Last week, the case study in Bangladesh highlighted the training of young married women educating their peers about family planning methods. One of my questions was how did the health workers behind the intervention ensured the security of these women and or themselves as they traveled from house-to-house in a male-dominated society, especially where the practice of purdah, or seclusion of women from public observation by wearing concealing clothing from head to toe or the use of high walls, curtains, and screens erected within the home (1) occurs. One of the possible security measures I remember being mentioned was husbands or male relatives accompanying the female health workers to and fro.
Polio eradication has been the goal of the Global Polio Eradication Initiative, a multi-organization effort which includes the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), and the United Nations Children’s Fund (UNICEF) since 1994 (2, 5). The polio eradication strategy includes routine immunizations, supplementary immunizations, surveillance, and targeted “mop-up” campaigns. Today, polio is endemic in Afghanistan, Nigeria and Pakistan (2). Every step of their strategy requires trained staff. Earlier today, I saw a headline of a bomb attack on a Pakistani polio vaccination center, killing two health workers and one policeman (3, 4). These attacks on international health workers have been going on for years where many believe that polio immunization is “a conspiracy by the Americans to sexually sterilise children and thereby control the population of Muslims” (5).
I tried to find more information about how this intervention was put in place, especially how foreign health workers are approaching the Pakistani, in this case. We keep talking about voluntary participation as part of an ethical intervention, but I am curious to see what the Pakistani themselves (or any other population of interest) are saying about us and how they feel about the immunization programs for instance. In the case of Pakistan, there seems to be an incredible level of resistance from the military and even religious leaders, so I feel as though lack of communication is to blame. Due to all of this violence, 240,000 children missed their immunization.
Jaci previously wrote about the effect of the war in Syria where people fled their homes to save themselves from war while unsanitary conditions and water await them at refugee camps (7). Syrians fled to stay alive, but the untold half of the story involves health workers (foreign or natives). I have had a couple friends work for NGOs in Africa, and most recently, one of them had to be evacuated from the Central African Republic (CAR) due to a rebel coup. All of the violence we see in the world today, especially in countries in need, prevent indigenous populations from getting help and health workers from helping, as Mercy Corps Country Director Jean-Philippe Marcoux noted “Before the coup, the humanitarian situation in CAR was already dire. Now it’s even worse” (8). He adds “Well, it was never really “safe” to go back in. But we knew that there were a lot of people affected and that we needed to get back respond to this emergency in whatever capacity we could. We focused on restarting things in Bangui so we’d be operational from our country headquarters and be prepared to take advantage of even the small chances when we could get out into the field” (8). These people are just awesome, risking their own lives to save others!
These people working in these disturbed zones are indeed awesome!! You have raised some critical points for working in the field of global health and once you read more and learn from experiences, you will find that the solutions are mired in complexities and dynamic environments. An easy answer to your question is well, safety can never be guaranteed anywhere, even in your own country. Its especially more complex in disturbed environments, war torn environments. A part of this unsafe environment has to do with US and European foreign policy and colonial legacy as well. You must have read that GPEI efforts are facing increasing resistance from religious leaders in Pakistan after the use of a doctor in a Vaccination program to track Osama. But nevertheless, going and doing humanitarian work in conflict zones is very challenging. Then there is the cultural element. How much can we outsiders really understand the local environment and not do anything "well meaning", "well intention-ed" that nevertheless is offensive to local cultural tenets. A further layer of complexity is when our humanitarian rights based work starts threatening well entrenched power structures and they respond with violence. Well, to sum up Aurelie, its not a field for the weak hearted...the path is not strewn with roses and its not as glamorous as it appears from newspapers/ videos and books. One thing is certain and I speak from experience that all said and done, the sense of satisfaction of having contributed to the well being is well worth the effort; and probably thats the reason why people keep on risking their lives...
ReplyDeleteThis is interesting...http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001529
ReplyDeleteAurelie- I completely agree with you on this topic of safety and health care workers. The factor of culture and immunizations is seen in worn-torn countries, developed countries, third world countries and everything between. You can walk down the street and find a neighbor that does not believe in immunizing their child because of they want to be natural or have heard of the autism scare. It is not surprising that other countries believe it is an effort to sterilize their children and religious group from multiplying. Rumors spread about the safety or "real" purpose of the vaccine and we are left with vaccinated children and rising disease rates. But to come back to your main point, I cannot imagine what these health workers feel on a day-to-day basis, especially in unsafe territories. I worry not only about their physical safety, but their mental health. The daily stress can be damaging to the peace of mine.
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