Complete Wellness

Ashfaq Yusufzai

PESHAWAR, Jan 24 2008 (IPS) – Although genetic sequencing tests conducted by the World Health Organisation (WHO) of samples from a man who died of H5N1 avian influenza do not confirm human-to-human transmission, authorities in this region, bordering Afghanistan, are taking no chances.
Ilyas, 28, a livestock official was admitted to the Khyber Teaching Hospital (KTH) on Nov. 22 with symptoms of bird flu and died on Nov. 22. But when it became known that his brother, Idrees, 22, had developed similar symptoms and died four days earlier it sent alarm bells ringing through the community and health officialdom.

On Dec. 28, WHO s headquarters in Geneva announced that a case of human-to-human virus transmission may have occurred in Pakistan, but a later statement on Jan. 3 said that a preliminary risk assessment found no evidence of sustained or community human-to-human transmission .

Meanwhile, KTH had received another three brothers and one cousin; all were tested positive for carrying H5N1 strain of virus.

Initially, the Ministry of Health, Islamabad dragged its feet on the result of the death of Ilyas, despite its confirmation by the National Institute of Health (NIH), Islamabad. The ministry was cautious, fearing that it would cause panic among the people, and pilgrims could face delay in flights to Saudi Arabia for Hajj.

Now it has issued an alert and started training doctors and health workers on the management of bird flu in the province. It has established two respiratory isolation units (RIUs) to cope with an emergency.
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The WHO is assisting the health department to establish two RIUs, one each at Peshawar and Abbottabad where six cases and three cases respectively of H5N1 were found, said WHO s Dr Saeed Akbar Khan.

In addition, the world health agency has agreed to establish two wards each at KTH and Ayub Teaching Hospital, Abbotabad in NWFP, at an estimated cost of 500,000 dollars, Dr Mukhtiar Zaman Afridi, a pulmonologist and focal person for bird flu told IPS.

The WHO has urged the health and agriculture departments in the NWFP to coordinate efforts because an estimated 35 percent of the population could be at risk. In case of a pandemic, thousands of people could die, and hospitals, which together have roughly 9,000 beds, would be unable to meet the challenge.

About 14 private rooms designated as the isolation ward are not up to the standard of the world health agency. There is no ventilation and investigation facility, such as x-rays, etc., due to which the affected patients had to be shifted to and from the ward, Dr. Saeed Akbar Khan told IPS.

The global health agency believes the world is closer to another influenza pandemic than at any time since 1968. Last month, its experts flew into Pakistan and visited Peshawar and Abbottabad districts of NWFP where some 200,000 poultry have been culled.

Two teams collected data on the nine bird flu cases reported from the two districts in effort to determine the epidemiological link between them. While one patient died, the rest have recovered.

Dr Khalife Mahmud Bile, WHO s country chief, said the visiting teams had validated the findings of the NIH.

Global health experts fear the virus which has killed 211 people out of 343 infections reported since 2003 could mutate into a form that spreads easily from one person to another, possibly triggering a pandemic that could kill millions.

WHO teams in Pakistan also investigated the possibility of human-to-human transmission in the reported cases. Since 2005, the government has confirmed the deaths of five people from bird flu.

Stocks of Tamiflu, an antiviral drug used for influenza virus, have been rushed to the affected districts to meet any eventuality, said Bile.

Concerned officials warn there is a need to educate ordinary people and health professionals about the risks. Most doctors are afraid of coming into contact with patients infected by the avian influenza.

According to Dr Khalid Khan of the NWFP s livestock department, the virus flourishes in zero temperature. There is a need to inform the people, especially those associated with the poultry businesses, about the preventive steps, he added.

Up to December, Pakistan reported 79 outbreaks of bird flu, the last on Nov. 29 in Murree, Punjab province. Of these, 53 outbreaks involved commercial and backyard poultry.

The NWFP, which houses 85 percent of the country s poultry farms, is introducing a law aimed at protecting people from bird flu, confirmed Shah Rukh Khan, secretary agriculture and livestock department.

Under the proposed legislation the sale of poultry would be permitted only in designated places. Poultry farms not be allowed in residential areas and poultry waste would be compulsorily buried in deep ditches.

Bird flu has crippled the provincial government. An estimated two million dollars has been paid in compensation to poultry owners who have suffered losses.

Michael Deibert

KIBUMBA, Democratic Republic of Congo, Mar 1 2008 (IPS) – In a mist-shrouded valley between the Mount Nyiragongo volcano and a pair of its dormant cousins looming in Rwanda to the east, nearly 3,000 souls wait in limbo, having fled a conflict that has succeeded in making this lush corner in eastern Democratic Republic of Congo (DRC) nothing less than hell on earth for its people.

Kibumba camp, eastern Democratic Republic of Congo. Credit: Michael Deibert/IPS

We arrived here fleeing the war, says Gilbert Naimrwango, president of the Kibumba camp #39s displaced persons association and a primary school teacher in his former life, speaking amidst a sprawling collection of grass and banana-leaf huts covered with thin sheets of tarpaulin. As he speaks, he is surrounded by dozens of other residents and shoeless children, some with distended bellies and reddish hair that suggest severe malnutrition. Life here is very complicated, and we have much difficulty finding food.

Here we are with women and children, with little food, little water, where bandits can get us, adds Rusigariye Nubaha, a 54-year-old farmer who says he fled conflict in the district of Rutshuru, to the north, in late November.

The camp took shape in November 2007 amidst brutal fighting between army forces loyal to President Joseph Kabila, backed by the government #39s local paramilitary allies such as the Patriotes Résistants Congolais (Congolese Resistance Patriots, PARECO), and the army of renegade general Laurent Nkunda. An ethnic Tutsi, Nkunda leads the Congrès National pour la Défense du Peuple (National Congress for the Defence of the People, CNDP), a politico-military organisation.

Further poisoning an already lethal mix, the Forces Démocratiques de Libération du Rwanda (Democratic Forces for the Liberation of Rwanda, FDLR) a group with its roots in Rwanda #39s 1994 genocide, and comprised mainly of ethnic Hutus also took part in the fighting.

