Global health security and sustainability Essay Dissertation Help

Global health security and sustainability Essay Dissertation Help

• Choose one of the 5 case studies presented at the start of this subject.
• What needs to change/occur by 2040 to ensure that the outcome of this case is benign– the subject of the case avoids death or disability.
• Analyse plausibly and specifically what would need to change between now and 2040: what it would take to achieve this good outcome. Possible areas to address include but are not limited to:

Five case studies:
1. Emília Machaieie:
Emília Machaieie was born and lived for 11 months and 15 days in the village of Mabuia in Mossurize District in central Mozambique. She was the fourth child of her 25-year-old mother and 28-year-old father. Her family farms a small plot recently cleared from the low dry forest around a riverbed that is marshy after the annual rains. They mostly plant cassava, using the leaves to make various sauces, and carefully soaking and drying the roots (to remove the natural cyanide that helps make cassava such a pest resistant crop) to make a thick porridge that is their staple diet. Emilia did well for her first four months. Her mother gave her breast milk and nothing else, and her weight rose steadily along the optimum trajectory. Once she started on weaning foods, however, things started to go wrong. During the wet season her family used water from the river, and when that dried up a couple of months later her mother walked 800 m each day to draw about 20 L of water from a hand dug well shared with the rest of the village. The water was commonly contaminated, and it was never enough (especially in the dry season) to wash hands, eating, or cooking utensils properly.

At five months of age Emília had her first bout of watery diarrhoea. She lost weight but survived. However the low energy density of her weaning foods meant that she never managed to recover the lost weight, and the regular bouts of diarrhoea every few weeks from then on meant that by 11 months of age she weighed only 5 kg – little more than she weighed at five months.

Emilia’s parents were very worried as they saw her grow weaker in her final bout of illness. They thought of taking her to the health centre in Espungaberra, but they knew that would involve a full day’s walk. There is no road suitable even for four-wheel-drive vehicles within 15 km of Mabuia, and is no regular transport even from there on to the district capital. Instead, they gave her a traditional remedy made from local roots but although the diarrhoea became less frequent she weakened further and died on the third day of her illness.

2. Sothearum Tong:
Sothearum Tong was born in Bantaey Manchaey province in Cambodia. She lived with her parents on the outskirts of Sisiphon, a small town that was strategically important during the Khmer Rouge period in Cambodia, and especially in 1979 when the Vietnamese military intervened and drove the Khmer Rouge from power. At some point during that poorly-documented conflict one or other of the two sides planted hundreds of anti-personnel land mines in a defensive arc around the town. However, no records have survived of exactly how many mines were laid, nor of where they are. The children of the town are taught from an early age to avoid known mine fields, and large areas have been officially de-mined. But somehow 6-year-old Sothearum strayed into a field with at least one unmarked, unexploded mine. Even her slight weight was enough to detonate the mine, and she immediately lost her left foot as far as the knee. Other pieces of shrapnel struck her right leg, abdomen and face. Although her older brother was nearby and was able to rush her to the local health centre for care, she spent two months in hospital and finally emerged minus one leg, and blind in her right eye.

3. Fatima Samadzai:
Fatima lived all of her 28 years in the village of Khosh Nazar in Khas Uruzgan district in Uruzgan Province in central Afghanistan. She married at 15, working in the home of her husband’s extended family, who grew wheat, other crops and kept a herd of goats. During the Taliban rule in the province she was unable to continue attending primary school and thus remained illiterate. Fatima and her family were pleased each time she fell pregnant, and by 25 she had four children, each born at home. At 27 she embarked on her 5th pregnancy.

Fatima received no antenatal care given the difficulty of accessing it; her mother-in-law felt it unnecessary and in any case it was costly and took the best part of a day to reach. Intermittent fighting between Australian military forces and Taliban fighters had made roads even less safe and travel difficult. An Improvised explosive device killed two members of a neighbouring family on their way home from market the previous week.

Fatima went into premature labor at 34 weeks, and was attended by her mother-in-law and an older woman in the village who served as a traditional birth attendant. After several hours of labor Fatima developed acute severe abdominal pain, as if multiple knives were cutting inside her womb. She become distressed and began to bleed profusely.

It was growing dark and it was winter. The nearest hospital was 2 hours by foot or donkey and then at least 6 hours by road if a vehicle could be arranged. Despite the danger and difficulty of travelling at night, the birth attendant realized after half an hour of uncontrollable bleeding that Fatima was in mortal danger. After consulting with village elders they set off with Fatima on the family donkey, but half an hour into the journey she expired from loss of blood.

4. Michael Matane:
Michael Matane would have been three years old had he lived another three months. He was the first child of his 20-year-old parents, and lived on the outskirts of Moro, a small town in the Southern Highlands province of Papua New Guinea. His family farm a small hill-side plot, moving from one area to another each year ‘slashing and burning’ to create a new fertile area from the bush. They grow sweet potato and other crops, covering their family’s food needs and generating a small surplus to sell in the town market to earn money for their other needs. Michael’s father sometimes supplements the family’s diet by hunting small animals. His skill with the bow and arrows brings him local recognition and respect.

Michael was exclusively breast-fed for six months, but then his mother fell pregnant again and he was rapidly weaned. His growth began to falter and he had a series of fevers. His mother took him each time to the local government health centre and he recovered each time with antimalarial drugs.

His last illness was different, though. It began with fever and a little cough. He stopped eating, and even had trouble drinking. It was clear that he had trouble breathing, and he was breathing very fast – at least seventy times per minute. His mother took him to the health centre but the health worker was puzzled, and sent him home with only a cough syrup. He continued to deteriorate during the following night, and to his parents’ increasing distress, weakened and died shortly before the dawn.

5. Yusuf Khan
Yusuf Khan is a 52 year old farmer who lives with his wife, 4 of his 7 children, and 3 of his 13 grandchildren in the Dharavi slum in Mumbai. The family moved to Mumbai in 2006 when they were displaced from the land they had farmed for generations by the construction of the Sardar Sarovar Dam on the Narmada River in Navagam, Gujarat. In Mumbai, he worked as an auto rickshaw driver to support the family and his wife supplemented the income by working as a domestic help.

Mr Khan has reduced lung function related to past tuberculosis (now inactive) and smoking tobacco. Soon after the family moved to Mumbai, he developed diabetes. Mr Khan sought medical care from the local ‘pharmacy’ however his diabetic treatment was erratic and control of his diabetes poor. He was also found to have high blood pressure thought to be related to diabetic kidney disease. Mr Khan was no longer able to work as an auto-rickshaw driver because of a stroke that caused paralysis of the left-side of the body. Subsequently, his 2 children had to withdraw from school to work in a ‘beedi’ factory to help earn income to cover Mr Khan’s medical treatment costs.

His wife and children help care for Mr Khan who is now severely disabled and needs help with most domestic tasks.

 

 

 

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