Complete Wellness

Dalia Acosta

HAVANA, Dec 2 2010 (IPS) – Margot Parapar gets plenty of laughs from the audience with this joke: Now the human body is divided into five parts: head, trunk, upper and lower limbs, and condom. Using his female stage name, Cuban drag queen, comedian and health promoter Oliver Alarcón includes HIV/AIDS prevention messages in his shows.

Transvestites and other artists at the Song for Life gala. Credit: Jorge Luis Baños/IPS

On-stage, I try to put my message into accessible language, so that it reaches people directly, without vulgarity and for a very mixed audience, because we are all vulnerable, the artist told IPS.

He took part in a gala titled Canto a la vida (Song to Life), in response to the global AIDS epidemic, at the Fausto Theatre in Havana Sunday.

The performance, one of the activities organised ahead of World AIDS Day, celebrated Dec. 1, was an initiative of the National Centre for Sex Education (CENESEX) and other cultural and health organisations working to promote health and respect for sexual diversity.

Tailoring one s language to each specific audience is, according to Alarcón, the key to promoting, through art, the practice of safe sex. The majority of the audience may sometimes be the gay community, or heterosexuals, or the elite. The main thing is to know at whom the message is aimed, he said.

After joining the HSH-Trans (MSM-Trans men who have sex with men and transgender persons) programme at CENESEX a year ago, Margot Parapar s stage appearances never fail to include messages on sexual health, blended with large doses of humour. You have to know all about an issue, even if your aim is to popularise it, Alarcón said about the preparation involved.
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MSM-Trans is a social network of transgender persons (transvestites, transsexuals and drag queens) and men who have sex with men (MSM), in several Cuban provinces, who are trained as health promotes by CENESEX.

On stage, in front of a rainbow flag as a backdrop, Margot states confidently: I know everything: I am a protected oracle.

Behind the scenes, the actor acknowledged the essential nature of doing research to face the global AIDS pandemic and recognise human diversity.

For his part, Leonardo León, garbed as his artistic persona Chantal, said it was important not to oversimplify issues when talking about them.

Our message must be perceived as attractive, up-to-date and close to people s hearts, he said, stressing the need to use these shows that attract mass audiences, with all their diversity, for educational purposes.

Cuba began to adopt measures against the HIV/AIDS epidemic in 1983, although the first case on the island was not diagnosed until 1986. At present official statistics indicate that there are about 13,000 HIV-positive people on the island, which has a total population of 11.2 million, representing a prevalence of 0.1 percent, the lowest in the Caribbean region.

Most heavily affected are men who have sex with men, who make up 72 percent of all diagnosed cases, Rosaida Ochoa, head of the National Centre for Prevention of Sexually Transmitted Infections (STIs) and HIV/AIDS (CNPSIDA), told the press.

As part of their prevention and awareness-raising programmes, both CNPSIDA and CENESEX have trained voluntary health promoters, who carry out active prevention work with their peer groups as well as wider population groups, and also through local media.

The health promoters are a key factor, because as volunteers, they give their efforts and spare time to prevent STIs and HIV/AIDS. Malú Cano Valladares, founder and coordinator of the MSM-Trans programme, told IPS.

They take their health messages to their usual meeting places, as well as to schools, communities and hospitals, she added.

CNPSIDA has trained 1,700 MSM as health promoters, and CENESEX has more than 400 in the MSM-Trans group, focused on STI prevention. At both institutions, other communities with specific goals, such as the right to freedom of sexual orientation, also join in the prevention work.

The two youngest members of the Oremi group of lesbian and bisexual women, for instance, were distributing leaflets and condoms last Sunday in Havana s Paseo del Prado. People sometimes think that lesbians run no risk of contracting the virus, but they do, said Yasmín de Robles, one of the activists.

With Anaylis Noa, her partner of nine years, this young blind woman advised people to stay in a stable relationship as a means of preventing HIV/AIDS. In her view, lesbians are also vulnerable, because of the low perception of risk, when they practise oral sex or use sex toys without protection.

A recently-created group, Hombres por la Diversidad (HxD, Men for Diversity), also linked to CENESEX, carried out its first health promotion activity Tuesday, on the eve of World AIDS Day, and to commemorate the International Day for the Elimination of Violence Against Women, celebrated Nov. 25.

According to Luis Enrique Mederos, a member of the HxD group and of the technical team working with a helpline for persons living with HIV/AIDS in Havana, promoting sexual health and facing AIDS in Cuba requires tighter links between the Education and the Health Ministries, especially in order to reach the teenage population.

In the view of Luis Rondón, another member of HxD and a volunteer with the MSM-Trans programme in Old Havana under the auspices of CNPSIDA, training more health promoters, developing closer relationships of trust, and expanding the social influence exerted by the volunteers are some of the improvements needed for fighting AIDS in this country.

