Telehealth Pilot Links Health Care Providers in Ethiopia, India

A one-year telemedicine pilot project launched in July 2007 connects hospitals in Ethiopia with India's leading cardiac institute in Hyderabad in an effort to boost health care in rural Ethiopian communities, Reuters reports.

The $2.3 million project is part of a larger $135.6 million pan-African electronic network, a joint initiative between the African Union and India to improve Internet connections and communications.

The project uses fiber-optic technology to connect physicians at Black Lion Hospital in Addis Ababa, Ethiopia, with physicians at Care Group of Hospitals in Hyderabad, India. So far, Ethiopian physicians have used the system more than 50 times to consult with Indian doctors, according to Asfaw Atnafu, an Ethiopian physician.

The project also has linked Black Lion with Nekempte Hospital, which is 185 miles west of Addis Ababa. Care Group is in talks to expand the project into Nigeria and Libya.

Indian officials estimate that 100 African patients have benefited from the pan-African network, which is linked to 12 specialist hospitals in India. India plans to continue providing funding and training for five more years before handing over the project to African countries (Malone, Reuters, 4/3).

There are more Ethiopian doctors in U.S. than in Ethiopia

Africa Hard Hit by Health Worker Gap

By KATY POWNALL

(AP) KAMPALA, Uganda - Every week, Charity Kiconco drives hundreds of miles down some of the world's worst roads on a motorbike, bringing drugs and counseling to hundreds of AIDS patients.

What the 26-year-old Kiconco lacks in medical training, she makes up for in commitment.

"It's a hard job. It's exhausting both physically and mentally," she said. "But then you see the difference you make to someone's life and it's worth it somehow."

Deploying workers like Kiconco trained in key tasks but without the range of qualifications of a nurse or doctor is one way of addressing a global health care shortage that is hitting African and other developing nations hardest.

Experts gathered in Uganda this week to discuss the problem also considered asking rich countries — which often benefit from the migration of health care workers — to compensate poorer nations for the staff they recruit and to pay to train health workers in the developing world.

The long-term goal, though, was galvanizing the funding and political will to radically expand the education and training of health workers in the developed and developing world.

The World Health Organization estimates that more than 4 million more health workers are needed worldwide to improve health systems and achieve international health and development goals. The gap is felt keenly in Africa, which carries 25 percent of the global disease burden yet has only 3 percent of the world's health workers and 1 percent of its economic resources.

"What's the use in having medicines if we don't have health workers to take it to the patients and ensure it's taken correctly?" asked Miriam Were, the head of the African Medical and Research Foundation.

Were previously worked as a teacher in Kenya but switched to medicine when she saw how many of her students missed classes due to preventable illnesses like diarrhea and malaria.

More typically, though, the movement is not from teaching to medicine, but out of Africa. For overworked and underpaid workers in developing countries, migration is often an appealing option.

The Global Health Workforce Alliance — organizers of this week's conference in Uganda — says a physician in sub-Saharan Africa or Asia might earn only $100 per month, but could earn $14,000 monthly in some developed countries. One in four doctors trained in sub-Saharan Africa works in a developing country.

"There are more Ethiopian doctors on the east coast of America than there are in Ethiopia," Were said.

According to figures published in the British medical journal The Lancet, the U.S. has 9.37 nurses per 1,000 people and Uganda has just 0.55. But even the United States is facing a shortage, according to organizers of the Uganda conference, needing 800,000 nurses and 200,000 doctors.

"Better working conditions at home would be a massive factor in mitigating migration but these countries don't have money," said Dr. Francis Omaswa, executive director of the Global Health Workforce Alliance. Rich countries should invest in training, he said, "so that we have a big enough pool of health workers to share between all of us."

Interim measures such as the training and use of community volunteers are being tried in many sub-Saharan and Asian countries.

Working in Uganda for a national charity called The AIDS Support Organization, Kiconco drives to drug distribution centers in rural areas and works with volunteers to mobilize patients to pick up their medication — rather than having to make home deliveries.

Volunteers, themselves HIV-positive, have been trained in basic counseling and are provided with bikes. Competitive salaries, loan programs and training programs as well as a relaxed and informal working environment keep morale high.

"You would need to at least double my salary before I would think about leaving because this place has such a good working environment," said Emmanuel Odeke, a doctor with the organization.

A service of the Associated Press(AP)

Google Gets Behind Harvard Genome Scientist With 100,000 People

By John Lauerman

Feb. 29 (Bloomberg) -- A Harvard University scientist backed by Google Inc. and OrbiMed Advisors LLC plans to unlock the secrets of common diseases by decoding the DNA of 100,000 people in the world's biggest gene sequencing project.

Harvard's George Church plans to spend $1 billion to tie DNA information to each person's health history, creating a database for finding new medicines. The U.S., U.K., China and Sweden this year began working together to decipher the genetic makeup of 1,000 people at a cost of $50 million.

