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UNITED NATIONS, Nov 8 2011 (IPS) – More than 5,000 Haitian cholera victims are seeking compensation, action and an apology from the U.N. and the United Nations Stabilisation Mission in Haiti (MINUSTAH) for the ongoing epidemic that has killed more than 6,600 Haitians and sickened more than 476,000 since October 2010.

A young child is seen crossing one of the canals of the Artibonite River, identified as the source of the cholera outbreak. Credit: UN Photo/Sophia Paris

Brian Concannon, who is based in Boston and is the director at the , helped organise a petition from Haitian victims and relatives of victims, before filing the claim to the U.N. simultaneously with a claim to its peacekeeping mission in Haiti, last Thursday.

The victims petition alleges that the U.N. and MINUSTAH are liable for hundreds of millions of dollars for failing to screen and treat peacekeeping soldiers arriving from Southeast Asian countries experiencing cholera epidemics, dumping untreated waste from a U.N. base directly into Haiti s longest and most important river, the Artibonite, and failing to respond adequately to the epidemic.

Concannon and his team say in the petition that reports compiled by the United States-based Centres for Disease Control and Prevention, the Harvard Cholera Group, Dr. Renaud Piarroux, a French epidemiologist who has spent his career studying cholera, the Wellcome Trust Sanger Institute in Cambridge, England and the International Vaccine Institute in Seoul, Korea found that the Vibrio cholerae bacteria was introduced to Haitian waters by MINUSTAH personnel deployed to Haiti from Nepal.

Prior to the peacekeepers arrival, Haiti had not reported a single case of cholera for more than 50 years.

Awaiting a U.N. Response
While Concannon and Kurzban are waiting for a response from the U.N., MINUSTAH has requested a meeting to discuss their petition, the date is yet to be scheduled.
“As far as we know, this hasn’t been done before, so it all depends on the U.N.’s response about how they will deal with it,” Concannon told IPS, in regards to how long they will wait until they pursue further action with a national court.
“If they come back to us and say they are willing to talk about it and follow a fair formula, then we will be happy to wait. This is the worst cholera epidemic in the world and some experts expect the death toll to reach 20,000, unless there is swift action. We want the U.N. to bring in medical treatment straight away.”
Kurzban agreed and said their goal was to work with the U.N. to resolve the issue before it goes too far.
Ever since the cholera outbreak, we have had people coming to us asking us what to do, Concannon told IPS.

We originally thought the U.N. would take on responsibility as we didn t originally see this as a legal case at first. But we could no longer dismiss the people after no action was taken.

Vibrio cholera

Cholera, a waterborne illness that causes diarrhoea and vomiting, is a result of an infection with a pathogenic strain of the Vibrio cholerae bacteria. If it is not treated immediately, cholera can kill adults and children in a matter of hours. According to the World Health Organisation, up to 80 percent of cases can be treated successfully with oral rehydration salts.

The virus, which is endemic in Nepal, reportedly had a surge of cases in the Kathmandu Valley in August and September 2010. With peacekeeping troops from Nepal deployed to Haiti every six months, a new contingent arrived at the Mirebalais camp on Oct. 9, 12 and 16, 2010. These troops had spent three months training in the Kathmandu Valley.

According to the petition, Nepalese soldiers deployed as part of the MINUSTAH mission in Haiti were not tested for cholera prior to entering Haiti.

Ira Kurzban, an attorney at Kurzban, Kurzban, Weinger, Tetzeil Pratt P.A. in Florida who is involved with the petition, said at a press conference at the U.N. Tuesday that a number of cholera carriers do not exhibit active symptoms which left room for error, as the U.N. only conducted tests on individuals who showed active symptoms.

According to the New York Times, the Cuban mission in Haiti has asked the U.S. to help finance a 30-million-dollar major hospital for specialists as part of a broader effort to remake the health system. Since the outbreak of cholera, the Cuban mission has treated more than 76,000 cases of the disease, with just 272 fatalities.

The chief of the Cuban medical mission, Dr. Lorenzo Somarriba, said they send people to the homes of the victims to educate them on the disease and provide them with tabs to clean the water purification tablets that have been critical in a country where treated water is rare.

In a statement released by the spokesman for the U.S. Embassy, Jon Piechowski, he said while recovery in Haiti was a broad international effort, particularly to advance the health sector support to Haiti, they had not entered into any agreements with the Cubans.

Compensation

Concannon spoke of a victim who was one of the first to die from cholera on Oct. 22, 2010. The petitioner had been working in a rice field and drank from the canal that irrigates the field. Afterwards, he alerted his family about a boiling water sensation in his stomach and began to vomit before spending the night at home in excruciating pain.

The next morning he went to hospital, and in the afternoon he died. He left his wife and 12 children behind.

The petitioners, who hail from Mirebalais, St. Marc, Hinche and Port- au-Prince regions of Haiti, make up more than 5,000 individuals filing a claim including victims, parents of children and relatives of victims who have died.

They are requesting three things 50,000 dollars per person or 100,000 dollars per person who died, an adequate nationwide response from the U.N. that includes better sanitation and clean water facilities to help prevent further cases, and a public apology.

Our clients are challenging the institution to act consistently with what it knows to be true and just, said Concannon.

Response

Secretary-General Ban Ki-moon appointed an independent panel of scientific experts to investigate the source of cholera in Haiti on Jan. 7, with a report released in May.

While the experts concluded that, the evidence overwhelmingly supports the conclusion that the source of the Haiti cholera outbreak was due to contamination of the Meille tributary of the Artibonite River, with a pathogen strain of current south Asian type Vibrio cholera as a result of human activity , they didn t attribute the outbreak to an individual.

At a press conference Tuesday, the secretary-general s spokesperson said the U.N. peacekeeping mission as well as humanitarian development agencies were working with Haitian authorities to do everything possible to bring the spread of cholera under control.

He confirmed that the U.N. and MINUSTAH had received the letter and it would be looked at by the relevant part of the peacekeeping department.

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The independent panel of experts concluded that the Haiti cholera outbreak was caused by the confluence of circumstances as described in the report and was not the fault of or deliberate action of a group or individual person, said the spokesperson addressing the U.N. s response to the petition.

The key focus for the U.N. has been since the outbreak and it remains the focus, to combat the outbreak and to help those who have suffered. That s what the U.N. will continue to do.

