London, United Kingdom — Community Health Workers (CHW) in Bangladesh has now restored clear vision for 2 million adults in less than two decades.

In 2006, social enterprise VisionSpring collaborated with BRAC Bangladesh to train 32,000 volunteers and bring the primary diagnosis of presbyopia, the common reason for farsighted vision in adults, to remote courtyards.

Presbyopia is an age-degenerative refractive vision error that makes it difficult to focus on subjects at a closer distance and affects income avenues. Today, 1.8 billion of the world’s population is affected by the epidemic. An estimated 826 million are close to visual impairment due to the lack of access to affordable vision correction.

Presbyopia in Bangladesh

Though one in every two adults in Bangladesh is deprived of their livelihood opportunities because of presbyopia, appropriate pairs of glasses can radically reverse the loss.

BRAC and VisionSpring have scaled up vision tests and distribution of spectacles through its Reading Glasses for Improved Livelihoods (RGIL) initiative in 61 of 64 districts in Bangladesh.

The programme has trained volunteers to assess visual complexities in the country’s distant communities, dispense affordable reading glasses, and refer to ophthalmologists and optometrists for advanced eye care.

In return, they earned remunerations depending on the number of spectacles distributed.

The role of community health workers

Community health workers lie at the heart of primary healthcare in rural Bangladesh. They support the local population in family planning, maintaining adolescent hygiene, vaccinations, and safe antenatal and prenatal care.

Their acceptance within the communities encouraged participation in the programme. Regular visits enabled a feedback loop to realign the project timely and maintain its efficacy.

Morseda Chowdhury, director of the BRAC Health Nutrition and Population Programme, has acknowledged the role of community volunteers in achieving the milestone.

He said, “This is a perfect example of an effective public health intervention scalable in a low-resource setting. A multi-tasking CHW can be utilised to tackle a stubborn problem that impedes the quality of life as well as reduces productivity and thus the economic potential of a country”.

Vision correction in addressing poverty

Vision impairment hits poor economies unevenly. While in Europe only 4 per cent of the population are presbyopic, up to 94 per cent are suffering from poor vision in lower-income nations. Research suggests presbyopia reduces the quality of life of affected individuals by 22 per cent.

Far-sighted adults struggle to perform daily chores, ranging from winnowing grain, and cooking food, to maintaining hygiene. A World Economic Forum survey has reported that the earnings of 23 per cent of office employees in Bangladesh were impacted as diagnosed with near vision impairment. The report also mentioned poor vision resulted in 3 times faster termination of workers in Rwanda.

Research in 2011 suggested that inadequate vision correction among the working population under 50 had contributed to a loss of US$ 11 billion in annual global productivity.

A randomised control trial of VisionSpring, Clearly, Orbis, and Queens University Belfast has observed that corrective lenses had led to a 21.7 per cent increase in productivity among presbyopic tea pickers in India.

The success of the RGIL programme in Bangladesh has laid a pathway for lower- and middle-income nations to promote the distribution of reading glasses, the neglected but affordable solution to restore employment and curtail poverty in the global south.

London, United Kingdom — Cambodia introduced a single-dose vaccine against Human Papillomavirus (HPV) in its national immunization framework in October. The move has facilitated Cambodian girls aged nine years and above to protect against cervical cancer free of cost.

The government has collaborated with the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), and Gavi, the Vaccine Alliance to roll out the vaccination through school and community outreach initiatives.

The magnitude of the crisis

Cervical cancer is the second most prevalent type of cancer among the women of the Kingdom of Cambodia, one of South Asia’s poor economies. Every year, around 643 of the country’s women lose their lives to the disease.

Dr Will Parks, UNICEF Representative in Cambodia, has emphasised the importance of the vaccine for sound public health.

He said, “Ensuring all eligible girls, especially those living in high-risk, urban poor, remote and rural communities, and ethnic and migrant populations, have access to the HPV vaccine is critical for promoting health equity and safeguarding the well-being of every child in Cambodia”.

Globally, an estimated 570,000 cases have been diagnosed with cervical cancer in 2018. According to the World Health Organisation (WHO), the number will increase to 700,000 by the end of the decade.

