Rural women in El Salvador participate in a literacy class in the Santa Rosa canton of the municipality of Sensuntepeque, in the northern department of Cabañas. Education authorities in this Central American country have done very little to continue with programs that teach adults to read and write, especially in rural areas. CREDIT: Edgardo Ayala / IPS

By Edgardo Ayala
SENSUNTEPEQUE, El Salvador , Sep 4 2023 (IPS)

El Salvador’s efforts to improve the educational level in the country seem to be falling short, with rundown schools, especially in rural areas, and little progress in overcoming illiteracy.

In almost a decade, this Central American country of 6.7 million inhabitants has moved just two percentage points in its fight against illiteracy, going from 11.8 percent in 2013 to 9.7 percent in 2021, the last year with available official data.

Illiteracy is higher in rural areas: 15.2 percent. And among people over 60 years of age the rate is 45.7 percent"Sometimes I would go to the offices in the town of Ilobasco, and I felt bad when I saw signs with messages written on them and I couldn't understand the words." -- Carmen Molina

Literacy efforts in the freezer

Even more worrisome is the suspension in the last three years of the government’s adult literacy program in rural areas, people involved in this effort told IPS.

“It is worrying, the literacy program ceased to exist,” Verónica Majano, executive director of the non-governmental Association of Popular Education (CIAZO), told IPS.

Her organization has been working on literacy programs since 1989, during the country’s 1980-1992 civil war.

And now CIAZO is perhaps the only organization that still runs adult literacy programs in rural areas of the country.

Other institutions that carried out similar projects have given up because they say the education authorities have abandoned the national effort.

“It is not only stagnation, it is a setback; the COVID-19 pandemic affected initial, basic, middle and higher education, but right or wrong it has continued. But in literacy nothing is happening,” Majano stressed.

The cancellation or suspension of the government’s Literacy Program has become evident, she said, since Nayib Bukele became president in June 2019.

She added that the effort to teach reading and writing to those who did not have the opportunity to go to school, or who had to drop out for one reason or another, had previously continued regardless of which government was in power, left or right.

She was referring to the administrations of the right-wing Nationalist Republican Alliance, which governed for four terms between 1989 and 2009, and those of the leftist Farabundo Martí National Liberation Front, which was in power for two terms between 2009 and 2019.

The United Nations Educational, Scientific and Cultural Organization (UNESCO) has pointed out that acquiring and improving literacy skills throughout life is an intrinsic part of the right to education and brings enormous empowerment and many benefits.

“Literacy drives sustainable development, enables greater participation in the labor market, improves child and family health and nutrition, reduces poverty and expands life opportunities,” the UN agency states.

According to UNESCO, a country can be declared free of illiteracy if less than 3.9 percent of the total population over 15 years of age is illiterate.

It has also stated that illiteracy is another form of modern slavery.

However, it notes that despite the progress made worldwide, 763 million adults still do not know how to read and write.

The hands of an elderly woman fill in a primer with which she is learning to read and write. Most of the women who participate in the literacy circle in Santa Rosa canton, in northern El Salvador, are over 60 years old. But that has not discouraged them from continuing to learn, despite the fact that some have vision problems and getting their eyes examined and buying glasses involves a cost that many cannot afford. CREDIT: Edgardo Ayala / IPS

Academic Óscar Picardo told IPS that part of the problem in El Salvador is that, historically, the arrival of each new government has meant a change of strategy and vision on how to promote education in general and literacy programs in particular.

This has generated discontinuity with some of the achievements or progress made by the previous authorities, he said.

“The country and the Ministry of Education have had a recurring problem that is still present, which is the absence of state policies,” said Picardo, director of the Institute of Science, Technology and Innovation, of the private Francisco Gavidia University.

He added; “The education system works with government policies, and every five years the whole system is rebooted, the minister changes and plans change, priorities change, but the major problems remain intact.”

The expert pointed out that if progress is to be made in education, and in particular in reducing illiteracy, the problem of school dropouts, caused by poverty and the insecurity generated by gangs, must be tackled.

According to official figures, 1.3 million people aged four to 29 (47.4 percent) reported not attending school in 2022.

The poverty rate stands at 26.6 percent of the population, but in the countryside the figure rises to 29.6 percent.

Picardo stressed that the so-called “war against gangs” waged since the end of March 2021 by the Bukele administration, which has succeeded in largely dismantling the operations of these criminal groups, is likely to lower the dropout rates and this is already reflected in the figures for the next school year.

“Of course, if the dropout rates decrease due to improved security that would be very positive; hopefully we will see statistics in that regard,” Picardo said.

The “mano dura” or iron fist strategy against the gangs, known here as “maras”, although it has largely dismantled the criminal activity of these groups, has also generated a dynamic of human rights violations and abuses by police and military authority that have been denounced by local and international human rights organizations.

With an average schooling of only 7.2 grades, it will be difficult for the Salvadoran populace to pull out of poverty and for the country to find foreign investment that offers better paying jobs, said the expert.

In El Salvador there are three grades of initial education, up to seven years of age on average. These are followed by nine grades of basic education, up to the age of 15, and three more of middle school, up to the age of 18. Schooling is considered compulsory until the completion of basic education.

Most other Central American countries face a similar problem to El Salvador, Picardo added, although Costa Rica has always shown better development in the educational and social areas, in general, and is the only country in the sub-region declared free of illiteracy.

The Salvadoran government has made a commitment to reducing the technological gap, with the distribution of thousands of laptops to elementary and high school students, which is an important achievement.

But the Bukele administration has also been criticized for the low level of investment in improving the conditions of most of the more than 5,000 schools in the country, especially in rural areas, and in remedying the deficiencies in teaching.

Blanca Velazco, a schoolteacher, shared with IPS the difficulties she faces every day in teaching essential knowledge to her kindergarten and first grade students, who share the same classroom at the Santa Rosa canton school in the municipality of Sensuntepeque, in the northern Salvadoran department of Cabañas.

