Africa – Page 4 – Alex B. Hill

why there is no doctor: introduction to an epidemic (1)

Subtitle: The Impact of HIV/AIDS in the Post-Apartheid Health Care System of South Africa

Introduction to an Epidemic

Everyone in the car remained silent as we passed a sea of gravestones on the way to Zonkizizwe, an informal settlement south of Johannesburg (1). The cemetery seemed to extend for miles. This was the reality of HIV/AIDS in the peri-urban, informal settlements. It is a reality that is not far departed from scenes in rural homelands as well as the urban townships of South Africa. I was not new to the HIV/AIDS epidemic, but I was new to the experiences of those living in an informal settlement under apartheid, struggling with the crippling impact of HIV in an area where I never even saw a doctor. Why were there no doctors?

It is estimated that one in five South Africans aged 15-49 are infected with HIV. Since the last UNAIDS report in 2008, 5.7 million people are living with HIV in South Africa and 1000 people die everyday from HIV/AIDS related causes (2). The cause of death for 71% of people aged 15-49 is now AIDS (3). Some people have even noted that South Africans spend more time at funerals than they do at weddings. There are an estimated 1,400,000 orphans as a result of HIV/AIDS (4). The numbers of those infected does not reflect the real impact of disease because the impact of HIV/AIDS extends further into families, friends, and communities.

Life expectancy has fallen considerably in South Africa as the prevalence of HIV/AIDS spread rapidly from 1990-2003 (5). This time period is marked by violent, but positive changes in government rule and policy. The first case of AIDS in South Africa was diagnosed in 1982 among the gay population, so why was the most rapid spread during this time period (6)? Many experts and professionals posit that this rapid spread of HIV and the lack of a response to the epidemic in South Africa is due to the political turmoil of the 1980s into the 1990s. However, this represents a failure to look deeper into the history of South Africa and its health care systems.

While violent conflict had a direct effect on the response to HIV/AIDS in South Africa, a number of other factors with greater impacts based in apartheid policy led to the rapid spread and limited possibility for a comprehensive government response even if there were an absence of violence. South Africa has a difficult history of formulating a response to HIV/AIDS: from apartheid health policy to AIDS denial, from a failed treatment program to the absence of doctors and adequate health infrastructures.

In the March 2009 elections, health was a driving factor for many voters and appeared on many political party platforms. The African National Congress (ANC) ran with promises to cut HIV infections by 50%, launch a National Health Insurance program, and ensure decent wages for health workers (7). With such a far-reaching crisis at hand, politicians must formulate a better, more comprehensive plan to address the effects of apartheid history combined with the current strains on the health care system if they are to effectively combat HIV/AIDS. Why has the response to HIV/AIDS been so poor? Why was HIV able to spread so quickly in South Africa? Why is there no comprehensive treatment program? Why are there no doctors?

Notes:
1. Personal account of Alex B. Hill who interned at Vumundzuku-bya Vana ‘Our Children’s Future’ in Zonkizizwe (Proper), South Africa from May-August 2008.
2. UNAIDS 2008 Report on the Global AIDS Epidemic http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/
3. Centre for Actuarial Research, South African Medical Research Council and Actuarial Society of South Africa (2006, November), ‘The Demographic Impact of HIV/AIDS in South Africa – National and Provincial Indicators for 2006’
4. HIV & AIDS in South Africa: The history of AIDS in South Africa
http://www.avert.org/aidssouthafrica.htm
5. UNAIDS 2006 Report on the Global AIDS Epidemic, Chapter 4: The impact of AIDS on people and societies
http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2006/default.asp
6. HIV & AIDS in South Africa: The history of AIDS in South Africa
http://www.avert.org/aidssouthafrica.htm
7. Cullinana, Kerry. “Healthy election promises.” 31 March 2009
http://allafrica.com/stories/200903310649.html

Coming next: The Health System via Apartheid

why are there no doctors?

Health

(photo: empty waiting room at Zonke Clinic 2, no doctor)

Over the past 8 years Africa, international development, and health care have been the focus of my work and studies. Just last year (it’s been a year already?) I completed an internship in South Africa at a center for children and youth affected by HIV/AIDS called VVOCF (Vumundzuku-bya Vana ‘Our Children’s Future’). The internship was a completion of my ‘field experience’ requirement for my International Relations major at James Madison College and was supported by the Young People For internship program. The paper that I wrote as an investigation, analysis, and report has been by far my most rewarding piece of academic work, but also my most depressing.

