Africa COR P OR AT E
Issue 60 Vol 2 Number 888 2014
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PARTNERSHIPS FOR PREVENTION AND CARE
Ebola Spirals Out of Control Dr David Heymann. Global Fund And Africa Partnership Fighting The Stigma of TB Gerry Elsdon.
CONTENTS 4 ..... Ebola Virus Lockdown Sierra Leone featuring Dr Monty Jones 8 ..... Ebola spirals out of control: Interview with Dr David Heymann 12 ... All-Africa response required to stop Ebola 16 ... The Global Fund and Africa Transformative Partnership 20 ... Gerry Elsdon’s battle with TB and its stigma
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3
Ebola Virus Lockdown Sierra Leone featuring Dr Monty Jones
Head of the Presidential Task Force on Ebola Dr Monty Jones
O
n the 6th of September 2014, Sierra Leone announced a three-day lockdown in an effort to tackle the outbreak of Ebola within its borders. As one of the worstaffected countries by the recent pandemic, government authorities are planning to deploy more than 20,000 people to tackle the issue.
His Excellency the President himself and comprises of ministries, development partners, civil society groups… you name it. We are all here looking at strategic and policy issues.
People are stopping flights coming to not only Sierra Leone, but Liberia and
James Norris at Corporate Africa spoke with Dr Monty Jones, Head of the Presidential Task Force on Ebola about the situation and the effect of Ebola on the country’s economy. Did the outbreak of Ebola catch the Sierra Leonean authority unawares?
Guinea as well. This does not help the situation at all.
In the midst of this body we have a group of all the relevant ministries that could work with the Ministry
I would say yes, it did catch us unawares because this
of
is the first time in history that we have been affected
implementation of strategies. The main functional and
by this devastating disease. It came at a time that
implementation arm of this program is what we call the
our economy was booming and the concentration was
Emergency Operations Center (EOC).
Health
and
Sanitation
to
ensure
the
effective
on developing the economy. We saw it in Guinea and Liberia but thought it would never come to Sierra Leone
This is a centre that comprises of all the technical
so fast. It came over even before we started talking
personnel from within the country. I mean medical
about it, before we started putting measures in place.
doctors, Ministry of Health officials and development partners like the WHO, the CDC, USAID, UNICEF, etc.
As Head of the Presidential Task Force, how are
They’re all part of this body and we meet on a daily
you responding to this challenge?
basis. I should also mention that apart from the national EOC in Freetown, the 12 districts have got their own
We are channeling most of our resources into this fight
EOCs operating on the ground.
and we believe that we have put structures in place that
4
will enable us to eventually win the war. For example,
This body has put together these response, contact, and
we have a Presidential Task Force which is chaired by
burial teams across the country. We’ve been doing a lot
Corporate Africa
of talking and coming up with measures to address the disease but - from what we’ve heard - it has mutated twice and this is really, very serious.
When it comes to international
It is attacking people and, of course, things are
media coverage, it seems like
complicated in a society like ours it is difficult. Sierra
every other person in Sierra Leone
Leoneans are peace-loving, religious people. We are
has got Ebola.
used to our own traditions of burials and things like that so people panic in these situations. They say, “I won’t see my loved one anymore,” and the tendency in such a situation is for them to say, “let me hide my family,” and that is the problem that we sometimes find. Customs and religions, how they believe them and are unwilling to bury their loved ones without seeing them, without the usual ceremony: these are some of the issues that we face in our country today and the reason why we are still fighting this war. Otherwise, we probably would have curtailed it a long time ago. It is very difficult for us to get people to understand that it is a very deadly disease and that they need to leave some customs and follow the advice given by the Ministry of Health and Sanitation. How is the disease impacting your economy, especially in relation to the very negative international media coverage? When it comes to international media coverage, it seems like every other person in Sierra Leone has got Ebola. We’re talking about a country in which we have 6 million people, and if we go by the WHO numbers we’re talking about over 1,000 people who have currently carry the disease and the number of deaths is just above 400. So it is not every other person who is affected.
The stigma is there and I believe it must be affecting our economy. For example, people are stopping flights coming to not only Sierra Leone, but Liberia and Guinea as well. This does not help the situation at all . because we know that you can only get the disease through contact. If the appropriate measures are taken, which we believe we have adopted across the country (not just at the airport but at the seaport and so on), then the likelihood of someone carrying the disease by flight is minimal. I think that 80-90 per cent of our society today knows what Ebola is and knows what you should and should not do, because we’ve adequately disseminated the information to our people. We need investors to still think of Sierra Leone. This disease will go one day, and they should come back. We know that our mining sectors are still functioning even if not all of them are functioning to full capacity. Some of the expatriates have left and they’ve left a minimal group of Sierra Leoneans to man the mining sectors. We want the private sector to be fully involved because we don’t want an economy that is booming to fall so that we start all over again just like how we started after the civil war.
