Inter Press Service » Health http://www.ipsnews.net Journalism and Communication for Global Change Thu, 17 Apr 2014 07:38:02 +0000 en-US hourly 1 http://wordpress.org/?v=3.8.3 Uruguay Not a ‘Pirate’ http://www.ipsnews.net/2014/04/uruguayans-pirates/?utm_source=rss&utm_medium=rss&utm_campaign=uruguayans-pirates http://www.ipsnews.net/2014/04/uruguayans-pirates/#comments Thu, 17 Apr 2014 07:34:29 +0000 Pavol Stracansky http://www.ipsnews.net/?p=133728 The Uruguayan government has made a controversial move to regulate the production and sale of cannabis. The government believes that this will help in the fight against drug-related crime and in dealing with public health issues. The move has been condemned by the UN’s International Narcotics Control Board (INCB), whose president Raymond Yans accused the country’s […]

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By Pavol Stracansky
VIENNA, Apr 17 2014 (IPS)

The Uruguayan government has made a controversial move to regulate the production and sale of cannabis. The government believes that this will help in the fight against drug-related crime and in dealing with public health issues.

The move has been condemned by the UN’s International Narcotics Control Board (INCB), whose president Raymond Yans accused the country’s government of having a “pirate attitude” for going against the UN’s conventions on drugs."It is not our aim that anyone follow us or do what we have done."

Diego Cánepa, secretary of the office of Uruguayan President José Mujica, tells IPS that he believes a regulated marijuana market was the right decision for his country.

Q. How do you feel about your country being labelled “pirates” by the INCB for legalising the marijuana market?

A. Well, the INCB is just one UN body and it is just one opinion. They have a special mandate and that mandate is not to decide what approach each individual country should follow. We have had a discussion over the correct interpretation of the UN drugs conventions. We believe, and we have the evidence to show this, that our interpretation is correct. We followed the original spirit of the convention and we hope that the step which we have taken is the right one to create better control of the marijuana market in our country.

Prohibition was a big mistake in the last 40 years, so we believe that a strictly regulated marijuana market is the best way to fulfil the spirit of the UN drugs conventions.

Q. Do you get frustrated when you hear people from other countries talking about how what you are doing is wrong, for example from countries which have a much more conservative, hard line approach to drugs?

A. We very much respect every opinion. It’s an open discussion. We do not think that we have the whole truth in our hands. We listen very carefully to the opinions of other countries but we defend our sovereign right to do what we think is right for our own country and our people. And we believe that in terms of our health policies this is the best option for Uruguay.

We don’t want to be a model for other countries over this, we just think that this is the best way for our country and we will defend our right to take this option. But we are open to discussion. We think that prohibition is not the answer and overwhelming evidence has shown that it is a mistake. We don’t want to have this kind of policy. We need to have the right to explore a different approach to drugs.

Q. If you find that after a couple of years things are not going well with the legalisation or that you are not seeing the kind of results you want with regards to public health, would you be prepared to go back to a ban on drugs?

A. I think the question is different. First of all, a few years is not enough. You need at least eight, nine or ten years before you can draw any conclusions. We need to have a lot of evidence over a long time period to really understand what effects this policy is having.

Looking at public health, violence, drug consumption – all the evidence shows us so far that by regulating the market and making visible what has until now been an invisible market means that you can control that market better, and control trafficking and then you have less violence. But I think that if that doesn’t happen in ten years then we will have another debate on this. But I do not think we would go back to banning [marijuana]. We would need to find another answer.

Q. Are you happy when you see other countries doing things which are similar to what you have done? For example states in the U.S. which have legalised commercial marijuana sales.

A. Actually, what they have done in Colorado is much more than what we have done. There you are free to buy and sell what you want. They have a different model to us. But there are 18 states in the U.S. where marijuana can be bought for medical purposes. But that is just an euphemism because we know that the majority of people use marijuana not with a medical purpose but with a medical excuse.

We see that an individual state in the U.S. is operating this way with no federal overrule on it so it is impossible to not accept that there is a big, open debate on this when you have different countries around the world taking different approaches to the problem.

Q. Could you see other countries following your lead and regulating their marijuana markets?

A. I really don’t know and it is not our aim that anyone follow us or do what we have done. We do not want to be a model for any other country. We respect everyone else’s policies but we think that this is the best model for our country.

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U.S. Tribe Looks to International Court for Justice http://www.ipsnews.net/2014/04/u-s-tribe-looks-international-court-justice/?utm_source=rss&utm_medium=rss&utm_campaign=u-s-tribe-looks-international-court-justice http://www.ipsnews.net/2014/04/u-s-tribe-looks-international-court-justice/#comments Wed, 16 Apr 2014 23:26:56 +0000 Michelle Tullo http://www.ipsnews.net/?p=133733 An indigenous community in the United States has filed a petition against the federal government, alleging that officials have repeatedly broken treaties and that the court system has failed to offer remedy. The petition was filed by the Onondaga Nation, a Native American tribe and one of more than 650 sovereign peoples recognised by the […]

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By Michelle Tullo
WASHINGTON, Apr 16 2014 (IPS)

An indigenous community in the United States has filed a petition against the federal government, alleging that officials have repeatedly broken treaties and that the court system has failed to offer remedy.

The petition was filed by the Onondaga Nation, a Native American tribe and one of more than 650 sovereign peoples recognised by the U.S. government. Onondaga representatives are calling on the Inter-American Court of Human Rights (IACHR), the human rights arm of the pan-regional Organisation of American States (OAS), to intervene.“We understand that the U.S. does not adhere to the OAS, but I don’t know where we go. We’ve exhausted our avenues.” -- Onondaga leader Sid Hill

In 2005, the Onondaga Nation filed a case against New York State, stating the state government had repeatedly violated treaties signed with the Onondaga, resulting in lost land and severe environmental pollution. Yet advocates for the trips say antiquated legal precedents with racist roots have allowed the courts to consistently dismiss the Onondaga’s case.

They are now looking to the IACHR for justice.

“New York State broke the law and now the U.S. government has failed to protect our lands, which they promised to us in treaties,” Sid Hill, the Tadodaho, or spiritual leader, of the Onondaga people, told IPS.

Hill and others from the Onondaga Nation gathered outside the White House, located near the IACHR’s Washington headquarters, on Tuesday. Hill brought an heirloom belt commissioned for the Onondaga Nation by George Washington, the first U.S. president, to ratify the Treaty of Canandaigua, affirming land rights for the Onondaga and other tribes.

In their petition to the IACHR, the Onondaga quote sections from the Trade and Intercourse Act of 1790. Signed by George Washington, this law assured the Onondaga that their lands would be safe, and if threatened, that the federal courts would protect their rights.

Yet since then, tribal advocates say, their 2.5 million acres of land has shrunk to just 6,900 acres. And rather than helping the Onondaga, the courts have ignored their case.

“We filed the original case in 2005,” Joe Heath, the attorney for the Onondaga Nation, told IPS.

“We did not sue, did not demand any return for original land. It was more aimed at protecting sacred sites and environmental issues … Our case was dismissed in 2010, so we appealed to the Second Circuit.”

The Second Circuit, and finally the Supreme Court, dismissed the case.

Landmark law

Since 2005, the U.S. courts have designed a new set of rules, called “equitable defence”. This now arms New York with a two-part defence in the Onondaga case. First, officials are able to argue that too much time has passed since the 1794 treaty was signed to when the case was filed, in 2005.

Second, equitable defence also states that the court is able to determine on its own whether the Onondaga people have been disturbed on their land.

“The legal ground on which [the Onondaga] claims rest has undergone profound change since the Nation initiated its action,” the District Court concluded. “The law today forecloses this Court from permitting these claims to proceed.”

The Onondaga Nation and other Native American nations are now fighting to change Native American land laws.

Current legal precedents go back to the 1400s, when Pope Alexander VI issued a papal decree that gave European monarchs sovereignty over “lands occupied by non-Christian ‘barbarous nations’”. In a case in 1823, the U.S. Supreme Court applied this principle to uphold the possession of indigenous lands in favour of colonial or post-colonial governments.

The Supreme Court again revived this doctrine as recent as 2005, when another New York tribe, the Oneida Nation, refused to pay taxes to the United States, citing its status as a sovereign nation.

“Under the Doctrine of Discovery … fee title to the land occupied by Indians when the colonists arrived became vested in the sovereign – first the discovering European nation and later the original States and the United States,” Justice Ruth Bader Ginsburg wrote in the 2005 decision.

This doctrine still underpins Indian land law and the dismissal of the Onondaga Nation’s case.

“This is the Plessy v. Ferguson of Indian law,” Heath told IPS, referring to a notorious landmark judicial decision that, for a time, upheld racial segregation in the United States.

Most polluted lake

Heath and others say the goal in “correcting” the U.S. legal system would be to provide the Onondaga Nation and other tribes more say in environmental decisions. Front and centre in this argument is the travesty they say has been visited on Onondaga Lake.

“Onondaga Lake, a sacred lake, has been turned into the most polluted lake in the country,” Heath says. “Allied Corp. dumped mercury in the lake every day from 1946 to 1970.”

In 1999, Allied Corp., a major chemicals company, purchased Honeywell, a company popularly associated with thermostats, and adopted its name, to try and shed its association with pollution. However, this merger has made it more difficult for the Onondaga Nation to get the company to clean up the lake.

“Before the Europeans got here, we had a very healthy lifestyle,” Heath said.

“All the water was clean and drinkable … With the loss of land, pollution of water, and loss of access to water, health has been impacted negatively.”

Another problem is salt mining.

“Only one body of water flows through the territory, Onondaga Creek, and this creek is now severely polluted as a result of salt mining upstream,” Heath says. “The salt mining was done over a century, and so recklessly that it severely damaged the hydrogeology in the valley.”

Heath says elder members of the Onondaga community can remember clear waters that supported trout fishing.

“Now you can’t see two inches into the water, it looks like yesterday’s coffee,” he says.

The Onondaga Nation is now waiting to see whether IACHR will hear the case.

This normally takes several years, however. And even if the court hears the case, it has no formal enforcement mechanisms, but can only make recommendations to the United States.

“We understand that the U.S. does not adhere to the OAS,” Onondaga leader Hill said. “But I don’t know where we go. We’ve exhausted our avenues.”

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Russian Law Corners Drug Users http://www.ipsnews.net/2014/04/russian-law-corners-drug-users/?utm_source=rss&utm_medium=rss&utm_campaign=russian-law-corners-drug-users http://www.ipsnews.net/2014/04/russian-law-corners-drug-users/#comments Wed, 16 Apr 2014 06:54:40 +0000 Pavol Stracansky http://www.ipsnews.net/?p=133685 As local authorities prepare to put an end to opioid substitution treatment (OST) programmes in the newly annexed Crimean peninsula, drug users there say they are being forced to choose between a return to addiction and becoming refugees. OST – where methadone and buprenorphine are given to opioid addicts under medical supervision – has been […]

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An OST patient in Simferopol, Crimea. OST programmes are to finish soon following annexation of the region by Russia. Credit: HIV/AIDS Alliance Ukraine.

An OST patient in Simferopol, Crimea. OST programmes are to finish soon following annexation of the region by Russia. Credit: HIV/AIDS Alliance Ukraine.

By Pavol Stracansky
KIEV, Apr 16 2014 (IPS)

As local authorities prepare to put an end to opioid substitution treatment (OST) programmes in the newly annexed Crimean peninsula, drug users there say they are being forced to choose between a return to addiction and becoming refugees.

OST – where methadone and buprenorphine are given to opioid addicts under medical supervision – has been available in Ukraine for almost a decade.

But Russian law forbids its provision, and Russian government officials have said they intend to close OST services in the region by the end of this month."We don’t know what the future holds. Without substitution therapy, I will die."

Organisations working to provide services to drug users on the peninsula say this has put the future health of more than 800 people receiving OST in the region in doubt.

They say that distances to the nearest facilities in Ukraine offering the treatment mean it would be impossible for drug users to access OST services without leaving Crimea permanently.

Without this lifeline treatment, they warn, many users will turn back to dangerous drug habits, reverting to crime or prostitution to support their addiction, and sharing contaminated needles.

Anton Basenko, a member of the All Ukrainian Association of OST Participants, told IPS: “Many of these people, just like me, have HIV, hepatitis C and other chronic diseases complementing their drug dependence. Stopping substitution therapy for the majority of them is the same as denying them oxygen to breathe. They are being thrown back to crime and despair.”

Drug users in Crimea who spoke to IPS said they were dreading their futures without OST.

One 32-year-old drug user from Sevastopol, a mother of one who gave her name only as Ludmila, told IPS: “I am hoping to start a full-time job in a few weeks but this will be impossible for me if I cannot receive OST. My husband, who also receives OST, currently has a job but he will lose it if he stops getting his treatment. Ending these programmes will be a disaster for this whole family.”

Another, who gave his name only as Vitaliy, told IPS he had been helped by the OST he had been receiving for the last four years. He said he did not want to leave his home in Sevastopol but was afraid of what might happen to him if he did not.

The 27-year-old said: “I don’t want to go but at the same time I don’t want to return to injection drug use.”

A 37-year-old man who asked to be called ‘Yevgeny Kovalenko’ (not his real name), who has been receiving OST in Simferopol since 2008, said he faced a stark choice.

He told IPS: “I am scared, my friends are scared. We don’t know what the future holds. Without substitution therapy, I will die. And that is not me just being dramatic or using a figure of speech, I will literally die.  So will many others.”

Groups such as the HIV/AIDS Alliance in Ukraine say some drug users have already left Crimea to ensure they can continue to access OST. The Alliance is preparing for hundreds to arrive in Kiev looking for help when the programmes close in Crimea.

But while those who make it to Kiev will be able to get help, those that cannot, or choose not to leave their homes in Crimea, will be left to deal with their addiction in a region where local authorities will be enforcing repressive Russian policies on drugs.

Under Russian legislation, minor drug offences are punished severely with, for example, convictions for possession of even the smallest amounts of heroin – including residue in a syringe. Such offences carry lengthy jail sentences.

Russia has one of the world’s fastest growing HIV/AIDS epidemics, which UNAIDS and other bodies say has been historically driven by injection drug use.

Ukraine, which also has a serious HIV/AIDS epidemic, has recently reduced the rate of new HIV infections – a success put down to the widespread implementation of harm reduction programmes.

It is unclear at the moment what effect Crimea becoming part of Russia will have on the provision of harm reduction services other than the OST programmes.

Ukrainian groups working with drug users say there are more than 14,000 people in Crimea who access such services, and that any threat to their provision could have devastating consequences for their health and create a serious public health threat in Crimea.

Meanwhile, drug users in Kiev are calling on the Ukrainian Ministry of Health to act.

They say that, even if they cannot persuade authorities in Crimea to allow the extension of OST programmes at least until January next year, when all legislation in the peninsula should be brought fully into line with that of the rest of Russia, the ministry should be setting up facilities for OST programmes in other parts of Ukraine.

Basenko told IPS: “Practical steps need to be taken to organise the accommodation of these refugees, these patients from Crimea, so they can continue their treatment in Ukraine.

“Drugs available in Ukraine must be redistributed and additional OST facilities need to be set up to meet the needs of these patients.”

