This week there were many big stories about the state of health in Africa, from extensive disease outbreaks to the launching of new eradication campaigns with new vaccines. The situation with food aid has saved Niger for this year, but how long will international commitment to food aid last?

Be sure to follow the “health-in-africa” Daily (HERE) for regular updates about various topics on Health in Africa and check back here at the end of the week for the highlights and top stories.

Over 1,500 Deaths from Cholera following floods in West and Central Africa

Are natural disasters the most dangerous health risk? While the cholera outbreak in Haiti gained extensive media coverage, the multi-country, months-long cholera outbreak across West and Central Africa lingered behind the shadows. Over 1,500 cholera deaths in Nigeria and over 38,000 cases reported, the United Nations noted that over 1.8 million people were affected by the flooding leaving 307 dead with Benin being the worst hit. Over 52,000 cholera cases have been reported since June across West and Central Africa according to World Health Organization figures. The worst flooding in Benin has affected almost 700,000 people. As the flood waters recede there is mounting concern for further health risks as many people have been disconnected from health care facilities.

UN-backed Polio Campaign to Reach 72 million African Children

Smallpox was all but eradicated through an aggressive vaccination campaign. Polio eradication campaigns have faced different and varying challenges from religious groups decrying the vaccine, to misinformation, to ineffective campaign structures. Now there is a supposedly “more effective” vaccine and vaccination campaigns have begun with restored vigor. Will this polio eradication campaign be a success?

Food Crisis Averted in Niger, this Year

A food crisis in Niger has been averted as a result of generous donor response, intervention by the United Nations, the Government’s facilitation of the humanitarian effort and good rainfall, but the situation remains fragile, the top UN humanitarian official said today.

Twelve African Countries Vow to Fight Gender Based Violence

If you missed last week’s guest post one our blog I highly recommend it: How could gender be contributing to the global HIV epidemic? Twelve African countries that have been taking part in the ‘International Conference on the Role of Security Organs in Ending Violence against Women and Girls,’ which ended yesterday in Kigali, affirmed their commitment to rid the continent of Gender Based Violence (GBV). In a 14-point signed declaration, the countries affirmed commitment to harmonize and standardize legal frameworks pertaining to violence against women and girls.

Recent cholera outbreaks in earthquake-stricken Haiti, a flooded Benin, and the newest natural disasters in Indonesia beg the question: what can be done when natural disasters are the cause of health problems in developing nations?  While cholera has long been a disease most people see as irrelevant and outdated, new cases have sprung up in both nations and disease will most likely threaten Indonesia in the near future.

In rural Haiti, cholera took the lives of 150 people, and several worry that the disease will spread into a full-on epidemic if it makes its way to the densely populated capital, Port-au-Prince. Despite media and supposed aid agency attention there are reports that cholera has spread to the Artibonite Valley, three hours away from Port-au-Prince.

Benin faces a similar threat. Cholera is threatening the already precarious health situation in the country, following the “worst flooding in the last forty years.” A World Health Organization (WHO) official said, “…the disease risk is imminent and means solid epidemiologic surveillance will be paramount.” As multiple natural disasters hit Indonesia, including an earthquake, tsunami and volcanic eruption disease and health concerns will be an inevitable issue.

What should aid agencies be doing to combat health issues brought on by an erratic, unpredictable and blameless force? How should nations, NGOs, and other agencies help prevent the spread of completely preventable and treatable diseases that threaten to kill thousands?

Among one of the most important aspects of having access to basic health care includes access to essential medicines. With access to the right (and low cost) medicines millions of needless deaths can be prevented. Medicines sans Frontiers (MSF)/ Doctors Without Borders as well as Universities Allied for Essential Medicines (UAEM) have been working to increase access and provide life-saving medicines. Other groups that have had important impacts on access to medicines are the Clinton Foundation and the Gates Foundation.