Corporate Africa
5
We came up with this agenda for prosperity focusing
Now we need help and the African countries should not
on
agricultural
close their doors to us, they should come and help us
sector, on how to boost the economy and get Sierra
fight this war. I am not saying that they’ve done that,
Leone to be prosperous. We are working with the
we’ve got lots of solidarity from many countries and
energy sector, and the mining sector has more than
philanthropists from Nigeria and other places that are
tripled compared to its operations five years ago.
giving us moral support and financial contributions.
Things were actually moving and now all of these have
The President of The Gambia made a contribution and
slowed down because the money has gone to the fight
now other countries are beginning to think about how
against Ebola. Our economy is shrinking but we believe
they can help. It’s probably a little bit late, but we’re
that we are going to get over this. We believe that after
grateful that they’re beginning to come in and we believe
it is over, we are going to tighten our belts again and
we can end this together.
various
sectors,
particularly
the
we’re going to continue with our development program. Should part of that solidarity be a regional task force to deal with future outbreaks of disasters?
We are, of course, aware that they
That type of solidarity should always be there and I
may be some adverse effects but we
believe that ECOWAS should come up with a task force
believe that the first priority now is to save lives.
that should be on standby for any country operating in the region to deal with this or any other deadly disease matter - to intervene immediately, as soon as the disease is announced. That task force should be able to act at the snap of a finger and I think that’s what ECOWAS, the AU and other regional or sub-regional bodies should do.
I must say that the international community has been
Our people, Africans, should show a Pan-African attitude
very supportive despite the fact that some countries cut
and work together to solve the problem.
off their airline carriers. To mention a few: the CDC, the World Food Program, and the US and UK governments
What sort of help are you getting from China?
have been sending resources through these NGO and UN systems. Although they have been slow in reacting, now
We are receiving quite a lot of help from China, apart
they’re coming in and we believe we’re on the path to
from the fact that they sent a whole plane to bring
solving this problem.
badly-needed
supplies,
equipment,
protective
gear,
gloves, masks, medication, etc., they also sent a team You mentioned support from the International
of Chinese personnel which included medical doctors,
Community, what about support from other African
nurses and other technical. We’re also going to put up
Governments and the African Union? Are you
a mobile lab which will eventually become permanent
having that kind of support from the germinal
because we need these structures and this infrastructure
economic community?
to make sure this is something we can beat once and for all, and as we get signs of these kinds of diseases, we
Let me start with the African Union. It has been working
should be able to curtail them immediately.
with African countries to come up with plans to boost our economies, especially in Sub-Saharan Africa. They’ve
China is playing a major role and we see that from other
done well but I’m afraid that they’ve been slow in coming
nationals like the US who sent a CDC group that are
to our assistance.
working with us to look at social mobilization issues. People have been really, very friendly. I wouldn’t stop
What is good is that they have come and they want
talking about the support that we get from the WHO,
to make their own contribution. We would like the AU,
the UN and so on. Recently, we were discussing getting
ECOWAS and all these regional bodies that we are working
something from Russia who would like to come to Sierra
with to know that Africans should slow solidarity for the
Leone with a team of over 100 people to work, build
affected countries. They should show solidarity because
laboratories, and carry out research and treatment.
Sierra Leone has always been there for Africa. We are
We will not only be able to monitor the disease but
not a very rich country but we support peacekeeping
determine or diagnose the carrier and be able to isolate
missions to other countries, working alongside UN troops
them while they wait for test results to come back.
on ECOWAS missions. 6
Corporate Africa
What
is
the
government
doing
to
sustain
partnerships for future disasters?
Geneva to look at these experimental drugs and vaccines to see which ones they’d recommend for testing. We would like to test any drugs that could save the lives of
We need a structure and we need to channel more
our people who are dying on a daily basis and I don’t
resources to the health sector. I have heard in the
think that we’d be losing anything if there’s something
international media that we are losing the war because
out there that we could test.
our health system is very weak, but we are now trying to build this system and sustain it so that in the future we
We are, of course, aware that they may be some
will be able to address a disease like this from the onset.
adverse effects but we believe that the first priority now is to save lives. This is not going to be a government
In the private sector, are major pharmaceutical companies like Pfizer and BD providing any support or making contributions?
pronouncement, it’s going to be individuals who want these drugs to be administered to them to sign whatever contract or agreement they need to sign.
