Vaccination Is the Best Bet Against Drug-Resistant Superbugs — Experts

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Experts encourage parents to vaccinate their children against typhoid to ensure that the child has access to clean drinking water. Credit: Zofeen Ebrahim/IPS

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

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

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

IPS UN Bureau Report

 


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Excerpt:

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

Quest for Safe Water in One of India’s Most Isolated Villages

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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

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

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.

IPS UN Bureau Report

 


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Women Suffer Harassment and Discrimination on Chile’s Public Transport

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Perla Venegas is one of 1444 female bus drivers in the surface public transport network in Santiago, Chile, which aims at gender inclusion and offers job stability and shift flexibility compatible with family life. CREDIT: Orlando Milesi / IPS

Perla Venegas is one of 1444 female bus drivers in the surface public transport network in Santiago, Chile, which aims at gender inclusion and offers job stability and shift flexibility compatible with family life. CREDIT: Orlando Milesi / IPS

By Orlando Milesi
SANTIAGO, Jun 26 2023 (IPS)

Sexual harassment and discrimination are daily realities for women on public transport in Chile and also an obstacle for plans to expand mass transit in order to reduce pollution in several cities in this South American country.

Santiago, the capital, is the most polluted city based on fine air particulate matter among the large Latin American cities, according to the World Air Quality Report 2022, ahead of Lima and Mexico City, while five other Chilean cities are among the 10 most polluted in South America.

Sexual harassment is the most visible form of discrimination against women in Chilean public transportation, in addition to insecurity due to poorly lit bus stops, inadequate buses, and more frequent trips at times when women are less likely to travel.

Personal accounts gathered by IPS also mentioned problems such as the constant theft of cell phones and the impossibility for young women to wear shorts or low-cut tops when traveling on buses or the subway, the backbone of Santiago’s public transportation system.

To address these problems, the Chilean government and the Santiago city government adopted gender strategies: they put in place special telephones to report harassers and thieves, began installing “panic buttons” and alarms at bus stops, and incorporated more women in driving and security.

“When I was younger I suffered a lot of harassment because I didn’t have the character to stand up to the harassers. Now that I am older, I am able to confront an aggressor without fear, even when he is harassing another person, whether a man or a woman. When I confront them, they run away,” Bernardita Azócar, 34, told IPS.

 

Bernardita Azócar, in a subway station in Santiago, Chile, heads to her job in a collection agency. She says she suffered sexual harassment on public transport in the capital when she was younger, but now she is more alert to any aggression and feels empowered to help others who suffer the same bad experience. CREDIT: Orlando Milesi / IPS

Bernardita Azócar, in a subway station in Santiago, Chile, heads to her job in a collection agency. She says she suffered sexual harassment on public transport in the capital when she was younger, but now she is more alert to any aggression and feels empowered to help others who suffer the same bad experience. CREDIT: Orlando Milesi / IPS

 

“It happened to me a couple of times when I was younger. They want to grope you or try to touch another girl and now I confront them. I suffer less because I’m more aware and I try not to put myself at risk,” she added during a dialogue at the University of Chile subway station in Santiago.

Azócar, who works for a collection company, said the root cause of harassment lies in education and in Chilean society.

“If you wear a miniskirt or show cleavage, society points the finger at you, as if you were provoking men and it was your fault. And I don’t think that’s why it happens. It’s abuse to be harassed in the public system…or anywhere else,” she said.

Maite, a humanities student at the Catholic University, feels that women are at a disadvantage on public transportation.

“When a woman takes a bus, she tends to sit next to the aisle to have an easier way to flee from any threat. Or she sits next to another woman so as not to travel alone. There are many things that women do that are not explicit. They are behaviors we learn, to get by on public transportation,” said the young woman who, like her friends, preferred not to give her last name.

According to Maite, “women can’t wear shorts or backpacks on the bus, or openly use a cell phone. Every time you get on the bus you have to take a lot of measures.”

Maite and four other classmates told IPS that they take a combination of buses and the subway to go to school and that none of them have suffered harassment on the bus, but they know of several cases that happened to their friends.

“If someone tries to touch me or crowd me too closely I don’t feel so safe,” said Elena, a commercial engineering student.

