This past week the health community made tremendous strides towards global eradication of malaria and the hundreds of thousands of deaths the disease causes each year.  The GlaxoSmithKline-funded and Gates Foundation-endorsed drug, RTS,S (commercial name, Mosquirix) was unveiled last Tuesday. This miracle malaria vaccine’s claim to fame, according to small preliminary trials previously done in Africa, is that it was found to have halved the risk of children becoming infected.

While this is wonderful news for the millions of people at risk of contracting malaria, the vaccine is still undergoing larger clinical trials at 11 health research centers in 8 African countries (Malawi, Ghana, Gabon, Burkina Faso, Mozambique, Kenya, Tanzania and Senegal). The vaccine will be tested on 5-18 month old children and would not be released commercially until 2014, at the earliest.

The famously generous Bill and Melinda Gates Foundation is playing a huge role in the funding and development of continued research on the vaccine, but the pharmaceutical giant, GlaxoSmithKline(GSK)  is the manufacturer and financial benefactor of the research and eventual production of the drug. Again, RTS,S may be an extraordinary success for global health. However, I can’t help but think of two possible problems with the release of this vaccine: accessibility and affordability. My hope is that GSK will make the vaccine affordable and accessible for those who need it most. My fear is that the vaccine will share the same fate as antiretroviral treatment, the drug treatment used to enhance and extend the lives of people living with HIV. Antiretroviral treatment, although extremely effective, remains inaccessible and unaffordable to many people living with the virus.

RTS,S, even in its early stages, is a huge step towards the eradication of malaria. Even if the vaccination’s effectiveness peaks at 50%, RTS,S will reduce malaria-related deaths in children by half. To guarantee that this life-saving vaccine is used to its fullest potential, GSK, the Gates Foundation, governments and the global community must understand that the development of a vaccine is not a success unless its affordability and accessibility is ensured for all.

Anti-malaria support has been occurring throughout the world for a while now. However, the anti-malaria prevention has been increased recently. Rwanda has been doing an outstanding job when it comes to preventing malaria with the mosquito nets rollout and implementing anti malaria interventions throughout the country. “In Rwanda, malaria cases or deaths have fallen by over 60 percent partly due to a large increase in international funding for malaria control, but in 2009, a delay of mosquito nets replacement led to nationwide stock-outs of ITNs” (allAfrica).

Each hotel that you go to in Rwanda will provide you with a net, if you can afford it. There are some locations that will not provide a net for people who do not pay the full amount. Not all the locals are aware of malaria and see it as a problem. While there I was taking anti-malaria pills at dinner and one of the waiters asked if I was sick. I explained to him what the pills were for and he asked me why I had to take those. I told him that it was to prevent me from getting malaria and he said that he was immune to it since he is African. I kindly explained how malaria works and that he can get it but if he just sleeps under a net he should be fine since he lives in the city. I am happy to hear that Rwanda scored a 100 on the global malaria scorecard and have reduced their malaria cases by 60%. Not only has the number of cases reduced but also those who do get malaria will be able to receive the proper treatments. “Health care outreach programmes will ensure that those who get malaria are able to get rapid diagnosis and early treatment” (allAfrica).

For more information, please see: http://allafrica.com/stories/201109180015.html and http://allafrica.com/stories/201109170121.html

The health care system in Uganda is overrun with problems.  As a community health volunteer for Peace Corps, I have been working with a Health Center II (a basic-services clinic) and have been assessing the state of health care here in Uganda.

While government health care is intended to be free, there are so many hidden costs that patients are often still unable to afford health care.  The government provides free drugs and care, but when those drugs run out (which is all-too-often), the patients are responsible for going to a private drug shop and buying their medicines.  Women who want to deliver at a government health center are often required to bring their own “mother kit”, a set of supplies which can include such things as cotton, gloves, needles, etc.  At our small Health Center II, we have no capability of running tests such as urinalysis, blood smears for malaria, or even taking blood pressure, and often have to refer patients to either a larger government health center or a private clinic for the care they need.  Many people cannot afford even 4,000 Ugandan shillings roundtrip (less than $2) to the Health Center III, a few kilometers away, for testing or maternal care, let alone a trip to a private clinic where all costs are out-of-pocket.  Some of our patients walk several miles to get to our clinic.

