Adequate maternal care during pregnancy, childbirth and the postpartum period is essential to curbing the high maternal mortality rates in Latin America, which stopped falling due to women's health care problems during the COVID pandemic. CREDIT: Government of Tigre / Argentina

By Mario Osava
RIO DE JANEIRO, May 27 2022 (IPS)

Brazil had the dubious distinction of champion of maternal mortality in Latin America during the COVID-19 pandemic, with a 77 percent increase in such deaths between 2019 and 2021.

A total of 1,575 women died in childbirth or in the following six weeks in the year prior to the pandemic in Latin America’s largest and most populous country, with a population of 214 million. Two years later the total had climbed to 2,787, according to preliminary data from the Health Ministry’s Mortality Information System.

In Mexico, the second-most populated country in the region, with 129 million inhabitants, the increase was 49 percent, to 1,036 maternal deaths in 2021. And in Peru, a country of 33 million people, the total rose by 63 percent to 493 maternal deaths.

In Colombia, recent data are not available. But authorities acknowledge that in 2021 COVID-19 became the leading cause of maternal deaths, as it was in Mexico.

Brazil is the extreme example of multiple mistakes and of stubborn denialism that led to many avoidable deaths, particularly of pregnant women, according to experts and women’s rights activists on the occasion of the International Day of Action for Women’s Health, celebrated May 28.

In Latin America maternal mortality remains a major problem.

The Pan American Health Organization (PAHO), the regional office of the World Health Organization (WHO), states that “maternal mortality is unacceptably high” and that they are “mostly preventable” deaths, which especially affect pregnant women in rural areas.

These levels, the agency adds, will delay reaching target 3.1 of the 17 Sustainable Development Goals (SDGs): to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030.

A woman takes part in a care program for pregnant women in a low-income area of the northern state of Pará, Brazil. PAHO warned that the disruption of health services caused by COVID drove up maternal mortality rates in Latin America and the Caribbean. CREDIT: UNFPA

Something smells rotten

“Inadequate prenatal and obstetric care,” largely due to inadequate medical training in these areas, is the cause of the tragedy in Brazil, said physician and epidemiologist Daphne Rattner, a professor at the University of Brasilia and president of the Network for the Humanization of Childbirth.

“Hypertensive syndrome is the main cause of death in Brazil, while in the world it is hemorrhage. In other words, there is some failure in a simple diagnosis like hypertension and in managing it during pregnancy and childbirth,” she said in an interview with IPS from Brasilia.

Of the 38,919 maternal deaths between 1996 and 2018 in Brazil, 8,186 were due to hypertension and 5,160 to hemorrhage, according to a Health Ministry report. These are direct obstetric causes, which accounted for just over two-thirds of the deaths. The rest had indirect causes, pre-existing conditions that complicate childbirth, such as diabetes, cancer or heart disease.

An excess of cesarean sections is another factor in mortality. It is “an epidemic” of 1.6 million operations per year, the Health Ministry acknowledges. This is equivalent to about 56 percent of the total number of deliveries. The proportion reaches 85 percent in private hospitals and stands at 40 percent in public services, well above the 10 percent rate recommended by the WHO.

“They don’t practice obstetrics, they practice surgery, they don’t know how to provide clinical care, and the result is more maternal deaths,” Rattner lamented.

And the pandemic made the situation more tragic.

Black women protest to demand respect for their rights in Brazil. Black women are the greatest victims of maternal mortality caused by COVID-19 in the country. They account for almost twice the number of deaths of white mothers, according to a study by the Oswaldo Cruz Foundation, the leading national health research institution. CREDIT: Fernando Frazão / Agência Brasil

The stork doesn’t come anymore

Brazil missed the target of reducing maternal mortality by 75 percent by 2015, from 1990 levels, but it was moving in that direction. The maternal mortality ratio (MMR) per 100,000 live births in the country fell from 143 to 60, a 58 percent drop.

The Stork Network, a government strategy adopted in 2011 to improve assistance to pregnant women and the infrastructure of maternity hospitals, humanize childbirth, ensure family planning and better care for children, helped bring the MMR down.

But COVID-19 and the government’s response to it caused a setback of at least two decades in Brazil’s maternal mortality rate.

Coronavirus killed more than 2,000 pregnant and postpartum women in the last two years and there are at least 383 other deaths from severe acute respiratory syndrome that may have been caused by COVID-19, according to the Feminist Health Network, an activist movement that has been fighting for sexual and reproductive rights since 1991.

The way the government of far-right President Jair Bolsonaro acted “was a maternal genocide, not just a disaster,” said Vania Nequer Soares, a nurse with a PhD in public health who is a member of the Feminist Health Network.

The government’s denialism and its response to the pandemic aggravated mortality in general, which already exceeds 666,000 deaths, as well as maternal mortality. Health authorities took more than a year to recognize that pregnant women were a high-risk group for COVID-19, made it difficult for them to receive intensive care and delayed their vaccination, Soares said.

To make matters worse, they decided to dismantle the Stork Network, whose public policies had promising results, and adopted new rules of “obstetric violence” included in the brand new Maternal and Child Care Network (Rami), which concentrates all power in doctors and hospitals, to the detriment of other actors and dialogue, she told IPS by telephone from Lisbon.

Miriam Toaquiza, a teenage mother, and her newborn daughter, Jennifer, are photographed at a hospital in Ecuador. Latin America is second in the world in teen pregnancy, one of the causes of the high maternal mortality rates in the region. CREDIT: Gonzalo Ortiz/IPS

Undernotification and negligence

But the numbers of maternal deaths are probably higher. Brazil was slow to begin using COVID-19 diagnostic tests and did not test widely. And because clinical identification of the new disease was doubtful, many mothers probably died without the correct diagnosis, especially in the first year of the pandemic, Rattner argued.

A study published this month in the scientific journal The Lancet Regional Health – Americas, with accounts from the families of 25 pregnant women who died of COVID-19, revealed three practices that condemned many women to death on the verge of childbirth.

First, doctors refused to hospitalize or better examine those who complained, for example, of difficulty breathing. They attributed it to late pregnancy and delayed a diagnosis that could have saved at least one life.

In other cases, health centers turned away pregnant women because they were dedicated to the COVID-19 emergency, arguing that they could not accept pregnant women because of the risk of infecting them. And in maternity wards, pregnant women were turned away because of the risk that they could bring in coronavirus and affect other women.

Finally, pregnant women who managed to be accepted in hospitals were denied intensive care, under the argument of protecting the baby’s life. In other words, the choice was made to save the child, to the detriment of the mothers, without consulting the families.

This was confirmed by the fact that all 25 pregnant women died, but 19 babies survived. Four families told the health professionals that they wanted the mother to be saved, even arguing that she could have other children in the future, but this proved to be in vain.

