Posts Tagged ‘Children’

Toxic Stress in Children of Immigrant Detainees

August 6, 2017

kids of deported parentsPediatricians are sounding the alarm on the health effects of children traumatically separated from detained immigrant parents. Responding to the Executive Order expanding deportation, American Academy of Pediatrics (AAP) President Fernando Stein stated

The executive orders signed today are harmful to immigrant children and families throughout our country.they deserve to be healthy and safe.”

Nonetheless, on June 15 the Secretary of Homeland Security rescinded the  Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) which protected undocumented parents of US citizen children from deportation.

5 million children who are US citizens have at least one undocumented parent. 660,000 children were separated from parents due to deportation between 1998 and 2012. By May, non-criminal immigration arrests increased by 150%.

Pediatricians warn that constant fear of parental deportation results in feeding, sleep and learning problems, depression, and illness and toxic stress, which can hinder brain development. Adverse experiences in childhood predispose individuals to heart disease, diabetes, and cancer.

Even before Trump’s actions, immigrant and American-born Hispanic mothers in Iowa were 24 percent more likely to have low-birthweight babies after a federal immigration raid. Delays in preventive care and medical treatment followed Arizona immigration legislation. Parents, even those with children with disabilities, hear of a single parent of a child with cerebral palsy being deported to Colombia, and stay home foregoing medical care due to fear of detainment.

Pediatricians are raising their voices, lobbying for protection of community sanctuary status, designing emergency care documents for immigrant families, and writing letters supporting parental care for special health needs.

Homeland Security must immediately limit arrests to immigrants with a documented criminal record, and provide agency assistance in creating family care plans before detention. Until federal raids are halted, states must defend the sovereignty of sanctuary communities for immigrants. Children must be put first.

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Urgent Need to Move on Alms Redistribution Plans to Get Begging ‘Taalibe’ Children out of Senegal’s Streets

August 12, 2015
Taalibe begging

‘Taalibe’ Qur’anic school students flood the streets with begging cans to collect their daily sums of money to turn over to their instructors. Children who fail to reach the daily quota may face beatings and incur debts (Credit S. Thiam 2007).

Up to 50,000 taalibe Qur’anic students, mostly children aged 5-15, are begging for hours on end in Senegal’s streets everyday. In 2010, Human Rights Watch shamed the national government for its inaction on the issue with a scathing report about the stomach-churning abuses that the taalibe (also talibé) children suffer at the hands of their Qur’anic masters who live off of their begging revenues. In addition to infringing upon on their human rights, the taalibes’ extensive begging and their crammed, unsanitary living conditions have been associated with numerous health and developmental risks, including malnutrition, high rates of infectious diseases, risks of street life including traffic accidents and exposure to violence and drugs, psychological suffering due to their separation from families and communities, and a lack of adequate education (see Thiam 2013).

This transnational attention to the issue in 2010 pushed the administration of then President Abdoulaye Wade to ban begging in public spaces in Dakar. On the day it was enacted, police lined the streets, begging children were rounded up in shelters, and eight Qur’anic masters were jailed. Opposition media and a national collective representing over 700 Qur’anic master associations effectively pressured the president to reverse the ban, claiming that without the population’s generous alms, the long-standing religious educational institution would not survive. A short six weeks later, the ban was repealed and the accused were released with token fines. Instead of outright banning begging, President Wade announced plans to implement an alms “mutualization” scheme to keep children out of the streets by redirecting donations to recipient institutions. The proposal calmed the raging national debates on the issue, but unsurprising to most, no further action was taken before the president left office. In 2013, current president Maky Sall, in a public response to a devastating fire that killed nine taalibes in their makeshift Dakar shack, indignantly pledged to prosecute exploiters and pursue a similar public policy to redirect alms. Again, three years later, there has been no change. Drawing valuable lessons from these political events and their fruitless outcomes, concerned local and transnational actors must join together to pressure Senegal’s political leaders and Qur’anic masters to find a workable giving redistribution scheme they can agree on, sooner rather than later, to get the thousands of begging taalibe children out of the streets and into schools.

Child Trafficking in Nepal

March 6, 2015

About the only thing the Government of Nepal has gotten right since passing the Human Trafficking and Transportation (control) Act of 2007 is that they’ve started prosecuting public officials accused of complicity in fraudulent recruitment of underage labor and sex trafficking even if the numbers of prosecutions is a drop in the bucket to how much corruption really exists in Nepal around child trafficking. However, at least this new law brought them in line with International Trafficking laws (which make them look good, right?) But, The GoN has no national anti-trafficking plan in place, nor is it a party to the 2000 UN Trafficking in Persons (TIP) Protocol.

Child trafficking in Nepal is unfortunately on the rise, with between 7,000 and 12,000 children being trafficked from Nepal each year to countries such as Bangladesh, India and the United Arab Emirates where they will face exploitation, predominantly in the commercial sex industry but also being sold into forced labor. There are many factors that help perpetuate this complex problem of human trafficking especially in children including; political instability, transition into peacetime (post-conflict), high poverty levels, high illiteracy, unemployment and the patriarchal social norm. Nepal has all of this in abundance.