This week saw the continued striking of Nigerian doctors as well as  empty promises of stretched health ministries and US food aid. Our blog hosted a bright discussion on HIV/AIDS in South Africa highlighting the issues of Gender Based Violence and the use of pornography to influence health behaviors and education. Please let us know what you think in the comments, we’d love to start a conversation! If you are interested in submitting a guest post – submit here.

Sierra Leone: Unfulfilled Promises of Free Maternal Health Care for Mothers

Marie Musa, 37, is devastated. After the mother of four gave premature birth, her baby boy died a few hours later – because the hospital did not have enough incubators to rescue the infant. In August, the same month that Musa’s baby died in hospital, James Bamie Davies, commissioner of the customs and excise department of Sierra Leone’s National Revenue Authority (NRA), announced in a government gazette an auction of medical appliances, including eight incubators. Only the public outcry that followed the announcement of the auction in the gazette, did the Ministry of Health and Sanitation spring into action and recover the goods.

Uganda: Nine Million Face Hunger

As Uganda joins the word to mark World Food Day today, Isaac Khisa looks at Uganda’s strides in ensuring that every citizen has at least a meal a day Uganda today joins the rest of the world in celebrating World Food Day but with millions of its population still malnourished. According to United Nations Food and Agriculture Organisations, nine million Ugandans are still facing hunger with many affording only one meal a day. Uganda population is now estimated at 31 million, meaning that about 30 per cent of Ugandans can hardly find something to eat.

Zimbabwe: Diarrhea claims 4000 yearly

About 4 000 children die from diarrhoea in Zimbabwe each year due to poor hygiene and unsafe drinking water, a United Nations senior official said last week. In a speech read on his behalf at the annual commemorations of the Global Hand-Washing Day held in Mutoko last week, Unicef country representative Dr Peter Salama said hand-washing is the single most effective and inexpensive way to prevent diarrhoea.

Benin: Disease Spreads as Floods Continue

Two-thirds of the African nation of Benin is underwater, with at least 43 people killed and nearly 100,000 made homeless. Heavy rain began falling at the start of October, and the Rivers Oueme and Mono soon overflowed. Thousands of hectares of land, mostly used for growing rice and other vegetables are now underwater. “Here, the water isn’t going away. We have it up to our knees and now it’s as high as our thighs,” said one resident. “The water, it’s everywhere, and it’s very difficult for people to escape.

South Africa: The Real Health Deal

Health minister Dr Aaron Motsoaledi will today sign the “real deal” with nine provincial health MECs and eight ministers, giving South Africans a shot at “a long and healthy life”. The Negotiated Service Delivery Agreement (NSDA) gives a frank, but brutal assessment of South Africa’s healthcare system and at the same time commits “not to keep doing things as usual” in finding solutions.

South African adult film producer, Tau Morena has just released his newest film, “Mapona,” the English translation being “naked.” This adult film is unique for two unexpected reasons. First, the film makes an empowering political statement about race and South Africa. For the first time in the South African adult film industry Morena employed an all-Black cast. Although the majority of South Africa’s population is Black, this is a first for South African adult films. Second, the film promotes HIV awareness, education and prevention. Although unpopular in the industry, the cast was asked to wear condoms in the film, in addition to being tested for HIV prior to shooting. The South African adult film industry is the first in the world to make such a powerful and blatant health statement. [1]

Other sensationalized publicity campaigns have proven effective at delivering a health message. In Bangladesh, the Bangladesh Rural Advancement Committee (BRAC) launched a similar campaign a few years ago. BRAC’s founder, Fazle Hasan Abed, started a nationwide campaign addressing the increase in HIV infections. Abed’s campaign “condomized” the country with a wide supply of birth control and safe sex education programs. He placed ads all over the country, handed out condoms in public places such as restaurants, stores and especially focused on brothels throughout Bangladesh. BRAC’s campaign dramatically improved the HIV-related health of the country in an effective and radical way.[2] This campaign is similar to Morena’s new film because it brings important and oftentimes stigmatized health issues into public view.

