Editorial 1 : World’s race to eradicate Guinea worm disease nears the finish line
Context
The world is on the brink of a public health triumph as it closes in on eradicating Guinea worm disease. As according to the World Health Organization’s (WHO) weekly epidemiological report, they dwindled to 14 cases in 2021, 13 in 2022, and just six in 2023.
Infection cycle
- Guinea worm disease, also called dracunculiasis, is the work of the Guinea worm (Dracunculus medinensis), whose infamy dates back to biblical times, when it was called the “fiery serpent” and whose presence researchers have confirmed in Egyptian mummies.
- Individuals whose bodies the worm has entered first experience a painful blister, usually on a lower limb.
- When seeking relief, they may immerse the affected area in water, which prompts the worm to emerge and release hundreds of thousands of larvae, potentially contaminating communal water sources and perpetuating the infection cycle.
- While a worm by itself is not lethal, it debilitates those whom it infects and prevents them from earning their livelihoods.It manifests as a painful skin lesion as the adult worm.
- This process, which can last weeks, often begins with a blister and develops into an ulcer from which the worm slowly exits the body.
- The symptoms involve intense pain, swelling, and sometimes secondary bacterial infections at the wound. Victims may experience fever, nausea, and vomiting.
Legs most susceptible
- More than 90% of Guinea worm infections manifest in the legs and feet.
- The individual has an excruciating experience when the adult female worm emerges through the skin.
- The open sore left by its exit is also susceptible to secondary infections.
- The disease affects people of both sexes. The struggle against Guinea worm disease is symbolic of a broader fight against the diseases of poverty and the self-fulfilling relationship between poverty and illness.
- The disease thrive where access to safe drinking water is a luxury, and health education and resources are scant.
In India
- India eliminated Guinea worm disease in the 1990s, concluding a commendable chapter in the country’s public health history through a rigorous campaign of surveillance, water safety interventions, and education.
- The government of India received Guinea worm disease-free certification from the WHO in 2000.
- This accomplishment was the result of a collaboration between the Indian government, local health workers, and international partners.
- The strategy that brought us to the brink of eradication was straightforward: intersectoral coordination, community participation, and a sustained focus on prevention through health education.
- Unlike many diseases that have been cornered by medical interventions, Guinea worm disease was and is being pushed to extinction using the fundamentals of public health: ensuring access to clean water (by applying a larvicide called Temephos), spreading awareness through community workers, and meticulously tracking cases and containing outbreaks.
New reservoir
- In 2020, researchers also discovered Guinea worms in animal reservoirs, particularly dogs, in Chad, casting a shadow of complexity over the final stages of eradication.
- This development is a crucial reminder of the disease’s tenacity and, importantly, signals to countries where the disease was previously endemic, including India, to not let their guard down.
Conclusion
- If the worm persists in this way, governments must stay vigilant and maintain adaptable public health strategies to ensure they don’t lose the upper hand.
- This said, the significant progress made towards eradicating Guinea worm disease is also threatened by human and political factors, notably civil unrest and poverty.
- Eradicating Guinea worm disease wouldn’t just represent a victory over a single parasitic but a triumph of humankind at large.
- Getting rid of this disease will also be a much-needed testament to what we can achieve when global efforts converge to uplift communities from preventable afflictions.
Editorial 2 : The women of ASHA: overworked, underpaid and on the edge of breakdown
Context
ASHAs engage in the double burden of domestic chores while running around the community as health workers, resulting in improper nutrition, inadequate sleep anddeprioritising their own health. They are at risk of anaemia, malnutrition and non-communicable diseases.
About
- The word Mitanins. translates to ‘friends’. A friendship, between women, one with the promise of compassion.
- In 2002, Mitanins also came to symbolise care, when Chhattisgarh designated women to play the role of community health workers.
- Mitanins inspired the ASHA framework three years later.
- The Accredited Social Health Activist — a saree-clad cadre of almost 10 lakh women today — is a friend.
- Her care work dictates the reach and success of India’s health schemes. But agents of change tire too.
Issues
- Every ASHA logs in a ‘triple shift’, spread out between the home, community and health centres.
- Overworked and underpaid, they are caught in a frenzied rhythm: many do not eat well and sleep enough, and are at risk of anaemia, malnutrition and non-communicable diseases, found a new study.
- It documented the limited autonomy the health workers have over their time, money and well-being.
- Experts place the ASHAs’ triple burden along an axis of power inequities — where gender, caste, and informal economy intersect.
- As women ‘volunteers’, and not designated health care workers, ASHAs experiences cut across “layers of marginalisation”.
- There is an economic, physical and psychological violence embedded in their role, crafted carefully by a system that refuses to assign value to their labour.
- Outside of homes, the duties under their umbrella of work have expanded too: it started with maternal and child health, and now includes vaccination follow-ups, data logging, learning palliative care, reporting domestic violence cases, providing mental health support, and more.
- Extreme weather conditions add a degree of precarity. Reports suggest the occupational hazards of working through heat waves or erratic weather will imperil the informal labour force.
- Their eating habits, irregular times and paucity of nutritious food make them vulnerable to malnutrition, anaemia and non-communicable diseases.
Monetary barriers
- As volunteers, ASHAs receive an honorarium and performance-based incentives.
- Moreover, ASHAs relied heavily on health department’s incentives.
- It becomes a form of “economic violence” when their wages are delayed and fixed honorariums are received months later.
- ASHAs incur out-of-pocket expenditures for the logistical costs of their job — on photocopies, travel, mobile data recharge.
- As honorary workers, however, their health is still not covered under the Central Government Health Scheme (CGHS) or similar programmes.
- ASHAs as health workers do have greater access to PHCs.
Many faces of violence
- Gender and caste hierarchies further shape ASHAs’ well-being.
- Abuse, harassment and assault receive scarce coverage; some were highlighted during the pandemic.
- Historically, ASHAs and other woman health workers come from marginalised communities.
- They work with the Panchayati Raj Institutions (PRIs) and medical systems — entities where the social composition is traditionally of men from privileged communities.
Government initiatives
- It is only during the recent Interim Budget that the Central government announced free health insurance cover for all ASHAs and Aganwadi workers and helpers under the Ayushman Bharat Scheme.
- In 2018, the Ministry of Health and Family Welfare approved an ASHA benefit package, providing coverage for accidents, deaths and disability.
Way forward
- The National Health Systems Resource in 2011 published a report documenting ASHAs’ duties, hierarchy and reporting mechanism.
- The document made no mention of working conditions and the challenges they face.
- India should “bite the bullet.” make them into full-fledged workers, pay them decently and look after them.