May you get a clean bill of health fromyour dentist, your cardiologist, your gastro-enterologist, yoururologist, your proctologist, your podiatrist, your psychiatrist, yourplumber and the I.R.S.
May your hair, your teeth, your face-lift, your abs and your stocks notfall; and may your blood pressure, your triglycerides, your cholesterol,your white blood count and your mortgage interest not rise.
May New Year's Eve find you seated around the table, together with yourbeloved family and cherished friends. May you find the food better, theenvironment quieter, the cost much cheaper, and the pleasure much morefulfilling than anything else you might ordinarily do that night.
May what you see in the mirror delight you, and what others see in youdelight them.
May someone love you enough to forgive your faults, beblind to your blemishes, and tell the world about your virtues.
May the commercials on TV not be louder than the program you havebeen watching, and may your check book and your budget balance - andinclude generous amounts for charity.
May you remember to say "I love you" at least once a day to your spouse,your child, your parent, your siblings; but not to your secretary, yournurse, your masseuse, your hairdresser or your tennis instructor.
And may we live in a world at peace and with the awareness of God's lovein every sunset, every flower's unfolding petals, every baby's smile,every lover's kiss, and every wonderful, astonishing, miraculous beat ofour heart.
In most African countries, health is in crisis. Staffing and resourcing remain serious problems in all aspects of health care,1 including essential public health functions and research.2 At the same time, there is a new optimism: Africa is definitely not where it was 50 years ago.3 Many years of capacity-building have increased the number of senior staff in spite of the continued “brain drain”, and globalization of communication has contributed to an increasing democratization and accountability of education and politics. Combined with attitudinal changes in donor countries and institutions,4 there is a stronger awareness of the need to phrase answers to problems in terms of local ability rather than of foreign assistance interests, although problems in “vertical programming” remain.5 While it is too early to judge the sustainability of these political realities, it is time to greatly enhance system support to enable nations and regions in Africa to govern and manage their health sectors. In particular, it is high time to enable Africa to educate its own leaders in public health – those needed to execute essential public health functions, improve system performance and form an African voice for public health.
Results Overall, 29/53 countries (54.7%) offer no postgraduate training in public health, 11/53 countries (20.7%) have one programme and 11/53 countries (20.7%) offer more than one programme. If the analysis is stratified by language group, major differentials appear: anglophone sub-Saharan African countries as well as those in north Africa have more developed postgraduate public health training programmes than francophone, lusophone and the one Hispanic country
It is obvious that the largest gap occurs in lusophone countries (91% of the population lives in countries without graduate public health programmes) followed by francophone Africa (34%; Fig. 1, Table 2).
In total, there are 854 staff members working in institutions offering postgraduate public health programmes, only 493 of whom work full-time. Male staff is in the majority (63%) and this differential increases if having a doctoral degree is taken into consideration (73%). Viewed in another way, 89.2% of male staff have either a master’s or doctoral qualification, in contrast to only 71.6% of female staff (Table 3, Table 4).
The age-distribution of staff skews towards younger age groups: 15% are aged 35 years or younger, 66% are aged between 36 and 50 years, and only 19% is older than 51 years of age. There is therefore a shortfall of senior staff in institutions of public health. This study did not allow an understanding of this dynamic, including whether it relates to migration, illness, internal transfer to better-paying externally funded positions, or to other causes. Finally, there are few foreign staff members working in institutions in Africa: of the 554 staff about whom information was available, 11 (2%) were nationals from other African countries and 40 (7%) were nationals from outside Africa.
A dwindling supply of wild medicinal plants is threatening South Africa's traditional medicine industry, according to new research.
In a paper published by the nongovernmental organisation Health Systems Trust this month (4 December), researchers found that the demand for traditional medicine is higher than ever — stimulated by HIV/AIDS, unemployment and rapid urbanisation.
"Many customers report that they choose to use traditional healers as they feel the treatment is more holistic than western medicine," the authors write. They go on to explain that it is this dual "spiritual and physiological treatment" that customers appreciate.
South Africa's traditional medicine industry is estimated to be worth 2.9 billion rand (around US$415 million) — 5.6 per cent of the country's health budget.
