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  • 1. This Week's News 19-23 October 2009 Weekly news clippings service featuring articles on the Global Health Workforce Alliance and selection of articles from around the world on the issue of the health workforce crisis Africa & Middle East ¦ Asia & Pacific ¦ North America ¦ Europe ¦ Latin America & Caribbean ¦ News from WHO and partners This compilation is for your information only and should not be redistributed Africa & Middle East Date Headline Publication 17.10.09 Govt to hire 5700 medical personnel o KBC, Kenya 20.10.09 Michigan Varsity Trains 40 in Aviation, NursingMi This Day, Nigeria 14.10.09 UGANDA: Camp closures worry HIV-positive IDPsU G PlusNews-Africa 15.10.09 Conference of Medical Superintendents Group opensC o Ghana News Agency 15.10.09 Another Woman Dies in Labour 'Out of Negligence' n Daily Monitor, Uganda 21.10.09 UCH Doctors Embark On StrikeU C Daily Champion, Nigeria 15.10.09 IMF accused of impeding health sector progress M Business Daily Africa 21.08.09 Be kind, health workers urgedB e New Vision, Uganda Asia & Pacific Date Headline Publication 18.10.09 ‘Intensify barangay’s dengue drive’ I Inquirer Global Nation, Philippines 16.10.09 'Made in India' dominates US AIDS scheme M Business Standard, India 17.10.09 Mission accomplished for Okinawa 'substitute doctor'Mi Japan Times 17.10.09 Hospital workers speak out Taranaki Daily 77 News, N. Zealand 17.10.09 Rural GPs glad to bend Kevin Rudd's earR u The Australian 16.10.09 New Clinical Training Agency Board appointedN e N. Zealand Doctor 1
  • 2. 21.10.09 Health Board denies hospital review claims e Ashburton Guardian, N. Zealand North America Date Headline Publication 19.10.09 Governor Rendell Announces Application for $5 Million Federal PR Newswire Recovery Act Grant to Train, Place Health Care Workers e 20.10.09 Nurses' Union Plans to StrikeN u Wall Street Journal 15.10.09 Return of India's Traditional Birth Attendants Urged to Meet MDG IPS Terra Viva 55 e 16.10.09 Flu shots not mandatory for local health workers l Star News Online, NC 18.10.09 Curbing costs falls to wayside in health-reform push u Denver Post 19.10.09 What Might Health Care Reform Have to Do With H1N1? h Huffington Post 16.10.09 HEALTH CARE AND PHYSICIAN SHORTAGESH E Cypress Times, TX 20.10.09 Health workers say passing I-1033 will hurtH e Yakima Herald- Republic. Wash 19.10.09 H1N1 could mean forced overtime for Quebec health workers 1 CBC News, Canada 16.10.09 De plus en plus d'infirmières enceintes au travail e Le Droit, Canada Europe Date Headline Publication 21.10.09 Iraqi doctors seize first training opportunity in 20 years in unique UK BMJ, UK programme r 21.10.09 Health workers first for flu jabH e BBC News, UK 20.08.09 IntraHealth to Lead $300 Million USAID Project in Global Health Reuters, UK Workforce, Systems Strengthening o 11.09 Operational research in low-income countries: what, why, and how? Lancet Infectious Op Diseases, UK 20.10.09 World Medical Association calls on Iran to respect medical ethics BMJ, UK codec o 16.10.09 Lyon sud : des opérations reportées faute d'infirmièresL y Le Progrès, France 16.10.09 : Conférence nationale sur les places d'apprentissage 2009 Romandie News, - Invitation à la conférence de presse- CH 19.10.09 Overcrowded hospital wards: Government blames industrial The Malta actiona c Independent 19.10.09 Occupational health and safety : Maltese nurses lack information and The Malta safe modes of practice – MUMN a Independent 2
  • 3. 19.10.09 Telemedicina contra las listas de espera e El País, Spain Latin America & Caribbean Date Headline Publication 16.10.09 Médicos venezolanos a la calleMé El Universal, Venezuela 18.10.09 Desafía la epidemia al sistema de Salud e Tabasco Hoy, Mexico 17.10.09 Hospital de Guanare no satisface demanda quirúrgica de Entorno pacientesp a Inteligente, Venezuela 17.10.09 Mozarildo apresenta sugestões para suprir a carência de médicos nas, regiões pobres do paísr e Brazil 17.1009 Moradores de Deodoro torcem para que Jogos tragam progresso o JB Online, Brazil 17.10.09 Médicos pedem demissãoMé O Dia, Brazil News from WHO and partners Date Headline Publication 21.10.09 Childhood vaccines at all-time high, but access not yet equitableC h WHO 15.10.09 European Development Days: GAVI and Global Fund organise debate GAVI Alliance on health Millennium Development Goals n 20.10.09 Asia Pacific Meeting Reaffirms Commitment to Reproductive and UNFPA Sexual Health e 22.10.09 *Contracting private sector providers for public sector health HRH Journal services in Jalisco, Mexico: perspectives of system actors e 19.10.09 Philippines typhoons: Deadly disease threat as emergency Merlin, UK worsenswo * All links to HRH Journal will be to an external web page - copy is not reproduced in this document. Back to top Africa & Middle East 1 Govt to hire 5700 medical personnel Kenya Broadcasting Corporation 17/08/2009 The government will this year employ 5,700 health workers to ease the shortage in public hospitals medical services Ps Ole Kipyapi has said. He also said the Ministry of Medical Services is also working on improving the packages of health workers in the next financial year In a bid now to take healthcare services next to Kenyans and alleviate the shortage the government thought the stimulus package intended to employ 20 nurses per constituency. 3
  • 4. Kipyapi says to curb the mushrooming of bogus medical training institutions the ministry will table in parliament a report on the national health training policy. He was speaking in the 7th graduation ceremony for Cline Irvine College of Nursing in Chogoria. The country's health sector has been facing acute shortage of personnel for years now. This was even made worse by the ban on the employment of civil servants in the late 1990s and the problem compounded by the setting up of new health facilities through the Constituency Development Fund 2 Michigan Varsity Trains 40 in Aviation, Nursing This Day, Nigeria 20/10/2009 Emmanuel Ugwu Umuahia — No fewer than 40 youths from Abia State have been pencilled down for a scholarship programme which would enable him to be trained in aviation and nursing at the Western Michigan University in the United States of America. The scholarship scheme, which is a product of a tripartite partnership involving the Abia State government, Cita Triax Education Foundation, and the Western Michigan University , is expected to commence this month after conclusion of the selection process for he pioneer beneficiaries To implement the scholarship programme, a committee has been set up headed by the Chief of Staff to the governor, Mr. Mascot Uzor Kalu as the chairman with the commissioners for health, local government and chieftaincy affairs; information, education, youths as members. Secretary of the committee, Mr Ben Kalu told newsmen at Umuahia that was saddled with the task of fine tuning the relationship structure between the state, the education foundation and the Western Michigan University in order to realise "this dream of raising a formidable army of young people from different localities of the state that will take up the role of leadership, tomorrow in this country and in this state." He said that the training programme was initially restricted to aviation but nursing was later added to address the immediate needs of the state, adding that in future it would further be expanded to include economics and agriculture as the state is desirous of introducing mechanised agriculture to enhance food production. Kalu acknowledged that the awareness of the existence of the scholarship programme was still poor, adding that the committee would involve traditional rulers, community leaders and the media to create the necessary awareness. According to him, those eligible for the scholarship programme must be in the age bracket of 16 and 24 with the requisite O'Level qualifications, adding that the selection process would be conducted annually and would involve the US Embassy in order to smoothen the visa process. The committee secretary explained that the number of beneficiaries would not exceed 40 no matter the number of applicants that scale through the qualifying examination and screening process because the "economic crunch" would make it difficult for the state government to foot the bill in excess of 40 students. "It is better for the state to do forty and do it very well than make too broad and not be able to give them quality education," he said. 3 UGANDA: Camp closures worry HIV-positive IDPs PlusNews-Africa 14/08/2009 GULU, 14 October 2009 (PlusNews) - The imminent closure of internally displaced persons (IDP) camps in northern Uganda is causing concern among HIV-positive residents, who fear they may not have access to vital health services when they return to their villages. The decommissioning of the IDP camps started in the region on 1 October, with six closed in Gulu district. The camps have accommodated more than one million people for the duration of the 20-year war between the government and the rebels of the Lord's Resistance Army; peace talks between the warring parties and more than two years of sustained security in the region prompted the decision to close the camps. 4
  • 5. "I don't know what is going to happen to some of us on ARVs; we are not being told where to access these drugs from our villages," said Joseph Ochieng*, who lived in Bobi camp, in Gulu district, until its recent closure. No services at home "There are no health or distribution centres for these drugs in the return villages," said Jane Atimango*, another former IDP. "We have no option but to travel long distances to look for these drugs." Organizations working in HIV have also expressed concern that monitoring their clients may become more difficult as they disperse to places lacking easy access to health centres. "In camps the facilities were in abundance, but now we need transport for proper monitoring as people are scattered in the villages," said Louis Okello, a representative of people living with HIV in Patiko sub-county, Gulu district. Prevention services are needed as well. Recent research by the AIDS, Security and Conflict Research Hub shows that the transition from war to peace can increase risks of HIV transmission as refugees go home, soldiers leave the army, relief agencies wind down, and rapid economic growth occurs around key urban centres. According to the Ministry of Health, HIV prevalence in Uganda's northern-central region is just over 8 percent, higher than the national average of 6.4 percent. Government officials say there are plans to roll out health services to the community by building new health centres and improving the capacity of existing ones. "There are already health centres in the return areas, although they are not sufficient," Kabakumba Masiko, the Minister of Information and National Guidance, told IRIN/PlusNews. "The government is committed to the rehabilitation and development of the region." "At the moment the services are only available at health centres … in county headquarters," said Stephen Oloya, chairman of Gulu District's camp phase-out committee. "For VCT services [voluntary counselling and testing], we are expanding them to sub-county level as we have tried to operationalize all the health centres at sub-county level," he added. "We are also planning to open health centres at parish level." Community distribution One local NGO, however, has already put in place measures to ensure people in its care continue their treatment uninterrupted; the AIDS Support Organization has opened community drug distribution points in various villages where patients can collect their drugs as well as seek psycho-social support and medical care. "We have the capacity to map and follow the clients to the places they will go; to make our work easy, we encourage them to give us maps to their places," said Sam Emukok, a TASO public relations officer. "TASO will continue delivering services to the registered clients regardless of where they will go after camp decongestion." Emukok said most HIV-positive IDPs would be happy to return to their homes, where they could cultivate their own food and eat a more balanced and varied diet than in the camps. "People who are living with HIV and are under our care know the importance of camp closure given the challenges they have faced in the camps; they can now engage in agriculture to get food to supplement their diets," he added. "We give this information during health education in the clinics, outreaches and during radio talk shows." More than two-thirds of the IDPs in the region have already left the camps - some returning to their original villages and others to satellite camps between the IDP camps and their villages. 4 Conference of Medical Superintendents Group opens Ghana News Agency 15/10/2009 Busua (W/R) Oct. 15, GNA - The Western Regional Health Directorate, has initiated steps to set up a Regional Research Unit to facilitate clinical excellence and provide evidence for critical medical decision- making. Mr Paul Evans Aidoo, Regional Minister, made this known in a speech read on his behalf, on Wednesday, at the opening of the 8th Annual General Conference of the Medical Superintendents' Group (MSG) at Busua. 5
  • 6. He said the Effia-Nkwanta Regional Hospital, the major referral centre in the region, was poorly equipped for adequate medical research. The three-day conference was on the theme: "Research and Medical Practice, Capacity Building in our Hospitals." Mr Aidoo said inadequate infrastructure and lack of key personnel including pathologists hinder clinical medical research. "New discoveries and expansion of medical frontiers could only be achieved with a well strategise medical research," he said. Mr Aidoo said critical areas that needed special attention were the re-emergence of certain tropical diseases such as yaws, filariasis, which abound in the Ahanta West District and guinea worm. He also listed the high disease burden of malaria, HIV/AIDS, hypertension, diabetes, soaring maternal and infant mortality and morbidity as well as health care financing improvement options and high technology development as other areas of focus. Mr Aidoo urged the conference to examine the issue of ethics, which relates to patients privacy and consent in medical research. Dr George Acquaye, President of MSG, said there was the need for the expansion of the country's health facilities, to avoid over crowding of patients. He said there was the need to regularly replace equipment at the facilities to increase efficiency and to motivate health workers to attend to patients. Dr Acquaye spoke of the delay in reimbursing health facilities under the National Health Service Insurance Scheme. He asked members of the group to publish their research works in the Ghana Medical Journal and other medium and also read other study findings. Dr Linda Vanotoo, a medical superintendent said health delivery in the region had to change because of the discovery of oil and asked the conference to consider the issue. She noted that organisational barriers and lack of requisite number of personnel and technical know-how at the medical centres could be overcome when the officials use guidelines that are developed by experts or availing themselves of competency based training and putting in structures that would help them to use results obtained from research. GNA 5 Another Woman Dies in Labour 'Out of Negligence' Daily Monitor, Uganda 15/10/2009 David Mafabi Kisakye was admitted to Mbale Regional Hospital but after examination, the midwives on duty neglected her and only returned to attend to her in the evening at about 9p.m. when the situation had gone out of hand. When Olivia Kisakye arrived at Mbale Regional Hospital on September 23, in labour, she knew she would give birth normally under the supervision of qualified medical personnel and return home. But unfortunately, when they reached the hospital's maternity ward from Bugusege, it took them the entire day to get the services of a medical worker and by the time the midwives responded, Kisakye had passed on. Amina Nabukwasi, the deceased's mother is a bitter woman and does not want to talk to anyone from the hospital. Why? She believes her daughter (Kisakye) could have been saved if the medical workers had attended to her in time. "What did I do to these nurses? Why do they treat me like this? The Ministry should intervene, investigate this matter to save other mothers who go to deliver at this hospital," Nabukwasi laments. 6
  • 7. Kisakye was admitted to the maternity ward at about 3.a.m. but after examination, the midwives on duty neglected her and only returned to attend to her in the evening at about 9p.m. when the situation had gone out of hand. "They told me to buy medicine and gloves before my patient could be attended to. I pleaded with them several times but they chased me away and said that they were too busy to attend to my daughter. They even threw a pillow at me to go away," Nabukwasi says. She says at about 11pm when they later responded, the nurses sent her out to go and look for hydralazine, magnesium sulphate and gloves. "I moved through the streets and never found anything. I decided to go back and found my daughter breathing her last, the foetus had already died," Nabukwasi narrates. Although the body was supposed to have undergone a post-mortem to ascertain the cause of death and remove the foetus, Ms Nabukwasi says they were chased out of the hospital and told to take the body with them. The girl was admitted after she experienced labour pains. She was examined by the doctor but shortly developed fits and high blood pressure, so he prescribed hydralazine and magnesium sulphate but unfortunately this medicine was not available at the hospital so we told her relatives to go the drugs buy but they did not," the senior principal nursing officer, Monica Odella says. She says at the time of Kisakye's death, there were only two midwives in the ward; one was attending to four women who were undergoing casearian deliveries and another attending to 24 women who were delivering normally. She says that maternal mortality rates especially for women in labour are common at the hospital because of shortage of drugs and understaffing at particularly the maternity ward. However, Ms Odella denies reports that the hospital refused to have a post mortem taken on the deceased and says her relatives came and demanded to be given the body to avoid mortuary and postmortem expenses. Sources at the hospital say that there is an outcry of lack of services at the maternity and casuality wards, theatre and the blood bank to the extent that if a patient does not have money they cannot access treatment. "We buy everything even if it means a medical worker just touching your patient. IV fluids are sold at Shs2000, a canular at Shs3000, a syringe at Shs500 and gloves at Shs2000. These prices are double the cost in some private clinics, so we are being cheated," a patient who spoke on condition of anonymity said. The patients cite poor services, scarcity of drugs; unsuccessful attempts to see a doctor, corruption, tribalism, poor attitude towards patients and an unhygienic environment as some of the setbacks of the hospital. "Our hospital is not operating as referral. In fact, it is not fit to be called referral as it is worse off than a health centre II in rural areas. It is an abuse to refer to Mbale Hospital as a referral when it refers patients to private clinics for diagnosis," a doctor who spoke on condition anonymity reveals. He said the situation at the hospital has forced many people to lose trust in the government and health system and opt for herbal remedies or private clinics which unfortunately offer sub-standard medical treatment. 6 UCH Doctors Embark On Strike Daily Champion, Nigeria 21/10/2009 Dele Ogunyemi Ibadan — Resident doctors of the University College Hospital (UCH), Ibadan on Tuesday embarked on an indefinite strike to express their grievances over the current developments at the premier teaching hospital. Specifically, the doctors are said to be annoyed over the recent hike in the tariff for services being rendered to patients by the hospital and recent hike in their official accomodation tariff together with the amount they pay for other utility services such as electricity. Sources close to the hospital revealed that the UCH management recently increased the accomodation tariff being paid by resident doctors by 700 per cent while amount being charged the doctors for electricity by the hospital also went up by almost the same percentage. The hospital management equally directed that the deduction of the new accomodation fees and fees for electricity should commence this month. 7
  • 8. It would be recalled that the hospital management had earlier in the year, increased the fee being charged patients attending the hospital to raise internally generated revenue for the hospital. It was reliably gathered that efforts by the resident doctors to make the hospital management rescind its decisions had met with stiff opposition. According to sources, the executives of the resident doctors had on about eight occasions met with management where their appeals for the downward review of the newly introduced fees were rebuffed. "We have no alternative than to commence this strike. In as much as we appreciate the hardships this may inflict on our patients, we have found ourselves in a situation where management has turned deaf ears to our grievances", one of the aggrieved resident doctors who pleaded for anonymity said. Commenting on the development, another resident doctor said management of the hospital had also given all the resident doctors 'quit notice' from their respective apartments under the guise that the apartments are to be renovated between now and next January. He said: "The idea is to cow us into paying the new rate. Even if you want us to pay new rate, where do you want us to be staying between now and January when the supposed renovation is expected to end. Some of us are not from this state. Some are from the East while some are from the North and you are saying we should quit; quit for where?" Vice Chairman of the UCH Branch of the resident doctors association, Dr. Adewole Badiru who confirmed the strike however, declined comments on the issue. Majority of the resident doctors who were sighted at the hospital were seen at the 'Resident Doctors' lounge where they congregated and were discussing the issue. In a sharp reaction however, the UCH Chief Information Officer, Mr. Toye Akinrinlola told newsmen that the management has met with the executive of the striking resident doctors expressing the hope that any moment from now, they might call off the strike. 7 IMF accused of impeding health sector progress Business Daily Africa 15/10/2009 By STEVE MBOGO (email the author Civil society groups are blaming conditions set by the International Monetary Fund for saddling patients with high medical bills and increasing the prevalence of infectious diseases such as Aids and tuberculosis. The organisations say expenditure ceilings on public health spending imposed in the ‘90s as part of the conditions for disbursing financial support to Kenya have held back progress in the health sector by restricting the recruitment of medical professionals. Kenya’s public health officials have previously said that the country urgently needs 10,000 nurses but an eight per cent ceiling on wage spend has made it difficult to hire them. “As a result of inadequate funding, coupled with the wage bill ceiling and employment freeze, Kenya is experiencing a health workforce crisis,” said Allan Ragi, the executive director of the Kenya Aids NGOs Consortium (Kanco). He spoke during the launch of a report that profiles how IMF policies in Kenya have impacted treatment HIV/Aids and tuberculosis. The study, conducted by the Center for Economic Governance and Aids in Africa in collaboration with Kanco and Results Educational Fund reveals that the fund’s policies restrict government spending, denying sick Kenyans access to drugs and quality healthcare. The ceiling has also left Kenya’s fight against HIV/Aids virtually dependent on donor funding. Institutions such as Kenyatta National Hospital have been acutely affected by the ceiling as the inability to engage additional personnel has also meant they cannot invest in new equipment because there will be no one to operate it. 8
