Population Explosion Fizzles, Controversy Sizzles
Posted on August 31st, 2004
Population has always been an explosive subject. So a story in the NewYork Times is bound to ignite controversy. According to the article the doomsday scenario of runaway population growth is no more, as birth rates all over the world have plummeted. This is a good thing or is it?
Any way, one thing is for sure it will add more fuel the already heated debate on family planning, religious proponents claiming that FP methods are leading to the demise of the worlds population, no doubt lead by the Vatican, and the family planning activists claiming they have given a greater proportion of the world a chance to share diminishing resources. Discretion being the better part of valour, that’s all I’ll say on that.
The issue of food (or lack of), famine and hunger has also been another contentious subject in the population war. Long have been the claims that world hunger was driven by the fiend of unfettered population growth. The only way earth could escape starvation on a biblical scale would be to embrace the unlimited promise of genetically modified foods. Something the US; world leader in GM food has been urging developing countries to take up, curiously supported by the FAO; with furious opposition from Europe who have rejected GM foods outright.
Migration which is all about population movements has existed since the beginning of time is. It is closely related to the politician’s perennial favourite subject immigration, normally referenced in terms of the swamp fear factor e.g. i/we/you fear being swamped by unwashed hordes of undeserving poor due to……
Depending on your point of view there are two ways to look at the situation. Population growth is either not enough, or is too high, it is a measure of economic success or developmental failure. High population growth will destroy the environment lead to socio economic collapse, and the ultimate demise of mankind as we run out of resources and food; it must be stopped. Low population growth will lead to destruction of the nuclear family, economic stagnation, social collapse and the ultimate demise of mankind as growth rates drop to below replacement levels. It must be countered.
While the bomb may have gone out in the rest of the world, in Africa it’s the equivalent of a megatonne nuke. In an age of AIDS when it has been fashionable to make dire predictions of negative population growth, the disappearances of nations, despite being assailed by disease, flood, war, pestilence; population growth has surged on the continent. In a region where countries such as Uganda, whose population increased by almost 50% in a decade (an astonishing figure) are more the norm than the exception, one has to take such predictions with a pinch of salt. Indeed, a large chunk of Africa has a population doubling time of around 20-25 years. That’s less than a generation. In classic development terms this is not a good sign. But given the current uncertainties in interpreting future population growth, what this high growth rate spells for Africa’s future is any ones guess.
Country Doubling Time in years
Niger - 20yrs
Somalia - 29yrs
Angola - 22yrs
Uganda - 23yrs
Mali - 27yrs
Liberia - 18yrs
Ethiopia - 25yrs
Nigeria - 25yrs
Zimbabwe - 35yrs
Botswana - 35yrs
South Africa- 41yrs
(Source: Medilinks – http://medilinkz.org/healthtopics/statistics/stats.asp)
Posted on August 30th, 2004
As the headlines scream about the latest victim of West Nile virus, or the SAR Virus or even the AIDS virus, billions, 2.6 billion people – over 40 per cent of the world’s population – do not have access to basic sanitation, and more than one billion people still use unsafe sources of drinking water. Most are in rural Africa and Asia, where the children are the first to suffer. And that is how they die, silently, their little bodies to weak to utter even the smallest cry.
IF THE CURE FOR HIV WAS ONLY A CLEAN CUP OF WATER, WE WOULD STILL BE UNABLE TO FREE AFRICA FROM AIDS!
Meeting the MDG drinking-water and sanitation target: A mid-term assessment of progress
Download the Report
Joint Monitoring Programme report 2004 [pdf 1815 kb]
Americans really are crazy
Posted on August 30th, 2004
It’s a preposterous notion but George Bush thinks they are (crazy that is). This one is really out the left field, to borrow an Americanism, but apparently a sweeping mental health initiative to screen the whole US population for mental illness was supposed to be unveiled by President George W Bush in July. I didn’t hear about it, how could I what with all those voices in my head. But I’m not American; and so you may ask what about all those other foreigners… a slippery slope indeed. Before you jump down my throat, I will state clearly I fully realize that mental health is a serious issue and shouldn’t be taken lightly. And I don’t. But even the title of the initiative is humorous in a darkly sinister way – “New Freedom Initiative” (www.whitehouse.gov/infocus/newfreedom/toc-2004.html).
