“My friends,” comes the voice from the radio, “take your chairs to sit down and have some discussion about cholera now on your favorite show, ‘Some information about cholera.’”
If it is hard to imagine a show about a deadly disease as your favorite, that may be because you don’t live in rural Haiti. Here, among the beautiful mountains and broad rivers, people live with a frightening reality: it’s easy to catch cholera, and reaching the nearest clinic may take more time than you have.
Without treatment, cholera can be fatal within hours. But in rural Nippes province, what serves as a road may be the bed of a river that after heavy rains becomes a torrent. Or a footpath over steep mountains, where the rocks are sometimes covered in mud so slick that only the most sure-footed can navigate them. Where swift access to medical care is out of the question, cholera prevention takes on special urgency.
“There are some localities where we have to walk three to four hours to reach people. We use horses to go there,” says Jean Bassette, the Oxfam public health officer who hosts the show. “We can’t travel to remote areas every week, but with the radio program we can reach them easily.”
“Ti koze sou kolera,” as the show is called in Creole, invites listeners to call in. The discussions cover whatever cholera issues people want to talk about but usually focus on prevention and emergency treatment.
“If we don’t have oral rehydration salts—or sugar and salt to prepare them—what can we do?” asks one caller.
Stephanie Lormil, an Oxfam public health promoter who sometimes joins the show, explains that coconut water can be a stopgap solution, hydrating the person well enough to make the trip to the hospital.
Sensitive topics like social stigma enter in, as well.
“Treat people who have cholera with respect,” advises Bassette. “Do not humiliate them. People who have the disease need to be able to tell that to the community, and the community needs to support them by preparing oral rehydration salts and helping them get to the hospital. If people with cholera keep the information to themselves, there is risk to the whole community.”
Feedback on the show has been overwhelmingly positive. Local leaders in communities throughout the broadcast area often call in with thanks and congratulations, and people on the street have kind words for the show.
“When we first heard about cholera, we were scared,” says Jose Mira of Petite Rivière de Nippes, who cited the radio show as one of Oxfam’s successful public health efforts. “We didn’t want to live next to people who had cholera. But Oxfam helped us understand the phenomenon of cholera and gave us training. After that, it became easier. We are not scared of cholera anymore, because we know how to protect ourselves.”
Read more about Oxfam's cholera program in rural Nippes.
Donate now to Oxfam's fund for Haiti relief and recovery.
]]>This, she explains, is the result of education.
Every month in the camps near El Fasher town, a team of health workers—elected by their community and trained by Oxfam—fans out to bring messages about health and hygiene to thousands of residents. The workers go house to house, teaching newcomers about disease vectors, hand washing, and the use of latrines, and they organize community-wide campaigns to clean everything from streets to latrines to household water cans.
You might think people would resent unsolicited advice about their personal habits, but the health workers generally get a warm welcome. Women, who have the primary responsibility for the care of children and homes, are happy to receive this information, say the workers. And for the most part they take the advice.
"If they don’t want to accept what we are saying, we don't go harsh on them," says health worker Halima Nasur "We just communicate the information peacefully." But the cost of not heeding hygiene messages could be outbreaks of deadly disease, so the health workers sometimes ask community leaders to intervene. "They nicely teach a woman the importance of our work to her family. Then she listens."
For the health workers, their job is a labor of love. "I believe that all the people in the camp are my sisters and brothers," says Nasur. "We are never going to let our people down."
When it came to guarding the health of her family and community, Gado needed no coaxing. "From the public health women, I learned to cover food to keep away flies because they transmit diseases. I also learned about keeping things clean—our jerry cans, kitchen utensils, latrines, and my children's hands," she says. "Previously, my children didn’t wash their hands before they ate. They were often weak and not healthy. Now, they wash their hands before eating. They don't suffer from diarrhea, and if they happen to get sick, it isn't something serious."
Once learned, it is hard to forget the life-and-death importance of good hygiene practices, and according to Gado, the work of Oxfam and the community health workers is likely to have a lasting impact. "I learned these values, and I'm going to apply them throughout my life," she says. "I would like to thank all of the people who have supported us," says Gado, "and I wish them good health."