The study by three researchers from the Anis Institute of Bioethics, Human Rights and Gender, based in Brasilia, corroborates the complaint of the Feminist Health Network that 20 percent of the pregnant and postpartum women did not have access to intensive care and 32.3 percent were not put on ventilators.

Women must be given protagonism, so that “they can take ownership of the process of motherhood, including childbirth,” said Ligia Cardieri, a sociologist who is executive coordinator of the Feminist Health Network.

Fewer mechanical interventions, a reduction of c-sections that increase risks, including anesthetics, and greater involvement of nurses and other maternal health actors are other recommendations to avoid so many maternal deaths, she told IPS from Curitiba, capital of the southern state of Paraná.

In other Latin American countries, pregnant women with COVID-19 suffered a similar lack of attention and problems.

Nearly a third of them were not given intensive care or respiratory support during the pandemic, revealed a study of 447 pregnant women from eight countries, including five from South America, two from Central America and one from the Caribbean, according to PAHO data.

The study, published in The Lancet Regional Health – Americas, is from PAHO’s Latin American Center for Perinatology/Women’s Health and Reproductive Health (CLAP/WR).

Congestion in public hospitals is frequent in Latin America even without epidemics. Long waits and the need to resort to out-of-pocket spending to obtain medical assistance are common in the region. CREDIT: Courtesy of Integralatampost

By Humberto Márquez
CARACAS, Apr 4 2020 (IPS)

Health systems in Latin America, already falling short in their capacity to serve the population, especially the poor, are in a weak position and face serious risks when it comes to addressing the COVID-19 pandemic.

Low levels of health spending and a relative scarcity of hospital beds are indicators that most countries in the region do not guarantee universal access to healthcare and risk being overwhelmed by the wave of the new coronavirus.

“Even in well-organised and robust health systems the challenges posed by a pandemic are felt swiftly, and this is even more true in weak ones like those in much of Latin America. In epidemiology, if you trail behind an epidemic, you are going to suffer havoc,” former Venezuelan health minister José Félix Oletta (1997-1999) told IPS.

Of the 630 million people in Latin America and the Caribbean, 30 percent do not have regular access to health services, mainly due to geographic or income issues, according to the Pan American Health Organisation (PAHO), an affiliate of the World Health Organisation (WHO).

That figure is in line with the proportion of people living in poverty, according to the Economic Commission for Latin America and the Caribbean (ECLAC), which counts 185 million poor people in the region, and reports that over 10 percent of the total regional population – 68 million people – live in extreme poverty.

The regional average for health spending is under four percent of gross domestic product (GDP) and only 2.2 percent is central government expenditure, according to ECLAC and PAHO figures.

In 2014, the region’s governments committed to raising health spending to at least six percent of GDP, but only Cuba (10.6 percent), Costa Rica (6.8 percent) and Uruguay (6.1 percent) have met that goal.

The most industrialised countries spend eight percent of GDP on health, between 3,000 and 4,000 dollars per inhabitant per year, compared to about 1,000 dollars per person in Latin America. Argentina, Chile, Cuba and Uruguay spend around 2,000 dollars per person, but Haiti, Honduras and Venezuela spend less than 400.

Out-of-pocket spending (the amount people spend directly on a service) is low in Cuba, Costa Rica or Uruguay (10 to 20 percent) and very high in others such as Venezuela (63 percent), Guatemala (54 percent) or the Dominican Republic (45 percent).

These out-of-pocket payments by individuals illustrate the inadequacy of public health provision, as well as of social security or private insurance, and the fact that the poor are the most vulnerable because they sometimes refrain from seeking care that they cannot afford.

Another indicator is the number of beds available in hospitals, which does not measure the quality of infrastructure, staffing or efficiency in these facilities: the regional average is 27 per 10,000 inhabitants. A portion, sometimes very small, are intensive care beds.

But “it is not enough to have hospitals and health centres. They must properly combine human resources, infrastructure and equipment, medicines and other health technologies, to provide quality care,” said PAHO Director Carissa Etienne.

If the COVID-19 pandemic continues to spread in the region, Bolivia, Guatemala, Haiti, Honduras, Nicaragua, Paraguay and Venezuela are “the Latin American countries most at risk,” according to PAHO.

A view of the University Hospital of Maracaibo, the “oil capital” of Venezuela, in the west of the country. Large hospitals do not guarantee good-quality service in and of themselves, because skilled staff and adequate equipment and technology are also needed, says PAHO. CREDIT: SAHUM

IPS took a closer look at the situation in four countries to show the different weaknesses and strengths of health systems in the region.

Brazil, persistent inequality

Over the last three decades, the largest country in the region, with a population of 211 million, has developed a unique public health system, with programmes such as Mais Médicos, Farmácia Brasil Poupa Lar and Estratégia Saúde da Família. The latter is a strategy enabling a team of doctors, nurses and assistants to care for up to 3,000 people at a local level.

Mais Médicos deployed up to 18,000 doctors, more than half of them Cuban, in remote villages and isolated rural communities in Brazil. But since December 2018 the programme shrank after Brasilia severed relations with Havana and thousands of Cuban doctors were forced to return home.

The social gap is widening, since public health, with 44 percent of the hospital beds, must serve 75 percent of the population, while private clinics have more than half of the beds for 25 percent of the inhabitants.

In 2009, Brazil had 18.7 beds per 10,000 inhabitants, which dropped to 17.2 in 2017, half of them in four of its 27 states, in the wealthier southeast. It has 47,000 intensive care beds, but for every one in the public health system – 90 percent of which are occupied – there are 4.6 in the private health sector.

Brazil “is not prepared to face the coronavirus epidemic, not so much because of a lack of resources, but due to their poor distribution, the high level of inequality in terms of access to services, poor management and lack of equity,” epidemiologist Eduardo Costa, an international cooperation advisor at the National School of Public Health, told IPS.

Cuba, medicine for export

The Cuban health system, touted by the socialist government as one of the achievements of the revolution, is public and free of charge for the country’s population of 11.2 million, with 90 doctors for every 10,000 inhabitants, according to official figures.

Although there are no precise figures on how many of its 47,000 beds are for intensive care – and there are complaints from the public about delays for non-urgent surgical procedures – Health Minister José Ángel Portal said the island nation has 274 beds to treat seriously ill coronavirus patients and plans to add another 200.

One of Cuba’s flagship programmes is the international medical cooperation missions, which began in 1963 and have sent 407,000 doctors, technicians and assistants to 164 countries, providing free medical assistance to poor countries, under the format of cost-sharing to other nations, or as a source of income in some cases.