We have made contact with one or two of those private sectors. When we heard about ZMapp, for example, we looked into if it could be sent to Sierra Leone. Unfortunately, not enough ZMapp was available and it went to treating the patients who were flown back to The States and some went to Liberia. Nigeria requested some but could not get it either, but the private sector has been in touch with us because some of them would like to come and work in Sierra Leone and test some of their experimental drugs. The WHO has got a meeting going on right now in
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Ebola spirals out of control: Interview with Dr David Heymann
Dr David Heymann, Global Pandemic Expert
D
octor David Heymann, globally renowned epidemiologist, speaks with Shan Bertelli at Corporate Africa about the urgently needed
halt to the spread of Ebola in West Africa.
An article you wrote on global surveillance, you identified “inadequate surveillance and response capacity” as a threat to global health even if it starts in a single country. Would you say this is the case here? What can be done to improve surveillance and response in these countries,
Foreign countries are currently giving financial
given their limited resources?
aid and medical support to fight the outbreak. In comparison, the African Union (who donated US$1
The problem was that there could have been a more
million to the effort) has not been so active in their
robust and rapid response in Guinea when the disease
response. Should there be a stronger response
first broke out in March. Even with good surveillance in
from the AU?
Guinea, the response would’ve had to be more robust.
The African Union would do well to mobilize doctors from
How much and what can private companies
the African continent. They understand Africa, they work
do to help support the public and non-profit
in African settings: they are African. They could be more
organizations?
effective than the doctors coming over, who are effective but won’t be as familiar. The African Union could be
I’ve just had a meeting in Australia (The Africa Down
funding this as well.
Under Meeting), which is a meeting of mining companies and I was there to talk to them about Ebola and emerging infections. I think there’s a clear understanding that if companies take care of the health of the communities
The African Union would do well to mobilize doctors from the African continent. They understand Africa, they work in African settings: they are African.
where their operations are held that they can decrease absenteeism and help the communities at the same time. They’re not so clear yet about the risk assessments and prevention of these emerging infections and, as of yet, they’ve taken care of their own employees but haven’t really joined in partnerships within Africa and I think that’s a step they’re considering taking. How can these companies be more involved in the communities?
8
Corporate Africa
They are involved in the community, what they need
bring back to their own countries. I’d expect that that’s
to do is be more involved in assessing the unknown
part of the reason (I don’t know the whole reason) but
infections that come from wild animals: things that they
it’s unfortunate and makes it very difficult for partners to
aren’t anticipating.
work with those countries.
They do a pretty good job with HIV and malaria and
In your article, “Experimental Medicine in a Time of
those diseases at a community level and they prevent
Ebola”, you said that “African governments should
absenteeism because of that. These Black Swan events,
be allowed to make informed decisions about
when they occur, they’re not prepared for them.
whether or not to use [experimental products such as antiviral drugs, monoclonal antibodies and
And so all the mining companies, for example, have had
vaccines]”. Realistically, is this a strategy that can
to shut down because there’s no support system around
be implemented given that much of the public in
them but the mining companies have these wonderful
the affected areas is suspicious about Western medical interventions and intentions?
logistic platforms to support their operations. These could be used in the case of an outbreak. If
the
private
companies
provide
It’s up to them to do it themselves and there is one thing support,
should their emphasis be on the production of pharmaceutical products, or financial aid, or even improving the conditions in the health centers? I think they should rise to the occasion and do what the government need them to do, they should be partnering with government to be sure they know what’s needed and they could be contributing whatever resources they might have. It might not be a hospital; it might be help with the public health work they do, contact tracing, for example.
that they could be trying now which is collecting blood from survivors and taking the plasma from that blood which contains antibodies, making sure that that blood is free of infection and then providing antibodies to those people who have infection hoping to neutralize it. This has been attempted in the past but never in a clinical trial and this is very similar to the monoclonal antibodies that have been used in international workers. So this is something African countries could try on their own, they would need to do it in a rigorous clinical trial methodology. If it works I think it could be a sustainable intervention that they can offer to Ebola patients.
As an example of how private enterprises can influence the situation: most airlines have suspended flights to the affected countries and this has an impact on how medics
When Ebola’s in a rural area, there’s
coming into the country can reach patients.
a whole society that’s built up in the
It’s a very difficult situation; they’ve stopped flying
communities that can work together.
because of the fear that they’d have patients they would
Corporate Africa
9
Before this interview took place, Médecins Sans
The third is community understanding, and
Frontiers (MSF), released a statement saying that
this is often best done by the Red Cross
we are “losing the fight against Ebola,” do you
or women’s groups in the communities, or
think this is true?
the city groups where there are ethnic
groups living together so there are
It’s a very difficult issue. When Ebola’s in a rural area,
things that can be done, those things have
there’s a whole society that’s built up in the communities
stopped outbreaks in the past and they can
that can work together. When Ebola hits urban areas,
do it again.
there’s a mixture of ethnic groups from all around the country and many times they don’t have the systems,
If you would add treatment, for example, and attempt
they don’t have the solidarity that they have in the rural
to give antibodies from survivors to patients, that might
communities.
attract more patients to the hospital settings and help with the outbreak control.
