September 2019 |
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Beatriz Paredes remembers the last time that the River Amazon almost destroyed her wooden home in Belén, a neighborhood in the city of Iquitos, Peru.
Water levels rose dramatically in just a few days and her living room, kitchen and bedroom were covered in murky river water. While the flood receded, her family of five slept on wooden planks that they had placed just below the house’s roof, making an improvised ‘attic’ that kept them dry.
“Some days we had to go to sleep without eating,” says Paredes, who sells sugar-cane juice at the local market and was not able to work during the flood. “I lost my pots, furniture, dishes; everything that we could not store in the attic was taken by the river.”
Flooding is part of life in Belen, a riverside community that is home for Paredes and thousands of people who cannot afford to pay rent in safer parts of Iquitos. But the district — touted by local tour guides as the ‘Venice of the Amazon’ — is being increasingly subjected to more dramatic flood seasons as climate change affects weather patterns in the Amazon basin.
In 2012, an estimated 200,000 people were affected by the floods in Iquitos and the surrounding province of Loreto that almost wiped out Paredes’ home. In 2015, another spate of extreme weather caused flooding along Peru’s stretch of the Amazon, affecting more than 160,000 people according to the United Nations Office for the Coordination of Humanitarian Affairs.
As seasonal floods become more extreme, a new programme run by the Peruvian Red Cross seeks to dramatically reduce the number of people impacted by flooding by completely reversing the way disaster relief happens. The idea is to provide humanitarian assistance to the most vulnerable people before floods hit, so that they can stay safe and healthy during these extreme events.
“We have been a humanitarian organization that traditionally focused on responding to disasters,” says Kemper Mantilla, the project’s national coordinator for the Peruvian Red Cross. “What we are doing now is a paradigm shift.”
Pioneered by the German Red Cross and the Red Cross Red Crescent Climate Centre, based in The Hague (Netherlands), the approach is known as Forecast-based Financing (FbF) and has been rolled out in numerous countries around the world, from Bangladesh to Togo.
In Peru, it is being tested in three areas that are prone to extreme weather events: towns along the Pacific Ocean coastline impacted by extreme rainfalls related to the El Niño phenomenon; villages high in the Andes mountains, located at 3,800 metres above sea level, where alpaca farmers struggle to deal with cold snaps and glacial snowstorms; and parts of the River Amazon basin around Iquitos.
In the case of the alpaca herders, forecasts trigger funds that enable construction of shelters and provision of medicine for the livestock. “We lose 15 to 20 alpacas each winter,” says Flavio Cabana, who has a herd of 400 alpacas in the Arequipa región of southern Peru. “The young ones are the most likely to die from the cold.”
The programme works with the national meteorological and hydrological service of Peru, which analyses incoming weather patterns and provides Peruvian Red Cross staff with advance warning of extreme events headed towards vulnerable communities. That gives humanitarian workers time to prepare and distribute help to people in need.
“We try to get scientific information into the hands of decision-makers as fast as we can,” says Juan Bazo, climate science adviser for the Red Cross Red Crescent Climate Centre, another key partner in FbF projects around the world.
“The benefit of this programme is that it uses weather forecasts, which give us a window of time to act, so that we can get help to the most vulnerable people.”
Preparation is critical
The real FbF work happens long before the dreaded forecasts of heavy rains or floods. In Iquitos, which is located deep inside the Amazon rainforest, the Peruvian Red Cross started to set up its FBF programme in 2016.
The first step, says Mantilla, was to identify neighbourhoods that could benefit from the project based on risk-data analyses that factor in the communities’ exposure to danger and vulnerability. Through community meetings, residents discussed their greatest needs during extreme floods, like the ones in 2012 and 2015.
During these meetings, it became evident that access to drinking water was one of the main challenges faced by the residents of Belén and several rural communities participating in the project.
Most people in these communities don’t have safe drinking water in their homes. They collect water in the nearby river for washing and cooking, and drink bottled water that they buy in local markets.
During floods, the distribution of bottled water collapses, while river water carries sediments and pollutants that make it dangerous to consume, Mantilla says.
With funding from an IFRC early action funding mechanism, the Peruvian Red Cross is now prepared to distribute water filters to 600 families in the region of Loreto the next time an extreme flood approaches. The Red Cross has run several simulations and drills to ensure the distribution will go smoothly.