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Uzbekistan’s Dying Aral Sea Resurrected as Tourist Attraction http://www.ipsnews.net/2014/04/uzbekistans-dying-aral-sea-resurrected-tourist-attraction/?utm_source=rss&utm_medium=rss&utm_campaign=uzbekistans-dying-aral-sea-resurrected-tourist-attraction http://www.ipsnews.net/2014/04/uzbekistans-dying-aral-sea-resurrected-tourist-attraction/#comments Tue, 15 Apr 2014 17:41:12 +0000 Adriane Lochner http://www.ipsnews.net/?p=133688 “I’m going for a swim,” says Pelle Bendz, a 52-year-old Swede, as he rummages in the jeep for his bathing trunks. The other tourists look at him, bewildered. What’s left of the Aral Sea is reputed to be a toxic stew, contaminated by pesticides and other chemicals. But the weather’s hot and Bendz insists his […]

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Rusting and stranded, ships that once operated on the Aral Sea now attract adventure tourists. Credit: Adriane Lochner/EurasiaNet

Rusting and stranded, ships that once operated on the Aral Sea now attract adventure tourists. Credit: Adriane Lochner/EurasiaNet

By Adriane Lochner
BISHKEK, Apr 15 2014 (EurasiaNet)

“I’m going for a swim,” says Pelle Bendz, a 52-year-old Swede, as he rummages in the jeep for his bathing trunks. The other tourists look at him, bewildered. What’s left of the Aral Sea is reputed to be a toxic stew, contaminated by pesticides and other chemicals.

But the weather’s hot and Bendz insists his travel agency told him “swimming” was part of the package.Activists have been jailed for exposing the disappearing sea’s impact on Karakalpakstan residents’ health.

In Nukus, the sleepy regional capital of western Uzbekistan’s Karakalpakstan region, local tour operators say the number of sightseers is growing each year. Many come to this remote part of the Central Asian country to see the famous Savitsky art collection. There are excursions to ancient fortresses and historic Khiva, once an important stop on the Silk Road.

But the Aral Sea – one of the world’s most infamous, man-made ecological disasters – is probably the top attraction.

“Last year almost 300 foreigners went on camping trips to the coastline, and numbers are increasing,” says Tazabay Uteuliev, a local fixer who arranges transport for several Uzbek travel agencies.

Spring and autumn are most popular, but this year he even had a group in January. “More and more people seem to like it extreme,” Uteuliev tells EurasiaNet.org. The tourists are usually adventurous, not looking for a trip to the beach, but to see the famous lake before the last of the water is gone, he adds.

Bendz, the Swede, claims a special interest in unusual places. On a previous trip to Ukraine he visited Chernobyl, site of the 1986 nuclear accident. As he runs toward the shore, his feet sink in mud. The other two tourists and their driver follow him with their eyes.

The driver explains that over the course of only one year, the coastline has receded about 50 metres. The former seabed is still damp and covered with clams.

“You don’t even have to swim,” Bendz shouts, giddily floating on the water. In 2007, one estimate put the Aral’s salinity at 10 percent. As the sea continues shrinking, salt content is believed to have risen to about 15 or 16 percent, or half the concentration in the famously salty Dead Sea.

For local activists, the swell of foreign interest offers a chance to educate, as well as entertain.

In a hotel in Nukus, a group of Swiss tourists listens to a seminar about the history of the Aral catastrophe as part of their tour programme. The lecturer asks EurasiaNet.org not to print his name because he is implicitly criticising Uzbekistan’s authoritarian government.

He has a legitimate fear: activists have been jailed for exposing the disappearing sea’s impact on Karakalpakstan residents’ health. In 2012, one activist said she was beaten and threatened with forced psychiatric care.

During his presentation, the speaker shows satellite images and videos of fishing boats from the time when the fish-packed Aral Sea was one of largest lakes in the world. He describes the consequences of the water loss for locals: extremely hot summers, freezing winters, dust storms and lung diseases.

“Only the government can do something about it,” the activist says, describing wasteful irrigation upstream on the Amu-Darya River.

In his opinion, poor government management of water resources is the main cause of the environmental problems. Only about 10 percent of the water diverted from the river makes it to the fields, he says. The rest evaporates or leaks out of aging irrigation canals.

“People should [be required to] pay for the water, then they would save it,” he says.

Uzbekistan’s centralised agricultural plan aims to produce three million tonnes of cotton annually. To meet this target, officials require farmers to grow the water-intensive plant and press-gang residents to help with the harvest each autumn.

Environmentalists are also concerned that powerful international interests have little reason to save the Aral: Energy companies from China, Russia, Uzbekistan and elsewhere are drilling in the former seabed for natural gas. The tour group drives past their rigs the next morning, across a salt desert, to visit Muynak.

A generation ago, this former fishing village was a port at the southern end of the sea. Now it is about 100 kilometres from the water’s edge. Ships once anchored offshore are now popular tourist attractions, rusting, leaning over into the desert sand. Local children play on the graffiti-covered wrecks.

Only a few hundred kilometres to the north, on the Kazakhstani side, there is hope for the Aral Sea. There, a dike built with assistance from the World Bank in 2005 catches water from the Syr-Darya River, helping bring a tiny portion of the lake back and spawning a renewed fishing industry.

But the Kazakh side does not attract as many visitors, says a representative at Tashkent-based OrexCA, a travel agency specialising in Central Asia.

The agent says she receives occasional inquiries but no bookings to visit the lake in Kazakhstan. She thinks visitors are discouraged by the higher prices and also because Kazakhstani officials have removed so-called ghost ships, selling them for scrap. Instead she touts OrexCA’s “shrinking Aral Sea tour” on the Uzbek side.

The package includes visits to historical sites and, according to the agency’s website, is “designed for admirers of extreme tourism, adventurers and fans of exotic photography.”

Editor’s note:  Adriane Lochner is a Bishkek-based writer. This story originally appeared on EurasiaNet.org.

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Yakama Nation Tells DOE to Clean Up Nuclear Waste http://www.ipsnews.net/2014/04/yakama-nation-tells-doe-clean-nuclear-waste/?utm_source=rss&utm_medium=rss&utm_campaign=yakama-nation-tells-doe-clean-nuclear-waste http://www.ipsnews.net/2014/04/yakama-nation-tells-doe-clean-nuclear-waste/#comments Mon, 14 Apr 2014 18:21:39 +0000 Michelle Tolson http://www.ipsnews.net/?p=133655 The Department of Energy (DOE), politicians and CEOs were discussing how to warn generations 125,000 years in the future about the radioactive waste at Hanford Nuclear Reservation, considered the most polluted site in the U.S., when Native American anti-nuclear activist Russell Jim interrupted their musings: “We’ll tell them.” He tells IPS “they looked around and […]

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At the perimetre of Hanford Nuclear Reservation in Washington State. Credit: Jason E. Kaplan/IPS

At the perimetre of Hanford Nuclear Reservation in Washington State. Credit: Jason E. Kaplan/IPS

By Michelle Tolson
YAKAMA NATION, Washington State, U.S. , Apr 14 2014 (IPS)

The Department of Energy (DOE), politicians and CEOs were discussing how to warn generations 125,000 years in the future about the radioactive waste at Hanford Nuclear Reservation, considered the most polluted site in the U.S., when Native American anti-nuclear activist Russell Jim interrupted their musings: “We’ll tell them.”

He tells IPS “they looked around and saw me. I said, ‘We’ve been here since the beginning of time, so we will be here then.’ That was when they knew they’d have a fight on their hands.”“Helen Caldicott told us in 1997 that if we eat fish from the Columbia, we’ll die." -- Yakama Elder Russell Jim

With his long braids, the 78-year-old director of the Environmental Restoration & Waste Management Programme (ERWM) for the Yakama tribes cuts a striking figure, sitting calmly in his office located on the arid lands of his sovereign nation.

The Yakama Reservation in southeast Washington has 1.2 million acres with 10,000 federally recognised tribal members and an estimated 12,000 feral horses roaming the desert steppe. Down from the 12 million acres ceded by force to the U.S. government in 1855, it is just 20 miles west from the Hanford nuclear site.

Though the nuclear arms race ended in 1989, radioactive waste is the legacy of the various sites of the former Manhattan Project spread across the U.S.

While the Yakama have successfully protected their sacred fishing grounds from becoming a repository for nuclear waste from other project sites by invoking the treaty of 1855 which promises access to their “usual and accustomed places,” Hanford is far from clean, though the DOE promised to restore the land.

“The DOE is trying to reclassify the waste as ‘low activity.’ They are trying to leave it here and bury it in shallow pits. Scientists are saying that it needs to be buried deep under the ground,” Jim explains.

Tom Carpenter of Hanford Challenge watchdog group tells IPS “it is a battle for Washington State and the tribes to get the feds to keep their promise to remove the waste. There are 42 miles of trenches that are 15 feet wide and 20 feet deep full of boxes, crates and vials of waste in unlined trenches.”

There are a further 177 underground tanks of radioactive waste and six are leaking. Waste is supposed to be moved within 24 hours from leak detection or whenever is “practicable” but the contractors say there is not enough space.

Three whistleblowers working on the cleanup raised concerns and were fired. Closely followed by a local news station, it is an issue that is largely neglected by mainstream media and the Yakama’s fight seems all but ignored.

“We used to have a media person on staff but the DOE says there is no need as ‘everything is going fine,” says Russell Jim. His department lost 80 percent of its funding in 2012 after cutbacks. His tribe doesn’t fund ERWM, the DOE does. “The DOE crapped it up, so they should pay for it.”

Russell Jim, Yakama Elder and Director of Environmental Restoration & Waste Management Program (ERWM) for the Yakama Nation. Credit: Jason E. Kaplan/IPS

Russell Jim, Yakama Elder and Director of Environmental Restoration & Waste Management Program (ERWM) for the Yakama Nation. Credit: Jason E. Kaplan/IPS

But everything is not fine. With radioactive groundwater plumes making their way toward the river, the Yakama and watchdog groups says it is an emergency. Some plumes are just 400 yards from the river where the tribe accesses Hanford Reach monument, according to treaty rights.

Hanford Reach nature reserve, a buffer zone for the site, is the Columbia’s largest spawning grounds for wild fall Chinook salmon

Washington State reports highly toxic radioactive contamination from uranium, strontium 90 and chromium in the ground water has already entered the Columbia River.

“There are about 150 groundwater ‘upwellings’ in the gravel of the Columbia River coming from Hanford that young salmon swim around,” explains Russell Jim.

“Helen Caldicott [founder of Physicians for Social Responsibility] told us in 1997 that if we eat fish from the Columbia, we’ll die,” he adds.

Callie Ridolfi, environmental consultant to the Yakama, tells IPS their diet of 150 to 519 grammes of fish a day, nearly double regional tribal averages and far greater than the mainstream population, puts them at greater risk, with as much as a one in 50 chance of getting cancer from eating resident fish.

Migratory fish like salmon that live in the ocean most of their lives are less affected, unlike resident fish.

According to a 2002 EPA study on fish contaminants, resident sturgeon and white fish from Hanford Reach had some of the highest levels of PCBs.

Last year, Washington and Oregon states released an advisory for the 150-mile heavily dammed stretch of the Columbia from Bonneville to McNary Dam to limit eating resident fish to once a week due to PCB toxins.

Fisheries manager at Mike Matylewich at Columbia River Inter Tribal Fish Commission (CRITFC), says, “Lubricants containing PCBs were used for years, particularly in transformers, at hydroelectric dams because of the ability to withstand high temperatures.

“The ability to withstand high temperatures contributes to their persistence in the environment as a legacy contaminant,” he tells IPS.

While the advisory does not include the Hanford Reach, the longest undammed stretch of the Columbia, Russell Jim doubts it’s safe.

“The DOE tells congress the river corridor is clean. It’s not clean but they are afraid of damages being filed against them.” A cancer survivor, Jim’s tribe received no compensation for damages from radioactive releases from 1944 to 1971 into the Columbia as high as 6,300,000 curies of Neptunium-239.

Steven G. Gilbert, a toxicologist with Physicians for Social Responsbility, tells IPS there is a lack transparency and data on the Hanford cleanup. “It is a huge problem,” he says, adding that contaminated groundwater at Hanford still interacts with the Columbia River, based on water levels.

Though eight of the nine nuclear reactors next to the river were decommissioned, the 1,175-megawatt Energy Northwest Energy power plant is still functioning

“Many people don’t know there is a live nuclear reactor on the Columbia. It’s the same style as Fukushima,” Gilbert explains.

In the middle of the fight are the tribes, which are sovereign nations. Russell Jim says they are often erroneously described as “stakeholders” when they are separate governments.

“We were the only tribe to take on the nuclear issue and testify at the 1980 Senate subcommittee. In 1982 we immediately filed for affected tribe status. The Umatilla and the Nez Perce tribes later joined.”

Yucca Mountain was earmarked by congress as a nuclear storage repository for Hanford and other sites’ waste but the plan was struck down by the president. Southern Paiute and Western Shoshone in the region filed for affected status.

The Waste Isolation Pilot Plant (WIPP) in New Mexico was slated to take waste from Hanford but after a fire in February, the site is taking no more waste. The Bulletin of Atomic Scientists has expressed concern about the lack of storage options.

The U.S. has the largest stockpile of spent nuclear fuel globally – five times that of Russia.

“The best material to store waste in is granite and the northeast U.S. has a lot of granite. An ideal site was just 30 miles from the capital, but that is out,” says Russell Jim with a wry smile, considering its proximity to the White House.

He does not plan to give up. “We are the only people here who can’t pick up and move on.”

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“Sanitation for All” a Rapidly Receding Goal http://www.ipsnews.net/2014/04/sanitation-rapidly-receding-goal/?utm_source=rss&utm_medium=rss&utm_campaign=sanitation-rapidly-receding-goal http://www.ipsnews.net/2014/04/sanitation-rapidly-receding-goal/#comments Sat, 12 Apr 2014 00:10:32 +0000 Michelle Tullo http://www.ipsnews.net/?p=133616 World leaders on Friday discussed plans to expand sustainable access for water, sanitation and hygiene, focusing in particular on how to reach those in remote rural areas and slums where development projects have been slow to penetrate. The meeting, which took place amidst the semi-annual gatherings here of the World Bank and International Monetary Fund (IMF) could […]

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An open drainage ditch in Ankorondrano-Andranomahery. Madagascar receives just 0.5 dollars per person per year for WASH programmes . Credit: Lova Rabary-Rakontondravony/IPS

An open drainage ditch in Ankorondrano-Andranomahery. Madagascar receives just 0.5 dollars per person per year for WASH programmes . Credit: Lova Rabary-Rakontondravony/IPS

By Michelle Tullo
WASHINGTON, Apr 12 2014 (IPS)

World leaders on Friday discussed plans to expand sustainable access for water, sanitation and hygiene, focusing in particular on how to reach those in remote rural areas and slums where development projects have been slow to penetrate.

The meeting, which took place amidst the semi-annual gatherings here of the World Bank and International Monetary Fund (IMF) could be the world’s largest ever to take place on the issue."Ministers are much happier to talk and support a hydro project, like a huge dam, and are less happy to open up a public latrine." -- Darren Saywell

Water, sanitation and hygiene, collectively known as WASH, constitute a key development metric, yet sanitation in particular has seen some of the poorest improvements in recent years.

Participants at Friday’s summit included U.N. Secretary-General Ban Ki-moon, World Bank President Jim Yong Kim, UNICEF Executive Director Anthony Lake as well as dozens of government ministers and civil society leaders.

“Today 2.5 billion people do not have access to clean water, sanitation and hygiene,” the World Bank’s Kim said Friday. “This results in 400 million missed school days, and girls and women are more likely to drop out because they lack toilets in schools or are at risk of assault.”

