courts, Sudha sent herself to law school and returned armed with a new skill set she has used to pursue the prosecution of ten rape cases that without her would have gone unpunished. In each case, she lead a column of Musahar women to the police stations to persuade officers to make the right arrest and in each case she has succeeded in putting the perpetrators behind bars, she says.

Known as the “bicycle nun” Sudha visits the various communities on her bicycle, and her fragile appearance belies a ferocious determination to provide Musahar children with education, self-esteem and purpose, its women with hope. For her courage, India’s national government recently awarded Sister Sudha the country’s highest civilian award, the Padmashri.

During a visit, the difference between children who attend her education centers and those who don’t was immediately apparent. Still, like any organization working in difficult circumstances that has been around for some time, achieving a constant flow of funding, even at the modest scale Nari Gunjan requires, is extremely hard. Some of the education centers have gone unfunded for 10 months although the teachers continue to work and the children appear.

In asia, children at risk, cultural preservation, health, impact investment, Microlending, Philanthropy, pollution, social enterprise , , , , , ,
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Fighting for Education on the Thai-Burmese Border

Lisa Genasci —  February 17, 2011 — Leave a comment

An estimated 50,000 children of refugees from Burma live in the Mae Sot area of Thailand,  80 percent with no access to schools. Among them are children from the Mon, Karen and Shan minority groups fleeing decades of political, economic and military oppression at home.

These migrant populations along the Burmese border are largely forgotten, subject to harassment and have little access to support or education.

Estimates are that with a near absence of economic, educational, health and job options at home, about 2 million Burmese have migrated to Thailand since 1988.

Of these, 150,000 are living in refugee camps, 500,000 are legal migrants and the rest live illegally in Thailand.

Although the camps and borders are officially closed, an estimated 1,000 people cross into Thailand daily and this was evident on a recent visit to Mae Sot, with fighting raging just across the border.

Life for migrant Burmese in Thailand, however, is not much better than at home.  In a report released last year, Human Rights Watch described “an atmosphere circumscribed by fear, violence, abuse, corruption and intimidation for illegal Burmese in Thailand.”

The illegal migrants are kept to just a few low-skill job opportunities.  Most work as day labourers with no rights, no protection. They are commonly exploited and abused by employers, police, immigration and others with little recourse, according to HRW.

Schooling options for their children are also limited. Places for them in local Thai schools  are almost non-existent, although there are some limited Burmese “education centres” as the Thai government prefers to call them.  

In the Mae Sot area, Ashoka fellow Naw Paw Ray has worked hard to get Burmese children into some sort of schooling over the past 11 years. Of the 50,000 locally, she estimates 12,500 attend the  60 education centres, as they are called by the Thai government, gathered under her Burmese Migrant Workers Educational Centre network.

BWMEC works to make sure the curriculum and facilities of the education centres under her umbrella are adequate for learning, providing training, funding, administrative support and school buildings or dormitories where necessary.

A migrant herself, Paw Ray’s story is fairly typical of the migrant Burmese community. She left Burma  in 1986 when her village was destroyed by soldiers and entered a refugee camp in Mae Sot when they were set up by the United Nations a year later.  

In Burma, Paw Ray was a teacher but in Mae Sot she worked in a gas station until she said she could no longer stand to see the discrimination. “I could teach and I wanted to teach. I wanted to do something to help my people,” she said, setting up a first school with just 25 Karen and Burmese students.

Chosen as an Ashoka fellow in 2007, Paw Ray said that in her work she hoped to address the vast educational gap between Thai children and the children of Burmese migrant workers.

Naw Paw’s schools hopefully give migrant children options – preparing them for a prospective return to Burma or integration into Thai society and culture – critical to establishing a pluralistic and tolerant Thai society. The idea is to pave the way for migrant schools, students, and teachers to gain public support and official accreditation in Thailand.

No other organisation in Thailand fields such an array of minority schools or is doing so much to build a long-term solution to the growing number of uneducated migrant children coming to or born in Thailand each year.

Yet like many good organizations, Paw Ray struggles to find adequate funding to support this forgotten community.

And the problem remains, children attending the Burmese elementary schools have only limited access to Thai secondary schools for reasons related to cost, discrimination and availability.  That limits future job opportunities and integration.

So Paw Ray’s challenge remains: what is the best way to provide education to a migrant population that may or may not return home ?

In asia, children at risk, cultural preservation, Philanthropy, social enterprise , , , , , ,
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Philanthropy and Climate Change

Lisa Genasci —  November 16, 2010 — 3 Comments

 

We recently hosted a forum with the Asia Foundation on Philanthropy and Climate change.  We hoped to encourage Asian funders to draw the lines between climate change (something that seems often hard for the individual to grasp) and the more tangible and immediate air pollution, forestry degradation, water scarcity etc.