The annual income from this programme – 29,000 doctors worked in 65 countries in 2019 – exceeds six billion dollars. For the COVID-19 pandemic, Cuba is setting up 14 medical brigades with 600 members, more than half of whom are women.

Chile is prepared, although it’s never enough

In Chile, a country of 18.7 million people, health coverage is public for 14 million and private for three million, and there is a separate system for the 400,000 members of the armed forces, put in place by the dictatorship of General Augusto Pinochet (1973-1990), which has not been modified.

All workers are required to contribute seven percent of their wages to the health institution of their choice. Those who are covered by the public health system complain about long waits of weeks or months to see a doctor and of up to a year or even more for surgery.

These were some of the shortcomings that fueled the mass protests that broke out in Chile in October 2019 and raged for months until a referendum was agreed to allow voters to choose whether to replace the constitution inherited from the dictatorship.

Chile has 22 hospital beds for every 10,000 inhabitants. That is a total of about 32,000, with 3,300 for emergencies, which the government aims to increase to 5,200 in the face of the pandemic.

Nelly Alvarado, a professor at the Diego Portales University and a public health specialist, told IPS that “the health system’s capacity is never going to be enough in the face of an unexpected situation coming from the rest of the world.”

She pointed out that critical care beds “have never been abundant either in Chile or the rest of the world. They are expensive and highly complex, because sophisticated equipment and specialised staff are required.”

Venezuela, on the verge of collapse

Official health statistics became unavailable in Venezuela over the past decade. But studies by non-governmental organisations warn that the health care system is on the verge of collapse and that the country is experiencing a “complex humanitarian emergency.”

Venezuela, a country of 30 million people, is at the bottom of the regional charts in terms of health spending and the provision of hospital beds. The NGO Doctors for Health reported that during 2019 there were power failures in 63 percent of 40 large hospitals it monitors, and water supply failures in 78 percent.

Barrio Adentro, a programme launched in 2003 that brought thousands of Cuban doctors to low-income areas, has almost disappeared and most of its premises have closed.

“We are at the bottom of a PAHO list of 33 countries in the hemisphere in terms of preparing for COVID-19,” Oletta said. “And the pandemic follows setbacks in vaccination campaigns and containment of preventable diseases that have re-emerged, such as malaria, measles and tuberculosis.”

The health crisis is part of the general collapse of basic services that has accompanied the economic recession over the past five years and hyperinflation over the past three years, driving the exodus of almost five million of Venezuela’s 32 million inhabitants. Among those who have emigrated were more than 22,000 doctors, according to the medical association.

Latin America, lagging behind in health care and spending, should heed the call of Maria Neira, WHO Director for the Department of Public Health, Environmental and Social Determinants of Health: “Something we have all forgotten is that investment in public health and health systems should not be regretted…it is always going to be a profitable investment.”

This article includes reporting by Ivet González in Havana, Mario Osava in Rio de Janeiro, and Orlando Milesi in Santiago.

Family photo of part of the 111 participants in the First Latin American and Caribbean Assembly of Organisations of People Affected by Hansen's Disease, on the steps of the Morisco Palace, the headquarters of the Oswaldo Cruz Foundation, which hosted the three-day meeting in Rio de Janeiro, Brazil. Credit: Mario Osava/IPS

By Mario Osava
RIO DE JANEIRO, Mar 14 2019 (IPS)

With the decision to found a regional coalition to promote rights and greater participation in national and international forums and decisions, the First Latin American and Caribbean Assembly of Organisations of People Affected by Hansen’s disease, popularly known – and stigmatised – as leprosy, came to an end.

The final session of the meeting, on Mar. 14, approved 40 of the 58 proposals presented by the 111 participants in three days of debates at the headquarters of the Oswaldo Cruz Foundation, a renowned scientific, medical and epidemiological research centre in Rio de Janeiro, Brazil.

José Picanço, 46, separated from his family and taken as a newborn to an orphanage because his parents were diagnosed with the disease in 1972, is one of those affected whose right to reparations remains unfulfilled. His three siblings are in the same situation.

When the family was reunited eight years later, the father turned his back on the children. The mother took them in, but died shortly afterwards. “I only lived with her, a saint, for five months,” Picanço recalled, barely managing to hold in his tears while giving testimony at the meeting.

“Humiliated as the children of lepers, suffering bullying and sexual harassment, many of the other children who were with me at the orphanage fell into drug abuse and alcoholism. It was a holocaust,” he said. “I hit my brother on the head, not knowing he was my own brother.”

“Of the 15,000 to 20,000 children separated from their families, more than 80 percent suffer from depression,” said Picanço in an interview with IPS, detailing some of the damage caused by the old rule of segregating the people then called “lepers”.

Mandatory isolation was widespread around the world, during different historical periods, and continues in some countries, even though it is known that the disease is curable and that patients cease to be contagious shortly after starting treatment.

Officially, Brazil abolished this practice in 1976, although it actually lasted 10 more years. Its direct victims were compensated starting in 2007, but their children were not. The activists gathered in Rio de Janeiro called for working for policies of reparations for children separated from their families.

Their complaints and proposals will be taken to the World Congress of associations of people affected by leprosy in Manila in September, which will also receive contributions from Africa and Asia, approved at recent similar regional assemblies.

“The goal is to form a large network of activists, to strengthen the movement” for the eradication of the disease and for care and reparations for those affected, said Kiyomi Takahashi of the independent Nippon Foundation, which is driving this international process of debate and cooperation.

The meeting in Rio de Janeiro fostered “a high-level dialogue, the result of Morhan and Felehansen’s long history of activities,” the Japanese expert told IPS, referring to the Movement for the Reintegration of People Affected by Hanseniasis (Morhan) in Brazil, and the National Federation of Entities Affected by Leprosy or Hansen’s Disease (Felehansen) in Colombia, the two organisers of the regional meeting.

Brazilian activists José Picanço (front) and Evelyne Leandro testified about how Hansen’s disease affected them during a Latin American and Caribbean meeting in Rio de Janeiro. Picanço was separated from his parents when they were diagnosed with leprosy when he was born in 1972 and was only reunited with them eight years later, shortly before his mother died. Leandro wrote a book about the difficulties of being diagnosed with the disease in Germany, where she lives. Credit: Mario Osava/IPS

“Morhan is my safe haven, to preach that separated children should be heard and have opportunities,” said Picanço, who explained that he joined the movement in 1992. Today he gives talks on the direct and indirect effects of the stigma still surrounding the disease, that is suffered by those affected and their families.

A blessing

The disease “was a blessing for me,” Isaias Dussan Weck, 50, the vice-president of the Colombian association Felehansen, told IPS without hesitation.

The diagnosis in 2006 destroyed him, he said. He lost the desire to work or to go out, he let his business of supplying cleaning products to companies go bankrupt, he even contemplated suicide. He ignored the stains on his body that did not prevent him from working and traveling, until they spread to his face, and he noticed that parts of his body were going numb.

