An artist’s impression of the completed Centre of Excellence in Kigali. The center supported by IRCAD is expected to assist with the training of surgeons throughout the continent with minimally invasive surgery training. Credit: Supplied
KIGALI, Nov 13 2023 (IPS) – In a newly established Centre of Excellence located in Masaka, a suburb of the Rwandan capital city, Kigali, an expanded lab, complete with innovative facilities and specialized instruments, is now giving surgeons a conducive environment to simulate how to perform minimally invasive surgeries.
French-based Institute for Research into Cancer of the Digestive System (IRCAD) played a major part in this initiative, the first ever on the African continent.
According to medical experts, in comparison to traditional open surgery, often requiring the patient to incur invasive large incisions, minimally invasive surgery procedures allow doctors to insert a camera through a small incision, or sometimes no incision at all.
Dr Alexandre Hostettler, head of the Surgical Data Science Team at IRCAD, pointed out that harnessing robotic and artificial intelligence is critical to enhance the capability of surgical treatment in Africa.
Robot-assisted minimally invasive surgery denotes the surgical technique where the robot-applied laparoscopic tools are remotely controlled by a human operator at a console.
“Performing surgeries using robotic assistance can be more comfortable for surgeons, as they can sit at a console rather than standing for extended periods, reducing physical strain,” he told IPS.
The center also aims to train medical doctors from across Africa about how to perform surgery using very small incisions, allowing the introduction of an endoscope connected to a camera with a magnified image leading to a very precise dissection of the operated organs.
Prof Jacques Marescaux, President and Founder of IRCAD, is convinced that the new center represents a turning point in surgical education and practice in Rwanda and sub-Saharan Africa. “The center is a catalyst for all African surgeons and computer scientists,” he said in an exclusive interview with IPS.
At the same time, Rwanda is striving to build an integrated medical service system that provides high-quality services and is efficient in medical facility management. Rwandan President Paul Kagame believes the key task is to keep investing significantly in public health infrastructure.
“The [new] Centre of Excellence is not serving Rwanda alone. It is serving Africa. It is also improving and taking beyond the talent we have in Africa to a much higher level,” Kagame said at the inauguration of the new facility, for which operations and running costs will be fully funded by the Government of Rwanda and IRCAD France.
Some medical experts observe that despite its numerous advantages over traditional surgery, especially the shorter hospital stay and less blood loss with lower overall costs, the new robotic surgery is not widespread in low- and middle-income countries, especially in Sub-Saharan Africa.
In addition, some researchers argue that computer-assisted navigation and robotics are sometimes challenging to use by perioperative nurses when caring for patients undergoing these procedures.
Dr Christine Mutegaraba, a surgeon from one of the private clinics in Kigali, told IPS that providing appropriate training remains critical for specialized medical practitioners to rely on these robotic surgery systems.
“Huge investment is also needed to ensure that clinics and other specialized referral hospitals are equipped with devices needed to perform these kind of surgical techniques,” Mutegaraba said.
According to the data from Rwanda’s Ministry of Health, laparoscopic was the sole type of minimally invasive surgical technique used by few medical practitioners across the country, and there wasn’t any formal training in place to develop the technical skills for additional doctors.
With the inauguration of the new center, both officials and health experts see hope in developing and advancing this technology, where specialized medical doctors will now be able to perform various kinds of surgeries.
While the introduction of innovative solutions in the health sector remains exciting for health officials, Marescaux points out that the new robotic technology is set to provide patients with high-quality medical services.
“We are working on building the largest team combined with computer scientists and surgeons in Africa,” he said.
Estimates by IRCAD show that access to surgical care in Low- and Middle-Income Countries (LMICs), such as countries in Sub-Saharan Africa, is still extremely limited, which causes a burden on the health care systems.
It said thanks to the center, African surgeons will not have to travel across the continent to receive the best training in surgery since it will be available right at home.
Whereas the UN agency recommends that African countries significantly increase investments in building the health workforce to meet their current and future needs, new findings show that that the region has a ratio of 1.55 health workers (physicians, nurses, and midwives) per 1000 people.
Experts now believe that robotic technology will also lessen surgeon’s workload by efficiently managing the patient flow.
“As technology evolves, robotic systems are likely to incorporate more advanced features, integrating AI, augmented reality, and other technologies to aid the surgical process,” Hostettler said.
MONTEVIDEO, Uruguay, Oct 10 2023 (IPS) – Mexico’s Supreme Court recently declared abortion bans unconstitutional, effectively decriminalising abortion throughout the vast federal country, so far characterised by a legislative patchwork.