To work with a community on difficult issues is one thing. To witness harsh realities while working within that community is another. But to know the historical and present reasons behind those issues and harsh realities is yet another – and it is painful only be able to watch. Sure you could argue that I and others spent time working with the community at VVOCF, but in truth all we can do as outsiders is watch. We will never live long-term in the community and we will never fully understand the issues that we study and claim to know so well.

My blogging well in South Africa took a hit because of the lack of internet access and since then has been limited to posts of some of my academic papers for classes. What will follow this post will be a series of posts copied and pasted from my final, field experience paper. I hope that it can be a resource for others. I also hope that it is a deeper look into an issue faced by a community with plenty of room for further research, learning and understanding.

There will be roughly a dozen posts on the health care system in South Africa: effects of apartheid, impacts of HIV/AIDS, issues in Zonkizizwe specifically, and conclusions. Be sure to check back later today for the first post.

history channel perpetuates misperceptions of africa

Development, Featured

Reminiscent of the 1800s, a new History Channel show describes a team of explorers, dressed in their colonial khaki, set out to discover the perils of the African continent.

Four modern-day explorers retrace the most famous search in history through 970 miles of hell. They face countless dangers from predators and insects to disease and nature’s own fury. Check out the television event of the summer!

Miles of hell in Africa, oh my! Don’t forget the natural danger!

Between Zanzibar and Ujiji, there are 970 miles of high seas, steep hillsides, scorching plains, fast-moving rivers and mud-filled swamps. Danger lurks around every corner, and any step could be their last.
(Expedition Africa, History Channel)

The webpage for the expedition show describes how the explorers will be following in the footsteps of the great explorers, “heroes” to some of these ‘modern-day’ explorers, Sir Henry Morton Stanley and Dr. David Livingstone.

Stanley a Welsh journalist, who spent a number of years of his life in the US, is best known for finding Dr. Livingstone after he was thought lost in the African bush. Regarded as one of the premier African explorers, a little known fact about Stanley’s African exploration is that he laid the foundation, through his exploration, for the takeover of the Congo (now DRC) by King Leopold II of Belgium. The King was interested in spreading Western civilization and religion to the region as well as claim land. This has led to a still destabilized region where some of the longest running African conflicts are located. Allegedly his expeditions were marked by violence and brutality. He is quoted, “the savage only respects force, power, boldness, and decision.” On a health related note for the central African region, the spread of trypanosomiasis is attributed to the movements of Stanley’s enormous baggage train.

Livingstone’s African exploratory era was marked by the greatest European penetration of the continent. He began his African explorations as a Protestant missionary, but supposedly did not force his preaching on unwilling ears as his main interest was exploring. He was known to travel lightly and was able to negotiate with local chiefs. Livingstone was a man in love with the continent and popularized the search for the source of the Nile. After being ‘found’ by Stanley he refused to return without completing his mission. Just 50 years after his death, colonialism exploded across the continent and was able to penetrate further into the interior due to his work. However, this also allowed missionaries to provide education and health care services to more central Africans. Livingstone was also a staunch abolitionist and made many friends among the African chiefs and populations.

Both men are examples of the Western colonial mindset scarring the African continent. While Livingstone was perhaps a step forward in Western engagement of Africans, Stanley is far from a figure to emulate. The History Channel fails to take note of the important contributions these men made to the destruction of the continent. Instead they focus on the meeting of the two in a popular media tale of discovery in the African wilderness.

Four Westerners with varying experience with the African continent will be followed on their journey that will pit them against the harsh natural environments of Africa. But, this show isn’t about Africa, learning about African peoples, remembering African history or highlighting the difficulties faced in Africa. The show makes generalizations about the continent and perpetuates the myths of Africa as primarily a place of danger. It focuses on Africa as “the unknown, the interior of Tanzania.” If I’m not mistaken people have been living on the African continent longer than any other place on earth. It may be a dangerous, unknown hell full of nature to outsiders, but it is far from a mystery to those who live there. The show seems to be all about these four privileged individuals and the story of their personal journeys. The explorers are worried about mosquitos, disease, death, and surviving. Rightly so in some regards, but what if the story included the people that actually live there?

When will Africa cease to be represented solely by its nature, its dangers and its forgotten history?

Written for the SCOUT BANANA blog.

the week in african health

Health

The impact of conflict on the environment and then the subsequent, direct effect on human health cannot be overlooked. This internally displaced peoples (IDP) camp in Sudan shows the seriousness of that impact.

