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Lesson From Haitian Public Health Week

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Susan J. Blumenthal, M.D., Pamela Savitz, Kate Pitts, Timothy Dempsey, Julia Liebner, and Anita Verma

A series of earthquakes have recently shaken the world, taking a traumatic toll on communities globally. More than half of the 130 cities worldwide with populations of over 1 million people are built on fault lines, making them susceptible to the calamitous impact of earthquakes, as witnessed in the recent events that occurred this Easter Sunday in southern California and Mexico as well as those that struck over the past several months . With 57 deaths following the March 8th earthquake in Turkey, 531 left dead after the February 27th quake in Chile, and an estimated 250,000 dead following the January 12th Haiti disaster, vulnerably located nations must be prepared with emergency response plans and strong public health infrastructures. Unfortunately, these natural disasters often occur in settings that are already shaken by financial instability and poor health systems. Haiti, a nation now devastated, had a weak public health system as well as a fragile economy when a 7.0 magnitude earthquake struck and shook Port-au-Prince on January 12, 2010. This traumatic event required extensive short-term emergency response efforts, but has also dramatically increased the need for health services and a strong public health infrastructure for the long term. With the United Nations Donor Conference pledging $15 billion last week, $9.9 billion of which is being allocated toward long-term reconstruction with the United States committing $1.15 billion over the next two years, it appears this urgent need will eventually be met.

The extent of Haiti’s devastation can be seen not just through the rubble, but also in the economic and public health data detailing the damage from the quake. The earthquake has been more destructive than the Indonesian tsunami of 2004 and has caused five times more deaths per million inhabitants than the 1972 earthquake in Nicaragua. It has destroyed over 75 percent of Port-au-Prince, including 250,000 houses and most government buildings, injured at least 250,000 people, and displaced 1.5 million more who are now forced to live in make-shift tent camps. The Haitian government has assessed the death toll to be between 200,000 and 250,000 people with the potential to reach or surpass 300,000.Costs related to damage from the earthquake have been estimated at $13.9 billion, twice the amount of Haiti’s annual GDP.

The earthquake has all but broken parts of this frail nation, exacerbating pre-existing conditions and creating new challenges as well. Even before the earthquake, Haiti had experienced social and health challenges in addition to facing severe economic problems. In 2006, Haiti spent just $96 per capita per year on health care (compared to the United States’ annual per capita health spending rate of $8,160), and only 1 in 50 Haitians had steady employment. In a country so impoverished, where 80% of people were indigent before the quake struck, it is easy to see how the health of Haitians has also become quite poor. Infectious diseases are the leading cause of death for infants and children in this country, and HIV/AIDS is the number one killer of adolescents and adults. As people are forced to live in crowded makeshift camps with unsanitary conditions in the earthquake’s aftermath, the threat of tetanus, typhoid, gastrointestinal infections and other water-borne communicable illnesses, such as malaria, looms dangerously close as the rainy season approaches this May. Furthermore, children, who comprise 40-50 percent of the Port-au-Prince population, are among those most at risk in disaster situations. Because their immune systems are less developed than adults, they face a range of threats, including malnutrition, acute respiratory infections, diarrhea, and susceptibility to illness resulting from a lack of availability of vaccines to protect against childhood diseases. Prior to the earthquake, only 58 percent of Haitian children under age 1 were immunized against diseases such as measles and tetanus.

The earthquake and subsequent aftershocks also had a devastating impact on Haiti’s infrastructure for safe water sources. Thus, conditions will only worsen for the 250,000 left without shelter unless a public health system is developed. Sanitation is not the only concern for Haitians now residing in tent cities with limited resources. Once nightfall arrives, women face the constant fear of rape and attack. To make things worse, the earthquake destroyed many of the rape counseling centers including Haiti’s Ministry for Women’s Affairs, which was in the midst of implementing its five-year plan to reduce violence against women. Currently steps such as the distribution of solar flashlights and rape kits, along with providing better lighting and security patrols have been implemented to protect women in the camps.

