South African miners have new hope

A South African judge said human rights lawyers could launch an unprecedented “class action” that, if successful, would force more than 30 mine companies to pay compensation to everyone they have employed since 1965 who has had silicosis. In a major breakthrough for campaigners, it would also mean payouts to relatives of former miners affected by the disease who have already died. The total sum could be billions. Former miners with silicosis and other diseases have long been entitled to limited compensation from a government-administered fund, to which some mining companies make a contribution. However, the sums are limited, there is a huge backlog of claims and relatives of miners who have already died receive nothing.

Lawyers acting for the miners say the dangers from silica-laden dust were raised a century ago as the great South African mining boom got under way. A solution – blowing vast quantities of chilled air through the mines and masks – was also known, but only began to be implemented recently.

Georgina Jephson of Richard Spoor Inc, one of the law firms behind the class action, said: “The apartheid government effectively facilitated the whole system through the provision of cheap and expendable black labour. There have always been very good and strict laws about health and safety underground, but these were not enforced, certainly not under apartheid and only haphazardly since. Mining is a very powerful industry and [it has been] in the government’s interest to allow it to prosper. Johannesburg would not be here if not for mining and our country was built on mining, but at massive expense in human life.”

Fact of the Day (life expectancy)

A new report by the World Health Organisation released on Friday shows that Africa has registered an increase in life expectancy by almost 10 years over the past 15 years.

The average life expectancy of Japan is 86.8 years compared to Sierra Leone with the world's lowest life expectancy for both sexes: 50.8 years for women and 49.3 years for men.

Kenya and Cancer

In Kenya, cancer treatment is becoming increasingly expensive. Few private hospitals are equipped to provide treatment, which makes it possible for those that are to charge higher rates. According to the Ministry of Health, there are 40,000 new cases of cancer reported annually in the country. Another 27,000 patients succumb to the disease each year. From 2011 to 2014, cancer deaths rose by 23 percent, up from 17 percent in 2010.

According to Faraja Cancer Support, an NGO that works with cancer patients, "the average cost of treatment ranges from $1,600 to $5,000, which is way beyond the reach of many Kenyans". Even the $5 cost of one radiotherapy session at the public hospital can be prohibitively expensive for poor Kenyans who live on a dollar or less a day. Private hospitals can charge around $300, about 60 times more for a single radiotherapy session.

Machines such as the positron emission tomography-magnetic resonance-imaging scanner can be critical to detecting cancer. But such technology is unavailable in Kenya because it uses radiation, and the country does not have laws and mechanisms in place to enable the safe handling of radioactive isotopes. Kenyatta National Hospital is the largest referral hospital not only in Kenya but in East and Central Africa. It is also the only public cancer treatment facility in the country. But it is poorly equipped and over-stretched. In March 2015, hundreds of cancer patients were unable to proceed with their scheduled cancer treatment when the two radiotherapy machines at KNH broke down. When the radiotherapy machines broke down again last September, Fatuma Hamisi, who had travelled to Nairobi from Kwale, about 500km away, was forced to reschedule her appointment for months later. The machines in question have been in use for 20 years, treating up to 100 patients a day - instead of the recommended limit of 50. Cancer victims from all over the country flood the facility to get cheap radiotherapy sessions. But they can sometimes wait almost a year for an appointment.

Dr Catherine Nyongesa, a Kenyan cancer specialist, explainsthe importance of prompt treatment: "Cancer treatment for patients should start as soon as possible. If delayed, it matures from a curable stage to an incurable one, hence making it more painful and expensive to deal with. The main cause [of delays] is a lack of financial support."

Cancer drugs are also expensive since they are not subsidised. Those Kenyans who can afford it often go outside the country for their cancer treatment. According to the country's health ministry, each year 10,000 Kenyans are treated elsewhere - mainly in India and South Africa, which both have more advanced medical facilities. These patients are thought to spend a total of $108m on treatment abroad. One thing you can be sure of, you receive better treatment if you are rich. 