Your Old Cell Phone Can Make a Difference in Global Health

Everyone in the global health sector is writing about the incredible reach of SMS technologies working for health in developing countries, and rightly so. Hope Phones has partnered with FrontlineSMS to provide old cell phones to communities in need through SMSmedic partner organizations.
More:
Your Old Phone Can Change the World

TeleMed
A service that I just recently came across is one that is not being as widely talked about. TeleMed is different from FrontlineSMS: Medic because it connects local health care workers directly to patients in need via SMS technology. SMS: Medic is focused on health infrastructure. TeleMed does not have a website up yet, but is definitely one to watch:

Paul Farmer and the US Government?

The other big talk within global health is whether Paul Farmer will take a job within the US government. Some have expressed great hope for potential reform others voice their plea with him to continue his incredible community based work outside the bureaucracies. My opinion is that Partners in Health has developed into a strong organization and does not depend on Paul Farmer to further their work. If he wants to take on the inefficiencies and inadequacies of the US government and global health, then all the more power to him.

Southern Africa: Global Financial Crisis Leads to HIV Budget Cuts

Broken promises abound as the economic crisis deepens and the right to health falters, but activists are coming together to ensure that funding for health and HIV are not cut. International donors are expected to slash budgets for health due to the economic crisis and health experts fear that this will lead to, “less food security and quality of nutrition, which will in turn put more stress on already weak health systems.” Paula Akugizibwe, regional treatment literacy and advocacy coordinator of Windhoek-based AIDS and Rights Alliance for Southern Africa (ARASA) in Namibia demanded, “We need to ensure that African lives do not become a silent casualty of the global financial downturn. Our lives are not cheap or expendable. We expect health to be prioritised over weapons, sports and lavish politics.” Tanzania was the first sub-Saharan country to announce a 25 percent cut of its annual HIV/AIDS budget.
Other budget cut impacts:
Guinea: Medicines Running Out

Zambian High Court to Hear Groundbreaking HIV Case

On Wednesday, the Livingstone High Court was supposed to hear a ground breaking case about whether mandatory testing for HIV and discrimination solely on the basis of HIV status is constitutional in Zambia. Unfortunately two days later news came that the trial was postponed until mid-July. Be sure to keep watching this story.
More:
Trial postponed until 15 July

HIV Prevention and Behavior Change

Mara Gordon writes on Change.org’s Global Health Blog about a direct campaign in Tanzania discussing behavior change. “This campaign is partially paid for by the President’s Emergency Plan for AIDS Relief, U.S. government money to fight HIV that’s notoriously had lots of conservative strings attached. Had I seen this ad a year ago, I probably would have dismissed it as unrealistic abstinence-only propaganda. But behavior change works. Behavior change – in combination with access to condoms, comprehensive sexual education, open discussion about HIV and sexually transmitted infections in general, all that good liberal stuff.”
More:
Changing Human Behaviors: Sexual and Social
During a course on Africa’s environmental history I wrote about the need for changing human behavior in both the sexual and social arena to make a real impact in HIV prevalence. The major social change is the response from Western institutions and organizations in how they talk about HIV/AIDS and Africa while seeking to change sexual behavior.
Lesotho: Cultural Beliefs Threaten Prevention of Mother-Child HIV Transmission
Health workers note an encouraging response to the PMTCT program. The number of facilities providing PMTCT has risen from nine in 2004 to 166 by the end of 2008. The number of women who received PMTCT and subsequent antiretroviral (ARV) treatment increased from 421 in 2004 to about 5,000 by end of last year, according to 2009 National AIDS Council statistics. “The primary health care coordinator at St. James Mantsonyane Mission Hospital, Khanyane Mabitso, says stigma and cultural beliefs make it difficult for medical personnel to follow up on HIV-positive mothers and their babies.”

Progress on health-related MDGs mixed

Many advances have been made in health. Some argue that these advances have been dwarfed by the HIV/AIDS epidemic, the economic crisis, or the failures of African governments. The WHO report shows that the only statistic with concrete results was the number of children dying before the age of five. Is this a solid example of the failure of big plans and blanket goals for development?

Sierra Leone: ACC Recommends Reform At Health Ministry

The Anti-Corruption Committee report provides a number of recommendations for reform all focused on improving the health care delivery services in Sierra Leone and eliminating the risk of corrupt practices in the health services across the country.
More on health service scale-up:
Chad: Paving the Way for Better Obstetric Care
Government meetings with UNICEF to help scale-up of health services for better obstetric care across the country.

