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PubMed2002

Barcelona 2002: law, ethics, and human rights. Global battle cry: health is a right, not a commodity.

Health is a fundamental right, not a commodity to be sold at a profit, argues Irene Fernandez in the second Jonathan Mann Memorial Lecture delivered on 8 July 2002 to the XIV International AIDS Conference in Barcelona. Ms Fernandez had to obtain a special permit from the Malaysian government to attend the Conference because she is on trial for having publicly released information about abuse, torture, illness, corruption, and death in Malaysian detention camps for migrants. This article, based on Ms Fernandez' presentation, describes how the policies of the rich world have failed the poor world. According to Ms Fernandez, the policies of globalization and privatization of health care have hindered the ability of developing countries to respond to the HIV/AIDS epidemic. The article decries the hypocrisy of the industrialized nations in increasing subsidies to farmers while demanding that the developing world open its doors to Western goods. It points out that the rich nations have failed to live up their foreign aid commitments. The article concludes that these commitments--and the other promises made in the last few years, such as those in the United Nations' Declaration of Commitment on HIV/AIDS--can only become a reality if they are translated into action.

Ethics↗
PubMed1998

[Worldwide care of people with HIV-infection or AIDS; report of an international conference held in Amsterdam].

Millions of people all over the world are HIV-infected; 90% of them are living in developing countries. Other heavily affected groups are homosexual males, drug addicts, workers in the sex industry and other fringe groups. Taking suitable care of these patients and their families is a major task. This was the subject of the third international conference on home and community care in HIV infection/aids, held in Amsterdam in May 1997. There is a world of difference between the rich West and developing countries in regard to number of patients and availability and accessibility of care. Moreover, in developing countries the inferior socioeconomic position of women and children substantially impairs effective care programmes. Drugs against HIV and against opportunistic infections, and means of palliative care are not available and not affordable in these countries. Local initiatives to improve this situation can only succeed given an infrastructure for the care that is supported by the authorities, so that continuity is guaranteed. Structural cooperation between these authorities and international bodies, and large-scale support by Western foreign aid services are indispensable.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Control of tsetse flies and trypanosomiasis: Myth or reality?

The African trypanosomiasis are among Africa's most devastating diseases. The human disease, sleeping sickness, and the animal disease, nagana, are caused by trypanosomes, protozoan parasites transmitted by tsetse flies, Glossina spp. Attempts have been made to control tsetse and trypanosomiasis for over 70 years, supported by ever-increasing amounts of foreign aid. Although progress has been made in the control of sleeping sickness, this disease still persists in many countries. Nogono excludes cattle from many of the potentially most productive areas of Africa and is a major constraint on economic development. In this paper, Robert Dransfield, Brian Williams and Robert Brightwell review the control of tsetse and trypanosomiasis in the light of recent progress in our understanding of tsetse population dynamics, with special reference to the experience gained in tsetse control on a Maasai ranch at Ngurumon in the Rift Valley of Kenya, and make suggestions for the management and funding of future control programmes in relation to rural development.

Journal Article↗
PubMed1985

The frontier of modern Western medicine in Nepal.

Using the concepts frontier and interface the introduction and spreading of modern Western medicine in Nepal and its relations to other medical systems are described and analyzed. Medical systems do not prevail in the same degree in all places; we may call the geographic areas of concentration the core areas or center(s) of medical systems and the remaining areas their periphery. The frontier of a medical system is defined as that part of the periphery where the presence of the system is increasing. The place of the frontier, its width and the forms in which a medical system appears at its frontier are determined by both internal dynamics and contextual factors. In non-socialist countries like Nepal the dynamics of modern Western medicine are characterized by three tendencies: centralization, expansiveness and a commercial and capitalist character. Some important contextual factors which have been shaping the frontier in Nepal are: migration, including tourism, labor-migration and trade; the role of foreign aid and geographical conditions. The situation at the frontier has an important influence on the nature of the interface between modern Western medicine and other medical systems. In the article Faith-healing, Ayurvedic medicine, Homeopathy and Tibetan medicine are described briefly and the interface between them and modern Western medicine is looked into.

China↗
PubMed2005

Community-based public health interventions in North Korea: one non-governmental organization's experience with tuberculosis and hepatitis B.

