In an interview with Clara Williams, who sounds like a super volunteer to the Gambian Ministry of Health with the Peace Corps, she talks about her work in The Gambia to decentralize health care decision-making, medical supply procurement as well as assisting the national government with polio eradication and the first national census in decades. Clara took on some amazing work that is central to our organizational beliefs, especially with her work to make health care more community focused and controlled. Do you think volunteers from other countries can have a real impact on health care in African countries?

Dr. Amy Lehman talks about her experience working in the ICU, visiting Lake Tanganyika, and launching the Floating Clinic. She speaks about the great cost of care in the US just to extend care when many in the Lake Tanganyika Basin don’t even have access to a health clinic. An area that has been “left behind” where there is a great need to innovations in health care access. The interesting side of the film is that it was called bringing “modern” health care to Africa. Does Africa need modern health care? Is there any room for traditional health practices?

Recently, The New York Times reported on the health care situation in turbulent Zimbabwe. Kathy McCarty, an American nurse working at Chidamoyo Christian Hospital in Zimbabwe reported being paid in peanuts, sacks of grain and other non-monetary forms of compensation. The virtual collapse of Mugabe’s economy and the worthlessness of Zim money have people bartering for medical attention. In turn health care providers turn peanuts and other food products into nutritional meals for sick patients.

The Times article explains, “For many rural Zimbabweans, cash remains so scarce that the 85-bed Chidamoyo Christian Hospital has continued to allow its patients to barter. Studies have found that fees are a major barrier to medical care in rural areas, where most Zimbabweans live.” The decision to barter non-monetary goods, turned medical supplies (food and nutrition for patients) in exchange for medical care creates an innovative and win-win situation for Zimbabwean patients.

During the hyperinflation and collapse of Zimbabwe’s economy in 2008 Chidamoyo kept its doors open as a result of patients providing necessary commodities to medical personnel. The staff of Chidamoyo Christian Hospital continues to barter using thrifty techniques to maximize their medical resources. Medical staff reuse latex gloves after sterilization, filling the gloves with water to ensure hole-free supplies. Nurses use cotton balls found in pill bottles to swab patients’ arms before injections.

Regardless of the imperfect Zimbabwean health system, the United States continues to swim in the chaotic, amoral world of health insurance companies, the never ending problem of lack of access to health care and confusing health care legislation. Luckily for Zimbabweans, they seem to have the whole thing figured out.

For more information, HERE is an interesting video recap!

(Photo Credit: International Foundation of the Red Cross)

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.

(Photo credit: Dominic Chavez/ WHO)

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.

(Photo Credit: Amazon)

History has set African health care up for failure. Lack of trained health workers places a massive burden on many African health care systems, inadequate or non-existent infrastructures make provision of basic needs like food and water impossible, debt and limited budgets move health care to a lower financial priority, medications are expensive and multinational pharmaceuticals want to make big profits, colonialism, apartheid, neo-colonialism, and the effects of an oppressed history perpetuate inadequacies in health care.

The varied record of health in Africa over the past century is inseparable from the history of change in control over political institutions and change in the organization of economic production. In the early years of colonial rule some governments relied on forced labor; in parts of colonial Africa, especially in the eastern and southern parts of the continent, male workers migrated from rural homes, leaving their families behind; in the postcolonial years class differentiation has become more pronounced, with some workers permanently separated from their roots in the countryside.[1]

Feierman and Janzen are right on target again in describing the scene of African health in relation to colonialism, politics, and history. African countries inherited health care systems from colonial authorities, but very often there was no health workforce to fill the void of colonial medical professionals. One Frenchman wrote,

La suele excuse de la colonisation c’est la medecin [the only excuse for colonialism is the doctor] – Hubert Lyantey (1926)[2]

If nothing else colonization was a positive in establishing health care systems and providing professional doctors? I wish I could agree, but mission societies that often ran health services relied on negative images of Africans.[3] The famed Dr. Livingstone was a doctor with the London Missionary Society and is best known for his explorations of the continent that allowed colonial empires to penetrate further into and conquer the African interior.

