This Week's News 6-10 June 2011

Médecins du Monde Canada: A reassuring presence in Cité Soleil

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Médecins du Monde Canada: A reassuring presence in Cité Soleil



Dadi Ediane is 19 and has two children. On a warm fall morning, a nurse from Médecins du Monde Canada (MdM Canada) making her rounds in a sector of Cité Soleil notices that Dadi's baby is sick. She gives the young mother a bar of antibacterial soap and advises her to take her baby to the clinic.
If MdM Canada did not have a clinic in Cité Soleil, it is doubtful Dadi Ediane would have access to health care for her sick baby. She does not have the means to pay for a consultation or for medication, as is the case for most of the 400,000 residents of Cité Soleil.
In this sprawling shantytown located in the metropolitan area of Port-au-Prince, Haitian people live in extreme poverty, without electricity, sewers, schools or stores. Sanitation is non-existent, making Cité Soleil a breeding ground for disease. The slum is also plagued by frequent robberies, rapes, kidnappings and murders.
When the first signs of cholera appeared in Port-au-Prince, MdM Canada once again responded quickly and effectively. The organization set up a 24-hour treatment centre for those infected. Mobile clinics provided bars of soap to prevent new infections and rehydration packets for affected families, Through all of this, MdM Canada imparts a source of stability and reassurance for the people of Cité Soleil.
Active in Haiti for more than a decade, MdM Canada provides health care and free obstetrical care to Cité Soleil's most vulnerable―women, newborns and seniors. The organization also does a lot of preventive health education, essential in an environment where safe drinking water is scarce and latrines inadequate, where mosquitoes are ever present, and where waste-strewn roads are turned to mud by the rain.
As Cité Soleil has very high rates of sexually transmitted diseases and HIV/AIDS, the organization has established a maternal health clinic, training midwives and health workers to provide quality care as well as raise awareness about contraception and sexual violence.
After the 2010 earthquake, MdM Canada, with support from CIDA, responded promptly to provide relief to the residents of Cité Soleil. The organization set up three mobile health clinic teams to visit 17 camps every week. In the midst of disaster and total chaos, these teams achieved impressive results: more than 21,000 consultations, 4,800 psychosocial support sessions, and more than 18,000 immunizations, as well as more than 700 workshops to entertain the children. Their visits provide reassurance for a community that has nothing and feels abandoned by everyone.
"I am very happy with the help MdM Canada provides. Following the earthquake, they brought in a psychologist to the camp. The doctors take care of us and help us to deal with stress. They sit down and talk to us about how to manage our lives." says Guerline Augustin. Adds Kemly Barais: "Thanks to them, our children are not dying of diarrhea."

Haiti Earthquake―Médecins du Monde Canada 2010
Maternal Health Care in Cité Soleil

Link to video: CIDA in Haiti: A day in the life of Médecins du Monde Canada


World leaders renew commitment to AIDS, health and sustainable development



NEW YORK/GENEVA, 8 June 2011­­—More than 20 Heads of State and Government have come together at a special event focusing on leadership, cooperation and country ownership in the response to HIV. The event, attended by close to 400 people, was held during the United Nations General Assembly High Level Meeting on AIDS to renew commitment and identify opportunities in scaling up the HIV response, improving health and achieving the 2015 Millennium Development Goals.
The President of Rwanda, Paul Kagame, hosted the debate which outlined ways of accelerating action to help countries move closer towards universal access to HIV prevention, treatment, care and support.
He outlined three main areas as key to the success of the AIDS response: leadership, ownership and collaboration. “Not a single country, not a single individual, business or entity can win this struggle alone,” he said. “Once the leadership and commitment is there in any country and any community, results begin to show.”
The need to increase access to services for people most vulnerable to HIV and respect for human rights was central to the discussions. Strong and visionary leadership combined with commitment and global solidarity around HIV were underlined as essential to moving the response forward.
“We can bring HIV deaths and new HIV infections to zero,” said United Nations Secretary-General Ban Ki-moon. “Our targets may seem ambitious but they are achievable if we are united.”
Leaders at the event also looked to the future of the HIV response and the importance of investing in youth as the leaders of tomorrow and encouraging their full engagement in the AIDS response.
“If we want to transform the response, we have to bring a new agenda for the future,” said Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). “This will only be achieved if we engage young people to lead a new social movement around AIDS and ensure a sustainable response.”
The speakers stressed the need to overcome the challenges to sustainable and predictable financing. In a report launched ahead of the High Level Meeting on AIDS, UNAIDS outlined that US$ 22 billion will be needed by 2015 to halve new HIV infections and expand access to HIV treatment. However, the report also revealed that international funding for HIV had declined from 2009 to 2010.
“What we need is resources, best policy, and law to ensure and protect the rights of people living with HIV,” said Ms Anandi Yuvuarj, Regional Coordinator of the International Community of Women Living with HIV. “Everyone must have access to HIV prevention, treatment, care and support, particularly people most vulnerable to HIV.”
Speakers emphasized the need for systematic improvement of the efficiency and effectiveness of existing AIDS and health spending, as well as the importance of ensuring the best value for money through effective and efficient HIV programming. In addition, they discussed the need for countries to look for new streams of revenue from domestic, regional and international sources.
Success in South-South cooperation efforts were discussed as an effective way of finding new paradigms of development and sharing innovation within regions for an accelerated response to HIV.
Leaders attending the event pledged to increase efforts to improve the effectiveness, efficiency and sustainability of their national AIDS responses to accelerate progress towards achieving universal access to HIV prevention, treatment, care and support services.