]]>In the midst of disasters where so many people have lost so much, why does Oxfam make providing soap such a high priority?
First and foremost, it’s because washing hands with soap is such an effective way to prevent the spread of diarrheal disease–which, under the difficult conditions of camp life, can be debilitating and even fatal.
But in emergencies, people have the right not only to health and safety but also to dignity. Soap enables a family to bathe and to wear clean clothes–simple acts with the power to restore a measure of well-being.
In the Pakistan flood emergency, Oxfam has distributed hygiene materials to more than half a million people. They include towels, water-purification tablets, sanitary pads, water buckets, and–no surprise–soap.
]]>“The destruction across the capital was stunning, and the sight of countless camps crowded with families gave me a powerful sense of how devastating this earthquake has been for people,” says Oxfam writer Coco McCabe, who recently returned to Boston from Haiti.
The camps are spontaneous, makeshift neighborhoods, marked out by plastic tarps, cardboard, and bed sheets strung between whatever’s there. Posts to hang materials on are in short supply, so people are scavenging wood from the wreckage of buildings.
“I saw one man with a flat, wide board, working hard with a small hand saw to cut the board into narrower pieces that could serve as poles for sheets, plastic, scraps of clothing—anything that might offer the semblance of a wall or roof to give families privacy,” says McCabe.
Plastic sheeting strung from poles may seem like a minimal shelter solution, and it is. But at this moment in the emergency, it’s something that works. Colored tarps keep off the sun and rain and, unlike tents, can be made to fit whatever space and terrain is available – or whatever other purpose they’re needed for on a given day.
Over the next two months, Oxfam aims to boost the supply of sturdy plastic sheeting, providing enough for at least 4,000 families (20,000 people) – a project that includes a cash-for-work component: we are employing local people to cut giant rolls of the material down to size. Families will get two pieces, each six meters by four meters, along with two 10-meter lengths of rope.
Meanwhile, we’re making plans to assemble and distribute home-repair kits to help those whose houses need patching up, not rebuilding.
But when it comes to figuring out if what’s left of your house is a danger to your family, no one should have to rely on guesswork. Oxfam will assemble a team of structural engineers to survey the damage to homes in Haiti and share their knowledge and suggestions with local residents, builders, and officials.
How long will it take for survivors of the quake to make their way from camp sites to temporary houses to real, permanent homes? For many, it will be years. But if donors continue to support the aid effort generously, Haitians will get the support they need every step of the way.
“Building back all that was lost in just a few seconds,” says McCabe, “is going to require a sustained commitment from us all.”
Farmers in Cusco are reporting irregular rains and intense heat. This is affecting their potato and corn crops: in recent years, production has fallen by at least half. The Peruvian Ministry of the Environment corroborated this information in its 2009 National Environmental Study, which revealed that 80,000 hectares (about 195,000 acres) of potato and 60,000 hectares (148,000 acres) of white corn have been lost in the last 12 crop years due to climate change. Livestock farmers also report that new diseases are affecting their animals.
Cirilo Quispe Latorre, mayor and resident of the district of Cachimayo. “Eighty percent of the farmland is seasonal. In other words, if there is rain, we plant. If there isn’t enough rain, we can’t keep planting. I’m a native of this region. When I was a child, there was quite a lot of water in this region. There were toads and frogs that you don’t see any more. It’s a big worry. And if I go up to the mountains around Urubamba, I see that they’re almost black now. I worry and tell my children that those mountains used to be white with snow. Now that I’m a bit older, they’re black. What’s happening? A big change is taking place on our planet. I don’t know who’s going to come and sort out this situation. It’s worrying. The rains used to start in October, and we would plant broad beans, wheat, and potatoes. Now the rains begin around mid-December, and we lose more than a month and a half of growing time. Now, by the end of March the rains are over. It used to rain throughout most of April, with the dry season only starting in May. So, the rain has decreased at the beginning and the end.”
