This Week's News 5 August 2011

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Human Rights Report Details Violence Against Health Care Workers in Bahrain

Journal of the American Medical Association

03/08/2011

JAMA.. 2011;306(5):475-476. doi: 10.1001/jama.2011.1091

M. J. Friedrich

When antigovernment protesters marched in February and March of this year on the streets of Manama, the capital of Bahrain, peacefully calling for political and economic reforms, a brutal response by the country's security services followed.
The majority of the injured and dead were brought to Salmaniya Hospital in Manama. Rather than being a safe haven for the wounded, however, this facility, the largest modern medical facility in the country, was declared by the government to be a stronghold of opposition protesters. Security forces occupied the building. According to human rights organizations such as Physicians for Human Rights (PHR), patients were beaten and abused. Physicians, nurses, and other health care workers who treated the civilian protesters were systematically abducted, detained, and interrogated, and many now are facing trial for allegedly using the hospital as a base to try to overthrow the royal government.
Several human rights organizations such as PHR and Doctors Without Borders have reported abuses against patients and health care workers.
Richard Sollom, MA, MPH, deputy director at PHR and forensic pathologist Nizam Peerwain, MD, chief medical examiner, Tarrant County, Texas, carried out medical evaluations of torture survivors and spoke with people who witnessed physician abductions. They described their findings in a report released by PHR in April, Do No Harm: A Call for Bahrain to End Systematic Attacks on Doctors and Patients (https://s3.amazonaws.com/PHR_Reports/bahrain-22April_4-45pm.pdf).The report also documents the use of medical transport for military purposes, the destruction of medical facilities and medical records, and the obstruction of medical care and treatment.
When reports about the injured protesters hit the international media, Sollom said, the Bahraini government put its own spin on the information, claiming that physicians were instigating political unrest, fomenting violence, turning the hospital into a political headquarters, and depriving thousands of people of treatment.
Many of the physicians targeted are the country's leading medical specialists, physicians with 20 to 30 years of experience and impeccable medical credentials, said Sollom. “It strains credulity to believe that these physicians would suddenly, out of the blue, start deliberately harming patients rather than helping them, as Bahrain's government has alleged,” he said.
At press time, dozens of physicians, nurses, and paramedics who were arrested for treating protesters were on trial before a military court. The government's use of a military trial for these cases calls into question whether the rights of the accused can be adequately protected. Families of the defendants have reported to PHR and other human rights organizations that the defendants have been tortured and forced to sign false confessions in detention.
Sollom noted that he and other human rights observers speculate that the Bahraini government has systematically targeted physicians and other health care professionals because these caregivers, who treated protesters taken to the hospital, have firsthand evidence of the excessive force used by the government security forces. “This is one of the most egregious sets of violations of medical neutrality and breaches of international law that I’ve seen personally and we as an organization have seen in decades,” said Sollom. Medical neutrality refers to the ethical duty of medical professionals to care for and treat those in need without regard to race, religion, or political affiliation and to have a neutral and safe space provided by the state to carry out their work.
It is important for those in the medical community in the United States and other countries to fully appreciate what is happening in Bahrain and to speak out against the violation of medical principles, said Susanna Sirkin, MEd, deputy director at PHR. Imagine reporting for work in the midst of a crisis, she said, trying to deal with large numbers of injured people pouring into your hospital, only to be charged with outrageous allegations, denied access to lawyers, or whisked away from your family and kept in prison for months to face trial and possibly a life sentence.
The response from the international health care community has been quite powerful, with many nations and health care associations calling for Bahrain to respect medical neutrality and either to throw out the charges against the physicians and nurses on trial or, at the very least, to ensure a fair trial.
These Bahraini health care professionals are relying on the international medical response to save their lives, said Sirkin.
The World Medical Association (WMA) and the International Council of Nurses (ICN) issued a joint statement in June calling on Bahraini authorities to ensure fair trials for health care workers. Mukesh Haikerwal, AO, professor in the School of Medicine at Flinders University, Adelaide, Australia, and chair of the council of the WMA, said the WMA is asking all its member associations to issue similar condemnations of this treatment, not as a political statement but in support of the human rights of health care professionals.
“In a civilized society, health care professionals have a very important role in the healing and recovery of a nation in trouble,” said Haikerwal. “While personally I don't think these men and women ever should have come to trial in the first place, we need to stand back and call for a fair and open trial,” he said. “The neutrality and independence of these professionals should be respected. This could happen anywhere, to any of our compatriots doing humanitarian work, and they must be protected.”
Haikerwal said that at the World Health Assembly in Geneva in May, Bahrain's Acting Minister of Health, Fatima Al-Beloushi, EdD, EdM, MA, gave a spirited defense of the regime. “She basically denied that there were any abuses, a patently false assertion,” he said.
David Benton, CEO of the ICN, met with Al-Beloushi at the assembly and said that she told him that the Bahraini government was surprised and concerned about the level of international interest in the situation. International pressure may be having some effect, he said, given that Bahrain has allowed a few international observers to attend the trials.
“Until recently Bahrain has been one of the peaceful countries in the region, a gateway of sorts to the area and one visited regularly by tourists,” said Benton. Continued scrutiny could affect the economy, providing more leverage to address the situation, he said.
In May, Bahrain's King Hamad lifted the 2-month state of emergency. But while a number of physicians have been released and some of the missing have reappeared, this does not mean that Bahrain has been responsive to all the requests, appeals, and demands of the international community, said PHR's Sirkin.
The US government has exerted some pressure on its long-term ally, which is home to the US Navy's Fifth Fleet. In early June, President Obama met with Bahrain's Crown Prince Salman bin Hamad al-Khalifa, who, while not in charge, is considered a progressive member of the royal family who is in favor of a national dialogue to resolve the crisis in his country.
The American Medical Association recently provided a sample letter for US physicians to use to write to Bahraini officials and urge for the fair treatment of the health care professionals detained in Bahrain (http://tinyurl.com/69v45yh).
PHR's Sollom noted that his organization is in touch with contacts in Bahrain who report that medical professionals are still being targeted. PHR continues to name people who have been targeted because the appearance of their names in the media provides them some protection. A list of names can be found at the PHR Web site.
Sollom returned from Libya in June and is preparing a report on violations of medical neutrality there as well as war crimes in general. He pointed out that although in Bahrain, there's been a systematic attack on health professionals as individuals, in Libya attacks are focusing on hospitals and medical transport, but not on individual health care workers.
“But there are indiscriminate attacks on civilians that are war crimes, and we’ve documented allegations of rape in Libya, torture, mass disappearances, and detention, all of which will be coming out in our report sometime in late July, I hope,” said Sollom.