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Africa & Middle East


Medical association applauds minister

Business Day, SA

HEALTH Minister Aaron Motsoaledi’s budget vote speech has been welcomed by the South African Medical Association, particularly his intention to look into the shortage of doctors in SA.
"This shows that he takes the training of medical doctors seriously," said spokesman Norman Mabasa.
On Wednesday, the minister said he was investigating ways to improve the standard of medical students’ training.
The association was hoping Dr Motsoaledi would introduce measures to ensure trained doctors did not leave the system .
"We also call upon the minister to take control of the academic complexities in tertiary institutions, so that they don’t fall under provincial administration. We also hope that the national Department of Health will have a role to play in the appointment of senior health officials in provinces," Mr Mabasa said.
Of significance to the organisation was the reversal of a merger between Medunsa and Turfloop that created the University of Limpopo. Last month, Dr Motsoaledi and Higher Education Minister Blade Nzimande announced that the Medunsa campus would become a new, standalone health sciences training institution .
Dr Motsoaledi also spoke of the government’s intention to intensify measures dealing with the HIV/AIDS pandemic. He undertook to eradicate backlogs in processing applications for new medicines to treat the disease.
Meanwhile, the South African Municipal Workers Union yesterday said the planned National Health Insurance system would work only if sustainable solutions were found for developing the country’s health infrastructure.
"While Samwu sees the (insurance system) as the financial arm of a national health service, the primary focus should always be on the actual provision of health services," spokesman Tahir Sema said. "Without a national health infrastructure of medical facilities, including the appropriate level of health staff … the (insurance) might end up being no more than a life saver for the ailing private sector."


MALAWI: UK aid cuts hit health care


BLANTYRE, 6 June 2011 (IRIN) - After several years of fragile gains, Malawi’s healthcare sector is running into trouble, with the latest challenge an aid freeze by its largest international donor, the UK's Department for International Development (DFID).
The UK provided about US$122 million annually to Malawi, of which $49 million went to funding Malawi’s public health sector, but DFID made its final aid disbursement in March and has decided not to renew a six-year funding commitment which ends in June.
“We have already started feeling the pinch,” said Martha Kwataine, a policy analyst with the Malawi Health Equity Network. “There is going to be a regression in the progress we have made with DFID in improving health services in the country.”
The UK’s decision not to renew its aid to Malawi followed the expulsion of its top envoy Fergus Cochrane-Dyet by the Malawian government for allegedly writing in a leaked memo that Malawian President Bingu wa Mutharika was “ever more autocratic and intolerant of criticism”.
Drug shortages

Malawi's health sector is nearly entirely donor-funded with foreign aid covering about 90 percent of the costs of all medicines.

“[The cuts] will really make a difference because we don’t have the means to buy most drugs ourselves,” Kwataine told IRIN.
However, drug shortages and stock-outs were a problem even before DFID's funding freeze. Anti-retrovirals (ARVs), for example, are provided entirely by the Global Fund to Fight AIDS, Tuberculosis and Malaria but their distribution to HIV patients across the country is the responsibility of the Ministry of Health's HIV Unit. Often, the drugs are not available where they are needed.
At a health clinic in southern Malawi run by Dignitas, a Canadian NGO which supports the development of local health care, Dr Belete Assefa has been dealing with inconsistent supplies of ARVs for the past two years.
“It’s a problem of the supply chain. It might be available in the country, but it’s the way they are distributed. There might be a lot of drugs at one health centre and no drugs at another,” he said.
Cuts to the health budget resulting from the withdrawal of UK aid are likely to deepen inefficiencies in the distribution of ARVs. In Blantyre’s suburb of Ndirande, one of the poorest urban areas in Malawi, ARV clinician Eddie Manda said drug shortages had already worsened in recent weeks.
“Normally when we request ARVs, we are supplied within two or three days. Now it has been three weeks,” he said.
Demoralized doctors

