Austria swept the first three places in the women’s marathon, which was won by Ursula Bredlinger in 2:49:20. She was six minutes ahead of second-paced compatriot Maria Zechmeister, while Dr Sabine Hofer came in third. Kenya’s Callen Moraa Areba was sixth.  

Ethiopian athlete Gidena Gebremedhin, also a guest of AMREF in Austria, won the Half Marathon for men in 1:04:46. Second was German Benedikt Fritz, who crossed the finishing line five minutes and 10 seconds later. Austrian Herbert Gruber was third.  The fastest woman in the Half Marathon was Lucy Karimi from Kenya. It took her 1:16:06 to run the 21,097km race. She was almost 10 minutes faster than Isabelle Heers of Germany, who came in second, while Austria’s Christina Gassner was third.  

The Salzburg AMREF Marathon was preceded on Saturday by the Coca-Cola Junior Marathon at which 1,300 children between the ages of 10 and 16 ran to raise money for AMREF. This is the biggest racing event for children in Austria.  

The Salzburg AMREF Marathon is not just an outstanding sports event; it is also a very successful charity event. The Kenyan Athletes ran side by side with Austrian and international personalities like Italian actress Caterina Murino, French rugby star Pierre Rabadan, Austrian Paralympics gold medalist Thomas Geierspichler and Austrian actor Fritz Egger. Consolata Kiragu, Kenya’s Charge d’Affairs in Vienna, and Counsellor Arown K Suge were also present to support the Salzburg AMREF Marathon.  

One of the side events arranged by AMREF in Austria was the “Black&White” gala, which included a concert by the Austrian band “Querschläger”. The gala was the highlight of the “Days of Dialogue”, a cultural programme in support of the Salzburg AMREF Marathon. Other events preceding the marathon included a series of African films, lectures and workshops.

Men’s Marathon

1. Christian Pflügl (Austria) – 2:23:32

2. Kennedy Matolo (Kenya) – 2:24:57

3. Karl Aumayer (Austria) – 2:28:42

Women’s Marathon

1. Ursula Bredlinger (Austria) – 2:49:29

2. Maria Zechmeister (Austria) – 2:55:21

3. Dr Sabine Hofer (Austria) – 2:56:55  

Men’s Half Marathon

1. Gidena Gebremedhin (Ethiopia) – 1:04:46

2. Benedikt Fritz (Germany) – 1:09:56

3. Herbert Gruber (Austria) – 1:12:35  

Women’s Half Marathon

1. Lucy Karimi (Kenya) – 1:16:06

2. Isabelle Heers (Germany) – 1:25:46

3. Christina Gassner (Austria) – 1:28:56

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'There Is a Real Sense of progress'

Flying AMREF’s Flag High

GSK Chief Executive Visits AMREF Projects, Announces New Funding for HIV/AIDS Initiatives in Africa

G8 did not do enough for African health, says AMREF 

Health at the G8: The Ultimate Delusion

Katine School to Take Part in British Council Link Programme

Barclays Chairman Visits Katine

Report Highlights Successes in Katine, but Shows Big Challenges Remain

Taking Africa’s Voice to the G8

Nipping Delicate Flowers in the Bud

Restoring Dignity to Women in Kenya

J&J Honours AMREF for ‘Vision and Dedication’

eLearning for Africa: AMREF Shares Crucial Lessons at ICT Conference

Austrian Athletes Shine at 6th Salzburg AMREF Marathon

Africa's Health Worker Crisis - An Interview with Dr Peter Ngatia

AMREF in The News

Training is essential in Katine

Katine's Village Health Teams Receive Gumboots

AMREF Launches New Publications

Measha Brueggergosman visits Northern Uganda with AMREF

Four Films and Blind Hope

Wanjiru to Support AMREF’s Worthy Cause

SOLD OUT and AMREF Flying Doctors present MAPENZI TAMU

 After a Devastating Birth Injury, Hope

Identifying Childhood's Killer Diseases

Katine: Still a great Deal to bo Done to End Poverty

AMREF Chats with Guardian Readers about Katine

When birth is Death: Stop Mothers from Dying in Southern Sudan

Olympic Gold Medalist visits AMREF Water and Sanitation Project in Ethiopia

Katine 'could be a Catalyst' for Community Development Elsewhere

Global Recession: A Death Sentence in Africa

Media and Development: Evolving Relationships

Childbirth 300 Times Riskier in Poor Countries Than Rich: UNICEF

Karibu AMREF

End Discrimination Against Women

Do hopes For Development in Africa Really Only Lie with Women?

French Government Honours Prof Miriam Were

AMREF Urges Engagement of Communities in Unpacking Global Principle

Former Street Children Show the Way in Fight Against HIV 

New Move to Improve Management of Health in Africa

Katine Website wins Second Award

Billions for Credit Crunch- and for Dying Mothers in Africa?

Giving Baby Martha a Firm grip And a smile

'Making Waves' In Support Of Water 

Health Systems Cannot Function Effectively Without Communities, AMREF

Katine's New Primary school Opens

Free VVF Camp-  Restoring Dignity To Women in Kenya

Equipping Managers to Run African Health Institutions

African Delegates Urged to Remain Focused Despite Gay Agenda 

People Go Naked as Dogs Dress Up To Protest Against Stigma

Where Is The Community, asks AMREF

G8 should invest in health workforce

AMREF to Train Nurses for Kenya's Largest Referral Hospital

EU Blue Card Rubs Salt into Wounds of Hurting Nations

Shortage of Personnel Hurting Delivery of Anaesthesia in Africa

Hammers Keeper Spreads Goodwill and Soccer Skills in Kenyan Slums

AMREF Seeks Effective Approaches to Save Africa’s Mothers and Children

Katine Website Wins An Award

Responding to Crisis: Lessons from Kenya’s Silent Emergency

NGOs Launch Code of Conduct to Support Public Health Systems

Community Partnering - The Missing Link

AMREF to host talks on community participation in health at global forum

Katine Community Gets into Drivers Seat

Village Health Teams: Setting the record straight!

Running Side by Side for Peace

Thinking Outside the Box to Meet Health Workforce Needs

AMREF Board Member Receives The Hideyo Noguchi Africa Prize 2008

Kenyas Political Unrest - Thoughts and memories from Kibera

Peace in Kenya: The Sick Can Now Access The AMREF Kibera Clinic

Kenya Airways Launches Charity Kitty to Change Lives

Let Communities Guide Decisions on Development of Health Workers

AMREF to lead Continental Network

'Camping' at Waithaka hill

AMREF Warns: 'Silent Emergency' Remains Even as Peace Beckons

Measles Outbreak Feared in Kibera

AMREF Mobile Clinics bring hope to Kibera

Baby Ryan Can Now Smile

Jamhuri Camp Reopened

HIV AIDS and TB Patients Unable to Access Treatment in Kenya

AMREF initiated Documentary Film, War/Dance, Nominated for Oscar

Government tells displaced families to leave Jamhuri Park

War/Dance Nominated for Academy Award

'Kenya In Crisis' Update of AMREF activities at Jamhuri Park

AMREF Takes Africa's Voice to World Economic Forum

Activities Resume at the AMREF Dagoretti Children in Need Project

AMREF’s ground breaking and award winning electronic learning (eLearning) project has launched in Uganda. The project which is designed to rapidly and cost effectively upgrade the skills of nurses and health workers across Uganda, was launched following a stakeholders meeting in Kampala.

“I am very pleased and indeed delighted to witness the beginning of the eLearning project in Uganda,” said the Minister of Health Honourable Stephen Malinga who presided over the launch. “As you are all aware, one of the biggest challenges in the health sector, not just in Uganda, but all over the world is the critical shortage of health workers. The focus of this project will be the nurse because they are the first point of contact for the communities seeking health services. They are the backbone of the health system and are placed to be the bridge that will close the gap that exists between communities and the peripheral end of the health system.”

For every 2000 people in Uganda, there is only 1 nurse and 1 doctor to almost every 200,000 patients, which is far below what is recommended by World Health Organisation (WHO) to ensure optimal care. For nurses, WHO recommends that there be 1 nurse for every 10 patients.

“Our nurse training institutions have been unable to train enough nurses to keep up with the country’s population growth rate and the increasing disease burden,” Said the honourable minister. “The Ministry of Health therefore greatly appreciates the introduction of this innovative eLearning approach to increase access for our nurses to quality, standardised training. ELearning has already been successfully used by our partner AMREF to rapidly and cost effectively up-scale nurses in Kenya (http://www.amref.org/info-centre/amref-courses--training-programmes/elearning-programme-/?keywords=nurses). By fast tracking the training of registered nurses, this eLearning project will greatly enhance the capacity of Uganda’s health system to provide care for the people of this country.” He reiterated.

The launch also saw the formation of a representative steering committee put together to guide the development and implementation of the project.