Though entirely preventable, inadequacy of medical infrastructures turns the infection into a death trap, especially in lower-middle income countries.

Human Papillomavirus is often transmitted during sexual intercourse. Although the virus mostly remains benign and goes away on its own, lasting infections develop cancer in the female’s cervix.

Immunization, early detection, and palliative care are crucial to the treat the illness.

Shortage in supply

Twenty years after the invention of the HPV vaccine, still a woman dies of cervical cancer every two minutes. Globally, only one in eight girls are vaccinated against human papillomavirus today.

To combat the soaring public health crisis, WHO has launched a global strategy to vaccinate 90% of the world’s adolescent girls by 2030. It will potentially save the lives of 62 million women over the next century.

But the primary hindrance is the shortage in supply. Since 2018, the demand for HPV vaccines has doubled worldwide. However, due to the complex manufacturing process of biological products, scaling up production takes longer for the manufacturers.

Single-shot jabs open a new horizon

A single-dose schedule provides comparable protection against cervical cancer to two and three-dose alternatives, the WHO Strategic Advisory Group of Experts on Immunization (SAGE) concluded in April 2022.

WHO Assistant Director-General Dr Princess Nothemba Simelela has hailed the breakthrough for its potential to promote equality in vaccine access and address the shortage in supply.

“It facilitates implementing catch-up campaigns for multiple age groups, reduces the challenges linked to tracing girls for their second dose and allows for financial and human resources to be redirected to other health priorities,” Simelela said.

She believes the milestone will take the world to its goal of immunising a generation against cervical cancer, faster.

By introducing the vaccine in its national immunisation program, Cambodia has now joined an expanding cohort of 132 nations waging war against the fourth common cause of cancer-related death among women.

This story was published in The Borgen Magazine on February 03, 2024.

A closed bike shed was David’s first street home. It was dark. It was damp. The floor went missing under piles of old litter. But it was safer than home.

The freedom did not last long, though. One day, while making food in the shelter, a cooking fume revealed his location, and he was subsequently caught and returned. According to the police, the streets were unsafe for a boy of 9.

David Harris, 53, once an autistic rape victim, is now a torchbearer of hope for homeless people. For the last 8 years, he has helped at least 300 rough sleepers find places to stay. Oftentimes, the rescued were survivors of violence and abuse.

The man, who once tried to end his life by inhaling toxic car fumes, now influences lives to help manage trauma and addictions.

“My job? I can’t explain! I love it. It’s a passion of mine. It’s what I want to do forever,” he exclaims.

David was abandoned by his biological father almost immediately after birth. He grew up with his mother and stepfather.

David fell prey to sexual abuse at the age of 7.

His parents used to hang out on weekends and his uncles used to babysit him. One of them was the culprit. For the man, it did not take long to force the minor.

The abuse continued until the youngster ran away to live on and off the streets. Being autistic made it awkward for him to reach out for help.

Subsequently, amidst the concern for safety by social services, he was taken to Grafton Close, a children’s home in Hounslow.

But there, a manager was aware of his troublesome childhood. One night, while asleep in the dormitory, David found himself being carried to the manager’s flat. He was molested again. Soon, it became customary for him to be got drunk and raped regularly.

At the age of 17, he was finally able to leave the children’s home but not his troubles. He was violated again while living with a foster family.

To deal with the agony, he started abusing himself with alcohol and Class-A drugs. Before being put into prison, David was living in a skip that belonged to a supermarket and survived on the food they threw away at the day’s closure.

But the traumatic past could not turn his life into ashes. He decided to fight back by seeking justice.

It may have taken him 40 years to speak out, and he may have fainted at the police station while reporting the incidents, but that was the first step in redirecting his life towards the light. He became a phoenix.

David says, “If it wasn’t my past, if it wasn’t that dreadful, if it wasn’t that journey — it wouldn’t make me the person I’m today. It could make me a monster; it could make an angel!”

After fighting legal battles for five years, he won a five-figure compensation last year. His dream now is not a luxurious trip to the Mediterranean, but to establish an online support network for other homeless and historical abuse victims.