“A friend of mine had her cell phone stolen. I have not been harassed, but I would never go on the bus or subway in shorts even if I were dying of heat. I wear long pants because wearing shorts is a risk,” added Emilia, a psychology student.

 

The five university students in this group lament the discrimination women suffer on Chilean public transport and recognize that they have a "code of conduct" that they personally follow to avoid problems, such as not wearing shorts or miniskirts or showing cleavage, even in summertime, although it sometimes restricts their personal freedom. CREDIT: Orlando Milesi / IPS

The five university students in this group lament the discrimination women suffer on Chilean public transport and recognize that they have a “code of conduct” that they personally follow to avoid problems, such as not wearing shorts or miniskirts or showing cleavage, even in summertime, although it sometimes restricts their personal freedom. CREDIT: Orlando Milesi / IPS

 

The joys and pitfalls of being a female bus driver

Getting more people to use buses and other public transport in Chile, a long narrow country with a population of 19.8 million, is difficult because 71 percent of households own at least one car.

The incorporation of more female bus drivers is aimed at a friendlier mass transit system.

Perla Venegas, 34, has been working as a bus driver in Santiago’s public transportation system for six years.

“I like my job and driving. The most complicated thing is dealing with cyclists, pedestrians and passengers, who are never satisfied,” she told IPS while parked waiting to pull out on the corner of Santa Rosa and Alameda, in the heart of downtown Santiago.

Her route connects downtown Santiago with the municipality of Maipú, in the western outskirts of the capital.

“I’m on a par with the male drivers, but I’m more cautious, not so aggressive and I’m a more defensive driver. I have been complimented several times, especially by elderly people,” said Venegas, who lives with her two daughters, aged 16 and 8.

“I have female colleagues who have been hit and beaten. I received a death threat from a passenger because when the route ended he wouldn’t get off. He was a homeless drug addict. It was 5:30 AM. In the end I found a carabineros (police) patrol car and I turned him in,” she said.

She added that she has had both pleasant and negative experiences and acknowledged that she is proud that her eldest daughter also wants to be a bus driver “although I would not like her to experience the hard parts.”

 

The Santiago subway is the backbone of the mass transit system in the Chilean capital. It makes it possible to reach 23 of the 32 municipalities that encompass the capital and allows passengers to combine with a bus network to reach any point of the metropolitan region. CREDIT: Orlando Milesi / IPS

The Santiago subway is the backbone of the mass transit system in the Chilean capital. It makes it possible to reach 23 of the 32 municipalities that encompass the capital and allows passengers to combine with a bus network to reach any point of the metropolitan region. CREDIT: Orlando Milesi / IPS

 

Staying alert in the subway, the main means of public transport

On the Santiago subway there are 2.3 million trips on working days. Its tracks cover 140 kilometers on six lines, with 136 stations in 23 of the 32 municipalities that comprise the metropolitan area. Greater Santiago is home to 7.1 million people.

An additional 2.1 million average daily trips are made on surface public transport.

According to official statistics, during the first five months of the year there were 21 pollution episodes in Santiago above the maximum standard level and eight environmental alerts for excess fine particulate matter, so increasing the use of public transport instead of private vehicles is considered a priority for the authorities.

Paulina del Campo, the subway’s sustainability manager, told IPS that gender issues are a strategic objective in this state-owned company.

“We have taken the issue of harassment very seriously. We do not have large numbers, but we do have moments like March 2022 when the issue was raised because of situations in the streets and in universities that included public transportation,” she said.

After meetings with authorities and student leaders, the subway increased the presence of female security guards at stations in the university district.

“One of the things they said is that in a situation of harassment it is much more comfortable to ask for help from a woman than from a man,” explained Del Campo.

The company thus hired a specific group of female guards to receive and respond to complaints.

“Qualified staff respond and are trained to provide support for the victims. We can quickly activate the protocols with the carabineros police. When it happens we can intercept the train and often arrest the people (aggressors) on the spot,” said Del Campo.

In another campaign, a standard methodology designed by international foundations with expertise in harassment was adapted to the situation in Chile.

At the same time, the subway increased its female staff and the number of women in leadership positions.

