Shabana Basij-Rasikh, co-founder and President of SOLA, speaks at the Women Deliver conference in Rwanda. Credit: Aimable Twahirwa/IPS
By Aimable Twahirwa KIGALI, Aug 1 2023 (IPS)
When providing education to her small group of Afghan girls, who had been studying at a boarding school back home, became tenuous, Shabana Basij-Rasikh, relocated them to Rwanda.
She had set up a pioneering school under the project SOLA, the Afghan word for peace, and a short form for School of Leadership Afghanistan. But as the Taliban swept to power in August 2021, she closed the doors of the school, destroyed any school records which could help identify the girls, and on August 25, relocated 250 members of the SOLA community, including the student body and graduates from the programme, totally more than 100 girls, to Rwanda.
Basij-Rasikh, co-founder and SOLA’s President said a major challenge had been the lack of resources and capacity to teach Afghan girls after the return of the Taliban deprived right to education of girls in secondary schools and above.
As the Taliban swept back into power in Afghanistan in the summer of 2021, Shabana Basij-Rasikh, the founder of the nation’s only all-girls boarding school, initially ran the school out of a former principal’s living room. But that soon became untenable.
Speaking on the sidelines of The Women Deliver 2023 Conference (WD2023), which took place in Kigali from 17-20 July 2023, Basij-Rasikh, who completed her undergraduate studies in the United States, explained that when Kabul fell under the control of the Taliban, she managed within a short time to evacuate the entire school community to Rwanda.
“Although we managed to move the school to a safe country, it is still embarrassing and shameful for me since Afghanistan is the only country in the world where women and girls’ access to education has been suspended,” she said.
Initially, SOLA started as a scholarship program where Afghan youth would be identified and could access quality education abroad and, later on, go back to their home country as highly-skilled Afghans in whichever profession they chose.
“When the US announced that they were to withdraw their troops in Afghanistan, it created a lot of anxiety among young Afghans who were in the West hoping to return to the country.”
Basij-Rasikh regrets that some of her former students, who were able to leave Afghanistan after the Taliban’s return, are still struggling to continue their education overseas.
“We wish to see many Afghan girls return to schools,” she said, explaining that the migration status of the students in many countries restricted their access to education.
Since the school opened last year’s admissions season, Shabana Basij-Rasikh and her team have been inviting Afghan girls worldwide to apply and join the rest in Rwanda. Last year they enrolled 27 girls in their first intake.
“The major challenge is that there are several hundreds of thousands of girls who want to join our campus, but space is limited, and so places are being granted on merit and need,” Shabana told IPS.
Shabana argues investing in girls’ education is a smart investment; she is convinced that the current situation in Afghanistan must and should not be accepted or supported by any country around the world.
On September 18, 2021, a month after taking over the country, the Taliban ordered the reopening of only boys’ secondary schools. A few months later, in March 2022, according to human rights organizations, the Taliban again pledged to reopen all schools, but they officially closed girls’ secondary schools.
“These girls deserve the opportunity to realize their full potential, and the international community has an important role to play,” Shabana said.
UNESCO’s latest figures show that 2,5 million or 80 percent of school-aged Afghan girls and women are out of school. The order suspending university education for women, announced in December last year, affects more than 100,000 students attending government and private institutions, according to the UN agency.
On the sidelines of the Women Deliver Conference 2023, Senegalese President Macky Sall pledged that his government would offer 100 scholarships for women who have seen their right to education decimated under Taliban rule in Afghanistan to pursue their university degrees in Senegal.
Rwanda is one of several African countries that agreed to temporarily host evacuated Afghans.
Sall, who was reacting to the concerns raised by Basij-Rasikhat, said his Government was ready to give chance to Afghan girls to pursue their studies.
So far, SOLA school has received 2,000 applications across 20 countries where some Afghans are living.
In 2022, it received 180 applications from Afghans living in 10 countries, but only 27 girls were admitted.
“That explains how families in Afghanistan are ready to support the girls in moving abroad to pursue their education,” Shabana said.
“Boarding schools that allow Afghan girls to study and live together are the best way to promote their education.”
