The best and worst of the world's eats

 Sudanese refugee mother has a daily struggle to feed her children in the Birak refugee camp, Chad. Photo by Cynthia Jones/World Food Program via Getty Images.

Fit, healthy Australians. Sleek, cycling Dutch. Icelanders living on dried fish.

Not so much, says a new survey, Good Enough to Eat, released Wednesday by Oxfam, compiled from data gathered by international organizations.

 It’s a global food index that weighs the most important factors of dietary health, including affordability, quantity, diversity and nutritiousness of food, as well as a country’s rate of obesity and diabetes. And it has turned up some surprising results.

Where's the best place to eat?

The Netherlands. And the much-touted French and Swiss come in second.

Canada ranks only 25th of 125 countries, thanks to growing obesity and “unhealthy eating.”

The problem is more than a plethora of poutine. “Even in a wealthy country like Canada there’s a big gap between what people need and what they get,” says Oxfam Canada’s Robert Fox, pointing out that aboriginal communities suffer most, and in Nunavut more than half of children live in food insecurity. Fox calls for a “national food policy” in Canada, and an overseas aid policy  that is focused on women food producers.

But food problems are often complex, the report points out.

While the Dutch have the highest overall rating  – and a well-known fondness for riding bicycles – they score lower on the obesity measure, with 19 per cent of people surveyed classed as fat. (Too many Dutch treats?)

Even worse is Australia, whose svelte beach bunny image is blown away by an obesity rate of 27 per cent. And 9 per cent of Australians also have diabetes.

At the very bottom of the unhealthy eating scale, strangely, are wealthy Kuwait and Saudi Arabia, which rate an “F” for obesity and diabetes.

Icelanders, not noted for grand cuisine, rate at the top of the food quality and diet diversity scale, in spite of their limited farm land and relatively high food prices.

But sadly, it’s all too easy to predict those at the bottom end of the index.

Impoverished Chad – home to hundreds of thousands of Sudanese refugees – is lowest overall, with food that’s too little and too dear. It also has scant nutritional value, and is kept in unsanitary conditions. One child in three is underweight. 

Meanwhile Angola, also near the bottom of the scale, suffers the highest level of food price volatility, except for inflation-battered Zimbabwe. In Angola, “60 per cent of people’s diet is made up of simple carbohydrates and almost half the population do not have access to clean water” to prepare food safely.

In Burundi, a whopping 67 per cent of people are undernourished, and 35 per cent of children are underweight. A number of other African countries have scores that are little better.

One surprise: the worst score for underweight children is in “Asian tiger” India –  some  44 per cent of kids have lower than normal weight, making them vulnerable to stunting and learning disabilities.

“Inequality, weak distribution, failed markets and poor governance mean that people in many countries go to bed hungry, especially women,” says Oxfam, calling for “urgent reform of the way food is produced and distributed around the world to put an end to this scandal.”

Olivia Ward has covered countries from the former Soviet Union, Middle East and South Asia, winning national and international awards.

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Philippines typhoon: A relief worker's small victories, lingering concerns

In late November, we met Toronto nurse Sherri Grady, who is currently helping with post-disaster relief in the Philippines with Médecins Sans Frontières. We last heard from Sherri one week after her arrival in the city of Ormoc, where she settled into her new surroundings and treated survivors of the devastating typhoon Yolanda.

 

Here is Sherri's latest update.

 

The last time we heard from you, you were based in Ormoc. Where have you been since and where are you now? Tell us about the journey and the logistics involved.

 

For the last two weeks, I have called the municipality of Carigara, Leyte home. Moving here was pretty painless for me, requiring little more than for me to pack my bags.

 

It did, however, require extensive logistical planning for my non-medical colleagues: a home and office were located, generators were put in place, food was organized for a team of 20-plus, cold chain for vaccines, staff were hired and trained on said generators... Typing this now, the list seems endless but as I hung my mosquito net that first night, I was most impressed by how organized these “logs” seemed. They made the impossible look easy.

 

It was only after a few days in our new home that I learned of our new Philippino/American benefactor who had temporarily rented two properties to us free of charge, out of respect for MSF’s work and reputation. The generosity that I have witnessed in this country continues to inspire me. 

 

Being able to live in Carigara provides our team with proximity to the population affected by Yolanda, and the hours previously spent driving now go towards consultations in some of the most isolated barangays of Leyte.

 

What is something that has really surprised you?

 

My medical team comes from all over the Philippines and when a nurse on my team commented on how you could hear Yolanda’s wind in Cebu, another replied, “You may have heard it, but in Ormoc we could see it.”

