Complete Wellness

BULAWAYO, Mar 24 2011 (IPS) – In the dusty streets of Bulawayo’s densely populated townships, Susan Nkiwane is making house calls today. She is one of a group of twelve women who form a fragile web of support for TB sufferers in her community.

Waiting for TB treatment. Credit: Gary Hampton/World Lung Foundation

The conditions in the Nkulumane neighbourhood where Nkiwane works are ripe for the spread of tuberculosis. The disease thrives in densely-populated areas and enclosed spaces that faciliate airborne transmission.

This is made worse by widespread fear and stigma of TB which is closely associated with AIDS here.

As a home-based caregiver, Nkiwane has witnessed silent suffering in many houses where she sees visibly-ailing people who resist her advice to get tested. It is common for people to hide their sick relatives.

People are still afraid, Nkiwane says. Many still believe getting tested for TB and being found with the disease also means you are living with HIV and AIDS.

TB and HIV
As resource-limited countries rapidly expand their HIV/AIDS treatment and care programmes, TB is now a major public health threat for people living with HIV and the community. Among people living with HIV, TB is the most frequent life-threatening opportunistic disease, even in those receiving antiretrovirals, and it has been shown to be a leading cause of death.
Globally, there were 700,000 TB cases among people living with HIV in 2006. An estimated 230,000 people living with HIV [died] as a result of TB in 2008 – around 630 people every day – despite the fact that TB is curable.
Prevention and treatment of TB in people living with HIV is an urgent priority for both HIV/AIDS and TB programmes. The Three ‘I’s, isoniazid preventive treatment, intensified case finding for active TB, and TB infection control, are key public health strategies to decrease the impact of TB on people living with HIV.
Source: World Health Organisation
The World Health Organisation (WHO) says that because of their weakened immune system, people living with HIV are less able to fight infection and are more likely to develop active TB. In the streets of Bulawayo, this well-known connection is slowing the fight against both diseases.

The two diseases are like evil twins. Co-infection rapidly increases the mortality rate and untreated sufferers of both HIV and TB are the most infectious, posing the greatest risk to those around them.

Both diseases can also be treated successfully but the first step in treatment is testing and diagnosis.

We get some patients who stay home after being told they need to take these TB tests because they have been conditioned to associate TB with HIV and vice versa, said Feluna Nxumalo, a senior nurse at the Bulawayo City Council’s Thorngrove Tuberculosis Clinic.

WHO recommends a three I’s approach to control HIV and TB: Isoniazid Preventive Therapy, Intensified TB screening and Infection Control for TB. The strategy is to screen people living with HIV who show signs of TB for the disease; this will enable them to be put on appropriate treatment both for their own health and to prevent them infecting others.

It is also recommended that all children and adults living with HIV be routinely given isoniazid, a cheap anti-TB drug, as a preventative measure for six to 36 months or longer in a setting with a high prevalence of TB and HIV.

Nkiwane and her colleagues work with the local clinic in Nkulumane, which provides them with latex gloves and face masks to protect the care-givers own health as they make their rounds of the neighbourhood.

We tell members of the family to avoid unnecessary contact with the patient as TB is highly contagious in closed spaces and especially for children, Nkiwane said.

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Others have advised total quarantine of TB patients but this is controversial with both patients and relatives who say it only serves to increase stigma against TB patients. Support and care from family can be an important part of successful treatment.

The Bulawayo municipality health services department has city-wide campaigns to help raise TB awareness and reverse perceptions that hinder control of the disease.

This has included awareness programmes at local clinics where TB patients are educated about how to avoid spreading infection wearing masks and ensuring rooms are as well-ventilated as possible reduces the risk.

Analysis by Peter Custers

LEIDEN, the Netherlands, Apr 25 2011 (IPS) – The accident could have served as a wake-up call to the whole of humanity. Twenty-five years ago, on Apr. 26 1986, disaster struck at the fourth reactor of the Chernobyl nuclear complex in the Ukrainian state of the former Soviet Union.
The accident actually started taking shape in the preceding night, when workers undertook a turbine test that had incompletely been carried out before the nuclear plant became operational. When the test was being carried out, the automatic emergency system was shut down, undermining reactor safety.

Gordon Ross

BEIJING, May 30 2011 (IPS) – Despite notable successes in the battle against HIV and AIDS in China, discrimination against infected people remains rife here and critics continue to question the Chinese government over allocation of treatment funds.
China has cut AIDS mortality by almost two-thirds since it began distributing antiretroviral drugs nine years ago, according to a study released in May by China s national centre for control and prevention of AIDS.

Roughly 63 percent of AIDS patients who require drugs now receive them, up from virtually none in 2002, resulting in a 64 percent drop in mortality in terms of person-years an estimate of how long someone would have lived without the disease. AIDS mortality dropped to 14.2 per 100 person-years in 2009, down from 39.3 in 2002.

Despite the success story, the Global Fund to Fight AIDS, Tuberculosis and Malaria has frozen hundreds of millions of dollars worth of grants to China over disagreements about how China manages the money, in particular its hostility towards community-based organisations.

About 740,000 people are infected with HIV or AIDS in China, a number that is expected to grow to 1.2 million by 2015, and AIDS continues to be a major killer. The disease claimed 7,743 lives on the mainland in 2010, a 16.79 percent increase from the previous year, making it the country s top killer among infectious diseases for the third year in a row, according to a Ministry of Health report in February.