The ruling came in response to a lawsuit filed by a civil society organisation, Information Group on Reproductive Choice. It forces the Federal Congress to repeal the Federal Penal Code articles that criminalise abortion. Effective immediately, those seeking abortions and those providing them can no longer be punished for doing so. The ruling also enshrines the right to access abortion procedures in all institutions of the federal health system network, even in states where the crime of abortion remains on the books.
Global trends
Mexico is part of a global, long-term trend of progress in sexual and reproductive rights. According to the Center for Reproductive Rights, the vast majority of countries that have changed their national abortion laws over the past couple of decades have made them less restrictive. Only four countries have gone the other way: El Salvador, Nicaragua, Poland and the USA.
Several Latin American countries have been swept by the ‘green tide’ that originated in Argentina, increasingly liberalising abortion laws. Before the 2010s, abortion was legal in only one Latin American country, Cuba. It was legalised in Uruguay in 2012, and eight years later in Argentina. Colombia decriminalised abortion in February 2022, and other countries, such as Chile and Ecuador, have since made it legal on limited grounds, notably when pregnancy is a result of rape – which women’s rights organisations see as a milestone on the road to full legalisation.
Globally, abortion is currently legal on request in 75 countries, often until 12 weeks into pregnancy. Around a dozen more allow it for broad socio-economic reasons. Many more permit it for specific reasons such as health grounds or to save a pregnant person’s life.
But abortion remains banned under any circumstances in 24 countries, and overall 40 per cent of women of reproductive age live under restrictive abortion laws. These restrictions have a significant impact on women: it’s estimated that unsafe abortions costs the lives of 39,000 women and girls every year.
A legislative patchwork
The trend towards decriminalisation in Mexico kicked off in 2007 in Mexico City, and it took 12 years for another state, Oaxaca, to follow its lead. Change accelerated in recent years, with Hidalgo and Veracruz legalising abortion in 2021.
In September 2021, the federal Supreme Court issued its first-ever decision on abortion rights, unanimously recognising a constitutional right to safe, legal and free abortion services within a ‘short period’ early in pregnancy, and on specific grounds later. The ruling came in response to a lawsuit against the state of Coahuila, which imposed prison terms of up to three years for voluntary abortion.
Although this ruling only applied to Coahuila, it had a wider impact: judges in other states were no longer able to sentence anyone for the crime of voluntary abortion in the early stages of pregnancy.
Two days after this judgment, the Supreme Court addressed another lawsuit concerning the state of Sinaloa, issuing a ruling that declared it unconstitutional for state laws to redefine the legal concept of personhood by protecting ‘human life from conception’. And soon after, it declared invalid the principle of conscientious objection for medical practitioners in the General Health Law. A couple of months earlier it had ruled unconstitutional the time limits set by some states for abortions in cases of rape.
By the time of the Coahuila ruling, only four federal entities allowed abortion on demand up to 12 weeks. But several have changed their laws since, and by the time of the latest Supreme Court ruling, abortion on demand was already legal in 12 of Mexico’s 32 states. All states also allowed abortions for pregnancies resulting from rape, most allowed abortion when necessary to save a pregnant person’s life, and several allowed it in cases of risks to a pregnant person’s health or severe congenital foetal abnormalities.
Regional experience however suggests that making abortion conditional on exceptional grounds that must be proven tends to result in denial of access. Additionally, in Mexico, access by particularly vulnerable women has often been restricted through resistance in bureaucracies and medical institutions, even in states where abortion is legal.
Now Congress has until the end of its current session, which runs until 15 December, to amend the Penal Code clauses that criminalise abortion. But even after this, abortion will continue to be a state-level crime in 20 states. This means that abortion complaints will continue to be filed in those states. In most cases judges will ultimately have to dismiss the charges – but women will continue to be subjected to unnecessary barriers and uncertainty. For this reason, the women’s rights movement is pushing locally for decriminalisation in every Mexican state.
Effective access the next struggle
Mexican women’s rights groups are getting ready for what promises to be a long battle for effective access. They feel confident, for now, that thanks to decades of hard work public opinion is on their side. But they know that, while there may be less up-front resistance than before, there are still powerful forces against change. Resistance manifests in the imposition of barriers to prevent effective access to what is now recognised as a right, particularly for people from the most excluded groups in society.
Denial of access can take many forms: long waiting times, the need for multiple doctors’ appointments and parental or marital consent, disinformation and the extension of conscientious objection from individual health personnel to entire institutions.
Sexual and reproductive health, including abortion procedures, is basic healthcare and should be easily accessible to all. Mexican feminists know this, and will continue fighting to change both policy and minds so nobody is denied access to their rights.
