Jailed Indian doctor Binayak Sen Wins 2008 Jonathan Mann Award for Global Health and Human Rights

The Global Health Council's prestigious Jonathan Mann Award for Global Health and Human Rights has been awarded to Binayak Sen of Raipur, Chhattisgarh, India. In an unprecedented step, the Council lifted its customary embargo to reveal the winner's identity prior to the awards ceremony scheduled for 29 May 2008. This is probably because Binayak Sen is in prison awaiting trial, where reliable sources claim that he has been subjected to mental torture through solitary confinement and threats to deny him a public trial. Each of those measures violates the Universal Declaration of Human Rights.

According to the award citation, "Dr. Binayak Sen is an Indian medical doctor and national Vice-President of the People's Union for Civil Liberties, whose imprisonment for defending the human rights of adivasis (indigenous tribes people) in Chhattisgarh state of India has interrupted his decades-long efforts setting up and guiding pioneering health services for the poorest, as well as his advocacy of non-violence and justice amidst armed conflicts in Chhattisgarh.”

Read more here.

Large areas of Chhattisgarh are embroiled in an armed conflict involving rebels, the state government and law enforcement, and armed civilian militias. Sen was detained on May 14, 2007, and accused of passing notes from a rebel leader he was treating in jail to someone outside the prison. Sen denies committing any crime and says his activities in the jail were supervised by prison authorities. However, the use of force to displace tribals from their lands convinced him of the unavoidable need to advocate and defend human rights if the poorest were to have any realistic chance of health. 

“For the past several years, we are seeing all over India - and as part of that in the state of Chhattisgarh as well —  a concerted programme to expropriate from the poorest people in the Indian nation, their access to essentials, common property resources and to natural resources including land and water... The campaign called the Salwa Judum in Chhattisgarh is a part of this process in which hundreds of villages have been denuded of the people living in them and hundreds of people —  men and women — have been killed. Government-armed vigilantes have been deployed and the people who have been protesting against such moves and trying to bring before the world the reality of these campaigns — human rights workers like myself —have also been targeted through state action against them.”
- Binayak Sen in a statement prior to his 14 May 2007 detention.

Binayak Sen started out by helping to establish the Shaheed Hospital, financed by contributions from mine-workers. He then expanded into work among indigenous people, running clinics, meticulously documenting their health and nutritional status and training women to serve as basic health workers — a scheme later named Mitanin and adopted by the government across better-served areas. His careful documentation highlighted widespread malnutrition and deaths from starvation.

Binayak Sen and his wife, Ilina Sen founded RUPANTAR, a NGO aimed at addressing health needs, civil liberties, and human rights in an integrated way. RUPANTAR has trained community health workers spread throughout 20 villages. Read more here.

To raise public awareness about Dr Sen’s detention The Monthly Free Binayak Sen Medical Camps for the urban and rural poor, are being held in cities and towns around India. These camps are also part of an effort to highlight the issues of nutrition, child health and the link between socio-economic rights and health.

According to the Organization for Economic Cooperation and Development, India is the world's third-largest economy after the U.S. and China, based on purchasing-power parity. However, India has one of the worst health indicators in the world, even lower than that of sub-Saharan Africa, particularly in the areas of infant and maternal mortality.

Hesperian Nominee Wins Goldman Prize for Ecological Sanitation in Africa

by Hesperian staff Jeff Conant

Feliciano dos Santos
Photo credit: John Antonelli

When Hesperian began work on our Community Guide to Environmental Health, we knew basic sanitation – provision of safe toilets, water for washing, and hygiene education – was fundamental. We hoped to promote a long-term environmental approach, so we began studying 'ecological sanitation,' by which we meant, or thought we meant, compost toilets. But were compost toilets promoted and used in developing countries? If they were, would they catch on? And equally important, how would we emphasize the danger of harmful germs in human waste while also promoting the notion that one could turn this waste into fertilizer for food crops?

Research led us first to Mexico. Several small organizations, some funded by the UNDP, were developing and promoting ecological toilets and educational methods to teach about their use in reducing pathogens and increasing crop production. From there we learned of other ecological sanitation work in southern India, Southeast Asia, Central America, and south and central Africa.