AMREF’s Country Director, Joshua Kyallo, expressed that the success of AMREF’s work is largely based on strategic partnerships. He requested the stakeholders to utilise their knowledge and expertise to ensure the feasibility and success of the implementation of the eLearning project in Uganda. “AMREF’s approach is to develop models that can be replicated across Africa. In this same spirit, the eLearning model, has been tried and tested in Kenya, and is now being replicated in Uganda. AMREF hopes to continue the replication throughout East Africa and beyond,” he added.

The launch, which took place at the Imperial Royale hotel in Kampala, drew participants and representatives from the ministry of health, ministry of education and sports, health training institutions, health facilities and other development partners. Other participants included representatives from the ministry of local government, professional health councils, the medical bureaus, the Uganda nurses and midwives union and council among others.

“The future lies in our innovative use of technology to improve the way our communities work, live, learn, communicate and, now, take charge of their own health,” said the minister. “The Ministry appreciates AMREF’s role in introducing this project and the Fresenius Foundation’s financial support through AMREF in Germany. Indeed it is only through working together in partnership and collaboration with other stakeholders like these that we will be able to get this country on the road to good health.”

AMREF, in a classic public-private partnership with the Nursing Council of Kenya (NCK), the African Medical and Research Foundation (AMREF), Accenture, the Kenya Medical Training Colleges, several private and faith-based nursing schools and the Ministry of Health Kenya pioneered a country-wide eLearning programme for upgrading nurses in Kenya. The programme commenced in September 2005 with a pilot of 4 schools and 145 students and aims to upgrade 22,000 Enrolled Community Health Nurses (KECHN) from ‘enrolled’ to ‘registered’ level within 5 years.

 

ELearning was the preferred mode due to its interactivity, cost effectiveness, ease of revision and ability to achieve the goal in less time and at a lower cost than the residential programme. It would also enable continued service provision, instant application of learning and improved quality of care.

 

For more information contact Steve Murigi, e mail steve.murigi@amref.org or Diana Mukami, email diana.mukami@amref.org.

Madam Ida Odinga calls on the media to highlight maternal health issues in Kenya ahead of International Women’s Day

Every day in Kenya, 21 women die during childbirth or pregnancy. It is a tragedy of enormous proportions, yet it receives very little public attention.

Madam Ida Odinga, patron of the White Ribbon Alliance for Safe Motherhood in Kenya (WRA-K), is challenging the media to highlight issues affecting the health of mothers in order for them to be addressed.

“Every single hour that we delay in taking action, a mother somewhere in Kenya is dying from complications related to pregnancy and child-birth. Yet maternal deaths can be prevented. You have a duty to actively bring the gravity of the matter to the awareness of the public and policy makers in order for it to be addressed,” she said.

Madam Odinga was speaking at a breakfast meeting at the Nairobi Sarova Stanley today, organised to bring to the media’s attention the unseen plight of thousands of mothers across the country. This is ahead of International Women’s Day to be marked on March 8, and which is set aside to celebrate the economic, political and social achievements of women.

“Women are at the heart of their families, communities and the country. Their health and survival has a huge impact on the economy and the environment, and on peace and stability. The death of a mother shatters her family and threatens the wellbeing of her family and her children. We all have a role to play to save their lives by advocating, among other things, increased funding for programmes to improve the health of mothers,” said Madam Odinga.

She pointed out that the solutions to improving maternal health already exist. “They include family planning, skilled attendance at birth and emergency obstetric care – things that some of us take for granted, yet they are inaccessible to the majority of Kenyan women.”

The White Ribbon Alliance for Safe Motherhood is an international coalition of organisations and individuals bound together by a common goal: to help ensure that safe pregnancy and childbirth are an attainable priority for all mothers and their newborns. With members in 118 countries, WRA advocates for changes to ensure every woman has access to quality health care before, during and after childbirth. 

While there has been progress in some health-related Millennium Development Goals (MDGs) set in 2001, the least progress has been made towards meeting MDG 5 – reducing the deaths of mother by three quarters by 2015. Maternal mortality in Kenya has remained unchanged over the years. And for every woman that dies in childbirth, 20 others suffer long-term illness and disabilities that are devastating to the woman and a serious economic drain on families and on society. 

“Maternal Mortality is the single greatest indicator of health systems that fail to meet the basic needs of the society’s poorest and most vulnerable women,” said Angela Nguku, WRA-K founder and National Coordinator.

For more information please go to www.whiteribbonalliance.org or contact Angela Nguku on Tel: + 254 20 699 3215

Following in the footsteps of the legendary Florence Nightingale, nursing students take free health care to a needy and neglected community 

Students of AMREF’s Virtual Nursing School (AVNS) will hold a Health Action Day Camp at the Jam City slum in Athi River on Friday, February 12, 2010, starting at 9am.   The event, to be held at the grounds of the Amrita Children’s Centre in Athi River, is part of the training programme for nurses enrolled at the AVNS, and is geared towards equipping them with skills in community health care, a key component of in their professional practice. The primary purpose of the camp is to help individuals and the community to develop knowledge, skills and motivation to take charge of their own health. The day’s activities will include screening and treatment for diseases, family planning services, cervical cancer screening, immunisation for children under five years and expectant mothers, nutritional counselling, health education and environmental clean-up. Complex cases will be referred to hospital. This day would not be possible without the generous contribution and funding from The Nation Media Group whose staff will participate as volunteers for the medical camp. 

AMREF’s Virtual School has been training nurses through eLearning, a revolutionary method that uses computer and mobile technology to upgrade the skills of nurses while they are still working. Since its inception in March 2007, AVNS students have emerged the best countrywide in the two state registration and licensing examination that they sat for.

To the Editor

The African Medical and Research Foundation (AMREF) is the largest Africa-based international non-governmental organisation working in health development. AMREF targets the very poor, those living within the lowest economic quartile, remote areas, urban slums, IDP camps, nomadic populations, in situations of chronic insecurity and those groups particularly vulnerable to diseases of poverty such as women, children, adolescent and youth. 

For more information, contact Angela Nguku on +254 722 365434 or 6993000

About the Nation Media Group (NMG)

NMG is the leading multi-media house in East & Central Africa and is a keen and proud investor in community programmes. Social and Community responsibility is one of its 15 top line principles that management and staff agree is a must-have in its formula for success as a corporate. NMG believes it is important to give back to the community, helping them to achieve their goals. NMG’s Corporate Social Responsibility section is therefore responsible for maintaining good contacts with key stakeholders to ensure sustainable community partnerships; planning and driving the promotion, co-ordination and delivery of employee participation in community events.

It was a bright day in Katine as members of the village heath teams (VHTs) and traditional birth attendants (TBAs) received extra support for their work in the form of gumboots.

Four VHTs from each of the 66 villages in Katine sub-county flocked to the AMREF office earlier this month to receive their boots, which will help protect them from thorns and rain as they travel around their communities offering health advice.

Emmanuel Ekolu, the VHT coordinator from Ojom parish, says the gumboots are a significant boost to the work of VHTs.

"You see mobilising the community is not a simple thing, so people need all the facilities to do their job, and I'm happy that AMREF the implementer of the Guardian-funded project, are doing a good job," he said.

Village health teams are a government initiative aimed at improving the health of needy communities, such as Katine. So far, members of the sub-county's teams have received bicycles and training.

The Katine project is steadily registering an impact with many residents as they get to know the importance of living a healthy life, says Florence Anamo, a VHT from Ojiji village, in Olwelai parish.

At least 26 traditional birth attendants also received the gumboots.

"Helping mothers here receive a normal delivery is something quite challenging, and puts our life at risk because you literally had to step on blood, but with this pair of gumboots, I'm pretty sure that our woes are history," says Josephine Achen, chairwoman of the TBAs. "We at times step on snakes while rushing to attend to mothers in labour pain,' she adds with a smile.

TBAs are seen as essential in Katine, where mothers have to trek between five and 14km to access antenatal services at Tiriri health centre, a situation that puts the health of many at risk.

AMREF's health programme assistant, Alfred Okurut, said: "We are giving gumboots to motivate and support them [VHTs and TBAs]. Visiting homes during the rainy season can really be challenging to these people - especially now that the rains are returning. So they requested us to get them gumboots."

While handing out the gumboots, Jorem Eboku, Katine's local council chairman, the top political leader of the sub-county, expressed fears that due to poverty levels some VHTs and TBAs were likely to sell the gumboots.

However, he pledged to monitor all assets AMREF donates to the two groups, warning that whoever sells the gumboots or bicycles faces his wrath.

"These assets you are getting are not yours to go and sell. You are supposed to utilise them to mobilise the community, and any one we find selling any of the items she/he has received will be forced to produce and even stopped from working with the partnership project," Eboku warned.

AMREF has received a 4.2 million Euro grant from the European Union (EU) to reduce maternal, newborn and child mortality in marginalised areas of Kenya, Southern Sudan and Tanzania, contributing to regional learning on MNCH while accelerating progress towards attaining the Millennium Development Goals (MDGs) in Africa. 25 % of the project budget will be co-funded by AMREF in the Netherlands who will also provide technical assistance on MNCH and monitoring and evaluation.