Kim said that this worldwide lack of access results in some 260 billion dollars in annual economic losses – costs that are significant on a country-to-country basis.

In Niger, Kim said, these losses account for around 2.5 percent of gross domestic product (GDP) every year. In India the figure is even higher – around 6.4 percent of GDP.

Friday’s summit was convened by UNICEF.

“UNICEF’s mandate is to protect the rights of children and make sure they achieve their full potential. WASH is critical to what we hope for children to achieve, as well as to their health,” Sanjay Wijesekera, associate director of programmes for UNICEF, told IPS.

“Every day, 1400 children die from diarrhoea due to poor WASH. In addition, 165 million children suffer from stunted growth, and WASH is a contributory factor because clean water is needed to absorb nutrients properly.”

Over 40 countries came to the meeting to share their commitments to improving WASH.

“Many countries have already shown that progress can be made,” Wijesekera said. “Ethiopia, for example, halved those without access to water from 92 percent in 1990 to 36 percent in 2012, and equitably across the country.”

A water kiosk in Blantyre, Malawi. Credit: Charles Mpaka/IPS

A water kiosk in Blantyre, Malawi. Credit: Charles Mpaka/IPS

Good investment

Indeed, the Millennium Development Goal (MDG) for water halved the proportion of people without access to improved sources of water five years ahead of schedule. Yet the goal to improve access to quality sanitation facilities was one of the worst performing MDGs.

In order to get sanitation on track, a global partnership was created called Sanitation and Water for All (SWA), made up of over 90 developing country governments, donors, civil society organisations and other development partners.

“Sanitation as a subject is a complicated process … You have different providers and actors involved at the delivery of the service,” Darren Saywell, the SWA vice-chair, told IPS.

“NGOs are good with convening communities and community action plans. The private sector is needed to respond and provide supply of goods when demand is created. Government needs to help regulate and move the different leaders in the creation of markets.”

In addition, sanitation and hygiene are not topics that can gain easy political traction.

“It is not seen as something to garner much political support,” Saywell says. “Ministers are much happier to talk and support a hydro project, like a huge dam, and are less happy to open up a public latrine.”

Saywell says that an important part of SWA’s work is to demonstrate that investing in WASH is a good economic return.

“Every dollar invested in sanitation brings a return of roughly five dollars,” he says. “That’s sexy!”

Sustainable investments

Friday’s summit covered three main issues: discussing the WASH agenda for post-2015 (when the current MDGs expire), tackling inequality in WASH, and determining how these actions will be sustainable.

“We would like the sector to the set the course for achieving universal access by 2030,” Henry Northover, the global head of policy at WaterAid, a key NGO participant, told IPS.

Although the meeting did not set the post-2015 global development goals for WASH, it was meant to call public attention to the importance of these related goals and ways of achieving them.

“Donors and developing country governments need to stop seeing sanitation as an outcome of development, but rather as an indispensable driver of poverty reduction,” Northover said.

WaterAid recently published a report on inequality in WASH access, Bridging the Divide. The study looks at the imbalances in aid targeting and notes that, for instance, Jordan receives 850 dollars per person per year for WASH while Madagascar, which has considerably worse conditions, receives just 0.5 dollars per person per year.

The report says this imbalance in aid targeting is due to “geographical or strategic interests, historical links with former colonies, and domestic policy reasons”. Northover added to this list, noting that “donors are reluctant to invest in fragile states.”

“In India, despite spectacular levels of growth over the past 10 years, we have seen barely any progress in the poorest areas in terms of gaining access to sanitation,” he continued. “Regarding inequality, we are talking both in terms of wealth and gender: the task falls to women and girls to fetch water, they cannot publicly defecate, and have security risks.”

Others see funding allocation as only an initial step.

“Shift the money to the poorer countries, and then, so what?” John Sauer, of the non-profit Water for People, asked IPS. “The challenge is then the capacity to spend that money and absorb it into district governments, the ones with the legal purview to make sure the water and sanitation issues get addressed.”

Friday’s meeting also shared plans on how to use existing resources better, once investments are made.

“If there is one water pump, it will break down pretty quickly,” WaterAid’s Northover said. “This often requires some level of institutional capability for financial management.”

Countries also described their commitments to make sanitation sustainable. The Dutch government, for instance, introduced a clause in some of its WASH agreements that any related foreign assistance must function for at least a decade. East Asian countries like Vietnam and Mongolia are creating investment packages that also help to rehabilitate and maintain existing WASH systems.

“This is probably one of the biggest meetings on WASH possibly ever, and what we mustn’t forget is that the 40 or 50 countries coming are making a commitment to do very tangible things that are measurable, UNICEF’s Wijesekera told IPS. “That bodes well for achieving longer-term goals of achieving universal access and equality.”

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When Medicines Don’t Work Anymore http://www.ipsnews.net/2014/04/medicines-dont-work-anymore/?utm_source=rss&utm_medium=rss&utm_campaign=medicines-dont-work-anymore http://www.ipsnews.net/2014/04/medicines-dont-work-anymore/#comments Thu, 10 Apr 2014 12:01:49 +0000 Martin Khor http://www.ipsnews.net/?p=133564 In this column, Martin Khor, executive director of the South Centre, warns that humanity is looking at a future in which antibiotics will no longer work, unless an effective global action plan is launched to address the crisis.

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In this column, Martin Khor, executive director of the South Centre, warns that humanity is looking at a future in which antibiotics will no longer work, unless an effective global action plan is launched to address the crisis.

By Martin Khor
GENEVA, Apr 10 2014 (IPS)

The growing crisis of antibiotic resistance is catching the attention of policy-makers, but not at a fast enough rate to tackle it. More diseases are affected by resistance, meaning the bacteria cannot be killed even if different drugs are used on some patients, who then succumb.

We are staring at a future in which antibiotics don’t work, and many of us or our children will not be saved from TB, cholera, deadly forms of dysentery, and germs contracted during surgery.

Martin Khor

Martin Khor

The World Health Organisation (WHO) will discuss, at its annual assembly of health ministers in May, a resolution on microbial resistance, including a global action plan. There have been such resolutions before but little action.

This year may be different, because powerful countries like the United Kingdom are now convinced that years of inaction have cause the problem to fester, until it has grown to mind-boggling proportions.

The UK-based Chatham House (together with the Geneva Graduate Institute) held two meetings on the issue, in October and last month, both presided over by the Chief Medical Officer for England, Dame Sally Davies.

This remarkable woman has taken on antibiotic resistance as a professional and personal campaign. In a recent book, “The Drugs Don’t Work”, she revealed that for her annual health report in 2012, she had decided to focus on infectious diseases.

“I am not easily rattled, but what I learnt scared me, not just as a doctor, but as a mother, a wife and a friend. Our findings were simple: We are losing the battle against infectious diseases. Bacteria are fighting back and are becoming resistant to modern medicine. In short, the drugs don’t work.”

Davies told the meetings that antibiotics add on average 20 years to our lives and that for over 70 years they have enabled us to survive life-threatening infections and operations.

“The truth is, we have been abusing them as patients, as doctors, as travellers, and in our food,” she says in her book.

“No new class of antibacterial has been discovered for 26 years and the bugs are fighting back. In a few decades, we may start dying from the most commonplace of operations and ailments that can today be treated easily.”

At the two Chatham House meetings, which I attended, different aspects of the crisis and possible actions were discussed. In one of the sessions, I made a summary of the actions needed, including:

- More scientific research on how resistance is caused and spread, including the emergence of antibiotic-resistance genes as in the NDM-1 enzyme, whose speciality is to accelerate and spread resistance within and among bacteria.

- Surveys in every country to determine the prevalence of resistance to antibiotics in bacteria causing various diseases.

- Health guidelines and regulations in every country to guide doctors on when (and when not) to prescribe antibiotics, and on instructing patients how to properly use them.

- Regulations for drug companies on ethical marketing of their medicines, and on avoiding sales promotion to doctors or the public, that leads to over-use.

- Educating the public on using antibiotics properly, including when they should not be used.

- A ban on the use of antibiotics in animals and animal feed for the purpose of inducing growth of the animals (for commercial profit), and restrictions on the use in animals to the treatment of ailments.

- Promoting the development of new antibiotics and in ways (including financing) that do not make the new drugs the exclusive property of drug companies.

- Ensuring that ordinary and poor people in developing countries also have access to the new medicines, which would otherwise be very expensive, and thus only the very rich can afford to use them.

On the first point, a new and alarming development has been the discovery of a gene, known as NDM-1, that has the ability to alter bacteria and make them highly resistant to all known drugs.

In 2010, only two types of bacteria were found to be hosting the NDM-1 gene – E Coli and Klebsiella pneumonia.

It was found that the gene can easily jump from one type of bacteria to another. In May 2011, scientists from Cardiff University who had first reported on NDM-1′s existence found that the NDM-1 gene has been jumping among various species of bacteria at a “superfast speed” and that it “has a special quality to jump between species without much of a problem”.

While the gene was found only in E Coli when it was initially detected in 2006, now the scientists had found NDM-1 in more than 20 different species of bacteria. NDM-1 can move at an unprecedented speed, making more and more species of bacteria drug-resistant.

Also in May 2011, there was an outbreak of a deadly disease caused by a new strain of the E Coli bacteria that killed more than 20 people and affected another 2,000 in Germany.

Although the “normal” E Coli usually produces mild sickness in the stomach, the new strain of E Coli 0104 causes bloody diarrhoea and severe stomach cramps, and in more serious cases damages blood cells and the kidneys. A major problem is that the bacterium is resistant to antibiotics.

Tuberculosis is a disease making a comeback. In 2011, the WHO found there were half a million new cases of TB in the world that were multi-drug resistant (known as MDR-TB), meaning that they could not be treated using most medicines.

And about nine percent of multi-drug resistant TB cases also have resistance to two other classes of drugs and are known as extensively drug-resistant TB (XDR-TB). Patients having XDR-TB cannot be treated successfully.

Research has also found that in Southeast Asia, strains of malaria are also becoming resistant to treatment.

In 2012, WHO Director General Margaret Chan warned that every antibiotic ever developed was at risk of becoming useless.

“A post-antibiotic era means in effect an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.”

The World Health Assembly in May is an opportunity not to be missed, to finally launch a global action plan to address this crisis.
(END/COPYRIGHT IPS)

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In Peru, Low-Income Cancer Patients Find Fresh Hope http://www.ipsnews.net/2014/04/peru-low-income-cancer-patients-find-fresh-hope/?utm_source=rss&utm_medium=rss&utm_campaign=peru-low-income-cancer-patients-find-fresh-hope http://www.ipsnews.net/2014/04/peru-low-income-cancer-patients-find-fresh-hope/#comments Thu, 10 Apr 2014 10:24:18 +0000 Milagros Salazar http://www.ipsnews.net/?p=133475 This story is the last installment of a three-part series on how social and economic inequalities impact cancer treatment.

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Claudia Alvarado, with her parents and her nail polish, who along with Peru’s Plan Esperanza have helped her to bravely face the treatment for leukaemia. Credit: Milagros Salazar/IPS

Claudia Alvarado, with her parents and her nail polish, who along with Peru’s Plan Esperanza have helped her to bravely face the treatment for leukaemia. Credit: Milagros Salazar/IPS

By Milagros Salazar
LIMA, Apr 10 2014 (IPS)

Her tiny fingers and toes have been painted with different shades of nail polish, the bright colours contrasting sharply with the bleak road she has been on for half her young life.

Since she was three years old, Claudia, who has not yet turned seven, has been fighting leukaemia, with the help of a public health cancer treatment programme in Peru: Plan Esperanza or Plan Hope."When you are diagnosed with breast cancer, you immediately think your life is over. But if you find out there is a programme that can help you, you carry on and fight." -- Susana Wong

As in the rest of the Americas, cancer is the second cause of death here, following cardiovascular disease. In this country of 30.5 million people, the annual death toll from cancer is 107 per 100,000 population, and each year 45,000 new cases are diagnosed, according to the Health Ministry.

The ministry estimates that 157 people per 100,000 population suffer from cancer in this South American country.

To bring down these statistics and the high costs of cancer treatment, the Peruvian government launched Plan Esperanza in November 2012. The programme is aimed at improving comprehensive treatment for cancer patients and providing guaranteed oncology services, especially for the poor.

Claudia Alvarado was diagnosed with leukaemia in June 2010. Since then, she has undergone constant lab tests and often painful treatments.

Attending school and having friends have been replaced by long, exhausting trips between hospitals in Lima, the capital, and La Libertad, the northern department where she used to live.

Her hometown is Santa Rosa, a community of rice farmers. Her mother, Ivon Sánchez, told IPS that the one-hour bus ride to the public hospital in the city of Chepén took them through “three ghost towns.”

From Chepén, Claudia was referred to a public hospital in Chiclayo, the capital of another northern department, Lambayeque. And from there she was sent to the National Institute of Neoplastic Disease (INEN) in Lima, another public health institution.

At the institute, she underwent an aggressive treatment programme, which was fully covered by the Intangible Solidarity Fund for Health (FISSAL), which finances care in cases of high-cost health problems like cancer for those affiliated with the national Seguro Integral de Salud (SIS – Comprehensive Health Insurance).

The SIS also provides free healthcare for people in the fourth or fifth income quintiles, such as Claudia’s family.

In January 2012, Claudia suffered a relapse. Her mother remembers that she broke down in grief and anger because she knew the term “relapse” might be a euphemism for a journey with no return.

The only option was a bone marrow transplant. But the tests showed that Claudia’s brother, 12-year-old Renzo, was not compatible as a donor. “We thought it was all over,” Claudia’s mother said.

But in November 2012, the government launched Plan Esperanza, and that year the SIS and FISSAL signed international agreements with two hospitals in the United States to perform bone marrow transplants on children who had not responded well to chemotherapy or who had suffered relapses.

Claudia received the transplant on Sep. 6, 2013 in the Miami Children’s Hospital in the U.S.

The operation took eight hours, followed by 28 days of fever as high as 40 degrees C.

She pulled through and flew back to Lima with her mother in December. Since then she has continued to fight her illness, in the house the family has rented in a poor district in the south of Lima, where IPS visited her.

Her family moved to the capital in order to be together, and her father, Fortunato Alvarado, left his job as a farm labourer and now works as a taxi driver.

As Claudia waits for the 200 critical post-operation days to pass, she has to rest and avoid active play, while staying away from other children to keep from getting sick. Her skinny body weighs just 18 kilos.

She is disciplined about taking her medicine, and eats lemon drops after swallowing the most bitter-tasting pills.

Up to late 2013, Plan Esperanza, whose services are completely free of charge, had benefited 57,531 people, with a total public spending of over 6.4 million dollars. The Plan also includes nationwide campaigns for cancer prevention and diagnosis.

So far 600,000 people have participated in mass screenings for early cancer detection, and three million people nationwide have received counselling and advice, oncologist Diego Venegas, the coordinator of Plan Esperanza, told IPS.

“The important thing is to provide patients with complete treatment, in order to save their lives,” he said.

Of those diagnosed, 75 percent had advanced stage cancer, so the plan began to include home treatments.

Venegas explained that treatment under the Plan is initially reserved for the nearly 13 million affiliates of the SIS.

The most common forms of cancer covered by FISSAL funds are cancer of the cervix, breast, colon, stomach, prostate, leukaemia and lymphoma.

