News Around the Globe


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In Cameroon, poverty and the need for domestic workers fuel trafficking in child laborers. Trafficked children often work long hours without adequate pay, and many are subjected to violence and sexual abuse. Across Cameroon, individuals, the government and nongovernmental organizations are assisting victims and bringing to justice violators of the nation’s 2005 child trafficking law.
Nakinti Nofuru, GPJ Cameroon
September 3, 2014
“I worked during the day like a machine and during the night like a sex assistant,” she says. “At the beginning, I didn’t understand what was really happening because I was only 14.”

BAMENDA, CAMEROON – When Annette Beri was 13, her parents arranged to have her work as a nanny for a couple in Douala, Cameroon’s economic capital.

Beri and her parents, who lived in a little village in the Donga-Mantung division of Cameroon’s Northwest region, 300 kilometers (186 miles) from Douala, saw the role as an extraordinary opportunity.

“I was happy to go to the city,” she says. “So too were my parents. My parents and I had never left the village – never. So they were happy that I would be the one to make them visit the township someday.”

Beri’s parents, who could not afford to send her to secondary school after she completed seventh grade, struck the deal with a man from their tribe whose wife was pregnant.

Under the agreement, Beri was to work for the family for two years, solely as a nanny. Her employers would then send her to learn a trade of her choice.

Things did not work out that way. Beri worked for the family for five years and took on several demanding roles.

Besides doing domestic work, she was required to hawk foodstuffs. Such traders move around selling goods they transport on their heads or in handcarts.

Ultimately Beri became the family’s home manager, a role that includes baby-sitting, managing the kitchen, and buying and selling foodstuffs.

“During my fourth and fifth year, I worked like a jackass,” she says.

But hard work was the least of her problems, Beri says.

Whenever the woman of the house found the baby crying, she denied Beri food, she says. She also deprived her of food whenever she came home late from the market where she hawked food.

During her first two years with the family, Beri says she was beaten regularly too. She says her bosses assaulted her with their hands or a gas pipe.

The beatings tapered off over the years but still occurred every three months or so, Beri says.

“Many times when my mistress comes home when the baby is crying, she makes sure she beats me up too,” she says through tears. “For five years, they treated me like a real slave.”

Beri’s parents never knew about the abusing, she says. They were too poor to visit her. And because she was never paid for her work, she was not able to visit them.

Beri begged her employer to honor his side of the agreement by sending her to train as a tailor, her dream job, she says.

“For five years, my employer did not pay me a franc,” she says. “They were not even ready to send me to learn a trade, as the agreement stated.”

Frustrated and angry, Beri finally packed her belongings and left.

It has been five years since she left, and her employers have yet to settle the debt, she says.

Since Beri, now 22, already spent her own money on the training the couple had promised to fund, she thinks the couple should settle the debt in cash.

“I cannot be suffering when I have my hard-earned money that is buried somewhere,” Beri says.

In Cameroon, many girls and young women who enter domestic service say their employers mistreat them. What’s more, many domestic servants are victims of trafficking, local advocates say. In response to growing demand for action, nongovernmental organizations are fighting for the rights of trafficked domestic servants and working to ensure that employers who abuse their employees are punished under a law enacted in 2005.

That law defines child trafficking as “the act of moving or helping to move a child within or outside Cameroon with a view to directly or indirectly reaping any financial or material benefit therefrom.” The crime is punishable by up to 20 years in prison and fines ranging from 50,000 Central African francs ($100) to 10 million francs ($20,000). Higher sentences and fines are for violators who traffic children under 15.

Cordelia Ndagha, the Mezam divisional delegate for the Ministry of Women’s Empowerment and the Family, says the trafficking of children for domestic work still occurs in Cameroon but is becoming less common. She says she does not have statistics to reflect the decrease because she is new in her role.