But how he was introduced to outreach work? David recalls it was a typical doomed day in his life eight years ago. He lost his job, was depressed and lying drunk in a dark corner of his home.

But then his elder son came to take him to Kingston for fresh air. They went for a stroll along the Thames and did some shopping. There, he encountered a homeless man sleeping rough in an alley. Like an electric shock, memories of him as a runaway kid flashed back. “It was my wake-up call,” David says.

“I’m a social worker with a life history. People tell me their stories — how, why, when — but nothing these days shocks me because I’ve seen that, I’ve done that. I’ve done addictions, done all the odds. That’s what makes me good at my job,” he further adds.

He goes to people living on the streets and tells his story. It motivates them to realise being on the streets, sunk in alcohol and the trauma of an abusive past does not mean the end of the world.

“Such was one young adult”, David recounts. It is an incident from his early days as an outreach worker. His team found a drunk man sleeping rough. By then, he had been on the streets for 3 to 4 weeks.

A couple of years before that, the boy was lost and desperately wanted to return to his family. But as he did not have money, stole a vehicle. Unfortunately, the man also allegedly killed someone in an accident way back home.

Serving a term in a prison cut him off from the world. With the support of David’s team, he gradually transformed into a life of education and work.

David remembers the moment the person got reunited with his family. He returned to bid goodbye. But his throat choked up and his eyes overflowed. “Ahh! It’s tears, tears of joy,” he recalls.

After years of turmoil, David, too, now finds solace in the warm company of his children and grandchildren. He feels relieved to think “nobody is going to abuse me anymore!”

His family and outreach work, today, comprise the world to him.

He adds, “With willpower, with great family support, friends’ support, if you want to change, you can always. Never suffer in silence.”

“Hope is the key thing in my life.”

At an empty café across the river Thames, David halts. It is Kingston again, the place which brought light to his life, the place where he started outreach works.

After days of downpours, it is a sunny day. The morning beams glorify the wrinkles on his face. Adventurers are exhilaratingly flying past on speedboats. Seagulls are nestling together.

LONDON, United Kingdom — Nigerian healthcare venture mDoc has launched an AI-powered chatbot to leverage accessibility to preventative care for incommunicable diseases.

Kem, mDoc’s virtual health coach, uses the large language model (LLM) of ChatGPT-4 to enable people living with or at risk of chronic health conditions to lead healthy lives.

Diabetes, cancer, and cardiovascular diseases are the prime cause of mortality across sub-Saharan Africa today. Between 2000 and 2019, the number of deaths from such incommunicable illnesses (NCD) has increased from 24 per cent to 37 per cent.

Dr Matshidiso Moeti, WHO Regional Director for Africa, said, “The growing burden of noncommunicable diseases poses a grave threat to the health and lives of millions of people in Africa: over a third of deaths in the region are due to these illnesses”.

“What is particularly concerning is that that premature deaths from noncommunicable diseases are rising among people younger than 70 years,” Dr Moeti added.

Each year, 17 million lives can be saved globally from premature deaths solely by early diagnosis and preventative measures. 85 per cent of the figure comes from developing countries due to the lack of critical care infrastructures.

The round-the-clock availability of Kem, the chatbot, on mobile phones and its ability to answer in simple terms makes the application an effective solution for remote communities for primary health advice in unusual hours.

L. Nneka Mobisson, Co-founder and CEO of mDoc, said, “We recognised that by investing in preventative care and focusing on behaviour change and nudges, we’d be able to stop what happened to my father from happening to other families.” Mobisson’s father suffered a massive stroke and succumbed prematurely after a brief period of paralysis and psychosis.

Dr Aldo Faisal of the UKRI Centre for Doctoral Training in AI for Healthcare at Imperial College London said that deploying AI can “improve the cost of care and improve outcomes” by enhancing the efficiency of diagnostic methods.

AI is currently being used in healthcare ecosystems to assist surgeries, develop pharmaceuticals, automate outbreak response, transcribe medical records, and promote communication between patients and doctors.