BACKGROUND: The Democratic People's Republic of Korea, also known as North Korea, is the most isolated country in the world, and has been a source of interest, politically and socially, since the 1953 ceasefire of the Korean War. While in the past year, interest has focused on the nuclear dispute with the USA, over the past decade, most interest has revolved around the economic plight of the country, the lack of funds and resources for health care, and the subsequent public health declines. North Korea's present economic and public health problems began in the early 1990s due to the gradual loss of economic support from its communist allies (i.e. after the fall of the Soviet Union and the capitalization of China), combined with an inordinate number of natural disasters (floods, famine and drought) all occurring within the same time span. These simultaneous events initiated a 'snowball effect' of severe economic depression and a rapid deterioration of the overall public health infrastructure in the country. North Korea's continued isolation and reluctance to release health statistics has left the international community uncertain of the precise extent of the public health devastation. The uncertainty of the situation has been further complicated by disparate accounts of the public health declines. For instance, the North Korean Government has estimated that approximately 220,000 people died due to famine in the 1990s, while the World Health Organization (WHO) claims that this figure is closer to 2 million. In the past few years, the willingness of the North Korean Government to engage the outside world has increased. This is reflected by the growing number of foreign aid organizations or non-governmental organizations (NGOs) that have been permitted entry into the country. NGOs have not only served to improve various aspects of the public health system but also serve as a source of 'on-the-ground' information for the outside world. This role has proven critical not only for public health purposes but for facilitating improved international relations between countries.

Altruism↗
PubMed2003

Vaccination priorities.

Selection of immunizations should be based on requirements and on risk of infection. According to the International Health Regulations, many countries require yellow fever vaccination and proof thereof as the International Certificate of vaccination. Additionally selected countries require proof of vaccination against cholera and meningococcal disease. A consultation for travel health advice is always an opportunity to ascertain that routine immunizations have been performed. Recommended immunizations often are more important for traveller's health than the required or routine ones. The most frequent vaccine preventable infection in non-immune travellers to developing countries is hepatitis A with an average incidence rate of 0.3% per month; in high risk backpackers or foreign-aid-volunteers this rate is 2.0%. Many immunizations are recommended for special risk groups only: there is a growing tendency in many countries to immunize all young travellers to developing countries against hepatitis B, as it is uncertain who will voluntarily or involuntarily get exposed. The attack rate of influenza in intercontinental travel is estimated to be 1%. Immunity against poliomyelitis remains essential for travel to Africa and parts of Asia. Many of the 0.2-0.4% who experience an animal bite are at risk of rabies. Typhoid fever is diagnosed with an incidence rate of 0.03% per month among travellers to the Indian subcontinent, North and West Africa (except Tunisia), and Peru, elsewhere this rate is 10-fold lower. Meningococcal disease, Japanese encephalitis, cholera and tuberculosis have been reported in travellers, but these infections are rare in this population. Although no travel health vaccine is cost beneficial, most professionals will offer protection against the frequent risks, while most would find it ridiculous to use all available vaccines in every traveller. It is essentially an arbitrary decision made on the risk level one wishes to recommend protection--but the priorities need to be set correctly.

Epidemiologic Factors↗
PubMedDate not supplied

Communicating across cultures: improving translation to improve complex emergency program effectiveness.

Translation is a vital activity in Complex Emergencies (CEs) in which the responders and the affected populations do not share the same language or culture. This particularly applies to CEs in developing countries in which a lack of local resources usually results in the importation of foreign aid workers. This paper describes many of the common issues surrounding translation that can affect CE response effectiveness, issues that frequently are not appreciated by aid workers, including clinicians. The authors describe how these issues can arise, their effects, and outline approaches to addressing them.

Disasters↗
PubMed1994

An opinion on the global impact of meat consumption.

The topic of vegetarian nutrition can be approached from several angles, perhaps one of the most important being the impact that meat production is having on the under-developed world, where ancient rain forests are being cleared to provide land for cattle grazing. Debt-burdened countries are turning over agricultural land to raise cattle and grains for feeding the cattle. These practices have resulted in less available land for the production of food, global warming because of the practices used for deforestation, exhaustion of the world's water supply, and other adverse effects on the health of the world. The consumption of meat for food is taking a toll on the consumer and the health of the world's poorest people. It is also contributing to an expanding need for foreign aid and growing world hunger.

Child↗
PubMed1997

Quality management--a challenge for the health care system in Poland.