A MINUSTAH spokesperson emailed IPS and confirmed that the petition had been received and would follow the procedures to be transmitted.

She wrote, MINUSTAH keeps and will remain committed in supporting all the efforts undertaken to fight the epidemic and its impact, in support of the government.

Fabíola Ortiz

RIO DE JANEIRO, Dec 23 2011 (IPS) – The fall in world tobacco consumption, especially in industrialised nations, is a sign of the urgent need for producer countries like Brazil, China, India and the United States to offer their farmers alternatives to growing tobacco.

Graphic picture-based health warnings on cigarette packs can help prevent youngsters from starting to smoke. Credit: Kara Santos/IPS

Tobacco has been grown in Brazil for 120 years, and is important for the trade balance of this South American country.

Tobacco industry statistics for 2011 show that China is the world leader in tobacco production with 2.4 million tonnes, and Brazil is the runner-up, with 867,000 tonnes.

Some 200,000 small-scale family farms, located mainly in the south and northeast of the country, produce 95 percent of Brazil s tobacco.

President Dilma Rousseff signed a tobacco control law Dec. 15 which increases taxes on tobacco, sets minimum prices for cigarettes, bans smoking in all public spaces and enclosed workplaces, and forbids advertising at points of sale.

Brazil, with its 192 million people, may thus become the most populous country to declare itself smoke-free, said the U.S.-based Campaign for Tobacco-Free Kids.

Brazil is the largest country to have adopted an anti-tobacco law, activist Patricia Sosa, in charge of Latin American programmes for the , told IPS.

Every year, exposure to secondhand smoke causes over 600,000 premature deaths, and passive smokers who are exposed to it at home or at work have a 30 percent higher risk of developing lung cancer, she said.

The new law bans advertising on cigarette packs and only permits the display of products with health warning messages that cover at least 30 percent of the front of the packets. This regulation will come into effect Jan. 1, 2016.

Taxes on cigarettes were increased by 300 percent, which will raise the consumer price by 20 percent in 2012, and by 55 percent in three years time.

But in the view of the Brazilian civil society organisation Aliança de Controle do Tabagismo (ACT Alliance for the Control of Tobacco Use), the tobacco industry remains extremely lucrative.

Around 90 percent of the tobacco produced in Brazil is exported, and tobacco production in the country is fairly high, although the prevalence of smoking has declined over the last two decades, ACT deputy director Mônica Andreis told IPS.

The tobacco industry argues that the new measures will bring economic chaos to the country. But many family farmers who depend solely on this crop to survive are exposed to difficult labour conditions, and they get sick from having direct contact with tobacco leaf chemicals, she said.

Working on tobacco plantations creates health problems associated with intensive use of toxic agricultural chemicals, as well as green tobacco sickness (GTS), a form of nicotine poisoning caused by absorption of nicotine through the skin as a result of handling wet tobacco leaves.

Many of the tobacco farmers have already said they would prefer to diversify or switch crops, Andreis said.

The ministry of agricultural development announced that during 2011 it invested six million dollars in technical support and agricultural extension services for approximately 10,000 family farmers who wish to diversify away from growing tobacco.

The funds have been used principally for families in the seven tobacco-growing states: Alagoas, Sergipe, Bahia and Paraiba in the northeast, and Rio Grande do Sul, Santa Catarina and Paraná in the south.

In one year s time, the government plans to increase to 50,000 the number of families receiving aid from the National Programme to Support Product Diversification in Tobacco-Growing Areas, created in 2005.

According to the authorities, this programme is part of one of the country s largest inter-ministerial initiatives, created to meet the guidelines of the World Health Organisation (WHO) Framework Convention on Tobacco Control, which came into force in 2005 and was ratified by Brazil that same year.

The programme facilitates access by tobacco farmers to funding and technology with the aim of converting or diversifying from tobacco growing.

Sixty-five current projects to diversify away from tobacco cultivation on family farms include raising chickens or dairy cattle, fish farming, and fruit and vegetable production. Over the last six years, 14 million dollars have been spent on services for 80,000 tobacco-farming families.

According to a study published by the Association of Tobacco Growers of Southern Brazil, out of nearly 187,000 families who grow tobacco, 47,000 have no land of their own and work as sharecroppers. And 80 percent of the 140,000 farms are less than 20 hectares in size.

The WHO Framework Convention on Tobacco Control, the first international public health treaty, has 174 states party at present and guides the implementation of public policies for combating smoking, regarded by the WHO as a non-communicable global epidemic.

Although the number of smokers in Brazil has been dropping for the past 20 years, there are still nearly 25 million people aged over 15 who smoke, Andreis said.

The typical Brazilian smoker is male and aged between 45 and 64 this group accounts for nearly 22 percent of tobacco consumers. The majority of smokers are people living in rural areas, less educated and with the lowest family income per person, according to a survey by the Brazilian Institute of Geography and Statistics (IBGE) and the National Cancer Institute (INCA).

Among people who had received less than one year of education, or none, 41 percent started smoking before they were 15 years old; and the proportion of students who had tried cigarettes in 2009 was almost 25 percent, Andreis said.

Latin America has a for applying the Framework Convention on Tobacco Control. Ten countries have already adopted tough restrictions on advertising, publicity and sponsorship by tobacco companies. Five countries have imposed taxes of 70 percent or more on the price of cigarettes, and seven have introduced compulsory health warnings that cover at least 30 percent of the packs.

Uruguay was the first country in the region to enact tough anti-tobacco laws. In the small South American country, health warnings and graphic images cover 80 percent of cigarette packets.

While the Ethiopian government boasts that the country can soon be categorised as middle-income, economic analysts are more cautious saying that the country has made “significant progress”.

ADDIS ABABA , Feb 21 2012 (IPS) – Ethiopia says that the double-digit economic growth the country has experienced over the last seven years has started benefitting its majority by boosting their income and productivity in agriculture and small-scale businesses.

While the and the state that the country has registered 8.7 percent GDP growth, the government claims the economy has grown by 11.4 percent.

However, the country was declared the second-fastest growing economy in Africa for 2011, after Ghana, in the annual economic report by the (ECA).

In the past, Ethiopia has made headlines for recording some of the worst famine situations in Africa, and for its poor health indicators – it has posted one of the highest maternal mortality rates in the world. In 2005, 871 women died per 100,000 live births.