Teresa Rocca Mismi, communal farmer in the community of Chacacurqu. “I have potato and corn crops. There isn’t as much rain. The hail that’s fallen (we don’t normally see hail in this region) is what’s affected us. It hailed in mid-February. For example, the potatoes that should be big by now are just seeds. I don’t know why we’ve had hail this year. The rain used to start in October, now it’s December. This has been happening for five years. We want the authorities to help us.”
Local residents in rural Piura report that changing rainfall patterns are damaging their mango and cassava crops. They also have noticed public’s health problems, specifically the emergence of diseases such as dengue fever (spread my mosquitos) and leishmaniasis (spread by sand fleas). A Ministry of Health employee corroborated this information, confirming the appearance of dengue in populations where the transmitting agent (the Aedes aegypti mosquito) never had existed previously.
Marco Sandoval García, president of the Santa Catalina Peasants’ Association. “When I was a lad, I remember that there would be two harvests a year in the lower rice-growing area. Now there’s only one. I also remember that in my community, we had drinking water 24 hours a day. Now it’s just two or three hours, depending on the rain. All the drinking water for Patachaco used to come from a single spring. Now we have to take it from two springs... There’s a shortage of water... The springs aren’t the same any more. Some of them are drying up. The elders say that the cassava never used to rot and could be harvested throughout the year. Last year, no one harvested cassava because it all rotted. My orange tree was full of blossoms, but then we had a sharp frost and all the flowers fell off. There’s instability. The climate is strange. For example, although it’s winter, we’ve just had seven days of strong sun. Some farmers think this is because there’s been a lot of deforestation of the hills. They don’t know that climate change is affecting the whole world. We’ve caused so much damage ourselves, with deforestation and pollution.”
Katerine Rosillo Quispe, Ministry of Health employee in charge of Health Center 1 in La Huaquilla (Morropón, Piura). “We’ve got high numbers of dengue transmitting agents in the region, which hadn’t been seen before. Those dengue mosquitoes are new for us. In La Huaquilla, the whole population is exposed: children, adults, the elderly. Climate change greatly affects health, especially as other types of pathologies appear, such as diarrhea, respiratory infections, but above all, the dengue mosquito.”
]]>I flew into Mogadishu in a plane full with nine tons of Oxfam aid. We took blankets, mosquito nets, medical supplies, and plastic sheets for families to build temporary shelters. We also took 3,500 buckets: Many of the families who have fled the fighting have lost everything they had, so they can use the buckets to carry clean water and store milk for their children.
At Mogadishu airport, I was met by some of our local Somali partners who quickly unloaded the aid for distribution. We carry out all of our work in the country through partners like them.
People are still fleeing the capital. Every day more buses, vans, and donkey carts carry families out of the city along a road called the Afgooye corridor. In the past few weeks, tens of thousands of people have fled down this road to escape the violence. They are settling in camps nearby, where about 400,000 people have taken refuge in the past two years.
The living conditions in the camps in Afgooye are some of the worst I have ever seen. Families are sheltering in tiny huts, pieced together from plastic bags and sticks. When the rains come, the huts are washed away. Oxfam is about to provide 10,000 new shelters, which will improve the lives of about 70,000 people.
The most urgent need is for shelter, but people also desperately need clean water, food, and medicine. The fighting has had an enormous impact on children's health. One doctor told me that there is so much gunpowder in the air in Mogadishu at the moment that it is making children sick.
When people leave the city and arrive in camps—which are so basic and overcrowded—diseases can quickly spread, and there are few health services. I saw young children lying on the floor of the shelters, too ill to move. Many children are suffering from diarrhea and cholera. Oxfam has helped set up an oral rehydration treatment center where mothers can bring their children for help. Oxfam has also distributed mosquito nets to mothers to help them protect their children from the spread of malaria.
To help address the critical need for water, Oxfam recently expanded its water system—which features large, circular holding tanks—to reach an additional 78,000 people. In total, we now provide water to more than 200,000 people in Afgooye—and we hope to increase the supply in the coming months. Despite these efforts, the need for water remains huge. People line up for hours to get clean water.