Fact of the Day

Two-thirds of last year's 2.6 million stillbirths were in Africa. At present rates of progress, it will be 160 years until a woman in Africa will have the same chance of her baby being born alive as a woman in a high-income country

NTDs

Many developing countries still lack the infrastructure to dispense drugs against neglected tropical diseases (NTDs). Neglected tropical diseases comprise various conditions that are prevalent in poor countries around the equator, but receive little international attention due to their limited spread. They include leprosy, river blindness, Chagas' disease and sleeping sickness. Nearly 1 in 6 people worldwide requires treatment for at least one NTD.

Drug delivery remains a crucial problem. Many NTDs are easily tackled by preventive chemotherapy and transmission control (PCT), a process that combines large-scale drug administration programmes with efforts to improve sanitation and raise awareness of how the diseases are spread. 5 million deaths could be averted.

"We have an abundance of cure," said Desmond Swayne, the United Kingdom's international development minister, during the report's launch last week (25 June) in London. "The problem isn't our ability to provide a cure. It's our will to provide the infrastructure that can deliver it to the sufferers."

http://unitingtocombatntds.org/sites/default/files/document/UTCNTD%20FULL%20REPORT.pdf

Trachoma

Infectious trachoma, a bacterial infection, is the world's most common cause of preventable blindness.

The World Health Organization estimates that 21 million people are affected by trachoma, of whom about 2.2 million are visually impaired and 1.2 million blind.

"Trachoma is a disease of poverty," says Simon Bush, director of the Neglected Tropical Disease programme at Sightsavers. "It is endemic in areas which have poor access to water and sanitation."

"The pain and the devastation of trachoma can be stopped by 10 minutes of surgery," says Dr Alemayehu.

Climate Change has Arrived

Too many people believe that climate change is something that will affect humans in the distant future, if at all. But its effects are now.

Droughts, which are also becoming more frequent due to global warming, dry up water supplies, especially in rural areas of the continent, forcing poor families to drink dirty, sediment-and-parasite-laden water and neglect their personal hygiene. This leads to increased occurrence of maladies like lice infestation, scabies and hookworm. Natural disasters such as hurricanes and floods can create breeding grounds for infectious diseases such as cholera. Global climate change also has substantial negative impacts on people’s mental health and well-being. As people cope with the trauma of extreme weather effects, such as losing their homes or experiencing violence and ill health, they also suffer from forms of mental illness such as depression and anxiety.

According to the World Health Organization (WHO) 2004 report on the global and regional burden of disease, at least 150,000 people die each year due to the direct effects of climate change. Of those, three percent die of diarrhea, another three percent of malaria, and just under four percent of dengue fever. Climate change is expected to trigger increased movements of people within and across borders. The International Organization for Migration estimates (that by 2050, between 25 million and 1 billion environmental migrants will move within their countries or across borders). Rural to urban migration increases migrants’ vulnerability to respiratory diseases and HIV infection. Migration is also one of the key causes of tuberculosis (TB) in countries which in the past rarely saw the disease, which often creates a steep financial burden for these countries.

Additionally, the prevalence of new and re-emerging mosquito-borne diseases is increasing worldwide due to climate change. Rising temperatures in the highlands allow mosquitoes and ticks to survive longer, leading to an increase in mosquito-borne diseases and the emergence of new diseases. Malaria, dengue fever and Leishmaniasis, a disfiguring disease caused by sand flies, are good examples. New kinds of Leishmaniasis have been detected across Africa. This type of Leishmaniasis is resistant to all forms of available treatment.This stigmatizing skin disease, which afflicts the infected person with sores and lesions that can cause permanent disfigurement, is becoming one of the main reasons for school drop-outs in Northern Ethiopia.

Climate change also impacts agriculture and livestock, increasing the prevalence of malnutrition and negatively affecting the health of children and pregnant women. It is estimated that 30 percent children under the age of five in Ethiopia are malnourished. The International Food Policy Research Institute estimates that by 2050 an additional 25 million people will be malnourished as a result of climate change. This is particularly dangerous because malnutrition, which has negative health risks of its own (macronutrient and micronutrient deficiency is a leading cause of childhood death in Africa), also increases people’s susceptibility to infectious diseases such as intestinal parasites, tuberculosis and HIV.