While global, regional and national policies to improve MNCH exist, and interventions to prevent maternal, neonatal and child deaths are available in Tanzania, Kenya, and Southern Sudan, MNCH indicators remain unacceptably poor.  Progress has been hindered by poor policy implementation and weak health systems, which do not engage with or respond to community needs. This results in poor access and utilisation of preventive and curative health services.

Tanzania has witnessed a significant reduction in child mortality rates over the past two decades, but maternal health statistics have yet to improve. Poor women are 7 times more likely to give birth at home than the rich, with little or no post-natal care. Huge discrepancies in utilisation of services between pregnancy and delivery prevail with 99% of women attending Antenatal Clinics (ANC) at least once, but only 46% of births are attended by skilled personnel.

Running in Mtwara and Tandahimba districts of Tanzania, the project Putting African Mothers, Newborns and Children First: Strengthening community capacity to improve maternal, newborn and child health, will work in line with the government’s Primary Health Sector Development Plan (PHSDP) towards improving the delivery of health services by empowering communities to actively participate in health service access and provision by building the capacity of community health workers to increase community awareness around essential health interventions (Reproductive and Child Health among others) through health communication and education activities, advocacy, community mobilisation, mediation and lobbying.

The inception of the project is based on needs identified by project partners and potential beneficiaries, and is designed to dovetail with Tanzania’s national health and poverty reduction strategies. Overall indicators in historically marginalised southern districts of Tanzania, such as Mtwara and Tandahimba are exceptionally poor with social services provision characterised by a shortage in health and education facilities and inadequate staffing.

The project’s specific objective will be to strengthen the capacity of communities, civil society organisations and local authorities to provide, improve access to, and demand quality MNCH services for marginalised communities. The expected results in line with local plans, national and international policies include:

• Communities, especially women and girls, who are empowered with the knowledge to promote health-seeking behaviour, demand and access MNCH services;
• Increased capacity of local health systems to manage and deliver inclusive and comprehensive community-responsive MNCH services;  
• Strengthened civil society organisation (CSO) capacity to participate in decision-making and influence MNCH policies and practices at local, national and international levels;
• Regional knowledge-base established on community based solutions to improving MNCH that will be used to inform policy making at national, regional and international levels.  

The project focuses on maternal, newborn and child health as linked public health issues, but strategies to address MNCH have wider benefits on the health system – a stronger referral system benefits others too, over and above mothers and children, by allowing access to health services in a timely fashion.  The project shall reach over 500,000 people in the target districts who will benefit from improved health and enhanced human resource capacity at the community and health facility level.

  ‘If fistula was a condition affecting men, would it have taken us this long to do something about it?”   Dr Eunice Kiereini, chairperson, Flying Doctors’ Society of Africa

Sarah Omwenga could easily have passed for a surgeon as she confidently took to the podium at the International Society of Obstetric Fistula Surgeons’ (ISOF) Conference in Nairobi this week. When she began to speak, her strong voice cutting across the room, the participants from across Africa, Asia, Europe and America fell silent, their undivided attention on the young Kenyan woman.

For the next 12 minutes, Sarah spoke of her ordeal with fistula, a condition caused by prolonged labour that leaves a woman unable to control the flow of urine, and sometimes stool as well. Young mothers whose bodies are not sufficiently formed to handle the rigours of childbirth, and women who cannot access qualified maternal health care, are particularly vulnerable to fistula, and to the disgrace, dejection and isolation that come with the demeaning condition.

Sarah became pregnant as a teenager after she was raped. 

“I was in labour at home for 20 hours and then I was taken to the local dispensary, where I spent another 18 hours in labour. When the child finally came, it was dead,” she told the hushed room.

Three days after delivery, she realised she could not control her urine. “I stayed in hospital for two months, hoping for a cure, but I was told that my condition required a doctor from abroad.” With no money to pay for an operation, she went home to hide away from the world.

 “My nights were full of tears. I felt trapped, lonely and dejected.”  For 12 years, she suffered from the pain and discomfort of genital sores and the ever-present, humiliating stench of her own urine. The shame and the dejection finally drove her into depression and in 2007; she was admitted to the Moi Referral Hospital’s psychiatric ward. It was here that a doctor told her that fistula could be treated at the hospital. Sarah was thrilled.

“After the surgery I regained my life and my dignity. I survived physical and emotional trauma to become a living testimony of how our health system has failed. I now speak on behalf of shattered families and children devastated by the deaths of their mothers,” she said.

Sarah’s story reflected the struggle of more than two million women across the world who live with fistula. Today, she is an ambassador for the United Nations Population Fund (UNFPA), adding her voice to a global campaign to eliminate fistula in the world and restore the dignity of women who suffer in silence from a condition that could be prevented and cured.

The three-day Fistula Surgeons’ Conference, hosted by the African Medical and Research Foundation (AMREF), aims at sharing knowledge in the prevention and treatment of a condition that mostly affects developing countries and particularly Africa.

From Kenya to Pakistan, the story is the same: more women are developing fistulas because health care systems across the developing world are poorly funded, inaccessible and too expensive for most rural women. Thousands of lives are being shattered by the poor attention mothers receive at the hands of untrained birth attendants and in poorly equipped rural health facilities.

According to Conference Chair, who is also AMREF’s Outreach VVF surgeon, Dr Weston Khisa Wakasiaka, 90 per cent all fistulas occur in Africa.

“Fistula in Africa is linked to the status of the health care system, malnutrition, poverty and ignorance. Women must be empowered with knowledge and resources to take decisions that enhance their health,” said Dr Wakasiaka.

Statistics presented at the conference indicated that rural women were most affected by fistulas, with tough terrain and cultural factors making them particularly vulnerable. In Ethiopia, for example, women are sometimes forced to walk for up to three days to access health facilities. “Even when they can take public transport, some find it difficult to use public vehicles because of urine leakage,” observed Amare Desta, a public health officer at Yirgalem Hamlin Fistula Centre in Ethiopia.

The situation is compounded by cultural factors, added Desta, because men often deny their wives permission to attend ante-natal clinics during the farming season, preferring them working on the land. At least 9,000 Ethiopian women develop fistulas every year. Desta believes that public awareness campaigns must be intensified to educate health workers and the public on how to identify and prevent them.

“Although many men and women of reproductive age have heard about obstetric fistula, they are not aware of the risk factors. Besides, most women living with the condition are poor and reside in remote areas where they cannot access health care,” Dr Julius Onesmo from Tanzania observed.

Studies conducted by AMREF in Kenya’s Kibwezi District showed a high level of awareness about the importance of seeking maternal health services, but women were prevented from accessing them by the long distances to health facilities.

“Women are not opposed to delivering in health facilities. Most of them cannot access the facilities and even when they can, they are unable to afford the medical charges,” observed Dr Johnson Musomi of AMREF’s Clinical Outreach programme.

Jane Makona, a district public health nurse who has worked in Western Kenya, fears that complications like fistula will continue causing misery to women in rural parts of Africa.

Working in the interior parts of Western Kenya for the last 20 years, Makona has seen the population grow without a corresponding increase in health facilities. She has also seen the rural population getting poorer.

“The women rely on traditional birth attendants because they can pay them using maize or chicken. The tragedy is that most of these attendants are not trained to detect or prevent complications like fistula,” she noted.

Dr Anne Wamae, head of Child and Adolescent Health at the Kenyan Ministry of Health, said that even in situations where the children survive after prolonged and poorly managed labour, they often end up with brain complications or retarded growth.

“We are integrating obstetric fistula into safe motherhood initiatives and equipping hospitals across the country with medical kits and qualified personnel to treat fistula,” Dr Wamae said in a speech she read on behalf of Public Health and Sanitation Minister Beth Mugo.

A number of local, regional and international non-government organisations have tried to supplement government efforts, but more resources are needed to eliminate fistula. In Kenya, AMREF has since 1992 been at the forefront of creating awareness about fistula and treating women affected by the condition. The organisation repairs 2,000 cases annually in East Africa.

“We want to train as many health workers as possible so that they take over the responsibilities of doing fistula repairs. Today, 80 per cent of surgeries are carried out by health specialists from countries where we operate and we only assist where complications occur,” said Mette Kjaer, Country Director of AMREF in Kenya.

Dr Festus Ilako, head of programmes and deputy country director of AMREF in Kenya, observed that partnership with the community is critical in preventing and treating fistula cases.

Other organisations are using innovative means to alleviate the suffering of fistula patients. Anne Gloag of the Freedom from Fistula organisation has combined radio campaigns and the popular mobile phone money transfer systems in Kenya to reach rural women with fistula and provide them with bus fare to health facilities.

  

A total of 93 clinical officers and 42 community midwives graduate from the Maridi National Health Training Institute

The students, their families and communities will always remember November 25 as a special day. For most of them, this is the culmination of a life-long journey to attain the right training and knowledge to serve their fledgling country.