Specifically, we learned of Peter Morgan in Zimbabwe, who was conducting experiments to develop the simplest form of ecological sanitation that could be safely implemented. (Ultimately, it's not surprising that this turned out to be little more than a simple shelter covering a hole in the ground, a few handfuls of soil with each use, and when the hole filled up, a tree seedling.) Simultaneously, we learned that these simple eco-san toilets were being successfully promoted by a small NGO called Estamos in northern Mozambique.

In late 2002, following the World Summit on Sustainable Development in South Africa, I spent two weeks with Estamos along with advisors from the UNDP and WaterAid UK, and an intrepid BBC reporter traveling the world to get "the scoop on poop"

In remote Niassa State, I met Feliciano dos Santos, director of Estamos. Not only did he direct a successful NGO doing life-saving work, he was also a guitarist in Massukos, one of Mozambique's hottest pop bands. In the village of Maua, after an exhibition of the villagers' success with eco-san, I danced to Massukos' lively music under one of the village's few shade trees. To hear and download music from Santos’s band Massukos, visit Calabash Music, the world’s first fair trade source for international music. The villagers' enthusiasm for ecological sanitation, coupled with Santos' vibrant way of educating about it, convinced me that indeed, A Community Guide to Environmental Health had to promote this as one successful model of development work.

Over the next few years, Santos and Estamos were instrumental in providing information and field-testing both the toilets we described and the teaching methods. I wrote an article about eco-san in Africa for Dam Nation (a book which Hesperian now distributes). And, since Hesperian is privileged to nominate some of the incredible people we meet in our work for the Goldman Environmental Prize, Santos was an obvious choice. His work protecting public health and the environment is innovative, inspirational, and replicable under even the most resource-poor conditions.

Hesperian is deeply pleased to announce that Feliciano dos Santos has been awarded the 2008 Goldman Environmental Prize for Africa, and to welcome him to our Bay Area home for the April 14 award ceremony and an all too short visit.

With Santos winning the Goldman Prize, and with our long-awaited Community Guide to Environmental Health being launched next month, 2008 – the United Nations Year of Sanitation – is a turning out to be a great year for raising awareness of ecological sanitation and global environmental health. Ecological sanitation may not be the most attractive environmental problem to work on, but there is no doubt it is one of the most important.

Congratulations, Feliciano!

To help Calabash support Santos’s sanitation work and send free Community Guides to poor communities in Africa, visit Massukos’ page at Tune Your World, a unique new music microfinance platform for artists ignored by the mainstream music industry.

International recognition for A Health Handbook for Women with Disabilities

Hesperian’s A Health Handbook for Women with Disabilities, less than a year off the press, is already being used and receiving great acclaim worldwide. It is currently being translated by Hesperian partners into 10 languages including Nepali, Vietnamese, Lao, Chinese, Khmer, Bengali, Urdu/Sindhi, Telugu, and Azeri. Hesperian is currently completing the Spanish edition, to be released in the Spring. We are proud to share this recent review from the UK based journal Disability Pregnancy & Parenthood international.

A Health Handbook for Women with Disabilities by

Jane Maxwell, Julia Watts Belser and Darlena David

‘Women with disabilities often discover that the social stigma of disability and inadequate care are greater barriers to health than the disabilities themselves.’ This book has been created to help women in 'developing countries' by giving useful advice, proper medical information and above all by promoting confidence and equality. It advocates not special treatment but equal treatment and it works on boosting self and general confidence in women to expect the same treatment as others and at the same time giving lots of information to allow women to be pro-active for themselves and take responsibility for their health. The book also recognizes the importance of support networks, care givers and the role of health workers. It provides advice for them but also encourages healthy relationships, promoting self-respect, clear boundaries and good communication.

Click here to read the rest of the review

Click to download A Health Handbook for Women with Disabilities for free

Beyond the Season of Giving

Through Hesperian’s Gratis Book Program, we send free books to poor health workers in communities around the world who have requested them. Crystal Plotner is our Quotes database intern, and shares her experience of reading and retyping their letters:

“As a student intern at Hesperian, I have the incredible (and often emotionally overwhelming) pleasure of reading the amazing thank you letters and stories we receive from all over the world as part of our Gratis/Gifts of Health program. The Gratis Program gives free Hesperian books by request to impoverished communities around the world that could not afford them otherwise.