While media coverage and relief efforts often focus on immediate support to provide food, water and medical aid, interventions are also needed to prevent the spread of another kind of wound caused by the wreckage — the mental health effects of this traumatic event. The mental stress of the earthquake’s victims must be emphasized and integrated into the reconstruction of Haiti’s public health infrastructure. Hopefully, these needs will be addressed when allocations of the recently pledged $15 billion from the United Nations are prioritized and distributed. In disaster situations, three groups are particularly vulnerable and deserving of aid. The first are those who suffer from pre-existing mental illnesses such as schizophrenia, autism, mood and anxiety disorders. Their illnesses may be exacerbated when access to care and medication is lost. The second and largest group is comprised of those who may develop post-traumatic stress disorder from the devastating nature of the circumstances or whose illness is exacerbated following the event. Measures must be taken to provide these people with interventions and support. The third group consists of the immediate responders who face the horror of traumatic emergency situations and suffer from the emotional consequences of these experiences. Mental health interventions are under way with the assistance of the Pan American Health Organization (PAHO) and the World Health Organization (WHO) that are forming a working group to develop a long-term strategy for a more decentralized system of service delivery, as well as training new mental health professionals.

Another major concern in rebuilding Haiti lies with the estimated 100,000 amputees and the thousands of people with serious wound infections that could lead to amputation in the future. Since an estimated 2% of the population now has an amputated limb, the demand for prosthetics outweighs the incoming supply, and rehabilitation services are limited, innovative solutions must be developed to tackle this new public health problem for the nation. Already in place to aid amputee victims are physical therapy efforts established by Handicap International, Miami University, and Healing Hands in over half of the existing 91 hospital facilities to aid the victims. Experts have suggested establishing a large-scale prosthetic industry and rehabilitation center in Haiti.

Priorities for rebuilding a stronger Haiti start with building the foundation for a modern, sustainable public health infrastructure. The Centers for Disease Control and Prevention (CDC) has described areas of long-term focus that address the need for water and sanitation, health care, food, verifying the status of health care facilities, assisting in supporting health care services, and providing health education to the people of this distressed nation. Social and economic needs, such as building schools, churches, and health facilities, must also be addressed so that aid provides both immediate relief and also establishes the foundation for rebuilding a nation that had only a marginally functioning public health system to begin with.

Since the quake’s strike in January 2010, aid and relief efforts have found their way to Haiti with the help of several countries. An estimated $2 billion had already been pledged internationally in February before last week’s United Nations Donor Conference, which promised an additional $15 billion to provide relief efforts to Haiti. With the help of volunteers from NGO’s including the Red Cross, UNICEF, Save the Children, and other partners, over 400,000 adults and children have been vaccinated against diseases such as measles, diphtheria, pertussis, and tetanus. While cases of acute respiratory infections, acute diarrheal disease, and tetanus have been reported, as of February, the numbers do not reach epidemic standards. The World Health Organization has reported that there are currently no increasing trends in disease outbreaks, and that widespread vaccination campaigns were successful in preventing them. To combat the prospect of a malaria outbreak during the upcoming rainy season, thousands of anti-malarial bed nets have been distributed in addition to programs financed by The Global Fund to Fight AIDS, Tuberculosis and Malaria that have supplied emergency anti-malaria drugs. Long-term goals are also being considered. Last week, Haiti’s Prime Minister and 300 Haitian and international experts at the United Nations Donor Conference presented a post-disaster needs assessment that requested not only food and supplies, but also called for a reconstruction of the country’s social, economic, and health systems over the next five, ten, and fifteen years.

To truly improve the health of Haitians, the social and economic drivers of disease must be addressed. This means providing educational and occupational opportunities for all, as well as establishing a sustainable, modern public health system. The public health lessons learned from this and previous disasters such as the tsunami of 2004 should be remembered and collected to inform future emergency response efforts in other nations. The creation of a web-based global resource bank that includes best practices and protocols in disaster response for all agencies of government, in collaboration with NGO’s, outlining their roles and responsibilities, is needed in order to more effectively respond to events that might occur in the months and years ahead.

As Louis Pasteur said, “Chance favors the prepared mind.” Today as we mark the beginning of National Public Health Week 2010, let us learn from the Haitian experience to help rebuild this country as well as put in place emergency preparedness and response plans to diminish the impact of natural disasters that may occur in the future around the world.

