Pacific Community health experts conduct laboratory training for COVID-19 testing with their healthcare colleagues in Nuku'alofa, Tonga. Credit: Pacific Community (SPC)

By Catherine Wilson
CANBERRA, Australia , May 3 2022 (IPS)

Before the pandemic emerged in 2020, health services in many Pacific Island countries were under-resourced, under-funded and under-staffed. Now following recent outbreaks of COVID-19, advancing the capacity and development of health and medical services in vulnerable nations, such as Tonga and Kiribati, is increasingly urgent.

In the central Pacific atoll nation of Kiribati, virus cases have skyrocketed from zero to more than 3,000 since the beginning of the year. Meanwhile, the Polynesian kingdom of Tonga was hit early this year by a devastating submarine volcanic eruption and then a spike in COVID-19 cases.

“Ashfall and a tsunami from the volcanic eruption affected an estimated 84 percent of the population covering the whole of Tonga,” Tongan Prime Minister Siaosi Sovaleni’s office announced in late January.

In Kiribati, Margaret Leong, SPC’s Infection Prevention and Control Adviser, conducted training in the use of PPE with local healthcare staff. Credit: Pacific Community (SPC)

The deployment of health and medical experts to Tonga and Kiribati in February by the regional development organization, Pacific Community, have proven to be crucial support missions.

“Tonga is in a unique and unprecedented scenario. It is contending with a triple event: the volcanic eruption, the tsunami and COVID-19 outbreak. They are all related to one another. We are in Tonga in response to the COVID-19 outbreak, helping to ensure the quality of COVID-19 testing is maintained, aspiring to zero contamination, to support infection prevention and control,” Dr Sunia Soakai, Deputy Director of the Pacific Community’s Public Health Division told IPS from Tonga.

Tonga, an archipelago nation of 104,494 people in the southern Pacific Ocean, managed, for a long time, to stave off the pandemic, recording its first COVID-19 case only in October last year. Then on the 15 January, the Hunga Tonga Hunga Ha’apai underwater volcano, located 65 kilometres northeast of the country’s main island of Tongatapu, erupted violently, propelling massive amounts of volcanic ash into the atmosphere and triggering far-reaching tsunami waves. Many islanders were affected, either by health problems, such as breathing and cardiovascular difficulties, the loss of food sources or forced displacement.

But, as the world reached out to help, disaster recovery efforts were complicated by a spike in the pandemic. As of 20 April, Tonga recorded 9,220 cases of COVID-19 and 11 related deaths.

While Tongans receive free public healthcare, the island nation has limited health infrastructure and human resources. “We are providing support to three hospitals located on Tonga’s outer islands to boost their capacities for COVID-19 testing. That involves assisting them to collect samples and, if needed, transporting them to locations where equipment for testing is available…We’ve also been asked to conduct a thorough review of the country’s health protocols and procedures, such as handling of the deceased, quarantine requirements and procedures related to health care workers returning to work after positive diagnosis of COVID-19,” Dr Soakai described. “And we are working to ensure that other health services continue to be available to non-COVID patients.”

Local nurses dedicated to working in COVID-19 patient hospital wards in the Pacific atoll nation of Kiribati. Credit: Pacific Community (SPC)

SPC is a member of the World Health Organisation (WHO)-led multi-agency Joint Incident Management Team and provides a wide spectrum of support services, including building the capacities of health systems, improving training and qualifications of healthcare workers across the region and commissioning new medical research.

“The team that was recently deployed to Tonga was very timely. They came when there was a lot of demand in our laboratory to do tests. This was before Rapid Antigen Tests were widely used for testing. We were sending up to 500 swabs per day and this was a challenge to our laboratory,” Dr Ana Akau’ola, Medical Superintendent of the main Vaiola Hospital in Tonga’s capital, Nuku’alofa, told IPS.

Earlier in the year, Elisiva Na’ati, a dietitian from the Pacific Community arrived in the country to aid recovery efforts following the volcanic disaster. “She came when there was a need to develop nutritional proposals for the islanders who had been displaced after the tsunami,” Dr Akau’ola added.

Across the vast Pacific Ocean, containing 22 island nations and territories with a total population of about 11.9 million, the role of the Pacific Community during the pandemic is, for many islanders, the difference between life and death. Many national governments work with constrained budgets and, therefore, funding and resources for health, with specialist and full hospital services often only available in main urban centres.

Only 12 of 21 Pacific Island countries have met the global goal of 4.5 healthcare workers per 1,000 people and national health expenditure per capita in 10 Pacific nations is US$500 or less, compared to the world average of US$1,000, WHO reports. It is not just islanders suffering from the virus, but also those afflicted with other serious illnesses, such as Tuberculosis, diabetes and cardiovascular diseases, who are experiencing over-burdened health clinics and hospitals.

Since the pandemic emerged, the Pacific Community has provided countries with laboratories, medical technology and skills for the testing of COVID-19, assisted vaccination initiatives, upskilled the capabilities of nurses for greater responsibility and strengthened national capabilities to monitor emerging public health threats.