“These filters separate sediments from the water and eliminate bacteria,” Mantilla explains. “They help us to prevent the spread of intestinal diseases.”
‘No product to sell’
For Beatriz Paredes, who survives on a daily income of around US$ 8 per day this kind of help during floods can also make a big difference — using a water filter can save her from having to purchase expensive bottled water.
Paredes says that she has also struggled to buy food and other basic items during floods because these weather events take away her main source of income: the sugar-cane juice that she sells in the local market. “When the water level rises, my land gets flooded and I can’t cut any cane,” says Paredes, who grinds her own sugar cane every morning on a large juice extractor. “And when I have no product to sell, we struggle to get by.”
Marcos Paimaya, a coriander (cilantro) farmer who lives in the village of Cantagallo, about an hour down the river from Iquitos, faces similar challenges.
Seasonal floods cover a forest clearing where he plants his crops. Paimaya says he prepares for the inevitable floods by saving money during the months of the year in which he can work. He has also built a boat to get around when the river seeps into his village.
But larger floods that take longer to recede eat away at his savings and make it harder for him to get around in a small boat, forcing him to pay for transport on larger boats when he needs to go somewhere.
“Those floods eat into my livelihood,” Paimaya says. “They affect my ability to provide for my children.”
Striving for a ‘better place’
For these reasons, a key part the Peruvian Red Cross’s FbF project is a money transfer programme for vulnerable families. The next time the Amazon starts to swell to extreme levels, 400 families will be given a one-time cash payment of approximately 220 Swiss francs (about US$ 225), a few days before their villages and neighbourhoods begin to flood.
It’s not a large amount. But it can help families get food, buy medicines, pay for transport or solve any other problems brought about by flooding, says Natalia Gomez de Travesedo, the German Red Cross’s FbF delegate in Peru and Ecuador. This type of funding helps the Red Cross reach communities that could potentially be affected earlier than traditional programmes that dispense funds after disaster strikes, Gomez de Travesedo explains.
The programme’s impact in the Amazon still has to be measured, she adds. But for people such as Marcos Paimaya, this kind of help relieves him from many of the burdens brought by the floods.
Like many parents here, Paimaya works feverishly to save money to put his four children through high school. It’s their one shot, he says, at having a better life. All the flood-related expenditures can be a big setback towards realizing that dream, he says.
“I burn my back [in the sun] every day so my children can be in a better place,” says Paimaya, adding that he never finished high school himself. “I want them to get higher education, so that perhaps they can move somewhere else and not suffer from floods and all the complications that we have here in our farm.”
Urbanization is exacerbating global warming and cities like Hong Kong are heating up fast.
How do you care for the caregivers? A group of volunteers explains why their wellbeing comes as a priority when caring for people affected by chronic diseases.
People who’ve fled Rakhine in Myanmar for safety in Bangladesh now face the threat of monsoon rains and cyclones.
Hong Kong: mega cities, mega heat.
Hong Kong is heating up. According to the Hong Kong Observatory, the city is seeing a significant long-term warming trend, which data from 2017 and 2018 confirm: 2017 was warmer than usual, with 41 hot nights [above 28°C] and 29 very hot days [above 33°C], ranking the highest and the sixth highest on record respectively. The 2018 ‘warm season’ opened with the hottest May on record since 1885 – with temperatures hitting 36.7°C.
Is this all down to climate change? We asked Lee Sai-ming, senior scientific officer for the Hong Kong Observatory to explain.
“When we talk about climate change, we look at the big picture,” he says. “We look at how the climate changes over long periods of time, not at specific years. But if put in the context of climate change, this year’s heatwaves in Hong Kong, and the many heatwaves going on around the world, show that it is increasingly likely to have very hot summers”.
Temperatures in Hong Kong are indeed rising – at a rate of 1.2 degrees per century, though data show that the rate of increase is becoming faster in the last decades.
Here and now: who is paying the price?
“Hot temperatures are dangerous for elderly people,” explains Irene Lui Sau-lan, manager of the Local Emergency Service of the Hong Kong Red Cross. “Many of them live alone and cannot count on the support of family. Often this situation is made worse when they live with chronic illnesses. Heat also affects their everyday life, reduces the time they can spend outdoor and makes them feel lonely”.
The effects that hotter temperatures have on vulnerable people can be seen in Kwun Tong, Hong Kong’s hottest district and home to the city’s highest proportion of low-income and elderly people. A large number of people here are very vulnerable to heat, but have little means to protect themselves.