He received treatment and was cured, left with only slight numbness in one arm and pains in his left leg.

But everything went badly for him until he was invited to meetings with other people affected by leprosy. “I began to understand, when I heard their testimonies and tears, why a young black girl with severe disabilities said that leprosy was a blessing to her,” Dussan said.

Activism for the benefit of those affected, against the stigma and the damage caused by the disease, in the association of the department of Huila, in southwestern Colombia, allowed him “to gain new meaning for life and to understand and practice love for my neighbour.”

“Helping and seeing a patient’s life improve is a wonderful emotion, and you help other people want to live,” he concluded. That new passion led him to Felehansen, where he took on leadership roles in the federation.

Irma Romero, 42, president of the Nuevo Amanecer Foundation in Barranquilla, on Colombia’s northern coast, had a similar experience. Her lengthy odyssey to a specialist’s diagnosis five years ago reveals the medical system’s shortcomings when it comes to detecting and treating the disease, also known as hanseniasis, which is still viewed by many as “a divine punishment.”

Romero stopped working in the textile industry due to disability and depression. “I couldn’t even walk,” she recalled. “I even denied God,” she told IPS.

Colombian activist Irma Romero, a native of the city of Barranquilla, sitting on the bus that transported the participants of the First Latin American and Caribbean Assembly of Organisations of People Affected by Hansen’s Disease, held Mar. 12-14 in Rio de Janeiro, Brazil. Credit: Mario Osava/IPS

Treatment using medicinal herbs, self-medication, rejection by relatives, attempts to separate her from her two children and abandonment by her husband all formed part of her suffering, which did not end with her treatment and cure.

The only permanent physical effects are numbness in her hands and feet, and sciatic nerve pain. But the discrimination continued.

“My life changed when I joined the association of affected people” four years ago, she said. “There I found people who had things in common with me, and a newfound love of my neighbour that I did not feel before,” said the activist, who became president of the Foundation the following year and reconciled with God.

Her foundation currently has 60 members. In Barranquilla she estimates that there are “about 200 affected people, but many more are hidden.”

The foundation is one of the 10 associations that make up Felehansen, eight of which call the disease hanseniasis or Hansen’s disease, one of which uses the term leprosy, and another of which refers to disabled people and is made up of patients who received a very late diagnosis.

The World Health Organisation (WHO) defines leprosy – the term it uses – as an infectious and chronic disease “transmitted by air through droplets from the nose and mouth, during close and frequent contacts with untreated cases.” It also specifies that leprosy is “one of the least infectious diseases.”

WHO reports that in 2017 there were 211,009 new cases worldwide, according to official data from 159 countries. That amounts to 0.3 cases per 10,000 inhabitants, which means it classifies as having been “eliminated,” according to WHO criteria.

Change of name: another recommendation

Proposing hanseniasis as the official name for the disease is one of the proposals that came out of the Latin American meeting, headed by Brazil, which has already adopted it, even prohibiting the mention of leprosy in the health system since 1995.

They are different concepts, because leprosy and leper have very negative connotations of “dirt, plague, impurities and divine punishment,” strengthened by numerous mentions with that moral burden in the Bible, argued Faustino Pinto, one of Morhan’s national coordinators.

But the activists from Colombia are not convinced. “People only know leprosy, they don’t know it’s Hanseniasis. To explain the issue to the population, you have to mention leprosy,” argued Romero.

“It will be necessary to educate the new generations about the concept of Hansen,” the Norwegian doctor Gerhard Hansen who discovered the bacillus that causes the disease, because adults are not likely to forget the stigma, said Dussan. “It’s harder to unlearn than to learn,” he added.

Another proposal of the Latin American Assembly is to extend the current Committee for Assistance to Brazilian Immigrants Affected by Hanseniasis to all Latin Americans and people from the Caribbean, in addition to extending it to other regions.

The reference point in this is Evelyne Leandro, a 37-year-old Brazilian who has lived in Germany for nine years and had a lot of difficulties getting diagnosed with the disease in a country where it is very rare and where very few doctors are familiar with it.

She was helped by her mother’s suspicion, awakened in Brazil by an outreach campaign on the disease, and by the Institutes of Tropical Medicine in Germany.

Her case and those of other immigrants in Europe are recounted in her book “The Living Death: the struggle with a long forgotten disease”.

Julio Berdegué, FAO representative for Latin America and the Caribbean, presents the region's Panorama of Food and Nutrition 2018 in Santiago, which has bad news due to the increase in hunger, malnutrition, overweight and obesity for the third consecutive year. Credit: Orlando Milesi/IPS

By Orlando Milesi
SANTIAGO, Nov 7 2018 (IPS)

“For the third consecutive year there is bad news” for Latin America and the Caribbean, where the numbers of hungry people have increased to “39.3 million people,” or 6.1 percent of the population, Julio Berdegué, FAO’s regional representative, said Wednesday.

At the regional headquarters of the United Nations agency in Santiago, Berdegué presented the conclusions of the Panorama of Food and Nutrition Security 2018, which brings more bad news: malnutrition and obesity also increased, in a situation closely linked to the persistence of inequality in the countries of the region.

The report was prepared jointly by the regional division of four U.N. agencies: FAO (Food and Agriculture Organisation), the Pan American Health Organisation (PAHO), the United Nations Children’s Fund (UNICEF), and the World Food Programme (WFP).

The four organisations called on governments in the region to implement public policies that combat inequality and promote healthy and sustainable food systems."There is no material or scientific reason to justify hunger...We are issuing a wake-up call to governments and societies." -- Julio Berdegué

“There is no material or scientific reason to justify hunger,” Berdegué said during the presentation, pointing out that for the past five years, no progress has been made in the region, and that it has in fact slid backwards for the past three years.

“We are issuing a wake-up call to governments and societies,” he said.

The regional representative highlighted the case of Colombia where “peace has begun to pay dividends in the eradication of hunger,” referring to the positive effects of the peace deal reached by the government and the FARC guerrillas in 2016.

At the other extreme, Venezuela became one of the countries with the greatest number of hungry people: 3.7 million – 11.7 percent of the population.

Since 2014, the number of undernourished people has grown in Argentina, Bolivia and Venezuela. The largest rise occurred in Venezuela, with an increase of 600,000 people from 2014 to 2017, according to the Panorama.

Other countries severely affected by hunger are Haiti – five million people, equivalent to 45.7 percent of the population – and Mexico – 4.8 million people, representing 3.8 percent of the population.

However, in both Haiti and Mexico, hunger has declined in the last three years. The same is true in Colombia and the Dominican Republic. But these are the only four countries in the region that managed to reduce hunger since 2014.