I remember being constantly aware of Yolanda’s destruction during my first week -- and newly amazed with each new piece of evidence of her wrath. However, at some moment near the end of my second week, I was surprised to realize that I had stopped noticing the devastation. Could I possibly be that callous, that hardened by the disasters I have seen? 

I spent the next few days focusing on the little details as we drove down now-familiar roads and onward to distant villages. I saw it then: improvement, clean-up and rebuilding. That stack of palm wood there used to be a tree that our car would have to drive around on the road. That house has a new roof built out of scrap metal and plastic sheeting, where last week there was a gaping void screaming up at the clouds, daring it to rain. Those choking evening fires that have us racing to roll up the car windows before yet another coughing fit ensues -- those are from people burning the debris that they have cleaned from around their homes.

It wasn’t that I had stopped noticing how bad things were. Instead, I had failed to recognize how much better they were getting. Now every day, I celebrate the small victories we come across: a new roof, fresh lumber being cut from downed trees, coconut plantation workers drying their lost crops for oil instead of food. It is here that I find hope, embodied in the men and women who keep pushing forward.

What are the most common health issues you are dealing with now?

Primary health care here in Leyte is not that different from most places I have practiced. I see a lot of coughs and colds, hypertension and skin diseases in my work here -- just like I do when working in the Canadian Arctic.

But what the medical teams are always monitoring for here, amongst these common complaints, are signs of outbreaks, dengue, cholera and meningitis, to name a few. These are precarious times for the people of Leyte and current conditions make them a population at risk when discussing health. 

Happily, I can report that the wounds we see are getting smaller and the infections less severe as people's access to health care improves. I had an interesting discussion with my project coordinator, in which he managed to put to words the sentiments I have been struggling to articulate: “Sherri, it’s not just about treating the common cold, it’s about restoring dignity."

What has been the most frustrating moment from your first few weeks in the Philippines?

The most frustrating part of my job is when we find a patient who needs more help then I know how to give. 

MSF’s emergency intervention in the Philippines has been appropriately focused on post-typhoon health needs. But what do I do when in a remote barangay, I find a psychotic man whose father has had to lock him up in his room for years to prevent him from running away and hurting himself? A one-year-old the size of a two-month-old baby with an unrepaired cleft palate? A little girl suffering from an unknown disease causing progressive paralysis and pain? Or a little boy with an eye deformity that I worry is a retinoblastoma?

In these moments, I depend on my colleagues and the partnerships we have formed with other organizations and the Department of Health. Together, we try to find the most appropriate places to refer these individuals, we advocate on their behalves, and we do everything we can -- but our time here is so short. We have already begun talking about the end of our emergency activities here: finding long-term partners to hand over projects to, donating supplies/equipment to the already-existing health structures, providing trainings as needed and making sure that the transition goes as smoothly as possible. 

While the plan for our departure has been well thought out and organized, and I am confident we will leave no gaps in the care for the local population, I can’t help but worry about these four innocent people. While not victims of Yolanda, life’s unfairness has caused them suffering nonetheless. 

Anything else you would like to share?

 

There are these surreal moments here where I drive around a bend or over a hill and suddenly, I find myself in this moment of suspended reality -- like time has stood still in the midst of Yolanda’s fury and if I listen I might still hear the wind. All the trees are leaning in the same direction, with the palm fronds still pointing straight out, suspended as if the wind is still blowing them. The houses on the hills are tilted, too, and for that split second, it seems to me as if someone has pressed pause on the world in the midst of Yolanda and if they dare hit play again it will all fall over.

 

Jennifer Yang is the Star’s global health reporter. Follow her on Twitter: @jyangstar

Hunger stalks Congo in war and peace

On the rocks: Neena holds her baby sister Amina outside their makeshift tent near a volcano in Democratic Republic of Congo. Photo:World Vision/ Paul Bettings

War or peace?

Democratic Republic of Congo's government has signed a peace deal with the M23 rebels who have been raping, pillaging and murdering their way across the mineral-rich eastern part of the country. since 1996.  But for the battered people who have survived years war,  hunger and deprivation are a daily battle.

And both are about to get worse.

"In the past six months, funding shortages have meant that the World Food Program has already had to halve the rations distributed to displaced people in the North Kivu province, at a time when the overall food security situation is deteriorating," said a bulletin from the UN agency earlier this month.