But this is slowly changing as the government has made progress in the provision of social services such as health, education and infrastructure.
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“In 2010, Ethiopia continued to register the fast growth, as it has for the last five years. GDP growth in 2010 remained strong at 8.8 percent. Growth is driven by the service sector (14.5 percent), followed by the industrial (10.2 percent) and agricultural (six percent) sectors,” the ECA report indicated.

In an exclusive interview with IPS, State Minister of the Office of Government Communication Affairs, Alemayehu Ejigu, said Ethiopia has registered remarkable growth by increasing major crop production from 11.9 percent in 2005 to 18.08 percent by the end of 2010. People’s lives are changing for the better in rural and urban areas because of health facilities and infrastructure development, he said.

Ejigu attributed the success to the effective implementation of the national five-year Growth and Transformation Plan (GTP). He said that the country’s GTP for 2011 to 2016 would help Ethiopia join the grouping of middle-income countries.

Ejigu also told IPS that the government planned job creation opportunities through the construction of 73,000 kilometres of rural roads. “This would create an opportunity for farmers to easily transport agricultural products to market,” Ejigu said.

Abeba Bezu, an economic affairs consultant in Addis Ababa, said that under the country’s ambitious Plan for Accelerated and Sustained Development to End Poverty government had reduced poverty from 38.7 percent in 2005 to 31 percent five years later.

“Although struggling with a large population estimated to be 82 million people, making it the second-most populous country in Sub-Saharan Africa, there has been significant progress towards improving livelihoods. There is notable development.”

However, assistant Professor Teshome Adugna at the Economics Department of the cautioned that as GDP considers the market value of goods and services, it cannot be a perfect instrument to show the country’s actual growth, given Ethiopia’s poor record handling and management systems.

“Since the GDP reporting does not provide information on who produces how much, it is difficult to know how individual citizens benefit from the reported growth,” he said.

Adugna described Ethiopia’s growth as “broad-based”, which he attributed to the growth of the agricultural, industrial and service sectors.

“Of course, we should not expect urban unemployment to end very shortly,

“I can say that many people are benefiting from the economic growth in Ethiopia, but I would not say that the life of the majority has improved. We need time to bring about social development that can change the lives of the majority.”

Ten years ago, only two thirds of Ethiopians had access to healthcare services, leaving another 68 million people across the expansive rural areas in dire need.

“Since 2004, the Ministry of Health has expanded access to healthcare through the (HEP), which targets the rural population,” said Amanuel Ayalew, a volunteer health worker in northern Ethiopia.

As a result, Ethiopia’s country report by the Department for International Development (DFID), the United Kingdom’s government department responsible for promoting development and poverty reduction, revealed that the impact of the health programme is notable since HEP reaches nine million households. DFID will spend an average of 524 million dollars per year in Ethiopia until 2015.

With more than 35 million insecticide-treated bed nets for malaria, there has been a 73 percent reduction in malaria cases. This, coupled with a massive and consistent vaccination programme for children under five against killer diseases, has seen deaths in that age group reduced by a significant 62 percent in villages with access to HEP.

There are now about 1.4 million more women on contraceptives than there were in 2005, and the gross primary school enrolment rate has risen from 91.3 to 96 percent between 2005 and 2010.

However, challenges remain.

“In spite of a constituent economic growth of double digits in the last five years with economic analysts projecting a similarly impressive growth, sustainable growth and poverty reduction remains a challenge,” Bezu said.

A majority of rural poor are still grappling with severe climate change and are still highly susceptible to drought.

It is a situation that government partially acknowledges. “When we say the country is growing it does not mean that every citizen has no problem…even in the United States there are people who are provided with food aid,” Ejigu said. He, however, added that no one would die of as there would be no food shortages in the country.

It is a view that the leader of the opposition Ethiopian Democratic Party, Mushe Semu, does not agree with.

“Ethiopia is a country where many citizens are starved. It is not a question of having food two or three times a day,” Semu told IPS.

He said it was impossible for Ethiopia to become a middle-income country. “When we think of the majority of the Ethiopian population we are talking about our farmers and rural communities that are 85 percent of the people. Here, the land management and fertility should be considered,” he said.

He said that without effectively distributing all arable land to people, and with the prevailing land degradation, it was not possible to bring about development.

The country is not conducive for private sector growth, analysts say.

The newly completed African Union building in downtown Addis Ababa. Credit: Mekonnen Teshome/IPS

“Although the government envisions a private sector led development, the environment is not conducive for the growth of the private sector. In fact, private investment as a percentage of GDP has remained on the decline since 2004,” Bezu said.

In a World Bank global survey dubbed Ease of Doing Business, in 2010 and 2011 Ethiopia ranked 103 and 104 respectively out of 183 countries.

But meanwhile, civil servant Abiy Getahun said that the double-digit economic growth repeatedly propagated by the government media has not yet brought the desired social development to his life. He cited the low wages paid in Ethiopia, which, according to him, are low compared to the rest of Africa. In the 2011 Human Development Report Ethiopia ranks 174 out of 187 countries worldwide.

He said that most people, especially urban dwellers, could not withstand the skyrocketing price of good and services.

“The total salary increment I got over the last 10 years is only 400 Ethiopian Birr (less than 25 dollars) while the price of goods and services has risen in an unbelievable manner.”

* Additional reporting by Miriam Gathigah in Nairobi.

(END/2012)

BUENOS AIRES, Mar 29 2012 (IPS) – A novel research study in Argentina explored women s knowledge and beliefs about cervical cancer, in the provinces with the highest mortality from this highly preventable form of cancer, to design more effective policies.
Although there are now effective tools to prevent cervical cancer, and vaccination against human papillomavirus (HPV) is free and mandatory for 11-year-old girls, the death rate from cervical cancer is not declining in Argentina, and the geographical distribution of the burden is extremely unequal.

This scenario was the starting point for the study titled (What Women Think: Knowledge and perceptions about cervical cancer and the Pap test , published by the Argentine Health Ministry and the Pan American Health Organisation (PAHO).

The study concluded that women have only a vague understanding of this health problem, and that most are unaware that HPV, a sexually transmitted disease, can cause cervical cancer.

Medical research has established that persistent infections with certain types of HPV cause nearly all cases of cervical cancer. Left untreated, invasive cervical cancer is almost always fatal, according to the World Health Organisation (WHO).