This is a complicating fact but there are three things that have worked in outbreaks in the past and it will work in
Where do we go from here? Does it come down to
this outbreak if they’re properly done.
the US$ 600 million that the UN says is needed to
Those are:
tackle Ebola or is there another way?
Identification and isolating them in hospitals
I think the most important way now is technical
and making sure those health workers don’t
partnership
get infected.
countries and equipment and supplies provided to protect
between
industrialized
and
developing
health workers.
The second is contact tracing of people who
had contact with those who had infection
Those are the things that are most important now and
and putting them under surveillance to
technical partnerships should include the African Union
check for fever twice a day. They should be
which doctors that hopefully they could provide to work
isolated and if it’s diagnosed as Ebola they
beside the international, non-African volunteers.
should be hospitalized.
10
Corporate Africa
ALL-AFRICA RESPONSE REQUIRED TO STOP EBOLA
As the UN Security Council meet to call for the restoration of flights to Ebolahit African countries and a greater international response, Harold James writes that nothing short of an all-inclusive African response is required to contain and prevent the spread of the virus.
W
hen the news of the latest outbreak of Ebola
While the situation in Liberia, Guinea, and Sierra Leone
hit headlines in March, no one anticipated
have reached desperation levels, Senegal recently
the scale and speed at which the disease
claimed to have eradicated the disease after successfully
would spread. It was not until it became established in
treating an infected student from Guinea and Nigeria
the urban centers of some of Africa’s poorest nations
is managing to keep infections at bay despite having
that the international community woke up to the lethal
a population of 180 million. Although regional and
threat.
international agencies are tasked with the responsibility of detecting and fighting disease, it is only six months after the first deaths that they are strategizing with
Even though the knowledge about antibodies from Ebola convalescents have been available for 30 years, Africans have shied away from preparing the necessary antibody treatments to deal with outbreaks
12
Corporate Africa
governments and organizations to arrange financial, military, and medical resources needed to combat the worst Ebola outbreak in history. In what is now a serious global concern, it is importato understand the political, social, and economic consequences and the role that governments of Africa and the scientific community have played in the spread of the virus.
The current outbreak The admission by Dr Monty Jones, Head of the Sierra Leonean Ebola Task Force that the rapid spread of the disease caught the authorities unaware suggests a failure of organized resources to provide the tenure of national security required to protect citizens against disaster. Likewise, Liberia recently proclaimed that they are being overwhelmed signals a nation in urgent need of support to prevent collapse. The current acceptable belief is that Ebola spreads to people by contact with bodily secretions, fluids, and organs through broken skin or mucous membranes. Outbreaks of the virus initiated in infected animals and transferred to humans who infect other people the same way. Those who care for or bury Ebola victims are often infected. It is also possible to catch the disease from infected needles or when it is transferred from surfaces to broken skin or mucous membranes. Cultural practices and social conditions may influence the rapid spread of the latest outbreak. People care for infected relatives or friends would be at risk were they not equipped with protective medical clothing and skills.
South Africa visiting Liberia and Sierra Leone to offer moral support and aid. These actions were required from the beginning to ensure that the virus did not spread. While Liberia is the worst-affected country with a fatality count of 1,224 (at the time of writing), the general belief is that there is no proven cure for Ebola despite the fact that the untested drug ZMapp appears to result in a full recovery. Furthermore, experiments carried out in 1995 in the DRC by a team of African doctors led by Dr. M. Massamba, proved to be successful. This involved the transfusion of antibodies taken from the blood of Ebola convalescents into the blood streams of infected patients (http://jid.oxfordjournals.org/content/179/ Supplement_1/S18.long).
An all African solution is the only one that will work for the continent, which does and probably will require foreign partners.
