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Carolina Flores

The scourge of women's health you've never heard of

As many as 45 million women in the world, most of them in sub-Saharan Africa [1], suffer from a painful sexual health condition. This scourge of women’s health may cause bleeding and pain (especially during sexual intercourse) [2], decrease fertility [3], and make women more susceptible to STDs [4,5]. The lesions, often acquired in childhood, can and do persist through adult life [6, 7]. Yet this condition is fully preventable: all we need is a cultural shift towards valuing women’s lives everywhere in the world.

You may be surprised to learn that I am not talking about female genital mutilation (FGM) [a]. FGM has received plenty of attention in mainstream media in the last few years, leading to a number of global campaigns pledging to stop this practice [8, 9, 10]. The problem I am talking about is female genital schistosomiasis (FGS), and you are very unlikely to have heard of it in the mainstream media. For example, whereas a quick search in The Guardian returns about 382,000 results on FGM, there isn’t a single article mentioning FGS.

While it is true that ending FGM mainly requires a shift in local traditions and views of women, this is by no means easy to achieve [11]. In contrast, wherever we are, we can all work on the cultural shift needed to end FGS. What we need is to value all human lives equally, and act in accordance – both individually, through giving, and politically, through campaigning for global justice.

And you should care about ending FGS, even if it is the first time you’ve heard about it. Here is why:

Female Genital Schistosomiasis is caused by infection with the S. haematobium, a parasite which infects people exposed to affected water. It is often contracted in childhood, with serious symptoms observed in girls as young as 3. [12] This parasite then continues its life cycle inside the human body. When its eggs lodge in the female reproductive system, the body’s reaction leads to a host of unpleasant lesions. [13, 14]

The most characteristic ones are ‘sandy patches’ (thickening and scarring of tissue), breaches and open wounds in the mucosal surface and skin. [13, 14] Scars in tissue are a lifelong condition once contracted. [6, 7] Other associated symptoms are stress incontinence [15], irregular bleeding [16] , discharge [4], and pain during intercourse [2]. It may also be associated with infertility [3] and severe acute diseases such as ectopic pregnancy [17].

It can lead to cancer and death at a young age

The internal injuries I mentioned above are not only painful, but they also facilitate the implementation of HPV [4, 5], which can lead to cervical cancer. As FGS favours a rapid propagation of the virus and eases the spread of malignant cells, it contributes to a higher chance of developing cancer more quickly.[18, 19]

Because girls often contract FGS at a young age, this type of cancer occurs shockingly early in sub-Saharan Africa. For example, a study in Tanzania found that 18% of women with FGS and cancer were younger than 25, whereas only 5% of women with cervical cancer and without FGS were in the same age group. [20]

There is evidence that what applies to HPV also applies to other STDs: FGS makes it far easier to contract them. This means that STDs will spread more where more women have FGS, worsening the sexual health of the whole population.

It makes HIV transmission much more likely

FGS is associated with a 3-4 fold increase in acquiring HIV/AIDS during sexual intercourse, which means that FGS may be one of the most important co-factors in HIV transmission in Sub-Saharan Africa’s HIV epidemic. It has been estimated that 16 million women will acquire FGS and that, if cured, 120 000 new cases of HIV could be averted through regular FGS treatments in the next decade [21, 22, 23]

More research needs to be done on the topic, but we now know that FGS causally contributes to HIV transmission by increasing the number of HIV-receptive cells in a woman’s reproductive system. A woman infected with both diseases poses an additional risk of infecting her partners, as the dual infection leads to increased HIV levels in genital ulcers. [23]

Finally, HIV in a woman with FGS is very likely to have a fast progression to AIDS. As with HPV, this is because FGS facilitates virus replication. All of this tends to happen at a very young age, because FGS is often contracted before women become sexually active.

You can read more about some recent research on the HIV-Schistosomiasis interaction 

It is a factor in gender inequality, poverty and social exclusion

It should be no surprise that suffering from disruptive symptoms since childhood, with a higher risk of contracting life-threatening illnesses, contributes to staying in poverty. But there is more to FGS than the health problems mentioned above.

Though men also contract schistosomiasis, these infections have a disproportionate impact on women’s quality of life through FGS symptoms. This is compounded by the social stigma associated to the disease, by other disruptive symptoms of schistosomiasis [24], and by the association between schistosomiasis and being unable to go to school or to work [25]. All together, suffering from FGS compromises women’s agency and makes it very difficult to escape poverty.