“If Haiti can do it (reduce hunger), all of the other countries can, too,” Berdegué said emphatically.

According to the Panorama, the rate at which the number of hungry people in the region grew accelerated: between 2015 and 2016 the number of undernourished increased by 200,000, but between 2016 and 2017, it grew by twice that number: 400,000 people.

For Berdegué, the numbers are dramatic because “it’s not about being closer to the goal of zero hunger (by 2030). The goal is not a few less hungry people,” he said, noting that this is a food-producing and -exporting region, where “there is no lack of food, what is missing is money to buy it.”

He added that serious food insecurity affects 47.1 million people in Latin America and the Caribbean, and said “the worst thing is that most of them live in South America, the richest part of the region. How is it possible that 62 percent of the hungry are in South America?”

The report establishes a close link between economic and social inequality and higher levels of hunger, obesity and malnutrition.

Five million children suffer from hunger, children in the poorest segment of the population, who are “condemned to a very limited life,” Berdegué said.

He pointed out that the four U.N. agencies found a correlation between hunger and belonging to some ethnic groups.

Referring to indigenous groups, he noted that “In Peru, 25 percent of Quechua children and 23 percent of Aymara children suffer from chronic malnutrition, while at the national level the proportion is 16 percent.”

At the same time, the number of obese people is growing by 3.6 million each year, and today one in four adults in the region are obese. And some 250 million people are overweight: 60 percent of the regional population.

Overweight affects 3.9 million children under the age of five, more than the global average of 5.6 per cent, the report says.

“It’s a rampant and out of control epidemic. We have never eaten so badly. We have to make a shift towards a healthy and nutritious diet,” Berdegué said.

He added that 18 countries in the region produce fruits and vegetables, but export most of them.

“It is essential to regulate fats and salt content in food. There are many people who can’t afford to eat healthy. School curricula should include healthy eating,” Berdegué said, suggesting possible solutions to deal with the epidemic.

Carissa F. Etienne, director of PAHO, said that “although malnutrition persists in the region, particularly in vulnerable populations, obesity and overweight also particularly affect these groups.”

“A multisectoral approach is needed, ranging from ensuring access to balanced and healthy food to addressing other social factors that also impact on these forms of malnutrition, such as access to education, water and sanitation, and health services,” she said in a connection from the organisation’s Washington headquarters.

In her view, “we must make progress in access to universal health so that all people can receive the care and prevention measures they need with regard to malnutrition and its long-term consequences.”

The Panorama states that hunger, malnutrition, micronutrient deficiencies, overweight and obesity especially affect lower-income people, women, indigenous people, blacks and rural families in the region.

In Latin America, 8.4 percent of women face severe food insecurity, compared to 6.9 percent of men, and indigenous populations are more food insecure than non-indigenous populations.

In 10 countries, children from the poorest 20 percent of households suffer three times more stunting than the richest 20 percent.

According to the report, one of the main causes of the rise in malnutrition among particularly vulnerable population groups is changes in the region’s food systems and food cycle from production to consumption.

The greatest effects occur in the most excluded sectors which, although they have increased their consumption of healthy foods such as milk and meat, often have to opt for products high in fats, sugar and salt because they are cheaper.

With respect to the gender divide, the Panorama reports that 19 million women suffer from severe food insecurity, compared to 15 million men.

In all of the countries, the obesity rate for adult women is higher than for men; in 19 countries, the obesity rate for women is at least 10 percentage points higher than for men.

“Gender equity is a valuable policy instrument to reduce inequalities. We need to strengthen it in practice, which involves promoting equality in access to and control of household resources, as well as in decisions to empower women,” said Miguel Barreto, WFP regional director, from Panama City.

FAO acting regional representative Eve Crowley (C) during the launch of the Panorama of Food and Nutrition Security in Latin America and the Caribbean 2016, at FAO headquarters in Santiago. The report , where it was warned that overweight affects 360 million people in the region. Credit: FAO

By Orlando Milesi
SANTIAGO, Jan 20 2017 (IPS)

In Latin America and the Caribbean 360 million people are overweight, and 140 million are obese, warned the United Nations Food and Agriculture Organisation (FAO) and the Panamerican Health Organisation (PAHO).

“The rise in obesity is very worrying. At the same time the number of people who suffer from hunger has diminished in the region. We need to strengthen our efforts and have food systems with improved nutrition based on sustainable production methods to reduce those figures,” Eve Crowley, FAO acting regional representative, said Thursday at the organisation‘s headquarters in Santiago.

At the regional FAO office in Santiago on Thursday Jan. 19 the two organisations launched the Panorama of Food and Nutrition Security in Latin America and the Caribbean 2016, which sounded the alarm about the phenomenon in this region of just over 625 million people.

The problem, highlighted the report, largely affects children and women, increasing chronic diseases, driving up medical expenses for countries and individuals, and posing a threat to the quality of the future labour force that national development plans will require.

At the same time, the region has considerably reduced hunger: today only 5.5 per cent of the population of Latin America and the Caribbean is undernourished, the Caribbean being the area with the highest prevalence (19.8 per cent), largely because Haiti has the highest malnutrition rate in the world: 53.4 per cent.

Chronic child malnutrition (low height for age) in Latin America and the Caribbean also dropped, from 24.5 per cent in 1990 to 11.3 per cent in 2015, which translates into a decrease of 7.8 million children.

Despite the progress made, currently 6.1 million children still suffer from chronic malnutrition: 3.3 million in South America, 2.6 million in Central America, and 200,000 in the Caribbean. About 700,000 million children suffer from acute malnutrition, 1.3 per cent of them under the age of five.

Asked whether the difficulty of access to natural, good quality foods is due to the high prices or to a flawed production and distribution system, Crowley told IPS that it is “a combination of factors“.

“We talk about a food system because it involves a set of factors – from supplies to which foods are available at a national level. For example in Latin America there is a great availability of sugary foods and meat. But ensuring physical availability and access to nutritious, healthy, affordable fresh food in every neighborhood is still hard to achieve,” she said.

“There is evidence that food high in bad calories, from ultra-processed sources, is less expensive than healthy food, and this poses a dilemma to guaranteeing good nutrition for the entire population, particularly people in low-income households,” she said.

Crowley said there are changes in consumption patterns, with people shifting away from their traditional diets based on legumes, cereals, fruits and vegetables toward super-processed foods rich in saturated fats, sugar and sodium, which are backed by extensive advertising.

A girl wearing traditional dress from Bolivia’s highlands region shows a basket with fruit during a school exhibit in La Paz to promote good eating habits among students.. Programmes to promote healthy eating are spreading through schools in Latin America, to address problems such as malnutrition and overweight. Credit: Franz Chávez/IPS

She called for better information, nutrition warnings, taxes on unhealthy foods, and subsidies for healthy foods necessary for the population.

