LIBERIA: Health facilities in disarray - malnutrition, unsanitary conditions stifling the young

What will be a country's end when the youth, its greatest hope, are left to fend for themselves, unattended and neglected (both materially and spiritually)! Let this be a sobering lesson to us all.
(Excerpt:)

Liberia's population is estimated at 3.5 million. "Over three million Liberians have no access to safe sanitation facilities," says Muyatwa Sitali, communications officer with Oxfam UK...

A relevant quotation from a sacred text states in this regard:

O YE RICH ONES ON EARTH!
The poor in your midst are My trust; guard ye My trust, and be not intent only on your own ease.
- Hidden Words of Bahá'u'lláh

WATER: Poor Sanitation Killing Liberia's Young
By Rebecca Murray

This is 7-month-old Inga Phillips's third visit to the Slipway health centre. The clinic's is unable to care for severely malnourished children with diarrhoea and dehydration. Credit: Rebecca Murray/IPS

MONROVIA and BOPOLU, Liberia, Nov 23 (IPS) - Nineteen-year-old Beauty Phillips clutches her emaciated baby tightly to her chest. At seven months, Inga suffers from malnutrition.

On this chaotic Friday morning in the Slipway Clinic registration room, over one hundred mothers, their crying infants wrapped in traditional lappa cloth, wait on narrow wooden benches for hours to be seen.

"She is always sickly," explains Phillips about Inga's constant vomiting and diarrhoea. "I get my water from the community hand pump, and for my toilet I'm going to the waterside or common toilet. This is why I think my daughter is getting sick."

One out of nine Liberian children die before their fifth birthday, or 110 out of every 1,000 live births, according to the Liberia Demographic Health Survey in 2007. Thirty-nine percent of children are stunted or short for their age.

Malaria, diarrhoea and respiratory illnesses like pneumonia are the leading causes of death here.

The crowded slum of Slipway lies along the polluted, marshy shoreline of the Mensurado River, near the heart of downtown Monrovia.

Although Liberia Water and Sewer are trying to reconnect pipes destroyed during the decades-long civil war, most residents cannot afford to buy or access the water.

Private septic tanks overflow regularly, and burning trash lies in heaps among the sewage surrounding the marshy pit latrines. 

Liberia's population is estimated at 3.5 million. "Over three million Liberians have no access to safe sanitation facilities," says Muyatwa Sitali, communications officer with Oxfam UK, which spearheads Liberia's water, sanitation and hygiene consortium.

"Most people have no choice but to defecate in the open, where both their lives and dignity are at risk," Sitali explains.

President Ellen Johnson Sirleaf has implemented a free nationwide public health care policy for children under five years old, a crucial step towards her promise to provide universal health care for all Liberians.

Still reeling from the decades-long civil war, Liberia's 2008 Poverty Reduction Strategy estimates almost two-thirds of its citizens live below the poverty line.

This is Inga's third visit to the tiny government health centre in Slipway, built to serve 15,000 community members. She will most likely be given an oral rehydration salt tablet (ORS) and spoon-fed protein out of a plastic sachet in the feeding room out back.

However, the clinic is unable to care for severely malnourished children with diarrhoea and dehydration. These cases are referred to government hospitals, and hooked up to feeding tubes and IV fluids to replenish electrolytes.

This year, the World Health Organisation (WHO) renewed calls for supplementary zinc treatments for diarrhoea for up to two weeks, which "decreases the duration and severity of the episode and the likelihood of subsequent infections in the 2–3 months following treatment."

WHO adds, "Low osmolarity ORS and zinc are inexpensive, safe and easy to use and have the potential to dramatically lower diarrhoea morbidity and mortality."   While low osmolarity - a formula with a lower concentration of salt - ORS supplies are available in Liberia, zinc treatments are yet to be formally introduced. Dr. Vivian Kpeh, who runs the Slipway clinic with the help of international health charity, Merlin, is working with the Ministry of Health to address this issue.

"If we included zinc in our guidelines, especially with children under five years of age, it could get good results instead of referring the children for other treatment," says Kpeh. "Maybe severe dehydration will not happen, because we have stopped the diarrhoea."

