But, as John Jensen reports, sex is being used to promote better health, and in the process, these advertisements are also breaking some taboos.

A boy in Cite Soleil carries water. Photo: UN on Flickr

Survivors of the Haitian earthquake need quick solutions that may not come in time for the punishing rainy season that starts in May. They now face the looming threat of disease, misery in makeshift tent camps and a lack of adequate food and water.

Despite all the pledges of rebuilding, there are some basic realities: poor people will suffer and some will die.

Reports from the field show that relief agencies are pushing to make things better, with a deadline from the weather that is almost impossible to meet. Partners in Health, one prominent relief organization, reports that it has to shift priorities “to long-term care and helping the hundreds of thousands of people who urgently need shelter, water, sanitation, and food.

We hear the same concerns from journalists and from relief organizations all around Haiti. The Miami Herald reported on Feb. 24:

The stench of human waste permeates the air around the crude shelters made of sticks and sheets…There are nowhere near enough toilets — portables, latrines or any other kind — for the tens of thousands living in the camps in and around Port-au-Prince.

The squalid conditions have government and relief workers worried about a potential outbreak of deadly diseases, such as diarrhea, spread by unsanitary conditions. And relief agencies scrambling to install toilets are still figuring out how to later dispose of their waste.

Sad to say, but as many people have noted all along, Haiti cannot be handled simply by relief and rescue through normal means. Haiti needs international concerted crisis management –- and Haitians must be empowered to choose the leaders who will allow real, humane, no-nonsense, incorruptible change. Is that happening?

Partners in Health reported this: “With cities destroyed and major roadways and ports obstructed or damaged, food is becoming increasingly scarce and expensive. The price of staples, like rice, oil, and beans, has risen dramatically. ‘Prices have skyrocketed – doubling and in some cases tripling,’ says Jesula Pierre, a PIH logistics coordinator currently working in Haiti’s Central Plateau.”

With its Haitian partner, the organization is pushing to plant fallow farmland and ratchet up farm yields. But each organization operating in Haiti can only do a small part to save as many people as possible.
It’s not enough. The list of problems goes on.

This is also from the Miami Herald:

Relief workers blame the shortage of toilets in part on having to deal with more urgent problems — like keeping people alive — immediately after the Jan. 12 earthquake…

But now, more than five weeks after the quake, the dangers of inadequate sanitation could amount to the most pressing public health issue.

At best, many Haitians had neither clean water or sanitation before the earthquake. They deserved help even before the earth shook.

Much more suffering is likely when the rains fall.

Aid workers are struggling to provide healthcare and safeguard against crippling disease as the aftermath of the disaster drags into its second week.

Photos: IMC and the United Nations Photo’s Flickr photostream.

For more Worldfocus coverage of Haiti, visit our extended coverage page: Haiti’s Poor.
(View full post to see video)

While the disease is still active in the U.S., increases are occurring in central and eastern Europe, and in parts of west, central and south Asia.

For more, Daljit Dhaliwal interviews Martin Blaser, past president of the Infectious Diseases Society of America and the current chairman of the Department of Medicine at the Medical School of New York University.

Damji discusses the growth of AIDS among women and looks at the countries where women are most vulnerable to the virus.

She also discusses possible solutions to bringing down the rate of infection for women with AIDS.

Producer Gary Strieker reports from Ethiopia’s Amhara region where 60 percent of children suffer from trachoma.

For more Worldfocus coverage of Ethiopia, visit our extended coverage page: Ethiopia Past and Present.

A Mexico city statue during the early days of swine flu. Photo: Flickr user olivcris

With concerns rising in the U.S. and abroad about the H1N1 virus, we want to hear your thoughts.

Do you think the U.S. government is doing enough to protect American citizens from H1N1?

Tell us what you think in the comments section below. Please remember to be respectful and on-point in your comments. Malicious or offensive comments will be deleted and repeat offenders will be banned.

It collects surplus medical supplies — such as hospital beds from a facility that is upgrading — and ships them to Africa.