In the atolls of Kiribati, home to about 119,940 people, SPC’s medical and health professionals worked alongside local health staff, patients and international partners, such as UNICEF, WHO and Australia’s Department of Foreign Affairs and Trade, which provided funding.

The country managed to keep COVID-19 from crossing its borders until January when its first case was identified in an incoming traveller. By April 20, 2022, Kiribati had diagnosed 3,076 virus cases in the country with 13 fatalities.

“We went into the country at the peak. We came to assist with preparing the wards, to support the training of PPE use. We set up isolation centres for patients in the community because the hospital beds were all full. We also worked with airport and border control staff, helping them to use practical and effective PPE, such as disposable gowns,” Margaret Leong, the Pacific Community’s Infection Prevention and Control Adviser, who was deployed to Kiribati in February, told IPS.

“Some of the issues and challenges they had were healthcare worker fatigue and psychological stress. Staff were getting sick, so there were insufficient numbers of healthcare workers at the peak. This put stress on the remaining healthcare workers,” Leong continued.

Laboratory training conducted by the Pacific Community-led health and medical mission in February and March boosted the capacity of Kiribati health services to cope with the pressures of a surge in COVID-19 cases. Credit: Pacific Community (SPC)

At the same time, Dr Lamour Hansell led the SPC’s Clinical Care Services part of the mission, helping to manage COVID patients in intensive care. “We started up a new hospital for COVID patients, supplying new infrastructure. An old hotel was found [in Nuku’alofa] and turned into a critical care facility. The Intensive Care Unit was located in the main hotel lobby and it was one of the best I have worked in,” Dr Hansell told IPS.

The work was relentless, round the clock and demanding, but Dr Hansell had only praise for his local colleagues, who, he said, were flexible and adaptable in the face of enormous professional and personal pressures. He witnessed many moments of courage and strength in his co-workers, remembering “one of the clinicians who had to treat and manage her own grandmother who had COVID-19. It was a very humbling thing to see, very humbling and inspiring,” he emphasised.

The number of new virus cases has slowed in both countries since the beginning of April, but internal lockdown restrictions remain in place. While the Pacific Community’s in-country missions responded to the peak of the crisis, the organization is accessible throughout the year to provide virtual, logistical support and mentoring to Pacific Island nations whenever it’s needed.

IPS UN Bureau Report

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Yohei Sasakawa, WHO Goodwill Ambassador for Leprosy Elimination and Chairperson of the Nippon Foundation, thanks participants at a webinar ‘Raising Awareness about Leprosy, Role of Health Professionals at the Grassroots Level’ organized by the Sasakawa Leprosy Initiative. He is with other participants from Japan, India and Nepal in the “Don’t Forget Leprosy” campaign event.

By Joyce Chimbi
Nairobi, Kenya, Jan 20 2022 (IPS)

The human rights of people affected by leprosy are central to Yohei Sasakawa’s concept of a leprosy-free world.

Sasakawa, the WHO Goodwill Ambassador for Leprosy Elimination and Chairman of the Nippon Foundation, was speaking at a webinar ‘Raising Awareness about Leprosy, Role of Health Professionals at the Grassroots Level’ organized by the Sasakawa Leprosy Initiative.

A leprosy-free world was one where “patients and those cured of leprosy live free of discrimination and, people around them will be free of the misunderstanding, ignorance and fear that perpetuate discrimination”, he told the webinar.

Sasakawa Leprosy Initiative is a strategic alliance between WHO Goodwill Ambassador for Leprosy Elimination, the Nippon Foundation and Sasakawa Health Foundation for achieving a world without leprosy and problems related to the disease. The initiative spearheaded a campaign, “Don’t Forget Leprosy”, to raise awareness about the condition in the face of the coronavirus pandemic.

The WHO Goodwill Ambassador envisions a post-COVID world where those affected by leprosy will be liberated from such stigma and discrimination in keeping with human rights.

Sasakawa says this world is now at risk of delaying leprosy elimination due to the COVID-19 pandemic, as there was a 37 percent drop in reported new cases and leprosy programs in many countries have stalled or scaled back.

Participants heard about the role of health professionals in combating leprosy, recognition of this role and the successes and challenges faced in addressing leprosy during the ongoing health pandemic.

Their role, Sasakawa said, was a central pillar to the vision of a leprosy free world as it helps reduce transmission and disability.

An estimated three to four million people live with some form of disability caused by leprosy, also known as Hansen’s disease.

“The ‘Don’t Forget Leprosy’ is a global campaign because our voices alone are not enough. Stopping leprosy requires (the involvement of) all of us, from India and Nepal to all other countries around the world,” he said.

Dr Rashmi Shukla outlined efforts in India to identify and treat patients with leprosy. She was speaking at a webinar ‘Raising Awareness about Leprosy, Role of Health Professionals at the Grassroots Level’ organized by the Sasakawa Leprosy Initiative. Credit: Joyce Chimbi/IPS

Dinesh Basnet, Central President of the International Association for Integration, Dignity and Economic Advancement (IDEA) in Nepal, said he was happy to see progress in recent years.

