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February 2006 - Feature Article 2

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FEATURE ARTICLE 2

VolunTourism & The Millennium Development Goals - Part II
With less than a decade left to achieve the Millennium Development Goals, the question to be addressed is: What role, if any, can VolunTourism play in helping to achieve these objectives by 2015?

In this, our second installment of this three-part series, we will address Millenium Development Goals #3, #4, #5, and #6. To reiterate, in September 2000, the United Nations General Assembly established eight (8) Millennium Development Goals (MDGs) to be achieved by the year 2015.

Each MDG has specific criteria established by which achievement can be measured. Our discussion, this month, will begin with MDG #3

MDG #3: Promote Gender Equality And Empower Women

According the the criteria for this MDG, there is one item of importance:

Eliminate gender disparity in primary and secondary education preferably by 2005, and at all levels by 2015.

Our question, therefore, is:

"Does VolunTourism have a way to eliminate gender disparity in primary and secondary education? "

The following excerpts were taken from a report filed by Deon Filmer, of the World Bank. He collaborated with a number of colleagues and wrote an interesting piece entitled The Structure of Social Disparities in Education: Gender and Wealth in 1999. Here is the first paragraph from the report:

Universal primary education was enshrined as a human right in the United Nation’s Universal Declaration of Human Rights in 1948. Forty years later the goal was still not in sight and a call on donors and governments to reaffirm their commitment to universal primary enrollment was part of the World Declaration on Education for All issued in Jomtien, Thailand in 1990. The year 2000 was set as the target for achieving this goal. It is now 1999 and we are still not near to achieving universal primary education – and as pointed out dramatically in a recent report by Oxfam International (1999) we do not appear to be closing in on it.

The paper concludes with the following two paragraphs:

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Can VolunTourism, then, address "wealth and gender gaps simultaneously?"

We have already discussed how VolunTourism can augment family income. But it is definitely too early to determine the viability of such strategies to affect cultural attitudes and conventions, especially in the area of gender equality.

Is it true that empowerment of women may occur when they are able to generate income? Yes, but this does not necessarily translate into better education for their daughters.

One interesting note, that I am sure has crossed your mind, is that with the interaction of VolunTourists comes the opportunity for education "outside of the classroom." No, this type of education does not fit within the parameters set forth by this MDG, but with the influx of foreign VolunTourists into villages and impoverished communities, different languages can be assimilated and children, especially girls, will be in direct contact with alternative cultural traditions.

Seeing a woman from another country bending over a shovel, digging a canal or irrigation ditch, may influence the adult women and their daughters in ways that we are not currently aware. It may prove inspirational - "these women are doing this to help me and my family." This is one area in which VolunTourism research will have much to explore in the future.

MDG #4: Reduce Child Mortality

Reduce by two-thirds the mortality rate of children under five.

MDG #5: Improve Maternal Health

Reduce by three quarters the maternal mortality rate

MDG #6: Combat HIV/AIDS, malaria and other diseases

  • Halt & begin to reverse the spread of HIV/AIDS
  • Halt & begin to reverse the incidence of malaria and other major diseases

This health grouping is an interesting cluster to address through VolunTourism. First, we need to understand what are some of the causes that lead to these health challenges. It would defeat the purpose of this discussion to simply say that poverty and lack of education are the reasons that such health challenges persist in the world. Stating the obvious does not alleviate it. Therefore, we will more intently focus on certain "causes" behind these challenges that may prove as plausible points of amelioration by VolunTourism.

As VolunTourists, we have the potential to review the following health information and discover what destinations are most affected by health challenges. The World Health Organization (WHO) offers an annual World Health Report and delivers the most recent figures and information regarding health issues and strategies for addressing these.

For this article, I reviewed the 2003 World Health Report (WHR) and the 2005 World Health Report (WHR) . Both present an overview of the health challenges and strategies for addressing these challenges. I have added some excerpts for your review.

From the 2003 WHR:

Of the 57 million deaths in 2002, 10.5 million were among children of less than five years of age, and more than 98% of these were in developing countries. Globally, considerable progress has been made since 1970 when over 17 million child deaths occurred. In 14 African countries, however, current levels of child mortality are higher than they were in 1990. Overall, 35% of Africa’s children are at higher risk of death today than they were 10 years ago. The leading causes of death in children are perinatal conditions, lower respiratory tract infections, diarrhoeal diseases and malaria, with malnutrition contributing to them all. In sub- Saharan Africa, HIV/AIDS was responsible for an estimated 332 000 child deaths in 2002. Across the world, children are at higher risk of dying if they are poor and malnourished, and the gaps in mortality between the haves and the have-nots are widening.

From the 2005 WHR:

Each year 3.3 million babies – or maybe even more – are stillborn, more than 4 million die within 28 days of coming into the world, and a further 6.6 million young children die before their fifth birthday. Maternal deaths also continue unabated – the annual total now stands at 529 000 often sudden, unpredicted deaths which occur during pregnancy itself (some 68 000 as a consequence of unsafe abortion), during childbirth, or after the baby has been born – leaving behind devastated families, often pushed into poverty because of the cost of health care that came too late or was ineffective...

It has become clear that the MDG for child mortality will not be reached without substantial advances for the newborn. Although modest declines in neonatal mortality have occurred worldwide (for example, vaccination is well on the way to eliminating tetanus as a cause of neonatal death), in sub-Saharan Africa some countries have seen reversals that are both unusual and disturbing...