The rise was attributed to patients infected with HIV in the late 1990s who are now developing full- blown AIDS. Hao Yang, the deputy director of the ministry s disease prevention and control bureau, also noted that many AIDS-related deaths in previous years went unaccounted for.
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Wu Zunyou, an AIDS expert and director of the National Centre for AIDS/STD Control and Prevention, told China News Agency that one of the main reasons for the increase in deaths was the large number of patients who refuse testing for fear of stigmatisation, leaving treatment until it is too late. He said that among the cases of AIDS-related deaths in the last five years, 80 percent had refused treatment.

It s common to see misunderstanding and discrimination against AIDS patients, Wan Yanhai, China s most outspoken AIDS activists who left China for the United States Last year, tells IPS on email.

AIDS patients seeking surgical treatment for other diseases are often refused, and sent to hospitals that treat only HIV/AIDS patients, which often lack proper surgical facilities, Xinhua News Agency reported this month.

Stigmatisation is fuelled by misinformation, Wan says, pointing to a survey conducted by the Chinese Journal of Health Education, which found that 51 percent of respondents said they would not shake hands with HIV carriers and 80 percent would not buy products from infected people.

A study conducted this March by the United Nations Joint Programme on HIV/AIDS, the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria, and Renmin University found that 49 percent of 6,000 respondents in six Chinese cities believed AIDS was transmitted through mosquito bites.

Over 18 percent said they could be infected if they shared a bathroom with an AIDS patient, and another 18.3 percent thought they might be infected if an AIDS patient coughed or sneezed near them.

Meanwhile, HIV/AIDS patients continue to face hardship.

Liu Cuiqin, a 32-year-old AIDS patient in Fuyang city, Anhui province, was diagnosed nine years ago when she delivered her baby. After she tested positive for HIV, which she picked up through a blood transfusion, her husband abandoned her, and her parents severed ties, she tells IPS.

Tian Xi, a 24-year-old from Zhumadian city, Henan province, received blood transfusion in March 1996. In 2004, he was diagnosed with AIDS, hepatitis B and hepatitis C. He filed a lawsuit against the hospital in which he was infected, but local courts refused to hear the suit.

Tian is currently serving one year in prison for intentional destruction of property. He damaged some office property in the hospital where he was infected after the hospital s president refused to speak with him, according to Tian s father.

Chinese law forbids discrimination against HIV/AIDS patients and ensures them the right to proper treatment. The government began addressing the issue seriously after an outbreak in the early 1990s, when contaminated blood was injected into tens of thousands of poor farmers.

In February, the State Council issued a notice requiring all relevant government departments to safeguard the rights of AIDS patients. The notice also asked government departments to strengthen medical services for AIDS patients, help alleviate economic burdens on patients and families, increase the production of medicine, and offer tax subsidies on drugs.

But the government has largely shunned grassroots groups in the fight to control AIDS, denying them funds it had promised under the Global Fund agreement. China has received 539 million dollars from the Global Fund since 2003, with an additional 295 million dollars in the pipeline.

Audits last year found that China had failed to give an agreed 35 percent of a 283 million dollar AIDS grant to community-based organisations. This prompted the Global Fund to freeze the money.

I think the Ministry of Health was fooling the Global Fund, Wan says.

PORTLAND, Oregon, Jul 18 2011 – How much good can a small red pouch, zip tie and sheet of paper do for someone living on the streets? Turns out, a lot.

The Vial of Life contains medical information that can help homeless people in case of emergency. Credit: Courtesy of the Downtown Chapel

Downtown Chapel is pioneering an innovative, potentially life-saving programme for medically vulnerable people experiencing homelessness called the Vial of Life programme. It s actually an adaptation of a nationally established programme used by people who have homes, applied now to those who do not.

Homeless participants can fill out a one-page sheet listing medical illnesses, prescriptions, emergency contacts, allergies and blood type, stuff it into a red plastic pouch no bigger than an index card, and attach it to their backpack. The vial provides an easily identifiable, relatively reliable record to emergency personnel, and Downtown Chapel keeps a copy in case the original is lost.

Since June, around 40 homeless individuals have participated in the Vial of Life programme at Downtown Chapel, meeting one-on-one for a few minutes with volunteer nursing students from the University of Portland who help them fill out medical information and even call pharmacies if there are questions about prescriptions.

Reviews by participants have been over the moon , says Andrew Noethe, pastoral associate at Downtown Chapel who is overseeing the implementation of the Vial of Life programme in collaboration with parish nurse Sharon Christenson.
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Participant Michelle says she recommends it to other friends on the street who have seizures or diabetes and thinks there should be a lot more awareness about the Vial of Life programme.

So far, people seem eager to sign up for the programme. When you re vulnerable and sick, you know it, says Michelle.

Diabetes, seizures and cognitive disabilities are at the top of the list of health issues that the Vial of Life programme hopes to track. The health record may be largely self-reported, but the volunteer nursing students at Downtown Chapel help ask the right questions in a safe place, says Noethe.

Sometimes a participant will just open their bag and show a nurse all the pills they ve been taking, and that s helpful if EMTs pick that person up, he says.

Piloted with Northwest Parish Nurse Ministries and Providence Health Systems, the Vial of Life programme is an enormous boon for homeless health care in Portland.

People who are homeless are often mobile, without health insurance, especially vulnerable to injuries and illness, and prime candidates for reduced recollection, often the result of past trauma or head injuries.

Emergency personnel, including EMTs, police and Central City Concern s CHIERS staff, are frequently forced to rely on guesswork when it comes to helping sick people on the streets.

For instance, last year more than 8,400 inebriated people were picked up off the streets and taken to Hooper Sobering Center on NE Burnside and MLK. One of the first questions asked is, do you have any medical conditions,’ says manager Steve Mattsson. But he admits that the homeless folks who come in are notoriously poor historians of medical history. Plus, alcohol can mask many serious medical issues.