A Group photo of participants of the regional conference on the humanitarian consequences of nuclear weapons and nuclear-free-zone in Central Asia held on August 29, 2023. Credit: Jibek Joly TV Channel
ASTANA, Kazakhstan, Sep 7 2023 (IPS) – Exactly 32 years ago, on September 29, 1991, Kazakhstan, then part of the Soviet Union, made a historic decision that would alter its fate. On that day, Kazakhstan permanently closed the Semipalatinsk Nuclear Test Site, defying the central government in Moscow. This marked the start of Kazakhstan’s transformation from a nuclear-armed state, possessing the fourth-largest nuclear arsenal at the time, to a non-nuclear-weapon state. Kazakhstan’s audacious move to eliminate its nuclear weapons was rooted in a profound commitment to global disarmament, setting an inspiring precedent.
Eighteen years later, in 2009, the United Nations General Assembly adopted a resolution, led by Kazakhstan, designating August 29 as the International Day Against Nuclear Tests. This day serves as a solemn reminder of the catastrophic consequences of nuclear weapons and underscores the urgent imperative for disarmament.
In a world where the threat of nuclear weapons being used again remains a grim reality, a pivotal question looms: Can we genuinely aspire to a world free of nuclear arms? To delve deeper into this pressing concern and comprehend the menace posed by nuclear weapons testing and deployment, we interviewed Karipbek Kuyukov and participants of the “Humanitarian Impact of Nuclear Weapons and the Central Asian Nuclear-Weapon-Free Zone” regional conference. This conference, organized by the Ministry of Foreign Affairs of Kazakhstan in partnership with the Center for International Security and Policy (CISP), Soka Gakkai International (SGI), the International Committee of the Red Cross (ICRC), and the International Campaign to Abolish Nuclear Weapons (ICAN), took place in Astana, Kazakhstan to commemorate this year’s International Day Against Nuclear Tests.
Karipbek Kuyukov is an armless painter from Kazakhstan, and global anti–nuclear weapon testing & nonproliferation activist. Credit: Jibek Joly TV Channel
One of the most poignant moments during the conference came from Dmitriy Vesselov, a third-generation survivor of nuclear testing. He provided a heartfelt testimony about the profound human toll exacted by nuclear testings on his family and the broader community. The nuclear tests conducted at the Semipalatinsk Nuclear Test Site over four decades unleashed explosions 2,500 times more potent than the atomic bombs dropped on Hiroshima and Nagasaki. The repercussions of these tests have echoed through generations, inflicting severe health problems and untold suffering.
Kuyukov, a renowned Kazakh artist born without hands due to radiation exposure in his mother’s womb, has devoted his life to raising awareness about the horrors of nuclear testing. His powerful artwork, created using his lips or toes, depicts the survivors of nuclear tests and serves as a poignant tribute to those who perished. Kuyukov’s unwavering commitment reflects the indomitable human spirit in the face of unimaginable adversity.
Dmitriy Vesselov’s testimony shed light on the ongoing challenges faced by survivors. He candidly shared his struggles with health issues, including acromioclavicular dysostosis, a condition severely limiting his physical capabilities. Vesselov expressed his deep concern about the potential transmission of these health problems to future generations. Consequently, he has chosen not to have children. The conference underscored the imperative of averting the repetition of history by delving into the past tragedies inflicted by nuclear weapons testings.
Hirotsugu Terasaki, Director General of Peace and Global Issues of SGI, commenting on the event said “I believe that this regional conference is a new milestone, a starting point for representatives from five countries of Central Asia to discuss how we can advance the process toward a nuclear-weapon-free world, given the ever-increasing threat of nuclear weapons.”
Terasaki observed that the international community is actively deliberating Articles 6 and 7 of the Treaty on the Prohibition of Nuclear Weapons (TPNW), mandating state parties to provide support to victims and address environmental remediation. He accentuated Kazakhstan’s pivotal role as a co-chair of the working group central to these discussions.
Kazakhstan does provide special medical insurance and benefits to victims of nuclear tests. However, these benefits are predominantly extended to individuals officially certified as disabled or a family member of those who succumbed to radiation-related illnesses. Numerous victims, like Vesselov, who do not fall within these categories, remain ineligible for assistance.
Despite his daunting challenges, Mr. Vesselov maintains an unwavering sense of hope. He hopes that his testimony will serve as a stark reminder of the perils of nuclear weapons and awaken global consciousness regarding the dangers posed by even small tactical nuclear weapons and the specter of limited nuclear conflicts. Ultimately, his deepest aspiration, shared by all victims of nuclear weapons, is that the world will never bear witness to such a devastating tragedy again.