They do not always know what the Pap smear is for, say the authors, referring to women’s understanding of the Papanicolau screening test, which involves taking a small scraping of cells from the cervix – the narrow lower portion of the uterus where it joins with the top end of the vagina.
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Examination of the sample in a laboratory can detect pre-cancerous lesions before they develop into cancer, a potentially life-saving step if it is followed by prompt treatment.

One of the authors, Dr. Silvina Arrossi, who is the scientific coordinator of the , told IPS the goal of the study was to find out about women s perceptions and knowledge about this type of cancer, in order to incorporate their views into prevention strategies at the design stage.

In Argentina, cervical cancer is the second cause of deaths from cancer in women aged 35 to 64.

We wanted to know if there were problems with the information women have about it, in order to design user-friendly educational materials that could help to overcome those difficulties, Arrossi said.

The interviews were carried out with women in the eastern province of Buenos Aires – the most populous and in the northern provinces of Jujuy, Salta, Misiones and Chaco, which have the highest cervical cancer mortality rates.

The national average for cervical cancer mortality is 7.5 deaths per 100,000 women. But in these four northern provinces, the mortality rate rises to as many as 15 deaths per 100,000, while in the city of Buenos Aires it falls to four deaths per 100,000 women, so the study examined both statistical extremes.

The interviews with the women were revealing. A considerable number believe the cancer lives in the body in a latent state, and is awakened by events like an abortion, rough intercourse, or insertion of an intra-uterine device (IUD).

According to this view, the Pap smear, seen as an invasive procedure, could also disturb or awaken the dormant cancer, the study says. One woman said her 52-year-old mother-in-law had never had a Pap test because of this fear.

Another mistaken idea that cropped up frequently in the interviews is that older women do not need to have Pap tests if they are no longer sexually active and are feeling well. There s nothing wrong with me, so why should I go to the doctor? one woman remarked.

The women referred to other difficulties, related to their home-making role, that cause them to put off their own needs. Who ll serve your father his dinner? one woman asked her daughter, when the younger woman urged her mother to go in for a Pap test.

The study also found that women are not always well enough informed about the continuing precautions they need to take to prevent the illness.

A 38-year-old mother of nine from Chaco has never had a Pap test in spite of the many times she has attended health clinics for antenatal care and childbirth. Evidently the health system is failing here, the authors said.

The women s most common sources of information about cervical cancer are television, radio and other women. The health system, in contrast, was not frequently cited as a source of knowledge.

Several women call cervical cancer la pudrición ( rot or putrefaction), because of the fetid odour of vaginal discharge when the cancer is in an advanced state. They are fatalistic and pessimistic about the disease, and in some cases they say directly that there is no cure.

Another worrying finding is that some women have a Pap test, but do not return for the test result. According to the authors, this would seem to indicate that they do not fully understand the importance of having the test and then following it up.

In general, the respondents also showed a complete lack of knowledge that untreated HPV infection is the main cause of cervical cancer.

In October 2011, the Health Ministry added HPV vaccination to the mandatory series of routine shots for 11-year-old girls. Arrossi believes the vaccination campaign will help spread knowledge of the association between the virus and cervical cancer.

The study, by Arrossi, Nina Zamberlin and Laura Thouyaret emphasises that in spite of these highly effective and low cost preventive measures, cervical cancer continues to be one of the main causes of cancer deaths among women in developing countries.

Experience in the industrialised world shows that screening women with the Pap test is effective in reducing incidence and mortality, the researchers point out. However, in Latin America incidence of cervical cancer has not declined because of the low coverage of screening, the study says.

Mortality from cervical cancer in Argentina has not declined significantly in the last 40 years, and the distribution of the burden (of deaths) is extremely unequal, it says.

In 2009, the Health Ministry found that only 46 percent of women aged 35 to 64 in the northeast and northwest of Argentina had had a Pap test in the two years prior to the survey.

Based on the information collected by Arrossi and her colleagues, a photo-novella has been designed in which a woman tells her daughter she (the mother) does not need to have Pap smears any more because of her age. But the daughter explains to her mother that, in fact, she really does need to keep having the test.

Training will be given to health centre personnel who offer women health advice, in order to ensure that they engage women in dialogue and exchange of information, rather than just send them away with a leaflet, Arrossi said.

Many of the women interviewed for the survey admitted that they felt embarrassed when they had Pap smears taken by male doctors. The study therefore recommends that health centre teams always have a woman available to take samples for the Pap test.

RIO DE JANEIRO, May 4 2012 (IPS) – María dos Prazeres de Souza has lost count of the number of births without a single death she has attended as a midwife, an occupation that there is renewed interest in strengthening in traditional communities in Brazil where state services are not available or are not entirely acceptable for cultural reasons.

In countries like Mexico, where this indigenous baby was born, and Brazil, many mothers still give birth at home, attended by midwives. Credit: Mauricio Ramos/IPS

The 74-year-old de Souza says that prior to 2008 she attended 1,000 births in her home city of Jaboatão dos Guararapes, in the rest of the state of Pernambuco, and in neighbouring states in Brazil s impoverished Northeast.

She said she never ceases to be amazed every time a mother s expression changes from pain to joy.

A woman in labour feels pain, but when her baby is born she smiles and cries with happiness, she told IPS, recalling the tears of emotion she has shed herself at each birth she has attended.

De Souza, an indigenous woman, learned her skills as part of her cultural heritage. Her mother, grandmother and great-grandmother taught her the skills from childhood.

At first I would attend the births of cats, dogs and other animals, but later on in emergency situations, when my mother was not available, I began to attend women in their homes, she said. Subsequently she trained as an obstetric nurse and worked in hospitals for 20 years.
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Now retired, she still attends home births, sometimes in exchange for just a thank-you hug, like many of her colleagues who are midwives in the poorest parts of the country.

It is undeniable that the technologies and practices of the official health model have brought great advances, but we must try to achieve a balance between the traditional and the biomedical approaches if we want to guarantee the health of mothers and children, not just physically but also mentally and spiritually, said Paula Viana, coordinator of the in Pernambuco.

Because of their wisdom and experience, in, not excluded from, the health system, Viana said in an interview with IPS.