Forms of cancer that are not included in the Plan are still treated free of charge for SIS affiliates.

Treatment in each case costs an average of 260,000 dollars.

In the case of Claudia, the costs of the transplant in Miami, the plane tickets for the patient and her mother, and the six-month stay in the U.S. amounted to more than 300,000 dollars. Added to that are the costs of the chemotherapy and medicines she received in Peru before and after the transplant.

Susana Wong, president of the Club de la Mama (Breast Club) at the National Institute of Neoplastic Diseases, has seen hundreds of breast cancer patients who have benefited from Plan Esperanza.

“People now have a chance to live, because treatment is very expensive. When you are diagnosed with breast cancer, you immediately think your life is over. But if you find out there is a programme that can help you, you carry on and fight,” Wong, who was diagnosed with breast cancer in 2006, told IPS.

Dr. Miguel Garavito, the head of FISSAL, said the state funding is compensated by the large number of patients – mainly from poor families – and the success of the transplants.

“Peru is one of the few countries in the world that have this kind of free coverage for cancer treatment,” he told IPS.

A more precise register of cancer cases is being drawn up, because currently statistics are only available from the three largest cities: Lima, Arequipa and Trujillo.

Venegas said more staff is needed, as well as training in advances made in cancer treatment, and greater decentralisation so that treatment reaches patients in more remote regions.

A multisectoral commission is being set up to fight cancer on all fronts, including better access to clean water and sanitation.

The link between poor sanitation and cancer is exemplified by the central department of Huánuco, where 70 percent of the people lack potable piped water. Deaths from gastric cancer total 150 per 100,000 population, significantly higher than the national average.

This type of cancer, according to Venegas, is associated with drinking water quality.

As a public health problem, cancer merits a strong response from the state – at least as strong as Claudia has proven herself to be, after spending over half of her life fighting leukaemia, and cheering herself up with her favourite colours of nail polish.

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Jordan Faces Looming and Complex Cancer Burden http://www.ipsnews.net/2014/04/jordan-faces-looming-complex-cancer-burden/?utm_source=rss&utm_medium=rss&utm_campaign=jordan-faces-looming-complex-cancer-burden http://www.ipsnews.net/2014/04/jordan-faces-looming-complex-cancer-burden/#comments Thu, 10 Apr 2014 10:23:48 +0000 Elizabeth Whitman http://www.ipsnews.net/?p=133472 This story is part two of a three-part series on how social and economic inequalities impact cancer treatment. The third installment examines how Peru's Plan Esperanza is providing comprehensive treatment for cancer patients, especially the poor.

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The King Hussein Cancer Centre, Jordan's premier cancer treatment facility located in Amman, is being expanded to double its capacity as national and regional cancer rates continue to rise. Credit: Elizabeth Whitman/IPS

The King Hussein Cancer Centre, Jordan's premier cancer treatment facility located in Amman, is being expanded to double its capacity as national and regional cancer rates continue to rise. Credit: Elizabeth Whitman/IPS

By Elizabeth Whitman
AMMAN, Apr 10 2014 (IPS)

The concrete skeleton of a twin 13-storey complex towers over surrounding buildings on one of Amman’s busiest streets. The ongoing expansion of the King Hussein Cancer Centre symbolises progress as much as it portends a crisis.

After its completion, expected in 2015, the new buildings will more than double the KHCC‘s current capacity, increasing space for new cancer cases from 3,500 per year to 9,000. Yet even this 186-million-dollar project may be insufficient to shoulder Jordan’s growing cancer burden."We don't have a single medical oncologist or radio oncologist in the south." -- Dr. Jamal Khader

In Jordan, cancer is the leading cause of death after heart disease. Over 5,000 Jordanians annually are diagnosed with cancer, a figure projected to reach 7,281 by 2020, statistics that reflect global trends.

Cancer was once viewed as a first-world scourge. But in 2008, 56 percent of new cancer cases were in the developing world. And by 2030, the proportion will have climbed to 70 percent.

If Jordan fails to actively prepare for a continuing wave of cancer cases, “we won’t be able to cope with the increased number of patients and the increased cost of treatment,” leading to “less treatment and more mortalities,” Dr. Sami Khatib, a clinical oncologist who is president of the Arab Medical Association Against Cancer and former president of the Jordan Oncology Society, told IPS.

Jordan is fortunate to have the KHCC, a non-governmental organisation run by the King Hussein Cancer Foundation that is the country’s only comprehensive cancer treatment centre and the only cancer treatment facility in the Arab world to receive Joint Commission accreditation.

The KHCC has been a pioneer in cancer treatment in Jordan, transforming the process from disjointed visits with various specialists to comprehensive care with a treatment protocol.

But it is merely one centre. About 60 percent of Jordan’s cancer cases are in Amman, according to the latest national statistics in cancer incidence, which are from 2010. Yet according to Khatib, around 80 percent of cancer treatment facilities in Jordan are in Amman.

For the half of Jordan’s population residing in Amman or its outskirts, this location is ideal. For residents of remote areas, reaching these facilities can be a major problem.

“Inequality of access is the major obstacle” in providing cancer treatment in a country where “the whole spectrum of cancer treatment is available,” concluded Dr. Omar Nimri, director of the Jordanian Cancer Registry at the Ministry of Health, in the 2014 World Cancer Report.

An island of care

Sitting on a plain bench in a waiting room at the KHCC one morning were Nisreen Harabi and Sana’ Iskafee, two wives of the same husband. Harabi rocked back and forth as if to distract herself from pain while Iskafee spoke.

To reach Amman from their home in the village of Luban one hour away, Iskafee said, the women had to take one or two affordable public buses or spend 15 dinars (21 dollars) on a taxi ride.

Nisreen has cancer in her lymph nodes, according to Sana’, and must go to the KHCC four times a week for radiation therapy.

“We started coming two months ago,” Sana said. “The hardest part for us is the transportation. We live so far away.”

That morning, they had left their home at 6:30 am for a noon appointment, as a variety of factors can often cause delays on public transportation in Jordan.

“The distribution [of cancer treatment facilities] is not fair, as a whole, for Jordan,” Dr. Jamal Khader, a radiation oncologist at the KHCC and president of the Jordan Oncology Society, told IPS.

Like Nisreen, about 60 percent of cancer patients will at some point go through radiology treatment, he pointed out. But they have to be in Amman daily for a 10 to 15-minute session, making for a lot of extra suffering for those living outside the capital.

“We don’t have a single medical oncologist or radio oncologist in the south” or other remote areas, Khader added. “The ideal scenario for a cancer patient is to be treated in a comprehensive centre,” of which the KHCC is the only one. And specialised doctors and technology are primarily available in Amman.

Although all patients across Jordan receive “almost” the same quality treatment, no matter the health care facility they visit, Nimri told IPS in an interview, poorer patients or those who live far from Amman face extra difficulties.

“They have to rent a place, or stay in a hotel, or stay with relatives if they have any,” he said.

In that sense, Harabi is lucky to live one hour away.

 

Travel and accommodations require time and money, the latter of which is in especially short supply in a country where average annual per capita income is 5,980 dollars. Although societies and charities may help to cover costs, the system that remains in place is a centralised one that does not cater to impoverished patients living far from the capital.

“We need to build facilities…in the north and in the south of Jordan to better cover all the population,” Khatib said. He said the government had “a plan to start building facilities for the treatment of cancer in the different governorates of Jordan” and that “maybe they will start implementing it… soon.”

The situation is changing, albeit gradually. King Abdullah University Hospital in the northern city of Irbid has plans to get radio therapy machines, so that cancer patients residing in northern Jordan would not have to go to Amman for radiation therapy.

A national control plan for cancer is currently being developed as well, with the goal of outlining guidelines for prevention, diagnosis, treatment, and beyond. Khader, the KHCC oncologist, hoped the plan would be finalised within a year and that it could help identify “what facilities are missing here and there.”

Cancer treatment is divided into several sectors, besides the KHCC. Members of the military and security services, and their families, are treated at military facilities; private hospitals are available for those who can afford them; and those who do not qualify or cannot afford to go elsewhere have public facilities run by the Ministry of Health.

Yet their capacity does not match that of the KHCC, with “variable cancer care across facilities,” a 2011 report by the Harvard Global Equity Initiative noted. Of 29 public hospitals, only one offers chemotherapy, it said.

Furthermore, a difference in quality in treatment does exist between public and private facilities, Khatib allowed. As is generally true in most countries, “I think it’s much better in the NGO and private sectors than in the public sector,” he said.

Most cancer patients have their treatment covered by the Ministry of Health or the royal court, Khader noted, since by law, every Jordanian can apply for free treatment. While this policy eases individual suffering, for the government, it will become a financial “crisis to cope with all the commitments,” he added.

Nimri calculated roughly that with 25,000 – 30,000 cancer patients and the average cost of cancer treatment at 20,000 dollars per patient per year, Jordan is spending annually at least half a billion dollars on cancer treatment.

A multi-factor disease

Forty-eight percent of men over the age of 15 in Jordan smoked cigarettes (compared to 5.7 percent of women), according to WHO statistics from 2009, while 63.3 and 70.4 percent of men and women, respectively, had a body mass index (BMI) over 25, or in other words were overweight.

Tobacco is the biggest risk factor for cancer, and the WHO estimates that its use causes 22 percent of cancer deaths and 71 percent of lung cancer deaths globally.

Another 30 percent of cancer deaths are due to behavioural and dietary risks overall, such as having a high body mass index, poor diet, or lack of exercise.

“Our population is growing and aging… without having embraced healthy lifestyles that may help prevent many non-communicable diseases such as cancer,” wrote Dr. Abdallatif Woriekat, then minister of health, in Jordan’s 2010 national report on cancer incidence.

“The unhealthy diet and potentially lethal habit of tobacco use in particular, unfortunately, remains highly common and acceptable among Jordanians, and will undoubtedly leave a large unwanted print with its strong contribution to the increasing incidence of cancer,” he concluded.

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Malignant Growth: Battling a New Cancer Pandemic http://www.ipsnews.net/2014/04/malignant-growth-battling-new-cancer-pandemic/?utm_source=rss&utm_medium=rss&utm_campaign=malignant-growth-battling-new-cancer-pandemic http://www.ipsnews.net/2014/04/malignant-growth-battling-new-cancer-pandemic/#comments Wed, 09 Apr 2014 22:25:29 +0000 Kanya DAlmeida http://www.ipsnews.net/?p=133469 This story is part one of a three-part series on how social and economic inequalities impact cancer treatment. The second and third installments will take a closer look at how low- and middle-income countries in the Middle East and Latin America are coping with their cancer burdens and employing multiple strategies to stem the epidemic.

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A patient being treated at the Regional Cancer Centre in Thiruvananthapuram, India. Credit: K.S. Harikrishnan/IPS

A patient being treated at the Regional Cancer Centre in Thiruvananthapuram, India. Credit: K.S. Harikrishnan/IPS

By Kanya D'Almeida
UNITED NATIONS, Apr 9 2014 (IPS)

Few people in the world can claim to be untouched by cancer. If not personally battling it in one form or another, millions are at this very moment sitting beside loved ones fighting for their lives, visiting friends recovering from chemo, or researching the latest treatments for their relatives.

The forecast by the world’s leading cancer research organisation predicts that things will only get worse. The World Cancer Report 2014 says we can expect a 70 percent increase in new cancer cases over the next 20 years, hitting 25 million by the year 2025.

Produced every five years by the International Agency for Research on Cancer (IARC), a specialised agency of the Geneva-based World Health Organisation (WHO), the 632-page report noted that new cancer cases rose from 12.7 million in 2008 to 14.1 million in 2012. The same year recorded 8.2 million cancer-related deaths globally.

A Barrier to Development

Lung cancer tops the list of the most frequently diagnosed forms of the disease, with 1.8 million cases or roughly 13 percent of the world’s total cancer burden.

Breast cancer follows a close second, with about 1.7 million cases, while cancers of the large bowel account for 9.7 percent of all cases reported worldwide.

Lung cancer remains the biggest killer, claiming 1.6 million lives annually, while cancers of the liver and stomach are responsible for 800,000 and 700,000 deaths respectively.

The massive loss of life is coupled with astronomical healthcare costs – about 1.6 trillion dollars in 2010.

Increasingly, the disease is gaining a foothold in low- and middle-income countries that have neither the experience nor the financial resources to deal with it.

A full 60 percent of cancer cases now occur in Asia, Africa and Central and South America, the same regions that account for 70 percent of cancer-related deaths.

Gauging the ‘Cancer Divide’

Experts from around the world say that, when it comes to cancer, developing countries are caught between the devil and the deep blue sea.

On the one hand, they continue to experience high rates of infection-related cancers like cervical, stomach and liver cancer, all of which are associated with poverty: lack of access to vaccines, an absence of screening facilities, and inadequate treatment options.

On the other hand, cancer associated with a wealthier lifestyle – such as cancers of the lung, breast and large bowel, which are linked to increased consumption of alcohol, tobacco and processed foods – are also on the rise in the ranks of these countries’ burgeoning middle classes.

For instance, the American Cancer Society reported just a few months ago that Africa is witnessing an “alarming rise” in tobacco use, with the number of adult smokers expected to skyrocket “from 77 million to 572 million by 2100 if new policies are not implemented and enforced.”

Evan Blecher, director of the international tobacco control research programme at the American Cancer Society and author of the report ‘Tobacco Use in Africa’, attributes the rise to multiple factors, economic growth being a primary one.

“African economies are growing faster and more consistently now than any time in the last 50 years,” Blecher told IPS from his native Cape Town. “Economic growth and development increases tobacco use because of higher disposable incomes.

“Some of the countries where we have seen the biggest increases include Angola, the Democratic Republic of the Congo, Ethiopia, Madagascar, Mozambique, Senegal, and Nigeria – these countries are amongst the most rapidly growing countries in Africa and the world,” he added.

This ‘double burden’ – of cancers associated with both growth and poverty – threatens to cripple healthcare systems already stretched too thin.

The International Atomic Energy Agency found that low- and middle-income countries account for 85 percent of the world’s population but possess just 4,400 megavoltage machines, less than 35 percent of global radiotherapy capacity.

Keeping in mind that roughly 50 to 65 percent of all cancer patients eventually require some type of radiotherapy, the huge dearth spells bad news for developing countries. According to the IAEA, some 23 countries – most of them in Africa – with populations of over one million people do not have a single radiotherapy machine.

Assessing inequality

R. Sankaranarayanan, special advisor on cancer control at the IARC, told IPS that the cancer divide does not only separate nations at various levels of development, but also affects different populations within countries.

“The wide disparities in survival outcomes from breast and large bowel cancer between rural and urban areas in countries such as China, India, Thailand, etc. and… breast cancer survival disparities between the black and white populations in the United States… are good examples,” he said.

The latter has been widely reported in the U.S., with researchers and medical professionals lamenting the 8.8 percent gap between breast cancer-related mortality rates for black and white women.

Data released last month by the American Cancer Society suggests that poverty fuels disparities in cancer diagnoses and mortality rates.

Given that obesity is a huge problem in African American communities, affecting roughly 50 percent of all adults compared to 35 percent of white adults, it is unsurprising that African Americans experience a higher incidence of colorectal cancer, which is associated with overconsumption of unhealthy, processed foods.

In India, where over a million new cancer cases were reported in 2012 and nearly a million people died from some form of the disease, a huge diversity of lifestyles seems to account for the gaping cancer divide.