“This is the happiest day of my life,” says 75-year-old Akec Aleer, who is here to witness her niece, Regina Achel, take the final step to becoming a clinical officer. “I am so proud of her. Now she will take care of all our sick.”

Each of the students at the AMREF-run Maridi NHTI is special in many ways. Most are former soldiers, who now offer themselves for selection by their communities and the Government of Southern Sudan (GoSS) to train as clinicians, offering scarce and vital medical services in this vast country.

According to Dr Stanley Ambajaro, Director for Human Resource Development in the GoSS’s Ministry of Health, “clinical officers are now providing 75 per cent of required health services in our country. This school is training competent and committed mid-level health professionals.”

 The Maridi School opened its doors in 1998, in the midst of the civil war in Southern Sudan, and has grown to be the leading health training institution in the country. In 2001, when the first class of 13 graduated, no one could have known that only eight years later, the Maridi NHTI would be celebrating the graduation of 145 students, over 10 times the number in the first class.

“Southern Sudan is uplifting,” says the school principal, Mr Eluzai Lou, himself a former student and a former soldier of the Sudan People’s Liberation Army. “Today allows us to throw a light into the future of our country.” Lou’s words are spoken with a passion and commitment. Three-quarters of the school’s faculty are alumni of this same institution.

Initially, the training offered at Maridi was only for clinical officers, but the class of 2009 comprises 93 clinical officers and 42 community midwives. The community midwives’ training is supported by the United Nations Population Fund (UNFPA) in a bid to quickly help reverse the grim dangers that women and children face from common conditions and diseases. Southern Sudan has the world’s worst health indicators, with 2,057 per 100,000 women dying during pregnancy or childbirth compared to 400 for 100,000 in Kenya and 3 in every 100,000 in Northern Europe.

 “I am really excited to be graduating today,” says Alex Mawa, a graduating clinical officer. “It has been tough. Sometimes we even have to use donkeys to get to the hospitals where we do our practicals, but now after the long journey, I can to go out and save many lives.” 

A recent report produced by the WHO and AMREF indicates that Southern Sudan needs 1,500 clinical officers in the next five years (a production of 300 per year). After 20 years of civil war, many professionals, including health workers, fled to neighbouring countries, Europe and North America. Currently, there are only 39 doctors working in the entire country, 20 of these in private clinics.

“We still need to find a way to train more mid-level workers,” says Dr Peter Ngatia, AMREF’s Director for Capacity Building. “We have the capacity to train 150 clinical officers every year here at Maridi, but because of funding constraints we are currently training only 45.”

Earlier in the day, representatives from AMREF, GoSS Ministry of Health, the West Equatoria State and the family of the founder of the School, the late Prof Chris Wood, were conducted on a tour of the facilities. The Chief Guest, HE Grace Datiro, who is the Minister for Social Development in West Equatoria, and AMREF’s Deputy Director General Dr Florence Muli-Musiime, commissioned two new buildings funded by USAID through the American Schools & Hospitals Abroad (ASHA) fund. Prof Wood’s daughter, Lucy Wood, unveiled a plaque dedicating the Maridi Resource Centre to her late father.

In her remarks to the graduates, the Chief Guest HE Grace Datiro said: “You will be joining many clinical officers from Maridi who have qualified before you and have gone on to become the backbone of Southern Sudan’s health services. A few years ago, many of you, young men and women, were fighting with guns but now you are properly armed to go and face our nation’s most daunting enemy - disease.”

Nash Colundalur: The Guardian

The vast expanse of the harsh landscape is broken by a gathering of a few hundred people, standing and crouched down in an unruly circle, all eyes focused on the centre. Emotions are running high among the ashen women, with some having slumped and collapsed to the ground. The men, desperately trying to take control of the situation, wave their long sticks furiously and yell agitatedly into the circle. Bellowing goats, sheep and cattle recklessly try to break into the ring.

They are all desperate for water. Abumon throws her arms up in the air, breaks out of the circle and in resignation crashes to the ground. She looks fretfully into the horizon. "I don't care any more, I will die here." She lifts a weak arm to point at the mountains. 'They will come and take everything." She beckons her small, severely malnourished child towards her. Suddenly there is great clamour from within the circle. A small container is making its way up, passed from hand to hand. A fresh flurry of yelling and stick-brandishing follows from the men, until the yellow plastic container finally arrives. The black sludgy water is first fed to the children, who lap it up quickly and cry for more.

It has not rained adequately for four years in Turkana, northern Kenya. The district is 80,000 sq km and is populated by nearly 500,000 nomadic pastoralists. For hundreds of years, the Turkana people have been herdsmen, rearing cattle, sheep and goat. They are one of the most nomadic people in the world, at times moving every month looking for pasture for their livestock. Climate change and marginalisation by successive governments have seen resources deplete at an alarming rate across their traditional home.

Lorus, where the tribe has gathered to fetch water, is a natural underground spring close to the Sudan border. In desperation, they have dug and blasted their way to the eye of the spring to get to the water, which is several metres from the scorched surface. Sand, mud and faeces from livestock slither into the rocky well, turning the water into a dangerous, dark sludge. The threat of heavily armed, ruthless cattle-raiders from neighbouring countries constantly hangs in the air. "The Topoza from Sudan took away 60 of my cattle," Namuge gestures with his head at the mountains. "I now have four left and they are dying." He pours the black liquid into a trough for the cattle; one of them has gone down on its knees, refusing the water. "I am waiting for it to die." he says, adjusting a long knife fastened around his waist.

Eberhard Zeyhle, a German parasitologist, came to Kenya 28 years ago to investigate Hydatid disease, a tapeworm infestation passed on from livestock to humans. Since then, as part of Amref (African Medical Research Foundation), he has been involved in providing general healthcare and facilitating social development for this remote community.

"Turkana district has enough water resources to feed the entire population, it just needs to be scientifically harnessed," he says. He also thinks that large parts of the land are fertile. If irrigated, farming could become an additional and fall back source of income for the Turkana. He points into the depths of the blasted rock "We need to protect the eye of the spring. It needs to be sealed and the water led to an underground tank. This will ensure clean water without any contamination." Though the solution seems simple, he says it is hard to do it now because the Turkana are terrified of the water depleting if the eye of the spring is sealed.

Eberhard thinks that donors, NGOs and the government can do their part, but the Turkana have to co-operate and the initiative has to come from within. This opinion is shared by Alex Lama, coordinator at Akosi (which translated from the Turkana language means "ours") an organisation involved in various development projects.

"The CDF [community development fund] allocated to the district, by the government is a drop in the ocean," says Lama.

Ekono is a 60-year-old man of very few words. He sports a grey cap with a feather in it and a large ivory coloured finger ring that he polishes constantly. Ekono is an Emeron, a revered spiritual leader for the whole of the Turkana district.

Sitting at one of Amref's container clinics, a robust health centre made from a shipping container located along the Turkana's migratory routes, he says slowly: "I will mobilise my people to part with a cow each, we can raise half the money needed for a borehole." He looks around the people gathered. "My people are dying, I only ask the government and donors to contribute the other half."

Elimnon Peunon, a Turkana from a neighbouring village who is squatting beside Ekono, stares intensely at the ground. "I had nine children," he says. "The drought killed two of my youngest children and two more were gunned down by the Topoza. We have tried to contact the government many times through our councillors. Our so-called MP has not once come here."

Raising his voice and standing up, he continues: "We want the government to give us protection and water." He sweeps his hand across the never-ending landscape and lowering his voice as if to tell a secret. "This land is fertile, the water is there, all it needs is irrigation; we are willing to diversify."

John Munyes is the elected MP for the district and a cabinet minister in the Kenyan government. Over the years he has been minister for various departments including water. "The reason the Turkana are being marginalised is political," he says. "The executives in the government see Turkana as a low-potential area. They are seen as not contributing to the GDP." He says because of bureaucracy the government of Kenya has not raised the threat level high enough to provide security along the border to tackle raids from Sudan and Uganda. "We need to improve our water sources to target dry-season grazing. We can plan water pans and boreholes along migratory routes and allow a system where it is used only during the dry season."

There has been pressure from the state for the Turkana to lead a more sedentary life, making it easier for services to be provided. Experts believe this will only devastate the climate even more. As pastures start dwindling, the Turkana target trees and large shrubs, cutting them down unscrupulously and burning them to produce charcoal. Sarah Mathew, a doctoral research student from the University of California, Los Angeles, says that there is general misconception that the nomadism of the Turkana is the problem, whereas nomadism is actually the solution to it.

Namuge has taken a break from retrieving water from the spring. He looks plainly at his collapsed cow. "We are nomadic; give us water during the dry season and then we will move on," he says. With collected energy the cow jerks its head, lets out a moan and dies. Namuge has come prepared. The withered animal is dragged away from the spring and with the help of his four sons, butchered into smaller pieces, to be carried back to the village. "At least my family can eat for a few days; I did not have the heart to slaughter it while it was alive."