I meet first responders who wonder, did I make the right choice?’ says Noethe, who hopes the Vial of Life programme will change that.

The bottom line is we need to make sure those in need however that is defined get the right help in an emergency, says Jean Marks with Providence Health Service s Public Relations office.

Emergency responders seem to be excited about this programme because it makes their job easier. They don t have to guess about their patients allergies and prescriptions, says Marks. It serves the poor and vulnerable, but it also helps everyone do a better job.

Bruce Strade, executive director of Northwest Parish Nurse Ministries, says they are just getting a feel for how successful the programme is, but thinks adapting the programme for other agencies is not out of our reach .

Downtown Chapel s idea for the Vial of Life programme originated from Northwest Parish Nurse Ministries and Providence Health Systems Vial of L.I.F.E. (Lifesaving Information for Emergencies) programme a traditional method of storing medical information of isolated elders in readily identifiable pill bottles in refrigerators.

Early this year, parish nurse Sharon Christenson asked, why not do this in the homeless community? and approached Noethe with the idea of implementing the Vial of Life programme at Downtown Chapel. Noethe says he immediately took to the idea, remembering times when homeless guests passed out mysteriously in Downtown Chapel s lobby.

He is especially hopeful that the programme will help guests with trauma history, including traumatic brain injuries, who cannot recall medical history.

They don t always keep everything in mind, says Michelle, who is borderline diabetic combined with other medical issues. And if (medics) don t know about it, that s a problem.

Noethe agrees. It is essential that first responders, especially in Old Town, are able to identify the Vial of Life pouches and make use of them, says Noethe.

His plan forward is to replicate the Vial of Life programme among other Portland service agencies. Noethe has even created a manual for other organisations to implement and evaluate the programme.

I have no doubt this is going to benefit someone, says Noethe. With Vial of Life, we re not doing case work where we follow people over time, and we won t always get to see the outcomes.

But I know this will improve lives.

*Published under an agreement with .

THIRUVANANTHAPURAM, Jul 12 2011 (IPS) – When Sujatha’s husband learned that she had conceived just five months after they got married, he became agitated over what he called her ill-timed pregnancy . To worsen her husband’s anxiety, a test to determine the sex of the foetus showed she was carrying a girl.
Sujatha, a public school teacher, and her husband, a civil engineer – who asked that their full names be withheld – are from well-off and educated families in Thiruvananthapuram, the capital of the southern state of Kerala. Yet they dared violate the law, approaching doctors at the Sree Avittam Thirunal Hospital for an abortion; they were granted one within a month.

The law prohibits Indian couples from selecting the sex of their unborn children, and from discriminating against female foetuses. Abortions are legal only for certain reasons, like when the mother is ill and pregnancy would endanger her life, or when a foetus is found to be severely handicapped.

But even with these laws in place, educated urban couples like Sujatha and her husband are opting for sex-selective abortions, thus causing a decline in the female population.

Sex determination tests have spurted across the nation, despite efforts to strengthen the Pre- Conception and Pre-Natal Diagnostic Techniques (PC PNDT) Act, the law against the misuse of pre- natal tests for sex selection.

Indian health minister Ghulam Nabi Azad told reporters in New Delhi that the central supervisory board on the PC PNDT Act has been reconstituted to prevent widespread sex determination tests.
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Azad said the Medical Council of India (MCI) should urgently ensure that guidelines for accreditation of training and experience are put in place quickly. The government has asked the MCI to implement a tough accreditation system for institutes that give training on the use of ultrasound machines, while considering the increasing trend of fraudulent institutions that use bogus certificates.

The health departments of the different states have also started cracking down on illegal sonography centres and fraudulent maternity clinics.

The Indian parliament enacted the PC PNDT law in 1994 and amended it in 2003. Sources in the central health department said that between 2003 and March this year, 805 cases had been filed against doctors for violating the law, resulting in 55 convictions.

The Indian socio-cultural psyche prefers a son to a daughter. This belief is very strong in northwest India, including Haryana and Delhi, where sex selection tests are very common, Dr. V. Raman Kutty, a health activist and professor at the Achutha Menon Centre for Health Science Studies in Thiruvananthapuram, told IPS.

Advances in medical science have aided the popularity of these tests. The metros are the major centres for the tests with sophisticated laboratories. However, amniocentesis and ultrasound are available even in the clinics of small towns and cities, he pointed out.

A study led by Dr. Prabhat Jha of the University of Toronto’s Centre for Global Health Research and published in the British medical journal The Lancet estimates that up to 12 million selective abortions of girl foetuses had occurred in India in the past three decades.

Sex-selective abortion was rare in India during the first half of the 20th century, but the availability of ultrasound machines has made sex determination easier, leading to an increase in the frequency of such tests.

Experts observe that the abortion law in the country, called the Medical Termination of Pregnancy (MTP) Act, has many loopholes that save violators from penal action.

Dr. Sunny Sebastian, a health expert in Mumbai, told IPS that in the present system, the doctor and patient can do abortions for wrong reasons. A survey conducted in Mumbai revealed that both doctors and patients do not heed legal warnings and have done abortions in advanced stages of pregnancy after discovering the foetus was female.

Sex selection is taking its toll on the population. The 2011 Census data found a decline in the number of girls in the zero-to-six age group, reflecting a steady decline in the child sex ratio (CSR). In 1981, there were 971 girls for every 1,000 boys; in 2011, the number of girls dropped to 914.