“More so Nepal’s efforts to track and eliminate leprosy. Even during the pandemic, detection and treatment interventions were uninterrupted, and this has been possible due to government commitment and unrelenting efforts of health professionals,” said Basnet.

“People affected by leprosy were not forgotten as communication continued through WhatsApp groups, and this was critical during the lockdown.”

Dr Indra Napit, a senior Orthopedic Surgeon at Anandaban Hospital, Nepal, spoke about innovative technology in the trial of Autologous Blood products to promote ulcer healing in Leprosy. He added that a new drug was on trial to manage reactions to this form of treatment at this leprosy mission.

In a video message, Birodh Khatiwada, Nepal’s Minister of Health and Population, spoke of Nepal’s undisrupted program to address leprosy, including the continued supply of leprosy medication despite the pandemic.

He says Nepal has already prepared the National Leprosy Roadmap, 2021-2030, National Leprosy Strategy 2021-2025, in line with the Global Leprosy Strategy, Neglected Tropical Diseases Roadmap and the Sustainable Development Goals (SDGs).

Sasakawa emphasized that it was indeed the ultimate goal for India and other affected countries worldwide to reach zero leprosy cases by 2030.

Despite challenges in the fight to eliminate leprosy, a ray of hope shines through, with Anju Sharma sharing good practices in case finding in India amid the ongoing health pandemic.

Sharma is an accredited Social Health Activist and is considered a driving force behind India’s public health system and an essential link between the community and the public health system.

“Screening for leprosy during the pandemic is much more difficult. As COVID-19 cases increase, so does my responsibilities because I have to strictly follow COVID-19 protocols, and this takes a lot of time,” Sharma explained.

“Due to the pandemic, people are hesitant about getting screened. But I reassure them that protocols will be observed and remind them that failure to detect and treat leprosy can lead to disability.”

Dr Venkata Ranganadha Rao Pemmaraju, acting team leader, WHO Global Leprosy Programme, emphasized that discussing the role of health workers was critical, and hearing from those in the frontlines helps efforts to eliminate the pandemic move forward.

WHO, he said, subscribes to the Don’t Forget Leprosy campaign. He lauded ongoing efforts to sustain counselling for those affected by leprosy and those who tracked and managed Nepal-India cross border leprosy cases despite challenges COVID-19 protocols like restrictions on movement and lockdowns.

Dinesh Basnet, a person affected by leprosy thanked health care workers and others for their efforts in eliminating the disease. He was talking at a webinar ‘Raising Awareness about Leprosy, Role of Health Professionals at the Grassroots Level’ organized by the Sasakawa Leprosy Initiative. Credit: Joyce Chimbi/IPS

Similarly, Dr Rabindra Baskota, the Leprosy Control and Disability Management Section director in Nepal’s Ministry of Health and Population, confirmed that health workers had been relentless to find new cases, raising awareness on leprosy and treating patients despite ongoing challenges.

“Still, there is a need to train community health workers to detect new cases and manage reactions to leprosy treatment even as older and more experienced health workers retire,” he said.

Dr Anil Kumar, the deputy director-general (Leprosy) in India’s Ministry of Health and Family Welfare, who spoke about good practices in combating leprosy said that a leprosy-free India was not very far off.

Despite a notable decline in screening and detecting cases due to COVID-19, he said critical interventions were nonetheless rolled out, and that leprosy-related services continued at the grassroots level.

“Migrant labourers were screened for leprosy at point of return to home districts and patients on treatment tracked. Treatment defaulters were cross notified based on the address in treatment record,” Kumar said.

“A WhatsApp group titled Leprosy Action Group was created for cross notification, and members included state leprosy officers and partners. Supportive supervision and monitoring up to sub-district level using virtual platforms continues.”

Executive Director of the Sasakawa Health Foundation, Dr Takahiro Nanri, moderated a panel discussion that included a session to further shed light on additional support needed to achieve leprosy elimination milestones.

Sasakawa suggested that health workers’ training included human rights, and the panel lauded health workers for their passionate and proactive steps to eliminate the disease.

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There is a critical shortage of qualified healthcare staff in Malawi to deal with the growing mental health burden in the country. Credit: Charles Mpaka

By Charles Mpaka
Lilongwe, Malawi, Dec 13 2021 (IPS)

When a former deputy speaker of Parliament shot himself dead within the National Assembly buildings in Lilongwe in September 2021, it shook Malawi. It also turned attention to the mental health burden in the country.

Experts say that a sharp rise in suicide cases has become the most visible expression of the burden of mental health challenges in Malawi.

“There’s depression, stress and many other silent forms of disorders. More often, we act quickly on a mentally challenged person because he is causing havoc,” says Harry Kawiya, a psychiatric clinical officer at the Zomba Mental Hospital, Malawi’s only referral mental health facility and one of the two specialised institutions in the country. “But the rising of cases of suicides recently tells us the severity of the mental health problem among us, which we are not adequately addressing.”

National police records show that suicide cases have increased drastically in Malawi over the past three years. For instance, between January and March 2021, the country registered 76 suicides – an increase of nearly 50 percent over the same period last year.

One police station in Lilongwe registers an average of six cases every month, the station’s spokesperson, Foster Benjamin, tells IPS.