“My first graders should be reading better by now, but I’ve had a hard time teaching them, because they are together with the kindergarteners, and that shouldn’t be the case,” said Velazco, 47.

She added that at 10:30 AM the kindergarteners leave and she only has 45 minutes to teach the first graders Language Arts and Math.

“”Forty-five minutes are not enough,” she stressed. In the afternoon, she also teaches fourth grade.

Livestock and small-scale and subsistence agriculture are the main economic activities in the canton of Santa Rosa, in the jurisdiction of Sensuntepeque, in northern El Salvador. CREDIT: Edgardo Ayala / IPS

Winning the battle against illiteracy

In this canton, where some 50 families live, the Association of Popular Education, CIAZO, is organizing five literacy circles aimed at adults, mostly women, who want to win the fight against illiteracy.

Official figures reveal that of those who cannot read or write in El Salvador, 14.4 percent are women and 7.7 percent are men.

One of the literacy circles is made up of a dozen peasant women over the age of 60. Half of them were present when IPS visited the area on Aug. 28, and several of them are visually impaired due to their age, but they are not giving up.

“Sometimes I would go to the offices in the town of Ilobasco, and I felt bad when I saw signs with messages written on them and I couldn’t understand the words,” said Carmen Molina, 66, as she worked on a primer, writing words and solving simple addition and subtraction equations.

She said that as a child she attended school but only got as far as the second grade, and what little she learned was forgotten over the years.

“I didn’t want to go anymore,” she explained, because she had to take breakfast to her father and siblings to the milpa – the traditional agricultural system that intermingles corn with beans and vegetables. “And then coming all the way back to school was very hard,” she said.

She got up the courage to go to the literacy circle because some of her younger children would ask her what to write on their assignments.

“Some have a harder time learning than others, but in general they have advanced quite a bit, little by little,” said Flor Echeverría, 30, who has been teaching in the circle since the beginning of 2023.

Echeverría commented that she herself only studied up to the eighth grade and did not want to finish ninth grade, the last grade offered at the school she attended.

“At that time the facilities to go to school didn’t exist, everything was even more complicated,” she said.

“It’s nice to dedicate time to share knowledge with people who did not learn to read or write,” she said.

Although some men participate in the literary circle, such as Julio, Carmen’s son, the vast majority are women who have come to understand that learning to read and write is in itself an act of rebellion and also of liberation.

A student at the Hazi Ibrahim Government Primary School in Bangladesh’s capital, Dhaka, raises her hand in response to her teacher’s questions. Credit: Shafiqul Alam Kiron/IPS

By Kanya D'Almeida
UNITED NATIONS, Apr 10 2015 (IPS)

If you are reading this article, consider yourself one of the lucky ones; lucky enough to have received an education, or to be secure in the knowledge that your child will receive one. Lucky enough to be literate in a world where – more often than not – the ability to read and write can mean the difference between a decent life and abject poverty.

In the 15 years since the landmark World Education Forum in Senegal’s capital Dakar laid out six ambitious education targets agreed upon by 164 governments, a lot has changed.

“There are still 58 million children out of school globally and around 100 million children who do not complete primary education." -- UNESCO
For one thing, 34 million more children have attended school as a result of policies rolled out under the Education for All (EFA) initiative; the number of children out of school has been halved since the year 2000; and many countries have made great strides towards bringing as many girls into classrooms as boys.

But dig a little deeper and the good news gives way to a bleak reality. According to the most recent EFA Global Monitoring Report released Thursday by the United Nations Educational, Scientific and Cultural Organisation (UNESCO), “There are still 58 million children out of school globally and around 100 million children who do not complete primary education. Inequality in education has increased, with the poorest and most disadvantaged shouldering the heaviest burden.

“The world’s poorest children are four times more likely not to go to school than the world’s richest children, and five times more likely not to complete primary school,” the report stated, adding, “Despite all efforts by governments, civil society and the international community, the world has not achieved Education for All.”

Six goals: A mixed report card

Given the vast spectrum of cultures, economies and political ideologies represented by the 164 governments in Dakar in 2000, the six targets agreed upon reflected some of the most urgent and universal challenges facing the world today: early childhood education and care; universal primary education; youth and adult skills; adult literacy; gender equality; and the quality of education.

Although the pre-primary school enrolment rate has improved by two-thirds since 1999, and the primary net enrolment rate is set to reach 93 percent by the end of the year, the fact remains that one in six children in low or middle-income countries – roughly one million kids in total – will not be in school at the time of the 2015 deadline.

Only 69 percent of countries studied will have achieved gender parity at the primary level by 2015, a number that falls to just 48 percent for secondary education. Although governments agreed in 2000 to halve the global illiteracy rate by 2015, a four-percent reduction is all that has so far been achieved.

Katie Malouf Bous, a policy advisor for Oxfam International based in Washington DC, told IPS the results of the monitoring report showed “a mixed bag, very uneven across different countries.”

She stressed that the widening of inequalities in education access and outcomes was a worrying trend, adding that there is an urgent need to “redouble investments in public education and make sure those investments are being targeted at the right communities and children.”

According to a March 2015 UNESCO policy paper, “The annual total cost of achieving universal pre-primary, primary and lower secondary education in low and lower-middle income countries is projected to increase from 100 billion dollars in 2012 to 239 billion dollars, on average, between 2015 and 2030.”

The policy brief went on to say that “the total annual financing gap between available domestic resources and the amount necessary to reach the new education targets is projected to average 22 billion dollars between 2015 and 2030.”

This funding gap proves that most governments are failing to allocate the required 20 percent of national budgets, or four percent of annual gross national product (GNP), on education.

Asia-Pacific: Is the region pulling its weight?

According to Oxfam’s Bous, “One of the things we’re really worried about is the trend we see of the state pushing some of its responsibilities on to the private sector, and focusing on low-cost private schools or public-private partnerships to deliver education.”