A five-hour drive inland from the capital, along muddy roads that are almost impassable during rainy season, the young patients at the Chief Jallah Lone government hospital in the rural town of Bopolu share the same deadly illnesses as their urban counterparts.

Esther Floumo, a 21-year-old mother and farmer whose husband was killed during the civil war, is here with her third child, one-year-old Caroline.

Attached to an IV drip, Caroline is suffering from severe malnutrition, diarrhoea, vomiting and dehydration after being fed a steady diet of mashed up burnt rice, mixed with untreated well water.

Caroline is slowly getting better; when she first arrived at the hospital one week before, she had to be force fed through a tube.

"There is very poor sanitation here," says Bennie Clarke, the RN on night duty. "Most people do not have toilets in their homes; they use the river here or pit latrines. People are washing their clothes, taking water to cook from the river."

"We treat the patients like Caroline with ORS, and if it's severe, with IV fluid," he says.

"We used to have zinc, but we are out of it," he sighs. "Let's say three or four months ago we had it here. Christian Aid was supplying it to us. They are just helping, sending supplies."

"ORS treatment with zinc – as a policy it is accepted in Liberia," explains Dr. Bernice Dahn, chief medical officer at the Ministry of Health.

"It's just a matter of getting the zinc treatment.  It means that we at the MOH have not focussed on procuring this. Currently we have a large quantity of ORS in country, that's what we are using for now.

"But we don't have zinc right now. It's a matter of being a part of our essential drug list. We are doing a revision of the essential drug list, and hopefully we will have it next year."

"Access to healthcare in general is so low in Liberia, its about 40-41 percent," says Dr. Musu Duworko, WHO's Family Health and Population Advisor in Liberia.

"We have a whole problem with system distribution. (Supplies) could be at the depot here in Monrovia or at the county depot, and not available at the county facility.  The closer clinics are accessible, but there are some where even the motorcycles cannot go."

With the lack of access, capacity and medicine, twinned with the country's abysmal sanitation conditions, the Ministry of Health has its work cut out for it.     

"Much has to be done to help Liberia get close to meeting the Millennium Development Goals on sanitation," says Oxfam UK's Sitali. "Without concerted effort that will be a far-fetched dream and lives will continue to be at risk."

Source: http://www.ipsnews.net/news.asp?idnews=49382

S. Korea as model on development

This OECD statement would reflect the fundamental principle of the interdependence of all nations, and that a nation's priority should be, first, to get on its own feet (often with the help of other, more advanced nations), and second, to fulfil its duty to assist the less advanced nations. As it has been said: "For unto whomsoever much is given, of him shall be much required."(1)

(Excerpt:)

Korea's story demonstrates the changing face of international development assistance. "Making good use of this assistance," said Oh Joon, "we worked hard to overcome poverty and achieve development. For many Koreans, including myself, it happened in our own lifetime. As a child, I went to an elementary school where we drank milk and ate corn bread that came in containers marked 'United Nations' or 'US Government'. A few months ago, I visited a kindergarten in Mongolia where children were studying with textbooks marked as gifts from the Republic of Korea."

"This is happening in the middle of an economic crisis," remarked OECD Secretary-General Angel Gurría, "when many countries are holding back, Korea is signalling the way forward, as it has done in many areas."

"OECD Development Assistance Committee (DAC) welcomes Korean membership," 26 November 2009 © OECD
http://www.oecd.org/document
/50/0,3343,en_2649_33721_44141618_1_1_1_1,00.html
Note: (1) From a letter written on behalf of Shoghi Effendi
http://bahai-library.com/compilations/living.life.html

The experience of eloquent speech - here on issues of governance in E.U.

It's rare to find such outstanding diction and expression as is wielded here - by former President of Latvia Ms. Vike-Freiberga.

(Excerpt:)

...Europe. Now, for the first time, it has a common voice on the international stage. It must use it well and use it sparingly. That means worrying less about detail and concentrating on the big ...issues — a little less time worrying about the curvature of bananas and a little more devotion to energy security and the environment.