The data revealed that CSR has declined in 431 districts, but improved in 149 districts of the country.

While citing the new census data, Azad said there were 7.1 million fewer girls than boys. In 2001, this gap was six million. This means around 3.1 to six million girls have been aborted in the past decade.

Activists say preventing female foeticide is a serious challenge before Indian society and that the economic factor plays a key role in the change in CSR.

Durga Lakshmi, a social activist and lecturer in Metca Institute of Teacher Education at Varkala, Kerala, told IPS that the financial wellness of a family determines whether it will decide to have a girl child or not.

Through empowerment, strengthening of rights, campaigning against vicious practices and ensuring strict implementation of law, society can wipe out sex selection and abortion of girls. Economic distress is the basis for smaller families preferring sons. Daughters are thought to be an economic burden in poor families, she said.

Denis Foynes

UNITED NATIONS, Aug 12 2011 (IPS) – A new report by the International Committee of the Red Cross (ICRC) describes a pattern of attacks on medical staff that the group says is undermining the safe delivery of medical assistance and health care across the globe.
The violence against health care faculties and medical personnel must end. It s a matter of life or death, said Yves Daccord, head of the ICRC. The human cost is staggering civilians and fighters often die from their injuries simply because they are prevented from receiving timely medical assistance.

The lists hundreds of attacks on patients, health care workers and facilities, including looting and kidnapping, as well as arrests by security forces and deliberate obstruction of access to vital medical help.

The ICRC focused on 16 war-torn countries, including Libya, Afghanistan, Somalia and Colombia. It analysed reports collected over a two-and-a-half year period, describing 655 violent incidents, using data obtained from humanitarian agencies, including the ICRC, and from open sources such as the media and websites.

In 33 percent of the cases, the violence was committed by state armed forces, and 36.9 percent by armed groups. The report says that these criminal actions could result in the unnecessary deaths of thousands if not a million people around the world.

Under a 150-year-old principle adopted in the first Geneva Convention, it is the right of those wounded in war to receive medical treatment and the right of medical workers to move freely to help people in need of vital assistance.
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Despite numerous efforts by the International Red Cross and its partner, the Red Crescent Movement over decades to put an end to these acts, the problem nonetheless continues, says the ICRC.

The most shocking finding is that people die in large numbers not because they are direct victims of a roadside bomb or a shooting, said Robin Coupland, whose research in the 16 countries formed the basis of the report.

They die because the ambulance does not get there in time, because health-care personnel are prevented from doing their job, because hospitals are themselves targets of attacks or simply because the environment is too dangerous for effective health care to be delivered.

A recent example of a hospital failing to be granted neutrality in a conflict zone can be seen in Manama, Bahrain during this year s Arab Spring revolt.

As injured protestors came into the hospital in Manama for treatment, the facility slowly evolved into a focal point for the movement. As thousands more took to the streets in the pursuit of democracy, the hospital filled with protestors and international media.

Allegations began to fly between the army and medical staff. The latter were accused of aiding the revolution, only treating rebels and supplying propaganda.

Forty-seven doctors were detained and put on trial, accused of aiding the protesters and trying to overthrow the state. They denied the charges, and said that some of their staff were tortured in the pursuit of confessions.

Asked by IPS about the root causes of the problem, Bijan Frederic Farnoudi, a Red Cross spokesperson, said that, There are several issues involved here which make an explanation quite complex. One fact is that while attacks of medical services are certainly illegal, in some places they are accepted as the norm.

Also the change in warfare must be considered. Conflict mainly takes place in urban areas now. Patients go to the hospital along with the military, hence the hospital and the staff becomes drawn into the conflict.

What is important to remember about the report is that while we have always known medical staff are hindered by these factors, the staggering extent of the damage this causes is now clearer, he said.

Asked what can be done by the international community, Farnoudi stated, There are a number of methods to tackle this problem. It is important to remember that this is cannot be solved by the Red Cross or the health community. This is because these attacks are not health issues but security issues.

There are a number of short-term or long-term solutions out there. The reason we are releasing this report and holding press conferences is to generate publicity and force the governments, armed forces and NGO s into action and protect medical services, he said.

Doctors and medical staff are now themselves becoming causalities of war. In the words of Daccord, the current situation is one of the most urgent yet overlooked humanitarian tragedies, the issue has been staring us in the face for years. It must end.

The release of the report marks the beginning of a four year campaign by the ICRC to remind armed groups of their responsibility to allow the injured to receive their treatment and to permit medical personnel to workout obstruction.

Elizabeth Whitman

UNITED NATIONS, Sep 21 2011 (IPS) – There is a well-documented and shameful history of certain players in industry who put public health at risk to protect their own profits, U.N. Secretary-General Ban Ki-moon told world leaders Monday as they met to address the issue of non-communicable diseases at the 66th U.N. General Assembly.
The high-level meeting provided countries with a chance to share stories of success and innovation to combat NCDs, the most common of which are cancer, diabetes, chronic respiratory illness, and cardiovascular disease.

Responsible for 63 percent of deaths worldwide, or 36 million deaths per year, NCDs constitute a serious threat to global social and economic development.

Yet throughout events held on Monday and Tuesday, and in the agreed upon by member states outlining the steps they would take to address NCDs, a clear, persistent and pervasive challenge emerged: ensuring that profit-driven corporations and industry groups are not able to influence policies or other efforts aiming to improve public health.

Government and civil society leaders alike agreed that, as the political declaration stated, NCD prevention and control require multisectoral approaches . But many also expressed concern that no clear boundaries exist to distinguish appropriate involvement of the private sector from the inappropriate and potentially unethical, or to ensure that profits do not trump public health.