  • 9. Of the Sh500 million allocated to the hospital this financial year, Sh100 million will go into the repair of lifts, with the remainder being applied to salaries and the construction of a national burn centre. Affordable care Altough the hospital currently needs renal units to provide affordable care to the growing number of kidney patients in Kenya, each renal unit would cost about Sh250 million, and would require the hospital to hire additional staff. The report by the non-profit groups calls on the IMF to phase out activities outside its areas of core competence which carry with them these conditions. “The IMF does not have a mandate for, or competence in, the long-term development of low-income countries,” said the groups. The report recommends that IMF’s Policy Support Instrument be phased out in order to end the IMF’s monopoly on ‘signalling’ to donors whether or not developing countries warrant support. Some of the conditions set by the IMF are that inflation should be at about 5 per cent, fiscal deficits should be at about 3 per cent and foreign currency reserves should be least two and a half months of export earnings. The groups said that the low-inflation targets set by the IMF lead to limits on overall national spending within the economies of poor countries which in turn reduces the pace of growth in these economies. It also exacerbates unemployment. For instance, Kenya has more than 10,000 trained but unemployed nurses who cannot get public sector jobs because of the IMF policies. In an earlier response to non-profit groups, IMF said the wage bill condition was being phased out and would henceforth be used only in countries with unstable macroeconomic conditions such as those emerging out of conflict. According to the the non-profit groups, however, the IMF still maintains these conditions only not as directly as they used to. The fund has also insisted that high wage bills have been a significant source of macroeconomic imbalances and that wage and employment conditions in other sectors would need to be reformed to allow for sustainable expansion in health and education. Kenya’s health budget has grown from Sh15.2 billion in 2002 to Sh37 billion 2010. 8 Be kind, health workers urged New Vision, Uganda 21/08/2009 By Frank Mugabi HEALTH workers have been urged to be kind to patients despite the difficulties involved. The registrar of the Allied Health Professionals Council, Benjamin Odongo, said being a health practitioner is a calling just like priesthood, where service to the people is a priority. “As health professionals, we handle life. Always smile although things are difficult. Very many are called but very few are chosen. You are lucky to be among the chosen few,” Odongo said. He was addressing the first graduands of Arua School of comprehensive nursing in Arua town last week. Odongo described nursing as a “noble” profession and urged the graduates to register with the professional council to help weed out quacks. He also urged them to adhere to the ethical code of conduct that was jointly developed by the health ministry and the professional council. The Bishop of Madi and West Nile diocese, Joel Obetia, advised the graduates to grow in their spiritual lives if they are to be compassionate. “It is surprising to see some nurses looking after vulnerable patients with a face of thunder. This shouldn’t be part of you,” Obetia advised. A total of 444 students, 246 of them females, got diplomas and certificates in enrolled nursing, midwifery and comprehensive nursing. The principal, Margaret Nyakuni, said the school which 9
  • 10. was built for 120 students, currently accommodates 533 students following the introduction of new programmes. The chairman of the governing council, Christopher Yiiki, applauded the education ministry for providing a bus to the school. Yiiki said a new resource centre and classrooms had been constructed with support from the European Union. He added that the old buildings had also been rehabilitated. Back to top Asia & Pacific 2 ‘Intensify barangay’s dengue drive’ Inquirer Global Nation, Philippines 18/10/2009 By Fe Marie D. Dumaboc Cebu Daily News The barangay health workers (BHWs) in the city and province of Cebu were urged yesterday to intensify their information campaign against dengue virus. The call was made yesterday to at least 8,000 BHWs of at least 100 barangays from the province and city, who attended the start of the weeklong celebration marking the 15th anniversary of the establishment of the BHWs. Disseminate information and call the attention of the people in your barangays to maintain cleanliness to prevent being afflicted with dengue virus, said Ermelinda Abadiano, seven-year president of the National Confederation of Barangay Health Workers of the Philippines, Incorporated (NCBHWPI). Abadiano cited that dengue scourge and the lack of medicine in the barangay health centers were a common problems of the BHWs. “We do referrals if naay magkasaskit na didto sa health clinic, doctors, or hospital, we also do health teaching regarding environmental sanitation and preventive measures,” Abadiano said of what other measures the BHWs do to prevent the dengue virus. “We also do orientations regarding dengue, we recruit blood donors for a blood letting to help regional blood center,” she added. Abadiano, who spoke before the BHWs at the Cebu City Sports Center, asked the barangay health workers to be united in accepting the challenges in their barangays. She encouraged them to go on with the spirit of voluntarism for the betterment of our country. One of the health workers, Josefina Villasan, 51 years old, of barangay Caladcaran, San Fernando town in Southern Cebu, said she had been a barangay health worker for 11 years and was happy to serve the people specially those in her barangay. “I don't care if the honorarium is small. I volunteered to serve the barangay. I'm just happy to serve and help even the children of the barangay,” she said Abadiano said honorariums for the BHW differs from place to place. Cebu City Councilor Hilario Davide III, who attended the activity, said the city's BHWs receive a P3,000 honorarium. Abadiano said the lowest honorarium was P50 for a BHW. She didn't however specify what place this was. in Cebu City, the City Health Department, reported 1460 dengue case with 32 deaths since January to October this year. Yesteday's gathering started with a parade from Fuente Osmena Rotunda to Mango Avenue to Lorega Street and to Cebu City Sports Center. 10
  • 11. Most of the BHWs who attended were in at least in their 50s but Abadiano said they preferred to join the parade to prove that they were physically fit and capable to do their jobs. 3 'Made in India' dominates US AIDS scheme Business Standard, India 16/10/2009 P B Jayakumar / Mumbai Indian drug companies have cornered an overwhelming majority of drug approvals under the US President's Emergency Plan for AIDS Relief (Pepfar). Out of the 100 approvals by the US drug regulator Food and Drug Administration (FDA) so far, close to 95 per cent are for Indian companies. Aurobindo leads the list with 34 approvals, followed by Cipla and US-based Mylan Laboratories' Indian arm Matrix Laboratories with about 15 approvals each. Companies such as Strides, Emcure and Hetero also would supply about 5-15 drugs each under the programme. The Pepfar programme, started in 2003, aimed at the prevention, treatment, and care of people infected with HIV/AIDS worldwide. On October 6, the FDA approved the 100th anti-retroviral drug under the Pepfar programme. "It is a service to the society and we are happy to be the leader in supplying anti-retrovirals, at one-third of the prices of original drugs under the programme," said K Nityananda Reddy, managing director of Hyderabad- based Aurobindo. The service to society makes business sense, too, for the drug companies. Pepfar is the largest commitment ever by any nation for an international health initiative dedicated to a single disease and is focused on 15 of the hardest-hit countries in Africa, Asia, and the Caribbean. These countries are Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam and Zambia. In May 2007, then US President George W Bush reauthorised the programme by increasing procurement of generic drugs and offered another $30 billion, in addition to the initial $15 billion commitment made in 2003. “On average, we have earned $20 million to $25 million (Rs 92 crore to Rs 115 crore) annually in the last few years from Pepfar supplies. I anticipate a slight plus or minus revenue to this figure in the coming years from this programme,” said Amar Lulla, joint managing director of Mumbai-based Cipla, another major supplier. As on September 30, 2008, the most recent figure available, Pepfar supported life-saving antiretroviral treatment for more than 2.1 million living with HIV/AIDS. In 2008, it provided nearly $1.6 billion in support of treatment programmes, including antiretroviral drugs and services. “There is no separate data on the spend for drug procurement under the programme. Companies involved in the programme do not reveal their revenues separately. Supplies are staggered and procurement takes months or quarters later from the date the orders are placed,” said Ranjit Kapadia, vice president, institutional research with HDFC Securities. "It is estimated that FDA’s actions are allowing Pepfar to spend $150 million (Rs 690 crore) more each year on patient access to care,” US FDA Commissioner Margaret A. Hamburg said in a statement. The approval process for drugs is rapid. Even patent-protected drugs are procured for supply with a tentative approval in the countries covered under the programme. The goal of the programme is to support treatment of at least 3 million people, prevention of 12 million new infections, and providing care for more than 12 million HIV-infected and affected people by 2013. In addition, Pepfar will support training for at least 140,000 health care workers in HIV/AIDS prevention, treatment, and care 4 Mission accomplished for Okinawa 'substitute doctor' Japan Times 11
  • 12. 17/10/2009 Kyodo News Zensho Miyazato's Okinawa hometown had been reduced to ashes by the time he returned in 1946 at age 25 from the Solomon Islands, where he had served as a medic during World War II The banana trees with their cool shade and fields of sugar cane that he once loved were gone. What remained unchanged was the scorching sun and emerald green sea. Okinawa was the site of one of the biggest battles between Japan and the United States, resulting in the deaths of thousands of civilians. After Japan's defeat, Okinawa was flooded with starving and sick people. But only about 60 doctors survived the war. To make up for the shortage, the U.S., which had control of Okinawa and Amami Island, had former Japanese soldiers who served as medics take medical courses and start practicing in remote areas in 1951. They were called "substitute doctors" and were allowed to practice medicine for a generation in a remote area. At his home village, Miyazato was the only soldier who returned from the Solomons. "The fact that I survived might mean that I was given a mission," said Miyazato, 88. That is how he became one of the 126 former medics who passed the medical exam to serve as substitute doctors. In 1952, Miyazato opened a clinic in the Heshikiya district of Uruma, Okinawa, becoming the only doctor serving in the area. He started working early in the morning and called on patients until late at night, treating up to 200 people a day. He walked through the mountains with a flashlight at night and took boats to call on patients on remote islands. Miyazato did not take money from the poor and even offered to pay the bus fare for patients in critical condition who had to go to a bigger hospital in the town. "He knew everything from family issues to financial situations," said Hatsuko Oshiro, 71. "When I went to the clinic, he would ask for my parents and brothers and didn't take money when we were going through a rough patch." In prewar Okinawa, midwives and those who cured people with medicinal herbs and other traditional methods effectively served as doctors, according to Sumiko Ogawa, 43, associate professor on public health at Meio University in Okinawa. "Substitute doctors were the same in the sense that the ones people were familiar with and had confidence in treated the patients," she said. When Okinawa was returned to Japan in 1972, the medical system rapidly developed as the political system and economy were integrated with the mainland. A medical department opened in the state-run University of the Ryukus in 1979 and a doctor shortage in remote areas was expected to be resolved. But most doctors wanted to practice in cities instead of remote villages and towns. According to research Ogawa conducted, only eight out of some 1,400 doctors who graduated from the University of the Ryukus served at clinics in remote areas. This proves that, in those areas, it was substitute doctors who offered the necessary medical services. But that did not mean the medical treatment given to residents there was below standard. 12
  • 13. Masazumi Harada, 75, a professor at Kumamoto Gakuen University, was surprised when he visited the remote Henza Island for a month in 1965 to conduct research into the mental health of the local residents. Harada was hoping to prove that Okinawa's medical standard was below average and that further support from the mainland was necessary. But what he saw instead were patients, who he thought needed to be hospitalized, living normal lives with the help of substitute doctors and neighbors. "I wonder which medical system is underdeveloped?" Harada asked. Is it better to increase the number of hospitals and admit more patients or to support them in a way that they can lead a normal life at home? It was this question that motivated Harada to become a doctor. When he was a researcher at Kumamoto University in 1960, he dealt with patients with Minamata disease, an illness caused by mercury poisoning, in the region. "Even if I sent all of them to the hospital, the problem won't be resolved," he said. "A health care system involving the local community is necessary." Harada got the answer from Okinawa — training people with medical knowledge like substitute doctors so the community can support each other. From two years to 1977, Harada ran a private school to teach basic medicine for Minamata patients and their families. Those who participated later became doctors and practitioners of acupuncture and moxibustion, practicing in regions. Substitute doctors attracted attention from abroad as well. In 2004, several Senegalese nurses visited Miyazato to learn about substitute doctors to address the shortage of doctors in their home country. Even though many of his fellow substitute doctors retired due to old age and illness, Miyazato continued his practice. But last autumn, he finally closed down his clinic because he was beginning to have difficulty hearing. "I have completed my mission," said Miyazato. "I have no regrets." 7 Hospital workers speak out Taranaki Daily News, New Zealand 17/10/2009 By GRETA CLEARY Hundreds of "undervalued" hospital workers vented their frustration in protests around the country yesterday. The Service and Food Workers Union said health boards were offering no wage increases this year and had been told they could not give raises without them being signed off by the Government. The union said more than 2700 cleaners, kitchen staff and orderlies at 35 hospitals across New Zealand took part in the protest. There were toots aplenty for Hawera and New Plymouth hospital orderlies and cleaners who took to the streets with placards to protest a possible five-year wage freeze. Union members gathered near both hospitals for a two-hour stopwork meeting calling for the wage freeze to thawed. 13
  • 14. Finance Minister Bill English said at the end of last month the health workers could face five years without a pay rise. On the picket in Hawera, union delegate and hospital cleaner Jennifer Dudley said the group was sick of being left behind despite being valuable and essential workers. "We do a lot for patients and we do important jobs," she said. "If they want a healthy hospital they need us there and if they want healthy patients, they need to be fed." They are already the lowest paid and have not had a pay rise in two years, she said. The Taranaki District Health Board has just been given a 3.1 per cent increase in funding and the protesting workers are not seeing any of it, said union representative Sam Jones. "They just want a fair deal. We're only asking for 3 per cent." Nurses had been given a 4 per cent pay rise and doctors also recently received an increase, he said. Health board negotiating team spokesman Craig Climo said the protest was all part of the usual bargaining process. "People have a right to make their views heard and this is part of the negotiating process," he said. "We value our staff who are doing valuable work in the DHBs." While maintaining good relationships with staff was a priority the health boards were facing unusual circumstances with tough financial restraints, he said. "Employers and staff want the same things: The best possible health care for patients, satisfying and valued work, and well-run and effective health services. "We want to work together with our staff to provide that." 8 Rural GPs glad to bend Kevin Rudd's ear The Australian 17/10/2009 Adam Cresswell, Health editor RURAL doctors have taken heart that they will not be overlooked in the looming reforms to the nation's health system, after Kevin Rudd extended a scheduled meeting at a country practice to hear concerns about the sector's problems. The Prime Minister was due to spend 15 minutes in a private meeting with doctors from the Bridge Clinic in Murray Bridge, southeast of Adelaide, on Wednesday but the talks ended up lasting nearly an hour, and finished with doctors hopeful of obtaining some key concessions. Peter Rischbieth, one of the 13 general practitioner partners who run the clinic and a former president of peak medical rural lobby the Rural Doctors Association of Australia, says these include the issue of taxation of government grant money, better support for overseas-trained doctors and the opportunity to enlist rural GPs to deliver the government's commitment to improving preventive health. ``This is the first general practice he has been to as part of the 50 visits done under the reform consultations,'' Rischbieth says. ``We were keen for him to come. Our main message was about infrastructure and the chance for general practice to be part of the new reform practices in preventive health care.'' Rischbieth says Rudd has indicated he will follow up concerns over inequitable tax treatment of commonwealth grant payments, which means that a private practice that receives infrastructure grants has to pay 45 per cent of the money back to the government as tax while similar grants paid to regional organisations called divisions of general practice are allowed to keep all themoney. He says overseas-trained doctors, on which rural Australia is particularly dependent, also need better support because at present they generally are not eligible for Medicare payments if they or their families become sick. 14
  • 15. In some cases their children are not even entitled to free public education. These are all issues that serve to make it difficult for overseas-trained doctors to perform at their best or stay longer than they need to. ``Pleasingly, after hearing RDAA's concerns, Prime Minister Rudd invited us to also work directly with his office in combating the key issues fuelling the continuing health workforce crisis in rural and remote Australia,'' Rischbieth says. ``We came away from the meeting with a great feeling that the Prime Minister now clearly appreciates the wide scope of work that rural doctors undertake in their communities, and the additional workload they carry from providing general practice-based primary care right through to being the emergency doctor at the local hospital. ``In rural and remote areas, the same doctors who see you in their general practice invariably are the ones who will be working closely with a range of other health professionals at the local hospital to deliver your baby, stabilise an acutely psychotic patient, save your life in the hospital (emergency department) after a car accident or a heart attack, treat your child in a pediatric emergency and provide the anaesthesia for local surgery such as orthopedic surgery, gynaecological surgery and general surgery like ear, nose and throat operations,'' Rischbieth says. Since the release of the final report by the National Health and Hospitals Reform Commission Rural in July, rural doctors have been increasingly anxious about the federal government's commitment to fixing health problems in the bush. At the time, the RDAA was particularly critical of what it saw as the report's failure to include ``any substantial recommendations to increase the number of health professionals working in the bush''. It also feared Rudd's decision to tour leading hospitals nationwide to gain feedback from health workers about the reform proposals would entrench a city-centric view of what reform changes were most required. The RDAA wrote to the Prime Minister in August, asking him to stage a national fact-finding tour of rural hospitals, rural practices, health centres and Aboriginal Medical Services to expand on the reform consultations. After Wednesday's meeting, Rudd said the discussions at the Bridge Clinic had included ``other support mechanisms ... including helping with the expansion of primary health care capital facilities as well''. ``The government is rolling out GP SuperClinics across the country and one of the discussions we've had today is how do we tailor a program like that to the expansion of existing GP SuperClinic-type facilities which already exist in rural and regional areas in particular,'' Rudd said. Rischbieth says his and many other rural practices already operate as defacto SuperClinics, and in his case has spent about $1million on upgrades that allow it to offer a range of services including minor surgery as well as training GP registrars. The RDAA says it hopes Rudd will visit more rural practices before the government decides on the shape of its health reform proposals to be put to the Council of Australian Governments by year's end. 9 New Clinical Training Agency Board appointed New Zealand Doctor 16/10/2009 Health Minister Tony Ryall has today announced the make up of the Clinical Training Agency Board, a new national body to unify workforce planning in New Zealand. Mr Ryall says, "The Government wants better and urgent integration of health education and training. There have been multitudes of reports mixed with indecision over the past 10 years, and it is past the time when we need to take a stronger approach to health workforce planning." "New Zealand has a health workforce crisis with too many clinicians disengaged and leaving the country." "This new Clinical Training Agency Board will unify workforce planning in New Zealand and ensure coordination of workforce training, planning and funding for our nurses and doctors and other health professionals." Mr Ryall has previously announced that the Board is being chaired by Professor Des Gorman, the Head of the School of Medicine at the University of Auckland. 15