Photo: Gratis recipients of Hesperian’s 'A Book for
Midwives' adapted their own edition for Inuit communities

I’ve read through hundreds of letters describing poor roads in Ghana, political instability and turmoil in Sierra Leone, lack of education in Nepal and lack of resources in Latin America. Addressing these glaring disparities between access to necessary services and infrastructure in the Global North and the Global South is a part of the founding philosophy behind Hesperian.

Reading the glowing words and loving concern with which Gratis recipients describe their deep dedication to their families and communities has made me question why I don’t regularly express my love and appreciation for my friends, family and community in such overt and profound ways. I was moved by the young woman in Ethiopia who was determined to put herself through college to be a teacher in order to pay for her younger brother to go to school, and by the deep sorrow of the community health worker in Uganda when his grandfather died whom he described as his best friend.

A young man in West Africa writing a thank you letter on behalf of himself and his family wrote that he had once heard that unexpressed gratitude will eventually poison the soul. I thought this was an interesting saying and didn’t understand it at first. However, the more I thought about it, the more I began to understand and truly take the expression to heart. I looked at it from the larger picture of going through life without ever truly appreciating things and sharing that gratitude. I realized that I just don’t acknowledge the worth of some things in my life, and while I appreciate other things I don’t consciously express my gratitude. Reading these letters has truly been an eye and heart-opening experience. I have been overwhelmed by the profusion of blessings and unreserved thanks by Gratis recipients. Their graciousness and emotional honesty has been contagious and I plan on carrying and sharing this gratitude not only through this holiday season but the years.”

This holiday season, thanks to donations made as Gifts of Health, we have been able to send 325 free books to communities requesting them. We at Hesperian are deeply grateful for the contributions of our supporters, both to the Gratis Book Program and to our mission in general. We couldn’t do what we do without you!

Welcome to our newest Hesperiana!

We are excited to announce the newest member of the Hesperian family: Sacha Rain Conant who was delivered in a water birth at her home in Berkeley, CA. Sacha's parents, Kristen Graser and Jeff Conant, along with the support of midwives welcomed her on December 31, 2007.

Kristen is a midwife herself and a contributor to the revised edition of A Book for Midwives, and Jeff is completing work on A Community Guide to Environmental Health, which will be published this spring.

Pictured to the left: Jeff and Sacha Conant

Health Promotors Win Award

Hesperian partner, El Comité Asociado de Promotores Interétnicos del Bajo Atrato en Salud (COAPIBAS), or the Interethnic Committee of Associated Health Promoters of the Lower Atrato, recently won The Clarence H. Moore Award for Voluntary Service. COAPIBAS was one of many groups nominated for the award granted by the Pan American Health and Education Foundation which recognizes outstanding contributions to public health by volunteers or non-governmental organizations working to improve the lives of the peoples of Latin American and the Caribbean.

COAPIBAS is an organization of local health promoters and midwives who work against the backdrop of war-torn Columbia, offering training courses and providing health care in their villages. This region of Columbia has about 40,000 displaced people who have almost no access to health care, roads, running water, electricity, sanitation systems, pharmacies, stores or schools.

COAPIBAS has partnered with Concern America, an international development and refugee aid organization, to help meet the emergency health needs of the region and set up a sustainable health system. Together they have established midwifery trainings with community visits, training female health workers to perform pap smear exams, and provided one community with rainwater collection tanks. Where There Is No Doctor is heavily relied upon for their trainings and outreach. For many of the health promoters, Where There Is No Doctor may be the only book they have ever owned.

COAPIBAS is also developing itself as a grassroots advocacy organization. They have met with the Columbian government and PAHO, advocating for the recognition of health promoters in the region.

Read more about training local health workers in Colombia here.

Concern America currently has volunteer openings in Colombia and Bolivia. Click here if you are interested.