“Two years ago we had a female staff of around 20 percent and now, in May, 26.5 percent of the 4,400 subway workers are women. In the area of security guards we have a staff of approximately 700 and of these 110 are women,” explained the company’s Sustainability Manager.

 

These two women are security guards at the Plaza Egaña subway station, on line 6 in Chile's capital. The state-owned Metro company is increasing the number of women in its services as part of a gender policy that even includes the maintenance of trains. CREDIT: Orlando Milesi / IPS

These two women are security guards at the Plaza Egaña subway station, on line 6 in Chile’s capital. The state-owned Metro company is increasing the number of women in its services as part of a gender policy that even includes the maintenance of trains. CREDIT: Orlando Milesi / IPS

 

Gender policies in public transportation

The Metropolitan Public Transport Directorate (DTPM) informed IPS that it aims to reduce the male-female gap in public transport.

It also plans to increase the number of women bus drivers.

The Red system, with buses running throughout Santiago, currently employs 1,444 women – only 7.6 percent of all drivers.

“Many women who have entered this field come from highly precarious and unregulated jobs, so this opportunity has allowed them greater autonomy and, on many occasions, to leave violent environments and improve their self-confidence,” the DTPM stressed in response to questions from IPS.

“This has meant an effort to train and generate conditions to keep and promote women who are part of the system,” it added.

Origin-Destination Surveys reveal that women are the main users of public transport and 65 percent of trips for the purpose of caring for the home, children or other people are made by women. They are more likely to make multidirectional trips and in the so-called off-peak hours, with little traffic.

According to the DTPM, waiting for the bus is one of the most critical moments in every trip.

“This is why we installed the panic button at bus stops and real-time information on the arrival of buses to improve the perception of security,” it explained.

The information is available through an application on cell phones, while the panic buttons began as a women’s safety pilot plan in October 2022 at stops in one of the capital’s municipalities. The plan is to extend them to a large number of stops in Santiago.

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Biodigesters Boost Family Farming in Brazil

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Lucineide Cordeiro loads manure from her two oxen and two calves into the "sertanejo" biodigester that produces biogas for cooking and biofertilizer for her varied crops on the one-hectare agroecological farm she manages on her own in the rural municipality of Afogados da Ingazeira, in the semiarid ecoregion of northeastern Brazil. CREDIT: Mario Osava / IPS

Lucineide Cordeiro loads manure from her two oxen and two calves into the “sertanejo” biodigester that produces biogas for cooking and biofertilizer for her varied crops on the one-hectare agroecological farm she manages on her own in the rural municipality of Afogados da Ingazeira, in the semiarid ecoregion of northeastern Brazil. CREDIT: Mario Osava / IPS

By Mario Osava
AFOGADOS DA INGAZEIRA, Brazil , Jun 24 2023 (IPS)

“The biodigester really gives a huge boost to those who have the courage to do things,” said Maria das Dores Alves da Silva, based on her own experience as a 63-year-old small farmer.

She did not hesitate to accept the offer of Diaconia, a social organization of Protestant churches in Brazil, to acquire the equipment to produce biogas on her farm in the rural area of Afogados da Ingazeira, a municipality of 38,000 people in the state of Pernambuco in the Northeast region of Brazil.”We seek to promote energy, food and water autonomy to maintain more resilient agroecosystems, to coexist with climate change, strengthening community self-management with a special focus on the lives of women.” — Ita Porto

At first she did not have the cattle whose manure she needed to produce biogas, that enables her to save on liquefied petroleum gas, which costs 95 reais (20 dollars) for a 13-kg cylinder – a significant cost for poor families.

She brought manure from a neighboring farm that gave it to her for free, in an hour-long trip with her wheelbarrow, until she was able to buy her first cow and then another with loans from the state-owned Banco del Nordeste.

“Now I have more than enough manure,” she said happily as she welcomed IPS to her four-hectare farm where she and her husband have lived alone since their two children became independent.

Das Dores, as she is known, is an example among the 163 families who have benefited from the “sertanejos biodigesters” distributed by Diaconia in the sertão of Pajeú, a semiarid micro-region of 17 municipalities and 13,350 square kilometers in the center-north of Pernambuco.