Marisol and Misael Menjívar pose next to the biodigester installed in March in the backyard of their home in El Corozal, a rural settlement located near Suchitoto in central El Salvador. With a biotoilet and stove, the couple produces biogas for cooking from feces, which saves them money. The biotoilet can be seen in the background. CREDIT: Edgardo Ayala / IPS
By Edgardo Ayala SUCHITOTO, El Salvador , Jul 25 2023 (IPS)
A new technology that has arrived in rural villages in El Salvador makes it possible for small farming families to generate biogas with their feces and use it for cooking – something that at first sounded to them like science fiction and also a bit smelly.
In the countryside, composting latrines, which separate urine from feces to produce organic fertilizer, are very popular. But can they really produce gas for cooking?
“It seemed incredible to me,” Marisol Menjívar told IPS as she explained how her biodigester, which is part of a system that includes a toilet and a stove, was installed in the backyard of her house in the village of El Corozal, near Suchitoto, a municipality in the central Salvadoran department of Cuscatlán.”When the first ones were installed here, I was excited to see that they had stoves hooked up, and I asked if I could have one too.” — Marisol Menjívar
“When the first ones were installed here, I was excited to see that they had stoves hooked up, and I asked if I could have one too,” added Marisol, 48. Hers was installed in March.
El Corozal, population 200, is one of eight rural settlements that make up the Laura López Rural Water and Sanitation Association (Arall), a community organization responsible for providing water to 465 local families.
The families in the small villages, who are dedicated to the cultivation of corn and beans, had to flee the region during the country’s 1980-1992 civil war, due to the fighting.
After the armed conflict, they returned to rebuild their lives and work collectively to provide basic services, especially drinking water, as have many other community organizations, in the absence of government coverage.
In this Central American country of 6.7 million inhabitants, 78.4 percent of rural households have access to piped water, while 10.8 percent are supplied by wells and 10.7 percent by other means.
With small stoves like this one, a score of families in El Corozal in central El Salvador cook their food with biogas they produce themselves, thanks to a government program that has brought clean energy technology to these remote rural villages. CREDIT: Edgardo Ayala / IPS
Since November 2022, the government agency has installed around 500 of these systems free of charge in several villages around the country.
The aim is to enable small farmers to produce sustainable energy, biogas at no cost, which boosts their income and living standards, while at the same time improving the environment.
The program provides each family with a kit that includes a biodigester, a biotoilet, and a small one-burner stove.
In El Corozal, five of these kits were installed by Asa in November 2022, to see if people would accept them or not. To date, 21 have been delivered, and there is a waiting list for more.
In El Corozal, a rural settlement in the municipality of Suchitoto in central El Salvador, the technology of family biodigesters arrived at the end of last year, and some families are now producing biogas to light up their stoves and cook their food at no cost. CREDIT: Edgardo Ayala / IPS
“With the first ones were set up, the idea was for people to see how they worked, because there was a lot of ignorance and even fear,” Arall’s president, Enrique Menjívar, told IPS.
In El Corozal there are many families with the surname Menjívar, because of the tradition of close relatives putting down roots in the same place.
“Here we’re almost all related,” Enrique added.
The biodigester is a hermetically sealed polyethylene bag, 2.10 meters long, 1.15 meters wide and 1.30 meters high, inside which bacteria decompose feces or other organic materials.
This process generates biogas, clean energy that is used to fuel the stoves.
The toilets are mounted on a one-meter-high cement slab in latrines in the backyard. They are made of porcelain and have a handle on one side that opens and closes the stool inlet hole.
One of the main advantages that family biodigesters have brought to the inhabitants of El Corozal, a small village in the Salvadoran department of Cuscatlán, is that the whole process begins with clean, hygienic toilets, like this one set up in Marleni Menjívar’s backyard, as opposed to the older dry composting latrines, which drew flies and cockroaches. To the left of the toilet is the small handle used to pump water to flush the feces into the biodigester. CREDIT: Edgardo Ayala / IPS
They also have a small hand pump, similar to the ones used to inflate bicycle tires, and when the handle is pushed, water is pumped from a bucket to flush the waste down the pipe.
The underground pipe carries the biomass by gravity to the biodigester, located about five meters away.