Here is the happy ending to this post: there is effective treatment for schistosomiasis ( praziquantel), and it is given for free by pharmaceutical companies in a program coordinated by the World Health Organization (

http://www.who.int/schistosomiasis/strategy/en/

). If we add the cost of organizing and monitoring distribution, we get the result that treating a child costs US$1.23 (through the 

 recommended charities). What are you waiting for?

http://www.who.int/neglected_diseases/integrated_media_urogenital_schistosomiasis/en/

[Morice, P. et al. (1996) [Genital bilharziasis and female infertility.Review of the literature and three case reports]. Contracept. Fertil. Sex24, 56–61](

[Kjetland, E.F. et al. (2008) Female genital schistosomiasis – adifferential diagnosis to sexually transmitted disease: genital itchand vaginal discharge as indicators of genital S. haematobiummorbidity in a cross-sectional study in endemic rural Zimbabwe.Trop. Med. Int. Health 13, 1509–1517](

[Mosunjac, M.B. et al. (2003) Cervical schistosomiasis, humanpapilloma virus (HPV), and human immunodeficiency virus (HIV): adangerous coexistence or coincidence? Gynecol. Oncol. 90, 211–214](

[Kjetland, E.F. et al. (2008) Prevention of gynecologic contact bleedingand genital sandy patches by childhood anti-schistosomal treatment.Am. J. Trop. Med. Hyg. 79, 79–83](

[Silva, I.M. et al. (2005) Therapeutic failure of praziquantel in thetreatment of Schistosoma haematobium infection in Braziliansreturning from Africa. Mem. Inst. Oswaldo Cruz 100, 445–449 

[a] Interestingly, the two may be historically related. A recent paper (

https://www.researchgate.net/publication/236052203_Female_genital_mutilation_and_female_genital_schistosomiasis-bourouwel_the_worm_Traditional_belief_or_medical_explanation_for_a_cruel_practice

) suggests that FGM may have started as a misguided attempt to cure visible symptoms of FGS. In fact, the areas with high prevalence of FGS and of FGM overlap.

WHO: Effectiveness of interventions designed to reduce the prevalence of female genital mutilation/cutting

El-Adnani, M.S., Saleh, K.M., 1982. Extraurinary schistosomiasisin Southern Iraq. Histopathology 6, 747–752

Poggensee, G., Feldmeier, H. (2001) Female genital schistosomiasis: facts and hypotheses. Acta Tropica 79, 193-210

Eyrun F. Kjetland, E. F, Leutscher, P. D. C., Ndhlov, P.D. (2002) A review of female genital schistosomiasis. Trends in Parasitology Vol. 28, No. 2, 58-65

Kjetland, E.F. et al. (2005) Simple clinical manifestations of genitalSchistosoma haematobium infection in rural Zimbabwean women. Am.J. Trop. Med. Hyg. 72, 311–319

Bland, K.G. and Gelfand, M. (1970) The effects of schistosomiasis onthe cervix uteri in the African female. J. Obstet. Gynaecol. Br.Commonw. 77, 1127–1131

Ville, Y. et al. (1991) Tubal schistosomiasis as a cause of ectopicpregnancy in endemic areas? A report of three cases. Eur. J. Obstet.Gynaecol. Rep. Biol. 42, 77–79

Moubayed, P., Ziehe, A., Peters, J., Mwakyoma, H., Schmidt,D., 1995. Carcinoma of the uterine cervix associated withschistosomiasis and induced by human papillomaviruses.Int. J. Gynaecol. Obstet. 49, 175–179.

Ylitalo, N., Sorensen, P., Josefsson, A.M., Magnusson,P.K.E., Andersen, P.K., Ponte´n, J., Adami, H.O., Gyllensetein,U.B., Melbyl, M., 2000. Consistent high viralload of human papillomavirus 16 and risk of cervicalcarcinoma in situ: a nested case-control study. Lancet 355,2194–2198.

Moubayed, P., Lepere, J.F., Mwakyoma, H., Neuvians, D.,1994. Carcinoma of the uterine cervix and schistosomiasis.Int. J. Gynaecol. Obstet. 45, 133–139.

Hotez, P.J. et al. (2009) Africa’s 32 cents solution for HIV/AIDS. PLoSNegl. Trop. Dis. 3, e430

Feldmeier, H. et al. (1994) Female genital schistosomiasis as a riskfactorfor the transmission of HIV. AIDS 5, 368–372

http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0001396

King, C.H. and Dangerfield-Cha, M. (2008) The unacknowledgedimpact of chronic schistosomiasis. Chronic Illn. 4, 65–79

Larissa Hesketh-Rowe

Why I choose to give now

Each year more than six million people die from preventable diseases. 