Farmer Maria das Dores Alves da Silva stands between the manure pit and the "sertanejo" biodigester designed by Diaconia, a social organization of Protestant churches in Brazil, which has already installed 713 biogas production plants in eight of Brazil's 26 states. CREDIT: Mario Osava / IPS

Farmer Maria das Dores Alves da Silva stands between the manure pit and the “sertanejo” biodigester designed by Diaconia, a social organization of Protestant churches in Brazil, which has already installed 713 biogas production plants in eight of Brazil’s 26 states. CREDIT: Mario Osava / IPS

Biofertilizer

In addition to using the biogas, she sells the manure after it has been subjected to anaerobic biodigestion that extracts the gases – the so-called digestate, a biofertilizer that she packages in one-kilo plastic bags, after drying and shredding it.

Every Saturday, she sells 30 bags at the agroecological market in the town of Afogados da Ingazeira, the municipal seat. At two reais (40 cents) a bag, she earns an extra income of 60 reais (12.50 dollars), on top of her sales of the various sweet cakes she bakes at home, at a cost reduced by the biogas, and of the seedlings she also produces.

The seedlings provided her with a new business opportunity. “The customers asked me if I didn’t also have fertilizer,” she said. The biodigester produces enough fertilizer to sell at the market and to fertilize the farm’s crops of beans, corn, fruit trees, flowers and different vegetables.

This diversity is common in family farming in Brazil’s semiarid Northeast, but even more so in the agroecological techniques that have expanded in this territory of one million square kilometers in the northeastern interior of the country, which has an arid biome highly vulnerable to climate change, subject to frequent droughts, and where there are areas in the process of desertification.

The Pajeú river basin is the micro-region chosen by Diaconia as a priority for its social and environmental actions.

On Lucineide Cordeiro's small farm, cotton, corn, sesame, sunflower, cassava and fruit trees are alternated in the fields, as recommended by agroecology, which is on the rise on family farms in Brazil's semiarid Northeast, which is threatened by longer and more severe droughts due to the climate crisis. CREDIT: Mario Osava / IPS

On Lucineide Cordeiro’s small farm, cotton, corn, sesame, sunflower, cassava and fruit trees are alternated in the fields, as recommended by agroecology, which is on the rise on family farms in Brazil’s semiarid Northeast, which is threatened by longer and more severe droughts due to the climate crisis. CREDIT: Mario Osava / IPS

Energy and food security

“We seek to promote energy, food and water autonomy to maintain more resilient agroecosystems, to coexist with climate change, strengthening community self-management with a special focus on the lives of women,” Ita Porto, Diaconia’s coordinator in the Pajeu ecoregion, told IPS.

“The production of biogas on a rural family scale fulfills the needs of energy for cooking, sanitary disposal and treatment of animal waste and reduction of deforestation, in addition to increasing food productivity, with organic fertilizer, while bolstering human health,” said the 48-year-old agronomist.

More than 713 units of the “sertanejo biodigester”, a model developed by Diaconia 15 years ago, have been installed in Brazil. In addition to the 163 in the sertão do Pajeú, there are 150 in the neighboring state of Rio Grande do Norte and another 400 distributed in six other Brazilian states, financed by the Caixa Econômica Federal, a government bank focused on social questions.

“Hopefully the government will make it a public policy, as it has already done with the rainwater harvesting tanks in the semarid Northeast,” said Porto.

More than 1.3 million rainwater harvesting tanks for drinking water have already been built, but some 350,000 are still needed to make them universal in rural areas, according to the Articulation of the Semi-Arid (Asa), a network of 3,000 social organizations that spearheaded the transformative program.

Maria Das Dores examines the biofertilizer that comes out of the biodigester, without the gases from the animal manure. She sells this by-product at the agroecological market in the town of Afogados da Ingazeira, the seat of the municipality where her four-hectare farm is located, which earns her an average extra income of 12.5 dollars a week. CREDIT: Mario Osava / IPS

The value of manure

“One cow is enough to produce the biogas consumed in our stove,” said Lucineide Cordeiro, on her one-hectare farm where she grows cotton, corn, sesame seeds and fruit, in an interconnected agroecological system, along with chickens, pigs and fish in a pond.