For thousands of "food insecure" -- read hungry -- school children the daily meal they can count on is no longer assured.  Some 180,000 malnourished children, pregnant women and nursing mothers across the country could also lose their vital rations, if international donors fail to stump up $75 million to bridge the gap from now to May 2014.

But with newer, urgent emergencies taking place in countries like Syria and the Philippines,  Congo's catastrophic struggle has fallen through the cracks of the world's aid efforts.

"Crops have been ravaged, homes burned and subsistance farmers don't have fertilizer," says Dave Toycen, head of World Vision Canada, who just returned from the strife-torn region. "The challenge is for people to find something they can work with. "

For women the plight is worsened by the danger of foraging for food for their families. "One woman was out collecting peanuts," said Toycen. "Two bandits followed her and raped her horribly. She was so ashamed she didn't tell her husband. When he found out he walked out and left her with four children."

In a particularly poignant case, a young girl called Neena and her baby sister Amini were sole survivors when a bombing raid destroyed her home and killed her family.  Carrying the child, she made her way to a refugee settlement where she lives in a makeshift tent pitched over rocky lava from a 2002 volcanic eruption. 

"She doesn't qualify for food distribution because she isn't with her family," said Toycen. "Neighbors do some scounging for her, and occasionally she goes into the national park, which is notorious for rape. At night she closes the tent flaps and piles up rocks to stop people from getting in. She's living in fear. "

World Vision and some other charities support displaced people in Congo:  "but we just don't have the resources to look after 50,000 people," Toycen says. Donations support basic medical and psychosocial care for wounded and traumatized people, and small grants to start up grassroots businesses. But even if the shaky peace holds, Congo's long journey to recovery is barely beginning.

"The encouraging thing is that word is getting out that women have rights, and boys have rights if they've been child soldiers," says Toycen. "Even among children there's a new realization of their rights.  It's a small first step.  After so many years of conflict we can be hopeful about the peace deal. But it's still hard to be optimistic."

Olivia Ward has covered politics, conflicts and human rights from the former Soviet Union to the Middle East and South Asia, winning national and international awards.

 

 

 

 

 

 

 

 

 

Improving child health in Malawi, one text message at a time

A girl is weighed at the Makhwira Health Centre in southern Malawi, where a growth monitoring clinic is screening children for malnutrition using a new text messaging system. Jennifer Yang/Toronto Star

Last week, I stood beneath the shade of a giant mango tree and met perhaps the most miserable little girl in all of Malawi.

Just moments ago, she had been happily strapped to her mother's back, held snugly in place with a patterned mint-green cloth known as a chitenge. But now, the chitenge is knotted to a weighing scale and hanging from a thick tree branch – and the little girl is still wrapped inside, suspended hammock-style and screaming bloody murder.

As she twists and squirms, her tiny legs scissoring frantically in the air, a man calmly holds her in place and leans in to peer at the scale. After he notes her weight, the little girl is taken down but her ordeal is not quite over yet – next, she is laid on a wooden measuring board and her upper arm is wrapped in measuring tape.

When all of this is over, the little girl's job here is finally done. But her measurements – weight, height, arm circumference – will travel more than 250 kilometres north to the capital city, Lilongwe, where a computer software program will analyze the data, assess the girl for malnutrition, and send back any necessary treatment instructions.

This process used to take months. But nowadays, it only takes minutes, thanks to a cheap, basic and increasingly accessible technology: text messaging.

In Malawi, malnutrition is a massive and widespread issue. An estimated 10.6 per cent of Malawian children die before their fifth birthdays and at least a third of these fatalities are caused by acute malnutrition. Seventeen per cent of all under-five children in Malawi are underweight and a staggering 47 per cent are stunted, meaning they have a low height for their age. 

Stunting is caused by chronic undernutrition and its effects are sometimes fatal. Children who are severely stunted are more vulnerable to disease and four times more likely to die.

But stunting also has long-term consequences. It impairs cognitive development and cripples a child's capacity to learn, thus trapping him or her in a cycle of poverty. According to estimates by the World Bank, countries with high levels of undernutrition suffer GDP losses of between two and three percent every year. The World Bank has also said that in Malawi – currently ranked 170 out of 186 on the Human Development Index – more than $600 million U.S. in GDP is lost every year thanks to vitamin and mineral deficiences. 

A child is measured at the Makhwira Health Centre in southern Malawi, where a growth monitoring clinic is screening children for malnutrition using a new text messaging system. Jennifer Yang/Toronto Star

A major challenge when it comes to stunting, however, is that it is largely irreversible. It also tends to set in before the age of two.