Dalijit Dhaliwal spoke last week with Doc to Dock’s founder, Dr. Bruce Charash.  He says the supplies are desperately needed in a continent where some hospitals are so ill-equipped that women give birth on the floor.

In conjunction with Magnum In Motion photographer Susan Meiselas, the human rights group produced a video/slideshow about a 25-year-old North Indian woman who died during childbirth.

Worldfocus spoke with Aruna Kashyap, the lead researcher of the in-depth study, “No Tally of the Anguish.”

Is the rate of maternal mortality still exceptionally high in India?

Kashyap: Yes. India is an emerging economic superpower known for its medical prowess. There are also large portions of money allocated for healthcare programs - including maternal healthcare programs - that go unspent annually. This context is very important when analyzing data on maternal mortality. If we look at the “BRIC” countries – India’s maternal mortality level is 16 times that of Russia, 10 times that of China, and 4 times that of Brazil. Also, about 1 in 70 girls who reach reproductive age in India will eventually die because of a pregnancy-related cause, compared to 1 in 7,300 in the developed world.

The latest all-India estimates show that there has been a small decline in maternal mortality since 1997. But maternal mortality measures are mere estimates. They are also presented as averages, and averages do not tell the actual story. For example, while all-India figures show a decline, Haryana and Punjab show an increase in maternal mortality. Critically, these estimates camouflage the huge disparities in access to healthcare, including maternal healthcare, between the rich and the poor. The question is whether the little progress that health authorities are making in reducing maternal mortality is percolating down to the marginalized and the poor. Many populations in India endure poor maternal health because of many levers of inequality, including those based on caste, residence, education and awareness, age, and number of children. For example, a 2007 UNICEF study showed that 60 percent of the maternal deaths documented in six northern Indian states occurred in Dalit and tribal communities.

Moreover, for every maternal death, around 20-30 women are left with injuries, diseases or infections after childbirth or unsafe abortions, many lasting a lifetime. A woman may survive childbirth but suffer obstetric fistula and ensure life-long humiliation and even abandonment if not treated. There is very little data on this, but health experts believe that maternal morbidity levels are also very high in India, which is a cause for concern.

What are the most successful government policies in reducing maternal mortality?

Kashyap: Globally, about 80 percent of all maternal deaths are said to be caused by direct obstetric causes—hemorrhage, obstructed labor, eclampsia, and unsafe abortions. Many years of research and evaluations of different health interventions have led public health experts to conclude that there are four key maternal mortality reducing strategies that address these direct obstetric causes–access to emergency obstetric care, good referral systems, skilled birth attendance, and reducing the number of unwanted pregnancies. Health authorities should also strengthen women’s access to safe abortions. The indirect causes of maternal mortality and morbidity are malaria, hepatitis, tuberculosis, and HIV. There have to be interventions to ensure that these indirect causes are also addressed.

In India, about 65 percent of all maternal deaths are caused by direct obstetric causes and 35 percent are caused by indirect causes. So for maximum impact, healthcare interventions have to address both.

To what extent do you blame village-level government officials for not doing enough?

Kashyap: It depends on what aspect we are looking at. For example, if we look at civil registration, there are village level officers who are supposed to register deaths which they are not doing. Where this is because the state has not appointed such officers the state is to blame, but otherwise, a part of the blame also lies with the village level authorities.

In the case of delivery of maternal healthcare services, at the village level, female health workers implement the maternal healthcare programs. Most of them have very little say in how programs are designed and implemented because the healthcare system is top-heavy. These workers should also be equipped with essential drugs, blood pressure measuring machines, weighing machines, gloves, and so on that they can use to check the health of pregnant women and conduct deliveries. If they are not equipped, then there is very little they can do. For example, we interacted with health workers who are charged with providing antenatal care but had not been given a blood pressure gadget for several years even though they had put in repeated requests to get such gadgets.

The decisions are made at the national, state, and district levels. So unless decision-makers at these different levels do not change policies and programs, health workers at the field level cannot be blamed. Be it caste-based discrimination or corruption at any level, the power to monitor and undertake corrective action largely lies with district and state health authorities.