Arguably, the main factors in the spread of Ebola across West Africa appears to have been a state of unpreparedness, the absence of a strategic national response, and a lack of resources in impoverished countries. Suggestions that the current outbreak started when an African ate infected bush meat are incredible, because it is linked to a nameless 2-year-old child whose mother, sister, and grandmother went on to spread it to nearby villages before succumbing to the virus (New England Journal of Medicine, 2014). The unanswered question is whether the nameless child ate the meat and how can it remain nameless when its entire family are named? The mystery surrounding Ebola is like HIV/AIDs which eventually mutated before ending up in Africa spreading through females and not male homosexuals as was the case in the US. Lethal diseases always end up in Africa to later appear in global statistics which undermine the continent. It begs the question, why did the African Union only recently tackle the issue of airlines ceasing their flights to West Africa? As a result, transportation of supplies and personnel was restricted and treatment was harder to access which is bringing these fragile economies to the brink of despair. The intervention of the AU has resulted in leaders from high-profile African nations like Nigeria, Ghana, and
The team was fiercely opposed by a group of European scientists observing the virus, including Dr. Peter Kilmarx and Dr. C.J. Peters of the CDC Special Pathogens Branch. Even after the African doctors’ treatment led to 8 out of 9 African patients making a full recovery, the European scientists refused to accept their conclusions and continue to discredit the African medical team. Even though this information has been available for 30 years and is well-documented on the internet, Africans have shied away from preparing the necessary treatment. ZMapp has been used to treat infected American and European patients. When asked why it was necessary to use untested drugs to treat European patients rather than African ones, western scientists claimed the analysis justified the risk. An unknown pharmaceutical company based in Santiago, USA, is said to have the rights to manufacture ZMapp, and over recent weeks its share price has appreciated significantly. On Wednesday, September 17, British newspapers reported that the WHO paid for British nurse, Will Pooley, to fly to Atlanta, USA, to save the life of an American who had contracted Ebola in Sierra Leone. Pooley had caught it earlier and was evacuated to the UK where he was successfully treated with ZMapp. The question is twofold: Why is it acceptable to use that treatment on European but not African patients? Corporate Africa
13
And is the antibody in ZMapp really from animal subjects or the thousands of blood samples that have been taken from Ebola convalescents in the DRC over the last 30 years? It must be addressed. The absence of western pharmaceutical companies, stocks, and commercial ambitions led to a total dismissal of Dr. Massamba’s treatment, but today it is made credible by the presence of these factors. Another fear about Ebola is that it might be mutating and that the disease control centers which have been studying and experimenting with the virus since the 20th century could be acting to spread it inside Africa. It seems illogical to place disease control centers in states like Sierra Leone and Liberia where most citizens live in dire poverty because resources are unavailable in the event that a disease escapes into the community. The return of the US military to assist Liberia to combat and contain the disease is also causing anxiety. While it could be perceived as altruism, it is feared that the poor country will need to repay American by allowing it a permanent base for Africom, and or access to mineral resources. The Future A continent of one billion people cannot be run from outside. It cannot, and should not, depend on other nations and organizations; especially Africa which is populated with people that have a history of slavery, oppression, and HIV/AIDs. Only an all-Africa solution will work for the continent, which will require foreign partners, especially now that the UN Security Council has called for greater support from the international community. The regional bodies entrusted to lead African nations must express visible leadership and respond to disasters with the equanimity and bravery required to represent the full interest of the continent’s people. It is shameful and uncourageous that brother nations 14
Corporate Africa
and airlines should close their borders and flights, to cut other Africans off in their moment of dire need. The adage has been proven time and time over; it is one country today and another country tomorrow; for whoever loves their life will lose it.
Empowered African communities with leaders versed in their responsibilities, coupled to African scientific communities receiving visible and proactive leadership from the African Union and African governments is urgently required to heal Ebola.
The future requires that Africans stand, fight, and die together. The task of cementing that unity began 6 months too late but must continue to build and work in the best interest of the people of Africa. A handful of doctors in Zaire were able to halt the virus in its tracks 30 years ago. Empowered African communities with leaders versed in their responsibilities, coupled with African scientific communities receiving visible and proactive leadership from the AU and African governments is urgently required to eradicate Ebola. The future of African lives is at stake, and should take precedence above all other things including American altruism, Western scientists, and the world media. Those who are witnessing this outbreak of Ebola in Africa will have a story to tell their children; and the good thing is that Africans can make the difference to whether that story is a successful one. It needs to be a success if they are to be children to tell that story.
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Photo © Gerardo Sabado
THE GLOBAL FUND AND AFRICA TRANSFORMATIVE PARTNERSHIP After twelve years of responding to medical emergencies and epidemics, the Global Fund reflects on the progress that has been made in the fight against HIV and AIDS.