The researchers say that at least 133,000 households are dependent on the trade in medicinal plants. The majority of those harvesting the plants are rural women who depend on money they make from selling the plants to feed their families.
At risk are 550 plant species. At least 86 per cent of the plant species harvested will result in the death of the entire plant. African Wild Ginger, for example, is now reportedly extinct in the wild.
The authors make practical suggestions on how a crisis can be averted. Most obvious is developing communication between all players, followed by the development of a strategic vision for the industry.
They also suggest incentives that promote the development of technology in harvesting, farming, storage, packaging, dosage and treatment.
Sazi Mhlongo, chairman of the National Professional Association of Traditional Healers in South Africa, told SciDev.Net, that traditional healers understood the issues surrounding the sustainability of medicinal plants and were planting what they needed.
"We are holding meetings with role players to discuss the building of warehouses in Johannesburg and Durban where herbs can be packaged and sold on to traditional healers," says Mhlongo. This way, he says, plant gatherers could also be told when a certain herb was not needed to avoid waste.
"There are also plans to register traditional healers and plant gatherers to ensure better control," he adds.
"The Bill & Melinda Gates Foundation grant will help DNDi fill critical gaps in the HAT and VL drug development pipelines by supporting our lead optimization drug discovery programs for HAT and VL, which will in turn fuel our drug development projects," stated Dr. Bernard Pecoul, Executive Director of DNDi. "With the goal of providing better, low-cost treatments, we are intensifying neglected diseases research and are endeavoring to rekindle the hopes of the many people who suffer from these diseases in the poorest regions of the world."
The grant, to be disbursed to DNDi over five years, will provide critical funding for the research and development of new drug candidates for HAT and VL. DNDi will foster the development of the drug candidates through the preclinical stages and select one lead candidate for each disease to advance into Phase I human clinical trials.
"The pledge of $25.7M highlights the urgent need to accelerate R&D for neglected diseases," remarked Dr. Shing Chang, Director of Research & Development at DNDi. "This important commitment to HAT and VL drug discovery will serve to encourage research into new, innovative treatment options for these diseases."
"Far too little R&D is devoted to neglected diseases such as trypanosomiasis and visceral leishmaniasis, which threaten millions of people in the developing world but are virtually unheard of in rich countries," said Dr. Regina Rabinovich, Director of Infectious Diseases Development at the Gates Foundation. "By helping to close this research gap, DNDi is bringing us closer to the day when the word 'neglected' no longer applies to these diseases."
About the Diseases - HAT and VL
A fatal disease if not treated, HAT threatens more than 50 million people in 36 countries in sub-Saharan Africa. The few drugs currently in existence to treat either Stage 1 or Stage 2 of the disease have a number of serious limitations including severe toxicity, the difficulty of administration, cost, and lost efficacy in several regions. The difficulty of diagnosis, stage determination, and increasing numbers of treatment failures pose additional clinical challenges.
The urgent need for new drugs to treat VL is also deeply compelling. A potentially fatal disease, VL threatens 200 million people in 62 countries and has a fatality rate as high as 100% within 2 years in some developing countries. Of the 500,000 new cases each year, almost all (~90%) arise from recurrent epidemics in poor, rural areas of the Indian subcontinent, Brazil, and Sudan, with approximately 60,000 deaths each year. Therapeutic options for VL are limited as there are significant drawbacks like route of administration, toxicity, or cost.
The Drugs for Neglected Diseases initiative (DNDi) is an independent, not-for-profit drug development initiative established in 2003 by five publicly-funded research organisations - the Malaysian Ministry of Health, the Kenya Medical Research Institute, the Indian Council of Medical Research, the Oswaldo Cruz Foundation Brazil, and the Institut Pasteur - as well as an international humanitarian organisation, Médecins Sans Frontières. The UNICEF/UNDP/World Bank/WHO's Special Programme for Research and Training in Tropical Diseases (TDR) is a permanent observer. With a current portfolio of 18 projects, DNDi aims to develop new, improved, and field-relevant drugs for neglected diseases, such as malaria, leishmaniasis, human African trypanosomiasis, and Chagas disease that afflict the very poor in developing countries.