According to the US Department of State 2014 Trafficking in Persons report, “Nepal is a source, transit, and destination country for men, women, and children who are subjected to forced labor and sex trafficking.”[i] Let’s take a closer look at what the government hasn’t done yet:

  • The GoN has been developing and anti-trafficking plan, but not yet completed or voted on.
  • No publicity surrounding the policy change of Human Trafficking in 2007 to raise awareness of the stand the GoN has finally taken.
  • There still exists a ban on women under 30 from travelling to foreign countries to work as domestic labor, which forces migration through illegal and dangerous channels.
  • There has been no sign of increased law enforcement against all forms of trafficking including girls and women.
  • Punishment of those trafficked without proper ID continues as usual (typically stolen by their captors), or those forced into prostitution.
  • Very little, if any police training on trafficking as well as prosecutors and judiciary (for the handling of human  trafficking prosecution)
  • No formal procedures put into place to recognize victims and protect them once taken away from trafficked environment (especially by police conducting raids).
  • There is very little provision of and/or a referral to protection services, immediate healthcare, legal services etc.
  • Finally, among the most heinous of these insults to trafficked victims is returning them to their captors after raids. (because the captors paid bribes to the police).

When you have societal norms of bribery among the local police, prosecutors, judiciary etc. much of what the government may try to do is undone by this corruption. According to the US State Dept., there are reports of all this and since some of those in authority own dance bars, or businesses that force child labor and slavery from trafficked children (i.e. brick kilns) it is entrenched in their society. Additionally, the huge, thriving networks of manpower agencies which lure children from their homes with promises of real jobs are powerful, have been around for centuries and bribery has always been a part of it – it’s called organized crime.

In 2013, according to the Government of Nepal’s (GoN) Report on Anti-Human Trafficking Initiatives[ii] they allocated a budget of 3 times as much to Nepal Embassies in other countries for trafficked Nepali citizens than they did for awareness programs, protection, rescue missions etc. within 75 districts in Nepal. (NRs 8 million vs. 3.7 million). Is this because the GoN will get more international coverage for what it is doing to ‘protect its citizens’ in other countries? They were the recipients of an international award for this.

The most important work is being done by local, national and international nongovernmental agencies and the communities they serve. The NGOs working in rural and urban areas develop awareness, create protection and shelters, provide legal aid and education include: Change Nepal and The Himalayan Foundation (). Since 1980, Bachpan Bachao Andolan (BBA) which has been at the forefront in the fight against slavery, has conducted rescues of over 82,800 children and the withdrawal of over 200,000 bonded and child laborers. The organization Global March is a collaboration among child rights’ organizations, trade unions and teachers’ organizations. It is the largest and most established active global coalition that specifically targets child labour elimination. Their belief is ”child labour can never be eliminated as long as hard-to-reach children continue to remain out of school”[IChild_labour_Nepalii].

The work these organizations are doing by saving children’s lives, putting them into schools and providing life after slavery ultimately creates the slow process of social change.

Expand the Basic Nutrition Program in Guyana

August 12, 2014

The Basic Nutrition Program (BNP) in Guyana has been internationally recognized for its success in reducing child malnutrition with targeted interventions in several of the countries rural, underserved interior regions (regions 1, 7, 8 and 9). Interventions include nutrient supplementation, breastfeeding education and food coupons, etc. However, not all of the regions have benefited from this program. Regions 6 and 10 where residents, particularly the Amerindian community, makes up the majority, disproportionately suffer from malnutrition.

The BNP program has been expanded twice since its inception in 2002 with support from the Inter-American Development Bank (IDB); however, these expansions have not included additional regions, but capacity building in current locations.

With demonstrated success in other regions that includes 12% increase in breastfeeding, 30% reduction in wasting and 21% reduction in stunting, expansion of the program is the next logical step. Malnutrition can lead to reduced growth, increase risk of infection, and death. Children in rural, underserved areas, particularly in the Amerindian community, should not have to suffer because of lack of education and access to resources.

Therefore the Guyana government in conjunction with in IDB should consider expanding the Basic Nutrition Program to the interior regions 6 and 10, where the isolated and underserved community can benefit from the “community-based child health interventions” already taking place in other regions. Every child should have adequate nutrition.

Postpartum Depression in Saudi Women: Culture and Biology Collide

March 10, 2014

Postpartum depression (PPD) is one of most common complications of childbirth. Currently, the prevalence rate of PPD is between 10–15% of mothers who recently delivered. Many women experience some emotional disturbances in the month after giving birth, often typified by crying, anxiety, and irritability. The “baby blues,” a normal, temporary period after childbirth, usually resolving a few weeks after delivery; however emotional disturbance may predict the development of chronic mood disorders that can have a lasting negative impact on the mother and her family.