“We believe this is only deepening educational inequalities, particularly in the Asia region, where a lot of donor-driven initiatives are supporting low-cost private schools, which are basically profit-making schools that charge fees from poorer families […],” she explained.

Home to four of the world’s six billion people, the Asia-Pacific region is rife with inequality, a situation that will only worsen unless governments take the necessary steps to educate this massive population. Currently, one-third of all students between six and 18 years of age in South Asia attend private rather than public schools.

A 2015 study by the United Nations Children’s Fund (UNICEF) revealed that over 40 percent of all out-of-school adolescents live in South Asia, with Pakistan alone accounting for one-half of that figure.

In a 2014 regional report tracking progress on Education for All, UNESCO noted that five of the so-called E-9 countries, defined as the world’s most populous developing nations, were in Asia: Bangladesh, China, India, Indonesia, and Pakistan.

Together, they accounted for some 45 percent of the total global enrolment in primary education and 80 percent of the Asia-Pacific region’s total enrolment in 2009, according to UNCEF.

While these states have made great strides in bringing children into the classrooms, they account for millions of out-of-school youth, most of whom will never receive a proper education.

This has major implications for the economic health of the entire region, which already hosts 64 percent of the world’s illiterate adults – roughly 497 million people as of 2014.

While 10 countries in the region have achieved universal (99 percent or more) participation in primary education, with nine countries on track to achieve the goal by the end of the year according to UNESCO, survival rates remain a challenge, with nations like Bangladesh, Cambodia, Lao PDR, Myanmar, Nepal, Pakistan and the Solomon Islands experiencing difficulty in retaining students up until the last year of primary school, let alone ensuring that they will enroll in – or complete – a secondary education.

As the U.N. moves closer to finalising its Sustainable Development Goals (SDGs), education experts around the world are pushing urgently for policies that direct all necessary funds, energy and action into the classrooms – where the futures of many developing nations will either be made or broken in the coming decade.

Edited by Kitty Stapp

Maximina Velasco reviews a reading and writing lesson in her home, as part of the literacy programme that made the town of Tapalhuaca, El Salvador, an illiteracy-free zone. Credit: Edgardo Ayala /IPS

By Edgardo Ayala
TAPALHUACA, El Salvador, Jan 8 2015 (IPS)

At the age of 74, Carmen López has proven that it’s never too late to learn. She is one of the 412 people in this small town in central El Salvador who recently learned to read and write.

“I was sad that I couldn’t write a letter or a receipt. But now I’m happy because I can,” she told IPS at the ceremony where Education Ministry authorities declared Tapalhuaca, population 4,000, an illiteracy-free zone.

A place is declared free of illiteracy when 96 percent of the inhabitants have learned to read and write. In the case of this small town in the department or province of La Paz, the proportion is even higher: 97.7 percent.

Like López, Maximina Velasco, 61, feels she broke through the barrier of ignorance when she signed up for the literacy course.“It’s a historic debt; for a long time, a majority of the population has been marginalised from education.” -- Maydé Recinos

“When I was a little girl, I started school. But I didn’t finish first grade because the teacher would hit me, and made me feel terrible,” she said, while writing out vowels and consonants during one of the classes she takes in her home, as part of a system that provides both group and one-on-one teaching.

She was forced to cut the class short because she had to cook lunch for her family – a problem shared by many of the women taking part in the literacy programme.

The literacy worker, 16-year-old Yanci Cubías, is one of the 130 volunteers teaching in this farming town. She spends two hours a day, a total of 10 a week, helping adults learn to read and write.

“At first it was hard to gain the trust of the people I was teaching, but in time everything went well, and it has become an unforgettable experience,” Cubías said.

Illiteracy became a serious problem in this impoverished Central American country of 6.2 million due to decades of social injustice that deprived a majority of the population of an education, especially in the countryside, where they worked as hired labour on coffee and cotton plantations belonging to the rural elite.

“It’s a historic debt; for a long time, a majority of the population has been marginalised from education,” activist Maydé Recinos, with the Salvadoran Foundation for Social Promotion and Economic Development (Funsalprodese), told IPS.

Her organisation forms part of the Salvadoran chapter of the Latin American and Caribbean Council for Popular Education (CEAAL).

Both López and Velasco, who have dedicated themselves to raising their children and helping their husbands in rural activities, have managed to overcome a hurdle still faced by many women in the country: for decades illiteracy has affected women more than men, because of a sexist culture.

The Salvadoran government’s National Literacy Programme has taught 200,000 people to read and write since 2009. That has brought the illiteracy rate among people over the age of 10 down from 17.9 percent in 2009 to 11.8 percent in 2013, according to the 2013 multi-purpose household survey.

Of that 11.8 percent, women represent 7.3 percentage points and men 4.5 points.

But in rural areas, the illiteracy rate stands at 18.9 percent, with women accounting for 11 percentage points and men 7.9.

The gender disparity “is due to the ‘machista’ culture. Dads used to say: boys should go to school and girls should do the housework,” the head of the Education Ministry’s literacy department, Angélica Paniagua, told IPS.

López remembers how, when she was a girl, her parents enrolled her in school, but she often missed class because they forced her to do housework.

“I liked school, but they left me at home alone to do the housework,” she said, “so I missed a lot of classes, and they finally pulled me out.”

Things will improve for women as the government puts a higher priority on education, especially in terms of expanding access to primary school and ensuring that children complete it, said Mirna Lemus with the Intersectoral Association for Economic Development and Social Progress (Cidep).

In its third and last report on compliance with the Millennium Development Goals (MDGs), a set of global anti-poverty and development targets to be met by 2015, the government reported in early 2014 that primary school coverage increased from 86 percent in 2000 to 93.1 percent in 2012.

But the school dropout rate, especially in rural areas, remains higher among girls than among boys, according to the 2013 household survey.