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RCGP helps drive reform of primary care in India

GP Online, UK

27/07/2011

By Colin Cooper
Dr Chandramouli: ‘Family medicine is very important in India but we have a huge shortage of doctors and gaps in medical education that need to be filled'
More than 50 leading figures in healthcare and government were invited from around India to the inaugural Family Medicine India event, including the health secretary and his deputy.
The meeting was jointly organised with Haymarket Medical Media, the publishers of GPonline.com and mycme.com, and the School of Health Sciences at MIT Pune.
The aim was to address the crisis in Indian primary care caused by the focus on specialist, hospital-based treatments at the expense of family medicine in the community.
India’s health secretary Dr K Chandramouli told the meeting: ‘Family medicine is very important in India but we have a huge shortage of doctors and gaps in medical education that need to be filled.
‘We need the presence of the general practitioner, and the RCGP have done a wonderful job in this direction. We should take their advice before embarking on a programme of this kind.’
Dr Raman Kumar, president of the Academy of Family Physicians of India, said the lack of educational courses in family medicine and the limited career opportunities meant few medical students were attracted to the discipline.
Professor Gautam Sen, director of surgical education at the Association of Surgeons of India, said family medicine had deteriorated to the point where the public and other healthcare professionals no longer recognised the concept.
‘With the tremendous advances in medical technology and designer drugs, somewhere down the line primary care took a back seat. Our role model was once the good family doctor but it became the highly trained specialist doing highly specialist procedures.’
Professor Sen said the Indian healthcare system was now 65% private and catering for the top 10% of the population.
‘We now have complex technology-driven healthcare when people are dying of malaria and road traffic accidents.’
Dr Garth Manning, medical director of the RCGP’s International Development Programme, said the college had been active in India for 12 years and produced an educational programme written by and for South Asian doctors, leading to college membership via the MRCGP[INT] exam.
He told the meeting: ‘We are in no way trying to export a UK version of general practice to India. But we know that comprehensive, preventive healthcare leads to better health outcomes, lower costs and greater equality in health, which are important issues for any governments to consider.’

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Africa & Middle East

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Interns' Strike Underscores Major Shortcomings

The New Vision, Uganda

27/07/2011
Over the past few days, the services at several public hospitals including Mulago, have been paralysed by the strike of intern medical doctors, dental surgeons, nurses and pharmacists.
The interns went on strike after a circulated report by the National Internship Committee which proposes to extend the medical internship programme for another year. This is intended to fill in the shortage of health workers in upcountry health facilities.
The interns are also unhappy with a proposal to undertake their internship in rural hospitals where there is no accommodation.
The director of health services, Dr Jane Aceng, has clarified that the ministry is yet to take a decision on the matter of extending the internship for medics from one to two years. She says there are only proposals being considered to address the problem relating to human resource availability in health facilities.
First, this crisis appears to be a consequence of the Government's poor communication methods. Such a major policy proposal should have been communicated to all the stakeholders and public promptly to facilitate wider consultations. Any decision taken after such consultations would make implementation easy.
The reasons why interns are resisting deployment upcountry are obvious. It is more lucrative to work in the city and big towns. There is need to make it attractive for professionals to work upcountry. Many districts currently do not have the required professionals because it is uneconomical and at times not conducive.
The Government should consider a policy for professionals graduating from public universities, such as medical doctors, to contribute to public service. Tax-payers incur a fortune to educate these professionals. They, therefore, have a moral duty to serve in public service, at least for some few years.

