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Asians in unhealthy crisis; Financial woes produce ill effects on depressed region's poverty-stricken

Washignton Times
25 September 1998

A generation of Asian families has begun to slip backward into disease, hunger, malnutrition, illiteracy and poverty as a result of the Asian economic crisis that began in the summer of 1997.

Millions of workers have already lost their jobs and are slipping back from the middle or working class into poverty in Indonesia, Thailand, South Korea, the Philippines and Malaysia.

Ripples from the crisis are also swamping poor families beyond the reach of aid programs on the fringe of the now-bankrupt East Asian economic miracles: Cambodia, Vietnam, Laos and Burma.

A sharp impact on the health of the newly poor was predicted when the crisis began. But families still had some savings, some possessions to sell, some relatives and friends to lend them enough to get by.

Now, many have reached the end of their rope.

Officials at the World Bank, U.N. Children's Fund, U.S. Agency for International Development and private relief agencies say they are beginning to see massive privation and malnutrition and the collapse of health care systems.

Among the most dangerous long-term health problems, said Nils Daulaire, a former AID senior adviser on international health, are a rise of AIDS in girls who turn to prostitution, a reduction in vaccination for measles and other diseases, and more infant deaths because of malnutrition. Another major threat is the new type of drug-**resistant** diseases that are spreading worldwide.

"It's pretty clear where things are heading," said Dr. Daulaire, the current president of the Global Health Council, an alliance of U.S. medical professionals, drug firms and relief groups.

He said the health of Asians is harmed because 100 million people have fallen below the poverty line since last year. They are no longer able to buy medicine or pay a private doctor so they turn to the public clinics.

But governments are bankrupt and can't afford to maintain their pre-crisis health programs, let alone care for tens of millions more people.

Without preventive measures, there will be increases in malaria, tuberculosis, AIDS, measles and many other diseases, said Dr. Daulaire and other experts.

"Statistical systems were not designed for a crisis," said Katherine Marshall, World Bank director for East Asia. "But a number of rapid studies are beginning to get information."

The World Bank and other agencies say the weight at birth of babies is the best single indicator of a health crisis. But that evidence is still in the womb and just beginning to reflect the huge jump in food prices, the loss of jobs and the resulting malnutrition spreading to hundreds of millions of people in Asia.

Early studies by Helen Keller International, Worldvision and other relief agencies in Indonesia and elsewhere in Asia paint a bleak picture.

Millions no longer eat more than one or two meals a day. Clinics are closing because the sick no longer can afford fees or medicines. Governments are unable to pay doctors' salaries. Women no longer get prenatal care or sanitary, medically attended deliveries.

In addition, millions of children are being pulled out of school and will fail to get an education, and millions of infants are suffering irreversible brain impairment from malnutrition - leaving a legacy of intellectual damage that will make recovery from the crisis more difficult, said Dr. Daulaire and senior UNICEF officials.

"Kids who do not get adequate food while their mother is pregnant and during the first years of their lives are at high risk of inadequate intellectual development," said Dr. Daulaire. "This could have long-term consequences.

"A generation of young people in 20 years will pay the price of the economic downturn," he said.

An unpublished University of Indonesia nutritional survey obtained by The Washington Times reports a 28 percent increase in urban poverty since the crisis hit.

In East Jakarta, among children under 5 years of age, approximately 18 percent are wasting, 16 percent stunting and 29 percent underweight, the March study reported.

Worldvision, the U.S.-based relief agency, said that 8 million children dropped out of school in Indonesia due to poverty. The number of 12- to 15-year olds in school dropped by 25 percent and is expected to decline further.

Before the crisis, poor families paid 43 percent of their income to keep their children in school: fees, books, clothing, lunches, transportation. Now "low-income families pay 85 percent of their income on food alone," said Worldvision in a study.

In the short term, poor families can use the saved school costs to provide food. Children who work instead of study add a few cents a day to the family budget.

But in the long run, education would have improved family health and increased income.