The Curumim programme has shown that traditional midwives contribute to earlier identification of problems in pregnancy, and that as natural leaders they help in cases of women who have been raped, in vaccination campaigns or in HIV/AIDS prevention programmes.

Midwives have contributed to the increase in prenatal checkups at public health facilities and healthy practices like breastfeeding, while they provide therapies such as massages, relaxing baths and emotional support.

The Curumim Group, on the occasion of International Day of the Midwife this Saturday May 5, is launching a campaign for recognition of the value of the role of traditional midwives among indigenous people and in quilombolas , communities of descendants of escaped slaves.

The campaign is also seeking recognition of home births attended by midwives within the Sistema Único de Saúde (SUS), the Brazilian national public health system, as well as the designation of midwives knowledge and practices as part of Brazil s intangible cultural heritage.

Traditional midwives are the bridge between the community and the health services. In many places where there are no doctors, they provide primary health care for the general population, and at other times they are the only person with the connections to get a sick person to hospitals or health clinics in nearby cities, Viana said.

De Souza has personal experience of the isolation of many rural, riverside or jungle communities. Once she attended a birth on the second floor of a half-built house that still did not have a stairway, so she had to climb up a rope rigged precariously by two police officers.

After the birth I had a lot of trouble getting down on my own, because one of the police officers was carrying the baby and the other was carrying the mother, she said.

According to Health Ministry statistics, 41,000 women a year give birth at home in this country of 192 million people, most of them attended by midwives. But the authorities admit the number may be higher.

Although health policies and projects officially take home births into consideration, the fact is that these births mostly take place in marginalised and isolated communities, without the involvement of the SUS, Viana said.

Traditional midwives can probably teach more than they can learn, but like any other health professionals they must train to improve and update their skills, and must have access to adequate materials and equipment, as well as means of transport for emergencies, she said.

De Souza said many of her colleagues in Brazil have no social benefits or labour rights, and receive no recognition for their work.

The government has to address this issue, especially as we have had a Brazilian president who was brought into the world by a traditional midwife, the expert said, referring to former president Luiz Inácio Lula da Silva (2003-2011), who is from the Northeast.

Viana emphasised that risk is inherent to childbirth, whether it takes place in a woman s home or in a hospital. But the danger of a serious health complication would increase if women in labour were deprived of the support of traditional midwives, she said.

That is why the Curumim Group s representative is calling for both healthcare models, the traditional and the biomedical, to join together, especially in remote and isolated communities.

In de Souza s view, pregnancy is a natural process, but many women have got it into their heads that they are ill, or else they don t want to suffer pain and they ask for a caesarean. SUS figures for 2008 show that half of the three million births registered that year were by .

The maternal mortality rate has declined steadily in Brazil since 1990, when there were 140 maternal deaths per 100,000 live births. By 2010 the figure was 58 per 100,000 and it is expected to drop still further. The main causes of childbirth-related death among women are hypertension, haemorrhages and postpartum infections.

The infant mortality rate has also fallen, to 15.6 per 1,000 live births in 2010, 47 percent lower than in 2000, according to the latest census.

In these circumstances, Viana said, the full range of regional obstetric care should be considered in order to achieve further improvement.

The more the scientific community endeavours to establish the biomedical model of health, the more we need to analyse the consequences of the excessively interventionist and medicalised nature of childbirth, she said, pointing out that the number of traditional midwives is in decline.

De Souza, the midwife who has brought more than 1,000 babies into the world, says: We have been blessed, and we continue to be blessed. We have thousands of years of history behind us, and that must command respect.

UNITED NATIONS, Jun 11 2012 (IPS) – The headline in a New York newspaper last March captured the essence of a future potential threat to political stability the world over: U.S. Report Sees Tensions Over Water.

The study, a collective vision of the U.S. intelligence community, warned that during the next 10 years, many countries important to the United States will almost certainly experience water problems shortages, poor water quality or floods that will contribute to the risk of instability and state failure, and increase regional tensions.

Carrying drinking water in a low-income Cairo district. Credit: Victoria Hazou/IPS

Still, there are fears that next week s U.N. Conference on Sustainable Development, also known as Rio+20, may marginalise both water and sanitation when it finalises its plan of action titled The Future We Want.

So is there a future for water in the U.N. scheme of things?

Not really, says Karin Lexen of the Stockholm International Water Institute (SIWI), a Swedish policy institution that seeks sustainable solutions to the world s escalating water crisis.

Many people are losing faith in the U.N. system and a weak Rio+20 outcome will build on to this mistrust, she told IPS.

We would of course like to see a strong outcome with concrete and forward thinking commitments, she added.

Lexen said that an agreement on Sustainable Development Goals (SDGs) would be one important outcome.

As a cross-cutting resource and the bloodstream of the green economy, water is an obvious candidate for one overarching SDG, but it also should be reflected in the other SDGs, particularly those on food and energy, she added.

The summit, to be attended by over 120 heads of state and government, will take place Jun. 20-22, and is a follow up to the 1992 Earth Summit in Rio de Janeiro.

Secretary-General Ban Ki-moon said last week he expects the summit to make progress on some of the building blocks of sustainability: energy, water, food, cities, oceans, jobs and the empowerment of women.

The U.N. Special Rapporteur Catarina de Albuquerque has already made a strong pitch urging member states to fully support the human right to safe drinking water and sanitation at Rio+20.
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In an open letter to member states negotiating the final outcome document, she expressed concern that a clear recognition of the human right to water and sanitation is at risk of being suppressed from the original text after three rounds of informal-informal negotiations held in New York in the past three months.

Some States suggested alternative language that does not explicitly refer to the human right to water and sanitation; some tried to reinterpret or even dilute the content of this human right, she said.

De Albuquerque, the first U.N. special rapporteur on the human right to safe drinking water and sanitation, said that water already has been recognised as a human right under international law, including by the General Assembly and the Human Rights Council in 2010.

When agreeing on a sustainable development target for water and sanitation, she said, governments have to integrate the human right to water and sanitation and aim at achieving access to safe and affordable drinking water and sanitation for all without discrimination.

They should also be available in sufficient quantities to protect human health and dignity, particularly for the most marginalised.

SIWI s Lexen told IPS that action to improve the wise and sustainable management of water is also critical to outcome at Rio.

By 2030, in a business as usual scenario, humanity s demand for water could outstrip supply by as much as 40 percent.