Nkunda claims to be defending the rights of Tutsis in North Kivu, where much of the fighting has been centered, as well as in neighbouring South Kivu. Both provinces straddle a mineral and timber-rich area, collectively abutting the borders of Burundi, Rwanda and Uganda.
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The Kabila government for its part has claimed that Nkunda is little more than a proxy for Rwanda itself, where a Tutsi-led government has ruled since toppling the Hutu regime that attempted the extermination of Tutsis and Hutu moderates over a decade ago, killing an estimated 800,000 people. All sides in the conflict have been accused of gross human rights abuses.

Intense combat and attendant atrocities, including widespread rape and the forced recruitment of child soldiers, have succeeded in emptying whole villages, with residents fleeing to what they regard as safer ground. The United Nations Office for the Coordination of Humanitarian Affairs estimates that since 2003, some 800,000 people have been displaced by fighting in North Kivu out of a population of 4.2 million, or roughly one in five.

A report released in January by the International Rescue Committee relief organisation asserted that 45,000 people were dying monthly in Congo, largely as a result of health-related concerns caused by the social and economic disruption of the ongoing conflict. The report estimated that 5.4 million deaths occurred between August 1998 and April 2007, and about 2.1 million since the formal end of the DRC #39s 1998-2002 civil war.

Everybody #39s victimised, even the people who have not been displaced: they are very poor and they have tremendous problems, says Johann Siffointe, emergency co-ordinator with the United Nations High Commissioner for Refugees, in Goma the provincial capital of North Kivu. It #39s a protected emergency.

In Rutshuru itself, a three-hour drive north from Goma over deeply-pitted roads, the situation is no better. A sprawling displaced persons camp has taken over the grounds of a local school and aid workers say they have witnessed first-hand the conflict #39s grievous toll.

The conflict has made things worse as far as the situation with malnutrition, because most of the people farm for themselves, says James Cogbill Jr, an American physician working at a hospital run by the humanitarian organisation Médecins Sans Frontières (Doctors Without Borders, MSF), in Rutshuru. When they get displaced from their land, they automatically have no food source.

According to the sexual violence programme at the MSF hospital, the facility recorded 129 cases of sexual assault between the start of the year and mid-February, with the victims ranging in age from 11 to 80 years old.

Despite a tentative peace deal reached between the CNDP and the Kabila government at a conference in Goma in January there is still deep distrust between the actors in the conflict, and many refugees are reluctant to return home to the scene of previous fighting.

The situation of exclusion and racial discrimination in this province, saying that some are more Congolese than others, continues, says Muiti Muhindo, an attorney in charge of external relations for Nkunda #39s CNDP in Goma, proceeding to rattle off areas which he says have seen massive movement of military material in recent days.

We need a commission of genuine national reconciliation, but on the contrary the government is moving arms from Kisangani towards Walikale, from Bunia towards Beni. They are preparing for war.

The government says that there have been clashes between CNDP and PARECO elements although it claims these were minor but it denies any plan for a return to full-scale conflict.

We are observing the ceasefire, says General Vainqueur Malaya, overall commander of the Congolese army in the North Kivu region. Things are improving slowly.

As darkness falls on Kibumba amidst the talk of renewed fighting, the residents of the camp, gathering outside their fragile shelters far from home, have a simple question.

Our biggest preoccupation is this, says Faustin Seruhungo, a former student who lives in the camp with his family. When will we be able to return home?

Daniela Estrada

SANTIAGO, Apr 2 2008 (IPS) – Chilean President Michelle Bachelet has announced a new policy for indigenous people, which includes novel approaches to political participation and the protection of natural resources in the hands of the country s native groups.
Some say the problem facing indigenous people is just poverty, and that good targeting of subsidies would be the most appropriate policy. But we, on the other hand, maintain that it is a matter of rights, of a collective identity seeking expression in a multicultural society, said Bachelet at a ceremony Tuesday in the palace of La Moneda, the seat of government.

We are making progress on indigenous affairs, but now is the time to go further, and above all at a faster pace. We have the will, the grassroots support, the resources, the commitment and the legitimacy to do so, she said.

The president announced the new policy for the nine ethnic groups recognised by the state, in the presence of ministers, members of Congress and representatives of indigenous communities, as well as former President Patricio Aylwin (1990-1994), who promulgated the 1993 Law on Indigenous Peoples and chaired the 2001-2003 Commission for Historic Truth and a New Deal.

A 2006 census known by the acronym CASEN found that 1,060,786 people identified themselves as belonging to native groups, equivalent to 6.6 percent of the Chilean population. The largest indigenous community is the Mapuche, who make up 87.2 percent of the country s indigenous people.

The new Social Pact for Multiculturalism addresses three main areas: political systems, rights and institutions; integrated development of indigenous communities; and multiculturalism and diversity. These are to be added to the guidelines for action presented by Bachelet in April 2007.
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In the first area, the president announced that she would promote direct participation by indigenous people in Congress, regional legislatures and local councils. I want indigenous representatives in parliament, said Bachelet, to a round of applause.

The proposal that has been analysed in greatest detail is to go back to a draft law presented in 1991 by two lawmakers, proposing the creation of an indigenous electoral district which would be entitled to elect a given number of members of both houses of Congress, Rodrigo Egaña, commissioner for Indigenous Affairs, said after the ceremony.

Egaña, appointed by Bachelet in February to coordinate and propose new policies for original peoples, said they hope to send several draft laws to Congress in three to five month s time.

It is likely that the draft law on the indigenous electoral district will be combined with reform of the two-candidate or binominal electoral system, which is part of Bachelet s government programme, as it has been for her three predecessors, all of them belonging to the centre-left Coalition for Democracy, since the return to democracy in 1990.

The binominal system, which benefits the two largest party coalitions, has not been eliminated because of opposition from the right, and because if affects the interests of sitting lawmakers.

The creation was also announced of a Subsecretariat of Indigenous Affairs within the sphere of the Planning Ministry (MIDEPLAN), a Council of Indigenous Peoples, conceived of as a representative body for consultation on policies affecting native communities, and a Ministerial Committee for Indigenous Affairs.

The present National Corporation for Indigenous Development (CONADI) is to be restructured, in order for it to implement policies. In addition, an Indigenous Affairs Unit will be established in each cabinet ministry.

