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Issue 143

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[image, unknown] HEALTH[image, unknown]

Injecting demand
Vaccination report from UNICEF

THE last twelve months have seen some of the most spectacularly successful immunization campaigns ever staged in the developing world. In Colombia, over 750,000 young children have been immunized in a campaign backed by 110,000 volunteers. In Brazil, almost all the nation’s children have been immunized by 450,000 volunteers manning 90,000 immunization posts across an area larger than Western Europe. In India, pilot campaigns in several hundred villages have lifted immunization rates from less than 10 per cent to more than 80 per cent.

In most of the developing world today, according to UNICEF’s 1985 State of the World’s Children Report, the real bottleneck is not the supply of immunization it’s the demand. Analyzing vaccination programmes recently surveyed by the World Health Organization they concluded that around 40 per cent of those children who had had their first DPT vaccination (against diptheria, whooping cough and tetanus) dropped out before completing the course of three injections.

‘Bluntly stated,’ says UNICEF, ‘the most significant recent breakthrough in knowledge about immunization is the realization that present immunization rates could be doubled and trebled if parents took advantage of existing services.’

In Europe and North America. a child is practically born onto a conveyor belt of immunization. New mothers are usually visited at home by health workers who make the first appointment at the mother and baby clinic. After every appointment another one is made and a missed appointment means a postal reminder and if necessary, another home visit. Good transport, refrigerators, reliable electricity, computerized record-keeping and universal awareness of the need for immunization - all of these make immunization easier.

But in the developing world, it is a different story.

When the time comes for the third immunization, a mother may be wondering if it’s worth it. She’s been told she ought to go, but she doesn’t know why. There was a notice in the clinic but she couldn’t read it. No-one around her is encouraging her, because no-one seems to know anything more about it than she does. Her working day begins at 5 am. and won’t end until she goes to bed at night. And she can’t afford to lose a day’s pay in the fields. The clinic is four kilometres away and there’s no bus. The child is now too heavy to carry very far - and too young to walk. When she gets there she’ll probably have to stand for an hour in line. And the last time she went, the baby had a fever after the injection and cried all night. They all sleep in one room and her husband had lost his temper. The child is playing outside and seems perfectly well. So why take him to the clinic? Surely two injections are enough?

And so an appointment is missed and another child goes unprotected.

Most developing countries also face a quicksand of logistical problems in getting the right vaccines into the hands of the right people at the right times and at the right temperatures. Together, these two problems of ‘supply’ and ‘demand’ explain why less than 20 per cent of the developing world’s children are immunized against six diseases which kill an estimated 5 million young children each year and leave another 5 million permanently disabled.

Percentage of the world's children immunized in the first year of life.

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[image, unknown] MEDIA[image, unknown]

TV traffic
BBC programmes the world.

ON a quiet night in Macau, nothing goes over quite like a little Sherlock Holmes on TV. In Lagos, a family in front of the set may well be glued to Coronation Street. In Tirana, Albanian viewers have a particular fondness for Dickens.

The world is developing a taste for British television, a habit proving highly profitable for a handful of producers. Although the United States accounts for about half the estimated $900 million TV programme export market. British sales will top $90 million this year. a tenfold increase in the past decade

The best-selling BBC television programme ever - ‘The Six Wives of Henry VIII’ - has been seen in 78 countries. It is followed by ‘Elizabeth R’ (67 countries) and ‘War and Peace’ (66).

The Corporation’s current top three best-sellers are ‘Flight of the Condor’, ‘FawIty Towers’ and the Shakespeare series. Says BBC sales director Roy Gibbs: ‘US producers provide the foundation of television around the world. After that it’s the BBC that provides the interesting layer of the sandwich’.

Natural history is popular everywhere. partly because it has little potential for political, religious or social controversy, and therefore is unlikely to offend local susceptibilities. One executive describes it as the industry’s ‘bread and butter’.

Humour, while having a higher risk factor, has a ready audience. This is shown by the success of Fawlty Towers’, although only 12 episodes were made. ‘Yes Minister currently plays in 30 countries.

Kelly McParland, Gemini

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[image, unknown] DISASTERS[image, unknown]

[image, unknown] Acts of man
Turning problems into catastrophes

THE Ethiopian famine has shocked the international community into action. But this is only the latest in a long list of ‘natural disasters’ which are killing more and more people each year.

There is no evidence that the earth is going through such drastic climatological or geological changes, So why then are disasters becoming more frequent, more deadly and more destructive?

A valuable report has recently been issued by the Swedish Red Cross. It makes the useful distinction between the ‘trigger’ event and the disaster itself. The trigger is likely to be a natural disaster like a drought or a hurricane but most of the associated catastrophe arises out of social conditions.

In 1974. for example, a hurricane killed over 4,000 people in Honduras while a similar hurricane in Australia killed 49.