  • 16. Professor Gorman is being joined on the Board by: Professor Max Abbott, Clinical Psychologist, Pro Vice-Chancellor (North Shore Campus) and Dean of the Faculty of Environmental Sciences at the Auckland University of Technology; and Deputy Chair of Waitemata District Health Board. Professor Gregor Coster, General Practitioner, Dean of Graduate Studies at the University of Auckland, and Chair of Counties Manukau DHB. Ms Helen Pocknall, nurse, Director of Nursing at Wairarapa DHB; and Chair of the Central Region Directors of Nursing and Chief Medical Officers group. Ms Karen Roach, enrolled nurse and midwife; Chief Executive Officer (CEO) of Northland DHB; Chair of Northern Region CEO Group; and Chair of the 21 DHB Employment Relations Strategy group. Professor Don Roberton, Paediatrician; Pro Vice-Chancellor, Division of Health Sciences; and Dean of the Faculty of Medicine at the University of Otago. He was a member of the Medical Training Board, the Health Workforce Taskforce. Dr Andrew Wong Public Health Medicine specialist; CEO of Ascot Mercy (private) Hospital. He is Managing Director of HealthCare Holdings Limited Mr Ryall says, "These people are not appointed as sector or professional representatives. They are there because of their abilities to support Professor Gorman and the government in driving change." "We know that with the workforce crisis we inherited, problems won't be fixed overnight, but we are taking action rather than taking stock." Related links Health minister Tony Ryall made this announcement at AUT yesterday, click here for his speech notes 10 Health Board denies hospital review claims Ashburton Guardian, New Zealand 21/10/2009 By Susan Sandys October 21 2009 Ashburton Hospital anaesthetist Ross Warring asked rural health representatives last night to seek retention of 24-hour surgical services. Dr Warring said continuation of the hospital’s around-the-clock service was being assessed, but the Canterbury District Health Board has denied this, saying there is no “active review” under way. Dr Warring, who is also an Ashburton GP, put his concerns to Rural Canterbury Primary Health Organisation (PHO) board members at a public meeting following their annual general meeting in the town last night. He said the other issue facing Ashburton was a fall-off in maternity services. Due to a desperate shortage of both hospital and independent midwives, not many babies were born at Ashburton Hospital’s maternity unit. Women were having to travel to Christchurch, resulting in more births on the side of the road. “I think these are very important issues facing the whole of our community at the moment,” Dr Warring said. He said the hospital was like a “stack of cards”, in that once services were withdrawn it became less attractive for medical personnel to work there. The hospital no longer offers orthopaedic surgery and caesarians as it did some years ago. If the 24-hour service was cut, those requiring surgery out of business hours would have to travel to Christchurch. Dr Warring called on the PHO to make representation to the Canterbury District Health Board on the issues. He suggested it seek increased salaries for the midwives in this area, who worked without GP back-up. “Rural midwives carry extra stress and they don’t get any recompense for that,” he said. 16
  • 17. Board member Marina Hughes said locals often knew best and it would be good to get information on the type of services the hospital should have. Dr Warring said a considerable amount of time had been spent on the “Doing it Differently” document about services in the area, but it was an older document many new board members may not be aware of. “Some of the issues in that document have been acted on, but very many of them have not,” he said. “I think what everybody in our area would like to see is more implementation of the ideas in the document. I think they are extremely relevant to care in this area.” Fellow GP and Canterbury District Health Board board member Chris Ryan wanted to see the PHO assist recrutiment of skilled medical personnel. Inactivity on “Doing it Differently” had meant the district had missed an opportunity to recruit surgeons, and there was a unique opportunity for the hospital to be accredited as a training venue which would ultimately assist recruitment. Canterbury District Health Board rural health service general manager Garth Bateup said after the meeting there was no active review of surgical services under way at Ashburton, and any such review would have to be approved by the DHB board. Back to top North America 1 Governor Rendell Announces Application for $5 Million Federal Recovery Act Grant to Train, Place Health Care Workers PR Newswire 19/08/2009 HARRISBURG, Pa., Oct. 19 /PRNewswire-USNewswire/ -- Governor Edward G. Rendell today said the commonwealth's application for a $5 million American Recovery and Reinvestment Act grant will help provide training and placement services for approximately 1,430 Pennsylvanians seeking careers in health care. "To help ensure that Pennsylvanians have access to the high-quality care they deserve, our workforce must have a greater number of highly skilled health care workers," Governor Rendell said. "Health care is among our most important industries and it is adding jobs - even during this recession." If awarded, the Pennsylvania Workforce Investment Board, or PA WIB, will use the grant to enhance statewide training and placement efforts for allied health workers. The Pennsylvania Center for Health Careers, an arm of the PA WIB, will develop a pipeline of allied health workers that is diverse and representative of Pennsylvania. The project will focus on traditionally underserved populations including dislocated, unemployed, low-wage workers such as those on public assistance, high school dropouts, individuals with disabilities, veterans and individuals with limited English proficiency. For more information about how Recovery Act funds are benefitting Pennsylvania, visit Media contacts: Christopher S. Manlove, L&I; 717-787-7530 Barry Ciccocioppo, Governor's Office; 717-783-1116 SOURCE Pennsylvania Office of the Governor 2 Nurses' Union Plans to Strike Wall Street Journal 20/10/2009 By KRIS MAHER A union is threatening a one-day strike involving 16,000 registered nurses at 39 hospitals in California and Nevada, saying hospitals aren't providing enough protections against swine flu for its members. 17
  • 18. The 86,000 member California Nurses Association, which covers all 50 states and is the nation's largest union representing nurses, is negotiating contracts that expired in June, covering 13,000 nurses. The planned Oct. 30 protest underscores the continuing debate over what kind of masks are needed to protect health-care workers against the H1N1 virus, as well as broader issues of staffing levels that have become a contract-negotiating issue. Nurses have long complained that hospitals keep nurse-staffing levels artificially low The union said one of its members died in August after contracting swine flu and that dozens of others have been sickened by the disease. It wants to use the contract negotiations to establish safety procedures around the U.S. More than 3,000 people have been hospitalized in California for swine flu, and 200 have died, according to the California Department of Health Services. The union decided to strike after "an onslaught" of patients admitted to hospitals made negotiations more urgent, said Jill Furillo, who heads union bargaining with Catholic medical facilities. She said the union was mainly striking over safety issues: "This is not really about money." The union is asking the health-care systems to create a monitor position to ensure that staffing ratios comply with California state mandates. The union also said it wants hospitals to stop a practice called "floating," in which nurses are assigned to areas outside of their expertise, such as an emergency-room nurse being assigned to labor and delivery. A union official also said a few hospitals are seeking salary freezes, which the union is fighting, and some hospitals have proposed increasing employee payments for health insurance. Elizabeth Nikels, vice president of communications for Daughters of Charity Health System, disputed the union's claim that it was striking only over safety issues. She said the health system was "dismayed" and "deeply disappointed" by the union's announcement that it will strike over safety issues and that the H1N1 virus "has never been discussed at any bargaining session." Chuck Idelson, a spokesman for the California Nurses Association, said that "swine flu has consistently been a major focus of our organization for months, and we've talked to hospitals about it." The nurses' association wants hospitals to require the use of disposable respirators known as N95 masks for nurses who have patients with swine flu. There has been debate in the medical community about whether the masks are practical because they have to be fitted to each individual's face. The Centers for Disease Control and Prevention has issued a statement saying the N95 respirators should be a priority, a recommendation that was disputed by the Society for Healthcare Epidemiology of America, which said the masks were neither necessary nor practical. Kevin Andrus, a spokesman for St. Joseph Health System in Orange, Calif., said its hospitals had made adequate preparations, including providing N95 respirators. "In all situations we are taking every precaution we can," Mr. Andrus said. The hospitals will provide H1N1 flu vaccinations for all employees, depending on its availability, he said: "We want them to be protected. They are our front line defense against the illness." Jan Emerson, a spokeswoman for the California Hospital Association, said the union was "grandstanding" by raising the respirator issue. She said hospitals would offer them but that there is a manufacturing shortage and "hospitals can not get enough of them." Write to Kris Maher at 3 Return of India's Traditional Birth Attendants Urged to Meet MDG 5 IPS Terra Viva 15/10/2009 Ranjit Devraj 18
  • 19. NEW DELHI, Oct 14 (IPS) - As India struggles to lower one of the world's highest maternal mortality rates, activists and experts are calling for a revision of polices aimed at "institutionalising" deliveries in resource-poor rural settings and phasing out the 'dai' or traditional birth attendant (TBA). According to a report released last week by Human Rights Watch (HRW), India's maternal mortality rate is 16 times higher than Russia's and 10 times higher than China's. Also, in several parts of the vast country, the rates have been worsening in spite of various government schemes and programmes - and possibly because of them. In 2005, the maternal mortality ratio (MMR) in India was 450 per 100,000 live births, slightly lower than the average ratio of South Asia (which comprises the country), estimated at 490, considered the second highest by region, next to African. According to the United Nations Children's Fund (UNICEF) an estimated 80,000 Indian women, either pregnant or new mothers, die each year from preventable causes, including haemorrhage, eclampsia, sepsis and anaemia. The HRW report, 'No Tally of the Anguish: Accountability in Maternal Health Care in India,' focuses on India's most populous state of Uttar Pradesh to show persistent failures in providing care for pregnant women. It also identifies caste discrimination, lack of accountability and limited access to emergency care as chief causes of maternal deaths. Annie Raja, general secretary of the Communist Part of India-affiliated National Federation of Indian Women (NFIW), told IPS that the failures were at least partly driven by policies blindly designed to meet the fifth Millennium Development Goal (MDG5) of reducing MMR by three quarters by 2015. MDGs are eight development goals to be achieved by 2015. ''There is a belief that MMR can be brought down by increasing skilled attendance at deliveries without considering realities on the ground such as non-functional or absent primary health centres as well as lack of personnel and funds," said Raja. A key MDG5 prescription is to maximise the number of births attended by skilled health personnel. In India this has meant a gradual phasing out of the 'dai' or TBA, who is considered illiterate, unskilled and difficult to train in the handling of pharmaceutical drugs that may be required during a birth emergency. Until 2005 when India launched its flagship National Rural Health Mission, some of the country's estimated one million 'dais' were also given training and had some recognition, but they have since then been steadily replaced by Accredited Social Health Activists (ASHAs) whose main job is to register pregnant women and encourage them to seek institutionalised care at government facilities. An ASHA (which translates as 'hope' in Hindi) must be literate and have received primary education until class eight. She acts as a primary health worker and receives incentives for providing referral and escort services for pregnant women to health care centres. But there are real practical problems, said Raja. "An ASHA gets just 600 rupees (12.8 US dollars) per live delivery in a government facility and is expected to bear the costs of transporting the pregnant woman and other costs along the way. If the delivery takes place outside the hospital premises, she gets nothing and then she has no training in midwifery." "Also, while the programme promised 'concrete service guarantees' such as free care before and during childbirth, emergency obstetric services and referral in case of complications, beneficiaries were limited to women classified as living below the poverty line or else belonged to tribal or 'dalit' (low caste) groups," Raja said. While a few 'dais' turned into ASHAs, the literacy criterion ensured that the vast majority of them got excluded, along with skills gained through sheer experience. "There is nothing wrong with the concept of 'skilled attendance at birth' as defined by the World Health Organization [WHO] and UNICEF except for the simple fact that basic health services are simply not available to the vast majority of people in India," said Raja. Dr Usha Shrivastava, a former researcher at the prestigious All-India Institute of Medical Sciences, said the problem is one of resources. "'Dais' provided a real service by operating in areas far away from any centre where a skilled birth attendant (SBA) may be available and deal with pregnant women who are often anaemic, malnourished and have no access to safe drinking water and, therefore, already compromised," she said. Shrivastava, editor of 'Health Positive,' a journal that specialises in 'best practices in clinical and public health,' said that even if qualified doctors or SBAs can be taken to remote rural areas, there is little that they can do in a birth emergency in a setting where there is no electricity, blood bank or sterile settings. 19
  • 20. Usha and Raja are not alone in their view that 'dais' should be empowered rather than phased out, as envisaged under MDG5. A team of researchers led by Anthony Costello at the department of child health at University College, London, reported in 2006 that while TBAs were not a substitute for trained midwives, they were the main provider of care during delivery of millions of women, especially in settings where mortality rates were high. "Since 1990 international agencies and academics without robust evidence have persuaded governments to stop training programmes for traditional birth attendants," Costello commented in the British 'Lancet' journal. Many national policies promoting institutionalisation of birth deliveries follow the ideals of the 'Safe Motherhood Initiative' launched in Nairobi in 1987 by the WHO, UNICEF, the United Nations Population Fund and the World Bank and by the International Conference on Population and Development in 1994. In September 2000, 189 world leaders committed their nations to the MDGs, which included improving maternal health. Raja said that in India a medical elite and a bureaucracy anxious to tote up figures showing increasing institutionalisation of deliveries have forgotten the harsh realities of rural India. "It is not difficult to see why, in spite of various government policies, only 17 percent of all deliveries in this country take place in a hospital or are attended to by an SBA," she said. Raja said the best way out is to develop alternate strategies that recognise the services and skills of TBAs, and incorporate them into the health system in such a way that women in the rural areas and those that belong to marginalised groups are adequately covered. Gargi Chakravarthy, a Delhi University historian and an activist with the NFIW, said the marginalisation of TBAs or 'dais' stretches back to British colonial times and has continued into contemporary India through policies drawn up by a bureaucracy with colonial moorings. "We need firstly to reorient the bureaucracy to current realities," she said. Chakravarthy pointed to copious documentation that shows the systematic devaluation of traditional health practitioners under colonial rule and the gradual replacement of the 'dai' by "lady health visitors" who promoted modern obstetric practices. The colonial period also saw the setting up of many hospitals where lying-in care was first made available for pregnant women. "It was possible for Britain and other industrialised countries in the West to drastically reduce maternal mortality in the last century by providing professional midwifery care and by improving access to hospitals. This model was later followed by developing countries, but success depended crucially on the existence of a functioning health delivery system," Chakravarthy said. Raja believes that the success of MDG5 lies in first implementing MDG3, which calls for the promotion of gender equality and the empowerment of women. "Too many of the decisions in public health are made by men while women's voices and concerns are routinely ignored." "Last week's HRW report," said Raja, "comes as no great surprise when the cruel reality is that the public health system, which was once a mainstay of healthcare for more than 75 percent of the population, has fallen into neglect through the privatisation of health care and reduced budgetary allocations that now stands at slightly more than one percent of GDP." "There is also the question of political will. Surely a country that calls itself an emerging power produces world- class doctors, has some of the finest medical facilities anywhere and promotes medical tourism can find a way to reach meet the MDGs," Raja said. 4 Flu shots not mandatory for local health workers Star News Online, NC 16/10/2009 By Vicky Eckenrode Area hospitals are offering flu shots to their employees but not making it a requirement as other facilities across the state and country have done Mandatory vaccination of health workers for the seasonal flu and H1N1 virus has kicked up controversy in some locations where employee groups bristle at the threats of people being punished or losing their jobs for not taking the shots. 20
  • 21. In New York, a suit has been filed against the statewide regulation that health care workers in the state receive both vaccinations this year. Despite all the messages for the public to get immunized against the seasonal flu, only 45 percent of health care workers got vaccinated last year – slightly higher than the 36 percent of the general population who did so, according to the U.S. Centers for Disease Control and Prevention. With the H1N1 virus creating an unusually active flu season this year, hospital administrators in Southeastern North Carolina have stepped up their encouragement for doctors, nurses and other staffers to receive the vaccines but have not made it compulsory. More than 60 percent of New Hanover Regional Medical Center’s staff has received seasonal flu shots, said spokeswoman Carolyn Fisher. She added that the hospital is making plans now for when more H1N1 vaccine becomes available – only a limited supply has been distributed lcoally so far. “We’ll have educational classes that will be starting within the next few days for employees who have questions or concern about the (H1N1) shot,” she said. Officials with UNC Health Care and Duke Medicine said this week their hospitals and medical facilities were not making vaccinations mandatory. But Wake Forest University Baptist Medical Center has made both seasonal flu and H1N1 vaccines a requirement for its more than 11,000 workers. Employees there can ask for religious or medical condition exemptions, such as being allergic to eggs, which can cause a reaction with the flu vaccine. Bonnie Davis, a spokeswoman at Wake Forest Baptist, said employees were given notice about the new policy. “If the 30 days comes and goes, and the employee has not gotten the vaccine, then it is assumed that employee is giving up their employment, and then the process begins there,” she said. “From the medical perspective, our folks, our medical experts here felt that requiring this vaccine is the best way to protect not only ourselves but also our patient population.” Like New Hanover Regional, Brunswick Community Hospital also will not require employees to take the seasonal flu or H1N1 vaccines. “We are asking physicians, employees and even volunteers to sign a declination form,” hospital spokeswoman Amy Myers said about workers who do not want the shot, whether for religious, medical or other reasons. But health workers at Brunswick Community who decline the H1N1 vaccine when it becomes available will be required to wear masks if they are within 4 to 6 feet of a patient. “It’s more to protect the patient no matter why they’re here,” Myers said. Local Private practices also strongly encourage their workers to get vaccinated. At Wilmington Health Associates, where staffers wear buttons to let patients know they have received their flu shot, 93 percent of the practice’s staff, or more than 480 employees, has been vaccinated against the seasonal flu. “According to the CDC, vaccinating health care workers against influenza is the single most important intervention to prevent the spread of flu in health care facilities,” said Paul Kamitsuka, an infectious disease doctor at the practice. 5 Curbing costs falls to wayside in health-reform push Denver Post 18/10/2009 By Michael Riley It's a simple idea with years of studies and data that show it works: Teams of nurses, nutritionists and community health workers that coordinate care of elderly patients with chronic disease can dramatically reduce hospital admissions and cut costs. 21