She also has two oxen and two calves, which she proudly showed to IPS during the visit to her farm.

“Pig manure produces biogas more quickly, but I don’t like the stench,” the 37-year-old farmer who is the director of Women’s Policies at the Afogados da Ingazeira Rural Workers Union told IPS.

The difference in the crops before and after fertilization by the biodigester by-product is remarkable, according to her and other farmers in the municipality.

She tends to her many crops on her own, although she is sometimes helped by friends, and has several pieces of equipment such as a brushcutter and a micro-tractor.

"It's the best invention," says Lucineide Cordeiro, as she shows IPS the seeder created by the Japanese for small-scale farming, which allows her to sow in half a day the land that used to take her two days to plant, on her one-hectare farm in Afogados da Ingazeira, in Brazil's semiarid Northeast. CREDIT: Mario Osava / IPS

“It’s the best invention,” says Lucineide Cordeiro, as she shows IPS the seeder created by the Japanese for small-scale farming, which allows her to sow in half a day the land that used to take her two days to plant, on her one-hectare farm in Afogados da Ingazeira, in Brazil’s semiarid Northeast. CREDIT: Mario Osava / IPS

“But the seeder is the best invention that changed my life, it was invented by the Japanese. Planting the seeds, which used to take me two days of work, I can now do in half a day,” Cordeiro said.

The seeder is a small machine pushed by the farmer, with a wheel filled with seeds that has 12 nozzles that can be opened or closed, according to the distance needed to sow each seed.

The emergence of appropriate equipment for family farming is recent, in a sector that has favored large farmers in Brazil.

Female protagonism clashes with male chauvinist violence

For the success of local family farming, the support of the Pajeú Agroecological Association (Asap), of which Cordeiro is a member and a “multiplier”, as the women farmers who are an example to others of good practices are called, is important.

In family farming the empowerment of women stands out, which in many cases was a response to sexist violence or oppression.

Blue flames emerge from the burners of Maria Das Dores' biogas stove at her home in Afogados da Ingazeira, in Brazil's semiarid Northeast region. A single ox or cow produces enough manure to generate more biogas than a family requires for its domestic needs. CREDIT: Mario Osava / IPS

Blue flames emerge from the burners of Maria Das Dores’ biogas stove at her home in Afogados da Ingazeira, in Brazil’s semiarid Northeast region. A single ox or cow produces enough manure to generate more biogas than a family requires for its domestic needs. CREDIT: Mario Osava / IPS

“The first violence I suffered was from my father who did not let me study. I only studied up to fourth grade of primary school, in the rural school. To continue, I would have had to go to the city, which my father did not allow. I got married to escape my father’s oppression,” said Cordeiro, who also separated from her first husband because he was violent.

After living in a big city with the father of her two daughters, she separated and returned to the countryside in 2019. “I was reborn” by becoming a farmer, she said, faced with the challenge of taking on that activity against the idea, even from her family, that a woman on her own could not possibly manage the demands of agricultural production.

Organic cotton, promoted and acquired in the region by Vert, a French-Brazilian company that produces footwear and clothing with organic inputs, has once again expanded in the Brazilian Northeast, after the crop was almost extinct due to the boll weevil plague in the 1990s.

In the case of Das Dores, a small, energetic, active woman, she has a good relationship with her husband, but she runs her own business initiatives. Thanks to what she earns she was able to buy a small pickup truck, but it is driven by her husband, who has a job but helps her on the farm in his free time.

“He drives because he refuses to teach me how, so I can’t go out alone with the vehicle and drive around everywhere,” she joked.

