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Friday, 25 April 2014

World Malaria Day

April 25 World Malaria Day

Mosquitoes are the world’s deadliest and most prolific killers .These tiny creatures kill over 6 lakh people every years ,through diseases like malaria and dengue . This world malaria day lets pledge to kill every single mosquito.
What is malaria?
Malaria is an infectious disease that is caused by mosquito-borne plasmodium parasite which infects the red blood cells. It’s one of the deadliest diseases in India. There’s no vaccine for malaria yet and immunity occurs naturally through repeated infection. Common symptoms are fever, chills, vomiting, nausea, body ache, headache, cough and diarrhoea. If untreated, it can lead to complications like jaundice, dehydration, anaemia, brain malaria, liver failure and kidney failure. Children, pregnant women, and the elderly – anyone with decreased immunity is at a greater risk.
How does one get malaria?
The life cycle of malaria is complicated and it involves two hosts- the human being and the mosquito. Once bitten by a female anopheles mosquito, the malarial parasite enters the blood stream. It travels all through his blood stream to reach the liver. In the liver the parasite matures and multiplies. Some of the parasites stay there whereas the other parasites move out from the liver attacking red blood cells. The parasite then multiplies in the red blood cells. In the next 48-72 hours, more parasites are released into the blood.  This is the reason why the chills of malaria are generally seen after 48 to 72 hours corresponding to the release of the malarial parasite in the blood.