Its high profile in the United States often overshadows its presence in nations outside the western hemisphere. In fact, compared to its prevalence of 10-20% in developed industrial countries, it is estimated that developing nations hold a prevalence of 20-40%.

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Figure: From Postpartum Depression and Miriam Carey

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Figure: From Postpartum Depression: Information for Rehabilitation Counselors

Saudi Arabia is one of the largest countries in the Middle East in size and population. Its recent economic growth and development has led to improvements in medical care and technology. However, psychological services are still in short supply for most of the population, most of all, pregnant women.

As an OB/GYN resident in Saudi Arabia, I found that most of my patients do not know about PPD and the vast majority of the time, do not seek help, even when having experienced similar problems in previous pregnancies. In addition, those mothers can be very young in age, with low educational levels, simply accepting the status quo. Conversely, a recent study showed that women who work and have children in Saudi Arabia have marginally increased prevalence of PPD. Researchers interpreted these results as stemming from the pressures of financial need: while Saudi Arabia’s economic development is growing fast, social systems to support low income families are non-existent.

The Saudi health system must improve their health policy and increase awareness of the risk and complications of PPD. Given the wide reach that primary health care services have in Saudi Arabia, general physicians must be involved in identifying the risk factors and early signs of PPD to prevent its complications. In addition, OB/GYN physicians must be familiar with PPD and at the very least, know the required methods available to detect PPD during standard postpartum visits. More specifically, physicians have to be familiar with Edinburgh Postnatal Depression Scale, the standard, validated scale used to measure a woman’s postnatal mood that has also been translated into Arabic.

Women whose PPD is identified are often shuffled around different specialists in the prospect of acquiring treatment. Unfortunately most Saudi primary care physicians did not have adequate training in identifying this condition, let alone the basics of its treatment. Moreover, OB/GYN staff usually refer any patients they believe to have any sort of psychiatric disorder to psychiatrists. Large hospitals usually have psychiatrists as well as a psychiatric ward, but hospitals like this are few throughout Saudi Arabia. However, knowledge of the postpartum needs of women is improving as recently, the new Health minister, D.Alrabeaah recommended that the government establish two large and well equipped hospitals to serve the community, especially poor and medically underserved communities.

PPD is also affected by a woman’s home life. Postpartum support from husbands is low in Saudi Arabia and it represents one of the major obstacles to improving a woman’s postnatal state. Husbands must be educated about the needs of their wives and provide support. Moreover, the child’s gender can often contribute to a mother’s PPD. When a mother delivers a baby girl, they tend to receive less care and support from mothers, sisters, and family. Saudi culture prefers boys for their potential to add to family wealth and productivity. These cultural expectations and beliefs must be fundamentally changed if mothers are to feel supported and worthy of their family’s care. To do this, people should be educated, starting with young children and women, who often serve to perpetuate these beliefs of unequal gender worth.

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Figure: From Ica’s Tales of Mommyhood

From my experience as a Saudi citizen and physician, the only real support new mothers can receive after delivery is from immediate family, especially their own mothers, who usually take their daughter and the new baby to stay with them for 1-2 months. While families can increase a woman’s risk of experiencing PPD, this much needed support serves to help a woman acclimate to her role as a mother to a new child.

Kuwait, a neighboring country, shares the same beliefs and cultural values and generally experiences similar issues with PPD. In recent years, the government of Kuwait took many steps forward in improving the mental health of its citizens, particularly those afflicted with PPD, and I hope the Saudi government uses these changes as an example to make strides in its own mental health system for women.

In conclusion, it is imperative that we improve access to PPD screening by increasing training for primary care physicians and OB/GYNs and on a more long term level, change cultural attitudes that decrease a husband’s involvement in the postpartum period and places greater value on one sex over the other.

Stop the Diabetes Epidemic-Start with our Kids

August 20, 2012

Diabetes is a chronic disease, which occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. This leads to an increased concentration of glucose in the blood which can lead to chronic issues that may result in blindness or amputation. The DDESS school district in the Territory of Guam is dedicated to reducing the incidence of diabetes in Guam.

According to statistics from the Guam Diabetes Association, there are over 40,000 diabetics on the island, that’s nearly 25% of the total population. Many islanders are on dialysis, with 112 dialysis chairs running 3-4 hour shifts seven days a week. In addition, childhood obesity is on the rise and without appropriate intervention, children could be diagnosed by age 10 and begin to have visual problems in their early 20’s. Something has to be done and we need to start with our kids.

GuamDiabetes.Org is committed to reducing the Diabetes incidence on the island of Guam. They have created a policy of removing sugary drinks and unhealthy snacks from the school grounds and replacing these with foods conducive to a healthy lifestyle. In addition, they plan to reintroduce exercise classes. These policies are in line with a district Health and Wellness Policy and are a first step that starts with our kids  to stop the Diabetes epidemic on the island of Guam.

Please donate to GuamDiabetes.Org and request funds be used for the DDESS school district Diabetes reduction program.