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  • Systems Management Specialist (CDI Corporation)

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  • Dropping the Last 10 Million

    If you're talking to me in my left ear, I can't hear you. That's because I was born in 1967, the same year the vaccine for mumps was invented - and my small-town doctor didn't get around to sticking it to kids until after the disease had nibbled away at the nerve endings in my 2-year-old ear. Luckily, I was otherwise a healthy kid, with lots to eat and a cozy home, so I survived with nothing more than a tendency to stare hard when people talk to me. Over the past 40 years, immunization for mumps and more deadly diseases like measles and TB has spread to small towns around the world, contributing to what UNICEF announced today as a "child survival milestone": The number of children dying before age five each year has fallen below 10 million for the first time in what the organization calls "modern history." Based on an analysis of data from national governments around the world, the UNICEF study shows child mortality currently at 9.7 million a year, down from 13 million in 1990. UNICEF Executive Director Ann M. Veneman calls this achievement "historic" in a statement released today. But she also admits that losing 9.7 million kids is "unacceptable," pointing out that "most of these deaths are preventable and, as recent progress shows, the solutions are tried and tested."There are naysayers. The Associated Press quotes Dr. Christopher Murray of the Institute for Health Metrics and Evaluation at Washington University: "Considering all the tools we have for child survival, we are not doing better at reducing child mortality now than we were three decades ago." In a critique that will be released in the UK medical journal The Lancet later this month, Murray casts doubt on figures provided by national governments stating how well they're doing keeping kids alive. According to his figures, the child-mortality rate now is falling at a rate of 1.3 percent a year, down from 2.2 percent a year from 1970 through 1985. Now this is not the kind of analysis you'll ever find in The Lancet, but when I think about decreasing rates, I think about losing weight - you know, how you can shed a bunch of pounds fast at first and then you have to work harder and harder to lose that last 10 pounds. A look at the the handy chart of the UNICEF figures whipped up by The New York Times bears this out: You see steady decline in the Middle East and North Africa, South Asia, Latin America and the Caribbean, East Asia and the Pacific, and Central and Eastern Europe. These regions have seen the biggest drops in child mortality in recent years, as they promote vaccination and the use of Vitamin A, which staves off death by measles, diarrhea, and malaria. The leveling off comes from adding in the extremely low levels of decrease in industrialized countries since immunization programs became widespread by the end of the '70s - and from the devastating spread of AIDs and warfare in sub-Saharan Africa, which has held back gains in that region over the past 30 years.Just like with weight loss, the biggest drops come from the simplest measures - even in Africa. The tiny West African country of São Tomé and Principe has the world record, cutting child mortality by 48 percent primarily through a national anti-malaria campaign.  Madagascar, which saw a 41 percent drop, did it by distributing Vitamin A drops. And Ethiopia managed a 40 percent drop by training some 30,000 community health workers to take the basics to the countryside: vaccinations, malaria nets, Vitamin A. I've been obsessed with this DIY approach, what the UN wonks call "community-directed" health care, since reading in The Economist last week about campaigns to wipe out a disease called river blindness in central Africa. (I can't help wondering if self-help might not be a way for us to make an end run around the health care crisis in our own country, but that's another story.) Currently practiced in 16 African countries, including Uganda and Congo, these programs train tens of thousands of everyday folks to administer the anti-river blindness drugs. The head of the program, Dr. Uche Amazigo, believes the same approach could work for distributing vitamins, vaccines, and malaria treatment - in short, the very things that save so many children. The problem, as The Economist points out, is that currently there is no proposal for the World Health Organization, or any other group, to expand DIY care. In fact, the funds for the river blindness program are due to run out soon - leaving all those people who've been trained to help each other without any medicine to administer. As we chip away at that last 10 million, looking for a way to save the children who are furthest from the reach of basic medical attention, isn't the best place to look among their family and friends?Celeste Fraser Delgado is the MOLI View's contributing editor for Worthy Causes.

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