The market for AI-assisted healthcare is estimated to grow from $11 billion

The technology can promote equality in healthcare in low- and middle-income countries (LMIC) by reducing the cost of medical treatment. However, its research and implications are majorly limited in wealthy nations.

Philanthropist and co-founder of Microsoft, Bill Gates has said, “The world needs to make sure that everyone — and not just people who are well-off — benefits from artificial intelligence. Governments and philanthropy will need to play a major role in ensuring that it reduces inequity and doesn’t contribute to it.”

mDoc Healthcare received funding from the Bill & Melinda Gates Foundation in July 2023 to onboard the LLM of ChatGPT into their virtual self-care assistant Kem.

Integration with artificial intelligence has allowed Kem to solve a wide range of queries with evidence-based precision. It has interpreted user behaviours to evolve into a culturally relevant product.

Mobisson’s team is running a community trial to escape the loop of human bias that LLMs are often prone to.

This story was published at The Borgen Project on January 23, 2024.

Alois is looking emptily at the flowing crowd. The Westminster Underground Station is overflowing with travellers. A street musician is playing merry tunes. It is Christmas Eve.

Alois Krajnc is a Slovenian immigrant. To produce music for a television network, he came to the United Kingdom a few years ago. He is one among the faceless masses of the Capital who have lost their jobs and shelters due to the cost-of-living crisis.

London has seen a sharp rise of 24 per cent in the number of people sleeping rough on the streets, according to the data released by the Combined Homelessness and Information Network (CHAIN) in October, last year.

Among them, 1844 people are living on the streets for the first time.

“Sleeping rough is more challenging than we perceive. A homeless person rarely gets a full night’s sleep. He has to stay awake to protect the belongings from getting robbed or attacked,” says David Harris, a veteran Outreach Manager in the homeless field.

He adds, “Generally, members of the public are not very nice towards them. They get a lot of bullying from the general public who just look down on the homeless but do not understand their background, or their needs. Even sometimes, light bulbs were thrown on some of my clients.”

“I had a client who lived in a tent. And someone one day set the tent on fire. Inside his tent was everything — IDs, pictures of family members etc. When he returned, found everything had turned into ashes,” David recounts.

Mandla Adebowale is surviving under the open sky at Fordham Park in Lewisham. A quilt and a backpack are his only possession.

Being homeless, he feels “reduced to a nameless creature isolated on a park bench, existing like a prisoner on a remote island”. He feels cut off from society.

People often kick deliberately, urinate on him, or abuse him verbally. If someone recognises, humiliates the most.

After getting terminated from his job as a security officer in December, he is now working part-time as a nightshift warehouse operative. The salary from the new employment only covers his food and daily expenses but not accommodation and utility bills.

The United Kingdom experienced an annual rate of inflation of 11.10 per cent, an unprecedented increase in four decades, last October.

Inflations increase the prices of goods and services. It makes availing sustenance even harder by costing more for the same amount of purchase.

In Great Britain, 09 in every 10 adults has reported an elevated cost of living compared to the previous year, in a survey by Office for National Statistics (ONS) in December.

Another data released by the ONS has shown the growth of inflation has outpaced the growth of wages in the Retail, Property, Finance, and Information and Communication sectors between July and September, 2022.

Dr Ariane Agunsoye, lecturer in economics at Goldsmiths, University of London, says, “There are currently two main discussions being put forward as underlying reasons for inflationary pressures.”

“One is relating to demand-pull factors where demand for goods is higher than the supply and one is relating to cost-push factors due to rising costs of production or rising profit margins which arguably, we can see now.”

She further states, the governmental policies adopted by far may curb “demand-side inflationary pressures” but would “put more pressure on the everyday person. Especially, lower-income households will suffer from further wage restraints and rising costs for borrowing”.

People are more often feeling forced to skip meals, eat cheap but unhealthy foods, and survive on donations. Compared to 2020, in 2022, a 22 per cent surge in the demand for food parcels has been observed by YMCA, a charity for the homeless young.

Individuals are also cutting expenses on essentials, e.g., winter coats, haircuts and socialising, the observation unveiled.

The cost of private renting has also ascended amidst the cost-of-living crisis, data released by the ONS confirmed.

