Dr. Asrat's story

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.”

Source: AMREF UK

Many hands make healthcare more efficient

JOHANNESBURG, 12 December 2007 (PlusNews)

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.

HEALTH: South Joins Hands to Reach Child MDGs

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."

Root Causes of Diseases: Perspective from a Professional

HIV/AIDS statistics for Ethiopia

Country rank of HIV infections in sub-Saharan Africa (2005): 5th
Source: World Bank

Percentage of HIV/AIDS cases in the world (2005): 7%
Source: World Bank

Overall HIV prevalence, adults 15-49, in 2003 (2006): 4.4% of population, or 3 million people
Source: World Health Organization

Adults infected weekly (2006): 5,000
Source: World Health Organization

Age group with highest rate of infection: 15-24 years; female prevalence 3 times greater than among males
Source: USAID in PPGG Fact Sheet

Women living with HIV, 15-49, in 2003 (2006): 770,000
Source: UNICEF

Mother-to-child HIV transmission: 2nd highest number of new infections per year
Source: USAID in PPGG Fact Sheet

Children dying from AIDS (2005): 1 in 16
Source: World Health Organization

Children orphaned by AIDS, aged 0-17, 2003 estimate (2006): 720,000
Source: UNICEF

THE AGE OF AIDS

Watch the whole show from Frontline (click here)

AIDS Perspectives 2007

Big drop in measles deaths in Africa: WHO

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.

"The commitment is not really there," he said.