The authors are experts from various international institutions

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…Creates Two New Offices In Govt House

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The Rivers State Governor, Chief Nyesom Wike has announced the creation of two new executive offices to guarantee efficiency and effectiveness of activities at the Government House, in Port Harcourt.
The governor’s action was made known in a statement signed by the Special Assistant on Media to the Rivers State Governor, Kelvin Ebiri in Government House, Port Harcourt, last Monday.
The terse statement reads, “To ensure activities are functioning efficiently and effectively, the Rivers State Governor, Chief Nyesom Wike has announced the creation of the Office of the Deputy Chief of Staff, Government House, Port Harcourt.
“The Deputy Chief of Staff will be in charge of the Logistics, Correspondence of the Governor and Legal Matters.
“Similarly, he has also announced the creation of the Office of the Special Adviser on Aviation”.

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Accelerating Gender Parity In Nigeria

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In virtually all societies, women are in an inferior position to men. Sex or gender determines  more rights and dignity for men in legal, social and cultural situations, These are reflected on unequal access to or enjoyment of rights in favour of men.
There are also the assumption of stereotype social and cultural roles.
In Nigeria, gender inequality has been for decades in spite of modernization and the fact that many females have done better than men in many spheres.
Analysts are convinced that gender inequality is largely influenced by religious and cultural beliefs, as some cultures and religions still hold strongly that women are the weaker vessels created mainly to be home keepers and child bearers.
Analysts are also worried that gender inequality negatively affects status in all areas of life in society, whether public or private, in the family or labour market.
Although the Global Gender Gap Report 2018 by the World Economic Forum (WEF) shows some progress amongst the 149 countries that were indexed, the progress toward closing the gender gap is slow, because it will take 108 years to close the gender gap and another 202 years to achieve parity in the workforce, according to the report.
The report benchmarks the 149 countries on their progress toward gender parity across four dimensions – economic participation and opportunity, educational attainment, health and survival, and political empowerment.
A number of initiatives have been made by corporate organisations and governmental and non-governmental organisations  to address gender imbalance in Nigeria.
One of the latest is the launch of First Women Network  (FWN) by the First Bank of Nigeria Ltd., in commemoration of the 2019 International Women’s Day (IWD).
IWD is celebrated globally every March 8 to recognise social, economic, cultural and political achievements of women.
The celebration is also a call to action for accelerating gender parity.
The global theme for the 2019 celebration is “Think Equal, Build Smart, Innovate for Change” while the theme for the social media campaign is “#BalanceforBetter”.
According to the bank, the FWN initiative is an avenue for career management and mentoring for women to enable them to balance their career with private endeavours.
The aim,  according to the bank, is to address gender gap and increase women representation in its senior and executive levels, as well as encourage women to tap into opportunities and contribute to nation-building.
The bank’s Chief Executive Officer (CEO), Dr Adesola Adeduntan,  explains that First Women Network is targeted at the banks’ staff and customers, among others.
He believes that women can achieve more if given the necessary strategic support, hoping that the initiative
will increase the bank’s productivity and profitability.
Adeduntan notes that the initiative is  also a demonstration of First Bank’s adherence to the Central Bank of Nigeria’s Sustainable Development Goals which mandate increased women representation in all banks.