A
t the turn of the millennium, Africa was being ravaged by the devastating spread of AIDS,
Today, the global health community has
malaria was killing millions of children under the age
a historic opportunity to defeat Africa’s
of five, and tuberculosis was a major threat. With life expectancy falling and the economy and education
biggest infectious diseases, removing
taking a tremendous hit, these diseases were having
them as public health threats.
a terrible impact on the lives of Africans. The Global Fund, a 21st century partnership made up of external funders, government and non-government implementers, communities of affected people, the private sector, faith- and community-based organizations, was created in 2002 to respond to the emergency and to turn the tide of these unchecked epidemics. Today, the global health community has a historic opportunity to defeat Africa’s biggest infectious diseases, removing them as public health threats. Advances in science and epidemiological expertise mean new investments can have a transformative impact in Africa,
16
Corporate Africa
Cumulative Grant Expenditure by Service Delivery – HIV
offering enormous potential gains in a continent that is home to seven out of the ten fastest-growing economies in the world. There have been solid indicators of this tremendous progress. Deaths from malaria in Africa have fallen by 49 per cent since 2000. Between 2005 and 2013, the number of AIDS-related deaths in sub-Saharan Africa fell by 39 per cent. Tuberculosis incidence rates in the African region are falling, although the region is not on track to achieve mortality and prevalence targets. Defeating these diseases will require smarter investments and reaching the most vulnerable, including men who have sex with men, sex workers and women and girls. In many societies, women and girls do not enjoy the same rights or opportunities as men, let alone the same access to health care, fuelling the spread of disease. A growing number of studies single out gender inequality as a major factor contributing to the spread of HIV, tuberculosis and malaria epidemics.
as immunity to the disease is diminished during this period. In Southern Africa, women aged 15-24 have twice the rates of TB of men of the same age.
Epidemiological intelligence points to multiple sexual partners as a key driver to the spread of the disease in HIV. Southern Africa continues to be the epicenter of HIV in the world. Yoked to tradition and limited by economic means, women continue to date or to marry much older men with concurrent multiple partners who are more likely to be living with HIV. As a result, women are disproportionately affected by the disease.
Because gender inequalities impact directly on human rights, health and well-being, the Global Fund recognizes the vital need of putting women and girls at the center of the response to the diseases. In the last decade, significant investments from the Global Fund have gone to general programs that include women and girls in Africa, engaging women in their design and implementation.
In 2013, UNAIDS reported that women in Southern and Eastern Africa account for 58 per cent of adults living with HIV and for 53 per cent of all adult AIDS deaths. It said deep social and psychosocial changes are needed to make women and girls less vulnerable.
In this line, the Global Fund also believes it is essential to protect the human rights of lesbian, gay, bisexual, and transgender communities. Studies show that when gay people face discrimination including abuse, incarceration and prosecution, they are less likely to seek HIV testing, prevention and treatment services. Yet in Africa alone - which has the largest number of people living with AIDS in the world - there are 38 countries that deem homosexuality criminal.
And it’s not just HIV. Numerous factors also predispose women and girls to TB and malaria. Women and girls are at particular risk of malaria during pregnancy
Cumulative Signed Funding 2003 – 2013
Corporate Africa
17
The Global Fund works with local community groups across the continent to ensure that people affected by HIV get the prevention, treatment and support they need, regardless of their sexual orientation.
and quality treatment, setting up 15,000 health centers and recruiting an army of 30,000 community health extension workers. South Sudan has launched its first blood bank and new national and regional laboratories, offering faster and more efficient diagnostic services.
Ethiopia, a leading example in the fight
Africa has also led the way in building partnerships and embracing country ownership. With strong economic growth, African countries have a real opportunity to invest more in health. Showing shared responsibility and mutual accountability, African governments have committed themselves to investing at least 15 per cent of government expenditure in health, under the Abuja Declaration signed in 2001.
against AIDs, has created a system of combining infrastructure with skilled health workers and quality treatment.
Since the Global Fund was established, it has worked with countries and partners to support health system strengthening as a way to maximize its core investments and to contribute to sustainable health programs. This is particularly pertinent in low-income countries in Africa, where the recent Ebola outbreak in West Africa is drawing attention to the need for comprehensive investments in health infrastructures. With support of the Global Fund, Ethiopia, a leading example in the fight against AIDS, has created a system combining infrastructure with skilled health workers
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Corporate Africa
Cumulative grant expenditure by service delivery Malaria
South Africa, which has the largest antiretroviral drug program in the world, has stepped up domestic financing of HIV programs to cover more than 80 per cent of the country’s total HIV and AIDS expenditure. In 2013, Nigeria, Kenya, Malawi, Zimbabwe and Zambia committed to contributing money to the Global Fund. Besides committing money to the Global Fund, African countries, which are disproportionately affected by infectious diseases, are coming up with other creative Cumulative grant expenditure by service delivery TB
ways to play their part in health financing. Zimbabwe, Tanzania and Kenya have formed AIDS Trust Funds to support the fight against HIV. As the world enters a decisive phase in the fight against these diseases, the Global Fund is very encouraged by Africa’s leadership in health. By working collectively, Africa will bring us ever closer to the transformative moment, when we can declare that HIV, tuberculosis and malaria are no longer big concerns for public Graph showing the number of deaths due to the outbreak of Ebola in the affected countries until the 5th of September 2014
health in the continent.