In the second area, the president said that land would be restored in the immediate term to 115 indigenous communities, and decisions would be made with respect to the applications of another 308 communities. The Land and Water Fund, administered by CONADI, will be overhauled.

Programmes will be set in motion to boost the economic development of native groups, as well as the areas of communications, housing, drinking water, electricity and rural innovation, Bachelet said.

The special indigenous health programme will be strengthened, and actions will be studied to guarantee the right of indigenous peoples to have a say in the education of their children.

The third and final area of the new policy is aimed at generating cultural change among the Chilean population. The main novelty is that a Code of Responsible Conduct will be drawn up to regulate private and public investment projects in Indigenous Development Areas and on indigenous lands.

The Code will include the right of indigenous people to be consulted about the projects, to share in the benefits, to be compensated for damages, and not to be relocated from their homes except under the conditions stipulated in the (International Labour Organisation) Convention 169 (on Indigenous and Tribal Peoples), the president said.

We are thinking of an indigenous communities impact assessment for investment projects, similar to the environmental impact assessment studies that are already required, Egaña said.

Lastly, policies fomenting multiculturalism and inclusion will be created, and specific programmes will be developed for indigenous people living in urban areas.

Although Bachelet launched an indigenous affairs policy in April 2007, intended to last until 2010 when her term of office ends, the resurgence of the Mapuche land conflict in the southern region of Araucanía forced her to announce further reforms.

The first five guidelines for action she proposed were strengthening indigenous communities participation in the political and social arenas, recognition and strengthening of their rights, improvement of the quality of life of indigenous people living in urban areas, empowerment of women, and promoting education and culture.

In January, however, Mapuche student Matías Catrileo was shot and killed by the police when, with a group of fellow activists, he trespassed on a private estate that the Mapuche claim as part of their ancestral lands.

Another activist for the Mapuche cause, Patricia Troncoso, who is serving a 10-year prison sentence for terrorist arson , went on hunger strike for over 100 days.

Troncoso called off her fast when the government granted her prison privileges, including transfer to a prison farm and weekend leave, measures which were implemented in March.

Mapuche communities involved in conflicts over land have accused the police of repression and the justice system of persecution. These complaints, Egaña said, will be dealt with by the Presidential Advisory Commission on Human Rights, and by the courts.

Meanwhile, the country s indigenous groups are opposed to the way Congress ratified ILO Convention 169, which it did with a controversial interpretative declaration on article 35.

The Convention and the appended declaration are now being studied by the Constitutional Court, after which the treaty could be approved by President Bachelet.

Another government promise that has not yet been fulfilled is a constitutional amendment recognising indigenous peoples, which is currently making its way through Congress.

Javier Mamani Castro, an Aymara town councillor in Colchane in the north of the country, told IPS he was pleased with the president s speech, especially her announcement about introducing indigenous political participation in Congress.

But according to Paulina Acevedo, of the non-governmental Observatory for Indigenous Peoples Rights, who was invited to Tuesday s ceremony, there were no important announcements in what the president said, except for the social policies to do with health and education.

Acevedo said the announcements about political participation were vague. Nothing was said, for example, about a quota system for parliamentary representation. We ll have to wait and see what mechanism is finally chosen to implement these measures, she told IPS.

Mohammed Omer

GAZA CITY, May 14 2008 (IPS) – The Israeli siege of Gaza that has restricted access to food, water and medicine is now beginning to hit unborn children and newborn babies.

It can be a hard life for babies from day one, or even earlier. Credit: Mohammed Omer

Many babies are born suffering from anaemia that they have inherited from their mothers, Dr Salah al-Rantisi, head of the women s health department at the Palestinian ministry of health in Gaza told IPS. And the mothers are becoming anaemic because they do not now get enough nutrition through pregnancy.

That in turn happens because the Israeli blockade has choked the supply of food and medicines.

Dr al-Rantisi also heads the women s health unit at Nasser hospital, where about 30 to 40 children are born every day. Many suffer from anaemia, he says.

Anwaar Abu Daqqa, 30, has lost three babies prematurely. The foetuses were malformed as a result of lack of nutrition and medicine for the mother, Dr al-Rantisi said. And in the last case she reached hospital late because she could not find transport.

Premature babies born dangerously underweight is a daily and increasing phenomenon in Gaza s hospitals, he says.
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The Gaza Strip is poorer and harder hit than the West Bank, but there too there are well documented instances of women having to give birth at checkpoints because of restrictions on movement.

The ministry of health says 9,000 to 10,000 babies are born in the Gaza Strip every month. Of every 1,000 born, 28 die from malnutrition, anaemia and other poverty-related causes. The ministry has no figures for surviving babies suffering from malnutrition.

There are many cases of pregnant women who need medicines that are not available in Gaza, al-Rantisi said. Most families could not afford them if they were available, he said.

The World Bank said last month that the poverty rate in Gaza is now close to 67 percent and that economic growth last year was zero.

One consequence of poverty is anaemia. The condition, a direct consequence of poor nutrition, is not new to Gaza. The United Nations Relief and Works Agency (UNRWA) reported in 2002 that 19 percent of Gazans suffer from anaemia. That figure is estimated by UNRWA now to be 77.5 percent. Children receive on average only 61 percent of their daily need of calories from UN supplies.

Many of the newly born have been hit by the political situation before they could open their eyes to the world. Of the many deliveries that take place at al-Shifa hospital, the largest in Gaza, no one can tell how many of these children could grow up to live happy and healthy lives. Through the many dangers has arisen awareness of this new one that sanctions can hit Gazans quite literally prematurely.

The fear of bombing comes later; the first dangers are the lack of food, water and medicines.

Tahani Safi, 29, lies worrying about the caesarean section scheduled for the next day. She suffers from malnutrition, high blood pressure, diabetes, and a shortage of protective water around the child in the womb.

There are many mothers with such difficulties. Such cases can be found at any hospital, but doctors say the number of cases of conditions a result of poor food and medical care in Gaza is now rising. Health authorities have warned that the life and health of countless unborn babies is in serious danger all across Gaza.

So far 146 Gazans have died directly as a result of the Israeli siege, and the border closures and shortage of medication and health care this has brought, according to the ministry of health.

The U.S. celebrated Mothers Day Sunday May 11. No one in Gaza did.