An estimated 33.4 million people worldwide are infected with the AIDS virus, according to a statement issued by the World Health Organisation and the Joint UN Program on HIV/AIDS (UNAIDS).

Here are some facts about AIDS, according to UNAIDS:

The Global Picture:

* Global deaths from AIDS reached an estimated 2 million in 2008, the same number as in 2007. Since the AIDS pandemic started in the early 1980s, almost 60 million people have been infected with the virus and 25 million have died of HIV-related causes.

* In 2008, around 430 000 children were born with HIV, bringing to 2.1 million the total number of children under 15 living with HIV. Young people account for around 40 percent of all new adult (15+) HIV infections worldwide.

* The annual number of new HIV infections remained the same in 2008 as for 2007 at 2.7 million. This is down from 3.0 million in 2001.

* Although 33.4 million people suffered human immunodeficiency virus infections in 2008, more of them are living with HIV than ever before because people are living longer at least in part due to the beneficial effects of antiretroviral therapy.

Africa & Asia:

* Sub-Saharan Africa remains the region most heavily affected by HIV, accounting for 67 percent of all people living with HIV worldwide and 91 percent of all new infections among children.

* Sub-Saharan Africa also accounts for 72 percent of AIDS-related deaths.

* An estimated 1.9 million people were newly infected with HIV in sub-Saharan Africa in 2008, bringing to 22.4 million the number of Africans living with HIV.

* The nine countries in southern Africa continue to bear a disproportionate share of the global AIDS burden, with each of them having an adult HIV prevalence greater than 10 percent.

* With an adult HIV prevalence of 26 percent in 2007, Swaziland has the most severe level of infection in the world. Lesotho's epidemic seems to have stabilised, with a prevalence of 23.2 percent in 2008.

* South Africa continues to be home to the world's largest population of people living with HIV - 5.7 million in 2007.

* In Asia, an estimated 4.7 million people were living with HIV in 2008. The number of new HIV infections decreased from 400,000 in 2001 to 350 000 in 2008.

* In 2008, an estimated 330,000 people died of AIDS-related illnesses.

* Asia, home to 60 percent of the world's population, is second only to sub-Saharan Africa in terms of people living with HIV.

* India accounts for roughly half of Asia's HIV prevalence. With the exception of Thailand, every country in Asia has an adult HIV prevalence of less than 1 percent.

* HIV prevalence in eastern Europe and Central Asia is on the rise, with severe and growing epidemics in the Ukraine and Russia. With an adult HIV prevalence of 1.6 percent in 2007, Ukraine has the highest prevalence in all of Europe.

* In Latin America, new HIV infections totaled an estimated 170,000 in 2008 bringing to 2 million the number of people living with HIV in Latin America. An estimated 77,000 people died of AIDS-related illnesses last year.

* In 2008, North America had 55,000 new HIV infections and Western and Central Europe had 30,000 new infections.

Sources: Reuters/UNAIDS

(Writing by David Cutler, London Editorial Reference Unit; Editing by Bill Tarrant)

It was a meeting of like souls, though on the surface they seemed like very dissimilar people. Indeed at first glance, one would not think that there was much in common between a senior, no-nonsense Kenyan minister and a lively community of disadvantaged children from a low-income Nairobi suburb. But when Hon John Michuki, Minister for the Environment and Mineral Resources, spent a day with the children of AMREF’s Dagoretti Child in Need Centre, they discovered that they were, indeed, kindred spirits.  

On Friday last week, the minister and the children were brought together by their mutual concern and passion for the environment. Hon Michuki joined the children and the Dagoretti community in planting trees at the Centre, and encouraged them not just to plant trees, but to ensure that those trees were nurtured to maturity. Touching on a major undertaking by his ministry to clean up rivers serving the city of Nairobi, the minister encouraged the community to take care of water sources.

“We have plenty of water – we just don’t take good care of it,” he said. “Water is life, yet we have polluted what we have and made it dirty. We are drinking this dirty water, and that is why instead of living to a ripe old age many people die young, while children are born stunted and weak. Many rivers have dried up because of man’s activities, such as cutting down of trees. We must look after the resources we have.”

Minister Michuki launched an e-Journal by the Different Perspectives group of the Dagoretti Child in Need Project, focusing on the Millennium Development Goals (MDGs). The online journal was developed by the Dagoretti team led by Project Manager John Muiruri, with assistance from Sayaka Hino, an intern at the centre. It features articles written by the children on progress on the ground towards achievement of the MDGs. At the same time, the Minister launched Millennium News, a documentary on the eight MDGs from the perspective of the children. Hon Michuki watched a segment of the documentary focusing on MDG 7 – environmental sustainability.

The minister was accompanied by Prof Hiriyuki Hino, economc advisor to Prime Minister Raila Odinga.

When he addressed the huge crowd that turned up at the centre, the minister was clearly impressed by the work done by the centre’s youth to promote environmental conservation, including the use of waste to make music.

“I never thought that such good music could come from plastic paper bags, or discarded water bottles, or rusty drums that others only deem fit for brewing chang’aa (an illicit alcoholic brew),” Hon Michuki said after watching a demonstration by the Jua Kali Drummers, who create music using instruments made from recycled waste. So taken was he with the performance that he invited the group to visit his Kangema Constituency in Kenya’s Central Province.

Minister Michuki is a stickler for time and detail. However, while his visit to the centre should have ended at 1pm, he agreed to visit to the children’s studios at the Dagoretti Theatre House. Here, the Different Perspectives Group interviewed the minister on environmental issues, ranging from how to care for trees to Kenya’s position at the recent global conference on climate change in Copenhagen. The minister then joined the children for a cup of tea, and told them of his childhood experiences. And herein lay the basis of a deep connection between the minister and the Dagoretti children.

“But for the grace of God, I would have been a street child,” he said. He went on to explain: “I was born into a large, wealthy family. My father was a chief with 43 wives, and in my early years, I lived a very privileged life. But when I was nine, my father died, and my mother and I were not able to get any of his wealth. Life changed for me. However, my illiterate mother was very keen that I get an education, and that is what got me where I am today.”

For the next couple of hours, the Minister spoke with the children, answering their questions and giving them advise. He urged them to be disciplined, committed and organised, and to study hard. Using himself as an example, he told them that it was possible to rise from obscurity to a place where they could make an impact in the world.

It was indeed a meeting of kindred spirits. At the end of the day, a special bond had been formed between the minister and the children. Each had discovered a part of themselves in the other.

For further information please contact:

Betty Muriuki- AMREF Writing Manager, on +254 20 6993327, email: betty.muriuki@amref.org

South Africa’s response to AIDS received a powerful boost with President Jacob Zuma’s landmark speech to the National Council of Provinces on 29 October 2009. The speech heralds the beginning of a new movement to accelerate access towards universal access to HIV prevention, treatment, care and support in the country which has the largest number of people living with HIV. In his speech the President calls on all leaders to work together and use evidence to inform the country’s AIDS response.

Congratulating the President on his bold leadership, UNAIDS Executive Director Michel Sidibé said, “President Zuma has shown extraordinary vision in prioritizing AIDS as an issue of national importance. His call to end denialism and embark on a national mobilization campaign will save thousands of lives.”

In his speech the President called for a major movement to cut new HIV infections by half and reach at least 80% access to antiretroviral treatment. UNAIDS will support the Government of South Africa in implementing this promise.

Here are some excerpts from speech of President Zuma of South Africa to the National Council of Provinces.

The full speech can be accessed online at http://www.thepresidency.gov.za/president/sp/2009/sp10291518.htm

“Our young democracy faces significant challenges. Though we have achieved much, there is much more that we need to do. Just as we cannot allow ourselves to be overwhelmed by these challenges, we dare not underestimate them. If we are to build the thriving nation for which we have worked so hard, and for which so many have sacrificed so much, we need to appreciate the extent and nature of these challenges.

The first of these challenges relates to our economy. The global economy is going through a major economic crisis. The impact of this crisis has been felt by every section of our society. Businesses, both big and small, have been closed. Thousands of workers have lost their jobs. As more families lose their livelihoods and businesses risk collapse, they look to government for assistance….”

“The second challenge that I wish to highlight is no less grave. Indeed, if we do not respond with urgency and resolve, we may well find our vision of a thriving nation slipping from our grasp.

Recent statistics from the Department of Health, Human Sciences Research Council, Medical Research Council, Statistics SA and other sources paint a disturbing picture of the health of our nation. They show that nearly 6 out 10 deaths in our country in 2006 were deaths of people younger than 50 years. If we consider mortality trends over the last decade, we see that the age at which people die has been changing dramatically.

More and more people are dying young, threatening even to outnumber in proportional terms those who die in old age.

Honourable Members, South Africans are dying at an increasing rate. The number of deaths registered in 2008 jumped to 756,000, up from 573,000 the year before.