"Be anxiously concerned with the needs of the age ye live in, and centre your deliberations on its exigencies and requirements." - Bahá'u'lláh

November 21, 2009

Focus on the big issues, not the bananas

Open elections, greater democracy, energy and aid should head the list for Europe's new leaders

Vaira Vike-Freiberga

Yesterday was a good morning for Europe. Now, for the first time, it has a common voice on the international stage. It must use it well and use it sparingly. That means worrying less about detail and concentrating on the big issues — a little less time worrying about the curvature of bananas and a little more devotion to energy security and the environment.
It also means addressing valid concerns that the European Union's governing structures should be more democratic. Choosing Herman Van Rompuy as first President of the European Union and Baroness Ashton of Upholland as High Representative for Foreign and Security Policy long before the sea bass and wild mushrooms were discreetly placed on the dinner table on Thursday evening in Brussels hardly assuages those concerns.
Making the selection somewhat more transparent would no doubt have enhanced the EU's democratic credentials. There is no reason why all candidates could not declare themselves publicly beforehand. The citizens of the EU's 27 states would surely have felt more confident if they had heard candidates set out their vision on television.
It isn't difficult to communicate with the public, especially with the new technologies available to us. I was surprised by the volume of response that my candidacy received on the internet; it showed that it is wrong to say Europeans don't care who is appointed.

Ultimately, I suspect, the president might be elected. In the future, it might be possible — indeed exciting — for 500 million people to elect their president directly. It is a goal worth aiming for if we are to carry the confidence of Europe's citizens.
The union was founded to cement Europe in peace. We risk losing that if people feel alienated, have no interest in voting for their European parliamentarians and don't care what they are doing. It hardly needs a historian to point out the dangers of such sentiments becoming commonplace in a recession.
Europe is as democratic as it can be for now. It is quite a challenge to stitch together this varied group of countries, different in size, weight and economic clout, with disparate pasts and levels of internal democracy. While Western European countries have taken decades or even centuries to hone their democracies, the countries that emerged from communism are only now evolving theirs. To get this far has been a huge achievement.
We must continue to be courageous. In my lifetime I have experienced the horror of war and totalitarian rule. Europe can never again have a political system imposed on it from above. Nor can powerful countries impress their will on smaller ones. There needs to be equality at some level regardless of disparities in size. This happens in federations such as Canada and the United States. Prince Edward Island (population, 140,000) is not the same as Ontario (population 13 million); New Hampshire (1.3 million) is not the same as California (36 million).
That is not to say that Europe is ready to become a federation. In 50 years' time, perhaps, but it is not something that can be imposed. If it is to evolve, it must happen slowly and openly.
There has been much debate about whether the president of the European Council should be a consensus builder or a strong personality. One would hope to find people with both qualities. The idea that a conciliatory politician must necessarily be a boring personality is nonsense. This is a presidential position. Europe's leaders should be exciting, inspiring and able to give citizens confidence in their future.
The time for faceless bureaucracy and high-table deal-making is over. European citizens expect their representatives to be visible and to talk to them. We hope to see the new leaders on television, explaining what they are doing to the citizens of all member nations of the EU.
In ten years' time I hope Europe will be speaking with one voice on the crucial issues of the day where common interests transcend individual countries' needs. A common energy policy with respect to the sourcing and distribution of gas and oil, for example, should exist at a European level. As a big customer Europe can get a better price from a powerful supplier such as Russia than separate countries trying to get a deal piece by piece.
In terms of foreign policy, Europe spends three times as much on aid to developing countries as the US, but makes less of an impact because it is done in a scattered way. Better value would be achieved through stronger co-ordination of European efforts.
Now that the EU is working within the framework of the Lisbon treaty it must avoid the risk of getting stuck in technical detail. The larger it grows, the more it must rise above the minutiae of administration and put more oil on its wheels. Maybe it should do fewer jobs, but do them really well.
The European Union's founding fathers knew that it had to be built brick by brick if it was to be accepted. We are an extraordinary continent of diverse sovereign states collaborating more and more closely, cautiously delegating elements of our sovereignty into a central pot.
Europe has come a long way. To get where we are today took courage and grit. The worst is behind us. Though we will still be hit by crises and challenges, we have a structure for peace and stability. Let's use it well. Go to it, Europe.
Vaira Vike-Freiberga was President of Latvia 1999-2007. She is vice-chairman of the Reflection group on the long-term future of the European Union