For instance, the highest incidence of cancer was recorded in the northeastern state of Mizoram, one of the fastest growing economies in India, while the lowest incidence was reported in Barshi, a rural registry in the western state of Maharashtra, where much of the population is engaged in agricultural activity.

Silvana Luciani, advisor on cancer prevention and control in the department of non-communicable diseases and mental health at the Pan American Health Organisation (PAHO), says interregional disparities in health services also result in lopsided mortality rates.

“In Central America you see cervical cancer mortality rates of about 15 or 18 per 100,000 whereas in North America the cervical cancer mortality rate will be around two, which is significantly lower,” she told IPS.

“This has a lot to do with better pap smear screening programmes in North America that have been in existence for a long time and are of a much higher quality than in Central America, where healthcare systems are much more fragmented,” she said.

Sankaranarayanan says countries such as South Korea, Turkey, Malaysia, India, Ghana, Morocco, Brazil, Chile, Colombia, Costa Rica and Mexico are “increasingly introducing universal health care coverage or national insurance schemes that target the most socio-economically downtrodden populations… although the rapidly ageing populations and continued introduction of high cost technologies for cancer care are increasing pressures on these systems.”

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Indigenous Leaders Targeted in Battle to Protect Forests http://www.ipsnews.net/2014/04/indigenous-leaders-targeted-battle-protect-forests/?utm_source=rss&utm_medium=rss&utm_campaign=indigenous-leaders-targeted-battle-protect-forests http://www.ipsnews.net/2014/04/indigenous-leaders-targeted-battle-protect-forests/#comments Wed, 09 Apr 2014 17:45:22 +0000 Michelle Tullo http://www.ipsnews.net/?p=133548 Indigenous leaders are warning of increased violence in the fight to save their dwindling forests and ecosystems from extractive companies. Indigenous representatives and environmental activists from Africa, Asia, Australia and the Americas met over the weekend here to commemorate those leading community fights against extractive industries. The conference, called Chico Vive, honoured Chico Mendes, a […]

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The open wounds of the Amazon. Credit:Rolly Valdivia/IPS

The open wounds of the Amazon. Credit:Rolly Valdivia/IPS

By Michelle Tullo
WASHINGTON, Apr 9 2014 (IPS)

Indigenous leaders are warning of increased violence in the fight to save their dwindling forests and ecosystems from extractive companies.

Indigenous representatives and environmental activists from Africa, Asia, Australia and the Americas met over the weekend here to commemorate those leading community fights against extractive industries. The conference, called Chico Vive, honoured Chico Mendes, a Brazilian rubber-tapper killed in 1988 for fighting to save the Amazon.“Right now in our territory we can’t drink the water because it’s so contaminated from the hydrocarbons from the oil and gas industry." -- Chief Liz Logan of the Fort Nelson First Nation in BC, Canada

The gathering also recognised leaders who are continuing that legacy today.

“His struggle, to which he gave his life, did not end with his death – on the contrary,” John Knox, the United Nations independent expert on human rights and the environment, said at the conference. “But it continues to claim the lives of others who fight for human rights and environmental protection.”

A 2012 report by Global Witness, a watchdog and activist group, estimates that over 711 people – activists, journalists and community members – had been killed defending their land-based rights over the previous decade.

Those gathered at this weekend’s conference discussed not only those have been killed, injured or jailed. They also shared some success stories.

“In 2002, there was an Argentinean oil company trying to drill in our area. Some of our people opposed this, and they were thrown in jail,” Franco Viteri, president of the Confederation of Indigenous Nationalities of the Ecuadorian Amazon, told IPS.

“However, we fought their imprisonment and the Inter-American Court of Human Rights ruled in our favour. Thus, our town was able to reclaim the land and keep the oil company out.”

Motivated by oil exploration-related devastation in the north, Ecuadorian communities in the south are continuing to fight to defend their territory. Viteri says some communities have now been successful in doing so for a quarter-century.

But he cautions that this fight is not over, particularly as the Ecuadorian government flip-flops on its own policy stance.

“The discourse of [President Rafael] Correa is very environmentalist, but in a practical way it is totally false,” he says. “The government is taking the oil because they receive money from China, which needs oil.”

China has significantly increased its focus on Latin America in recent years. According to a briefing paper by Amazon Watch, a nonprofit that works to protect the rainforest and rights of its indigenous inhabitants, “in 2013 China bought nearly 90% of Ecuador’s oil and provided an estimated 61% of its external financing.”

The little dance

Many others at the conference had likewise already seen negative impacts due to extractives exploration and development in their community.

“We have oil and gas, mines, we have forestry, we have agriculture, and we have hydroelectric dams,” Chief Liz Logan of the Fort Nelson First Nation in British Columbia, Canada, told IPS.

“Right now in our territory we can’t drink the water because it’s so contaminated from the hydrocarbons from the oil and gas industry … The rates of cancer in our community are skyrocketing and we wonder why. But no one wants to look at this, because it might mean that what [extractives companies] are doing is affecting us and the animals.”

Logan described the work of protecting the community as a “little dance”: first they bring the government to court when they do not implement previous agreements, then they have to ensure that the government actually implements what the court orders.

Others discussed possible solutions to stop the destruction of ecosystems, and what is at stake for the communities living in them. The link between local land conflicts and global climate change consistently reappeared throughout many of the discussions.

“My community is made up of small-scale farmers and pastoralists who depend on cattle to live. For them, a cow is everything and to have the land to graze is everything,” said Godfrey Massay, an activist leader from the Land Rights Institute in Tanzania.

“These people are constantly threatened by large-scale investors who try to take away their land. But they are far more threatened by climate change, which is also affecting their livelihood.”

Andrew Miller of Amazon Watch described the case of the contentious Belo Monte dam in Brazil, which is currently under construction. Local communities oppose the dam because those upstream would be flooded and those downstream would suddenly find their river’s waters severely reduced.

“People are fighting battles on local levels, but they are also emblematic of global trends and they are also related to a lot of the climate things going on,” Miller told IPS. “[Hydroelectric] dams, for example, are sold as clean energy, but they generate a lot of methane, which is a powerful greenhouse gas.”

According to Miller, one value of large gatherings such as this weekend’s conference is allowing participants to see the similarities between experiences and struggles around the world, despite often different cultural, political and environmental contexts.

“In each case there are things that are very specific to them,” Miller said. “But I think we are also going to see some trends in terms of governments and other actors cracking down and trying to limit the political space, the ability for these folks to be effective in their work and to have a broader impact on policy.”

Yet activists like Viteri, from Ecuador, remain determined to protect their land.

“We care for the forest as a living thing because it gives us everything – life, shade, food, water, agriculture,” Viteri said. “It also makes us rich, even if it is a different kind of richness. This is why we fight.”

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New Treatments May Defuse Viral Time Bomb http://www.ipsnews.net/2014/04/new-treatments-may-defuse-viral-time-bomb/?utm_source=rss&utm_medium=rss&utm_campaign=new-treatments-may-defuse-viral-time-bomb http://www.ipsnews.net/2014/04/new-treatments-may-defuse-viral-time-bomb/#comments Wed, 09 Apr 2014 08:10:04 +0000 Cam McGrath http://www.ipsnews.net/?p=133530 Mohamed Ibrahim first learned he had hepatitis C when he tried to donate blood. Weeks later he received a letter from the blood clinic telling him he carried antibodies of the hepatitis C virus (HCV). He most likely acquired the disease from a blood transfusion he received during surgery when he was a child. “I […]

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Egyptian HCV carriers will soon have cost-effective alternatives to interferon therapy. Credit: Cam McGrath/IPS.

Egyptian HCV carriers will soon have cost-effective alternatives to interferon therapy. Credit: Cam McGrath/IPS.

By Cam McGrath
CAIRO, Apr 9 2014 (IPS)

Mohamed Ibrahim first learned he had hepatitis C when he tried to donate blood. Weeks later he received a letter from the blood clinic telling him he carried antibodies of the hepatitis C virus (HCV). He most likely acquired the disease from a blood transfusion he received during surgery when he was a child.

“I needed a lot of blood, and this was at a time before they screened it,” Ibrahim recalls.Even with new drugs showing promise in reversing cirrhosis, it may already be too late for late-stage HCV patients.

Now, at 24, Ibrahim is living with the blood-borne virus, knowing it is slowly eroding his liver. Unless treated, by the time he reaches his forties the disease will likely advance to cirrhosis or liver cancer.

While Ibrahim has been undergoing treatment since he first learned of his infection, the medication is costly and yet ineffective.

“Nothing has worked, and the side effects of the medicine are as bad as the disease,” he says. “I can’t work in [other places such as) Dubai or Saudi Arabia, because they require a clean blood test before issuing a work permit.”

Ibrahim is one of an estimated eight to 10 million Egyptians living with hepatitis C.

Egypt is said officially to have the highest prevalence of hepatitis C in the world, with 10 to 14 percent of its 85 million people infected, and about two million in dire need of treatment. HCV-related liver failure is one of the country’s leading causes of death, taking over 40,000 lives a year.

But Egyptians infected with HCV now have fresh hope in novel treatments.

The Egyptian government recently struck a deal with U.S. pharmaceutical firm Gilead Sciences to purchase its new hepatitis C pill Sovaldi at a fraction of its American price.

Under the agreement, Gilead will supply a 12-week regimen of Sovaldi to Egypt for 900 dollars, instead of the 84,000 dollars the medicine costs in the United States. Egypt’s health ministry is expected to make the drug available at specialised government clinics in the second half of 2014, once local drug registration procedures are completed.

Studies have shown that Sovaldi is up to 97 percent effective in curing HCV type-4, the most common strain of hepatitis C among Egyptians. The pill is seen as a significant improvement over the traditional HCV treatment in Egypt, which is a 48-week course of the anti-viral drug interferon taken in combination with ribavirin tablets.

The existing treatment costs up to 7,000 dollars using pegylated interferon supplied by multinational pharmaceutical firms Roche and Merck, and is only about 60 percent effective. Many patients also report severe side effects such as anaemia and chronic depression.

Interferon is available without a prescription at pharmacies in Egypt, but at 150 dollars per weekly injection, the 48-week regimen is well beyond the reach of most Egyptians. Reiferon Retard, a locally manufactured interferon, costs a third of that price, but critics claim it is less than 50 percent effective.

Since 2006, the Egyptian government has treated more than 250,000 HCV patients at specialised units affiliated to the National Committee for the Control of Viral Hepatitis, a government body formed to tackle the disease. Interferon injections are provided at reduced cost or free to uninsured Egyptians, but as many as half of the patients treated suffer a relapse within six months.

A 2010 study by the U.S.-based National Academy of Sciences estimates that more than 500,000 new cases of HCV infection occur in Egypt each year. Researchers attributed the spread of the disease to the high background prevalence of HCV in Egypt – about 20 times higher than the global average – and to poor medical hygiene practices, including the use of unsterilised medical equipment and unscreened blood.

Egypt’s government claims the figures are highly exaggerated, and that the high prevalence is the clinical outcome of infections decades earlier.

Many HCV carriers were infected during a national campaign in the 1960s and 1970s to stamp out the water-borne disease schistosomiasis, also known as bilharzia. Health authorities administered repeated injections of the bilharzia treatment to Egyptians in rural areas using unsterilised needles, inadvertently spreading hepatitis C among the population.

“Doctors at that time were unaware of HCV, which was only identified in 1987, and were using glass syringes instead of the plastic disposable syringes that is current practice,” explains Dr. Refaat Kamel, a surgeon and specialist in tropical diseases. “Once a needle got infected, the disease spread quickly.”

Kamel says a better understanding of the structure and reproductive mechanism of HCV has allowed scientists to devise more effective treatments.

Gilead’s Sovaldi received the approval of the U.S. Food and Drug Administration (FDA) in December 2013 after clinical trials demonstrated its effectiveness in curing HCV without significant adverse effects. The drug, one of a new line of direct-acting antiviral agents, combats the disease by targeting infected liver cells and inhibiting the enzymes that allow the virus to replicate.

The FDA has also approved Janssen Therapeutics’ Olysio, a direct-acting antiviral agent that is about 25 percent cheaper than Gilead’s pill. Pharmaceutical firms AbbVie, Bristol-Myers Squibb, Merck and others are all hustling to develop their own oral therapies.

Sovaldi’s effectiveness on HCV type-4 is proven only when used with interferon and ribavirin. Further testing will establish whether the drug can be taken without weekly interferon injections, or as a combined therapy with other direct-acting antiviral agents.

“Trials here of six months of Sovaldi without interferon but with ribavirin showed similar success rates, higher than 96 percent (cured),” says Dr. Mohamed Abdel Hamid, director of the government-run Viral Hepatitis Research Lab (VHRL). “The drug might also be effective taken for three months without interferon. We just don’t know yet.”

He says that apart from the reduced cost and greater efficacy of Sovaldi, oral medication could reduce the manifold problems associated with long-term intravenous interferon therapy.

“Obviously, over 48 weeks there is a lot more that can go wrong,” Abdel Hamid tells IPS. “Adherence is a problem as patients must visit the treatment centre at the same time every week to receive the injection. There are also problems keeping the interferon cold, and the medication has many side effects.”

But he cautions that even with new drugs showing promise in reversing cirrhosis, it may already be too late for late-stage HCV patients. With a limited healthcare budget, Egypt is expected to prioritise treatment for those in whom the disease has not yet manifested.

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To Tell or Not to Tell? Ugandan Teens Grapple with HIV Disclosure http://www.ipsnews.net/2014/04/tell-tell-ugandan-teens-grapple-hiv-disclosure/?utm_source=rss&utm_medium=rss&utm_campaign=tell-tell-ugandan-teens-grapple-hiv-disclosure http://www.ipsnews.net/2014/04/tell-tell-ugandan-teens-grapple-hiv-disclosure/#comments Tue, 08 Apr 2014 08:07:34 +0000 Wambi Michael http://www.ipsnews.net/?p=133502 This is the second in a three-part series on youth and AIDS in Africa

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Many HIV positive teenagers struggle to disclose their status to their sexual partners. Credit: Mercedes Sayagues/IPS

Many HIV positive teenagers struggle to disclose their status to their sexual partners. Credit: Mercedes Sayagues/IPS

By Wambi Michael
KAMPALA, Apr 8 2014 (IPS)

Silence is golden, it is said. But not for Constance Nansamba* from Uganda, who paid a dear price for keeping silent about being HIV positive and pregnant at age 18.  

“I was terrified. I ran away from my brother’s home. I could not follow the PMTCT [prevention of mother-to-child transmission] guidelines, so the baby is HIV positive,” she told IPS.“There are few designated adolescent-friendly outpatient health care facilities, while in-patient paediatric wards care for children up to age 12." -- Dr. Sabrina Kitaka, an adolescent health specialist

Nansamba knew she was born with the virus but, afraid of rejection, she did not tell her boyfriend. “We used a condom, he always complained, we abandoned the condom, I got pregnant.” Although he did not contract HIV from her, they broke up.

Nansamba, now 20, has found the courage to tell her story to help others. She is a member of Uganda Young Positives (UYP), an organisation that offers HIV counselling, testing and treatment adherence advice.

She told IPS that many teenagers born with HIV do not know their status when they start having sex, or they know but don’t tell their sex partners.

A survey by Uganda’s Mildmay Health Centre involving 200 adolescents receiving antiretroviral treatment found that 75 percent were not willing to disclose their HIV status to their sexual partners and 30 percent did not want to have protected sex.

