World Health IDentification

Erstes Treffen der MAA-Arbeitsgruppe „Tourismus“ am 27. Juni 2019 The First Meeting of the MAA-Working Group “Tourism” on 27th May, 2019 Première rencontre des groupes de travail MAA « Tourisme» le 27 mai 2019

admin — Sat, 03 Aug 2019 08:25:10 +0000

Diskussionsrundebeim Treffen der Mittelstandsallianz Afrika-Arbeitsgruppe „Tourismus“ am 27. Juni2019 in der Bundeszentrale des BVMW in Berlin. Die Arbeitsgruppe „Tourismus“ der Mittelstandsallianz Afrika versammelte sich am 27. Juni 2019 in der Bundeszentrale des BVMW in Berlin,um Projekte in Afrika zu besprechen und Kooperationspartner für deren Umsetzung zu finden. Unter den Teilnehmern befanden sich neben in Afrika aktiven und an Geschäften auf dem Kontinent interessierten Mittelständlern, Vertreter afrikanischer Botschaften sowie der Zivilgesellschaft. Auch Mittelstandspräsident Prof. Dr. h.c. Mario Ohoven beehrte das Arbeitsgruppentreffen. Die Veranstaltung wurde von der Leiterin der Mittelstandsallianz Afrika, Bienvenue Angui, mit einem Überblick über wichtige Zahlen und Prognosen zum Tourismussektorin Afrika eröffnet. Als den Mittelstand vertretender Verband betonte Frau Angui, welche enormen Chancen der afrikanische Kontinent deutschen Mittelständlern bietet. Ebenso sind viele afrikanische Länder daran interessiert, mit ausländischen Investoren zusammenzuarbeiten. Weltweit hat jeder zehnte Angestellte einen Job, der im direkten Zusammenhang mit dem Tourismus steht und Schätzungen zufolge könnten in den nächsten zehn Jahren allein in Afrika drei Millionen neue Arbeitsplätze durch den Tourismus entstehen. Auch hob Frau Angui hervor, dass laut dem Brookings Institute bis 2030 die Ausgaben der Konsumenten im Bereich Tourismus, Unterkünfte und Erholung in Afrika auf ca. 261.77 Mrd. USD prognostiziert werden. Also 137.87 Mrd. mehr als noch 2015. Bundesverband mittelständische Wirtschaft Unternehmerverband Deutschlands e.V. Einer kurzen Vorstellungsrunde der Teilnehmer folgten zwei zehnminütige Impulsvorträge. Frank Tetzel, Vertreter der Botschaft Lesotho, begann mit dem ersten Vortrag zum Thema Tourismus in Afrika, mit dem Fokus auf nachhaltige Entwicklung von Tourismus und Zulieferindustrie, sowie die Schaffung von Arbeitsplätzen durch diesen. Im Rahmen seiner Präsentation stellte er die globale Initiative The African Tourism Board (ATB) vor, welche mit Schlüssel-Quellmärkten zusammenarbeitet, um Afrika als Touristenziel zu fördern. Er betonte, dass die Bevölkerung in Afrika steigt und der Tourismus als Motor der Wirtschaft auch die Migration stoppen kann.

Im zweiten Impulsvortrag referierte Thomas von Kalckstein, CEO der Organisation World Health IDentification (WHID), über das Thema Gesundheitstourismus und welche Möglichkeiten dieser in Afrika bieten könnte. Er merkte an, dass der Ausbau des Gesundheitswesens nicht nur potentiellen Touristen zugute kommt, sondern ebenso der einheimischen Bevölkerung. Durch das Smartphone soll nicht nur die nächste Gesundheitsstation mit einem Arzt gefunden werden, sondern auch Touristen das Vertrauen geben, dass sie während ihrer Reise ärztliche Versorgung finden können.

Im Anschluss an die Impulsvorträge, welche eine solide Grundlage für die weitere Diskussion ergaben, tauschten sich die Teilnehmer des Arbeitsgruppentreffs sehr aktiv aus. Die Mittelstandsallianz Afrika, die Akteure sowohl aus der Wirtschaft als auch der Diplomatie, Politik und Zivilgesellschaft an einen Tisch bringt, bietet die Möglichkeit, Fragen und Anliegen mit relevanten Entscheidungsträgern direkt zu besprechen. Zentrale Ergebnisse der Diskussion waren unter anderem, dass der Tourismussektor nicht nur Arbeitsplätze schafft, sondern auch die Infrastruktur und das Gesundheitssystem eines Landes verbessern kann. Wichtig zu betonen ist, dass hiervon nicht nur Touristen profitieren, sondern auch die lokale Bevölkerung. Ein weiterer entscheidender Punkt ist die Einbeziehung der lokalen Bevölkerung durch den Ausbau kleiner bis mittelgroße Hotels und die Ausbildung der jungen Bevölkerung. Dies könnte zum Beispiel in Form eines Senior-Experten-Trainings mit erfahrenenExperten aus Deutschlandrealisiert werden. Hier könnten nicht nur Reisebüros und lokale Guides als Zielgruppe ausgewählt werden, sondern auch Hotels, um einen Multiplikatoren-Effekt und bessere Marketingstrategien zu verwirklichen. Die Diskussion kam auch zu dem Ergebnis, dass ein entscheidender Faktor für den Erfolg im Tourismussektor das Image der jeweiligen Länder nach Außen ist. Dies kann durch Digitalisierung und die relevanten digitalen Tools erfolgreich gestaltet werden und ist für das Imagemarketing unabdingbar. Die Regierungen sind hier gefragt, sich stärker in dem Bereich einzubringen, um den Erfolg zu unterstützen. Ebenfalls sollten mehr Delegationsreisen durchgeführt werden, die nicht nur professionell organisiert sind, sondern auch kulturelle Punkte miteinbeziehen. Viel wichtiger ist noch, dass Delegationsreisen das Zielverfolgen, Geschäftsbeziehung aufzubauen. Als deutsch-afrikanisches Unternehmernetzwerk, das als Brücke für Geschäftsbeziehungen zwischen Deutschland und den afrikanischen Ländern fungiert, ist die Mittelstandsallianz Afrika dafür der ideale Partner. Zusammen mit unseren Lokalpartnern vor Ort, steht unser Berliner Team Ihnen für den erfolgreichen Eintritt in den afrikanischen Markt gern zur Seite. Das nächste Treffen der MAA-AGs „Bildung und Digitalisierung“wird EndeSeptemberebenfalls in der Bundeszentrale des BVMW in Berlin stattfinden. Weitere Informationen finden Sie unter www.maa-bvmw.de. Berlin, 23. Juli2019 Das MAA-Team