With three out of four people being at risk of malaria in South-East Asia region, World Health Organization today called for greater investment in the battle against malaria on the occasion of World Malaria Day. Even though the number of confirmed malaria cases in the Region, which is home to a quarter of the world’s population decreased from 2.9 million in 2000 to 2 million in 2012, the disease remains a significant threat to the lives of people.
’1.4 billion people continue to be at risk of malaria in South-East Asia. They are often the poorest, including workers in hilly or forested areas, in development projects such as mining, agroforestry, road and dam constructions, and upland subsistence farming in rural and urban areas,’ said Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia. Stressing that the funding needs to be increased for diagnostics, drugs, insecticide-treated mosquito nets, and research and response to drug and insecticide resistance, Singh said, ‘We need to empower communities to protect themselves. Eliminating malaria will take greater political will.
India is expected to decrease malaria case incidence by 50?75 per cent by 2015. Sri Lanka is in the elimination phase with no indigenous case reported since November 2012. Maldives has been malaria-free since 1984. Bangladesh, Bhutan, Democratic People’s Republic of Korea, Nepal, and Sri Lanka reduced the incidence of malaria cases by more than 75 per cent from 2000 to 2012. Thailand and Timor-Leste are on track to achieve a decrease of over 75 per cent. But the gains in malaria control, although substantial, could be reversed due to increasing parasite resistance to drugs, mosquito resistance to insecticides and re-introduction of transmission in places where the disease has been eliminated. The emergence of artemisinin resistance in Cambodia, Myanmar, Thailand and Vietnam threatens the global achievements in malaria control and elimination. Artemisinin-based combination treatment (ACT) is currently the first line treatment for the most lethal type of malaria, Plasmodium falciparum. Resistance to this drug would compromise the lives of hundreds of thousands of people affected with malaria, and there is an urgent need to invest in ways to contain the spread of resistance to these drugs, said,Singh.Another danger lies in the fact that the Anopheles mosquitoes, which carry malaria parasites, are increasingly become resistant to insecticides. ‘Investments are needed to develop new tools, to conduct operational research to address bottlenecks in malaria control programmes, and to scale-up and ensure rational use of existing interventions,’ said Singh.
WASH Related Diseases
Malaria, the world's most important parasitic infectious disease, is transmitted by mosquitoes which breed in fresh or occasionally brackish water.
The disease and how it affects people
The symptoms of malaria include fever, chills, headache, muscle aches, tiredness, nausea and vomiting, diarrhoea, anaemia, and jaundice (yellow colouring of the skin and eyes). Convulsions, coma, severe anaemia and kidney failure can also occur. The severity and range of symptoms depend on the specific type of malaria. In certain types, the infection can remain inactive for up to five years and then recur. In areas with intense malaria transmission, people can develop protective immunity after repeated infections. Without prompt and effective treatment, malaria can evolve into a severe cerebral form followed by death. Malaria is among the five leading causes of death in under-5-year-old children in Africa.
The cause
Malaria is caused by four species of Plasmodium parasites (P. falciparum, P. vivax, P. ovale, P. malariae). People get malaria after being bitten by a malaria-infected Anopheles mosquito. Some female mosquitoes take their blood-meal at dusk and early evening, but others bite during the night or in the early hours of the morning. When a mosquito bites an infected person, it ingests malaria parasites with the blood. During a period of 8 to 35 days (depending on the ambient temperature), the parasite develops in the mosquito. The infective form (sporozoite) ends up in the salivary glands and is injected into the new human host at subsequent blood-meals. In the human host, the sporozoites migrate to the liver, multiply inside liver cells, and spread into the bloodstream. The liver phase can last between 8 days and several months, depending on the malaria species. Their growth and multiplication takes place inside red blood cells. Clinical symptoms occur when the red blood cells break up. If this happens in large numbers, the person experiences the characteristic intermittent fevers of the disease. The released parasites invade other blood cells. Most people begin feeling sick 10 days to 4 weeks after being infected.
Today, malaria occurs mostly in tropical and subtropical countries, particularly in Africa south of the Sahara, South-East Asia, and the forest fringe zones in South America. The ecology of the disease is closely associated with the availability of water, as the larval stage of mosquitoes develops in different kinds of water bodies. The mosquito species vary considerably in their water-ecological requirements, (sun-lit or shaded, with or without aquatic vegetation, stagnant or slowly streaming, fresh or brackish) and this affects the disease ecology. Climate change (global warming) appears to be moving the altitude limits of malaria to higher elevations, for example in the East African highlands and Madagascar.
The construction of irrigation systems and reservoirs in some parts of the world can have a dramatic impact on malaria distribution and on the intensity of its transmission.
Scope of the Problem
WHO estimates 300-500 million cases of malaria, with over one million deaths each year.
The main burden of malaria (more than 90%) is in Africa south of the Sahara with an estimated annual number of deaths over 1 million. Two thirds of the remaining burden hits six countries: Brazil, Colombia, India, Solomon Islands, Sri Lanka and Viet Nam. In many parts the natural habitat sustains intense malaria transmission; in others, water resources development (irrigation, dams, urban water supply) has exacerbated the transmission intensity and caused the distribution of the disease to spread. In yet others, for example the Central Asian republics of the CIS, malaria has returned as a result of a breakdown in water management and maintenance problems of local irrigation systems.
To be declared malaria free India
Has to go through four phases: Malaria control, pre elimination, elimination and prevention of re-introduction. India is currently in the control phase and will enter the pre elimination in 2017 with a target to bring down cases to less one person at risk per 1000 in a year to reach elimination status . Nearly 85% of the country’s population is at risk of malaria. Almost 65% of cases occurs in poor and marginalized population . Unlike in Africa where malaria is one of the leading causes of under five deaths ,most reported cases in India are in the productive age group of 15 -45 years.

