Vector: Issue 1 June 2006 by The Australian Medical Students' Association

June 2006 Inside this issue:

Drought in the Horn of Africa By Jacqueline McDonnell

ONSIDER TWO children born in 1984. Abeba is a 1 Feature Article little girl, born to a loving family in a small village in Ethiopia, in by Jacqui McDonnell the Horn of Africa. She is one 1 The Stats of 5 children in a family whose by Ashraf Saleh only income is from the sale of a drought-stricken, dwindling 2 Drought and its herd of cattle. At the same time impact on health in a completely different world 2-3 Interview Dillon is born. He is a white male, with Dr Jill John-Kall the long awaited first born to a tertiary educated couple in the 3 DWG Update suburbs of Melbourne. 4 Links & Resources The child mortality rate in Ethiopia is 80 per 1000 live 4 Contacts births, due mainly to preventable diseases and malnutrition. If IMC waterpoint in Deileij Abeba does make it to the age of 5 she will already be working in her family’s their race, their parents’ income and educasubfertile fields, helping her mother prepare tion, their urban or rural location, much less meals and carrying jugs of water from a well their sex. Yet statistics propose that these By Ashraf Saleh one kilometre away. Because she is a girl predestined demographics will make a major and the youngest, Abeba will be allocated difference to the lives they will lead. URRENTLY, OVER 70% of the popFast-forward into their future. Abeba less food than her brothers and will not be ulation of the Horn of Africa has no sent to school. Due to chronic malnutrition at 15, is married to a man much older than access to healthcare or clean, potable washe will be small for her age and constantly herself and pregnant with their first child. ter. Around half a million people are now With yet another drought in Ethiopia there plagued with infections. threatened by severe food shortages. The In contrast, at 5 years of age, Dillon will is even less food for Abeba and her unborn cycle of unremitting drought, which began child. Food aid was promised for her area have spent a year in kindergarten. in 1999, has put 3.5 million people, includHe may have begun learning a second but it did not come. Whether it has been ing 500,000 children in need of emergency language and his BMI is already slightly high lost to governmental corruption, logistical assistance, particularly in the arid northern problems or another of the many African for his age. districts. Yet the crisis has captured scant Abeba and Dillon can in no way be held countries gutted by the ravishing drought media attention. responsible for their family circumstances; is irrelevant to Abeba, whose only concern In Sudan, drought is translating into is enduring each day. With barely enough widespread famine, where malnutrition food to sustain herself, if the pregnancy is on the increase as escalating violence does go to term and Abeba survives the The drought has also had a shattering and lack of funds hamper aid efforts. The delivery, her baby will be small for dates surge in fighting has forced some 200,000 effect on the already fragile economy. Anwith only a diminutive chance of surviving people to flee, bringing the total displaced nual Gross National Product is as low as the neonatal period. Abeba herself will be US$90 per capita in Ethiopia. More than to over 2 million. lucky to live to 42. In Kenya, minimal access to water 1 in 3 people in this region earn less than Dillon’s story, on the other hand, is one has rendered the population vulnerable to a dollar a day. we already know well. At 15 he is learnThese condihunger, disease and ing to drive, looking for a part time job to poor sanitation. Due “… in this part of the world, tions result in a life supplement pocket money, and wonderexpectancy of 44 to inaccessible food ing what he is going to be when he grows and a lack of clean there are less than 15 doctors years for men and up. There is plenty of time to decide, as 47 years for women, water, Kenyans are per 1 000 000 people …” he will probably live till he is 80. He might with infant and maforced to constantly go to university, study medicine and have move in search of these, resulting in de- ternal mortality rates being the tenth and an altruistic vision to change the world and creased access to health services and a third highest in the world respectively. In help Abeba. But where will he start? He greater risk of contracting diseases includ- this part of the world, there are less than will need a Vector… 15 doctors per 1,000,000 people. ing malaria and HIV/AIDS.

Stats ...

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Photo courtesy of IMC

ISSUE 1

EALTH, WHILE regarded by those in the developed world as a right, is a luxury in the Horn of Africa, where severe drought and ongoing civil unrest propagate disease and decrease access to basic health services. On a backdrop of the ever present threat of violent death, survivors face the day-to-day health risks that accompany water, and subsequent food shortage. Chronic malnutrition renders people at an increased susceptibility to disease, including malaria, diarrhoea, respiratory infections, measles and meningitis. Sickness in turn aggravates nutritional losses, and a vicious cycle ensues. This cycle is echoed on a population level, where the unforgiving drought is hardest felt in areas with the highest burden of disease, weakest health systems, and most limited resources.