As Kazakhstan assumes its role as President-designate of the third Meeting of States Parties to the TPNW, it reaffirms its steadfast commitment to global peace and disarmament. President Kassym-Jomart Tokayev’s resolute words resonate with the sentiment of a nation that has borne the scars of nuclear testing: “Such a tragedy should not happen again. Our country will unwaveringly uphold the principles of nuclear security.”
At the conference, member states of the Treaty of Semipalatinsk were encouraged to support Kazakhstan in this endeavor, and in its efforts to represent the Central Asian region’s contribution to nuclear disarmament, through attending the second Meeting of States Parties of the TPNW, at least as observers, which will take place at the United Nations Headquarters in New York between 27 November and 1 December this year, and by signing and ratifying the TPNW at the earliest opportunity.
In a world still grappling with the looming specter of nuclear devastation, Kazakhstan’s journey from a nuclear test site to a leading advocate for disarmament serves as a beacon of hope. Kazakhstan’s unwavering commitment to peace stands as a testament to the enduring legacy of a nation that once bore the weight of nuclear tests and now champions a safer, more secure world for all.
Katsuhiro Asagiri is President of INPS Japan and Kunsaya Kurmet-Rakhimova is a reporter of Jibek Joly(Silk Way) TV Channel.
United Nations Secretary General Antonio Guterres addresses the 22nd session of the Permanent Forum on Indigenous Issues at the General Assembly Hall of the United Nations headquarters in New York City on 17 April 17 2023. Credit: Ed Jones/AFP via Getty Images
NEW YORK, Sep 7 2023 (IPS) – This September, world leaders and public policy advocates from around the world will descend on New York for the UN General Assembly. Alongside conversations on peace and security, global development and climate change, progress – or the lack of it – on the Sustainable Development Goals (SDGs) is expected to take centre-stage. A major SDG Summit will be held on 18 and 19 September. The UN hopes that it will serve as a ‘rallying cry to recharge momentum for world leaders to come together to reflect on where we stand and resolve to do more’. But are the world’s leaders in a mood to uphold the UN’s purpose, and can the UN’s leadership rise to the occasion by resolutely addressing destructive behaviours?
Sadly, the world is facing an acute crisis of leadership. In far too many countries authoritarian leaders have seized power through a combination of populist political discourse, outright repression and military coups. Our findings on the CIVICUS Monitor – a participatory research platform that measures civic freedoms in every country – show that 85% of the world’s population live in places where serious attacks on basic fundamental freedoms to organise, speak out and protest are taking place. Respect for these freedoms is essential so that people and civil society organisations can have a say in inclusive decision making.
UN undermined
The UN Charter begins with the words, ‘We the Peoples’ and a resolve to save future generations from the scourge of war. Its ideals, such as respect for human rights and the dignity of every person, are being eroded by powerful states that have introduced slippery concepts such as ‘cultural relativism’ and ‘development with national characteristics’. The consensus to seek solutions to global challenges through the UN appears to be at breaking point. As we speak hostilities are raging in Ukraine, Sudan, the Occupied Palestinian Territories and the Sahel region even as millions of people reel from the negative consequences of protracted conflicts and oppression in Afghanistan, Ethiopia, Myanmar, Syria and Yemen, to name a few.
Article 1 of the UN Charter underscores the UN’s role in harmonising the actions of nations towards the attainment of common ends, including in relation to solving international problems of an economic, social, cultural or humanitarian character, and to promote respect for human rights and fundamental freedoms for all. But in a time of eye-watering inequality within and between countries, big economic decisions affecting people and the planet are not being made collectively at the UN but by the G20 group of the world’s biggest economies, whose leaders are meeting prior to the UN General Assembly to make economic decisions with ramifications for all countries.
Economic and development cooperation policies for a large chunk of the globe are also determined through the Organisation for Economic Cooperation and Development (OECD). Established in 1961, the OECD comprises 38 countries with a stated commitment to democratic values and market-based economics. Civil society has worked hard to get the OECD to take action on issues such as fair taxation, social protection and civic space.
More recently, the BRICS – Brazil, Russia, India, China and South Africa – grouping of countries that together account for 40 per cent of the world’s population and a quarter of the globe’s GDP are seeking to emerge as a counterweight to the OECD. However, concerns remain about the values that bind this alliance. At its recent summit in South Africa six new members were admitted, four of which – Egypt, Iran, Saudi Arabia and the United Arab Emirates – are ruled by totalitarian governments with a history of repressing civil society voices. This comes on top of concerns that China and Russia are driving the BRICS agenda despite credible allegations that their governments have committed crimes against humanity.