The reduction of illiteracy is considered significant, but still insufficient to reach the MDG education targets.

The second MDG, achieving universal primary education, sets the specific targets of universal primary school enrollment and completion of sixth grade, and 100 percent literacy among 15 to 24 year olds.

“We still have a ways to go to reach the goals, but with the efforts we are making, we think the country is going to make more progress in the next five years,” said Paniagua.

The education authorities project that El Salvador will be declared free of illiteracy in 2019, the last year of the government of Salvador Sánchez Cerén, a former left-wing guerrilla commander and former teacher who became president in June.

Civil society organisations agree that reducing illiteracy by seven percentage points is an important achievement. But they say a bigger effort is needed, especially in terms of funding.

The spokespersons for Cidep and Funsalprodese said seven percent of GDP should be spent on education, but the proportion remains stuck at 3.3 percent as a result of the government’s tough financial straits.

“That is still insufficient to cover the country’s huge education needs,” said Funsalprodese’s Recinos.

Meanwhile, Maximina Velasco told IPS, with her face lit up by a big smile, that she is sure she will keep alive her interest in reading and writing, and that she will never return to the illiteracy that kept her so blind for most of her life.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

‘Copyists’ (transcribers) on duty in downtown Kabul. Some 66 percent of Afghans are illiterate, with figures reaching 82 percent among women. Credit: Karlos Zurutuza/IPS

By Karlos Zurutuza
KABUL, Sep 26 2014 (IPS)

Seventy-year-old Mohamad Arif still earns a living in the streets of Kabul. He prepares all kind of documents for those who cannot read or write – in other words, the majority of people in this country of 30.5 million people.

“I was a Colonel of the Afghan Air Force but I can barely survive with my pension. I had no other choice but to keep working so I took this up 10 years ago,” Arif tells IPS during a short break between two clients.

"People usually want me to write a letter to a relative, often someone in prison. However, most show up because they need us to fill out official forms or applications of all sorts." -- Seventy-year-old Mohamad Arif, a transcriber in Kabul
Arif says he has two sons in college, and that he only leaves his post on Fridays – the Muslim holy day. He spends the rest of the week sitting in front of the provincial government building, in downtown Kabul. That’s where he has his umbrella and his working desk, also essential tools for the rest of the transcribers lining up opposite the concrete wall that protects the government compound.

“People usually want me to write a letter to a relative, often someone in prison. However, most show up because they need us to fill out official forms or applications of all sorts,” explains the most veteran pen-worker in this street, just after his last service, which earned him 50 afghanis (0.80 dollars) for a claim over a family inheritance not yet received.

In its National Literacy Action Plan, statistics provided by the Afghan Ministry of Education speak volumes: some 66 percent of Afghans are illiterate, with figures reaching 82 percent among women.

At 32, Karim Gul is also illiterate so he’s forced to come here whenever he needs to tackle an administrative process. The problem this time is that he sold a car but he has not yet been paid.

“My parents came to Kabul from Badakhshan [a north-eastern Afghan province] when I was a child but they prevented me from going to school. They said the other children would laugh at me,” recalls this young Tajik, who thinks he is “already too old” to learn how to read and write.

Customers like him need only wait a few minutes before they’re attended to. The copyists – fifteen in total here – are experts in their trade, but probably none more so than Gulam Haydar, a 65-year-old man who has worked for decades behind the high wall.

‘Copyists’ (transcribers) in Afghanistan can earn up to one dollar for each letter or document they prepare for their illiterate customers. Credit: Karlos Zurutuza/IPS

“I was a civil servant until I retired eight years ago but I had to keep working to survive,” this Kabuli tells IPS. His age, he adds, does not allow him to conduct any physical work, so this alternative came as “holy salvation.”

“Prices for all of us range from 20 to 100 afghanis [0.30-1.7 dollars] depending on the request,” explains Haydar, adding that his monthly income varies accordingly. In any case, he says, the amount he receives helping his illiterate countrymen and women is “far better” than the average 203 dollars an Afghan civil servant gets monthly.

Sitting next to him, Shahab Shams nods.

“I just get enough to survive and to send my two children to school,” says this 42-year-old man, who has spent the last 13 years in his post.

“In Afghanistan there is no work for anybody. Besides, corruption is rife,” adds the copyist. “You constantly need to pay under the table for everything: to get your passport or any other official certificate; to enrol your children in school; in hospitals, in every single government building,” laments this man with a degree in engineering from the University of Kabul. It was never of any use to him.

Starting from scratch

According to a joint survey conducted by the Afghan High Office of Oversight and Anti-Corruption (HOOAC) and the United Nations Office on Drugs and Crime (UNODC), half of all Afghan citizens paid a bribe in 2012 while requesting a public service.

The 2012 study said most Afghans considered corruption, together with insecurity and unemployment, to be “one of the principal challenges facing their country, ahead even of poverty, external influence and the performance of the Government.”

Interestingly enough, such surveys also reveal that corruption is increasingly being considered an admissible part of day-to-day life. About 68 percent of citizens interviewed in 2012 said it was acceptable for a civil servant to top up a low salary by accepting small bribes from service users (as opposed to 42 per cent in 2009).

Similarly, 67 percent of the Afghan citizenry considered it “sometimes acceptable” for a civil servant to be recruited on the basis of family ties and friendship networks (up from 42 percent in 2009).

Leyla Mohamad had no chance whatsoever of ever becoming a civil servant. While it is no longer strange to come across female workers in the administration, illiteracy still poses an insurmountable hurdle. From under her burka, Mohamad explains she wants to denounce an assault she suffered in broad daylight, while she was accompanied by her three children, the oldest being just 10 years old.

“Every day we hear several cases like this one,” Abdurrahman Sherzai tells IPS after filling Mohamad’s form. “Too much time was lost in the failed election process and the economy has stalled because many companies and businesses depended on government subsidies. Eventually, sheer desperation leads to attacks against the most vulnerable [members] of society,” notes Sherzai, moments after being paid for the service.