With the exception of Haiti (38.5 per cent), Paraguay (48.5 per cent) and Nicaragua (49.4 per cent), overweight affects more than half of the population of the countries in the region, with Chile (63 per cent), Mexico (64 per cent) and the Bahamas (69 per cent) showing the highest rates, states the report.

Erick Espinoza, a physical education teacher in a private school in a middle-class neighborhood in Santiago, sees the problem of the change in eating and behavioural habits of his students, aged six to 10, which is a reflection of what is happening throughout the region, and in particular in the countries with the highest overweight and obesity rates.

“As snacks, they don’t bring fruit, only potato chips, crackers or cookies, fizzy drinks, juice or milk high in sugar. And they don’t just bring a small package, but sometimes two or three packages or even a big one,” he told IPS, referring to the snack during recess.

Since 2016, kiosks that sell food in Chilean schools have been prohibited from selling foods high in sugar, sodium or fat. “They have to sell fruit, but the kiosk is not doing well because the children don’t buy fruit or yoghurt, but bring other things from home,“ said the teacher.

Alexandra Carmona, a teacher at a municipal school for children aged four to 17 in a low-income neighborhood in Santiago, pointed to a different problem.

“There was an obese boy who was really bullied. Everybody would say ‘hey fattie‘, ‘hey grease ball‘. So I called the parents to tell them what was happening, but they didn’t give it any importance,“ she told IPS. The boy ended up in a special school even though he had no learning disability.

At her school, the school provides meals, but many children won‘t accept the legumes and balanced diet that is offered.

The Panorama reports that 7.2 per cent of children under five years old in the region are overweight, which means a total of 3.9 million children, including 2.5 million in South America, 1.1 million in Central America and 200,000 in the Caribbean.

The countries with the highest rates of overweight in children under five years old are Barbados (12 per cent), Paraguay (11.7 per cent), Argentina (9.9 per cent), and Chile (9.3 per cent).

The report also points out that several countries have adopted taxes on sugary beverages, including Barbados, Chile, Dominican Republic and Mexico, while others such as Bolivia, Ecuador, Peru and Chile have laws on healthy nutrition which regulate advertising and labeling of food products.

With respect to the countries that stand out in sales per person of ultra-processed products, the report says that Argentina, Chile, Mexico and Uruguay exceed the regional average of 129.6 kilograms per inhabitant. Mexico ranks first, with 214 kg per inhabitant, and Chile is second with 201.9 kg.

In 30 of the 33 countries studied , more than half of the population over 18 is overweight, and in 20 of them obesity among women is at least 10 percent higher than among men.

According to PAHO Director Carissa F. Etienne, “the region is facing a two-fold burden of malnutrition, which has to be fought with a balanced diet which includes fresh, healthy and nutritious foods, produced in a sustainable manner, besides addressing the main social factors that lead to malnutrition.”

In addition to the lack of access to healthy foods, she mentioned the difficulty of access to clean water and sewage services, education and health services, and social protection programmes, among others.

Providing pregnant mothers with antiretroviral medicines can reduce the risk of HIV transmission from 45 percent to just one percent, according to the World Health Organisation (WHO). Credit: Jeffrey Moyo/IPS

By Kanya D'Almeida
UNITED NATIONS, Jun 30 2015 (IPS)

In 2013, an estimated 240,000 children were born with HIV. This was an improvement from 2009, when 400,000 babies tested positive for the infection, but still a far cry from the global target of reducing total child infections to 40,000 by 2015.

Bucking the global trend, one small island nation has made gigantic strides towards the 2015 goal. That country is Cuba, and in 2013 it recorded just two babies born with HIV.

Today, Cuba has become the first country in the world to receive validation from the World Health Organisation (WHO) that it has eliminated mother-to-child transmission of HIV and syphilis.

Executive Director of UNAIDS Michel Sidibé said in a press release today, “This is a celebration for Cuba and a celebration for children and families everywhere. It shows that ending the AIDS epidemic is possible and we expect Cuba to be the first of many countries coming forward to seek validation that they have ended their epidemics among children.”

Every single year, over 1.4 million women living with HIV become pregnant. Without proper treatment, they run a 15-45 percent chance of transmitting the virus to their kids – during pregnancy, labour, delivery or breastfeeding.

But if both mother and child receive proper antiretroviral treatment, the risk of transmission falls to just one percent.

Since 2010, the Pan American Health Organisation (PAHO), which serves as the Regional Office for the Americas of the WHO, has been working with its partners in Cuba and other states in the region to roll out a comprehensive programme to eliminate mother-to-child transmission of both HIV and syphilis.

This process has involved improving early access to prenatal care, testing for pregnant women and their partners, caesarean deliveries and substitution of breastfeeding.

Such services were undertaken and provided within the larger framework of equitable access and universal healthcare, in which maternal and child health is integrated with programmes to combat sexually transmitted diseases.

“Cuba’s success demonstrates that universal access and universal health coverage are feasible and indeed are the key to success, even against challenges as daunting as HIV,” PAHO Director Carissa F. Etienne said in a statement on Jun. 30.

“Cuba’s achievement today provides inspiration for other countries to advance towards elimination of mother-to-child transmission of HIV and syphilis,” she added.

WHO and its partners first published comprehensive guidelines on the processes and criteria for validation of eliminating mother-to-child transmissions in 2014.

Because treatment and prevention can never be 100 percent effective, ‘elimination’ is defined as “a reduction of transmission to such a low level that it no longer constitutes a public health problem”, according to PAHO.

In March of 2015, a group of international experts visited Cuba to assess its progress towards the elimination target, and spent five days visiting health clinics, labs and government institutions interviewing a range of experts and other stakeholders.

Comprised of experts from 10 countries including Argentina, Japan and Zambia, the mission considered a number of indicators – all of which must be met for at least one year – including confirming that new child infections as a result of mother-to-child transmissions are less than 50 cases per 100,000 live births.

Other indicators, which must be met for at least two years in order to receive validation, include ascertaining that more than 95 percent of HIV-positive women know their status, receive at least one ante-natal visit, and receive antiretroviral drugs.

“Eliminating transmission of a virus is one of the greatest public health achievements possible,” WHO Director-General Margaret Chan announced on Jun. 30.

“This is a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation,” she added.

According to the World AIDS Day 2014 Report, there were 35 million people living with HIV/AIDS in 2013. Since the start of the epidemic in the 1980s, 39 million people have died of AIDS-related illnesses and close to 78 million have become infected with HIV.

Thanks to sustained local and global efforts to fight the epidemic, the death toll has fallen significantly in the past decade, from 2.4 million deaths in 2005 to 1.5 million in 2013, representing a 35-percent decline.