This makes it crucial to identify and treat malnutrition as early as possible – which brings us back to the disgruntled little girl dangling from the mango tree in Chikwawa, a district of more than 500,000 people in Malawi's southern region.

This tree grows just outside the Makhwira Health Centre, which I visited last week as a press fellow with the United Nations Foundation.

It serves as the site of an ongonig growth monitoring clinic and every week, mothers bring their children here from all over Chikwawa, some trekking for hours with their babies strapped to their backs (roughly 80 per cent of Malawians live in rural, often-remote areas). On the Friday that I visited, a line of more than 50 mothers snaked up to this mango tree, the air filled with the screams and cries of babies.

In the past, measurements were recorded on paper and shipped off to Lilongwe, where the information would be manually entered into a database. Needless to say, this was a time-consuming process, with data entry and analysis taking anywhere between two months to a year – precious time lost for the malnourished child in need of treatment.

The paper-based system was also prone to mistakes. According to a UNICEF report, an average of 14.2 per cent of all data collected was unusable in 2007 due to data entry errors or illegible handwriting.

So in 2009, UNICEF teamed up with the Malawian government and graduate students from Columbia University to develop a new system using text messages and an open-source software platform called RapidSMS.

Here is how RapidSMS works: after a child is weighed and measured, a health surveillance assistant – typically a high school graduate who has received two hours of RapidSMS training – texts the information to a central server in the capital Lilongwe, where the software program automatically analyzes the data for signs of malnutrition. A reply is then texted back to the health assistant, along with a diagnosis and any necessary treatment instructions.

Any data entry mistakes are caught by the software program, which can detect them and message the health worker to re-send the info. The data also gets updated in real time on a website, which automatically flags cases of severe malnutrition.

A pilot study of RapidSMS was a resounding success and the award-winning system is now being rolled out across Malawi, including in Chikwawa, which launched the new SMS system in September 2012. (You can read UNICEF's final report of the pilot program here).

A new text messaging system is being used at the Makhwira Health Centre in southern Malawi, where a growth monitoring clinic is screening children for malnutrition. Jennifer Yang/Toronto Star

Last Friday, I watch as a health worker named Stephane January types the following message into his weathered Nokia cellphone:

GM 1177 031211 m 9.6 83.0 n 12.1

January explains that the "GM" stands for "growth monitoring" and the "1177" is a code identifying the child. The next six digits are the date of birth – December 3, 2011 – followed by the sex (male).

The remaining characters paint a picture of how this two-year-old is developing; he is 9.6 pounds, 83 centimetres tall and a mid-upper arm circumference of 12.1 centimetres. The "n" also indicates "no" for oedema, which is a symptom of severe acute malnutrition.

According to UNICEF nutrition officer Benson Kazembe, this child's measurements indicate he is "mild to moderate malnourished" and may even be "moderately acute malnourished" judging from his arm circumference. He is eligible for treatment and has likely now been admitted to a feeding program, where he will receive a corn-soy blend and nutrition counselling. 

The above information is what should have been texted back to January after he hit "send" on his cellphone. But on this particular Friday, there is a problem.

"The network," he says, laughing sheepishly as he stood up and waved his cellphone around, trying to capture a signal. "I'll just try and send it again."

This is a common issue, January admits, and likely the biggest hiccup in Malawi's RapidSMS program so far. Kazembe says the RapidSMS servers are currently being hosted by UNICEF but there are now plans to move to a server hosted by the Malawian Ministry of Health, which should hopefully improve connectivity.

But server issues aside, the program has been a huge success and is only growing in size. Kazembe said 4,619 Malawian children are now registered and in Chikwawa alone, RapidSMS is being used at 21 health facilities.

"Now we are able to track – to monitor – every child," said John Mugawa, the district nutrition coordinator for Chikwawa. "This technology has really helped us."

Jennifer Yang is the Star’s global health reporter. Follow her on Twitter: @jyangstar

Philippines typhoon: Tales of inspiration, tale of heartbreak

Survivors stand among debris and ruins of houses destroyed after Super Typhoon Haiyan battered Tacloban city, the capital of the province of Leyte in central Philippines. REUTERS/Erik De Castro

Last week, we introduced you to Sherri Grady. On her birthday, the Sick Kids nurse learned she was going to the Philippines with Médecins Sans Frontières (Doctors Without Borders), which is currently providing medical aid to survivors of Typhoon Haiyan, known locally as Yolanda.