After a presidential election that took place on Apr. 5, followed by a second runoff on Jun. 14, a fraud allegation forced a full ballot recount.

However, contenders agreed to share power on Sept. 21 so Ashraf Ghani was announced as the new Afghan president with his challenger, Abdullah Abdullah, joining him in a unity government. Despite the two runoffs and the painful audit process, no results of any kind will finally be published.

It was the Afghan Education Minister himself, Ghulam Farooq Wardak, who assured IPS that “none of this would have happened” were Afghanistan a fully literate country.

“But also bear in mind that we literally started from scratch, with a 95-percent illiteracy rate only 12 years ago,” the senior official underlined from his ministerial office.

But current statistics, he claims, lead to optimism. “We’ve gone from just a million children in school 12 years ago to nearly 13 million today; from 20,000 teachers to over 200,000,” asserted Wardak, adding that 2015 “will be the year for full school [enrolment], and full literacy in Afghanistan will be a reality in 2020.”

Edited by Kanya D’Almeida

Rukia (in the foreground) recovers after a successful fistula operation at Malalai Maternity Hospital in Kabul (August 2014). Credit: Karlos Zurutuza/IPS

By Karlos Zurutuza
KABUL, Sep 2 2014 (IPS)

“The smell of faeces and urine isolates them completely. Their husbands abandon them and they become stigmatised forever” – Dr Pashtoon Kohistani barely needs two lines to sum up the drama of those women affected by obstetric fistula.

Alongside the health centre in Badakhshan – 290 km northeast of Kabul – Malalai Maternity Hospital is the only health centre in Afghanistan with a section devoted to coping with a disease that is seemingly endemic to the most disadvantaged members of the population: women, young, poor and illiterate.

“Given that a caesarean birth is not an option for most Afghan women, the child dies inside them while they try to give birth. They end up tearing their vagina and urethra,” Dr Kohistani told IPS. “Urinary, and sometimes faecal incontinence too, is the most immediate effect,” added the surgeon as she strolled through the hospital corridors where only women wait to be seen by a doctor, or just come to visit a sick relative.“Pressure mounts on them from every side, even from their mothers-in-law. They have to hear things such as `I had five children without ever seeing a doctor´. Many of these poor girls end up committing suicide” – Dr Nazifah Hamra

They are of practically all ages. Some show obvious signs of pain while others look almost relaxed. In fact, they are in one of the very few places in Afghanistan where the total lack of male presence allows them to uncover their hair, take off their burka and even roll up their sleeves to beat the heat.

According to Nazifah Hamra, head of Malalai´s Fistula Department, “malnutrition is one of the key factors behind this problem. You have to bear in mind that women from remote rural areas in Afghanistan always eat after the men. Girls often don´t get enough milk and essential nutrients for their growth. And add to it that they only get to see a doctor when they marry, and usually at a very early age.”

Dr Hamra told IPS that she attends an average of 4-5 patients suffering from a fistula at any one time. Rukia is one of the two recovering in an eight-bed ward on the hospital´s second floor.

“I was 15 when I got married and 17 when I got pregnant,” recalls the 26-year-old woman from a small village in the province of Balkh, 320 km northwest of Kabul.

“When I was about to give birth, I had a terrible pain but the road to Kabul was cut so I was finally taken to Bamiyan, 150 km east of Kabul.”

Sitting on the bed carefully in order not to obstruct the catheter that still evacuates the remaining urine, Rukia tells IPS that her son died in her womb. An unskilled medical staff only made things worse.

“What the doctors did to her is difficult to believe. She was brutally mutilated,” said Dr Hamra, adding that medical negligence was “still painful common currency” in Afghanistan.

In a 2013 report on the risks of child marriage in Afghanistan, Human Rights Watch claims that children born as a result of child marriages also suffer increased health risks, and that there is a higher death rate among children born to Afghan mothers under the age of 20 than those born to older mothers.

Brad Adams, Asia Director at Human Rights Watch, called on Afghan officials to end the harm being caused by child marriage. “The damage to young mothers, their children and Afghan society as a whole is incalculable,” Adams stressed.

Rukia´s husband left to marry another woman so she had no other choice but to move back to her parents´ house, where she has lived for the last nine years. But even more painful than her ordeal and the defection of her husband, she says, is the fact that she will never be a mother.

Dr Hamra knows Rukia´s story in detail, as well as those of many others in her situation. “Pressure mounts on them from every side, even from their mothers-in-law,” she told IPS. “They have to hear things such as `I had five children without ever seeing a doctor´. Many of these poor girls end up committing suicide.” However, preferring to look towards the future, she said that Rukia will do well after the operation.

“From now on she´ll be able to enjoy a completely normal life again,” stressed the surgeon, who also wanted to express her gratitude to the UN Population Fund (UNFPA) which “seeks to guarantee the right of every woman, man and child to enjoy a life of health and equal opportunity.”

Annette Sachs Robertson, UNFPA representative in Afghanistan, briefed IPS on the organisation´s action in the country:

“We started working in 2007, in close collaboration with the Afghan Ministry of Public Health. We train surgeons and we provide Malalai with the necessary equipment and medical supplies. Thanks to this initiative, over 435 patients have been treated and rehabilitated at Malalai Maternity Hospital and we have plans to extend the programmes to Jalabad, Mazar and Herat provinces,” explained Robertson, a PhD graduate in biology and biomedical sciences from the University of Harvard.

“You hardly ever see these cases in developed countries,” she added.

According to a 2011 report on obstetric fistula in six provinces of Afghanistan conducted by the country’s Social and Health Development Programme (SHPD), “the prevalence of obstetric fistula is estimated to be 4 cases per 1000 (0.4 percent) women in the reproductive age group. 91.7 percent of women with confirmed cases of obstetric fistula cannot read and write while 72.7 percent of fistula patients reported that their husbands are illiterate.”