Gerry Elsdon’s Battle with TB and its Stigma
Gerry Elsdon, Celebrity World Health Organization’s Champion Against TB Campaign
A
t the height of her success as a television
practiced in rural villages around South Africa and treated
personality, Gerry Elsdon was diagnosed
many women who had TB in the womb. He was the first
with tuberculosis. Having beaten the illness,
Gerry worked as Secretary General to the Red Cross in South Africa and is one of the celebrities working in the WHO’s Champions Against TB campaign.
Q. What was your first reaction to your diagnosis of TB?
person to speak to me about non-pulmonary TB, found outside of the lungs. He insisted I begin treatment for mainstream TB. I did a nine-month course of vitamins and antibiotics, between 6 and 8 pills a day.
The lack of knowledge of TB is what causes the greatest stigmatism.
It brought great sadness and confusion. I was attempting to conceive at the time, and since the TB was found in the lining of my womb we would have to delay our “baby project”. I was confused because I had no symptoms whatsoever: no weight loss, fatigue, coughing and definitely no loss of appetite. I knew absolutely nothing about TB at the time.
she had heard that people die from TB and secondly I looked for a
second opinion, and to my relief the tests were negative for TB.
I mentioned the misdiagnosis to a physician
friend and I was thrown back into my abyss. He had
20
Corporate Africa
the knowledge that South Africa was the fourth highest burdened country in the world and understanding the consequences of compliance and non-compliance, I was
My mother broke down when we told her, first because because she thought it was hereditary.
Empowered with information about TB, its symptoms,
able to go through my treatment without fear or anxiety. After nine months of treatment a biopsy of the womb confirmed success of my treatment. Unfortunately the damage to the lining of my womb was severe and I will never conceive a child. It was the stigma and the discrimination I read about that angered and motivated me into becoming a social activist.
Q. Can you describe the stigmatism attached to TB?
Heck yes it can be improved!
The treatment has not
changed in decades and research is on-going. I hope for The stigma originates from the high percentage of people
a shorter term of treatment, 6 to 9 months is a long time
living with HIV in the world. Years ago, there was the
Once people feel better they drop their treatment and
distinct impression that only people living with HIV suf-
non-compliance could be fatal.
fered from TB. It is still believed in some circles that HIV and TB are caused by sexual behavior.
Husbands still
I am overjoyed by the introduction of the GeneXpert
abandon wives who display symptoms of TB without hav-
machine which can diagnose TB within 2 hours instead
ing themselves checked out.
of 2 weeks. Sadly, not many poor countries can afford this system and are completely reliant on foreign aid.
The lack of knowledge of TB is what causes the greatest
The challenge is to get medication at the speed at which
stigmatism. You would stay at the bedside of someone
the GeneXpert can diagnose, and since we cannot afford
with cancer or heart disease, but the person infected by
the infrastructural expansion of our TB clinics, we cannot
airborne bacteria is ostracized.
house patients in need of in-patient care.
Q. Do you feel that your status as a celebrity was compromised by your plight with TB? I chose to visit a public clinic for my treatment. Doctors in the private health care system have very little knowledge of TB. They don’t see many cases and misdiagnoses are rife.
You would stay at the bedside of someone with cancer or heart disease or diabetes, but the person infected by airborne bacteria is ostracized.
I have always been a celebrity. I was born in the township and have stood on the soap in defense of the people of South Africa on many occasions. I wanted to experi-
Q. Do you feel that part of the problem with TB’s
ence what they experience.
mortality rate is that people are afraid of seeking
When one of the nursing
sisters asked for an autograph I realized that information
help, or are ignorant of the symptoms?
about TB status may go viral. I was concerned that people may say I was HIV positive, a sign of my own fear of
Sometimes it’s misdiagnosis. But there needs to be bet-
stigma and discrimination. I had to pre-empt this so I
ter access to information about TB no matter which conti-
went public. My ex-husband was infuriated: “What would
nent or society you live in. TB receives 10 per cent of the
people say!” I knew I was doing the right thing. I had a
budget of HIV and yet a vast amount of people living with
responsibility to speak for those who could not speak for
HIV die of TB. I find this despicable. In recent years, the
themselves. The stigma had to be dealt with and I was in
relationships between those working in TB and HIV have
a position to do so.
been improved but they must improve further.
A journalist wrote that I was using TB to boost my career.