The challenge before the UN’s leadership this September is to find ways to bring coherence and harmony to decisions being taken at the G20, OECD, BRICS and elsewhere to serve the best interests of excluded people around the globe. A focus on the SDGs by emphasising their universality and indivisibility can provide some hope.
SDGs off-track
The adoption of the SDGs in 2015 was a groundbreaking moment. The 17 ambitious SDGs and their 169 targets have been called the greatest ever human endeavour to create peaceful, just, equal and sustainable societies. The SDGs include promises to tackle inequality and corruption, promote women’s equality and empowerment, support inclusive and participatory governance, ensure sustainable consumption and production, usher in rule of law and catalyse effective partnerships for development.
But seven years on the SDGs are seriously off-track. The UN Secretary-General’s SDG progress report released this July laments that the promise to ‘leave no one behind’ is in peril. As many as 30 per cent of the targets are reported to have seen no progress or worse to have regressed below their 2015 baseline. The climate crisis, war in Ukraine, a weak global economy and the COVID-19 pandemic are cited as some of the reasons why progress is lacking.
UN Secretary-General Antonio Guterres is pushing for an SDG stimulus plan to scale up financing to the tune of US$500 billion. It remains to be seen how successful this would be given the self-interest being pursued by major powers that have the financial resources to contribute. Moreover, without civic participation and guarantees for enabled civil societies, there is a high probability that SDG stimulus funds could be misused by authoritarian governments to reinforce networks of patronage and to shore up repressive state apparatuses.
Also up for discussion at the UN General Assembly will be plans for a major Summit for the Future in 2024 to deliver the UN Secretary-General’s Our Common Agenda report, released in 2021. This proposes among other things the appointment of a UN Envoy for Future Generations, an upgrade of key UN institutions, digital cooperation across the board and boosting partnerships to drive access and inclusion at the UN. But with multilateralism stymied by hostility and divisions among big powers on the implementation of internationally agreed norms, achieving progress on this agenda implies a huge responsibility on the UN’s leadership to forge consensus while speaking truth to power and challenging damaging behaviours by states and their leaders.
The UN’s leadership have found its voice on the issue of climate change. Secretary-General Guterres has been remarkably candid about the negative impacts of the fossil fuel industry and its supporters. This July, he warned that ‘The era of global warming has ended; the era of global boiling has arrived’. Similar candour is required to call out the twin plagues of authoritarianism and populism which are causing immense suffering to people around the world while exacerbating conflict, inequality and climate change.
The formation of the UN as the conscience of the world in 1945 was an exercise in optimism and altruism. This September that spirit will be needed more than ever to start creating a better world for all, and to prove the UN’s value.
Mandeep S. Tiwana is chief officer for evidence and engagement + representative to the UN headquarters at CIVICUS, the global civil society alliance.
Experts encourage parents to vaccinate their children against typhoid to ensure that the child has access to clean drinking water. Credit: Zofeen Ebrahim/IPS
By Zofeen Ebrahim KARACHI, Jul 6 2023 (IPS)
The first thing you notice about eight-month-old Manahil Zeeshan is how tiny she looks on the adult-size hospital bed at the government-run Sindh Institute of Child Health and Neonatology (SICHN) in Korangi, a neighbourhood in Karachi.
Her right foot is taped with a cannula, and she whimpers incessantly. “I have been in and out of the hospital for the last seven days,” said Uzma Mohammad, Zeeshan’s mom, with worry lines on her forehead. “High fever that refused to come down, severe cough for days and breathlessness,” were some of the symptoms Mohammad described. She was convinced someone had “put a spell” on her daughter.
The doctors, however, suspected she had typhoid.
Salmonella Typhi bacteria cause typhoid fever, and Salmonella Paratyphi bacteria cause paratyphoid fever. According to the US-based public health agency, Centers for Disease Control and Prevention, along with a fever that can be as high as 103 to 104°F (39 to 40°C), the sick person can have weakness, stomach pain, headache, diarrhoea or constipation, cough, and loss of appetite. Some people have a rash of flat, rose-coloured spots. Internal bleeding and death can occur but are rare. It affects between 11 and 20 million people each year, leading to 128,000 to 161,000 deaths, according to the World Health Organization (WHO). The highest fatality rates are reported in children under four years of age.
While Zeeshan’s blood culture report had yet to come to ascertain the cause of her sickness, she needed urgent medical care, said Dr Shabita Bai, who had admitted her.