DNDi needs an additional EUR 200 million in funding in order to achieve its objectives of building a robust pipeline and delivering six to eight new treatments by 2014. To date, DNDi has secured EUR 74 million from public and private donors, including a significant initial contribution from Médecins Sans Frontières/Doctors Without Borders
Dr Asrat Mengiste arrives at the Kilimanjaro Christian Medical Centre in Moshi, Tanzania. It’s 8am, and already 70 patients are lined up for a consultation. In the operating room are 20 local doctors. Dr Mengiste talks them through every action and explains every decision. After four days he will have operated on 40 patients and passed his knowledge and expertise on to another group of medical staff, eager to put into practice what they have learned.
Outreach patients travel for miles to reach Dr Mengiste’s team. Dr Mengiste insists: “The operations make a big difference to the lives of my patients. Most of them have suffered for a long time, often since birth. It may be a cleft palate so that one is unable to talk, eat or go to school. It may be a burn that has left one unable to walk or to hold things.”
More than 60% of the patients waiting in line are children. Amongst those awaiting surgery is four-month-old Angelina, whose mouth and nostrils are badly disfigured due to a cleft lip and palate. Angelina’s mother carried her for six hours to the nearest bus stop in order to bring her to the AMREF team in Moshi. Angelina cannot be breastfed because of her disfigurement - her mother has to feed her milk andporridge drop by drop.
Angelina is first on the operating table. Like with all his operations, Dr. Mengiste explains to observing medical students what has caused the condition, answers their questions, talks them through the surgery, and discusses aftercare.
This simple operation will transform Angelina’s life and her mother is overjoyed by the results: “Before the operation I had so many worries, that she would not survive, have friends or find a husband, now I am sure she will survive and live a normal, happy life”.
Next in line is a boy who injured his hand by falling into an open cooking fire. His little fingers were badly burned and have not healed well; his forefinger is now attached to his thumb by scar tissue. Nearly 99% of Tanzanians cook on open fires. Too often children fall into fires or scald themselves with boiling liquid. If the burns are not treated they form thick cobwebs of scar tissue, causing crippling deformities, making the simplest of tasks such as dressing or eating impossible.
During surgery Dr Mengiste separates the boys thumb and finger so they move independently again. Such a small operation will make an enormous difference to this little boy’s life. While recovering from surgery the boy tells Dr. Mengiste he is looking forward to going back to school and being able to write like the other children in his class.
Dr Mengiste and his team spend their lives travelling to remote rural hospitals. The challenges of performing surgery in these hospitals are immense. Water supplies are often scarce, surgical facilities and basic medical equipment are poor or non existent, and power cuts happen every day.
Despite these challenges, Dr Mengiste has carried out 1,702 consultations and 801 operations during 80 outreach trips in the last twelve months. “The fact that we are able to make a difference in the lives of many desperate people in our region makes me proud.”
The world is running a deficit of more than 4 million healthcare workers, but a proposed new shift in healthcare delivery may alleviate the shortage and bring new players to the field. An article in the 13 December edition of the New England Journal of Medicine, Rapid Expansion of the Health Workforce in Response to the HIV Epidemic, introduces the World Health Organisation's battle plan to combat the shortage and revolutionise the way we think of healthcare.
The plan, called Treat, Train, Retain, aims to treat and prevent HIV among healthcare workers, train newcomers to facilitate "task shifting", and attempt to retain existing workers. In Swaziland for example, a 2006 WHO report found that the public health sector has been crippled by staff shortages: 44 percent of posts for physicians, 19 percent of posts for nurses and 17 percent of nursing assistant posts are unfilled. The authors argue that the plan's second focus - training - presents the most challenging imperative to expanding the healthcare workforce, while in task shifting duties like administering treatment are moved to less specialised healthcare workers. Task shifting has been implemented in both low- and high-income settings with positive results.