Taken from here 

Too much water - not enough water

Nigeria is one of Africa's leading economies, with its GDP second only to South Africa. The country has abundant natural resources such as gold, oil and natural gas and diamonds. Its economic growth, however, hasn't had the trickle-down effect. Basic living standards such as safe drinking water and sanitation are abysmal.

According to the NGO WaterAid, 63 million people lack access to safe drinking water and 111 million have no sanitation. 85,000 children die every year in the country from diarrhoea caused by unsafe drinking water and poor sanitation.

 Lagos' population has doubled to more than 21 million residents. According to estimates, this number is likely to rise to 35 million by 2025, making it the world's most populous city.

Makoko, a one-square-kilometre settlement of Lagos is sometimes called the "Venice of Africa". This 200-year-old slum is hovels built upon wooden stilts. There are no official census records, but estimates suggest the population totals 150,000. Residents here lack access to safe drinking water. When it rains, conditions turn particularly nasty, rain pushes sewage and waste through the slum, leaving behind a foul stench. Makoko lacks drainage and sanitation. Sewage from the slums flows straight into the surroundings, increasing the risk of infectious disease among inhabitants. Earlier this month there was an outbreak of cholera.Many of Makoko's inhabitants are from neighbouring Benin and Togo - most have lived here for decades. An average of eight people live in each house, and sustain themselves on fishing or collecting wood from the lagoon.

Theophilus Damijida is a general physician at the local health centre. "The health implications are vast. We encounter a lot of health problems as a result of no access to clean water," he said Patients coming here are diagnosed with diseases such as typhoid, malaria, diarrhoea and cholera. "It is all over as a result of no access to clean water. They believe this water is clean, they will even wash fresh wounds in it. The government has a big role to play so that there is more awareness to improve the situation and the people know the water they are using is not okay."

In July 2012, city authorities left thousands of people homeless after an eviction in one neighbourhood of Makoko. Since the area was considered an illegal settlement, they were given a 72-hour notice before their houses were destroyed. The government offered no rehabilitation or compensation. In an ever-growing city, where many wealthy desire waterfront property, there are suspicions the city wants the entire community gone.

Gold leading to poison

The Nigerian village that suffered one of the world's worst recorded incidents of lead poisoning is now habitable and doctors can start treating more than 1,000 contaminated children, a doctor and a scientist from two international agencies said.  People were exposed to rates of lead contamination: Some residential soil with up to 35,000 parts per million of lead and the processing area with over 100,000 parts per million. The United States considers 400 parts per million safe for residential soil. The entire human population of 6,000 to 9,000 was exposed.

For some, it already is too late to reverse serious neurological damage, said Dr. Michelle Chouinard, Nigeria country director for Doctors Without Borders, told The Associated Press. Some children are blind, others paralyzed and many will struggle at school with learning disabilities, she said.

Doctors Without Borders uncovered the scandal in 2010 but nothing was done until this year about the worst-affected village, Bagega, because the federal government did not provide a promised $3 million. The government released money for the cleanup in February, Doctors Without Borders began prescreening in March and found that nearly every one of 1,010 children tested need therapy. Of them, 267 are severely contaminated and will get chelation — where medication binds the lead to a child's blood and helps them to eliminate it faster from their system. All the children had more than the international standard maximum of 10 micrograms per deciliter of lead in their blood. Some had as much as 700 micrograms per deciliter. The children will have to be treated for one to two years.

The Moscow, Idaho-based foundation advised Nigeria's northern Zamfara state government and oversaw the 5 ½-month cleanup, or remediation, of Bagega that ended two weeks ago.