The slow demise of colonization did not end Western interference in Africa. Well into the 1980s and 1990s some African populations remained under the oppressive control of Western and minority populations. This control led directly to the ill health of those populations, notable South Africa and Mozambique. Black South Africans were denied basic health care services, training, and other needs.[4] South Africa fought a proxy war in Mozambique that specifically targeted the destruction of health care infrastructures. In African countries that gained earlier independence there were other powers to face.

[...] the IMF and World Bank have much to answer for. [Their] policies have eroded Africa’s health care systems and intensified the poverty of Africa’s people. – Salih  Booker[5]

Structural Adjustment Programs (SAPs) and other policies forced by Western institutions made the development from colonialism to independence that much more difficult for African countries. As Hunter writes, these policies often increased the poverty of African populations as opposed to providing for their basic needs. Health became a lower priority as African countries fell into debt because of loans from the IMF and SAPs of the World Bank. Even today with the economic recession African governments are cutting their health budgets to make ends meet. Health services should be the last item cut from a budget as health is central to all other human development.

Health is a major issue in Africa as the basic needs becoming increasingly difficult to provide and there have already been numerous reforms and attempted mechanisms to provide adequate health care.

[2] Hunter, 136.

[3] Ibid, 144.

[4] Hill, 6.

[5] Hunter, 47.

Photo Credit: African Health Platform

After a long overdue absence, The Week in African Health is back. Subscribe to the blog to continue to get the latest news and innovations related to health and health care across the African continent.

Bringing everything full circle, Alanna Shaikh provides us with a repost: Why you can’t understand global health

Alanna reminds us all that if we overlook the intricate relationship between poverty and ill-health then we are set to misunderstand global health. “If you can read this, that’s not you. By definition, you speak English and you have access to the internet. You earn more than a dollar a day. You can’t understand.” For all the talk, analysis, and good intentions – we must remember that it is the poor who know best what interventions will work for better health around the world.

The World Health Organization has released the first ever guidelines for procurement of effective anti-malarial medicines

The guidelines emphasize testing for effective treatment. The WHO cites in 2008 that only 22% of suspected cases were tested in 18 of the reporting African countries. Thanks to new quality assured Rapid Diagnostic Tests (RDTs) that use a dip stick, testing is easier and quicker.This emphasis on testing will assist in stemming drug-resistance issues with quick and effective treatment.

South Africa has launched a massive HIV Testing campaign that marks a definite reversal from its past HIV/AIDS initiatives more focused on denial.

Beginning on April 15th, everyone who enters a clinic will be offered an HIV test, regardless of history or symptoms. Every health facility “should” be prepared to test by April, but the larger problem will then be access to medications and clinics have not yet been certified to distribute ARVs, especially those located in remote or peri-urban areas.

One of the few good things that I have heard about the Millennium Development Goals (MDGs) is that most countries are on track to reach the goal on access to clean water.

With 80% of all disease transferred by contaminated or dirty water, this MDG is a critical piece to improving health. Some countries are even set to exceed this goal by 2015. On the flip side the UN reports that unless “huge efforts” are made most countries will fail to achieve the sanitation MDG. This could be an unfortunate setback as clean water sources require proper sanitation to remain clean.

“If you kiss for five minutes you get it” HIV/AIDS in Namibia

This is one of the lessons learned by young students in one of Namibia’s HIV/AIDS after-school courses. The primary student ended by saying, “People with AIDS should keep to themselves.” Some of the teaching may be misguided, but the program offers much needed psychosocial assistance to young children who have difficulty coping. One student learned he was HIV-positive 3 years ago at age 8, but that hasn’t ended his dreams of becoming a doctor someday.

Need HIV/AIDS help? Look on the map!

A new program in East and Central Africa has printed 20,000 road maps that pinpoint the locations of roadside clinics where truck drivers can go for help with HIV/AIDS. One driver said, “Many of us want treatment but at times you might not know where to get it when you are on the road but these maps can help us now.” The wellness centres and clinics have been constructed in areas where high-risk populations converge.