  • 22. But a $30 billion program to set up what are known as community health teams in all 50 states is nowhere to be found in the thousands of pages of draft health reform legislation — even though data show it would save three to four times that in lower Medicare costs. The absence of that program in the bills is a lesson in the failure of reform to achieve one of its basic goals — instituting widely agreed upon ideas that would curb runaway inflation in the cost of delivering care. Veering off cost course To their dismay, many health experts say they have watched the reform debate move from a starting point several months ago that emphasized curbing the cost of America's bloated system of delivering health care to one dominated by contentious debate about insurance coverage and cost. "The dilemma was that the committees were at a point where they were basically throwing everything overboard as fast as they could to get the bills down under $1 trillion," said Ken Thorpe, an Emory University professor who had discussed the teams program with lawmakers and their staffs over several months. Lobbyists weighed in, nixing some well-conceived reforms. Others were scuttled by growing concerns over deficits or the vagaries of Congressional Budget Office scoring. "Once we get the insurance reform piece in place — which is essentially what this bill is — and we get everyone enrolled in insurance, we can start filling in the gaps of implementing best practices," said Rep. Diana DeGette, a Denver Democrat and key negotiator on health care. "There are a lot of us in Congress who feel like health care reform will not be complete until we implement some of these practice reforms," she said. That two-pronged approach was not the original plan. In making the public case for sweeping reform, President Barack Obama and other Democrats pitched reining in costs as a primary justification. "The bill I sign must reflect my commitment and the commitment of Congress to slow the growth of health care costs over the long run," Obama said in July. That's because the problem plaguing the American health care system is not just the uninsured, but the fact that the cost of care is much higher than in other countries and growing rapidly. The $2.1 trillion the U.S. spent on health care in 2006 was almost $650 billion above what would be expected based on the country's relative wealth, according to researchers. Angry town-hall meetings over the summer were filled with frustrated stories of $200,000 hospital stays and redundant tests prescribed by multiple physicians. Stack those stories one upon another, economists say, and you get a system of hyper-expensive care and misaligned incentives that drive the rising insurance costs now grabbing lawmakers' attention. For years — in some cases decades — reformers have been studying a set of ideas that could alter that trajectory. "About 60 percent of the recent rise in Medicare spending is driven by nine chronic diseases, including diabetes, cardiovascular disease and hypertension," said Thorpe. Those diseases are poorly addressed in America's fee-for-service delivery system. Community health teams combine nutritionists, mental- health experts and nurse practitioners who stress continuity of care and the critical transition period after hospital stays. Studies suggest they could help avoid $12 billion annually in preventable hospital readmissions. A study of one program in Pennsylvania found it reduced total medical costs by 7 percent while delivering higher-quality care. Reform bills in both the House of Representatives and the Senate contain pilot programs designed to gather more information about how those and other innovative approaches would work in different settings. Providers must join in Thorpe and other experts counter that there are already years of high-quality studies. "It's fair to say their characterization of the literature is accurate," said Len Nichols, a health-reform expert from the New America Foundation who also is working closely with lawmakers. 22
  • 23. "But the reality is Congress can't just dictate what must happen. Providers have to be led into it. "It is true we could do it if we had the 101st Airborne take over. But you and I really don't want that to happen," Nichols said. Democrats say that while the bills they have written may not be as aggressive as reform experts like, they do provide significant opportunities to change the way doctors and hospitals deliver care. The Senate Finance Committee proposal includes a Medicare Commission, which could ask Congress to pass innovative cost-saving measures if Medicare costs rise faster than expected. Those might include a national version of health teams and other ideas. The Finance bill establishes a $1 billion a year Innovation Center to test new payment structures and methods that could help contain costs. But an analysis by the Brookings Institution found no clear path for how those ideas could be expanded or implemented nationally. "If the way we implement these changes doesn't work for doctors and patients, it's not really health care reform," said Erin Shields, a spokeswoman for the Senate Finance Committee. "What we've really tried to do is create a common-sense balanced approach that meets the president's goals of slowing health care cost growth but also can be implemented in a realistic fashion," she said. But the reform process has exposed the limits of Congress' ability to undertake a sweeping re-engineering of one-sixth of the economy. Critics' claims that Democrats wanted to ration care made lawmakers skittish of some reforms, experts say. And as the debate heated up and opponents focused on cost, lawmakers were increasingly driven by how the Congressional Budget Office would score the bills, DeGette and others said. The CBO consistently failed to find costs savings from innovative programs that Democratic staffers assumed would occur based on other studies. Many experts are still hopeful some of the innovations and cost-cutting ideas will be inserted in the bills during floor debates, especially as conservative Democrats look for ways to further justify the bill to voters back home. What's more likely, reform experts and some lawmakers say, is that Congress will have to return to the question of runaway costs again — and probably sooner than later. 6 What Might Health Care Reform Have to Do With H1N1? Huffington Post 19/10/2009 Terry Leach Health Care Policy Specialist In June of 2008, researchers from the Tohoku University School of Medicine in Tokyo warned, in a report re- published by the CDC, well before the masked and panic-laden Spring Break of 2009 images from Mexico City emerged, that mortality rates from a future pandemic would likely be higher in countries where: Its citizens lack access to adequate medical care Its public health infrastructure is weak Conditions, including housing and population density, contribute to spread of disease Host factors exist, including nutritional status and co-existing medical conditions; and Its citizens experienced a high HIV/AIDS prevalence. The researchers from Japan were profiling the potential impact of the next influenza pandemic in developing countries, well before H1N1 burst on the scene. And, in the end, they may be right -- deaths associated with H1N1 will likely be considerably higher in developing countries than in high-income countries. But how will the United States fare against other industrialized countries that offer adequate health care to all of its citizens? Already we are observing death rates in children and teenagers early in the year. Indeed, as of October 9, we had already seen over 75 deaths in children, a figure that is higher than the rate typically seen for seasonal flu over an entire season, and winter hasn't even begun. 23
  • 24. And could these heartbreaking deaths, many of them affecting otherwise healthy children, have been avoided in the United States, still the richest country in the world? We must ask our policymakers whether some children died in the U.S. because a) care was delayed or refused because of cost, b) there weren't enough providers to diagnose and treat , c) whether too many of our children have underlying diseases, including diabetes and asthma, because of health and reimbursement policies skewed away from prevention and/or chronic disease management and/or d) our public health infrastructure has been significantly impacted because of thousands of layoffs in the last two years. We must also ask about vaccine production, but more on that later. Consider the following information, because for good or ill, California is often a harbinger of what's to come for the rest of the country. Since the recession began, 661,000 Californians have lost their employer-based coverage, resulting in an uninsured statewide rate of over 26%. Even for those who have coverage, access to care is no guarantee -- scores of hospitals and emergency departments have closed throughout California leaving long lines, and delay of care to critically ill patients. Many of these facilities closed because of bankruptcy driven by increasing numbers of uninsured patients and patients on public plans with low reimbursement rates. In the poorest parts of Los Angeles, citizens with the highest rates of diabetes, asthma, cancer and HIV in the country, have a difficult time obtaining access because of high rates of un-insurance and limited numbers of healthcare providers, thus placing an even greater burden on the remaining provider community. Even if we expand coverage, the American Academy of Family Physicians reports that we do not have enough primary care practitioners to treat everyone who needs care, and estimates that we will face a shortage of 40,000 family practice physicians by 2020 just when the baby boomers' health care needs spike. Estimates are that California's shortfall alone will exceed 4,200 by that time. This means that even for families with healthcare coverage, the emergency room has become the 'primary care' default office, once again leading to long lines and delayed care. The numbers of medical students going into primary care has declined by more than 50% since 1990, in great part, because the reimbursement rates from both commercial and public payers is much lower than those paid to specialists. And finally, a strong public health infrastructure is integral to a nation's ability to respond to a public health disaster. The U.S. has been preparing for such an occurrence, particularly since 2002, and has taken many steps to protect its citizens. The recession, however, has taken its toll, at exactly the wrong time. In 2008 alone, over 12,000 public health workers were laid off. And what about the H1N1 Vaccine? Policymakers initially indicated that distribution of H1N1 vaccine to high-risk groups and healthcare workers would begin by mid-October with an anticipated delivery of 40 million vaccines. Instead, we are learning about delays of approximately 25% of promised vaccines, amounting to delays of 10 to 12 million doses. Perhaps the delay is warranted because of the time it takes to develop and distribute a safe vaccine. Clearly, many concerned parents are worried about safety, and some are indicating that they will not have their children vaccinated even when the vaccine becomes available. But the question must be asked as to whether companies charged with the production of the H1N1 vaccine are setting aside production of, say, more profitable drugs, in order to get needed vaccines to our high-risk groups and/or are refusing to commit more resources to expediting delivery. Indeed, GlaxoSmithKlein, the only manufacturer licensed to develop H1N1 vaccine for Canada, has already been challenged and, as of August 19th, has apparently refused to commit more resources to packaging the vaccine in order to facilitate its delivery. Hospitals are typically required to comply with surge capacity protocols, including the diversion of ambulances and cancellation of elective procedures when disasters strike, even though this means the potential loss of millions in revenue. Are pharmaceutical manufacturers privileged to do business in the United States similarly required to expedite the safe manufacture and distribution of antivirals and vaccines, even if doing so means more profitable business lines are placed on hold, and/or the cost of meeting pre-established delivery dates is higher than originally contracted? If the answer isn't yes, then policymakers should act fast to create the appropriate remedy to protect our most medically vulnerable populations. Thus far, it should be painfully obvious, even to families who haven't been affected by H1N1 yet, that policies skewed toward the maximization of profits for health insurance and, quite possibly, pharmaceutical companies, may not be good for American families. 24
  • 25. As the healthcare reform debate continues, we must ask whether our country's collective 'Katrina' movement has arrived. And have we served our children well? 7 HEALTH CARE AND PHYSICIAN SHORTAGES Cypress Times, TX 16/10/2009 Mark Roberts Doctors are forecasted to be in short supply. Although plenty of physicians are currently in practice across the country, surveys indicate that the availability is on the decline. According to, over the past several years, a growing number of national and state or specialty specific studies indicate that the U.S. physician workforce is facing current or future shortages. Since 2002, there have been at least 24 studies of current or future state physician workforce needs. In nearly all of these studies, the underserved and elderly populations are most likely to be affected. Additionally, many of the state reports point out shortages in specialties that are featured in the specialty report section, including allergy and immunology, cardiology, child psychiatry, dermatology, endocrinology, neurosurgery, primary care, and psychiatry. If physician supply and use patterns stay the same, the United States will experience a shortage of 124,000 full-time physicians by 2025. The report details shortages by state and specialty and can be found at . According to (American Medical News--AMN), the number of physicians, especially primary care physicians, in the pipeline is not sufficient to keep pace with the needs of a growing and aging population. The problem is not that the supply of physicians, including those in primary care, isn't growing -- because it is. It's just not growing fast enough. Physicians, like the rest of the population, are reaching retirement age in large numbers. In 2017, more than 24,000 will turn 63, and the number of new physicians entering practice each year is about 26,000--just about enough to maintain the status quo. If suddenly, 20,000 to 60,000 more doctors retire because the stock market is back up, America will be in trouble. The problem, according to AMN, has been highlighted by efforts at health system reform that, if successful, likely will require additional primary care physicians. Among the steps suggested to bolster the supply is to increase graduate medical education slots and to expand the use of support staff, including physician assistants and nurse practitioners, where numbers of new graduates are soaring. Some physicians describe another method -- reach out to students in medical school early, expose them to the health professions and "nurture the heck out of them". This approach has been underway for several years in rural areas and areas with high concentrations of minorities -- parts of the nation that have long faced a dearth of health care professionals. There are reasons that physicians leave the medical practice, according to AMN. A chaotic work environment -- with insufficient time for proper patient care and lack of control over work -- takes a toll on primary care physicians. Studies show that more than half of these physicians feel time pressure during office visits, while 48% said their work pace is chaotic and 78% said they have little control over their work. These conditions were strongly associated with low physician satisfaction, high stress, burnout and intent to leave. Health system reform efforts to provide coverage to the uninsured make it especially important to attract and retain primary care physicians. A major issue in health reform is who is going to care for those millions of uninsured people, so recruitment and retention in primary care is a major issue for the country. According to, an alternative suggestion is worth strong consideration. If experts are predicting a shortfall of doctors under the current workforce model, maybe it's the model, and not the number of doctors, that needs to be fixed. The analysis goes like this: While there is a healthcare services shortage, that doesn't necessarily translate into a doctor shortage. There are a number of ways to meet that demand for services, and the mistake reformers of any industry often make is to look for answers from existing models and stakeholders. The alternative is to ask what doctors are doing today that could be shifted to other workers who may be more affordable, but could have very specific technical expertise in treating certain select conditions, and do it very well, like a form of outsourcing. Some care can be shifted from some of physicians' workloads onto non-physician practitioners, such as nurses, physician assistants, and technicians, and shifting certain types of care to retail clinics and other settings outside of physician offices. Healthcare services are already being provided outside of doctors' offices more frequently, according to It's not just happening in retail clinics—over-the-counter at-home tests and medical devices now let patients diagnose, monitor, and treat conditions that were formerly the physician's domain. If the shortage projections are accurate, increasing medical school enrollment and funneling more money into physician development aren't alone enough to meet the growing demand for medical services. So if there will not be enough physicians, consideration must be given on how to care for an aging population in that environment. 25
  • 26. The key in all this is to enhance, not replace, physician services. If physicians view non-physicians and retail care as threats, then care will continue to be disjointed and the strain on the system will grow. But if physicians recognize the opportunity for collaboration, they can work with new nonphysician providers to coordinate care and focus even more on the high-level services at which they best serve. But Americans get it, according to The American people in general get it – they are weary of waiting months for a doctor appointment. Rural Americans, in particular, get it- they are often unable to find a physician at all. Citizens of Massachusetts get it – they are having a hard time locating a physicians in spite of a state health care plan that promise universal coverage. Americans seeking care during the night, at dawn, on weekends , and on holidays get it – they must go to hospital emergency rooms to get help. Older doctors get it – they are working flat out to handle their current load of patients. Younger doctors get it - they are unwilling to work as low paying primary care physicians, swamped with patients and with limited family or personal life. Primary care physicians get it – their numbers are dwindling and they may become obsolete in the next two decades at present rates of decline. General surgeons get it – according to the American College of Surgeons, their declining numbers have created a “crisis.” Physician groups with retiring partners get it – they are unable to recruit replacements. The Physicians’ Foundation, which represents 500,000 doctors in state and local medical societies gets it – they have just completed a national survey of 270,000 primary care doctors and 50,000 specialists indicating that doctors are in despair, having difficulty recruiting, are thinking of retiring or quitting or seeing fewer patients, and are not recommending medical careers for younger people. Community hospitals get it – they find themselves unable to recruit, retain, or even afford physicians to staff for essential services, serve their communities, and cover their emergency departments. Physician recruiting firms get it - they have to hunt high and low to find the right persons for their clients. The nursing profession and the physician assistant association gets it – they are mobilizing to produce more physician extenders. The nation’s largest staff recruiting firm, AMN, and its subsidiary Merritt, Hawkins, and Associates, gets it. As the economy grows, the nation spends more money on health care, and there is a double whammy because of a an accompanying shortage of nurses of an even greater magnitude than the doctor shortage. A great overview can be found at . The bottom line is that America needs more doctors and nurses. Providing medical care to an aging population and an ever increasing overall population of over 300 million people demands action that will help solve some of the critical issues of shortages in the medical field. Your Best Health Care is a blog that was created in 2007 to relay information to readers interested in how to navigate various health care topics. The notes contained on each topic are credited to sources relative to the material. Not all information is original, but the blog references additional sources that have been edited for the benefit of readers. Over the past 9 years as I have been involved in the health care industry, I have found that good information gives value to people who need help finding out how things work in the health care market place. This Blog also links to other valuable sources for health care information from sources like the CDC, the Mayo Clinic, Time, CNN, and many other news feeds. I hope you find the topics informative and helpful 8 Health workers say passing I-1033 will hurt Yakima Herald-Republic, Wash 2010/2009 By Leah Beth Ward YAKIMA, Wash. -- Hospital executives, health-care workers and administrators took a stand Tuesday against Initiative 1033, saying the measure would hurt services already suffering under state budget cuts. "I-1033 would be a disaster for hospitals, health-care workers and the thousands of people we serve every day," Russ Myers, chief operating officer of Yakima Valley Memorial Hospital, said at a news conference at the hospital. I-1033, which is before the voters in the Nov. 3 election, would cap revenue that state, county and municipal governments could collect from taxes and fees. The revenue cap would be fixed at 2010 levels and could only rise to take into account inflation and population growth. Revenue above the cap would be used to reduce property taxes. Voters could approve spending above the cap. Myers was joined by Anita Monoian, chief executive of Yakima Neighborhood Health Services, and leaders of the Service Employees International Union Local 1199, which represents health-care workers. Health care costs, they said, rise faster than inflation. 26