Panel Discussion at the meeting of the “Tourism”-Working Group of the Mittelstand Alliance Africa on the 27th of June2019 in the Headquarters of the BVMW in Berlin.The“Tourism” Working Group of the Mittelstand Alliance Africa came together on the 27th of June 2019 in the Headquarters of the BVMW in Berlin to deliberate about projects in Africa and to find cooperation partners for their implementation. Approximately ten participants took part in the event; among them were representatives of small and medium-sized enterprises (SMEs) that are either already active in Africa or interested in doing business on the continent as well as representatives of African embassies and civil society. The working group meeting was also honoured to have the president of the BVMW-Prof. Dr. h.c. Mario Ohovenin attendance. The Managing Director of the Mittelstand Alliance Africa, Ms. Bienvenue Angui, opened the event with an overview of important figures and forecasts about the African tourism sector. Ms. Angui emphasized that the BVMW is an organisation that represents small and medium-sized enterprises and that the African continent offers enormous opportunities for German Mittelstand/SME firms. Furthermore, it was noted that many African countries are interested in working together with foreign investors. Worldwide, a tenth of all employees are employed directly by the tourism industry and it is estimated that in the next ten years, three million new employment opportunities could be created in Africa alone through tourism. Ms.Angui also pointed out that Bundesverband mittelständische WirtschaftUnternehmerverband Deutschlands e.V. according to the Brookings Institute, consumer spending on tourism, housing and recreation in Africa is projected to reach approximately $261.77 billion by 2030. That would be $137.87 billion more than in 2015. Thereafter a short introductory session by the participants commenced and was followed by two ten-minute keynote lectures. Mr. Frank Tetzel, a representative from the Lesotho Embassy, started the first lecture with the theme of tourism in Africa. He focused on issues that foster a sustainable development of the tourism and supply industry, as well as discussing the jobs that would be accrued from it. During his presentation, he introduced the global initiative titled “The African Tourism Board (ATB)”, which works with key source markets to promote Africa as a tourist destination. He stressed that Africa’s population is growing and that tourism, as an engine of the economy, can also stop migration. In the second keynote lecture,

Mr. Thomas von Kalckstein, CEO of the World Health IDentification (WHID) organisation, spoke about the topic of health tourism and the possibilities that it could offer Africa. He noted that the expansion of the health system does not only benefit potential tourists, but the local population as well. He showcased technology which shows that a smartphone can, in addition to finding the nearest health station with a doctor, also give tourists the confidence that they can find medical care during their trip.

Following the keynote lectures which provided a solid basis for further discussion, the participants of the working group began actively exchanging information. The Mittelstand Alliance Africa, which brings together actors from business, diplomacy, politics and civil society around the same table, offers the opportunity to discuss questions and concerns directly with relevant decision-makers. One of the key results of the discussion was that the tourism sector does not only create jobs but that it can also improve a country’s infrastructure and health system. It is important to stress that this does not only benefitthe tourists but also the local population. A further crucial point is the involvement of the local population by training young people and establishing small and medium-sized hotels. This could be realised, for example, through senior expert training with experienced experts from Germany. In addition to travel agencies and local guides, hotels could also be selected among the target groups so as to achieve a multiplier effect and ensure better marketing strategies.The discussion also came to the conclusion that the external image of the respective countries is a decisive factor for success in the tourism sector. It is indispensable for image marketing and can be successfully achieved through digitisation and the relevant digital tools. The governments are called upon to be more strongly involved in the area in order to support its success. Likewise, more delegation trips should be carried out;they should not only be professionally organised but should also incorporate cultural points. More importantly, delegation trips should aim to achieve the goal of building business relationships. As a German-African business network that acts as a bridge for business relations between Germany and the African countries, the Mittelstand Alliance Africa is your ideal partner.Together with our local partners on the ground, our Berlin team will be happy to assist you in successfully entering the African market.The next MAA meeting of the Working Groups-“Education and Digitisation”-is also scheduled to take place at the Headquarters of the BVMW in Berlin at the end of September. Please find further information at our website www.maa-bvmw.de. Berlin, 23rdJuly 2019 TheMAA-Team

Les participants ont pris part à la table ronde du groupe de travail «Tourisme»de l ́Alliance du Mittelstand Afrique, le 27 juin 2019 au siège fédéral du BVMW à Berlin. Le groupe de travail «Tourisme»de l ́Alliance du Mittelstand Afrique s’est réuni le 27 juin 2019 au siège fédéral du BVMW à Berlin pour discuter de projets en Afrique et trouver des partenaires de coopération pour leur mise en œuvre. Parmi les participants figuraient des PME actives en Afrique et intéressées par les affaires sur le continent, des représentants des ambassades africaines et de la société civile. Le président de l ́association fédérale allemande des PME (BVMW), le professeur Dr. h.c. Mario Ohoven a honoré le groupe de travail «Tourisme» de sa présence. Le groupe de travail a été ouvert par la directrice de l ́Alliance du Mittelstand Afrique, Bienvenue Angui, avec un aperçu des chiffres et prévisions importants sur le secteur du tourisme en Afrique. Madame Angui a souligné les énormes possibilités offertes par le continent africain aux PME allemandes, not amment dans le secteur du tourisme. Eneffet un employé sur dix dans le monde a un emploi directement lié au secteurdu tourisme et on estime que le tourisme pourrait créer trois millions de nouveaux emplois en Afrique seulement au cours des dix prochaines années. Dans cette perspective de nombreux pays africains sont également intéressés à coopérer avec des investisseurs étrangers. Madame Angui aégalement souligné que, selon l’Institut Brookings, les dépenses de consommation consacrées au tourisme, à l’hébergement et aux loisirs en Afrique devraient atteindre environ 261,77 milliards de dollars d’ici 2030, notamment 137,87 milliards de plus qu’en 2015. Bundesverband mittelständische Wirtschaft Unternehmerverband Deutschlands e.V. Le tour de tabledes participantsa été suivi dedeux présentations de projet d ́environ 10 minutes chacun. Frank Tetzel, représentant de l’ambassade du Lesotho, a fait une introduction sur le tourisme en Afrique, en mettant l’accent sur le développement durable, l’industrie d’approvisionnement ainsi que la création d’emplois dans le secteur touristique. Dans son exposé, il a informé de la mise en place d ́une initiative mondiale : l’Office du tourisme africain (ATB) qui travaille sur des études de marchés pour promouvoir l’Afrique comme destination touristique. Il a également souligné que la population de l’Afrique augmente et que le tourisme, en tant que moteur de l’économie, peut aussi contribuer á éradiquer la migration clandestine africaine vers l’Europe. La deuxième présentations’est articuléeautour du tourisme médical et l’objectif visé par cette directive.

Thomas von Kalckstein, PDG de l’organisationmondiale d’identification (WHID), est intervenu sur les effets du tourisme médical dans une perspective de développement économique et social en Afrique. Il a souligné que l’expansion du système de santé profite non seulement aux touristes, mais aussi à la population locale. A cet égard, Il a introduit un smartphone qui ne se contente pas seulement de trouver le centre de santé le plus proche, mais qui donne également aux touristes la certitude qu’ils pourront trouver des soins médicaux pendant leur voyage.