“We could not wait for five days for the blood culture report as she was not doing well. And because she had already been given an antibiotic (a medicine used to kill bacteria) from outside, our chances of finding if the baby had typhoid for sure were slim, and we had to rely on the history,” justified Bai.
Decisions had to be made. Based on her condition, symptoms, and clinical diagnosis, the baby was given Ceftriaxone, an intravenous antibiotic, but she showed no improvement. The doctors then administered the stronger Meropeneme intravenously, a last-resort antibiotic.
Manahil Zeeshan’s foot has a drip in an effort to bring her temperature down and fight suspected typhoid. Credit: Zofeen Ebrahim/IPS
Battling the Superbug
But even if she had typhoid, the bacteria in her body had taken on the form of a superbug — the extensively drug-resistant (XDR) typhoid and the current antimicrobials had become ineffective, said paediatrician Dr Jamal Raza, the executive director of the SICHN.
According to a Lancet study published in 2022, multidrug-resistant (MDR) typhoid has been seen in Pakistan, while typhoid bacteria resistant to the widely-used antibiotic azithromycin have been found in Bangladesh, Nepal and India. “Our analysis revealed a declining trend of MDR typhoid in south Asia, except for Pakistan, where XDR S Typhi emerged in 2016 and rapidly replaced less-resistant strains,” stated the study, which researchers claim is the largest ever examination of the S.Typhi bacterium.
The reason why antibiotics are losing their punch against some types of bacteria, said Raza, was the “indiscriminate use of antibiotics” that health practitioners prescribe to provide immediate relief. Another big problem was self-medication by people. “I know people often use an old prescription by a doctor to get the same medicine if they feel they have the same symptoms, thinking they do not need to visit the doctor.”
But he pointed out viruses, which are also small germs like bacteria, are causing bacteria-like infections, like a cold or the flu.
“Taking an antibiotic for the latter does not treat the disease; it only leads to antibiotic resistance,” said Raza.
A study conducted by researchers from three medical institutions, namely, the Aga Khan University (AKU) in Karachi, the Armed Forces Institute of Pathology (AFIP) in Rawalpindi, and the Shaukat Khanum Memorial Cancer Hospital & Research Center (SKH) in Lahore in 2018, found indiscriminate use of antibiotics to be causing new drug-resistant “superbugs.”
It found a high prevalence of multidrug and fluoroquinolone resistance for both S.Typhi and S. Paratyphi strains of typhoid bacteria. From 20% in 1992, the resistance was found to have increased to around 50% in 2015. The stubborn bacteria were resistant to antibiotics like ampicillin, chloramphenicol (and co-trimoxazole), as well as fluoroquinolone (ciprofloxacin and/or ofloxacin).
“The situation is quite grim,” said Dr Mashal Khan, chairperson of the government-run paediatric medicine department at Karachi’s National Institute of Child Health, referring to the increase in the number of children developing resistance to typhoid drugs. His worry is not that the bacteria has spread; his concern is the bacteria has mutated and become resistant to the drug.
“We’re running out of new antibiotics to treat bacterial infections; Meropeneme is the last one, and a very expensive one too,” he said resignedly, adding: “Although the development of newer antibiotics is the need of the day, I must emphasise the rational use of the ones being used is more urgent.”
Developing new drugs is challenging, and antibiotics more so, as the science is tricky.
“Antibiotics are not the most lucrative drugs to develop for pharmaceuticals as their utility is limited in the future due to the bacteria developing the ability to resist them,” said Infectious Diseases specialist and epidemiologist Dr Faisal Mahmood at the Aga Khan University Hospital in Karachi. “A lot of money goes into developing new drugs, and since most of the funding is from the global north, they prefer to work on infections which concern them directly. Typhoid is unfortunately endemic in the low and middle-income countries in the South, which have poorer water quality and have warmer, more humid climates.”
And that is why the only sure-shot way of reducing the disease burden of typhoid is to vaccinate the children.
In 2019, Pakistan became the first country to get the World Health Organization (WHO)-recommended single-dose typhoid conjugate vaccine (TCV) injected intramuscularly, added to its routine immunisation (RI) regime. This is given to babies at nine months, alongside measles-rubella vaccinations, without impacting either vaccine.
“Childhood vaccination complemented with clean drinking water and improved hygiene practices is the much more cost-effective way of eradicating typhoid than pumping antibiotics in a child,” said Raza. Meropenem costs as much as Rs. 30,000 (USD 105) for a 10-day course, and if hospitalisation is included, it can go up to Rs 100,000 ($349), said the doctor. Being in a government hospital, Zeeshan is treated free of cost.