A demonstrated conflict of interest
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The political declaration itself explicitly noted a fundamental conflict of interest between the tobacco industry and public health, but it did not do the same for the food and beverage or pharmaceutical industries. Rather, it called on the private sector to consider producing and promoting more food products consistent with a healthy diet and to contribute to efforts to improve access and affordability for medicines.

Tobacco, overconsumption of alcohol, an unhealthy diet, and lack of exercise are the four main causes of NCDs. Industry groups play a key role in the first three of these areas, though whether that role is advantageous or dangerous to public health can vary.

Bill Jeffery, national coordinator for , Canada (CSPI-Canada), told IPS private sector engagement will have no integrity without a code of conduct. Nor was the relationship between trade and health squarely addressed in this political declaration, Jeffery pointed out.

CSPI-Canada is part of the calling for the creation of such a code.

Douglas Bettcher, director of the s (WHO) Tobacco Free Initiative WHO is considered the world s primary specialised health agency told IPS that WHO had very clear and strict guidelines vis-à-vis work with commercial enterprises to make sure that our policy work is not deviated and not open to undue influence by the private sector.

He insisted that the political declaration did protect against such undue influence. It says very strictly, where and as appropriate,’ he told IPS.

Nevertheless, there are certain aspects of reducing risk factors where the cooperation of the industry can be beneficial, Bettcher said. Actually implementing policies by cutting down on sodium in foods and engaging in responsible marketing can help improve public health, for example.

But when industry groups participate in discussions or are involved in policy making decisions, their influence can run the gamut from directly opposing public health interests to emphasising control of NCDs, a more profitable aspect from the pharmaceutical perspective, for instance, over prevention.

Ensuring that the focus is less on prevention and more on how to control NCDs is one way the pharmaceutical industry can profit from the NCD crisis, Gigi Kellet, deputy campaign director for , told IPS.

Prior to the start of the NCD summit, PepsiCo co-hosted, with two U.N. agencies, a breakfast panel discussion at the U.N. on Monday for government representatives.

When asked about the potential for a conflict of interest in such an event, Bettcher told IPS that side events were separate from the U.N. and WHO.

Dr. Mehmood Khan, CEO of PepsiCo s Global Nutrition Group, spoke at a related event on Tuesday, where he emphasised the need for public- private partnerships. He stated explicitly that his job was to help the group grow to 30 billion dollars by 2020, and reminded the audience, Processing (foods) equals preservation of important food groups.

Resistance to hard targets

WHO recommended setting a goal of reducing NCD deaths by 25 percent by the year 2025, a target whose exclusion from the political declaration drew criticism from many leaders. Monitoring NCDs and setting reduction targets are the next crucial steps and challenges they said.

Without clear targets there will be neither accountability nor a real incentive to deliver, Princess Dina Mired of Jordan, director of the King Hussein Cancer Foundation in Jordan, told the General Assembly on Monday.

Joanna Ralston, CEO of the World Heart Forum, a member of the NCD Alliance, highlighted the disparity between NCD rates in developed versus developing countries, where 90 percent of NCD-related deaths occur.

Because people are increasingly urbanised, living in huge dense cities in low and middle income countries, their lifestyles and food options have changed, Ralston told IPS. They generally get less exercise and don t have as many options for healthy food.

There s a host of factors that affect this, she elaborated, ranging from urban planning to agricultural development to trade. These aspects are in some ways part of the problem, but they can also be part of the solution, she said. She also mentioned a need for stronger language surrounding specific targets.

Regulating the amount of sodium allowed in foods, for instance, has a clear impact on cardiovascular disease, Ralston said.

All over the world, evidence points to the feasibility of reducing NCD deaths. The challenge that remains for many countries is simply to take action.

After imposing advertising bans and anti-tobacco laws, Uruguay, for example, saw a 25 percent reduction in smoking over a three-year period. Meanwhile, Brazil has taken steps to increase the amount of physical activity children get at school and to better label foods while reducing sodium content and eliminating trans fats from foods.

WHO estimates that NCD-related deaths will increase by 17 percent in the next decade, but in Africa the increase will be 24 percent. According to the World Economic Forum, over the next 20 years, the global economic impact of the four major NCDs, plus mental ill- health, could total 47 trillion dollars.

UNITED NATIONS, Nov 8 2011 (IPS) – More than 5,000 Haitian cholera victims are seeking compensation, action and an apology from the U.N. and the United Nations Stabilisation Mission in Haiti (MINUSTAH) for the ongoing epidemic that has killed more than 6,600 Haitians and sickened more than 476,000 since October 2010.

A young child is seen crossing one of the canals of the Artibonite River, identified as the source of the cholera outbreak. Credit: UN Photo/Sophia Paris

Brian Concannon, who is based in Boston and is the director at the , helped organise a petition from Haitian victims and relatives of victims, before filing the claim to the U.N. simultaneously with a claim to its peacekeeping mission in Haiti, last Thursday.

The victims petition alleges that the U.N. and MINUSTAH are liable for hundreds of millions of dollars for failing to screen and treat peacekeeping soldiers arriving from Southeast Asian countries experiencing cholera epidemics, dumping untreated waste from a U.N. base directly into Haiti s longest and most important river, the Artibonite, and failing to respond adequately to the epidemic.

Concannon and his team say in the petition that reports compiled by the United States-based Centres for Disease Control and Prevention, the Harvard Cholera Group, Dr. Renaud Piarroux, a French epidemiologist who has spent his career studying cholera, the Wellcome Trust Sanger Institute in Cambridge, England and the International Vaccine Institute in Seoul, Korea found that the Vibrio cholerae bacteria was introduced to Haitian waters by MINUSTAH personnel deployed to Haiti from Nepal.