Ten Things You Can Do to Fight World Hunger

The Nation provides an interesting set of things you can do in your everyday life to fight world hunger. They properly focus on how food, a basic human need, has been commodified in our global capitalist structure. “Our planet produces enough food to feed its more than 960 million undernourished people. The basic cause of global hunger is not underproduction; it is a production and distribution system that treats food as a commodity rather than a human right.” When in February I wrote that agricultural experts had said the food crisis of the last year was over evidence from this past week point to the contrary.
More:
Tanzania: Food Shortage Unnecessary
“Tanzania has since independence sang the song of ‘Agriculture is the backbone of the economy’, but little has gone into strategizing and implementing viable actions towards surplus food production.”
Kenya: UN Agency Makes First Local Food Purchase from Small Scale Farmers
The United Nations World Food Programme (WFP) has for the first time bought food from small-scale farmers in Kenya under a new initiative aimed at boosting agriculture by connecting farmers to markets.
Zimbabwe: Another Year Without Much Food
Rwanda: Nearly Half the Country’s Children Are Malnourished
Kenya: Over Three Million Face Food Shortages

Africa: High Level Engagement with Continent Has Started

Speaking at a gala reception in Washington marking the beginning of “Africa Week,” Carson said: “Most of the Obama administration’s Africa team is in place, and we are gearing up. We will continue to build on and strengthen the strong bipartisan consensus in Congress and among the people of America that has motivated U.S. policy towards Africa. Over the next four years, we will be focusing our efforts on strengthening democracy, promoting sustainable development, resolving or mitigating conflict, and dealing with transnational issues such as climate change and agriculture,” he pledged. While Obama has built a great team, the White House has yet to announce any Africa Policy, greater control and influence for the Bureau of African Affairs, or take any serious (or effective) action for the continent.
More:
Tanzania: Obama, Kikwete Meet in Oval Office on Africa’s Conflicts

World Bank Resumes Zimbabwe Aid

Zimbabwe owes the World Bank and the African Development Bank more than $1bn, how much potential does renewed aid really hold for the country. If the debt is not forgiven there will be no way the country will be able to rebuild necessary infrastructures for health, water, etc. There are countless case studies to show this historical fact. It must also be noted that Western sanctions were a huge detriment to a country in need, maybe this marks a turnaround?

Originally posted on the SCOUT BANANA blog.

the universal currency of being under the weather

Health, Research

Review of Healing and Curing: Issues in the Social History and Anthropology of Medicine in Africa
by: Megan Vaughan

Everyone everywhere gets sick whether it is a common cold, a serious disease, or even a life-threatening virus. Likewise, communities across the world work to heal these illnesses and afflictions. Megan Vaughan reminds us that illness and healing are everywhere; there are unwell bodies everywhere and always attempts to heal those bodies. Illness and healing are regular, even normal, features in our lives. However, as Vaughan notes, illness and healing have different definitions and meanings in different areas of the world and within different cultures. How then can we unite the rhetoric into one common topic for academics to discuss?

One of my first thoughts goes to the international organization, Medecines Sans Frontiers (MSF, Doctors Without Borders), and their work across the globe conducting medical missions. How are they able to work towards comprehensive fighting of illness and healing when there are so varied ideas of illness and healing? Do they have anthropological training? Are they equipped with a cultural guide?

Vaughan notes that in Feierman’s article he cited Gilbert Lewis’ work in Papua New Guinea.

Lewis had defined the universe of misfortune by determining who was and who was not ill according to scientific criteria, and then observed how illness was diagnosed and treated within the community. As Feierman pointed out, this was a radically different anthropological approach to that taken by Victor Turner in The Drums of Afflication, a study in which illness appeared to have little independent biological reality, but was described as an important stage in a social drama. (284-5)

Lewis’ work was both innovative and radical in that he worked to apply his Western scientific knowledge well at the same time watching and learning how local communities treated illnesses.
I’d have to say this idea is no longer so radical and more likely than not has become the norm for those working in organizations like MSF.

Among ordinary people in cases of illness caused by sorcery, or in other words by one person’s aggression against another, the course of treatment developed into a contest of power between the medicine men working for and against the sick person. The patient could not recover unless his supporting healer proved fully dominant, and therefore capable of ending the contest of strength. (286)

An issue often arises between separating metaphor and symbol from biological reality in discussions of illness and healing. This is an especially important context in Africa where illness and sickness can refer to actual disease as well as spiritual imbalances or curses. Recognizing the overlaps of science and culture within medical practice is key to effective healing. If culture is ignored in scientific medical realities there can be terrible consequences. But, where is the boundary of biological science in medicine?