Julio Godoy

BERLIN, Jun 13 2008 (IPS) – Climate change induced by global warming is provoking health hardships in Europe, especially through new, prolonged allergies, authorities say.
The most important new allergy affecting Europeans is being caused by ambrosia artemisiifolia, popularly known by several names, including common ragweed, annual ragweed, bitterweed, blackweed, or, more telling, hay fever weed.

The plant was native to North America, but was brought to Europe several decades ago, according to German biologists and health authorities. But with the recent, steady rise in temperatures in Europe, the plant, which grows to about a metre in height, has spread in Germany, France, Hungary, Italy and other European countries.

The plant s pollen is known to provoke hay fever, characterised by sneezing, runny nose, itching eyes, and even heavy attacks of asthma and conjunctivitis. Cases of skin infection provoked by ambrosia have also been reported.

Because the plant blooms during the summer and until October, it is prolonging the normal European allergy season by at least two months, Thomas Duemmel, meteorologist at the Free University of Berlin told IPS.

Duemmel said other allergenic plants, such as birch, alder, hazel, and horse chestnut flourish in the early spring and until mid-May. Now, with ambrosia added, the allergy season starts early in March and can go on until October.
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The higher temperatures of recent years have prolonged the blossom season of all these plants, thus worsening the allergenic affections of millions of people, Duemmel said.

The proliferation of ambrosia is particularly worrisome in health terms, because one single tree can produce up to one billion pollen, which, helped by wind, can spread hundreds of kilometres, Duemmel added.

We have to stop the proliferation of ambrosia, because the plant produces one of the most allergenic pollen known, said Stefan Nawrath, biologist and ambrosia expert at the Institute for Ecology, Evolution and Diversity at the University of Frankfurt, some 450 kilometres south of Berlin.

Ten grains of the ambrosia pollen per one cubic metre of air are enough to cause headaches, rhinitis, and even asthma, Nawrath told IPS.

The state-owned Julius Kuehn Institute for botanical research points out that ambrosia has been the most allergenic plant in North America.

In an official research paper, the institute says that ambrosia, because of its late blossoming, is unfertile in cooler regions of the world, and therefore cannot proliferate. The paper adds that given rising temperatures associated with climate change, it is important to research which climatic conditions make possible the fertilisation of ambrosia s seeds.

The health worries caused by ambrosia are so serious that several German health agencies have approved a plan to exterminate the plant. The health of millions is at stake.

Nawrath told IPS that in some regions in countries like France and Italy, at least 12 percent of the population is allergic to ambrosia s pollen. Ambrosia can also be a plague for agriculture, because it reduces productivity of fields.

In Germany, the incidence of allergies caused by environmental change has markedly increased since the post-war era.

According to official health reports, the percentage of the West German population suffering from hay fever or other forms of pollinosis went up from 20 percent for those born between 1942 and 1951 to 27 percent for those born between 1962 and 1971.

The German Society of Allergology and Immunology goes further, and says that today a third of the country s population suffers from one form of allergy or other. In its White Book on Allergies in Germany , the society says allergies have dramatically increased in recent years.

By now, deaths caused by allergenic asthma are more numerous than those caused by traffic accidents, the society says.

This increase in allergic diseases is necessarily linked to changes in the environment, says Heidrun Behrendt, director of research on allergology and immunology at the Technical University in Munich, 500 kilometres southeast of Berlin.

The genetic disposition for allergies cannot increase substantially within a given population, Behrendt said in an interview. Therefore, we have to look for explanations for the increase of allergic diseases in environmental changes.

In her most research, Behrendt and her team found that so-called pollen dependent lipid signallers (PALMS, after its German name) trigger allergic diseases by provoking interaction between allergen pollen and airborne chemical pollutant particles, such as auto emissions.

We could prove that pollen corns and air pollutants set free the PALMS, and are therefore an explanation for the recent increase of allergies, Behrendt said.

According to Behrendt s study, PALMS activate infected cells and suppress immune cells in human organisms, thus opening the way for allergies. This finding could explain why people suffer more from allergies in regions with high concentrations of air pollutants, either in urban zones with dense automobile traffic or near intensive chemical industries.

Diego Cevallos* – Tierramérica

MEXICO CITY, Jul 20 2008 (IPS) – Mexico is drafting measures to regulate the sales of pharmaceuticals over the Internet: reforms have been announced for laws dating back to the 1980s, when the world wide web did not yet exist, and new monitoring systems are in the works to track the who, how and what of online sales.

For medications sold online, caveat emptor. Credit: Public domain

Enlarge your penis. Want to lose weight? Say good-bye to impotence. Who hasn t received messages like this by e-mail?

The sale of medications over the Internet involves thousands of vendors and continues to grow, fuelled by low prices, lack of need for a medical prescription and a supposed guarantee of anonymity. But the medicine that is purchased this way may be adulterated, it may have been stolen, it may be contraband, or may simply have passed its expiration date, and in the worst case may contain dangerous or even deadly compounds.

The World Health Organisation (WHO) estimates that 10 percent of the medications sold worldwide are fake, although in some developing countries that proportion can reach 25 percent. And half of the medicines sold over the Internet on web sites that hide their real address are believed to be fakes.

A study published last month by the European Alliance for Access to Safe Medicines says that 62 percent of the pharmaceuticals sold online are false and do not meet the minimum standards for health, including those intended to treat serious cardiovascular, respiratory, neurological and psychiatric conditions.

Ninety-five percent of the online pharmacies studied operate illegally, and 94 percent of their web sites do not have an identifiable pharmaceutical chemical in their product. More than 90 percent provide people with prescription-only medications without requiring a prescription.
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In Mexico, which has the largest pharmaceutical market in Latin America and ninth in the world, annual sales of medications represent about 9 billion dollars. But because of sales of fake medications the drug companies lose 700 to 900 billion dollars annually.

Furthermore, every so often pharmaceutical shipments are reported stolen, and 40 percent of the medications that expire end up in the garbage, in illegal markets or sold on the Internet.

The government and non-governmental organisations warn of the dangers surrounding online sales of drugs, but general measures to fight the trade have yet to be defined, although there are some isolated efforts.

Mexico will confront the phenomenon, although authorities, pharmaceutical executives and activists consulted by Tierramérica admit that it will be very difficult to shut down Internet sales.