A 2011 survey by the Center for Human Rights and Peace Advocacy, a Bamenda-based independent organization that promotes the rights of Cameroonians, found that the Northwest region has the highest incidence of child trafficking in the country. And Donga-Mantung, where Beri grew up, is the biggest supplier of trafficked children among the seven divisions of the Northwest region.

This could be because the Northwest region has a large population – more than 1.8 million people as of the 2010 census – and most of the residents are poor, Ndagha says. 

Most children trafficked in Cameroon are still in primary school or have just completed primary school, says Ndagha, the officer responsible for all women and family issues in the division. She also mediates in cases of domestic conflict and abuse.

“Female children have been victims of child trafficking and domestic work in Cameroon,” Ndagha says. “This has led to abuse of the rights of these children.”

Trafficked children are commonly taken from villages to big cities, where they are put to work as domestic servants, she says. Agreements typically call for employers to send children to learn a trade after they have worked for at least two years.

But employers often break these agreements, leaving the children with no form of compensation and often further impoverished.

This poverty fuels child trafficking in Cameroon, she says.

Poor rural parents are unable to send their children to school, Ndagha says. Instead, they send them to cities to work as domestic servants. In some cases, a servant’s wages are paid directly to the child’s parents.

In addition to withholding pay and committing physical abuse, there is also evidence of employers sexually abuse their servants.

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The Nepalese government, under pressure from China, has sharply constricted the rights and movements of Tibetan refugees living within its borders. Since the government stopped issuing refugee identity cards to Tibetan refugees in 2002, many exiles – and their offspring – have been unable to enter college, land permanent jobs and travel outside their host country. Even Tibetans who have never stepped foot in Tibet find they cannot gain traction in the country they would like to make their home.
Shilu Manandhar, GPJ Nepal
August 27, 2014
“My daughter has no identification. What is going to happen to her future? Her education, her career and her life – everything will depend on her identification, and that she does not have.”

POKHARA, NEPAL – Karma Tsedar, the son of Tibetan refugees, applied for a driver’s license in 2008.

After he filled out an application at the Department of Transport Management, a department official asked him to provide proof of citizenship or a refugee identity card. Possessing neither, Tsedar was told to produce some other proof of identity.

Tsedar returned to the department with his father’s refugee identity card, which lists him among his father’s offspring. Officials initially declined to honor the card as validation of Tsedar’s refugee status.

Only after he visited the office repeatedly did the agency finally accept the father’s documentation as proof of Tsedar’s legal status.

“Nepali people do not have to go through this hassle,” Tsedar says.

Although born in Nepal, Tsedar is not a citizen of the country. As the son of refugees, he is classified as a refugee; he will never be eligible for Nepalese citizenship.

His refugee status makes him eligible to apply for college and most private-sector jobs, but his lack of a refugee identity card of his own hinders his ability to get ahead.

Tsedar, 27, lives in a small, three-room house with his parents at the Tashi Palkheil Tibetan Refugee Settlement. Surrounded by green hills, the settlement is the largest of four Tibetan refugee camps in Pokhara, a densely populated city at the foot of the Annapurna massif, part of the Himalayan mountain range.

Some 800 refugees live in 300 homes on lanes so narrow they can accommodate only motorbikes and small cars.

Tsedar’s parents have lived at the settlement ever since they fled Chinese-occupied Tibet in 1962. When they arrived, the Nepal Ministry of Home Affairs issued them refugee identity cards that establish their identities and legal status.

But Tsedar, who was born in the settlement and has lived his entire life in Nepal, has never obtained a refugee identity card; he is merely listed on his father’s card.

As a result, he lacks the identification he needs to prove his legal status, which has deprived him of many opportunities, he says.

“I work as a waiter to sustain myself,” he says. “I cannot pursue a profession because I have no legal documents.”

Without a refugee identity card, Tsedar cannot travel outside the country, he says. He cannot open a bank account or apply for scholarships.