The proponents of the programme want to start by screening 52 million students and 6 million adults who work at the schools, presumably to get those who are diagnosed with severely disruptive behaviours and emotional disorders on treatment. Scary huh? Oh yes the other sponsors are Big Pharma; giving a nod to George Orwell (1984) and Aldous Huxley (Brave New World). Mind Control; government as a drug pusher; Is this the shape of things to come? Just say NO.
Read it at:
Bush plans to screen whole US population for mental illness
Nature gets biblical in Africa
Posted on August 25th, 2004
August seems to be turning into a month when nature shows off her power. A devastating plague of locusts has hit the Sahel and Western Africa. Drought in parts of Kenya, East Africa is leading to famine conditions. In the Eastern part of the Democratic Republic of the Congo two years of emissions of gas, ash and cinders from Nyiragongo and Nyamulagira volcanoes is bringing disease and sickness to 60,000 people, and in Burundi a meningitis outbreak is stalking the citizens. And as if that is not enough, there is also the threat of volcanic fire raining down on the inhabitants on the Ugandan side of Mount Elgon.
But manmade disasters still vie with nature for bringing untold misery to people. Darfur is at the top of the list where war and terror, constant companions in the humanitarian disaster created at the hands of Sudan and their client militia the Janjeweed, has now been joined by disease in the form of a deadly hepatitis E outbreak. Let’s hope September brings some relief.
Read these and other stories on Medilinks
STATEMENT BY WHO REGIONAL DIRECTOR FOR AFRICA
Posted on August 25th, 2004
STATEMENT BY WHO REGIONAL DIRECTOR FOR AFRICA, DR EBRAHIM SAMBA,ON THE EDITORIAL IN THE 7 AUGUST 2004 ISSUE OF THE LANCET; Brazzaville, 11 August 2004 — An editorial in the August 7 issue of The Lancet painted a bleak picture of the work of WHO in the African Region, giving the impression that WHO is not recording any successes there. In fact, despite the challenges of poverty and ongoing instability, the opposite is true.
For example, in spite of recent political difficulties, the number of polio-endemic countries in the African Region has fallen from 20 in 1999 to just two today. Huge efforts are underway to eliminate the disease completely.
Four years after I took office, the African Region reached the goal of eliminating leprosy as a public health threat. Today, the average regional leprosy prevalence is below one case per 10,000 population.
The number of people affected by debilitating guinea worm has also continued to drop; only 9,031 cases were reported in 2003. Half of all the guinea worm endemic countries (there were only 12 in 2001) reported less than 50 cases in 2003.
Support from the Regional Office and WHO Headquarters has helped to restore some order to the health systems of hitherto war-torn countries such as Liberia and Sierra Leone. As at the end of 2003, 42 of the 46 countries in the region were implementing the WHO-recommended Directly Observed Treatment, Short Course (DOTS) for tuberculosis control. The Regional Office is collaborating with WHO Headquarters and other development partners to respond to requests by Member States to improve access to HIV/AIDS care and treatment under WHO’s “3 by 5″ Initiative – critical to improve the lives of millions affected by HIV/AIDS.
There is definitely hope for Africa and WHO/AFRO will continue to play its part.
To address some of the specific comments in the editorial:
The Lancet: “At the heart of the regional office’s ineffectiveness is its acting as a political rather than as a technical agency. Recruitment of senior staff is rarely based on competence and qualification…appointments of country representatives …are often paybacks for political or other favours.”
WHO is the only UN agency where the Regional Directors are elected by Member States. Furthermore, WHO’s governance structure comprises Regional Committees, the Executive Board and the World Health Assembly. The membership of these is drawn from Member States. Therefore, a close relationship between WHO and its Member States is inevitable because WHO was established to support countries.
Recruitment at WHO/AFRO is carried out strictly in accordance with the rules and regulations of WHO. All staff are recruited strictly on the basis of qualification, experience, proven track record and competence. …/1 The WHO Representatives I have appointed over the past ten years have been a mix of senior personnel from national government ministries as well as from other sectors and institutions within and outside Africa. The majority of these had joined WHO as staff members thus allowing us time to assess their suitability for appointment as WHO Representatives. WHO is currently conducting a global review of its policy for the selection, placement and rotation of WHO Representatives, and WHO/AFRO will follow the new procedures once this has been finalized.
