Global Pulse Blog

This past week an excellent discussion of important global health challenges and developments, including those related to the Millennium Development Goals, took place at the TEDx Change Meeting, “The Future We Make”. TEDx is a new program enabling local communities and organizations to organize, design and host their own independent events to discuss innovative and important ideas.

Check out the webcast from the recent “The Future We Make” meeting on the Bill and Melinda Gates Foundation website for an engaging and insightful discussion of issues related to the Millennium Development Goals such as child mortality rates, birth rates, literacy, HIV/AIDS and more on a global level.

TEDxChange Webcast

The UN Summit on the Millennium Development Goals was held this past week in New York City. Occurring at a crucial time, with five years remaining until the 2015 deadline, world leaders met to discuss needed actions to reach the eight global development targets agreed to by the world’s countries and leading development institutions in September 2000 at the Millennium Summit when the United Nations Millennium Declaration was adopted, committing the UN nations to a new global partnership to reduce extreme poverty and setting out a series of time-bound targets – with a deadline of 2015 – known as the Millennium Development Goals. The Millennium Development Goals include:

• End Poverty and Hunger
• Universal Education
• Gender Equality
• Child Health
• Maternal Health
• Combat HIV/AIDS
• Environmental Sustainability
• Global Partnership

The Millennium Development Goals Report 2010 summarizes the progress which has been made thus far while striving to meet these goals as well as potential actions, strategies and policies which could be implemented to continue positive progress.

The World Health Organization (WHO) classifies female genital mutilation (FGM) into four types, ranging from partial to total removal of the external female genitalia. The first type is known as clitoridectomy and involves the partial or total removal of the clitoris. The second type is referred to as excision and involves the partial or total removal of the clitoris, labia minora, with or without the excision of the labia majora. The third type is called infibulation, requiring the narrowing of the vaginal opening through the creation of a covering seal by cutting and repositioning the inner or outer labia with or without removal of the clitoris.  The fourth type has no official designation and involves all other harmful procedures to the female genitalia for non-medical purposes such as pricking, piercing, incising, scraping and cauterizing the genital area.

It is estimated that about 140 million women worldwide have been subjected to FGM and a further two million are at risk every year. FGM takes place in about 40 countries (28 of them in Africa) such as Egypt, Democratic Republic of Congo, Yemen, Kurdistan, the United States, Saudi Arabia, Australia and Canada.

The procedure is not limited to a single religion and is heavily influenced by the desire to conform to tradition.    Many girls are compliant with the procedure because they believe they will be outcasts if they are not circumcised.   In Sudan for example, it is prevalent in Muslim communities while in Kenya, it is common among Christians. Neither the Qu’ran nor the Bible endorse the practice.  FGM predates both the Qu’ran and the Bible and possibly Judaism, appearing in the 2^nd century BC.

Typically, it is the parents of girls aged 5-14 who initiate the FGM process because they believe that it will preserve virginity, communicate status, and even protect them from rape. Despite the medical implications involved, many mothers believe that they are doing the best for their daughters.  It is also believed that FGM will decrease sexual desire in women, increase male pleasure during intercourse and maintain fidelity within a marriage.

The procedure is often done on the pretense that the child will be receiving a special gift, going on a vacation or will be “becoming a woman”.  A young girl would visit a trusted older female relative who lacks medical training in a different town or distant village. One day during that visit, she would be taken to a location where she would be restrained by adults who would hold her down to the ground as she endures the extremely painful procedure that is carried out using a knife or some other cutting tool. In some cases, instruments such as tin can lids are used to cut and thorns are used to stitch the victims up.  Only in rare cases is this carried out with anesthetic or in a clinical environment.

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With heavy flooding covering much of the country and leaving millions of people homeless in Pakistan, concerns over the potential for a major outbreak of cholera are growing. With continuing rains throughout the region, Dr. Michael Merson, the founding director of the Duke Global Health Institute believes that ”Basically there is no question” there’s a major risk of an outbreak. With a lack of adequate aid to the area to ensure a consistent, clean water supply, the risk of this diarrheal illness is immense. While the flood has already killed over 1,500 people thus far, even more are at risk from a potential cholera outbreak with 3.5 million people in Pakistan lacking access to clean water. In the past year, cholera epidemics in Zimbabwe killed over 4,000 people with over 350 killed by the disease in Nigeria over the last three months, demonstrating the deadliness of this disease. Without adequate rehydration therapy, victims can die within a day or two from overwhelming dehydration secondary to extreme diarrhea with up to a liter of stool output every hour. But with adequate rehydration therapy to replace fluids and restore electrolytes, death rates can be lowered to less than one percent.