Source :
Hindustan times

Wednesday, 23 April 2014


A plate laden with three large rotis topped with a generous helping of spicy dal (lentils) is laid infront of Roshni. She is hungry, but will not eat it yet. While her husband and two teenage sons quickly polish off what is on their plates, she puts away her plate. "Yes, I am hungry. I have not eaten since morning, but if I eat now I will have to go to the toilet by the time the food is digested and there is always a long queue at the washroom. We have just two toilets for women in this camp. So I eat only one meal a day, to minimise the number of visits to the toilet," she says.
The women affected by the limited access to toilet facilities confess that the only solution available is to ensure that their need to use a toilet is reduced as far as possible which means avoiding water even      whilst thirsty. This in turn means that their health suffers, because denying the body sufficient fluid intake can result in kidney problems and other serious illnesses. These health hazards are in addition to those that both men and women, as displaced persons in relief camps, face in terms of unsatisfactory living conditions. Echoing this point of view, the women of one family affected by the earthquake in Gujarat said, "We can speak boldly about the lack of sheets and pillows and blankets, but somehow find it difficult to bring ourselves to mention toilets. That is a subject we are not supposed to mention, it's not done. It is considered improper, unbecoming. Sharam aathi hai (we feel ashamed)." "Sharam" (shame) is considered a woman's precious ornament, even if it means attending to perfectly natural and normal functions. And that continues to be so, even today!

Is anybody really surprised that nearly half of India's 1.2 billion people have no toilet at home?
Open defecation is rife, and remains a major impediment in achieving millennium development goals which include reducing by half the proportion of people without access to basic sanitation by 2015. Mahatma Gandhi, India's greatest leader,  once inspected toilets in the city of Rajkot in Gujarat and reported that they were "dark, stinking and reeking with filth and worms" in the homes of the wealthy and the  temples. Moreover, the homes of the untouchables had no toilets at all. "Latrines are for you big people," an untouchable told Gandhi.
India's enduring shame is clearly rooted in cultural attitudes. Even after more than 60 years of Independence, many Indians continue to relieve themselves in the open and litter unhesitatingly, but keep their homes spotlessly clean. Yes, the state has failed to extend sanitation facilities, but its high time that people should also take the blame.
Illnesses caused by germs and worms in faeces, wastes and pollutants are constant source of discomfort for millions of people. Poor sanitation is something that not only affects the health of the people of the country, but also affects the economic and social development of the nation. Most cities and towns in India are characterized by over-crowding, congestion, inadequate water supply, and inadequate facilities of disposal of human excreta, wastewater and solid wastes. Fifty five percent of India’s population (nearly 600 million people) has no access to toilets.

Proper sanitation refers to principles, practices, provisions, or services related to cleanliness and hygiene in personal and public life for the protection and promotion of human health and well being and breaking the cycle of disease or illness. It is also related to the principles and practices relating to the collection, treatment, removal or disposal of human excreta, household waste water and other pollutants. The World Health Organization states that: Sanitation generally refers to the provision of facilities and services for the safe disposal of human urine and faeces. Inadequate sanitation is a major cause of disease world-wide and improving sanitation is known to have a significant beneficial impact on health both in households and across communities.

A study conducted by World Bank’s ‘South Asia Water and Sanitation Unit’ estimated that India loses Rs 240 billion annually due to lack of proper sanitation facilities. The multilateral body said that premature deaths, treatment for the sick and loss of productivity and revenue from tourism were the main factors behind the significant economic loss. Poor sanitation is something that not only affects the health of the people of the country, but also affects the development of the nation. In fact, women are most affected by the hazards of lack of proper sanitation. For instance, in India majority of the girls drop out of school because of lack of toilets. Only 22% of them manage to even complete class 10. On economic grounds, according to the Indian Ministry of Health and Family Welfare, more than Rs 12 billion is spent every year on poor sanitation and its resultant illnesses.

Until there is shift in the mindset of people to a point where they actually believe that “Cleanliness is next to Godliness”, nothing is going to change.

Wednesday, 9 April 2014

Dying In Manhole

At least two to three workers must be dying every day inside manholes across India .