Health for All Podcast

Amma Semenya, a graduate student at Emory University, was one of 40 participants in the four-day International People’s Heath University course at the US Social Forum last June. She has just released a podcast to share her experience and gained knowledge of the People’s Health Movement and the interplay of health and the global economy. As a health student wanting to take action, Amma and her student colleagues run Curbside Consult program, a site where students can search, listen, and post podcasts and other media on topics related to medicine and healthcare.

The podcast is now available: click here to listen. (Scroll down and click the play button on the People’s Health Movement.)

Amma is a 3rd year PhD student in the department of Immunology and Molecular Pathogenesis at Emory University, and a member of HealthSTAT (Health Students Taking Action Together)

Read more about the IPHU and the Social Forum:
People’s Health Movement activities at the US Social Forum
Day 1 of the US Social Forum: Promoting Health for All
“Sicko” at the US Social Forum
If Another World is Possible, Another US is Necessary: First US Social Forum Meets in Atlanta

Via Campesina Links Food Production to Climate Change

At Hesperian, we take great care to ensure that our approach to health is at once comprehensive and rooted in common sense. Health is not merely about the provision of healthcare, but about community self-sufficiency, the ability of all people to live up to their full health potential, and the capacity to provide the conditions for good health to future generations. Our forthcoming Community Guide to Environmental Health, for example, will offer material that makes direct links between sanitation, toxic exposures, food sovereignty, environmental stewardship, and people’s health.

Further, we believe that in order for governments and international development agencies to protect and defend health as a human right they (and we) need to follow the lead of social movements. One such social movement that we admire, and whose principles we seek to further with our own work, is Via Campesina, an international movement of peasants, small- and medium-sized producers, landless, rural women, indigenous people, rural youth and agricultural workers.

Following is a paper Via Campesina has just released drawing the links between food production and global warming, and whose call to action we wholly endorse.

Small scale sustainable farmers are cooling down the earth: A Via Campesina background paper on global warming.

Current global modes of production, consumption and trade have caused massive environmental destruction including global warming that is putting at risk our planet's ecosystems and pushing human communities into disasters. Global warming shows the failure of a development model based on high fossil energy consumption, overproduction and trade liberalization.

Farmers - men and women - around the world are joining hands with other social movements, organizations, people and communities to ask for and to develop radical social, economic and political transformations to reverse the current trend.

Farmers - and especially small farmers - are among the first to suffer from climate change. Changing weather patterns bring unusual droughts, floods and storms, destroying farmlands, stock and farmers houses. Moreover, plants and animal species are disappearing at an unprecedented pace. Farmers have to adjust to these changes by adapting their seeds and usual production systems to an unpredictable situation. Moreover, droughts and floods are leading to harvest failures, increasing the number of people going hungry in the world.

Studies predict a decline in global farm output of 3 to 16% by 2080. In tropical regions, global warming is likely to lead to a serious decline in agriculture (up to 50% in Senegal and 40% in India) and to the acceleration of farmland turning into desert. On the other hand, huge areas in Russia and Canada will turn into arable land for the first time in human history, yet it is still unknown how these regions will be able to grow crops.

Corporate food production and consumption are significantly contributing to global warming and to the destruction of rural communities. Intercontinental food transport, intensive monoculture production, land and forest destruction and the use of chemical inputs in agriculture are transforming agriculture into an energy consumer and are contributing to climate change.

Under neo-liberal policies imposed by the World Trade Organisation, the regional and bilateral Free Trade Agreements, as well as the World Bank and the International Monetary Fund, food is produced with oil-based pesticides and fertilizers and transported all around the world for transformation and consumption.

Via Campesina, a movement bringing together millions of small farmers and producers around the world, asserts that it is time to radically change our way to produce, transform, trade and consume food and agricultural products.

We believe that sustainable small-scale farming and local food consumption will reverse the actual devastation and support millions of farming families. Agriculture can also contribute to cool down the earth by using farm practices that store CO² and reduce considerably the use of energy on farms.

Moreover, farms can also contribute to the production of renewable energy, especially through solar and biogas energy.