We also hoped to then get them to think beyond the environment to a wider philanthropic portfolio and to consider the impact of climate change on livelihoods, health, education – even how funders in the arts might get involved to build awareness around the need to act.

Why? We feel that given the enormity of the problem, it’s often hard for the individual funder, the family office foundation, to see how they might act in any way that is impactful.

But what we found was remarkable energy in the room. Rather than despair, we felt that participants left informed and energized by our panelists and keynote speaker, Stephen Heintz of Rockefeller Brothers Fund, which has an excellent environment and health, southern China program, managed by Shenyu Belsky.

Dr. James Hansen, one of the world’s leading climate scientists and head of the New York’s NASA Goddard Institute for Space Studies, provided an overview of climate science – setting the scene for discussion. Dr. Hansen, an advocate for a carbon tax, spoke of our inertia in the face of an emergency, the possible extermination of species, receding glaciers, bleaching of coral reefs, acidification of the ocean, basically that we are a planet out of balance.

Heintz also spoke about urgency, describing climate change as a “planetary threat that knows no bounds.” He emphasized the particular threat in Asia – that of 16 countries facing extreme risk, five are in in this region and they are among the most impacted, low-lying Bangladesh for example.

In all, he said, global warming could cost southeast Asia 6-7 percent of GDP. Clearly, Asia is squarely at the intersection of climate and development and he emphasized the need for new ideas and new ways of thinking, something that accurately reflects current realities and anticipates new needs.

It is easy, Heintz pointed out, to be discouraged by the science, yet philanthropy, government, civil society and the private sector all have roles to play. In reality , it is imperative that we act because, inevitably, climate change will impact every other issue that we are working on.

Global grant-making, Heintz said, has increased dramatically over the past decade yet environmental issues are way behind, receiving only 5 percent of funding. Resources targeting climate change specifically, of course, are far less.

The philanthropy sector, Heintz said, can play a crucial catalytic role, take risk, experiment, support advocacy to change public policy and trigger larger systemic change. Important will be innovative public-private partnerships, helping to develop emerging models of low-carbon prosperity. His was an excellent speech.

Our three panelists, Runa Kahn of Bangladesh’s Friendship, Dorjee Sun of Carbon Conservation and John Liu, an environmental filmmaker and journalist based in Beijing, spoke of the practicalities of working effectively within this context – and they also were inspiring.

Runa spoke about making life possible for the 4 million people living  in impossible circumstances in Bangladesh’s northern chars, John Liu on a massive ecological restoration project in China and showed the results, Dorjee on carbon, community and market solutions for saving forests.

The entire session was expertly moderated by the Asia Business Council’s Mark Clifford who managed to draw together the discussion, keeping an often amorphous and difficult topic moving toward practical solutions and away from fear.

The forum was a private side event to the C40 Climate change conference early this month organized by the Civic Exchange and supported by the Hong Kong government and Jockey Club Charities Trust.

It would be great to hear about other experiences linking climate change with a wider philanthropic portfolio, about nudging funders into action in this arena.

In air pollution, asia, carbon, children at risk, china water, Environment, Fish, forests, health, Hong Kong, indonesia conservation, Marine, Philanthropy, pollution, redd, social enterprise, Uncategorized, water , , , , , , , , , , , , , , ,
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Break The Silence:Child Sex Trafficking

Lisa Genasci —  April 22, 2010 — 2 Comments

The sex trafficking and abuse of children is a growing problem regionally fueled by the $32 billion internet porn industry. As I’ve written earlier, UNICEF estimates that every year 1.2 million children are trafficked for sex, adding to the millions more already in captivity. 

Trafficking of children is highly lucrative and while profits are high, penalties are low in most Asian countries.  Internet porn isn’t the only outlet; growing sex tourism in Asia hasn’t helped. Child victims usually come from small villages, where awareness is lowest and poverty worst. 

Southeast Asian countries are source, transit and destination countries for child-sex traffickers and pedophiles. There is clear need for better education and awareness regarding the dangers children face. 

While, there are some excellent programs for Child Protection developed by local and international groups in Asia, for budgetary reasons these usually do not include smaller villages and often even slum communities where children are most at risk. 

It is here that awareness is lowest and families are often groomed to part with their children, supposedly to good jobs in the cities.

Parents, often faced with terrible decisions around paying medical and food bills, will separate from a child thinking they will be looked after by the kindly “auntie” or “uncle” who has promised the family financial support in return.

In rural and some slum communities, families, authorities, teachers and even small NGOs are neither aware of the problem nor able to prevent it.

Stairway Foundation  recognized years ago that in the Philippines, a favorite child-sex tourism destination, the 1.5 million street children and many millions more living in urban slums were easy targets.