The aim of this paper is to describe the origins, initial steps and strategy, current progress and main accomplishments of introducing a quality management culture within the healthcare system in Poland. The following main points will be discussed: A general overview of the national healthcare context with specific emphasis on major structural and functional problems of the system and on the main factors and forces influencing current changes in healthcare in Poland. Suggestion and explanation of why quality management philosophy, methods and tools introduced into the healthcare system may constitute part of a solution for the problem of how to improve healthcare in Poland. A summary of national activities, illustrating how an implementation strategy was put into action, what has happened so far, and the results and perspectives for the future. A conclusion that foreign aid and international collaboration, used in an appropriate and effective way, may constitute a crucial factor in promoting beneficial changes in countries which, like Poland, are currently undergoing dramatic political, economic and cultural transition.

Cost of Illness↗
PubMed2000

Bernstein's failure to join the space race: his commentary on Tsiolkovskii's "Mechanics in Biology" (1964).

October 4, 1957, the Soviet Union launched Sputnik I into orbit from Tyuratam in Turkistan. An event "with the suddenness and surprise of a Pearl Harbor and of the impact of a Hiroshima atomic explosion" (Stoiko, 1970, p. ix). Nor would this be the only time America lost to the Russians in the space race. November 3 of the same year, Sputnik II carried the dog Laika, the first living being who traveled, and died, in space. In the USA, Senator Lyndon B. Johnson lamented: "Control of space means control of the world" (quoted from Heppenheimer, 1997, p. 126), and attempts were made to speed up Wernher von Braun's launching program (Piszkiewicz, 1995; cf. Von Braun, 1968). Alas, on December 6, when the American rocket began to lift, "it seemed as if the gates of hell had opened up. Brilliant stiletto flames shot out from the side of the rocket near the engine. The vehicle agonizingly hesitated for a moment, quivered again, and in front of our unbelieving, shocked eyes, began to topple" (Halberstam, quoted from Heppenheimer, p. 127). Thus, at the UN, "Soviet delegates asked their American counterparts if the United States might wish to receive foreign aid under Moscow's program of technical assistance to backwards nations" (from Heppenheimer, p. 128). Von Braun finally succeeded with the Explorer I on January 31, 1958, but for the Americans the agonizing wasn't over. On August 21, 1957, the Soviet Union launched an intercontinental ballistic missile (ICBM), this time carrying a dummy, but able to carry a nuclear bomb (Harford, 1997). So, the first ICBMs in the world were aimed at the USA. And then, on the morning of April 12, 1961, Yuri Gagarin shouted "Poyekhali" ("Let's go!") (quoted from Heppenheimer, p. 172), and was launched into space at 9:06 to fly "over America" 51 minutes later. Quite naturally, the Soviet authorities wanted to show that Russia had been ahead all the time, and historical heroes were in strong demand. The Russians didn't have to look far.

Biology↗
PubMed1993

Sustaining health service developments in the 'Third World'.

An increasing number of 'third world' health development projects are proving to be unsustainable once foreign aid has been withdrawn. It is argued that this is partly due to the fact that such projects usually deliver health care free of charge rather than allowing communities to incorporate the costs of health care into their local economies. There should be more emphasis on health development projects paying for themselves from the outset. Such projects might also incorporate the extant community based infra-structure of traditional medicine through direct collaboration with its practitioners.

Developing Countries↗
PubMed2006

Management of expatriate medical assistance in Mozambique.

This paper discusses how Mozambique coped with the health system needs in terms of specialized doctors since independence, in a troubled context of war, lack of financial resources and modifying settings of foreign aid. The Ministry of Health (MOH) managed to make up for its severe scarcity of specialist MDs especially through contracting expatriate technical assistance. Different scenarios, partnerships and contract schemes that have evolved since independence are briefly described, as well as self-reliance option possibility and implications. Lessons learned about donor initiatives aimed at contracting specialists from other developing countries are singled out. The issue of obtaining expertise and knowledge in the global market as cheap as possible is stressed, and realistic figures of cost planning are highlighted, as determined by the overall health system necessities and budget limitations.

Journal Article↗
PubMed2003

A clinical and educational telemedicine link between Bulgaria and Greece.

During its transition to a market economy, Bulgaria benefited from foreign aid provided by Greece. One of the projects was the clinical and educational telemedicine link between the Medical University of Varna in Bulgaria and the Faculty of Medicine of Aristotle University of Thessaloniki in Greece. This began in 1997. In terms of the educational activities, the Bulgarian side of the network supports: an electronic classroom equipped with personal workstations, multimedia projectors and videoconference facilities; electronic design and publishing activities; Web hosting and mail server activities; and satellite communications. Communications are via ISDN. The main clinical experience has been remote consultations in immunology. This experience (admittedly limited) demonstrates that telemedicine can be used to provide assistance to remote colleagues. In addition, the use of telemedicine can greatly improve the quality of care available to travellers and migrant workers in cases where the patient cannot communicate with the attending physician because of a language barrier.