Tweeting Against Malaria

The UN has selected a group of 24 social media envoys to tweet for malaria control. The WHO says that 3.3 billion people (half the world’s population) is at risk for malaria and sub-Saharan Africa is the epicenter where 90% of malaria deaths occur.

Other interesting articles of the week:

• Using mobile phones to fight counterfeit medicine
• Aid workers struggle to reach cyclone-hit villages
• Kenya Acts to stem cross-border HIV spread
• HIV/AIDS situation alarming at Tanzanian colleges
• New medical school launching in Uganda
• Cholera situation “stationary” in Mozambique

Before you have anything else, you have your health. Hopefully if you have nothing else, at least you have your health. Unfortunately, for millions across the African continent this is not an absolute fact. Even more unfortunate is the fact that many Africans have no ability to change their health status. They are trapped in a system that is driven by Western market based, profit driven health care systems. As the failures of Western development practices come to light, alternatives to what has been are becoming increasingly visible. These alternatives will form a revolution in African health care delivery. This revolution will be fueled by health care delivery models that will give local communities agency in the provision of their own health care. Community-based models involving cooperative financing, proven para-professional training, new information technology, and social enterprise for the social good will drive the revolution in African health care. People will be able to determine for themselves, their level of health.

What does “Health” mean anyway?
This is a question often left to remain ambiguous. For the purposes of my writing I will provide a comprehensive view of “health” and all that is entailed in sustaining and maintaining health. “Health” in all instances will refer directly to the “basic needs” of a person in regards to health care.

Healing, like health, is obviously rooted in the social and cultural order. [...] To define dangerous behavior, and to define evil, is to define some causes of illness. As the definition of evil changes, so does the interpretation of illness. To understand change in healing, we must understand what it is that leads people to alter the definition of dangerous social behavior. It can easily be accepted that health and healing in Africa are shaped by broad social forces.

As Feierman and Janzen state, health (and healing for that matter) are directly linked to social forces. If a comprehensive understanding of health is to be understood, it must be studied in the context of politics, economics, and other societal structures.

Health is defined by the World Health Organization (WHO) as, “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” The WHO and many other international organizations recognize that this broad and encompassing definition of health. Where this definition becomes ambiguous is what qualifiers meet, “a state of complete physical, mental, and social well-being.” In 1978 the WHO made primary health care its number one objective with the Declaration of Alma Ata. However, even this statement had no clear definition of health or its qualifiers.

Feierman and Janzen provide a more clear definition of the qualifiers of health in the preface to their volume: The Social Basis of Health and Healing in Africa,

[…] it [health] is maintained by a cushion of adequate nutrition, social support, water supply, housing, sanitation, and continued collective defense against contagious and degenerative disease. Such a view is necessary if we are to understand those contexts in today’s Africa where health levels deteriorate, and where they improve.

These authors provide a complete set of qualifiers, or “basic needs,” of health that can be researched further to understand where political, economic, and social structures interfere with sustaining and maintaining health and where health care is inadequate.

Health care should thus be understood as the system and structure that works to provide the above defined “basic needs” to each individual. Often this role falls to governments, but sometimes is taken up by communities and organizations when government’s fail to provide these basic needs.

This blog series will cover four key areas identified that will fuel this revolution in African health care: cooperative financing, para-professional training, information technology, and social enterprise. SCOUT BANANA works to tackle social medicine (social, economic, structures) while enabling others to provide medical services. Be sure to follow closely to learn more!

Want to get published? Got an exciting term paper? Have some eye-opening stories about your work abroad? Looking to have your voice heard?

Articulate: Undergraduate Research Applied to International Development is now accepting submissions for its Fall 2009 issue! The journal will be published in November, and we encourage all undergraduates and young people (under 30) who are interested and experienced in the areas of development, African studies, and/or health care to consider making a contribution. See the Call for Papers below for more information.

Four modern-day explorers in Expedition Africa (from History Channel)

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?