The system can also be fed with organic waste, by means of a tube with a hole at one end, which must be opened and closed.
Once it has been produced, the biogas is piped through a metal tube to the small stove mounted inside the house.
“I don’t even use matches, I just turn the knob and it lights up,” said Marisol, a homemaker and caregiver. Her husband Manuel Menjívar is a subsistence farmer, and they have a young daughter.
In El Corozal, biodigesters have been installed for families of four or five members, and the equipment generates 300 liters of biogas during the night, enough to use for two hours a day, according to the technical specifications of Coenergy, the company that imports and markets the devices.
But there are also kits that are used by two related families who live next to each other and share the equipment, which includes, in addition to the toilet, a larger biodigester and a two-burner stove.
With more sophisticated equipment, electricity could be generated from biogas produced from landfill waste or farm manure, although this is not yet being done in El Salvador.
Marleni Menjivar gets ready to heat water on her ecological stove, watched closely by her four-year-old daughter, in El Corozal in central El Salvador, where an innovative government program to produce biogas has arrived. With this technology, people save money by buying less liquefied gas while benefiting the environment. CREDIT: Edgardo Ayala / IPS
Saving money while caring for the environment
The families of El Corozal who have the new latrines and stoves are happy with the results.
What they value the most is saving money by cooking with gas produced by themselves, at no cost.
They used to cook on wood-burning stoves, in the case of food that took longer to make, or on liquefied gas stoves, at a cost of 13 dollars per gas cylinder.
Marleni Menjívar, for example, used two cylinders a month, mainly because of the high level of consumption demanded by the family business of making artisanal cheeses, including a very popular local kind of cottage cheese.
Every day she has to cook 23 liters of whey, the liquid left after milk has been curdled. This consumes the biogas produced overnight.
For meals during the day Marleni still uses the liquefied gas stove, but now she only buys one cylinder a month instead of two, a savings of about 13 dollars per month.
“These savings are important for families here in the countryside,” said Marleni, 28, the mother of a four-year-old girl. The rest of her family is made up of her brother and grandfather.
“We also save water,” she added.
The biotoilet requires only 1.2 liters of water per flush, less than conventional toilets.
In addition, the soils are protected from contamination by septic tank latrines, which are widely used in rural areas, but are leaky and unhygienic.
The new technology avoids these problems.
The liquids resulting from the decomposition process flow through an underground pipe into a pit that functions as a filter, with several layers of gravel and sand. This prevents pollution of the soil and aquifers.
Also, as a by-product of the decomposition process, organic liquid fertilizer is produced for use on crops.
Most families in the rural community of El Corozal have benefited from one-burner stoves that run on biogas produced in family biodigesters. Larger two-burner stoves are also shared by two related families, where they cook on a griddle one of the favorite dishes of Salvadorans: pupusas, corn flour tortillas filled with beans, cheese and pork, among other ingredients. CREDIT: Coenergy El Salvador
Checking on site: zero stench
Due to a lack of information, people were initially concerned that if the biogas used in the stoves came from the decomposition of the family’s feces, it would probably stink.
And, worst of all, perhaps the food would also smell.
But little by little these doubts and fears faded away as families saw how the first devices worked.
“That was the first thing they asked, if the gas smelled bad, or if what we were cooking smelled bad,” said Marleni, remembering how the neighbors came to her house to check for themselves when she got the latrine and stove installed in December 2022.
“That was because of the little information that was available, but then we found that this was not the case, our doubts were cleared up and we saw there were no odors,” she added.
She said that, like almost everyone in the village, her family used to have a dry composting toilet, but it stank and generated cockroaches and flies.
“All that has been eliminated, the bathrooms are completely hygienic and clean, and we even had them tiled to make them look nicer,” Marleni said.
She remarked that hygiene is important to her, as her little girl can now go to the bathroom by herself, without worrying about cockroaches and flies.
ECW’s Yasmine Sherif and Graham Lang walk with UNHCR partners through Borota, where thousands of new refugees, most of them women, and children, have arrived after fleeing the conflict in Sudan. Credit: ECW
By Naureen Hossain UNITED NATIONS, Jul 20 2023 (IPS)
If you want lasting peace, the best investment you can make is in education, said Education Cannot Wait’s Executive Director Yasmine Sherif in an exclusive interview with IPS.
