Cured into Destitution: Surgery, poverty, and international development

5 billion people around the world cannot access surgical care when they need it, and 81 million people are driven into financial catastrophe every year by the costs of getting surgery. This talk explored the complex and multi-directional interplay between surgical care, poverty, and inequity and discussed the role that strengthening surgical systems can have in international development.

Vision for vision: translating ideas into practice

The Kapuscinski talk was given by eye surgeon and social entrepreneur, Dr. Andrew Bastawrous. He shared his journey from surgeon to public health practitioner, then founder of the social enterprise Peek Vision which has a mission to bring vision and eye health to everyone.

The event was moderated by Mario Calderini, Professor at Politecnico di Milano School of Management, Director of Tiresia, Research Centre for Impact Finance and Innovation, and current member of the Italian government’s Task Force on Social Impact Investment.

The event started with welcome messages by the moderator prof. Mario Calderini, by Emilio Paolucci (director of the ASP), Gabriella Fesus (EC, DG Development and International Cooperation) and Jan Szczycinski (UNDP). After welcomes, two pre-recorded videos by Andrew Bastawrous were played. In these videos, he explained that his motivations for first becoming an eye-doctor and then establishing Peek Vision, was a sense of injustice for the many people in poor countries who are blind or have poor vision due to diseases that we already know how to cure or prevent.

Children with poor sight may look lazy and appear as though they do not pay attention at school. They grow up believing all these things while the reality is that the world they see is out of clarity. Andrew revealed that he himself grew up with very short eyesight and received his first pair of glasses when he was about 12. This changed his world and from this experience he understood that clear vision corresponds to many opportunities, such as education and ability to socialize.

In 2012 he moved with his family to Kenya, where, similar to other developing countries, most of the resources for eye care were in the big towns and cities, while most patients who needed them lived in rural areas. An option would have been to take the eye care equipment to communities. However, such equipment were sensitive, heavy, costly and needed about 15 people to be moved to the communities. Communities also suffered scarcity of electricity, therefore, that option had poor feasibility.

Andrew’s entrepreneurial idea was to recreate the tests done in the clinic on a smartphone and to simplify the process so that a rather complex test could be delivered anywhere to anyone, with the results shared with specialists who then decide whether to treat the patient or not.

This novel approach was initially tested at schools, where teachers were trained to do vision testing on children to pre-identify those with low vision. For every child identified as having a vision problem, a text message was sent to parents and to head teachers with instructions on what to do next. This approach allowed capillary screening without increasing the load on already overburdened hospitals and nurses.

The system was initially tested on 21,000 children who were screened by only 25 teachers in 9 days. 900 of them were found to be visually impaired. The program was then scaled up to cover the whole county. 160,000 more children were screened and treated if they had a problem. Today, the program is being extended to other parts of Kenya and to countries such as Botswana and India.

As he concluded the lecture, Andrew stressed that an important part of the program implementation was understanding why some patients who needed treatment exited the program without being treated. Thankfully, this information could be got through data collection and smartphone technology and it helped program planners and implementers make appropriate decisions locally.

Reproductive health in a changing humanitarian climate

In her lecture, “Gender Equality and Reproductive Health in a Changing Humanitarian Climate” Sarah Costa discussed recent changes in the sexual and reproductive health of forced migrants. Before, during and after their migration trajectories, forcibly displaced people are vulnerable to harm in their sexual and reproductive health. Regardless of one’s legal status, everyone should get access to reproductive health services and information about their reproductive rights. Therefore, leading questions in this lecture were: can gendered migration dynamics have a transformative effect on people? How can institutions, aid workers and organisations collaborate on a stronger shared knowledge base regarding migration and reproductive health? And how can we create safe spaces where people can enjoy a safe and satisfying sex life?

Today, the humanitarian sector is confronted with many challenges. More than 69 million people are forced to leave their place of residence because of violence, persecution or  violation of their human rights. In addition to this growing number of displaced people,  the length of the displacement is increasing as well. Furthermore, an expanding number of people are fleeing to urban areas in search of employment opportunities and emergency services. On the other hand, wealthy nations are becoming more and more isolationist and borders are closing. Humanitarian resources are thus disproportionately overstretched and underfunded. Against the backdrop of all these challenges, Sarah Costa stressed the particular risks and vulnerabilities of women and girls. At least 25% of refugee women are of reproductive age, 14 % of these women are pregnant, and 15 % of these pregnancies will lead to life threatening complications. Nonetheless, a gender analyses is lacking in the design and implementation of most humanitarian programs. Costa pointed to the importance of  target group-oriented facilities for women and men. For example, migrant women are afraid to use latrines in refugee camps. No safe spaces are established, leaving women vulnerable and exposed to violence. Moreover, humanitarian programs should not solely focus on supplying reproductive health services, working on women’s social and economic empowerment in the humanitarian field is at least as important.

Despite these intersectional vulnerabilities of forced migrants and refugee women, transformative change is achievable. In her lecture, Sarah Costa listed eight strategies that can contribute to transformative and positive practices. First off, Costa referred to a necessary shift in our discourses about migrants and practices towards them to adapt to the changing experiences of forced migrants. Displaced people are not merely victims in need of assistance and humanitarian care. Rather, they must be regarded as survivors with strengths, skills and capacities that can be tapped and supported. Second, the social and political field should stop treating the so-called ‘migration crisis’ as  short-term problem, instead long-term programs must be supported. Sustainable capacity building programs will stimulate local economies. Third, humanitarian actors must involve women and support women’s participation. Migrant women can offer unique insights in limitations and opportunities of existing humanitarian programs. Fourth, local women’s organisations can play a powerful role in developing accurate services for women. Their contribution is too often ignored or sidelined by international aid organisations. Therefore, allocation funds need to strengthen their capacity and leadership. Fifth, along with local women, local capacity must be supported. Favourable framework guidelines have been set by humanitarian organisations, but implementation of these guidelines remains poor. Sixth, the humanitarian and development actors must improve their partnership relations. Although organisations in both fields share many common goals, they remain often separated. Seventh, it is necessary to focus on empirical data demonstrating the impact of a gendered-based approach. Without data it is impossible to demonstrate and evaluate the advantageous results of gender-based programs. Lastly, increasing accountability of humanitarian actors by donors with regards to the integration of gender perspectives in all aspects of their work. Local organizations again can play an essential role in evaluating whether their needs are being answered.

In a panel discussion after the lecture, Ines Keygnaert (Assistant professor in sexual and reproductive health an Ghent University) talked about the sexual and reproductive health context for forced migrants in Belgium. In her contribution, she emphasized that sexual and gender-based violence continues when migrants arrive in ‘host’ countries. Keygnaert pointed f.e. to the maternal mobilitiy problems women face. European rules about access to safe delivery for all migrant women is being turned back in more and more countries. Childbirth is no longer regarded as an urgent medical intervention. More generally, she underlined the importance of providing assistance regardless of legal status. This principle lay at the basis of the recently started sexual assault care centre in Belgium.

In their concluding remarks, Keygnaert and Costa stressed that both the accountability and gender-sensitivity of humanitarian organisations have to be strengthened to protect the reproductive health of refugees and migrants.

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