The poisoning caused by artisanal mining from a gold rush killed at least 400 children. The more basic methods used to get at gold helped cause the poisoning. Some women used hammers to beat open rock ore. Others used some of the 60 grinding mills at a processing area adjacent to the village and water reservoir. Many took the rocks that carried high concentrations of lead into their homes for processing. The poisoning was facilitated because the particular lead compounds are very toxic and easily absorbed into the body, unlike other forms of lead.

 Villagers initially tried to hide the deaths, fearing the government would stop their illegal mining. Government officials initially reacted by trying to enforce a ban on illegal mining but when that did not work, they promised to find other sources of income for villagers, but nothing has happened in a country where corruption is endemic. Villagers still say they would rather die of lead poisoning than poverty. Villagers make 10 times as much money mining as they do from farming in an area suffering erratic rainfall because of climate change. Despite its remote location, the booming economy attracted people from Burkina Faso, Mali and Niger to Bagega. In addition, cattle herders and nomads came here to water their animals at a reservoir so dangerously contaminated it killed goats and cows.

Managing five landfills with some 13,000 cubic meters (nearly 460,000 cubic feet) of highly contaminated soil, and teaching villagers how to mine safely are major challenges to prevent new contamination environmental scientist Simba Tirima said. His TerraGraphics Foundation has trained dozens of Nigerians to clean up any future contamination.

Woo-woo cures

Gambian dictator, Yahya Jammeh, continues to insist that he has a cure for HIV/AIDS. While people might think he is a lunatic and that his claims are bizzare and should be ignored, many sick people in Gambia take him seriously. They go to the state house to receive “free treatment"with no proof of efficacy or effectiveness from his ‘Excellency’.


Jammeh, who came to power in 1996 through a military coup, has repeatedly declared that he could cure HIV/AIDS and asthma using natural herbs with some banana and peanuts and by reciting prayers and some verses from the Koran. He has refused to reveal the ingredients he used in preparing some of the concoction. Jammeh had no medical training. He claimed to have inherited the “healing power” from his father. There is no evidence that Jammeh has inherited any form of healing power from anybody. He is a quack taking advantage of the situation of poverty, disease and poor medical care in his country. During his ‘healing session’, he carries a copy of the Koran and his muslim beads to attempt to give the process some legitimacy and credibility in the eyes of the majority muslim population in the country.

Jammeh’s cure claims have been dismissed by medical experts globally. And many people are particularly concerned that Jammeh’s reckless and irresponsible cure claims could undermine efforts to combat the AIDS pandemic in Gambia and in other parts of the region. It is difficult to know the number of people who must have died since Jammeh came out and started administering his unsubstantiated and quack cure claims.

Traditional is not always the best

Malnutrition remains a key cause of numerous diseases that have led to death of children under the age of five in Rwanda and herbalists have been blamed for this. Most rural residents in Eastern Province, particularly in Kirehe and Ngoma districts, prefer herbs from traditional healers to drugs prescribed at health centres.

Alice Muhongerwa, the provincial coordinator National Women Council (CNF), the persistence of malnutrition in the area was mainly due to traditional healers. "In Kirehe, it is a sad reality...malnutrition has prevailed because of herbalists. Parents keep on feeding their children on herbs instead of recommended foods like beans and milk, which they do not lack by the way. A typical example is that of Gahara Sector which is the richest in food production and has the highest cases of malnutrition. Ignorance is still a problem,"

Source

The new apartheid

Rina Venter, the National Party's health minister, talks of how F W de Klerk, the last apartheid president, had asked her to get rid of racial discrimination in the country's health system. Venter convened the state law advisers and repeated the request to them - only to find out that there were, in fact, no laws in place to segregate state hospitals and never had been. Hospital administrators and doctors had implemented an inhumane system largely because they believed it was expected of them to do so.

 Now South Africa's healthcare system can essentially be divided into public and private. Out of 49 million people, some 8 million are covered by health insurance, referred to as medical schemes. It is a system where the scheme makes no profit but those who are paid from it - private hospitals, doctors, et cetera - do. Up until a short while ago, the division may have appeared racial. Most of those with health insurance were white, while blacks mainly used the public health system. But now, of the eight million with health insurance, approximately half are black. The private healthcare system features world-class hospitals, the most advanced equipment and the best doctors - for most will work where they can earn the best salary.

