Opinions: Obstetric fistula; malaria and climate change

Nov 3 2009

Fistula Hospital Plan Is A Great Investment For American Foreign Aid

In a New York Times opinion piece, columnist Nicholas Kristof examines a new plan to tackle obstetric fistula, "a childbirth injury, often suffered by a teenager in Africa or Asia whose pelvis is not fully grown." According to Kristof, "Just about the happiest thing that can happen to such a woman is an encounter with Dr. Lewis Wall, an ob-gyn at Washington University in St. Louis. ... [who] has devoted his life to helping these most voiceless of the voiceless, promoting the $300 surgeries that repair fistulas and typically return the patients to full health."

Wall has been campaigning to build a fistula hospital in West Africa. Kristof writes that "Niger recently approved Dr. Wall's plan for a fistula hospital, affiliated with an existing leprosy hospital run by SIM, a Christian missionary organization. ... Aside from repairing fistulas, the hospital will also organize outreach efforts to promote maternal health and reduce deaths in childbirth. It will also undertake education and microfinance efforts to empower women more broadly."

This step "could be just the beginning," Kristof writes, adding that the "new hospital is part of a grand vision [that has been circulated to U.S. policymakers] to eradicate fistulas worldwide by building 40 such hospitals in the world's poorest countries. The plan, drawn up by Dr. Wall, would cost $1.5 billion over 12 years and operate as an American foreign aid program." He notes that President Barack Obama "hasn't signaled a position yet" and concludes, "I can't imagine a better use of foreign assistance dollars - or better symbolism than having the most powerful nation on earth reach out to help the most stigmatized, suffering people on the planet" (10/31).

To Combat Malaria, Focus On Smarter Policies, Not Climate Change

"Warmer, wetter weather will improve conditions for the malaria parasite. Most estimates suggest that global warming will put 3% more of the Earth's population at risk of catching malaria by 2100. If we invest in the most efficient, global carbon cuts—designed to keep temperature rises under two degrees Celsius - we would spend a massive $40 trillion a year by 2100. In the best case scenario, we would reduce the at-risk population by only 3%," Bjorn Lomborg, director of the Copenhagen Consensus Center, writes in a Wall Street Journal opinion piece about the relationship between climate change and malaria.

"In comparison, research commissioned by the Copenhagen Consensus Center shows that spending $3 billion annually on mosquito nets, environmentally safe indoor DDT sprays, and subsidies for effective new combination therapies could halve the number of those infected with malaria within one decade. For the money it takes to save one life with carbon cuts, smarter policies could save 78,000 lives," he writes.

According to Lomborg, malaria is "strongly related to poverty" and "only weakly related to temperature." The number of malaria cases "has risen in sub-Saharan Africa over the past 20 years not because of global warming, but because of failing medical response. The mainstay treatment, chloroquine, is becoming less and less effective. The malaria parasite is becoming resistant, and there is a need for new, effective combination treatments based on artemisinin, which is unfortunately about 10 times more expensive." He concludes that "spending money on global warming" will do "[v]ery little" to combat malaria. "For a lot less, we could achieve a lot more" (11/1).