New infections have also declined by an estimated 38 percent since 2001, from 3.4 million to 2.1 million in 2013.

Among children, new infections have fallen from an estimated 580,000 in 2001 to 240,000 in 2013. If more countries emulate Cuba’s example, the international community will be closer to its 2015 goals, and the ultimate goal of eliminating AIDS altogether.

Edited by Kitty Stapp

Seismologists say a new children's hospital being planned for Couva, in Trinidad, is located near a fault line. According to one report, 67 per cent of hospitals in the Caribbean and Latin America are located in areas at high risk for natural disasters. Credit: Jewel Fraser/IPS

By Jewel Fraser
PORT OF SPAIN, Trinidad, Sep 21 2014 (IPS)

When floods overwhelmed the Eastern Caribbean in December last year, St. Vincent’s new smart hospital, completed just a few months earlier, stood the test of “remaining functional during and immediately after a natural disaster.”

The floods, later dubbed the Christmas rains, killed more than a dozen people and caused millions of dollars in infrastructural damage. However, the Georgetown Hospital in St. Vincent weathered the natural disaster, living up to the definition of a smart hospital in that it continued to serve the community without interruption.“We had the Christmas floods on Dec. 24 and the island’s water supply system was down whereas the hospital’s water supply remained functional. The community bought into it [after that]." -- Shalini Jagnarine of PAHO

According to a report by the UK’s Department for International Development (DFID), “More than 67% of hospitals in the Caribbean and Latin America are located in areas of higher risk of disaster.

“Enormous economic losses occur (including lost income and work days) when health facilities are destroyed or damaged by natural disasters — they must be re-built and downtime limits their ability to provide emergency care to victims and ongoing healthcare for their communities.”

The report adds, “Building resilience of communities and critical buildings like hospitals and schools delivers better results in terms of lives saved and livelihoods protected than simply through responding to the effects of disasters or climate variability.

“Establishing an integrated and forward looking approach to hospital design is essential if health facilities are to be safe, green and sustainable.”

Dr. Dana Van Alphen, the regional advisor for PAHO’s Disaster Risk Management Programme, told IPS that during a meeting of PAHO officials there were discussions about “how we could include climate change adaptation measures into our safe hospital initiative.”

The safe hospital initiative was launched in the Caribbean about a decade ago and has become a global standard for assessing the likelihood a hospital can remain functional in disaster situations.

PAHO worked with the DFID to launch the Smart Hospital Initiative. The DFID agreed to fund the initiative from its International Climate Fund for one year, citing “building resilience to climate change and disasters [as] a central pillar” of its 2011-2015 Operational Plan for the Caribbean.

Dr. Van Alphen said the Georgetown Hospital was chosen as one of two demonstration hospitals for the Smart Hospital Initiative because PAHO wanted “to convince policy makers that there are tangible measures for safety and natural disasters, there are practical measures that one can take and still see a benefit” without the costs being prohibitive.

Georgetown Hospital and the Pogson Hospital in St. Kitts were chosen as the two demonstration hospitals, after surveying 38 hospitals in the region. Of the 38 surveyed, 18 per cent were found to have structural and functional issues that required urgent measures to protect the lives of patients and staff.

“We took [those] two hospitals where we got support from the community and support from the government to implement the project. We wanted to do a success story,” Dr. Van Alphen said.

Some 350,000 dollars was allocated to retrofit Georgetown Hospital, which had structural and functional deficiencies including an unsafe roof, no backup power supply, and no water storage system.

The hospital, built in the 1980s, is a 25-bed facility in the parish of Charlotte that serves a population of almost 10,000.

The work done on the hospital included the renovating of the roof, waterproofing of the windows, installation of photovoltaic solar panels to ensure an alternative power supply, and the introduction of a rainwater harvesting system. The hospital was generally refurbished and upgraded to make it a more comfortable and pleasing environment for working and convalescing.

As a result of the retrofitting, there was a 60 percent reduction in energy consumption, said Dr. Van Alphen.

The DFID in its “Intervention Summary: Smart Health Care Facilities in the Caribbean”, notes that “according to Environmental Protection Agency (EPA) calculations, every dollar a hospital in the United States saves on energy is equivalent to generating 20 dollars in new revenues.

“Therefore, investing in activities that help reduce the health sector’s climate footprint will ultimately liberate money for allocation towards a hospital’s genuine purpose — improving overall patient care and health in the community.”

Since energy costs in the Caribbean are among the highest in the world, reduction in hospitals’ energy bill would free up significant resources, the DFID noted.

While the community was generally happy with the upgrades — according to the results of surveys conducted before and after the retrofitting that showed a significant increase in patients’ and staff’s satisfaction levels — there remained some concerns.

One of these was the community’s reluctance to accept the use of harvested rainwater. Shalini Jagnarine, a structural engineer with PAHO’s Disaster Management Unit, told IPS that that reluctance melted away with the Christmas floods.

“We had the Christmas floods on Dec. 24 and the island’s water supply system was down whereas the hospital’s water supply remained functional. The community bought into it [after that],” she said.

Another issue, according to the cost-benefit analysis of the project, was the financial sustainability of the project. The cost-benefit analysis report stated that “the cost of maintenance and operation [needs to be] minimized and other sources of revenue schemes…identified to financially support the project over its lifespan.”

The retrofitting of St. Kitt’s Pogson Medical Centre in Sandy Point village focused on showing how small changes can make a new and otherwise safe hospital more efficient, safe and environmentally friendly.

The work done included the installation of emergency exits, better access for the disabled, and upgrade of the plumbing fixtures and electrical systems.

Jagnarine said, “When you have a hospital that is already built, to make it safe you have to be smart about the financial decisions you make. To make it 100 per cent green may be too expensive.”

Dr. Van Alphen added, “The cost-benefit analysis is very important…What is the cost of not implementing these measures? What is the cost to your country and community if you do not make your health facility green and you are impacted by a natural disaster? The decision we take depends on the money we have, but there are simple things that can be done.”

Edited by: Kitty Stapp

The writer can be contacted at jwl_42@yahoo.com

A man crosses a bridge over one of Cité Soleil’s waste canals that lead to the Port-au-Prince harbor. Credit: HGW/Marc Schindler Saint Val

By Correspondents
PORT-AU-PRINCE, Jul 26 2013 (Haiti Grassroots Watch)

Lack of financing for a 10-year eradication plan means that cholera will likely be endemic to Haiti for years to come.