This, she warned, would place water, energy and food security at risk, increase public health costs, constrain economic development, lead to social and geopolitical tensions and cause lasting environmental damage.

Therefore, the foundation for a resource efficient green economy must be built upon water, energy and food security and these issues must be addressed in an integrated, holistic manner and be reflected in the Rio outcome and also as a cornerstone in the SDGs, she said.

Asked if water has found its rightful place on the international agenda since the first Stockholm Conference on the Human Environment back in 1972, Lexen said that given the fundamental role water has for all life, for wealth and economic development and being a source for conflict but also a tool for cooperation, water has not been given the prominent role it should have.

Water has a place in the Rio draft, but the different thematic areas are still very much compartmentalised.

Take the energy section, for example: water is not mentioned once in the remaining texts despite the fact that it is an essential resource for energy production, she said.

Other issues, like the recognition of access to drinking water and sanitation as a human right, and transboundary waters, are still under discussion now, only a few days before the Rio Summit begins.

She said The Friends of Water group has played a role in pushing water into the global environmental agenda.

But we have important work in the final week ahead, and at the summit, to ensure that a wider group priorities water and ensure concrete commitments and a strong outcome document is produced in Rio, Lexen said.

Sex workers march through a street in the Indian city Kolkata to condemn U.S. denial of visas to attend an AIDS conference. Credit: Sujoy Dhar/IPS.

KOLKATA, Jul 26 2012 (IPS) – Bare-chested and beaming in the company of many like him, London-based male sex worker Thierry Schaffauser wipes the beads of sweat trickling down his face on a humid Kolkata evening, and slams U.S. President Barack Obama.

“He is against sex workers. His policies are actually killing sex workers across the world and hindering HIV/AID prevention,” says France-born Thierry.

Thierry and thousands of sex workers from across the world who are gathered in Kolkata Jul. 21 to 27 at the ‘Sex Workers Freedom Festival’ are critical of the U.S. government for denying them visas to attend the international HIV/AIDS conference being held this week in Washington.

The International AIDS Conference is the premier gathering for those working in the field of HIV, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic.

But sex workers, who are the most HIV/AIDS prone community, were denied entry in the U.S. under laws which limit travel for sex workers.

The sex workers community chose instead to hold a parallel meeting in this eastern city. Nearly 800 sex workers and activists turned up from 41 countries to join thousands of Indian counterparts at the Kolkata meet.

Sex workers from India were also vocal against the U.S. laws. “I am here because this is like a festival for us,” says a transsexual sex worker from south Indian state of Andhra Pradesh. “But we are also protesting the U.S. visa denial. It is like denying one’s human rights.”

Anna, who represents the Canadian sex workers’ organisation Stella, says the Kolkata conference will send a strong message.

“I am a worker. A sex worker is a real worker. You should decriminalise the profession and accept us as workers. It is strange that the U.S. does not understand that,” says Anna, marching with hundreds of others holding a red umbrella, now a sex workers symbol of resistance against discrimination.

Visitors from across the world are overwhelmed by the organisational skills of the host organisation Durban Mahila Samanwaya Committee (DMSC).

With 65, 000 members, DMSC is the world’s largest association of sex workers. It operates out of Sonagachi in Kolkata, the hub of more than 10,000 brothel-based sex workers.

Akhila Sivadas, executive director of New Delhi-based Centre for Advocacy and Research, which is partnering with the Global Network of Sex Work Projects (GNSWP), the All India Network of Sex Workers (AINSW) and DMSC to organise the conference, says the Kolkata gathering is the manifestation of a bold stand taken by the community.

“This conference is an affirmative statement where sex workers from diverse cultures and economies have come together. There are differences but the overall similarities are the same. If you do not decriminalise you will lose the battle.”

According to Dr. Smarajit Jana, chair of the conference and father figure of the sex workers’ movement in Kolkata, the U.S. is continuing with an earlier restriction on visa denial to sex workers. “So when they were denied visa by the U.S., we in Kolkata came forward. The government in India does not have such restrictions on entry of sex workers.

“Despite all our failures and social taboos, India is transparent about fighting AIDS and so we could bring down the HIV population from five million to 3.5 million at the moment,” says Dr. Jana. “The policy in India is effective and progressive.”

“The roadmap ahead is to clearly strengthen partnership at every level,” says Akhila Sivadas. “The community is designing, shaping, fighting economic injustice to fight HIV/AIDS.

“We will focus more on social entitlement and economic justice,” she says. “Here DMSC is the ideological vanguard because they started at a time when tolerance was not there. But while they are at the vanguard, those taking inspiration from them have to also innovate in their environment in each area, in different milieus.”

BUENOS AIRES, Sep 17 2012 (IPS) – The Argentine government has opened legal aid centres in slum neighbourhoods, to provide a range of services, from assistance for immigrants and victims of domestic violence to dental care services.

“Many of the situations can be solved by picking up the telephone,” said Ariel Pereira, coordinator of the centre that is operating in Villa 1-11-14, a shantytown on the south side of Buenos Aires.

People living in the neighbourhood seek help from the centre in applying for pensions or identity documents, and filling out paperwork in the case of immigrants. They also file reports of domestic violence and application forms for social assistance payments or exemption from taxes or fees for certain services.

“In our centre, the people who come for help are mostly foreigners and battered women,” Pereira told IPS.
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In both cases, the obstacle that leads them to turn to the centre is the police themselves, who often pay no attention to reports of domestic violence, considering them minor incidents, or simply because of discrimination.

To apply for residency in Argentina, immigrants, mainly from Bolivia and Paraguay, need to show proof of address, which has to be issued by the federal police after they verify where the applicant lives.

But “since this is a ‘villa’ (slum), the police don’t come here, and people get desperate because their appointment date is coming up (in the immigration office) and they don’t have the proof of address,” he said.

In such cases, the legal aid centre takes a hand in the matter, to get the police to issue the necessary document.

In the case of domestic violence victims, the police do not take down the women’s complaints, “sending them instead to the courts in the centre of the city, which makes things difficult for the women,” he said.

The legal aid centres, by contrast, offer the women support from lawyers, social assistants and psychologists, who inform them of their rights and, in case they file a legal complaint, help them every step of the way.

Of the total number of people who turn to the legal aid centres for help, 63 percent are women and 45 percent are foreigners of either sex.