Eight-month-old Manahil Zeeshan is treated for typhoid at the government-run Sindh Institute of Child Health and Neonatology (SICHN) in Korangi, a neighbourhood in Karachi. Credit: Zofeen Ebrahim/IPS
Typhoid Vaccine Launch Hits a Snag as Covid-19 Surfaces
The 2019 TCV campaign was first launched in the two cities of Sindh – Karachi and Hyderabad (children up to 15 years of age were also given a shot), which reported the highest number of typhoid cases among children. There was a pause when Covid-19 hit the world. But by 2022, TCV had been launched across Pakistan, and 35.5 million children were vaccinated, after which it was added to the government-run Expanded Programme on Immunisation (EPI) programme.
“Many parents do not know that the TCV is a more effective vaccine but only available at government vaccination centres, and not at private clinics and hospitals as Gavi has only given it to the government of Pakistan,” said paediatrician Dr D.S. Akram.
“There is another typhoid vaccine available in the private sector (typhoid polysaccharide vaccine), but it can only be given to children over two years of age, and it needs boosters every three years. My advice to parents is to vaccinate their kids against typhoid bacteria at nine months,” she said.
But it is still a drop in the ocean, and the fight against typhoid and other childhood diseases continues. The WHO places Pakistan among the ten countries that account for almost two-thirds of the world’s unimmunised children.
When Covid-19 hit the country’s already crumbling health system, it also brought the country’s immunisation programme to a halt too. An estimated 1.5 million children across Pakistan missed out on basic vaccines from March to May 2020, according to Gavi.
For Pakistan, which already has low immunisation coverage (the percentage of fully immunised children aged 12-23 months is just 66%), it meant a further dip in coverage which led to an unprecedented rise in the number of zero-dose children (those that have not received any routine vaccine). Add to these were the almost 19,000 new births every day. But when the lockdown eased and vaccinators returned to work, there was less demand for vaccination, having been replaced by fear of the new virus.
While Pakistan has yet to reach the optimal immunisation coverage of 90%, during Covid-19, Pakistan’s EPI received plaudits internationally for taking both vaccine coverage and the number of zero-dose children close to pre-pandemic levels in 2021. “What Pakistan achieved needs to be celebrated. In fact, Pakistan and Chad are used as examples internationally of how to get it right in an emergency,” said Huma Khawar, an immunisation and child health advocate working closely with EPI.
“Despite a year’s delay due to Covid-19, which was unforeseen, I think it is the best thing that the government has done for its country’s children,” said Khawar. She credited the RI programme that bounced back to the pre-pandemic level in 2021.
Clean water, Good Hygiene Key to Preventing typhoid
While immunisation can protect children from getting infected, clean drinking water and improved hygiene practices can reduce the risk of catching the disease to a great extent.
“Vaccines provide immunity when there is exposure to the bacteria,” agreed Dr Jai Das, assistant director at the Institute for Global Health and Development at the Aga Khan University and one of the co-authors of the 2018 report on typhoid, but emphasised the need for improved water and sanitation, a situation that continues to remain dismal and compromised in Pakistan.
The same study not only found a strong correlation between water and sanitation but to literacy levels as well. In addition, it stressed improving the country’s food safety protocols and implementing regulations.
While Mohammad believes that her daughter is under a curse, one reason could be that the unpasteurised cow’s milk she gives her daughter may not be properly boiled at home. “I was unable to breastfeed her,” she said. Further, she confessed to diluting it with unboiled tap water to make it last longer.
Doctors say giving Pakistani babies a lease of life is simple and costs nothing. “Exclusive breastfeeding up to at least six months of age (right now it is only 43%), attaining 90% coverage of RI across Pakistan and improving water and sanitation quality,” according to Dr Akram.
Bacteria Don’t Respect Geographic Borders
The XDR typhoid bacteria propagating in Pakistan has crossed borders and reached as far as the UK, Canada and the US. Earlier this year, a team of Pakistani and US researchers published their findings in the American Journal of Tropical Medicine and Hygiene, stating that with numerous typhoid bacteria variants circulating in Pakistan have also been identified in Southeast Asia and Eastern and Southern Africa and have been introduced into the United Kingdom, Canada, and the United States by travellers.
The Lancet study said strains from South Asia had spread 200 times to other countries since 1990. When these superbugs grow and spread, they can cause infections that are hard to treat. Sometimes they can even spread the resistance to other bacteria they meet.
The future looks frightening. While the need for improving water and sanitation cannot be overemphasised, along with the need for vaccinating children, newer and stronger antibiotics need to be developed and fast as typhoid may surface in deadlier ways than now since very few antibiotics remain effective against the bacteria.