“I studied and worked hard, and I cannot find a good job because I am a Tibetan refugee,” he says. “Even educated Tibetan youth are not getting jobs because we have no citizenship.”

Tibetans fleeing the Chinese occupation of their country have sought refuge in neighboring Nepal since the late 1950s.

Over the past two decades, Nepal, under pressure from the Chinese government, has cut back on services it provides Tibetan refugees. Among other things, the government has stopped issuing refugee identity cards. It renews the cards of early refugees each year, but the children and grandchildren of those refugees cannot obtain cards of their own.

Without proof of legal status, many younger Tibetan refugees cannot pursue higher studies, find permanent jobs or even open bank accounts. 

Tibetans launched an uprising nine years after Chinese armed forces invaded their country. When China cracked down on the rebels, thousands of Tibetans fled to Nepal and India.

Nepal became a permanent refuge to many Tibetans. It also became a transit point for Tibetans traveling to Dharamshala, a city in northern India where the Tibetan leader, the Dalai Lama, and his followers established a government-in-exile.

About 20,000 Tibetan refugees now live in a dozen camps in Nepal, according to the Office of the United Nations High Commissioner for Refugees.

The Nepalese government does not know how many refugees live within its borders, says Shesh Narayan Paudel, undersecretary of the Nepal Ministry of Home Affairs and deputy coordinator of the National Unit for the Coordination of Refugee Affairs.

When the government last conducted a census of the Tibetan community in 1993, it recorded 12,540 refugees scattered across 21 districts. 

Initially the Nepalese government issued refugee identity cards that established the exiles’ legal status, Paudel says. It ended that practice in 2002.

The government does not have a record of the number of cards it has issued to Tibetan refugees, and it has no plans to issue more.

This is because the Chinese government has pressured Nepal to stop providing protection to Tibetan refugees, Meenakshi Ganguly, the South Asia director of Human Rights Watch, says in a Skype audio interview. Human Rights Watch is an independent international organization that conducts research and advocacy on global human rights issues.

When China hosted the Olympics in 2008, Tibetans and their supporters used the international spotlight to protest China’s occupation of their homeland. They also conducted peaceful protests all over the world, including in China and Nepal.

In response, China tightened its control over the Tibetan region and pressured Nepal to restrict the rights of the many Tibetan refugees living within its borders, Ganguly says.

Since then, Nepal has signed several security agreements with China, intensified border security cooperation, enforced restrictions on public demonstrations by the Tibetan community, and implemented surveillance programs, she says. On politically sensitive dates, large numbers of Nepalese armed police are deployed in Tibetan neighborhoods to prevent refugees from holding demonstrations.

“The Nepali authority clamped down on Tibetans in Nepal,” Ganguly says. “Peaceful celebrations of Tibetans were closely monitored. They are being denied their fundamental freedoms.”

Recognizing that Nepal lacked the means to step up security and did not have a compelling national interest in curbing the activities of the Tibetan community, which has strong historical ties to Nepal, Beijing has significantly stepped up its economic and diplomatic engagement with the country, Ganguly says.

Nepal now says it cannot allow “anti-China activities,” she says. However, Nepal’s policy of prohibiting peaceful political protest violates well-established international human rights law.

The president of the National Human Rights Foundation, an independent organization engaged in human rights advocacy work in Nepal, agrees.

“The government of Nepal has stopped issuing refugee identity cards to Tibetan refugees because they are under pressure from the Chinese government,” Bhawani Prasad Kharel says in a phone interview. “The Chinese government does not want Tibetans to get out of Tibet. They do not want Tibetans to get refugee status anywhere in the world.”

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Transgender women face rejection by their families and severe discrimination in Kashmiri society. A 2013 Indian Supreme Court verdict criminalizing homosexual conduct has further marginalized them, transgender women say. Noting that Islam, the dominant faith in the region, extols tolerance and inclusion, they look forward to a time when they are accepted and respected as social equals.
Aliya Bashir, GPJ Indian-administered Kashmir
August 20, 2014
“My transgender experience is full of pain.”