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Global Community Celebrates Medical Innovations and Milestones Since Defining Leprosy Discovery 150 Years Ago

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Yohei Sasakawa, WHO’s Goodwill Ambassador for Leprosy Elimination, speaks at the two-day Bergen International Conference on Hansen’s Disease. The conference coincided with the 150th anniversary of the discovery of Mycobacterium leprae by Norwegian doctor Gerhard Armauer Hansen. Credit: Thor Brødreskift/Sasakawa Leprosy (Hansen’s Disease) Initiative

Yohei Sasakawa, WHO’s Goodwill Ambassador for Leprosy Elimination, speaks at the two-day Bergen International Conference on Hansen’s Disease. The conference coincided with the 150th anniversary of the discovery of Mycobacterium leprae by Norwegian doctor Gerhard Armauer Hansen. Credit: Thor Brødreskift/Sasakawa Leprosy (Hansen’s Disease) Initiative

By Joyce Chimbi
NAIROBI, Jun 22 2023 (IPS)

The 1873 discovery of Mycobacterium leprae, the causative agent of leprosy by Norwegian doctor Gerhard Armauer Hansen, remains one of the greatest paradigm shifts in medical history, a true revolution.

“Before the great discovery, even in the days when communication and transportation technologies were not as developed as today, leprosy was detested by the entire world. Leprosy was believed to be a divine punishment or a hereditary disease; once affected, patients were segregated to remote areas and islands for life,” says Yohei Sasakawa, WHO’s Goodwill Ambassador for Leprosy Elimination.

Sasakawa, who also serves as chairperson of The Nippon Foundation, spoke during a two-day conference in Bergen, Norway, to commemorate the 1873 discovery. In attendance were over 200 people, including medical, human rights, and historical preservation experts, researchers, NGOs, and organizations of persons affected by the disease.

The Bergen International Conference on Hansen’s Disease, held on June 21 and 22, 2023, was organized by the Sasakawa Leprosy (Hansen’s Disease) Initiative and the University of Bergen. It focused on medical efforts against leprosy, human rights, and dignity issues and preserving the history of leprosy for the lessons it can teach future generations. All three are pillars of the Sasakawa Leprosy (Hansen’s Disease) Initiative’s activities for a world free of leprosy and the discrimination it causes, in line with the UN’s Resolution on Elimination of discrimination against persons affected by leprosy and their family members.

In his speech to delegates, Sasakawa acknowledged the extraordinary advances made by medical professionals since Dr Hansen’s discovery that leprosy was neither a curse nor a punishment from God but a chronic disease caused by a bacillus.

With the 1873 discovery, leprosy went from being a mythological divine disease shrouded in mystery to something one could observe and explain—although it would take more than half a century before a cure was found.

Delegates at the Bergen International Conference on Hansen’s Disease held on June 21 and 22, 2023. The conference was organized by Sasakawa Leprosy (Hansen’s Disease) Initiative and the University of Bergen. Credit: Thor Brødreskift/Sasakawa Leprosy (Hansen’s Disease) Initiative

Delegates at the Bergen International Conference on Hansen’s Disease held on June 21 and 22, 2023. The conference was organized by the Sasakawa Leprosy (Hansen’s Disease) Initiative and the University of Bergen. Credit: Thor Brødreskift/Sasakawa Leprosy (Hansen’s Disease) Initiative

Margareth Hagen, Rector, University of Bergen, said there was a clear shift in the scientific discourse about leprosy before and after the discovery.

Sasakawa said the journey towards a cure started with a single anti-leprosy drug to more effective drug regimens and, ultimately, a recommendation from WHO’s medical team that leprosy patients receive drug regimens consisting of multiple drugs.

“A single anti-leprosy drug tended to increase drug resistance. Since the development of multi-drug therapy, with early detection and treatment, leprosy has become totally curable. About 60 million patients have been cured over the last 40 years,” he said.

Abbi Patrix, the great-grandson of Dr Hansen, now responsible for his great grandfather’s history, spoke about the man behind the science in a session titled, ‘My grandfather, my mother, the documents and me.’

Patrix, a European performance storyteller, talked about the day his mother, the only direct descendant of Dr Hansen at the time, learned that leprosy was named Hansen’s disease after her grandfather.

She was moved and wondered why? His mother was informed that Dr Hansen’s discovery had put a name to a disease that had confounded scientists and society alike and that labeling it ‘Hansen’s disease’ meant freedom for those afflicted because a cure could now be found.

The conference venue was, therefore, a recognition of his renowned great-grandfather because he was born in Bergen, and this was the site for his landmark 1873 discovery at only 32 years of age.