“I go to the park early in the morning,” says Shuk-man Wong, an 82-year-old widow who lives alone in an apartment building of the Tsui Ping Estate in Kwun Tong. “I cannot do that during the day when it gets hot, so I come here at 5 or 6 am. I can exercise, talk with other people, but especially I can play my Erhu [a two-stringed bowed instrument]. My house gets too hot during the day and I can only play for a little while because I must keep my door wide open to let air circulate. But then the neighbours complain and I must stop.”
It’s even too hot to cook inside the apartment. “I cook here in the hallway,” she says. “I must bring my rice cooker out here. And I eat here every day. Because it is cooler here, I am suffocating inside”.
In Shuk-man’s tiny 8m2 flat, the only (small) window is blocked by her belongings — after all, she has little room to choose where to stacks her things. Originally from Fujian, China, Shuk-man has been living in Hong Kong for over 30 years: “Yes, Hong Kong is getting hotter,” she explains, adding that on some days, it keeps her from doing much of anything. The worst was the day they call ‘the great heat’ when it reached over 35 degrees “For the day of the ‘great heat’, on 23 July 2018, I did not dare to go out, but then I felt lonely. So I finally went to the elderly community centre”.
Catherine Wong Kuk-ching, senior manager of the True Light Villa District Elderly Community Centre knows situations like Shuk-man’s very well. “Elderly people, especially when leaving alone, can suffer badly from the consequences of heat. To protect themselves, they must stay at home, but this is risky as they can start to feel very isolated, and in the worse cases, develop depression. Also, many people do not use air conditioning because it is too expensive for them. So community centres can become people’s (second) homes. They come here to talk with their friends, and for the programmes we have. But of course, they also like to cool down in the air conditioning we have at the centre.”
Are cities making it worse?
But as cities get larger and larger, do they also play a role in pushing temperatures on the streets even higher?
According to studies conducted by the Hong Kong Observatory, urbanization contributes to about 50 percent of the warming in cities like Hong Kong. First of all, tall buildings block air circulation and reduce wind speed, limiting the sea breeze that the city would naturally enjoy. In addition, buildings made of dense materials such as concrete and steel trap and retain heat longer than wooden structures used in suburban and rural areas. At night, buildings release the heat they absorb during the day, but that heat cannot easily escape the narrow spaces between the lower floors. This means the city is less able to cool down at night, compared to rural areas. Studies show that temperature differences between countryside and cityscape can be very high. Some cases, have been recorded in which minimum temperatures in urban and rural areas differ by as much as 10 degrees.
There are other elements too. “Emissions of traffic and transportation contribute to the formation of rain-bearing clouds, so urban areas can get more rainfall than rural areas,” explains the Observatory’s Sai-ming. “A study we conducted shows that the increase of rainfall in Hong Kong is higher than in rural areas. A possible cause of this is high urban activity. So because of urban activities and hotter temperatures, the intensity and frequency of precipitation are also increasing in Hong Kong. Hot weather causes more evaporation from the oceans and the warmer atmosphere can hold more moisture. So when it rains, the chance of extreme rainfall increases”.
What can be done in response to a trend that seems irreversible? In short, the city needs to adapt. “We can increase greening in the city,“ suggests Sai-ming. “Planting more trees and vegetation can help cool the city without increasing carbon emissions. We can use heat-proof materials to reduce the amount of heat absorbed by buildings, and use reflective materials on the top of structures, to reflect more solar radiation back to space.”
Hong Kong Red Cross is also working on helping people adapt to hotter temperatures: “We help elderly single people,” says Irene Lui Sau-lan. “During home visits our volunteers talk about health risks and what steps people can make to keep cool when it’s very hot. Volunteers check that cooling equipment works well and there’s no risk of fire. It is simple things. But it can help.”
For Shuk-man, the visits were a welcome relief. “The volunteers cared about me very much,” she says. “They reminded me to use the ‘Call and Care Service’ to get help if I am unwell. They gave me a whistle to draw attention in case of fire. They also noticed my 10-year-old electronic fan. The fan had no cover but I did not want to throw it away. They helped replace it and now I have a better one”.
Who cares for the caregivers?