Prior to the peacekeepers arrival, Haiti had not reported a single case of cholera for more than 50 years.

Awaiting a U.N. Response
While Concannon and Kurzban are waiting for a response from the U.N., MINUSTAH has requested a meeting to discuss their petition, the date is yet to be scheduled.
“As far as we know, this hasn’t been done before, so it all depends on the U.N.’s response about how they will deal with it,” Concannon told IPS, in regards to how long they will wait until they pursue further action with a national court.
“If they come back to us and say they are willing to talk about it and follow a fair formula, then we will be happy to wait. This is the worst cholera epidemic in the world and some experts expect the death toll to reach 20,000, unless there is swift action. We want the U.N. to bring in medical treatment straight away.”
Kurzban agreed and said their goal was to work with the U.N. to resolve the issue before it goes too far.
Ever since the cholera outbreak, we have had people coming to us asking us what to do, Concannon told IPS.

We originally thought the U.N. would take on responsibility as we didn t originally see this as a legal case at first. But we could no longer dismiss the people after no action was taken.

Vibrio cholera

Cholera, a waterborne illness that causes diarrhoea and vomiting, is a result of an infection with a pathogenic strain of the Vibrio cholerae bacteria. If it is not treated immediately, cholera can kill adults and children in a matter of hours. According to the World Health Organisation, up to 80 percent of cases can be treated successfully with oral rehydration salts.

The virus, which is endemic in Nepal, reportedly had a surge of cases in the Kathmandu Valley in August and September 2010. With peacekeeping troops from Nepal deployed to Haiti every six months, a new contingent arrived at the Mirebalais camp on Oct. 9, 12 and 16, 2010. These troops had spent three months training in the Kathmandu Valley.

According to the petition, Nepalese soldiers deployed as part of the MINUSTAH mission in Haiti were not tested for cholera prior to entering Haiti.

Ira Kurzban, an attorney at Kurzban, Kurzban, Weinger, Tetzeil Pratt P.A. in Florida who is involved with the petition, said at a press conference at the U.N. Tuesday that a number of cholera carriers do not exhibit active symptoms which left room for error, as the U.N. only conducted tests on individuals who showed active symptoms.

According to the New York Times, the Cuban mission in Haiti has asked the U.S. to help finance a 30-million-dollar major hospital for specialists as part of a broader effort to remake the health system. Since the outbreak of cholera, the Cuban mission has treated more than 76,000 cases of the disease, with just 272 fatalities.

The chief of the Cuban medical mission, Dr. Lorenzo Somarriba, said they send people to the homes of the victims to educate them on the disease and provide them with tabs to clean the water purification tablets that have been critical in a country where treated water is rare.

In a statement released by the spokesman for the U.S. Embassy, Jon Piechowski, he said while recovery in Haiti was a broad international effort, particularly to advance the health sector support to Haiti, they had not entered into any agreements with the Cubans.

Compensation

Concannon spoke of a victim who was one of the first to die from cholera on Oct. 22, 2010. The petitioner had been working in a rice field and drank from the canal that irrigates the field. Afterwards, he alerted his family about a boiling water sensation in his stomach and began to vomit before spending the night at home in excruciating pain.

The next morning he went to hospital, and in the afternoon he died. He left his wife and 12 children behind.

The petitioners, who hail from Mirebalais, St. Marc, Hinche and Port- au-Prince regions of Haiti, make up more than 5,000 individuals filing a claim including victims, parents of children and relatives of victims who have died.

They are requesting three things 50,000 dollars per person or 100,000 dollars per person who died, an adequate nationwide response from the U.N. that includes better sanitation and clean water facilities to help prevent further cases, and a public apology.

Our clients are challenging the institution to act consistently with what it knows to be true and just, said Concannon.

Response

Secretary-General Ban Ki-moon appointed an independent panel of scientific experts to investigate the source of cholera in Haiti on Jan. 7, with a report released in May.

While the experts concluded that, the evidence overwhelmingly supports the conclusion that the source of the Haiti cholera outbreak was due to contamination of the Meille tributary of the Artibonite River, with a pathogen strain of current south Asian type Vibrio cholera as a result of human activity , they didn t attribute the outbreak to an individual.

At a press conference Tuesday, the secretary-general s spokesperson said the U.N. peacekeeping mission as well as humanitarian development agencies were working with Haitian authorities to do everything possible to bring the spread of cholera under control.

He confirmed that the U.N. and MINUSTAH had received the letter and it would be looked at by the relevant part of the peacekeeping department.

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The independent panel of experts concluded that the Haiti cholera outbreak was caused by the confluence of circumstances as described in the report and was not the fault of or deliberate action of a group or individual person, said the spokesperson addressing the U.N. s response to the petition.

The key focus for the U.N. has been since the outbreak and it remains the focus, to combat the outbreak and to help those who have suffered. That s what the U.N. will continue to do.

A MINUSTAH spokesperson emailed IPS and confirmed that the petition had been received and would follow the procedures to be transmitted.

She wrote, MINUSTAH keeps and will remain committed in supporting all the efforts undertaken to fight the epidemic and its impact, in support of the government.

Fabíola Ortiz

RIO DE JANEIRO, Dec 23 2011 (IPS) – The fall in world tobacco consumption, especially in industrialised nations, is a sign of the urgent need for producer countries like Brazil, China, India and the United States to offer their farmers alternatives to growing tobacco.