“This is a steep rise, and it’s worrying,” he says. “The reasons [why people are committing suicide] range from family disagreements to financial troubles. In almost all the cases, those that kill themselves are men.”

The former deputy speaker, Clement Chiwaya, 50, left a suicide note detailing frustrations with sorting out benefits, including an official vehicle which he had bought, as the reason.

In a village just outside Lilongwe, a man hanged himself around last year due to debts related to his small-scale tobacco farm.

His wife, Christina Makwecha, says she lost her 43-year-old husband in October 2020 after the tobacco marketing season had just closed.

“We made heavy losses such that we could not pay some of the debts for labourers and the inputs we got from agro-dealers,” says Makwecha, a mother of four children.

One evening on her return from a village savings group meeting in the area, she found the man hanging in a tree in a field not too far from their home.

“It was then that I remembered that for almost two weeks before the incident, he had become increasingly restless, unusually angry and started skipping meals,” she says.

While the country is registering a rising number of suicides, many Malawians lack the awareness of mental health disorders that lead to people killing themselves, says Dr Charles Masulani, Chief Executive Officer of the St John of God Hospitaller Services Ltd, a Catholic Church mental health hospital in Malawi.

“Just as people would know where to go when they have malaria because there is a lot of knowledge about malaria, we do not know about mental health disorders in Malawi. So, people tend to struggle within themselves without seeking help from counsellors, faith leaders or therapists, or any other who would offer help,” Masulani says.

Records at the hospital show that it registered 7,671 mental health patient consultations last year – including 4,142 men and 3,529 women.

The mental health disorders diagnosed included anxiety, bipolar disorder, psychosis, dementia, delusional disorder, depression, delirium, epilepsy, hippomania, antisocial personality disorder, learning disability and schizophrenia.

Experts say that the COVID-19 impact on businesses has worsened the high prevalence of mental health disorders in Malawi, and the government’s response has been falling short.

In 2017, the Office of Ombudsman investigation found glaring deficiencies in mental health management in the public health system.

It faulted the government for failing to fund district health offices adequately for them to be able to handle patients before sending them to the referral hospital.

The Ombudsman also blamed the Ministry of Health for the persistent acute shortage of psychiatric staff, which compromised the quality of care for patients with mental disorders.

The inquiry established, for instance, that in two districts in the central region, the mental healthcare worker to population ratio ranged between 1:80,840 and 1:558,470.

According to the report, the problem of staff shortage starts with how the training for doctors in Malawi is designed.

“Whilst the undergraduates are exposed to the different aspects of the medical profession including psychiatry, during the internship psychiatry is completely shunned thereby further depriving [the system of] additional and potential psychiatric staff,” reads the report.

The investigation further exposed inefficiencies in the procurement of psychotropic drugs for patients with mental disorders, leading to their unavailability most of the time.

Four years after the investigation, these challenges remain.

During the commemoration of World Mental Health Day in October, Dr Michael Udedi, a mental health expert in the Ministry of Health, admitted the critical shortage of specialised personnel in the public health system.

He said while the country does have some mental health clinicians and nurses in almost every district hospital of the country, there is only one psychiatrist based at Zomba Mental Hospital and no psychologist in public hospitals.

He also disclosed that in May this year, the Ministry of Health advertised vacancies to recruit psychologists; there was no response.

In addition, there is no dedicated budget for mental health, Udedi told IPS in an interview last week.

“Therefore, it is not easy to track the funding for mental health per se,” he says.

He, however, says the ministry does disburse some funding to the referral hospital. He also says it falls on district health offices to dedicate part of their funding from treasury towards mental health activities such as drug procurement.

In her report, the Ombudsman attributed the apparent lack of attention to mental health as a primary healthcare problem to a weak and old legislative framework.

The treatment of patients with mental disorders is catered for in the Mental Health Act passed in 1948 – when Malawi was still under British colonial rule.

“This law is out of touch with the current trends in mental health service delivery,” reads the report.

In 2000, Malawi developed its first National Mental Health Policy. But this too has had no significant impact on mental health service delivery. The policy has, thus, been under review.

Now the government hopes that the challenges in the sector will be addressed once a bill, currently being drafted, is tabled, and passed in Parliament, possibly in February next year.

The Mental Health Bill has a provision for ring-fenced mental health funding. According to Udedi, this is key to addressing most of the challenges in mental health.

“This will see to it that mental health is adequately funded. This would have an implication on human resources for mental health, that’s including support in training,” he says.

But Udedi also challenges communities to play their part in raising awareness, minimising stigma and discrimination towards people with mental health problems and linking such people with service providers for assistance.

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Quality, safe, gender-responsive and inclusive education for Africa’s children increasingly out of reach, say experts. Credit: Joyce Chimbi/IPS

By Joyce Chimbi
Nairobi, Nov 24 2021 (IPS)

Kenya’s secondary schools’ administration has been in the eye of a storm since schools reopened in October 2021. Since then, students have set on fire 35 schools and counting, forcing the government to announce an unscheduled break from school – ahead of the planned December 23 closing.