Before the end of the year, Mexican health authorities will present new Internet monitoring and tracking systems. There will be a new focus on this reality, Luis Hernández, an advisor of Cofepris, the federal health protection commission, told Tierramérica.

This agency, entrusted with monitoring the safety of medications, is in an intense process of readaptation that aims to determine which medical products are being sold online, said Hernández.

In addition, Cofepris will propose a new general law on health to replace the law currently on the books, drafted in 1984 and since then undergoing regular reforms. Globalisation brought with it a new focus on commercial practices, which is why there has to be legislation with a current viewpoint, he said.

Cofepris warns the public that medicines are not merchandise, that it s not the same as buying a pair of shoes. They are inputs for health, which implies a risk, so that this new form of sales over the Internet needs to be dealt with and regulated, Hernández said.

Thousands of web sites, some operating inside Mexico, offer mostly pharmaceuticals to enhance sexual performance, fight depression, lose weight or lower cholesterol.

Mexico right now has no regulation for sales of medicines over the Internet, but the best way is to raise consumer awareness with broad campaigns and set up pages on the Internet itself to inform people about the risks of buying their medications online, said Héctor Bolaños, president of the Association of Free Access Medications Manufacturers (medicines that do not require prescriptions).

We have seen adulterated medicines or which do not contain the ingredients of the original formula, and others with lower quantities (of the active ingredient) or toxic substances, he told Tierramérica.

For Alejandro Calvillo, president of the consumer protection group El Poder del Consumidor, many pharmaceutical companies that operate in Mexico sponsor the Internet sales sites, although they complain that some send fake or adulterated products, in the end for them it is part of the business, it is a way of positioning their brands.

The WHO discourages pharmaceutical advertising, but in Mexico medications are openly advertised and, further, through ad campaigns they even create diseases in order to sell more and more, Calvillo said in a Tierramérica interview.

In this country of 104 million people, with 70 percent of the population self-prescribing its meds, there are 224 pharmaceutical laboratories belonging to 200 companies, 46 of them corporations that are majority foreign-owned. Their drugs are sold in supermarkets and in about 23,000 pharmacies.

Mexico is a good market for the sector, because of its demographic characteristics. In 1970, the population over age 65 represented four percent of the total. By 2025 it will be 15 percent, and life expectancy will reach 81.6 years for women and 76.8 years for men.

The drug companies know that the higher the age the greater demand for health services and for medications.

I know that because of embarrassment many adults buy Viagra (a drug for erectile dysfunction) over the Internet. It s difficult to fight that, but they have to be warned that they could be in danger from the pills they buy online, said Bolaños.

In 2004, The U.S. Drug Enforcement Administration found in a worldwide investigation that in Mexico there were about 200 pharmacies that sold their products online, and most were located along the U.S.-Mexican border. From those sites they sold adulterated versions of Viagra and some illegal narcotics.

According to the U.S.-based Centre for Medicine in the Public Interest, in 2010 the global value of sales of falsified medications will reach 75 billion dollars, representing a jump of more than 90 percent from 2005 levels.

The Internet, where sites appear one day and disappear the next, is an excellent place to sell adulterated medicines. The consumers must be informed about this because their health is at stake, and the authorities should monitor it to the maximum extent, said Bolaños.

(*Diego Cevallos is an IPS correspondent. Originally published by Latin American newspapers that are part of the Tierramérica network. Tierramérica is a specialised news service produced by IPS with the backing of the United Nations Development Programme, United Nations Environment Programme and the World Bank.)

Emilio Godoy* – Tierramérica

MEXICO CITY, Aug 15 2008 (IPS) – Four years ago, when Guillermo Soberón one of Mexico s most prominent scientists became a grandfather, the newborn s parents received a letter requesting a donation of biological material to be used for medical research.

Sample collected at a sperm bank. Credit: Photo Stock

Requests of this kind reflect the mushrooming of biobanks banks that collect human biological material in Latin America, whether public or private, almost all of which operate without any specific legislation for their regulation.

Scientific research is advancing quickly, and has made evident the need for an appropriate legal framework, said Carlos Romeo, director of the Law and the Human Genome inter-university group, sponsored by the BBVA Foundation, the Diputación Foral de Bizkaia and the Spanish universities of Deusto and Basque Country.

A biobank is a not-for-profit entity that holds a collection of biological samples intended for biomedical diagnosis or research, and is organised as a technical unit that follows criteria for quality, organisation and purpose, according to Agustín Zapata, an expert with the Carlos III Health Institute of Madrid.

The LatinBanks project, a study of the legal and social implications of biobanks in Latin America, emerged to study the creation of laws. The initiative is the result of cooperation amongst the European Union, Argentina, Brazil, Chile, Colombia, Costa Rica and Mexico.

One of the aims is to elaborate proposals for optimising the legal structures and forms of organisation and participation with respect to biobanks.
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In Mexico, Article 6 of the constitution guarantees protection of data, and the Penal Code in Mexico City protects genetic information. Medical information is covered in broad terms by the General Law on Health.

In Argentina, there are public and private biobanks, for clinical and scientific research, physician Salvador Bergel, an Argentine member of the LatinBanks project, told Tierramérica.

So far they have followed administrative regulations established by the National Institute for Excision and Implants, which coordinates and monitors donations and transplants of organs, tissue and cells, he said.

In Brazil, the Biosafety Law, approved in 2005, refers to embryonic cells, but does not include management of samples or protection of personal data.

Meanwhile, in Costa Rica, biobanks are just getting started.

Carlos Valerio, representative of Costa Rica s Association of Medical law, said in a Tierramérica interview that there are sets of biological samples that were taken for very specific purposes and are not used for any purpose besides the one for which they were collected.

The risk of operating without regulations is, according to experts, that the confidentiality of the donors may not be respected or that the samples may be utilised without authorisation.

Ensuring the effective use of biobanks implies standardising the protocols they employ, adopting appropriate methods for codifying and identifying samples, obtaining informed consent from donors and hiring qualified medical staff.

In other Latin American countries, standards seem to be more lax. I m a supporter of first thinking about stimulating research and letting it be, before controlling it, attorney Emilssen González de Cancino, director of the genetics and law research centre at the private Externado University of Colombia, told Tierramérica.