“They simply don’t have information to guide them in negotiating disclosure, dual protection and consistent condom use,” said Nansamba. “I faced the same challenge because I would not discuss issues about sex with my elder brother, who was like my father.”

Nansamba’s parents died when she was a baby and her brother raised her.

HIV among the young

Uganda is a young country; nearly 80 percent of its 34 million people are below the age of 30.

National seroprevalence is 7.2 percent and, worryingly, is slowly rising. Among youth aged 15-24, five percent of women and two percent of men are HIV-positive, according to the Uganda AIDS Indicator Survey 2011.

The United Nations Children’s Fund’s Stocktaking Report on Children and AIDS 2013 estimates that Uganda has some 110,000 adolescents aged 10-19 living with HIV, of whom 64,000 are girls and 48,000 boys.

Emmanuel Elwanu was 14 years old when he learned that he had been born HIV positive. Fearing discrimination, he struggled with telling his HIV negative friends. “I had to go through a lot of counselling before I could open up,” he told IPS.

Elwanu was lucky: his school had weekly counselling sessions around HIV and he joined the Reach Out Mbuya Parish HIV/AIDS initiative.

“Many of my HIV positive colleagues out there are going through really difficult times with relationships,” explained the 18-year-old Elwanu. “I think about sex, but it is not my biggest priority.”

Elwanu, whose parents died while he was a child, has decided to abstain from sex until completing his studies.

Polly Nuwagaba, a counsellor with the Naguru Teenage Information and Health Centre in Kampala, told IPS that most adolescents have a problem with disclosure.

“They look healthy, they attract HIV negative partners, and they have sexual desires,” she explained. “Some tell us that when they say they have HIV, those they tell don’t believe it, and they end up having unprotected sex.”

No condoms for teens

Dr. Sabrina Kitaka, an adolescent health specialist at Makerere University’s College of Health and Sciences in Kampala, notes the gap in health services for the youth.

“There are few designated adolescent-friendly outpatient health care facilities, while in-patient paediatric wards care for children up to age 12. So adolescents are typically admitted to adult wards,” said Kitaka.

In 2013, the World Health Organisation (WHO) warned that the failure to put in place effective HIV services for youth has resulted in a 50 percent increase in AIDS-related deaths among adolescents globally, compared with the 30 percent decline of such deaths in the general population from 2005 to 2012.

WHO asked governments to review their laws to make it easier for adolescents to obtain HIV testing without parental consent.

But Ugandan health officials are divided on whether teenagers should be offered family planning services and condoms.

Dr. Stephen Watiti, a physician who lives with HIV, observed that the laws and policies surrounding condoms and contraceptives for adolescents in Uganda are unclear and interpreted inconsistently. This makes it difficult for both youth and health staff to understand their options.

Officially, only those 18 and over qualify for family planning services and condom distribution. However, more than half of young women aged 18-24 had had sex before the age of 18, according to the 2011 Uganda Demographic and Health Survey.

“As clinicians, you cannot go to schools and promote condoms or contraceptives. But when you come across a 14-year-old who is sexually active, then you have no option but to teach them how to use condoms,” Watiti told IPS.

At the UYP meeting held in Kampala, the Ugandan capital, in late January, Nansamba told the young audience: “You guys, it is not easy to live with HIV. You will always feel guilty whenever you sleep with someone, but at the same time you have sexual desires that need to be fulfilled.”

Her decision these days is “to abstain [from sex] because I don’t want to put anybody at risk of HIV.”

But for many HIV positive teenagers, abstaining is not an easy option – and neither is disclosing their status or practicing safe sex.

*Name changed to protect identity.

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IFC-Negotiated Privately Run Hospital Sapping Lesotho Budget http://www.ipsnews.net/2014/04/ifc-negotiated-privately-run-hospital-sapping-lesotho-budget/?utm_source=rss&utm_medium=rss&utm_campaign=ifc-negotiated-privately-run-hospital-sapping-lesotho-budget http://www.ipsnews.net/2014/04/ifc-negotiated-privately-run-hospital-sapping-lesotho-budget/#comments Mon, 07 Apr 2014 23:12:48 +0000 Carey L. Biron http://www.ipsnews.net/?p=133498 The world’s first hospital to be built and run in a developing country under a public-private partnership is taking up more than half of the health budget in Lesotho, according to new estimates, diverting resources from populations outside of the capital. The unique funding arrangement for the Queen ‘Mamohato Memorial Hospital, which opened in 2011 […]

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By Carey L. Biron
WASHINGTON, Apr 7 2014 (IPS)

The world’s first hospital to be built and run in a developing country under a public-private partnership is taking up more than half of the health budget in Lesotho, according to new estimates, diverting resources from populations outside of the capital.

The unique funding arrangement for the Queen ‘Mamohato Memorial Hospital, which opened in 2011 in the capital city of Maseru, came about under a deal brokered by the International Finance Corporation (IFC), the World Bank’s private sector arm.“It’s very concerning that the deal was structured to give a 25 percent return to a private company – that’s a phenomenally high rate." -- Anna Marriott of Oxfam

Yet while the Washington-based IFC was negotiating on behalf of the Lesotho government, the final agreement will see returns of around 25 percent for the private company running the hospital.

Now, critics from civil society and within the Lesotho government are warning that the contract, which lasts for 18 years, is already forcing officials to cut back on health and other services, particularly for the country’s rural areas – where 75 percent of the Lesotho population lives.

“The big promise was that the new hospital would cost exactly the same as the old hospital and bring better results, but that’s clearly not the case. Even at the point the contract was signed [in 2009], costs had already escalated beyond what was agreed to be affordable,” Anna Marriott, a health policy advisor with Oxfam Great Britain, a humanitarian and advocacy group, told IPS.

“It’s very concerning that the deal was structured to give a 25 percent return to a private company – that’s a phenomenally high rate – and the idea that the World Bank would advise on a deal of that type is truly surprising. It feels as though the IFC was negotiating on behalf of the company rather than the government.”

In a report released Monday, Marriott writes that the new hospital is costing around 67 million dollars a year, three times more than the old hospital. Further, it’s currently accounting for some 51 percent of the country’s health budget, even while rural services are being cut, including for agriculture and education.

“The [new] hospital has had a bad impact on how we’ve allocated resources over the last two years,” the report quotes an anonymous senior Ministry of Health official as stating. “There are less and less resources for primary health care and district services.”

Non-competitive bidding

While the Lesotho government has proposed a significant increase in its health budget for coming years, a large majority – some 84 percent – of this will be earmarked for the new hospital. Yet most people in Lesotho can’t easily make use of these facilities.

“For many people, travelling to urban areas or the capital can take two days or more,” Lehlohonolo Chefa, director of the Lesotho Consumers Protection Association (CPA), which co-authored the new report, told IPS.

“For a long time, the government has been relying on the Christian Health Association of Lesotho to provide most of the primary health-care services in rural areas. But with the advent of this project, the majority of funding goes to financing the federal hospital while sacrificing that primary health care.”

Chefa is in Washington ahead of semi-annual meetings between the World Bank and International Monetary Fund (IMF), which are taking place later this week.

Lesotho is one of the poorest and most unequal countries in the world. The new Queen ‘Mamohato Hospital replaces the country’s previous central health service provider, a century-old institution that nearly everyone agreed needed to be renovated or overhauled entirely.

Yet when the government of Lesotho went to the World Bank to request funding to do so, Oxfam’s Marriot says the bank’s window had already closed for the concessional assistance that would typically be used in such a situation. Instead, officials were pointed towards the IFC, which took over the main technical advisory role for the deal.

That process resulted in a contract between the government of Lesotho and Tsepong, a consortium headed by Netcare, a South African company that has long experience in the private health-care business.

Critics point to a host of problems with the negotiating process and structure of the eventual contract, however, including that only two companies engaged in the bidding process. In addition, the contract significantly underestimated the number of patients the hospital would see, while requiring the government to pay Tsepong for visits over that number.

Further, Tsepong’s priorities are at times at odds with those of the government. Lesotho, for instance, has the world’s third-highest rate of HIV/AIDS, yet CPA’s Chefa says the new hospital has scaled back these services.

“Most of the HIV/AIDS treatments are not provided in the new federal hospital, so people have to look elsewhere,” he says. “For the private sector, HIV/AIDS is not profitable – we’re seeing the same problem with mental health services.”

Landmark model

The deal was quickly lauded by the IFC, which continues to embrace the project’s broader aims.

“The World Bank Group shares Oxfam’s concern that the health network in Lesotho is being overburdened as it attempts to fulfil greater than anticipated public demand for basic health services,” Geoffrey Keele, an IFC spokesperson, told IPS in a statement.

“The World Bank Group is supporting the Government of Lesotho in strengthening the country’s health system so that everyone in Lesotho, especially the poorest, can access the essential health services they need.”

Keele notes that the project has improved the quality of care for around a quarter of the country’s population, while the overall mortality rate at the new hospital has fallen by 41 percent.

Indeed, the IFC started making plans to replicate the project in other countries almost immediately.

“The landmark deal might serve as a model for aging and overburdened health care systems across Africa,” the IFC said in a statement at the time. “The real potential of the Lesotho project becomes apparent if it could be scaled up across populous countries such as Nigeria, where there could conceivably be scope for 20 or more such hospitals.”

Currently, the IFC is advising on similar projects in Nigeria and Benin.

Oxfam is now urging the World Bank to investigate the IFC’s role in the project. Meanwhile, CPA’s Chefa says the Lesotho government will need to renegotiate the contract, but warns that the contract details remain under wraps.

“Renegotiating the contract is the only way out of this mess, and whether that’s possible is based on the government’s and the IFC’s willingness to change,” he says.

“For the moment, there is incredible secrecy around the project. But if this is a flagship project, how can they not be open about what’s in the contract?”

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Italian Doctors Abort a Law http://www.ipsnews.net/2014/04/italy-aborts-law/?utm_source=rss&utm_medium=rss&utm_campaign=italy-aborts-law http://www.ipsnews.net/2014/04/italy-aborts-law/#comments Sat, 05 Apr 2014 07:19:47 +0000 Silvia Giannelli http://www.ipsnews.net/?p=133355 Two out of three doctors in Italy are ‘conscientious objectors’ to abortion, according to new data. The Italian Ministry of Health reveals that in 2011, 69.3 percent of doctors refused to carry out abortions, with peaks of over 85 percent in some regions. In the face of such numbers, the ruling of the European Committee […]

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A demonstration in support of abortion rights in Dublin. Credit: Irish Family Planning Association.

A demonstration in support of abortion rights in Dublin. Credit: Irish Family Planning Association.

By Silvia Giannelli
ROME, Apr 5 2014 (IPS)

Two out of three doctors in Italy are ‘conscientious objectors’ to abortion, according to new data. The Italian Ministry of Health reveals that in 2011, 69.3 percent of doctors refused to carry out abortions, with peaks of over 85 percent in some regions.

In the face of such numbers, the ruling of the European Committee of Social Rights of the Council of Europe against Italy earlier this month over a complaint for violating the right to protection of health came as no surprise.“Many doctors object simply because they have nothing to gain from doing this extra work.”

“The Italian situation really worries us, and this is why we filed the complaint,” Irene Donadio, advocacy officer at the International Planned Parenthood Federation European Network (IPPF_EN) told IPS. “We believe that there is a problem with the functioning and application of the abortion law, which, in fact, would be a good law but is often violated.

“We acknowledge the fact that the right to conscientious objection is included in the same law, but the right of women to access a service that is legal and fundamental for their health needs to be respected as much as this right.”

IPPF_EN sees the high number of conscientious objectors in Italy as the main cause behind refusal of women’s right to termination of pregnancy.

IPPF_EN, with the help of several Italian associations, presented to the Committee a scenario of never-ending waiting lists and arbitrary suspensions of the service. It listed many instances where women were forced to travel for abortions within the country or to go abroad.

“According to data from the Ministry of Health, the number of voluntary interruptions of pregnancy per year is around 110,000,” Giuseppe Noia, president of the Italian Association of Catholic Gynaecologists Obstetricians (AIGOC) told IPS.

“If we consider that there are about 1,500 non-objecting physicians, each physician carries out around 74 abortions per year, that is an average of five or six per month. The fact that non-objectors are overloaded and cannot guarantee an efficient system is therefore absolutely false,” Noia said.

In its response to the Council, the Ministry had said that due to a decline in abortions, “the workload for non-objecting doctors was cut by half in the last 30 years” and therefore “it appears difficult…to maintain that the high number of conscientious objectors would be an obstacle for accessing the interruption of pregnancy.”

The ministry’s note does not elaborate on the geographical distribution of objectors across the country. This is what, according to the Council of Europe, creates a disparity in treatment depending on where the woman seeking an abortion resides.

In the southern region of Basilicata, according to official data, 85.2 percent of physicians are conscientious objectors, in Apulia they account for 79.4 percent of the total, and in Sicily 81.7 percent.

“The situation is generally worse in the South, but also Lombardy [in the north bordering Switzerland] has serious problems, and we know that this is because is a not very laic region,” Silvana Agatone, president of  the Free Italian Association of Gynaecologists for the Application of Law 194 (LAIGA) told IPS. Law 194 is the law that regulates abortion in Italy.

The decrease in abortions claimed is subject to different interpretations. The ministry maintains that this is due to “the promotion of a higher and more efficacious recourse to conscious procreation.” But Marilisa D’Amico, a lawyer who was involved in presenting the complaint, says that the increase of cases of spontaneous abortions, or miscarriages, “can only be explained as an increase of clandestine abortions” presented as miscarriages. There were less than 57,000 such abortions in 1990, 68,000 in 2000 and more than 76,000 in 2011, according to ISTAT.

The official figures show a constant increase in the number of miscarriages through recent years.

LAIGA provided a list of 45 hospitals that have a gynaecology unit but do not perform terminations of pregnancy, disregarding Article 9 of the Italian law on abortion. This article states that hospital establishments and authorised nursing homes shall ensure that procedures for the termination of pregnancy are guaranteed.

Clandestine abortions continue to take place, says Massimo Srebot, head of the department of obstetrics and gynaecology at the Lotti Hospital of Pontedera in Tuscany region, the first structure in Italy to introduce RU-486, a pill that blocks the action of the hormone progesterone in order to cause abortion without surgical intervention.

“Women who find obstacles in public hospitals seek alternative channels with physicians who, upon receiving a bribe, are willing to simulate a spontaneous abortion. These are conscientious objectors only when they have to work for free. They turn a blind an eye to their conscience in their private clinics.”

Srebot says “many doctors object simply because they have nothing to gain from doing this extra work.” Also, “carrying out abortions doesn’t help a doctor’s professional career because it is not a high-level specialisation operation.”

Srebot has proposed new solutions to ensure the respect of Law 194. One option would be to nominate a non-objector as a sub-head physician for every public hospital.

“I truly respect the real conscientious objectors, but there are those who speculate on women’s difficult situations, they don’t sustain them, they don’t help them preventing further incidents, they only wait for them to get pregnant again, so they once again cash in.”