Note: This story was supported by the Sabin Vaccine Institute and Internews
Childhood vaccination, complemented with clean drinking water and improved hygiene practices, are the key to eradication of typhoid XDR, not indiscriminate use of antibiotics, say Pakistan health experts. Source
Simita Devi, whose daughter spent days in hospital recently suffering from typhoid caused by contaminated water, collects clean water brought to the surface by a solar pump. Credit: Umar Manzoor Shah/IPS
By Umar Manzoor Shah Champad, India, Jul 4 2023 (IPS)
Simita Devi spent over ten days in a government-run hospital a year ago anxiously watching her critically ill nine-year-old daughter, Gudiya, who was diagnosed with typhoid.
Gudiya was so sick she even went into a coma for a day. Medical staff attending to the child said she contracted the disease from drinking contaminated water.
After being discharged, Devi’s main worry was to get safe drinking water for her ailing daughter.
She was advised not to consume water from village wells or untested sources like river streams or springs.
Hailing from Champad, a tribal village in India’s Jharkhand state, Devi works as a daily wage labourer alongside her husband. With a limited income, Devi couldn’t afford packaged drinking water for her daughter.
She then decided to boil the water using firewood to make it safe to drink. But to get the firewood, she had to trek the treacherous terrains of the nearby forests – a long, difficult work and the fear of wild animals loomed.
It was not Devi alone impacted by contaminated water, it was making many people in her village ill, and there was nothing the inhabitants could do about it.
According to government records, 80% of India’s rural drinking water comes from underground sources. One-third of India’s 600 districts do not have safe drinking water because fluoride, iron, salinity, and arsenic concentrations exceed tolerance levels. India’s water quality is poor, ranking at 120 of 122 nations.
The solar panels on the water tower have meant clean waters for the villagers of Champad, a tribal village in India’s Jharkhand. Credit: Umar Manzoor Shah/IPS
Experts believe that the source of these heavy metals is industrial waste being dumped untreated into water systems and nitrates which surface due to excessive and prolonged use of fertilizers. The government estimates that every year, over one lakh (100,000) people die of waterborne diseases in the country.
Champad, a village inhabited by a tribal community, has 105 households per the 2011 census. Until 2022, the community depended on only two tube wells as their source of drinking water. However, these tube wells often experienced malfunctions, leaving the villagers with no choice but to fetch water from a nearby river or pond. Consequently, there has been a rise in waterborne diseases, particularly affecting the health of women and children. The need to travel long distances for safe drinking water has increased women’s workload, increasing their workload.
Perturbed by the threat of waterborne diseases, the village locals congregated earlier this year to try to find a solution. They at first visited the local politicians for help. Then they headed towards government offices. “Nothing happened—absolutely nothing. We were virtually left high and dry. Except for God, no one is there to help us. At times, we were told to wait, and at times, we were told that government funding wasn’t available. But we were slowly dying. Our children are suffering in front of our own eyes,” Ram Singh, a local villager at Champad, told IPS.
Earlier this year, a team from a non-governmental agency working to uplift rural areas in India visited the village to assess the villagers’ hardships.
The agency then mooted the idea of a solar water tower in the village. The villagers were made aware of the process involved in the tower’s construction and that government approval for the facility was needed.
The village representatives were taken on board, and a proposal was submitted to the water department of the district.
“Government liked the idea, and it was readily approved. The entire village worked together to make the project a success story,” says a member of the humanitarian agency who wished to remain anonymous.
The towers were equipped with solar panels, enabling them to operate sustainably and with minimal environmental impact. The selection of sites for the towers was a collaborative effort involving the village communities. The first solar water tower was constructed in February 2023, while work on the other two towers is still ongoing. As a result, 45 families now directly benefit from the convenience of having clean drinking water channelled to their homes through pipelines. The water provided is of good quality and considered safe, in contrast to the open well water that was previously relied upon. This development has significantly alleviated the burden on women, who no longer have to travel long distances to fetch water from various sources.
The impact of this intervention was significant. The community’s health improved, and they were no longer at risk of waterborne illnesses. The women and children, who were often responsible for collecting water from distant sources, could now spend their time on other activities. The community’s overall quality of life improved, and they could focus on their livelihoods and education.
For Simita Devi, the facility is no less than a major solace in her life. She excitedly uses this water for drinking and thanks God for such an endeavour.
“Safe water means life for us. The solar tower has become a messiah for poor villagers like us. We will cherish the moments for life when we find its water coming to our homes,” Devi told IPS.
