After moving from Germany to the not-so-distant Netherlands, I went to the gynaecologist looking to schedule a routine check-up, only to be told that at age 21, I wasn’t entitled to such unless I had health complaints. I was struck – I had been so sure that I needed to get checked annually! The crux of a routine check-up is the ‘pap smear’. A quick, cheap and non-intrusive procedure, it can reveal the presence of abnormal cells indicative of cervical cancer. Cervical cancer is therefore easily preventable if its precursors are detected early. In the Netherlands, screening starts at age 30 and is ideally done every five years; in Germany, screening involves women age 20 onwards, and is done annually. The World Health Organization urges to begin routine gynaecological check-ups at age 30 – the Netherlands thus abides by the medically necessary standards. Rather than asking why the Netherlands ‘start so late’, I must ask: Why does Germany start so early?
My professor at Leiden University College recently asked us as a class about the recent suggestion of French doctors to test a possible COVID-19 vaccine on vulnerable populations in the African continent (read more here). Apart from the fact that this case is absolutely appalling, especially to us as a class studying public health ethics, we were asked to write about whether pharmaceutical companies are bound to respect the ethical guidelines - that is: Even though we agree that it's an absolutely stupid idea, could it still be done? Is there anything stopping pharma companies from doing it? And if there isn't anything stopping them, would they do it?
This was my answer.
This paper argues that the contemporary community development approach to eradicating open defecation must involve not only those who represent the community traditionally or on a political level, but must be truly inclusive of all community members. To come to this conclusion, the paper first reviews Community Led Total Sanitation as an approach and assesses it suitability to end open defecation through the lens of collective action theory and Asset Based Community Development. Second, the paper considers the case study of Eritrea, where the government launched the above-mentioned approach in 2008 in collaboration with UNICEF. Finally, the case study of Eritrea is used to understand how gender and power issues ought to be better integrated into eradicating open defecation.