More often we have to choose between approaches, since we simply do not have the textured evidence which might allow us to trade both the extent of biologically defined illness and the cultural experiences and constructions of that illness. I would like to argue, then, that we might want to learn something from the new well-documented pluralism of African healing systems. (287)

Something that I have studied and seen is this pluralism of African healing systems. Most notably in Ghana the traditional healers and birth attendants are integrated into the formal health care system. They are provided training and certification and often work alongside those practicing Western orthodox medicine.

[…] we neither have to be totally biologically ‘blinkered,’ focusing exclusively on the disease vector, nor do we have to go so far down the road of social constructionism as to render ‘biology’ totally passive. (287)

Beyond various relative understandings of illness and healing it is important to break into the realm of colonial medicine in order to understand certain inadequacies in response to illness and failures of healing. Vaughan notes that the study of colonial medicine has been one of the areas that has illuminated most clearly the limits of colonial power (288). In Africa, she writes how, “colonial medics were simply too thin on the ground and their instruments too blunt to be viewed either as agents of oppression or as liberators from disease, and studies of African demography confirm this view.” (288)

Although colonial medicine may have been more an inadequate colonial department, it is important to look further and apply the past to the present. The impacts of Western diseases brought by colonial powers ravaged Africa. Because of perceptions of Africans and lacking colonial medical systems, these new diseases were not addressed. A history of disease patterns doesn’t reflect on colonial medicine, but the responses to disease patterns in Africa does. Colonial responses to illness reflected problematic representations of Africa and Africans and so the historical medical accounts are filled with issue.

[…] of course there are many important differences between theories and practices of twentieth century biomedicine, and those of African healers, but in order for us to understand these differences the practice of scientific medicine in its various forms needs to be specified with the same attention to detail as are those of its African counterparts. (291)

To conclude, I applaud Vaughan’s call for medical practice to reflect the pluralism found in Africa health care systems. She writes a compelling piece and hopefully her ideas are heeded at least in medical work conducted in Africa.

changing human behaviors: sexual and social

Featured, Health, Research

Review of AIDS in Africa: a perspective on the epidemic
by: Michael C. Latham

Africa is a continent wrought with many pressing issues, these issues are often not natural or specific to the continent, but they have been forced and applied to the people and so become a burden of near epic proportions. One of these pressing issues is the epidemic of HIV/AIDS. Responses to HIV/AIDS are based in human behaviors, both sexual and social.

Michael Latham noted that many accounts, “may suggest that the virus originated in Africa, and therefore it is Africans who are blamed for this human scourge.” (39) However, as many know, HIV/AIDS is not solely an African problem, uncontrolled and spreading like wildfire. These accounts springboard off of old myths of a ‘dark continent’ into new myths of dirt, death, and disease. This new myth is of a continent ravaged by disease inside and out, you can’t run from all the disease in Africa. It is also important to note that there is still no solid proof or knowledge of the origin of HIV/AIDS.

If the world is to blame Africa for HIV/AIDS, then Latham writes,

[…] but does it matter that syphilis was probably spread to the rest of the world from cases brought back to Europe from the Americas, to that cholera originated in the Ganga Delta of India and eventually reached East Africa from the middle east only in the mid twentieth century. Should Africans flagellate North Americans and Asians for spreading highly infectious diseases to Africa? (39)

Here we are at the historical spread of diseases and also, more notably, the social implications of associating one area or group of people with a disease. The social implications of chalking AIDS up to African causes becomes especially problematic in the medical community. Latham writes about when one potentially useful drug in the treatment of AIDS [HIV] waa described by the Kenya Medical Research Institute in 1990, it was largely ignored by the world press and […] the west.” (40) This proves a strong disdain and indifferent to Africa as well as a lack of respect for African doctors.

A key feature of HIV/AIDS is that it places all segments of society at risk: mother and father, child and grandparent, youth and elderly. Latham decries the lack of adequately funded research on HIV/AIDS in Africa, or anywhere (42).