Prohibiting new processes means losing opportunities for progress, said González de Cancino, who is coordinating a two-year study that began eight months ago.

In 1995, the European Union adopted a slate of standards for protection of physical persons and respect for personal data and circulation. In addition, the Protocol to the Convention on Human Rights and Biomedicine has been in effect since 2005.

In the last few years, interest in biological research with human material has developed very quickly, because of the implications it could have, said Romeo, one of the leading experts in the field.

According to a survey by the Institute of Juridical Investigations (IIJ) of the National Autonomous University of Mexico, in that country there are 38 biological banks operating in 51 public medical institutions.

Of the 38, 14 said they utilise blood, skin, brain tissue or bone marrow samples to carry out research on diseases like cancer and Alzheimer s, and that they conduct biomedical analyses. Furthermore, 12 said they have systems to protect patient confidentiality, one admitted it had no such protections, and the rest did not respond.

We are starting from zero because in Mexico there are no precedents in this area, said IIJ researcher Ingrid Brena.

Valerio cited the example of the efforts of the Health Ministry and the University of Costa Rica, that work under their own norms, which demonstrates that there is much yet to be done in the field of biological material in this Central American country, where there is only the private Provida, which collects umbilical cord blood.

The samples collected so far are derived from blood. Costa Rica has no cell banks for assisted reproduction or for bone marrow samples.

In Colombia, biobanks are found primarily in university institutions and they follow guidelines based on the Constitution, but it is medical ethics standards that provide the framework for the work that is currently being carried out.

It s obvious that we have to apply the standards on informed consent for the collection of samples, norms on confidentiality of the data that emerge from those samples, and standards for research on humans in general, but there are no specific laws as of yet in Colombia, said González de Cancino.

The ultimate goal of LatinBanks, according to Romeo, is to give rise to national laws that are based on common ground, but that also apply to the needs and characteristics of each country.

Another important question involves the economic benefits derived from donated biomaterial and from scientific uses of such material. Many experts believe that, since donation is voluntary, the benefits should go to the community.

Valerio notes that Costa Rica is trying to make a contribution towards better regulation of areas like ownership of biological samples and their storage. He predicts that through LatinBanks the members will formulate standardised guidelines that are in line with those of Europe.

In Colombia, research is advancing slowly, but without ignoring existing studies. The discussions lead more and more towards bioethics, said González de Cancino.

(*With additional reporting by Myriam B. Moneo in San José, Helda Martínez in Bogotá and Marcela Valente in Buenos Aires. Originally published by Latin American newspapers that are part of the Tierramérica network. Tierramérica is a specialised news service produced by IPS with the backing of the United Nations Development Programme, United Nations Environment Programme and the World Bank.)

Joyce Mulama

NAIROBI, Oct 15 2008 (IPS) – The war against HIV/AIDS, it is emerging, will not be won unless sexual and gender-based violence is tackled.
Participants at a recent regional meeting looking at linkages between violence against women and girls and HIV/AIDS described the two as dual pandemics that needed to be addressed concurrently for the HIV/AIDS fight to be successful.

We have continued to treat these two issues separately, yet they go hand in hand. The complexity of HIV/AIDS calls upon us to join together and seriously address sexual violence, noted Ludfine Anyango of the United Nations Development Programme.

Held in Nairobi, the conference on Strengthening Linkages between Sexual and Reproductive Health and HIV/AIDS Services, gathered donors, civil society and government officers working in the health sector in 13 countries in East, Central and Southern Africa.

The severity of sexual violence in Africa was reiterated by Nduku Kilonzo, the director of Liverpool VCT, a Kenyan non-governmental organisation advocating for HIV prevention, treatment and care, which organised the conference.

Sexual violence is fundamentally a public health problem that often times results in HIV/AIDS. We know that due to violence, many women are prone to the risk of contracting HIV/AIDS. For this reason, we must start to look at sexual and gender-based violence as a key intervention when addressing HIV/AIDS, she asserted.
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Her remarks echo those of the World Health Organisation (WHO) which has it that the risk of HIV transmission is greater when sex is forced and therefore the need to address sexual violence in countries HIV/AIDS plans. A report by WHO, presented at the meeting shows that 39 percent of sexually active girls in South Africa say they have been forced to have sex. This in a country with approximately 5.7 million people living with HIV/AIDS, the highest in the world, according to 2008 statistics from the joint United Nations Programme on HIV/AIDS (UNAIDS).

Sexual and gender violence is also widespread in East Africa, where states like Kenya have continued to record an increase in the number of sexually abused women and girls. The 2003 Kenya Demographic Health Survey (which is the latest) indicates that 43 percent of 15-49 year old women reported having experienced some form of gender based violence in their lifetime, with 29 percent reporting an experience in the previous year. About 16 percent of women reported having ever been sexually assaulted, up from 13 percent in the previous year.

Statistics like these have prompted critics to ask why legislation outlawing sexual violence is failing. International and regional instruments that require signatories to address violence against women and girls have come under the spotlight.

Examples that come to mind include the Convention on the Elimination of All Forms of Discrimination against Women adopted by the United Nations General Assembly in 1979, which recognises women s right to violence-free lives, the Beijing Platform for Action adopted in 1995 which calls upon governments to take measures to address violence against women.

More recently, the UN Security Council declaration 1325 passed in 2000 made an urgent call to end impunity for sexual violence. In 2005, a Protocol condemning violence against women and girl children was ratified and added to the African Charter on Human and People s Rights.

It is argued that lax implementation of these instruments stems from the fact that there are no sanctions or punitive measures against countries that fail to adhere to them.

Domestic laws that seek to address sexual violence have been criticised as lenient and overtly flawed. In Kenya and Uganda, the maximum sentence for rape is life imprisonment, but the minimum sentence for rape is life imprisonment, but the law is silent on the minimum sentence.

Kenya s Sexual Offences Act, passed two years ago, leaves it to the discretion of the magistrate civil society groups are concerned that this paves the way for magistrates to hand down sentences sentences that would not reflect the severity of sexual offences.

However, even as the clamour for these laws intensifies, the issue of rape within the context of marriage is even more serious. In most countries across Africa, marital rape is not acknowledged by the law as a form of sexual violence, exposing many women to the HIV infection by their partners.