The Democratic Republic of the Congo introduced the practice in the 1970s and '80s in response to a shortage of fully trained healthcare workers. Studies found that doctors could delegate standardised tasks to auxiliary workers without reducing the quality of care. In recent years, American and Australian nurses have increasingly taken on medical interventions previously handled by doctors, with studies showing an enhanced quality of care with reduced costs.
Clinical officers or medical assistants are already crucial to administering HIV treatment in Kenya,Ethiopia and Malawi, while Zambia is said to be moving in the same direction. But the WHO's new model of healthcare moves beyond medical personnel like nurses and clinicians to include communities, an approach already practiced in countries like South Africa, Zambia, India and Lesotho. However, the authors caution that a shift to innovative healthcare will need to be accompanied by a shift in mindset, and that the new systems will not offer a quick fix: training and credential systems will have to be developed, as will standardised protocols, including simplified drug regimens. Adopting these new models will involve political and financial commitments by governments, donors and international organisations.
The Guidelines for Treat, Train, Retain will be launched at the first-ever global conference on task shifting, to be held in Addis Ababa, Ethiopia, in mid-January 2008.
UNITED NATIONS, Dec 10 (IPS)- By Philip Rouwenhorst - The U.N. children's agency UNICEF says that increased cooperation among developing countries is benefiting the lives of poor children around the world, particularly in the critical first months of life.
"What we have seen is a very exciting new South-South collaboration in some of the areas of child health, specifically in the last few years," Peter Salama, UNICEF chief of health, told IPS. "One of the most exciting is actually around neonatal help."
"There've been [community-based] models that have been developed in India, for example," he said. "Over the last couple of years, we've seen that a team from India is actually traveling, particularly in East and Southern Africa, to do capacity-building and training in similar community-based models to reduce mortality in the first months of life."
In its "Progress for Children" report launched Monday, UNICEF highlighted several areas in which progress is being made, but also stressed the importance of more urgent action.
"This [report] is new in terms of the large number of countries that this is applicable for. It's relevant because it is data that has been taken mainly in 2006, which is roughly halfway through the period of the Millennium Development Goals from 2000 to 2015," said Alan Court, UNICEF chief of programmes.
"It gives a very good indication of how the world is doing and how different countries are doing in relation to those goals," he said.
In 2000, the world's countries and major development institutions agreed on eight goals, known as the MDGs, to ease severe poverty and promote environmental conservation by a deadline of 2015.
The MDGs include a 50 percent reduction in extreme poverty and hunger; universal primary education; promotion of gender equality; reduction of child mortality by two-thirds; cutbacks in maternal mortality by three-quarters; combating the spread of HIV/AIDS, malaria and other diseases; ensuring environmental sustainability; and developing a North-South global partnership for development.
To achieve the MDGs in the next eight years, U.N. Secretary-General Ban Ki-moon has stressed the growing importance of South-South cooperation.
In his latest report on this trend, Ban noted that, "Recent years have witnessed impressive increases in South-South development assistance... The stage is set for the ushering in of a new and more participatory form of international cooperation for development."
Reducing child mortality in the first five years of life is one of the major improvements highlighted in the UNICEF report. For the first time in modern history, the annual number of children younger than five who died worldwide fell below 10 million, to 9.7 million -- a reduction of 60 percent since 1960.
The report shows a significant increase in key survival interventions. For example, children receiving doses of vitamin A, which promotes healthy bone growth and prevents many diseases, increased more than four-fold since 1999.
Many countries in sub-Saharan Africa are expanding the use of insecticide-treated bed nets to prevent malaria infections, with 16 of 20 surveyed at least tripling coverage since 2000. In the 47 countries where 95 percent of measles deaths occur, measles immunisation coverage increased from 57 percent in 1990 to 68 percent in 2006.
There was also a modest reduction in the number of primary-school-age children without access to education. In 2005-2006, 91 million children were out of school, down from 115 million in 2002.
UNICEF also found evidence suggesting a decline of HIV prevalence in some sub-Saharan African countries. Court told IPS that international networking among experts and policymakers was one likely factor.
"For instance, there was a forum a week ago in South-Africa looking specifically at mother-to-child transmission, in which there were delegates from many, many countries who shared information on what works and what doesn't work. There are mechanisms for that sharing of information and for developing countries to learn from each other rather than necessarily programme jointly," he said.