At this rate, there is a real danger that the number of deaths will soon overtake the number of births. The births registered during this period were one million two hundred and five thousand one hundred and eleven (1, 205, 111). The Independent Electoral Commission had to remove 396 336 deceased voters from the Voters Roll during September last year and August this year.

What is even more disturbing is the number of young women who are dying in the prime of their life, in their child-bearing years. In 2006, life expectancy at birth for South African men was estimated to be 51 years. By contrast, life expectancy in Algeria was 70 years and 60 years in Senegal. These are some of the chilling statistics that demonstrate the devastating impact that HIV and AIDS is having on our nation.

Not even the youngest are spared. Some studies suggest that 57% of the deaths of children under the age of five during 2007 were as a result of HIV. This situation is aggravated by the high tuberculosis prevalence. The co-infection rate between HIV and TB has now reached a staggering 73%. Statistics indicate that the numbers of citizens with TB number at 481 584. These statistics do not, however, fully reveal the human toll of the disease. It is necessary to go into the hospitals, clinics and hospices of our country to see the effects of HIV and AIDS on those who should be in the prime of their lives.

It is necessary to go into people’s homes to see how families struggle with the triple burden of poverty, disease and stigma. Wherever you go across the country, you hear people lament the apparent frequency with which they have to bury family members and friends.

Let me emphasize that although we have a comprehensive strategy to tackle HIV and

AIDS that has been acknowledged internationally, and though we have the largest anti-retroviral programme in the world, we are not yet winning this battle. We must come to terms with this reality as South Africans.

We must accept that we need to work harder, and with renewed focus, to implement the strategy that we have developed together. We need to do more, and we need to do better, together. We need to move with urgency and purpose to confront this enormous challenge.

If we are to stop the progress of this disease through our society, we will need to pursue extraordinary measures. We will need to mobilize all South Africans to take responsibility for their health and well-being and that of their partners, their families and their communities.

All South Africans must know that they are at risk and must take informed decisions to reduce their vulnerability to infection, or, if infected, to slow the advance of the disease.

Most importantly, all South Africans need to know their HIV status, and be informed of the treatment options available to them. Though it poses a grave threat to the well-being of our nation, HIV and AIDS should be treated like any other disease. There should be no shame, no discrimination, no recriminations. We must break the stigma surrounding AIDS.

In just over a month, we will join people across the globe in marking World Aids Day.

Let us resolve now that this should be the day on which we start to turn the tide in the battle against AIDS. Let us resolve now that this should be the day on which we outline those additional measures that need to be taken to enhance our efforts.

Let World Aids Day, on the 1st of December 2009, mark the beginning of a massive mobilisation campaign that reaches all South Africans, and that spurs them into action to safeguard their health and the health of the nation. Though a considerable undertaking, it is well within our means, and we should start now, today, to prepare ourselves for this renewed onslaught against this epidemic.

We have very impressive awareness levels in our country, well over 95%. We should now seriously work to convert that knowledge into a change of behaviour. We have demonstrated in the past that, working together as a nation, we can overcome even the greatest of challenges.  We can and will overcome this one.

But we must begin by acknowledging the true nature of that with which we are confronted. We should not be disheartened by what we find. Rather, we should be encouraged to act with greater energy and motivation to overcome.

I have instructed the Minister of Health, as we prepare for World Aids Day, to provide further detail to the nation on the impact of HIV and AIDS on our people.

He will do so next week.

The important factor is that our people must be armed with information.

Knowledge will help us to confront denialism and the stigma attached to the epidemic.

Informed by this understanding, we expect that the South African National AIDS Council, under the leadership of the Deputy President of the Republic, Mr Kgalema Motlanthe, will develop a set of measures that strengthen the programmes already in place.

We must not lose sight of the key targets that we set ourselves in our national strategic plan.

These include the reduction of the rate of new infections by 50%, and the extension of the antiretroviral programme to 80% of those who need it, both by 2011. Prevention remains a critical part of our strategy. We need a massive change in behaviour and attitude especially amongst the youth. We must all work together to achieve this goal.

As we prepare for World Aids Day, and as we undertake the programmes that must necessarily follow, let us draw on our experience of mass mobilization and social engagement. The renewed energy in the fight against AIDS and in mobilizing towards World Aids Day must start now, by all sectors of our society. Working together, we cannot fail.

Whatever challenges we face, we will overcome.

Whatever setbacks we endure, we will prevail.

Because by working together we can and will build a thriving nation

By Dagi Kimani

Tanzania is lagging behind other EAC countries in rolling out treatment for HIV/AIDS, according to a report released by the World Health Organisation, Unicef and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

While Kenya, Uganda and Rwanda have over 40 per cent of all HIV-positive people on antiretrovirals, Tanzania’s level has fallen below 28 per cent, the average for low and middle-income countries.

In the EAC, Kenya now has the highest number of people on the life-saving drugs, with over 250,000 receiving ARVs.

Like in Tanzania, treatment programmes in countries like Mozambique and Zimbabwe continue to face various challenges, with their access levels too being below 28 per cent.

According a report released recently by the three agencies, more than 1.3 million people in sub-Saharan Africa are now receiving ARV treatment, a dramatic increase over the figure three years ago when only 100,000 people were on treatment and coverage was just 2 per cent.

The rise in the number of those being treated has largely been due to financial support of treatment programmes by donor agencies, including the Global Fund and Pepfar, the US government fund which has now committed to contribute about $50 billion over five years to fight the disease.

Globally, more than four million people in poor countries were receiving antiretroviral therapy (ART) at the close of 2008, representing a 36 per cent increase in one year and a tenfold increase over five years, according to the three agencies.

The greatest progress was witnessed in sub-Saharan Africa, where two-thirds of all HIV infections occur, with countries like Kenya and Uganda achieving above average treatment rates.

In Botswana, which like South Africa has a prevalence rate in excess of 15 per cent, treatment has reached over 80 per cent of the patients who need it.

But according to the UN report entitled “Towards universal access: scaling up priority HIV/Aids interventions in the health sector,” at least five million people living with HIV still do not have access to life-prolonging treatment and care.

The WHO, Unicef and UNAids attribute the progress made so far in rolling out treatment to availability of cheaper ARVs, including generics, as well as better access to free voluntary counselling and testing services.

“The cost of most first-line regimens decreased by 10-40 per cent between 2006 and 2008,” the organisations noted. “However, second-line regimens continue to be expensive.”

Accessibility to VCT also improved dramatically. In 39 countries, the UN bodies say, the total reported number of HIV tests more than doubled between 2007 and 2008.

In total, 93 per cent of all countries reported that they were providing free HIV testing through public sector health facilities in 2008.

According to the UN report, notable progress was in particular made in 2008 in widening access to HIV services for women and children.

By year end, approximately 45 per cent of HIV-positive pregnant women in poor countries were receiving ARVs to prevent HIV transmission to their newborns up from 35 per cent in 2007.

Some 21 per cent of all pregnant women in these countries had an HIV test, up from 15 per cent in 2007.

Siaya, Kenya — A mother watched with dread as a nurse inserted a tube in her baby's head. Blood streamed into the anemic 4-month-old who already has malaria, the mosquito-borne disease that kills a million African children every year.

"Malaria is one of the deadliest sicknesses for children," the nurse said — words that sent the young mother into a crumpled heap on the bed beside her wide-eyed baby boy, wrapped in a blue-and-yellow floral blanket.

There is new hope, however, in this verdant area where President Barack Obama's relatives live. A vaccine that appears to be able to prevent the disease in about 50 percent of children, is now undergoing the final stage of testing.

If regulators determine the vaccine is safe, it could be on the market in three to five years — the first vaccine against a human parasite.

Tens of millions of Africans are plagued by malaria every year, and more than a third of the hospital beds in this rural Kenyan region next to Lake Victoria are dedicated to its victims. More than 1 million children die of the disease in Africa annually, a crippling economic drain that prolongs a cycle of disease and poverty throughout the continent.

Malaria is also prevalent in parts of Asia, the Middle East and Central and South America.

This vaccine was developed specifically for Africa and will only prevent the African strain of the disease. Experts say it would be a historic advancement.

"Some may say, '50 percent, that's not great.' And that's true. If you get a measles vaccine, you're not going to get measles again," said Dr. Dave Jones, a U.S. Army colonel and director of a clinic in nearby Kombewa operated by the Walter Reed Army Institute of Research and the Kenya Medical Research Institute.

"But at the same time, when you consider we lose 1 million kids a year, if you could cut that in half it would be a great step forward."

Experts from around the globe are meeting in the Kenyan capital, Nairobi, this week as part of the fifth pan-African malaria conference, and a news conference on the vaccine trial is scheduled for Tuesday.

More than $500 million has been spent on the combined efforts by drug maker GlaxoSmithKline and the PATH Malaria Vaccine Initiative, which is funded by the Bill & Melinda Gates Foundation. The Phase III testing is being done at 11 sites in seven African countries on 16,000 children under the age of 18 months.

The goal is to immunize children against malaria during their youngest high-risk years, and then for them to develop their own natural immunities as they age.

