Global View
Where Living Is Lethal
L
BY GEOFFREY COWLEY
T
O EXPERIENCE CHILDHOOD AS
Americans knew it a century ago,
you don't have to travel very far.
Just 700 miles from Miami, on
Haiti's desolate Central Plateau,
obesity and food allergies and attention
deficit disorder are unheard 0£ In this part
of the world, a healthy child is the one
who escapes death from tetanus or tuberculosis-someone like 14-year-old Noula.
When the boy's family carried him into Dr.
Paul Farmer's frontier clinic in the village of
Cange two years ago, he had a raging fever
and a ballooning abscess on his back.
Farmer's team saved his life by treating the
TB and other infections that were devouring his spine. But they couldn't restore life
to his legs- and they knew he wouldn't survive in his mountaintop settlement without
them. So Noula lives in the clinic now. He
wheels around behind the auxiliary nurses,
coaxing moribund children to hang on, and
he seems to feel he's the luckiest guy alive.
When I met him last March, he had just
been given a new wheelchair. His smile
could have lit an office building.
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NEWSWEEK SEPTEMBER 22 , 2003
J
necessities-skilled birth attendants, 50cent vaccines, antibiotics that were developed eight decades ago. "We know what
to do,'' says Dr. Robert Black of Johns Hopkins University's Bloomberg School of Public Health. "We have interventions that are proven. What we
haven't done is commit the resources needed to deliver them."
Children's lot is clearly improving by many measures.
The overall death rate for kids
younger than 5 has dropped by
30 percent since 1980. Some
countries (Cuba, Brazil, Bangladesh) have made even
greater strides. And bold initiatives by Bill Gates and other
philanthropists have helped
create a new sense of urgency
and possibility. But obscene
disparities persist. Kids born in
South Asia and sub-Saharan
Africa still die at 20 to 30 times
the rate of kids in the industrialized world. In fact 90 percent
of the world's childhood deaths
-roughly 9.7 million a yearnow occur in 42 developing
countries. And 99 percent of
the victims are poor.
Farmer with Noula at
What exactly is killing all
Clinique Bon Saveur
these kids? Birth complications
(above); a Haitian child
and neonatal infections are the
who survived malnutrition
biggest scourges, together killing 3.2 million children in the
11 MILLION
42 hardest-hit countries each
year. Diarrhea and pneumonia
NUMBER OF CHILDREN
claim an additional 2.1 million
WHO DIE BEFORE THEIR
lives each, followed by malaria,
5TH BIRTHDAY EACH
AIDS and measles. But none of
YEAR, WORLDWIDE
these conditions kills at random. In a sense, every one of
9.2 MILLION
them is a symptom of poverty.
NUMBER OF CHILDREN IN
Poor kids, wherever they live,
THE UNITED STATES WHO ARE
encounter more than their
NOT COVERED BY HEALTH
share of health hazards- more
INSURANCE
crowding, more vermin, more
contaminated water-and inadIn a sense, Noula is lucky. Kids like him equate diets leave them doubly vulnerable
still die in droves in Haiti-and Angola and to whatever hazards they confront. "More
Afghanistan and Bolivia and dozens of other than half of the deaths in children can be
poor countries. Worldwide, nearly 11 million attributed to undernutrition alone," says
children perish before their 5th birthdays ev- Black. "What finally kills the child may be
ery year. They don't die because science has pneumonia, but if the child were well nouryet to find treatments for their conditions. ished, he never would have developed it in
Most die for the lack of clean water, ade- the first place." The final blow is a lack of
quate nutrition and the most basic medical adequate health services. Kids in poor
l Around the world, millions of kids die
needlessly each year. Can they be helped?
PHOTOGRAPHS SY PHILIP JON ES GRIFFITHS-MAGNUM FOR NEWSWEEK
DIE EACH YEAR FROM BIRTH
COMPLICATIONS AND NEONATAL
INFECTIONS IN 42 NATIONS
2.1 MILLION
NUMBER OF CHILDREN WHO DIE
EACH YEAR FROM PNEUMONIA.
ROUGHLY THE SAME NUMBER
DIE FROM DIARRHEA.
countries are not only more exposed and
more susceptible to disease. Once sick, they
often go untreated.
This dynamic plays out incessantly in
the hills of central Haiti. Farmer started
his clinic there in the mid-1980s, while
studying medicine and anthropology at
Harvard. His patients were landless peasants who'd been forced off their farms
and onto the barren hillsides by a
U.S.-sponsored hydroelectric-dam project. Thanks to his vision, tenacity and
fund-raising acumen, the Clinique Bon
Saveur is now a thriving community center with a school and a 104-bed hospital.
Partners in Health, the relief group he
founded with Harvard in 1987, now operates in seven countries. Traversing the
shaded grounds at dawn, Farmer is
mobbed by supplicants who have walked
for days to get there and camped on the
pavement once they arrive. "Feel my
stomach," they plead. "Can you fix my
hands?" "Please, look at my baby."
The medical staff works 16-hour days to
avoid turning anyone away, and it has
achieved astounding results. In the region
served by Zanmi Lasante (Creole for Partners in Health), infant mortality now
stands at one third Haiti's national rate.
The interventions that make the biggest
difference are often simple ones: sterile
birth kits; antibiotics for typhoid; milk,
zinc and vitamin A to combat malnutrition.
Policy analysts estimate that these and other basic measures could save 6 million children a year- all for the price of a few aircraft caniers.
Unfortunately, the gap between possibilities and realities is growing ever wider.
As World Bank health consultant Davidson
Gwatkin observes, "The more you need
health care, the less likely you are to receive
it." Some 46 percent of children are still
born without skilled attendants in the
neediest countries. Fewer than half have
access to potable water and only 5 percent
of those who are at high risk of malaria
sleep under insecticide-treated mosquito
nets. Vaccination rates are actually falling
throughout sub-Saharan Africa. In that region, according to UNICEF, the proportion
of kids immunized against measles fell
from 62 percent in 1990 to 50 percent in
1999, as government priorities shifted.
Political will is the key commodity. For
all the talk of leaving no child behind, the
United States has yet to commit more than
a 10th of 1 percent of its
gross domestic product to
foreign health assistance.
And as a global task force
noted recently in The
Lancet, U.S. development
aid for child survival has declined in the past few years.
Even within the United
States, 12 million children
still live in poverty, 9.2 million lack health insurance,
and federal rules bar immigrant children from receiving public-health benefits
until they've been here five
years. "The consequences
of this neglect are painful
and expensive," says Irwin
Redlener, president of the
nonprofit Children's Health
Fund and associate dean of Columbia University's Mailman School of Public Health.
"We've made a mockery of our rhetoric. It
turns out not to mean very much in terms
of real dollars and services."
Dollars and services are important. But
like many doctors who serve the poor,
Farmer dreams of something more fundamental. The ultimate challenge is not just to
manage the symptoms of poverty, he says,
but to change the social anangements that
perpetuate it. His clinic is set up to handle
35,000 patients a year, but it took in nearly
200,000 destitute peasants in 2002- even as
Haiti struggled to meet interest payments on
foreign debts incurred by past dictators. His
efforts may inspire awe, but as he is the
first to admit, they are stopgaps.
With KAREN SPRINGEN
The more you need care, the less likely you are to receive it.
-DAVIDSON GWATKIN, World Bank health consultant
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