The sustainable goals require that the financial services sector should adopt a quota system to increase women representation on boards to 30 per cent and that of senior management level to 40 per cent by 2014.
Adeduntan is optimistic that the FWN will address six key area –  career management, personal branding, mentoring, welfare, financial planning and empowerment.
He is convinced that the initiative will address gender disparity at the workplace.
“It is commonly agreed that gender parity is an essential factor influencing the advancement of institutions, economies and societies.
“Studies have shown that gender parity in corporations promotes increased performance and returns on investment.
“The need to invest in composite women empowerment and enhance their contributions at senior management levels to achieve organisational goals cannot be over-emphasised,” the CEO says.
For him,  it is paradoxical that the presence of women in paid employments continues to increase, yet the progression of professional women to positions of leadership and management remains slow.
“Gender gaps persist in economic opportunities and political participation in many countries.
“This is part of the reasons for this women network initiative,” he notes.
The chief executive officer wants employers of labour and the entire society to encourage women to advance, excel and contribute optimally in  workplaces and communities.
Mr Abiodun  Famuyiwa, group head, Products and Marketing Support, promises that First Bank  will continue to promote female entrepreneurship for national growth and development.
“We recognise that promoting female entrepreneurship and independence is key to economic viability of every home in the country,” he says.
 According to him, FWN is a further demonstration of the bank’s commitment to women empowerment after the launch  of FirstGem in 2016.
He is satisfied that FirstGem is providing opportunities for women to achieve their financial goals and aspirations through with access to support funds, free business advice, specialised trainings on business development and insight on business development.
For Mr Lampe Omoyele, managing director, Nitro 121, an integrated marketing communications agency,  points out that courage is important in addressing gender imbalance.
“For gender imbalance to be resolved, there has to be courage, vision, values and character,” he says.
He is convinced that women should  have courage and confidence in taking risks within  organisations.
Omoyele advises that women must not play the victims.
“Ultimately, whether you are a female or male, what is going to sustain you is your character and values.
“You need to have values; character is important in the balance that we live to, and it sustains you as you move into the future,” he adds.
The Chief Executive Officer,  Standard  Chartered Bank, Mrs Bola Adesola, wants women to take advantage of FWN to make their lives better.
 She urges women to aspire to grow in their endeavours and refuse be limited because of their gender, stressing that they should use all resources at their disposal to grow.
 For the bank chief, FWN is not a silver bullet to creating the first female chief executive officer of First Bank, but  about opportunity.
“So, it is important that as women, we take advantage of it,” she urges.
 Ms Cecilia Akintomide, independent non-executive director, FBN Holdings Plc, is dissatisfied that Nigeria is still far in gender balancing.
Akintomide says Nigerian  women are still being restricted from working in some places and owning some property.
According to her, restrictions are rendering 50 per cent of Nigeria’s population –  mainly women –  economically unviable.
 A First Bank customer,  Mrs Ifeyinwa Okoye, lauds the FWN, and urges the bank to ensure that its customers – the secondary target of FWN –  benefit from it.
Okoye describes women as critical to economic growth and development but regrets that many women were lagging behind in their endeavours because of gender inequality.
She wants the banks to enlighten its customers on FWN for maximum results.
 “If you empower a woman, you empower a nation.
“Empowering women is especially effective because the benefits are felt throughout the whole community,” she argues.
Analysts call for more strategic support for Nigerian women to  enhance gender parity.