At the spartan, open-air clinic in Kombewa last week, Patrician Mrunde, a 34-year-old mother of six, sat in the hallway with her youngest, 6-month-old Linda, who was waiting to receive a shot as part of the trial.

Mrunde has seen her eldest child stricken with fever and lapse into convulsions from malaria, and a young relative die from it.

"I decided to join the study to get help for the disease," she said.

Dr. Allen Otieno, a 38-year-old pediatrician, said "everybody is afraid" of malaria in the region. He called the new vaccine promising. "As scientists we have great hope that it will reduce the burden of malaria," he said.

Joe Cohen, a top researcher for GlaxoSmithKline, said all the data collected during testing have been encouraging.

The 66-year-old Cohen, who has been working on a malaria vaccine for two decades, said the trial results will be submitted to regulators in 2012, and that a vaccine could be on the market shortly afterward.

No prices have been set for the vaccine, Cohen said, though families in Africa may not have to pay anything for it because the Gates Foundation, UNICEF, WHO and the GAVI Alliance would provide funds.

GlaxoSmithKline "is committed to making sure pricing will never be a barrier to access for this vaccine," Cohen said.

The vaccine has been in development for more than 20 years through the combined efforts of GlaxoSmithKline, the Malaria Vaccine Initiative, the Walter Reed Army Institute of Research and others.

"No single person could have ever achieved this," Cohen said. "That's the lesson that should be taken out of the collaboration."

Malaria is caused by a parasite and spreads through a bite from an infected mosquito. The parasite travels quickly to the liver where it matures, enters the bloodstream and causes fever, chills, flu-like symptoms and anemia. The vaccine is designed to attack the parasite before it can infect the liver.

Until now, the main line of defense in preventing the disease has been distribution of bed nets and mosquito spraying.

Jonathan Odro Anyumba, chairman of the board of the Kombewa district hospital, said malaria is a huge burden in this verdant area of Kenya, where many live in mud huts and collect water in plastic jugs from flowing streams.

Families must sleep under nets to protect against the disease, though many don't have any. Even half the beds at his hospital don't have nets, Anyumba said.

"When you visit these areas you'll find that each and every child has malaria. Thirty to 50 percent of the deaths in this community are from malaria," he said. "I think this vaccine is going to be very, very useful."

AMREF’s ground breaking VIRTUAL NURSING SCHOOL (AVNS) has done it again. The Class of 2009 attained a 100% pass rate in the State Registration Examination, with 2 students attaining Distinctions, 20 getting Credits and 13 with Passes. Though still in its second year, AVNS has emerged as one of the top Nursing schools in Kenya according to the Nursing Council of Kenya Examination council ahead of other older training facilities.

Grappling with the Health crisis

A majority of Kenya's nurses are trained at the lowest ‘enrolled’ status. Yet with less than 10 per cent of Kenya’s health workers being doctors, nurses are the backbone of the health system.  In 2001, the Nursing Council of Kenya approached AMREF to develop a solution on how to upgrade all 22,000 enrolled nurses to registered level. Kenya, like most developing countries has limited training facilities; only 100 nurses can be upgraded each year using traditional classroom methods, so the Council and AMREF decided on distance learning which with the support of  Accenture, a global management consulting and technology service company, to evolved into the globally acclaimed eLearning programme. But eLearning as a new discipline has posed many challenges to the implementers, partners and students, hence the AMREF’s Virtual Nursing School was established to research into and test innovative eLearning methods for nursing education in Kenya.

Technology saves the day

 “The AVNS is documenting the implementation process, the successes, the challenges and the lessons learnt and will share them with the implementing partners and stakeholders and recommend best practices in Registered Nurses’ training” says to Dr Peter Ngatia, AMREF’s Director of Capacity Building, “In this way the students and faculty are participating in generating knowledge about eLearning in the context of a resource-constrained country like Kenya, where connectivity, human resources and skills are still a challenge.”

To address the need for clinical practicum for the students, the school entered into an MOU with various private, public and faith based institutions to enable its students acquire the required clinical practice. These include the Aga Khan University Hospital, Pumwani Maternity Hospital, Mathare Mental Hospital, Mater Hospital and all government district and provincial hospitals. This way, the students are able to do their clinical practicum without any difficulty. Early 2009, the AMREF Virtual Nursing School also entered into an MOU with the biggest referral hospital in Kenya, the Kenyatta National Hospital, to upgrade over 500 enrolled community health nurses to diploma level.

“I would like to congratulate all the Newly Registered nurses and faculty for this excellent performance once again. They are proving that technology and innovative modes of learning are surely one of the key ways to address Africa’s Human Resource challenge,” added Dr Ngatia.

About the eLearning Programme

In 2005, AMREF and the Nursing Council of Kenya partnered with Accenture, a global management consulting and technology service company, to convert the printed course materials into electronic versions. So far computers, eLearning courseware and printers have been installed in 105 hospital- and school-based training centers across the country. In the wake of a successful pilot project, 135 nurses enrolled for the first diploma course in September 2005. This number has grown to close to 6,000 students to date. Following the Programme’s success in Kenya, it will be replicated in Uganda in 2010.

For further information please contact:

•    Bob Kioko – AMREF Acting Communications Director, on +254 20 6993111 or Cell: +254 735 546440, email: bob.kioko@amref.org

Kenya’s Public Health Minister Beth Mugo has issued a new cholera alert and urged Kenyans to observe hygiene. The outbreak, which has affected parts of North Eastern, Eastern, Rift Valley and Nairobi provinces, has killed 48 people.

"In one month we have experienced new cases of Acute Watery Diarrhoea (AWD). Some 3,872 cases have been reported out of which 89 have been confirmed as cholera in the laboratory," Mrs Mugo said in a statement.

Areas affected are Kilifi, Nairobi, Turkana, Kitui, Mbooni, Makueni, Kipkelion and Laisamis Garbatulla.

The ministry has attributed the outbreak of Cholera to water scarcity due to biting drought affecting most parts of the country and poor sanitation due to low number of pit latrines with latrine coverage standing at 5 per cent in parts of the country. According to the Minister, the lower Eastern cases are attributed to drying up of water sources like Athi and Tana," she said.

In response, the Government with Non-Governmental Organisation partners like AMREF is giving technical and financial support to affected districts, supplying drugs and availing clean water to the affected. The Government has also banned food hawking and closed unsanitary food premises. Mugo assured the public that the Government will enhance management of new cases at all public health facilities.

This is yet another challenge that Kenya’s weak health systemsare being forced to cope with.

Cholera kills nine in Turkana

According to AMREF’s Programme Manager Peter Ofware, nine people are reported dead and others hospitalised following a cholera outbreak in Turkana districts.

“The figures from the Ministry of Public Health and Sanitation indicate that, so far in Kenya’s Turkana North there are approximately 247 acute watery diarrhoea cases with 36 confirmed cholera and 9 deaths. In the Turkana West area there are a total of 9 cases of diarrhoea, with 3 confirmed

Turkana West Medical Officer of Health Dr Donald Mogoi said that three victims succumbed in Kalobeyei location, about 30km from the Kakuma refugee camp. 13 other residents tested positive for cholera and were admitted at the Kakuma Mission Hospital.

"Some of the cholera victims admitted to the hospital were treated and discharged," he said.

There are fears the disease might spread to neighbouring villages in Kakuma and the refugee camp following an acute water shortage but government officials have denied an outbreak in the camp.

Residents are being provided with clean water and are being urged to report any suspected cases of AWD.

The AMREF Turkana project team together with the Ministry of Public Health and Sanitation are monitoring the situation very closely. They are carrying out disease surveillance to combat further outbreak. In Turkana, AMREF is also providing staff, medicines, transport, community education, clean water and even fuel for pumping water as an emergency measure.

(See related story “The People That Time Forgot”)

 About ECSA-HC

The ECSA Health Community (ECSA–HC) is a regional intergovernmental organisation established in 1974 by the Convention of the Commonwealth Regional Health Community for East, Central and Southern Africa as a permanent mechanism for promoting cooperation in health under the direct control of member states.  The mandate of ECSA is to foster and encourage regional cooperation in health and to strengthen capacity to address the health needs of its member states so as to attain the highest standard of health for the people of the region.  
Membership of ECSA Health Community currently includes Kenya, Lesotho, Malawi, Mauritius, Seychelles, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe.  The ECSA Health Community has, in the territories of the member states, legal recognition by member states and is accorded status similar to that granted by the Convention on Privileges and Immunities of the United Nations.

Strengthening Leadership and Management for Results 

We look forward to seeing you there.

Read more on AMREF at the XVII International AIDS Conference in Mexico City

Through the AMREF’s Dagoretti Child in Need Project, the team of former school dropouts who operate under the banner of Different Perspectives has produced a five-minute television news feature highlighting the fight against HIV in informal settlements. Members of the crew, who have all grown up in Dagoretti, intend to use the film to educate their peers on “making a difference in the communities in the fight against HIV and AIDS”.