(In case you missed it, the Star's Amy Dempsey recently travelled to the Philippines with a Toronto woman searching for her loved ones. You can read her stories here and here and see photographer Lucas Oleniuk's pictures here).

Before departing on Dec. 1, Sherri agreed to send occasional updates from the Philippines, which is still picking up the pieces from Typhoon Haiyan, known locally as Yolanda. This is Sherri's first update.

Tell us about your first 24 hours in the Philippines.

My first 24 hours in the Philippines were a sweaty whirlwind of activity involving several briefings, a ferry ride and a handover from the outgoing nurse I was replacing.  Twelve hours after landing in Cebu and the first of my briefings, I found myself on a ferry to Ormoc on Leyte Island. Tired, sore and overwhelmed, I was heading to my project and the base for our medical, logistical, water and sanitation activities.

The ferry landed in the midst of the hustle and bustle of city life and as I walked out to the street in search of the MSF car, I was immediately assaulted with a symphony of car horns, street hawkers and generators.  Amidst a backdrop of destroyed buildings, power failures, damaged roofs and debris, life has continued and I was standing in the thick of it.

Where in the Philippines are you right now and what role have you been given?

While MSF may be based in Ormoc, our medical activities are far reaching in Leyte and we are providing primary health care and completing health assessments in areas all over the island that have been heavily damaged by the typhoon Yolanda. 

My first day I was struck by the scale of the devastation amidst the natural beauty of the Philippines as the route to our mobile clinic took us over mountains, along the ocean and past rice fields for over two hours. It somehow seems unfair to me that the hardest hit areas appear to also be the poorest, shacks constructed out of bamboo with woven walls and roofs made out of what appears to be palm fronds lay collapsed on the ground. I can’t help but remember the children’s story of the thre little pigs; Yolanda “huffed and puffed” and the homes of families all over Leyte Island just blew right over.

The medical team that I am a part of comprises doctors, nurses, midwives and mental health workers – 75% of which are individuals from the Philippines, the other 25% are expats like me working as aid workers for MSF in the Philippines. Together we have been providing primary healthcare through both mobile clinics and in supporting local health structures.

Tell us about a typhoon survivor you have met.

During consultations I try to take time to speak with people about their experiences and how they are coping now.  I hear stories daily, capable of simultaneously breaking and inspiring one’s heart. 

One woman described to me how her home had lost its roof during the typhoon and as we stood there in yet another rainstorm, she explained how she and her family were sleeping under the kitchen counters to keep dry at night.  Less than 3 weeks after what she described as the most terrifying experience of her life, she had come to our clinic looking for painkillers so that she could continue rebuilding her home. 

Parents arrive, concerned about children who are now terrified of the wind and rain. Many describe episodes of panic, inconsolable crying and even fainting when a storm rolls through (which has been happening in this region on almost a daily basis). 

When we encounter these families, I am grateful for the commitment and expertise of our mental health team who work alongside us daily. The physical scar Yolanda has left behind is present everywhere we work. I only hope MSF’s focus on mental health will prevent the less obvious but perhaps more long-term emotional scarring associated with traumatic events.

What are you expecting from week two in the Philippines?

Week two in Leyte is starting to look busy.  There is talk of moving our base to be closer to our medical activities, assessments in Barangays (small subdivisions of municipalities) in the mountains, and even mobile clinics along the coastal region by boat.

Jennifer Yang is the Star’s global health reporter. Follow her on Twitter: @jyangstar

From Toronto's Sick Kids Hospital to a disaster zone in the Philippines

Sherri Grady, a nurse with Sick Kids hospital, has worked with Médecins Sans Frontières for seven years, including in the Central African Republic, DRC, Chad, Niger and Haiti. On Monday, she arrived in the Philippines, where she will be spending six weeks helping survivors of Typhoon Haiyan. Photo source: Sherry Grady

Meet Sherri Grady, a nurse with Toronto's Sick Kids Hospital. On Nov. 15th – Sherri's birthday – she got a phone call that would temporarily uproot her life and fling her into a disaster zone halfway across the world:

"You're going to the Philippines."

Just days earlier, one of the most powerful typhoons in history had blown through the archipelago nation in Southeast Asia, leaving a major humanitarian crisis in its wake. On Saturday, more than two weeks after the storm, officials said the death toll from Typhoon Haiyan had reached 5,235, making it the country's deadliest disaster on record.

But Grady has gotten these kinds of calls before – she is also a humanitarian worker with Médecins Sans Frontières, a gig that has taken her everywhere from the Central African Republic and DRC to Chad and Niger. She also spent three months in Haiti following the 2010 earthquake, running a nutrition program in Carrefour, one of the most impoverished districts of Port-au-Prince (you can read some of her blog posts from Haiti here).