Globalized agriculture and corporate food production create global warming:
• by transporting food all around the world
• by imposing industrial forms of production (mechanization, intensification, use of agrochemicals, monoculture…)
• by destroying biodiversity (and carbon sinks)
• by converting land and forests into non-agricultural areas*
• by transforming agriculture from an energy producer into an energy consumer

The false solutions:
• Agrofuels (fuels produced from plants, agriculture and forestry) are often presented as one of the solutions to the current energy crisis.
However, leaving aside the insanity of producing food to feed cars while so many people are starving, industrial agrofuel production will actually increase global warming instead of reducing it.
• Carbon trading is a privatization of carbon after the privatization of land, air, seeds, water and other resources. It allows governments to allocate permits to big industrial polluters so they can trade "rights to pollute" amongst themselves.
• Genetically modified crops and trees will not solve any environmental crisis as they themselves pose a risk to the environment as well as to health and safety.

Food sovereignty provides livelihoods to millions and protects life on earth. Via Campesina believes that solutions to the current crisis have to emerge from organized social actors that are developing modes of production, trade and consumption based on justice, solidarity and healthy communities. No technological fix will solve the current global environmental and social disaster.

Sustainable small-scale farming is labor-intensive and requires little energy use; it can and does contribute to cooling down the earth.

All around the world, we practice and defend small-scale sustainable family farming and we demand* *food sovereignty. Food sovereignty is the right of peoples to healthy and culturally-appropriate food produced through ecologically sound and sustainable methods, and their right to define their own food and agriculture systems. It puts the aspirations and needs of those who produce, distribute and consume food at the heart of food systems and policies rather than the demands of markets and corporations. Food sovereignty prioritizes local and national economies and markets and empowers peasant and family farmer-driven agriculture, artisan-style fishing, pastoralist-led grazing, and food production, distribution and consumption based on environmental, social and economic sustainability.

We urgently demand of local, national and international decision makers:
1: The complete dismantling of agribusiness companies: they are stealing the land of small producers, producing junk food and creating environmental disasters.
2: The replacement of industrialized agriculture and animal production by small-scale sustainable agriculture supported by genuine agrarian reform programs.
3: The promotion of sane and sustainable energy policies. That includes consuming less energy and producing solar and biogas energy on the farms instead of heavily promoting agrofuel production as is currently the case.
4: The implementation of agricultural and trade policies at local, national and international levels supporting sustainable agriculture and local food consumption. This includes the ban on the kinds of subsidies that lead to the dumping of cheap food on markets.

For the livelihoods of billions of small producers around the world, and for people's health and the planet's survival: We demand food sovereignty and we are committed to struggle to achieve it collectively.

World AIDS Day 2007: Take the Lead

How ironic that, with the theme “Take the Lead” for this year’s World AIDS Day, the world is presented with newly revised and lowered estimates of AIDS prevalence around the world. This “correction” comes from UNAIDS, the Joint UN Program on HIV/AIDS which oversees or coordinates ten co-sponsors (UNHCR, UNDP, UNICEF, WFP, UNFPA, UNODC, ILO, UNESCO, WHO and the World Bank), a pantheon of global leadership indeed. And yet it has taken years of clamoring and criticism — by everyone from academic epidemiologists to African activists — to push UNAIDS to rework its estimates of this devastating pandemic. Not a very good example of leadership in action.

The lowered estimates are mainly the result of “refined” statistical methods. While previous estimates were based largely on surveys at urban prenatal clinics (whose rates were then extrapolated to whole countries), house-to-house and other surveys showed the prevalence to be about 80% of what had been estimated.

As Stephen Lewis points out, it is hard to know what people will make of these numbers. Perhaps some will see them as an opportunity to feel hope that there is progress. Others may see them as confirmation that the HIV establishment doesn’t know what it is doing. Most dangerously, however, some donors and governments might relax a little, somehow believing that there is less to do — which can hardly be farther than the truth.