And both Tokyo and the Nicaraguan capital Managua are prone to earthquakes. But the people of Tokyo are far less vulnerable because they have strictly enforced building codes.

According to the Natural Disasters Research Group, Asia is the continent most prone to natural disasters with fifteen times as many as Europe or Australia. Africa and Latin American are not far behind. And in the poor countries the disasters are likely to have more damaging consequences. On average there are 3,000 deaths per disaster in low-income countries compared with 500 in high-income countries. Strangely. however, most of the effort and money devoted to natural disasters has been spent on studying climatological and geological triggers - over which man has very little control - rather than studying the wide range of human actions which can be controlled.

A lot of human activity is making the land itself more vulnerable to disaster. The poorest in the Third World are likely to face more disasters because they are forced to overcultivate. deforest and generally overuse their land. This removes the vegetation and increases vulnerability to drought.

Earthscan

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[image, unknown] POPULATION[image, unknown]

Reliable rubber
Condom usage on the increase

If ever there was a born-again contraceptive, it must be the condom. Production and usage rates are rising particularly rapidly in the developing world.

But acceptability has come reluctantly and only very recently, arguably because the condom has been with us for so long. The ancient Egyptians are known to have worn it ornamentally more than 3,000 years ago.

It is now 320 years since the Italian anatomist Gabrielle Fallopio recommended its use as a defence against venereal disease, at least 250 years since it was popularized as a contraceptive and over a century since rubber (rather than animal membrane) sheaths were widely marketed.

But it is the only contraceptive device widely available for men. And, lumbered with a legacy of unreliability and clandestine sex, it has tended to be prescribed in most family planning programmes more in hope than with any real faith.

The most notable exception is Japan. With the Pill and voluntary sterilization legally restricted, spermicides and diaphragms culturally unpopular and IUDs relatively expensive, the Japanese family planning programme has relied heavily on the condom. Japan’s 0.7 per cent population growth rate, one of the lowest in the world, has been achieved with over 75 per cent of contracepting couples choosing condoms.

The Japanese produce a third of the world’s condoms and make up 25 per cent of all users. Not surprisingly the country has led the world, with the United Kingdom and the United States, to today’s ultra-thin and virtually flawless products.

In late 1982, the Johns Hopkins University estimated world production at five billion condoms - about one third of manufacturing capacity was said to be in developing countries. There were an estimated 30-40 million users in the world and per capita usage among contraceptors was much higher in developed than in developing countries.

The condom’s popularity has increased as suspicions, real and imaginary, have grown about the side-effects and health hazards of some modern hormonal contraceptives. It has also gained, particularly in developed countries, as studies have shown it to be an effective physical barrier against sexually transferable diseases,

Gemini Seneviratne, People

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[image, unknown] BABYFOODS[image, unknown]

After Nestle
Campaigners switch their sights

BREAST is Best’ campaigners have given Nestle, the Swiss-based food conglomerate, an almost clean bill of health. They have switched their attention to other US. European and Japanese companies who are still busy promoting infant formula in the Third World.

A recent study of a dozen developing countries reveals that abuses of the World Health Organisation’s code regulating the sale of baby milks, which was adopted in 1981, are still commonplace. More than 600 violations were spotted during just two months of 1984.

Ten years ago the New Internationalist was the first to highlight the problem of manufacturers persuading mothers to abandon breast feeding and use powdered milk instead. In developing countries where money, clean water and fuel are all scarce, bottle-fed babies often suffer from diarrhoea. Some die through dehydration.

‘Nestle has made significant changes to its marketing practices in the developing world. None of Nestle’s competitors has come as far,’ judges Douglas Johnson, chairperson of INFACT, the infant formula campaigners in the United States.

Nestle executive vice-president, Carl Angst, has agreed to stop giving new mothers ‘discharge packs’ and to apply the WHO code in Europe if other baby food companies will do the same.

Angst is worried about competition from local firms in the Third World as well as from overseas companies. ‘There are a number of markets where we are losing market shares because we are applying the code,’ gripes a Nestle spokesperson in Geneva.

That does not seem to have been the case in Chile for example. Certainly the market itself has shrunk - from 1,300 tons per year in 1973 to only 210 tons last year. But Nestle’s share of this does seem to have held up at 80 per cent, compared with 20 per cent for Wyeth, a subsidiary of American Home products,

The IBFAN study found many examples of tins of infant formula with labels showing healthy babies and not carrying warnings about the dangers of bottle feeding.

In the Philippines where competition is particularly fierce, the IBFAN study found that another US-based company, Mead Johnson, supplied nurses uniforms and babies’ cribs free to two hospitals in Manila in 1984 in defiance of the code, Nestle is also accused of supplying

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[image, unknown] DEVELOPMENT[image, unknown]

Backward Britain
Third World experts criticize UK rural development

REVERSING the usual pattern of sending Western experts to the Third World, academics from Nigeria and India have come to none too flattering conclusions about the current state of rural development in Britain.