Research from the housing charity Shelter has found that one in 12 private renters in England is under the threat of being homeless, this winter. The total figure accounts for affecting 941,000 lives.

Polly Neate, Chief Executive of Shelter, says, “Every day our emergency helpline advisers are taking gut-wrenching calls — from the mum who’s skipping meals to pay the rent to the family terrified they will be spending Christmas in a grotty homeless hostel.”

Annika Byrne, a psychology student, has experienced the same fate. Last August, she was evicted from her rented accommodation and had to couch surf at friends’ places.

Being in the city for the previous 20 years has gifted her with that support network.

Byrne recalls, “I was homeless for two full months and went to housing offices every day saying I need help, I’m type 1 diabetic, had PTSD, am disabled and very vulnerable. And it took over two months for the council to find me a place.”

She is now being housed temporarily by a local council. But to describe the depth of the crisis, she adds, “The housing crisis in London is insane. The rents, at the moment, have gone up so much, deposits are so expensive, that there are people who look like me, sound like me, well educated, seem quite like well-off, are actually homeless.”

A gust of chilly wind pours in. Alois slips into his sleeping bag. In the cold, his face has swollen and turned reddish.

Every day two homeless people die in England and Wales.

London has witnessed the maximum number of deaths of homeless people in 2021, the latest data released by the Office for National Statistics, last November, has shown.

But the price of homelessness is not solely physical. It also leaves deep mental scars.

Crisis UK, a London-based charity that contributes to curbing homelessness, reported 45 per cent of homeless people are diagnosed with a mental health problem.

The figure ascends to 80 per cent when they are sleeping rough. Social stigma around the issue adds layers of complexity to the crisis.

Emma Haddad, Chief Executive of St Mungo’s, says, “Health and homelessness are inextricably linked, and it is an awful reality that sleeping rough causes chronic illness and can lead to premature death, with the average age of death for someone living on the streets being around 30 years earlier than the general population.”

“Every single death of a person experiencing homelessness is an absolute tragedy. Each one of these people was someone’s child, sister, or brother — all with their own hopes and dreams.”

Alois Krajnc has fallen asleep.

He dreams of a postal mail from his family. He dreams of putting up a water treatment plant on the Ganges and getting rich, one day. He dreams of “a happy world” with plenty of fortune.

Meanwhile, life slips away.

Note: Alois Krajnc, Annika Byrne and Mandla Adebowale are not original names. The names have been changed to protect their identities.

Machine harvesting is nothing new in the first world countries. In India also, five decades have elapsed since its first introduction in Punjab. But in the fields of Birbhum of West Bengal, a combine harvester is still afresh. It is only three or four winters this locale has witnessed these machines operating. And Raja was one of the first people to realise the business prospect of combine harvesters in the region.

For the initial one and a half years, Raja had to hire professionals from Punjab. But it did not take much to learn the basics. Today this man can harvest more than 30 bighas of rice a day. And three seasons a year- the wheat, winter and summer rice harvests- he with his machine is on hire.

But these combine harvesters have not only displaced a massive number of agricultural workers but posed a serious threat to the environment with stubble burning. The ripen crop-plants previously used to feed the livestock, now get chopped and wasted by the giant fossil-fuel-powered machines. Farmers burn those residues to clear their fields for the next course.

However, this man of 36, thinks the crisis lies not in machine harvesting. After each harvest, if the crop butts are ploughed enough to go into the soil, that not only keeps the environment clean, as a bio-manure can help yield better, too. But farmers do not want to put that much effort, as traditional agriculture has become less-and-less profitable over the years and turned into a profession in the deputation. Agriculturalists can no more rely solely on the agricultural produce to make their ends meet. Besides cultivating, they need to work elsewhere to have a steady income. He also gives an insight that farmers cannot retreat from their current stand as it is no more possible to make a significant profit by harvesting manually with human resources. On each bigha of the rice harvest, preferring a combine harvester over the manual methods saves 1700 Indian bucks.

And for an already debt-ridden farmer, though it is not in good for all, there is no way to move back.

Originally published at https://www.sohammitra.com on December 27, 2020.