Sarah Kitana, a secondary school teacher in Kathiani, Machokos County, tells IPS that fewer students are in classrooms after a year of COVID-19-driven disruptions and the ensuing prolonged out-of-school period. This is even more evident in rural areas.

“Those that returned are finding it very difficult to cope with the new fast-paced learning to make up for the lost time. Secondary school students take on eight to 13 subjects. Some schools have their students waking up at 3.00 am to be in class by 4.30 am and to end the day at 10.45 pm,” she says.

“These are efforts to help bring some normalcy to a disrupted, restructured and shortened academic calendar. It will take up to January 2023 for Kenya’s school calendar to regain some normalcy.”

Pre-COVID Africa and more so, sub-Saharan Africa was already off-track to achieve Sustainable Development Goal 4 to “ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.”

In 2019, UNESCO’s Institute for Statistics indicated that of all regions, sub-Saharan Africa has the highest rates of education exclusion, as, over one-fifth of children between ages six and 11, one-third of 12 to 14-year-olds and 60 percent of those aged 15 to 17 were not in school.

In July 2021, UNICEF announced that at least 40 percent of all school-aged children across Eastern and Southern Africa were out of school due to COVID-19 and other pre-pandemic challenges facing the persistently fragile education system.

UN data shows there are at least 15 countries with active armed conflict in sub-Saharan Africa. Civil war, adolescent girls’ pregnancies, child marriages, access challenges due to disabilities, climate change-induced displacements, COVID-19 economic shocks will only increase the number of out of school children, says Josephat Kimathi, an educationist at Kenya’s Ministry of Education.

Missing out on education can have lifelong impacts. Save the Children’s July 2020 forecasts suggested that children, at that time out-of-school due to pandemic-driven school closures, could lose out on $10 trillion in earnings.

In 16 out of Kenya’s 47 counties, a baseline survey by UNICEF found that more than 27,500 children with disabilities were out of school.

Not only has an entire generation’s education disrupted in the history of humanity, Kimathi says quality, safe, gender-responsive and inclusive education for Africa’s children is increasingly out of reach.

“In comparison, Kenya is a fairly stable country. But the fact that 1.8 million children and adolescents aged six to 17 years are out of school. Another 700,000 small children, aged four to five years, cannot access early childhood interactive opportunities to prepare them for entry into primary school speaks volumes about less stable nations,” Kimathi tells IPS.

One in four children in Africa live in conflict zones. A new analysis by Save the Children of 12 countries at extreme risk of increased school dropouts show that apart from Afghanistan, Pakistan and Yemen, the rest are African countries, including Cote d’Ivoire, Guinea, Liberia, Mali, Chad, Niger, Mauritania, Nigeria and Senegal.

Across Africa, Kimathi says, the poorest children in rural, drought-stricken, minority and marginalized communities will suffer the most from the devastating effects of the pandemic.

Grace Gakii, a Nairobi-based gender expert, says the pandemic is already pushing even more girls out of Africa’s education system. At least one million girls in Africa may never return to school, according to a 2021 report by the Mo Ibrahim Foundation.

Pre-COVID, nine million girls between six and 11 years, compared to six million boys of the same age, living in sub-Saharan Africa will never go to school, according to UNESCO.

Gakii speaks of escalating challenges in arid, semi-arid and pastoralist communities to enrol and retain girls in school and fears losing gains made.

Elangata Enterit boarding primary school in Kenya’s pastoralist community of Narok South is a perfect example of success. In 2007, the school did not have a single girl sit for the crucial and compulsory Kenya Certificate of Primary Education (KCPE).

With intervention, the number of girls sitting for KCPE rose to 30 students in 2016 and continues to grow.

Despite 42 countries in Africa providing free and compulsory primary school education and the Africa Union Member States striving to invest at least 20 percent of their domestic budget in education, before COVID-19, UNESCO data shows that 100 million children were out of school in sub-Saharan Africa.

In July 2020, Save the Children estimated that the pandemic-driven “recession will leave a shortfall of $77 billion in education spending in some of the poorest countries in the world over the next 18 months.”

Kimathi says that Africa will need context-specific education plans to help build resilience against shocks to an already weak education system to get back on track. It will also need money to implement the action plans. Finally, it will require proactive measures to keep children safe and systems to track and ensure that the continent stays on course.

He lauds Kenya’s efforts to accelerate the implementation of the right to education for all children.

This includes the ongoing ‘Operation Come to School Programme’ targeting 16 rural Counties notorious for out-of-school children.

This, he says, is critical to achieving SDG 4, especially in light of dire predictions by UNESCO estimating that 50 percent of children in sub-Saharan Africa will not complete secondary school education by 2030.

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In many countries reporting mental health issues is frowned upon – even though statistics show there is a massive need for therapy and support. This illustration is by Dilselekhika Prerna explores mental health and identity. Credit: Fuzia.com

By Fairuz Ahmed
New York, Nov 18 2021 (IPS)

“I was told to wait and cry it out. How could I explain to them that I have been crying for years? That was not the solution,” asks Azra Zeng, a divorced mother of four in an interview with IPS. “I wanted to speak to someone. I wanted to seek help where I could feel whole again. It felt that I was dying from inside, but no one could see.”