The greatest risks to life are in its beginning, but they do not disappear as the newborn grows into an infant and a young child. Programmes to tackle vaccine-preventable diseases, malnutrition, diarrhoea, or respiratory infections still have a large unfinished agenda. Immunization, for example, has made satisfactory progress in some regions, but in others coverage is stagnating at levels between 50% and 70% and has to find a new momentum. These programmes have, however, made such inroads on the burden of ill-health that in many countries its profile has changed.

Securing Child Health (WHR 2005):

The Integrated Management of Childhood Illness (IMCI) combines a set of effective interventions for preventing death and for improving healthy growth and development. More than just adding more subsets to a single delivery channel, IMCI has transformed the way the health system looks at child care – going beyond the mere treatment of illness. IMCI has three components: improving the skills of health workers to treat diseases and to counsel families, strengthening the health system’s support, and helping households and communities to bring up their children healthily and deal with ill-health when it occurs. IMCI has thus moved beyond the traditional notion of health centre staff providing a set of technical interventions to their target population...

It is bringing health care closer to the home, while at the same time improving referral links and hospital care; the challenge now is to make IMCI available to all families with children, and create the conditions for them to avail themselves of such care whenever needed...

The common project that can pull together the different agendas is universal access to care.

Securing Women's Health (WHR 2005):

For optimum safety, every woman, without exception, needs professional skilled care when giving birth, in an appropriate environment that is close to where she lives and respects her birthing culture. Such care can best be provided by a registered midwife or a health worker with midwifery skills, in decentralized, first-level facilities.

Securing Relief For HIV/AIDS (WHR 2003):

Prevention activities need to be designed with the local epidemiology of the disease in mind. In settings in which HIV is largely sexually transmitted, information and education campaigns can save lives. In Thailand, for example, it is estimated that aggressive condom promotion targeting military personnel and sex workers has resulted in significantly fewer new infections than had been predicted (18) . In settings in which HIV transmission is linked more closely to injecting drug use, harm-reduction strategies (for example, the provision of clean injecting equipment as well as adequate therapy for drug dependence) have proved to be effective (19) .

It is difficult categorically to class on-the-ground activities as contributing either to “prevention” or “care” exclusively. For example, most people would class the prevention of mother-to-child transmission (pMTCT) of HIV as a prevention activity. But implementing such programmes has often called for improved prenatal care: “MTCT-Plus” initiatives follow up the initial preventive intervention with ARV treatment for HIV-positive mothers, when clinically indicated, allowing women not only to give birth to healthy babies but also to live to raise them (20) . Similarly, improving HIV care helps to destigmatize AIDS. Decreased stigma is associated with increased interest in voluntary counselling and testing, which is a cornerstone of effective HIV prevention and care (13) . Some recent studies have begun to catalogue the mechanisms by which increased access to quality HIV care can strengthen prevention efforts (15) .

In reviewing the recommendations of the WHO, there are two primary areas upon which VolunTourism can focus via the implementation of VolunTourist-based activities:

  1. Prevention & Care, and
  2. Access

Prevention & Care

The prevention of illness and disease as well as the care of destination residents can be addressed through VolunTourism - even at a modicum of functionality. VolunTourism experiences can target medical technicians but also those who have a genuine interest in supporting the health and well-being of children and adults throughout the world. VolunTourists can, therefore, be broken into two subsets - skilled and unskilled.

The Skilled

Health practitioners represent amazing opportunities for VolunTourism. Doctors Without Borders has demonstrated the interest level of physicians and nursing staff to participate in journeys that are dedicated to supporting the welfare of citizens in countries throughout the world. Incorporating a less strenuos itinerary with tourism-related products and services via VolunTourism may increase the number of participants who otherwise could not dedicate a longer term of service.

There may also be other models of engaging health practitioners perhaps in the training of resident health workers or midwives. This would be much less stressful for those who may very well deserve rest and relaxation from their regular caretaking duties.

The health concerns identified by the MDGs can be communicated directly to tourism industry professionals and NGOs that service destinations in and around the areas identified by the WHO as "hot spots." These VolunTourism Operators can thus develop itineraries specifically tailored to health professionals with vital information of the health concerns included in their promotional materials.

The Unskilled

Those individuals without official medical training can be tapped to assist in capacities that do not require such training. Immunizations and/or the delivery of medical supplies such as anti-malarial netting, etc. can be orchestrated for such individuals. By establishing an agreed upon "price" with VolunTourism Operators that includes monies for medical supplies, these types of projects can be easily implemented.

They may also have an interest in constructing rural or urban clinics to improve accessibility. If a destination is organized to at least know where it has specific limitations, coordination with inbound VolunTourism Operators could help to strategically place clinics in areas where funding is least available.

Unskilled individuals can also be directed to support prevention activities. If there are communities in which breeding grounds for mosquitos are most prevalent, there may be projects that such VolunTourists can adopt to eliminate these spaces. VolunTourists may also be able to help in the struggle to gain access to purer drinking water. It is simply a matter of organization at the community level, conveyance to the VolunTourism Operator, and the delivery of an itinerary to a potential VolunTourist.

Conclusion

I want to be very clear that VolunTourism can prove to be one of many "helping hands" that move the world toward the achievement of the MDGs. Visitors have never truly been seen as a resource, a true asset, other than the economic impact that they represent. But visitors can be much more than "money bags" walking around urban and community settings. These individuals are an incredible resource. It is my hope that the development community will see what a viable resource these individuals can be.

Planning is the key element in the crafting of VolunTourism itineraries that can support the MDGs. In March, Kristin Lamoureux will address MDGs #7 & #8 to conclude this first look at VolunTourism and the MDGs.

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