The majority of those using the public health system are still black and poor. The starkest contrast between public and private healthcare in South Africa is to be found not in the colour of its patients but in the facilities it offers. Run-down buildings, missing medication and widespread corruption characterise the public health system, and not a day passes without a story about broken equipment leading to deaths or facilities closing because they cannot afford to pay their creditors. 40 million South Africans - and an additional approximately three million refugees - must rely on a system that is falling apart.

It is a different apartheid.

"Our people need proper housing, not ghettos like Soweto." These were the words of Nelson Mandela to tens of thousands at Soweto's Soccer City Stadium just one day after his release from 27 years behind bars in 1990. Soweto, whose name is taken from the first two letters of "South Western Townships", was known as the capital of black South Africa. Originally established for labourers in western Johannesburg's mines in the late 19th century, it became home to black families forcibly removed from areas around Johannesburg and other parts of the country.

Today, Soweto has become a microcosm of the prosperity, poverty and everything in between experienced by the black population of today's South Africa. "Our country will never be prosperous or free until all our people live in brotherhood, enjoying equal rights and opportunities," read the Freedom Charter. However, just opposite the raitracks near Water Sisulu Square are rickety, one-room homes with roofs made from corrugated zinc. Inside the narrow alleyways where children run shoeless lives 41-year-old Bob Nameng, the founder of Soweto Kliptown Youth. SKY provides shelter to more than 70 black children from impoverished communities in and around Johannesburg. Nameng listed a number of difficulties that Kliptown and other poor Sowetan communities face, and said the government is making little effort to fix them. "The situation is getting worse and worse," he said. Crime, drug use, HIV and rape continue to be real fears for communities across the country, and especially in densely populated areas like Soweto.

Shops like McDonalds, KFC, Timberland and Levi's opening at the Maponya Mall which has received widespread praise as the first of its kind in an area like Soweto. Nameng isn't excited. "I feel it's a monster, it's swallowed so many small businesses. It's deprived so many poor women and youth a chance to be able to put bread on their table." The poor people from the area now have to travel miles into Johannesburg to find affordable goods that are no longer available in Soweto. Nameng, like many blacks in South Africa, have grown disheartened by the post-apartheid era as most of the country's land and wealth has remained in the hands of the white minority. "At first we were complaining about the white government, which was the oppressor. Fine, so we've got a black government now in power. What now? It's the same old boring song," Nameng said

Changing Africans health

The international community has done little to help Africa to help itself, and not keep it alive on a drip feed of pennies from collection tins.

Most people in developed countries think of the biggest health challenges confronting the developing world, they envision a small child in a rural, dusty village beset by an exotic parasite or bacterial blight. But increasingly, that image is wrong. Instead, it is the working-age woman living in an urban slum, suffering from diabetes, cervical cancer, or stroke – non-communicable diseases (NCDs) that once confronted wealthy nations alone.

Charities know that raising money for exotic disease eradication in the West is a good deal easier than asking for funding to upgrade sub-standard cardiac facilities. But by ignoring the far greater, non-communicable problems Africans are doomed to low life expectancies. NCDs in developing countries are occurring more rapidly, arising in younger people, and leading to far worse health outcomes than ever seen in developed countries. This epidemic results from persistent poverty and unprecedented urbanization. According to the World Economic Forum's 2010 Global Risks report, these diseases pose a greater threat to global economic development than fiscal crises, natural disasters, corruption, or infectious disease.

Heart disease, diabetes, cancers and chronic respiratory illnesses are the biggest killers globally, according to the United Nations agency. They account for 36 million deaths a year, or 63% of all mortality, and one-quarter of premature deaths under the age of 60. Deaths from noncommunicable diseases are rising in Africa where they are projected to be the biggest killer by 2030.

south africa's shame

More than half of South Africa's children live in poverty and one in four has HIV.  South Africa is now judged to be one of the most unequal societies in the world and its 19 million children bear the brunt of the disconnect.