If your average person in the US just donated 10% of their income 

 700 people from malaria for at least three years with mosquito nets or treat 7,100 people for neglected tropical diseases that keep them from work and school.

But what if you could double or triple even those numbers? What if in the future we discover even more helpful ways to donate our money? Would we regret ‘wasting’ our donations on less effective interventions in the past?

Should we donate to charities that tackle extreme poverty now or invest our money and wait for the future when we might understand more which poverty interventions work?

I have chosen to give now to charities that fight extreme poverty. Here’s why.

2015: An important year for eradicating poverty

This year is an important time in our our mission to eliminate extreme poverty.

 funds to top charities. Effective Altruism is growing as a movement with 

 books both out and a record breaking number of people attending the 

In international development more broadly, the Millenium Development Goals end in 2015 having 

 the number of children who did not make it to their fifth birthdays compared to 1990. They will be replaced by the 

), which are more inclusive and far reaching. The Sustainable Development Goals aim for a world free of extreme poverty by 2030.

Only a couple of months ago (on the 24th July) Nigeria marked 

. A small step in completely eradicating this deadly disease from the planet by removing it from the last remaining countries; Nigeria, Pakistan and Afghanistan.

We’re also setting the new climate change targets and as we know it is the world’s poorest that will be 

All of this momentum strengthens my feeling that now is an important time to give. The more success we achieve, the more people can see what is possible and how much of an impact individuals can have. We can seize the opportunity to create a worldwide movement where giving is both normal and clearly effective.

Nearing success on some of the most cost effective interventions

These successes also mean some of the cheap and effective interventions against extreme poverty will soon become superfluous (we hope!). This means there are cost effective giving opportunities now that might not be there if we wait. Yes, we can invest our money now and give more later. But will current interest rates really yield enough extra money to offset the cost effectiveness of current charities?

Not only that, but will the interest gained 

 (the effect of current investments in the receiver’s ability to help others)? Money we donate to, for example, deworming charities keeps people in work and school. These people then contribute to their families, their communities and their society in ways that they otherwise would not have done. These changes then benefit their children and their children’s children.

Are we losing generations of impact the longer we delay?

The age of the randomised controlled trials

One argument for delaying is that in the future we’ll have more information and be able to give even more effectively.

It will likely always be the case that we will know more in the future. Should we therefore always put off giving?

With so much focus on the Sustainable Development Goals and measuring effective poverty interventions, rigorous evidence in international development is starting to become the norm. By supporting those charities which set the gold standard of measuring effectiveness we can build pressure for other charities to improve and continue this trend. We can drive innovation by demanding it.

Where new developments seem to be just on the horizon, putting off giving is likely to be prudent. Where advances are slower or supporting current charities is the very way to drive innovation then donating now seems to be the best way to create better future outcomes.

It’s not only a culture of rigorous evidence we want to encourage but also a culture of giving.

By donating now we also encourage others to give. Even if saving to give were more effective it’s not a convincing argument for people new to the ideas.

“I’m saving my money to give to charity later, honest”

If saving to give later reduces the number of people that can be introduced to giving in the first place, then it may well be restricting its impact. Whatever I can achieve can be vastly increased as I persuade others to join me. With momentum behind the campaign to eradicate extreme poverty in the next 15 years, now is the time to engage a wider audience. The more people that give, the more the culture of giving grows.

 campaigning to eradicate poverty. Effective giving is another way they can reach their goals.

Think of the impact we could have if giving became normalised.

This is my vision for my giving. What is yours?

Coralie Oddy

Action on the refugee crisis and action on global poverty: thoughts, facts and ways to do good better. 

The Syrian refugee crisis has recently dominated news and social media. Away from the horror and devastation (not to mention the shocking apathy from some parties), 

I have been deeply struck by the compassion and support from ordinary people.

I know somebody who organised a donation drop for clothes and essential items for refugees in Calais that was inundated with contributions. My newsfeed keeps me constantly updated on news items about the refugee situation, shared and shared again with overwhelmingly sympathetic commentary and multiple calls for action. I’ve been asked to 

 by people I’ve never considered remotely political, and tens of thousands of people 

 to show their solidarity with refugees, giving up their time for an act of anonymous compassion.

My first thought on this is that I am tremendously proud, and somewhat awed, at our capacity for empathy.

 We are moved so deeply by the human desire to reduce suffering that we campaign tirelessly on issues that do not impact our own lives, and give generously to those we have never met and are never likely to meet. 