We should have African anthropologists and sociologists in the bars and on the truck routes, in the urban slums and rural villages, gathering data on human behaviours, including sexual behavior, that may influence the spread of the disease. We need local epidemiological sleuths conducting the kinds of studies which led us to understand how cholera was spread and how pellagra could be controlled. (42)

Comprehensive understandings of HIV/AIDS and sexual behaviors in Africa will only be more helpful, but the social behaviors of the West and its institutions create a serious roadblock. The Kenyan discovery of Kemron was shown to reduce the effects of full-blown AIDS, but the announcement by the Kenyan president didn’t even make headlines. If a Western doctor had made the discovery the coverage would have been entirely different (46).

Another well-known fact about HIV/AIDS is that it is highly preventable. The only thing that needs to be changed or taught is human behavior: both sexual and social. There needs to be adequate health education for female members of a community. Female members also need more control in those communities, socially and sexually. Very often there is a strong gendered focus on women, but men also need serious engagement and education if their mindsets are going to change about women.

HIV/AIDS is an illness that requires changes in human behaviors: socially and sexually. There needs to be more comprehensive education on sexual prevention as well as a shift in the minds of Western organizations and institutions. There cannot only be a call for changed sexual behaviors in Africa, there must also be a concurrent change in the social behaviors of the West.

the week in african health

Health

More:
A Tale of Two Refrigerators
Fighting has renewed in southern Sudan, but its not just between militant groups – aid groups fall victim to needless fighting as well. Diane Bennet writes on William Easterly’s Aid Watch blog about the 2001 peace in Sudan and how it was a ripe time to treat disease and build health infrastructure. Unfortunately internal bureaucracy and politics became the largest hurdle.

Sudan: Darfur – Thousands Flee to African Union Safety
More recently, South Darfur has become the seen of violent clashes between government forces and militants. It is important to never forget the impacts that conflict has on health services.

Africa: Public Health Care Must Lead

Oxfam International has released a report [access here] “challenging the myths about private health care in developing countries.” The report emphasizes the role that private health care can play in developing countries, but reminds us that there is no way a scale-up of private health services will reach poor people in need. Key recommendations are to increase funding for free universal health care infrastructure, rejecting ineffective practices of the past, and combining efforts to fuel effective initiatives – sounds a lot like SCOUT BANANA

Global Health: Mobile Phones to Boost Healthcare

Revolutionizing access to health knowledge, the efforts of the Mobile Health Alliance (mHealth), supported by the Rockefeller Foundation, the UN Foundation, and Vodafone Foundation are making a mark across the African continent boasting 51 existing or to-be-implemented programs in 26 countries around the world. Harnessing the potential of growing technology in ‘developing’ countries for the purpose of health can only signal a major shift in access to health care across Africa.

Getting the Continent on Obama’s Agenda

It appears that Obama’s administration is stacked in the favor of Africa and in favor of better international development practices all around. With Susan Rice serving as Ambassador to the UN action against genocide may be bolstered, Gayle Smith more likely than not will be tapped as USAID Director, she was a major proponent of the HELP Commission creating a cabinet level position for foreign aid, and a well known name among insiders and outsiders in African affairs, Johnnie Carson, is expected to be named head of the Bureau of African Affairs of the State Department. The future of US relations in Africa has incredible potential and hope to change.

Zimbabwe: Staff Return to Hospitals, But Not to Work

As a massive cholera outbreak tears across the country, medical staff have returned to their posts, but the nature of their strike, that began in 2008 over poor working conditions and wages, is now “more like a sit-in.” In a country so crippled by Western exploitation and resulting politics, a strike of the health workers in the face of a rampant disease outbreak does not bode well for a vulnerable population.
More:
Too Much Cholera, Too Little Food
Over 80,000 Zimbabweans Infected with Cholera

Africa: U.S. Naval Engagement Offers Health Dividends

Imagine the potential of the US’ military might if it was dedicated to coordinating naval and health care workers from 13 countries to bring aid and health services to communities in need. This becomes a reality with the African Partnership Station Initiative and Project Handclasp. I can only dream of a day where initiatives like this are more a norm than a surprising gesture of good will.

Mali: Raising Money and Hygiene Standards

One of the most innovative programs that I have read most recently is the work the Dutch based Gender and Water Alliance which is employing women to make soap as well educate and use it to increase hygiene and combat preventable diseases. Health benefits, a source of income and empowering women!

Food Crisis Over, Say Experts

Supposedly the global food crisis of last year is over! Agricultural experts from Africa and Asia are saying that we are no longer in a food crisis and that there needs to be an increased production of rice in Africa in order to keep the food crisis at bay. In my opinion, as long as we continue our unsustainable and capitalist practices that commodify a basic human need, we will remain in a global food crisis affecting both the US and Africa.
More:
Rwanda: Food Production Up, Thanks to Green Revolution
Thankfully the increase is not due to the ‘Green Revolution,’ but instead to increase in practices that are focused on protecting the environment.