By: Chinyere Joel-Nwokeoma
Joel-Nwokeoma is of the News Agency of Nigeria.

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Covid-19 Vaccination: Role Of Local Leaders

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It was a matter of time, but Covid-19 vaccination has already started to generate heated arguments following a hint that the Federal Government could start sanctioning anybody who refused to be vaccinated.
Dr Faisal Shuaib, Executive Director,  National Primary Health Care Development Agency, NPHCDA, disclosed this at a recent press conference in Abuja. He, however, said that implementation was dependent on availability of the vaccines.
“The Presidential Steering Committee and the Federal Ministry of Health are exploring ways of making vaccines more available to all Nigerians, including federal civil servants and corporate entities.
“Once these vaccines are made equitably available to all Nigerians, then we will need to have a frank discussion about justice, fairness and liberty that exist around vaccine hesitancy.
“So, you have a right to refuse vaccines, but you do not have the right to endanger the health of others,” he said.
Already, attempts have been made by two states – Ondo and Edo – to make Covid-19 vaccination compulsory, especially for public servants and members of the public who wish to gain access to certain places.
These places include religious worship centres, banks and public buildings.
However, those attempts and the suggestion that the Federal Government might sanction those who refuse vaccination have been criticised by some trade, professional and religious associations.
 The Nigeria Medical Association (NMA) and Joint Health Sector Union (JOHESU) that kicked against the compulsory vaccination, said that government should rather embark on advocacy and persuasion, than coerce citizens into getting vaccinated.
The spokesman for JOHESU, Mr Olumide Akintayo, said the policy would only be sensible if there were enough vaccines to inoculate eligible citizens.
Akintayo stated: “If you are thinking of it in terms of responsibility, it makes sense; but practically, we all know it is an impossible task.
“ If all the doses that have been sent to Nigeria since this outbreak is less than 10 million, how do you enforce that kind of policy in a country of over 200 million people?
“You don’t just come up with policies that are not backed by common sense; you don’t just say things because you want to talk. It would have made some sense if the vaccines are available for everyone.”
The General Secretary of the NMA, Philips Ekpe, said citizens could not be forced to be vaccinated against Covid-19 the same way they had the right to reject medical treatment.
Rather than being forced, he said Nigerians should be made to understand the need to be vaccinated. 
According to him, although they cannot be forced, citizens who refuse vaccination should stay in their houses so that they don’t endanger others.
He said: “The Federal Government needs to make people understand the reason why they need to be vaccinated. They have the right to say no. You cannot force people. People have the right to say no to medical treatment.
“But you should let them understand the dangers of not getting vaccinated.
“For example, if you want to travel out of the country, if you are not vaccinated, you will not be let in. The reason is because the other country you are going to won’t want to endanger the lives of its citizens.
“Let them understand the importance, but then if they refuse, they should stay in their houses and not go out and endanger others.”
Experts believe that properly communicating the advantages of being vaccinated, through the use of existing structures, such as religious and cultural institutions, would yield better results than subtle threats.
Communication connotes persuasion, even on occasions when the purpose of a piece of communication is not to persuade, there is still the need to win over the audience to accept the message.
In this era of fake news, and when the social media is awash with conspiracy theories against vaccination, persuasion must first be deployed to get the attention of citizens.
The burden increases tremendously when there are cultural and religious stereotypes which could prevent many adherents from accepting that being vaccinated is safe.
This challenge is not peculiar to Nigeria. In the U.S. for instance, vaccine hesitancy is responsible for over 90 per cent of all Covid-19 related hospitalisation.
Getting some Americans vaccinated has been so challenging that many people have been offered monetary incentives to convince them to get vaccinated in an unusual case of persuasion.
In Nigeria, where religious and traditional leaders are custodians of faith and culture respectively, they wield great influence on devotees and those institutions can be deployed to boost vaccination drive.
Historically, religious and traditional rulers often employ the cognitive process of persuasive communication to change an entrenched social perception or public opinion hindering required public support for relevant people-oriented policies.
Leaders have the influence to subtly appeal to the target to listen, accept, comprehend and act.
Therefore, before considering the stick, government should first explore the use of carrot.
Religious and traditional leaders can help in giving correct messages on vaccination as well as being role models, making sure that they and their loved ones too are vaccinated.
Faith-based and culture-based organisations can also collaborate with other leaders to sensitise communities on the benefits of vaccination and to also dispel the many myths and disinformation about it.
King Bubaraye Dakolo of Epetiama Kingdom in Bayelsa has been putting this practice to use, since vaccination was first rolled out in Nigeria in March.
“The arrival of the vaccine brought a huge relief to our kingdom. I mobilised my people to carry out awareness campaigns in the various communities to guard against apathy.
“My council chiefs and I led by example in being vaccinated early. When the people saw that, they were fully convinced that the vaccine is not harmful.
“We made it clear to our people through town hall meetings that the vaccine is safe and is designed to save humanity.
“We equally reminded them how some persons who refused to be vaccinated for poliomyelitis in the past are suffering the consequences of their actions today,” the traditional ruler said. 
According to the WHO Covid-19 Dashboard, Nigeria had administered 4.4 million Covid-19 vaccine doses as at Aug. 31, 2021. Out of that number, 2.9 million Nigerians have been fully vaccinated, according to the NPHCDA.
With a fairly efficient vaccination structure, owing to many years of immunisation against polio, the Nigerian government should activate collaboration with religious and traditional bodies in its vaccination drive.
Experts, including health professionals and public administrators, believe that involving these leaders in advocacy and public enlightenment will lead to more people accepting to voluntarily get Covid-19 vaccination.
Of course, with just a paltry 0.7 per cent of the population vaccinated, the key indicator for any punitive measure for avoiding vaccination will be subject to availability of the vaccines.
However, to achieve the goal of vaccinating 40 per cent of its 200 million population before the end of 2021 and 70 per cent by the end of 2022, Nigeria will need more than availability of vaccines.
There has to be the acceptance and willingness of the majority of its population to be vaccinated.
One of the crucial and effective way to achieve that is to work with religious and traditional leaders.

By: Kayode Adebiyi

Adebiyi writes for News Agency of Nigeria.

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