The orientation of sexual desire does not increase a person s risk of contracting STIs or HIV, but unprotected sexual practices and behaviours do, said a sign projected at the Fausto Theatre before the gala performance, echoing the views of institutions like CENESEX and CNPSIDA with regard to respect for sexual diversity.

Milagros Salazar

LIMA, Jan 15 2011 (IPS) – The U.S. mining and metallurgical company Doe Run has once again challenged the Peruvian government. The Renco Group, of which it is a subsidiary, notified the government of its plans to start an international arbitration process, invoking the free trade agreement between this South American country and the United States.
The U.S.-based holding company said the arbitration will be filed in 90 days if no agreement is reached. What is behind this ultimatum?

In ads published Jan. 5 in newspapers in Lima, the Renco Group said it was turning to the mechanisms provided for by the trade promotion agreement because it had received unfair treatment at the hands of the Peruvian government and had not been given protection and security as an investor, as required by the treaty.

Doe Run began to run the large multi-metal smelter in the central Peruvian highlands city of La Oroya, known as one of the most polluted places on earth, after the plant was privatised and acquired by the Missouri-based firm in 1997.

When it won the concession to operate the plant, Doe Run promised to complete an environmental improvement programme, known by its acronym PAMA, within 10 years. But the Peruvian state also assumed a commitment to clean the soil in and around the town, because the factory, which was built in 1922 by the Cerro de Pasco Corporation, a U.S. firm, was taken over by the state-run Centromin Peru in 1974.

Doe Run now claims that Activos Mineros, the state-run firm that took over Centromin s responsibilities, has refused to clean up the soil in La Oroya, and has refused to accept responsibility for the legal action brought by the citizens living in and near the town of La Oroya who claim various injuries resulting from alleged lead exposure and environmental contamination from the smelter complex.
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But it is Doe Run that has failed to fully implement PAMA and has continued to pollute in La Oroya, former deputy minister of mines María Chappuis told IPS. This communiqué is as if they were telling the government: we pollute and you clean up.

Chappuis resigned from her post in December 2004 to protest an extension of the PAMA deadline that the government granted to Doe Run.

The former official complained that the company wants the government to pay for any damages that a U.S. court could order for the families of more than 100 children with lead poisoning in La Oroya.

In late 2010, a court in St. Louis, Missouri, where Doe Run s corporate offices are based, ruled that 11 lawsuits filed against the Renco Group and Doe Run by a group of citizens from La Oroya could go ahead in that venue. The plaintiffs are suing over injuries from lead exposure and environmental pollution caused by the smelter.

If the court rules in favour of the plaintiffs, the company will have to pay reparations to the families of the children.

Doe Run committed itself, through PAMA, to reaching a target of 95 percent of children under six in La Oroya with a lead level below 10 micrograms of lead per decilitre of blood (mcg/dl), regarded by the World Health Organisation as the maximum safe limit.

But Peru s Health Ministry found that 99 percent of children under six in La Oroya had lead poisoning.

Doe Run also promised to build three sulphuric acid plants for its lead, zinc and copper processing operations. But the copper circuit plant, the most crucial, has not been completed.

As of mid-2009, Doe Run had failed to fulfil 20 percent of the PAMA programme. And since then, no progress has been made, because the company was temporarily shut down in June 2009 after declaring bankruptcy, despite soaring metals prices.

It then missed the July 2010 deadline set by the government of Alan García for proving that it had the necessary financing to restart operations and complete an environmental cleanup.

The 90 day deadline (that Doe Run gave Peruvian authorities) sounds suspicious, said Chappuis. What it is trying to do is provide enough time for the emergence of someone who yields to its pressure, as happened before, especially now, during an election year. General elections are due in April.

The former official was referring to a letter sent in October 2007 by then prime minister Jorge del Castillo (2006-2008) to then U.S. ambassador to Peru Michael McKinley, asking the State Department to intervene in a lawsuit that had recently been brought in Missouri against Doe Run Resources Corporation.

In the letter, Del Castillo asked the U.S. government to contact the Department of Justice and the St. Louis court, in order to avoid setting a disturbing precedent for investors in both countries, which would undermine legal security.

In response to criticism, the former prime minister said he had sent the message to avoid controversy in the face of the approval of the free trade agreement with the United States, which went into effect in early 2009.

If the international arbitration proceeding goes ahead, the Renco Group would become the first company to turn to the mechanisms for that purpose created by the free trade agreement.

The Peruvian government must not make another mistake, and has to act cautiously, said economist José de Echave of CooperAcción, a Peruvian NGO working for development.

In response to a query by IPS, the Ministry of Energy and Mines said The state will only pronounce itself on this matter through the legal routes.

Activos Mineros, for its part, published an insert in a local magazine, stating that it had planned to invest 35 million dollars in a cleanup plan between 2007 and 2015, and that so far 4.8 million dollars have been spent to carry out a study on soil remediation and urban cleanup actions.

IPS was also informed that Activos Mineros has already calculated how much Doe Run would have to pay Peru for the remediation, because it was reported that the contract establishes that if the company that took over the smelter did not have better environmental performance than Centromin, it would have to assume part of the costs.