South Africa: Treasury Blamed for Shortage in Aids Drugs

Years of controversy seem to have brought the blame down on the South African Treasury. With an extensive bureaucracy, it is no wonder that the ARV roll-out program has taken much longer than it should – as many die without the proper medications. While the numbers of people enrolled in the ARV program has increased significantly there still exists a problematic policy of access. Access hinges on wealth, CD4 count, and location. To access the government’s ARV program your CD4 count has to be less than 300, which is at a point where you are already very vulnerable. This creates an issue of sustained treatment because it forces an irregular regimen. If your CD4 count is above 300, you will have to pay. Many cannot pay and if you live far from a government hospital access is just that much more difficult because of taxi fare and time sacrificed for travel. It seems the health and wellbeing of its citizens is not a high budget priority of the South African government.
More:
Rapid HIV evolution avoids attacks
Much like the flu virus, HIV mutates and evolves in response to treatments. This really exposes the South African ARV program as highly ineffective.
Duncan discusses HIV/AIDS in Morocco
Little known to the world, the HIV/AIDS crisis grows in Morocco.

Originally posted on the SCOUT BANANA blog.

the week in african health

Health

Ethiopia a scene of over-grazing and desertification, making it difficult for both people and animals to survive. (From the MSF Photo Blog)

• ’There’s no reason only poor people should get malaria’

In an action that surprised many audience guests, Bill Gates, released a small number of mosquitoes into the crowd at the TED conference. Gates quit Microsoft last year to focus more on his philanthropic work. He spoke of the need, and his commitment, to put more funding towards developing drugs to combat malaria, one of the highest killers in the ‘developing’ world.
Watch the video:
More:
Mosquito Genes Linked To Insecticide Resistance May Be New Target in Fight Against Malaria,
Insecticide malaria impact clue

• When there is no village doctor

It is estimated that every fourth medical doctor and every twentieth nurse trained in Africa leaves the continent for better job prospects and better pay in wealthier countries. The UN Global Health Workforce Alliance warns that the economic crisis could further increase the medical workforce crisis across Africa.

For David Werner, who wrote the widely-translated 1970s village health care manual, “Where There is No Doctor,” medical specialization is not the best answer. “Experts come in and think they have all the answers, and end up drowning out solutions villagers could devise themselves.”

• Need to Focus on Maternal, Child Health – Top AU Official

As the African Union meets in Addis Ababa, Commissioner for Social Affairs Biencé Gawana said in regards to the AU’s proposed launch of a continent-wide program,

“We will launch a movement to promote maternal and child health in the continent,” she told reporters. “It will be an advocacy campaign… together with partners like UNFPA [the UN Population Fund] and UNICEF [the UN Children’s Fund].

With 500,000 women dying in childbirth each year, Africa has some of the highest rates of maternal, infant, and child mortality. As part of the solution the AU report noted: “One of the main challenges in the promotion of maternal, infant and child health and development is access to health care facilities and services, especially at primary health delivery level and [in] rural areas.”

• Zimbabwe: Cholera Infection Rate Climbs As UN Cleared to Assess Crisis

On Monday the WHO reported an increase of 2000 cholera deaths in Zimbabwe. The report was released just as President Mugabe agreed to allow a top level UN assessment team to tour the country to find solutions to curb the cholera pandemic as well as the current hunger crisis. Food security continues to plummet in may areas of Zimbabwe as many worry they will not receive aid in time.
More: Zimbabwe Cholera Statistics Rise Again As New Malaria Fears Grow,
Zimbabwe Diary: fighting cholera

• South Africa: The Quiet Water Crisis

There is great concern with the cholera outbreak in Zimbabwe, but what the South African government may be missing is its very own growing water crisis. With an aging infrastructure and rising demand, the potential for deadly bacteria to be released into its water systems is high. When Mandela’s government took power in 1994, an estimated 14 million South Africans lacked access to clean water supply and 21 million people lacked proper sanitation. Although the numbers have changed drastically, the Department of Water Affairs and Forestry (DWAF) reported in 2008 that 5 million people still lacked access.

• Twestival and Charity: Water

Last year SCOUT BANANA conducted a ‘Year of Water’ Project to benefit the work of Charity: Water. The organization is now utilizing the social media tool, Twitter, to raise a large amount of money to build wells across the world. Charity: Water began its work by supporting well projects across the African continent.