Graphic picture-based health warnings on cigarette packs can help prevent youngsters from starting to smoke. Credit: Kara Santos/IPS

Tobacco has been grown in Brazil for 120 years, and is important for the trade balance of this South American country.

Tobacco industry statistics for 2011 show that China is the world leader in tobacco production with 2.4 million tonnes, and Brazil is the runner-up, with 867,000 tonnes.

Some 200,000 small-scale family farms, located mainly in the south and northeast of the country, produce 95 percent of Brazil s tobacco.

President Dilma Rousseff signed a tobacco control law Dec. 15 which increases taxes on tobacco, sets minimum prices for cigarettes, bans smoking in all public spaces and enclosed workplaces, and forbids advertising at points of sale.

Brazil, with its 192 million people, may thus become the most populous country to declare itself smoke-free, said the U.S.-based Campaign for Tobacco-Free Kids.

Brazil is the largest country to have adopted an anti-tobacco law, activist Patricia Sosa, in charge of Latin American programmes for the , told IPS.

Every year, exposure to secondhand smoke causes over 600,000 premature deaths, and passive smokers who are exposed to it at home or at work have a 30 percent higher risk of developing lung cancer, she said.

The new law bans advertising on cigarette packs and only permits the display of products with health warning messages that cover at least 30 percent of the front of the packets. This regulation will come into effect Jan. 1, 2016.

Taxes on cigarettes were increased by 300 percent, which will raise the consumer price by 20 percent in 2012, and by 55 percent in three years time.

But in the view of the Brazilian civil society organisation Aliança de Controle do Tabagismo (ACT Alliance for the Control of Tobacco Use), the tobacco industry remains extremely lucrative.

Around 90 percent of the tobacco produced in Brazil is exported, and tobacco production in the country is fairly high, although the prevalence of smoking has declined over the last two decades, ACT deputy director Mônica Andreis told IPS.

The tobacco industry argues that the new measures will bring economic chaos to the country. But many family farmers who depend solely on this crop to survive are exposed to difficult labour conditions, and they get sick from having direct contact with tobacco leaf chemicals, she said.

Working on tobacco plantations creates health problems associated with intensive use of toxic agricultural chemicals, as well as green tobacco sickness (GTS), a form of nicotine poisoning caused by absorption of nicotine through the skin as a result of handling wet tobacco leaves.

Many of the tobacco farmers have already said they would prefer to diversify or switch crops, Andreis said.

The ministry of agricultural development announced that during 2011 it invested six million dollars in technical support and agricultural extension services for approximately 10,000 family farmers who wish to diversify away from growing tobacco.

The funds have been used principally for families in the seven tobacco-growing states: Alagoas, Sergipe, Bahia and Paraiba in the northeast, and Rio Grande do Sul, Santa Catarina and Paraná in the south.

In one year s time, the government plans to increase to 50,000 the number of families receiving aid from the National Programme to Support Product Diversification in Tobacco-Growing Areas, created in 2005.

According to the authorities, this programme is part of one of the country s largest inter-ministerial initiatives, created to meet the guidelines of the World Health Organisation (WHO) Framework Convention on Tobacco Control, which came into force in 2005 and was ratified by Brazil that same year.

The programme facilitates access by tobacco farmers to funding and technology with the aim of converting or diversifying from tobacco growing.

Sixty-five current projects to diversify away from tobacco cultivation on family farms include raising chickens or dairy cattle, fish farming, and fruit and vegetable production. Over the last six years, 14 million dollars have been spent on services for 80,000 tobacco-farming families.

According to a study published by the Association of Tobacco Growers of Southern Brazil, out of nearly 187,000 families who grow tobacco, 47,000 have no land of their own and work as sharecroppers. And 80 percent of the 140,000 farms are less than 20 hectares in size.

The WHO Framework Convention on Tobacco Control, the first international public health treaty, has 174 states party at present and guides the implementation of public policies for combating smoking, regarded by the WHO as a non-communicable global epidemic.

Although the number of smokers in Brazil has been dropping for the past 20 years, there are still nearly 25 million people aged over 15 who smoke, Andreis said.

The typical Brazilian smoker is male and aged between 45 and 64 this group accounts for nearly 22 percent of tobacco consumers. The majority of smokers are people living in rural areas, less educated and with the lowest family income per person, according to a survey by the Brazilian Institute of Geography and Statistics (IBGE) and the National Cancer Institute (INCA).

Among people who had received less than one year of education, or none, 41 percent started smoking before they were 15 years old; and the proportion of students who had tried cigarettes in 2009 was almost 25 percent, Andreis said.

Latin America has a for applying the Framework Convention on Tobacco Control. Ten countries have already adopted tough restrictions on advertising, publicity and sponsorship by tobacco companies. Five countries have imposed taxes of 70 percent or more on the price of cigarettes, and seven have introduced compulsory health warnings that cover at least 30 percent of the packs.

Uruguay was the first country in the region to enact tough anti-tobacco laws. In the small South American country, health warnings and graphic images cover 80 percent of cigarette packets.

While the Ethiopian government boasts that the country can soon be categorised as middle-income, economic analysts are more cautious saying that the country has made “significant progress”.

ADDIS ABABA , Feb 21 2012 (IPS) – Ethiopia says that the double-digit economic growth the country has experienced over the last seven years has started benefitting its majority by boosting their income and productivity in agriculture and small-scale businesses.

While the and the state that the country has registered 8.7 percent GDP growth, the government claims the economy has grown by 11.4 percent.

However, the country was declared the second-fastest growing economy in Africa for 2011, after Ghana, in the annual economic report by the (ECA).