In most developed countries, manhole workers are provided bunny suits and respiratory apparatus. In Hong Kong, a sewer worker needs to have 15 licences in order to enter a manhole. In India, conservancy workers – mostly from the balmiki subcaste of dalits -- go in almost naked. The mortality rate amongst them is a
According to a 2002 report prepared by the International Dalit Solidarity Network -- which includes Human Rights Watch (United States), Navsarjan Trust (Ahmedabad, Gujarat), and the National Campaign on Dalit Human Rights, the government estimates that there are 1 million dalit manual scavengers in India.ppallingly high.
At the very least, 22,327 Dalits die every year cleaning sewage.
Human beings shrink from any contact with faecal matter. We are paranoid about stepping on shit even accidentally, with our shoes on. If it does happen, we rush to wash the offending substance off the soles of our shoes. Can we even begin to comprehend the experience that thousands of balmiki men go through every day of their lives?
There are no sewerage facilities in rural areas, Urban Slums are also not touched by proper sewerage facilities .Still workers manually clean the septic tanks, “these septic tanks are becoming death tanks for the workers”.  It is full of many poisonous and dangerous gases, many people are died by inhaling poisonous gases and many of them going to die if we would not stop this Dehumanising Practices.Many of them are the sole bread winners of their families .These dependents were force by social and economic conditions to come into these practices to feed their families. Most of the Manual Scavengers belongs to SC & ST, last year MHA (Ministry Of Home Affairs) told to all states that engaging or employing a member in SC or ST in manual scavenging fall within the ambit of SC & ST prevention of Atrocities Act, but there is no record of any one being convicted under this Act.There are poor Sanitation Facilities in these places. People are still using dry latrines which encourage Manual Scavenging. We have to stop the dry latrines practices and help them in making Proper Sanitation Facilities.

A manhole is a confined, oxygen-deficient space where the presence of noxious gases can cause syncope -- a sudden and transient loss of consciousness owing to brief cessation of cerebral blood flow. The brain cannot tolerate even a brief deprivation of oxygen. The long-term neurological effects of syncope can be debilitating.”In most developed countries, manhole workers are protected by bunny suits to avoid contact with the contaminated water. They also sport respiratory apparatus. The sewers are well lit, mechanically aerated with huge fans and therefore not so oxygen-deficient. In Hong Kong, a sewer worker, after adequate training, needs to have at least 15 licences and permits in order to enter a manhole. In India, our sanitation workers go in almost naked, wearing just a lungot (loincloth) or briefs. In Delhi, in accordance with the directives of the National Human Rights Commission in October 2002, most permanent workers of the DJB wear a ‘safety belt’. This belt that connects workers in the manhole, via thick ropes, to men standing outside offers no protection against the gases and sharp objects that assault them. It’s a cruel joke; at best it helps haul them out should they lose consciousness or die inside the hole. The CEC study of 200 DJB manhole workers found that 92.5% of workers wore the safety belt. But this did not prevent 91.5% of them suffering injuries, and 80% suffering eye infections.
Manual scavengers are exposed to the most virulent forms of viral and bacterial infections that affect the skin, eyes, limbs, respiratory and gastro-intestinal systems. Reports show that tuberculosis is rife among the community.Most men in the community die young; indeed, the average lifespan of a sanitation worker is 45 years. The civic body does not offer any monetary compensation to these workers for illness or death due to occupational risks, unless the worker actually dies inside a manhole, In Delhi, permanent workers get a monthly ‘risk allowance’ of Rs 50. In some states, the figure rises to Rs 200.