“Twenty-five percent of women with fistula reported that they were younger than 16 years old and 67 percent reported they were 16 to 20 years old when they had got married. Seventeen percent of women with fistula reported that they were younger than 16 years old when they had their first delivery. Twenty-five percent of women with fistula reported that they developed the fistula after their first delivery, while 64 percent reported prolonged labour.”

Meanwhile, thanks to yet another successful operation, Najiba, a 32-year-old from Baghlan – 220 km north of Kabul – will soon be back home after suffering from a fistula over the last 14 years.

Born in a remote rural village, she was married at 17 and lost her first son a year later, after three days of labour. Despite the fistula problem, she was not abandoned by her husband and, today, they have six children.

“I was only too lucky that my husband heard on the radio about this hospital,” explains Najiba, with a broad smile hardly ever seen among those affected.

(Edited by Phil Harris)

Many pharmacies and herbalists in Egypt prescribe their own 'wasfa' (secret drug or herbal elixir). Credit: Cam McGrath/IPS

By Cam McGrath
CAIRO, Aug 10 2014 (IPS)

Magda Ibrahim first learnt that she had endometrial cancer when she went to a clinic to diagnose recurring bladder pain and an abnormal menstrual discharge. Unable to afford the recommended hospital treatment, the uninsured 53-year-old widow turned to what she hoped would be a quicker and cheaper therapy.

A local Muslim sheikh claimed religious incantations, and a suitable donation to his pocket, could cure the cancer. But when her symptoms persisted, Ibrahim consulted a popular herbalist, whose wasfa (secret drug or herbal elixir) was reputed to shrink tumours.

“I felt much better for a few months and thought the tumour was shrinking,” she says. “But then I got much worse.”

When she returned to hospital the following year, tests revealed that the tumour was still there, and the cancer had spread to her lymph nodes. Moreover, the herbal mixture she was taking had caused her kidneys to fail.“Successive [Egyptian] governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery” – Dr Ahmad Bakr, Egyptian health care reform lobbyist

Egypt is a “minefield” of bad medicine, says paediatrician Dr Ahmad Bakr, a health care reform lobbyist. He says successive governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery.

“Our health care system is deeply deformed,” Bakr told IPS. “It’s not just a matter of low funding and corruption, ignorance (pervades every tier of) the health system, from government and doctors to the patients themselves.”

He says Egypt’s lax regulation and poor enforcement has created room for unqualified doctors to perform plastic surgery out of mobile clinics, peddle snake tonic on satellite television, and dabble dangerously in reproductive health.

It is estimated that one in every five private medical clinics in Egypt is unlicensed, and thousands of medical practitioners are suspected of using false credentials or having no formal training.

“There are a lot of so-called doctors who practise medicine in Egypt,” says Bakr. “They mostly work out of small clinics, but you’ll even find them in the most prestigious hospitals.”

The incompetency goes all the way to the top.

In February, Egypt’s military announced it had invented a device to remotely detect hepatitis C – along with acquired immunodeficiency syndrome (AIDS), swine flu and a host of other diseases. The device, which is said to work by detecting electromagnetic waves emitted by infected liver cells, is based on a fake bomb detector marketed by a British con artist.

The military also claimed that it had invented a revolutionary blood dialysis machine that can cure hepatitis C, AIDS and even cancer in a single treatment.

“I was shocked when I saw these incredible claims were being made with barely any clinical evidence,” says Dr Mohamed Abdel Hamid, director of the government-run Viral Hepatitis Research Lab (VHRL). “With any new medical treatment you should perform peer-reviewed, double-blind clinical trials before announcing it.”

Critics say Egypt’s government contributes to a climate of medical irresponsibility. State media routinely exaggerates health threats and feeds public hysteria, while the knee-jerk reactions of government authorities – including high-ranking health officials – are coloured by popular sentiment and political motives.

Reacting to the global swine flu pandemic in 2009, overzealous parliamentarians passed a motion to slaughter all of Egypt’s 300,000 pigs.

There was no evidence that pigs transmitted swine flu to humans, nor had the virus been detected in Egypt. But officials, swayed by the Islamic prohibition on eating pork, appeared to seize the opportunity of a like-named virus to rid the Muslim-majority nation of its swine.

“The pigs were kept almost exclusively by poor Christian zebaleen (rubbish collectors), who used them to digest the organic waste,” says Milad Shoukri, a zebaleen community leader. “Thousands of families lost their livelihoods to this absurd decree, which had no scientific basis.”

Global pandemics such as severe acute respiratory syndrome (SARS), avian flu and the latest contagion, Middle East Respiratory Syndrome (MERS), have presented golden opportunities for Egypt’s myriad quacks and swindlers to fleece the uninformed masses.

“With each health scare we see the same patterns,” says Cairo pharmacist Amgad Sherif. “People panic and throw science out the window. The low level of education and high illiteracy among Egyptians makes them susceptible to believe even the most ridiculous medical claims.”

When a swarm of desert locusts descended on Cairo, enterprising charlatans took out ad space in local newspapers offering a “locust vaccine” to anxious citizens.

Not surprisingly, the injected serum, which turned out to be tap water dyed with orange food colouring, offered no protection against “locust venom”. But it did leave duped households poorer, and at risk of blood contamination or hepatitis C infection from jabs with unsterilised needles.

“The people doing this only care about getting money from people who don’t know any better,” says Sherif. “They know nothing about medicine and do not follow even the most basic hygiene practices.”

In one popular scam, people claiming to be state health officials troll low- and middle-income neighbourhoods offering costly “preventative medicine” for infectious diseases. The fake medical personnel, dressed in lab coats and wearing official-looking badges, administer bogus vaccinations to unsuspecting families.

“Sometimes they give people injections – who knows what’s in them,” says Sherif.

Health officials say the sham physicians create confusion that affects legitimate health campaigns, such as Egypt’s national door-to-door polio eradication campaign.