Today, Grady arrived in Cebu, one of the hardest-hit areas in the Philippines. When I spoke with her a few days ago, she had no idea where she'll be working in the country, what she'll be doing, or who she'll be doing it with – just that she will be calling the Philippines home for the next six weeks and doing whatever she can to help.

Before heading to Pearson airport, Sherri answered a few questions about how she was feeling prior to her mission. Over the next six weeks, we'll be checking in with Sherri periodically and sharing her updates here on this blog.

When did you find out you would be going to the Philippines – and how did this mission come about?

I found out that I would be leaving for the Philippines on my birthday a few days after the call had gone out for experienced expats to help with MSF's emergency response.  It took numerous discussions between MSF, my current employer the Toronto Hospital for Sick Children (affectionately known as Sick Kids), and myself before the many necessary details were organized, enabling me to accept the mission.

What have you done this last week to prepare?

This last week has been a blur of activity.  Prior to the mission, I already had a full schedule of shifts at Sick Kids into the new year.  It was only through the amazing generosity of my Sick Kids colleagues, who volunteered to cover my shifts for me, that I have been able to negotiate the time off to go to the Philippines. Once my shifts were covered, I was able to focus on packing, updating my vaccinations, seeing friends and family and basically putting my life in order prior to leaving for six weeks – a task that seems to have become much more difficult, now that I have given up my nomadic life of yesteryears.

As far as you know, what will you be doing there?

This is the most frequently asked – yet most difficult to answer – question that I get.  In other emergencies, I have been involved in providing primary healthcare through mobile clinics, secondary healthcare in a hospital setting, emergency vaccinations and even treating malnutrition. The key is flexibility and adaptability in the face of sometimes overwhelming medical and logistical needs and I am happy to fill any role necessary. I do really find that working directly with the local population is tremendously rewarding

What are you the most worried about?

Not having enough underwear. Seriously, that and being able to pay my mortgage while I am gone. I love my career and know my skills. Any anxieties are about what I am leaving behind, not where I am going.

Tell us three things you’ll be packing in your suitcase.

A headlamp, summer-weight sleeping bag, decongestants (I currently have a cold).

What are some lessons you’ve learned from past missions that you will be bringing with you to the Philippines?

Prioritize, be flexible and find the little successes to carry you through the hard times.

A final thought before you leave?

I am answering these questions while waiting for a friend to pick me up to take me to the airport... I have many final thoughts. Did I turn off the water heater? Have I thanked everyone who made this possible? What will I find when I land in Cebu?

I can only hope that my time in the Philippines will be spent in a meaningful way and that I have as much impact on their lives as the people I encounter usually have on mine. I carry people with me from every mission, kept safe and protected in my heart, and I wonder what new memories will find a home there in the next six weeks.

Jennifer Yang is the Star’s global health reporter. Follow her on Twitter: @jyangstar

Superbugs and 3 million missing cases – the latest, greatest challenges in the TB fight

A nurse injects a child with a TB vaccine as part of the South African Tuberculosis Vaccine Initiative trials in January 2011. TB is one of the deadliest diseases in the medical lexicon. Untreated, it kills roughly half the people it infects. AFP PHOTO/RODGER BOSCH

MISSING: Nearly 3 million people with tuberculosis who are not getting diagnosed or receiving treatment.

WANTED: More resources for tackling the scourge of TB superbugs.

These are the two most urgent messages contained in the World Health Organization's latest tuberculosis report, released today. Tuberculosis is a highly contagious bacterial disease that is both curable and preventable — yet next to HIV/AIDS, it is the world's biggest killer due to a single infectious agent.

The WHO report provides a snapshot of the global TB problem and the emerging picture does contain some bright spots: TB treatment has saved 22 million lives since 1995; the number of cases dropped from 8.7 million in 2011 to 8.6 million last year; deaths have come down from 1.4 million to 1.3 million; and the world is on track to meet the UN Millennium Development goal of cutting TB deaths in half by 2015.

But two major challenges threaten to reverse the gains: an estimated 2.9 million people are still being "missed" by health systems (amounting to about one in three people getting sick with TB), and there is a growing threat from multidrug-resistant tuberculosis, which infected an estimated 450,000 people last year.

Both challenges have the same root problem, the WHO says: a lack of resources.