Bulgaria↗
PubMed2002

African independent churches in Mozambique: healing the afflictions of inequality.

The recent explosive proliferation of African Independent Churches (AICs) in central Mozambique coincided with rapid growth of economic disparity in the 1990s produced by privatization, cuts in government services, and arrival of foreign aid promoted by Mozambique's World Bank/International Monetary Fund Structural Adjustment Program. Drawing on ethnographic research in the city of Chimoio, this article argues that growing inequality has led to declining social cohesion, heightened individual competition, fear of interpersonal violence, and intensified conflict between spouses in poor families. This perilous social environment finds expression in heightened fears of witchcraft, sorcery, and avenging spirits, which are often blamed in Shona ideology for reproductive health problems. Many women with sick children or suffering from infertility turn to AICs for treatment because traditional healers are increasingly viewed as dangerous and too expensive. The AICs invoke the "Holy Spirit" to exercise malevolent agents and then provide a community of mutual aid and ongoing protection against spirit threats.

Anthropology, Cultural↗
PubMed1977

The international transfer of medical technology--an analysis and a proposal for effective monitoring.

The international transfer of medical technology to the developing countries occurs at four levels--medical education, research, and missions; multinational corporate transactions; technical assistance projects sponsored by the World Health Organization; and bilateral foreign aid programs. In this article, a proposal is made for effective monitoring of international medical technology transfer through political and legal means, including a specific code of conduct for corporations engaged in medical technology transfer. The development of "intermediate health technologies" along the lines suggested by E. F. Schumacher, and the advantages of such an innovation in terms of population issues and economic development are also discussed.

Communicable Disease Control↗
PubMed1987

The impact of civil disturbances on the migration of physicians: the case of Lebanon.

During the 1970s, the migratory flow of physicians was an issue of major concern to the world medical community. Numerous publications have focused on the issue of the foreign medical graduates in the United States the impact of the "brain drain" on developing countries, and the various related issues of licensure, quality of medical care, "reverse" foreign aid, and ways and means to stem the tide of migration. Of the numerous studies on this subject, however, few have focused on the impact of civil disturbances and political instability on the decision of physicians to emigrate, even though this type of migration has been known to occur during or subsequent to political crises. Examples include the large-scale emigration of Hungarian, Cuban, and Czechoslovakian physicians to the United States in the late 1950s and 1960s. Mejia refers to this type of migration and characterizes it as "... likely to be sudden, to reach a high peak within a short period of time and to decline almost as rapidly...." This description fits closely the definition of a "point epidemic"--a condition wherein the political events that led to the outflow of these physicians constituted a one-time event, limited in time and duration. Lebanon presents a different picture: ever-raging civil disturbances have plagued that country continuously for the past 11 years. The epidemiologic analogy is more akin to an "endemic" situation, with point exacerbations and remissions between ferocious fighting and relative peace leading to situations of acute, subacute, and chronic civil instability.(ABSTRACT TRUNCATED AT 250 WORDS)

Civil Disorders↗
PubMed2001

[The situation of anesthesia in Afghanistan].

As a medical co-ordinator of the International Red Cross, I surveyed the situation of the anesthesia in the major hospitals in Afghanistan. There was almost no hospital to be able to carry out elective surgery except emergency operation, and even the basic facilities for anesthesia were not available in these hospitals. The improvement of country's health situation depends mainly on country's economical progress, besides foreign aid. Although the medical aid for these conflict areas is strongly requested to Japan as international contribution, a conflict itself destroys the social infra-structure of war torn countries, and therefore such medical aid is not easily accomplished.

Afghanistan↗
PubMed2001

Searching excellence in project management.

A main outcome of this paper is supposed to be a model of an effective management of projects in specific conditions of foreign aid programmes funded by the European Union. It was decided to fund three basic projects focused on the Health Care Financing, Health Management and Privatisation. All these projects were completed by the end of 2000 with a different level of success. Different projects' results were achieved in dependence on both the internal management system and external factors. Based on a theory examined, empirical, practical and evidence-based experience from the above projects the paper discusses particularly those aspects of project management that may influence a successful implementation of projects and may lead to the excellence in managing projects. (Ref. 25.)

Efficiency, Organizational↗