The WHO report presented at the Nairobi meeting indicates that increasing numbers of married women are getting infected due to their partners behaviour. The report cites three studies in India, in which over 80 percent of HIV positive women were monogamous.

This scenario is reflected in several parts of Africa where where women even those who know their partner are HIV positive are unable to practice safer sex.

Many women are afraid to say no to sex with their spouses because they may be beaten. They cannot even ask their partners to use condoms because they will be battered or suspected to be having other affairs. In the end, they are forced to have sex without protection and may end up getting infected, Vivian Sebahire, coordinator of Solidarity Women for Development in Congo, told IPS at the conference.

Such incidents are causing fear of increasing cases of HIV/AIDS in a country whose prevalence rate is at 4.1 percent.

What came out clearly at the conference was the fact that in most African countries, organisations working on the prevention of violence against women are not specifically addressing women s vulnerability to HIV/AIDS infection and vice versa, jeopardising effective action.

It is therefore imperative, analysts argue, that countries enact laws that recognise and specifically address sexual violence particularly within marriage in order to win the war against HIV/AIDS.

Diego Cevallos

MÉRIDA, Mexico, Dec 4 2008 (IPS) – With cutting-edge science, social organisation and a strategy that puts an emphasis on prevention and environmental controls, Cristina Díaz and her team checked the spread of dengue in Cuba, while María Monroy did the same with Chagas disease in Guatemala.
Díaz has a doctorate in biochemistry and won Cuba s National Science Award in January, and Monroy has a PhD in medical entomology and won the National Science Award from Guatemala in 2004.

The Cuban researcher is fighting a disease that affected 866,000 people in Latin America and the Caribbean between January and October alone, while the Guatemalan scientist is working to curb a disease that has infected more than 10 million in the region.

The achievements of Díaz and Monroy, and of several other women involved in the field of ecohealth, were celebrated during the Dec. 1-5 International Ecohealth Forum 2008, which drew some 600 academics, scientists, government experts and activists from dozens of countries around the world to Mérida, on Mexico s southeastern Yucatan peninsula, to discuss the relationship between health and the environment.

In separate interviews with IPS, Díaz and Monroy both pointed out that climate change, which is modifying temperatures and seasonal cycles, and the destruction of ecosystems, are increasing the spread of the two diseases, which are transmitted by insect bites.

DENGUE DROPS TO ZERO
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This year, we have not had any cases of dengue in Cuba, we have it under control. If there are cases, they are all imported (by carriers of the disease visiting from other countries), the Cuban researcher said with obvious pride.

Díaz attributed that success to the multidisciplinary approach that she said was followed in her country, where cases of dengue fever were counted in the thousands in the not-so-distant past.

In fact, it was in Cuba that the first epidemic of the potentially deadly dengue hemorrhagic fever occurred in the Americas, in 1981, with more than 10,000 cases.

The health sector pays the costs of dengue fever, but the causes of the problem are found in the environment, said the expert.

Díaz and her team at the Pedro Kouri Institute of Tropical Medicine in Havana convinced the authorities that it was necessary to incorporate environmental controls and wide social participation in the fight against dengue.

As a result, starting in 2002, areas that served as mosquito breeding grounds were identified, and the authorities, along with local residents, got to work.

The dengue virus is carried by the Aedes aegypti mosquito, which transmits the disease by biting an infected person and then biting someone else.

Although there is neither a cure nor a vaccine for the disease, the symptoms generally abate if the patient follows a regime of complete rest, continued hydration intravenous in severe cases and treatment with acetaminophen. But complete recovery can take up to a month.

Symptoms include a high fever, rash, severe headache, pain behind the eyes, muscle and joint pain, loss of appetite, nausea and vomiting. Most infections result in relatively mild illness, but some cases progress to dengue hemorrhagic fever, which can be fatal.

Prevention efforts involve making sure that water does not accumulate in containers, like discarded tires, flower pots or old oil drums in shady areas close to human dwellings in urban areas, where the mosquitoes thrive because they prefer to lay their eggs in clean water.

According to the Pan-American Health Organisation (PAHO), nearly 866,000 people in the region were infected by dengue fever this year as of late October, and 238 patients died. The countries of South America, with Brazil at the head, were hit hardest.

If the vector appears, it means we have an environmental problem, which has to be attacked, said Díaz.

The multi-disciplinary approach goes beyond the spraying of affected zones, which is not effective on its own, said the researcher.

FEWER FORESTS, MORE CHAGAS

Three weeks ago, Guatemala became the first country in Central America to be declared free of Chagas disease transmission by the WHO (World Health Organisation), said Monroy, the founder of the laboratory of entomology and parasitology at the University of San Carlos School of Science and Pharmacy in Guatemala.

The Swiss-educated scientist said that a decade ago, hundreds of cases of Chagas disease were reported annually in her country. But this year, after several years of work with local communities, we have controlled the problem, using a holistic approach, she said.

There is no cure or vaccine for the often deadly Chagas disease, and in most cases only treatment of symptoms is possible.

The disease is caused by the bite of the reduviid bug, which lives in crevices and gaps in poor rural housing like thatch, mud or adobe huts in a number of Latin American countries.

The bug transmits a protozoan parasite named Trypanosoma cruzi through its faeces, which human victims unwittingly rub into the bite wound left by the bug, or into their eyes, mouth or nose. The parasites thus enter the victim s bloodstream and gradually invade organs of the body, often causing severe damage to the heart, digestive tract or nervous system.

The disease has three stages: acute infection, in which symptoms occur soon after infection; an asymptomatic phase, which can last months or years; and chronic infection.

In the first stage, which only a small minority of patients suffer, symptoms include swelling of the eye on one side of the face, exhaustion, fever, enlarged liver or spleen, swollen lymph glands, a rash, loss of appetite, diarrhea and vomiting.

Symptoms in the chronic stage can appear years or even decades after infection. Health problems include serious, irreversible damage to the heart or intestinal tract.

Monroy said that most reduviid bugs live in the forests, and that when we cut down the forests, the bugs have to go somewhere, and we provide them with ideal conditions. What temperature does the bug like? 23 degrees Celsius, the same temperature I prefer, so they come to our homes where it is warm, slightly damp, and dark, she said.