“We pervert reason when we humiliate life … man stopped respecting himself when he lost the respect due to his fellow-creatures.”— José Saramago
Sewage travels across Delhi’s 5,600- kilometre sewer lines at the speed of one metre per second. That is a rather leisurely pace of 3.6 km per hour — the time an obese person may take to complete one round of Lodi Gardens. Along this river of filth — the Ganga is just half this length — there are 1.5 lakh manholes servicing the effluents released by the capital’s 15 million people. Much of this ‘infrastructure’ was designed more than a 100 years ago. According to an estimate I made in 2007, at least 22,327 men and women die in India every year doing various kinds of sanitation work. Figures are hard to come by since this concerns the deaths of a section of population that most of India refuses to see. Santosh Choudhary, then chairperson of the National Commission for Safai Karamcharis, had told me in 2007 that at least “two to three workers must be dying every day inside manholes across India.”
On the morning of March 27, Bezwada Wilson of the Safai Karmachari Andolan (SKA) sent a message to his well-wishers about the impending ruling of the Supreme Court in a Public Interest Litigation that had dragged on for 12 years. All that SKA had been seeking was the enforcement of fundamental rights guaranteed in the Constitution under Articles 14 (Right to Equality), 17 (Abolition of untouchability), 21 (Protection of life and personal liberty) and 47 (Duty of the State to raise the level of nutrition and the standard of living and to improve public health).
Judgment with a caveat
THE WORLD BENEATH: At least two to three workers must be dying every day inside manholes across India. Picture shows a worker entering a manhole in Chennai. Photo: B. Jothi RamalingamLater in the day, the three-judge Supreme Court Bench headed by the Chief Justice, P. Sathasivam, issued directions to the state, the railways, and several organisations to implement the provisions of the Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013 — itself a result of SKA’s relentless efforts. While everyone congratulated Mr. Wilson and the SKA team, a part of me froze at the sight of a certain clause in the judgment.
After ruling that “entering sewer lines without safety gears should be made a crime even in emergency situations,” the Bench added a caveat: “For each such death, compensation of Rs. 10 lakhs should be given to the family of the deceased.”
This, in effect, is like saying these deaths — rather murders — will continue to happen. They are inevitable. They are murders, for we know that each time a person enters these oxygen-deficient dungeons that spew a mixture of hydrogen sulphide, methane, carbon dioxide and carbon monoxide, there’s a good possibility he will die. Yet, the highest court of the land condoned these murders by merely offering compensation. Given that sewer workers anyway are considered socially dead because of their occupation, their legal death is just a matter of record. What kind of ‘safety gear’ can ensure that a person socially survives such an ordeal? Can there be a just way of being unjust? We reason with ourselves to accept the perversion of reason.
Law apparently has an answer for such a conundrum, derived from the Latin maxim: quod feri non debuit factum valet, also known as factum valet. “What ought not have been done is valid once it is done.” Dayabhaga, the 12th century brahmanic law that was prevalent in the eastern parts of the subcontinent, echoes this maxim when its says, “A fact cannot be altered by a hundred texts.” Ideally, don’t send a man into a sewer, but if you have to send him, make sure he wears safety gear. And if he dies after that, give his family 10 lakh rupees. If he refuses to wear safety gear that weighs 18 kilos and gum boots that gnaw at his toes, that’s his problem. Ideally, sati or child marriage should not be committed, but when it happens, we can always have eminent social scientists tell us why we need to understand the difference between pratha (custom) and ghatana (event).
No change on the ground
What is the point of laws, and judgements to back these laws, when the situation on the ground or rather beneath the ground has not changed? Urban India is serviced by four-inch house drains that empty into nine-inch trunk sewers that carry the slush to bigger lines of 2-metres to 3-metres in diameter. These make it necessary for a human being to be lowered into a drain. A clog demands at least three entries into a manhole: to fix the cleansing rod, to make it work, and to detach it.
In 2002, the Jawaharlal Nehru National Urban Renewal Mission envisaged spending Rs. 1,20,536 crore over seven years on urban local bodies. Of this, 40 per cent was allotted for drainage and sewerage work. Thousands of crores have been likely spent on laying or relaying pipes and drains designed to kill. Phases 1 and 2 of Delhi’s metro cost Rs. 30,000 crore. While the metro works, the sewage system continues to foul the air all around us.
Meanwhile, each sewer worker’s death will cause something to die in us. A million rupees is a very small price we are agreeing to pay to stop respecting ourselves.

Edited By : Sonika 

Source:     http://infochangeindia.org/livelihoods/sidelines/dying-for-a-living.html
                : the hindu