Applying for a certificate of poverty

Some 15 people were waiting in line for assistance when IPS visited one of the legal aid centres set up in Villa 31, a long-time slum in the central neighbourhood of Retiro.

Three public employees are on duty from 10 AM to 4 PM every day in the legal aid centre, which is just two by six metres in size. It is next to a Catholic church in this poor neighbourhood which according to the 2009 census was home to just over 26,000 people, 51 percent of whom were from neighbouring countries, mainly Bolivia, Paraguay and Peru, and 20 percent of whom from Argentina’s provinces.

IPS randomly interviewed seven of those waiting in line, and found that they were all immigrants who had come to apply for a “certificate of poverty” – the name given to the document they need to be exempted from a 300 peso (65 dollar) fee for applying for an Argentine identity card.

Also waiting in line were people seeking other documents, or people who wanted to talk to the lawyer, like Sandra, a 31-year-old Peruvian woman who needed legal aid for obtaining custody of her daughter.

“Her father doesn’t give me money, and I know he’s here (in Argentina),” said Sandra, who wants to visit her two other children who are living with a relative in Peru. But in order to take her seven-year-old daughter with her on the trip, she needs authorisation from the father, who has not shown up.

Mediators

The first five legal aid centres were created in 2008 in Buenos Aires. These pilot centres found the need for offering a wider range of services. Another 33 were gradually opened, several of them in the provinces, Florencia Carignano, the head of the National Office for the Promotion and Strengthening of Access to Justice, told IPS.

“There are economic, social, cultural and geographic barriers standing in the way of everyone having access to the same rights. For that reason, rather than sporadic interventions, what we are seeking at the centre is to provide a stable state presence,” she said.

Once it was clear what kinds of assistance would be sought in the centres, Carignano’s office, which is under the Justice Ministry, signed cooperation agreements with other ministries and public offices, as well as with universities and foreign consulates.

In some cases, these different institutions supply their own staff to the legal aid centres where their services are needed.

“The paperwork of foreigners is often bogged down in their countries of origin,” Carignano said. “In these cases, we set up mobile units. Consuls come to take note of the needs, and in 15 days they come back with the papers.”

The centres also act as mediators, and they raise awareness – through pamphlets and conferences on new laws that expand rights, for example, in the areas of immigration, mental health or domestic violence

The Justice Ministry’s office of Social Readaptation, which helps ex-convicts rejoin society, also has representatives in the centres.

In addition, young people from the Labour Ministry’s “More and Better Jobs” programme work as administrative employees at some of the centres. These youngsters are completing their secondary school studies and seeking to join the labour market.

The elderly seek help at the centres in applying for a pension, exemption from taxes or fees, or benefits to which they are entitled by law, but which they do not know how to claim. One example is the right to receive a free digital TV converter box.

Under an agreement with the Health Ministry, the centres also provide vaccines or dental care when there is no nearby public clinic offering such services.

According to a study by the National Office for the Promotion and Strengthening of Access to Justice, the legal aid centres have provided assistance in more than 152,000 cases since they were created.

Because the centres were overwhelmed by the number of people seeking help, nine mobile units were added this year, which go from neighbourhood to neighbourhood in Buenos Aires. These mobile legal clinics demonstrate the success of the programme and how important it is for the justice system to reach out to those who are claiming their rights.

UNITED NATIONS, Oct 26 2012 (IPS) – As the Millennium Development Goals (MDGs) limp towards their target date of 2015, the United Nations is shifting its focus to another long-term action plan: a new set of Sustainable Development Goals (SDGs).

Indigenous baby and mother in Chihuahua, Mexico. Social movements want indigenous rights and gender equity included in the concept of sustainable development. Credit: Mauricio Ramos/IPS

A follow-up to a decision taken at the Rio+20 Conference on Sustainable Development last June, the will be a list of post-2015 development and environmental goals touted as a logical successor to the eight MDGs adopted by the General Assembly back in 2000.

The 193-member General Assembly has been mandated to appoint a still-to-be-named Working Group of about 30 countries as part of an intergovernmental process which will be entrusted with the task of articulating a list of post-2015 SDGs.

The recommendations of this group will eventually be integrated with that of a High Level Panel (HLP) of Eminent Persons comprising Indonesian President Susilo Bambang Yudhoyono (chair), Liberian President Ellen Johnson Sirleaf and British Prime Minister David Cameron.

The HLP plans a meeting in London on Nov. 1, to be followed by a dialogue with civil society on Nov. 2. The latter event is scheduled to be live-streamed on www.worldwewant2015.org.

Meena Raman, legal advisor to the Penang-based Third World Network and an active participant in the Rio+20 summit, told IPS that any post-2015 development agenda should be based on an analysis of the factors that hinder or threaten development in developing countries.

Just having a set of goals and targets, as was the case in the initial approach to MDGs, is clearly inadequate, she noted.

The eight MDGs include the eradication of extreme poverty and hunger; universal primary education; empowerment of women; reduction of child mortality and improvement of maternal health; eradication of HIV/AIDS, malaria and other diseases; environmental sustainability; and a global partnership for development.

But most developing nations are expected to miss some or most of these goals by 2015.

Raman said there is a need to spell out international factors that undermine development in developing countries, such as the unstable and speculative-based financial system which has distorted the global economy; the unfair trading system, including free trade agreements that are skewed against the global South; and an investment system that has unfair investor-State dispute mechanisms (allowing companies to sue governments for important measures governments take to protect the public interest).

Additionally, she said, there is an intellectual property system that hinders technology transfers and raises costs of essentials.

All these are worsened by the global economic crisis which will overwhelm development prospects, Raman predicted.

Asked if the SDGs will focus more on the environment and sustainable development (as the name implies) or on enhanced MDGs, Manish Bapna, managing director of World Resources Institute, told IPS there are currently two tracks.
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But, ultimately, these tracks should converge into one framework that incorporates sustainability, without losing the importance of reducing global poverty and improving human well-being.

The proposals on the table are incredibly wide-ranging, including topics like biodiversity, oceans, sustainable cities, and changing consumption patterns; and proposals for MDG-like goals focused on poverty, health, education, and gender, he added.

There are also numerous groups advocating for the addition of a particular theme, such as peace, the private sector, and climate rights.

The challenge will be to create goals that are few in number, focused, and simple, he said.