But it was the terrible condition of people's shelters that struck me most.
"Our biggest problem is shelter," Halima Abdi, a mother of six children, told me. "If people see this house and the conditions that we live in they will be shocked. It is raining heavily during the nights. Without shelter it is a disaster for us. My children are sick and I'm worried what will happen to them. They don't have enough water or food either.'"
]]>My gift, according my father, is that while most people look at a 15-hour flight as torture, I look at is a time to get some rest. And he is right. My flight went by in a flash. I got some reading done, some work done, and slept the rest of the way curled up in my seat with my neck pillow and noise-cancelling earphones (best birthday gift ever).
My first hours in Zimbabwe were filled with contradiction. As I walked out of the airport in Harare I was greeted by clean, cool evening air. I was then welcomed by Oxfam's humanitarian program coordinator, Ransam, with a hug and a joke. But as we drove to my hotel the empty streets were shocking. It was only 10 pm, but there were almost no other cars on the road and very few people walking. We pulled into the hotel and as we walked up to reception the crickets were singing. I could tell, even in the dark, how beautiful the landscape was. But as a sign of the times in Zimbabwe, when I checked in I learned the hotel wanted me to pay cash—in advance—for my room and it preferred US dollars or Euros.
After checking in, I met up with Lyndsay, Oxfam's public figures liaison. She worked to put this trip together and I could tell she wanted it to go well. She has a lot of respect for Emile after their trip to the Congo last year. He gets it, she said, and really wants to learn. As for me, I couldn't wait to meet him and made her knock on his door at 10 p.m. to introduce us. He was tired but cheerful and very excited about the trip. We kept the meeting short: tomorrow would be the car ride to the rural area and we could get acquainted then.
I am always so tired at the end of the day in Mudzi, a region in the northeast part of the country where Oxfam has been working on the cholera outbreak. After a two-hour car ride from Harare we arrived at the Pumpkin Hotel—the only hotel in this region. We settled in (Emile got the suite with the waterbed, and I got the one next door) and had some lunch: Eggs and sadza—a finely ground cornmeal boiled in water.
After lunch, we headed out to look at a bore hole—a narrow well drilled deep into the ground. Mudzi has hundreds of them. They're the source of drinking water for many people in this rural region. This one was a half-hour-drive away on a bumpy, dry road—and when we arrived, we found hundreds of community members waiting for us.
Sitting in two large groups, they had prepared a speech and gifts: beautiful hand-crafted baskets and several large bags of fresh peanuts tied in large burlap bags with "product of USA" stamped on their sides. These bags had been recycled from earlier food distributions. The villagers wanted to show their gratitude for the work Oxfam and our local partner, Single Parents Widow(er)s Support Network, or SPWSN, had done together: teaching communities about hygiene , providing them with basic goods like soap, and repairing their bore holes.
Emile confessed to me that he thought the word was "boar" hole. And why not? if you were not a water engineer or public health person or someone dependent on these holes for water, how would you know what they were? It made me realize how little the developed world knows or understands about those who still fetch water by hand and don't have access to flushing toilets—or even pit latrines.
Back at the meeting, Emile addressed the village, thanking them for their hospitality and acknowledging their strength as a people and as a community. He was nervous and I could tell he had really thought through what he wanted to tell his hosts.
That is why this trip is so important: To get the word out. Yes, the number of cases of cholera might be less each week, but what about next year? How do we stop an outbreak from happening again? This year in this village this outbreak left 25 orphans. This is a staggering number of children who have lost their stability—all because they and their families could not access clean water.
As we drove back to the Pumpkin Hotel, I thought again, with amazement, about how so much devastation can happen in such a beautiful setting, and how the people can keep going with such optimism and positive attitudes. I realized it had been an important day for Emile, too: He was beginning to understand the context of people's lives, how they cope, and the importance of supporting them when their options run out.