There have been attempts to change this. The Indian government has tried to decentralize decision making under its flagship rural healthcare program, the National Rural Health Mission, 2005. Under this, the Indian government has provided for “untied funds” that can be managed by health workers along with local elected village council heads. But this has not been very effective for several reasons. Poor awareness regarding these provisions, a lack of initiative by elected village council heads, corruption, are some of the reasons. The Indian government has also created Patient Welfare Committees (Rogi Kalyan Samiti) to decentralize decision-making and management of the hospital. These committees also have grievance and redress powers. But once again, these are yet to be effectively utilized.

What is your outlook for realistic improvements in maternal mortality over the next two decades?

Kashyap: There has been little progress in the last decade not only in India but in many other countries. But since 2005, at least on paper, the Indian government guarantees a host of maternal healthcare services free of cost. In order to ensure that these are effectively implemented, the Indian government should monitor the implementation of these programs. This can be done in several ways: recording and investigating all maternal deaths to identify and rectify health system failures; monitoring whether women with pregnancy-related complications are actually getting access to maternal healthcare; setting up a grievance and redress protocol including emergency response systems like a telephone hotline that can be used by pregnant women in distress; paying attention to strengthening the public health system, including training health workers in midwifery.

If all of this is done, then perhaps India will be able to show more results not only in averages but also for the poor and the marginalized.

How has your experience with maternal mortality issues affected you personally?

Kashyap: I feel outraged by the injustice of these preventable deaths. There are some women’s faces and stories that come back to me often. For example, the mother-in-law who cried while describing how her pregnant daughter-in-law died in a community health center because she could not afford to take her a better health facility. She had just one lingering plea that it should not happen to anyone else. Then another woman who asked me why she would take 1400 rupees (the cash assistance given to rural women to deliver in health facilities) and go to a health facility to kill herself –- referring to the fact that many women are often turned away from such facilities without medical assistance because they are ill-equipped to handle pregnancy complications. I hope the government will read some of these stories and make their health system more accountable to these women.

- Ben Piven

Mobile testing units like the one featured in the video below offer free test results and spread the message that living with HIV is not a death sentence, but a chronic disease.

Worldfocus correspondent Martin Seemungal’s signature story “AIDS ravages 1,000 per day in South Africa” explores South Africa’s AIDS epidemic in further detail.

Ambassador Morten Weltand, the permanent representative of Norway to the United Nations, joins Martin Savidge to discuss the feasibility of the program, other global immunization programs and progress toward reducing the world’s infant mortality.

Now, Thailand’s efforts to combat AIDS — including its “100 Percent Condom Use” program and its creation of low-cost antiretroviral drugs — have helped reduce the prevalence of the disease from 140,000 new cases a year to fewer than 20,000.

However, because the disease now seems less urgent, infected mothers pass on the disease to their children — 15,000 Thai children are infected with AIDS. Stigma surrounding the disease persists.

Worldfocus correspondent Mark Litke travels to Thailand to assess the country’s progress and remaining challenges. He speaks with Mechai Viravaidya, or “Mr. Condom,” who has led the country’s fight against AIDS.

Blogger “Ciee” writes about the history of AIDS in Thailand, including the role of prostitution in spreading the disease, arguing that the country still has a long way to go.

Blogger “Katie Tibone” argues that the successes of Thailand’s fight against AIDS have allowed the government to slip into complacency, and urges local communities to take action.

The “American in Bangkok” blog visits an AIDS hospice in Lopburi, Thailand, that is working to combat social stigma.

Worldfocus contributor Samuel Loewenberg travels to the east African country of Tanzania to look at the impact of river blindness on one village, where the only source of water is also a breeding ground for disease.

A family waits for cholera treatment in Zimbabwe.

On Thursday, Zimbabwe declared a national emergency due to a cholera outbreak that has claimed more than 560 lives.

The day before, police broke up a riot in the country’s capital, Harare, where doctors and nurses rallied for better pay as the epidemic worsens — along with Zimbabwe’s plummeting economy. Earlier in the week authorities cut the water supply to Harare in order to curb the spread of the disease.

Since August of this year, at least 12,546 cases of cholera have been reported, according to the United Nations.