“(This will) make children and adolescents literate, learn critical thinking, address trauma and psycho-social challenges from being victims of a conflict or crisis, develop their potential, and become financially independent,” Sherif said, adding that these were critical skills to participate in good governance of their countries in the future.
She was speaking to IPS ahead of her participation in the ECOSOC High-Level Political Forum side event “Ensuring Education Continuity: The Roles of Education in Emergencies, Protracted Crises and Building Peace” at the UN Headquarters in New York.
Education is the answer to breaking the vicious circle of violence, conflict, and crisis – while this often is associated with war and conflict, the same applies to climate change.
“If the next generation that is today suffering from climate-induced disasters are not educated, do not understand or have an awareness of how to treat mother earth, and do not have the knowledge or skills to mitigate or prevent risks in the future, the negative impact of climate-induced disasters will only escalate.”
Unfortunately, conflicts and climate risks increasingly combine to multiply vulnerability, she said – and instead of declining, the number of children who need urgent support is increasing.
“Today, 224 million crisis-affected children do not receive a quality, continuous education. More than half of these children – 127 million – may have access to something that resembles a classroom, but they are not learning anything. They are not achieving the minimum proficiencies outlined in the Sustainable Development Goals (SDG4).”
Sherif stressed the crucial linkage between education and protection for children in crisis-affected countries and explained how protection is a core component of the holistic package of education ECW is supporting together with its partners.
“On the legal side, we advocate for the respect of the international humanitarian law, national human rights law, and the National Refugee Law, and for an end to impunity for those who violate these,” said Sherif. “We also call for additional countries to adopt the Safe Schools Declaration, and actively support its implementation at the national level.”
To prevent violence around and in schools, practical measures are included to ensure the children are safe.
“It’s important to ensure safe transport to and from the school. And that would, of course, bring a sense of safety to the parents, who may not be willing to send the girls to school because of that. You ensure the infrastructure of the school provides protection. You may need wards around the school so that nobody can walk into the school and abduct a girl.”
ECW funding also includes protections to prevent sexual and psychological violence.
“All the funding that we invest requires giving protection a priority. And that is essential wherever you operate or invest funding in a country of affected by armed conflict; you need to ensure protection is prioritized.”
Sherif said that in countries like Afghanistan, where the Taliban have banned girls from attending secondary school and upwards, ECW works with local partners to support non-formal education.
“There is a lot of work at the community level, with local authorities allowing ECW’s investments in civil society and UN agencies to continue to operate. So community-based schooling is pretty much (being) run now, where we are investing at the community level,” she said, and while it may not be ideal, it does work.
Likewise, non-formal learning centers have been set up in Cox’s Bazar, where the Rohingya refugees live after fleeing violence, discrimination, and persecution in Myanmar.
“Our aim is for every child to be able to access national education systems, but sometimes it is not possible politically or physically due to the dangers of the conflict. So we also support our partners to establish non-formal learning centers until another more sustainable solution can be found.”
During the Covid-19 pandemic, ECW’s partners were innovative in ensuring education continued – with remote learning programmes such as radio and TV-based education, where IT connections were available through phones and WhatsApp with learning kits and tools.
“Home-based, going from door-to-door, that was how it was done during COVID. There was some creativity and innovation. It is possible. It is not ideal, but it is possible.”
Sherif said ECW had developed a proven model to bring quality education to every child – even in the most challenging crisis-affected contexts of war and conflicts – but that the biggest hindrance is the financing.
“If we had the financing, we could reach the 224 million (children) immediately. So financing is the big hindrance today. While peace is the number one (solution), if peace is not possible, education cannot wait.”
“If financing for education is provided in crisis and climate disasters, ECW can reach 20 million children and adolescents in the coming four years. And that requires about another USD700 million for Education Cannot Wait between today and 2026. Just USD 700 million is a small amount when you consider the return on investment you get when you invest in human potential.”