  • 27. They said the initiative would force the Legislature to cut funding for Medicaid and the Basic Health Plan -- which provide coverage for poor and low-income residents -- and that, in turn, would send more sick people to emergency rooms. Memorial could lose $11.7 million over the next five years if the initiative passes, Myers said. Monoian said the cuts would add to the damage done by the 2009-2011 state budget, which slashed the Basic Health Plan by 43 percent. Memorial, a nonprofit hospital, is absorbing $9.5 million in state cuts by freezing executive pay, leaving positions vacant, voluntary and involuntary furloughs and some benefit reductions. Yakima Regional Medical and Cardiac Center, a for-profit hospital, also sustained funding cuts. Tim Eyman, the initiative's author, said government revenues would still be allowed to climb consistent with inflation and population growth. Plus, he said, I-1033 has a safety valve: voters. "The voters, if they are convinced by elected officials that every other option has been exhausted, have shown that 70 percent of the time they are willing to say 'yes,'" Eyman said. Representatives from Yakima Regional didn't attend the news conference but also oppose the initiative. "Along with WSHA (Washington State Hospital Association) and hospitals across the state, we oppose I-1033 as a measure that would have a negative impact on patient care," chief executive Monte Bostwick said in a statement. 9 H1N1 could mean forced overtime for Quebec health workers CBC News, Canada 19/10/2009 The Quebec government is considering a contingency plan to cope with the swine flu that could force nurses and other health-care workers to work longer hours, CBC News has learned. But, it is a plan that is angering health-care workers who are at the front lines of the battle against the virus, also known as H1N1. According to the worst-case scenario being studied by the government, 35 per cent of the population would be sick with the flu. More than 30,000 people would require hospitalization, and up to 8,000 could die. The government's planned response includes the adoption of a cabinet order declaring a "sanitary emergency" which would impose certain working conditions on health-care employees. "In case of an emergency, we have to take emergency measures — and that is what the order would allow us to do," said Health Minister Yves Bolduc. But the plan could lead to further problems said Régine Laurent, president of the province's biggest nurses union. "What were're worried about is that ... it could be badly organized and that people could get sick because they are working too many hours, and too many days in a row," said Laurent. Nadine Lambert, vice-president of the health-care workers union at the CSN labour federation agreed. "People don't like to have conditions imposed on them, when we can work together," said Lambert. Parti Québecois health critic Bernard Drainville said the government should have worked with the health-care workers to draft the plan "We all know that if the second wave [of the flu] is going to strike, we are going to need the nurses very, very badly. So, I think instead of threatening the nurses with [a cabinet order], I think the minister should be living up to his word, and try to come to an agreement with the nurses," said Drainville. But the premier said the government is simply doing its job. "It is up to us to establish the conditions under which we can give the vaccinations, and manage a pandemic if it comes to that," said Jean Charest. 27
  • 28. Two million doses of the H1N1 vaccine have already been distributed to the provinces. Vaccination of health-care workers is expected to start next week. The vaccine is expected to be available to the rest of the population starting Nov. 2 10 De plus en plus d'infirmières enceintes au travail Le Droit, Canada 16/10/2009 Caroline Barrière De plus en plus d'infirmières enceintes sont maintenues au travail dans les centres hospitaliers, en raison de la pénurie de main-d'oeuvre. Elles effectuent alors habituellement des tâches qui sont mieux adaptées à leur état, jusqu'à 28 semaines de grossesse. C'est ce que conclut une recherche menée par Romaine Malenfant, professeure au Département de relations industrielles de l'Université du Québec en Outaouais (UQO), et ses collègues au sujet de la conciliation travail- grossesse dans le milieu de la santé. Les travaux de recherche ont eu lieu entre 2005 et 2008. Soixante-six entrevues ont été réalisées auprès de gestionnaires, travailleuses de la santé et syndicats des régions de l'Outaouais, Montréal et Québec. Connaître les risques Avec l'introduction du droit au retrait préventif pour les travailleuses enceintes au début des années 1980, il y avait peu d'effort mis dans la réaffectation des tâches. À cette époque, plus de 90 % des demandes aboutissaient à un retrait. « On connaissait peu les risques liés au travail de femmes enceintes. Avec le temps, il y a eu une augmentation des demandes et depuis cinq ou sept ans, on voit que le taux de réaffectation a augmenté, particulièrement dans le secteur de la santé, atteignant 30 % à 40 % », souligne Romaine Malenfant. Selon elles, les employeurs ont alors vu un intérêt à la réaffectation de la main-d'oeuvre - notamment en milieu hospitalier - avec d'un côté, la pénurie, et de l'autre, les précisions apportées par la Commission de la santé et de la sécurité au travail (CSST). Selon la CSST, il ne s'agit pas nécessairement du retrait du travail, mais plutôt du retrait à l'exposition aux risques pour la femme enceinte ou l'enfant à naître. L'objectif premier de la Loi sur la santé et la sécurité au travail est de maintenir les femmes au travail le plus longtemps possible. Cas par cas « On ne peut pas dire que toutes les infirmières sont maintenues au travail. Cela dépend du département [...], de la taille de l'équipe ou de la lourdeur de la tâche, puisque ça affecte toute une équipe. C'est une décision qui demande beaucoup d'efforts de coordination. À l'urgence, ce n'est pas toujours facile. S'il n'y a pas d'ouverture, la situation peut devenir intolérable », précise la professeure. La réaffectation semble être davantage offerte dans les grands hôpitaux, où les possibilités sont plus nombreuses que dans de plus petits établissements. Elle a souvent lieu jusqu'à un maximum de 28 semaines de grossesse. Au-delà de cette période, il devient alors plus difficile de concilier emploi et grossesse. Il existe toutefois un écart entre le travail prescrit et le travail réel, précise-t-elle en citant, par exemple, les soins aux patients. Les chercheurs notent également que, malgré l'avancée des connaissances, les travailleuses sont encore confrontées à un certain scepticisme de la part des employeurs. L'étude sur la conciliation travail-grossesse s'intéressait également aux travailleuses enceintes au sein des marchés d'alimentation. D'après les données obtenues, Romaine Malenfant note que la question du retrait préventif ne semblait pas problématique contrairement à la situation dans les centres hospitaliers. 28
  • 29. Selon elle, peu importe le milieu de travail, les femmes sont toujours hésitantes à annoncer leur grossesse à leur employeur. Il est parfois possible d'aménager le travail pour s'adapter à leur état. Mais cette nouvelle peut parfois déranger et certaines se le font dire, note la spécialiste. Back to top Europe 1 Iraqi doctors seize first training opportunity in 20 years in unique UK programme British Medical Journal, UK 21/10/2009 Zosia Kmietowicz 1 London By the end of November, 330 doctors, 20 nurses, and 50 key policy makers from Iraq will have passed through the United Kingdom on a unique training programme designed to kick start the rebuilding of the country’s health system. Shadowing doctors in the NHS, the selected group of Iraqi doctors, most of them surgeons, are already passing on the skills they learnt during their visits to colleagues back home. The Iraq Clinical Training and Development Programme is a response by the Department of Health to the conundrum of how to rebuild a health system from the rubble left by 30 years of war, invasions, sanctions, and civil unrest. Once a beacon of excellence in the Middle East, Iraq’s health service collapsed towards the end of the 1970s and is currently in need of a $1000bn investment to establish a functioning infrastructure, said Adel Abdullah, inspector general of the country’s Ministry of Health. He was speaking at a meeting in London on 19 October to thank the hosting trusts for their role in the programme and to report on the impact it has had since the first cohort of 25 doctors embarked on their eight week training in 2007. "It is the first time for 20 years that doctors in Iraq have had an opportunity to learn new skills," said Hilal Al Shaffar, from the college of medicine at the University of Baghdad. Since 2000, about a third of Iraq’s doctors (about 8000) have fled the country, some fearing for their lives under a regime that targeted people with an education and which led to a massive brain drain, not just of medical professionals. Threats, kidnappings, and killings were commonplace. With the average wage of doctors in Iraq at $10 a month, most had to take other jobs just to feed themselves and their families, and there was no time left for professional development, said Dr Abdullah. In 2002 the mortality rate for children under 5 in Iraq was 128 per 1000 and maternal mortality rate 294 per 100 000, he said. "We had no communication, no transport, no clean water, no sewage system. There was no structure to the health system, no guidelines, no patient safety, no medicine management system, and no clear documentation in hospitals," said Dr Abdullah. Medical specialties simply disappeared because of lack of capacity and trained personnel, said Dr Al Shaffar. But things have started to improve. The Iraqi government has allocated funds to build hospitals and primary care health centres. The country now has about 19 000 doctors, including 1500 who returned after 2003. More than 800 doctors were interviewed for the training scheme in the UK, and 80% of those who took part have returned to Iraq with projects, such as reducing infection rates, which will be audited. Although under the scheme the Iraqi doctors were not allowed to treat patients, they spent four weeks shadowing their counterpart specialists in NHS trusts in Glasgow, Sheffield, Birmingham, Bristol, Newcastle, Leicester, and London. They completed training modules developed by BMJ Learning on team working, communication, leadership, management, and change management. They returned home, said Dr Al Shaffar, with ideas about how to reduce waiting times, minimising complications after surgery, and working with colleagues to increase throughput. 29
  • 30. During their training the doctors saw surgical techniques that they had never used, such as carotid endarterectomies and various laparoscopies. They also visited centres of excellence, such as the National Institute for Health and Clinical Excellence and the royal colleges, which left many with an appetite for guidelines and postgraduate training, said Dr Al Shaffar. "This training project inspired our minds," he said. Eight emergency care doctors who have completed the course have already met with more than 150 colleagues in Iraq and 25 paramedics from six difference provinces to pass on what they learnt. But the learning was not just one way, said James Miller, chief executive of the Royal College of Physicians and Surgeons in Glasgow. With their vast experience in trauma, many of the visiting doctors were able to share their knowledge about situations that UK doctors would never have seen. Shirin Irani, a consultant gynaecologist at the Heart of England NHS trust in Birmingham, who helped support a cohort of doctors visiting her hospital, said it made her and other staff realise how well the NHS works. "You take so much for granted. It is eye opening to see how little they have and makes you appreciate the NHS," she said. Cite this as: BMJ 2009;339:b4329 2 Health workers first for flu jab BBC News, UK 21/10/2009 Marie-Louise Connolly, BBC NI health correspondent It's finally arrived - the day when Northern Ireland sees the start of the vaccination programme against swine flu. Thousands of health and social care workers will be among the first to receive the jab The government believes they are a priority as their good health will help sustain the health service in what's expected to be a busy few months. Health and social care workers in Northern Ireland's six health trusts, including the ambulance service, will be rolling up their sleeves ready to get the jab. It is not compulsory, but the government is urging staff to lead by example and to take up their offer of being vaccinated. So, in numerous hospitals, even in elderly care homes, it's those people who have direct access to the sick who will be among the first to get the Pandemrix vaccine. With around 90,000 health care workers and at this stage, 80,000 doses available, the Health Minister Michael McGimpsey said he's confident that with further supplies due to arrive here, there will be enough to supply demand. According to the BMA's Dr Brian Dunn, GPs are currently preparing letters to send to those who fall within the "at risk" groups, for example, children with asthma or anyone with diabetes. Those letters will be dispatched when the government gives the go ahead that the vaccines are available. We first heard of the H1N1 virus back on 24 April when Mexico reported a high number of swine flu cases. I remember the day well. It was a Friday afternoon and shortly after four o'clock the news wires were carrying the story that there had been an outbreak in Mexico. At that stage, it was thought around 100 people had died. Six months on, and what was once a little-known illness, is now becoming increasingly familiar in many homes across Northern Ireland. 30
  • 31. 3 IntraHealth to Lead $300 Million USAID Project in Global Health Workforce, Systems Strengthening Reuters, UK 20/10/2009 CHAPEL HILL, N.C., Oct. 20 /PRNewswire-USNewswire/ -- IntraHealth International has been awarded a new 5- year global cooperative agreement, with a $300 million ceiling, by the United States Agency for International Development (USAID) to improve the quality of health services in the developing world by strengthening the health care workforce. Worldwide, there is a shortfall of 4 million health workers needed to increase access to critical primary health care services, and 57 countries fall short of the World Health Organization's minimum ratio of 2.3 health workers for every 1,000 people. Under IntraHealth's leadership, the Human Resources for Health and Quality Services (HRHQS) Project will increase the quantity and quality of available health workers and services by working with global organizations and developing country institutions to test and roll out successful workforce planning, retention, recruitment, training and deployment interventions. The HRHQS Project builds on the foundation established by USAID's investment in the Capacity Project, a 5- year global initiative, also led by IntraHealth, which worked in 47 countries around the globe to strengthen health systems and workforce planning, development and performance support. "The HRHQS Project will serve as a catalyst at this critical juncture to further advance human resources for health knowledge and practice," says IntraHealth CEO Pape Gaye. "The ultimate goal is a more efficient and effective global health workforce that will reach more people and improve health status and quality of life, especially for the poor and most vulnerable." The HRHQS Project will be led by Maurice Middleberg, who brings almost 30 years of experience to his new role. Mr. Middleberg joins IntraHealth from the Global Health Council, where he served as Vice President for Public Policy. He has also held positions at USAID, the Futures Group, CARE and EngenderHealth. "The global health worker crisis is at the heart of the crushing burden of disease that holds hundreds of millions of people in poverty; all other health investments depend on resolving the dearth of qualified, productive health workers," says Mr. Middleberg. "I am honored to join IntraHealth, a global leader in developing human resources for health. I am equally pleased to join a global partnership of highly capable organizations." IntraHealth has formed a collaborative partnership to implement the HRHQS Project. Partners include Abt Associates, IMA World Health, Liverpool Associates in Tropical Health (LATH) and Training Resources Group, Inc. (TRG). To strengthen regional technical assistance and networking capacity, the HRHQS Project includes five associate partners: the African Population & Health Research Center (APHRC), Kenya; Asia-Pacific Action Alliance on Human Resources for Health (AAAH), Thailand; EQUINET, the Regional Network on Equity in Health in Southern Africa, South Africa; the West African Institute of Post-Graduate Management Studies (CESAG), Senegal; and Partners in Popula tion and Development (PPD), Uganda and Bangladesh. IntraHealth International is a North Carolina-based non-profit organization that has served the public health needs of developing countries for 30 years. IntraHealth's mission is to create sustainable, accessible health care by strengthening health workers and the systems that support them. In addition to USAID, IntraHealth receives funding and support from the US Centers for Disease Control and Prevention, private foundations, corporations and individuals SOURCE IntraHealth International David Nelson, Communications Director of IntraHealth International, +1-919-313-9139, © Thomson Reuters 2009 All rights reserved 4 Operational research in low-income countries: what, why, and how? Lancet Infectious Diseases, UK 11/2009 Volume 9, Issue 11, Pages 711 – 717 Dr Rony Zachariah PhD a , Anthony D Harries FRCP c d, Nobukatsu Ishikawa MD e f, Hans L Rieder MD c, Karen Bissell PhD c, Kayla Laserson MD g, Moses Massaquoi MD h, Micheal Van Herp MD b, Tony Reid MD a Summary Operational research is increasingly being discussed at institutional meetings, donor forums, and scientific conferences, but limited published information exists on its role from a disease-control and programme 31
  • 32. perspective. We suggest a definition of operational research, clarify its relevance to infectious-disease control programmes, and describe some of the enabling factors and challenges for its integration into programme settings. Particularly in areas where the disease burden is high and resources and time are limited, investment in operational research and promotion of a culture of inquiry are needed so that health care can become more efficient. Thus, research capacity needs to be developed, specific resources allocated, and different stakeholders (academic institutions, national programme managers, and non-governmental organisations) brought together in promoting operational research. Introduction Tukur, an illiterate patient diagnosed with malaria for the second time in a month, receives a prescription from the doctor for chloroquine pills, but he is unhappy and returns to the doctor to seek an alternative therapy, arguing that he has taken chloroquine several times in the past and it does not work. The doctor tells him that chloroquine is what the national malaria programme recommends and that it is the only medicine available. Tukur is not a health professional, policy maker, or scientist, but he realised that the medicines he was given were not working, and had questioned his doctor. His experience should have prompted the doctor to ask similar questions about the drugs that he was prescribing. Similarly, those responsible for the malaria programme should have been monitoring the results of treatment as a part of routine care. Several months later, operational research done by an international non-governmental organisation (NGO) proved that Tukur's experience was correct—chloroquine treatment had a 91% failure rate1—and the drug was not effective in most patients with Plasmodium falciparum malaria. The described example does not lay blame on clinicians in this kind of setting, who often do the best they can with limited resources. However, what was clearly lacking within this malaria control programme was a systematic process of monitoring drug resistance and treatment failure, and the ability to assess the implications on health-care delivery. The subject of operational research is increasingly being discussed at institutional meetings, donor forums, and scientific conferences, but there is limited published information on its role from a disease-control and programme perspective. We have been involved with operational research in the field of infectious diseases over many years in resource-limited settings, and this article is thus based on our experiences. From a programme perspective, we will suggest a definition of operational research, clarify its relevance to infectious- disease-control programmes, and describe some of the enabling factors and challenges for its integration into programme settings and into changing policy and practice. What is operational research? Operational research has its roots in military and industrial modelling, in which it is defined as the discipline of applying advanced analytical methods, including mathematical models, to help make better decisions.2, 3 In the commercial sector, operational research has been widely used, for example, to improve the scheduling of airline crews and in the design of queuing systems at Disney theme parks.2, 3 However, its application to health programming is much less developed. Many definitions of operational research have been proposed,4—6 but from a health programme perspective, a pragmatic definition is as follows: the search for knowledge on interventions, strategies, or tools that can enhance the quality, effectiveness, or coverage of programmes in which the research is being done. Operational research involves three main types of method: descriptive (cross-sectional, if a strong analytic component is also present), case—control, and retrospective or prospective cohort analysis. Basic science research and randomised controlled trials should not be included as operational research. The randomised controlled trial determines efficacy of an intervention in a strictly controlled environment with inclusion and exclusion criteria, whereas operational research should assess effectiveness within routine settings. Both types of research play an important part in the generation of new knowledge: the randomised trial provides clear-cut data on the efficacy of an intervention in defined groups of patients, whereas operational research determines how such interventions are translated into benefit in the heterogeneous setting of routine care. The key elements of operational research are that the research questions are generated by identifying the constraints and challenges encountered during the implementation of programme activities (prevention, care, or treatment), and the answers provided to these questions should have direct, practical relevance to solving problems and improving health-care delivery. Of course, this might not happen all at once, and is often a continuous and iterative process. A strong connection exists between good monitoring and evaluation of infectious-disease programmes and operational research. Good quality data on cases and treatment outcomes can be used to do operational research, which in turn can help to improve the routine data collected in the field. Nothing is more encouraging to health-care workers than to see their work in recording and monitoring data on treatment cards and registers being used to answer important questions, provided that this performance is recognised and applauded. Why is operational research relevant? There are at least three reasons why operational research is relevant to health. To improve programme outcomes in relation to medical care or prevention, to assess the feasibility of new strategies or interventions in specific settings or populations, and to advocate for policy change. Table 1 presents some examples of operational research in each category. In all cases, the research questions were generated from the field and answered issues of relevance for particular health programmes. Some studies provided descriptions of programmes with results over time (based on monitoring and evaluation), whereas others were purposefully 32