Although “Mapona” is a new, progressive and interesting way to address the HIV epidemic in South Africa, is pornography the medium that should be used to make such a public statement? Using the medium of pornography as a social platform to supposedly promote racial equality and HIV awareness (both of which have a very dependent relationship) is a paradox in itself.  Using an all-Black cast to promote HIV awareness in an adult film could very well perpetuate the colonial and racist stereotypes in the hyper-sexualized images of Black people, especially in an African context.

Does Morena’s highly publicized film reflect a progressive and effective social statement, like BRAC’s HIV awareness campaign? Or is it a publicity stunt that, in the end, defeats the primary purpose of racial and health equality for Black South Africans?

Our guest blogger of the week is Anna Aulette-Root, a Ph.D. candidate and lecturer at the University of Cape Town in South Africa. Aulette-Root has done extensive research on the global health epidemic of HIV and gendered violence.

Activists, practitioners, and scholars in South Africa are currently looking at the significant role gender-based violence (GBV) plays in the spread of HIV. In contexts outside of South Africa, especially in the Global North, GBV is not commonly understood as a health problem. In the USA, for example, GBV is often thought of as a woman’s rights issue, or a psychological problem in men, or a problem best left to the criminal justice system. In the USA, GBV is not usually viewed as being a result of a combination of the above, and making the leap in understanding GBV as a health issue is virtually unheard of.

Certainly, in South Africa we see GBV as a social and human rights issue, but we pay close attention to GBV as a health issue. GBV is a problem that impacts the healthcare system in many ways and, importantly, it is an issue that impacts the health of individuals in South Africa and around the globe. Before we look at how GBV creates health problems, it is important to understand what exactly GBV is.

The term ‘gender-based violence’ encompasses any violence where gender plays a role (and if you think about this carefully, the argument could be made that any violence is gender-based). However, it is understood that this term includes violence such as intimate partner violence, domestic violence, physical abuse, psychological abuse, coercive sex, rape, economic violence, and intimate femicide. This list, for sure, is incomplete and many other forms of gendered violence exist. Perhaps the most well-known type of gender-based violence is domestic violence or intimate partner violence, in which (in heterosexual relationships) a man or boy is doing the abusing and a girl or woman is surviving the abuse. GBV/violence against women occurs because of the way gender is constructed (men have power over women) and also as a way of keeping the status quo (men use violence as a way of maintaining power over women). So what exactly are the health consequences of GBV?

GBV is a health concern in terms of the physical and psychological damage incurred by survivors. GBV has also been implicated as being intimately linked to the global HIV epidemic. We know that between 10%-60% of all women world-wide, will experience GBV in their lifetime.[1] We also know that the number of women living with HIV has been on the increase since the 1990s[2] and is now listed as the leading cause of death and disease in women world-wide. [3] Numerous studies have established and a number of scholars have written about direct as well as indirect links between GBV and HIV infection.[4] [5]

In its most graphic expression, violent acts such as rape or coercive sex may lead to HIV infection due to women’s bodies being ripped and torn—wounds make entryways for the virus. In addition, women in violent partnerships often find it difficult or even impossible to refuse sexual advances; persuade their partner to stop cheating; or seek treatment for abuse or STIs.2 And in terms of using condoms (which is the global message we all receive in curbing the spread of HIV), imagine the difficulties in insisting on or even negotiating condom use with a partner who is abusive? If an abuser is unwilling to stop their violence, it is likely they are also unwilling to heed the request of their partner to use condoms.2

So what does all of this mean and what can be done? The fact southern Africa has reportedly been particularly hard-hit in the HIV pandemic means that a great deal of attention, focus, and work has been done in South Africa (as well as in other nations on the continent) in finding solutions to this health crisis.  What scholars, practitioners, and activists in South Africa have found is that: unequal power between men and women in intimate relationships and the way that gender is constructed is furthering the spread of HIV and therefore, GBV is more than simply a social or human rights problem—it is a major health problem as well. If gender is constructed such that part of being a man means being violent toward woman partners and part of being a woman means being attracted to violent men—something has to give. South African scholars, practitioners, and activists have called for a fundamental change in the ways in which we go about educating people, intervening in, and treating people living with HIV. Rather than focusing on behaviors such as ‘abstaining, being faithful, and condomizing,’ our focus should be on transforming the ways in which we are ‘allowed’ to be men and women. This means envisioning a world in which there is no gender inequality; where being a ‘manly’ man might include caring for partners and children; where being a ‘good’ woman might include being strong and vocal; and where there is less need for recognizing so-called differences between the genders—for we are all human.