Ligoria Felipe dos Santos poses for a photo on her agroecological farm that mixes corn, squash, fruits, vegetables and medicinal herbs. She is part of the women’s movement that is trying to prevent the installation of wind farms in the Borborema mountain range, in the northeastern Brazilian state of Paraíba. CREDIT: Mario Osava / IPS
By Mario Osava ESPERANÇA, Brazil , Jul 14 2023 (IPS)
Zé Pequeno cried when he learned that the heirloom seeds he had inherited from his father were contaminated by the transgenic corn his neighbor had brought from the south. Fortunately, he was able to salvage the native seeds because he had shared them with other neighbors.
Euzébio Cavalcanti recalls this story from one of his colleagues to highlight the importance of “passion seeds” for family farming in Brazil’s semiarid low-rainfall ecoregion which extends over 1.1 million square kilometers, twice the size of France, in the northeastern interior of the country.”These are seeds adapted to the semiarid climate. They can withstand long droughts, without irrigation.” Euzébio Cavalcanti
Saving heirloom seeds is a peasant tradition, but two decades ago the Brazilian Semiarid Articulation (ASA), a network of 3,000 social organizations that emerged in the 1990s, named those who practice it as individual and community guardians of seeds. By September 2021, it had registered 859 banks of native seeds in the region.
Cavalcanti, a 56-year-old farmer with multiple skills such as poet, musician and radio broadcaster, coordinates the network of these banks in the Polo de Borborema, a joint action area of 14 rural workers’ unions and 150 community organizations in central-eastern Paraíba, one of the nine states of the Brazilian Northeast.
“These are seeds adapted to the semiarid climate. They can withstand long droughts, without irrigation, that is why they are so important,” he explained. They also preserve the genetic heritage of many local crop species and family history; they have sentimental value.
“Don’t plant transgenics, don’t erase my history”, is a slogan of the movement that promotes agroecological practices and is opposed to the expansion of genetically modified organisms in local agriculture. “Corn free of transgenics and agrotoxins (agrochemicals)” is the goal of their campaign.
In Paraíba, the name “passion seeds” has been adopted, instead of native or heirloom seeds, since 2003, when the state government announced that it would provide seeds from a specialized company to family farmers.
“If the government offers these seeds, I don’t want them. I have family seeds and I have passion for them,” reacted a farmer in a meeting with the authorities.
“‘Passion seeds’ spread throughout Paraíba. In other states they’re called ‘seeds of resistance’,” Cavalcanti said.
Agroecology is one of the banners of the Polo de Borborema, as it is for ASA in the entire semiarid ecosystem that covers most of the Northeast region and a northern strip of the southeastern state of Minas Gerais.
“Passion seeds,” as heirloom seeds are known locally, ensure better harvests on semiarid lands, free of transgenics or “agricultural poisons,” according to Euzébio Cavalcanti, a small farmer, poet and musician who helped lead the struggle for agrarian reform and cares for the seeds in the highlands of Borborema, in northeastern Brazil. CREDIT: Mario Osava / IPS
Learning to coexist with semiarid conditions
This approach arose from a change in the development strategy adopted on the part of local society, especially ASA, since the 1990s. “Coexisting with semiarid conditions” replaced the traditional, failed focus on “fighting the drought”.
Large dams and reservoirs, which only benefit large landowners and do not help the majority of small farmers, gave way to more than 1.2 million tanks for collecting rainwater from household or school rooftops and various ways of storing water for crops and livestock.
It is a process of decolonization of agriculture, education and science, which prioritizes knowledge of the climate and the regional biome, the Caatinga, characterized by low, twisted, drought-resilient vegetation. It also includes the abandonment of monoculture, with the implementation of traditional local horticultural and family farming techniques.
The Northeast, home to 26.9 percent of the national population, or 54.6 million inhabitants according to the 2022 demographic census, concentrates 47.2 percent of the country’s family farmers, according to the 2017 agricultural census. There are 1.84 million small farms worked mainly by family labor.
Brazil’s semiarid region is one of the rainiest in the world for this type of climate, with 200 to 800 millimeters of rain per year on average, although there are drier areas in the process of desertification.