WHO Director-General Dr Tedros Adhanom Ghebreyesus told the audience: “WHO was born halfway between 1873 and today, 75 years ago. Much progress has been made since the two major milestones in the fight against leprosy. But much remains to be done toward our shared goals of zero disease, zero disability, and zero discrimination. Cases of leprosy have decreased significantly in recent decades, but more effort is needed to recover from the health system disruptions of the COVID-19 pandemic and move further ahead.”

Ghebreyesus said the WHO was committed to supporting countries in their bid to eliminate leprosy in line with the roadmap for neglected tropical disease for 2021 to 2030.

“So far, 49 countries have eliminated at least one neglected tropical disease, including Human African trypanosomiasis, rabies, and trachoma. With your support and those of our global partners, we can achieve that goal for leprosy too.”

Other dignitaries who spoke at the conference include United Nations High Commissioner for Human Rights Volker Türk, who said the conference celebrated medical innovations over the last 150 years.

“But when leprosy was eliminated as a global public health problem in 2000, it did not mean that the disease disappeared. Over 250,000 people suffer from leprosy every year, 15,000 of them are children. The actual figures are likely far higher,” he emphasized.

“Around three to four million people who have already been cured still bear varying degrees of impairment. The burden of leprosy is heaviest in countries with the greatest inequality, poverty, and marginalization.”

Türk further said that to better the lives of people affected by leprosy, “We need to address the physical symptoms, but we also need social and behavioral measures to address stigma and discrimination. We need comprehensive strategies with access to quality care, education, and social protection,” and told participants that “together we can make a real difference in ending leprosy, which causes immense preventable and unjustifiable suffering for thousands of people.”

Against this backdrop, Sasakawa stressed that further action is needed to combat stigma and discrimination, pointing out that as many as 130 discriminatory laws against leprosy are still in place in more than 20 countries.

“When respect for human rights is a must, it is unacceptable to leave such a large-scale and serious human rights violation unaddressed,” he said.

As the curtain fell on the Bergen conference of a remarkable journey to end leprosy over the last 150 years, Dr Takahiro Nanri, executive director of Sasakawa Health Foundation, noted that this was the third international conference that the foundation has helped to organize since launching its “Don’t Forget Leprosy” campaign in 2021 to help to ensure that the disease and those affected by it are not overlooked amid the coronavirus pandemic.

“Our purpose in organizing these conferences is to make the world aware that there are still many people who have Hansen’s disease and its consequences; to build momentum for collaboration toward the realization of a leprosy-free world; and to provide a setting for both formal and informal exchanges that can be a catalyst for innovative solutions that we as a foundation are ready to support,” he said.

IPS UN Bureau Report

 


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Human Rights Defenders in Exile Safety Imperiled by Host Countries’ Declining Civil Rights

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Irene Grace says human rights defenders hiding in Kenya fear harassment and intimidation due to a decline in civic rights. Credit: Joyce Chimbi/IPS

Irene Grace says human rights defenders hiding in Kenya fear harassment and intimidation due to a decline in civic rights. Credit: Joyce Chimbi/IPS

By Joyce Chimbi
NAIROBI, Jun 20 2023 (IPS)

While leaving one’s country and becoming a refugee is a last resort, it is a decision that many, like Steve Kitsa, have had to make. As conflict becomes increasingly protracted in many African countries, many others will take this step.

“In a matter of life and death, I fled the Democratic Republic of Congo (DRC) five years ago and left my elderly mother behind. One day we were seated in a group of young men, chatting and enjoying the morning sun, when a lone gunman in uniform approached us and started firing away unprovoked. Such incidences had become too common in the eastern region, and some of my friends were killed,” Kitsa tells IPS.

Kenya hosts one of the largest refugee populations in Africa. Kitsa is one of more than 520,000 registered refugees and asylum seekers. But human rights defender Irene Grace, who fled Uganda two years ago, says the number is much higher because borders are porous.

Nevertheless, official records show that about 287,000 refugees come from Somalia, 142,000 from South Sudan, 50,000 from DRC, and 32,000 from Ethiopia; many live in Dadaab and Kakuma camps.

Others, like Kitsa, have found their way into the urban centers of Nairobi, Kisumu, Mombasa, and Eldoret. Outdated statistics from 2017 indicate that more than 67,267 refugees live in Nairobi.