The Unicef report found that 1.4 million children live in homes that rely on often dirty streams for drinking water, 1.5 million have no flushing lavatories and 1.7 million live in shacks, with no proper bedding, cooking or washing facilities.

Four in 10 live in homes where no one is employed and, in cases of dire poverty, the figure rises to seven in 10.

Contrary to the rest of Africa, where pneumonia and diarrhoea are the biggest child killers, South African children are most likely to die from HIV/Aids. More than five million are currently infected with HIV, and 40 per cent die from the pandemic annually.

Aida Girma, Unicef's South African representative, said that two thirds of child deaths were preventable with simple improvements in primary care for children.

Rhoda Kadalie, executive director of Impumelelo Social Innovations Centre which seeks out novel ways to tackle poverty, said the problem could be traced back to 1994, when the post-apartheid, ANC government focused on "the economy, black economic empowerment and the consolidation of power" rather than education and health care.These subjects are not sexy and those ministries are given to the weaker ministers who have little political power," she said. "As a result, we are awash with policies but there's no political will or competence at a local level to implement them. The facts speak for themselves: if we don't invest in our children now, we might as well give up on our future."

http://www.telegraph.co.uk/health/healthnews/9280481/More-than-half-of-South-Africas-children-live-in-poverty.html

South Africa's real drug problem

Lifesaving drugs under disputed patents could become more easily available in future depending on the outcome of a case before the South African Supreme Court of Appeal. The case revolves around a Sanofi-Aventis cancer drug docetaxel, an important drug used to treat many forms of cancer. It has the potential to save lives or improve the quality of life of cancer patients, but remains expensive as it is under patent.

More often than not, patented medicines are more expensive than generic versions of drugs, with most cancer medicines being extremely expensive. It is not unusual for cancer patients on medical aid to exhaust their oncology benefits, facing crippling bills at the end of their treatment regimen. It is known that once a generic enters the market it encourages competition driving prices down even further.

The Treatment Action Campaign is arguing that it is in the interests of cancer patients that the generic drugs be available, and that the harm to patients will be greater than the harm to Sanofi-Aventis. If the Court accepts TAC's argument it will be an important advance for the rights of access to affordable medicines. It will mean that in future in any dispute over patents in respect of medicines, the courts will have to consider the public interest and the Constitutional right of access to health care services.

Unlike many other countries where patents can only be registered following substantive examinations, in South Africa it is relatively easy to register patents. South Africa currently provides patent protection beyond what is required by the TRIPS agreement. Unlike South Africa, India, Brazil and Thailand, among others, have used flexibilities allowed under TRIPS to curb excessive patenting of pharmaceuticals and promote public health. South Africa granted 2,442 pharmaceutical patents in 2008 alone, Brazil only granted 278 pharmaceutical patents between 2003 and 2008. Generic versions of the disputed drug are now available in the United States - a country that upholds strict patent protection.

The consequences of South Africa's strict patent protection are high medicine costs and the delayed availability of affordable generic medicines. Medicine expenditure increased 25.2% between 2008 and 2010, while actual medicine use only increased 5.8%.

Access to life-saving medicine is a human right, not to be dictated by a bank balance or company profits.


http://allafrica.com/stories/201205141151.html

Niger's shame

Niger is the worst country in the world in which to be a mother, according to a report by Save the Children. Save the Children has highlighted the vast differences between women's experience in Niger and the UK, with those in the former expecting having a one in 16 chance of dying from a pregnancy-related cause, against almost one in 5,000 in the UK.

http://www.guardian.co.uk/world/2012/may/08/niger-worst-country-mother

Africa's sick record

Shedding more insight on global health issues, Luis Sambo, Director of WHO-Afro disclosed that while 59 million people died globally in 2008, 19 per cent of these deaths were in the African continent which attributes only 12 per cent of world population. He further pointed out that 63 per cent of these deaths were caused by communicable diseases of which about 16 per cent are attributed to Human immune Virus (HIV).