SRINAGAR, INDIAN-ADMINISTERED KASHMIR – Five years ago, Salma Jan’s parents locked her in her room for two days as they and her siblings celebrated her cousin’s wedding. They told relatives Jan couldn’t attend because she was away on a trip.

When the family came home, laughing and worn out from the family festivities, Jan’s parents unlocked the door to her room, gave her a 500-rupee ($8) note and sent her to the store for vegetables and milk.

Jan took the money, headed out the door and never returned.

Born the eldest son in a family of six, Jan never regrets her sudden and permanent departure. Staying would have meant subjecting herself to endless criticism.

“My father would always shout at me and say, ‘Can’t you get a more boyish hairstyle instead of growing your hair?’” she recalls. “He would yell at me, saying: ‘Do you want to be a woman? Don’t you ever dream about it or you’ll be kicked out of the house.’”

Jan, 35, and her parents never frankly discussed her desire to change her sexual identity. They could not accept the very possibility.

“My transgender experience is full of pain,” Jan says, her eyes wet with tears as she fiddles with her faded gray gown.

Jan’s torment was not limited to rejection. About a month before she ran away, Jan was sexually assaulted by a family acquaintance.

“I was molested for two days,” she recalls, seated on a thin sheet on the floor of the small, dark, one-room apartment she shares with another transgender woman in Srinagar, the summer capital of the Indian-administered state of Jammu and Kashmir.

“I returned home weeping and explained the incident to my family," Jan says. "But they didn’t believe me and instead blamed me for what happened.”

Convinced that no one else would believe her – and not wanting her family shamed by the public knowledge of such an ugly crime – Jan declined to report the assault to police.

“I became a victim of exploitation just because I was a transgender,” she says. “My family was never supportive of me.”

Jan now earns a meager income as a matchmaker – a traditional profession for transgender women, along with singing and dancing, in the Kashmir Valley and across India. Transgender women face discrimination in every other field.

Jan earns barely enough to live on. Her share of the rent consumes about half of her 1,000-rupee ($16) monthly income.

“Even a beggar earns more than us,” she says.

Transgender women face intense discrimination in the Kashmir Valley, a predominantly Muslim region whose people once celebrated what these women now call “the third gender.” Rejected by their families and unrecognized as a distinct gender class, these women are just beginning to demand that society accept and honor them. Transgender women are asking the government to help them achieve financial independence, and they are calling on Muslim leaders to foster the bedrock Islamic virtues of tolerance and acceptance.

As far back as the 16th century, transgender women enjoyed a special respect in Jammu and Kashmir state, says Bashir Ahmad Dabla, a sociology professor at the University of Kashmir.

During the Mughal dynasty – two centuries of Muslim Turkic-Mongol rule over large parts of the Indian subcontinent – Kashmiris honored transgender women.

“They were considered caretakers, trusted messengers and skilled entertainers during the Mughal period,” Dabla says. “But today they have to face discrimination.”

Today, most Kashmiris consider any form of gender reassignment unacceptable, he says.

Families reject transgender women for fear of being shunned by society, and society scorns them because their families have turned them away. Regardless of how transgender women identify themselves, the Indian government – and its Kashmiri administrators – record their sex as the one they had at birth.

“Society has not accepted their existence,” Dabla says.

India legitimized opposition to same-sex relations in December 2013, when the Supreme Court upheld a colonial-era law that criminalizes “carnal intercourse against the order of nature,” according to the Indian penal code. The crime of “unnatural offenses” is punishable by a sentence of up to 10 years in prison.

No one in the LGBT – that is, lesbian, gay, bisexual and transgender – community has been arrested or sentenced in Jammu and Kashmir state since the verdict was handed down, says Rafiq Fida, acting chairman of the State Human Rights Commission, Jammu and Kashmir.