South Africans have paved the way for this goal of eliminating GBV, HIV, and transforming gender—these messages must now find their ways out to the rest of the world.

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[1] Ellsberg, M. & Heise, L. (2005). Researching Violence Against Women: A Practical Guide for Researchers and Activists. Washington, DC, USA: World Health Organization.

[2] World Health Organization (2009). Women and Health: Today’s Evidence Tomorrow’s Agenda. Geneva, Switzerland: WHO.

[3] Ribeiro, P., Jacobsen, K., Mathers, C. & Garcia-Moreno, C. (2008). Priorities for women’s health from the Global Burden of Disease study. International Journal of Gynaecology and Obstetrics, 102, 82–90.

[4] Jewkes, R. & Morrell, R. (2010). Gender and sexuality: Emerging perspectives from the heterosexual

epidemic in South Africa and implications for HIV risk and prevention. Journal of the International AIDS Society, 13, 6-17.

[5] Jewkes, R. & Morrell, R. (2010). Gender and sexuality: Emerging perspectives from the heterosexual

epidemic in South Africa and implications for HIV risk and prevention. Journal of the International AIDS Society, 13, 6-17.

As the least glamourous or well-known position in any health care system, community health workers often have the most difficult jobs, the smallest pay, and the greatest impact on many people’s lives. This is a video from an organization committed to “better health for Africa.” AMREF is best known for its “flying doctors” service among many other programs that strengthen community health systems. This is part of the story about a community health worker in Ethiopia, Almaz Nagade.

This week comes with controversy and numerous calls for the eradication of various diseases by the WHO. Health workers in go on strike in another African country after South Africa’s months long strike. Liberian doctors said they would only treat “critical” patients. Tuberculosis is becoming more resistant among young people and HIV positive individuals, but more effort is being put into research.

WHO sees end to TB

Last week TB was discussed as a “forgotten disease for forgotten people,” but now it seems that the WHO has released a plan that identifies gaps in research to create faster treatment regimes. “There is an urgent need to scale up action against TB – 10 million people, including 4 million women and children, will lose their lives unnecessarily between now and 2015 if we fail,” Dr. Margaret Chan, the WHO director-general, said.

Its Time to End the Double-Standard of Food Aid

Tido von Schoen-Angerer, Executive Director of Doctors Without Border’s “Access to Essential Medicines Campaign” wrote on Huffington Post about how the US government continues to send sub-standard food supplies to areas in need. The United States, the world’s biggest food aid donor, continues to send the corn-soy flours that do not address childhood malnutrition. You would be hard pressed to find these foods in American grocery stores, because it’s food we would never feed our own children.

More: Can the story on US food aid get any worse from Aid Watch posting Financial Times

“Paradigm” Shift Needed in Health Care, Experts Say

In Africa there needs to be a greater focus on prevention and treatment of noncommunicable diseases like diabetes and hypertension and not just infectious diseases like HIV/AIDS, health experts told the 2010 U.S.-Africa Private Sector Health Conference October 6. “Health is as critical as institutions, infrastructure and education for Africa’s economic competitiveness and growth. It is a prerequisite for human energy, entrepreneurship, dynamic markets and a productive society,” said Haskell Ward, vice-president of Seacom Corporation and chairman of the Global Health Strategic and Advisory Committee of the American Cancer Society.