Google, owner of the most popular Internet search engine, is looking for ways to give people greater control over their medical data. Along with the unspecified donation to Church, the Mountain View, California-based company said last week that it would work with the Cleveland Clinic to better organize health records, and last year gave $3.9 million to 23andme Inc., a seller of genomic data to individuals.

Church's plan ``would be the largest human genome sequencing project in the world,'' Stephen Elledge, a geneticist at Harvard Medical School in Boston, said in a telephone interview today. ``The genetic variations are what make people different, and we need to understand the connections to human disease. They'll get a tremendous amount of information from this,'' said Elledge, who isn't involved in the project.

About a dozen full genomes have been sequenced, said David Altshuler, a geneticist at the Broad Institute in Cambridge, Massachusetts. He is a leader of the project involving the U.S., U.K., China and Sweden. That plan, announced in January, aimed to increase the number of sequenced genomes about 100 times.

`Going for 1 Million'

Church, who helped develop the first direct genomic sequencing method in 1984, said that while he plans to enroll 100,000 participants, he may not end it there.

``If we can expand the project, we'll probably go for a million genomes,'' Church said. Since 1984, Church has advised 22 companies including Helicos Biosciences Inc., which recently began selling high-speed gene sequencers, and 23andme.

Google Chairman and Chief Executive Officer Eric Schmidt unveiled a new product, Google Health, at a conference yesterday in Orlando. The Internet-based service will help people manage their medical records and test results so they can be shared safely and privately with various specialists. Genomic data may eventually be included, said Marissa Mayer, vice president for search products.

``We have some genetic partners where we've already been making investments,'' Mayer said in a telephone interview. ``Genetics is much further out, and will be done at the control and discretion of the user.''

Ideally Suited

Ross Muken, a Deutsche Bank Securities Inc. analyst in San Francisco, said Google is ideally suited to help consumers keep track of genetic data, as new sequencing technology becomes available.

``They want to have an ability to display to the individual their genetic information in a user-friendly interface,'' he said in a telephone interview. ``Who better to do that than Google?'''

Google's involvement would also be a boon to companies that sell sequencing equipment, including Helicos, Illumina Inc., Applied Biosciences Group, and Danaher Corp., he said.

``Players like Google and Microsoft have the ability to move things along at a quicker pace,'' Muken said.

Google spokesman Andrew Pederson said it began supporting Church, who teaches at Harvard Medical School in Boston, with a donation late last year.

Database Builder

By matching genetic data from each person with his or her health history, Church would build a database that would link DNA variations and disease for scientists and drugmakers, the first step in deciding on treatments that can block the mutations or adjust how they work within the body.

Church also said he'll explore other human traits under genetic control. Participants will give facial and body measurements, tell researchers what time they get up in the morning, and detail other behaviors, he said.

Church has already partially sequenced genomes from 10 people, and the jump to 100,000 is under review by a Harvard ethics panel. The project ``only stops when we stop learning things,'' Church said.

The Harvard scientist is controlling costs by sequencing only protein-making genes, which make up about 1 percent of the genome. He is asking for at least $1,000 from most participants to defray costs and subsidize some nonpaying subjects.

Helicos and Norwalk, Connecticut-based Applied Biosystems, which are contributing to the project, compete with Illumina in a $650 million gene-sequencing market, Deutsche Bank's Muken said. As the procedure becomes commonplace, the market's annual revenue could rise into the billions of dollars, he said.

OrbiMed Interest

``We do have an interest in the space from an investment perspective,'' said David Darst, a venture capital associate at New York-based OrbiMed, which manages more than $6 billion, in a telephone interview. ``We see a lot of promise around the overlaps with personalized medicine.''

By pairing medical histories with genetic data on the Web, Church is also confronting ethical boundaries. It's possible that subjects' identities can be deduced from their health information, scientists said.

``He's explicitly going after medical histories, and there's very mixed feelings about this,'' said Kevin McKernan, one of the developers of Applied Biosystems' SOLiD sequencer. ``I think it's helpful and needed. We need to understand some of these issues that could scare everyone out of the field.''

Early Enrollee

Esther Dyson, an investor in technology and health-care companies, is already enrolled in a pilot portion of the Personal Genome Program for people who will have their sequences posted online. Last month, at the World Economic Forum in Davos, Switzerland, she encouraged attendees to have their genomes sequenced by Church, she said.

``The reaction was amazingly positive,'' said Dyson, a board member of 23andme. ``Most people are curious and interested, and it's one of the last frontiers.''

``I wouldn't do it,'' said Amy McGuire, a Baylor College of Medicine medical ethicist, in an interview at a gene sequencing meeting in Florida. ``I want my privacy protected more than that. I have difficulty putting family pictures on Facebook,'' the social networking Web site.