The drugs shortage means that Manda spends hours each day driving to other health centres to pick up a supply of ARVs that will last for a few days. It also means he can only prescribe patients with a two-week supply of ARVs instead of enough for a month. This is no small problem in Malawi where many people struggle to afford the transport costs to distant health centres. “It’s not supposed to be like this,” he said. “My work as a clinician is compromised.”

We're already starting to feel the pinch. There is going to be a regression in the progress we have made with DFID

Assefa faces the same problem at the Dignitas clinic. Because of widespread fuel shortages in the country, he is sometimes forced to send patients out on their own to search for ARVs when the supply at his clinic runs out.

“Patients have had to go up and down to different clinics looking for drugs. For medical professionals, this is very discouraging. This will affect the morale of healthcare workers,” he said.
The problem of low morale has contributed to a critical shortage of health workers in Malawi, with many migrating to South Africa and elsewhere in search of better pay and working conditions. A DFID-sponsored programme was making huge strides in improving working conditions for doctors and had helped increase the doctor to patient ratio from 1 to 60,000 in 2004, to the current ratio of 1 to 46,000. These gains are now at risk as health workers become increasingly frustrated by a lack of resources.
Diplomatic stalemate

It seems unlikely that the UK and Malawi will be re-establishing ties any time soon. In an emailed response to questions from IRIN, DFID communications officer Andrew Massa said the UK was "reviewing its relations with Malawi, including DFID's aid programme" and that no new aid would be committed until this review was completed.

"We and other donors have urged the [Malawian] government to finalize a new 5-year national health strategy to accelerate progress. Without this, donors cannot begin the process of considering what support they will provide," he added.
A London spokesperson with DFID wrote: "We have raised concerns with the Government of Malawi on a number of occasions and it is right that we should review our aid programme. We have to ensure that British taxpayers’ money delivers a better life for the poor of Malawi.''
While the UK's aid freeze may have been meant as a political retaliation, Kwataine said it was not the country’s leadership who would pay the price if the freeze continues. "Whatever decision they make, they need to know that it’s the ordinary man and woman who will suffer,” she told IRIN.
President Mutharika responded to the withdrawal of UK support by announcing in his State of the Nation address on 23 May a “zero-deficit” budget that will necessarily entail increased taxation. Meanwhile, Finance Minister Ken Kandodo told Reuters he plans to introduce a host of austerity measures to deal with the gap in the country's budget.
Kwataine worried that such measures could include shifting the burden of healthcare costs to Malawians, a move that would only aggravate poverty levels in a country where 74 percent of the population are already living on less than US$1.25 a day. “The poorer you are, the more likely you are to have poor health indicators,” she pointed out.


Mobile technology 'can play role in healthcare'