If in 2004 the company had not received an extension of the deadline for completing PAMA, the firm would not have invoked the free trade agreement, which did not enter into effect until five years later, de Echave said.

He also questioned claims that a court like ICSID (International Centre for Settlement of Investment Disputes) has environmental sensibility, when its rulings tend to go in favour of investors.

De Echave pointed out that since the start of the negotiations of the free trade agreement, a number of organisations warned that the chapter on investment made too many concessions. And today we re seeing the consequences, he said.

Dahr Jamail

TAMPA, Florida, Mar 1 2011 (IPS) – A first-of-its-kind lawsuit alleging gross negligence and fraud has been filed in a Florida state court against Kenneth Feinberg, the administrator of the 20-billion-dollar compensation fund for victims of BP s Gulf oil spill, and the Gulf Coast Claims Facility (GCCF).
Attorney Brian Donovan of the Donovan Law Group from Tampa filed the complaint against Feinberg, his firm Feinberg Rozen, LLP and the GCCF on behalf of Pinellas Marine Salvage, Inc. and John Mavrogiannis.

The complaint alleges, in part, gross negligence, fraud, fraudulent inducement and unjust enrichment on the part of the defendants.

Feinberg and the GCCF have done more damage than the oil spill, Donovan told IPS. My client has relied on what Feinberg said he would do. They ve made promises they didn t keep. John s company was promised money they have not received.

Mavrogiannis told IPS, We re sick and tired of this runaround. I m tired of Feinberg s lies. He s made promises he hasn t kept. He s manipulating the system and that s not right.

Mavrogiannis is far from alone in not having received compensation for the severe losses his business has suffered as a direct result of BP s oil disaster in the Gulf of Mexico that began last April.
It was recently revealed that more than 130,000 compensation claims will be refused by Feinberg, who claims they lack adequate documentation.

State governments of Florida, Alabama, Mississippi and Louisiana are accusing Feinberg of delaying claims and causing great hardship to local businesses, as well as underestimating losses to coastal businesses.

Donovan believes Feinberg is simply doing what he is being paid by BP to do.

He s doing his job, Donovan told IPS, Feinberg is a defence attorney representing BP. To think otherwise is being foolish. As a defence attorney, he s doing a great job for BP. But they are saying go with us, or sue us .

Feinberg s Washington-based firm, Feinberg Rozen, was being paid 850,000 dollars a month by BP to administer the compensation fund and claims process for Gulf residents and fishermen.

A 46-page contract between BP and Feinberg detailing the arrangement was made public on Jan. 7 when it was filed in the U.S. District Court in New Orleans as part of the multi- district spill litigation against BP.

As of Jan. 15, the firm s fee, according to the document, will be mutually agreed to by the parties on a quarterly basis in advance of the first day of each successive calendar quarter. This clause has led many critics to believe that Feinberg could stand to gain from dispensing less of the fund s 20 billion dollars to claimants and tying the amount of its payments to Feinberg s success in limiting BP s liability.

Any funds remaining from the 20 billion would revert to BP under an agreement with the White House. Feinberg has told reporters, My understanding is that if 20 billion dollars is sufficient and there is money left over it is retained by BP.

In late December, Feinberg told Bloomberg Television that he anticipates about half of the fund should be enough to cover claims for economic losses.

Donovan believes lawsuits haven t been filed against Feinberg before now because of politics .

His political connections is all I can think of. I can t think of why more people won t go after Feinberg for this, because it s obvious they should, he said.

The only attorneys involved in the BP oil spill who I know are those trying to sign up victims for class action lawsuits, Donovan added. This is understandable given that Reuters recently reported that fewer than three percent of the approximately 470,000 businesses and individuals who have filed claims with GCCF have lawyers helping them negotiate.

Mavrogiannis feels their complaint is solid, Because Feinberg has lied to us on several occasions. Had he told me from the beginning he was working for BP, I would have filed suit against BP right when this happened. I believed he was impartial with no ties, but he has deceived me, and that s fraud.

If I lose my property, business, and house because I can t make my mortgage payments because Feinberg is late in paying me, who is going to compensate me for this? Mavrogiannis, whose home is close to being forclosed, told IPS. I have to take my IRA s [individual retirement accounts] out to pay my bills. I can only hang in there for another month or two then the banks are going to want their money.

Mavrogiannis lawsuit alleges, in part, The defendants employ a Delay, Deny, Defend strategy against claimants. This strategy, commonly used by unscrupulous insurance companies, is as follows: Delay payment, starve claimant, and then offer the economically and emotionally-stressed claimant a miniscule percent of all damages to which the claimant is entitled. If the financially ruined claimant rejects the settlement offer, he or she may sue.

The amount paid out so far averages nearly 16,000 dollars per claimant. According to the U.S. Department of Health and Human Services, the 2009 poverty threshold for a family of three was 18,310 dollars.

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.