Malaria is one of the leading causes of morbidity and mortality, and is severely over-diagnosed.  Practically everyone with a fever is given anti-malarial drugs, and subsequently health centers often run out of the drugs before the next shipment arrives from the government.  The cost of these drugs in a private drug shop can be 15,000/- (about $7), which is too expensive for the average rural Ugandan.  The nurses at the health centers have little choice when they have no way to test for malaria before dispensing drugs – if the patient does have malaria and is not treated, he or she could die.  Better to be safe than sorry, but being safe in this situation causes its own host of problems.

There is also a big problem with motivation among health workers.  Salaries are very low, and some workers feel no obligation to give good ‘customer service’, which is a huge concern in privatized health care systems such as the U.S.  Health workers often show up whenever they feel like it, and leave the clinic hours before the official closing time, leaving some patients to wait for hours to be seen.  A small aspect of this stems from the culture where family comes first – if the nurse has to harvest millet or help a family member out, they don’t see a big problem in staying home.

So what, as a Peace Corps Volunteer (PCV), can I do?  It’s a difficult question to answer – if there were an easy fix, Uganda would have great health care.  PCVs don’t come with any funding or external assistance, we come to act as change agents and co-facilitators to mobilize local resources and work with what is already available.  While it’s difficult to make system-wide changes or improve facilities and equipment without funding, I am working to encourage healthy behaviors, build capacity among health workers, and provide people with the knowledge they need to keep themselves and their families happy.  Another PCV I know is working at the district health office, so he can encourage health officials to improve efficiency and make positive changes in the health care system.  These are small steps, not a big NGO project with millions of dollars backing it, but these small steps are (hopefully) sustainable, using local resources and requiring the community to get involved to make changes in their own lives.

With Hanukkah and Christmas in the past and Kwanzaa and New Years Day fast approaching holiday cheer and charitable acts are in full swing, along with the dollars fueling these two year end activities. Playing off of these charitable and cheerful feelings, the (RED) Campaign swings into full force at this time. The (RED) Campaign coordinates the marketing of “(RED)” branded products, such as Starbucks coffee merchandise, GAP t-shits and Nike shoelaces to “give up to 50 percent of their profits to the Global Fund to invest in HIV and AIDS programs in Africa.” In addition to the (RED) Campaign’s obvious ambiguity in regards to the amount of money actually given to the Global Fund, and the claim that the campaign is funding “HIV and AIDS programs in Africa,” without a clear description of what HIV and AIDS programs are actually being funded, the Global Fund is notorious for its lack of financial transparency. The Global Fund along with the (RED) Campaign is often questioned about its efficiency and efficacy, particularly in light of the huge media and marketing campaign that pulls in millions and millions of dollars from often clueless, though well-intentioned customers.

Not wanting to be totally Grinch-like, I must sing some praises of the (RED) campaign. For one, it has one of the most well known and ubiquitous charitable advertizing campaigns ever launched and sustained across a wide variety of products.  It has not only substantially impacted, and even changed the face of the philanthropic world, but has had an impact on the business world that fuels the campaign as well. And it cannot be denied that the campaign gives money to a large foundation whose goal it is to end HIV/AIDS, Tuberculosis and Malaria in African countries. And finally, buying a (RED) product will further benefit its stated mission in some way.

Regardless, there are two major things that make the (RED) Campaign inherently problematic. First, with such a powerful presence across a wide range of outlets around the world, shouldn’t the campaign do, give, devote, make, change, and affect more? And if it does, how do we really know?

And second, isn’t promotion of mindless consumerism ($200 iPods, overpriced T-shirts and Coffee, and running shoes made God-knows where by what age worker) contrary to the goal of public health in Africa, the ultimate goal of  the (RED) Campaign in the first place?

In fact, it may be true that goals and intentions of the (RED) Campaign are honorable.  But as consumers and producers in the developed world, we should be sure that our hard earned dollars, euros, yen and pounds, our charity to the less fortunate, and our holiday cheer make it to people and organizations that will use those things to the most effective and fullest extent. Although buying a red coffee cup, a red T-shirt, a red iPod, and red shoelaces are easy and fun ways to give, be sure of what you are giving and to whom you are giving it.

P.S. HAPPY HOLIDAYS!

P.P.S. Check out SCOUT BANANA’s own holiday campaign, TI(RED) for more information!