Business Live, SA

Miriam Mannak
SA's most urgent health problems could be more efficiently tackled by up-scaling the usage of mobile technologies by those working in the health system, according to Yogan Pillay, deputy director-general for the Department of Health's strategic health programmes, but, he said, the country did not need more pilot projects.
"We know by now what works and what doesn't. It is time we build on that," he said on Monday, during the first day of the 2011 Mobile Health Summit, which is being hosted by GSMA, the global mobile communication alliance, and mHA, the mobile health alliance, in Cape Town this week.
"The Themba Lethu clinic in Johannesburg, for instance, sends out text messages to remind HIV patients, including moms and pregnant women, about appointments and medication," he explained.
"The number of missed appointments between 2007 and 2011 has dropped from 15% to 7%. The same counts for TB patients."
"In other regions of Gauteng, young mothers living with HIV are sent text messages to remind them of follow-up clinic visits," Pillay continued.
"This is in support of the prevention of mother-to-child transmission of HIV. This strategy has helped to find children who have not been immunised against various children's diseases.
"So again, we therefore do not need more pilot programmes as we know what works. We simply need to upscale those successful programmes we have," he stressed.
Pillay added that more effective and wider-scale usage of mobile technology was not the only solution to SA's health problems.
"More healthcare workers are needed. There is a strong correlation between the number of doctors, nurses, and healthcare personnel and the survival rate of patients. In the whole of Africa, we have 1.6 million health workers, or 2.3 per 1,000 people. The global average is 9.3 per 1,000 people," he noted.
Training and deploying more community healthcare workers can moderate the impact of the chronic nurse and doctor shortage, which also affects SA.
"We only have 65,000 community healthcare workers in SA. Their role is crucial, as it is them who live and work in communities and therefore are able to reach vulnerable households before real problems occur," Pillay said.
"The problem is that they are not highly motivated because they are not well-trained, supervised and paid. SA simply does not know what to do with them.
"If trained and supervised properly, community health workers can do things nurses and doctors normally do, such as screenings, assisting pregnant women to prevent them from dying, and treating children against diseases like pneumonia, diarrhoea, and malnutrition," he concluded. "These are the main mortality causes among South African children under five years."
During a committee briefing on SA's progress on the Millennium Development Goals, which took place last month, Health Minister Aaron Motsoaledi explained that the mortality rate for children under the age of five had risen from 97 per 1,000 live births in 1998 to 104 in 2007.
Maternal mortality rates, he said, stood at 625 per 100,000 births in 2007 - almost a 100% rise from the situation in 2001.


«Nous exerçons dans des conditions catastrophiques»

El Watan, Algeria

Achaque fois que la question du service civil est abordée avec les médecins résidents, ces derniers n’hésitent pas à vider leur sac, dénonçant le discours des officiels qui ne cessent de les dénigrer devant la population, exprimant au passage leur dégoût total face aux conditions de travail qu’ils qualifient de catastrophiques.
«Nous ne sommes pas contre le fait de servir la population en matière de soins, mais devant les difficultés que nous rencontrons dans les contrées éloignées où manque le strict minimum et où la prise en charge des différentes pathologies devient vraiment aléatoire, on s’interroge parfois si notre présence est utile aux malades», s’exprime Amine F., spécialiste en réanimation dans un établissement hospitalier à Oum El Bouaghi. «Devant cette situation, le service civil devient vraiment caduc», poursuit-il.
Côté professionnel, le manque de moyens demeure la principale préoccupation des praticiens, la dernière pour les bureaucrates de l’administration, selon l’expression de notre interlocuteur.
«Figurez-vous que le programme opératoire à Oum El Bouaghi n’est pas appliqué depuis des mois, à cause du manque de consommables, notamment les produits d’anesthésie, ce qui nous oblige à ne prendre en charge que les cas simples, alors que les malades graves sont évacués directement vers le CHU de Constantine», affirme-t-il, citant surtout les cas des parturientes souffrant de complications, alors que le bloc opératoire de la maternité ne dispose même pas de table d’intervention gynécologique. Un autre médecin résident avoue même qu’il n’a pas opéré un seul malade depuis un an. «Je ne comprends pas pourquoi le ministre de la Santé cherche toujours à occulter ces vérités, alors que nous avons saisi à maintes reprises les responsables des établissements de santé, mais sans résultat ; tout ce qu’ils savent faire, c’est de nous gaver de promesses sans lendemain, sachant que nous sommes les premiers à être jugés en cas d’accident», dira un médecin résident à Oum El Bouaghi. Ce dernier ne manquera pas de soulever l’épineux problème du manque d’effectifs devenu chronique, et il est souvent difficile de gérer les urgences. «Faute de personnel, et au lieu de recruter, on nous impose souvent d’assurer jusqu’à dix gardes par mois, dans des conditions inadmissibles, et faute de logements de fonction, on est contraints de faire quotidiennement la navette entre Constantine et Oum El Bouaghi ; les responsables savent bien que nous ne pouvons pas refuser le travail», avouera-t-il.
Des salaires de misère

Réagissant aux dernières déclarations d’Ahmed Ouyahia, lors d’une récente conférence de presse diffusée à la télévision, Abderrezak A., médecin résident ayant exercé à Khenchela, n’y va pas avec le dos de la cuillère pour fustiger l’hypocrisie des politiciens. «Je défie les autorités de divulguer les fiches de paie des médecins chinois et celles des Cubains exerçant à Djelfa et Khenchela pour que les gens sachent qu’on ne demande pas vraiment grand-chose, alors que nous sommes en droit d’avoir un salaire digne», dénonce-t-il. Et de poursuivre : «De quel droit on privilégie les étrangers aux dépens des nationaux, alors que dans d’autres pays, les médecins locaux sont mieux considérés.» Pour Abderrezak, le service civil est devenu une manière aussi de faire pression sur les médecins qui désirent ouvrir leur propre cabinet.