• South Africa: ‘Development Must Adapt to Water Resources We Have’

98% of water resources are being used in South Africa. Water security is becoming an issue as pollution from mining has been difficult to clean up and no other water resources remain unused.

• Obama Lifts “Global Gag Rule”

Also known as the Mexico City Policy, this move is being applauded by women’s and productive rights groups across the globe.
More: Obama Reverses U.S. Ban on Abortion-Linked Aid

• University Partnership Aims to Fight HIV/AIDS More Effectively

Backed by an almost $5 million grant from the Bill & Melinda Gates Foundation, John Hopkins University is growing a partnership with Makerere University in Uganda in an attempt to combat the growing HIV/AIDS epidemic. The partnership is only in its initial steps.

Originally posted on the SCOUT BANANA blog.

agency in community development

Development, Health, On the Ground

Previous entry: a first glimpse: zonke

13 May 2008

South Africa is much the same and different as many African countries that I have visited. Same in the sense of the smell of burning oil and gasoline, shipping containers as buildings, the red dirt, the friendly people, passenger vans as taxis, crazy driving, dogs for security, chickens and goats roaming everywhere, and the seemingly common practice of taking things as they come. The differences and nuances come in the country’s history – white minority oppressive rule. White people are not unheard of in this area of Africa and South Africa specifically – uncommon, but not unseen. You get a sense that you are always being watched, but in a different way than what may be experienced in other African countries without such a history. It is more of a, “why are you here” look instead of the, “oh! You are white.” The history of white oppression and the current issue of white organizations taking away from the communities makes the dynamic similar in skepticism, but different in why.

Today there was a meeting of the parents and guardians of the children at the center. I was not surprised to see that the majority of the guardians in attendance were women. The meeting was excellent in that it is incorporating the families and parents with the work of the center, since everyone is working towards the same goal – the children’s future. ‘China’ and another man [Mr. Ndaba] came today – they both work for the Library system and are self-proclaimed educators. For the success of the center it is also vital for the teachers to be interested and involved in the activities of the center. Parents, guardians, librarians, educators, teachers – the center requires a community coalition invested in the children’s future if it is to be a success as well as a strong positive for the future of the community.

In a sense community development has been hindered by the negation of education. Bantu education Acts left the black majority behind and now its effects perpetuate into inadequate schools in remote informal settlements and townships.

We had a tour of Zonkizizwe. There are 2 clinics for the 6 zones of Zonkizizwe Proper. Health services are free, provided by the government and are much used by the residents. I hope to be able to closer look at the health impacts of development and education in Zonke. It seems a pressing issue for many families and children is nutrition [malnutrition] and access to food. I have not yet been able to tell the extent of HIV/AIDS in Zonke, but that will be essential to understanding health and development in South Africa.

As much of what I have seen in African communities there is an incredible potential and energy to make change and improve for the future. The key is now facilitate that for those communities to actualize it themselves. “It takes a village to raise a child” – this idea really seems to be at the root of the African heritage and essential to future understandings of development in Africa. (This is a large generalization, but the basic idea of family structures and how that plays out is important all across Africa when working in development).

Back to the meeting: it was a great way to get community feedback and evaluate progress, programs, and potentially identify actions for the future that can be implemented. The issue I see in coming in the near future is employment. We can only do so much to supplement education, we cannot run schools. When students don’t pass the test for university there needs to be something in place to give them the skills to get trained and employed. My thinking now cuts to the idea of green-collar jobs/ green jobs/ green economy in the US to fight poverty, promote conservation, and cut crime and unemployment. A similar model must be able to work here. We hope to also start a book club in conjunction with the libraries and maybe the schools – this will be important to fostering and sustaining the coalition of teachers/ educators.

29 August 2008 Reflections:

The guardian meeting helps to build a community coalition that is dedicated to one another. People in the community who may have been facing issues alone can now come together and see that there are others also facing the same issues. The meeting also makes a family of those benefiting from the center. This also serves as an evaluation of the center’s activities where guardians can say what is working, what isn’t, or give suggestions of things they need. What is really important as part of these meetings is that the suggestions of the children and youth served by the center are used for everything. Their ideas, suggestions, and needs are utilized in decision making since it is their center – no one else owns it. As a very related issue, the center is starting a Young Intern program to train youth at the center to become the next staff members. So those who directly benefit from the center will soon become the next staff who will be able to give suggestions straight from experience.