Après des échanges inter-projets, les participants du groupe de travail ont apporté leurs contributions et leurs points de vuequiont été très enrichissants. L ́Alliance du MittelstandAfriquedu BVMW, qui regroupe des acteurs du monde des affaires, de la diplomatie, de la politique et de la société civile, a offertaux participants l’opportunité de discuter directement des questions et préoccupations avec les décideurs concernés. L’une des principalesconclusions de la discussion a été que le secteur du tourisme peut non seulement créer des emplois, mais aussi améliorer l’infrastructure et le système de santé d’un pays. Il est important de souligner que cela profite non seulement aux touristes, mais également à la population locale.Un autre point essentiel est l’implication de la population locale à travers le développement d’hôtels de petite et moyenne taille et la formation des jeunes. Cela pourrait par exemple se faire,sous la forme d’une formationd’experts seniors dispensée par des coopérants allemands expérimentés dans le domaine touristique pour renforcer les compétences locales. Ici, non seulement les agences de voyages et les guides locaux pourraient être choisis comme groupe cible, mais également les hôtels afin de produire un effet multiplicateur et de meilleures stratégies de marketing. La discussion a également abouti à la conclusion que l’image des pays respectifs à l’extérieur est un facteur essentiel de réussite du secteur touristique. Cet objectif, indispensable pour réussir une stratégie marketing, peut être atteint avec succès grâce à la numérisation et la mise en œuvre d’outils numériques pertinents. Les gouvernements sont invités à s’impliquer davantage dans ce domaineafin d’atteindre le succès escompté. De même,Il devrait yavoir davantage de voyages de délégations non seulement organisés de manière professionnelle, mais également liés à des questions culturelles. Cependant il est plus important que les voyages de délégation poursuivent l’objectif d’établir des relations d’affaires. En tant que réseau entrepreneurial germano-africain, qui sert de passerelle pour les relations commerciales entre l’Allemagne et les pays africains, l ́Alliance du Mittelstand Afrique est donc le partenaire idéal. En collaboration avec nos partenaires locaux, notre équipe de Berlin se fera un plaisir de vous aider pour réussir l’entrée de votre entreprise sur le marché africain.La prochaine réunion du groupe de travail MAA « Education et numérisation», aura lieu fin septembre au siège fédéral du BVMW à Berlin. Pour de plus amples informations, veuillez consulter le site www.maa-bvmw.de. Berlin, le 23Juillet 2019 L‘équipe de l ́Alliance du Mittelstand Afrique

Lift the veil on drug pricing and trade agreements, the UN urges companies and states

admin — Mon, 19 Sep 2016 06:14:38 +0000

New United Nations report calls for drug companies to spill closely held secrets and patent reforms.

A United Nations panel has called for pharmaceutical companies and governments to be more transparent about drug prices and closed door trade agreements it says are working to keep pills priced out of patients’ hands, according to a new report.

In November, United Nations secretary general Ban Ki-moon launched a high-level panel to investigate access to medicine globally. A large part of the work focused on how to balance the economic interests of governments and manufacturers keen to, for instance, retain patent protection on drugs with public health needs.

“Governments seek the economic benefits of increased trade. On the other hand, the imperative to respect patents on health technologies could, in certain instances, create obstacles to the public health objectives and the right to health,” Ruth Dreifuss, panel co-chair and former president of the Swiss Confederation, explained in a statement. Dreifuss chaired the group alongside former Botswana president Festus Mogae.

In 10 months, the UN body gathered more than 6 000 contributions from governments, the private sector and civil society. It also held international consultations in Johannesburg and London.

In a report released on Wednesday, the group called for far-reaching changes to increase transparency about not only how drug prices are set but also how countries such as the United States negotiated free trade agreements that often put patent protection in the spotlight.

What companies spend on research and development and how much this contributes to drug prices often remain closely guarded secrets. The report notes that the average cost of a 12-week course of the hepatitis C drug Sofosbuvir costs about $42 017, according to a survey of 26 countries. But the study also found wide variations in national prices for the drug, with US patients paying about 70% more for the drug than those in Japan.

The panel notes that without access to information about how drug prices are set, countries have varying success in negotiating affordable drug prices.

It argues that governments should require manufacturers to disclose not only how much of drug prices are driven by the need to recoup costs but also how public funding, including tax incentives, contribute to drug development.

Report comes as South African patent reform drags on

In 2011, South Africa was able to halve the price of HIV treatment after it required that companies tendering to supply HIV drugs submit detailed breakdowns of drug costs, listing the proportion of costs associated with production — from active ingredient purchases and drug formulation to shipping.

Following testimonies made in Johannesburg from patients, the panel has also recommended that patent laws be amended to prevent abuse, in particular instances in which older drugs are given new patents in a process called “evergreening”.

Babalwa Malgas told the panel that when she was diagnosed with an aggressive form of breast cancer, medical aid denied her treatment with the recommended drug Herceptin because of its high costs.

Doctors Without Borders (MSF) has argued that South African patents on the drug expire at least 10 years later than they do in the United Kingdom or the US as a result of unmerited patent extensions in South Africa.

After more than four years reviewing its patent policy, South Africa’s department of trade and industry released what it is calling a consultative framework for public comment on Friday. Although the document is not a policy, it does say that adopting a more rigours patent examination is crucial. It also notes that making the process more transparent — and allowing third parties to contest patents before they are issued, as is done in India — would help the country ensure awarded patents were merited.

Further UN action urged

In April, MSF also raised the alarm over what it believed was calls by the European Union for India to tighten its patent regime during bilateral trade talks. With a long history of generic medicine production, India provides many of the affordable antiretrovirals that HIV-stricken countries in Africa depend on.

While the European Union and India remain in negotiations, the new UN report has slammed tactics and threats it says have been used in such trade talks to elicit patent protection gains that run contrary to international intellectual property laws that protect public health interests.

MSF has welcomed the report.

“(The report) puts forth actionable recommendations to help overcome the challenges that our medical teams have faced for decades – being left essentially empty-handed when the medicines, vaccines and diagnostics we need for our patients don’t exist, or are too expensive,” said Rohit Malpani, director of policy and analysis for the organisation’s Access Campaign.

“The report’s global scope recognizes that today all countries face challenges in ensuring availability and affordable access to the medical tools that people need to live healthy and productive lives.”

The panel has called on Ban to establish an independent review body to monitor progress in access to medicines and the implementations of recommendations made in the report. It has also asked that a special UN session on the topic be held by 2018.

by M&G 14 Sep 2016 19:17 Laura Lopez Gonzalez

Pedal power: Malawi’s ‘rickshaw’ bush ambulances cycle the sick to care

admin — Sat, 27 Aug 2016 07:32:17 +0000

Already used in countries like Namibia, the ambulances could help cut child and maternal mortality rates.

It is a sweltering day in Malawi’s Nsanje district and the gravel paths in Nelson village are deserted. Two young women lie under the shade of a big tree that hangs low over their mud house

The women’s father, Stephan Nkhono, watches them from the doorway. “I didn’t think I would be here today,” he says.

Last year Nkhono fell ill. He had diarrhea, a high temperature and was vomiting. He had malaria, which is endemic in the area. Although Trinity hospital is less than 2km from his home, Nkhono was too weak to walk.

“My relatives came here but there was no motor vehicle to take me to the hospital,” Nkhono recalls.

Even if the family had access to a car, they would have struggled to get him to the hospital. Nsanje is one of the districts hardest hit by the floods of 2015 and the infrastructural damage is yet to be repaired: the road leading to the Nkhono’s home is narrow, steep and bumpy.

“My family had to run to the hospital to collect the bicycle ambulance and used it to transport me to the hospital. That way they didn’t have to carry me and I was able to get help before it was too late,” he says.

The bicycles are especially designed to pull a stretcher or a similar structure, turning them into ambulances for use in rural areas where people struggle to get to clinics or hospitals because the facilities are too far away and the patient is too weak to walk.