We spent another long and dusty day in the field. Today we watched as nearly 2,000 people gathered to learn about cholera. They sang, laughed, and watched plays all about a deadly bacterial disease that can kill a person in a matter of days with diarrhea and vomiting. We listened to health promoters from Oxfam and SPWSN as they talked and sang about feces, and watched as they faked illness and dying—all to teach the audience about cholera.
Emile was amazed at the teams' drama and acting capabilities and at the community's ability to laugh about something so devastating. My favorite part was the singing—so lyrical and powerful. I found myself singing along (not nearly as well, of course) and envious that they could make such beautiful music with nothing but their voices.
We spent the second half of the afternoon driving to a cholera treatment center. The number of cases had finally started to wane but it was hard to know if it was just because the rains had stopped or if all our hard work was paying off. I am sure it was a combination of both—but we will know for sure next year when the rains come again. That is why we are going to continue our work after the outbreak is over: We'll introduce clean water at the level of the household using sand filters. We are going to try and break the cycle of yearly diarrheal outbreaks—lofty goal, but worth shooting for.
The day started out with a 9 a.m. meeting at the local hospital and a report on new cases. Yesterday, the cholera early warning surveillance system Oxfam put in place with SPWSN detected new cases. For the past several weeks there were only sporadic cases, but yesterday, following a funeral the day before , 19 cases were detected. It was amazing to be there and see our early warning system working—and to learn about the response. All 19 patients were brought to the health center and the response featured bore hole repairs, the delivery of supplies to the health center (including a salt and sugar solution for oral rehydration, disinfectant, tents, and beds) and the launch of a public health education campaign for the affected community. Amazing! By getting the patients to the health center so fast the hope was to avoid more deaths—and more funerals.
As we were listening to the report, I looked over at Emile, who was absorbing all the details and asking thoughtful questions. I was glad he was there so he could return home and share what he had learned about the seriousness of the situation in a way other people might be able to understand.
Oxfam had jumped in to supply ever-scarce fuel and supplies for the response. While everyone hopes this epidemic is winding down, no one was surprised that that there were still cases erupting. The infrastructure in Zimbabwe is so broken down it will take years to build a safe water system for all to use. Our biosand filters—a water treatment method that is used in the household—will provide more long-term protection for families and hopefully prevent diarrhea for them in the coming year.
The filters arrived the other day—thanks to UPS, who shipped them from the US for free—and we swung by the warehouse to look at them: large blue buckets with very little tubing. Their simplicity is amazing. I had drawn a picture for Emile the night before and explained how they worked. When he saw them in person, his eyes lit up: it all came together. I was happy to see someone who was just as excited as me about these blue plastic buckets and their potential to save lives.
We spent the night talking about the trip—all the things we saw and experienced. I pulled out my computer and we had a discussion, using a power point lecture, about the role of evidence in humanitarian response: How do you set up an early warning surveillance? Why is it so complicated? Why is it so important? I could see that Emile was synthesizing all the things he had learned over the past week, putting them together and grasping the complexities that make up Zimbabwe.
I am looking forward to reading what he writes. I am sure I will learn something from him and can't wait.
]]>Working closely with Sri Lankan partner organizations, Oxfam is providing primarily clean water, sanitation and public health assistance to families arriving in government-controlled areas, as well as cooked food and other essential relief items. Plans are in place to assist up to 60,000 more.
However, over 50,000 civilians may still remain trapped in a small, heavily crowded rebel-held enclave in northeast Sri Lanka, where humanitarian conditions are now catastrophic. Hundreds have been killed or injured in the past few days. Children are dying of untreated wounds as well as a lack of clean water and unhygienic conditions.
Both sides must pause in their battle to allow trapped civilians to leave safely and for humanitarian workers to reach the sick and wounded, said Oxfam.
"For each day that passes without at least pause in fighting, civilian families are paying with their lives," said Joan Summers, Oxfam Country Director in Sri Lanka.
Oxfam calls on both parties to the conflict to fulfill their obligations under international humanitarian law by permitting safe civilian evacuations and humanitarian access, respecting the lives and neutrality of all non-combatants.