  • 33. designed to answer research questions. From a programme perspective, the ultimate relevance of operational research is whether it contributes to an improvement in performance or influences policy change at district, national, or even international levels.23 Imbedding operational research into a programme setting brings with it intellectual stimuli that are an attractive change to the, at times, routine monotony of planning, logistics, supervision, data management, and dealing with bureaucracy. Enabling factors and challenges for operational research We have suggested several factors that we believe can foster programme-related operational research and the translation of its results into policy and practice (panel). We also discuss our failures over the past 10—15 years and their possible solutions (table 2). Direct relevance to the programme A research study is only thought relevant to busy and often overburdened programme managers and staff if the study question is of importance to programme implementation. Much of the internationally published research done in Africa has been generated by academic institutions and researchers, predominately reflecting their interests or based around basic science or questions of intervention efficacy.24 Although these issues might be very useful in their own right, this type of research needs to be balanced by increasing the work done by operational organisations (eg, NGOs) who will have different perspectives. Different actors will naturally have comparative advantages for particular kinds of research and this should be used to the benefit of programmes. For example, an academic institution might be best placed to design and implement a randomised clinical trial or a vaccine study, whereas an implementing organisation might be best suited to take the lead in feasibility and acceptability studies. If research is disconnected from health-service delivery and there is little or no input from programme staff in terms of design, implementation, analysis, and writing, it risks being resented as an additional and often unwanted burden on existing services. One of the challenges is that foreign academic institutions often have the funding, time, and mandate for research and thus the associated power in decisions about what gets done. The way forward is surely to ensure that local institutions are also supported with money and staff for operational research, thus allowing them the necessary independence to make decisions, take responsibility, and establish partnerships that are more equal in resources and decision-making power. These issues are being addressed internationally by organisations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, US Agency for International Development, WHO, UN Joint Programme on HIV/AIDS, and World Bank Global HIV/AIDS Program.5 Nationally, at which level we have the most experience, we suggest building a research agenda into district and national programmes, based on local needs, but primarily reflecting the research priorities of the country. Within a country, it is important to have a coordination mechanism to provide a clear strategy of who sets research priorities and how choices are made at national level. This is particularly important because research resources for addressing health problems in low-income countries remain disproportionately scarce compared with their massive disease burdens. A bibliometric analysis of tuberculosis research done globally between 1997 and 2006 showed that Africa, which has the highest tuberculosis case rate burden in the world, contributed only 7% of global research output.25 The focusing of resources in a concerted manner has been shown to optimise direct health benefits at the levels of programmes and patients.26, 27 Partnering with local programmes Local programmes have a tendency to outsource research to academic institutions, which then set up parallel research systems or affiliated sites.23 Although this might be a highly efficient means to produce quality research and scientific publications, if there is no satisfactory mechanism for integration, collaboration, and communication with the programme, then such an approach might hinder the development of operational- research capacity by drawing national researchers away from national programmes. Furthermore, because research institutions and technical agencies (either international or national) normally have no mandate or responsibility for implementing research findings after their studies are completed, the results often end up being sent or presented to busy programme managers, who have no ownership of the research and who are therefore unlikely to direct the effort needed to translate the research into policy and practice. Continued Full-text: 5 World Medical Association calls on Iran to respect medical ethics code British Medical Journal, UK 20/10/2009 Jacqui Wise 1 London The World Medical Association has called on Iran to respect the international code of medical ethics after receiving several reports of abuse. The German Medical Association raised the motion at the association’s annual general assembly in Delhi on 18 October, urging national medical associations to speak out in support of the rights of patients and doctors in Iran. The motion was passed unanimously. 33
  • 34. Frank Montgomery, vice president of the German Medical Association, told the meeting that his organisation had received reports from doctors in Iran that injured people had been taken to prisons without adequate medical treatment or the consensus of attending doctors. He also said that he had received reports of doctors being hindered from treating patients; concern about the veracity of documentation that related to the death of patients; and reports of doctors being forced to support clinically inaccurate documentation. He also raised concern about reports of corpses and badly injured prisoners being admitted to hospital with signs of brutal torture, including sexual abuse. He said, "Physicians serve people not governments. They must be able to fulfil their duties without government harassment. Physicians will not participate in torture or degrading treatment. They are the ‘whistleblowers’ of such criminal acts committed by governments. I call upon the Iranian government to reaffirm the position that independent, free medicine is a cornerstone of democracy." Otmar Kloiber, secretary general of the World Medical Association, said, "We were approached by a number of different physicians in Iran. Because the reports came from different sources we thought they were likely to be reliable." He told the BMJ that the association did not want to publish the details of the cases because of fears for the safety of the doctors and families, some of whom are still in Iran. Dr Kloiber said, "We are very concerned about the rights of patients and physicians in Iran and wanted to send out a strong signal with this motion." The international code of medical ethics states that "physicians shall be dedicated to providing competent medical service in full professional and moral independence, with compassion and respect for human dignity." The World Medical Association is the confederation of national medical associations from 95 countries and represents more than eight million doctors. Iran is not a member of the association. A spokesman for Amnesty International said that the organisation is aware of reports of doctors being hindered in their work in Iran but was not in a position to confirm the allegations. But it is launching an urgent appeal about two doctors, Arash Alaei and Kamiar Alaei, who were working to prevent the spread of HIV among drug users in Iran. In January they were sentenced to six and three years imprisonment respectively for "cooperating with an enemy government" (BMJ 2009;338:b109, doi:10.1136/bmj.b109). Amnesty considers the two brothers to be prisoners of conscience because they seem to have been imprisoned solely in relation to their work with international, and specifically US, institutions in the discipline of prevention and treatment of HIV/AIDS. Cite this as: BMJ 2009;339:b4321 6 Lyon sud : des opérations reportées faute d'infirmières Le Progrès, France 16/10/2009 Après un bloc en septembre, une vingtaine de lits de chirurgie sont fermés. Selon la direction, les non- remplacements sont dus à la pénurie d'infirmières et non à des raisons budgétaires « J'ai dû décommander des patients qui avaient des rendez-vous depuis plus de trois mois et repousser leurs opérations en décembre ou janvier. Et j'ai demandé à mes 7 collaborateurs d'en faire autant. C'est insupportable ! » Chef du service de chirurgie endocrinienne, digestive et thoracique à l'hôpital Lyon sud, le Pr Jean-Louis Peix est « très en colère ». Depuis plusieurs semaines, les services de chirurgie générale de cet hôpital ne peuvent répondre aux demandes des patients faute de personnel infirmier suffisant. Après les traditionnelles fermetures de lits estivales, l'activité n'a pas pu reprendre normalement en septembre en raison d'un nombre insuffisant d'infirmières anesthésistes. Seuls trois des quatre blocs opératoires ont fonctionné et, bien que le temps d'utilisation de ces blocs soit passé, en mai, de 7 h 30 à 10 h 20, la situation est restée tendue. « Les heures supplémentaires ont explosé. Le personnel a fait face de façon remarquable mais il s'épuise et travaille dans des conditions indécentes. On est passés près du pépin à plusieurs reprises », explique le Pr Peix. Dès la sortie des écoles, fin septembre, huit infirmières anesthésistes ont été embauchées. Les quatre blocs fonctionnent à nouveau mais c'est dans les services d'hospitalisation que ça coince désormais. 34
  • 35. Il y a actuellement un afflux de congés maternité - qui ne sont pas remplacés aux HCL - ainsi que des arrêts maladie. Une des trois unités - de 24 lits chacune - a été fermée. Des opérés sont ainsi hospitalisés en gynécologie, en ORL ou en orthopédie. Les durées d'hospitalisation sont également réduites. « On va avoir non seulement une baisse de la quantité mais aussi de la qualité des soins », juge Jean-Louis Peix, pour qui les non-remplacements sont liés aux contraintes budgétaires. Le directeur de Lyon sud, Yves Servant, assure, lui, qu'« il n'y a pas de raison budgétaire ». « S'il y avait des infirmières disponibles, nous recruterions mais nous n'en trouvons pas. Il faut donc trouver des mesures d'ajustement jusqu'à début décembre où aura lieu la prochaine sortie d'école », explique le directeur, en précisant que si le manque est « particulièrement prononcé » en chirurgie générale tout le pôle chirurgie est touché. Yves Servant met en avant l'excellence de la chirurgie à Lyon sud, « saluée dans de nombreux classements », et la montée de l'activité : +10 % sur les 9 premiers mois de l'année par rapport à 2008. « C'est plutôt un problème de riche que nous avons. Il faut pouvoir soutenir de bout en bout la montée de l'activité », explique le directeur. Reste qu'à l'heure où la concurrence du privé est de plus en plus aiguë, cette situation est « embêtante », reconnaît Yves Servant. Le Pr Peix précise qu'il oriente certains de ses patients vers d'autres services des HCL ou vers des confrères du privé. Mais Yves Servant relativise la perte de patientèle qu'une telle situation peut entraîner car Lyon sud possède « un fort potentiel de recrutement (de patients) ». Sylvie Montaron 7 : Conférence nationale sur les places d'apprentissage 2009 - Invitation à la conférence de presse Romandie News, CH 16/10/2009 Manque de personnel dans le domaine de la santé et possibilités de pilotage en matière de politique de la formation Mesdames, Messieurs, Les prévisions actuelles dans le domaine de la santé indiquent que le besoin en personnel de santé va augmenter de façon significative au cours des années à venir. Dans le cadre de la 5e Conférence nationale sur les places d'apprentissage, la conseillère fédérale Doris Leuthard discutera de la situation actuelle avec les professionnels de la santé et des soins, les partenaires de la formation professionnelle et les représentants du monde politique. Cette conférence a pour objectif de coordonner les mesures existantes visant à garantir le système de santé et à identifier les mesures à prendre. D'autres thèmes seront abordés, dont le manque de personnel qualifié dans certaines branches et la lutte contre le chômage des jeunes adultes lors du passage de la formation professionnelle initiale au marché du travail. La conseillère fédérale Doris Leuthard, cheffe du Département fédéral de l'économie, informera les médias des résultats de la conférence sur les places d'apprentissage le lundi 26 octobre 2009, de 13 h 00 à 13 h 45 à l'Hôpital cantonal de Baden Pour lire cette news dans son intégralité, veuillez cliquer ici. 8 Overcrowded hospital wards: Government blames industrial action The Malta Independent 19/10/2009 by ANNALIZA BORG The industrial action ordered by unions to various support staff and care worker categories at Mater Dei Hospital, is placing heavy burdens on other sections of staff, management, and patients. The Accident and Emergency Department (A&E), operating theatres, Emergency Admissions Ward II, the Observation Unit, surgical wards and Day Care Unit are among the affected wards, a Health Secretariat spokesperson confirmed. On 30 July, Union Haddiema Mghaqudin ordered support staff and porters at the Central Sterile Services Department (CSSD) and the Medical Imaging Department (MID) to take industrial action in a bid to receive a bonus for handling patients. CSSD staff has since been abstaining from giving services outside Mater Dei Hospital, including other hospitals, health centres and private clinics, and only handing necessary products and items to the nursing officer concerned. MID staff and Health Centre staff stopped carrying out work related to patients including registration. These actions are indefinite and the union was considering more drastic actions if the situation did not improve. 35
  • 36. While agreeing that the action is affecting others, UHM secretary-general Gejtu Vella said the government was buying part of the service not being carried out by the support staff. This was affecting public spending but not patients directly, he explained. Mr Vella blamed overcrowding in wards and long waiting times on bad administration, manning problems and shortage of staff. Asked about the current situation with regard to the dispute, Mr Vella said that the collective agreement is being interpreted in different ways and so far there seems to be no light at the end of the tunnel even though discussions are going on at all levels, including ministerial ones. The hospital is also facing bed shortages and patients often have to wait at A&E until a bed becomes available. At times the department gets “really overcrowded” the Health spokesperson said. Area II of the A&E Department is at times overcrowded with as many as 15 patients when it is supposed to take six persons. “In extreme emergencies, where no empty beds are available in wards, patients are put on stretchers while waiting for a bed,” he added. Moreover, since wards are sometimes full, patients are transferred to other wards so it is not unusual for say, a patient who had undergone cardiac surgery, to be transferred to another ward rather than the specialised cardiology ward. Asked about the average waiting time for patients at the Emergency Unit, the spokesperson said patients are admitted according to how serious the emergency is and not on a first come first served basis. While the average waiting time was not disclosed, it is not clear whether such data is available. On the other hand, nurses and workers in higher categories are doing their best to deal with the situation. Back in July, the Malta Union of Midwives and Nurses strongly condemned the actions calling them “unethical and immoral”, as they were placing unfair burdens on its members. UHM had resorted to industrial action when the Social Policy Ministry failed to implement parts of an agreement reached on 6 March 2008, which specified that workers doing ‘nurse related activities’ and who were in contact with patients automatically benefit from an annual allowance of e1,050 as they will be classified as Category A staff, the union said. MUMN said that only employees in clinical areas and who were in direct contact with patients were entitled to the allowance. CSSD and MID were not clinical environments, the union said. MUMN president Paul Pace pointed out that this clause made a lot of sense and served as an incentive to attract staff to clinical areas and patient-related duties and not just handing over products or papers. Mr Pace believed that UHM was taking advantage of nurses, who were not represented by the same union, at a time when nurses were facing staff shortages. If the government gave in to UHM’s calls, it would be creating further problems with employees in clinical areas who were entitled to the e1,050 annual allowance. “The level playing field would be broken and new agreements would have to be sought,” Mr Pace said. 9 Occupational health and safety : Maltese nurses lack information and safe modes of practice – MUMN Malta Independent 19/10/2009 by Annaliza Borg Contracting infectious diseases, back and neck injuries, and psychological trauma are common obstacles for health care workers but they get little information promoting good health and preventing sickness, Paul Pace, president of the Malta Union of Midwives and Nurses told a news conference yesterday. Nurses and midwives (as well as doctors and other professionals), do not get assessed and when a person is actually diagnosed to be suffering from a particular disease or a mental condition, for instance, it is often too late. Many hours of sick leave are taken and some health workers would not be able to return to the job. 36
  • 37. When nurses are employed abroad or start receiving training at a foreign hospital, they are first taken to the OHS Unit where policies and practices are explained. Malta is 30 years behind Europe in the field, Mr Pace said. He added that MUMN had invited the Federation of Occupational Health Nurses in the EU to hold their board meeting in Malta and raise awareness about the local situation. FOHNEU promotes training, education and standards of professional qualifications. It also encourages research and dialogue into areas of occupational health practice, education and management with publication of the results. Explaining the situation further, Mr Pace said Mater Dei Hospital alone has an estimated workforce of 4,000 (nurses make up a third of the population), however there is only one appointed health and safety officer who is mainly responsible for fire safety. While there is an occupational health unit, no officials have been appointed to it and it has had no patients since the hospital opened. The lack of policy on occupational health and safety is in breach of Maltese and European laws. Mr Pace said there are some 40 laws and legal notices covering occupational health and safety and the nursing community is directly exposed to 27 of them, however they are not followed. Undue and over-exposure to carcinogenic and corrosive chemicals is still the norm and expensive safety equipment is not in use out of ignorance. Other safety equipment which should have been in place since the hospital’s opening have not been acquired. Mr Pace explained that new high tech equipment and state of the art hardware brought new promises as well as new responsibilities and work practices. Equipment such as class four lasers are being used, though there has been no training, and there are no appointed accountable laser safety officers. Nursing officers at managerial level are accountable at law for OHS issues, still everyone carries out their duties, based on the exigencies of their job, totally oblivious of the perils involved. The rate of sick leave in nursing categories is one of the highest among all categories of workers in Malta. Still, no case of sick leave is properly treated. Moreover, the occurrence is not being scientifically tackled and documented. Little if any statistical data on the matter exists and the underlying health reasons are never dealt with. The union voluntarily disseminates information on risk assessment through various management training programmes and seminars however there were still many shortcomings. In addition, Occupational Health Nurses are not recognised as a category in Malta even though some people are employed as OH officers in private companies, factories and at schools. A national register and accessible database of currently practising OH nurses is not available. FOHNEU president Julie Staun, said Malta should start looking at ways to collect evidence and statistics. The information is available to all but political support is necessary for things to improve. “Good health is good business and the workforce in general benefits from it,” she noted. 10 Telemedicina contra las listas de espera El País, Spain 19/10/2009 JAIME PRATS Decenas de miles de pacientes británicos no tienen a sus radiólogos en su propio hospital, ni en su ciudad, ni siquiera en su país. Ante la falta de especialistas, el National Health Service lleva años llegando a acuerdos con clínicas extranjeras. Algunas están en Bélgica, otras son suecas -una de las cuales, Telemedicine Clinic, tiene sede en Barcelona-, a las que envían las imágenes por Internet (resonancias magnéticas, por ejemplo). Allí las analizan y remiten de vuelta a sus colegas del otro lado del canal de la Mancha, informes con el diagnóstico del enfermo en una particular variedad de subcontrata sanitaria Si existiera un error, ¿de quién sería la responsabilidad? ¿Del médico británico que atiende a su paciente o del belga que lo ha diagnosticado a distancia? No está muy claro. Como sucede en otras parcelas, el desarrollo de las tecnologías de la comunicación y la información (TIC) ha irrumpido de tal forma que, en la misma medida que soluciona problemas, plantea otros, no sólo de regulación (responsabilidad de actos médicos, confidencialidad de datos), sino de encaje en unas estructuras de salud demasiado rígidas. Pero, a pesar de 37
