Photo: Flickr

Emergency cholera treatment centre

Prof Chris Beyrer of Johns Hopkins University in the United States was among a group of investigators from an international non-profit organization, Physicians for Human Rights, who visited Zimbabwe in December 2008.

Their mission was to assess the country’s cholera epidemic, which has claimed over 4,100 lives so far, but they soon learned that far more widespread problems, including the total breakdown of the healthcare system, lay at the root of the crisis.

Zimbabwe’s average life expectancy has dropped from 62 years to 36 years, the lowest in the world, with HIV/AIDS alone claiming an estimated 400 lives a day.

Beyrer told delegates that the state of public healthcare, which had been in decline for years, abruptly worsened after a strike by healthcare workers in November 2008 over the lack of essential medicines, food, and running water at hospitals in Harare, the capital.

The Physicians for Human Rights investigators found evidence of deliberate suppression of data by the government on health issues, including cholera and malnutrition. Malnutrition is very political; we’re not supposed to have hunger in Zimbabwe, even though we see it, we can’t report it, one nurse told them.

About 205,000 people are thought to be accessing antiretroviral (ARV) treatment from both the public and private sectors, but Beyrer said no programme was enrolling new patients and the supply of ARV drugs was often interrupted, which meant patients had to keep switching regimens. HIV testing is now only available in the private sector at a cost of US$100.

The TB programme in Zimbabwe is a joke, said one expert the investigators interviewed, who told them that the national TB laboratory had only one employee, data collection effectively stopped in 2006, and there was no one trained to conduct drug sensitivity tests to determine whether patients had drug-resistant TB strains.

Beyrer described Zimbabwe’s healthcare crisis as a direct consequence of the malfeasance of the[President Robert] Mugabe regime, and systematic violation of a wide range of human rights. Physicians for Human Rights advocated referring the healthcare crisis in Zimbabwe for investigation by the International Criminal Court.

According to Beyrer, a prosecution for crimes against humanity based on the denial of the right to healthcare would be unprecedented, but was warranted in the case of Zimbabwe.

The Ministry of Health in Zimbabwe’s new unified government falls under the Movement for Democratic Change (MDC), but Beyrer pointed out that the permanent secretary for health was affiliated with Mugabe’s ZANU-PF party.

Beyrer urged the delegates in Durban to view the collapse of Zimbabwe’s health system as a regional problem that required a regional response. Millions of Zimbabweans have fled to neighbouring countries, in particular South Africa, where they are still often unable to access healthcare.

Zimbabwe’s medical schools have been closed since November 2008, and Beyrer recommended that neighbouring nations support Zimbabwean medical students to attend universities in their countries. He also called for increasing assistance to the Ministry of Health, with strict measures to ensure that funds were not diverted to support the Mugabe regime.

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source.www.irinnews.org

Photo: Glenna Gordon/IRIN

Some goodnews in AIDS battle

DURBAN,- The race is on for countries in Southern Africa to meet their targets of providing universal access to care, treatment and prevention by 2010. But will they make it?

The need to meet the goals is clear: the region is the worst affected by the epidemic, and despite good intentions in many countries, the numbers of people living with the virus have remained stubbornly high.

Yet South Africa’s fourth AIDS conference heard on Thursday that the countries of the region have made extraordinary progress towards meeting their goals. UNAIDS defines universal access as 80 percent of the people who need treatment receiving it.

Mark Stirling, head of UNAIDS in southern and eastern Africa, told delegates that half the region’s HIV-positive pregnant women were accessing services to prevent transmitting the virus to their babies, and about 40 percent of those in need of treatment were getting it.

Although many countries were recording a decline in new infections, South Africa, Swaziland and Mozambique were still struggling with high levels of transmission.

In Botswana, which has long been regarded as the region’s poster child for treatment provision, universal access “ 80 percent “ has been achieved. About 90 percent of those in need of antiretroviral (ARV) drugs are receiving them, and the success of the prevention of mother-to-child transmission programme means that paediatric HIV could soon be eliminated.

Fragility

However, Dr Khumo Seipone, director of the HIV/AIDS programme in the Health Ministry, cautioned that “Not everything is good in Botswana. The rate of HIV transmission is not going down as fast as we would like ¦ issues of prevention are not as good as we want [them] to be.

Seipone said this could be a result of “disinhibition” among Batswana on ARV treatment, causing people to become complacent. “Who is afraid of HIV in Botswana? It’s now seen as [a] chronic illness, she remarked.

Admitting that there had been no coordinated approach to prevention as there had been to treatment, Seipone said the country would now be focusing on prevention, prevention and more prevention. For example, in April this year Botswana will start scaling up male circumcision across the country.

Elizabeth Mataka, the UN Special Envoy for HIV/AIDS in Africa, warned that all the progress made in the region was extremely fragile right now, if you look at the global economic downturn.

She called on the region to hold leadership accountable, especially African leaders, to make sure that the goals were met.

It’s very embarrassing to be holding the world to their promises [of funding the HIV/AIDS response] without demanding the same of our leaders, Mataka told delegates.

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source.www.irinnews.org

Photo: WHO

First sign of flesh-eating Buruli ulcer before lesions and bone deformity

COTONOU,  – It starts as a painless lump, swelling or a hardened skin patch but if undetected and untreated can turn into a festering lesion and then permanent disability. Researchers are still stumped as to what causes the spread of Buruli ulcer, named for the city where the infection was first described in Uganda more than a century ago. In the face of unanswered questions about the oft-neglected disease, scientists and health officials at a World Health Organization (WHO) conference in one of the endemic countries, Benin, stressed prevention.weeks of antibiotics, which can prevent the infection from becoming an ulcer, to surgery to remove infected tissue.

What is most serious about Buruli ulcer is not linked to the mortality rate [estimated two percent, WHO], but the disease’s aftermath,  said Yves Bargui, the head of a Buruli ulcer testing and treatment in Lalo, 100km west of Benin’s economic capital Cotonou.

In addition to painful disfiguring skin lesions, if the infection reaches the bones, it can cause permanent deformity. What is important for us is early detection, said Bargui. If we can diagnose it early, then there is no need for surgery.

Depending on severity, treatment ranges from eight

The head of National Buruli Control Programme in Còte d’Ivoire, one of the most heavily-affected countries, told IRIN more money and government support is needed to improve prevention. Researchers’ initiatives alone will not be enough. Without a stronger political will than we have now, we will never conquer [this disease]said Didier Yao Koffi.

More than 60 years after the infection was first identified and analysed in Australia, researchers told IRIN a lack of funds limit research. According to the Australia-based George Institute for International Health, donors and governments invested US$2.4 million for Buruli ulcer research and vaccine development in 2007, which was less than 0.1 percent of spending on neglected disease research worldwide.

Australian scientist Tim Stinear said Buruli ulcer research is sorely lacking. “Sixty years later, we still do not know where the bacterium is found or its mode of transmission.

Buruli ulcer is caused by the same family of bacteria responsible for tuberculosis and leprosy. The vaccine used for tuberculosis can prevent the most serious Buruli ulcers, according to WHO, but researchers said a more targeted

vaccine is needed to prevent a disease that affects fewer people than more well-known diseases in poor countries like HIV or malaria, but can be costly, debilitating and leave severe deformities.

In Còte d’Ivoire approximately 24,000 cases were recorded from 1978 to 2006; in Benin nearly 7,000 cases between 1989 and 2006; and in Ghana more than 11,000 cases since 1993, according to WHO.

But the health agency has written that given scant research, poor diagnostics and lack of information on the disease’s spread, it is most likely underreported.

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source.www.irinnews.org