In response, SF has developed three purpose-made animated films on incest, pedophilia and child-trafficking that have helped hundreds of organizations warn communities there.  But the message needs to spread widely in Asia and parents need to see alternatives.

Hong Kong-based ADM Capital Foundation is helping SF develop the animation materials and accompanying training into a regional strategy under the title, Break the Silence.  We believe that not only will BTS be complimentary to child protection programs already in place, but could be used in Western countries to educate young people about internet child pornography.

Ultimately, the goal is to build an effective awareness and protection program through local organizations that are able to offer a first line of support to children at risk of trafficking and abuse.

The program is designed to grow into a sustainable initiative driven by SF in co-operation with regional partners, sharing its approach toward reaching out to and effectively protecting marginalized children across Asia.

Have you seen any particularly innovative child protection work in Asia or beyond?  We are keen to learn of others working effectively in this arena.

In asia, children at risk, Philanthropy, social enterprise , , ,
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Supporting Life in Bangladesh’s Chars: When microfinance doesn’t work

Lisa Genasci —  April 5, 2010 — 1 Comment

I recently spent some days in Bangladesh with Friendship and the excellent social enterprise’s executive director, Runa Khan. Friendship works with tens of thousands of the world’s most-vulnerable people who live in the northern Chars, remote and shifting sandbar islands that flood in winter and suffer drought in the summer.

Located about seven hours from Dhaka, these must be some of the most inhospitable habitats anywhere and consequently life expectancy for the forgotten people is only late 40s. In the rains, the islands shrink to slips of land with a few banana trees, with inhabitants and their livestock often forced to rooftops to survive the floods. In the heat of summer, the walks to the villages are often as long as three kilometers from the river through unforgiving sand.

An estimated 4 million nomadic people inhabit the 200 islands woven through the Brahmaputra river where land flattens toward the Bay of Bengal. The sand dwellers migrate from one island to another as much as 50 times in a lifetime, carrying with them their tin houses in the floods.

Climate change is clearly felt in Bangladesh’s distant northern and equally distant southern regions, where Friendship is almost alone among NGOs in working. Government reach here is also limited, Khan says. The people used to at least have certainty about the weather patterns but now the rains and droughts are harder to predict and more extreme, she says.

Friendship started its work more than ten years ago providing health care to the communities on a specially outfitted hospital barge, brought from France by Khan’s now husband, French sailor Yves Marre.  Now two hospital ships and an ambulance boat ply the Brahmauptra spending a month or two in each location, offering primary care at about US 10 cents for men, 5-7 cents for women and children as well as affordable basic surgery to the region’s weather-beaten inhabitants.

From medical care, Friendship has extended into education, (both for children and adults), livelihood and vocational support, working closely with communities to help them meet all their needs. With a staff of around 350, a complex schedule of foreign doctors and other medical professionals who fly in for specialized care, Friendship works with an estimated 40-50,000 people previously served mostly by microfinance providers, who often prayed on the extreme poverty.

Khan points out that although microfinance can work for people with at least some education and means of support, it is often not appropriate for the poorest, who will use any available funds simply to buy food for their families.    Many lenders, she says, show up on the islands with offers of cash, promising interest rates of only 10 percent annually. Without knowledge of basic arithmetic, the people take the money, spend it and then must meet the payments that often add up to rates closer to 50 percent, she says. And these are some of the better microcredit institutions. Money lenders charge as much as 120 percent.

“When we first start working with a char one of the first things we must do is unwind the microfinance loans,” Khan says. “People at that level of poverty need grants and other forms of support not loans.”

Khan says that the char people more than anything need, “hope for tomorrow” and Friendship offers education where there were no schools, healthcare where there were no doctors, livelihoods where people had none, community organization where people were disperse and disaster preparedness where there wasn’t any. A focus is on discussion, trading information, and building savings to prepare for years where the floods or droughts are life-threatening or force a relocation.

Friendship is also working to create a harmonious environment in the stark landscapes, building appropriate and local farming techniques for sand, bringing in solar where they can – with an emphasis on keeping people in their places of birth. Without Friendship, many people from these regions have swelled the slums of Dhaka in search of work.

Schools can be disassembled in three hours and moved to higher ground, girls are taught weaving and dying – skills that help them contribute to the family income and avoid an early marriage (12-14 was the norm before Friendship arrived). Community health workers are trained and sent to the villages, where they teach local people about nutrition, sanitation, about warning signs in a pregnancy and basic child health techniques. They also can dispense basic medicines.

“We listen to the communities, hear their needs and respond in ways that are appropriate,” says Khan of Friendship, which is surely one of the more innovative organizations I have seen.

In asia, children at risk, Environment, Philanthropy, Uncategorized, water , , , ,
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