  • 38. ello, pocos dudan que representan una de las principales herramientas con las que contará la sanidad para resolver los problemas asistenciales del presente y del futuro. Más pacientes, con más enfermedades y más viejos. La sanidad de los países desarrollados está marcada en buena parte por estos factores, a los que se suma el coste creciente de fármacos y tratamientos, cada vez más sofisticados. En España, en torno al 15% de los pacientes genera el 65% del gasto sanitario. Pero además, estas personas, que suelen ser mayores de 65 años, no padecen sólo una enfermedad, sino varias a la vez, y generalmente crónicas. Así, de todos los diabéticos, sólo el 8% tiene únicamente esta enfermedad. Lo habitual es que además padezcan hipertensión, obesidad, hipercolesterolemia... En 2020 se estima que más del 60% de las patologías serán crónicas. Las recetas milagrosas no existen, y menos ante este escenario tan complejo. Sin embargo, la aplicación de las TIC se presenta como un instrumento clave para hacer una sanidad más sostenible. Y tanto Europa, junto a países como Australia o Canadá, están tomando la delantera en este tipo de aplicaciones, que abarcan desde la informatización de los historiales clínicos de los pacientes, a las teleconsultas o el telediagnóstico, pasando por las intervenciones robotizadas. La irrupción generalizada de Internet en los hogares, el incremento de las capacidades de los teléfonos móviles y las posibilidades que abre la televisión digital terrestre apuntan hacia una nueva dimensión en la telemedicina. "Éstos son los tres pilares que harán posible un cambio de provisión de servicios sanitarios", asegura Carlos Hernández Salvador, jefe de proyectos de la Unidad de Telemedicina y e-Salud del Instituto de Salud Carlos III. El salto, especialmente en telemedicina para crónicos y mayores, no tiene pinta de estar muy lejos, según su compañero, José Luis Monteagudo, jefe de la Unidad de Telemedicina y e-Salud de este instituto sanitario, vinculado al Ministerio de Sanidad. "Se están concentrando tal cantidad de intereses, nuevos actores, posicionamiento de empresas, cambios tecnológicos, redes sociales... que da la impresión de que nos encontramos en un momento de saturación que puede ser precursor del cambio", sostiene. En este campo "por una vez, Europa lleva la delantera a los Estados Unidos", apunta Gérard Comyn, jefe de la Unidad TIC para la salud de la Dirección General de la Sociedad de la Información de la Comisión Europea. En cabeza se sitúan los países nórdicos, donde la historia clínica digitalizada es operativa en el 90% del sistema sanitario. A la cola, los últimos Estados incorporados a la UE, que "están descubriendo la e-salud", con excepciones "como puede ser Eslovenia". Sin embargo, ni siquiera en el interior de los mismos Estados el nivel de desarrollo es homogéneo. "El factor regional es un elemento clave", apunta Comyn en conversación telefónica desde Bruselas. Los países con sistemas administrativos descentralizados permiten que gobiernos locales apuesten por este tipo de tecnología y logren desarrollos más avanzados y adaptados a las particularidades de la zona. Es el caso de Andalucía, como destaca el responsable de TIC de la UE, donde "empezaron hace 10 años con la prescripción electrónica o la integración del historial clínico en un archivo informático único". También destaca el trabajo desarrollado en Cataluña, en este caso, para el tratamiento de enfermos crónicos por teleconsulta, acompañado por una nueva organización de los servicios hospitalarios. En países de tradición más centralizada, como Francia o Alemania, sin embargo, se han dado problemas al tratar de aplicar pautas globales para todo el Estado, que ofrecen resultados diversos en función de los departamentos donde se aplica. Canadá y Australia, países con una dispersión de población muy amplia, son otros Estados que han apostado fuerte por la e-health, frente a Estados Unidos, donde "se prioriza la estructura hospitalaria". Al margen de los diferentes ritmos de incorporación a este tren en marcha de los distintos sistemas de salud, cada vez hay más consenso sobre las ventajas de las aplicaciones de las TIC a la sanidad. Por un lado, los beneficios redundan directamente en los pacientes. El hecho de poder pasar consulta desde el centro de salud de una pequeña población rural con el servicio de cardiología de un hospital a 150 kilómetros a través de una pantalla, como sucede en Extremadura, es un ejemplo de evidente comodidad que evita desplazamientos. Pero, además, los sistemas de monitorización de enfermos -crónicos o recién operados- desde casa a través del envío de datos al hospital, donde son supervisados por el médico, evitan un buen número de ingresos, especialmente en urgencias. Una revisión de estudios del British Medical Journal en 2007 mostró que este tipo de control a crónicos redujo las tasas de ingresos por fallo cardiaco un 21% y todas las causas de mortalidad un 20%. A estas ventajas, se suman las que aportan a los sistemas de salud. Especialistas de la UE destacan en el documento Telemedicina al servicio de los pacientes, los sistemas de salud y la sociedad, de junio de este año, aspectos como el incremento de la eficiencia, la reducción de las listas de espera, de ingresos por descompensaciones en enfermos crónicos o el ahorro de costes que supondría la generalización de estos procedimientos. El desarrollo de dispositivos de control del ritmo cardiaco, por ejemplo, podría ahorrar por paciente y año 292 euros en Francia (un 30%) y 712 en Alemania (61%), según un artículo de Proceedings of the Computers in Cardiology Congress de 2006. 38
  • 39. El impacto real de la e-salud en los sistemas sanitarios, sin embargo, tiene el inconveniente de apoyarse en estudios parciales. Y los especialistas que impulsan el desarrollo de estas prácticas en la UE son conscientes de ello. Para armarse de argumentos más sólidos, se está creando un sistema de evaluación que analizará el impacto de la telemedicina en siete países europeos y cuyos resultados se anunciarán dentro de unos dos años. Existe también el problema de la falta de una regulación legal suficientemente clara y amplia para abordar el extraordinariamente extenso terreno de juego que abren las nuevas tecnologías. De vuelta a los radiólogos belgas y los pacientes británicos, los enfermos sólo conocen al médico que les trata personalmente, no a quien les ha diagnosticado. ¿A quién presenta la reclamación? ¿Quién se responsabilizaría? "No existe una respuesta clara; pero además existen otros vacíos legales", señala el responsable de la unidad de las TIC para la salud de la UE. Comyn comenta que para elaborar un informe radiológico es necesario que el especialista cuente también con el historial clínico del paciente, que contiene datos básicos para elaborar un diagnóstico preciso. En Europa hay directivas que regulan la confidencialidad de esta información. Sin embargo, no sucede lo mismo en otros países. Y cada vez son más numerosas las empresas de radiodiagnóstico que ofrecen todo tipo de servicios, desde y hacia cualquier punto del mundo, como, por ejemplo, segundas opiniones. Este cambio de paradigma en la medicina que ya se vislumbra y que no supondrá un modo alternativo o paralelo de atención, sino distintas formas de prestar los mismos servicios, llevará un tiempo. Pero, además requerirá ir acompañado de "una penetración afable" de esta tecnología "centrada en las personas, tanto en pacientes como en médicos y demás implicados", según José Luis Monteagudo. De hecho, la implicación del personal sanitario es clave para el éxito de estos desarrollos. Y hay muchas experiencias fallidas debido a estrategias equivocadas al no haberse contado suficientemente con los médicos.Comyn sostiene que no es deseable crear nuevas figuras (e-médicos, e-enfermeras...) sino reciclar en las nuevas tecnologías al personal. Se trata, ni más ni menos, del mismo reto al que se enfrentan miles de trabajadores en otros sectores que necesitan reciclarse para seguir el paso de los nuevos hábitos (de consumo, de producción, de relación) que está imponiendo el impacto de las nuevas tecnologías en buena parte de los sectores económicos. "La disposición de los médicos es completa siempre que suponga ventajas", apunta Luis Aguilera, presidente de la Sociedad Española de Medicina Familiar y Comunitaria. Cuestión aparte es el distinto ritmo de aplicación de las nuevas tecnologías entre las comunidades autónomas o los problemas de incompatibilidades de aplicaciones informáticas que impiden el intercambio de información entre ellas. El enorme mercado potencial de la salud electrónica es otro importante aliciente para el desarrollo de aplicaciones y un fuerte motor de cambio. De acuerdo con los datos que maneja la Unión Europea, el mercado global de la e-salud mueve 60.000 millones de euros, de los que unos 20.000 corresponden a Europa. Con estas cifras, esta parcela puede considerarse como el tercer mercado relacionado con el ámbito sanitario en el continente, detrás de la farmacéutica (205.000 millones) y la tecnología sanitaria (64.000 millones). Con estas perspectivas económicas, las empresas han comenzado a moverse. Dos gigantes que ya han tomado posiciones son Microsoft y Google. El primero con la plataforma Microsoft HealthVault. El segundo, con Google Health. Básicamente, en ambos casos se trata de servicios gratuitos que permiten a sus usuarios albergar el historial clínico en la Red y compartirlo con quien desee. "De momento funciona como una experiencia piloto y sólo en Estados Unidos", comenta José María García, director de la división de multisector de Google España, sobre su plataforma. A través de diversos acuerdos que la compañía tiene con empresas y médicos, los pacientes pueden subirse sus datos sanitarios (análisis, pruebas, historial, médicos...) y usarlos si los necesitaran ante cualquier emergencia médica en cualquier lugar del mundo a través de la Red. "La idea es contar con una herramienta abierta que pueda contener información sanitaria de cualquier tipo de proveedor". En los sistemas públicos, la mayor parte de esta información la albergan en sus archivos -cada vez más informatizados, aunque aún queda mucho por hacer- las diferentes administraciones sanitarias. ¿Cómo funcionaría Google Health en España? "Es un sistema sanitario muy distinto, de momento no hay planes de expansión desde Estados Unidos, ya se verá", comenta José María García. En Europa, la movilidad de sus ciudadanos choca con la imposibilidad de intercambio de información sanitaria de sus pacientes entre los distintos sistemas de salud. Es fácil pensar que el uso generalizado de estos archivos (albergados por Microsoft, Google u otros que pudieran surgir) pudiera crear de facto estándares de almacenamiento privados paralelos a los registros públicos. "Es una forma de comenzar a desarrollar un futuro negocio", advierte Gérard Comyn. Para hacer frente a esta eventualidad existe un proyecto piloto de la UE, denominado Epsos, que estará listo en dos años, dirigido a hacer posible, por ejemplo, que los médicos austriacos tengan acceso al historial de un paciente español que tenga un accidente en Viena mediante el desarrollo de una interoperatibilidad entre las bases de datos sanitarias nacionales. Esta alternativa trata de aprovechar todo el trabajo de informatización de los distintos países -en los que aún queda mucho por hacer- para construir una plataforma de interconexión 39
  • 40. pública europea de intercambio de historiales con las garantías que dan las leyes de confidencialidad existentes. Back to top Latin America & Caribbean 2 Médicos venezolanos a la calle El Universal, Venezuela 16/10/2009 Francisco Rivero Valera Los médicos venezolanos están llevando más palo que una gata ladrona: del Gobierno, de la comunidad y de la misma Federación Medica Venezolana. Del Gobierno por ser la cara visible de la protesta permanente por las pésimas condiciones de las instituciones de salud debido al deterioro de la estructura física, déficit de personal y carencia crítica de recursos medico-quirúrgicos. Y esa actitud nacionalista de los médicos es la piedra en el zapato de este régimen comunista que intenta fabricar una imagen de excelencia de su proceso "robolucionario" para implantar en Venezuela su sistema de salud socialista a la cubana, con médicos cubanos. En consecuencia, atropella a nuestros médicos con salarios denigrantes de su condición profesional, planes miserables de seguridad social y, el colmo, con campañas mediáticas de odio, criminalizacion y descrédito para hacer creer a la población que el medico venezolano es "rico, renuente a la asistencia de la gente pobre de los barrios y organizador de guarimbas". La intención del Gobierno es muy sencilla: hacer creer que nuestra medicina es imperialista y mala, y la cubana es socialista, buena y necesaria para solucionar todos nuestros problemas, a pesar de los resultados negativos de los indicadores que tenemos hasta ahora. Adicionalmente, los médicos también "reciben palo" de la comunidad como consecuencia de ese escenario de campaña mediática de odio del Gobierno y sus instituciones carentes hasta de algodón, que incita a la violencia de la gente, no contra este gobierno que es el responsable directo e intencional de esa situación de crisis asistencial, sino contra el medico que tiene enfrente trabajando "hasta con las uñas" para solucionar su problema de salud. Es la paradoja que vive diariamente el medico venezolano. Y para rematar y profundizar la miseria de nuestros médicos, la Federación Médica Venezolana ha perdido hasta su dignidad al tolerar no solo ese atropello constante sino la inmigración de 1.000 médicos cubanos adicionales a los 28.000 cooperantes instalados en nuestro país, sin exigir ni siquiera la revalida para médicos extranjeros implícita en la Ley de Ejercicio de la Medicina. Ese mismo juego a la cubana también fue puesto en movimiento en Brasil, pero la Federación Médica de ese país exigió la aplicación de la Ley y la subsecuente expulsión de 96 médicos cubanos que no habían cumplido con ese requisito para autorizar su ejercicio como médicos extranjeros. En cambio, esa tolerancia de la Federación Médica Venezolana hacia este desmadre del Innombrable, también ha contribuido a la emigración de 7.800 especialistas, según sus propias estadísticas; a la renuncia de nuestros médicos a los puestos de trabajo, a la baja motivación por los cursos de posgrado y a que el Gobierno esté haciendo lo que le da la gana con sus cubanos. Definitivamente: "lo que le falta es guáramo". En consecuencia, en este estado de indefensión, en cualquier momento veremos a los médicos venezolanos en la calle como trabajadores de bata blanca, con una mesa, un tensiometro y un estetoscopio para tomar la tensión arterial y el pulso a los transeúntes a cambio de unos bolívares, para sobrevivir. Sería la tragedia de un ex país. De nosotros depende. De todas maneras, como dice mi pueblo: "a correr piojo que viene el peine". 3 Desafía la epidemia al sistema de Salud Tabasco Hoy, Mexico 18/10/2009 Por: Margarita Vega/Agencia Reforma México, D.F. Los hospitales del país enfrentan la segunda oleada de la epidemia de influenza A H1N1 con infraestructura limitada e insuficiencia de personal. Aunque se preveía que el rebrote se produjera en invierno, el número de casos confirmados de la enfermedad aumentó sustancialmente desde septiembre y especialistas de la Secretaría de Salud (Ssa) advierten que el pico más alto podría registrarse en las próximas semanas. 40
  • 41. De acuerdo con proyecciones de la dependencia, al menos 200 mil personas buscarán atención médica a causa de la enfermedad en los próximos meses. El número de hospitalizados por la epidemia, según sus cálculos, podría llegar a 20 mil, de los cuales entre 8 mil y 10 mil estarían internados de manera simultánea, lo cual implicaría ocupar el 25 por ciento de las camas censables a nivel nacional, tanto en hospitales públicos como privados, desplazando a pacientes con otras enfermedades. Además, estimaciones de la Organización Mundial de la Salud indican que alrededor del 15 por ciento de los hospitalizados por influenza podrían requerir cuidados intensivos. Ante ese panorama, la Ssa adquirió recientemente 800 respiradores; sin embargo, el número total de esos equipos en los hospitales del país es de sólo 7 mil 500. Pero ese no es el único problema. La propia dependencia reconoce que el principal reto lo constituye el personal de salud, pues no se cuenta con los trabajadores suficientes para enfrentar la epidemia y al mismo tiempo mantener la atención de otras enfermedades. "Estamos con necesidad de contratar personal por honorarios, pero el decreto de austeridad nos lo impide. No hay partida para contratar y es algo que nos hace mucha falta. (Necesitamos) desde neumólogos hasta técnicos de laboratorio, enfermeras intensivistas, médicos internistas", señaló en entrevista Mauricio Hernández, subsecretario de Prevención y Promoción de la Salud. En uno de cada 10 hospitales el personal médico no ha sido capacitado para la adecuada prescripción de los antivirales para atacar la influenza A H1N1. El sureste es la región con mayores carencias de personal médico especializado, principalmente de neumólogos e infectólogos, según una encuesta de la Subsecretaría de Innovación y Calidad de la Ssa. Los casos graves de influenza A H1N1 en México tienden a empeorar rápidamente, requieren atención intensiva y enfrentan alto riesgo de muerte, advierte un estudio publicado esta semana en The Journal of the American Medical Association. El documento indica que de 899 pacientes atendidos en seis hospitales de México entre el 24 de marzo y el 1 de junio, 58 desarrollaron síntomas graves y 24 murieron. "El tiempo transcurrido entre su llegada al hospital y su ingreso a las unidades de cuidado intensivo fue corto (un día en promedio) y todos, excepto dos, requirieron ventilación mecánica por problemas respiratorios severos". Estiman 300 muertes Aunque se ha confirmado la muerte de 263 personas a causa de la influenza A H1N1, la Secretaría de Salud (Ssa) estima que la cifra podría llegar a 300, ello debido a la tardanza de los estados para enviar a la Federación los expedientes de los fallecidos. "Hay un Estado en donde el Secretario me había dicho que tenía como 20 (muertos) y en las cifras que tenemos llevaba como 10, lo que pasa es que manda los expedientes más tarde", dijo Córdova tras inaugurar la semana de la salud en un club deportivo de la Ciudad de México. "Ahorita tenemos 263 registrados, pero hay 300 probables que se van a confirmar en unos días. En ese rezago estamos, como de un 10 por ciento o 15 por ciento (de los fallecidos con expedientes) que están en estudio". El funcionario indicó que es necesario que los médicos estén alerta de los síntomas de sus pacientes y que si tienen factores de riesgo como embarazo, alguna enfermedad crónica o son menores de 5 años, se les debe recetar algún antiviral y no esperar a confirmar el diagnóstico a través de una prueba de laboratorio. "No tiene caso estar haciendo pruebas a diestra y siniestra, ni tampoco las pruebas rápidas. Si el paciente tiene síntomas de influenza y datos de gravedad o de riesgo, (hay que) tratarlo siempre", dijo. Que se espera Estas son las proyecciones de la dependencia de Salud: 200 mil buscarán atención médica 20 mil hospitalizados se esperan 25% de las camas censables ocupadas 41
  • 42. 15% de hospitalizados requerirían cuidados intensivos. 4 Hospital de Guanare no satisface demanda quirúrgica de pacientes Entorno Inteligente, Venezuela 17/10/2009 El hospital universitario doctor Miguel Oráa de Guanare es el principal centro asistencial de la capital portugueseña. El déficit de médicos, el colapso ante la demanda de intervenciones quirúrgicas y áreas de servicio en ruinas porque no han sido remodeladas, caracterizan su funcionamiento actual. El personal y los pacientes reconocen que la dotación de medicinas e insumos es aceptable, pero exigen que se resuelva el resto de los problemas. Al recorrer las áreas de hospitalización y entrevistar a médicos y enfermeras se constata que en los 6 municipios del sur de Portuguesa hay más de 1.000 pacientes, entre menores de edad y adultos, que llevan de 1 a 6 meses en cola por una intervención quirúrgica. Los cirujanos expresan que la crisis obedece a que sólo dos de los cuatro quirófanos funcionan y uno es para emergencias, por lo que tienen un único espacio para atender las cirugías electivas. Los otros dos no operan por falta de personal médico y de enfermería. Cada 22 días. La planificación de uso del quirófano electivo obliga a los médicos a tener opción para usarlo una vez cada 22 días, oportunidad en la que pueden atender entre 3 y 7 pacientes de una lista que supera los 150 por médico, sólo en la consulta pediátrica. César Antonio García, del municipio Ospino, acudió al hospital porque se fracturó una pierna en un choque. Tiene 3 meses esperando que lo operen "A cada rato se daña el quirófano, se contamina o se dañan los aires, señala. Luego de 4 meses, Omar Fernández mantiene la esperanza de ser intervenido de una fractura en una pierna, aunque no recibe ningún tratamiento y la comida se la llevan sus familiares. "Por nada del mundo me voy para mi casa, porque pierdo la cola y ahí sí es verdad que menos me operan", afirma. Jhonny Mejías González, del caserío Las Matas, fue operado en una clínica y regresó al hospital para cumplir el postoperatorio. Reconoce la atención que recibe de los médicos, pero se queja de la desbalanceada dieta del hospital: "Aquí lo que traen es galletas con queso y, a veces, un poco de jugo". La deficiencia más notable del Miguel Oráa es el déficit de médicos. Hay entre 10 y 15 internos y residentes, cuando debería haber 50, según cálculos de los propios médicos. En la emergencia hay 2 médicos por turno, dinámica utilizada desde hace más de 25 años pese a que la población del estado se ha triplicado. Otras carencias del centro de salud, enumeradas por trabajadores que prefirieron el anonimato, son la falta de tensiómetros, nebulizadores, camillas, sillas de ruedas y ambulancias. Tampoco hay jabón ni cloro para la limpieza. Las cavas de la morgue no enfrían como debe ser, los baños no sirven y el aire de la emergencia se dañó con el último apagón que hubo en la zona 5 Mozarildo apresenta sugestões para suprir a carência de médicos nas regiões pobres do país, Brazil 17/10/2009 Por: Agência Senado Mais de 400 municípios brasileiros não contam com médico algum, disse nesta sexta-feira (16) o senador Mozarildo Cavalcanti (PTB-RR). Ao homenagear os médicos pelo seu dia - 18 de outubro -, o senador chamou a atenção para a distribuição desigual, no país, dos profissionais de saúde, especialmente nas regiões Norte, Nordeste e Centro-Oeste. Mozarildo, que também é médico, afirmou que é preciso formular uma política para garantir que todas as regiões atendam ao índice recomendado pela Organização Mundial de Saúde (OMS), de um médico para cada mil habitantes. 42