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Youth Around the World See Meagre Opportunities http://www.ipsnews.net/2014/04/youth-around-world-see-meager-opportunities/?utm_source=rss&utm_medium=rss&utm_campaign=youth-around-world-see-meager-opportunities http://www.ipsnews.net/2014/04/youth-around-world-see-meager-opportunities/#comments Thu, 03 Apr 2014 22:49:18 +0000 Bryant Harris http://www.ipsnews.net/?p=133413 Although half the world’s population is under 25 years old, young people in more than two dozen countries feel that their opportunities for educational, economic and societal advancement are limited, according to new research released here Thursday. Researchers say the results should help to drive and prioritise both public and private investment in services. In order […]

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Young Bangladeshi women raise their fists at a protest in Shahbagh. Credit: Kajal Hazra/IPS

Young Bangladeshi women raise their fists at a protest in Shahbagh. Credit: Kajal Hazra/IPS

By Bryant Harris
WASHINGTON, Apr 3 2014 (IPS)

Although half the world’s population is under 25 years old, young people in more than two dozen countries feel that their opportunities for educational, economic and societal advancement are limited, according to new research released here Thursday.

Researchers say the results should help to drive and prioritise both public and private investment in services.“The youth bulge can become a security, economic and humanitarian worry, and even maybe a disaster, or it can become a resource for development and change.” -- William Reese

In order to assess the many factors that contribute to healthy lifestyles for youth, the International Youth Foundation (IYF) and the Centre for Strategic and International Studies (CSIS), the latter a think tank here, put together the Global Youth Wellbeing Index.

The index aggregates data from 30 countries, representing around 70 percent of the world’s youth population, and rates the wellbeing of youths in each country on a scale from zero to one.

“This is certainly … one of the biggest issues we’re dealing with in the world today,” Christopher Nassetta, the CEO of Hilton Worldwide, the index’s principle funder, said at the index’s launch.

“It hasn’t been an issue that really has been discussed around the world the way that, in my mind, it should be, in the sense of really getting governments, civil society and business … to really think about the issues.”

Nassetta says each of these sectors now needs to figure out not only how to attack the problems that can be associated with youth wellbeing, but also the “opportunity”.

Approximately 85 percent of youths under the age of 25 live in developing countries, in some countries comprising almost 40 percent of the total population.

Development advocates and economists suggest such numbers highlight the importance of providing such a large segment of the population with the resources necessary to drive economic growth while maintaining adequate health, security and stability.

“The youth bulge can become a security, economic and humanitarian worry, and even maybe a disaster, or it can become a resource for development and change,” said William Reese, IYF’s president.

Palestinian youth in the Old City of Jerusalem. Credit: Pierre Klochendler/IPS

Palestinian youth in the Old City of Jerusalem. Credit: Pierre Klochendler/IPS

The index collects data on youths between the ages of 15 and 24. Nearly all of this data, drawn from public, independent sources, is from 2008 or later.

The index then establishes 40 indicators to assess six major fields, or “domains”, of relevance to youthful wellbeing: safety and security, information and communication technology, citizen participation, economic opportunity, education, and health. It then determines each country’s overall ranking from the scores in each field.

In the 30 countries assessed, the average score for youths’ overall wellbeing is .576, with two-thirds of countries falling below the average. As for the averages for each specific domain, youths across the world fared best in health and worst in economic opportunity.

Australia has the highest rate of youth wellbeing with a score of .752, while Nigeria comes in last with .375.

Although the index only covers 30 countries at present, its creators hope that its publication will now encourage other countries to run their own wellbeing analyses, potentially encouraging data-driven investment in youth programming.

“A number of these data points are available in many of the countries not included in the index … but we did make some choices to be strategic and to have regional diversity, as well as income diversity, in this first index,” Nicole Goldin, the director of the CSIS department that spearheaded the index, told IPS.

“But to those countries that are not included, we hope that this index can be seen as a framework and a tool so that governments, young people, implementing organisations, corporations and any other stakeholders can take it, run their own wellbeing analysis, and see how they may compare and drive their own policies, programmes and investments to better serve the interests of youth.”

In July 2012, under the leadership of 23-year-old Patrick Arathe, a group of youth without parents started their own farming enterprise in Munda, Solomon Islands. Credit: Catherine Wilson/IPS

In July 2012, under the leadership of 23-year-old Patrick Arathe, a group of youth without parents started their own farming enterprise in Munda, Solomon Islands. Credit: Catherine Wilson/IPS

Data-driven investment

IYF and CSIS hope that governments, civil society and businesses will use the index’s findings to better evaluate and calibrate programmes designed to build youth capacity.

“You can’t manage what you don’t measure,” said Nassetta. “There’s been a massive lack of transparency and data with which to make good investments, whether that’s human capital or financial capital, so the wellbeing index is the start of that.”

For instance, IYF’s Reese noted that developing countries’ heavy investment in certain sectors, like education, have yet to yield desirable results.

“[The] domains can tell us where to invest intelligently,” Reese said. “That can be the host government, but even in some of the poorest countries in the world, their largest expenditure is in education, it’s just not being well spent.”

Reese emphasised that the index is not adversarial in nature, but rather designed for countries to compare and contrast their relative strengths and weakness, and to learn from each other.

“The index will help us compare and frame some needs and look at countries as to where they’re doing better and where they have some gaps,” he said. “Then we can compare across countries – not to name and shame at all, but to look further so we invest better.”

In addition to emphasising the need for more data-driven policies, programmes and investments, many at Thursday’s unveiling of the index highlighted a key component necessary to drive those changes: youths themselves.

“If you’re talking about a post-2015 development agenda, one thing missing from that, based on a youth perspective, is the idea of what the ‘youth problem’ is,” said Angga Dwi Martha, the 23-year-old Youth Advocate at the United Nations Population Fund.

“I think this index can give a very general identification of the problem. And then, as young people, we can [relay] this to our government, the private sector and civil society.”

Others argued that the best way to figure out “what works” to improve youth wellbeing is by actively including and engaging youths in the development process.

According to Emmanuel Jimenez, the World Bank’s director of public-sector evaluations, “We, as older people who design policy, often forget, or don’t do enough, to consult with the ultimate beneficiaries, which are young people.”

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Using Ethiopia’s Healthcare Gaps to Do Good and Make a Profit http://www.ipsnews.net/2014/04/using-gaps-ethiopias-healthcare-good-make-profit/?utm_source=rss&utm_medium=rss&utm_campaign=using-gaps-ethiopias-healthcare-good-make-profit http://www.ipsnews.net/2014/04/using-gaps-ethiopias-healthcare-good-make-profit/#comments Thu, 03 Apr 2014 07:45:46 +0000 James Jeffrey http://www.ipsnews.net/?p=133341 For a while now, Magnetic Resonance Imaging or MRI scanners have typically been a luxury that both government and private hospitals in Ethiopia have struggled to afford to purchase for in-house use. Addis Ababa, the Ethiopian capital with an ever-growing population of around 3.8 million, currently has only four stationary MRI scanners that provide services […]

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Ethiopians waiting inside a hospital in Addis Ababa on the weekend. The capital has only four stationary MRI scanners, providing services to 30 government- and private-run hospitals. Credit: James Jeffrey/IPS

Ethiopians waiting inside a hospital in Addis Ababa on the weekend. The capital has only four stationary MRI scanners, providing services to 30 government- and private-run hospitals. Credit: James Jeffrey/IPS

By James Jeffrey
ADDIS ABABA, Apr 3 2014 (IPS)

For a while now, Magnetic Resonance Imaging or MRI scanners have typically been a luxury that both government and private hospitals in Ethiopia have struggled to afford to purchase for in-house use.

Addis Ababa, the Ethiopian capital with an ever-growing population of around 3.8 million, currently has only four stationary MRI scanners that provide services to 30 government and private hospitals, according to Zelalem Molla, a surgeon based in Addis Ababa.

Outside of the capital, only two MRI scanners exist. But the six scanners — in this Horn of Africa nation of some 92 million people — are old fashioned and far behind the technological curve in the West.

“It would be wrong to claim that the mobile MRI scanner would save lives,” says Zelalem, whose lunchtime chat with American entrepreneur Peter Burns III about the paucity of scanners sparked a business idea.“[In a developing economy] a government’s focus on financial market stability and security issues can result in healthcare issues remaining on the side-lines.” -- Alayar Kangarlu, MRI research centre, Columbia University

But, Zelalem notes, more MRI scanners — which use strong magnetic fields and radio waves to generate images of the inside of the body that can be analysed on computers — would crucially allow more doctors to diagnose illnesses far earlier when they are operable and potentially curable.

“Often it is not possible for doctors to diagnose illnesses such as tumours until they physically appear at a stage when the chances of saving a patient are slim — or it is too late,” Zelalem tells IPS.

However, actual figures about the number of people directly affected here by the lack of MRI scanners do not exist.

In the past, some Ethiopians have needed to travel to other African countries such as Kenya and South Africa, or to Europe to have scans. This even included Haile Gebrselassie, Ethiopia’s track runner, who used to go to Munich, Germany for scans to help diagnose running injuries.

Ethiopia technically has free healthcare for all, which is provided by government-run hospitals. The reality, however, is that “there are not enough hospitals and most suffer from inadequate staffing, budgets and machinery,” Zelalem says. Private hospitals exist but as an option affordable to very few Ethiopians.

And the cost of an MRI scan proffered privately is a frightening figure for most Ethiopians, many of whom earn between 500 to 1,000 birr (28 to 56 dollars) a month.

The scale of demand at government-run hospitals for free MRI scans means patients can be left with the choice of having to wait and risking their health, or raising funds to pay for a scan at a private hospital or institution.

Such gaps in Ethiopia’s healthcare are areas of concern to the government and many NGOs as three of the eight United Nations Millennium Development Goals (MDGs) for 2015 are healthcare focused, concentrating on reducing child mortality, improving maternal health as well as combatting HIV/AIDS, malaria and other diseases.

But people like Burns are taking advantage of these gaps to do good while making a profit at the same time.

“This project represents the highest form of achievement edified by the mantra: ‘Doing well by doing good,’” Burns, who is based in Addis Ababa as a self-styled “ExPatrepreneur”, tells IPS.

Burns describes the project to provide the country with scanners as a for-profit enterprise with a charitable component.

“We will be offering a total of 25 percent of our scans for free to those that are unable to afford it,” Burns says.

So far, Burns says he will only bring one mobile MRI scanner to Addis Ababa and will sell its services on a pay-per-scan basis.

Also, there is a plan for a portion of profits to fund a not-for-profit venture called Doctors Within Borders, which aims to provide financial incentives to encourage Ethiopian doctors to remain within Ethiopia, as well as work in remote rural areas.

A previous private MRI scanner service in Addis Ababa set a precedent for profitability, Zelalem says. The business conducted about 30 scans a day — an MRI scan typically costs from about 115 to 150 dollars to conduct and process the images — totalling annual revenue of more than one million dollars. However, this scanner is fixed and patients are transported to it from various hospitals across the city.

“[In a developing economy] a government’s focus on financial market stability and security issues can result in healthcare issues remaining on the sidelines,” Alayar Kangarlu, who leads the physics and engineering group at the MRI research centre at Columbia University in New York, tells IPS. At the same time this creates an opening for private business, he notes.

And generating a healthy bottom line can have a beneficial role in healthcare provision, some say.

“NGO-based humanitarian healthcare usually struggles with sustainability and operates from grant to grant,” a worker within the health sector in Ethiopia, who wished to remain anonymous due to current work commitments, tells IPS.

Private enterprise, on the other hand, he notes, can achieve long-term sustainability thanks to profit generation. And it is usually more flexible, and more efficient due to greater accountability, than NGOs typically hampered by rigid fiscal rules on profit. Private enterprise can also free up capacity within public- or NGO-provided healthcare.

Admittedly profit generation within healthcare can turn sour and escalate wildly, he notes, as witnessed in the U.S., but Ethiopia’s healthcare system remains light years away from encountering such problems.

Burns remains confident that he can improve MRI scanner availability in Addis Ababa.

And if that is achieved, then the same business model could be applied to other major Ethiopia cities around the country — and go some way towards helping achieve the MDGs related to healthcare.

“Much can be accomplished through the small combined efforts of the many, and it is each of our responsibility to contribute,” Burns says. “This is one small step to serving just one of the many needs of a population in a place like Ethiopia.”

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Zimbabwe’s Positive Children, Negative News http://www.ipsnews.net/2014/04/zimbabwe-positive-children-negative-news/?utm_source=rss&utm_medium=rss&utm_campaign=zimbabwe-positive-children-negative-news http://www.ipsnews.net/2014/04/zimbabwe-positive-children-negative-news/#comments Thu, 03 Apr 2014 07:42:07 +0000 Busani Bafana http://www.ipsnews.net/?p=133392 This is the first in a three-part series on youth and AIDS in Africa

The post Zimbabwe’s Positive Children, Negative News appeared first on Inter Press Service.

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Afraid of losing playmates, children hide their HIV positive status from their peers. Credit: Busani Bafana/IPS

Afraid of losing playmates, children hide their HIV positive status from their peers. Credit: Busani Bafana/IPS

By Busani Bafana
BULAWAYO, Apr 3 2014 (IPS)

Three years ago, Robert Ngwenya* and his father got into a heated argument over medication. Ngwenya, then aged 15, refused to continue swallowing the nausea-provoking pills he had been taking since he was 12 years old, and flushed them down the toilet. 

During the argument, Ngwenya understood he had been born HIV positive, had been taking antiretrovirals (ARV) and not vitamins and anti-allergenics, and that his father too lived with the virus and the guilt of having infected him.

“This is unfair, what did I do to deserve this?” Ngwenya laments.

How to Dance
"Next time you see me walking on the street
Know there's a story that hides in me
Don't look away and pretend that l'm not there
All l want is for someone to care for me

I too have dreams of a better life
That someone will love me as I am
To hold my own child in my arms
And make sure she's safe from harm

What l'd like is some of your affection
Not your pity, just some kind of attention
You think l'm worthless,
You don't even know me
It's not my fault that this
Blood flows through me.

I want you to know that we're just kids
Even though we were born with HIV
Prenatal, virgin contraction
The first of a fighting generation,
We fight against AIDS and discrimination
We're God-made, put there for a reason
It's time to change and now's the reason
Yes, we're special but we're no different

But in the Storm
We've learned how to dance"

Ngwenya lives in the high density suburb of Pumula in Bulawayo, Zimbabwe’s second city, with his father, a car mechanic, and his younger brother, who is HIV negative. His mother died when Nwengya was 10 and his father never remarried.

Ngwenya’s life was all planned: finish high school, get a degree in information technology, find a job and buy a car. Not any more. After the revelation, he is no longer the same outgoing teenager whose company brought smiles to friends and family.

“How do I tell my friends? How do I start a relationship knowing someone will have to carry my burden?” he asks.

Like Ngwenya’s father, other HIV positive parents, weighed down by guilt, find it hard to tell their children they were infected at birth.

How and who tells a child or teenager that they will live with the virus for the rest of their lives?

Hard choices

Thanks to ARV therapy, increasing numbers of HIV infected children are living to adolescence. In 2012, Zimbabwe had 180,000 children aged 0-15 and 1.2 million people aged 15 and above living with HIV, says the Joint United Nations Programme on HIV/AIDS (UNAIDS).

“As these children grow and surpass the immediate threat of death, the issue of informing them of their HIV status arises,” says a study on teenagers born with the virus in Zimbabwe.

Disclosing to adolescents is different from telling younger children and requires tailored, age-appropriate guidelines, says the study.

Adolescents aged 16-20 interviewed for the study preferred to be told by health care workers at clinics, with the presence of family.

“Disclosure to this age group in a healthcare setting may help overcome some of the barriers associated with caregivers disclosing in the home environment and make the HIV status seem more credible to an adolescent,” reports the study.