The Indian Constitution prohibits discrimination on grounds of religion, race, caste, sex or place of birth. Such protection should extend to transgender women, Fida says.

“They too are human beings,” he says. “There should be no hesitation for the government to come up with legislation to protect them.”

The verdict has shaken the Kashmir Valley’s transgender community, says Aijaz Ahmad Bund, a social work scholar at the University of Kashmir whose study of the problems of transgender women in the region was published in the international Journal of Humanities and Social Science.

Bund calls the ruling a regressive act that reveals the depth of contemporary India’s intolerance of the LGBT community. He could not estimate how many transgender women live in the Kashmir Valley because, fearing discrimination, most of them keep a low profile.

The Supreme Court decision has made transgender women even more reluctant to openly express their sexuality in the Kashmir Valley, Jan says.

“If a developed place like New Delhi cannot give protection to a minority community, what can we expect from a closely knit place like Kashmir?” Jan asks. “Our battle has become tougher now.”

One Kashmiri family illustrates the resolve with which most local families reject gender reassignment.

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Unable to defend themselves, mentally ill women in Bamenda, Cameroon, often become victims of sexual assault.
Comfort Mussa, GPJ, Cameroon
August 6, 2014
“I am afraid to go out because men will be calling me to come and take money, and I don't want to take their money.”

BAMENDA, CAMEROON – Emelda Awambeng is 32 years old, but she rarely leaves her house alone after dark. Even in the daytime, she asks her mother’s permission before she goes anywhere.

“I am afraid to go out because men will be calling me to come and take money, and I don't want to take their money,” she says.

Men use money to lure mentally ill women to drink alcohol and put themselves in vulnerable situations, says Emelda’s mother, Beatrice Awambeng. They make lewd comments, and if the women come near them, they may try to sexually assault them.

Emelda Awambeng has never been formally diagnosed, but her family understands her to be developmentally disabled.

Among the vulnerable women of Cameroon, Emelda Awambeng is lucky. Her family is devoted to protecting her, and she hasn’t attempted to leave home.

Mentally ill women who are not closely protected by their families often face sexual harassment, government officials and caregivers say. Women who wander the city, whether because they are homeless or because they choose not to stay in their homes, often face the worst fates.

It’s impossible to know how many people in Cameroon are mentally ill. Very few studies have been done to identify who they are, where they live and what illnesses they have.

There are just seven psychiatrists in Cameroon, a country of over 22 million people, one of them, Dr. Jean-Pierre Olivier Kamga Olen, confirmed in an email to GPJ.

That’s less than the average rate for low-income countries, where gross national income per capita is $1,045 or less. Kenya, a low-income country with a population of over 44 million, has almost 80 psychiatrists.

Until recently, there were no psychiatry training programs in Cameroon.

Kamga Olen, like his nation’s other psychiatrists, studied abroad. In 2010, the University of Yaoundé, located in Cameroon’s capital, opened a school for psychiatric training, Kamga Olen says. The World Health Organization previously reported that the country was without such a program.

The country now has eight psychiatry residents, he says.

But hurdles remain: A 2011 World Health Organization study found that Cameroon has no federal legislation dedicated to mental hea­­­lth.

Cameroonian doctors and nurses are inclined to emigrate. According to the International Organization for Migration, 46 percent of Cameroonian doctors and 19 percent of nurses emigrated between 1995 and 2005.

George Kisob, an officer of Child Protection Services at the Mezam divisional delegation of the Ministry of Social Affairs, says his office keeps no statistics on mentally ill women who have been sexually harassed or assaulted.

Such cases are not reported, he says.

“The cases we have handled are the cases where the sexual assault leads to a pregnancy,” Kisob says.

This year, the office has handled two such cases, he says.

Mentally ill women are more vulnerable to sexual violence than other women because they tend to be less assertive, Kisob says. Some don't even understand that they are being molested.  

