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the wellbeing of their citizens.” He adds: “In large emergencies it is


often difficult for governments to mobilise the capacity to respond without the help of organisations such as MSF. But once the situation stabilises, we start working towards handing over our projects and interventions so that the country can resume its responsibility of providing healthcare to its citizens. In all situations, the vast majority of MSF staff are from the country where our activities are.”


Neglected Diseases – South Sudan Last year’s outbreak of kala azar (visceral leishmaniasis) in South Sudan occurred as the country prepared for the cessation referendum. Kala azar is one of Africa’s neglected, yet deadly tropical diseases and it is the second largest cause of parasitic deaths. The disease is transmitted through a bite by a sandfly. An unknown fact is that kala azar is endemic in 88 countries worldwide and puts approximately 350 million men, women and children at risk of infection, with an annual incidence rate of 500,000, and 90% of these cases occur in India, Nepal, Brazil and Sudan, especially in the south, according to the WHO. Amid fears that the recent outbreak


in South Sudan may worsen, the WHO reported a rise of infections in October with 9330 cases and 303 deaths – a case fatality rate of 4.7% since the outbreaks were first reported in September 2009. In Southern Sudan, it is estimated that 70% of those affected are children under the age of 15, and 75% of recorded deaths in the current outbreak are also in the same age group. Kala azar is treatable by a daily injection of pentavalent antimonials for 30 days but early diagnosis makes the difference. However, if untreated, it can be fatal. Since 1988, MSF has treated over


95,000 kala azar patients in Sudan, Ethiopia, Kenya, Somalia and Uganda. In response to the crisis in Southern Sudan, it has set up an additional base in Pagil, Jonglei State in order to expand its capacity to deal with the increase of patients being infected. Vanessa Cramond, medical coordinator for MSF in South Sudan, said: “It is [lack of] access to healthcare in Southern Sudan which only serves to compound the major health crisis that a neglected disease such as kala azar can cause. With only one quarter of people in southern Sudan having access to the most basic form of healthcare, treatment for this disease is difficult to come by for the vast majority of people. “An already weak healthcare system


simply cannot cope with large outbreaks, such as we saw last year. MSF treated eight times the number of people than in 2009 – up until the end of December 2010, we treated 2,766 patients. A big concern for us is also the number of people returning to live in southern Sudan, particularly to Upper Nile and Jonglei States where the disease is endemic. Many people who have been living in the north where kala azar is non-endemic, would have had no or little previous exposure to the disease and are therefore vulnerable. We anticipate an increase in cases over the next few months, the time it takes for kala azar-related symptoms to appear.”


Training of health personnel In the last decade, the “brain drain” has seen the mass migration of qualified African medical professionals to Europe, the US and other developed nations where they are guaranteed better living conditions and higher wages. It is estimated by the UN Economic


Commission for Africa and the International Organisation for Migration (IOM) that since the 90s, over 20,000 have left the continent for greener pastures annually and this includes doctors, nurses and healthcare workers in various capacities. At the end of 2010, it was reported that there is a critical shortage of workers in over 50 countries and Africa requires 800,000


“Africa’s 105 medical schools do not currently have


the capacity to meet the urgent demand for doctors, nurses, midwives and other cadres of health worker.”


health workers by 2015, if it stands a chance of achieving the UN MDG goals. A complex set of factors such as failing


economies, high unemployment, human rights abuses and armed conflicts compels people to leave. The exodus of healthcare professionals is an acute problem in Angola, Liberia, Mozambique, Sierra Leone and Tanzania. It is a grim reality best demonstrated by Malawi, where it is estimated that there are now just two doctors and 26 nurses for every 100,000 people and in Southern Sudan, there are only 50 doctors and 20 midwives catering to a population of 10 million. It is a stark contrast to the UK, where there are 250 doctors for every 100,000 people. Given the dire statistics, there are


initiatives to address the gap and one such is led by the African Medical and Research


their skills through its innovative eLearning programme and having surgeons train over 1,000 doctors in more than 100 remote hospitals in seven African countries. Dr Peter Ngatia, AMREF’s director of capacity- building, said: “Healthcare workers are meant to be the glue that binds the health system. Without them, the system fails.” He added that it was time people stopped talking and “Walked the talk, which means investing in innovative methods of training and retaining health workers. The scaling up of human resources production cannot happen unless we invest in the use of technology to train the numbers that are required. The 105 medical schools in Africa do not have the capacity to meet the urgent demand for doctors, nurses and midwives among many other cadres of health worker.”


New African March 2011 | 69


Foundation (AMREF), an African-based NGO with offices across the world delivering projects and programmes, which include training doctors, providing emergency care and tackling diseases like malaria and TB. It operates in six African countries, including Tanzania and Ethiopia, and trains health workers from over 40 countries across the continent. Every year AMREF trains people in


different capacities. This includes more than 10,000 community health workers, helping 20,000 nurses in Kenya to upgrade


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