Silence and lies

Zivai Mupambireyi, a researcher with the Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) and co-author of a 2013 study of HIV positive children aged 11-13 in Zimbabwe, told IPS that children prefer to learn about their HIV status at the clinic because they believe health workers give them more and better information than their carers.

Children reported that their carers delayed disclosure, concealed information and lied about the pills.

“Most of these children were looked after by non-biological carers, as their parents were the first generation of AIDS patients and died before ARVs,” Mupambireyi explains.

Whether it is parents overwhelmed by guilt or carers distressed by the enormity of the revelation, telling adolescents they are HIV positive is fraught with pain and ambivalence.

Mupambireyi found that HIV positive children believe that disclosing to peers will expose them to discrimination. Although this often was not the case, fearing a loss of social interaction and friendship, children hide their HIV status.

“Although HIV status disclosure is noble and recommended, children’s concerns and fears around disclosure must be addressed before they are encouraged to disclose,” says Mupambireyi.

Health workers, parents and educators are tongue-tied as to the timing and best method of disclosing HIV status to youth.

Building trust

Definate Nhamo is the coordinator of Shaping the Health of Adolescents in Zimbabwe (SHAZ), a research and intervention project. One offshoot, SHAZ for Positives, reaches more than 700 youth living with HIV in Chitungwiza, a suburb of Harare, the capital.

Nhamo told IPS that the best age to disclose HIV status is probably around nine or 10 years, before puberty, and preferably in the presence of parents, guardians or a counsellor.

“When the child is younger, she is trusting, and will grow up knowing she must take the ARVs religiously,” says Nhamo.

SHAZ for Positives members agree that knowing their status early helps kids accept their condition and learn to be open about it, Nhamo told IPS.

Some adults tell children the ARV pills are for tuberculosis, without realising that children can google it. “Teenagers just stop taking their ARVs and do not tell their parents because they feel they are more informed since they have access to the internet,” observes Nhamo.

A young female participant in the SHAZ study, who did not want to be identified, tells IPS that her mother, distressed at having infected her, never told her the truth. At age 17, the girl took a routine HIV test and tested positive. Since she had never had sex, she confronted her mother and learned that her two siblings were HIV negative but she had been born positive.

“I was angry and frustrated. If my mother had told me earlier, I could have accepted my status better,” she says.

Zvandiri, meaning “what I am” in the Shona language, is a support group that helps adolescents deal with HIV.

In 2013, Zvandiri produced a catchy song and DVD, How to Dance, with cool young people spiritedly belting out their hopes and fears: “I too have dreams of a better life, that someone will love me as I am.”

They sing, “how to dance in the storm”.

* Not his real name

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California Cities Gear Up to Fight “Big Soda” http://www.ipsnews.net/2014/04/california-cities-gear-fight-big-soda/?utm_source=rss&utm_medium=rss&utm_campaign=california-cities-gear-fight-big-soda http://www.ipsnews.net/2014/04/california-cities-gear-fight-big-soda/#comments Wed, 02 Apr 2014 21:39:59 +0000 Judith Scherr http://www.ipsnews.net/?p=133384 Mexico is fighting obesity and accompanying diseases with a one-peso per litre tax on sugar-sweetened beverages that kicked in Jan. 1. France implemented its “cola tax” in 2012. Several U.S. states tax sugar-sweetened beverages, including Vermont, Rhode Island, Arkansas, Tennessee, West Virginia and Virginia. Illinois legislators are considering such a tax. To date, no U.S. […]

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By Judith Scherr
BERKELEY, Apr 2 2014 (IPS)

Mexico is fighting obesity and accompanying diseases with a one-peso per litre tax on sugar-sweetened beverages that kicked in Jan. 1. France implemented its “cola tax” in 2012. Several U.S. states tax sugar-sweetened beverages, including Vermont, Rhode Island, Arkansas, Tennessee, West Virginia and Virginia. Illinois legislators are considering such a tax.

To date, no U.S. city has approved a tax on sugar-sweetened beverages. Advocates of the tax in San Francisco and Berkeley, California hope they will be the first. But they’ll have to fight the “big soda” industry lobby to do it."We don’t want to start a precedent - every time a corporation threatens to put a bunch of money in, we back down.” -- San Francisco Supervisor Scott Wiener

Proponents say the taxes would reduce consumption of drinks that contribute to costly diseases like diabetes. But the American Beverage Association, representing the 141-billion-dollar non-alcoholic drink industry, says the tax would hurt the poor by inflating grocery bills, and argues that the choice to drink sugary beverages should be made by the individual, not the government.

Berkeley and San Francisco residents will vote Nov. 4 on whether to tax sugary drinks.

Dr. Vicki Alexander, MPH, co-chairs the Berkeley Healthy Child Initiative Coalition, the tax measure sponsor in Berkeley. She said sweetened beverages can be even more harmful than cake or cookies.

“When [a sugar-sweetened drink] enters your mouth, it is quickly swallowed and enters the organ that regulates sugar in the bloodstream,” Alexander said at a recent council meeting. “You don’t even have time to feel full. So you drink more – you supersize it. This high sugar content can lead straight to diabetes.”

The ABA spent millions of dollars opposing sweetened-drink tax campaigns in Richmond and El Monte, California, soundly defeating both in 2012.

But Berkeley City Councilmember Darryl Moore said the powerful industry doesn’t scare him. “We were the first community to divest [from South Africa], the first community to have domestic partner benefits, the first to put curb cuts for our disabled community,” he said at a recent city council meeting. “No city has been able to successfully pass a sugar-sweetened beverage tax, but it will happen here in Berkeley.”

Across the Bay, San Francisco Supervisor Scott Wiener is sponsoring San Francisco’s ballot measure to tax sugar-sweetened beverages. Like Moore, he said he’s ready to take on big soda.

“The beverage industry is a bad actor,” Wiener said. “They are going to put a lot of money into the campaign, just like tobacco and big oil put a lot of money in any time we try to do anything in California around taxes or regulations. We don’t want to start a precedent – every time a corporation threatens to put a bunch of money in, we back down.”

Tax measure details won’t be finalised until July. In its present form, the San Francisco measure would tax sugar-sweetened beverages at two cents per ounce; Berkeley’s levy would be one cent per ounce. Sodas, sports drinks, and sugar-sweetened teas would be taxed; the tax wouldn’t include milk and medical drinks, diet sodas and alcohol.

Distributors would pay the tax, which proponents believe would be passed on to consumers. Adding a penny-per-ounce tax on sweetened beverages across the U.S. would prevent 240,000 cases of diabetes per year, according to Dr. Kirsten Bibbins-Domingo, associate professor of medicine, epidemiology and biostatistics at the University of California San Francisco.

The San Francisco measure directs tax funds to nutrition, health and physical activity programmes. The Berkeley coalition is evaluating polling data to decide whether its measure will specify where funds are spent.

Advertising by the sweetened beverage industry often targets children. Credit: Judith Scherr/IPS

Advertising by the sweetened beverage industry often targets children. Credit: Judith Scherr/IPS

Retired cardiologist and former Richmond Councilmember Dr. Jeff Ritterman, who spearheaded failed efforts to pass the tax in Richmond, is advising proponents in San Francisco and Berkeley.

“Being first out of the gate, we didn’t have money,” Ritterman told IPS. “We didn’t have professionals running the campaign. And we didn’t have polling data. A cardiologist turned city councilmember flying by the seat of his pants is what we had in Richmond.”

The beverage industry spent 2.5 million dollars in Richmond, a city of about 100,000, and 1.5 million dollars in El Monte, with about 20,000 people, to defeat the measures. (Berkeley’s population is about 112,000 and San Francisco’s is about 825,000.)

With seven months before the election, tax proponents in Berkeley and San Francisco have instituted many elements the Richmond campaign lacked. They’ve tapped volunteers, raised funds, hired professional consultants, taken polls and launched websites.

The beverage industry also got an early start. It established the Coalition for an Affordable City, which sent mailers to San Francisco voters targeting the city’s “rising cost of living, escalating rents, [and] impending evictions,” arguing that instead of addressing housing costs, tax proponents want to make life harder by taxing sodas.

Supervisor Wiener said the mailer used “the very real anxiety around the cost of housing” to attack the tax. “To suggest that a two-penny per ounce tax on soda is even in the same universe as seniors who are losing their housing is pretty specious,” he said.

IPS asked the ABA for comment; they responded by directing this reporter to their websites.

An overarching question is how the Berkeley and San Francisco campaigns will compete, given that, no matter how much money they raise, the industry will outspend them.

San Francisco campaign consultant Maureen Erwin said they’ll depend, in part, on “enthusiastic” volunteers. “Person to person contact is absolutely the best method of getting the message out,” she said.

In Richmond, the beverage industry split the community along racial lines, garnering opposition to the tax from minority city council members and communities by claiming the tax was regressive and would hurt poor Latino and Black communities.

Dr. Alexander, who is African American, told IPS that although seven of the 15 members of the Berkeley coalition steering committee are people of colour, and the initiative is endorsed by the local NAACP and prominent Latino organisations, there is still need for vigilance.

“If they offer a [Black] minister 5,000 dollars for a church garden, would he accept it?” Alexander asked. “We’re prepared for attempts to divide the community.”

Another argument the beverage industry used effectively in Richmond, and the Coalition for an Affordable City is using in San Francisco, addresses the issue of personal responsibility.

“When it comes to our food and beverage choices and the choices we make for our families, we don’t need the city government’s input,” the Affordable City SF website says. “It should be up to parents to make responsible choices for their children. A beverage tax is no substitute for parental responsibility.”

But Sara Soka, consultant to the Berkeley pro-tax coalition, told IPS that while people have nominal choice about what they drink, “pervasive marketing from the beverage industry has made having a real choice a lot harder for all of us, especially kids and their parents.”

The beverage industry ads target children – especially children of colour, she said, adding, “About two-thirds of California teens drink one or more sweet drinks each day. And cheap drinks don’t help. A sugary drink tax is one way we can fund programmes that raise awareness for kids and parents.”

Berkeley Councilmember Laurie Capitelli cautioned it won’t be easy to fight the industry. “They’ll try to divide us by race, they’ll try to divide us by class, they’ll accuse Berkeley of trying to be a ‘nanny state,’” he said.

But Ritterman said understanding the tactics and messages big soda used in Richmond and El Monte, the Berkeley and San Francisco campaigns will “inoculate the public to what’s coming and take the power out of the beverage industry message.”

The post California Cities Gear Up to Fight “Big Soda” appeared first on Inter Press Service.

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OP-ED: Europe’s Commitment to Africa’s Children is Still Needed http://www.ipsnews.net/2014/04/op-ed-europes-commitment-africas-children-still-needed/?utm_source=rss&utm_medium=rss&utm_campaign=op-ed-europes-commitment-africas-children-still-needed http://www.ipsnews.net/2014/04/op-ed-europes-commitment-africas-children-still-needed/#comments Tue, 01 Apr 2014 11:29:26 +0000 Philippe Cori http://www.ipsnews.net/?p=133342 
Philippe Cori, director of the United Nations Children’s Fund’s (UNICEF) European Union Partnership Office in Brussels, says over the last decades, development assistance from partners like the EU and its member states has been critical to expanding and improving the quality of basic social services, especially for the poorest and most marginalised children.

The post OP-ED: Europe’s Commitment to Africa’s Children is Still Needed appeared first on Inter Press Service.

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UNICEF says in many parts of the African continent children are living beyond their fifth birthday, more children are going to school and more children are better equipped for the challenges of the 21st century. Pictured here are students at Motshane Primary School, Mbabane, Swaziland. Credit: Mantoe Phakathi/IPS

UNICEF says in many parts of the African continent children are living beyond their fifth birthday, more children are going to school and more children are better equipped for the challenges of the 21st century. Pictured here are students at Motshane Primary School, Mbabane, Swaziland. Credit: Mantoe Phakathi/IPS

By Philippe Cori
BRUSSELS, Apr 1 2014 (IPS)

As African and European leaders meet in Brussels this week under the theme of “Investing in People, Prosperity and Peace”, it is clear Africa’s greatest natural resource, its children, must be centre stage. 

Between 2010 and 2025, the child population of sub-Saharan Africa will rise by 130 million, making it the youngest continent in the world. By 2050, one in every three births and almost one in every three children under 18 will be in Africa.

Yet for this youth dividend to be the driver of Africa’s prosperity, it is critical that all of the continent’s children have the right foundations to be able to participate as well as benefit.

This means equitable access to basic quality social services in health and education, especially early childhood care as well as access to safe water, sanitation, good nutrition and protection from abuse, violence and exploitation.

A lot of the focus is now on how business can be a critical driver in the continent’s transformation.  And there is no doubt that new economic investment is yielding results, stimulating growth and new opportunities.

But it is also clear for Africa to ultimately benefit from these economic investments, it still needs a development focused partnership that builds the foundation of a strong, fair and equitable society for its youngest citizens.

In many parts of the African continent, life for millions of children is changing for the good. Along with the new investments in infrastructure, the rapid changes in access to mobile technology and an increase in economic growth, the good news is more children are living beyond their fifth birthday, more children are going to school and more children are better equipped for the challenges of the 21st century.

Philippe Cori, director of the United Nations Children’s Fund’s European Union Partnership Office in Brussels, says in many parts of the African continent, life for millions of children is changing for the good. Courtesy: UNICEF

Philippe Cori, director of the United Nations Children’s Fund’s European Union Partnership Office in Brussels, says in many parts of the African continent, life for millions of children is changing for the good. Courtesy: UNICEF

As Europe’s own experience demonstrates, investments in early childhood care, good nutrition, a quality public health system and safety nets to protect the most vulnerable,  are the foundations that lead to stable, inclusive and prosperous societies.

Over the last decades, development assistance from partners like the European Union and its member states has been critical to expanding and improving the quality of basic social services, especially for the poorest and most marginalised children. The success can be measured in concrete results, including a drop in child mortality by 45 percent between 1990 and 2012 and an increase in primary school enrolment among others.

We also know there is much more to be done. At least one in three children under five in Africa are stunted and over half of the world’s out-of-school children live in Africa (33 million).

Preventable disease like pneumonia, malaria and diarrhoea still account for 40 percent of all under five deaths. Hundreds of millions remain without access to safe water and adequate sanitation. Poverty pushes families to migrate, affecting children directly: whether they are left behind, migrating with parents or alone, they are increasingly exposed to vulnerabilities, including child trafficking — its darkest facet.

And we also know that economic growth, trade and business alone cannot translate Africa’s youth dividend into the dynamic asset it could and should be. Investments in human security, strong public institutions and equitable access to basic social services will remain vital to stability and our shared global prosperity.

Europe’s commitment to Africa’s children, especially the poorest, is still needed. Not just because it makes good business sense as it can help make sure there is a financial return on economic investments.

Not just because it will lead to less chances of conflict, insecurity and displacement. Not just because it makes sense for our shared humanity and our shared global future. But ultimately because Europe is and can make a difference by giving every Africa child the opportunity to reach their potential, to determine their own future and write their own story.

Philippe Cori is the director of UNICEF’s EU Partnership Office in Brussels which is managing UNICEF’s relations and partnership with the European Institutions with a view to influence and contribute to EU policies particularly in key areas such as nutrition, health, education, protection, gender, disability, poverty eradication and humanitarian assistance. This partnership aims at mobilising and leveraging quality resources for the realisation of children’s rights everywhere and especially the most disadvantaged.

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