Set to be released on World AIDS Day (December 1), the short film features George Olali, a community health worker who takes care of people living with HIV and TB in the Kibera slum. The soft-spoken George acts as a counsellor, friend and home-care provider and ensures that those on antiretroviral drugs (ARVs) take their medication as they are supposed to. He encourages those affected or infected by the virus, helping to ease stigma and prejudice in families and the community.

The feature gives viewers a unique chance to explore a big problem in a small part of the world through the youngsters’ lenses.

AMREF Project Manager John Muiruri says: “The film seeks to show how people and organisations living and working with disadvantaged communities are rising to the challenge of HIV. It will also be a useful tool to educate young people on how to make a difference in their communities in the fight against the virus.”
While George is a shining example of leadership and achievement against great odds, the filmmakers too have their own stories of triumph to tell – stories of victory over neglect and want as street children, having to fend for themselves from the trash cans and begging, a dalliance with drugs, as well as petty crime. Joining AMREF’s Dagoretti Child in Need Project and learning useful skills helped to turn their lives around and start them on the road to great story telling and filmmaking.

World AIDS Day 2008 offers an opportunity to challenge the global community to keep its promises and renew its commitment to tackling the enormous challenges of HIV. Experience has demonstrated that significant advances in the response to HIV and AIDS have been achieved where there is strong and committed leadership. Leaders are not necessarily politicians or bureaucrats but even individuals like George who are making a difference in the lives of others through their personal example and dedication

With only one in five Kenyans now able to afford two meals a day , the treatment that AMREF administers to some of the 2.5 million Kenyans living with HIV  is ineffective for many of them. Many sufferers have even stopped taking the free anti-retroviral drugs AMREF provides in Africa’s poorest areas which have limited or no access to formal health care.

AMREF is providing food supplements to some sufferers in remote communities of rural Kenya where nursing provision is rare. It is also continuing to provide supplements in the vast neglected slum of the Kenya’s capital, Nairobi. But project staff in Kibera have already noticed a drop off in attendance of community members with HIV at AMREF community mobilisation meetings.

“Adequate nutrition is vital to the effectiveness of anti-retroviral drugs”, said Sakwa Mwangala, AMREF’s project manager in Kibera, one of Nairobi’s vast slums . “Without sufficient nutrition available, the effects of HIV and AIDS related illnesses in people living with HIV are exacerbated. The patients know this and stop taking their medication or weaken.”

Following one of the toughest droughts in the region, food shortages have spread across East Africa, affecting people not only in Ethiopia and Uganda, but now also the economic stronghold of Kenya. Food is even short in the African Rift Valley – the traditional breadbasket grain-producing region of Kenya.

One in every three people in Kenya is expected to experience dire shortages of food, according to the Kibaki Government, when it appealed for US$500 million of emergency aid on Friday 16 January. Food prices in Kenya have risen nearly fivefold over the past 12 months.

“No matter how severe, the global recession will affect Africa in ways the rest of the world can only imagine”, said AMREF Director General Michael Smalley.

“The huge HIV problem and lack of adequate formal health care are a death sentence when coupled with food scarcity and economic hardships.

“The amount required to provide health care in Africa is minuscule compared with the trillions which governments in the developed world found to prop up banking systems last year. Government and business leaders must remember Africa during these tough times and invest in Africa’s health so that the economic downturn does not mean human tragedy for millions.”

AMREF celebrated this year’s World Sight Day at Ilpolei in Kenya’s Laikipia district. Scores of community members turned up for the celebration and to attend the free eye clinic at the local health centre.

Forty year old Esther Kirubia was one of the patients who turned. She sat quietly waiting for her turn to see the doctor. Her eyes were puffy and sore.

The theme for this year’s World Sight Day; Gender and Eye health- equal access to care; reflects the predicament that women such as Esther and girls face when trying to access eye care services.

Preliminary studies have shown that in the least developed countries in the world, women utilize eye care services less than men.              

Esther, a mother of six, had suffered with inverted eyelashes which would scratch her eyeballs and cause excruciating pain for ten years. Esther coped by using a nail cutter to remove the eye lashes from her eyes.  Luckily Esther’s mother-in-law visited Nairobi and learned that Esther’s condition was treatable.

Esther visited one of AMREF’s eye clinics at the Nanyuki District Hospital where she was diagnosed with trachoma. She underwent surgery and received medication for free.

Although still recovering, Esther is now back to normal life. She is free from the excruciating pain and has been rescued from a potentially blinding condition.

The AMREF Trachoma project funded by the European Union through Sight Savers International began in 2007 and is currently implemented in Kenya’s Kajiado, Laikipia and Samburu districts which have the highest trachoma rates in Kenya.

The program is also being rolled out in partnership with the Ministry of Health and is committed to the World Health Organisation’s global vision to eliminate blindness and visual impairedness by 2020.

Just like Esther, over 600,000 people comprising nearly 80% of the district have been treated for active trachoma.

There is an urgent need to professionalise this role and develop a cadre of well-trained HR managers, especially in large public sector and private sector health institutions. This would include expanding both the number of HR managers and the organisational view of their role, as well as updating their skills. These changes would enable HR managers to be more effective in leading and implementing positive solutions that in turn would improve the performance and retention of staff.

To specifically document the needs of staff in HR management roles, Management Sciences for Health (MSH) and AMREF, with support from the Office of HIV/AIDS of the US Agency for International Development (USAID), undertook an exploratory study of managers with significant responsibility for human resource management in health institutions in four East African countries: Ethiopia, Uganda, Tanzania, and Kenya. This study was designed to:

• document the role and experience of health professionals with significant responsibility for HRM;
• identify the challenges that these health professionals face;
• identify additional skills and knowledge needed by these health professionals to address HRM challenges;
• solicit recommendations for changes in pre-service and in-service HRM training.
  

Download the full report

A summary of Human Resources Management study

We've been conducting more training for village health teams. We only train two parishes at a time because there are so many of them that they can't be trained at once. The training needs to be done in small groups so it is effective and interactive. The training is looking at childhood illnesses - how to identify the symptoms of malaria and diarrhoea, which kill children if not responded to in the first 24 hours. The village health teams (VHTs) give anti-malarial drugs and oral rehydration salt respectively and then refer the children to health centres and advise mothers and fathers to refer their children to hospital.

• This week we are equipping the newly built Ojom health centre and will supervise the staff there jointly with the district health officer to get it running. Besides this, we shall also jointly conduct on the job supervision of lab technicians, trained by the project, in other health centres to ensure they are effective in their work.

• The project district steering committee (DSC), chaired by the district chief administrative officer, is meeting this week. It's composed of district technical staff, political leaders, interest groups and other partner NGOs, like Care and UWESO. They will make comments on how the project can be improved in line with the district development plan and government policy. We've prepared a report with the chairman of the sub-county project management committee and will present it to the district this week.

• Ivan Lewis, the UK minister for international development, will be visiting Katine on Monday. It will be a short visit. The aim of his visit is to see how an NGO like AMREF works to complement, rather than to compete, with government. It will also be the chance for us to raise the issue of the lack of drugs, a national problem. I think it will be an opportunity to send a strong message about what we're trying to do in Katine, as a development model. I think these trips are beneficial. We may not raise money from DfID immediately, as the process of raising funds from big donors takes time, and we are halfway through the project. But it will raise the profile of Katine and of the work of Amref nationally, and raise awareness of what we're doing among a UK audience. DfID may later support the Katine model in AMREF elsewhere, or scale it up in other organisations. But that in itself is an achievement - that what we have done works. We want to recreate the Katine model of how development can be done.

• We've also been training female teachers in gender mainstreaming and the inclusion of girls in the education system, to be role models for girls and to support girls in school. We want to give girls confidence in their social interaction with boys, so they don't feel discriminated in class, and encourage them to study subjects like science and maths. We've trained 42 teachers and they are now ready to go back to school.

• Next week we will begin training community animal workers, which has been delayed. There are seven workers who will be providing animal services to villagers. Each will be given a bicycle and a drugs kit. The community will pay a fee for their services to allow them to buy drugs to replenish their stocks. They will form an association and have a central store so that they can get cheap drugs at discount if they buy in bulk.

Denise Grady, a New York Times reporter, travelled to Dodoma in central Tanzania, where AMREF was carrying out an obstetric fistula surgery and training camp. Grady's article describes the problem facing women with Fistula, a condition caused by prolonged labor that inflicts a dreadful internal injury on mothers: which leaves them incontinent and soaked in urine.

Every year fistula affects an additional 10,000 women in sub Saharan Africa. Over the last 15 years, AMREF has been performing surgeries and training doctors to perform this operation. In 2008, nearly 1000 women received Vesico Vaginal Fistula - VVF - repairs and were restored back to social life after many years through the AMREF Surgical outreach.

Read the full article “After a Devastating Birth Injury, Hope” at: http://www.nytimes.com/2009/02/24/health/24hospital.html