The perpetrators of such crimes are most often drunk men and boys, Kisob says. He adds that no one has been charged with sexual assault in such a case.

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Since it was introduced in Nepal in 2010, music therapy has helped more than 400 autistic children learn to listen attentively and express themselves in words.
Kalpana Khanal, GPJ, Nepal
August 6, 2014
“Music therapy has given a new life to my son. He couldn’t speak at all, but now he has started communicating.”

KATHMANDU, NEPAL – The walls of a small, brightly lit room are decorated with colorful musical instruments. A guitar is stored in one corner of the room. In another, a keyboard lies on the floor. A table against the wall holds a flute and two traditional Nepalese drums, a tabla and a madal.

Maulik Bhandari, 7, slowly steps into the room, looking down at his feet and gripping his mother’s hand. He shows no interest in the instruments or the man seated on a stool in the room.

But when the man begins to strum the guitar, Maulik’s eyes light up. He instantly lets go of his mother’s hand and moves toward the man.

Maulik is beginning his daily music therapy session at the day care center run by AutismCare Nepal, the first organization to provide music therapy for people with autism, in Kathmandu, Nepal’s capital.

Within a few minutes, Maulik is singing his favorite English nursery rhyme, “Twinkle, Twinkle, Little Star.” He keeps up with the melody and enunciates the occasional word. Moving in rhythm with the music, he points skyward whenever the song mentions the star.

Maulik’s mother, Alina Bhandari, 33, takes him to the day care center each day, traveling by bus for more than an hour from their home in Lalitpur, a district adjoining Kathmandu district.

Before he began therapy in April 2013, Maulik used to hit people, Bhandari says. He could not sit still or communicate basic needs such as asking for food when he was hungry.

But from the time he began music therapy, Maulik has followed what is said to him and communicates his basic needs. Although he still does not speak in full sentences, he started using single words to communicate last January, Bhandari says.

“Music therapy has given a new life to my son,” she says. “He couldn’t speak at all, but now he has started communicating.”

AutismCare Nepal introduced music therapy for autistic children in Nepal in 2010. Parents and professionals working with autistic children say music therapy has helped children develop social and communication skills, reduce their aggression and focus their thoughts. The government aims to allocate funding for people with autism, and AutismCare Nepal plans to extend its services beyond Kathmandu.

There is no research available on autism in Nepal because it is a new area of disability studies for the government and scientific researchers, says Raj Kaji Prajapati, chief administrator of AutismCare Nepal.

But AutismCare Nepal estimates there are 200,000 to 300,000 children with autism in Nepal, based on a 2012 U.S. projection that one child in 88 has an autism-spectrum disorder, an umbrella term for a wide spectrum of neurobiological disorders.

In March, the U.S.-based Centers for Disease Control and Prevention revised its estimate of the prevalence of autism in the U.S. to one child in 68. AutismCare Nepal has not yet revised its estimate for Nepal according to that ratio.

The organization, which was formed in 2008 by a group of parents of autistic children, discovered the effectiveness of music therapy through Music Therapy Trust Nepal, Prajapati says. The groups continue to partner in developing music therapy programs at AutismCare Nepal, training new therapists and popularizing music therapy as a treatment for autism.

Since AutismCare Nepal began providing music therapy six years ago, it has reached about 400 autistic children in Nepal, he says. The group currently provides music therapy for 13 students.

Music therapy has become a popular treatment for autism in Kathmandu, says Kedar Gandhari, one of two music therapists who provide services through AutismCare Nepal.

“The effectiveness of music therapy has become common knowledge,” he says. “Other organizations have also started to work in collaboration with us. The demand for music therapy is increasing.”

Since AutismCare Nepal began providing music therapy, eight other organizations in Kathmandu have added it to their programs for children with autism.

For more than four years before they brought Maulik to AutismCare Nepal for treatment, Bhandari and her husband performed hundreds of pujas – Hindu prayer rituals – and visited many doctors seeking treatment for their son, Bhandari says.