Dr Amboobham V Patel of the University of Ibadan and Dr Baburao S Baviskar from the University of Delhi toured Wales and Scotland at the invitation of the Arkleton Trust.

The two experts, along with John B Wright, a Canadian development planner, found what they called a ‘lack of clarity surrounding basic rural development objectives’ in Britain. They also criticised the domination of development agencies by central government, saying that this provided ‘limited scope for meaningful popular participation and involvement’.

They also pointed out the glaring social inequalities’ inherent in the landed estates which dominate the otherwise deprived rural land around Aberdeen which has prospered with the coming of North Sea oil. They said it was questionable whether the management of such estates was ‘the best way of using the UK’s land resources’. They described as ‘anachronistic’ the ownership of these estates.

The report was not, however, entirely critical. It praised the island council of the Western Isles, commending it for its effort in developing local resources

VSO Orbit

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[image, unknown] TAKING ISSUE

Ashok Mitra

Ashok Mitra looks back on India’s Prime Minister.

Mrs Gandhi’s obituary

You do not have to indulge in surrogate memories of underdevelopment. the real thing is right next to you. It is a fantastic jumble; the revolution rendered by microchips snugly co-exists with mediaeval feudalism. Indira Gandhi was charming, sophisticated; impeccably part of the Western milieu. She could discuss with you a particular chapter from Simone de Beauvoir’s latest volume. She would travel a few thousand miles to look at an obscure painting by Mondrian recently unearthed. She quoted from Yeats and Dylan Thomas. She was the charmingest hostess, with both the cuisine and the wine most carefully chosen. Given a languorous afternoon, she could enjoy the nuances of cricket.

But she could be the epitome of mid-fifteenth century modes and manners. She fiercely believed in dynastic succession; it was axiomatic with her that none but her family were capable of ruling the Indians. who, by and large, are a barbarian lot, waiting to be civilised by the Nehrus. She built a party in her own image and named it after herself. She selected its office-bearers; she disposed of them. The moment you started asking questions. Out you went. In any case, she was the party’s president and her son the general secretary. She believed in palmistry and astrology; she would not decide upon the date of an election or a journey with outconsulting her house astrologers. who were always several in number. And she believed in temple-hopping, synagogue-hopping, church-hopping, mosque-hopping. This show of religiosity, some would say, was a pretence. She merely wanted to demonstrate to her illiterate, superstitious countrymen and women that there could be no-one more religious-minded, and therefore more voteworthy, than her. This however reveals the other contradiction she nurtured within herself: she was a mediaeval despot who nonetheless could not quite get away from the concept of democratic elections.

Only up to a point. A democratic election which was unlikely to bestow favour upon her was anathema to her thinking. She was a great one for manipulating elections. She lost one, but that was simply because she was outmanoeuvred by her rivals. In the weeks immediately preceding her murder, she was planning, plotting, scheming how to manage the impending general elections. and at the same time manage the succession of her surviving son. The revolution in communications ushered in by microchips and satellites she wanted to put to exclusive use for clinching the elections for herself and her offspring. Even in a so-called totalitarian country, the public media would not be so unabashedly set to work in the cause of the ruling household or coterie as has been the case in India. Close to two-thirds of the nation’s population cannot read or write and are denied the supply of pure drinking water; never mind, thanks to Indira Gandhi they can now watch colour television.

The circumstances of her death once more illustrated the dualism which India is; it belongs to the final quarter of the twentieth century; it also belongs to the dark interior of the Middle Ages. All the sophisticated gadgetry and equipment which the electronic age can provide were accessible to Indira Gandhi and her government for ensuring her security and that of her near and dear ones. Umpteen rounds of screening of those in her proximity were a commonplace; there would be constant checking by computer of the history and records of individuals who were ‘ picked to belong to her privileged circle. None of these precautions proved of any avail. She was murdered by a couple of men from her own security guards. It is in the true tradition of mediaeval drama; someone from within your fold turns against you, and you are a goner.

The India over which Indira Gandhi and her father ruled - and currently her son is ruling - is a near-perfect correlation of an under-developed nation, Under-development represents so many strata in the condition of living, so many levels in the conditions of the mind. Cross superstition with sophistication, cross democratic convictions with dynastic succession. cross the latest innovations in space technology with faith-healing, cross compassion with vile murder, and you have India; you also have under-development. On the day of her murder. Indira Gandhi left India in the same state of under-development as it was when some two decades ago. she took charge of the country’s reins. How appropriate that a pictorial book of the coffee table genre she edited a couple of years ago was entitled Eternal India.

Ashok Mitra is Finance Minister in the State government of West Bengal, India.


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