Ending Africa’s Hunger Means Listening to Farmers

Africa is hungry – 240 million people are undernourished. Now, for the first-time, small African farmers have been properly consulted on how to solve the problem of feeding sub-Saharan Africa. Their answers appear to directly repudiate a massive international effort to launch an African Green Revolution funded in large part by the Bill and Melinda Gates Foundation. “Food and agriculture policy and research tend to ignore the values, needs, knowledge and concerns of the very people who provide the food we all eat – and often serve instead powerful commercial interests such as multinational seed and food retailing companies,” said Michel Pimbert of the International Institute for Environment and Development (IIED), a non-profit research institute based in London.

African cholera outbreak kills 2000

A preventable disease that is linked to the need for clean water sources has continued to kill people in a number of countries. WHO officials report that, as of October 3, there have been 40,468 reported cases of cholera and 1,879 reported cholera deaths in four countries, including Cameroon, Chad, Niger and Nigeria. The outbreaks started a few months ago, officials said.

Obesity: an underestimated “silent killer”

There is a new “silent killer” in town. It joins the ranks of malnutrition, malaria, hypertension, diabetes, HIV/AIDS, etc. It is obesity. “We are eating our way to the grave’’ and “obesity is rising in rural areas.’’ Adults are overweight or obese, while children are malnourished – a paradox. In the men still look at a potbelly as a badge of pride and success.” The World Health Organization reports that more than one-third of African women and a quarter of African men are estimated to be overweight, and predicted that it will rise to 41 percent and 30 percent respectively in by 2016. Once considered a problem only in high income countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings.

Western international development agencies tend to portray the continent of Africa as a basket-case, a place that needs to be saved by the “highly developed” western countries. Contrary to the conventional and paternalistic wisdom, African people throughout the continent represent huge sources of technological, environmental, and – especially – health innovations.  The western world could take a few notes from scientists and inventors throughout the African continent.

For example, the Clay House Project, a non-profit health organization based in Namibia has recently introduced new advanced dry toilet technology to improve sanitation throughout the world. The inventor of the dry toilet, a device that does what the name suggests, provides a sanitary mechanism that does not require precious water supplies and could improve the health of 2.6 billion people. Lack of access to proper sanitation, currently causes major sanitation problems that can be avoided by utilizing the new technology.[1]

Elsewhere, in South Africa, researchers have invented a vaginal gel which radically reduces a woman’s risk of the contraction of HIV.[2] According to World Health Organization (WHO) statistics, more than 30 million people are living with HIV/AIDS on the planet.  It is well known that South Africa has a high rate of HIV infections.  New technology like this is a truly significant innovation and improvement in South African health.

An especially interesting and impressive environmental innovation was made by a Malawian inventor, William Kamkwamba. When Kamkwamba was 14 years old, he engineered and built an electricity-generating wind

mill for his family from parts he found around his home and village.[3] He taught himself this relatively complex technology from instructions he found in a book. Kamkwamba is featured in an inspiring video produced by the non-profit,

TED, featured here and pictured below.

If the Namibian inventors of dry toilet technology, the South African HIV/AIDS researchers, and innovators like William Kamkwamba can produce and distribute their innovative technology, they could improve the combined health of nearly 3 billion people.  That’s nearly half the world’s population, and three-quarters of the developing world.

[1]Smith, Jana-Mari. “Namibia: Locally Invented Toilet to Improve Lives of Millions.” AllAfrica.com. 5 July 2010

[2] Brown, David. “Gel Found to Reduce AIDS Risk in Women.” The Washington Post. 20 July 2010

[3] http://www.ted.com/talks/william_kamkwamba_on_building_a_windmill.html

[4]http://summerfeyfoovay.com/foovays_cauldron/wpcontent/uploads/2009/07/william_kamkwamba_windmill.jpg

Malnutrition and water are HUGE issues when it comes to health. Listen to the interview with Jim Hocking of ICDI. The video covers some potentially disturbing, but everyday health problems associated with malnutrition and water. In 2007 SCOUT BANANA organized a Year of Water Project in Michigan with twelve different universities and colleges participating to raise almost $8000 while educating over 50,000 students in Michigan. The work of Charity:Water benefited from the project and they continue to take incredible actions! Learn more about why good food and clean water are essential to good health.