Zeng was trying to make a living and look after her children while fighting a one-woman battle with mental health issues.

She was the sole breadwinner, and her parents also depended on her. Depression and mental health issues plagued her, but due to social stigma associated with mental health issues, she could not seek help from counsellors.

“My parents were lecturers at universities, I was earning, but I could not seek help. My boss told me that it shows me as weak at work, and my record will be marked negatively if I mention that I feel depressed at times. After trying to cope for four years, I left my job and moved to another country with my children. The first thing I did was to seek therapy from a licensed professional, and now after two years, I feel alive and thriving.”

Mental health awareness and making therapy, counselling normalized and unstigmatized is a massive step for many countries, cultures and demographics.

According to an article published in Kaiser Family Foundation on February 10, 2021, one in ten adults surveyed before the pandemic reported anxiety and depressive disorder symptoms in the United States.

In 2018, over 48,000 Americans died by suicide. The numbers skyrocketed during the pandemic, and nearly eleven million adults reported having serious thoughts of suicide in 2019, and 47 million people reported having any mental illness.

A 2019 study by a British charity, Mental Health Research U.K., found that 42.5 percent of India’s corporate sector employees suffer from depression or an anxiety disorder.

The number of people reaching out for help or reporting mental health issues is not the same globally. The low-income countries and higher-income countries have massive gaps in treatment facilities, support systems, and acceptance. This is also highly influenced by cultural beliefs, norms and social acceptance.

Juniper Barua, a counsellor, working with underprivileged communities and minorities in New York for the last nine years, says, “it has been incredibly difficult to explain to parents of youth that it is acceptable to seek out counselling.”

In an exclusive interview with IPS, she said that spouses and parents often see mental health as taboo.

“They speak of how they feel and getting treatment. Counselling or even text support during a triggering phase is deemed negative. I have seen hundreds of patients who requested to keep the service secret and gave other excuses while coming to my office. Cultural and religious biases also play a major role in opening up.”

Center for Disease Control and Prevention (CDC) surveyed adults across the U.S. in late June of 2020. U.S. adults reported considerably elevated adverse mental health conditions associated with COVID-19. About 31% of respondents reported symptoms of anxiety or depression, 13% reported having started or increased substance use, 26% reported stress-related symptoms, and 11% reported having serious thoughts of suicide. It was also alarming that younger adults, racial and ethnic minorities, essential workers, and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance usage, and elevated suicidal ideation.

Fuzia’s co-founder Shraddha Varma says, “it is interesting to notice that most people focus on physical health when it comes to health. But when it comes to mental health, there is not much awareness. We at Fuzia understand that going through a rough time alone can make things difficult. Through our ‘Fuzia Wellness’ initiative, community support groups and paid counselling sessions, we want to stand by as a friend, sister, guide and companion”.

Fuzia.com has more than 5 million followers and an active user base on Facebook, Instagram, Twitter, and LinkedIn. Fuzia uses its extensive global presence to create a safe and creative space for users. For World Mental Health Day in October, Fuzia held many support sessions, drawing competitions, supporting podcasts and blogs. It used creative avenues where users could seek information about mental health, learn ways to cope, ask for help, and express themselves in a safe and judgment-free way.

Fuzia’s co-founder Riya Sinha says, “there may be off days and days when you feel like the world is crumbling down. You need to seek help from family and experts for well-round mental and physical health. As a social media platform supporting female health, we want to be there for you for your emotional and mental wellbeing. Academics, relationships, careers or other issues can be hard to deal with, and we are there for you to cope”.

In many countries, mental health is stigmatized, and because of this, people are hesitant to seek help. Innovative awareness building, ways to connect online and offline, involvement in workshops, educational institutes, workplaces and communities can promote mental health awareness.

A teenager currently in therapy, Laibah Ahmed, comments that she finds it extraordinarily comforting when celebrities speak of mental health issues.

“I have seen superstars like Park Jimin of BTS speak freely of his insecurities, saying that he felt shrunk to a room, felt hopeless, and everything was falling apart during the #BTSLoveMyself campaign by UNICEF. This gave me hope. Many of my friends and I got inspired to seek mental health support and open up about our needs. I am now seeking youth counselling through a New York-based NGO. It is great to be able to speak without judgment and have a safe space.”

The CDC states, it has been noticed that helping others is a coping strategy that can reduce the mental health impacts. Spreading messages of support by the Government and making mental health accessible can curb many issues later. Online portals like Fuzia, local NGOs, volunteers and influencers can create a significant impact in making mental health services accessible to the masses.

• This article is a sponsored feature.

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Korea is one of the world's top economies. Yet, behind the success, many feel alienated. Does the recent hit show Squid Game, reflect the underbelly of the society's success? Credit: Ori Song/Unsplash

By Ahn Mi Young
Seoul, Nov 16 2021 (IPS)

Immediately after its release, the Squid Game went viral, grabbing the attention of the world’s entertainment stage. The grotesque and hyper-violent thriller has reportedly become Netflix’s biggest show, the world’s most-watched and the most-talked-about streaming entertainment. Is it a case of art imitating life?