Children walk down dirt path in Muona, Malawi (Amos Gumulira)

A lifeline for mothers and infants
“Normally, when we talk of ambulances, we always think of motor vehicles. But here in the rural areas, our village is difficult to access because our roads are very bad. It’s not everywhere where you can have motor vehicles,” says William Allan, the chief administrator at Trinity Hospital.

He removes his spectacles and wipes the sweat off his face and neck with a washcloth. In long, quick strides he walks down the crowded corridors of the hospital towards his office.

“A lot of people were dying, obviously, because they couldn’t reach the hospital. Many pregnant women would not make it to hospital in time and delivered their babies on their way here. As a result, many babies died, and so did some of their mothers.”

Women gather water in a flood-prone river in southern Malawi. The area was hard hit in 2015 by flooding and some roads have yet to be rebuilt. (Amos Gumulira)

Transport is critical in healthcare access, according to a 2015 article in the journal BMC Health Services Research.

Allan says many women in his village turned to traditional birth attendants when they could not get to the hospital, which often results in babies and mothers dying. Trinity Hospital has a catchment population of about 150 000 people.

“This hospital is strategically situated because the other hospitals are far. The nearest hospital is in Thyolo, which is 70km from here. Nsanje District Hospital is 80km to the south, but you cannot drive directly from here. Because the bridge we had was washed away by the floods, you have to travel 200km just to get to the other hospital,” says Allan.

A 2014 Pan African Medical Journal study in Kenya found that pregnant women whose medical care was delayed because of the long distance between their homes and the nearest health facility resulted in “some women arriving at the hospital too late to save the life of the unborn baby”.

Failure to access healthcare is also a key contributor to child mortality. A 2014 survey published in the Journal of Health, Population and Nutrition showed that children from poor households were less likely to be seen by a doctor when they are ill than their wealthier counterparts. Conducted in Malawi, the survey found that “families from rural households spent more time traveling compared to urban households. In addition, visiting a trained healthcare provider was associated with longer travel time and higher direct costs compared to visiting an untrained provider.”

A nurse attends to a patient at Trinity Hospital in Nsanje district, Malawi (Amos Gumulira)

Bikes go missing
Bicycle or bush ambulances were introduced at Trinity Hospital in 2002 when businessmen from Blantyre, Malawi’s commercial capital, donated the bicycles.

“Every group village headman was allowed to keep a bicycle ambulance so that if anybody in the village fell ill they could use the bush ambulance to take the patient to the hospital and then bring the bicycle back,” explains Allan.

“It was important to keep them in a central place so that anybody who can ride a bicycle can use the bush ambulance. Those who cannot ride a bicycle can just push it.”

Bicycle ambulances, which are provided mostly by charity organizations, are common in Malawian villages. They are also used in rural areas in Nepal, Uganda and Namibia.

But most of Trinity Hospital’s 12 bicycle ambulances are gone — there are only three left and they are badly damaged. “Unfortunately, we cannot trace where they are. If we had a GPS we could easily track down where they go.”

Some patients use spare parts from their own bicycles to fix bush ambulances but when they are done with an ambulance they take their spare parts back.

“One of the three bush ambulances we have left is new; we recently received it from Gift of the Givers,” says Allan.

The international aid organization works with rural communities and health officials around the country to “create committees to run the bicycle ambulance project at community level”. These committees raise funds each month to carry out any repairs needed on the bicycle ambulances. Gift of the Givers is hoping to establish similar groups in Nsanje.

But Allan says getting to the hospital is only one problem that rural communities face in getting medical care — the hospital is also severely understaffed.

Allan hopes to raise the funds for more bicycles.

To prevent loss of the three remaining bicycle ambulances, Allan has enlisted the help of the village chiefs.

“We have talked to the traditional leadership to tell their people that the bicycle ambulances must remain at the hospital all the time when not in use. Whoever is found to have a bicycle ambulance at his home will be punished.”

by M&G 26.08.2016 Ina Skosana

Rains and conflict will make bids to control South Sudan’s cholera outbreak harder

admin — Wed, 03 Aug 2016 04:34:50 +0000

Violence has contributed to the epidemic; aid agencies can’t travel freely and are removing nonessential staff.

In the wake of renewed violence and insecurity, South Sudan is now also facing a cholera outbreak. But many aid agencies are working with diminished staff and supplies, which could severely hamper efforts to control the epidemic.

Cholera is spread by food or water contaminated with feces, and can kill within hours if left untreated, according to the World Health Organisation.

WHO communication officer Jemila Ebrahim says the country’s cholera outbreak is approaching its second month, with 586 cases having been reported.

But the WHO’s country representative in South Sudan, Abdulmumini Usman, warns that the impending rainy season may bring more cholera cases. “The risk of further spread of the disease is a major concern. With the coming rains, it is realistic to expect an increase in malaria and waterborne diseases.”

A recent surge of fighting between forces loyal to President Salva Kiir and those aligned to former vice president turned opposition leader Riek Machar has displaced more than 30000 people, the UN Refugee Agency reports. Many aid agencies have had to temporarily withdraw their personnel and only have essential staff in the country.

Tim Irwin, Unicef’s spokesperson in South Sudan, says there is a security threat to aid workers and many parts of the country remain insecure. “We are unable to access them, and this is a concern.”

According to Zlatko Gegic, South Sudan country director at the aid organization, Oxfam, providing aid will become logistically impossible if security conditions deteriorate further. “If aid agencies cannot operate fully, the consequences could be catastrophic,” he says.

The WHO, the United Nations Children’s Fund (Unicef) and Doctors Without Borders (MSF) have set up a cholera treatment center at Juba Teaching Hospital in the capital, where the bulk of South Sudan’s cases have been reported. As an oral vaccination drive strives to inoculate more than 14 000 people against the disease in high-risk areas — such as camps housing thousands of people displaced by violence — the organizations have also set up eight centers to treat dehydration among people with the diarrheal disease.

But aid supplies — including vehicles, fuel and nutritional supplements — of agencies such as the World Food Program have been looted. With only 200km of paved road in South Sudan and restrictions on internal travel, aid agencies have not been able to restock their bases across the country. Some regions are impossible to get to because even helicopter travel has been prohibited.

WHO epidemiologist Joseph Francis Wamala, who is responding to the epidemic, says the conflict is partly to blame for cholera outbreaks that have haunted the country annually since 2014.

“The fact that we had pockets of insecurity all these years means that you don’t have the time you need to build very good water systems and very good sanitation systems to handle sewage,” Wamala says.

Decades of conflict have destroyed sanitation and healthcare systems in the world’s newest nation, which gained independence from Sudan five years ago. Hunger and malnutrition are widespread and 4.8-million people — nearly one in every three— don’t have enough to eat, according to the International Rescue Committee.

The local media is airing prevention messages and advertisements for a toll-free phone line to report cholera cases.

MSF emergency co-coordinator Anja Wolz says people should seek treatment urgently if they experience more than three bouts of watery diarrhea a day.

“Our main challenge is making sure that people know to protect themselves from cholera and what to do if they think they have the disease,” she says.

M&G 03.08.2006 by Mugume Davis Rwakaringi

In rural Kenya, camel clinics bring care to those who need it

admin — Wed, 13 Jul 2016 05:10:24 +0000

Healthcare for Kenya’s semi-nomadic communities comes in an unlikely form of camels, who carry medicine to the country’s most remote villages.