"Quality TB care for millions worldwide has driven down TB deaths," said Dr. Mario Raviglione, director of the WHO's TB program, in a news release. "But far too many people are still missing out on such care and are suffering as a result."

The WHO estimates that 75 per cent of the "missing" TB cases are in just 12 countries: India (where 31 per cent of the world's TB cases are located), South Africa, Bangladesh, Pakistan, Indonesia, China, the Democratic Republic of Congo, Mozambique, Nigeria, Ethiopia, the Philippines and Myanmar.

Even more alarmingly, the most dangerous TB infections — those that are drug resistant — are also being missed and fewer than 25 per cent of these superbug cases were diagnosed in 2012. As for the drug-resistant cases that do get picked up, many of them aren't being treated; last year, an estimated 16,000 TB superbug infections went untreated, according to the WHO.

"The unmet demand for a full-scale and quality response to multidrug-resistant tuberculosis is a real public health crisis," Raviglione said. "It is unacceptable that increased access to diagnosis is not being matched by increased access to (multidrug-resistant TB) care.

The WHO report listed five priorities in the fight against TB, including catching the missing 2.9 million cases and treating multidrug-resistant TB as a public health crisis.

The report also called for more funding to ensure a full response to the TB crisis. Funding for TB in 2013 is currently pegged at about $6 billion (U.S.) but at least $7 billion to $8 billion is needed, the report says.

Jennifer Yang is the Star’s global health reporter. Follow her on Twitter: @jyangstar

Saving Syria's Children: "You can't say you didn't know"

A Syrian child in a refugee camp near the Turkish border.                                               (Photo: BBC) 

When "Saving Syria's Children" aired on British television, the BBC broadcast a warning at the start of the documentary: "There are scenes which some viewers may find upsetting."

Shots of children, staring solemnly at the camera with huge, dark eyes. Premature babies, thin and tiny, reaching out to doctors who coo over how small their fingers are.

Then, this: "I think there's been some kind of chemical attack. There's dozens of people that have just been rushed in, covered in burns and some kind of white powder dust. All their clothes are hanging off them."

And that is in the first three minutes. It's bloody, even though there is actually very little blood, and upsetting.

It's bloody upsetting.

BBC reporter Ian Pannell and cameraman Darren Conway were in Syria earlier this year with two doctors from a charity called Hand in Hand for Syria. Dr. Rola Hallam usually works in a pediatric ICU in London; her colleague, Dr. Saleyha Ahsan, in ahospital in Essex, just outside London.

In August, the doctors, trailed by the journalists, travelled close to the front lines to see what conditions are like; they met families who have lost children and homes, yet still bake bread and offer it to visitors.

They spoke to an 85-year-old man who is suffering with diabetes and hasn't had his medication. He and his family have been forced to move from place to place for two years. A tear rolls down his cheek as he speaks to Hallam; she leaves him an emergency food parcel, something she calls a drop in the ocean.

"It's not a home. It's not your health. It's not your medication you need. It's not your dignity back," Hallam says. "It's not your broken heart mended."

After their trip, the doctors return to a hospital in the city of Aleppo. Ahsan is looking after a baby with a burned face; it's difficult, and the doctors are concerned that there's little in the way of pediatric supplies.

Then, cars and vans and ambulances begin pulling up. And people, their skin and clothing hanging off them, start staggering in. They're mostly teenagers. Their school, they say, has been attacked. They are very badly burned, and the doctors are worried they're dealing with a chemical attack. 

"It was a surreal, slow-motion event," Pannell recalls. "The hospital was overwhelmed. And you had these kids writhing on the floor."

In the footage, children look like zombies, shaking, swaying on their feet and drooling in what must be shock and pain.

A father screams at the camera, pointing at the blistered face of his child: "This is my daughter! This is my daughter!"

Ten of the children died.

"I found it difficult not to be touched by what (we) saw," says Pannell, an experienced conflict journalist who has reported from Afghanistan and Iraq, among other war zones. "The overriding thing is nobody can say they didn't know what was happening.

"You may choose to do nothing about it - you may choose not to donate ... and politicians may choose not to act," he says. "But you can't say you didn't know."

"Saving Syria's Children" airs Saturday, Oct. 5 at 10 p.m. on The Passionate Eye on CBC News Network. 

Jennifer Quinn is a foreign affairs and investigative reporter at the Star. As a journalist with the Associated Press, based in London, she wrote extensively about British politics. Follow her on Twitter @JQStar.

Afghan police fuel costs latest expense to come under glare of reconstruction watchdog

If there was a competition for most depressing Twitter feed, @SIGARHQ would be a contender.