"The impact of the economic crisis has been felt at the human level much more quickly and with more severity than we expected," said the World Bank's Mrs. Marshall.

"When the crisis first struck, it was in banking and high finance. There was a hope and expectation it would last a relatively short time. The thinking was you needed to bridge it for a short time - to ensure food supply and price, to focus on public works to create jobs.

"Now you've got a fundamental change in the social picture that calls for rethinking social policy agenda," Mrs. Marshall said. "You need to protect people who have no safety net."

More than half the children under 2 years old on Indonesia's heavily populated island of Java are malnourished, according to UNICEF.

The Helen Keller relief agency reports that severe malnutrition in Indonesia nearly doubled since last year when the value of the currency fell by more than two-thirds and average income dropped from $1,000 per year to about $350.

Anemia, a key sign of malnutrition and a cause of permanent mental impairment, now affects 60 percent of Java's children. Diarrhea rates doubled in women and children, the Keller study said.

Dr. Daulaire said, "It's likely we'll see a reduction in the proportion of women receiving prenatal and obstetrical care. We expect to see increases in both maternal deaths and bad outcomes from pregnancies; that is, child deaths.

"I'm also concerned people will take shortcuts on treating infections. Instead of taking a two-week course, they'll take a three-day course of **antibiotics**. It's a classic setup to increase the **resistance** {of germs} to **antibiotics**, which could have an effect around the world as they spread so rapidly."

Prostitution is another effect worrying Dr. Daulaire and others.

In the Philippines, the Tambayan Center for Abused Street Girls reports more than 1,000 teen-age girls have turned to prostitution in Davao City, charging as little as from 50 cents to $2.50.

This rise in prostitution increases the spread of AIDS, especially as contraceptive costs have gone up with the currency collapse and bankrupt governments cut back on distribution programs.

There is also fear that "as people become desperate and forlorn, they will turn to drug use, whose direct consequences are addiction and AIDS," said Dr. Daulaire.

Right now, the crisis that began with high-rise banks collapsing from poorly- planned borrowing and lending has come down to lack of food.

Worldvision, which has 40 years' experience working in Indonesia, said in a new report released to The Washington Times that due to the El Nino drought, rice production has crashed, leaving a shortfall of 4.4 million tons. That's equal to 40 percent of the rice sold on international markets and it would cost $5 billion to cover the rice shortage, assuming that much rice can be found.

The World Bank and other foreign agencies are moving to supply some emergency food, some of it in exchange for work cleaning drains in preparation of an expected period of heavy rains because of La Nina, and some in the form of subsidized rice to be sold to the poor.

But beyond the food problem, the health crisis is expected to grow as medicines become increasingly expensive and unavailable.

Medicines produced in Indonesia contained up to 90 percent foreign materials, according to one expert. Because of this, the cost of medicines has tripled as the Indonesian currency collapsed.

Studies are being launched to examine how people will pay for malaria medication and other essentials.

There is a growing fear that many people will turn back to herbal and other traditional medicines, which may work for minor illnesses, but won't help serious ones. Already, health experts fear people will delay seeking professional help due to poverty and that delay will cost lives.

Worldvision, CARE and the Baltimore-based Catholic Relief Services are also looking at how the crisis is affecting women and microcredit, which had enabled many families to run small businesses before the crisis.

Spinoff effects on health and society include increasing violence within the family, rising crime, anti-immigrant hostility and hatred of ethnic minorities - especially the ethnic Chinese in Indonesia, targets of several riots.

Malaysia and Thailand have already moved to deport immigrant workers.

Thailand relented when it found few Thais willing to haul 200- pound rice sacks at rice mills and allowed Burmese, Laotian and Cambodian workers to remain and do those jobs.

But hundreds of thousands of Thais and other Asian urban workers laid off in the crisis have migrated back to their home villages to find few jobs, their family land had been sold off, and housing in short supply.

This has spawned rivalries and family tension, despite traditional family unity, which has gone a long way in easing the early pain of the economic crisis.