It’s long before dawn in the thorny scrublands of northern Kenya. A recalcitrant camel grunts as nurse Pauline Nunu fastens the wooden boxes filled with medical supplies.

Her small team is used to working fast and in the dark: breaking camp and loading the bulky boxes onto the backs of their eight camels. They have to get to the next settlement while the morning is still cool. The terrain ahead is rough and full of dangers.

“Distances are so long,” says Nunu, who is in her mid-forties. “Sometimes you have to walk between four and six hours.”

In this vast and scenic area of northern Kenya, the mobile camel clinic team treks between communities for up to six hours a day.

The area is underdeveloped, remote and vast. When Nunu completed her training in HIV counseling and testing, she never thought she would end up depending on camel handlers’ bush tracking skills to avoid stumbling into a herd of elephants. Or, as she says with a shudder, nearly step on a deadly puff adder snake sunning itself in a path.

The semi nomadic communities here are peppered across 30 000 square kilometers of arid bush. They sorely need medicine and care. But there is only one doctor for every 63 000 people in the Laikipia and Samburu counties, according to government revenue allocation data. More than two-thirds of the population lives below the poverty line and nearly a quarter of children younger than five are at risk of malnutrition.

“You find that the men make all the decisions,” Nunu says. “Women still have no say.”

Out in the wild, the medical team rely heavily on the survival skills of the camel handlers. Here, they draw on traditional knowledge to dig a shallow well in a dry riverbed.

In these communities, Nunu’s camel mobile clinic is often the only health service people access in months. She is a veteran of the Communities Health Africa Trust (Chat), which brings mobile health services to the remotest areas. They focus on family planning and basic reproductive services, but also raise ecological awareness.

The fragile ecosystem here is buckling under alternate droughts and floods. This is exacerbated by environmental degradation, caused in part by a rapidly growing population.

Rain upstream can turn this seasonal river into a raging torrent in just a few hours, and delay the mobile clinic’s progress.

“Right now there are floods,” Nunu says, “The rivers are swollen all over. We have to wait for the water to go down before we can cross.”

Intense competition among pastoralist communities for ever-scarcer grazing land has led to “tribal clashes and insecurity”, Nunu explains.

Her colleague Violet Otieno says clinic staff is sometimes caught between warring communities: “Most of the time the people we are serving shield and protect us. But we stay close to the chiefs’ houses or police posts for security, and the injured then come to us for treatment.”

A Samburu moraan (warrior) and his wife accompany the camels to the next clinic. While serving the community, the camel clinic team relies on locals for protection and support.

Chat was started 15 years ago by Sharon Wreford-Smith, who was born in Kenya and has lived in Laikipia most of her life.

While the camel mobile clinic operates in remote areas, a purpose-built Landrover mobile clinic criss-crosses wherever it can, in an area where more than 90% of the roads are un-tarred.

HIV testing on two wheels
The organization has also developed a network of “community-own resource persons” (Corps) who prepare people in advance of the clinic’s arrival. Trained in family planning or HIV testing and counseling, these community members provide ongoing support when the clinic moves on. A recent innovation has been “backpack mobiles”, which allow Corps to carry a mini-clinic with them as they go door-to-door in their communities.

Samwel Parare makes a living as a boda boda (motorbike taxi) driver. As a Corp in Laikipia North, Parare’s day job melds seamlessly with his HIV testing and counseling work. Parare carries his HIV testing kits with him, provides on-the-spot counseling, and refers anyone who tests positive to their nearest clinic.

But the men here, for a variety of cultural reasons, do not approve of their wives, daughters or partners accessing these services.

“There are many practices – such as female genital mutilation, beading [culturally accepted casual sexual liaisons between young men and girls], early marriages, polygamy, bush abortions and traditional medical beliefs – which make life very difficult for women,” Parare explains.

A Samburu woman and her young family watch as a CHAT nurse updates their medical records. CHAT works closely with the health ministry.

Dispensing medicine provides a pretext for women to come to the clinic for their regular family planning insertions. Men who come to the clinics for basic healthcare are encouraged to have an HIV counseling and testing session, or to sit under a thorn tree listening to Parare explain family planning and ecological awareness.

“They think contraception is a way to stop a woman from giving birth forever,” says Parare, who often gives talks to groups of knobkierie-wielding men. “But once we have helped them understand that it’s just a matter of spacing, of allowing each child to grow properly, rather than being a permanent thing for women, that’s when they allow their woman to access services. They also get a positive response from other beneficiaries, and can start to accept it.”

Answering the call

Nurse Pauline Nunu and a colleague examine a patient with a chest complaint.

Last year, Chat reached 140 980 people, with the Corps and Landrover clinics serving the majority. But the camel team added a crucial 8 663 people in the furthermost areas who might otherwise not have been served. Nearly 5 000 people received basic medicines for ailments such as malaria, diarrhea and skin infections.

In a day Nunu will provide basic medicines to between 20 and 30 patients and see up to 80 clients for family planning.

“When a client comes for insertion, she decides for how long, and then I do a pregnancy test. If it’s negative, she chooses the method she wants. It could be a one-month pill, or a three-month injection or a three-year insertion. Then I do the insertion in the privacy of a tent.” Last year, the clinics administered family planning to 40 604 women; more than half of whom chose a three to five-year insertion. It also distributed more than 200 000 condoms.

“When we provide people with it (contraception), maternal health complications go down. Economically, people become better off.”

For Nunu, her work is “a passion to serve this community”. “You know, when we went for training it was like a call. And when we serve the community to which we are called, we feel content.”

by M&G 10.07.2016 Lionel Faull

Sunlight + plastic bottles = clean drinking water in Africa’s largest urban slum

admin — Thu, 30 Jun 2016 07:10:31 +0000

A novel and easy way to disinfect water using freely available solar power is helping to combat the spread of disease in developing countries.

When David Ingavo, a village elder in the Kibera slums in Nairobi, started having persistent stomach problems, he assumed they were normal abdominal aches that would go away with time. He would go to a chemist and buy tablets that soothed the pain, albeit temporarily. But a time came when the self-medication no longer worked.

“The stomach pains were now persistent and more painful,” recalls Ingavo. Dignified and graying, he blinks in embarrassment. “I started to have diarrhea and had to wrap a towel around my waist after soiling all my clothes. I was unable to walk and had to always remain near a toilet.”

Ingavo was eventually diagnosed with typhoid and amoebiasis.

Typhoid fever is a bacterial disease transmitted through food or drink contaminated by the feces or urine of infected people, according to the World Health Organization. Symptoms may be severe and include high fever, headache, diarrhea and enlarged spleen or liver. Amoebiasis is caused by a parasite also transmitted by fecal contaminated food or water.

“I was given drugs and warned against using untreated water. I was advised to always drink boiled water,” Ingavo says.

Piped water in the slums does get contaminated with sewage and waste water, admits Kibera’s sub-county public health officer, Charles Warutere. “When residents make illegal connections, the pipes sometimes suck in raw sewage or waste water and get contaminated,” he explains. Kibera assistant county commissioner Hesbon Kayesi says providing water is not a problem in the slum, but treating it is. “Whenever there is a leakage in the pipes, water is contaminated. Cholera outbreaks have been reported as a result of this contamination.”