Water must not only be available, but uncontaminated. UNICEF reps have received reports of 117 cases of watery diarrhoea (typhoid and cholera) in the last two months. The mortality rate of those affected is approximately 10%. In such a setting, where morbidity so quickly descends into mortality, prevention is a key concept. During droughts, measles together with malnutrition poses the biggest risk for children. At least 34 children have died of measles in eastern Ethiopia in recent months.

Photo courtesy of Philip Keightley (U. Newcastle)

Drought and its impact on health By Veena Pillai

United Nations envoy Kjell Magne Bondevik addressed elders from pastoral communities in Ethiopia on the 2nd of May in an attempt to find sustainable short and long term solutions to the drought that has affected more than 15 million people since 1999. Empowerment of these communities within their natural lifestyles is the key to future battles with humanitarian crises.

“We never know the worth of water till the well is dry.” ~Thomas Fuller, Gnomologia, 1732.

Interview with: Dr Jill John-Kall

Sitting in our comfortable homes in Australia, we cannot begin to understand the magnitude of the crisis in Africa right now. Could you give us a brief rundown of the present situation?

At this time in D a r f u r, d r o u g h t is not the only thing that threatens the meager existence of the IDPs (internally displaced people). The Darfur conflict is called a “complex” emergency and Dr Jill John-Kall, Medical Director of it’s this complexity which International Medical Corps, in Sudan makes finding solutions quite challenging. There are inter-tribal issues, cross border issues with Chad, several rebel factions trying to get their piece of the pie and of course, the GoS (government of Sudan) and their armed militia, the janjaweed. Harvests get stolen, and there are difficulties in actually harvesting due to the insecurity of the area. And finally, massive budget cuts across the board - donor fatigue, other emergencies (tsunami, earthquakes), other agendas, etc - all take away from money donated to Darfur relief efforts. In fact, the World Food Program (WFP) is now decreasing their rations due to a lack of funds.

By Kathryn Loon

What are the priorities as far as emergency response/ disaster relief is concerned in the current setting? What is the role of medically trained personnel in such emergencies?

International Medical Corps’ primary goal is to increase access to medical services for the conflict-affected population. By increasing access, we contribute to decreasing the overall morbidity and mortality as well as stemming any potential outbreaks. While IMC delivers healthcare and some watersanitation, we also work with other partners and the Ministry of Health (MoH) to ensure consistent delivery of these same services. IMC also works in tandem with other agencies such as WFP to implement selective feeding centers combating malnutrition as well as working with UNFPA to deliver reproductive health services. We strive to offer comprehensive primary health care services to as many of the affected people as possible, while training national staff who can sustain our programs even in our absence.

Q) A)

What is your personal role at present in the relief efforts?

As the medical director for IMC Darfur, some of my duties include working with our field staff to implement our programs/find ways to improve them, training our national staff, ensuring adequate drugs are available for our patients, meeting with other NGOs and UN agencies to coordinate our health efforts, contributing to proposals to ensure future funding of our programs, meeting with donor agencies to update them on our programs, etc. The best part of my job is going to our field sites and spending time with our staff and our patients.

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Interview with: Dr Jill John-Kall, continued ...

How did you come to be involved in this line of work/with the IMC? When and why did you realise you wanted to work in global health?

“In relief work, we become the voices for all those who cannot speak for themselves.”

It was a combination of having a medically inclined family that would always give back to their communities, and going to med school in India where I witnessed firsthand how disease affected the poor. Even during my residency in NY, I saw the difference between the “haves” and the “have nots”. However,

the big difference was that in countries like the US and India, the governments were generally in favor of helping their most disenfranchised groups and even if they weren’t, there were people who could raise their voices in protest. In relief work, we become the voices for all those who cannot speak for themselves.

Q) A)

Have you any advice for aspiring medical students wishing to get involved in healthcare in the developing world?

There is nothing easy about relief work but then there’s nothing as rewarding. It’s not that you can make a difference, you WILL make a difference. So, if the inspiration strikes you, run with it!