The couple followed the advice of relatives, friends and neighbors in hopes of improving Maulik’s condition, Bhandari says.

“I believed everything people said and followed it with a hope that it would heal my son,” she says.

All previous efforts proved ineffective, Bhandari says.

Before Maulik began therapy, he was unable to perform any task by himself, and he never acknowledged Bhandari’s presence.

But music therapy has brought about a transformation in Maulik, who spends one hour each day, six days a week, in music therapy as part of his comprehensive therapy program at the center.

“I am very happy to see the changes in my son,” Bhandari says. “With music therapy, he holds the end of my shawl whenever he sees me. Also, he can walk by himself, tell me when he wants to use the toilet, and he has started eating solid food.”

Bhandari aims to help Maulik become independent. The teachers at AutismCare Nepal have suggested that he continue his therapy for seven years, until he is 14.

Gandhari has seen hundreds of children react positively to music therapy, usually within six months to a year, depending on the severity of their autism.

“Music therapy increases communication, awareness and the social and emotional skills of patients with autism,” he says. “The behaviors of children are modified. They are taught to interact with their environment, which enables them to be part of society.”

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Recognition of Autism Lags in Low-Income Countries
When it comes to autism, wealthy nations seem to have it all: the most advanced research, the highest prevalence rates, and the most money to diagnose and treat the disorder. In less affluent countries, the opposite is true: Research is scant or nonexistent, reported prevalence rates are low, and little or no money is allocated to diagnose and treat autism. The disparity is no coincidence. Countries that report the highest autism rates are those with the most researchers and doctors devoted to looking for and treating it. The world's poorest countries haven’t done enough research to determine how many of their citizens are autistic, and health officials who say autism is nonexistent in their regions likely don't know how to identify it, experts on the disorder say. “Culture affects many things, including how someone interprets symptoms and which symptoms they would decide to seek help from a medical doctor to alleviate,” says Dr. Carla Marienfeld, a psychiatrist with Yale Psychiatry Residency’s Global Mental Health Program, which aims to increase awareness of global mental health issues and social disparities. The rate at which autism is recognized varies widely around the world. About one child in 160 has an autism-spectrum disorder, an umbrella term for a wide spectrum of neurobiological disorders, according to research by the World Health Organization conducted in high-income countries in the Americas and Europe. Some studies conducted in those regions suggest the rate could be much higher. One in 68 U.S. children has autism, according to a March report by the U.S. Centers for Disease Control and Prevention. Despite a lack of research in the world's poorest countries, and even though some potential causes of autism are specific to postindustrial nations, experts say rates could be similarly high across the globe. Detection of autism is simply better in developed countries, the Harvard College Global Health Review noted in 2013. Where little is known about autism, parents are apt to interpret children’s developmental delays in terms of religious beliefs and cultural myths. “Some people believe it’s because of their sin in a previous birth,” says Suguna Fernando, a teacher at the Chitra Lane School for the Special Child in Sri Lanka. “It’s karma. Some parents blame themselves.” In some countries, even top doctors and health officials aren’t familiar with autism. “Autism is a very rare case in Zambia,” says Dr. Ndashi Chitalu, a senior pediatrician at the University Teaching Hospital at the University of Zambia. “Personally, I have not seen one case in my over 20 years of practicing.” Zambia’s Ministry of Health spokesman, Dr. Kamoto Mbewe, says autism isn’t a problem in his country. “It is one disease that I personally just watch in movies,” he says. One movie in which Mbewe might view a depiction of the disorder is 2012’s “El Pozo” (“The Well”), an Argentine film about a family grappling with a grown daughter’s autism. Argentine researchers and parents are making strides in educating the public about autism and developing effective ways to treat it. “Music therapy is one of the best disciplines to treat autistic children,” says Horacio Joffre Galibert, president of the Argentine Association of Parents of Autistics. “Music brings happiness to the