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Hospitals 'crying out' for retired nurses
Times Live, SA

03/08/2011

HARRIET MCLEA
A dire shortage of nurses has forced the Department of Health to launch a nationwide drive to attract retired nurses back to the profession.
Gauteng MEC for health Ntombi Mekgwe made a plea yesterday to 200 women from the provincial Retired Nurses Forum to come back to work.
"In the eyes of the community you will remain a nurse until you depart from this Earth," she told the women, most of whom have cared for the sick for more than 30 years.
The shortage of nurses is a national problem.
The 2010 SA Health Review, published by the Health Systems Trust, reported that Gauteng had a 15% vacancy rate for health professionals compared with a 68% vacancy rate in Limpopo. Last year 1209 nursing posts were unfilled in Gauteng alone.
Vacancy rates in other provinces were:

■Eastern Cape 58%

■Free State 49%

■Northern Cape 42%

■Mpumalanga 34%

■Western Cape 28%

■KwaZulu-Natal 29%

■North West 12%.

Eastern Cape spokesman for health Sizwe Kupelo said that some nurses "leave office while they're still fresh". The province had been recruiting retired nurses for some time "to close the gap".
Health Minister Aaron Motsoaledi's spokesman, Fidel Hadebe, said the recruitment of retired nurses was part of a nationwide campaign to fill vacancies in the primary healthcare sector, which was being "re-engineered".
It is also part of the department's preparation for the introduction of national health insurance and the implementation of plans to send district health teams to communities and schools.
Advertisements had been placed in national newspapers asking all retired nurses to contact the department so that "as and when the need arises" they can be contracted on a six-month basis, Hadebe said.
Mekgwe appealed to the nurses to set an example to their younger counterparts.
"These young ladies who are now employed sleep all the time. Please make them awake."
Mekgwe said she had received complaints about the "negative attitudes" of many young nurses and that the government needed retired nurses to turn the situation around.
"As long as you can walk, and use your hands and your ears and your eyes, you have a role to play," she said.
Mekgwe thanked the nurses who were choosing to return to work.
Retired Nurses' Forum chairman Ethel Lesolang said Kalafong Hospital, Pretoria, is "crying out" for retired nurses.

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UNICEF rescues clinics

The Zimbabwean

28/07/2011
The Chief Executive Officer of Vungu Rural Discrict Council, Wellington Ngulube, last week confirmed the donation.
“The grant is meant to improve the health delivery system in the district. It is meant to purchase drugs and other clinic materials that will be distributed to various clinics in the district,” said Ngulube.
He added that the decentralization of anti-retroviral drugs (ARVs) to provinces had been challenging for the few nurses who were now working over time with no extra pay.
“As you might be aware, there are many people who require ARVs, but the shortage of nurses has exacerbated the situation. We need to budget for these extra costs,” he said.
Meanwhile, Ngulube said the council had already started preparations for the 2012 budget.
“We will be consulting stakeholders and residents this month. The thrust of the budget will be to include the people’s views,” he said, adding that the budget would also identify weaknesses in their process.
“We will use the 2011 budget as a post-mortem and will establish the reasons for various shortcomings and shortfalls. We will then identify the corrective measures to come up with a people driven budget,” he added.

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Rural Medics to Get Scholarships
New Vision, Uganda

01/08/2011

Paul Watala

DOCTORS and other medical workers working in hard-to reach-areas will soon get scholarships to further training in various fields both within and outside the country.

Dr. Christine Ondoa, the health minister, made this revelation at a meeting with Kazuo Managawa, the Japanese ambassador to Uganda at Mbale Regional Referral Hospital recently.
Managawa was on a three-day tour of projects run by the Japan International Cooperation Agency in eastern region.
Ondoa disclosed that health workers who have served for a long time and those with excellent performance will also be rewarded. Their remuneration will also be improved.
"The Government wants to reward to staff that have dedicated their time to serve this country without hesitation," she said.
Ondoa said this will work as an incentive to those working in hard-to-reach areas and also attract those who had refused to work upcountry.
It will minimise on the current brain drain," Ondoa said.
She said a recent study by the health ministry indicates that over 95% of medical personnel are demanding for better pay, adequate equipment and infrastructure, to help them execute their services effectively.
Ondoa hailed the Japanese Government for being the first government to offer infrastructural development in health and immunisation, adding that plans to renovate hospitals countrywide are underway.