A Kibera resident shows the extent of pollution in the water available to the slum. (Cyrus Kinyungu)

The mistrust of piped water extends to the rest of Nairobi and, indeed, several other parts of the country. This has seen a mushrooming of companies bottling water for the wealthy. There are 600 licensed water bottling companies in the country, according to the Kenya Bureau of Standards.

Recently, the bureau suspended the licenses of 369 of these companies because of a rise in counterfeit or substandard bottled water products that may have posed a risk to human health. However, for the majority of Kibera’s residents, who live on less than a dollar a day, the bottled water is not even an option: it sells at an average price of KSh75 ($0.75) a liter. Like Ingavo, most slum-dwellers can’t afford to buy the fuel to boil their drinking water.

But these problems, Ingavo says, no longer affect him. He shields his eyes as he gestures towards the rusty iron sheet roof of his mud shack, where an array of shining plastic bottles are basking in the Kenyan sun.

“I always have around 15 of them up there,” Ingavo proclaims.

His entire family’s health depends on these bottles. Each is filled with water and laid down horizontally in direct sunlight for at least six hours. As simple as it seems, this is a highly effective water treatment solution developed by Swiss scientists that has helped to solve Kibera’s water treatment problems.

Solar disinfection of water in Kibera
The system, which is known as solar disinfection (Sodis), is suitable for treating relatively small quantities of drinking water.

“When I learnt of Sodis, I was very excited, as I escaped from the high cost of boiling drinking water daily. I carry the water even when traveling,” says Ingavo. The science behind Sodis is straightforward: when clean, clear plastic bottles are filled with water and set out in the sun for six hours, the UVA rays in the sunlight kill germs such as viruses, bacteria and parasites.

The water has to be relatively clear, says Naimo Abdulahi, executive director of the Savo Foundation, which has been promoting Sodis in the slums since it was introduced there in 2004. The bottles, which must be colorless and transparent to allow in light, must hold less than three liters.

The Savo Foundation mostly targets mothers and children under five, according to Abdulahi. “They are the most vulnerable to waterborne diseases like cholera, typhoid and amoebiasis. They also spread the message to schoolchildren and make them goodwill ambassadors of the Sodis technology. Health clubs help promote the idea.

“We are covering 21 schools within the Kibera slums and at least 2 500 households within the slums,” says Khadija Swaleh, the foundation’s program coordinator.

Josphat Kaleka, a teacher at Adventure Pride Center, a school in Kibera, says Sodis has helped to reduce the constant absenteeism caused by illnesses.

“Before, students used to get sick with stomach problems but after we adopted Sodis the incidences have been reduced,” says Kaleka.

Children in Kibera slum benefit from using the Sodis water disinfection system so they do not get sick and have to skip school. (Cyrus Kinyungu)

According to Abdulahi, the biggest problem is providing the schools and households with empty plastic bottles. “We are unable to meet the demand for bottles. We have asked several hotels in the city to give us used water bottles, which we clean and distribute to schools,” she explains. Only five hotels have done so.

Mistrust between neighbors is another hurdle. Leah Kivoni, an elderly woman living in Kibera, only places her water on the rooftop when she is at home. When she leaves, she takes her water to a trusted relative who takes care of it while it remains exposed to sunshine. “I wouldn’t trust anyone with my water. You may not know who wants to poison you,” she says as she gulps water from a 1.5-litre bottle.

The foundation also has to contend with residents whose religious beliefs forbid them from using water exposed to light.

Despite these problems, Sodis has helped to reduce cases of waterborne infections in the slums, Abdulahi says. A quantitative field study conducted from 2005 to 2006 in Kibera and submitted at the WHO conference in 2008 found that there was no diarrhea in most (84%) households that used Sodis. More than two out of three households that did not use the Sodis method (69.7%) reported incidences of diarrhea.

Similar results have been seen elsewhere. More than two million people in 28 developing countries use Sodis for daily drinking water treatment, according to the Centers for Disease Control and Prevention.

In the Kibera slums, Ingavo has become known for telling anyone who wants to listen — and even those who don’t — about the benefits of his plastic bottles. “At times I am forced to tell my story to make people understand the dangers of untreated water,” he says. “I help educate them. As an elder, I have to.”

by M&G 29.06.2016 Cyrus Kinyungu

Camp closure is next health crisis

admin — Mon, 20 Jun 2016 05:45:05 +0000

Camp closure is next health crisis

Sending Dadaab’s refugees back to Somalia will become the next health emergency.

Sitting in a shelter made of branches and torn fabric, Amina cradles a small boy on her lap. The child is listless and shockingly thin. He is severely malnourished and needs to get to hospital fast.

This was one of many stories five years ago, during the height of a malnutrition emergency in Somalia, causing thousands to cross the border to Kenya. Amina and her five children had just arrived in Kenya’s Dadaab refugee camp, after walking from the Somali border, 70km away across the baking red desert.

They had been driven from their village by a long and vicious war and a terrible two-year drought. Thousands of other Somalis were arriving at Dadaab each month, weak from the long walk and having had too little to eat. Doctors Without Borders (MSF) data show that one in five of the newly-arrived children was severely malnourished, and at MSF’s hospital in the camp, staff were rushing to put up tents to make more space for the sick and the dying.

That emergency was in 2011. The MSF hospital staff have since dismantled the extra tents and the health situation in Dagahaley camp has somewhat stabilized. But in such a precarious environment, things could change at any time. In a vast camp like Dadaab — which houses about 350 000 refugees, and where people live on top of each other, with poor sanitation and limited food rations — infectious diseases can spread like wildfire.

Last year saw a major outbreak of cholera in the camp, and there are regular cases of measles, mainly among new arrivals from Somalia. MSF’s hospital sees a constant stream of people with diarrheal diseases, skin diseases, respiratory tract infections and malnutrition.

Mental health conditions among the population are common. At the same time, chronic diseases, including diabetes, hypertension and end-stage cancers, are also on the rise. MSF’s team is always on its toes, wondering where the next health crisis will come from.

Residents of Dadaab face innumerable health problems. (Reuters)

Closure of Dadaab camp
And now the next potential crisis has appeared, this time from an unexpected direction. The Kenyan government announced in May that it will close Dadaab and send all its residents back to Somalia — the very place they are seeking refuge from. No one would say that life in Dadaab refugee camp is good for your health.

Denied the right to work or to travel, with no opportunity to become integrated into Kenyan society and with little hope of being resettled abroad, depression and other mental health disorders are common among the refugees; around two percent of the population in Dagahaley camp are on psychiatric medication, according to MSF data.

In addition to the other myriad health risks of the camp, patients in need of advanced healthcare face difficulties getting referrals to specialist hospitals elsewhere. But the health consequences of being forcibly returned to Somalia will be a great deal worse.

Facts about the health situation in much of Somalia are sketchy — because of the insecurity, few journalists or aid workers venture there. But we do know that, in large parts of the country, even basic healthcare services are scarce or nonexistent. In Dadaab, MSF often finds that children arriving from Somalia have never been vaccinated against common childhood diseases — another telling indication of the health landscape there. Few families have so far taken the decision to return to Somalia despite an agreement signed in 2013 between the governments of Kenya and Somalia and the United Nations High Commissioner of Refugees.