Our willingness to help others who are suffering acts as the measure of our humanity. We must keep up our efforts.

This chain of events has also led me to consider how we respond to the suffering of others in different contexts. As an effective altruist, I am concerned with how we can alleviate the most suffering, for the most people, in the best ways. While doubtless a humanitarian catastrophe we should all concern ourselves with, the current refugee crisis is an extremely complex problem to solve on both logistical and political levels. In contrast, we have a 

 that gives us comparatively straightforward guidance on what we can do to ease suffering and prevent deaths in the developing world.

 protects children from diseases that cause malnutrition, stunted growth, cognitive defects and increased risk of infection from HIV/AIDS. The immediate reduction in human suffering is immense, and long term these benefits to health support people to build better lives for themselves. The cost? Around 81p per treatment. It is with good reason that SCI is considered one of the 

But if that is the case, why has almost nobody heard of SCI? 

Given that the problem is so much easier to solve, and the level of human suffering broadly comparable

 (bereavement, poverty, physical pain and lack of opportunity are arguably just as bad whether caused by war or disease), 

why do we not see the same level of engagement the refugee crisis has sparked?

The refugee crisis is all over our media.

 Obviously, people are engaged with the suffering caused by the refugee crisis because it is constantly in the news. Also, because the situation throws up controversial issues (relating to immigration, for example), more people are inclined to voice their opinion. People feel they must argue for compassion as not everyone shares their views. This leads to more general discussion, but also an ‘us and them’ mentality which prompts people to validate the beliefs of others who share the same views on the crisis as themselves, encouraging action to be taken. 

With issues like extreme poverty in the developing world, the take-home point is this: 

just because an issue isn’t in the news, it doesn’t mean it isn’t newsworthy.

 Compared to the relatively sudden Syrian crisis, extreme poverty is a constant, and therefore is rarely commented on in the news. Yet it is because poverty is a constant fact of life for millions of people that we should be acting.

We know from the success of highly publicised events like Children in Need and Comic Relief that media coverage of extreme poverty creates empathy and a surge of generosity from the general public. We need to keep talking about poverty and how best to alleviate it by using relatable, human stories to promote effective charities as much as possible.

As with the refugee crisis, sparking a debate could increase engagement. 

 are a brilliant way to get people thinking about which charities alleviate suffering most effectively, and how and where we should be donating to make the biggest impact.

This refugee crisis is a relatively recent turn of events.

 In contrast, because of the notion that poverty is a ‘constant’, we think of it as being somehow ‘without end’; something which has always been present and always will be. Clearly, this is untrue: between 1981 and 2013, the number of people in the developing world living in extreme poverty has 

 from 50% to 21%, despite a 59% increase in population size.

To incentivise people to take action on extreme poverty, we need them to know what has been achieved as well as what still needs to be done. We should be promoting success stories and celebrating achievement, constantly working to discredit the idea that extreme poverty is a problem which can never be eliminated.

Public interest in the refugee crisis will fall and face the same difficulties - like apathy and lack of publicity - that reduce action on extreme poverty.

 Actions will lag long before they cease to be needed. Continuing to talk about issues, changes and, importantly, successes in the struggle is key to keeping up engagement with the refugee crisis and reducing the apathy that comes when a problem cannot be solved simply. I personally will continue to take action on the current crisis, and on global poverty as a whole. Which brings me to....

Emergencies like the Syrian crisis and ongoing problems like global poverty MUST be acted on, but possibly in different ways.

 In terms of global poverty, we know that giving to effective charities (such as those 

) is one of the most effective ways to impact the problem, but the same can't be said for emergency relief. According to the 

, emergency aid is one of the worst uses of donations in terms of effectively eliminating suffering.

 while donations to support refugees are unsustainable, 

grassroots political campaigning and lobbying may be the most effective way for ordinary individuals to limit the suffering of refugees

. We need to consider each of the issues we care about rationally, examining the evidence for what the best thing is to do in each situation.

We should be acting on both emergency situations and the ongoing battle to end extreme poverty, but also recognising that these situations are different and require distinct tactics to affect the most good.

 While our heart should call us to action, our head should tell us what needs to be done. Let's work on emergencies and ongoing poverty using the best tools we can, for as long as it takes.

Blog

The scourge of women's health you've never heard of

Why I choose to give now

Action on the refugee crisis and action on global poverty: thoughts, facts and ways to do good better.

Should we give to SCI or fund research into schistosomiasis?

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