Egyptian authorities have also found themselves in a cat-and-mouse game with thousands of “sorcerers”, whose superstition-based folk medicine draws desperate working-class patients suffering physical and psychological ailments. The self-proclaimed doctors and faith healers are particularly difficult to catch, say prosecutors, because they tend to work out of rented apartments and advertise mostly by word of mouth.

An Egyptian judicial official told pan-Arab newspaper Al Arabiya that despite attempts to prosecute sorcerers for swindling and fraud, most cases are dropped when the sorcerers reach a settlement with their victims. “There is almost one sorcerer for every citizen,” he concluded.

(Edited by Phil Harris)

School children in the Eastern Highlands Province of Papua New Guinea. Credit: Catherine Wilson/IPS

By Catherine Wilson
SYDNEY, Jul 7 2013 (IPS)

Many Pacific Island nations are celebrating the success of rising school enrolment rates, with 14 members of the 16-member Pacific Island Forum on target to meet Millennium Development Goal 2: achieving universal primary education by 2015.

But a closer look inside the classroom, and in communities surrounding these schools, reveals a shockingly low literacy rate.

Two organisations – the Asia South Pacific Association for Basic and Adult Education (ASPBAE) and Papua New Guinean Education Advocacy Network (PEAN) – teamed up to assess the impact of formal education on people between the ages of 15 and 60 years in the Madang Province of Papua New Guinea, a southwest Pacific Island nation of just over seven million people.

“There is very little exposure to books in the home and in schools, and many children do chores to supplement family income after school, so they have no time to read." -- Lice Taufaga, lecturer at the University of the South Pacific, Fiji.
Their findings suggest that so-called strides in education have not yielded much concrete success: the literacy rate in the national languages of English and Tok Pisin was just 23 percent, with many students unable to read or write after completing primary education.

Similar findings have been reported in Melanesian countries throughout the southwest Pacific region:  in 2011, ASPBAE surveyed 1,475 people aged over 15 years in the Shefa Province of the South Pacific nation of Vanuatu, and discovered that while 85 percent declared they could read and write a simple letter in the official languages of Bislama, French or English, individual testing confirmed that only 27.6 percent were literate.

Vanuatu boasts a primary enrolment rate of 88 percent, and although 90 percent of respondents had experienced some formal education, only 40 percent completed primary school.

In the Solomon Islands, an archipelago nation located southeast of Papua New Guinea, the government has claimed remarkable recovery from a five-year-long civil war (1998-2003), with primary school enrolment at 91 percent. However, poor school facilities in rural areas and disinterest in formal learning have been cited as contributing factors to a critically low literacy rate of 17 percent.

While 97.7 percent of the 2,200 people surveyed by ASPBAE in the capital, Honiara, and in Malaita Province agreed that it was important for children to attend school, 53.8 percent of females and 37.6 percent of males, aged 15 to 19 years, were not in education.

“The issue of low literacy is prevalent mainly with those who are learning in a language other than their primary one,” Lice Taufaga, lecturer at the school of education at the University of the South Pacific, Fiji, told IPS.  “Literacy is best learnt in one’s primary language, yet most learners in South Pacific countries are expected to achieve it in English, the language of business and administration.”

Taufaga added that there were also cultural challenges, as the solitary activity of reading was not always encouraged or supported in many communal-oriented Pacific societies.

“There is very little exposure to books in the home and in schools, and many children do chores to supplement family income after school, so they have no time to read,” she said.

The linguistic diversity of the region, which contains a population of 10 million and one fifth of the world’s languages – plus European languages introduced during the colonial era – makes literacy a complex issue.

In Melanesian countries, there are hundreds of commonly used local vernacular languages, many of which are only oral. These are used by 88 percent of the population in Vanuatu, while 60 percent claim to utilise the national languages of Bislama, English or French in everyday communication.

Yet low literacy also extends to national indigenous languages, with a World Bank study last year in the Polynesian South Pacific state of Tonga concluding that only three in 10 students who had engaged with three years of primary education were able to read fluently enough in either English or Tongan to comprehend content.

More than a decade ago Pacific educationalists began rethinking the legacy of introduced western curriculums and claiming a priority for Pacific languages and cultures within the education process.  However, the reality is that a bilingual approach remains, with English and French perceived as necessary for engaging in a global world.

“The long term impacts of low literacy levels in English and French are a key concern because much of the information about development is only available in English or French, hence a higher level of literacy in these languages will enhance transfer of technology, information and knowledge at all levels of society,” Rex Horoi, director of the Foundation of the Peoples of the South Pacific told IPS, although he is supportive of translation into vernacular languages.

“It is critically important that Pacific people have direct access to information relevant for their sustainable livelihoods and improvement of life in the language they understand and communicate in…” Horoi emphasised.

Government budgets do not appear to be the main issue, although their allocation raises questions about the delivery of quality education.

According to the World Bank, 23.7 percent of Vanuatu’s government expenditure is allocated to education and this rises to 34 percent in the Solomon Islands, compared to approximately 16.1 percent in New Zealand and 13.5 percent in Australia.

However, up to 90 percent of Pacific Island education budgets are committed to teachers’ salaries, with little funds left to develop education systems, infrastructure and resources.

Inadequately qualified teachers are another issue, especially in light of evidence that only 29 percent of teachers in the Solomon Islands and 54 percent in Vanuatu are trained.

According to Taufaga, many “who are teaching English lack the proficiency to model or teach it well.”  She also pointed out that urban class sizes in the region can be as large as 40 to 50 students and most schools cannot afford suitable books for reading.

Remote students remain the most disadvantaged, with poor education facilities and lack of basic materials plaguing rural communities. In Papua New Guinea, similar to the neighbouring Solomon Islands, approximately 80 percent of schools do not have libraries.

“People keep talking about quality education,” a school graduate named Niniu Oligao told IPS in Honiara. “I believe in people reading books in order to be able to write in full sentences and be exposed to meaningful ideas.”