“There is a lot of exploitation because we need the locals to survive. Along the highways, you will find many young men hawking peanuts. You can tell they are from DRC because of the kind of Swahili they speak. They sell these peanuts under the hot sun, all day, every day, in exchange for a plate of food and somewhere to sleep as the profits go to the host. Most of us are desperate to go to France,” he explains.

Irene Grace fled Uganda for promoting the rights of the LGBTQI community as the country clamped down on their rights. As the government-endorsed crackdown against the community intensified, so did threats against her life.

“The issue of human rights defenders in exile is one aspect of the refugee situation that is hardly ever talked about. The risk is very high because you are under an alias in a foreign country, and if murdered, you are likely to remain unidentified for a long time, and it might take years to connect the dots. The question of who bears the duty of protection for us remains unanswered,” Grace says.

Her fears and concerns reflect the 2022 report findings by the global civil society alliance, CIVICUS, and the Kenya Human Rights Commission (KHRC), highlighting the decline in civil rights in Kenya. According to the report, the government was using excessive force to quieten dissent.

Kenya was placed on the CIVICUS Monitor’s human rights ‘Watchlist’ in June 2022. The Watchlist highlights countries with a recent and steady decline in civic freedoms, including the rights of free speech and peaceful assembly.

Kenya was rated Obstructed by the CIVICUS Monitor. There are 42 countries in the world with this rating. The rating is typically given to countries where power holders heavily contest civic space and impose a combination of legal and practical constraints on the full enjoyment of fundamental rights.

In 2021, Front Line Defenders released a report accusing the governments of Uganda and Kenya of giving the South Sudanese National Security Service (NSS) intelligence agency the freedom to target refugee human rights workers who fled the country.

“It is very difficult to continue with activism in such a hostile environment, on top of the many other challenges confronting us, such as a lack of documentation and access to services. Some of us left our families behind, exposed and unprotected. Over the eight years, I have lived in Kenya, I have received many threatening calls from South Sudan, but I know the information of my whereabouts came from within this country,” Deng G, an activist from South Sudan, tells IPS.

“Our situation worsens when local activists are targeted. In exile, you must connect with local networks to survive and continue with your activism. I am aware of activists in Kenya currently being held without trial for protesting against the high cost of living.”

KHRC continues to express concerns over the misuse of laws to undermine peaceful protest and recently responded with speed when five activists from the Social Justice Center, a Nairobi-based grassroots group, were arrested during a peaceful protest against the controversial Finance Bill 2023.

A pre-independence Public Order Act requires activists to notify authorities of protests at least three days in advance. Police have mistakenly understood the provision as a requirement for protests to be approved or denied, using it as an excuse to deem protests ‘unpermitted.’ Even though the right to peaceful assembly is guaranteed in Kenya’s constitution, it is continually undermined, says CIVICUS and KHRC.

Irene Grace says ongoing hostilities have derailed efforts to promote the safety and security of LGBTQI asylum seekers and refugees in the Kakuma Refugee Camp complex in northwestern Kenya whose lives are at risk. She says they are experiencing discrimination, and physical and sexual violence, among other forms of human rights violations.

“I am unable to travel there to determine how we can mobilize and improve their safety, working hand in hand with grassroots activists in Kenya. There are corrupt security officers, and once they discover you are hiding in the country, you become a target. They want you to pay them to turn a blind eye as you go on with your activities,” she says.

Kitsa says the issue of bribes is a most pressing challenge for many refugees seeking to integrate with the locals.

“They usually threaten to send you to the refugee camps despite having refugee documentation allowing you to live among the locals. They can create many problems for you.”

Against this backdrop, Irene Grace says activism is being suppressed from multiple angles, and human rights activists, local and those operating from exile, must now go back to the drawing board to find safer, impactful ways to speak truth to power and take the powers that be head-on.
IPS UN Bureau Report

 


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Excerpt:

Home Away From Home is the theme of World Refugee Day 2023. However, for many, including human rights activists who have fled their homes, a decline in civil rights in their host countries means their lives are often endangered and their activism curtailed. Source