“There are strong arguments for decentralization of WHO/AFRO to at least four or five subregions.”.
My predecessor experimented with this idea. He established three sub-regional offices but later closed them down for a number of practical reasons. Nevertheless, alternative methods should continue to be explored, including the current level of operations that we are maintaining in Harare, Zimbabwe, and Ouagadougou, Burkina Faso.
“WHO/AFRO has a very limited core budget and focuses on vertical donor-driven initiatives, almost certainly because this strategy is seen as the best way to ensure the agency survives”.
The Regular Budget of WHO (the portion funded by assessed contributions from Member States) has had zero growth for many years now. WHO appreciates the strong support by donors and partners. It is right to say that some important programmes have been donor-driven vertical initiatives. This, indeed, has been the subject of considerable discussion both within the WHO secretariat as well as in its Governing Bodies. However, in its programme budgeting, WHO globally is integrating Regular Budget with Extra Budgetary resources into a comprehensive, results-based approach. I should mention that WHO/AFRO is bringing together national Ministries, civil society, multilateral and bilateral agencies, NGOs and other development partners to ensure a coordinated approach in support of public health expenditure programmes. WHO has also developed a strategic approach for working with countries based on a Country Cooperation Strategy which we in AFRO have articulated in almost all 46 countries in the Region. Extrabudgetary resources placed at the disposal of AFRO have grown substantially from $90m in the 1994-1995 biennium when I assumed office to $350m in the 2002-2003 biennium. This, obviously, is a vote of confidence in WHO/AFRO. I would like to add that we work in close cooperation with WHO Headquarters and our relationship with Geneva has never been better.
“Dr Samba is to step down after serving his maximum of two terms as Director of WHO’s Africa Region”
Under my terms of appointment, the “maximum” two-term rule does not apply. However, I am voluntarily retiring in January 2005 in keeping with the pledge I made after my nomination for a second term during the forty-ninth session of the WHO Regional Committee for Africa held in Windhoek, Namibia, in 1999.
Nomination of a new Regional Director
The election will take place in accordance with the rules of procedure of the Regional Committee for Africa. While these are essentially the same as for other WHO regions, there is additional transparency in the case of AFRO which is the only region where each of the candidates will be interviewed for an hour by the Regional Committee (comprising Health Ministers from the 46 countries which constitute the WHO African Region). This exercise will take place on Wednesday 1 September 2004. We will keep the world appraised on the important results.
Dr Ebrahim M. Samba
Out of Africa – Not all the time
Posted on August 23rd, 2004
Bad things are brought to Africa on occasion, slavery, syphilis, colonialism to name a few. Add another one to the list, drug-resistant malaria. People traveling to Africa from South East Asia and South America should be screened and treated for drug-resistant malaria, experts recommend according to an article in Science. The international community has finally caught on to something Doctors and health workers in Africa have known for decades, resistance to drugs is not always due to misuse and abuse on the continent.
This is not something to cheer about however. Common wisdom and thinking has long had it that lower standards of health care and practices in Africa are responsible for much of the development of drug resistant varieties of bacteria and viruses. Indeed the dangers of developing drug resistant strains of HIV has been advanced often as a reason to delay the introduction of anti-retrovirals to African nations.
But the true culprits are the developed world and newly industrialized countries. The over use and abuse of antibiotics in the developed world, both in the health and agriculture has lead to such serious problems of resistance that it has reached the point where in the case of some infections, only one antibiotic remains. A good example is MRSA (methicillin-resistant Staphylococcus aureus) which sometimes requires extraordinary levels of hygiene in hospital settings to prevent its emergence. It was also not unknown in the past for resistance to new antimalarials to be present by the time the drugs were introduced to Africa. Resistance developed because of over use and misuse in Asia, an ominous sign of things to come.
And it is to Asia we turn, because while people are focusing on the dangers of resistance coming out of Africa, they are willfully being blind about the “elephant” in the room. Take HIV/AIDS in Asia; according to current projections, the numbers of HIV positive people will surpass those of Africa in the near future. And you can be sure they will be doing their best to get access to anti-retrovirals. If history holds true, one can be reasonably certain that the patterns of the past will be repeated. And soon enough we will see the emergence of drug resistant strains of HIV. A truly worrying development. And what measures are in place to deal with such an eventuality? Probably none.