Blogger Grace Mutandwa of the United Kingdom’s Foreign and Commonwealth Office in Zimbabwe writes from Harare that without water or proper sanitation, the population is doomed, claiming that authorities are not taking the crisis seriously.

The “This is Zimbabwe” blog says that raw sewage flows in the streets of Harare — not far from the city’s marketplace — and that the medical system has collapsed, blaming the country’s leaders.

Michael Trapido of “Thought Leader” writes that President Robert Mugabe’s administration endangered not only Zimbabweans but also South Africans by attempting to conceal the epidemic.

A member of Doctors Without Borders writes from Beitbridge, Zimbabwe, about that city’s attempts to manage the quick spread of the disease despite overwhelmed and undersupplied hospitals.

Blogger “Lauben Muhumuza” from Uganda sympathizes with Zimbabweans, wondering, “Where is Africa heading?”

The epidemic has been linked to the country’s political impasse, since cholera is easily prevented or cured but the country’s health sector is flailing. For more on Zimbabwe’s political struggles, read our previous blogwatch: African countries step in to resolve Zimbabwe’s impasse.

Below, see a map courtesy of the United Nations Office for the Coordination of Humanitarian Affairs detailing the spread of the disease in Zimbabwe.

Photo courtesy of Flickr user Sokwanele under a Creative Commons license.

AUDIO: Elizabeth Shelburne of GlobalPost discusses South Africa’s efforts to deal with tuberculosis.

A tuberculosis patient at the Botsabelo Hospital in Lesotho.

South Africa has one of the highest rates of tuberculosis (TB) infection worldwide and has declared a national emergency in response to the disease.

TB is a source of stigma in the country, which forcibly quarantines patients.

Countries must weigh the civil liberties of patients infected with the airborne disease against the greater public’s health interests.

Blogger “Peter” writes about the new home care for patients with Extreme Drug Resistant Tuberculosis (XDR-TB).

The “Encyclopedia of Earth” blog argues that environmental risk factors must be addressed to solve the TB problem, saying that one group has helped families pay for an additional room to house the infected patient — thus lessening the chance of spreading infection.

Blogger “Rick Stark” criticizes South Africa’s practice of dumping infected migrant workers across the border, arguing that the “cruel” tactic only augments the spread of the disease.

For more on migrant labor’s role in South Africa’s tuberculosis problem, read a recent report: The mining sector, tuberculosis and migrant labor in Southern Africa [PDF].

Blogger “Ethan Zuckerman” posts the work of photographer James Nachtwey, who chronicled the lives of XDR-TB patients in Southern Africa in an effort to raise awareness and put a human face on the disease.

South African blogger “Ridwan” despairs at the average life span in his country, made worse by TB prevalence and poor medical care.

Drug-resistant TB dominated U.S. headlines over a year ago, when one infected man flew to and from Europe and another was imprisoned for failing to wear a protective mask in public.

In the 1950s, New York confined uncooperative TB patients to Rikers Island to prevent the spread of the disease.

In 2006, about 9.2 million new cases of TB were reported — a 40 percent increase from 1990. The United Nations fears that the global financial crisis will limit medical research and the rate of infection will worsen still.

For more on the global health challenge that tuberculosis presents, see the World Health Organization’s 2008 report on tuberculosis control.

Photo courtesy of Flickr user Open Society Institute under a Creative Commons license.

The tainted milk has left four children dead and thousands ill in China. A reported 1,500 dogs also died after eating food laced with the chemical.

The Chinese government has admitted partial responsibility in the scandal, and several dairy companies have apologized.

Nonetheless, the health scare questions the ability of the Chinese government to effectively regulate. Officials admitted that Sanlu — a dairy company in China that was one of the largest offenders — was exempted from inspection. Sanlu also asked the Chinese government for help in covering up the extent of the crisis.

Read our previous Blogwatch on bloggers’ responses to the initial scandal.

Below is a map detailing the spread of the contamination and countries’ responses to the scare. Click on the country to see the effects of the milk scandal and the actions taken against Chinese dairy products. Use the arrows to navigate the world.