The growing resistance to the most effective malaria treatment on the market, Artemisinin therapy is a grave concern in Southeast Asia. Resistance to the drug has spread across most of Asia, and has the potential of spreading in a significant way to Africa. This is especially detrimental because African countries are the most affected by malaria and this resistance to treatment could put millions of lives at risk.

According to the World Health Organization (WHO), nearly half of the world’s population is at risk of contracting malaria and one million people die each year from the disease.  In African countries, 1 out of 5 childhood deaths are malaria-related.  If resistance to Artemisinin treatment for malaria becomes a reality in African countries, like it has throughout Asia, what does that mean for efforts to promote African health and welfare, and efforts to reduce childhood mortality?

As of 2007, resistance to Artemisinin therapy in 55 countries worldwide was below 5%. WHO has called for a broad and up-to-date study of the efficacy of malarial treatment throughout Africa.  According to one report, health experts in African nations believe that the problem doesn’t lie with the efficacy of Artemisinin therapy but poor manufacturing and use of “fake drugs and substances,” replacing and mixing with the drug components in Artemisinin.

One Zambian public health official said, ‘We have to try to find other drugs and new regimens to avoid a catastrophe.” Overall, resistance to a drug that has made strides in reducing malarial rates throughout the world, especially African countries, is not a death sentence. There are alternatives to Artemisinin therapy. With research, cooperation and utilization of resources the growing resistance to malaria treatments is a solvable problem.

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.

(via HoboTraveler.com)

American Food Aid: Saving Lives, or US Jobs

Change.org takes on US food assistance and its implications for foreign countries. Most often US food aid has very negative and often damaging effects on local communities and economies.

Swaziland: Poor Health Services Hamper PMTCT Progress

While much progress has been made in reducing HIV transmission, many are worried that the lack of adequate health workers and centers will reverse the advances that Swaziland has made.

Who’s Tracking the World’s Biggest ARV Programme?

South Africa runs what is probably the world’s largest ARV programme – over 700,000 people are receiving ARVs at public sector facilities. The South African National AIDS Council (SANAC) reports on the national program to fight HIV/AIDS. With good and bad news, the report demonstrates that there needs to be better implementation, monitoring, and evaluation.

Cameroonians Arrested for Operating Illegal Hospital

The largest issue with this article was not that there was a hospital started by local Cameroonians, but instead that they were distributing unregistered and illegal Chinese medicines. Is this an example of the growing influences of Chinese investment and aid? The hospital registered and defrauded over 2,000 people.

Why Studying Human Migration Can Help Stop Malaria

You may often hear this argument when talking about the spread of Tuberculosis, HIV/AIDS and other STDs, but not often for malaria. One of Change.org’s authors gives a great history and background on the spread of malaria. The World Health Organization (WHO) has written since 1957 that population movement exacerbates the spread of malaria.

Uganda: HIV/AIDS Centers Turn Away New Patients

As a direct cause of the reduction in funding from US government agencies, centers that provide treatment and prevention have begun turning away patients because they have to make budgetting cuts.

Read more about the Obama Administration’s Global Health Initiative that is causing issues across Africa in regards to funding for HIV/AIDS treatment and prevention.

Also on Health in Uganda:

• Public Irritated by Yet Another Condom Shortage
• Why Uganda Shouldn’t Criminalize HIV/AIDS Transmission
• Want to Help Uganda? Send Condoms 95% of condoms are supplied by foreign donors

In Mali, Using Cell Phones to Create Patient Records

New Echoing Green fellow Josh Nesbit and his organization FrontlineSMS:Medic have partnered with the Mali Health Organizing Project (MHOP) to streamline and clean up patient records to improve health services.

Other Articles of Interest:

• Troubled Water Aid Watch chronicles the issues with PlayPumps
• A Miner-Led Tuberculosis Crisis
• West Africa: 10 million face Hunger in Region
• Nigeria: Researchers seek ways to End Maternal Deaths
• Africa: Enticing Health Workers to the Outback

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

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

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

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

• When there is no village doctor

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

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

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

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

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

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

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

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

• South Africa: The Quiet Water Crisis

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

• Twestival and Charity: Water

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

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

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

• Obama Lifts “Global Gag Rule”

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

• University Partnership Aims to Fight HIV/AIDS More Effectively

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