family and allows autistics to communicate.” Galibert’s association, a nationwide network, has 250 active members. It provides counseling, instruction in the psychology of autism, and legal advice. It also trains grandparents, aunts, uncles and other family members in the care of autistic children. “We, the parents, are the ones who take the reins of the treatment of our children,” Galibert says. In poorer countries, however, families struggling to survive lack the knowledge and resources to grab those reins. “It is difficult to mobilize parents. They are busy trying to make ends meet,” says Ruth Owino, a parent working with Uganda Parents for Children with Autism. There are no specialists to treat autistic children in Uganda, Owino says. Owino’s group formed more than a decade ago but has just 30 members. Mulago National Referral Hospital in Uganda, a state-run facility with more than 1,500 beds, operates a weekly clinic for autistic children. The clinic diagnoses three to five autism cases each week, says Dr. Joyce Nalugya, a consulting psychiatrist at the hospital. The clinic needs a multidisciplinary team that includes behavioral therapists, speech and language therapists, occupational therapists, psychologists and psychiatrists to treat autistic patients, Nalugya says. But it’s tough to assemble such a team because the government doesn’t employ specialists in all those fields. Families in low-income countries frequently treat poorly understood psychiatric disorders with traditional folk practices. Parents often bring mentally disabled children to the school where Fernando teaches in Sri Lanka after herbal medications, incantations and other approaches have failed, says Champika Mahapatuna, the school’s principal. “We don’t laugh at these practices of the parents because it’s their desire to believe in something,” she says. “But after seeing their child in our school, all the parents have so far gradually dropped the faith healing and actively participate in doing the therapy at home.” Sri Lanka needs to conduct more research on autism, says Hemamali Perera, a psychiatry professor at the University of Colombo. Sri Lanka has only conducted one study on the prevalence of autism. A 2011 study by the university found that 1 in 93 children ages 18-24 months has the disorder. The university conducted that study in semi-urban areas; it didn’t survey the entire country. Perera was one of the study’s authors. As long as awareness of the disorder is limited, early detection – a crucial step for good treatment, experts say – isn’t as common as it ought to be. “Parents wait and wait and wait for their child to begin to talk,” Perera says. “They don’t see the delayed talking as something that can have implications for later learning and intellectual development.” Because of cultural differences, some signs of autism that are red flags in Western countries don’t spur alarm in Asia. For example, Sri Lankan parents don’t perceive a lack of eye contact from children as abnormal, even though parents in Western countries readily recognize it as a sign of developmental delay, Perera says. Cultural beliefs also affect the way delays are perceived, she says. Some Sri Lankans believe that if a baby’s hair is cut too early – or at an inauspicious time – the child will not speak. Screening tools developed in the West aren’t always effective in Sri Lanka, Perera adds, because mothers around the world don’t recognize symptoms in the same way. Sri Lanka’s Ministry of Health is rolling out a program to help children with special needs called the National Program for Children with Special Developmental Needs, says Perera, who was part of the program’s development team. The community-based program is training primary health care providers to recognize signs of autism and refer those children for screenings at a specialty clinic. In addition, the World Health Organization is implementing its Mental Health Gap Action Programme in Sri Lanka, among other countries. That’s a similar program that aims at scaling up services for mental and neurological disorders, and trains community health workers and primary health care providers to recognize signs of autism. Perera stresses that an autism diagnosis is a cause for hope. Once a family recognizes and learns about the disorder, everyone involved can engage in effective treatment. “There was a time when the prognosis was gloomy,” she says. “I dreaded telling a mother that her child had autism. But now I will boldly tell them, and then say, ‘Now let’s get going!’” Apophia Agiresaasi in Kampala, Ivonne Jeannot Laens in Buenos Aires, Manori Wijesekera in Colombo and Prudence Phiri in Lusaka contributed to this report. GPJ translated interviews from Sinhala and Spanish.




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