Almost two-thirds of all people with HIV/AIDS live in sub-Saharan Africa. The report notes that only 11 percent of more than two million pregnant women living with HIV in low- and middle-income countries in 2005 received antiretroviral drugs to prevent them from infecting their babies. Botswana, Brazil and Thailand are among seven countries that gave such drugs to more than 40 percent of pregnant women with HIV.
In low- and middle-income countries, only 15 percent of children under age 15 in need of antiretroviral treatment in 2006 actually received it.
However, Salama told IPS that the news is not all bad. "There are many other examples where African countries themselves are really showing strong progress. One of them is Ethiopia, where in the last few years the government has made a very ambitious plan to train 30,000 community health workers."
"This model is attracting a lot of interest in southern Africa from surrounding governments because they see this as a potential way to really get around one of our major constraints in progress on the health-related Millennium Development Goals," i.e., cash-strapped public health systems and persistent misconceptions about how to prevent HIV/AIDS.
While Court also pointed to higher rates of exclusive breastfeeding, particularly in West Africa, as helping to lower child death rates, the UNICEF report found little progress in the area of maternal deaths, which total five million women each year.
According to Court, "This has been something that's been very difficult to move for sometime. This is particularly difficult because the numbers in a sense are not so alarming enough in any one culture to create the kind of crisis approach to dealing with the problem."
Early next year, UNICEF will release its annual "State of the World's Children Report". Court said "it will be looking at community-based approaches to care regarding health-related issues."
"This is going to be a major shift and one based on the lessons that we've learned coming from this database. This circulates through in terms of how we work in the United Nations country teams and countries and how we interact with governments."
GENEVA (AFP) — Deaths from measles fell by 91 percent in Africa over the past six years, the World Health Organisation (WHO) announced Thursday.
But the WHO warned that figures were still far too high in South Asia, singling out India and Pakistan for criticism.
Measles deaths between 2000 and 2006 in Africa dropped from 396,000 to just 36,000, contributing to a worldwide decline in measles deaths of 68 percent, according to the Geneva-based health organisation.
"This is a major victory, but our job is by no means done," Peter Strebel, measles officer for the WHO said.
"We need to expand the successful vaccination strategy used primarily in Africa to South Asia," he added.
"Large countries with high numbers of measles deaths, such as India and Pakistan, need to fully implement the proven control strategy," the WHO warned in a statement accompanying the report.
The WHO-led vaccination campaign is thought to have saved around 7.5 million lives. However, measles still kills nearly 600 children under five every day around the world.
Since 2000 nearly half a million children have been vaccinated in the 46 countries the most affected by measles, with "major gains" seen in Nigeria, Democratic Republic of Congo, Angola and Ethiopia, Strebel said.
But the vaccination campaign has been less well-applied in South Asia, where more than half of new-born babies are never vaccinated.
South Asian measles deaths last year stood at 178,000 -- more than five times the African figure.
The WHO's objective is to reduce measles' deaths by 2010 by 90 percent from the year 2000. Doing that will require an additional 200 million dollars (135 million euros), the WHO reckons.
Last year 80 percent of the world's infants had been vaccinated, compared with 72 percent in 2000.
To see the highly contagious virus eradicated, at least 93-95 percent of the population must be vaccinated -- which will require greater assistance from some countries' health services, emphasised Strebel.
"We know that the virus could be eradicated. It is biologically possible," he added, pointing out that measles transmission had completely disappeared on the American continent since 2002.
But one of the problems in entirely eradicating the virus, Strebel added, was that the major Western countries no longer considered it a "major threat" in terms of public health. Measles is more often fatal in poor countries because it attacks malnourished children.
Ethiomedicine strives to raise awareness about the inequitable access to health care services around the world, focusing more on Ethiopian/African health issues.
Awareness to action promotes meaningful change.
I am open to suggestions as to how, as a collective or individuals, we can help best; email me at michael.lethiopia@gmail.com or check the TAKE ACTION sites in my blog...
Health is a social good. Healthy society is a happy society!
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