Source: http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article6926160.ece

Coherent lines of action key to solving global problems

I find it remarkable to witness this new development toward a /coherent/ approach to solving the world's manifold problems --
(Excerpt:)

"There cannot be food security without climate security"... Mr Ban's comments signal how leaders are grappling with the need to respond coherently – and simultaneously – to energy, food and climate challenges. "The three are key for political security and stability," said Alexander Muller...

UN links climate with hunger

By Javier Blas in Rome
Published: November 16 2009

The world cannot achieve food security without first tackling global warming, the United Nations secretary-general said on Monday, warning that failure at next month's international climate change negotiations would result in a rise in hunger.
The warning by Ban Ki-Moon at the start of a three-day UN world food summit in Rome came one day after Barack Obama, US president, backed European and UN views that the Copenhagen summit would not produce a legally-binding agreement to tackle global warming.

A woman stands on top of maize sent by Oxfam to Kenya where the crop failed because of a lack of rain

EDITOR'S CHOICE

"There cannot be food security without climate security," Mr Ban said. "Today's event is critical," he said, referring to the food summit, "so is Copenhagen."
Mr Ban's comments signal how leaders are grappling with the need to respond coherently – and simultaneously – to energy, food and climate challenges. "The three are key for political security and stability," said Alexander Muller, assistant director-general at the UN's Food and Agriculture Organisation.
Jim Fitzpatrick, UK minister for food, farming and environment, told the Financial Times that food and climate security were "two sides of the same coin".
The summit was convened in response to last year's food crisis, which saw record prices for staples such as wheat and rice, food riots in about 30 countries and pushed the number of chronically hungry people above 1bn for the first time.
"Millions of families have being pushed into poverty," Mr Ban said. "Over the past year and a half, food insecurity led to political instability in more than 30 countries."
The problems are just a prelude of worse to come unless countries take rapid action to improve food security and tackle global warming, according to the UN chief. "By 2050, we will need to grow 70 per cent more food," Mr Ban said. "But weather is becoming more extreme and unpredictable The food crisis of today is a wake-up call for tomorrow."
He stressed that water was rapidly becoming a scarce commodity.
The International Food and Policy Research Institute, a government-funded think-tank based in Washington, estimates that if countries do not tackle climate change, child malnutrition will rise by 20 per cent by 2050.
"Climate change will eliminate much of the improvement in child malnourishment levels that would occur with no climate change," the institute said in a recent report on food security and climate.
"The accelerating pace of climate change, combined with global population and income growth, threatens food security everywhere," the report added.
The summit's declaration, approved yesterday, reflects that sentiment. "Climate change poses additional severe risk to food security and the agriculture sector," it said. But the declaration was short on setting targets and timeframes, and was watered down from an early draft, non-governmental organisations cautioned. Countries committed to "a crucial, decisive shift towards increased" investment in agriculture but without setting any target or timeframe.
Even so, diplomats said it was a strong change after almost three decades of neglect during which time the share of official development aid devoted to agriculture plunged; by 2006 it had sunk to 3.8 per cent, down from 17 per cent in 1980. In the past few months, aid for long-term investment in agriculture has started to rise.
The declaration is, in effect, an endorsement of the the strategy adopted by the world's most industrialised nations at the Group of Eight's summit in L'Aquila, Italy, where they promised a shift towards long-term investment in agriculture from a previous focus on food aid and promised $20bn over three years

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Source: http://www.ft.com/cms/s/0/99bc96e0-d293-11de-af63-00144feabdc0.html?nclick_check=1

The legacy and promise of 1989: fall of the Berlin Wall

A historian's candid analysis of the significance and possible implications of the Wall's fall. From the New York Times.
(Excerpts:)