Oxfam urges the Sri Lankan government to fulfill its obligations under national laws and international humanitarian law by ensuring the humanitarian relief effort is increased rapidly and significantly, allowing both national and international aid workers safe and unhindered access to affected families.
Oxfam also urges the international community to help affected civilians by pressing for a humanitarian pause in the fighting by and supporting efforts to provide the 250-300,000 Sri Lankans displaced by the war with both adequate emergency relief and longer term recovery assistance.
Oxfam has been working closely with local partners to provide safe drinking water, sanitation facilities such as latrines and hygiene kits, emergency shelter, and other essential items to thousands of displaced civilians. Our relief activities have been targeting the most vulnerable civilians such as women and children.
]]>Trees provide shelter from the blazing sun, traditional medicines, building materials, firewood, and food. So, it was fitting that a group of 30 women chose to gather beneath a tree in Welgeval village, South Africa, in 2002 and decided they had to take action.
"When we became aware of the deadly effect of HIV and AIDS in our community, we realized we had to do something," says Itumeleng Modimola. "It was not easy when we started; people were not used to the idea of caregivers and because of the stigma around HIV and AIDS, people would pretend they were not at home when we came to visit."
But the women persevered, and in 2006 their efforts were rewarded when the local traditional council offered them land and a building as a base for their organization. Today Modimola is the manager of Pholo Modi Wa Sechaba, a thriving community-based HIV/AIDS project in Welgeval in South Africa's North West Province. The organization—whose name means "health is the root of the nation" in the local language, Setswana—is dedicated to overcoming the devastating impact of HIV/AIDS in the local community.
South Africa has the world's largest number of HIV infections—an estimated 5.5 million of the country's 48 million people live with HIV. Women are hardest hit. In 2005, one in three women in South Africa aged 30–34 were living with HIV.
Every day the Pholo Modi Wa Sechaba site is alive with activity as children from AIDS-affected families crowd into the small day care room and spill out onto the dusty playground. In the afternoon, they are joined by their elder siblings and other schoolchildren for a healthy meal and supervised afterschool activities where they learn life skills—such as how to prevent HIV/AIDS. The once-barren garden is now green with tidy rows of vegetables. The foundation and walls of a new community center are taking shape nearby, the material and labor provided by members of the organization.
Pholo Modi Wa Sechaba runs a support group for people living with HIV/AIDS and has 20 caregivers who provide home-based care services to almost 300 families in four villages. It is a member of the AIDS Consortium, a South African national umbrella organization that helps community groups struggling to provide services for people living with HIV/AIDS. A grant from Oxfam America is helping the AIDS Consortium extend its reach to the North West Province, where Pholo Modi Wa Sechaba and some 100 other community organizations will get additional training to raise and manage money, design and carry out better community programs, and train their staff.
With the AIDS Consortium's help and growing awareness about HIV/AIDS in the community, Modimola says her organization is making progress.
"The situation has changed for the better; people are more aware of HIV and take informed decisions to protect themselves and their families. But we still have a long way to go. Government and other partners need to increase access to anti-retroviral [ARV] treatment and health services in our area," says Modimola. "While we are doing the best we can with limited resources," she admits, "training and retaining caregivers...is an ongoing challenge."
Modimola has built strong partnerships with the local clinic, tribal authorities, and government departments. Pholo Modi Wa Sechaba receives an annual grant from the provincial government to provide food to 60 families and a monthly stipend for the caregivers. Once this grant is depleted, however, Modimola predicts many caregivers will be forced to quit; they cannot afford to work without pay.
Local caregivers provide a vital service to the community and fill the gaps in the national health care system. Often they are the first to identify members of the community who may have become infected with the HIV virus and the last line of care for those with AIDS. While ARV treatment and hospital care is the responsibility of the state, there are not enough doctors, nurses, and hospitals to cope with the spread of the disease.
Like the tree beneath which Pholo Modi Wa Sechaba was founded, Modimola and local caregivers serve as symbols in their community. Their steady commitment in the face of challenges has given strength to many.
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