Ruth Mufalali Van Rooyen was worried. One of her most dedicated volunteers was distraught. A young girl the volunteer was helping was very sick. “The volunteer was in tears on a daily basis because she was really worried that this child was not going to make it,” says Van Rooyen, who manages South African Red Cross Society volunteers who provide home care to 50 patients with multi-drug resistant tuberculosis (MDRTB) near Port Elizabeth, South Africa.
For the volunteer, who had been visiting the girl every day for over a year, ensuring she took her medicine and cared for herself, it was like losing a loved one. Fortunately, a few months earlier, Van Rooyen had sought out a volunteer psychologist to offer free counselling sessions for all the caregivers at the local Port Elizabeth and Uitenhage branches. “Through sessions with the counsellor and fellow volunteers, she kept going,” says Van Rooyen. “Today, this child is cured.”
Van Rooyen’s decision to seek out support is one example of a growing recognition in humanitarian circles that helping communities get healthy requires healthy caregivers, able to remain calm and compassionate despite the many pressures they face. After all, most volunteers on the front lines of today’s crises usually come from the same community as the people they serve. They are affected by same worries and challenges. Photographer and documentarian Alexia Webster talked to some of the South African TB caregivers. Here’s what they have to say.
Jeanette Mqaqa, 45, became a caregiver because she likes teaching people how to better care for themselves and move forward in their lives.
“When people pass away, it’s sometimes very difficult. It’s like you’re not doing your job.
Sometimes I go to the others and say, ‘This person is defaulting [on their medication regime]. Maybe I think, ‘Hey, this person is a defaulter and I blame myself. Maybe she’s a defaulter because of me. Maybe she doesn’t like me.’
“To deal with the stress, sometimes I go to church. There’s a kid’s club; we educate the children and then I play with them. I sing and talk with the people and the stress is relieved. I have also done a group session with the Red Cross psychologist. I’ve learned that I have to carry myself before I can carry others.”
Lindeka Nkumanda, 41, says she’s an empathetic person by nature with a long-time interest in psychology and in caring for people.
“There are cases where the client’s condition gets worse and sometimes I cry. Like the cases where a client was a mother, a single mum who’s got kids… and the mum is going to pass away. Who is going to look after the kids and what kind of care are the kids going to get? In those cases I cry a lot… but not in the presence of a client because I don’t want her to lose hope. I have to wear a mask and stay strong for the sake of the client.
“The most interesting thing we learned from counselling was how to cope with stress — like what we can do to assist ourselves before visiting clients. Because we won’t be able to help others if we are not in a good way. You have to know your weaknesses and your strengths. And not to take things personally. Don’t blame yourself for things that are out of your control… You have to just let go.”
Akhona Williams started volunteering with the South African Red Cross in 2016 after finishing a university degree in psychology. Now a masters student in the psychology department at Rhodes University, he offers free counselling sessions to the multi-drug resistant tuberculosis caretakers.
“Their job is very stressful and complex psychologically because if someone is really ill, and has the potential to infect the whole house, the other family members, how do you get that person to take the treatment without actually forcing them? I mean they have this individual right, but at the same time they’re endangering other people’s lives. So those are also some of the factors that the caregivers bring up in the debriefing sessions.
“Through these sessions, I try to find out where everyone is mentally and emotionally and then build a supportive environment. Depending on the major things that come from the debriefing, we work to find solutions. Let’s say they have a problem with a client or a patient who doesn’t want to adhere to treatment. We try to find ways the volunteers can help without forcing them.”
As provincial programmes manager for the South African Red Cross, Ruth Mufalali Van Rooyen coordinates the volunteers who care for people infected by HIV, tuberculosis or other chronic illnesses.
“Tuberculosis (TB) is a disease that takes over six months to cure and the clients are people you see from Monday to Friday for the duration of the treatment period. So naturally, there will be a very strong relationship or bond. When there’s a negative outcome, it really affects you.
“TB is a disease that is curable, and it can get frustrating especially when you know that. If you’re in a situation where you’re trying to educate and encourage somebody to take treatment for a disease that is curable, and they don’t listen… it’s a sad reality. That takes a toll. And when a patient dies, the volunteers feel like they didn’t do enough.
“To help volunteers cope, I try to ensure they have adequate education and training in TB and home-based care, as well as monthly counselling sessions. After the counselling, you can see a difference in the way they apply themselves and the way they handle their patients. The nurses say, ‘Your volunteers know exactly what it is that they’re doing. When they’re called, they always respond with a joyful heart.’”