We provide the conditions that make Chagas disease a public health problem, said the scientific researcher.

Monroy works with health authorities in Guatemala to combat the spread of the disease, with the direct participation of affected communities. Local communities are taught about the disease and its characteristics, and with that information, they adapt their homes to keep the reduviid bug out and to live in harmony with the environment, she said.

Only an integrated approach that leaves aside spraying as the sole method for fighting the disease is effective, said the scientist.

PAHO reports that the socioeconomic impact of Chagas disease in Latin America is extremely high, ranking it behind respiratory infections, diarrhea and HIV/AIDS.

In Guatemala we have curbed the disease; we no longer have a significant number of cases, thanks to the integral approach. If this strategy is applied in the rest of the countries, the battle will be won, said Monroy.

Nergui Manalsuren interviews THERESE DOOLEY, UNICEF sanitation advisor

UNITED NATIONS, Feb 6 2009 (IPS) – While 2008 declared by the U.N. as the International Year of Sanitation came and went with 2.6 billion people, including almost one billion children, still living without basic facilities, UNICEF s sanitation and hygiene senior advisor, Therese Dooley, says there is reason for hope.

Therese Dooley Credit: Nergui Manalsuren/IPS

Hundreds of organisations are now working alongside governments and U.N. agencies to build safe, hygienic waste disposal systems, as well as to change cultural norms so that dangerous practices like open defecation are abandoned in the poorest communities.

It is almost like a social movement, she told IPS. It is about everybody working together.

IPS correspondent Nergui Manalsuren spoke with Dooley at UNICEF headquarters in New York. Excerpts from the interview follow.

IPS: According to recent U.N. statistics, every 20 seconds, a child dies as a result of a poor sanitation. That s 1.5 million preventable deaths each year. How does UNICEF hope to help resolve this global problem? TD: Sanitation is a huge issue for children. On the ground, we ve got water, sanitation and hygiene projects in about 96 countries at the moment operational. I m going to speak specifically on sanitation and hygiene because you can t distinguish sanitation from hygiene because even by building toilets and latrines, they have to be properly used, so that s when the hygiene component comes in. And, indeed, hand washing by soap after using the toilet is critical because [not doing so] is responsible for about 44 percent of diarrhea diseases.

Some of our great successes is Community-Led Total Sanitation. It s basically following a model where communities work for themselves to improve their own sanitation. We re moving away from the idea of subsidised individual latrines that may or may not be sustainable. We re getting exceedingly positive results in Asia and in Africa.
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If I take Zambia for example, it s been introduced in Zambia a year ago, in 12 communities to start with. What happens is the whole process followed by bringing the community together, the one who decides to make a change.

It s not about demonstrating shame to the community, it s about pride, and it s about the community wanting to have a clean, open defecation-free community. Within three months, all 12 communities declared themselves open defecation-free. Which means no one in those communities goes and defecates openly. And, the figures now are about 100 open defecation-free communities in Zambia. It s not just Zambia; it is Sierra Leone, Mozambique and Cambodia.

IPS: How did the International Year of Sanitation help to spotlight the problems of sanitation, mostly in the developing world? TD: The International Year of Sanitation had many achievements. The overall aim was to increase awareness among a number of different target groups. Primarily we were looking at influencing aid administration, governments, and implementers, but also the general public. We have reports that we re currently evaluating, but the preliminary results were really positive.

So, in some countries there were sanitation policies put in place, in some they started looking at strategies, or the development of standards for sanitation. In some countries it meant that it s increased the budget allocation made by government.

We also looked at multilateral and bilateral donors have they done anything special for sanitation? Have they increased their budget allocations? I think all in all the proof will come in the next six to eight months. I don t think the year is over, I think the year is just started for sanitation.

IPS: Are there any estimates of how much of funding is needed to provide adequate sanitation to the 2.6 billion people suffering from the lack of it? How much of this funding is available now? TD: There s huge difference in opinion because in some cases you have much higher investments needed for urban and urban infrastructure if you like large-scale sewage systems versus rural. But you have to do both. And, the issue is how much then is needed for ongoing maintenance and repair.

How much is currently invested is a very difficult question to answer and how much more is needed. Because one of the problems with sanitation is that it doesn t have its own ministry, or its own investment line. It can be split across the ministry of environment, the ministry of urban development, the ministry of rural development, the ministry of health.

But the reality is there s still not enough investment in sanitation. There s not enough investment at all. We re not coming near anywhere what is needed.

IPS: Are developing countries themselves doing enough to help resolve the problem? What are the success stories in the developing world? TD: There are countries that have really achieved such tremendous coverage. If you take a country like Malawi or a country like Sri Lanka, you ve got practically full coverage. If you look at the map, you sort of see that we re not going to achieve MDGs [Millennium Development Goals], but then you ve got these jewels in the middle of that map who basically are doing very well, and are achieving success.

I think what you ve got to look at is the statistics showing us that people may not be achieving the MDG but they are moving up by the ladder of success. So, the change is really desired, and people are really changing and moving. The whole issue is how we take to the next step.

The International Year of Sanitation has given us motivation and encouragement to do something, and the whole thing now is not to let it stop. And, to keep working with our colleagues and governments in developing world not only to achieve the MDG on water and sanitation, but to get best results for other MDGs. Because, sanitation affects girls, it affects schooling, health, and economy. Improving sanitation has so many benefits, but because it s so basic, people tend to forget about it.

IPS: What role does the private sector and non-governmental organisations (NGOs) have in sanitation? The World Toilet Association (WTA) in Korea is currently funding sanitation projects in several developing nations, including Ghana, South Africa, Cameroon, Mongolia, Indonesia and Laos. What are your thoughts on this? And does UNICEF work with NGOs on the ground? TD: The role of NGOs and private sector is absolutely enormous in this whole process. UNICEF works with governments and through other partners: NGOs, private sector, community-based organisations, faith-based organisations.

I think it is crucial for sanitation because if we talk about sanitation it is almost like a social movement, the role of NGOs is very important. So, we definitely work with many of them. The WTA is one of hundreds of NGOs actively working in sanitation, and without NGOs and community-based organisations, without people who out there on the ground whether governmental or non-governmental, we can t do sanitation alone. It is about everybody working together.