...it seems the lessons of the 20 century learned in Europe are bound to be forgotten.
Namely, that there is no such thing as a permanent rivalry among nations; that neighbors, whatever the obstacles, can be partners; that zero-sum relationships can be the exception, not the norm; that peace is forged both from the top down and from the bottom up; and that global issues — like the environment, crime, trade — are best handled in a regional framework with institutions that promote good neighborliness while at the same time setting higher standards for others to emulate. ...
It may have taken a half-century of immense destruction at the hands of Europeans to transform the above into axioms that few challenge today. But, again, this is mainly the case in Europe and America.
The West, as it was once proudly called, has come to seem more and more like an island rather than a beacon. Along its peripheries, even just next door, are frightening echoes of the late 19th and early 20th centuries.
The response of most Europeans and Americans to them has been, sadly, one of limited liability. Most spent the 1990s cultivating their own gardens; so far, much of the following decade has been spent building new walls...

Op-Ed Contributor

The False Promise of 1989

By KENNETH WEISBRODE

Published: November 6, 2009

FLORENCE — Twenty years is not a very long time in history but the fall of the Berlin Wall already seems like another era. The euphoria, confidence and excitement that accompanied that event were overtaken in short order by cynicism, fear and doubt resulting, according to some quarters at least, from American triumphalism.

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Ellen Weinstein

Despite the new leaf that Barack Obama's election appears to have turned over, it will be a long time before the world hears the United States speaking of itself again as the "indispensable nation" or the American way of life as the harbinger of the end of history.
This has also been called the beginning a "new" era of globalization. But 1989 was mainly about Europe. Nobody should forget the tanks and bullets that appeared in Beijing that very same year.
In truth, 1989 represented a culmination more than a new departure. It marked the final end of a long European civil war, the third since 1914. To some it was the apotheosis of a very long campaign for continental unity, George H.W. Bush's "Europe, whole and free."
To many Americans, Bush's statement rang true. Not only because of their own history of e pluribus unum, but also because the European project — and America's critical role in it — had much to do with Americans' sense of themselves as transplanted Europeans, eager to prove to the so-called Old World that it could master its diplomatic ways.
But in the end, both Americans and Europeans realized there was much they could teach one another.
Nothing like this relationship exists elsewhere in the world, least of all in its most contentious regions. Like the once great powers of Europe, the United States has long played a powerful role in the Middle East and Northeast Asia, going back to the days of the Barbary Pirates and Commodore Perry's Black Ships, but in an itinerant and episodic fashion.
Asian civilization does not carry the same cultural significance for most Americans that European civilization once did. An "Asia whole and free" is not a phrase we expect to hear any time soon from an American president.
This is a terrible pity because it seems the lessons of the 20 century learned in Europe are bound to be forgotten.
Namely, that there is no such thing as a permanent rivalry among nations; that neighbors, whatever the obstacles, can be partners; that zero-sum relationships can be the exception, not the norm; that peace is forged both from the top down and from the bottom up; and that global issues — like the environment, crime, trade — are best handled in a regional framework with institutions that promote good neighborliness while at the same time setting higher standards for others to emulate.
For Americans, in particular, a good deal of Europe's success came down to trusting Europeans and letting them take much of the credit.
It may have taken a half-century of immense destruction at the hands of Europeans to transform the above into axioms that few challenge today. But, again, this is mainly the case in Europe and America.
The West, as it was once proudly called, has come to seem more and more like an island rather than a beacon. Along its peripheries, even just next door, are frightening echoes of the late 19th and early 20th centuries.
The response of most Europeans and Americans to them has been, sadly, one of limited liability. Most spent the 1990s cultivating their own gardens; so far, much of the following decade has been spent building new walls or in being consumed by the passions of the moment.
The world of 2009 is still much freer, more open and more peaceful than the one of a generation ago. But how much longer can this last?
As the zeitgeist of 1989 recedes into distant memory, we should do all we can to keep alive the promise it once represented.

Kenneth Weisbrode is a historian at the European University Institute and author of "The Atlantic Century."

Source: http://www.nytimes.com/2009/11/07/opinion/07iht-edweisbrode.html?nl=todaysheadlines&emc=a24