  • 43. - Incentivar os novos médicos, formados nas regiões mais ricas, a se deslocarem para regiões pobres ou carentes, reequilibrando o índice de distribuição dos médicos para o país, deve ser uma prioridade para o governo brasileiro - afirmou. De acordo com o senador, enquanto o Sul e o Sudeste atingem a média de 2,33 e de 1,81 médicos por mil habitantes, e o Centro-Oeste, graças à concentração de profissionais em Brasília, chega a 1,76; o Nordeste tem 1,03 e o Norte conta com apenas 0,85. Entre as soluções para o problema, Mozarildo sugere a criação de escolas de medicina longe das áreas de grande concentração de escolas e profissionais. Além disso, ele disse que voltará a apresentar projeto de lei com o objetivo de tornar obrigatório, para obtenção de registro a todos os profissionais de saúde formados em universidades públicas, a realização de um estágio de um ano em localidades onde a média de médicos é menor do que a recomendada pela OMS. - Entendo que, para o cidadão que se forma na área de saúde em uma universidade pública, não seria nada demais que tirasse um ano para uma pós-graduação no interior do Brasil - disse Mozarildo, lembrando que modelos como esse foram aplicados com sucesso em muitos países, como a Austrália. Mozarildo apresentou números que comprovam o grande desequilíbrio no acesso à medicina no Brasil. Dos 329 mil médicos do país, mais da metade, observou, está em São Paulo, que conta com 188 mil profissionais. Juntas, as regiões Sudeste e Sul têm 238 mil médicos, o que explica a deficiência no atendimento às populações das regiões mais pobres. O parlamentar, que integra a Universidade Federal de Roraima, tendo ajudado a formular o curso de medicina da instituição, reconheceu que não basta deslocar médicos, seja com o estágio obrigatório ou com o oferecimento de altos salários. Pois a área exige grande carga de estudos, acesso às novas tecnologias e troca de experiência entre os profissionais, o que costuma acontecer em grandes centros urbanos. Por isso, defendeu, é preciso estimular a criação de novas escolas de medicina no interior do país. - Os médicos dão o suporte indispensável à elevação do Índice de Desenvolvimento Humano de que o Brasil necessita para alcançar patamar de justiça social compatível com o projeto de ingressar no seleto clube dos países desenvolvimentos - afirmou Mozarildo, que citou dados do livro Rumo ao Interior: Médicos, Saúde da Família e Mercado de Trabalho (editora Fiocruz), do pesquisador Rômulo Maciel Filho, do Centro de Pesquisas da Aggeu Magalhães da Fundação Oswaldo Cruz em Recife (PE) e de Maria Alice Fernandes Branco, também do departamento de saúde coletiva do CNPq da Fiocruz. 6 Moradores de Deodoro torcem para que Jogos tragam progresso JB Online, Brazil 17/10/2009 Flavio Dilascio, Jornal do Brasil RIO - Contemplado com sete instalações olímpicas – três delas ainda a serem construídas – o bairro de Deodoro tem realidade bem distinta das demais localidades do Rio incluídas no caderno de encargos para 2016. Com uma população predominantemente de baixa renda, a região carece de infraestrutura básica – como pavimentação das ruas e manutenção de praças e áreas de lazer – além de não possuir um posto de saúde sequer. A chegada da Olimpíada, no entanto, divide os moradores entre descrentes e esperançosos. De acordo com a secretaria especial da prefeitura para a Rio 2016, Deodoro passará por várias reformas nos próximos anos. As principais delas dizem respeito à melhoria de algumas vias, que se encontram, em sua maior parte, em péssimo estado de conservação. Mesmo não tendo detalhes – a secretaria está aguardando a instalação do comitê executivo, que traçará o planejamento das obras – e informa que haverá investimentos em meio ambiente, urbanização e tratamento paisagístico. Definidas estão apenas as obras que acontecerão na Vila Militar, localidade do bairro que abrigará sete modalidades dos Jogos. O local pertence ao Exército e é utilizado por diversos atletas profissionais e amadores, sendo considerado por especialistas como o maior legado dos Jogos Pan-Americanos. Apesar da vizinhança com a Vila Militar e dos planos da prefeitura e do COB, muitos moradores estão descrentes que a Olimpíada possa mudar alguma coisa em suas vidas. – Não estou muito a par dos Jogos Olímpicos, só sei que várias competições serão disputadas na Vila Militar. Não acredito que o bairro vá ter melhorias. Pode ser um projeto ou outro, mas a maioria é da boca para fora – opina a enfermeira Aparecida França, moradora das proximidades da Vila Militar. Ela enumera as principais carências de Deodoro e região. 43
  • 44. – Precisamos de investimentos em saúde, segurança e transportes. Se vai haver melhorias nesse sentido, só o tempo dirá – complementa ela, que diz não ter torcido para que a Olimpíada viesse para o Rio. Drama em posto de saúde Diferente de Aparecida, o comerciante e gari comunitário André Eduardo tem esperanças de que a Olimpíada possa mudar a cara de Deodoro. Ele pede melhorias na área de saúde e cita um drama familiar vivido há pouco tempo. – Vamos acreditar que a Olimpíada vai melhorar o bairro. Espero que não fique só nas promessas. Acho que nossa maior carência aqui é na área de saúde. Não temos um posto médico em Deodoro. Para sermos atendidos, temos que ir a Guadalupe ou Realengo. Outro dia, levei o meu filho para ser atendido em Guadalupe às 6h e só saí de lá à 1h do dia seguinte – relata. Moradora de Deodoro há 14 anos, a doméstica Estela Vieira de Souza reforça o coro por melhorias na saúde e na segurança. – Acho que a Olimpíada tem tudo para melhorar o bairro, principalmente se construírem um posto de saúde e se melhorarem o policiamento – afirma ela, que pede também investimentos em áreas públicas de lazer. 7 Médicos pedem demissão O Dia, Brazil 17/10/2009 Rio - Dos 300 médicos contratados em caráter de urgência pela Prefeitura do Rio, para os quatro hospitais de emergência, em março, 100 já abandonaram o emprego devido às más condições de trabalho. O dado faz parte de relatório do Conselho Regional de Medicina do Rio (Cremerj), que vistoriou unidades federais, estaduais e municipais e constatou carência de profissionais e superlotação de pacientes. As vistorias foram entre agosto e setembro em dez hospitais do Rio. Segundo o secretário-geral do Cremerj, Pablo Vasques Queimadelos, dos 100 que saíram, cerca de 60 são clínicos gerais e mais de 20, pediatras. A maioria era do Hospital Souza Aguiar, no Centro. O anúncio da contratação dos 300 profissionais, através da Fiocruz, fora feito no início do ano, em função do fechamento da emergência do Lourenço Jorge, na Barra, por três horas, devido à falta de médicos, em janeiro. “O Souza Aguiar tem déficit de pediatras, neurocirurgiões e anestesistas. Pela falta de 8 intensivistas, o funcionamento do CTI pediátrico está comprometido. Além disso, faltam 16 clínicos”, declara. Pablo disse que os recém-contratados recebem R$ 3 mil mensais por plantões de 24 horas semanais, o que não consideram boa remuneração. Segundo ele, a Secretaria Municipal de Saúde prometeu gratificação de R$1,5 mil, não paga. A Secretaria informou que repõe continuamente os médicos que saem e pretende chamar, ainda esse ano, mais 206. Três setores fechados No Hospital Estadual Carlos Chagas, em Marechal Hermes, os setores de ortopedia, cirurgia plástica e ginecologia foram fechados pela falta de especialistas. Além disso, houve redução de 40% nos leitos. Já nas unidades federais, o principal problema são contratos irregulares e a falta de novos concursos. O Ministério da Saúde informou ontem que pretende contratar 4,3 mil profissionais ainda este ano. Já a Secretaria estadual de Saúde disse que também está investindo na contratação de mais profissionais via Ceperj, e que houve aumento de 51% no quadro de médicos desde 2007. Back to top News from WHO and partners 1 Childhood vaccines at all-time high, but access not yet equitable WHO 21/10/2009 44
  • 45. 21 OCTOBER 2009 | WASHINGTON, DC | GENEVA -- Reversing a downward trend, immunization rates are now at their highest ever and vaccine development worldwide is booming, according to a new assessment released today by the World Health Organization (WHO), UNICEF and the World Bank. The State of the world’s vaccines and immunization reports that more infants are being immunized today than ever before - a record 106 million in 2008 - according to new data. At the same time, its authors are calling on donor nations to address a funding gap that leaves millions of children still at risk, particularly in the poorest nations and communities, where preventable diseases take their deadliest toll. The release of new evidence of success in the overall global immunization effort takes place just as many nations are conducting pandemic influenza A (H1N1) immunization campaigns, underscoring the unparalleled role of vaccines in preventing communicable diseases and the challenges of reaching the most vulnerable communities. "The influenza pandemic draws attention to the promise and dynamism of vaccine development today," said Dr Margaret Chan, Director-General, WHO. “Yet it reminds us once again of the obstacles to bringing the benefits of science to people in the poorest nations. We must overcome the divide that separates rich from poor - between those who get life-saving vaccines, and those who don’t." Leading officials from international agencies warn that life-saving vaccines, now common in wealthy countries, still do not reach an estimated 24 million children who are most at risk. At least an additional US$ 1 billion per year will be needed to ensure that new and existing vaccines will be delivered to all children in the 72 poorest countries. "Worldwide measles deaths fell by 74% between 2000 and 2007, and vaccinations played an important part in that decline," said Ann M. Veneman, Executive Director, UNICEF. “Such progress must inspire new efforts to immunize children around the globe against life-threatening diseases." The report states that the reversal of the downward trend was in great part due to the efforts of developing countries, who made good use of support from the GAVI Alliance - a vaccine-financing partnership that includes WHO, UNICEF, the World Bank and the Bill & Melinda Gates Foundation. Since 2000, this has increased the introduction of new and underused vaccines, which now reach more than 200 million children in developing countries. Experts report that at least 120 vaccines - a record number - are now available against deadly diseases. Over the last few years, scientists in academia and at pharmaceutical companies, many in public-private partnerships created with support from governments and philanthropy, have developed new life-saving vaccines for meningococcal meningitis, rotavirus diarrhoea, pneumococcal disease, and human papillomavirus (HPV). In addition, over 80 new products are in late-stage clinical testing, including more than 30 that target diseases for which no vaccine currently exists. At the same time, a significant number of vaccine candidates, including ones targeting diseases such as HIV/AIDS, malaria, tuberculosis and dengue, are moving through the research pipeline. The report also notes that the global vaccine market has tripled over the last eight years, reaching more than US$17 billion in revenue. Rising demand for vaccines via United Nations procuring agencies and a renaissance in vaccine discovery and development have fueled industry’s renewed focus on vaccines. Significantly, manufacturers in developing countries are now meeting 86 % of the global demand for traditional vaccines, such as those protecting against measles, whooping cough (pertussis), tetanus and diphtheria. "We have seen a dramatic turnaround in the availability of vaccines in even the poorest countries," said Graeme Wheeler, Managing Director, World Bank Group. "Yet the international community, together with the countries themselves must ensure that new and existing technologies actually reach the most vulnerable populations, especially children." The cost of delivering vaccines to those that need them is increasingly an issue that is only partially solved by financing partnerships such as GAVI. Middle income countries are not eligible for GAVI assistance, yet they are home to 30 million children and 2 billion people, a large number of whom live on less than US $2 a day. Even at greatly reduced prices, the cost of new vaccines for pneumococcal disease, rotavirus diarrhoea and HPV are individually greater than the cost of all other traditional vaccines combined. "Vaccines are an incredible tool to control disease in all countries and are still a very smart buy in health and economic terms," said Dr Fred Were, National Chairman of the Kenya Paediatric Association. “Practicing in my country, we still unfortunately see a lot of illness and death from vaccine-preventable diseases. If this can be reduced we will have more resources and time to focus on other health issues." 2 European Development Days: GAVI and Global Fund organise debate on health Millennium Development Goals GAVI Alliance 45
  • 46. 15/10/2009 Geneva, 15 October 2009 – For this year's European Development Days, to be held in Stockholm from 22-24 October, the GAVI Alliance will be co-organising a debate on global health - together with the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, UNAIDS, the Stop AIDS Alliance, and AIDS Accountability International. High-level representatives from all five organisations will be discussing the challenges of funding for global health in times of crisis. The key question for the debate will be: “Can the Health MDGs still be met in times of crisis?” Reinforce commitments Panelists are Michel Kazatchkine, Executive Director of the Global Fund, Michel Sidibé, Executive Director of UNAIDS, and Joelle Tanguy, GAVI’s Managing Director for External Relations, among others. The governments of Sweden and Spain, as well as the European Commission will also send high-level representatives to the panel. Emphasis will be placed by all stakeholders on the necessity to reinforce commitments on health despite the current economic slowdown. A focus of the debate will be the need for more accountability and to ensure an integrated approach to health as a constructive way forward. European Commission supporting ACP countries through GAVI More than 70 per cent of GAVI’s support for immunisation and health programmes goes to African, Caribbean and Pacific countries (ACP). Since 2003, the European Commission has committed a total of up to € 53 million to support introduction of new and underused vaccines and reduce child mortality in ACP countries. The ACP Committee of Ambassadors this year approved an additional € 20 million from the 10th EDF Intra-ACP Development Cooperation Funds to ensure that children in ACP countries continue to receive life-saving vaccines in 2010 and 2011. Funds GAVI’s funds also come from a number of EU member states including Denmark, France, Germany, Ireland, Italy, Luxembourg, the Netherlands, Spain, Sweden and the UK. The commitment of the European Commission and EU member states has helped GAVI immunise millions of children. WHO estimates that by the end of 2008 GAVI-funded programmes have averted 3.4 million premature deaths. The health-related Millennium Development Goals (MDGs) ■MDG 4, reduce child mortality by two thirds: although the number of children dying before reaching their fifth birthday has fallen below nine million for the first time on record, progress is uneven and especially in sub- Saharan Africa child mortality rates are still alarmingly high. ■MDG 5, improve maternal health: the global maternal mortality ratio of 400 maternal deaths per 100 000 live births in 2005 has barely changed since 1990. Every year an estimated 536 000 women die in pregnancy or childbirth. Most of these deaths occur in sub-Saharan Africa where the maternal mortality ratio is 900 per 100 000 births and where there has been no measurable improvement since 1990. A woman in Africa may face a 1-in-26 lifetime risk of death during pregnancy and childbirth, compared with only 1 in 7300 in the developed regions. ■MDG 6, combat HIV/AIDS, malaria and other diseases:HIV/AIDS: the percentage of adults living with HIV worldwide has remained stable since 2000 but there were an estimated 2.7 million new infections during 2007. Moreover, deaths are increasing in parts of Africa, particularly eastern and southern Africa. One third of the estimated 9.7 million people in developing countries who need antiretroviral treatment are receiving it. Tuberculosis: the MDG target for reducing the incidence of tuberculosis was met globally in 2004. Since then, incidence has continued to fall slowly. Thanks to early detection of new cases and effective treatment, success rates have been rising from 79% in 1990 to 85% in 2006. Malaria: efforts to control malaria are beginning to pay off with significant increases in the proportion of children sleeping under insecticide-treated mosquito nets. Twenty-seven countries – including five in Africa – have reported a reduction of up to 50% in malaria cases between 1990 and 2006 3 Asia Pacific Meeting Reaffirms Commitment to Reproductive and Sexual Health UNFPA 46
  • 47. 20/10/2009 BEIJING, China —The effort to ensure that all Asians can access reproductive health services is falling short, despite global agreement that this is essential to meeting other development goals. That was the consensus at a regional forum here involving a wide range of experts, activists and practitioners in the field. Nearly 1,000 people from around the world took part in the 5th Asia Pacific Conference on Reproductive and Sexual Health and Rights, which looked at progress and ongoing challenges in family planning, maternal health, AIDS prevention and women’s empowerment. The 1994 International Conference on Population and Development (ICPD) in Cairo called for universal access to reproductive health by 2015. Two years ago the United Nations linked this objective to the Millennium Development Goal (MDG) of a three quarters reduction in maternal deaths by the same year. But “there has been a lacklustre reaction by governments, donors and development institutions” in funding the Cairo action plan, according to the Beijing Call for Action drafted by the conference organizers. The Call urges “civil society, parliamentarians, governments, donors and young people” to rapidly fulfil “the unfinished agenda of the ICPD”. “ICPD is about human rights and choices,” Thoraya Ahmed Obaid, Executive Director of UNFPA, the United Nations Population Fund, declared in her opening address. She said there have been important gains since 1994, but many countries, particularly in South Asia, are still far from the MDG maternal mortality target. Dr. Gill Greer, Director General of the International Planned Parenthood Federation (IPPF), said the global recession is threatening support for NGOs working for reproductive and sexual health and rights. She stressed that fundraising necessary to combat climate change must not reduce resources needed for development. Dr. Zhao Baige, Vice Minister of China’s National Population and Family Planning Commission (NPFPC), noted her country’s dramatic reductions in fertility and maternal deaths in the past three decades, and said the national family planning programme had moved from an administrative approach to one of informed choice. In plenary meetings and dozens of smaller sessions, participants shared scientific evidence and programmatic experience from many countries, covering a broad set of issues related to population and reproductive and sexual health and rights. These included, among others: poverty alleviation and access to health care; climate change; ageing; migration and trafficking; sexuality and culture; pregnancy, abortion and childbirth; linkages between reproductive health and HIV/AIDS programmes; violence against women; reproductive health in crisis situations; sexuality education and youth-friendly services. Young people from throughout the Asia Pacific region received advocacy training in a pre-conference Youth Forum and played active roles in the three-day gathering. Conference organizers and supporters included the China Family Planning Association, IPPF, UNFPA, Partners in Population and Development (a coalition of developing countries promoting South-South cooperation) and NPFPC. Contact Information: William A. Ryan Tel. +66 89 897 6984. 6 Philippines typhoons: Deadly disease threat as emergency worsens Merlin, UK 19/10/2009 Deadly water-borne diseases are on the increase in the Philippines following the recent onslaughts of floods and typhoons. Tropical Typhoon Ketsana devastated the Manila area on 26 September and was almost immediately followed by Typhoon Parma, which hit the Luzon region north of Manila on 3 October, triggering massive landslides and further compounding the crisis. Prolonged exposure to contaminated water has increased the incidence of diseases, such as leptospirosis, usually caught after direct contact with animal urine. According to the Philippines Department of Health, almost 47
  • 48. 100 deaths and over 1,300 cases have been reported since Typhoon Ketsana – more than a year’s worth of cases. Merlin’s emergency health assessor, Dr Sean Keogh, recently visited the Binangonan municipality in the Rizal Province on Lake Laguna. He explains: “Many of the islands are completely flooded and children are swimming in the contaminated floodwaters, contracting fungal infections. All but four of the 17 health clinics on the islands have been completely flooded out. And the hospital on the mainland is waist deep with water. “The standing water is creating the perfect conditions for diseases, such as dengue fever, transmitted by mosquitoes. Officials say that there will be a dengue fever outbreak in one to two weeks time. All of their predictions so far, including the one on the leptospirosis outbreak, have been correct. The water will not drain this side of Christmas, so the problem is ongoing.” Acute watery diarrhoea, which is endemic to certain areas of the Philippines, is also a problem, especially with the poor sanitation, lack of clean drinking water and overcrowded conditions. Dr Keogh also visited Bagulin, one of the poorest municipalities in La Union province in the north of the country. “A 40ft torrent of water swept through and damaged much of the town. The health centre, church and the convent is now buried under 5ft of mud.” Lloyd Donaldson, Merlin’s Philippines Response Manager said: “With numerous communities still flooded and many roads impassable due to landslides, collapsed bridges and burst dams, these diseases are only going to spread. Yet with so many health centres and hospitals flooded or destroyed, it is difficult to ensure that people have access to the treatment they need.” Merlin has already begun work with partners on the ground and will now target resources at re-establishing essential health care activities. We will particularly focus on preventing the spread of communicable diseases, together with supporting mobile health clinics, providing essential hygiene kits and rehabilitating health facilities. However, at a time when an unprecedented three disasters hit the Asia-Pacific region in a week (including the earthquake in Indonesia and tsunami in Samoa), finding the funding needed is a major challenge. Help Merlin to save lives in the Philippines: Please donate now 48