Perhaps this screening idea is not such a bad thing after all.
Africa’s drug resistant malaria ‘migrated from Asia’
Rakai’s Human Guinea pigs
Posted on August 18th, 2004
The issue of human rights, health and clinical trials doesn’t often make headline news. But as increasing costs and ever more stringent regulations force big pharma, biotech and research institutions to turn the developing world to conduct clinical trials, I predict that state of affairs will soon change. That the situation is ripe for exploitation and violation of rights as impoverished third world citizens are coerced or bribed into taking part in research studies and clinical trials that may never benefit them and actually be harmful to their health.
So let me kick off the debate with my own two shillings worth on behalf of the people of Rakai in Uganda. They have been participating in a cohort study conducted by John Hopkins University for a decade and a half now. The study consists of observing and following the population to see the dynamics of HIV in rural population in an African country. My problem with this, and I must stress I’m not the first person to bring this up, is this. What can possibly be gained from continuing to passively observe this population when we know almost all there is to know about HIV? We know how the virus is spread, we know how people transmit it, we know who is at risk. So apart from providing material for researchers to present at International HIV/AIDS conferences like the one in Bangkok, nothing new that can benefit the people of Rakai is being discovered.
Wouldn’t it make more sense to start a study that involved more direct intervention; say the introduction of antiretrovirals to prevent the resurgence of AIDS which could possibly happen. In fact in this case, not using the knowledge gained over the last 15 years to help introduce anti-retrovirals and intervene directly to assist the people of Rakai in tackling the problem of HIV/AIDS borders on unethical behaviour. And this speaks to the heart of the issue of the rights of participants in clinical trials. At point in research does withholding beneficial interventions, treatment, education or the equivalent cease to be good science and become actively harmful to the participants? In the case of Rakai, I think that point has long been passed. Perhaps it’s time for the good folk of JHU to roll up the cohort study and start one that may actually benefit the citizens of Rakai.
An ethical dilemma: availability of antiretroviral therapy after clinical trials with hiv infected patients are ended
An ethical dilemma: availability of antiretroviral therapy after clinical trials with hiv infected patients are ended
The Right to Health
Posted on August 18th, 2004
Polio in Nigeria, AIDS in Cambodia, both have recently been in the news. The issue of polio in Nigeria was headlines for several weeks, when the Governor of Kano State suspended the immunization campaign over fears of local residents that the vaccines may be contaminated with the HIV virus.
In Cambodian the Prime Minister Hun Sen intervened to stop a major HIV drug trial the BBC reported, amid claims it violated people’s human rights. Earlier this month, the prime minister had urged Cambodians to boycott the study, saying the country was not a test bed for “out-of-date” technologies. The Cambodian Health Minister Nuth Sokhom was reported to have said the prime minister was worried the trial would contravene people’s human rights.
Nigeria were soundly castigated for the actions taken in the polio case and even had health sanctions from the WHO slapped on them. Polio as you may or may not know will soon be eradicated from the face of the earth forever. The action in Nigeria has threatened to delay achieving this momentous goal.
So what do Polio in Nigeria, AIDS in Cambodia have in common? The issue of health and human rights. Health is routinely recognized as a human right. And that’s a good thing. But what about patients rights, how are issues of health interventions and the rights of the people to whom they are being applied being reconciled? This is an issue that is not given enough attention particularly in the developing world.
As so often happens, in the zeal to provide people with life saving health interventions, health workers may overlook the rights of the very people they are trying to serve, while trying to keep a focus on the ultimate prize. And they risk falling into the position of benevolent dictatorship – “we know what’s best for you”.
The reaction to the action Nigeria was every indication of this, and in some cases smacked of outright racism and religious bigotry. Think about it, some foreigner comes from abroad, and then says they are going to stick a needle in you for your own good. And all the while, you are receiving messages of the dangers of spreading AIDS by needles and blood. Of course you have a Right to ask what is going on. You have a Right to know what is being done to you. But what if you are unable to speak out, because you do not understand? Then others who are more knowledgeable will have to speak out for you.
The success of Public health intervention depends on the trust and cooperation of the public. Trust can only be achieved by ensuring the public are kept fully informed and educated about all the interventions that are going to be performed on them. Then and only then will the people be able to understand that the health interventions you are bringing are good for them.