Developing world group updates

ITH A FOCUS on issues of global and developing world health, the International Health Network is comprised of student-run Developing World Groups from around the nation. Here are some of the things you guys have been up to… In Melbourne, the members of IGNITE (U. Monash) have been busy, running a number of educational sessions including a very successful seminar on “International Child Health”, and an upcoming ‘African’ themed Annual Dinner, at which speakers will discuss their involvement in the current humanitarian crisis troubling sub-Saharan Africa. Their activities abroad include the bimonthly “Movies for Medicines” initiative (with proceeds aiding a health clinic in Uganda); continued work with local refugee and asylum seekers; advocacy for the cause of ethical recruiting of health professionals and ongoing efforts in the Make Poverty History campaign. The University of Queensland’s TIME group has been similarly passionate about working Towards International Medical Equality. They’ve approached this goal through running a series of informative seminars, hands-on birthing kit workshops,

Developing World Conference 2005, Sydney

fundraising events and Medical Aid Projects. Since their inception, they have sent medical aid with students to Indonesia, India, Kenya and the Solomon Islands. This year they continue sending needed supplies to Nepal, India and the Solomon Islands – and beyond! Though relatively young, Griffith University’s HOPE group have launched into furthering Health Opportunities for People Everywhere in a big way, from integrating international health topics into their curriculum, to collaborating with the Watson foundation to build a medical centre in Ghana (the HOPE4GHANA project). They have also enjoyed fundraising through movie nights and a World Cup Soccer draw. Insight, the group from Adelaide, has taken a collaborative approach to global health. Through establishing partnerships with organisations such as Engineers Without Borders, Rotary SA, OPAL and Zonta, Insight members have increased opportunities for local hands-on involvement in many facets of aid delivery. Insight also helps provide elective opportunities for students both logistically and financially through the Insight Development Fund. Sustainability is the word for The Health and Human Rights g roup at Flinders University. They’ve formed contact and friendships with some of the prisoners at the Baxter Detention Centre, and provide a monthly outreach service of company and suppor t. T he g roup also r uns a

The creation of the IHN, Sydney

regular lunchtime lecture series, at which Professor Emeritus Anthony Radford recently provided insight on common difficulties in initiating public health programs in developing countries. “Wake Up!” from Newcastle have been drawing on regional knowledge for a series of speaker nights inviting local doctors to discuss current issues in international health. A medical supply program is underway, with potential destinations of Malawi, Vanuatu, Kirribas, and Central/South America as 3rd year students embark on their health equity electives this year. And last, but not least, our friends in Perth are putting in the hard yards to make the second inaugural AMSA Developing World Conference happen this July. With a packed academic program, a great line up of international speakers and 300 attendees from around the country, it’s set to be a truly awesome event.

AMSA IHN Developing World Conference: 7th-9th July 2006 page 3

“Empowering medical students in creating sustainable health improvements in developing communities”

[ ihn@amsa.org.au ]

Links & Resources For more information about the crisis in the Horn of Africa, check out these sites… Reliefweb: http://www.reliefweb.int Go to Countries and Emergencies – then East Africa (Horn of Africa Drought) under Complex Emergencies. Comprehensive current and background information on the crisis. Includes links to other African natural disasters. Summary of findings and recommendations of the Special Envoy’s mission to Ethiopia, Djibouti, Eritrea and Kenya: http://www.reliefweb.int A rather long but professional document with solid background information. National Public Radios: http://www.npr.org/templates/story/story.php?storyId=5286826 Another good short article with audio link. Wikipedia: http://en.wikipedia.org/wiki/2006_Horn_of_Africa_food_crisis Updated information about Horn of Africa crisis, with a breakdown of causes, current situation in the different countries that make up the horn, relief efforts and external links.

...with thanks to Gail Cross

Credits Editor Kathryn Loon vectormag@gmail.com. Design & Layout Vanessa Fitzgerald orangebutterflyness@hotmail.com

Next Issue ... “Lending a hand” – Stories on aid work in developing countries, an interview with a plastic surgeon leading a double life, and much more… Feedback – Tell us what you think! Please email questions, comments, suggestions and expressions of interest to vectormag@ gmail.com. Call for submissions to “From the Field” Been involved in healthcare or aid work in the developing world? Have a few stories to share? Send your experiences, in the form of an article no longer than 600 words to vectormag@gmail.com. Join the Vector team! – Interested in writing for or assisting in the production of Vector? Send us your details with a quick spiel about your background/area of interest and/or a sample of your work and you’ll be hearing from us soon!

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