This recent announcement by the Kenyan government strips refugees of any choice. If the return of the refugees is not done voluntarily, it is likely to have major consequences for their health, escalating their vulnerability to malnutrition, weakening their immune systems and making them vulnerable to infectious diseases.

People with incommunicable diseases will also be at increased risk, as symptoms do not usually become severe until an advanced stage of the disease, lessening their impetus, in a difficult situation, to seek healthcare until it is too late.

Patients with chronic diseases and who are already on medication need continuity of care to safeguard their health — whether they are diabetics who need insulin, or people with hypertension who need ongoing treatment. With diseases such as tuberculosis, interrupted treatment brings with it the risk of drug-resistance developing, and if a patient with psychosis is forced to come off their medication, their cognitive function and behavior development goes into reverse.

If the Kenyan government goes ahead with the threatened closure of Dadaab, I dread the thought of what will happen to MSF’s patients and the most vulnerable refugees. Sending the camp’s residents back to Somalia without due care is likely to become the next health emergency.

M&G 19 Jun 2016 Melat Haille medical co-ordinator for Médecins Sans Frontières.

South Sudan: From war to water crisis

admin — Thu, 09 Jun 2016 06:28:39 +0000

The start of the rainy season in the war-torn country could spell a cholera outbreak.

Martha Nyimun, 35, wipes the sweat from her brow. She’s breathing heavily but doesn’t slow down.

With the sun blazing from a cloudless sky, Nyimun is walking to the only piped water in the Gabat neighborhood of Juba, where she lives.

At the distribution point, one of the few in the capital of South Sudan, she pays SSP4 or about R2.51 to get 20 liters of clean water. The queues are long and, with the heavy container balanced on her head, it takes Nyimun more than an hour to get back to her four children.

The water barely lasts a day. “Sometimes I don’t have enough water for washing or even for cooking. I usually have to beg for water from neighbors and when they don’t give it to me, my children cry because they can’t get water to drink,” she explains.

Nyimun can’t afford to buy water regularly. She is a single mother and never went to school. Now and again she gets an odd job at a restaurant for which she’s paid SSP30 or about R15.60. When she runs out of clean water, she uses untreated water from the river Nile, taking the risk of contracting diseases such as cholera.

War ravaged infrastructure
Nyimun, like many Juba residents, has little choice. In the decades of conflict the urban water systems have been neglected or destroyed.

One in three people use contaminated water and only 2% of households have water piped to their homes, yard or plot, according to the 2010 South Sudan Household Survey, released in 2013 by South Sudan’s Ministry of Health.

There is little or no infrastructure in rural areas. Many boreholes have been deliberately destroyed in the conflict. Girls of 15 years or younger are responsible for fetching water. They sometimes walk up to four hours to fetch water, often from a dirty swamp.

Although an uneasy peace agreement seems to hold, there are still pockets of fighting. Katrice King, context analyst for aid organization Oxfam in South Sudan, says frustration, anger and resentment linger across the country, rendering girls and women fetching water extremely vulnerable. “We see a lot of gender violence, a lot of attacks on women.”

According to the United Nation’s Children’s Fund (Unicef), being “needed at home” is a major reason children, especially girls from poor families, drop out of school.

Limited supplies
Nyimun has to leave her two youngest children — aged five and eight — at her hut when she fetches water. It’s too far for them to walk, “but soon they will have to start helping me and I might not be able to keep them safe”, she says.

Tim Irwin, communications officer for Unicef in South Sudan, says the country’s worsening economic crisis and rising fuel prices have more than doubled the cost of delivering water, sanitation and hygiene services. “Even the water treatment centre in Juba is running out of supplies, running out of fuel to keep the power going, the generators going.”

This directly affects families’ health. “We see diseases such as cholera and typhoid spread,” he explains. “It is essential that people in cities such as Juba and also in rural areas have access to potable, clean and safe water.”

Unicef figures for 2015 show that 1 818 cases of cholera were reported in South Sudan, including 47 deaths. Cholera is a diarrheal disease causded by the bacterium Vibrio cholera and can kill someone in hours if left untreated, says the World Health Organization. It is spread mainly by fecal contamination of water and food.

Rainy season outbreaks
Nyimun says she and her children have suffered from diarrhea and typhoid on several occasions. The first downpours have already signaled the start of the long and difficult rainy season, which usually lasts from May until October, and aid agencies are bracing themselves for another cholera outbreak.

Juba resident Lesuk Emmanuel Alison sometimes goes thirsty for up to 30 hours because he is terrified of the diseases he might get from untreated water. From time to time his family — he has a wife and two children — don’t eat because they can’t get clean water with which to cook. Like many others, Alison buys water from the privately owned tanker trucks that make their way through the city.

“Sometimes you find that the tanks of water cannot reach some areas in time. You find that some people do not have the money to buy,” Alison says.

Oxfam’s research shows that a person needs at least 20 liters of water a day. “That is just for the most basic needs: you need more for hygiene and cleaning,” says King. A 200 liter container of water costs between R109 and R140 in Juba. Gross national income in South Sudan in 2014 was R15 156 per capita, or R41.50 a day, according to the World Bank.

There are no quick-fix solutions here. Political stability is a prerequisite for any long-term improvement, says King. “This country has been at war for 40 of the last 60 years. There is no capacity, limited commitment and no money. The ministries (responsible for water supply) are completely underfunded.” Infrastructural investment is needed but with the country on a knife-edge and its economy teetering, the international community is hesitant to spend money on it.

Donor support
One exception is the government of Japan. In 2012 it pledged $50-million of aid in infrastructure support. The project includes building a 180 000 cubic liter water distribution plant which will, once it is completed in 2017, distribute water to more than 400 000 Juba residents.

Project Engineer Lawrence Lopula Muludyang says they are also constructing 120 public water kiosks where people can easily buy water. The project will provide 60km of new water delivery pipelines and eight water filling stations.

“This will help prevent the cholera outbreaks every year,” says Muludyang. “The local people will now have public water points near their houses and (it will) stop women from having to travel long distances to queue and buy water — and children having to fetch water from faraway places instead of going to school.”

King says it is important to build capacity in the South Sudanese government. Until now, aid organizations have shouldered much of the responsibility for the crisis. This has included emergency water treatment measures, drilling boreholes and the provision of chlorine. “Government has to take responsibility for water provision. We need a shift in thinking.”

She urges donors not to give up on South Sudan.

“They are tired of putting money into a system that is broken. But that is not the point of being a donor…it is not to help governments. It is to support the people who are caught in a cyclical hell.” — Additional reporting by Adri Kotze.

M&G 23.05.2016 Mugume Davis Rwakaringi

8 things you should never say to a depressed person

admin — Fri, 03 Jun 2016 05:24:22 +0000

Clinical depression is tough to experience and understand. It consists of a wide variety of mood disorders, which impact lives differently.

Experiencing the peaks and plunges of feeling down or having a bad day is universal – clinical depression is an enduring and debilitating condition. Mood disorders differ but that doesn’t make any of them any less “real” or severe. Misunderstanding the difference between clinical depression and feeling down happens often, especially to someone who has never experienced depression or who approaches it with the view that only illnesses that manifest physically are important or relevant.

For those living with the condition, sometimes the unintentionally hurtful platitudes of family and friends can have a negative impact on how they deal with their depression. Here are some of the worst things you can say to someone living with depression.