A stand at the ecological market in the municipality of Esperança, in northeastern Brazil, is a link between urban consumers and family farmers opposed to agrochemicals, monoculture and transgenic products. CREDIT: Mario Osava / IPS
Borborema, the name of a high plateau that obstructs the humidity coming from the sea, making the territory to its west drier, is the scene of various peasant struggles, such as the mobilization for agrarian reform since the 1980s and for small-scale agriculture “without poisons” or agrochemicals, of which the “seeds of passion” are a symbol.
Cavalcanti is a living memory of local history, also as a founder of the local Landless Workers Movement (MST) and an activist in the occupations of unproductive land to create rural settlements, on one of which he gained his own small farm where he grows beans, corn and, vegetables and has two rainwater collection tanks.
Women help drive the expansion of agroecology
Women have played a key role in the drive towards agroecology. The March for Women’s Lives and Agroecology is an annual demonstration that since 2010 has defended family farming and the right to a healthy life.
This year, on Mar. 16, 5,000 women gathered in Montadas, a municipality of 5,800 inhabitants, to block the creation of wind farms that have already caused damage to the health of small farmers by being installed near their homes.
Borborema is “a territory of resistance,” say the women. About 15 years ago, they succeeded in abolishing the cultivation of tobacco.
The president of the Union of Rural Workers of the municipality of Esperança, Alexandre Lira (C) and other leaders pose in front of a poster declaring the union’s current goals: “Agroecological Borborema is no place for a wind farm,” he says about this area in Brazil’s semiarid Northeast region. CREDIT: Mario Osava / IPS
When the citrus blackfly arrived, the government tried to combat it with pesticides, but “we resisted; we used natural products and solved the problem for our oranges and lemons,” said Ligoria Felipe dos Santos, a 54-year-old mother of three.
“That is agroecology, which is strengthened in the face of threats. Farmers are aware, they resort to alternative defenses, they know that it is imbalance that leads to pests,” she told IPS.
“Agroecology is a good banner for union activity,” said Lexandre Lira, 42, president of the Rural Workers Union of Esperança, a municipality of 31,000 people in the center of the Polo de Borborema.
It is also a factor in keeping farmers’ children on the farms, because it awakens the interest of young people in agriculture, said Edson Johny da Silva, 27, the union’s youth coordinator.
Maria das Graças Vicente and Givaldo Firmino dos Santos stand next to the machine they use for making pulp from native fruits little known outside Brazil, such as the umbu (Brazil plum), cajá (hog plum), acerola (Amazon or Barbados cherry), along with cashews, mangos, and guava. CREDIT: Mario Osava / IPS
Pulp, added value
Maria das Graças Vicente, known as Nina, 51, along with her husband Givaldo Firmino dos Santos, 52, is an example of agroecological productivity. On 1.25 hectares of land they produce citrus fruits, passion fruit, acerola (Amazon or Barbados cherry), mango and other fruits, as well as sugar cane, corn, beans and other vegetables.
Grafted fruit tree seedlings are another of the products they use to expand their income, as IPS was shown during a visit to their farm.
Using their own harvest and fruit they buy from neighbors, they make pulp in a small shed separate from their home, with a small machine purchased with the support of the Advisory and Services to Projects in Alternative Agriculture (AS-PTA), a non-governmental organization that supports farmers in Borborema and other parts of Brazil.
“Luckily we have a microclimate in the valley, where it rains more than in the surrounding areas. Everything grows here,” Santos told IPS.
But the couple created three reservoirs to collect rainwater and withstand droughts: a 16,000-liter water tank for household use, another that collects water on the paved ground for irrigation, and a small lagoon dug in the lower part of the farm.
But in 2016 the lagoon dried up, because of the “great drought” that lasted from 2012 to 2017, Vicente said.
The fruit pulp factory has grown in recent years and now has seven small freezers to store fruit and pulp for sale to the town’s stores and restaurants. The couple decided to purchase a cold room with the capacity of 30 freezers.
“I work in the mornings on the land, in the afternoons I make pulp and my husband is in charge of the sales,” she said.
Hiring workers from outside the family to reduce the workload costs too much and “we try to save as much as possible on everything, to sell the pulp at a fair price,” Santos said.
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.