Closer to the ground, we can see what real leadership on HIV and AIDS looks like:

• The people living with HIV who publicly disclose their status, especially those who were earliest to disclose in their communities, where they risked their lives to do so.
• The thousands of health workers and community organizers who have dedicated themselves to providing care for communities overwhelmed with HIV, and have strategized brilliantly to mobilize and manage scarce resources to have the greatest impact.
• The children who, having lost parents, step capably and uncomplaining into the role of raising younger children in their care.
• The determination and rage of groups like Act Up, which have forced the development and greater accessibility of ARV medicines.
• The solidarity represented by organizations like Partners In Health and Medecins Sans Frontieres, committed to providing first world health care and pharmaceuticals to poor communities around the world.

This is leadership in action.

Those agencies and individuals in control of the world’s vast streams of wealth, whose small spigots are so inadequately turned on over the giant basins of HIV need, may wear the mantle of world “leadership,” but many don’t deserve it. If the elite and powerful had anywhere near the courage, dedication, intelligence, and passion of the people directly confronting HIV in the world today, things would be different. We could restore health care systems, relieve poverty, extend public water and sanitation projects, improve nutrition, and widely distribute affordable second-line medicines. We could also generate hope, little nurtured by the timid and bureaucratic half-measures deemed realistic by the “leaders.”

If the AIDS Day slogan “Take the Lead” is to have any real meaning, we have to find ways to empower and recognize leaders who treat health as if people matter — especially people with HIV.

by Susan McCallister, Hesperian staff
Susan is editing the new edition of HIV, Health and Your Community
Click here to purchase
Click here for free download
Click here to give this book as a Gift of Health

Hesperian attends London conference on reducing maternal mortality

By Jane Maxwell, Hesperian Staff

Every single minute of every single day, a woman somewhere in the world dies from complications in pregnancy and childbirth—mainly in poor countries. In addition, for each of these 600,000 maternal deaths every year, there are about 15 million women so severely damaged by pregnancy and childbirth that they never regain their full health.

In an attempt to change this, almost 2,000 people from 109 countries attended the Women Deliver Global Conference in London from 18 to 20 October, 2007. This conference was an attempt to reinvigorate the Safe Motherhood Initiative, first launched in Nairobi in 1987 with the goal of reducing at least half of maternal mortality globally by the year 2000. Despite the Initiative’s good intentions, this has not happened. In fact, the number of women dying has increased.

An important focus of the conference was to acknowledge how undervalued women’s contributions to their communities and the world have been, which leads to inadequate support and services, and thus to the devastating rates of maternal mortality as well as other serious, life-threatening health problems for women.

While the conference generated a strong commitment by legislators, journalists, donors and international NGOs to reinvigorate worldwide support for conquering maternal mortality, it was disappointing to see how little attention was paid to women with disabilities, either at the conference itself or in the program planning. Disability issues were not included in any of the panel discussions I attended. The one panel dedicated to reproductive health for women with disabilities was held in the most difficult to find room at the conference. Only 2 speakers were on this panel (most other panels had at least 4) and both had physical disabilities that affect walking, making the location difficult for them to get to. In addition to an absence of attendees and participants with disabilities, there were also no sign language interpreters. I can’t remember the last conference of this significance I’ve been to without a sign language interpreter!

However, speaker after speaker at the conference emphasized how poverty and poor health lead to poor economic development, and therefore demand stronger and more effective intervention. All agreed that the crucial components for saving the lives of women and newborn babies are:

access to comprehensive reproductive health care, including family planning, and management of unsafe abortion

skilled care during and immediately after pregnancy and childbirth

emergency care for mothers and newborns with complications

And despite the focus on macro-level policies and advocacy, the importance of “working on the ground” was repeated throughout the conference. Even in sessions that focused on scaling up services and on policy change, the importance of working directly with women – and with men – almost always arose.

Indeed, this conference emphasized the role men must play to improve the health status of women and girls more forcefully than at most women’s health conferences. Many men spoke at plenaries and on panel discussions, and amongst the attendees there was a noticeably large number of men from various countries, many of them doctors and government ministers. All agreed that women deliver as mothers, individuals, family members, and as citizens. And because woman's health is critical to the well-being of her family and to the economy of her community and her country, they pledged to make the improvement of maternal health a high priority on their national, regional and international health agendas.