Cholera spreads via contaminated food, water and fecal matter. One of the essential parts of the government’s 2.2-billion-dollar National Plan for the Elimination of Cholera in Haiti is financing for sanitation systems nationwide.“Haiti is the only country in the entire world whose sanitation coverage decreased in the last decade.” -- Dr. Rishi Rattan of Physicians for Haiti

The majority of Haitians – about eight million out of the country’s 10 million people – do not have access to a hygienic sanitation system. They defecate in the open, in fields, in ravines and on riverbanks. The capital region produces over 900 tonnes of human excreta every day, according to the United Nations Office for Project Services (UNOPS).

“Haiti is the only country in the entire world whose sanitation coverage decreased in the last decade,” noted Dr. Rishi Rattan, a member of Physicians for Haiti, an association of U.S.-based doctors and health professionals.

“Before the cholera outbreak or the earthquake, diarrhea was the number one killer of children under five and the second leading cause of all death in Haiti. Given that cholera is a water-borne illness that relies upon lack of access to clean water, it is highly likely that cholera will become endemic in Haiti without full funding of Haiti’s cholera elimination plan by entities such as the United Nations,” Rattan told Haiti Grassroots Watch (HGW) in an email.

Cholera, brought to Haiti in October 2010 by soldiers from the United Nations Stabilisation Mission in Haiti (MINUSTAH), quickly spread throughout the country. Almost 3,000 are infected each month. To date, over 600,000 people have been infected and at least 8,190 have died.

The death rate is on the rise in the countryside, due in part to the lack of cholera treatment centres. At the epidemic’s peak, there were 285. Today, there are only 28. Once financing ran out, most humanitarian agencies abandoned the country.

Worse, one of the two large waste treatment facilities built following the earthquake recently went out of service.

The cholera-excrement connection

Written with help from the Pan-American Health Organisation (PAHO), the U.S. government and UNICEF, the cholera elimination plan targets human excrement. The sanitation budget alone tops 467 million dollars.

“According to our figures, less than 30 percent of the population has access to what we might call basic sanitation,” Edwige Petit, head of sanitation for the government’s National Agency of Water and Sanitation (DINEPA), told HGW. “In neighbouring countries, 92 to 98 percent have basic sanitation.”

By DINEPA’s count, about half of households in the countryside, and 10 to 20 percent in the cities, lack access to a proper toilet or latrine. In Cité Soleil, a slum that is part of the capital region, some use any open patch of ground available.

“When our children have to take a poop, we put them on a little bowl,” explained resident Wisly Bellevue. “We put a little water in there. Once they are done, we throw it into an empty lot.”

Big institutions with septic systems are serviced by “desludging” trucks. In 2010 and 2011, for example, humanitarian agencies emptied the thousands of portable toilets in the refugee camps for the 1.3 million people made homeless by the 2010 earthquake.

Those who cannot pay for that service often hire a more economical one: the men called “bayakou” in Haiti, who empty latrines and septic systems by hand. The bayakou work at night. Most dump their cargo in rivers, canals and ravines.

Before the cholera epidemic, even the trucks used to dump the feces mixed with urine into the ravines that drain into the Caribbean Sea.

Advances and challenges

DINEPA and its partners have made considerable advances in sanitation since 2010. With assistance from the Spanish government, UNICEF and others, DINEPA built two treatment centres for the capital region, and hopes to build 22 others for a total budget of 159 million dollars.

To date, however, only three have begun to be built: near St. Marc, in Les Cayes in the south, and in Limonade in the north.

The impressive Morne à Cabri waste treatment centre, costing about 2.5 million dollars and inaugurated in September 2011, “has the capacity to treat 500 cubic metres of excreta per day, which is the equivalent of what 500,000 produce,” according to DINEPA.

But there is already a problem.

Today, the centre is closed down. The gates are locked. Lack of financing is one reason. The fees paid by excreta trucking companies don’t generate enough revenue.

Also, after the humanitarian agencies stopped managing the refugee camps – they pulled out once funding ended – deliveries from the portable toilets became problematic.

“We went from having latrine matter being made up of 10 to 20 percent trash, to 70 to 80 percent,” Petit explained. “The treatment centre was not built to handle trash. It was built to handle water and fecal matter. The pools collapsed, blocked with trash.”

Even though it is struggling financially, DINEPA is determined to get things working again.

“We are going to use government equipment. If we can get 40,000 or 50,000 dollars, we will be able to clean it,” she said.

Of course, the other treatment centre is working, but two challenges remain: convincing the bayakou and others to deliver their loads, and the financing issue. For, even if the excreta is delivered, bayakou will not be able to pay.

Another part of the plan is an education campaign aimed at combating “poor defecation and hygiene practices”. According to Petit, many rural families don’t even bother building latrines any longer.

“Over the past 30 years, a certain mentality has developed, where people know that it’s quite possible somebody else [like a foreign agency] will give them toilets,” Petit explained.

Rather than giving out free toilets and latrines, DINEPA hopes to set up a 120-million-dollar fund that will allow families to borrow the money necessary to do their own construction.

Anti-cholera plan up a creek?

But many aspects of the cholera elimination plan are on hold. Haiti requires 2.2 billion dollars, and a plan for the neighbouring Dominican Republic needs an additional 77 million dollars. For the years 2013 and 2014 alone, Haiti needs 443.7 million dollars.

The World Bank, PAHO and UNICEF recently promised 29 million dollars, and U.N. agencies just offered another 2.5 million dollars. But, as of May 31, the pledges remain around 210 million dollars, less than half of what is needed.

“[The U.N.] has decreased the amount of money they initially pledged and it has yet to actually be disbursed,” said Dr. Rattan. “This is crippling the Haitian government’s ability to implement their life-saving cholera elimination plan.”

In Cité Soleil, Michelène Milfort knows very well that there will be no plan implemented any time soon. She lives in a tent. Her camp has 38 deteriorating temporary shelters, tents and shacks and only three SOIL latrines to take care of their needs. Before SOIL’s help, they used a nearby empty lot.

John Abniel Poliné is a neighbour.

“Some people have no regular place to take care of their needs. Sometimes a person has to use a little plastic bag, that he then throws into a canal,” he admitted. “It is not always the fault of the individual. You need to understand that if the person had a place to go, he would not be forced to that extreme.”

Poliné said he wonders about the priorities of the Haitian government and of international actors, especially MINUSTAH.

“They just keep giving MINUSTAH thousands of dollars, while the people of Cité Soleil live in subhuman conditions,” he said.

MINUSTAH’s 2012-2013 budget is 638 million dollars, over 200 million more than what is needed by the Haiti and the Dominican Republic for the first two years of their cholera elimination plans.

Haiti Grassroots Watch is a partnership of AlterPresse, the Society of the Animation of Social Communication (SAKS), the Network of Women Community Radio Broadcasters (REFRAKA), community radio stations from the Association of Haitian Community Media and students from the Journalism Laboratory at the State University of Haiti.