«J’ai passé mon service civil dans une région de Khenchela, éloigné de ma famille, où la situation est vraiment précaire, avec des moyens rudimentaires, et on trouve enfin le prétexte pour prolonger mon séjour et m’obliger d’attendre des mois pour avoir l’autorisation d’exercer pour mon propre compte», regrette-t-il.

La plupart des médecins soutiennent à l’unanimité que l’Etat ne s’est jamais soucié de leur situation, surtout que nombreux parmi eux sont des pères de famille qui exercent dans des contrées éloignées de leur domicile, sans bénéficier ni de logement de fonction ni de regroupement familial. «Finalement, ce ne sont pas les administrateurs qui se préoccupent de la santé des malades, car en cas de problème, on se retrouve seuls face aux canons», conclut Abderrezak.


Striking medics looking for greener pastures

The Botswana Gazette

Written by Sello Motseta
Officials at the Namibian High Commission in Gaborone have revealed that approximately 250 medical personnel who are facing retrenchment or are uncertain about their future are opting to pursue employment opportunities elsewhere in the region.
“I cannot give breakdown in figures as forms are not routed through this Mission, but nurses are the most numerous, though there are also doctors and midwives. Some of them are dismissed, others are not,” acknowledged Bernhard von Seyldlitz, spokesperson for the Namibian High Commission.He maintained, “The reasons mentioned verbally by some are dismissal; want to go to Namibia; heard there are vacancies in Namibia; etc. They will fill in the application forms and send them to the Namibian Ministry of Health and Social Services, attaching copies of their qualifications. They will mail these applications themselves - not through the High Commission.”
According to Botswana government officials, human resource challenges are usually addressed through various bi-lateral relations such as with the Cuban Government, which has an understanding with Botswana allowing Cuba to provide specialised health personnel in different areas, such as doctors, biomedical engineers and pharmacists.
Doreen Motshegwa, spokesperson for the Ministry of Health, said, “There are currently 45 Cuban health employees whose contracts are coming to an end. These were engaged to alleviate the shortage of health personnel, especially doctors, experienced in the country. The Cuban Government has expressed interest in continuing to assist the Ministry of Health with more doctors.”
She said, “As a result, we are expecting not more than 25 health workers from Cuba.The coming of the Cuban doctors should not, and is not in any way linked to the current situation. We are expecting the Cuban doctors anytime from June 2011.”Officials insist there will be no language barriers and that the doctors concerned understand and communicate well in English although with a strong accent.
“And where appropriate other personnel within the facility bridge the gap. We have only one closed health post in Bonwapitse in the Mahalapye area,” said Motshegwa.
She said all hospitals are operating as normal. A visit to the only State hospital in Gaborone, Princess Marina, showed that some allied health professionals such as physiotherapists, pharmacists, occupational therapists and x-ray specialists were apparently at work throughout the public sector strike. According to a hospital insider the worst affected areas are the wards, the kitchen, the laundry and porters. “You may see a doctor only once a day when your condition requires that he should really check on you 3 times a day,” said Utlwanang Sesupo, a patient at Princess Marina.
He said, “Things are bad because of the shortage of staff; we are forced to eat takeaways. The food comes in plastic containers and not the metal plates we are used to. I do not think it comes from the kitchen.”
Police presence was visible around the State hospital, which is next to the Gaborone Senior Secondary School where striking civil servants meet daily.Komissa Burzlaff, Botswana Confederation of Commerce Industry and Manpower (BOCCIM) Corporate Communications and Public Relations officer, said, “Hospitals and pharmaceutical companies were experiencing border delays in the supply of medication, which can have a detrimental effect on public health.
The reduction in waste collection is also posing a health hazard to business employees and the public.”
According to official reports the dismissals from the health sector include 65 medical/dental doctors, 531 nursing personnel, 211 allied health workers and 668 support staff. There is however no comprehensive report on the impact of the strike on health facilities countrywide.“While it is true that the strike has had, and continues to have impact on the delivery of health services nationwide, it is difficult to demonstrate direct cause and effect of the strike on the casualty rate at the facilities, as casualties happen even outside the strike,” said Motshegwa.
She said, “There is obviously impact on the delivery of the health service, but we have so far managed to address patients’ needs and will continue to ensure that the services are restored to near normal as possible, under the circumstances.”


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