According to Sambo, "While developing countries especially those in sub-Saharan Africa face both communicable and non-communicable diseases, some of the health inequalities seen could have been averted through the adoption of relevant health and economic policies."

Samir Banoob, Professor of Health Policy and Management and President of International  Health Management, stressed the need for medical professionals to live up to public expectations and adhere to ethical  standards. "Public health saves thousands of live and professionals should serve the public without prejudice - not closing their eyes to victims of negligence, war and political unrest while people die unreasonably,"


http://www.businessdayonline.com/NG/index.php/entrepreneur/126-health/36708-world-health-congress-tasks-governments-to-global-health-equity

The population problem

In a quarter-century, at the rate Nigeria is growing, 300 million people — a population about as big as that of the present-day United States — will live in a country roughly the size of Arizona, New Mexico and Nevada. In this commercial hub, where the area’s population has by some estimates nearly doubled over 15 years to 21 million, living standards for many are falling.

A typical apartment block is known as a “Face Me, Face You” because whole families squeeze into 7-by-11-foot rooms along a narrow corridor. Up to 50 people share a kitchen, toilet and sink — though the pipes in the neighborhood often no longer carry water.

At Alapere Primary School, more than 100 students cram into most classrooms, two to a desk. As graduates pour out of high schools and universities, Nigeria’s unemployment rate is nearly 50 percent for people in urban areas ages 15 to 24

Last October, the United Nations announced the global population had breached seven billion and would expand rapidly for decades, taxing natural resources if countries cannot better manage the growth. Nearly all of the increase is in sub-Saharan Africa, where the population rise far outstrips economic expansion. Of the roughly 20 countries where women average more than five children, almost all are in the region. Elsewhere in the developing world, in Asia and Latin America, fertility rates have fallen sharply in recent generations and now resemble those in the United States — just above two children per woman.

“The pace of growth in Africa is unlike anything else ever in history and a critical problem,” said Joel E. Cohen, a professor of population at Rockefeller University in New York City.

Nigeria, already the world’s sixth most populous nation with 167 million people, is a crucial test case. If this large nation rich with oil cannot control its growth, what hope is there for the many smaller, poorer countries? Nigeria made contraceptives free last year, and officials are promoting smaller families as a key to economic salvation, holding up the financial gains in nations like Thailand as inspiration. Some experts worry that it, and other African nations, will not act forcefully enough to rein in population growth. For two decades, the Nigerian government has recommended that families limit themselves to four children, with little effect. Nigeria, like many sub-Saharan African countries, has experienced a slight decline in average fertility rates, to about 5.5 last year from 6.8 in 1975. But this level of fertility, combined with an extremely young population, still puts such countries on a steep and disastrous growth curve. Half of Nigerian women are under 19, just entering their peak childbearing years. In a deeply religious country where many Roman Catholics and Muslims oppose contraception, politicians and doctors broach the topic gingerly, and change is slow. Posters promote “birth spacing,” not “birth control.” Supplies of contraceptives are often erratic.

“Population is key,” said Peter Ogunjuyigbe, a demographer at Obafemi Awolowo University in the small central city of Ile-Ife. “If you don’t take care of population, schools can’t cope, hospitals can’t cope, there’s not enough housing — there’s nothing you can do to have economic development.”