Q. What do you feel is the single biggest challenge
If that were true I should fire my entire PR team. A local
in fighting TB?
talk radio host questioned whether I was HIV positive and using TB to hide my status.
There are as many people who are not HIV positive but who are diagnosed with TB as there are who are HIV
A friend or two took a wide berth when we were in the
positive. It’s a message that must be emphasized. TB
shopping mall but my resolve was strengthened when or-
patients suffer no matter what and their lifestyles and ill-
dinary people would stop me to express how empowered
nesses are impacted by TB. It preys on the vulnerable,
they felt to talk about their status based on my story. If I
older people and children, anyone whose immune sys-
would do it unashamedly so could they. One woman used
tems may be compromised. Sufferers have been known
the magazine story as an educational tool: telling people
to lose their jobs because they have to visit the clinic on
that TB was not a death sentence and that with treatment
a monthly basis.
and compliance they could live a long TB free live. Q. Can you describe the work the Red Cross does in Q. Do you feel the TB treatment you received could
fighting TB, and your role within this? Do you feel
be improved further?
more could be done by government in fighting TB? Corporate Africa
21
If the South African Government allocated more funds
steps. Sometimes this is of more value than any amount
to TB we could do more. However, I must add that the
of money given to campaigns.
small team in the Department of Health is highly efficient, hardworking and dedicated to the task of eradicat-
Q. If it is true that those most at risk from TB are
ing TB in our lifetime. I am very proud of my alignment
the very poor, immigrants, slum dwellers, illiterate
to government.
people? Does something need to be done that is greater than a media campaign, as for these peo-
The South African Red Cross offers home-based care to
ple, the media is often inaccessible?
those living with HIV and TB. We administer treatment to the bedridden so as to ensure compliance to treatment.
Yes! In South Africa we attempt to get as many food
We ensure that food parcels are delivered to them. We
parcels to sufferers as possible. A problem is that the
counsel sufferers and offer support where needed.
people delivering are as poor as those receiving it. It feels as though the pain and humiliation just never ends.
Q. What is your specific role with the Champions
Access to clean water and health care is still a problem and
Against Tuberculosis campaign?
water and sanitation programs are few and far between. We attempt to teach that ventilation is an imperative
This is a role I take very seriously.
Champions are
to prevent the spread of TB but when you don’t have a
encouraged
for
window in your shack this advice is pointless.
to
highlight
the
need
treatment,
compliance and knowledge to the communities in their various countries and network with leaders and
Q. According to WHO policy recommendations on
decision-makers. I do talks in the corporate sector and
TB, a country should have a control model for TB,
on government health day. I seem to have become the
at provincial, regional and district levels. What is
television go-to-girl on behalf of our government, telling
the health policy toward TB in South Africa at the
the human interest story while the Minister of Health,
moment?
Dr. Aaron Motsoaledi, tackles technical and medical
questions. We sit on panels together and make a good team. He is knowledgeable and passionate about the issue.
We sit on the Board of the WHO Stop TB Partnership. We adhere to all of the standards and policies recommended by WHO.
We have developed twinning programs be-
tween the TB and HIV departments in our Ministry of
Q. Do you feel that Africa can look at the all-time low TB rates in other parts of the developed world, and hope to emulate these statistics?
Health. Regular information is passed on to the WHO.
It is well known how infuriated and frustrated I have become about complacency in our sector. Other parts
It is so humbling; each patient is more courageous than
of the developing world do not have the HIV rate of
months of starting their medications they will be non-
the African continent. With more infections come more
infectious. The most impressive are the people I meet
fatalities.
Q. Can you describe working with TB sufferers?
the other. Most have the understanding that within three
Funders and organizations focused on HIV
when they are first diagnosed, when they are ill: I hold
need to admit the severe impact TB has on people and
a timid skinny hand, massage the loose skin until its
ensure that their clients receive treatment. Tunnel vision
warm, and try to be comforting. I ask them that for the
is a killer!
sake of family and friends to hang in there; complete the treatment and I assure them that God and I are
Q. Do you think more could done politically, and by
watching. I often promise to return and when I do, I find
private investors, in order to fight TB?
that same sufferer, full-bodied, radiating life and looking forward to the future. It is a wonderful sight.
As with any cause and particularly something like TB
22
which is ravaging our country, there has to be political
At this point, however, it becomes important to celebrate
will. TB should not be an issue only highlighted during
but moreover, to preach compliance to treatment. It’s so
the month of March, which is TB month. And yes more
easy to stop a course of antibiotics when you are feeling
health and safety officers in the corporate sector need
on top of your game. But every patient must be warned
to be trained and exposed to the information available
that with non-compliance, they could find themselves
to better understand and advise workers on their next
right back where it all started.
Corporate Africa
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