The global rise of Korean entertainment is reminiscent of South Korea’s rags-to-rich story. The once war-stricken country with per-capita GDP of 67 US dollars after the 1950-53 Korean War has become one of the world’s top economies with a per-capita GDP of 32,860 US dollars in 2020.

South Koreans enjoy high-tech conveniences, and many of their enterprises are sought after internationally, including home electronics, vehicles and ships.

Despite the COVID-19 pandemic, success stories abound about its business, technology or entertainment industries.

K-pop BTS is now a global star who often tops the Billboard charts. A few years ago, it was unthinkable that Korean entertainment could surpass the content produced in the United States.

Squid Game has become a global success. Is it a case of art imitating life?

“The Squid Game has become a hope for our students to go to the global stage,” Kim Sang-Hoon, a professor at Cheju Halla University who teaches future talents video-making or filmmaking or broadcasting, told IPS.

However, the storyline suggests that success is not the only parameter with which to measure Korean society. Squid Game is a story of the “losers” who dropped out from the success story.

The hero, Gi-Hoon, was in debt after losing his job and squandering his money on a horse-racing game. He got divorced and missed his ten-year-old estranged daughter. Sang-Woo was once a brilliant stockbroker but went broke after gambling away his money.

The drama director Hwang Dong-Hyeok told local media: “In fact, I used to be one of the losers.”

He elaborated that “as a boy of a single-mother at the backstreet of Seoul, I used to be a boy at the back street spending almost the whole day playing the games (all of which) appear in the Squid Game”.

Although many more South Korean people live the “most affluent life” ever in the country’s history, many people feel like they are playing the squid game, where a few winners take all at the expense of many losers.

In the Squid Game, an elderly character Ilnam said to another character, Gi-Hoon, while playing marbles: “Cheating on others is OK, but being cheated, is not OK?”

This soundbite is one that many South Koreans identified with.

“I felt thrilled when I heard this because it sounds like our reality,” said Ko June-Ho, a South Korean fan and a university student told IPS. He added he identified with so much in the story. “When the elderly character Il-Nam met Ki-Hoon after the squid game, Il-Nam said: ‘Life here (outside the game) is more hellish (than the life I spent in the squid game)’.”

In the death game, the losers are separated from their family, friends and community. Like Sae-Byok, a North Korean woman defector struggles to rebuild her lost family connections but all in vain. Or, Ali, a worker from Pakistan, is in debt because his Korean employer didn’t pay him. Even the elderly character Il-Nam, the Squid Game host, is wealthy but misses his old family ties. He tells Gi-Hoon: “I used to live with my family”.

Some experts say that the squid game losers are like South Korean losers, who feel isolated from the glory story.

Ironically, South Korea, one of the world’s most affluent countries, records one of the world’s top suicide rates. South Korea’s suicide rate in 2020 was the average of 25.7 suicides per 100,000 persons, compared with the Organisation for Economic Co-operation and Development (OECD) countries average of 10.9 suicides.

While technology businesses, like the online selling platform Coopang, have become successful during the COVID-19 pandemic, restaurant owners were forced to shut down because of regulations. The impact is clear.

Dr Park Chanmin, Seoul Central Mental Health Clinic, reflects this in a recent interview here.

“Since the start of the pandemic, people have become more and more worried about their jobs, they are seeing their incomes falling, and that is having an impact on their day-to-day lives.”

Asia Nikkei reported that a study by the Korea Economic Research Institute found that sales by independent merchants were down 78.5% in the first half of the year from the same period in 2020, with 58% of respondents attributing the decline to COVID.

Sanjog Lama, a Nepali student who studies hotel management in South Korea, believes the show was excellent.

“The cast and crews have done such an outstanding job. On top of that, the content of the series is just superb. It is thrilling, many scenes are gruesome, yet there is meaning in it.”

Another South Korean fan, Lee Ji-Hyeon, said: “The drama was like a puzzle game. I felt thrilled as I was putting the pieces of actors’ talk and each scene together so that I kept thinking about what it means and how it will be related to the next move.”

However, even in the extreme death game, the underlying warmth of the South Korean traditional culture is reflected.

The thriller’s punch line, with “Kkak-Ttu-gi” or “Kkan-Bu”, demonstrates Korean culture. The elderly Il-Nam says to Gi-Hoon: “Let’s make ‘Kkan-Bu” friendship between two of us.”

Kkan-Bu is a life-long friendship that lasts unchanged regardless of whether a person is a loser or a winner. Some characters made decisions that touched the heart of the fans.

Gi-Hoon did not give up their heart even in the live-or-die moment. Ji-Young gives up her life to let her game partner Sae-Byok can win the game. Even the hardened heart of the elderly Il-Nam softens as the senior and becomes friends with warm-hearted Gi-Hoon.

Another female character Mi-Nyo said: “They call me Kkak-Ttu-gi” In Korean children’s games.”

Kkak-Ttu-Gi shows how Korean culture values human connection. Even though the player is poor and cannot contribute, the team won’t kick them out.