The account belongs to John Sopko, a former prosecutor who is now the special inspector general for Afghanistan Reconstruction.

That job was created in 2008 by Congress using the template of a similar job related to Iraqi reconstruction. The inspector general’s findings, released every few months, are a sobering tale of how the billions of dollars that has poured into the crippled country has been funneled off through corruption, influence peddling and self-dealing.

Today’s story of waylaid funds, courtesy of Sopko, focuses on the Afghan National Police Fuel program.

“Poor oversight and documentation resulted in the use of higher-priced vendors and questionable costs, including $1 million in additional costs over the two-month period as a result of using higher-priced vendors,” Sopko writes in his report adding that the mulitnational Combined Security Transition Command (CSTC) has bought fuel for the ANP for six years, yet still does not have reliable information about the number of ANP vehicles and generators.

Similarly, the Afghan Ministry of the Interior has not handed over fuel consumption data.

In Helmand province, police have received more fuel than they could store on 24 days over a 28-month period.

Even though CSTC officials believed direct funding of ANP fuel would be a “high-risk” for waste, fraud, and abuse, CSTC still approved $243 million for direct funding for 2014, even though there was no plan to mitigate this risk.

Sopko’s findings have been an embarrasment to both the Afghan and international governments, and a wealth of information for journalists and critics alike.

The New York Times two years ago reported on the ballooning cost of the Gardez-Khost Highway in Afghanistan, one of the world’s most expensive and beleaguered road projects.

The 64-mile highway, which The Times reported was yet to be completed, had cost about $121 million so far, with the final price tag expected to reach $176 million — or about $2.8 million a mile. Security alone had cost $43.5 million.

Earlier this year, Sopko sent out a so-called “alert warning” about “serious deficiencies” in a $47 million U.S. government project to improve the justice system in Afghanistan. Another letter spotlighted how $34 million was spent on a new headquarters for the U.S. Marines in southern Afghanistan. The headquarters would never be used.

There was the $47 million spent stabilizing a contested area that was hardly improved.

Not many dull days for a government watchdog studying corruption in battered Afghanistan.

Rick Westhead is a foreign affairs writer at The Star. He was based in India as the Star’s South Asia bureau chief from 2008 until 2011 and reports on international aid and development. Follow him on Twitter @rwesthead

How you can help train a health care worker in the developing world

Dr. Alcade Rudakemwa recently graduated from the National University of Rwanda Medical School and now receives medical mentorship and training through Partners In Health. Photo source: Partners In Health Canada

Here in Canada, we have 20.7 doctors for every 10,000 people, according to the World Health Organization. The average Canadian can expect to live until the ripe old age of 82.

Compare these figures to Rwanda, however, where there are only 0.6 doctors per 10,000 people. The average life expectancy for Rwandans? Sixty – more than two decades shorter than in Canada and five years before most Canadians retire.

It is now well recognized that health worker shortages are a major barrier to improving health and survival in the developing world. This is particularly true in Africa, which has 24 per cent of the world's burden of disease but only 3 per cent of the world's health workers.

Partners In Health, however, has long been working to build long-term health capacity in the developing world, especially in Rwanda and Haiti (one of the founders of PIH, by the way, is the current president of the World Bank).

And today, Partners In Health Canada  – the new-ish Canadian arm of the international non-profit organization – launched a new campaign called Share The Health, one that allows you, too, to contribute towards the cause.

The campaign will run for the length of October and allows people to honour their own career mentors by making donations – money that will pay for a health care worker in Haiti or Rwanda to receive educational training and mentorship.

What donors will get is two-fold:

1) An opportunity to honour a mentor who has influenced or shaped their careers (whether in health care or otherwise) with a testimonial that will be published on the Partners In Health Canada website and Facebook page.

2) The knowledge that their $198 will help feed a medical resident for a month or that their $600 will train a doctor in life-saving emergency obstetric care. (For other examples of donation amounts and what they could help fund, see here).

For people wanting to contribute in some way – but feel overwhelmed by the multitude of donation options and the complexity of donating effectively – this provides a way to make a direct impact, says Mark Brender, director of Partners In Health Canada.

And once the campaign is over, donors will be contacted directly and informed of where, exactly, their dollars have gone.

"This particular campaign – I think it starts with the goal of not wanting to do just what we can for poor people living in poor countries but wanting to be able to provide high quality care. The same as we would expect," Brender says.

Jennifer Yang is the Star’s global health reporter. Follow her on Twitter: @jyangstar