Parfait M. Eloundou-Enyegue, a professor of development sociology at Cornell University, said, “Many countries only get religion when faced with food riots or being told they have the highest fertility rate in the world or start worrying about political unrest.” In Nigeria, experts say, the swelling ranks of unemployed youths with little hope have fed the growth of the radical Islamist group Boko Haram

Sub-Saharan Africa, which now accounts for 12 percent of the world’s population, will account for more than a third by 2100, by many projections. Because Africa was for centuries agriculturally based and sparsely populated, it made sense for leaders to promote high fertility rates. Family planning, introduced in the 1970s by groups like Usaid, was initially regarded as foreign, and later on, money and attention were diverted from family planning to Africa’s AIDS crisis. As Nigeria urbanizes, children’s help is not needed in fields; the extended families have broken down. “Children were seen as a kind of insurance for the future; now they are a liability for life,”  Dr. Ogunjuyigbe said

Dr. Eloundou-Enyegue worries that Africa’s modestly declining birthrates reflect relatively rich, educated people reducing to invest in raising “quality” children, while poor people continue to have many offspring, strengthening divisions between haves and have-nots. “When you have a system with a large degree of corruption and inequality, it’s hard not to be playing the lottery because it increases the chances that one child will succeed,”

In Nigeria’s desperately poor neighbor, Niger, women have on average more than seven children, and men consider their ideal to be more than 12. But with land divided among so many sons, the size of a typical family plot has fallen by more than a third since 2005, meaning there is little long-term hope for feeding children, said Amadou Sayo, of the aid group CARE

http://www.nytimes.com/2012/04/15/world/africa/in-nigeria-a-preview-of-an-overcrowded-planet.html?_r=1&pagewanted=2&nl=todaysheadlines&emc=edit_th_20120415#

Crippled Congo

The outlook for people living with disabilities in the Democratic Republic of Congo remains bleak

"There are roughly 9.1 million people with disabilities in Congo, 11 percent of the total population of 60 million," said Patrick Pindu, coordinator of the National Federation of Associations of People Living with a Disability in Congo. "Amongst people with disabilities, 90 percent are illiterate, 93 percent are jobless and 96 percent live in an unhealthy and inhumane environment."

Jolie Apelo is a member of the Kikwit Association of Disabled Persons. "As you see me here, I don't eat properly due to a lack of financial resources. I'm unable to buy clothes so I can present myself like a human being worthy of the name, even if I am a member of an association."

Godefroid Kiyaka gets around the capital, Kinshasa, on his hands and knees because of the extreme deformity of his legs. "I don't have a wheelchair to go longer distances," he told IPS. "Many people turn away from me when I ask them for donations."

22-year-old Alphonse Mumbaka relies on crutches for limited mobility. His father died when he was young, and left to his own devices, Mumbaka never went to school or learned to read. "No one educated me."

"It's not acceptable that the government still doesn't get involved in resolving the problems facing the disabled. These people must enjoy their full rights like everyone," said Cyrile Mupasa, from the League for the Defence of the Rights of Children and Students in the Central Africa zone.

http://www.ipsnews.net/text/news.asp?idnews=107003

Kenya's nurses strike

Kenya's public hospitals face a potentially devastating health worker shortage after the government fired 25,000 striking nurses.

Luke K'Odambo, chairman of the National Nurses Association of Kenya, said that the sacking did "not make sense in any way", and that it was not possible to dismiss such a large part of the workforce.

"We are ignoring the sacking threat." Alex Orina, spokesman of the 40,000-strong Kenya Health Professionals Society, said. "These are cat-and-mouse games, you cannot sack an entire workforce. It is a ploy to get us to rush back to work, but our strike continues until our demands are met," .

The nurses went on strike on March 1 to protest the government's failure to implement a salary increase agreed last year, when they also stopped work to press for improved services in Kenya's mostly ill-equipped public hospitals. On average, a health worker earns about 25,000 shillings ($300) a month in salary and allowances, and this amount was likely to double if their demand for higher allowances were met. Private hospitals and clinics, where richer families send their sick, have opened as usual because their nurses are not members of the strikers' union. In public hospitals patients pay as little as one and a half dollars for most outpatient services. This is incomparable to established private health facilities where patients pay up to over 120 dollars for outpatient services.

The industrial action comes barely two months after government doctors in Kenya went on strike for a rise in salary

"Nyongo, we want our rights, like you had medical treatment abroad," the protesters chanted in Swahili, in reference to a stay in the United States last year when the minister was treated for prostate cancer.