There is irony in the money matters. Even though Gi-Hoon emerges as the winner of the game, grabbing $40 million, his life did not change. When he returns home after the game, he finds his mother dead. He remains a divorced, lonely man. Even though he has the prize in his bank account, he doesn’t spend it. Instead, he borrows Won10,000 from a banker and gives it to a street flower-selling woman.

“The drama makes me think about what matters in my life. People risk their lives for money, which turns out to be no solution,” said South Korean fan Lee Ji-Hyeon.

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COVID-19 lockdowns and restrictions meant that many informal sector traders lost their jobs. Not eligible for compensation, some have turned to sex work. Credit: Marko Phiri/IPS

By Marko Phiri
Bulawayo, ZIMBABWE , Nov 4 2021 (IPS)

Thirty-six-year-old Thandiwe Mtshali* watched helplessly as her informal cross-border trading (ICBT) enterprise came to a grinding halt when the Zimbabwean authorities closed the border with South Africa as part of global efforts to stem the spread of the deadly novel coronavirus.

“That was last year, and I had no idea what to do next,” Mtshali told IPS.

Before the lockdown, she made up to four trips each month to Musina and Johannesburg in neighbouring South Africa to buy goods ranging from clothes to electrical appliances for resale in Bulawayo, Zimbabwe’s second city.

And by her account, the money was good.

“I could rent a full house in the suburbs, and my long-term plans have always been to build my own home,” she said.

After months of being idle in Bulawayo, a colleague tipped her about what appeared to be an easy route out of her money troubles: truckers had not been banned from transporting goods between South Africa and Zimbabwe.

As truckers got stuck at the Beitbridge border post for weeks waiting to get their consignments processed by port authorities, it presented a new venture for informal cross-border traders such as Mtshali: sex work.

Today, Mtshali, who has two young children back in Bulawayo, rents a small shack in the border town where she “entertains” truckers and other men willing to pay for sex.

Commercial sex work is illegal in Zimbabwe, but COVID-19 has turned the sector into a necessity for many women who were made redundant by lockdown measures imposed by the government because of public health concerns.

“I do not want to do this, but it is better than sitting and waiting,” Mtshali said.

“My kids are with my mother, and all they know is that I am working in Beitbridge. As long as I send them money and groceries, they don’t need to know anything else,” she told IPS.

Local residents, however, complain that despite the lockdown restrictions that banned travel across cities, there appeared to be an influx of sex workers to the border town, each seeking to make a living.

“We have always had a problem here with sex workers, young and old competing for clients. But now we see even more after borders closed,” said Dumisani Tlou, a resident and taxi driver.

“Every tenant knows they can rent any available backroom to the women who entertain truckers and other illegal dealers, but no one seems to be doing anything about it,” he told IPS.

While the Zimbabwean authorities have made efforts to provide bailout stipends for informal traders, this has been criticised for being too little to improve the lives of millions on the fringes of official economic activity.

Many more, like Mtshali, missed out on the bailouts because they are not registered with any informal traders’ association.

“There is a need to consider special exemptions that will allow cross-border traders to import goods during the lockdown and border closures,” said Fadzai Nyamande-Pangeti, International Organisation for Migration – Zimbabwe spokesperson.

“It is also important for women cross-border traders to formalise their businesses, to make them less likely to be impacted by shocks caused by the pandemic,” she told IPS.

However, for many here at the border town, sex work comes with challenges.

While borders were closed in line with public health safety measures, this has exposed sex workers to concerns about HIV/Aids.

“These women have no social protection or insurance or any other mitigation measures to cushion them in times of disasters such as the current pandemic,” said Mary Mulenga, a representative of the Southern Africa Cross-border Traders Association (SACBTA).

In a submission to the UN Special Rapporteur on Health ahead of the UN General Assembly in October, the Global Network of Sex Work Projects (GNSWP), which brings together sex worker-led organisations across ninety-six countries, says, “during the pandemic, there has been a (global) drop in the availability of HIV treatment services due to the prioritisation of treating and stopping the spread of COVID-19.”

“As a result, sex workers living with HIV have experienced even greater challenges in accessing HIV treatments, further endangering their health and ability to work,” the network says in its brief to the UN.

Truckers have for years been identified as an HIV/Aids high-risk group in southern Africa, raising concerns among campaigners, such as the GNSWP, that while resources are being directed toward addressing the spread of COVID-19, both old and new entrants into the sex trade such as Mtshali are being left out.

According to the UN’s International Organisation for Migration (IOM), informal cross-border trade accounts for up to 40 percent of southern Africa’s intra-trade estimated USD17 billion annually. Still, border closures have upended this due to COVID-19.

Despite these disruptions brought by the novel coronavirus, the once-thriving informal cross-border trade could present more public health concerns: an increase in those living with HIV/Aids.

In recent months, Zimbabwe’s First Lady Auxillia Mnangagwa launched countrywide self-sufficiency projects for sex workers. Still, with the industry continuing to take in new entrants such as Mtshali, it could be a race against daunting odds as global health experts see no easy end to COVID-19.

• The Pulitzer Centre supported this story.
• Name changed to protect identity.

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