``We don't know enough about the actual risks,'' McGuire said.

There are many ways in which making genetic information public might hurt people, she said. Health insurers may not want to offer coverage to people with inherited risks of cancer or heart disease; other family member may be affected.

Those are precisely the issues that the field needs to resolve, Church said. The payoff is an unobstructed view of the next revolution in medicine, he said.

``Some people bought Apple IIe's and went on to become entrepreneurs in the electronics revolution,'' he said. ``People who participate in the Personal Genome Program will have a ringside seat for something that might be very similar.''

Dental mission to Ethiopia

Dr. Richard Parker, a Loma Linda University School of Dentistry graduate, and a team of dental students recently returned from a medical missionary trip to western Ethiopia, where they provided medical and dental service to more than 350 people.
Parker and his team spent two weeks at Gimbie Adventist Hospital. They also traveled the countryside to serve Ethiopians who rarely have dental care available.

Parker, who runs a private dental practice in Calimesa, said the missions are aimed at providing dental students an opportunity to practice dentistry in a setting outside the traditional clinic environment.

Parker's first dental mission was to Guatemala in 1967.

"It gives you a sense of satisfaction to be able to do that, and I think the students get that same satisfaction," Parker said.

Accompanying Parker on the most recent trip were his wife, Bonnie, their son, Scott, who is a dental student at Loma Linda University, and Scott's wife, Erika, a physician. Dental student Tate Montgomery of Redlands also went on the trip.

Kindling Hope In Northern Ethiopia By Keeping Adolescent Girls In School

On the day of her graduation from the Berhane Hewan project, Yideneku Chanie got up especially early. After attending 18 months of classes at the project, she was awarded a certificate, along with a pregnant ewe, for successfully completing her education.

"I like Berhane Hewan so much. It has saved me from being married off," said 12-year-old Yideneku, her dark eyes shining. Around her, hundreds of girls and their families stood around the hot, dirt-packed common area of the Mosobo Kebele Association, commenting and discussing the graduation ceremony they had just witnessed.

Amharic for 'light of eve', Berhane Hewan is designed to impart to adolescent girls in rural areas the knowledge, skills and resources they need to avoid early marriage, with additional support to girls who are already married. The project is funded by UNFPA, the United Nations Population Fund, through the Nike Foundation, with technical support from the Population Council. The Ministry of Youth and Sports and the Amhara Region Youth and Sports Bureau implement the project.

The project was developed through extensive consultation with the community in Mosobo, a neighbourhood, or kebele, in Yilimana Densa, some 40 kilometres north of the Amhara region capital Bahir Dar. It incorporates lessons learned from previous programmes to end early marriage and provides families with opportunities to stop the practice.

"One of the prominent factors that has contributed to the appalling reproductive health situation of Ethiopian women is the traditional practice of early marriage," said Ayalew Gobezie, President of the Amhara Regional State, in his speech to the community. In Ethiopia, 850 women die per 100,000 live births.

The impact of early marriage is tremendous on women and families worldwide. Besides the number of health issues associated to early marriage such as fistula or maternal death, child brides are typically deprived of an education, and thus condemned to a lifetime of dependence on her husband and his family.

In the Amhara region of Ethiopia where the Berhane Hewan project is based, rates of child marriage are among the highest in the world. Half of all girls in this region are married before their 15th birthday. Of this total, most had never met their husbands at the time of marriage, according to a recent survey, and were subjected to forced sex. Even worse, most married girls interviewed in the survey reported they had not started menstruating when they had sex for the first time.

"Besides a violation of their human rights, the practice is in violation of Ethiopian law, which states that marriage is legal only between consenting adults, who have, at minimum reached the age of 18 years," said Monique Rakotomala, Country director of UNFPA.

The practice will only change when Ethiopian society begins to value women as equal players in the country's social and economic development. But in the meantime, Berhane Hewan buys time for hundreds of girls, placing them in a learning programmes until they reach the legal age for marriage.

Besides Yideneku, nearly 650 other adolescent girls have so far received their Berhane Hewan diplomas. Set up as a mentoring scheme, the project brings together married and unmarried girls aged 10 to 19. The girls take part in non-formal and life skills education led by adult female mentors, or participate in weekly married girls clubs. Unmarried girls meet five times a week and married girls meet once a week.

With school materials provided by the project, girls and young women learn functional literacy, life skills, and reproductive health. It takes six months to complete an educational cycle and most girls are ready to move on to formal schooling after completing the 18 months schooling, after which they enter grade 4. So far 84 are attending primary school in the small town of Adet, about an hour's walk from Mosobo.

"Previously, since our parents did not have enough means to buy us educational materials like pen and exercise books, we did not get education. Our fate used to be being married early. But since the project started this problem has been solved," said Yideneku.