Darfur – A Timely Intervention
Posted on August 16th, 2004
In the world of conflict, misery, suffering and strife symbols stand out. Sometimes symbolism is all that is offered. This week a small contingent of 300 AU troops arrived in Darfur. Not much in the grand scheme of things to be sure; but 150 of these troops are from Rwanda. And symbols do not get more powerful than that. Rwanda is a country that just 10 short years ago underwent the harrowing ordeal of one of the greatest genocides of modern times as the world stood by. These soldiers have an intimate and personal experience of what genocide can be. They know what can happen if people just stand by. The UN Secretary General, Kofi Annan and US Secretary of State made also symbolic visits to see the suffering in Darfur, and show how concerned they were, but offered little besides words. Thank god the AU have a little more imagination. Sometimes symbols are all that can be offered, and sometimes they offer more than just a little hope.
The Road To Harare paved with hell.
Posted on August 13th, 2004
They say the road to hell is paved with good intentions. If that’s the case, a fiery end awaits the donors, activists, relief workers involved with Zimbabwe. This week the New York time reported that funding for AIDS is being with held because “Foreign donors are skeptical that Zimbabwe’s “increasingly repressive government” will “fairly or honestly” channel funds for antiretroviral drugs to groups and individuals who need the money… Heartlessness has nothing to do with it say the officials from the Global Fund and other relief agencies say, Rather, they say they are trying to save as many lives as possible without channeling money to untrustworthy governments.” There will be no epiphany on the road to Harare, only hell awaits.
The moralist hand wringing of the donors is nauseating. Especially when taken against the back drop of Sudan, and the genocide happening in Darfur. “Deal secured with the government of Sudan” thunder the headlines. Remember this is the government that has been accused of arming and aiding Arab Janjaweed militias in killing tens of thousands and driving hundred’s of thousands into camps. This is a government accused of aiding the Lords Resistance Army (LRA), a crazed, evil bunch of maniacal killers that have waged a campaign of war, kidnap, terror, principally against children in Northern Uganda for 17 years.
What sanctions have been applied to the Sudanese government? None, the UN voted against them last week. Instead, the some of very same agencies that are involved in Zimbabwe plead, argue and cajole with the Sudanese government to be allowed to work in Sudan. And the Sudanese government continues its reign of terror.
So spare me the moralist hand wringing. Mr. Mugabe may have persecuted political opponents, shut down independent media, seized land from white farmers, driven the economy into the ground. And while the death of two white farmers or 5 activists in Zimbabwe may make headline news all over the world, it has taken tens of thousands dying in Darfur, for that story to become news. And still nothing beyond begging the Sudan government is being done. The double standards of organisations from the West sticks in my gullet. I’m not defending Mugabe’s government, but there is just no comparison. Repression is Not genocide.
The arguments for withholding AIDS funding from Zimbabwe just don’t wash. After all history is littered with similarly expedient actions, of providing aid and funding to ven more unsavory regimes. The Oil for Food programme in Iraq, where billions of dollars were diverted and helped keep Saddam in power for another decade is one that springs to mind. Having tried and failed to impose sanctions on Zimbabwe, to remove a regime that does not meet their standards, Western donors have decided to take the action of withholding AIDS funding because now they are worried it may have been diverted. Of course it all makes perfect sense. But what is so different from last year, or the year before, or the year before that? Who knows.
And who will this hurt? Not the government in Zimbabwe. This is one case where sanctions are only going to hurt the people; the people of Zimbabwe that is. How many people have died in Zimbabwe due to political violence compared to those who have died and will die of AIDS? If sanctions cannot be imposed on Sudan then why Zimbabwe? Just what is going to be accomplished? Presumably the idea is that so many Zimbabweans will become sick and die from AIDS that Robert Mugabe, tired of governing a country of the sick and moribund will resign in disgust or shame. I have news for you, the Zimbabwe government doesn’t care and Robert Mugabe is not going anywhere. If they didn’t care before, then they certainly wont now. Just because donors do not like Mugabe’s government, there is no reason to take it out on the people. Somebody should please tell the people from the Global Fund and the other relief agencies. Their souls are in mortal danger.
Read the New York Times article here:
Donor Mistrust Worsens AIDS in Zimbabwe