In the past, Ethiopia has made headlines for recording some of the worst famine situations in Africa, and for its poor health indicators – it has posted one of the highest maternal mortality rates in the world. In 2005, 871 women died per 100,000 live births.

But this is slowly changing as the government has made progress in the provision of social services such as health, education and infrastructure.
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“In 2010, Ethiopia continued to register the fast growth, as it has for the last five years. GDP growth in 2010 remained strong at 8.8 percent. Growth is driven by the service sector (14.5 percent), followed by the industrial (10.2 percent) and agricultural (six percent) sectors,” the ECA report indicated.

In an exclusive interview with IPS, State Minister of the Office of Government Communication Affairs, Alemayehu Ejigu, said Ethiopia has registered remarkable growth by increasing major crop production from 11.9 percent in 2005 to 18.08 percent by the end of 2010. People’s lives are changing for the better in rural and urban areas because of health facilities and infrastructure development, he said.

Ejigu attributed the success to the effective implementation of the national five-year Growth and Transformation Plan (GTP). He said that the country’s GTP for 2011 to 2016 would help Ethiopia join the grouping of middle-income countries.

Ejigu also told IPS that the government planned job creation opportunities through the construction of 73,000 kilometres of rural roads. “This would create an opportunity for farmers to easily transport agricultural products to market,” Ejigu said.

Abeba Bezu, an economic affairs consultant in Addis Ababa, said that under the country’s ambitious Plan for Accelerated and Sustained Development to End Poverty government had reduced poverty from 38.7 percent in 2005 to 31 percent five years later.

“Although struggling with a large population estimated to be 82 million people, making it the second-most populous country in Sub-Saharan Africa, there has been significant progress towards improving livelihoods. There is notable development.”

However, assistant Professor Teshome Adugna at the Economics Department of the cautioned that as GDP considers the market value of goods and services, it cannot be a perfect instrument to show the country’s actual growth, given Ethiopia’s poor record handling and management systems.

“Since the GDP reporting does not provide information on who produces how much, it is difficult to know how individual citizens benefit from the reported growth,” he said.

Adugna described Ethiopia’s growth as “broad-based”, which he attributed to the growth of the agricultural, industrial and service sectors.

“Of course, we should not expect urban unemployment to end very shortly,

“I can say that many people are benefiting from the economic growth in Ethiopia, but I would not say that the life of the majority has improved. We need time to bring about social development that can change the lives of the majority.”

Ten years ago, only two thirds of Ethiopians had access to healthcare services, leaving another 68 million people across the expansive rural areas in dire need.

“Since 2004, the Ministry of Health has expanded access to healthcare through the (HEP), which targets the rural population,” said Amanuel Ayalew, a volunteer health worker in northern Ethiopia.

As a result, Ethiopia’s country report by the Department for International Development (DFID), the United Kingdom’s government department responsible for promoting development and poverty reduction, revealed that the impact of the health programme is notable since HEP reaches nine million households. DFID will spend an average of 524 million dollars per year in Ethiopia until 2015.

With more than 35 million insecticide-treated bed nets for malaria, there has been a 73 percent reduction in malaria cases. This, coupled with a massive and consistent vaccination programme for children under five against killer diseases, has seen deaths in that age group reduced by a significant 62 percent in villages with access to HEP.

There are now about 1.4 million more women on contraceptives than there were in 2005, and the gross primary school enrolment rate has risen from 91.3 to 96 percent between 2005 and 2010.

However, challenges remain.

“In spite of a constituent economic growth of double digits in the last five years with economic analysts projecting a similarly impressive growth, sustainable growth and poverty reduction remains a challenge,” Bezu said.

A majority of rural poor are still grappling with severe climate change and are still highly susceptible to drought.

It is a situation that government partially acknowledges. “When we say the country is growing it does not mean that every citizen has no problem…even in the United States there are people who are provided with food aid,” Ejigu said. He, however, added that no one would die of as there would be no food shortages in the country.

It is a view that the leader of the opposition Ethiopian Democratic Party, Mushe Semu, does not agree with.

“Ethiopia is a country where many citizens are starved. It is not a question of having food two or three times a day,” Semu told IPS.

He said it was impossible for Ethiopia to become a middle-income country. “When we think of the majority of the Ethiopian population we are talking about our farmers and rural communities that are 85 percent of the people. Here, the land management and fertility should be considered,” he said.

He said that without effectively distributing all arable land to people, and with the prevailing land degradation, it was not possible to bring about development.

The country is not conducive for private sector growth, analysts say.

The newly completed African Union building in downtown Addis Ababa. Credit: Mekonnen Teshome/IPS

“Although the government envisions a private sector led development, the environment is not conducive for the growth of the private sector. In fact, private investment as a percentage of GDP has remained on the decline since 2004,” Bezu said.

In a World Bank global survey dubbed Ease of Doing Business, in 2010 and 2011 Ethiopia ranked 103 and 104 respectively out of 183 countries.

But meanwhile, civil servant Abiy Getahun said that the double-digit economic growth repeatedly propagated by the government media has not yet brought the desired social development to his life. He cited the low wages paid in Ethiopia, which, according to him, are low compared to the rest of Africa. In the 2011 Human Development Report Ethiopia ranks 174 out of 187 countries worldwide.

He said that most people, especially urban dwellers, could not withstand the skyrocketing price of good and services.

“The total salary increment I got over the last 10 years is only 400 Ethiopian Birr (less than 25 dollars) while the price of goods and services has risen in an unbelievable manner.”

* Additional reporting by Miriam Gathigah in Nairobi.

(END/2012)