Oligao is so concerned about the repercussions of the absence of a library in the Takwa Community Primary and High School, an institution of 2,000 students based in the North Malaita Province, that he has taken it upon himself to build a collection of donated books. Though he has no funding, he hopes this initiative will form the beginnings of a library for students’ research.

Addressing poor literacy now is vital to improving students’ chances of completing secondary and tertiary qualifications and empowering Pacific Islanders to contribute to social and economic development, whether at the local, national or regional level.

Radio Mahananda, a local station, helps farming communities in Bangladesh to share research and best practices on crop production. Credit: Naimul Haq/IPS

By Naimul Haq
CHAPAINAWABGANJ, Bangladesh, Feb 21 2013 (IPS)

The sun is just beginning its descent as a knot of farmers gathers around a small, portable radio in the grounds of the Nachol Pilot High School in Bangladesh’s northwestern Chapainawabganj district, about 300 kilometres from the capital, Dhaka.

The voices of Kauser Ali and Dhiren Karmakaur — two farmers from Nachol who are sitting in a studio about 15 kilometres away from the crowd of eager listeners – come in clearly on the airwaves, welcoming their remote audience to ‘Krishi O Jibon’ (Agriculture and Life), a daily programme on Radio Mahananda.

The anchor begins by playing a popular song known as Gambhira, a blend of folk music performed in the native dialect by local artistes, before launching the farmers into a discussion about a common problem among this community of roughly 5,000 agriculturalists: pest attacks on maize crops.

I had a pest attack in my mustard field two years ago. Last season I avoided that by seeking advice in advance from experts who discuss these problems live on the air.” - Habibur Rahman, a local farmer in Bangladesh.
“The feeling here is absolutely electric,” says the anchor, Selim Kabir, a local farmer who uses this radio show to promote crop production in Chapainawabganj.

“Gambhira enlightens farmers about various aspects of agriculture,” Kabir told IPS, “so, we chose to use it throughout our programme, which delivers important messages and hosts live discussions on best practices to solve farm-related problems.”

Radio Mahananda, launched last April, has today become an indispensable communication tool in an almost entirely agriculture-dependent region, where illiteracy rates are as high as 50 percent.

The long fingers of development have not yet reached this part of the country, hundreds of miles from Bangladesh’s bustling industrial centres, where there is little infrastructure and few plans to build any.

Chapainawabganj lies partially within the 7,780-square-kilometre Barind region, an arid expanse of land located in northwestern Bangladesh. Here, extreme weather brought on by climate change has made crop production a huge challenge.

Characterised by an exceptionally high population density, Barind is also forced to contend with severe drought in the summer months, inadequate rainfall during the monsoon season, excessive withdrawal and depletion of groundwater, gradual loss in soil moisture and progressive deforestation.

In a bid to confront these challenges, the government set up the Agriculture Information Service (AIS), which resulted in the establishment of over 1,000 farmers’ clubs – each with between 30 and 50 members — in all 64 districts, to facilitate regular exchanges of information about boosting crop production and adapting traditional growing and planting cycles to a changing climate.

A group of farmers in northwestern Bangladesh tune into ‘Agriculture and Life’, a radio show on farming. Credit: Naimul Haq/IPS

Now, with the help of Radio Mahananda, the government initiative is having an even greater impact.

The rural community station reaches a 17-kilometre radius and helps farmers share their own crop research with listeners and even invites farmers to participate in studio discussions on capacity development, cultivating improved varieties of seeds, promoting use of organic fertilisers, using less water for irrigation and improving yields.

Ahmed Moin, producer of the 30-minute-long Krishi O Jibon show, told IPS, “Over 60 percent of our programmes are focused on developing agriculture. We use the benefits of radio transmission to build awareness and overcome crop production crises.”

Earlier this year, in response to massive popular demand, Radio Mahananda introduced another special programme – ‘a masher krishi’, meaning ‘agriculture this month’, which focuses on cultivating seasonal crops.

“We have seven hours of daily programmes,” Hasib Hossain, chief executive officer of Radio Mahananda, told IPS, “and since Chapainawabganj is an important agricultural zone we design our programmes to maximise benefits to local farmers.”

Radio shows typically begin after three p.m. to enable farmers to gather together at the end of the workday and tune in live. The programmes are interspersed with useful tips on how to avoid pest attacks or use drought-resistant seeds.

Television is a rare luxury in this part of the country, and a high illiteracy rate among farmers makes it almost impossible to disseminate agriculture-related news and information in print – the radio shows offer an excellent alternative to farming communities, who can even tune in using their cell phones.

Habibur Rahman, a local farmer and regular listener from Delbari village, told IPS, “We certainly benefit from listening to the radio programmes. For instance, I had a pest attack in my mustard field two years ago. Last season I avoided that by seeking advice in advance from experts who discuss these problems live (on the air).”

Farmers are encouraged to participate and send queries directly to the radio office through phone calls or text messages.

There has been “huge enthusiasm among the farmers. Requests for advice keep pouring in and many have reported better grain harvests” after the radio prgrammes came into existence, according to Moin.

Mohammad Mosharaf Hossain, senior scientific officer of a local mango research institute, told IPS, “We… teamed up with Radio Mahananda recently to disseminate information on our research and received an unbelievable response.”

In 2013 alone the institute has developed four new varieties of sweet mango, popularised among the local farmers through radio programmes. Such information is crucial in Chapainawabganj, home to over 90 percent of Bangaldesh’s mango production, with hundreds of square kilometres dedicated to growing and harvesting the fruit.

“We participated in regular live discussions to inform and encourage mango farmers to use the new varieties of mango seeds known as BARI-6, 7, 8 and 9,” Hossain told IPS.

According to Enayet Khan, a local farmer, “Mahananda has united the local farmers and has played a huge role in contributing to boosting regional crop production.”

(END)