“My town has no light,†writes my friend from Ghana. “The high school has no computer. All of us have to travel to Tamale on a rough road for 5 hours to have internet or better education. My parents have never touched a computer.â€We all have images of young Abe Lincoln studying by firelight. The reality is that most kids who lack electricity just go to bed after dark. Too few parents can afford to light a lantern so their kids can do their lessons.It is difficult to study and to be productive after dark without artificial light. A recent medical article pointed out that “…1.6 billion people are exposed to adverse health risks because of lack of access to electricity.†Even if there were medicines and the best of doctors living in their towns, they would be useless without electricity for medical instruments and refrigerators to cool medication.Yet two billion people live without a reliable source of electricity. Kerosene is the alternative for many of these people. Kerosene lanterns always present the risk of fire, and they generate air pollution. Their smoke adds to the burden of respiratory disease that afflicts millions.The World Health Organization estimates that indoor air pollution kills 1.6 million people annually in developing countries. That means that one person dies every twenty seconds from smoke from kerosene lights and from cooking and heating fires. Those who do not die from the fumes may suffer permanent damage to their heath. Many of the affected are children, who cannot escape the pollution.Many of the poorest people—the billion who live on the equivalent of just one dollar a day—cannot even afford kerosene. They are doomed to a life of darkness between sunset and dawn.Burning coal and biomass fuels is responsible for much ill health in the poorest countries. When we visited India last winter we watched a woman harvest manure from the sacred cattle. After drying, this biomass was used to cook and heat.Sometimes help comes from unexpected places. An ex-Marine recognized the importance of a safe source of light for people in poor countries and has developed a solar flashlight. How could he get them where they are needed, without a huge grant or government support?BOGO! This stands for “Buy One, Give One.†We’ve had our BogoLight for several months now, and use it frequently. It sits recharging in a sunny window and is ready to go when we are. We take it camping, where it hangs from the top of our tent when we bed down at night and read a bit before sleep. Part of it glows in the dark to help find it for late night pit stops.In bright orange or pink, BogoLights are waterproof, dazzlingly bright and rugged. To order these lights, go to www.bogolight.com. I plan to do some holiday shopping there! You pay $25, which buys your light and the one that goes to a dark country. On the website you can choose what organization gets the gift. My current favorite is Saboba’s Hope, a medical clinic in northern Ghana near where my friend grew up. I recently saw a similar (but inferior) light in a store for more money.Perhaps you have heard of the One Laptop per Child program. It is an educational program to supply robust little computers designed for children in developing countries. They draw so little electricity that the child herself can generate it with a crank. The plan is for each child to have her/his own computer! The specifics are available at www.laptopgiving.org. Although the manufacturer has contracts from the governments of several countries, they are using BOGO to kick-start the program.Hurry if you want one of these gems! They are only available in this country until November 26th—that’s tomorrow. Each order costs $399. Of that, $200 is a tax-deductible donation that pays for the unit that goes to a child in a poor country.These two products, the solar light and simple computer, are both high tech and, at the same time, simple. Each is designed to help people in the developing world, but can fulfill a need in our country. Neither is bankrolled by big money. In each case, the generosity of individuals can help our friends in poorer areas. Remember, two of the most important factors leading to lower birth rates in developing countries are education (especially of girls) and promoting health.© Richard Grossman MD, 2007[The article above may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald†accompany any publication. For more information, please write the author at: richard@population-matters.org.]
Author: Richard
I am a retired obstetrician-gynecologist who has been fortunate to live and work in the wonderful community of Durango, Colorado for 40 years.
Did you know that a new contraceptive just became available in Durango? Implanon was approved for use in this country over two years ago, but its manufacturer has been very cautious in making it available.
Almost all women can safely use Implanon. It is effective for up to three years, and can be removed easily when the user wants. Best of all, once it is in place, it requires no action on the woman’s part to provide essentially perfect protection against pregnancy. Compliance is not a problem with this contraceptive method.
The availability of effective contraceptive methods is one of the three most important factors in helping to lower fertility rates in poor countries. (The other two factors are education of girls and lowering child mortality rates. Thanks to almost universal literacy and modern pediatric care in our country, we don’t have to worry about these two factors.) The sad fact is that half of pregnancies conceived in the United States are unplanned. Can a method that is reliable and simple to use help lower this statistic?
Implanon is similar to Norplant in some ways, but has significant differences. You may remember that Norplant consisted of six flexible plastic rods filled with a hormone. Although it was initially well received, a problem forced it off the market a number of years ago.
Many women were keen on Norplant, but doctors weren’t. It had to be inserted properly, so each of the rods was right under the skin of the woman’s arm. Norplant was difficult to remove if it were placed too deep. Bad insertion technique is what got Norplant into trouble. Too many were inserted by people who weren’t properly trained, so doctors attempted removal and ran into difficulties.
The similarities between Implanon and Norplant include the hormonal makeup, which has no estrogen. Both Norplant and Implanon just use a progestin, making them safe—especially for women with blood clotting disorders or migraine headaches. Both systems cause menstrual irregularity; most women using them either have irregular menstrual bleeding. Both offer very reliable contraception, with failure rates of just a fraction of a percent. Both have the hormone in one or more flexible plastic rods that are implanted under the skin of a woman’s arm. Implanon has only one rod, which makes insertion and removal much easier than Norplant’s six.
Learning from the Norplant fiasco, the manufacturer of Implanon has taken precautions to prevent it from getting misused. Implanon will only be available to doctors (and other medical providers) who have completed a comprehensive training program. I attended such a program in Durango in August with a dozen other providers. After practicing the technique on plastic models, we were all impressed with how easy Implanon is to insert and remove. In real people insertion or removal is done with a bit of local anesthesia and takes just a minute or two.
How do women like Implanon? According to the manufacturer, women like it very much. They advised us, however, to warn women before getting this contraceptive method that it will mess up their menstrual cycles. Almost all women will have some spotting or irregular bleeding with Implanon. After a period of adjustment, however, some women will stop bleeding entirely. Skipping periods is entirely safe. Fewer periods helps prevent anemia and PMS, and is the goal of some new birth control pill formulations.
An Implanon wearer should not be aware of its presence. The implant is placed under the skin of a woman’s upper arm. The rod is small and flexible, so an observer cannot see it hidden below her skin. A health care provider (or the woman herself) can find it easily by touching in the correct place.
Implanon works in two different ways. Most important is that the hormone stops ovulation. Without an egg, pregnancy cannot begin. An additional action is that the hormone makes cervical mucus impenetrable to sperm. These two actions make it very reliable, with only one failure per year per thousand women using it.
When a woman wishes to conceive, her fertility should return quickly after Implanon is taken out. Likewise, if a woman doesn’t like the method (for instance, if the irregular bleeding gets to her), the side effects are rapidly reversed as soon as it is removed.
Implanon might not be the contraceptive answer for all couples, but it provides another method that will be safe and effective for some. I am glad that we can now offer it in Durango!
© Richard Grossman MD, 2007
[The article above may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald†accompany any publication. For more information, please write the author at: richard@population-matters.org.]