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HORN OF AFRICA: Drought and HIV - a dangerous combination

UN IRIN

28/07/2011
NAIROBI, 28 July 2011 (PlusNews) - More than 11.6 million people are facing starvation in the Horn of Africa, and as aid agencies struggle to feed them, experts are warning that a lack of food could have wider consequences, including jeopardizing the health of people on HIV treatment.
Here are some ways the drought could affect people living with HIV and hamper prevention efforts:
Food insecurity - To maintain the same body weight and level of physical activity, asymptomatic HIV-positive people need an increase of 10 percent in energy, according to the UN World Health Organization. This proportion can rise to 20-30 percent for symptomatic adults and as high as 50-100 percent for HIV-positive children experiencing weight loss.
Lack of food is a widely acknowledged barrier to successful antiretroviral therapy; a 2010 Ugandan study found that ARVs increased respondents' appetite. They also reported that the side-effects of ARVs - including headaches, stomach pain, dizziness, shivers, loss of energy, fainting, and rapid heartbeat - were exacerbated without food.
Many participants felt they should either abandon their ARVs or delay initiation until they could afford a more nutritious diet. Research shows that earlier initiation on ART significantly improves survival rates of people living with HIV.
HIV-positive mothers may be forced to use a mix of breast milk and solid food for babies who ideally should be exclusively breastfed to cut down the risk of transmission.
Access to safe water - Pastoralist communities often end up sharing water with animals, putting them at higher risk of contracting water-borne diseases.
HIV-positive people find it harder to resist or recover from diarrhoeal diseases, skin conditions and other opportunistic infections.
In addition, people with HIV may be too weak to walk long distances to collect and carry water; homes headed by children orphaned through HIV or older people may also be incapable of accessing safe water.
The UN recommends that each person use 20-50 litres of water every day for drinking, cooking and cleaning.
Sexual violence - Women do the bulk of housework in much of the Horn of Africa, including fetching water and firewood. Girls and women risk being sexually assaulted on the long walks to fetch water.
For refugees walking or hitch-hiking from Somalia to neighbouring Kenya, the risk of rape is very real. The NGO CARE International reported on 12 July that the number of reports of sexual and gender-based violence in Kenya's Dadaab refugee camp - where an estimated 3,500 Somalis are arriving daily - had increased from 75 between January and June 201 to 358 during the same period in 2011.
According to CARE, the most dangerous time for women - many of whom are travelling alone with their children - is when they are on the move. Overcrowding in refugee camps also makes it more difficult for regular protection mechanisms to work.
Post-exposure prophylaxis may be available at camps like Dadaab, but awareness is poor and many rapes go unreported.
Transactional sex - During humanitarian emergencies, desperate women often turn to desperate measures to feed themselves and their families.
A 2007 study by the Overseas Development Institute in Kenya's chronically arid northeastern Turkana area found that the effects of drought led many young women and orphans to turn to sex work to survive.
The study found that as many Turkana people moved to new areas - usually urban and semi-urban - the separation from their families and communities made it easier to have transactional sex.
Where condoms are not readily available or regularly used, transactional sex can increase the risk of contracting HIV.
Migration - According to the International Organization for Migration (IOM), migration itself is not a risk to health, but "the migration process can increase vulnerabilities to poor health, especially for migrants who move involuntarily, fleeing natural disasters or humanitarian crises, or those who find themselves in irregular or exploitative conditions".
IOM says many of the underlying factors that cause migration - including uneven distribution of resources and socio-economic instability - also determine the increased risk of migrants and their families to HIV infection.
Female migrants are at particular risk of being sexually exploited and coerced into sex in exchange for food, shelter or even by unscrupulous police officers threatening them with arrest or deportation.
For people on treatment, abrupt movement to new areas can cause problems for adherence, as stigma can prevent people from seeking services at unfamiliar health centres.
Access to HIV services - With millions of people on the verge of starvation, limited health services in the Horn of Africa are stretched to capacity, and people living with HIV may not get the attention they need from overburdened health workers.
Many people living with HIV rely on networks for support; during an emergency these may break up as members move away in search of food and others succumb to hunger or illness. Home-based care networks may also collapse or become weakened by the effects of drought.
Illegal refugees may not have access to HIV and other health services; many fear the consequences of registering at national hospitals, lest they be discovered and deported. Not understanding local languages in the host country can also mean refugees miss out on vital information on HIV/AIDS prevention, treatment and care.

http://www.plusnews.org/report.aspx?ReportID=93358

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