1. Pray about it
Prayer may be helpful for them as part of a treatment plan, but offering prayer alone as a solution is dismissive and detrimental. Praying doesn’t make depression go away any more than praying will make climate change go away.

2. Be grateful for the things you have
Instead of invalidating their illness and their current situation by reminding them of what they don’t have to deal with, try to listen to what they’re saying. Be present and pay attention.

3. I know how you feel
No, you probably don’t. You may gain insight into what another person is experiencing, but you will never know exactly how or what they think and feel. Telling someone ‘I know how you feel’ may seem helpful, but can come across as supercilious and insincere.

4. It’ll pass soon
While a healthy person can regroup and change their attitude, clinical depression prevents this. Instead of invalidating their experience as a phase or fleeting feeling, try to listen to their concerns. Conflating clinical depression with the blues is wrong because the latter is an isolated and passing event, while the former is a chronic mental illness.

5. You don’t seem/look sick
Not all illnesses “show” or have tell-tale symptoms. Saying this is akin to telling them they are making up their illness.

6. It’s all in your head
Of course it is all in their head. Chemical and electrical imbalances happen in the brain. Saying “it’s all in your head” suggests the person living with depression can control it as though thinking differently would make them feel differently. It also trivialises the real, physical limitations depression can cause.

7. Pull yourself together
Any variation of pull yourself together/cheer up/smile/snap out of it are all one-dimensional in their view and understanding of clinical depression. Would you suggest to a person with a broken leg to go cycling? Depression is not a choice.

8. Other people have it worse
The fact that you, or other people, are having a difficult time in life doesn’t negate or diminish another person’s depression.

Sources: Psychology Today, #MyDepressionLooksLike (Twitter hashtag started by people living with mental illness), Health.com, Psych Central, Life Hack, Huffington Post, Upworthy

by: M&G 02.06.2016 Kiri Rupiah

Millions are denied morphine that will free them from pain

admin — Tue, 10 May 2016 08:18:53 +0000

Markets, attitudes and the war on drugs are the barriers that prevent patients having access to opioid-based pain medication.

COMMENT
The city in which a terminal cancer patient lives should not determine whether he or she suffers pain, or has access to pain relief. Yet this is the reality we live in. Three-quarters of the world’s population – 5.5-billion people – have no access to effective pain medicine.

According to a 2016 report by the Open Society Foundation, every year tens of millions of people suffer pain and distress because they can’t get medication.

If freedom from unnecessary pain and suffering is a human right, this is a damning assessment of the state of the world. At a broad level, access to pain relief is impeded by attitudes, knowledge, skills, regulation and markets – and though these barriers are different in each country, most of us operate under the international system of drug control.

In 1961 and as revised in 1972, the United Nation’s Single Convention on Narcotic Drugs recognized that narcotic drugs such as morphine and opioid-based pain medicines are “indispensable” for medical and scientific purposes, including the relief of pain and suffering. It noted that “adequate provision must be made to ensure availability”. Preserved in the International Drug Conventions, this was intended to promote a balanced approach to drug policy, one that ensured access to controlled medicines while including appropriate protections against misuse.

An overwhelming focus on the control of illicit use of these drugs under the auspices of a war on drugs has, however, meant not enough attention and resources have been committed to ensuring the supply of controlled medicines for medical and scientific use.

Access to controlled medicines, including opioid-based pain medicines, is central to the delivery of quality palliative care – a concept of holistic care that seeks to improve the quality of life of people with life-limiting and life-threatening conditions and their families.

Palliative care was introduced in an African context in Zimbabwe in 1979, then in Kenya and Uganda in the 1990s. Uganda’s leadership in palliative care has been recognized globally: it is strongly committed to providing home-based palliative care services and has an innovative regime of nurse-led pain prescription. Low-cost morphine production through a public-private partnership ensures patients in rural areas have better access to pain relief, which is significant in a country where 82% of the population live in rural areas, and the doctor to patient ratio is about one per 24 725 people.

Countries suffer from ‘opiophobia’
There is much work to be done. Despite successes in scaling up, Uganda reports low annual use of morphine. People are still dying in unnecessary pain.

The attitudes of the general population, and to a larger extent our healthcare professionals, have been shaped by a punitive and stigmatizing war on drugs. In some African countries, this has resulted in fear of prescribing or consuming opioid-based pain relief, often referred to as “opiophobia”. We need our healthcare professionals to bring evidence-based and rational decisions to their prescription practices and broader policy decisions. This will ensure patients are treated appropriately for their individual needs and conditions regardless of whether the controlled medicine required treats pain, drug dependency or a neuropsychiatric or mental condition.

Regulation – often in excess of that required by the International Drug Conventions – significantly hampers access to controlled medicines for palliative care patients. This may include limiting prescribing to only doctors; limiting number of days for a prescription; or requiring special stamps, special prescription pads or multiple approvals for opioid prescriptions. The World Health Organization has observed that special multiple-copy prescription requirements typically reduce prescribing of covered drugs by at least 50%. In many less affluent countries pharmacies and pharmaceutical companies may decide not to supply opioid analgesics because of the excessive administrative burden that accompanies procurement and distribution of controlled medicines.

Cost of patented medicine is prohibitive
Market forces also lower access to controlled medicines. Although morphine is an effective, low-cost, relatively easy to make, generic medicine, there may be financial incentives for doctors, hospitals or pharmacies to supply patented analgesics. Where patented medicines dominate a market, cost can become a prohibitive factor. In Kenya, the government overcomes this problem by importing powdered morphine and reconstituting it locally into a liquid preparation. In Uganda, a public-private partnership, which includes the health ministry, National Medical Stores, Joint Medical Stores and Hospice Africa Uganda, run projects that get medicine to facilities around the country. Malawi, Swaziland and Rwanda have established a centralized system for the reconstitution of affordable oral liquid morphine. But it is not enough. Stock-outs are still reported in these and other African countries, affecting patients and healthcare providers.

The right to pain relief was recognized by the World Health Assembly in 2014. The resolution specifically recognizes the place of palliative care in treating noncommunicable and infectious diseases across all age groups and calls for palliative care to be provided in an equitable manner.

If every patient is treated and diagnosed as an individual with unique requirements, we can begin to overcome the ignorance, stigma and scaremongering associated with pain management medications and ensure all patients – regardless of where they live – have access to pain relief.

M&G 09.05.2016 by Fatia Kiyange

World Health IDentification

Erstes Treffen der MAA-Arbeitsgruppe „Tourismus“ am 27. Juni 2019 The First Meeting of the MAA-Working Group “Tourism” on 27th May, 2019 Première rencontre des groupes de travail MAA « Tourisme» le 27 mai 2019

Lift the veil on drug pricing and trade agreements, the UN urges companies and states

Pedal power: Malawi’s ‘rickshaw’ bush ambulances cycle the sick to care

​Rains and conflict will make bids to control South Sudan’s cholera outbreak harder

In rural Kenya, camel clinics bring care to those who need it

Sunlight + plastic bottles = clean drinking water in Africa’s largest urban slum

Camp closure is next health crisis

Camp closure is next health crisis

South Sudan: From war to water crisis

8 things you should never say to a depressed person

Millions are denied morphine that will free them from pain

Rains and conflict will make bids to control South Sudan’s cholera outbreak harder