While tough choices need to be made, prioritisation of the goals will be essential for their success, said Bapna, who participated in last week s U.N. Special Event Panel on Conceptualizing a Set of Sustainable Development Goals, which took place before an audience of senior policymakers and U.N. ambassadors and delegates.

Asked if the SDG process will be any different from the MDG process, Raman of the Third World Network, told IPS, The SDGs should cover all three pillars of economic, social and environment in a balanced manner and not just focus on one pillar like the environment over the other two pillars.

It is important to have a holistic approach in developing the goals, and not just focus on the goals, but also address how to implement them, including the means of implementation, she added.

Raman also pointed out that the development of the SDGs should be guided by the Rio+20 outcome document.

She said all the existing shortcomings must be addressed and corrected as a prime approach to the new U.N. development agenda.

There is a need for economic production to take place in developing countries which is supported by and not hindered by global factors like destabilising finance, unfair trade and overly strict intellectual property regimes.

She said incomes and jobs, complemented by good social policies, should be the focus of development policies, and this should be enabled and not hindered.

Goals and targets alone cannot be sufficient, Raman said.

Asked about inputs from civil society, she pointed that this is what the Rio+20 outcome document also recommends.

This must be followed through, and efforts must especially be made to ensure the participation of civil society from developing countries, she added.

Asked about the participation of non-governmental organisations (NGOs), Bapna said, We believe that the process will be open, bringing in perspectives from NGOs, civil society and more.

He said WRI is currently working with a diverse group of civil society organisations to provide input and we intend to be deeply engaged going forward .

We recognise that an inclusive, consultative process that engages the global poor and historically disenfranchised is crucial for achieving the goals that emerge, Bapna said.

This is particularly true, he said, compared to 20 years ago because the international aid landscape is much more complicated.

Clinique de Confiance was the first clinic in Côte d’Ivoire to begin targeting men who have sex with men. Credit: Robbie Corey-Boulet/IPS

ABIDJAN , Dec 1 2012 (IPS) – When Emmanuel Kokou, a 28-year-old sex worker, moved from his native Togo to Abidjan, Côte d’Ivoire in 2010, he knew there was a good chance that he had previously been exposed to HIV. But he had no intention of getting tested.

“I had done a lot of silly things,” said Kokou, whose name has been changed to protect his identity. “But I never got a test because I was afraid.”

That changed only after he visited Clinique de Confiance, a compact one-story facility tucked behind an unassuming blue gate in an upscale section of this West African nation’s economic capital. The test came back positive, and since then Kokou has learned how to manage his health and avoid transmitting HIV to others – namely, by insisting his clients wear condoms.

“If the clinic wasn’t here I wouldn’t have had the courage to do this,” he told IPS, referring to the process of learning his status and how to live with it. “There are people here who give us advice and reassure us.”
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Clinique de Confiance was the first clinic in Côte d’Ivoire to begin targeting men who have sex with men (MSM), starting in 2004 with sex workers and their partners before expanding to all MSM in 2007. Although two other clinics offering similar services have opened recently, Clinique de Confiance remains by far the most established.

As such, the clinic has played a critical role in Côte d’Ivoire’s bid to lower the adult HIV prevalence rate, one of the highest in West Africa. Staff members estimate that roughly 1,000 MSM have visited the clinic over the years – only a portion of the total population (for which there are no good estimates), but still a significant achievement.

Activists warn, however, that unless something is done about the heavy stigmatisation that MSM face in Ivorian society – especially those who are HIV positive – it will be difficult to build on progress the clinic has made so far.

Unlike regional neighbours such as Liberia and Nigeria, where the issue of homosexuality has been highly politicised and lesbian gay bisexual and transgender (LGBT) populations have recently been targeted by harsh anti-gay legislation, Côte d’Ivoire does not have a reputation for persecuting MSM. A report broadcast by a Dutch radio outlet last year went so far as to declare that Abidjan was “becoming a gay Eldorado.”

Yet Dr. Camille Anoma, coordinator of the NGO that runs Clinique de Confiance, said discrimination against MSM – at home, at school, at work, in health centres and out on the streets – is common. He noted that no other health facilities were even trying to serve the MSM population before Clinique de Confiance started in 2004.

“Before that, the focus of our activity was female sex workers,” Anoma told IPS. “But the staff at the clinic kept seeing commercial sex workers who were men having sex with men. Our question was, ‘What is the situation of MSM in this country?’ And nobody seemed to know. That’s the reason why we decided to offer services for this group.”

Though the available data is limited, it is clear that HIV prevalence rates are considerably higher for MSM than the general population. , estimates that the national adult prevalence rate was three percent in 2011. Internal numbers from Clinique de Confiance show that figure was 24.5 percent for MSM in 2009.

Claver N. Toure, executive director of the LGBT group Alternative Côte d’Ivoire, said the situation would be far worse without Clinique de Confiance and the two other clinics that welcome MSM. “It would be a catastrophe,” he told IPS. “The MSM are obligated to get their treatment and their prevention from these clinics because they’re not going to the general hospitals,” where they may be treated with derision.

There are a number of factors preventing Clinique de Confiance from expanding its reach, including logistical challenges such as transport costs. But Morley Bienvenu Nangone, head of monitoring and evaluation for Arc-En-Ciel Plus, a group that combats HIV/AIDS and homophobia, said the most formidable challenges were cultural.

He said the stigma associated with homosexuality prevents many men from acknowledging even to themselves that they are gay, making it far less likely that they will seek out HIV prevention and treatment resources. “What needs to be done for health is not just to focus on health, because health problems are linked to socio-cultural problems,” Nangone told IPS.

Nangone said that is why it was essential that Clinique de Confiance maintain a low profile. “If it wasn’t confidential, if there were large signs outside, then it wouldn’t work as well,” he said.

The experience of Kokou, the Togolese sex worker, underscores just how pervasive the stigma can be. He said that even though he had come to terms with his sexuality and his HIV-status, he kept both a secret for fear of how others would react.

“I don’t share my status because people will see me differently,” he said. “You’re seen badly, and people don’t trust you. I haven’t told anybody, not even a friend, not my dad or my mom. Nobody knows outside of the clinic.”

He went on: “As for being open as a gay person, I don’t even know how that would work. I just don’t go out. I just don’t have very many friends.”