As part of the programme, the project holds monthly community dialogues, where members of the kebele can discuss topics related to the well-being of their daughters, including reproductive health, HIV and AIDS, and household management issues. The discussions are similar to those held by the girls themselves.

"The real difference here is that the families of the girls are included in both the planning and the execution," said Dr. Tekleab Mekbib of the Population Council. "This gives people ownership of the process, and a measure of pride and the success of the project."

The families were taught skills such as the construction of improved stoves and household management, for example. They also get family planning counselling and services free of charge at the local health post. In addition, families were given the chance to cultivate vegetables for consumption and sale, and they received support to engage in small-scale poultry farming to supplement their income.

As a sign of their appreciation for the project, the community took the initiative to build four houses for the project. It also actively participated in the registration of the students. Over 700 girls joined Berhane Hewan in the first two months - roughly 40 per cent of eligible girls. Seventy-seven percent of the participants have never married, 20 per cent are married, and about 3 per cent are divorced.

The assistance of husbands is enlisted as well. To alleviate the workload of the married girls and help the community, improved stoves have been constructed and water wells have been dug in some selected sites in the locality. This helps the girls to have access to clean water nearby and gives them the time to participate in the discussions in the girls' clubs.

"Project like this are urgent in Ethiopia, and can put a halt to much child abuse in the country's urban centres," said Monique Rakotomalala.

Many girls flee their homes for urban areas to escape early marriage. A study conducted in the slum areas of Addis Ababa found that many female migrants come the city to escape early marriage. Most end up as child domestic workers or sex workers.

So far, not a single underage girl was married in the past year in Mosobo. This was partially due to a firm commitment by local authorities to curb the practice. Working closely with the district administration, as well as the police and the district prosecutor, the local authorities brought to justice three families who tried to marry off their children. The marriages were annulled.

Scheduled to be expanded to another 10 kebeles, the commitment by national leaders is also crucial for the success of the programme. The graduation ceremony was overwhelming: In addition to community members and graduating girls, it included senior officials of the federal and regional government - including Deputy Speaker of the Ethiopian Parliament, the Minister of Youth and Sports, State Minister of the Ministry of Women's Affairs, and the President of the Amhara Regional State.

Yideneku's mother sends all her daughters to school. She always blames her own parents for not sending her to school, and she is happy that her daughters will have more opportunities.

As for Yideneku, now that she has successfully completed her non-formal education, she cannot wait to attend a formal school. She dreams of becoming a medical doctor one day.

United Nations Population Fund

Meningitis Cases Reported in SNNPR

Addis Ababa

Suspected cases of meningitis were reported from Kambata Tembaro and Hadiya zones in SNNPR last week, according to the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA).

A total of six cases with one death were reported in Adorro Tuntoo, Kadida, Kaccha Birra, and Tenbarro woredas in Kambata Tembaro zone, the UN agency said in its humanitria weekly bulletin.

ONOCHA added that, in Hadiya zone, five cases and one death were reported from Hadiya hospital.

It said laboratory investigation is underway to confirm the reports .
In late December 2007, the Federal Ministry of Health (FMoH) alerted humanitarian partners to be prepared for a possible large scale Meningitis outbreak.
Following the alert, the FMoH in collaboration with partners developed a preparedness and response plan seeking for US$ 28 million.

The plan focuses on pre-positioning of vaccines, drugs and medical supplies.

It also plans to enhance a disease surveillance system, training of health workers on case detection, appropriate case management and community awareness raising, according to OCHA.

Potential Malaria vaccine gives hope in trial

Source:
Agence France Presse
By Staff Writers 24 Jan 2008

The vaccine elicited a strong immune response among 40 adults who received it, all of whom tolerated the vaccine "very well," the National Institute of Allergy and Infectious Diseases said in a statement Tuesday.

It was the first trial on the candidate vaccine, designed to block the malaria parasite from entering human blood cells, the statement said.

A second trial involving 400 Malian children aged one to six years old is now underway.

Malaria is one of the deadliest diseases in Africa and in developing countries. It kills more than one million people each year, most of them children.

Research for the study was led by Mahamadou Thera at the University of Bamako, Mali, with support from the National Institute of Allergy and Infectious Diseases, part of the US National Institutes of Health (NIH).

The researchers recruited study participants in Bandiagra, a small town in northeastern Mali where malaria is prevalent.

At the peak of the rainy season in August and September, people in this part of Mali typically get up to 60 malaria-transmitting mosquito bites per month, the researchers said.

Volunteers received three injections, spaced one month apart, of the vaccine or a licensed rabies vaccine, as a control.

At the start of the study, all volunteers had high levels of antibodies against malaria in their blood, showing they had had prior exposure to the parasite, the researchers said.

Those who received the candidate vaccine showed up to a sixfold rise of vaccine-specific antibodies, while the levels of antibodies declined among those who received the rabies vaccine, it said.